Dental Amalgam
Silver amalgam has been the most important restorative material in the history of dentistry. The overall use of amalgam in Western countries is decreasing. However, in many countries amalgam is still of great importance for restoring decayed teeth. This c
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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . Composition and Setting Reaction . . . . . . . . Mercury-Based Amalgams . . . . . . . . . . . . . . Mercury-Free Amalgams . . . . . . . . . . . . . . . . Systemic Toxicity . . . . . . . . . . . . . . . . . . . . . . Metabolism, Distribution, and Excretion of Mercury . . . . . . . . . . . . . . . Immunotoxicity . . . . . . . . . . . . . . . . . . . . . . . Neurotoxicity . . . . . . . . . . . . . . . . . . . . . . . . . Fertility Dysfunction and Teratogenicity . . Local Toxic Reactions . . . . . . . . . . . . . . . . . . . Cytotoxicity and Implantation Studies . . . . . Pulp Reactions . . . . . . . . . . . . . . . . . . . . . . . . Reactions of the Oral Mucosa . . . . . . . . . . . . Allergies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carcinogenicity . . . . . . . . . . . . . . . . . . . . . . . . Clinical Studies . . . . . . . . . . . . . . . . . . . . . . . . Relationships Among Symptoms, General Diseases, and Amalgam Fillings . . . . . . . . . . Removal of Amalgam Restorations . . . . . . . Public Discussion . . . . . . . . . . . . . . . . . . . . . . Conclusions for the Dental Practitioner . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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ample, in Denmark, with a population of 5.5 million, the number of amalgam fillings dropped from about 3.5 million in 1980 to about 700,000 in 2006. The material is relative cheap, and when handled correctly, the durability of amalgam fillings exceeds that of alternative direct restorative materials [24, 161, 225, 247] (Fig. 4.1). Acceptable durability can be obtained even under difficult operative circumstances, in contrast to analogous materials, which are more technique-sensitive (Fig. 4.2). On the other hand, silver amalgam has been and still is a matter of concern for patients and
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Introduction
Silver amalgam has been the most important restorative material in the history of dentistry. The material has been widely used for almost two centuries, although the composition has changed during this period. In many countries, silver amalgam is still of great importance for restoring decayed teeth. For example, in England and Wales, out of a population of 38 million people (those age 18 years and over), approximately 17 million amalgam fillings were placed each year in the early 1990s (Dental Practice Board, United Kingdom, 2002). However, the overall use of amalgam in Western countries is decreasing; for ex-
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.. Fig. 4.1 A 19-year-old intact amalgam filling
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4 Dental Amalgam
4.2.1.1 Setting Reaction
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.. Fig. 4.2 Extended amalgam restorations on an upper molar and premolar tooth. Indirect restorations
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