Index

Definitions

History

Classification

Manufacturing process

Composition

Role of each ingredient

Phases present in amalgams

DEFINITION

AMALGAM --- an alloy containing mercury.

DENTAL AMALGAM --- an alloy of mercury,silver,copper and tin which

may also contain other elements to improve

handling characteristics and clinical

performance.

AMALGAMATION -- - the process of mixing liquid mercury with one or

more metals or alloys to form an amalgam.

DENTAL AMALGAM ALLOY --- an alloy of silver, copper, tin and other

1
 elements that is formulated and
processed

in the form of powder particles or

as

a compressed pellet.

Introduction

( To add )

History

 Chinese developed silver amalgam more than thousand years

before dentists in the west

 Silver paste is mentioned in Materia media of Su kung (AD 659)

and again in 1108 by Tsang Shen- Wei

 During Ming period , in the 15 th century ,Chinese formulated

100 parts of mercury to 45 parts of silver and 900 parts of tin .
Their trituration produced paste said to be as solid as silver

 In 1826 , Introduction of Silver-Mercury paste (pate-d'argent) by

Peter O. Taveau of Paris, France.

 amalgam was introduction by Crawcour brothers to the North

American continent in 1833, and was called ‘Royal Mineral
Succedaneum’ Prepared from shavings of silver cut from coins
,mixed with mercury to from a sloppy paste

.It became very popular but was subjected to much controversy soon for
a number of reasons:

2
1) The mercury used was considered to be poisonous.

2) Method of condensing amalgam was very crude compared to gold

foil .

3) It caused black discoloration of teeth

4) Final restoration was porous.

5) There was shrinkage in the final set

 Amalgam war I ;Because of lot of opposition by the American

Society of Dental Surgeons in 1843, use of amalgam was
considered as a malpractice; and all those using it as unethical.
Thus the “Amalgam War” began. In 1845, all members signed a
pledge never to use amalgam again and those who didn’t were
expelled. many highly reputable dentists still used amalgam in
poor patients who could not pay for gold and compete with
quacks , who were using it widely

The pledge was rescinded in 1850, by then it had been established that
amalgam is a complete failure. Finally the American society of dental
surgeons dissolved in 1856. several dentists who had not taken strong
position in amalgam war joined new organization A DENTAL
CONVENTION

However it was not until the classic work of G.V.BLACK in 1896, that a
systematic study was made of the properties, appropriate manipulation
and relation of amalgam to cavity preparation. As a result many failures
related to early amalgam were overcome.

The new composition of amalgam consisted of apx 65- 68%silver

28-30%tin

Traces of copper
(<5%)

& zinc.

1895 - G.V. Black develops formula for modern amalgam alloy

3
67% silver, 27% tin, 5% copper, 1% zinc .This mix overcame expansion
problems

 In 1899 the ADA came into existence & it endorsed Amalgam

They brought an end to Amalgam war

o 1900: Introduction of Copper amalgam.

AMALGAM WAR II

In 1920s dr Alfred stock ,commented on the hazards of amalgam

1960’s

conventional low-copper lathe-cut alloys were introduced

smaller particles

first generation high-copper alloys

Dispersalloy (Caulk)

admixture of spherical Ag-Cu

eutectic particles with conventional lathe-cut
eliminated gamma-2

1970’s

first single composition spherical

terniary system (silver/tin/copper)

1980’s

alloys similar to Dispersalloy

1990’s

mercury-free alloys

However, in 1930, in a dental survey organized by American Dental

Association Research Commission, showed that only a few of the dental
amalgams in the market were reliable as there was a vast degree of
discrepancy in the composition of the material. The results of the survey

4
prompted the introduction of the American Dental Associations
Specification No.1 for amalgam.

Indications

 Class I class II

 Large Cl-I and Cl-II cavities, involving more than the middle 3rd of
the occlusal surface of the posterior teeth, where indirect
restorations are contraindicated.

 Class II cavities where the cervical margin of the box finishes

subgingivally / is composed entirely of dentin.

 Class IV

 Class III –distal of cuspids where esthetics is not a concern

 Foundations for cast restoration

 Core build ups

 Can be used as retrograde filling material

 Where moisture control is difficult

 Teeth with questionable prognosis

 aesthetic is not the prime concern

 cost is a major patient concern

contraindications

 anterior teeth where eathetics is the prime concern

 Posterior teeth ,where esthetics is a prime concern

 Remaining tooth structure requires support / would require

extensive preparation to accommodate amalgam.

 Patients allergic to amalgam

 Small to moderate size preparations :which would require more

removal of tooth structure ,as composites require conservative
tooth preparation

5
 Advantages

Economical

Ease of placement

Less technique sensitive

Good wear resistance

Self sealing ability

Good marginal adaptation ,which improves with time

Can be done in single appointment

Longevity of restoration

Disadvantages

Compromised aesthetics

Lack of adhesion to tooth structure

Brittle material –less tensile strength

Requires definitive tooth preparation to incorporate resistance

and retention features

Does not reinforce the remaining tooth structure

High thermal conductivity – needs pulpal protection

Can undergo tarnish and corrosion

Marginal deterioration seen in low copper alloys

CLASSIFICATION Dispensed as powder and liquid.

The powder is a silver based alloy with various types and

combinations; and can be classified in the following ways:

6
  According to the Number of Alloyed Metals

Binary alloys : silver-tin

Ternary alloys : silver-tin-copper

Quaternary alloys : silver-tin-copper-indium

 According to the shape of Powder Particles

Spherical (smooth surface spheres )

Spheroidal (spheres with irregular

surfaces)

lathe- cut(irregular shapes spindles

to shavings )

 According to Powder’s particle diameter

Micro cut

Fine cut

Coarse cut

 According to the Copper Content of the Powder

copper content of 6% or less--- Low Copper

Alloys

copper content of greater than 6%--- High

copper Alloys

 According to Addition of Noble Metals

Non noble alloy

noble metal alloy: containing gold,palladium ,palatinum

7
  According to the Number of Alloys in the Powder

only one alloy—single composition –unmixed

mixture of two or more alloys –admix composition

 According to the Zinc Content

Zinc containing amalgams --- more than 0.01% zinc

Zinc free amalgams --- less than 0.01%zinc

According to Compositional Changes of Succeeding Generations of

Amalgam

First Generation - 3 parts silver and 1 part tin, peritectic

alloy

Second Generation - Addition of 4%copper and 1%zinc in

basic alloy

Third Generation - admixed alloy . Silver Copper Eutectic

alloy is added

Fourth Generation - Alloying of Copper to silver and tin

(29%)

in a ternary alloy in which most of the

tin binds to copper

8
Fifth generation - Alloying of silver copper tin and indium

creates true Quaternary alloy in which

none

of the tin is available to react with

mercury

when mixed.

Sixth generation - Alloying of Pd (10%)

Ag (62%)

Cu (28%)

to form a eutectic which is lathe cut and

blended into 1st, 2ndor 3rd generation

amalgam

in a ratio of 1:2.

