Roulet J F
Department of Operative Dentistry, Preventive Dentistry and Endodontics, School of Dental Medicine, Humboldt University Berlin, Charité, Germany.
J Dent. 1997 Nov;25(6):459-73. doi: 10.1016/s0300-5712(96)00066-8.
To give the practising dentist scientifically based data to assist him/her in the responsible decision-making process necessary to weigh the options available to the patient if she/he prefers not to have an amalgam placed.
Based on the literature and on the research work, which was done in the author's department, the indications and limitations of the known alternatives of amalgam were formulated. DESCRIPTION OF ALTERNATIVES TO AMALGAM: With the exception of cast gold restorations, all alternatives require the strict use of adhesive techniques. When compared with similar amalgam restorations, placing composite restorations (if they are indicated) takes approximately 2.5 times longer because complex incremental techniques are needed. Despite all the efforts, direct composite restorations placed in large cavities still show unacceptable amounts of marginal openings. Tooth-coloured inlays are a better alternative for large restorations. These restorations must be inserted with adhesive techniques. With composite inlays it is difficult to achieve a composite-composite bond. Ceramic inlays may be micromechanically bonded to the luting composite. They all show clinically a good marginal behaviour and the use of ultrasonic energy may further simplify the application technique of aesthetic inlays.
Papers describing the different techniques were used as a base for the corresponding chapter. To assess and compare the longevity of the different restoration types, literature data were used. We limited ourselves to papers reporting at least 5-year clinical data. Longitudinal, clinically controlled studies were preferred. However, to be more complete, retrospective, cross sectional studies were also included. LONGEVITY OF POSTERIOR RESTORATIONS: Amalgam shows excellent longevity data with studies up to 20 years. The average annual failure rate is 0.3-6.9%. Posterior composites are in the same range (0.5-6.6%), however, the study times are much shorter (max. 10 years). For tooth-coloured inlays much less data are available. Longevity is reported up to 6 years with annual failure rates of 0.6-5%.
All aesthetic alternatives to amalgam require more complex procedures and more time. If cost benefit considerations are a concern, amalgam is still the most convenient restorative material for posterior teeth.
为执业牙医提供基于科学的数据，以帮助其在患者不愿使用汞合金时，在权衡患者可用选择的必要责任决策过程中提供协助。
基于文献以及作者所在科室开展的研究工作，阐述了已知汞合金替代材料的适应证和局限性。
除铸造金修复体外，所有替代材料都需要严格使用粘结技术。与类似的汞合金修复体相比，放置复合树脂修复体（如果适用）所需时间大约长2.5倍，因为需要复杂的分层技术。尽管付出了所有努力，但在大窝洞中放置的直接复合树脂修复体仍显示出不可接受的边缘缝隙量。牙齿颜色的嵌体是大型修复体的更好选择。这些修复体必须采用粘结技术插入。对于复合树脂嵌体，很难实现复合树脂与复合树脂之间的粘结。陶瓷嵌体可通过微机械方式粘结到粘结性复合树脂上。它们在临床上均表现出良好的边缘性能，并且使用超声能量可能会进一步简化美观嵌体的应用技术。
描述不同技术的论文用作相应章节的基础。为了评估和比较不同修复类型的使用寿命，使用了文献数据。我们将自己局限于报告至少5年临床数据的论文。纵向、临床对照研究更佳。然而，为了更全面，也纳入了回顾性横断面研究。
汞合金在长达20年的研究中显示出出色的使用寿命数据。平均年失败率为0.3 - 6.9%。后牙复合树脂修复体处于相同范围（0.5 - 6.6%），然而，研究时间要短得多（最长10年）。关于牙齿颜色嵌体的数据要少得多。报告的使用寿命长达6年，年失败率为0.6 - 5%。
汞合金的所有美观替代材料都需要更复杂的操作和更多时间。如果考虑成本效益，汞合金仍然是后牙最方便的修复材料。
