Its time to bury our amalgamators!

What?!? The Amalgam King is not putting in amalgam, the space-age material you`ve been preaching about?" These were the words of Elizabeth Casas, RDHEF, my former assistant, when I told her that I had stopped placing amalgam about a year ago. Yes, my decision was based on several factors - none of which involved the mercury issue!

Alexander Vasserman, DDS, BS

What?!? The Amalgam King is not putting in amalgam, the space-age material you`ve been preaching about?" These were the words of Elizabeth Casas, RDHEF, my former assistant, when I told her that I had stopped placing amalgam about a year ago. Yes, my decision was based on several factors - none of which involved the mercury issue!

The "Amalgam Debate Revisited" letters in the November issue of Dental Economics persuaded me to voice my reasons in hopes of settling this issue once and for all.

It is true that amalgam was a space-age material when it first came out. There is no doubt it saved many teeth from caries and extraction. But, at the same time, amalgam has cracked many teeth, most of which ended up as crowns and some of which were intentionally devitalized for restorative purposes. Amalgam has made us tattoo artists by releasing silver into dentin and gingival tissues. It has forced us to extend cavity preparations to accommodate the material rather than have the materials accommodate the preparation. For years, patients have been complaining about thermal sensitivity while trying to enjoy an ice cream cone.

These are all side effects of amalgam restorations. For a long time, we kept saying to ourselves that the benefits outweighed the risks. Ten, 15 years ago, during the "bonding crisis," this was true. But today, with the new composites, glass polymers, and fifth-generation bonding agents, these risks are too great.

Last spring, I decided to attend a dental materials lecture at the California Dental Association`s Spring Scientific Session. The seminar was given by one of my former clinical instructors from USC, Terrance Donovan. I was curious about what my "alma mater" had to say about the new materials.

During the lecture, Terry said, "With the new breakthroughs in composites and the success we have been seeing, as a clinical instructor, I now am caught in a bind. How can we abandon teaching dental students valuable hand skills that we learned while placing amalgams when it appears the future is going toward composites?"

The research shows the seal, the bond strength, and the wear-resistance of the new composites is far superior to amalgam.

Yes, it is true that there is a learning curve in placing composites in such a way as to eliminate post-op sensitivity, short margins, and contamination from crevicular fluids. However, attending a few lectures given by Bill Dickerson, David Hornbrook, George Freedman, and Ray Bertolotti will get anyone started on the right track.

As far as the Oeconomically challenged patients,O how presumptuous is it for us to think that these patients would not find the extra money to go for the modern materials! If they were made aware that the new materials are safer for their teeth and may prevent costlier treatment in the future (i.e., the need for a larger filling on the same tooth, root-canal therapy, and/or a crown), I believe most patients would choose the new materials. They would do it because it is the sensible thing to do. How economical is it to restore a pulpotomy on a deciduous tooth with a composite instead of an ugly steel crown? These are all advantages to composite restorations.

I have been a big fan of amalgam for a long time. Although I have only been placing posterior composites exclusively for about a year, I have seen composites at least five years old placed by others. There is no comparison to amalgam; these composites are far superior!

We are now in the 21st century. Our amalgamators need to be buried next to our goal-foil instruments. After all, our patients deserve the best we have to give!

Dr. Vasserman maintains a private practice in Los Angeles, focusing on cosmetic, restorative, and implant dentistry. He can be reached by phone at (323) 931-8400 or by e-mail at alexdds@cyberdude.com. He is a member of the Academy of General Dentistry, the ADA, and the California Dental Association.

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