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8/19/2019 Amalgam tumpatan gigi
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Dental AmalgamDental Amalgam
Col Kraig S. VandewalleUSAF Dental Evaluation & Consultation Service
8/19/2019 Amalgam tumpatan gigi
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Official Disclaimer
• !e o"inions e#"ressed in t!is "resentation are
t!ose of t!e aut!or and do not necessaril$
reflect t!e official "osition of t!e US Air Force or
t!e De"artment of Defense %DOD
• Devices or materials a""earing in t!is
"resentation are used as e#am"les of currentl$
availa'le "roducts(tec!nologies and do notim"l$ an endorsement '$ t!e aut!or and(or t!e
USAF(DOD
8/19/2019 Amalgam tumpatan gigi
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Overview
• )istor$
• *asic com"osition
• *asic setting reactions• Classifications
• +anufacturing
• Varia'les in amalgam
"erformanceClic, !ere for 'riefing on dental amalgam %-DF
8/19/2019 Amalgam tumpatan gigi
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)istor$
• /00 1 Crawcour 'rot!ers introduce
amalgam to US• "owdered silver coins mi#ed wit! mercur$
1 e#"anded on setting
• /23 1 4.V. *lac, develo"s formula
for modern amalgam allo$• 567 silver8 967 tin8 37 co""er8 7 :inc
1 overcame e#"ansion "ro'lems
8/19/2019 Amalgam tumpatan gigi
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)istor$
• 25;<s
1 conventional low=co""er lat!e=cut allo$s
• smaller "articles
1 first generation !ig!=co""er allo$s
• Dis"ersallo$ %Caul,
1 admi#ture of s"!erical Ag=Cu
eutectic "articles wit!
conventional lat!e=cut
1 eliminated gamma=9 "!ase
+a!ler > Dent ?es 226
8/19/2019 Amalgam tumpatan gigi
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)istor$• 26;<s
1 first single com"osition s"!erical• $tin %Kerr
• ternar$ s$stem %silver(tin(co""er
• 2/;<s 1 allo$s similar to Dis"ersallo$ and $tin
• 22;<s 1 mercur$=free allo$s
+a!ler > Dent ?es 226
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Amalgam
• An allo$ of mercur$ wit! anot!er metal.
8/19/2019 Amalgam tumpatan gigi
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@!$ Amalgam
• Bne#"ensive
• Ease of use
• -roven trac, record
1 ;; $ears
• Familiarit$
• ?esin=free
1 less allergies t!an com"osite
Clic, !ere for al,ing -a"er on Amalgam Safet$ %-DF
8/19/2019 Amalgam tumpatan gigi
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Constituents in Amalgam
• *asic 1 Silver
1 in
1 Co""er
1 +ercur$
• Ot!er 1 inc
1 Bndium
1 -alladium
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*asic Constituents
• Silver %Ag
1 increases strengt!
1 increases e#"ansion
• in %Sn
1 decreases e#"ansion
1 decreased strengt!
1 increases setting time
-!illi"<s Science of Dental +aterials 9;;0
8/19/2019 Amalgam tumpatan gigi
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*asic Constituents
• Co""er %Cu
1 ties u" tin
• reducing gamma=9 formation 1 increases strengt!
1 reduces tarnis! and corrosion
1 reduces cree"
• reduces marginal deterioration
-!illi"<s Science of Dental +aterials 9;;0
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*asic Constituents
• +ercur$ %)g 1 activates reaction
1 onl$ "ure metal t!at is liuidat room tem"erature
1 s"!erical allo$s• reuire less mercur$
1 smaller surface area easier to wet
G; to G37 )g
1 admi#ed allo$s
• reuire more mercur$ 1 lat!e=cut "articles more difficult to wet
G3 to 3;7 )g
Clic, !ere for ADA +ercur$
)$giene ?ecommendations
-!illi"<s Science of Dental +aterials 9;;0
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Ot!er Constituents
• inc %n 1 used in manufacturing
• decreases o#idation of ot!er elements 1 sacrificial anode
1 "rovides 'etter clinical "erformance• less marginal 'rea,down
1 Os'orne >@ Am > Dent 229
1 causes dela$ed e#"ansion wit! low Cu allo$s
• if contaminated wit! moisture during condensation 1 -!illi"s ?@ >ADA 23G
-!illi"<s Science of Dental +aterials 9;;0
)9O H n nO H )9⇒⇒
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Ot!er Constituents
• Bndium %Bn 1 decreases surface tension
• reduces amount of mercur$ necessar$
• reduces emitted mercur$ va"or
1 reduces cree" and marginal 'rea,down
1 increases strengt!
