Amalgam is one of the materials used for filling and restoring teeth. It is a practical filler with advantages such as:

• High strength
• Long lifespan
• Affordable cost
• Easy technique

However, this material also has disadvantages, including:

• Silver and metallic appearance
• Potential for causing sensitivity

Almost since ancient times, dentists have always sought a material to fill cavities and empty spaces in teeth that is both resistant and bonds well with the natural tooth, meaning it does not cause any sensitivity in the patient’s teeth and mouth.

Therefore, in this article, we aim to familiarize you with one of the oldest and most well-known dental filling materials, namely amalgam. A material that has been used in dentistry for centuries and is composed of specific metals.

So, join us in this article from Dr. Bonianian’s dental practice as we delve into a detailed review of amalgam, its properties, applications, and also discuss the issues surrounding its safety.

What is Amalgam?

Amalgam is a metal alloy composed of mercury combined with metals such as silver, tin, and copper. This material, due to its unique properties like high strength, resistance to wear, and shaping ability, has been used in dentistry for many years to fill dental cavities.

Essentially, amalgam is a paste-like mixture that, after being placed in the tooth cavity, hardens and bonds with the tooth.

Although amalgam has gained significant popularity in dentistry due to its reasonable cost and high durability, it is nowadays being replaced by other materials like composite, owing to its silver color and concerns related to the presence of mercury.

What is amalgam?

An amalgam is an alloy of mercury with one or more other metals, commonly including silver, tin, and copper, and it is well-known for its use in dental fillings due to its durability, strength, and relatively low cost. Dental amalgam hardens quickly, making it suitable for restorations in areas difficult to keep dry, and it has a long lifespan compared to some other filling materials.

While concerns about the mercury content exist, major dental and health organizations consider dental amalgam safe for most individuals, highlighting its effectiveness in restoring teeth affected by decay.

What are the components of Amalgam?

As mentioned, amalgam is made from a combination of several different metals. However, the main composition of amalgam typically includes the following:

• Mercury: Approximately 50% of amalgam is composed of mercury. Due to its adhesive properties and ability to combine with other metals, mercury allows amalgam to transform into a hard and resistant substance.
• Silver: Silver is another main component of amalgam, providing it with strength and resistance.
• Tin: Tin helps make the amalgam softer and easier to shape.
• Copper: Copper adds greater strength and resistance to the amalgam and also helps reduce creep (gradual deformation) of the amalgam.
• Zinc: Zinc acts as a moisture scavenger and prevents the oxidation of amalgam.

Types of Dental Amalgam

With technological advancements and the production of various types of alloys, amalgams have also undergone significant changes. Today, various types of dental amalgam exist, each differing based on their chemical composition, particle shape, and production method.

Amalgam classification based on:

1- Chemical Composition

• Low-Copper Amalgams: In this type of amalgam, the copper content is less than 12%. These amalgams were widely used in the past due to their softness and ease of use, but due to weaknesses in mechanical properties, they are less used today.
• High-Copper Amalgams: In this type of amalgam, the copper content is greater than 12%. High-copper amalgams have greater strength and durability, and their resistance to wear and corrosion is higher than the low-copper type.

2- Particle Shape

• Spherical Amalgams: In this type of amalgam, the alloy particles are spherical. This shape allows the amalgam to be easily placed in the tooth cavity and achieve higher density.
• Irregular (Lathe-cut) Amalgams: In this type of amalgam, the alloy particles have an irregular shape. These amalgams were more commonly used in the past but are less used today due to issues like lower density and the potential for micro-void formation.

3- Production Method

• Mixed Amalgams: In this type of amalgam, the alloy powder and liquid mercury are mixed by the dentist in the tooth cavity.
• Capsulated Amalgams: In this type of amalgam, the alloy and mercury are pre-mixed and packaged in a capsule. The dentist simply needs to place the capsule in a special machine (amalgamator) and place the prepared amalgam into the tooth cavity.

Is Amalgam Safe for Teeth?

We know that many of you are concerned about the use of amalgam due to the presence of mercury. However, you should know that to date, no reports based on dental evidence have been published indicating that amalgam is dangerous for teeth.

