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:Seminar outline (: I) Amalgam restoration technique
.Selection of alloy -1 .Isolation and matricing -2 .Proportioning and dispensing -3 .Trituration -4 .Mulling and squeezing -5 .Condensation -6 .Precarving burnishing -7 .Carving -8 .Postcarving burnishing -9 Finishing and polishing -10
.II) Mercury hazards)
I) Amalgam restoration manipulation technique)
:Selection of alloy -1
There are many commercial brands of dental amalgam, with different alloy types and different mode of supply. It is very important to choose amalgam alloy that meets the ADA specification or a similar specification. Manipulative characteristics such as rate of hardening, smoothness of the mix and the ease
has high physical and mechanical properties that are important in posterior region Conventional lathe cut alloy needs more mercury.contamination occurs when using zinc containing alloy. reaching values more than 4%. It is produced by electrolytic action by zinc. and is resistant .to condensation forces (positive pack).of condensation and finishing are a matter of subjective preference. This type . field isolation should be applied. After the cavity preparation is ready to receive amalgam. matrix application is necessary.properly. If such . either a complete or partial isolation. gives the restoration a shape and . excessive delayed expansion takes place Excessive delayed expansion usually starts after 3 to 5 days and may continue for months. The effect is due to some type of reaction of Zinc with water. has high physical properties. which . It is essential that the alloy selected . One of the products of reaction is hydrogen. gives rough surface on carving and finishing but it . and maintains them till the hardening of the restoration Wedging is very important to prevent overhanging filling. The internal pressure of the hydrogen may build up to levels high enough to cause the .amalgam to creep and producing this expansion When one wall is missing after the cavity preparation.be one with which the dentist and assistant feel comfortable It is recommended to use high copper amalgam or at least the first choice in the most of cases. The matrix serves as a temporary wall during condensation of amalgam.(offers high resistance to condensation forces (positive pack Spherical alloy needs less mercury. Hence. and the anodic constituents present. using cotton rolls and saliva ejectors Contamination should be prevented. It is less resistant to condensation forces. it is not preferred for class II Admixed alloy has the good physical and mechanical properties as a high copper alloy. Isolation used is .strength. the electrolyte. as in class V restorations Isolation and matricing -2 Isolation must be done during amalgam manipulation. and also it compensate for the band thickness by mild separation of teeth.enhances condensation that provides proper physical and mechanical properties . This hydrogen does not combine with amalgam constituents but collects within the restoration. Using a wedge stabilizes the band during condensation of amalgam.usually partial. especially during trituration and condensation procedures.form. making it the best choice for class II restorations Alloys that are not containing zinc is indicated in cases where isolation is difficult to be achieved . as in class II. good adaptation and high early .
Most modern precapsulated amalgams are formulated with only 42% to 45% mercury by weight. Less mercury will not be enough to wet all particles of alloy by mercury leading to: • Friable mix with more voids. For spherical alloys.Volumetric dispensing: . • Increase setting time. Mercury-rich mixtures. without affecting physical and . Excess mercury will lead to formation of gamma 1 and gamma 2 on the expense of the stronger gamma phase that will: • Increase setting expansion. smooth and coherent mass.Amalgam balance (by weight) 2. In the 1960s. Eames was the first to promote a low mercury-to-alloy mixing ratio (Eames technique or nosqueeze-cloth technique). • Increase creep.(tofflemire matrix) :Proportioning and dispensing -3 Mercury ratio is critical to provide a plastic. it is possible to reduce the mercury portion of the mixture to less than 50% by weight. historically could be partially condensed by wringing the mass in a squeeze cloth. • Decrease strength. • Decreased strength.mechanical properties of amalgam Conventional lathe-cut alloys require a relatively large amount of mercury (50% to 60% by weight in the mixture) to fill in the spaces. • Increased liability for tarnish and corrosion. Methods of proportioning: 1. • Increase tarnish and corrosion. after trituration but before placement into the preparation.
