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Dental amalgam

2
Contents
Manipulation
Introduction Quality of dental amalgam
History Failure of restorations
Classification
Uses and advantages
Components and
composition Recent advances
Manufacture of alloy Gallium alloys
Mercury
Bonded amalgam restorations
Amalgamation
Properties mercury exposure
Clinical considerations Mercury hygiene
Tarnish and corrosion recommendations
Management of mercury
vapour 3

Current status of amalgam


REFERENCES

PHILLIPS Science of Dental Materials;11th ed


Kenneth J. Anusavice
CRAIGs Restorative Dental Materials;12th ed
John M. Powers, Ronald L. Sakaguchi
Materials used in dentistry 1st edition
s.mahalakshmi
Materials science for dentistry;9th ed
B.W.Darvell
Sturdevants Art & Science of Operative Dentistry; 5 th ed;
fundamentals of operative dentistry, a contemporary approach;
ed
Summitt, Robbins, Hilton, Schwartz
4
Dental amalgam: An update
J Conserv Dent.2010 Oct-Dec;13(4): 204208
The amalgam controversy-an evidence based analysis ;
JADA,Vol.132,march 2001
Effect of admixed indium on the clinical success of
amalgam restorations
. operative dentistry journal1992 Sep-Oct;17(5):196-202

American Dental Association (ADA) Council on Scientific Affairs,


Statement on dental amalgam, 2011,
Dental Materials Volume 15, Issue 6, November 1999, Pages 382-389

Biomaterials, Volume 18, Issue 13, July 1997, Pages 939-946 5

Journal of Endodontics
Volume 9, Issue 12, Pages 551-553, December 1983
Jones DW: Putting dental mercury pollution into perspective.
BDJ 2004;197:175-177.

Eichmiller FC: Research into Non-Mercury Containing Metallic


Alternatives. Op Dent 2001;6:111-118.

Ronald K Harris: Dental Amalgam: Success Or Failure?. Op


Dent 1992;17:243-252.

Dunne SM et al: Current materials and Techniques for direct


restorations in posterior teeth. IDJ 1997;47:123-136.

6
INTRODUCTION
Dental amalgam is
one of the most
versatile restorative
materials used in
dentistry.
75% of all restorative
materials used by dentists.

A dental restoration for


more than 165 years. 7

Dentalamalgam: Anupdate Conserv Dent.2010 Oct;13(4


8

Dentalamalgam: Anupdate Conserv Dent.2010 Oct;13(4


Over the last few years improvements in
composition have led to -

Reduced Early seal


marginal between the
failure due to tooth and
decreased restoration
creep and
corrosion

But development of alternatives based on ceramics


and composites , and questions on its safety have led 9

to its decline.
What is amalgam????

10

Source: Websters New World Dictionary of the American


Language, Guralnik DB, Ed., New York: World Publishing Co.,
11

Sturdevants Art & Science of Operative


HISTORY OF AMALGAM
A Chinese
medical
text(Material
medica)
mentions using
a silver
paste, a type
of amalgam, to
fill teeth in the
7th century
-by Su Kung in
659 AD
12

J Conserv Dent.2010 Oct;13(4):


8.
In Europe, Johannes Stokers,
a municipal physician in Ulm,
Germany, recommended
amalgam as a filling material
in 1528.

13
14

J Conserv Dent.2010 Oct;13(4):


8.
In year 1603 tobias
dorn kreilius
Copper sulphide +
strong acids + mercury
= amalgam

D arcets mineral
cement
8 parts Bi
1 part lead
3 parts tin 15

1 part mercury
In the 18th century, John Hill, an
Englishman, described mercury as, It
penetrates the substance of all metals, and
dissolves, and makes them brittle.

In 1818, Louis Nicolas Regnart, a


Parisian physician invented amalgam
by the addition of one-tenth by weight
of mercury to another metal or metals.
Father
Dental silver amalgam was probably introduced
of
in England by Joseph Bell, amalgam
a British chemist, in
1819, and was known as Bells putty.
16

J Conserv Dent.2010 Oct;13(4):


8.
Traveau described a silver
paste filing material in
1826. He produced
amalgam by mixing the
silver coins with mercury.
17
18

J Conserv Dent.2010 Oct;13(4):


8.
John tomes
18 61
First research programme in amalgam

Charles tomes
18 71
Shrinkage and expansion in amalgam

19
20

J Conserv Dent.2010 Oct;13(4):


8.
21

J Conserv Dent.2010 Oct;13(4):


8.
Stocker 1900 s copper
amalgam

ADA specification No 1 was adapted for


amalgam in 1929.
22

J Conserv Dent.2010 Oct;13(4):


8.
Gayler ML. Dental amalgams.J Inst
Metals.1937;60:40719

Greener EH. Amalgam-yesterday, today and tomorrow.Oper


Dent.1979;4:2435.
23

J Conserv Dent.2010 Oct;13(4):


8.
In 1959, Dr. Wilmer Eames
recommended a 1:1 ratio
of mercury to alloy, thus
lowering the 8:5 ratio of
mercury to alloy that
others had recommended.
Eames WB. Preparation and condensation of amalgam with low
mercury alloy ratio.
J Am Dent Assoc.1959;58:7883

24

J Conserv Dent.2010 Oct;13(4):


8.
25

J Conserv Dent.2010 Oct;13(4):


8.
26
Amalgam wars

27
AMALGAM WARS-the
controversy
In 1841, the American Society of Dental
Surgeons declared that
the use of amalgam constitutes
malpractice

AMALGAM USE DECLINED

Dr. Christopher S. Brewster (1846) - condemned the use


of amalgam

28

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
1842 a belief prevailed that amalgam
exerted a vitiating influence upon the fluids
of the mouth and gives rise to an unhealthy
action in the gums.

1844 - the societys members were warned


that they were to sign a pledge NEVER TO
USE amalgam or they would risk being
expelled from the membership.

