Nama : Yoshua C.

Hendrik
NPM : 0906627070
Scenario 5 (Food Retention)

AMALGAM
Dental amalgam alloy refers to the combination of metals, such as silver, tin, copper,
and sometimes zinc, indium, palladium or platinum. A range of amalgam alloys is
available comercially and these may be distinguished from each other by the
following descriptors:
1. Copper Content
Total copper content in low copper amalgam alloys is less than 6%. The
formula is approximately 70% Ag; 26% Sn; 3-4% Cu with some minor
elements.
High copper amalgam alloys have a total copper content greater than
approximately 12%. Most modern alloys are usually containing
approximately 41-61% Ag; 28-31% Sn; 12-27% Cu and some minor
elements.
2. Zinc Content
Alloys containing more than 0,01% zinc = zinc containing, and less than 0,01
zinc = zinc free. Amalgam that contain zinc appear not only to exhibit a
lower rate of margin fracture under clinical loading, but also to exhibit an
excessive delayed expansion if contaminated with moisture during placement.
3. Minor Elements
A number of elements, such as indium, palladium, and platinum, may be
included in the alloy in minor quantities.
4. Gamma 2-phase content (γ2)  The bad content
Low copper amalgams contain Sn-Hg reaction product which is called the γ2
phase to distinguish it from the γ phases of the Ag-Sn and Ag-Hg alloy
systems. This reaction product is slow-setting, weak and corrodes easily.
Within several hours after amalgamation, all correctly manipulated high
copper amalgams are γ2 free.
5. Particle shape and type
Particle types depending on manufacture method:
- Lathe cut (or chip) refers to the irregularly shaped fillings produced by
cutting an ingot of alloy on a lathe. Prior to cutting, the ingot is
traditionally homogenised to produce an alloy with a Ag-Sn phase (γ) as
well as some regions of Cu2Sn (ε).
- Spherical particles are produced by atomising the alloy, whilst still liquid,
into a stream of inert gas. They are usually not subjected to an
homogenising heat treatment and therefore contain Cu2Sn (ε) finely
dispersed in a Ag-Sn (γ) matrix.
 Some alloys contain a blend of lathe-cut particles and spherical particles
and, depending on the propotion of each in the mix, the handling properties,
particularly the packability will be modified. Packability is a clinical
characteristic referring to the resistance offered by the amalgam to packing
loads during amalgam placement.

CLASSIFICATION OF ALLOYS AND AMALGAMS

Based on the copper content, the shape of the particles, and the major elements
present in the spherical particles of a blended particle alloys; dental amalgam alloys
and their corresponding amalgams can be simply classified into six types:
• Low copper, lathe cut
• Low copper, spherical
• High copper, lathe cut
• High copper, spherical
• High copper blend, Ag-Sn-Cu*
• High copper blend, Ag-Cu*
*: The types of blended particle alloys contain both lathe cut and
spherical particles and the spherical particles, which habe a high copper
content, mainly content either Ag-Sn-Cu or Ag-Cu.
The first two types have been called “conventional” or ‘silver tin” and the
fourth one has also been known as “single melt high copper” or “ternary”. Terms
such as “dispersion modified” and “Ag-Cu dispersed” have been applied to the last
one and a general label of “admixed” has been applied to all alloys containing both
lathe cut and spherical particles.
The range of high copper amalgam alloys available, with different handling
characteristics, ensures that there is no longer any justification for the clinical use of
a low copper amalgam.

AMALGAMATION AND STRUCTURE

Phases present in unreacted alloy
When mercury reacts with the particle, the metals in the alloy are usually present as
phases which approximate stoichiometric composition. Two phases, γ and ε are
present in all unreacted alloys and a third, the dispersant component (d), is only
present in the “high copper blend, Ag-Cu” type of alloy.
