COMPLEX AMALGAM RESTORATIONS

Amalgam:
Restorations are customarily anchored by small undercuts within the dentin,
when a large portion of crown is missing because of caries or for other reasons
such as fracture. It is difficult to obtain this anchorage. There are many features
that provide resistance and retention form to the amalgam such as pins, locks,
cores, slots etc. Bonding also provide anchorage of restorative materials to the
dentin. It has been seen that the mutilated teeth are successfully restored with the
use of pins. These are called the complex amalgam restorations. Thus are the
restorations which involve more than two surfaces of the tooth with or without
cusp capping. These complex amalgam restorations are used occasionally as an
alternative to indirect restorations.
Indications:
Complex amalgam restorations are indicated.
! "hen large amounts of tooth structure are missing.
#! "hen one or more cusps need capping.
$! "hen increased retention and resistance form is re%uired.
Uses:
Complex amalgam restorations may be used as,
! Control restorations in teeth with %uestionable pulpal and periodontal
prognosis.

#! Control restorations in teeth with acute and severe causes. & control
restoration helps,
a. To protect the pulp from oral cavity
b. 'rovides anatomic contour against which the gingival tissue may be
healthier
c. (acilitates control of caries and pla%ue
d. 'rovides some resistance against tooth fracture or propagation of an
existing feature.
$! )efinitive final restoration
*! (oundations
+! &butment teeth for fixed prosthesis may utili,e a complex restoration as a
foundation
-! In patients for periodontal and orthodontic treatment, the complex
restoration may be the restoration of choice until final phase of treatment
when cast restoration may be preferred.
Contraindications:
If patient has significant occlusal problems.
If the tooth cannot be properly restored with direct restoration because of
anatomic and functional considerations.
If the areas to be restored in the esthetic region.
#
Advantages:
Conserves tooth structure. The preparation for a complex amalgam
restorations is usually more conservative than the preparation for indirect
restoration or a crown.
&ppointment time./ The complex restoration can be completed in one
appointment. The cast restoration re%uire at least two appointments.
Resistance and retention form. Resistance and retention form is
significantly increased by pins, slots and bonding.
0conomics./ Compared to an indirect restoration, the amalgam restoration
is relatively inexpensive restoration procedure. "hen cost is the factor the
complex amalgam restorations provides the patient with only extraction of
severely broken down teeth.
1artin and Bader have published the 2#3 of the * to + surfaced complex
amalgam restoration are of successful at five years compared with 4*3 of both
gold and porcelain crowns.
In another study it is reported that 2#3 of amalgam restorations survived
for + yrs including those of cusp coverage.
isadvantages:
! )entinal micro fractures./ 'reparing pinholes and placing pins may create
cra,e lines or fractures, as well as internal stresses in the dentin. Cra,e line
and internal stresses have little or no clinical significance but they may be
very important when minimum dentin is present.
$
#! 1icro leakage./ In amalgam restoration using cavity varnish micro leakage
around all types of pins has been demonstrated. &malgam bonding has
reduced the incidence of micro leakage.
$! )ecreased strength of amalgam. The tensile and compressive strength of
pin amalgam restorations are significantly reduced.
*! Resistance./ Resistance form is more difficult to develop when preparing a
tooth for cusp covering onlay. 5owever amalgam restorations with cusp
coverage significantly increases the fracture resistance than amalgam
restoration without the cusp coverage.
+! Tooth anatomy. 'roper contours and occlusal contacts and6or anatomy are
sometimes difficult to achieve with large complex restorations.
The various features that provide resistance and retention to the complex
restorations.
! 7lots
#! 'ins
$! Bonding
!" Slot Retained Com#le$ Amalgam Restorations:
(or complex restoration, a slot is a retention groove in dentin whose length
is in hori,ontal plane. 7lot retention may be used with the pin retention or as an
alternative to it. 7lots are prepared with 8o. $$ 9 bur approximately :.-mm deep
and :.+ to mm inside the dentino enamel ;unction.
&nother retentive feature that provides additional retention form is cores.
Cores are prepared with 8o < bur. )epth = :.#+mm.
*
&nother retentive feature that provides the retention is proximal locks
placed in proximal bone and in other locations where sufficient vertical tooth
preparation permits.
>perators use slot retention and pin retention interchangeably. 7lot
retention is used in preparation with vertical walls that allow retention locks to
oppose one another. 'in retention is used for fre%uently in preparation with few or
no vertical walls.
7lots are particularly indicated in short clinical crowns and in cusps that
have been reduced # to $ for amalgam.
The amount of tooth structure removed in slots is more as compared to the
pins. 5owever slots are less likely to create micro fractures in dentin and to
perforate the tooth or penetrate into the pulp.
7tudies have shown that slots placed within :.+mm of the pulp do not show
any inflammatory response but the medium si,ed self threading pins do show.
7tudies whether in vitro or in vivo have shown that the retention provided
by slots and pins are %uite similar. But 'ashley and associates reported that the
shear strength of pin retention was significantly stronger than slot retention.
Pin retained amalgam restorations:
& pin retained restoration may be defined as any restoration re%uiring the
placement of the one or more pins to provide ade%uate resistance and retention
form.
+
'ins are used whenever ade%uate resistance and retention form cannot be
established with slots, locks or undercuts. 'in retained amalgam is an important
ad;unct in the restoration of teeth with caries or fracture.
Armamentari%m:
7uccessful pin placement does not re%uire large number of specialty items.
Basic list include./
! Contra angle hand piece ?slow speed! latch type
#! )rill and matching pins
$! (inger wrench for accessible areas
*! Cable drive pin setter for inaccessible areas
+! Bending tool
-! 7harp fissure bur ?e.g. no. ++2! for cutting of the pins
>ptional list include./
! &utoclutch hand piece
#! &ltered comborundum disk to make a self/tapping pins
$! 5aemostat forceps ?needle holder!
*! 1agnifying glasses
Cable/drive pin setter available as the @oma @inda alloy.
Classi&ication o& Pins:
'ins can be classified as A
a! )irect 6 8onparallel pins
b! Indirect pins6 parallel pins
-
A" irect Pins:'
&re usually made of stainless steel, titanium or stainless steel with gold
plating etc. and inserted into dentin followed by placement of restorative materials
like amalgam, resin or cement directly over them.
