DENTAL AMALGAM

DENTAL AMALGAM
Seminar by
Dr. SUBHASHINI R
Postgraduate Student
DEPARTMENT OF
CONSERVATIVE DENTISTRY &
ENDODONTICS

DENTAL AMALGAM

CONTENTS
INTRODUCTION
HISTORY
CLASSIFICATION
COMPOSITION
MANUFACTURE OF ALLOY PARTICLES
SETTING REACTION
PHYSICAL PROPERTIES
MANIPULATION AND TECHNICAL
CONSIDERATIONS OF DENTAL AMALGAM
FACTORS CONTROLLING QUALITY OF DENTAL
AMALGAM
INDICATIONS/CONTRAINDICATIONS
ADVANTAGES/DISADVANTAGES

CAUSES OF FAILURE OF DENTAL AMALGAM

MERCURY TOXICITY
RECENT ADVANCES IN DENTAL AMALGAM
CONCLUSION
REFERENCES

INTRODUCTION

DENTAL AMALGAM
Amalgam is one of the oldest of all materials used for restoring the carious
lesion. It has been used more than any other materials in restorative dentistry.
Thus on the basis of frequency of use, one might say that dental amalgam is
the most important restorative material used by the dentist.

Amalgam technically means an alloy of mercury with any other metal:

Dental amalgam is an alloy made by mixing mercury with a silver tin alloy.
Dental amalgam alloy is a silver tin alloy to which varying amount of copper and
small amount of zinc has been added.

According to Skinners, amalgam is a special type of alloy in which one of its

constituent is mercury. In dentistry, it is common to use the term amalgam to mean
dental amalgam.

To make dental amalgam, mercury is mixed with a powder of amalgam alloy.

The powder which consists of silver, tin, copper and small amount of zinc may be in
the shape of lathe-cut, spherical or spheroidal. This mixing which is technically
known as trituration will form a plastic mass which can be directly forced into the
prepared cavity by a process known as condensation. The wetting of the powder
particle with mercury will initiate a physicochemical reaction that in time causes
hardening onset of the material.

HISTORY:
Dental amalgam is one of the oldest filling materials in use today. Its origin
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DENTAL AMALGAM
can be traced back to the second century A.D. in China were silver amalgam was
developed for filling teeth more than a 100 years before dentists in the west. Silver
paste is mentioned in the material medica of Sukung (AD 659).
In 1819, Bell from England advocated the use of a room temperature mixed
amalgam as a restorative material.

M.Traveau is credited with advocating the first

form of amalgam paste in 1826, in France.

In 1833, Amalgam was officially introduced to the United States. Then,
Crawcour brothers used a silver coin mercury mixture called "Royal Mineral
Succedaneum" and promoted the material as an inexpensive and convenient
restorative material. But this technique led to slow setting amalgam that released
mercury from unset mass into unprotected dentinal tubules.

First Amalgam War:

In 1845, American Society of Dental Surgeons condemned the use of all
filling material other than gold as toxic, thereby igniting "first amalgam war'. The
society went further and requested members to sign a pledge refusing to use amalgam.
However, this policy was reconsidered in 1850,and there followed several
investigations into amalgam composition and properties in UK,USA and France. The
use of amalgam was also promoted by the work of J F Flagg and the final stamp of
approval for its clinical use came from G V Black. The improved handling and
performance of these materials blocked criticism of amalgam as an inferior restorative
material and inspired general confidence in its safety.
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.
His writings attracted widespread attention. Charite hospital in Berlin, appointed a
committee to investigate the allegations of amalgam toxicity. An account of the
committees findings, published in 1930, declared that there was no reason to
4

DENTAL AMALGAM
condemn the newer silver tin amalgams.
Third Amalgam War;
The current controversy, sometimes termed as "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
He also stated that patients claimed recoveries from multiple sclerosis,
Alzheimers disease and other diseases as a result of removing their dental amalgam
fillings.
But research in United States and other first World countries demonstrated
clearly that there is no cause and effect relationship between dental amalgam
restoration and other health problems.
Classification (Marzouk):
The amalgam alloy can be classified in the following ways:
I.

According to number of alloy metals:

1. Binary alloys (Silver-Tin)
2. Ternary alloys (Silver-Tin-Copper)
3. Quaternary alloys (Silver-Tin-Copper-Indium).

II.

According to whether the powder consist of unmixed or admixed alloys.

Certain amalgam powders are only made of one alloy. Others have one or
more alloys or metals physically added (blended) to the basic alloy. E.g.
Adding copper to a basic binary silver tin alloy

III.

According to the shape of the powdered particles.

1. Spherical shape (smooth surfaced spheres).
2. Lathe cut (Irregular ranging from spindles to shavings).
3. Combination of spherical and lathe cut (admixed).

IV.

According to Powder particle size.

1. Micro cut
2. Fine cut
3. Coarse cut

V.

According to copper content of powder

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DENTAL AMALGAM
1. Low copper content alloy - Less than 4%
2. High copper content alloy - more than 10%
VI.

According to addition of Nobel metals

1.Platinum
2.Gold
3.Pallidum

VII.

According to compositional changes of succeeding generations of amalgam.

1. First generation amalgam was that of G. V Black i.e. 3 parts silver one part
tin (peritectic alloy).
2. Second generation amalgam alloys - 3 parts silver, 1 part tin, 4% copper to
decrease the plasticity and to increase the hardness and strength. 1 % zinc,
acts as a oxygen scavenger and to decrease the brittleness.
3. Third generation: First generation + Spherical amalgam copper eutectic
alloy.
4. Fourth generation: Adding copper upto 29% to original silver and tin
powder to form ternary alloy. So that tin is bounded to copper.
5. Fifth generation. Quatemary alloy i.e. Silver, tin, copper and indium.
6. Sixth generation (consisting eutectic alloy).

The alloying of palladium (10%), silver (62%) and copper (28%), to form a
eutectic al1oy, which is lathe-cut and blended into a first, second or third generation
amalgam in a ratio of 1:2.
The set amalgam exhibits the highest nobility of any previous amalgam and
has been the most recent (sixth) generation of amalgam to be developed

VIII. According to Presence of zinc.

1.

Zinc containing (more than 0.01%).

2.

Non zinc containing (less than 0.01%).

ADA Specification No.1, for amalgam alloy includes a requirement for

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DENTAL AMALGAM
composition. This specification does not states precisely what the composition of
alloy shall be; rather it permits some variations in composition. The chemical
composition must consist essentially of silver and tin. Copper, zinc, gold, palladium,
indium or mercury may be included in lesser amount.

Conventional Amalgam Alloys: (G.V. Blacks: Silver- tin alloy or Low copper
alloy).
Low copper alloys are available as comminuted particles (Lathe -cut and
Pulverized) and spherical particles.
Low copper composition:
Silver : 63-70%

Tin

: 26-28%

Copper: 2- 5%

Zinc

: 0-2%

Silver: It constitutes approximately 2/3rd of conventional amalgam alloy. 1t

contributes to strength of finished amalgam restoration. It also decreases flow and
creep of amalgam. It also increases expansion on setting and offers resistance to
tarnish. To some extent it regulates the setting time.
Tin: Second largest component and contributes th of amalgam alloy. It readily
combines with mercury to form gama-2 phase, which is the weakest phase and
contributes to failure of amalgam restoration. Tin tends to reduce the expansion but at
the same time decreases the strength of amalgam. It also tends to increase the flow.
Tin controls the reaction between silver and mercury. Without tin the reaction would
be too fast and the setting expansion would be unacceptable. Tin reduces both the rate
of the reaction and the expansion to optimal values.
Copper: It contributes mainly hardness and strength. But, it also tends to decrease the
flow and increases the setting expansion
Zinc: It acts as Scavenger of foreign substances such as oxides. Zinc also 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.

DENTAL AMALGAM
HIGH COPPER AMALGAM ALLOY (COPPER ENRICHED ALLOYS)
To overcome the inferior properties of low copper amalgam alloy,
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.
I.