1 must 'e used in admi#ed allo$s
1 e#am"le• Bndis"erse %Bndis"erse Distri'uting Com"an$ 1 37 indium
-owell > Dent ?es 2/2
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Ot!er Constituents
• -alladium %-d
1 reduced corrosion
1 greater luster 1 e#am"le
• Valiant -!D %Bvoclar Vivadent
1 ;.37 "alladium
+a!ler > Dent ?es 22;
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*asic Com"osition
• A silver=mercur$ matri# containing filler "articles ofsilver=tin
• Filler %'ric,s 1 Ag0Sn called gamma
• can 'e in various s!a"es 1 irregular %lat!e=cut8 s"!erical8
or a com'ination
• +atri# 1 Ag9)g0 called gamma
• cement
1 Sn/)g called gamma 9• voids
-!illi"<s Science of Dental +aterials 9;;0
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*asic Setting ?eactions
• Conventional low=co""er allo$s
• Admi#ed !ig!=co""er allo$s
• Single com"osition !ig!=co""er allo$s
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• Dissolution and "reci"itation
• )g dissolves Ag and Sn
from allo$• Bntermetallic com"ounds
formedAg-Sn
Alloy
Ag-Sn
Alloy
Ag-Sn Alloy
Mercury
(Hg)
Ag
AgAg
Sn
Sn
Sn
Conventional Iow=Co""er Allo$s
Hg Hg
Ag Ag00Sn H )gSn H )g ⇒⇒ Ag Ag
00Sn H AgSn H Ag99)g)g
00 H SnH Sn//)g)g
-!illi"<s Science of Dental +aterials 9;;0
γ γ γ 1 γ 2
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Conventional Iow=Co""er Allo$s
• 4amma % J Ag0Sn
1 unreacted allo$
1 strongest "!ase and
corrodes t!e least
1 forms 0;7 of volume
of set amalgam
Ag-Sn
Alloy
Ag-Sn
Alloy
Ag-Sn Alloy
Mercury
Ag
AgAg
Sn
Sn
Sn
Hg
Hg
Hg
Ag Ag00Sn H )gSn H )g ⇒⇒ Ag Ag
00Sn H AgSn H Ag99)g)g
00 H SnH Sn//)g)g
-!illi"<s Science of Dental +aterials 9;;0
γ γ γ 1 γ 2
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Conventional Iow=Co""er Allo$s
• 4amma 9 % 2 J Sn/)g
1 wea,est and softest "!ase
1 corrodes fast8 voids form
1 corrosion $ields )g w!ic!reacts wit! more gamma %
1 ;7 of volume
1 volume decreases wit! time
due to corrosion
Ag Ag00Sn H )gSn H )g ⇒⇒ Ag Ag
00Sn H AgSn H Ag99)g)g
00 H SnH Sn//)g)g
-!illi"<s Science of Dental +aterials 9;;0
γ γ γ 1 γ 2
2
Ag-Sn Alloy
Ag-Sn
Alloy
Ag-Sn
Alloy
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Admi#ed )ig!=Co""er Allo$s
• Ag enters )g from Ag=Cu s"!erical eutectic"articles 1 eutectic
• an allo$ in w!ic! t!e elements are com"letel$ solu'le inliuid solution 'ut se"arate into distinct areas u"onsolidification
• *ot! Ag and Sn enter )g from Ag0Sn "articles
-!illi"<s Science of Dental +aterials 9;;0
Ag Ag00Sn H Ag=Cu H )gSn H Ag=Cu H )g ⇒⇒ Ag Ag
00Sn H Ag=Cu H AgSn H Ag=Cu H Ag99)g)g
00 H CuH Cu55SnSn
33 γ γ γ 1 η
Ag-Sn
Alloy
Ag-Sn
AlloyMercury
Ag
AgAg
SnSn
Ag-Cu Alloy
AgHg
Hg
