Amalgam Restorations Research Articles

Amalgam phase down: baseline data preceding implementation in Nigeria

The Minimata Convention on mercury includes amalgam phase-down and eventual phase-out from dentistry. To aid its subsequent evaluation it is important to have baseline data of amalgam use in a locality prior to implementing a phase-down. Records of patients spanning 5years from January 2011 to January 2016 were analysed to determine and the compare frequency of amalgam usage with other dental materials for carious teeth restorations in a Nigerian university teaching hospital. Classes of cavities restored and cadres of operators who employed the different materials were included. Institutional ethics committee approval was obtained prior to commencing the study. 2,058 patients' records were retrieved, 59% females and 41% males. Their ages ranged 19-80years, mean 33.5±12.7years, young adults 20-39years old were the majority (62.9%). Filling materials included 57.5% amalgam, 17.6% glass ionomer cement (GIC) and 24.9% resin composite. Class I restorations constituted 70.5% of amalgam restorations, while Class II restorations made up 29.4% and Class V restorations accounted for 0.1%. Undergraduate dental students placed most of the amalgam restorations (60.5%), and 78.9% of all their restorations were amalgam. Less experienced dentists used all materials equally; the more experienced dentists placed more composite resin and GIC (43.3%). Amalgam fillings constituted nearly 60% of the restorations of carious teeth. Training of dental students in placement of non-mercury alternatives to amalgam and Minimum Intervention Dentistry needs to be emphasized in dental schools. Phase-down of amalgam should be intensified in Nigeria with the ultimate aim of a phase-out in line with the Minamata Convention.

Dental implant placement is a possible risk factor for the development of multiple cracks in non-endodontically treated teeth

The objective of this study was to evaluate potential risk factors, including the placement of dental implants, for the development of tooth cracks. A series of 212-patients, who were referred for endodontic treatment, were retrospectively screened, of which 72 (34%) patients had been diagnosed with 80-cracked teeth confirmed with an operating microscope. These patients had an average age of 53-years and were equally distributed between genders. Forty-one percent of the cracked teeth were diagnosed after the placement of dental implants, with an average of 3-implants per patient. Seventy percent of the cracks were diagnosed more than 1-year after implant loading. Implant placement was associated with higher odds of having multiple cracks (OR = 9.78, CI:2.320, 41.216)(p < 0.05). The proportion of cracked premolars was relatively high (30%), and most cracked teeth (79%) were vital and with a normal periapical diagnosis (86%). Most cracked teeth (71%) had an amalgam restoration, and teeth restored with amalgam were at a higher risk of having multiple cracks (p < 0.05). Clinicians should be aware of a common profile of endodontic patients with multiple cracks in a non-endodontically treated premolar, restored with an amalgam restoration, which was diagnosed with the cracks more than 1-year after reconstruction utilizing multiple implants.

Comparison of In Vitro Dose Perturbation Effects of Amalgam, Composite Resin, Glass Ionomer Cement and Ketac Silver During Head and Neck Radiation with Photon Beam

The most common oral manifestation from head and neck radiotherapy is mucositis. A part of complications is backscattering from metallic dental materials in radiation field, resulting in a dosage enhancement at the tissue-metal interface. The proper management of the patient’s restorative materials must be performed preoperatively to reduce these complications. This research compared the relative dose enhancement (RDE) in the different restorative materials (Amalgam, Composite resin, Glass ionomer cement and Ketac Silver®), the different tooth preparations (Class I, Class I other, Class II MOD, Cusp Tipping and Core build-up) and the location of ionizing chamber (buccal, occlusal, lingual surface). The dimension of controlled 20 teeth are as followed lower third molar, buccolingual width (10.41±0.82mm), mesiodistal width (11.28±0.72mm), dentin and enamel buccolingual width (1.5±0.5mm). The experiment is set using a modular radiation beam analyzer with at least 2 cm water as soft tissue equivalent material, 3 times irradiated with LINAC 6MV 200MU. The backscattering occurred in the amalgam filled tooth at the buccal and occlusal aspect in every preparation. The highest RDE occurring at the buccal aspect of cusp tipping amalgam filled tooth was 2.7%. In the lingual aspect, every preparation of amalgam filled tooth demonstrated lower RDE. The composite resin and glass ionomer cement produced low backscattering, while Ketac Silver® produced higher RDE. For any amalgam restorations in the radiation field, we recommended using the one-layer glass ionomer technique, which is suitable in preparing patient ahead of head and neck radiation. The recommended filling technique may decrease mucositis the adjacent area and improve the patient’s quality of life.

