*

*
*Dental Amalgam is a metal like restorative
material composed of a mixture of silver/tin/copper alloy and mercury.

*
Dimensional change Strength Corrosion Creep

Ideally, an amalgam should have:
No change in dimensions Remain stable for the life of the restoration.

 Ideally the dimensional change should be small

Severe contraction:Microleakage Plaque accumulation Secondary caries Excessive expansion :-

Pressure on the pulp

Postoperative sensitivity Protrusion of restoration

* ANSI/ADA SPECIFICATION NO.1

Amalgam neither contract nor expand more than 20 m /cm measured at 37degcelsius Between 5 min and 24 hr after the beginning of triturition . With a device that is accurate to at least 0.5m

The specimen size should be essentially equivalent to the bulk used in large 7 restorations

The leading causes for failures include Secondary caries Marginal fracture Bulk fracture Tooth fracture At microstructural level Corrosion & tarnish Transformation Stress associated with mastication forces
8

*
*Under triturition Restoration in the mouth has contracted or As
expanded within the required 20micrometers limit of such dimensional change . average human hair is 40micrometer it is virtually impossible to detect margins that may be open a a few micrometers either wit a eye or dental instrument

*
*Early surveys 16.6% of a large group of
defective restoration failed because of excessive expansion.

There are several causes of excessive expansion

*1.Delayed expansion
*2.Insufficient triturition or condensation
10

*In delayed expansion large expansion

begins after 4-5 days following condensation

*Patient may experience pain after 10-12

days after the insertion of the restoration .

*Assumed that when a expansion of thin

magnitude occurs ,the restoration may become wedged so tightly against the cavity walls that a pressure towards the pulp chamber results and finally protrusion of restoration. 11

*If the patient complains of pain after 1 day after

a restoration is placed cannot be suffering from delayed expansion

Shiny abrasion marks

Possibility of hyper occlusion

Occlusion should be adjusted

12

*
oPrimary requisite- sufficiently high strength to
resist fracture.

oFracture of even a small area , especially at the

margins , increases the risk for corrosion , secondary caries , &subsequent clinical failure.

oMargin defects are the most frequently defects in

amalgam.

13

*
Compressive strength of a satisfactory amalgam should be 310MPa compressive strength tensile strength

(MPa)
Amalgam Low copper Admix 137 1hour 145 7days 343 431 24hour 60 48

(MPa)

Single
composition

262

510

64

14

*EFFECT OF TRITURATION:- The type of amalgam alloy

-the trituration time
- speed of the amalgamator

so either undertrituration or overtrituration decreases the strength in both

traditional &high copper amalgam.

*EFFECT OF CONDENSATION:-condensation pressure

-technique -alloy particle

Lathe cut alloy- high condensation pressure. Spherical alloy- light pressure. Good condensation techniques express mercury result in a
smaller volume fraction of matrix phases .
15

*Effect of porosity:plasticity decreases

due to plasticity of the mix .

increase in time
undertrituration & delayed condensation

*Effect of amalgam hardening rate: probably a high % of

restorations that fractures do shortly after insertion. Clinical manifestation may not be evident but an initial crack may occur within few hours. the 1- wk strength .

At the end of 20 min , compressive strength may be only 6% of

ANSI/ADA specification stipulates a minimum compressive

strength of 80 MPa at 1hr.

16

*
*Any exccess mercury left in the restoration can produce a
marked reduction in strength.

*Mercury content increases more than app. 54% than the

strength is markedly reduced .

*Low mercury amalgam contain more of stronger alloy particles

&less of weaker matrix phases.

*But increasing the final mercury content increases the volume

fraction of the matrix phases at the expense of the alloy particles .

17

*
*Amalgam restorations often tarnish &corrode in the oral
environment.

*Degree of tarnish and the resulting discoloration depends

greatly on the individuals oral environment & to a certain extent to the alloy employed. metal surface along the interface between the tooth and the restorations .

