1. Dental Amalgam

2. Objectives Differentiate between amalgam alloy and amalgam
Describe the function of major elements in amalgam
Describe the effect of moisture contamination on dental amalgam
Describe acceptable mercury hygiene practices
Explain the trituration and setting processes
Describe the reactions involved in both conventional and high-copper amalgams
Describe the self-sealing property of amalgam

3. Definitions Amalgam alloy Dental Amalgam
The powdered metal before it is mixed with mercury
Dental Amalgam
Powdered metal mixed with mercury used to restore teeth
Amalgamation
Combining mercury with an alloy of silver, tin, and copper
Trituration
Mechanical mixing of amalgam alloy particles with mercury to achieve amalgamation

4. Advantages of Dental Amalgam
Tough, wear resistant
Long lasting
Cost-effective
Self-sealing margins as material corrodes
Least technique-sensitive material
Might work in wet, contaminated field
Life expectancy of the material depends on patient’s diet & OH and on the size of the restoration

5. Definitions cont. Condensation Ditching
Use of mechanical or hand instruments to place or condense the amalgam mass into the cavity preparation
Ditching
Gradual deterioration of amalgam at the tooth-restoration interface
Microleakage may occur

6. Composition of Modern Amalgam
Mercury
Forms workable mass
Silver
Increases setting expansion and strength
Tin
Helps amalgamation
Decreases expansion
Copper
Increases strength, hardness & setting expansion; redness
Zinc
Minimizes oxidation
Palladium
Whitens

7. Conventional (low copper) alloy
Black’s composition
65% silver (Ag)
25% tin (Sn)
5% copper (Cu)
1% zinc (Zn) (sometimes)

8. Setting Reaction of Low Copper Amalgam
γ + Hg γ + γ1 + γ2
γ = Ag-Sn alloy
γ1 = Ag-Hg phase
γ2 = Sn-Hg phase
Mercury is absorbed by the alloy particles and dissolves the surfaces of them
Liquid mercury becomes saturated with silver & tin and the Ag-Hg and Sn-Hg precipitate until solid mass results – may take as long as 24 hours to completely harden

9. High Copper High Copper Dental Amalgam > 6% Copper
Almost universally used today
Higher strength
Higher corrosion resistance
Less marginal breakdown
Low creep
Types of high copper
Admixed, blended
Dispersion

10. Admixed versus Single Composition
Dispersion alloys
Oldest type of high Cu
Alloy powder is a mixture of two alloys
Mix of spherical and lathe-cut particles
Various sizes
Adapt better to cavity walls
Produce better contacts

11. Single Composition
Alloy powder contains powder particles of one composition
Spherical or comminuted
Require less mercury for mixing
Require less condensation force
60% of dentists use admixed
40% of dentists use spherical

12. Spherical High Copper Amalgam
Tytin is good example

13. Zinc versus Non-zinc
Zinc aids in minimizing the oxidation of other metals present in the alloy during the manufacturing process
Zinc-containing
Zinc in excess of .01%
Non-zinc
Zinc less than .01%

14. Definitions-Physical Properties
Excessive expansion
Put pressure on pulp, protrusion of restoration or fracture
Excessive contraction
Pulls away from the cavity walls
Permits leakage between tooth and restoration
Strength
Gains strength in 1 wk.
Variables
Trituration
Residual Mercury
Porosity
Creep
Deforms under a constant load

15. Physical Properties cont.
Tarnish = Surface discoloration
Can be removed by polishing
Corrosion
Loss of surface by chemical attack
Affects surface and subsurface
Deterioration by chemical or electrochemical action

16. Mercury Content and Function
Refers to the amount of mercury in the amalgam mix
40-50% mercury in mix is common
Liquid which provides the “plastic” mass so that the alloy can be inserted into cavity preparation
Acts as a matrix material to bind alloy particles

17. Manipulative Variables
Original alloy-mercury ratio of the mix
Amount of trituration
Pressure and technique of condensation
Time elapsed during mixing and condensation
Mercury content highest at margins

18. Excessive vs. Insufficient Mercury
Effects of excessive mercury
Serious loss of strength
Increase in creep and marginal breakdown
Effects of insufficient mercury
Stiff, grainy mix that is difficult to condense
Final restoration probably contains voids that decrease strength

19. Trituration time
Varies with brand of alloy, alloy-mercury ratio, size of the mix, type of amalgamator, and speed setting
Undertrituration
Grainy mix with excess mercury
Overtrituration
Excessive heat production
Causes mix to set up too quickly

20. Triturator
Ivoclar Vivodent Silamat S5

21. Effects of Moisture Contamination
Excessive expansion
Moisture and zinc
Liberates hydrogen gas within the amalgam mass which leads to delayed expansion beginning at 1 week and continues for months
Protruding restorations lead to:
secondary caries at overhang, corrosion, loss of strength, postoperative pain from pressure

22. Finishing and Polishing
After carving, amalgam is smoothed by burnishing it with a ball burnisher
Polishing
Reduces surface roughness, eliminates pits from carving
Increases life of restoration if done periodically by preventing tarnish & corrosion

23. Marginal Breakdown
In time, most amalgam margins become chipped or ditched
Most likely in the following
Alloys with high creep values
Alloys with high mercury content in marginal areas
Areas of flash due to incorrect finishing technique

24. Types of failures Secondary or recurrent caries Bulk fracture
Marginal breakdown
Excessive dimensional change
Excessive tarnish and corrosion

25. Cracked Tooth Syndrome

26. Bonded Amalgams Rationale For Amalgam Bonding
Adhesively prepared tooth surface
Bonding agent
Amalgam is packed directly into the uncured resin cement, forcing the glass filler in the resin cement to intermingle with the amalgam.
These materials harden together in an interlocking matrix that provides tremendous bond strength of amalgam to dentin, increases the strength of the restored tooth and reduces microleakage and sensitivity

27. Amalgam Bonding ResiLute Resin Cement (one example)
Chemically bonds to the DenTASTIC Adhesive Primer
Micromechanically bonds to the amalgam, locking in the amalgam and increasing the strength of the restored tooth.
ResiLute is dual cure, fluoride releasing and is available in both universal and clear shades.

28. Safety of the Patient
Primary concern is whether mercury can produce local or systemic toxic effects
Major controversy between 1988 and 1991
National Institute of Health announced in 1991 that amalgam is safe and effective except for those few people who have a true allergic reaction to mercury or other components of amalgam

29. Mercury and Safety of Dental Office Staff
Prevention
Ventilation of office
No carpet
For spills use a mercury-spill kit
Vacuum cleaners should not be used for spills
Hazard when inhaled during mixing
Can lead to a cumulative toxic effect
Vapor is colorless, odorless and tasteless
Can be absorbed through skin

30. Precautions cont. In cases of skin contact, wash with soap and water
Excess mercury (which includes waste amalgam) should be collected & stored
Capsules should be tightly capped
Triturators should have hoods over arms
Use pre-proportioned capsules
When cutting amalgam-water spray and suction needed
Wear gloves and mask
Periodic monitoring of exposure levels