VOLU ME 43 NU M BER 2

AUGUST 195 1

Restorations of silver amalgam

Mi les R. M arkley. D.D.S., Denver

Preserva tion of a healthy set of na tural

teeth for each patient should be th e objective of every dentist. All wo rk in th e
health field is ai med basicall y at conservation of th e human body and its functions. The opth almologist does not revel
in the number of socke ts he can p r~pa re
for plastic and glass substi tutes for eycs.
T he surgeon is so conservative th at loss
of even a small part of a finger or toe,
notwithsta ndi ng th e fact th at th e pat ient
will still have nin e more, is considered
a tragedy. Likewise, loss of even a part
of a human tooth sho uld be regarded as
a serious inj ury, neve r to be consi de red
lightly, and th e tooth is certai nly worthy
of the most careful restoration . Ther efore. in th e tradit ion of all health care,
dentis try offers its high est service in th e
combina tion of routine preventive and
restorative care. U n til com plete control
of caries by preventive mt;asures is accomplished , restor ative dentistry must
continue as a most im portant part of
dental pra cti ce.

Silver amalgam ha s saved and continu es to save more teeth th an all other
materia ls combined . Carefully handled,
silver ama lga m restorat ions will give
more servi ce for th e t ime and effort
expe nded than any other. No apology
need be made to any pati ent for th eir
use. There a re not eno ugh dent ists to
serve th e pub lic with any durab le material, .amalgam not excepted . I Iowev er,
mor e amalga m resto ra tions ca n be ma de
in a given len gth of tim e. Pract ical suggest ions for m aking good silver amalg am
restorations follow.
CAvtTY PIlEPARAnO N .
CLASS I AN D II

Although well condensed silver amalgam

resists crushing forces u p to 5O,OClO
po unds per sq uare inch, it is bri tt le, it
Pre~e n ted be fo ,t! the Section 011 Oper.ti..~ Delll il"."
ninety -fi",t ."nu. 1 ",,;on 01 tl.e Am~.i cen D~"I,1 Auo
ci, l;o n. Alle"t ic City. Nc vemb er I , 1'l'5O.

IJJ

I H . THE JO URN A L O F THE A MERICAN DENTAL A SSOCI ATI O N

Fig. J Modifltd B,o,u, ~r ty p, of CltUS II

cavit y for silver amalgam

lacks edge strength a nd it depends upon

bulk for strength . Therefore, it serves
best in a ca vity designed to favor these
properties. Bronn er' suggested adapting
the pr inciples of G. V. Black' s Class IV
cavity to C lass II , result ing in a two surface prepara tion highly favorable to
am a lgam . It is retenti ve, it is conservative, and it subjects the restoration to a
minimum amount of occlusal stress. (See
cavity ou tline, Fig. 1.)
Since the enam el rods of a tooth run
in a d irection perpendicular to th e surface, preparati on of cavity walls so as to
parallel or follow the ena mel rod s will
yield strong filling ma rgins with right
angle joints. T he operator shou ld be ever
mindful of the direction of the ename l
rods on a ll margins of the ca vity. T o
bevel the enamel in a stress-bearing area
results in a frai l margin of amalgam
which will be subject to fra cture. At th e
other extreme, leaving unsupported
enamel rods invites failure with any fill.
ing material. Figure 2 illustrates typical
amalgam failure of occlusal margins
where traditionally parallel walls are pre.
pared . The thin margin has chipped

leavi ng a crevice. Corrosion set in, open,

ing a pa th fo r ca ries to sta rt again.
Figure 3 sho ws that by more nea rly following the en amel rods in occl usal prcparati on , much stronger filling margins
result . More occlusal stress is taken by the
tooth structure a nd less by the rcstora,
tion itself. Figure 4 shows that the: buccal
and lingua l walls, at the proxima l portion
of a two surface filling, must closely follow the cleava ge of ena mel. Violation
of this rule results in failures illustrated
in A and n of Pigure 4.
A gingiva l bevel is ncecs sary for an
amalgam restora tion as sho wn in Figure
,1. The ging ival scat of a two surface
cavity is properly cut at a righ t angle to
the occlusal stress. Th is scat, extended
th rough the ena mel, will inva riably leave
un sup ported rods at the gingival margin.
Therefo re, a slight bevel of about 20 de.
grC'Cs is rout inely necessary here, un less
the gingival marg in fa lls on cementum.
Then no bevel is needed . The ax iopulpal
a ngle is roun ded at the same time, adding
strength at the junctu re of the occlusal
and proximal portions of th e filling, and
redu cing intern al stress cre ated by an)'
sha rp intern a l angle.
If a tri angular hardwood wedge is
forced into each proximal space to be prepared, it will hold the septa l tissue and
the dam safely away from th e bur and
provide easy access for enn ing the gingival scat and bevel. The bur will cut into
the wedge to the desired depth of th e seat.
Usua lly th is same wedge can be used
later to sup port the matri x. Such a wedge
is a lso useful d uring the roughi ng-out
process befo re the dam is placed . Septal
tissue compressed in this way does not
present th e hea ling problem of lacerated
tissue, an d the nu isance of hemorrhage is
practicall y elimin ated.
The resul tant cavity has a narrow occlusal surfa ce, a nd is narrow across the

margina l rid ge, wh ich leaves maximum

strength in too th struc tu re. Su ch a na rrow occl usal ste p will o bvio usly not su pport the proxima l port ion of a filling .
However, neither will a broad oc cl usa l
extension alone adeq uat el y support the
proxi mal po rtion of a two su rface amal gam filling in a permanent tooth , Functional stre ss through the ~"t:a rs will ca use
such a filling to flow ou t of th e cavity
a nd fai l. T he refore, the prox imal port ion
must be so sha ped as to la rgely retain itself, T h is is accomplished by locks, opposing groo ves, cu t in tht de nt in with no.
699 or no , 700 tapered fissu re bur s, t-x tendin g from the- gingi va l seat j ust to th rocdmal surface. but witho ut cpprcciablv
showing in the occ lusal en amel ( Fig. 6 ) .
T hese groo\"es must no t unde rmine the
proximal en a me l. M> in a ..hall ow cav ity
the grOO\TS a rc r ut part ly a t the expe!lSt'
of the axia l wa ll. \\' hen a ma lga m is wel l

cundcnsed into these grooves . a filling I"

