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Overseas Registration Exam

Dr.Sayij M,
B.D.S, I.Q.E, M.D.S

SILVER AMALGAM
Definition: An amalgam is a special type of alloy in which one of its constituents is mercury. Before these alloys (metal) combine with mercury they are known as dental alloys.

Historically Amalgam alloys contained


Ag - 65% Tin - 29% Cu < 6%

During the 70s amalgam alloys containing between 6 and 30 % were produced High Copper Alloys

Shape and method of production of alloy particles


A cast ingot of the alloy is passed through a lathe machine Lathe-cut alloy A cast ingot is milled Milled alloy Molten alloy is sprayed into a column of inert gas and solidify as fine droplets of alloy Spherical alloy

Hence the alloy powder can be supplied as either:


1.

2.
3.

Lathe-cut Spherical particles Admixed (varying size & shape of particles; better packing efficiency) AND

High copper alloys

Single-composition, Cu enriched alloys High Cu alloys similar in shape and size and have same chemical composition Admixed alloy Combination of lathe-cut low copper and spherical Ag-Cu eutectic alloy

Particle size

Modern powders particle size 15-35m Small particle size < 3 m es the surface area of powder thus requires more Hg Current trend use smaller particle size powders for rapid hardness with greater early strength

Setting reactions of conventional alloys


Ag3Sn + Hg
( Gamma + Hg
1.
2.

Ag2Hg3 + SnHg
Gamma 1 +

Ag3Hg

Gamma 2 + Gamma )

Ag3Sn

Gamma

Ag2 Hg3 Gamma 1

3.

SnHg

-- Gamma 2 (weakest phase)

* Copper is added to eliminate the gamma 2 phase.

* Gamma 2 phase is least stable in corrosive environment * In a high copper system, gamma 2 phase is virtually eliminated by the (Cu-Sn phase) and to accomplish this at least 12 % copper is required in the alloy powder

COMPOSITION OF MODERN AMALGAM POWDER SILVER (40% min) TIN (32% max) COPPER (30% max) ZINC (2% max) MERCURY (3% max , used in pre-amalgamated alloys) Sometimes, traces of Indium and Palladium COMPOSITION OF MERCURY Hg is purified by distillation

Role of Copper

To eliminate the weakest (tin-Hg or gamma-2) phase in amalgam the content of copper is increased Copper therefore hardens and strengthens the amalgam.

Role of zinc :

Scavenges the available oxygen to stop oxidisation of Ag, Sn or Cu during the melting of the alloy. Zinc-containing alloy > .01 % Non-zinc containing alloy .01 % Alloys without zinc are brittle and less plastic Prevents early corrosion and enhances marginal integrity Disadvantage : it causes an abnormal expansion if amalgam is condensed in presence of moisture

Spherical vs Lathe-cut vs Admixed


Amalgams with lesser Hg content have better properties Spherical alloys have smaller surface area and hence require lesser mercury Spherical alloys give a more fluid mix, easy to condense and can be carved immediately Spherical alloys preferred for Class V and pinned restorations.

Contd.

Because they are very plastic establishing proximal contours is difficult Admixed alloys resist condensation better Spherical alloys occlusal strength 3hr Lathe-cut alloy occlusal strength > 6hr

Lifetime of Amalgam
Material

Dentist

Patient

Factors governing quality

By Dentist Selection of alloy Mercury-alloy ratio Trituration Condensation Anat. characteristics Marginal integrity Final finish

By manufacturer Composition Heat treatment Size, shape and method of production Surface treatment Form in which supplied

Dimensional change

Severe contraction microleakage and caries Expansion pressure on pulp and may cause post-operative sensitivity Hg, condensation pressures and longer trituration time will favour contraction

Effect of moisture contamination

Some admixed alloys expand upto 2 yrs If zinc containing alloy is contaminated during trituration or condensation expansion starts 35 days later and may continue for months, sometimes > 4 % - DELAYED EXPANSION

STRENGTH

Weaker in tension and stronger in compression


Single

composition (strongest)

Admixed
High copper amalgam.

Effect of mercury content


Too less or too much weakens amalgam Should be sufficient to wet alloy powder otherwise a dry granular mix results If Hg content es above 54-55 % the strength rapidly reduces Excess Hg also causes more formation of the weak gamma 2 phase (weak phase)
ALLOY : MERCURY VARY BETWEEN 5:8 AND 10:8

For optimum properties, set amalgam should contain lee than 50% mercury

Condensation and Porosity

Lathe-cut needs greater pressure Spherical needs lighter pressure condensation pressure will porosity and the strength

Properties

Compressive strength: at 1 hr.. 50 MPa (minimum) at 24hr. 300 MPa (minimum)


(enamel cusp is 250 MPa)

Creep: 3% (maximum) much less for copper-enriched Tensile strength: at 7 days 60 MPa (enamel cusp is 35 MPa) but still very brittle and weak in thin sections. Need about 2mm thickness of amalgam Dimensional change : - 0.1% to +0.2%

Contd.

