After 14 years, 40 patients from an in vitro/in vivo study of 12 amalgam alloys were evaluated. All these patients had been attending private practitioners over the past 10 years, and the clinical evaluation revealed that 320 restorations were intact and 47 (12.8%) had been lost. The majority (75.0%) of the lost restorations were lost to crown placement or the replacement with another amalgam restoration. The six high-copper alloys exhibited bettter clinical performance, in both loss rate and fracture at the margins, than did traditional low-copper materials. Fracture at the margins was a better predictor of the loss of a restoration than were mechanical properties.