Amalgam Lec 2 Operative (2)

- Definition of "Amalgam" : Alloy of mercury with another metal or metals.

- Definition of "Dental Amalgam" : Specific amalgam alloy that contains silver, tin and
copper plus mercury.

- Amalgam is the most common and widely spread restorative material used in dentistry.

- The term "Amalgam" indicates that this amalgam is used in many fields as industry and
dentistry while the term "Dental Amalgam" indicates that this amalgam is used in dentistry.
o
- Mercury is a liquid at room temperature, its freezing point is -39 C.

- Survey about using of amalgam in dental practice shows that :

1- Amalgam users equal 68 %.

2- Another material users as resin composite, glass ionomer and ceramic (Amalgam free)
equal 32 %.

Advantages of amalgam restorations :

1- Have superior adaptation to the cavity walls, and the adaptation is improved with time
(aging).

- Q / Why the adaptation of amalgam restorations to the cavity walls is improved with time ?
= Why the amalgam is termed "Self-sealing restoration" ?

Answer : Due to their corrosion products which precipitate and seal the gaps between the
amalgam restoration and cavity walls, this prevent (cut off ) saliva, food debris and bacteria
form microleakage .

- Corrosion products are materials result from the reaction between the amalgam and saliva.

- Corrosion products are high in the low-copper amalgam (conventional type) while they are
low in the high-copper amalgam (new type).

- Microleakage leads to = Problems that may result from using a restorative material that
isn't chemically boned with the tooth structure :

a- Recurrent caries. b- Margins discoloration. c- Pulp affection.

d- Hypersensitivity. e- Failure of the restoration.

2- Have high compressive strength which enables the restorations to withstand high forces of
mastication without fracture.
3- Their coefficient of thermal expansion is relatively close to (simulates) that of the tooth,
this prevents overhang margin or gap.

4- They are indestructible (insoluble) in saliva or any fluids taken by the oral cavity, this
indestructibility helps in maintenance (stability) of :

a- From of the restoration.

b- Marginal sealing ability of the restoration.

c- Surface texture of the restoration.

- Q / What will happen if the amalgam restorations are destructible or highly soluble in saliva
or any fluids taken by the oral cavity ?

Answer :

a- Form of the restoration will change.

b- Marginal sealing ability of the restoration will reduce.

c- Surface texture of the restoration will be rough.

5- They have the ability to take and maintain a good polish, the good polishing gives the
restoration a smooth and lustrous surface.

- Q / Why any restoration should have highly smooth, shiny and lustrous surface ?

Answer :

a) To prevent collection of food or calculus.

b) To prevent irritation of the gingiva if there is a direct contact with the gingiva.

c) To prevent stress concentration in a particular area, and thus prevent splitting of the
tooth.

d) To prevent corrosion products and discoloration.

6- They are inexpensive (cheap) and need no laborious procedures or expensive equipment.

7- Its convenience of manipulation makes the materials a most wide spread restorative, i.e.
amalgam is easy in manipulation and the technique of amalgam is not sensitive.

- "Not sensitive" means that : If there is a defect in the amalgam restoration as improper
insertion or improper manipulation, this defect will not appear immediately after put the
amalgam inside the cavity, it take long time to appear.
- Note : The technique of resin composite is sensitive, i.e. If there is a defect in the resin
composite restoration as improper insertion or improper manipulation, this defect will appear
immediately.

the most important advantage of amalgam ‫ ٔاقٕنك‬mcq ‫ انذكخٕس قال يًكٍ اجيبهك في انـ‬: ‫ يهذٕظت‬-
‫ انـ‬، ‫ دٔل كهٓى صخ بس انذكخٕس عايز أْى ٔادذة فيٓى‬advantages ‫ انـ‬، ‫ انهي يعاَا‬advantages ‫ يثالً يٍ انـ‬4 ‫ٔاجيبهك‬
‫ ٔدٔل ↓ انـ‬، ‫ أْى ٔادذة ٔبعذيٍ انخاَيت ْٔكزا‬1 ‫ انهي يكخٕبيٍ فٕق دٔل يخشحبيٍ دسب األًْيت يعُي سقى‬advantages
: ‫ حاَي إْ بس يخخصشيٍ عهشاٌ َعشف َجًعٓى بس‬advantages

1- Superior adaptation.

