1

AMALGAM RESTORATIONS
INITIAL CLINICAL PROCEDURES

 Review of chart

 Assessment of occlusion

 Occlusal contacts of the tooth to be restored.

 Occlusal contacts of opposing and adjacent teeth

 Local anesthesia

 Comfortable and uninterrupted procedure.

 Marked reduction in salivation.

 Isolation of the operating site

 Insertion of wedge preoperatively in the gingival embrasure if restoring a posterior proximal

surface.

 Separation of operated tooth from adjacent tooth.

 Protect rubber dam and interdental papilla.

CLASS I AMALGAM RESTORATIONS

Restorations on

 Occlusal surface of premolars and molars.

 Occlusal two thirds of the facial and lingual surfaces of molars.

 Lingual surface of maxillary incisors.

 Conservative Class I amalgam restorations.

 Faciolingual width 1 - 1.5mm

 Depth 1 - 1.5mm

 Extensive Class I amalgam restorations.

 If distance between infected dentin and pulp < 1mm OR

 If faciolingual extent of defect is up the cuspal inclines.

CONSERVATIVE CLASS I AMALGAM RESTORATIONS

 2

INITIAL TOOTH PREPARATION

 Outline form

 Primary Resistance form

 Primary Retention form

 Convenience form

FINAL TOOTH PREPARATION

 Removal of remaining pits and fissures, infected dentin and/or old restorative material.

 Pulp protection if indicated

 Secondary resistance and retention form

 Finishing of external walls

 Cleaning, inspecting and sealing

OUTLINE FORM

 No. 245 bur (Inverted cone)

 Head length 3mm

 Diameter 0.8mm

 No. 330 bur (Smaller and pear shaped version of No. 245 bur)

Produces occlusal convergence and rounded line angles and point angles.

 Enter most deepest or carious pit.

 If both pits equally involved enter the distal pit.

Distal aspect of bur is placed over the distal pit to minimize extension into the marginal ridge

 If thickness of marginal ridge

 >1.6mm

Mesial and Distal walls should converge occlusally.

 <1.6mm
 3

Mesial and Distal walls should diverge occlusally to prevent undermining of the marginal ridge.

 Depth 1.5mm (1/2 the length of No. 245 bur).

 Width of isthmus 1/4th the intercuspal distance.

 Enameloplasty if fissure does not extend to 1/3 rd the thickness of enamel.

PRIMARY RESISTANCE FORM

 Flat floor at right angles to the line of stress.

 Adequate bulk of the restorative material  (1.5-2mm).

 Preserve cusps and marginal ridges.

 Cap weak cusps.

 Occlusal cavity margins in areas not subjected to excessive occlusal trauma . In practice
one-quarter (1/4) of the intercuspal width.

 Rounded internal and external line angles and point angles.

 Walls of the cavity parallel to the direction of the stress.

 No unsupported enamel (undermined)

Cavosurface angle: 90 degree

PRIMARY RETENTION FORM

 Box form

 Parallel/Divergent/ slightly occlusally convergent walls

CONVENIENCE FORM

Shape or form of the preparation that provides for adequate observation, accessibility and ease
of operation in preparing and restoring the tooth.

FINAL TOOTH PREPARATION

 Removal of remaining pits and fissures, infected dentin and/or old restorative material.

 Pulp protection if indicated.

 Secondary resistance and retention form.

 Finishing of external walls.

 4

 Cleaning, inspecting and sealing.

EXTENSIVE CLASS I AMALGAM RESTORATIONS

 If distance between infected dentin and pulp < 1mm OR

 If faciolingual extent of defect is up the cuspal inclines.

INITIAL CLINICAL PROCEDURES

 Review of chart

 Assessment of occlusion

 Occlusal contacts of the tooth to be restored.

 Occlusal contacts of opposing and adjacent teeth

 Local anesthesia

 Comfortable and uninterrupted procedure.

 Marked reduction in salivation.

 Isolation of the operating site

STEPS OF TOOTH PREPARATION

INITIAL TOOTH PREPARATION

 Outline form

 Primary Resistance form

 Primary Retention form

 Convenience form

FINAL TOOTH PREPARATION

 Removal of remaining pits and fissures, infected dentin and/or old restorative material.

 Pulp protection if indicated

 Secondary resistance and retention form

 Finishing of external walls

 Cleaning, inspecting and sealing

 5

OUTLINE FORM

 Initial Depth 1.5mm (1/2 the length of No. 245 bur).

 Extent Sound tooth structure

 Cusp Capping

 Distance b/w primary groove and cusp tip < ½ the distance No need of cusp capping

 Distance b/w primary groove and cusp tip = ½ - 2/3 rd Consider cusp capping

 Distance b/w primary groove and cusp tip > 2/3 rd the distance Cusp capping

PRIMARY RESISTANCE FORM

 Flat floor at right angles to the line of stress.

 Adequate bulk of the restorative material  (1.5-2mm).

 Preserve cusps and marginal ridges.

 Cap weak cusps.

 Occlusal cavity margins in areas not subjected to excessive occlusal trauma . In practice
one-quarter (1/4) of the intercuspal width.

