Professional Documents
Culture Documents
Write Up
Write Up
Write Up
Dental amalgam has been used for over 150 years for the treatment of dental
cavities and is still used, in particular in large cavities due to its excellent
mechanical properties and durability. Dental amalgam is a combination of alloy
particles and mercury.It contains about 50% of mercury in the elemental form.
Terminologies
Amalgam: An alloy of mercury with one or more metals.
Dental amalgam alloy: An alloy that contains solid metals of silver, tin, copper and
sometimes zinc.
Dental amalgam: An alloy that results when mercury is combined with the
previously mentioned alloys to form a plastic mass.
History
1833: Crawcour brothers introduced amalgam to U.S.A, powdered silver coins
mixed with mercury, expanded on setting
1895: G.V. Black developed formula for modern amalgam alloy, 67% silver, 27%
tin, 5% copper, 1% zinc, overcame expansion problems
1960s: conventional low-copper lathe-cut alloys, smaller particles.
first generation high-copper alloys: Dispersalloy (Caulk), admixture of spherical
Ag-Cu, eutectic particles with , conventional lathe-cut, eliminated gamma-2 phase
1970s: first single composition spherical alloys: Tytin (Kerr), Ternary system
(silver/tin/copper)
1980s: alloys similar to Dispersalloy and Tytin
1990s: mercury-free alloys
Debut of Amalgam
Introduced in 1800s in France: alloy of bismuth, lead, tin and mercury plasticized
at 100 C poured directly into cavity.
Classification
According to the number of alloyed metals
Binary alloy
(silver, tin)
Quaternary
Ternary
alloy (silver,
alloy (silver,
tin, copper,
tin, copper)
and zinc)
Spherical
Smooth surface spheres
Advantages :
Require less mercury.
Lath cut
Spheroidal
Formulated by mixing the lath cut and
spherical particles
Increase the packing efficiency of the
alloy
Reduce the amount of mercury
required to produce a workable mix.
Advantages:
Easily carved.
Advantages:
Require less mercury.
Disadvantages:
Require more mercury.
Lower early compressive strength.
Disadvantages:
Difficult to carve.
Zinc containing
amalgam (>0.01%
zinc)
Powder
Zinc free
amalgam (<0.01%
zinc)
Tablets of
condensed
powder
particles
Capsules
together
with gauged
amount of
mercury
separated
by a
diaphragm.
Admixed
Unicompositional
Constituents in Amalgam
Basic:
Silver (Ag 4070%)
Tin (Sn 1230%)
Copper (Cu 1224%)
Mercury
Other:
Zinc (Zn 0-1%)
Indium (04%)
Palladium ( 0.5%)
Basic Constituents:
1. Silver (Ag): Major element. Whitens alloy. Decreases creep. Increases
strength. Increases expansion on setting. Increases tarnishing resistance.
2. Tin (Sn): Controls the reaction between Ag & Hg. Reduces strength &
hardness. Reduces resistance to tarnish & corrosion.
3. Copper (Cu): Ties up tin reducing gamma-2 formation Increases strength
Reduces tarnish and corrosion Reduces creep Reduces marginal
deterioration
4. Mercury (Hg): Activates reaction Only pure metal that is liquid at room
temperature Spherical alloys require less mercury smaller surface area easier
to wet 40 to 45% Hg Admixed alloys require more mercury Lathe-cut
particles more difficult to wet 45 to 50% Hg
Other Constituents:
1. Zinc (Zn): 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.
2. Indium (In): Decreases surface tension reduces amount of mercury
necessary reduces emitted mercury vapor Reduces creep and marginal
breakdown Increases strength Used in admixed alloys Example:
INDISPERSE (indisperse distributing company) 5% INDIUM
3. PALLADIUM (PD): Reduced corrosion Greater luster Example VALIANT
PHD (ivoclar vivadent) 0.5% PALLADIUM
ALLOY PRODUCTION
Alloy is produced predominantly as:
Irregular particles
Spherical particles
Irregular particles
Spherical particles
Gamma 1 (1) = Ag2Hg3 : matrix for unreacted alloy 2nd strongest phase 60% of
volume
Gamma 2 ( 2) = Sn8Hg: weakest and softest phase corrodes fast, voids form 10%
of volume volume decreases with time due to corrosion
2. High copper alloys :
High-copper amalgam was developed in1962 by the addition of silver-copper
eutectic particles to low-copper silver-tin lathecut particles. Compared to lowcopper amalgam counterparts, high-copper alloys exhibit the following properties:
greater strength less tarnish and corrosion less creep less sensitive to handling
variables and produce better long-term clinical results. High-copper amalgam
restorations also have a much lower incidence of marginal failure compared to
low-copper amalgam.
