INTRODUCTION
An Amalgam is an alloy that contains Hg as one of its constituents.
Unspecified amounts of other elements for eg Cu, Zn, Au and Hg are allowed in
concentrations less than silver or tin content.
Alloys containing zinc in excess of 0.01% are zinc containing alloys. There is no
specification of low or high copper alloy per se.
Strength
Compressive strength
Tensile strength
Longevity
Ease of use
* Amalgam is the only restorative material with an interfacial seal that improves over
time.
INDICATIONS
The following is a list of clinical indication for amalgam restorations in Classes I, II, and
VI.
6) Foundations
CONTRAINDICATIONS
1) Ease of use
DISADVANTAGES
The primary disadvantages of amalgam relate to
Esthetics
Other are
1) Non insulating
5) Initial microleakage
CLINICAL TECHNIQUE
The outline form for Class I occlusal amalgam tooth preparation should include only the
faulty occlusal pits & fissures.
2) Keeping the facial and lingual margin extension as minimal as possible between
central groove and cusp tips.
3) Extending the outline to include fissures thereby placing the margins on relatively
smooth sound tooth structure.
4) Minimally extending into marginal ridges without removing the dentinal support.
5) Eliminating a weak wall of enamel by joining two outlines that come close
together (i.e. less than 0.5 mm apart)
# 245 bur
- head length = 3 mm
- tip diameter = 0.8 mm
- slightly convergent towards shank
- slightly rounded corners of the end.
# 330 bur
- for smaller cavities
- pear shaped version of # 245 bur
Procedure:
Enter the deepest or most carious pit with a punch cut using No. 245 bur of high speed
with water spray long axis of bur in kept parallel to long axis of tooth.
If entering distal pit, bur is tilted distally to prevent undermining the marginal ridge. (not
more than 10 degrees).
The distance from the margin of such an extension to proximal surface should not
be less than
* 2 mm for molars.
Maintain the burs orientation and depth while moving from central tissue towards the
mesial pit.
Eg. # 169 L
# 329 L
* Use enameloplasty
Pulpal floor should follow DEJ to maintain a more uniform pulpal floor depth.
If fissure extends to marginal ridge, the long axis of bur should be changed to have slight
occlusal divergence to mesial wall, otherwise marginal ridge will be devoid of dentinal
support.
The strongest an ideal enamel margin should be made up of full length enamel
rods resting on sound dentin, supported on the preparation side by shorter rods , also
resting on sound dentin .
1. By crossing one marginal ridge at ¼ the intercuspal distance, there is almost 10%
loss of a tooth’s resistance to splitting.
4. By crossing two marginal ridges by 1/3 the intercuspal distance, there is almost
35% loss of a tooth’s resistance to splitting.
5. By crossing one marginal ridge at ½ the intercuspal distance, there is almost 40%
loss of tooth’s resistance to splitting.
8. By crossing a crossing ridge at 1/3 the intercuspal distance, there is almost 35%
loss of a tooth’s resistance to splitting.
* Mesial and distal walls must CONVERGE OCCLUSALLY when distance is greater
than 1.6 mm in premolars
* Mesial and distal walls must DIVERGE OCCLUSALLY if only 1.6 mm distance is left
ENAMELOPLASTY
Enameloplasty refers to eliminating the developmental fault by removing with the side of
flame shaped diamond stone. The surface left by enameloplasty should meet the tooth
preparation wall preferably with a cavosurface angle 80-100 degrees.
Extend through the marginal ridge when margins will be lingual to contact.
Enameloplasty.
D,Cavosurface angle should not exceed 100 degrees, and marginal-amalgam angle should
not be less than 80 degrees. Enamel external surface (e) before enameloplasty When the
remaining fissure is no deeper-than one quarter to one third the thickness of enamel,
enameloplasty is indicated.
Extend through the marginal ridge when margins will be lingual to contact.
It includes
(1) Removal of remaining defective enamel and infected dentin on the pulpal floor
If the tooth preparation is of ideal shallow depth no liner or base is indicated. In deeper
carious excavations place a thin layer of RMGI base.
RMGI should be placed in deeper areas Entire dentin surface should not be covered.
Dentin peripheral to liner should be available for bonding and support of restoration.
TOOTH PREPARATION
OCCLUSAL PREPARATION
Mesiodistal width of lingual extension should not exceed 1 mm, except when
caries are extensive.
Tooth preparation should cut more at the expanse of oblique ridge rather than
centering over fissure
On smaller teeth the occlusal portion may have a slight distal tilt to conserve the
dentin support of distal marginal ridge.
Margins should extend as little as possible onto oblique ridge, DL cusp and distal
marginal ridge
LINGUAL PREPARATION
I Lingual surface is prepared with burs long axis parallel with lingual surface
holding the tip of bur at the gingival extent of lingual fissure.
