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An Amalgam is an alloy that contains Hg as one of its constituents. American National Standards Institute (ANSI) / American dental Association (ADA) specification NO. 1 requires that amalgam alloys contain predominantly silver and tin. Unspecified amounts of other elements for eg Cu, Zn, Au and Hg are allowed in concentrations less than silver or tin content. Alloys containing zinc in excess of 0.01% are zinc containing alloys. There is no specification of low or high copper alloy per se. Historically, amalgam alloys contain 65 wt % silver 29 wt % tin <6 wt % copper a composition close to that recommended by G V Black in 1896. During 1970s high copper amalgams were developed. The clinical success of amalgam restoration is based on meticulous attention to detail. Each manipulative step from the time the cavity is prepared until the restoration has been polished can have an effect on the physical and chemical properties of amalgam and the success and failure of restoration violation of the fundamental principles of cavity preparation has contributed substantially to failure.
PERTINENT MATERIAL QUALITIES AND PROPERTIES
Strength Compressive strength Tensile strength Longevity
Ease of use Clinically proven success.
* Amalgam is the only restorative material with an interfacial seal that improves over time.
The following is a list of clinical indication for amalgam restorations in Classes I, II, and VI. 1) 2) 3) 4) 5) 6) 7) 8) Moderate to large restoration Restorations that are not in highly esthetic areas of mouth. Restorations that have heavy occlusal contacts. Restorations that can’t be well isolated. Restorations that extends onto root surfaces Foundations Abutment teeth for R PD Temporary of caries control restorations.
1) 2) 3) Esthetically prominent areas of post teeth Small to moderate Class I & II restorations that can be well isolated. Small Class VI restorations
1) 2) 3) 4) 5) 6) Ease of use High tensile strength Excellent wear resistance Favourable long term clinical research results Lower costs than for composite Bonded amalgam have ‘bonding’ benefits
The primary disadvantages of amalgam relate to Esthetics Increased tooth structure removal
Other are 1) 2) 3) 4) 5) Non insulating Weakens tooth structure unless bonded. More technique sensitive if bonded More difficult tooth preparation Initial microleakage (LCTE 2.5 times greater than tooth).
ISOLATION OF THE OPERATING SITE Isolation for amalgam restorations can be accomplished with a rubber dam or cotton rolls. Should have minimum thickness of 0. OTHER PREOPERATIVE CONSIDERATIONS For eg . Assessment of operative site and assessment of occlusion Local Anesthesia Profound anesthesia contributes to a comfortable and uninterrupted operative and usually results in a marked reduction in salivation. wedge for restoring a posterior proximal surface TOOTH PREPARATION FOR AMALGAM RESTORATIONS Because of amalgam’s physical properties It 1) 2) Must be Placed in a tooth preparation that provides for or 90 degree or greater restoration angle at cavosurface margin.75 to 2 mm. CONSERVATIVE CLASS I AMALGAM RESTORATIONS Conservative preparation is recommended to . 3) Should be placed into a prepared undercut form in the tooth in order to be mechanically retained.AMALGAM RESTORATIONS CLINICAL TECHNIQUE INITIAL CLINICAL PROCEDURES A complete examination diagnosis and treatment plan must be finalized.
conservative depth of the pulpal wall. while maintaining a specified limited depth and providing resistance and retention form ) The outline form for Class I occlusal amalgam tooth preparation should include only the faulty occlusal pits & fissures. Eliminating a weak wall of enamel by joining two outlines that come close together (i.e. less than 0. Extending the outline to include fissures thereby placing the margins on relatively smooth sound tooth structure. Keeping the facial and lingual margin extension as minimal as possible between central groove and cusp tips.5 mm apart) Extending the outline form to include enamel undermined by caries Using enameloplasty on the terminal ends of shallow fissure to conserve tooth structure Establishing an optimal. Resistance principles include 1) 2) 3) 4) 5) 6) 7) 8) Extending around the cusps to conserve tooth structure and prevent internal line angles from approaching the pulp horns too close. Minimally extending into marginal ridges without removing the dentinal support.* protect the pulp * presence the strength of tooth * reduce deterioration of amalgam restoration Features of conservative preparations are * minimal extension of tooth preparations * supra gingival margins * rounded internal angles INITIAL TOOTH PREPARATION (establishing the outline form by extension of external walls to sound tooth structure. .
