Sunday, 27 September 2015

#TubulesLive Event with Trevor Burke: Is there life after Amalgam?

Last week saw the return of #TubulesLive and a fantastic presentation by Trevor Burke. This event was exclusively live on Dentinal Tubules online or in the studio! One of the perks of Tubules Premium members!



For all of you that missed this entertaining and educational presentation by Professor Burke, here is a summary of the main points of his lecture. 
  • We all learn at dental school that amalgam has a longer lifespan than any other direct material, with 42% still in place after 15 years! However, some of the short term data is surprising, with 10% failure rate after 1 year and 20% after 2 years. 
  • Overall, the evidence shows that there is around 7 years difference in survival between small occlusal amalgams and large MODs.
  • The Minamata Convention is 2013 aimed to phase down the use of mercury containing products globally by setting national objectives for caries prevention, promoting cost effective and clinically effective mercury-free alternatives and promoting research and development
  • This phase down is not limited to just dental amalgam, but to also other products such as thermometers and fluorescent lighting tubes
  • There have been some Randomised Controlled Trials (RCTs) to shown there are no problems caused in children after having dental amalgams placed
  • BUT if you remove an amalgam, high levels of mercury can be released into a patient's blood so you should use rubber dam and high volume suction
  • Advantages of amalgam include: cheap and easy to use, technique tolerant, good life span and less moisture sensitive BUT it is not adhesive and is not tooth-coloured
  • Indirect alternatives such as gold, cast alloys and porcelain are expensive
  • GIC needs more development in order for it to be a good amalgam-alternative as it can be dissolved but it could be considered as a long term provisional which can be resurfaced with composite when it wears
  • Due to composite being an adhesive, a study has shown that an occlusal cavity removed only 5% of the tooth surface in comparison to 25% in amalgam
  • Studies have shown that failure rate per annum for composite is around 2%
  • A main concern in composites is its polymerisation shrinkage although ways around this have been explored such as increasing the filler load, bulk fills and high molecular weight resins
  • On average, a posterior composite does take 2.5X longer to place than an amalgam, so perhaps bulk-flow materials should be considered as alternatives
  • Some concerns with bulk flow materials include C factors leading to increased sensitivity and stress, poor shade selection and costs. 
  • There needs to be more development in finding an ideal alternative to amalgam which is self-adhesive, low shrinkage, with good physical properties, is wear resistant, is quick and easy to place and non-toxic

Make sure you tune in for the next #TubulesLive event on the 15th October! Let me know your thoughts on the phase down of amalgam in the section below!

To see my posts about previous #TubulesLive events see here


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