Amalgam Restoration

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Dental amalgam is an alloy made by mixing
mercury with a silver tin alloy.

This type of alloying is called amalgamation

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 History of amalgam
Initially, dentists use silver coins in filling
and mixing these filling with mercury,
creating a putty like mass that was placed
into defective tooth.

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Dental amalgam continuous to be the most
used restorative material for more than 175
years; it was used as early as 1820 in Europe,
and by the mid -1830s, it was in use in the
United States.

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 Classification

 Based on copper content:

- Low copper alloy < 6% copper
- High copper alloy 6-30 % copper

 Based on zinc content:

- Zinc containing alloy > 0,01 % zinc
- Zinc free alloy < 0,01 zinc

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 Based on size of alloy particles:

-Micro-cut

-fine-cut

- Coarse-cut

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 Based on shape of alloy particles:

The powder may be of

1- lathe-cut variety which is made by milling
an ingot of the alloy.
2- spherical type which is made by atomizing
liquid alloy.
The spherical particles usually are not true
spheres but take on various rounded shapes
3- admixed powder alloy.

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 Composition
 Low copper alloys:

Silver 63 – 70 %

Tin 26 – 28 %

Copper 2 – 5 %

Zinc 0–2%
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 ‫تفاعل التصلب‬
‫يتم تصلب األملغم التقليدي من خالل تفاعل كل من الفضة‬
‫(‪ )Ag‬و القصدير (‪ )Sn‬الموجودين ضمن جزيئات ِ‪ Ag-Sn‬مع‬
‫الزئبق(‪ )Hg‬ليشكال نوعين من النواتج التفاعلية ‪:‬‬
‫•الناتج األول و يدعى غاما ‪)Ag-Hg (1-‬‬
‫•الناتج الثاني و يدعى غاما‪) Sn-Hg ( 2 -‬‬

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 ‫•تكون بلورات المركب األول غاما ‪ 1-‬صغيرة و متساوية وهي‬
‫تشكل معظم قالب الحشوة وهي تعطي المقاومة تجاه القوى‬
‫الساحلة‪.‬‬
‫•في حين أن بلورات المركب الثاني غاما ‪ 2-‬تكون طويلة على‬
‫هيئة نصلة المشرط‪ ،‬وعلى الرغم من أنها ال تشكل إال ‪ %10‬من‬
‫كامل المزيج النهائي إال أنها تسبب الضعف تجاه قوى التآكل و‬
‫االنسحال ‪.‬‬

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- This type of amalgam results gamma-two
phase (tin- mercury) which showed
corrosion.
- This corrosion led to breakdown of
amalgam.
- That is why High copper amalgam were
developed to eliminate this corrosion
created by gamma- two phase.

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 High copper alloys:
Silver 69 %
Tin 17 %
Copper 13 %
Zinc <1%

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 Advantages
1- Ease of use, easy to manipulate.
2- inexpensive.
3- It wears at a rate similar to that of tooth.
4- Its ability to corrode results in a reduction
of structure microleakage at its interface
with tooth structure.
5- Of long-term restorative materials, dental
amalgam is the least time-consuming to
replace.

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 Disadvantages
1- non esthetic
2- less conservative.
3- weakens tooth structure.
4- more difficult tooth preparation.
5- Initial marginal leakage.
6- It does not, on its own, bond to tooth
structure.
7- Amalgam contains mercury, which must be
handled properly or the vapor can create a
hazard for dental staff.

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8- AMALGAM TATTOO: This may occur during
amalgam removal when a rubber dam is not used and
the particles of amalgam are flung by the bur into the
gingival tissues where they remain embedded, become
fibrous tissue encapsulated, and corrode to form black
corrosion products.
There are no known adverse reactions but it is
esthetically unpleasing

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 Indications

Amalgam can be a restorative for classes

I, II, and class V in posterior teeth.

- Material selection in such cases will

depend on:

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1- The extent of the lesion
The most suitable indication for amalgam
is the moderate to large class I and II
preparation.

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2- Esthetics

For esthetic-conscious
patients, amalgam will
be objectionable
particularly in apparent
areas of teeth and
posterior composites
may be favored.

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3- Caries incidence
Amalgam may be favored if repair is likely
to include extensions for original cavities
and for patients with moderately high caries
incidence; being less costly and having good
sealing ability.

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4- Economics
A cost-consequence analysis comparing
amalgam and composite resin restorations of
permanent posterior teeth found that, on
average, amalgam restorations have a
longer life and cost less

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 Indications of amalgam

1- class I and class II cavities. moderate to

large restorations.
2- Can be used for cuspal restorations (with
pins usually).
3- Restorations that cannot be well isolated.

