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Amalgam:
Restorations are customarily anchored by small undercuts within the dentin,
when a large portion of crown is missing because of caries or for other reasons
such as fracture. It is difficult to obtain this anchorage. There are many features
that provide resistance and retention form to the amalgam such as pins, locks,
cores, slots etc. Bonding also provide anchorage of restorative materials to the
dentin. It has been seen that the mutilated teeth are successfully restored with the
use of pins. These are called the complex amalgam restorations. Thus are the
restorations which involve more than two surfaces of the tooth with or without
cusp capping. These complex amalgam restorations are used occasionally as an
alternative to indirect restorations.
Indications:
Complex amalgam restorations are indicated.
! "hen large amounts of tooth structure are missing.
#! "hen one or more cusps need capping.
$! "hen increased retention and resistance form is re%uired.
Uses:
Complex amalgam restorations may be used as,
! Control restorations in teeth with %uestionable pulpal and periodontal
prognosis.
#! Control restorations in teeth with acute and severe causes. & control
restoration helps,
a. To protect the pulp from oral cavity
b. 'rovides anatomic contour against which the gingival tissue may be
healthier
c. (acilitates control of caries and pla%ue
d. 'rovides some resistance against tooth fracture or propagation of an
existing feature.
$! )efinitive final restoration
*! (oundations
+! &butment teeth for fixed prosthesis may utili,e a complex restoration as a
foundation
-! In patients for periodontal and orthodontic treatment, the complex
restoration may be the restoration of choice until final phase of treatment
when cast restoration may be preferred.
Contraindications:
If patient has significant occlusal problems.
If the tooth cannot be properly restored with direct restoration because of
anatomic and functional considerations.
If the areas to be restored in the esthetic region.
#
Advantages:
Conserves tooth structure. The preparation for a complex amalgam
restorations is usually more conservative than the preparation for indirect
restoration or a crown.
&ppointment time./ The complex restoration can be completed in one
appointment. The cast restoration re%uire at least two appointments.
Resistance and retention form. Resistance and retention form is
significantly increased by pins, slots and bonding.
0conomics./ Compared to an indirect restoration, the amalgam restoration
is relatively inexpensive restoration procedure. "hen cost is the factor the
complex amalgam restorations provides the patient with only extraction of
severely broken down teeth.
1artin and Bader have published the 2#3 of the * to + surfaced complex
amalgam restoration are of successful at five years compared with 4*3 of both
gold and porcelain crowns.
In another study it is reported that 2#3 of amalgam restorations survived
for + yrs including those of cusp coverage.
isadvantages:
! )entinal micro fractures./ 'reparing pinholes and placing pins may create
cra,e lines or fractures, as well as internal stresses in the dentin. Cra,e line
and internal stresses have little or no clinical significance but they may be
very important when minimum dentin is present.
$
#! 1icro leakage./ In amalgam restoration using cavity varnish micro leakage
around all types of pins has been demonstrated. &malgam bonding has
reduced the incidence of micro leakage.
$! )ecreased strength of amalgam. The tensile and compressive strength of
pin amalgam restorations are significantly reduced.
*! Resistance./ Resistance form is more difficult to develop when preparing a
tooth for cusp covering onlay. 5owever amalgam restorations with cusp
coverage significantly increases the fracture resistance than amalgam
restoration without the cusp coverage.
+! Tooth anatomy. 'roper contours and occlusal contacts and6or anatomy are
sometimes difficult to achieve with large complex restorations.
The various features that provide resistance and retention to the complex
restorations.
! 7lots
#! 'ins
$! Bonding
!" Slot Retained Com#le$ Amalgam Restorations:
(or complex restoration, a slot is a retention groove in dentin whose length
is in hori,ontal plane. 7lot retention may be used with the pin retention or as an
alternative to it. 7lots are prepared with 8o. $$ 9 bur approximately :.-mm deep
and :.+ to mm inside the dentino enamel ;unction.
