Presentation by:

Dr. Piyush Verma

Dept of Pedodontics & Preventive
Dentistry
Index
Introduction
History
Classification
Indications & contraindications
Advantages/disadvantages
Composition of amalgam & Amalgamation reactions
Manufacturing process
Properties of amalgam
Manipulation of amalgam
Index
Mercury toxicity & various health hazards
Recent advances
Repair of amalgam restorations
Clinical considerations
Amalgam wars
Conclusion
Introduction
Dental amalgam is an alloy made by mixing mercury
with a silver tin alloy. 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.
 History
Amalgam -- First used by Chinese. There is a mention
of silver mercury paste by Sukung (659AD)
in the Chinese medic

1578-lshitichen used 100 parts if Hg, 45 parts of Ag

and 100 parts of Sn

Liu Wen-Thai (1508) and Li Shih-Chen (1578)

discussed its formulation; 100 parts of mercury to 45
parts of silver and 900 parts of tin, trituration of these
ingredients produced a paste said to be as solid as
silver.
.
 Introduced in 1800s in France alloy of bismuth, lead,
tin and mercury plasticized at 100C poured directly
into cavity

1819, Bell advocated the use of a room temperature

mixed amalgam as a restorative material, in England

1826, M.Traveau is credited with advocating the first

form of amalgam paste , in France.
 1833
Crawcour brothers introduced
amalgam to US
powdered silver coins mixed with
mercury
expanded on setting

1895
To overcome expansion problems
G.V. Black developed a formula
for modern amalgam alloy
67% silver, 27% tin, 5% copper, 1% zinc
 Blacks formula was well accepted and not much
changed for nearly sixty years.(1890-1963)

1946 - Skinner, added copper to the amalgam alloy

composition in a small amount. This served to
increase strength and decrease flow.

 Traditional or conventional amalgam alloys

predominated from 1900 to 1970.

1960s - conventional low-copper lathe-cut alloy

was introduced

1962 - A spherical particle dental alloy was

introduced, by Demaree and Taylor
 The work of Innes and Youdeis (1963) has led to the
development of high copper alloys.

Had longer working time, less dimensional change,

easy to finish, set faster, low residual mercury, low
creep & higher early strength

Added spherical silver copper eutectic alloy(71.9wt%

Ag and 28.1wt%Cu)particles to lathe cut low copper
amalgam alloy particles.

These alloys are called admixed alloys

 1971 Johnson designed a spherical particle alloy
having the composition 64% Ag, 26% Sn and 10%
cu by weight, and exhibiting no Sn8Hg after
amalgamation.

1973 - first single composition spherical alloy

named Tytin (Kerr) a ternary system
(silver/tin/copper) was discovered by Kamal Asgar
of the University of Michigan

1980s alloys similar to Dispersalloy and Tytin was

introduced
Classification (Marzouk)
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.
Others have one or more alloys or metals physically
added (blended) to the basic alloy. E.g. Adding copper
to a basic binary silver tin alloy
 III. According to the shape of the powdered
particles.
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. Micro cut
2. Fine cut
3. Coarse cut
 V. According to copper content of powder
1. Low copper content alloy - Less than 4%
2. High copper content alloy - more than 10%

VI. According to addition of Nobel metals

Platinum
Gold
Pallidum
 VII. According to compositional changes of
succeeding generations of amalgam.

First generation amalgam was that of G. V Black i.e. 3

parts silver one part tin (peritectic alloy).
Second generation amalgam alloys - 3 parts silver, 1 part
tin, 4% copper to decrease the plasticity and to increase the
hardness and strength. 1 % zinc, acts as a oxygen scavenger
and to decrease the brittleness.
Third generation: First generation + Spherical amalgam
copper eutectic alloy.
Fourth generation: Adding copper upto 29% to original
silver and tin powder to form ternary alloy. So that tin is
bounded to copper.
Fifth generation. Quatemary alloy i.e. Silver, tin, copper
and indium.
Sixth generation (consisting eutectic alloy).
 According to Presence of zinc.

Zinc containing (more than 0.01%).

Non zinc containing (less than 0.01%).
 INDICATIONS OF AMALGAM
Class I and class II cavities.-moderate to large restorations.
As a core build up material.
Can be used for cuspal restorations (with pins usually)
In combination with composite resins for cavities in
posterior teeth. Resin veneer over amalgam.
As a die a material.
Restorations that have heavy occlusal contacts.
Restorations that cannot be well isolated
In teeth that act as an abutment for removable appliances
INDICATIONS OF AMALGAM
Class 3 in unaesthetic areas eg.distal aspect of
canine.especially if
Preparation is extensive with minimal facial
involvement

Class 5 lesions in nonesthetic areas especially when

access is limited and moisture control is difficult and
for areas that are significantly deep gingivally.
CONTRA INDICATIONS OF AMALGAM
Anterior teeth where esthetics is a prime concern

Esthetically prominent areas of posterior teeth.

Small to-moderate classes I and II restorations that

can be well isolated.

Small class VI restorations

Advantages
Ease of use, Easy to manipulate

Relatively inexpensive

Excellent wear resistance

Restoration is completed within one sitting without

requiring much chair side time.

