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Amalgam
Slide 2 :

(part1)

Good Morning. Today well start with dental amalgam which its one of the commonly used dental material.

So Ill introduce to U the basic composition, the classification of dental amalgam, how it sets after its mixed, some of its properties, how to handle & manipulate it.

Slide 3 :
So why using amalgam ?? because: 1- easy to use 2-cheap material 3- proven track record; it has been used for many years with good successes . But it has some drawback with mid esthetics thats why composite takes over sometimes, most people do fillings using composite but they cant perform as well as amalgam especially in posterior part of the oral cavity because they arent strong. The other thing is that amalgam contain mercury in its composition ,,& there is some researches about being (mercury) hazardous to the patients health , but on the other hand a large number of research articles proved that {since the amount of mercury very small it wont be hazardous to the patients health at all} , so unless the patient is in direct contact with mercury on its own or the patient ingests large amount of amalgam thatll be dangerous but when you just place a filling or remove an old filling with good suction allowing all amalgam to be outside the oral cavity preventing any from coming inside the patient & No direct contact with mercury therell be no hazardous effect from mercury. Nowadays we have capsulated amalgam, one end of it contains the powder (alloy or metal) the other contains the mercury, then they placed in a machine called amalgamator, it shakes the
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capsule very quickly mixing the 2 component together then U open it & do your filling so there is no contact & that improves the safety . but in the past they bring the powder & mercury then do the mixing so there was a big chances of contact & even inhalation from the mercury paper.

Slide 4+5 :
So as we said its strong & durable material so mostly or all the time its used in posterior teeth. Now in this semester Ull be working in the operative dentistry lab with Dr. Gada so youll be doing a variety of cavities, & cavities in posterior teeth mainly class 1, class 2 cavities which involve the occlusal surface of molar or premolar & mesial or distal or even buccal or lingual. They all can be filled using amalgam restoration. For example this is class 2 cavity because it involves occlusal & mesial surfaces. So caries were excavated the cavity was prepared , then proper carving, then placing the amalgam in layers & condense using an instrument called a condenser. So its packed layer by layer in the cavity until we over fill it & then its carved just to maintain the general morphology of the tooth.& the end result is in (picture 8). So using a restoration means restore the original shape of the tooth & its function.

Slide 6 :
Whats the basic composition of amalgam?? Basically its a powder & a mercury liquid . So its mainly composed of metal & when I say alloy I mean more than one metal is involved. These basic component in the alloy are: Silver, Tin, Copper. All of these are mixed together then mixed with mercury. There also might be: Zinc, Indium, Palladium. All of these are added to improve properties,, to increase strength, to minimize corrosion.

Slide 7:
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Classification of amalgam : we classify amalgam according to the shape of its particles : some of amalgam have irregular particles, some have spherical, some of them is a mixture of two. each of them have certain properties as well.
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Irregular ( lathe-cut amalgam) : usually they bring a block & start cutting it irregularly Spherical amalgam (spherical alloy): they have the alloy in the melted state & they spray it in a chamber containing an inert gas ,,this cause the alloy to form a small balls (spherical shape) then itll solidify. Admixed amalgam (admixed alloy): is just a mixture of two .

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Slide 8 :
A picture presenting different types of amalgam : A- irregular B- spherical C- admixed

Slides 9 + 10 + 11:
The setting reaction : Ag Sn + Hg Ag Hg + Sn Hg + un-reacted Ag-Sn

- Once the alloy (silver, copper, tin,..) is mixed with mercury a series of compound is produced. & they call them different names. The alloy itself ( un-reacted alloy) { Ag-Sn} is called Gamma () or gamma phase . when it reacts with mercury many things can form : part of alloy might remain un-reacted , silver may react with mercury & tin may react with mercury. Amalgam as a whole is composed many compound so its not totally composed of silver mixed with mercury for example. Its composed of unreacted part (Ag Sn) () , silver that reacts with mercury (1 ) & Sn that reacts with mercury (2) . So its a combination .
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Each material have certain properties for example the 2 phase leads to weakness to amalgam & susceptible to corrosion which its a chemical attack leads to breakdown. **So having a large amount of 2 phase leads to weakness & corrosion. This was a characteristic of the old amalgam. Newer amalgam is better,, 2 phase doesnt form a lot because they add more Copper. Copper will capture Tin (Sn) & prevent its reaction with mercury so it prevents the formation of 2 phase. And its called Copper Rich Amalgam , which its the amalgam we use it nowadays. This whole setting reaction take around 24 hours, although it becomes hard after initial set or maybe 10 min but U cant work with it because the setting reaction hasnt finished yet,, the mercury is still reacting with alloy powder so no finishing or polishing before 24 hours. So aw we said when alloy is mixed with mercury a three phases will result :
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Gamma phase () : silver tin is the strongest & the least material that is susceptible to corrosion Gamma 1 phase (1) : silver mercury its strong but no as the & less susceptible to corrosion than 2 . Gamma 2 phase (2) : tin mercury is the weakest & more susceptible to corrosion.

