Dental amalgam

INTRODUCTION
• Dental amalgam is produced by mixing liquid mercury with
solid particles of an alloy of silver, tin, copper and sometimes
zinc, palladium, indium and selenium.

• This combination of solid metals is known as the amalgam

alloy.

• The dental amalgam alloy consists principally of silver in the

form of lathe-cut particles, spherical particles, or as an
“admixture”, a combination of both.
• These particles are wetted with mercury to initiate a

physicochemical reaction that in time causes

hardening or a set of the material.

• During the early stages of reaction the amalgam

mass display a plastic consistency that enables it to

be directly inserted into a cavity prepared in a tooth.

In spite of certain shortcomings, it remains the most widely
used of the restorative materials because of
1. The relative simplicity of the technique involved in its
manipulation
2. The minimal time necessary for its direct insertion into the
prepared cavity
3. Its versatility for restoring the carious surfaces of teeth in
most positions in the mouth
4. Its clinical characteristics which provide for good intraoral
serviceability.
 The first Amalgam War

• The foundation for the earliest recorded “amalgam

war” were laid around 1833.
• The Crawcour brothers, then exiled from France for
dental practice irregularities started a thriving practice
in New York city using a silver coin-mercury mixture
called “Royal Mineral succedaneum”.
• However, there was no attention to the proper
mercury alloy ratios or to the type of alloy being
used.
• For the most part, the alloy mixed with the mercury
was prepared by filling silver coins whose
composition was considerably variable.
• After a few years of the unscrupulous and inept work
of the Crawcours and their followers, disastrous side
effects started to appear.
• In many cases, the inconsistency in materials and
techniques led to slow setting amalgams that released
mercury from the unset mass into unprotected
dentinal tubules.
• Although there were no reported cases of patient
deaths, there were several cases of pulp death.
• In 1843, the American Society of Dental Surgeons
condemned the use of all filling materials other than
gold, thereby igniting the ‘first amalgam war’.
• The question of amalgam composition was finally
settled in 1895 by Dr. G.V. Black, who after years of
scientific research on amalgams, demonstrated the
proper quantitative and qualitative mixture of mercury in
amalgam to make an effective restorative material.
 The Second Amalgam War

• The second amalgam war was started by a German

chemist, professor Alfred Stock in the mid 1920’s.

• when Stock claimed to have evidence showing that

mercury could be absorbed from dental amalgams and
that this led to serious health problems.

• Stock reported that nearly all dentists had excess

mercury in their urine.
• He reported that mercury levels in urine of 7 patients
with amalgam ranged from 0.1 to 40 mg/L but failed
to record any mercury urine levels before restorations
were placed.
• Stock’s work was later questioned: even Stock, in
1934, repudiated his earlier analyses.
• Following these controversies, a dramatic health history
was reported.

• A 17-year-old girl, withdrawn, totally lacking in energy.

When she became ill, she began to hyperventilate and
started withdrawing from life and eventually dropped out
of school.

• She was sent to psychiatrists, internists and cardiologists

without results and became progressively sicker.
• A detailed case history recorded by a dentist disclosed
that her symptoms had begin 6 months earlier, after
the placement of several dental amalgam restorations.
• A mercury evaluation and biochemical tests were
done. The amalgam restorations were removed and
within days all symptoms cleared.
 The Third Amalgam War

• The current controversy, sometimes termed the “Third

Amalgam War” began primarily through the seminars,
writings and videotapes of H.A. Huggins, a dentist from
Colorado Springs.

• He was convinced that mercury released from dental

amalgam was responsible for a plethora of human
diseases affecting the cardiovascular and nervous systems.
• Patient claimed recoveries from multiple sclerosis,
Alzheimer’s disease and other afflictions as a result of
removing their amalgam fillings.
 Phase down of amalgam

• The Minamata Convention on Mercury (2013) is an

international legally binding treaty that aims to protect the

human health and the environment from anthropogenic

emissions and releases of mercury and mercury compounds.

• The convention addresses mercury-added products, including

dental amalgam, which is made of approximately 50% of

elemental mercury by weight, and proposes nine measures to

phase down the use of dental amalgam.

• These measures show the interconnected and interdependent

nature of phasing down dental amalgam, and reinforce the

need for a multipronged approach as called for by WHO.

Minamata Convention, Annex A, Part II

Nine measures to phase down the use of dental amalgam

1.Setting national objectives aiming at dental caries prevention

and health promotion, thereby minimizing the need for dental

restoration;

2. Setting national objectives aiming at minimizing its use

3. Promoting the use of cost–effective and clinically effective
mercury-free alternatives for dental restoration;
4. Promoting research and development of quality mercury-
free materials for dental restoration;
5. Encouraging representative professional organizations and
dental schools to educate and train dental professionals and
students on the use of mercury-free dental restoration
alternatives and on promoting best management practices;
6. Discouraging insurance policies and programmes that favour
dental amalgam use over mercury-free dental restoration;

7. Encouraging insurance policies and programmes that favour

the use of quality alternatives to dental amalgam for dental
restoration;

