AMALGAM

ABDULLA ASSAN ABDULLA 4th batch R.D.C

DEFINITION

Dental amalgam is a metal like restorative material composed of a mixture of silver/tin/copper alloy and mercury.

HISTORY
Amalgam has been primary restorative material for more than 150 yrs. Initially, amalgam restorations were made by dentists filing silver coins and mixing the filings with mercury. This was made to a putty like mass that was placed into the defective tooth.

USES
AS CLASS 1,2,5 RESTORATION. AS FOUNDATION- IN COMBINATION WITH RETENTIVE PINS TO RESTORE CROWN. FOR MAKING DIES. FOR RETROGRADE ROOT CANAL FILLING. AS CARIES CONTROL RESTORATION.

Components of dental amalgam

1)Amalgam alloy 2)Mercury

CLASSIFICATION

Classification of dental amalgam alloys

BASED ON Cu CONTENT

HIGH Cu ALLOYS

LOW Cu ALLOYS

> 6% Cu

< 6% Cu

ADMIXED

REGULAR

UNICOMPOSITION

SINGLE COMPOSITION

BASED ON Zn CONTENT

Zn CONTAINING

Zn FREE ALLOY

> 1% Zn

< 1% Zn

BASED ON SHAPE OF ALLOY

LATHECUT

SPHERICAL

ADMIXED

BASED ON NUMBER OF ALLOY METAL

BINARY

TERTIARY

QUATERNARY

Ag,Sn

Ag,Sn,Cu

Ag,Sn,Cu,Zn

BASED ON SIZE OF ALLOY

MICROCUT \FINE CUT MACROCUT \COURSE CUT

MANUFATURE OF ALLOY POWDER

1)LATHECUT ALLOY POWDER 2)SPHERICAL ALLOY POWDER

COMPARISON OF LATHECUT WITH ATOMIZED SPHERICAL POWDER

AMALGAM FROM LATHECUT \ ADMIXED POWDER,TEND TO RESIST CONDEN-SATION BETTER THAN AMALGAM MADE ENTIRELLY FROM SPHERICAL POWDER. AMALGAM OF SPHERICAL POWDER ARE VERY PLASTICCANNOT RELY ON PRESSURE OF CONDENSATION TO ESTABLISH PROXIMAL CONTOUR. SPHERICAL ALLOYS REQUIRE < Hg THAN LATHECUT ALLOY DUE TO SMALL SURFACE AREA PER VOLUME . AMALGAM WITH LOW Hg CONTENT BETTER PROPERTIES.

COMPOSITION

COMPOSITION
Low Copper: Silver - 63-70% Tin - 26-29% Copper - 2-5% Zinc 0-2%

Admixed:

Silver 40-70% Tin - 26-30% Copper-13-30% Zinc - 0-1%

Unicompositional : Silver- 40-60% Tin - 22-30% Copper-13-30% Zinc -0%

FUNCTION OF EACH CONSTITUENT

SILVER:MAJOR ELEMENT. WHITENS ALLOY. DECREASES CREEP. INCREASES STRENGTH. INCREASES EXPANSION ON SETTING. INCREASES TARNISHING RESISTANCE IN RESULTING AMALGAM.

TIN:CONTROLS THE REACTION BETWEEN Ag & Hg. REDUCES STRENGH & HARDNESS. REDUCES RESISTANCE TO TARNISH & CORROSION.

COPPER:INCREASES HARDNESS & STRENGTH. INCRESES SETTING EXPANSION.

ZINC:SMALL AMOUNT NOT AFFECT SETTING REACTION \ PROPERTIES OF AMALGAM. ACT AS A SCAVENGER \ DEOXIDISER. WITHOUT Zn ALLOYS ARE MORE BRITTLE & AMALGAM FORMED LESS PLASTIC. CAUSES DELAYED EXPANSION , IF CONTAMINATED WITH MOISTURE DURING MANIPULATION. BENEFICIAL EFFECT ON CORROSION & MARGINAL INTEGRATION.

PLATINUM:

HARDENS THE ALLOY & INCREASES THE RESISTANCE TO CORROSION.

