Class II Amalgam Restorations

Operative Dentistry Dent 343/335

Mohammad Atieh , BDS, MS
 Reminder

Amalgam (Silver Filling!)

Indications: Contraindications:

Class I, II & VI defects that are: • Esthetic areas.

• Are moderate to large in size. • Small to moderate Class I and II
• In non-esthetic areas. defects that can be well
• In areas with heavy occlusal isolated.
contact.
• Extends to root surface. • Small class VI defects.
• Difficult to isolate.
Dr. Mohammad Atieh
 Initial Clinical Procedures

1. Preoperative occlusal contacts should be identified.

Courtesy of Dr. Sumitha Ahmed

 Initial Clinical Procedures

1. Preoperative occlusal contacts should be identified.

Initial Clinical Procedures
Initial Clinical Procedures
 Initial Clinical Procedures

Preoperative After restoration Adjusted to

High spot =Preoperative occlusion
 Initial Clinical Procedures

2. Obtain adequate isolation and retraction.

https://optident.co.uk/app/uploads/2016/02/Mouthgurad.jpg
 Initial Clinical Procedures

3. Preoperative wedging.
• Depresses the protects rubber dam
and/or underlying soft tissue.
• Separate teeth slightly.
• May serves as a guide to prevent
overextension of the proximal boxes.
Initial Tooth Preparation
 Class II Amalgam Restorations
• Initial tooth preparation objectives:
• Establish cavity outline in a sound DEJ:
• Occlusal step:
• High speed drill with water to enter the pit nearest to
the involved proximal surface (#245 bur).
• Bur should be parallel to the long axis of tooth.
• Bur should be rotating while entering the tooth
and rotating until removed.
• The target depth is for the initial depth is 0.1-0.2 mm
into dentine (= 1.5-2 mms).
• Isthmus should be as narrow as possible ( ideally the
width of the #245 bur) = better longevity.
• However, the extension of caries determine the
resultant width.
 Class II Amalgam Restorations
• Initial tooth preparation objectives:
• Establish cavity outline in a sound DEJ:
• Occlusal step:
• Before extending into the involved proximal
surface. The final locations of the facial and
lingual walls should be visualized (imagined).
• This prevents unnecessary overextension of
the occlusal outline where it meets the
proximal box.
 Class II Amalgam Restorations
• Initial tooth preparation objectives:
• Establish cavity outline in a sound DEJ:
• Occlusal step:
• The preparation should be extended mesially at
the same pulpal depth until approximately 0.8
mm short of cutting into through the marginal
ridge.
• The extension should be slightly wider
facicolingually than the occlusal step.
• This is necessary to access the caries and
form the proximal box.
 Class II Amalgam Restorations
• Initial tooth preparation objectives:
• Establish cavity outline in a sound DEJ:
• Occlusal step:
• Develop 90º cavosurface margins.
• Ensures supported enamel is present.
• Provides maximal edge strength of
amalgam.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound DEJ:
• Occlusal step:
• Reverse curve
• Most commonly on the facioproximal wall.
• It provides access to proximal caries while
conserving the cusp.
• It provides 90º cavosurface margins.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound DEJ:
• Occlusal step:
• Reverse S curve
• Most commonly on the facioproximal wall.
• It provides access to proximal caries while
conserving the cusp.
Nonconservative
• It provides 90º cavosurface margins.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound DEJ:
• Occlusal step:
• Reverse S curve
• Most commonly on the facioproximal wall.
• It provides access to proximal caries while <90º
conserving the cusp.
• It provides 90º cavosurface margins.
 Class II Amalgam Restorations
• Initial tooth preparation objectives:
• Establish retention form:
• Occlusal step:
• Occlusal convergence of the F,L and D walls.
• Dove tail
• It provides retention against mesial
displacement of the restoration.
• It is not required if the preparation has
enough retention and caries doesn't extend
to the developmental grooves.
 Class II Amalgam Restorations
• Initial tooth preparation objectives:
• Establish resistance form:
• Occlusal step:
• Protect cusps by limiting F/L extension (Isthmus).
• Remove unsupported enamel.
• Join two outlines that are separated by weak
wall ( <0.5 mm apart).
• Box-shaped cavity with relatively horizontal
pulpal floor.
• Sufficient thickness of restorative material ( 1.5
mm for amalgam).
• Rounded pulpal line angles.
 Class II Amalgam Restorations
• Initial tooth preparation objectives:
• Establish convenience form:
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound DEJ:
• Proximal box:.
• Should include all caries, defects or existing restorative
material.
• Should provide 90º cavosurface margins.
• Establish (ideally) not more than 0.5 mm clearance
(separation) with the adjacent proximal surface facially,
lingually and gingvally.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound
DEJ:
• Proximal box:.
• Proximal ditch cut ( in gingival direction):
• Bur is initially allowed to cut the
ditch 0.2-0.3 mm into the exposed
DEJ.