The axial wall should follow the contour of the lingual surface of tooth, with a
uniform depth of 0.5 mm inside the DEJ.
II No. 245 bur is held perpendicular to the cusp ridge and lingual surface as it
extends the preparation from the occlusal surface gingivally. If it is wider
mesiodistally additional retention by preparing locks in mesioaxial & distoaxial line
angles.
LOCKS -
*depth of lock at the gingival floor is one half the diameter of No ¼ bur.
* The cutting direction of each lock is the bisector of respective line angle.
* Locks should diminish in depth towards the occlusal surface, terminating midway along
axial wall.
The occlusal outline from of a Class II tooth preparation for amalgam is similar to that for
Class I tooth preparation .Enter the pit nearest the involved proximal surface.
Before extending into the involved proximal marginal ridge, visualize the final location
of facial & lingual walls of proximal box relative to the contact area. This will prevent
the overextension of occlusal outline form where if joins the proximal box.
PROXIMAL BOX
The initial procedure in preparing the outline form of the proximal box is isolation of
proximal enamel by proximal ditch cut.
Extend the preparation mesially, stopping approximately 0.8 mm short of cutting through
marginal ridge into contact area. 0.5 to 0.6 mm into dentin
With the same orientation of bur, cut the ditch gingivally 2/3rd at the expense of dentin
1/3rd at the expense of enamel.
The ideal dentinal depth of axial wall of proximal box should be 0.5 to 0.6 mm. When
extension places the margin in cementum, the initial pulpal depth should be 0.7 mm to
0.8 mm
REVERSE CURVE
Developing the mesiofacial wall perpendicular to the enamel rod direction and
conserving the facial cusp structure results in reverse curve in occlusal outline of Class II
preparation.
It permits 90 o amalgam at mesiofacial margins and yet curves around the mesial portion
of facial cusp.
ADVANTAGES
* mesiaofacial wall is perpendicular to the enamel rod direction
* conserves the facial tooth structure
ISTHMUS WIDTH
Extension of Margins
The proximal ditch cut may be diverged gingivally to ensure the Faciolingual extension
at gingival is greater than occlusal
D, Proximal ditch cut results in axial wall that follows outside contour of proximal
surface.
E, Position of proximal walls (i.e., facial, lingual, gingival) should not be overextended
with No. 245 bur, considering additional extension provided by hand instruments once
remaining spurs of enamel are removed
(a) In line with axio pulpal line angle facially and lingually a groove is prepared on
each of the facial and lingual walls, respectively. Each groove is started at the axio
pulpal line angle and continues occlusally to the occlusal surface.
(b) Facial or lingual dentinal grooves may be prepared at the expense of facial or
lingual walls of proximal portion, but having their maximum dimension at the pulpal
floor level, tapering to a point termination at the bucco-gingivo-axial point angles i.e. the
reverse arrangement of the regular retentive groove
In a narrow proximal lesion it is permissible not to extend. The Outline of the proximal
box facially or lingually beyond the proximal contact to conserve the tooth structure.
To prevent the bur from marring the proximal surface of the adjacent tooth.
(1) The pulpal and gingival walls being relatively flat and perpendicular to forces
directed with long axis of tooth
(3) Restricting occlusal outline form to areas receiving minimal occlusal contacts.
(5) Slightly rounding the internal line angles to reduce stress concentration
(7) Occlusal convergence of facial and lingual walls and occlusal dovetail.
RETENTION LOCKS
* Occlusogingival orientation: Tilt of bur which dictates occlusal height of the lock.
(should disappear midway between enamel margin and dentin
When preparing the occlusal portion, bur is tilted occlusally (leading to facial
inclination of pulpal wall). Otherwise it will weaken the lingual cusp.
Excessive extension in facial direction could approach and expose facial cusp.
Extension into enamel oblique ridge is avoided whenever possible to maintain the
cross splinting strength it provides to the tooth
When the occlusal fissure extends into the facial cusp ridge defect should be eliminated
by extension of tooth preparation, accomplished by tilting the bur to create an occlusal
divergence of facial wall, while maintaining the dentinal support.
Then the proximal portion of the tooth is prepared by extending through the fault with #
245 bur so that margins are lingual to contact.
Often this means that the proximal box will be the Faciolingual width of the bur and
gingival floor may be at the same depth as pulpal floor.
When restoring a small, cavitated proximal lesion in a tooth with neither occlusal
fissures nor a previously inserted occlusal restoration, a proximal box preparation
without an occlusal step has been recommended.
To maximize retention, preparations facial and lingual wall should oppose each
other
This is indicated if caries are appreciably gingival to proximal contact. The tooth
preparation is usually approached from facial and has a form of slot.