According to our reports:

• The U.S. Food and Drug Administration (FDA) has declared that the use of amalgam is safe for adults and children over 6 years old.
• Many global health organizations have also confirmed the safety of amalgam.

Does Amalgam Cause Cancer?

Numerous scientific studies regarding amalgam show that there is no direct link between the use of amalgam and the occurrence of cancer.

The U.S. Food and Drug Administration has also confirmed the safety of amalgam for adults and children (over 6 years old). However, like any other substance, amalgam can cause sensitivity in some individuals, in which case alternative materials should be used for these people.

Nevertheless, if you have serious concerns about using amalgam, you can use the free dental consultation services at Dr. Bonianian Dental Clinic and discuss your questions with our specialists.

Advantages of Amalgam for Filling Teeth

As one of the oldest and most common filling materials, amalgam offers significant advantages. Advantages that have led to its use by dentists for many consecutive years.

Below, we mention some of the most important advantages of amalgam.

Very High Strength

Amalgam has a metallic structure and, therefore, possesses very high strength. Thus, it is an excellent option for posterior teeth (which are usually under greater pressure).

By using an amalgam filling, you can comfortably eat any food you like, without worrying about the filling fracturing or wearing down your teeth.

Long Lifespan

Another advantage of using amalgam is its very long lifespan. This means amalgam has greater resistance compared to other fillings (like composite), especially if the tooth is crowned after restoration.

Due to this feature, amalgam fillings can remain in your mouth for many years without needing replacement or re-restoration, essentially serving you well for a long time!

The high resistance of amalgam against wear, pressure from chewing, and temperature changes is one of the main reasons for its long lifespan.

Resistance to Wear

Amalgam, as a dental filling material, exhibits very high resistance to wear and abrasion due to its metallic structure and unique composition. This feature ensures that amalgam fillings experience less wear over time and retain their original shape.

This high resistance acts as a strong barrier against chewing forces and prevents further tooth destruction.

Cost-Effectiveness

Another reason that has made amalgam a popular choice among people is its lower cost compared to other fillings (like composite). This affordability is mainly due to the type of material used and its lack of aesthetic appearance.

Other Advantages of Amalgam

• Strong Seal: Amalgam adheres well to the tooth surface and prevents bacteria and food particles from entering beneath the filling.
• Low Contraction and Expansion: Amalgam is very stable against temperature changes and exhibits minimal contraction and expansion.

Side Effects of Filling Teeth with Amalgam

One of the main concerns regarding amalgam is the presence of mercury in its composition. Mercury is a heavy and toxic metal, and there have been many reports of poisoning associated with it. This is the reason for people’s concern about amalgam side effects – they fear that mercury might be released from the amalgam and enter the body!

However, as we mentioned earlier, the amount of mercury in amalgam is very small and poses no risk to the health of healthy individuals.

Nevertheless, it is better for pregnant women, nursing mothers, and children under 6 years old not to use this material.

Among other potential side effects of amalgam, we can mention sensitivity to metals. Some individuals might show sensitivity to one of the components present in amalgam and experience gum inflammation, a metallic taste in the mouth, or allergic reactions.

Another point regarding amalgam side effects is that placing amalgam in a tooth usually requires removing more healthy tooth structure, and this might weaken the tooth.

Despite these side effects, amalgam remains a strong and durable filling material and, in many cases, is the best option for tooth restoration. However, we suggest making the decision about using or not using amalgam in consultation with specialized dentists like those at the Dr. Bonianian practice.

Steps for Filling a Tooth with Amalgam

The dentist follows the steps below one by one to fill a tooth with amalgam:

1. Examination and Diagnosis of Decay

Initially, the dentist assesses the location and depth of the decay through a thorough examination of the mouth and teeth, using diagnostic tools like radiographs (X-rays). This stage is crucial as it determines whether the tooth is restorable or requires other treatments like root canal therapy.

If the decay hasn’t reached sufficient depth and the tooth structure is preserved, filling with amalgam is chosen.

2. Local Anesthesia

To perform the treatment painlessly, the area around the tooth is completely numbed using local anesthesia. This is usually done by injecting an anesthetic agent and requires a few minutes to take full effect. This step assures the patient that they will feel no discomfort or pain during the procedure.

