The use of amalgam in pediatric dentistry: new insights and reappraising the tradition.

The debate on amalgam led to its being phased out in some countries. Results of clinical trials report failure rates of amalgams ranging from 12 percent to over 70 percent. Treatment of caries should meet the needs of each particular patient, based on his/her caries risk. In general, for small occlusal lesions, a conservative preventive resin restoration would be more appropriate than the classic Class I amalgam preparation. For proximal lesions, amalgam would be indicated for two-surface Class II preparations that do not extend beyond the line angles of primary teeth. This recommendation might not be appropriate for high-risk patients or restoring primary first molars in children four years old and younger where stainless steel crowns have demonstrated better longevity. Currently, amalgam demonstrates the best clinical success for Class II restorations that extend beyond the proximal line angles of permanent molars. The need to reduce the use of amalgam as a mercury-containing material is inevitable when aiming to reduce environmental contamination. It is important always to praise prevention and constantly search for biologically safe materials regarding health, clinical work, and environment. The purpose of this report was to summarize several factors that affect the effectiveness, advantages, and disadvantages of using dental amalgam in primary teeth.