2- High compressive strength.

3- Their coefficient of thermal expansion is relatively close to that of the tooth.

4- Indestructibility.

5- Good polish.

6- Inexpensive.

7- Convenience of manipulation.

Disadvantages of amalgam restorations :

1- Have low tensile strength = Have low edge strength = Amalgam is a brittle material.

- "Brittle" means that the amalgam can withstand the force of mastication in case of
compressive stress, while the amalgam is weak in case of tensile or shear stress.

- The disadvantage number 1 may lead to the occurrence of fracture at the isthmus or the
margins especially if :

a) There is no sufficient amount (bulk) of amalgam material at these areas.

b) They are subjected to relatively great tensile forces.

- Note : Because amalgam restoration is brittle, it should be put in a sufficient bulk or it

should be put in non stress bearing area. If the amalgam restoration is put in thin section, it
may fracture.

- To put the amalgam restoration in a sufficient bulk, the cavosurface angle for amalgam
o
restoration should be butt joint, i.e. right angle (90 ) during cavity design. If the cavosurface
angle is beveled angle, this will result in thin edge and the restoration will fracture.

2- Have the ability to conduct (transmit) thermal changes.

- The disadvantage number 2 may cause pulp affections that begins with pulp hyperemia,
then may lead to pulpitis, then may lead to acute periapical abscess.
3- Amalgam has objectionable esthetics which prevents its use in the anterior teeth. Why ?

Answer : Due to its : a) Metallic color. b) Inherent tendency to tarnish in the mouth.

- Note : Amalgam restorations are used in some cases in the anterior teeth as in cases of
distal surface of canine class III cavities .

4- Their tendency to creep and flow under functional forces as indicated by

(Clinical manifestations of creep) :

a) Flattened contact points. b) Gingival overhangs (Overhang margin).

c) Saucering of occlusal anatomy. d) Changes in the contour.

‫ دي‬alloy ‫ ٔانـ‬، inferior quality type of alloy ‫ ؟ نٕ أَا عُذي‬creep ‫ ايّ ْٕ انـ‬: ِ‫ حفسيش انكالو د‬-
cannot withstand the force of mastication completely and at the same time it is not weak
‫ بذأث‬، cavity ‫ دطيخٓا في انـ‬restoration ‫ بًعُي أَا عُذي‬creep ‫ ْٕ دِ انـ‬enough to fracture
is not strong enough to withstand these ِ‫ د‬restoration ‫ حُزل عهيٓا بس انـ‬forces of mastication ‫انـ‬
‫ يذصم ايّ َخيجت انكالو دِ ؟‬is not weak enough to break down ِ‫ د‬restoration ‫ ٔفي َفس انٕقج انـ‬forces
‫ ْٕ ياحكسشش ٔفي َفس انٕقج يص قادس يسخذًم انـ‬، ‫ يعُي حقعش‬occlusal surface ‫ نهـ‬saucering ‫يبذأ يذصم‬
‫ يبقي‬occlusal surface ‫ انهي ْٕ انـ‬rest resistant area ‫ انزيادة انهي طهعج يٍ انخقعش ْخشٔح عهي انـ‬، forces
‫ إرا اسخًش‬، overhang margin ‫ يبقي ْخعًهي‬border of cavity ‫انزيادة انهي طهعج يٍ انخقعش ْخطهع بشِ انـ‬
‫ ٔحعًهٓا‬proximal surfaces ‫ ْخٕصم نهـ‬changes ‫ دي انـ‬high forces ‫ أٔ بًعُي حاَي إرا اسخًشث انـ‬creep ‫انـ‬
.flattening

- Definition of "Creep" : Time dependent plastic deformation of set material (amalgam).

- Plastic = Permanent = Irreversible.

- Definition of "Flow" : There are 2 definitions :

1- Deformation before material (amalgam) setting.

3- Deformation under constant load of the setting material (amalgam) .

- True or Flase : Creep is time dependent plastic deformation of setting material. (False).

- True or False : Flow is deformation under constant load of the set material. (False).

