DENTAL AMALGAM

CHHATTISGARH DENTAL COLLEGE &

RESEARCH INSTITUTE, RAJNANDGAON (C.G.)

DEPARTMENT OF CONSERVATIVE DENTISTRY

AND ENDODONTICS

DENTAL AMALGAM
(SEMINAR)

Presented by : Dr. Aastha Ranka

(I YEAR M.D.S)
 DENTAL AMALGAM

CONTENTS

 Introduction
 History
 Terminologies
 Classification of Amalgams
o Particle Size
o Copper Content
o Zinc Content
 Manufacture of Alloy Powder
 Metallurgic Phases in Dental Amalgam
 Manipulation of Amalgam
o Alloy: Mercury Ratio
o Size of Mix
o Trituration
o Placement and Finishing
 Properties of Amalgam
o Compressive Strength
o Tensile Strength
o Strength in various Phases
o Elastic Modulus
o Creep
o Dimensional Change
o Corrosion
o Properties of Mercury
 Mercury Toxicity
o Forms of Mercury
o Amalgam Tatoo
o Dental Mercury Hygiene
 Indications & Contra-Indications of Amalgam
 Clinical Considerations
o Marginal Adaptation and Seal
o Self-Sealing
o Bonded- Amalgams
 Marginal Fracture of Amalgam
 Repair of Amalgam Restorations

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 Galvanic Effect
 Conclusion
 References

INTRODUCTION
Dental amalgam is produced by mixing liquid mercury with solid particles of an alloy of silver, tin,
copper and sometimes zinc, palladium, indium and selenium. This combination of solid metals is known as
the amalgam alloy. It is important to differentiate between dental amalgam and the amalgam alloy that is
commercially produced and marketed as small filings, spheroid particles, or a combination of these, suitable
for mixing with liquid mercury to produce the dental amalgam.

The freshly mixed mass of amalgam alloy and liquid mercury developed by the dentist has a
plasticity that permits it to be conveniently packed or condensed into a prepared tooth cavity. A dental
amalgam restoration results. Such amalgam restorations usually are limited to the replacement of tooth
tissue in posterior teeth because their silvery gray metallic appearance. Dental amalgam restorations are
reasonably easy to insert, are not overly technique-sensitive, maintain anatomic form, have reasonably
adequate resistance to fracture, prevent marginal leakage after a period of time in the month, and have a
relatively long service life.

HISTORY
Humankind always has been plagued by the problem of restoring parts of the body lost as a result of
accident or disease. Practitioners of dentistry have been confronted with this problem since the beginning of
the dental practice, and the means of replacing missing tooth structure by artificial materials contains to
account for a large part of dental science. During the period from 1600 to 1840, the foundations for the
science of dentistry were established.

In 1819 in England dental amalgam was first known as BELL’S PUTTY. M. Traveau is credited
with advocating the first form of dental amalgam-silver-mercury paste in 1826, in Paris France. It was
presented by Crawcour brothers to the dental profession in America in 1833 as “Royal Mineral
Succedaneum” as substitute for gold. The ensuing chaos in organized dentistry of that time is known
historically as the “Amalgam War”. E.Parnly stated that dental amalgam was “ Wholly inapplicable and
UNFIT for use in the MOUTH”.

The Crawcour brothers introduced “Silver paste”, the amalgam of silver with mercury in the U.S as a
filing material in 1883. The first National Dental Society, the American Society of Dental Surgeons was
established in 1840. One of the early actions of the American Society of Dental Surgeons was to forbid its
members to use Silver amalgam for restoring lost tooth structure. About the time of this, “war” copper
amalgam was introduced in 1844. A silver-tin-mercury alloy, or amalgam was introduced in 1855 by Elisha
Townsend, followed by another formula by J.F.Flogg., Dr.J.Foster Flagg and Dr.G.V.Black studied
amalgam, and the research of Black led to the development of the formula in 1896 that has been closely
adhered to until recent years.

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Dr.G.V.Black’s formula in 1896: Formula 150 yrs later:

68.50% - silver 65% - silver
25.50% - tin 29% - tin
5% - gold <6% or 13-30 % - copper
1% - zinc 0.01 % - zinc

Since amalgam is the most widely used single restorative material in dentistry, its overwhelming
importance cannot be ignored. It is relatively easy to use, a fact that perhaps invited its use in many
unwarranted circumstances and widespread abuse.

There is still no adequate, economic alternative for dental amalgam as a restorative material for
moderately sired carious lesion in a high-load-bearing area. The combination of reliable long-term
performance in load-bearing situations and small cost per unit is unmatched by any other dental restorative
material.
TERMINOLOGIES USED IN DENTAL AMALGAM

o “Amalgam”: Technically means an alloy for one or more metals with mercury.

o “Dental Amalgam”: refers to a particular type of amalgam. Which is the most commonly
used and one of the oldest dental restorative materials. It is the product of an amalgamation
reaction between particles of an alloy, containing varying amounts of silver, copper and tin
with mercury.

o “Dental Amalgam Alloy”: is a silver-tin alloy to which varying amounts of copper and small
amounts of zinc have been added.

o “Low copper dental amalgam” alloys contain 2% to 5% copper. Combining filings of

such alloys with mercury made the earliest successful dental amalgams.

o A typical modern “low-copper dental amalgam” alloy may contain: 69.4% Ag, 26.2%
Sn, 3.6% cu and 0.8% Zn.

o Amalgams made from such low-copper alloy filings are often referred to as “Conventional
Dental Amalgams”.

o “High copper dental amalgam” alloy contain 12% to 30% copper and, due to their high
copper content, display significantly better corrosion resistance than low-copper dental
amalgams.

o A typical high-copper dental amalgam alloy may contain 60% Ag, 27% Sn, 13% Cu and
0% Zn.

