The use of Amalgam in Pediatric Dentistry

Resident’s Name: Derek Banks Date: February 13, 2009
Article title: The use of Amalgam in Pediatric Dentistry
Author(s): A Fuks
Journal: AAPD Journal
Volume (number): 24:5
Month, Year: 2002
Major topic: Crowns and Alloys
Minor topic(s): Amalgam in Pediatric Dentistry
Type of Article: Review of literature/position paper
Main Purpose: Evaluate the safety and efficacy of Amalgam as a restorative material in pediatric patients
Overview of method of research: Review of current literature regarding Amalgam use in pediatric dentistry
Findings: Safety: Most documented problems arising from amalgam use were related to the occupational hazard of handling and mixing amalgam, a problem that has been remedied since the advent of premeasured ampules mixed with trituration. One study showed that the correlation between the levels of mercury in mothers and newborn was more closely related to the amount of fish consumed than the presence of amalgam fillings. True allergy to mercury is very rare. Early amalgams fractured and corroded more easily, a problem that has been addressed by the introduction of more copper into the mix, which prevents the tin/mercury (gamma 2) phase as copper has a higher affinity for the tin, and forms a more dental-friendly mix by avoiding the problematic gamma 2 phase. The oxidation of amalgam helps maintain a good marginal seal – this paper claims the marginal seal of amalgam improves over time. In patients 4 and under SSC’s had twice the longevity of amalgam restorations. Failure is usually attributed, at least in part, to poor preparation on the part of the operator – a statement qualified by studies showing longer duration of restorations in patients treated in pediatric specialty practices, and that the major cause for failure of amalgam restorations was fracture or total loss – not recurrent decay.
Key points/Summary : The author placed emphasis on selecting the right restoration for each patient and for each tooth, taking into account caries risk, life expectancies of each tooth etc… For small occlusal lesions, a PRR is recommended. For class 2 lesions that don’t extend beyond the line angles, the author recommends amalgam. For more then 2-surface restorations, or those in which the proximal surface caries extends beyond the line angles, SSC is recommended.
Assessment of article: Good summary.