AMALGAM

Amalgam: any alloy containing Mercury

Dental Amalgam: Alloy of Mercury, Silver, Copper & Tin which may also contain Palladium, Zinc & other elements to improve the handling characteristics & clinical performance

ADA specification no.1 for Dental amalgam

Classification of amalgam
Based on: 1. Composition:
Copper content of the alloys: Low Cu alloys- <6 wt% Cu High Cu alloys- > 6wt% Cu (2 types: Admixed & Single composition alloys)

Cu - increases strength, hardness & corrosion resistance, reduces plasticity

 Zinc content of the alloys Zn free - <0.01wt%Zn Zn containing - >0.01wt% Zn Zn - reduces brittleness, acts as a scavenger or deoxidizer Number of alloyed metals:
Binary (Ag-Sn) Ternary (Ag-Sn-Cu) Quarternary (Ag-Sn-Cu-In)

2. Particle geometry:
Size of the particles: Microcut Fine cut Coarse cut Shape of particles: Spherical (by a process called atomization) Lathe cut (by ball milling) Admixed Spherical Lathe cut Admixed

3. Bonded & non-bonded amalgam

Manufacture
Alloys melted & cast Cooled Homogenizing heat treatment to relieve stresses (6-8 hrs at 400 C)
0

Ball milled Lathe cut

Atomization spherical

Acid washed to increase reactivity

Composition
Low Copper alloys: 65% Ag, 29%Sn, 2-5%Cu, rest Zn Admixed High Copper alloys: 70% Ag,17%Sn,13%Cu,1%Zn Single composition High Copper alloys: 40-60% Ag,22-30%Sn,13-30% Cu,0-4%Zn

Effects of various components

SILVER Major element Whitens the alloy Decreases creep Increases the strength Increases the setting expansion Reduces tarnish and corrosion

 TIN Controls the reaction between silver and mercury Reduces strength and hardness Reduces tarnish and corrosion resistance Hence tin content should be controlled

COPPER
Increases hardness and strength Increases setting expansion Decreases brittleness of the alloy

 ZINC Acts as scavenger or deoxidizer Adds plasticity to the mix PLATINUM Hardens the alloy Increases resistance to corrosion PALLADIUM Hardens and whitens the alloy MERCURY Necessary for reaction to form plastic mass

Effects of various components

Ag
Strength
Expansion Creep & Flow Setting time

Sn

Cu

Zn

Ag
Corrosion resistance Hardness Brittleness Scavenger/deoxidizer

Sn

Cu

Zn

Mercury
ADA specification no. 6 <0.02% non-volatile residue Freezing point = -38.870C Boiling point =356.9 0C Surface tension - 465 dynes/cm at 200 C, as compared to water 72.8 dynes/cm Hg has lower melting point - 1270 C

Reaction
Low Copper alloys: Ag-Sn + Hg Ag-Hg + Sn-Hg + Ag-Sn g + Hg g1 + g 2 + g
(unreacted)

 Low copper aloys has gamma 2 phase(weakest phase)and is least stable to corrosion process High copper alloy contains more than 6% wt copper. They have improved mechanical propertie Resistance to corrosion Better marginal integrity (preferred over low copper alloy as weakest gamma 2 phase is eliminated)

 Admixed high Copper alloys: 2- step reaction 1. Ag-Sn (g )+ Hg Ag-Hg(g1) + Sn-Hg(g2)

+unreacted Ag-Sn (g)

2. Ag-Cu eutectic + Sn-Hg(g2) Cu6Sn5(h) + Ag-Hg(g1) + Cu3Sn(e) + unreacted Ag-Cu combining 1 & 2: Ag-Sn (g )+ Hg+ Ag-Cu eutectic

g1+ h +g +e +unreacted Ag-Cu

 Unicomposition alloys: Ag-Cu-Sn + Hg g1+ h +e + unreacted Ag-Cu-Sn

Manipulation of amalgam

1. Selection of type of alloy:

Powder, pellet or capsule, High/low Cu content, Zn content, Spherical, lathe cut or admixed

