1

2

Introduction

Dental amalgam has been
used for over 150 years for
the treatment of dental
cavities and is still used, in
particular in large cavities
due to its excellent
mechanical properties and
durability.
Dental amalgam is a
combination of alloy
particles and mercury.
It contains about 50% of
mercury in the elemental
form.
3
Amalgam: An alloy
of mercury with one
or more metals.
Dental amalgam
alloy: An alloy that
contains solid metals
of silver, tin, copper
and sometimes zinc.

Dental amalgam: An
alloy that results when
mercury is combined
with the previously
mentioned alloys to form
a plastic mass.

4
1833
Crawcour brothers
introduced amalgam to
U.S.A
powdered silver coins
mixed with mercury
expanded on
setting
1895
G.V. Black developed
formula for modern
amalgam alloy
67% silver, 27% tin, 5%
copper, 1% zinc
overcame
expansion
problems

1960s
conventional low-copper lathe-cut
alloys
smaller particles
first generation high-copper alloys
Dispersalloy (Caulk)
admixture of spherical
Ag-Cu
eutectic particles with
conventional lathe-cut
eliminated gamma-2
phase
1970s
first single composition spherical
alloys
Tytin (Kerr)
Ternary system
(silver/tin/copper)

1980s
alloys similar to Dispersalloy and
Tytin
1990s
mercury-free alloys

5
Debut of Amalgam
Introduced in 1800s in France
alloy of bismuth, lead, tin
and mercury
plasticized at 100 C
poured directly into cavity
1826 - Traveau
compounded a silver paste amalgam
mixture of silver shavings from coins and mercury
condensed into tooth at room temperature

Mackert JADA 1991
6
Amalgam War I
1833 - Crawcour brothers
heavily marketed their amalgam
of silver and mercury

1843 - American Society of Dental Surgeons
declared use of amalgam malpractice
mercury is a poison
threatened to expel users

Amalgam use declined
Mackert JADA 1991
7
Amalgam War I
1895 - G.V. Black
developed effective amalgam
improved handling and performance
similar to contemporary low-copper
amalgam

Popularity of amalgam increased
Black Dent Cosmos 1896
8
Amalgam War II
1924 - Alfred Stock
German professor of chemistry
became poisoned with mercury
25 years of laboratory research
published papers on the dangers of mercury in
dentistry

Created considerable public concern
Stock Med Klin 1296
9
Amalgam War II
1934 - German physicians
studied patients
occupationally exposed to mercury
with and without amalgams
published papers
no health risk from amalgams

1941 - Alfred Stock recanted his position
Mackert JADA 1991
10
Amalgam War III
1970 - 1990
concern over occupational
exposure of mercury vapor
to dentists
excess levels in 10% of dental
offices
> threshold limit of 50
ug/mm
3
urinary mercury levels high
mild functional effects
found
ADA institutes mercury
hygiene campaign
urinary mercury levels
lowered 50 %
a shift in concerns
from occupational risk to
dentists to patient risk
ability to measure mercury
release from amalgam
restorations in expired air
early tests grossly
overestimated

11
Mandel JADA 1991
According to the number of alloyed
metals
Binary alloy
(silver, tin)
Ternary
alloy (silver,
tin, copper)
Quaternary
alloy (silver,
tin, copper,
and zinc)
12
According to the shape of the powdered
particles
Lath cut
Irregular shaped powder
particles ranging from
spindles to shavings.
Spherical
Smooth surface spheres
Advantages :
Require less mercury.
Develop early strength.
Require less condensation
force.
Disadvantages:
More difficult to obtain
inter-proximal contact and
contours in class II cavity.
Have shorter working time

Spheroidal
Formulated by mixing the
lath cut and spherical
particles
Increase the packing
efficiency of the alloy
Reduce the amount of
mercury required to
produce a workable mix.
13
14
According to the particle diameter
1.Very fine particle size
alloy
Advantages:
Easily carved.
Produce excellent surface
finish.
Disadvantages:
Require more mercury.
Lower early compressive
strength.
High rate of marginal
breakdown.
2.Fine particle size alloy.



3.Medium particle size alloy
4.Coarse grained particle
size alloy
Advantages:
Require less mercury.
Produce amalgam with higher
early strength.
Disadvantages:
Difficult to carve.
15
According to the zinc
content of the alloy

Zinc containing
amalgam (>0.01%
zinc)
Zinc free
amalgam (<0.01%
zinc)
According to the
form supplied of the
powder
Powder
Tablets of
condensed
powder particles

Capsules together
with gauged amount of
mercury separated by
a diaphragm.

