DENTAL

AMALGAM

PRESENTED BY
DR. SAYAK GUPTA
 CONTENTS
1. HISTORY
2. DEFINITION
3. CLASSIFICATION
4. INDICATION/CONTRAINDICATION
5. ADVANTAGES/DISADVANTAGES
6. COMPOSITION
7. AMALGAMATION REACTION
8. MANUFACTURING PROCESS
9. PROPERTIES
10. MANIPULATION
11. CLINICAL ASPECTS OF SILVER AMALGAM
12. RECENT ADVANCES IN SILVER AMALGAM
13. FAILURES OF SILVER AMALGAM
14. HYGIENE RECOMMENDATION FOR MERCURY IN
DENTISTRY
15. STUDIES DONE ON AMLAGAM
16. CONCLUSION
17. REFERENCES
 HISTORY
 1833- Crawcour brothers introduced dental amalgam in the U.S (powdered silver
coins mixed with mercury)- expands on setting
 1895- G.V Black develops formula for modern amalgam alloy- (67% silver, 27%
tin, 5% copper, 1% zinc)- overcame expansion problem
 1960s
- Conventional low copper lathe cut alloys (smaller particles)
- First generation high copper alloys (eliminated gamma 2 phase-disperse alloy)
 1970s - first single composition alloy
 1990s- mercury free alloys
 AMALGAM WARS - The Controversy
In 1841, the American Society of Dental Surgeons declared
that “the use of amalgam constitutes malpractice”
AMALGAM USE DECLINED.

1842-a belief prevailed that amalgam exerted “a influence upon

the fluids of the mouth and
gives rise to an unhealthy action in the gums.”

1844- the society’s members were warned that they were to sign a
pledge “ NEVER TO USE amalgam ” or they would risk being
expelled from the membership.
Townsend - gave his personal directions for preparing the
amalgam, known as “ Townsend’s Amalgam”.

In 1858, Townsend reversed his stance on amalgam and

recommended removal of teeth that could not be saved by gold.

1924 - Alfred Stock became poisoned with mercury & published papers on
the dangers of mercury in Dentistry

1934 - German physicians - no health risk from Amalgams

In December 2003, Dr. Frederick miller, - Amalgam is a SAFE, AFFORDABLE,

AND DURABLE MATERIAL.”
The Second Amalgam War….

In mid 1920's a German dentist, Professor A. Stock started the so

called "second amalgam war".

He claimed to have evidence showing that mercury could be

absorbed from dental amalgam, which leads to serious health
problems.

He also expressed concerns over health of dentists, stating that

nearly all dentists had excess mercury in their urine
3 Amalgam War In 1980s
rd

It was the Neurobiologist Mats Hanson, Assosiate

professor in physiology at Lund University in Sweden,
who in 1981 started the fight against the authorities.

"Third Amalgam War' began in 1980 primarily

through the seminars and writings of Dr.Huggins,
a practicing dentist in Colorado.

He was convinced that mercury released from dental

amalgam was responsible for human diseases affecting
the cardiovascular system and nervous system
DENTAL AMALGAM- An alloy of mercury,
silver, copper and tin which may also include palladium,
zinc and other elements to improve the handling
characteristics and clinical performance.
CLASSIFIACTION OF DENTAL
AMALGAM (MARZOUK)
1.According to the number of alloys
 Binary alloys (silver tin)
 Ternary alloys (silver tin copper)
 Quaternary alloys (silver tin copper indium)

2. According to whether the powder consist of admixed or

unmixed alloys
 Certain amalgam powders are made up of one alloy
 Others have one or more alloys physically blended to the basic alloy – eg
adding copper to basic silver tin alloy
3. According to the shape of the alloy particle
 Spherical shape (smooth surface spheres)
 Lathe cut (irregular ranging from spindles to shavings)
 Combination of spherical and lathe cut (admixed)

4. According to powder particle size

 Micro cut
 Fine cut
 Coarse cut

5. According to copper content of the powder

 Low copper content alloy-less than 4%
 High copper content alloy- more than 10%
6. According to the addition of noble metals
 Palladium
 Gold
 platinum

