Direct Composites Vs Amalgam

This Cochrane systematic review titled "Direct Composite Resin Fillings versus Amalgam Fillings for Permanent Posterior Teeth" (Worthington et al., 2021) (click to download and read) provides essential insights into the performance, and safety of composite resin and amalgam fillings for permanent posterior teeth. As dental materials evolve and regulations shift, it is crucial for dental professionals to make informed, evidence-based choices. Please note, the longevity data should be interpreted with caution as explained in the last video.

1. Durability & Performance:

Composite fillings are significantly more prone to secondary caries (Risk Ratio 2.14), increasing the risk of further dental treatment.
There is no significant difference in fracture rates between the two materials.

2. Health & Safety Considerations:

No strong evidence suggests that either material poses significant long-term health risks (e.g., neuropsychological, renal, or immune function).
Some studies reported higher urinary mercury levels in children with amalgam, but these levels remained well below toxic thresholds.

3. Regulatory & Environmental Factors:

The Minamata Convention on Mercury is leading a global phase-down of dental amalgam due to environmental concerns.
Many countries are transitioning to mercury-free alternatives, making composite an increasingly relevant option.

4. Clinical Implications & Decision-Making:

While amalgam remains a reliable and cost-effective choice, composite fillings provide aesthetic benefits and align with current regulatory trends.
Advances in composite technology may improve durability, though current evidence still suggests a higher failure rate.
Patient preferences, clinical conditions, and regulatory guidelines should guide material selection.

Final Thought for Practitioners:

The decision between composite and amalgam fillings should be a collaborative discussion between the dentist and the patient, balancing longevity, aesthetics, cost, and environmental considerations.

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