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Because of a concern about the possible toxicity of mercury in dental amalgams, a number of
materials have been developed as “dental amalgam substitutes”. Gallium alloys are an example of such a
substitute that is made with Ag-Sn particles in Ga-In. Gallium melts at 28˚C and can be used to produce
liquid alloys at room temperature by the addition of small amounts of other elements such as indium. In this
case, Ga-In has been substituted for Hg in dental amalgam.

The ADA in combination with National Institute on Standards Technology (ADA-NIST), patented a
“mercury-free” direct filing alloy based on Ag coated Ag-Sn particles that can be self-welded by
compaction to create a restoration. This approach is being proposed as an alternative to dental amalgam.

Other transitional approaches include redesigning amalgam to have much less initial mercury. If
alloy particle sires are judiciously chosen to pack together well, it is possible to minimize the mercury
required for mixing to the 15% to 25% range. The actual clinical properties of these “low-mercury
amalgams” are not yet known.

Since the 1960’s, high-copper amalgams have largely replaced high-silver alloys, which had changed
little in composition since the 1980’s. Extensive clinical studies have provided information on performance,
longevity and reasons for failure. Laboratory tests have been developed to obtain a greater understanding of
their structure and performance. Amalgams have always been regarded as very tolerant materials, which will
perform well in the oral cavity in spite of great variations in placement techniques.

However, improvements in methods of prevention and control of caries and consequent

modifications to cavity design have resulted in changes in diagnostic concepts, treatment philosophies,
restorative techniques and materials. Amalgam is likely to be used less in the future. The potential for
allergy to or toxicity from the mercury content has been recognized for many years and intensive
investigation and research have been undertaken.

Currently, it is apparent that any restriction in the use of amalgam will be related to environmental
concerns rather than to the health of individual patients and there appears to be no justification to either
cease using it or replace it entirely in the hope of altering a patient’s state of health.

CLASSIFICATION OF DENTAL AMALGAM

A range of amalgam alloys is available commercially and they may be differential from each other as
follows:
o Particle shape and type
o Copper content
o Zinc content

Particle shape and type

In the 1830’s, dental amalgam was obtained by filing or grinding silver coins into coarse particles to
mix with mercury. The composition were inconsistent at best and the reaction conditions were quite
variable. This process could not reliably produce a final amalgam with uniform properties. During the

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1860’s and 1860’s, Townsend, Flagg and others contributed immensely to investigations of composition
versus properties. However, true dental amalgam science began with investigations by G.V.Black during the
1890’s.

Traditional (or conventional) dental amalgam alloys were produced by early dental manufacturers
such as S.S White and predominated from 1900 until 1970. The basic composition was 65% Ag, 30% Sn,
5% cu and <1% 2n.

Traditionally alloy was manufactured in bricks that were ground with a file into ‘filings’ and mixed
with mercury. A more efficient process was grinding up the ingot of alloy, typically on a lathe. For that
reason those particles became known as “lathe-cut” particles. Filings were irregular in shape and gradually
were produced in finer and finer sizes by manufacturers to control the reaction, produce smoother mixtures
and enhance final properties.

LATHE-CUT PARTICLES: could be purchased in regular cut, fine cut, and micro-fine cut
versions. Conventional amalgam alloys were commonly classified on this basis of particle sire.

Irregular powder particles pack together relatively poorly require a relatively large amount of
mercury (50% to 60% by weight in the mixture) to fill in the spaces, After transfer of mixture to the cavity
preparation, it is possible to compact the mass and extrude some of the mercury-rich matrix. By eliminating
the mercury-rich matrix as much as possible, the amount of reaction product matrix, which forms, is limited,
there by improving the overall properties of the set dental amalgam. Mercury – rich mixtures (after
trituration but before placement into the cavity) historically could be partially condensed by wringing the
mass in a squeeze cloth. In the 1960’s, Eames was the first to promote a low-mercury-to-alloy mixing ratio.
(Eames technique or no squeeze cloth technique).

SPHERICAL- SHAPED PARTICLES

Later it was demonstrated that by spherodizing the alloy particles, the particles packed more
efficiently and required much less mercury to make a practical mixture. Spherical particles also:
o Increased the fluidity of the mixture by presenting less resistance to particle sliding, and also
o Reduced the mercury portion of the mixture to less than 50% by weight.

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COPPER-CONTENT
Classification of dental amalgams based on copper contents is the main system in use today. Low
copper amalgam alloys have a total copper content of less than 6%. Until the mid-1960’s, almost all-dental
amalgam alloys were of this type.

High-Copper amalgam alloys have a total copper content greater than 12% and most modern dental
amalgam alloys are in this category. They have superior physical properties and clinical performance partly
because they show low creep and an absence of a Tin-mercury (gamma-2) reaction phase.

ZINC CONTENT
Alloys containing more than 0.01% zinc are described as “Zinc Containing” and those with less
than 0.01% Zinc are referred to as “Zinc-Free”.

Originally zinc was added to conventional dental amalgam as a Processing Aid to suppress oxidation
of key elements in the alloy. Zinc tends to oxidize film that covers the surface of liquid alloy during
manufacture and suppresses oxidation of other elements. Generally 1% or more is added to accomplish this
end. However some (0.2% to 1%) is left in the dental amalgam alloy at the end. A detrimental side effect of
this residual zinc was that moisture contamination prior to setting converted zinc-to-zinc oxide and produced
hydrogen gas that could expand the amalgam excessively, resulting in patient pain. Once this mechanism of
“Delayed Expansion” was understood, care during dental amalgam manipulation prevented this problem.

