CONTENTS

1. INTRODUCTION
2. PAST HISTORY
3. PRESENT
i)
CLASSIFICATION
ii)
DIFFERENT PHASES OF AMALGAMATION
iii)
FUNCTION OF EACH CONSTITUENT
iv)
COMPOSITION AND REACTION
a) LOW COPPER ALLOYS
b) HIGH COPPER ALLOYS
1. ADMIXED ALLOYS
2. UNICOMPOSITIONAL ALLOYS
c) DIFFERENCES BETWEEN HIGH COPPER AND
LOW COPPER ALLOYS
v)
MANUFACTURE OF ALLOY PARTICLES
a) LATHE CUT ALLOY PARTICLES
b) SPHERICAL ALLOY PARTICLES
vi)
PROPERTIES OF AMALGAM
a) DIMENSIONAL STABILITY
b) STRENGTH
c) CREEP
d) CORROSION
vii) TECHNICAL CONSIDERATIONS
a) SELECTION OF ALLOYS
b) MERCURY ALLOY RATIO
c) PROPORTIONING OF ALLOY
1. HAND
2. AMALGAMATORS
d) TRITURATION
1. OBJECTIVES
2. MOVEMENTS
3. FACTORS
4. TIME
e) MULLING
1. TYPES
f) CONDENSATION
1. OBJECTIVE
2. HAND CONDENSATION
3. MECHANICAL CONDENSATION
4. CONDENSATION PRESSURE

g) BURNISHING
1. OBJECTIVES
2. PRECARVE BURNISHING
3. POST CARVE BURNISHING
h) CARVING
1. DEFINITION
2. OBJECTIVES
3. METHODS
i) FINISHING AND POLISHING
viii)
ix)
x)
xi)
xii)

MERCURY TOXICITY
INDICATIONS
LIMITATIONS
FAILURES OF AMALGAM
RECENT ADVANCES
a) FLUORIDE RELEASING AMALGAM
1. RESULTS / ADVANTAGES
2. DISADVANTAGES

b) INDIUM ALLOYS
1. FACTORS RESPONSIBLE
2. PROPERTIES
c) GALLIUM ALLOYS
1. INTRODUCTION
2. PROPERTIES
3. COMPOSITION
4. REACTION
5. BIOLOGICAL CONSIDERATIONS
d) BONDED AMALGAM RESTORATION
1. INTRODUCTION
2. INDICATIONS
3. ADVANTAGES
4. DISADVANTAGES
5. MANIPULATION PROCEDURE
6. BONDING INTERFACE
4. REFERENCES
5. CONCLUSION / FUTURE

INTRODUCTION
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. It has been estimated that more than 160 million amalgam restoration
are placed each year all over the world.
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 of mercury, silver, tin, copper which may
also contain palladium, zinc and other metals. 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.
The Average life span of silver amalgam is 8-10 years, though the
failure have also been found. 50% of failures of amalgam restorations are due
to faulty cavity preparation. American National Standard Institute (ANSI) and
American Dental Association (ADA) specification No. 1 is given to amalgam
alloys predominantly containing silver and tin.
PAST: HISTORY:
Dental amalgam is one of the oldest filling materials in use today. It is
available to dental profession for over 150 years. Its origin can be traced back
to the second century A.D. in China where 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). Formulation consisted
of mixing 100 parts of mercury to 45 parts of silver and 55 parts of tin
producing a paste which was solid as silver.
Amalgam as a restorative material has sparkled controversies several
times in its history of 200 years. The material used in early 1800s is mineral
cement also called as DArcets cements. This alloy of bismuth, lead, tin and
mercury was plasticized to 100oC and poured directly into the cavity.
However in 1818 Regnart, perhaps out of some kindness for the long
suffering patients, suggested a lowering of the fusing temperature of the
DArcets cement by increasing the concentration of mercury, he lowered the
temperature to 68oC and eased the patients discomfort considerably.
3

And so to Regnart we give the title father of Amalgam. In 1819 Bell

from England advocated the use of a room temperature mixed amalgam as a
restorative material.
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 1843 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. Then during later half of 1800s the improved amalgam by
G.V.Black came into widespread use.
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 1920s 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 lead to serious health problems. He also expressed
concerns over health of dentists, starting that nearly all dentists had excess
mercury in their urine.
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 Colarado.
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, Alzhemers 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.
However the controversy has intestified again recently, particularly as a
result of the 60 minute television programme on December 6, 1991, that
created considerable public alarm with a sensationalistic treatment of the issue.
But National Institute of Health (NIM), National Institute for Dental Research
(NDR), Food and Drug Administration claimed that there were no basis for
claims that amalgam was a significant health hazard. This controversy will
probably never be resolved became there will always be a certain percentage of
4

patients seeking a miracle cure for their problems. Now it should be concluded
that fears of amalgam are not a basis for amalgam removal.
But the greatest contribution was probably by Dr. G.V. Black at North
Western University Dental School, Chicago. Black conducted a number of
experiments and developed an amalgam alloy of superior physical and
mechanical properties. Black's publication in 1985 in Dental COSMOS,
concluded that an alloy containing 72.5% Silver, 27.5% Tin, 5% copper gave
the best results when amalgamated with mercury.
PRESENT:
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. Other have one
or more alloys or metals physically added (blended) to the basic alloy.
eg. adding copper to a basic binary silver tin alloy.
III. According to the shape of the powdered articles.
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. Microcut
2. Fine cut
3. Coarse cut
I.
According to copper content of powder
1. Low copper content alloy Less than 4%
2. High copper content alloy more than 10%
V.
According to addition of Nobel metals.
- Platinum
- Gold
- Pallidum
VI. 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 plasticity and increase hardness and strength. 1%
zinc, as oxygen scavenger and decrease 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 : Quaternary alloy ie.. silver tin and copper and
indium.
6. 6th generation (Eutectic alloy consisting).
The alloying of palladium (10%), silver (62%) and copper (28%), to
form a eutectic alloy, 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.
VII. According to Presence of zinc.
1. Zinc containing (more than 0.01%).
2. Non zinc containing (less than 0.01%).
ANSI/ADA Specification No.1 for amalgam alloy includes a
requirement for 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, selenium or mercury may be
included in lesser amount.
CLASSIFICATION ACCORDING TO STURDAVENT
According to Sturdavent amalgam is classified into :
1) Amalgam alloy particle according to geometry and size.
2) Copper content
3) Zinc content
1) Amalgam alloy particles according to Geometry and size :
A) Irregular powder particles (lathe cut) : In these more mercury is
needed to fill the spaces between the particles. Mercury is later removed by
wringing the mass in a squeeze cloth.
B) Spheroidal alloy particles.
2) Copper content :
A) High Copper (More than 11.9% to 28.3%)
B) Low copper (2.4% to 8.6%)
3) Zinc content
A) Zinc containing
B) Zinc free
DIFFERENT PHASES OF AMALGAMATION :
1) Original Gamma Phase
2) Gamma 1 Phase (Silver Mercury Phase)
3) Gamma 2 Phase (Tin Mercury Phase)
4) Mercury phase
5) Voids (Pores) phase
6) Trace Element Phase
6

7) Interphases
1) Original Gamma Phase () Ag3Sn
Silver tin as alloy powder are not completely dissolved in mercury. It is
strongest phase. For this reason it should occupy maximum available space.
2) Gamma -1-Phase (1) Ag2Hg3
Silver mercury phase. It is noblest phase. This phase is most resistant
to tarnish and corrosion and every effort is done so that these phase stays for
maximum time in final product.
3) Gamma-2-Phase (2) Sn7Hg8
It is a product of amalgamation reaction. It is least resistant to tarnish
and corrosion and every effort should be made to minimize this phase. Most of
amalgam failures are due to this phase which is prone to corrosion and creep.
4) Mercury Phase :
Unreacted or residual mercury is present in some areas of the mass.
Although unreacted mercury will keep on reacting with alloy particles in other
phases. This is the weakest phase and when it exceeds to certain volume there
is drastic drop in the strength and hardness of amalgam.
5) Void (Pores) Phase :
Occurs during the process of building the amalgam restoration there is
trapment of an bubbles a voids. Such voids act as N1D1 not only for internal
corrosion but also decrease the stress concentration. Both of these leads to
earlier failure of restoration.
6) Trace Element Phase :
This is a phase in which copper and zinc are found. These elements
plays very important role in final preparations as copper increases hardness,
strength and brittleness whereas zinc increases strength and resistance to
oxidation.
7) Interphase :
The interphase is specially between three phase Gamma, Gamma-1
and Gamma-02. More continuous these phases and less dimensions (closer
together) there is better binding between these phases. Therefore the final
restoration will be more resistant.
FUNCTION OF EACH CONSTITUENT :
1) Silver :
Whitens the alloy
Decreases creep
Increases strength and this increase in strength is because of phase.
Increases expansion on setting
Increases resistance to tarnish and corrosion
Decrease flow
2) Tin :
Tin controls reaction between silver and mercury. Without tin reaction
would be too fast and setting expansion is unexceptable. So tin reduces both
setting reaction and rate of expansion.