7. According to the presence of zinc

 Zinc containing (more than 0.01%)
 Zinc free ( less than 0.01%)
8. According to succeeding generations
 First generation amalgam was of G.V.Black with 3 parts silver and one part mercury
(peritectic alloy)
 Second generation amalgam alloy with 3 parts silver, 1part tin and 4 parts copper to
decrease the plasticity and increase the strength and hardness. 1%zinc acts as oxygen
scavenger and to decrease the brittleness
 Third generation- first generation + spherical amalgam copper eutectic alloy
 Fourth generation- adding copper to 29% to original tin and silver powder to form
ternary alloy. So that tin bounded to copper
 Fifth generation- quaternary alloy i.e silver, tin, , copper and indium
 Sixth generation- consisting of eutectic alloy
INDICATIONS
 Class 1 and class 2 cavities- moderate to large restorations
 As a core build up material
 Can be used for cuspal restorations (with pins usually)
 In combination with composite resin for cavities in posterior teeth.
 Restorations having heavy occlusal load
 Restorations that can’t be isolated
 In teeth that act as abutment for removable appliances
 Class 3 cavities in un-aesthetic areas- Eg distal aspect of canine
 Class 5 cavities where moisture control is extremely difficult and in non-
aesthetic areas
CONTRAINDICATIONS
 Anterior teeth where aesthetics is of prime concern
 Aesthetically prominent areas of posterior teeth
 Small to moderate class 1 and class 2 cavities that can be well isolated
 Small class 6 restorations
ADVANTAGES
 Ease of use, easy to manipulate
 Relatively inexpensive
 Excellent wear resistance
 Restoration is completed in one sitting without requiring much chairside time
 Well triturated and condensed amalgam has a good compressive strength
 Sealing ability improves with age by formation of corrosion products at the tooth
restoration interface
 Not technique sensitive
 Bonded amalgam have “bonding benefits”
-less microleakage
-slightly increases strength of bonded amalgam
-minimal post operative sensitivity
DISADVANTAGES
 Unnatural appearance (un aesthetic)
 Tarnish and corrosion
 Metallic taste and galvanic shock
 Discolouration of tooth structure
 Lack of chemical or mechanical adhesion to the tooth structure
 Mercury toxicity
 Promotes plaque adhesion
 Delayed expansion
 Weakens tooth structure (unless bonded)
COMPOSITION OF DENTAL AMALGAM
Convention amalgam alloy (G.V. Black’s- silver tin copper alloy or
low copper alloy)
Low copper alloys are available as comminuted particles (Lathe cut and Pulverized) or
spherical particles
LOW COPPER COMPOSITION
silver : 63-70%
Tin : 26-28%
Copper :2-5%
Zinc : 0-2%
ROLE OF INDIVIDUAL COMPONENT

SILVER:
 Constitutes approximately 2/3rd of conventional amalgam
alloy.
 Contributes to strength of finished amalgam restoration.
 Decreases flow and creep of amalgam.
 Increases expansion on setting and offers resistance to tarnish.
 To some extent it regulates the setting time
Tin:
 Second largest component and contributes ¼th of amalgam alloy.
 Readily combines with mercury to form gamma-2 phase, which is the
weakest phase and contributes to failure of amalgam restoration.
 Reduce the expansion but at the same time decreases the strength
of amalgam.
 Increase the flow.
 Controls the reaction between silver and mercury.
 Tin reduces both the rate of the reaction and the expansion to
optimal values.
Copper:
 Contributes mainly hardness and strength.
 Tends to decrease the flow and increases the setting expansion

 Zinc:
 Acts as Scavenger of foreign substances such as oxides.
 Helps in decreasing marginal failure.
 The most serious problem with zinc is delayed expansion, because of
which zinc free alloys are preferred now a days.

Indium/Palladium:
 They help to increase the plasticity and the resistance to deformation.
HIGH COPPER AMALGAM ALLOY (COPPER ENRICHED
ALLOYS)
To overcome the inferior properties of low copper amalgam alloy - shorter working
time, more dimensional change, difficult to finish, set late, high residual mercury,
high creep & lower early strength, low fracture resistant .

Youdelis and Innes in 1963 introduced high copper content amalgam alloys.
They increased the copper content from earlier used 5% to 12%.
Copper enriched alloys are of two types:
1) Admixed alloy powder.
2) Single composition alloy powder.
ADMIXED ALLOY POWDER:
 Also called as blended alloys.
 Contain 2 parts by weight of conventional composition lathe
cut particles plus one part by weight of spheres of a silver
copper eutectic alloy. (2 :1)
 Made by mixing particles of silver and tin with particles of
silver and copper.
 The silver tin particle is usually formed by the lathe cut
method, whereas the silver copper particle is usually
spherical in shape.
Composition:
Silver-69 %
Copper-13 %
Tin-17 %
Zinc-1 %

Admixed alloy powder:

 Amalgam made from these powders are stronger than amalgam
made from lathe cut low copper alloys because of strength of Ag-Cu
eutectic alloy particles.
 Ag-Cu particles probably act as strong fillers strengthening the
amalgam matrix.
 Total copper content ranges from 9-20%.
II. SINGLE COMPOSITION ALLOY (UNICOMPOSITION):
 It is so called as it contains particles of same composition.
 Usually spherical single composition alloys are used.
 As lathe cut, high copper alloys contain more than 23% copper.
 