Factors that affect Creep :

1- Magnitude of load : ↑ Magnitude of load → ↑ Creep.

2- Time of application : ↑ Time → ↑ Creep.

3- Type of alloy : Low-copper amalgam → ↑ Creep, while High-copper amalgam → ↓ Creep

i.e. resistance of low-copper amalgam to creep is low while resistance of high-copper
amalgam to creep is high.
4- Changes of temperature : ↑ Wide range of temperatures → ↑ Creep.

.‫ بيأكم ساقع ٔسا سخٍ ْٔكزا‬patient ‫ دي يعُاْا إٌ انـ‬4 ‫ سقى‬-

- Creep has a relation with "Marginal integrity", low creep causes break down of the margins
leading to gap.

- Example about alloys that may affected by creep : Low-copper amalgam, it is with inferior
quality.

- Creep to occur in an alloy and affect marginal integrity, the creep percentage inside this
alloy should be equal or more than l %.

‫ نًا‬alloy ‫ يبقي انـ‬% 1 ٍ‫ فيٓا بخسأي أٔ أكبش ي‬creep ‫ انهي بأسخخذيٓا انًصُع كاحب عهيٓا َسبت انـ‬alloy ‫يعُي نٕ انـ‬
.marginal break down ‫ ْٔخعًم‬creep ‫اسخخذيٓا ْيذصم‬

- Creep percentage inside high-copper amalgam equals 0.1 %, so high-copper amalgam will
not cause marginal break down.

- Creep percentage inside low-copper amalgam (Silver amalgam) equals 0.8 – 8 %, so all the
low-copper amalgam that has a creep percentage more than 0.8 % will cause marginal break
down.

- Creep is inherent weakness.

- Creep is with inferior quality.

the most worst disadvantage of amalgam ‫ ٔاقٕنك‬mcq ‫ انذكخٕس قال بشضٕ يًكٍ اجيبهك في انـ‬: ‫ يهذٕظت‬-
، ‫ أسٕأ ٔادذة ٔبعذيٍ انخاَيت ْٔكزا‬1 ‫ انهي يكخٕبيٍ فٕق دٔل يخشحبيٍ دسب األسٕأ يعُي سقى‬disadvantages ‫ انـ‬،
: ‫ حاَي إْ بس يخخصشيٍ عهشاٌ َعشف َجًعٓى بس‬disadvantages ‫ٔدٔل ↓ انـ‬

1- Low tensile strength = Low edge strength = Brittle.

2- Conduct thermal changes.

3- Objectionable esthetics.

4- Tendency to creep and flow.

Indications of amalgam restorations :

1- Small and medium size cavities of class I, II and class V cavities except those of anterior
teeth.

- Note : Class V caries occurs in the cervical third of the buccal (labial) and lingual (palatal)
surfaces of all teeth.

2- Distal surface of canine class III cavities.

- Q / Why amalgam restoration is indicated in distal surface of canine class III cavity ?

Answer : Because there is concentration of anterior component of forces at the distal surface
of canine, i.e. when the patient eats, the stresses (compressive – tensile – shear) concentrate
at the distal surface of canine and begin to wear the surface, so a restorative material with
high wear resistance as amalgam should be indicated.

- Q / What will happen if a restorative material with low wear resistance as resin composite
or glass ionomer is indicated in the distal surface of canine class III cavity?

Answer : Flattening of the distal surface of canine, so tilting of the other teeth begins.

3- For building up cores and posts under full crown restorations : During root canal
treatment, if there is no sufficient amount of tooth structure to put the crown above it, post
and core of amalgam are indicated.

- Note : In case of large cavity, and the patient has no money enough to pay for cast or
ceramic restoration, in this case a pin-retained amalgam restoration is used in the large
cavity.

- Pin-retained amalgam restoration is a type of amalgam restorations that requires placement

of one or more pins in the dentin to provide adequate resistance and retention forms, i.e. for
reinforcement of amalgam restoration.

Contraindications of amalgam restorations :

1- In conspicuous cavities in the anterior part of mouth. Why ?

Answer : Due to their : a) Lack of aesthetic color, i.e. due to its metallic color.

b) Inherent tendency to tarnish in the mouth.

2- In mouths containing another dissimilar metal. Why ?

