DENTAL

AMALGAM

Dr. Abbas Rizvi

1
 INTRODUCTION restorative material today

and that it has saved more

The word “Amalgam” is teeth than any other

derived from the Greek word material. It is used in

“Emolient” which means conjunction with other

paste. contemporary materials.

Amalgam is an alloy of Amalgam as a dental

two or more metals in which restorative material has

one of the constituents in sparked controversy several

essentially mercury. times during its 150 year

Dental amalgam is an history.

alloy of mercury, silver, For many years it was

copper and tin which may considered a “Cinderella”

also contain zinc, palladium among dental materials.

and other elements to Early amalgams were made

improve handling by mixing mercury with the

characteristics and clinical fillings from Spanish or

performance. Mexican silver coins. The

Silver amalgam is the mass was difficult to mix; it

most commonly used hardened slowly and

2
expanded enormously when of bismuth, lead, tin and

condensed into the cavity. mercury was plasticized at

This amalgam stained the 100°C and poured directly

tooth black. into the cavity. In 1818,

Regnert moved a step closer

HISTORY to modern amalgam by

increasing the amount of

Earliest history of mercury used in preparing

amalgam used was recorded the mineral cement, a

in 1659 AD by Chieng Sung modification that lowered

in China. History records it the plasticizing temperature

as and accidental spills of to 68°C and eased patient

mercury on to silver coins. suffering considerably.

Amalgam is alloy of The first use of a room-

various metals with temperature mixed amalgam

mercury, the material used as a restorative material are

in the early 1800s in France attributed to Bell in England

– D’ Arcet’s Mineral Cement in 1819 and was known as

could be considered the first “Bells Putty”. The

dental amalgam. This alloy combination of silver and

3
mercury to form the “Silver Thus the “First Amalgam

Paste” was announced by O. War” began. In 1845 the

Taveau of Paris in 1826. “Amalgam Pledge” was

Amalgam had an adopted by the same society.

inauspicious introduction “First Amalgam War”

into United States in 1833 gradually ended during the

by the name “Royal Mineral latter half of the 1800s as

Succedanem”. The the improved amalgams of

Crawcour brothers, with Elisha Townsent, J. Fost

only a superficial knowledge Flag and G.V. Black came

of dentistry, left behind into wide spread use. Elisha

many unsatisfactory Townsent in 1855

amalgam restorations, when introduced silver – tin –

they were driven from the mercury alloy.

country in 1834. In 1861 John Tomes

A resolution was measured the shrinkage of

passed by American society amalgam. In 1871, Charles

of Dental Surgeons in 1843, Tomes measured

declaring the use of dimensional changes using

Amalgam as a malpractice. specific gravity tests.

4
G.V. Black in 1895 dentistry, particularly

conducted a systematic copper amalgam. His

study on the properties and writings caused widespread

manipulation of amalgam attention and created

and its relation of cavity considerable public concern.

preparation. It is reported that Dr. Stock

The “Second Amalgam later dissociated himself

War” erupted in Europe in from critics of amalgam and

1926 as a result of the in 1941 he stated that the

writings of a German rare cases of mercury

Chemist Dr. Alfred Stock. poisoning caused by the

He became poisoned with evolution of mercury vapour

mercury through 25 years of from amalgam restorations

the exposure to the metal in should in no way affect the

his laboratory and in use of silver amalgam in

teaching. He published dental practice.

papers on the dangers of In 1930 ADA

mercury vapour, and he specification No.1 was

argued passionately against introduced for amalgam.

the use of mercury in The specification was

5
revised in 1934, 1960 and in involvement in the issue to

1970. The American 1973, when he was exposed

National Standards Institute to claims by Dr. Olympio

(ANSI) specification No.1 for Pinto of Brazil. Dr. Pinto

amalgam was introduced in held that a variety of

1977 and re-approved in diseases – every thing from

1985 as No. 1a. leukaemia to bowel

Perhaps the most disorders – could be

important advance in the mimicked by a patient’s

amalgam alloy was the reaction of mercury.

introduction of high copper The controversy

alloy patented by Youdelis in subsided some what, but

1967. has intensified again in early

The current 1990s particularly as the

controversy, sometimes result of the popular

termed as the “Third television program “60

Amalgam War”, began minutes” that created

through writings of Dr. H.A. considerable public alarm

Huggins in 1981. Dr. with a sensationalistic

Huggins traces his own treatment of the issue,

6
which was telecast on 16th Silver – Tin – Copper

Dec 1990 by CBC television - Indium

network. II. Based on Copper

content

CLASSIFICATION Due to the extremely

influential effect of copper

I. Based on No. of alloyed on the properties of

materials amalgam, alloys with a

a. Binary: in binary copper content of 6% or less

alloys two metals are are called “low copper”

alloyed together. E.g. alloys. Those containing

Silver – Tin more than 10% copper are

b. Ternary : means considered “high-copper”

alloying three metals alloys. In concentrations

together. E.g. Silver below 4%, copper can be an

– Tin – Copper admixture, without adverse

c. Quaternary : in this effect on the alloy

four metals are properties, above 4%,

alloyed together. E.g. however, copper should be

alloyed with the rest of the

7
powder components or at IV. Based on Powder

least with some of them in Particle Size

order to avoid undesirable Although the particle

properties in the final set diameter can be used to

amalgam. classify alloys, it is the least

III. Based on Zinc content used classification.

Traces of zinc upto 1% However, by this method,

were also added to act as a alloys may be microcut, fine

deoxidizer or scavenger for cut, coarse cut.

the alloy and to decrease its V. Based on Composition

brittleness. The addition of a) Unicompositio

copper and zinc gave rise to nal- Alloys that have

the newer, second the same chemical

generation amalgam. composition

a. Zinc free : If the throughout.

alloy contains Zinc < b) Admixed- It is a

0.01% mixture of spherical

b. Zinc containing : If eutectic high Cu alloy

the alloy contains and lathe cut low Cu

Zinc > 0.01% alloy.

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VI. Based on Shape of effective noble metal

Powdered Particles addition to modern alloys.

The alloy particles may VIII. Based on Generation

have a spherical (smooth- 1st Generation -

surfaced spheres) shape or Contains 3 parts Silver + 1

irregular shapes ranging Part Tin

from spindles to shavings (Peritectic- When two metals

(lathe-cut), or in between are not completely soluble in

shapes, e.g. spherical with each other a more complex

irregular surfaces alloy system results and the

(spheroidal) solid state is a mixture of

VII. Based on addition of two or more phases. It is an

Noble metals invariant reaction occuring

When metals such as at a particular composition

palladium, gold, or platinum and temperature.

are alloyed to the powder, (Liquid + β solution

the resulting amalgams may α solid solution).

be classified as “Noble-metal

alloys”. To date, palladium

has proven to be the most

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2nd Generation - The generation of

Contains 3 parts Silver + 1 amalgam, for example, was

part Tin + Copper + 1% Zinc that studied and

3rd Generation - recommended by G.V.

Consists of blending Black. Popular for more

spherical Silver - Copper than 80 years, this first

(Eutectic) original powder generation amalgam was a

4th Generation - basic three part silver and

Alloy Copper to Silver one part tin, peritectic alloy.

and Tin upto 29% ternary The alloy is a product

alloy. of the reaction between the

5th Generation - beta-phase of solid solution

Silver + Copper + Tin + of tin in silver with the

Indium liquid phase of silver and

6th Generation - tin. This is defined as

Alloy Palladium (10%), Silver gamma-phase, which is one

(62%) and Cu (25%) to 1st, of the ordered solutions of

2nd, 3rd generation. tin in silver. To this basic

formula, copper was added

(admixture) upto 4% to

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decrease the plasticity and most favourable properties

to increase the hardness for dental use. However,

and strength of the alloy. there will definitely be some

Traces of zinc (upto 1%) traces of the two other

were also added to act as a ordered solid solutions

deoxidizer or scavenger for (alpha and beta) and the

the alloy and to decrease its eutectic alloy, even after

brittleness. The addition of proper aging and

copper and zinc gave rise to homogenization heat

the newer, second treatment during the

generation amalgam. manufacturing process.

Although silver can In recent years, new

make three types of ordered, compositions for amalgam

solid solution alloys (alpha, alloy powder have been

beta, and gamma) and one introduced. The admixture

eutectic alloy with tin, its (blending) of a spherical

manufacturers aim to have Silver-Copper eutectic alloy t

only one type of solid the original alloy powder

solution, namely gamma, creates a very interesting

because it possesses the and valuable effect in the

11
final product. This silver – the powder, was the fifth

copper eutectic containing generation amalgam to be

alloy may be classified as developed.

the third generation Finally, the alloying of

amalgam. palladium (10%), silver

The alloying of copper (62%), and copper (28%), to

to silver and tin, in a form a eutectic alloy, which

percentage up to 29%, forms is lathe-cut and blended into

a ternary alloy, in which a first, second, or third

most of the tin is firmly generation amalgam in a

bonded to the copper. This ratio of 1:2. The set

development was the fourth amalgam exhibits the

generation amalgam. highest nobility of any

The alloying of silver, previous amalgam and has

copper, tin and indium been the most recent (sixth)

together, creating a true generation of amalgam to be

quaternary alloy in which developed.

almost none of the tin is

available to react with the

mercury when mixed with

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 COMPOSITION Copper - 13 –

30%

1. Low Copper Alloy Zinc - 0 – 2%

Silver - 65% Functions of Individual

Tin - 29% alloying metals

Copper - 2-5% 1. SILVER

(<6%) Silver is the main

Zinc - 0 – 2% constituent of the alloy.

2. High Copper Alloy It whitens the alloy and

Admixed increases the strength;

Silver - 65 – the strength is because

70% of the un-reacted

Tin - 17% gamma particles in the

Copper - 9 – matrix of the alloy.

20% Higher the silver

Zinc - 1 – 2% content higher will be

Single Composition the gamma phase.

Silver - 60% Silver also decreases

Tin - 27% creep it is because of

the un-reacted gamma

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particles. Higher the silver and mercury is

un-reacted particles fast.

lesser will be the creep. 2. TIN

Silver increases setting In the alloy the

expansion this is percentage of tin is

because of the next to silver. It

formation of gamma decreases the setting

one phase which is expansion, the gamma

silver mercury phase. two phase causes

Volume of gamma contraction. Tin

phase is greater than decreases the

both silver and strength, with the

mercury individually. increase of tin the

It increases gamma phase is

tarnish and corrosion reduced and gamma

and decreases setting two phase is increased

time by accelerating which is a weaker

the setting process phase. It decreases

since the reaction of tarnish resistance and

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 increases the setting during manufacturing

time. process of the alloy. It

3. COPPER increases the plasticity

Copper is also an and decreases tarnish

important constituent and corrosion. Zn

of the alloy. Cu responsible for delayed

decreases the expansion of the

brittleness of the alloy amalgam, if it is

and increases the contaminated with

hardness. It also moisture at the time of

increases the setting insertion or

expansion; it has been condensation of

shown that if Cu is amalgam into the

more than 5%, cavity.

excessive expansion 5. PALLADIUM

occurs.  Increases hardness

4. ZINC  Whitens the alloy

Zinc in the alloy acts 6. MERCURY

as a scavenger as it  Sometimes present

prevents oxidation in alloy powder in

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 large of 2-3% - Pre  Specific gravity 8.10

Amalgamated. The ANSI / ADA

advantage of adding specification no.6 for dental

Hg in the alloy mercury requires that

powder is that it mercury have a clean

hastens the reflecting surface that is free

amalgamation from surface film when

reaction. agitated in air. It should

have no visible evidence of

MERCURY surface contamination and

contain less than 0.02%

PROPERTIES nonvolatile residue.