2 mm into DEJ. Eg.BUR RECOMMENDED → # 245 bur .head length = 3 mm . If these fissures require extensions of more than a few tenths of millimeter.5 mm is measured at central fissure * Depth of prepared external walls will be 1. * Change the bur size to smaller one. * Faciolingual width of no more than 1 mm If entering distal pit. Care should be taken to not to undermine the marginal ridges.5 – 2 mm .pear shaped version of # 245 bur Procedure: Enter the deepest or most carious pit with a punch cut using No. The distance from the margin of such an extension to proximal surface should not be less than * * 1. (not more than 10 degrees).8 mm . Maintain the burs orientation and depth while moving from central tissue towards the mesial pit. bur is tilted distally to prevent undermining the marginal ridge. 245 bur of high speed with water spray long axis of bur in kept parallel to long axis of tooth. * Depth of 1. # 330 bur .6 mm for premolar 2 mm for molars. # # 169 L 329 L . * Desired pulpal depth is 0.slightly rounded corners of the end.tip diameter = 0.for smaller cavities .slightly convergent towards shank .
2. The strongest an ideal enamel margin should be made up of full length enamel rods resting on sound dentin. Direction of mesial and distal walls is influenced by remaining thickness of marginal ridge as measured from distal or mesial margin Effect of various extensions in tooth preparation on tooth’s resistance to fracture 1. also resting on sound dentin . otherwise marginal ridge will be devoid of dentinal support. BY crossing two marginal ridges at ¼ the intercuspal distance. . there is almost 10% loss of a tooth’s resistance to splitting. there is almost 15% of a tooth’s resistance to splitting.* Use enameloplasty Pulpal floor should follow DEJ to maintain a more uniform pulpal floor depth. the long axis of bur should be changed to have slight occlusal divergence to mesial wall. If fissure extends to marginal ridge. supported on the preparation side by shorter rods . By crossing one marginal ridge at ¼ the intercuspal distance.
9. 4. there is almost 45% loss of a tooth’s resistance to splitting. there is almost 35% loss of a tooth’s resistance to splitting.3. there is almost 45% loss of a tooth’s resistance to splitting. there is almost 20% loss of a tooth’s resistance to splitting. By crossing two marginal ridges by 1/3 the intercuspal distance. 7. there is almost 35% loss of a tooth’s resistance to splitting. there is almost 30% loss of a tooth’s resistance to splitting. By crossing a crossing ridge at 1/3 the intercuspal distance. By crossing one marginal ridge at 1/3 the intercuspal distance. By crossing a crossing ridge at ½ the intercuspal distance.6 mm distance is left . By crossing two marginal ridges at ½ the intercuspal distance. By crossing one marginal ridge at ½ the intercuspal distance. By crossing a crossing ridge at ¼ the intercuspal distance. 6. 5. 8. * Mesial and distal walls must CONVERGE OCCLUSALLY when distance is greater than 1.6 mm in premolars * Mesial and distal walls must DIVERGE OCCLUSALLY if only 1. there is almost 40% loss of tooth’s resistance to splitting.
If enameloplasty is unsuccessful in eliminating mesial fissure extending to Marginal Ridge.ENAMELOPLASTY Enameloplasty refers to eliminating the developmental fault by removing with the side of flame shaped diamond stone. three alternatives are there . D. three alternatives are there Make no further changes in the outline form Extend through the marginal ridge when margins will be lingual to contact. and marginal-amalgam angle should not be less than 80 degrees.Cavosurface angle should not exceed 100 degrees. Enameloplasty. If enameloplasty is unsuccessful in eliminating mesial fissure extending to Marginal Ridge. Enamel external surface (e) before enameloplasty When the remaining fissure is no deeper-than one quarter to one third the thickness of enamel. B. C. Include the fissure in conservative Class II tooth preparation. Smooth surface after enameloplasty. Fine-grit diamond stone in position to remove fault. Developmental fault at terminal end of fissure. The surface left by enameloplasty should meet the tooth preparation wall preferably with a cavosurface angle 80-100 degrees. A. enameloplasty is indicated.
e. RMGI should be placed in deeper areas Entire dentin surface should not be covered. Include the fissure in conservative Class II tooth preparation. FINAL TOOTH PREPARATION It includes (1) (2) (3) (4) Removal of remaining defective enamel and infected dentin on the pulpal floor Pulp protection Finishing external walls Cleaning and inspecting the prepared tooth Removal of infected dentin is best accomplished by discoid type spoon excavator slowly revolving round carbide bur If the tooth preparation is of ideal shallow depth no liner or base is indicated. i. Dentin peripheral to liner should be available for bonding and support of restoration. Cavosurface angle = 90 – 100 degrees Amalgam margins = 80 – 90 degrees OTHER CONSERVATIVE CLASS I AMALGAM PREPARATION The facial pit of mandibular molar The lingual pit of maxillary molar Butt joint is . In deeper carious excavations place a thin layer of RMGI base. Occlusal cavosurface bevel is contraindicated in enamel preparations. Make no further changes in the outline form Extend through the marginal ridge when margins will be lingual to contact. strongest.
