DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

COMPLEX AMALGAM RESTORATIONS

Prepared By :
Mahima (40)
BDS Final year
 PRINCIPLES OF PIN LOCATION
The following principles of pin placement are recommended:
1. Occlusal clearance should be sufficient to provide 2 mm of amalgam over the pin.
2. Placement of pins is ideal in areas where the greatest bulk of amalgam would
occur to minimize the weakening effect of the pins on the tooth structure.
3. The pinhole should be placed no closer than 0.5 - 1 mm to the DEJ or no
closer than 1 - 1.5mm to the external surface of the tooth, whichever distance
is greater.
4. The pinhole should be parallel to the adjacent external surface of the tooth.
5. A minimum clearance of 0.5 mm is necessary around the circumference of the pin
for adequate condensation of amalgam.
6. The pinhole must be placed on a flat dentinal floor.
7. The minimum interpin distance is 3 mm for the Minikin pin and 5 mm for the
Minim pin.
8. Whenever more than two pinholes are planned, they should be placed at different levels
to prevent stresses in same transverse plane of the tooth.
9. Intermittent radiographic monitoring should be done constantly, while preparing
and placing the pins.
10. Knowledge of normal pulp anatomy to avoid pulpal exposure or external tooth
perforations.
 PIN PLACEMENT FOR MAXILLARY TEETH
Tooth Site for placing pin Areas to be avoided

Central and lateral incisor Middle of labial gingival floor Middle of lingual gingival
incisal with minimum 2mm floor. Proximolingual floor,
of depth with insufficient depth

Canine Close to labial and lingual Gingival pin close to groove or

proximal part of tooth concavity
incisal, close to incisal angle

First and second premolars Close to proximobuccal and Middle of gingival floor
lingual corner of the tooth bucally and lingually

First and second molars Gingival floor close to Gingival floor mesial to
distolingual part of tooth buccal part of tooth

Third molar Because of variable

anatomy, pin is placed after
radiographic evaluation
 PIN PLACEMENT FOR MANDIBULAR TEETH
Tooth Site for placing pin Areas to be avoided

Central and lateral incisor Because of less thickness of

depth, pins are avoided
except in teeth where pulp
chamber is very much
reduced

Canine Same as maxillary canine Same as maxillary canine

First and second premolars Close to labial and lingual Middle of gingival floor
proximal part of tooth bucally and lingually

First and second molar Distolingual portion of Mesiobuccal corner of

gingival floor gingival floor
Distobuccal and
mesiolingual part of gingival
floor

Third molar Because of variable anatomy,

pin is placed after
radiographic evaluation
 PINHOLE PREPARATION
1. When the pinhole locations have been determined , penetrate a small round bur (No.¼) at low speed upto
half of its diameter. This will make pilot hole or lead hole which allows adequate positioning of twist drill.
2. Pinholes are prepared using twist drills. Commonly used drill is Kodex drill. Drill performs cutting when
rotated clockwise at slow speed. It should be used to prepare pinholes with a contra-angled hand piece
rotating at a very low speed (300-500 revolutions per minute).
3. The optimum depth of the pinhole into the dentin is 2 mm
(only 1.5 mm for the minikin pin), a depth limiting drill should be
used to prepare the drill.

4. Direct the drill towards desired location of pin placement.

Drill should be kept continuously moving only in one axis and
one direction from the time of insertion till
removal to avoid fracture of drill in the pinhole and over-cutting.

5. While cutting dentin, apply slight pressure during drilling, avoid

slanting of the hand-piece or allowing the drill to rotate more at
the bottom of the pinhole as it may result in a large hole.

6. After pin preparation is complete, confirm the depth using

omni-depth guage and take a radiograph.
 PIN BENDING AND TRIMMING
• Ideally bending and trimming of trimming of pin, if required, should be done before
their placement but it is not possible in friction locked and threaded pins.

• If possible, at least 1.5mm of the pin should be exposed.

• At least 1 mm of space for restorative material around the periphery of the pin and
at least 2 mm of space occlusal to the pin should be available.

• To trim the pin, cut it short with a sharp fissure bur running in a high speed hand
piece keeping bur perpendicular to the pin.

• Stabilize the pin with a hemostat while lateral pressure is applied.

 MATRIX PLACEMENT
• In general tofflemire retainer and band is used.
• When tofflemire matrix cannot be used, auto-matrix which is a retainerless matrix system can also be used.

PLACEMENT OF AMALGAM
• Spherical or admixed high copper alloy is preferred for restoration of these teeth because of high early
compressive strength and excellent clinical performance.
• Spherical alloys have higher early strength and can be condensed quicker with less pressure when compared
with admixed alloys.
• Admixed alloys are preferred for proximal contacts because of their condensability and long working time
which allows sufficient time for condensation, matrix removal and carving of restoration.
• First pack and condense the amalgam restoration around pins and then all step areas and proximal box area.
Each increment of amalgam is properly condensed to produce a flat surface. Amalgam must be properly
condensed around the pins.
 CARVING OF AMALGAM
• Remove excess of amalgam from the occlusal surface.
• Use discoid and hollenback carver to develop anatomy of tooth.
• Marginal ridge must be at the same height as the adjacent marginal ridge.

