OVERVIEW OF

AMALGAM RESTORATION
DR. SARANG SURESH HOTCHANDANI
CONTENTS 2

• INTRODUCTION
• GENERAL TOOTH PREPARATION
• TYPES OF AMALGAM
• HISTORY
• GENERAL CONSIDERATIONS
• GENERAL CLINICAL TECHNIQUE
INTRODUCTION 3

• It is a Direct Metallic Restorative

material.

• Amalgam means alloy of mercury with

another metal.
• Mixture of silver-tin-copper alloy and
mercury.
GENERAL TOOTH PREPARATION FOR AMALGAM 4

• Possess a uniform specified minimum specified thickness

for compressive strength (1.5-2 mm)

• Produce a 90-degree amalgam angle at the cavo-surface

margin (butt joint form)

• Be mechanically retained to tooth (undercut formation)

TYPES OF AMALGAM 5

• Conventional amalgam restoration

• Desensitizer is used (5% glutaraldehyde + 35% hydroxyl-ethyl methacrylate [HEMA])

• Bonded amalgam restoration

• Bonding, technique & isolation similar to composite
• Retention is minimal
• Strengthen the remaining tooth structure
• However, tooth preparation is similar to conventional amalgam restoration defined above.

• Sealed amalgam restoration

• In this light cured adhesive is placed under amalgam restoration to close dentine.
HISTORY OF AMALGAM 6

Initially, dentists use silver coins in

filling and mixing these filling with
mercury, creating a putty like mass that
was placed into defective tooth.
CURRENT STATUS OF AMALGAM 7

• Today popularity is decreased because of;

• Reduction in caries rate
• Esthetic concerns
• Development of composites (primary cause of
reduction in use of amalgam)
• Environmental concerns
TYPES OF AMALGAM 8
LOW COPPER AMALGAM 9

•Prominent till 1960.

•Composition
• Silver; 65% wt.
• Tin; 29% wt.
• Copper; <6% wt.
LOW COPPER AMALGAM 10

• This type of amalgam results gamma-two phase

(tin-mercury) which showed corrosion.
• This corrosion led to breakdown of amalgam.
• That’s why High copper amalgam were developed to
eliminate this corrosion created by gamma-two phase.
HIGH COPPER AMALGAM 11

• Currently used today

• Reduces formation of gamma-two phase (reacts with tin) resulting decreased

corrosion but;
• Corrosion still occurs which is beneficial because it provides marginal sealing of amalgam
to cavity walls.

• Composition
• Silver; 40% wt.
• Copper; 12% - 30% wt.
HIGH COPPER AMALGAM 12

• This material can provide performance for more than 12

years

• Two types of high copper amalgam

• Spherical amalgam
• Admixed amalgam

• Zinc containing high copper amalgam does not show

delayed expansion on condensation.
EFFECT OF “ZINC” IN AMALGAM 13

•Enhance mechanical properties

•Reduce marginal fracture

•Prolong the service of restoration

TRITURATION 14

• it is the process by which amalgam alloy powder is mixed with

liquid mercury.

• The powder may be;

• Lathe cut ( milling(crushing) an ingot(slab) of the alloy)
• Spherical type (atomizing liquid alloy)
• Admixed
• Contain both lathe cut and spherical type of alloys.

• Filing; when dental amalgam alloys contain only lathe cut particles.
SPHERICAL AMALGAM 15

• Little condensation pressure.

• High early strength.

ADMIXED AMALGAM 16

• More condensation pressure (required

by many dentists)
• Displaces matrix bands to generate
proximal contacts more easily.
NEW AMALGAM ALLOYS 17

• Mercury free

• Lowe mercury amalgam

• Alloys with gallium or indium or gold alloys

POINTS TO CONSIDER… 18

• It has been theorized that during mastication, pressure of 200 MPa and this
force with friction can generate heat which would break bond in amalgam and
release mercury in the oral cavity.

• 12 amalgam restoration would release 1.7 micro gram per day.

• Dental amalgam restoration contains approx. 50% mercury.

