Dental Amalgam

Col Kraig S. Vandewalle

USAF Dental Evaluation & Consultation Service
 Official Disclaimer
• The opinions expressed in this presentation are
those of the author and do not necessarily
reflect the official position of the US Air Force or
the Department of Defense (DOD)
• Devices or materials appearing in this
presentation are used as examples of currently
available products/technologies and do not
imply an endorsement by the author and/or the
USAF/DOD
 Overview
• History
• Basic composition
• Basic setting reactions
• Classifications
• Manufacturing
• Variables in amalgam
performance
Click here for briefing on dental amalgam (PDF)
 History
• 1833
– Crawcour brothers introduce
amalgam to US
• powdered silver coins mixed with mercury
– expanded on setting
• 1895
– G.V. Black develops formula
for modern amalgam alloy
• 67% silver, 27% tin, 5% copper, 1% zinc
– overcame expansion problems
 History
• 1960’s
– conventional low-copper lathe-cut alloys
• smaller particles
– first generation high-copper alloys
• Dispersalloy (Caulk)
– admixture of spherical Ag-Cu
eutectic particles with
conventional lathe-cut
– eliminated gamma-2 phase

Mahler J Dent Res 1997

 History
• 1970’s
– first single composition spherical
• Tytin (Kerr)
• ternary system (silver/tin/copper)
• 1980’s
– alloys similar to Dispersalloy and Tytin
• 1990’s
– mercury-free alloys

Mahler J Dent Res 1997

 Amalgam

• An alloy of mercury with another metal.

 Why Amalgam?
• Inexpensive
• Ease of use
• Proven track record
– >100 years
• Familiarity
• Resin-free
– less allergies than composite
Click here for Talking Paper on Amalgam Safety (PDF)
 Constituents in Amalgam
• Basic
– Silver
– Tin
– Copper
– Mercury
• Other
– Zinc
– Indium
– Palladium
 Basic Constituents
• Silver (Ag)
– increases strength
– increases expansion
• Tin (Sn)
– decreases expansion
– decreased strength
– increases setting time

Phillip’s Science of Dental Materials 2003

 Basic Constituents
• Copper (Cu)
– ties up tin
• reducing gamma-2 formation
– increases strength
– reduces tarnish and corrosion
– reduces creep
• reduces marginal deterioration

Phillip’s Science of Dental Materials 2003

 Basic Constituents
• Mercury (Hg)
– activates reaction
– only pure metal that is liquid
at room temperature
– spherical alloys Click here for ADA Mercury
Hygiene Recommendations
• require less mercury
– smaller surface area easier to wet
» 40 to 45% Hg
– admixed alloys
• require more mercury
– lathe-cut particles more difficult to wet
» 45 to 50% Hg
Phillip’s Science of Dental Materials 2003
 Other Constituents
• Zinc (Zn)
– used in manufacturing
• decreases oxidation of other elements
– sacrificial anode
– provides better clinical performance
• less marginal breakdown
– Osborne JW Am J Dent 1992
– causes delayed expansion with low Cu alloys
• if contaminated with moisture during condensation
– Phillips RW JADA 1954

H2O + Zn  ZnO + H2

Phillip’s Science of Dental Materials 2003

 Other Constituents
• Indium (In)
– decreases surface tension
• reduces amount of mercury necessary
• reduces emitted mercury vapor
– reduces creep and marginal breakdown
– increases strength
– must be used in admixed alloys
– example
• Indisperse (Indisperse Distributing Company)
– 5% indium

Powell J Dent Res 1989

 Other Constituents
• Palladium (Pd)
– reduced corrosion
– greater luster
– example
• Valiant PhD (Ivoclar Vivadent)
– 0.5% palladium

Mahler J Dent Res 1990

 Basic Composition
• A silver-mercury matrix containing filler
particles of silver-tin
• Filler (bricks)
– Ag3Sn called gamma
• can be in various shapes
– irregular (lathe-cut), spherical,
or a combination
• Matrix
– Ag2Hg3 called gamma 1
• cement
– Sn8Hg called gamma 2
• voids

