Are there times when composite should not be used for a filling ?

For patients with high rates of decay along the gum line, composite fillings are often not the best choice. Some patients have a greater tendency to develop decay on teeth near the gum lines than normal. Some of these patients suffer from dry mouth,poor oral hygiene, poor diet,acid reflux, bulimia or even a combination of these conditions.

For these patients I usually choose a restorative material that release a relatively high rate of fluoride over time and can cause a zone of "caries inhibition". This term implies that the tooth immediately adjacent to the filling is offered some additional protection from developing recurrent decay. Composite restorations, even when they contain fluoride do not offer this additional protection.

If I am treating a senior citizen and I working on a tooth in a non aesthetic zone I often choose a material by GC, termed Miracle Mix. It is an interesting material that combines glass ionomer cement with the metal fillings from amalgam(sans mercury of course) and can work well in restoring moderate size cavities adjacent to gingival areas. Apparently this material does offer protection for these patients and I have witnessed a decrease in recurrent decay on the teeth that have been restored with it.

Another material that I often use for teeth at high risk for recurrent decay is Vitremer restorative material by 3M. This material is tooth colored, offers high fluoride release and can be used in aesthetic areas and also offers the patient some caries protection.

A disadvantage of both of these materials is that the are not as tough as composite or amalgam materials. Since they tend to be on the brittle side, they can be accidentally gouged out by a hygienist who is unaware of their presence or are more likely to crack when they are placed in an area of the tooth that is in occlusion.