Professional Documents
Culture Documents
AUGUST 195 1
Silver amalgam ha s saved and continu es to save more teeth th an all other
materia ls combined . Carefully handled,
silver ama lga m restorat ions will give
more servi ce for th e t ime and effort
expe nded than any other. No apology
need be made to any pati ent for th eir
use. There a re not eno ugh dent ists to
serve th e pub lic with any durab le material, .amalgam not excepted . I Iowev er,
mor e amalga m resto ra tions ca n be ma de
in a given len gth of tim e. Pract ical suggest ions for m aking good silver amalg am
restorations follow.
CAvtTY PIlEPARAnO N .
CLASS I AN D II
IJJ
t""
I ~ SO ,
Fig, 3
Sa fnt ou/usa!
f(IT amalgam .
Co n(,uJ:itl~
walls
more
nead y follow enamel , ,,,11 .
R es/ora/io/l is carve d witll'
out .11,,111' J;WO i''''1. N ote that
a mill imum amou nt of st ress
a'ill be tol. ..." by t h... filling
matuial, A ll fillt d tul h a'e
~ u bj(( 1 to [racture but a caoIt)" p"pa"d to .r is st , onet .
than o,, ~ p, tpa,td to r.
Preparation at X has amp/t
seot 0 '1 sou "d dnlti"
p ' ~pa'at l otl
Ill> " Htf JOU ~ NAL OF t HE AVEI1 ICA N DEN TA L A SSC C IAT ION
S I I."I'E "'OR C I. A S S II
..
. ;:> Z ...
..
'.
" :\
GtI\~I~
A )-.. 1l
III
shou'n
1Il1ll .
Badl y broke-n down u-r- th ca n he sa risIar-to rily n -sto n-d with a ma lga m if a de q uate re tention is provided fo r eve rv
stress. It m ust he ren u-mbered th at fillings
do not stick to teeth. hut cavit ies m ust hI'
engi nee red with a reten tive des ign. Wh en
re tention b y lock s cut into dentin is insuffic ien t. 0.02:") inch diame te r threa ded
iridioplat inum p ins cemen ted into holes
drilled by a no . ~ round bur will provide
exce llent anchorage about wh ich amal ga m ca n he co nde nsed ( Fig. 13) ,
C A\"l 1"Y I'REPA RATION FOR CLASS \ '
The gi ngiva l third or Cl ass V cavity presents specia l problems of its ow n. On the
Silver a malgam is tln- be st n-storar ivr- m a teria l fo r pr act ica lly a ll decid uous u-e tb
including incisors, a nd for pe rmane nt
poste r io r teeth to th e ages of 1;-) o r 16.
Fig. 7 lAJu'a bicu spids and uppa .molars at~ stton ga if u pa,a ft
mtJloocdusa{ alld di JtooulUJol resto' atio'lJ a't p/au d ItfllJllIg toolh
s~ PP O t' bttwu n t ht occl usal po, tlons. V ppa bicu spi ds an d 10 lL'tr
molo! J. UJuoll )' htwt Jho, p g too Vt J
' tqI1. 11Int 0 sup t :dtn din j! comP/t ltl)' ee ross tht occlu Jal Ju t fau
10 a Mfr nrra f(>1 {11I;Jhi ng
~ 1I 1"i .
Il l .
,,,.
E,te ~ t
fi.9 L eft : Prox im al shape should be routi'lei)' o urlined in Ihe m out h wilh t1 pen cil
cut to a tnin flat point . POJitioll and silt of tht plOximalin g tooth d,teTmin tl th,
outlint. L ines art drawn from tht maTgin al rid gt to th e gingiv al tiHUt on both Ih,
bucca! and !in gtla! sid es. The se lints ale Ih, n m odifi ed to de serib, the ideal outli ne for
' he partieular rt storativ, "lat uic.l to be uJtd , as shown at righ t. Hight : T he curved
proxi ma l line s urere inscribed b)' the pen eil shoum at Ihe leit , Cat'it ) outline fOl amalKnm and gold inla )' restorat ions w ill ha t'e a com m on Klngival otltline onl)'. A m alIa",
permits a gin gival rxun sion lat er all ) across Ihe scri bed lines into zones safe from
luurr,n l ca nes, The fillin g is narrow aer ou th e m arginal ridge a nd occl usal step. -1
broad occlusal oul/ine and mo rt' constricted gingival art' necessar y for a n in la). \fodd
a l , xt rem, right shows bolh mila /Knill lind in la }' ,avit)' out lines stlpuim po"d
~pan: .
\\"h{"fl it
cavi ty involves one or mo re sides of a
tooth, a form or mat rix must be bu ilt
which will bot h rigid ly support the restoration while build ing, and define the con tour on those su rfaces which ca nnot be
readily built to excess. Dozens o f commercial mat rixes have been ma rketed,
alI with defects an d limita tions.