Components of the amalgamation reaction
In the amalgamation, mercury comes into contact with the surface of the alloy
particles and approximately 3-5 µmof the surface of each particle undergoes a
reaction. The metals in the particles are combined together in phases and these go
into solution in the mercury and then precipitate out and in the form of new reaction
products. Two of these (γ and η) are present in all amalgams and the third product,
the γ2 phase, is only present in low copper amalgams. The product of this reaction
becomes the matrix which, once it is set, holds the remaining particles together as a
coherent mass.
Initial mercury content
Depending on the shape, size, and composition of the alloy particles, the amount of
mercury required to provide food amalgamation can vary from 40-53% by weight.
Low copper microfine a relatively large amount of mercury initially and high copper
spherical alloys require the least. The final mercury content is influenced by the
initial content and the clinical technique used when placing the amalgam and is
approximately 37-48%. Retention of excess mercury in the matrix will lead to loss of
physical properties. A lack of dispensed mercury, or faulty trituration, will lead to
failure to wet the surface or all the particles, a weak particle/matrix interface and a
reduction in physical properties.
Structure of the set amalgam
Providing the minimal amount of mercury, commensurate with complete
amalgamation, is incorporated initially, and then proper condensation techniques are
carried out, approximately 35-50% of the final volume of the set amalgam will
consist of unreacted portions of alloy particles, held together by the γ1 (or Ag-Hg)
phase matrix.
Clinically, amalgams deteriorate with time as a result of corrosion. Corrosion
products will be formed within the amalgam as well as on the surface and Sn-Hg
phase may be lost from low copper amalgams. A clinically significant result of
corrosion is an increase in the number of voids in the amalgam.

PROPERTIES
Corrosion
Corrosion is the electrochemical destruction of a metal by reaction with its
environment. Corrosion is most the one most important property of amalgam
influencing the clinical longevity of the restoration. Amalgam restorations may
undergo one or more types of corrosion.
Tarnishing
Tarnishing arises from surface corrosion caused by oxidation of the Sn-Hg phase in
low copper amalgams or the Cu-containing phases in high copper amalgams with the
formation of a film of oxides, sulphides, and hydroxides. Polarisation may also take
place with breakdown of the film and formation of a corrosion product leading to
pitting and roughening of the surface.
Crevice corrosion
A differential oxygen concentration cell may develop at the tooth/restoration
interface resulting in the surface facing the cavity walls becoming anodio in relation
to the outer surface of the restoration. Selective attack on phases in the amalgam, as
well as the release of tin and copper, result in the formation of corrosion products
containing tin and copper as well as Ca, Cl, Fe, S, and Zn. These become lodged in
the crevice and can seal the interface producing the so-called self-sealing of the
margin between the amalgam and the cavity wall.
Corrosion fatigue
This occurs particularly around the margins of restorations. Fine, branchlike
penetrations, having the appearance of fatigue cracks, extend along the grain
boundaries of the γ1 matrix phase in regions subjected to occlusal load.
The γ2 phase is most suspectible to corrosion in low copper amalgams and the
process extends through the restoration via the γ2 phase, between grains of γ1 phase,
and through voids. In high copper amalgams the η, d, e (and possibly the γ1) phases
appear to corrode concurrently. Corrosion is a slower process in high copper
amalgams and extends along the grain boundaries of the γ1 phase.
Galvanic corrosion
Contact between dissimilar metals within an electrolyte may lead to galvanic
corrosion. Saliva will act as an electrolyte between amalgam and cast gold, between
amalgam and prosthodontic alloys, and between fresh amalgam and old amalgam.
Occasionally, this can cause sharp pain shortly after placement of a new amalgam
restoration sufficient to require its urgent removal. There will also be the potential
for long-term corrosion with pitting and roughening of adjacent metal restorations.
This means that the margin of a crown prepared over an amalgam core should be
placed on tooth structure beyond the gingival extent of the amalgam.