*Active corrosion of a newly placed restoration occurs on the *Self sealing restorations . *Presence of 2
Most common products oxides &chlorides of tin
18

If gold restoration is placed in contact with an amalgam .

*
* DEFINITION:-time dependent plastic strain of a material under a static load or
constant stress.

* Creep has been found to correlate with the marginal breakdown of traditional low
copper amalgams. Higher the creep of marginal deterioration. It is prudent to select a commercial alloy that has a creep rate below the level of 3% specified in ANSI/ADA specification no. 1 . Greater degree magnitude

19

* Low copper * Admix * Single composition

2.0% 0.4 %

0.13%

20

Influence of microstructure on creep: 1 phase has a primary influence on low copper

amalgam creep rates .

*Creep rates - higher 1volume fractions . *Creep rate - larger 1grain sizes. Presence of 2 - higher creep rates Very low creep rates in single composition high copper alloys
which may be associated with rods .

Effect of manipulative variables on creep-

Mercury alloy ratio should be minimized . Condensation pressure maximized for lathe cut & admixed
alloys .
21

FOUR MAJOR MANIPULATIVE

VARIABLES OF SILVER AMALGAM

1. 2. 3. 4.

The proportioning of mercury and alloy Trituration Condensation Contouring and finishing

22

*
*Historically only way to achieve smooth & plastic *Because of deleterious effects mercury contents
are reduced
amalgam mix is by considerable amount of mercury .

For conventional mercury 2 Techniques were used

1. Removal by squeezing & wringling.

2. During condensation

But there is considerable chance of error . So the most obvious method is to reduce the mercury
content by reducing mercury alloy ratio.
23

Minimal mercury technique or Eames technique- designed for manipulation with reduced mercury/alloy ratios .

Sufficient mercury should be present in the original

mix to provide a coherent & plastic mass after triturition but it should be as minimal as kept.

Mercury content of the finished restoration should

be comparable of that of the original mercury alloy ,usually about 50% with lesser amounts (~42wt%)being used with spherical alloys.

Excellence of clinical restorations Proper 24 manipulation

*
*Amount of alloy & mercury *Acc. to ratio
mercury/alloy ratio Mercury /alloy ratio 6 parts of mercury of 6/5 indicates 5 parts of alloy by wt. * According to percentage a mix of amalgam prepared with a mercury / alloy ratio of 6:5 contains 54. 5% of mercury . Recommended mercury/alloy ratios :Lathe cut alloys - 1:1 or 50% mercury Spherical alloys 42% If Mercury content low Mix can be dry and grainy . - Corrosion resistance is reduced .
25

Disposable capsules

* Pre-proportioned aliquots of
alloy.

mercury &

* Contain alloy powder either in pellet form

or as pre-weighed portion of powder in conjunction with appropriate quantity of mercury.

Separated from each other to prevent

amalgamation.

Self activating capsules. Eliminates the chance of mercury spills during

proportioning.
26

*Its objective is to wet all the surfaces of the alloy

particles with mercury. *For proper wetting ,the alloy surface should be clean . *Rubbing of the particles mechanically removes the oxide film coating on alloy particles.

*Trituration is achieved either by:-

*1. Hand mixing *2. Mechanical trituration

27

*
Glass mortar
& pestle are used. Glass mortar inner surface roughened to increase the friction between amalgam and the glass surface . Pestle is a glass rod with a round end.
28

Three factors to obtain a well mixed amalgam mass are

1. Number of rotations 2. Speed of rotation 3. Magnitude of pressure placed on the pestle.

29

*
*Mechanical amalgamators are more
commonly used to triturate amalgam alloy & mercury.

*CAPSULE mortar *PISTON pestle *Capsule is inserted between the arms on

top of the machines . When put on, the arms holding the capsule oscillate at high speed , thus triturating the amalgam . confine mercury spray & prevent accidents .
30

*Newer amalgamators have hoods to

*
Mixing time

refer to manufacturer
recommendation.

Spherical alloys usually require less

cut

amalgamation time than do lathe alloys. mixing time than a smaller one .

