Comprehensive Overview of Complex Amalgam Restoration in Conservative Dentistry
RUNGTA COLLEGE OF DENTAL SCIENCES & RESEARCH
TITLE OF THE TOPIC: COMPLEXAMALGAM RESTORATION
DEPARTMENT OF CONSERVATIVE DENTISTRY AND
ENDODONTICS
1
Specific learning Objectives
At the end of this presentation the learner is expected to know ;
2
CONTENTS
•
Introduction
•
Indications and contraindications
•
Factors to be considered.
•
Advantages and disadvantages
•
Pin retained amalgam restorations
•
Tooth preparation for pin retained amalgam restorations
•
Retentive pins
•
Mechanical aspect of pin retained restoration
I
N
T
R
O
D
U
C
T
I
O
N
•
Historically, the term complex amalgam restoration referred to one that involved three or
more surfaces of a tooth. The term has been redefined in recent years to refer to an
amalgam restoration that replaces one or more cusps
•
When a cuspal-coverage restoration is indicated, a gold alloy casting is considered by many
to be the restoration of choice. Newer ceramic materials with high strength and wear
resistance also represent viable options for these restorations.
•
However, for various reasons, an indirect material cannot always be chosen as the
definitive restoration. In these situations, amalgam is an excellent alternative restorative
material.
D
E
F
I
N
I
T
I
O
N
•
These restorations usually involve the replacement of
one or more
missing cusps , and often, they utilize a bonding technique.
Complex posterior restorations are used to replace missing tooth
structure of teeth that have fractured or are severely involved with
caries or existing restorative material.( Sturdevant’s)
F
A
C
T
O
R
S
D
E
T
E
R
M
I
N
I
N
G
T
H
E
A
P
P
R
O
P
R
I
A
T
E
N
E
S
S
O
F
A
C
O
M
P
L
E
X
R
E
S
T
O
R
A
T
I
O
N
Resistance and retention forms
When conventional retention features are not adequate because of
insufficient tooth structure,
pins, nonpin mechanical features, amalgam
bonding
techniques may be used to enhance retention form. They also
provide additional resistance form to the restoration.
Status and prognosis of the tooth
A tooth which is grossly decayed that may require endodontic therapy or crown
lengthening or that has an uncertain periodontal prognosis is often treated initially
with a
control restoration
, which helps to:
Isolate
the pulp from the oral cavity
Provide an
anatomic contour
against which the gingival tissue may be healthier
Facilitate
control of caries and plaque
Provide some
resistance
against tooth fracture
Role of the tooth in overall treatment plan
•
Abutment teeth for fixed prosthesis may utilize a complex restoration as a
foundation
ie if adequate resistance and retention forms can be provided.
•
For periodontal and orthodontic patients, the complex restoration may be the
restoration of choice until the final phase of treatment when cast restorations
may be preferred.
OCCLUSION, ESTHETICS AND ECONOMICS
indicated as interim restorations for teeth that require
elaborate occlusal alterations
.
When cost of the indirect restorations is a major factor for the patient, the complex direct
amalgam restoration may be an appropriate treatment option
.
•
Age and Health of the patient
For some
geriatric and debilitated
patients complex amalgam restorations
may be the treatment of choice over the more expensive and time consuming
restorations
•
Burgress
was the first to consider pin retention from scientific point of view and he
published his findings in 1915.
Rationale for use of pins:
•
Pins help to support the restorative materials and resist their dislodgment in teeth
that have been severely damaged and weakened.
•
Conventional cavity preparations in badly mutilated
cases
require removal of large
amounts of tooth structure
for obtaining retention and resistance forms
OCCLUSION, ESTHETICS AND ECONOMICS
indicated as interim restorations for teeth that require
elaborate occlusal alterations
.
When cost of the indirect restorations is a major factor for the patient, the complex direct
amalgam restoration may be an appropriate treatment option
.
•
Age and Health of the patient
For some
geriatric and debilitated
patients complex amalgam restorations
may be the treatment of choice over the more expensive and time consuming
restorations
I
N
D
I
C
A
T
I
O
N
S
•
When large amounts of tooth structure are missing,
•
when one or more cusps need capping.
•
When increased resistance & retention form is needed.
•
Definitive final restoration
•
Foundation restoration- abutment teeth for fixed prostheses may use a complex
restoration
•
Control restoration
•
Interim restoration
C
O
N
T
R
A
I
N
D
I
C
A
T
I
O
N
1)
Patient with significant occlusal problems.