Creep
Creep is progressive permanent deformation of a set amalga under load. Low copper
amalgams show high creep values of greater than 2.5% which can be associated
clinically with greater margin fracture.
The presence or absence of the γ2 phase in the principal factor influencing creep. The
presence of the γ2 phase enchances the ability of the γ1 phase grains to slide
underload, particularly when the γ2 phase and with creep resisting η crystals at γ1
grain boundaries, show less than 0.2% creep at seven days.
Strength
The importance of laboratory testing of the strength of an amalgam in determining
clinical success or failure is uncertain, although some tests may be representative of
the clinical situation. Operator variables may significantly influence the achievement
of these values.
High copper spherical amalgams have the highest physical properties of all
amalgams at one hour after placement and this may be of clinical importance if the
restoration is to be subjected to early load. However, they are not fully set at this
time and it is unwise to subject a new restoration to immediate stress. The tensile
strength is only about 20-38Mpa at 1 hour so there is a need for care when checking
the occlusion. At seven days the properties of high copper amalgams are
substantially greater than for low copper amalgams. The transverse strength relates
directly to the final mercury content and this may be of clinical importance in large
restorations which are to be subjected to heavy occlusal loads.
Rigidity
The rigidity of restorative materials is an important property if they are to be used in
load bearing sites. The modulus of elasticity of high copper amalgams
(approximately 55 GPa) far exceeds that of glass-ionomers and composite resins (3-5
GPa and 4-16 GPa, respectively) and may be contrasted with dentine (18GPa) and
enamel (82.5GPa).
Fatigue strength
This is the response to repeated loading at relatively low subfracture loads for
extended periods of time. High copper amalgams show low creep and take extended
periods of time before fracturing. If fracture does occurs it is preceded by very little
bending.
Thermal expansion
Amalgam has a linear coefficient of the thermal expansion of 25mm/°C x 10^-6,
compared with glass-ionomers (10-11), composite resins (30-60) and tooth structure
(11.4). The larger the coefficient, the greater the dimensional change of the material
following change of temperature.
Dimensional change
Most amalgams exhibit a slight contraction on setting and this is of relatively minor
clinical significance. Zinc containing amalgams, particularly low copper amalgam,
may exhibit delayed expansion about 3-5 days after placement reaching in excess of
400 µm/cm. It appears to be the result of incorporation of water during clinical
handling leading to an electrolyte reaction between the water and zinc. Hydrogen gas
will be generated within the amalgam leading to expansion out of the cavity,
increased marginal leakage and pain. All contaminated amalgams exhibit increased
tarnish and zinc-containing amalgams will undergo excessive delayed expansion.

CLINICAL MANIPULATION
Cavity design
There is not a great deal of latitude available in the design of a cavity for restoration
with amalgam. G. V. Black laid down a set of principles and many of those still
apply although not so rigidly. Extension for prevention is out of date but elimination
of the disease is essential because amalgam has limited resistance to margin
penetration of bacteria and has no bioactivity. Inclusion of fluoride is of no benefit
because there is no water available to allow ion migration. In the absence of adhesion
it is generally necessary to remove unsupported to try to develop margins where the
angle of the amalgam margin will be at least 70° to limit the potential for fracture.
Trituration
Trituration (or mixing) of the alloy with the mercury is carried out in a mechanical
mixer (amalgamator) with the alloy and mercury in single use (ideally) or reusable
capsules. The object is to wet the entire surface of the alloy particles with the
mercury, to bring about the process known as amalgamation. The effectiveness of the
mixing process will be influenced by the speed of the particular unit, the length and
the direction of movement of the capsule in the machine, the presence of a pestle in
the capsule and the length of time of mixing.
