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Amalgam Restorations I

Dental Amalgam Tin-silver amalgam alloy + mercury = Dental amalgam Copper Content Conventional Vs High Copper Amalgam Alloy High copper amalgam alloy have superior resistance to discoloration, corrosion, marginal breakdown, and creep compared to conventional amalgam. Particle Size & Shape Spherical Vs Lathe-cut Spherical alloy particles require less condensation pressure than lathecut fillings. Spherical alloy particles have less mercury content since less mercury is needed to coat the particles during amalgamation (amalgam mixing). Spherical Vs Lathe-cut Spherical alloy requires greater care in condensation than admixed or lathe-cut alloys to obtain good adaptation & tight contact. Larger size condenser should be used with the spherical alloy. Spherical high copper amalgam is the fastest in setting. Advantages 1. Strong 2. Durable 3. Relatively easy to use 4. Low-technique sensitivity 5. Marginal sealing with time 6. Antibacterial properties 7. Wears at rate similar to that of tooth structure 8. Least time consuming & has the lowest cost Disadvantages 1. Not tooth colored 2. Susceptible to corrosion & galvanism 2. Dose not bond to tooth structure 3. Contains mercury

Indications 1. Class I, II and V restorations in posterior teeth. 2. Base build-up prior to crown preparation. Properties Adaptation: There is a microscopic gap between amalgam & restoration that cause microleakage. Condensation of amalgam in the cavity should be done efficiently & promptly to minimize this microgap. Amalgam dose not strengthen the remaining tooth structure, as more tooth structure is lost, the possibility of fracture increases. Amalgam Bonding: Attempts have been made to bond amalgam with adhesive resin liners. Some of the studies found good result in increase retention & strength of amalgam but most of them are laboratory studies. Setting Dimensional Changes: There is a number of dimensional changes during setting of amalgam (expansion & contraction). Most of this dimensional changes occur in the first 6 to 8 hours after mixing. Factors that contribute to expansion are: undermixing, excess mercury & moisture contamination. Factors contribute to contraction are: overmixing, increased condensation forces & the use of smaller particle size alloy. High copper amalgam have less setting dimensional change than conventional amalgams. Strength: Amalgam tensile strength is lower than its compressive strength, so fracture of amalgam occurs due to tensile forces. Amalgam should have sufficient bulk to compensate for this weakness. All margins should be 90 to minimize marginal fracture. Factors that contribute to increased strength of amalgam: removal of excess mercury during condensation & increase condensation forces to eliminate voids.

Decreased strength will result from undermixing or contamination during placement. Setting Speed: The fastest setting amalgam is the high-copper spherical. The high copper admixture & the low copper spherical have intermediate setting speed. The low copper lathe-cut amalgam is the slowest in setting. The working time is related to the setting speed. Manufacturers classification: fast-set, regular-set & slow-set. Alloy should be selected that has appropriate working time. Creep: The permanent deformation of set amalgam when it is subjected to mild, continuous or cyclical forces. Can result in marginal or proximal extrusion of amalgam restorations. High copper amalgam alloy have lower creep than conventional amalgam alloy. Creep of conventional amalgam is influenced by increasing mercury, incorrect mixing time and deceased condensation to a greater degree than is the creep of high copper amalgam. Corrosion: It is the slow deterioration of amalgam in the oral environment. Initially can result in pitting and discoloration of the surface of amalgam. If proceeds, it can weaken & cause fracture to the amalgam. One advantage of amalgam corrosion is the filling of the marginal gap with the corrosion products. Two types of corrosion: chemical & electrochemical. Cavity Preparation for Amalgam Outline Form The cavosurface outline should be continuous, curved line, especially on occlusal surface. It is difficult to condense, carve & burnish amalgam in to sharp angles. The outline should be kept as conservative in width as possible, removing only carious & potential carious pits & grooves. The cavosurface margins on proximal surfaces should not touch the adjacent teeth or restorations.

Resistance Form The pulpal & axial walls should be in dentin. The pulpal floor should be flat & smooth. The axial walls should be convex & follow the contour of the surface of the tooth. Cavity depth & width should be enough to create sufficient bulk to the restoration. The opposing walls of the cavity preparation should be parallel or slightly convergent toward the surface of the tooth. All cavosurface angles should be approximately 90. Retention Form: Sufficient retention is obtained by resistanceform. In large preparations, auxiliary retention features can be added. Convenience Form: Wide enough for instrumentation of the cavity & condensation of amalgam. In proximal lesions, the access should whenever possible avoid extension beyond what is necessary to access the proximal lesion & the adequate retention form. If occlusal lesion is present, it should be treated separately whenever possible. Removal of Carious Dentin Finishing the Enamel All enamel margins should be 90 Cleaning the Cavity Class I Buccal Pit Amalgam Outline Form All of pit area & any portion of buccal groove that is carious or potentially carious Resistance Form Mesial & distal walls are parallel or slightly divergent toward buccal wall. Occlusal & gingival walls are parallel or slightly divergent toward the buccal surface.

The axial wall depth is 1.5 mm or just inside the DEJ. The axial wall follow the external contour of the buccal surface of the tooth. Retention Form In ideal size buccal pit, no need for additional retention. In large size preparations, retention grooves can be placed in mesial, distal or gingival walls. Class I Occlusal Amalgam Outline Form Include mesial & distal pits. Central, buccal & lingual grooves. Free flowing outline form with no sharp corners. All faciolingual width should be 1-1.25 mm except at the intersection of grooves. 2 separate occlusal cavities: Mandibular first premolars Maxillary molars Resistance & Retention Forms Pulpal floor should be at right angle to the long axis of the tooth. Except of the mandibular first premolar( angled lingually). Resistance & Retention Forms Pulpal depth: 1.5-2 mm B & L walls are parallel or slightly convergent occlusally

Resistance & Retention Forms:

Class I with Buccal Extension

M & D walls diverge occlusally

Outline form Same as Class I Buccal groove is extended to include buccal pit Depth pulpally:1.5-2 mm

Depth axially:1.25 mm

Resistance & Retention Forms Pulpal floor should be at right angle to the long axis of the tooth B & L walls are parallel or slightly convergent occlusally M & D walls: On occlusal diverge occlusally. Those on facial extension are parallel Retention grooves: Grooves in M, D walls

Class I with Palatal Extension Outline Form: Mesial: Central pit, mesial pit, of buccal groove. Distal: L shaped preparation. Include distal pit and lingual groove. Pulpal depth: 1.5-2 mm Axial depth: 1.25-1.5 mm

Resistance & Retention Forms B & L walls: Parallel or slightly convergent M & D walls: Mesial diverges. Distal wall is vertical M & D walls of the extension: Parallel Resistance & Retention Forms

Retention grooves in the lingual box. In M, D walls, from gingival to pulpoaxiall line angle.

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