29

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
Townsend - gave his personal
directions for preparing the amalgam,
known as Townsends Amalgam.

In 1858, Townsend reversed his stance


on amalgam and recommended
removal of teeth that could not be
saved by gold.
In 1867, the St. Louis Odontological
Society unanimously adopted a
resolution to the effect that amalgam
was injurious and detrimental to
health AMALGAM

30
Dr. J. Payne in 1874, claimed that the dental
profession was poisoning thousands of people all
over the world from corrosive sublimate generated
in the mouth from amalgam plugs in the teeth.

IN 1883, DR. ALTON H. THOMPSON COMMENTED

The presence of amalgam with us is a tremendous


fact which we must accept 31

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
AMALGAM WARS
the first one

In 1845, American
Society of Dental
Surgeons condemned the
use of all filling material
other than gold as toxic,
thereby igniting "first
amalgam war'. The amalgam controversy-an evidence
32

based analysis ; JADA,Vol.132,march 2001


What ended the amalgam war??

33

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
Then came the second amalgam
war.

Controversy over amalgam use surfaced


again in 1926 and into the 1930's when a
German physician, Dr. Alfred Stock, showed
that mercury escaped from fillings in the
form of a dangerous vapor that could cause
significant medical damage.

34

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
During this Second Amalgam War, the
ADA vigorously defended silver
amalgam and its widespread use was
continued

35

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
36

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
1930
Charlie hospital in berlin
Committee no reason to
condemn newer silver tin
amalgams

37

Materials used in dentistry 1st edition


s.mahalakshmi
3rd amalgam war in 1980s

It was the Neurobiologist Mats Hanson,


Assosiate professor in physiology at Lund
University in Sweden, who in 1981 started
the fight against the authorities

38

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
3rd amalgam war in 1980s

39

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
3rd amalgam war in 1980s

40

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
but problem flared in 1990s by the
telecast of television program 60
minutes in CBC television
Dr murray from univ. of calgary

41
No clear end for 3rd
war

May 13- 1997


Safety was again
proved in media

42

Materials used in dentistry 1 edition


st

s.mahalakshmi
Current status on the
amalgam war

The amalgam war continues to


rage on today. some states
have already appointed
holistic/biological dentists to
dental boards, effectively
ending theADA monopoly on
state dental boards.

43

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
Current status on the
amalgam war
American Council on Health &
Science, has determined that
allegations against amalgam
constitute one of the greatest
unfounded health scares of recent
times

44

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
There is presently a congressional bill
in The United States House of
Representatives (H.R. 4163)
introduced by Rep. Diane Watson (D-
CA) and Rep. Dan Burton (R-IN) to ban
the continued use dental amalgam
fillings.

45

The amalgam controversy-an evidence


based analysis ; JADA,Vol.132,march 2001
STATEMENT ON AMALGAM-
ADA
"No controlled studies have been published
demonstrating systemic adverse effects from
amalgam restorations-FDI & WHO;1997

based on available scientific


information, amalgam
continues to be a safe and
effective restorative
material.-ADA;1998

"There currently appears to be no


justification for discontinuing the use of
dental amalgam.-ADA;1998
46

American Dental Association (ADA) Council on


Scientific
Affairs, Statement on dental amalgam, 2011,
47

American Dental Association (ADA) Council on


Scientific
Affairs, Statement on dental amalgam, 2011,
there were no statistically significant
differences in adverse
neuropsychological or renal effects
observed over the 5-year period in
children whose caries are restored
using dental amalgam or composite
materials- Journal of the American
Medical Association(JAMA)
andEnvironmental Health
Perspectives;2006
48

American Dental Association (ADA) Council on


Scientific
Affairs, Statement on dental amalgam, 2011,
49

American Dental Association (ADA) Council on


Scientific
Affairs, Statement on dental amalgam, 2011,
Classification of Amalgam
A) According to Alloyed
Metals
Binary alloy
(Ag-Sn)

Number
of
alloyed
metal
Quarternary
Tertiary
alloy
alloy
(Ag-Sn-Cu-
(Ag-Sn-Cu)
Zn) 50

Sturdevants Art & Science of Operative


Dentistry; 5th ed
B) According to shape of powdered
particle

Lathecu spheric
t al
Admixe
d
51

Sturdevants Art & Science of Operative


Dentistry; 5th ed
Particle Shape

Lathe cut Spherical


low Cu low Cu
New True Cavex SF
Dentalloy high Cu
high Cu Tytin, Valiant
ANA 2000

Admixture
high Cu
Dispersalloy, Valiant
PhD

52
C) According to copper
content

Low copper High copper


amalgam(<0- amalgam(>6-
6%) 13%)
53

Sturdevants Art & Science of Operative


Dentistry; 5th ed
D)According to zinc content
Zinc Non zinc
containing containing
alloy alloy
(>0.01-2%) (<0-0.01%)
54

Sturdevants Art & Science of Operative


Dentistry; 5th ed
E)Generations based on the
improvement in composition

1st 3Ag +
generation Sn
2nd 3Ag + Cu Zn
generation Sn Ag3C
3rd 3Ag +
uCu
generation
4th Sn
A Ternary
Sn upto
generation g alloy
29%
A C
5th Sn
Quaternary alloy In
g u
generation
A Eutectic
C 1st, 2nd, 3rd
6th Pd+ generation
g alloyu
55

generation
Components of dental
amalgam

Other
Zinc
Indium 56

Palladium Phillips Science of Dental Materials;11th


Silver(Ag)

57

Phillips Science of Dental Materials;11th


Tin(Sn)

58

Phillips Science of Dental Materials;11th


Copper(Cu)

59

Phillips Science of Dental Materials;11th


Zinc(Zn)

60

Phillips Science of Dental Materials;11th


Indium(In)