Well condensed and triturated amalgam has good

compressive strength.
Advantages
Sealing ability improves with age by formation
of corrosion products at tooth amalgam
interface.
Relatively not technique sensitive.
Bonded amalgams have bonding benefits.
Less microleakage
Slightly increased strength of remaining tooth
structure.
Minimal postoperative sensitivity.
Disadvantages
Unnatural appearance (non esthetic)
Tarnish and corrosion
Metallic taste and galvanic shock
Discoloration of tooth structure
Lack of chemical or mechanical adhesion to the tooth
structure.
Mercury toxicity
Promotes plaque adhesion
Delayed expansion
Weakens tooth structure (unless bonded).
Composition of amalgam
Conventional Amalgam Alloys: (G.V. Blacks:
Silver- tin alloy or Low copper alloy).

Low copper alloys are available as comminuted

particles (Lathe -cut and Pulverized) and spherical
particles.
Low copper composition:
Silver : 63-70%
Tin : 26-28%
Copper : 2- 5%
Zinc : 0-2%
Role of individual component
Silver:
Constitutes approximately 2/3rd of
conventional amalgam alloy.
Contributes to strength of finished
amalgam restoration.
Decreases flow and creep of amalgam.
Increases expansion on setting and
offers resistance to tarnish.
To some extent it regulates the setting
time.
Tin:
Second largest component and
contributes th of amalgam alloy.
Readily combines with mercury to form
gama-2 phase, which is the weakest
phase and contributes to failure of
amalgam restoration.
Reduce the expansion but at the same
time decreases the strength of amalgam.
Increase the flow.
Controls the reaction between silver and
mercury.
Tin reduces both the rate of the reaction
and the expansion to optimal values.
Copper:
Contributes mainly hardness and strength.
Tends to decrease the flow and increases the
setting expansion

Zinc:
Acts as Scavenger of foreign substances such
as oxides.
Helps in decreasing marginal failure.
The most serious problem with zinc is delayed
expansion, because of which zinc free alloys
are preferred now a days.

Indium/Palladium: They help to increase the

plasticity and the resistance to deformation.
 HIGH COPPER AMALGAM ALLOY (COPPER
ENRICHED ALLOYS)

To overcome the inferior properties of low copper

amalgam alloy -- shorter working time, more dimensional
change, difficult to finish, set late, high residual mercury,
high creep & lower early strength, low fracture resistant

Youdelis and Innes in 1963 introduced high copper

content amalgam alloys. They increased the copper
content from earlier used 5% to 12%.
Copper enriched alloys are of two types:
1) Admixed alloy powder.
2) Single composition alloy powder.
 I. Admixed alloy powder:
Also called as blended alloys.
Contain 2 parts by weight of
conventional composition lathe cut
particles plus one part by weight of
spheres of a silver copper eutectic alloy.
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.
I. Admixed alloy powder:
Composition:
Silver-69 %
Copper-13 %
Tin-17 %
Zinc-1 %
I. Admixed alloy powder:
Amalgam made from these powders are stronger than
amalgam made from lathe cut low copper alloys
because of strength of Ag-Cu eutectic alloy particles.

Ag-Cu particles probably act as strong fillers

strengthening the amalgam matrix.

Total copper content ranges from 9-20%.

 II. Single composition alloy
(Unicomposition):
It is so called as it contains
particles of same
composition.

Usually spherical single

composition alloys are used.

As lathe cut, high copper

alloys contain more than
23% copper.
 II. Single composition alloy
(Unicomposition):
1. Ternary alloy in spherical form, silver 60%, tin 25%,
copper 15%.

2.Quaternary alloy in spheroidal form containing Silver:

59%, copper 13%, tin: 24%, indium 4%.
 AMALGAMATION REACTION/ SETTING
REACTION
Low copper conventional amalgam alloy

Dissolution and precipitation Ag-Sn Alloy

Hg dissolves Ag and Sn Hg Hg
from alloy
Sn Ag Ag
Intermetallic compounds Ag
Sn
Sn
Ag-Sn Ag-Sn
formed Alloy Alloy
Mercury
(Hg)

Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg

1 2
Low copper conventional amalgam alloy
Gamma () = Ag3Sn Hg
unreacted alloy Ag-Sn Alloy

strongest phase and Hg

corrodes the least Hg
Ag
Sn Ag
Ag
forms 30% of volume Sn
Sn
of set amalgam Ag-Sn
Alloy
Ag-Sn
Alloy
Mercury
Low copper conventional amalgam alloy
Gamma 1 (1) = Ag2Hg3
Ag-Sn Alloy
matrix for unreacted alloy
and 2nd strongest phase
10 micron grains
1
binding gamma () Ag-Sn Ag-Sn
60% of volume Alloy Alloy
Low copper conventional amalgam alloy
Gamma 2 (2) = Sn8Hg
Ag-Sn Alloy
weakest and softest phase
corrodes fast, voids form
corrosion yields Hg which
reacts with more gamma () Ag-Sn
Ag-Sn Alloy
10% of volume Alloy 2
volume decreases with time
due to corrosion
 Admixed High-Copper Alloys
Initial reaction

