ORIGINAL ARTICLE, AMALGAM REPAIR: EFFICACY OF SPHERICAL-PARTICLE AMALGAM AS REPAIR MATERIAL Asaad JM*, BDS, MCPS, MDS. Feroze AK**, BDS, FCPS Haleem A***, BDS, MSc Faisal ABY** OBJECTIVE: Repair of faulty or broken amalgam restorations is a routine procedure carried out in dental practices. Various factors affect the bond - strength of repaired restorations. One of such factors is the type of amalgam alloy used to repair the restoration. This study was conducted to determine which type of alloy produces highest bond-strength, METHODOLOGY: One hundred twenty samples were prepared from conventional, admixed and lathe-cut amalgams (40 samples from each type). Equal number of these samples was repaired with spherical-particle amalgam, conventional amalgam, admixed amalgam and lathe-cut amalgam using amalgambond (a 4-META dentine adhesive) as a bonding material. Tensile bond-strength of the samples was tested on electro-mechanical testing machine at ctoss head speed of 10 mm per minute at Pakistan Ordnance factory, Wah Cantonment. To determine the significance of the findings, Anova (one-way) was applied. RESULTS: revealed that spherical amalgam produces highest bond-strength. The p-values <0,05 were considered significant. CONCLUSION: The samples repaired with spherical amalgam (p- value p<00,0001) show highly significant bond strength. KEY WORDS: Amalgam repair, bond-strength of repaired amalgam, spherical amalgam, ‘Pak Dent Assoc.2009; 18(2): 054-058, INTRODU ‘TION treat children and lactating mothers and was found safe. The National Institute of Dental and Craniofacial ilver amalgam is one of the oldest filling materials Research (NIDCR) have released results of two long-term used in dentistry’, Though great concern has been _linical trials which studied the health effects of amalgam shown about toxicity of mercury but it has been in children.’ One of the studies was conducted in Europe, proved that mercury levels higher than released from the other in the United States. These studies reached the same conclusion: children whose cavities were filled with, dental amalgam had no adverse health effects." No health Children and pregnant women are considered most problem has been identified in infants born to women with susceptible subjects to contract toxic effects of any amalgam restoration, ¢ oF material. Dental amalgam has been used to dental amalgams donot pose any health problem? Due to alleged toxicity of mercury, researchers have 7 Profeso, Deparaent, of Operative Pemsny, Qussin developed materials to replace silveramalgam but they do niversity, Qassim, Saudi Arabia. aoc forall clink ce ver ame gam but ey ++ Assistant Professor, Operative Dentistry, inquatUniversiy of "Ot sult for all clinical applications. Moreover, they are Medical and Health Sciences, Hyderabad, Pakistan, costlier than amalgam ‘eee Assistant Profesor, Community Dentistry, Qassim University, Qassim Saudi Arabia, Dental amalgam is popular because of its cost sone TES eat Material Sciences, Qassim Universiy, °ffectiveness, ease of manipulation, adequate mechanical Qassim, Saudi Arabia. properties, proven longevity, low technique sensitivity, Correspondence: Dr Asad IN ‘200d wear- resistance, self sealing ability and insolubility JPDA Vol. 18 No.2 Apr-Jun 2009 s4‘Asaad JM J Feroze AK / Haleom A Faisal AB Efficacy Of Spherical-particle Amalgam As Repair Material in oral fluids.**It therefore, remains material of choice for posterior restorations."* Defective dental amalgam restorations are usually treated by replacement with new amalgam or other restorative materials, causing dentists to spend about half their chair time replacing restorations.” In certain clinical situations replacement may not be recommended as it ‘enlarges the cavity by 0.2-0.5 mm and further weakens the tooth structure." Teeth with cavity preparation become weak as the sthmus widens and fractures more easily than intact tecthI1. Therefore, it is recommended that instead of replacing a whole restoration, its repair should be preferred wherever, possible. It will maintain resistance of the tooth.” It is reported that the smaller the restoration, the stronger the tooth, thus, if unnecessary sound enamel and dentin removal is avoided, strength is maintained and longevity of the tooth is increased,’** ‘Amalgam repair is considered @ viable conservative altemative to replacement as it