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Introduction

Dental amalgam has been used for over 150 years for the treatment of dental
cavities and is still used, in particular in large cavities due to its excellent
mechanical properties and durability. Dental amalgam is a combination of alloy
particles and mercury.It contains about 50% of mercury in the elemental form.
Terminologies
Amalgam: An alloy of mercury with one or more metals.
Dental amalgam alloy: An alloy that contains solid metals of silver, tin, copper and
sometimes zinc.
Dental amalgam: An alloy that results when mercury is combined with the
previously mentioned alloys to form a plastic mass.
History
1833: Crawcour brothers introduced amalgam to U.S.A, powdered silver coins
mixed with mercury, expanded on setting
1895: G.V. Black developed formula for modern amalgam alloy, 67% silver, 27%
tin, 5% copper, 1% zinc, overcame expansion problems
1960s: conventional low-copper lathe-cut alloys, smaller particles.
first generation high-copper alloys: Dispersalloy (Caulk), admixture of spherical
Ag-Cu, eutectic particles with , conventional lathe-cut, eliminated gamma-2 phase
1970s: first single composition spherical alloys: Tytin (Kerr), Ternary system
(silver/tin/copper)
1980s: alloys similar to Dispersalloy and Tytin
1990s: mercury-free alloys
Debut of Amalgam
Introduced in 1800s in France: alloy of bismuth, lead, tin and mercury plasticized
at 100 C poured directly into cavity.

1826 - Traveau compounded a silver paste amalgam, mixture of silver shavings


from coins and mercury, condensed into tooth at room temperature
Amalgam War I
1833 - Crawcour brothers: heavily marketed their amalgam of silver and mercury
1843 - American Society of Dental Surgeons: declared use of amalgam malpractice
mercury is a poison threatened to expel users
Amalgam War I
1895 - G.V. Black: developed effective amalgam, improved handling and
performance similar to contemporary low-copper amalgam
Amalgam War II
1924 - Alfred Stock: German professor of chemistry became poisoned with
mercury, published papers on the dangers of mercury in dentistry
Amalgam War II
1934 - German physicians: studied patients occupationally exposed to mercury
with and without amalgams, published papers , no health risk from amalgams
1941 - Alfred Stock recanted his position
Amalgam War III
1970 1990: concern over occupational exposure of mercury vapor to dentists
excess levels in 10% of dental offices > threshold limit of 50 ug/mm3 urinary
mercury levels high mild functional effects found ADA institutes mercury hygiene
campaign urinary mercury levels lowered 50 % a shift in concerns from
occupational risk to dentists to patient risk ability to measure mercury release from
amalgam restorations in expired air early tests grossly overestimated

Classification
According to the number of alloyed metals

Binary alloy
(silver, tin)

Quaternary
Ternary
alloy (silver,
alloy (silver,
tin, copper,
tin, copper)
and zinc)

According to the shape of the powdered particles

Spherical
Smooth surface spheres
Advantages :
Require less mercury.
Lath cut

Develop early strength.

Irregular shaped powder particles


ranging from spindles to shavings.

Require less condensation force.


Disadvantages:
More difficult to obtain inter-proximal
contact and contours in class II cavity.
Have shorter working time

Spheroidal
Formulated by mixing the lath cut and
spherical particles
Increase the packing efficiency of the
alloy
Reduce the amount of mercury
required to produce a workable mix.

According to the particle diameter

1.Very fine particle size alloy

4.Coarse grained particle size alloy

Advantages:

2.Fine particle size alloy.

Easily carved.

Advantages:
Require less mercury.

Produce excellent surface finish.

Produce amalgam with higher early


strength.

Disadvantages:
Require more mercury.
Lower early compressive strength.

3.Medium particle size alloy

High rate of marginal breakdown.

According to the zinc


content of the alloy

Disadvantages:
Difficult to carve.