Phillip’s Science of Dental Materials 2003

 Basic Setting Reactions
• Conventional low-copper alloys
• Admixed high-copper alloys
• Single composition high-copper alloys
 Conventional Low-Copper Alloys
• Dissolution and precipitation
• Hg dissolves Ag and Sn Ag-Sn Alloy

from alloy Hg Hg

Ag Ag
• Intermetallic compounds
Sn
Ag
Sn
Ag-Sn Sn Ag-Sn
formed Alloy
Mercury
Alloy
(Hg)

Ag3Sn + Hg  Ag3Sn + Ag2Hg3 + Sn8Hg

  1 2
Phillip’s Science of Dental Materials 2003
Conventional Low-Copper Alloys

• Gamma () = Ag3Sn Hg

– unreacted alloy Ag-Sn Alloy

– strongest phase and Hg

Hg

Ag
corrodes the least Ag
Sn Ag
Sn
– forms 30% of volume Ag-Sn
Alloy
Sn Ag-Sn
Alloy
of set amalgam Mercury

Ag3Sn + Hg  Ag3Sn + Ag2Hg3 + Sn8Hg

  1 2
Phillip’s Science of Dental Materials 2003
Conventional Low-Copper Alloys
• Gamma 1 (1) = Ag2Hg3 Ag-Sn Alloy

– matrix for unreacted alloy

and 2nd strongest phase
1
– 10 micron grains Ag-Sn Ag-Sn
binding gamma () Alloy Alloy

– 60% of volume

Ag3Sn + Hg  Ag3Sn + Ag2Hg3 + Sn8Hg

  1 2
Phillip’s Science of Dental Materials 2003
 Conventional Low-Copper Alloys
• Gamma 2 (2) = Sn8Hg
Ag-Sn Alloy
– weakest and softest phase
– corrodes fast, voids form
– corrosion yields Hg which
reacts with more gamma () Ag-Sn
Ag-Sn Alloy
– 10% of volume Alloy 2
– volume decreases with time
due to corrosion

Ag3Sn + Hg  Ag3Sn + Ag2Hg3 + Sn8Hg

  1 2
Phillip’s Science of Dental Materials 2003
 Admixed High-Copper Alloys
• Ag enters Hg from Ag-Cu
spherical eutectic particles Ag-Cu Alloy

– eutectic
• an alloy in which the elements Hg Hg
Ag Ag Ag
are completely soluble in liquid
Ag
solution but separate into distinct Sn
Sn
areas upon solidification Ag-Sn Ag-Sn
Alloy Alloy
• Both Ag and Sn enter Hg Mercury

from Ag3Sn particles

Ag3Sn + Ag-Cu + Hg  Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5

  1 
Phillip’s Science of Dental Materials 2003
 Admixed High-Copper Alloys
• Sn diffuses to surface of

Ag-Cu particles Ag-Cu Alloy

– reacts with Cu to form

(eta) Cu6Sn5 ()
Ag-Sn
• around unconsumed Alloy
Ag-Sn
Alloy
Ag-Cu particles

Ag3Sn + Ag-Cu + Hg  Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5

  1 
Phillip’s Science of Dental Materials 2003
 Admixed High-Copper Alloys

• Gamma 1 (1) (Ag2Hg3)  Ag-Cu Alloy

surrounds () eta phase

(Cu6Sn5) and gamma ()
alloy particles (Ag3Sn) Ag-Sn Ag-Sn
Alloy Alloy
1

Ag3Sn + Ag-Cu + Hg  Ag3Sn + Ag-Cu + Ag2Hg3 + Cu6Sn5

  1 
Phillip’s Science of Dental Materials 2003
 Single Composition
High-Copper Alloys
• Gamma sphere () (Ag3Sn)
with epsilon coating ()  Ag-Sn Alloy

(Cu3Sn) Sn Sn
Ag

• Ag and Sn dissolve in Hg Ag-Sn Alloy

Ag

Ag-Sn Alloy

Mercury (Hg)