alloy powder and mercury bottles) 3.Alloy tablet (pellet) and mercury dispenser: The alloy powder is tablet is pressed into a tablet of standard weight. and the other for the alloy. mortar and pestle. there are plenty of brands supply amalgam preweighed capsules of different amounts and different characteristics. one for mercury. (amalgam balance. • 1-Spill 1 2. Mercury is dispensed as standardsized droplet from an automatic dropper bottle. and pestles) :preweighed capsules -5 Modern amalgams are produced from precapsulated alloy and mercury.Spill 2 Types of capsules according to spills: .Amalgam is supplied in 2 bottles. or preweighed mercury envelop. A typical reusable capsule was a hollow tube with rounded ends constructed as two pieces that could be friction-fit or screwed together.Reusable capsules: Alloy used for this type is usually alloy tablet. (different shapes of amalgam capsules. A small metal or plastic pestle was added to the capsule and it was closed. (alloy tablets) 4. and the mercury is either dispensed into the capsule as a standard-sized droplet from an automatic dropper bottle. This method is not accurate as the balance. The capsule and its contents were then automatically mixed using an amalgamator.
It enhances trituration. This pestle is usually plastic.Spill 3 4. • • (septum between mercury and alloy powder) The setting of amalgam within the capsule may be fast. or 800 mg (spill 3) of alloy and the appropriate amount of Hg. mercury envelop alloy powder. and mercury begin to wet the powder before trituration. A pestle may or may not be present. color coded for ease of identification. 600 (spill 2). • Capsules may be self-activated or non self-activated: In self activated amalgam capsule the mercury is present in an envelop which rupture by the high frequency of amalgamator. It is usually suggested that if larger amounts are required that several smaller mixes be made at staggered times so the consistency of the mixed amalgam remains reasonably constant during the preparation of the restoration. (contents of self-activated capsules.Spill 4 Manufacturers commonly supply capsules containing 400 (spill 1). •The capsule may be opened by screwing the cap or by friction(less reliable in mercury hazards) .3. regular or slow. when the plunger is pressed the diaphragm is dislodged. However capsules containing 1200 mg (spill 4) of alloy are available if a large amount of amalgam is needed to produce an amalgam core on a severely broken down tooth. Clinical consensus is that these amounts are sufficient for most restorations. color coded capsules) In non self-activated capsule there is a sheath or diaphragm between mercury and alloy powder.
4. It is more hygienic.•Ultrasonic welded capsules: this capsule is completely sealed. This procedure allows the rubbing of the surface oxide on amalgam particles. bending the rod. for there is no mercury hazard.Trituration: It is the process by which the alloy and mercury are mixed together to produce a coherent homogenous plastic shiny mass. exposing an active surface to react with mercury.Amalgamator: The typical amalgamator has been designed to grasp the ends of the capsule in a claw (fork) that is oscillated in a figure-eight pattern (eccentric movement). The alloy powder and mercury is rubbed between mortar and pestle until a workable mass is obtained. This accelerates the mixture toward each end of the capsule during each throw. (ultrasonic welded capsules) •Direct placement capsules: it has a nozzle through which amalgam is placed into the cavity by means of an injecting device. the force should be about one kg 120 revolution per mn. . The advantage of this type of capsules is control over mercury mishandling. Hand trituration: Clean rough glass mortar and pestle are used in hand trituration. The kit is supplied with plastic rod used to fracture the capsules by inserting the rod into a hole in the capsule. and high infection control measure. (mortar and pestles) Mechanical trituration: May be done by different types of machines and devices: 1.
and is difficult to handle. simple. Advantages of mechanical trituration: • Uniform reproducible mix. making it inconvenient to manipulate.Portable miniamalgamator: Contains a fork and shank. The effect of undertrituration : • Decreased strength. that is inserted into a straight handpiece. 2. • Weight of the capsule. • Distance of movement of the fork. Overtriturated mix appears soupy and tends to stick to the inside of the capsule. • Shorter trituration time. Undertiturated mix is dull in appearance and crumbly. it is very important to periodically calibrate amalgamators. • Rough surface full of voids • Less adaptability.Amalgamizer: Provides automatic dispensing and mechanical mixing. 3. The effect of overtrituration: . • Greater alloy to mercury ratio can be used. convenient and chesp method of mechanical trituration. portable. After several years of use. • Decrease corrosion resisitance.(amalgamator) Trituration energy of amalgamator depends on: • Speed of amalgamator. 4. • Presence of the pestle.amalgamator-amalgamizer: Contains both of them. • Time of trituration. To guarantee that amalgam alloy and mercury are mixed both efficiently and consistently. It is small in size. the bearings become worn and the mixes no longer are sufficiently triturated.
