Amalgam Restorations II

Dr.Ghada Maghaireh BDS,MS,ABOD

Lecture Outline

Class II amalgam restorations. Class V amalgam restorations. Amalgam mixing & placement.

Class II Amalgam Preparation

Cavity preparation for caries that originate in the proximal surfaces of molars & premolars.
Usually interproximal caries starts just below the contact point.

Class II Amalgam Preparation

Occlusal Outline Form

If a groove is not carious, it should not be included in the outline. Faciolingual width is approximately 1 mm except at the intersection of grooves.

Proximal Outline Form

The cavity should be extended buccally & lingually to break the contact with the adjacent tooth.

Proximal Outline Form

The gingival wall should be extended gingivally to break the contact.

Proximal Outline Form

Proximal clearnce:0.250.5 mm.

Proximal Outline Form

Buccal & lingual walls should be parallel.

B L

They can be slightly convergent toward occlusal.

Resistance Form

Buccal & lingual walls of the occlusal part should be parallel or slightly convergent occlusally. Well defined internal line angles.

Resistance Form

About 1.5-2 mm pulpal depth. 1.25 -1.5 mm mesiodistally.

D

1.5-2.0 mm

Resistance Form

Parallel or slightly convergent buccal & lingual walls of the box.

Well defined internal line angles & point angles. Buccal & lingual proximal walls should meet the external portion o the tooth at 90. S shaped or reverse curve buccal outline.

Resistance Form

The axial wall should be just inside the DEJ, about 1.25 mm in depth. The buccolingual contour of the axial wall should be parallel to the proximal surface of the tooth.

Resistance Form

Rounded pulpoaxiall line angle. Gingival wall is horizontal.

Retention Form

Occlusal. Proximal: Retention grooves. Inside the DEJ along the buccoaxial & linguoaxial line angles. The groove extend from the gingival floor to the pulpal floor.

Retention is made with (small) round bur. Retention grooves aid in retention as well as strengthen the restoration.

Class V Amalgam Preparation

Outline Form

Usually determined by the extent of caries. All carious lesion & decalcification that is not hard should be included. Occlusal cavosurface margin should be parallel to the occlusal table & gingival cavosurface parallel to the gingival floor. About 4 mm wide mesiodistally & 2 mm wide occlusogingivally.

Resistance Form

Mesio & distal walls are divergent toward the external tooth surface. The occlusal & gingival walls are parallel. The axial wall is just inside the DEJ, 1.5 mm deep at the occlusal wall, 1.0 mm at gingival.

The axial wall is convex parallel to the external surface of the tooth.

Retention Form:

Retention grooves in dentin of the occlusal & gingival walls near the internal line angles.

The grooves should not be placed in the mesial & distal walls.

Amalgam Mixing & Placement

1. Mixing the amalgam
2. Placing the amalgam in the cavity

3. Carving & burnishing the amalgam

4. Polishing the amalgam

Mixing the Amalgam

Trituration of amalgam includes combining or mixing the mercury with the alloy powder. Electric amalgam mixers (amalgamators). Amalgam pellets & bottled mercury is still in use. Precapsulated amalgam alloy is recommended: - Provide more consistent mix. - Eliminate the possibility of mercury spills.

The duration and speed of trituration of amalgam should be just enough to coat all the alloy particles with mercury.
Over mixing of the amalgam will set prematurely & this will prevent enough condensation & adaptation of the amalgam. Overmixed amalgam is dry & coherent.

Undermixed amalgam is dry , but crumbly.

Well mixed amalgam is shiny & coherent. Mixed amalgam is placed in the amalgam well. Amalgam should be used directly after mixing.

Condensation of the Amalgam

Condensing is the process of compressing & directing the amalgam in the cavity with the amalgam condenser.

Amalgam carrier is used treo carry the amalgam in increments to the cavity.

The cavity should be overfilled & then carved back in order to eliminate voids & remove excess mercury.

Amalgam should be condensed both vertically & laterally to adapt it to the walls.

Condensation forces:

The force should be 2-5 kg for admixture & conventional amalgam. Result in slight movement of the patients mandible or head. Less condensation is required for spherical alloy. Small condenser should be used initially & in small areas and larger condenser for overfilling of the restoration.

Precarve Burnishing

Burnishing prior to carving with large burnisher.

Immediately after condensation.

Heavy strokes in the mesiodistal & buccolingual direction. Produce denser amalgam at the margins of the restoration.

The first step in shaping the occlusal surface of the restoration.

Carving of Amalgam

Carving should create contours & occlusion that reproduce the missing tooth structure.
The carver should rest on the enamel adjacent to the preparation and be pulled in a direction parallel to the margin of the preparation.

Carving of Amalgam

Amalgam should not be overcarved leaving the groove anatomy deep. If the anatomy is shallow, it may affect occlusal masticatory function or create occlusal interferences. Amalgam restorations should ideally have 75 to 90 degree amalgam margins.

Ideally, carving should be completed within 6 minutes of amalgamation.

Placing amalgam in Class II cavities

Matrix band & retainer.

The Universal Tofflemire Retainer

Straight & contra-angled Tofflemire retainer.

Parts of the Tofflemire Retainer

1. Set screw 2. Rotating spindle 3. Slide 4. Head 5. Band

Matrix Band
Ideal Properties of the Matrix Band

Easy to apply & remove.

Extend below the gingival margin.

Extend above the marginal ridge height.

Resist deformation during material insertion.

Shapes of Matrix bands:

Universal matrix band (# 1). # 2 (MOD) band. # 3 band.

Wedge:

Obtain a tight proximal contact. Obtain proper interproximal contour. Prevent gingival overhang.

Other uses of the wedge:

Protect the gingiva during preparation.

Many different shapes & sizes of plastic and wooden wedges. Most commonly used is the triangular shape. The wedge is placed in the wider embrasure, usually the lingual.

Correct Position of the Wedge:

The base of the wedge should be gingival to the gingival margin.

Incorrect Position of the Wedge

Can cause concavity in the matrix, and this concavity can transfer to the amalgam.

Tofflemire Retainer & Wedge in Position

Postcarve Burnishing

Light rubbing of the carved amalgam with a burnisher to smooth the surface of the restoration.
The amalgam can be wiped with water-damp cotton roll for additional smoothening.

Adjusting the Occlusion

Occlusion should be checked with an articulating paper. Ask the patient to very gently to tap the posterior teeth together. Interferences should be checked first in maximum intercuspation, and then in eccentric movements.

Amalgam Polishing
Reasons for polishing: 1. Improve oral hygiene since smooth surfaces & margins accumulate less plaque. 2. Removal of overhangs that can irritate the gingival tissues. 3. Occlusion & occlusal anatomy can be refined. 4. Corrosion is inhibited, therefore extending the life of the restoration. 5. The esthetic of a polished, light colored restoration is better than tarnished, blackened restoration.

Amalgam Polishing

Should be done at a succeeding appointment, or at least several hours after placement of the restoration. The restoration should be checked first for defects or overhangs. Gross smoothening & refining of occlusal anatomy should be accomplished first with stone or finishing burs.

Amalgam Polishing

Abrasive-impregnated rubber cups & points are used for smoothening & polishing.