Amalgam alternatives

amalgmKemdent explains the reasons why amalgam is no longer the preferred restorative dental material and offer a viable alternative.

Amalgam has been used in dentistry since the 1800s. It was first established as a strong, durable and versatile restorative material. Its exact origins are debated among sources. There’s no denying that it became the go-to solution for filling teeth around the world.

However, it has fallen out of favour in recent times. This is due to potential concerns regarding mercury content as well as rising aesthetic demands. Although amalgam remains in circulation for some patients, clinicians are tasked with finding suitable alternatives in more and more situations. Having a reliable product on hand that can be trusted to maintain treatment quality standards is essential.

No longer the favourite

There are a few reasons why amalgam is no longer the stand-out preferred restorative dental material. Containing a small amount of mercury, the material emits mercury vapour into the air. This bonds to methyl to create methylmercury. This can be harmful for humans to inhale as it is easily absorbed into the bloodstream and organs. Or, it can travel through the system into the brain (Park and Zheng, 2012).8

Wider environmental impacts of methylmercury include contamination of aquatic wildlife, where it accumulates as it passes up the food chain. Not only could this be toxic to creatures of the sea, but there is potential for humans to consume fish containing harmful mercury levels.

Though, more conclusive evidence is needed to determine the dangers presented (Park and Zheng, 2013; Balshaw et al, 2007). The Environment Quality Standards Directive regulates mercury levels in fish in order to protect humans from secondary mercury poisoning (EU directive, 2000).

It’s important to note here that the amount of mercury in a single amalgam restoration will be minimal. Rather, it is the cumulative impact of dental amalgam that creates most risk.

A mandatory stand down

In light of the evidence available regarding the negative effects of dental amalgam, the Government has introduced a mandatory (albeit gradual) move away from the material. As of June 2019, the Department of Health and Social Care released the “Dental amalgam: plan to phase down use in England” document (DoH paper, 2019). 

This mandates the avoidance of amalgam fillings for specific patient groups. This includes childing under the age of 15 and pregnant women. Though less decisive, a European Commission Scientific Committee opinion (2015) states that, while further research is needed into the neurotoxicity of mercury from dental amalgam, other materials should be considered for deciduous teeth. It adds that particular attention should be paid to the restorative material chosen when treating pregnant women. 

Patient supported

In many cases, the move away from amalgam is often supported by patients. Greater awareness of environmental factors means that some will appreciate solutions that don’t pose any sort of threat to the planet and its wildlife.

A bigger driving factor for more patients, however, is likely aesthetics. Despite the many advantages amalgam offers, a natural-looking appearance has never been one of them. While not an issue several decades ago, aesthetics has become a priority for many in today’s world. Societal pressure, personal ambitions and the desire to boost self-confidence combine to form highly aesthetic patient expectations for any type of dentistry.

As such, many individuals will seek a restorative solution that blends with their dentition far more than the traditional silver of an amalgam filling. For dental practitioners, this patient demand offers another powerful incentive to utilise amalgam alternatives in everyday practice.

Quality and efficiency 

When selecting a suitable restorative material, several factors must be considered. Clearly, a safe and highly aesthetic solution is required. However, it is also critical for the material chosen to be easy to work with. It should support a fast and efficient clinical workflow.

This is particularly important in dentistry today – not least due to the many pressures of delivering quality care, but also given the additional challenges presented by the pandemic. As practices continue to battle the backlog of patients created by lockdowns and widespread social restrictions, everyday life has become busier than ever.

Speed without compromise is therefore essential for every GDP and their team. With enhanced infection control protocols, it is also hugely beneficial for clinical procedures to support exceptional safety standards as well. 

Restorative materials may only be a small part of the story. However, they are still an important part for practitioners looking to optimise every aspect of their workflow. The Kemdent Diamond Rapid Set Glass Ionomer Cement (GIC) Capsules are an ideal solution.

Singularly packaged for quick, simple and hygienic application, the material is uniquely formulated for maximum durability and minimal chipping for non-load-bearing Class I and Class II restorations, deciduous teeth, the sandwich technique or core build ups. Kemdent Diamond Rapid Set GIC Capsules support everyday speed and efficiency alongside exceptional clinical outcomes, making them an ideal alternative to amalgam in many cases.

The natural choice

For a restorative material that doesn’t harm the environment or threaten aquatic life, helps to meet patients’ aesthetic expectations and streamlines the professional workflow, clinicians need to look beyond amalgam. Extensive research and development in the field has led to some viable alternatives, so now it’s up to dental professionals to make the most of them.


This article first appeared in Private Dentistry magazine. You can read the latest issue here.

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