Some provide impact type force. Decrease setting expansion. • Reducing amount of residual mercury within the mix.Condensation: Condensation is the process of compressing and directing dental amalgam into the cavity preparation walls with amalgam condensing instruments. others use rapid vibration. to express the excess mercury. 6. • Creation of interlocking layers (by the use of serrated condensers). produces similar clinical results to the hand condensation. Increase total contraction. Decrease working time. Proper condensation of amalgam: • Promotes adaptation of amalgam against cavity walls. Mechanical condensation: Where condensation of amalgam is done by automatic device.• • • • Increased physical reaction. Properly triturated amalgam is a homogeneous mass with slightly reflective surface. until the cavity is completely filled and overpacked with dense mass of amalgam. It produces heat with the possibility of mercury vapor production (mercury hazard).Mullling and squeezing: Piece of rubber dam is used to rub the hand mixed amalgam for 2 to 3 seconds. Hand condensation: • Only fresh mix is used: . (properly triturated mix) 5. • Compacts the material (pushing alloy powder together) resulting in • Elimination of voids. Then it is squeezed in piece of cloth. to give a more homogenous and plastic mass.
• • Dry clean field should be ensured. Usually a smaller condenser is used while filling the preparation and a larger one for overpacking. Condense the amalgam over the pulpal floor of the preparation (90 degrees). Each condensed increment should fill only one third to one half the preparation depth. Increments extruded from the carrier should be smaller (often only half or less of a full-carrier tip) for a small preparation. (direction of condenser 45 degrees on line angles) The initial condenser should be small enough to condense into the line angles but enough not to "poke holes" in the amalgam mass. Small successive increments: Use an amalgam carrier to transfer amalgam to the tooth preparation. (serrated condenser) . Discard the mix if it becomes dry.. shape and size of the condenser: Use a flat-faced. Be careful to condense the amalgam into the pulpal line angles (45 degrees). Otherwise. circular or elliptic condenser. crystallization of the unused portion will be too advanced to react properly (i. chemically bond) with the condensed portion. (amalgam carrier) • Direction. There are many condensers according to angles within. Should be serrated to make a mechanical interlocking between successive layers. particularly during the initial insertion. monoangled and the more common contrangled. and quickly make another mix to continue the insertion.e. Thoroughly condense each portion extruded from the carrier before placing the next increment.Condensation of a mix should be completed within the time specified by the manufacturer (usually 2 1/2 to 3 1/2 minutes).
It helps reduce the amount of mercury at peripheral surface of amalgam. This will ensure that the cavosurface margins are completely covered with well condensed amalgam. Final condensation over cavosurface margins should be done perpendicular to the external enamel surface adjacent to the margins. • Overpacking: The preparation should be overpacked 1 mm or more using heavy pressure. Another thing is that Condensers with larger-diameter nibs require greater condensation pressure. Heavy pressure with great number of thrusts is needed in case of condensable amalgam (lathe-cut and admixed alloys). (overpacking. while light pressure with low number of thrusts are needed in case of spherical alloys. large condenser) . The spherical alloys need less force.(different tip designs) • Condensation pressure: Condensable amalgam need 2-5kg force to be condensed.
it carves easily but liable to miscarve or overcarve. egg burnisher) 8. (different carver designs) . especially at the margins. the burnisher head should be large enough that in the final strokes it will contact the cusp slopes but not the margins. Amalgam can be carved with any bladed instrument with sharp edge. • Can be considered as the first step of shaping the occlusal restorations (different nib designs of amalgam burnishers) (large burnisher is used for precarve burnishing. To maximize its effectiveness. • Excess mercury is pushed to the surface. interproximal carver.Precarve burnishing: Precarve burnishing is a form of condensation. the overpacked amalgam should be burnished immediately with a large burnisher.Carving: Carving may begin immediately after condensation but with care. To ensure that the marginal amalgam is well condensed before carving. spoon and hoe excavators can also be used. using heavy strokes mesiodistally and faciolingually (from center to peripheries). The most common carvers are small discoid cleoid carver. • Obtaining a smooth amalgam surface. Hollenback no 1/2 carver.7. The objectives of precarve burnishing: • Ensure proper adaptation of amalgam.