They are also referred to as non/parallel pins since they are directly inserted
into the tooth structure and hence not parallel to each other. These category pins
include cemented, friction locked and threaded pins.
( Indirect #ins:'
They are slightly undersi,ed to their pinholes and are the integral part of the
cast restoration. These are known as parallel pins as the method necessitates
placement of pins parallel to each other as well as parallel to the path of insertion
of the restoration. Retention of parallel pins are less than the non/parallel pins.
There are basically two types of pin used in parallel pin techni%ue.
a" Cast gold #ins:'
They have relatively smooth surface. Restorations using these pins are
fabricated by keeping the nylon bristles or plastic pins in the pinholes over which
the rest of the restoration is built in the conventional form with blue inlay wax.
The whole assembly is then invested and casted with pins forming an inherent part
of the cast restoration.
)" *ro%g+t #recio%s metal #ins:'
They have surfaces that is deformed or roughened by means of threaded or
knurled patterns. These pins are alloys of gold, platinum, palladium or platinum
2
indium. The pins are placed in the pinhole and are included in the wax pattern.
Their high melting point and tarnish resistance enable them to be incorporated into
the final gold casting. These are #:/$:3 more retentive than smooth cast pins.
irect #ins:
The three ma;or categories of direct pins are./
a! Cemented
b! (riction locked
c! Threaded pins
A" Cemented Pins:'
1arkley introduced this type of pin in B+4. These pins are cemented into
the pinholes prepared :.:: to :.::#C ?:.:#+ to :.:+mm! larger than diameter of
the pin. The difference in the diameter provides space for luting cement.
Cemented pins comes in two si,es
'in diameter 'in channel diameter
:.:#+C :.:#2C
:.:#:C :.:#C
Indication o& cemented #ins:
Cemented pins are generally indicated in cases where least cra,ing and
stresses are desired in the remaining tooth structure e.g. 0ndodontically treated
teeth, where there is no other choice but to place a pin near the dentino/enamel
;unction, where bulk of dentin to accommodate the pin is limited or where dentin
has lost its elasticity because of sclerosis or dehydration.
4
&dvantages of cemented pins./
Cemented pins are approximately :.::C A :.::#C smaller than their
pinholes and hence are more likely to be seated to the full length.
7ince they are passively relined in the dentin, they virtually place no stress
on the surrounding dentin during or after placement.
Because the cement seals the interface between pin and tooth, chances of
micro leakage are reduced.
These can be cut or bent to their final configuration before fixing them in
the pinholes.
)isadvantages of the cemented pins./
They offer less retention compared to the friction locked and threaded pins.
If it is often difficult to insert cement into the pinholes and later locate the
hole after cement has been introduced.
&t times the poorly cemented pins get dislodged when filling material is
being inserted.
Dreater time is re%uired for mixing and hardening the cement.
(" ,riction loc-ed #ins:'
These were introduced by Doldstein in B--. The diameter of the prepared
pinhole is :.::C ?:.:#+ mm! smaller than the diameter of the pin. The pins are
tapped into place and retained by the resiliency of the dentin. The pins are # to $
times retentive than the cemented pins. These pins come in only one si,e i.e.
'in diameter 'in hole diameter
B
:.:##C :.:#C
Indications for friction locked pins./
Teeth that are vital and periodontally sound and where direct access can be
obtained so that tapping force can be applied parallel to the long axis of the
pin.
7ufficient amount of dentin is available to surround the pin and no way
should they be placed closer than .+mm to the dentino enamel ;unction.
&dvantages of friction locked pins./
Cement is not re%uired so one does not have to wait for the cement to set
and other related problems.
'ins ac%uire stability from moment they are inserted.
Better retention than the cemented pins.
)isadvantages of friction locked pins./
The length of the pin is ;udged by trial and error. It cannot be removed from
dentin for cutting to the desire length once inserted.
Bending or contouring of the pin after it has been inserted into pinhole
leads to further stresses.
)riving pins into their respective pinholes generates stresses in dentin in
the form of cracks or cra,e lines.
1any a times, pin do not reach to the full length due to gauging, and hence
loose their retentive properties.
:
1icroleakage is higher than cemented pins if the overlying restoration
leaks.
C" T+readed #ins. sel& t+readed #ins:
The most fre%uently used pin type is small self threading pins. (riction
locked and cemented pins although are still available are rarely used. The pin
retained amalgam restoration using the self threading pins was originally described
by Doing in B--.
The diameter of the prepared pin hole is :.::+C to :.::*C smaller than
the diameter of the pin. The threads engate the dentin as it is inserted, retaining the
pins. The resiliency of the dentin permits insertion of a threaded pin into a hole of
smaller diameter.
&lthough the threads of the self/threading pins do not engage the dentin for
their entire width, the self/threading pins are the most retentive of the three types
of the pins being three to six times more retentive than the cemented pins.
Eertical and hori,ontal stresses are generated when the self/threading pins
are inserted into the dentin. The self threading pins are available in four diameter
in thread mate system ?T17! by cotton6 "haldent Inc 1ahwah, 8ew Fersy.
T/#e Color Pin diameter
in.mm
Pin +ole diameter
0in.mm"
Regular ?7tandard!
Regular ?self shearing!
Regular ?Two in one!
Dold :.:$C 6 :.24 :.:#2 6 :.-4
1inimum ?standard!
1inimum ?two in one!
7ilver :.:#* 6 :.- :.:# 6 :.+$

1inikin ?self shearing! Red :.:B 6 :.:*4 :.:26 :.*$

1inuta ?self shearing! 'ink :.:+ 6 :.$4 :.:$+ 6 :.$*

)utts et al. have reported that insertion of :.:$C self threading pins
produce more dentinal cra,e lines than insertion of either :.:#C self/threading
pins or :.:##C friction lock pins.
5owever other studies done by 'amei;ar and 7altard et al. have shown that
self/threading pins do not create dentinal cra,ing and the cra,ing demonstrated in
some studies may be caused by the techni%ue for the preparation of the specimen.
'ulpal stresses in maximum when the self/threading pin is inserted
perpendicular to the pulp. The depth of the pin hole in the dentin varies between
.$ to #mm depending upon the diameter of the pin used.