3. Caries Removal and Cavity Preparation

In this stage, the dentist carefully removes the decayed tissue from the tooth using instruments like a turbine or dental handpiece. Then, a cavity with a suitable shape for retaining the amalgam is created within the tooth structure. The dentist strives to preserve as much healthy tooth structure as possible while completely removing the decay.

4. Placing Amalgam in the Cavity

After preparing the cavity, the amalgam, which is a mixture of metals like silver, tin, copper, and mercury, is placed inside the cavity. The amalgam is placed in the site as a soft paste and then condensed using special instruments to fit well into the cavity and reconstruct the original shape of the tooth. Attention to proper occlusion (bite) when closing the mouth is important at this stage.

5. Finishing and Final Adjustment

After placing the amalgam, the dentist smooths and polishes the restored surface to prevent sharp or rough edges. Also, using special blue articulating paper (occlusal paper), the contact points between the teeth are checked, and minor adjustments are made if necessary to distribute chewing pressure evenly. Sometimes, the final finishing is done in a separate appointment after the amalgam has fully hardened.

What Other Materials Can Be Used for Dental Fillings, and What Are Their Benefits and Risks?

The use of amalgam for dental fillings has decreased over the years, and materials like composite resins and glass ionomers (sometimes called “porcelain,” “resin,” or “white fillers”) are more commonly used.

Although the durability of these alternative materials has improved since their introduction, they may still not match the filling properties of amalgam, especially in areas subjected to high wear and stress from chewing, such as posterior teeth (molars and premolars).

This method of tooth filling has advantages over resin materials in specific clinical situations, such as:

• When a patient is identified as being at higher risk for tooth decay.
• In cases requiring large fillings in posterior teeth where chewing forces are high.
• Where moisture control can be problematic for placement, such as near the gum line.

Difference Between White and Black Amalgam

One of the common questions patients ask when visiting the dental office is, “What is the difference between white and black amalgam?” In response, it must be said that, in reality, there is no such thing as “white amalgam.” This term has mistakenly become common among the general public. What is known as a “white filling” is actually composite resin.

Composites are tooth-colored restorative materials widely used for restoring cavities, especially in visible areas. In contrast, amalgam is a metallic material with a silver color (sometimes referred to as “black”) that is used more often in posterior teeth due to its durability and strength.

Therefore, the main difference is not in color but in the type of material, application, aesthetics, and durability. The choice between the two depends on the tooth’s condition, the location of the decay, and the dentist’s professional opinion.

Is Restoring Teeth Better with Composite or Amalgam?

Choosing between composite or amalgam depends on various factors. However, to make this choice, it’s helpful to know a bit more about the differences between these two materials:

1. Composites, due to their natural color and aesthetic appearance, are more suitable for anterior teeth and small restorations. In contrast, amalgams, due to their high strength and longer lifespan, are prioritized for restoring posterior (molar) teeth and deeper cavities.
2. Composites require more maintenance and may need replacement sooner than amalgam.

Feature	Amalgam	Composite
Appearance	Dark, metallic, unnatural appearance	Natural tooth color, high aesthetics, adaptable to tooth shade
Strength	Very strong, suitable for large and deep restorations	Less resistant to strong chewing forces, suitable for small to medium restorations
Longevity	High (10-15 years), longer durability	Moderate (5-10 years), may need earlier replacement
Cost	Cheaper	More expensive
Sensitivity	Higher sensitivity to staining, color change	Less sensitivity to staining, color change

Amalgam Alloy

Main Material: Silver, Tin, Copper, and Zinc Alloy

Application: Restorations of posterior teeth, deep cavities, durable restorations

Considerations: Requires more tooth preparation, potential sensitivity to metals

Composite Resins

Main Material: Resin Composites

Application: Restorations of anterior teeth, aesthetic restorations, small and medium cavities

Considerations: Requires less tooth preparation, better adhesion to the tooth

So, with this information, you should either leave the choice between composite and amalgam to your dentist or, using the features of each material, choose one for yourself.

How Much Does Filling a Tooth with Amalgam Cost?

Usually, the cost of tooth restoration is determined based on the extent of the filling. Meaning, if the decay is superficial and small, your restoration cost will be lower, and if the decay is more severe and extensive, your restoration cost will be higher.

