INDIRECT POST AND CORE FABRICATION

Fig. 7. Undercuts are removed from post and cores.

tion of DVP for gypsum as the die-investment material

offers two additional advantages: (1) the expansion Fig. 8. Cemented post and cores.
between the invested die and the remainder of the
investment is the same, which minimizes finning on the 2. Abadie FR: Plastic stopping-Its multiple uses. J PROXHET
casting, and (2) dental alloys can be cast in DVP without DENT 24~103, 1970.
mold decomposition and sulfide contamination. 3. Lau VM: The reinforcement of endodontically treated teeth.
Dent Clin North Am 20:313, 1976.
SUMMARY 4. Sheets CE: Dowel and core foundations. J PKOSTHET DENT
23:58, 1970.
A technique has been presented for indirect fabrica- 5. Whiteside WD: A simplified dowel crown technique. J PROS-
tion of a cast post and core with the refractory material THET DENT 23:554, 1970.
DVP. This method eliminates the need for developing 6. Cavelis JR, Hope DM: A modified indirect cast post and core
full contoured patterns and their removal from the technique. J PROSTHET DENT 51:55, 1984.
working cast for investment. Less time is required and Refmnt rryue~~, h:
the accuracy of the castings is improved. DR B. ED KANOY
UNIVERSITY OF NORTH CAROLIN.~
REFERENCES Scrmo~. OF DEE;TISTRY 211 H
1. Henry PJ, Bower RC: Post core systems in crown and bridge. CHAPEL. HILL, NC 27514
Aust Dent J 22:46. 1977.

Composite-veneered amalgam restorations

Moshe Gordon, D.M.D.,* Ben-Zion Laufer, D.M.D.,** and Zvi Metzger, D.M.D.***
Israel Defense Forces Center of Oral and Dental Medicine, Tel Hashomer, Israel; and School of Dental Medicine,
Tel Aviv University, Tel Aviv, Israel

The opinions and assertions contained herein are the private views of
Am algam is the restorative material most frequently
used in posterior teeth. Its use was once essentially
the authors and are not to be construed as official or as reflecting the
views of the Israel Defense Forces (I.D.F.) Center of Oral and limited to intracoronal restorations. Ha’wever, develop-
Dental Medicine or the Medical Corps. ment of higher quality amalgams and the introduction of
*Director, I.D.F. Center of Oral and Dental Medicine, and Section of pins increased its versatility. When properly designed
Operative Dentistry, Tel Aviv University.
and skillfully manipulated, amalgam restorations that
**Department of Prosthetics and Maxillofacial Prosthetics, I.D.F.
Center of Oral and Dental Medicine. replace a cusp a two, or even restore an entire occlusal
***Director, Research Laboratories, and Section of Operative Dentist- surface, may serve for many years. Esthetically, amal-
ry, Tel Aviv University. gam has a major disadvantage that prevents its use for