Admixed alloy powder:

They are also called as blended alloys, these contain 2 parts by weight of conventional
composition lathe cut particles plus one part by weight of spheres of a silver copper
eutectic alloy (71.9% Ag, 28.1% Cu, approximately).
The admixed alloys are 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 %
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. A number of different types of single composition
alloys are available.

DENTAL AMALGAM
1.

Ternary alloy in spherical form, silver 60%, tin 25%, copper 15%.

2.

An alloy similar to the first of those detailed in above, but contains particles in
spheroidal form.

3.

Quaternary alloy in spheroidal form containing Silver: 59%, copper 13%, tin:
24%, indium 4%.

Pre Amalgamated Alloys:

In this, the surface of alloy particles has been introduced to mercury by
manufacturer for rapid amalgamation after trituration to make pre-compacted pellets.
Pre amalgamated alloy contain upto 35% mercury and may be indirectly responsible
for reducing total mercury content to less than 40%.

MANUFACTURE OF ALLOY PARTICLE:

Lathe cut filings:
To produce lathe-cut alloys, ingredients metals are heated, with protection from
oxidation, until they are completely melted, and the melt is poured into suitable mold
to form an ingot. The ingot may be 3-4 cm in diameter and 20 -30 cm in length. The
ingot is cooled relatively slowly. After the ingot is completely cooled, it is heated for
various periods of time (frequency 6-8 hours) at 400 OC to produce a more
homogenous distribution of silver and tin. The ingot is then reduced to filings, cut
with a suitable tool on a lathe and ball milled. The particles are filtered through a fine
sieve of mesh and larger filings are ball milled again to reduce them to the proper
particle size. The particles are typically 50-100 m in length, 10-60 m in width and
10-30 m in thickness. For manufacturing high copper irregularly shaped particles
molten alloy is sprayed into water under high pressure.
Ageing of the alloy is desirable to improve the shelf-life of the product. The
aging is related to relief of stress in the particles produced during the cutting of the
ingot. At room temperature the residual stress is relieved over a period of week or
month. Current practice is to age the particles artificially by subjecting them to a
controlled temperature of 60-100OC for 1-6 hours.

DENTAL AMALGAM

Spherical/ Spheroidal / Atomized Powder:

Today manufacturers can provide a variety of shapes and sizes such as Lathecut, Spherical, Spheroidal or combination. If a combination of different particulate
shapes is used in the amalgam system it is called a blend.
Atomizing process produces these different shapes. After 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.
Particle Size:
Initially, lathe-cut particles was used which is no longer used. Modern days,
smaller spherical particles are whose size is 15-5 m. Smaller particle size is chosen
because low mercury, rapid hardness,

and early compressive strength, produces

smoother surfaces on carving and is less susceptible to corrosion.

Symbols & Stoichiometry of Phases that are Involved in the Setting of Dental
Amalgams:

Ag3Sn

Ag2Hg3

Sn7-8Hg

Cu3Sn

Cu6Sn5

Silver-Copper eutectic

Ag-Cu

AMALGAMATION REACTION/ SETTING REACTION

In low copper conventional amalgam alloy.
Amalgamation occurs when mercury comes into contact with the surface of
the Ag-Sn alloy particles when a powder is triturated, the silver tin in the outer portion

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DENTAL AMALGAM
of the particles dissolve into mercury. At the same time, mercury diffuses into the
alloy particle.
The mercury has a limited solubility for silver (0.035 wt%) and tin (0.6 wt%).
When that solubility is exceeded, crystals of low binary metallic compounds
precipitate into the mercury. These are the body- centered cubic Ag 2Hg3 compound (1
phase) and the hexagonal closed packed Sn7-8 Hg compound (2 phase). Because of
solubility of amalgam in mercury is much lower than that of tin, the gamma-1 phase
precipitates first, and the gamma-2 phase precipitates later.
Immediately after trituration, the alloy powder coexists with the liquid
mercury, giving the mix a plastic consistency. As the remaining mercury dissolves the
alloy particles, gamma-1 and gamma-2 crystals grow. As the mercury disappears, the
amalgam hardens. As the particle become covered with newly formed crystals mostly
gamma-1, the reaction rate decreases. The al1oy is usually mixed with mercury in
approximately I: 1 ratio. There is insufficient mercury to completely consume original
alloy particles. Consequently, unconsumed particles are present in the set amalgam.
The reaction can be conveniently expressed in terms of phases that form during
amalgamations.
Ag3Sn + Hg Ag2Hg3 + Sn7-8Hg + Ag3Sn
()

(l)

(2)

() (unreacted)

The physical properties of the hardened amalgam depend on the relative

percentage of each of the micro structural phases. The unconsumed Ag-Sn particles
have a strong effect. The more of the phase that is retained in the final structure, the
stronger is the amalgam. The weakest component is the 2 phase. The hardness of 2
is approximately 10% of the hardness of l whereas the phase hardness is somewhat
higher than that of 1 phase.

phase is also the least stable in a corrosive environment and may

experience corrosion attack, especially in "crevices" of the restoration. Generally

(Ag3Sn) and pure 1 (Ag2Hg3) phases are stable in an oral environment. However 1
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DENTAL AMALGAM
phase in amalgam does contain small amounts of tin, which can be lost in a corrosive
environment. The interface between the gamma phase and the matrix is important.
The high proportion of the unconsumed gamma phase does not strengthen the
amalgam unless the particles are bound to the matrix.
The conventional amalgam contains the following component phases and their
properties.
A. The original Gamma Phase (Ag3Sn) - which has not been completely
dissolved in mercury. Strongest phase and it could occupy maximum available
space in the volume of restoration.
B. The Gamma -1 Phase (Ag2Hg3) is the noblest phase and most resistant to
tarnish and corrosion.
C. The Gamma -2 Phase (Sn7-8Hg) it is least resistant to tarnish and corrosion.
More prone to corrosion and creep
D. The Mercury Phase unreacted residual mercury will be present within the
amalgam mass. Weakest phase and when exceeds a certain volume limit, there
will be drastic drop in the strength of the amalgam.
E. The Voids (Pores) Phase- occurs on the process of building amalgam
restoration. Traps, air bubbles or voids lead to corrosion and early failure of
restoration.
F. The Trace Element Phase in which copper and zinc might be found, only in
trace amounts in the final product. Copper can increase strength, brittleness
etc. Zinc can increase strength and resistance to oxidation of final product.
G. The Inter Phase applies to the inter phases between gamma, gamma -1 and
gamma -2. In the final restoration, the more continuous they are and close
together, the better in the bonding, the more coherent and more resistant to
environment variable the restoration will be.

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DENTAL AMALGAM

ADMIXED ALLOYES AND UNICOMPOSITIONAL ALLOYS

The reaction occurs in two phases. The first phase is equivalent to the one as
shown in conventional alloys i.e.
Ag3Sn + Hg Ag2Hg3 + Sn7-8Hg + Ag3Sn
()
(l)
(2)
() (unreacted)
The second phase is the eutectic of silver copper phase, which are called 1 and 2 .
This type of reaction occurs in admixed typed of high copper alloy. In a eutectic, two
metal phases are present, which are separated but closely adjacent to each other. Here
1 is silver rich and 2 is copper rich. These two along with (Ag3Sn) react with
mercury and again 1 (Ag2Hg3) and 2 (Sn7-8Hg) is formed. All the tin does not react
with mercury; part of tin reacts with the eutectic 1 and 2.
After
Ag3Sn + Ag-Cu + Hg

Ag2Hg3 + Sn7-8Hg + Ag3Sn +Cu3Sn + Cu6Sn5

Mixing

1 + 2

+ Ag-Cu
1 + 2
The reaction goes on. After one week, the Sn7-8Hg () phase reacts completely

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DENTAL AMALGAM
with eutectic. The silver forms , and the tin forms and .
After

Ag3Sn + Ag-Cu + Hg

Ag2Hg3 + Ag-Cu +Cu3Sn + Cu6Sn5 + Ag3Sn.

