We agree with Dr. Young’s assertion that third-party payers should increase the amount allowed for amalgam restorations that replace cusps. But the point of the article was that the filled bonding resin used in this study was as successful as mechanical retention features in retaining restorations. This could then be translated to smaller restorations that may need some added retention and that may be accomplished in less time.
Since amalgam is not esthetic, we must assume that Dr. Young refers to nonesthetic indirect restorations when he states that indirect restorations provide better service. Certainly, well-done cast gold alloy restorations have been shown to perform extremely well, and, in most cases, may be preferred to complex amalgam restorations.
However, there is a large difference in cost to the patient. Many patients are unable to pay for the more expensive restorations. Because complex amalgam restorations do provide good longevity and service, many practitioners incorporate them into their practices, whether the practices are private or governmental.
As with any restoration, it is up to the private practitioner to decide if he or she is able to provide complex amalgam restorations in his or her practice. The decision may be based on income generated or on preference and ability.
The investigators in this study are certainly not putting amalgam forward as the material of choice for replacing every cusp, or even as a necessary part of every practice. We are just reporting the results of a study comparing the performance of bonded and mechanically retained complex amalgam restorations.