Tooth preparation should cut more at the expanse of oblique ridge rather than centering over fissure On smaller teeth the occlusal portion may have a slight distal tilt to conserve the dentin support of distal marginal ridge. except when caries are extensive. DL cusp and distal marginal ridge LINGUAL PREPARATION Lingual extension may be accomplished by two techniques I Lingual surface is prepared with burs long axis parallel with lingual surface holding the tip of bur at the gingival extent of lingual fissure. TOOTH PREPARATION Preparation has occlusal and lingual convergence. 330 or 169 L bur if lesion is very small. Margins should extend as little as possible onto oblique ridge. 245 bur No. The occlusal pit of mandibular first premolar The occlusal pits and fissures of maxillary first molar The occlusal pit and fissures of the mandibulars second premolars The preparation may be accomplished with a No. ¼ or 33 ½ bur CLASS I OCCLUSOLINGUAL AMALGAM RESTORATION On maxillary molars when a lingual fissure connects with distal oblique fissure and distal pit on occlusal surface. OCCLUSAL PREPARATION Mesiodistal width of lingual extension should not exceed 1 mm. Retention grooves are added with No. .
245 bur is held perpendicular to the cusp ridge and lingual surface as it extends the preparation from the occlusal surface gingivally.Enter the pit nearest the involved proximal surface.5 to 0. cut the ditch gingivally 2/3rd at the expense of dentin 1/3rd at the expense of enamel. * The cutting direction of each lock is the bisector of respective line angle. terminating midway along axial wall. LOCKS *depth of lock at the gingival floor is one half the diameter of No ¼ bur. 0. The ideal dentinal depth of axial wall of proximal box should be 0. * Locks should diminish in depth towards the occlusal surface.7 mm to 0. Extend the preparation mesially. PROXIMAL BOX The initial procedure in preparing the outline form of the proximal box is isolation of proximal enamel by proximal ditch cut.5 mm inside the DEJ.8 mm short of cutting through marginal ridge into contact area. II No. Before extending into the involved proximal marginal ridge.6 mm into dentin With the same orientation of bur. the initial pulpal depth should be 0. CLASS II AMALGAM RESTORATIONS CLASS II AMALGAM RESTORATIONS INVOLVING ONLY ONE PROXIMAL SURFACE OCCLUSAL OUTLINE FORM The occlusal outline from of a Class II tooth preparation for amalgam is similar to that for Class I tooth preparation .8 mm . with a uniform depth of 0. When extension places the margin in cementum.5 to 0.The axial wall should follow the contour of the lingual surface of tooth. This will prevent the overextension of occlusal outline form where if joins the proximal box. visualize the final location of facial & lingual walls of proximal box relative to the contact area. If it is wider mesiodistally additional retention by preparing locks in mesioaxial & distoaxial line angles. stopping approximately 0.6 mm.
B. ADVANTAGES * mesiaofacial wall is perpendicular to the enamel rod direction * conserves the facial tooth structure ISTHMUS WIDTH One fourth the distance between the pulp tips Extension of Margins Facial/ lingual: Clearance of 0..2 – 0. .e. floor).REVERSE CURVE Developing the mesiofacial wall perpendicular to the enamel rod direction and conserving the facial cusp structure results in reverse curve in occlusal outline of Class II preparation. Proximal ditch in extended gingivally to desired level of gingival wall (i. Variance in pulpal depth of axiolingual line angle as extension of gingival varies: a. at minimal gingival extension.3 mm Gingival: clearance of 0. It permits 90 o amalgam at mesiofacial margins and yet curves around the mesial portion of facial cusp.5 mm The proximal ditch cut may be diverged gingivally to ensure the Faciolingual extension at gingival is greater than occlusal A. C. Bur position to proximal ditch cut.