Answer : To avoid galvanic shock.

- Q / What will happen if two dissimilar metals as gold and amalgam are indicated in the
same mouth ?

Answer : Short circle of electricity will produced between the 2 dissimilar metals, so the
patient will complain of pain (galvanic shock), and corrosion products of one of the two
metals will be produced.

- Note : Gold has high electric potential than amalgam.

- Treatment of galvanic shock that results from using two dissimilar metals in the same
mouth :

a- If the patient is anxious, painting the outer surface of one of the two dissimilar restorations
by varnish or bonding agent will stop the galvanic shock.

b- If the patient is not anxious, it can be left without intervention of the dentist because after
24 or 48 hours, the galvanic shock will disappear spontaneously because the intensity of
electricity decreases during this period.

3- Extensive lesions especially those including undermined cusps. (In this case, cast gold
restoration serves better).

4- Rampant caries.

- Rampant caries occurs at adult (young) age.

- Etiology of rampant caries : There is no a definite cause, it may be due to hormonal

disturbances, and it may occur during age of puberty.

- If a patient came to your clinic and told you that his teeth were intact and suddenly multiple
lesions occured within 2 weeks and they were rapidly spread in the mouth, for example all
anterior teeth show caries, the diagnosis in this case is rampant caries.

- Treatment of rampant caries : Permanent restoration is contraindicated. Excavation of all

the soft caries lesions and put a temporary filling as glass ionomer cement then the dentist
gives the patient a second appointment to permanent filling.

- In case of rampant caries, glass ionomer can act as a control restoration.

- Q / Why the dentist should excavate all the soft caries lesions firstly in case of rampant
caries, not treat the chief complaint ?

Answer : To improve the oral hygiene because the saliva is highly acidic in case of rampant
caries.

- Q / What will happen if a permanent restoration as amalgam restoration is indicated in case

of rampant caries ? Answer : Recurrent caries will occur.

: ٍ‫ يجًعي‬amalgam ‫ بخاعج انـ‬contraindications ‫ دٔل ↓ انـ‬-

1- Conspicuous cavities in the anterior part of mouth.

2- Mouths containing another dissimilar metal.

3- Extensive lesions especially those including undermined cusps/

4- Rampant caries.
Classification of dental amalgam alloys :

I- According to the shape of the particles :

1- Lathe cut : The particles are irregular in shape.

2- Spherical : The particles are ovoid in shape with smooth surface.

3- Spheroidal : The particles are spherical in shape with irregular surface.

II- According to the size of the particles :

1- Micro-cut (The smallest size).

2- Fine-cut.

3- Coarse-cut (The biggest size).

III- According to the number of elements included in the alloy :

1- Binary : 2 elements as Silver + Copper.

2- Ternary (Tertiary) : 3 elements as Silver + Copper + Tin.

3- Quaternary : 4 elements as Silver + Copper + Tin + Induim.

IV- According to zinc containing :

1- Zinc containing alloy.

2- Zinc free alloy.

V- According to nobel metal containing :

1- Nobel metal containing alloy : Nobel metals as silver, indium and palladium.

2- Nobel metal free alloy.

VI- According to commercial availability :

1- Powder.

2- Tablets.

3- Capsules.
VII- According to copper content : (This is the most important classification) :

1- Low-copper amalgam = Silver amalgam = Conventional amalgam = Traditional amalgam

= γ2 amalgam.

2- High-copper amalgam = Copper enriched amalgam :

a) Admixed or Blended or Dispersion or Modified amalgam.

b) Unicompositional amalgam :

i- Ternary (Tertiary) alloys.

ii- Quaternary alloys.

Low-copper amalgam :

- The percentages of elements in the low-copper amalgam :

a) Silver → 67 - 74 %.

b) Tin → 25 - 27 %.

c) Copper → 0 - 4 %.

d) Zinc → 0 - 2 %.

- Note : Silver is the most predominant element in the low-copper amalgam, so it is called
silver amalgam also.

Disadvantages of low-copper amalgam :

a) Has low hardness or strength.

b) Produce many corrosion products. Why ? Because of formation of γ2 phase during

setting reaction, γ2 phase is the weakest phase, and hardness of γ2 phase is 0.1 % of γ
phase.