The clinician can determine the maximum and minimum times for a new amalgam
alloy in a particular machine by carrying out several trial mixes. If, after mixing, the
amalgam feels hot to the hand or is difficult to remove from the capsule, the mixing
time should be reduced. To set a minimum time limit, drop the freshly mixed mass
on to the bench from a height of approximately 30cm. If the mix is dry and crumbles
on hitting the bench, the trituration time should be increased. A well-mixed amalgam
should stay together when dropped but should be a little flattened and retain in wet
gloss on the surface. It is unwise to substantially change the trituration time in an
attempt to modify working time. Manufactures control the working time of each
alloy and it is generally preferable to use their recommendation.
It is also better to slightly over triturate rather than under triturate an amalgam. The
following should be kept in mind:
• Prolonged trituration may reduce plasticity, shorten working time and
increase final contraction
• Inadequate trituration may result in complete wetting of the surfaces of the
alloy particles by the mercury, a weak interface between the matrix (γ1) and
the particles, lower strength, increased porosity, a rougher surface and
increased corrosion.
Although it is preferable, from the perspective of mercury hygiene, to use
single use, predispensed capsules, some clinicians preder alloy pelets/powder and
mercury dispensed in reusable capsules. In this case, the lowest possible mercury
proportion, in accordance with the manufacturer’s instructions should be used, so
that excess mercury does not have to be removed after trituration and before
placement into the cavity. Dispensing and trituration of the mass must be aimed at
ensuring optimum platicity. Probably no other characteristic has as much influence
on the adaptation of the amalgam to the cavity floor and walls thus optimising the
seal and minimising postinsertion sensitivity.
Packability
Packability refers to the resistance offered by the amalgam to the forces of
condensation used in placement. Amalgams can be described as offering a high or
low degree of packability and this will vary according to the size and proportional
distribution of lathe cut or spherical particles. Amalgams containing only spherical
particles are relatively easy to pack because they move readily from under the
condenser. Use a larger packing instrument with these amalgams. A substantial load
will still be required to achieve proper adaptation to the cavity and to eliminate as
much mercury-rich material as possible during condensation.
Purpose of condensation
Refers to the incremental placement of the amalgam into the prepared cavity and
compression of each increment into the others to form a continous homogeneous
mass.
Purpose of condensation are to:
• Adapt amalgam to the margins, walls, and line angles of the cavity.
• Minimise voids and layering between increments within the amalgam.
• Develop maximum physical properties.
• Remove excess mercury to leave an optimum alloy/mercury ratio.
It is best carried out using hand instruments with a smooth flat face which can
deliver reasonable force, per unit area, and compress the layers together. This means
that the smaller the diameter of the face of the plugger the greater the pressure that
can be applied.
Mechanical condensers are available and reduce the need for application of
load. However, they tend to lead to unreliable condensation, as well as the generation
of heat and mercury vapour, both of which are undesireable. Ultrasonic condensation
is unacceptable because of the release of mercury vapour.
Speed of placement
Immidiately amalgam is triturated, phase formation commences and the setting
reaction is underway. It must be used in a plastic state so there should be no delay
between trituration and condensation. No amalgam should be placed more than three
minutes from the start of mixing. Attempting to condense a partly set amalgam into a
cavity will result in poor adaptation, increased post insertion sensitivity, reduced
marginal seal, layering between increments, a weak restoration, and increased
potential for corrosion.
Moisture contamination
Keep the amalgam completely free from moisture contamination during the entire
condensation procedure. The cavity must be completely dry and free of gingival
seepage or haemorrhage. For preference, work under rubber dam. Inclusion with
water leads to corrosion and tarnishwith a reduction of physical properties. Contain
with Zinc-Containing amalgam will, in addition, develop a delayed expansion and
rise out of the cavity or show localised “bubbles” on the surface.
Need for matrix
Because of the need for appropriate condensation pressures, it is essential to use an
effective matrix for any cavity that is not entirely enclosed within four walls. The
matrix strip be metal and of sufficient size for the particular task. It must be adapted
tightly to the gingival margin, using a wooden wedge, to minimise the risk of
developing an overhanging excess of amalgam beyond the confines of the cavity.