2. Proportioning (Mercury - alloy ratio):

- for plastic & smooth mix
- to reduce the amount of residual Hg -earlier 8:5 ratio was used -Eames technique / Minimal Hg technique-1:1 -lathe cut alloys need 50% Hg -Spherical alloys need only 42% Hg Wilmer B. Eames (1914-2001)

Methods of proportioning:
a. Dispensers based on proportion by volume/ weight b. Preweighed pellets / tablets c. use of capsules with preproportioned Hg & alloy

- excess Hg: continued reaction- expansion

- Mercuroscopic expansion- in corrosion prone g2

phase

Sn-Hg + Chlorides

SnCl2 + Hg

3. Trituration:
Objectives:

-To dissolve Hg in alloy particles & obtain a workable plastic mass with
sufficient working time -To remove oxide film on the surface of the alloy particles. -To wet all the surfaces of the alloy particles with mercury. Methods of trituration: -hand trituration with mortar & pestle, or -mechanical trituration with an amalgamator Amalgamatorsvariable speed, reciprocation/ centrifugal mixing -Spherical alloys-less time for trituration -larger mix- longer mixing time -longer trituration- shortens working time

NORMAL MIX Appears shiny and separates in a single mass from the capsule Has maximum strength Carved surface retains its luster after polishig Mix is warm when removed from capsule UNDER-TRITURED MIX Appears dull and crumbly Mix is rough and grainy Less strength Susceptable to tarnish after carving OVER-TRITURED MIX Appears sopy and tends to stick to the inside of capsule Decrease working time Increases creep Results in higher contraction of amalgam

4. Mulling:
Its a continuation of trituration Done to improve homogenity of the mass and to assure a consistent mix Accomplished in two ways: 1. Mix is enveloped in a dry piace of rubber dam and vigorously rubbed between first finger and thumb for 2-5 sec. 2. After trituration the pestle is removed and mix is triturated in the pestle free capsule for 2-3 sec Properly mixed amalgam smooth, non-granular, plastic mass that is warm & lustrous

5. Condensation:
Objectives:

-to get a void free restoration

-proper adaptation to cavity walls -removing excess Hg to top layer - each increment bonds

-3-4min delay in condensation -reduces strength,increased mercury content and creep. -Condensation pressure = 3-4 lbs

lathe cut alloys -- vertical condensation with a 1-2mm diameter tip- greater condensation pressure
-spherical alloys -mild pressure - lateral followed by vertical - large tip

-admixed - heavy pressure -vertical then lateral condensation- medium sized tip Hand/ mechanical condensation - Mechanical condenser provide vibration or impact type of force - Less effort required

6. Precarved burnishing:
-Process of rubbing with pressure to make the surface shiny & lustrous -Continuation of condensation & beginning of carving -increases adaptation & compaction of amalgam at the margins & surface of the restoration

7. Carving:
-to reproduce normal anatomy of tooth produce restorations with no under or over hangs produce restoration with functional non interfearing anatomy and adequate,compatible marginel ridge -Time of carving ringing sound, amalgam should offer resistance to carving -Types of carvers Hollenbeck carver, Wards carver,Diamond carver,cleiod carver

8. Postcarved burnishing:
-Rubbing without pressure to smoothen the surface -produces denser amalgam at the margins -done with burnishers from amalgam to tooth(ball burnisher) -heat during burnishing not > 60 degrees, results in Hg release

6. Finishing & Polishing procedures:

-done after 24 hrs in wet atmosphere -use of diminishing grade of abrasives

- Initial finish - green carborundum stone - Final finish - finishing burs - Polishing - coarse to fine rubber abrasive points or rubber cup with pumice

Finished

burnished

polished

Advantages of Amalgam
Ease of use,manipulate Self sealing property Good strength Good wear resistance Long lasting Economical Less chair side time required Direct restorative material Easy to repair Favourable long term clinical research results Less technique sensitive