One week

1 + 2

1 + 2

The reaction is not finished yet. After approximately one year, copper tin phase is
also vanished. The tin further diffused into the silver copper eutectic slowly and forms
more of phase. The final reaction is:
After
Ag3Sn + Ag-Cu + Hg

Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5

One year

1 + 2

1 + 2

The difference of reaction in an admixed type and the unicomposition type is that
the eutectic Ag-Cu is absent and the reaction is directly with silver, tin and copper tin
phases.
Ag3Sn + Cu3Sn + Hg Ag2Hg3 + Cu6Sn5 + unreacted alloy particles

Thus finally the phase formed is Cu6Sn5 () and no 2 phase i.e. Sn7-8Hg is formed.
Thus time taken for the reaction is faster in case of unicompositional as compared to
admixed type

PROPERTIES:
ADA specification No.1 for amalgam alloy contains certain requirement that
aid significantly to control the qualities of dental amalgam. The specification lists 3
physical properties as a measure of quality of the amalgam.
1. Creep

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DENTAL AMALGAM
2. Compressive strength
3. Dimensional changes.
Strength:
A prime requisite for any restorative material is strength sufficient to resist
fracture. Fracturing of even a small area, especially at the margins, fastens corrosion,
secondary caries, and subsequent clinical failure. It is said that dental amalgam is
strongest in compression and weaker in tension and shear. Therefore, 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. The high copper unicompositional material has the highest early
compressive strengths of more than 250 MPa at 1 hour. The compressive strength of 1
hour was lowest for Lathe-cut alloy i.e.145 MPa. and does not meet ADA
specifications. The compressive strengths at 7 days, or the final strengths, again are
highest for high copper unicompositional alloys.
Comparison of Compressive Strength & Creep of a Low-Copper and High
Copper Amalgam:
Amalgam
Low copper
Admix
Single

Compressive Strength (MPa)

1h
7 day

Creep (%)

145
137
262

2.0
0.4
0.13

343
431
510

Tensile Strength
-24h(MPa)
60
48
64

Composition
High values of early compressive strength are advantageous for amalgam. Since, they
reduce the possibility of fracture by prematurely high contact stresses from the patient
before final strength is reached. As amalgam is brittle material, it does not undergo
deformation or elongation on loading. Therefore sudden application of excessive
forces tends to fracture amalgam restoration.
The tensile strength of both low and high copper amalgam alloy ranges
from48-70 MPa. The elastic modulus of amalgam ranges from 11-12 GPa. High
copper alloy tend to be stiffer than low copper alloy.

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DENTAL AMALGAM

The factors that effect strength of amalgam are:

1. Temperature: Amalgam looses 15% of its strength when its temperature is
elevated from room temperature to mouth temperature and looses 50% of room
temperature strength when temperature is elevated to 60OC e.g. hot coffee or soup.
2. Trituration: The 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. However, excess trituration after formation of matrix crystals will
create cracks in the crystals, lead to drop in strength of set amalgam.
3. Mercury Content: Mercury content is a very important factor in control of
strength. Sufficient mercury should be mixed with the alloy to coat the alloy
particles and allow a thorough amalgamation. Each particle must be wetted by
mercury. Low mercury alloy content, contain stronger alloy particles and less of
the weaker matrix phase, therefore more strength. If mercury is too less it will
result in dry, granular mix, which results in a rough, pitted surface that invites
corrosion. Any excess mercury if present can drastically affect the compressive
strength. If mercury content of amalgam mix is more than 53-55%, it causes drop
of compressive strength by 50%. Increase in the final mercury wi1l cause increase
in volume fraction at exposure of alloy particle resulting in amalgam that is
weaker.
4. Effect of condensation: Condensation pressure, technique and alloy particle shape
affect amalgam properties, when typical condensation technique and lathe-cut
alloys are employed, the greater the condensation pressure, the higher the
compressive strength, particularly the early strength (e.g., at 1 hour) and good
condensation techniques express mercury and result in a smaller volume fraction
of matrix phases. Higher condensation pressure is required to minimize porosity
and to express mercury from lathe-cut amalgam. On the other hand, spherical
amalgams condensed with lighter pressure produce adequate strength.
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DENTAL AMALGAM

Effect of Porosity:
Voids and porosity are factors influencing the compressive strength of
hardened amalgam. Although, porosity cannot be completely eliminated, it should be
minimized. Pores facilitate stress concentration, propagation of cracks, corrosion, and
fatigue failure of amalgam restoration. 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.
Strength after 1 hour is only 6% of I week strength. Patient should be asked
not to bite on that side for at least 8 hours, as by that time a typical amalgam has
reached at least 70% of its strength.
Inter particle distance
The closer the particles of amalgam alloys are to each other, the stronger will
be the end product. There is increase in compressive strength in 24 hour specimens
when the average inter particle distance is 38 or less. In one week specimen, the
strength increases, when the average interparticle distance is 32 microns or less.
In terms of tensile strength, 24 hour specimen demonstrated a marked
increase, when average inter particle distance is < 28. For one week specimens, the
increase exhibited, when average inter particle distance is <39 microns.

Particle size
Smaller the diameter of original particle, greater will be the strength.1 day
specimens, shows increase in compressive strength, when the average particle
diameter is <12 microns and for tensile is <18.

One week specimens, shows

increase in compressive strength, when the average particle diameter in < 16 microns
and for tensile strength, when diameter < 12 microns.

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DENTAL AMALGAM
DIMENSIONAL CHANGES:
When mercury is combined with amalgam it undergoes three distinct
dimensional changes.
Stage -1: It is called the initial contraction, which occurs for about 20 minutes after
beginning of trituration. Contraction results as the alloy particles dissolve in mercury.
Contraction, which occurs, is no greater than 4.5 cm.
Stage -2. Expansion- this occurs due to formation and growth of the crystal matrix
around the unconsumed alloy particles.
Stage -3: Limited delayed contraction. This occurs when any excess mercury that may
be present diffuses into the unreacted alloy particles and cause contraction.
For both low copper and high copper the above 3 stages occurs, but the final
dimensional change can never reach zero. Expansion is more for low copper than high
copper alloys. This may be due to two reasons:
1. Older amalgams contained larger alloy particles and were mixed at higher
mercury: alloy ratio than high copper amalgam alloy.
2. Hand trituration was used for low copper amalgam alloys. Now, high-speed
amalgamators are used which have a large increase in trituration time, resulting in
contraction of high copper alloys.
The following are the most predictable factors that affect the dimensional
changes:
1. Particle size and shape: Smaller the particle size more the surface area present.
Silver enters the mercury faster and gamma-1 phase grows faster from the solution
and consumption of mercury is accelerated. Therefore, stage 1 will occur more
rapidly. Stage 2 will also occur fast to neutralize the original contraction and
contraction of stage 3 becomes more noticeable. More regular the particle shape,
more smoother the surface area. Faster and more effectively the mercury can wet
the powder particles and faster amalgamation occurs in all stages with no apparent
expansion.
2. Mercury: If more mercury is present in the amalgam mix, more will be the
expansion, as more crystals will grow. Thus, stage 2 will be prolonged i.e. expansion.
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DENTAL AMALGAM
Low mercury: alloy ratio favors contraction.
3. Manipulation: During trituration, if more energy is used for manipulation, the
smaller the particles will become and also mercury will be pushed between the
particles, thus discouraging expansion. More the condensation pressure used during
condensation, closer the particles are brought together; more mercury is expressed out
of mix inducing more contraction.
Moisture contamination (Delayed Expansion):
Till now we have seen dimensional changes that occur in the first 24 hours.
The certain zinc containing low copper or high copper amalgam alloys which get
contaminated by moisture during manipulation results in delayed expansion or
secondary expansion, This occur 3-5 days after insertion and continues for months.
This type of expansion can reach values greater than 400 m (4%). In this type of
delayed expansion zinc reacts with water, forming zinc oxide and hydrogen gases.
These hydrogen gases accumulate within the amalgam exciting the pressure causing
expansion.
Complications that may result 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.