Ag-Cu Alloy

Hg Hg
Ag Ag Ag
Ag
Sn
Ag-Sn Sn Ag-Sn
Alloy Alloy
Mercury

Ag3Sn + Ag-Cu + Hg Ag3Sn + Ag2Hg3 + Sn8Hg + Ag-Cu

1 2
 Ag-Cu Alloy
Final reaction

Ag-Sn Ag-Sn
Alloy Alloy
1

Sn8Hg + Ag-Cu Cu6Sn5 + Ag2Hg3 + Ag-Cu

2 1

Ag-Sn Alloy
Single Composition
High-Copper Alloys
Ag-Sn Alloy
Ag-Sn Alloy

Ag3Sn + Cu3Sn + Hg Ag2Hg3 + Cu6Sn5 + Ag3Sn + Cu3Sn

1
 Manufacturing Process
Lathe-cut alloys
Ag & Sn melted together
alloy cooled
phases solidify
heat treat
400 C for 8 hours
grind, then mill to 25 - 50 microns
heat treat to release stresses of grinding
Manufacturing Process
Spherical alloys

Atomizing process produces these

different shapes.
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.
 PROPERTIES:
ADA specification No.1 for amalgam lists following
physical properties as a measure of quality of the
amalgam.

Creep
Compressive strength
Dimensional changes
Modulus of elasticity
 Strength
Compressive strength

Amalgam is strongest in compression and weaker in

tension and shear
The prepared cavity design and manipulation should
allow for the restoration to receive compression forces
and minimum tension and shear forces.
The compressive strength of a satisfactory amalgam
restoration should be atleast 310 MPa.
Compressive Strengths of Low-Copper and High
Copper Amalgam
Amalgam Compressive Strength
(MPa)
1h 7 day

Low copper 145 343

Admix 137 431

Single 262 510

Composition
 Tensile strength
Amalgam is much weaker in tension
Tensile strengths of amalgam are only a fraction of
their compressive strengths
Cavity design should be constructed to reduce tensile
stresses resulting from biting forces
High early tensile strengths are important resist
fracture by prematurely applied biting forces
Tensile strengths of amalgam
Product Tensile strength (Mpa)

15min 7 days

LOW COPPER ALLOYS

a) Lathe cut 3.2 51
b) spherical 4.7 55

HIGH COPPER ALLOYS

a) Admixed 3.0 43
b) Unicompositional 8.5 56
 The factors affecting strength of amalgam are:
1) Temperature:
Amalgam looses 15% of its strength when its
temperature is elevated from room temperature to
mouth temperature
looses 50% of room temperature strength when
temperature is elevated to 60OC e.g. hot coffee or
soup.
2) Trituration:
Effect of trituration on strength depends on the type
of amalgam alloy, the trituration time and the speed of
the amalgamator.
Either, under trituration or over-trituration decreases
the strength for both traditional and high copper
amalgams.
More the trituration energy used, more evenly
distributed are the matrix crystals over the amalgam
mix and consequently more the strength pattern in the
restoration.
Excess trituration after formation of matrix crystals
will create cracks in the crystals, lead to drop in
strength of set amalgam
3) Mercury Content:
Low mercury alloy content, contain
stronger alloy particles and less of the
weaker matrix phase, therefore more
strength
Mercury is too less -- dry, granular mix,
results in a rough, pitted surface that
invites corrosion.
If mercury content of amalgam mix is
more than 53-55%, causes drop of
compressive strength by 50%.
4) Effect of condensation:
For lathe-cut alloys
Greater the condensation pressure, the higher the
compressive strength
Higher condensation pressure is required to minimize
porosity and to express mercury from lathe-cut
amalgam.

For spherical alloys

Amalgams condensed with lighter pressure produce
adequate strength.
5) Effect of Porosity:
Can be due to
Under trituration,
Particle shape,
Insertion of too large increments into the cavity,
Delayed insertion after trituration,
Non-plastic mass of amalgam.

Facilitate stress concentration, propagation of cracks,

corrosion, and fatigue failure of amalgam restoration.
6) Effect of rate hardening
Patient may be dismissed from the dental chair within 20
min, rate of hardening of the amalgam is of considerable
interset
At the end of 20 min, compressive strength 6% of the 1
week strength
ADA specification stipulates minimum compressive
strength of 80 Mpa at 1 hr
Clinical significance -- Patient should be cautioned not
to subject the restoration for high biting force for 8 hrs
after placement 70% of its strength is gained
Modulus of elasticity
High copper alloys tend to be stiffer than low copper
alloys
When rate of loading increased, values of approx 62
Gpa have been obtained
Knoop Hardness
110 kg/mm2
DIMENSIONAL CHANGES:
When mercury is combined with amalgam it
undergoes three distinct dimensional changes.
Stage -1: Initial contraction, occurs for about 20
minutes after beginning of trituration. Contraction
results as the alloy particles dissolve in mercury.
Contraction, which occurs, is no greater than 4.5 cm.
Stage -2: Expansion- this occurs due to formation and
growth of the crystal matrix around the unconsumed
alloy particles.
Stage -3: Limited delayed contraction.
Factors that affect the dimensional changes:
1) Particle size and shape:
More regular the particle shape, more smoother the
surface area.
Faster and more effectively the mercury can wet the
powder particles and faster amalgamation occurs in all
stages with no apparent expansion.