Manufacturing Process

Lathe-cut alloys

– Ag & Sn melted together to form an ingot

– Alloy slowly cooled

-- phases solidify

– heat treatment to the alloy (400 ºC for 6- 8 hours),to

produce more homogeneous distribution of phases

– grind on a lathe , then mill to 25 - 50 microns

– heat treat to release stresses of grinding

9
 Spherical alloys

– melt alloy

– atomize( hot melted alloy passed through a sieve into a cold

atmosphere for solidification )

- spheres form as particles cool

– sizes range from 5 - 40 microns

• variety improves condensability

basic components

 Basic

 Silver
 Tin
 Copper
 Mercury
 Other
 Zinc
 Indium
 Palladium

ROLE OF INGREDIENTS

SILVER:

 Major ingredient .

 increases strength

 Reduces the flow and creep

 Contributes to the expansion on setting.

 Accelerates setting time.

 Increases resistance to tarnish.

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  Whitens the alloy

TIN:

 Controls the reaction between silver, mercury and tin .

 Reduces the setting expansion

 reduces the strength.

 Reduces hardness.

 Increases flow and setting time.

 reduces the resistance to corrosion.

Copper:

 Increases strength and hardness.

 Increases setting expansion

 Combines with tin ,reducing weakest phase ie: gamma 2

 Increases resistance to tarnish and corrosion

 Reduces creep .

ZINC:

 Acts as a scavenger or de-oxidizer. When the various metals are

melted together during manufacture of the alloy, zinc reacts
rapidly and preferentially with oxygen and other impurities
present and prevents the oxidation of more important elements
like silver, copper and tin. Oxidation of these elements would

11
 seriously affect the properties of the alloy and the amalgam. Acts
as sacrificial anode

 Alloys without zinc are more brittle and the amalgam formed by
them tends to be less plastic.

 causes delayed expansion

 INDIUM :

 increases strength

 decreases surface tension. Hence helps in

 Reduces the amount of mercury required

 reduces mercury vapor
 reduces creep and marginal breakdown

PLATINUM:

 Hardens the alloy.

 Increases resistance to corrosion.

PALLADIUM:

 Hardens and whitens the alloy

 Increases luster

 . reduced corrosion

12
 MERCURY: Mercury (Hg) ADA sp no6

Clean reflecting surface ,free of any surface films

only pure metal that is liquid at room temperature

Triple distilled ,impurity free mercury used

Should have 0.02% of non volatile mercury

 activates reaction

 Important constituent

 Alloy powder mixed with mercury

 spherical alloys require less mercury as smaller surface area

easier to wet

40 to 45% Hg

 admixed alloys require more mercury as lathe-cut particles more

difficult to wet

45 to 50% Hg

 sometimes mercury (upto 3%) is added to the alloy, usually just

sufficient to cover the surface of the alloy particles. They are called
as pre amalgamated alloys. This pre amalgamation produces a
more rapid reaction.

Phases present in amalgams

 gamma phase: .Ag3Sn unreacted particles ,not dissolved in

Mercury.

13
 Strongest phase .occupies maximum space in volume in
restoration
 gamma -1 phase : Silver-Mercury Phase Ag2Hg3 , amalgamation
product Resistant to tarnish and corrosion.
 gamma -2 phase : Tin -Mercury Phase weakest phase Sn7Hg8
Least resistant to tarnish & corrosion

 the mercury phase : unreacted , residual mercury present in the

amalgam mass. Unreacted hg reduces strength, and hardness &
increases flow, creep and causes mercuroscopic expansion.

 Void phase : occur due to air entrapment in amalgam build up.act

as foci for corrosion ,stress conc.,and propogation .cause failure of
amalgam
 epsilon – cu3sn
 eta – cu6sn5
 beta – agsn

 eutectic phase –ag 3 cu

 beta-1 - aghg
 beta (galloy) - GaCu + Sn

 ag 2 cusn

 the trace elements phase : Cu, Zn present in very small

quantities. Combine with silver ,tin ,mercury
 the interphase: High Cu Alloys in which Ag - Cu Eutectic is
present.
The Gamma-2 ( Sn7Hg6) phase reacts with Ag-Cu eutectic to form
more stable Cu6Sn5 which is more corrosion resistant.

The free Mercury reacts with the Gamma Phase till a stage is
reached when no Gamma -2 Phase is left and is replaced by Gamma -1
phase

COMPOSITION (add composition of high copper- single comp and

admixed)

A ) LOW COPPER ALLOYS

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Conventional silver- tin alloys contain (by weight):

Silver 65% (minimum)

Tin 29% (maximum)

Copper 6% (maximum)

Zinc 2% (maximum)

On mixing with mercury, the following (simplified) reaction occurs.

Ag3Sn + Hg → Ag2Hg3 + Sn7-8Hg + Ag3Sn

Gamma Gamma 1 Gamma2 Gamma (unreacted)

Phases present

• Gamma (g) = Ag3Sn

– unreacted alloy

– strongest phase and corrodes the least

– forms 30% of volume of set amalgam

• Gamma 1 (g1) = Ag2Hg3

– matrix for unreacted alloy

2nd strongest phase

– 10 micron grains
binds gamma (g)

– 60% of volume

• Gamma 2 (g2) = Sn8Hg

– weakest and softest phase

– corrodes fast

15
 – corrosion yields Hg which reacts with more gamma (g)

– 10% of volume

– volume decreases with time due to corrosion

• dissolution and precipitation reaction

• Hg dissolves Ag and Sn from alloy and forms Intermetallic

compounds

Setting sequence

 dissolution of silver, tin into mercury

 precipitation of gamma1 crystals in mercury

 consumption of remaining mercury by the growth of gamma1 and

gamma2 grains

 final set of amalgam

B] HIGH COPPER ALLOYS

contain more than 6% copper, often between 10-30%

Modern high copper alloys are presented in two main forms:

 ADMIX ALLOY

Setting reactions of alloys containing a silver/copper eutectic may be as

follows:

Ag3Sn + Hg → Ag2Hg3 + Sn7-8Hg + Ag3Sn

Gamma Gamma1 Gamma2 Gamma

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Sn8Hg + AgCu → Ag2Hg3 + Cu6Sn5

Gamma2 Gamma1 Eta

Setting sequence

• Ag enters Hg from Ag-Cu spherical eutectic particles

– eutectic

• an alloy in which the elements are completely

soluble in liquid solution but separate into
distinct areas upon solidification

• Both Ag and Sn enter Hg from Ag3Sn particles

• Sn diffuses to surface of Ag-Cu particles

– reacts with Cu to form (eta) Cu6Sn5 (h) around

unconsumed
Ag-Cu particles

• Gamma 1 (g1) (Ag2Hg3) surrounds (h) eta phase (Cu6Sn5) and

gamma (g) alloy particles (Ag3Sn)

SINGLE COMPOSITION Single composition alloys may contain spherical

or lathe cut particles.

setting reaction

Ag3Sn + Cu3Sn + Hg → Ag2Hg3 + Cu6Sn5

Gamma Gamma1 Eta

High-Copper Alloys

Setting sequence

• Ag and Sn dissolve in Hg

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 • Gamma 1 (g1) (Ag2Hg3) crystals grow binding together partially
dissolved gamma(g) alloy particles (Ag3Sn)

• Epsilon (e) (Cu3Sn) develops crystals on surface of gamma particle

(Ag3Sn) [spherical gamma particles (g) (Ag3Sn) are coated with
epsilon (e) (Cu3Sn) ] in the form of eta (h) (Cu6Sn5)

– reduces creep

– prevents gamma-2 formation

LATHE CUT COMPARED WiTH spherical ALLOYS

CONVENTIONAL/LATHE CUT SPHERICAL ALLOYS

ALLOYS

1) More difficult to manufacture easier to manufacture.