According to the form


supplied of the
powder

Zinc containing
amalgam (>0.01%
zinc)

Powder

Zinc free
amalgam (<0.01%
zinc)

Tablets of
condensed
powder
particles
Capsules

together
with gauged
amount of
mercury
separated
by a
diaphragm.

According to the copper content of the alloy

High copper alloys (Cu > 6%).

Low copper alloys (Cu < 6%)

Admixed
Unicompositional

Constituents in Amalgam
Basic:
Silver (Ag 4070%)
Tin (Sn 1230%)
Copper (Cu 1224%)
Mercury
Other:
Zinc (Zn 0-1%)
Indium (04%)
Palladium ( 0.5%)

Basic Constituents:
1. Silver (Ag): Major element. Whitens alloy. Decreases creep. Increases
strength. Increases expansion on setting. Increases tarnishing resistance.

2. Tin (Sn): Controls the reaction between Ag & Hg. Reduces strength &
hardness. Reduces resistance to tarnish & corrosion.
3. Copper (Cu): Ties up tin reducing gamma-2 formation Increases strength
Reduces tarnish and corrosion Reduces creep Reduces marginal
deterioration
4. Mercury (Hg): Activates reaction Only pure metal that is liquid at room
temperature Spherical alloys require less mercury smaller surface area easier
to wet 40 to 45% Hg Admixed alloys require more mercury Lathe-cut
particles more difficult to wet 45 to 50% Hg
Other Constituents:
1. Zinc (Zn): Small amount not affect setting reaction \ properties of
amalgam. Act as a scavenger \ deoxidiser. Without Zn alloys are more brittle
& amalgam formed less plastic. Causes delayed expansion , if contaminated
with moisture during manipulation. Beneficial effect on corrosion &
marginal integration.
2. Indium (In): Decreases surface tension reduces amount of mercury
necessary reduces emitted mercury vapor Reduces creep and marginal
breakdown Increases strength Used in admixed alloys Example:
INDISPERSE (indisperse distributing company) 5% INDIUM
3. PALLADIUM (PD): Reduced corrosion Greater luster Example VALIANT
PHD (ivoclar vivadent) 0.5% PALLADIUM

ALLOY PRODUCTION
Alloy is produced predominantly as:
Irregular particles
Spherical particles

Irregular particles

Generally lathe-cut. Annealed ingot of alloy placed in a


milling machine or lathe.

Chips removed are needle-like, size reduced by ball-milling.

Homogenizing heat treatment performed for 8 hours at 400C


.

Treatment of the alloy particle with acid is performed.

Annealing at 100C to reduce stress.

Spherical particles

Produced by atomizing molten alloy in a chamber filled with


an inert gas such as argon.

The molten metal falls through a distance of approximately


30 feet and cools as it does.

This results in spherical particle shapes(15 to 35 m)

AMALGAMATION AND RESULTING MICROSTRUCTURE


1. Low copper alloys: These are also known as traditional or conventional
amalgam
Available as: Lathe cut alloys- coarse or fine grain Spherical alloys Blend of lathe
cut and spherical alloys
Composition:
Silver ( Ag 67-74%) Tin (Sn 25-28%). Copper (Cu 0-6%). Zinc (Zn 0-1%).
Setting Reaction: Mercury + Amalgam alloy, Mercury absorbed by the
particles and dissolves the surface of the particles , Mercury becomes
saturated with silver and tin, Gamma-1 (Ag-Hg) and Gamma-2 (Sn-Hg)
phases begin to precipitate, Precipitation continues as long as 24hours when
strength reaches a maximum .
Gamma () = Ag3Sn: unreacted alloy strongest phase corrodes the least 30% of
volume of set amalgam