2) Mercury:
More mercury , more will be the expansion, as more
crystals will grow.
Low mercury: alloy ratio favors contraction
3) Manipulation:
During trituration, if more energy is used for
manipulation, the smaller the particles will become ,
mercury will be pushed between the particles,
discouraging expansion.

More the condensation pressure used during

condensation, closer the particles are brought
together; more mercury is expressed out of mix
inducing more contraction.
Moisture contamination (Delayed Expansion):
Certain zinc containing low copper or high copper
amalgam alloys which get contaminated by moisture
during manipulation results in delayed expansion or
secondary expansion

Occur 3-5 days after insertion and continues for months.

Zinc reacts with water, forming zinc oxide and hydrogen

gases.
 Complications that may result due to delayed
expansion are:
Protrusion of the entire restoration out of the cavity.
Increased micro leakage space around the restoration.
Restoration perforations.
Increased flow and creep.
Pulpal pressure pain.

Such pain may be experienced 10-12 days after the

insertion of the restoration
 Flow and Creep:
Time dependent plastic
deformation

When a metal is placed under

stress, it will undergo plastic
deformation.

The high copper alloys, as

compared with conventional silver
tin alloys, usually tend to have
lower creep values.
Factors influencing creep:

A) Phases of amalgam restorations

Creep rates increases with larger 1 volume fraction
and decreases with larger 1 grain sizes.

2 is associated with high creep rates.

In absence of 2, low creep rates in single composition

alloy may be due to phase which act as barrier to
deformation of 1 phase.
B) Manipulations:
Greater compressive strength will minimize creep
rates.

Low mercury: alloy ratio, greater the condensation

pressure and time of trituration, will decrease the
creep rate.
Corrosion
Excessive corrosion can
lead to:
Increased porosity.
Reduced marginal integrity.
Loss of strength.
Release of metallic products
in to the oral environment.
Phases in decreasing order of corrosion resistance
Ag2Hg3
Ag3Sn,
Ag-Cu
Cu3Sn
Cu6Sn5
Sn7-8Hg.
Low copper amalgam system:-
Most corrodible phase is tin-mercury or 2 phase.
Neither the nor the 1 phase is corroded as easily.
The corrosion results in the formation of tin
oxychloride, from the tin in 2 and also liberates Hg.

Sn7-8Hg + 1/202 + H2O + Cl- Sn4 (OH) 6 Cl2 + Hg

Tin oxychloride
 Reaction of the liberated mercury with unreacted
can produce additional l and 2 (Mercuroscopic
Expansion).

Results 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 has better corrosion resistance.
However, is the least corrosion resistant phase in high
copper amalgam
Corrosion product CuCl2.3Cu (OH)2 has been associated
with storage of amalgams in synthetic saliva.

Cu6Sn5 + 1/202 +H2O + Cl- CuCl2.3Cu (OH)2 + SnO.

Types of Corrosion:
1) Galvanic corrosion:
Dental amalgam is in direct contact
with an adjacent metallic
restoration such as gold crown

2) Crevice Corrosion:
Local electrochemical cells may arise
whenever a portion of amalgam is
covered by plaque on soft tissue.
The covered area has a lower oxygen
and higher hydrogen ion
concentration making it behave
anodically and corrode.
Stress Corrosion:
Regions within the dental
amalgam that are under stress
display a greater probability for
corrosion, thus resulting in
stress corrosion.

For occlusal dental amalgam

greatest combination of stress
and corrosion occurs along the
margins.
MANIPULATION OF DENTAL
AMALGAM
 PROPORTIONS OF ALLOY TO
MERCURY
Correct proportioning of alloy and mercury-
essential for forming a suitable mass of amalgam
Some alloys require mercury alloy ratios in excess
of 1:1 (Eames technique)
whereas others use ratios of less than 1:1 with the
percentage of mercury varying from 43% to 54%.
 Automatic mechanical
dispensers for alloy & mercury
have been used in the past

Capsules with pre proportioned

amounts of alloy & mercury
have been substituted
Cross section sketch of a disposable capsule
containing amalgam alloy & mercury
SIZE OF MIX
Manufacturers commonly supply capsules containing
400, 600, or 800 mg of alloy and the appropriate
amount of mercury.

For large size cavities - capsules containing 1200 mg of

all0y are also available.
TRITURATION
Process of mixing the amalgam alloy particles with
mercury

Originally, the alloy and mercury were mixed, and was

triturated by hand with a mortar and pestle

Mechanical amalgamation saves time and standardizes

the procedure.
Amalgamator
Mechanical amalgamators are available in the following
speeds:
Low speed: 32-3400 cpm.
Medium speed: 37-3800 cpm.
High speed: 40-4400 cpm.

