MANAGEMENT OF

BADLY BROKEN DOWN

TEETH (II)
Dr. Nasrien Ateyah

PIN-RETAINED AMALGAM
RESTORATION

Defined as any restoration requiring the

placement of one or more pins in the
dentin to provide adequate resistance and
retention forms.
Used whenever adequate resistance and
retention forms cannot be established
with slots, locks, or undercuts only.
It has a greater retention than those using
boxer or relying solely on bonding system.

PIN-RETAINED AMALGAM
RESTORATION

It is indicated for tooth with

extensive caries or fractures.

Rarely used in anterior teeth

(Bonding Technique).

In class V is rare (horizontal groove

in the gingival & occlusal aspect).

ADVANTAGE

Conservation of tooth structure

Save time vs. cast restoration

Economic

Provide resistance & retention form

DISADVANTAGE

Dentinal microfracture or crazing

Microleakage around pin

strength of amalgam

Perforation of the pulp or external tooth

structure

TYPE OF PINS
Cemented

1.

Larger than other pin

Use Zn Ph cem or Zn Polycar cem

Friction locked pins

2.

Smaller
Retained by resilience of dentin
retentive than cemented pin

With time dentin relax loose pin

TYPE OF PINS
Self-threading pin (TMS)

3.

Different size
Threads engage dentin
Depend on elasticity of dentin
Most retentive (3-6 times)
No corrosion (gold plated)
Create horizontal & vertical stress
Cause dentinal craze line (size of pin)

MOST CURRENTLY MARKED PINS

HAVE:

Metal thread separated

Wider dentinal thread retained well in
dentin
Shoulder stop (to prevent putting stress
at the end of pin channel)

TMS PIN (THREAD MATE SYSTEM)

Regular 0.031 inch diameter

Minim

Minikin 0.019 inch diameter

Minuta 0.017 inch diameter

0.024 inch diameter

TMS PIN (THREAD MATE SYSTEM)

Available in

Double shear (two pins in one)

Gold plated, stainless steel or

titanium alloy

Inserted manually or with low-speed,

latch-type handpiece

FACTORS AFFECTING THE

RETENTION OF THE PIN IN DENTIN
AND AMALGAM
Type of pin

Self-threading most retentive

Friction-locked intermediate
Cemented least

Surface characteristics

Number & depth of the elevation on the pin

(serration or thread)

Shape of self-threading pin greatest retention

FACTORS AFFECTING THE RETENTION OF

THE PIN IN DENTIN AND AMALGAM

Orientation, number and diameter

Non-parallel pin - retention

Bending of pin not desirable
Interfere with condensation of amalgam
Weaker pin, fractured dentin

no. of pin - retention

crazing & fracture

amount of dentin available
amalgam strength

FACTORS AFFECTING THE RETENTION OF THE PIN

IN DENTIN AND AMALGAM

diameter of pin retention

no. , diameter, depth

Danger of perforation on pulp or
external tooth surface
Interfere with condensation of amalgam
and adaptation to pins

Extension into dentin and amalgam

Retention is not increase when depth of the pin

2mm in dentin fracture of dentin
If 2mm in amalgam fractured amalgam

PIN PLACEMENT FACTORS AND

TECHNIQUES

Pin Size

Depend on the amount of dentin available and

amount of retention desired.

TMS pin of choice is Minikin (0.019 inch)

and Minim (0.024)

Minikin risk of:

Dentin crazing
Pulpal penetration
Potential perforation

PIN PLACEMENT FACTORS AND

TECHNIQUES

Number of Pins
Several factors must be considered:

Amount of tooth structure

Amount of dentin available to receive pin

safely

Amount of retention required

Size of the pin

PIN PLACEMENT FACTORS AND

TECHNIQUES

Number of Pins
As a rule one pin/missing axial line angle

should be used
Excessive number of pins
fracture the tooth
weaken the amalgam restoration

PIN PLACEMENT FACTORS AND

TECHNIQUES

Location
Several factors aid in determining pinhole
location:
1.

2.
3.
4.

Knowledge of normal pulp anatomy &

external tooth contour
Current radiograph of the tooth
Periodontal probe
Patients age

SOME CONSIDERATIONS:

Occlusal clearance should be sufficient to

provide 2mm of amalgam over the pin.

Pinhole should be located halfway

between the pulp and DEJ
(0.5-1 mm inside DEJ)

At least 1 mm of sound dentin around the

circumference of the pinhole.