- To overcome the low hardness and to decrease the corrosion products of low-copper
amalgam, manufacturers developed high-copper amalgam.
Admixed or Blended or Dispersion or Modified high-copper amalgam :

- It contains 2 parts by weight :

a) 2/3 of conventional lathe cut alloys particles.

b) 1/3 of spherical silver copper eutectic alloy (72 % silver and 28 % copper approximately).
The overall composition is approximately (9 - 20 % Cu)

Silver → 69 %

Tin → 17 %

Copper → 13 %

Zinc → 1 %

.9 - 20 % ‫ فيّ بخسأي‬copper ‫ َسبت انـ‬admixed type ‫ يبقي انـ‬-

- Admixed high-copper amalgam upgrades the physical criteria as it improves the hardness
and strength and decreases the corrosion products, but this type is not very strong.

Unicompositional high-copper amalgam :

- Particles of alloy are spherical.

- This type contains : 13 - 30 % copper + 40 - 60 % silver.

- There are 2 types of unicompositional amalgam :

1- Ternary (Tertiary) alloys :

- Particles of alloy are spherical or spheroidal (particles are not perfectly spherical).

- This type contains : 60 % silver + 25 % tin + 15 % copper.

2- Quaternary alloys :

- Particles of alloy are spherical.

- This type contains : 59 % silver + 24 % tin + 13 % copper + 4 % indium.

- Indium improves the physical criteria and decreases the corrosion products.

Ways of manufacturing of any amalgam alloy :

1- The powder may be produced by milling or lathe cutting a cast ingot of the amalgam alloy
(silver-tin alloy), the particles of this lathe-cut powder are irregularly shaped.

2- The powder may be produced by atomizing the liquid alloy as follow : The liquid alloy is
put in high temperature then the liquid undergo solidification producing essentially spherical
particles.
Functions of alloy constituents :

Functions of Silver :

1- Increases hardness and strength.

2- Increases setting expansion reactivity with mercury.

3- Contributes to resistance to tarnish of the amalgam, and decreases corrosion.

Function of Tin : Reacts very rapidly with mercury and other elements and makes
amalgamation of the alloy easier.

- Note : Silver & Tin can form an intermetallic compound of formula Ag3Sn.

Disadvantages of Tin : If too much tin is present, it will :

1- Decrease hardness and strength of the set amalagam.

2- Cause setting contraction of amalgam.

3- Increase corrosion.

- So Tin is considered the worst element in amalgam alloy.

Functions of Copper :

1- Increases hardness and strength.

2- Increases setting expansion.

3- Decreases corrosion.

- Note : Functions of copper are as those of silver, so copper may replace silver to some
extent.

Functions of Zinc :

1- Acts as scavenger for oxygen in the fusion of the alloy, i.e. it acts as a deoxidizing agent
because it units with oxygen and prevent tarnish of the particles of the restoration.

2- Increases the plasticity (softness) of the alloy to be easily condensed.

- Sometimes small amounts of the gold or other noble metals such as indium and palladium
are included in the alloys in attempts to improve their properties.
Zinc containing amalgam alloys:

- Q / What will happen if the zinc containing amalgam is used in area (field) of moisture
contamination that may be due to high salivation or the patient has large tongue, i.e. difficult
to do complete isolation of the field ?

Answer : Delayed expansion will occur as follow :

Zn + Moisture (H2O) → ZnO + H2↑

Zinc units with oxygen, hydrogen accumulates inside the restoration and exerts pressure (400
micron/cm) leading to expansion. If the direction of expansion is toward the pulp, the patient
will complain of pain. If the direction of expansion away the pulp, it will lead to blistering
(air bubbles on the restoration) and surface corrosion. This reaction (expansion) occurs
within 3-5 days or 24-72 hours after amalgam insertion.

- Note : Zinc free amalgam is used when moisture isolation is impossible.

، contraction ‫ ْخبقي‬expansion ‫ كهًت‬: Notes ‫ في انًذاضشة األٔني انصفذت انخانخت انسطش انشابع يٍ جزئيت انـ‬-
.‫دي غهطت يُي ٔأَا بأكخب آسف‬