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Medical Forum / General / Dentistry / April 2005Amalgam
One of the problems with amalgam is that it works under excellent conditions and it still works under crap conditions. Composites, no. Once all dentists use composite exclusively, oh boy, we are going to be in for trouble. Composites are "technique sensitive." This is going to imply lots more root canal, crowns and extractions! Joel Do you think similar things were said when high speed handpieces became the norm? How could every dentist learn how to control such a device that cuts through teeth like butter? If a dentist can't place a comfortable, long lasting posterior composite, maybe 'he' shouldn't be in practice. Fawks > Once all dentists use composite exclusively, oh boy, we are going to > be in for trouble. Composites are "technique sensitive." > > This is going to imply lots more root canal, crowns and extractions! > > Joel > Do you think similar things were said when high speed handpieces > became the norm? How could every dentist learn how to control [quoted text clipped - 4 lines] > > Fawks I don't really think that is a fair comparison. The former is a tool that required a period of learning and adjusting. The latter is a material that has some definite issues which make it harder to handle. Anything that requires a dry field and is used in a wet place is starting off at a disadvantage. Something that cannot be condensed without a degree of rebound is not the ideal material to fill a hole. We can learn to work around the issues that make resin more challenging to handle, (the technique sensitive issue) but while a high speed handpiece was a far superior tool than those it replaced, posterior resin materials are a compromise at best. They, like every other material we use, offer properties that make them superior to other restorative materials, but have other characteristics that make them an inferior choice in some situations. T >> Do you think similar things were said when high speed handpieces >> became the norm? How could every dentist learn how to control [quoted text clipped - 10 lines] >requires a dry field and is used in a wet place is starting off at a >disadvantage. No not a disadvantage ... A FAILURE! You cannot bond to saliva! You can squish through saliva when condensing amalgam .... its never good technique, but it works and works well. The restoration last 15 years instead of 30. Joel > Something that cannot be condensed without a degree of rebound >is not the ideal material to fill a hole. We can learn to work around the [quoted text clipped - 6 lines] > >T > >> Do you think similar things were said when high speed handpieces > >> became the norm? How could every dentist learn how to control [quoted text clipped - 17 lines] > You can squish through saliva when condensing amalgam .... its never > good technique, but it works and works well. If it works well why is not considered good technique? How many dentists do this? How would the Hg concentration near the surface layer of the amalgam be affected as opposed to the correct method of condensation? The restoration last 15 > years instead of 30. > > Joel I guarantee you that anything which affects the physical properties of the amlagam will have an effect on the chemical properties esecially over time. >> You cannot bond to saliva! >> >> You can squish through saliva when condensing amalgam .... its never >> good technique, but it works and works well. > >If it works well why is not considered good technique? Because the moisture causes advanced corrosion of the restoration "before its time." In fact, if I take one look at any amalgam, I can tell immediately under what conditions it was placed. Joel > How many >dentists do this? In the old days many, many. Today, the treatment plan is different. Either you get the crown or you get the dentures! With amalgam, there is another alternative, although dentists will claim one cannot "shoe the cusp" so to say, with any filling material. Joel > How would the Hg concentration near the surface >layer of the amalgam be affected as opposed to the correct method >of condensation? The surface layer is actually easy to remove excess mercury. The difficulty is in removing it SEQUENTIALLY in a wet field. Therefore the amalgam/tooth adaptation (mechanical at best) is often not right. Now amalgam is forgiving. After it sets it expands and seals the thing very tight! > The restoration last 15 >> years instead of 30. > >If it works well why is not considered good technique? > > Because the moisture causes advanced corrosion of the restoration > "before its time." In fact, if I take one look at any amalgam, I can > tell immediately under what conditions it was placed. Unfortunately I didn't save my replaced amalgam because I didn't