16


According to the copper content of the alloy

.
Low copper alloys (Cu < 6%)
High copper alloys (Cu > 6%).
Admixed
Unicompositional
Based on size of alloy
Microcut/fine cut Macrocut/coarse cut
17
According to generation
Class 1
Silver and tin
(8:1)
Class 2
Silver, tin,
copper (4%)
and zinc
Class 3
Silver eutectic
alloy added to
original alloy
Class 4
Copper content
increased to
29%
Class 5
Indium added to
mixture of silver,
tin and copper
Class 6
Noble metal
such as
palladium added
18
Basic
Silver (Ag 4070%)
Tin (Sn 1230%)
Copper (Cu 1224%)
Mercury
Other
Zinc (Zn 0-1%)
Indium (04%)
Palladium ( 0.5%)
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208.
19

Silver (Ag)
Major element.
Whitens alloy.
Decreases creep.
Increases strength.
Increases expansion on setting.
Increases tarnishing resistance.

Tin (Sn)
Controls the reaction between Ag & Hg.
Reduces strength & hardness.
Reduces resistance to tarnish & corrosion.




20

Copper (Cu)
Ties up tin reducing
gamma-2 formation
Increases strength
Reduces tarnish and
corrosion
Reduces creep
Reduces marginal
deterioration


Mercury (Hg)

Activates reaction
Only pure metal that is
liquid at room
temperature
Spherical alloys
require less mercury
smaller surface area
easier to wet
40 to 45% Hg
Admixed alloys
require more mercury
Lathe-cut particles
more difficult to wet
45 to 50% Hg


21
ts

Zinc (Zn)
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.

22

Indium (In)
Decreases surface
tension
reduces amount of
mercury necessary
reduces emitted
mercury vapor
Reduces creep and
marginal breakdown
Increases strength
Used in admixed alloys
Example:
INDISPERSE
(indisperse distributing
company)
5% INDIUM




PALLADIUM (PD)
Reduced corrosion
Greater luster
Example
VALIANT PHD (ivoclar
vivadent)
0.5% PALLADIUM

Mahler J Dent Res 1990 Powell J Dent Res 1989
23
Effects of palladium addition on properties of dental amalgams
Palladium-containing amalgam alloys were developed utilizing the atomization
method. Single-compositional type alloys were fabricated and palladium was
substituted for silver in concentrations up to 5 w/o. Alloy powder with a particle
size of less than 45 microns was collected and triturated with mercury. Creep,
compressive strength and dimensional change tests were performed according
to ADA Specification No. 1 along with controls of Tytin, Valiant and Valiant-Ph.D.
Values for creep decreased and compressive strength increased markedly with
additions of palladium. Current densities of the experimental amalgams
containing palladium were determined to be an order of magnitude less than
the original amalgams in the electrochemical test. A trend of positive
relationships between properties and palladium additions was indicated.
Dent Mater. 1992 May;8(3):190-2
24
PROPERTY INGREDIENT

Silver Tin Copper Zinc
Strength Increases
Durability Increases
Hardness Increases
Expansion Increases Decreases Increases
Flow Decreases Increases Decreases
Color Imparts
Setting time Decreases Increases Decreases
Workability Increases Increases
Cleanliness Increases
25
ALLOY PRODUCTION

Alloy is produced predominantly
as:


Irregularly
shaped
Spherical
shaped
Mixture of
both types
26
Irregular particles
Generally lathe-cut. Annealed ingot of alloy placed in a
milling machine or lathe.
Chips removed are needle-like, size reduced by ball-
milling.
Homogenizing heat treatment performed for 8 hours
at 400C .
Treatment of the alloy particle with acid is performed.
Annealing at 100C to reduce stress.
27
Spherical particles
Produced by atomizing molten alloy in a chamber filled
with an inert gas such as argon.
The molten metal falls through a distance of
approximately 30 feet and cools as it does.
This results in spherical particle shapes(15 to 35 m)
28
COMPARISON OF LATHECUT WITH
ATOMIZED SPHERICAL POWDER
AMALGAM FROM LATHECUT
POWDER
AMALGAM FROM SPHERICAL
POWDER
1. Resist condensation better 1. Very plastic-cannot rely on
pressure of condensation to
establish proximal contour.
2. Require > Hg 2. Require < Hg due to small surface
area per volume .
29
Metallurgical phases in
dental amalgam
30
Silver-Tin system
31
AMALGAMATION AND
RESULTING
MICROSTRUCTURE
32

Low copper alloys

These are also known as traditional or
conventional amalgam
Available as:
1. Lathe cut alloys- coarse or fine grain
2. Spherical alloys
3. Blend of lathe cut and spherical alloys

Composition:
Silver ( Ag 67-74%).
Tin (Sn 25-28%).
Copper (Cu 0-6%).
Zinc (Zn 0-1%).