sufficient ly lucke d so th a i litt le stress I '
ta ken h y the occlusal dovetail.
:\0 occlusal stt'p is made on lower bicuspi ds a nd on ly a sma ll ail e is made on
th e d ista l port ion of upper mola rs ( FiA"'
i ) . M csic di stcocclusa l restorations shou ld
be avoided in upper molars. The stronJ:
oblique rid ge should be con served wher ever possible to strengthe n this toot h
aga ins t spliui ng . [ \, ('0 sou nd teet h an'
some times split ill fu nction hy th e hyd ra ulic pr cSSl ln ' created hy chl' wing ( Fig.
8, r iA"h t ) . Ik eI' a nd broad caviti es crea te
th e effect of r-longa ted cu sps whic h a n'
mor e suscep tible to fr acrurr-." The grea test st rengt h is ach ieved Ly a conservative
ex te nsion of till' occlusal po rtion of a ll
2. Inq ' .:l h.:l "". Ro , , ~ ... " p p l;,,,,;,,,, 01 , a~ "d bie , ,,.."";e..,1 P' ~ "c ;p l
i"
d ...;,!" 0 ' ;"t " , "",,,1 '1"'"
a nd <;l a id /o il ,..",,,,,1;0"'. J .A .D.A . 40 :4(lZ l A p ,,1)

t""

I ~ SO ,

fi g. 2 S hou 'i"g U:t Q.l"~H

of am algam ou/uwl m a,cifl l
:l' h n~ ~ilI 'i /r il p"pa,t d
u:ilh pa'alltl n'alls. T'h r t h m ,
frail margins haoe ch i pptJ .
,lflouilll: corr osion and ca ries
ns illu str at ed "n til" I...ir

Fig, 3

Sa fnt ou/usa!
f(IT amalgam .
Co n(,uJ:itl~
walls
more
nead y follow enamel , ,,,11 .
R es/ora/io/l is carve d witll'
out .11,,111' J;WO i''''1. N ote that
a mill imum amou nt of st ress
a'ill be tol. ..." by t h... filling
matuial, A ll fillt d tul h a'e
~ u bj(( 1 to [racture but a caoIt)" p"pa"d to .r is st , onet .
than o,, ~ p, tpa,td to r.
Preparation at X has amp/t
seot 0 '1 sou "d dnlti"
p ' ~pa'at l otl

Ill> " Htf JOU ~ NAL OF t HE AVEI1 ICA N DEN TA L A SSC C IAT ION

.uualgam cavitv just to th l" dent in, as

narrow as pmsihlt- ( F i ~ . H. lr-It}.
<=,\\'11' \ ' ot IT I.l:-,;t-., " ROX I M ,,,,1.

S I I."I'E "'OR C I. A S S II

A lIa t poi nted J-X"K il hel d pnpnld icula r

to the tooth to be p repared, wi th the flat
side resting agui nst th e co nmcr ing tooth
can be m ade to dl'snihl' the proximal
c-a vity outl ine ( F i ~ . 9, left ) . This line is
mod ified 10 fa vo r the kind of resto rative
man-ria l to he used ( F i ~ , 9, right ). T he
o utline for ama lgam a nd go ld resto rations
wi ll ha ve a common ging iva l sea t of varying widt h, broa d for amal gam , giving
splendid exten sion for p rcvc miou a nd it
will be na rrow arrovs till' ma rg inal rid gv.
For the inla y the gi ngiva l v-at m ust bl'
narrower a nd tilt' margina l rid ge a rea
wider to provide draft . It will tw seen that
with amalgam an idea l extension for
p revention at th e but Togillg:ival and linguog-ingiva l angles ca n lx- m ad r- w ith a
minimum of widt h at tht' ma rginal ridge.
The esthetic result is nlso good . Figu rt'
10 compares ama lgam cav ity and in lay
cav ity preparat ion s in an u pper mola r.
Although r-onc-rvation is thr- rule w ith

..
. ;:> Z ...
..
'.

" :\

GtI\~I~
A )-.. 1l

Fjg. 4 Cavit)' fOT tlmtll gam sho wi n ~ lait.l1t

and S Il CCUS in proximal sha pes. -t: .. I f poralld
cavi t )' walls ate pttpatcd al in ...t , at X - X
10 fa L'o, rcte fltio n , IIndun/in cd ,namd at
r - r uill fail . B: I f divcr~in~ a'alls arc prtpa rcd fOT amalgam , as lit .r X , thc frai l
filfjflf margin wifl [roct ure , oprninf d fiJJ1ITC
[or corrosion and caries, r - r sh ows direcli "n 01 enamel rods. C . C o" cc/ t:avit)' outlinc
lo llou., in!! the ename l rods ifl pToximal rrgion
at X -X. }' - }' , which w ill tiN t hr stro nge st
1l'Jult

1"i/.: . 5 " CI"H udio" of CIlHS IJ (if/jllf.. A

l!i ji h t 1!iujiil'lI! bt vd is 'U(f HU rr [or ' Hl I Ii jilml
:1,1II'Il' Ill l' ('(II ' it)' I//( II /.:in

js 011 rnamrt , 'I'lu

1/ ,t;i"/, ,,ll w l 1I 1l !:1.. il fllj() rouruled

III

shou'n

tlu-, mauriul . nl'p ~ should 1)1: ca p ped wit h

amalgam wlu-n- they an- weak ( Fig. II ) .
In fa ct. more ('usps sho uld be capped with
amalgam th an arc necessary with gold in lays, lx-r a uv- tough gold alloy s r a n resist
the spl itt ing tende ncy of fun ction . I n
cavity preparation for amalgam restorations, tooth struc ture too wea k to with sta nd the lo ad unassisted shou ld be reII1m '("d and the cusp ca p ped ( Fig. 12 ) .
Remembering thai strengt h resu lts from
hulk , such ("li SpS shou ld be ca pped with
two o r lh n T times as m uc h mat eri a l as
wo u ld h l; used with cast go ld; that is, 2
or 1

1Il1ll .