A large mix requires slightly longer

31

ADVANTAGES :1.Shorter mixing time .

2. More standardized procedure.

3. Requires less mercury as compared to hand mixing technique.

32

*
NORMAL MIX

Shiny surface & a smooth & soft consistency. Warm but not hot when removed from the capsule . Best compressive strength & tensile strength . Have increase resistance to tarnish and corrosion.

OVERTRITURATION

Hot mix. Mix is soupy & sticks to capsule. Decreases working / setting time. Slight increase in setting contraction. Creep is increased.
33

UNDERTRITURATION
Grainy,

crumbly mix. Rough surface after carving . Strength is less . Mix hardens too rapidly.

34

*
*Actually a continuation of triturition .
-Improve the homogenecity of the mass. -To assure a consistent mix

it can be accomplished in 2 ways:-

1. Mix is enveloped in a dry piece of rubber dam & vigrously rubbed between the 1st finger & the thumb ; or the thumb of one hand &palm of the other hand . The process should not exceed 2 to 5 seconds . 2. After trituration the pestle can be removed from the capsule , & the mix can be triturated in the pestlefree capsule for an additional 2 to 3 seconds .

35

*
GOAL- To compact the alloy into the prepared cavity so that the greatest possible density is attained , with sufficient mercury present to ensure complete continuity of the matrix phase between the alloy particles. It is of two types :-

1. Hand condensation.
2. Mechanical condensation.
36

*
Increments should be carried to &inserted into the
prepared cavity by means of instruments such as an amalgam carrier.

Once placed , should be immediately condensed to

remove voids & adapt to the marginal walls .

Condensation is usually started at the centre & then

the condenser point is stepped little by little towards the cavity walls.

After condensation of an increment, the surface

should be shiny in appearance.

37

*
The procedure of adding an Increment ,condensing it
, adding another increment & so forth is continued until the cavity is overfilled .

Any mercury-rich material at the surface of the last

increment , constituting the overfill, is removed when the restoration is carved.

Most important factor- size of the amalgam

increment carried into the cavity . Larger the piece ,more difficult to reduce the voids & adapt it to the cavity walls.

38

*
The condensation pressure is
governed by

1. 2.

The area of the condenser point, or face. The force exerted on it by the operator .

39

Smaller the Condenser

Increased

pressure is exerted on the

amalgam

Thrust of 44(N)(10lb)
Circular Condenser 2mm 13.8mpa

(2000psi)
Circular Condenser 3.5mm 4.6mpa (667 psi)

40

Force recommended

66.7N

For condensation

(15lb)

But forces applied Generally

13.3N-17.8N (3-4lb)

41



Oval
Crescent Trapezoidal

Square
Round condenser Triangular Rectangular point

42

*
*The procedures and principles of mechanical
condensation are the same as those for hand condensation.

* The only difference is that the condensation of the

amalgam is performed by an automatic device.

* Various mechanisms are employed for these instruments. Impact type of force Rapid vibration.
43

Advantages:

1.

Whichever device , less energy is needed than for hand condensation 2. The operation may be less fatiguing to the dentist .

Similar clinical results

The method selected is usually based on the preference of the dentist.

44

*
* After condensation , the restoration is carved to
reproduce the proper tooth anatomy. OBJECTIVE-

* To simulate the anatomy rather to reproduce

extremely fine detail.

* Carving is too deep Bulk at marginal areas are reduced. Thinning will leads to its fracture under
masticatory forces .

* Craving should not be started until the amalgam is hard

enough to offer resistance to the instrument.

45

*
After the carving is completed the surface should
be smoothed .This may be accomplished by judiciously burnishing the surface &margins of the restoration.

Burnishing of the occlusal anatomy can be accomplished

with a ball burnisher . surfaces.