8. Restricting the use of dental amalgam to its encapsulated form;

9. Promoting the use of best environmental practices in dental

facilities to reduce releases of mercury and mercury compounds
to water and land.
ADVANTAGES DISADVANTAGES
•Lack of esthetics
• Ease of use
•Less conservative
• High compressive
•Non insulating
strength •Corrosion and galvanism
• Excellent wear resistance •Initial marginal leakage

• Economic • Lack of reinforcement of

weakened tooth structure
• Self sealing ability
•More difficult tooth preparation
•Mercury Toxicity
 CLASSIFICATION OF DENTAL AMALGAM ALLOYS

According to no. of Alloy Metals

1. Binary Alloys (silver-tin)

2. Ternary Alloys (silver-tin-copper)

3. Quaternary Alloys (silver-tin-copper-indium)

According to the Shape of Powder Particles

4. Spherical

5. Lathe Cut

6. Admixed
According To Powder Particle Size

1. Micro cut

2. Fine Cut

3. Coarse Cut

According To Copper Content

4. Low Copper Alloy

5. High Copper Alloys

According To Zinc Content

6. Zinc Containing Alloys

7. Zinc Free Alloys

Presence of Noble Metals

1. Noble Metal Alloys

2. Non Noble Metal Alloy

According to development of Amalgam Alloy

3. First Generation Amalgam Alloy-

Basic three part silver and one part tin, peri-tectic alloy.

2. Second Generation Amalgam Alloy-

• The alloy is product of the reaction between solid solution of tin in

silver with the liquid phase of silver and tin. This is defined as

gamma-phase, which is one of the ordered solutions of tin in silver

• To this basic formula, copper was added upto 4% to
decrease the plasticity and to increase the hardness and
strength of the alloy.

• Traces of Zinc (up to 1%) were also added to act as a

deoxidizer or scavenger for the alloy and to decrease its
brittleness.
Third Generation Amalgam Alloy-

• Admixture of spherical Ag3-Cu eutectic alloy to the original

alloy powder creates a very interesting and valuable effect in
the final product.
• This silver–copper eutectic alloy may be classified as the
third generation amalgam.
Fourth Generation Amalgam Alloy-
• The alloying of copper to silver and tin, in percentage up to
29%, forms a ternary alloy, in which most of tin is firmly
bonded to the copper.
• Fifth Generation Amalgam Alloy- The alloying of silver,
copper, tin and indium together, creating a true quaternary
alloy in which almost none of the tin is available to react with
the mercury when mixed with the powder.
• Sixth Generation Amalgam Alloy- The alloying of
palladium(10%), silver(62%) and copper(28%) to form a
eutectic alloy, which is lathe-cut and blended into a first,
second or third generation amalgam in ratio of 1:2. The set
amalgam exhibit the highest nobility of any previous
amalgam.
 COMPOSITION OF ALLOY

LOW COPPER ALLOYS HIGH COPPER AMALGAM

Admixed Alloy Powder
• Silver 65%
Silver 60%
• Tin 30%
Tin 27%
• Copper 5% Copper 13%

• Zinc 1% Zinc 0%

Single Composition Alloy

Silver 60%

Tin 25%

Copper 15%
 Effect of constituent metals on the properties
of Amalgam -
Silver (Ag)

• Increases strength

• Increases expansion

• Decreases flow
 Tin (Sn)

• Reduces Strength: Sn-Hg is increased which is a

weaker phase.

• It helps in amalgamation since tin has great affinity for

mercury. It also controls the fast reaction between

silver and mercury.

• Increases setting Time

• Decreases setting expansion

 Copper (Cu)

• Increase the resistance to tarnish and corrosion

• Increase strength: Only Ag Sn alloys are very brittle

and do not show uniform coherence i.e why some
amount of copper is a must.
• Reduces Flow

• Increases setting expansion: If copper is more than 5%

excessive expansion occurs.
 Zinc (Zn)

• Zinc free alloy more brittle and less plastic.

• Prevents oxidation during manufacturing of

alloy.
• Contributes to the cleanliness or workability of
silver amalgam.
• Responsible for delayed expansion.
 Indium (In)

• Decreases surface tension

• Reduces creep and marginal breakdown
• Increases strength
 Mercury (Hg)

• This is an important factor in the control of strength

of the restoration.
• Excess of mercury left in the restoration can
produce a marked reduction in strength.
• Each particle must be wetted by the mercury
otherwise a dry granular mix results. Such a mix
results in a rough, pitted surface that invites
corrosion.
• Increasing the final content of mercury increases the volume
fraction of the matrix phases at the expense of the alloy
particles. Hence alloys containing higher amounts of final
mercury are weaker
 MANUFACTURE OF ALLOY POWDER

Lathe-cut Powder-
• To make lathe-cut Powder, an annealed ingot of
alloy is placed in a milling machine or in a lathe
and is fed into a cutting tool or bit.
• The chips removed are often needlelike, and some
manufactures reduce the chip size by ball-milling.
 Homogenizing Annealing
• An ingot of an Ag-Sn alloy has cored structure and

contains non-homogenous grains of varying composition.

• A homogenizing heat treatment is performed to

reestablish the equilibrium phase relationship.

• An ingot is placed in an oven and heated at a temperature

below the solidus for a sufficient time to allow diffusion

of the atoms to occur and the phases to reach equilibrium.

