Is Silver Amalgam Still a Viable Option in Modern Dental Practices?

Until my retirement five years ago, I relied on silver amalgam for durable and cost-effective fillings, especially in back teeth. This material, while not without its drawbacks, remains one of the finest restorative materials available, second only to the costly gold. However, with advancements in dental technology and growing concerns over environmental and health impacts, the use of amalgam is on the decline, particularly in regions with advanced dental care.

Advantages of Silver Amalgam Compared to Other Materials

Combining the hardness of silver with the malleability of mercury, silver amalgam offers several advantages. It is durable, capable of lasting up to 45 years, and significantly cheaper than gold. For decades, I have trusted this material for extensive restorations on lower molars where a resin filling might be too small and a crown might be overkill. However, advancements in resin technology have dramatically improved its performance, making it a viable option for most basic restorations.

The Decline of Silver Amalgam Usage

If I were still practicing today, I would still utilize amalgam for certain situations, but not nearly as extensively as in the past. Over the past few decades, the suitability of amalgam for back teeth has been questioned due to advancements in materials and the increasing emphasis on patient and environmental health. In Northern Europe, where I resided and practiced, there has been a significant movement against amalgam, driven by health concerns and environmental impacts.

Health and Environmental Concerns

The last time I used amalgam was over two decades ago. During the 1990s, there was a heated debate about the health and environmental effects of amalgam fillings, largely initiated by concerns in Sweden. The adverse health effects of mercury led to regulations that restricted the use of amalgam fillings, especially for children's first fillings. The debate extended to the dental profession and manufacturing chain, highlighting severe environmental impacts. Many countries eventually banned amalgam due to increased levels of mercury in soil around cemeteries and crematories.

Patient and Technological Preferences

Today, patients are no longer willing to accept amalgam fillings. They prefer tooth-colored fillings, such as composite resins, for aesthetic reasons. Composite fillings, while they may start to degrade after 2-3 years, offer better aesthetics and are now suitable for most back teeth restorations. The dental industry has made significant strides in improving resin durability, making these materials an excellent choice for general dental care.

Conclusion

Silver amalgam, while still used in some parts of the world, is becoming less common in advanced dental practices due to its cost and potential health and environmental impacts. Composite fillings, though more expensive initially, provide long-term benefits and improved aesthetics, making them a preferred choice for many patients. As the dental industry continues to innovate, patients and dentists alike are moving towards more sustainable and patient-friendly solutions.