 Mercury is denoted by Mercury that complies with

symbol Hg the requirements of the

 Atomic No.80 United States

 Atomic weight 200 Pharmacopoeia also meets

requirements for purity in

 Isotopes range from 196 –
ANSI/ADA specification
202
No.6. Mercury amalgamates
 Hardness 2.5
with small amounts of many

16
metals and is contaminated ordinary conditions with

by sulfur gases in the such metals as nickel,

atmosphere, which combine chromium, molybdenum,

with mercury to form cobalt, and iron.

sulfides. Small quantities of Mercury boils at 356.9°

these foreign materials in C, and if pure, has a

mercury destroy its bright, significant vapour pressure

mirror like surface and can at room temperature.

be readily detected by visual Extended inhalation can

inspection. result in mercury poisoning.

Mercury, which has a Globules dropped on a

freezing point of -38.87° C, surface roll about freely

is the only metal that without leaving a tail and

remains in the liquid state retain their globular form.

at room temperatures. It This tendency to form

combines readily to form an globules is related to the

amalgam with several high surface tension of

metals such as gold, silver, liquid mercury, which is 465

copper, tin, and zinc, but dynes / cm at 20° C, as

does not combine under compared with 72.8

17
dynes/cm for water. This reaction begins at

Mercury with a very high 250°C and is complete by

degree of purity exhibits a 800°C.

slight tarnish after a short Mercury can be

time because impurities purified by distillation.

contaminate the metal and Triple distilled mercury is

produce a dull surface used for dental and medical

appearance. Impurities in purposes. Dilute HNO3

mercury can reduce the rate wash removes base metals

at which is combines with and mercury can be filtered

the silver alloy. through chamois skin to

Production remove impurities.

 Rare metal

 Commercial ore is ALLOY – MODE OF

Cinnabar (HgS)
SUPPLY
It is roasted with lime

(CaO) or Fe or O2 which
 Bulk powder
oxidizes the S to SO2 or FeS
 Alloy and mercury in
and volatilizes the Hg which
disposable capsules
is condensed and collected.

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  Pre-weighed alloy as 27% tin is slowly cooled

tablets below a temperature of

 Pre-proportioned 480°C, an intermetallic

capsules compound (Ag3Sn) known as

the gamma () phase is

METALLURGIC produced. This Ag3Sn

PHASES OF AMALGAM compound is an important

ingredient in the silver

amalgam alloy and

Silver Tin Alloy
combines with mercury to
Because two of the
produce a dental amalgam
principle ingredients in the
of desired mechanical
amalgam alloy are silver and
properties and handling.
tin it is appropriate to
This silver-tin compound is
consider the binary system
formed only over a narrow
and the equilibrium phase
composition range. The
diagram for these two
silver content for such an
metals.
alloy would be
When an alloy
approximately 73%.
containing approximately
Practically, the tin content is

19
held between 26% and 30%, compound (Cu3Sn).

and the remainder of the In general, larger

alloy consists of silver, (>30%) or smaller (<26%)

copper, and zinc. If the quantities of tin in the alloy

concentration of tin is less are detrimental to the final

than 26%, the beta one (1) properties of the amalgam.

phase, which is a solid The reason for this

solution of silver and unfavourable shift in

mercury, forms. In one properties is generally

product, 5% tin is replaced considered related to the

by 5% indium, whereas fact that the amount of

another product contains Ag3Sn is reduced as the

less than 1% palladium. percentage of tin is altered

Adding this small amount of beyond the indicated limits.

palladium enhances the This is the basis for the

mechanical properties and rather narrow limits of the

corrosion resistance. The alloy compositions of

replacement of silver by an current products with

equal amount of copper acceptable properties.

produces a copper – tin

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 The influence of other

elements on Ag-Sn Alloys

and Amalgams

21
 Silver – tin alloys are melting, uniting with oxygen

quite brittle and are difficult to minimize the formation of

to comminute uniformly oxides. Unfortunately, the

unless a small amount of zinc even in small amounts

copper is included to causes an abnormal

“replace” silver atoms. The expansion of the amalgam if

degree of this atomic the amalgam is condensed

replacement is limited to in the presence of moisture.

about 4 or 5 weight percent.

Zinc is seldom present MANUFACTURE OF

in an alloy to an extent ALLOY POWDER
greater than 1 weight

percent. Alloys without zinc

Lathe-cut Powder
are more brittle than alloys
An annealed ingot of alloy
with zinc and their
(either low or high alloy) is
amalgams tend to be less
placed in a milling machine
plastic. The chief function
or in a lathe and is fed into
of zinc in amalgam alloy is
a cutting tool or bit. Since
that of a deoxidizer. It acts
the chips removed are often
as a scavenger during

22
needle-like, some occur and the phases to

manufacturers reduce the reach equilibrium.

chip size by ball-milling. Although the solidus is 480°

Homogenizing Anneal C (900° F), the danger of

Due to the rapid “as insipient melting within the

cast” cooling conditions the ingot exists at temperatures

ingot of a silver – tin alloy above 450° C (840° F).

has a cored structure and At the conclusion of

contains non-homogeneous the heating cycle, the ingot

grains of varying is brought to room

composition. In order to re- temperature for the

establish the equilibrium succeeding steps in

phase relationship, a manufacture. The

homogenizing heat proportion of  and  phases

treatment is performed. The present in the ingot after

ingot is placed in an oven cooling will be affected by

and heated at a temperature the manner in which the

below the solidus for

sufficient time to allow

diffusion of the atoms to

23
 ingot is cooled. If the ingot

is withdrawn from the heat

treatment oven rapidly and

24
then quickly quenched, the Aging

phase distribution will Once the alloy ingot

remain essentially has been reduced to

unchanged. On the other cuttings, many

hand, if the ingot is manufactures perform some

permitted to cool very type of surface treatment to

slowly, the proportions of  the particles. It is generally

and  phases will continue accepted that treatment of

to adjust toward the room the alloy particles with acid

temperature equilibrium has been a manufacturing

ratio. practice for many years.

In general, then, rapid Amalgams made from acid-

quenching of the alloy ingot washed powders tend to be

results in the maximum more reactive than those

amount of  phase retained, made from unwashed

while slow cooling results in powders.

the formation of the The microstresses

induced into the particle

maximum amount of the 
during the cutting and ball-
phase.
milling must be relieved. If

25
they are not removed by the Atomized Powder

manufacturer, they will Atomized powder is

slowly release over a period made by melting together

of time, causing a change in the desired elements to

the alloy, particularly in the produce either a low or high

rate at which amalgamation copper composition. When

will occur and the all the desired elements are

dimensional change that will melted together they are

occur during hardening. then sprayed under high

The process is called aging pressure of an inert gas

and involves an annealing through a fine crack in a

cycle at a moderate crucible into a large

temperature. Usually chamber. Depending on the

“aging” is done for several difference in surface energy

hours at approximately of molten alloy and the gas

100°C. A properly “aged” used, the shape of the

alloy will generally then is particle may be somewhat

stable in its reactivity and irregular or spherical. Like

properties when stored for the lathe-cut powders,

an indefinite time. spherical powders are given

26
a heat treatment. The heat the surface area per unit

treatment coarsens the volume of the powder. A

grains and slows the powder containing tiny

reaction of these particles particles requires a greater

with mercury. Spherical amount of mercury to form

powders are usually washed acceptable amalgam.

with an acid. The present trend in

Particle Size amalgam technique favours

The average particle the use of a small average

sizes of modern powders particle size. Other factors

range between 25 and being equal, a smaller

35µm. average particle size tends to

The most significant produce a more rapid

influence on amalgam hardening of the amalgam

properties is not the average with a greater early strength

particle size but rather the than does the use of larger

distribution of sizes around alloy particles.

the average. For example, The particle size

very small particles (less distribution can affect the

than 3 µm) greatly increase character of the finished

27
surface. When the amalgam When alloy powder and

has partially hardened, the mercury are triturated, the

tooth anatomy is carved in silver and tin in the outer

the amalgam with a sharp portion of the particles

instrument. During this dissolve into the mercury.

carving, the larger particles At the same time mercury

may be pulled out of the diffuses into the alloy

matrix, producing a rough particles and start reacting

surface. Such a surface is with the silver and tin

probably more susceptible to present in it, forming silver

corrosion than a smooth mercury and tin mercury

surface. compounds.

Silver-tin compound

(unreacted alloy powder) is

known as the () gamma

phase. The silver – mercury

compound is known as the

SETTING REACTION

Low Copper

28
29
 (1) phase or gamma one

phase and the tin – mercury

as the gamma two (2)

phase.

30
The simplified reaction is 56%), unreacted alloy (27% -

outlined below: 35%) and 2 (11% - 13%).

Ag3Sn + Hg Ag2 Hg3 + The properties of

() (1)

Sn8 Hg + Ag3Sn unreacted

hardened amalgam depend
(2) ()
upon the proportion of each

The alloy particles do not of the reaction phases. If

react completely with more unconsumed Ag3Sn

mercury about 2% of phase is present, the

original Ag3Sn remains as stronger the amalgam. The

unreacted particles. 2 phase is the weakest

As mercury is component and is least

insufficient to completely stable to corrosion process.

consume alloy. So Interface between  and 1

unconsumed particles matrix is important >1>2.

present in set amalgam

particles embedded in 1 and

High Copper
2 phases. The dominating
High copper alloys
phase in well condensed low
contain more than 6%
copper amalgam is 1 (54% -
weight copper. They are

31
preferred because of their alloy (high copper spherical

improved mechanical particles) with 2 parts silver-

properties, resistance of tin alloy (low copper lathe-

corrosion and better cut particles).

marginal integrity (because Amalgam made from

the weakest 2 phase is admixed powder is stronger

eliminated in high copper than amalgam made from

amalgam). lathe-cut low copper

Types particles which act as fillers

a. Admixed alloy in amalgam matrix, hence

powder strengthening the amalgam

b. Single matrix and increases

composition alloy resistance to marginal

powder breakdown.

30wt % - 55wt% -

spherical high copper alloy.