• The time of heat treatment may vary depending on the
temperature used and the size of ingot. At the conclusion of
the heating cycle, the ingot is brought to room temperature
for succeeding steps in manufacture.

• If the ingot is cooled is withdrawn from the heat treatment

oven rapidly and then quickly quenched, the phase

distribution remains essentially unchanged ( β phase) .

• On other hand, if ingot is permitted to cool very slowly, the

proportions of phases continue to adjust toward the room

temperature equilibrium ratio ( ϒ phase).

 Particle size
• The average particle sizes of modern powder range
between 15 and 35 um.
• The most significant influence on amalgam properties
is the distribution of sizes around the average.
• The present trend in amalgam technique favors the use
of a small-to-average particle size, which tends to
produce a more rapid hardening of the amalgam with a
greater early strength.
 TYPES OF AMALGAM RESTORATIVE MATERIAL

LOW-COPPER AMALGAM-

• When the setting reaction occurred, the material was subject to

corrosion because a tin-mercury phase (gamma-two) formed.

• This corrosion led to rapid breakdown of the amalgam

restorations.

• Subsequent research for improving amalgam led to the

development of high-copper amalgam materials.
 HIGH-COPPER AMALGAM.
• The increase in copper content to 12% or greater designates
an amalgam as a high-copper type.
• The advantage of the added copper is that it preferentially
reacts with the tin and prohibits the formation of the more
corrosive phase (gamma-two) within the amalgam mass.
• This change in composition reduces or eliminates possible
deleterious corrosion effects on the restoration.
• However, the reduction of the corrosion products reduces
the formation of a corrosion layer at the amalgam-tooth
interface, the formation of which sometimes aids in sealing
the restoration.

• These materials can provide satisfactory performance for

more than 12 years. High-copper materials can be either
spherical or admixed in composition.
 Spherical Amalgam-
• A spherical amalgam contains small, round alloy particles
that are mixed with mercury.
• Because of the shape of the particles, the material is
condensed into the tooth preparation with little condensation
pressure.
• This advantage is combined with its high early strength 25
to provide a material that is well suited for very large
amalgam restorations, such as complex amalgams or
foundations.
 Admixed Amalgam-

• An admixed amalgam contains irregularly shaped

and sized alloy particles, sometimes combined with
spherical shapes.
• The irregular shape of many of the particles makes a
mass that requires more condensation pressure
(which many dentists prefer) and permits this heavier
condensation pressure to assist in displacing matrix
bands to more easily generate proximal contacts
 AMALGAMATION AND RESULTING
MICROSTRUCTURE.

Low-copper Alloys :

• Amalgamation occurs when mercury comes into

contact with the surface of the Ag-Sn alloy particle.

• When a powder is triturated, the silver and tin in the

outer portion of the particle dissolve into mercury.
• At the same time, mercury diffuses into the alloy
particle.
• When solubility is exceeded, crystals of two binary
metallic compounds precipitate into the mercury.

• These are Ag2Hg3 compound ( the γ1 phase) and the

Sn7-8Hg compound (the γ2 Phase).

• As the remaining mercury dissolves the alloy
particle, γ1 and γ2 crystals grow. As the mercury
disappears, the amalgam hardens.
• As the particles become covered with newly
formed crystals, mostly γ1, the reaction rate
decreases. The alloy is usually mixed with
mercury in approximately a 1:1 ratio.
• This is insufficient mercury to completely consume original
alloy particles; consequently, unconsumed particles are present
in the set amalgam. Alloy particles (smaller now, because their
surfaces have dissolved in mercury) are surrounded and bound
together by solid γ1 and γ2 crystals.

• γ (Ag3 Sn) +Ag-Cu (eutectic) +Hg γ(Ag3 Sn) + γ 1(Ag3

Hg3) + γ2 (Sn78Hg) + Ag-Cu (eutectic) unreacted
• The unconsumed Ag-Sn particles have a strong effect the
more of this phase that is retained in the final structure, the
stronger is the amalgam.

• The weakest component is the γ2 phase.

• Hardness of γ2 is approximately 10% of the hardness of γ1

whereas the γ phase hardness is somewhat higher than
that of γ1 .

• γ2 phase is also the least stable in a corrosive environment.

• This phase is prone to corrosion in clinical
restorations, a process that proceeds from outside of
the amalgam, along the crystals, connecting to new
crystal at inter-crystalline contacts.
• This produces penetrating corrosion that generates a
porous and spongy amalgam with minimal
mechanical resistance.
 High copper alloy:

• The main difference between the low and high-

copper amalgam alloy is not merely the
percentage of copper but the effect that the higher
copper content has on the amalgam reaction.
• The copper in these alloy is in either the silver-
copper eutectic or ε (cu3sn) form.
• The proper amount of copper causes most, if not all, of
the γ2 phase to be eliminated within a few hours. After
its formation, or prevents its formation entirely.
• The γ2 phase in amalgam is the weakest and is the most
susceptible to corrosion; Cu-Sn phases that are part of
the set amalgam matrix are much less corrosive than Sn-
Hg phase they replace.
• Both low and high copper undergo two kinds of
corrosion, chemical corrosion and electrochemical
corrosion.

