Journal of Oral Rehabilitation, 1981, Volume 8, pages 517-526

Experimental microleakage around ageing

dental amalgam restorations: a review

A. J O D A I K I N MRCI University of the Witwatersrand Dental Research Institute,

Johannesburg

Summary
In vitro and in vivo experimental microleakage around ageing dental amalgam res-
torations has been reviewed. The methodologies, materials and results were examined
and discussed. The initial experimental microleakage which occurred around unlined/
unvarnished dental amalgam restorations and the development of leakage around
lined/varnished dental amalgam restorations underlines the problem of attaining a
permanent effective seal around dental amalgam restorations. The limitations of
microleakage studies have been outlined and the importance of an understanding of
the chemical changes which occur in the microcrevices stressed. This understanding
may facilitate the production of a lifelong successful dental amalgam restoration and
perhaps the development of an anticariogenic amalgam type fissure sealant.

Introduction
Unlined/unvarnished freshly packed dental amalgam restorations have been shown to
leak initially. However, with time, these restorations have displayed a reduction in
experimental microleakage between the cavity wall and the amalgam (Nelsen, Wolcott
& Paffenbarger, 1952; Going, Massler & Dute, 1960; Menegale, Swartz & Phillips,
1960; Phillips et al., 1961; Swartz & Phillips, 1961; Lyell, Barber & Massler, 1964;
Pickard & Gayford, 1965; Going & Sawinski, 1966; Hals & Nernaes, 1971; McCurdy
et al, 191 A; Andrews & Hembree 1978; Boyer & Torney, 1979; Hembree & Andrews,
1979).
The decrease in experimental microleakage has been attributed to corrosion
(Nelsen et al, 1952; Von Kreudenstein, 1958; Pickard & Gayford, 1965; Hals &
Nernaes, 1971; Andrews & Hembree, 1975, 1978). Nelsen et al. (1952) felt in particular
that the accumulation of plaques on uncleansed margins may play a role in the for-
mation of corrosion product plugs which seal the amalgam cavity wall interface.
Jorgensen (1965, 1979) stated that the decreased microleakage around unlined amalgam
restorations is known to be caused by the precipitation of solid corrosion products in
the irregular gaps between the amalgam and the cavity wall. D. C. Smith (personal

Correspondence: Dr A. Jodaikin, Dental Research Institute, University of Witwatersrand, 1 Ian

Smuts Avenue, Johannesburg 2001, Republic of South Africa.

O3O5-182X/81/11OO-O517 $02.00 ©1981 Blackwell Scientific Publications

517
518 A. Jodaikin ' ' '

communication), however, suggested that these corrosion products may combine

with proteins from the cavity wall debris and/or saliva and/or the diet to form a
precipitate plug.
Other factors which have been suggested as being responsible for the decrease in
experimental microleakage include the following: microbiological growth and organic
accretions (Pickard & Gayford, 1965), saliva (Stowell, Taylor & Wainwright, 1962;
Pickard & Gayford, 1965), mineral salts similar to supragingival calculus (Von
Kreudenstein, 1958), dietary substances in conjunction with mastication (Pickard &
Gayford, 1965), humidity (Galan, Mondelli & Coradazzi, 1977) and creep (K. D.
J0rgensen, personal communication).
This phenomenon of decrease in experimental microleakage around ageing,
unlined/unvarnished dental amalgams may be attributed to a series of factors and not
to a single entity. Thus, all factors must be considered; for example, oil from hand-
pieces, acquired pellicles, sclerotic changes, denti nal fluid flow and even factors unrelated
to the clinical situation such as may only be present under experimental conditions
(e.g. algae growing in a storage medium).
The purpose of this report is to review the literature on experimental microleakage
around ageing dental amalgam restorations.

