Material Selection for Direct Restorations
Amalgam vs. Composite vs. Glass Ionomer
When treatment planning for direct restorations, it is important that you select the correct material by taking into consideration the dental implications as well as patient preference. Below you will find a list of the available materials used to restore teeth as well as their indicated use.
Pros: Macro-retention (from prep). Longevity. Time-tested. Self-sealing margins (over time). Wear-resistant.
Cons: Larger preparations than composite. Not esthetic. Allergy possible (but rare).
There is a lot of controversy over the use of amalgam due to its mercury content. However, this material has not only been time-tested, but also proven to be safe. Amalgam can be used in almost any situation, but is usually reserved for patients who are concerned about finances, larger restorations, or posterior restorations.
Pros: Conservative prep design, macro and micro-retention (from prep and bonding), esthetic
Cons: Not expected to last as long as amalgam. Can wear opposing enamel.
Composite has come a long way as a restorative material. Due to the ability to control its properties such as strength, ability to polish, and color, it has become the most popular restorative material. Because of its strength, color, and ability to bond, composite is generally chosen for patients who are concerned about esthetics, for anterior restorations, and for smaller/more conservative restorations, but can also be used for posterior restorations.
Pros: Conservative prep design. Self-adhesive. Fluoride-containing (recharge possible). Semi-esthetic.
Cons: Difficult to color match. Not as strong as composite or amalgam. Not as wear resistant as composite or amalgam.
Glass ionomer has a unique ability to not only release fluoride, but have its fluoride reservoir recharged. However, it is not as strong as amalgam or composite, so it is generally reserved for non-load bearing restorations (such as class V) and in pediatric or geriatric patients where recurrent caries is a concern. It can also be used as a liner/base when performing deep caries protocol or the "sandwich technique".