 Reduces stress because with more tin AgHg is reduced and SnHg is
increased which is weaker phase.
Increases setting time.
3) Copper :
Increases hardness
Increases setting expansion
Reduces flow
4) Zinc :
Zinc acts as "Scavanger" and "Deoxidizer". When various metals are
melted together during manufacture of alloy zinc acts rapidly with impurities
and oxygen present in the metal thus protecting other metals like silver, copper
and tin from getting oxidized. Alloys without zinc are more brittle. Amalgam
is less plastic. Zinc causes delayed expansion if contaminated with moisture
during condensation and penetration.
5) Mercury :
In some case very less amount of mercury is added i.e. 3% to alloy to
cover the surface of alloy particles. These are called preamalgated alloys.
Preamalgamation produces more rapid reaction.
6) Platinum :
Hardens the alloy
Increases resistance to corrosion
7) Palladium :
Hardens and whitening the alloy.
COMPOSITION AND AMALGAMATION :
According to ANSI and ADA Specification No.1 amalgam alloys
contains predominantly silver and tin. Unspecific amount of other elements
such as Copper, zinc, Gold and Mercury can be added but less than Silver or
Tin content.
LOW COPPER ALLOYS : (G.V. Blacks Silver Tin Alloy or Conventional
Amalgam Alloy)
Silver
: 63 70%
Tin
: 26 28%
Copper
: 2- 5%
Zinc
: 0-2%
Reaction :
Amalgmation occurs when mercury comes in contact with surface of
Ag-Sn alloy particles. When powder is triturated Ag and Sn in outer portion of
particles dissolve into mercury and at the same time mercury diffuses with
alloy particles. Mercury has low solubility for silver 0.035% by weight and
greater for Sn i.e. 0.6% by weight.
When the solubility increases the crystals of two binary metallic
compounds precipitates into mercury. There are body centered cubic Ag 2Hg3
(1) phase and hexagonal closed packs Sn7Hg (2) phase. Because of solubility
of silver in mercury is much more lower than tin, 1 ppts first and 2 ppts later.

Immediately after triturating both alloys dissolve in mercury and gives plastic
consistency. As remaining mercury dissolves the 1 and 2 crystals grows and
as mercury disappears amalgam becomes harder and harder.
Alloy is mixed with mercury to the ratio of 1:1. This percentage of mercury
is less to dissolve the alloy particles and so unconsumed alloy particles are also
present in the set amalgam.
These alloy particles which are small are mixed and surrounded by solid
1 and 2 crystals. Thus a typical low copper is that which contains mixture of
unconsumed particles embedded in 1 and 2 phases.
Ag3Sn + Hg
Ag2Hg3 + Sn7Hg8 + Ag3Sn
()
(1)
(2)
Unreacted
Physical properties of set amalgam depends upon relative percentage of each
phase. Unconsumed Ag2Sn have strong effect. The more the phase in final
structure the more will be the strength.
Weakest phase 2 phase.
Hardness of 2 is 10% of hardness of 1. Whereas phase hardens is
higher than that of 1 phase. 2 phase is also least stable in corrosive
environment and can be easily attacked by corrosion. So and 1 phases are
stable.
However 1 phase contains small amount of tin that can be lost in
corrosive environment.
HIGH COPPER ALLOYS :
To overcome the inferior properties of low copper amalgam alloy.
Youdelis and Innes in 1963 introduced high copper content amalgam alloy.
They increased the copper content from earlier used 5% to 12%.
Composition :
These are 2 types :
A) Admixed Alloys
B) Single Compositional (Unicompositional) Alloys
A) ADMIXED ALLOYS :
These are also called as blended alloys, sometimes also referred as
"dispersion modified 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 (70% Ag = 30% 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.
Particle Shape
Lathe Cut
Spherical
Silver
40-70%
40-65%
Tin
26-30%
0-30%
Copper
2-30%
20-40%
Zinc
0-2%
0%

High copper alloys have become material of choice because of

Improved mechanical properties
Improved corrosion characteristics
Improved marginal integrity
Overall Composition :
Amalgam
: 69%
Silver
: 17%
Copper
: 13%
Zinc
: 15
Discovery or Invention of Admixed Alloys :
In 1963 Innes and Youdelis added spherical silver copper eutectic alloy
(Alloy we shows complete liquid solubility by limited solid solubility) to lathe
cut low copper alloy particles.
AgCu
+ Lathe cut Admixed
(Spherical) Low Cu alloy
This was first major change in history of amalgam after Black's work.
These are of admixed alloys because final result is mixture of two kind of
particles. These admixed powder shown presence of lathe cut and spherical
particles. The amalgam made from these alloys is stronger than the amalgam
made from lathe cut particles this is because of strength of Ag-cu particles. It
is suggested that materials can be strengthened by addition of strong fillers and
Ag-Cu and AgSn acts as a strong fillers.
CONTENTS :
Admixed alloy, powder contains 30 wt% - 55 wt%, spherical high
copper powder. Total content of copper ranges from 9 wt% - 20 wt%. The
phases in copper containing particles depends upon these composition.
REACTION :
Ag-Cu alloys consist of mixture of 2 phases. Silver rich and copper rich
with crystal structure of pure silver and pure copper. Each phase contain small
amount of other phase.
In atomized powder two phases mixture formed very fine lamellae. When
mercury reacts with admixed powder. Silver dissolve within mercury from Ag
Cu alloy particles and both AgSn dissolves into mercury from Ag-Sn alloys
particle.
Ag Sn + Ag-Cu + Hg
Tin in the solution diffuses to surface of Ag-Cu alloys.
Then the Sn reacts with copper to form phases i.e. Cu6Sn5
The layer of crystals forms around silver-copper alloy particles.
Thus layer on Ag-Cu particles also contains some 1 crystals.
Thus 1 forms simultaneously with phase and surrounds both covered
silver Cu alloys and silver tin alloy particles. 1 phase binds the unconsumed
alloy particles together.

