Dental Materials 3rd Edition Stephan

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Chapter 10: Dental Amalgam

MULTIPLE CHOICE

1. For what reason have insurance carriers seen a reduction in the use of dental amalgam for
posterior restorations by approximately 45% in the past 20 years?
a. Other direct restorative materials have superior durability, ease of handling, and
physical characteristics.
b. Its wear resistance and compressive strength are inferior to composite resin and
glass ionomer cement.
c. A study conducted by the National Institutes of Health (NIH) in 1991-1993
concluded that amalgam is not safe for human use.
d. Concerns by patients about its safety and its lack of esthetics have prompted many
patients to request tooth-colored materials.
ANS: D
Insurance carriers have seen a reduction in the use of dental amalgam for posterior
restorations by approximately 45% in the past 20 years, probably because concerns by
patients about its safety and its lack of esthetics have prompted many patients to request
tooth-colored materials. Still, no other direct restorative material has the durability, ease of
handling, and good physical characteristics of amalgam. Its wear resistance and compressive
strength are superior to composite resin and glass ionomer cement. A study conducted by the
National Institutes of Health (NIH) in 1991-1993 concluded that amalgam is safe for human
use.

REF: p. 150 TOP: Dental Amalgam

2. When the silver-based alloy used to create dental amalgam is mixed with _____, the reaction
that occurs is called amalgamation.
a. methyl methacrylate
b. a bonding agent
c. an acid etchant
d. mercury
ANS: D
When the silver-based alloy used to create dental amalgam is mixed with mercury, the
reaction that occurs is called amalgamation. The material that is produced is called dental
amalgam.

REF: p. 150 TOP: Dental Amalgam (Alloy Used in Dental Amalgam)

3. Modern dental amalgams are considered to be high in _____ content compared with their
predecessors.
a. copper
b. silver
c. zinc
d. tin
ANS: A
 Modern dental amalgams are considered to be high in copper content (13% to 30%) compared
with their predecessors, which had 2% to 4% copper by weight. They generally contain 40%
to 70% silver and 12% to 30% tin. They are mixed with mercury 43% to 50% by weight.

REF: p. 151 TOP: Dental Amalgam (Composition)

4. Spherical alloys require _____ mercury to wet the particles and generally set _____ than
lathe-cut particles.
a. more; more quickly
b. more; more slowly
c. less; more quickly
d. less; more slowly
ANS: C
Spherical alloys require less mercury to wet the particles and generally set more quickly than
lathe-cut particles.

REF: p. 151 TOP: Dental Amalgam (Composition)

5. In the low-copper amalgams, zinc was responsible for the gradual _____ of the amalgam over
time if moisture contamination was present during placement.
a. tarnish
b. corrosion
c. expansion
d. contraction
ANS: C
In the low-copper amalgams, zinc was responsible for the gradual expansion of the amalgam
over time if moisture contamination was present during placement. Contact of the moisture
with zinc caused the formation of hydrogen gas within the amalgam, which caused it to
expand. Delayed expansion could cause the restoration to expand beyond the cavity walls and
could cause cracking in the adjacent enamel.

REF: p. 151 TOP: Dental Amalgam (Composition)

6. It takes up to _____ for most amalgams to gain their maximum strength.

a. 30 minutes
b. 1 hour
c. 12 hours
d. 24 hours
ANS: D
It takes up to 24 hours for most amalgams to gain their maximum strength. Many of the
high-copper spherical amalgams gain approximately 50% of their compressive strength in the
first hour. Once fully set, they are hard, strong, durable restorations.

REF: p. 151 TOP: Dental Amalgam (Setting Transformation [Amalgamation])

7. High-copper amalgams do not have a _____ phase and are superior in their clinical
performance to low-copper amalgams.
a. gamma
b. gamma-1
 c. gamma-2
d. gamma-1 or gamma-2
ANS: C
High-copper amalgams do not have a gamma-2 phase and are superior in their clinical
performance to low-copper amalgams. The gamma phase is the silver alloy phase; it is the
strongest phase and has the least corrosion. The gamma-1 phase consists of mercury reacting
with the silver. It is strong and corrosion resistant, although not as resistant as the gamma
phase. The gamma-2 phase consists of the reaction of mercury with tin. Gamma-2 is weak and
corrodes readily.