Badl y broke-n down u-r- th ca n he sa risIar-to rily n -sto n-d with a ma lga m if a de q uate re tention is provided fo r eve rv
stress. It m ust he ren u-mbered th at fillings
do not stick to teeth. hut cavit ies m ust hI'
engi nee red with a reten tive des ign. Wh en
re tention b y lock s cut into dentin is insuffic ien t. 0.02:") inch diame te r threa ded
iridioplat inum p ins cemen ted into holes
drilled by a no . ~ round bur will provide
exce llent anchorage about wh ich amal ga m ca n he co nde nsed ( Fig. 13) ,
C A\"l 1"Y I'REPA RATION FOR CLASS \ '

The gi ngiva l third or Cl ass V cavity presents specia l problems of its ow n. On the

VOLU ME ~ ) , A UG USt I~I 1)1

convex bu ccal surfaces o f po ste-rior tee th,

follo w ing the ena me l rod s lea ves d ive rg ing wa lls which ma ke rlu-sr- fillings dimn th to retain, a... shown in B a nd C o f
Figu re 14. If parall el wa lls an- n i t to
favo r re te ntion, fra il un...uppo ru-d ruanu-l
is left to fra t-run- a nd fa il ( Fig. 14, A ) .
Retent io n m ust be accomplishe d hy u nd ercuts in th e denti n of the occl usa l a nd
gingiva l wa lls. Ve ry la rge ging iva l fillin gs
an: best ret ai ned by threaded iridiopl ari nun: pins , rx-nn-nu-d in to holes d rilled in
tlu- d ent in mesially a nd d ista lly to the
pu lp , C lass V fillings should fa ith fu lly restn n- tlw rO I\V('x sh a pe which s luircs food
safe lv across ra the-r than int o th e gingi...a l
etc vicc.
A M AL GA M FO R C IIIl. Il RE:'\

Silver a malgam is tln- be st n-storar ivr- m a teria l fo r pr act ica lly a ll decid uous u-e tb
including incisors, a nd for pe rmane nt
poste r io r teeth to th e ages of 1;-) o r 16.

O nly a fn-r this 'IKe a rc teeth sufficiently

e ru p ted pa st ti ll" ron tact a reas to pe rmit
gingi va l I''\ (('nsio ns wa rra nt ing gol d
restora t io u -. Thr- co nse rvatis m possible
,v ith a ma lga m a bo recommend s this rna u-rial for YOlln~ pa tients.
CJ-:l\.tE:"T tH,S ES

On ly th ose ca vities close to the denta l

pulp need rr-nu-n t ba ses under alllal ~ alll
resto ration s. Cl inical x pc rie-m-e indicat es
less therma l sho ck to teeth bea ring amal ga m restora tion s tha n to tho se with (' 0 111pa ra hie gold foi l resto ra tio ns. T he ro nserva tivc ca vities best suited for amal gam
('X I>OSI a m inimum a rea of metul surfac e to cond uct hea t. Rout ine a ppl ica tio n of interm edi a ry varnish to cut den tin
will p rovide a mple pr o tec tio n fo r 90 pl'l"
cent of ca vities. Di scolo ra tion of tooth
struc tu re u nde r a m alga m f ill ings ca ll hl"
k-sse-nr-d hy va rn i..hing' the den tin wa ll.. of
a ca vity .

Fig. 6 \J odi{lt d Bronner t)'Pt 0/ (ad l)' J ho u ' i 'l ~

lock cut into drll li n 0/ op posi ng ptoxim al w all ,
wil h a no. 700 0 ' 699 to pr tt d {lJJu,r but . Carr
t/l UJ! br lokt n to leaue suf!icit nt d rnli n Htp portin j:
t Ilt enamel. I tI shallo il' carities th t' ( ut is nmdr
Jom t'll,h n! a t l lit' " p r," r of ti lt' a.tin/ w all

Fig. 7 lAJu'a bicu spids and uppa .molars at~ stton ga if u pa,a ft
mtJloocdusa{ alld di JtooulUJol resto' atio'lJ a't p/au d ItfllJllIg toolh
s~ PP O t' bttwu n t ht occl usal po, tlons. V ppa bicu spi ds an d 10 lL'tr
molo! J. UJuoll )' htwt Jho, p g too Vt J
' tqI1. 11Int 0 sup t :dtn din j! comP/t ltl)' ee ross tht occlu Jal Ju t fau
10 a Mfr nrra f(>1 {11I;Jhi ng

1)8 TH E J OU RN Al O f ! H E A "'E RIC AN DEN TA L A SSO C IA l l nN

Wh ere cem en t bases a re used, the ir

bu lk sho u ld be kep t sma ll in the in terest
of keepi ng am algam bu lk and streng th
a t a m aximum . Dental cemen ts lack
c rus h ing stre ngth su fficien t to support a
restora tion , They have only a bou t one
fourth the strength of well conde nsed
a malgam . T herefore a ll fillings subject to
stress mu st ha ve a mple sea ting upen
sou nd d entin." Si lver a ma lga m freq uently
can be used to adva n tag e- as a base for
go ld crowns a nd inlays. It is not on ly four
limes stronger th an cemen t, but it is
..econd on ly to gold foil in resista nce to
d issoluti on a nd rec urrence of deca y. It
ca n be pl aced whe re access is difficult
be tte r th an gold . It is invalua ble as a
founda tion for fixed bridge abutme nts.
Sensitive tee th with a malgam fillings
usuall y ca n be traced to overhe a ting th e
tooth d uring ca vity preparation . An y
temperature exceed ing 136 F . is considered injurious to the pro toplasm of pu lp
tissu e. The ca vity is ro ughed out under
a strea m of water, th en com pleted wit h
a rubber dam in place. Dental burs a nd
sto nes shou ld at a ll times be ru n either
very wet or very d ry. T eeth resto red with
amalgam should he com fort a ble beca u..e

th.... cavi tv I S pn-pun-d a nd th c lilling

pla ced ill O il .... co n tinuous operat ion in a
cavity which m-vr-r need 1)(' co nta mina ted.
With amu lgau i a nd gn ld foil a like, G.
V. Black stressed the importa nce of recutting ca vity margin s a fn-r conta mina,
rio n with a n)" moistu re O !" drug. ~ la rgi nal
di scolorati on and nvu m-nt ca ries mav
resu lt from ti l(' w~sh ill~ o u t o f tla- soluble
n-sidu r- left n il ronrnmina n-d ca vity mar,

~ 1I 1"i .