10

Reaction :
1st Reaction :
Ag3Sn + Ag2 Cu + Hg Ag3Hg + Sn8Hg + Ag3Sn + Ag3Cu

1
2

nd
2 Reaction :
Sn8Hg + Ag3Cu Cu6Sn5 + Ag2 Hg3

1
Note that 2 has been eliminated in this relation 2 is formed at a same
time as but is later replaced by it.
To accomplish this elimination of 2 phase it is necessary to have copper
concentration o atleast 12% in alloy powder.
B) SINGLE COMPOSITION ALLOY :
Composition :
Silver
: 40-60%
Tin
: 22-30%
Copper
: 13-30%
Zn
: 0-4%
After success of admixed alloys there is development of
unicompositional alloy. Unlike admixed alloy, each particles of these alloy
powder has same chemical composition therefore these are of a single
composition alloy. Major components of these particles are usually Silver,
Copper and Tin. First single compositional alloys contain
Copper
: 13-30%
Silver
: 27 wt%
Tin
: 60%
Zinc
:1
Recently some amount of indium or palladium is also added.
Phases :
Number of phases are found in each single compositional alloy particles.
Including , , E (Ag-Sn) (Ag3-Sn) (Cu6Sn5) E (Cu3Sn)
Some of the phases may also contain phases.
Atomized molecules have dendritic microstructures consisting of fine
lamellae.
Reaction :
When triturated with mercury, silver and tin from Ag-Sn phase dissolves in
mercury.
Very little copper dissolves in mercury.
Ag-Hg 1 crystal grow forming a matrix that binds together partially
dissolved alloy particles.
-Cu-Sn crystals are formed on the surface of alloy particles.
Ag-Sn-Cu + Hg Ag3Hg + Cu6Sn5 + Ag3Sn
1

or
Ag3Sn + Cu3Sn + Hg Ag3Hg + Cu6Sn5 + Ag3Sn

11

Difference between the elimination of 2 phase in an admixed and

uncompositional alloy is that in the admixed alloys, 2 forms around silver tin
(lathe cut ) and is eliminated around silver copper particles (spherical).
In uncompositioned particles at the beginning of reaction function
like Ag-Sn particles of admixed type and later same particles functions like the
Silver Cu particles of admixed alloys eliminating 2 phase.
The Major Differences between Low Copper and High Copper :
Low Copper
More mercury is required for
amalgamation (53.37%). Solubility of
mercury in tin is 170 times more than
in copper and 17 times more than in
silver.

High Copper
Less mercury is required

2.

Dominant phase is AgHg i.e. 1

Dominant phase I sCu6Sn5 i.e.

3.

Corrosion due to 2 phase is due to

formation of tin oxychloride from tin.
Dissolution of this oxide or chloride
leads to porosity.

Cu6Sn5 () phase is the least corrosion resistant

phase. Corrosion occurs in the form of CuCl2 3
Cu (OH)2. Order of corrosion of different phase
is :
AgHg < AgSn < Ag3Cu2 < Cu3 Sn
1

Eutectic

4.

Surface tarnish is associated with 1

Surface tarnish is due to copper rich phases.

5.

Lower copper alloys can be

amalgamated in slow speed and low
energy amalgamation.

High copper alloys require high speed and high

energy amalgamation because copper has low
solubility in mercury as compared to silver and
tin.

6.

Setting reaction is slow.

burnishing and finishing
recommended.

Early
not

Setting reaction is fast. It can be burnished at

first appointment.

7.

Low copper amalgam has higher value

of creep. The range is between 1-8%.

Creep is much less (Mostly less than 1% and

might be as low as 0.1%)

8.

Compressive strength between 1 hour

and 7 days is 150-350 MPa.

Compressive strength varies between 250-500

MPa for one hour and 7 days especially with
unicomposition alloys.

9.

Tensile strength in 24 hours is 60 MPa.

Tensile strength is
composition alloys.

1.

is

10. Dimensional change are more in low

copper alloy varies from 10 to 20
m/cm.

64

MPa

for

single

Much less with high copper alloy, varies from 1

to 9 m/cm.

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 a suitable mold to form an ingot. The ingot may be 3.8 cm in width
12

and 20 to 25 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 400oC to produce a more homogenous distribution of silver tine.
This process is known as thermodynamic equilibrium. The ingot is then
reduced to filings being cut with a suitable tool on a lathe and ball milled. The
particles are passed through a fine sieve of 100 mesh or more and then are ball
milled to form the proper particle size. Control of the particle size and its
general dimensions are important. The particles are typically 60-120 m in
length, 10-70 m in width, and 10-35 m in thickness. Most products are
labeled as fine-cut. Irregularly shaped high-copper particles are made by
spraying the molten alloy into water under high pressure.
In general, fresh cut alloys amalgamate and set more properly than aged
particles, but some aging 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 o to
100o c for 1-6 hours. This process of releasing stresses is called annealing.
Spherical / Spheroidal / Atomised Powder :
Today manufacturers can provide a variety of shapes and sizes such as
Lathe cut, spherical, (spheroidal) or combination. If a combination of different
particulate shapes is used in the amalgam system it is called a blend.
These different shapes are produced by atomizing process. 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 particle shape was used which is no longer used.
Modern day smaller spherical particles are used whose size is 15-35 m.
Smaller particle size is chosen because low mercury, rapid hardness, early
compressive strength produces smoother surface or carving and is less
susceptible to corrosion.
PROPERTIES OF AMALGAM (BEHAVIOUR OF AMALGAM) :
There are 3 main properties of amalgam.
A. Dimensional stability
B. Strength properties
C. Creep
D. Corrosion
A. DIMENSIONAL STABILITY
Ideally amalgam should set with no dimensional changes and should
remain stable for whole life of restoration.
13

a) Dimensional changes
b) Effect of moisture contamination
a) Dimensional Changes :
Introduction :
Amalgam can either expand or contrast depending upon its
manipulation. However these dimensional change should be small.
Severe contraction and can lead to Microleakage, plaque accumulation and
secondary caries.
Excessive Expansion : Excessive expansion can lead to pressure on pulp and
post operative sensitivity. Protrusion of a restoration from excessive
expansion. Demineralized change depends upon how much amalgam is
constrained.
ADA Specification No.1
Required that amalgam should neither contract nor expand. More
than 20 m/cm at 37oC between 5 minutes 24 hours after beginning of
trituration.
STAGES OF DIMENSIONAL CHANGES :
Dimensional Changes occurs in 3 stages :
1) Stage I : Called initial contraction for approximately 20 minutes after
beginning of trituration. . It results from absorption of mercury, into
interparticular spaces of alloy powder.
2) Stage II : Called as expansion stage. This is due to formation and
growth of matrix crystals.
3) Stage III : Called as limited delayed contraction. This occurs due to
absorption of unreacted mercury.
Factors Affecting Dimensional Changes :
a) Constituents :
More the gamma phase the greater is possibility of expansion.
More traces of Tin less expansion.
b) Mercury:
More amount of mercury in amalgam, produces prolonged 2 nd stage of
amalgamation (expansion).
> Hg > Expansion.
More amount of crystals i.e. 1 and 2 more will e expansion.
> 1 2 > Expansion.
c) Particle Size :
Smaller size of particle has more surface area / unit volume. So when
they are mixed with mercury than 1 st stage will occur more rapidly and more
efficiently. Thus leading to marked contraction.
2nd Stage also occurs very fast which may neutralize original
contraction. Expansion pleatue is achieved too early (before cavity is filled).
Therefore contraction of stage 3 is more noticeable.
14

Smaller size of particle

Greater surface area / unit volume

First stage more rapidly 2nd stage more early.

3rd Stage contraction 2nd Stage occurs earlier (To compensate contraction)
more noticeable
d) Trituration :
More trituration energy, the more smaller particles are made and if more
force is there more mercury is pushed into the particles. Both of these
discourage expansion.
More forces of trituration more will be the distribution of matrix crystal
over the mix, this will prevent outward growth hence Expansion of second
stage.
More energy of trituration faster amalgation
Limited contraction No apparent expansion So pleatue of expansion is
Reached much earlier of
2nd stage
e) Condensation :
Greater the energy use in condensing the amalgam into cavity, more
closer are the particles brought together.
More condensation energy Squeezes more mercury out of mix.
Both of the conditions will lead to less formation of growing matrix
crystals More contraction.
f) Shape of Particles :
More regular shape of the particles and smoother surface Mercury
will wet the particles more easily and faster Thus leads to faster
amalgamation in all the stages More expansion occurs before filling the
cavity And not much expansion afterwards.
g) Moisture Contamination :
Dimensional change occur after 24 hours but it is studied that in
admixed alloy expansion use to occur even after 2 years. This expansion may
be due to disappearance of some of all of 2 in these high Copper.
If zinc containing low copper or high copper amalgam is contaminated
by moisture during trituration or condensation a large expansion occurs. This
expansion usually starts after 3-5 days and may continue for months reaching
the value greater than 400 m. This type of expansion is called as delayed
expansion or secondary expansion.
Delayed expansion is associated with zinc. In amalgam this effect is
caused by reaction of Zn with water and is absent in non zinc containing
amalgams. Hydrogen is produced by the reaction of zinc with water.