Microtensile Bond Strength Evaluation of Composite Resin to Discolored Dentin After Amalgam Removal

BackgroundTo obtain prolonged clinical success with composite restorations, better bonding of resin to the tooth substrate is crucial.AimThe study was aimed to evaluate the microtensile bond strength (µTBS) of bulk-fill composite resin restorations when bonded to a cavity previously restored with amalgam, comparing with that of freshly prepared dentin.Materials and methodMesio-occlusal cavity preparations were done on 80 extracted human mandibular molars with a buccolingual width of 4 mm and a 1.5 mm axial depth by placing the gingival seat 0.5 mm coronal to the cementoenamel junction (CEJ) and were restored with fine-grain amalgam alloy. After thermocycling, the amalgam restorations were removed. Disto-occlusal cavities with similar dimensions of mesial cavities were prepared, and both the proximal surfaces were filled with bulk-fill composite using either etch-and-rinse or self-etch adhesives. Following thermomechanical cyclic loading, all the teeth were sectioned for µTBS testing. Bond strength data expressed in megapascals (MPa) were subjected to statistical analyses using analysis of variance (ANOVA) and Tukey’s multiple post-hoc tests.ResultsThe total-etch adhesive exhibited statistically higher bond strength values to both dentin substrates compared to self-etch adhesives (p<0.05). Failure mode analysis reported more of adhesive failures.ConclusionThe µTBS of bulk-fill composite resin restorations bonded to a cavity previously restored with amalgam was significantly lower than that of freshly prepared dentin. Total-etch adhesives bond strength was higher than self-etch adhesives to both the substrates tested.

Choice Between Composite and Amalgam Restorations According to Dentists and Patients Perception

Choice Between Composite and Amalgam Restorations According to Dentists and Patients Perception

Exposure to mercury from dental amalgam: actual contribution for risk assessment.

Mercury dental amalgam restorations are an important source of chronic exposure to mercury in the whole population and special attention should be paid not only to occupational exposure to mercury during the preparation and administration of amalgam. The authors' report is an up-to-date contribution to the health risk assessment of mercury use in dentistry, namely occupational exposure to mercury in dentists working with dental amalgam and exposure to mercury in persons treated with amalgam dental restorations. Determination of total mercury in samples of biological material (urine, hair) was performed during 2017 and 2018 in 50 persons by the AAS method using the mercury vapour generation technique at 254.6 nm. Current dental exposures based on the most recent findings do not exceed acceptable risk levels and are below the biological limit of mercury in urine valid for occupationally exposed persons (100 μg.g-1 of creatinine), namely median value was 1.48 (min. < limit of detection (LOD), max. 17.14) μg.g-1 of creatinine (40 persons), total mercury content in hair of dental personnel expressed as median value was 0.340 (min. 0.060, max.1.628) μg.g-1. In controls (10 persons) was total mercury content in urine expressed as median value 0.36 (min. < LOD, max. 2.74) μg.g-1 of creatinine, in hair was median value 0.224 (min. 0.059, max. 0.453) μg.g-1. Authors support opinion that amalgam fillings in the oral cavity are a permanent source of mercury for the body itself.

Macroscopic and microscopic effects of elevated temperatures on unrestored and restored teeth: An in-vitro forensic study

