CDA Essentials 2018 • Volume 5 • Issue 5

21 Issue 5 | 2018 | N ews and E vents CADTH researchers looked for the best available evidence and found that amalgam restorations, in comparison to composite resin, appear to be “more clinically efficacious and as safe, while also costing less.” They also found that the environmental impact of mercury contamination from dental amalgam waste is relatively small, compared to other sources. The key findings of the CADTH report are: ❙  Dental restorations with dental amalgam last longer and cost less compared with restorations with composite resins. ❙  The evidence shows no clinically important differences in the safety of amalgam compared with composite resin dental restorations. ❙  Whereas the environmental impact of the release of mercury from dental amalgam in Canada is small, the environmental impact of chemicals included in composite resin materials is not known. ❙  Shared decision-making between dental providers and patients is encouraged to address the use of optimal dental material for a given situation. Dr. Benoit Soucy, CDA director of clinical and scientific affairs and an external reviewer of the CADTH report, says that the use of dental amalgam in Canada has been going down for a number of years, in part, because patients have concerns about the impact of amalgam on their health or the environment, or because they prefer tooth-coloured restorations. He notes that patients sometimes request composites, even in posterior teeth, without fully understanding the treatment options or potential risk associated with the available options. Given the many factors that can influence both clinician and patient preference for a dental restoration material, it made sense to compare the two most commonly used dental restoration materials using a health technology assessment (HTA), says Mr. Chris Kamel, CADTH director of HTA & Rapid Response for Medical Devices. “An HTA is an attempt to examine both the intended and unintended effects of a technology,” he explains. “One of the strengths of this HTA was that we looked particularly at studies that directly compared amalgam and composite resin restorations; from our perspective, that’s the best way to evaluate which material is preferred, performs better, and has a better safety profile.” Dentists consulted by CADTH noted that patient profile and clinical indications influence their choice of restoration material. For example, amalgam may be a more suitable option for patients with special needs or seniors with poor oral hygiene practices, when there is a higher risk of restoration failure, and when esthetic considerations are not a concern. Amalgam also COMPOSITE RESIN vs. AMALGAM RESTORATIONS The Canadian Agency for Drugs and Technologies inHealth (CADTH) has published a comprehensive report comparing amalgam and composite resin restorations according to clinical efficacy and safety, environmental risks, implementation barriers and other factors. 1 The bottom line is that dentists should use the most appropriate material for the individual patient, in consultation with the patient. – Dr. Benoit Soucy