3) require more mercury. require less mercury

4) Corrode easily Better resistance to corrosion

5) inferior one hour and final Superior one hour and final
compressive strength. compressive strength

6) difficult to condense Easier to condense

7) difficult to carve Easier to carve

8) difficult to polish Easier to polish

9) Adapts better to cavity walls Adapt less well to cavity wall

10)particle size 28-35 microns Particle size 2-4 to 25 -35 microns

INDICATIONS: i) large
restorations
11) INDICATIONS:
ii)post endodontic restorations

18
i) Class I

ii) Class II

Spherical alloys make table showing difference

 different size of spheres present containing silver, tin and copper.

 Requires 10% less Hg , due to lesser surface area.
 Less condensation force but voids easier to occur
 Difficult to adapt to cavity walls and contacts due to spherical
shape
 particles- are smaller and have a smoother surface
 Higher strength within 15 min of condensation compared to
admixed.
 Higher 15 minutes and 1 hour.compressive strength
 Tensile strength comparatively lesser than admixed

Admix alloys

 Contains both spherical and irregularly shaped particles

 Requires more hg to amalgamate due to bigger size particles

 Higher condensation force required
 Easier adaptation to cavity walls and better contacts
 Irregular particles cause rougher surface
 Medium to high strength
 Early compressive strengths (15min.-1hr.) but lower than spherical

 Tensile strength of spherical improved over pure lathe cut

FACTORS GOVERNING THE QUALITY OF DENTAL AMALGAM

Each manipulative step has an effect on the physical and chemical

properties of amalgam, and the success or failure of the restoration.

The factors governing the quality of the dental amalgam restoration can
be divided into two groups :

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Factors controlled by the Dentist :

1) Selection of the alloy

2) Mercury- alloy ratio

3) trituration

4) condensation technique

5) marginal integrity

6) carving the tooth morphology

7) finish

Factors controlled by the Manufacturer:

1) Composition of the alloy

2) Heat treatment of the alloy

3) The size, shape and method of production of the alloy particles

4) The surface treatment of the alloy particles

5) The form in which the alloy is supplied.

TECHNICAL CONSIDERATIONS OF AMALGAM

1) Selection of materials.

2) Mercury alloy ratio.

3) Proportioning.

4) Trituration-

i. Hand mixing.

20
 ii. Mechanical trituration.

5) Condensation.

i. Hand condensation.

ii. Mechanical condensation.

6) Burnishing.

7) Carving.

8) Finishing and polishing.

Repaired amalgam restorations.

 Selection of materials Alloy

Its selection is based on clinical requirement

 Particle shape: choose between lathe cut or spherical

 Particle size For restorations subjected to occlusal forces: Smaller

size have rapid hardening, high early strength, smoother
surface. .

 . Presence or absence of zinc Moisture area: Responsible for

delayed expansion

 High Cu or Low Cu: High Cu alloys have little or no γ2 phase,

which is the weakest phase.

 Rate of hardening: Affects working time. To be used with pins,

internal boxes, groves

 Hg:ALLOY ratio

21
 Previously 2 tech were used to reduce the amount of mercury in
final restoration-

i) Squeezing cloth technique.

ii) Increasing dryness technique.

Eame’s technique

Introduced in 1959 (minimum mercury technique or no squeeze

cloth technique).

For lathecut alloy Hg is 50% by weight.(1:1)

For spherical alloy Hg is 42% by weight.

 High copper alloys 43 % Hg

 Low copper alloys 53 % Hg

If the mercury content is slightly low-

i) Dry and grainy mix.

ii)Insufficient matrix to cohesively bond the mass.

 If it is too low-

i) Corrosion resistance is reduced.

ii) Impairs the strength.

 If Hg is more than 55%-

i) Strength markedly reduced

ii) Excess mercury promotes formation of

gamma 2 phase in high copper amalgam

 alloy mercury ratio Controls carving time and speed of set

REGULAR SET:

 Normal carving time, normal setting time

 Moderate excess mercury

22
 FAST SET:

 Low carving time, quick setting time

 Enough excess mercury to wet the alloy

SLOW SET:

 Long carving time, slow setting time

 High excess mercury

 Proportioning

Preportioned capsules

Disposable capsules containing preproportioned aliquots of

mercury and alloy.

 A wide variety of mercury and alloy dispensers are available.

 Dispensers are based on volumetric proportioning. As a liquid,

mercury can be measured by volume by mercury dispensers.

 Different ways of dispensing ;Preweighed pellets,preproportioned

aliquots

 These contain alloy in either pellet form or as a Preweighed

portion of powder in conjugation with the appropriate quantity of
mercury.

 the mercury and the alloy are physically separated by a barrier

from each other To prevent any amalgamation to occur during
storage,

23
 when the pellets or aliguot is ready for mixing ,the barrier breaks
and ,the capsule becomes one single compartment

 Some alloys are available in the self-activating capsules, which

automatically release the mercury into the alloy chamber during
the first few oscillations of the amalgamator.

Trituration ;It is the process of mixing the amalgam alloy

particles with mercury

Objectives of trituration

1) To achieve a workable mass of amalgam in minimum time.

2) To remove oxides from alloy particle surface.

3) To pullverize pellets into particles that can be easily attacked by

mercury.

4) To reduce particle size. ,hence also increases surface area

5) To dissolve the powder particles in the mercury, which is a

prerequisite for the formation of matrix crystals.

6) To keep the amount of gamma 1 and gamma 2 matrix crystals as

minimum as possible.

There r 2 methods of trituration

 Hand trituration

 Mechanical trituration

Hand mixing:

Done with motar and pestle.

3 Different movements to triturate amalgam :

-back and forth

24
 -figure of eight

-circular

Mechanical trituration

Powdered alloy + Hg ® capsule + pestle

Pelleted alloy + Hg ® capsule + pestle r

Powdered Alloy + Hg ® Pre-capsulated

factors to obtain a well mixed amalgam mass are-

i) No. of rotations.(3500-5000 rpm

iii) Magnitude of pressure placed on pestle.

