OPERATIVE TECHNIQUE

& APPLIED DENTAL

MATERIALS
SEMINAR: AMALGAM DEBATE

TITLE OF DEBATE: AMALGAM RESTORATION

IS NOT SAFE AND SHOULD BE REPLACED
LONGEVITY
OF
AMALGAM
GROUP 2: APPOSING TEAM
Longevity
What is longevity? :

• According to Cambridge Dictionary, longevity means a

long life/ living for a long time. Longevity is a term used
to explain the life expectancy.
• A study has been carried out in order to compare the
longevity of composite with amalgam. And the result shows
that amalgam has better longevity compared to composite.
 Why do we need to consider longevity as a parameter?
It is because longevity can be measured.
A study comparing the longevity of amalgam and
resin based restoration has clearly indicates that
amalgam has highest longevity - high
compressive tensile
According to Kolker er al., amalgam restorations
can sustain approximately about 5 years and
according to Anuasavice, a modern dental
amalgam can be manipulated, so the average
durability can be 12 to 15 years. but there is
some authors argues that about 90% of amalgam
restoration are functional for over than 10 years
while some said that 67% survive for 10 years.
In
comparison,
Composite restoration can be more
aesthetic but it is low durability when put on
posterior teeth.
A study by
Collons et al., it is stated that composite
restorations fail at rate 2 or 3 times higher
than amalgam restoration.
This study has been supported by Opdam et al.,
who reported that the survival time for
composite is about 3 to 4 years
 1st case
A study has been carried out among 30
graduate students in dental medicine, with
observation period in range 5-20 years.
Class l and class ll amalgam restoration
were included to evaluate the median
survival time (years) and annual failure rate
of both restoration.
- Results: under optimal condition, class l
and class ll amalgam restoration have a
median survival rate time, which is 27
years according to Smales and
Hawthrone (1997) and 25 years
according to Jokstad and Mjor (1991).
- Based on Kaplan Meier curve (2018),
the median survival times were 12.8
years for amalgam restoration compared
to 7.8 years for resin composite.
2nd case
A clinical trials have been conducted among randomized
children aged 6 to 10 years comparing the longevity of
amalgam and resin-based compomer/composite
restorations.
The children who had 2 or more posterior occlusal carious
lesions are grouped into amalgam group and composite
(primary teeth)/compomer (permanent teeth) group.
The author compared the replacement rates of these types
of restorations in posterior teeth of the New England
Children’s Amalgam Trial.
This trial took 5 year of follow-up to gain the results.
Results: Compomer was replaced frequently due to
recurrent caries and composite restorations required 7 times
repairs more that amalgam. This showed that
compomer/composite restorations in posterior tooth
surfaces of children may require replacement or repair more
often than amalgam restorations even within 5 years of
placement.
 WEAR AND
FRACTURE
RESISTANCE 
 WHAT IS WEAR
AND FRACTURE
RESISTANCE?
Wear resistance refers to the Fracture resistance is the material’s
material's ability to resist ability to resist fracture or cracking
surface loss resulting from the application of
excessive force
 Wear and fracture
resistance 

• Amalgam is kind to opposing teeth and other restorations

• Amalgam in bulk section has the ability to resist applied forces without fracture
or excessive deformation.
• Dental amalgam has high wear resistance due to their ability to adapt through
smearing from deformation under load (Yip et al., 2004)
• Amalgam can hold out against deformation
• Fracture resistance of amalgam also is due to resisting plastic deformation
under a particular load.
1st case

• A study done in Spain

• To evaluate the worn surfaces of amalgams 
• Found out that amalgam restoration behaviour is entirely ductile with no tensile
cracks.
•  it was found that amalgam has the least material loss on abrasion compared to
zinc polyacrylate, glass ionomer cement and composite hybrid. 