is @ simple and quick procedure.” In a clinical study, 44 out of 45 amalgam repairs were considered satisfactory after two years.""In a 15- year review, 67 out of 1117 mechanically condensed amalgams had been refinished or repaired and only 25% failed after unspecified periods.” This proves that repair of amalgam is an acceptable, beneficial and durable clinical procedure, Various methods, techniques and materials have been reported in literature to accomplish dental repair with varying degree of success. One factor which has an influence on strength of repair is the type of amalgam, alloy used to repair faulty restoration. Amalgam alloys have undergone great variations since its introduction into dentistry. Initially, amalgam alloys were prepared as ingots and the alloy powder was achieved by grinding the ingot on a lathe. These particles used to be like lathe-cut filings with low copper content 8. Bat since then, amalgam composition has been greatly improved by the scientists. High copper amalgam alloy ‘can now, be produced either as lathe cut particles or as spherical particles.” Dental amalgam alloy is currently classified into three categories on various bases. Alloys classified on the basis ‘of copper content include conventional or low copper alloy and copper enriched or high copper alloy. Secondly Alloys classified on the bases of particle geometry and size consist of “Lathe cut particles”, “Spherical particles” and Admixed patticles. Thirdly, Alloys classified on the base of zine content comprises Zine free and Zine containing." Spherical-particle alloy and admixed-particle were used to repair the old amalgam. The result show highly significant enhancement in bond strengths of the specimens repaired with spherical-particle alloys.” In another study the researchers found the same results. They reported that spherical alloy produce more bond strength ascompared to admixedalloy.”” These observations negate the results presented by Cooley, Teseng and Barkmeir in 1991." In their study, they used spherical and admixed alloys with amalgambond as an adhesive. They found no difference between the bond strengths of spherical and admixed alloys. In another study on strength of repaired amalgam, the researcher found that same kind of alloy, as used in existing broken restoration should be used to repair amalgam.” Recently, a study showed that amalgams repaired with 2 different amalgam yielded higher strength values than those repaired with the original amalgam.” This study was planned to confirm the results of above mentioned studies. ‘The purpose of this study was to compare and determine the efficacy of spherical-particle amalgam as repair material METHODOLOGY Three types of amalgams were used to prepare 120 cylindrical samples, 40 samples from each type. ‘The amalgam used were Conventional Amalgam alloy (Best Industry & Commerce Co., Ltd. North Zhongsha Road Shanghai), admixed alloy, ARISTALLOY (Engelhard- CLALUK, Ltd, David Road, Chessington K'T9, UK) and lathe-cut alloy, CAVEX AVALLOY (Haarlem, Cavex Holland, BV) and were designated as group ‘A’“B’ and‘C” respectively. ‘The three amalgams included in the study were mixed according to manufactures’ instructions and were condensed with persistent force, into transparent hard stie tubes of 4.0 mm diameter and 10.0 mm length to prepare 120 samples. 40 tubes were filled up to 5.0 mm (half of their lengths) with conventional amalgam; similarly 40 tubes were filled with admixed amalgam and, 40 with lathe-cut amalgam. They were allowed to set hard for 7 days. On the flat exposed side of the samples, a dentine adhesive, AMALGABOND (Parkell, srmingdale, NY 11735, USA) was applied. The adhesive-coated sides, with the help of a probe were pushed inside the tubes such that uncoated sides (opposite sides of the samples) came in level with the margins of the tubes. JPDA Vol. 18 No.2 Apr - Jun 2009‘Asaad JM J Feroze AK / Haleom A Faisal AB Efficacy Of Spherical-particle Amalgam As Repair Material From Group ‘A’ 10 samples were picked up randomly. Freshly mixed high copper spherical amalgam, CINALUX (Dental Corp. P.O. Box # 16315-477 Tehran) was packed against the coated sides to completely fill transparent tubes. Similarly, conventional, admixed and Jathe-cutamalgams were filled to prepare 10 samples each from group A. The plastic tubes were removed after 24 his. Similarly, from