Page 21
professionals) including the formation of an international advisory group to establish guidelines and evaluate the collected data. § Research to develop affordable preventive caries programmes, making any restorative material unnecessary, including studies helping to identify fractions of various populations at high risk of caries, for targeted actions. § Studies to identify special risk groups and individuals highly sensitive to various restorative materials. § Development of restoration methods and inexpensive biomaterials that can withstand local climatic, storage and handling limitations. § Research to develop improved and novel materials, including development of biological materials (biomimetics/tissue engineering) for restorative purposes. § Development of better diagnostic methods for dental caries and methods for clinical decision making. § Development of criteria regarding the replacement of failed restorations. § Improvement in methods for minimal intervention in caries management: § Improved and affordable methods for recovering and recycling of restorative materials. § Improved methods to make relevant dental material information available, including use of Internet. § Development of direct filling materials with easy handling characteristics. 1.5 Use of dental amalgam for restoration During the past 10 years or so, the awareness and recognition of the environmental implications of mercury have increased and dentistry has gained further attention as being a source of contamination of the environment. In addition, within the dental profession and the oral health research community the interest of serving patients through the use of alternative dental restoration materials has grown markedly. A few high-income countries have introduced a ban on use of dental amalgam in light of the higher availability and accessibility of tooth-coloured dental materials. Others have required or recommended dental practices to manage amalgam wastes so that they are not released to the environment. In some high income countries having introduced preventive dental care, the use of dental amalgam has declined partly due to the fact that dental caries is less prevalent and that caries lesions are less complicated. 5 Future Use of Materials for Dental Restoration It is worth noting, however, that in the majority of countries having third-party payment systems dental schemes do not yet recognize the use of alternative materials and one implication of this is that use of these materials for restoration of tooth structure is more expensive to consumers than dental amalgam. In the vast majority of low- and middle-income countries, the use of dental amalgam remains the preferred material for dental fillings or build-up material as alternative materials are currently far too expensive for people and society. Even today dental restoration is expensive often leading to tooth extraction in the case of dental pain or discomfort. The research on alternative materials for restorative dental care has grown significantly over the past 10-15 years. Alternatives are now available on the market in some of the wealthiest industrialized countries and some materials have been tested in clinical investigations as well as in population studies. These studies have been conducted on both primary and permanent teeth (9-22). However, such research is mainly carried out in high-income countries and research findings from the use of alternative biomaterials may not apply directly to low-and middle income countries. 1.6 Recent major international statements on dental restorative materials In May 2008, a Scientific Committee of the European Commission addressed the use of dental amalgam and the available alternative restorative materials (23,24). The committee concluded that dental amalgams are effective and noted that none of the dental materials - amalgam and alternatives- was without clinical limitations and toxicological hazards. Because dental amalgam is neither tooth-coloured nor adhesive to remaining tooth tissues, its use has been decreasing in recent years and the alternative tooth-coloured