Introduction: Preparation form of amalgam restoration has traditionally been designed to provide adequate retention.

Retention form is defined as that shape or form of cavity that best permits the restoration to resist displacement through tipping or lifting forces. Historically, in class II dental amalgam restorations occlusal convergence of facial and lingual wall and dovetail design provide sufficient retention form to occlusal portion of cavity preparation. The occlusal convergence of buccal and lingual proximal wall offers retention in proximal portion of preparation against displacement occlusally. xtensive class II dental amalgam restorations, however, demand for additional retention measures. These auxiliary methods of retention are! I. Proximal retention loc"s. II. #entinal slot. III. $oves. I%. Pin&retained amalgam restorations. %. 'malgapin. %I. (onded amalgam restorations. This seminar focuses on such auxiliary methods of retention which are required for extensive class II dental amalgam restorations. I. Proximal retention locks: )' Retention loc" is a prepared groove whose length is in a vertical plane and which is in dentin.* To enhance retention of the proximal portion, proximal loc"s may be indicated to counter proximal displacement. +any operators use proximal loc"s routinely to ensure that each portion of tooth preparation is independently retentive. However, evidence suggests that retentive loc"s may not be needed in conservative narrow proximal boxes.

To prepare retention loc", no. ,-./ bur with air coolant 0to improve vision1 and reduced speed 0to improve tactile feel and control1 is used. The bur is positioned at the axio&lingual and axio&facial line angle and directed 0translated1 to bisect the angle, approximately parallel to # 2. This positions the retention loc" 3.4mm inside the # 2, thus maintaining enamel support. The bur is tilted to allow cutting to the depth of diameter of the bur end at a point angle and permit the loc" to diminish in depth occlusally, terminating at the axio&lingual&pulpal or axio&linguo& facial point angle. 5hen the axio&facial and axio&lingual line angles are less than 4mm in length, reduce the tilt the bur slightly so that the proximal loc"s are extended occlusally to disappear midway between # 2 and the enamel margin. There are four characteristics or determinants of proximal loc"s. ,1 Position. 41 Translation.

61 #epth. 71 8cclusogingival orientation. 1) Position: It refers to the axio&facial and axio&lingual line angles of initial tooth preparation 03.4mm axial to # 21. Retention loc"s should be placed 3.4mm inside # 2 regardless of depth of axial walls and axial line angles. 2) Translation: Translation refers to the direction of movement of axis of bur. 3) Depth: It refers to the extent of translation i.e. 3.9mm at gingival floor level and diminishing occlusally. 4) Occluso-gingi al orientation: It refers to the tilt of the no. ,-./ bur, which dictates the occlusal height of the loc", given a constant depth. 'lso, instead of ,-./ bur, no. : bur can be used to cut proximal loc"s. The rotating bur is carried into axio&linguo&gingival and axio&facio&gingival point angles and then moved parallel to # 2 to the depth of diameter of bur. It is then drawn

occlusally along the axiolingual and axiofacial line angles, allowing the loc" to become shallower and to terminate at the axio&linguo&pulpal or axio&facio&pulpal point angle. 2ose +ondelli et al suggested three retention designs at axio&buccal and axio&lingual line angles. ,1 line angle. 41 ' cone shaped vertical groove which diverges towards the occlusal surface. The greater diameter is located at the level of occlusal dentinoenamal ;unction, while the minor diameter is located close to the axio&gingivo&buccal and axio&gingivo&lingual point angles. 61 ' cylindrical groove made with straight fissure bur for deciduous teeth. Regardless of the method used in placing the loc"s, extreme care should be ta"en to prevent the removal of dentin that immediately supports the proximal enamel. 'lso, it is essential not to prepare loc"s entirely in the axial wall because no effective retention is obtained and there is ris" of pulpal involvement. 'n angular area from the axio&gingivo&buccal and axio& gingivo&lingual point angles to a narrow vertex ;ust apical to the axiopulpal

!d antage: ' relatively conservative method for obtaining auxiliary retention in class II dental amalgam restoration. Disad antage: In case of wrong translation, there is ris" of pulpal involvement if loc" is placed too far axially.