Methods of demonstrating experimental microleakage

A number of different methods have been used to demonstrate experimental micro-
leakage around ageing dental amalgam restorations. A large proportion of the experi-
ments reviewed used the radioactive isotope penetrant method. Within this method
labelled 45^^ penetrant was most often used, although other radioactive isotope
penetrants have been used, namely: ^sp (Von Kreudenstein, 1958), i^ij (Going et al.,
1960; Stowell et al., 1962; Galan et al., 1977) and 35S (Lyell et al., 1964).
Dye penetrants have been used alone (Smith, Wilson & Combe, 1978; Wilson &
Smith, 1978) and in combination with the radioactive isotope penetrants (Going et al.,
1960; Lyell et al., 1964). The dyes used were: crystal violet, combined methylene and
fluorescein. Although Smith et al. (1978) combined methylene and a fluorescein dye,
the other studies reviewed used only a single dye.
The marginal percolation method has been used alone (Nelsen et al., 1952) as well
as in combination with a radioactive isotope penetrant (Von Kreudenstein, 1958). The
technique adopted for the marginal percolation method was to subject restorations to
thermal changes whilst observing the margins of the restoration with a binocular
microscope for fluid droplets exuding from in between the cavity wall and the restora-
tive material.
Pickard & Gayford (1965) used an air pressure method in which air was forced
through possible microcrevices under water. The resulting bubbles indicated possible
leaks between the restorative material and the cavity walls.
An artificial caries demineralization acid gel method has also been used by Hals &
Nernaes (1971) to test aged and freshly packed dental amalgam restorations. The use
of an artificial caries system in the study of microleakage has the advantage that
microleakage may be linked directly with the development of the artificial lesion
(Kidd, 1976).
A series of in vitro studies employed thermal cycling to simulate possible clinical
thermal stresses (Smith era/., 1978; Wilson era/., 1978; Newman e/a/., 1978;Hembree
& Andrews, 1979). Although most of the studies reviewed used in vitro models, in vivo
 Microleakage around restorations 519

studies in man, monkeys and dogs have also been undertaken. In some cases a combi-
nation of in vitro and in vivo models have been used for evaluating experimental
microleakage (Nelsen et al., 1952; Going et al., 1960; Lyell et al., 1964; Hals &
Nernaes, 1971; McCurdy et ah, 1974). It is clear that no direct comparison can be made
between in vitro and in vivo microleakage experiments at this stage because ofthe many
variables present (Jodaikin, 1981).
Besides the methods detailed above, other factors such as the mechanical and
chemical preparation of cavities and the material type and manipulation also introduce
a complex series of variables. Factors such as these have not been sufficiently investi-
gated to provide a full understanding of their effects on microleakage around dental
amalgams.
Storage factors such as time, temperature and medium may also influence micro-
leakage patterns as they appear to close the microcrevices at different rates and
possibly in different manners. Saliva, sodium sulphate, tap water, distilled water and
moist air in descending order of effective sealing have been compared (Lyell et al,
1964). In the studies which have been reviewed, normal saUne and Ringer's solution
were used on their own (Andrews & Hembree, 1975; Smith et al, 1978; Wilson &
Smith, 1978) and thus cannot be compared with other substances. Galan et al (1977)
and Newman et al (1978) have demonstrated that in time, unlined/unvarnished dental
amalgam restorations decrease leaking when stored in distilled water. Thus with time,
leakage around amalgam restorations would seem to decrease irrespective of the
storage medium employed.
As the rate and manner of closure of the microcrevice may bear no relationship to
the clinical situation, care should be exercised in correlating experimental micro-
leakage tests with the clinical reality. From the studies which have been reviewed it is
difficult to correlate the rates of closure of the microcrevices, or even at what stages the
leakage of amalgam would cease. This is due to the many variables.
Not only may the storage variables hamper analysis of microleakage results, but
some storage regimes may blur experimental microleakage patterns. This latter aspect
may be exemplified by two studies (Crawford & Larsen, 1956; Going et al, 1960) in
which the teeth were stored at low temperatures. The resulting thermal stresses may
have masked the experimental microleakage patterns (C. F. Valcke, personal
communication).
The maximum storage period in the studies reviewed for lined/varnished amalgam
restorations is 1 year (Andrews & Hembree, 1975) whereas the durability of an acquired
seal around unlined/unvarnished amalgam restorations in the studies reviewed has not
been investigated for storage periods greater than 24 months (Hembree & Andrews,
1979).
Apart from the storage factors, the type of penetrant used, the temperature, time,
and the method of penetrant application, an important variable which must be
considered is the state ofthe pulp (Roydhouse, Weiss & Leonard, 1967).
Most of the studies reviewed failed to include strategic examinations of the speci-
mens before and during the microleakage experiments. Undetected damage such as
fractures or caries may influence the microleakage results. It is suggested that speci-
mens be examined under magnification at all the appropriate intervals.
Sectioning of specimens may alter experimental microleakage results due to
smearing and/or the washing out of the penetrants. Although all of the early studies
failed to use an experimental microleakage measuring system, most of the more
35
520 A. Jodaikin