61

operative dentistry journal1992 Sep-


Palladium (Pd)
reduced corrosion `
greater luster
example
Valiant PhD (Ivoclar Vivadent)
0.5% palladium

62

Mahler J Dent Res 1990


Dental Materials Volume 15, Issue 6, November 1999,
Pages 382-389

Biomaterials, Volume 18, Issue 13, July 1997,


Pages 939-946
63
Mercury (Hg) - only
pure metal that is liquid
at room temperature

64

Phillips Science of Dental Materials;11th


Alloy Powder Composition

Type Ag Sn Cu Zn Other

Low copper 63-72 26-28 2-7 0-2

High-Cu admixed lathe-


cut 40-70 26-30 12-30 0-2

High-Cu admixed
spherical 40-65 0-30 20-40 0 0-1 Pd

High-Cu single spherical


0-5 In,
40-60 22-30 13-30 0
0-1 Pd

compositions in weight percent

65

Sturdevants Art & Science of Operative


Alloy Powder: Dispersalloy

Silver
69%

Zinc
1% Copper Tin
12% 18%

Mixing proportions: 50% alloy, 50% mercury


66

Sturdevants Art & Science of Operative


Alloy Powder: Tytin

Silver
59%

Tin
Zinc 13%
0%
Copper
28%

Mixing proportions: 57.5% alloy, 42.5% mercury


67

Sturdevants Art & Science of Operative


Phases in Amalgam Formula
Alloys and Set Dental
Amalgams
Ag3Sn
Ag2Hg3
Sn7-8Hg
Ag4Sn (silver-rich)
Cu3Sn
Cu6Sn5
Silver-copper Ag-Cu
eutectic
68

Phillips Science of Dental Materials;11th


BASIC COMPOSITION
A silver-mercury matrix containing filler particles
of silver-tin.

Filler (bricks)
Ag3Sn called gamma can be in various
shapes irregular (lathe-cut), spherical or a
combination of both.

Matrix
Ag2Hg3 called gamma 1 - cement
Sn7Hg called gamma 2 - voids

Ag3Sn
Ag2Hg3
69

Sn7Hg8
70
In low copper conventional amalgam alloy.

Ag3Sn + Hg Ag2Hg3 + Sn7-8Hg + Ag3Sn


( ) ( l) ( 2) ( ) (unreacted)

71
ADMIXED ALLOYES AND UNICOMPOSITIONAL ALLOYS

Ag3Sn + Hg Ag2Hg3 + Sn7-8Hg + Ag3Sn


() (l) (2) () (unreacted)

Ag3Sn + Ag-Cu + Hg Ag2Hg3 + Sn7-8Hg + Ag3Sn +Cu3Sn + Cu6Sn5 + Ag-Cu


1 + 2 1 2
1 + 2

After
Ag3Sn + Ag-Cu + Hg Ag2Hg3 + Ag-Cu +Cu3Sn + Cu6Sn5 + Ag3Sn.
One week

1 + 2 1 1 + 2

After
Ag3Sn + Ag-Cu + Hg Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5
One year

1 + 2 1 + 2 1
72
Unicompositional

Ag3Sn + Cu3Sn + Hg Ag2Hg3 + Cu6Sn5 + unreacted alloy particles



1

73
Silver-Tin (Ag - Sn) System

Most commercial alloys fall within the limited composition


range of B to C i.e ( + ) and
If Sn > 26.8 wt% + Sn-rich phase is formed. 74
Conventional Low-Copper
Alloys

Dissolution and precipitation


Hg dissolves Ag and Sn
from alloy
Intermetallic compounds
formed

Ag3Sn + Hg Ag3Sn + Ag2Hg3 + Sn8Hg


1 2 75

CRAIGs Restorative Dental


Gamma ( ) = Ag3Sn
unreacted alloy
strongest phase and
corrodes the least
forms 30% of volume
of set amalgam

Gamma 1 ( 1) = Ag2Hg3
matrix for unreacted alloy
and 2nd strongest phase
60% of volume
76

CRAIGs Restorative Dental


IMPORTANCE OF 2 PHASE:-

Sn Hg in a set amalgam may be reduced in


8
quantity or even eliminated by the
presence of phase (Cu3Sn)

Potentially valuable reaction for several


reasons:-

tin act as a most electropositive


element present in absence of Zn, so
with high activity in the 2 phase, it
makes the most electropositive phase,
hence the most easily corroded 77

Materials science for


dentistry;9th ed B.W.Darvell
2 phase is extremely
weak & soft, deforming
readily & the strength of
amalgam is limited by its
presence

Contributes to static creep


of amalgam 78

Materials science for dentistry;


B.W.Darvell
Scanning electron microscopic view of SnHg (2) crystals, that occurs
in the matrix of set low copper amalgam

79

Sturdevants Art & Science of Operative


COPPER

Improves strength of the resulting amalgam


But if in excess, leads to expansion on setting

80

Materials science for dentistry;


B.W.Darvell
Depending on its quantity & amt of Sn in the alloy, it
may present as:-
1.Cu3Sn (-phase)
2.Cu6Sn (-phase)

As solubility of Cu in and 1 phase is low, thus


Cu-Sn
phase formed during setting process will probably be
phase

81

Materials science for dentistry;


B.W.Darvell
SLOW
REACTIONS
The reaction rate of or phase Ag-Sn with Hg is
sufficiently fast that the 2 phase is always formed
initially, but Cu3Sn ( phase) & 2 phase cannot exist
together for long & relatively slow reaction must occur.