Proximal retention locks in "ox-onl# preparations: 8ne of the concepts in class II dental amalgam, as suggested by +ar"ley, is to eliminate the occlusal portion of the preparation if no caries is present. The (ox&only preparation considered to be ideal for teeth in which there is no evidence of any caries in occlusal portion. 4

5hen giving retention loc"s in such box only preparation, retention loc"s should extend from gingival floor to occlusal surface at axio&facial and axio&lingual line angles< unli"e in conventional design in which loc"s are extended only upto length of axial wall, here loc"s are extended to occlusal surface. /oc"s are also given in class II design where dovetail is used in proximal box retention. However, Ter"a, +ahler and %an ysden have demonstrated clinically that class II dental amalgam restoration with dovetail and retention loc" serves as satisfactory as dovetail without retention loc".

II$ %lot &etained !malgam &estorations: ' slot is retentive groove in dentin whose length is in hori=ontal plane. >lot retention may be used in con;unction with pin retention or as alternative to it. >lots in gingival floor may be used to provide additional retention in an extensive proximal box that has facial and lingual walls extending to or beyond proximal line angles of tooth crown. >lot dimension depends upon si=e of the proximal box. ?enerally slots are prepared with the no. : or @ round burs, 3.9&,mm deep gingivally, 4&6mm in length faciolingually and 3.4 A 3.9mm inside dentinoenamel ;unction. In ,.B., 8uthwaits et al introduced circumferential slot, prepared with 66 @ inverted cone bur and compared it with T+> pins. They reported that pin retained restorations have a greater tendency to slip on their bases whereas slippage did not occur in circumferential slot. >lot retained restorations are more sensitive to displacement during matrix removal than pin retained restorations. $ircumferential slot has its greatest indications in teeth with short clinical crowns and in cusps that have been reduced 4&6 mm for coverage with amalgam. In these situations, slot provides more resistance and retention than amalgapins. !d antages: & Celton et al reported that medium si=ed self threading pins elicit an inflammatory response if placed within 3.9 mm of pulp. >lot placed in the same location does not. >lot is less li"ely to create micro fractures in dentin and to perforate the tooth or penetrate into pulp. Disad antages: $ompared with pin placement, more tooth structure is removed while preparing slots. Pashley et al reported that shear strength of pin retention was significantly stronger than slot retention.

III$ 'o es: $oves are always used to provide additional retention in preparations that utili=e slots or pins. $oves are prepared with no. : bur.

I($ Pin &etained &estorations: ' pin retained restoration may be defined as )'ny restoration requiring the placement of one or more pins in dentin to provide adequate retention form and D or resistance form.* >ince ,E33s dentistry has been using various types of pins to retain filling materials in mutilated teeth. (urgess was the first to approach pin retention from scientific point of view and published his finding in ,.,B. The first approach that was systematic was published by +ar"ley and #enver, $olarado in ,.9E. >ince that time the dental profession has through careful research and clinical experience, developed various principles of design and usage of retentive pins. %arious problems resulting from their use have also been discovered, and attempts made at handling them have proved to be useful. ?enerally, pins are placed whenever satisfactory retention form cannot be established with undercuts, proximal retention loc"s, slots or coves. T#pes o) pins: There are three basic types of pins! ,1 $emented pins. 41 Criction loc"ed pins. 61 >elf threading pins. ,1 $emented pins! In ,.9E +ar"ley described a technique for restoring teeth with amalgam and cemented pins, using threaded or serrated stainless steel pins cemented into pinholes prepared 3.33, to 3.334 inch 03.349 to 3.39mm1 larger than diameter of pins. The cementing medium may be either =inc phosphate or polycarboxylate cements. The retentiveness of pins using these two materials can be approximately equal, but, depending upon brand or si=e of pins used a significantly higher retentiveness may be obtained with =inc phosphate cement. The irritation by use of =inc phosphate cement by acid penetrating into dentinal