* Retention grooves with a No. ¼ burs are prepared into occlusoaxial & gingivoaxial
line angles 0.2 mm inside the DEJ or 0.3 – 0.5 mm inside the cementoenamel cavosurface
margin.
The depth of these grooves is one half the diameter of bur head.
Ideally the direction of occlusal groove is slightly more occlusal than axial, and the
direction of an gingival groove would be slightly more gingival than axial.
ROTATED TEETH
The outline form for a MO teeth preparation on the rotated mandibular second premolar
has its proximal box displaced facially because proximal caries include mesiofacial line
angle of crown.
ADJOINING RESTORATIONS
Where two restoration adjoin care should be taken that outline of second restoration
doesn’t weaken the amalgam margin of first. The intersecting margins of two restorations
should be at right angles as much as possible. A weak wall of enamel joining two outlines
that are less than 0.5 mm apart should be removed.
Class II lesion prepared and restored before preparing Class V lesion. This avoids
condensation problems which are encountered if both the lesions are prepared
first.
The facial and lingual proximal walls and respective occlusal margins must be
extended so that entire rest seat can be prepared in amalgam without encroaching
the occlusal margins.
There should be minimum 0.5 mm of amalgam between rest seats and margins
These extensions occur at same initial pulpal depths and follow DEJ. Alteration
in orientation of bur is also required, by tilting lingually while extending facially and
vice-versa.
CUSP REPLACEMENT
PROXIMAL EXTENSIONS:
CONTRAINDICATIONS
Esthetically prominent areas.
TECHNIQUE
A lingual approach is preferred over facial unless lesion is more facial than lingual.
Using a No. ½, 1, or 2 round bur prepare the outline form extending the external, walls to
sound tooth structure while extending pulpally to an initial depth of 0.75 mm.
Groove retention may be necessary groove is prepared 0.25 mm from root surface to a
depth of 0.25 mm. Groove is directed as the bisector of the angle formed by function of
axial wall and external wall. Usually the outline form includes only proximal surfaces.
However a lingual dovetail may be indicated if one existed previously or if additional
retention is needed for a larger restoration.
1) gingival groove
2) Incisal cove
d) If labial or lingual walls is lost it is essential to create a very short wall to try to
lock the restoration.
This can be accomplished by deepening the axial wall at its labial or lingual
periphery and by establishing a very pronounced axiolabial or axio-lingual line angle
e) In senile decay, where incisal margin of lesion is apical to the contact area the
incisal wall will be one planed, inclining gingivodistally making an acute angle with axial
walls.
CLASS IV MALGAM RESTORATIONS
INDICATIONS
Gingival and labial margins are exactly as described for Class III. The lingual
margin is located in lingual embrasure just clearing the contact. The incisal margin is
located at slope of incisal edge.
If retention forms are deficient, and some walls are either partially or totally lost,
pins should be used.
CLASS V RESTORATION
The outline form of the Class V amalgam tooth preparation is primarily determined by
location and size of caries or old restorative material.
Proper outline form for Class V amalgam tooth preparation results in extending the
cavosurface margins to sound tooth structure while maintaining a limited axial depth of
0.5 mm inside the DEJ and 0.75 mm inside the cementum when on root surface.
The lesion is entered by a tapering fissure bur. All the walls of the tooth preparation are
perpendicular to the external tooth surface, they usually diverge facially. Consequently
there is no inherent retention.
Two retention grooves, one along incisoaxial line angle and other gingivoaxial
line angle are prepared using No. ¼ bur.
Alternatively, four retention cover may be prepared, one in each of the four axial
point angles. – This conserves dentin and reduces the possibility of mechanical pulp
exposure.
Large lesions on the facial surface may extend beyond the line angles of the tooth.
Maxillary molar, particularly second molars are most commonly affected by these
extensive defects. If the remainder of the distal surface is sound and distal caries is
accessible facially, the facial restoration should extend around the line angle.
MODIFICATIONS OF CLASS V
If most of the facial or lingual surface is involved in a Class V lesion and they are
to be part of cavity preparation, the occlusal wall will diverge in occlusal
direction. This will decrease the retentive capability of the preparation. It is
advisable to make this divergence only at the areas where margin approximates
the occlusal surface. In this situation gingival retention grooves should at least be
doubled on size, and mesioaxial and disto-axial considerably.
INDICATIONS
, There are multiple lesions or defects in gingival third, which are limited in size, with
sound tooth structure separating them from each other The general shape of this design is
of several preparations which are small, box shaped and with rounded corners.
COMPLEX AMALGAM RESTORATIONS
These are contraindicated if patient has severe occlusal problems or if tooth cannot be
properly restored with a direct restoration.
