DENTAL AMALGAM

Midterm exam
Date: 4/11/2012 Day: Sunday Time: 11.30-12.30. Location: 10H2,3,4

Overview
Basic composition Classifications Basic setting reactions Properties Clinical handling notes Manipulation
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Why Amalgam?
Inexpensive Ease of use Proven track record
>100 years

Familiarity Drawbacks:
Esthetics Mercury content
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Dental Caries

Constituents in Amalgam
Basic
Silver Tin Copper Mercury

Other
Zinc Indium Palladium
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Classification
According to the shape of particles in the powder:
Irregular: Formed by shaving particles from a block of the alloy by a lathe (lathe-cut alloy) Spherical: Formed by spraying molten alloy into an inert gas (spherical alloy) Admixed: Mixture of the two (admixed alloy).

Setting reaction continue,

Ag-Sn + Hg

Ag-Hg + Sn-Hg +unreacted Ag-Sn

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What does actually occur during the setting reaction:

Silver and Tin dissolve into mercury and saturate the solution and also absorb mercury. Newly formed particles start to precipitate until there is no more Hg to react (takes 24 hrs).

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Setting transformation
After mixing: amalgam is packed in cavity.

When amalgam reaches initial set, it cannot be carved, but still not fully reacted (brittle). Needs 24 hours to attain full strength.

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Setting reaction
When the alloy is mixed with mercury, three phases occur:
Gamma phase () silver-tin alloy phase, strongest with least corrosion Gamma 1 phase (1) consists of mercury reacting with silver, not as strong as . Gamma 2 phase (2) consists of mercury reacting with Tin. Weak phase and corrodes easily.
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Physical properties
Tarnish: oxidation that attacks amalgam surface and extends slightly below the surface. Cause: contact with
Oxygen Chlorides Sulfides

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Continue,
Clinical picture: dark and dull appearance Tarnish is more likely to occur with rough surfaces How to avoid and minimize it: Palladium Polishing after 24 hrs Excessive heat from polishing?
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Physical properties
Corrosion: what causes it,
Chemical reaction between amalgam and saliva/food leading to oxidation of amalgam. Contact between to dissimilar metals (galvanism) oxidation of amalgam Interaction of amalgam components
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Continue,
The outcome of corrosion:
Weakens restoration Deterioration of its margins Stain surrounding tooth structure as corrosion products penetrates dentinal tubules
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Physical properties
Creep: usually seen with low-copper amalgam. It involves a change in the shape of the restoration due to compression from chewing and opposing teeth.

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Physical properties
Dimensional change: expansion and contraction. This property is affected by:
Moisture contamination Composition of the alloy Ratio of Hg : alloy powder

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Physical properties
Strength: High compressive strength 400-450
MPa, but low tensile strength (12% of C.S) and low shear strength, therefore enough bulk of amalgam is needed to provide enough strength.

High copper amalgam have higher strength values after the first hour of placement than low copper amalgams.

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Fracture

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Handling characteristics
Available amalgam is mostly high copper, spherical or admixed amalgam Spherical amalgam has a low surface area therefore requires less mercury for the reaction Softer when condensed Higher 1 and 24 hrs strength compared to admixed Newly placed spherical amalgam shrink more compared to admixed.
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Manipulation
Dispensing of alloy and mercury:
Capsulated available with different quantities depending on the size of restoration
Single mix or spill Double More

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Trituration
Mixing time
refer to manufacturer recommendations

Overtrituration

hot mix

sticks to capsule

decreases working / setting time slight increase in setting contraction grainy, crumbly mix
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Undertrituration

 Placement and condensation:

Dappen dish Amalgam carrier Condenser is used to fill the cavity layer by layer using vertical and lateral condensation Cavity overfilled so that when carved, excess mercury is removed

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 Burnishing and carving:

Burnishing maybe done before carving to further condense amalgam and remove excess mercury Carving is done soon after amalgam is placed in cavity Finishing and polishing is done after 24 hours.

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Polishing
Increased smoothness Decreased plaque retention Decreased corrosion

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Bonding amalgam
Amalgam is conventionally retained in cavities mechanically.
Low copper amalgam Expand as they set Produce corrosion Reduce microleakage High copper amalgam shrink slightly corrode slowly postoperative sensitivity

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Bonding amalgam
Using resin bonding agents:
Etching of cavity preparation Bonding is done with one or two bonding resins:
1st technique: bonding agent applied to enamel and dentine, followed by chemical cured resin. Amalgam is condensed against the wet resin. 2nd technique: a single chemical cure bonding agent is applied before placement of amalgam.
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Mercury safety
Mercury is toxic, but released in small amounts from set amalgam. Safety should be considered for:
Patient Operator Environment

How does mercury enter the human body?

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Continue,
Skin contact Vapor inhalation Ingestion To protect the patient:
Use high volume suction Rubber dam isolation

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Continue,
How are the operator or dental staff exposed to amalgam:
Placing or removing amalgam Sterilizing instruments Improper disposal of amalgam Carpeted clinics, or tile floors that can collect mercury spells

OSHA: acceptable level of mercury exposure 0.005 mg/m3

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Safety procedures
Adequate ventilation Avoid heating instruments to>80C Floors should be nonporous and easy to clean Use gloves, masks, glasses Amalgam scrap stored under water in airtight containers Recycling of amalgam scrap appropriately
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Continue,
Reduction of mercury vapor:
Use amalgam capsules Use amalgamator with enclosed mixing arm Store amalgam scrap under water Clean instruments from any amalgam before sterilization Avoid ultrasonic condensers Clean mercury spills promptly with spill kit
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Mercury-free amalgam
Gallium as a substitute for mercury Similar handling characteristics to traditional amalgam Not a good alternative due to high corrosion and lower strength Not commonly used

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 Reference:
Chapter 8. Dental Materials, clinical applications for dental assistants and dental hygienists

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