Dental material Science Dent 305

2008-2009

References and syllabus

References:

Introduction to Dental Materials Applied Dental Materials Dental Materials, Clinical Applications For Dental Assistants And Dental Hygienists Phillips Science of Dental Materials Dental materials, properties and manipulation

Assessment policy Theory exams

Weight
First exam 20% Second exam 20% Final exam 60% At least 85% of lectures should be attended Absence allowed two lectures

Lectures attendance

DENTAL AMALGAM

General information

Dental amalgam has been the most widely used material for the restoration of posterior teeth due to:

High strength and durability Ease of use Good physical characteristics

However, its use has decreased over the past decade due to concerns regarding:

Esthetics Mercury content

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Alloy versus amalgam

Alloy: is a mixture of two or more metals. Main components of amalgam alloy:

When these components are mixed with mercury, the reaction that occurs is amalgamation and the resulting material is dental amalgam.
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Silver Tin Copper Zinc Palladium or indium

Composition
Weight (%) Metals Limits prior to 1986 (conventional alloy) 65 (min) 29 (max) 6 (max) Current limits (Cu-rich alloy) 40 (min) 32 (max) 30 (max)

Silver
Tin Copper

Zinc
Mercury

2 (max)
3 (max)

2 (max)
3 (max)
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Classification

According to the shape of particles in the powder:

Irregular: Formed by shaving particles from a block of the alloy by a lathe (lathe-cut alloy) Spherical: Formed by spraying molten alloy into an inert gas (spherical alloy) Admixed: Mixture of the two (admixed alloy). Alloy maybe made from different particle shapes to increase packing efficiency and reduce amount of Hg needed to obtain a workable mix

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Classification

According to composition:

Conventional alloys (6% copper content, refer to Table 1) Copper enriched alloy:
Single composition-copper enriched alloys Dispersion modified-copper enriched alloys: ratio is 2 (conventional alloy): 1 (silver-copper alloy), overall copper content 12%

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Setting transformation

Alloy powder + liquid mercury mixed Packable amalgam in a cavity firming phase of the mix 1st stage of firming amalgam can b carved. When amalgam reaches initial set, it cannot be carved, but still not fully reacted (brittle). Needs 24 hours to attain full strength.

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Setting reaction continue,

Conventional alloys:

Ag3Sn + Hg

Ag2Hg3 + SnxHg +unreacted Ag3Sn 1 2

Ag2Hg3 + Cu6Sn5+ Ag3Sn 1

Copper-enriched alloys:

Ag3Sn + Cu+ Hg

The gamma 2 phase was replaced with copper-tin

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Setting reaction

When the alloy is mixed with mercury, three phases occur:

Gamma phase () silver-tin alloy phase, strongest with least corrosion Gamma 1 phase (1) consists of mercury reacting with silver, not as strong as . Gamma 2 phase (2) consists of mercury reacting with Tin. Weak phase and corrodes easily.
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Physical properties

Tarnish: oxidation that attacks amalgam surface and extends slightly below the surface. Clinical picture: dark and dull appearance Tarnish is more likely to occur with rough surfaces. Mechanical properties are not affected Cause: contact with

Oxygen Chlorides Sulfides

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Physical properties

Corrosion: what causes it,

Chemical reaction between amalgam and saliva/food leading to oxidation of amalgam.

Contact between to dissimilar metals (galvanism) oxidation of amalgam Interaction of amalgam components
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Continue,

The outcome of corrosion:

Weakens restoration Poor appearance of restoration Deterioration of its margins Stain surrounding tooth structure as corrosion products penetrates dentinal tubules Mercury release from gamma 2 phase, maybe ingested
High copper alloys Polishing of amalgam
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Corrosion maybe minimized by:

Amalgam corrosion
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Physical properties

Creep (plastic deformation): usually seen

with low-copper amalgam (due to gamma 2 phase). It involves a change in the shape of the restoration due to compression from chewing and opposing teeth. Creep causes protrusion of amalgam which is susceptible to fracture and corrosion. This leads to formation of a ditch around amalgam. This decreased by:

High copper alloys Palladium or indium in the alloy

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Physical properties

Dimensional change: expansion and contraction during setting occurs in amalgam. It is important that the net effect does not change the dimensions of the restoration. During the 1st half hour, contraction occurs Followed by expansion due to crystallization End result is either final expansion or contraction

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Tooth crack most likely caused by amalgam expansion

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Physical properties

This property is affected by:

Moisture contamination (zinc produces hydrogen when in contact with water) Particle size and shape Type of the alloy Manipulation of amalgam such as condensation

Net contraction or expansion should not exceed 0.1% Improving marginal seal (varnish use)
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Physical properties

