Changing Trends of Posterior Restoration in Pakistan: A Cross-Sectional Study

Abstract

Background: Dental amalgam use is declining globally due to environmental concerns, patient demand for aesthetics, and improvements in adhesive restorative materials, yet its perceived durability continues to influence clinical decision-making. Objective: To assess current trends in posterior restorative material selection among dental clinicians in Pakistan and to identify factors influencing these choices. Methods: A cross-sectional observational survey was conducted among undergraduates in clinical years, house officers, postgraduate trainees, and practicing general dentists across Pakistan. A structured questionnaire assessed demographics, knowledge of amalgam-related guidance, attitudes toward amalgam restriction, and clinical practices including material choice for posterior Class II restorations, perceived durability, isolation methods, and recent preference shifts. Data were analyzed using descriptive statistics and inferential tests for categorical distributions with 95% confidence intervals for key proportions. Results: Among 205 respondents, composite resin was the most commonly reported material for posterior Class II restorations (51.7%; 95% CI 44.9–58.5), followed by dental amalgam (28.8%; 95% CI 23.0–35.3) and glass ionomer cement (11.7%; 95% CI 8.0–16.8). Despite lower use, amalgam was most frequently perceived as the most durable material (73.7%; 95% CI 67.2–79.2). Most clinicians reported shifting from amalgam to composite within the last five years (68.3%). Rubber dam isolation was reported by 50.2% of respondents. Conclusion: Posterior restorative practice in Pakistan is transitioning toward composite resin use, while durability perceptions remain strongly in favor of amalgam, supporting the need for targeted training in adhesive techniques, isolation, and context-sensitive policies aligned with mercury phase-down goals