Silver Amalgam vs. White Tooth-colored Composite and others

Simply put, I am pro-composite. Why?

First let me define the different materials to be discussed.

• Amalgam: silver colored metal material used to do fillings
• Composite: white or tooth-colored resin material used to do fillings
• Glass-Ionomer: also white, but more opaque than composite.

Now that you know what it is, I will go into why I'm against Amalgam.

• material itself stains teeth
• is a conductor, a metal, and can cause
• a degree of hot/cold sensitivity
• shrinking and expanding from conducting temperature
• weakening and eventually cracking of teeth due to pressure from this thermal expansion
• need to cut out more of the healthy part of the tooth
• need to make sharp angles on the intaglio of the tooth which becomes stress points - again aiding in possible cracking and dentinal sensitivity
• it's inert, but it does contain mercury
• looks bad, simply put

Why do I like Composite for my patients?

• the composite itself does not stain the tooth
• is not a conductor, so you can rule out the problems that comes from a conductor
• can remove just the bad parts of the tooth for the most part and save more of the healthy parts of the tooth
• internal design of the tooth can be rounded, which is much more friendly to the rounded anatomy of the tooth and the pulp (nerve)
• not a heavy metal - more biocompatible
• esthetic! multiple shades which can match all kinds of different teeth colors!

There are times, though, when it is impossible to get saliva under control when composites just cannot be used. This is one disadvantage of composite. In this case, I use a resin-based glass-ionomer material. Glass-Ionomers

• can stick to teeth pretty easily even if there is some saliva around.
• releases fluoride at a slow and steady rate
• more flexible than composite
• is a great material for certain types of restorations but will not last as long as a composite

So if someone tells you, amalgam is the best filling material because it is highly durable - think twice. This may have been true a long long time ago when composites were not so advanced, but things are different now.