REF: p. 151 TOP: Dental Amalgam (Setting Reactions)

8. Which of the following metals is used to control the rate of set of the amalgam?
a. Silver
b. Copper
c. Tin
d. Mercury
ANS: C
Tin is used to control the rate of set of the amalgam. Both silver and tin dissolve into the
liquid mercury until the solution becomes saturated with them; they also absorb mercury.
Newly formed particles begin to precipitate out of the mercury until no more mercury is left to
react.

REF: p. 151 TOP: Dental Amalgam (Setting Reactions)

9. Which of the following is true of tarnish?

a. It is very destructive to the amalgam.
b. Polishing the restoration will increase the tarnish.
c. The smoother the surface, the more it tends to tarnish.
d. It results from contact with oxygen, chlorides, and sulfides in the mouth.
ANS: D
Tarnish results from contact with oxygen, chlorides, and sulfides in the mouth. It causes a
dark, dull appearance, but it is not very destructive to the amalgam. The rougher the surface,
the more it tends to tarnish. Polishing of the restoration can reduce the tarnish.

REF: p. 151 TOP: Dental Amalgam (Tarnish)

10. Which of the following statements is true of high-copper amalgams in contrast to low-copper
amalgams?
a. High-copper amalgams are more durable than low-copper amalgams.
b. High-copper amalgams have more corrosion than low-copper amalgams.
c. High-copper amalgams have more deterioration at the margins than low-copper
amalgams.
d. High-copper amalgams have more of the gamma-2 product than low-copper
amalgams.
ANS: A
 High-copper amalgams are more durable than low-copper amalgams. The higher copper
content of newer alloys eliminates the formation of the gamma-2 reaction product that caused
weakening of the amalgam. High-copper alloys have virtually replaced low-copper alloys
because high-copper amalgams have less deterioration at the margins, less corrosion, and
greater strength.

REF: p. 152 TOP: Dental Amalgam (Corrosion)

11. Creep is a phenomenon associated with the gamma-_____ phase seen with _____-copper
amalgam alloys.
a. 1; high
b. 1; low
c. 2; high
d. 2; low
ANS: D
Creep is a phenomenon associated with the gamma-2 phase seen with low-copper amalgam
alloys. It refers to the gradual change in shape of the restoration from compression by the
opposing dentition during chewing or by pressure from adjacent teeth. High-copper alloys
exhibit far less creep and have superior marginal integrity.

REF: p. 152 TOP: Dental Amalgam (Creep)

12. Which of the following may happen if a newly placed amalgam contracts excessively?
a. It can put pressure on the cusps.
b. It will open gaps at the margins, contribute to leakage of fluids and bacteria, and
cause sensitivity.
c. It can cause pain with biting pressure.
d. It can result in fracture of the cusps.
ANS: B
If it contracts excessively, it will open gaps at the margins, contribute to leakage of fluids and
bacteria, and cause sensitivity. If it expands excessively, it can put pressure on the cusps and
cause pain with biting pressure, or it may result in fracture of the cusps. Ideally, the
dimensions of a newly placed amalgam should not change. Some expansion and contraction
occur during the setting reaction of the amalgam. It is the net effect of these two processes
that is important.

REF: p. 152 TOP: Dental Amalgam (Dimensional Change)

13. Which of the following statements is true regarding the strength of dental amalgam?
a. Amalgams are stronger in compression than composites but weaker than glass
ionomers.
b. Amalgams are relatively weak in tension and shear and therefore require adequate
bulk to resist breaking.
c. Some high-copper amalgams gain approximately 80% of their strength in the first
hour.
d. High-copper amalgams have a much higher compressive strength than low-copper
amalgams once they have completely set at about 24 hours.
ANS: B
 Amalgams are relatively weak in tension and shear and therefore require adequate bulk to
resist breaking. Amalgams are stronger in compression than composites or glass ionomers.
Some high-copper amalgams gain approximately 80% of their strength in the first 8 hours.
Low- and high-copper amalgams are comparable in compressive strength once they have
completely set at about 24 hours.