15

This hydrogen does not combine with amalgam but rather collects
within the restoration and thus increasing internal pressure to levels high
enough to cause amalgam to creep thus producing the expansion.
STRENGTH PROPERTIES :
Set amalgam has weak tensile and very high compressive strength. If it
is properly fabricated then strength of amalgam is adequate for normal
situations within the oral cavity.
However strength can be reduced during manipulative procedures.
Compressive strength of satisfactory amalgam is 310 MPa (45,000 psi).
Unicompositional material have highest compressive strength after 1 hour i.e.
250 MPa. Lathe cut have lowest compressive strength after this ie. 140 MPa.
Tensile strength of both high copper and low copper ranges from 4870MPa.
Following are the factors which effects strength of the amalgam :
a) Temperature :
Amalgam loses about 15% of its strength when temperature is elevated
from room temperature to mouth temperature and looses 50% of its strength
(room temperature) when temperature elevated upto 60oC.
Trituration :
More trituration energy is used more continuous phases between
amalgam matrix. Crystals and original particles and even distribution of matrix
crystals. This leads to greater strength. If further trituration is continued after
crystal formation Excess energy will create cracks between crystals.
Drop in the strength of set amalgam.
c) Condensation :
More energy during condensation less will be residual mercury, which
will result in strong original particles More continuous interphases between
original particle and primary matrix More strength.
Condensation of amalgam after formation of matrix crystals does not
decreased strength.
d) Porosity :
Total elimination of porosity is not possible but it is important to
minimize number of pores and size of pores. And pores should be kept away
from the margins and the surface. Porosity of only 1% can reduce strength
upto 10%.
Porosity results because of different phases of amalgam does not
completely wet each other.
Porosity is increased by : Under trituration, under condensation
Insertion of too large increments
Delayed insertion after trituration.
Non plastic mass of amalgam.
e) Mercury :
Because it is the weakest phase in amalgam so mercury effects strength
of the restoration very much.
16

Mercury is fluid at room temperature and mouth temperature so it

cannot resist any slip or dislocation while condensation. It is estimated that by
increasing mercury content in amalgam upto 50-55% will decrease
compressive strength of amalgam upto 50%.
f) Particle Shape :
Particles of regular shape will combine more effective hence
strengthening the mass.
g) Interparticle Distance :
Closer the original particles of amalgam alloy are to each other the
stronger the end product will be.
It has been studied that when the interparticle distance is 38 or less
after 24 hours this gives maximum compressive strength.
h) Particle Size :
Smaller the diameter of original particles greater will be the strength.
i) Dispersion :
By addition of copper, silver-copper, eutectic alloy, silver-Cu-Palladium
alloy. All of these are capable of Solid state modifications and Preparations of
new phases.
Without changing dimensions this will lead to increased strength.
j) Gamma-2 Phase :
Mechanically 2 phase is the second weakest phase. So increase in 2
will reduce strength and decrease in 2 phase will increase strength.
k) Corrosion :
Decreasing the corrosion activity will protect joining of different phases
thus increasing strength.
CREEP :
Creep is time dependent plastic deformation. Creep rate leads to
marginal breakdown of low copper amalgams. That is greater the creep greater
is the marginal breakdown. However in case of high copper Creep is not a
noticeable cause of marginal fracture.
ADA Specification No.1 : Creep rate should be lower than 3%.
Low Copper Amalgam
: 0.85 8%
Higher Copper
: 0.4 less than .1%
Microstructure of Creep :
1 phase is the major cause of creep in low copper alloys. Creep rate
increases with larger 1 volume fraction. Decreases with larger 1 grain size.
2 presence of 2 is also associated with higher creep rates.
Low creep rate is seen in higher copper alloys as this is related to rods.
These rods acts as a barrier to deformation of 1 phase.
Factor Effecting Creep :
More the strength lesser is the creep.

17

Therefore mercury alloys ratio should be minimize and condensation

pressure should be maximized. But careful attention should be paid for timing
of condensation and trituration.
Excessive Mercury: Will increase the creep. It is estimated that creep of 53%
mercury in mix and 1.5 time more than 43% mercury in the mix.
How to Measure a Creep :
On removal of load creep recovery curve can be obtained.
- After load is removed there is instantaneous drop in strain.
- This instantaneous drop in strain represents recovery of elastic strain.
- Slower recovery
represents an elastic strain and remaining
permanent strain represents viscous strain.
Creep can be calculated by creep compliance
Creep compliance : Is defined as strain divided by stress at a given time (Jt).
Once creep curve is obtained, creep compliance curve can be calculated.
Creep compliance can be made by the equation
Jt = JO + JR + (t/n)
JO
= Is instanceous elastic compliance
JR
= Is retarded elastic compliance
t
= Time
n
= Viscosity
- The strain associated with JO is completely recoverable after the load
is removed.
- The strain associated with JR is not recovered immediately but
requires some finite time.
- Strain associated with t/n is not recovered and represents, permanent
deformation.
CORROSION :
The general corrosion is the destructive attack of a meal 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.
Electrochemical measurement on pure phases have shown that the
Ag2Hg3 phase has the highest corrosion resistance, followed by A 3Sn, Ag3Cu2,
Cu3Sn, Cu6Sn5 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 that 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 then for high copper alloys. The
average depth of corrosion for most amalgam alloys is 100-500 um.
In the low copper amalgam system, the most corrodible phase is tinmercury or 2 phase. Even though a relatively small portion (1% to 13%) of the
amalgam mass consists of the 2 phase, in time and in an oral environment the

18

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.
The low copper alloy the corrosion results in the formation of tin
oxychloride, from the tin in the 2 and also liberates Hg.
Sn7-8Hg + 1/2O2 + H2O + Cl- Sn4 (OH)6 Cl2 + Hg
Tin oxychloride.
The reaction of the liberated mercury with unreacted can produce
additional 1 and 2. It is proposed that the dissolution of the tin oxide or tin
chloride and the production of additional 1 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 r 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.
Cu6Sn + 1/2O2 +H2O + Cl- CuCl2 3Cu (OH)2 + SnO.
Phosphate buffer solutions inhibit the corrosion process; thus saliva may
provide some protection of dental amalgams from corrosion.
Types of Electrochemical Corrosion :
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 also arise whenever a portion of
amalgam is covered by plaque on soft tissue. The covered area has a lowered
oxygen and/or higher hydrogen ion concentration making it behave anodically
and corrode. If these occur in cracks or crevice it is called crevice corrosion.
Stress Corrosion :
Region within the dental amalgam that are under stress display a greater
propensity for corrosion called stress corrosion. For occlusal dental amalgam
greatest combination of stress and corrosion occurs along the margins.
DENTAL AMALGAM : TECHNICAL CONSIDERATIONS :
I) SELECTION OF ALLOY :
The selection of alloy mainly depends on the operator. Generally
speaking, the basic lathe cut alloy Ag 3Sn without any modifications are rarely
used these days and have given way to dispersed alloys, ternary and quaternary
as well as noble phase alloys.
The choice between spherical and lathe cut depends on type of
population being treated. It is estimated that 90% of amalgams used are high
Cu alloys basically for elimination of 2 phases. A high copper alloy is
selected because of no 2 phase and high early strength, low creep, good
corrosion resistance, good resistance to marginal fracture. Finer particle size
are used for ease of handling and dispensing and also they produce a smoother
19

surface for carving and finishing. Shape of particles are also important. Lathe
cut alloys exhibit rough, irregular surfaces and require 50% or more mercury to
obtain adequate plasticity as compared to spherical particles which have more
regular surfaces and require less mercury for trituration. Lathe cut and
spherical alloy react differently to condensation pressures.
These differences result from frictional forces within the amalgam mass
that offer higher resistance to face of condenser in lathe cut alloys than in
spherical alloys.
Another criteria is presence or absence of zinc. If an alloy contain more
than 0.01% zinc. It must be mentioned in packaging as amalgam from such
material will show excessive corrosion and expansion if allowed moisture
contamination. Alloy not containing zinc will be less plastic, less workable
and more susceptible to oxidation. So non zinc containing alloys should be
chosen only for the cases where it is clinically impossible to eliminate
moisture. Indium containing alloys are exception to this rule as Indium
performs the same function of zinc.
II. MERCURY: ALLOY RATIO :
There are two mercury concentration techniques ;
i)
High mercury technique (increased dryness technique)
ii)

