DENTAL AMALGAM

1
Definition
 Dental amalgam consists, essentially, of
mercury combined with a powdered
silver–tin alloy.
 Mercury is a liquid at room temperature
and is able to form a ‘work- able’ mass
when mixed with the alloy
 The reaction is called amalgamation

2
 Overview

 Basic composition
 Classifications
 Basic setting reactions
 Properties
 Clinical handling notes
 Manipulation

3
Dental Caries

1 2

3 4
4
5 6

7 8
5
Why Amalgam?
 Inexpensive
 Ease of use
 Proven track record
◦ >100 years
 Familiarity
 Strong and durable
 Drawbacks:
◦ Esthetics
◦ Mercury content
◦ Brittleness
◦ Corrosion
◦ Marginal breakdown

6
Constituents in Amalgam
 The metal alloy:
◦ Basic
 Silver
 Tin
 Copper
 Mercury(if present in alloy (pre-amalgamated amalgam))
◦ Other
 Zinc
 Indium
 Palladium +copper in large amounts

Alter mechanical
properties and
corrosion resistance
7
Composition
Weight (%)
Metals Limits prior to 1986 Current limits
(conventional alloy) (Cu-rich alloy)
Silver 65 (min) 40 (min)
Tin 29 (max) 32 (max)
Copper 6 (max) 30 (max)
Zinc 2 (max) 2 (max)
Mercury 3 (max) 3 (max)
8
Basic Constituents
 Silver (Ag)
◦ increases strength
◦ increases expansion
 Tin (Sn)
◦ decreases expansion
◦ decreased strength

9 Phillip’s Science of Dental Materials 2003

 Basic Constituents

 Copper (Cu)
◦ ties up tin
 reducing gamma-2 formation
◦ increases strength
◦ reduces tarnish and corrosion
◦ reduces creep
 reduces marginal deterioration

10 Phillip’s Science of Dental Materials 2003

 Basic Constituents
 Mercury (Hg)
◦ activates reaction
◦ only pure metal that is liquid
at room temperature
◦ spherical alloys
 require less mercury
 smaller surface area easier to wet
◦ admixed alloys
 require more mercury
 lathe-cut particles more difficult to wet

Phillip’s Science of Dental Materials 2003

11
 Other Constituents
 Zinc (Zn)
◦ used in manufacturing
 decreases oxidation of other elements

◦ provides better clinical performance

 less marginal breakdown

◦ causes delayed expansion with low Cu alloys

 if contaminated with moisture during condensation

H2O + Zn  ZnO + H2
Phillip’s Science of Dental Materials 2003
12
 Other Constituents

 Palladium (Pd)
◦ reduced corrosion
◦ greater luster
◦ example
 Valiant PhD (Ivoclar Vivadent)
 0.5% palladium

13
Classification
 According to the shape of particles in the
powder:
◦ Irregular: Formed by shaving particles from a
block of the alloy by a lathe (lathe-cut alloy)
◦ Spherical: Formed by spraying molten alloy
into an inert gas (spherical alloy)
◦ Admixed: Mixture of the two (admixed alloy).
Benefit?

14
15
Classification
 According to composition:
◦ Conventional alloys (6% copper content, refer
to Table 1)
◦ Copper enriched alloy (10-30%):
 Single composition-copper enriched alloys
 Dispersion modified-copper enriched alloys: ratio is
2 (conventional alloy: 1 (silver-copper alloy), overall
copper content 12%

16
Setting transformation
 Alloy powder + liquid mercury mixed Packable
amalgam in a cavity firming phase of the mix
1st stage of firming amalgam can b carved.

 When amalgam reaches initial set, it cannot be

carved, but still not fully reacted (brittle). Needs 24
hours to attain full strength.