• Hypersensitivity to mercury is extremely rare.

• Less than 1% showed clinical features of hypersensitivity to mercury (oral lichenoid
reaction, erythematous, burning or itching)
IMPORTANT PROPERTIES OF AMALGAM 19

• Linear coefficient of thermal expansion of amalgam is 2.5

times greater than tooth structures.
• While it is close to composite.
• Linear coefficient of thermal expansion; the change in size per
degree change in temperature.
IMPORTANT PROPERTIES OF AMALGAM 20

• Compressive strength is similar to tooth structure.

• Tensile strength less than tooth structure.

• Make amalgam prone to fracture

• Usually amalgam fracture is bulk fracture not

marginal fracture.
IMPORTANT PROPERTIES OF AMALGAM 21

•Amalgam is brittle and have low edge

strength

•Amalgam should have sufficient bulk (1.5-

2 mm) and 90 degree or greater marginal
configuration.
IMPORTANT PROPERTIES OF AMALGAM 22

• No clinically relevant creep or flow is shown

by amalgam.
• Creep/flow; it is the deformation of material
under load.

• Amalgam is good thermal conductor

• Always use base/liner under this material.
GENERAL CONSIDERATIONS OF AMALGAM 23
INDICATIONS & USES 24

• Class 1, 2 & 5 cavities, root caries or areas where isolation is not

possible.
• Coz, amalgam has greater wear resistance than composite and
• There is no any effect of contamination on amalgam restoration

• Temporary caries control restorations till final restoration is

placed.

• Foundations (core buildup for crown)

CONTRAINDICATIONS TO AMALGAM 25

• Allergy to alloys

• Esthetic areas

• Weakened tooth structure which can be

preserved by composite do not use amalgam.
 ADVANTAGES V/S DISADVANTAGES 26
ADVANTAGES OF AMALGAM RESTORATION DISADVANTAGES OF AMALGAM RESTORATION
 Ease of use/ least time consuming  Non-tooth colored/non-esthetic
 High compressive strength/strong  Mechanical bonding to tooth
 Excellent wear resistance (similar to tooth)  Large natural tooth removal
 Long term durability  Difficult tooth preparation
 Low cost than composite  Initial marginal leakage
 Reduced micro-leakage due to formation of  Limited edge strength
corrosion products at the tooth-amalgam
restoration
 No alteration of gingival flora as compared to
composite when placed in root caries
Cusp fracture is not caused by amalgam restoration
but it is caused large cavity preparation used form
amalgam.
GENERAL CLINICAL TECHNIQUE 27
INITIAL CLINICAL
PROCEDURES/CONSIDERATIONS 28

• Complete examination, diagnosis and

treatment plan before start of
restoration.
• Assessment of occlusion.
• Identify contacts on tooth to be restored and
opposing and adjacent teeth
• Help in planning outline form and occlusal
contacts on restoration.
INITIAL CLINICAL
PROCEDURES/CONSIDERATIONS 29

• Local anesthesia

• Placement of wedge in gingival embrasure.

• Separate the operated tooth
• Protect rubber dam & interdental papilla

• Isolation of operating site with rubber dam or cotton rolls.

• Visualize anticipated extension of the tooth preparation

TOOTH PREPARATION OF
AMALGAM RESTORATION 30
REQUIREMENTS 31

• Amalgam margin 90 degree or greater (butt-joint

form) coz of amalgam’s low edge strength.

• Adequate depth of 1.5 – 2mm thickness for

adequate compressive strength.

• Adequate mechanical retention form (undercut

form)
INITIAL TOOTH PREPARATION DEPTH 32

• Initial pulpal depth in cavity for amalgam filling should be;

• One half length of the No. 245 bur (1.5mm) (total length of this bur is; 3mm) OR
• 1.5 mm measured from central groove OR
• 0.2 mm inside/ internal to DEJ

• Depth for axial wall should be;

• 0.2 mm inside DEJ if retention grooves are not going to formed
• 0.5 mm inside DEJ if retention grooves are going to formed

• Axial depth on root surface

• 0.75 – 1 mm deep
33
34
OUTLINE FORM 35

• The extension of cavity depends primarily on amount of caries, old restorative

material or defect.