Disadvantages of Amalgam
Non-esthetic More brittle and less tough Galvnic action Do not bont to tooth structure Prone to tarnish and corrosion Marginal breakdown Microlekage Mercury toxicity Delayed expansion

Amalgam substitutes
Have equal or better properties than amalgam. Contain some of the components of amalgam like Ag-Sn alloys but no Mercury Gallium alloys : Gallium substitutes Hg in amalgam. Ga is a liquid at room temperature Disadv of Ga: -Early expansion - post-operative pain -Difficult manipulation sticky mix -Margin deterioration & surface corrosion

Properties of Dental Amalgam

Discussed under:

Dimensional stability Strength properties Creep Elastic Modulus Tarnish & Corrosion Hardnesss Thermal conductivity Linear coefficient of thermal expansion

Dimensional stability

ADA specification no.1 requires that amalgam

neither contract / expand > 20mm/cm measured at 37 C between 5 mins & 24 hrs after beginning of trituration.
0

 I: absorption of Hg into interparticle spaces of alloy powder , dissolution of particles -contraction II: formation & growth of matrix crystalsPrimary expansion Plateau stage: After matrix formation III: limited delayed contraction due to absorption of unreacted Hg - not apparent

Moisture contamination
- in Zn alloys: Zn + H2O ZnO + H2 - This H2 increases internal pressure of restoration & causes creep delayed or secondary expansion - Starts after 3-5 days, continues for months - Complications protrusion of restoration out of cavity microleakage pitted surface and corrosion All this results to dental pain,recurrence of caries and fracture of the restoration.

Effects of dimensional change

Expansion >> 4%
-Pressure on pulp pain -High point / occlusal interference - pain -Pressure on cavity walls tooth fracture - pain -Greater susceptibility to corrosion -Expansion over the cavity margins fracture of the restoration ("ditched amalgam")

Contraction >> than 50/cm

-microleakage

-secondary caries

Strength
Maximum stress that a structure can withstand without sustaining a specific amount of plastic strain or stress at the point of fracture Amalgam is weak in tensile strength than in compressive strength. Tensile strensth is 48 to 70MPa

Compressive strength(MPa) 1 hr 7 days

Tensile strength(MPa)

Low Cu 145 Admixed 137 Single comp 262 Enamel Dentin 262 MPa 234 MPa

343 431 510

60 48 64

Creep

time dependent plastic deformation of a material under static load or constant stress Occurs over a period of time Mainly due to the g1 (Ag-Hg) phase & also due to g2 phase

 In High Cu alloys h (Cu6Sn5) phase crystals are embedded in & between g1 grains & thereby interlocking them. This h phase inhibits the grain boundary sliding & decreases creep. Leads to marginal deterioration

 ADA recommends a creep value of not more than 3% Creep values of various types:

Low Cu alloys: 0.8 - 8% High Cu alloys ( 0.4 0.1%) Admixed alloys - 0.4% Single comp - 0.13% With 0.5%Pd - 0.06%

Factors affecting creep

Microstructure of amalgam: -increased creep with Increased g1 & g2 fraction -decreased creep with Increased grain size of g1, Presence of g phase Hg/Alloy ratio: -when increased, increases creep (due to more residual Hg)

 Trituration: -Over & undertrituration - increases creep Condensation pressure: -Increased pressure, decreases creep (due to less residual Hg) Delay between trituration and condensation -Increases creep

Modulus of elasticity
Also called Youngs modulus / elastic modulus relative stiffness of a material E = Stress Strain When E decreases, Stiffness reduces Amalgam = 30 GPa Enamel = 50 GPa Dentin = 12 GPa

Tarnish
- Observable surface discolouration on a metal or a slight loss of surface finish or luster Occurs due to: -soft/hard deposits - formation of thin flm of oxides of sulphides / chlorides

Corrosion
Its not surface discoloretion but actual deterioration of a metal by reaction with environment. Process in which a metal reacts with a nonmetallic element in the environment to produce a chemical compound with inferior properties Sulphides of H or NH4 , chlorides
-g1 phase -g2 phase -Cu - Sn phase
+ +