Flow and Creep:

When a metal is placed under stress, it will undergo plastic deformation. This
characteristic is referred to as flow or creep. The flow is measured during setting of
an amalgam and reflects the change in dimension of amalgam under load. Creep on
other hand, is usually measured after amalgam setting and it reflects a constant change
in dimension under either static or dynamic loading. Creep is defined as incremental
deformation.

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DENTAL AMALGAM

Generally, it is considered that if the flow is high, the restoration will be more
likely to result in failure. The creep values of commercial alloy vary widely, as high as
approximately 4 % to as low as 0.10 %. 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 restorations
Creep rates increases with larger 1 volume fraction and decreases with larger
1 grain sizes. 2 is associated with high creep rates. In absence of 2, low creep rates in
single composition alloy may be due to phase which act as barrier to deformation of
1 phase.
B. Manipulations:
Greater compressive strength wiI1 minimize creep rates. Low mercury: alloy
ratio, greater the condensation pressure and time of trituration will decrease the creep
rate.
Corrosion:
The general corrosion is the destructive attack of a metal by chemical or
electrochemical reaction with its environment. Excessive corrosions can lead
to increased porosity, reduced marginal integrity, loss of strength and the release of
metallic products into the oral environment.
a) Chemical Corrosion: Occurs most notably on the occlusal surface and produces a
black amalgam silver tarnish film. Corrosion products are mainly oxides and chlorides
of tin.
b) Electrochemical corrosion: Is an important mechanism of amalgam corrosion and
occurs, whenever chemically different sites act as anode or cathode. This requires the
sites to be connected by an electric circuit in presence of an electrolyte (saliva). The
anode corrodes, producing soluble and insoluble reaction products.
Electrochemical measurement on pure phases has shown that the Ag 2Hg3
phase has the highest corrosion resistance, followed by Ag 3Sn, Ag-Cu, Cu3Sn, Cu6Sn5

20

DENTAL AMALGAM
and Sn7-8Hg.
The presence of a relatively high percentage of tin in low copper alloys
reduces the corrosion resistance of their 1 phase. So, it is lower than their phase.
This is not true for high copper alloys. In general, the tin content of the 1 phase is
higher for low copper alloy than the high copper alloys. The average depth of
corrosion for most amalgam alloys is 100-500 m.
In the low copper amalgam system, the most corrodible phase is tin-mercury
or 2 phase. Even though, a relatively small portion (1- 13%) of the amalgam mass
consists of the 2 phase and in an oral environment, the structure of such an amalgam
will contain a higher percentage of corroded phase. On other hand, neither the nor
the 1 phase is corroded as easily.
In low copper alloy, the corrosion results in the formation of tin oxychloride,
from the tin in 2 and also liberates Hg.
Sn7-8Hg + 1/202 + H2O + Cl- Sn4 (OH) 6 Cl2 + Hg
Tin oxychloride.

The reaction of the liberated mercury with unreacted can produce additional l and 2
(Mercuroscopic Expansion). It is proposed that the dissolution of the tin oxide or tin
chloride and the production of additional l and 2

result in porosity and lower

strength.
The high copper admixed and unicomposition alloy do not have any 2 phase
in the final set mass. The phase formed with high copper alloys is not an
interconnected phase such as the 2 phase, and it has better corrosion resistance.
However, is the least corrosion resistant phase in high copper amalgam and a
corrosion product CuCl2.3Cu (OH)2 has been associated with storage of amalgams in
synthetic saliva.
Cu6Sn5 + 1/202 +H2O + Cl- CuCl2.3Cu (OH)2 + SnO.
21

DENTAL AMALGAM

Phosphate buffer solutions inhibit the corrosion process. Thus, saliva may
provide some protection of dental amalgams from corrosion.

Types of Electrochemical Corrosion:

1. Galvanic corrosion: If dental amalgam is in direct contact with an adjacent
metallic restoration such as gold crown, the dental amalgam is the anode in the circuit.
Crevice Corrosion:
Local electrochemical cells may arise whenever a portion of
amalgam is covered by plaque on soft tissue. The covered area has a lower oxygen
and higher hydrogen ion concentration making it behave anodically and corrode. If
these occur in cracks or crevice, it is called crevice corrosion.
Stress Corrosion:
Regions within the dental amalgam that are under stress display a greater
probability for corrosion, thus resulting in stress corrosion. For occlusal dental
amalgam greatest combination of stress and corrosion occurs along the margins.

Manipulation and Technical Consideration of Dental Amalgam:

Selection of Alloy:
The selection of an alloy involves a number of factors including particle size,
particle shape, and composition, particularly as it relates to the elimination of the 2
phase and the presence or absence of zinc.

22

DENTAL AMALGAM
It is estimated that over 90% of the dental amalgam currently placed are high
copper alloys. The majority of these alloys are spherical unicompositional or admixed
types being selected. A high copper alloy is selected to form a restoration with no 2
phase that results in high early strength, low creep, good corrosion resistance and
good resistance to marginal fracture.
Finer particle sizes are used for low copper lathe cut alloy, because of
improved properties and enhanced clinical convenience, such as the ease of
dispensing from mechanical propositioning devices.
Also, finer particles are considered to produce a smoother surface during
carving and finishing. The clinical manipulation of dental amalgam alloys influenced
to a modest extent by the shape of the particles. Lathe cut alloys exhibit rough,
irregular surfaces having a large area to volume ratio to react with mercury, and
generally require nearly 50% or more mercury to obtain adequate plasticity during
trituration.
Spherical alloys are smoother, and consist of various sizes of spheres (2-3m),
which are important in packing the more regular surfaces with a low area to volume
ratio, and generally require less mercury for trituration and suitable plasticity
development. Mercury concentration as low as 42% permit acceptable handling
characteristics with certain products.
The lathe cut and spherical alloys react differently to condensation forces.
These differences results from frictional forces within the amalgam mass that offer
higher resistance to the face of the condenser in lathe cut alloys than in spherical
alloys.
Another criteria depend on the presence or absence of zinc. If an alloy
contains more than 0.01% zinc such material will show excessive corrosion and
expansion in moisture contamination. Alloy not containing zinc, will be less plastic,
less workable and more susceptible to oxidation.
Mercury: Alloy Ratio:
There are two Hg concentration techniques:

23

DENTAL AMALGAM
1. High mercury technique.
2. Minimal mercury technique (Eames technique).
High Mercury Technique: In this, the initial amalgam mix contains little
more mercury than needed for the powder (52-53% Hg) producing a very plastic mix.
It is necessary to squeeze the mercury out of the increments being introduced during
built up of the restoration so that each increment is larger than the previous one.
Because of deleterious effect of high mercury content on physical and mechanical
properties of amalgam, it is not used these days. Special indications may be pin
amalgam restoration or very large restoration where more wetting of amalgam is
required. But with advent of amalgam bond, this can be eliminated.
Minimal Mercury Technique:
In 1959, W. Eames was the first to promote low mercury: alloy ratio. This
method reduces the mercury content upto 43% for high copper single composition
alloys compared to 55% for lathe cut low copper alloys. The excellence of clinical
restoration placed by this technique depends on proper manipulation including
propositioning of mercury and alloy.
Trituration and condensation should be done with equal care. The recommended
mercury: alloy ratio is 1: 1.
Proportioning:
The amount of alloy and mercury to be used can be described as the mercury:
alloy ratio, which signifies the part by weight of mercury and of alloy to be used for
the particular technique employed. For example, mercury: alloy ratio of 6:5 indicates
that 6 parts of mercury are to be used with 5 parts of alloy by weight.
Sometimes, instead of mercury: alloy ratio, the manufacturers specify the
percentage of mercury by weight to be employed in mix. A mix of amalgam prepared
with a mercury: alloy ratio of 6:5 would contain 54.5 percent mercury.

The recommended ratio will vary for different alloy compositions, particle
size, shapes, and heat treatment. The recommended mercury: alloy ratios for most
modern lathe-cut alloy are

1: 1 or 50 % of mercury. And with spherical alloy, the

recommended amount of mercury may be closer to 40%.