ADVANTAGES
4) It is relatively inexpensive
DISADVANTAGES
1) Preparing pinholes and placing pins may create craze lines or fractures
Other principles of retention form like converging opposite walls, flat pulpal
floors, facial or lingual grooves should also be undertaken.
Coves (horizontal plane) and locks (vertical plane) are preparation before preparing
pinholes and inserting pins
TYPES OF PIN
1) Cemented
2) Friction locked
3) Self threading → Most frequently used
CEMENTED PINS
• Cemented into pinholes
• 0.001 – 0.02 inch larger than diameter of pins
• The cementing media is any standard dental luting agent
In general, increasing the number of pins increases the retention in dentin and
amalgam but benefits must be compared with potential problems created like.
* Crazing of dentin
* Amount of available dentin between pins, decreases Strength of amalgam restoration
decreases
Retention is not increased significantly when depth of pin into dentin exceeds 2
mm.
PIN SIZE : four pin sizes are available with a corresponding colour coding drill.
Minikin pins are usually selected to reduce the risk of dentin crazing, pulpal
penetration and potential perforation.
Minim are used as backup of pin holes for minikin was over prepared.
Minuta is half to one third retentive as minim. It is too small to provide adequate
retention in posterior teeth.
NUMBER OF PINS: one pin for missing line angle is used.
LOCATION
Caputo & standlee state that ideally, pinholes should be located half way between pulp
and DEJ or external surface of tooth root.
Standlee and others have shown that there should at least 1 mm of sound dentin around
the circumference of pin hole.
Felton and associates have demonstrated that pin placement providing at least 1 mm of
remaining dental thickness from pulp elicits minimal pulp inflammatory response.
In the cervical third of molars and premolars (where most pins are located), pinholes
should be located near the line angle of tooth. The pinhole should be positioned no closer
than 0.5 to 1 mm to DEJ or no closer than 1-1.5 mm to the external surface of tooth.
PIN DESIGN
For each of the four sizes of pins, several designs are available.
Standard
Self shearing
Two in one
Link series
Link plus
PIN INSERTION
o Standard pins may break it turned more than needed to reach the
bottom of pinhole
3) LOOSE PINS
Self threading pins sometimes do not properly engage the dentin because
(i) pin hole was inadvertently prepared too large
(ii) self shearing pin failed to shear
(iii) while shortening, bur is not held perpendicular to pin hole.
• Both are obvious if there is hemorrhage in the pin hole following removal
of drill.
PULPAL PENETRATION
EXTERNAL PERFORATION
* Occlusal to gingival attachment.
* Apical to gingival attachment
Treatment options
Pin can be cut flush off the tooth and no further treatment rendered.
Pin can be cut flush off the tooth and preparation for a cast restoration
extending gingivally beyond the perforation.
Pin removed external aspect of pin hole enlarged slightly and restored
with amalgam.
Apical To Attachment
(1) reflect the tissue surgically, remove the necessary bone, enlarge the pin hole
slightly, restore with amalgam.
(2) perform a crown lengthening procedures, and place the margin of a cast
restoration gingival to perforation
Indications
• Short clinical crowns
Disadvantage
Compared with pin placement more tooth structure is removed in preparing slots.
Advantages
Tooth preparation:
Dimensions
0.5 mm in depth
1 mm or more in length
AMALGAM FOUNDATIONS
Definition
A form is an initial restoration of a severely involved tooth. The tooth is restored so that
the restorative material will serve in lieu of tooth structure to produce resistance and
retention forms during the development of subsequent cast restorations.
The technique of tooth preparation for or foundation depends on type of retention that is
selected. All techniques have in common the axial location or retention i.e. sufficiently
deep axially so that final preparation for subsequent indirect restoration does not
compromise the resistance and retention form of foundation.
SUMMARY
Class I & II amalgam restorations are still common procedures, when used correctly and
in properly selected cases, amalgam restorations have demonstrated the potential to serve
for many years.
A
SEMINAR
0N
AMALGAM
RESTORATIONS
Presented by :
Dr. Shivani Arora
CONTENTS
Introduction
Indications
Contraindications
Advantages
Disadvantages
Amalgam restorations
Initial clinical procedure
Tooth preparation for amalgam restorations
Conservative class I restoration
Enameloplasty
Class I occlusolingual preparation
Class II amalgam restorations
* for one proximal surface
Modifications of class II
Variation of one proximal surface tooth preparation
Class II restoration involving both proximal surfaces
Class III amalgam tooth preparation
Modifications for class III restorations
Class IV tooth preparation
Modifications for class IV preparations
Class V preparations
Modifications for class V
Complex amalgam restorations
Pin retained restorations
Slot retained amalgam restorations
Amalgam foundations