2)
If tooth cannot be restored with a direct restoration because of
anatomic and/or functional considerations.
3)
Esthetically important areas.
A
D
V
A
N
T
A
G
E
S
1)
Conservative tooth preparation (compared to indirect or crown
restoration)
2)
Completed in one appointment.
3)
Resistance & retention forms increased by use of pins, slots and
bonding.
4)
Economic
D
I
S
A
D
V
A
N
T
A
G
E
S
•
Dentinal micro fractures
Preparing pinholes and placing pins may create craze lines or fractures and internal stresses
in the dentin.
•
Microleakage
Amalgam restorations using cavity varnish exhibit microleakage around all types of pins
•
Decreased strength of amalgam
The tensile strength and horizontal strength of pin-retained amalgam restorations are
significantly decreased
•
Resistance form is difficult to develop
The complex amalgam restoration does not protect the tooth from
fracture as well as an extracoronal restoration.
•
Penetration & perforation
increases the risk of penetrating into the pulp or perforating the
external tooth surface
•
Proper contours & occlusal contacts difficult to achieve
R
E
T
E
N
T
I
O
N
A
N
D
R
E
S
I
S
T
A
N
C
E
F
O
R
M
•
PINS
•
AMALGAM
BONDING
•
NON PIN
MECHANICAL
FEATURES
N
O
N
P
I
N
M
E
C
H
A
N
I
C
A
L
F
E
A
T
U
R
E
S
•
Parallel or convergent walls.
•
Box form.
•
Flat pulpal and gingival floors.
•
Grooves in proximal line angles.
•
Dovetails.
•
Reduction of undermined cusps.
•
Coves/locks.
•
Amalgapins.
•
Slots.
T
y
p
e
s
o
f
c
o
m
p
l
e
x
a
m
a
l
g
a
m
r
e
s
t
o
r
a
t
i
o
n
1)
Pin retained
amalgam
restorations
2)
Slot retained
amalgam
restorations
3)
Cove
4)
Proximal lock
5. Amalgam
foundations
6. Amalgapins
7. Bonded
amalgam
P
I
N
R
E
T
A
I
N
E
D
R
E
S
T
O
R
A
T
I
O
N
•
PIN
: Miniature metal rods inserted in dentin to
enhance mechanical retention of a restoration
Definition :
A pin retained restoration is defined as any restoration requiring the
placement of one or more pins in the dentin to provide adequate resistance and
retention forms. (According to Sturdevant)
P
I
N
R
E
T
A
I
N
E
D
R
E
S
T
O
R
A
T
I
O
N
•
PIN
: Miniature metal rods inserted in dentin to
enhance mechanical retention of a restoration
Definition :
A pin retained restoration is defined as any restoration requiring the
placement of one or more pins in the dentin to provide adequate resistance and
retention forms. (According to Sturdevant)
•
Burgress
was the first to consider pin retention from scientific point of view and he
published his findings in 1915.
Rationale for use of pins:
•
Pins help to support the restorative materials and resist their dislodgment in teeth
that have been severely damaged and weakened.
•
Conventional cavity preparations in badly mutilated
cases
require removal of large
amounts of tooth structure
for obtaining retention and resistance forms
•
Burgress
was the first to consider pin retention from scientific point of view and he
published his findings in 1915.
Rationale for use of pins:
•
Pins help to support the restorative materials and resist their dislodgment in teeth
that have been severely damaged and weakened.
•
Conventional cavity preparations in badly mutilated
cases
require removal of large
amounts of tooth structure
for obtaining retention and resistance forms
•
Pins provide efficient and adequate retention to the restorations with
the
least possible sacrifice
of healthy tooth structure.
•
With the use of pins, cavity preparation can also be
limited to only
damaged surfaces
there by preserving esthetics and contours.
I
N
D
I
C
A
T
I
O
N
•
As
auxiliary aids
of retention in badly broken or mutilated teeth, large class II, Class
III, IV, and Class V cavity preparations.
•
As
foundations
for full or partial metal or metal ceramic restorations.
•
As a
cross linkage
mode between two bulky, sound parts of the remaining tooth
structure, which is discontinued by abnormal tooth involvement or cracks.
•
In teeth with
guarded prognosis
i.e in endodontically and periodontally involved
teeth.