REMOVAL OF THE MATRIX

• Avoid premature removal of matrix band as it can result in fracture of the restoration.
• If tofflemire is being used, separate the band from the retainer and take out the band without disturbing the set
restoration.
• If auto-matrix is being used , cut the auto-lock loop using shielded nippers. Remove the band in oblique direction.

FINISHING AND POLISHING PROCEDURE

• Objective of polishing is refinement of margins, development of contour and smoothening of the surface.
• Polishing must be done after 24 hours of restoration placement.
• Round steel finishing bur or small wheel diamond is used to contour the occlusal restoration.
• Silica or Aluminium oxide is applied by prophylactic cup to polish the surface
 Factors affecting retention of pins in tooth structure
: diameter :
Pin

Within limits , retention is directly proportional to diameter of pin however overzealous

increase in diameter may decrease amount of dentin and thus weaken the tooth

Pin number :

Within limits , increase in number of pins increases the retention in dentin

Pin type :

Cemented pins are least retentive , friction locked pins show intermediate retention and
threaded pins are most retentive because they are retained by elasticity of dentin

Pin depth in dentin :

Within limits , increase in the depth of pin in dentin increases the retention
Cementing agents :

Zinc phosphate cement is more retentive than polycarboxylate and zinc oxide
eugenol cements. Glass ionomer cement is also more retentive

Association between pin channel and pin circumference :

Poor quality in the manufacture of pins can result in problems like mismatch
between the pin and drill diameters,variations in the inside diameter and thread
shape of the pins etc

Type of dentin :

Young resilient primary dentin offers more retention than secondary dentin
Factors affecting retention of pins in restorative material:

1. Pin length : within limits , directly proportional to length

2. Pin number : within limits , increase in number of pins increase the retention of
restoration

3. Pin diameter : within limits , retention increases with increase in diameter of pin

4. Pin orientation : it also affects retention , for example pins placed in non parallel
fashion increase retention

5. Pin shape: Retention cleats and square or pear shaped heads on the pins improve
retention of pin

6.Interpin distance :placing pins close to each other increases retention. If distance is
less than 2mm pin retention is reduced because of less amount of material present in
between the pins and increase in residual stresses in dentin
Pin restoration interphases :

An ideal interphase between pin and material is one which is not interrupted

Surface characteristics :

Number of serrations present on pin interphase affects its retention , serrated pins are
more retentive than smooth pins

Bulk of material surrounding the pin :

Pin retention is directly proportional to bulk of material surrounding the pin. Retention
is almost lost when the material around the pin is less than half the diameter of the pin
Pins and stresses:
Stresses are seen maximum with use of friction locked and threaded pins in dentin

If stresses exceed dentin’s plastic limit craze lines or cracks are seen

Threaded pins show only apical stresses whereas friction locked pins result in lateral
stresses, cracked tooth syndrome, gross fractures , loose restorations etc

Pins do not strengthen or reinforce a restoration but aid in retention of restoration,

neither compressive strength nor tensile strength of amalgam is improved
 Failure
1 Within the restoration :

Restoration may fracture because of improper condensation , trituration or manipulation

2 Within the pin:

Pin fracture may occur in following conditions ;

During bending
Excessive force is applied while placement
Pin is rotated despite being fully seated in the pinhole
At the pin restoration interface :

Restoration may pull away from pin because of corrosion products at pin restoration
interface

At the interface between pin and dentin :

Pin may separate along with restoration because of improper pin tooth joint

Within dentin :

Dentinal fracture can occur because of concentration of internal stresses because of

improper selection of pin according to dentin type

Failure of pin retained restoration can also occur due to broken drills and loose pins
ALTERNATIVES TO PINS FOR ADDITIONAL RETENTION IN AMALGAM RESTORATION

1. Horizontal Pin : It was described by Burgess. It should be placed 0.5 – 1 mm from DEJ. It should not be
placed too close to the surface of restoration.

2. Slot : It is a groove which is placed in the transverse plane. It is placed in dentin. It has 1 – 1.5 mm depth
which can be given an occlusal or gingival wall or both. It has 4 walls and is given along the width of
occlusal or gingival walls.

3. Circumferential Slot : It is prepared with No. 331/2 inverted cone. It increases retention and resistance
of the restoration.

4. Lock : It is a groove whose length is in longitudinal plane. It is 0.2 – 0.3 mm wide and 0.5 mm deep into
dentin. It is usually prepared for class II amalgam restoration for increasing resistance and retention
form.