Should I replace my amalgam fillings?

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General Dental Care
BDSc (Hons) (Melb)

Not too long ago, amalgam was the material of choice for dentists when placing fillings. Amalgam fillings, when properly done, were inexpensive, easy to place and long lasting. As dentistry has evolved, however, the disadvantages of amalgam have become more apparent. Apart from a lack of visual appeal, one of the main disadvantages of amalgam is that, traditionally, it cannot be chemically bonded to tooth structure and is retained in the tooth by way of physical undercuts. This means that the dentist has to remove healthy tooth structure to hold in an amalgam filling.

Additionally, amalgam expands and contracts and can cause cracks and fractures in the tooth as well as in the filling itself. Concern has also been raised about the mercury content in amalgam.

Waste in the form of removed amalgam also presents an environmental burden. Given the above considerations, the question arises as to whether your amalgam fillings should be replaced.

My recommendation is not to replace any kind of filling simply for the sake of it. A well-designed, intact amalgam filling should be watched and will need replacing only if signs or symptoms warrant this – for example, if there are signs of decay around the filling, chipping or cracking or poorly adapted margins. Some may also choose to replace amalgam fillings purely for aesthetic reasons.

What are the alternatives? There are two different alternatives to amalgam fillings: composite fillings (made of resin) and CEREC fillings (made of porcelain). For replacing larger fillings, CEREC porcelain is a superior material. It is durable, is aesthetically appealing and enjoys a success rate of at least 90 per cent after 10 years.

For a more detailed comparison of composite fillings and CEREC fillings click here.

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