caption: This amalgam restorative have been placed 15 years ago and still going strong.
The reliability of dental amalgam restorations have been proven from time to time by the patient's own testimonials and a very low reported failure rate.
First, let's talk about what exactly is amalgam? Dental amalgam is a metallic filling material which composed of a mixture of Silver-tin-copper alloy and mercury (mercury being the most controversial substance in the filling). Amalgam itself have been developed into many types , mainly: low-copper amalgam, high-copper amalgam, spherical amalgam or admixed amalgam; but we shall not dwell too deep into the technical aspect of it but instead we will talk about the properties of dental amalgam.
One of the most intereting characteristics of dental amalgam is, it is not technique sensitive, which means amalgams have a very wide margin of error and even if it is not placed perfectly, the filling itself will still last. This is partly because of the dental amalgam's "creeping" effect after placement, the creeping effect is the amalgam's ability to "adapt" itself into the cavity of your tooth over time which is beneficial because it creates a tight margin with the outline of the cavity to seal itself in place. Hence the low failure rate of amalgams. The structural durability of amalgams are also of superior value because of it's compressive strengh which is similar to your tooth structure.
But nevertheless, amalgam can leech and erode over time if not placed properly and preparation of the "box" before amalgam placement is the most crucial step in ensuring the longevity of the filling. Amalgam also tends to stain and cause surrounding tooth area to be "slightly" greyish over time, though recent advancements of amalgam may be decreased this incident (the use of varnish before placement of amalgams)
Amalgams are placed firstly by preparing the cavity, making sure it is void of any decayed structures and preparing it in a box-like manner, followed by placing the amalgam in and compacting it and lastly by polishing it.
Contrary to popular belief, amalgams WILL NOT cause any systemic illnesses to the human body. It certainly is not the reason behind bouts of headaches, bodyaches, hallucinations, flu, cough, fever etc. This is because the alloy itself is inert. A number of independent health agencies have extensively reviewed the issues of safety and efficacy of amalgam in recent years and have all concluded that available data does not justify either the discontinuance of use of amalgam or the removal of existing amalgams. In fact, if you are at all concern, it is the removal of old amalgam fillings that you should be worried about. Many patients in Malaysia have claimed that amalgams are causing their "pain" and is the main cause of their various sickness, we would like to make it clear again that Dental Amalgams are NOT harmful to your health; it is a myth. But that being said, amalgams as silver fillings are definitely not suitable to be used on your front teeth (unless you're an aspiring pirate), hence the existence of composite materials.
caption: This fractured incisor (front tooth) has been restored using composite materials. Teflon tapes and adequate cotton rolls have been used for isolation.
Composites are tooth-coloured fillings which can be placed in almost any tooth surface for any kind of restorative procedures. Composite materials have come a long way since the invention of it during the 1960's. The search for an ideal esthetic material for restoring teeth has resulted in significant improvements in esthetic materials and in the techniques for using these materials. All general dental practitioners in Malaysia are equiped to place a composite filling if requested.
The steps in placing a composite filling are as follows, firstly the cavity if prepared and all decayed materials are removed, the surface is acid-etch and bonding is applied, followed by the placement of the composite incrementally and finally polymerization of the materials (which involves the blue light you normally see in your dentist's office). Placement of the composite itself is the most crucial step in which moisture control is important to not contaminate the composite material itself.
caption: these premolars have been restored using the sandwich technique. The green background in the first picture is a "rubber-dam" , basically a rubber sheet used during composite placement to avoid moisture contamination.
There are various types of composites, including macrofill, microfill, hybrid composites, nanofill composites, nanohybrid, flowables, glass ionomer cements and packable types.The mix and match of these different kinds of materials depends on which technique your dentist opts for, for example, the sandwich technique utilizes a layer of glass ionomer cement followed by composite material to mimic your natural tooth (the enamel and dentine). Composites are bonded to your tooth with the help of adhesives. Adhesive materials that have strong bonds to enamel and dentine further simplify restorative techniques. Placing a composite is somewhat more technique sensitive compared to placing an amalgam filling due to it's moisture control requirements. Composite materials also come in many custom shades to match your natural tooth colour to make it a bit more aesthetically pleasing.
caption: the 1st molar and 2nd molar are both restored using composite materials.
The lifespan of a composite restoration may vary from 1 year to 20 years which depends on many factors, including the nature and extent of the initial caries cavity, the treatment procedure, the restorative material and technique used, the operators' skills, and patient factors such as oral hygiene, the way you bite, caries risk, and adverse habits. Therefore, to make your investment worthwhile, it only makes sense for you to take good care of your teeth by brushing with a soft bristle toothbrush, flossing as often as possible and also revisit your dentist regularly so that we can detect any defect early on and repair it before it's too late. (Composites are repairable) Also, if you have many composite fillings in your front teeth, it is advisable to avoid too much consumption of coffee and tea because composites stains faster than your natural teeth which will lead to colour difference. While bleaching might be a good idea for staining, bleaching your teeth which contains several composite fillings will lead to your teeth turning out to be whiter than the composite restorations, or the shade will come out different where the composite was previously placed.
At the end of the day, it is up to you and your preference of this 2 main restorative materials. The price of amalgam restorations in Malaysia ranges from RM50-200 while the price of composite fillings ranges from RM90-500;and it all depends on the difficulty of the case and many factors. Amalgam needs a large enough cavity to hold it in place because it is secured by physical retention while composite materials are held in place by micromechanical bonding. Your dentist will suggest which material to use according to your clinical presentation and other factors.