clinical aspects of amalgam

Question 1

what is amalgam

Answer 1

an alloy of mercury with another metal or other metals

Question 2

what is dental amalgam

Answer 2

consists of silver mercury and tin with some other metals to modify the properties

Question 3

what is the chemical equation of amalgam

Answer 3

Ag + Sn —> Ag3Sn

Question 4

what is the shape of amalgam

Answer 4

lathe cut

spherical

Question 5

what is amalgam currently stored in

Answer 5

in a capsule and the mercury and the amalgam alloy are separated by a membrane but is ruptured before being placed in the amalgamator

Question 6

what are the three possible stages of the dissolved metals

Answer 6

Ag+Sn—->Ag3Sn known as the gamma phase
Ag+ Hg—-> Ag2Hg3 known as the gamma phase 1
Hg+ Sn —->Sn7Hg known as the gamma phase 2

Question 7

what is gamma 2 responsible for

Answer 7

corrosion
creep
decrease in strength

Question 8

what does the addition of copper

Answer 8

AgCu + Sn7Hg ( gamma 2) = Cu6Sn5 +Ag2Hg3 ( gamma 1)

reduces the gamma 2 phase

Question 9

what is the typical modern amalgam powder composed of

Answer 9

silver
tin
copper
zinc

Question 10

what is the powder:liquid ratio

Answer 10

Ideally final amalgam restoration should contain <50% mercury

Question 11

how much mercury should be added to make the mixture movable

Answer 11

more than 50% to make it movable

Question 12

what happens if there less than 50% mercury in the filling

Answer 12

it makes the amalgam very dry

Question 13

what happens when the amalgam is packed

Answer 13

the mercury is drawn to the top and the excess is scraped away during carving

Question 14

what do we use to pack the amalgam

Answer 14

the condenser

Question 15

what layer lies on top of the restoration

Answer 15

the mercury rich layer which we can then scrap away

Question 16

what are the properties of spherical amalgam

Answer 16

softer more flowable

Question 17

what are the properties of lathe cut amalgam

Answer 17

less flowable,

good for building up large amounts of missing tooth structure

Question 18

what do we typically use

Answer 18

ADMIXED

Question 19

advantages of amalgam

Answer 19

good compressive strength 
good wear resistance 
easy to use
kind to opposing teeth
chemical set
cheap
radiopaque

Question 20

disadvantages of amalgam

Answer 20

do not stick to teeth
weak in thin sections minimum is 2mm depth
thermal conductor
unaesthetic

Question 21

what type of reaction can we get with amalgam fillings

Answer 21

lichenoid reactions

localised allergic reaction- red, white blotchy where the amalgam is located

Question 22

how do we treat lichenoid reactions on the buccal surface

Answer 22

remove the amalgam filling and can replace with GIC/composite

Question 23

what do we need to consider with amalgam fillings

Answer 23

they can act as a Plaque retention factor if there are overhangs

Question 24

when do we use amalgam

Answer 24

class 1 and class 2 restorations
where heavy occlusal force is there
where aesthetics are not important
building up teeth before the tooth is crowned

Question 25

how do we prepare teeth for an amalgam restoration

Answer 25

undercut
no unsupported enamel- wider at the base than the top
cavo surface angle should be greater than 90
the amalgam margin angle should be less than 70

Question 26

how do we create an undercut

Answer 26

if we use the pear shaped bur in the HS and drill across the longitudinal axis of the tooth it should naturally create a undercut

Question 27

what is retention

Answer 27

the prevention of the amalgam cavity being pulled out by vertical forces
macro mechanical

Question 28

what is resistance

Answer 28

the prevention of the amalgam cavity being moved by lateral forces

Question 29

what is the amalgam margin angle

Answer 29

where the restoration meets the prepared surface

Question 30

what can we use instead of pins

Answer 30

pits and grooves- cut directly into the tooth to allow for the amalgam to macromechanically bond

Question 31

what is bonding

Answer 31

the active substances (MDP or 4-META) form a hybrid layer with dentine and chemical bond to amalgam

Question 32

what are the disadvantages of polishing

Answer 32

the heat generated from polishing might damage the pulp

Question 33

will polishing improve the life expectancy

Answer 33

NO

Question 34

how long does it take for amalgam to fully set

Answer 34

24 hours

Question 35

in the 2001 study what was the average life span for amalgam and composite

Answer 35

12 years
5 years

Question 36

what is the risk of secondary caries in the composite group

Answer 36

3.5 x

Question 37

is mercury vapour safe

Answer 37

highly toxic

Question 38

how is mercury vapour taken in

Answer 38

ingested

released when chewing or brushing

Question 39

describe the toxicity of amalgam

Answer 39

When mercury enters the environment it can be converted by bacteria into methyl mercury (MeHg) in fresh and salt water
Methyl mercury is highly poisonous

Question 40

which governments have banned mercury

Answer 40

sweden and germany

Question 41

what do we need to do with mercury in the clinical skills lab

Answer 41

Report mercury spills
Put empty capsules and waste amalgam in the receptacles provided
Clean the heads into the designated sink( dirty sink) (This has a separator on it)