Current status of composite vs. amalgam restorations practice among dental surgeons: percentage, preparation guidelines and causes

Objectives: Mercury is considered a global threat to humans and environmental health.
Mercury is recognized as a substance producing significant adverse neurological and other health effects, with particular concerns expressed about its harmful effects on unborn children and infants. Apart of the environmental problem, dental clinicians are exposed to mercury vapors, during dental procedures with amalgam. There are dental schools in the world, which ceased teaching amalgam restorations. In order to learn the patterns of amalgam usage on the way to implementation of amalgam-free dentistry, some questions must be asked: What is the pattern of current use of amalgam vs. mercury-free dental restorative materials in Israel (universities, private practices, health maintenance organizations)?
Which would be the considerations for selecting a restoration material?
And more.
Methods: A Questionnaire was designed in order to assess the usage of composite materials, amalgam restorations and the preference of Israeli dentists, according to the research goals presented above. The questionnaires were circulated in the local dental schools, at professional meetings and in private and public practices.
Results: 162 practitioners answered the questionnaires.
95% were introduced to non-amalgam restorations in university.
63% are general practitioners
73% use composite restorations for minimal occlusal cavities
45% use composite restorations for deeper occlusal cavities
51% use amalgam for minimal proximal cavities
71% use amalgam for deeper proximal cavities
46% when using composite, abandoned GV Black preparation rules
Four most important parameters, by which practitioners decide whether they use amalgam or composite, were "residual tooth material", "the ability to control saliva flow", "the position of the tooth in mouth" and "caries activity level".
Conclusions: The usage of amalgam based restorations is very popular in Israel.
Most of recipients prefer not to use composite in deep cavities.
There is not enough complimentary education for non-amalgam materials.
Most of these using more composite than amalgam have specialization of some kind.
The majority of the recipients did not mention biological properties or biocompatibility as an important factor, which influences their decision.