All ca rio us de-n tin llithl 1M' rt'1IIU\T d . for

rln- infe('(ioll will romi nur- u nd r-r ttl!'
n-st o ra tion u nk -ss r-n rin-ly n-move-d . Expe,
ri.nn ha.. shown th at ('OIri('ji r-an I", de.
u-r-u-d by app l ' ;U"a IU T a nd by rlu- dt'mit y
or fl't'1 of d en tin tn a sha rp instr unu-m.
Lo upe bin ocu lar- will aid in ca n'Iul in.
sllt(:tion. O nl y in cx rn-nu- ('a se~ is any
med icamen t need ed . Pn-cipita u-d silver
nitra te for po ste-rio r n-r-rh o r ht'lThwood
creosote" for a nter ior n-crh will sanitizes
qu estiona ble dent in ill thosr- o cca sio nal
cases wlu-n- romph-n- ca ries removal
migh t n ..ult in pu lp e xposure. Ena mel
wa lls must lx- n 'ru t nln-r tlu- use of these
or any d ru gs. t
~ IA T R I X

If silve-r ama lgam is to 1)(' ..t ron ~ a nd du ro

nbk-, it mu st Ill' condensed for ce full y in to
a space with rigid walls. If one of the
wall s yields in the prnn'ss, crysta llization
is dist urbed a nd wea kness results. Condensin g into a wea k or yield ing ma trix
ca nno t redu ce mercury content down to
a pe rce ntage wh ich wil! provide strength
a nd hold a po lish resistant to co rrosion.
Prope r adap ta tion to cavity wa ll" rannot

1. BI.. ck . G . v Ope''' ' ;..e deM; , ,,-y. "0 1. II. ed. ~ .

Chi t ..q o. Med it o -De "'.. 1 Pu b l>, h ; ~q Co " 1910. P . 1l2 .

Il l .

Fig. 8 S ouftd ' "t h ar' som"imlS fract ur, d

in f'metiol'l , as shown at t h, righ t, by t h,
hyd rald ie w,d,;n, Det iol'l of ,h, opposing
' oath against a mass of food . Tk e occlusal
outli,1t show n at the lt/t fD vors the prop, rties
of silv, r am olRom by im posing mo st of 'h t
occltd al stress load Oft 'ht r,m aining tooth
struct urt

~ . BI.. tl . G . Y. O~'ol ;"e d e "';" ..... "0 1. II. ed . ~ .

C hieaqo. M e d i to De~ ' . 1 Pub .i, hi" q Co .. 1920. p. 1211,

,,,.

5. Oo ,fm,,". Albe rt ; M.. " tt , J . A.. .."d Steph..". R. M.

I~ " ii'" , Iud ;e\ 0" " .,ili, ..l i.... 01 t .. ,io.., d l'flli". II .
of ; ~f et ljo~ i~ ea';ou, 'e. iotll" J .A.D.A. 10: 1'101
{Det .} t'Yool l .
. Co.." til On De",.. l The' '' &:>e"t;u. At upted de~, .t
'em edi e' _ e d . I ~. Ch ;ea q o, Ame. ;t .." De ~I .. 1 A...o d .. ' io" . " . '. P. In.
,

E,te ~ t

MARK LE Y VOl UME .1 . AUGUST 1'1$1 I) '

fi.9 L eft : Prox im al shape should be routi'lei)' o urlined in Ihe m out h wilh t1 pen cil
cut to a tnin flat point . POJitioll and silt of tht plOximalin g tooth d,teTmin tl th,
outlint. L ines art drawn from tht maTgin al rid gt to th e gingiv al tiHUt on both Ih,
bucca! and !in gtla! sid es. The se lints ale Ih, n m odifi ed to de serib, the ideal outli ne for
' he partieular rt storativ, "lat uic.l to be uJtd , as shown at righ t. Hight : T he curved
proxi ma l line s urere inscribed b)' the pen eil shoum at Ihe leit , Cat'it ) outline fOl amalKnm and gold inla )' restorat ions w ill ha t'e a com m on Klngival otltline onl)'. A m alIa",
permits a gin gival rxun sion lat er all ) across Ihe scri bed lines into zones safe from
luurr,n l ca nes, The fillin g is narrow aer ou th e m arginal ridge a nd occl usal step. -1
broad occlusal oul/ine and mo rt' constricted gingival art' necessar y for a n in la). \fodd
a l , xt rem, right shows bolh mila /Knill lind in la }' ,avit)' out lines stlpuim po"d

fit . 10 Co m pa rali vt' eal/i, y plt'parati ofts O TI

uppu m olar for am algam at th, Itft and for
gold inla), at th t right. For amalgam Ihe
stronK obtiqtle ridge if prt'u rved t'Vt'TI if both
proxi mal furfau s require fillin f . I f th, intay
is mad, to crou the obliq ue r,dge, arm s are
uten ded thr ough t ht bucc al and lin gual
grooves 10 tit t ht toot h cro wn togethe r 10
preve nt possib ft splitt ing

be achi eved in a yielding

~pan: .

\\"h{"fl it
cavi ty involves one or mo re sides of a
tooth, a form or mat rix must be bu ilt
which will bot h rigid ly support the restoration while build ing, and define the con tour on those su rfaces which ca nnot be
readily built to excess. Dozens o f commercial mat rixes have been ma rketed,
alI with defects an d limita tions.
. Two types of matrix, each easily mad e
In the office, will serve for almost an)'
situation. One is made of a stainless steel
strip 0.0015 of an inch thic k. This mate-

rial i... thin eno ugh to permit burnishing

a nd con touring of the proximal port ion
from th e gingival margin up to an d including the contac t area. Using the small
hole of the rubber dam punch, with a
shea ring action holes a re made nea r the
gingival corne rs of th e matrix. The strip
is next laid on a pa per pa d and with a
circular motion of a large egg shaped
burnisher the cen ter is made somewha t
conca ve to sta rt tooth fonn shape ( Fig.
15 ) . Proper width is next esta blished. The
strip should be one o r two millimeters

1-40 THE JO URNA L O F TH E AME RICAN OENI Al A SSOC IA TION

F i g. JJ u jl : P, o tT"ing lJ j,lJil ( lH p in "ites

Jpl i tt i ng . flight : C US pJ (lJ ,. b, SlJj tly (lJpp ed
with lJUllJ fglJlIl ij ,,.owgh hu ll. of ma t erial
( 2 t o 3 mm .) if uJed