Minimal mercury technique (Eames technique)

i) High Mercury Technique or Increased Dryness 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 build up of the
restoration so that each increment is drier 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 indication 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.
ii) Minimal Mercury Technique or EAMe's Technique : In 1960, Eames
was the first to promote a low mercury : alloy ratio. This method reduces the
mercury content upto 43% for high Cu single composition alloy as compared to
55% for lathe cut low Cu alloys. The excellence of clinical restoration placed
by this technique depends on proper manipulation including proportioning of
mercury and alloy. Trituration and condensation should be done with equal
care. The recommended mercury : alloy ratio is 1:1.
Again to choose the technique, will depend on type of alloy being used.
Excellence of clinical restoration depends upon proper manipulation including
proportions of mercury and alloy.
III. PROPORTIONING :

20

The amount of alloy and mercury to be used can be described as

mercury / alloy ratio. For Example, Mercury/ alloy ratio of 6/5 indicates 6
parts of mercury and 5 parts of alloy by weight.
This recommended ratio varies from different alloys to different alloys, particle
size, particle shape and heat treatment. Recommended mercury/ alloys ratio for
most of modern lathe cut alloy is 1:1 or 50% of mercury.
For spherical alloys the recommendations for mercury is closer to 42%.
Because spherical particles have lower surface/ volume ratios requiring less
mercury to completely wet the particles. For proper proportioning wide variety
of dispenses are available.
During the early part of the twentieth century alloy powder and mercury
were proportioned crudely and mixed manually and excess squeezed with a
cloth. To proportion and mix dental amalgam more carefully, manufacturers
later recommended use of alloy pellets, mercury dispensers, reusable mixing
capsules and pesttes pastes and amalgamator.In amalgamators, it is preferable
to proportion by weight and not by volume.
Initially preweighed pellets or tablets were used for dispensing the alloy.
The individual pellets are uniform in weight provided care is exercised in
handling to avoid chipping of pellet. Disposable capsule containing
proportioned aliquots of mercury and alloy are now widely used. These
preproportioned 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
placed 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 or
plastic pate was added to the capsule and it was closed. The capsule and its
contents are automatically mixed using an amalgamator. The amalgamator has
been designed to oscillate in figure of eight pattern.
On electric amalgamator, the trituration speed and trituration time are
manually set in front of the equipment. Disposable precapsulated dental
amalgam are advantageous for convenience, saving of proportion time,
minimize contamination, mercury hygiene is also maintained. For reusable
capsules, threaded ones are better than friction fit as latter may create a
mercury aerosol in office atmosphere.
Size of the Mix :
Manufacturer's commonly supply capsules containing 600, 900, 800 mg
of alloy and the appropriate amount of mercury. Clinical usage results have
shown that these amounts are sufficient for most restorations. It is usually
suggested that if larger amount are required that several smaller mixes be made
at staggered time so the consistency of the mixed amalgam remains reasonably
constant during the preparation of the restoration. Capsule containing 1200 mg
are also available, if amalgam is needed in large amount.
21

IV. MECHANICAL TRITURATION :

Definition :
It is defined as the process of mixing the amalgam alloy particles with
mercury in an amalgamator. Originally the alloy and mercury well mixed or
triturated by hand with mortar and pestle. Today however mechanical
amalgamator saves time and standardizes the procedure.
The objectives of trituration process are :
1. To achieve a workable mass of amalgam within a minimum time,
leaving sufficient time for insertion into cavity.
2. To remove oxides from the powder particle surface, facilitating direct
contact between particles and mercury.
3. To pulverize pellets into particles that can be easily attacked by
mercury.
4. To reduce particle size so as to increase surface area of alloy
particles/unit vol.
5. To keep the amount of 1 or 2 matrix crystals as minimal as possible,
yet evenly distributed throughout the mass.
Alloy and mercury are dispensed into the capsule, or a disposable
capsule system is being used.
1. When the capsule is secured into the machine and machine is turned on,
the arm holding the capsule ossilates and thus trituration is
accomplished.
2. Automatic timer is there for controlling the mixing time and most of
modern amalgamators have 2 or more mixing speeds.
3. New amalgamators have hoods that cover the reciprocating arms
holding the capsule. The purpose of this hood is to prevent the
scattering of Mercury due to accidental escape of mercury from
amalgamator.
4. An amalgamator should be used at the recommended speed by alloy
manufacturer.
The three basic movement of mechanical trituration are :
1. Mixing arm carrying a capsule moves back and forth in a straight line.
2. 2. Mixing arm travel back and forth in a figure of 8.
3. Mixing arm travels in a centrifugal fashion.
Factors that affect trituration are :
1. Speed or number of movements / unit volume.
2. Thrust of the movement.
3. Weight of the capsule and/or pestle eg. more the weight more is the
energy required.
4. Time involved in trituration.
5. Difference in size between pestle and the encasing capsule.
Time of trituration or amalgamation ranges from 3-30 seconds.
Variation in 2-3 seconds can also produce a under or over mixed mass.
For mechanical amalgamators.
Work (Trituration) : time X Motor Speed X Capsule-pestle action.
22

Speed varies from 100-300 alterations/minutes with an increase from

400-1200 mg of amalgam in the capsule.
V. MULLING:
Milling is actually a continuation of trituration. Mulling is mainly done
to improve the homogenicity 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 placed 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.
After trituration pestle can be removed from the capsule and mix
triturated at a low speed for 2-3 seconds. This process also allows cleaning of
capsule.
VI. CONDENSATION :
The objectives of condensation are :
1. To squeeze the unreacted mercury out of the increments building up the
restoration, there by preventing entrapment of mercury.
2. To bring the strongest phases of amalgam closer together, thereby
increasing the final strength of the restoration.
3. To adapt the plastic amalgam mix to cavity walls margins thereby
increasing retention and minimizing microleakage.
4. To reduce the number of voids and keep matrix crystals to minimal
dimensions and continuous.
Condensation should start immediately after trituration. Usually 33.5 minutes can be given for condensation of amalgam mix. Further
condensation can create cracks in already formed matrix. Field of operation
must be kept absolutely dry during condensation. The incorporation of
slightest moisture in a zinc containing amalgam at this stage can result in
delayed expansion and finally corrosion and loss of strength. The ultimate
result of moisture contamination is premature failure of the restoration.
Condensation can be done in two ways :
1) Hand condensation
2) Mechanical condensation.
1) Hand Condensation :
Amalgam mixture should be never touched with bare hands because
freshly mixed amalgam contains free mercury and also moisture on the skin is
source of contamination of the amalgam.
a) Increments of alloy should be called to and inserted in prepared cavity
by the help of amalgam carrier.
b) One increment of amalgam is inserted into the cavity preparation, it
should be immediately condensed with sufficient pressure for proper
removal of voids.

