Dental Amalgam

Prof. Wedad Etman, Professor of Operative Dentistry

Introduction
Amalgam has been an accepted part of dental therapeutics for more than years and is still used for the majority of direct posterior restorations.

 The reasons for its popularity lie in its ease of manipulation, relatively low cost. an long life. Some concern has been raised about mercury toxicity from both biologic and an environmental point of view; however, it is believed that amalgam presents an acceptable risk-to-benefit ratio when properly used.

 Alloy: Alloy is a union of two or more metals Amalgam: Amalgam is an alloy in which mercury occurs as a main constituent. Dental amalgam: The dental amalgam is an alloy of mercury with silver, tin, and varying amounts of copper, zinc and other minor constituents.

Composition
Mercury (Hg) in dentistry
Have a bright , mirror-like surface Amalgamates i.e. Dissolves other metals (silver, zinc) to produce a plastic mass at room temperature

Constituents in Amalgam
Basic
Silver Tin Copper Mercury

Other
Zinc Indium Palladium

 Silver

% about / of alloy

Contributes to strength Flow (i.e. deformation under load) Regulates setting time to some extent It contributes to the setting expansion of amalgam Tarnish & corrosion resistance

 Tin - % ( of amalgam alloy) Helps in amalgamation (has great affinity to mercury) but: During amalgamation Tin-mercury (gamma two phases) weakest phase reduces strength of amalgam Setting expansion of amalgam Flow Increases setting time Reduces strength, hardness, and setting expansion.

 Copper - %:
Contributes hardness & strength Flow Setting expansion

Zinc - % . % or more (zinc containing alloy) . % non zinc alloy Act as a scavenger for foreign substances such as oxides during manufacturing The most serious problem related to zinc is delayed expansion

In Brief
Mercury ( % to %) Alloy powder ( % to %) Silver ..gives strength Tin.workability Copper..strength & corrosion resistance Zinc.prevents oxidation

Indications
- Restoration of posterior teeth (Class I & II) (Moderate to large preparations) - In some cases restoration distal surface of the canine - Class V preparations (some cases) - Class VI preparation - Core build up for badly broken down teeth in the posterior teeth

Contraindications
. When esthetics is important (e.g. anterior teeth ) . Patients have a history of allergy to mercury or other amalgam components . Remaining tooth structure requires support. . Treatment of incipient or early, primary fissure caries.

Advantages
) High compressive strength ) Good adaptability to cavity walls ) Low coefficient of thermal expansion ) Indestructibility in oral fluids ) Convenience of manipulation ) Capable of taking & maintaining high Polish ) Fairly low cost.

Disadvantages
. . . . Objectionable esthetics (silver color) low edge strength (must not be in thin sections) Thermal conductivity (Pulp protection) Galvanic current with other metallic restorations or even non-uniform condensation . Do not support weakened tooth structure

. Low tensile and shear strength. It is a brittle restoration that is greatly vulnerable to fracture under high tensile or shear stresses, such as the isthmus and the margins. . Poor esthetics due to its objectionable metallic color, which may be further complicated by excessive discoloration due tarnish and corrosion.

. Creep tendency (time-dependent deformation of set material in the mouth) may result in form instability in term of marginal deterioration, flattening of contacts, saucering of occlusal anatomy and formation of gingival overhangs. However, creep values are markedly decreased in recent high copper amalgam.

Slow deformation of amalgam placed under a constant load

. High thermal conductivity which may cause pulp irritation unless it is adequately protected by adequate thickness of remaining dentin bridge or by an intermediary insulating base material if the cavity preparation is deep. . Lack of adhesion to tooth structure which dictates the use of mechanical means of retention like undercuts and grooves in the cavity preparation.

. Electrical irritation through Galvanism can occur if another metallic restoration with different degree of electronegativity was placed in its close proximity, e.g. cast gold. The resultant currents can cause patient's discomfort or leave a metallic taste in the mouth, and can accelerate the corrosive breakdown of the electro-negative metal. . Potential health hazards due to presence of mercury in dental amalgam have raised concerns over its safety along many years.

Types of Amalgam
According to particle shape:
. Lathe cut . Spherical

According to the copper content:

. Traditional / conventional ( - % copper) . High copper amalgam (> % copper & up to %)

According to the zinc content:

. Zinc containing > . % alloy . Non-zinc alloy < . %

According to the mercury content:

. Conventional % Hg . Mercury free galloy . Cold-welded Amalgam (Silver fill)

 Lathe cut: ball milled irregular shaped powder particles ranging from spindles to shavings.

Spherical: atomized (round) smooth surfaced spheres: Require less mercury as they have smaller surface area per volume Develop more early strength due to its faster set Require less condensation force -

However, spherical amalgams have certain disadvantages as: More difficult to obtain good interproximal contacts and contours in class II restorations . Have shorter working time.