• Chemical corrosion occurs most notably on the occlusal

surface and produces a black Ag-s tarnish film.

• This reaction limited to the surface and does not

compromise any properties, except for esthetic.
 Reaction of Mercury in an Admixed High-
copper Amalgam Alloy:
• During trituration, mercury diffuses into the
amalgam particles and dissolves.
• The solubility of mercury in silver, tin, and
copper differs considerably.
• Therefore particles composed mainly of silver and
dissolve almost all the mercury, whereas very little
mercury is dissolved by the silver-copper eutectic
particles.
• The mercury dissolved in the silver-tin particles reacts
as in low-copper alloys and forms the γ1 and γ2 phases,
leaving some silver-tin particles unreacted.
• In a relatively short time, however, the newly formed γ 2 phase

(Sn7-8Hg) around the silver-tin particles react with silver-copper

particles, forming cu6Sn5, the eta prime phase of copper-tin

system, along with some of the γ1 phase (Ag2Hg3) around the

silver-copper particles.

The amalgamation reaction may be simplified as follows:

γ (Ag3 Sn) +Ag-Cu (eutectic) +Hg γ(Ag3 Sn) + γ 1(Ag3 Hg3)

+ γ2 (Sn78Hg) + Ag-Cu (eutectic) unreacted
And the secondary, slow solid-state reaction is
• γ2 (Sn7-8Hg) + Ag-Cu (eutectic) η (Cu6Sn5) + γ 1(Ag3
Hg3) + Ag-Cu (eutectic) excess
Reaction of mercury in unicompositional Alloys

• In uni-compositional alloys, the difference in solubility of

mercury in tin, silver and copper plays an important role.

• Because the solubility of mercury in tin is 170 times

more than in copper and 17 times more than in silver,

much more mercury dissolves and reacts with tin than

with silver or copper.

• As a result, particles of unicompositional alloys in the very early stages

of setting are surrounded by γ1 and γ2 phases, whereas the periphery of

unicompositional alloy becomes an alloy of silver and copper phase,

forming Cu6Sn5(η’ ) and more Ag2Hg3(γ1).

• The unicompositional particle is composed of a very fine distribution of

Ag3Sn (ϒ) and Cu3Sn5(ε ).

The overall simplified reaction with Hg is

(ϒ) Ag- Sn-Cu alloy particles+Hg (η)Cu6Sn5

+ γ1 (Ag2Hg3)
 MICROSTRUCTURE OF AMALGAM

• In dental applications the amount of liquid mercury

used to amalgamate with the alloy particles is less
than that required to complete the reaction.
• Thus the set amalgam mass consists of unreacted
particles surrounded by a matrix of the reaction
products.
• The reaction is principally a surface reaction, and the matrix
bonds the unreacted particles together.
• The initial diffusion and reaction of mercury and alloy are
relatively rapid, and the mass changes rapidly from a plastic
consistency to a hard mass.
• Completion of the reaction may take several days to several
weeks, which is reflected by the change in mechanical
properties over this time.
 PROPERTIES OF DENTAL AMALGAM
Dimensional Change-

• Mercury can expand or contract, depending on its

manipulation. Ideally, the dimensional should be small.

Severe contraction can lead to microleakage, Plaque

accumulation, and secondary caries.

• Excessive expansion can produce pressure on the pulp and

post operative sentivity.

• ADA specification No. 1 requires that amalgam neither
contract not expand more than 20 µm/cm, measure at 37oC,
between 5 minutes and 24 hours after the beginning of
trituration.
 Theory of dimensional change-

• Most modern amalgams exhibits a net contraction when

triturated with a mechanical amalgamator and evaluated by

the ADA procedure.

• The classic picture of dimensional change is one in which

the specimen undergoes and initial contraction for about

20 minutes after the beginning of trituration and then
begins to expand.
• When the alloy and mercury are mixed, contraction
results as the particles dissolve (and hence become
smaller) and the γ1 phase grows. If there is sufficient
liquid mercury present to provide a plastic matrix,
expansion will occur when γ1 crystals impinge.

• After a rigid γ1 matrix has formed, growth of γ 1 crystals

cannot force the matrix to expand.
• If sufficient mercury is present in the mix when the
measurement of dimensional change begins,
expansion will be observed. Otherwise, contraction is
seen.
• Therefore, manipulation, such as lower mercury alloy
ratios and higher condensation pressures, which result
in less mercury in the mix favours contraction.
 Effect of Moisture Contamination
DELAYED EXPANSION
• Some admixed amalgams continue to expand for at least 2
years.
• This expansion may be related to the disappearance of some or
all of the γ2 in these high-copper amalgams or other solid-state
transformations.
• Zinc containing low-copper amalgams is contaminated by
moisture during trituration or condensation; a large expansion
can take place.
• This expansion usually starts after 3 to 5 days and may
continue for months, reaching values greater than 400 µm
(4%).
• This type of expansion is known as delayed or secondary
expansion.
• Hydrogen is produced by electrolytic action involving zinc
and water.
• This hydrogen does not combine with the amalgam but rather

collects within the restoration, increasing the internal pressure

to levels high enough to cause the amalgams to creep.

