dental amalgams Flashcards

1
Q

What is dental amalgam?

A

Silver and shiny
Metal alloy powder (Ag3Sn) and liquid (Hg) capsule- safety
Conducts heat
Cheap

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2
Q

What are the two types of amalgams?

A

Conventional

High copper content (non gamma 2)

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3
Q

What is the composition of conventional amalgams?

A

Gamma phase-
~Silver, Ag 67-74%
~Tin, Sn 25-27%

~Copper, Cu ~6%
~Zinc, Zn ~2%

=alloy powder

+ triple distilled mercury, Hg
=liquid

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4
Q

What is the gamma phase?

A

Alloy

Eg. Ag3S, intermetallic compound, very narrow compositional range=3rd pure phase of Ag and Sn

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5
Q

How do you work out the type of alloy?

A

Atomic size
Covalency
Structure

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6
Q

What are the three types of alloy?

A

substitutional solid solution
interstitial solid solution
intermetallic compound

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7
Q

What do the size and shape of the powder particles influence?

A

Handling
Setting reactions
Final properties

Lathe cut (course/fine grains) OR spherical

Spherical handled easier
Fine grain sets faster

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8
Q

What is the setting reaction?

A

Ag3Sn + Hg—> Ag3Sn + Ag2Hg3 + Sn7-8Hg

Solid + liquid—> 3 solids

Alloy + triple distilled mercury—> unreacted alloy + silver mercury phase (gamma 1) + tin mercury phase (gamma 2)

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9
Q

What does the amalgam look like on a micrograph?

A

A. Outer layer of alloy particles dissolve in mercury
B. Gamma 1 phases form
C. Gamma 2 phases form (less)
D. Unreacted gamma alloy particles in a matrix of gamma 1 and 2 matrix

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10
Q

Why are amalgams placed?

A
Primary caries
Secondary caries
Poor margin
Restoration fracture
Tooth fracture 
Other
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11
Q

Why are amalgams replaced?

A

Tooth fracture
Recurrent caries
Gross amalgam fracture
Marginal breakdown

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12
Q

Why might the tooth fracture?

A
Undermined enamel (done via prep)
Weakened tooth structure (aim for minimal removal of tooth)
Residual caries (spreads and undermines cusp) + inflam of pulp
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13
Q

Why might recurrent caries occur?

A

Amalgam adults- 72%
Amalgam kids- 56%
Composites- 43%
~1985

Contamination
Poor matrix techniques (overhangs)
Poor condensation (porosity and excess Hg- reduced strength) (poor margins)

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14
Q

Why might there be a gross amalgam fracture?

A
Shallow prep
Pressure points (sharp internal angles)- stress concs 
Not well mechanically retained proximally (reduced w grooves)
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15
Q

What is the tensile strength of amalgams?

A

69 MPa

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16
Q

Why might there be marginal breakdown?

A

Incorrect cavo-surface angles (esp acute)
Delayed expansion (if site not dry, zinc reacts w saliva to form ZnO and H2 gas- bubbles expand, amalgam expands, pressure on pulp)
Over/underfilling
Over carving
Creep and corrosion (metal dislocates and degrades)

17
Q

What are problems with amalgams?

A
Non-adhesive
Not aesthetic 
Not strong/tough
Susceptible to creep and corrosion
Biocompatibility
18
Q

What is the benefit of having a stronger amalgam?

A

Preparing cavity simpler

Remove less tooth structure

19
Q

What are the tensile strengths?

A

Amalgam- 60MPa
Gamma- 170MPa
Gamma-1- 30MPa
Gamma-2- 20MPa

Would be stronger if we got rid of gamma-2

20
Q

What are lathe cut particles?

A

Machined from solid ingot
Graded chippings
Highly reactive w/o prior heating

21
Q

What are spherical alloys?

A

Reach full strength more quickly
Easier to condense
Easier to carve and polish
Lower mercury content

22
Q

What is admix?

A

Dispersed phase amalgams
Addition of Cu

Lathe cut + spherical= admix

AgSn alloy + AgCu alloy= AgSn +AgCu alloy

23
Q

What is the dispersed phase amalgam modified reaction?

A

Gamma + mercury + AgCu—> gamma + gamma-1 + gamma-2

—> (gamma-2 + AgCu)—> gamma + Cu6Sn5 + gamma-1

24
Q

What is the single phase high copper content formulation?

A

AgSnCu + Hg—> gamma-1 + (AgSnCu) + Cu6Sn5

Cu>12%

CuSn can be Cu3Sn or Cu6Sn5 depending on precise starting composition

25
What is the microstructure of the high copper amalgam?
Gamma Gamma-1 Unreacted AgCu CuSn phases (Cu3Sn, Cu6Sn5)
26
How corrosive is traditional amalgam?
Cathodic- ~Gamma -0.10V ~Gamma-1 +0.15V Anodic- ~Gamma-2 -0.70V Galvanic cell- Electrochemical difference in electrolyte so anode metal corrodes So if we get rid of gamma-2- less corrosion
27
What’s re the benefits of high copper amalgams?
``` Reach full strength more quickly Easier to condense/carve/polish Lower mercury content Higher strength Better resistance to corrosion ```
28
What are dental amalgam variations?
Conventional - lathe cut Ag3Sn - spherical Ag3Sn High Cu dispersed phase - Lathe cut Ag3Sn + spherical AgCu - Lathe cut AgSnCu + spherical AgSnCu High Cu single phase - Spherical AgSnCu - Lathe cut AgSnCu
29
What are the potential symptoms and hazards of mercury exposure?
``` Respiratory failure Kidney impairment Cognitive disturbances Reduced visuoperceptual and constructional skills Memory loss Hypertension Headaches ```
30
What are potential sources of Hg contamination?
Spills Leaky dispensers or capsules Removing or polishing amalgams Sterilising mercury contaminated instruments
31
How should mercury contamination be avoided?
- Use pre-capsulated alloys - Avoid direct skin contact and wear mask - Use high vol evacuation when finishing or removing amalgams - Store bulk mercury in unbreakable containers - Store amalgam scraps under radiographic fixer solution - Dispose contaminated items in sealed bags - Report and clean up spilled mercury immediately using clean up kit - Wear professional clothing only in dental surgery - provide proper ventilation - monitor mercury vapour levels in dental surgery - monitor personnel eg. Mercury urine level - use proper work area design - use an amalgamator with a cover - treat w respect