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Title Ideal Core Build-Up Material As An Interim Restoration
Clinical Question For a healthy adult with a fractured cusp, is amalgam core build-up more durable compared to composite resin core build-up when restored to function if full coverage restoration has to be delayed by a few months?
Clinical Bottom Line Presently there is no evidence establishing the superiority of one core build up material over the other, however amalgam has shown to be more durable if used alone as a posterior restoration replacing 3 or more surfaces. Bonding of amalgam with a filled, 4-META-based bonding resin appears to be a satisfactory method of retaining large amalgam restorations replacing cusps.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 10551078Combe/1999In vitro studyComparative Study
Key results5 different materials were tested for compressive strength, modulus of elasticity, diametral tensile strength and flexural strength and modulus as a function of time up to 3 months. All the materials tested including high copper amalgam and composite resin were found to meet the minimum specification requirements except for flexural strength which was lacking in amalgam only at 1 hour, and silver cement at all time intervals.
#2) 17545266Bernardo/2007472 subjects between 8-12 yearsRandomized Controlled Trial
Key resultsTotal of 1748 restorations, half restored with amalgam and half with composite resin were followed up to 7 years. Overall 10.1% of baseline restorations failed. The survival rate of amalgam restorations was 94.4%, that of composite restorations was 85.5%. Annual failure rates ranged from 0.16% to 2.83% for amalgams and 0.94% to 9.43% for composites. Risk of secondary caries was 3.5 times greater in the composite group.
#3) 15195725Summitt/200460 amalgam restorationsRandomized Controlled Trial
Key results60 amalgam restorations replacing at least 1 cusp (28 pin retained and 32 bonded) were placed. At 6 years, 11 restorations had failed 8 of which were pin retained and 3 were bonded.
Evidence Search A PUBMED search performed using the following terms1)"Mechanical Phenomena"[Mesh] direct core build –up materials”2)("Dental Amalgam"[Mesh]) AND "Composite Dental Resin" [Supplementary Concept]3)"Dental Pins"[Mesh] AND "Amalgambond"[Substance Name]
Comments on
The Evidence
The studies cited above are of average strength in terms of evidence as the first one is a bench top comparative study with good parameters and the second one is a Randomized Clinical Trial which evaluates longevity of posterior restorations. However, by comparing the studies, one can conclude that for restoring 4 surfaces and a cusp in a fractured tooth Amalgam can provide better strength and durability until the tooth can get a full coverage restoration. The clinical trial comparing methods of retention show that bonding amalgam with a 4-META based bonding resin is a satisfactory method of retaining large amalgam restorations.
Applicability There is no strong evidence establishing the superiority of one core build up material over the other, and the particular clinical circumstances like isolation, remaining tooth structure, the time of crowning the tooth should determine the choice of a core build up material. If longevity is a criterion and multiple surfaces have to be restored, amalgam should be the material of choice for a build up.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Amalgam, Core build-up, Composite Resin
ID# 890
Date of submission: 05/09/2011spacer
E-mail shethv@livemail.uthscsa.edu
Author Vidhi Sheth
Co-author(s) e-mail
Faculty mentor/Co-author Mary Norma Partida, DDS, MPH
Faculty mentor/Co-author e-mail PARTIDAM@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Connor Marshall (San Antonio, Texas) on 12/01/2017
A search was conducted in PubMed on November 28, 2017 and found articles by Kumar/2015 (PMID 25684905) and Jayanthi/2013 (PMID 24431748). The study conducted by Kumar found results that were similar to those previously found by the author of the CAT. The conclusions of the new research done by Kumar agreed that amalgam appeared to be the most durable of materials for core buildups; however, research conducted by Jayanthi appeared to disagree. Jayanthi concluded that amalgam had the least flexural strength when compared to Fluorocore and nanocomposite, and the latter materials should be considered the preferred standards for conventional core build-ups.

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