Strength: High compressive strength 300MPa

Enough bulk of amalgam is needed to provide enough strength. Requires support from surrounding tooth structure

minimum, but low tensile strength and low shear strength, it a brittle material so:

High copper amalgam and spherical alloy amalgams have higher strength values after the first hour of placement than conventional lathecut amalgams.
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Thermal properties

High thermal conductivity: so, expansion and contraction occur and may lead to microleakage 3 times the coefficient of thermal expansion of dentine In large cavities an insulator is needed underneath amalgam to protect the pulp

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Biological properties

Research showed conflicting results as to the systemic effect of mercury in amalgam Body maybe exposed to higher amounts during placement, polishing, corrosion and removal of amalgam fillings Systemic effects related to mercury (no strong evidence):

Mild behavioral problem, major psychiatric problems, multiple sclerosis Fetal damage and abortions
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Biological properties cont.

One possible effect is allergic reaction to mercury:

Contact dermatitis Lichenoid reactions

This sensitivity is usually due to prior sensitization of patients to mercury present in some medicines

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Biological properties cont.

Dentists and assistants are mainly in danger from mercury (vapor) exposure during amalgam condensation, placement, removal, amalgam or mercury spells, improper disposal of amalgam scraps, carpeted or tile floors in clinics. Increase in temperature increases mercury vapor pressure so never sterilize instruments unless they are cleaned from any amalgam remnants
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Mercury safety

Safety should be considered for:

How does mercury enter the human body?

Patient Operator Environment

To protect the patient:

Skin contact Vapor inhalation Ingestion

Use high volume suction Rubber dam isolation

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Safety procedures

Adequate ventilation Avoid heating instruments to>80C Floors should be nonporous and easy to clean Use gloves, masks, glasses Amalgam scrap stored under water of film fixer in airtight containers Recycling of amalgam scrap appropriately
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Continue,

Reduction of mercury vapor:

Use amalgam capsules Use amalgamator with enclosed mixing arm Store amalgam scrap under water Clean instruments from any amalgam before sterilization Avoid ultrasonic condensers Clean mercury spills promptly with spill kit
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Clinical handling notes

1.

Cavity design:
1.
2. 3. 4. 5. 6.

Mechanical retention (occlusal convergence) Be conservative Remove unsupported enamel Rounded internal angles Flat floors If a large part of tooth structure is lost, amalgam pins maybe used
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Continue,

Matrices:
Used

to provide a surface against which amalgam maybe condensed (lost proximal wall) Should be tight contact gingivally to prevent ledge formation should restore contact with adjacent tooth:

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Manipulation

Proportioning and dispensing of alloy and mercury: Alloy/mercury: 5:8 (wet, hand mixing) or 10:8 (drier, mechanical mixing)

Spherical alloy particles require less Hg Hg should be <50% for optimum properties

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Dispensing amalgam

Semi automatic dispenser, also carries out mixing (Hg and alloy are released into a mixing chamber) Capsules (alloy is separated from Hg by a membrane)

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Manipulation of amalgam

Trituration (mixing): Hand mixing: rare nowadays Mechanical mixing:

Amalgamator: adjustable speed and time Always follow manufacturer instructions with regard to mixing time Some capsules require activation before trituration, others are activated when machine starts vibrating (self-activating capsules)
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Advantages of mechanical mixing:

Uniform mix Shorter mixing time maybe used Greater alloy/mercury ratio maybe used Reduce risk from Hg exposure
Make sure capsule is sealed Open away from face

Precautions:

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Placement and condensation:

Manual using condensers, or ultrasonic condensers Dappen dish Amalgam carrier Condenser is used to fill the cavity layer by layer using vertical and lateral condensation Cavity overfilled so that when carved, excess mercury is removed Good condensation to minimize porosities
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Burnishing and carving:

Burnishing maybe done before carving to further condense amalgam and remove excess mercury Carving is done soon after amalgam is placed in cavity, and helps to remove excess mercury, and reestablish tooth morphology Always keep in mind where the cavity margins are (avoid positive margins) Spherical alloy amalgams are easier to carve

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Positive amalgam margins

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Matrix removal: done when amalgam is sufficiently hard so that bulk failure will not occur Polishing:

Improves appearance Produces a smooth surface Minimizes corrosion Should be done after 24 hours Finishing burs are used, then abrasive pastes or abrasive impregnated points or discs Avoid excess hat production
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Mercury-free amalgam

Gallium as a substitute for mercury Similar handling characteristics to traditional amalgam Not a good alternative due to high corrosion and lower strength Not commonly used

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Reference: Applied dental materials, chapter 21 Dental materials, clinical applications for dental assistants and dental hygienists

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