• Preserve the strength of cusps and marginal ridges.

• Try to extend cavity around the cusps and avoid undermining of dentinal support of marginal
ridges.

• Extend facial and lingual proximal walls into facial or lingual embrasure but not
beyond it

• The less the outline form the more conservative is the cavity and less the tooth
structure is removed.
CAVOSURFACE MARGIN 36

• Must be 90 degrees or greater. Butt joint should be formed

between amalgam & tooth structure.

• Occlusal margins should be made in such a manner that full length

of enamel rods or buttressed by shorter enamel rods

• Central groove after carving should be rounded

37
PRIMARY RETENTION FORM 38

• Mechanical locking of amalgam into surface irregularities

of cavity

• Vertical walls especially facial/lingual should converge

occlusally.

• These both primary retention features can be obtained

by “pear shaped carbide bur No. 330 or 245)
PRIMARY RESISTANCE FORM 39

• Resistance features which prevent THE TOOTH from

fracturing are obtained by;
• Maintaining as much unprepared tooth structure as possible
(preserving cusps & marginal ridges)

• Making pulpal & gingival walls perpendicular to occlusal forces

• Having rounded line angles

• Removing unsupported or weakened tooth structure.

PRIMARY RESISTANCE FORM 40

• Resistance features which prevent THE AMALGAM from fracturing

are obtained by;
• Adequate thickness of amalgam
• 1.5 – 2 mm occlusal cavity

• 0.75 mm in axial areas

• Margins of amalgam greater or equal to 90 degrees.

• Box like cavity form which provide uniform amalgam thickness.

• Rounded line angles.

CONVENIENCE FORM 41

Obtained by extending outline

form, walls or margins.
SECONDARY RESISTANCE FORM 42

Obtained by pins, grooves, coves,

slots, steps, amalgam pins.
RESTORATIVE TECHNIQUES 43
 44
Matrix in case
Tooth Application of
of Proximal
Preparation Desensitizer
Restoration

Insert Mixed
Carving of
Finishing Amalgam into
Amalgam
Cavity
45
Matrix Placement in case of Proximal
Restoration 46

• Provide proper contact & contour

• Confine restorative material

• Reduce amount of excess material

• It should be easily applied and removed, extend below gingival margin, extend above
marginal ridge height & resist deformation during insertion of restorative material.

• Matrix can be applied during tooth preparation.

• In this case matrix is applied on that tooth which is adjacent to tooth which is being prepared.
Filling or Condensation of Amalgam 47

• Spherical is easily condensed than admixed.

• Smaller amalgam condensers are used first to

allow amalgam to be condensed in the grooves,
coves, line angles etc.

• Burnish the amalgam with burnisher to finalize

condensation.
Carving of Amalgam 48

• Occlusal areas;
• A discoid-cleoid instrument is used for this purpose.
• The rounded end (discoid end) of discoid-cleoid instrument is positioned on the
unprepared enamel adjacent to the amalgam margin and pulled parallel to margin.
• The pointed end (cleoid end) is used for creating primary grooves, pits or cuspal inclines.
Or these can also be made with Hollenbeck carver.
• Mesial & distal pits should be inferior to marginal ridge height to prevent wedging of food
into occlusal embrasure.
• For large class 2 or foundation restorations, the initial carving of the occlusal surface
should be rapid, concentrating primarily on the marginal ridge height and occlusal
embrasure areas.
• These areas are developed with explorer or carving instrument by mimicking adjacent tooth.
Carving of Amalgam 49

• Facial and Lingual areas;

• Hollenbeck carver/ amalgam knife is useful in carving
these areas.

• Proximal Embrasure Areas;

• Made by amalgam knife
• Assessed by visual examination & dental floss.
 THE END 50
DR. SARANG SURESH HOTCHANDANI
(BDS)
hotchandaniss@hotmail.com
Larkana, Sindh, Pakistan