2nd case

• A study done in India in 2020 

• To evaluate the fracture resistance of four core buildup materials: Amalgam, resin
composite/dual cure, resin-modified glass ionomer, and SureFil packable composite
restorative material under universal testing machines, 
• Shows that fracture resistance value of amalgam in this study was reported to be the
highest at 1.82kN while  fracture resistance for composite resin was reported to be
the lowest at 0.68kN.
 MARGINAL
LEAKAGE AND
PREDISPOSAL
TO SECONDARY
Marginal Leakage and Predisposal to
Secondary Caries

What is marginal leakage?

A condition where there is penetration of fluids,
bacteria and ions into the space existing between
all restorative materials and cavity walls. (A Ben-
Amar et al)

Microleakage - Restorations with

composite
 HOW AMALGAM HELP PREVENT MARGINAL
LEAKAGE AND SECONDARY CARIES?

Low
01 Marginal-sealing 02 polymerization
capability
•
shrinkage
• Due to corrosion products It has lesser chances of bond
released from dental amalgam disruption and this prevents leakage
restorations. around margins and subsequently
secondary caries.

(A research article in 2009 entitled corrosion

sealing of amalgam restoration)
 Why
Amalgam is
better?
Why amalgam is better?

• Formation of zinc
Make teeth that are restored with
corrosion products in the amalgam material less prone to
amalgam margin secondary caries.
contributes to more rapid
sealing.

• Amalgam has lower • Amalgam is dimensionally

polymerization shrinkage stable compared to
than composite. composite resin.

(Journal of Evolution of Medical and Dental Sciences 2013)

 COST-
EFFECTIVENES
S OF AMALGAM
 ● Although amalgam is only slightly cheaper than the cost of composite
fillings, the cost difference tends to increase when taking longevity
differences into consideration.
● Mostly Malaysian will prioritize cheaper treatment available.
● According to research done by Malaysian Dental Association, the price for
amalgam restoration in Malaysia ranges from RM50-RM200 while the price
for composite fillings ranges from RM90-RM500.
REBUTTALS TO
GOVERNMENT'S
POINTS
 1 Mercury exposure to humans

• Harmful to human’s health?

- No specific evidence that can correlate between amalgam and any systemic disease.

• Mercury from amalgam reduce hypersensitivity reaction?

- Studies conduct on lymphocyte levels of subject proven this to be wrong.

• Mercury leads to neurological disease?

-    Again, is proven to be not true based on studies conducted in a population of nuns. 

• Allergic reaction?

- Rare, however dentist will ask about any medical background beforehand. 
 2 Loss of sound tooth structure

• High wear resistance

- Can withstand much stronger mechanical forces (350MPa) compared to micro filled
composite (260 MPa) and hybrid composite (300 MPa).

• Low coefficient of thermal expansion

- More resistance towards microleakage which may lead to secondary caries.

 3 Poor aesthetic appearance

• Most amalgam filling is being used at the posterior teeth.

• Probability of having low self-esteem after amalgam restoration is

low.

• Amalgam is more long lasting (12-15yrs) compare to other restorative

material such as composite (5-7yrs). 
 4 Toxicity to environment

• Less than 1% of mercury waste to environment come from dental practices.

- Small amount that can barely give any undesirable toxic effect to environment.

• California Dental Association and American Dental Association have developed

recommendations on the best way to handle dental amalgam waste. 

• Techniques recommended broadly by the Safe Mercury Amalgam Removal Technique (SMART).

- Installing an amalgam separator to collect mercury amalgam waste. 