PALLADIUM:

HARDENS THE ALLOY. WHITENS THE ALLOY.

PRE AMALGAMATED ALLOYS:SMALL AMOUNT UPTO 3% OF Hg IS ADDED TO THE ALLOY BY MANUFACTURER.

RECENT DEVELOPMENT OF D.AMALGAM

Mercury free direct filling amalgam alloys Gallium based alloys Low mercury amalgams Indium in mercury

AMALGAMATION

AMALGAMATION AND RESULTING MICROSTRUCTURE.

DURING TRITURATION Ag & Sn IN THE OUTER PORTION OF THE PARTICLES DISSOLVE INTO Hg . Hg DIFFUSES INTO ALLOY PARTICLES. Hg HAS LIMITED SOLUBILITY FOR Ag (.035WT%) & Sn (.6wt%).

AMALGAMATION OCCURS WHEN Hg CONTACTS THE

SURFACE OF Ag-Sn ALLOY PARTICLES. WHEN THE SOLUBILITY IN Hg EXEEDED- CRYSTALS OF 2 BINARY METTALIC COMPOUND PRECIPITATE INTO Hg. THESE ARE BCC Ag2Hg3 & HEXAGONAL Sn7-8Hg.

Low copper Alloys

Ag3Sn+Hg > Ag2Hg3 + Sn8Hg + Ag3Sn (r) (r1) (r2) (unreacted)

High Copper Alloys

(1)

Admixed alloys Ag3Sn + Ag-Cu +Hg>Ag2Hg3 + Sn8Hg + Ag3Sn + AgCu

LATER, Sn8Hg + AgCu > Cu6Sn5 + Ag2Hg3 (r2) (eutectic) (n) (r1)

Single Composition

AgSnCu+ Hg > Cu6Sn5 + Ag2Hg3 +AgSnCu

PROPERTIES OF SET AMALGAM.

MICROLEAKAGE. DIMENSIONAL CHANGES. STRENGTH. CREEP. TARNISH & CORROSION.

MICROLEAKAGE.

OCCURS DUE TO PENETRATION OF FLUIDS OR DEBRIS AROUND THE MARGINS THAT CAN LEAD TO SECONDARY CARIES. AMALGAM HAS GOT A SELF SEALING PROPERTY CORROSION PRODUCT WILL FILL THE TOOTH RESTORATION INTERFACE & PREVENT MICROLEAKAGE.

DIMENSIONAL CHANGES
CONTRACTION EXPANSION

ACCORDING TO ADA SPECIFICATION ,IT SHOULD NOT EXPAD OR CONTRACT MORE THAN 20u\cm AT 37 degree celcious BETWEEN 5min AND 24hrs AFTER BEGINNING OF TRITURATION. MODERN AMALGAM ALWAYS SHOWS CONTRACTION. OLDER AMALGAM SHOWS EXPANSION.

CONTRACTION.
RESULT IN MICROLEAKAGE & SECON DARY CARIES. FACTORS FAVOURING CONTRACTION

LONGER TRITURATION TIME. HIGHER CONDENSATION PRESSURE. SMALL PARTICLE SIZE. Hg ALLOY RATIO.

EXPANSION.

IF A Zn CONTAINING LOW Cu \ HIGH Cu IS CONTAMINATED DURING TRITURATION \ CONDENSATION ,A LARGE EXPANSION TAKE PLACE.IT USUALLY STARTS FROM 3-5 DAYS AND CONTINUE FOR MONTHS CREATING VALUES UPTO MORE THAN 400um DELAYED EXPANSION. H2O + Zn ZnO + H2

PROTRUSION OF RESTORATION OUT OF CAVITY INCREASE CREEP INCREASE MICROLEAKAGE PITTED SURFACE OF RESTORATION & CORROSION.

STRENGTH.

AMALGAM IS SRONGEST IN COMPRESSION & MUCH WEAKER IN TENSION & SHEAR , THE PREPARD CAVITY DESIGN SHOULD MAXIMIZE THE COMPRESSION FORCES IN SERVICE & MINIMIZE TENSION \ SHEAR FORCES.