24

DENTAL AMALGAM

During the early part of the twentieth century, alloy powder and mercury were
proportioned crudely and mixed manually. To proportion and mix the dental amalgam
more carefully, manufacturers later recommended the use of alloy pellets, mercury
dispensers, mixing capsules and pestles, and amalgamators.
For amalgamators, the capsules are proportioned by weight and not by
volume. These proportioned capsules containing alloy particles and mercury in
compartments separated by a disk or membrane are available. Before use, the
membrane is ruptured by compression of capsule and then capsule is place in an
amalgamator.
A typical reusable capsule is a hollow tube with rounded ends constructed as
two pieces that can be friction fit or screwed together. Amalgam alloy is dispensed
into the capsule as a pellet of pressed powder of standard weight. Mercury is
dispersed from automatic dropper bottle. A small metal on plastic pestles were added
to the capsule and it was closed. The capsule and its contents are automatically mixed

using an amalgamator.
On amalgamators, the trituration speed and time are manually. Disposable
precapsulated dental amalgams are advantageous because of convenience, saving of

25

DENTAL AMALGAM
time, minimizing the contamination and also mercury hygiene is maintained.
Size of Mix:
Manufacturer commonly supplies capsules containing 400, 600 or 800 mg of
alloy and the appropriate amount of mercury. Clinical usage results have shown that
these amounts are sufficient for most restorations. Capsule containing 1200 mg are
also available, if amalgam is needed in large amount.
Trituration:
In general, trituration means the process of grinding powder, especially within
a liquid. In dentistry; the term is used to describe the process of mixing the amalgam
alloy particles with mercury in an amalgamator. Originally, the alloy and mercury
were mixed, and was triturated by hand with a mortar and pestle. Now a days,
mechanical amalgamation saves time and standardizes the procedure. In fact, it is
probably impossible to employ hand trituration for mixing modern amalgams
prepared with low mercury: alloy ratios.
Objectives of Trituration are:
1) To provide proper amalgamation of the mercury and alloy and to achieve a
workable mass of amalgam within a minimum time, leaving sufficient time for its
insertion into a cavity preparation and carving to the predetermined tooth anatomy.
2) To remove the oxide layer, as alloy particles are coated with a film of oxide, which
is difficult for the penetration of mercury. The oxide layer is removed by abrasion
when the alloy particle and mercury are triturated.
3) To pulverize pellets into particles, that can be easily attacked by the mercury.
4) To reduce particle size so as to increase the surface area of the alloy particle per
unit volume, leading to a faster and more complete amalgamation.
5) To keep the amount of 1 or 2 matrix crystal as minimal as possible, yet evenly
distributed throughout the mass for proper binding and consistent, adequate strength.
There are 3 basic movements of mechanical triturations.
1. The mixing arm carrying a capsule moves back and forth in a straight line. Such
movements can occur at varying speed.
2. The mixing arms travels back and forth in figure of 8, also at varying
speeds.
3. The mixing arm travels in a centrifugal fashion.

26

DENTAL AMALGAM

automatic triturator

Trituration energy is corelated to (factors affecting trituration):

1) The speed or the number of unit movements per unit time.
2) The thrust of the movement
E.g. The more the distance that the mixing arm travels from one part to
another to be repeated over and over, the more energy used. Also, the more
complicated the pathway of the mixing arm is the more energy used (straight line
versus figure 8).
3) The weight of the capsule and/or the pestle, e.g. the more weight , the more energy
there will be.
4) The time involved in trituration, eg. the more time is used, the more precipitated
energy there will be.
5) The difference in size between a pestle (ball) and the capsule, e.g. the greater this
difference is, the more the distance the pestle can travel within the capsule, so more
energy will be expended.
Time of trituration on amalgamation ranges from 3-30 seconds. Variations in 2-3
seconds can also produce a under or over mixed mass.

27

DENTAL AMALGAM
CONDENSATION:
The condensation of the amalgam mass into the tooth cavity is one of the most
important steps in the operation of forming an amalgam restoration.
The objectives of condensation are:
1. To squeeze the unreacted mercury out of the increments during building up the
restoration, thereby preventing entrapment of mercury.
2. To bring the strongest phases of amalgam close together, thereby increasing the
final strength of the restoration.
3. To adapt the plastic amalgam mix to cavity walls and margins, thereby increasing
retention and minimizing microleakage.
4. To reduce the number of voids, and keep matrix crystals continuous.
During condensation, proper adaptation of the amalgam mass to the cavity
walls is accomplished to control the amount of mercury that will remain in the
finished restoration, which in turn influences the dimensional change, creep and
compressive strength. In general, the more mercury left in the mass after
condensation, the weaker the alloy.
With irregular shaped alloy i.e. (Lathe cut alloy) in which a higher percentage
of mercury is used. Initially, the operator should remove as much mercury as possible
during condensation by using as greater force as possible on the condenser.
With spherical alloy, the initial mercury is lower, and it is not necessary to
remove as much mercury as for the irregularly shaped alloy.
Hand Condensation:
The mix of amalgam should never be touched with bare hands. The freshly
mixed alloy contains free mercury, and so skin contact should be avoided. If there is
moisture on the surface of skin, that is a source of amalgam contamination. The
increment of alloy should be carried and is inserted in the prepared cavity by means of
instruments such as small forceps or an amalgam carrier designed to that purpose.
The condensing instrument generally is contra -angled and the working end is
usually larger than that used in direct gold alloys. In many instances, circular
condenser tips may prove adequate, whereas
in other cavity areas and design,

oval, crescent or other shapes of tip may be

effective.
Mulling Operations:
For many years, it has been customary for some members of the profession to
28

DENTAL AMALGAM
advocate that, a portion of the mixing operation be completed by a hand mixing
procedure described as mulling.
Mulling is actually a continuation of trituration. Mulling is mainly done to
improve the homogeneity of the mass and to assure a consistent mix with improved
texture. It is mainly done, when mechanical amalgamation with pestle is
accomplished. It can be done in two ways.
1. Mix is place in a dry piece of rubber dam and vigorously rubbed between the first
finger and the thumb. This process should not exceed 2-5 seconds.
2. After trituration, pestle can be removed from the capsule and the mix is triturated
at a low speed for 2-3 seconds. This process also allows cleaning of capsule.
Undermix, Normal Mix and Overmix :
Undermix, normal mix or overmix can result from variations in the condition
of trituration of the alloy and mercury. Not only do the 3 mixes have different
appearance and response differently to subsequent manipulation and but they have
characteristically different mechanical properties regarding dimensional changes,
strength and creep. Spherical alloy and lathe cut alloy respond differently to over and
undertrituration.
These effect on:
Working time: Working time for both spherical and low copper decreases with
overtrituration.
Dimensional changes: Both show higher contraction with overtrituration.
Compressive and tensile strength: Compressive and tensile strength of lathe cut alloys
increases by overtrituration. But, this is not in the case of spherical alloys. They show
higher compressive and tensile strength at normal trituration time.
Creep: Overtrituration increases creep and undertrituration lowers it.
Undertriturations:. When amalgam is triturated for shorter period of time, mercury
does not completely wet the outer surface of amalgam particles; as a result mercury
does not react with the amalgam alloy over entire surface of the particle. The mass
remains soft for longer period of time, producing amalgam with longer working time,
such an amalgam mass contain excessive amounts of porosity, has low strength, and
possesses poorer corrosion resistance.

29

DENTAL AMALGAM

With irregular shaped alloys, one should use condensers with a relatively
small tip, 1-2 mm and apply high condensation forces in vertical directions. During
condensation as much mercury rich mass as possible should be removed from the
restoration.
When condensers with sma11 tips are used with high condensation forces on
spherical amalgams, the particle tend to roll over the another, the tip adapts well to the
cavity walls.With spherical alloys one should use condensers with large tips, almost as
large as the cavity permits.