Background: The present “in vitro” study was done to observe the effects of high temperatures on teeth restored with different restorative materials and unrestored teeth.&#x0D; Aim and Objective: This study aims to investigate the nature of damage to unrestored and restored teeth subjected to high temperatures. The main objective of the study is to assess whether it could serve as an aid in identification of human dental remains in forensic odontology for cases of incineration by means of comparison between ante-mortem and post-mortem records.&#x0D; Materials and Methods: The present study was conducted on 125 extracted premolar teeth which were later on divided into five groups (25 premolar teeth each) as control group, group of teeth restored with class I amalgam restorations, group of teeth restored with class I composite/adhesive system restorations, group of teeth restored with glass ionomer restoration and group of teeth restored with metal ceramic crown restored teeth. The restored teeth were placed in a furnace and heated at a rate of 10°C/min. The effects of the predetermined 200°C, 400°C, 600°C, 800°C, 1000°C and 1200°C temperatures were examined macroscopically and then microscopically by means of a stereomicroscope. Data obtained in the present study was subjected to the statistical analysis using SPSS 18 software for one-way ANOVA andindependent t-test (paired).&#x0D; Result: The class I restorations made of amalgam could be identified till 1200°C because they maintain their shape despite the disintegration of the crowns along with PFM restoration with disintegration of remaining restorations along with tooth. Systematic approach toward the preservation of charred dentition, as at times could prove to be the best evidence for identification of those who are extensively burned.&#x0D; Conclusion: Pre-planned and systematic approach toward the preservation of charred dentition is important as at times it could act as a potential evidence for the identification of those who are severely burnt.

Amalgam and Composite Use among Dentists and Dental Interns in Saudi Arabia

Aim: The aim of this study was to detect the use of amalgam versus resin composite restorations placed in permanent posterior vital teeth among dentists practicing in Saudi Arabia and dental interns training in Saudi Arabia.&#x0D; Materials and Methods: 318 patients aged ≥ 8 years were randomly selected and clinically examined for amalgam and resin composite restorations placed in permanent posterior vital teeth by dentists and by dental interns in Saudi Arabia. The restorations were placed in teeth preparations Class I and Class II. Also, bitewing and or periapical radiographs were used to define the depth of the cavity. The data obtained were documented in a patient examination form then statistically analyzed using Chi-Square Test or Fisher-Freeman-Halton Test and Spearman’s Correlation Coefficient.&#x0D; Results: Composite was the predominant kind of restoration placed by dental interns, and dentists placed more composite restorations than amalgam ones. There was an insignificant relationship between the kind of restoration placed by dental interns (amalgam, composite) and the tooth type (maxillary / mandibular premolar, maxillary / mandibular molar), the class of tooth preparation, the cavity depth, the age of the patient, and the gender of the patient p&gt; 0.05. However, there was a significant relationship between the kind of restoration placed by dentists (amalgam, composite) and the cavity depth p &lt; 0.05. Also, dentists placed more composite restorations in maxillary first premolars and in young patients 8-29 years, while they placed more amalgam restorations in mandibular second molars and in older patients 41-50 years p &lt; 0.05. There was an insignificant relationship between the kind of restoration placed by dentists (amalgam, composite) and the class of cavity preparation and the gender of the patient p &gt; 0.05.&#x0D; Conclusion: Both dentists and dental interns used composite restorative material more than amalgam, but dentists placed more amalgam restorations than dental interns. Dental interns mainly used composite.&#x0D; Keywords: Amalgam, Composite, Class, Dentist, Depth, Intern, Type.

Type and time of first re-intervention of posterior restorations – 13-year scenario at the public dental service

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention.Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25–30 years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n = 2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention.Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7 years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions.Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.

Restorasi Endocrown Gigi Molar Pertama Rahang Atas Pasca Perawatan Endodontik (Laporan Kasus)

Background: Restoration after endodontic treatment is still a challenge that must be performed by doctors in daily practice. The gold standard treatment for this case is post-core crown. However, this aggressive preparation for post-core crown does not in line with the minimally invasive concept in modern dentistry. Objective: To restore the function and aesthetic of maxillary first molars after endodontic treatment using Endocrown. Case: A 54-year-old male patient came to the clinic with a broken amalgam restoration on the first right upper molar since 3 months ago. The restoration was felt sharp thus iritate the tongue. On clinical and radiographic examination, an old amalgam restoration was seen on the occlusal surface and had reached the pulp. At the first visit, one visit endodontic was done with warm vertical condensation technique. Gutta-percha masterpoint was cut until ⅓ apical was filled and at ⅓ middle and ⅓ coronal the root canal was filled with injectable thermoplastized gutta-percha which is compacted until 2 mm below the orifice. On the next visit, gutta percha was cut as much as 2 mm and filled with core material as intraradicular retention as deep as 4 mm. Preparation is made by the butt-joint equigingival margin around the surface with a retention cavity in the middle of the pulp chamber. After the completion of tooth preparation, the impression was made with polyvinyl siloxane silicone. At the third visit, endocrown was tested to check the marginal fit and accuracy, then cemented using resin cement, and checked using radiography. Conclusion: Endocrown can serve as an alternative restoration which is conservative, have good aesthetic, functional, and minimally invasive.