Admixed Alloy Powder The total copper

Developed in 1963. content ranges from 9 –

They are made by mixing 1 20wt%.

part silver- copper eutectic

32
 Silver enters the The reaction may be

mercury from silver-copper simplified as follows:

eutectic alloy particles, and Ag3Sn + Ag-Cu + Hg

both silver and tin enter the () (Eutectic)

Ag2Hg3 +Sn8Hg+ Ag3Sn unreacted

mercury from the silver-tin
(1) (2) ()
alloy particles. The mercury
+ Ag – Cu unreacted
dissolved in the silver –tin
(Eutectic)
particles will react like low
And later,
copper alloys and will form Sn8Hg + Ag-Cu

the 1 and 2 phases; (2) (eutectic)

leaving the silver- copper Cu6Sn5 + Ag3 Hg3

particles unreacted. In a (n) (1)

relatively short time, the In this reaction, 2

newly formed 2 phase phase has been eliminated

(Sn8Hg) will react with silver- and is replaced by n phase.

copper particles forming To accomplish this, it is

necessary to have a net

Cu6Sn5 (n or eta). Some 1
copper content of atleast
phase will also be formed
12% in the alloy powder.
around the silver-copper

particles.

33
 The Cu6Sn5 is present crystals are formed at the

as a ‘halo’ surrounding the surface of alloy particles.

Ag-Cu particles. The overall simplified

SINGLE COMPOSITION reaction is

ALLOYS Ag3Sn + Cu3Sn + Hg

Unlike admixed alloy () ()

Cu6 Sn5 + Ag2Hg3

powders, each particle of
(n) (1)
alloy powder has the same
The difference between
composition. Therefore,
the elimination of the 2
they are called “Single
phase in an admixed and
Composition” alloys.
unicomposition alloy is that,
When triturated, silver
in the admixed type the 2
and tin from silver-tin
forms around the silver-tin
phases dissolve in mercury.
(lathe cut particles) and is
Very little copper dissolves
eliminated around the Ag-
in mercury. The Ag2Hg3 (r1)
Cu (Spherical particles). In
crystals grow forming a
uni-compositional type, the
matrix that binds together
particles at the beginning of
the partially dissolved alloy
the reaction function like
particles. Later n (Cu6- Sn5)

34
Ag-Sn particles of the PROPERTIES
admixed type, and later the

same particles function like 1. DIMENSIONAL

the Ag-Cu particles of the CHANGE

admixed type, eliminating 2 Theory of dimensional

phase. change. During setting

In this, the Cu6 Sn5 is amalgam undergoes three

present in the 1 matrix distinct successive

rather than as a halo dimensional changes.

surrounding silver-copper. Stage I : Initial

contraction

Stage II : Expansion

Stage III : Contraction

35
Dimensional change curves for three amalgam alloys. A; a high

Cu admixed, B; a high Cu single composition,

C; a lathe cut low Cu

INITIAL CONTRACTION as the growth of 1

When alloy is mixed continues, this continues in

with mercury contraction the first 20min. The 1

results. As the absorbed crystals as they grow

mercury enters inter impinge against one

particular spaces of alloy, another, and produce an

reaction continues and the outward pressure tends to

alloy dissolves in mercury oppose contraction. IF there

become smaller, 1 phase is sufficient mercury present

grows contraction continues to provide a plastic matrix

36
an expansion will occur restoration. On non-

when 1 crystals impinge. occlusal surfaces the entire

After a rigid 1 matrix has restoration may appear

formed, growth of 1 crystals extruded. On occlusal

cannot force the matrix to surfaces the attrition and

abrasion tend to limit the

expand. Instead 1 crystals
overall extrusion. However
will grow into interstices
the occlusal margins
containing mercury,
become fracture susceptible
consuming mercury and
ledges elevated the natural
producing continued
contours of enamel.
reactions. Low mercury
Extrusion at margins is
alloy ratio and high
promoted by electrochemical
condensation pressure
corrosion, during which
favours contraction.
mercury from tin – mercury
MERCUROSCOPIC
reacts with silver – tin
EXPANSION
particles and produces
Secondary expansion
further expansion. This
can occur throughout the
mechanism is called
clinical life of an amalgam
“Mercuroscopic expansion”.

37
MEASUREMENT OF ANSI/ADA specification No.

DIMENSIONAL CHANGE requires only the value at 24

hours.
The dimensional

change may be determined. The largest

The amalgam specimens dimensional change of

identified by the arrows are 19.7µm/cm occurred with

placed in position 5 minutes the low –copper, lathe-cut

after the arrows are placed alloy, and the lowest change

in position 5 minutes after of 1.9 µm/cm was for the

setting, and the probe is high copper admixed alloy.

placed on top of them. The The remainder of the alloys

probe is mechanically had values ranging from

attached to a differential -8.8 to 14.8µm/cm. All the

transformer, and the amalgams meet the

electrical output is used to requirements of ANSI/ADA

determine expansion or specification No.1 of ±

contraction. The change in 20µm/cm.

length can be determined

continuously, although

38
DELAYED CONTRACTION favor contraction including

After rigid 1 matrix longer trituration times and

formed growth of 1 cannot use of smaller particle size

force matrix to expand 1 alloys. Smaller particle size

crystals grow into interstices accelerates the consumption

containing mercury. This of Hg because small

leads to delayed contraction particles have a larger

of mass caused by surface area/unit mass than

absorption of unreacted larger particles. Because a

mercury. larger surface area is

Factors Favouring dissolving, Ag enters the

Contraction solution faster, gamma one

Higher condensation grows from the solution

pressures squeeze Hg out of faster and the consumption

amalgam, producing a lower of Hg is accelerated.

Hg/alloy ratio and favoring Factors Favouring

contraction. In addition, Expansion

manipulative procedures Measurements of the

that accelerate setting and dimensional change of many

consumption of Hg also modern amalgams reveal a

39
40
net contraction, whereas in strength 1hr after setting

the past, measurements when a cylindrical specimen

indicated an expansion. Two is compressed at a rate of

reasons for difference are 0.25mm/min is 80 MPa.

that older amalgams Lack of strength to resist

contained larger alloy masticatory forces causes

particles and they were inherent weakness.

mixed at higher
Most common fracture
mercury/alloy ratios than
of amalgam is at margins.
present day amalgams.
(Marginal Breakdown) which
Likewise, hand trituration
hastens corrosion and lead
was used in preparing
to secondary caries.
specimens now high speed
It was found that
amalgamators are employed.
amalgam made from the
STRENGTH
admixed powders was
ANSI / ADA
stronger than amalgam
specification No.1 for
made from lathe-cut low
amalgam alloy minimum
copper powder. The
allowable compressive
investigators hypothesized

41
that the silver copper strength of the silver copper

particles “dispersion particles.

hardened” the amalgam.

Measurement of Strength
Dispersion hardening is a
The strength of dental
strengthening that is
amalgam has been
observed in metals when a
measured under
large volume fraction of
compressive stress using
ultrafine particles (typically
specimens of dimensions
less than 1µm) is dispersed
comparable to the volume of
throughout the metal.
typical amalgam
It seems unlikely that
restorations. When strength
the silver-copper particles in
is measured in this manner,
admixed amalgams are
the compressive strength of
either small enough or
a satisfactory amalgam
closely enough spaced to
probably should be at least
produce dispersion
310 megapascals (MPa).
hardening. It is more likely
When they are manipulated
that hardening of admixed
properly, most amalgams
amalgams is due to the
exhibited a compressive

42
strength in excess of this high-copper amalgams have

value. tensile strengths that range

between 48 and 70 MPa.

After 7 days, the

compressive strengths of Tensile stresses can be

high-copper amalgams are easily produced but

generally higher than those amalgam cannot withstand

of low-copper amalgams. high tensile /bending

stresses.
The significance of the

7-day compressive strength Compressive Strength

relative to clinical
Resistance to
performance has been
compression forces is the
questioned. The strength of
most favourable strength
amalgam is more than
characteristic of amalgam.
adequate to withstand
Because amalgam is
potential compressive loads.
strongest in compression
It is unfortunate that
and much weaker in tension
amalgam is much weaker in
and shear, the prepared
tension than in
cavity design should
compression. Both low-and
maximize the compression

43
forces in service and amalgam does not exhibit

minimize tension or shear significant deformation or

forces. In general, the elongation and as a result,

higher the rate of loading functions as brittle material.

the higher the compressive Therefore a sudden

strength, although some application of excessive

studies have shown that forces to amalgam tends to

compressive strength may fracture the amalgam

decrease at very high strain restoration.

rates. As a result, when

The high – copper
comparing the compressive
unicompositional materials
strength of amalgam
have the highest early –
samples, it is imperative
compressive strengths of
that they be tested at the
more than 250 MPa at 1
same rate of loading.
hour. The compressive

When subjected to a strength at 1 hour was

rapid application of stress lowest for lathe-cut alloy (45

either in tension or in MPa), followed by one of the

compression, a dental low copper spherical alloys

44
(88 MPa), and then two low stresses from the patient

copper spherical alloys and before the final strength is

the high copper admixed reached. The compressive

alloy (118 to 141 MPa). strengths at 7 days and the

High values for early final strengths are again

compressive strength are an highest for the high copper

advantage for an amalgam, uni-compositional alloys,

because they reduce the with only modest differences

possibility of fracture by in the other alloys

prematurely high contact

Compressive strength and creep of amalgams

7-day
1hr compressiv
compressiv e strength
Mercur
e strength (MPa) Creep
Product y in
(MPa) 0.05 %
Mix (%) 0.2
(0.5mm/ mm
mm/
min) /
min
min
Low copper Alloys
Caulk 20th
century 53.7 45 302 227 6.3
Micro Cut
Spherical
Caulk 46.2 141 366 289 1.5
Spherical 48.5 88 380 299 1.3
Kerr 48.0 132 364 305 0.50

45
Spheraloy
Shofu
spherical
High Copper Alloys
Admixed
Dispersalloy 50.0 118 387 340 0.45
Unicompositional
Sybraloy 46.0 252 455 452 0.05
Tytin 43.0 292 516 443 0.09

TENSILE STRENGTH

The tensile strengths of various amalgams after 15

minutes and 7 days are given below:

Dimensional
Tensile strength at
Product Change
0.5mm/min (MPa)
(µm/cm)
Low Copper
Alloys
Fine – Cut 3.2 51 -19.7
Caulk 20th
Century Micro cut
Spherical 4.7 55 -10.6
Caulk – 3.2 55 -14.8
spherical 4.6 58 -9.6
Kerr spheraloy
Shofu
Spherical
High – Copper
Alloys
Admixed 3.0 43 -1.9
Dispersalloy
Unicompositional 8.5 49 -8.8
Sybraloy 8.1 56 -8.1
Tytin
The tensile strength at

46
7 days for both non-2 and of the high copper

2 containing alloys are unicompositional alloys are

about the same. The tensile important, because they

strengths are only a fraction resist fracture by premature

of their compressive biting stresses better than

strengths; therefore cavity other amalgams.

designs should be Transverse Strength

constructed to reduce These values are

tensile stresses resulting sometimes referred to as the

from biting forces. modulus of rupture.

