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Amalgam: practical alternatives to smooth your transition

Amalgam: practical alternatives to smooth your transition

Smooth your amalgam phase-down with practical alternatives

As amalgam is phased out in the EU and beyond, Kent Express suggests some alternatives which will give the same great results.

Amalgam, once the most used restorative material worldwide, is to be completely phased out in the EU by 2025.

This decision was made earlier this year on the grounds that the mercury in amalgam is toxic in its free and unbound form and therefore harmful when released into the environment.

The most extreme example of the damage mercury can cause occurred in 1956 when mercury-tainted industrial wastewater poisoned thousands of people in Minamata in Japan, leading to severe health damage.

The global agreement on the phase out of mercury, the Minamata Convention, was named after this tragedy.

As the UK is no longer an EU member state, the Minamata Convention and ban on amalgam does not apply to it, with the potential exception on Northern Ireland.

While not openly stating its intention to cease all use of amalgam, the UK government, and associations such as the BDA, agree that the use of amalgam needs to be ‘phased down’ and other restorative materials considered.

Which restorative will take over from amalgam?

It is unlikely that amalgam will be replaced by just one material any time soon, but several materials.

Alternatives that are already used globally in their millions include resin-based composite materials, glass ionomers and glass hybrids.

Professor Dr Falk Schwendicke, director of the Polyclinic for Dental Conservation and Periodontology at the LMU Clinic in Munich, offered the following assessment of these three options.

Glass ionomer and glass hybrids

Glass ionomers and glass hybrids are among the potential amalgam replacements and have shown a considerable evolution over the last two decades. Evidence supports the usage of glass hybrids for both cervical and posterior load-bearing restorations.

In a range of lab studies, it was confirmed that glass hybrids come with significantly superior properties compared with traditional glass ionomers, while retaining the advantages of this material class, namely the option to place it in bulk, the ease of placement and its high bioactivity (especially the known release of fluoride).

The cost-effectiveness and applicability of these materials is likely superior to that of other materials, while improvements in further material characteristics (specifically flexural strength) would be welcome to establish this material as truly universal amalgam replacement material.

For most healthcare systems worldwide, though, glass ionomers and glass hybrids are already ‘essential medicines’ according to WHO.

Product recommendation – EQUIA Forte HT

Moisture-tolerant and forgiving glass hybrid

  • Ideal to use when isolation is difficult to achieve
  • Chemical adhesion eliminates the need for a separate bonding
  • Minimally invasive as only infected dentine needs to be removed.

Excellent long-term success rate, even in load bearing cavities

  • Thanks to the very resistant final coating layer
  • EQUIA Forte HT is a reliable long-term restorative system based on 12 years of proven clinical experience.

Bulk placement resulting in a fast and easy procedures

  • Unlimited depth of cure
  • Virtually no shrinkage due to the absence of resin monomers
  • Very low technique sensitivity of the procedure.

Resin-based composites

Micro and nanohybrid resin composites have shown excellent physical properties, such as high resistance against abrasion and erosion, high flexural strength, polishability and aesthetics.

These materials can be placed adhesively and therefore do not rely on macro retentive cavity preparation, allowing for minimally invasive dentistry.

Notably, the placement of resin composites comes with several prerequisites like strict moisture control, stepwise preparation and conditioning of the cavities, eg involving acid etching and adhesive placement.

Hence, resin composites can safely be regarded as one of the contemporary amalgam alternatives. Nevertheless it does not check as many boxes as glass hybrids.

Product recommendationEverxflow

Strong dentine reinforcement material

  • Fibre reinforcement effect
  • Superior fracture toughness
  • Optimal for large or cracked cavities.

Easy bulk placement

  • Layers of up to 5.5 mm thickness with the bulk shade
  • Flowable consistency for a perfect adaptation to the cavity.

Affordable solution for patients

  • Enables to make a direct restoration where an indirect one could have been indicated.

Product recommendationG-ænial Universal Injectable

Thixotropic and versatile material

  • Injectable viscosity: stays in place but adapts to every cavity
  • One material for all cavities (even load-bearing), without covering layer.

High wear resistance

  • Based on FSC technology: excellent dispersion and adhesion of the fillers in the matrix
  • Excellent durability in time.

Beautiful restorations

  • Achieved with a short polishing time
  • Optimal gloss retention
  • Wide shade range.

Where is the best place to buy these amalgam alternatives?

All products listed in this article are available to purchase from Kent Express, one of the UK’s leading dental suppliers.

Shopping online with Kent Express comes with free next working day delivery as standard. Click here to shop now.

This article is sponsored by Kent Express.

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