Ternary alloy in spherical form,

- silver 60%, tin 25%, copper 15%.

Quaternary alloy in spheroidal form containing

-Silver: 59%, copper 13%, tin: 24%, indium 4%.
 AMALGAMATION REACTION/
SETTING REACTION
LOW COPPER CONVENTIONAL AMALGAM
ALLOY
 Dissolution and precipitation reaction
 Hg dissolves Ag and Sn from alloy
 Intermetallic compounds formed
 Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg
γ γ γ1 γ1
Gamma (γ ) = Ag3Sn
-Unreacted alloy
-Strongest phase and corrodes the least
-Forms 30% of volume of set amalgam

Gamma 1 (γ1) = Ag2Hg3

-Matrix for unreacted alloy and 2nd strongest phase
-10 micron grains binding gamma
-60% of volume
Gamma 2 (γ2) = Sn8Hg
-weakest and softest phase
-corrodes fast, voids form
-corrosion yields Hg which reacts with more gamma 2
-10% of volume
-volume decreases with time due to corrosion
ADMIXED HIGH-COPPER ALLOYS

Initial reaction
Ag3Sn + Ag-Cu + Hg Ag3Sn + Ag2Hg3 + Sn8Hg + Ag-Cu
γ γ γ1 γ1

Final reaction
Sn8Hg + Ag-Cu Cu6Sn5 + Ag2Hg3 + Ag-Cu
γ2 γ1
SINGLE COMPOSITION - HIGH COPPER ALLOYS

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

γ γ1 γ η
MANUFACTURING PROCESS
Lathe-cut alloys
 Ag & Sn melted together
 Alloy cooled
-phases solidify
 Heat treat
-400 ºC for 8 hours
 Grind, then mill to 25 - 50 microns
 Heat treat to release stresses of grinding
Spherical alloys
 Atomizing process produces these different shapes.
 First liquefying the amalgam alloy, it is sprayed through a jet
nozzle under high pressure in a cold atmosphere.
 If particles are allowed to cool before they contact the
surface of chamber, they are spherical in shape.
 If they are allowed to cool on contact with the surface they
are flake shaped.
 PROPERTIES:
ADA specification No.1 for amalgam lists following physical properties
as a measure of quality of the amalgam.

1. Creep
2. Compressive strength
3. Dimensional changes
4. Modulus of elasticity
 STRENGTH
Compressive strength
 Amalgam is strongest in compression and weaker in tension and shear
 The prepared cavity design and manipulation should allow for the restoration to receive
compression forces and minimum tension and shear forces.
 The compressive strength of a satisfactory amalgam restoration should be atleast 310
MPa.
Tensile strength
 Amalgam is much weaker in tension
 Tensile strengths of amalgam are only a fraction of their compressive strengths
 Cavity design should be constructed to reduce tensile stresses resulting from biting
forces
 High early tensile strengths are important – resist fracture by prematurely applied biting
forces
TENSILE STRENGTH
The factors affecting strength of amalgam are:
1) Temperature: Amalgam looses 15% of its strength when its temperature
is elevated from room temperature to mouth temperature to 6OOC e.g. hot
coffee or soup.
 
2) Trituration:
 Effect of trituration on strength depends on the type of amalgam alloy, the
trituration time and the speed of the amalgamator.
 Either, under trituration or over-trituration decreases the strength for both
traditional and high copper amalgams.
 More the trituration energy used, more evenly distributed are the matrix
crystals over the amalgam mix and consequently more the strength pattern
in the restoration.
 Excess trituration after formation of matrix crystals will create cracks in the
crystals, lead to drop in strength of set amalgam
3) Mercury
: Content:
 Low mercury alloy content, contain stronger alloy particles and less of the weaker matrix
phase, therefore more strength
 Mercury is too less -- dry, granular mix, results in a rough, pitted surface that invites
corrosion.
 If mercury content of amalgam mix is more than 53-55%, causes drop of compressive
strength by 50%.
 4) :Effect of condensation:
 For lathe-cut alloys
 Greater the condensation pressure, the higher the compressive strength
 Higher condensation pressure is required to minimize porosity and to express mercury from
lathe-cut amalgam.
 For spherical alloys
 Amalgams condensed with lighter pressure produce adequate strength.
5)Effect of porosity- Can be due to
-Under trituration
-Particle shape
-Insertion of too large increments into the cavity
-Delayed insertion after trituration
-Non plastic mass of amalgam
o Facilitates stress concentration ,propagation of cracks, corrosion and fatigue failure of amalgam
restoration
6) Effect of rate hardening
 At the end of 20 mins- compressive strength is 6 %
 At the end of one hour- compressive strength is at 80%

clinical significance- patient should be cautioned not to subject the

restoration for high biting force for 8 hours as 70% of strength is gained
DIMENSIONAL CHANGES
When mercury is combined with amalgam it undergoes three distinct stages
Stage 1- initial contraction occurs for about 20 mins immediately after
trituration. Contraction results as the alloy particles dissolve in mercury.
About 4.5 micro cm