23

c) Condensation is usually started at the central and then the condenser

point is stepped little by little towards the cavity walls. Force required
depends upon the shape of alloy particles.
d) After condensation of an increment, the surface should have shiny
appearance. This indicates that there is sufficient mercury present at the
surface to diffuse into the next increment. If this is not done and
increments do not bond and the restoration is laminated. Such
restoration may fracture probably when matrix is removed.
e) Even with minimum mercury technique one should remove some of the
soft or meshy material that is brought to the surface of each increment.
f) This procedure of adding the increments is continued till the cavity is
overfilled.
g) 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.
h) Small size increments should be carried into the cavity. The large
increments make it more difficult to reduce voids and adapt alloy to the
cavity walls.
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 alloys, the need for mechanical
condensers was eliminated.Ultrasonic condensers are not recommended
because during condensation they increase the mercury vapour level to values
above the safety standards for mercury in dental office.
Condensation Pressure :
The area of condenser point or, face and force exerted on it by the
operator govern the condensation pressure (force/unit area). Smaller condenser
will produce greater pressure on amalgam.
For Example,
2 mm dia condenser result sin condensation pressure of 13.8 MPa
when thrust of 44 neutons is exerted.
Now when 3.5 mm dia condenser results in condensation
pressure of 4.6 MPa when same thrust is applied.
Forces of 66.7 N (15 Lb) are recommended for condensation but it is
doubtful that forces of this magnitude are used. Study has shown that 30
practitioners shoed the forces in range of 13.3 17.8 N.
With irregular shaped alloys, one should use condensers with a relatively small
tip, 1-2 mm and apply high condensation forces in a vertical directions. During
condensation as much mercury rich mass as possible should be removed from
the restoration.
When condensers with small tips are used with high condensation forces
on spherical amalgams, the particle tend to roll over the another, the tip adapts
24

well to the cavity walls, with spherical alloys one should use condensers with
large tips, almost as large as the cavity permit. 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 or spherical alloy and 45 o to
walls and floors for non spherical amalgam. Subsequently condensation should
be done at 90o to prevent displacement of primary increment. Each portion
must be condensed from centre to periphery.Shape of condenser points should
conform to the area under condensation for example, a round condenser point
is ineffective adjacent to corner of angle of prepared cavity. In such area
triangular or rectangular point is indicated.
VII. BURNISHING :
Burnishing is a process sin which smooth, rigid instrument is used for
smoothening restoration surface which has become rough by carving. There is
a conflict between that what should be carried out first burnishing or carving.
If carving is done before burnishing the effect of carving is lost. If burnishing
is don before carving the carving leads to production of rough surfaces. This
has lead to concept of precarve burnishing and post carve burnishing.
Objectives of Burnishing :
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.
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 step.
Pre Carve Burnishing : Is carried out before carving. It smoothens margins
and shapes the contour and curvatures
Post carve Burnishing :
After carving the rough surface which is produced is later smoothed by
final burnishing. At this stage the mass is hard enough to prevent any
disturbance of anatomy formed by carving.
VIII. CARVING :
Definition : Carving is anatomical sculpturing of amalgam.
The objectives of carving are :
1. To produce a restoration with no underhangs.
2. To produce a restoration with proper physiologic contours.
3. To produce a restoration with minimal flash or overhanging.

25

4. To produce a restoration with functional non-interfering occlusal

anatomy
5. To produce a restoration with adequate marginal ridge, proper size,
location of contact areas and embrasures.
6. To produce a restoration which will not interfere with the periodontium.
Carving is begun soon after condensation but the amalgam should be
hard enough to offer resistance to carving instrument. A scraping or "ringing"
sound should be heard. If carving is started too soon amalgam will pull away
from margins.
First carve the embrasures with Hollenbeck carvers, then triangular
fossa with discoid/cleoid carvers which will enhance marginal ridge. Remove
marginal flash. Then inclined planes as well as occlusal fossae and grooves are
carved. Occlusal contours are checked during centric occlusion and during
lateral mandibular movements. Carving is done by moving the instrument
laterally and cutting the amalgam while guided by intact tooth. Post carve
burnishing is done to remove scratches irregularities on the amalgam surface,
facilitating easier and efficient finishing and polishing.
FINISHING AND POLISHING OF AMALGAM RESTORATIONS :
Finishing and polishing of amalgam is most important for proper
success of restoration but most often these step is neglected because it requires
final appointment. Finishing and polishing reduces plaque accumulation and
decreases secondary caries and gingival inflammation. This decreases Fatigue
failure under masticatory load. Fatigue failure is that we occurs by joining of
surface cracks towards inside of restoration which join together to form a
fracture line. Vens (1982) showed that he Vickers hardness of amalgam
improved from 75-90 after polishing and transverse strength also increased.
Procedure:
1) Cavity is overfilled during amalgam condensation.
2) Mercury rich layer is removed during carving after 3-5 minutes. Carving
can be initiated. Amalgam CRY is the absolute time for carving and
carving time depends upon different silver alloy (setting).
3) Burnishing is done both prior and after the carving to smoothen the
surface as it prepares the surface both for finishing and polishing.
4) Restoration is then left undertubed for 24 hours. This time period is
recommended to allow for the setting hardening and dimensional
changes of amalgam to take place which continues for 24 hours. Patient
is cautioned that heavy biting force should not be applied to the filling
for 7-8 hours.
After 24 hours :
Surface of restoration is rough due to heterogeneous structure of
amalgam on setting.
A) Finishing is now begun with use of steel finishing burs or stones. This
includes
26

- Trimming excess and over extending margins.

- Creating contour
- Correcting occlusal disharmonies.
High point appears as a shiny point WC is later reduced by
carborundum stones as finishing burs. Common errors during finishing
of amalgam is that of carving fins or flashes on margins.
B) For Proximo-oclcusal restoration : Finishing begins at cervical margins
and buccal and lingual proximal margins and then occlusal margins.
There may be some overhangs. These overhangs are reduced by using
Thin trimmers.
a) Back and parallel knife
b) Periodontal film
c) Gold foil knifes
C) Finishing of cervical areas is done by inserting fine water resistant
strips. Cervical to the contact area through interdental space and then
moving to and fro.
D) Facial and lingual proximal margins are marginated by cuttle fish
sandpaper discs.
E) Superficial Scratches and Irregularities : These are also removed
simultaneously one thing should along be keep tin mind that always
apply abrasures in descending order i.e. coarse, medium, fine ultra fine.
The final polish or metallic luster is obtained by application of polishing agent
taken Tin oxide, Zinc oxide, Chalk, Pumice, Extra fine silex extra.
For polishing in cervical areas : Polishing steeps, and dental tapers are used.
During polishing the surface is kept moist and at only speed and low pressure is
used otherwise it will lead to overheating and at temperature above 60 o there is
irreversible damage to pulp and also there is formation of mercury vapours wc
are injurious both to individual and the patient. With high copper amalgam
one can finish the restoration much more earlier i.e. they can be polished 15-30
minutes after the condensation.
MERCURY TOXICITY :
Like all other materials, mercury has the potential for being hazardous if
not used properly. Infact when dental amalgam was first introduce in the
United States, the first amalgam war was because of release of potentially
harmful mercury as compared to gold foil. Though mercury present in
amalgam always been under controversy, the contribution of mercury to overall
body burden has been relatively low. Mercury is ubiquitous in the environment
and is taken into the body in one form or another via, water, air diet etc and
excreted through urine.
Forms of Mercury :
Mercury has many forms, including inorganic and organic compounds.
Both inorganic and organic compounds are potentially toxic. Mercury is
normally mixed as an inorganic sulfide ore which is heated in air to oxidize and
drive off sulphur. The most toxic organic compounds are methyl and ethyl
27

mercury. The conversion of mercury from dental amalgam into methyl

mercury invivo is impossible. Mercury released in dental office is in forms of
mercury vapours. Mercury vapours are released during all procedures such as
mixing, setting, polishing and removal, mercury vapours has also been reported
to be released during mastication on drinking of hot beverages.
Concentration of Mercury :
The occupational safety and health administration has set a threshold
limit value (TLV) of 0.01 mg/m3 as maximum amount of mercury vapour
allowed in the work lace. Mercury concentration of 2 mg/m 3 showed no ill
effects.
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.
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 spruce of mercury vapours such as (a)
Spills, (b) Leavy dispensers, (c) Polishing amalgam, (d) Removing
amalgam.
3. Ventilation provide sufficient ventilation by ensuring that the air flow 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/lt 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, reaction with sulphur to form sulphide (cinnabar)
is slow and inefficient.
7. Precapsulated alloy : Use precapsulated 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 of
freshly mixed amalgam.
10. Evacuation system : Use high volume evacuation when finishing and
removing amalgam. Use rubber dam.
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11. Recycling : Scarp dental amalgam should be collected and stored under
water, glycerine 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.
INDICATIONS 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
bicuspids and molars.
2. In Class I, Class II, Class V, Class III on distal of cuspids especially
when involve the permanent teeth.
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 eg. Medically
compromised patients. In such cases amalgam is the material of choice
regardless of age of the patient.
5. Rampant caries : In primary teeth, where children have rampant caries in
such cases amalgam can be the material of choice.
6. High prevalence of dental caries : In permanent teeth where patient is
highly potential to have caries.
7. 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".
8. 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.
9. Age of the patient : Although amalgam can be used regardless of age of
the patient, they can be used for invalid and aged patients, where
physical conditions of patient warrants such a restoration, as they can be
completed in one sitting and are less time consuming.
10. Galvanism : In certain cases complete rehabilitation of posterior teeth
with amalgam may become necessary if patient complains of sensitivity
due to dissimilar metals.
11. Size and position of carious lesions : Amalgam can be used on distal
surface of canine if lesion is mall and has not involved the facial surface
and has not undermined the incisal corner.
12. Complex restoration : Amalgam can be used where large amount of
tooth structure is undermixed by preparing slots and using pins to
enhance the retention form.
13. Control restoration : Amalgam can be used as control restoration in teeth
which are either symptomatic preoperatively and are poor periodontally.
29

