There are 6 types of fillings from which to choose. What works well for one filling may not be the best choice for another. Since February 1996, we have not used any amalgam in our practice. Since I am often asked my opinion about this disputed material, I will briefly list the pros and cons of using it and of the other various filling materials.
1. AMALGAM FILLINGS
Amalgam is easy to form.
It is a cheap filling material.
Amalgam can withstand high pressure and is therefore useful as filling material for molars.
Amalgam is a very long-lasting material (8-10 years).
50% of amalgam's content is highly toxic mercury, which is absorbed by the body.
Amalgam oxidizes, which means it can interact with saliva as an electrolyte, influencing the electric current in the mouth.
The free radicals penetrate the body and can weaken the immune system, possibly leading to various illnesses and symptoms.
Components in amalgam filling material can cause allergic reactions.
Aesthetically, the dark silver colour is not acceptable.
Amalgam does not adhere to the tooth but is forced in to form a seal. When the filling becomes brittle after some time due to the vaporization of the mercury, cracks form in the filling and cavities can form unnoticed underneath it. Since a toothache is usually the first sign of a crack, a root canal treatment or tooth crown is then often unavoidable.
We do not use Amalgam in our practice anymore, since there are too many things pointing to it as a hazard to good health. The Toxic Institute in the Clinic of the Christian-Albrecht University in Kiel has records of medical examinations which document this. The law prescribes all dentists to install expensive amalgam separators to reduce the amount of heavy metals released into the water system and dentists must discard unused amalgam in special refuse containers. The medical council has prohibited the use of amalgam for pregnant women and for children under six years of age.
For these and many other reasons I no longer use amalgam in my practice.
2. CEMENT FILLINGS
Material toleration is very good.
Good aesthetics (light colour).
Easy to normal way of handling.
Costs are covered by medical aid.
Uncertain lifespan (3-5 years depending on location and size).
Slightly raw surface.
3. COMPOSITE FILLING MATERIALS
Adheres to the tooth structure.
Minimally invasive procedure.
Middle price class.
No corrosion occurrences in combination with metals.
Functionally very good.
No impressions necessary.
Fits very well in the cavity.
Lifespan corresponds with that of amalgam
Very time intensive. (Must be built up in layers)
A few patients are allergic to the components of the composite adhesive. Through material improvement, it now can be used in high-pressure molar region, though it use to be considered undesirable for larger fillings in molars. Composite filling material is often used for fillings in the front tooth or premolar region.
This filling material is a good alternative to expensive gold and ceramic inlays.
4. COMPOSITE INLAYS
Well tolerated material components.
Good aesthetics (Tooth coloured).
Lifespan shorter than ceramic.
While it can reduce high laboratory costs as an alternative to gold or ceramic, this is in my opinion not a good alternative for fillings.
5. GOLD INLAYS
Long lifespan (15 - 20 yrs.)
Well tolerated, inert, non-corrosive material.
Can withstand high chewing pressure.
Forms well into the cavity, and if decay forms under the inlay, it will fall out; the decay can then be removed and the inlay reinserted.
Very time intensive.
Gold inlays are a good but expensive alternative to amalgam in non-visible side-tooth region.
6. CERAMIC INLAYS
Can not be differentiated from the tooth.
Very good fit.
Porcelain is very well-tolerated with all other materials.
Does not influence mouth currents.
Very time intensive.
Needs very skilful preparation of the tooth cavity.
In rare cases, allergies to components of the composite adhesive can occur.
The ceramic inlay is the best but most expensive alternative to amalgam fillings in the side-tooth region, and can be used for smaller fillings in the front-tooth region.