* A rigid, flat bladed instrument is best used on smooth * Pre-burnish * removes excess mercury
*

improves margin adaptation

improves smoothness

* Post-burnish
*

46

*
Final smoothing Done b y rubbing The surface Moist cotton pellet or Rubber polishing cup with prophylactic paste

Final finish of the restoration should not be done until

the amalgam is fully set.

It should be delayed for 24hr after condensation. The use of dry polishing powders can raise the surface
temperature above the 60deg c (danger point).

Thus a wet

abrasive powder in a paste should be used.

47

*Toxicology is derived from greek word toxicon (arrow

of poison) and logus (knowledge). It is the study of adverse effects of chemicals on living organisms.

*Mercury is a liquid metal.

*Any
alloy in presence of mercury forms amalgam, which forms a plastic mass which is inserted and finished in the prepared cavity. vapor from amalgam fillings.

*Patients can be exposed to mercury, by release of its

48

*
* Mercury * Mercury
toxicity from dental restorations is the cause for certain undiagnosed illness, and a real hazard may exist for dentist when mercury vapor is inhaled during mixing, placement and removal. penetrates from the restoration into tooth structure leading to discoloration of the tooth.

* Small amounts of mercury are released during mastication.

* Most
significant contribution to mercury assimilation from dental amalgam is via vapor phase.

49

Mercury release from amalgam fillings is phasic and consists of a very low release, and an increased stimulated release results due to tooth brushing or chewing. Mercury emitted from amalgam may be in one or two forms. Mercury vapor(hg0) which passes into intra oral air and from here may be either inspired into the lungs or expired into the outside air. Mercuric ions (hg2+)which passes into the saliva and from there to the gastro intestinal tract.
50

* * *

*Dentists

are exposed daily to the risk of mercury intoxication,through skin,or by inhalation. readily detected by simple means.

*Mercury vapor has no color, odor, or taste and cannot be

*As
liquid mercury is almost 14 times more dense than water in volume it becomes very significant. level of occupational exposure considered safe is 50g of mercury per cubic meter of air.

* Maximum

51

*
AUTHOR NO. OF SURFACES 12.6 MERCURY(g/ DAY) 19.8

VIMY & LORSEHEIDER (1985) LANGWORTH (1988) SNAPP (1989) SKARE & ENGQVIST (1994)

25 14

3 1.3

39

12

52

*
*VAPOR
METALLIC hg CAN BE INHALED AND ABSORBED THROUGH THE ALVEOLI IN THE LUNGS AT 80% EFFICIENCY, AND THUS CONSIDERED AS THE MAJOR ROUTE FOR ENTRY INTO HUMAN BODY.

*Concentrates in certain organs such as liver, kidney and

brain.

*Eventually

all are excreted but rate is dependent upon bodys ability to convert it to other forms.
53

INVESTIGATOR

CHEWING/ BRUSHING BEFORE

AFTER

UNITS

SVARE (1981) OTT et al(1986) VIMY (1985)

0.88 0.29 4.91

54

13.74 1.35 29.10

g/cubic meter g/cubic meter g/cubic meter

*
EFFECT NO EFFECT DECREASE INCREASE AVERAGE STIMULATION FACTORS FOOD AND DRINK HOT AND COLD DRINK,APPLE MIXED LUNCH,EGGS BRITTLE BISCUITS

GUM CHEWING
MIXED FOOD CHEWING TOOTH BRUSHING
55

X 5.3
X 3.7 X 1.9

SUBJECTS

CONC.IN TISSUES (ng/g) KIDNEY MEAN(n)

PITUITARY n

BRAIN n

DENTISTS (3)
CONTROL (12)

1533
273
56

1599
107

61
11

*
*CLINICAL MERCURISM THRESHOLD -100g per cubic
meter.(Loael low observed adverse effect level)

*Nephrotoxicity threshold -50g per cubic meter.(Loael)

*World health organization industrial threshold -25g per

cubic meter.(Noael no observed adverse effect level)

*General public threshold -5g per cubic meter.(Noael) *Children,pregnant,sick threshold -1g per cubic
meter.(Noael)
57

*
* Vimy/lorscheider
*
(am physio 1990/258/939-945) j

5 adult ewes autopsied after amalgam placement. fetal lambs exposed in utero after mothers amalgam placement.

