A) The tooth-colored appearance of composite fillings is more cosmetically appealing than dental amalgam.

There is no question that the tooth-colored appearance of composite fillings is more cosmetically pleasing than the silver coloration of dental amalgam fillings. And in those cases where the use of either restorative is appropriate it is easy to see why a dental patient would prefer a white composite filling. However, in those cases where the cosmetic appearance of dental composite is placed ahead of a consideration of its (possibly less than optimal) physical properties, dental composite can be a poor choice.

B) A completed dental composite filling will often be smaller in size than a comparable dental amalgam filling.

When placing a dental filling a dentist will first use their drill and shape the tooth. Some aspects of this shaping are dictated by requirements associated with the type of dental filling material being used. Comparatively speaking, the required shape for a dental composite filling can typically be smaller than that shape required for a dental amalgam filling.

The flip side to this argument however could be as follows. Most dentists would probably feel that one of their primary treatment goals is to conserve as much natural tooth structure as is possible. In light of this statement you might anticipate that in most cases a dentist would likely recommend the placement of a composite filling rather than a dental amalgam restoration since the size of the cavity preparation can be minimized when dental composite is placed.

A point to the contrary could be made however. Since a composite filling quite possibly won’t last as long as a dental amalgam filling and because each time a dental filling is replaced the overall size of the filling typically increases, placing dental composite may not be as conservative a treatment as one might have initially anticipated. Clearly it would take your dentist’s evaluation and judgement to make a determination regarding this argument.

C) Dental bonding can possibly have a strengthening effect on teeth.

Some dentists feel that teeth restored with dental amalgam fillings are more likely to experience cusp fracture than those teeth restored with tooth bonding (a composite filling). The thought is that the adhesive nature of the bond between the dental composite and the tooth serves to strengthen the tooth being repaired, as opposed to the typical dental amalgam filling where a bond with the surrounding tooth structure does not exist.

This conventional wisdom is not necessarily confirmed by dental research. One study (Wahl, 2004) evaluated the rate of tooth cusp fracture in more than 10,000 teeth that had either a dental amalgam or dental composite filling. The study’s findings were that overall there was no significant difference in the rate of tooth cusp fracture in regards to either type of filling. As a conclusion, this study stated that when choosing between a dental amalgam filling and a dental composite filling (in regards to the likelihood of a future cusp fracture) that either type of filling should be considered acceptable.

To continue this discussion further, we would like to bring to your attention that even though conventional dental amalgam fillings do not create a bond with tooth structure there is a technique of using a bonding protocol with dental amalgam where such a bond is created. Two of our references (Rasheed, 2005 and Zidan, 2003) evaluated the use of bonded dental amalgam fillings as a means to reinforce weakened teeth and both studies found that this bonding technique did provide a benefit. More specifically, the Zidan study evaluated the effect of bonding technique on the stiffness of teeth. The study found that a dental amalgam filling alone did not provide a stiffening effect whereas bonded dental amalgam fillings and dental composite fillings both did. Bonded dental amalgam fillings on average restored teeth to 62% of their original stiffness whereas tooth bonding (composite fillings) on average restored teeth to 77% of their original stiffness.

A review of just these three studies is hardly conclusive (and we admit that comparisons of their individual findings are even somewhat contradictory) but these studies would lead us to believe that the tooth strengthening argument attributed to the use of dental composite is not as strong as some would claim. It seems just as valid to suggest that a bonded amalgam filling might provide the best choice in regards to tooth strengthening, since this technique can offer the more durable type of filling material and also the benefits of bonding technique. Clearly your dentist’s evaluation of your specific situation should weigh heavily when making a decision regarding what type of filling is best for your tooth.

D) Tooth bonding usually creates less post treatment thermal sensitivity.

Dental amalgam is a metal and therefore is an efficient thermal conductor. This means that after amalgam fillings are placed (especially relatively large ones) it is common that people will experience a sensation in their tooth when they consume hot or cold foods and beverages. In most cases this thermal sensitivity will subside as days and weeks pass but for some people it most certainly can be a nuisance.

Since dental composite is a plastic it is a comparatively poor thermal conductor. This means that a strong sensitivity to hot and cold stimuli is usually not a problem with composite fillings. This is not to say that post treatment sensitivity is never occurs with composite fillings. In fact, especially during that era when creating an effective bond with tooth dentin was less well understood by dentists, sensitivity with dental bonding could at times be very problematic. Nowadays however, subsequent to the development of new dental bonding materials and protocols, the potential for post treatment sensitivity with dental bonding has become less of a concern.

E) Dental composite fillings are ready to be used immediately after the dental appointment has been completed.

As a matter of convenience, a dental patient may be pleasantly surprised to find that the composite filling they have just had placed is fully cured (hardened) and ready for use. In comparison, dental amalgam fillings need several hours before they approach full strength.

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