(L Williams, Wilkins: 2004)
33
Setting Reaction
Mercury + Amalgam alloy


Mercury absorbed by the particles and
dissolves the surface of the particles


Mercury becomes saturated with silver
and tin


Gamma-1 (Ag-Hg) and Gamma-2 (Sn-Hg)
phases begin to precipitate


Precipitation continues as long as 24hours
when strength reaches a maximum

Ag-Sn
Alloy
Ag-Sn
Alloy
Ag-Sn Alloy
Mercury
(Hg)
Ag
Ag
Ag
Sn
Sn
Sn
Hg Hg
Ag
3
Sn + Hg Ag
3
Sn + Ag
2
Hg
3
+ Sn
8
Hg

1 2
34
Gamma () = Ag
3
Sn
unreacted alloy
strongest phase
corrodes the least
30% of volume
of set amalgam
Ag-Sn
Alloy
Ag-Sn
Alloy
Ag-Sn Alloy
Mercury
Ag
Ag
Ag
Sn
Sn
Sn
Hg
Hg
Hg
Ag
3
Sn + Hg Ag
3
Sn + Ag
2
Hg
3
+ Sn
8
Hg

1 2
35
Gamma 1 (
1
) = Ag
2
Hg
3

matrix for
unreacted alloy
2
nd
strongest phase
60% of volume

1
Ag
3
Sn + Hg Ag
3
Sn + Ag
2
Hg
3
+ Sn
8
Hg

1 2
Ag-Sn Alloy
Ag-Sn
Alloy
Ag-Sn
Alloy
36
Gamma 2 (
2
) = Sn
8
Hg
weakest and softest
phase
corrodes fast, voids
form
10% of volume
volume decreases
with time due to
corrosion
Ag
3
Sn + Hg Ag
3
Sn + Ag
2
Hg
3
+ Sn
8
Hg

1 2

2
Ag-Sn Alloy
Ag-Sn
Alloy
Ag-Sn
Alloy
37
High copper alloys
High-copper amalgam was developed in1962 by the
addition of silver-copper eutectic particles to low-copper
silver-tin lathecut particles.
Compared to low-copper amalgam counterparts, high-
copper alloys exhibit the following properties:
greater strength
less tarnish and corrosion
less creep
less sensitive to handling variables and produce better
long-term clinical results.
High-copper amalgam restorations also have a much lower
incidence of marginal failure compared to low-copper
amalgam.
(JF McCabe, AG Walls: 1998)
38
Two different types:
1. Admixed alloy powder
2. Single composition
alloy powder

Composition:
Admixed alloy:
Silver 40-70%
Tin - 26-30%
Copper- 9-20%
Zinc - 0-1%
Unicompositional alloy:
Silver- 40-60%
Tin - 22-30%
Copper-13-30%
Zinc -0%

(JF McCabe, AG Walls: 1998)
39
Admixed High-Copper Alloys
Amalgam is triturated


Mercury diffuses into the silver-tin particles


Silver and tin dissolve


Silver from the silver copper eutectic
particles also enters mercury
Ag
3
Sn + Ag-Cu + Hg Ag
3
Sn + Ag-Cu + Ag
2
Hg
3
+ Cu
6
Sn
5



1

Ag-Sn
Alloy
Ag-Sn
Alloy
Mercury
Ag
Ag
Ag
Sn
Sn
Ag-Cu Alloy
Ag
Hg
Hg
40
Admixed High-Copper Alloys
Copper combines with tin

Ring of Cu6Sn5 around the
eutectic particles

Silver precipitates out as
Gamma 1

Ag-Sn
Alloy
Ag-Cu Alloy

Ag-Sn
Alloy
Ag
3
Sn + Ag-Cu + Hg Ag
3
Sn + Ag-Cu + Ag
2
Hg
3
+ Cu
6
Sn
5



1

41
Admixed High-Copper Alloys
Final set amalgam

Gamma and silver-copper
eutectic particles in a matrix
of gamma 1

Eutectic particles are
surrounded by the eta phase
Ag-Sn
Alloy

1
Ag-Cu Alloy

Ag-Sn
Alloy
Ag
3
Sn + Ag-Cu + Hg Ag
3
Sn + Ag-Cu + Ag
2
Hg
3
+ Cu
6
Sn
5


1

42
Single Composition High-Copper
Alloys
Amalgam is triturated

Mercury diffuses into the
silver-tin-copper particles

Silver and Tin dissolve into
Mercury

Silver precipitates out first as
silver-mercury (gamma 1)
Ag-Sn Alloy
Ag-Sn Alloy
Ag-Sn Alloy
Mercury (Hg)

Ag
Sn
Ag
Sn
Ag
3
Sn + Cu
3
Sn + Hg Ag
3
Sn + Cu
3
Sn + Ag
2
Hg
3
+ Cu
6
Sn
5



1



43
Single Composition High-Copper
Alloys
Copper + Tin

Cu6Sn5 on the surface of the
particles and in the gamma-1
matrix

Set amalgam = core gamma
particles in matrix of gamma 1
and Cu6Sn5

Ag-Sn Alloy
Ag-Sn Alloy
Ag-Sn Alloy

1

Ag
3
Sn + Cu
3
Sn + Hg Ag
3
Sn + Cu
3
Sn + Ag
2
Hg
3
+ Cu
6
Sn
5



1



44
Physical Properties of
Dental Amalgam
Dimensional
stability
Strength
Creep
Microleakage
45
Dimensional stability

The net contraction or expansion of an amalgam is called its dimensional change
Dimensional changes on setting:
CONTRACTION during alloy dissolution
EXPANSION during impingement of reaction product crystals

ANSI/ ADA specification No.1 requires dimensional change of no more than
20m/cm at 37 C between 5min and 24hrs after beginning of trituration.


