[Enamel-dentinal adhesives in amalgam restorations. Review of the literature]

Amalgam is still the material most often used to restore posterior teeth, since it is easy to use, it has a low cost and a long clinical life. However, its use requires the solutions of several problems: lack of adhesion to tooth structure, marginal leakage, postoperative sensitivity and susceptibility to corrosion. In order to combine the advantages of dentinal adhesives with the excellent mechanical properties and good long clinical behaviour of amalgam, their use under amalgam restorations has been proposed. Adhesives improve marginal sealing and guarantee an additional retention to restorations, due to the formation of a layer linked with micromechanical bonds both to the tooth and the amalgam; they create a barrier that occludes dentinal tubules access, protecting the pulp. In this article the results of several in vitro studies performed to assess amalgam restorations properties are summarized. Present knowledge, based on an accurate literature review, allows to consider bonded amalgam restorations as a real progress in conservative dentistry: if long-term longitudinal studies, that are presently carried out, confirm the good short-term results, bonded restorations will represent the solution of choice for amalgam application.