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So decreasing the amount of 2 in the amalgam by adding more copper results in a stronger material . by the way all of this is done by the manufacturer . you do nothing with these reaction but you buy the material .

Slide 12 :
now well take about some properties of amalgam . therere certain properties that are specific to amalgam because its a metallic restoration & contains mercury first is :

Tarnish : which means oxidation of amalgam surface.

Oxidation will attack the surface because of some chemical

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contact within the oral cavity like oxygen, chlorides, sulfide . All of these react only with the surface so no break down underneath,, only the surface will be changed & usually you can see it clinically when U see the filling becoming dark & dull .

slide 13 :
We have a picture showing the differences between a recently polished (right) , a tarnished & corroded amalgam restoration (left) .

Slide 14 :
If the surface of the filling is rough,, this increase the chances to have tarnish because it retain food particles >> this increase the chance of contact between the filling & particles >> increase the chance of oxidation >> then tarnish. But in the surface is smooth & polished it wont retain food, so there will be no contact or oxidation. U should know that a tarnish filling isnt a weak one like corrosion, so U dont need to replace it >> all U do is finishing & polishing with certain instrument. But clinically a tarnish filling & corrosion look the same. Unless U start to examine it to see if part of it is broken down U cant really tell if its a tarnish or corroded filling. Both of them look similar < dark dull appearance > . Now to minimize the chances of tarnish they can play with composition of material, by adding Palladium which prevents the oxidation reaction, so the composition can affect if the material is weak or not , if it susceptible to corrosion or tarnish or not. This is one way to minimize the tarnish. But U also need to do finishing & polishing after 24 hour to produce the nice smooth surface. Always when doing finishing & polishing U need to be careful because of the friction thatll result from finishing & polishing, it
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will produce heat & amalgam its a metallic filling which conducts heat which can harm the pulp. So you need to use water every now & then to prevent excess heat formation during finishing & polishing. But the composite in glass inomer cement is a different story, they arent good heat conductor like amalgam.

Slide 15:

Susceptible to corrosion : means to be broken down

by chemicals,, usually this takes few years (doesnt happened very quickly) especially if the amalgam is copper rich & its used properly . Its a chemical reaction between the amalgam filling & oral environment ,, & this leads to break down & releasing its component in to oral cavity like tin & mercury, this weakens the filling & itll break off, then U should redo it again . Another thing might cause corrosion which is Galvanism & its defined as electric current between two opposing metallic fillings . & this lead to releasing of its component then oxidation >> which lead to weakness of the filling.

Slide 16 :
So the outcome of corrosion. If U notice it also has a dark dull appearance but part of this restoration has broken off because the material was weakened . the outcome of corrosion : 1- Weakens restoration
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Deterioration of its margin,, they wont be in complete contact with the tooth.. therell be a space between the filling & the tooth & this leads to micro leakage & all its consequences like sensitivity, staining,.. Stain surrounding tooth structure as corrosion products penetrate dentinal tubules. So corrosion leads to releasing amalgam component, then these metallic component will

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go to dentinal tubules ,,this cause blacking or darkening the dentine or enamel. U can notice this on people with old amalgam that there enamel is a bluish color. On the other hand,, there is one benefit of these products. They close any space between the filling & the wall of the cavity. But again this isnt a solution, this is a problem called staining of dentine & enamel. & if U want to replace the filling U should drill more to remove the stained dentine & enamel >> this means U lost more from tooth structure.
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So a corroded filling needs to be removed completely : U drill it >> remove it >> clean the tooth >> then place a new one.

Slide 17 :

Creep : means plastic deformation, change the shape of

the material due to continuous pressure. In the case of amalgam due to chewing, with time the shape of amalgam will change a little bit & it wont go back to its original shape.

Slide 18:
This is an example of creep, part of the filling came out of the cavity wall, & its a weak part , if it breaks off it might break part to the tooth structure with it. - So an amalgam filling with creep also needs to be replaced because its weakened.

Slide 19+20 :

Dimensional changes : when alloy powder is mixed

with mercury & the material start setting,, then it sets. Some expansion or contraction might happen,, & its alright if its just a little bit. We dont want large contraction because this will lead to a space between the tooth & the filling thus cause micro leakage. We also dont need large expansion

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because itll create pressure on the cavity wall which will crack or fracture the tooth. Now whether contraction or expansion to happen,, it depends on certain factors which are:

Moisture contamination: ideally when placing amalgam there should be no contact with saliva or blood. Older amalgam used to have zinc( now amalgam is zinc free),, if there is a moisture (saliva or H2O) zinc will react with oxygen & hydrogen will be released,, H2 is a gas so itll try to escape & causing expansion of the filling.

The composition of alloy : some amalgam dont have zinc which its good cause there will be no H2 formation. Ratio of Hg : alloy : also affect the dimensional changes .

Finished now Done by :Ayah Tareef

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