Ii )time 25 to 45 seconds period is sufficient.-depends on

manufacturers instructions

 A capsule serves as a mortar. A cylindrical metal or plastic piston

of smaller diameter than the capsule is inserted into the capsule,
and this serves as the pestle.

 The alloy and mercury are dispensed into the capsule.

 When the capsule has been secured in the machine and it is

turned on, the arms holding the capsule oscillate at high speed,
thus trituration is accomplished.

 A wide variety of capsule-pestle combinations are available.

 Pestles may be plastic or metal and come in variety of sizes, shapes

and weights.

 The diameter and length of the pestle should be considerably less

than the comparable dimensions of the capsule.

25
 Under mixed amalgam appears dull and crumbly.

 Normal mix appears shiny and separates in a single mass from the
capsule.

 Over mixed amalgam appears soupy and tends to stick to the

inside of the capsule.

over-trituration.

› “Hot” mix

› Sticks to capsule
› Shiny wet & soft

Decreases working time

slightly higher contraction

effects compressive and tensile strength

increases creep

under trituration

› Grainy, dry mix

effects compressive and tensile strength

surface of restoration will be rough and granular

increase in voids

restoration more susceptible to tarnish

MULLING :

 Is a continuation of trituration

26
  It causes the mix to cohere so that it can be readily removed from
the capsule.

 Basically to achieve a homogeneous mix

CONSISTENCY OF THE MIX

 After trituration the resulting mix should not be granular in

appearance.

 Should have a smooth, shiny appearance and should be coherent.

 Such an amalgam mix may be warm when it is removed from the

capsule.

The mix is enveloped in a dry piece of rubber dam and is

vigorously rubbed or kneaded for 2-5 secs

CONDENSATION(to add)

Objectives of condensation
 to compact the alloy into the prepared cavity to achieve maximum
density , with sufficient mercury present to ensure complete
continuity of matrix phase between the remaining alloy particles
 To adapt amalgam to the preparation
 Increase the strength of amalgam
 Decrease creep
 To remove voids
 To bring all phases together
 To bring Hg on the top of each increment so as to bind the
increments to one another (increasing dryness technique
 to remove any excess mercury from each increment as it is worked
to the top by the condensing procedure

27
 Condensation can be accomplished with either hand or mechanical
instruments by different ways
(a) . Hand pressure condensers,
(b) handpiece activated condenser -can be vibratory or impact
activated
(d) Pneumatic condenser

HAND CONDENSATION
 Once the increment of amalgam is inserted into the prepared
cavity, it should immediately be condensed with sufficient pressure
to remove voids and to adapt the material to the walls.
 Condensation is usually started in the center of the restoration,
and then the condenser point is stepped little by little toward the
cavity walls.
 Force requirements depends on the shape of the alloy particle and
the size of the condenser point.
 After condensation of an increment, the surface should be shiny in
appearance.
 This indicates that there is sufficient mercury present at the
surface to diffuse into the next increment so that each increment
bonds to the preceding one.
 Relatively small increments of amalgam should be used
throughout the condensation procedure to reduce the void
formation and to obtain maximum adaptation to the cavity walls.
 Sufficient condensation pressure must be used to force the alloy
particles together, reduce voids, and work mercury to the surface
to achieve bonding between the increments.

MECHANICAL CONDENSATION
 performed by an automatic device.
 Some provide and impact type of force, whereas others use rapid
vibration.
 Less energy is needed than for hand condensation, and the
operation may be less fatiguing to the dentist.
 Similar clinical results can be obtained using either hand or
mechanical condensation.

28
 The longer the time elapses between mixing and condensation, the
weaker the amalgam.
 Creep of the amalgam is increased.
 Condensation of partially set amalgam probably fractures and
breaks up the matrix that has already formed.
 When the alloy has lost a certain degree of plasticity, it is difficult
to condense without producing internal voids and layering.
 Incorporation of slightest moisture in zinc containing alloys at this
stage can result in delayed expansion and associated problems
such as corrosion and loss of strength.

 Ultimate result of moisture contamination is premature failure of

the restoration.

CONDENSATION PRESSURE
 The area of the condenser point, and the force exerted on it by the
operator, govern the condensation pressure.
 Smaller the condenser, the greater the pressure exerted on the
amalgam.
 Average forces exerted is in the range between 13.3 to 17.8N.
 3 to 4 lbs: force at the tip of condenser point of 2 mm diameter is
around 600 -800 psi.
 10 lbs: the force at the tip of the condenser point of 2 mm
diameter is 2,000 psi.

 To ensure maximum density and adaptation to the cavity walls,

the condensation forces should be as great as the alloy will allow,
consistent with the patient comfort.

 lathe-cut alloys
 small condensers
 high force
 spherical alloys
 large condensers
 less sensitive to amount of force
 vertical / lateral with vibratory motion
 admixture alloys
 intermediate force between lathe-cut and spherical

Condensing instruments

29
 Shapes and size :round and parallelogram condensers are used

Blotting mix add

Burnishing (pre carve and post carve ) amalgam cry ,ringing

Large rounded burnisher is used.

Direction of use should be from restoration to tooth surface

 This process has 4 objectives -

1) It is a continuation of condensation.

2) brings any excess mercury to the surface.

3) adapts the amalgam to the cavosurface anatomy.

4) conditions the surface amalgam for carving

5) Further reduce the size and number of voids specially at the

surface

6) .better marginal adaptation –hence reduces tarnish and corrosion

 Carving done to simulate a tooth morphology and function

To produce a restoration-

 with no underhangs.

 with proper physiological contours.

 with minimal flash.

30
 with functional non-interfering occlusal anatomy.

 with adequate compatible marginal ridges.

 with the proper size, location, extent and interrelationship of

contact areas.

 with physiological compatible embrasures.

 No interference with the integrity of the periodontium.

 Carving should be accomplished using sharp instruments like

Hollenbeck carver or cleoid carver.

 It is also possible to use sharp binangle hatchet or cheisel in direct

movements from tooth surface to amalgam.