Indications for self/threading pins./
Indicated in vital teeth where maximum retention is desired.
'ins should be given when sufficient amount of dentin is available to
surround the pin.
&dvantages of self/threading pins./
Eersatility
"ide range of pin si,es
Color coding system of thread mate system
0ase of insertion
1aximum retention offered
#
Dold plated surface finish, which may eliminate the possibility of
corrosion.
$
)isadvantages of self/threading pins./
0xcessive stresses in the form of cracks or cra,e lines are generated in the
surrounding enamel and dentin, especially with large sei,ed pins.
'ins may need to bent, cut or contoured after insertion, which may place
extra stresses or the tooth may loosen the pin.
"hen the pin is forced into the channel it may strip the sides of the dentin
resulting in a loose fit.
'in may fail to seat completely.
1icro leakage is higher than the cemented pins if the overlying restoration
leaks.
i&&erent #in designs o& t+readed #ins:'
(or each of the four si,es of pins several designs are available. 7tandard,
self/shearing, two/in/one, link series and link plus.
The link series and link plus pins are recommended.
a! 7tandard./ It is approximately 2mm long with the flattened head to engage the
hard wrench or the appropriate hand piece chuck and is threaded to place until
it reaches the bottom of pinhole as ;udged by tactile sense.
&dvantage of standard design. it can be reversed one/%uarter to one half turn
following insertion to full depth to reduce stress created at the apical end of the
pinhole.
b! 7elf/shearing pin./ It has a total length that varies according to the diameter of
the pin. It also consists of flattened head to engage the hand wrench or the
appropriate hand piece chuck for threading into the pin hole. "hen the pin
*
approaches the bottom of the pinhole, the head of the pin shears off, leaving a
length of the extending from the dentin. 7hearing occurs when there is marked
resistance to turning i.e. pin insertion is tor%ue limited.
c! Two/in/one pin./ It has actually two pins in one i.e. the two pins are connected
to each other at a ;oint. The ;oint act as the shear time for the two pins. The
;oint act as the shear time for the two pins. The two/in/one pin is
approximately B.+ mm in length. It has also flattened end that engages the
wrench or the chuck of the hand piece that aids in threading it to the pinhole.
>ut of the two pins which is released first is known as pin & or peripheral pin
whereas the one which is released second is called 'in B or wrench attachment
pin.
"hen the pin reaches the bottom of the pin hole the pin shear approximately in
half, leaving a length of the in extending form the dentin, with the other half
remaining in the hand wrench or hand piece chuck. This second pin may be
then positioned in another pinhole and threaded to place in the same manner as
the standard pin.
&dvantage of two/in/one design is that hand piece need not to be reloaded
during two pin insertions.
d! @ink 7eries./
@ink series pin contained in a color coded plastic sleeve that fits to the latch
type contra angle hand piece or specially designed hand wrench. The pin is free
floating in the plastic sleeve to allow it to align it self as ti is threaded into the
pinhole.
+
"hen the pin reaches the bottom of the hole, the top portion of the pin
shears off leaving a length of the pin extending from the dentin. The plastic sleeve
is then discarded. The minuta, minikin are minimum and regular pin are available
in the link series.
&dvantage./ The link series pins are versatile,
/ 7elf/aligning ability
/ Retentiveness
e! @ink 'lus 'ins./
&re self shearing and are available as a single or two in one pin contained
in a color coded plastic sleeve. The design has a sharper thread, a shoulder stop at
#mm and tapered tip to more readily fit the bottom of the pinhole as prepared by
twist drill.
It also provides #.2 mm length of pin to extend out of the dentin which
usually needs shortening. 1inimum si,es are available in these. Theoretically and
as suggested by 7tandlee these innovations should reduce the stress created in the
surrounding dentin as the pin is inserted an reduce the apical stress at the bottom
of pin hole.
@ or T/shaped threaded pins./
1attos ?B2$! introduced these pins to overcome the need for bending after
their placement. The @ and T shaped threaded pins are well suited for class IE
prepared as it devoids the need for second pin at the incisal third.
Pin Materials:
1aterials used for construction of pins which include stainless steel,
titanium, stainless steel with gold plating, silver, cast gold alloys, platinum/
-
palladium, platinum iridium, plastic aluminium, acrylic, composite resin. 7tainless
steel, titanium and silver pins are commonly used for the direct or non/parallel pin
techni%ues.
7tainless steel pins or stainless steel pins coated with gold are most
fre%uently used. 7tainless steel are stronger than its Titanium and gold
counterparts but has disadvantage of getting corroded and non/adherence to silver
amalgam and composite restorative material.
Titanium pins have the advantage of non/corrosive and most biocompatible
of all metals but their strength and modulus of elasticity is less compared to that of
stainless steel. &lso titanium pins show no adherence to the amalgam and
composite restorations.
7ilver pins have excellent bond with the silver amalgam restorative material
as shown by 1offa et al. ?B2+!, but solid silver pins are soft and easily deformed.
'ins constructed in cast gold, platinum/palladium or platinum iridium are
used with indirect6 parallel pin techni%ue. These pins are relatively corrosion
resistant.
'lastic pins are used in the indirect parallel pin techni%ue but not to serve as
a part of the final restoration. They are meant for taking impressions of the
pinholes for fabricating a cast gold alloy restoration.
&luminium pin are used for manufacturing a temporary restoration until the
final restoration is fabricated and inserted.
&crylic pins and composite resin pins have been tried for use with
composite restoration for anterior restoration due to esthetic purposes.
2
evices &or Pin Insertion:
The pins can be inserted into the dentin in various ways.
!" 1and 2renc+:
5and wrench which provides tactile sense during the threading of the pin
into the dentin. )ifferent designs of hand wrenches available for the different
T17 pins.
If the hand wrench is used without rubber dam isolation, a gau,e throat
shield must be placed in the place and strand of dental tape approximately # to +
inches ?$: to $4 cm! in length should be securely tied to the end of wrench. This
will prevent the accidental swallowing or aspiration of the wrench. 5and wrench
are mainly recommended for the insertion of the standard pins.
