FAILURES OF AMALGAM

RESTORATIONS
RANIYA KUTTIPPULAN
3rd YEAR
introduction
• In routine, properly restored silver amalgam
may not last more than 10 years
• Early restored teeth appear excellent but
gradually peculiar things begin to happen
altering technical details of restoration
• Everything that is done , from the time of cavity
preparation until restoration is polished has a
definite affect upon the success and failure of the
restoration
 • Different types of failure in amalgam restoration
can be grouped as:
1. At visual level:
▫ Secondary caries
▫ Marginal fracture
▫ Bulk fracture
▫ Tooth fracture
▫ Dimensional change
2. At microstructural level
▫ Corrosion and tarnish
▫ Stresses associated with masticatory forces
▫ Pain following amalgam restoration
▫ Pulp and periodontal involvement
 • Failures in amalgam restoration is studied under
three headings:
1. Failures due to faulty cavity preparation
2. Failures due to poor matrix adaptation
3. Failures due to faulty amalgam manipulation
Faulty cavity preparation
• Improper cavity preparation leading to
recurrence of caries and fracture is the greatest
single factor responsible for failure
• Different causes of failure includes:

1.Inadequate occlusal extension:

▫ On occlusal surfaces the preparation should be
extended to include all the susceptible pits and
fissures while terminating margins in areas that
can be finished
2. Inadequate extension of proximal box
▫ if proximal box walls are not adequately extended
into embrasures they are not amenable to
brushing and cleaning and leads to secondary
caries
▫ Radical extension can result in weakened tooth
▫ Special attention should be provided to lower
bicuspids and distal regions of maxillary and
mandibular first molar where frail walls are
formed easily
• 3.overextension of cavity preparation walls
▫ Ideal width of cavity is ¼ th intercuspal distance
▫ If cavity preparation extend half of intercuspal distance
consideration should be given to capping of the cusps
▫ If the cavity preparation extends to 2/3rd of intercuspal
distance cusp capping become mandatory
▫ If remaining cusps are not capped in large amalgam
restorations there are chances that cusps can fracture
▫ During cusp capping amalgam should be present in a
minimum thickness of 2 mm over functional cusps and
minimum thickness of 1mm over non functional cusps to
give adequate strength
4. Amalgam cavity preparations should have a minimum depth
of 1.5mm to provide bulk and hence resistance to fracture
5. if pulpal floor is not flat restoration produces a wedging
effect thus increasing chances of fracture of tooth
6. To assure strong junctions between amalgam and tooth butt
joints should be created. If the cavosurface angle is acute there
are chances of margin fractures and if angle is obtuse acute
marginal amalgam is likely to collapse under stress
Cavity margin should be adequately finished to remove any
unsupported enamel rods which are susceptible to fracture
leading to gap formation and secondary caries
6. Failure to round off the axio pulpal line angle
as well as internal line angles and point angles and
point angles can lead to concentration of stresses
and fracture of tooth or restoration. Rounding off
provides bulk of silver required for strength
7. Occasionally fracture occurs at isthumus portion
of proximal occlusal restoration which may be
because of narrow isthumus relative to rest of
cavity preparation
8. Failure to diverge mesial and distal walls can cause fracture of
restoration
9. Retentive device should be prepared entirely in dentin
without undermining the enamel
10.Incomplete removal of carious tooth structure leads to failure
11.Pulpal floor should be flat at the excavation sites of caries.
Appropriate amount of dentin should be present around each
excavated site
12. Dentist should use high speed rotary instrument with
intermittent cutting and adequate cooling to minimize post
operative pain
Poor matrix adaptation
• Matrix should be very stable after it has been
inserted
• Instability of matrix results in:
▫ Distorted restoration
▫ Gross marginal excess
▫ Uncondensed soft amalgam
• Cerevical excess can irritate periodontium
,gradually destroying it.
Faulty amalgam manipulation
MERCURY ALLOY RATIO
• A serious loss of strength occurs when residual mercury
is in excess of 55%in restoration
• Clinical result of excess residual mercury includes :
▫ Reduced crushing strength
▫ Increased flow
▫ Increased susceptibility to tarnish and corrosion
• Higher the mercury content used in mixing higher is the
residual mercury
• Muling is carried out to ensure that all alloy particles are
duly coated with mercury
• In manual mulling moisture can be incorporated into
it if bare hands are used
• Mechanical mulling is done in amalgamator
• Amalgam which hardens in the capsule if not removed
will contaminate future mixes and cause a hard
amalgam islands which pull out of the plastic mass
• Under trituration leads to soft powdery non coherent
mix
• Over trituration may break the already forming matrix
CONDENSATION
• Rationale of condensation is to reduce residual
mercury, to ensure amalgam reach all parts of
preparation and to obtain homogenous restoration
devoid of voids
• Amalgam should be used within 4 mints after
trituration, delayed use does not allow proper
condensation and also does not remove mercury from
restoration
• Elasticizing mix by adding mercury will reduce strength
• Elimination of mercury by excessive squeezing may
induce a laminated effect and seriously reduces strength
• Condensation should be done by using stepping process
to avoid voids
• Small increments should be used rather than large to
ensure proper condensation
• Very small plugger size may punch hole in amalgam
whereas very large may not condense all corners of
amalgam
• Condensation pressure should be adequate
• Packing motion is most effective if the condenser
is rocked under a heavy steady thrust
• Mechanical condenser should be used with
caution to avoid fracture of enamel margins
CONTAMINATION
• Contamination of amalgam with moisture reduces
strength especially with zinc containing alloys
• There occurs:
▫ Delayed expansion
▫ Marginal flaws
▫ Tarnish
▫ pitting
▫ blistering
FINISHING AND POLISHIING
• Amalgam should be finished gently
• Occasionally during finishing excess amalgam at margin
is dressed down to thin flakes or spur like overhangs
which can fracture from the restoration leaving
susceptible crevices in vulnerable areas of tooth surface
• Over carving should be avoided as it reduce thickness of
amalgam and increase chances of fracture
• Failure to polish accelerate corrosion due to surface
irregularities
POST OPERATIVE PAIN
• Occurs because of:
▫ Hyper occlusion
▫ Cracks in tooth
▫ Galvanism
▫ Delayed expansion
▫ Inadequate pulp protection
• Varnish should be routinely applied under amalgam
restoration
• Failure to apply varnish lead to continuous leakage and may
cause post operative sensitivity and amalgam blues due to
penetration of corrosion products into dentinal tubules
references
• TEXT BOOK OF OPERATIVE DENTISTRY-
VIMAL K SIKHRI
THANK YOU