In my 14 years of practicing dentistry I have come across this question most of the time, most probably because silver Amalgam fillings are not done as commonly as it were 15 years ago . This is because the concept of bonded restoration became more popularized and advanced in the past decade. White composite restoration has quite a few advantages over silver Amalgam restoration but at the same time in my opinion Silver Amalgam restoration is still gold standard..
So do we need to change Silver Amalgam restoration.??
In my opinion replacing a good functioning silver Amalgam restoration to composite just for aesthetic reasons is a big NOOOOOO.
You should definitely change to composite bonding if you see that the silver restoration or the tooth is fractured or if there is food lodgement or discoloration under the filling.
In the UAE we have slowly phased out doing Amalgam restorations as technology and quality of materials available have proved to be better and more effective as compared to Amalgam restorations.
I will now mention the pros and cons for getting composite and amalgam restorations.
COMPOSITE
Pros
- Tooth coloured restoration makes it supremely aesthetic.
- Works on the principle of chemical bonding which improves the overall contact between the tooth and restoration.
- The tooth needs minimum preparation as compared to amalgam.
- Very rarely the patient may have any allergies associated with the materials.
- Patients can start eating and drinking immediately after the procedure.
Cons
- Since it works on the concept of bonding, and if proper isolation is not maintained the composite will not bond to the teeth causing sensitivity or complete loss of restoration.
- We have still not achieved similar strength as that of Amalgam.
Amalgam
Pros
- Undoubtedly stronger than composite. Amalgam has proven itself over the years since it have been done since the past 3 to 4 decades.
Cons
- The color is the most obvious reason why the patient would not want Amalgam restoration.
- Studies have shown that since mercury is in Amalgam there may be toxic reactions and in some cases possibly carcinogenic.
- Works in the principle of mechanical retention and hence a minimum dept of 1.5 cm is needed for optimum strength of the restoration.