A
D
V
A
N
T
A
G
E
S
•
Pins are used whenever adequate resistance and retention forms cannot be
established with slots, locks, or under cuts only
•
Pin retained amalgam is an important adjunct in the restoration of teeth with
extensive caries or fracture
•
Significantly greater retention
D
I
S
A
D
V
A
N
T
A
G
E
S
•
Craze lines, fractures, internal stresses in dentin
•
Increases the risk of perforation in to the pulp or the external tooth
surface
•
Decreases the tensile strength of the pin retained amalgam restorations
T
O
O
T
H
P
R
E
P
A
R
A
T
I
O
N
The general concept
similar to conventional amalgam restorations.
CUSP CAPPING
When caries is extensive, reduction of one or more of the cusps for
capping may be indicated.
When the facio lingual extension of the occlusal preparation exceeds
2/3rd
the distance between the facial and lingual cusp
•
Depth cuts should be made on the
remaining occlusal surface of each
cusp to be capped
side of a carbide
fissure bur or a suitable diamond
instrument.
•
The depth cuts should be
2 mm
deep
for functional cusps and
•
1.5 mm
deep minimum for
nonfunctional cusps.
•
Using the depth cut as a guide, the
reductions is completed to provide for
an uniform reduction of tooth
structure.
•
The occlusal contour of the reduced
cusp should be similar to the normal
contour of the unreduced cusp
•
improve its resistance to fracture from occlusal forces.
•
When reducing only one of two facial or lingual cusps, The cusp reduction should be
extended first past the facial or lingual groove creating a vertical wall against the
adjacent unreduced cusp.
Any sharp internal corners of the tooth preparation formed at the junction
of the prepared surfaces should be rounded which reduce stress
concentration in the amalgam
T
A
K
E
H
O
M
E
M
E
S
S
A
G
E
•
Because of its history, the complex amalgam restorations may be the
most frequently placed complex restoration.
•
However due to the increasing benefits of composites, the many types of
auxiliary retention forms available, and the variations of tooth
preparations required for complex restorations, the operator should be
familiar with all of these techniques, if he or she is to use these
restorations on a regular basis.
QUESTIONS
•
TYPES OF AMALGAM RESTORATION
•
INDICATION
•
CONTRAINDICATION
•
ADVANTAGES
•
DISADVANTAGES
•
REFERENCES:
1. Sturdevant's Art and Science of Operative Dentistry
- fourth Edition
2. Operative Dentistry - Modern theory and practice -
First Edition-
M.A.
Marzouk
3. Text book of operative dentistry - Vimal K. Sikri
4.Fundamentals of Operative Dentistry- Summit JB- 2
nd
edition
5.Text book of operative dentistry
nisha carg,amit carg
6.Principles and Practice of Operative Dentistry-Gerald T. Charbeneau-Third
edition.
7.Clinical operative dentistry-principles and practice
ramya Raghu,Raghu
sreenivasan
THANK YOU
In the field of conservative dentistry and endodontics, complex amalgam restoration plays a crucial role in restoring teeth with multiple surfaces affected. This presentation delves into the indications, advantages, mechanical aspects, and considerations involved in performing complex amalgam restorations, providing valuable insights for dental learners and professionals alike.
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Presentation Transcript
RUNGTA COLLEGE OF DENTAL SCIENCES & RESEARCH TITLE OF THE TOPIC: COMPLEXAMALGAM RESTORATION DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS 1
Specific learning Objectives At the end of this presentation the learner is expected to know ; Core areas* Domain ** Category # RESISTANCE AND RETENTION FORM COGNITIVE MUST NOW INDICATIONS AND CONTRAINDICATION ADVANTAGES AND DISADVANTAGES PSYCHOMOTOR NICE TO KNOW TYPES OF AMALGAM RESTORATION AFFECTIVE DESIRE TO KNOW 2
CONTENTS Introduction Indications and contraindications Factors to be considered. Advantages and disadvantages Pin retained amalgam restorations Tooth preparation for pin retained amalgam restorations Retentive pins Mechanical aspect of pin retained restoration
INTRODUCTION INTRODUCTION Historically, the term complex amalgam restoration referred to one that involved three or more surfaces of a tooth. The term has been redefined in recent years to refer to an amalgam restoration that replaces one or more cusps When a cuspal-coverage restoration is indicated, a gold alloy casting is considered by many to be the restoration of choice. Newer ceramic materials with high strength and wear resistance also represent viable options for these restorations. However, for various reasons, an indirect material cannot always be chosen as the definitive restoration. In these situations, amalgam is an excellent alternative restorative material.
