DENTAL AMALGAM

1. State the classification of amalgam alloys

2. Explain the composition, manufacture, amalgamation reaction, properties, manipulation, merits,
demerits and uses of high and low copper dental amalgam
3. Choose the appropriate dental amalgam for restoration of tooth in a given clinical case
4. Explain the failures and remedies of amalgam restorations
5. List the types of mercury
6. Explain the mercury hazards and safety precautions
COMPOSITION (RATIO OF SILVER TO TIN)
↑ strength
COMPOSITION
AMALGAM TYPES Ag (Silver) Sn (Tin) Cu (Copper) Zn (Zinc)
Low Copper (Lathe-cut) 70.3 25.9 -
2.8 0.9
Low Copper (Spherical) 72.0 25.0 3.0 -
High Copper (Admix) 69.5 17.7 11.8 1.0
High Copper (Spherical) 61.0 26.0 13.0 -

CLASSIFICATION
1. Based on Copper Content
(a) Low Copper Alloys/Conventional (<6% Cu)
(b) High Copper Alloys (6-30% Cu): admixed, single composition
2. Based on Zinc Content
(a) Zinc Containing (>0.01% of Zn)
(b) Zinc Free (<0.01% of Zn)
3. Based on Shape of Alloy Particles
(a) Lathe-cut Alloys: irregular, resist condensation better than spherical powder
(b) Spherical Alloys: smaller surface area, require lesser mercury
(c) Spheroidal/Admixed Alloys: mixture of lathe-cut with spherical alloy
4. Based on Number of Alloyed Metals
(a) Binary
(b) Ternary
(c) Quaternary
5. Based on Size of Alloy
(a) Microcut
(b) Macrocut
LOW COPPER / CONVENTIONAL ALLOYS
- Brittle, hard to blend uniformly unless less amount of copper substituted for silver
- Increase in copper content hardens, strengthens silver-tin alloy
- Zinc act as deoxidizer (oxygen scavenger) which minimize formation of oxides during melting
- Without zinc is more brittle, less plastic during condensation and carving
- Mix with mercury with ratio of 1:1
- Reaction:
(a) Body-Centered Cubic Phase ( 1) Ag2Hg3
(b) Hexagonal Phase ( 2) Sn7-8Hg
HIGH COPPER ALLOYS
- First type: formulated by mixing one part of silver-copper, spherical eutectic particles to 2 parts of Ag3Sn, provide as
lathe-cut particles
Modification raises copper content to 11.8% by weight known as dispersed-phase/admixed high-copper alloy
- Second type: made by melting all components of dispersed phase alloy
Yields a single composition system
- High copper content makes mechanical cutting of ingots into particles difficult thus provided in spherical form
produced by atomization process
- Gallium-based alloys: can be triturated with alloys for high-copper amalgam
To eliminate mercury from direct metallic restorative materials
Liquid when alloyed with indium and tin at room temp can act as substitute
- Types of high-copper alloy powders: (>6% of Cu by weight)
(a) Two-Phase Admixed Powder
(b) Single-Composition/Single Phase Powder
Major component: silver, copper (13-30%), tin
Small amount of indium/palladium are included
Phases:
I. Phase (Ag-Sn)
II. Phase (Ag3Sn) **predominant phase
III. Phase (Cu3Sn)
MANUFACTUE
1. Powder Configuration
Influences setting process
Reaction begins at particle/mercury interface
Amalgam is made by mixing alloy powders with mercury
2. Lathe-cut Powder
As-cast ingot is annealed to retain uniform phase and placed in milling machine/lathe to be fragmented
Powder obtained from cutting are acid-washed to produce more reactive surface
Stress-relief process performed by annealing powder particles at moderate temp
3. Atomized Powder
Liquid metal is atomized into fine spherical droplets of metal in chamber of inert gas
Droplets solidify before hitting surface, spherical shape is preserved as spherical powders
Lathe-cut powders, spherical powders undergoes annealing heat treatment and surface washing with acid
 4. Particle Size
15-35 m
Smaller particles, higher surface area per unit volume of powder
Tiny particles require greater amount of mercury
Particle size distribution affect character of finished surface
When amalgam is partially hardened, tooth anatomy is carved in amalgam with sharp instrument
Smaller particle size produce more rapid hardening of amalgam with greater early strength
5. Amalgamation
Minimum reaction after trituration between Ag3Sn and mercury
Copper also contribute in final microstructures of set amalgams
CLINICAL MANIPULATION
- Use of alloys and techniques that are technique intensive relative to manipulation and placement of amalgam will
enhance quality and durability of restoration
- When mortar and pestle were used for mixing, excess amount of mercury is used to achieve smooth and plastic
amalgam
- Removal of excess mercury is done by squeezing/wringing mixed amalgam in a squeeze cloth prior to insertion of
increment into the prepared cavity
- Preweighed pellets/tables are first placed in capsule, mortar serves as capsule in mechanical mixing
- Dispenser should held vertically to ensure consistent dispensing of mercury
1. Mechanical Trituration