+ 2 +
(Hg)

82

Materials science for dentistry;


B.W.Darvell
This is at relatively low rate because
it is a solid state reaction

Also the 2 phases will be distributed


as small grains throughout the
amalgam without necessarily touching
, & all diffusion of metal atoms must
be through other phases or grain
boundaries
83

Materials science for dentistry;


B.W.Darvell
In the long term the conversion of
1 to 1 may occur in the presence
of unreacted phase alloy
+ 1 1

84

Materials science for dentistry;


B.W.Darvell
In the presence of excess Hg ( in
terms of reaction with Ag-Sn
phases),namely the decomposition of
Cu-Sn phases to give the phase
Cu7Hg6 (2 phase) occurs.
, (IN Presence of EXCESS
Hg) 2 + 2

85

Materials science for dentistry;


B.W.Darvell
Added Cu

As >6% Cu - excessive expansion not


included in conventional

extra Cu (admixed alloy),the difficulty may


be avoided

86

Materials science for dentistry;


B.W.Darvell
One such second alloy is eutectic
of Ag-Cu system;this corresponds to
composition 3Ag.2Cu
+ 1 + 2 + 1

The elimination of 2 phase


improved properties - compressive
strength.

87

Materials science for dentistry;


B.W.Darvell
High copper admixed alloy

1. Ag3Sn + AgCu + Hg Ag2Hg3 + Sn8Hg +


Ag3Sn + AgCu
( ) (1 ) (2 )
( )

2. Sn8Hg + AgCu Cu6Sn5 + Ag2Hg3


+ Ag3Sn
(2) ( ) (1 )
( )
88

CRAIGs Restorative Dental


High copper
unicompositional alloy

Ag3Sn + Cu3Sn + Hg Cu6Sn5


+ Ag2Hg3
( ) () () 89

(1 )
CRAIGs Restorative Dental
Microstructure of Set Low Copper
Amalgam.

(Ag3Sn)
2(Sn8Hg)
Voids

1(Ag2Hg3)

90
Microstructure of Set High-Copper
Admixed Amalgam.

1(Ag2Hg3)
Eutectic(Ag3C
u2)
(Cu6Sn5)

(Ag3Sn)

91
Manufacture of alloy powder
Lathe cut alloy powder

92

Materials science for dentistry;


B.W.Darvell
Spherical alloy powder
Produced by atomizing the molten alloy in a chamber
filled with an inert gas- argon

Molten metal falls through a distance of approximately


30 feet and cools

Results in characteristic spherical particle shapes.

If particles are allowed to cool before they contact the


surface of chamber, they are spherical in shape. If they
are allowed to cool on contact with the surface they are
flake shaped.

Particle size ranges form 5 to 40 microns 93

Materials science for dentistry;


B.W.Darvell
A. Lathecut
alloy
B. Spherical
alloy 94

C.Dental
Phillips Science of Admixed
Materials;11 th
95

Phillips Science of Dental Materials;11th


Temperatur
e

for Ag-Sn: if Cu if Zn
present: 465 present:
480 degree degree lower it
Celsius celsius further

The time of heat treatment may vary


depending on the temp. used & size of
ingot, but 24 hr at the selected temp.(350
to 450 C) is usual. 96

Phillips Science of Dental Materials;11th


At the end of heat treatment:-

97

Phillips Science of Dental Materials;11th


Particle(surface) treatment

98

Phillips Science of Dental Materials;11th


The aging is related to relief of
stress in the particles during the
cutting of the ingot
(Phillips Science of Dental Materials;11th ed )

The alloy particles are aged by


subjecting them to a controlled
temperature of 60-100 degree
celsius for 1-6 hrs
(Craigs restorative dental materials,12th ed)
99
PARTICLE SIZE

100
Properties of amalgam

ANSI/ADA specification No.1 for


amalgam alloy contains certain
requirements:-

1. Maximum creep value of 3%

2. Minimum Compressive strength of 80 MPa at 1 hr when a


cylindrical specimen is compressed at a rate of
0.25mm/minute

3. Dimensional change between 5 min & 24 hrs after trituration, 101

should fall within a range of 20m/cm at 377 7C.

CRAIGs Restorative Dental


DIMENSIONAL CHANGES

102

Materials science for


dentistry;9th ed
103

20m 20m 20m 20m


High-Cu, admixed

High-Cu, single comp.

Low-Cu

104
If amalgam expanded during
hardening, leakage around the
margins of restorations would be
eliminated.

105
Shrinkage
when alloy & mercury are mixed ,contraction results as
particles begin to dissolve & 1 crystals grow

8Ag3Sn + 31Hg
(823.5ml/mol)=6Ag4Hg5 + Sn8Hg

(774.9ml/mol)

Thereby a decrease of 5.9% by


volume, or 2.0% by length (effect of
solidification of mercury) 106

Materials science for


dentistry;9th ed
Evidently the detrimental effect of
shrinkage occurs only when the amalgam
mass shrinks > 50 m.

107
LOSS OF GLOSS
Shrinkage due to reaction will
initially cause a decrease in the bulk
volume, but once contacts between
alloy particles or new crystals
interfere with this Hg will be
withdrawn into the mass, leaving
behind outline of the alloy particles.

108

Materials science for


dentistry;9th ed
The failure of any amalgam to provide a
marginal seal is due to the shrinkage of the
liquid mercury on reaction & surface
tension(a,b) 109

Materials science for


dentistry;9th ed
The surface thus produced clearly
cannot be in direct contact with the
cavity wall & a leakage path exists
which survives even if there is
subsequent expansion

110

Materials science for


dentistry;9th ed
The effect infact lead to loss of gloss -
frosted or sand blasted appearance.

