Title Dental Amalgam Has A Lower Failure Rate In Restoring Dental Caries Compare To Composite
Clinical Question Is dental amalgam a better choice for treatment of dental caries restorations compared to composite?
Clinical Bottom Line Dental amalgam is better choice in treating carious lesions compared to composite resin. (See Comments on the CAT below)
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
11317384Hickel/2001AdultsSystemic Review
Key resultsAnnual failure rates in posterior stress-bearing restorations are: 0% to 7% for amalgam restorations, 0% to 9% for direct composites, 1.4% to 14.4% for glass ionomers and derivatives, 0% to 11.8% for composite inlays, 0% to 7.5% for ceramic restorations, 0% to 4.4% for CAD/CAM ceramic restorations, and 0% to 5.9% for cast gold inlays and onlays.
11763918Hickel/2000Adults Systemic Review
Key resultsAnnual failure rates in posterior stress-bearing cavities were determined to be: 0-9% for direct RBC restorations, 0-7% for amalgam restorations, and 1.9-14.4% for GIC restorations. The median annual failure rate of longitudinal studies for amalgam was calculated with 1.1%, for RBCs 2.1% and for GICs 7.7%. GIC is significantly worse compared with amalgam and RBC. Main reasons for failure were secondary caries, marginal deficiencies, fracture, and wear. Longitudinal studies showed a strong trend towards a higher longevity compared with cross-sectional investigations.
Evidence Search Search Systematic Reviews "Dental Caries"[Mesh]Search "Composite Resins"[Mesh]Search "Dental Amalgam"[Mesh]
Comments on
The Evidence
The dental literature predominantly of the last decade was reviewed for longitudinal, controlled clinical studies and retrospective cross-sectional studies of posterior restorations. A systemic review article with RCT it has highest of validity.
Applicability The patient and dentist can use this information to chose which method to restore a carious lesion. The dentist may wish to consider relative clinical lifetimes in selecting a restorative material when other factors (e.g., esthetics) do not predominate.
Specialty (General Dentistry) (Restorative Dentistry)
ID# 624
Date of submission 04/02/2010
E-mail Ghanizadeh@uthscsa.edu
Author Hoda Ghanizadeh
Co-author(s) e-mail
Faculty mentor Barry K. Norling, MS, PhD
Faculty mentor e-mail NORLING@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?)
None available
Comments and Evidence-Based Updates on the CAT
by Inna Piskorska (San Antonio, TX) on 08/08/2013
Meta-analysis from 2012, Heintze, PMID# 23082310 finds composite restorations (hybrid and microfilled) to have the best results and longevity “similar to amalgam restorations.” Composite restoration success rate was 92% (10 years) and amalgam restorations was 94%. In one of the studies they mentioned, found “prevalence rate of marginal caries of 5-6%-irrespective of restoration used”. The study brought to attention the fact that longevity discrepancy between amalgam and composite restorations found in studies that were conducted in faculty practice. There is no big difference on longevity between amalgam and composite restorations when studies are conducted in general practice. This difference between general practitioners and faculty practice “may be explained by the overall inferior quality of the restorations placed by the general practitioners.” Authors bring to attention that most dentists confuse marginal staining with marginal caries and this way prematurely replace posterior restorations.