Stage 2- Expansion- this occurs due to formation and growth of the crystal
matrix around the unconsumed alloy particle

Stage 3- limited delay contraction

Factors affecting dimensional changes
1. Particle size-
• More regular the particle shape, more smoother the surface area
• Faster and more effectively mercury can wet the amalgam particles and faster
amalgamation occurs in all stages without much expansion

2. Mercury content
• More mercury more will be the expansion as more crystals will grow
• Low mercury : alloy ratio favours contraction

3. Manipulation
• If during trituration, more energy is used, smaller particles will become and mercury will be
pushed between the particles discouraging expansion
• More the pressure during condensation, particles are brought together , more mercury is
expressed out of mix inducing more contraction
MOISTURE CONTAMINATION (DELAYED
EXPANSION)

 Certain zinc containing low copper or high copper amalgam alloys which
get contaminated by moisture during manipulation results in delayed
expansion or secondary expansion
 Occur 3-5 days after insertion and continues for months.
 Zinc reacts with water, forming zinc oxide and hydrogen gases.
Zn + H2O  ZnO + H2
Complications that may result due to delayed expansion are :

 Protrusion of the entire restoration out of the cavity.

 Increased micro leakage space around the restoration.
 Restoration perforations.
 Increased flow and creep.
 Pulpal pressure pain.
Such pain may be experienced 10-12 days after the insertion of the restoration
MODULUS OF ELASTICITY
 High copper alloys tend to be more stiffer than low copper alloys
 When rates of loading is increased, values of approx. 62GPa have been obtained

KNOOP HARDNESS VALUE

110 kg/mm2
FLOW AND CREEP:
 Time dependent plastic deformation
 When a metal is placed under stress, it will undergo plastic
deformation.
 The high copper alloys, as compared with conventional
silver tin alloys, usually tend to have lower creep values.
Factors influencing creep
A) PHASES OF AMALGAM RESTORATION
 Creep rates increase with larger gamma 1 volume fraction
decrease with larger gamma one grain size
 Gamma 2 is associated with high creep rates
 In absence of gamma 2, low creep rates in single composition
alloy may be due to η phase which acts as a barrier to
deformation of gamma 1 phase
B) MANIPULATION

 Greater compressive strength will minimize creep rates

 Low mercury : alloy ratio, greater the condensation greater the
trituration, will decrease the creep rate
MANIPULATION OF DENTAL
AMALGAM
PROPORTION OF ALLOY TO MERCURY
 Correct proportioning of alloy and mercury- for forming a suitable mass of amalgam
 Some alloys require mercury- alloy ratio in excess of 1:1 (Eames technique) whereas
other use ratio less than 1:1 with the percentage of mercury varying from 43% to 54%
 Automated mechanical dispensers for alloy and
mercury have been used in the past

 Capsules with pre-proportioned amounts of alloy and

mercury have been substituted
TRITURATION
 Process of mixing the amalgam alloy particle with mercury
 Originally alloy and mercury were mixed and were triturated by hand with
mortar and pestle
 Mechanical amalgamation saves times and standardizes the procedure.
 Mechanical amalgamators are available in the following speed
o Low spped-32-3400 cpm
o Medium speed-37-3800cpm
o High speed-40-4400cpm
 Spherical/irregular alloys are triturated at low speed whereas lathe cut are
triturated at high speed

 Time of trituration usually ranges from 3-30 seconds, variation in 2-3 secs can
also produce a under or over mixed mass
 Over-triturated- alloy will be hot, hard to remove from the