Leakage path - surface tension of mercury

111

Materials science for dentistry;9th ed


B.W.Darvell
EXPANSION

crystal growth pressure


If sufficient Hg expansion occurs as a
result of growth of 1 crystals

112

Materials science for


dentistry;9th ed
DELAYED EXPANSION

113

Materials science for


dentistry;9th ed
Hydrogen is produced by electrolytic
action involving zinc & water

H2 doesnt combine with the amalgam


rather it collects within amalgam,
increasing internal pressure of
amalgam leading to expansion

114

Materials science for


dentistry;9th ed
Delayed expansion

115

Materials science for


dentistry;9th ed
STRENGTH

A)Compressive strength
)strongest in compression & much weaker
in tension & shear

)result function as a brittle material

116

Phillips Science of Dental Materials;11th


amalga Compressive strength
(Mpa)
m
1 hr 7 days

Low copper 145 343


Admix 137 431

Single 262 510 117

composition
B) Tensile strength
cannot withstand high tensile or
bending stresses
amalgam Tensile strength
( Mpa)

Low copper 60
Admix 48
Single 64
composition 118

Phillips Science of Dental Materials;11th


Factors affecting strength

1) Effect of trituration

-depends on the type of amalgam


alloy, the trituration time & the
speed of amalgamator

-either under or overtrituration


decreases the strength in both
traditional & high copper amalgams
119

Phillips Science of Dental Materials;11th


2) Effect of mercury content

sufficient mercury
should be mixed with
the alloy to wet each
particle of the alloy

dry granular low mercury


high mercury contentmore
mixrough &
contentmore unreacted AgSn
pitted
2 phase particlesimpar
surfacecorrosion
ts strength to
restoration
120
3) Effect of
condensation
-good condensation techniques express
mercury & results in smaller volume
fraction of matrix phases

-in lathe cut alloys, higher condensation


pressure results in higher compressive
strength, particularly the early
strength(at 1 hr)

-on the other hand spherical amalgams


condensed with lighter pressures
produce adequate strength 121

Phillips Science of Dental Materials;11th


4) Effect of porosity
-voids & porosities reduces strength
-porosity is caused by:-

a. decreased plasticity of the mix


(due to low Hg/alloy ratio, delayed
condensation, undertrituration)

b. inadequate condensation
pressure(results in inappropriate
adaptation at the margins & increase 122

number of voids)
Phillips Science of Dental Materials;11th
c.irregularly shaped particles of alloy
powder

d. insertion of too large increments

-voids very less - with spherical


alloys

123

Phillips Science of Dental Materials;11th ed


5) Effect of rate of
hardening

-amalgams do not gain strength as


rapidly as might be desired

-at the end of 20min,compressive


strength may be only 6% of 1 wk
strength

-ADA stipulates a min of 80MPa at 1 hr


124

Phillips Science of Dental Materials;11th


-the 1 hr compressive strength of
high Cu single composition
amalgams is relatively high
compared with admixed high Cu
amalgams

-patients should be cautioned not


to subject the restoration to high
bitting stresses for atleast 8 hrs
after placement ,by that time a
typical amalgam has reached at
least 70% of its strength
125

Phillips Science of Dental Materials;11th


even after 6 months ,some
amalgams may still be
increasing in strength,
suggesting that the
reactions between matrix
phases & the alloy particles
may continue indefinitely

126

Phillips Science of Dental Materials;11th


Strength of various phases

By studying the initiation &


propagation of crack in a set
amalgam strength studied
metallographical microscope
The propagation of the crack can be
halted & the specimen etched to
identify the various phases

127

CRAIGs Restorative Dental Materials;12th


Results of such studies have led to
the following ranking of different
phases of a set low copper amalgam
from strongest to weaker:
Ag3Sn(),silver-Hg phase(1),tin-
Hg phase(2) and the voids

In high copper amalgams, there is


preferential crack propagation
through the 1 phase & copper
containing particle
128

CRAIGs Restorative Dental Materials;12th


End of part 1

129

Thank you..
CREEP

Defined as time dependent strain or


deformation produced by stress(as
in Phillips)

Creep of dental amalgam is a slow


progressive permanent deformation of set
amalgam which occurs under constant
stress(static creep) or intermittent
stress(dynamic creep)

130

Phillips Science of Dental Materials;11th


Creep is related to marginal breakdown
of low copper amalgams

Higher the creep, the greater is the


degree of marginal
deterioration(ditching)

131

Phillips Science of Dental Materials;11th


According to ADA sp. No.1 creep
should be below 3%

creep values:-
-low copper amalgam:0.8-8%
-high copper amalgam:0.1-1%

132

Phillips Science of Dental Materials;11th


spec. #1: creep rate < 3%
Creep rate has been found to correlate with
marginal breakdown of conventional low-copper
amalgams.

133
crostructure Vs. Creep

Low-Cu Larger volume Larger grain


fraction sizes

Presence of

High-copper amalgams have creep resistance:-


lack of gamma-2 phase.
(Cu6Sn5) embedded in
Single composition
spherical 1 grains and interlock

(Cu6Sn5) around Ag-Cu


Admixture
134

particles improves bonding to



Factors influencing creep:

High CREEP Low CREEP

Large 1 volume fraction


smaller 1 grain sizes
Larger 1 grain sizes
Phases of
amalgam
restorations
phase which act as
2 associated with high barrier to deformation of 1
creep rates. phase.
135

Materials science for dentistry;9t


B.W.Darvell0
Effect of manipulative
variables

For increased strength & low creep values:-

Mercury alloy ratio should be minimum

Condensation pressure should be maximum for lathe cut


or admixed alloys

Careful attention should be given towards timing of


trituration & condensation

136

Phillips Science of Dental Materials;11th


Compressive % Creep Tensile Strength
Strength (MPa) (24 hrs) (MPa)

Amalgam Type 1 hr 7 days

Low Copper1 145 343 2.0 60

Admixture2 137 431 0.4 48

Single Composition3 262 510 0.13 64

1
Fine Cut,
Caulk 2
137
Dispersalloy,
Caulk
Phillips Science of Dental Materials 2003
3
Tytin, Kerr
MICROLEAKAGE OF AMALGAM

Poor condensation
The 2 to 20micron-
techniques -
wide gap
marginal voids

Lack of corrosion Coefficient of


by-products thermal expansion

Single-composition-spherical alloys which


leak more - do not adapt as well to the
margins 138
Penetration of fluids & debris around
the margins may cause secondary
caries

If the amalgam restoration is inserted


properly, leakage decreases as the
restoration ages in mouth due to the
corrosion products that forms in the
tooth-restoration interface

Thus amalgam is the self sealing 139

restoration Phillips Science of Dental Materials;11th


Both low & high copper amalgams
are capable of sealing against
microleakage but the accumulation
of corrosion products is slower with
the high copper alloys*

*Corrosion sealing of amalgam restorations -in


vitro study
Oper Dent. 2009 May-Jun;34(3):312-20.
140
The sealing ability of different types of
dental amalgams when used as retrograde
fillings with and without a cavity varnish
was studied.