Technique for carving a class II restoration :

Check existing occlusal contacts with articulating paper and study

the remaining tooth structure,marginal ridge,contour

Instruments needed:explorer,discoid and cleoid carver (small and

large ),hollenback,spoon excavator

Immediately after condensation use an explorer to separate any

attached amalgam ,resting the tip against the matrix band bucco
lingually

Use discoid/cleoid ,to remove any excess amalgam from the

occlusal surface

Start carving when the amalgam shows a little resistance to

carving instruments

Use Discoid/cleoid carver to develop a continuous surface from

the enamel to the restoration . Occlusal carving is done with "pull
stroke", however, the "push stroke" can also be suitable in
developing occlusal grooves. The prior occlusal record and
remaining tooth morphology will act as a guide to the carving

The carver is pulled (or pushed) as the cleoid instrument edge is

placed parallel to the cavity margin or cuspal slopes .part of the

31
 instrument rests on the restoration and part of it rests on
remaining tooth slope

- carver is pulled from the restoration toward the enamel. Thin fins
of excess material are formed and fractured and removed away
from the restoration

To carve the triangular fossa . remove the retainer ,leaving behind

the matrix band and wedge .use a hollenback carver to contour
the proximal marginal ridge ,by holding the tip resting on the band
and moving it from buccal to the center and then from lingual to
the center of the ridge .this will result in a two plane marginal
ridge

Adjust the height and shape of the marginal ridges, occlusal

embrasures with the help of a hollenback carver

- Remove the wedge and matrix band .the band is removed first
from the non-involved proximal side.the band is pressed against
the adjacent tooth and slowly with a wriggling motion pulled away

Use an explorer or hollenback carver to remove excess amalgam from

the cervical area, if any.
Check the contact by checking for any light passing through the contact
and with a floss . do not push the floss hard or else the newly
constructed marginal ridge can fracture .remove the floss buccally .
After carving , remove the rubber dam .
Remove any excess powdered debris from the restoration with a cotton
pellet lightly
The patient is allowed to bite very lightly . . Any shiny area on the
restoration is indicative of a premature contact.
Use a spoon excavator to remove this high point .
Check the occlusion with an articulating paper in centric and lateral
and protrusive movements to check for any interferences

Burnishing

Creates a smoother surface than carved surfaces.

Reduces any plaque accumulation ,hence improves marginal

integrity ,reduces corrosion

32
 Undue pressure should not be exerted and heat generation should
be avoided.

Finishing and polishing

Objectives-

1) Conversion of the superficial amalgam into a relatively inert layer

galvanically.

2) Removal of superficial scratches and any correct any minor

irregularities.

3) Hence decreases fatigue failure, decreasescorrosion and decreases

accumulation or adherence of plaque.
4) To make the restoration aesthetically more pleasing

Usually done after 24 hrs .Done with slow speep .use tin oxide
powder ,rubber cups check for heat generation

Properties

 Physical Properties of Amalgam

The most important physical properties of amalgam are flow and

creep, dimensional change, and strength and corrosion

 Flow and creep. Property of amalgam undergoing deformation

when stressed. The lower the creep value of an amalgam, the
better the marginal integrity . High copper alloy have lower
creep values than the conventional alloys.

 Compression strength. Sufficient strength to resist fracture is

an important requirement for any restorative material. At a 50
percent mercury content, the compression strength is
approximately 52,000 pounds per square inch (psi). In
comparison, the compressive strength of dentin and enamel is
30,000 psi and 100,000 psi, respectively. The strength of an
amalgam is depends on the composition of the alloy, the

33
 amount of residual mercury remaining after condensation, and
the degree of porosity in the amalgam restoration.

STRENGTH check chart

Amalgam Compressive Strength Creep (%) Tensile

(MPA) Strength–
24hr
1 Hr 7
Days (MPa)

Low Copper 145 343 2.0 60

Admix 137 431 0.4 48

Single 262 510 0.13 64

Composition

At the end of 20 min. , only 6% of the 1st week strength is gained.

 The ADA specification stipulates a minimum compressive strength

of 80Mpa at 1 hour .

 High-Cu-Single alloys have much early strength than high-Cu-

Admixed.

 Patient should be cautioned not to subject restoration to high

biting stress for at least 8 hours i.e. until 70% of the total strength
is gained .

 Factors affecting the strength of amalgam restoration are:

a. Trituration.

b. Mercury content.

c. Condensation.

34
 d. Porosity.

e. Amalgam hardening rate.

Effect of Trituration-

Both under-trituration or over-trituration decreases the strength

Effect of Mercury content-

If the mercury content increases more than 55%, the strength

reduces.

Effect of Condensation-

 Higher condensation pressures are required to minimize porosity

and to express mercury from lathe-cut amalgams.

 spherical amalgams condensed with lighter pressures produce

adequate strength.

Effect of Porosity-

 under- trituration and delayed condensation increase porosities

and hence lower the strength.,decreased plasticity of the mix
,inadequate condensation pressure ‘, large increments

 For spherical alloys, the condenser simply punches through the

amalgam if heavy pressures are applied.Voids are not such a
problem with these amalgams.

 DIMENSIONAL STABILITY

Amalgam can expand or contract, depending upon its

manipulation. the dimensional change should be small.

35
  contraction can lead to microleakage, plaque accumulation and
secondary caries.

 expansion can produce pressure on the pulp and postoperative

sensitivity and protrusion of restoration.

 Initially amalgam undergoes contraction for approximately 20

min after the beginning of trituration and then begins to expand.

 Contraction result as the particles dissolves and g1 phase grows

 Outward thrust of crystal growth opposes contraction

Theory of Dimensional Change

 When alloy and mercury are mixed, as particles begins to dissolve

contraction occurs and γ1 grows.

 As γ1 phase grows, they impinge upon each other which produces

a outward pressure, tending to oppose this contraction.

 If there is sufficient mercury present to provide a plastic matrix,

expansion will occur when γ1 crystals impinge upon each other.

 After a rigid γ1 matrix has formed, the growth of γ1 crystals

cannot force the matrix to expand. Instead γ1 crystals grow in the
interstices containing mercury, and producing a continued
reaction.

 if sufficient mercury is present in the mix, expansion will be

observed. Otherwise contraction will occur.

 Factors Resulting in Net Contraction::

Lower Mercury:Alloy ratio

High condensation pressure (Expells Excess Hg)

Longer trituration

Smaller alloy particles (Microcut

Dimensional changes on depend on different

variables:

• Particle size

36
 • Hg/alloy ratio
• Trituration time
• Condensation

Zinc content and Effect of Moisture Contamination

 If a zinc containing amalgam is contaminated with water during its

trituration or condensation a large expansion which usually starts
after 3-5 days and may continue for months, reaching values
greater than 400μm(4%).This type of expansion is known as
delayed expansion or secondary expansion.

 Hydrogen is produced by electrolytic action involving zinc and

water.

Zn + H2O → ZnO + H2 ↑

This hydrogen that is formed does not combine with amalgam, rather
gets collected in the restoration, increasing the internal pressure levels
high enough to cause the amalgam to creep, thus producing the
observed expansion. The contamination of amalgam with moisture can
occur during the following processes :

 During trituration

 During condensation

 Skin secretions : if zinc containing amalgam is touched with bare

hands during tituration or condensation

 Improper/poor isolation during the operative procedure

. The expansion is visible clinically sometimes usually as raised

margins. May cause

37
 o Over hanging margins

o Inviting stagnation

o Periodontal diseases

o Recurrent caries

o Excessive intra cavity pressure causing pain and possible fracture

of the tooth --- if the amalgam is unable to expand outside the
cavity.

All amalgam alloys must be protected from moisture regardless of their

zinc content. Using a rubber dam reduces or almost eliminates this
problem.

CLINICAL MANIFESTATIONS OF EXPANSION:

1. pain on chewing

2. shiny marks on the surface of the restoration → hyperocclusion

3. development of cracks in the tooth.

