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Issa Y, Brunton PA et al. Oral Surg 2004; 98: 553–565

Diagnosis of oral lichenoid lesions (OLL) and whether adjacent amalgam restorations should be replaced are controversial matters. This review identified no RCTs or CCTs, and therefore included 19 cohort studies and 5 case control studies on a total of 1,158 patients, mostly in Scandinavia.

The studies were judged of varying quality; for instance, in only 8 studies were +ve patch tests required before adjacent amalgams were replaced. Altogether, 512 patients had improvement or healing of OLLs after amalgam replacement. Greatest improvement after replacement was noted when lesions were in close contact with amalgam, varying from 45% to 77% of patients.

The authors suggest that patch testing may have limited value as an indicator for amalgam replacement and a predictor of its outcome, and also that amalgam restoration components other than mercury (silver, tin, zinc etc.) should be examined for their effects.