tubules is slightly higher. This irritation may be minimi=ed by or eliminated by placing cavity varnish into pinholes before cementing the pins. However, using cavity varnish to pinholes can reduce the retention of pinholes almost to half. 'ccording to $han and >vare, cemented pins have a greater degree of lea"age than non cemented pins< those cemented with =inc phosphate cement have a greater degree of lea"age than those cemented with polycarboxylate cement. #epth of hole for cemented pins should be 6&7 mm for maximum retention. $emented pins are the least retentive of the three types of pins. They will provide adequate retention if correctly placed in sufficient numbers. 41 Criction loc"ed A pins! In ,.-- ?oldstein described a technique for friction loc"ed pins in which the diameter of prepared pinhole is 3.33, inch 03.349 mm1 smaller than diameter of the pin. The pins are tapped to placed, retained by resiliency of dentin and are two to three times more retentive than cemented pins. >tresses are created in dentin when the pin is tapped to place and may result in lateral crac"s perpendicular to axis of pins. 'lso shearing of dentin occurs apical to the leading edge of the pins. Pulpal stresses are more when lateral surface of friction loc"ed pin is ad;acent to the pulp. +icrolea"age occurs to a great degree around friction loc"ed pins than around Thread&+ate system of self threading pins. The pinhole should be 4&7 mm deep. +a;or disadvantages with this system are the difficulty in placement of these pins in posterior teeth, patient apprehension during placement and lesser retention as compared to T+> pins. 61 >elf A threading pins! ?oing in ,.-- described pin&retained amalgam using self&threading pins. The diameter of prepared pinhole is 3.334 inch to 3.337 inch 03.36E to 3.3,mm1 smaller than diameter of the pin. The pin is retained by the threads engaging resilient dentin as it is inserted. The compression of dentinal tubules that has been observed during insertion of threaded pins may be evidence, although speculative,

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of the elastic factor that accommodates insertion of threaded pins into hole of smaller diameter. 'lthough threads of self threading pins do not engage the dentin for entire width, the self threading pins are most retentive of three types of pins. Pulpal stresses are more when the self threading pins are inserted perpendicular to the pulp. The depth of pinhole is ,.6 to 4mm depending upon diameter of pin used. >everal types of self&threading pins are available li"e, & & & & & $enterlo" pin 0'R+ laboratories, Fephyr core, Gev1. #olphin Retention 'id 0Hnion broach company, Inc, GI1. Reten pin 0#ental product company, $onshoho"eni, Pa1. >tabilo" Pin 0Pulpdent $orp of 'merica1. Thread +ate >ystem 05hale dent Inc, GI1.

Thread +ate >ystem 0T+>1 is the most widely used self threading pin system. $han and >vare have demonstrated that T+> pins exhibit less microlea"age than friction loc"ed or cemented pins.

!d antages: &Tooth preparation is more conservative than for alternative retentive methods.

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& 'long with retentive form in selected cases, resistance form is also improved. Disad antages: & #rilling pin holes and placing pins may create cra=e lines or fractures, as well as internal stresses in dentin. & +icrolea"age around all types of pins is demonstrated. *actors a))ecting retention o) the pin in dentin and amalgam: ,1 Type of pin! The least retentive pin in dentin is the cemented pin, followed by friction loc"ed pin. The self threading is the most retentive of three. 41 >urface characteristics of the pin! Retention of the pin in amalgam is increased by increase in number and depth of deformations on the pin. 5ith the use of spherical or admixed amlagam alloy instead of a conventional alloy the adaptation of amalgam to all three types of pins is greatly improved. 61 8rientation of the pins! Retention provided by pins is increased by placing pins in non&parallel manner. xcessive bending of pins to improve retention in amalgam is not xcessive bending may also desirable since bending may interfere with adequate condensation of amalgam around the pin and thereby decreases the retention. wea"en the pins. 71 Gumber of pins! 5ithin limits, increasing the number of pins increases retention in dentin and somewhat in amalgam. (ut as the number of pins increase! & $ra=ing of dentin and potential for fracture increases. & The amount of available dentin between pins decreases and potential for further dentinal cra=ing increases. & >trength of amalgam restoration decreases.