Non-Zinc Amalgams: They were favored where isolation was difficult.

It now seems as though zinc may have some beneficial effect on amalgam longevity. There is
clinical research evidence that zinc containing low-copper and high-copper amalgams may last 20% to 50%
longer than zinc-free ones. On the basis of this new evidence, amalgams continue to be produced and
designated as zinc (zinc-containing) or non-zinc (zinc-free).

Particle size
1. Lathe- cut: 60-120 µm in length
70 µm in length
10-35 µm in length
2. Spherical: 2-43 µm in length
MANUFACTURE OF ALLOY POWDER
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Lathe-Cut powder
To make lathe-cut powder, an annealed ingot of alloy is placed in a milling machine or in a lathe and
is fed into a cutting tool or bit. The chips removed are often needlelike, and some manufacturers reduce the
chip size by ball milling.

Homogenizing Anneal
Because of the rapid cooling conditions of from the as-cast state, an ingot of an Ag-Sn alloy has a
cored structure and contains non-homogenous grains of varying composition. A homogenizing treatment is
performed to re-establish the equilibrium phase relationship. The ingot is placed in an oven and heated at a
temperature below the solidus for sufficient time to allow diffusion of atoms to occur and the phases to
reach equilibrium. The time of heat treatment may vary, depending on the temperature used and the size of
the ingot, but a thermal time of 24 hours at the selected temperature is not unusual.

At the conclusion of the heating cycle, the ingot is brought to room temperature for the succeeding
steps in manufacture. The proportion of phases present in the ingot after cooling is affected by the manner in
which the ingot is cooled. If the ingot is withdrawn from the heat treatment oven rapidly and quickly
quenched, the phase distribution will remain essentially unchanged. On the other hand, if the ingot is
permitted to cool very slowly, the proportions of phases will continue to adjust towards the room
temperature equilibrium ratio.

For example, in a Ag-Sn alloy, rapid quenching of the ingot results in the maximum amount of 
phase retained, whereas slow cooling results in the formation of the maximum amount of the  phase.

Particle Treatments
Once the alloy ingot has been reduced to cuttings, it is treated with acids. The exact function of this
treatment is not entirely understood, but it is probably related to preferential dissolution of specific
components from the alloy. Amalgams made form acid washed powders tend to be more reactive than those
made from unwashed powders.

The stress induced into the particle during cutting and ball milling must be relieved or they slowly
release over time, causing a change in the alloy, particularly in the amalgamation rate and dimensional
change occurring during hardening. The stress relief process involves an annealing cycle at a moderate
temperature of 100C for several hours.
Atomized Powder
Melting together the desired elements makes atomized powder. The liquid metal is atomized into
fine spherical droplets of metal. If the droplets solidify before hitting a surface, the spherical shape is
preserved, and these atomized powders are called “spherical powders”.

Particle Size
The manufacturer controls maximum particle size and the distribution of sizes within an alloy
powder. The average particle sizes of modern powders range between 15 and 35 m. Te most significant
influence on amalgam properties is the distribution of sizes around the average. For example, very small

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particles (<3m) greatly increase the surface area per unit volume of the powder. A powder containing tiny
particles requires a greater amount of mercury to form an acceptable amalgam.

AMALGAMATION AND RESULTING STRUCTURE

Low-Copper Alloys
Amalgamation occurs when the mercury comes into contact with the surface of the Ag-Sn particles.
When the powder is triturated, the silver and tin in the outer portion of the particles dissolve into mercury.
At the same time, mercury diffused into the alloy particles. The mercury has a limited solubility for silver
(0.035 wt%) and tin (0.6 wt%).

When that solubility is exceeded, crystals of two binary metallic compounds precipitate into the
mercury. These are the body-centered cubic Ag2Hg3 compound (the  phase) and the hexagonal close
packed Sn7-8Hg compound ( the 2 phase ). Because the solubility of silver in mercury is much lower than
that of tin, the 1 phase precipitates first, and the 2 phase precipitates later. As the mercury dissolves the
alloy particles, the 1 and 2 crystals grow. As the mercury disappears, the amalgam hardens. The alloy is
usually mixed with mercury in approximately 1:1 ratio. This is insufficient mercury to completely consume
original alloy particles. Therefore unconsumed particles are present in the set amalgam. Hence a typical low-
copper amalgam is a composite in which the 1 and 2 phases are surrounded by unconsumed particles.

The reaction can be expressed as :

Alloy particles (+) + Hg  1 + 2 + unconsumed alloy particles (+).

High-Copper Alloys
High-copper alloys have become materials of choice because of their improved mechanical
properties, corrosion characteristics, and better marginal integrity and performance in clinical trials as
compared to traditional low-copper alloys. Two different types of high-copper alloy powders are available:
o Admixed alloy powder.
o Single compositional alloy powder.
Both types contain more than 6 wt% copper.

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Admixed Alloys
In 1963, Innes and Youdelis added spherical silver-copper )Ag-Cu) eutectic alloy (71.9 wt% silver
and 28.1 wt% copper) particles to lathe-cut low-copper amalgam particles. This was the forst major change
in the composition of alloy for dental amalgam since Black’s work. These alloys are termed “admixed
alloys” because the final powder is a mixture of at least two kinds of particles (lathe-cut low-copper alloy
particles and spherical Ag-Cu alloy particles).