• The contamination must occur during trituration or

condensation; after the amalgam is condensed the external
surface may come in contact with saliva without the
occurrence of delayed expansion.
 Coefficient Of Thermal Expansion
• The linear coefficient of thermal expansion (LCTE) of
amalgam is 2.5 times greater than that of tooth structure, yet
it is closer than the LCTE of composite.
• One of the consequences of thermal expansion and
contraction differences between a restorative material and
adjacent tooth structure is percolation.
• This process is typified by an intracoronal amalgam restoration.

• During cooling, the amalgam contracts faster than tooth

structure and recedes from the preparation wall, allowing the
ingress of oral fluids. During subsequent expansion, the fluid is
expressed.

• Cyclic ingress and egress of fluids at the restoration margin is

called percolation
 Percolation along the margins of an amalgam
restoration due to its difference in linear coefficient of
thermal expansion from tooth structure during intraoral
temperature changes. Fluid influx occurs during cooling
(contraction). Fluid efflux occurs during heating
(expansion)
 MERCUROSCOPIC EXPANSION

• Extrusion at margins is promoted by electrochemical

corrosion, during which mercury from Sn-Hg rereacts
with Ag-Sn particles and produces further expansion
during the new reaction.
• The associated expansion makes the amalgam protrude
from the tooth preparation. Such secondary expansion
can occur throughout the clinical life of a restoration.
• On non occlusal surfaces, the entire amalgam restoration may
appear extruded and this can produce unwanted esthetic
problems or overhangs in some areas.
• On occlusal surfaces, abrasion and attrition tend to limit the
overall extrusion.
• However, occlusal margins become fracture-susceptible
ledges elevated above the natural contours of the adjacent
enamel.
 • This mechanism, called mercuroscopic expansion, was
originally proposed by Jorgensen as an explanation for the
prevalence of marginal fracture associated with occlusal
amalgams.

Clinical photograph of Class V

amalgam restoration being extruded
by mercuroscopic expansion
 Strength

• A prime requisite for any restorative material is a strength

sufficient to resist fracture. Fracture of even a small area,
especially at the margins, increases the risk for corrosion,
secondary caries and subsequent clinical failure.
• When strength is measured in this manner, the
compressive strength of a satisfactory amalgam probably
should be at least 310 MPa.
• 1 hour compressive strength of the single-composition
amalgam is almost double that of the other two amalgams.
• Amalgam is much weaker in tension than in compression.

• Tensile stresses can easily occur in amalgam restorations,

For example, a compressive stress on the adjacent cusp
introduces complex stresses that result in tensile stresses
in the isthmus area.
Effect of manipulation on strength
• Effect of Trituration: The effect of trituration depends on
the type of amalgam alloy, the trituration time, and the
speed of the amalgamator.
• Either under trituration or over trituration decreases the
strength in both traditional and high copper amalgams.
• Effect of Mercury Content: For either low-copper or high-
copper admixed amalgam, if the mercury content increases
above approximately 54% to 55%, the strength is markedly
reduced.
• Effect of Condensation: When typical condensation
techniques and lathe-cut alloys are employed, the greater the
condensation pressure the higher the compressive strength
particularly the early strength (e.g. at 1 hour)
• Good condensation techniques express mercury and result in
a smaller volume fraction of matrix phases.
• On the other hand, spherical amalgams condensed with lighter
pressures produce adequate strength.
• Effect of Porosity: Voids and porosity decrease the
compressive strength of hardened amalgam.
• Effect of Amalgam Hardening Rate: At the end of 20
minutes compressive strength may be only 6% of the 1 week
strength. The ADA specification stipulates a minimum
comprehensive strength of 80 MPa at 1 hour.
• The 1 hour compressive strength of high copper single
composition amalgams is exceptionally high.
• This strength may have some advantages clinically.

• For example, fracture is less probable if the patient

accidentally bites on the restoration soon after leaving the
dental office.
• Patients should be cautioned not to subject the restoration to
high biting stresses for at least 8 hours after placement. By
that time a typical amalgam has reached at least 70% of its
strength.
 Creep

• Amalgam creep is plastic deformation principally due to very slow

metallurgic phase transformations that involve diffusion-controlled
reactions and produce volume increases.
• Creep rate has been found to correlate with marginal breakdown of
traditional low-copper amalgams, that is, the higher the creep, the
greater the degree of marginal deterioration.

• creep values of low-copper amalgams range between 0.8% and

8%.
 Influence of Microstructure on Creep:

• Creep rates increase with larger γ1 volume fractions and decrease

with larger γ1 grain size absence of γ2, the very low creep rates in
single composition high copper amalgams may be associated with
η rods, which act as barriers to deformation of the γ 1 phase.

Mercury alloy ratios should be minimized, condensation pressure

should be maximized for lathe-cut or admixed alloys and careful
attention should be paid to timing of trituration and condensation.
 Tarnish and Corrosion
• Degree of tarnish and the resulting discoloration appear to
be dependent on the individual’s oral environment and to a
certain extent, on the particulars alloy employed.
• A tendency toward tarnish, although perhaps unaesthetic
because of black silver sulfide. The space between the alloy
and the tooth permits the microleakage of electrolyte and a
classic concentration cell (crevice corrosion) process results.
•
• The build up of corrosion products gradually seals
this space making dental amalgam a self sealing
restoration.
• The most common corrosion products found with
traditional amalgam alloys are oxides and chlorides
of tin.
• Corrosion products containing copper can also be
found in high copper amalgams.
• However the corrosion process is more limited in high copper

because the η phase is less susceptible to corrosion than is the γ 2

phase of traditional amalgam.