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91 /ength of pin into dentine and restorative materials! Cor cemented pin the retention in dentin increases linearly as the depth of pinhole increases. Cor friction loc"ed pins and self threading pins there is no significant increase in retention when length embedded into dentin exceeds 4mm. -1 #iameter of the pin! 5ithin limits as diameter of pin increases, the retention in dentin and amalgam increases. ' pin technique should be used that permits optimum retention with minimal danger to the remaining tooth structure. Pin placement )actors and techni+ues: a1 #etermination of pin type! 's the retention provided by threaded pins is greater than friction loc"ed and cemented pins, threaded pins are the widely used pins. 'lso Thread mate system 0T+>1 pins which are a type of threaded pins are the most commonly used. b1 #etermination of pin si=e! Cour si=es of T+> pins are available! & & & & Regular 03.36,inch1 03.BEmm1. +inim 03.347inch1 03.-,mm1. +ini"in 03.3,.inch1 03.7Emm1. +inuta 03.3,9inch1 03.6Emm1.

Two determining factors for selecting appropriate si=e of pin are & & The amount of dentin available to safely receive the pin. 'mount of retention desired.

e.g. The pins of choice in severely destructed posterior teeth are the mini"in and minim. c1 #etermination of number of pins! 's a general rule, one pin per missing axial line angle should be used.

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'lso fewest possible pins are used to achieve desired retention. 5hen only 4&6 mm of occluso&gingival height of cusp has been reduced no pin is required as enough tooth structure remains to use conventional retention features. d1 #etermination of the location of pinholes! 'ids in determining the location for pinholes are "nowledge of normal pulp anatomy and external tooth contours, a current radiograph, a periodontal probe and patientJs age.

'reas of occlusal contact on the restoration must be anticipated, since vertical pins placed directly below an occlusal load wea"ens the amalgam significantly. $aputo and >tandlec state that ideally pinholes should be located halfway between pulp and the # 2 or external surface of root. >tandlec and others have shown that there should be at least ,mm of sound dentin around circumference of pinhole. The pinhole should be placed no closer than ,mm to # 2 and no closer than ,.9mm to the external surface of tooth. 'lso one should provide occlusal clearance to have 4mm of amalgam over pin. (efore final decision is made operator should carefully probe the surface gingival crevice to determine if any abnormal contours are present on external surface of the tooth. It may be necessary to prepare )cove* in vertical wall if position of pinhole is close to vertical wall of tooth structure that ;eopardi=es condensation of amalgam. The cove is prepared with number 479 bur to enable the preparation of pinhole in previously described location, as well as to provide a minimum of 3.9mm dentin around circumference of the pin for adequate condensation of amalgam. The minimal interpin distance is 6mm for mini"in and 9mm for minim pins. 5hen possible, the location of pinholes on distal surface of mandibular molars should be avoided. 8btaining the proper direction of preparing pinholes in these teeth is difficult because of abrupt flaring of roots ;ust apical to $ 2. If pinholes are placed parallel to the external surface of tooth crown in these areas, 15