EFFECT OF WI-FI RADIATIONS ON AMALGAM RESTORATIONS IN CLASS V CAVITIES USING ICP-OES-AN IN VITRO STUDY

Context: This study has been conducted to study the effect of wifi radiations on amalgam restorations. Aims: To evaluate the release of mercury from class V cavities in presence of Wi-Fi radiations. Methods

Association between Dental Amalgam Filling and Essential Tremor: A Nationwide Population-Based Case Control Study in Taiwan.

Essential tremor (ET) is a common neurological disorder and the most common movement disorder. Low-level occupational exposure to mercury vapor is known to be a crucial factor that increases the risk of tremor. Dental amalgam is one of the main sources of mercury in those who possess amalgam restorations. However, the relationship between ET and amalgam filling (AMF) is not quite clear. The purpose of this study was to investigate the association between AMF and the risk of ET using a population-based administrative databank. The data for this study were sourced from the Taiwanese National Health Insurance Research Database (NHIRD). A retrospective case-control study was conducted using this databank from 2000 to 2013. Case and control groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index using the propensity score method with a 1:1 ratio. In this study, 3008 cases and 3008 controls were included. The results from this nationwide population-based case-control study did not indicate any association between ET and AMF in Taiwan. Although the results were not significantly statistical, the findings may be worthy to be valued.

Khat Chewing Induces a Floral Shift in Dental Material-Associated Microbiota: A Preliminary Study.

BackgroundThe habit of khat (Catha Edulis Forskal) chewing is widely practiced in the southern regions of Saudi Arabia, Yemen, and East Africa. This social habit has tremendous effects on oral and general health of khat chewers. Khat may affect bacterial species in plaque biofilms on oral rehabilitation materials. This preliminary case-controlled study aimed to assess and compare the effect of khat chewing on bacterial biodiversity between non-khat chewers (NKC) and khat chewers (KC) in oral biofilms on oral rehabilitation materials using polymerase chain reaction (PCR).Material/MethodsFifty participants were organized into 2 equal groups of NKC and KC, each containing 5 subgroups related to filling material type. Some participants had amalgam (A) or composite (C) restorations, while others had feldspathic porcelain (FP), nickel chromium (NC), and zirconia ceramic (ZC) crowns or bridges. Oral biofilm samples were collected from all participants, DNA was extracted, and samples were subjected to PCR. Bacterial species were then identified and counted. PCR products were sequenced to detect similarity. Partial 16S rRNA gene sequences of the current study samples were compared with 16S rRNA gene sequences from GenBank using BLAST on the National Center for Biotechnology Information website.ResultsThe Streptococcus sp. was the most common bacterial species among our participants (40; 80%), followed by Lactobacillus and Veillonella spp., accounting for 12% (6) and 8% (4), respectively. Streptococcus sp. was observed equally among NKC and KC, but Lactobacillus and Veillonella spp. were higher in KC and NKC, respectively. Lactobacillus was associated mainly with prosthetic materials, and Streptococcus was found among all examined dental restorative materials.ConclusionsThis research concluded that khat chewing significantly affects bacterial biodiversity in oral biofilms in the presence of different restorative and prosthetic dental materials.