Gamma 1 (1) = Ag2Hg3 : matrix for unreacted alloy 2nd strongest phase 60% of
volume
Gamma 2 ( 2) = Sn8Hg: weakest and softest phase corrodes fast, voids form 10%
of volume volume decreases with time due to corrosion
2. High copper alloys :
High-copper amalgam was developed in1962 by the addition of silver-copper
eutectic particles to low-copper silver-tin lathecut particles. Compared to lowcopper amalgam counterparts, high-copper alloys exhibit the following properties:
greater strength less tarnish and corrosion less creep less sensitive to handling
variables and produce better long-term clinical results. High-copper amalgam
restorations also have a much lower incidence of marginal failure compared to
low-copper amalgam.
Two different types:
Admixed alloy powder
Single composition alloy powder
Composition:
Admixed alloy:
Silver 40-70%
Tin

- 26-30%

Copper- 9-20%
Zinc

- 0-1%

Unicompositional alloy:
Silver- 40-60%
Tin - 22-30%
Copper-13-30%

Zinc

-0%

Admixed High-Copper Alloys: Amalgam is triturated, Mercury diffuses into the


silver-tin particles , Silver and tin dissolve, Silver from the silver copper eutectic
particles also enters mercury, Copper combines with tin , Ring of Cu6Sn5 around
the eutectic particles , Silver precipitates out as Gamma1, Final set amalgam :
Gamma and silver-copper eutectic particles in a matrix of gamma 1, Eutectic
particles are surrounded by the eta phase .
Single Composition High-Copper Alloys: Amalgam is triturated, Mercury diffuses
into the silver-tin-copper particles , Silver and Tin dissolve into Mercury, Silver
precipitates out first as silver-mercury (gamma 1) , Copper + Tin =Cu6Sn5 on the
surface of the particles and in the gamma-1 matrix, Set amalgam = core gamma
particles in matrix of gamma 1 and Cu6Sn5
Physical Properties of Dental Amalgam
1. Dimensional stability
The net contraction or expansion of an amalgam is called its dimensional change
Dimensional changes on setting: CONTRACTION during alloy dissolution,
EXPANSION during impingement of reaction product crystals . ANSI/ ADA
specification No.1 requires dimensional change of no more than 20m/cm at 37 C
between 5min and 24hrs after beginning of trituration. Low-copper alloy have the
greatest dimensional change ( 19.7m/cm). High-copper unicompositional alloy
have the least dimensional change (-1.9 m/cm). Other alloys are ranging from (8.8 to 14.8 m/cm)
Dimensional change is affected by many factors:
Mercury/alloy ratio
Trituration
Condensation techniques

CONTRACTION:
Result in microleakage & secondary caries.
Factors favouring contraction:
Longer trituration time.
Higher condensation pressure.
Small particle size.
High Hg alloy ratio.
Delayed Expansion : Zn containing low cu \ high cu alloy contaminated during
trituration or condensation , large expansion take place. Starts from 3-5 days and
continue for months creating values more than 400um.
H2O + Zn

ZnO + H2O

Results in:
Protrusion of restoration out of cavity
Increase creep
Increase microleakage
Pitted surface of restoration
corrosion.

2. STRENGTH
The strength of an amalgam restoration must be high enough to resist the biting
forces of occlusion.
1 hour = 40% to 60% compressive strength
(e.g., Tytin 45% and Dispersalloy 51%)
24 hours = 90% or more of their final strength

The rate at which an amalgam develops strength is an important clinical


characteristic.
If the amalgam restoration is subjected to chewing or other oral forces before
sufficient strength develops, it is at risk for fracture.
Spherical particle alloys and copper-enriched alloys develop strength more rapidly
than conventional lathe-cut materials.
Fine-grain, lathe-cut products develop strength more rapidly than coarse-grain
products.
3. CREEP
Creep is a slow change in shape caused by compression due to intra-oral stresses.
Creep causes :
Amalgam to flow = unsupported amalgam protrudes from the margin of the cavity.
These unsupported edges may be further weakened by corrosion.
Fracture = formation of a ditch around the margins of the amalgam restoration.
Overhangs = food trapping & secondary decay.
The gamma-2 phase of amalgam is primarily responsible for high values of creep
4. MICROLEAKAGE
Amalgam has got a self sealing property. Corrosion products will fill the tooth
restoration interface & prevent microleakage.
Factors that promote microleakage:
2 to 20 micron-wide gap that always exists between the amalgam and tooth
structure.
Poor condensation techniques ,result in marginal voids.
Lack of corrosion by-products necessary to seal the margins.

