I have some comments on the January JADA cover story ("Clinical Evaluation of Amalgam Bonding in Class I and II Restorations," by David B. Mahler, Ph.D., and John H. Engle, D.D.S.).
The authors conclude that after three years of clinical service, amalgam bonding for "traditional" Class I and Class II restorations had no effect on postoperative sensitivity or marginal integrity.
After bonding amalgam for 10 years with a tremendous reduction in sensitivity, I was surprised. I see the operative word here is "traditional." From the five restorations pictured, I surmise the author’s use of "traditional" to mean conservative. I, therefore, do not dispute the postoperative sensitivity conclusion. However, this is comparable to studying the use of seat belts and air bags in 10-miles-per-hour collisions.
I personally have found a dramatic reduction in postoperative sensitivity. My opinion may be anecdotal, but after 15 years’ experience of not bonding amalgams, I started using adhesive on my deep amalgams, and complaints of postoperative sensitivity have been reduced remarkably.
Whether it is the acid etch or the adhesives I am not certain, but again, postoperative sensitivity is significantly reduced. I have thrown my Dycal away. I do not bond small (traditional) amalgams, as I find Gluma or Micro Prime work well on them.
In addition, the beauty of amalgam bonding is that you do not do "traditional" preparations. The traditional amalgam preparation requires undercuts for retention. Bonding amalgams eliminates the need for mechanical retention. You can prepare teeth as you would for an inlay, remove all undermined enamel and provide almost onlay-type strength to a tooth. How many times have you removed amalgam from a cracked tooth to find amalgam packed under a cusp?