The tensile strengths at Because amalgams are

15 minutes for the high- brittle materials, they can

copper unicompositional withstand little deformation

alloys are 75% to 175% during transverse strength

higher than for the other testing. The main factors

alloys. However, no related to the high values of

correlation exists between deformation are (1) the slow

the tensile strengths at 15 rates of load application, (2)

minutes and 7 days. The high creep of the specific

high early tensile strengths amalgam, and (#) higher

47
temperature of testing. modulus, values of the

Thus, high copper approx 62 GPa have been

amalgams with low creep obtained.

should be supported by FACTORS AFFECTING

bases with high moduli to STRENGTH

minimize deformation and 1. Trituration

transverse failure. Either over –

ELASTIC MODULUS trituration or under

When the elastic trituration will decrease the

modulus is determined at strength for both low –

low rates of loading, such as copper and high-copper

0.025 to 0.125mm/min, amalgams.

values in the range of 11 to 2. Effect of Mercury

20 GPa are obtained. High content

Cu alloys, tend to be stiffer Sufficient mercury

than low Cu alloys, if the should be mixed with the

rate of loading is increased alloy to wet each particle of

so the visco-elastic property the alloy. Otherwise, a dry,

does not significantly granular mix results which

influence the elastic has rough and pitted

48
surface that invites  Irregularly shaped

corrosion. particles of alloy

If sufficient mercury is powder

not present, insufficient  Insertion of too large

matrix forms which increments

decreases strength. Increased

Mercury / alloy ratio condensation pressure

48 – 52%. improves adaptation at the

3. Effect of Condensation margins and decreases the

Voids and porosities no of voids. Fortunately,

reduce strength. Porosity is voids are not a problem with

caused by: spherical alloys.

 Decreased plasticity of CREEP

the mix (caused by too Defined as a time

low mercury/alloy dependent plastic strain of a

ratio, under trituration material under constant

and over trituration) stress.

 Inadequate Significance of creep to

condensation pressure amalgam performance

49
 Creep is related to The 1 Ag-Hg phase

marginal breakdown of low has been found to exert a

copper amalgams. That is primary influence on low

the higher the creep, the copper amalgam creep rates.

greater the degree of Creep rates increase with

marginal deterioration larger 1 volume fractions

(ditching). and decrease with larger 1

According to A.D.A. grain sizes. Pure 2 has a

specification No.1 creep higher creep rate than pure
should be below 3%.
1. Although creep rate is
Creep Values
not directly proportional to
Low – Cu Amalgam -
the volume fraction of 2, it
0.8 to 8.0%
is clear that the presence (or
High – Cu Amalgam -
absence) of 2 can
0.4 to 0.1%
dramatically affect the creep

rate. For example, high

copper amalgams that

Influence of
contain little or no 2 have
Microstructure of Creep
low creep rates.

50
 The dependence of increases the creep rate

creep rate on the inverse of because it is extremely

the grain size is consistent plastic, easily changing

with mechanisms of creep shape to make way for

which involve grain sliding 1 grains. If 2 is not

boundary sliding at slow present, the rate at which

strain rates, plastic sliding occurs is reduced.

deformation and diffusion Likewise, the n crystals

change grain shapes in a may play a role in

manner to permit grain contributing to the slowness

boundary sliding. Such of sliding in high copper

grain boundary sliding has amalgams. Numerous n

been observed in the matrix Cu6Sn5 crystals are found

of dental amalgams. embedded in and between 1

1 phase grains grains in such amalgams

throughout have been and they interlock the 1

delineated by grain grains. Before the grain

boundary sliding. In this boundary sliding can occur,

process of plastic grains must flow plastically

deformation, the 2 phase and by diffusion around

51
these crystals. Thus, these the bonding of these

n crystals inhibit grain particles to the 1 matrix. It

boundary sliding and is believed that such

thereby decrease the creep improved bonding will

rate of single composition contribute to improved creep

amalgams. resistance of these systems.

 crystals at the The Effect of Manipulative

surfaces of unconsumed Variables on Creep

alloy particles in single The creep rate of an

composition amalgams amalgam can be changed by

restrict the sliding of 1 altering the trituration time

grains adjacent to these and the condensation

particles. Mesh of n crystals pressure. For many

improves the bonding amalgams, there is a

between the alloy particles trituration time which will

and the 1 matrix in single produce a minimum creep

composition amalgams. The rate. Either under-

reaction layer around the trituration or over

Ag-Cu particles in admixed trituration tends to increase

amalgams may also improve the creep rate. If there is a

52
delay between trituration mercury content of the

and condensation, the creep amalgam and decreasing its

rate increases. However, creep rate. The influence of

increasing the condensation final mercury content on

pressure decreases the creep rate is less significant

creep rate. for high copper amalgams,

The mercury alloy ratio which inherently have low

can also affect this property. creep values and relatively

Those factors that tend to low mercury contents.

increase the final mercury However, for certain of

content of an amalgam will these amalgams when the

increase its creep rate. For mercury content exceeds

example, a delay between approximately 46 percent,

trituration and condensation there is a sudden increase

will increase both the final in creep and 2 begins to

mercury content and the form. Thus regardless of the

creep rate. On the other alloy used, it is wise to

hand, high condensation utilize techniques that will

pressures express mercury, provide an amalgam with

thereby lowering the final low mercury content.

53
Measurement of Creep The highest value of

Values for creep are 6.3% was found for the low-

determined. A cylindrical copper cut alloy, and the

sample is placed in the lowest values (0.05% to

position indicated by the 0.09%) were determined for

arrow 7 days after the high-copper

preparation. A static stress unicompositional spherical

of 36 MPa is applied by the alloys. The high copper

spring. The change in admixed alloy and one of the

length of the sample is low-copper alloys had

determined at 37± 0.3° C by slightly higher creep values

a calibrated differential of 0.45% to 0.50% and the

transformer, the output of remaining two low-copper

which is recorded on a spherical alloys had values

chart. The change in length of 1.3% to 1.5%.

between 1 hour and 4 hours

after placing the static

stress is used to calculate

the percentage creep. MANIPULATION

54
The steps involved in This excess mercury was

manipulation are: removed from the amalgam

 Mercury/alloy ratio by:

 Proportioning  Squeezing the excess

 Trituration mercury out by using a

 Mulling squeeze cloth

 Increasing dryness
 Condensation
technique: during
 Burnishing
condensation of each
 Carving
increment, a mercury
 Finishing and Polishing
rich layer comes to
MERCURY / ALLOY RATIO
surface. This is
In earlier days, when
removed during carving
amalgam was triturated
Eames Technique
manually excess mercury
The better method of
and had to be used in order
reducing mercury content is
to achieve smooth and
to reduce the original
plastic amalgam mixes.
mercury: alloy ratio. This is

known as the minimal

mercury or Eames

55
technique. (Mercury /Alloy PROPORTIONING

1:1). However it is still The amount of alloy

necessary to squeeze and mercury to be used can

mercury out of the mix be described as the mercury

using the increasing dryness – alloy or alloy – mercury

technique. Hence, with this ratio. It signifies parts by

technique, 50% or less weight of mercury and alloy.

mercury will be in the final Mix of amalgam with

restoration, with obvious mercury / alloy ratio 6:5

advantages. One popular contains 54.5% mercury.

technique was to express With the older alloys

mercury in increasing mercury/alloy ratio in the

amounts from each order of 8:5 or 7:5 was used.

successive increment, with Recommended ratio for lathe

each new increment serving cut alloys is 1:1 (50%

somewhat as a blotter. mercury). Recommended

This was referred to as the amount of mercury for

“increasing dryness spherical alloys is 42%.

technique”. A wide variety of

mercury and alloy

56
dispensers, or proportioners, pellets all that is required is

are available to the dental an accurate mercury

profession. They are of two dispenser.

general types. The most Because mercury is a

common type is the liquid, it can be measured

dispenser that is based on by volume without

volumetric proportioning; appreciable loss of accuracy.

the other measures by Standard deviations in

weight. weights of mercury as low as

Probably the most ± 0.5 percent may be

convenient method for attained with a number of

dispensing the alloy is to commercial mercury

use pre-weighed pellets or dispensers. However, even

tablets. The individual though the mercury

pellets in each bottle are dispenser may be well

quite uniform in weight, designed to provide

provided normal care is reproducible spills of

exercised in handling to mercury, precautions must

avoid chipping of the pellet. be exercised in its use. The

Thus with pre-weighed dispenser should be held

57
almost vertically to insure alloy are now available.

consistent spills of mercury. They contain alloy either in

Tilting the bottle to a 45° pellet from as a pre-weighed

angle results in unreliable portion of powder in

mercury – alloy ratios. The conjunction with the

dispenser should be at least appropriate quantity of

half full when used. If the mercury. To prevent any

dispenser is one fourth or amalgamation from

less full, the weight of occurring during storage,

mercury dispensed may be the mercury and alloy are

erratic. Finally, use of dirty separated from each other

mercury leads to by a plastic membrane.

entrapment of the Before trituration, the

contaminants in the membrane is ruptured and

reservoir and orifice of the the mercury falls into the

device, preventing accurate compartment with the alloy.

delivery of the mercury. Although more expensive,

Disposable capsules the – proportioned material

containing pre-portioned is convenient and eliminates

aliquots of mercury and

58
the chance of mercury spills  Hand mixing

during proportioning.  Mechanical mixing

In traditional

TRITURATION trituration Mortar and Pestle

Objective were used. The motion of

To wet all the surfaces the pestle in the mortar has

of the alloy particles with to be unidirectional i.e. in

mercury. For proper one direction.

wetting, the alloy surface Amalgamator

should be clean. Rubbing of Mechanical

the particles mechanically amalgamators are more

removes the oxide film commonly used to triturate

coating on alloy particles. amalgam alloy and mercury

Trituration is achieved as it saves times and

either by standardizes procedure.

59
 A) Amalgamator with manually set trituration

speed &

time

B) Amalgamator with digital controls and programming for

trituration speed and time

60
Principle of operation at high speed, thus

The disposable triturating the amalgam.

capsules serve as mortar. A The amalgamatous have

cylindrical metal or plastic automatic times and speed

piston is placed in the controlling device. Newer

capsule which serves as the amalgamatous have hoods

pestle. The capsule is that cover the arms holding

inserted between the arms the capsule in order to

on top of the machines. confine mercury spray and

When put on the arms prevent accidents.

holding the capsule oscillate

61
 Reusable capsules used in amalgamators and magnified view
of pestles
the easiest factor to vary;
Reusable capsules are
however, it should be
available with friction fit or
emphasized that variations
screw type lids. At one time
of 2 to 3 seconds of mixing
not more than 2 pellet alloy
time may be enough to
should mix in a capsule.
produce an amalgam that is
Diameter and length of
undermixed or overmixed.
pestle is less than
Mechanical amalgamators
dimension of capsule.
allow some variation in
Spherical or irregular
speed to adjust to differing
low copper alloys may be
amounts of alloy and
triturated at low speed (low
mercury in capsules.
energy) but most high
Low-, medium- and
copper alloys require high
high speed amalgamators
speed (high energy).
operate at about 3200 to
Effective trituration depends
3400, 3700 to 3800, and
on a combination of the
4000 to 4400 cycles per
duration and sped of mixing.
minute, respectively, at
Duration of amalgamation is
correct live voltage.