capsule, shiny wet and soft

 Under-triturated- alloy will be dull dry crumbly, will crumble

if dropped from approx. 30cm

 Normal mix- shiny appearance separates in a single mass

from the capsule

Objectives of trituration are
 To achieve a workable mass of amalgam within a workable time
 To remove the oxide layer
 To pulverize pellets into particles,that can be easily attacked by the
mercury
 To reduce particle size
 To keep the amount of γ1 and γ2 matrix crystals as minimal as
possible, yet evenly distributed
Mixing variables
Working time and dimensional change- all types of amalgam whether spherical or
irregular decreases with over-trituration
Over-trituration- slightly higher concentration for all types of alloy
Compressive strength and tensile strength
irregular shaped alloys-increases by overtrituartion
spherical alloys- greatest at normal trituration time
Creep
under-trituration lowers the creep
over-trituration increases the creep
MULLING
 Mulling of the amalgam which can be done either mechanically or
manually is the continuation of trituration. It is done so all the alloys
particles are coated with mercury
 Mechanical mulling can be done in an amalgamator by triturating for 1-2
seconds after the removal of pestle from the capsule
 Manual mulling is done by placing the mix in a dry piece of rubber dam
and vigorously rubbing between the palm of one hand and the other
CONDENSATION
 Refers to the incremental placement of amalgam into the prepared cavity and
compression of each increment into the others
 Amalgam should be condensed into the cavity within 3 minutes after
trituration

Aims of condensation
 Adapt amalgam to the margins ,walls and line angles of the cavity
 Minimize the voids and layering between increments within the amalgam
 Devlope maximum physical properties
 Remove excess mercury to leave an optimal alloy: mercury ratio
 TYPES OF CONDENSERS

HAND CONDENSERS
 Should allow the operator to readily grasp and exert the force of condensation

 Size of condenser tip and direction and magnitude of the force

placed,depends on the type of alloy selected

Irregular shaped alloys-
Condensers with relatively small tip,1-2mm
High condensation force in vertical direction
As much as mercury rich mass should be removed

Spherical amalgam alloys-

Condensers with large tips are used
Condensers used in lateral direction
High copper spherical amalgam- vertical and lateral direct condensation with vibration

A condensation pressure of 15lbs should be applied to each increment

MECHANICAL CONDENSERS
 Useful for condensing irregular shaped alloys when high condensation forces are
required
 Need was eliminated with the advent of spherical alloys
 One of the major disadvantage of using this is generation of heat and mercury vapour,
both of which are undesirable

ULTRASONIC CONDENSERS
 Not recommended
 Causes release of considerable quantities of mercury vapour in the office
Speed of placement
 Once amalgam is triturated ,phase formation commences and the
setting reaction is underway
 Amalgam must be placed in a plastic state
 No amalgam should be placed more than 3 mins after the start of
mixing
 Attempting to condense a partly set amalgam will result in
 Poor adaptation
 Reduced marginal seal
 A weak restoration
BURNISHING
First burnish (pre carve burnish)
 Carried out using a large burnisher for 15 seconds
 Use light forces and move from centre of restoration to the margins
Objectives of pre-carve burnishing
- Continuation of condensation ,further reduces the size and number of voids

on the critical surface and marginal area of amalgam

- Bring any excess mercury to the margin and to be discarded during carving
-Adapt the amalgam to the cavosurface margin
CARVING
 Using remaining enamel as a guide ,carve gently from
enamel towards the centre of restoration and recreate the
lost anatomy of the tooth.
 Amalgam should be hard enough to offer resistance to
the carving instrument.
 A scrapping/ringing voice (amalgam cry) should be heard.
 If carving is started too soon, amalgam will pull away from
the margins.
Objectives of carving-
To produce
 Restoration without any under hangs
 Restoration with proper physiologic contacts
 Restoration with minimal flash
 Restoration with adequate compatible margins
 Restoration with proper size ,location ,extent and
interrelationship of contact areas
Final burnish (post carving burnishing)
 Following carving, check the occlusion and carry out a brief final
burnish
 Use a large burnish with a low load and carry out the burnish towards
the margin
 Improves smoothness
 Heat generation should be avoided

If temperature rises above 60 c, it causes release of mercury, accelerates

corrosion and fracture of amalgam
FINISHING AND POLISHING
Finishing can be defined as the process which continues the carving objectives,
removes flash and overhangs and corrects minimal enamel underhangs.

Polishing is the process which creates a corrosion resistant layer by removing

scratches and irregularities from the surface.
 Can be done by using descending grade abrasives eg rubber mounted stone or
cups
 A metalic lustre is always done with a polishing cup(precipitated chalk, zinc or
tin oxide)
Objectives of finishing and polishing
Removal of superficial scratches and irregularities

Advantages
 Minimizes fatigue failure of amalgam under cyclic loading of mastication
 Minimizes concentration cell corrosion occurring which could begin in the surface
irregularities.
 Prevents adherence of plaque.
Usually 24 hours should pass for finishing and polishing after the insertion of amalgam into
the prepared cavity
However new alloys can be polished after 8-12 hours while others require only
30 minutes wait
CLINICAL APPLICATION OF
AMALGAM
Amalgam clinically is used in

 Class 1 cavity

 Class 2 cavity

 Core build up material

Since amalgam lacks physical bonding with the tooth structure ,so certain

features like primary retention and primary resistance forms are added to

increase its longevity and bonding.