penetration into pulp is li"ely. 'lso morphological features must be considered for mesial concavity of first maxillary premolar and furcation area of molars and teeth that are extremely tilted. Pinhole preparation: The Kodex drill 0a twist drill1 should be used for preparing pinholes. The drill is made of a high speed tool steel that is swaged into an aluminum shan". The aluminum shan", which acts as a heat absorber, is color coded so that it can easily match the appropriate pin si=e. (ecause optimal depth of pinhole into dentin is 4mm 0,.9mm for mini"in pins1 a depth limiting drill should be used to prepare the pinhole. 'lso number : bur can be used to prepare pilot hole. 5ith drill tip placed in proper position and with handpiece rotating at very low speed 0633 A 933rpm1 apply pressure to drill and prepare pinhole in one or two movements until depth limiting portion of drill is reached, and remove the drill from pinhole. >tandard drill can also be used for this purpose. 5hen the location for starting pinhole is neither flat nor perpendicular to desired pinhole direction, either correct the located area or use this drill, whose blades are 7&9mm in length to prepare pinhole that has effective depth of 4mm. To measure depth of pinhole omni&depth gauge can be used. Pin insertion: a1 $emented pin technique! Hold the pin with a loc"&in or magneti=ed twee=er or a hemostat. Try it in the pin channel for proper fitting and protrusion in the restoration. (e sure to mar" each pin channel end as well as cavity end of every pin. Finc phosphate cement or polycarboxylate cement is mixed 0luting consistency1 and then introduced swiftly into pin channel using explorer tip or lentulo spiral at very low speed. Pin is firmly held into the pin channel to ensure complete seating. 'fter cement has completely set excess is removed with an excavator. ' lateral facet is placed on the side of pin using a carborandum dis" to create an escape way for the cement during cementation and to reduce friction

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during seating into the channel. 's claimed by $ourtade, this procedure will increase retention of cemented pins within the pin channel. b1 Criction grip pin techniques! Pin is held by hemostat or a twee=er and seated at the pin channel orifice. Then with a specially made seater with a concave head is firmly applied on the pin head, being sure that its axis is parallel to that of the pin. 5ith a hammer apply light stro"es to the seater until the established mar" on pin comes to the cavity floor. Cinally remove all holding devices and chec" the cavity floor, walls and surrounding tooth surface for any crac" or gross fracture. c1 Threaded pin techniques! Two instruments for insertion of threaded pins are available. & $onventional latch type contra angle handpiece. & T+> hand wrenches. 5hen using the latch type of handpiece, insert a lin" series or lin" plus pin into the handpiece and place the pin in the pinhole. 'ctivate the handpiece until the plastic sleeve shears from the pin. Then remove the sleeve and discard it. ' standard design pin is placed in the appropriate wrench and slowly threaded into pinhole until a definite resistance is felt when pin reaches bottom of hole. The pin should be then rotate : to @ turn counter cloc"wise to reduce dentinal stress created by end of pin pressing the dentine. $arefully remove hand wrench from the pin. Hand wrench should not be used without rubber dam or throat shield. To cut excess length of the pin, use a sharp no. @ or ,-./ bur at high speed oriented perpendicular to the pin.

"ending o) pins: Pins are not to be bent, to ma"e them parallel or to increase their retentiveness. However occasionally bending of pins may be necessary to allow for condensation of amalgam occluso&gingivally. 5hen pins require bending the T+> bending tool must be used.

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The bending tool should be placed on the pin where the pin should be bent and with firmly controlled pressure, the bending tool should be rotated until the desired amount of bend is achieved. 'brupt or sharp bend increases the chance of brea"ing the pin. 'omplication during pin placement: ,1 #rill penetrates into the pulp! >ometimes during pin placement or during drilling the pinhole, pulp exposure occurs. It occurs mostly due to wrong orientation during placing the drill or due to incorrect radiographic measurement. In such cases, bleeding should be controlled from exposed site with sterili=ed paper points and calcium hydroxide liner should be placed. Gew hole is drilled at least 4mm away from exposed site. 41 The drill penetrates into the periodontium! If exist point is above alveolar crest, the pin inserted and trimmed flush with root surface or pin is removed and external aspect of pinhole slightly enlarged and restored with amalgam. If the perforation is apical to the gingival attachment then two treatment options are available. & Reflect the tissue surgically, remove the necessary bone, enlarge

pinhole slightly and restore with amalgam, 8R & Perform a crown lengthening procedure and place margin of cast

restoration gingival to perforation. 61 Pin fails to bind and shear but "eeps rotating within its channel! The best course if this occurs is to cement the pin or use larger pin. 71 The pin shears off well short of its intended depth! Hnscrew the pin with finger wrench or small hemostat, clean the channel with finger held drill and try again. 91 The dentin fractures away peripheral to the pin! Remove the loose fragments and extend the preparation to include defect.