On a page titled Tooth Restoration Cost, we have provided you with the latest costs related to tooth restoration (with amalgam and composite) so that you can more easily find out the latest fees for tooth restoration with different materials.

Class V or Single-Surface Amalgam Restoration

Dr. Nazi Bonianian defined Class V (single-surface) amalgam restoration as follows:

Class V amalgam restoration is a type of dental treatment performed to repair cavities limited to the labial or buccal (outer) surface of posterior teeth, particularly in the cervical (gum line) area.

In this type of restoration, the decay is first completely removed, and a small, controlled cavity is created. Then, the amalgam material, a combination of various metals including silver, tin, and mercury, is placed inside this cavity and carefully condensed and shaped.

Amalgam, due to its high durability and resistance to chewing forces, is a suitable choice for restorations in non-anterior areas. This type of treatment is typically quick, cost-effective, and efficient in preserving the natural function of the tooth.

Three-Surface Restoration with Composite and Amalgam

A three-surface restoration with composite or amalgam is a method for repairing more extensive cavities that involve three surfaces of the tooth (the chewing surface, one side surface, and the interdental surface).

In this type of restoration, after complete removal of the decay, depending on the tooth’s condition and the dentist’s opinion, either composite (a tooth-colored material with high aesthetics) or amalgam (a metallic material with high durability) is used to fill the cavity.

Composite is recommended for anterior teeth or situations where aesthetics are important, while amalgam, due to its high strength, is a suitable option for posterior teeth.

If your tooth requires professional and durable restoration, contact Dr. Bonianian Dental Clinic now and benefit from our specialized services.

Tooth Restoration with Amalgam at Dr. Bonianian Dental Clinic

As we learned throughout this article, tooth restoration with amalgam is one of the common, effective, and durable methods for repairing decayed teeth, especially in the posterior regions of the mouth.

This treatment is performed at Dr. Bonianian Dental Clinic using modern equipment and adhering strictly to infection control principles by experienced dentists.

Amalgam, as a metallic and resistant material against chewing pressures, is a suitable choice for teeth that are less visible but require high strength.

In this method, the decay is first completely removed, then the cavity is prepared, and the amalgam is placed and shaped to restore the natural function of the tooth.

If necessary, final adjustments will be made after the material has fully hardened. If you are looking for a reliable, durable, and scientific restoration, Dr. Bonianian Dental Clinic is ready to provide the best services to you.

Experience of a Patient at Dr. Bonianian Dental Clinic with Amalgam Filling

A few weeks ago, I visited Dr. Bonianian Dental Clinic for a vague pain I felt in my lower molar. After an examination and taking an X-ray, it was determined that one of my back teeth had decay and needed restoration. Considering the location of the tooth and the significant pressure applied during chewing, Dr. Bonianian suggested using amalgam as a resistant and durable option.

The treatment steps were carried out very precisely and professionally, from the anesthesia to removing the decay and accurately shaping the restorative material. A few days after the amalgam hardened, I felt no pain, and my tooth fully regained its natural function. I’m glad I trusted the doctor’s recommendation, and now I eat without worry. I am truly grateful to the professional and kind team at the clinic!

Final Summary

Amalgam is a widely used material in dentistry, made from a combination of mercury with other metals. This material has been used for many years to restore teeth due to its high strength, long lifespan, and reasonable cost. However, amalgam also has some disadvantages, including its dark and metallic appearance, potential for sensitivity to metals, and concerns related to the presence of mercury.

With the advancement of technology and the production of newer filling materials, the use of amalgam is decreasing. The decision regarding the use of amalgam should be made in consultation with a dentist, considering individual circumstances and the type of restoration needed.

Dr. Nazi Bonyanian

Dental Surgeon (DDS) — Medical Council Number: 138662
Graduate of Isfahan University of Medical Sciences with over 15 years of experience in implants, laminates, and oral and dental surgery.

Dr. Bonyanian Dental Clinic

Address: No. 22, Unit 7, West Alley 6, Bokharest Street, Argentina Sq., Tehran, Iran
Phone: +98-21-88539720 | WhatsApp: +98-912-514-2202
Email: info@drbonyanian.com

Working Hours: Sat–Wed 09:00–20:00 | Thu 09:00–14:00 | Friday Closed

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Last Reviewed: 5 October 2025

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