Ag3Sn + Cu3Sn + Hg  Ag3Sn + Cu3Sn + Ag2Hg3 + Cu6Sn5

    1 
Phillip’s Science of Dental Materials 2003
 Single Composition
High-Copper Alloys
• Gamma 1 (1) (Ag2Hg3) crystals
grow binding together partially- Ag-Sn Alloy
dissolved gamma () alloy 
particles (Ag3Sn)
• Epsilon () (Cu3Sn) develops Ag-Sn Alloy
crystals on surface of Ag-Sn Alloy
gamma particle (Ag3Sn)
in the form of eta () (Cu6Sn5) 1
– reduces creep
– prevents gamma-2 formation
Ag3Sn + Cu3Sn + Hg  Ag3Sn + Cu3Sn + Ag2Hg3 + Cu6Sn5
    1 
Phillip’s Science of Dental Materials 2003
 Classifications
• Based on copper content
• Based on particle shape
• Based on method of adding
copper
 Copper Content
• Low-copper alloys
– 4 to 6% Cu
• High-copper alloys
– thought that 6% Cu was maximum amount
• due to fear of excessive corrosion and expansion
– Now contain 9 to 30% Cu
• at expense of Ag

Phillip’s Science of Dental Materials 2003

 Particle Shape
• Lathe cut • Spherical
– low Cu – low Cu
• New True • Cavex SF
Dentalloy – high Cu
– high Cu • Tytin, Valiant
• ANA 2000
• Admixture
– high Cu
• Dispersalloy, Valiant PhD
 Method of Adding Copper
• Single Composition Lathe-Cut (SCL)
• Single Composition Spherical (SCS)
• Admixture: Lathe-cut + Spherical Eutectic (ALE)
• Admixture: Lathe-cut + Single Composition
Spherical (ALSCS)
Single Composition Lathe-Cut
(SCL)
• More Hg needed than spherical alloys
• High condensation force needed due to
lathe cut
• 20% Cu
• Example
– ANA 2000 (Nordiska Dental)
Single Composition Spherical
(SCS)
• Spherical particles wet easier with Hg
– less Hg needed (42%)
• Less condensation force, larger condenser
• Gamma particles as 20 micron spheres
– with epsilon layer on surface
• Examples
– Tytin (Kerr)
– Valiant (Ivoclar Vivadent)
 Admixture:
Lathe-cut + Spherical Eutectic
(ALE)
• Composition
– 2/3 conventional lathe cut (3% Cu)
– 1/3 high Cu spherical eutectic (28% Cu)
– overall 12% Cu, 1% Zn
• Initial reaction produces gamma 2
– no gamma 2 within two years
• Example
– Dispersalloy (Caulk)
 Admixture:
Lathe-cut + Single Composition
Spherical (ALSCS)
• High Cu in both lathe-cut and spherical
components
– 19% Cu
• Epsilon layer forms on both components
• 0.5% palladium added
– reinforce grain boundaries on gamma 1
• Example
– Valiant PhD (Ivoclar Vivadent)
 Manufacturing Process
• Lathe-cut alloys
– Ag & Sn melted together
– alloy cooled
• phases solidify
– heat treat
• 400 ºC for 8 hours
– grind, then mill to 25 - 50 microns
– heat treat to release stresses of grinding

Phillip’s Science of Dental Materials 2003

 Manufacturing Process
• Spherical alloys
– melt alloy
– atomize
• spheres form as particles cool
– sizes range from 5 - 40 microns
• variety improves condensability

Phillip’s Science of Dental Materials 2003

 Material-Related Variables
• Dimensional change
• Strength
• Corrosion
• Creep
 Dimensional Change
• Most high-copper amalgams undergo a
net contraction
• Contraction leaves marginal gap
– initial leakage
• post-operative sensitivity
– reduced with corrosion over time

Phillip’s Science of Dental Materials 2003

 Dimensional Change
• Net contraction
– type of alloy
• spherical alloys have more
contraction
– less mercury
– condensation technique
• greater condensation = higher contraction
– trituration time
• overtrituration causes higher contraction

Phillip’s Science of Dental Materials 2003

 Strength
• Develops slowly
– 1 hr: 40 to 60% of maximum
– 24 hrs: 90% of maximum
• Spherical alloys strengthen faster
– require less mercury
• Higher compressive vs. tensile strength
• Weak in thin sections
– unsupported edges fracture

Phillip’s Science of Dental Materials 2003

 Corrosion
• Reduces strength
• Seals margins
– low copper
• 6 months
– SnO2, SnCl
– gamma-2 phase
– high copper
• 6 - 24 months
– SnO2 , SnCl, CuCl
– eta-phase (Cu6Sn5)

Sutow J Dent Res 1991

 Creep
• Slow deformation of amalgam placed under
a constant load
– load less than that necessary to produce
fracture
• Gamma 2 dramatically affects creep rate
– slow strain rates produces plastic deformation
• allows gamma-1 grains to slide
• Correlates with marginal breakdown