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-1 #entinal crac"s D cra=ing! +icro crac"s are usually not noticed during the procedure and sometimes do not form until wee"s after pin placement. If crac"s are suspected, the pin should be removed and smaller si=ed pin cemented. *ailures o) pin retained restorations: The failure of a pin retained restoration might occur at the following different locations! a& Cracture of restorative materials< b& >eparation of pin from restorative material< c& Cracture of pin< d& >eparation of pin from dentin< e& Cracture of dentin< However fracture is most li"ely to occur at the pin Adentin interface.

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($ !,!-.!, PI/% 0!,!-.!PI/): In spite of great acceptance and proven clinical efficacy of techniques using prefabricated pins on dentin to retain large amalgam restorations, such techniques have been the target of criticism because of potential disadvantages and clinical complications. >havell and >eng et al in ,.E3 introduced the amalgapin technique for complex amalgam restorations. 'dvantages and #isadvantages of 'malgapin over technique employing prefabricated pins!

!d antages: & The correct drilling of amalgapin orifices is easier and faster, representing considerably less chair side time. & >trong, vigorous, inner dentinal pressures caused by self threading pins could result on cra=ing, fissures or fractures or fracture of the dentinal element whereas with amalgapins such problems do not exist. & $ontrary to amalgapins, the prefabricated pins exert a harmful effect over the restorative material, cutting down on restoration resistance. & The LamalgapinsJ do not imply in any additional cost, constituting a

simpler and less expensive treatment form as compared to prefabricated pins. & 'malgam pins can be used in situations where loss of dental structure is less than 7 mm. Disad antages: & 'malgam pins require an orifice diameter usually greater than that of prefabricated pins, and for this reason should not be used in situations where dentin thic"ness is too limited. & Restorative technique becomes more critical where dislodgement or premature removal of matrix might determine treatment failure.

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'linical procedure: & Planning, field isolation and cavity preparation care is practically same

as that given to self threading pins. & $avity preparation concluded, similarly to technique using prefabricated

pins, the site and number of orifices to be performed are determined 0number of amalgapins1. Ideal places to drill the pinholes as well as criteria to determine such places are same as with the prefabricated pins. 's to number of orifice, one each per absent cusp would suffice, exception made at cases where whole clinical crown needs to be reconstructed. In this instance, it would be recommended to perform more than one orifice at gingival wall corresponding to each proximal box. )'malgapin* orifices can be performed with a round end cylindrical bur 0no. ,,9- from >> 5hite1, with a number 66 @ or 67 inverted truncated cone bur or with a number 663, "ept parallel to external surface of tooth and preferably half way between enamel&dentin ;unction and the pulp. >election of one of above bur will depend on the available amount of dentin and desired degree of retention. In case available amount of the dentin is criterium, a resin stop must be prepared on the active part of the bur, to limit pinhole depth to , or 4mm. 8rifices must be drilled in one only pass as the repeated insertion and withdrawal of the bur might enlarge them too much, resulting a greater ris" of perforation at pulpal or periodontal level. 8rifices ,mm deep supplies as much retention as those with 4or6mm. To ma"e possible an additional amalgam volume and consequently, greater resistance to the amalgapin, a cavosurface chamfer must be performed at each orifice using a smooth round bur at low speed. This bur shall have greater diameter than that of the orifice. The orifices concluded the cavity must be washed with a calcium hydroxide solution and dried with gently blown air. 'fter that, a 4M sodium fluoride solution is applied for 4min. to all cavity walls and orifices. $avities having a mean depth and also the deep ones must receive calcium hydroxide cement on the bottom walls. Then selected matrix is now positioned and stabili=ed with wooden wedge and amalgam is condensed carefully into orifices and with all cut cavities.

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'lso, sturdvent introduced preparation of dentinal chamber for modified amalgapin technique. In this technique several dentinal chambers are prepared with no. 479 bur and using appropriate si=e round bur chambers are beveled to provide additional bul" of amalgam. 'malgam is carefully condensed into the chamber and restoration is completed.