• Whenever a gold restoration is placed in contact with an amalgam,

corrosion of the amalgam can be expected as a result of the large

differences in electromotive forces of the two materials.

• The corrosion process can liberate free mercury, which can

contaminate and weaken the gold restoration.

 TECHNICAL CONSIDERATIONS OF DENTAL
AMALGAM
Choice of the alloy and Mercury
1. Mercury/ Alloy ratio
2. Proportioning
3. Trituration
4. Mulling
5. Matricing
6. Condensation
7. Burnishing
8. Carving
9. Finishing and Polishing
 Choice of the alloy and Mercury-

• The selection of one type of amalgam over others should

be based on clinical performance and physical properties.
• Alloys of traditional composition are still available, and
acceptable amalgam restorations can be obtained from
many of these products. However, it is obvious that the
newer high-copper alloy systems are the materials of
choice.
• Improved physical properties, the elimination of ϒ2 phase, and

the better corrosion resistance associated with these alloy

generally lead to superior clinical performance.

• There is only one requisite for dental mercury: purity.

Common contaminating elements, such as arsenic, can lead to
pulpal damage.

• Furthermore, a lack of purity may adversely affect the physical

properties of the amalgam. It is unfortunate that terms such as
pure, redistilled and triple distilled do not indicate the
chemical quality of the mercury.
• The designation U.S.P. (united states pharmacopeia) ensures
mercury of satisfactory purity with no surface contamination
and less than 0.02% nonvolatile residue.
• This requirement is encompassed in the ANSI/ADA
Specification no. 6 for dental mercury.
 Mercury /Alloy Ratio-

• The only way to achieve smooth and plastic amalgam

mixes was to use an amount of mercury considerably in

excess of that desirable in the final restoration.

• Because adverse effect on the physical and mechanical

properties of amalgam, manipulative procedures were

employed to reduce the amount of mercury left in the
restoration to an acceptable level.
• For conventional mercury –added systems, two
technique were used for achieving mercury reduction
in the final restoration.
• Initially, the removal of excess mercury was
accomplished by squeezing the mixed amalgam in a
squeeze cloth before insertion of the increments into
the prepared cavity.
• Also additional mercury was worked to the top during
condensation of each increment, and this excess was
removed as the amalgam mix was built up to form a
restoration.
• Minimal mercury technique or Eames technique- This
technique is recommended for reduced mercury/alloy
ratios alloy.
Proportioning

• Recommended mercury/alloy ratio for most modern lathe-cut

alloys is approximately 1:1 and for spherical recommended
amount of mercury is closer to 42% because spherical particles
require less mercury to completely wet the particle.

• Mercury is commonly dispensed by volume, Bottle should be

held vertically and kept at least half full to ensure uniform spills.

• Semi automatic dispensers are commonly employed which also

carry out trituration. These dispensers have two containers
containing alloy and mercury
• The ratio is set by the operator. On pressing the button given

amount of mercury and alloy is released.

• In case of large cavities, button can be pressed twice.

• Another method used is the use of encapsulated

alloy/mercury material.

• The required proportion of alloy and mercury is separated

by a thin membrane, In a mechanical mixer, the membrane

is broken as the mixer starts vibrating.

Trituration-

6 objectives-

• To achieve workable mass of amalgam within a minimum

time leaving sufficient time for insertion into cavity

preparation and carving.

• To pulverize pellets into particles that can easily attacked by

mercury

• To reduce particle size so as to increase the surface area of the

particles per unit volume, leading to a faster and more

complete amalgamation.
• To dissolve the particles or part of the particles of the

powder in mercury, which is a prerequisite for the formation

of the matrix crystals.

• To remove oxides from the powder particle surface,

facilitating direct contact between particle and mercury.

• To keep the amount of gamma-1 or gamma-2 matrix crystals

as minimal as possible, yet evenly distributed throughout

the mass for proper binding consistent and adequate
strength.
• Tituration can be carried out by hand or by
mechanical amalgamtors.
• Hand trituration is performed in glass mortar
and pestle, preferably with a roughened surface.
• Mechanical mixing is done in semi automatic or
fully automatic amalgamator.
• In amalgamator capsules are used which act as mortar and
plastic or metal pestle is inserted in the capsule.

• The size of pestle should be less than capsule.

• This is done to produce enough friction so as to remove

oxide layer of alloy particles and to ensure proper coating of
alloy particles with mercury.
Hand mixing with Mortar and pestle Amalgamator
• Following trituration the consistency of the mix can be

normal or it can under mix or over mix.

• The normal mix consistency is convenient to handle, shiny in

appearance, warm, homogenous and have good strength.

• The over mix consistency is soupy, can’t be held in a form,

difficult to remove from the capsule and pestle and have low

strength.