62
However, an amalgamator optimized if mixing is

set at la speed of 3300 cpm carried out for a time of 5t.

may actually be operating at The value of tc can be

3000 cpm with a decrease in determined experimentally

line voltage from 120 to 100 for particular amalgam

volts, and undermixed alloy, size of mix, and speed

amalgams may result. This of mix, and speed of the

problem can be avoided by amalgamator. However,

installing a voltage regulator most packages of amalgam

between the line plug and alloys will contain

the amalgamator. Using a recommendations for times

parameter called the and speeds for a variety of

coherence time (t), defined amalgamators, and these

as the minimum mixing time guidelines should be

required for an amalgam to followed.

form a single coherent Mulling

pellet, it has been found It is actually a

that the compressive continuation of trituration.

strength, dimensional It is done to improve the

change, and creep are homogeneity of the mass

63
and to get a single of trituration. Under

consistent mix. It can be trituration produces grainy

accomplished in to 2 ways. mix.

 The mix is enveloped in MIXING VARIABLES

a dry piece of rubber Under Trituration

dam and vigorously If the mix is under

rubbed between the triturated not only it is

first finger and thumb, rough and grainy but also it

or the thumb of one may crumble. It gives a

hand and palm of rough surface after carving

another hand for 2-5 and becomes more prone to

secs. tarnish and corrosion. An

 After trituration the under triturated mix of

pestle is removed and amalgam is low in strength.

the mix is triturated in The under triturated mix

the pellet free capsule hardens too rapidly which

for 2 -3 secs. results in excess mercury

Consistency remaining in the mix.

Attainment of a proper Normal Trituration

mix is controlled by timing

64
 A normal mix of alloy

powder with Hg has a shiny

65
 contraction of the amalgam.

During over trituration the

surface with smooth and strength of lathe-cut alloys

soft consistency. The mix is increased whereas it is

may be warm (not hard) decreased in the high Cu

when removed from the alloy. If the mix is over

capsule. A normal or triturated it results in

properly triturated mass of increased creep.

amalgam has greatest CONDENSATION

compressive strength as well The amalgam is placed

as tensile strength. in the cavity after

Over Trituration trituration, and packed

Over trituration using suitable instruments.

produces a mix is soupy and It compacts the alloy so that

is difficult to remove from the greatest possible density

the capsule. The mix is also is attained. During

too plastic to manipulate. condensation mercury rich

Over trituration also layer comes on top of each

decreases the working time. increment. Delayed

It results in higher condensation results in

66
weaker amalgam. requiring lateral direction

Ultrasonic condensers are condensation and vertical

not recommended. with vibration.

Condensation increases Admixed alloy requires

strength and decreases small to medium, medium to

creep (7-10MPa). high condensation force in

Condensers are vertical and lateral direction.

instruments with serrated Hand Condensation

tips of different shapes and The mixed material is

sizes. The condenser type is packed in increments. Each

selected as per the area and increment is carried to, the

shape of the cavity. prepared cavity by means of

Irregular shaped alloy, a small forceps or an

small tip condenser (1-2mm) amalgam carrier.

is used. It requires Once inserted, it

increased condensation should be condensed

force in the vertical immediately to the sufficient

direction. pressure. Condensation is

Large tip condenser is started at the centre and the

used spherical alloys condenser pt. is stepped

67
little by little towards the mix. Done by automatic

cavity walls. device, less effort is needed

As the mix is than for hand condensation.

condensed some mercury Condensation Pressure

rich material rises to the It is the area of

surface. Some of this has to condenser point and force

be removed to reduce the applied. Its formula is given

final mercury content and by:

improve the mechanical Pressure is inversely

properties. proportional to the surface

For amalgams to area. Smaller the condenser

condense well a proper greater will be the pressure.

consistency of mix is For application of 3-4 lb

required. Larger increments average force, condenser

are more difficult to adapt. point should be 2mm in

Mechanical Condensation diameter.

Mechanical One of the advantages

condensation provides of spherical amalgam alloys

vibration or impact type of is that the strength

force to pack the amalgam properties tend to be less

68
sensitive to condensation cavity, a triangular or

pressure. In fact, many of square point is indicated in

the spherical alloys have such an area. Points of

little “body” and thus offer various shapes are,

only mild resistance to the therefore, provided for the

condensation force. In most effective condensation.

many instances Burnishing

condensation becomes a After the carving, the

matter of attaining good restoration is smoothened

adaptation. When by burning the surface and

condensing these alloys, a margins of the restoration.

large condenser can often be Fast setting alloys gain

used. sufficient strength by this

The shape of the time to resist rubbing

condenser points should pressure. Burnishing slow

conform to the area under setting alloys can damage

condensation. For example, the margins of the

a round condenser point is restoration.

ineffective adjacent to a Burnishing is done

corner of angle of a prepared with a ball burnisher using

69
light strokes proceeding burnish the occlusal portion

from the amalgam surface to with a large egg shaped or

the tooth surface. Heat ball burnisher large enough

generation should be to preclude under

avoided during burnishing. contouring the restoration.

If the temp rises above 60° Used pressure equal to the

C, mercury is released force used when condensing

which may cause corrosion the amalgam. Move the

and fracture at margins. burnisher mesiodistally and

Final smoothening can be facio-lingually until it

done by rubbing with a contacts the enamel

moist cotton pellet. surfaces external to the

margins. Burnishing should

PRE CARVE BURNISHING not continue after this since

& POST CARVE some amalgam should

BURNISHING remain for carving

Pre carve burnishing procedure.

Before carving Post carve burnishing

procedures are initiated When carving is

some operators pre carve completed some operators

70
post carve burnish the maximize its effectiveness,

amalgam surface using a the burnisher head should

small burnisher. This be large enough that in the

accomplished by lightly final stroke it will contact

rubbing the surface until a the cusp slopes but not the

satin finish appears. Cease margins. Pre carved

burnishing if the amalgam burnishing produces denser

has hardened to a point that amalgam at the margins of

burnishing creates a shiny occlusal preparations

or reflective surface. restored with high Cu

Pre carve burnishing amalgam alloy.

is a form of condensation. Post carve burnishing

To ensure that the marginal is the light rubbing of the

amalgam is well condensed carved surface with a

before carving, the over burnisher of suitable size

packed amalgam should be and shape to improve

burnished immediately with smoothness and produce a

a large burnisher using satin (not shiny)

heavy strokes mesiodistally appearance. Post carve

and facio lingually. To burnishing producer denser

71
amalgam at the margins of resistance to the carving

occlusal preparations instrument. If the carving is

restored with low Cu started too soon, the

amalgam alloys. With high amalgam may be so plastic

Cu amalgam post carved that is may pull away from

burnishing is unnecessary the margins. Burnishing

because no significant effect alone does not provide

on the clinical performance scratch free and retention

of HCA is seen. free surface. Slow speed

CARVING, FINISHING AND handpieces are used for

POLISHING finishing and polishing

The amalgam is amalgam. Restoration

overfilled into the cavity and surface is finished initially

the mercury rich surface with fine prophylactic paste

layer is trimmed away. The applied with cotton pellet /

filling is carved to reproduce non ribbed rubber cup with

the tooth anatomy. The light pressure.

carving should not be If amalgam is

started until the amalgam is hardened, contour with slow

hard enough to offer speed green stones or

72
diamond bur, brown and is completed, the tip of an

green rubber points or explorer should pass from

mixture of fine pumice and the tooth surface to the

water/alcohol with a rotary restoration surface and vice

brush or felt wheel. versa, without jumping or

An amalgam catching. Begin the

restoration is less prone to furnishing procedures by

tarnish and corrosion if a marking the occlusion with

smooth, homogenous articulating paper and

surface is achieved. evaluating the margins with

Polishing of HCA is less an explorer. If the occlusion

important than with can be improved or there is

conventional amalgams, not a perfect continuity of

because HCA are less surface contour across the

susceptible to tarnish and margins, a pointed white

corrosion and marginal fused alumina stone or a

breakdown. Finishing and green carborundum stone is

polishing reduces the used. Initiate the polishing

roughness of a carved procedure by using a coarse,

restoration. After polishing rubber abrasive point at low

73
speed to produce an accomplished using a

amalgam surface with a rubber cup with flour of

smooth, satiny appearance. pumice by a high lusture

It is important that the agent such as precipitated

rubber points be used at low chalk.

speeds or “stall out” speed

for two reasons FAILURE OF

1. The danger of point RESTORATIONS
disintegrating at high

speed.
I) FAILURE OF
2. The danger of elevating
RESTORATION DUE TO
temperature of the
FAULTY TOOTH
restoration and the
PREPARATION
tooth.
II) FAILURE OF
If a higher lusture does not
RESTORATION DUE TO
appear within a few seconds
MATERIAL
the restoration requires

additional polishing with a

more abrasive point. Final

polishing may be

74
I) FAILURE OF be extended to include

RESTORATION DUE TO all susceptible pits and

FAULTY TOOTH fissure while

PREPARATION terminating the

The different causes of margins in areas that

failure that can occur at can be finished.

various steps while 2. Inadequate extension

preparing a cavity for of proximal box: If the

amalgam are as follows: proximal box is not

1. Inadequate occlusal adequately extended

extension: inadequate into the embrasures

extension to include they are not amenable

pits and fissures to brushing and

increases the chances cleaning by

of caries reoccurrence mastication, which

particularly in oral predisposes to

cavities with high secondary caries.

dental caries index. On However, radial

the occlusal surface extension of the

the preparation should proximal box margins

75
 can result in the considerations should

weakened tooth. be given to capping of

Special attention the cusps. If the cavity

should be directed preparation extends to

towards lower 2/3rds of the

bicuspids and the intercuspal distance

distal regions of the cusp capping becomes

maxillary and mandatory. If the

mandibular first remaining cusps are

molars where frail not capped in large

walls can be formed amalgam restorations,

easily. there are chances that

3. Over extension of the the cusps can fracture.

cavity preparation This is because

walls: The ideal facio- amalgam restoration

lingual width of the acts as wedge and

cavity preparation for tends to split the

amalgam should be opposing cusps apart.