Low-copper alloy have the greatest dimensional change
( 19.7m/cm).
High-copper unicompositional alloy have the least dimensional change
(-1.9 m/cm).
Other alloys are ranging from (-8.8 to 14.8 m/cm)


46
Dimensional change is affected by many factors:
Mercury/alloy ratio
Trituration
Condensation techniques

CONTRACTION:
Result in microleakage & secondary caries.
Factors favouring contraction
Longer trituration time.
Higher condensation pressure.
Small particle size.
High Hg alloy ratio.




47
Delayed Expansion :

Zn containing low cu \ high cu alloy contaminated
during trituration or condensation , large expansion
take place.
Starts from 3-5 days and continue for months
creating values more than 400um.
H2O + Zn ZnO + H2O

Results in:
Protrusion of restoration out of cavity
Increase creep
Increase microleakage
Pitted surface of restoration
corrosion.


48
Effect of Moisture Contamination on High-Copper
Amalgam
Moisture contamination caused delayed excessive
expansion and deterioration of the physical
properties only with the non-high-copper lathe-cut
alloy amalgam containing zinc, but not with the new
high-copper amalgam and the non-high-copper
spherical alloy amalgam containing zinc. It affected
the compressive strength and creep but not the
hardness. The setting dimensional change of all
amalgams containing zinc was slightly affected by it.

JDR March 1981 vol. 60 no. 3 716-723
49
50
STRENGTH
The strength of an amalgam restoration must be high enough
to resist the biting forces of occlusion.

1 hour 40% to 60% compressive strength
(e.g., Tytin 45% and Dispersalloy 51%)

24 hours 90% or more of their final strength
51
Compressive Strength (psi) Tensile Strength (psi)
15-min 1-hr 24-hr 15-min 1-hr 24-hr

LOW COPPER:
Velvalloy 5,400 17,400 56,200 625 1,900 9,000
Spheralloy 5,800 18,500 56,900 450 1,550 8,800

HIGH COPPER:
Optalloy II 9,100 23,800 55,900 1,000 2,350 7,250
Dispersalloy 6,200 22,400 59,900 575 1,750 6,990
Indiloy 4,600 26,300 64,500 450 2,400 6,500
Sybraloy 23,800 50,000 72,700 2,190 4,700 6,600
Tytin 10,200 40,800 79,100 990 4,000 9,300
The two types of strength are compressive strength and tensile
strength.

Tensile strength is 7 times less than compressive strength

Since tensile and shear strengths are low, amalgam should be
supported by tooth structures for clinical success
52
The rate at which an amalgam develops
strength is an important clinical characteristic.

If the amalgam restoration is subjected to
chewing or other oral forces before sufficient
strength develops, it is at risk for fracture.

Spherical particle alloys and copper-enriched
alloys develop strength more rapidly than
conventional lathe-cut materials.

Fine-grain, lathe-cut products develop strength
more rapidly than coarse-grain products.


53

Fracture
54
Fracture toughness and critical strain energy release
rate of dental amalgam

Fracture toughness, critical strain energy release rate and
critical stress intensity factor were determined for lathe-cut,
spherical, admixed, and two atomized high-copper dental
amalgams. At a loading rate of 0.005cm min
1
for 24-hour
samples, the spherical amalgam had the highest resistance to
unstable crack propagation. At a loading rate of 0.05cm
min
1
for both 24-hour and one-month samples, the lathe-cut
amalgam had the highest resistance to unstable crack
propagation. One of the atomized high copper amalgams
showed the lowest resistance to crack propagation
Dental Materials Volume 8, Issue 3, May 1992, Pages 19019
55
CREEP
Creep is a slow change in shape caused by compression due
to intra-oral stresses.
Creep causes :
Amalgam to flow unsupported amalgam protrudes from
the margin of the cavity.
These unsupported edges may be further weakened by
corrosion.
Fracture formation of a ditch around the margins of
the amalgam restoration.
Overhangs food trapping & secondary decay.
The gamma-2 phase of amalgam is primarily responsible for
high values of creep

56
Material type Creep (%)
Conventional lathe-
cut
2.5
Dispersion-modified,
copper-enriched
0.2
Copper-enriched,
containing 0.5%
palladium
0.06
Values for static creep for amalgam
57
58
Creep-fatigue as a Possible Cause of Dental
Amalgam Margin Failure