0.2-0.3 mm
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound
DEJ:
• Proximal box:.
• Proximal ditch cut ( in gingival direction):
• Bur then moved facially and
lingually while maintaining the
established depth.
• The axial wall should follow the
outside contour of the proximal
surface.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound
DEJ:
• Proximal box:.
• Proximal ditch cut ( in gingival direction):
• The gingival extension is gradually
increased just beyond caries or
proximal contact (whichever is
greater).
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound
DEJ:
• Proximal box:.
• Proximal ditch cut ( in gingival direction):
• Now the bur is moved more
proximally and perpendicular to
weaken enamel further.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound
DEJ:
• Proximal box:.
• Proximal ditch cut ( in gingival direction):
• Now the bur is moved more
proximally and perpendicular to
weaken enamel further.
• A hand instrument like spoon
excavator is then used to break the
thin enamel.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound
DEJ:
• Proximal box:.
• Proximal ditch cut ( in gingival direction):
• Now the bur is moved more
proximally and perpendicular to
weaken enamel further.
• A hand instrument like spoon
excavator is then used to break the
thin enamel.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish cavity outline in a sound DEJ:
• Proximal box:.
• Proximal ditch cut ( in gingival direction):
• To provide 90º cavosurface margins:
• Enamel hatchet is used to remove the
unsupported enamel on the facial, lingual
and gingival margins.
• Using the bur to accomplish this step may
be difficult and may cause damage to the
adjacent tooth or crawl out of the box into
the gingiva or across the proximal margins (
affecting the 90º cavosurface margins)
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish retention form:
• Proximal box:.
• Occlusal convergence.
 Class II Amalgam Restorations

• Initial tooth preparation objectives:

• Establish resistance form:
• Proximal box:.
• Protect cusps by limiting F/L extension.
• Remove unsupported enamel.
• Join two outlines that are separated by
weak wall ( <0.5 mm apart).
• Box-shaped cavity with relatively
horizontal gingival floor.
• Sufficient thickness of restorative material
( at least 1.5 mm for amalgam).
• Rounded line angles.
 Correction

-External line angles : whose

apex pointing outside the cavity
preparation (axiopulpal)

-Internal line angles: whose

apex pointing inside the cavity
preparation
Final Tooth Preparation
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Removal of remaining carious enamel
and infected dentine selectively.
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Pulp protection if indicated.
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Secondary resistance and retention
forms if indicated:
• In cases of extensive proximal boxes:
• Axiofacial and axiolingual retention
grooves.
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Finishing external walls.
• 90º cavosurface margins.
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Finishing external walls.
• Ensure 90º cavosurface margins occlusal,
facially and lingually.
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Finishing external walls.
• Ensure 90º cavosurface margins occlusal,
facially and lingually.
• Using enamel hatchet.
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Finishing external walls.
• 90º cavosurface margins occlusal, facially
and lingually.
• Gingival bevel to remove unsupported
enamel
• Using gingival margin trimmers.
• Not indicated if ending on cementum.
 Class II Amalgam Restorations

• Final tooth preparation objectives:

• Final cleaning and inspection
• Remove debris.
• Air-Water syringe.
• Dry and don’t overdissicate.
• Check all surfaces for any remaining caries.
• Underneath cusps adjacent to preparation outline.
• Have a look at the DEJ all around.