CREEP.

DEFINED AS A TIME DEPENDENT PLASTIC DEFORMATION UNDER CONSTANT STRESS. ACCORDING TO ADA SPECIFICATION NO 1 CREEP SHOULD BE BELOW 3%.

CREEP OF LOW Cu AMALGAM IS 0.8-8% & HIGH Cu IS 0.4-1%.

MANIPULATION

MANIPULATION
(1) (2) (3) (4) (5) (6) Selection of materials Mercury:Alloy ratio Trituration Mulling Condensation Shaping & finishing

SELECTION OF MATERALS
a)

b)
c) d)

ALLOY MERCURY DISPENSORS PRE PROPOTION CAPSULE

MERCURY: ALLOY RATIO

(1) (2) (1)

Squeezing cloth Increased dryness technique EAMES technique

TRITURATION
(1)Hand mixing (2)Mechanical

MULLING

Improve homogenity of mass & get a single consistent mix

CONDENSATION
(1)

(2)

Hand condensation Mech.condensation

SHAPING & FINISHING.

CARVING. BURNISHING. POLISHING.

MERCURY TOXICITY.

PRECAUTIONS
Ventilation Disposal Sealed containers Vaccum cleaners

INDICATIONS
(1) (2) (3) (4)

Moderate to Large Class I & Class II Restorations Class V Restorations Temporary Caries Control Restorations Foundations

CONTRAINDICATIONS
(1)Esthetics (2)Extensive tooth destruction (3)Small Class I & II Cavities

CAVITY PREPARATIONS FOR AMALGAM RESTORATION

What is a Cavity Preparation?

It is a mechanical alteration of a defective, injured, or diseased tooth to receive a restorative material that reestablishes a healthy state for the tooth, including esthetics corrections where indicated & normal form & function.

STEPS IN CAVITY PREPARATION

(1)

Initial Cavity preparation

(2)

Final Cavity Preparation

Initial
1.

2.
3. 4.

Outline form & initial depth Primary Resistance form Primary Retention form Convenience form

Final
1. 2. 3. 4.

Removal of any remaining defective Enamel or Dentin on Pulpal floor Pulp protection Finishing External Walls Final Cleaning & Inspection

CLASS I
They are restorations on occlusal surfaces of premolars & molars, occlusal 2/3rd of facial & lingual surface of molars & lingual surface of maxillary incisors

CLASS II
They are reostorations on the proximal surfaces of posterior teethmesio occlusal , disto occlusal, mesio occluso distal

CLASS III
They are restorations on the proximal surface of anterior teeth that that do not involve incisal angle.

CLASS V
They are restorations on gingival 1/3rd of facial & lingual surface of all teeth.

CLASS VI
They are restorations on incisal edge of anterior teeth or cusp tip region of posterior teeth.

FAILURES OF AMALGAM RESTORATIONS

Signs of failures :
1.

2.
3. 4.

5.
6. 7.

8.
9.

Fracture Lines Marginal Ditching Proximal Overhangs Poor anatomic contours Marginal Ridge incompatibility Improper Proximal Contacts Recurrent Caries Poor occlusal Contacts Amalgam Blues

Reasons For Failures:

1.

2.
3. 4. 5.

Improper Case Selection Improper Cavity Preparation Faulty Selection & manipulation of Amalgam Errors in Maricing Procedures Post Operative Factors

AMALGAM TATOO
Accidental implantation of silver containing compounds into oral mucosal tissue Occur:

1. 2. 3. 4.

Removal of old amalgam Broken Pieces-socket-tooth extraction Particles entering surgical wound Amalgam dust in oral fluids- abrasion areas Seen as Grayish black pigmentation Com. Sites- Gingiva, buccal mucosa, alveolar mucosa

CONCLUSION
Class I & II Restorations are still common procedures performed by general Dentists. Class VI are used infrequently It is important for practitioners to understand the indications, advantages, techniques & limitations of these restorations. When used correctly & properly selected cases, these restorations have the potential to serve for many years

THANK YOU!!!!