• The under mix consistency is dry and crumbly, dull in

appearance and inconvenient to manipulate during insertion

Normal Mix
Undermix
Mulling

• It is the process by which the mix is given a cohesive form.

• After hand trituration mulling is done by taking mix in hand

and rubbing between fingers.

• After mechanical trituration, mulling is done by rotating the

mix in a pestle free capsule. It gives mix a cohesive form.
Matricing
• If a cavity preparation for amalgam involves more
than one surface , in order to have the required four
surrounding walls and a floor for the amalgam
condensation into the cavity, a matrix should be
adapted to the tooth.
Condensation

• Condensation is process by which the mix is compacted into

a prepared cavity to attain a dense mass. Major objective is

to remove excess mercury from each increment as it is
worked to the top by condensing procedure. Condensation
accomplished within four walls and a floor. Condensation
can be accomplished either hand or mechanical instrument.

Types of Condensation :

• Hand condensation

• Mechanical condensation
Hand Condensation-

• Increasing the area of condenser decreases the amount of

pressure acting at the bottom of the condenser.

• The condensation should preferably start from center to

periphery.

• The increments should be small at one time.

• Large bulk of increments leads to air entrapment and lead

to porous and weak restoration.
• The Condensation pressure in the range of 4 to 8 lb is regarded

as most appropriate.

• Various studies have indicated that use of extremely high

condensation pressure substantially seemed to be no

correlation between strength and residual mercury content

when it was within the range 33%.

• After proper condensation the surface of restoration becomes

shiny. This is due to accumulation of residual mercury at the

surface of restoration.
• Burnishing is process in which smooth, rigid instrument is
used for smoothening restoration surface which has become
rough by carving.
• what should be carried first - carving or burnishing

• If carving is done before burnishing, the effect of carving is

lost.
• If burnishing is done before carving, then the carving leads to
production of rough surfaces.
• This has led to the concept of pre carve and post carve
burnishing.
Carving-
• It is an anatomical sculpturing of the amalgam
material.
There are 8 objectives to this process:
• To produce a restoration with no under hangs,
i.e. all margins details of the cavity preparation
are completely covered with amalgam without
any shouldering or shelving of tooth structure
there.
• To produce a restoration with proper
physiological contours.
• To produce a restoration with minimal flash, i.e. not
to the extent of overhangs. Flashes can be easily
removed with the finishing and polishing.
• To produce restoration with functional, non-
interfering occlusal anatomy.
• To produce a restoration with adequate, compatible
marginal ridges.
• To Produce restoration with adequate size, location, extent, and

interrelationship of contact areas.

• To produce restoration with physiological compatible embrasures.

• To produce a restoration not interfering in any way with the integrity

of the periodontium, enhancing its health and amenable plaque control.
• Amalgam carver should be accomplished using sharp instruments and
with strokes either proceeding from tooth surface to amalgam surface
or laterally, along the tooth amalgam interface.
Post Carve burnishing: After carving, the
rough surface so produced is smoothened
by final burnishing.
• Final smoothening can be done by
rubbing the surface with moist cotton
pellet.
• Burnishing slow setting alloys can
damage amalgams
Finishing & Polishing-
1. Amalgam flash left behind after carving is removed
and minor overhangs are corrected.
2. Conversion of superficial amalgam into relatively
inert layer galvanically.
3. Removal of superficial scratches and irregularties.
Principle and procedure for finishing and polishing-

• Usually 24 hr should pass after amalgam insertion before any

finishing and polishing commences.

• Some newer alloy can be polished after 8-12, still other require

30 min wait after insertion.

• All accessible areas of an amalgam restoration should be

finished and polished.

• The final polishing act i.e. obtaining metallic luster , is always

done with polishing agent (e.g. precipitated chalk, tin, zinc

oxide) applied with rubber cup.

 Repaired Amalgam Restorations
• Occasionally when an amalgam restoration fails, as from
marginal fracture, it is repaired.

• A new mix of amalgam is condensed against the remaining part

of the existing restoration. Thus the strength of the bond
between the new and the old amalgam is important.

• The flexure strength of repaired amalgam is less than 50% of

that of unrepaired amalgam. The bond is a source of weakness.
• Factors such as corrosion and saliva contamination at the

interface present formidable barriers that interfere with

bonding of the old and new amalgam.

• Repair of amalgam restorations probably falls into the category

of a hazardous procedure. Repair should be attempted only if

the area involved is one that will not be subjected to high

stresses or the two restoration parts are adequately supported

and retained.
 Recent Advances In Dental Amalgam

• Resin coated Amalgam

• Fluoridated Amalgam
• Bonded Amalgam
• Gallium
• Miracle- Mix
 Resin coated Amalgam-