group Band C, samples were randomly picked and 10 samples were repaired with each type of repair material ie. spherical, conventional, ‘admixed and lathe-cut amalgams. The samples were subjected to clectromechanical universal testing machine (SATEC USA) at the crosshead speed of 10 mm per minute to collect the data.” The collected data were analyzed using SPSS. One- way ANOVA was applied to determine the significance of the results that were considered significant at p value < 0.05, RESULTS The samples prepared with conventional amalgam and repaired with spherical showed mean Tensile Bond Strength (TBS) of 4.8 MPa. The samples repaired with conventional, admixed and lathe-cut amalgams showed bond strength in the range of 3.6-3.8 Mpa (Figure 1) ‘Mean of TBS (Ma) Sper ‘maim Repair Material Figure 1. Conventional amalgam The samples prepared with admixed amalgam and repaired with conventional, admixed and_lathe-cut amalgams showed mean TBS between 3.6 and 3.8 MPa showed significantly higher mean TBS of 4.8 MPa (Figure 2) 50 48 46 44 42 40 38 36 ‘Mean of TBS (Mda) 34 im Repair Material ‘Sonim Figure 2, Admixed amalgam, The samples prepared with lathe-cut amalgam when repaired with conventional amalgam showed mean TBS, between 3.6 - 3.8 MPa. This bond strength was slightly higher than samples repaired with admixed and lathe-cut amalgams in this group. The samples repaired with ‘admixed and lathe-cut amalgams showed mean TBS in the range of 3.4 — 3.6 MPa. These samples showed lowest bond values undertaken in this study. Though in this group conventional amalgam-repaired samples showed better 50 48 46 44 42 40 38 ‘Mean of TBS (Ma) 34 Repair Material ea Figure 3. Lathe cut amalgam, ‘The same samples when repaired with spherical amalgam JPDA Vol. 18 No.2 Apr-Jun 2009 56‘Asaad JM J Feroze AK / Haleom A Faisal AB Efficacy Of Spherical-particle Amalgam As Repair Material bond strength but it was still significantly lower than the samples repaired with spherical amalgam having TBS of 4.8 MPa (Figure 3). The samples repaired with amalgams otherthan spherical-particle amalgam showed variation in their TBS values but none of them had mean TBS higher than 3.80 Mpa (Figure 1-3). The results of this study show that spherical amalgam has shown to be the best of all ‘materials that were used for repair purposes (P-value = 00.0001). DISCUSSION This study clearly reveals that amalgam repair performed with spherical-particle amalgam has higher ‘TBS than performed with any other type of amalgam as was suggested in a study done by Speigel and Mjor.* Results of present study also contradict the results of the study done by Cooley, Teseng and Barkmeir.” These searchers found that there is no difference between TBS values of samples repaired with spherical amalgam or admixed amalgam. Geometry of packing particles has significant role in the density of materials. Sphere particles pack more densely than irregular particles." The reason for higher bond strength with spherical amalgam may be due to its packing density. Due to the close packing of spherical- particle amalgam, the density increases, porosity ‘decreases and the quality of the amalgam improves. Less porous and better quality amalgam probably, gives better bond strength, In order to improve the packing density of the lathe- ‘cut particles, they have to be displaced in relationship to ‘each other. In order to achieve such a displacement, one ‘must overcome an "internal friction” that exists between the different particles. That frietion is lower for spheres than for lathe-cut particles. Admixed alloys have irregularly shaped particles which display improved physical characteristic. Such particles should entrap easily into resin adhesive and should produce higher bond strengths. But admixed alloys, are not unicompositional. Therefore, on storage, oxidation ‘of one of the components may occur. It may cause reduction of bond strength of this type of alloys as delay in insertion and condensation of amalgam during restoration, of a cavity allows oxidation of remaining amalgam. ‘Oxidation of these particles reduces cohesive bond between them.” It subsequently, decreases the longevity of the restoration, Its therefore, recommended that once ‘mixed, amalgam should be packed into the cavity within 3-4 minutes: ‘One more logical sson to develop higher TBS with Spherical-particle alloys may be that