To prevent the bur from marring the proximal surface of the adjacent tooth. 245 bur. but having their maximum dimension at the pulpal floor level. D. E. at extension that places gingival margin in cementum. respectively. facial. Proximal ditch cut results in axial wall that follows outside contour of proximal surface.e. The Outline of the proximal box facially or lingually beyond the proximal contact to conserve the tooth structure. tapering to a point termination at the bucco-gingivo-axial point angles i.e. considering additional extension provided by hand instruments once remaining spurs of enamel are removed MODIFICATION FOR CLASS II IN TAPERED TEETH In tapered teeth in which gingival margin of the proximal portion of preparation is located so far gingivally that preparing the regular facial and lingual retentive grooves will undermine tooth structure at axial angle of the tooth. c. whereupon pulpal depth is 0. (a) Matrix band may be used around adjacent tooth . the reverse arrangement of the regular retentive groove In a narrow proximal lesion it is permissible not to extend. (a) In line with axio pulpal line angle facially and lingually a groove is prepared on each of the facial and lingual walls.75 to 0. lingual.8 mm and bur may shave side of wedge. one of the two types of grooves can be created.b: at moderate extension. Each groove is started at the axio pulpal line angle and continues occlusally to the occlusal surface. (b) Facial or lingual dentinal grooves may be prepared at the expense of facial or lingual walls of proximal portion.. gingival) should not be overextended with No. Position of proximal walls (i.
) . Occlusal convergence of facial and lingual walls and occlusal dovetail. SECONDARY RETENTION AND RESISTANCE FOR RETENTION LOCKS Bur: # 169 L Bur ( with air coolant & reduced speed. → If the gingival cavosurface margin is in enamel. it will usually require a slight bevel. Reverse curve Slightly rounding the internal line angles to reduce stress concentration Providing enough thickness of restorative material.(b) A thin proximal enamel is spared which can be fractured out with a spoon excavator. PRIMARY RETENTION FORM (1) The pulpal and gingival walls being relatively flat and perpendicular to forces directed with long axis of tooth (2) (3) (4) (5) (6) (7) Restricting extension Restricting occlusal outline form to areas receiving minimal occlusal contacts.
transition.2 mm inside the DEJ * Translation: direction of movement of axis of bur * Depth: extent of translation (0. A. B. and F. . (should disappear midway between enamel margin and dentin Four characteristics of retentive locks. C and D. E. Proximal view of MO preparation.* Position: Axiofacial & axio lingual line angles 0.5 mm at gingival floor) * Occlusogingival orientation: Tilt of bur which dictates occlusal height of the lock. position. Occlusogingival orientation The use of retention locks in proximal boxes is controversial. Occlusal view of MO preparation before placement of retention locks. and depth.
is not treatable with enameloplasty doesn’t involve the proximal contact * * * Then the proximal portion of the tooth is prepared by extending through the fault with # 245 bur so that margins are lingual to contact. The Occluso-gingival preparation of facial wall of mesial box should be parallel to long axis of tooth rather than converging occlusally to minimize unesthetic display of amalgam at faciogingival corner of restoration. bur is tilted occlusally (leading to facial inclination of pulpal wall). Otherwise it will weaken the lingual cusp. In disto-occlusal tooth preparation an extension onto lingual surface should be prepared only after disto-lingual proximal margin is established. . The facial extension should minimally clear the contact. If mesial proximal involvement is limited to a fissure in marginal ridge. accomplished by tilting the bur to create an occlusal divergence of facial wall. Excessive extension in facial direction could approach and expose facial cusp.With high copper amalgam and dovetail design retention locks are unnecessary VARIATION OF ONE PROXIMAL SURFACE TOOTH PREPARATIONS Mandibular first premolar When preparing the occlusal portion. while maintaining the dentinal support. Maxillary first molar Extension into enamel oblique ridge is avoided whenever possible to maintain the cross splinting strength it provides to the tooth When the occlusal fissure extends into the facial cusp ridge defect should be eliminated by extension of tooth preparation. It is accomplished by preparing the lingual fissure extension more at the expense of mesio lingual cusp Maxillary First Premolar Mesiofacial embrasure is esthetically prominent therefore Class II mesial preparation requires special attention.