When mercury reacts with an admixed powder, the silver dissolves into the mercury from the Ag-Cu
alloy particles, and silver and tin dissolve into the mercury from Ag-Sn alloy particles. The tin in solution
diffuses to the surface of the Ag-Cu alloy particles and reacts with the copper phase to form the  phase
(Cu6Sn5). A layer of  crystals forms around unconsumed Ag-Cu alloy particles. The  layer on Ag-Cu
alloy particles also contains some 1 crystals. The 1 phase forms simultaneously with the  phase and
surrounds both the  covered Ag-Cu alloy particles and the Ag-Sn alloy particles. As in the low-copper
amalgams, 1 is the matrix phase, that is, the phase that bibds the unconsumed alloy particles together.

Alloy particles ((+) + Ag-cu eutectic + Hg   + + unconsumed alloy particles of both types of
particles.

Note that 2 has been eliminated in this reaction. 2 does form at the same time as  but is later
replaced by it. Some set admixed amalgams do contain 2, although the percentage is smaller than that in
low-copper amalgams.

2. Single Compositional Alloys

In this type each alloy particle contains the same chemical composition. Therefore the name “single-
compositional”. The major components are silver, copper and tin. The first alloy of this type contained 60-
wt% silver, 27-wt% tin, and 13 wt% copper. The copper content in various single-composition alloys ranges
from 13 wt% to 39 wt%. In addition small amounts of indium or palladium are also found.

When triturated with mercury, silver and tin from the Ag-Sn phases dissolve in mercury. Little
copper dissolves in mercury. The 1 crystals grow, forming a matrix that binds together the partially
dissolved alloy particles. The  are found as meshes of rod crystals at the surfaces of alloy particles, as well
as dispersed in the matrix.

Ag-Sn-Cu alloy particles + Hg  1 +  + unconsumed alloy particles.

METALLURGIC PHASES IN DENTAL AMALGAM

The setting reactions of alloys for dental amalgam with mercury are usually described by the
metallurgic phases that are involved. These phases are named with Greek letters that correspond with the
symbols found in the phase diagram of each alloy system.

Phases In Amalgam Alloys & Stoichiometric

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Set Dental Amalgam Formula

1.  Ag3 Sn
2 1 Ag2 Hg3
3. 2 Sn7-8 Hg
4.  Cu3 Sn
5.  Cu6 Sn5
6. Silver-copper-eutectic Ag-Cu
The other phases that are formed are: voids, trace elements: copper (either alone or in combination
with zinc) and zinc.

MANIPULATION OF DENTAL AMALGAM

A. PROPORTIONS OF ALLOY TO MERCURY
Correct proportioning of alloy and mercury is essential for forming a suitable mass of amalgam for
placement in a prepared cavity. Some alloys require mercury – alloy ratios in excess of 1:1, whereas others
use ratios of less than 1:1 with the percentage of mercury varying from 43% to 54%.

B. SIZE OF MIX
Manufacturers commonly supply capsules containing 400, 600, or 800 mg of alloy and the
appropriate amount of mercury. For large size cavities capsules containing 1200 mg of ally are also
available.
C. MIXING OF AMALGAM: (TRITURATION)
Trituration of the alloy with the mercury is normally carried out in a mechanical amalgamator. The
efficiency of the machine will be influenced by:
1. Speed of the particular unit.
2. The length and type of “throw” of the capsule.

3. The presence of a pestle in the capsule.

4. Length of time of mixing.

Mechanical amalgamators are available in the following speeds:

Low speed: 32-3400 cpm.
Medium speed: 37-3800 cpm.

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High speed: 40-4400 cpm.

Over-trituration: Alloy will be hot, hard to remove from the capsule, shiny wet and soft.

It is better to slightly over-triturate than to under triturate an amalgam since:

o Extended trituration may reduce plasticity,
o Shorten working time and
o Increase final contraction.
Under-trituration: Alloy will be dry, dull and crumbly; will crumble if dropped from approx 30 cm.
Reduced tritutation may result in:
o Incomplete wetting of the surfaces of the alloy particles by mercury.
o A weak interface between the matrix (gamma1) and the particles.
o Lower strength.
o Increased porosity.

o A rougher surface.
o Increased corrosion.
o Loss of surface finish.
Normal Mix: Shiny appearance separates in a single mass from the capsule.

PLACEMENT AND FINISHING

Amalgam should be condensed into the cavity within 3 min after trituration.

Purpose of Condensation

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Condensation refers to the incremental placement of the amalgam into the prepared cavity and
compression of each increment into the others to form a continuous homogenous mass that is well adapted
to all margins, walls and line angles. It is best carried out using hand instruments.

Mechanical Condensers: Tend to lead to unreliable condensation as well as generation of heat and
mercury vapor, both of which are undesirable.

Ultrasonic Condensers: It causes the release of considerable quantities of mercury vapor.

AIMS OF CONDENSATION
o Adapt amalgam to the margins, walls and line angles of the cavity.
o Minimize voids and layering between increments within the amalgam.
o Develop maximum physical properties.
o Remove excess mercury to leave an optimal alloy: mercury ratio.