1/4th the intercuspal During cusp capping

distance, amalgam should be

76
 present in a minimum 5. If the pulpal floor

thickness of 2mm over of the cavity

functional cusps and a preparation is not flat

minimum thickness of but curved the

1.5mm over non- restoration produces a

functional cusps to wedging effect thus

give it adequate increasing the chances

strength. If the of the fracture of tooth.

required thickness of 6. To assure strong

restorative material is junctions between

not present, there are amalgam and tooth

chances of fracture of regardless of its

restoration. location, butt joints

4. Amalgam cavity should be created

preparations should particularly in those

have a minimum depth regions where occlusal

of 1.5mm to provide it stresses are to be

bulk and hence encountered. If the

resistance to fracture. cavosurface angle is

acute there are

77
 chances of fracture of angle as well as

the tooth margins internal line angles and

whereas if the point angles can lead

cavosurface angle is to concentration of

obtuse the acute stresses and fracture of

marginal amalgam is the tooth or restorative

likely to collapse under material. The rounding

occlusal stress. The off of the axio-pulpal

cavity margins should line angle also provides

be adequately finished bulk of the silver which

to remove any is also required for its

unsupported enamel strength.

rods, which are 8. Occasionally,

susceptible to fracture fracture may be seen at

leading to gap the isthmus portion of

formation and the proximo-0cclusal

subsequently restoration, which may

secondary caries. be because of a very

7. Failure to round narrow isthmus

off the axio-pulpal line relative to the rest of

78
 the cavity preparation 11. Incomplete

or inadequate proximal removal of carious

retention form. tooth structure leads to

9. Failure to diverge failure of amalgam

the mesial and distal restoration.

walls of the occlusal 12. Flat pulp floor

cavity preparation. should be provided

When the mesio-distal around the excavation

extension of the cavity site of caries. If this is

is extensive it can not possible at least

cause fracture because three flat seats should

of the undermining of be provided to resist

the mesial and distal the forces directed

marginal ridge enamel. along long axis of the

10. Retentive devices tooth. Appropriate

should be prepared amount of dentin must

entirely in dentin be present around

without undermining each excavated site.

the enamel. 13. Post operative

pain can also be

79
 routine failure. The food debris. Surface

dentist should use high discolouration may arise

speed rotary from the formation of oxides,

instruments, with sulphides or chloride on the

intermittent cutting surface.

and adequate cooling Corrosion is a chemical

of tooth structure or electrochemical process

thereby minimizing the by which the metal

post operative pain undergoes deterioration by

reaction with the

II) FAILURE OF environment.

RESTORATION DUE TO Corrosion of Amalgam

MATERIAL 2 phase (Sn7-8Hg) is

Tarnish and Corrosion the most prone phase to

Tarnish is a process in corrosion whereas 1 phase

which a metal surface loses (Ag2Hg3) is resistant.

its lusture and gets Low Copper

discoloured. Tarnish can In the 2 reaction

result from deposits such as product, crystals are long

calculus, plaque and other blade like penetrating

80
throughout the matrix. but less when compared to

Although they may form less Sn-Hg. In Cu-Sn when

than 10%, they form a corrosion occurs,

penetrating matrix because penetrating corrosion does

of inter-crystalline contacts not take place since the

between the blades. particles do not have inter

Corrosion proceeds from the crystalline contacts.

outside of amalgam, along Chemical

corrosion
the crystals connecting new Corrosion (Dry corrosion)

crystals at inter-crystalline Electrochemical

corrosion
contacts. This produces (Wet corrosion)

penetrating corrosion that Both low-copper and

generates a porous, spongy high-copper amalgams

amalgam with minimum undergo two kinds of

resistance. corrosion, chemical

High Copper corrosion and electro-

In this the Sn-Hg chemical corrosion.

particles are replaced by the

Cu5-Sn6 phase. Cu-Sn

phase is corrosion prone,

81
82
Chemical Corrosion (Dry b. Microscopic

Corrosion) 2. Stress corrosion

Chemical corrosion 3. Concentration cell

occurs most notably on the corrosion

occlusal surface and Electrochemical

produces a black Ag-S corrosion is an important

tarnish film. This reaction mechanism of amalgam

is limited to the surface and corrosion and has the

does not compromise any potential to occur virtually

properties, except for anywhere on or within a set

esthetics. Those amalgams amalgam. Electrochemical

with very high levels of corrosion occurs whenever

copper also are capable of chemically different sites act

producing a copper oxide as an anode and cathode.

patina, but that is relatively This requires that the sites

uncommon. be connected by an

Electrochemical corrosion electrical circuit in the

(Wet corrosion) presence of an electrolyte,

1. Galvanic corrosion typically saliva. The anode

a. Macroscopic corrodes, producing soluble

83
and insoluble reaction high – copper amalgams,

products. respectively.

Galvanic Corrosion Concentration cell or

If an amalgam is in crevice corrosion

direct contact with an Local electrochemical

adjacent metallic restoration cells also may arise

such as a gold crown, the whenever a portion of the

amalgam is the anode in the amalgam is covered by

circuit. This type of plaque or soft tissue. The

electrochemical corrosion is covered area has a locally

called galvanic corrosion lowered oxygen and / or

and is associated with higher hydrogen ion

presence of macroscopically concentration, making it

different electrode sites. behave more anodically and

Residual amalgam corrode. Cracks and

alloy particles act as the crevices produce similar

strongest cathodes. Sn-Hg conditions and preferentially

or Cu-Sn reaction product corrode.

phases are the strongest

anodes in low-copper and

84
Stress Corrosion tends to fill up the spaces

Regions within an occupied by the original Sn-

amalgam that are under Hg phase. Along the

stress also display a greater margins of the amalgam,

propensity for corrosion. Sn-O helps seal the space

For an occlusal against micro-leakage.

amalgam, the greatest Amalgam has a linear

combination of corrosion coefficient of thermal

and mechanical stresses expansion that is 2.5 times

occurs along margins. greater than tooth structure,

Therefore most visible and it does not bond to

changes are associated with tooth structure. Therefore,

margins. during expansion and

During electrochemical contraction, percolation

corrosion of low-copper could otherwise occur along

amalgams, the Sn-Hg phase the external walls if

is oxidized into Sn-O and / corrosion products did into

or Sn-O-Cl. The oxychloride impede fluid ingress and

species is soluble. The oxide egress along the margins.

precipitates as crystals and

85
86
Electrochemical corrosion of DELAYED EXPANSION

Sn-Hg does not appear to This phenomenon is

release free mercury into the related to the expansion of

oral environment. Rather, amalgam for atleast 2 years.

mercury immediately reacts When zinc containing low or

with locally available Ag and high copper amalgam is

Sn from residual amalgam contaminated by moisture

alloy particles and is re- during trituration or

consumed to form more condensation, a large

reaction products. expansion, which may start

Electrochemical corrosion of after 3-5 days may go on to

Cu-Sn in high copper values greater than 400µm

amalgams produces both (4%). This is called

copper and tin oxides and secondary or delayed

oxychlorides, but no expansion. It is associated

mercury is involved in the with Zn in amalgam.

process. Electrochemical Zn reacts with H2O to

corrosion is not a form Zn Oxide and in this

mechanism of mercury reaction hydrogen is

liberation from set amalgam. liberated. Hydrogen does

87
88
not combine with amalgam marginal fracture. Then at

but rather gets collected some point occlusal stresses

within the restoration, of opposing tooth contact

increasing internal pressure creates local fractures which

to high levels enough to produce a ditch. This is

cause amalgam to creep. called marginal ditching.

Severe expansion can cause This is measured on basis of

pressure on pulp leading to “MAHLER’S SCALE”.

severe pain. Pressure Progression of the

centered can go upto 2000 events of deeper or more

pounds /sq. inch. extensive ditching has been

Marginal Ditching used as visible clinical

The most common evidence of conventional

evidence of degradation of amalgam deterioration and

amalgam is marginal was the basis of the Mahler

fracture. Combinations of scale. Mahler ratings were

brittles, low tensile strength established from No.1 to

and electrochemical No.11 by comparing the

corrosion make occlusal image of the clinical

amalgam susceptible to restoration of interest to a

89
series of five photographs in to the dentinal

(scale values of No.2, No.4, tubules

No.6, No.8, and No.10)  From the colour of

representing increasingly underlying amalgam

worse marginal breakdown. seen through

The rest of the rating scale translucent enamel.

deals with the severity of This occurs when the

marginal ditching that is enamel has no dentin

below (No.1), intermediate support.

(No.3, No.5, No.7, and No.9) Amalgam Tattoo

or greater (No.11) than the These are macular and

main scale images. bluish gray or black lesions

Amalgam Blues found on the buccal

Discoloured areas often mucosa, gingiva or palate

seen through enamel in and are present in the

teeth that have amalgam vicinity of teeth with large

restorations. The bluish amalgam restorations. This

hue result either from; can be due to,

 Leaching of corrosion  Iatrogenic mishop –

products of amalgam where by the dentists

90
 bur loaded with small MERCURY TOXICITY
amalgam particles

accidentally veneers Although there is no

into adjacent mucosa doubt that mercury is toxic,

and induces metal there is no strong evidence

flecks. to show that carefully

 Fragments get prepared and placed

deposited from amalgam restorations pose a

multiple tooth danger.

extractions containing In nature mercury exists in

amalgams. Metal three forms. There are,

fragments fall into  Elemental (Hg°)

tooth sockets and  Inorganic Mercurous

become entorubed (Hg+1) and Mercuric
within the connective (Hg+2)
tissue which
 Organic – Methyl, ethyl
reepithelises
and phenyl mercury
eventually.
salts

91
 Degree of absorption of mercury

Absorption efficiency of Mercury

SKIN LUNGS GIT

Elemental - 80% 0.01%

Inorganic - 80% 7%
Organic - - 95-98%

Events occuring during mercury absorption, transportation &

excretion in the body

As a vapor, metallic in the lungs at 80%

mercury can be inhaled and efficiency. This is clearly the

absorbed through the alveoli major route of entry into the

92
human body. Metallic release mercury ions into

mercury is poorly absorbed solution. Some of these

through the skin or via the compounds have been used

gastrointestinal tract. in the past as medicaments.

In addition to metallic Such materials are poorly

mercury, both inorganic and absorbed through the lungs

organic mercury compounds but are easily absorbed in

are potentially toxic. the gastrointestinal tract.

Mercury is normally mined Mercury also can form

as an inorganic sulfide organic compounds such as

(cinnabar) ore, which is methyl mercury. Such

heated in air to oxidize and mercury compounds are

drive off the sulfur. The readily absorbed by many

mercury is then collected as organisms and concentrated

a liquid. as they are passed up the

Mercury can exist in a food chain.

wide variety of inorganic The concentration of

compounds, in addition to naturally derived mercury in

the sulfide. Many of them food is at times aggravated

are water soluble and by the use of fungicides and

93
pesticides containing methyl Sources of mercury

mercury. For most people, hazards in dental

organically bound mercury operatory:

in food is the primary source 1. Amalgam raw materials

of mercury exposure. being stored for use

Humans absorb methyl (usually as

mercury from food readily, precapsulated

but excrete it less effectively packages).

than other forms of 2. Mixed but unhardened

mercury. Once absorbed it amalgam during

has a tendency to trituration, insertion

concentrate in certain and intra-oral

organs such as the liver, hardening.

kidney, and brain. 3. Amalgam scrap that

It has been suggested has insufficient alloy to

that metallic mercury can be completely consume

changed into methyl the mercury present.

mercury by microorganisms 4. Amalgam undergoing

in either the mouth or finishing and polishing

gastrointestinal tract. operations.