Two different types:
Admixed alloy powder
Single composition alloy powder
Composition:
Admixed alloy:
Silver 40-70%
Tin
- 26-30%
Copper- 9-20%
Zinc
- 0-1%
Unicompositional alloy:
Silver- 40-60%
Tin - 22-30%
Copper-13-30%
Zinc
-0%
CONTRACTION:
Result in microleakage & secondary caries.
Factors favouring contraction:
Longer trituration time.
Higher condensation pressure.
Small particle size.
High Hg alloy ratio.
Delayed Expansion : Zn containing low cu \ high cu alloy contaminated during
trituration or condensation , large expansion take place. Starts from 3-5 days and
continue for months creating values more than 400um.
H2O + Zn
ZnO + H2O
Results in:
Protrusion of restoration out of cavity
Increase creep
Increase microleakage
Pitted surface of restoration
corrosion.
2. STRENGTH
The strength of an amalgam restoration must be high enough to resist the biting
forces of occlusion.
1 hour = 40% to 60% compressive strength
(e.g., Tytin 45% and Dispersalloy 51%)
24 hours = 90% or more of their final strength
Coefficient of thermal expansion for amalgam which is 22 times greater than the
coefficient for tooth structure.
Use of single-composition-spherical alloys which leak more than lathe-cut or
admixed alloys.
CHEMICAL PROPERTIES
1. CHEMICAL CORROSION (TARNISH):
Tarnishing involves the loss of luster from the surface of a metal or alloy due to
formation of a surface coating. The integrity of the alloy is not affected, so no
change in mechanical properties. Amalgam readily tarnishes due to the formation
of a sulphide layer on the surface.
2. ELECTROCHEMICAL CORROSION:
Galvanic corrosion occurs when two dissimilar metals exist in a wet environment.
Electrical current flows between the two metals, corrosion of one of the metals
occurs. An acidic environment promotes galvanic corrosion. Corrosion occurs both
on the surface and in the interior of the restoration. Surface corrosion discolors an
amalgam restoration, lead to pitting and also fills the tooth/amalgam interface with
corrosion products, reducing microleakage. Internal corrosion will lead to
marginal breakdown and fracture.
THERMAL PROPERTIES
1. Thermal diffusivity:
Amalgam has a relatively high value of thermal diffusivity. Thus, in constructing
an amalgam restoration, an insulating material, dentine is replaced by a good
thermal conductor. In large cavities it is necessary to line the base of the cavity
with an insulating, cavity lining material prior to condensing the amalgam. This
reduces the harmful effects of thermal stimuli on the pulp.
2. Coefficient of thermal expansion:
This value for amalgam is about three times greater than that for dentine. This
coupled with the grater diffusivity of amalgam, results in considerably more
expansion and contraction in the restoration. Such a behavior may cause
microleakage around the filling since there is no adhesion between amalgam and
tooth substance.
BIOLOGICAL PROPERTIES
1. MERCURY TOXICITY:
It is a concern in dentistry because mercury and its chemical compounds are toxic
to the kidneys and the CNS. Mercury is toxic, but released in small amounts from
set amalgam. Safety should be considered for:
Patient
Operator
Environment
Proper handling and storage along with prompt cleaning of all mercury spills will
minimize risk of toxicity.
OSHA: acceptable level of mercury exposure 0.005 mg/mm3
How does mercury enter the human body?
Mercury Dose from Amalgam:
Average daily dose from 8 10 amalgam surfaces: 1-2 ug per day, well below
threshold levels
Threshold urine mercury levels:
subtle, pre-clinical effects: 30 ug per day
considered dangerous: 82 ug per day
Precautions:
The clinic should be well ventilated.
Proper storage of mercury in a container with tight lid.
While using capsules, lids of the capsules should be tight fitted and no spilling
should occur.