Dr.
Dr. Mohammad
Mohammad Atieh
Atieh
Dr. Mohammad Atieh
 Restorative Technique
for
Class II Amalgam Preparations
1. Applying desensitizer (optional):
• A desensitizing agent in form of liquid that is applied on freshly cut dentinal surface to reduce the
permeability and sensitivity of dentine by forming plugs from protein precipitation.
• GLUMA is one of the desensitizing materials.
 Restorative Technique
for
Class II Amalgam Preparations
2. Matrix placement:
• The functions of the matrix is to facilitate restoring the
proximal contours and contact areas.
• One type is the universal matrix system ( Tofflemire). Other
types will be introduced later during the semester.
 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• Condensation starts at the proximal box:
• Vertical (occlusogingival) and lateral (facial and lingual)
condensation is necessary to properly adapt amalgam to the
line angles of the box and at the junction between the
cavosurface margins and the matrix band.
• Proper proximal ( mesial or distal) condensation is necessary
to ensure the development of good proximal contact.
• Incremental buildup
• Condensation of the occlusal part of the preparation:
• Shift towards larger condenser when amalgam reaches the
pulpal level.
• Going back to smaller condensers as needed to condense
amalgam in narrow extension area of the preparation or near
proximal margins.
 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• Pre-carve burnishing
 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• Carving
• While the matrix band still in place :
• Carving the majority of occlusal anatomy is done.
• Defining marginal ridges and occlusal embrasures with
explorer or hollenback carver.
 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• Carving
• While the matrix band still in place :
• Carving the majority of occlusal anatomy is done.
• Defining marginal ridges and occlusal embrasures with
explorer or hollenback carver.
 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• Carving
• While the matrix band still in place :
• Carving the majority of occlusal anatomy is done.
• Defining marginal ridges and occlusal embrasures with
explorer or hollenback carver.
• Marginal ridge height should be equal to the
adjacent tooth ( general rule).
• Matrix bad and wedges are removed.
• Any excess amalgam at the margins or embrasures
is removed.
 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• Carving
• While the matrix band still in place :
• Carving the majority of occlusal anatomy is done.
• Defining marginal ridges and occlusal embrasures with
explorer or hollenback carver.
• Marginal ridge height should be equal to the
adjacent tooth ( general rule).
• Matrix bad and wedges are removed.
• Any excess amalgam at the margins or embrasures
is removed.
 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• Carving
• Final occlusal anatomical details.

Courtesy of Dr. Sumitha Ahmed Courtesy of Dr. Sumitha Ahmed

• When carving margins, the carver be
is held perpendicular to the margin
and carving procedure should be
parallel while the adjacent tooth
surfaces being used to guide the
carver.

Courtesy of Dr. Sumitha Ahmed

 Restorative Technique
for
Class I Amalgam Preparations
3. Insertion and carving of the amalgam:
• A thin Unwaxed dental floss is passed through the
proximal contact to :
• Remove any amalgam shavings
• To assess the gingival margin ( to feel if there is a catch)
 Restorative Technique
for
Class I Amalgam Preparations
4. Post-carve Burnishing
• Smoothening and polishing the restoration by light rubbing.
• May enhance marginal integrity.

Courtesy of Dr. Sumitha Ahmed

 Restorative Technique
for
Class I Amalgam Preparations
4. Occlusion check
• Using articulating paper.

Courtesy of Dr. Sumitha Ahmed

 Initial Clinical Procedures

Preoperative After restoration Adjusted to

High spot =Preoperative occlusion
 Lecture Reference

• Art and Science of Operative Dentistry

• Any picture without courtesy was taken from the book.
 Weekend Quiz

• Content of this lecture.

Please read/watch lab material before your lab!
Thanks!