Conventional Low-Copper Alloys

Dissolution and precipitation Hg dissolves Ag and Sn from alloy Intermetallic compounds formed
Ag-Sn Alloy Hg Sn Hg

Ag Ag Ag Sn Sn Ag-Sn Ag-Sn Alloy Alloy Mercury (Hg)

Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg

Phillips Science of Dental Materials 2003

 Gamma () = Ag Sn

Hg Ag-Sn Alloy Hg Hg Ag Ag-Sn Alloy Sn Sn Mercury Ag Sn Ag-Sn Alloy Ag

unreacted alloy strongest phase and corrodes the least forms % of volume of set amalgam

Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg

Phillips Science of Dental Materials 2003

 Gamma (1) = Ag Hg

Ag-Sn Alloy

matrix for unreacted alloy and nd strongest phase micron grains binding gamma () % of volume

Ag-Sn Alloy Ag-Sn Alloy

Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg

Phillips Science of Dental Materials 2003

 Gamma (2) = Sn Hg

weakest and softest phase corrodes fast, voids form corrosion yields Hg which reacts with more gamma () % of volume volume decreases with time due to corrosion

Ag-Sn Alloy

Ag-Sn Alloy

Ag-Sn Alloy

Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg

Phillips Science of Dental Materials 2003

Admixed High-Copper Alloys

Ag enters Hg from Ag-Cu spherical eutectic particles

eutectic

an alloy in which the elements are completely soluble in liquid solution but separate into distinct areas upon solidification Hg Ag Ag-Sn Alloy

Ag-Cu Alloy

Both Ag and Sn enter Hg from Ag Sn particles

Ag Ag Sn Mercury Sn

Hg Ag

Ag-Sn Alloy

Ag3Sn + Ag-Cu + Hg Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5 AgAg-

Phillips Science of Dental Materials 2003

 Sn diffuses to surface of Ag-Cu particles

Ag-Cu Alloy

reacts with Cu to form

(eta) Cu Sn ()

around unconsumed Ag-Cu particles

Ag-Sn Alloy

Ag-Sn Alloy

Ag3Sn + Ag-Cu + Hg Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5 AgAg-

Phillips Science of Dental Materials 2003

 Gamma (1) (Ag Hg ) surrounds () eta phase (Cu Sn ) and gamma () alloy particles (Ag Sn)

Ag-Cu Alloy

Ag-Sn Alloy

Ag-Sn Alloy

Ag3Sn + Ag-Cu + Hg Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5 AgAg-

Phillips Science of Dental Materials 2003

Single Composition High-Copper Alloys

Gamma sphere () (Ag Sn) with epsilon coating () (Cu Sn) Ag and Sn dissolve in Hg

Ag-Sn Alloy Ag Sn Ag Ag-Sn Alloy Ag-Sn Alloy Sn

Mercury (Hg)

Ag3Sn + Cu3Sn + Hg Ag3Sn + Cu3Sn + Ag2Hg3 + Cu6Sn5

Phillips Science of Dental Materials 2003

 Gamma (1) (Ag Hg ) crystals grow binding together partiallydissolved gamma () alloy particles (Ag Sn) Epsilon () (Cu Sn) develops crystals on surface of gamma particle (Ag Sn) in the form of eta () (Cu Sn )

Ag-Sn Alloy

Ag-Sn Alloy Ag-Sn Alloy

reduces creep prevents gamma- formation

Ag3Sn + Cu3Sn + Hg Ag3Sn + Cu3Sn + Ag2Hg3 + Cu6Sn5

Phillips Science of Dental Materials 2003

High copper amalgam alloys

more than % & up to % copper Two types are available - Admixed or dispersion alloy - Single composition - Admixed or dispersion alloy / Lathe cut particles (conventional) & / Spherical - Single composition amalgam silver-tin-copper High copper content ranging from to %

Manipulation of Amalgam

. . . . .

Trituration Condensation Carving Burnishing Polishing

. Trituration
It is the process by which the alloy and mercury are amalgamated together into a coherent, homogenous smooth plastic mass of amalgam Its either Hand or Mechanical

Amalgamator (Triturator)
Speeds vary upward from rpm Times vary from seconds Mix powder and liquid components to achieve a pliable mass Reaction begins after components are mixed

 Mixing time
refer to manufacturer recommendations
Click here for details

Overtrituration

hot mix

sticks to capsule

decreases working / setting time slight increase in setting contraction grainy, crumbly mix

Undertrituration

Phillips Science of Dental Materials 2003

Proportioning (Alloy / Mercury ratio)

recommended ratio that gives optimum performance & best physical properties i.e. reduce the amount of mercury left in the restoration to an acceptable level

 Dispensing of alloy & Hg Alloy: dispensed either by: weight or by volume Pre-weighed pellet or tablets Hg: Can be measured by weight or volume

