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Core build up and Amalgam

bonding
12th October

Learning outcomes

To know the definition of a core build up.


To understand the advantages and
disadvantages of amalgam as a restorative
material
To understand the aims of amalgam bonding
To know the clinical stages to perform a
bonded amalgam

Core Definition

'that part of a preparation for an


indirect restoration consisting of
restorative material'.

Types of Core Materials

Amalgam
Composite
Glass Ionomer
Resin Reinforced Glass Ionomer
Compomer

AMALGAM
Advantages

Not especially technique sensitive


Strong in bulk section
Sealed by corrosion products

Disadvantages

Best left to set for 24 hours before tooth preparation


Weak in thin section
Mercury content may be of concern to some patients
and dentists
Potential electrolytic action between core and metal
crown

Not intrinsically adhesive

How is the amalgam retained as the


core?

Retention Form

Resistance Form

How is the amalgam retained as


the core?

Mechanical

Retentive grooves and notches

Pin Placement
Adhesion

Amalgam Bonding
A technique to bond amalgam to
the cavity.

Aims Behind Bonded


Amalgams

Conserve more tooth structure by reducing


the need to remove sound tooth tissue for
mechanical retention.
Increased Amalgam retention.
Reduce marginal leakage
Reduce the need for dentine pins.
Potentially reduce sensitivity
Improve fracture resistance
Improved amalgam margins

Materials for Amalgam


Bonding

Resin Cements ( Panavia)


Adhesive Bonding Agents
-initially designed for composites
-OptiBond solo
-Amalgambond
-Scotchbond multipurpose

OptiBond solo

How do they work?

Etching dentine opens up dentinal


tubules enabling adhesive resin to flow
into dentine and is retained
micromechanically
Adhesive resin adheres to amalgam
roughness micromechanically and by 4META adhesive

Claimed Advantages of
Amalgam Bonding Techniques

Decreased microleakage

Increased amalgam retention

YES

YES, if cavity lacks mechanical retention

Avoids risk of using pins

YES, 20% of pins perforate, 80oC rise

Claimed Advantages of
Amalgam Bonding Techniques

Improved amalgam margins

Depends on adhesive used. Panavia


weakens amalgam at margins
Technique may reduce incidence of
ditching

Tooth reinforcement

YES, if large cavity


NO, if small cavity

Clinical Indications

Not recommended for routine amalgam


cavities with sufficient mechanical retention
and undercuts. No evidence of increased
benefit to balance increased costs.
Useful for large multisurface amalgams to
avoid use of pins
Useful for amalgam repairs
Some easier to use than others

Bonding Agents

Technique
Place matrix band ( lightly vaselined)
Etch 10% phosphoric acid
Wash and dry
Apply adhesive ( Kerr Optibond solo)
Blow off excess solvent
Light cure
Pack amalgam

Limitations of Technique

Increased cost of restoration


Technique sensitive?
Not in use long enough to permit
adequate evaluation of clinical
performance
Adhesion may breakdown over time

Amalgam Bonding
Summary
Amalgam is an excellent core build-up
material for posterior teeth
Excellent interim restoration for posterior
teeth
Adhesives can be used to improve retention
in large amalgam restorations and cores
Adhesives and preparation features can often
substitute for pin retention for cores

References

R. W. Wassell, E. R. Smart G. St. George. Crowns and


other extra-coronal restorations: Cores for teeth with
vital pulps. BDJ 2002 May,192(9): 499-509
Setcos J.C, Staninec M, Wilson N.H.F
The development of resin-bonding for amalgam
restorations. BDJ 1999 Apr, Vol186 (7): 328-330
Staninec M, Setcos
Bonded amalgam restorations: current research and
clinical procedure.
Dent Update. 2003 Oct;30(8):430-4, 436