 CONCLUSI
ON
Why we don’t need to replace
Why we should use amalgam for
amalgam with alternative material
restorative material?
such as composite?
 Composite Resin Filling
● Risk of microleakage and secondary
caries  thus indicating possible failures
in the adhesion process
● Composite undergo polymerisation
shrinkage  the cavities
-implications on the long-term stability
of a composite resin.
● Expensive
Amalgam 
● Has no scientific evidence that
prove its toxicity.
● Reduce the possibility of
secondary caries over time by
forming oxides in the margin of
● Has better longevity
● Much cheaper than composite
 References
● Brennan, F. (2020, April 08). The Safe Mercury Amalgam Removal Technique (SMART). Retrieved November 24,
2020, from https://iaomt.org/resources/safe-removal-amalgam-fillings/?cn-reloaded=1

● Catarina A, Cavalheiro A. (2010). A review of Amalgam and Composite Longevity of Posterior Restorations.
Volume 51. Online Journal retrieved from
https://www.researchgate.net/publication/257678476_A_Review_of_Amalgam_and_Composite_Longevity_of
_Posterior_Restorations

● Dr Uttarwar V, Dr Gunwal M, Dr Sonarkar S, et al. (15th May 2019). clinical longevity of dental amalgam vs resins
based composites. Journal of dental and medical sciences. Volume 18, Issue 5 series 15. retrieved from
http://www.iosrjournals.org/iosr-jdms/papers/Vol18-issue5/Series-15/H1805156264.pdf

● Gil, F. J., & Planell, J. A. (2001). Comparison of the Abrasive Wear Resistance between Amalgams, Hybrid
Composite Material and Different Dental Cements. Key Engineering Materials, 218–220, 553–556.
https://doi.org/10.4028/www.scientific.net/kem.218-220.553
● Jennifer Ann Soncini, Nancy Nairi Maserejian, Felicia Trachtenberg, Mary Tavares, Catherine Hayes, The
longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth:
Findings From the New England Children's Amalgam Trial, The Journal of the American Dental Association,
Volume 138, Issue 6, 2007, Pages 763-772, ISSN 0002-8177,
https://doi.org/10.14219/jada.archive.2007.0264.

● Patil, A., Deshpande, S., P, R., Patil, V., R, S., & Reza, K. (2020). To evaluate the fracture resistance of four core
buildup materials: Amalgam, resin composite/dual cure, resin-modified glass ionomer, and SureFil packable
composite restorative material under universal testing machine. Ijocr.org. Retrieved 30 November 2020,
from
https://www.ijocr.org/article.asp?issn=2347-6249;year=2020;volume=8;issue=1;spage=5;epage=7;aulast=Pa
til
.

● Prakash, S. (n.d.). Restorative Materials: Dental Amalgam. Retrieved from

http://repository.uobabylon.edu.iq/2010_2011/4_24117_983.pdf

● Ramesh, K., Ramesh, M., & Krishnan, R. (2019, May). Management and Disposal of Mercury and
Amalgam in the Dental Clinics of South India: A Cross-Sectional Study. Retrieved November 25, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555386/
● Rathore, M., Singh, A., & Pant, V. (2012, May). The dental amalgam toxicity fear: A myth or actuality.
Retrieved November 26, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388771/

● Siso, H., Kustarci, A., & Göktolga, E. (2009, May 01). Microleakage in Resin Composite Restorations
After Antimicrobial Pre-treatments: Effect of KTP Laser, Chlorhexidine Gluconate and Clearfil Protect Bond.
Retrieved from https://meridian.allenpress.com/operative-
dentistry/article/34/3/321/107419/Microleakage-in-Resin-Composite-Restorations-After

● Smallman, R. E., & Bishop, R. J. (1999). Biomaterials. Modern Physical Metallurgy and Materials
Engineering, 394–405. https://doi.org/10.1016/b978-075064564-5/50013-6

● Team, D. (n.d.). What're Amalgam and Composite Restorations? Retrieved November 28, 2020, from
https://www.dentistsnearby.com/misc/patient-education/121-what-re-amalgam-and-composite-
restorations.html

● Zabrovsky, A., Beyth, N., Pietrokovski, Y., Ben-Gal, G., & Houri-Haddad, Y. (2017). Biocompatibility and
functionality of dental restorative materials. Biocompatibility of Dental Biomaterials, 63–75.
https://doi.org/10.1016/b978-0-08-100884-3.00005-9
THANK
YOU!