& standard design pin placed in the hand wrench and slowly threaded
clockwise till definite resistance is felt when the pin reaches the bottom of the
pinholes. The pin than should be rotated counterclockwise < to 9 turn to reduce
the dentinal stresses.
In most instances tactile sense is advantageous in seating pins. This means
screwing of the pin into position is best done with fingers than by motori,ed hand
piece.
)" Conventional latc+ t/#e contra'angle +and #iece:'
This is mainly recommended for the insertion of link series and link plus
series. & : . reduction gear contra angle hand piece is available to insert the
pins. )uring the insertion of the pins the low speed hand piece is with low gear
4
increases the tor%ue and increases the tactile sense of the operator. It also reduces
the risk of stripping the threads in the dentin once the pin is in place.
c! &crylic wrench./
The acrylic wrench can be fabricated by %uick/curing acrylic. Gsing a metal
bur shank a ball of the acrylic about the si,e of the pea is molded over the end.
&fter curing it can be removed and can be used as a in wrench to screw the pin in
and out of the pin hole.
d" Ca)le drive #in setter:
(or pin placement in posterior areas that are inaccessible, the cable drive in
setter is %uite effective. It provides essential tactile sense. The knob is twisted
forward and backward to screw the pin into or to back it out of the pin hole.
T+e T2ist rill:
7uccess with the pin techni%ue re%uires a working knowledge of three
things. the dull, the pin and the dentin.
'in holes are prepared using a device called Htwist drillsI. This is an end
cutting, revolving instrument with two blades bibeveled in longitudinal section at
precisely the same distance from the toolIs center.
&s one compares its shape to that of dental bur, a marked difference is
apparent. The twist dull cuts only on the end, a dental bur which is a router, cuts
on the sides as well.
The two cutting blades of the drill tip are sloped so that they will cut only
when the drill is turning a clockwise direction. The sides of the drill are helix
fluted allowing the escape of debris formed during end cutting.
B
Twist drills may be either made one piece or two piece. >ne piece twist
drills is made of steel, is less expensive and more likely to fracture. Two piece
drill is made of steel that is swaged onto an aluminium shank, is more expensive
stronger and less likely to fracture.
The aluminum shank, which act as the heat absorber, is color coded so that
it can be easily matched with appropriate pin si,e.
The drill is always made of steel, not carbide so that there can be some
slight plasticity in the drill substance. Carbide is not used for construction of the
drill as they are brittle.
(or cutting the dentin the right one is preferred because flutes are less likely
to become clogged with dentin, the one on the left is designed for cutting metal
and to withstand strong tor%uing forces, which are not encountered when cutting
dentin.
Two type./
&! Jodex twist drills
a. 7tandard
b. )epth enlarged
R%les &or %sing t+e t2ist drills:
! It should be used at ultra low speed ?$::/+:: rpm! because coolant cannot be
used at such depths of dentin engagement. &lso some tactile feeling is needed
during cutting. Time is also needed to allow debris to travel out of the channel.
#! Be sure the drill is sharp.
#:
$! It should be used in direct cutting acts, with force applied parallel to the long
axis of the drill, lateral cutting acts widen the pin channel and lead to drill
fractures.
*! The drill should be revolving while inserting or withdrawing the drill from the
pin channel otherwise lead to drill or tooth structure fracture.
+! )o not use pumping strokes ?several up and down strokes!. This will widen the
pin channel more than is re%uired.
-! 8ever use to drill in enamel. These drills will not cut enamel and will be drilled
even fracture by it.
T+e &o%r )asic designs o& t2ist drills are:'
! Regular twist drill./ They have their cutting part about *mm or more in length
without limiting shoulder6 stop.
#! @imited depth twisted drill./ They have their cutting part of about #mm in
length with the limiting shoulder 6 stop. The limiting shoulder are either
preferred or ad;ustable.
$! 1iniature twist drills./ They are same as regular or limited depth type but their
cutting blade length is smaller i.e. 2mm.
*! Twist drills with parallelometer attachment./ These are regular or limited type
of drills designed to function with the paralleling instrument. They have
narrow shanks that penetrate freely in the bur sleeve of the hand piece and a
sleeve to fit in the parallelometer.
The drill shanks for the link series and link plus pins are tapered to provide
a built in K"obbleC when placed in a latch type contra angle hand piece. This
#
wobble allows the drill to be Kfree/floatingC and thus to align itself as pinhole is
prepared to minimi,e dentinal cra,ing or breakage of small drills.
Because the optimal depth of the pinhole into the dentin is #mm ?only
.+mm for minikin pin!, a depth limiting drill should be used to prepare the hole.
The pinhole to the correct depth can only be prepared when the drill
prepare or hole on flat surface that is perpendicular to the drill.
Thus drilling of the pin hole should be done against the flat surface.
)rilling against a sloping surface makes calculation of pinhole depth difficult.
&lso to restricts the placement of a deeper hole depth/limiting shoulder on
the drills should be given. >mni/depth gau,e can also be used to measure the
depth of the hole.
S+ar#ening o& t2ist drills:
)ull drills used to prepare pinholes can cause increased frictional heat and
cracks in the dentin. 7tudies have demonstrated that twist drills becomes too dull
for use after cutting #: pinholes or less and signal for discarding is the need for
increased pressure on the hand piece.
Gse of a drill whose self limiting shank shoulder has become rounded is
contraindicated.
7harpening a dental twist drill is accomplished by making the drill slightly
shorter in all respects so that the leading edges are again longer. 7harpening must
be done with the help of carborundrum disk mounted on a straight hand piece.
0ach carborundrum disk has a coarse and a smooth side. The smooth side should
face the hand piece.
##
&dditional tilting is then done so the disk slopes away fro the cutting edge.
Princi#les o& #in #lacement:
The placement of pins whether any si,e and shape utili,ing any techni%ue
should follow certain principles for the success of the restoration. The principles
are as follows.
! 'in si,e. )iameter./ The selection for the diameter of pin depends upon.
a! &mount of the dentin available to safely receive the pin.
b! 7i,e of concerned tooth.
c! &mount of retention desired
It is difficult is specify a particular si,e of pin that is appropriate for the
particular tooth. Increasing in the diameter of the pin offers increased retention,
but large si,ed pins are also associated with the heavy concentration of stress in
dentin.