Amdent scalers used for mechanical condensation

Because of the spherical shape of the particles, a lateral direction of
condensation provides better adaptations of amalgam to cavity walls than of
condensation towards the pulpal floor. With high copper spherical amalgams, a
vertical and lateral direction of condensation with vibration is recommended.
Small to medium diameter condensers are advocated with admixed high
copper alloys with a medium to high force and vertical and lateral direction of
condensation with vibration is recommended. Condensation is usually started at entire
of spherical alloy and 45 to walls and floors for non spherical amalgam.
Subsequently, condensation should be done at 90 to prevent displacement of primary
increment. Each portion must be condensed from centre to periphery.
Upon condensation, the increment should have a shiny appearance. Then next

30

DENTAL AMALGAM
increment is added to the previous one. If this shiny appearance is not present,
increments do not bond and restoration will be laminated.
The increments are added until the cavity is overfilled. After this, the amalgam
mix on surface is condensed heavily over the restoration using largest condensers
possible. This is called blotting mix. It serves to blot excess mercury from marginal
and surface area of restoration and to adapt amalgam more intimately to cavosurface
anatomy.

Mechanical Condensation:
Mechanical condensers are more useful and more popular for
condensing lathe cut alloys, when high condensation forces are required. With the
development of spherical alloy, the need for mechanical condenser was eliminated.
Ultrasonic condensers are not recommended because during condensation they
increase the mercury vapour level to value above the safety standards for mercury in
dental office.

Precarve Burnishing:
Immediately after discarding the blotting mix, a large rounded burnisher is
used in light strokes from amalgam surface to tooth surface on occlusal portion.
Inaccessible areas, such as proximal positions of the restoration should be similarly
burnished using beaver tail burnisher
This process has four objectives.
1. It is continuation of condensation, in that it will further reduce the size and
number of voids on the critical surface and marginal area of the amalgam.
31

DENTAL AMALGAM
2. It brings any excess mercury to the surface, to be discarded during carving.
3. It will adapt the amalgam further to cavosurface anatomy.
4. It conditions the surface amalgam to the carving procedure.
Carving:
Carving is the anatomical sculpturing of the amalgam material.
Objectives:
1. To produce a restoration with no underhangs i.e. all marginal details of the cavity
preparation are completely covered with amalgam without any shouldering or
shelving of tooth structure.
2. To produce a restoration with the proper physiological contours.
3. To produce a restoration with minimal flash.
4. To produce a restoration with functional non-interfering occlusal anatomy.
5. To produce a restoration with adequate, compatible marginal ridges.
6. To produce a restoration with proper size, location, extend and interrelationship of
contact areas.
7. To produce a restoration with physiological compatible embrasures.
8. To produce a restoration not interfering in any way with the integrity of the
periodontium. Thus, enhancing its health.
Carving is begun soon after the condensation. But, the amalgam should be hard
enough to offer resistance to carving instrument. A scarping or "ringing"
(amalgam crying) should he heard. If carving is started too soon, amalgam will
pull away from margins.
To start the carving, first carve the embrasures with Hollenback carvers, then
triangular fossa with discoid/cleoid carvers which will enhance marginal ridge.
Remove marginal flash. Then, incline planes as well as occlusal fossae and
grooves are carved. Occlusal contours are checked during centric occlusion and
during lateral mandibular movements.
Post carve burnishing is done to remove scratches, irregularities on the
amalgam surface, facilitating easier and efficient finishing and polishing. The
combination of frictional heat and pressure with these materials achieve the desired
results.
Finishing and Polishing:

32

DENTAL AMALGAM
The most important objective of finishing and polishing is the removal of
superficial scratches and irregularities. If this is accomplished properly, it will
minimize fatigue failure of the amalgam under the cyclic loading of mastication and
also this scratch and irregularity free surface layer created by the polishing procedure
not only minimizes concentration cell corrosion which could begin in the surface
irregularities but also prevents the adherence of plaque, with all of its sequelae.
Usually, 24 hours should pass after amalgam insertion before any finishing
and polishing commences. However, some new alloys can be polished after 8-12
hours still others require only a 30-minute wait after insertion.
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.
This can be done using descending grade abrasive, eg. rubber mounted stone
or rubber cups. For final finishing i.e. obtaining, a metallic lusture, is always done
with a polishing agent (precipitated chalk, tin or zinc oxide).
Note: One should bear in mind throughout these procedures that overabrading can
cause a loss or anatomy or contact or contour. Likewise, too much friction can
produce overheating, which may endanger the P-D organ as well as adversely affect
the mechanical properties of amalgam, dentine and enamel.
Factors Controlling Quality of Dental Amalgam:
A. Factors under control of manufacture.
B. Factors under control of operator.
A. Factors under control of manufacture:
1. Composition of alloy: whether high copper or low copper, whether zinc
containing or non zinc containing ,whether admixed or single composition.
2. Heat treatment of alloy, whether heated rapidly or slowly, whether cooled rapidly
or slowly.
3. Particle size, shape and method of production whether lathe cut, spherical,
spheroidal
33

DENTAL AMALGAM
Factors under control of operator are:
1. Selection of alloy
2. Mercury: Alloy ratio
3. Proportion of mercury: alloy ratio, whether volumetric dispenser or
preproportioned capsules.
4. Trituration procedure: Hand or mechanical
5. Condensation technique will affect the strength, dimensional change and creep.
6. Marginal integrity.
7. Anatomical characteristics.
8. Final finishing.
Mercury Toxicity:
Like all other materials, mercury has the potential for being hazardous, if not
used properly. Infact when dental amalgam was first introduced in the United States,
the first amalgam war was because of release of potentially harmful mercury. Though
mercury present in amalgam always been under controversy, the contribution of
mercury to overall body burden has been relatively low.
Forms of mercury:
Mercury is available in 3 forms
1)

Elemental mercury (liquid or vapour)

2)

Inorganic compound

3)

Organic compound

The risks from mercury are to the operator, staff and the environment from poor
mercury oral hygiene.
Elemental mercury is most volatile of the three and mercury vapor in air is most
predominant form of elemental mercury. It is rapidly absorbed into blood via lungs.
It can cross the blood brain barrier (E.g. HgO).

34

DENTAL AMALGAM
Inorganic compound of mercury
Source of this is drinking water and food. They are poorly absorbed and do
not accumulate into body tissue and well excreted (E.g. Mercurous Hg+; Mercuric
Hg+2).

Organic compound of mercury

Source drinking water and food (particularly sea food)
Some organic compounds (methyl mercury) are highty toxic at low concentrations.
The normal daily intake of mercury is 15 g from food, 1 g from air ad 0.4 g from
water, (Anusavice).
The maximum allowable level of mercury in the blood is 3 g/L.
The release of mercury in amalgam restoration is greater
For low copper amalgams
From unpolished surface
Allergic response to the mercury associated with amalgam is rare but may be
manifested in 2 ways:
1)

An immediate sensitivity may follow amalgam restorations with skin lesion

being more common than oral lesions. An urticarial rash may appear on the
face and limb followed by dermatitis.

2)

There may be long term response in the form of lichenoid reaction

erosive lesion on the tongue or buccal

with

mucosa adjacent to amalgam

restorations.
Naleway C. et al (1991) investigated the average mercury levels among dentist in
1980 19.5 m g/L, 1986 6.7 g/L, 1991 4.9 g/L. The mercury levels decreased
due to mercury hygiene techniques.
The most toxic organic compounds are methyl and ethyl mercury. Mercury
released in dental office is in forms of mercury vapors. Mercury vapors are released

35

DENTAL AMALGAM
during all procedures such as mixing, setting, polishing and removal, mercury vapors
has also been reported to be released during mastication or drinking of hot beverages.
Concentration of Mercury:
The occupational safety and health administration has set a threshold limit
value (TLV) of 0.05 mg/m3 as maximum amount of mercury vapour allowed in the
work place.
Sources of Mercury Exposure in Dental Office:
1. Dental amalgam raw materials being stored for use.
2. Mixed but unhardened dental amalgam during triturations, insertion and intraoral
setting.
3. Dental amalgam scrap that has insufficient alloy to completely consume the
mercury present.
4. Dental amalgam undergoing finishing and polishing procedure.
5. Dental amalgam restoration being removed.

36

DENTAL AMALGAM

Mercury Management:
1.

Symptoms: Know the potential hazards and symptoms of mercury exposure

such as development of sensitivity and neuropathy.