DEFINITION DEFINITION Complex posterior restorations are used to replace missing tooth structure of teeth that have fractured or are severely involved with caries or existing restorative material.( Sturdevant s) These restorations usually involve the replacement of one or more missing cusps , and often, they utilize a bonding technique.
FACTORS DETERMINING THE APPROPRIATENESS FACTORS DETERMINING THE APPROPRIATENESS OF A COMPLEX RESTORATION OF A COMPLEX RESTORATION Resistance and retention forms When conventional retention features are not adequate because of insufficient tooth structure, pins, nonpin mechanical features, amalgam bonding techniques may be used to enhance retention form. They also provide additional resistance form to the restoration.
Status and prognosis of the tooth A tooth which is grossly decayed that may require endodontic therapy or crown lengthening or that has an uncertain periodontal prognosis is often treated initially with a control restoration, which helps to: Isolate the pulp from the oral cavity Provide an anatomic contour against which the gingival tissue may be healthier Facilitate control of caries and plaque Provide some resistance against tooth fracture
Role of the tooth in overall treatment plan Abutment teeth for fixed prosthesis may utilize a complex restoration as a foundation ie if adequate resistance and retention forms can be provided. For periodontal and orthodontic patients, the complex restoration may be the restoration of choice until the final phase of treatment when cast restorations may be preferred.
OCCLUSION, ESTHETICS AND ECONOMICS indicated as interim restorations for teeth that require elaborate occlusal alterations. When cost of the indirect restorations is a major factor for the patient, the complex direct amalgam restoration may be an appropriate treatment option. Age and Health of the patient For some geriatric and debilitated patients complex amalgam restorations may be the treatment of choice over the more expensive and time consuming restorations
Burgress was the first to consider pin retention from scientific point of view and he published his findings in 1915. Rationale for use of pins: Pins help to support the restorative materials and resist their dislodgment in teeth that have been severely damaged and weakened. Conventional cavity preparations in badly mutilated cases require removal of large amounts of tooth structure for obtaining retention and resistance forms
OCCLUSION, ESTHETICS AND ECONOMICS indicated as interim restorations for teeth that require elaborate occlusal alterations. When cost of the indirect restorations is a major factor for the patient, the complex direct amalgam restoration may be an appropriate treatment option. Age and Health of the patient For some geriatric and debilitated patients complex amalgam restorations may be the treatment of choice over the more expensive and time consuming restorations
INDICATIONS INDICATIONS When large amounts of tooth structure are missing, when one or more cusps need capping. When increased resistance & retention form is needed. Definitive final restoration Foundation restoration- abutment teeth for fixed prostheses may use a complex restoration Control restoration Interim restoration
CONTRAINDICATION CONTRAINDICATION 1) Patient with significant occlusal problems. 2) If tooth cannot be restored with a direct restoration because of anatomic and/or functional considerations. 3) Esthetically important areas.
ADVANTAGES ADVANTAGES 1) Conservative tooth preparation (compared to indirect or crown restoration) 2) Completed in one appointment. 3) Resistance & retention forms increased by use of pins, slots and bonding. 4) Economic
DISADVANTAGES DISADVANTAGES Dentinal micro fractures Preparing pinholes and placing pins may create craze lines or fractures and internal stresses in the dentin. Microleakage Amalgam restorations using cavity varnish exhibit microleakage around all types of pins Decreased strength of amalgam The tensile strength and horizontal strength of pin-retained amalgam restorations are significantly decreased
Resistance form is difficult to develop The complex amalgam restoration does not protect the tooth from fracture as well as an extracoronal restoration. Penetration & perforation increases the risk of penetrating into the pulp or perforating the external tooth surface Proper contours & occlusal contacts difficult to achieve
RETENTION AND RESISTANCE FORM RETENTION AND RESISTANCE FORM NON PIN MECHANICAL FEATURES AMALGAM BONDING PINS
NON PIN MECHANICAL FEATURES NON PIN MECHANICAL FEATURES Parallel or convergent walls. Box form. Flat pulpal and gingival floors. Grooves in proximal line angles. Dovetails. Reduction of undermined cusps. Coves/locks. Amalgapins. Slots.