* 3-5

58

* 80 Wistar Rats Exposed: 40 to Hg0,

40 to Hg0 + chlorine vapors

and

(P L VIOLA AND CASSANO AUTORADIOGRAPHIC STUDY 1968/59/437-44)

* AFTER 6 WKS OF EXPOSURE

TO hgo RATS REVEALED HYPEREXCITEMENT SOMETIMES FOLLOWED BY ATAXIA AND TREMOR WHILE THE RATS EXPOSED TO BOTH SHOWED MILD DYSPNOEA,COUGH AND DIARRHOEA. * After 8 wks 10 out of40 rats died in 1st group and 4 out 40 died in 2nd group.

59

Pink Disease: the iatrogenic poisoning of babies with mercury-containing teething powders & worming medicines
* Warkany
( am j dis child 1966/112/147-156) estImated that 1 in 500 exposed infants developed the disease.

* For over a hundred yrs thousands

of children were killed by accidental poisoning and many suffered in misery. disappeared after the Hg containing medicine were with drawn. Adult survivors of pink disease tend to have aspergers syndrome.

* Disease

60

* Mad as a hatter" will forever be linked to the madcap

millionaire in Lewis Carroll's classic children's book, Alice in Wonderland. relates to a disease peculiar to the hat making industry in the 1800s. turning fur into felt, which caused the hatters to breathe in the fumes of this highly toxic metal.

* But few actually know that the true origin of the saying

* A mercury solution was commonly used during the process of * Resulting in symptoms such as trembling (known as "hatters'

shakes"), loss of coordination, slurred speech, loosening of teeth, memory loss, depression, irritability and anxiety -"The Mad Hatter Syndrome." The phrase is still used today to describe the effects of mercury poisoning.

61

* Hg poisoning induces a wide range of

psychiatric disturbances
* GERSTNER
AND HUFF JOURNAL OF TOXICOLOGY AND ENVIORNMENTAL HEALTH 1977/2/491-526

* Exposed

persons experience feelings of fatigue and restlessness; they lose interest in their surroundings and in their own life; they withdraw more and more from social contacts; they become increasingly irritable and sensitive, reacting strongly to relatively innocent remarks uttered by family or friends; and they have a tendency for sweating and blushing. In this blushing - or reddening the classical term "erethism finds its origin. * In very severe cases, the depression may reach suicidal proportions. * A deterioration of intelligence gradually emerges during chronic exposure to elemental mercury. Previously bright persons become dull and slow in thinking.

62

* Experts Agree: Its an Intriguing

Neurotoxin. Nothing else even comes close!
CLARKS JOURNAL OF TRACE ELEMENTS IN EXPERIMENTAL MEDICINE 1998/11/303-317 Inhaled mercury vapor produces a range of fascinating and bizarre changes in human behavior. Erethism is a wide spectrum of psychological and personality disturbances. One end of the spectrum involves delirium, hallucinations, excessive shyness, and fits of rage. . . [while] irritability, insomnia, and lassitude may be the lower end of the erethism spectrum. No other metal can affect the central nervous system in this way. In fact, it is doubtful that any chemical, even hallucinogenic drugs, can compare with mercury vapor. It is a tantalizing problem to the neuroscientist.
63

*
*This
at times been claimed as potential hazard. This is an immune system response to very low level of mercury.

*The

antigen antibody reaction marks by itching, rashes, sneezing, difficulty in breathing, swelling, or other symptoms.
hypersensitivity to mercury results in a contact eczematous reaction on the skin and possibly the 64 oral mucosa.

* Delayed

* Its

prevalance is low in population. Only 41 published cases of allergy to amalgam restoration from 1905-1986. Oral manifestations were present in only 17 cases. such a reaction has been documented, an alternative material, such as composite, ceramic or cast metal alloy must be used.