SPEED OF PLACEMENT
Once amalgam is triturated, phase formation commences and the setting reaction is underway.
Amalgam must be placed in a plastic state, so no amalgam should be placed more than 3 minutes after the
start of mixing. Attempting to condense a partly set amalgam into a cavity will result in
Poor adaptation,
Reduced marginal seal and
A weak restoration.
MOISTURE CONTAMINATION
Moisture contamination during mixing and condensing operations may produce excessive expansion.
Moisture contamination of a Zinc-containing amalgam mass from any source results in an excessive delayed
expansion of several hundred micrometers per centimeter after the restoration has been placed in the
tooth for several hours or days. This excessive expansion results from the decomposition of moisture. The
trapped hydrogen gas in the amalgam restoration continues to be developed until sufficient force is produced
to cause the excessive expansion.

Placement
Place the amalgam into the cavity in relatively small increments and condense using:
o Lathe-cut alloy: Small pluggers.
o Blended alloy: Small pluggers.
o Spherical alloy: Large pluggers.

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First Burnish (Pre-carve Burnish)

On completion of condensation carry out a pre-carve burnish using a large burnisher for 15 seconds.
Use light force and move from the center of the restoration outwards to the margins. This will further the
mercury to the surface and also improve adaptation to the cavity margins.

Carving
Using remaining enamel as a guide, carve gently from enamel towards the center and recreate the
lost anatomy of the tooth

Final Burnish
Following carving, check the occlusion and carry out a brief final burnish. Use a large burnisher at a
low load and burnish outwards towards the margins to finally adapt the alloy to the marginal enamel.

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Finishing
The restoration should always be finished at a later appointment to further adjust occlusal contacts
and proximal anatomy. Carry out all polishing procedures under an air-water spray to minimize the
generation of heat and the liberation of mercury vapor.

PROPERTIES OF AMALGAM
Important properties of dental amalgam include Dimensional changes, (compressive) strength, creep
and corrosion resistance.

ANSI/ADA Specification No: 1 for dental amalgam alloy

This specification was first formed in October 1929. The latest review of this specification was done
in 1980.

It contains requirements that aid significantly to control the qualities of dental amalgam. The
specification lists 3 physical properties as a measure of quality of amalgam: Creep, Compressive strength
and Dimensional change.

When a cylindrical specimen is 7 days old, a 36 Mpa stress is applied in a 37 C environment. Creep
is measured between 1 and 4 hours of stressing.
o The maximum allowable creep is 3%.
o The minimum allowable compressive strength 1 hour after setting, when the cylindrical specimen is
compressed at a rate of 0.25 mm/minute is 80 Mpa.
o The dimensional change between 5 minutes and 24 hours must fall within the range of 20 m/cm.

PHYSICAL AND MECHANICAL PROPERTIES

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Compressive Strength
Resistance of compressive forces is the most favorable strength characteristic of amalgam. Because
amalgam is strongest in compression and much weaker in tension and shear, the prepared cavity design
should maximize the compression forces in service and to minimize tension of shear forces.

When subjected to a rapid application of stress either on tension or in compression, a dental amalgam
does not exhibit significant deformation or elongation and, as a result, functions as a brittle material.
Therefore a sudden application of excessive forces to amalgam tends to fracture the amalgam restoration.

The high-copper unicompositional materials have the highest early compressive strengths of more
than 250 Mpa at 1 hour. The compressive strength at 1 hour was lowest for lathe-cut alloy (45 Mpa),
followed by one of the low-copper spherical alloy (88 Mpa) and then two low-copper spherical alloys and
the high-copper admixed alloy (118 to 141 Mpa).

High values for early compressive strength are an advantage for an amalgam because they reduce the
possibility of fracture by prematurely high contact stresses from the patient before the final strength is
reached.

Tensile Strength
Tensile strengths are only a fraction of their compressive strengths; therefore cavity designs should
be constructed to reduce tensile stresses resulting from biting forces. The high early tensile strengths of the
high-copper unicompositional alloys are important because they resist fracture by premature biting stresses
than other amalgams.

Strength Of Various Phases

The relative strengths of different amalgam phases are important. By studying the initiation and
propagation of a crack in a set amalgam (under a conventional metallographical microscope with a strain
viewer) , the relative strength of the different phases can be observed.

In low-copper amalgam: the strongest to weakest phases are as follows:

Ag3 Sn ()------ Silver-mercury phase (ı) ------- Tin-mercury phase (2) ------ and the voids.
Silver –mercury and tin-mercury act as a matrix to hold the unreacted amalgam alloy together. A set
amalgam is STRONGER, when relatively smaller amounts of silver-mercury and tin-mercury phases form,
up to a certain minimum required for bonding together of the unreacted particles. When a higher percentage
of mercury is left in the final mass, it reacts with more of the amalgam alloy, producing larger amounts of
silver-mercury and tin-mercury phases and leaving relatively smaller amounts of unreacted particles. This
results in a WEAKER mass.

Elastic Modulus
When the elastic modulus is determined at low rates of loading, such as 0.025 to 0.125 mm/minute
values in the range of 11 to 20 Gpa are obtained. High copper alloys tend to be stiffer than low-copper
alloys.

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Creep
The creep or permanent deformation under static loads also reflects the viscoelastic properties of
amalgam. Under a continued application of force in compression, an amalgam shows a continued
deformation, even after the mass has completely set.

Highest value of 6.3% was found for the low copper cut alloy.
A lowest value of 0.05% to 0.09% was determined for high copper unicompositional spherical
alloys.

Multiple regression analyses of creep data have shown that the most influential variables were:
o Volume % of the “” phase.
o Grain size of the ı phase.
o Volume % of the “” and “” phases.
o Number of very small “” crystals (less than 1.5m/mm).
o Weight % of mercury.