In thread mate system pins for choice for severely involved posterior teeth
are A manikin ?:.:B inch! and occasionally minim ?:.:#* inch!.
1inikin is selected to reduce the risk of the dentin cra,ing pulpal penetration and
potential perforation.
1inim pin are used as a backup in cases where the pinhole for the manikin
was over prepared or pin threads stripped the dentin and manikin pin lack
retention.
7tudies have shown that larger diameter pins have greater retention. 'ins
shows 9 retention than minim and 6$
rd
as retentive as manikin pin.
#$
0ither minim or minikin can be used in a given tooth depending on the
dentin available in the area where the pins are to be inserted. The regular :.:$C
?:.24mm! are rarely used because of the significant amount of cra,ing, cracking in
the tooth during the insertion.
3" N%m)er o& #ins:'
7everal factors must be considered when deciding how many pins are
re%uired.
! the amount of missing tooth structure
#! the amount of dentin available to receive pin safely
$! the si,e of the pins
&s a rule, one pin per missing axial line angle should be used. Certain
factors may cause the operator to alter this rule.
"hen only # to $ mm of the occlusogingival height of a cusp has been
removed, no pin is re%uired because enough tooth structure remains to use
conventional retention features.
Increasing the number of pins increases the chances of increased stresses,
pulpal damage and or perforation. 5ence aim should be maximum retention with
minimum number of pins. The fewest pins possible should be used to achieve the
desired retention for a given restoration.
4" Pin lengt+:'
The ideal ratio of the dentinal engagement pin protrusion is #.. although a
ratio of . is tolerable. & lower ratio will make the dentinal portion of the pin
#*
the short side of a type of a level. This causes the movement of the cavity end of
the pin during the loading of the restoration.
The ratio also varies with the different types of pin for cemented it is $mm
and #mm for friction locked pins it is $mm and $mm for threaded pins it is #mm
and #mm. preferably the length of the pin inside the dentin and in the cavity
should be e%ual.
5" Pin orientation:'
'in should be oriented parallel to the long axis of the tooth. 5owever in
excessively cervically placed areas towards the cemento/enamel ;unction where
sharp constructions are likely to present and dentin thickness is reduced, it is
mandatory to direct the pin parallel to the closest external surface of the tooth then
bend it slightly as needed.
This will prevent the perforation and the external surface or the penetration
of the pulp. To determine the abnormal contours place a probe ad;acent to the
surface close to the intended location and examine its direction.
6" Inter #in distance:'
7pacing between the pins or the interpin distance must be considered when
two or more pinholes are prepared. The distance between the two pins should
allow space for insertion of restorative material and should prevent the excessive
concentration of residual stresses in dentin.
The optimal interpin distance depends on the type and si,e of the pin used.
The minimal interpin distance for cemented pin is #mm for friction locked pin is
#+
*mm and for manikin ?:.:: inch! threaded pins is $mm and for minim threaded
?:.:#* inch! pin is +mm.
Pin location:
7everal factors aid in determining pinhole location.
! Jnowledge of normal pulp anatomy and external tooth contours.
#! Current radiograph of the tooth
$! 'eriodontal condition
*! 'atients age with aging the si,e of the pulp chamber reduces and increase in
the dentin dimension.
Consideration also must be given to the placement of pins in areas where
the greatest bulk of amalgam will occur to minimi,e the weakening effect of the
pins to the tooth structure.
&rea of the occlusal contacts must be anticipated because a pin oriented
vertically and positioned directly below an occlusal load weakens the amalgam
significantly. >cclusal clearance should be sufficient to provide #mm of amalgam
over the pin.
+! Cavity extent./ The more apically located that a gingival floor is, the higher
will be the possibility of surface and pulp root canal perforation in trying to
prepare a pin channel. This is due to decrease in dentin bulk, root surface
concavities and grooves and taper of the tooth as one proceeds apically.
-! Tooth alignment./ 1alalignment of the teeth in the form of rotation,
inclination etc. necessitates individual evaluation of tooth involved to
determine the best access, location and angulation of pin channel.
#-
MEC1ANO'ANATOMICAL PRINCIPLES O, PIN PLACEMENT:
A" Ma$illar/ central incisor:
The tooth has four pulp horns. Three in 1/) direction and one labio/
lingual direction ?cingulum!. The cingulum pulp horn is most pronounced. The
lateral horns are close to the incisal angles and whole pulp chamber is lingually
deviated.
In cross section cervical margin there is an average of .+ A .4mm of
dentin circumferentially gignivally with more dentin labially than lingually.
Pin Location:
Ideal location./ Close to proximo labial and proximolingual corners.
7econd choice./ 1iddle of proximal gingival floor or middle of labial gingival
floor.
Third choice./ Incisal where there is at least #mm or more of dentin between labial
and lingual enamel.
&reas avoided./ 1iddle of lingual gingival floor. Incisal when the dentin between
the labial and lingual enamel plates is not bulky enough to stand pin insertion
without possible failure. Incisal near the proximal horn.
'in angulation./
'roximal and labial pins always should have slight labial angulation in
labio/lingual direction. In mesiodistal direction they have a very limited
angulatiion of about :/#:3 with the longitudinal axis of the tooth.
#2
(" Ma$illar/ lateral incisors:
7ame general anatomy of the pulp horn and chamber as central incisors.
Circumferentially gingivally at the cervical line an average of .# A .+mm of
dentinal thickness is there.
'in location./
Ideal location and second choice is same as that of the central incisors.
&reas avoided./ The areas to be avoided are the middle of lingual gingival floor
and incisally.
'in angulation./
/ 'in should be labially directed in labiolingual direction.
/ In mesiodirection gingival pins should have more angulation ?+/#:3! with
the longitudinal axis of the tooth.
C" Ma$illar/ C%s#id:
The pulp chamber has only two pronounced surface wise pro;ections,
incisally and middle of the tooth and lignually ?cingulum!. The pulp chamber is
lingually deviated. &t cervical line in cross section, on the average there is from
#.+ A $.+mm of dentin circumferentially gingivally. There is more dentin labially
than lingually.
'in location./
The tooth ranks second only to the upper first molar in freedom of pin
insertion.
