AMALGAM

RESTORATION

The word amalgam means an alloy of

mercury with another metal or metals .
This type of alloying is called
amalgamation

Prior to the development of highcopper

amalgam alloys.dental amalgam alloys
contained at least 65wt% silver,29wt%
tin,and less than 6wt% copper.

The high-copper amalgam alloys

contain between 13wt% to 30wt%
copper and at least 40wt% silver.
This higher level of copper has
resulted in the elimination of the
highly corrosion and weak gamma2
(tin-mercury) phase . that existed in
the low-copper dental amalgams.

Amalgam is made by mixing mercury

with a powder of amalgam alloy.
This process is called trituration

The powder may be of the lathe-cut

variety which is made by milling an
ingot of the alloy ,or of the spherical
type which is made by atomizing
liquid alloy.
The spherical particles usually are not
true spheres but take on various
rounded shapes

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.

Nowadays,its use has been controversial.

The most recent controversy is related
to amalgam's release of mercury

There is considerable evidence of the

safety of dental amalgam.
and there is no confirmed evidence to
indicate that the mercury in dental
amalgam is related to any disease.

Advantages and
Disadvantages

Dental amalgam has many advantages

as a restorative material.It is strong,
durable,and relatively easy to use.It
wears at a rate similar to that of
tooth structure.

Its ability to corrode results in a reduction

of microleakage at its interface with
tooth structure.Of long-term restorative
materials,dental amalgam is the least
time-consuming to replace and has the
lowest cost.

Dental amalgam also has disadvantages.

it is not tooth-colored,and it does not,
on its own,bond to tooth structure.
although amalgam bonding systems are
proving to be able to provide a
mechanical attachment of amalgam to
enamel and dentin.

Amalgam contains mercury,which

must be handled properly or the
vapor can create a hazard for dental
staff.

It is still the primary posterior restorative

material for more than 150 million
amalgam restorations placed in the
United States each year.

Resistance Form

One of G.V.Black`s steps in tooth

preparation is obtaining resistance
form.There are two considerations in
resistance form when a tooth is being
prepared to receive an amalgam
restoration.

First,resistance form should be

developed for the restoration;the
restoration must be of adequate
thickness and have marginal design
that will allow it to bear the forces
of mastication without fracture or
deformation.

Second, the remaining tooth structure

must be left in such a state that it ,too,
will resist the forces of mastication.
as much sound tooth structure as possible
must be maintained.

To maximize resistance form for tooth

structure ,minimum sound tooth
structure should be removed when
teeth are prepared for class1 or class 2
amalgam restorations

Several studies have demonstrated that,

as an amalgam restoration becomes
wider faciolingually ,the tooth is more
subject to fracture and the integrity of
the restorations less likely to be
maintained

An increase in the depth of the oclussal

portion of an amalgam preparation
has also been linked to a decrease
in resistance to fracture of the tooth

Class 2 restoration that are confined to

the marginal ridge areas (proximal slot
restorations)may minimize the severity
of tooth fracture compared to class2
restorations that extend through
occlusal grooves .

Based on the knowledge the following

goals should guide the preparation and
restoration of teeth :
1-removal of pathosis (carious tooth
structure)
2-preservation of the integrity of the
tooth and periodontium
3-maximization of the life of the
restored tooth

The Class1
Preparation

indications

Occlusal Caries :the indication for an

initial Class1 amalgam restoration is
carious tooth structure in the occlusal
surface (or in facial or lingual pits in
posterior teeth) detected clinically
and with bitewing radiographs

The objective of treatment are to

eliminate carious lesions ,to remove
any enamel that has been
undermined by the caries process,
to preserve as much sound tooth
structure as possible ,and to create
a strong restoration that mimics the
original sound tooth structure and
allows little or no marginal leakage

If deep fissure that are to be sealed

exhibit enamel demineralization or
heavy stains, they may benefit from
being prepared with a small bur to
a width and depth to approximately
0.4mm before they are acid etched
and sealed with a resin fissure sealant

Traditionally, in a Class1 amalgam

preparation, occlusal fissure or at least
those in the developmental grooves,
have been included in the preparation
even when caries has not extended
throughout the fissures.

Detective Restoration and

Recurrent caries

Another indication for class1 restoration is

replacement of a restoration that is
defective beyond repair or associated
with recurrent carious lesion is one that
occurs adjacent to an existing restoration

Outline Form

When an occlusal restoration must be

placed because of initial carious lesions,
two guidelines should be applied in
establishing the outline form :

1-carious tooth structure should be

eliminated .
and
2-margins should be placed on sound
tooth structure .

The enamel at the margin of the

preparation should be supported by
sound dentin .any enamel that has
been undermined by the removal of
carious dentin should be removed.

The preparation should be widened

only enough to obtain enamel margins
supported by sound dentin .

Although the outline form should not

contain sharp angles, sound tooth
structure should not be removed
simply to obtain wide,smooth curves in
the outline form .

The outline form should be smooth to

facilitate the uncovering of the margins
during carving of amalgam .

When replacing a defective restoration

or a restoration associated with
a recurrent carious lesion,the outline
form will be determined by several factors:

First, the outline form of the old

restoration will have a major influence.
also,the outline form may have to be
extended because of additional
pathosis.

Finally the resistance form for the tooth

structure or restoration may have to
be improved,and that will affect the
outline form.

Resistance and Retention

Form

To provide retention form for the

amalgam restorations of Class1.
occlusal oppositing walls should be
parallel to each other.or should converge
occlusaly .

To enhance their ability to resist

fracture . enamel margins should be
prepared at a 90 degree or more
(obtuse angle) , enamel margins of
less than 90 degree are much more
subject to fracture .

For resistance form in the amalgam

restoration . amalgam margins should
be approximately 90 degree

Although many amalgam restorations

will have amalgam margins that are
significantly less than 90 degree on
the occlusal surface,very acute
amalgam margins are much more
subject to fracture .

If the faciolingual width of the

preparation exceeds one third the
distance between the tips of the facial
and lingual cusps themselves should be
carefully evaluated .

Occlusal amalgam restoration should

have an occlusogingival thickness
of at least 1.5 mm,and preferably 2.0
mm, to resist fracture during function
(resistance form for the retention )