Of the materials tested, a copper-


containing spherical amalgam gave the
best results.

Regardless of material used, the apical seal


was significantly improved when a varnish
was applied to the cavity prior to the
placement of the retrograde amalgam
filling

141
Journal of Endodontics
Volume 9, Issue 12, Pages 551-553, December 1983
THERMAL EXPANSION
AND CONDUCTIVITY
Thermal expansion Thermal conductivity
coefficient E 10-6 / C K 10-6 / C(mm2/s)

Amalgam 22-28 9.4


Composite resin 20-60 0.25
GIC 10-11 0.15-0.35
Tooth 11.4 0.18-0.47

E = volume expansion for unit rise in temperature


K = quantity of heat passing per s through a block of unit thickness
and cross sectional area for a temp. difference of 1C
142

CRAIGs Restorative Dental Materials;12th


CHEMICAL PROPERTIES
Dental amalgam restorations undergo both
chemical and electrochemical corrosion.

TARNISH AND CORROSION

Tarnish : is a surface discolouration on a metal or


even a slight loss or alteration of the surface
finish or luster.

Corrosion : is an actual deterioration of a metal by


reaction with its environment.
143

CRAIGs Restorative Dental Materials;12th


The degree of tarnish depends on :

i. The oral environment

ii. The type of alloy used

144

CRAIGs Restorative Dental Materials;12th


In dental practice , a limited amount of
corrosion around the margins of amalgam
restorations may be beneficial, since the
corrosion products tends to seal the
marginal gap & inhibit the ingress of
fluids & bacteria

But excessive corrosion can lead to


increased porosity, reduced marginal
integrity, loss of strength & the release of
metallic products into the oral
environment
145

CRAIGs Restorative Dental Materials;12th


Liberation of
corrosion products

GAP

146

CRAIGs Restorative Dental Materials;12th


Electrochemical measurements on
pure phases
Ag2Hg3(1)
(highest Ag3Sn() Ag3Cu2
corrosion
resistance)

Sn7-8Hg(2)
(least corrosion Cu6Sn5() Cu3Sn(),
resistance)

147

CRAIGs Restorative Dental Materials;12th


The p/o small amounts of tin,
silver & copper that may
dissolve in various amalgam
phases has a great influence on
their corrosion resistance

148

CRAIGs Restorative Dental Materials;12th


The higher content of tin ,
less the corrosion resistance

The tin content of the 1


phase is higher for low
copper alloys than for high
copper alloys
149

CRAIGs Restorative Dental Materials;12th


The p/o a relatively high %age of tin in low copper alloys
reduces the corrosion resistance of their 1 phase so its
lower than their phase

This is not true for high copper alloys

150

CRAIGs Restorative Dental Materials;12th


Chemical Corrosion :

Occurs most notably on the


occlusal surface and produces a
black amalgam silver tarnish film

Corrosion products are mainly


oxides and chlorides of tin.

151

CRAIGs Restorative Dental Materials;12th


Electrochemical corrosion

Chemically different sites act as anode or


cathode.

Electrolyte (saliva)

The anode corrodes, producing soluble and


insoluble reaction products.

Ag2Hg3 phase has the highest corrosion resistance, followed


by Ag3Sn, Ag-Cu, Cu3Sn, Cu6Sn5 and Sn7-8Hg.
152

CRAIGs Restorative Dental Materials;12th


LOW COPPER ALLOYS low
corrosion resistance
Most corrodible phase is tin-mercury or 2 phase

The average depth of corrosion for most


amalgam alloys is 100-500 m.

Even though, a relatively small portion (1- 13%)


of the amalgam mass consists of the 2 phase, in
an oral environment, the structure of such an
amalgam will contain a higher percentage of
corroded phase 153

CRAIGs Restorative Dental Materials;12th


The corrosion results in the formation of tin
oxychloride, from the tin in 2 and also
liberates Hg.
Sn7-8Hg + 1/202 + H2O + Cl- Sn4 (OH) 6 Cl2 + Hg
Tin oxychloride

Unreacted 1 and 2

( Mercuroscopic Expansion )

Additional l and 2 result in porosity and lower strength.


Additional l and 2 result in porosity and lower strength.

154

CRAIGs Restorative Dental Materials;12th


THE HIGH COPPER ADMIXED
AND UNICOMPOSITION ALLOY

No 2 phase in the final set mass.

The phase formed with high copper alloys is


not an interconnected phase such as the 2
phase, and it has better corrosion resistance.

phase is the least corrosion resistant phase in


high copper amalgam - corrosion product
CuCl2.3Cu (OH)2

Cu6Sn5 + 1/202 +H2O + Cl- CuCl2.3Cu (OH)2 + SnO.

155

CRAIGs Restorative Dental Materials;12th


Surface tarnish of low copper
amalgams is more associated with
than 1 phase, whereas in high
copper amalgams surface tarnish is
related to the copper rich phases, &
silver-copper eutectic

156

CRAIGs Restorative Dental Materials;12th


Galvanic corrosion
If dental amalgam is in direct contact with
an adjacent metallic restoration such as gold
crown, the dental amalgam is the anode in
the circuit.

