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Amalgam versus composite restorations: a cost-consequence analysis
Oliver Bailey1, Laura Ternent2, Simon J Stone3
1School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom. oliver.bailey1@newcastle.ac.uk.
British Dental Journal
|July 24, 2026
Summary
Amalgam restorations for posterior teeth are more cost-effective and lead to better tooth survival than composites, despite appearance concerns. Phasing out amalgam without changes may negatively impact NHS dental services and vulnerable patients.
Area of Science:
- Dental materials science
- Health economics
- Public health
Background:
- Global phase-out of dental amalgam by 2034 necessitates evaluation of alternatives.
- Amalgam is the primary material for posterior teeth restoration in English NHS care.
- Need for comprehensive assessment of amalgam vs. composite restorations.
Purpose of the Study:
- To evaluate the comparative costs and consequences of amalgam versus composite restorations for posterior permanent teeth in adults.
- To inform the phase-out of amalgam under English NHS provision.
- To analyze impacts on patients, funders, and clinicians.
Main Methods:
- Synthesis of multiple research strands: clinician survey, discrete choice experiment, and cost-effectiveness analysis.
- Quantification of costs and consequences for amalgam and composite restorations over time.
- Cost-consequence analysis under English NHS provision.
Main Results:
- Amalgam restorations showed better tooth survival at 4 and 12 years (non-discounted).
- Amalgam favored in patient valuation (£33), lifetime patient costs (£70 direct; £15 indirect), funder costs (£34), and clinician costs (£83).
- Differences in tooth survival and cost favored amalgam over composites.
Conclusions:
- Except for aesthetics, amalgam restorations are favored over composites for posterior teeth in English NHS care across all outcomes and stakeholders.
- Phasing out amalgam without fundamental changes poses significant implications for vulnerable populations and NHS dental services.
- The study highlights potential negative consequences for equity and service sustainability.