If proximal caries is limited to mesiolingual embrasure .Often this means that the proximal box will be the Faciolingual width of the bur and gingival floor may be at the same depth as pulpal floor. * Bur: No.5 mm inside DEJ if Occlusal margin is in enamel. a proximal box preparation without an occlusal step has been recommended.2 mm inside the DEJ or 0. ¼ burs are prepared into occlusoaxial & gingivoaxial line angles 0.3 – 0. BOX ONLY PREPARATION When restoring a small. Ideally the direction of occlusal groove is slightly more occlusal than axial. The tooth preparation is usually approached from facial and has a form of slot.75 to 1 mm at the gingival aspect 1 – 1. ROTATED TEETH . The depth of these grooves is one half the diameter of bur head. To maximize retention. preparations facial and lingual wall should oppose each other Retention locks are necessary SLOT PREPARATION FOR ROOT CARIES This is indicated if caries are appreciably gingival to proximal contact.25 mm at the occlusal wall axial depth: 0. * Retention grooves with a No.5 mm inside the cementoenamel cavosurface margin. 4 * Dimensions: 0. and the direction of an gingival groove would be slightly more gingival than axial. 2 or No. cavitated proximal lesion in a tooth with neither occlusal fissures nor a previously inserted occlusal restoration. do not involve the mesial proximal contact in the tooth preparation.
5 mm apart should be removed. If lesion is small consideration must be given to slot preparation. This avoids condensation problems which are encountered if both the lesions are prepared first.5 mm of amalgam between rest seats and margins LARGER CLASS II RESTORATION . A weak wall of enamel joining two outlines that are less than 0. ADJOINING RESTORATIONS Where two restoration adjoin care should be taken that outline of second restoration doesn’t weaken the amalgam margin of first. * The occlusal fissure segmented by coalesced enamel should be treated with individual amalgam restoration if preparations are separated by approximately. ABUTMENT TEETH FOR REMOVABLE PARTIAL DENTURE The facial and lingual proximal walls and respective occlusal margins must be extended so that entire rest seat can be prepared in amalgam without encroaching the occlusal margins.5 mm or more sound tooth structure.The outline form for a MO teeth preparation on the rotated mandibular second premolar has its proximal box displaced facially because proximal caries include mesiofacial line angle of crown. The intersecting margins of two restorations should be at right angles as much as possible. There should be minimum 0. CLASS II LESION CONTIGUOUS WITH CLASS V LESION Class II lesion prepared and restored before preparing Class V lesion. 0. UNUSUAL OUTLINE FORM * Dovetail is not required unless a fissure emanating in occlusal step is involved in preparation.
then usually cap the cusp If indicated. it is usually associated with a reduction in involved cusp. When proximal extension around a line angle is necessary. then no cusp capping. Alteration in orientation of bur is also required. by tilting lingually while extending facially and vice-versa. then consider cusp capping: * If the extension is more than two thirds of the distance. CUSP REPLACEMENT Rule for cups capping: * If extension from a primary groove toward the cusp is no more than half the distance. Extending the outline form up the occlusal inclines. These extensions occur at same initial pulpal depths and follow DEJ. PROXIMAL EXTENSIONS: Large proximal box preparations also need secondary retention features. * If this extension is from one half to two thirds of the distance. Class III Amalgam Restorations INDICATIONS Distal surface of maxillary and mandibular canine if (1) (2) (3) Preparation is extensive with only minimal facial involvement Gingival margin involves primarily cementum Moisture control is difficult. This may include Extending grooves that are fissured Capping cusps that are undermined. CONTRAINDICATIONS .Often a larger Class II restoration may require greater extension of occlusal surface outline form. cusp replacement increases the resistance form of tooth.
or 2 round bur prepare the outline form extending the external.25 mm.25 mm from root surface to a depth of 0. However a lingual dovetail may be indicated if one existed previously or if additional retention is needed for a larger restoration. 1. b) If incisal wall is not bulky enough to accommodate a retentive groove without underlying the distal slope. walls to sound tooth structure while extending pulpally to an initial depth of 0. c) If horizontal gingival groove cannot be located without perforation to a surface concavity. in that case wall anatomy of labial and lingual wall will be reversed. Using a No.Esthetically prominent areas. This can be accomplished by deepening the axial wall at its labial or lingual periphery and by establishing a very pronounced axiolabial or axio-lingual line angle e) In senile decay. Groove is directed as the bisector of the angle formed by function of axial wall and external wall. TECHNIQUE A lingual approach is preferred over facial unless lesion is more facial than lingual. Usually the outline form includes only proximal surfaces. ½. it may be replaced by a labial and to a lesser extent lingual groove. inclining gingivodistally making an acute angle with axial walls. it can be replaced by deepening the point angle retention groove. SECONDARY RETENTION FORM 1) 2) (3) gingival groove Incisal cove lingual dovetail MODIFICATIONS FOR CLASS III a) The decay extent may dictate a labial approach. where incisal margin of lesion is apical to the contact area the incisal wall will be one planed. d) If labial or lingual walls is lost it is essential to create a very short wall to try to lock the restoration. Groove retention may be necessary groove is prepared 0.75 mm. .