Such location ensures proper stress

distribution of occlusal force
Pinhole:

Should be located near the line angles

of the tooth

Should be parallel to the adjacent

external surface of the tooth
(not closer than 1 - 1.5 mm)

Should be prepared on a flat surface


If three or more pinholes

are placed:

Should be located at different vertical

levels on the tooth ( stress if pin in same
horizontal plane)

Inter-pin distance depend on the size of

the pin to be used

For Minikin (0.019 inch) 3mm

For Minim (0.024 inch) 5 mm

Maximal inter-pin distance results in

lower level of stress in dentin.

EXTERNAL PERFORATION MAY

RESULT FROM PINHOLE PLACEMENT
1.

Over the prominent mesial concavity

of the maxillary first premolar.

2.

At the midlingual and midfacial

bifurcations of mandibular
first & second molars.

3.

At the midfacial, midmesial,

mid-distal furcations of maxillary
first and second molars.

PULP PENETRATION MAY RESULT

FROM PIN PLACEMENT
At mesiofacial corner of:

Maxillary first molar

Mandibular first molar

When possible, location of pinholes on:

Distal surface of mandibular, molars

Lingual surface of maxillary molars

Should be avoided

PINHOLE PREPARATION:
No. bur used to prepare a pilot hole

(dimple)

To permit more accurate placement

of the twist drill

Prevent the drill from crawling once

it has began to rotate

Optimal depth of the pinhole into the

dentin is 2mm

(Omni-Depth gauge used)

PINHOLE PREPARATION:

The hole should be prepared on flat

surface and the drill perpendicular to
it.

Place flat thin-bladed hand instrument

into the crevice and against the
external surface of the tooth
To indicate the proper

angulations for the drill

PINHOLE PREPARATION:

Place the drill tip in its proper position

Hand piece rotating at very low speed

Apply pressure to the drill

Prepare pinhole in one or two movement

until the depth-limiting portion is reached

Remove the drill from pinhole

Using more than one or two

movements, tilting the hand
piece

too large pinhole

The drill should never stop

rotating
to prevent the drill from
breaking while in the pinhole

PINHOLE PREPARATION:

Dull

drill

frictional

heat

Cracks in the dentin

To bend the

pin TMS bending tool

INTERNAL STRESS CAUSE BY THE

PIN BY:
1.

space between pins

2.

Channel 2mm deep

3.

Pins parallel to occlusal force

The success of all amalgam restoration depend on

stability of the matrix

Matrix:
Tofflemire
Double matrix
Copper
Auto matrix

FAILURE OF PIN-RETAINED RESTORATION

Occur at any of five different location:
1.
2.
3.
4.
5.

Restoration fracture (failure within rest)

Pin restoration separation (at the interface
between the pin and restorative material)
Pin fracture (within the pin)
Pin dentin separation (at the interface
between the pin and dentin)
Dentin fracture (within the dentin)

Failure is more likely to occur at the

pin dentin interface

PROBLEMS THAT ARISE DURING PINRETAINED RESTORATION:

Broken drills and pins

1.

Twist drill will break if:

Stressed laterally

Allowed to stop rotating before
removing from the pinhole

Dull (20 holes)

Pin will break

During pending

Over - screwed in the hole

Solution:

Leave it in place.
Do another hole 1.5mm from
broken item

PROBLEMS THAT ARISE DURING PINRETAINED RESTORATION:

Loose pins

2.

Due to:

Loosened while shortened with bur

Pinhole prepared too large

Solution:

Remove pin , pinhole prepared with next largest

size drill , appropriate pin inserted

Drill another hole 1.5mm from original pinhole,

close the other one with
amalgapins or cement the pin

PROBLEMS THAT ARISE DURING PINRETAINED RESTORATION:

Penetration into the pulp and perforation of the
external tooth surface:

3.

Either penetration is obvious if there is hemorrhage in the

pinhole
Radiograph can help sometimes.

Pulpal penetration treated as a pinpoint exposure

Ca OH and prepare another hole
If patient complains of pain after that
endodontic treatment

PROBLEMS THAT ARISE DURING PINRETAINED RESTORATION:

Lateral Perforation:
Occlusal to gingival attachment
Pin cut-off flush with the tooth surface.
Pin cut-off and cast restoration extend gingivally.
Remove pin , enlarge hole and restored with
amalgam.

Apical to gingival attachment

Surgically remove the bone after

reflecting the tissue, enlarge
pinhole, restored with amalgam
Crown lengthening and cast
restoration cover the
perforation.

Resin Bonded Amalgam

Restoration

RESIN BONDED AMALGAM

RESTORATION
An amalgam restoration that has been
bonded to the existing tooth structure
through the placement of a resin dentin
bonding agent followed by a viscous resin
(or glass ionomer) liner into which the
fresh amalgam is condensed while the
liner is still unset.