2.

Hazards: Know the potential source of mercury vapours such as (a) Spills, (b)
dispensers, (c) Polishing amalgam, (d) Removing amalgam.

3.

Ventilation: Provide sufficient ventilation by ensuring that the airflow is

reasonably high and that fresh air is brought into the office in path from waiting
room, through the outer office and expelled to the outer building area without
contaminating other building areas.

4.

Monitor office: Monitor the mercury vapour level in the office periodically
(this may be done using dosimeter badges) as recommended by OSHA.

5.

Monitor personnel: By periodic urine analysis (the average mercury level in

urine is 6.1 g/L for dental office personnel.

6.

Mercury spills: On the floor covering can be decontaminated by replacing

them. There is no effective treatment for removing liquid mercury from carpet.

7.

Pre-capsulated alloy: Use pre-capsulated alloy to eliminate possibility of bulk

spills.

8.

Amalgamator cover: Use amalgamator fitted with cover to contain aerosol

produced during trituration.

9.

Handling care: use care by avoiding stress contact with mercury or freshly
mixed amalgam,

10.

Evacuation system: Use high volume evacuation, when finishing and

removing amalgam. Use rubber dam.

11.

Recycling: Scrap dental amalgam should be col1ected and stored under water,
glycerin or spent x-ray fixer in a tightly capped jar. Spent x-ray fixer has an
advantage of controlling mercury because it is a source of both silver and sulfide
ions for reaction to solid product.

12.

Contaminated items: Dispose of mercury contaminated items in sealed bags

according to applicable regulations.

13.

Clothing: Wear professional clothing only in the dental operatory.

37

DENTAL AMALGAM

INDICATION FOR USE OF AMALGAM:

1.

Pit and fissure caries: Amalgam is appropriate for conservative cavity

preparation, when pit and fissure caries are not extensive especially in bicuspids
and molars.

2.

In Class I, Class II, Class V, and Class III on distal of cuspids

3.

Cemental caries: They can be used as treatment restoration for root caries.

4.

Short life expectancy of tooth: Patient with large cavity preparation when life
expectancy of tooth is questionable, e.g. Medically compromised patients. In
such cases, amalgam is the material of choice regardless of age of the patient.

5.

Preventive procedure: Hyatt had recommended a preventive on prophylactic

procedure, in which pits and fissures may be minimally prepared and restored
with amalgam before visible attack by caries. He referred to this procedure as
""prophylactic odontomy""

6.

Core build-up: Amalgam may be considered a core built up material prior to

complete crown restoration. It can also be used for endodontically treated teeth.

7.

Age of the patient: Although, amalgam can be used regardless of age of the
patient.

8.

Galvanism: In certain cases, complete rehabilitation of posterior teeth with

amalgam may become necessary if patient complains of sensitivity due to
dissimilar metals.

9.

Size and position of carious lesions: Amalgam can be used on distal surface of
canine, if lesion is small and has not involved the facial surface and has not
undermined the incisal corner.

10.

Complex restoration: Amalgam can be used where large amount of tooth

structure is undermined. This can be done by preparing slots and using pins to
enhance the retention form.

11.

Control restoration: Amalgam can be used as control restoration in teeth which

are either symptomatic preoperatively and are poor periodontally. These
restoration help to (1) Isolate pulp from oral fluids, (2) Provide an anatomic
contour against which gingival tissue may heal, (3) Facilitate control of caries
and plaque.

12.

Retrograde filling: They have been used extensively as a retrograde filling

material and from a standard against which other materials are compared.
38

DENTAL AMALGAM
13.

Economic: Not the least, but amalgam restoration are inexpensive and
therefore can be indicated for patients who cannot afford a more expensive cast
gold restoration, provided adequate resistance and retention forms are available.

Limitations of Dental Amalgam:

The subject of dental amalgam has been the subject of considerable discussion
since the introduction of new resin composition and glass ionomer cements.
The shortcomings of dental amalgam are;
1. Poor aesthetics: Being metallic restoration, they are not visually attractive. Also
polished finish is lost with time due to tarnishing. With advent of glass ionomer
cement and composites, use of amalgam in anterior restorations has been
eliminated.
2. Mercury toxicity: Mercury vapours released into the dental office can be
potentially hazardous and management is extremely essential. Mercury hygiene
procedures must be followed.
3. High thermal conductivity: Being a metallic material, thermal conductivity of
amalgam is very high. Problems presented are pulp sensitivity due to
hydrodynamic effect of pumping fluid through marginal gap.
4. Galvanic effects: When 2 dissimilar metallic restorations are in contact in the
mouth, there may be a galvanic cell set up which can result in patient discomfort
in form of strong metallic taste and can accelerate corrosive break down of the
more electronegative metal.
5. Lack of adhesion: Large amounts of sound enamel and dentine are removed under
banner of "extension for prevention".
6. Secondary caries: One of the hazardous with amalgam restoration is micro
leakage. Formation of corrosion products decreases microleakage, but this is
usually slower in high copper alloys, resulting in passage of oral fluids and
secondary caries.
7. Marginal integrity: Marginal breakdown of amalgam restoration ranging from
ditching to complete break down of marginal restoration can also result in many
secondary discrepancies.

39

DENTAL AMALGAM

RECENT ADVANCES IN DENTAL AMALGAM:

RECENT

ADVANCES

IN

DENTAL

AMALGAM:
a. Bonded amalgam
b. Gallium alloys
c. Indium alloys
d. Palladium alloys
e. Fluoride containing alloys
f. Consolidated

silver

amalgam
NEED FOR BONDED AMALGAM RESTORATION: _
Despite all the advantages, amalgam has its own limitations as a restorative
material such that it lacks adhesion to the tooth structure and thereby requires
considerable removal of more intact tooth structure to provide long term retention.
Accordingly, amalgam weakens remaining tooth structure rather than strengthening it.
This is the main reason of cuspal fracture in long standing silver amalgam
restorations.
Other limitations of amalgam restoration are:
1. Increased microleakage under amalgam restorations. Though these decrease
with time, microleakage can cause secondary caries and subsequent ill effects.
2. Decreased tensile strength under complex amalgam restorations.
3. Corrosion.
To combat the above mentioned limitations, adhesive systems designed to
bond amalgam to enamel and dentin have been introduced in an effort to compensate
for the "disadvantages particularly marginal microleakage and need for additional
retentive devices.
ADVANTAGES:
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DENTAL AMALGAM
The advantages of adhesive amalgam restoration over non-adhesive treatment
alternatives are :
1. It is a treatment option for extensively carious posterior teeth, with a lower cost
than either cast metal restoration or metal-ceramic crowns.
2. It allows use of amalgam in teeth with low gingivo-occlusal height which is not
possible in conventional amalgam, amalgam with pins, inlays, onlays, complete
cast crown restoration.
3. It permits more conservative cavity preparations, as it does not require additional
retention in form of groove, pins etc.
4. It can eliminate use of retention pins and inherent risk involved with it such as
periodontal perforation, pulp exposure, stress patterns, cracking, crazing etc.
5. It reduces marginal leakage to minimal.
6. It reinforces the tooth structure weakened by caries and cavity preparation, which
is not with pin amalgam.
7. It reduces incidence of post-operative sensitivity commonly observed with
amalgam restorations.
8. It reduces incidence of marginal fracture and recurrent caries. It allows biologic
sealing of P-D complex by formation of hybrid layer.
9. It can be done in single sitting.
10.It allows for amalgam repairs.

AMALGAM BONDING AGENTS:

Some bonding agents which are able to bond amalgam to tooth structure are:
1. Amalgam bond plus
2. All Bond 2 and AU Bond Liner F
3. Panavia Ex .
Chemical composition:
Amalgam bond plus:
o Activator/Conditioner: 10% citric acid, 3% ferric chloride.
o Adhesive: HEMA (Hydroxyethyl methacrylate).
o Catalyst: TBB(Tri-N-Butyl-Borane oxide).
o Base: 4META(4-Methacryloxyethyl trimellitate anhydride).