REF: p. 153 TOP: Dental Amalgam (Strength)

14. When spherical high-copper dental amalgam alloys are contrasted with admixed dental
amalgam alloys, the spherical alloy:
a. needs approximately 10% more mercury than the admixed alloy for the
amalgamation process.
b. has very little resistance to condensation into the cavity preparation and feels soft
compared with an admixed amalgam.
c. displaces a matrix band and keeps it in contact with the adjacent tooth in class II
preparations better than admixed amalgams.
d. has lower 1-hour and 24-hour compressive strengths than admixed amalgams.
ANS: B
When spherical high-copper dental amalgam alloys are contrasted with admixed dental
amalgam alloys, the spherical alloy has very little resistance to condensation into the cavity
preparation and feels soft compared with an admixed amalgam. The spherical alloy needs
approximately 10% less mercury than the admixed alloy for the amalgamation process.
Spherical alloys do not displace a matrix band and keep it in contact with the adjacent tooth in
class II preparations as well as admixed amalgams do. Spherical amalgams have higher
1-hour and 24-hour compressive strengths than admixed amalgams do.

REF: p. 153 TOP: Dental Amalgam (Handling Characteristics of High-Copper Alloys)

15. What mechanical device mixes the dental amalgam alloy and mercury?
a. Condenser
b. Triturator
c. Carrier
d. Plugger
ANS: B
The dental amalgam alloy and mercury are mixed together in a mechanical device called a
triturator. The triturator has settings that allow adjustment in the speed and time of the mixing
process. The manufacturer’s recommendations should be followed for the selected material.

REF: p. 154 TOP: Dental Amalgam (Trituration)

16. Undertriturated amalgam alloy has a _____ appearance and sets too _____, resulting in a
weaker restoration.
a. dry, crumbly; quickly
b. dry, crumbly; slowly
c. wet; quickly
d. wet; slowly
ANS: A
 Undertriturated amalgam alloy has a dry, crumbly appearance and sets too quickly, resulting
in a weaker restoration. This occurs because the components have not completely mixed,
leaving a higher level of unreacted mercury and alloy particles. Overtriturated alloy is too wet.
It also results in an amalgam that sets too quickly because of the heat produced by the
prolonged mixing. It results in a weaker restoration that will corrode more readily because it
forms too many reaction products.

REF: p. 154 TOP: Dental Amalgam (Trituration)

17. Why is the cavity preparation slightly overfilled during the placement and condensation of
amalgam?
a. Increases the overall height of the patient’s bite forced to the surface during the
condensation process
b. Makes sure no material goes to waste in the amalgam well
c. Forms the initial surface anatomy when the patient occludes against the opposing
dentition
d. Allows enough material to carve to contours and remove excess mercury
ANS: D
The cavity preparation is slightly overfilled during the placement and condensation of
amalgam to allow enough material to carve to contours and remove excess mercury that has
been forced to the surface during the condensation process. If excess mercury is left, the
physical properties will be poorer.

REF: p. 155 TOP: Dental Amalgam (Placement and Condensation)

18. Patients should be advised to avoid chewing on a newly placed amalgam for at least:
a. 8 minutes.
b. 8 hours.
c. 2 days.
d. 2 weeks.
ANS: B
Patients should be advised to avoid chewing on a newly placed amalgam for at least 8 hours.
Most amalgams will gain about 80% of their strength by then.