Ideal location choice is at or close to facio/linguo proximal corner.
7econd choice./ 1iddle of proximal gingival floor. 1iddle of labial gingival floor.
#4
Third choice./ Close to incisal angle
&reas to be avoided./ 1iddle of lingual gingival floor, gingival pins close to
surface concavities or grooves which can occur proximally.
'in angulation./
/ Dingival pins proximally and labially should have slight labial angulation in
labiolingual direction.
/ &ll gingival pins should form an angle with long axis of the tooth in
mesiodistal direction, coinciding with the taper of the root. This angle can be
between #: / $+.
/ Incisal pins should be parallel to the ad;acent proximal slope of the tooth in the
mesiodistal direction, coinciding with the taper of the root.
" Ma$illar/ ,irst (ic%s#id:
/ The pulp chamber is narrower mesiodistally than buccolingually.
/ 1esial distal walls of pulp chamber are flat and buccal and lingual walls are
concave from inside.
/ Two pulp horns are there of which buccal is pronounced.
/ &lways there is a pronounced concavity on the mesial surface of the tooth
?canine fossa!.
/ Circumferentially gingivally at he cervical line an average of #mm of dentin
buccally and lingually, mm mesially and .+mm distally. There is more dentin
lingually than buccally.
'in location./
Ideal location./ Close to proximofacial and lingual corners of the tooth gingivally.
#B
7econd choice./ Between the corners and the middle of axial surfaces with the
exception of the mesial surface.
&reas to be avoided./ 1esial gingival floor ?canine fossa!. 1iddle of the gingival
floors buccally and lingually ?because of concavity of the pulp chamber especially
buccally!. Dingival floor occlusal to furcation.
'in angulation./
&ll gingival pins should be angulated to the longitudinal axis.
E" Ma$illar/ second #remolar:
The tooth resembles the first premolar in its pulp anatomy with more dentin
circumferentially gingivally ?on the average mesially and distally .+mm, buccally
and lingually #.+mm!.
There is no mesial surface concavity. There is more dentin thickness
lingually than buccally.
'in location./
There is more freedom in using pins in #mm bicuspid than first bicuspid.
Ideal location./ 7ame as that of first premolars.
7econd choice./ Dingival floor between the corner and their middle proximally,
facially and lingually.
&reas to be avoided./
1iddle of gingival floor facially and lingually ?concavity of the pulp
chamber!. &reas of gingival floor occlusal to the furcation.
$:
," Ma$illar/ ,irst Molar:
The whole pulp chamber on the upper first molar is mesiobuccally
deviated. (our pulp horns, the mesiobuccal is one of the most pronounced. "alls
of pulp chamber is almost convex inwardly. Circumferentially gingivally at the
cervical line, the dentin measures an average of #/#.+ mm mesially and distally
and #.+ A $.+mm buccally and lingually.
There is more dentin distally i.e. distolingually and less dentin mesially i.e.
mesio/buccally. There are three furcations. one is located buccally and each of the
other two are located proximally.
The proximal furcations are deviated lingually and inwardly. The closed
furcation to the surface is buccal followed by distal and followed by mesial which
is deepest apically and inwardly.
'in location./
Ideal location./ Dingival floor at or close to distolingual corner.
7econd choice./ )istobuccal or the mesiolingual corners of the tooth.
Third choice./ Dingival floor lingually, mesially and distally. &t this point the
furcation and isthmus portion of the future restoration should be taken care.
&reas to be avoided./
/ Corners of the tooth
/ &ny part of the gingival floor occlusal to the furcation ?facially and
proximally! its flutes, or a root concavity and mesiobuccal to the cusp tips.
'in angulation./
Dingival pin facially and lingually should be approximately parallel to the
occlusal #6$
rd
of the lingual surface.
$
Dingival pins mesially and distally should be parallel to the longitudinal
axis of the tooth.
G" Ma$illar/ second molar:
The tooth is very similar to the first molar in all respects except there may
be less dentin circumferentially gingivally and the pulp horn is less pronounced.
1" Ma$illar/ t+ird molar:
This is the youngest upper tooth and unfortunately, there are numerous
varieties in its morphology and pulp anatomy.
If %uadric/tubercular, it can be similar to the first molar.
If tritubercular the anatomy is very peculiar for each tooth.
Denerally speaking pulp chamber can be expected to be more occlusally
located and its walls can be expected to coverage more toward the cervical line.
There is always distobuccal inclination of the tooth causing more chances
of buccal distal surface perforation as well as mesial and lingual pulpal
perforations.
To say the upper $
rd
molars are the poor candidates for pin retained
restorations.
A" Mandi)%lar Central Incisor:
This tooth has peculiar pulp chamber which is wider mesio/distally at its
incisal half than labiolingually, yet its cervical half is under mesiodistally than
labiolingually.
$#
There are three pulp horns. two in mesiodistal direction and one in lingual
direction. Circumferentially gingivally in a cross/section one on average there is
:.4 A .2 mm thick dentin. There is more dentin labially than proximally and
lingually.
'in location./
Ideal location./ 8o ideal location in this tooth. In fact the pins should be avoided
as the retentive feature for restorations in thin tooth. 'ins may be used at the
gingival floor proximally in tooth where the pulp has receded appreciably.
7econd choice./ 'roximolabial and proximolingual corners.
Third choice./ Dingival middle of proximal and labial surface.
&reas to be avoided./
Dingivally lingual surface incisal.
'in angulation./
&ll gingival pin should be angulated slightly labially in labiolingual
direction.
1esiodistally to prevent perforation of the root surface or involving the
mesiodistal widening of pulp chamber in incisal half, pins could have angulation
and the $:/*: to the longitudinal axis of the tooth in the mesiodistal direction.
(" Mandi)%lar lateral incisors:'
The morphology and pulp chamber anatomy of this tooth are very similar to
those of central incisors. The tooth and pulp chamber are more fan/shaped inciso/
apically.
$$
Circumferentially gingivally in cross/section the tooth has an average and
/# mm dentin.
'in location./
'in should be located exactly at the central incisors.
"ith similar advise not to use pins except in aged patients.
'in angulation./
The tooth is similar to the central incisors, except in the mesiodistal
direction, the angulation relative to the long axis of the tooth could be +: to avoid
perforation and encroachment.
