The phase down of amalgam fillings - what you need to know!

In 2017 the European Parliament introduced legislation that will see a gradual phase down in the use of dental amalgam. How will this impact on UK dentistry and what are some of the alternatives?

Dental amalgam has been used in dentistry for over 150 years and remains a durable, safe and cost-effective solution for dental restorations. However, dental amalgam is a combination of metals including up to 50% liquid mercury and there has been increasing global concern about the implications caused by mercury being released into the environment resulting in numerous regulations surrounding the use of mercury and dental amalgam.

The most significant regulation to date came in March 2017 when the European Parliament agreed to the final version of its Regulation on Mercury, the EU’s method of ratifying the 2013 Minamata Treaty, a global environmental agreement aimed at reducing the release of mercury into the environment.

It’s important to note that this Regulation does not ban the use of amalgam outright as it is specifically an environmental, not a health regulation. However, its implementation has seen a series of requirements aimed at reducing and phasing out the use of amalgam in dentistry, potentially by 2030.

The first stage that will have a significant impact on UK dentistry comes into force on the 1st July 2018 when dental professionals will no longer be able to use amalgam in the treatment of deciduous teeth, children under 15 years and pregnant or breastfeeding women, except when deemed strictly necessary on the grounds of specific medical needs of the patient. This alone will affect the treatment of over 12 million women and children, a significant amount of the population for whom a safe alternative to amalgam needs to be found.

Finding the alternatives
Mercury-free restorative materials are nothing new and a wide variety of materials have been developed to meet all needs, including glass ionomers which can offer many advantages over amalgam:

• Reduced environmental impact: glass ionomers are mercury-free with no evidence of environmental toxicity and are therefore considered a safe alternative to amalgam(i).
• Minimally invasive: glass ionomers help to preserve and strengthen tooth structure. They do not damage healthy tissue, weaken tooth structure or fracture teeth(ii) .
• Caries prevention: glass ionomers gradually release fluoride and chemically bond to the tooth structure which can help to prevent tooth decay(iii).
• Faster placement: glass ionomers can be placed up to five minutes faster than amalgam - saving valuable time(iv).
• Low failure rate: glass ionomers have a low mean annual failure rate of 4.2% when compared with 7.6% for amalgam(v).

Going mercury-free
There is now a variety of extremely strong, mercury-free glass ionomer restoratives. riva self cure HV (SDI) is an ideal self-curing conventional glass ionomer restorative for minimally invasive dentistry, bulk fill and radiopacity. With excellent tooth adhesion and fluoride release, it can withstand high penetration of the surface and, because it does not contain resin, eliminates the problem of volumetric shrinkage after curing.

riva light cure (SDI) is a radiopaque, resin-reinforced glass ionomer restorative that chemically bonds to the tooth structure while offering the aesthetics of a composite. With excellent tooth adhesion, sustained fluoride release, high compressive strength and command set it can be used for a wide range of restorative applications, preventing long-term microleakage.

The end for mercury
The phasing-down of the use of amalgam will have a significant impact on the practise of dentistry in the UK, considering how long it has been and continues to be used as a restorative material. With a move towards more patient-centred, minimally invasive and preventative dentistry, based on the use of tooth-coloured restorative systems, finding suitable mercury-free aesthetic alternatives to amalgam that are fast to place, cost-effective and long-lasting, is key.

SDI offers a range of professional restorative solutions to meet all your patients’ needs. Click here to see the range.

(i) World Alliance for Mercury-Free Dentistry. Mercury-free alternatives (Accessed 30/11/17)
(ii) World Alliance for Mercury-Free Dentistry. Mercury-free alternatives (Accessed 30/11/17)
(iii) World Alliance for Mercury-Free Dentistry. Mercury-free alternatives (Accessed 30/11/17)
(iv) Centre for Policy Studies (University College Cork, National University of Ireland). Cost-effectiveness of ART Restorations in Elderly Adults: A Randomized Clinical Trial (Accessed 30/11/17)
(v) Environmental European Bureau (EEB), 2016. Technical Advantages of Mercury-Free Dentistry (Accessed 30/11/17)