17
Setting reaction low copper amalgam,

 What does actually occur

during the setting reaction:
◦ Silver and Tin dissolve into
mercury and saturate the Ag-Sn Alloy
solution and also absorb
mercury. Hg Hg

Sn Ag Ag
Ag
◦ Newly formed particles start Ag-Sn Sn
Sn
Ag-Sn
to precipitate until there is no Alloy Alloy
more Hg to react (takes 24 Mercury
hrs). Un-reacted particles will (Hg)
remain

Ag-Sn (γ)+Hg Ag-Hg (γ1) + Sn-Hg (γ2) +unreacted Ag-Sn

18
 Reaction of Hg in high copper alloys
 The higher copper content eliminates the gamma 2 phase yielding a better
mix
 Copper-enriched alloys:
◦ Ag3Sn +Cu+ Hg Ag2Hg3 + Cu6Sn5+ Ag3Sn
γ1 η γ
 Dispersion modified:
◦ Silver-Tin dissolve Hg γ1 + γ2 around un-reacted silver-Tin γ2+silver-
copper Cu6Sn5 (ή) + γ1

19
Physical properties
 Tarnish: oxidation that attacks amalgam
surface and extends slightly below the
surface.
 Cause: contact with
◦ Oxygen
◦ Chlorides
◦ Sulfides

20
Amalgam tarnish

21
Continue,
 Clinical picture: dark and dull appearance
 Tarnish is more likely to occur with rough
surfaces
 How to avoid and minimize it:
◦ Palladium
◦ Polishing after 24 hrs
 Excessive heat from polishing?

22
Physical properties
 Corrosion: what causes it,
◦ Chemical reaction between amalgam and
saliva/food leading to oxidation of amalgam.

◦ Contact between to dissimilar metals

(galvanism) oxidation of amalgam

◦ Interaction of amalgam components

23
Corrosion
 The heterogeneous, multiphase structure of dental
amalgam makes it prone to corrosion.

 Gamma 2 phase is highly reactive, breaks down to give

tin corrosion products and Hg that react with
unreacted alloy (ingestion of mercury?)

 In copper rich alloys, the copper – tine phase is the

most corrodible.

24
Continue,
 The outcome of
corrosion:
◦ Weakens restoration
◦ Deterioration of its
margins
◦ Stain surrounding tooth
structure as corrosion
products penetrates
dentinal tubules

25
Physical properties
 Creep (plastic deformation):
◦ usually seen with low-copper amalgam (due to gamma
2 phase).
◦ Definition?
◦ Outcomes?
◦ Decreased by:
 High copper alloys
 Palladium or indium in
the alloy

26
Physical properties
 Dimensional change: expansion and
contraction.

 This property is affected by:

◦ Moisture contamination
◦ Composition of the alloy
◦ Ratio of Hg : alloy powder

27
28
Tooth crack most likely caused by
amalgam expansion

29
Continue,
 Postoperative sensitivity was associated
with spherical alloys due to uneven
amalgam surface adjacent to cavity walls

 Suggested solutions: using varnish, or

bonding agents to seal dentinal tubules.

30
Physical properties
 Strength: High compressive strength 300MPa
minimum, but low tensile strength and low
shear strength, it a brittle in thin sections.
Solution?
◦ Bulk
◦ Surrounding tooth structure
 High copper amalgam and spherical alloy amalgams have
higher strength values after the first hour of placement
than conventional lathe-cut amalgams.

31
32
Fracture

33
Thermal properties
 High thermal conductivity
 3 times the coefficient of thermal
expansion of dentine
 High thermal diffusivity
 In large cavities an insulator is needed

34
Biological properties
 Research showed conflicting results as to the
systemic effect of mercury in amalgam

 Body maybe exposed to higher amounts during

placement, polishing, corrosion and removal of
amalgam fillings

 Systemic effects related to mercury (no strong

evidence):
◦ Mild behavioral problem, major psychiatric
problems, multiple sclerosis
◦ Fetal damage and abortions

35
Biological properties cont.
 One possible effect is allergic reaction to
mercury:
◦ Contact dermatitis
◦ Lichenoid reactions
 This sensitivity is usually due to prior
sensitization of patients to mercury
present in some medicines

36
Mercury safety
 Safety should be considered for:
◦ Patient
◦ Operator
◦ Environment
 How does mercury enter the human body?
◦ Skin contact
◦ Vapor inhalation
◦ Ingestion
To protect the patient:
◦ Use high volume suction
◦ Rubber dam isolation