Spherical/irregular low-copper alloys triturated at

low speed
High copper alloys high speed

Time of trituration on amalgamation ranges from 3-30

seconds. Variations in 2-3 seconds can also produce a
under or over mixed mass.
 Over-trituration: Alloy will be hot,
hard to remove from the capsule,
shiny wet and soft.

Under-trituration: Alloy will be

dry, dull and crumbly; will crumble Under-trituration

if dropped from approx 30 cm.

Normal Mix: Shiny appearance

separates in a single mass from the
capsule.
Normal Mix
Objectives of Trituration are:
To achieve a workable mass of amalgam within a
minimum time
To remove the oxide layer
To pulverize pellets into particles, that can be easily
attacked by the mercury.
To reduce particle size
To keep the amount of 1 or 2 matrix crystal as
minimal as possible, yet evenly distributed
 Mixing variables
1) Working time & dimensional change
All types of amalgam, spherical or irregular
decreases with overtrituration

Overtrituration slightly higher contraction for all

types of alloys
2) Compressive & tensile strength

Irregular shaped alloys increase by overtrituration

Spherical alloys -- greatest at normal trituration time

3) Creep

Overtrituration increases creep

Undertrituration lowers it
 Condensation

Refers to the incremental placement

of the amalgam into the prepared
cavity and compression of each
increment into the others
Amalgam should be condensed into
the cavity within 3 min after
trituration.
 Aims of condensation
Adapt amalgam to the margins, walls and line angles
of the cavity.
Minimize voids and layering between increments
within the amalgam.
Develop maximum physical properties.
Remove excess mercury to leave an optimal alloy:
mercury ratio.
 Purpose of Condensation

To get a continuous homogenous mass that is well

adapted to all margins, walls and line angles.

Best carried out using hand instruments.

Hand condenser :
Should allows a operator to
readily grasp it & exert a force
of condensation

Size of condenser tip &

direction & magnitude of the
force placed, depends on the
type of amalgam alloy selected
 Irregular shaped alloys
Condensers with relatively small tip, 1 to 2 mm
High condensation forces in vertical direction
As much mercury-rich mass as possible should be
removed

Spherical amalgam alloys

Condensers with large tips are used
Condensed in lateral direction
High copper spherical amalgams vertical & lateral
direction condensation with vibration

Condensation pressure load of 15 lb is

recommended to be applied to each increment
Mechanical Condensers:
Useful for condensing irregular shaped alloys when
high condensation forces are required
Need was eliminated with the advent of spherical
alloys
Tend to lead to unreliable condensation as well as
generation of heat and mercury vapor, both of which
are undesirable.
 Ultrasonic Condensers:
Not recommended

Causes the release of considerable quantities of

mercury vapor in the dental office
 SPEED OF PLACEMENT
Once amalgam is triturated, phase formation
commences and the setting reaction is underway.
Amalgam must be placed in a plastic state
No amalgam should be placed more than 3 minutes
after the start of mixing.
Attempting to condense a partly set amalgam into a
cavity will result in
Poor adaptation,
Reduced marginal seal and
A weak restoration.
 Burnishing
First Burnish (Pre-carve Burnish)
Carried out using a large burnisher
for 15 seconds

Use light force and move from the

center of the restoration outwards to
the margins.
Objectives of precarve burnishing :

Continuation of condensation, further reduce the size

and number of voids on the critical surface and
marginal area of the amalgam.
Brings any excess mercury to the surface, to be
discarded during carving.
Adapt the amalgam further to cavosurface anatomy.
 Carving
Using remaining enamel as a guide,
carve gently from enamel towards the
center and recreate the lost anatomy
of the tooth.
Amalgam should be hard enough to
offer resistance to carving instrument
A scarping or "ringing" (amalgam
crying) should he heard.
If carving is started too soon,
amalgam will pull away from margins.
Objectives of carving :

To produce :
A restoration with no underhangs
A restoration with the proper physiological contours.
A restoration with minimal flash.
A restoration with adequate, compatible marginal ridges.
A restoration with proper size, location, extend and
interrelationship of contact areas.
Final Burnish (Post carve burnishing)
Following carving, check the occlusion
and carry out a brief final burnish.
Use a large burnisher at a low load and
burnish outwards towards the margins
Improves smoothness
Heat generation should be avoided

If temp raises above 60C, causes release of mercury

accelerates corrosion & fracture at margins
Finishing & Polishing
Finishing can be defined as the process, which continues
the carving objectives, removes flash and overhangs and
corrects minimal enamel underhangs.

Polishing is the process which creates a corrosion resistant

layer by removing scratches and irregularities from the
surface.

Can be done using descending grade abrasive, eg. rubber

mounted stone or rubber cups.
A metallic lusture, is always done with a polishing agent
(precipitated chalk, tin or zinc oxide).
Objective of finishing and polishing :
Removal of superficial scratches and irregularities

Advantages:
Minimizes fatigue failure of the amalgam under the
cyclic loading of mastication
Minimizes concentration cell corrosion which could
begin in the surface irregularities
Prevents the adherence of plaque
 Usually, 24 hours should pass after amalgam insertion
before any finishing and polishing commences.

