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Silver amalgam restorations are the traditional silver filling materials.
They have been used with success by all dentists for more than 150
years. Silver amalgam fillings were originally meant to be a low-cost substitute filling material for those patients who could not afford the standard-of-care gold restorations. They can be used to replace small or large amounts of tooth structure lost through decay or fracture. They are not technique sensitive. They are composed of silver, tin, mercury, copper, and other metals. Some of the newer silver amalgam materials are mercury-free. We have no long-term studies on how well these mercury-free amalgams will serve.
The silver amalgams available have a life expectancy of 14 years with a plus/minus deviation of 14 years. They can last a long time or need to be replaced within a year of when they were originally completed. As with resin restorations, the smaller the filling, the longer it can last. This is still the restorative material of choice for many dentists but that number is declining. Most restorations for back teeth, regardless of size, are silver amalgam. With the advent of the newer bonded resin materials, many posterior (back) teeth that previously would have been restored with amalgam are now being restored with the more conservative and more naturally appearing tooth colored resin and porcelain materials. Silver amalgam fillings can now also be bonded when there is little remaining tooth. This, of course, will add to the total fee charged for the restoration.
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Disadvantages of the silver fillings are esthetics. It is impossible to have them look natural, and the appearance deteriorates as time goes by. If the surrounding enamel is thin, the gray/black color of the metal will show through. They can make the tooth turn dark. They add no strength to the tooth (unless bonded). They weaken the tooth because they have a higher expansion/contraction ratio than the surrounding tooth. These forces can, after time, cause the tooth to fracture. They are not considered a conservative restoration because they require more tooth prepared (drilled) than is actually necessary to be removed due to the decay. This extra drilling is strictly to allow the retention of the restoration. In some instances, it might be more cost-effective and better for the gingival (gum) health to place a cast restoration (crown or onlay). This would be the case when the silver filling would be large. When there are extensive amounts of tooth structure to be rebuilt replaced, it is often quite difficult to establish the proper physiologic contour to the tooth. Remaining tooth structure may be more prone to fracture.
Advantages of the silver amalgam fillings are that they are quick and easy to place, relatively inexpensive, and have a proven record of success. If finances are a major concern and cosmetics are not important, then this material is well suited for all types of restorations. If the cavity is small or on a previously undamaged portion of a tooth, a more conservative resin restoration would be a better choice.
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The practice of the art and science of dentistry has changed tremendously during the last 15 to 20 years. Nowhere is
this more evident than in the variety of dental materials now available for tooth restoration. Composite resins (tooth colored bonding plastics) permit us to restore teeth with less removal (drilling) of sound tooth structure. The
composites look like natural tooth structure, are bonded to the tooth for a tight seal, last a long time, and add back
strength to the prepared tooth. Silver amalgam (metal filling) materials don’t look like natural teeth; they leak fluids at
the tooth/metal interface; can crack teeth by volumetric and thermal expansion; require more removal of tooth structure than is required to eliminate decay; make the tooth weaker; and can last a long time but often seriously
damage the tooth while in place. Silver fillings were invented around 1814 by the French as a temporary, inexpensive
filling material to be used until the patient could afford a better-quality gold restoration.
Base metals have been used in dentistry as an inexpensive alternative to the noble and high noble metals. Noble and
high noble metals contain precious metals such as gold, palladium, and platinum in varying percentages. Base metals
are composed of metals that can have high allergenic, toxic, or even carcinogenic properties. We do not use base
metals in any laboratory processed restoration. We have used casting metals that are of proven high quality. Because we are considerate of your overall medical health, we do not offer base metals as an option for any crown, bridge, or implant-supported casting.
We have made a decision in our practice to provide you with the best and most appropriate procedures and materials
that dentistry has to offer. This does not necessarily mean the most expensive treatment. We want them to look good
and be functional and comfortable too. We feel that silver amalgam materials will not help you meet this goal. We
feel that routine use of new silver fillings and base metal has a place in dentistry but it is better to avoid them and use
other non-reactive materials instead. |
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