Dr shabeel pn
DEFINITION
Dental amalgam is a metal like restorative material composed of a mixture of silver/tin/copper alloy and mercury.
HISTORY
Amalgam has been primary restorative material for more than 150 yrs. Initially, amalgam restorations were made by dentists filing silver coins and mixing the filings with mercury. This was made to a putty like mass that was placed into the defective tooth.
USES
AS CLASS 1,2,5 RESTORATION. AS FOUNDATION- IN COMBINATION WITH RETENTIVE PINS TO RESTORE CROWN. FOR MAKING DIES. FOR RETROGRADE ROOT CANAL FILLING. AS CARIES CONTROL RESTORATION.
CLASSIFICATION
HIGH Cu ALLOYS
LOW Cu ALLOYS
> 6% Cu
< 6% Cu
ADMIXED
REGULAR
UNICOMPOSITION
SINGLE COMPOSITION
BASED ON Zn CONTENT
Zn CONTAINING
Zn FREE ALLOY
> 1% Zn
< 1% Zn
LATHECUT
SPHERICAL
ADMIXED
BINARY
TERTIARY
QUATERNARY
Ag,Sn
Ag,Sn,Cu
Ag,Sn,Cu,Zn
COMPOSITION
COMPOSITION
Low Copper: Silver - 63-70% Tin - 26-29% Copper - 2-5% Zinc 0-2%
Admixed:
SILVER:MAJOR ELEMENT. WHITENS ALLOY. DECREASES CREEP. INCREASES STRENGTH. INCREASES EXPANSION ON SETTING. INCREASES TARNISHING RESISTANCE IN RESULTING AMALGAM.
TIN:CONTROLS THE REACTION BETWEEN Ag & Hg. REDUCES STRENGH & HARDNESS. REDUCES RESISTANCE TO TARNISH & CORROSION.
ZINC: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.
PLATINUM:
PALLADIUM:
AMALGAMATION
DURING TRITURATION Ag & Sn IN THE OUTER PORTION OF THE PARTICLES DISSOLVE INTO Hg . Hg DIFFUSES INTO ALLOY PARTICLES. Hg HAS LIMITED SOLUBILITY FOR Ag (.035WT%) & Sn (.6wt%).
LATER, Sn8Hg + AgCu > Cu6Sn5 + Ag2Hg3 (r2) (eutectic) (n) (r1)
Single Composition
MICROLEAKAGE.
OCCURS DUE TO PENETRATION OF FLUIDS OR DEBRIS AROUND THE MARGINS THAT CAN LEAD TO SECONDARY CARIES. AMALGAM HAS GOT A SELF SEALING PROPERTY CORROSION PRODUCT WILL FILL THE TOOTH RESTORATION INTERFACE & PREVENT MICROLEAKAGE.
DIMENSIONAL CHANGES
CONTRACTION EXPANSION
ACCORDING TO ADA SPECIFICATION ,IT SHOULD NOT EXPAD OR CONTRACT MORE THAN 20u\cm AT 37 degree celcious BETWEEN 5min AND 24hrs AFTER BEGINNING OF TRITURATION. MODERN AMALGAM ALWAYS SHOWS CONTRACTION. OLDER AMALGAM SHOWS EXPANSION.
CONTRACTION.
RESULT IN MICROLEAKAGE & SECON DARY CARIES. FACTORS FAVOURING CONTRACTION
LONGER TRITURATION TIME. HIGHER CONDENSATION PRESSURE. SMALL PARTICLE SIZE. Hg ALLOY RATIO.
EXPANSION.
IF A Zn CONTAINING LOW Cu \ HIGH Cu IS CONTAMINATED DURING TRITURATION \ CONDENSATION ,A LARGE EXPANSION TAKE PLACE.IT USUALLY STARTS FROM 3-5 DAYS AND CONTINUE FOR MONTHS CREATING VALUES UPTO MORE THAN 400um DELAYED EXPANSION. H2O + Zn ZnO + H2
PROTRUSION OF RESTORATION OUT OF CAVITY INCREASE CREEP INCREASE MICROLEAKAGE PITTED SURFACE OF RESTORATION & CORROSION.
STRENGTH.
AMALGAM IS SRONGEST IN COMPRESSION & MUCH WEAKER IN TENSION & SHEAR , THE PREPARD CAVITY DESIGN SHOULD MAXIMIZE THE COMPRESSION FORCES IN SERVICE & MINIMIZE TENSION \ SHEAR FORCES.
CREEP.
DEFINED AS A TIME DEPENDENT PLASTIC DEFORMATION UNDER CONSTANT STRESS. ACCORDING TO ADA SPECIFICATION NO 1 CREEP SHOULD BE BELOW 3%.
MANIPULATION
MANIPULATION
(1) (2) (3) (4) (5) (6) Selection of materials Mercury:Alloy ratio Trituration Mulling Condensation Shaping & finishing
SELECTION OF MATERALS
a)
b)
c) d)
TRITURATION
(1)Hand mixing (2)Mechanical
MULLING
CONDENSATION
(1)
(2)
MERCURY TOXICITY.
PRECAUTIONS
Ventilation Disposal Sealed containers Vaccum cleaners
INDICATIONS
(1) (2) (3) (4)
Moderate to Large Class I & Class II Restorations Class V Restorations Temporary Caries Control Restorations Foundations
CONTRAINDICATIONS
(1)Esthetics (2)Extensive tooth destruction (3)Small Class I & II Cavities
(2)
Initial
1.
2.
3. 4.
Outline form & initial depth Primary Resistance form Primary Retention form Convenience form
Final
1. 2. 3. 4.
Removal of any remaining defective Enamel or Dentin on Pulpal floor Pulp protection Finishing External Walls Final Cleaning & Inspection
CLASS I
They are restorations on occlusal surfaces of premolars & molars, occlusal 2/3rd of facial & lingual surface of molars & lingual surface of maxillary incisors
CLASS II
They are reostorations on the proximal surfaces of posterior teethmesio occlusal , disto occlusal, mesio occluso distal
CLASS III
They are restorations on the proximal surface of anterior teeth that that do not involve incisal angle.
CLASS V
They are restorations on gingival 1/3rd of facial & lingual surface of all teeth.
CLASS VI
They are restorations on incisal edge of anterior teeth or cusp tip region of posterior teeth.
Signs of failures :
1.
2.
3. 4.
5.
6. 7.
8.
9.
Fracture Lines Marginal Ditching Proximal Overhangs Poor anatomic contours Marginal Ridge incompatibility Improper Proximal Contacts Recurrent Caries Poor occlusal Contacts Amalgam Blues
2.
3. 4. 5.
Improper Case Selection Improper Cavity Preparation Faulty Selection & manipulation of Amalgam Errors in Maricing Procedures Post Operative Factors
AMALGAM TATOO
Accidental implantation of silver containing compounds into oral mucosal tissue Occur:
1. 2. 3. 4.
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 Com. Sites- Gingiva, buccal mucosa, alveolar mucosa
CONCLUSION
Class I & II Restorations are still common procedures performed by general Dentists. Class VI are used infrequently It is important for practitioners to understand the indications, advantages, techniques & limitations of these restorations. When used correctly & properly selected cases, these restorations have the potential to serve for many years
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