Types of corrosion
Chemical corrosion / dry corrosion - eg: oxidation of Ag-Cu alloys Electrochemical corrosion / wet corrosion

 GALVANIC CORROSION
Occurs when dissimilar metals lie in direct physical contact with each other Saliva with its salts provide weak electrolyte If gold restoration comes in contact with amalgam restoration, amalgam forms anode and starts corroding. The electric couple created when 2 restorations come in contact causing sharp pain called galvanic shock

Galvanism

Adv of corrosion: Amalgam-tooth interface seals over time,reduces post-op sensitivity even without use of pulp protecting material Clinical significance of Galvanism: Galvanic shock in a newly inserted restoration subsides once the pulp normalizes after the trauma of tooth prep Management: Insulating by coating surface with varnish

Hardness
Resistance to indentation
Knoop Hardness No. 343 68 155

Enamel Dentin Amalgam

Thermal conductivity
Denotes transfer of heat / cold through a material by conductive flow High thermal conductivity = conductors
Enamel Dentin Amalgam - 0.93 W/m/sec/ K - 0.57 W/m/sec/ K - 22.6 W/m/sec/ K
0 0 0

Linear coefficient of thermal expansion

Change in length per unit of the original length of a material when its temperature is raised by 1 K. High coefficient of thermal expansion-- material is highly susceptible to temperature changes Significance: marginal percolation Enamel 11.4ppm K Dentin 8.3ppm K Amalgam 25ppm K
0 0 0 0

Mercury
ADA specification no. 6 <0.02% non-volatile residue 0 Freezing point = -38.87 C 0 Boiling point =356.9 C 0 Surface tension = 465 dynes/cm at 20 C, as compared to water 72.8 dynes/cm 0 Hg has lower melting point = 127 C

 Sources of Hg:
-Food fish etc -Air, water, soil -Amalgam -occupational exposure

Availability:
-Elemental metallic Hg -Inorganic Hg as cinnabar ore of Hg sulphides -Organic methyl Hg through pesticidesinto food chain (most toxic)

 Hg release levels:
-during trituration condensation dry finish wet finish removal - 1 - 2 micrograms - 6 - 8 micrograms - 44 micrograms - 2 - 4 micrograms - 20 25 micrograms (melting of phases)

OSHA limit for Hg vapour (TLV) is 50 micrograms / cu. m. in the work place The lowest dose of Hg that elicits a toxic reaction is 3 to 7 micrograms/kg body wt Dosage of Hg to cause death is 4000 micrograms/kg body wt.

MERCURY TOXICITY
Its due to chronic exposure to high levels of methyl mercury concentrated in food. Excess Hg concentrates in liver,kidney and brain Toxic effect depend upon Hg levels present in urine. Urinary Hg level upto 25 microgram/gm of creatinine in urine no ill effects Urinary Hg level between 25 to 100 microgram/gm of creatinine in urine causes decrease in verbal skills andreduction in nerve conduction tests Between 100 to 500 micrigram/gm of creatinine in urine irritability,depression,memory loss,mild tremors,nervous disturbance and early kidney disfunction Over 1000 microgram/gm of creatinine in urine toxic signs include kidney inflammation, swollen gums,pronounced tremors and nervous system disturbence


1. 2. 3. 4. 5. 6. 7. 8.

Mercury hygiene recommendations:

Good ventilation of operatory Mercury monitoring Use of amalgamators and precapsulated alloys Avoid skin contact of Hg use gloves & mask Use of high volume evacuation suction during removal or finishing Store waste amalgam in air-tight containers under water, glycerin, or radiographic fixer solution filled fully Recycling of waste amalgam Cleaning of spilled Hg using trap bottles, tapes or freshly mixed amalgam and newer cleaning kits. Do not use a vacuum cleaner. Sprinkling of Sulphur powder to form cinnabar (slow process) Use of intra-office recapture systems for scrap recapture Instruments contaminated with Hg cleaned properly before sterilization to prevent vaporization

9. 10.