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Discussing Restorative Materials With Patients

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When presenting a treatment plan to a patient, we have to explain all available options, including why specific restorative materials are superior or contraindicated in certain situations. The trends are shifting more towards esthetic dentistry and less consideration is being given to long-term prognosis. If finances are an issue, patients might compromise and not choose the “optimal” option. Whichever factors drive the patient, it is up to us to educate them to the best of our ability to make sure they understand the implications of choosing a material.

Many choices of restorative materials exist for patients presenting with cavities, tooth wear, trauma or cosmetic issues. All materials have different properties and require various techniques for placement. Ideally, a restorative material should be identical to natural tooth structure, including physical properties, biocompatibility, esthetics and application. Some long lasting restorative materials are composite resin, amalgam and gold.

Direct resin based composite restorations have increased in popularity because they closely replicate the appearance of natural teeth. However, are they the most superior material for posterior restorations? It is important to remember that posterior restorations need to withstand greater occlusal forces. The current resin-based composite materials have improved enormously, but research still shows that for posterior restorations, they are at a disadvantage in comparison to amalgam due to decreased longevity and bacteriostatic properties. Resin based composite allows for a more conservative preparation, but is more technique sensitive. Overusing resin-based composite can be detrimental to the patient’s teeth in the long-term, due to shorter longevity of the material and decreased strength of the tooth every time the restoration needs to be replaced.

Amalgam is the most cost effective of the three materials and has great strength and longevity. Amalgam is easily placed, can withstand high occlusal forces, and has a marginal seal that improves over time. However, due to misconceptions about mercury and poor esthetics, amalgam is not a favorite for many patients and dental professionals. Clinicians must be aware that it is unethical to replace sound amalgam restorations by preying on patient’s misinformation or solely to make a profit. Amalgam can produce staining on the teeth over time or fractured cusps can result due to the preparation technique and wedging effect. An additional limitation of amalgam is different expansion and contraction characteristics in comparison to natural tooth structure. Still, it is a great material to be used on high caries risk patients.

Gold’s popularity has also decreased due to esthetics and cost. Gold does not discolor the tooth and, up until resin based composite increased in popularity, it used to be considered esthetic for posterior restorations. Some dentists still use gold and have learned to do exceptional esthetic dentistry through techniques like the invisible onlay or adequate placement of intracoronal restorations. Gold restorations have excellent durability, an almost nonexistent marginal gap on the cavosurface and will not exhibit marginal wear. The coefficient of expansion is similar to natural tooth structure. Gold is very biocompatible with gingival and supporting tissues and does not contribute to allergic responses. Even thought the procedures have become more efficient, gold foil technique is no longer taught in most dental schools or postgraduate programs.

Adequate informed consent is imperative before starting any procedure. It is important to stay knowledgeable about the latest products and to be aware of existing research and the longevity of the materials. As dental professionals, we should know how to work with all restorative materials and how to educate the patient to choose the most adequate option for their treatment goals.