To provide proper amalgamation of mercury and alloy
Oxide layer of alloy surface hinders diffusion of mercury into alloy
Removed by abrasion when alloy particles and mercury are triturated
Disrupt the film for a clean surface of alloy to make intimate contact with mercury
Triturator:
Reciprocating arms holds capsule under protective hood to confine mercury which might escape into
room/prevent capsule from accidentally ejected from triturator
Pestle should be removed from capsule>replace the lid>reinsert the capsule in trituration, turn on for few
sec>remove amalgam
Enable the mix to cohere so that can be readily removed from capsule with minimal residue in the capsule
Minimizes need of scraping out partially hardened alloy which will produce scratches in capsule
2. Consistency of Mix
Undertrituration (very grainy mix):
Weak restoration
Rough surface after carving of granular amalgam increase sensitivity to tarnish
Overtrituration (soft mix):
Due to high speed/longer mixing time
Sticks onto the wall of capsule
3. Condensation
To compact alloy into prepared cavity to obtain greatest density
Sufficient mercury ensure continuity of matrix phase (Ag2Hg3) between remaining alloy particles
Enable reduction of excess mercury and porosity within set amalgam
Smaller condenser, greater pressure exerted on amalgam
Condensation pressure: area of condenser tip and force exerted on it by operator
4. Carving & Finishing
After amalgam has been condensed into prepared cavity, it is carved to reproduce proper tooth anatomy
To stimulate anatomy rather than to reproduce extremely fine details
Carving too deep: bulk of amalgam become too thin, may cause fracture under direct occlusal loading
Carve when amalgam is hard enough to resist carving instrument
Matric band should be removed during final carving
After carving, surface should be smoothen by burnishing the surface and margins with a ball burnisher
Smoothing concluded by gently rub the surface with moist cotton pellet/with rubber polishing cup
PROPERTIES OF AMALGAM
1. Dimensional Stability
Can expand/contract depending on manipulation
Range of dimensional change: 15-
Severe contraction leads to microleakage, plaque accumulation, secondary caries
Contraction due to:
Particles dissolve when alloy and mercury are mixed
Manipulation with less mercury in mix
High condensation pressures
Manipulative procedures that accelerate setting and consumption of mercury
Long trituration time
Use of smaller alloy particles
Excessive expansion produce pressure on pulp and postoperative sensitivity
*
** Delayed expansion occurs due to contamination of Zn-containing amalgam with moisture during
trituration/condensation
Causes intense pain (1-12days)
Filling become wedge tightly against the cavity wall produce pressure in pulp chamber
Not removed: contaminated amalgam will continue to expand and cause protruding filling
2. Compressive Strength
Lack of strength to resist masticatory forces
Common defects at margins of amalgam
Compressive strength of satisfactory amalgam: 310Mpa
Weaker in tension than compression
3. Effect of Moisture Contamination
Delayed/secondary expansion occurs when zinc-containing low-copper/high-copper amalgam is contaminated
by moisture during trituration/condensation
Expansion starts 3-5d after placement and continue for months until >400 m/cm
Effect caused by hydrogen produced by electrolytic action involving zinc and water
 Hydrogen collects within filling, increase internal pressure high enough to cause amalgam to creep thus
expansion produced
Source of contamination: saliva from poor isolation field
4. Effect of Trituration
Depend on types of amalgam alloy, trituration time, speed of triturator
Undertrituration/overtrituration decreases strength for low and high copper amalgam
5. Effect of Mercury Content
Increase mercury content, increase volume fraction of matrix phase at expense of allot particles
Higher mercury content promotes formation of 2 phase
Higher mercury content, incidence of fracture increase as amalgam restoration age
6. Effect of Condensation
Good condensation techniques express mercury thus smaller volume fraction of matrix phase
Higher condensation pressures, minimize porosity and express mercury from lathe-cut amalgam
Higher condenser pressure will punch through amalgam
7. Effect of Porosity
Void and porosity reduced by compressive strength of set amalgam
Lack of plasticity of amalgam mixes due to delayed condensation/undertrituration leads to porosity
Insufficient condensation pressure on lathe-cut alloys cause more porosity
8. Effect of Amalgam Hardening Rate
Minimal compressive strength of 80Mpa at 1 hour is required
FAILURES AND REMEDIES
1. Creep
Occurs when a solid material slowly deforms plastically under influence of stress
-