it is advisable to make them in two planes Make them in two planes * * rods. dentinal plane at right angle to axial wall outer. . In such cases lingual wall must be more slanted in inciso-gingival direction than labial wall. If retention forms are deficient. enamelo-dentinal plane following the directions of enamel Sometimes the entire cavity preparation may be inclined inciso-lingually especially in upper canine. MODIFICATIONS OF CLASS IV RESTORATIONS If labial or lingual walls are not bulky enough to accommodate the retention grooves.CLASS IV MALGAM RESTORATIONS INDICATIONS * Incisal angle is undermined or involved by lesion * Labial and lingual walls are intact and bulky * There is pronounced intact gingival floor * A restoration that replaces the distal slope or Part of it will be subjected to that slope’s mechanical problems The general shape of cavity preparation is an inverted truncated cone. resulting in preparation opening partially at its incisal end. The incisal margin is located at slope of incisal edge. pins should be used. inner. The lingual margin is located in lingual embrasure just clearing the contact. Gingival and labial margins are exactly as described for Class III. and some walls are either partially or totally lost.
Proper outline form for Class V amalgam tooth preparation results in extending the cavosurface margins to sound tooth structure while maintaining a limited axial depth of 0. one in each of the four axial point angles. which are limited in size. particularly second molars are most commonly affected by these extensive defects. – This conserves dentin and reduces the possibility of mechanical pulp exposure. There are multiple lesions or defects in gingival third. four retention cover may be prepared. LARGE PREPARATION THAT INCLUDE LINE ANGLES. Maxillary molar. box shaped and with rounded corners.75 mm inside the cementum when on root surface. with sound tooth structure separating them from each other The general shape of this design is of several preparations which are small. they usually diverge facially. and mesioaxial and disto-axial considerably. It is advisable to make this divergence only at the areas where margin approximates the occlusal surface.5 mm inside the DEJ and 0. the facial restoration should extend around the line angle. If the remainder of the distal surface is sound and distal caries is accessible facially. This will decrease the retentive capability of the preparation. . ¼ bur. All the walls of the tooth preparation are perpendicular to the external tooth surface. one along incisoaxial line angle and other gingivoaxial line angle are prepared using No. INITIAL TOOTH PREPARATION The lesion is entered by a tapering fissure bur. Alternatively. MULTIPLE ISOLATED BOXES INDICATIONS . Two retention grooves. MODIFICATIONS OF CLASS V If most of the facial or lingual surface is involved in a Class V lesion and they are to be part of cavity preparation. Large lesions on the facial surface may extend beyond the line angles of the tooth. Consequently there is no inherent retention. In this situation gingival retention grooves should at least be doubled on size. the occlusal wall will diverge in occlusal direction.CLASS V RESTORATION The outline form of the Class V amalgam tooth preparation is primarily determined by location and size of caries or old restorative material.
The cusps reduction is accomplished during initial tooth preparation only because it improves access and visibility for subsequent steps. Initial tooth preparation The general concept of tooth preparation for amalgam is followed.COMPLEX AMALGAM RESTORATIONS Complex posterior amalgam restorations should be considered when (1) (2) (3) large amount of tooth structure is missing when one or more cusps need capping increased resistance and retention form are needed. PIN RETAINED AMALGAM RESTORATIONS. Any restoration requiring the placement of one or more pins in dentin to provide adequate resistance and retention form. The tensile strength and horizontal strength of pin retained amalgam restoration is significantly reduced. . These are contraindicated if patient has severe occlusal problems or if tooth cannot be properly restored with a direct restoration. ADVANTAGES 1) 2) 3) 4) Conserves tooth structure Can be completed in one appointment Resistance and retention form is significantly increased It is relatively inexpensive DISADVANTAGES 1) 2) 3) Preparing pinholes and placing pins may create craze lines or fractures Microleakage around all types of pins has been demonstrated.
