amalgam tumpatan gigi

8/19/2019 Amalgam tumpatan gigi

http://slidepdf.com/reader/full/amalgam-tumpatan-gigi 1/59

Dental AmalgamDental Amalgam

Col Kraig S. VandewalleUSAF Dental Evaluation & Consultation Service



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



Overview

• )istor$

• *asic com"osition

• *asic setting reactions• Classifications

• +anufacturing

• Varia'les in amalgam

"erformanceClic, !ere for 'riefing on dental amalgam %-DF



)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



)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



)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



Amalgam

• An allo$ of mercur$ wit! anot!er metal.



@!$ 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



Constituents in Amalgam

• *asic 1 Silver

1 in

1 Co""er

1 +ercur$

• Ot!er 1 inc

1 Bndium

1 -alladium



*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



*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




*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




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


)9O H n nO H )9⇒⇒



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



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;



*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




*asic Setting ?eactions

• Conventional low=co""er allo$s

• Admi#ed !ig!=co""er allo$s

• Single com"osition !ig!=co""er allo$s



• 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


γ γ γ 1 γ 2




• 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



00 H SnH Sn//)g)g


γ γ γ 1 γ 2




• 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



00 H SnH Sn//)g)g


γ γ γ 1 γ 2

2

Ag-Sn Alloy

Ag-Sn

Alloy

Ag-Sn

Alloy



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


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




• 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




00 H CuH Cu55SnSn

33 γ γ γ 1 η




• 4amma % 1 %Ag9)g0

surrounds %η eta "!ase

%Cu5Sn3 and gamma %

allo$ "articles %Ag0Sn Ag-Sn

Alloy

1

Ag-Cu Alloy

Ag-Sn

Alloy




00 H CuH Cu55SnSn

33 γ γ γ 1 η



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


00 H CuH Cu55SnSn

33


γ γ γ 1 ηε ε



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


00 H CuH Cu55SnSn

33

-!illi"<s Science of Dental +aterials 9;;0γ γ γ

1 ηε ε



Classifications

• *ased on co""er content

• *ased on "article s!a"e

• *ased on met!od of addingco""er



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




-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



+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



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



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



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



+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




+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$




+aterial=?elated Varia'les

• Dimensional c!ange

• Strengt!

• Corrosion

• Cree"



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




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




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




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



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



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



*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



Earl$ Finis!ing

• After initial set 1 "ro"!$ cu" wit! "umice

1 "rovides initial smoot!ness to restorations 1 recommended for s"!erical amalgams



-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



Allo$ Selection

• )andling c!aracteristics

• +ec!anical and "!$sical

"ro"erties

• Clinical "erformance

Clic, !ere for more details



)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




)andling C!aracteristics

• Admi#ed

1 advantages

• eas$ to ac!ieve tig!t contacts

• good "olis!

1 disadvantages

• !ardens slowl$

1 lower earl$ strengt!



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


Fine Cut8 Caul,9 Dis"ersallo$8 Caul,

0$tin8 Kerr



Surve$ of -ractice $"es

Civilian 4eneral Dentists

68%

32%

Amalgam

Users

AmalgamFree

)aP=Ali 4en Dent 9;;3

Freuenc$ of -osterior +aterials



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



-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



?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



'

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!

amalgam tumpatan gigi

Documents