higher than the finis hed n -sto rarion . T he

matrix strip is then secured around the
neck of the tooth by De n tota pe threaded
through th e holes, wrapped around the
tooth twice and tied .
A tria ng u la r wedge of ha rd wood is
inserted fr ee of the ging iva l margin so
as no t to in terfere with conto ur. It can
be inserted eithe r from the bu ccal o r the
lingu al side, depend ing on whi ch is most
accessible, a nd from which side it is least
a pt to im pinge u pon the m atrix st rip
a bo ve th e ging ival margin ( Fig. 16 ) . Th is
wed ge aga inst th e cush ion of the Dente tape perfon ns three important tasks :
1. It hol ds the matrix snugly against
the tooth so tha t subseq uent sha ping wi th
a warm instrument does not a lter the gin.
giva l fit.
2. It sepa ra tes the teeth slig htly to
co mpensate for th e thickness of th e matrix a nd to give sn ug contact in the finished restoration .
3. It holds the pro ximat ing teeth finn
so tha t th ey offer rigid support for con d en sation , co ntrolling a tenden cy of the
teeth to mov e away from the matrix
which is o ne co mmon cause of ov erhang.
ing ma rgins.
.
H o t green stick modeling co m po und is
no w built ove r the steel stri p, two separate
pieces being used for each p roxim a l space,

otu ' huo-al nud onr lingu a l. Finger and

th um b pressure from th r- b uccal , lingual
.
a nd occlusa l sides
tlu-n fo rces the ram.'
pound throug-h l ilt' interpro xim a l space.
The hOI moodill.!.: ouupound Slicks secun-l v 10 tl n- dry too th su rfarr-s . It is irn.
portan t that matri x :'> Irips o r hands be
su ppo rted . \"1" 1)"\\111'1. ' with ('()JJ lpo und.
:\ctua lly, thr- ri ~id ,olllpound is the
rnntrj x. T h e thin IIl1"t;1 1 silll p ly provides a
smooth. hard . bumi -habh - lining a~ai nst
whic h Iht" a llla lg:a lll rn u h. bui lt . Th is
done. a \\ armed bu ru i..h ill ~ ill!>trulllf'nt
(SS W <lollhl,.t'fI(kd fill ill~ porcelain in.
ct runu-ut 110 . 2:\ i-, .xn lknt ) r-a n he
ma ni pula ted wit hin thl" ca vitv sidr- o f the
t uat r-ix to d n -d op thr- too th fon n of the
finish ed rest oration from the Ring-ivai
margi n lip to a nd illdud ing: th e co ntact
a rea . TIl(" C'<lll lpOUII<I. wa rnu-d through
th. stt'.' 1 strip. will flo w 10 allow thi s ad.
11I'llIlI'lIt ( Fig. 17 ). I t i, important that
till' hu ccal a mi liug ual margi ns hr kept
fi n ed slIugly hy till matrix . for a n open
rrevio- lu-n - \\ ill trap m crr-urv duri ng
r o nden sarion. !"nlllting in a wea k. ITH'rl"Iuy-ridl rua rg iu: If the met al is in ad \"l,rtc'lltl y p ushed aw ay from a ma rgin ,
a hea ted pl astic instrument sho uld he advanr-cd through 111(' compound to rcposilion th e ll1 C' t,1I a t thr- ma rgi n. A finper
he-ld force l ull y Oil thr- so l tr-n-d COlli po und
at th is spo t will u-ad upt the a rt-a . On
cooling. lnu-nishinq thl' me tal to establis h
too th fo rm is resumed .
TIll' matrix Irom Ihe contact area to
till' occlusa l surfao- is sha ped like a fun111'1 " to invite the- filling." 10 quote C harles
W oo d bu ry.' Afte r the co ndensa tio n is
completed . and before th e ma trix is removed the ama lgam is cut to a natomica l
fo rm with a go ld knife . from the height
of the margin al rid~l' to thr co ntact area .
For restorations wh ere there is 110 contacti ng tooth a nd a lso fo r la rge. co m plica ted resto rations. a seco nd kind of
mat rix is made frnm an annealed , sea m-

MARK lE Y

I s copper band, contoured to approxi;~te tooth form , . and thinned with a

coarse sandpa pe r disk at th e con tac t areas.
This is placed over th e tooth, and a tuck
is made with flat nose pliers up the side
~'1here a sound cu sp remains if possible.
This is done in such a way as to fa sten it
close to the neck of th e tooth, but to leave
it free for full contour elsewhere . It is
wedged where possible. The copper band
rnatrix is th en blocked arou nd the entire
circumference with com pound . Here
again, th e compound is really the m atrix ,
while th e metal provides a smoot h lining
against which the fillin g is built. The

coppe r band is now co nto ured from th e

inside with a wa rm burnishin g instrumen t
as was th e sta in less steel matrix. Thi s
procedure is to the ama lga m filling wha t
shaping a wax pattern is to an inlay , exce pt th at an inlay ca n hI' correc ted by
solde ring and poli shing ou tside of th e
mouth . A com pleted am algam restoration
ca n be no better than th e matrix and
cavity preparation into which it is built.
PREPARIN G THE AMALGAM

Routine usc of a n a lloy th at meets till'

spec ificat ions of th e Council on Dent al

Fig. 12 First row : Th e cr OJ5 sntio n of an up per bicu spi d requ iri ng an MOD restora tiOn and ha ving a ca ries-we ake ned port ion is sh ow n in A. Placin g ama lgam in an
occlusal pr eparation havin g para llel walls in an eff ort to shield the weak buccal wall
somewhat wi ll result in an acute -an gle margin wh ich commo nly ch ip s, as shown in D,
allowin g co rrosion to undermine the Test oratio n . I f th e con servat ive converging -wall
design is follo wed, the amalgam ma rgins are safe eno ugh with th e bulk of the st ress
on toot h stru ct u re. Houi euer, the toot h structu re ma y be so weak as to fract ure,
as show n in C. T he cu sp should be capped with am*lgam, preferably to a depth of
3 mm. as show n in D.
.
,
S econd row : Wh en gold ma rgin s are kep t stro ng, as in E , a we ak toot h ca n be co n.servativtly pr ot ect ed with out capping the cusp. On a still we ak er tooth, as in F,
th e bucca l cus p ca n be esth etically capped, using from 1 to 1.5 mm. of gold alloy.
Failu res wi th gold, as show n in G, are co mmo n w here insufficient bu lk of gold is
u.fed or where rest orat ions are seated on cement rath er than sound den tin