these alloys have ‘greater surface area, If an adhesive is applied on greater surface area (adherent), higher bond results. Similarly, it ‘might have happened here, because of more contact area between resin adhesive and spherical particles. The results, of this study match with the results of studies done by Morril et al. The previous latest study done on this, subject also proves that spherical-particle amalgam creates higher bond strength than any other type ofalloy.” CONCLUSION ‘Whenever decision is taken to repair an old amalgam, restoration, spherical-particle amalgam alloy should be used ittespective of alloy used in original restoration. REFERENCES de'Morais PMR, Rodrigues AL. Je, Pimenta LA, Qualitative ricroleakage evaluation around amalgam restorations with iferent treatments on cavity walls. J Oper Dent 1999; 24: 217- 22. Dodes JE. The amalgam controversy: an evidence analysis, JAm Dent Asso° 2001; 132: 348-356, DeRouen TA, Matin MD, Leroux BG, Townes BD, Woods 35 Leito J, Casto-Caladas J, Luis H, Bernardo M, Rosenbaum G, Martin IP Neurobehavioral effects of dental amselgam in children a randomized clinical tial. J Am Med Assoc 2006; 295:1784- 1792, Gelband H. ‘The science and politics of dental amalgam. Int. J ‘Technol Assess Health care 1998; 14: 123-134, Diefenderfer KE, Reinhardt JW, Brown SB, Surface treatment effects on amalgam repair strength. Am JDent 1997; 10:9-14, Ozer F, UnluN, Ozturk B, Sengun A. Amalgam repair evaluation cofbondstrength and microleakage. J OperDent2002: 199-203 Anioniades MH, Pahini ST, Papadogiannis Y, Karezis A. Microleakage of bonded amalgam restorations; effect of thermal cycling. JOper Dent 2000; 25: 316-223. Osbome JW. Amalgam: dead or alive? Dental Update 2006; 33| 94.98, Going’R, Jendreson M. Failure related to materials used in restorative dentistry. Dent Clinic of North Am 1972; 16:71-86 Baratieri LN, Monteiro JrS, Andrada MAC. Amalgam repair: ceaserepor. Quintessence Inter 1992; 23:527-53 de’Souza GMD, Perera S Ir, Dias CTS, Paulillo LAMS. Practare resistance of the teeth restored with the bonded amalgam technique, JOper Dent 2001;26: 511-515, Diefenderier KE, Reinhardt JW. Shear bond strength of ten aghesiveresin amalgam combinations, Oper Dent 1997;22: 50- 56 Mondeli J, Stegall L,Ishikitiama A, Navarro MEL, S Fracture strength of human teeth with cavity prep Prosthetic Dent 1980; 47.419-422. Berry TG, Laswell HR, Osborne JW, Gale EN, Width of isthmus and marginal feilure of restorations of amalgam. J Oper Dent 1981; 6555-58, Penning C. Repair and revision 1, Repair or replacement of ‘amalgam, Ned Tijdschr Tandheetkd 200; 108:46-49. ipriano T M, Santos JF. Clinial behavior of repaired amalgam restorations: A two-year study.J Prosthetic Dent 1995;73:8+1 Kreulen C M, Tobi H, Gruythuysen RJM, van Amerongen WE, based JPDA Vol. 18 No.2 Apr - Jun 2009‘Asaad JM J Feroze AK / Haleom A Faisal AB Efficacy Of Spherical-particle Amalgam As Repair Material Borgmeljer PJ. Replacement risk of amalgam treatment modalities: | S-yearresuls. Dent 1998; 26: 627-632. 18, Roberson TM, Heymann HO, Swift FJ. Sturdevant's Art and ‘Science of Dentistry, th edition Mosby, Ine 2002; 133-230 19, Nuckles DB, Draughn RA, Smith TI. Evaluation of an adhesive system for amalgam repair: bond strength and porosity (Quintessence in 1994;25:829-833. 20, Taruta K, Kilyjima B, Takusagwa Y, Takagai K, Okada and (Otsuka. Influence of coarse particle shape on packing and sintering of bimodal size-distibuted alumina powder mixtures. J ‘ater Sei lets 1993512: 424-826, 21, Cooley RL, Tseng EY, Barkmeir WW, Dentinal bond strengths land micto” leakage of 4-META adhesives to amalgam and ‘composite resin. Quintessence Int 1991; 22: 979-983, 22, Hadavi F, Hey JH, Czech D, Ambrose ER. Tensile bond strength cof epaired amalgam. J Prosthet Dent 1992; 67:313-317, 23, Kanako Y, Masashi M, Toshiki, Keishi T,Akitomo R. Influence of cross hetd speed on micro-tenile bond strength of two-step achesive systems. J Dent Mater 2006; 22: 420-425, 24, Speigel J, Mior IA. Repair strength of dental amalgams. J Oper Dent 2006;31:122-126 25, Muhammed H, Sodetholem KI, Material system in dentistry, 2nd cdi, Dental amalgam-material system. Dept. of dental biomaterials, College of Dentistry, University of Florida, Gaines vileFL. 1981; 1-25. 26, Mort F, Galburt R, Kugel G, Zive M, Habib C. Comparison of JPDA Vol. 18 No. 2 Apr Jun 2009