If by chance mercury is spilled on the floor, it should be wiped clean immediately.
If mercury comes in contacts with skin, one must wash with soap and water
immediately.
Proper waste disposal methods undertaken.
Use of eye protection, disposable face masks, and gloves.
Periodic monitoring of actual exposure levels in blood and urine.
Avoid heating instruments to> 80C
Biocompatibility of dental amalgam
Biocompatability of amalgam is thought to be determined largely by the
corrossion products released. Corrosion depends on the type of amalgam.
In cell culture screening tests, free or non leaded mercury from amalgam is
toxic .With the addition of copper, amalgams becomes toxic to cells in culture but
low copper amalgam that has set for 24hrs does not inhibit cell growth.
Implantation tests show that low copper amalgams are well tolerated but the high
copper amalgams can cause severe reactions when in direct contact with tissue.
In usage tests, the response of the pulp to amalgam in shallow or in deep but lined
cavities is minimal and amalgam rarely causes invisible damage to the pulp
however, pain results from using amalgam is deep unlined cavity preparations( 0.5
mm or less)
Margins of newly placed amalgam restorations show significant microleakage.
Marginal leakage of corrosion and microbial products is probably enhanced by the
natural daily thermal cycle in the oral cavity.
Lichenoid reaction represent a long term effect in the oral mucous membrane
adjacent to amalgam restoration. Buccal mucosa and lateral border of the tongue
being the areas affected often.
2. Amalgam tattoo:
Accidental implantation of silver containing compounds into oral mucosal tissue
Occur during:
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
Common Sites- Gingiva, buccal mucosa, alveolar mucosa
Indications
Amalgam should be considered for:
class I, II.
the distal surface of the cuspids.
class V in posterior teeth.
Material selection in such case will depend on:
The extent of the lesion.
Amalgam is preferable in the following situations:
Small and medium sized class I and II cavities
Cavities with four walls and floor to decrease the tensile load
Under mined cusps will require cusp capping
In extensive lesions cast gold will serve better.
Caries incidence
Amalgam may be favored if:
Corrosion products seal the tooth restoration interface and prevent bacterial
leakage.
Minimal placement time
Long lasting if placed under ideal conditions.
Very economical.
Self sealing
Biocompatible
DISADVANTAGES
Some destruction of sound tooth tissue.
Poor esthetic qualities.
Long-term corrosion at tooth-restoration interface may result in ditching leading
to replacement.
Galvanic response potential exists.
Local allergic potential.
Marginal breakdown.
Bulk fracture
Secondary caries
Sometimes excess Hg within the restoration may seep through the dentinal
tubules, discolor dentin and result in blackish or grayish staining of teeth.
Concern about possible mercury toxicity that affects the CNS, kidneys and
stomach.
Gallium alloy
The current composition of gallium alloy comes as a powder and contain:
Silver 50%wt.
Tin 25.7%wt.
Copper 15%wt.
Palladium 9%wt.
Traces 0.3%wt.
Traces 0.5%wt.
It is also available as a liquid containing;
Gallium 65%wt.
Indium 18.95%wt.
Tin 16%wt.
Conclusion
Historically, amalgam restorations have been among the most common of all
dental restorations. The use of high-copper amalgams has improved dramatically
the clinical longevity of amalgam (5-10 years under ideal conditions). Its major
advantage has been the decline in the cases of microleakage. The use of
precapsulated amalgam has reduced significantly the risk of exposure of dental
personnel to mercury vapor.Although small amounts of mercury release from
amalgam is known to occur, it does not cause any major health problems. Although
there are other alternatives to amalgam they cannot match amalgams longevity,
ease of manipulation and versatility.Hence dental amalgam will be a part of
dentistry for a long time to come.
References
Phillips Science of Dental Materials 11th Edition
Craigs Restorative Dental Materials 12th Edition
Sturdevants Art and Science of Operative Dentistry 5th Edition
Textbook of Operative Dentistry Amit garg and Nisha garg
Dental Materials, clinical applications for dental assistants and dental hygienists
Dental Amalgam: Update on Safety Concerns
JADA 1998; 129:494-501
Materiales dentales: Federico Humberto Barcel Santana & Jorge Mario Palma
Calero