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Amalgam substitutes: a critical analysis.

F Lutz1, I Krejci

  • 1University of Zurich, Dental Institute, Clinic of Preventive Dentistry, Periodontology, and Cariology, Zurich, Switzerland. lutz@zzmk.unizh.ch

Journal of Esthetic Dentistry
|April 28, 2001
PubMed
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This study evaluated amalgam substitutes for dental restorations. Few materials met radiopacity and wear resistance standards, with significant marginal integrity issues observed in vitro, questioning their clinical suitability.

Area of Science:

  • Dental Materials Science
  • Restorative Dentistry

Background:

  • Switzerland has established quality standards for dental restorations, including amalgam substitutes.
  • Restorations must preserve tooth structure, restore form and function, and have a simple operative technique.
  • A minimum service life of 8 years is mandated for amalgam substitutes.

Purpose of the Study:

  • To investigate the clinical potential of various compomer and resin-based composite materials as amalgam substitutes.
  • To assess these materials against Swiss Grade 2 restoration requirements, focusing on operative technique, guidelines, and service life.
  • To evaluate in vitro the marginal adaptation and wear resistance of potential amalgam substitutes.

Main Methods:

  • Evaluated compomers (Compoglass, Dyract, Dyract AP, Elan, F 2000) and resin composites (Alert, Ariston, Definite, Nulite, Solitaire, Surefil).

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  • Used Adaptic and Tetric Cream as negative and positive controls, respectively.
  • Measured in vitro radiopacity (mm Al equivalent), marginal adaptation, and wear in Class II cavities.

    • Main Results:

    • All compomers met radiopacity requirements; only Dyract AP and Elan showed superior wear resistance to amalgam.
    • Resin composites Alert, Surefil, and Tetric met radiopacity minimums; Definite, Surefil, Solitaire, and Tetric exceeded amalgam's wear resistance.
    • Post-stress marginal adaptation was poor for all materials, with continuous margins at best 31% overall and 8% in dentin.

    Conclusions:

    • Several amalgam substitutes demonstrated inadequate marginal integrity and wear resistance under simulated clinical conditions.
    • Current compomers and resin composites may not fully meet the stringent Swiss quality standards for dental restorations.
    • Further research is needed to develop materials that combine acceptable radiopacity, wear resistance, and long-term marginal stability.