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Publisher
Jim Glidewell, CDT
Editor-in-Chief and Clinical Editor
Michael C. DiTolla, DDS, FAGD
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Editor’s Letter
It was interesting to read recently that students at NYU
College of Dentistry received a letter from the faculty
informing them that the dental school’s default direct
restorative material was being changed from amalgam
to composite. It’s not that the school has completely
abandoned amalgam — the amalgam technique will still
be taught in preclinical, and dental school patients with
clinically acceptable amalgams will not have to have those
restorations replaced — but new amalgam restorations will
now require justification by faculty for placement. I wonder
how often amalgams will be approved?
A main reason for the faculty’s decision to make composite
the dental school’s default restoration is the material’s ability
to be used as a “caries-specific restoration.” In other words,
the faculty feels that with bonded composite resin, the
students only need to remove the caries and the surrounding
affected dentin before restoring the lesion. This is in contrast
to an amalgam preparation that needs to be a certain depth
for strength, regardless of the depth of the caries. So they
made the decision to conserve as much tooth structure as
possible by going with composite over amalgam.
When you consider that amalgam has been a successful
restorative material for nearly 150 years, some might think
the conservative choice would be utilizing the material with
that amazing track record. In the letter to the students,
the faculty quotes a 12-year study showing that bonded
composite performs as well or better than amalgam over
that time period. It would seem there is more than one way
to define conservatism in dentistry.
At the laboratory, our most popular product is BruxZir ®
Solid Zirconia. While it doesn’t have the track record of
PFMs, it is the most conservative material we have for fullcoverage
crowns — with the exception of full-cast gold.
Considering that many patients are reluctant to have cast
gold placed in their mouths, BruxZir crowns are the only
tooth-colored crowns we offer that can be prepared with
feather-edge margins and milled as thin as 0.6 mm.
I didn’t think I would live to see composite become the
restoration of choice in a dental school, or a time when
a high-strength, cementable all-ceramic restoration like
BruxZir Solid Zirconia would outsell PFMs by a margin of
3-1, but both are here.
Yours in quality dentistry,
Dr. Michael C. DiTolla
Editor-in-Chief, Clinical Editor
mditolla@glidewelldental.com
Editor’s Letter 3