141 0 'I1E J OU ~NI\l Of Tl1f AMf~ I C AN Df NIAL ASSO CIA TION

Resea rch of the America n Den ta l ASS04

d ation is a sim ple safeguard . A good filling ca n never be mad e with a n infer ior al10)'.' The alloy an d mercury a rc ca refully
proportioned acc ording to manufacturers'
di rect ion s. Too much mercu ry will yield a
mercury-rich filling. Once excess mercu ry
has been incorporated, it never ca n be
reduced sufficien tly to produce a strong
filling. T oo litt le mercury will leave some
su rfaces of the alloy pa rti cles u namalgamat ed . Th is ca uses voids in th e rompk-tr-d
restoration whi ch invitr- pittin g- a nd r-or rosion." More mer cury sho uld OI'\'('r 1)1'
added 10 a ll amalgama ted maxs. To do
so will ca use a weakr-m-d prod uct. '"
Ama lgama tion is best don e ill an a pproved type of mech ani ca l a malga ma to r." Abou t r igh t seconds with the
pestle, followed b y two seco nds with the
pestle removed will yield a complctclv
a ma lgama ted and pla..ticiecd mass in a
fracti on o f th e time req ui red hy mo rta r
a nd pestle o r th u mbstall .
The exac t amoun t of time fo r a given
a lloy a nd ama lgamator mu st he de ter m ined by experience. Successive tri al
mixes sho uld be made, varyi ng the- tim e.
Visual inspection o f carh tr ial m ix, wip-

Fig. 13 B<2dl)' broltll dOWII tttt h call bt

tOtclivdy rtstortd wit h amal"a m as shou 'lI
at tht ri, ht . It is i mpo, t<211t Iha t 'tlt'lIlioll
locis bt b"ilt i nto tht dtll t ill '" strattgit
, oill tl '" shou.'ll. u lt : II'h ,.,t extreme loIS 01
looth It , ,,tt ,,rt m<2i tl dtntill loc41 illadt qu alt.
0.025 th ,tadtJ i,idi o,latill um u,ir, , i" "
tt mtnttd i" to holes dnlltd b" a no . V, , oulld
bu' " ovidt UCt lltllt s" " ltm' lIta,y ' t'l tll lio n

j.' ig. 14 Th t problt m of CI<21S V 0' gillgival

t hi,d , t st oratiolls. 111 A . B alld C, }' - }' show s
Iht di rtttioll 01 tllamtl rods ill la rlt alld
Hllall cav itlts on t h, COIIVt X buctal sll,lac"
of lau'tr mo /au. 11 a cav it)' with para/ltl wall,.
is p" par,d tU ill ..t, X - X undtrm i lltd t nom,1
, od s will diJi lllt'Kla tt 1ts llll illK in 10illiFt 01
th e /illinN a/ Iht FIIorgins, IJ ond C show t ht
co"re/ Oil/li n, l or small and lorg, couitit J,
il/llstrati" K aho tht di ffi, ult)' 01 uCllrill g
t llollgh " tn,li MI i n Iht dtn tin to lod Iht
lil/illg in , Iou

ing it across Ih(' pa lm o f the hand , will

det ermine the least tim e necessary to
create a I'omplrtdy smooth mix. Each
ind ividua l ama lgamator an d brand o f
alloy will be fou nd to vary.
A standa rd amount which ca n be cond cnscd in rhrrr- minu tes is a malgamated
at one time, Five h un dred a nd eight)' 109:,
o f alloy propo rt ioned with mercu ry can
usually he condensed in th ree minu te!'.
One m ix is eno ugh for ave rage occl usal
cavities. Two or th ree mixes will fill idea l
two su rfa ce cavit ies. SOl Il(~ la rge restora tions may req uire as many as 10 or 12
m ixes, eac h m ix being a malgama ted th ree
min ute s for thorough condensatio n. A
time clock is set for th ree minutes a nd a ny
excess left aft er that time is d isca rded
a nd successive mixes p rep ared . J ames
Sween ey ca lls this " m ixing on the install ment plan," u Aft er th ree m inutes haw'
I. S~ in". " E. W . Th" sci"nce 01 de"'. 1 m""'; II I , .,d .
I ~ ", p. 2'9 17.
I . Ph;l. delphi. , w . . S. ... nd" ..
9. S'-',oo no"., I. C . tId SollCl"', W il"'e. eomx;on
of d...'. l . nOl"'. J ...... D.A. 11:1271 I A~Q . 1 1941,
10. TI , I",. N. O. Atn. IQ.tn ' ..:hnic : du,,,nd. bl,, . "'"
d l n Q ."'~1 pt. c!;UI J .A.O...... 17:1880 (Ocl.) I'J:I.
I I: Phillips , R. W . PhySi", 1 p",~,' i.,. 01 ..... IQ.m
n
,,,nu enc"
by ,he mee h"",,, l ..... IQ.m. lor . nd
pr>e ..." ,.' k conde"''''. J A .OA . ) 1:1)Ql lOcI. I) 1 ~44 .
12. S...,.,,,,,, , J. 1. A ~ imp.oved tec hnic 10< pld ;"Q
,,"d cond " ",i"Q unifo'm . m. IQ"m te~lo'll i o... b, h. nd .
J ...... OA . 28:1463 lSepl.1 1 ~41 ,

eo.,

MARKLE Y .. VO LUME 43. A UG USl

I~l

14)

assed crysta llization has progressed to

~e ex;ent that excess m?rcu ry cannot be

removed sufficiently to yield a strong filling.
Dental amalgam .IS hirg h IY suscepuible
to contaminat ion. W ith the best ?lIo)'s
today the slightest amo unt of moist u re
or salt solution suc h as perspirat ion or
saliva will cause gas to form withi n the
mass. Gas pressure results in delayed expansion and blisterin g. Delayed expa nsion may result in toothach e afte r severa l
days, and it may cause fillings to bulge
from the ca vil )" Moistu re con ta mination
will also cause pits, voids and layeri ng.
For these reasons amalgam must never be
touched with the fingers and mu st be
condensed into a clea n, absolutely d ry,
cavity.U. ' t
CO N DE N SATt O N

The prepared mass of ama lgam is placed

on the bracket table and divided into
three parts. The first portion is picked
up in the squeeze cloth a nd the mercu ry
content reduced by sq ueezing to a con sistency which will pack \..'ell under heavy
. hand condensation pressure. T he filling
is built up in th in layers, bringing mercury
to the top of each successive layer. T he
first portion should be sq ueezed much
the same as succeed ing po rtions, never
starting with a soft mix wh ich may leave
mercury-rich margins. T he time dock is
kept in view of the assistant. Wh en one
minute has passed , sh e tak es the second
po~ion of ama lgam. discard ing any re~amd er of the fi rst, squeezes and rubs it
m the squeeze d oth and passes it bit by
bit into the cavity for conde nsation. At
the end of the second mi nute the third
portion is likewise prepared , to be repl~ced quickly with a newly ama lga mated
mIX at the end of th e third minute. If
the .entire portion wer e squee zed imme~tately after ama lga mation, crysta llization ....-ould be hast ened on the entire
mass and the working time sho rtened .
Pn-proportioning of a n estimated nu m-

