Amalgam Restoration

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Alloy

2 or more metals
1)silver
2)tin
3)copper
4)zinc
5)ratio of alloys depends on what the operator prefers

Mercury

liquid metal (hazardous material)
Alloy and mercury combined to form amalgam

Advantages of Amalgam

a)easy to insert into the cavity prep
1)adapts readily to cavity walls
b)limited dimensional change
c)remains plastic long enough to allow for placement, condensation, and carving
d)good compressive strength
e)limited marginal leakage
f)withstands corrosion

Disadvantages of Amalgam

a)does not match tooth color
b)will tarnish in time
c)inadequate edge strength
d)high rate of thermal conductivity
e)needs mechanical retention to be held in place

Uses

a)restore teeth for class 1, 2, and 5
b)core build-up for crowns
c)retention pins

Mixing of amalgam

a)armamentarium
1)amalgamator
2)pestle
3)mortar
4)cotton pliers
5)dappen dish, amalgam well, squeeze cloth

Ratio

1 pellet of alloy to 1 drop of mercury

Length of Time

according to manufacturer's directions

Armamentarium and procedure for a class 2 amalgam

a)Armamentarium
1)local anesthetic
2)rubber dam set-up
3)basic set-up
4)hand cutting instrument
5)cotton pellets
6)cotton rolls
7)cavity varnish and cavity liner
8)zinc phosphate cement
9)matrix and tofflemire
10)wedges
11)HVE tip
12)saliva ejector
13)amalgam carrier
14)condenser
15)burnisher
16)carver
17)interproximal knife
18)high and slow speed
19)contra angle attachment
20)burs
21)articulating paper

Procedure

1)the doctor checks the tooth with a mouth mirror and an explorer
2)placement of local anesthetic
a)set-up of anesthetic depends on the tooth being worked on
3)placement of the rubber dam
a)used to isloate the area to keep dry and free of debris

Operator prepares class 2 cavity prep with the high speed handpiece

a)assistant suctions with the HVE to keep area clean and dry
b)the operator may use hand instruments to finish the prep and retention grooves
c)the operator may use the slow speed with the contra angle attachment to buff and refine the prep

Category Depths

1) the assistant will mix the cavity liner
a)operator or RDA places the liner in the deepest part of the prep

The assistant mixes the base cement

1)operator or RDA places the base on the floor of the prep

Assistant prepares the varnish

1)operator or RDA places varnish on the floor and walls of the prep

Tofflemire and Matrix are placed around the tooth

a)operator or RDA
b)wedges placed on missing walls of cavity prep

NOTE

NOT ALL AMALGAM RESTORATIONS NEED A TOFFLEMIRE AND MATRIX

Assistant prepares amalgam and places it into the dappen dish amalgam well or squeeze cloth

a)assistant uses the amalgam carrier to pass the amalgam to the operator
b)the condenser and amalgam carrier are passed back and forth until the cavity prep is filled

Assistant passes the carver and the operator carves down the excess amalgam

assistant suctions the excess amalgam with the HVE

Tofflemire and Matrix are removed

a)assistant passes the cotton pliers to help remove the matrix
b)rinse out the mouth after removal of matrix

Procedure Continue

a)Assistant passes the carver to the operator to finish carving the restoration
b)assistant passes the interproximal knife to check the mesial and distal area of the restoration
c)assistant passes the burnisher to smooth the restoration

The rubber dam is removed

a)rinse out the mouth

Assistant passes the articulating paper to check the bite

a)if the bite is right; the patient is given post-op instructions and dismissed
b)if the bite is too high, pass the carver to reduce restoration and recheck the bite

Post-Op instructions

a)do not chew on the side of the restoration for a least 4-6 hours
(24 hours to completely set-up)

Handling of Amalgam

1)at any time during mixing or placement of amalgam; it should not be touched with your hands
2)the cavity prep must be dry and moisture free

Storage of excess amalgam

1)amalgam scraps should be stored in a sealed container with water or fixing solution

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