4. minor cracks.

Add photos

38
 MERCUROSCOPIC EXPANSION

MERCUROSCOPIC EXPANSION WITH MARGINAL FRACTURE

CREEP

– It is a time dependent plastic strain of a material under a

static load or constant stress. Load is less than that
necessary to produce fracture

39
  It increases susceptibility of amalgam restoration to marginal
breakdown.

Influence of microstructure on Creep

 Creep rates increase with higher γ1 volume fractions and decrease

with larger γ1 grain sizes

• The presence of γ2 phase is also associated with higher creep

values

– slow strain rates produces plastic deformation

• allows gamma-1 grains to slide

• Correlates with marginal breakdown

• High-copper amalgams have better creep resistance

– prevention of gamma-2 phase

• requires >12% Cu total

– single composition spherical

• eta (Cu6Sn5) embedded in gamma-1 grains

– Presence η rods , which acts as barriers to

deformation of γ1 phase, results in lower creep
rates

– admixture

• eta (Cu6Sn5) around Ag-Cu particle improves bonding

to gamma 1

The following manipulative variable minimize creep rate

 Mercury : alloy ratio should be minimized

40
 Condensation pressure should be maximized for lathe cut or
admixed alloys

 Careful attention should be paid to timing of trituration and

condensation.

 TARNISH AND CORROSION

 Tarnish - A process by which a metal surface is dulled in

brightness or discolored through the formation of a chemical film,
such as a sulfide or an oxide.

 Corrosion : the action, process, or effect of corroding, the loss of

elemental constituents to the adjacent environment. Corrosion is
not merely a surface deposit.

 CLASSIFICATION OF CORROSION

 There are two general types of corrosion reactions :

Wet corrosion / Dry corrosion /

electrochemical corrosion chemical corrosion

 Chemical corrosion: in this there is a reaction of metallic and

non-metallic elements to yield a chemical compound through
processes such as oxidation, halogenations, or sulfurization
reactions. Usually oxidation is seen .

 Examples:

41
 Corrosion of dental gold alloys that contain silver.

 Oxidation of silver–copper alloy particles mixed with mercury.

 ELECTROCHEMICAL CORROSION

 Also called wet corrosion as it requires a fluid electrolyte or

water.

 Requires a pathway for transport of electrons and electrical

current.

 Anode -- Positive ions are formed with the production of free

electrons.

 Cathode-- Reduction reaction must occur that will consume free

electrons produced at the anode.

 The electrolyte supplies the ions needed at the cathode and

carries away the corrosion products at the anode. Saliva acts as
the electrolyte .

Anode and cathode are two dissimilar metal fillings .

 Galvanic corrosion

 Heterogeneous compositions

 Stress corrosion

 Concentration cell corrosion

Pitting corrosion

42
 Crevice corrosion

 Erosion corrosion.

GALVANIC CORROSION / DISSIMILAR METALS CORROSION

 when dissimilar metals are in direct contact with each other.

 This metallic contact produces Electro galvanism / Galvanic

current/

Galvanic shock .this causes a short pain sensation due to electric

current production

 Example :when amalgam comes in contact with a gold restoration

 HETEROGENOUS SURFACE CORROSION

 Occurs in individual restoration

 Occurs due to heterogenous composition of an alloy

 It is a surface phenomenon.

 Grains with lower electrode potential are attacked and corrosion

results

 Impurities in alloy enhance corrosion

 STRESS CORROSION

 Stress corrosion occurs due to fatigue or cyclic loading of a

restoration in the oral environment.

43
 Stress increases the internal energy of an alloy ,which displaces
atoms or creates micro strained fields which have higher tendency
for corrosion.

 Eg. Repeated removal and insertion of a partial denture will

develop a severe stress pattern of certain alloys especially at the
grain boundaries.

 CONCENTRATED CELL CORROSION

 This type of corrosion is seen when there is a different electrolytes

present or in the composition of the given electrolyte within the
system.

 Pitting Corrosion

 localized breakdown of the outer protecting passive layer causes

pitting which is clinically visible as holes on the surface.

 Also seen when there is a difference in the oxygen concentration

between different parts of the same restoration, with the greatest
attack at the areas containing the least oxygen The rate of such
corrosion may be very rapid , since the area of the anodic region is
much smaller than that of the cathodic region

 Hence it is important to polish all metallic dental restorative

materials

 Crevice Corrosion

 Preferential attack occurs at crevices in dental prostheses or at

margins between tooth structure and dental restorations.

 Occurs due to plaque accumulation ,which causes low oxygen

levels in localized crevices compared to rest of the restoration

 EROSION CORROSION .

 Also called fretting corrosion.

44
 occurring at contact areas between materials under load subjected
to vibration and slip.

 Example:During implant placement, some abrasion between

fixing screws and implants or between tools (screw drivers, etc.)
and implants occurs

 PROTECTION AGAINST CORROSION

 Gold coating can be done on base metals

 Iron, steel and certain other metals may be electroplated with

nickel followed by chromium for corrosion protection .

 Polishing metal restoration like amalgam and gold to a high luster

minimizes corrosion.

 Paint application or coating with inorganic nonconductive

coatings.

 Protective films :

 Co-Cr alloys can be plated with a ZrO2 layer

 Alloys with high corrosion resistance like Fe-Cr-P-C & Al-W can
be used.

 Addition of noble metals like gold, platinum and palladium in

dental alloy to increase corrosion resistance

 CLINICAL CONSIDERATIONS

 Application of varnish in the dentinal walls and on the surface of

the filling to avoid galvanism in amalgam restorations.

 Avoid giving amalgam restoration opposing gold filling because the

mercury released from the silver amalgam will weaken and

45
 discolour both the fillings and also gives a metallic taste in the
mouth.

 Amalgam restorations often tarnish and corrode in the oral

environment.

 Active corrosion of a newly placed amalgam occurs on the metal

surface along the interface between the tooth and the restoration.

 The space between the alloy and the tooth permits the
microleakage of electrolytes, and a classic concentration cell
process results.

 The formation of corrosion products gradually seals this space,

making dental amalgam a self-sealing restoration.

 The most common corrosion products found with amalgam are

oxides and chlorides of tin.

 These are found along the tooth restoration interface and within
the bulk of older amalgam restorations.

 Corrosion products containing copper can also be found in high

copper amalgams.

 However, the corrosion process is more limited because the η

phase is less susceptible to corrosion than the γ2 phase.

 Every effort should be made to produce a smooth, homogenous

surface on a restoration to minimize tarnish and corrosion.

 Whenever a gold restoration is placed in contact with the amalgam,

corrosion of the amalgam occurs as a result of large differences in
electromotive force of the two materials.

 Corrosion process can liberate free mercury, which can

contaminate and weaken the gold restoration.

 Biologic effects such as galvanism also results.