C" Mandi)%lar c%s#id:
7urface, pulp chamber and root canal anatomy are very similar to those
features of upper cuspid. &side from the fact that pulp chamber is slightly
compared mesio/distally, the pulp horns are little bit blunt in this tooth and there is
a distant possibility of two root canals.
Circumferentially gingivally, the average amount of dentin in cross/section
is # A #.$mm with more dentin labially than mesially, lingually and distally.
'in location./
7imilar to upper cuspid
Ideal choice./ 'roximolabial and proximolingual corner of gingival floor.
7econd choice./ Dingival middle of the facial floor mesial and distal surfaces.
Third choice./ Incisal
&reas to be avoided./
Dingival lingual surface ?as the dentinal thickness is very less!.
$*
'in angulation./
7imilar to upper cuspid
" Mandi)%lar ,irst (ic%s#id:
/ 1ost predictable pulp chamber and root canal anatomy
/ 'ronounced buccal pulp with the blunt lingual pulp.
/ 'ulp chamber is in shape cervically
/ 'ulp chamber is wider bucco/lingually than mesiodistally
/ Circumferentially gingivally the average thickness at the cervical line is # A
#.+mm.
/ There is more dentin buccally and lingually than mesially and distally.
'in location./
Ideal location./ 'roximolabial and proximolingual corners of the gingival surface.
7econd choice./ Dingival floor between the mesial and distal corners and their
centers.
Third choice./ &nywhere between the two distal or mesial corners avoiding the
isthmus part of one restoration.
&reas to be avoided./
1iddle of the gingival floor, buccally and lingually.
'in angulation./ 7hould be always parallel to the long axis of the tooth.
" Mandi)%lar second #remolar:
If this is a bicuspid then its anatomy is similar to the first premolar with the
exception that it always has lingual pulp and pulp chamber is more rounded. If it is
$+
tricuspid premolar A pulp chamber will be mesiobuccally deviated and it has three
pulp horns.
Circumferentially gingivally the average thickness of dentin at the C0F is #/
$mm buccally and lingually, #.$ A #.-mm mesially and distally.
'in location./
In a bicuspid premolar pin location is exactly like first molar.
In tricuspid premolar
Ideal location./ )istolingual corner of the gingival floor.
7econd choice./ >ther corners of the gingival floor except the mesiobuccal one.
Third choice./ 1esiobuccal corner and in between the four corners except the
areas which are to be avoided.
&reas to be avoided./ &rea under the lingual groove. 1iddle of buccal gingival
floor ?maximum concavity of the pulp chamber and pulp horn!.
'in angulation./
If bicuspid then the pin angulation is similar to that of the first premolar.
If tricuspid it should be similar to the first lower premolar.
E" Mandi)%lar ,irst Molar:
The tooth has usually five pulp horns. the mesiobuccal being the most
pronounced and closest to the surface. The whole pulp chamber is mesiobuccally
deviated with more dentin distally, especially distolingually with more dentin. The
floor of the pulp chamber is smaller than its roof.
$-
The side walls of pulp chambers are flat to concave inwardly.
Circumferentially gingivally, the average thickness of dentin is #/$mm at the
cervical line.
'in locations./
Ideal choice./ )istolingual corner of gingival floor
#
nd
choice./ )istobuccal and mesiolingual corner of gingival floor.
$
rd
choice./ Dingival floor mesially or distally avoided the isthmus portion of
future restoration.
&reas to be avoided./ 1esiobuccal corner of the gingival floor ?furcation! and
mesiobuccal to any cusp tip ?pulp horn!.
'in angulation./
1esially and distally, gingival pins should be parallel to the long axis of the
tooth. Buccally and lingually, gingival pin should be approximately parallel to the
occlusal #6$
rd
of buccal surface.
," Mandi)%lar Second Molar:
The tooth is very similar to first molar, except that the pulp chamber has
four pulp horns only, and less surrounding dentin bulk.
G" Mandi)%lar T+ird Molar:
&s in the upper third molars, there is infinite anatomical variations in these
teeth. They can have some similarities to first molar if they have five cusp and to
second molar if they have four cusp. There is a great tendency of the mesiolingual
$2
angulation of tooth as a whole, which increases the probability of mesial and
lingual surface perforation together with distal and buccal pulpal perforation.
"hatever approach is used, it should be executed very cautiously, with an
understanding that pins are the last resort for retaining restorations in these teeth
because of unpredictability of their anatomy.
7everal attempts have been made to identify the ideal location of the
pinhole. Caputo and 7andlee state that ideal pinhole position is half way between
the pulp and the )0F or external surface of the tooth root.
7tandlee and others have shown that there should be about at least mm of
the dentin around the circumference of the pinhole. 7uch locations ensure the
proper stress distribution of occlusal forces.
(elton associates have demonstrated that pin placement providing at least
mm of remaining dentin thickness from the pulp elicits minimal pulpal
inflammatory responses.
)elts and associates have reported the pinholes should be placed at :.+mm
inside the )0F.
&s a rule. In the cervical 6$
rd
of molar and premolars ?where most pins are
located! pinholes should be placed near the line angles of the tooth. &t line angles
dentinal thickness is the maximum. The pin hole should be positioned no closer
than :.+ to .:mm to )0F or no closer than to .+mm to the external surface of
the tooth, whichever distance is greater.
&s a rule pinhole should be parallel to the ad;acent external surface of the
tooth. The position of a pinhole must not result in the in being close to vertical
wall of tooth structure that condensation of amalgam against the pin or wall is
$4
;eopardi,e. Therefore it is necessary to prepare on a recess in the vertical wall with
no.#*+ bur to permit proper pin hole preparation as well as to provide a minimum
of :.+mm clearance around the circumference of the pin for ade%uate condensation
of the amalgam.
The distance between the axial wall6 vertical wall and the pin should be
such that it should provide sufficient space for the smallest condenser to ensure
that amalgam can be condensed ade%uately around the pin.
'inhole should be prepared on a flat surface that is perpendicular to the
proposed direction of the pinhole. >therwise the drill tip may slip or crawl.
"henever three or more holes are present they should be located at
different vertical levels on the tooth if possible. This will reduce the stresses
resulting from pin placement in the same hori,ontal plane of the tooth.