Between titanium High copper dental Gallium direct


and direct filling amalgams when in filling alloys
alloys contact with Ti galvanic
Small galvanic little galvanic interaction
interaction corrosion more
detrimental

157

Dental Materials, Volume 15, Issue 5, September 1999, P


Crevice Corrosion:
Local electrochemical cells may
arise whenever a portion of
amalgam is covered by plaque on
soft tissue. It behaves anodically
and corrodes. If these occur in
cracks or crevice, it is called crevice
corrosion.
Stress Corrosion:
Regions that are under stress display a
greater probability for corrosion, thus resulting
in stress corrosion.
For occlusal dental amalgam greatest 158

combination of
CRAIGs Restorative Dental Materials;12th
159

Sturdevants Art & Science of Operative


Factors related to excess tarnish & corrosion

Surface
High residual texture-small
mercury scratches &
exposed voids

Contact of Moisture
dissimilar contamination
metals, eg. gold during
& amalgam condensation

Type of alloy-
low cu
alloy>high cu
alloy 160

CRAIGs Restorative Dental Materials;12th ed


Corrosion of amalgam can be
reduced by:-

Smoothening & polishing the restoration


Correct mercury/alloy ratio & proper manipulation
Avoid dissimilar metals including mixing of high & low
copper amalgams

161
Manipulation of
dental amalgam

162
How to select an alloy ??
Set Par
tin ticl
g e
tim siz
e
e Par
ticl
e Comp
osiitio
sh n
ap
e
Elimi
natio
n of
Zin
2 c 163

phase
Aim at High strength
achievi
ng Minimal dimensional change

Lowest creep

Good condensation

High corrosion resistance

Good finishing and polishing


164
Mercury alloy ratio

Earlier
excess Current
mercury minimum
mercury

165
Eames technique -
minimum mercury and
alloy 1:1 ratio

50 %
Lathe cut Spheri
cal 42
%

166
proportioning
Pre weighed
Manual Capsules (48 to
55%)

167
168
Equipment for hand mixing of alloy powder and Equipment for mixing of alloy pellets and
mercury in mortar and pestle using excess controlled mercury in reusable capsules
mercury.( 1900 to 1940 ) with mechanical mixing in amalgamator
(1940 to 1970 )

169
Capsules

Disposable Self activating Reusable Pre


proportioned

170
Size of mix

Single mix 400 mg

Single mix 600 mg

Double mix 800 mg

Amalgam core -
1200 mg
171
Trituration

Defined as process of grinding


powder, esp. within a liquid.
In dentistry, the term is used to
describe the process of mixing the
amalgam alloy particles with
mercury in an amalgamator
172
Objectives

To wet allot particles


Surface should be clean
Rubbing Removes oxide layer
173
Hand mixing
Mechanical mixing
174
Hand

Number of rotations
Speed of rotation
Magnitude of pressure 25 to
45 secs
175
Mechanical mixing

Amalgamator or trituration
Capsule mortar
Piston pestle

176
Amalgamators or triturators

SPEED TIME

ENERGY = Speed x Time


177
Coherence time ( Tc )

Minimum mixing time


required for formation of a
single coherent pellet
5 tc is ideal
178
Variations of mixing time

shape of Particles
Size of mix
179
Advantages of mechanical trituration

Efficient
Short time
Standardised
Less mercury
180
Variations of trituration

Under Normal Over


Soupy
Rough grainy Shiny
difficult to remove
May crumble Smooth & soft from capsule
Becomes hard Warm when Too plastic to
soon removed from manipulate
Excess mercury capsule Decreased working
time
Tarnish and Besty
compressive and Higher contraction
corrosion of amalgam
tensile strength
Low strength Increased creep
Increased tarnish
and corrosion Strength of lathe
cut alloys increased
resistance &
181
reduced for high
copper amalgam
Mulling
Continuation of trituration
Hand with rubber dam or
glove
Mechanical pestle free
capsule
Coherent, consistent and
homogenous mix 182
Condensation

To achieve greatest possible density


Sufficient mercury only remains
To enhance matrix phase
Should enhance
Adaptation to walls and margins
Homogenous bulk
Excess mercury removal
Minimum voids
183
Modes of condensation

Manual
Mechanical - pneumatic &
electrical

184
185
Technique of condensation

Absolute isolation
Small increments
3-4 lbs pressure on average
From smaller to larger condensers
Centre to walls
Overfill by 1 mm
remove excess mercury on surface
186
Lathe cut high mercury
greater forces and large
condensers
Spherical low mercury low
condensation pressure
187
Pre carving burnishing

Form of condensation
adaptation to margins
Burnishers - heavy strokes
larger condensers centre to
beyond margins
188
189
Carving

Only after attaining adequate strength


Scraping or ringing sound
Cleoid discoid , hollenbeck , wards ,
diamond carvers
Embrasures - triangular fossa remove
flash - inclined planes occlusal fosa
carved
Check centric occlusion
190
Mostly pulling strokes
Pushing strokes for occlusal
anatomy
70 to 90 degree angle to
preserve bulk at margins
Under carving grown out
appearance 191
Post carve burnishing

Light rubbing of carved surface with burnisher


Which improves
Smoothness and shiny appearance
Denser amalgam with more compaction
Sealing at margins
Both pre & post carve burnishing improve adaptation

192
Finishing and polishing

Refine anatomy ,contours and


marginal integrity
Resistance to tarnish and corrosion
24 hrs after restoration
Spherical high copper 8 to 12 hrs
193
Pumice mixed with tin oxide slurries is
used

Rubbere cup ,wheel , brush used


Temperature should be < 60o

194
Quality of dental amalgam

Manufacturer composition , heat


treatment , particle nature
Operator selection , mercury alloy
ratio, dispensing , trituration ,
restorative technique ,cavity design ,
marginal integrity , final finishing
195
Failure of amalgam restoration

Secondary / recurrent caries


Marginal fracture / marginal ditching
Bulk fracture of tooth or amalgam
Dimensional change
Tarnish and corrosion
Pain succeeding amalgam restoration
Proximal overhangs
Poor contouring / marginal ridge incompatibility

