Alternatives to amalgamAlternatives to amalgam include composite resin, glass ionomer, porcelain, and gold, among other options.  Most consumers choose direct composite fillings because the white coloring matches the tooth better and the cost is considered moderate.

In the past, a common argument against composite fillings was that they were not as durable as amalgam. However, recent studies have debunked this claim. Researchers of a study which was published in 2016 and conducted on over 76,000 patients for over ten years found that posterior amalgam fillings had a higher annual failure rate than composites.1Two separate studies published in 2013 found that composite fillings performed as well as amalgam when comparing failure rates2and replacement filling rates.3Other research has offered similar findings: a study published in 2015 documented “good clinical performance” of composite resins over a 30-year evaluation,4a meta-analysis published in 2014 noted “good survival” of posterior resin composite restorations,5a study published in 2012 showed certain types of composite materials last as long as amalgam,6and a study published in 2011 found “good clinical performance” of composites over a 22-year period.7

Composite fillings have also been criticized because some of them contain the controversial material bisphenol-A (BPA). Dentists have a variety of opinions about the safety of BPA and other types of bisphenol, such as Bis-GMA and Bis-DMA. There has likewise been concern about glass ionomers, all of which contain fluoride.

Patients who are concerned about the ingredients in their dental materials often choose to speak with their dentists about using a material that does not contain certain ingredients. For example, a product named Admira Fusion8/Admira Fusion X-tra9released in January 2016 by the dental company VOCO is reported to be ceramic10and not to contain Bis-GMA or BPA before or after it has been cured.

Another option for dental patients concerned about which mercury-free alternative to use as a filling material is to do their own research and/or take a dental biocompatibility test. If biological testing is used, a patient’s blood sample is sent to a laboratory where the serum is evaluated for the presence of IgG and IgM antibodies to the chemical ingredients used in dental products.11 The patient is then provided with a detailed list of which name-brand dental materials are safe for their use and which ones could result in a reaction. Two examples of labs that currently offer this service are Biocomp Laboratories12and Clifford Consulting and Research.13

Also, in regards to dental allergies, Dr. Stejskal introduced the MELISA test in 1994. This is a modified version of the (Lymphocyte Transformation Test) LLT designed to test for metal sensitivity type IV delayed hypersensitivity to metals, including sensitivity to mercury.14

In addition to considering which material to use for dental fillings, it is essential that dental patients and professionals be familiar with and utilize safety measures when removing dental amalgam mercury fillings.


1. Laske Mark, Opdam Niek JM, Bronkhorst Ewald M, Braspenning Joze CC, Huysmans Marie-Charlotte D.N.J.M. Longevity of direct restorations in Dutch dental practices. Descriptive study out of a practice based research network. Journal of Dentistry. 2016. Abstract available from:  Accessed January 12, 2016.

2.  McCracken MS, Gordan VV, Litaker MS, Funkhouser E, Fellows JL, Shamp DG, Qvist V, Meral JS, Gilbert GH. A 24-month evaluation of amalgam and resin-based composite restorations: Findings from The National Dental Practice-Based Research Network. The Journal of the American Dental Association. 2013; 144(6):583-93. Available from:  Accessed December 17, 2015.

3. Laccabue M, Ahlf RL, Simecek JW. Frequency of restoration replacement in posterior teeth for US Navy and Marine Corps personnel. Operative dentistry. 2014; 39(1):43-9.  Abstract available from:  Accessed December 17, 2015.

4. Pallesen U, van Dijken JW. A randomized controlled 30 years follow up of three conventional resin composites in Class II restorations. Dental Materials. 2015; 31(10):1232-44.  Abstract available from:  Accessed December 17, 2015.

5. Opdam NJ, van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, Gaengler P, Lindberg A, Huysmans MC, van Dijken JW. Longevity of Posterior Composite Restorations: A Systematic Review and Meta-analysis. Journal of Dental Research. 2014; 93(10):943-9.  Available from:  Accessed January 18, 2016.

6. Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations—a meta-analysis. J Adhes Dent. 2012; 14(5):407-31. Available from:  Accessed December 17, 2015.

7. Rodolpho PAD, Donassollo TA, Cenci MS, Loguércio AD, Moraes RR, Bronkhorst EM, Opdam NJ, Demarco FF. 22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics. Dental Materials. 2011; 27(10):955-63. Available from:  Accessed January 18, 2016.

8. See Admira Fusion on the VOCO website at  Accessed January 18, 2016.

9. See Admira Fusion X-tra on the VOCO website at  Accessed January 18, 2016

10. See Admira/Admira Fusion X-tra News on VOCO website at  Accessed January 18, 2016.

11. Koral S.  A practical guide to compatibility testing for dental materials. 2015.  Available from the IAOMT Website.  Accessed December 17, 2015.

12. Biocomp Laboratories Website is

13. Clifford Consulting and Research Website is

14. Stejskal VD, Cederbrant K, Lindvall A, Forsbeck M. MELISA—an in vitro tool for the study of metal allergy. Toxicology in vitro. 1994; 8(5):991-1000.  Available from:  Accessed December 17, 2015.

MELISA Web site is

Tooth in mouth with saliva and silver-colored dental amalgam filling containing mercury
Dental Amalgam Danger: Mercury Fillings and Human Health

Dental amalgam danger exists because mercury fillings are associated with a number of human health risks.