Manipulation of Amalgam 1.

SELECTION OF ALLOY
• High-copper alloy vs low-copper alloy
Advantages Amalgam Restoration • High-copper spherical amalgam alloy vs
high-copper admixed amalgam alloy
1. Ease of use
2. High compressive strength
3. Excellent wear resistance
4. Favorable long term clinical research results
5. Lower cost than for composite restorations
6. Moderate to large Class I and II restorations
(especially restorations that involve heavy
occlusion, cannot be isolated well, or
extend onto the root surface)
7. Class V restorations (including restorations
that are not esthetically critical, cannot be
well isolated, or are located entirely on the
root surface) 2. PROPORTIONING (MERCURY:ALLOY RATIO)
8. Temporary caries-control restorations 1. Use of squeeze cloth
9. Foundations 2. Increased dryness technique
3. Eames technique
Disadvantages Of Amalgam Restoration
1. Non-insulating
2. Non-esthetic
3. Less conservative (more removal of tooth
structure during tooth preparation)
4. More difficult tooth preparation
5. Initial marginal leakage • THE AMOUNT OF ALLOY AND MERCURY TO
6. Amalgams are contraindicated in patients BE USED IS TERMED AS MERCURY/ALLOY
who are allergic to the alloy components. RATIO
• 1:1 is recommended, 50% mercury
7. Amalgam should not be used when
• If dispenser is used:
composite resin would offer better
➢ Dispenser must
conservation of the tooth structure and
be held vertically.
equal clinical performance.
➢ Dispenser must
be half-full
Manipulation of Amalgam
(1) Selection of alloy and mercury FACTORS THAT AFFECT THE STRENGTH OF
(2) Proportioning AMALGAM
(3) Trituration 1. Trituration – overtrituration or
(4) Mulling undertrituration?
(5) Condensation 2. Mercury content
(6) Pre-carve burnishing 3. Condensation – pressure, technique, and
(7) Carving alloy particle shape
(8) Post-carve burnishing 4. Porosity
(9) Polishing 5. Amalgam hardening rate
Proportioning (Mercury:Alloy Ratio)
Excessive amount of mercury:
• If more than 55%: loss of strength
• Increased flow
• Decreased strength
• Increased tarnish and corrosion
How to reduce amount of mercury:
1. Use of squeeze cloth
2. Increased dryness technique
3. Eames technique/ minimal mercury
technique
Insufficient amount of mercury may make the
mass:
• Grainy
• Non-coherent
• Impairs the strength of high-copper
amalgams as much as an excessive
quantity of mercury. Corrosion resistance is
also reduced.
3. TRITURATION
• The process by which mercury is allowed
to react with the amalgam alloy particles.
To provide proper amalgamation of the
mercury and the alloy.
• 2 methods of trituration:
1. Mechanical trituration
- Amalgamator
- Precapsulated
amalgam: capsule
serves as mortar
- Speed ranges from
3200-4400 cpm
- High copper requires higher speed
2. Hand trituration
- Alloy particles are coated
with films of oxides which is
removed by abrasion by
trituration.
- 25-45 sec
- mortar and pestle
- mortar has rough, rounded inner
surface for increased friction
TRITURATION
• To achieve a workable mass of amalgam
within a minimum time
• To remove the oxide layer
• To pulverize pellets into particles, that can
be easily attacked by the mercury
• To reduce particle size
• To keep the amount of gamma-one and
gamma-2 matrix crystal as minimal as
possible, yet evenly distributed.
OVERTRITURATION: “HOT MIX”
• The forming matrix may break
• The mix sticks to the capsule
• Decreases working time
• Setting contraction increases
• Increased creep
UNDERTRITURATION
• Soft, powdery, non-coherent mix
• Set too rapidly, which results in
high residual mercury content,
reduced strength, and the
increased likelihood of fracture or marginal
breakdown
4. MULLING
• Continuation of the process of
trituration
• Improve homogeneity of mass
and get a single consistent mix
• Done by gathering the triturated mass in a
rubber sheet and using finger tips, the mass
is rubbed for 2-5 sec.
5. CONDENSATION OF AMALGAM MIX
• Goal of condensation:
Is to compact the alloy into the prepared
cavity so that the greatest possible
density is attained, with sufficient mercury
present to ensure complete continuity of
the matrix phase (Ag2Hg3) between the
remaining alloy particles
• It increases the strength and decreases
the creep
Compress (condense) the mixture to:
• Reduce voids in the material,
• Adapt it closely to the tooth preparation
walls, and
• Express excess mercury-rich matrix.
Condensation pressure:
• The smaller the condenser, the greater the
pressure exerted on the amalgam
• Forces as great as 66.7 N (15 lb) are
recommended for condensation,
• Forces in the range of 13.3 to 17.8 N (3 to 4
lb) represent the average force employed
• Maller condenser is used while filling the
preparation and a larger one for over-
packing
• An amalgam carrier is used to transfer
amalgam to the tooth preparation.
6. PRE-CARVE BURNISHING
• To ensure that the marginal amalgam is well
condensed before carving, the over-
packed amalgam should be burnished
immediately with a large burnisher, using
heavy strokes mesiodistally and
faciolingually,
• Provides continuation of condensation,
reducing the size and voids on the surface
and margins of amalgam
• Brings any excess mercury to the surface, to
be discarded during carving
• Adapt the amalgam further to the
cavosurface anatomy
• Tooth to amalgam

