The “Phase Down” of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

Miranda, Diogo de Azevedo; Silveira, Lorena Esteves; Schirm, Júlia Alves; Lima, Izabella Lucas de Abreu; Manzi, Flávio Ricardo

doi:10.1590/pboci.2024.028

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Pesquisa Brasileira em Odontopediatria e Clínica Integrada

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CRITICAL REVIEW • Pesqui. Bras. Odontopediatria Clín. Integr. 24 • 2024 • https://doi.org/10.1590/pboci.2024.028 copy

The “Phase Down” of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4.

Material and Methods:

The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality.

Results:

Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth.

Conclusion:

The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

Keywords:
Dental Materials; Dental Amalgam; Long Term Adverse Effects

Authors	Amalgam	Resins	Period of Evaluation
Van Nieuwenhuysen et al. [⁹[9] Van Nieuwenhuysen JP, D'Hoore W, Carvalho J, Qvist V. Long-term evaluation of extensive restorations in permanent teeth. J Dent 2003; 31(6):395-405. https://doi.org/10.1016/s0300-5712(03)00084-8 https://doi.org/10.1016/s0300-5712(03)00... ]	Failures occurred in 28% of amalgam restorations. The highest percentage of extractions was related to complete amalgam restorations in premolars. The mean time of survival was 12.8 years for amalgam fillings.	Failures occurred in 30% of resin restorations. The mean time of survival was 7.8 years for resin restorations.	17 years
Wahl et al. [¹⁰[10] Wahl MJ, Schmitt MM, Overton DA, Gordon MK. Prevalence of cusp fractures in teeth restored with amalgam and with resin-based composite. J Am Dent Assoc 2004; 135(8):1127-1132; quiz 1164-5. https://doi.org/10.14219/jada.archive.2004.0371 https://doi.org/10.14219/jada.archive.20... ]	In 10,082 teeth restored with amalgam, the prevalence of cusp fracture was 1.88%.	In 787 teeth restored with resin composite, the prevalence of cusp fracture was 2.29%.	-
Tyas [¹¹[11] Tyas MJ. Placement and replacement of restorations by selected practitioners. Aust Dent J 2005; 50(2):81-89; quiz 127. https://doi.org/10.1111/j.1834-7819.2005.tb00345.x https://doi.org/10.1111/j.1834-7819.2005... ]	Secondary caries were the main reason for replacing restorations, predominantly affecting amalgam restorations in Class I and V cavities. Teeth are restored with amalgam fractured almost twice as often as teeth restored with composite resin. The mean age of replacement for amalgam was 13.6 years (?)	The mean age of resin composite at time of replacement was 7.1 years(?).	-
Mannocci et al. [¹²[12] Mannocci F, Qualtrough AJ, Worthington HV, Watson TF, Pitt Ford TR. Randomized clinical comparison of endodontically treated teeth restored with amalgam or with fiber posts and resin composite: Five-year results. Oper Dent 2005; 30(1):9-15.]	The survival rate of amalgam found in this study was 91.3%;	The survival rate of teeth restored with fiberglass post and composite resin was 90%.	5 years
Opdam et al. [¹³[13] Opdamÿ NJM, Bronkhorst EM, Roeters MJ, Loomans BAC. A retrospective clinical study on longevity of posterior composite and amalgam restorations. Dent Mater 2007; 23(1):2-8. https://doi.org/10.1016/j.dental.2005.11.036 https://doi.org/10.1016/j.dental.2005.11... ]	For amalgam, they revealed a survival rate of 89.6% in 5 years and 79.2% in 10 years.	For resin composite, they revealed a survival rate of 91.7% in 5 years and 82.2% in 10 years.	Between 5 and 10 years
Bernado et al. [¹⁴[14] Bernardo M, Luis H, Martin MD, Leroux BG, Rue T, Leitão J, et al. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc 2007; 138(6):775-783. https://doi.org/10.14219/jada.archive.2007.0265 https://doi.org/10.14219/jada.archive.20... ]	The survival rate of amalgam restorations was 94.4%.	The survival rate of resin composite restorations was 85.5%.	7 years
Burke and Lucarotti [¹⁵[15] Burke FJ, Lucarotti PS. How long do direct restorations placed within the general dental services in England and Wales survive? Br Dent J 2009; 206(1):E2; discussion 26-27. https://doi.org/10.1038/sj.bdj.2008.1042 https://doi.org/10.1038/sj.bdj.2008.1042... ]	Amalgam restorations, Class I have a mean survival time of 10 years before reintervention (58%) compared with large amalgam fillings, such as Class II (43%).	Composite resin and glass ionomer restorations have a worse performance than amalgam restorations.	10 years
