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Which material?

It is perhaps surprising to some to realise that the dental profession has been using silver amalgam for over 250 years, since the days of Pierre Fauchard. Over the years it has been the tried and tested material for the restoration of teeth in both adults and children. Indeed, in children it has been the most forgiving of materials and can be placed in the most difficult circumstances. How many of us have restored primary teeth by placing amalgam swimming in saliva in a difficult wriggling child? Yet many, but not all, of such restorations have lasted until exfoliation of the teeth.

In adults well placed amalgams can last for over half a century. As a dental student in the late 1950's I often saw elderly patients with amalgams over 50 years old, beautifully placed contoured and polished, almost like jewellery, albeit placed by dental students under the eagle demanding eyes of their instructors. But even while a student we also had silicate and acrylic restorative materials. These were much more difficult to use and very moisture sensitive. Placed carefully however, these materials could last for many years. Even so these newer tooth coloured materials could cause death of the pulp, had shrinkage problems and were certainly totally unsuitable for use in young children.

Today the ever changing pace of dental materials research has brought to us many different materials, mainly over the past 20 years. We have an ever wider range of materials, easier to handle, well matched in colour to different shades of tooth, and in demand from parents who reject the dark appearance of amalgam. Glass ionomer cements, composite resins, resin modified glass ionomer cements and compomers provide an armamentarium of materials for restoring primary teeth.

However, with such a wide range of materials available which should we use, when and how? This second part of our review series on dental materials and techniques for the restoration of primary teeth, deals with amalgam, glass ionomer cements and the appropriate polishing and finishing techniques. Our aim is to provide readers with a critical review of the research background to the use of these materials in children. As before in Part I (EAPD Volume 7, issue 3), reviewers were asked to evaluate the literature and then to assess clinical trials of their respective materials against a given set of criteria. This brings about some interesting results in that few studies meet all or most criteria. Nevertheless, more recent studies give us a firm basis for their use.

What is quite clear from these reviews is that, while modern materials are superior in many aspects to amalgam, their longevity, at present, is nowhere near as good. How many restorations made with compomers placed in adults, for example, will be still be in good condition in 50 years time? I hope some will, but they will need to be placed under optimum conditions with an exacting and precise technique. In children our time span needed for restoring primary teeth is a lot less, perhaps about seven years, and most of these materials are entirely suitable for that period. No doubt even better materials will become available. This set of reviews we hope will be valuable for paediatric dentists when deciding which material to use when and how.
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Title Annotation:dental materials
Author:Curzon, Martin
Publication:European Archives of Paediatric Dentistry
Article Type:Editorial
Date:Mar 1, 2007
Previous Article:Calendar of future events.
Next Article:Durability of amalgam in the restoration of class II cavities in primary molars: a systematic review of the literature.

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