* When

65

*What is a safe level of

*The
U.S. Environmental Protection Agency sets a non-occupational reference air concentration (RfC). In 1996, the RfC was: 0.300 g Hg0/m3 *The U.S. Agency for Toxic Substances and Disease Registry (ATSDR) publishes a Minimal Risk Level (MRL) for nonoccupational exposure. In 1999, the MRL for mercury vapor was set at: 0.200 g Hg0/m3
66

vapor?

*
*Mercury is the most toxic non-radioactive element on
earth. *A silver-coloured mercury amalgam filling normally contains 52 percent mercury. *On average, amalgam fillings weigh 1 gram and contain gram of mercury. *Half a gram of mercury in a 10-acre lake would warrant issuance of a fish advisory for the lake. *1 OUT OF EVERY 10 DENTAL OFFICE CROSSES THE MAX. EXPOSURE LEVEL OF MERCURY.

67

*SO WHY ARE DOCTORS

AVOIDING IT?
There have been epidemics of mercury poisoning among wildlife and human populations in many countries. With very few exceptions and for numerous reasons, such outbreaks were misdiagnosed for months or even years. Reasons for these tragic delays included the insidious onset of the affliction, vagueness of early clinical signs, and the medical profession's unfamiliarity with the disease.

HARDMAN J G,LIMBIRD L E THE PHARMACOLOGICAL BASIS OF THERAPEUTICS,10TH EDITION,MC GRAW HILL 2001 68

*
* Chelation was first used in the 1940s by the U.S. Navy to treat lead
poisoning and was subsequently approved by the FDA as a safe method of treating heavy metal toxicity. Chelation therapy is a medical treatment that improves metabolic and circulatory function by removing toxic metals and abnormally located nutritional metallic ions (such as iron) from the body. This is accomplished by administering an amino acid, ethylene-di- amine-tetra-acetic acid (EDTA), by either an oral or intravenous infusion.

* When a molecule of EDTA travels through the blood stream, it grabs

on to the heavy metal particles, binding tightly and pulling them out of the membrane or body tissue in which they are embedded. Since EDTA is an artificial amino acid, the body regards it as a foreign substance and delivers it to the kidneys to be excreted in the urine.

69

*
MAIN AREAS THAT BEEN INVESTIGATED ARE

* CNS * RENAL SYSTEM * IMMUNITY * ORAL CAVITY

* BIRTH DEFECTS
* GENERAL HEALTH
70

*
* THE
MINIMUM URINARY LEVEL TO SHOW ANY SIGN OF NEUROTOXICITY IS 25/g CREATININE AND THIS IS 6 TIMES HIGHER THAN HIGHEST URINE LEVEL ATTRIBUTABLE TO PRESENCE OF DENTAL RESTORATION.

*A

recent study in greenland (tulinus -arctic medical research 1995/54) showed intellectual ability of school children with dental amalgam restoration in their mouth.

* No

corelation found in marks in any shool subjects and no.Of amalgam restoration.

* So

no relationship between the presence of amalgam fillings and neurological function.

71

*
* Studies
of industrial workers exposed to mercury show that altered kidney dysfunction does not occur until the urine mercury level is more than 25 times higher than that associated with dental amalgam fillings. on humans by weismann and hoffmannn (pharmaco toxicology 1995/76/47-49) showed no evidence of kidney impairment after measuring urine mercury and n acetyl pglucosaminidase (nag) levels in 100 subjects.

* Studies

* In 66 subjects dental restorations were present and 34 subjects * So

were without fillings. No significant difference between the groups. no evidence dysfunction. linking dental amalgam with kidney

72

*
* Studies
by wilheim,dunninger (clinical investigation 1992/70/728-734) compared 2 patient groups,1 having st amalgam fillings for 1 time other having all existing amalgam fillings removed. determined before and after these treatments.

* The relative no. Of t- lymphocytes, b lymphocytes were

* No

difference between 2 groups and no effects of amalgam fillings on any white blood cells or immunocompetence.