94
 5. Amalgam restorations During insertion

being removed. mercury vapor is released by

Mercury released from condensing and carving of

dental restorations: amalgam. This mercury can

Mercury is released be measured in the saliva

during the placement and and expired air. Measurable

removal of amalgams, but quantities of mercury vapor

the level of vapor from were found during

amalgam particles can be placement of multiple

kept well below the restorations. However after

acceptable levels by, rinsing the mouth and after

a) Care in preparation of

amalgam

b) Avoiding ultrasonic

condensers

c) Use adequate water

spray and high volume

suction during cutting

or polishing.

d) Use of rubber dam.

95
 it was covered with

saliva levels return to the

baseline levels in two to

three days.

The magnitude and

proportion of the released

mercury level is directly

proportional to the surface

area of the restoration. The

amount released by high

96
copper amalgam was much solidified mercury is tightly

less when compared to low bound. However, one of the

copper. reaction products, Ag2Hg3

The removal of amalgam has a very low melting point

restorations by high speed (127°C) and can be easily

rotating instrument can liquefied during finishing or

result in evolution of both polishing procedures that

mercury vapor and mercury generate heat and this

containing amalgam dust increase the vapor pressure

which can be inhaled by the (normal vapor pressure is

dentist, patient and 20). The Ag2Hg3 phase is

assistant. It was noted that melted producing a mercury

exposure could be rich liquid phase that is

eliminated or kept to easily smeared over dental

minimum by using wet amalgam making it look

cutting procedures and high bright and shiny.

volume suction. Accumulation of mercury

Polishing can also in body organs:

release mercury. Once Much of the confusion

dental amalgam has about mercury effects is

97
related to inadequate slowly removed. This fact

understanding of mercury has become the basis for

processing by the human many claims of

body. Mercury that is neuromuscular problem in

absorbed into the patients with dental

circulatory system may be amalgams. However this

deposited in any tissue. mercury is not uniquely fro

Accumulations are higher m dental amalgams, the

than average in the brain, levels are low, and removing

liver and kidneys. Mercury amalgams restorations does

ions (Hg+2) circulate readily not eliminate exposure to

in the blood but pass the mercury. Mercury does not

membrane barriers of the collect irreversibly in human

brain and placenta only with tissues. There is an average

difficulty. In contrast non- half life of 55 days for

ionized mercury (Hg°) is transport through the body

capable of crossing through to the point of excretion.

lipid layers of the barriers Thus mercury that came

and if subsequently oxidized into the body years ago is no

within these tissues, is only longer present in the body.

98
 Various events mitigate elevated, are lower than

the conversion of mercury brain concentrations in the

into ions and affect the mother. Effects on fetal

conversion of the ions to development are not fully

other compounds. For known. All of the

example, ethyl alcohol is contemporary evidence from

known to interrupt some of surveys and posthoc surveys

the biochemical steps indicates that female

required for blood-brain dentists, assistants, and

transport, thereby hygienists who are pregnant

facilitating its rapid are at no higher risk of

excretion. miscarriage or fetal mal-

The placental barrier is development. Even so, it

less effective than the blood- seems to be judicious to

brain barrier, and some minimize any exposure of

mercury ions are capable of these individuals to any

placental transfer, as is potential hazard such as

about anything else in the mercury during pregnancy.

circulatory system. Fetal Safe and threshold levels

mercury contents, although of Mercury:

99
 Maximum level of 500 Micrograms

occupational Hg/m3 of air.

exposure considered Daily dose of Mercury

safe is 50 from Amalgam:

Micrograms Hg/m3 An estimate of 1.2µg of

of air. mercury per day was

 Maximum allowed obtained for subjects with

concentration in an average of 8.6 occlusal

blood – 4 surfaces restored with

Micrograms /ml of amalgam and 1.8µg of

blood. mercury per day for subjects

 Maximum allowed with 12 or more occlusal

concentration in amalgam surfaces.

urine – 15 Since the total daily intake

Micrograms /1to 20 of mercury for individuals

Micrograms/1of with no occupational

urine. exposure to mercury is

 Threshold value for estimated to be 10 to 20µg,

workers in mercury the 1 to 2µg contribution of

industry – 350 to dental amalgam mercury per

100
day is minor even for the release from amalgam

non-occupationally exposed restoration:

individual. 1) Neurotoxicity – not

A person exposed to only the classic

the World Health problems associated in

Organization threshold limit the past with

value for mercury would occupational hazards,

receive a mercury vapor bur also an

does of 300 to 500µg each involvement in the

day, for five days per week; cause of multiple

hence the total weekly dose sclerosis.

that can be tolerated in such 2) Kidney dysfunction.

a work environment without 3) Reduced immuno-

any adverse effects – 1500 to competence resulting

2500µg – is more than 100 in varied disorders.

times the weekly dose of a 4) Increased still births

person with 12 amalgam and birth defects.

restoration would receive. Levels of Hg in patients

Adverse effects attributed with amalgam restoration

to the mercury vapor

101
 1) Average reported toxicity been observed in

concentration of Hg in human beings (industrial

blood 0.6 to 1.9ng/ml. pollution in Minamata Bay;

2) Average reported inadvertent contaminated

concentration of Hg in grain consumption in New

urine 0.57 to 1.66ng/l. Mexico and in Iraq). The

3) Magnitude of vapour Minamata Bay incident in

exposure to patients Japan in 1952 is the most

with 8-10 amalgam infamous. A local chemical

restoration 1.4 to plant (Chisso Corporation)

4.4ng/day. disposed of its methyl

mercury waste into the

ENVIRONMENTAL nearby bay, contaminating

HAZARDS OF the shellfish, and causing

toxic levels of mercury in the

MERCURY
fish eaten by the local

population. By the time the

Only under very rare
sources were identified, 52
circumstances have the
individuals had died and
symptoms of mercury
202 others were stricken by

102
mercury poisoning. Since without some special

this time, mercury poisoning knowledge of an individual’s

of this kind is known as risk to environmental

Minamata disease. exposure.

The symptoms of Restrictions placed by

mercury poisoning identified the governments and

during this incident were: agencies on mercury due to

1) Ataxic gait environmental hazards and

2) Convulsion esthetic considerations,

3) Numbness in mouth rather than mercury toxicity

and limbs from amalgam restorations

4) Constriction in the will eventually lead to the

visual field and /or decline of amalgam.

5) Difficulty in speaking.

Unfortunately, none of DEVELOPMENTS IN

this symptomatology is AMALGAM
particularly unique to

mercury poisoning.
1. GALLIUM ALLOYS
Therefore it is very difficult

to diagnose the problem

103
 In the late 1920’s Association nearly three

gallium was one of the decades ago. This direct

substitutes suggested for filling material contains no

mercury by Puttkamener mercury. Its use was

(1928), and early in the partially based on the

1950s work by Smith and remarkable ability of liquid

associates showed the gallium to wet the surfaces

potential for using a gallium of many solids, including

system. These publications human teeth. Like mercury,

lay dormant until recently gallium is a liquid at room

when the mercury toxicity temperature.

issue renewed the interest in Triturated with a silver

non-mercury alloys. A based alloy similar in

number of companies in composition to high copper

Japan, Australia and United amalgam alloys, the material

States have begun has many of the handling

marketing gallium based characteristics of

alloys. It was developed as a conventional amalgam. Also

part of a program supported many of its physical and

by the American Dental mechanical properties such

104
as creep, dimensional Industries Australia and

changes and compressive Gallium Alloy G.F. by

strength are similar to Tokuriti Houten Co. Tokyo,

traditional amalgam. Japan.

Two gallium restorative

materials have been

commercially developed.

Galloy by Soouthern Dental

Composition (by weight %)

Gallium G-F Galloy

Liquid Gallium 65% 61.98%

Indium 18.95% 24.99%

Tin 16% 12.98%

105
 Silver 0.05% ---------

Palladium 0.05% ---------

Bismuth -------- 0.05%

Powder Phase Gallium 50% 60.10%

Tin 25.71% 28.05%

Copper 15% 11.80%

Palladium 9% …………

Zinc 0.3% …………

Platinum …….. 0.05%

Meticulous moisture unset material react quickly

control is mandatory when with water to form a

using Gallium alloys. tarnished and corroded

Moisture contamination surface, the completed

causes dramatic expansion restoration should be coated

of the restoration during with a protective layer of

setting which can lead to resin. Since unpolished

tooth sensitive and tooth Gallium alloys often tarnish

fracturing. Because of the

106
and pit, these restorations than high copper

should be polished. amalgam.

Studies of 2. When Gallium alloy and

biocompatibility have shown high copper amalgam

that is not significantly was placed in the oral

different from amalgam. cavity, galvanic

Much lower vapour pressure corrosion was found

of liquid gallium should with preferential

result in fewer occupational corrosion of gallium

and environment safety alloy.

risks. 3. The handling was

Disadvantages difficult because of

1. Low resistance to wetting and adhesive

corrosion. Clinical property. The alloy

studies have shown sticks to all the

marginal breakdown condensing

and reduced surface instruments and

texture within one year carving instruments.

of placement. It was

found more corrosive

107
4. Gallium alloy left a dark consolidation took place at

residue an gloves when room temperature under

handled moderate pressure. The

5. High cost physical properties

2. MERCURY FREE examined showed higher

DIRECT FILLING SILVER rupture strength than

ALLOYS amalgam; however

In 1994 Daniel et al compressive strength and

developed a metal hardness valued were lower

alternative for traditional than those of silver

amalgam, which consisted of amalgam. Consolidated

silver particles suspended in silver is a cold welded

a dilute acid solution. The system that requires rotary

acid treatment cleaned the instruments for contouring

surface by removing the and finishing. This

oxide or other absorbed approach was based on

layers from the silver powder technology arrived at

particles, thus enabling transforming an extremely

ferric consolidation and cold plastic mixture of mercury

welding. This acid-assisted free alloy powder in to a

108
cohesive solid at room study, pure indium powder

temperature. was admixed into dispersed

Although this material phase high copper alloy, and

is not available currently it this admixed powder was

may hit the market in future them triturated with pure

after researches and bio- mercury. They found a

compatibility trials. significant decrease in

Presumed composition is mercury evaporation from

Silver - 50% this amalgam compared to

Silver –Tin Particles - 40% amalgam without indium.

As the amount of indium

3. INDIUM CONTAINING added to the alloy increased

ALLOY POWDER AND from 0 to 14%, a significant

BINARY MERCURY – decrease in mercury vapour

INDIUM LIQUID ALLOY released during setting was

Powell et al in 1989 recorded. The indium

first reported on a method of containing alloy powder is

decreasing mercury commercially available in

evaporation through the the name “Indisperse”

addition of indium. In their marketed by indisperse

109
industries, Inc. Ontario or Whether pure indium

Indiloy by Shofu was incorporated into the

Corporation, Japan. alloy powder or into pure

In 1994 Okabe et al mercury, this addition

reported a study in which minimized the evaporation

the amalgams were prepared of mercury form the

with mercury – indium amalgam during setting.

liquid alloy instead of pure This reaction was explained

mercury and found that the as a reduction of the

vapour release from setting mercury concentration in

was significantly reduced. the amalgam, a reduction of

An increase in the indium vapour pressure of mercury

concentration upto 50% in in the mercury releasing

the Mercury – Indium liquid phases, a more efficient

alloy produced a notable formation of a surface oxide

decrease in mercury layer or a combination of

evaporation. However, the these factors.

type of amalgam powder is 4. FLUORIDE

important for the control of CONTAINING AMALGAM

mercury vapour release.

