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Yesterday, a gentleman came to me as a new patient. He had not been to a dentist for two years, but had had extensive work performed in the suburbs. To be precise, he had wanted his amalgam (silver) fillings replaced by esthetic composites because he wanted to improve the appearance. He stated that none of the silver restorations, placed when he was an adolescent, were deemed to be failing functionally, or leaking significantly. In other words, there was no decay present at the time of their replacement.
Clinical examination revealed seven composites, and four remaining silver fillings. There were gray shadows around the margins of several of the composites. Periodontal health very good despite not having prophylaxes for two years.
Radiographic (x-ray) examination revealed significant decay between the teeth at each of the composites, three of which will require the patient to undergo root canal therapy and crowns. Distinct breakdown was occurring at the exact interface between the restorations and the tooth, indicating that there was a breakdown in the bonding at the subgingival level. There were no observations of any decay around the silver restorations.
I would surmise that the practitioner who placed the restorations did not ensure that there was a satisfactory bond and the failure for this is catastrophic. I would tell all who contemplate replacing their silver fillings with these composites to ask the dentist to please monitor these areas carefully with radiographs every six months, despite the radiation dosage. The fact of the matter is that if left unattended, more radiation will be required to diagnose and treat, and repair the affected areas.
What is interesting here is that this is a situation of iatrogenic causation (practitioner-induced), and is going to be more commonplace as more and more composites are placed in a substandard fashion.
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