REF: p. 156 TOP: Dental Amalgam (Burnishing and Carving)

19. Polishing of amalgam restorations should be:

a. dry with a light touch.
b. wet with a light touch.
c. dry with heavy pressure.
d. wet with heavy pressure.
ANS: B
Polishing of amalgam restorations should be wet with a light touch. This will avoid generating
heat that can bring mercury to the surface and potentially irritate the pulp. Typically, polishing
agents such as Silux or a slurry mix of fine pumice or abrasive-impregnated rubber polishers
are used. Care should be taken not to generate heat. Do not polish dry.

REF: p. 156 TOP: Dental Amalgam (Finishing and Polishing)

20. Which of the following is true concerning mercury safety procedures in the dental office?
a. A “mercury-free” amalgam is available for use in the United States.
b. The elemental mercury used in amalgam is more toxic than organic mercury.
c. Dental offices contribute an insignificant amount of mercury to the environment.
d. Studies have shown mercury levels in most dental offices to be far below OSHA’s
recommended minimum.
ANS: D
Studies have shown mercury levels in most dental offices to be far below OSHA’s
recommended minimum. The elemental mercury used in amalgam is less toxic than organic
mercury. Although dental offices do not contribute as much mercury to the environment as
large companies, their contribution is not insignificant. A “mercury-free” amalgam was
developed that had an appearance and handling characteristics similar to amalgam. It used
gallium as a substitute for mercury. These products are still used in some countries but not in
the United States.

REF: p. 160 TOP: Dental Amalgam (Mercury Safety Procedures)

21. Amalgam restorations are a combination of which alloys?

a. Copper and tin
b. Silver and mercury
c. Specific amounts of each of the above
ANS: C
Modern dental alloys are considered to be high in copper content (13% to 30%) compared
with their predecessors, which had 2% to 4% copper by weight. They generally contain 40%
to 70% silver and 12% to 30% tin. They are mixed with mercury 43% to 50% by weight.

REF: p. 151 TOP: Dental Amalgam (Composition)

22. High-copper alloys gain about 50% of their compressive strength:

a. after 1 hour.
b. after 10 hours.
c. after 24 hours.
d. immediately.
ANS: A
Many of the high-copper spherical amalgams gain approximately 50% of their compressive
strength in the first hour, but it takes up to 24 hours for most amalgams to gain their maximum
strength.

REF: p. 151 TOP: Dental Amalgam (Setting Transformation [Amalgamation])

23. Amalgam goes through three phases when setting, the weakest of which is the _____ phase.
a. gamma
b. gamma-1
c. gamma-2
ANS: C
Gamma-2 is weak and corrodes readily.

REF: p. 151 TOP: Dental Amalgam (Setting Reactions)

24. Why is it not as necessary to polish today’s generation of amalgam restorations as it was to
polish earlier amalgams?
a. They are high in copper, which is shiny.
b. They are low in copper and don’t tarnish.
c. They are well burnished to finish them.
d. They set faster, so it is not necessary.
ANS: A
High-copper amalgams have a smoother surface after carving than low-copper amalgams and
tend to tarnish less. Polishing is not as critical to their longevity as with low-copper
amalgams.

REF: p. 152 TOP: Dental Amalgam (Tarnish)

25. What is the result if an amalgam restoration corrodes?

a. Weakens over time
b. Stains surrounding tooth
c. Breaks down at the margins
d. All of the above are possible.
ANS: D
The restoration weakens the amalgam over time, can stain surrounding tooth structure as
corrosion products enter the dentinal tubules, and can lead to deterioration of the margins.

REF: p. 152 TOP: Dental Amalgam (Corrosion)

26. Compared to composites or glass ionomers, amalgams are higher in compression strength but
weaker in:
a. stress and shear.
b. stress and strain.
c. tension and shear.
d. flexion and tension.
ANS: C
Amalgams are stronger in compression than composites or glass ionomers. However, they are
relatively weak in tension and shear and therefore require adequate bulk to resist breaking.