Following aging at oral temperature for 6 months, amalgam exhibits a reduction in creep. This
reduction in creep is related to 1 formation and not due to changes in either 1 grain size or composition.

Dimensional Change
Dimensional change during the setting of amalgam is one of it’s most characteristic properties.
Current amalgams mixed with mechanical amalgamators have dimensional changes that are usually
negative. The initial contraction (the first 20 min) is believed to be associated with the solution of mercury
in the alloy particles. After this period an expansion occurs, although change remains negative, which is
believed to be a result of the reaction of mercury with silver and tin and the formation of the inter metallic
compounds. The dimensions become nearly constant after 6 to 8 hours, and thus the values after 24 hours
are final. The only exception to this statement is the excessive of zinc – containing alloy with water during
trituration or condensation.

The largest Dimensional change occurred with low copper lathe-cut alloy: -19.7 m/cm.

The lowest change of –1.9m/cm was for the high copper admixed alloy. ANSI/ADA Specification
No 1 for dental amalgam allows up to 20m/cm shrinkage.

Corrosion
In general, corrosion is the destructive attack of a metal by chemical or electro-chemical reaction
with it’s environment.
There are two types of corrosion:
o Crevice corrosion.
o Galvanic corrosion.

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Excessive corrosion can lead to:

o Increased porosity.
o Reduced marginal integrity.
o Loss of strength.
o Release of metallic products in to the oral environment.

Ag2 Hg3 phase has the highest corrosion resistance followed by:
o Ag3 Sn
o Ag3 Cu2
o Cu3 Sn
o Cu6 Sn5
o Sn7-8 Hg.

o Average depth of corrosion for most amalgam alloys is: 100 to 500 m.
o Low copper: most corrodible phase is the tin-mercury or “2” phase.
o High copper: ‘’ phase least corrosion resistant.
o Surface tarnish of low copper amalgams is more associated with  than ı whereas in high-copper
amalgams surface tarnish is related to the copper-rich phases, ‘’ and silver-copper eutectic.

Properties of Mercury
ANSI/ADA Specification No 6 for dental mercury requires
o Mercury have a clean reflecting surface that is free from a surface film when agitated in air.
o It should have no visible evidence of surface contamination.
o Contain less than 0.02% non-volatile residue.

Freezing point: -38.87 C, only metal in liquid state at room tempts.

Mercury boils: 356.9 C.
Surface tension of liquid mercury: 465 dynes/cm at 20 C.

Impurities in mercury can reduce the rate at which it combines with silver alloy.

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BIO-COMPATIBILITY –MERCURY TOXICITY

Mercury is available in 3 forms:

1. Elemental mercury (liquid or vapor).
2. Inorganic compounds.
3. Organic compounds.

The only risks from mercury are to the operator, staff and the environment from poor mercury
hygiene.

Amalgams have been used for 150 years and about 200 million amalgams are inserted each year in
the United States and Europe. The biocompatibility of amalgam has been the subject of extensive
investigation, particularly in relation to the presence of mercury. There is no material that 100% of the
population is immune to 100% of the time. There is concern, some of it appropriate, that mercury in dental
amalgam may pose threats to the health of patients, to the health of dental care providers and to the
environment.

ELEMENTAL MERCURY
Liquid mercury: is absorbed relatively poorly across skin or mucosa. Most mercury becomes
charged (ionized) before it reaches the blood. Ionized mercury is excreted well through kidneys and urine.
There is no known risk to patients from liquid mercury.

Mercury vapor: mercury vapor is less benign because it is rapidly absorbed into the blood via the
lungs and remains uncharged and therefore highly lipid soluble, for several minutes. During this time it can
cross the blood-brain barrier where it becomes charged and exists the extra cellular fluid of the brain and
returns into the blood much more slowly. This means that mercury levels can accumulate in the brain in
those exposed to mercury vapor at high levels for a long time.

High tissue levels- can lead to impaired brain function, insanity and death may occur at 4000 g/kg.

Low tissue levels- can lead to restlessness, tremors, and loss of concentration.

Inorganic compounds of mercury

Dental amalgam contains several different inorganic mercury compounds, but they are of low or very
low toxicity and are apparently harmless when swallowed. They are poorly absorbed, do not accumulate in
body tissues and are well excreted.

Organic compounds of mercury

Some organic compounds of mercury are highly toxic at low concentrations but none are known to
form in the oral environment through dental amalgam use.

ESTIMATED DAILY INTAKE OF MERCURY

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Source g Hg vapour g inorganic Hg g methyl Hg

Atmosphere 0.12 0.038 0.034
Drinking -- 0.05 --
Water
Food & 0.94 -- 3.76
Fish
Food & -- 20.00 --
Non-Fish

Concentrations of Mercury
The Occupational Safety & Health Administration (OSHA) has set a Threshold Limit Value (TLV)
of 0.05 mg/m3 as the maximum amount of mercury vapor allowed in the work place.

The maximum allowable level of mercury in the blood is 3 g/L. Release of Mercury from
amalgam restorations: Average Daily dose of mercury from dental amalgam for patients with more than 12
restored surfaces has been estimated at up to 3 g.

This represents 10-15% of the normal daily intake of up to 20 g of mercury from all sources for a
person who is not occupationally exposed to mercury.
Mercury release has been quantified for a number of procedures:
1. Trituration: 1-2g
2. Placement of amalgam restoration: 6-8 g.
3. Dry polishing: 44 g.
a. Wet polishing: 2-4 g.
b. Amalgam removal under water spray & high velocity suction: 15-20 g

The release of mercury is:

o Greater for low-copper amalgams, because of corrosion related loss of tin and increased porosity.
o Greater from Unpolished surfaces
o Increased by tooth brushing, which removes a passivating surface oxide film-although this re-forms
rapidly.