Corrosion :

more gamma 2-- more corrosion; copper enriched less corrosion; when in contact with gold corrosion is accelerated due to large difference in potential

Tarnish:

loss of surface lustre due to formation of sulphide layer

Thermal diffusivity:

78 x 10 units (while dentine is 2 x 10)

Coefficient of thermal expansion:

25 x 10 units (dentine 8 x 10) three times more than dentin. Amalgam contracts and expands more than dentine when subjected to thermal changes

Condensation pressure:
3-4 pounds

Disadvantages of Amalgam

Allergy Galvanism Delayed expansion Plaque accumulation Poor esthetics Lack of chemical bond

BIOHAZARDS OF AMALGAM ???

Micro-mercurial poisoning Micro-leakage Thermal conductivity Polishing - release of mercury Bruxism - release of mercury Replacement - release of mercury Mercury found in pulp post amalgam condensation

Still widely used

Used for over 80 years in the UK Excellent track record Studies are longer for amalgam 20 million fillings placed or replaced in one year

Release of mercury in practice ..


30 g /m3 could be released during a clinical session Urinary levels for dentists 2.18 moles mercury/mole creatinine Urinary levels for nurses 2.26 moles mercury/mole creatinine It means: 0-5 Band A Normal for occupation 5-10 Band B some exposure 10-20 Band C significant exposure > 20 Band D exceeds HSE Health Guidance Value

Mercury poisoning

Forms - Metal (Hg0) shows absorption~ 0.01% - Inorganic ion (Hg) shows absorption ~ 1-7% - Organic (methyl or ethyl mercury) have absorption ~ 90% Access to body Skin, Vapour, Gut

Mercury toxicity :

Paraesthesia - ~500g/kg Ataxia Joint pain Death - ~ 1000 g/kg - ~ 2000 g/kg - ~ 4000 g/kg

Mercury in amalgam

About 1 3 g/day as amalgam particulate Hg0 Parafunctionists, ingestion ~45 g/day as amalgam particulate or Hg+ But the gut absorption is about 1-7 % Half-life is about 20-90 days Fish consumption is about 4 g/day of methyl mercury (absorption > 90%) Intake from all sources other than amalgam ~20 g/day of Hg+

Cary Bopiah

Levels needed from dentistry for MINIMAL observable effect ... * 450-530 amalgam surfaces to give a urine mercury level of 30 g/g creatinine * If all teeth were restored - - only 192 surfaces

Recommendations

An average of 5 amalgams a year is unlikely to cause mercury poisoning Mercury released from a normal number of surfaces unlikely to cause any poisoning Pregnant patient should not take part in removal or replacement of amalgam fillings Not advisable to replace amalgam with non-amalgam if the reason is one of suspected mercury poisoning

Bonded amalgam restorations


An auto-polymerizing dentine bonding agent is coated then amalgam placed in cavity. Panavia Scotch bond All bond 2 Amalgam bond plus Advantages Less tooth structure removed Increased fracture resistance Easy repair of ditched or fractured amalgam

Longevity of Restorations
Material Amalgam (I,II,V) Range (yrs)
5-25 3-10

Adjusted
11 6

mean

Ant. Composites
Post. Composites

3-9 3-5 10-25 10-25

5 6 17 18

Glass Ionomer Cast high noble


Porcelain fused to metal

Composites :
.. are resins consisting of organic and inorganic phases bonded by a coupling agent.

COMPOSTION :

RESIN - BISGMA - UDMA - plus TEGDMA (to reduce viscosity of resin and to allow

fillers to be added to resin)

FILLERS

Quartz Glass

: conventional composites (1-5 m) : conventional composites (aluminosilicate or borosilicate) (1-5 m) Fused silicon : microfilled (0.4 m)

Uses of filler: To increase strength Increase abrasion resistance Decrease polymerization shrinkage Better polishability

Composition Contd..

Coupling agent : Silane (coats filler particles to enhance bond between resin matrix and fillers) Opacifier : Barium oxide Initiator : Benzoyl peroxide Photo initiator : Camphoroquinone

Classification
1. 2. 3.

According to filler size Macrofilled quartz or glass Microfilled silica Hybrid quartz or glass + silica (80-90% by weight) Macro have better strength and mechanical properties (60-80% by weight) Micro have better polishability, lesser strength Hybrid intermediate qualities

Classification (contd.)