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(I$ "O/D1D 2 !,!-.!, &1%TO&!TIO/: (onded amalgam restorations are indicated for large restorations that require additional retentive features or strengthening of remaining unprepared tooth structure. ven if amalgam restoration is to be bonded, retention form must be provided by auxiliary retentive features such as loc"s, slots, coves, pins and amalgapins. 'malgam bonding is an ad;uvant to mechanical retention form not a substitute. 'dhesion of amalgam is not necessary in clinical circumstances when satisfactory retention form already exists. !d antages: & & & & ' more conservative cavity preparation may be possible. 'dditional retention may be gained through bonding procedure. Teeth can be strengthened as a result of bonding process. The teeth will be sealed. +icrolea"age and post operative sensitivity

will be reduced or eliminated. Disad antages: & It is technique sensitive procedure. Proper isolation while the procedure

being performed is a must. & & The technique is more tedious and time consuming. 'mount of retention achieved is not as significant as obtained with

other auxiliary methods of retention, so it can only be used as an ad;uvant procedure. 3istorical &e ie4: & In ,.43s aiding the retention of amalgam with phosphate cement was

advocated and was "nown as )(aldwern technique*. & In ,.99, (uonocore introduced the concept of adhesive dentistry, a

method to increase the adhesion of resin material to enamel. & In ,.BB, Cusayama et al advocated the conditioning of enamel and

dentin with phosphoric acid and coating both with chemical adhesive resin system. 23

&

The first reports of experiments involving the use of adhesives under

amalgam restorations were published in ,.E- by %arga et al. They assessed the bond between amalgam and human enamel as well as their effect on the marginal seal. & In ,.EB, >himi=u et al studied use of an adhesive liner to reduce

microlea"age with or without glass ionomer base and fluoride treatment. & In ,.EE, >taninec and Holt measured tensile strength of amalgam to

tooth structure as well as the microlea"age at amalgam tissue interface. They reported that amalgam can adhere to acid treated enamel and dentin through a thin coat of Panavia resin. & In ,..,, Ga"abayashi et al showed the formation of resin reinforced

dentinal =one located between cured resin and the dentin. The =one, also called as hybrid layer seems to be responsible for inhibiting the marginal microlea"age and also in the high resin to dentin adhesion strength. & In ,..4 a"le et al showed the effect of bonded amalgam restoration in

relation to resistance of teeth to fracture. They reported that a tooth restored with bonded amalgam requires a significantly greater load to fracture than does a tooth restored with amalgam and no adhesive. !malgam 5onding s#stem: 'malgam bonding systems may be used to seal underlying tooth structure and bond amalgam to enamel and dentin. They require dual characteristics to achieve optimal wetting. 'malgam is strongly hydrophobic, whereas enamel and dentin are hydrophilic. Therefore the bonding system must be modified with wetting agent 0comonomer1 that has the capacity to wet both hydrophobic and hydrophilic surfaces. Typical bonding agent systems may be used, but special 7&methyloxy ethyl trimellitic anhydride 07&+ T'1&based systems are used frequently. This monomer molecule contains both hydrophobic and hydrophilic end. +acro shear bond strengths for ;oining amalgam to dentin are relatively low 04&- +Pa1. The bond that develops between dentin and amalgam is essentially a micromechanical bond and no chemical bonding occurs. To accomplish micromechanical bonding at the amalgam&bonding surface interface, system is applied in much thic"er layers 24

0,3&93Nm1, so that amalgam being condensed against resin adhesive layer will force fluid components of amalgam to squee=e into unset bonding adhesive layer and produce micromechanical laminations of two materials, several laboratory and clinical studies have shown the dentin adhesive system such as 'll&(ond 4 0(isco, Inc, >chaumburg, Illinois1, 'malgambond plus 0parallel Cermingdale, GI1 Panavia 0Kuraray, 8sa"a, 2apan1 and >cotchbond +ulti&purpose plus 06+, >P , >t. Paul, +inhesota1 can be used to bond amalgam restorations. This bonding mechanism actually may depend on type of amalgam used< for example, spherical amalgam alloy typically have higher bond strength than dispersed phase or admixed amalgam alloy. The bonding system used for amalgam bonding should be essentially self cure system. >ome studies also suggest that use of dual cure bonding systems may be beneficial for bonding amalgam to dentin.