know you can "read" the conditions and quality of placement just by looking at it. The Advanced corrosion you mention equals more Hg release. Consider that some of the non-gamma2s have exponential corrosion products with depth and add in (as in my case) a tremendous amount of decay on the filling surface, which could even add acid from bacteria to the mix. What would also be interesting to know is if water in the amalgam surface can increase galvanic effects. (Maybe that is what you are saying). I really would like to see a well designed study where they take amalgams graded by quality of placement/condensation and see what the results are in terms of health effects and toxicity 10 years down the road. > Joel > [quoted text clipped - 22 lines] > > The restoration last 15 > >> years instead of 30. > With amalgam, there is another alternative, although dentists will > claim one cannot "shoe the cusp" so to say, with any filling material. Vas ist das? "shoe the cusp" means what? Merci SP  SignatureFinally: take out the TRASHH "Hood" the cusp "overlay" the cusp "replace" the cusp tip Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >> With amalgam, there is another alternative, although dentists will [quoted text clipped - 3 lines] > Merci > SP > "Hood" the cusp > > "overlay" the cusp > > "replace" the cusp tip Oh Blimy.... I should-a thunk it! Thanks SP SignatureFinally: take out the TRASHH >> With amalgam, there is another alternative, although dentists will >> claim one cannot "shoe the cusp" so to say, with any filling material. > >Vas ist das? "shoe the cusp" means what? >Merci >SP Open mouth, insert foot ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >Vas ist das? "shoe the cusp" means what? > >Merci > >SP > > Open mouth, insert foot ? > -- Go pop some protons SP SignatureFinally: take out the TRASHH >Do you think similar things were said when high speed handpieces >became the norm? Actually they WERE said and it was erroneous! Composite is another story. We already note lots of cases of sensitivity leading to root canal therapy and crowns! Joel > How could every dentist learn how to control >such a device that cuts through teeth like butter? > >If a dentist can't place a comfortable, long lasting posterior >composite, maybe 'he' shouldn't be in practice. That would be 2 out of 3 dentists ....... Joel >Fawks > [quoted text clipped - 4 lines] >> >> Joel > Do you think similar things were said when high speed handpieces > became the norm? How could every dentist learn how to control [quoted text clipped - 4 lines] > > Fawks I've been thinkin' about your assertion here: If a tooth has caries so subgingival that herodontics must be used to save that tooth, what then? Do we give up and whip out the tooth? We don't all have your talent or know-how. I have also seen some beautiful posterior composites done in Filtek Z250 by my former boss... I mean huge MODL where the 'DL' part is all composite... Sure, they look better than mine, but they STILL wear faster than the MODBL Am's next to them (those teeth that were left alone because of all the pins and high Endo probablilities). Just look at the plethora of courses being given on composites: each purports to have T.H.E. best method of making sure-fire tight and physiologic contacts for posterior composite. If it was so easy, how come we still are seeing these courses so well attended? I take one of these each year, and I have yet to see a repetition of any one method of obtaining tight predictible posterior composite contacts. To me, this means that much of what is being suggested may be OK for exceptional cases, rather than for the majority. What about when it bleeds? Wedge it? Sure: sometimes. FeSO4 it? Sure: sometimes. Use a tightly placed contour matrix? or a modified AutoMatrix? Sure: sometimes. But: I'd REALLY like to see some of your Composite gurus come in and sit down in my chair and merrily make an MOD composite filling on that case I posted a couple of weeks ago. We don't all have the possibility of placin' a matrix and then Laserin' away the caries right down to the bone either. I still would if I had chosen not to sterilize my handpiece, but there ya go... Ain't going into the Poor House just to kiss Biolase's a.s... I ain't sayin' it can't be done. I AM sayin' that your assertion about using composite placement technique as a selection for dental excellence is unrealistic, to say the least, in MANY MANY cases. At least I believe it is where _I_ am. And don't forget: I ain't just makin' excuses: this is coming from one who is ALWAYS thinking and drilling with the ultimate intention of filling with composites as first choice; even when it's hopelessly subgingival. Just some thoughts SP SignatureFinally: take out the TRASHH |
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