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Amalgam Free Dentistry - Why should you replace it with ceramic filling

Amalgam fillings have been in use for more than 165 years* for restoring form and function of the premolar and molar teeth. It has also been estimated that about 75% of the dentists worldwide still use dental amalgam to restore decayed teeth. Longevity, low cost and ease of use has been the main reasons for its widespread use in dental offices. However, in the recent times, concerns are being raised about the impact of mercury in the amalgam fillings. Let’s know more about this.

What is an amalgam filling?

Dental amalgam is an alloy comprising about 40-70% of silver, 12-30% of tin, 12-24% of copper and up to 10% of mercury*. The alloy comes in a powder format which is mixed with the required amount of mercury and then placed in the tooth prepared to receive the filling.

Advantages of amalgam fillings

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There are a few advantages of amalgam fillings. Some of these include:

  •    Low cost dental implants
  •    Longevity
  •    Self sealing ability
  •    Low technique sensitivity

Drawbacks of amalgam fillings

While there are many advantages, there are a few issues of concern associated with the use of dental amalgam. These include:

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  •    Presence of mercury
  •    Amount of tooth preparation required is higher (cavity size required for a strong filling is considerably bigger than that for ceramic restorations)
  •    Dark colour of the restorations

Amalgam free dentistry – Mercury concern

The main concern with amalgam fillings is the mercury content in these fillings. All dental amalgam fillings contain up to 10% of mercury. This is of concern as mercury is a liquid metal which can vaporise gradually. The amount of mercury released may depend on factors such as a number of fillings, size of the fillings, eating habits and presence of conditions such as bruxism. This property of mercury referred to as ‘leaching’ has raised concern both among dentists as well as patients, owing to the harmful effects of mercury. Exposure to mercury at high levels has been proven to cause disorders related to the nervous system. However, studies have proven that the amount of mercury used in dental fillings are safe and can be used in almost all patients above the age of 6 years; except in pregnant women and those with kidney diseases, where other precautionary measures are also applicable.

Nevertheless, dentists and patients who opt for amalgam free dentistry are still concerned about the trace amounts of mercury in dental amalgam fillings.

Amalgam free dentistry – Filling options

Amalgam fillings were earlier preferred due to the lack of other filling materials which could match the amalgam fillings in terms of strength and durability. However, with the advent of technology, other options such as ceramic fillings, and composite resins are now available. The durability and strength of these materials are comparable to that of dental amalgam. Hence, both patients and dentists now prefer these instead of amalgam fillings in many instances.

Amalgam free dentistry – Benefits of other fillings

There are several benefits of other filling materials, especially ceramic and composite resin materials when compared to dental amalgam fillings.

One of the main benefits is the preservation of tooth structure. The strength of dental amalgam mainly relies on bulk (amount of filling material) where the dentist is required to prepare a cavity large enough to have sufficient amount of amalgam. However, this leads to compromise in tooth structure. On the contrary, other filling materials used in amalgam free dentistry do not require extensive tooth preparation. Only the affected part of the tooth needs to be cleared and the filling material can be placed directly into the prepared cavity.

Cosmetic appearance is the other benefit of amalgam free dentistry. The ceramic and composite resin restorative materials are available in different shades of white. So you can get a filling that matches the colour of your teeth, thus making the filling inconspicuous. Amalgam fillings are darker in colour and may also stain the teeth over a period of time. Hence amalgam fillings are not considered as esthetically pleasing. Ceramic and composite resin filling materials are considered esthetic as it matches the tooth colour and in many instances, it is difficult to make out that a filing exists.

Immediate chewing ability is the next benefit of ceramic fillings used in amalgam free dentistry. Composite resins mechanically bond to the tooth structure and harden immediately following exposure to a curing light. The ceramic and composite resin materials are strong enough to withstand the chewing forces immediately after they harden. Thus, one need not wait for 4-8 hours (as required after dental amalgam fillings) before chewing on the side where the filling has been done.

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Should I opt for amalgam free dentistry?

Ceramic or composite resin fillings are primarily preferred for front teeth because of esthetic reasons. As these fillings are available in different shades of white, the colour of the filling material can be closely matched to that of the tooth being filled. Hence, your smile will not be affected at all. Additionally, due to improved strength of the filling material, ceramic or composite resins are as durable as amalgam fillings. Hence, it can be opted for filling rest of the teeth too. As mentioned earlier, there are several other benefits of the ceramic or composite resin filling material, which makes it a preferred choice among dentists as well as patients.

Older amalgam restorations may often be required to be replaced as they tend to fracture along the margins. Such micro fractures can lead to microleakage, eventually causing decay below the filling (referred to as secondary caries). Hence, it is advisable to get such fillings replaced. Consult your dentist today to know more about amalgam free dentistry and how you can improve your smile with tooth coloured restorations.

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