Class 1 Amalgam Restoration
Authored by:
Dr. Grace De Souza
Class I lesions
are associated with caries in the pits and
fissures system. Dental amalgam may be
recommended for the restoration of those lesions
due its strength, resistance to wear and the
ability to self-seal the margins of the
restoration over time.
The materials
needed for the placement of an amalgam
restoration are:
- Rubber dam
materials and instruments;
- Cotton
pliers;
- Explorer;
- Copal
varnish;
- Amalgam
capsules and triturator;
- Amalgam
carrier;
- Condensers of
different sizes;
- Egg-shaped
burnisher;
- Small round
burnisher;
- Hollenback
carvers;
- Cleoid-Discoid
carver
The placement of
a class I amalgam restoration in a posterior
tooth can be accomplished with the following
steps:
- Application of
Copal varnish in two layers with a microbrush
or a small cotton pellet for 10 sec., gently
drying each layer with air
- Selection of
amalgam (high copper admixed alloy is preferred
for this application) and size of capsule (one
spill or two spill)
- Activation and
trituration of the capsule for the time
recommended for the type of
amalgam
- Placement of
the amalgam mixture in a dappen dish, to be
carried to the cavity preparation with an
amalgam carrier; (use amalgam immediately after
trituration)
- Condensation
of amalgam in the cavity:
- Start by using
the smallest condenser possible (try the
condensers in before mixing the
amalgam)
-
Condense
vertically as well as laterally under maximum
compaction (you should feel the muscles in
your shoulder contract) in order to
achieve:
- Absence of
voids
- Maximum
adaptation to the cavity preparation to
reduce marginal leakage
- Removal of
excess mercury
- Maximum
physical and mechanical
properties
- Remember that
larger condensers require higher
forces
- Overfill the
cavity (approximately 1mm) in order to remove
the mercury rich layer during the burnishing
and carving;
- Pre-carve
burnishing with a large radius instrument
(egg-shaped burnisher); it is performed from
the center of the restoration to the margins of
the restoration (M-D and B-L
directions)
The purpose of
this step is to:
- continue the
condensation
- begin the
carving procedure
- Increase
adaptation and reduction of porosity at the
cavosurface margin
- Carving of the
amalgam with a cleoid-discoid, Hollenback or
other instrument;
This will help
to further remove the mercury-rich layer while
developing occlusal anatomy – it is important to
keep in mind the anatomy of the surrounding tooth
as well as the occlusal relationship with the
opposing teeth.
- Final
burnishing with a round-ended burnishing
instrument immediately after carving – apply
light pressure to the carved surface to ensure
a smooth finish with well adapted
margins
The
desired outcome is a long-lasting restoration,
with no surface voids, no marginal gaps, and
anatomy that is harmonious with the anatomy of
the remaining tooth structure. At this point,
finishing should be limited to occlusal
adjustments only. No additional finishing
or polishing is recommended within 24 hours
of completion, to allow the amalgam to fully
crystalize.
Article Reviewed By
Dr. Greg Anderson & Dr. Joel
Rosenbloom