Opdam et al. [¹⁶[16] Opdamÿ NJM, Bronkhorst EM, Loomans BAC, Huysmans DNJM. 12-year survival of composite vs. amalgam restorations. J Dent Res 2010; 89(10):1063-1067. https://doi.org/10.1177/0022034510376071 https://doi.org/10.1177/0022034510376071... ]	In the high-risk group, composite resin and amalgam restorations showed comparable performance, with amalgam performing better in more minor restorations.	Composite resin restorations showed better survival for the combined risk group and the low-risk group.	12 years
Heintze and Rousson [¹⁷[17] Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations - A meta-analysis. J Adhes Dent 2012; 14(5):407-431. https://doi.org/10.3290/j.jad.a28390 https://doi.org/10.3290/j.jad.a28390... ]	The ratio of Class I/Class II restorations did not significantly influence the results. The mean success rate of amalgam fillings was 94%.	The general survival rate of resin composite restorations was 90%. The frequency of caries adjacent to restorations was low in most studies, with a mean prevalence of around 3% after 10 years. The mean survival rate of resin composite restorations was approximately 92%.	10 years
Moraschini et al. [¹⁸[18] Moraschini V, Cheung KF, Alto RM, Santos GO. Amalgam and resin composite longevity of posterior restorations: A systematic review and meta-analysis. J Dent 2015; 43(9):1043-1050. https://doi.org/10.1016/j.jdent.2015.06.005 https://doi.org/10.1016/j.jdent.2015.06.... ]	The mean survival rate of amalgam ranged from 76%, with a mean annual failure rate of 1.71.	The mean survival rate of amalgam ranged from 56% with a mean annual failure rate of 3.17%, respectively.	5 years
Naghipur et al. [¹⁹[19] Naghipur S, Pesun I, Nowakowski A, Kim A. Twelve-year survival of 2-surface composite resin and amalgam premolar restorations placed by dental students. J Prosthet Dent 2016; 116(3):336-339. https://doi.org/10.1016/j.prosdent.2016.02.005 https://doi.org/10.1016/j.prosdent.2016.... ]	Sixty-six amalgam restorations (5.9%) failed. Long-term failures (over two years) occurred in 43 amalgam restorations (3.8%). In 12 years, the probability of survival was 91.5% for amalgam.	Resin restorations showed 1.3 times more propensity to failure; 134 Resin Composite restorations (7.9%) failed. Long-term failures (over two years) included 77 resin composite restorations (4.5%). In 12 years, the probability of survival was 86% for resin composite.	12 years
Burke and Lucarotti [²⁰[20] Burke FJT, Lucarotti PSK. The ultimate guide to restoration longevity in England and Wales. Part 10: key findings from a ten million restoration dataset. Br Dent J 2018; 225(11):1011-1018. https://doi.org/10.1038/sj.bdj.2018.1029 https://doi.org/10.1038/sj.bdj.2018.1029... ]	In 4 years. the results indicated a cumulative rate of reintervention by direct restoration, crown, or extraction of 66.1% for single-surface restorations (i.e., Class I and Class V), 67.5% for two-surface, 63.0% for three-surface restorations and 55.8% for four-surface restorations, however, their data did not include details of the materials used.	For composite restorations, 34% survived for 15 years, with approximately 43% surviving for up to 10 years and approximately 59% for five years. When the data concerning extraction time were reanalyzed, it was apparent that about 83% of teeth restored with a composite restoration survived for 15 years.	15 years
Worthington et al. [²¹[21] Worthington HV, Khangura S, Seal K, Mierzwinski-Urban M, Veitz-Keenan A, Sahrmann P, et al. Direct composite resin fillings versus amalgam fillings for permanent posterior teeth. Cochrane Database Syst Rev 2021; 8(8):CD005620. https://doi.org/10.1002/14651858.CD005620.pub3 https://doi.org/10.1002/14651858.CD00562... ]	Low-certainty evidence suggested that composite resin restorations may have a failure rate nearly twice that of amalgam restorations.	The risk of restoration fracture does not appear to be greater with composite restorations, but there is a much greater risk of developing secondary caries.	3 years

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[1] Correspondence: Diogo de Azevedo Miranda, E-mail:diogoodonto@yahoo.com.br