¬her retentive feature that provides additional retention form is cores.
Cores are prepared with 8o < bur. )epth = :.#+mm.
*
¬her retentive feature that provides the retention is proximal locks
placed in proximal bone and in other locations where sufficient vertical tooth
preparation permits.
>perators use slot retention and pin retention interchangeably. 7lot
retention is used in preparation with vertical walls that allow retention locks to
oppose one another. 'in retention is used for fre%uently in preparation with few or
no vertical walls.
7lots are particularly indicated in short clinical crowns and in cusps that
have been reduced # to $ for amalgam.
The amount of tooth structure removed in slots is more as compared to the
pins. 5owever slots are less likely to create micro fractures in dentin and to
perforate the tooth or penetrate into the pulp.
7tudies have shown that slots placed within :.+mm of the pulp do not show
any inflammatory response but the medium si,ed self threading pins do show.
7tudies whether in vitro or in vivo have shown that the retention provided
by slots and pins are %uite similar. But 'ashley and associates reported that the
shear strength of pin retention was significantly stronger than slot retention.
Pin retained amalgam restorations:
& pin retained restoration may be defined as any restoration re%uiring the
placement of the one or more pins to provide ade%uate resistance and retention
form.
+
'ins are used whenever ade%uate resistance and retention form cannot be
established with slots, locks or undercuts. 'in retained amalgam is an important
ad;unct in the restoration of teeth with caries or fracture.
Armamentari%m:
7uccessful pin placement does not re%uire large number of specialty items.
Basic list include./
! Contra angle hand piece ?slow speed! latch type
#! )rill and matching pins
$! (inger wrench for accessible areas
*! Cable drive pin setter for inaccessible areas
+! Bending tool
-! 7harp fissure bur ?e.g. no. ++2! for cutting of the pins
>ptional list include./
! &utoclutch hand piece
#! <ered comborundum disk to make a self/tapping pins
$! 5aemostat forceps ?needle holder!
*! 1agnifying glasses
Cable/drive pin setter available as the @oma @inda alloy.
Classi&ication o& Pins:
'ins can be classified as A
a! )irect 6 8onparallel pins
b! Indirect pins6 parallel pins
-
A" irect Pins:'
&re usually made of stainless steel, titanium or stainless steel with gold
plating etc. and inserted into dentin followed by placement of restorative materials
like amalgam, resin or cement directly over them.
They are also referred to as non/parallel pins since they are directly inserted
into the tooth structure and hence not parallel to each other. These category pins
include cemented, friction locked and threaded pins.
( Indirect #ins:'
They are slightly undersi,ed to their pinholes and are the integral part of the
cast restoration. These are known as parallel pins as the method necessitates
placement of pins parallel to each other as well as parallel to the path of insertion
of the restoration. Retention of parallel pins are less than the non/parallel pins.
There are basically two types of pin used in parallel pin techni%ue.
a" Cast gold #ins:'
They have relatively smooth surface. Restorations using these pins are
fabricated by keeping the nylon bristles or plastic pins in the pinholes over which
the rest of the restoration is built in the conventional form with blue inlay wax.
The whole assembly is then invested and casted with pins forming an inherent part
of the cast restoration.
)" *ro%g+t #recio%s metal #ins:'
They have surfaces that is deformed or roughened by means of threaded or
knurled patterns. These pins are alloys of gold, platinum, palladium or platinum
2
indium. The pins are placed in the pinhole and are included in the wax pattern.
Their high melting point and tarnish resistance enable them to be incorporated into
the final gold casting. These are #:/$:3 more retentive than smooth cast pins.
irect #ins:
The three ma;or categories of direct pins are./
a! Cemented
b! (riction locked
c! Threaded pins
A" Cemented Pins:'
1arkley introduced this type of pin in B+4. These pins are cemented into
the pinholes prepared :.:: to :.::#C ?:.:#+ to :.:+mm! larger than diameter of
the pin. The difference in the diameter provides space for luting cement.