Phillip’s Science of Dental Materials 2003

 Creep
• High-copper amalgams have creep
resistance
– prevention of gamma-2 phase
• requires >12% Cu total
– single composition spherical
• eta (Cu6Sn5) embedded in gamma-1 grains
– interlock
– admixture
• eta (Cu6Sn5) around Ag-Cu particles
– improves bonding to gamma 1

Click here for table of creep values

 Dentist-Controlled Variables
• Manipulation
– trituration
– condensation
– burnishing
– polishing
 Trituration
• Mixing time
– refer to manufacturer
recommendations
• Click here for details
• Overtrituration
– “hot” mix
• sticks to capsule
– decreases working / setting time
– slight increase in setting contraction
• Undertrituration
– grainy, crumbly mix

Phillip’s Science of Dental Materials 2003

 Condensation
• Forces
– lathe-cut alloys
• small condensers
• high force
– spherical alloys
• large condensers
• less sensitive to amount of force
• vertical / lateral with vibratory motion
– admixture alloys
• intermediate handling between lathe-cut and spherical
 Burnishing
• Pre-carve
– removes excess mercury
– improves margin adaptation

• Post-carve
– improves smoothness
• Combined
– less leakage

Ben-Amar Dent Mater 1987

 Early Finishing
• After initial set
– prophy cup with pumice
– provides initial smoothness to restorations
– recommended for spherical amalgams
 Polishing
• Increased smoothness
• Decreased plaque retention
• Decreased corrosion
• Clinically effective?
– no improvement in marginal integrity
• Mayhew Oper Dent 1986
• Collins J Dent 1992
– Click here for abstract
 Alloy Selection
• Handling characteristics
• Mechanical and physical
properties
• Clinical performance

Click here for more details

 Handling Characteristics
• Spherical
– advantages
• easier to condense
– around pins
• hardens rapidly
• smoother polish
– disadvantages
• difficult to achieve tight contacts
• higher tendency for overhangs

Phillip’s Science of Dental Materials 2003

 Handling Characteristics
• Admixed
– advantages
• easy to achieve tight contacts
• good polish
– disadvantages
• hardens slowly
– lower early strength
 Amalgam Properties
Compressive % Creep Tensile Strength
Strength (MPa) (24 hrs) (MPa)

Amalgam Type 1 hr 7 days

Low Copper1 145 343 2.0 60

Admixture2 137 431 0.4 48

Single 262 510 0.13 64

Composition3

1Fine Cut, Caulk

2 Dispersalloy,
Caulk
3Tytin, Kerr
Phillip’s Science of Dental Materials 2003
Survey of Practice Types
Civilian General Dentists

32%
Amalgam Amalgam
Free
Users

68%

Haj-Ali Gen Dent 2005

 Frequency of Posterior Materials
by Practice Type
3% 7%

39%

Amalgam Users

51%

Amalgam Direct Composite Indirect Composite Other

12% 3%
8%
Amalgam Free

Haj-Ali Gen Dent 2005 77%

 Profile of Amalgam Users
Civilian Practitioners
Do you use amalgam in Do you place fewer amalgams
your practice? than 5 years ago?

22% 12%
No No
Yes Yes

78%
88%

DPR 2005
 Review of Clinical Studies
(Failure Rates in Posterior Permanent Teeth)
% Annual Failure
8

0
Amalgam Direct Comp Ceramic CAD/CAM Gold GI
Comp Inlays Inlays Inlays Inlays &
Onlays

Longitudinal Cross-Sectional

Hickel J Adhes Dent 2001

 Review of Clinical Studies
(Failure Rates in Posterior Permanent Teeth)
% Annual Failure

15
Standard Deviation

10
Longitudinal and Cross-Sectional Data

a m p er
ys ys M ld GI nel
RT
g m m la la A o n A
al t Co po In In D/C
st G
Tu
Am rec m p ic A a
i Co Com ram C C
D
Ce Manhart Oper Dent 2004
Click here for abstract
 Acknowledgements
• Dr. David Charlton
• Dr. Charles Hermesch
• Col Salvador Flores

Questions/Comments
Col Kraig Vandewalle
– DSN 792-7670
– [email protected]