Coefficient of thermal expansion for amalgam which is 22 times greater than the
coefficient for tooth structure.
Use of single-composition-spherical alloys which leak more than lathe-cut or
admixed alloys.
CHEMICAL PROPERTIES
1. CHEMICAL CORROSION (TARNISH):
Tarnishing involves the loss of luster from the surface of a metal or alloy due to
formation of a surface coating. The integrity of the alloy is not affected, so no
change in mechanical properties. Amalgam readily tarnishes due to the formation
of a sulphide layer on the surface.
2. ELECTROCHEMICAL CORROSION:
Galvanic corrosion occurs when two dissimilar metals exist in a wet environment.
Electrical current flows between the two metals, corrosion of one of the metals
occurs. An acidic environment promotes galvanic corrosion. Corrosion occurs both
on the surface and in the interior of the restoration. Surface corrosion discolors an
amalgam restoration, lead to pitting and also fills the tooth/amalgam interface with
corrosion products, reducing microleakage. Internal corrosion will lead to
marginal breakdown and fracture.
THERMAL PROPERTIES
1. Thermal diffusivity:
Amalgam has a relatively high value of thermal diffusivity. Thus, in constructing
an amalgam restoration, an insulating material, dentine is replaced by a good
thermal conductor. In large cavities it is necessary to line the base of the cavity
with an insulating, cavity lining material prior to condensing the amalgam. This
reduces the harmful effects of thermal stimuli on the pulp.
2. Coefficient of thermal expansion:
This value for amalgam is about three times greater than that for dentine. This
coupled with the grater diffusivity of amalgam, results in considerably more
expansion and contraction in the restoration. Such a behavior may cause

microleakage around the filling since there is no adhesion between amalgam and
tooth substance.
BIOLOGICAL PROPERTIES
1. MERCURY TOXICITY:
It is a concern in dentistry because mercury and its chemical compounds are toxic
to the kidneys and the CNS. Mercury is toxic, but released in small amounts from
set amalgam. Safety should be considered for:
Patient
Operator
Environment
Proper handling and storage along with prompt cleaning of all mercury spills will
minimize risk of toxicity.
OSHA: acceptable level of mercury exposure 0.005 mg/mm3
How does mercury enter the human body?
Mercury Dose from Amalgam:
Average daily dose from 8 10 amalgam surfaces: 1-2 ug per day, well below
threshold levels
Threshold urine mercury levels:
subtle, pre-clinical effects: 30 ug per day
considered dangerous: 82 ug per day

Precautions:
The clinic should be well ventilated.
Proper storage of mercury in a container with tight lid.

While using capsules, lids of the capsules should be tight fitted and no spilling
should occur.
If by chance mercury is spilled on the floor, it should be wiped clean immediately.
If mercury comes in contacts with skin, one must wash with soap and water
immediately.
Proper waste disposal methods undertaken.
Use of eye protection, disposable face masks, and gloves.
Periodic monitoring of actual exposure levels in blood and urine.
Avoid heating instruments to> 80C
Biocompatibility of dental amalgam
Biocompatability of amalgam is thought to be determined largely by the
corrossion products released. Corrosion depends on the type of amalgam.
In cell culture screening tests, free or non leaded mercury from amalgam is
toxic .With the addition of copper, amalgams becomes toxic to cells in culture but
low copper amalgam that has set for 24hrs does not inhibit cell growth.
Implantation tests show that low copper amalgams are well tolerated but the high
copper amalgams can cause severe reactions when in direct contact with tissue.
In usage tests, the response of the pulp to amalgam in shallow or in deep but lined
cavities is minimal and amalgam rarely causes invisible damage to the pulp
however, pain results from using amalgam is deep unlined cavity preparations( 0.5
mm or less)
Margins of newly placed amalgam restorations show significant microleakage.
Marginal leakage of corrosion and microbial products is probably enhanced by the
natural daily thermal cycle in the oral cavity.
Lichenoid reaction represent a long term effect in the oral mucous membrane
adjacent to amalgam restoration. Buccal mucosa and lateral border of the tongue
being the areas affected often.