RESISTANCE AND RETENTION
FORMS
PRIMARY RETENTION FORMS
Attained by

• Mechanical locking of inserted amalgam into

surface irregularities to allow good adaptation

• Preparation of vertical walls that converge

occlusally
PRIMARY RESISTANCE FORMS
FOR TOOTH

 Maintaining as much unprepared tooth structure as possible

 Having pulpal and gingival walls perpendicular to occlusal forces

 Having rounded internal preparation line angles

 Removing unsupported and weakened tooth structure

 Placing pins into the tooth as a part of final stage of tooth preparation
FOR AMALGAM

 Adequate thickness of 1.5-2 mm in areas of occlusal contact, 0.75mm

in axial areas.

 Marginal amalgam of 90 degrees or greater.

 Box like preparation form.

 Rounded axial pulpal line angle in class 2 preparation.

SECONDARY RESISTANCE AND RETENTION FORM

 When insufficient resistance and retention forms

are present in tooth, additional preparation is
indicated.
 Such features include
- Placement of grooves ,locks ,amalgapins ,coves
,pins or slots
- Larger the tooth preparation ,more is the
requirement of secondary retentive and resistance
features
NEED FOR PULP PROTECTION
 Mechanical protection from amalgam
 Barrier to the chemical leaching of components from amalgam restoration
 Since the coefficient of thermal expansion and coefficient of thermal diffusion of
amalgam is twice than that of enamel and dentin, the amalgam restoration clinically
contract and expand contributing to cyclic fatigue of tooth structure and cusp fracture.
 Electrical protection against galvanic currents
 To form a secondary dentin barrier, helping in pulp medication in case of deep defects
 Adequate seal at tooth restoration interface against bacterial ingress
COPAL RESIN VARNISH
 Usually used for shallow cavities having about 1mm depth so as to prevent
leaching of amalgam products into the dentinal tubules thus preventing post of
sensitivity.
 2 thick coats are applied to the prepared cavity before the placement of amalgam
and it gradually dissolve beginning at the cavosurface, over 2-3 months

 As the varnish dissolves out, the gap will be filled with corrosion products of the
amalgam and dissolution of varnish will cease
GLASS IONOMER CEMENT
 Since amalgam has poor bonding to the tooth structure , glass ionomer

cement is used to enhance the bonding.

 Moreover seals the dentinal tubules and provides fluoride release thereby

preventing post-op sensitivity and secondary caries respectively

 Will not effect enamel margin or enhance the seal at the margin
OXALATE SOLUTIONS
 Such as potassium oxalate ,can be applied to cavity surfaces to reduce the

permeability of tubules and possibly seal of the dentinal tubules

 The crystals thus deposited will not wash out but will allow deposition of

corrosion products
ZINC PHOSPHATE CEMENT
Traditionally this has been the material of choice as base under
metallic restoration. It has superior physical properties and provides
excellent thermal insulation

ZINC POLYCARBOXYLATE
 This is the most commonly base material used under amalgam
restoration.
 Its advantages over zinc phosphate is its biocompatibility and
adhesion to the tooth structure.
 RECENT ADVANCES
1) BONDED AMALGAM
 During the 1900’s some clinicians began to routinely bond amalgam
restorations to enamel and dentin
 After preparation of the cavity ,enamel and dentin etched using a
conventional etchant ,a chemically cured resin bonding agent applied to the
walls of the cavity
 Amalgam is immediately condensed into the cavity before the resin has bond
has been cured
Advantages of bonded amalgam

 Conservation of tooth structure

 Fracture resistance as high as composite material

 Decreases marginal leakage in class 5 restorations

 Reduced post operative sensitivity

 Reduced incidence of marginal fracture and secondary caries

 Allow for amalgam repair

Disadvantages of bonded amalgam

 Clinically difficult application of more viscous bonding agent

 Lightly filled resin bonding agents tend to pool at the gingival

margin resulting in higher potential for microleakage

 Carving is difficult

 Increased cost

 Technique sensitive
GALLIUM BASED ALLOYS
 Mercury free metallic restorative material proposed as a substitute for mercury
containing amalgam are gallium containing materials and pure silver and or silver
based alloys