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.
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 short comings 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 : The need for use of retentive cavity designs
with dental amalgam imposes secrete constraint. 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 are microleakage. 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.
CAUSES OF FAILURE OF AMALGAM RESTORATIONS :
The different types of failure in an amalgam restoration are ;
1. At visual level
Secondary caries
Marginal fracture
Bulk fracture
Tooth fracture
Dimensional change
2. At the microstructural level

30

 Corrosion and tarnish

Stresses associated with masticatory forces
3. Pain following amalgam restoration
4. Pulp and / or periodontal involvement.
Failures in an amalgam restoration can be studied in detail under three
main headings :
I.
Failures due to faulty cavity preparation
a) Inadequate occlusion extension
b) Inadequate extension of the proximal box
c) Overextension of the cavity preparation walls
d) Minimum depth of cavity preparation
e) Curved pulpal floor
f) Incorrect cavosurface angle
g) Sharp internal line angle
h) Less or more isthmus width
i) Non retentive proximal box
II.
Poor matrix adaptation
III.
Faulty amalgam manipulation
a) Mercury alloy ratio
b) Trituration
c) Condensation
d) Contamination
e) Burnishing
f) Carving
g) Finishing and polishing
RECENT ADVANCES IN DENTIN AMALGAM :
Fluoride Containing Amalgam :
Secondary caries is one of the most important cause of failure in
amalgam restoration. This was considerably low in case of silicate cement
which was associated with the high fluoride content of that material. The
addition of fluoride to amalgam was therefore attractive way to stimulate the
anticariogenic properties of silicate cement.
Stannous fluoride was added
Results / Advantages :
Studies showed that there was reduced solubility of enamel adjacent to
fluoride containing amalgam.
One study has shown that there was lower incidence of secondary caries
around the fluoride containing amalgam restoration.
Exact mechanism played in fluoride uptake in the fluoride containing
amalgam restoration is unknown.
Disadvantages :
Invitro studies have shown that there is reduction in mechanical
properties such as compressive strength and corrosion resistance when
stannous fluoride is added to the amalgam.
31

INDIUM :
The possibility of adverse effects caused by exposure to mercury vapour
caused researchers to experiment with alternative materials. In one such series,
indium was incorporated into the amalgam structure to minimize the
vaporization of mercury of mercury from the amalgam surface.
Powell et al in 1989 first reported that the addition of pure indium
powder to a high copper amalgam alloy decreases mercury vaporization. This
type of amalgam is currently marketed by Indisperse (Indisperse Inc, Canada).
Okare et al (1994) conducted a study which showed that amount of indium
incorporated into amalgam was less than reported by Powell in 1989. Several
effects of the incorporation of indium into the mercury releasing phase may be
responsible for the reduction of mercury evaporation from amalgam.
Effects :
These Are :
i. Total reduction in the amount of mercury present.
ii. More efficient oxidation of the surface of mercury releasing phase. A
reduction of vapour pressure of mercury in mercury releasing phase.
iii. It is good wetting agent and adapts well to tooth surface.
The use of admixed indium is dispersed phase alloy permits a
significantly higher amount of dispersed phase that can be used for preparation
of amalgam restoration. Johnson reports that indisperse (5% indium) is higher
in compressive strength by 16% (24 hours and 79,800 psi), lower in creep by
40% (0.17%) and has a lower dimensional change on setting when compared to
Disperse alloy. Creep rate is important as marginal breakdown is directly
related to creep rate.
GALLIUM ALLOYS :
Silver amalgam, though an accepted restorative material, yet the
mercury controversy limits it use. The toxic effects of mercury coupled with
problems of mercury hygiene, led the researchers think of mercury free alloys.
Gallium alloy is the first of its kind and was suggested by Putt Kammer as
early as in 1928. However, it was used for dental purposes a couple of decades
later.
Properties :
The melting point of Gallium is 24.78oC and the boiling point is 1983oC.
The density of the gallium is 5.90 gm/cm3. It has the property of wetting many
materials including tooth structure. The alloys of gallium are mixed and
condensed as silver amalgam using almost the same instruments. It sets in
reasonable time and possesses strength, diametrical stability and corrosion
resistance equal to or even greater than silver amalgam.
The compressive and tensile strength increases with time comparable
with silver amalgam.
Creep values are as low as 0.09%.
It sets early so polishing can be carried out the same day.
They expand after mixing therefore provides better marginal seal.
32

The physical properties of high copper silver alloys and gallium alloys
are depicted in following table.
Table
Alloy
Creep %
Compressive
Setting
Strength (After 6
Contraction /
hours)
Expansion (%)
Silver Alloy
1.04 0.06
370 MPa
-0.05
(High Copper)
Gallium Alloy
0.09 0.03
350 MPa
+0.39
Composition :
The recent gallium alloys has the following composition :
Alloy :
Silver (Ag)
60%
Tin (Sn)
25%
Copper (Cu)
13%
Palladium (Pd)
20%
Liquid :
Gallium (Ga)
62%
Iridium (Ir)
25%
Tin (Sn)
25%
The early gallium alloys had wide variations in the composition.
Variation in alloy composition :
Tin (Sn)
5 38%
Palladium (Pd)
1-40%
Copper (Cu)
3-30%
Zinc (Zn)
1-12%
Silver (Ag)
6-80%
Variation in liquid composition :
Gallium (Ga)
47-83%
Iridium
7-38%
Tin (Sn)
3-30%
Reaction :
The alloy and the liquid are mixed as usual. The structure of the gallium
alloy resembles that of silver amalgam. The reaction between AgSn particles
and liquid Gallium involves the formation of GaAg phase and a pure tin phase.
AgSn + Ga
AgGa + Sn
The basic reaction remains the same, however, the composition of the alloy
gallium varies considerably. After mixing, the alloy tends to adhere to the walls
of the capsule and thus reported to be more difficult to handle. However, as
per manufacturer's instructions, by adding a few drops of alcohol, the problem
of sticking can be minimized.
Biological Considerations :
Biologically, the results are not promising. In early gallium alloys,
surface roughness, marginal discoloration and fracture were reported. With the
33