THE JOURNAL OF PROSTHETIC DENTISTRY 759


Fig. 1. Schematic representation of buccolingual cross-
cut through premolar restored with composite resin-
veneer amalgam restoration. A = Amalgam; C = com-
posite resin; P = prefabricated post; RG = retaining
groove.
restoration of buccal cusps and surfaces of maxillary
premolars and first molars.
The introduction of composite restorative materials
has been esthetically advantageous. However, despite the
major developments in their physical properties, these
materials are still unsuitable for extensive restoration of
the functioning surfaces of posterior teeth.
The purpose of this article is to present a method of
combining the mechanical properties of amalgam with
the esthetic qualities of composite resin in a composite-
veneered amalgam restoration. A report on the results of
a 2-year clinical study of 14 such restorations performed
on maxillary premolars is included.
TECHNICAL PROCEDURE
The procedure requires two visits. At the first visit the
amalgam restoration is completed. At the second visit
veneer cavity is prepared and a composite veneer is
constructed.
Amalgam restoration
Follow the procedures used regularly for a large
amalgam restoration, which includes a partial or total
restoration of the occlusal surface of the tooth.‘,’ Restor-
ing a nonvital tooth usually requires cuspal reduction by
2 to 2.5 mm.‘p3 Retention of the amalgam restoration is
usually provided by pins or by a prefabricated post with
or without the addition of pins.‘,2,4 The design of the
composite veneer precludes locating the pins in the
region of the projected veneer cavity and resin-retaining
pins (Fig. 1). High-copper amalgam is indicated for this
760
GORDON, LAUFER, AND METZGER
Fig. 2. Schematic representation of occlusal view of
premolar restored with composite resin-veneer amal-
gam restoration. A = Amalgam; C = composite.
kind of large restoration. 2,5s6 Nogama-2 (Sabrablend,
Silmet Ltd., Givataim, Israel) amalgam gave favorable
results for the restorations in the 2-year clinical study.
Special attention should be given to a functional carving,
which should conform to vertical and lateral mandibular
excursions.
Veneer cavity preparation
At the second appointment, finish and polish the
amalgam restoration. Then prepare the veneer cavity.
Use a cylindrical, short diamond stone in a high-speed
handpiece. The depth of the cavity should not be less
than 1 mm in its shallowest part. This will ensure
acceptable esthetic results. No amalgam margin is
required occlusally; the composite veneer will merge
with the occlusal surface of the restoration (Fig. 1). The
mesial and distal walls of the cavity are prepared
perpendicular to the amalgam surface, thus avoiding
thin and fragile amalgam margins (Fig. 2). Sharp or
uneven margins at the cavosurface angle are corrected
and smoothed, using amalgam finishing burs at low
speed. The gingival wall of the veneer cavity is prepared
in sound tooth structure. A retentive groove in the dentin
is prepared in the gingival wall, using a No. 0.5 round
bur (Fig. l), and the gingival cavosurface margin is
slightly beveled.
Veneer-retaining pins
Retention for the composite veneer will be provided by
two self-threading pins. Use Minikin (0.17) or Minuta
(0.135) (TMS Whaledent International, New York,
N.Y.) pins with the appropriate drills. Prepare the pin
channels in the axial amalgam wall of the veneer cavity
(Figs. 1 and 2). The pin channels should be kept at least
1 mm from the mesial or distal margin and about 2 mm
DECEMBER 1985 VOLUME 54 NUMBER 6
COMPOSITE-VENEERED AMALGAM RESTORATION

from each other to avoid fractures of the amalgam. After

preparing a starting point with a No. 0.5 round bur,
start the channel while keeping the drill perpendicular to
the axial wall of the veneer cavity (Figs. 1 and 2). Insert
a self-threading pin into each channel, avoiding excessive
force once the pin has reached the fundus of the channel.
When using Minikin pins, bend their protruding part
gingivally or toward each other with the bending tool
provided by the manufacturer. The bent pins should be
kept within the veneer cavity and should not protrude
buccally from the surface of the projected veneer. Fur-
thermore, enough space should be available for the
composite resin to cover the pins in a thick layer to
ensure the esthetic result (Figs. 1 and 2).

Composite veneer
The facial veneer is made of a composite resin that
matches the shade of the restored tooth and the adjacent
teeth. Light-cured composite resins are preferable
because they are easier to manipulate and provide better
results in wide restorations. Nevertheless, favorable
results can also be achieved with conventional paste-
to-paste composites. During insertion, protect the inter-
dental spaces from being filled with resin by placing a
wooden wedge mesially and distally to the treated tooth.
Carefully clean the gingival enamel that borders the
veneer cavity, etch it, then rinse and dry it thoroughly.
Apply a bonding agent to the etched enamel and insert
the composite resin into the veneer cavity. While insert-
ing the resin, attention should be given to a good
adaptation around the retentive pins and in the retentive
gingival groove (Fig. 1). When using a paste-to-paste
type of composite, add a small amount of unfilled resin to
slightly thin the paste mix; this will enhance adapta-
tion.
As soon as the composite resin is fully cured, finish
and polish its surface using Soflex (3M Dental Products,
St. Paul, Minn.) disks following the manufacturer’s
instructions. Finally, check the contacts of the finished
restoration in both vertical and lateral mandibular
excursions and remove any interferences.
DISCUSSION AND CLINICAL SURVEY
Recent developments in amalgam have provided the
dental profession with a restorative material of superior
physical properties and corrosion resistance.5-7 These
developments, in addition to the introduction of easy to
use self-threading pins and new types of prefabricated
dowels, have widened the scope of use of amalgam as a
restorative material. At present, the combined use of
retentive pins or posts and amalgam of better physical
qualities make it possible to restore cusps and even the
entire occlusal surface of a tooth. In suitable endodon-
tically treated teeth, cuspal protection can be provided
Fig. 3. Amalgam restoration of endodontically treated
upper left first premolar. A, Buccal view. B, Occlusal
view.
by restoration of the occlusal surface with amalgam
(Fig. 3).3,8
Attempts to use composite resin to veneer amalgam
restorations have been reported. One such method used a
composite resin that claimed to adhere permanently to
amalgam.’ Unfortunately, this composite resin failed to
meet expectations and could not be used as a permanent
esthetic coat for amalgam. Another method used conven-
tional composite resins inserted into a. veneer cavity
prepared in the amalgam restoration; retention of the
composite resin was attained with undercuts in the
cavity.‘O Fragility of the thin amalgam on the occlusal
wall of the cavity is a limitation of this procedure.
The presently proposed method avoids weak areas in
the amalgam restoration and provides retention of the
composite resin by a combination of pins, a gingival
groove, and etched enamel (when such enamel is present
gingival to the veneer cavity). With the proposed design,
the inner slope of the buccal cusp is restored with
amalgam, which resists functional loads, while the
composite resin masks the amalgam and provides accept-
able esthetic results (Fig. 4).
The use of microfilled light-cured composite resins is
beneficial when the proposed procedure is used. Easier

