Amalgam alternatives: what can compete?

I have not discussed the full veneer restoration of metals or ceramics. These are costly services-between four and six times amalgam's cost. No clinical evidence supports longevity much greater than amalgam. Full veneer restoration requires significant reduction of tooth structure and may also require a buildup for appropriate retention. A buildup requirement again debates the question of alternative to amalgam. Full cast restorations have not been discussed as legitimate alternatives, though partial veneers would be equivalent to onlay procedures. Full veneer procedures are better suited to significant reconstructions of tooth structure, and only then when there can be some expectation of home care by the patient. Dr. Miles Markley extolled the use of amalgam during his career. He was innovative in creating extremely conservative preparations, and the placement procedures for quality amalgam restorations. He stated: "Amalgam is the standard." All techniques for single tooth restoration, whether esthetic or not, could stand a comparison to this standard. There are materials and techniques that begin to compare well with amalgam. No one material or technique fits all the needs amalgam has fulfilled, but some can begin to compete.