Fig. 15 M atrix con Jtnuti on. S tlJirtl'JJ J"d

of 0 .001 5 inch thicl n' JJ iJ cut IJ ntl p.nch, tl
with ' he sm all h ole of th, rub b,r d am p unch
uJing a JhelJ ,inl act ion . W il h a IlJ rg, ball
b.rniJh,r uu tl in a circular mot ion. ,h, cc nt"
ar' lJ is Jtrel ,h,tl to JtlJ , t co nfo rma ncc t o t ooth
fo rm . Dentolap c ;J nut t hreatl , tl Ih ro ugh the
holu, t o be wrap p,tl Iw icc aroun tl th, nec k
of Ihe ' ooth anti li,tl

ber of mixes into ama lgama to r capsules

saves time between mixes. T he operato r
shou ld con tinue condensation meanwhi le,
or else the sett ing of th e ma ss will cause
layering with in the restoration.
Amalgam m ust be conde nsed fo rcefully
into every part o f th e ca vity preparation
by successive th rusts wi th instrumen ts so
shaped th at the y will reach into every
part o f the cav ity. Otherwise voids and
mercu ry rich poc kets will be left . A
d iamond shaped instrum ent, such as the
one d eveloped by H ollenback, is best for
reach ing the im portant buccal a nd lingual
ma rgins of a C lass II ca vity ( Fig. 18) . A
small inst rum en t which will co ndense the
amalgam into th e proxim al locks of this
cavity is important. A cavity with an odd
shape sho u ld be tested by the insertion
of conde nsers in order to judge the accessibility of every port ion.
Both th e manufactu re rs an d the profcsn. S<:h~o ...er . l. c.: Soud er. Wilrner. ond ! u n .
J . R. b een....e eI PO ni ion o f dentol ornol<;1 orn. J .A.O.A.
7'1:.825 (Oct .) " 42.
14. S ~inner . E. W. The scie nce of d en, .r rno' e, ie l,
1. Phile de lp hio , W. ! . Sounders Co. .,... P. 17'1:

ito.

I~~

THE JOURNAL Of THE At.4Ell:ICAN DENTAL ASS OCI ATIO N

sion have shown much interest in mechanical conde nsers for amalgam. The
merit of machine technic for condensing
ama lgam , however, i$ questionable,
There arc: two general types of m echanica l amalgam condensers. One strikes
a blow as for gold foil, while the other
ca rries a vibrating point. The fint type
habitually injures enamel margins. All mechanical condensers tend to co ntinue trituration , reducing alloy particle size
which may result in a shrinking filling,
The specifications of th e Cou ncil on Dental Research of the Associat ion for ama lgam ca ll for an alloy which expands
sligh tly, between 3 and 13 microns per
cen timeter at the end of 24 hou rs. This
is necessary because ama lgam has a very
high coefficient of expansion, al most three
times that of tooth structure. In the
ra nge between ho t and cold foods, amalgam expands and shrinks eno ugh to cause
lea kage unless a setting ex pansion has
locked it tightly int o th e dentin." Leak.
age a rou nd a filling ca uses ch aracteristic
" blue margins," and may result in recurrent ca ries.
Hand co nde nsation will dependably
pack am algam with out these hazards. Almost any opera tor can dev elop enough
hand p ressure to do it well with med ium
a nd small conde nser points." As eac h
new port ion of amalgam is added, several
10 pound thrusts should first be made to
weld the new mass to th e mercury-rich
su rface of the preceding mass, Then the
condenser point is ste pped toward the
margins with five or six pound thrusts,
which will closely adapt the amalgam to
the ca vity and reduce me rcury content
sufficiently to produce a durable restoration. M ercury ' excess coming to the surfa ce during co ndensa tion is flipped out
with th e conde nser' point. It is likely th at
if the operator's ann does not ache after
conde nsing a large filling, the filling is
not well conde nsed. Household scales can
be used to test hand pressures, pressing a
co nd ensing instrument to the platform
with various imtrument grasps,

F IN ISII I Nt :

All am algam fillings should Ix bu ilt to an

of a full millinu-ter o r 1Il0 f(" be,
cause the top portion is neve r so well
condensed as the part undernea th . Carv_
ill~ ha ck 10 contour will th en Icave
thoro ughly condensed ama lgam on the
su rfa ce o f the finished res to ra tio n.
A wr-ll cond ensed lilli ll~ o f quic k lictting
alloy ran he ca rved immed iately. With a
slow setting a llo)' Ill(' operator should
wait for fro m Illn ,t, to five minutes. Carv.
ill ~ sho uld not he' sta rte d u ntil the amal,
~;~ m i~ l,., t enough 10 resist ca rving. It
Wi ll ~ I\T forth a r in~ i nlZ' sound in the
p rocr-ss. A ... ha rp ins t rumen t should be
uv-d to rut amalga m a nd th e n ttti ng
shou ld never 1)( done in thr- direction of
fillill~ to r -nnn u-l b ccausc th a t brings merCUI)' 10 the margin . A d ull ca rve r will
burnish ra the r than r-ut and in doin g so
~\' i11 di...rurh ...urf are rrystalliznt ion, bring,
IIlg lTwrnJr)' to tlu- surfare. It m ay open
a m a rgin hy d istort ing th e c ru irc ruass. A
sligh t r-xeess o f a ma lga m sho uld be left on
:.11 ca rved surfaces except whe re it would
r-a us,' a ct ua l occlusa l in u-rferr-ncc . This
Ir-a....l 'i tx("(s<; man-ria l fo r su bseq uent
d ressing a nd polish ing . Area s b uilt next
to the smoot h mat ri x ner-d no t'a r....ing a nd
little polishing. If the matrix flttt'd the
gingival. b ur-cal . a nd lingual margins
r-losr-ly. these m a rgin s shou ld not he
touchr-d until thr- pol ishing a p pointment
at which tiun- a sha r p gold knife' will
readi ly remove thr- s l i ~h l excess. H a
fault y matrix allows cou sidcrabh- margina l ex cess. most. hut not all, should be
removed at thr- fl lli n ~ appointment. A
romplctclv ca rved ma rgi n leaves no excess for tri mmin g and po lishing a t a la tte r
time. Carving ac tually Dicks out alloy
nart k -les from the n Y"it allizing mass. leavinJ:! a rough . un dercu t surface. SubseCX I' ("S5

IS. SkiM." . E. W . Th

~, i e "'e

" I d enl. 1 ....le. i. 1s

.-d. 1. 'hil.d e lphi . W. I . S,u..d e~ Co " p . lOS.