However, some new alloys can be polished after 8-12

hours still others require only a 30-minute wait after
insertion.
RESISTANCE & RETENTION FORMS
Primary retention form
Attained by:
Mechanical locking of
inserted amalgam into
surface irregularities to
allow good adaptation

Preparation of vertical
walls that converge
occlusally
Primary resistance form
For tooth :
Maintaining as much unprepared tooth structure as
possible
Having pulpal & gingival walls perpendicular to
occlusal forces
Having rounded internal prepartaion angles
Removing unsupported & weakened tooth structure
Placing pins into the tooth as a part of final stage of
tooth preparation
Primary resistance form
For amalgam :
Adequate thickness 1.5 -2 mm in areas of occlusal
contact, 0.75 mm in axial areas
Marginal amalgam of 90 degrees or greater
Box like preparation form
Rounded axiopulpal line angles in class II
preparations
 Secondary resistance & retention
form
When insufficient
resistance/retention forms are
present in tooth, additional
preparation is indicated

Such features include :

Placement of grooves, locks,
coves, pins, slots or amalgam pins
Larger the tooth preparation,
greater the need of secondary
resistance & retention forms
BIO-COMPATIBILITY MERCURY
TOXICITY
 Amalgams have been used for 150 years

About 200 million amalgams are inserted each year in

the United States and Europe

Concern -- mercury in dental amalgam may pose

threats to the health of patients, to the health of
dental care providers and to the environment.
Mercury is available in 3 forms:

Elemental mercury (liquid or vapor).

Inorganic compounds.
Organic compounds.
 ELEMENTAL MERCURY
Liquid mercury:
Absorbed relatively poorly across skin or mucosa.
Most mercury becomes charged (ionized) before it
reaches the blood.
Ionized mercury is excreted well through kidneys and
urine.
There is no known risk to patients from liquid
mercury.
 ELEMENTAL MERCURY
Mercury vapor:
Less benign -- rapidly absorbed into the blood via the
lungs , remains uncharged and therefore highly lipid
soluble, for several minutes.

Can cross the blood-brain barrier where it becomes

charged and exists in extra cellular fluid of the brain
and returns into the blood much more slowly.
 High tissue levels- can lead to impaired brain
function, insanity and death may occur at 4000 g/kg.

Low tissue levels- can lead to restlessness, tremors,

and loss of concentration.
 Inorganic compounds of mercury
S0urce Drinking water, food
Amalgam contains several different inorganic mercury
compounds,
They are of low or very low toxicity and are apparently
harmless when swallowed.
Poorly absorbed, do not accumulate in body tissues
and are well excreted.
 Organic compounds of mercury

Source -- Drinking water, food (sea food)

Some organic compounds of mercury are highly toxic
at low concentrations
But none are known to form in the oral environment
through dental amalgam use.
ESTIMATED DAILY INTAKE OF MERCURY
Source g Hg vapour g inorganic Hg g methyl Hg

Atmosphere 0.12 0.038 0.034

Drinking Water --- 0.05 ---

Food & Fish 0.94 --- 3.76

Food & Non-Fish --- 20.00 ---

 CONCENTRATIONS OF MERCURY

The Occupational Safety & Health Administration

(OSHA) has set a TLV of 0.05 mg/m3 as the maximum
amount of mercury vapor allowed in the work place.

Average Daily dose of mercury from dental amalgam

for patients with more than 12 restored surfaces has
been estimated at up to 3 g.
CONCENTRATIONS OF MERCURY
Clarkson TW (1997) --
Lowest dose of mercury that elicits a toxic reaction
3to7 g/kg body weight
Paresthesia -- 500 g/kg body weight
Ataxia -- 1000 g/kg body weight
Joint pain -- 2000 g/kg body weight
Hearing loss & death -- 4000 g/kg body weight
CONCENTRATIONS OF MERCURY
Mercury release has been quantified for a number of
procedures:
Trituration: 1-2g
Placement of amalgam restoration: 6-8 g.
Dry polishing: 44 g.
Wet polishing: 2-4 g.
Amalgam removal under water spray & high
velocity suction: 15-20 g
CONCENTRATIONS OF MERCURY
The release of mercury is:
Greater for low-copper amalgams, because of
corrosion related loss of tin and increased porosity.

Greater from Unpolished surfaces

Increased by tooth brushing, which removes a

passivating surface oxide film-although this re-forms
rapidly.
Mercury in urine
Body cannot retain metallic mercury, but passes it
through urine
Skare I et al (1990)
urine mercury level peak at 2.54 g/L 4 days after
placing amalgam restorations, return to zero after 7
days
On removal of amalgam, urine mercury levels reach a
maximum value of 4g/L, return to zero after 7 days
 Mercury in blood
Maximum allowable level of mercury in blood is 3
g/L

Chang SB et al(1992) showed that freshly placed

amalgam restorations elevated blood mercury
levels to 1 to 2 g/L

As with urine mercury levels, there is first an

increase of around 1.5 g/L, which decreases in
about 3 days
 Ott KH et al (1996) monitored blood mercury levels for 1
year, showed that patients with amalgams had lower than
average blood mercury level (0.6 g/L ) than patients
without amalgams (0.8 g/L )