110
 The addition of fluoride hydroxyapatite –

to conventional amalgam producing calcium

was first referred to in works fluoride. Ionic

to Innes and Youdelis in interchanges should

1966, Jerman in 1970 and produce

Stoner et al in 1971. It is fluorohydroxyapatite,

postulated that the which is more

liberation of fluoride ions resistant to acid

occur by two mechanisms. attacks.

1. Dilution of salt

crystals that are in Example of fluoride

contact with the containing amalgam

cavity wall and - Fluoralloy –

2. By corrosion that Dentoria SA, France.

liberates fluorides 5. LOW MERCURY

contained in the mass AMALGAMS

of amalgam. These They are still under

ions should be research. In these

capable of interacting amalgams, mercury is used

with the calcium from to low as 15 to 25%.

111
 be removed, in excess of

BONDED AMALGAM that removed during caries

RESTORATIONS excavation and elimination

of undermined enamel.

Further, since amalgam

Conventional amalgam
does not bond to tooth
is an obturating material,
structure, micro-leakage
merely filling the space
immediately following
remaining after cavity
insertion is inevitable.
preparation. In
The introduction of
consequence, the fracture
clinical techniques that
resistance of the tooth,
reliably bond amalgam to
reduced during cavity
enamel and dentine may
preparation, is not restored
offer the following potential
by the filling material (Eakle,
advantages:
Maxwell and Braly, 1986).
1. Conservative
In addition, the provision of
preparation.
adequate resistance and
Undercuts, dovetails,
retention form may require
retention grooves and
that healthy tooth structure
dentine pins may not

112
 be required to provide Shimizu, Ui and

resistance and Kawakami.

retention form. 4. Conservative repair of

2. Increased fracture existing restorations.

resistance of the The concept of bonding

tooth, by amalgam to tooth structure,

extrapolation of data by use of intermediary

from studies involving material, was introduced by

composite resins and Baldwin as long as long ago

porcelain inlays. as 1897. The Baldwin

3. Reduced micro- technique involved the

leakage and condensation of amalgam

consequently a lower onto unset zinc phosphate

incidence of recurrent cement. Using this

caries postoperative technique, the amalgam

pain and pulp became incorporated into

damage. Reduced the cement and when the

micro-leakage around two materials had, set, was

bonded amalgam has physically retained by the

been reported by cement. Although the

113
cement did not physically More recently,

bond to the tooth, the Zardiackas and Stoner

retention of the set mass (1983) studied bonding to a

was considered by Messing liner by selective interfacial

(1972) to be clinically amalgamation, while Varga,

satisfactory. Adhesive Matsumura and Masuhara

cements, such as zinc (1936) employed 4-META (4-

polycarboxylate and glass methacryloxyethyl

ionomer cements have been trimellitate) and Panavia Ex

suggested as substitutes for as the intermediate bonding

zinc phosphate cement. agents. Shimizu, Ui and

However, a number of Kawakami (1986)

objections to the technique investigated a range of

have been raised; in bonding materials including

particular the risk of Panvia Ex and glass ionomer

extrusion of soluble cement cements. Staninec and Holt

to the cavity margins, the (1988) developed the

technique has largely fallen technique employing

into disuse. Panavia Ex, previously

described by Shimizu, Ui

114
and Kawakami (1986). In interface. The excellent

laboratory experiments, wetting characteristics of the

non-retentive proximal methyl methacrylate base

amalgam restorations in and the hydrophilic

posterior teeth were bonded activator may be largely

using Panavia Ex. These responsible for the retentive

exhibited better resistance properties of this material.

and retention form than A clinical technique for

non-bonded preparations the repair of a fractured

possessing resistance tooth cusp, employing

grooves or dovetails. Mean Panavia Ex as the bonding

tensile bond strength to material, was described by

enamel (7.8 MPa) was Lacy and Staninec (1989).

considerably higher than The procedure included the

that to dentine (2.6 MPa). following stages:

The dentine adhesive / 1. Isolation using rubber

amalgam bond was dam

considered to be similar to 2. Removal of the dentine

that reported for the smear layer by

dentine/adhesive/composite

115
 application of 10 – 40% Oxyguard to ensure

polyacrylic acid polymerization in these

3. Lining of all dentine areas, since polymerization

with a glass ionomer of Panavia Ex is inhibited in

cement air. Furthermore, since the

4. Etching of both glass adhesive will bond to

ionomer cement and stainless steel, the matrix

enamel using 40% should be coated with a thin

phosphoric acid gel film of Vaseline prior to

5. Application of Panavia placement.

Ex adhesive over enamel The simple technique

and glass ionomer has obvious appeal but has

cement been criticized on the

6. Condensation, carving grounds of pulpal toxicity of

and finishing of the bonding agent. Masaka

amalgam in the (1989) recommended that

conventional manner. Panavia Ex be abandoned in

It may also be favour of 4-META, which be

necessary to cover the considered was able to seal

marginal bonding agent with the dentine tubules and

116
reduce, or eliminate, using 10% citric acid and

bacterial infection. 3% ferric chloride. This may

“Amalgam bond” (developed remove the smear layer,

jointly by Parkell Bio make the surfaces more

Materials, Farmingdale, New retentive and dissolve some

York and Mitsui, Japan) has of the inorganic component

been recently marketed in of the dentine, exposing

the U.S.A. The adhesive collagen fibrils.

agent employed is based on This activator was

4-META and is reported by found to be superior to

the manufacturers to bond preparation of dentine by

to any brand of amalgam, phosphoric or citric acids by

both fresh and old. It is Nakabayashi, Kojima and

described as particularly Masuhara (1982). The

suitable for the repair of adhesive is reported by the

restorations. Prior to manufacturer to enter the

application of the adhesive, dentine tubules and

the manufacturers infiltrate de-mineralized peri

recommend that the dentine and intra tubular dentine.

and enamel are activated Entanglement of the 4-

117
META molecule with the restorations using 4-META

collagen may enhance the has also been reported

bond. However, since the (Sheth, Fuller and Jensen

usual mode of failure of both 1988).

4-META and Panavia Ex Preliminary research

bonded amalgam suggests that intermediate

restorations is through the resins, such as those

bonding resin / amalgam described above, may

interface, these provide a useful interface

considerations may be between silver amalgam and

relatively minor importance. tooth structure, which

High bond strengths possess greatly differing

between 4-META and coefficients of thermal

amalgam have been reported expansion. Furthermore,

(Murrey and Bailey, 1988) the greater area under the

and this adhesive has been stress/strain curve for resin

considered biocompatible bonded amalgam

(Nakabayashi, 1989). restorations, in comparison

Increased fracture with that of a non – resin

resistance of the tooth after bonded amalgam

118
restorations, in comparison the cavity design, cavity

with that of a non –resin preparation was simply

bonded amalgam, implies limited to access and caries

that the former restoration excavation, without local

may require greater energy anaesthesia.

to fracture, a property that An alternative

may prove to be of some technique has been

clinical significance. It must described by Warren and

be strongly emphasized, Soderholm amalgam to a

however, that no long-term glass ionomer lining. The

clinical trials have been resulting bond was shown to

reported using these withstand exposure to

techniques. A short clinical moisture, at least in the

trial (Ueno, 1988) reported short-term. The technique

no mechanical failures of is however, operator

129 bonded amalgam sensitive and dependent on

restorations after 1 year, an optimum film thickness

despite the fact that no of polyacrylic acid.

mechanical retention Amalgam Bonding Systems

features were introduced in

119
 Amalgam bonding anhydride (4-META) – based

systems may be used to seal systems are used frequently.

underlying tooth structure This monomer molecule

and bond amalgam to contains both hydrophobic

enamel and dentin. They and hydrophilic ends.

require dual characteristics Macroshear bond

to achieve optimal wetting. strengths for joining

Amalgam is strongly amalgam to dentin are

hydrophobic, whereas relatively low (2 to 6 MPa).2

enamel and dentin are

hydrophilic. Therefore the

bonding system must be

modified with a wetting

agent (comonomer) that has

the capacity to wet both

hydrophobic and hydrophilic

surfaces. Typical dentin

bonding systems may be

used, but special 4-

methyloxy ethyl trimellitic

120
 Although good bonding

occurs to tooth structure,

micromechanical bonding at

the interface of the amalgam

with the bonding system is

poor. Most de-bonding

occurs by fracture along this

interface. Since no chemical

bonding occurs at this

interface, it is important to

develop micromechanical

bonding. To accomplish

121
this, the bonding systems is The primary

applied in much thicker advantages for amalgam

layers (10 to 50µm), so that bonding agents in most

amalgam being condensed clinical situations are the

against the resin adhesive dentine sealing and

layer will force fluid improved resistance form,

components of the amalgam but the increased in

to squeeze into the unset retention form is not

bonding adhesive layer and significant. Adhesion of

produce micromechanical amalgam to tooth structure

laminations of the two is not necessary in clinical

materials. Thicker bonding circumstances when

agent films can be produced satisfactory retention and

by adding thickening agents resistance forms of tooth

to the unset bonding preparation already exist.

materials or by applying Primary indication for

many (five to eight amalgam bonding is when

applications) of bonding weakened tooth structure

material. remains and bonding may

improve the overall

122
resistance form of the Copper amalgam is

restored tooth. manufactured as small

cylindrical pellets of metal.

COPPER AMALGAM These are placed in an

amalgam spoon and heated

Copper amalgams until small drops of liquid

should not be mistaken for mercury are visible on the

the high copper or non- surface. The mass is

gamma-2 amalgams. mechanically mixed in the

The composition of spoon and after cooling

copper amalgam is not somewhat it is placed in the

regulated in any ISO cavity.

standard. They consist of Copper amalgams are

approx. 30% copper and used primarily in the case of

70% mercury. Sometimes extensive caries attacks and

small amounts of other cavities with poor retention

metals such as cadmium, in children but sometimes

silver and zinc have been also in grownups. As early

added. as 1890 Miller found copper

amalgams to be cariostatic.

123
Although statistics are inexpensive service to

lacking it is anticipated that patients longer than any

copper amalgams have been other material available.

used to a much lesser extent It has many positive

than conventional attributes and remains an

amalgams. They are important part of dentist’s

regarded to be the most restorative source.

unstable of the three types Mercury free alloys are

of corroding extensively. likely to be available to

Sometimes this results in provide the advantages of

greenish teeth from copper amalgam without

containing corrosion environmental concerns

products. about mercury.

CONCLUSION

From the stand point

of a healing profession,

amalgam has provided

valuable and comparatively

124
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