• To overcome microleakage with amalgams, a

coating of unfilled resin over the restoration
margins and the adjacent enamel, has been tried.
• Although the resin may eventually wear away, it
delays microleakage until corrosion products
begin to fill the tooth restoration interface.
Fluoridated Amalgam-
• Fluoride, being cariostatic, has been included in amalgam
to deal with the problem of recurrent caries associated with
amalgam restorations.
• An anticariogenic action of fluoride amalgam could be
explained by its ability to deposit fluoride in the hard tissue
around the filling and to increase the fluoride content of
plaque and saliva , subsequently affecting demineralization.
• The fluoride amalgam serves as “slow release device”.
Bonded Amalgam-
• It is used to seal underlying tooth structure and bond
amalgam to enamel and dentin.
• They require dual characteristic to achieve optimal
wetting. Amalgam dentin are strongly hydrophobic,
whereas enamel and dentin are hydrophilic.
• Therefore the bonding system should have capacity
to wet both surfaces.
• Typical dentin bonding systems may be used, but special
4-methyloxy ethyl trimellitic anhydride (4-META)-based
systems are used frequently.
• This monomer molecule contains both hydrophobic and
hydrophilic ends. Bond strengths for joining amalgam to
dentin are relatively low (2 to 6 MPa).
• Primary indication for amalgam bonding is when
weakened tooth structure remains and bonding may
improve the overall resistance form of the restored tooth.
Gallium alloys

• Gallium is a metal with similar atomic structure and

characteristics to mercury and has a melting point of 29°C.

• This property has been used to produce gallium based alloys

which can be used in a similar way to mercury based amalgam.

• They consist of about 65% gallium and in the commercial

products, the material is supplied in a powder / liquid form. The

liquid is an alloy of silver, tin, indium and gallium.

 MERCURY TOXICITY
• Mercury is a known toxic , bio accumulative substance and it often
finds its way into body through dental amalgams, which is used to
restore cavitated tooth.
• Taking out fillings with a high speed dental bur generates a cloud of
particles, at least 65% of which are one micron or less in size.

• The silver fillings used by dentists to restore teeth are composed of a

metal "amalgam" containing roughly 50% elemental mercury and
50% other metals (mostly silver with some tin and copper).
Mercury release in dental office
• During trituration , insertion and intraoral
hardening
• When Amalgam raw material being stored in
use.
• During finishing and polishing from amalgam
scrap.
• Removal of old restoration
Amount of mercury released during
manipulation of amalgam
• Trituration: 1-2µg
• Condensation: 6-8µg
• Dry Polishing: 44µg
• Wet Polishing: 2-4µg
• Removal of amalgam restoration under water
spray and high volume suction: 15-20µg.
• Additional evacuation for 1 min to remove
residual amalgam dust: 1.5-2µg.
Mercury symptom on oral cavity

• Ulceration of gingiva, palate, tongue

• Stomatitis (sores in the mouth)

• Tissue pigmentation (amalgam tattoo of gums)

• Burning sensation, with tingling of lips, face

• Metallic taste

• Foul breath

• Excessive salivation

• Loosening of teeth

• Alveolar bone loss

• Bleeding gums
DENTAL MERCURY HYGIENE RECOMMENDATIONS

• OFFICE DESIGN: Use proper work area design to facilitate

spill containment and cleanup.

• Monitor personnel: Monitor office by periodic analysis. vapour

analyzer (limit – 50µg/m³ 8 hr shift over 40 hr work week).

• Monitor office: Monitor the hg vapor level in the office

periodically. This may be done by using dosimeter badges

• Ventilation: Provide proper ventilation in the place by having

fresh air exchanges and periodic replacement of filters, which

may act as traps for mercury.

• Evacuation systems: Use high volume evacuation
when finishing or removing amalgam. Evacuation
system have traps or filter. Check, clean / replace
traps and filter periodically.
• Handling care: Use care in handling amalgam,
avoid skin contact with mercury or freshly mixed
amalgam avoid dry polishing.
• Amalgamator cover: use an amalgamator fitted
with a cover.
• Pre-capsulated alloys: Use pre-capsulated Alloy.
• Eliminate the possibility of a bulk mercury Spill,
otherwise store bulk hg properly in unbreakable
containers on stable surface.
• Select an appropriate alloy: Proper Hg: alloy ratio to

avoid the need to remove excess Hg before packing.

• Spills: Clean up Hg properly by using bottle tapes/ fresh

mixes of amalgam to pick- up droplets/ use commercial

clean up kits. Do not use household vacuum cleaner.

• Contaminated items: Dispose of Hg contaminated

items in sealed bags according to applicable regulation .

• Masks: Change mask as necessary when removing
amalgam restoration.
• Use rubber dam during insertion, condensation,
and polishing of amalgam.
• Avoid carpet/floor coverings in dental office ;
Floor coverings should be easy to clean,
nonabsorbent and seamless.
• Clothing: Wear professional clothing only in dental
operatory.
• Recycling: Store amalgam scrap under radiographic
fixer solution in covered container. Recycle
amalgam scraps through refiners.
CONCLUSION

• Amalgam has been used in clinical dentistry for our 100 years.

• About 75% of all restorations filled are amalgam restorations.

• The only adverse effects documented is the rare occurrence of

hypersensitivity to mercury in a very tiny proportion of the

population.

• Alternatively to amalgam though in use do not match up to it in

strength, longevity and ease of manipulation.

• The new high copper single composition alloys offer superior
properties but may not offer as good seal as older amalgams.

• The use of amalgam can be continued as a material of choice

if esthetics is not a concern.

• Prepare a tooth as conservative as possible, making access

large enough only for removal of carious dentin and using
resin sealants for non carious fissures