Mackert JR et al(1997) indicated higher blood

mercury levels in dentists, stated that -
elevated blood mercury levels may relate to mercury
spills in the office
Both blood & serum mercury levels seem to correlate
best with occupational exposure, not with number of
amalgam & length of time with amalgam in place
 BIO-COMPATIBILITY MERCURY
TOXICITY
Sensitivity to amalgam restorations
Skin lesions being more common than oral lesions.
An urticarial rash may appear on the face and limbs and
this may be followed by dermatitis.
Long- term response -- oral lichen planus or lichenoid
reactions with erosive areas on the tongue or buccal
mucosa adjacent to an amalgam restoration.
 BIO-COMPATIBILITY MERCURY
TOXICITY
AMALGAM TATTOO
AMALGAM TATTOO
Possible causes are:
Scraps of amalgam may fall into open surgical or
extraction wounds.
Excess amalgam may be left in the tissues following
sealing the apex of a root canal with a retrograde
amalgam.
Pieces of amalgam may be forced into the mucosa.
 Sources of Mercury Exposure in
Dental Office:
Dental amalgam raw materials being stored for use.
Mixed but unhardened dental amalgam during
triturations, insertion and intraoral setting.
Dental amalgam scrap that has insufficient alloy to
completely consume the mercury present.
Dental amalgam undergoing finishing and polishing
procedure.
Dental amalgam restoration being removed.
DENTAL MERCURY HYGIENE
Recommendations from the ADA include the following:

The work place should be well ventilated, with fresh air

exchange and outside exhaust
Use only precapsulated alloy, discontinue use of Bulk
mercury & bulk alloy
Avoid the need to remove excess mercury before or
during packing by selecting an appropriate alloy:
mercury ratio
Use an amalgamator with a completely enclosed arm.
 Mercury and unset amalgam should not be touched by
the bare hands.
Floor coverings should be non absorbent & easy to
clean
Spilled mercury should be cleaned up using trap
bottles, tape or freshly mixed amalgam to pick up
droplets
Do not use a house hold vaccum cleaner to clean
spilled mercury.
Skin accidentally contaminated by mercury should be
washed thoroughly with soap and water.
 If a mercury hygiene problem is suspected, personnel
should undergo urine analysis to detect mercury levels

Remove professional clothing before leaving the work

place
Scrap amalgam disposal
In a tightly closed container
Under radiographic fixer solution
Dispose mercury contaminated items in sealed bags
Donot dispose mercury contaminated items in
medical waste containers or bags or along with the
waste that will be incenerated
 CLINICAL TECHIQUES TO ENHANCE
MARGINAL SEAL
1) Copal resin varnish:
Apply two thick coats to the cavity walls and margins
before placing the amalgam and it will gradually
dissolve, beginning at the cavosurface, over 2-3
months.

As the varnish dissolves out, the gap will be filled with

corrosion products from the amalgam and dissolution
of the varnish will cease.
 CLINICAL TECHIQUES TO ENHANCE
MARGINAL SEAL
2) Glass-ionomer linings
Placed under an amalgam will seal the dentinal
tubules and release small quantities of fluoride

Will not affect enamel margins or enhance the seal at

the margin.
 CLINICAL TECHIQUES TO ENHANCE
MARGINAL SEAL
3) Oxalate solutions :
Such as potassium oxalate, can be applied to the
cavity surface to reduce the permeability of the tubules
and possibly seal the dentine.

The crystals this deposited will not wash out but will
allow deposition of corrosion products.
 RECENT ADVANCES
1) BONDED AMALGAMS
During the 1990s some clinicians began to routinely
bond amalgam restorations to enamel and dentine
After preparation of the cavity, enamel and dentine
etched using a conventional etchant, a chemically
cured resin-bonding agent applied to the walls of the
cavity.
Amalgam is immediately condensed into the cavity
before the resin bond has cured
Advantages of Bonded-Amalgam :

Conservation of tooth structure.

Fracture strength was as high as for composites
Decreased marginal leakage in class 5 restorations
compared with unbonded amalgams
Some operators claim elimination of post-insertion
sensitivity.
Reduces incidence of marginal fracture and recurrent
caries.
Can be done in single sitting.
Allows for amalgam repairs.
 Disadvantages of Bonded-Amalgam :

Clinical difficulty of application of more viscous bonding

agents
Lightly filled resin bonding agents tend to pool at the
gingival margin resulting in a higher potential for micro
leakage.
Carving is difficult.
Requires practitioner to adapt to new technique.
Increases cost of amalgam restorations.
2) Gallium alloys
Mercury free metallic restorative materials proposed as
substitute for mercury containing amalgam are gallium
containing materials and pure silver and/or silver based
alloys

Puttkammer (1928), suggested the use of gallium in

dental restoration

Attempts to develop satisfactory gallium restorative

materials were unsuccessful until Smith et al in 1956,
showed that improved Pd-Ga and Ag-Ga materials has
physical and mechanical properties that were similar to or
even better than those of silver amalgam.
 ADVANTAGES OF GALLIUM BASED ALLOYS:

Rapid solidification.
Good marginal seal by expanding on solidification.
Heat resistant.
The compressive and tensile strength increases with
time comparable with silver amalgam
Creep value are as low as 0.09%
It sets early so polishing can be carried out the same
day
They expand after setting therefore provides better
marginal seal
REACTION :

Ag3Sn + Ga Ag3Ga + Sn.