 Puttkammer (1928), suggested the use of gallium in dental restorations

 Attempts to develop satisfactory gallium restorative material were unsuccessful

until Smith et al in 1956 showed that improved Pd-Ga and Ag-Ga material has
similar physical and mechanical properties that were even better than silver
amalgam
ADVANTAGES OF GALLIUM BASED ALLOYS
 Rapid solidification
 Good marginal seal on expanding on solidification
 Heat resistant
 The compressive and tensile strength increases with time comparable with
silver amalgam
 Creep values are low as 0.09%
 Since it has fast setting ,polishing can be done on the same day
 Expansion after setting provides better marginal seal
REACTION

Ag3Sn + Ga Ag3Ga + Sn

 After mixing ,the alloy tends to adhere to the walls of capsule ,thus difficult

to handle

 This problem of sticking could be minimized with few drops of alcohol

BIOLOGICAL CONSIDERATIONS
 Surface roughness ,marginal discolouration and fracture were reported
 With improvement in composition, these defects were reduced but not
eliminated
 Could not be used in larger restoration as the considerable setting
amount of expansion could lead to fracture of cusp and post-operative
sensitivity
 Cleaning of instrument tips is also difficult
 Less popular as more costly than amalgam
FLUORIDE RELEASING AMALGAM
 Have been shown to have anti carious properties sufficient to
inhibit the development of caries in cavity walls
 Concentration of fluoride is sufficient to enhance
remineralization
 Tviet and Lindh (1980)- suggested that the greatest amount
of fluoride concentration i.e about 4000 microgm/ml in
enamel surfaces exposed to fluoride containing amalgams
were found in the outer 0.05um of the tissue
 In dentin ,the greatest concentration i.e about 9000ug/ml were found at a depth of
11.5um
 However this release of fluoride decreases to minor amounts after a week

 Forsten(1976)- fluoride released from amalgams loaded with soluble fluoride was
detectable within the first month and therefore fluoride was not released in
measurable amounts

 Garcia godoy et al (1990) – fluoride release continues as long as two years (but at
lower rate than that of GIC)
The fluoride amalgam thus serves as “slow releasing device”
FAILURES OF AMALGAM
RESTORATION
 TARNISH
Tarnish is surface discoloration on a metal, or slight loss or alteration of the surface
finish or lustre
MAIN CAUSES
 Deposition of principle hard deposits such as calculus and soft deposits such as
plaque
 Stains or discolouration arising from pigment producing bacteria
 Formation of thin films of oxides, chlorides or sulphides- this could be a simple
surface deposit which may be protective in nature
Also it can be early indication of corrosion.
CORROSION
Excessive corrosion can lead to
 Increased porosity
 Reduced marginal integrity
 Loss of strength
 Release of metallic products into the oral environment
Phases in decreasing order of corrosion resistance is
Ag2Hg3 >Ag3Sn >Ag Cu >Cu3Sn> Cu6Sn5 >Sn7-8Hg

The most common corrosion products formed found with traditional amalgam
alloys are oxides and chlorides of tin along the tooth amalgam interface
Types of corrosion
GALVANIC CORROSION- it is a type of electrochemical corrosion. When dental amalgam
is in direct contact with an adjacent metallic restoration such as gold crown, the large
difference in electromotive force between the two material liberates free mercury which
contaminates and weakens the gold restoration and corrodes the amalgam restoration.
This process causes galvanic shock

CREVICE CORROSION-Local electrochemical cells may arise whenever a portion of

amalgam is covered by plaque or soft tissue.
 The covered area has a lower oxygen and a higher hydrogen ion concentration
making it behave anodically and corrode causing concentration cell corrosion
STRESS CORROSION-
 Regions within the dental amalgam which are under stress(fatigue or cyclic loading)
display a greater possibility of corrosion resulting in a stress corrosion.
 For occlusal dental amalgam ,greatest combination of stress corrosion occurs along
the margins due to cold working such as bending, malleting or burnishing causing
permanent deformation in some parts of the appliance
 Hence excessive burnishing on the margins is avoided
MARGINAL FRACTURE OF AMALGAM
 Referred to as “Marginal ditching” ,”Crevice formation” and

“Marginal breakdown”

 Regardless of the type of amalgam ,marginal fracture increases

with time

 The rate of increase of fracture is greater for low copper amalgam

 CLINICAL CONSIDERATIONS TO PREVENT MARGINAL
FRACTURE
 Excess amalgam, left lying over the occlusal or proximal surface should be
carved correctly
 The angle of cavo-surface margin should be greater than 70degrees and cavity
should be designed to allow for this
 On completion of packing ,burnish the margins before and after the carving to
improves the marginal adaptation
FACTORS CONTRIBUTING TO THE REPAIR OF
AMALGAM