 Rounded line angles and point angles.

 Walls of the cavity parallel to the direction of the stress.

 No unsupported enamel (undermined)

Cavosurface angle: 90 degree

PRIMARY RETENTION FORM

 Box form

 Divergent/ slightly occlusally convergent walls

CONVENIENCE FORM

Shape or form of the preparation that provides for adequate observation, accessibility and ease
of operation in preparing and restoring the tooth.

FINAL TOOTH PREPARATION

 6

 Removal of remaining pits and fissures, infected dentin and/or old restorative material.

 Pulp protection if indicated.

 Secondary resistance and retention form.

 Finishing of external walls.

 Cleaning, inspecting and sealing.

PULP PROTECTION

 RDT 0.5-1mm Base

 RDT < 0.5mm Liner + Base

RMGI

 Resist forces of condensation.

 Avoid dissolution of Ca(OH)2 during etching.

SECONDARY RESISTACE AND RETENTION FORM

 Excavation of caries has removed most or all of the flat floor that was initially prepared

Secondary resistance form

Reestablishing flat floor 0.2mm within DEJ around the periphery of

excavation.

Secondary retention form

Undercuts that are left in dentin after removal of infected dentin and are not
covered by the base.

CLASS I COMPOUND CAVITY

Cavities involving the occlusal surfaces of molars and occlusal two thirds of the facial and lingual
surfaces.

 Class I occlusolingual amalgam restorations.

 Class I occlusobuccal amalgam restorations.

CLASS I OCCLUSOLINGUAL PREPARATION

 7

Lingual fissure connects with the distal oblique fissure and distal pit on the occlusal surface.

OUTLINE FORM

 Occlusal preparation

 Lingual preparation

 OCCLUSAL PREPARATION

 No. 245 bur along the long axis of the tooth.

 Start from distal pit.

 Initial depth 1.5mm.

 Conserve strength of

 Distal marginal ridge

 DL cusp

Cutting 70:30 rather than 50:50 mesial to the pit.

 LINGUAL PREPARATION

 No 245 bur

 Two methods

 Preparation with bur’s long axis parallel with the lingual surface.

 Preparation with bur’s long axis perpendicular to the cusp ridge and lingual
surface.

 Axial depth 0.2-0.5mm within DEJ

 MD width 1mm

PRIMARY RESISTANCE FORM

Preservation of

 Marginal ridge
 8

 DL cusp

 Oblique ridge

SECONDARY RETENTION FORM

 OCCLUSAL PREPARATION

 Occlusal convergence of mesial and distal walls absent or inadequate

 Retention cove in faciopulpal line angle.

 LINGUAL PREPARATION

 Lingual extension wide MD OR

 No lingual convergence

 Locks in mesioaxial and distoaxial line angles.

 No. ¼ bur

 Depth ½ the dia of bur

 Lock terminate midway along the axial wall

RESTORATIVE TECHNIQUE

Dentin desensitizer or Adhesive system

Dentin Desensitizer

Conservative restorations

Procedure

Rubbed into dentin surface for 30 sec and dried.

Adhesive system

 Extensive restorations

 Foundations

Procedure

 Etching 15-30 sec

 9

 Wash

 Dry 10 sec

 Primer Dried

 Adhesive application

CLASS II AMALGAM RESTORATIONS

 Occlusal box

 Proximal box

OUTLINE FORM

 OCCLUSAL BOX

 No. 245 bur along the long axis of the tooth.

 Start from pit nearest the involved proximal surface.

 Initial depth 1.5-2mm.

 Extension to central fissure and opposite pit if involved. Extension to include the facial
and lingual developmental fissures provides the dovetail feature.

 Enameloplasty

 Visualize the final location of facial and lingual walls of the proximal box relative to the
contact area.

 Reverse curve in the occlusal outline of facial wall.

 Conserve facial cusp structure.

 Provide 90° amalgam at facial margin.

 Extension of preparation proximally stopping 0.8mm short of cutting through the

marginal ridge.

 Exposes the marginal ridge DEJ which serves as a guide in the development of
proximal preparation.

 PROXIMAL BOX
 10

 Positioning of bur over the DEJ in the pulpal floor next to the remaining mesial marginal
ridge.

 Cutting of a ditch gingivally along the exposed DEJ 0.5-0.6mm into dentin and 0.2-
0.3mm into enamel.

 By moving the bur facially and lingually ditch is extended gingivally just beyond caries or
proximal contact whichever is greater.

 Depth of axial wall 0.5mm for enamel preparation

0.8mm for non enamel preparation

 Clearance of proximal margins (facial, lingual and gingival) with adjacent tooth 0.5mm

PRIMARY RESISTANCE FORM

Reverse curve providing the strength of both the amalgam and tooth structure at the junction of
the occlusal step and proximal box.

PRIMARY RETENTION FORM

 Occlusal convergence.

 Dove tail.

SECONDARY RESISTANCE FORM

 Resistance of tooth structure against fracture from oblique forces.

 Restricting the extensions of external walls.

 Resistance of restorative material against fracture.

 Rounding of axiopulpal line angle.

 Increase bulk of restorative material.