'
16-, BI. d , A. O. G. Y. BI. d ', -0'. on o~,.' i..e
~ e~."d ...... vo l. II. e-d. 7. Ch iuq o. t.Ae-d;, o ~"I. 1 Puel.t h." q Co .. 1916 P. 207.

MAH l f Y

. VOLUME 4) , " UG UST 19$1

I ~$

Fig. 16 Sho /I,j,, "l at rix tir d tlboul ,I"

upper m olar fo r m t sioocc /1ual nlld di sto
ocdusnl cal,itit l. Hardwood wedgrs art'
forced illto Ih, p, oxltn"l befow thl ( ln i ll-af
ma rgin . A hem oslal fo ,ceps p,ol/idt J tas )'
ml'ltnJ for i,uertion a nd /I,ithd",wltl

Fig 17 M al1ix ha s ball sla bilizt' d wi th

Kr Ull stick cOlllJ,ou nd [arced
Ihrough t ht int uproxim.al spaces, A w arm t d
bllrnishinR in strum tnl IS uud as sho w n to
(o nlou r tht m at rix 10 to ot h for m . Co m po und
can be su n flowing out fru m un der the
matrix band. L igatlHt tn ds art usuall,
slipped int o one of tilt rubbe r dam da m p
;tJws. I f they wert c u i shor t, Ofl t' might be
forgotl t n tJnd left ", nder tilt [ree ma rgin of
thl Rum to CQ !<IJt iflj u ry lin d in"ite infte lio n

fou ~ blod s of

Pig. 18 A m algltlll co nd ensin inst 'umtn ts

m ust be lIu d which can and ,n t m ade to
reach ever ), part of th t cavit )'. li e" th ,
essent ial d iam ond sha ped co ndens er is show ,l
to fit the co, ntis where matrix meets buccaf
and linK",al mar1!i,u

qu em contouring and polishi ng removes

the excess which has ber-n deli beratel y

left. The resulting su rface is made up of
polished facets of un amalgamated alloy
particles .....hich reta in a polish a nd resist
corrosion. The su rface ca n be likened
to that of the polished ma rble chips
fonni ng the- du rable fi nish of a ter ra zzo
Boor. The Portl and cement binder holds
the marble part icles together mu ch as
amalgam binds the alloy fi lings. T he
better the condensation, the less of the
weaker binding mater ial.

Schoonover and So ude r

~ h {)\'oI'd

that

even we ll co nd ensed ama lgam fi llings will

corrod e if they a rc not smooth at the

margins and polishe d .t-" It is best to defer po lishing for severa l days altho ugh a
satisfac tory result rna)' be obtained after
24 hou rs, Carved su rfaces a re d ressed with
sh arp round burs and finishin g bU TS.
M argins are pe rfect ed with a sha rp gold
knife. Wet pum ice on bristle brushes fol17. Skinne r. E. W . The , c;ien<:e of d en Io' mol eri ol, .
ed . ] , " hilod olp" io, W . B. ~~n de" Cc., 1 9~h, o. 327.

I.' TH E JO UIlN Al O F TH E A t.4ftI CA N OENTA l A SSOC IA TIO N

lowed by wet wh iting or rouge will remo ve scratches and leave a h igh polish.
H ea t from polishin g will quickly ru in an
amalgam filling. The critical temperature
is on ly 140o F.u Therefore only very wet
polishing agents sho uld be used to reduce
the hazard of heat.
D eep occlusa l grooves shou ld not be
ca rved into amalgam fillings, for d eep
grooves weak en the restoration and subject margins to chi pping ( Fig. 3 ) . Otherwise tooth fonn should be fa ithfully restored. Embrasure fonn is very important.
It shou ld be re membe red that th e contact
area is a millimeter or more rem oved
from th e height of the marginal rid ge.
Dentists have bee n so accu stomed to condensing fillings into plan e su rfa ce mat rixes that th ey have come to think of the
int erproxim al surfaces as bein g straight
lines wit h th e con tact a t th e crest of the
ma rgin al ridge. Normal conta cts should be
stud ied in in terp roximal roentgenograms.
It is ......ell to rem em ber th at marginal
ridges do not occlude necessarily and that
proper em brasures provide im portant
sluice-ways for food , relieving excessive
hydraulic p ressure wh ich is crea ted in
che wing food and ......hich traumatizes a
tooth.
It ca n be truthfully said that an am a lga m filling is usually much better than
it looks, whil e a gold inlay is seldo m as
good as it loo ks. Amalgam fillings resist
recu rr en t ca ries at their margins, while
most gold inlays invite margina l ca ries

which progn'sS{"s rapi d ly. The rea son ~

that ......ith ama lgam and gold foil, the 6t
o f metal to rna mel sea ls the tooth mOrt
d ependabl y than the r r-mcnt seals gold
in lay, which " II too frequently has a
margina l disc repa nc y somew he re.
Becau se good n-sto ra rions of sih'tr
a malgam yield a se rv ice h ighly m nnnen.
sura te to the effort expe nded , the demist
who perfects him self in the tech nic should
receive ad equ at e compe nsa tion. Cer ta inly
Ill' is emit ted to th e same ho u rly return
that he would de rive fro m gold reston,
tin' service. "'

CO NCLUS IOS

Amalgam restorat ions can be so good

th at th e)' a rc well wor th the ex ira cffon
necessary to make thcrn good. Am algam
fi llings ran be bu ilt consisten tly which
will serve from 15 to 20 years or more,
Th e lasting results possible with good
restorations of silver ama lga m help the
profession to mee t the demand fo r dental
ca re without th e d anger of pr icing OUf
p rofessional services beyo nd the reach of
the public.
632 R epublic Ruilding

18, Soud e. , W ilme. ~nd P ~He n b~ 'Q e . Geo'9 ~ C.

Phl'>ical p . oP ...
01 den l~ 1 m~ !""~ll, ci"u la 13,
U.S. Oe pa ,lme nt of Co mm e"It, Wa l hinqlon . Na tion"l
81,1'10,01,1 of St" nd a , dl , IH 2, p , 15.
l'i . Blacl , G. v , O per ali ve denli, t.y, vo l , II , ed.
~ Ch icaq o. Med ico -Oe nla l Pub li' hinQ Co. 1920. p. 329.

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