Cemented pins comes in two si,es
'in diameter 'in channel diameter
:.:#+C :.:#2C
:.:#:C :.:#C
Indication o& cemented #ins:
Cemented pins are generally indicated in cases where least cra,ing and
stresses are desired in the remaining tooth structure e.g. 0ndodontically treated
teeth, where there is no other choice but to place a pin near the dentino/enamel
;unction, where bulk of dentin to accommodate the pin is limited or where dentin
has lost its elasticity because of sclerosis or dehydration.
4
&dvantages of cemented pins./
Cemented pins are approximately :.::C A :.::#C smaller than their
pinholes and hence are more likely to be seated to the full length.
7ince they are passively relined in the dentin, they virtually place no stress
on the surrounding dentin during or after placement.
Because the cement seals the interface between pin and tooth, chances of
micro leakage are reduced.
These can be cut or bent to their final configuration before fixing them in
the pinholes.
)isadvantages of the cemented pins./
They offer less retention compared to the friction locked and threaded pins.
If it is often difficult to insert cement into the pinholes and later locate the
hole after cement has been introduced.
&t times the poorly cemented pins get dislodged when filling material is
being inserted.
Dreater time is re%uired for mixing and hardening the cement.
(" ,riction loc-ed #ins:'
These were introduced by Doldstein in B--. The diameter of the prepared
pinhole is :.::C ?:.:#+ mm! smaller than the diameter of the pin. The pins are
tapped into place and retained by the resiliency of the dentin. The pins are # to $
times retentive than the cemented pins. These pins come in only one si,e i.e.
'in diameter 'in hole diameter
B
:.:##C :.:#C
Indications for friction locked pins./
Teeth that are vital and periodontally sound and where direct access can be
obtained so that tapping force can be applied parallel to the long axis of the
pin.
7ufficient amount of dentin is available to surround the pin and no way
should they be placed closer than .+mm to the dentino enamel ;unction.
&dvantages of friction locked pins./
Cement is not re%uired so one does not have to wait for the cement to set
and other related problems.
'ins ac%uire stability from moment they are inserted.
Better retention than the cemented pins.
)isadvantages of friction locked pins./
The length of the pin is ;udged by trial and error. It cannot be removed from
dentin for cutting to the desire length once inserted.
Bending or contouring of the pin after it has been inserted into pinhole
leads to further stresses.
)riving pins into their respective pinholes generates stresses in dentin in
the form of cracks or cra,e lines.
1any a times, pin do not reach to the full length due to gauging, and hence
loose their retentive properties.
:
1icroleakage is higher than cemented pins if the overlying restoration
leaks.
C" T+readed #ins. sel& t+readed #ins:
The most fre%uently used pin type is small self threading pins. (riction
locked and cemented pins although are still available are rarely used. The pin
retained amalgam restoration using the self threading pins was originally described
by Doing in B--.
The diameter of the prepared pin hole is :.::+C to :.::*C smaller than
the diameter of the pin. The threads engate the dentin as it is inserted, retaining the
pins. The resiliency of the dentin permits insertion of a threaded pin into a hole of
smaller diameter.
<hough the threads of the self/threading pins do not engage the dentin for
their entire width, the self/threading pins are the most retentive of the three types
of the pins being three to six times more retentive than the cemented pins.
Eertical and hori,ontal stresses are generated when the self/threading pins
are inserted into the dentin. The self threading pins are available in four diameter
in thread mate system ?T17! by cotton6 "haldent Inc 1ahwah, 8ew Fersy.
T/#e Color Pin diameter
in.mm
Pin +ole diameter
0in.mm"
Regular ?7tandard!
Regular ?self shearing!
Regular ?Two in one!
Dold :.:$C 6 :.24 :.:#2 6 :.-4
1inimum ?standard!
1inimum ?two in one!
7ilver :.:#* 6 :.- :.:# 6 :.+$