Failure of

Amalgam Restoration

1
 Isthmus fracture

 recurrent caries

2
thmus fracture

Definition
Etiology
Patient complains
treatment
3
thmus fracture
Isthmus fracture
related to compound and complex cavities

Definition
Isthmus
is an imaginary area in compound or
complex cavities connected two main parts
of the restoration .
its the most weakened area subjected to
fractured if its not prevented during cavity
preparation and manipulation of filling. 4
thmus fracture

Definition
Etiology
Patient complains
treatment
5
thmus fracture

Etiology
According to preparation.

According to material.

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thmus fracture

According to preparation:

Etiology
1. unfavorable stresses on surface area of
amalgam filling due improper cavity
preparation
2. inadequate proximal retention
3. Narrow or shallow isthmus

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thmus fracture

Etiology
According to preparation.

According to material.

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thmus fracture

According to material:
1. production of stresses on surface area of

Etiology
due improper manipulation of dental
amalgam.
2. reduction of strength properties of dental
amalgam; which commonly due to
improper manipulation of dental amalgam
ONLY 9
thmus fracture

Definition
Etiology
Patient complains
treatment
10
thmus fracture

A woman in her mid 50s wanted to replace an

Patient complains
older amalgam restoration with a more esthetic
looking restoration ,The tooth was
asymptomatic and tested positive for vitality.
Because of the isthmus width of the amalgam
restoration and a peripheral rim fracture at the
mesial marginal ridge, the tooth was diagnosed
as being at a high risk
for fracture. The patient
was proactive in treating
the tooth to prevent
additional breakdown. 11
thmus fracture

Patient complains
The patient was very pleased with the function and
esthetics of the restoration. In addition, there was no
reported postoperative sensitivity or pain on biting
12
12
thmus fracture

Patient complains
Q: Child came to the clinic with amalgam
restoration fracture at isthmus portion, this
fracture due to:
a) Wide preparation at isthmus.
b) High occlusal.
C) shallow preparation.
D) constricted isthmus
13
13
thmus fracture

Definition
Etiology
Patient complains
treatment
14
thmus fracture

during cavity preparation avoid the following to prevent

isthmus fracture:

Treatment
during obtaining outline form of compound or
complex class I & II :
1. prepare CAVITY WALLS AND MARGINS
parallel to respective tooth surfaces.
2. preparing PULPAL FLOOR parallel to
occlusal surface at right angle to long
axis of tooth, except at lower premolars,
parallel to GINGIVAL WALL. 15
thmus fracture

3. Gingival wall also have enough width

about 1.5 - 2mm varying from premolars

Treatment
and molars and flat, regular and at right
angle to long axis of tooth, parallel to
pulpal floor and occlusal surface of tooth .

4. AXIAL WALL prepared at right angle to

both pulpal floor and gingival wall, parallel
to long axis of tooth with slight slanting
occlusally to give a great chance for bulky
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of amalgam at isthmus portion.
thmus fracture

5. AXIO-PULPAL LINE ANGLE is being rounded or

beveled or slightly slanted not sharp which lead to

Treatment
concentration of unfavorable forces during function
at isthmus portion and fracture of dental amalgam.
6. PRESENCE OF GINGIVAL WALL OR SEAT with
enough width and proper direction itself is very
important because of , in the absence, easily
fractured of amalgam filling at isthmus area.

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thmus fracture

7. ISTHMUS AREA should be prepared with enough

Treatment
depth and width specially width to avoid pulp
injury. As amalgam is over-come fracture at
isthmus area when there is bulky restoration

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thmus fracture

during obtaining retention & resistance form of

class II cavity preparation, as amalgam have an

Treatment
inadequate tensile & shear strengths, each part of
compound class II cavity should have it's own retention
& resistance forms.
during finishing of the cavity walls and margins,
through which they should be flat, regular, smooth and
parallel to the respective tooth surfaces to avoid the
production of unfavorable stresses upon amalgam
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surfaces during function.
 Isthmus fracture

 recurrent caries

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ecurrent caries

Definition
Etiology
Patient complains
treatment
21
ecurrent caries
Recurrent caries:
defined as that type of caries which occurs at

Definition
the margins of restoration. The causes of
secondary caries are poor adaptability of
restoration materials to the cavity wall and
leaky margins or inadequate extension of
restorative material to margin of cavity , which
favor the retention of food debris and
bacteria . 22
ecurrent caries

Definition
Etiology
Patient complains
treatment
23
ecurrent caries

Etiology
According to preparation.

According to material.

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ecurrent caries
according to preparation:

1.inadequate occulsal extension: inadequate

extension to pits and fissure increase chance of caries

Etiology
recurrance particularly in high caries risk individuals.