73

*
*
Study showed by summers and wireman (antimicrobial agents chemotherapy 1993/37/825-834),changes in antibiotic resistance of oral and intestinal bacteria in monkeys with 12 amalgam restoration for 5 weeks did not show any change in the pattern of antibiotic resistance to these bacteria.

*
*

This was because there were a large no. Of antibiotic resistant bacteria present in the gut both before and after this experiment.
No evidence to support that mercury from amalgam fillings can increase the no. Of antibiotic resistant bacteria in the mouth or gut

74

*
* Human studies (kuntz d,pitkin american journal obstestrics gynaecology
-1982/143/440-443) attempted to relate still birth and birth defect to mercury level in maternal and umbilical cord blood.

* No

significant association with the no. Of amalgam fillings in the mothers. survey of dentists and dental nurses(brodshy and cohen jada 1985/111/779-780) found no difference in the rates of spontaneous abortion and fetal abnormalities in subjects exposed to high low level of mercury.

* Ada

* No association between amalgam fillings and birth defects.

75

*
*A
large survey was conducted on 1024 subjects (aged 38-72 by ahlgwist and bengtsson cdoe/1988/16/227-231) by questioning on specific symptoms and complaints to the no. And size of amalgam restoration in their mouth.

* No

corelation were found between them instead those with dental amalgam fillings showed better general health than those without fillings probably reflecting greater concern for health matters.

76

21.09.2006

77

*
* * *
SYMPTOMS KNOWING POTENTIAL HAZARDS, eg SENSITIVITY AND NEUROPATHY Hazards - potential sources of mercury vapor, eg spills, leaky dispensers,polishing and removal of amalgams,heating of contaminted instruments. Ventilation proper ventilation in work place by having fresh air exchanges and periodic replacement of filters which may trap mercury.

Monitor office the mercury vapor level should be periodically monitored by dosimeter badges.THE CURRENT OSHA LIMIT FOR MERCURY VAPOR IS 50 gm/cubic meter IN ANY 8 HR WORK SHIFT OVER A 40 HR WEEKLY WORK
78

*
* Monitor * Office
personnel periodic analysis (avg.Mercury level in urine is 6.1g/lt FOR DENTAL OFFICE PERSONNEL. design proper work area design to facilitate spill containment and clean up. or store mercury in unbreakable containers.

* Precapsulated alloys to eliminate the possibility of a bulk mercury spill * Amalgamator cover it should be fitted with a cover.

79

*
*Handling
care avoid skin contact with mercury or freshly mixed amalgam. system high volume evacuation when finishing or removing amalgam. Evacuation systems should have traps or filters,check clean or replace traps and filters periodically. change mask more often when removing amalgam.

*Evacuation

*Masks

80

*
* Recycling
store amalgam scrap under radiographic fixer solution in a covered container. items dispose of mercury contaminated items in sealed bags according to regulations. clean up spilled mercury by using trap bottles,tapes or fresh mixes of amalgam to pick up droplets or use comercial clean up kits.

* Contaminated * Spills

* Clothing wear professional clothing in dental operatory.

81

*
*
Dental amalgam raw materials being stored for use.

*
* * *

Mixed but unhardened dental amalgam during trituration,insertion,intraoral setting.

Dental amalgam scrap that has insufficient alloy to completely consume the mercury. Dental amalgam undergoing finishing and polishing operations. Dental amalgam restoration being removed.

82

*
83
21.09.2006

*
*Glasses, mercury
filter and mouth masks should be used.

*Routine exposure

badges should be worn as recommended by osha.

84

*
*In
plastic wrapping packages leakage is possible. in closets or

*Stored

cabinets.

*Storage location should be

near a vent that exhausts air out of the building.

85

*
*During *To
trituration small amount of material escape. minimize this precapsulated capsules of alloy and mercury are available.

