ryanef123: The Clinical Performance of Silver Amalgam vs. Resin Composite (Dr. Irusa)

What are the benefits of silver amalgam?

- Excellent strength

- Cost-effective

- User-friendly

- Marginal seal

What are all benefits of resin composite?

- Esthetic

- Conservation of tooth structure

Has the use of amalgam increased or decreased since 1979?

Decreased

(1979: 75% ; 1991: 50% ; 2023: 34%)

What are four reasons for decline in amalgam use?

- Esthetic concerns

- Caries decline

- Conservation of tooth structure

- Mercury

Which takes more time, amalgam or composite?

Composite (especially when time is taken to go layer by layer)

Which is more expensive, amalgam or composite?

Composite

What is the average cost of a 1 surface amalgam filling?

$160

What is the average cost of a 1 surface composite filling?

$208

What is the average cost of a 2 surface amalgam filling?

$199

What is the average cost of a 2 surface composite filling?

$264

What is the average cost of a 3 surface amalgam filling?

$237

What is the average cost of a 3 surface composite filling?

$319

What is the average cost of a 4 surface amalgam filling?

$279

What is the average cost of a 4 surface composite filling?

$377

What type of composite has the following characteristics?

- Can place in 4-5mm increments

- Filler allows for less shrinkage

- Translucency allows for greater depth of curing

- Less esthetic

Bulk fill composites

What is the main takeaway from the Worthington et al. (2021) Cochrane review on composite resin versus amalgam fillings for permanent posterior teeth?

It was a systematic review and meta-analysis, representing high-level evidence comparing composite and amalgam restorations

In the Casa Pia 2007 study, did they find an effect in renal function in children with amalgam restorations?

No

In the New England Children's Amalgam Trail, was there any evidence that exposure to Hg via AgF was associated with adverse psychosocial outcomes?

No

What has the WHO set as the threshold limit value (TLV) for mercury vapor?

25ug/m3

What has OSHA set as the threshold limit value (TLV) for mercury vapor?

50ug/m3

What is the worst dose a patient could receive of mercury vapor with 10-12 amalgam restorations?

1/100 of the threshold limit value (TLV)

So...

WHO: 25 µg/m³ ÷ 100 = 0.25 µg/m³

OSHA: 50 µg/m³ ÷ 100 = 0.5 µg/m³

T/F: We get far more mercury exposure from our diets than amalgam restorations

True

What have studies shown about the effect on birth weight and pregnancy viability for amalgam restorations?

No significant results

Due to environmental concerns about amalgam disposal and crematories, it is required in many jurisdictions that dentists install what?

amalgam separators

What was the main finding from Soncini et al.'s study (NECAT) comparing amalgam and composite restorations in children?

The study found that both materials were effective, but amalgam generally had greater longevity, particularly in posterior teeth

T/F: Resin composite is the material of choice for high risk caries patients

FALSE!!!

What restorations are more frequently replaced: amalgam or composite?

composite

What had a greater survival rate after 7 years in the Bernardo Casa Pia Trial study, amalgam or composite?

Amalgam (94.4% AgF vs 85.5% RC)

What had a greater Annual Failure Rate (AFR) after 7 years in the Bernardo Casa Pia Trial study, amalgam or composite?

Resin composite (9% RC vs 3% AgF)

There is a ____x greater risk of secondary caries with resin composite

3.5x

What may have double the failure rate, amalgam or resin composite?

Resin composite

The process of composite placement is highly _______ at each step leaving a lot of room for error in the inexperienced clinician

technique sensitive

T/F: RC restorations have a higher risk of developing secondary caries

True

T/F: There may be no clinically significant difference in the safety profile of amalgam vs composite

True

The choice of which dental material to use will depend on what?

Shared decision-making between dental providers and patients in the clinic setting, and local directives and protocols

What is the primary function of bioactive resin materials in restorative dentistry?

To interact biologically with the tooth environment by releasing ions and inhibiting bacteria through a multimodal approach

T/F: While bioactive resins show promise, their long-term results and clinical longevity remain insufficiently studied

True

The process of ___________ placement is highly technique

sensitive at each step leaving a lot of room for error for the inexperienced clinician

Composite

What restorations were 10x more likely to be replaced, amalgam or composite?

Composite

What material has a higher survival rate in extensive restorations, amalgam or composite?

Amalgam (92% AgF vs 87.7% RC)

Did amalgam or resin composite have more comparable survival rates of extensive restorations to crowns?

Amalgam

(Amalgam: 12.8 years ; Resin composite: 7.8 years ; Crowns: 14.6 years)

What was notable about the study design in Hofsteenge et al. (2023)?

It was a retrospective clinical study involving one operator, ensuring consistency, and followed restorations for up to 17 years.

What was the main finding of Hofsteenge et al. (2023) regarding the longevity of extensive resin composite restorations after amalgam replacement?

The restorations had a 74.7% cumulative survival rate at 15 years, showing good long-term performance of extensive resin composites.

What factor most significantly increased the likelihood of failure in Hofsteenge et al.'s study?

Loss of cusps on premolars significantly increased the risk of failure by 297%

What is more esthetic and appealing to the majority of patients with esthetic concerns, amalgam or composite?

Composite

What is the more ideal material choice when minimum preparation is indicated?

composite

composite works well when supported by tooth structure therefore the ________ the cavity the better it works

Smaller

T/F: There are specific lesions in specific patients for which amalgam is still the ideal restorative material

True

What is the more ideal material choice with extensive restorations involving cuspal coverage?

amalgam

What is the more ideal material choice in posterior teeth of high caries risk patients?

amalgam

What is the more ideal material choice when complete moisture control is not possible?

amalgam

T/F: There are lesions that are clearly best restored with composite resin, there are lesions that are clearly best restored with amalgam, & there are lesions than can be restored equally well with either material.

True

What material may have a higher failure rate according to early clinical trials in high caries risk pediatric patients, amalgam or resin composite?

Resin Composite

What restorations have a higher risk of developing

secondary caries, amalgam or resin composite?

Resin composite

T/F: There does not seem to be any clinically significant difference in the safety profile of amalgam vs composite

true

What material is indicated for extensive direct restorations, amalgam or resin composite?

Amalgam