Types of complex amalgam restoration Types of complex amalgam restoration 1) Pin retained 5. Amalgam amalgam foundations restorations 2) Slot retained 6. Amalgapins amalgam restorations 7. Bonded 3) Cove amalgam 4) Proximal lock
PIN RETAINED RESTORATION PIN RETAINED RESTORATION PIN: Miniature metal rods inserted in dentin to enhance mechanical retention of a restoration Definition :A pin retained restoration is defined as any restoration requiring the placement of one or more pins in the dentin to provide adequate resistance and retention forms. (According to Sturdevant)
PIN RETAINED RESTORATION PIN RETAINED RESTORATION PIN: Miniature metal rods inserted in dentin to enhance mechanical retention of a restoration Definition :A pin retained restoration is defined as any restoration requiring the placement of one or more pins in the dentin to provide adequate resistance and retention forms. (According to Sturdevant)
Burgress was the first to consider pin retention from scientific point of view and he published his findings in 1915. Rationale for use of pins: Pins help to support the restorative materials and resist their dislodgment in teeth that have been severely damaged and weakened. Conventional cavity preparations in badly mutilated cases require removal of large amounts of tooth structure for obtaining retention and resistance forms
Burgress was the first to consider pin retention from scientific point of view and he published his findings in 1915. Rationale for use of pins: Pins help to support the restorative materials and resist their dislodgment in teeth that have been severely damaged and weakened. Conventional cavity preparations in badly mutilated cases require removal of large amounts of tooth structure for obtaining retention and resistance forms
Pins provide efficient and adequate retention to the restorations with the least possible sacrifice of healthy tooth structure. With the use of pins, cavity preparation can also be limited to only damaged surfaces there by preserving esthetics and contours.
INDICATION INDICATION As auxiliary aids of retention in badly broken or mutilated teeth, large class II, Class III, IV, and Class V cavity preparations. As foundations for full or partial metal or metal ceramic restorations. As a cross linkage mode between two bulky, sound parts of the remaining tooth structure, which is discontinued by abnormal tooth involvement or cracks. In teeth with guarded prognosis i.e in endodontically and periodontally involved teeth.
ADVANTAGES ADVANTAGES Pins are used whenever adequate resistance and retention forms cannot be established with slots, locks, or under cuts only Pin retained amalgam is an important adjunct in the restoration of teeth with extensive caries or fracture Significantly greater retention
DISADVANTAGES DISADVANTAGES Craze lines, fractures, internal stresses in dentin Increases the risk of perforation in to the pulp or the external tooth surface Decreases the tensile strength of the pin retained amalgam restorations
TOOTH PREPARATION TOOTH PREPARATION The general concept similar to conventional amalgam restorations. CUSP CAPPING When caries is extensive, reduction of one or more of the cusps for capping may be indicated. When the facio lingual extension of the occlusal preparation exceeds 2/3rd the distance between the facial and lingual cusp
Depth cuts should be made on the remaining occlusal surface of each cusp to be capped side of a carbide fissure bur or a suitable diamond instrument. The depth cuts should be 2 mm deep for functional cusps and 1.5 nonfunctional cusps. Using the depth cut as a guide, the reductions is completed to provide for an uniform reduction structure. The occlusal contour of the reduced cusp should be similar to the normal contour of the unreduced cusp mm deep minimum for of tooth
Any sharp internal corners of the tooth preparation formed at the junction of the prepared surfaces should be rounded which reduce stress concentration in the amalgam improve its resistance to fracture from occlusal forces. When reducing only one of two facial or lingual cusps, The cusp reduction should be extended first past the facial or lingual groove creating a vertical wall against the adjacent unreduced cusp.
TAKE HOME MESSAGE TAKE HOME MESSAGE Because of its history, the complex amalgam restorations may be the most frequently placed complex restoration. However due to the increasing benefits of composites, the many types of auxiliary retention forms available, and the variations of tooth preparations required for complex restorations, the operator should be familiar with all of these techniques, if he or she is to use these restorations on a regular basis.
QUESTIONS TYPES OF AMALGAM RESTORATION INDICATION CONTRAINDICATION ADVANTAGES DISADVANTAGES
REFERENCES: 1. Sturdevant's Art and Science of Operative Dentistry - fourth Edition 2. Operative Dentistry - Modern theory and practice - First Marzouk Edition- M.A. 3. Text book of operative dentistry - Vimal K. Sikri 4.Fundamentals of Operative Dentistry- Summit JB- 2nd edition 5.Text book of operative dentistry nisha carg,amit carg 6.Principles and Practice of Operative Dentistry-Gerald T. Charbeneau-Third edition. 7.Clinical operative dentistry-principles and practice ramya Raghu,Raghu sreenivasan