Methods of proportioning: Simple weighing balance for both alloy & mercury Mechanical dispensers for both alloy & mercury (by weight) Dispensers can achieve quit accurate ratios of Hg to alloy But: Risk of office Hg contamination

Hg ratio
Either excess or little mercury in the final amalgam has a marked effect on its properties Excess mercury gives large amount of weak reaction products and causes lowering of C.S. Little mercury non coherent dry grainy mix

Pre-proportioned capsules
contains compartments st alloy powder or pellet nd .. Hg Separated by a membrane which is ruptured either manually Before mixing or by itself during mechanical mixing

 Some capsules require activation before trituration, others are activated when machine starts vibrating (selfactivating capsules) color coding of capsules indicates: number of spills type of amalgam Some Capsules contain plastic or metal pestle to help in trituration

Capsules are expensive BUT

They are more convenient More time saving Correct proportioning & less waste Better mercury hygiene

Amalgam Capsules
Contain (in separate compartments):
powdered amalgam alloy liquid mercury

Some are manually activated, others selfactivated Pestle usually included

Mechanical trituration:
By the use of amalgamators

Amalgamator (Triturator)
Speeds vary upward from rpm Times vary from seconds Mix powder and liquid components to achieve a pliable mass Reaction begins after components are mixed

Factors that control the quality of trituration

Speed (medium- high or low speed in rpm)
The more speed less time

Time of mixing ( -

seconds or more)

e.g. spherical less than conventional

size of mix large more time Force exerted by capsule (size) & pestle (weight) Distance traveled by the arms holding the capsule

Quality of trituration
Properly triturated amalgam is convenient to handle shiny warm homogenous Poorly triturated amalgam is dull, gray appearance dry & crumbly & non cohesive inconvenient to manipulate Over triturated amalgam is more plastic (or soupy) more difficult to remove from capsule faster setting low strength

Mulling
It is the process by which the mix is given a cohesive form done by rubbing (mulling) of amalgam a few seconds in a piece of rubber dam between thumb & fingers Never done in bare hands to avoid Contamination

 Conventional types requires more Hg by weight range from: : to : For good wetting of alloy with hg The excess hg will be removed later by squeezing before condensation

- Condensation
It is the process of packing and adaptation of the triturated amalgam in the prepared cavity It should start immediately after trituration

Methods of condensation
- Hand condensation - mechanical condensation - ultrasonic condensation

Objectives of condensation
- Properly adapt amalgam to cavity walls - Elimination of excess mercury - Pushing together alloy particles - Elimination of voids holes

Condensation
Forces
lathe-cut alloys
small condensers high force

spherical alloys
large condensers less sensitive to amount of force vertical / lateral with vibratory motion

admixture alloys
intermediate handling between lathe-cut and spherical

During hand condensation two techniques could be used:

A -Increasing dryness technique: st increment of amalgam condensed into the cavity not squeezed dry while the following layers were dryer until the surface of the cavity So the dryer layers act as a blotter to absorb excess mercury B- Minimal mercury technique: (Eames technique) Decreasing the mercury alloy ratio before mixing as to : So mercury in the mix will be %

- Carving
Carving is carried out to produce/simulate functional anatomy of the restoration Objectives:
Is to remove mercury rich layer on the surface Re-establish contour & contact

 Carving should be done with sharp instruments as dull instrument disturb crystallization & draw excess mercury to the surface Alloy mass should be properly hardened before starting carving to prevent amalgam from pulling from the margins Carving could be done in any direction except towards the cavity margins to avoid creation submerged margins & prevent excess mercury from being drawn to this critical area

- Burnishing
Pre-carve
removes excess mercury improves margin adaptation

Post-carve

improves smoothness less leakage

Ben-Amar Dent Mater 1987

Combined

Pre-carve Burnishing
This step is performed before carving A large ball or egg-shaped brusher is rubbed upon the surface of the over-filled cavity It smoothens margins and improves the adaptation It draws the excess mercury out to be removed by carving It Increases the corrosion resistance It decreases porosity

Post-carve burnishing
A small burnisher is used to apply force to the carved amalgam surface This will produce a shiny surface Improves smoothness & marginal integrity

- Early Finishing
After initial set

prophy cup with pumice provides initial smoothness to restorations recommended for spherical amalgams

Polishing
Increased smoothness Decreased plaque retention Decreased corrosion Clinically effective?
no improvement in marginal integrity
Mayhew Oper Dent Collins J Dent
Click here for abstract

Classifications
Based on copper content Based on particle shape Based on method of adding copper

Phases of amalgam
Hardened amalgam is a multiphase structure: The strongest phase is gamma phase Y The weakest phase is Y (tin mercurySn Hg) most susceptible to corrosion

Cu-Sn phase has: High strength Good corrosion resistance So high copper alloys show: Reduced tarnish & corrosion Less marginal breakdown Higher compressive strength particularly Early strength