recent studies use one or other type of measuring system. However, these different
measuring systems make the comparisons between papers difficult. The measuring
systems used and the mieroleakage patterns examined may introduce elements of
chance (Roydhouse, 1968), thus the significance, precision and accuracy of the data
obtained is questionable.
Only two of the papers reviewed (Smith et al, 1978; Boyer & Torney, 1979)
subjected their mieroleakage results to statistical analysis. The analysis of results is,
however, not only dependent on the statistical aspects, but also on the validity of the
mieroleakage measuring system.
It is evident from the points made above that there are many variables that must be
considered. Thus it is imperative that all procedural information be accurately recorded
in the methodologies to allow for possible analysis and comparison with past and
present studies.

Materials
Cavity cleansers
No studies which investigated the effects of vacity cleansers on experimental micro-
leakage were found. The removal of the smear layer by effective cavity cleansers may
enhance adaptation of dental amalgam (D. C. Smith, personal communication)
and/or cavity liners/varnishes. However, exuding fluids from open dentinal tubules
(Johnson, Olgart & Brannstrom, 1973) may interfere with liners/varnishes due to
wetting.
An important consideration which can be drawn from suggestions such as that
mentioned above is that any new operative procedure and/or dental material which is
favourable in limiting experimental mieroleakage should also be investigated for other
aspects, including the long-term marginal seal. It is possible that, although the initial
seal is favourable, the long-term seal may be lost by the introduction of a new
factor.

Linersjvarnishes and bases

For the purpose of this paper a liner or varnish is defined as any material placed under
a restoration as a relatively thin layer on the walls and floor of the cavity. A base is
deflned as a thick or thin layer under a restoration and is intended primarily to cover
only the cavity floor.
A number of liners/varnishes have been shown in short-term studies to effectively
seal dental amalgam restoration cavity wall interfaces (Boing & Massler, 1961;
Brannstrom & Soremark, 1962; Barber, Lyell & Massler, 1964; Hals & Simonsen,
1972; Grieve, 1973). Recent studies have, however, shown that lined/varnished cavity
walls do not always maintain their initial sealing ability (Andrews & Hembree, 1975,
1978; Smith et al, 1978; Wilson & Smith, 1978; Newman et al, 1978).
Newman et al. (1978) had disappointing results with an etched and unetched
cyanoacrylate liner which was no better than the unlined control after 6 months.
Larsen et al. (1978) reported that intermixing of bases of either calcium hydroxide or
zinc oxide-eugenol and resinous cavity liners may increase the experimental micro-
leakage. However, Yates, Murray & Hembree (1979) have shown that lined/varnished
newly placed amalgam restorations with Dycal®, Flecko®, B & T®, Procal®, or
MPC® bases showed no or slight leakage, whereas the lined/varnished cavities with a
Cavitec® base showed moderate to gross leakage.
 Microleakage around restorations 521

The effects of different bases in lined/varnished and unlined/unvarnished cavities

need to be considered and investigated in longitudinal experimental microleakage
tests as these materials are extensively used under clinical amalgam restorations.
Caution should be exercised in analysing these results as it is possible that a clinically
unrelated experimental penetrant may react chemically with a base or liner/varnish. .