Patient satisfaction towards composite and amalgam restorations in IIUM dental polyclinic

Background: Dentistry continues to evolve with the development of restorative materials. Patient satisfaction is an increasingly significant issue in dental practice; therefore, knowledge of the level of patient satisfaction with restorative materials is important. Objectives: The objective was to assess patient satisfaction with composite and amalgam restorations carried out by International Islamic University Malaysia (IIUM) dental students and the criteria that influence satisfaction. Methods: This cross-sectional study involved 42 patients treated by year 4 and 5 dental students of the Kulliyyah of Dentistry, IIUM. Sampling was conducted using a single proportion formula, and patients were reviewed 2 weeks following placement of amalgam and composite restorations. Satisfaction was assessed using a self-administered five-point Likert scale questionnaire previously validated by a pilot study involving ten patients. Data were analyzed using independent sample t-tests and the Chi-square tests. Results: Patients were more satisfied with composite restorations than with amalgam restorations in terms of color and esthetics (P < 0.001). Other criteria, such as operator skills, treatment procedures, and external factors, had no significant effect on patient satisfaction with the restoration (P > 0.05). Overall, patient satisfaction with amalgam (81.0%) and composite restoration (88.1%) did not differ when restorations were placed by IIUM dental students. Conclusion: Most patients were satisfied with the amalgam and composite restorations placed by IIUM dental students. The color and esthetic value were the major criteria affecting patient satisfaction. Treatment procedures, operator skills, and external factors did not significantly influence patient satisfaction. Hence, in terms of satisfaction, amalgam remains a reliable material for use in restorative dentistry.

Mercury Loss From Dental Amalgam Fillings

Objective: To compare the amount of mercury in new and old dental amalgam restorations. Material and Methods: This study analyzed twenty samples of dental amalgam restorations, dividing into two groups. Group 1 consisted of samples of new dental amalgam restoration (n=10) and group 2 consisted of samples of old dental amalgam restoration (5-years old) (n=10). In each group, the mercury involved in the dental amalgam restoration was calculated using the cloud point extraction (CPE) method. The new dental amalgam restorations are taken from the patients' mouth after condensation and analyzed directly after setting. The old dental amalgam restorations are removed from the patients' mouth, after 5 years of use by the patients, and then they are analyzed. The independent-samples t-test was used to analyze the differences (p<0.05) . Results: For new amalgam restorations, the mean of mercury was 0.1281 μ g/mL, while for old restorations it was 0.1029 μ g/mL. There was a significant difference between the new and old amalgam restorations in the amount of mercury available (p<0.001) . Conclusion: There is a significant loss of mercury over a five years period in the patient mouth.

Assessment of Influence of Polishing on The Quality of Class 1 Amalgam Restoration - A Retrospective Analysis

The advent of various restorative materials in dental practice has given the operator dilemma on which material to be used for various case scenarios. Out of the different restorations materials, amalgam and composites have shown increased usage with amalgam being used almost 150 years. Polishibility after restorations play a crucial role in its long-term success and shows better adaptation of the prepared tooth structure. The aim of this study was to assess the influence of polishing on the quality of Class 1 amalgam restoration by a retrospective analysis in an institutional setup. The assessment was done by a retrospective evaluation using electronic dental records from the time period June 2019 to April 2020. Grading of these restorations were carried out by using FDI criteria for direct restorations in which class 1 pre-polish amalgam restoration and post-polish amalgam restoration was assessed pictorially by 2 reviewers. The assessment showed statistically significant differences between preoperative/postoperative surface luster quality (p=0.000), preoperative/postoperative surface marginal staining (p=0.000), preoperative/postoperative anatomical form quality (p=0.002), preoperative/postoperative material retention and fracture assistance (p=0.006). The marginal adaptation quality was not altered by polishing(p=0.617). From the overall parameters assessed, quality of the restoration post polishing was seen considerably better when compared to pre polished amalgam restoration. Polishing of amalgam restoration is deemed necessity, providing better strength and prognosis for the restoration

Histological Evaluation of Periapical Tissues after Root Canal Treatment with or without Coronal Seal in Dogs for Six Months.