Fracture of the margins is the most common cause of
failure of dental amalgam restorations. Both corrosion
and creep have been identified as possible contributors
to this type of failure. The stresses that induce creep may
arise from the continued setting expansion of the
amalgam, the formation of corrosion products,
mastication, or from the thermal expansion of the
amalgam during ingestion of hot foods.
Biomaterials Volume 23, Issue 2, January 2002, Pages 597608
59
MICROLEAKAGE
Amalgam has got a self
sealing property.
Corrosion products will
fill the tooth
restoration interface &
prevent microleakage.
60
Factors that promote microleakage:

2 to 20 micron-wide gap that always exists between
the amalgam and tooth structure.
Poor condensation techniques ,result in marginal
voids.
Lack of corrosion by-products necessary to seal the
margins.
Coefficient of thermal expansion for amalgam which
is 22 times greater than the coefficient for tooth
structure.
Use of single-composition-spherical alloys which leak
more than lathe-cut or admixed alloys.

61
Conventional and high-copper Class V amalgam restorations showed
leakage after seven months' storage in artificial saliva and thermal-
stressing. The rate of marginal microleakage was not significantly
affected by the application of a Copal varnish after this period. At the
14-month storage and thermal-stressing period, all varnished and
unvarnished high-copper restorations and the varnished
conventional amalgam restorations showed significantly improved
sealing properties in the occlusal wall compared with the seven-month
period. The unvarnished conventional amalgam restorations appeared
to have reached their peak sealing level by seven months under the
conditions of this experiment. No significant improvement in the
sealing properties of either the conventional or high-
copper amalgam restorations was achieved after the 14-month period
by the application of Copal varnish.

Long-term sealing properties of amalgam restorations:
An in vitro study

Dental Materials Volume 5, Issue 3, May 1989, Pages 168170
62
CHEMICAL PROPERTIES

1. CHEMICAL CORROSION (TARNISH):

Tarnishing involves the loss of luster from the
surface of a metal or alloy due to formation of a
surface coating.
The integrity of the alloy is not affected, so no
change in mechanical properties.
Amalgam readily tarnishes due to the formation
of a sulphide layer on the surface.

63
2. ELECTROCHEMICAL CORROSION:

Galvanic corrosion
occurs when two
dissimilar metals exist in
a wet environment.
Electrical current flows
between the two
metals, corrosion of one
of the metals occurs.
An acidic environment
promotes galvanic
corrosion.

64
Corrosion occurs both on
the surface and in the
interior of the
restoration.
Surface corrosion
discolors an amalgam
restoration, lead to
pitting and also fills the
tooth/amalgam interface
with corrosion products,
reducing microleakage.
Internal corrosion will
lead to marginal
breakdown and fracture.

65
Internal corrosion
Corrosion at margins
66
Low-copper amalgams High-copper amalgams
Corrosion products of Tin oxides and
Tin chlorides

Tin oxides and tin Chlorides
along with copper chloride.
The most corrosion-prone phase is
gamma-2 (Sn8Hg)

The most corrosion-prone phase is
the eta phase (Cu6Sn5).

Corrode slower than low-copper
amalgams (6 months to 2 years)

67

Corrosion of dental amalgams: electrochemical
study of AgHg, AgSn and SnHg phases

Dental amalgams, formed by reaction of mercury with a powder alloy
containing mainly Ag, Sn, Cu and Zn, have a complex metallurgical
structure which can contain up to six phases. Their observed corrosion is
thus a complex process, which involves contributions from each of the
phases present as well as intergranular corrosion. It is thus of interest to
investigate the corrosion of individual phases present in dental amalgams.
In this work the corrosion behaviour in 0.9% NaCl solution of AgHg, Ag
Sn and SnHg phase components of dental amalgams was investigated
by electrochemical methods. The corrosion resistance was found to
decrease in the order
1
-Ag
2
Hg
3
, -Ag
3
Sn and
2
-Sn
7
Hg.


Journal of Oral Rehabilitation Volume 31, Issue 6, pages 595599, June 2004
68
THERMAL PROPERTIES
1. Thermal diffusivity:
Amalgam has a relatively high value of thermal
diffusivity. Thus, in constructing an amalgam
restoration, an insulating material, dentine is
replaced by a good thermal conductor.
In large cavities it is necessary to line the base of
the cavity with an insulating, cavity lining material
prior to condensing the amalgam.
This reduces the harmful effects of thermal
stimuli on the pulp.

69
2. Coefficient of thermal expansion:
This value for amalgam is about three times
grater than that for dentine.
This coupled with the grater diffusivity of
amalgam, results in considerably more
expansion and contraction in the restoration.
Such a behavior may cause microleakage
around the filling since there is no adhesion
between amalgam and tooth substance.