2. Amalgam tattoo:
Accidental implantation of silver containing compounds into oral mucosal tissue
Occur during:
Removal of old amalgam
Broken Pieces-socket-tooth extraction
Particles entering surgical wound
Amalgam dust in oral fluids- abrasion areas
Seen as Grayish black pigmentation
Common Sites- Gingiva, buccal mucosa, alveolar mucosa
Indications
Amalgam should be considered for:
class I, II.
the distal surface of the cuspids.
class V in posterior teeth.
Material selection in such case will depend on:
The extent of the lesion.
Amalgam is preferable in the following situations:
Small and medium sized class I and II cavities
Cavities with four walls and floor to decrease the tensile load
Under mined cusps will require cusp capping
In extensive lesions cast gold will serve better.
Caries incidence
Amalgam may be favored if:

Repair or remake is likely to include extensions for original cavities.


Patient with moderate to high caries incidence; as it is
Less costly
Having good sealing ability
Economics
Amalgam restorations cost far less than cast gold per se.
If the restoration has to be replaced repeatedly this advantage becomes
questionable.
Core-build under full crown restorations.
Contraindications
1. Amalgam will be objectionable for:
Esthetic conscious patient.
In conspicuous areas of the tooth
The posterior composite may be favored.
2. In cases of undermined cusps, where the tooth subjected to high load of tensile
strength , where cast gold serve better .
ADVANTAGES
It is durable.
Least technique sensitive
Applicable to a broad range of clinical situations.
Newer formulations have grater long-term resistance to surface corrosion.
It has good long-term clinical performance.
Ease of manipulation by dentist.

Corrosion products seal the tooth restoration interface and prevent bacterial
leakage.
Minimal placement time
Long lasting if placed under ideal conditions.
Very economical.
Self sealing
Biocompatible
DISADVANTAGES
Some destruction of sound tooth tissue.
Poor esthetic qualities.
Long-term corrosion at tooth-restoration interface may result in ditching leading
to replacement.
Galvanic response potential exists.
Local allergic potential.
Marginal breakdown.
Bulk fracture
Secondary caries
Sometimes excess Hg within the restoration may seep through the dentinal
tubules, discolor dentin and result in blackish or grayish staining of teeth.
Concern about possible mercury toxicity that affects the CNS, kidneys and
stomach.

RECENT DEVELOPMENTS OF Dental AMALGAM


Mercury free direct filling amalgam alloys
Gallium based alloys
Low mercury amalgams
Indium in mercury
Resin coated amalgam
Fluoridated amalgam
Bonded amalgam
Consolidated silver alloy system
Mercury-free amalgam
RESIN COATED AMALGAM
To overcome the limitation of microleakage, a coating of unfilled resin over the
restoration margins and the adjacent enamel, after etching the enamel. Resin may
eventually wear away, it delays microleakage until corrosion products begin to fill
the tooth restoration interface. Mertz-fairhurst and others evaluated bonded and
sealed composite restorations versus sealed conservative amalgam restorations and
conventional unsealed amalgam restorations. Results indicate that both types of
sealed restorations exhibited superior clinical performance and longevity compared
with unsealed amalgam restorations over a period of 10 years.
FLUORIDATED AMALGAM
Fluoride, being cariostatic, has been included in amalgam to deal with the problem
of recurrent caries. Disadvantage: fluoride is not delivered long enough to provide
maximum benefit. Several studies investigated fluoride levels released from
amalgam. These studies concluded that a fluoride containing amalgam may release
fluoride for several weeks after insertion of the material in mouth. Fluoride release
from this amalgam seems to be considerable during the first week. An
anticariogenic action of fluoride amalgam could be explained by its ability to
deposit fluoride in the hard tissues around the fillings and to increase the fluoride

