Amalgam
Restorations
Presented by
01/13/10 Arpita Pareek
ARPITA PAREEK
I. FAILURES OF DENTAL AMALGAM
Dental amalgam is one of the most
frequently used restorative materials for
restoration of posterior teeth. In routine
properly restored silver amalgam may not
• last for more than ten years.
Early restored teeth appear excellent but
• gradually peculiar things begin to happen
• altering the technical details of the
restoration.
• These may lead to fracture of’ restoration,
• tooth fracture, recurrent caries,
discoloration, corrosion, loss of restoration
• and etc.
• The observed amalgam failures are most
likely because of factors other than the
• material itself. The success of the amalgam
• restoration depends upon the control and
attention to many variables.
• The different types of failure in an amalgam
restoration are -
• I. At visual level
• Secondary caries
• Marginal fracture
• Bulk fracture
• Tooth fracture
• Dimensional change
• II. At the microstructural level
• Corrosion and tarnish
• Stresses associated with masticatory forces
• III. Pain following amalgam restoration
• IV. Pulp and/or periodontal involvement
•
• Failures in an amalgam restoration
can be studied in detail under two
main headings:
• Failures due to faulty cavity
preparation
• Failures due to poor matrix
adaptation
• Failures due to faulty amalgam
manipulation
• I. Faulty Cavity Preparation
• Most clinical studies have concluded that improper cavity preparation leading to
recurrence of caries and fracture is the greatest single factor responsible for
failure.
• Healey and Philips (1949)40 evaluated 1521 defective amalgam restorations and
reported that 56% of the failures were because of improper cavity
preparation and 42% of the failures were because of faulty manipulation of
amalgam.
• The different causes of failure that can occur at various steps while preparing a
cavity for amalgam are as follows:
• Inadequate occlusal extension : On the occlusal surface the preparation should
be extended to include all the susceptible pits and fissures while terminating
the margins in areas that can be finished.
• b) Inadequate extension of the proximal box
• If the proximal box walls are not adequately extended into the embrasures they
are not amenable to brushing & cleaning by mastication which predisposes
to secondary caries
• c) Overextension of the cavity preparation walls:
• The ideal facio-lingual width of the cavity preparation for amalgam should be
1/4th the intercuspal distance.
• If the cavity preparation extends to half of the intercuspal distance,
consideration should be given to capping of the cusps.
• If the cavity preparation extends to 2/3rds of the intercuspal distance cusp
capping becomes mandatory.
• If the remaining cusps are not capped in large amalgam restorations, there are
chances that the cusps can fracture. This is because amalgam restoration
on acts as a wedge and tends to split the exposing cusps apart.
• During cusp capping amalgam should be present in a minimum thickness of 2
mm over functional cusps and minimum thickness of 1.5 mm over non-
functional cusps to give it adequate strength.
• d)Amalgam cavity preparations should have a
minimum depth of 1.5 mm to provide it
bulk .Hence resistance to fracture.
• e) If pulpal floor of the cavity preparation flat
but curved the restoration produces wedging
effect thus increasing the chances of fracture
of tooth.
• To assure strong junctions between amalgam
and tooth regardless of its location, butt joints
created particularly in those regions where
occlusal stresses to be encountered.
• Cavosurface angle is acute there are chances of
fracture of the tooth margins whereas if the
cavosurface angle is obtuse the acute
marginal amalgam is likely to collapse under
occlusal stress.
• The cavity margins should be adequately
finished to remove any unsupported enamel
rods, which are susceptible to fracture leading
• g) Failure to round off the axio-pulpalline angle as well as
internal line angles and point angles can lead to
concentration of stresses and fracture of the tooth or
restorative material.
• h) Occasionally, fracture may be seen at the isthmus
portion of the proximo-occiusal restoration, which may
be because of a very narrow isthmus or inadequate
proximal retention form.
• i) Failure to diverge the mesial and distal walls of the
occlusal cavity preparation. When the mesio-distal
extension of the cavity is extensive it can cause fracture
because of the undermining of the mesial and distal
marginal ridge enamel.
• j) Retentive devices should be prepared entirely in dentin
without undermining the enamel.
• k) Incomplete removal of carious tooth structure leads to
failure of amalgam restoration.
• l) Flat pulpal floor should be provided around the excavation
site of caries. If this is not possible at least three flat
seats should be provided to resist the forces directed
along long axis of the tooth
• m) Post operative pain can also be a routine failure. The
dentist should use high speed rotary instruments, with
intermittent cutting and adequate cooling of tooth
• II. Poor matrix adaptation