Operative Dentistry - Best Practices
(last modified June 22, 2016)
SAFETY & EFFICACY:
- 150+ year usage due to strength, durability and ease of manipulation
- Minimal mercury exposure if handled appropriately
- WHO, CDC, FDA and the ADA agree that, based on extensive scientific evidence, dental amalgam is safe and effective for patients.
- EU Commission SCHER - Dental Amalgam is still a safe material to use with no evidence of systematic disease (March 2014)
- Dental clinics should use amalgam separator devices
- Follow ADA Best Practices: Handling and Disposables
- Large Posterior restorations
- Adequate field control is not obtainable in non-esthetic regions
- Foundations for crowns
- Compromised posterior teeth when modifying factors preclude indirect cuspal coverage restorations
- High caries risk patients
MINIMAL INVASIVE TREATMENT:
- Encourage conservation of tooth structure by repairing dental amalgam restorations rather than replacing whenever possible
- GENERAL RECOMMENDATIONS:
- Dentinal liner (Superseal) to reduce sensitivity
- Clinical trials have failed to show that bonded amalgams significantly reduce sensitivity
COMPLEX AND CUSPAL COVERAGE:
When there is significant loss of tooth structure and conventional retention and resistance form is not sufficient to retain amalgam, retention and resistance can be enhanced using additional tooth preparation such as:
- slots/grooves (segmented or continuous)
- extension of grooves
- Circumferential slots and amalgapins have been shown have equal resistance form and resistance to displacement as traditional pins.
- "GRIT" actions in your practices to prevent mercury pollution:
- Gray Bag It - Discard amalgam wastes into appropriate containers.
- Recycle It - Select a responsible dental amalgam recycler who can manage your waste amalgam safely from the list of recyclers below.
- Install It - Install an amalgam separator to capture up to 95% of the mercury going down the drain. This is the KEY to success.
- Teach It - Educate and train staff about the proper management of dental amalgam.
- European Commission: Scientific Committee on Emerging and Newly Identified Health Risks. The Safety of Dental Amalgam and Alternative Dental Restoration Materials for Patients and Users May 6, 2008. Accessed October 9, 2013.
- ADA Council on Scientific Affairs. Dental Amalgam: Update on Safety Concerns. J Am Dent Assoc. 1998;129:494-503. Accessed October 9, 2013.
- FDI Policy Statement/WHO Consensus Statement on Dental Amalgam. September 1997. Accessed October 9, 2013.
- EPA Mercury in Dental Amalgam, Updated March 2014.