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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.
COMPOSITION
COMPOSITION
Low Copper: Silver - 63-70% Tin - 26-29% Copper - 2-5% Zinc 0-2% Admixed: Silver 40-70% Tin - 26-30% Copper-13-30% Zinc - 0-1%
MANIPULATION
MANIPULATION
TRITURATION
(1)Hand mixing
(2)Mechanical
CONDENSATION
(1) Hand condensation
(2) Mech.condensation
MERCURY TOXICITY.
PRECAUTIONS
Ventilation
Disposal
Sealed containers Vaccum cleaners
INDICATIONS
(1) Moderate to Large Class I & Class II Restorations
(2) Class V Restorations (3) Temporary Caries Control Restorations (4) Foundations
CONTRAINDICATIONS
(1)Esthetics (2)Extensive tooth destruction (3)Small Class I & II Cavities
The important factors to consider in preparing a tooth for amalgam restoration are tooth anatomy and material requirements. Aspects of preparation due to tooth anatomy .
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 teeth- mesio occlusal , disto occlusal, mesio occluso distal.
Both buccal and lingual contacts are broken just to allow the very tip of the explorer to pass thru. Gingival contact opened just to see the rubber-dam. The rationale for braking contact is to allow self-cleansing of the cavosurface margins. Breaking contacts was not necessary on distal proximal surface since the adjacent tooth is missing.
smooth and 90
Due to amalgam physical properties and tooth anatomy (position of enamel rods) it is important to always have approximately 90
angle at the cavosurface margin. This provides strength to both the amalgam and enamel and prevents enamel not supported by sound dentin being left at the margins of the restoration.
3. All walls are convergent Retention form of the preparation is obtained by convergence of all
walls. A very simple way to provide convergent walls is to use 330 bur which has a pear-shaped design with rounded corners and can provide convergent walls to the preparation. The convergent walls can not be seen when looking from the occlusal surface of the preparation.
4. Rounded internal lines and angles The axiopulpal line angle is rounded in order to reduce stress concentration on amalgam. Other rounded internal angels have important role in reducing stress concentration on tooth structure.
5. Gingival cavosurface beveled and parallel to axiopulpal wall Due to orientation of enamel rods at gingival cavosurface it is necessary to bevel this surface in order to eliminate unsupported enamel. Parallelism of axiopulpal wall to gingival cavosurface margin is essential in protecting the pulpal chamber.
It is important to have the pulpal depth just into the dentin due to extension for prevention, there is also a minimum depth of 1mm required for amalgam restoration because of its lack of compressive forces. Extension for prevention principle is also applied on outline form whish means that central groove is included in the preparation, width of the preparation is determined by the width of the condenser in order to allow proper condensation of amalgam and should not exceed 1/3 the occlusal width.
7. Reverses In the preparation of a Class II amalgam restoration, extension of the preparation in the proximal area is important for elimination of caries and breaking proximal contacts. This convenience form includes arbitrary extension of the outline form into a reverse-S shape to both widen the box yet remove less tooth structure and is required only when necessary to open the contact. In the 35 MOD preparation reverse S is not present on distal. The reason is there was no need to break contact with adjacent tooth.
8. No iatrogenic flaws The adjacent teeth should be protected from any iatrogenic flaw. One
way to achieve that is to place matrix band around the neighboring teeth.
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
Improper Case Selection Improper Cavity Preparation Faulty Selection & manipulation of Amalgam Errors in Maricing Procedures Post Operative Factors
AMALGAM TATOO
1. 2. 3. 4.
Accidental implantation of silver containing compounds into oral mucosal tissue Occur: 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