Firm wedging will also slightly separate the teeth and this will compensate for the
thickness of the matrix band and ensure firm proximal contact between the
restoration and the adjacent tooth. Redevelopment of the proximal contour of a
posterior tooth is difficult at the best of times and calls for considerable clinical skill.
If an excessive amount of tooth structure is missing it is possible to reinforce the
matrix strip with greenstick compound. First place and contour the matrix as best
possible and support the gingival margin with a wedge. Then take a short length of
greenstick compound and soften one end in a bunsen burner. Condition the hot end in
hot water momentarily then push the softened material in to the proximal area of the
matrix and mold it to shape to offer maximum support as it sets.
Following successful restoration of the cavity with amalgam, heat the tip of a No. 6
flat plastic instrument and push it into the compound to soften it before gently
levering it away from the matrix, taking care not to overload the newly setting
amalgam.
Placement
Place the amalgam into the cavity in relatively small increments and condense
rapidly on to the walls and in to the line angles using appropriate load of short
duration. Pack laterally as well as vertically to ensure complete adaptation,
particularly into the angles of the cavity. Use a smooth faced condenser of
appropriate size.
The appropriate load to apply for a particular amalgam is related to the type of
amalgam and the size of the condenser. Always remove the mercury-rich surface of
the last increment before placing a subsequent load and increase the size of the
condenser when packing excess beyond the confiness of the cavity.
When placing very large restorations (e.g. cuspal coverage), large increments of
amalgam may be placed providing each increment is spread widely so that it is thin
and can be thoroughly condensed.
First burnish (precarve burnish)
On completion of condensation carry outa precarve burnish using a large burnisher
for 15 seconds. Use light force and move from the centre of the restoration outwards
across the margins. This will bring further mercury to the surface, which must be
removed, as well as improving adaptation to the cavity margins.
Carving
Carving instruments must be of appropriate shape and very sharp so as to create
minimum disruption to the amalgam at the margins. Do not carve a deep or sharp
occlusal anatomy but use the remaining enamel as a guide and take care to maintain
marginal ridges and occlusal spillways. Deep, sharply carved patterns on the occlusal
surface may look nice but they act as crack initiators and are undesireable.
Inadequate bulk of amalgam is the principal cause of amalgam fracture. It is also
very easy to over carve and take a restoration out of contact with the opposing tooth
thus altering occlusal relationships leading to over-eruption and lateral interferences.
However, well-defined marginal ridges and lateral spillways will dissipate load from
the occlusal table and lead the food bolus away from contact areas.
• Remember that excess flash left over the surface of the cusp inclines will be
fragile and will break away easily, usually leaving a crevice or ditch at the
margin that is liable to gather plaque and therefore make the enamel below
suspectible to further demineralisation.
• Always be prepared to adjust the occlusal anatomy of the opposing tooth to
avoid developing deep intercuspation between the arches because this may
lead to interferences during lateral and protrusive excursions and prejudice
 the longevity of the restoration or the tooth. It is wise to anticipate this before
cavity preparation and advise the patient accordingly at that time.
Final burnish (postcarve burnish)
Following carving, check the occlusion, particularly in relation to lateral excursions
and then carry out a brief final burnish. Use a large burnisher at a low load and
burnish outwards across the margins to finally adapt the amalgam at the margin on
both the occlusal and the proximal surfaces where access permits.
Finishing
The amalgam restoration should be finished at a later appointment to:
• Refine the amalgam tooth/margin.
• Adjust occlusal contact.
• Refine (but not deepen) occlusal anatomy.
• Smooth the surface of the restoration to minimise plaque retention. Note that
a high gloss is not required and over polishing represents poor mercury
hygiene.
Do not increase the depth of fissures or increase the angle of the cuspal
inclines because this may increase margin failure over time. Carry out all
finishing procedures under an air/water spray to minimise the generation of
heat because that may lead to the liberation of mercury vapour.