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DENTAL AMALGAM

MECHANISM OF BONDING
First the dentin and enamel are treated with an acid conditioner i.e. 10% citric
acid, 3% ferric chloride for 10 seconds. This causes the removal of smear layer and
partial demineralization of collagen with removal of only apatite mineral and
preserving the integrity of dentinal protein molecules. These open pores are now
penetrable by 4 META/MMA-TBB monomer. Monomer penetration can be improved
by treating the surface with application of HEMA. This will enhance the diffusion of
monomer into the dentin and around the exposed collagen. To enable the
polymerization in situ, accomplished by unique initiator, tri-n-butyl borane (TBB) in
conjunction with O2 and H2O available from dentinal tubules. Once polymerized, the
resin formed not only entangles and envelops collagen but also encapsulates
hydroxyapatite crystals, creating the acid-resistant, insoluble transitional zone, hybrid
layer. The width of hybrid layer in 5 m and is sandwiched between cured resin and
dentin.
TECHNIQUE:
Due to bonding system available, minimal retention form is required during
cavity preparation. However, cavity preparation still requires adequate resistance
form. Fragile cusps and walls should be reduced. Reduction of cusps, if required must
be done.
After proper isolating and anesthesia, all carious tooth structure is removed.
Surface is etched with 10% phosphoric acid gel. Then washed for 15 seconds and
dried with air jet. After drying, conditioned enamel has dull white appearance. Three
coats of primer A and primer B are applied till shiny aspect caused by hydrophilic
resin incorporated in primers is obtained. The dentin-enamel bonding agent is applied
with brush and freshly triturated amalgam is condensed into cavity before the auto
curing bonding agent is polymerized.
LIMITATIONS OF BONDED AMALGAM:
a) Time consuming and may be technique sensitive due to bonding agents used.
b) Requires practitioner to adapt to new technique.
c) Increases cost of amalgam restorations.

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DENTAL AMALGAM

GALLIUM ALLOYS:
Although, amalgam remains the most inexpensive, reliable and popular
restorative material for posterior teeth. Recent controversy surrounding mercury has
renewed interest in developing a mercury free restorative material with physical
properties comparable to dental amalgam. Other drawbacks of amalgam include lack
of adhesion to mineralized dental tissues, lack of esthetics, secondary caries.
Mercury free metallic restorative materials proposed as substitute for mercury
containing amalgam are gallium containing materials and pure silver and/or silver
based alloys. Puttkammer suggested the use of gallium in dental restoration in 1928.
However, attempts to develop satisfactory gallium restorative materials were
unsuccessful until Smith and others in 1956, showed that improved Pd-Ga and Ag-Ga
materials has physical and mechanical properties that were similar to or even better
than those of silver amalgam.
ADVANTAGES OF GALLIUM BASED ALLOYS:
o Rapid solidification.
o Good marginal seal by expanding on solidification.
o Heat resistant.
o The compressive and tensile strength increases with time comparable with silver
amalgam
o Creep value are as low as 0.09%
o It sets early so polishing can be carried out the same day
o They expand after setting therefore provides better marginal sea
Compressive
Alloy

Creep %

strength (after 6 Setting

Silver Alloy (High 1.04 + 0.06

hrs)
370 MPa

-0.05

copper)
Gallium Alloy

350 MPa

+ 0.39

0.09 + 0.03

Composition:

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DENTAL AMALGAM
Alloy:
Silver (Ag)

60%

Tin (Sn)

25%

Copper (Cu)

13%

Palladium (Pd)

20%

Liquid:
Gallium (Ga)

62%

Iridium (Ir)

25%

Tin (Sn)

25%

Reaction
The alloy and liquid are mixed as usual. The structure of gallium alloy
resembles that of amalgam. The reaction between AgSn particles and liquid Gallium
involves the formation of AgGa phase and a pure tin phase.
AgSn + Ga AgGa + Sn.
After mixing, the alloy tends to adhere to the walls of capsule, thus difficult to handle.
Moreover, by adding few drops of alcohol, the problem of sticking can be minimized.

Biologic considerations
In early gallium alloys, surface roughness, marginal discoloration and fracture
were reported. With improvement in composition, these defects were reduced but
not eliminated
The gallium alloys could not be used in larger restorations as the considerable
setting amount of expansion leads to fracture of cusps and post operative
sensitivity.
The cleaning of instruments tips is also difficult
It is also less popular because it is costlier than amalgam.

INDIUM ALLOYS:

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DENTAL AMALGAM
Powell et al in 1989 reported that addition of pure indium powder to a high copper
amalgam alloy decreases mercury vaporization.
Due to:
a. Total reduction in the amount of Hg present
b. More efficient oxidation of one surface of Hg releasing phase. A vapor
pressure of Hg in Hg releasing phase
c. It has good wetting property and adapts well to tooth structure.
Advantages:
a. increases compressive strength
b. resistance to creep and corrosion
Marketed as Indisperse.
FLOURIDE CONTAINING AMALGAM:
Stannous fluoride 5% was added to amalgam to reduce the chances of secondary
caries, which is one of the most important causes of failure of amalfam restoration.
Concentration of fluoride release at enamel level is 4000 microgram and at dentin is
9000 microgram.
PALLADIUM ALLOYS
Cherlin added 0.5 to 0.7 weight of palladium , which decrease corrosion, increases
luster, compressive strength, creep resistance.
CONSOLIDATED

SILVER

AMALGAM/MERCURY

FREE

ALLOY/

CHEMICALLY PRECIPATED PRECIPITATED SILVER POWDER:

It is anew experimental mercury free direct filling alloy made up of combination of
powdered metals which have a similar handling properties as direct gold. The
powdered metal is thermally annealed, chemically treated to remove surface oxides
and then compressed to form a solid mass.
Welding together of individual oxide free particles is accompalished by manual
consolidation of metal similar to cohesive gold at room/body temperature.
Method of preparation:
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DENTAL AMALGAM
Chemically precipitated silver powder is thermally annealed in air for 2 hour, 450 0 C ,
then passed through a 200 mesh sieve to obtain an average particle particle size of
approximately 150 micro meter.
Powder is activated immediately prior to use 0.5g of silver powder is mixed with 350
ml of 10% fluoroboric acid on a magnetic stirrer for 1 min. the solution is then
allowed to settle for 2 min , excess liquid is then discarded, leaving the powdered
covered with acid. This slurry can be carried with an amalgam carrier and incremently
condensed.

CONCLUSION
Dental amalgam has been used in dentistry for over 150 years. From the
conventional composition of dental amalgam which was proposed by Dr. G.V.Black
to the new generation adhesive, amalgam has come a long way with the advent of
adhesive materials, which actually bonds amalgam to the tooth structure, the protocol
for placement of amalgam restoration has changed.
There are certain advantages inherent with amalgam such as technique
insensitive, excellent wear resistance, less time consuming, less expensive which are
not present in the newer materials, these factors will continue to make amalgam the
material of choice for many more years to come.

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DENTAL AMALGAM

REFERENCES:
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)

11)
12)
13)

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of operative Dentistry, Mosby 3rd Edition 1997:219-235.
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W.B. Saunders Company, 10th Edition 1996: 361-410.
M.A. Marzouk D.D.S. M.S.D. et al, Operative Dentistry Modern theory and
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Jagannathan, K, Cruise for Gamma 2 Free Mercury, Materials in
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John F. McCabe, Angus W.G. Walls, Dental Amalgam, Applied Dental
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Vimal. K. Sikri, Silver Amalgam, Text book of Operative Dentistry CBS
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Thomas G. Berry, James B. Summit, Albert K.H. Amalgam at the new
millennium, JADA, vol. 129, November 1998: 1547-1555.
Fredericks C. Eichmiller, Kathleen M. Hoffman and Anthony A Guiseppetti,
Acid assisted consolidation of silver alloys for direct fillings J. Res Nath.
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B.M. Eley, The future of dental amalgam: a review of the literature (part 1-7):
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William J. O Brien-Dental Amalgam Dental Materials and their selection
Quintissence publishing company, 2nd edition, 1997; 197-202.

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