46
 High copper amalgam is cathodic with respect to a conventional
amalgam. Thus concern has been expressed that if high copper
amalgam is placed in the same mouth with existing restoration of
low copper amalgam, corrosion and failure would be accelerated in
the latter.

 Clinical observation do not indicate accelerated corrosion in such

situations.

 MODERN AMALGAM,MERCURY SUBSTITUTES AND

MODIFICATIONS IN CAVITY DESIGNS

To overcome the disadvantages of amalgam ,alterations were made

in amalgam

Disadvantages of amalgam:

 Not adhesive.

 Poor marginal integrity.

 Mercury toxicity.

 Weakens tooth structure.

 Types of modern amalgam

1. Bonded amalgam.

2. High silver content amalgam.

3. Low silver content amalgam.

4. Nickel-Indium amalgam.

5. Indium containing amalgam.

47
6. Gallium containing amalgam.

7. Anti-cariogenic amalgam.

8. Gold coated silver amalgam.

9. Manganese containing amalgam.

10. Pre amalgamated alloy

Bonded amalgam:

-introduced in 1980’s

- merge the benefits of new adhesive materials with the amalgam,

Advantages

 Conservative tooth preparation.

 Increased fracture resistance of the tooth.

 Reduced microleakage and consequently a lower incidence of

recurrent caries and post operative pain.

repair of existing restorations.

 Disadvantages

 Technique sensitive.

 Hydrolytic stability of the bond is questionable.

 Manipulation

Isolation

Removal of the dentin smear layer

Lining of dentin with GIC

Etching

48
 Application of bonding agent

Condensation of freshly mixed amalgam

Carving and finishing of amalgam

High silver containing amalgam

 Introduced by Kropp.

Composition :

Advantages

 Free of g2 phase.

 No increased setting expansion.

 Low creep.

Low -silver content amalgam

 Introduced by H. H. Simpson.

 It has been found in order to assure superior physical, mechanical

and handling properties for the alloy, the atomic ratio of silver plus
copper to the tin must be about 3:1.

Nickel-Indium amalgam

 Indium containing amalgam

 Described by H. Kaji and N. Suzuki.

 Silver content less than 20% makes amalgamation with mercury

difficult, accompanied by slow hardening speed.

49
 Copper content of 9.1% less is insufficient to prevent the g2 phase
in the amalgam, while more than 50% copper makes
amalgamation with mercury difficult with slow hardening speed.

 Tin content less than 20% makes amalgamation with mercury

difficult with too rapid hardening speed, while more than 50% tin
results in large aging contraction and slow hardening speed.

 Indium content of less than 0.5% gives insufficient protection

against discoloration.

 Gallium amalgam : referred to as hg free amalgam

 V. F. Heldham and R. F. Harvey

 3% to 10 %Gallium added

 Provides good adhesion to tooth structure.

 Hence can have more conventional cavities

 Huge problems with moisture-sensitivity leading to expansion.

 accelerated corrosion when placed in contact with , high copper

amalgam

.add Composition

 Anti-cariogenic amalgam

 Introduced by J. C. Muhler

stannous hexafluorozirconate (SnZrF6) added with the alloy

particles prior to or at the time of trituration

 Composition

50
 Gold coated silver amalgam

 Introduced by T. Wolf

 Silver particles are plated or coated with gold.

 the gold layer controls the rate of penetration of the mercury into
the silver-tin core providing longer working time.

 Manganese containing amalgam

 RM Waterstrat

 Add 8% manganese

 manganese is used in silver tin based dental alloys to react with

the tin during amalgamation and thus reduce or eliminate the
tendency of these alloys to form the undesirable g2 phase.

 Ag(1-x)MnxSn + Hg – Ag2Hg3 + MnSn2 + MnSn + Mn2Sn

 Increase amount of manganese will decrease progressively the

amount of tin which is available to form the g2 phase.

 Mercury substitutes

 Silver amalgam, though an accepted restorative material , yet the

mercury controversy limits its use.

 The toxic effects of mercury coupled with problems of mercury

hygiene , led the researchers think of mercury free alloys.

 Gallium alloy is the first of its kind and was suggested by

puttkammer in 1928.

 Physical properties.

Composition

Reaction

AgSn + Ga ---------- AgGa + Sn

51
  The reaction between AgSn particles and liquid gallium involves
the formation of GaAg phase and a pure tin phase.

Advantages

 Eliminates mercury toxicity.

The creep values are best suited for gallium alloys.

 Adheres to the tooth structure.

 The compressive strength is adequate, therefore it can be given

in stress bearing areas .

Disadvantages

 In early gallium alloy , surface roughness, marginal discoloration,

and fracture were reported.

 not used in larger restorations as the expansion may lead to

fracture of weakened cusp.

 Difficult to Manipulate due to sticky nature.

Pre amalgamated alloy

 contains upto 3% mercury are called “pre-amalgamated” alloys.

 React more rapidly when mixed with mercury.
 Reduced Mercury : Alloy Ratio
 Manufactured by treating the alloy with 3% Mercuric Chloride
in a weak acid
 Excess washed away with sulphuric acid.

 Failures in dental amalgam restorations

 Depending on alloy

 Type of alloy

 Composition of alloy

52
  Effect of zinc in alloy

 Mercury alloy ratio

 Pre-amalgamated alloys

Depending on cavity preparation

1) Case selection

2) Tooth preparation preparation –incorporation of resistance

and retention forms properly

Manipulation of the alloy

1) Proportioning of alloy

2) Method of manipulation

3) Trituration & Mulling

Clinical steps

Adaptation of the matrix band

Trituration

Condensation of alloy

Carving & finishing

Occlusal adjustments

After Care by patient specially immediately after the

restoration

Oral Environment

 Clinical Level Micro-structural Level

 Secondary Caries - Corrosion

 Marginal Fracture - Stresses due to mastication

53
  Bulk Fracture

 Tooth Fracture

MERCURY HYGIENE

 Mercury also called quicksilver or hydrargyrum, is a chemical

element with the symbol Hg (Latinized Greek: hydrargyrum,
meaning watery or liquid silver). Atomic number 80.

 A heavy, silvery metal, liquid at or near room temperature and

pressure.

Physical Properties

 Melting Point - 38°C

 Boiling Point - 356°C

 Density - 13.5 gm/mL

 Found in nature as Cinnabar (HgS)

 Low heat of vaporization allows oxide-free metallic Hg to

evaporate easily at room temperature

SOURCES OF MERCURY

 Ubiquitous in environment

54
 30,000 to 150,000 tons/year released worldwide

 Natural

volcanic emissions

degassing of soil

volatilization from oceans

 Anthropogenic

. fossil fuels

 coal

EXPOSURE TO MERCURY

 Food :fish, grain

 Air, water :naturally occurring

 Commercial products : antiseptics, ointments ,thermometers

 Occupational :Dental surgeon ,Factory workers

Significance in dentistry

55
  Absorption :readily from lungs ,poorly from GIT and skin,< 0.1%
not toxic when swallowed

MERCURY VAPOUR

 Accounts for most occupational and home exposures

mercury spills

thermometers

fluorescent light bulbs

 Significant toxicity when inhaled 80% absorbed by lungs

 Acute toxicity is rare

 Organic mercury- found as methyl mercury. most toxic form. 95%

absorbed in gut. responsible for several mass poisoning.