70
BIOLOGICAL PROPERTIES
71
1.MERCURY TOXICITY:

It is a concern in dentistry because mercury
and its chemical compounds are toxic to the
kidneys and the CNS.
Mercury is toxic, but released in small
amounts from set amalgam.
Safety should be considered for:
Patient
Operator
Environment
Proper handling and storage along with
prompt cleaning of all mercury spills will
minimize risk of toxicity.
OSHA: acceptable level of mercury exposure
0.005 mg/mm3


72
How does mercury enter the
human body?



Mercury vapour from
surface of filling by
chewing , tooth brushing
or bruxism
Filling surface through
wear or corrosion
Mercury particles
embedded in gums or soft
tissue of the mouth during
the removal of old fillings.
Inhalation
Dissolved in saliva
and swallowed
73
74
Mercury Dose from Amalgam
Average daily dose from 8 10 amalgam
surfaces
1-2 ug per day
well below threshold levels
Threshold urine mercury levels
subtle, pre-clinical effects
30 ug per day
considered dangerous
82 ug per day


Olsson J Dent 1995 Mackert Crit Rev Oral Biol Med1997 Berdouses J Dent Res1995
75
76

Side effects of mercury

Allergy
Hypersensitivity
Systemic toxic
effects
77

Precautions

The clinic should be well ventilated.
Proper storage of mercury in a
container with tight lid.
While using capsules, lids of the
capsules should be tight fitted and
no spilling should occur.
If by chance mercury is spilled on
the floor, it should be wiped clean
immediately.
78
If mercury comes in contacts with
skin, one must wash with soap and
water immediately.
Proper waste disposal methods
undertaken.
Use of eye protection, disposable
face masks, and gloves.
Periodic monitoring of actual
exposure levels in blood and urine.
Avoid heating instruments to> 80C


79
Amalgam disposal
Contact amalgam
Non-contact amalgam
Dental amalgam particles
collected by any suction line .
Removed amalgam
filling and teeth with
filling
Excess dental amalgam generated
during the placement of a filling
Broken and unused
amalgam capsules
All amalgam waste must be released to an approved waste carrier
for recycling or disposal in trenches
80
Biocompatibility of dental
amalgam
Biocompatability of amalgam is thought to be determined
largely by the corrossion products released.
Corrosion depends on the type of amalgam.
In cell culture screening tests, free or non leaded mercury
from amalgam is toxic .With the addition of
copper, amalgams becomes toxic to cells in culture but low
copper amalgam that has set for 24hrs does not inhibit cell
growth.
Implantation tests show that low copper amalgams are well
tolerated but the high copper amalgams can cause severe
reactions when in direct contact with tissue.

BIOCOMPATIBILITY OF DENTAL MATERIALS
81
In usage tests, the response of the pulp to amalgam in
shallow or in deep but lined cavities is minimal and
amalgam rarely causes invisible damage to the pulp
however, pain results from using amalgam is deep unlined
cavity preparations( 0.5 mm or less)
Margins of newly placed amalgam restorations show
significant microleakage. Marginal leakage of corrosion and
microbial products is probably enhanced by the natural
daily thermal cycle in the oral cavity.
Lichenoid reaction represent a long term effect in the oral
mucous membrane adjacent to amalgam restoration.
Buccal mucosa and lateral border of the tongue being the
areas affected often.
BIOCOMPATIBILITY OF DENTAL MATERIALS
82

Accidental implantation of
silver containing
compounds into oral
mucosal tissue

Occur during:
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
Common Sites- Gingiva,
buccal mucosa, alveolar
mucosa

2.AMALGAM TATTOO:
83
Amalgam pigmentation (amalgam tattoo) of the
oral mucosa: A clinico pathologic study
The most common location was the gingiva and alveolar mucosa,
followed by the buccal mucosa. Histologically, the amalgam was
present in the tissues as discrete, fine, dark granules and as irregular
solid fragments. The dark granules were arranged mainly along
collagen bundles and around blood vessels. They were also
associated with the walls of blood vessels, nerve sheaths, elastic
fibers, basement membranes of mucosal epithelium, striated muscle
fibers, and acini of minor salivary glands. Dark granules were also
present intracellularly within macrophages, multinucleated giant
cells, endothelial cells, and fibroblasts. Although in 45 percent of the
cases there was no tissue reaction to the amalgam, in 17 percent
there was a macrophagic reaction and in 38 percent there was a
chronic inflammatory response, usually in the form of a foreign
body granuloma, with multinucleated giant cells of the foreign body
and Langhans types.
JADA 1982, Vol. 40, No. 1 , Pages 9-16
84
Indications
Amalgam should be considered for:
class I, II.
the distal surface of the cuspids.
class V in posterior teeth.
Material selection in such case will depend on:
The extent of the lesion.
Amalgam is preferable in the following situations:
Small and medium sized class I and II cavities
Cavities with four walls and floor to decrease the
tensile load
Under mined cusps will require cusp capping
In extensive lesions cast gold will serve better.