Multi disciplinary panels of experts, report, “Although it is not possible to completely rule out
adverse effects in a minority of susceptible patients, it is concluded that there is insufficient evidence
to justify that claims that mercury from dental amalgam restorations has an adverse effect on the
health of the vast majority of patients”. (Eley and Cox, 1988).
Sensitivity to amalgam restorations

Allergic response to the mercury associated with dental amalgam is rare but may be manifested in 2 ways:
1. An immediate sensitivity may follow amalgam restoration with, skin lesions being more common than
oral lesions. An urticarial rash may appear on the face and limbs and this may be followed by dermatitis.
Once the amalgam has set and the level of free mercury is greatly reduced, the skin lesions resolve.

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2. There may be a long- term response in the form of oral lichen planus or lichenoid reactions with erosive
areas on the tongue or buccal mucosa adjacent to an amalgam restoration.
3. Factors may be related to persistence of the mucosal lesions:
o Allergy to mercury.
o Cytotoxicity related to the corrosion products.
o Trauma from the rough restoration.

AMALGAM TATTOO
The so-called Amalgam Tattoo, in which components of amalgam are trapped in the oral tissues,
appears clinically as a macular or slightly elevated blue, black or gray pigmentation, generally in close
proximity to an existing amalgam.

Possible causes are:

1. Scraps of amalgam may fall into open surgical or extraction wounds.
2. Excess amalgam may be left in the tissues following sealing the apex of a root canal with a retrograde
amalgam.
3. Pieces of amalgam may be forced into the mucosa.

DENTAL MERCURY HYGIENE

Recommendations from the World Dental Federation include the following:
o All personnel involved in the handling of mercury should be alerted, especially during training, to the
potential hazard of mercury vapor and the need to observe good mercury hygiene practice.
o The work place should be well ventilated, with fresh air exchange and outside exhaust. Air filters such as
those in air-conditioning systems may act as mercury reservoirs and should be replaced periodically.
o The surgery atmosphere should be checked periodically for mercury vapor.
o Mercury should be stored in unbreakable, tightly sealed containers away from any source of heat.
o Use single use capsules rather than reusable ones or any other methods of dispensing the alloy and
mercury.
o Avoid the need to remove excess mercury before or during packing by selecting an appropriate alloy:
mercury ratio.
o Use an amalgamator with a completely closed activator arm.
o Mercury and unset amalgam should not be touched by the bare hands.
o All amalgam scrap and free mercury should be salvaged and stored in a tightly closed container under
used radiographic fixer solution.
o Spilled mercury should be cleaned up immediately and placed in the scrap jar.
o Do not use ultrasonic amalgam condensers.
o Skin accidentally contaminated by mercury should be washed thoroughly with soap and water.
o If a mercury hygiene problem is suspected, personnel should undergo urinalysis to detect mercury levels.

INDICATIONS AND CONTRA-INDICATIONS OF AMALGAM

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Amalgam is indicated for relatively small restorations of the material will not be subjected to
excessive stress and where it is supported and contained by sound tooth structure. It must not be expected,
therefore, that it can be consistently relied on to serve for extended periods of time when relatively large
portion of the occlusal surface to be restored will be subjected to heavy masticatory forces.
o Restorations of proximal cavities, defective pits and fissures, gingival third lesions of posterior teeth,
the distal surfaces of canines and other areas where it’s placement will not result in diminished
esthetic results.
o Repair of defective restorations
o As a temporary protective covering over pulp treatments.
o To build bases or foundations, often ī pins, to retain cast restorations.
o For general use in deciduous teeth in preference to gold.

Factors to be considered when amalgam is to be used

o Size of the areas to be restored.
o Other materials in the tooth or adjacent teeth.
o Economic factors.
o Esthetic result.

Contra Indications
(Low tensile strength, which contributes to marginal deterioration).
o Extensive restorations, which are subject to excessive stress,
o If the restoration would be unduly displayed, there is a poor esthetic result.

CLINICAL CONSIDERATIONS
Marginal Adaptation And Seal
In the first few weeks after placement, amalgam may exhibit a lack of marginal adaptation, which
permits micro leakage of fluids and microorganisms between the restoration and the cavity wall. This may
be associated with marginal deterioration, accumulation of debris, recurrent caries, post-restoration
sensitivity or pulpal reactions.

Self-Sealing
After 48 hours, a well-placed amalgam restoration will begin to exhibit a reduction in leakage that
can be attributed to the formation of corrosion products at the amalgam-tooth interface (cervical corrosion),
a process which is termed “self-sealing”. Thereafter, the restoration experiences periods of intermittent
micro leakage and re-sealing.

Low-copper amalgam seal within 2-3 months, but high-copper amalgams corrode less and therefore
take 10-12 months to provide a comparable seal.

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CLINICAL TECHIQUES TO ENHANCE MARGINAL SEAL

A number of techniques have been used to minimize or prevent the initial marginal leakage or to seal
the dentinal tubules beneath the amalgam. These involve the use of:

Copal resin varnish: Apply two think coats to the cavity walls and margins before placing the
amalgam and it will gradually dissolve, beginning at the cavo-surface, over 2-3 months. As the varnish
dissolves out the gap will be filled with corrosion products from the amalgam and dissolution of the varnish
will cease.