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Admi#ed )ig!=Co""er Allo$s
• Sn diffuses to surface of
Ag=Cu "articles
1 reacts wit! Cu to form%eta Cu5Sn3 %η
• around unconsumed
Ag=Cu "articles
Ag-Sn
Alloy
Ag-Cu Alloy
Ag-Sn
Alloy
-!illi"<s Science of Dental +aterials 9;;0
Ag Ag00Sn H Ag=Cu H )gSn H Ag=Cu H )g ⇒⇒ Ag Ag
00Sn H Ag=Cu H AgSn H Ag=Cu H Ag99)g)g
00 H CuH Cu55SnSn
33 γ γ γ 1 η
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Admi#ed )ig!=Co""er Allo$s
• 4amma % 1 %Ag9)g0
surrounds %η eta "!ase
%Cu5Sn3 and gamma %
allo$ "articles %Ag0Sn Ag-Sn
Alloy
1
Ag-Cu Alloy
Ag-Sn
Alloy
-!illi"<s Science of Dental +aterials 9;;0
Ag Ag00Sn H Ag=Cu H )gSn H Ag=Cu H )g ⇒⇒ Ag Ag
00Sn H Ag=Cu H AgSn H Ag=Cu H Ag99)g)g
00 H CuH Cu55SnSn
33 γ γ γ 1 η
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Single Com"osition
)ig!=Co""er Allo$s• 4amma s"!ere % %Ag0Sn
wit! e"silon coating % ) %Cu0Sn
• Ag and Sn dissolve in )g
Ag-Sn Alloy
Ag-Sn AlloyAg-Sn Alloy
Mercury (Hg)
Ag
Sn
Ag
Sn
Ag Ag00Sn H CuSn H Cu
00Sn H )gSn H )g ⇒⇒ Ag Ag00Sn H CuSn H Cu
00Sn H AgSn H Ag99)g)g
00 H CuH Cu55SnSn
33
-!illi"<s Science of Dental +aterials 9;;0
γ γ γ 1 ηε ε
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Single Com"osition
)ig!=Co""er Allo$s
• 4amma % 1 %Ag9)g0 cr$stals
grow 'inding toget!er "artiall$=
dissolved gamma % allo$
"articles %Ag0Sn• E"silon % ) %Cu0Sn develo"s
cr$stals on surface ofgamma "article %Ag0Sn
in t!e form of eta %η) %Cu5Sn3 1 reduces cree"
1 "revents gamma=9 formation
Ag-Sn Alloy
Ag-Sn AlloyAg-Sn Alloy
1
η
Ag Ag00Sn H CuSn H Cu
00Sn H )gSn H )g ⇒⇒ Ag Ag00Sn H CuSn H Cu
00Sn H AgSn H Ag99)g)g
00 H CuH Cu55SnSn
33
-!illi"<s Science of Dental +aterials 9;;0γ γ γ
1 ηε ε
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Classifications
• *ased on co""er content
• *ased on "article s!a"e
• *ased on met!od of addingco""er
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Co""er Content
• Iow=co""er allo$s
1 G to 57 Cu
• )ig!=co""er allo$s 1 t!oug!t t!at 57 Cu was ma#imum amount
• due to fear of e#cessive corrosion and e#"ansion
1ow contain 2 to 0;7 Cu• at e#"ense of Ag
-!illi"<s Science of Dental +aterials 9;;0
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-article S!a"e
• Iat!e cut 1 low Cu
• ew rue
Dentallo$
1 !ig! Cu• AA 9;;;
• Admi#ture 1
!ig! Cu• Dis"ersallo$8 Valiant -!D
• S"!erical 1 low Cu
• Cave# SF
1 !ig! Cu• $tin8 Valiant
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+et!od of Adding Co""er
• Single Com"osition Iat!e=Cut %SCI
• Single Com"osition S"!erical %SCS
• Admi#tureL Iat!e=cut H S"!erical Eutectic %AIE
• Admi#tureL Iat!e=cut H Single Com"osition
S"!erical %AISCS