86

*
* DURING
TRITURATION HIGH FREQUENCY CAN FORCE hg RICH MATERIAL OUT TO CREATE AEROSOL OF LIQUID DROPLETS AND VAPOR. minimize this amalgamator with covers are preferred. reduce mercury content, reduced mercury : alloy ratio, known as minimal mercury or eames technique is used.

* To * To

87

*
*Small
droplets that spill on floor or carpets are best advised to deal with help of a vacuum aspirator.

88

*
* The
scrap after condensation should be collected and stored under water,glycerine or x-ray fixer in a tightly capped jar, which should be almost filled with liquid to minimize the gas space where mercury can collect. in the office at any time.

* No more than a small jar of material should be present

* Once

dental amalgam is solidified mercury is tightly bound but can be easily liquified during polishing procedures that generate heat when adequate cooling water is not used.

89

*
*THE
Ag Hg PHASE IS MELTED PRODUCING A MERCURY LIQUID RICH PHASE THAT IS EASILY SMEARED OVER DENTAL AMALGAM SURFACE MAKING IT LOOK BRIGHT AND SHINY. is deceptive to the dentist as he can misinterpret this appearance as a highly polished surface.
90

*It

*
* It is common where high speed
burs contact tooth structure, increase of temperature leading to release of mercury vapors. dam, high volume evacuation and water cooling should be used to control this situation.

* Rubber

91

92

21.09.2006

*
*Instruments
which are used for inserting, finishing, polishing or removing dental amalgam restoration contain some amalgam material on their surfaces. sterilization techniques mercury vapors are released on heating so proper isolation or venting the air from sterilization areas should be done.

*During

93

*
* Capsules
and mercury contaminated cotton rolls or paper napkins should not be thrown out in regular trash. They should be kept in separate plastic containers for disposal.

94

* Best non mercury alternative. * It has similar atom structure and characteristics to mercury. * Used in the same manner as mercury based amalgam. * They
are 16 times more expensive than similar amount of mercury based amalgam.

* It is sticky so used by teflon instruments.

* Has high level of corrosive properties.
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*
*Metal alloys (gold)
The only real alternative to amalgam in moderate to large cavities. Demands high levels of clinical and lab skills in fabrication. Costs 7 -8 times the amount of an equivalent amalgam restoration.
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* * * * * *
Glass ionomer cement Composite resins Glass ionomer resin hybrids Compomers Ceramics Ormocers used in restoring anterior and cervical cavities in primary and permanent teeth and restorations of posterior teeth of primary dentition. All these have shorter life span than amalgam.

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AMALGAM FAILURES
*

*
* Inadequate condensation * Material pulling away or breaking from the

marginal area when carving bonded amalgam

* Potential solutions include: * Proper condensation technique * Careful carving of marginal areas, especially
bonded amalgam restorations

*
* Causes of marginal ridge fractures: * Axiopulpal line angle not rounded in Class II tooth
preparations

* Marginal ridge left too high * Occlusal embrasure form incorrect * Improper removal of matrix * Overzealous carving * Potential solutions include: * Proper rounding of axiopulpal line angles in Class II tooth
preparations

* Creating marginal ridge height correctly, with both the

adjacent tooth and occlusion adjacent tooth

* Creating an occlusal embrasure form that mirrors the

*
*Causes of amalgam scrap and mercury

collection and disposal problems include:

*Careless handling * Inappropriate collection technique *Potential solutions include: *Careful attention to proper collection and
disposal

*
* Amalgam has been used in clinical dentistry for about 200 years.

* Approximately
* However

22 million amalgam restorations are placed each year in united states.

in continuing to use amalgam, dentists should observe strict mercury and amalgam hygiene procedures in their practices so that the health of dental workers is not put at risk.

* Enviornmental

contamination from dental practices should cut down to low levels or this could be the main reason for government action against the use of amalgam in the future.

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*THERE IS A PRINCIPLE
WHICH IS PROOF AGAINST ALL ARGUMENT, AND WHICH CANNOT FAIL TO KEEP MAN IN EVERLASTING IGNORANCE.

21.09.2006

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