When was the last time you placed an amalgam? When was the last time you placed a pin?
Back in dental school, the first thing we were taught was how to prepare teeth for amalgam restorations and how to place them. But with the advent of new composites and bonding systems as well as increasing patient awareness of modern dentistry, amalgams simply have no place in clinical care in 2017 (and beyond).
Let’s face it. Amalgam restorations are damn ugly. Even if you carve anatomy into them. Patients prefer something that looks natural in their mouths. Also with increasing concerns about mercury (whether they are unfounded or not) most patients will try to avoid them. If there were no price differences between composite and amalgam, there would be no market for amalgam.
How many cracks have you seen around amalgam restorations during your practice? It makes sense – given that teeth have been prepared with undercuts. Although it may take years for catastrophic failures to occur (vertical root fractures), why risk it in the first place?
We no longer need to create undercuts or dovetails to retain restorations. But since we teach amalgam like its an entry step into placing restorations, aren’t we promoting a more aggressive form of dentistry from the get-go?
Instead of teaching students amalgams during their course, we should focus more time on how to place composites correctly. This would most likely improve the longevity of these restorations in the long run, improve patient outcomes, and really promote the concept of conservative dentistry we’re so used to saying.