196
Reasons for failure

Improper case selection


Improper cavity preparation
Improper manipulation
Improper isolation
197
Removal of old amalgam restoration

Rubber dam
Charcoal and vacuum suction
Thorough patient protection and
operator protection
Newer burs recommended
Better to section and scoop out
198
199
Amalgam blues

200
Amalgam tattoo

201
Recent advances in dental amalgam

Bon
ded
Galli amal
um Low
Indiu merc gam
bas m
ury
contai
ed ning amal
allo alloy gam
powd
ys
Conso er & fluor
lidate binar ide
d y Hg
silver - In cont
alloy syste ainin
syste m g
m amal
gam

202
Gallium based alloys

Mendeleef in 1871
De boisbandran 1875
Putt kammer 1928 replacement
for Hg

203
Gallium

Liquid at room temperature


Lowered melting point with addition of
In and Sn
Trade names
Galloy
Bayswater
Gallium GF
Gallium GF II 204
Composition
Silver 60.5%

Tin 24.5%
Copper 12.3 %
Indium 2.7 %
Liquid
Gallium 65 %
Indium 19 %
Tin 16 %
205
Reaction

AgSn + Ga --------------------- AgGa


+ Sn

206
Properties

207
Advantages

Low creep
Adequate compressive strength
Polishing on same day possible
Good wear resistance
Heat resistant
Good marginal seal
208
Disadvantages

Excessive expansion post operative sensitivity


Difficult to manipulate
Instrument cleaning is difficult
Low corrosion resistance
High cost

209
Recent studies indicated

More corrosion permite Ga o


2 3 & tin oxide
More roughness than amalgam
Low edge strength

210
Consolidated silver alloy system

National institute of standards & technology


Silver alloy particles in dilute fluoro boric acid solution
Alloy surfaces are very clean
Similar to direct filling gold restoration
Strain hardening is needed
Excessive forces to achieve void free compaction

211
Indium containing alloy powder &
binary mercury indium liquid alloy

Powell et al in 1989 indium to alloy and mercury


Reduced mercury release
Indium oxide and tin oxide
Indisperse and indilloy
Less cytotoxic than original
Increased strength
Less mercury needed
Low creep value
212
Fluoride containing amalgam

Innes & youndelis in 1966 , serman in 1970 , stone in 1971


Possible mechanisms are
Dissolution of salt crystals in contact with materials
Through corrosion products fluoralloy
Slow releasing device

213
Clust summall phaseall
Minimax
Aristoloy
oy oy CR
er

214
CuF InF SnF CaF
2
2 3 2

215
Low mercury amalgam

Alloy particles are pre condensed by manufacturer


Requires less mercury

216
Bonded amalgams

Baldwin technique amalgam on zinc phosphate cement


GIC and polycarboxylate were tried
4 META ,10 MDP ,BIS GMA was tried recently
Based on dentin bonding system of nakabayashi
Bond strength upto 12 to 15 Mpa can be achieved
Spherical - bond strength more than admix
Longevity is not enhanced

217
C & B METABOND
PANAVIA 21
ALL BOND 2
SCOTCH BOND
MULTIPURPOSE
AMALGABOND
PLUS
Bonding procedure

Excess Thin film of


Self etching
primer adhesive
primer
removed resin placed

Amalgam
Finishing & Anaerobic placed
Polishing adhesives directly onto
unset resin
218
219
Indications

Auxiliary retention &


reinforcement
Improvement of marginal seal
necessary
Posterior teeth extensive caries
Low gingivo occlusal height
Core for cast crowns 220
Advantages

More conservative preparation


Reinforce tooth
Minimize microleakage
Low Incidence of marginal fracture
Cost effective
221
Disadvantages

Highly technique sensitive


Reduced mechanical
properties
Questionable hydrolytic bond
stability
Longterm results not
confirmed yet 222
Mercury considerations

Mercurodontics ??

223
Mercury A Global Issue

Mercury distribution
and exposure is a
global problem
Side effects of mercury

Allergy
Toxicity
225
Types of mercury

Inorganic Organic
Elemental
mercury mercury
Dental Mercury salts Methyl
Pure Mercuric mercury
Dermal or chloride , More potent
inhalational iodide and bio
Long-term ,cinnabar accumulative
exposure or Corrosive Humans are
one large Hepatic primarily
exposure damage exposed
Folk
medicine
Skin irritation 226

staining
Normal daily intake of mercury

15 micro.g from food


1 micro.g from air
0.4 micro.g from water
227
228
Mercury released during manipulation

229
TLV at 8 hours/day or 40 hours /week

O.o5 mg / m 3
(much lower concentration in dental
office )
maximum limit in urine and saliva 0.15 mg / lt
maximum limir in blood is o.30 mg/lt

230
Toxic reactions of mercury
Microgra
ms /kg Reactions
body wt
3 to 7 Lowest dose to elicit
100 Decreased brain activity & verbal
skills
500 Paraesthesia, irritability , depression
,tremors
1000 Ataxia, kidney inflammation, swollen
gums,
Excessive tremors
2000 Joint pain
4000 Hearing loss & death 231
Minamata disease (1952)

232
Mercury hygiene considerations

While manipulating
While restoring
While removing
233
Amalgam Separator
Technologies on the Market

Sedimentation
Filtration
Chemical filtration (e.g., chelation)
Centrifuging
Combination of above technologies
Typical Amalgam Separator Installation
Locations

1= inline, chairside
2= inline, central,
before separator Dental operatories
3= outlet side, air
Air water separator
Exhaust

Basement 2a Dry system


or utility 1
closet
Wet system
2

3 Wastewater
to sewer
Vacuum
pump
Air water separator
Present amalgam status

237
Future????????

238
To conclude

239
Thank you..

240