G.R. Horton, DDS
Pinehurst, N.C.
In assessing the validity of Dr. Steven`s pro-amalgam argument, his failure to mention gold castings for inlays and onlays is evidence of more than a cosmetic gap between the two sides of the debate. There is an engineering, or structural, gap wherein Dr. Steven may do either fillings or crowns, with no in-between restorative choice.
The longevity and historical success of gold as a material cannot be questioned. Most dental schools teach criteria for shoeing cusps and doing indirect restorations short of full coverage to support remaining tooth structure rather than undercut it. The undercuts necessary to retain amalgams are tooth-weakening, not tooth-strengthening. Conversely, bonded restorations (and gold can be bonded to tooth structure), which require more conservative tooth preparation, serve to strengthen the prepared tooth. Space-filling cement is inferior to adhesive techniques for retention, as are divergent axial walls less likely to promote the salvage of enamel and dentin.
While amalgam has served the public well when used properly for many years, most dentists stretched the limits of amalgam use beyond that for which it was intended. The abuse of amalgam in restoring teeth - where indirect restorations were indicated - has been more costly to patients` tooth structure over the years than have bonded restorations since their inception. Amalgam restorations are not indicated for the vast array of situations to which they have been adapted. I think it`s because dentists have been afraid to tell patients what actually is in their best interests that we see so many amalgams out of their niche. Do the right thing!