8/19/2019 Amalgam tumpatan gigi
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Single Com"osition Iat!e=Cut
%SCI• +ore )g needed t!an s"!erical allo$s
• )ig! condensation force needed due to
lat!e cut
• 9;7 Cu
• E#am"le 1 AA 9;;; %ordis,a Dental
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Admi#tureL
Iat!e=cut H S"!erical Eutectic
%AIE• Com"osition
1 9(0 conventional lat!e cut %07 Cu
1 (0 !ig! Cu s"!erical eutectic %9/7 Cu
1 overall 97 Cu8 7 n
• Bnitial reaction "roduces gamma 9 1 no gamma 9 wit!in two $ears
• E#am"le 1 Dis"ersallo$ %Caul,
Ad i t
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Admi#tureL
Iat!e=cut H Single Com"osition
S"!erical %AISCS• )ig! Cu in 'ot! lat!e=cut and s"!erical
com"onents
1 27 Cu• E"silon la$er forms on 'ot! com"onents
• ;.37 "alladium added
1 reinforce grain 'oundaries on gamma • E#am"le
1 Valiant -!D %Bvoclar Vivadent
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+anufacturing -rocess
• Iat!e=cut allo$s 1 Ag & Sn melted toget!er
1 allo$ cooled• "!ases solidif$
1 !eat treat• G;; MC for / !ours
1 grind8 t!en mill to 93 = 3; microns
1 !eat treat to release stresses of grinding
-!illi"<s Science of Dental +aterials 9;;0
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+anufacturing -rocess
• S"!erical allo$s 1 melt allo$
1 atomi:e• s"!eres form as "articles cool
1 si:es range from 3 = G; microns
• variet$ im"roves condensa'ilit$
-!illi"<s Science of Dental +aterials 9;;0
8/19/2019 Amalgam tumpatan gigi
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+aterial=?elated Varia'les
• Dimensional c!ange
• Strengt!
• Corrosion
• Cree"
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Dimensional C!ange
• +ost !ig!=co""er amalgams undergo a
net contraction
•Contraction leaves marginal ga" 1 initial lea,age
• "ost=o"erative sensitivit$
1 reduced wit! corrosion over time
-!illi"<s Science of Dental +aterials 9;;0
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Dimensional C!ange
• et contraction 1 t$"e of allo$
• s"!erical allo$s !ave more
contraction 1 less mercur$
1 condensation tec!niue• greater condensation J !ig!er contraction
1 trituration time• overtrituration causes !ig!er contraction
-!illi"<s Science of Dental +aterials 9;;0
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Strengt!
• Develo"s slowl$ 1 !rL G; to 5;7 of ma#imum
1 9G !rsL 2;7 of ma#imum• S"!erical allo$s strengt!en faster
1 reuire less mercur$
• )ig!er com"ressive vs. tensile strengt!
• @ea, in t!in sections 1 unsu""orted edges fracture
-!illi"<s Science of Dental +aterials 9;;0
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Corrosion
• ?educes strengt!
