PIN AMALGAM

PIN RETAINED RESTORATIONS:

1. Introduction
2. Definition
3. Indications and contra indications
4. Advantages and Disadvantages
5. Types of pin
- Advantages and Disadvantages of each type
- Placement techniques of pins and restorations
6. Complications of pins during treatment
7. Failure of pin amalgam restoration
Definition:
A pin retained restoration may be defined as any
restoration requiring the placement of one or more
pins in the dentin to provide adequate retention form
and/or resistance form.
Generally pins are used whenever satisfactory
retention form cannot be achieved with undercuts,
grooves or slots or by acid etch method (-for tooth
coloured restorations)
Indications:
1. Extensively decayed tooth:
a) Fractured tooth where there is little or no coronal
tooth structure.
b) Extensive restoration and having questionable
prognosis
(Eg: Periodontally compromised condition)
2. In extended preparation:
Carious lesion which dictate the outline of cavity, which
extends beyond the recommended limits for restoration
without support
Eg: Cusp slopes, beyond line angles, wide proximal
box where grooves cant be placed
3. Core Build-up:
4. Extensive class V restorations
5. Economic factor
6. Time factor
7. Teeth with questionable prognosis (Pulpally or
Periodontally involved)
8. Age and health of the patient
9. Cross splinting
10. Morphological limitation.
Contraindications:
1. Occlusal rehabilitation.
2. Role of tooth in the overall treatment plan.
- Tooth serving as abutment to RPD.
3. Functional cusp protection.
4. Esthetics.
Advantages:
1. Tooth preparation is more conservative than for
other alterative restoration.
2. Time factors.
3. Economical.
4. Retention form is significantly improved with the
use of amalgam.
5. Resistance form can be improved in selective
cases.
Disadvantages:
1. Difficult to achieve proper contact and contour.
2. Drilling pin holes and placing pins may create
craze lines and fracture of dentin.
It may also create internal stresses in dentin.
3. Microleakage around pins.
4. Pins do not reinforce amalgam and therefore do
not increase the strength of restoration. Tensile
and transverse strength are significantly
decreased.
5. Retention by pins increase the risk of perforating
pulp and external tooth surface.
6. Resistance form is more difficult to develop than
when preparing for inlay.
Functions of Pins
1. The primary function of the pin was to tie the
restoration and tooth structure together and to
retain the restoration in the cavity.
2. Pins in amalgam would reinforce and increase the
tensile strength (not true because not possible).
Types of Pins:
Basically 3 types
1. Cemented pins.
2. Friction locked pins.
3. Self threaded pins or
Self shearing pins.
Cemented Pins:
- Introduced by Dr. Markely in 1958.
- The pin channel (pin hole) is larger in diameter
than pin.
Pin Channel diameter Pin diameter
0.027 0.025
0.021 0.020
- Cementing media Zn PO
4

or Zn polycarboxylate
Advantages:
1. Does not produce internal stress or craze lines in
dentin
2. Pin of choice for restoration in endodontically
treated tooth.
Disadvantages:
1. Microleakage.
2. It is least retentive amongst all three.
3. There will be weak point of interface between pin
and cement used.
Friction Locked (or) Friction Grip Pins
- In 1966 by Goldstein.
- Preparation of pin channel is smaller than pin
diameter.
Pin channel Pin diameter
0.021 0.022
- The pins are tapped into place.
- Retained in tooth by resiliency
of dentin
- Threads are less on pins.
Advantages:
1. More retentive than cemented pins
2. Used in vital teeth
3. No interface of cement
Disadvantages:
- Microleakage
- Difficult to place in posterior teeth (DO).
- Patient apprehension while placing pins
- Cracks and shearing of dentin
- Pulpal stress is maximal when the lateral surface of
friction lock pin is adjacent to pulp.
Self Threading Pins:
- In 1966 by Going.
- Pin channel diameter is smaller than pin
- Different sizes are available
- Colour coded and widely used.
Pin channel diameter Pin diameter
Regular 0.027 0.031
Minim 0.021 0.024
Minikin 0.017 0.019
Minuta 0.013 0.015
Four sizes of TMS pins.
A. Regular, B. Minim, C. Minikin, D. Minuta
Pin is retained by the threads engaging the resilient
dentin as it is inserted
Advantages:
1. Most retentive of the three
2. Less microleakage
3. Can be placed in posterior teeth (DO)
4. Patient apprehension is less.
Disadvantages:
Produce more dentinal craze
Pulpal stress is more when the pins are inserted
perpendicular to pulp.
Most commonly used self threading pins are
T.M.S
- Thread mate system.
AMALGAPIN:
- Introduced in 1980 by Shavell
- Retention for amalgam is provided by 2-3mm
deep holes placed in dentin by using round
ended bur No. 1156, 1157, 1158. Instead of
placing pin.
Amalgam is then condensed into holes and the
remainder of restoration.
Advantages:
1.No microleakage
2. No stress in dentin.
3. No need of pins and pin system
4. Pulp irritation is avoided
Disadvantages:
1. More tooth structure is removed.
2. Shear strength of amalgam pin is less than that
of pin amalgam.
Factors affecting retention of pin in dentin
and amalgam:
1. Type of pin:
Least retentive is cemented pins. Next is friction
lock. Best is self threading.
2. No. of pins used:
Commonly 4-6 pins are used.
General rule:
In molars 1pin for each cusp missing
Proximal box 2 pins.
Minimum : 4 to 6 pins