Preventing recontamination of the obturated root canal is important for successful root canal treatment (RCT). The main purpose of this study was assessing the histological health of periradicular tissue in obturated root canals with or without coronal seal between two and six months. Sixty roots from five dogs with vital pulps were randomly assigned to one of the following five groups (n=12): Group 1, RCT and six months oral exposure; Group 2, RCT and immediate amalgam restoration; Group 3, RCT and amalgam restoration after two months exposure to the oral cavity; Group 4, RCT and amalgam restoration after four months exposure to the oral cavity; Group 5, RCT with two months exposure to oral cavity. The teeth were prepared and filled with gutta-percha and sealer using lateral condensation technique. Two intact root canals of each animal were regarded as the negative control group (n=10), and the two root canals exposed to the oral cavity constituted the positive one (n=10). After six months the animals were euthanized. The upper and lower jaws were removed and submitted for histological processing. Longitudinal sections were obtained from each root. After staining the sections, periradicular regions were examined histologically under light microscope. The Kruskal-Wallis and Mann-Whitney tests was used to analyze the data (P<0.05). The results showed a significant difference between all groups (P<0.05). The negative control group was free of any inflammation. Two-by-two comparison revealed that the positive control group, Group 1 and Group 4 displayed the most intense inflammation. Groups 2, 3 and 5 showed similar results without developing any significant inflammation. Based upon the findings of this animal study, it can be recommended that the obturated root canals which are exposed to oral cavity for around four months or more should be retreated before crown restoration.

Qualitative and quantitative analysis of Mercury ions on the surface of amalgam restorations after home bleaching

ABSTRACT Objective The bleaching agents may interact with restorative materials, such as dental amalgam, providing an increase mercury ions (Hg) release, whose toxic effect is known. Whereas many patients have amalgam restorations (AR) and seek bleaching treatments, the present study aimed to evaluate in vitro the amount of Hg released from AR made with spherical alloy, after being subjected to different concentrations of carbamide peroxide (CP) for home bleaching. Methods 40 class I AR were prepared in bovine teeth. Afterthe restoration, the samples were randomly allocated into 4 groups (n = 10): C (control group), CP10 (CP 10%) CP15 (CP 15%) CP20 (CP 20%) and its treatments were simulated for 14 days for 6 hours daily. The Hg ions released was measured by energy dispersive X-ray spectroscopy (EDS) and surface changes were assessed in the Scanning Electron Microscope (SEM). Hg levels (percent mass) were recorded and the differences were statistically analyzed using the Kruskal-Wallis test and Dunn’s “Post hoc” test. Results Statisticalanalysis showed the bleaching treatment resulted in a higher Hg release (p &lt;0.05), although no visible changes were identified in micrographs when comparing the control group with the other groups (CP10, CP15, CP20). Conclusion Increased Hg release may be observed during simulated home bleaching.

Contact lichenoid reaction secondary to cast metal and amalgam restorations

Hypersensitivity reactions to dental restorative materials such as metals and amalgam may induce localized lesions in oral tissues contacting the restoration, usually manifested as lichenoid reactions. It is important to recognize and diagnose the lesion and etiology and further provide a suitable alternative restorative option for the patient. This article describes a case report of lichenoid reaction secondary to cast metal and amalgam restorations and sequential management of the same.

Restorative Direct Management of Cavitated Proximal Carious Lesions of Permanent Molars using Elastic Separators in Children and Adolescents

Purpose: The purpose of this study was to assess the longevity of direct amalgam and composite restorations placed on the mesial surface of permanent molars after separation with elastic separators. Design: One hundred and seventy seven (177) restorations placed on the mesial surfaces of first and second permanent molars in 140 patients aged 10-25 years-old (median age 12.2 years) were followed for a period of 1 to 12 years (median time 4.3 years). Eighty four (84) amalgam and 93 composite resin restorations were placed randomly on carious lesions that were detected by bite-wing x-rays at the dentino-enamel junction and verified as cavitated after tooth separation. Restorations were evaluated clinically according to the modified Ryge criteria. Flexible parametric proportional-hazards and proportional-odds models for censored survival data was used to analyze the data, with application to prognostic modelling and estimation of treatment effects at 95% CI. Results: Of the 177 restorations, 13 (7.2%) failed in a median time to failure of 8.8 years. There was no statistically significant difference on the cumulative median time to failures between amalgam and composite while statistically significant difference was found between patients that were using fluoride mouthrinse or not (p<0.048) and if there was bleeding detected at the interproximal area of the restoration or not (p<0.001). Conclusions: Restorative management of cavitated proximal carious surfaces of permanent teeth with amalgam or composite resin, using elastic separators, seems to be a very good and promising alternative technique in the context of the minimal invasive dentistry in children and adolescents.