85
Caries incidence
Amalgam may be favored if:
Repair or remake is likely to include extensions for
original cavities.
Patient with moderate to high caries incidence; as it is
Less costly
Having good sealing ability
Economics
Amalgam restorations cost far less than cast gold per se.
If the restoration has to be replaced repeatedly this
advantage becomes questionable.
Core-build under full crown restorations.

86
Contraindications
1. Amalgam will be objectionable for:
Esthetic conscious patient.
In conspicuous areas of the tooth
The posterior composite may be favored.

2. In cases of undermined cusps, where the tooth
subjected to high load of tensile strength , where
cast gold serve better .
87
ADVANTAGES OF DENTAL
AMALGAM
It is durable.
Least technique sensitive
Applicable to a broad
range of clinical
situations.
Newer formulations
have grater long-term
resistance to surface
corrosion.
It has good long-term
clinical performance.
Ease of manipulation by
dentist.


Corrosion products seal
the tooth restoration
interface and prevent
bacterial leakage.
Minimal placement time
Long lasting if placed
under ideal conditions.
Very economical.
Self sealing
Biocompatible

88
DISADVANTAGES OF DENTAL
AMALGAM
Some destruction of
sound tooth tissue.
Poor esthetic qualities.
Long-term corrosion at
tooth-restoration
interface may result in
ditching leading to
replacement.
Galvanic response
potential exists.
Local allergic potential.

Marginal breakdown.
Bulk fracture
Secondary caries
Sometimes excess Hg
within the restoration may
seep through the dentinal
tubules, discolor dentin and
result in blackish or grayish
staining of teeth.
Concern about possible
mercury toxicity that affects
the CNS, kidneys and
stomach.


89
Failures
Bulk fractures






Sensitivity or pain

Corrosion
90
Secondary caries






Marginal fractures
91
Signs of failures
1. Fracture Lines
2. Marginal Ditching
3. Proximal Overhangs
4. Poor anatomic contours
5. Marginal Ridge incompatibility
6. Improper Proximal Contacts
7. Recurrent Caries
8. Poor occlusal Contacts
9. Amalgam Blues

92
Reasons For Failures
1. Improper Case Selection
2. Improper Cavity Preparation
3. Faulty Selection & manipulation of
Amalgam
4. Errors in Matricing Procedures
5. Post Operative Factors

93
RECENT DEVELOPMENTs OF
Dental AMALGAM
Mercury free direct filling amalgam alloys
Gallium based alloys
Low mercury amalgams
Indium in mercury
Resin coated amalgam
Fluoridated amalgam
Bonded amalgam
Consolidated silver
alloy system

94
Mercury-free amalgam

Gallium as a substitute for mercury
Similar handling characteristics to
traditional amalgam
Not a good alternative due to high
corrosion and lower strength
Not commonly used
95
RESIN COATED AMALGAM

To overcome the limitation of
microleakage, a coating of unfilled
resin over the restoration margins
and the adjacent enamel, after
etching the enamel.

Resin may eventually wear away, it
delays microleakage until corrosion
products begin to fill the tooth
restoration interface.
96


J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
Mertz-fairhurst and others evaluated
bonded and sealed composite
restorations versus sealed conservative
amalgam restorations and conventional
unsealed amalgam restorations.
Results indicate that both types of sealed
restorations exhibited superior clinical
performance and longevity compared
with unsealed amalgam restorations over
a period of 10 years.

97 J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
FLUORIDATED AMALGAM

Fluoride, being
cariostatic, has been
included in amalgam to
deal with the problem of
recurrent caries.

Disadvantage: fluoride is
not delivered long
enough to provide
maximum benefit.

Several studies
investigated fluoride
levels released from
amalgam.
These studies concluded
that a fluoride
containing amalgam
may release fluoride for
several weeks after
insertion of the material
in mouth. Fluoride
release from this
amalgam seems to be
considerable during the
first week.

98
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
An anticariogenic action of fluoride amalgam could
be explained by its ability to deposit fluoride in the
hard tissues around the fillings and to increase the
fluoride content of plaque and saliva, subsequently
affecting remineralization.
In this way, fluoride from amalgam could have a
favorable effect not only on caries around the filling
but on any initial enamel demineralization.
The fluoride amalgam thus serves as a slow
release device


99
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
BONDED AMALGAM

Since amalgam does not
bond to tooth structure,
microleakage immediately
after insertion is inevitable.
So, to overcome these
disadvantages, adhesive
systems that reliably bond to
enamel and dentin have
been introduced.
Amalgam bond is based on a
dentinal bonding system
developed in Japan by
Nakabayashi and co-workers.