As no. of pins increases, there will be
1. Crazing of dentin and potential for fracture
increases
2. Minimum space for amalgam. No. bulk for
amalgam leads to decreased strength fracture
3. Depth of pin in dentin:
Increase in depth in dentin increases retention in
cemented pins. But there is no increase in retention
for friction lock and self shearing pins.
Depth in dentin varies from 2-3mm
2mm for self shearing pins.
3mm for cemented pins.
Sometimes 1.5-2.5mm when vertical height of
crown in very less.
4.Pin length into amalgam:
Pin should be long enough to retain restoration and
withstand occlusal forces. 2mm of pin provide
maximum required retention.
When pins are placed nearer to occlusal surface as
in cuspal coverage areas the pin should project only
minimal into restorative material.
5. Inter pin distance:
For small threaded pins: > 4mm.
For larger threaded
Distance increases
pins and friction grip
pins
For cemented pin: Distance can be decreased.
6. Diameter of pin:
Within the limits as diameter of pin increases, the
retention in dentin and amalgam increases.
7. Surface characteristics of pins:
Retention of the pin in amalgam is influenced by
number and depths of the deformations on pin
therefore friction locked pin is lowest followed by
cemented and best is self threaded pins.
Spherical and admixed have better bonding than
conventional amalgam. Bonding can be improved
by coating the pins with silver.
8. Orientation of pins:
Factors Governing Pin Placement:
1. Knowledge of root anatomy to avoid perforation.
(X-ray).
2. Pin channels should not be prepared in areas of
bifurcation of roots and areas of convolution.
3. Pin channel should be parallel to that of root
surface.
4. Ageing decreases the size of pulp chamber and root
canal system and increases the dentin
mineralization.
Guidelines for pin placement:
1. Sufficient no. of pins should be used to bind the
tooth and restoration.
2. Pins should be placed in areas previously occupied
by cusps and marginal ridges near the line angles.
3. Pin holes must be placed in dentin 0.5mm from
DEJ to prevent crazing of enamel.
4. Pin should be seated to a depth of atleast 2mm in
dentin only.
5. Pin channels are made parallel to the external tooth
surface to avoid perforation.
6. In keeping with tooth size the largest diameter pin
should be selected for best strength and retention of
the pin in the tooth surface.
7. The pin should be adjusted to a length so that it
will allow enough bulk for amalgam.
Placement of Pins:
For self threading Pins
1. TMS hand wrenches
2. Loma Linda pin setter.
3. TMS auto clutch handpiece
4. Conventional contra angled handpiece
For placement of cemented pins:
Pin holes are prepared with twist drill 0.027 0.025
0.020
- The pin is cut to proper length with the wire cutter.
- End is rounded with disc.
- Pins are cemented with Zn PO
4
cement
- Cement is carried by Lentelospirals
- Bending of pins done before cementation
Application of Matrix:
Matrices used are
1.Toffelemiere
2.Auto matrix
3.Copper band
Regardless of the type used, matrix must be
stable. Matrix adaptation is tested by passing light
so that no gap is there. They should be
supplemented with wedges for proper contour and
stabilization of matrix.
Problems during pin placement:
Broken drills and broken pins:
Twist drill will break if it is stressed laterally or
allowed to stop rotating before being removed
from pin holes.
Pins usually break when they are bent or if extra
1/4
th
turn is given after it is seated.
Treatment for both is selecting another location
as removing the pin is difficult.
2. Loose pins:
Self threading pins do not properly engage the dentin
because of wide pin channel. Pin fails to shear and
strips out of dentin.
It is corrected by
The pin hole is prepared with next large drill.
Depth of pin hole is increased.
3. Penetration of pulp and perforation of
external tooth surfaces:
Pulp penetration is treated by doing direct pulp
capping and changing the place of pin in safe
location. External perforation is treated by
surgical opening of flap and cutting of
extended pin which is there in PDL after taking
radiograph.
Failure of pin retained restorations:
1. Within the restoration.
2. At the interface between pin and restorative material
3. Fracture within the length of pin.
4. At the interface between pin and dentin.
5. Within the dentin (Dentin can fracture).