 Decrease stress conc. within the restorative material.

 Proximal retention locks.

 Strengthen isthmus of restoration.

SECONDARY RETENTION FORM

 Retention locks
 11

 Resistance to displacement proximally.

CHARACTERISTICS OF PROXIMAL LOCKS

 Position

 Translation

 Depth

 Occlusogingival orientation

MODIFICATIONS IN TOOTH PREPARATION

 Box only preparation

 Slot preparation

 Tunnel preparation

Box only preparation

 Indications

 Small cavitated proximal lesions in a tooth with

 No previously inserted occlusal restoration.

 No occlusal fissures.

 Narrow proximal contact.

Slot preparation

 Indications

 Lesions < 2.5mm gingival to the crest of the marginal ridge.

 Root caries.

 Procedure

 Facial or Lingual approach.

 No. 2 or 4 bur (round bur).

 Axial depth 0.75-1mm Gingivally for non enamel prep

 Cavosurface angle 90°

 12

Retention grooves

 No. ¼ bur

 Occlusoaxial and gingivoaxial line angle.

 0.2mm inside the DEJ or 0.3-0.5mm inside the cemental cavosurface margin.

Tunnel preparation

 Indications

 Lesions > 2.5mm gingival to the crest of the marginal ridge.

 Procedure

 Access the lesion obliquely through the marginal fossa retaining the marginal
ridge.

CLASS VI CAVITY

Cavities occurring on the cusp tips of posterior teeth and incisal edges of anterior teeth.

 No. 169L bur

 Depth 1.5mm

 Occlusally divergent walls.

 Retention by small undercuts along the internal line angles.

INDICATIONS FOR AMALGAM RESTORATIONS

 Occlusal factors

 Isolation factors

 Operator ability and commitment factors

 Clinical indications

 Moderate to large class I and II restorations.

 Class V restorations.

 Temporary caries control restorations.

 Foundations.

REQUIREMENTS FOR SUCCESSFUL AMALGAM RESTORATIONS

 13

 Tooth factors

 Preservation of cuspal inclines.

 Preservation of marginal ridges.

 No unsupported enamel.

 Material factors

 90° or > amalgam margin.

 Adequate depth.

 Adequate mechanical retention form.

CLASS III AMALGAM RESTORATIONS

INDICATIONS

 Reserved for distal surface of max and man canines if

 Preparation is extensive with only minimal facial involvement.

 Gingival margin involves primarily cementum.

 Moisture control is difficult.

 OUTLINE FORM

 No 2 bur (No ½ or 1 bur when tooth or carious lesion small)

 Entry from lingual side at the marginal ridge.

 Axial depth 0.5mm within DEJ

0.8mm for root surface

 Extension

 Facial margin 0.2-0.3mm into the facial embrasure

Curved outline from incisal to gingival margin.

 Lingual margin Little or no lingual wall

Blends with incisal and gingival margins in a smooth curve.

 Cavosurface angle 90°

 14

 External walls

 Facial

 Incisal

 Gingival

Meet axial wall at right angle

 Lingual Meet axial wall at an obtuse angle or may be continuous with the axial
wall.

 Axial wall Follow faciolingual contour.

 Axial line angles accentuated with no. ½ bur

 Facilitate placement of retention groove.

 Leave the line angles rounded.

 Reduce stress concentration.

 Permit more complete condensation of amalgam.

 SECONDARY RETENTION FEATURES

 Gingival groove

 Incisal cove

 Lingual dovetail

GINGIVAL GROOVE

 No ¼ bur (dia 0.5mm)

 Gingivoaxial line angle

 Depth 0.25mm (1/2 the dia of bur)

If less retention form needed

Placement of two gingival coves at point angles.

INCISAL COVE

 No ¼ bur

 Axiofacioincisal point angle

 15

 Depth 0.25mm

LINGUAL DOVETAIL

 INDICATION

Large preparations with excessive incisal extension.

 PREPARATION

 No 245 bur

 Extension

MD not beyond midpoint of the lingual surface.

Incisogingivally 2.5mm

 Depth 1mm

FINISHING

 For enamel preparations beveling (20°) at the gingival margin.

CLASS V AMALGAM RESTORATIONS

INDICATIONS

 Non esthetic areas.

 Areas with limited access and visibility.

 Difficulty in moisture control.

 Areas that are deep gingivally or when soft tissue flap has to be reflected for adequate
access and visibility.

 For partial denture abutment teeth.

OUTLINE FORM

 Tapered fissure bur

 Axial wall depth Incisal wall 1-1.25mm

Gingival wall 0.75-1mm

 External walls

Mesial
 16

Distal

Incisal or occlusal

Gingival

Perpendicular to external tooth surface therefore diverge facially

SECONDARY RETENTION FEATURES

 Retention grooves

 Retention coves

RETENTION GROOVES

 No. ¼ bur

 Two retention grooves

 Incisoaxial line angle

 Gingivoaxial line angle

 Depth 0.25mm

RETENTION COVES

Conserves dentin near the pulp as compared to grooves reducing the possibility of
mechanical pulp exposure.

 No. ¼ bur

 Four retention coves in point angles