7. CARVING
• Using enamel as guide, carve gently from
enamel towards the center and recreate
the lost anatomy of the tooth.
Manual Condensation: • Amalgam should be hard enough to offer
• condensation is done using hand instrument resistance to carving instrument
and is done in increments. • A scraping or “ringing” AMALGAM CRYING
• sufficient pressure is delivered (3-4 lbs) should be heard.
• If carving is started too son, amalgam will
pull away from margins.
Mechanical condensation:
• uses mechanical condensers that provide
vibration
• Delayed condensation does not allow
proper condensation and will not remove
mercury from the restoration
• decreases restoration’s strength and
Aims of carving
increases the creep in the material.
To produce:
• Condensation technique
must be done using STEPPING • A restoration with no
PROCESS to drive away voids underhangs
• A restoration with the proper
• Small increments must be
physiological contours.
used to ensure proper
• A restoration with minimal flash.
condensation
• A restoration with adequate, compatible
• The preparation should be over-packed 1
marginal ridge
mm or more using heavy pressure
• A restoration with proper size, location,
• this ensures that the cavosurface margins external and interrelationship of contact
are completely covered with well- areas.
condensed amalgam.
• Final condensation over cavosurface
Objectives of carving:
margins should be done perpendicular to
• to simulate the anatomy, rather than to
the external enamel surface adjacent to the
reproduce extremely fine detail.
margins.
• If the carving is too deep, the bulk of
amalgam, particularly at the marginal
areas, is reduced. If this area is too thin, it
may fracture under masticatory stress.
• amalgam should be ready for carving soon
after completion of condensation;
• however, the carving should not be started
until the amalgam is hard enough to offer
resistance to the carving instrument.
• If the carving is started too soon, the
amalgam may be so plastic that it may be
pulled away from the margins, even by the
sharpest carving instrument.
• discoid–cleoid instrument is used to carve
the occlusal surface of an amalgam
restoration.
• The rounded end (discoid) is positioned on
the unprepared enamel adjacent to the
amalgam margin and pulled parallel to the
margin
This removes any excess at the margin while
not allowing the marginal amalgam to be
over- carved (too much removed).
• The pointed end (cleoid) can be used to
define the primary grooves, pits, and cuspal
inclines.
• The Hollenbeck carver is also useful in
carving these areas.
• The mesial and distal pits are carved to be
inferior to the marginal ridge height, helping
prevent food from being wedged into the
occlusal embrasure.
• marginal ridge height and occlusal
embrasure areas are developed with an
explorer tip or carving instrument by
mimicking the adjacent tooth
• The explorer tip is pulled along the inside of
the matrix band, creating the occlusal
embrasure form.
• the height of the amalgam marginal ridge
should be the same as that of the adjacent
tooth
Proximal Embrasure Areas
• amalgam knife (or scaler) is used for
removing proximal excess and developing
proximal contours and embrasures
8. POST-CARVE BURNISHING
• lightly rubbing the carved surface with a
burnisher of suitable size and shape to
improve smoothness and produce a satin
(not shiny) appearance.
9. FINISHING AND POLISHING
• eliminate surface scratches and blemishes,
which act as centers of corrosion
• remove any remaining amalgam flash not
carved away,
• refine the anatomy and occlusion.
• with finishing burs, and abrasive stones and
rubber points impregnated with abrasives.
• alumina stone or a green carborundum
stone is used to correct the discrepancy
• The green stone is more abrasive than the
white stone
The polishing procedure is started by using a
coarse, rubber abrasive point at low speed
and air-water spray to produce an amalgam
surface with a smooth, satiny appearance
• final polish can be accomplished with a tin
oxide compound
• use water when polishing to prevent the
vaporization of mercury from the amalgam.
• Most amalgam restorations should not be
polished for 24 hours, although the spherical
high-copper amalgam can be polished
almost immediately because its strength is
obtained rapidly.
• alternative to rubber abrasive points is
rubber cup with flour of pumice followed by
a high-luster agent, such as precipitated
chalk.
BURNISHING AND POLISHING
• Temperatures above 60° C (140° F) cause a
significant release of mercury. The mercury-
rich condition created at the margins results
in accelerated corrosion, fracture, or both.
• When overheated, the amalgam surface
appears cloudy, even though it may have a
high polish. This cloudy appearance
indicates that mercury has been brought to
the surface,.
BONDED AMALGAMS
• During the 1990’s some clinicians began to
routinely bond amalgam restorations to
enamel and dentin
• After preparation of the cavity, enamel and
dentine etched using a conventional
etchant, a chemically cured resin-bonding
agent applied to the walls of the cavity.
• Amalgam is immediately condensed into
the cavity before the resin bond has cured

CLINICAL FAILURES OF AMALGAM

Clinical failure is the point at which the
restoration is no longer serviceable or at which
time the restoration poses other severe risks if it
is not replaced.
Amalgam restoration-related failures include:
1. bulk fracture of the restoration,
2. corrosion and excessive marginal fracture,
sensitivity or pain,
3. secondary caries,
4. fracture of tooth structure forming the
restorative tooth preparation wall(s).

ADVANTAGES OF BONDED-AMALGAM
The thin portion of amalgam extending
beyond the margin is referred to as flash.
• Conservation of tooth structure. □
• Fracture strength was as high as for
composites □
• Decreased marginal leakage in class 5
restorations compared with unbonded
amalgams □
• elimination of post-insertion sensitivity. □
• Reduces incidence of marginal fracture and
recurrent caries
• Allows for amalgam repairs.

MICROLEAKAGE
• Dental amalgam has the
tendency to minimize
micro leakage if the
restoration is properly
inserted.
• leakage decreases as the
restoration ages in the
mouth due to the
formation of corrosion products which forms
at the interface between the tooth and the
rectoration (Copper and Tin corrosion
products
• The corrosion products seal the interface
and