The bond strengths recorded
in studies have varied,
approximately 1215 Mpa.
Using a spherical amalgam in
one study of bonded
amalgam, Summitt and
colleagues reported mean
bond strength of 27 MPa.
Bond strengths achieved with
admixed alloys tend to be
slightly lower than those with
spherical alloys.

100
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
Study compared post-insertion sensitivity of
teeth with bonded amalgams to that of teeth
with pin-retained amalgams. After 6 months,
teeth with bonded amalgams were less
sensitive than teeth with pin-retained
amalgams.
If bonding proves successful over the long term,
method of mechanical retention can be
eliminated, thus reducing the potential for
further damage to tooth structure that occurs
with pin placement or use of amalgam pins.

101
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
CONSOLIDATED SILVER ALLOY
SYSTEM

One amalgam substitute
being tested is a
consolidated silver alloy
system developed at the
National Institute of
Standards and Technology.

It uses a fluoroboric acid
solution to keep the
surface of the silver alloy
particles clean.

The alloy, in a spherical form,
is condensed into a prepared
cavity in a manner similar to
that for placing compacted
gold.
One problem associated with
the insertion of this material
is that the alloy strain
hardens, so it is difficult to
compact it adequately to
eliminate internal voids and to
achieve good adaptation to
the cavity without using
excessive force

102
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
Gallium alloy

The current
composition of gallium
alloy comes as a
powder and contain:
Silver 50%wt.
Tin 25.7%wt.
Copper 15%wt.
Palladium 9%wt.
Traces 0.3%wt.
Traces 0.5%wt.

It is also available as a
liquid containing;
Gallium 65%wt.
Indium 18.95%wt.
Tin 16%wt.

103
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
Structure of gallium amalgam

The structure of gallium amalgam has
been interpreted in terms of a reaction
of CuGa2 and PdGa5, surrounding the
unreacted alloy particles, which are held
together by a matrix of Ag9In4 in which
island of Ag9Ga3 and beta tin can be
found.


104
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
Clinical behavior of gallium alloy

Changes in marginal integrity, surface
texture, luster, and color were measured
clinically over a period of up to 2 years.
Significant change in luster and surface
roughness occur within 4 months.
Apparent corrosion behavior
105
J Conserv Dent. 2010 Oct-Dec; 13(4): 204208
A comparison of the mechanical properties of a
gallium-based alloy with a spherical high-
copper amalgam

The mean hardness, 1 h compressive fracture strength, 24 h diametral
tensile and 24 h flexural strengths of Galloy

were significantly lower

(P<0.001) than Tytin

. No significant differences in modulus of elasticity,

creep, dimensional change on setting, 24 and 168 h compressive fracture
strength for the two alloys were identified.
Significance: The significant reduction in the 1 h mean compressive fracture
strength and hardness identified for Galloy

compared with Tytin

possibly
indicate a slower setting reaction in the gallium-based alloy. Manual
condensation of the gallium-based alloy produced specimens with inferior
mechanical properties.P revious reports indicating poor corrosion resistance
and moisture sensitivity of gallium-based alloys highlight the need for
further research to investigate the effect of the oral environment on the
gallium-based alloy.

Dental Materials Volume 17, Issue 2, March 2001, Pages 166169
106
The effect of water contamination on dimensional
change and corrosion properties of a gallium alloy

The gallium-based alloy exhibited expansion if
contaminated with water during the condensing
and setting process. Post-setting exposure to water
did not result in expansion of the gallium-based
alloy. The alloy also exhibited a greater susceptibility
to corrosion than the amalgam. Due to the
possibility of delayed expansion, this material
should be used cautiously, particularly in
applications involving weakened tooth structure.
Dental Materials Volume 17, Issue 2, March 2001, Pages 142148
107

Conclusion

Historically, amalgam restorations have been
among the most common of all dental
restorations.
The use of high-copper amalgams has
improved dramatically the clinical longevity of
amalgam (5-10 years under ideal conditions).
Its major advantage has been the decline in
the cases of microleakage.
The use of precapsulated amalgam has
reduced significantly the risk of exposure of
dental personnel to mercury vapor.

108
Although small amounts of mercury
release from amalgam is known to occur,
it does not cause any major health
problems.
Although there are other alternatives to
amalgam they can not match amalgams
longevity, ease of manipulation and
versatility.
Hence dental amalgam will be a part of
dentistry for a long time to come.

109

References

Phillips Science of Dental
Materials 11
th
Edition
Craigs Restorative Dental
Materials 12
th
Edition
Sturdevants Art and Science
of Operative Dentistry 5
th

Edition
Textbook of Operative
Dentistry Amit garg and
Nisha garg
110
Dental Materials, clinical
applications for dental
assistants and dental
hygienists
Dental Amalgam: Update
on Safety Concerns
JADA 1998; 129:494-501
Materiales dentales:
Federico Humberto
Barcel Santana & Jorge
Mario Palma Calero

111