We appreciate Dr. Henschel’s interest in the article. I certainly agree that amalgam is inferior esthetically. However, many amalgam formulations have no shrinkage on setting, which is a distinct advantage over composite.
As for the superiority of bonded amalgams, as we stated in the article, it could not be demonstrated in conventional preparations, which is consistent with the other clinical studies we quoted. While slight differences may appear in the published photographs, they were not enough to change the average ratings. Our previous SEM analysis of replicas at two years also failed to show significant differences.
As for the discoloration in the surrounding tooth structure, we did not examine this phenomenon in our study, but I agree with Dr. Henschel’s observation, and I can comment on this from my experience.
Having placed amalgam restorations almost exclusively with bonding in my practice since 1984, I can say that even after more than 10 years, there appears to be almost no discoloration of the adjacent tooth structure when the filled adhesives are used. When I have removed a few bonded-amalgam restorations, I have found the same to be true of pulpal and axial dentin walls.
However, leakage or lack thereof is not possible to demonstrate directly in a clinical trial. As we have stated in the article, so far the only clinically demonstrable advantage of bonding is improved retention in preparations without mechanical undercuts.