• Seals margins 1 low co""er
• 5 mont!s 1 SnO98 SnCl
1 gamma=9 "!ase
1 !ig! co""er • 5 = 9G mont!s
1 SnO9 8 SnCl8 CuCl
1 eta="!ase %Cu5Sn3
Sutow > Dent ?es 22
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Cree"
• )ig!=co""er amalgams !ave cree" resistance 1 "revention of gamma=9 "!ase
• reuires 97 Cu total
1 single com"osition s"!erical• eta %Cu5Sn3 em'edded in gamma= grains
1 interloc,
1 admi#ture• eta %Cu5Sn3 around Ag=Cu "articles
1 im"roves 'onding to gamma
Clic, !ere for ta'le of cree" values
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Condensation
• Forces 1 lat!e=cut allo$s
• small condensers
• !ig! force
1 s"!erical allo$s• large condensers
• less sensitive to amount of force
• vertical ( lateral wit! vi'rator$ motion
1 admi#ture allo$s• intermediate !andling 'etween lat!e=cut and s"!erical
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*urnis!ing
• -re=carve
1 removes e#cess mercur$
1 im"roves margin ada"tation• -ost=carve
1 im"roves smoot!ness
• Com'ined 1 less lea,age
*en=Amar Dent +ater 2/6
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Earl$ Finis!ing
• After initial set 1 "ro"!$ cu" wit! "umice
1 "rovides initial smoot!ness to restorations 1 recommended for s"!erical amalgams
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-olis!ing
• Bncreased smoot!ness
• Decreased "laue retention
• Decreased corrosion
• Clinicall$ effective
1 no im"rovement in marginal integrit$
• +a$!ew O"er Dent 2/5
• Collins > Dent 229
1 Clic, !ere for a'stract
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Allo$ Selection
• )andling c!aracteristics
• +ec!anical and "!$sical
"ro"erties
• Clinical "erformance
Clic, !ere for more details
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)andling C!aracteristics
• S"!erical 1 advantages
• easier to condense
1 around "ins• !ardens ra"idl$
• smoot!er "olis!
1 disadvantages
• difficult to ac!ieve tig!t contacts• !ig!er tendenc$ for over!angs
-!illi"<s Science of Dental +aterials 9;;0
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)andling C!aracteristics
• Admi#ed
1 advantages
• eas$ to ac!ieve tig!t contacts
• good "olis!
1 disadvantages
• !ardens slowl$
1 lower earl$ strengt!
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Amalgam -ro"erties
Com"ressive
Strengt! %+-a
7 Cree" ensile Strengt!
%9G !rs %+-a
Amalgam $"e !r 6 da$s
Iow Co""er G3 0G0 9.; 5;
Admi#ture9 06 G0 ;.G G/
Single
Com"osition0
959 3; ;.0 5G
-!illi"<s Science of Dental +aterials 9;;0
Fine Cut8 Caul,9 Dis"ersallo$8 Caul,
0$tin8 Kerr
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Surve$ of -ractice $"es
Civilian 4eneral Dentists
68%
32%
Amalgam
Users
AmalgamFree
)aP=Ali 4en Dent 9;;3
Freuenc$ of -osterior +aterials
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Freuenc$ of -osterior +aterials'$ -ractice $"e
39%
51%
3% 7%
Amalgam Direc Com!o"ie #n$irec Com!o"ie &er
3%
77%
8%
12%
Amalgam Users
Amalgam Free
)aP=Ali 4en Dent 9;;3
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-rofile of Amalgam UsersCivilian -ractitioners
78%
22%
Do $ou use amalgam in
$our "ractice
Qes
o
D-? 9;;3
88%
12%
Do $ou "lace fewer amalgams
t!an 3 $ears ago
Qes
o
? i f Cli i l St di
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?eview of Clinical Studies%Failure ?ates in -osterior -ermanent eet!
'
2
6
8
Amalgam D irec
Com!
Com!
#nlay"
Ceramic
#nlay"
CADCAM
#nlay"
*ol$
#nlay" +
nlay"
*#
,ongiu$inal C ro"" -Sec iona l
)ic,el > Ad!es Dent 9;;
7 Annual Failure
? i f Cli i l St di
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'
5
1'
15
7 Annual Failure
+an!art O"er Dent 9;;G
Clic, !ere for a'stract
Standard Deviation
Iongitudinal and Cross=Sectional Data
?eview of Clinical Studies%Failure ?ates in -osterior -ermanent eet!