content of plaque and saliva, subsequently affecting remineralization. In this way,


fluoride from amalgam could have a favorable effect not only on caries around the
filling but on any initial enamel demineralization. The fluoride amalgam thus
serves as a slow release device
BONDED AMALGAM
Since amalgam does not bond to tooth structure, microleakage immediately after
insertion is inevitable. So, to overcome these disadvantages, adhesive systems that
reliably bond to enamel and dentin have been introduced. Amalgam bond is based
on a dentinal bonding system developed in Japan by Nakabayashi and co-workers.
The bond strengths recorded in studies have varied, approximately 1215 Mpa.
Using a spherical amalgam in one study of bonded amalgam, Summitt and
colleagues reported mean bond strength of 27 MPa. Bond strengths achieved with
admixed alloys tend to be slightly lower than those with spherical alloys. Study
compared post-insertion sensitivity of teeth with bonded amalgams to that of teeth
with pin-retained amalgams. After 6 months, teeth with bonded amalgams were
less sensitive than teeth with pin-retained amalgams. If bonding proves successful
over the long term, method of mechanical retention can be eliminated, thus
reducing the potential for further damage to tooth structure that occurs with pin
placement or use of amalgam pins.
CONSOLIDATED SILVER ALLOY SYSTEM
One amalgam substitute being tested is a consolidated silver alloy system
developed at the National Institute of Standards and Technology. It uses a
fluoroboric acid solution to keep the surface of the silver alloy particles clean. The
alloy, in a spherical form, is condensed into a prepared cavity in a manner similar
to that for placing compacted gold. One problem associated with the insertion of
this material is that the alloy strain hardens, so it is difficult to compact it
adequately to eliminate internal voids and to achieve good adaptation to the cavity
without using excessive force

Gallium alloy
The current composition of gallium alloy comes as a powder and contain:
Silver 50%wt.
Tin 25.7%wt.
Copper 15%wt.
Palladium 9%wt.
Traces 0.3%wt.
Traces 0.5%wt.
It is also available as a liquid containing;
Gallium 65%wt.
Indium 18.95%wt.
Tin 16%wt.

Structure of gallium amalgam: The structure of gallium amalgam has been


interpreted in terms of a reaction of CuGa2 and PdGa5, surrounding the unreacted
alloy particles, which are held together by a matrix of Ag9In4 in which island of
Ag9Ga3 and beta tin can be found.
Clinical behavior of gallium alloy: Changes in marginal integrity, surface texture,
luster, and color were measured clinically over a period of up to 2 years.
Significant change in luster and surface roughness occur within 4 months.
Apparent corrosion behavior

Conclusion
Historically, amalgam restorations have been among the most common of all
dental restorations. The use of high-copper amalgams has improved dramatically
the clinical longevity of amalgam (5-10 years under ideal conditions). Its major
advantage has been the decline in the cases of microleakage. The use of
precapsulated amalgam has reduced significantly the risk of exposure of dental
personnel to mercury vapor.Although small amounts of mercury release from
amalgam is known to occur, it does not cause any major health problems. Although
there are other alternatives to amalgam they cannot match amalgams longevity,
ease of manipulation and versatility.Hence dental amalgam will be a part of
dentistry for a long time to come.

References
Phillips Science of Dental Materials 11th Edition
Craigs Restorative Dental Materials 12th Edition
Sturdevants Art and Science of Operative Dentistry 5th Edition
Textbook of Operative Dentistry Amit garg and Nisha garg
Dental Materials, clinical applications for dental assistants and dental hygienists
Dental Amalgam: Update on Safety Concerns
JADA 1998; 129:494-501
Materiales dentales: Federico Humberto Barcel Santana & Jorge Mario Palma
Calero