According to method of curing: Chemically cured Light cured Dual cured

GLASS IONOMERS

Generally known to be an IRM (intermediate restorative material) Only restorative material that truly bonds to tooth surface Water based and hence hydrophilic

Types of GIC

Type I Luting Type II restorative Type III lining Type IV - Light cure and Dual cure

Composition

Aluminosilicate glass + polyalkenoic acid Resin modified GIC HEMA is added

Properties

Adhesion to enamel and dentin, there is ionic displacement of Ca and Po4 ions by polyacrylate ions and adsorption of polyalkenoic acids onto collagen Cariostatic due to fluoride release Thermal expansion similar to enamel and dentin Radiolucent except ketac-bond Abrasion resistance is poor Biocompatibility good (not resin modified GIC) Polyacrylic acid is mild and molecule is large and cannot diffuse into dentinal tubule

Contra-indicated

High stress bearing areas Esthetic areas Large class II and IV

IMPRESSION MATERIALS :

IMPRESSION MATERIALS

NON ELASTIC POP Imp. Compound ZOE paste Wax

ELASTOMERS Silicone (add, cond) Polysulphides Polyethers

HYDROCOLLOIDS Reversible Irreversible

COMPOSITION OF ALGINATE

K or Na alginate reacts with water to form a solution Calcium sulfate reactor Diatomaceous earth filler Trisodium phosphate retarder Potassium titanium fluoride accelerator Zn oxide - filler

USES OF ALGINATE

Bleaching trays, mouthguards RPD, crown and bridge Ortho study casts Mouth protectors for sportsmen

Problems with alginate

Sticks to teeth Voids in impression Tears during removal Lack of detail Grainy appearance Early setting Pulls away from tray

ELASTOMERS
TYPES: Polysulfide Silicones : Addition and Condensation Polyether ADDITION SILICONES (Reprosil, Aquasil) Base Poly methyl hydrogen siloxane (PMHS) and fillers Reactor divinyl polydimethyl siloxane (DPDS) and fillers

Elastomers (contd.)
Advantages : Addn. silcn Dimensionally stable Easy manipulation Most elastic of all impression materials Multiple pours possible Compatible with gypsum products Long shelf life

Elastomers (contd.) Disadvantages: Addn. silcn Latex inhibits reaction Hydrophobic Hydrogen gas evolution (wait 1 hr before pouring) Low tear strength

Mineral Trioxide Aggregate (MTA)


Composition: Calcium oxide Zinc oxide Aluminium oxide

Uses Pulp capping Perforation repair Apexification Root end restoration after apicectomy

DENTAL CEMENTS
LUTING LINING FILLING

GIC ZnPo4

Varnish GIC

ZOE GIC

Zn polycarboxylate

Calcium hydroxide

Composite based luting cement

Ideal requirements :

Healing of pulp dentin organ Sedative action Seal dentinal tubules Provide insulation Dentin bridge formation

Zn Oxide Eugenol Cement

Powder Zn Oxide Liquid Eugenol Resin bonded ZOE 10 % hydrogenated powder added (HEMA) Weakest cement eugenol is an obtundent, has analgesic action Antiseptic and anti-inflammatory Contraindicated under resins (interferes with polymerization)

Calcium Hydroxide

Powder CaOH2 + fillers Liquid polysalicylate fluid Or base paste +catalyst paste Ph is 11 Bacteriostatic can induce mineralization of adjacent pulp Uses- pulp capping, perforations, root canal medicament, apexification,lining

Zn Phosphate

Powder Zn oxide and Mg oxide Liquid 50 % phosphoric acid Always use varnish underneath Advantage good strength, good adaptability, best insulator Disadv irritant to pulp, exothermic reaction

Zn Polycarboxylate

Powder Zn oxides and Mg oxides Liquid 40 % aqueous polyacrylic acid Similar to ZnPo4, good strength, good insulator Difficult to handle(eg.mixing)

Dental Porcelain
Porcelain refers to a family of ceramic materials composed essentially of Kaolin, Feldspar, Quartz fired at a high temperature Other constituents fluxes, colour pigments, opacifying agents, stains, colour modifiers

Properties

Chemically stable Excellent compressive strength 350-500 mpa Thermal conductivity and coefficient of expansion similar to dentin Biocompatible Minimal plaque accumulation Excellent esthetics

Types of Ceramics
High fusing 1300 C Medium fusing 1101-1300 C Low fusing 850-1100 C Ultra low fusing <650 C Depending on preparation: Sintering (Porcelain fused to metal) Castable glass ceramics (Dicor) Pressable ceramics (IPS empress, IPS empress 2) Glass infiltrated ceramics(In-ceram) Cad-Cam technology (Procera)

METAL ALLOYS

PRECIOUS ALLOYS (NOBLE METALS) Platinum Palladium Iridium Osmium Rhodium Silver Ruthenium Gold

NON-PRECIOUS ALLOYS (BASE METAL ALLOYS) Nickel Chromium Cobalt Iron Magnesium Copper

Uses in dentistry

Precious Crown and Bridge Non-precious Metal ceramic alloy RPD alloys - Co-Cr - Ni-Cr - Co-Cr-Ni

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