 Presence of porosity and gamma 2 phase

 Inadequate condensation
 Excessive carving
 Contamination of surface of existing amalgam
 Corrosion and contamination from saliva
 Improper removal of matrix
 Marginal ridge left too high
 Axiopulpal line angle not rounded in class 2 tooth preparation
REPAIR OF AMALGAM RESTORATION
 When an amalgam restoration fails ,as from marginal fracture ,it is repaired
 A new mix of amalgam is condensed against the remaining part of the
existing restoration
 The strength of the bond between new and old amalgam restoration is
important and this is achieved by KEY HOLE PREPARATION in which a key
hole like pattern is prepared on to the old amalgam for easy adaptation and
retention of new amalgam
 Careful carving of bonded amalgam
 Proper rounding of axio-pulpal line angle in class 2 preparation

 Creating marginal ridge height correctly ,with both the adjacent tooth and

occlusion

 Creating an occlusal embrasure from that mirrors the adjacent tooth

 Removing the matrix correctly after defining the marginal ridge and embrasure

forms
POST OP-SENSITIVITY
CAUSES
 Lack of adequate condensation, especially lateral condensation in the proximal
boxes
 Lack of proper dentinal sealing with sealer or bonding system

SOLUTION
 Proper condensation technique
 Proper dentinal sealing technique such as double coating the prepared cavity
with varnish and applying a thick base.
AMALGAM BLUES
Discoloured area seen through enamel in teeth having amalgam restoration
Bluish hue maybe due to
- Leaching of corrosion products into the dentinal tubules
- Colour of underlying amalgam seen through translucent enamel
AMALGAM TATTOO
Possible causes are-
 Scraps of amalgam may fall into open surgical wounds or
extraction sockets
 Excess amalgam maybe left in the tissue following the sealing
of the apex of a root canal with a retrograde filling
 Pieces of amalgam maybe forced into the mucosa
 HYGIENE
RECOMMENDATION OF
MERCURY IN DENTISTRY
 Mercury containing products should be stored in cabinets to minimize local
concentration in rest of the office, storage location should be near a vent that
exhausts air out of the building
 Spilled mercury can be made harmless by dusting with sulphur powder or spraying
with a sodium thiosulphate solution (spent fixer solution)
 Local spills or spatters should not be collected with a vaccum aspiration
 To control the vapours of mercury during placement and condensation or during
removal of old restoration, rubber dam should be used and high volume suction
should be used so as to prevent vapour from diffusing
 Scrap amalgam from condensation procedure should be collected and stores under
water, glycerine or spent fixer solution in a tightly capped jar
 Silver mercury has a very low melting point and easily melts during finishing and
polishing procedures, producing mercury rich liquid phase, so amalgam should be
polished at slow speed using water spray
 Mercury vapour levels in office and the office personnel should be periodically
evaluated
 Pre-capsulated capsules of the alloy should be used to eliminate the possibility of the
bulk mercury spill
 Change mask after removing amalgam restoration
 Amalgamators should be properly covered
 Dental office should be well ventilated and carpeted floors should be avoided
 CONCLUSIO
N inherent with silver amalgam such as technique
There are certain advantages
sensitive, excellent wear resistance, less time consuming, less expensive. Some
of its advantages are lacking in newer material such as composites and GIC.
These factors make amalgam material of choice for years to come provided
excellent precautions are taken in safe disposal of mercury.
 REFERENCES
 Anusavice KJ, Shen C, Rawls HR. Phillips' science of dental materials. Elsevier Health Sciences; 2013.
 Heymann HO, Swift Jr EJ, Ritter AV. Sturdevant's Art & Science of Operative Dentistry-E-Book. Elsevier
Health Sciences; 2014 Mar 12.
 Marzouk MA, Simonton AL, Gross RD. Operative dentistry. Modern theory and practice, 1st ed. St Louise-
Tokyo, Ishiyahu EuroAmerica Inc. 1985.
 Hegde NN, Attavar SH, Hegde MN, Priya G. Antibacterial activity of dental restorative material: An in vitro
study. Journal of conservative dentistry: JCD. 2018 Jan;21(1):42.
 Mickenautsch S, Yengopal V, Banerjee A. Atraumatic restorative treatment versus amalgam restoration
longevity: a systematic review. Clinical oral investigations. 2010 Jun 1;14(3):233-40.
 Ziebert AJ, Dhuru VB. The fracture toughness of various core materials. Journal of Prosthodontics. 1995
Mar 1;4(1):33-7.
 Unterbrink G. Indications for amalgam vs. composite.
 Aqrabawi J. Endodontics: Sealing ability of amalgam, super EBA cement, and MTA when used as
retrograde filling materials. British dental journal. 2000 Mar 11;188(5):266.
Thank You !