a submarginal defect greater than 0. because these may thin the amalgam at the margins. the smoothness of the carved surface may be improved by wiping with a small. An amalgam restoration that is more than minimally overcarved (i. a submarginal defect greater than 0. damp ball of cotton held in the operating pliers.e.e.. The thin portion of amalgam extending beyond the margin is referred to as flash. High spots will be marked.2 mm) should be replaced. and weaken the restoration. Undercarving: leaves thin portions of amalgam (subject to fracture) on the unprepared tooth surface. invite chipping.All carving should be done with the edge of the blade perpendicular to the margins as the instrument is moved parallel to the margins. All shavings from the carving procedure should be removed from the mouth with the aid of the oral evacuator. An amalgam restoration that is more than minimally overcarved (i. which are then removed by additional carving. If total carving time is short enough. (direction of carving) Overcarving: Deep occlusal grooves should not be carved into the restoration. (articulating paper marks before and after occlusal correction) . Such margins give the appearance that the amalgam has expanded beyond the preparation. Part of the edge of the carving blade should rest on the unprepared tooth surface adjacent to the preparation margin.2 mm) should be replaced.. The restoration is checked by articulating paper for hyperocclusion in centric position of the mandible and during mandibular excursions. Using this surface as a guide helps to prevent overcarving the amalgam at the margins and to produce a continuity of surface contour across the margins.
and smoothing the amalgam surface. defining the anatomy. Also it improves adaptation at the margins and the delicate pressure exerted produce a denser amalgam at the surface. Postcarve burnishing in conjunction with precarve burnishing of low-copper amalgams may serve as a viable substitute for conventional polishing. at least 24 hours after it has been placed and carved. postcarve burnishing may improve the marginal integrity of high-copper amalgams but it is not recommended as a routine part of the procedure (although it may also improve the smoothness of the restoration). Postcarve burnishing is done by lightly rubbing the carved surface with a burnisher of suitable size and shape to improve smoothness and produce a satin (not shiny) appearance. Finishing the restoration involves contouring.abrasive materials for smoothing and shining the amalgam surface . removal of marginal discrepancies.Finishing and polishing: The finishing and polishing procedures should not be initiated on an amalgam restoration until the amalgam has reached its final set. Finishing procedures are completed prior to polishing and require abrasive agents that are coarse enough to remove the bulk from the surface. • Reduces tarnish and corrosion. thus reduce stresses by removal of sharp edges. Polishing enhances the quality of the restoration by producing the smoothest shiniest surface possible— one which will offer better resistance to corrosion and tarnish. and reduces plaque accumulation and possibility of recurrent decay.9. Polishing procedures require more mildly . Premature finishing and polishing will interfere with the crystalline structure of the hardening amalgam. • Any occlusal prematurity that is mistakenly left can be adjusted during this procedure. With highcopper amalgams. Objectives: • Eliminates rough surface of amalgam.Postcarve burnishing: Some operators prefer to postcarve burnish the amalgam surface using a small burnisher when carving is completed. (small ball burnisher is used for postcarve burnishing) 10. • Maintains periodontal health.
pumice) to help reduce the heat created by the friction of the abrasive particles during polishing Tin oxide or Amalgloss is used as the finest abrasive agent. and are less messy than the pumice and tin oxide.:Finishing procedure First instrument to be used is finishing diamond and carborundum stones.Heat may result in mercury vapor -2 . sandpaper disc) :Polishing procedure is either done by one of the following :Rubber cups and brushes in conjunction with polishing agents -1 Pumice is an abrasive powder of volcanic origin and is available in a variety of grits. applied dry. readily adapt into all areas of the restoration. applied first as a slurry followed by dry tin oxide.Heat can cause thermal damage to the pulp -1 . Sandpaper disc is not recommended for proximal box finishing because it may . Fine grades of pumice are used for polishing amalgam restorations.with separate rubber polishing cups abrasive rubber cups or abrasive-impregnated points and cups (Shofu Brownies. soflex discs are more appropriate (finishing bur) (carborundum finishing stones. It may be applied in a slurry. Both pumice and tin oxide are applied to the tooth . Greenies.cause damage to the enamel. then finishing bur is used to give a smooth surface. Super -2 :(Greenies These points and cups are very easy to use. The drawbacks to their use are expense and the fact that the rubber contributes to heat generation :The creation of heat during the polishing procedure is potentially dangerous for two reasons . It is usually mixed with water (slurry of .