REF: p. 153 TOP: Dental Amalgam (Strength)

27. How will properly triturated amalgam appear?

a. A satiny ball
b. Dry and shiny
c. Shiny and wet
d. Dry and crumbled
ANS: A
 Undertriturated alloy has a dry, crumbly appearance and sets too quickly. It produces a weaker
restoration because the components have not totally mixed, leaving a higher level of unreacted
mercury and alloy particles. On the other hand, overtriturated alloy is too wet. It also results in
an amalgam that sets too quickly because of the heat produced by prolonged mixing. It results
in a weaker restoration that will corrode more readily, because it forms too many reaction
products. Properly triturated alloy has a satin appearance and produces the desired physical
properties.

REF: p. 154 TOP: Dental Amalgam (Trituration)

28. Which of the following would not be hygienic when amalgam material is used?
a. The floor is carpeted.
b. The rubber dam is placed.
c. The assistant uses the HVE.
d. Staff wears PPE when handling.
ANS: A
Carpets and tiled floors with seams tend to trap amalgam particles and mercury droplets and
therefore are not recommended.

REF: p. 160 TOP: Dental Amalgam (Mercury Safety Procedures)

29. Why is the wet resin technique used under an amalgam restoration?
a. Bond the amalgam to the tooth
b. Keep the tooth from staining
c. Decrease sensitivity
d. Seal dental tubules
ANS: A
With either technique, the wet resin mechanically intermixes with the amalgam during
condensation, and when the resin sets, it bonds the amalgam to the tooth.

REF: p. 159 TOP: Dental Amalgam (Bonding Amalgam)

30. What will occur if one attempts to carve amalgam once the amalgam is set?
a. Seal the margins
b. Damage the margins
c. Make the surface dull
d. Make the surface shiny
ANS: B
Once the amalgam is hard, attempts at carving may damage the amalgam margins or cause
fracture of portions of the amalgam mass.

REF: p. 155 TOP: Dental Amalgam (Burnishing and Carving)

MATCHING

Match the items with the correct description below.

a. Gamma phase ()
b. Gamma-1 phase (1)
 c. Gamma-2 phase (2)

1. Strongest phase
2. The silver alloy phase
3. Phase with the least corrosion
4. Phase that is weak and corrodes easily
5. Phase that consists of mercury reacting with the silver
6. Phase that consists of mercury reacting with tin

1. ANS: A REF: p. 151 TOP: Dental Amalgam (Setting Reactions)

2. ANS: A REF: p. 151 TOP: Dental Amalgam (Setting Reactions)
3. ANS: A REF: p. 151 TOP: Dental Amalgam (Setting Reactions)
4. ANS: C REF: p. 151 TOP: Dental Amalgam (Setting Reactions)
5. ANS: B REF: p. 151 TOP: Dental Amalgam (Setting Reactions)
6. ANS: C REF: p. 151 TOP: Dental Amalgam (Setting Reactions)

SHORT ANSWER

1. Describe the different particle shapes in amalgam alloys.

ANS:
• Lathe-cut alloy: Irregularly shaped particles formed by shaving fine particles from an
alloy ingot
• Spherical alloy: Alloy particles produced as small spheres
• Admixed alloy: Mixture of lathe-cut and spherical alloys

REF: pp. 150-151 TOP: Dental Amalgam (Silver-Based Amalgam Alloy Particles)

2. List the advantages and disadvantages of amalgam.

ANS:
Advantages
• Can withstand high chewing forces
• Useful when isolation is difficult
• Easy to manipulate
• Very durable
• Relatively inexpensive

Disadvantages
• Not an esthetic material
• May require more tooth structure removal to maintain the restoration
• Cannot chew on it immediately after placement
• Possible temperature sensitivity after placement
• Possible galvanic reaction with other metals in the mouth
• Requires mercury hygiene measures with scrap material

REF: p. 156 TOP: BLUE BOX: Advantages and Disadvantages of Amalgam

3. List the main components of amalgam alloy and describe their function.
ANS:
• Silver: Strength, corrosion
• Tin: Improves physical properties when compounded with Ag
• Copper: Strength, hardness, corrosion
• Zinc: Oxidation of other metals

REF: p. 151 TOP: Table 10-1: Main Components of Amalgam Alloy