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4- In teeth that acts an abutment.
5- Class 5 lesions in nonesthetic areas
especially when access is limited and
moisture control is difficult and for areas
that are significantly deep gingivally.

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 Contra indications of amalgam
1- Anterior teeth where esthetics is a prime
concern.
2- Small –to- moderate classes I and II
restorations that can be well isolated.

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3- Patients have a history of allergy to
mercury or other amalgam components
marked by rashes , sneezing , difficult in
breathing , swelling or other symptoms.

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 Properties
1-Dimensional changes
Initial contraction

Expansion

Delayed expansion

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 Initial contraction
 Occurs for about 20 minutes after
beginning of trituration.

 Contraction results as the alloy particles

dissolve in mercury.

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Expansion

This occurs due to formation and growth of

the crystal matrix around the unconsumed
alloy particles.

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Delayed Expansion (Moisture
contamination)
- Amalgam alloys which get contaminated by
moisture during manipulation results in
delayed expansion.

- Occur 3-5 days after insertion and

continues for months.

- Zinc reacts with water , forming zinc oxide

and hydrogen gases.

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 Complication that may result due to
delayed expansion are:
1-Protrusion of the entire restoration out of the cavity.
2- Increased micro leakage space around the restoration.
3- Restoration perforations.
4- Pulpal pressure pain.

Such pain may be experienced

10 -12 days after the insertion
of the restoration.

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 2- Corrosion
Excessive corrosion can lead to :
1- Increased porosity.
2- Loss of strength.
3- Release of metallic products into the oral
environment.

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 3-Microleakage
Dental amalgam has a tendency to minimize
microleakage.
- If the restoration is properly inserted, leakage decrease
as the restoration ages in the mouth. This is due to the
formation of corrosion products which forms at the
interface between the tooth and the restoration.
 This corrosion products
- seals the interface
- and prevent the microleakage.

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4-Thermal Properties
-Amalgam is a good thermal conductor.
- pulp should be protected with either
varnish, liners or bases.

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 Safety of amalgam fillings

- Toxicity:
Total amount of mercury vapor released
during occluding on amalgam restoration is far
below “ no effect” level.

- Allergy:
Are experienced by less than 1% of the treated
population.

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- Biocompatibility:
- It is related to the mercury vapor released
during manipulation, placement and removal
of amalgam.
- The amount is minimal and the possibility of
toxic reactions in patients is less.
- Careful handling of mercury reduces the risk
of dentist or dental assistant.

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 Clinical performance of
amalgam restoration

- Amalgam does not adhere to the

tooth structure. - At best it affords only
a reasonably close adaptation to the
walls of the prepared cavity.

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 Failures of dental amalgam
- usually amalgam lasts for about 10 years

- Reasons for replacement of amalgam are

usually associated with:
- Tooth fracture.
- Recurrent caries.
- amalgam fracture.
- Marginal breakdown.

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2- Amalgam fracture:

- Shallow preparation leads to thin

section of amalgam placement.

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3- Marginal breakdown:

- Primary cause is incorrect cavosurface angle

leading to marginal fracture of enamel or amalgam.
- Occurs more readily when amalgam has acute
margin angle.
- Delayed expansion can cause extension of amalgam
beyond the surface.
- Overfilling, underfilling causes acute amalgam
margins.

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Amalgam bond is based on a dentinal bonding
system developed in Japan by Nakabayashi .

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 Technique
Methods involves:
- Etching the tooth surface
- and primer application
- followed by adhesive resin liner, The
adhesive resin liner is chemically activated.
- Amalgam is condensed on the unset adhesive
resin liner that leads to mechanical
interlocking.

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 Advantages
1- conserve more tooth structure by reducing
the need to remove tooth tissue for
mechanical retention.
2- increased amalgam retention.
3- reduce marginal leakage.
4- reduce the need for dentine pins.
5- potentially reduce sensitivity.
6- improve fracture resistance.

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 Indications
1- Not recommended for routine
amalgam cavities with sufficient
mechanical retention .
2- Useful for large multi surface
amalgams to avoid use of pins.
3- Useful for amalgam repairs.

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 Limitations
1- Technique sensitive.
2- Adhesion may breakdown over time.
3- Increased cost of restoration.

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 Current status of amalgam
Today population is decreased because of:
- Reduction in caries rate.
- Esthetic concerns.
- Development of composites (primary cause of
reduction in use of amalgam).
- Environmental concerns.

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