. Two types of matrix, each easily mad e
In the office, will serve for almost an)'
situation. One is made of a stainless steel
strip 0.0015 of an inch thic k. This mate-
MARK lE Y
Fig. 12 First row : Th e cr OJ5 sntio n of an up per bicu spi d requ iri ng an MOD restora tiOn and ha ving a ca ries-we ake ned port ion is sh ow n in A. Placin g ama lgam in an
occlusal pr eparation havin g para llel walls in an eff ort to shield the weak buccal wall
somewhat wi ll result in an acute -an gle margin wh ich commo nly ch ip s, as shown in D,
allowin g co rrosion to undermine the Test oratio n . I f th e con servat ive converging -wall
design is follo wed, the amalgam ma rgins are safe eno ugh with th e bulk of the st ress
on toot h stru ct u re. Houi euer, the toot h structu re ma y be so weak as to fract ure,
as show n in C. T he cu sp should be capped with am*lgam, preferably to a depth of
3 mm. as show n in D.
.
,
S econd row : Wh en gold ma rgin s are kep t stro ng, as in E , a we ak toot h ca n be co n.servativtly pr ot ect ed with out capping the cusp. On a still we ak er tooth, as in F,
th e bucca l cus p ca n be esth etically capped, using from 1 to 1.5 mm. of gold alloy.
Failu res wi th gold, as show n in G, are co mmo n w here insufficient bu lk of gold is
u.fed or where rest orat ions are seated on cement rath er than sound den tin
eo.,
I~l
14)
ito.
I~~
sion have shown much interest in mechanical conde nsers for amalgam. The
merit of machine technic for condensing
ama lgam , however, i$ questionable,
There arc: two general types of m echanica l amalgam condensers. One strikes
a blow as for gold foil, while the other
ca rries a vibrating point. The fint type
habitually injures enamel margins. All mechanical condensers tend to co ntinue trituration , reducing alloy particle size
which may result in a shrinking filling,
The specifications of th e Cou ncil on Dental Research of the Associat ion for ama lgam ca ll for an alloy which expands
sligh tly, between 3 and 13 microns per
cen timeter at the end of 24 hou rs. This
is necessary because ama lgam has a very
high coefficient of expansion, al most three
times that of tooth structure. In the
ra nge between ho t and cold foods, amalgam expands and shrinks eno ugh to cause
lea kage unless a setting ex pansion has
locked it tightly int o th e dentin." Leak.
age a rou nd a filling ca uses ch aracteristic
" blue margins," and may result in recurrent ca ries.
Hand co nde nsation will dependably
pack am algam with out these hazards. Almost any opera tor can dev elop enough
hand p ressure to do it well with med ium
a nd small conde nser points." As eac h
new port ion of amalgam is added, several
10 pound thrusts should first be made to
weld the new mass to th e mercury-rich
su rface of the preceding mass, Then the
condenser point is ste pped toward the
margins with five or six pound thrusts,
which will closely adapt the amalgam to
the ca vity and reduce me rcury content
sufficiently to produce a durable restoration. M ercury ' excess coming to the surfa ce during co ndensa tion is flipped out
with th e conde nser' point. It is likely th at
if the operator's ann does not ache after
conde nsing a large filling, the filling is
not well conde nsed. Household scales can
be used to test hand pressures, pressing a
co nd ensing instrument to the platform
with various imtrument grasps,
F IN ISII I Nt :
IS. SkiM." . E. W . Th
~, i e "'e
MAH l f Y
I ~$
fou ~ blod s of
~ h {)\'oI'd
that
lowed by wet wh iting or rouge will remo ve scratches and leave a h igh polish.
H ea t from polishin g will quickly ru in an
amalgam filling. The critical temperature
is on ly 140o F.u Therefore only very wet
polishing agents sho uld be used to reduce
the hazard of heat.
D eep occlusa l grooves shou ld not be
ca rved into amalgam fillings, for d eep
grooves weak en the restoration and subject margins to chi pping ( Fig. 3 ) . Otherwise tooth fonn should be fa ithfully restored. Embrasure fonn is very important.
It shou ld be re membe red that th e contact
area is a millimeter or more rem oved
from th e height of the marginal rid ge.
Dentists have bee n so accu stomed to condensing fillings into plan e su rfa ce mat rixes that th ey have come to think of the
int erproxim al surfaces as bein g straight
lines wit h th e con tact a t th e crest of the
ma rgin al ridge. Normal conta cts should be
stud ied in in terp roximal roentgenograms.
It is ......ell to rem em ber th at marginal
ridges do not occlude necessarily and that
proper em brasures provide im portant
sluice-ways for food , relieving excessive
hydraulic p ressure wh ich is crea ted in
che wing food and ......hich traumatizes a
tooth.
It ca n be truthfully said that an am a lga m filling is usually much better than
it looks, whil e a gold inlay is seldo m as
good as it loo ks. Amalgam fillings resist
recu rr en t ca ries at their margins, while
most gold inlays invite margina l ca ries
CO NCLUS IOS
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