Dental amalgams
Although most of the early experimental microleakage studies failed to stipulate
the specific type of dental amalgams selected, most recent studies have provided details
on the types of dental amalgams used. Ageing of the various types of amalgams may
play different roles in the closing of the microspaces. With the introduction of the non-
gamma two dispersed and single phase alloy systems, which are known to be corrosion
resistant, a question posed by Andrews & Hembree (1975) is pertinent—what would
the microleakage pattern around a non-corrosive dispersed phase amalgam be like as
opposed to conventional and spherical alloy systems? The corrosion resistant amalgam
restorations used in longitudinal experimental microleakage studies have indicated
that experimental microleakage decreases with time (Andrews & Hembree, 1975, 1978;
Newman et al., 1978; Boyer & Torney, 1979; Hembree & Andrews, 1979).
An important point should be made in this regard. Non-corrosive non-gamma two
dental amalgams were probably introduced clinically before long-term experimental
microleakage studies ratified their ability to close microcrevices with time. The closure
of the microcrevices is possibly a result of the limited corrosion which occurs (Mateer
et al., 1977; Marek & Okabe, 1977; Sarkar & Nanda, 1979). Nevertheless, this point
supports an earlier suggestion that any new operative procedure and/or dental material
should be subjected to a long-term marginal seal experiment as well as other tests,
before being used clinically.
Conventional comminuted and spherical, admixed and atomized high copper
amalgams have been used, whereas fluoridated dental amalgams appear to have been
neglected in long-term experimental microleakage studies. The fluoridated dental
amalgams have been seen to reduce the associated enamel solubility (Jerman, 1970;
Heintze & Mornstad, 1979). The tests which are needed before the widespread use of
fluoridated amalgams can be considered should include longitudinal experimental
microleakage tests.

Results
Nelsen et al. (1952), using the marginal percolation method, showed that freshly
packed dental amalgam restorations placed in extracted teeth displayed marginal
'seepage'. However, they observed no marginal 'seepage' around old amalgam restora-
tions with unrecorded histories which had been in service in the mouth for some
time. These old dental amalgam restorations were tested in extracted teeth and in
in vivo 'vital' teeth.
Crawford & Larsen (1956) tested the marginal seal of nine uncontrolled old dental
amalgam restorations which had unrecorded histories with an isotope penetrant. They
claimed that service in the oral cavity certainly did not make these fillings less sus-
ceptible to fluid penetration. Von Kreudenstein (1958) used an isotope method on a
specimen which displayed no marginal percolation 'seepage'. He claimed that the
522 A. Jodaikin

