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A growing problem in dentistry is complications associated with failing amalgam restorations that have been in place for many years. At present, there is a wide variety of treatment options available in the clinician's armamentarium when this situation arises, however, without the correct diagnosis, the prognosis for the tooth may quickly diminish, despite the clinician's best efforts. A confusing array of symptoms and failures may confound even the most experienced dentist, which will inevitably lead to invasive and time consuming approaches in a desperate attempt to rectify the initial problem. This paper, the first part of a three-part series, discusses the possible aetiological factors responsible for restoration failure, including occlusal issues and cracks within the tooth structure. The second part of the series will focus on restorative options and root-treated teeth. The third, and final, part of the series will provide an overview of the previous papers and conclude with a case report.
CPD/Clinical Relevance: Failure of amalgam restorations is a commonly encountered clinical problem in general practice and no one case presents in the same way. A competent diagnosis regarding the occlusion and tooth structure, followed with implementation of the most appropriate, minimally invasive treatment option, requires an adequate knowledge of current literature.
Article
Amalgam has served as an excellent and versatile dental restoration for over 100 years. Traditional preparation designs were initially proposed by GV Black in the mid-nineteenth century. Furthermore, the serial replacement of restorations by ever larger and more complex restorations, termed the ‘restorative cycle’, has made it common practice to see large amalgam restorations still functioning. However, no restorative solution is eternal and the clinician must be able to detect the early signs of failure before irreversible damage occurs. When a patient does present with a sudden onset of symptoms, the nature of the problem may elude the unsuspecting dentist. A successful outcome can be further complicated when numerous, heavily restored teeth are present on the same arch. It is vital that the clinician is aware of the differential diagnoses in order to avoid unnecessary and overly invasive treatment options which are condemned to failure because the underlying cause(s) was(were) overlooked.
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