2.inadequate extension of proximal box: If

inadequately extend into embrasure they are not
amenable to brushing and cleaning by mastication 
secondry caries

3.overextension of cavity preparation walls: Ideal

faciolingual width of cavity is 1\4 of intercuspal distance.
If the width is more than 1\2 capping should be
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considered.
ecurrent caries

Etiology
According to preparation.

According to material.

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ecurrent caries

 According to material:

1. Improper application of all means of resistance and

retention form : one of character of prepared cavity to

Etiology
amalgam filling that, each part of compound cavities
must have it's own resistance and retention form .

2. do not carry cavity walls and margins to the

stress bearing areas about 8-15kg load cycle are
applied and the filling not apple to withstand without
marginal disintegration and breakdown at the tooth /
restoration interface and creation of recurrence of
caries occur .
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ecurrent caries

3. In case of amalgam it is suitable to do cleaning of

the cavity by jets of air and water and using probe
to remove the chips if present then dry the cavity
by gentle air jets and avoid desiccation of dentin.

Etiology
4. THE RULE OF IMPROPER MANIPULATION OF
THE FILLING MATERIAL FOR RECURRENCE
OF CARIES : Specially during condensation,
Carving, Finishing and polishing

5. the presence of gingival seat is very important with

other means of resistance &retention form, box
shape , undercuts dove tails
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ecurrent caries

Definition
Etiology
Patient complains
treatment
29
ecurrent caries

The clinical diagnosis of recurrent caries are:

Patient complains
1. a gray discolouration of enamel around
filling.
2. a brownish discolouration of the amalgam-
enamel margin.
3. marginal breakdown of the restoration.
4. deep fissures at the margin of the
restoration. 30
ecurrent caries

Patient complains
Failed amalgam restoration with recurrent caries 31
ecurrent caries

Patient complains
Failed amalgam restoration with recurrent caries 32
ecurrent caries

Patient complains
defective amalgam restorations on the mandibular
right first and second molars. The existing
restorations had open margins with recurrent caries 33
ecurrent caries
A 25 year old woman has Pain and

Patient complains
Sensitivity to hot and cold food and
beverages. She also has Bad Breath
(halitosis).
: Clinical finding
1. previous silver amalgam filling had open margins
with recurrent caries .
2. Also the gray hew reflected through tooth enamel .
3. The old amalgam restoration had a microscopic
defect from the beginning . Having gap between the
tooth structure and filling (marginal leakage ) with
Poor oral hygiene care, improper tooth brushing and
lack of flossing , bacterial remnants diffuse and
could have caused more extensive decay over time. 34
ecurrent caries

Patient complains
After removal of silver filling, you
can see black decay caused by
.bacterial infection

Final restoration with Ceramic

Inlay. Notice brightening white
.tooth without the gray hew
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ecurrent caries

Definition
Etiology
Patient complains
treatment
36
ecurrent caries

The prevention method of the recurrent caries can

be as:

Treatment
A) proper selection of the restorative filling material
Factors consideration in proper selection:
1. Factors related to the material choice (it should have
properties so that it can protect the tooth from recurrent
caries like materials having fluoride as Glass ionomer)
2. Factors related to tooth condition which restored.
3. Factors related to the operator
4. Factors related to patient (In case of bad oral hygiene and
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high caries index )
ecurrent caries
:B) Obtaining proper cavity preparation by
1. Following Biological principle of avoidance

Treatment
recurrence of decay
2. Following Mechanical principles
3. Remove all the carious dentin found (the final floor
of the cavity which performed just below the DEJ by
about 0.5mm should be formed of sound and
hard not discolored dentin)
4. All cavity walls and margins should be extended to
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the self cleansable areas
ecurrent caries

5. Cavity walls and margins should be running in

sweeping curve around the cusps

Treatment
6. All pits and fissures and grooves should be included
7. Supplied the prepared cavity with suitable and right
cavosurface angle
8. All short and loose enamel prisms at the enamel walls
should be removed
9. Remove all the undermined enamel
10. proper application of all means of resistance and
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retention form (as box shape,undercuts and dove tails)
ecurrent caries

7. proper use of the cavity cleaners (specially before

application of chemically adhesive filling materials
clean cavity from any debris, saliva, blood or even

Treatment
smear layer of the smear unit to enhance an
excellent adhesion between filling and tooth to
reduce or diminish microleakage)

C) proper manipulation of restorative filling

Material Specially during condensation, Carving,
Finishing and polishing.
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Thank
you
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 By:
Abeer Al-Ofi
Alaa Al-Johani
Ameenah
Osamah Asia Al-Nakhli

Eman Khalil Khawla Al-

Shamani
Nora Al-Khalifa
Raghad Al-Ansari
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