specimen was completely permeable to the ^sp isotope and that there was no question
of the junction between a dental amalgam restoration and a cavity wall becoming
watertight even after years in the mouth. He also stated that the interspaces undergo
changes in the mouth after a long period, thereby effecting a reduction of the original
size and making the passage of fluids more difficult.
Going et al (1960), using a dye isotope combination method, stated that old
amalgam restorations appear to show less penetration at their margins when compared
to freshly placed amalgam restorations. The teeth with unknown operative histories
that were extracted after more than 1 year in the mouth displayed variable degrees of
penetration.
While investigating the influence of cavity preparations on the penetration of
isotope around restorations, Menegale et al (1960) showed that amalgam
restorations decreased leaking after 90 days storage in water at 37 °C. The unexpected
increase in experimental microleakage after 30 days storage may have been due to
variables such as micro-anatomical tooth differences.
In an in vivo study in dogs (Philhps et al, 1961), 54Ca completely surrounded the
dental amalgam restorations after 48 h storage in situ. However, this penetration was
considerably reduced after 1 month storage in situ. Although no appreciable difference
was observed after 2 months, a noticeable decrease occurred after 6 months storage
in situ. Increased sealing around lined/varnished cavities was attained initially and after
6 months in this in vivo dog experiment. In a human in vivo experiment (Phillips et al,
1961) the same initial sealing ability seemed evident around the lined/varnished
cavities. The unlined/unvarnished human specimens were readily penetrated by the
^^Ca, but leakage appeared to diminish as the restorations aged.
Swartz & Phillips (1961) using a similar method to Phillips et al. (1961), claimed
that the margins of an in vitro 24 h old amalgam restoration leaked readily, but that
the leakage diminished with ageing if the restorations were stored in tap water. Initial
sealing which did not deteriorate was achieved with two different liners/varnishes.
Stowell et al. (1962) compared an in vitro salivary storage medium with a standard
test medium used in their laboratory (the description of the test medium was not
specified in the abstract). With brief storage times the extent of penetration was
similar, although a greater density of isotope was often found in teeth kept in saliva.
A marked reduction in penetration of the isotope was observed in the teeth maintained
in saliva for 2 or more weeks.
Lyell et al (1964) used an isotope dye combination method to show that experi-
mental microleakage decreased markedly around amalgam restorations, after the
specimens had been stored in saliva or sodium sulphate solutions for 2 weeks. This
reduction in experimental microleakage was similar to the leakage around amalgam
restorations that were placed in the mouth at least 6 months prior to extraction. In this
study, storage in tap water for 2 weeks resulted in only a slight decrease in leakage,
but there was no reduction in leakage after a 2 week storage period in distilled water or
moist air.
Pickard & Gayford (1965), using an air pressure method, stated that it was
characteristic of the series that experimental microleakage was greatest during the
first 2 days after dental amalgam insertion. Thereafter the experimental microleakage
became progressively less and in most cases ceased before the end of 10 weeks. The
introduction of abnormal factors may account for the first of the experimental series
being atypical. Going & Sawinski (1966), using an isotope method to compare
 Mieroleakage around restorations 523

Addent®* with dental amalgam restorations, showed that the amalgam restorations
decreased leaking over 8 weeks when storaged in saliva.
Hals & Nernaes (1971) used an in vitro artiflcial caries acid gel mieroleakage
experiment on teeth with old and new fillings. They stated that the mieroleakage
patterns may have been influenced by the flxative in which the teeth were stored.
Nevertheless, three out often old amalgam specimens had no wall lesions. This flnding
was in contrast with the results of the new dental amalgam flllings, as all these fillings
had wall lesions. When this study was compared with a similar in vivo study (Hals &
Simonsen, 1972), it was stated that the in vivo wall lesions seemed to develop more
slowly than the in vitro experimental lesions.
McCurdy et al (1974) stated that in all three isotope application series the amalgam
showed poor sealing quahties at 24 h, but that improvement followed. The sealing
around the in vivo group seemed to improve more rapidly than the in vitro group.
Andrews & Hembree (1975) claimed that restorations placed without using a liner/
varnish exhibited signiflcant marginal leakage at all three early time intervals after
in vitro storage in normal saline. However, there appeared to be some reduction of
leakage after 6 months. No significant differences between the amalgam types seemed
obvious in the few specimens used. Lined/varnished cavity walls demonstrated no
leakage until 3 months in the case of Spheraloy® and until 12 months in the case of
Velvalloy® and Dispersalloy® amalgams.
Galan et al. (1977) stored amalgam restorations in distilled water and a 0-1 N Na2S
solution for 18 months. All the specimens showed small marginal penetration which
did not pass the dentine-enamel junction. Andrews & Hembree (1978), using an in vivo
isotope method, showed that restorations placed without liners/varnish, exhibited
significant mieroleakage after 24 h and 3 months. At the end of 6 months, a decrease
in experimental mieroleakage was exhibited by all the alloys. Similar degrees of
experimental mieroleakage were seen for the corrosion resistant and the conventional
alloys. With the exception of two specimens (one after 3 months and the other after 6
months), restorations placed in lined/varnished cavities demonstrated slight or no
marginal leakage throughout the 6 months in situ period.
Newman et al. (1978) using the isotope method to investigate isobutyl cyanoacry-
late as a cavity liner, used amalgam alone as a control. The control displayed a
comparatively high degree of leakage at 2 days but the leakage decreased over 6
months. However, the etched and unetched cyanoacrylate liner was no better in
limiting experimental mieroleakage than the unlined control, after 6 months.
Smith et al. (1978) used dyes combined directly with thermal cycling. They claimed
that 14 days storage of unlined/unvarnished dental restoration in Ringer's infusion
solution produced no significant change in experimental mieroleakage. It was claimed
that cavity liners/varnishes are desirable prior to the placement of lathe-cut con-
ventional amalgams. However, considerable mieroleakage occurred around ternary
dental amalgams placed in lined/varnished cavities after a 14 day storage period. This
was considered to be the result of a slow corrosion rate and/or the loss of cavity
liners/varnishes.
Wilson & Smith (1978) using a similar method to Smith et al (1978) stated that the
patterns and extent of dye penetration around unlined/unvarnished amalgam restora-
tions were not found to differ from those reported above. Great amounts of dye