FACTORS AFFECTING IN RETENTION OF PINS IN DENTIN AND AMALGAM 1) Type: Self threading > Friction locked > cements (from maximum to minimum retentiveness in dentin. o The resiliency of dentin permits insertion of threaded pin into a hole of smaller diameter. facial or lingual grooves should also be undertaken. • These are 2-3 times more retentive than cemented pins SELF THREADING PINS: o Diameter of prepared pinhole is 0. FINAL TOOTH PREPARATION Coves (horizontal plane) and locks (vertical plane) are preparation before preparing pinholes and inserting pins TYPES OF PIN 1) Cemented 2) Friction locked 3) Self threading → CEMENTED PINS • • • Cemented into pinholes 0.The occlusal contour of the reduced cusp should be similar to normal contour of the unreduced cusps.5 mm for non-functional cusps.02 inch larger than diameter of pins The cementing media is any standard dental luting agent Most frequently used FRICTION LOCKED PINS: • Diameter of prepared pinhole is 0.001 – 0.0015 inch 0. Other principles of retention form like converging opposite walls. o They do not engage dentin for their entire width.004 inch smaller than diameter of pin.) . Vertical and horizontal stresses generated are maximum in self treading pins. retained by resiliency of dentin. o These are 3-6 more retentive than cemented pins.001 inch smaller than diameter of pin • Pins are tapped into place. flat pulpal floors. Final restoration should have restored cusps with minimal thickness of 2 mm for functional cusps and 1.
Number And Diameter Placing pins in a non parallel manner increases their retention.019 0. Bending the pins is not desirable.027 0. Minim are used as backup of pin holes for minikin was over prepared. it weakens the pin and risk fracturing the dentin. retention in dentin and amalgam increases Extension into dentin and amalgam Retention is not increased significantly when depth of pin into dentin exceeds 2 mm.024 0. 1) 2) 3) 4) Regular Minim Minikin Minuta Color code Gold Silver Red Pink Pin dia (INCHES) 0. decreases Strength of amalgam restoration decreases 4) 5) Diameter: As diameter increases.0135 Minikin pins are usually selected to reduce the risk of dentin crazing. It is too small to provide adequate retention in posterior teeth. In general. 1) Amount of dentin available 2) Amount of retention desired. .2) 3) Surface characteristics: Number and depth of serration or threads on pin influence retention of pin in amalgam restoration. increasing the number of pins increases the retention in dentin and amalgam but benefits must be compared with potential problems created like. pulpal penetration and potential perforation.017 0. Determining factors for selecting a appropriate size pin.015 drill dia (INCHES) 0.021 0. Minuta is half to one third retentive as minim. PIN PLACEMENT FACTORS AND TECHNIQUE PIN SIZE : four pin sizes are available with a corresponding colour coding drill. Orientation.031 0. * Crazing of dentin * Amount of available dentin between pins.
5 mm to the external surface of tooth. the pinhole should be parallel to adjacent external surface of tooth. LOCATION Several factors aid in determining pinhole locations (1) pulp anatomy and contours of teeth (2) recent radiograph (3) periodontal probe (4) patient age Consideration must be given to placement of pin in area where greatest bulk of amalgam will occur A pin placed directly below the occlusal contact weakens amalgam significantly Occlusal clearance should be sufficient to provide 2 mm amalgam over pin Caputo & standlee state that ideally. Felton and associates have demonstrated that pin placement providing at least 1 mm of remaining dental thickness from pulp elicits minimal pulp inflammatory response. Pinholes should be prepared on a flat surface that is perpendicular to the proposed direction of the pinhole. pinholes should be located near the line angle of tooth. But the most practical philosophy is. Standlee and others have shown that there should at least 1 mm of sound dentin around the circumference of pin hole. In the cervical third of molars and premolars (where most pins are located). Several factors must be considered (1) amount of missing tooth structure (2) amount of dentin available (3) amount of retention required (4) size of pin. The pinhole should be positioned no closer than 0.NUMBER OF PINS: one pin for missing line angle is used. pinholes should be located half way between pulp and DEJ or external surface of tooth root. As a rule.5 to 1 mm to DEJ or no closer than 1-1. .
Whenever three or more pinholes are placed. they should be located at different vertical levels on the tooth if possible. several designs are available. PIN DESIGN For each of the four sizes of pins. • Titanium PIN INSERTION Two instruments for insertion of threaded pins are available o Conventional latch type contra angle handpiece o TMS hand wrenches. (Three is abrupt flaring of roots just apical to CEJ). The minimize inter pin distance 3 mm for the manikin 5 mm for minimum Maximal inter pin distance results in lower level of stress in dentin. POSSIBLE PROBLEMS WITH PINS 1) FAILURE OF PIN RETAINED RESTORATIONS . Pinholes on the distal surface of mandibular molars and lingual surface of maxillary molars should be avoided. Standard Self shearing Two in one Link series Link plus The link series and link plus are recommended TMJ pins are available in • Stainless steel plated with gold.