37
Safety procedures
 Adequate ventilation
 Avoid heating instruments to>80°C
 Floors should be nonporous and easy to
clean
 Use gloves, masks, glasses
 Amalgam scrap stored under water of
film fixer in airtight containers
 Recycling of amalgam scrap appropriately

38
Continue,
 Reduction of mercury vapor:
◦ Use amalgam capsules
◦ Use amalgamator with enclosed mixing arm
◦ Store amalgam scrap under water
◦ Clean instruments from any amalgam before
sterilization
◦ Avoid ultrasonic condensers
◦ Clean mercury spills promptly with spill kit

39
Clinical handling notes
1. Cavity design:
1. Mechanical retention (occlusal
convergence)
2. Be conservative
3. Remove unsupported enamel
4. Rounded internal angles
5. Flat floors
6. If a large part of tooth structure is lost,
amalgam pins maybe used

40
41
 Continue,

 Matrices:
 Used to provide a surface
against which amalgam maybe
condensed (lost proximal wall)
 Should be tight contact
gingivally to prevent ledge
formation
 should restore contact
with adjacent tooth:

42
Manipulation
 Proportioning and dispensing of alloy and mercury:
 Alloy/mercury: 5:8 (wet, hand mixing) or 10:8 (drier,
mechanical mixing)
◦ Spherical alloy particles require less Hg
◦ Hg should be <50% for optimum properties

43
Manipulation
 Dispensing of alloy and
mercury:
◦ Capsulated available with
different quantities
depending on the size of
restoration
 Single mix or spill
 Double
 More

44
 Trituration
 Mixing time
◦ refer to manufacturer
recommendations

 Overtrituration
◦ “hot” mix
 sticks to capsule
◦ decreases working / setting time
◦ slight increase in setting contraction
 Undertrituration
◦ grainy, crumbly mix

45
 Continue,
 Effect on working time and dimensional change
◦ Overtrituration  decreases working time, slightly higher
contraction
 Effect on strength
◦ Overtrituration  increases strengths in lathe-cut alloys
◦ Both over- and undertrituration  decrease strengths in
spherical alloys and admixed high-Cu alloy
 Effect of creep
◦ Overtrituration  increases creep
◦ Undertrituration  decreases creep

46
 Condensation
 Forces
◦ lathe-cut alloys
 small condensers
 high force
◦ spherical alloys
 large condensers
 less sensitive to amount of force
 vertical / lateral with vibratory motion for good adaptation
◦ admixture alloys
 intermediate handling between lathe-cut and spherical

47
Condensation of Amalgam
 The more Hg left in the mass after
condensation, the weaker the alloy. 
Great condensing force should be used.
 Hand v.s. Mechanical condensation
◦ Spherical amalgam  large tip condenser
◦ Mechanical condenser  high condensing
force, more useful for condensing lathe-cut
alloys

48
 Placement and condensation:
◦ Dappen dish
◦ Amalgam carrier
◦ Condenser is used to fill the cavity layer by layer using
vertical and lateral condensation
◦ Cavity overfilled so that when carved, excess mercury is
removed

49
 Burnishing and carving:
◦ Burnishing maybe done before carving to further
condense amalgam and remove excess mercury
◦ Carving is done soon after amalgam is placed in
cavity
◦ Finishing and polishing is done after 24 hours.

50
 Polishing

 Increased smoothness
 Decreased plaque retention
 Decreased corrosion

51
Polishing
 Gross irregularities in the surface are reduced using
multi-bladed steel burs in a slow hand piece.
 Fine polishing using graded abrasives. Pastes need to be
applied using a rubber cup or brush, but are less
frequently used now that impregnated points are
available.
 Care is required when using impregnated rubber points
as the amalgam can be heated significantly

52
Mercury-free amalgam
 Gallium as a substitute for mercury
 Similar handling characteristics to
traditional amalgam
 Not a good alternative due to high
corrosion and lower strength
 Not commonly used

53
 Reference:
◦ Applied dental material. Chapter 21

54