Minimal Invasive Dentistry

Marinescu Andrada

Gr. 3 Anul V

MD ENG
 Dental Materials: Composite
vs. Amalgam for Minimally
Invasive Dental Restorations

Introduction

In the 21st century, minimal invasive

dentistry is a philosophy which adopts

the goal of an intervention in which the

conservation of a healthy tooth structure is key. This philosophy encompasses a

rangle of clinical procedures that integrates prevention, remineralization and

minimal intervention for the placement and replacement of restorations. This

conservative approach minimizes the restoration/re-restoration cycle, thus

benefiting the patient over a lifetime. The two dental materials, amalgam and

composite resin, will be discussed and analyzed in this paper while taking into

consideration their aesthetics, biocompatibility effects and their respective tooth

preparations.

Composite vs Amalgam

The longevity of dental restorations is dependent on many factors, but one of

the most important of them being that related to the materials used. Dental

amalgams have been used in the dental profession for over a century because of its
strength and durability, however, due to its inferior aesthetic appearance and

concerns over the adverse health effects of the material, it is being replaced by

alternative tooth coloured materials - composite being one of them. Dental

amalgam is a combination of mercury with other metals, which is soft enough to

adapt to the size and shape of the tooth cavity yet hardens sufficiently fast to make

it practical. However, during the placement and removal of an amalgam filling, and

even during the time that an amalgam filling is in place in a patient’s cavity, both

the patient and the dentist is exposed to the mercury vapors that are being released

through this proccess. Studies show that inhalation of mercury vapors may produce

health effects such as bronchitis, pneumonia, brain and kidney damage, however,

there needs to be a high concentration absorbed into the lungs for this to occur. The

main adverse effect of amalgam fillings is the local effects caused in the mouth,

such as allergic reactions of the gums and oral mucosa. Additionally, pregnant

women must also try to avoid this type of restorative materials due to its effects. In

conclusion, amalgam may constitute potential toxic hazards to patients through

mercury release and absorption, surface corrosion, and the reaction of released

mercury with residual alloy particles from an amalgam restoration into the enamel,

dentin, pulp tissues, and adjacent gingival tissues where it accumulates. Among the

disadvantages of amalgam as a restorative material, some are: its unaesthetic

appearance, tarnish and corrosion, it lacks chemical or mechanical adhesion to

tooth structure therefore requiring a meticulous cavity preparation and healthy

tooth removal to provide mechanical retention, it is a brittle material with low edge

strength which requires bulk for strength, it has a high thermal conductivity, it

promotes plaque adhesion and finally, requires special waste handling.

Composite, on the other hand is a tooth-colored plastic and glass mixture

that provides good durability and resistance to pressures of constant stress and

chewing. Due to their aesthetic features, it can be used in both frontal and posterior

teeth, offering a more natural result. As opposed to amalgam materials, composites

offer excellent resistance to corrosion, chemical attack and outdoor weathering. In

addition, composite materials are insulative materials, they are repairable, they can

be polished during the same appointment as the tooth filling, and most importantly,

they bond to the tooth structure which means that less healthy tissue is removed

through preparation, which is an important component of the minimal invasive

philosophy.

Minimal Tooth Preparations

Conventional preparations are based on the theory of “extension for

prevention” and the needs of the restorative material rather than the health of the

tooth. Minimally invasive dentistry offers a more conservative preparation as seen

in composite restorations as opposed to large amalgam preparations which require

more healthy tooth structure to be removed. An amalgam restoration has the

following cavity preparations:

- 90 degree cavosurface angle

- the walls must be parallel or perpendicular to occlusal loads

- a definite gingival seat of 1.5-2mm. in depth for compound cavities

- rounded internal line angles

- sufficient bulk at the isthmus area

- each portion must have its own independent retention and resistance

A composite restoration has the following cavity preparation:

- minimal extention

- pulpal and axial walls of varying depth

- enamel bevel

- butt joint on root surface

- tooth preparation walls must be rough

As a cavity outline form, amalgam prepartions must include all pits and fissures

and adjacent suspicious areas; for class ll tooth preparations, proximal contact has

to be broken. For composite restorations, they must include faults but they need

not be extended to adjacent pits and fissures; for class ll preparations, proximal

contact need not be broken. The pulpal depth of an amalgam restoration must be

uniform, with a minimum depth of 1.5 mm, while for a composite restoration, the

pulpal depth does not need to be uniform, and a depth of 1.2mm is usually

sufficient. The axial depth for an amalgam preparation should be uniform, with a

depth of 0.2 - 0.5 mm inside the DEJ, while for a composite restoration the axial

depth does not neccessarily need to be uniform, while the depth is made to extent

of the defect. For secondary retention, amalgam preparations have grooves, slots,

pins and locks while for composite preparations these secondary retentions are

indicated only for extensive preparations, not all. In conclusion, tooth preparations

that are to receive an amalgam restoration are much more extensive and must be of

a certain depth to achieve proper retention, as compared to a composite preparation

which is limited to the cavity, shallow or deep, small or big. This is why, in my

opinion, composite restorative materials are much more minimally invasive.

Conclusion
 In conclusion, although amalgam is a durable and strong material, especially

for posterior restorations, it is still considered to contain a toxic material which can

pose a threat to the health of patients. Additionally, it does not comply with the

importance and the philosophy of minimal invasive dentistry used in today’s

society, as it requires a more extensive removal of healthy tooth structure in order

to offer resistance to the filling. Composite material is not only much more esthetic

and can be used in both anterior and posterior teeth, but it is also much more

biocompatible. It is up to the patient and doctor to discuss the options available

and come to a final decision as to which material would best fit the needs of the

patient, while also respecting biocompatibility considerations of each material.

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