AMALGAM ATTRIBUTES

Proven clinical longevity despite being nonadhesive

Various resistance/retention forms have
been successful even in large restorations

Long - term seal

AMALGAM DEFICIENCIES

Amalgam is not adhesive

Restorations are passive and do not significantly

strengthen remaining tooth structure

Mechanical retention/resistance form is provided

at the expense of tooth structure

Microleakage is present until corrosion seals the

cavo - surface interface

(process is much slower in high-copper amalgams)

ADVANTAGES OF RESIN BONDED

AMALGAM
1.
2.

3.

4.
5.

6.

Minimize or eliminate microleakage

Enhance traditional resistance and
retention methods
Increase the fracture resistance of the
restored tooth
Permit more conservative restorations
Decrease marginal breakdown and
ditching
Reduced incidence of postoperative tooth
sensitivity

Used for:

INDICATION

Supplementing mechanical resistance feature in

large, complex amalgam restorations
especially those replacing cusps.

When an improved initial seal is needed, such as

after a direct or indirect pulp capping
procedure in tooth being restored.

BONDING MECHANISM
Dentin Interface micromechanical
(formation of hybrid layer)
Amalgam Interface micromechanical
(interlock between viscous
resin and fresh amalgam)
Weak Links resin/amalgam interface and

resin/dentin interface

SOME COMMERCIAL SYSTEMS

All bond 2 with

-Resin bonding agent

-Liner F
-Resinomer (BISCO)

Amalgam bond plus (HPA) (Parkell)

Multipurpose resin bonding agents
- Optio-bond (Kerr)
- Scotchbond
multipurpose plus (3M)

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION
Rubber dam isolation is essential for the best clinical
results.
Clean preparations and apply
conditioner (etchant) to enamel and
dentin following the manufacturers
recommendations.
Rinse and dry lightly. Do not desiccate
the tooth. This step should be done
prior to Matrix band placement.

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION

Apply dentin primer/sealer following

manufacturers recommendations.

Apply the chemically-cured resin

bonding liner manufacturers
instructions.

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION

Condense the amalgam immediately into the

wet liner before it cure. The resin will have
a tendency to stick to metal condensers
and you may need to wipe them frequently.
You will find the bonding material will
ooze out at the cavosurface margins and
some of this excess can be removed before
the material is completely set. Do carving
as you can at this stage to minimize the
finishing time. Try to keep excess resin off
of adjacent tooth structure.

CLINICAL TECHNIQUE FOR RESIN BONDED AMALGAM

RESTORATION

Remove the wedge and matrix band carefully. If

you have lubricated the band properly, this
step should not present problems.

Check inter proximal and cervical first.

Scalpels and sharp chisels will help carve any
resin at margins. Resin at Occlusal margins
can be carefully removed with rotary finishing
burs. Occlusal anatomy can be refined with
carvers and rotary instrumentations.

CLINICAL TECHNIQUE FOR RESIN BONDED AMALGAM

RESTORATION

Remove rubber dam and check and adjust

occlusions as necessary

DISADVANTAGES

Extra steps and expense

(both time and materials)

Technique sensitive and messy

Adhesive may stick to matrix,
instruments and adjacent tooth
structure

Carving more difficult

Finishing usually requires rotary
instrumentation

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION
1.

Rubber dam isolation is essential for the best

clinical results.

2.

Current recommendations are to execute

conventional amalgam preparation following
traditional guidelines. It is possible to be
somewhat conservative, but you must remember
that the bulk of the restoration will be dental
amalgam and that you cannot treat these as
preparations for composite resin.

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION
3.

Clean preparations and apply

conditioner (etchant) to enamel and
dentin following the manufacturers
recommendations.

Rinse and dry lightly. Do not desiccate

the tooth. This step should be done
prior to Matrix band placement.

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION

4.

Carefully lubricate (very thin coat of

Vaseline) matrix band and wedge. Do not
contaminate conditioned tooth surface.

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION
5.

Apply dentin primer/sealer following

manufacturers recommendations.

NOTE:
in systems that have a separate dentin bonding agent
that is placed before the more viscous bonding
liner is applied,
apply that dentin bonding agent prior to matrix band
placement

CLINICAL TECHNIQUE FOR RESIN BONDED

AMALGAM RESTORATION
6.

Apply the chemically-cured resin bonding liner

manufacturers instructions.

Current research indicates that the best attachment

between amalgam and liner occurs with the more
viscous materials. In addition, it has been suggested
that systems that have a fluoride release mechanism
may be advantageous

The use of adhesive resins to

increase the retention,
resistance, and
marginal seal of amalgam
restorations
has gained much popularity


The

use of adhesive resins to increase the

retention, resistance, and marginal seal of
amalgam restorations has gained much
popularity


Several

posterior teeth have anatomic

features that may preclude
safe pinhole placement

Fluted & Fureal areas should be

avoided.