Some abrasive materials (pumice and tin oxide. • Use compressed air directed at the amalgam surface during polishing. High speeds increase friction and thus generate heat. • Use abrasive agents that are wet rather than dry. intermittent pressure with rotary instruments lifting the instrument off of the restoration frequently.:To minimize heat production • Use light. Increase speed only to produce the final high shine. for example) can be mixed with water or alcohol to help lubricate and cool the agents. Heavy or prolonged pressure generates heat. . • Use slow to moderate speed with rotary instruments.
kidney disease. • Organic mercury (methyl and ethyl mercury).Sensitization (allergic reaction): normal allergic reaction. grayish discoloration of the soft tissue is presented. then the least toxic are the inorganic compounds. after healing of the socket.Mercurialism: symptoms are excitability. In spite of its substantial history.Amalgam tattoo: remnants of amalgam may be mistakenly contaminate an extraction socket. loss of memory. (Absorption efficiency of mercury) Biological effects of mercury: 1. albeit infrequently. (arrow points at the grayish discoloration of amalgam tatoo) . followed by mercury vapor. about 200 million amalgams are inserted each year in the United States and Europe. It has been estimated that a patient with 9 amalgam occlusal surfaces will inhale daily only about 1% of the amount the Occupational Safety and Health Administration (OSHA) allows to be inhaled in the workplace. Allergic reactions to mercury in amalgam restorations do occur.(II) Mercury hazards: Amalgams have been used for 150 years. The most toxic is the organic. fatigue. however. 3. periodically concern arises about the biocompatibility of amalgam. 2. This is not surprising. because there is no material that 100% of the population is immune to 100% of the time. headache. Forms of mercury: • Elemental mercury • Inorganic mercury.
patients and dental office personnel) potentially at risk to mercury exposure with dental amalgam. 3. 4. 4. 2. 5-Use a no-touch technique for handling the amalgam.Use tightly closed capsules during amalgamation.Amalgam undergoing finishing and polishing operations.To confine and facilitate the recovery of spilled mercury or amalgam. Droplets may be picked up with narrow-bore tubing connected (via a wash-bottle trap) to the low-volume aspirator of the dental unit.Clean up any spilled mercury immediately.e. 5. perform all operations involving mercury over areas that have impervious and suitably lipped surfaces.Amalgam raw materials being stored for use (usually as precapsulated packages). In the dental office.biological effect on the tooth: mercury overexpansion may lead to tooth splitting. the sources of mercury exposure related to amalgam include: 1. 6-Salvage all amalgam scrap and store it under water that contains sodium thiosulfate (photographic fixer is convenient).. decontamination of carpeting is very difficult. The concern with the potential for mercury toxicity therefore centers primarily on dental office personnel.Store mercury in unbreakable. insertion. especially in endodontically treated teeth. Recommendations for mercury hygiene are: 1. and intraoral hardening. 3. Each of these is more carefully considered in the following paragraphs.Mixed but unhardened amalgam during trituration. the dental office personnel are at greater risk because of frequent handling of the freshly mixed material. 7-Work in well-ventilated spaces. tightly sealed containers. Amalgam blue is the discoloration of tooth structure that is not underlined by varnish or cement. . 2.4.Amalgam restorations being removed. 8-Avoid carpeting dental operatories. RISKS TO DENTISTS AND OFFICE PERSONNEL: Of the two groups of people (i.Amalgam scrap that has insufficient alloy to completely consume the mercury present.
of the potential hazard of mercury vapor and the necessity for observing good mercury and amalgam hygiene practices. manual and mechanical. but do not use ultrasonic amalgam condensers. 11-Use water spray and suction when grinding dental amalgam. 14-Determine mercury vapor levels in operatories periodically. especially during training or indoctrination periods. . 15-Alert all personnel who handle mercury. 12-Use conventional dental amalgam condensing procedures.9-Eliminate the use of mercury-containing solutions. 10-Avoid heating mercury or amalgam. 13-Perform yearly mercury determinations on all personnel regularly employed in dental offices.
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