Dental amalgam--what are the alternatives?

Alternatives to amalgam include glass ionomer cements, direct placement composites, composite inlays, and ceramic inlays. Glass ionomer cements are suitable only in minimally stress-bearing areas but have the advantages of reliable adhesion and fluoride release. For the larger cavity, resin inlays offer a viable alternative to direct placement composites because of better control of contour and contact areas, and management of polymerisation shrinkage. However, there are reservations regarding the long-term marginal quality in view of possible wear of the cement lute. Ceramic inlays offer maximum aesthetics, but similar cement lute concerns have been expressed. The cost of the restoration to the patient is in the order direct resin < resin inlay < ceramic inlay. Tooth-coloured resin or ceramic alternatives to amalgam are indicated for aesthetic restoration of moderate lesions, in patients with good oral hygiene. Contraindications include high caries rate, inability to obtain perfect moisture control, heavy occlusal stress, and poor or absent marginal enamel.