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,ethod o) use and theor# o) amalgam 5onding: 'fter removal of carious lesion, proper isolation of the affected tooth is carried out using a rubber dam. The tooth is etched using 66&6BM phosphoric acid. The acid is washed away by a stream of water. The preparation should then be briefly dried, resulting in moist and glistening dentin surface. 's an alternative to drying, the preparation may be blot dried with a damp cotton pellet. If preparation is over dried, it may be rewetted with water or with H +' and gluteraldehyde based desensiti=er an applicator tip. The primer should then be applied using technique described by the manufacturer. 'fter primer application preparation should be dried, but not rinsed. 'fter drying the primed surface should be glossy in appearance. If it is not, primer should be reapplied until surface is glossy. >eparate applicator tips should be used for primer and adhesive components. (efore mixing base and catalyst from the adhesive, the amalgam should be triturated and ready to be inserted into the preparation. (ase and catalyst should be mixed, following manufacturers instructions. 'fter resin is placed amalgam should be condensed into the cavity and carved. Thus, in this method of restoration the acid is used to decalcify the dentin surface, followed by the use of hydrophilic primer which penetrate the remaining layer of collagen networ". 5ith subsequent application of the adhesive the formation of a Lhybrid layerJ results and a micromechanical bond is formed to the dentin surface. The bond to the enamel is formed through the use of auto& polymerising resin. The amalgam bonding agent employs a 7 + T' 0+etheryloxyethyl trimetallic anhydride1 system. The H +' acts as a vehicle which carries the tri&n&butyl borane catalyst and 7 + T' base into the dentin where oxygen and water supportably serves as co&catalyst for polymeri=ation.

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'onclusion: 'lthough not absolute, there are indications for each of the retention forms described. 'malgapins and slots have their greatest indications in teeth with short clinical crowns and in preparation where the cusps that have been reduced 4&6 mm for coverage with amalgam. 5hen technical requirements for placement of vertical pins can be met, they provide excellent retention form. Proximal retention loc"s, coves and amalgam bonding can be used whenever indicated. The literature suggests that distribution of retention features to all areas of preparation is necessary for maximum effectiveness. Pins, amalgapins, loc"s, coves, slots, amalgam bonding may be used independently in many clinical situations. However, effectiveness of these retention features can be maximi=ed when used in combination and proper distribution, which leads to successful class II dental amalgam restorations.

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&e)erences: ,1 41 (aratieri et al. Textboo" of advanced operative dentistry, 4 nd edition. $roc"ett 5# et al. The influence of proximal retention groove on retention and resistance feature of class II preparation for amalgam. 2 'm #ent 'ssoc .,091! ,396&,.B9. 61 #uane R. 5ac"er et al. Retentive pins, their use and misuse. #ent $lin Gorth 'm 4.041! 64B&673, ,.E9. 71 ?winnett '2 et al. 'dhesive restorations with amalgam< ?uidelines for clinicians, Ouintessence Int. 490,31< -EB! ,..7. 91 http!DDdentistry.ouhsc.eduDintranct&webDcoursesD8P#T E79,D8P #ent ,& 33&36 D (onded amalgam. html. -1 2ose +ondelli et al A Influence of proximal retention on the fracture strength of class II amalgam restoration. 2 Prosthet #ent. 7-071< 743& 747! ,.E-. B1 Robbins 25 et al. Retention and resistance features of complex amalgam restorations. 2 'm #ent 'ssoc ,,E071< 76B&774! ,.E.. E1 >turdevantJs art and science of operative dentistry A 7 th ediDeditor A Theodore + et al. .1 The art and science of operative dentistry A 4 nd dition D editor $liffor H. >turdevant et al.

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