Sharp twist drills helps eliminate the possibility o Standard pins may break it turned more than needed to reach the bottom of pinhole Pins may break during bonding even Removal of broken drill and pin is difficult if not impossible and usually should not be attempted. PENETRATION INTO THE PULP AND PERFORATION OF EXTERNAL TOOTH SURFACE. bur is not held perpendicular to pin hole. a pulpal penetration is treated as any other small mechanical exposure Ideal treatment of pulpal treatment is endodontic therapy EXTERNAL PERFORATION . 3) 4. • • Both are obvious if there is hemorrhage in the pin hole following removal of drill. LOOSE PINS Self threading pins sometimes do not properly engage the dentin because (i) pin hole was inadvertently prepared too large (ii) self shearing pin failed to shear (iii) while shortening. Usually penetration and perforation can be felt by an abrupt loss of resistance of drill to hand pressure. PULPAL PENETRATION In an asymptomatic tooth.i) ii) iii) iv) v) 2) o Restoration fracture Pin restoration separation Pin fractures Pin dentin separation → Most likely dentin fracture BROKEN DRILLS AND BROKEN PINS A twist will break if it is stressed laterally or allowed to stop before being removed from the pinhole.
restore with amalgam. enlarge the pin hole slightly.* Occlusal to gingival attachment. and place the margin of a cast restoration gingival to perforation SLOT RETAINED AMALGAM RESTORATION A slot is a retention groove in dentin whose length is in horizontal plane. Pin removed external aspect of pin hole enlarged slightly and restored with amalgam. remove the necessary bone. Indications • • Short clinical crowns Cusps that have been reduced 2 – 3 mm for amalgam. Slot retention may be used in conjunction with pin retention or as an alternative. Pin can be cut flush off the tooth and no further treatment rendered. Tooth preparation: Slot may be continuous or segmented . Advantages Less likely to produce (i) micro fractures (2) external perforation. Apical To Attachment (1) (2) reflect the tissue surgically. perform a crown lengthening procedures. Pin can be cut flush off the tooth and preparation for a cast restoration extending gingivally beyond the perforation. * Apical to gingival attachment Treatment options Occlusal To Gingival Attachment. Disadvantage Compared with pin placement more tooth structure is removed in preparing slots.
The tooth is restored so that the restorative material will serve in lieu of tooth structure to produce resistance and retention forms during the development of subsequent cast restorations. amalgam restorations have demonstrated the potential to serve for many years. sufficiently deep axially so that final preparation for subsequent indirect restoration does not compromise the resistance and retention form of foundation. Unlike conventional amalgam restoration an amalgam foundation may not depend primarily on remaining coronal tooth structure for support. TOOTH PREPARATION FOR AMALGAM FOUNDATIONS The technique of tooth preparation for or foundation depends on type of retention that is selected. except at the gingival. Dimensions 0. when used correctly and in properly selected cases.5 mm in depth 1 mm or more in length AMALGAM FOUNDATIONS Definition A form is an initial restoration of a severely involved tooth. As a rule foundations are placed in preparation for a full crown.33 ½ No bur is used. to aid in forming a matrix for amalgam condensation. remaining unsupported enamel may be left.e. SUMMARY Class I & II amalgam restorations are still common procedures. Instead it may rely mainly on secondary preparation retention features and some what on bonding benefits. When preparing a tooth for foundation and / or caries control restoration. All techniques have in common the axial location or retention i.5 mm axial to DEJ 0. especially in endodontic treated teeth. .
Shivani Arora .A SEMINAR 0N AMALGAM RESTORATIONS Presented by : Dr.
CONTENTS Introduction Indications Contraindications Advantages Disadvantages Amalgam restorations Initial clinical procedure Tooth preparation for amalgam restorations Conservative class I restoration Enameloplasty Class I occlusolingual preparation Class II amalgam restorations * for one proximal surface Modifications of class II Variation of one proximal surface tooth preparation Class II restoration involving both proximal surfaces Class III amalgam tooth preparation Modifications for class III restorations Class IV tooth preparation Modifications for class IV preparations Class V preparations Modifications for class V Complex amalgam restorations Pin retained restorations Slot retained amalgam restorations Amalgam foundations .