 REACTION :

After mixing, the alloy tends to adhere to the walls of

capsule, thus difficult to handle.

Moreover, by adding few drops of alcohol, the problem

of sticking can be minimized.
 Biologic considerations of Gallium based alloys :

Surface roughness, marginal discoloration and fracture

were reported. With improvement in composition,
these defects were reduced but not eliminated
Could not be used in larger restorations as the
considerable setting amount of expansion leads to
fracture of cusps and post operative sensitivity.
Cleaning of instruments tips is also difficult
Less popular because it is costlier than amalgam.
3) Fluoride releasing amalgam

Have been shown to have anticaries properties sufficient to

inhibit the development of caries in cavity walls.

Concentration of fluoride is sufficient to enhance

remineralization

Tviet and Lindh (1980) -- greatest concentration of

fluoride i.e. about 4000g/mL in enamel surfaces exposed
to fluoride-containing amalgams were found in the outer
0.05m of the tissue.
 In dentin, the greatest concentrations, i.e. about
9000g/ml were found at a depth of 11.5m.

However, this release of fluoride decreases to minor

amounts after 1 week.

Forsten L (1976) -- fluoride released from amalgams

loaded with soluble fluoride salts was detectable
within the first month and thereafter fluoride was not
released in measurable amounts.

Garcia Godoy et al( 1990) fluoride release can

continue as long as 2 years (but at a much lower rate
than that for GIC).
Marginal fracture of amalgam
Referred to as Marginal
breakdown, ditching, and
crevice formation.
Regardless of the type of
amalgam, marginal fracture
increases with time
The rate of increase is greater for
low-copper amalgams.
 CLINICAL TECHNIQUES TO PREVENT
MARGINAL FRACTURE
Excess amalgam, left lying over the occlusal or
proximal surface should be carved correctly

The angle of the carvo-surface margin should be

greater than 70 and the cavity should be designed to
allow for this.

On completion of packing, burnish the margins both

before and after carving to improve marginal
adaptation.
Repair Of Amalgam Restorations
When an amalgam restoration fails, as from marginal
fracture, it is repaired

A new mix of amalgam is condensed against the

remaining part of the existing restoration

The strength of the bond between the new and the old
amalgam is important
Factors contributing to strength of
repair
Presence of porosity and phase at the junction.

Inadequate condensation.

Contamination of the surface of the existing amalgam.

Corrosion & contamination from saliva.

CLINICAL CONSIDERATIONS
Marginal Adaptation And Seal :

Lack of marginal adaptation in first few weeks

May be associated with marginal deterioration,

accumulation of debris, recurrent caries, post-
restoration sensitivity or pulpal reactions.
CLINICAL CONSIDERATIONS
Self-Sealing :

After 48 hours, self sealing occurs

Low-copper amalgam -- seal within 2-3 months
High-copper amalgams -- corrode less and therefore
take 10-12 months to provide a comparable seal.
Amalgam wars
In 1845, 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.

In mid 1920's 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 leads to serious health problems.
He also expressed concerns over health of dentists, stating
that nearly all dentists had excess mercury in their urine.
Amalgam wars
"Third Amalgam War' began in 1980 primarily
through the seminars and writings of Dr.Huggins, a
practicing dentist in Colorado.
He was convinced that mercury released from dental
amalgam was responsible for human diseases affecting
the cardiovascular system and nervous system
Also stated that patients claimed recoveries from
multiple sclerosis, Alzheimers disease and other
diseases as a result of removing their dental amalgam
fillings.
CONCLUSION
There are certain advantages inherent with amalgam
such as technique insensitive, excellent wear
resistance, less time consuming, less expensive which
are not present in the newer materials, these factors
will continue to make amalgam the material of choice
for many more years to come.
 References
Stephen. C. Boyne, Duane. F. Taylor, Dental materials, The Art and
Science of operative Dentistry, Mosby 3rd Edition 1997:219-235.
Kenneth J Anusavice, D.M.D., PhD., Philips Science of Dental
materials, W.B. Saunders Company, 10th Edition 1996: 361-410.
M.A. Marzouk D.D.S. M.S.D. et al, Operative Dentistry Modern theory
and Practice, IEA inc 1997:105-120.
Craig, Science of Dental Materials.
Jagannathan, K, Cruise for Gamma 2 Free Mercury, Materials in
Restorative Dentistry, MADC & H, 1998 66-69.
John F. McCabe, Angus W.G. Walls, Dental Amalgam, Applied Dental
Materials, Blackwell Science, 8th Edition, 1998:157-168
Satish Chandra, Shaleen Chandra, Dental Amalgam, A Text Book of
Dental materials with Multiple Choice Questions, Jaypee Brothers; 1st
Edition 2000.
Vimal. K. Sikri, Silver Amalgam, Text book of Operative Dentistry
CBS publishers, 1st Edition 2002, 204-242.
Thank you