improvement in composition these defects were significantly reduced but not

totally eliminated. The problem of setting expansion though considered good
initially later proved to be deleterious. The gallium alloys could not be used in
larger restorations as the expansion lead to fracture of the weakened cusps.
The expansion may lead to post-operative sensitivity.
The creep values are best suited for gallium alloys. Even high copper
alloys which are 2 free still exhibit significant creep value. Gallium alloys
exhibit negligible creep value, which is beneficial for the life of the restoration.
The compressive strength is adequate; therefore, it can be given in stress
bearing areas. However, manipulation of these is difficult. Since these alloys
are sticky, their condensation into the cavity is time consuming. This also
creates problem with removal of matrix bands. The cleaning of instrument tips
and carriers is also difficult and time consuming. It is also less popular because
of its cost, which is approximately 16 times that of silver alloys.
BONDED AMALGAM RESTORATIONS :
To overcome one of the major disadvantage of silver i.e. it does not
adhere properly to cavity walls, adhesive systems designed to bond amalgam to
enamel and dentin have been introduced. It also improve its adhesion, inability
to strengthen remaining tooth structure and the need for removal of healthy
tooth structure for gaining retention. One of the earliest methods to bond and
hence improve retention of amalgam restorations to the cavity surface relied on
painting the walls of the cavity with a layer of zinc phosphate cement and then
condensing amalgam over the wet surface. Later, the 'selective interfacial
amalgamation liner' was tried. This liner was developed by combining the
components of polycarboxylate cement and amalgam alloy particles. Though
these techniques improve bond strength by 2.3 MPa but were not sufficient and
desirable.
Further improvement in amalgam bonding became possible with the
introduction of adhesive resins meant for the "Maryland bridge; technique.
Two Japanese manufacturers marketed special adhesive resin systems,
Superbond (Sun Medical) and Panavia (Kurary) which contained monomers
and enhanced bonding to metal surfaces after air abrading or tin plating these
surfaces. Superbond was based on 4-META/MMA-TBB resins while Panavia
was based on a BisGMA phosphonated ester.
The use of Panavia Ex to reduce microleakage of amalgam restorations
with or without a glass ionomer base has not been documented well in
literature. Shear bond strengths for Panavia Ex to etched enamel and dentin
were reported to be 10 MPa and 6.4 MPa respectively. Panavia used in
combination with glass ionomer cement was more effective than Panavia used
alone and Panavia in combination with both fluoride and glass ionomer cement
was even more effective.
Since then not only resin cements but dentin bonding agents have also
been a subject of bonding amalgam to dentin in a number of studies. Various
agents that have been tried are amalgam bond, amalgam bond with HPA
34

(Parkell), All Bond 2 (Bisco), Optibond 2 (Kerr), Panavia 21 (Kurary), Clearfil

Linerbond 2 (Kuraray), Scotchbond MP (3M) and etc.
Indications :
These are indicated in situations that warrant auxillary retention,
reinforcement of remaining tooth structure, conservative preparations
and improvement of marginal seal.
Boned amalgam restorations are specially indicated for extensively
carious posterior teeth where the more expensive cast metal restorations
and metal ceramic crowns cannot be afforded by the patient.
It also allows use of amalgam in teeth with low gingivo-occlusal height
where conventional amalgam, pin retained amalgam, inlays, onlays and
complete cast crown restorations are difficult to place.
Bonded amalgam restorations may be used as a temporary restoration,
which later can be reduced to a core under a cast crown.
Can be used as amalgam sealants.
Advantages :
It permits more conservative cavity preparations because it does not
require extensive undercuts and additional mechanical retention unlike
conventional amalgam, pin retained amalgam, inlays, onlays and
complete cast crown restorations.
It reinforces tooth structure weakened by caries and cavity preparation.
It eliminates the use of retention pins and their associated problems like
periodontal perforation and pulp exposure etc.
It decreases the incidence of marginal fracture.
It provides a bond at the tooth restoration interface and hence minimizes
microleakage, recurrent caries and post-operative sensitivity.
It allows biologic sealing of the pulpodentinal complex.
It permits restoration of a tooth in one appointment compared to cast or
ceramic restorations that may require more than one appointment.
It is a cost effective treatment compared to the more expensive cast
metal restorations or metal ceramic crowns.
Limitations and Disadvantages :
It is technique sensitive, as it requires the amalgam to be introduced into
the cavity while the adhesive resin is still wet.
It requires time to adapt to the new technique.
Long term results of its clinical performance are not yet documented to
prove its success.
Experiments have shown no sustained effects of amalgam bonding when
subjected to thermocycling.
Hydrolytic stability of the bond is questionable over a prolonged time
period.
It increases the cost of an amalgam restoration.
Manipulation :
The design of cavity for bonded amalgam restorations does not require
the traditional form of cavity preparation. The unnecessary removal of healthy
35

tooth structure is avoided as bonded amalgam technique preserves the

remaining tooth structure. The cavity form is conservative yet an adequate form
of resistance should be provided, as the bonding agent does not remove the
need for parallel walls, grooves and box forms. A high copper single
composition alloy is selected as it offers excellent strength and immediate
mechanical qualities that permit early polishability.
The bonding agent to be chosen under amalgam should preferably be
chemically cured to dual cured. The most commonly used amalgam adhesives
are based on the 4- META system or 10 MDP (Methacryloxy decyl dihydrogen
phosphate) system. Amalgam bond, which utilizes the 4 META system, uses a
solution of 10% citric acid and 3% ferric chloride to remove the smear layer
and demineralize the dentin surface. A primer is subsequently applied on the
conditioned dentin followed by a self curing 4 META system. High
performance additive powder (HPA) in Amalgam bond plus contains
polymethyl methacrylate fibers, which may cross the interface between the
amalgam and the bonding resin producing a reinforced connection between the
two materials.
Panavia resin is a chemically activated.
Bisphenol glycydyl
methacrylate based resin cement. The addition of 10 MDP in the formulation
contributes to the adhesive properties. Panavia Ex is a powder liquid system
while Panavia 21 is a paste system. Both products are chemically cured and
will not polymerize when oxygen is present i.e. are anaerobic in nature.
Panavia 21 includes application of a self etching primer following by the
application of the resin.
A rubber dam is applied to isolate the concerned tooth.
The carious lesion is removed with a slow speed round carbide bur. The
unsupported enamel is removed and finished.
The cavity preparation is gently rinsed with water and dried. If the
depth of the cavity so dicates, a protective base of chemically cured or
light cured glass ionomer cement can be placed.
Remember fragile cusps need not be sacrificed.
Properly fitted auto matrices and wedges are applied. Automatrix is
preferred as it is convenient to place and does not hinder manipulation.
Wedges may have been inserted earlier prior to cavity preparation if
there are chances of damaging the rubber dam during cavity cutting.
Enamel and dentin are etched with a 10% phosphoric acid gel for 15
seconds after which the acid gel is removed with an air water spray.
The vital dentin and enamel are dried with absorbent paper or gently
with air through chip syringe. Properly etched enamel will have a dull
white frosted appearance.
Adhesive primer (Primer A + Primer B, All Bond 2 System) is applied
thoroughly throughout the cavity surface.
The enamel dentin bonding agent (All Bond Liner F) is applied with a
disposable brush.

36

 Freshly initiated amalgam which has been triturated by an assistant is

condensed immediately into the cavity while the resin is still wet i.e. has
not polymerized.
The restoration is carved, finished and polished.
The Bonding Interface :
a) It may include tag formation.
b) Formation of precipitates on pretreated dentin surfaces to which an
adhesive resin mechanically or chemically binds.
c) Chemical binding to the inorganic and /or organic components of dentin,
or
d) Diffusion and impregnation of monomers into the substrate of pretreated
dentin and subsequent polymerization resulting in a hybrid layer of
reinforced dentin.
CONCLUSION :
Amalgam has been used in clinical dentistry for over 100
years.Till today in India it is used as the most common restoration ,however if
one continues use of amalgam, strict mercury and amalgam hygiene should be
maintained.
REFERENCES :
1. D.B. Mahler : High Copper Dental Amalgam Alloys. Journal of Dental
Research. 76 (1) : 1997 : 537-541.
2. B.M. Eley : The future of dental amalgam : A review of the literature.
Part 7 : Possible alternative materials to amalgam for the restoration of
posterior teeth. Br Dent J. Vol. 183 : 12, 1997.
3. Alton M. Lacy and Michal A. Staninec : The bonded amalgam
restoration. Quintessence International. Vol.20 : No.7 : 1989. 521-541.
4. Simonsen R.J. : Move over amalgam at last. Quint. Int. 26 : 157 ; 1995.

DEPARTMENT OF CONSERVATIVE DENTISTRY

AND ENDODONTICS

37

COLLEGE OF DENTAL SCIENCES

DAVANGERE.

SEMINAR ON

PAST, PRESENT AND FUTURE OF DENTAL

AMALGAM

Presented by :

Dr.
Dr BHAWANPREET SINGH

38