*3M Brand Addent; Denta-Restorative System, Minnesota Mining & Mfg Co., St Paul.
524 A. Jodaikin

were reported to be present around the lined/varnished cavities which had been
stored in Ringer's solution. The four lined/varnished amalgam alloy type restorations
displayed no difference in their microleakage behaviour. : . :v ; / ' •* •
Boyer & Torney (1979) used an isotope method to show that nine high copper
amalgams fell into high and low initial leakage groups. There was a significant de-
crease in leakage at 6 months, but there was no significant difference in experimental
microleakage patterns amongst the materials at this stage. Hembree & Andrews
(1979), using a similar method, showed that the amalgam restorations exhibited
significant marginal leakage at the early time periods. The corrosion resistant high
copper content alloys showed essentially the same degree of experimental microleakage
as the conventional alloy. The results of this study correlate with the previous studies
(Andrews & Hembree, 1975, 1978). However, a longer period of time was required in
this laboratory study for the restorations to show diminished microleakage, as opposed
to Andrews & Hembree (1978) in vivo experiment.

Discussion
The microleakage studies reviewed show that most unlined amalgam restorations were
susceptible to penetration at the amalgam-tooth interface. Penetration was greatest
soon after insertion and decreased with time. (Note: a complete seal may be masked due
to marginal degeneration.) The in vivo studies support the fact that after 6 months of
intra-oral service, leakage around most unlined/unvarnished amalgam restorations
will have decreased substantially (Phillips et al, 1961; McCurdy et al, 1974; Andrews
& Hembree, 1978).
Some ofthe reviewed studies have shown that lined/varnished amalgam restorations
start leaking with time (Andrews & Hembree 1975, 1978; Smith et al, 1978; Wilson &
Smith, 1978). Thus the hning/varnishing of cavities does not seem to be a reliable
means of preventing leakage around dental amalgam restorations. The initial micro-
leakage which occurs around unlined/unvarnished amalgam restorations and the
development of leakage around lined/varnished amalgam restorations underhnes the
problem of attaining a permanent effective seal around dental amalgam restorations.
A group of old clinical restorations that displayed little or no macroscopic lesions
was seen to have microscopic lesions (Hals, Andreasen & Bie, 1974). The micro-
scopic demineralization may have been residual caries, or due to marginal breakdown
of amalgam or clinical microleakage resulting in secondary caries. An important
consideration is whether the microscopic lesions were active or not. This point empha-
sizes the fact that not only the microspaces, but also the chemistry and possibly the
ecosystem of the amalgam-tooth interface should be understood. It is apparent,
therefore, that we are dealing with a complex system which cannot be simply analysed
and understood on the basis of experimental microleakage data. An understanding of
the chemical changes which occur in microcrevices and the manner in which marginal
seals are effected in vivo may facilitate the production of a lifelong successful amalgam
restoration and perhaps the development of an anticariogenic amalgam type fissure
sealant.

Acknowledgments
The author would like to thank Dr J. C. Austin, Professors P. E. Cleaton-Jones and
C. F. Valcke for their advice during the preparation of this review and to Mrs J. Long
for typing the manuscript.
 i^:^ff^y;fi^^^-^^ •y^rYS:^^

Microleakage around restorations 525

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Manuscript accepted 12 December 1979