THE JOURNAL OF PROSTHETIC DENTISTRY 761

 GORDON, LAUFER, AND METZGER

Esthetically, these restorations have the same draw-

backs as any other composite resin restoration; namely,
superficial discoloration that can be corrected by pol-
ishing.

SUMMARY
A procedure is described for the construction of
composite resin veneers for large amalgam restorations.
The resulting restoration combines the physical qualities
of amalgam with the esthetic benefits of composite resins.
Among the 14 restorations that have been studied for 2
years, none failed mechanically and minor surface
discolorations have been satisfactorily corrected by pol-
ishing.
We wish to thank Ms. Dalith Salman for the photographic work.

REFERENCES
1. Brown DR, Barkmeier WW, Anderson RW: Restoration of
endodontically treated posterior teeth with amalgam. J PROS-
THET DENT 41:40, 1979.
2. Mozer JE, Watson RW: The pin retained amalgam. Oper Dent
4149, 1979.
3. Frank AL: Restoration of the pulpless tooth. In Ingle JI, editor:
Endodontics, ed 2. Philadelphia, 1976, Lea & Febiger, p 778.
4. Deutsch AS, Musicant BL, Cavallari J, Lepley JB: Prefabri-
cated dowels: A literature review. J PR~~THET DENT 49:498,
1983.
5. Eames WB, MacNamara JF: Eight high-copper amalgam
alloys and six conventional alloys compared. Oper Dent 1:98,
Fig. 4. Composite resin-veneer amalgam restoration of
1976.
endodontically treated upper left first premolar. A,
6. Marker BC, Marshall GW: Characteristics and handling of
Bucco-occlusal view (photographed diagonally). B,
&-rich amalgam. Quintessence Int Dent Digest 10~125, 1979.
Occlusal view.
7. Duke ES, Cochran MA, Clark HE: Laboratory profiles of 30
high copper amalgam alloys. J Am Dent Assoc 105~636, 1982.
8. Goerig AC, Mueninghoff LA: Management of the endodontical-
manipulation to achieve the right form is one advantage, ly treated tooth. Part I: Concept for restorative designs. J
but the major advantage lies with the color blending and PROSTHET DENT 49:340, 1983.
the opportunity to effectively mask the metal and to give 9. Zalkind M, Rehany A, Revah A, Stern N: A composite resin
bonded to dental materials. J PROSTHET DENT 46:300, 1981.
different parts of the veneer different shades.
10. Anylis LF, Fine L: The amalgam-composite resin restoration. J
Among the 14 restorations that have been studied for 2 PROSTHET DENT 47~685, 1982.
years, none had lost its composite resin veneer or
Reprint requests to:
sustained fractures of the amalgam. The results are
DR. M. GORDON
encouraging although not conclusive. Longer periods of SCHOLL OF DENTAL MEDICINE
follow-up and additional restorations will provide a TEL AVIV UNIVERSITY
more decisive evaluation of the life expectancy of this TEL AVIV. 69978 ISRAEL
type of restoration.

DECEMBER 1985 VOLUME 54 NUMBER 6