Determined by placing a cylinder of set amalgam under 36Mpa compressive stress

Creep rate correlate with marginal breakdown of conventional low copper amalgams
Higher amount of creep greater degree of marginal deterioration
Cause unsupported amalgam protrudes at margin of restoration
2. Tarnish & Corrosion
Tarnish due to silver sulphide forming on surface but does not affect mechanical properties of amalgam
Corrosion has negative effect on properties in low-copper alloys forming oxides and chlorides of tin at tooth
interface and within bulk of amalgam restoration
3. Leakage
Amalgam does not adhere to tooth surface only sallow close adaptation to walls of prepared cavity
Cavity varnishes: to reduce gross leakage which occurs around new filling
Dentin bonding agents: to reduce microleakage
Can be prevented by properly inserting the amalgam, scaling of the interface between tooth and filling
4. Microstructural Change
Due to corrosion and stresses associated with mastication forces
5. Visual Change
Amalgam restoration has to be changed due to secondary caries, gross fracture of amalgam, fractured margins,
excessive tarnish and corrosion
6. Marginal Breakdown
Restoration is unsightly and further deterioration is anticipated
Restoration have to be replaced as preventive measure
7. Improper Cavity Preparation/Finishing
Unsupported enamel left at marginal areas of preparation, tooth will fracture over time
Failure to remove mercury-rich surface layer leaves thin weak ledge of amalgam extending over enamel which
will fracture leaving a ditch margin
8. Repaired Amalgam Restorations
New mix of amalgam is condensed against the remaining part of existing restoration
The quality of amalgam repair depends on the interfacial bond between new and existing amalgam
Surface of old amalgam should be roughened to remove corrosion and saliva contaminants, loose debris
Repair attempted should only involve the part which will not be subjected to high stresses/which the 2
restoration parts are adequately supported and retained
Etch enamel adjacent to restoration after rinsing and drying marginal gap area, sealing the gap with dentin
bonding adhesive
Reason for repairing: secondary caries, fracture
MERCURY HAZARDS & SAFETY PRECAUTIONS
1. Allergy
Antigen-antibody reaction marked by itching, rashes, sneezing, difficulty in breathing, swelling
ty
Alternative material: composite/ceramic material
2. Toxicity
Injury to biological tissues, organ damage, cell destruction to death
Mercury toxicity: when mercury vapour is inhaled during mixing, placement, removal
3. Mercury Hygiene
Hazards of mercury can be greatly reduced by:
Well-ventilated operatory
Excess mercury, waste, disposable capsule, amalgam removed during condensation should be collected and
stored in well-sealed containers
Debris of amalgam from cutting and grinding can be trapped by installing amalgam particle separators in
dental wastewater stream
Proper disposal through reputable dental vendors to prevent environment pollution
Amalgam scrap materials contaminated with mercury/amalgam should be incinerated
Wash skin with soap and water if mercury comes in contact with skin
Reusable capsule with mechanical triturator should have tightly fitting cap to prevent mercury leakage
Use water spray suction when grounding amalgam
Eye protection, disposable mask, gloves
Use ultrasonic amalgam condenser