The use of chemically activated or light-activated bonding of luting agents, to achieve “bonded
amalgams” may seal the cavity walls against micro leakage. They also offer some degree of adhesion of
amalgam to dentin and enamel.

Glass-ionomer linings placed under an amalgam will seal the dentinal tubules and release small
quantities of fluoride, but will not affect enamel margins or enhance the seal at the margin.

Oxalate solutions such as potassium oxalate, can be applied to the cavity surface to reduce the
permeability of the tubules and possibly seal the dentine. The crystals this deposited will not wash out but
will allow deposition of corrosion products.

BONDED AMALGAMS
During the 1990’s some clinicians began to routinely bond amalgam restorations to enamel and
dentine. After preparation of the cavity, enamel and dentine can be etched using a conventional etchant, and
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 with the intention to adapt the amalgam to the
walls and develop a mechanical interlock between the amalgam and the resin.

To date, there is encouraging evidence from laboratory studies suggesting that the system works
well, but further clinical studies, extending beyond 2 years are required provide convincing evidence.

Advantages of Bonded-Amalgam
o Conservation of tooth structure. There is less need to prepare specific retentive elements in the cavity
design. Retention of complex restorations may be enhanced overall.
o Resistance to cusp fracture appears to be enhanced in laboratory studies. However, clinical evidence
is still required to substantiate this concept.
o Some operators claim elimination of post-insertion sensitivity.

Disadvantages of Bonded-Amalgam
o Clinical difficulty of application of more viscous bonding agents, which are the ones, identified in
the laboratory as being the most effective.

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o Lightly filled resin bonding agents with a high thermal coefficient of expansion tend to pool at the
gingival margin resulting in a higher potential for micro leakage.
o Excess resin bond and amalgam tend to bend at the margins of the cavity during condensation and
make carving difficult.
o Clinical studies do not extend beyond 3 years so longevity is not established.

Marginal fracture of amalgam

Marginal fracture has also been referred to as “Marginal breakdown”, “ditching”, and “crevice
formation”. Regardless of the type of amalgam, marginal fracture increases with time. The rate of increase is
greater for low-copper amalgams. Only if the crevice exceeds 300 m in width, a decision should be made
to replace an amalgam restoration. Few amalgams look perfect beyond 3-5 years, but the presence of active
caries is the only justification for replacement.

CLINICAL TECHNIQUES TO PREVENT MARGINAL FRACTURE

A number of factors influence the development of marginal fracture. These include the following:
1. Excess amalgam, left lying over the occlusal or proximal surface through failure to carve correctly, is
subject to fracture and may result in marginal ditching.
2. The angle of the carvo-surface margin of an amalgam restoration should be greater than 70º and the
cavity should be designed to allow for this.
3. On completion of packing, burnish the margins both before and after carving to improve marginal
adaptation.
4. Where possible, design the cavity to avoid undue stress on the margin of a restoration because amalgam
is subject to plastic deformation (creep) and “corrosion fatigue”.

Repair Of Amalgam Restorations

Occasionally, when an amalgam restoration fails, as from marginal fracture, it is repaired. A new
mix of amalgam is condensed against the remaining part of the existing restoration. Thus, the strength of
the bond between the new and the old amalgam is important. The flexure strength of repaired amalgam is
less than 50% of that of unrepaired amalgam. The bond is a source of weakness. Factors such as corrosion
and saliva contamination at the interface present formidable barriers that interfere with bonding of the old
and new amalgam.

Factors contributing to strength of repair

1. Presence of porosity and  phase at the junction.
2. Inadequate condensation.
3. Contamination of the surface of the existing amalgam.
4. Corrosion & contamination from saliva.

Galvanic Effect
Patients may complain of a metallic taste following placement of an amalgam, restoration. This is
caused by rapid short-lived corrosion that takes place between the new restoration and other old restorations

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in the vicinity of either amalgam or gold. The galvanic effect is mediated by saliva and produces an electric
current of sufficient intensity to elicit a metallic taste or even pain. Within a few hours, once a layer of
corrosion products is formed, the current is much reduced.

Factors controlled by the operator/ dentist

o Selection of an alloy.
o Mercury: alloy ratio
o Trituration procedures.
o Condensation techniques.
o Marginal integrity.
o Anatomical characteristics.
o Final finish.

Factors controlled by manufacturer

o Composition of the alloy.
o Heat treatment of the alloy.
o Size, shape and method of production of alloy.
o Surface treatment of the particle.
o Form in which the alloy is supplied.

CONCLUSION
As emphasis nowadays is on esthetics and tooth colored restorative materials, the usage of dental
amalgam in the future will be on the decline.

REFERENCES
1. Stephen.C.Bayne, Duane.F.Taylor, “Dental Materials”, The Art And Science Of Operative Dentistry,
Mosby 3rd edition 1997:219-235.
2. Kenneth J Anusavice, D.M.D., Ph.D. , “Philip’s Science Of Dental Materials, W.B. Saunders Company
10th edition 1996:361-410.
3. M.A.Marzouk D.D.S., M.S.D et al, “Operative Dentistry Modern theory And Practice”, IEA Inc
1997:105-120.
4. RW Bryant, “Dental Amalgams”, “Preservation And Restoration Of Tooth Structure”, Mosby 1998:107-
120.
5. William W Howard, D.M.D, “Atlas Of Operative Dentistry”, Mosby 1981:83-87.
6. Craig, “Science Of Dental Materials”
7. Jagannathan.K , “Cruise For Gamma 2 Free Mercury”, “Materials In Restorative Dentistry”, MADC&H,
1998:66-69.

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