56
 In 1952 ,Minamata Bay, Japan - inorganic mercury dumped in the
bay. Most of the aquatic life was effected as mercury Concentrated up
food chain and the disease so called the minimata disease .it is a
neurological syndrome ,showing symptoms of ataxia ,numbness,muscle
weakness ,narrow field of vision .in extreme cases insanity ,paralysis,
coma and death

Dental Mercury Hygiene Recommendations given by ADA

57
  Train all personnel involved in handling of mercury or dental
amalgam regarding the potential hazard of mercury vapour and
necessity of observing good mercury hygiene.
 Area design for working should be proper to facitilate spill
contamination and clean up.

Floor covering should be non absorbent , seamless , and easy to clean.

 Amalgamators should be used with a completely enclosed arm.

 Precapsulated alloys should only be used.
 Use of high volume Evacuation when finishing or removing
amalgam.

Evacuation systems should have traps or filters. Check and clean or

replace traps and filters periodically to remove waste amalgam from the
waste stream.

 Check periodically the dental operatory atmosphere for mercury

vapours. Dosimeter and mercury vapour analysers may be used for
this purpose.

The current limit for mercury vapour established by OSHA is 50 µg/m 3

in any 8-hour work shift over a 40 hour work week.

 During handling amalgam , Avoid skin contact with mercury or

freshly mixed amalgam.
 Clean up spilled mercury properly using trap bottles ,tape or
freshly mixed amalgam to pick up droplets and commercial
cleanup kits can also be used. Do not use a household vacuum
cleaner.
 Professional Clothing should be removed before leaving the
workplace.
 Dispose mercury contaminated items in sealed bags according to
applicable regulations. Consult state or local dental society about
the regulations in a given area. Do not dispose mercury
contaminated items in regulated waste containers or bags or along
with waste that will be incinerated.
 Store and salvage all scrap amalgam in a tightly closed container,
either dry or under radiographic fixer solution. Amalgam scrap
should not be stored in water. If scrap is stored dry, mercury
vapours can escape into room air when the container is opened. If

58
 the scrap is stored under the radiographic fixer solution, special
disposal of the fixer may be necessary.
 Recap single use capsules from precapsulated alloy after use.
Properly dispose of them according to applicable waste disposal
laws.
 dispose of amalgam scrap and waste amalgam in accordance with
applicable laws. When choosing a recycling company, check that
the company has obtained all required government permits and
has not been the subject of a state or a federal enforcement action
 Ventillated spaces with fresh air exchanges and outside exhaust
should be designed. If the spaces are air conditioned , air
conditioning filters should be replaced periodically

PRECAUTIONS TO BE TAKEN

Mercury containing products should not be stored in open, but rather in

closets or cabinets , to minimize local concentrations in rest of the office.
Storage locations should be near an exhaust vent that carries air out of
the building .

 Small local spills or spatters of triturated materials are best dealt

by collection with vacuum aspirator but not a vacuum cleaner.

 When small droplets of mercury rich material contaminate the

floor coverings , the only practical approach to decontaminate the
area is to replace the coverings.

 During the intraoral placement and condensation procedures,

some mercury vapours are released.To control the vapour,a rubber
dam can be used to isolate the patient and high volume evacuation
should be used to prevent intraoral vapour from diffusing.

 Scrap amalgam from condensation procedures should be collected

and stored under glycerine or spent X-ray fixer in tightly capped
jar. Spent X-ray fixer has an advantage for controlling mercury
because it is a source of silver and sulfide ions for reaction to a
solid product. The material should be recycled and not more than
a small jar of material should be present in the office at any time.

 Polishing of amalgam should be done using slow speed and

adequate water. If it is not done then the Ag-Hg phase is melted
(127ºc),producing a mercury rich liquid phase that is smeared over

59
 the amalgam surface making it look shiny and bright. The operator
can misinterpret this appearance as a highly polished surface.

Melting of Ag-Hg phase also occurs during amalgam removal.

Rubber dam, high volume evacuation and water cooling can be
used to control this.

 Instruments used for inserting, finishing, polishing or removing

amalgam restorations may contain some amalgam on their
surfaces which on sterilization may get heated and release mercury
vapour.It is advisable to isolate or vent properly the air from
sterilization areas.

 Spent capsules and mercury contaminated cotton rolls or paper

napkins should not be thrown out with regular trash.They should
be stored in a tightly capped plastic container or closed plastic bag
for separate disposal.

60
 draw diagram

MERCURY MONITORING

 Exhalation - difficult to perform reliably

 Urine -best method for chronic

exposure

symptoms – 300 ug/L

normal < 25 ug/L

MERCURY MONITORING

 Blood --normal < 6 ug/L

reflects recent exposure 3-day half-life

reliable measurement of methylmercury exposure

61
  Hair ---

not a reliable method

MERCURY VAPOUR HEALTH LIMITS

 OSHA Permissible Exposure Limit (PEL) 0.1 mg/m3

Mercury toxicity

Symptoms of Toxicity

 Acute high-level exposure hypersalivation

cough

dyspnea

bronchitis

Pneumonia

vomiting

gastroenteritis

 Chronic low-level exposure

depression

irritability

weakness

tremor

insomnia

renal failure

memory loss

Acute symptoms

 Neurological or Renal - >500µg/kg.

 Ataxia - >1000µg/kg.

 Joint pain - >2000µg/kg.

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  Death - >4000µg/kg.

Chronic symptoms

 Weakness, fatigue, anorexia, weight loss, insomnia, irritability

,dizziness

 Tremors in the extremities or the eyelids.

Other Signs and Symptoms

 Allergic reactions

 young children can have severe neurological consequences,

preventing nerve sheaths from forming properly. Mercury inhibits
the formation of myelin, the building block protein that forms
these sheaths.
 damages the central nervous system, endocrine system, kidneys,
and other organs, and adversely affects the mouth, gums, and
teeth. Exposure over long periods of time or heavy exposure to
mercury vapor can result in brain damage and ultimately death.
 Mercury and its compounds are particularly toxic to fetuses and
infants. Women who have been exposed to mercury in
pregnancy have sometimes given birth to children with serious
birth defects

 mercury poisoning may predispose to Youngs syndrome (men with

bronchiectasis and low sperm count)

Treatment

 Identifying and removing the source of the mercury is crucial.

Decontamination requires removal of clothes, washing skin with
soap and water, and flushing the eyes with saline solution as
needed.

 Inorganic ingestion such as mercuric chloride should be

approached as the ingestion of any other serious caustic.
Immediate chelation therapy is the standard of care for a patient
showing symptoms of severe mercury poisoning or the laboratory
evidence of a large total mercury load

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