"hen the pinhole locations have been determined, a no < bur is first used
to prepare a pilot hole ?dimple! approximately one half the diameter of the bur at
each location. The purpose of this hole is to permit more accurate placement of the
twist drill and to prevent the drill from KcrawlingC once it has begum to rotate.
PIN1OLE PREPARATION. C1ANNEL PREPARATION:
! & rubber dam should be placed when pin channels are prepared to protect the
patient from accidental aspiration of pin and to prevent contamination by
saliva in case there is pulpal perforation.
#! The tips of drills tend to move when the rotating tip placed against dentin, it is
usually helpful to place an indentation or starting point in the dentin at the
desired location for the initiation of pin channel.
$B
$! The pilot point may be placed with a small bur such as no. < or no. 64 bur.
*! &ppropriate twist drill is selected mainly the depth limiting drill with shoulder
is selected.
+! To avoid perforation of the pulp and the external pulp on surface the location
of pin channel is critical.
-! The channel should be usually parallel to the nearest external tooth surface.
2! "ith the drill in the latch type contrangle hand piece place the drill in gingival
crevice beside the location of the pin hole.
4! 'osition it until it lies against the external surface of the tooth. (or alignment,
the twist drill is placed against the external tooth surface and the angulation of
this is changed until the drill separates from the margin of the preparation. It is
then rotated back until it ;ust contacts the margins.
B! "ithout changing the angulation obtained from the crevice position, more the
hand piece occlusally and place the drill in the previously prepared pinhole.
:! 8ow view the drill from B: angle to the previous viewing position to
ascertain that the drill is correctly angled in this plane.
! 7hould the proximity of an ad;acent tooth interfere with the placement of the
drill into the gingival crevice, place a flat, thin bladed hand instrument into the
crevice and against the external surface of the tooth to indicate the proper
angulation for the drill.
#! "ith the drill tip in its proper position and with the hand piece rotating at very
low speed ?$:: to +:: rpm! apply the apically directed pressure to the drill
and prepare a pinhole in one or two thrusts until depth/limiting position of the
drill is reached.
*:
$! Gsing more than two movements, tilting the hand piece during the drilling
procedure, or allowing the drill to rotate more than very briefly at the bottom
of pinhole will result in pinhole that is too large.
*! &lthough not usually recommended the air of stream is used to dissipate the
heat of the drill.
+! The drill should never stop rotating ?from insertion to removal from the
pinhole! to prevent the drill from breaking while in the pinhole.
Certain clinical locations re7%ire e$tra care in determining #in+ole
ang%lation:'
The distal of mandibular molar and lingual of maxillary molar. They are
area of problem due to abrupt flaring of root ;ust apical to the C0F.
1andibular posterior teeth ?with their lingual tilt!, teeth that are rotated in
the arch, and teeth that are abnormally tilted in arch deserve careful attention.
(or mandibular second molar with mesial tilt, the extra caution should be
taken to prevent the external perforation on the mesial surface and pulpal
penetration on the distal surface.
Pin Insertion:
A" Cemented #in tec+ni7%e:'
Indications./
This techni%ue is ideal for all pin retained restorations as it creates the least
cra,ing and stresses in remaining tooth enamel and dentin.
It is only techni%ue used for the endodontically treated teeth.
It is used when the available location for the pin is very close to )0F.
*
It is only techni%ue to be used for G and @ shaped pins in class IE
restorations and foundations.
It is used when the bulk of dentin to accommodate a pin is limited.
It is ideal techni%ue for a sclerosed, tertiary, calcific barrier or any other
highly minerali,ed or dehydrated dentin.
Techni%ue for cross linkage of two parts of same tooth.
Proced%re:'
The procedure was advocated by )r. 1arkley with subse%uent
modifications.
'repare the pin channel as mentioned
If the area of the pin channel is easily and readily accessible, cut a piece of
wire to the designated length using a wire cutter or preferably a dial/a/pin
cutter.
7lightly round the end of the pin with the carborundum disk if they are not
smooth.
'lace pins in the tooth and evaluate need for bending
5old pin with tooth pair of pliers and blend if necessary.
&llow setting ,inc phosphate cement, polycarboxylate cement in case of
endodontically treated teeth, copper phosphate cement is mixed and
introduced slightly in the pin channels using a root canal perio/explorer tip
or lentulo spiral at low speed.
*#
Gsing a haemostat, or a magneti,ed forcep 6 twee,er, the pin is held firmly
at its cavity end, dipping the pin channel end into the cement and seating it
firmly into the pin channel.
& large amalgam plugger is re%uired for the complete seating of the pin.
If the pin with same diameter as the pin channel is used as advocated by
Courtade, the same procedure is followed except that a lateral facet is
placed on the side of the pin using a carborundum disc to create a escape
way for cement during cementation and reduce friction during seating into
pin channel.
In case of class IE restoration foundation, where it may be necessary to
bend pins to confirm with the incisal angles, bending should be done prior
to cementation. Bending a pin while it is in the tooth will loosen the cement
;oint and it may stresses the surrounding dentin beyond recovery.
(" ,riction gri# #in tec+ni7%e:
Indications:'
Gsed in vital teeth only
Eery bulky dentin should be available to encompass the pin ?at least *mm
in three dimensions!
'in should be located at least #.+mm from the )0F
Gse only inaccessible areas of the mouth, so the sealing force will be
parallel to the pin axis.
Proced%re:'
*$
'in channel is prepared to the designated depth.
& counter sink is prepared at the pin orifice to the depth :.+mm using a -4
bur.
The correct length of the bur is then cut from the supplied wire or precut
pins using cutting pliers or carborundum disk. Both the ends are s%uared up
and smoothed.
The pins are held by haemostat or magneti,ed twee,er or lockup twee,er at
its cavity end.
'ut a mark on the pin with color marker to show the exact depth of the pin
channel as prepared.
The pin is then seated at the pin channel orifice.
"hile the pin being held there, a specially made seater with concave head
is firmly applied on pin head, being sure that its axis is parallel to that of
the pin in three dimensions.
"ith the hammer, apply light strokes to the seater, parallel to its
longitudinal axis, until the established mark on the pin comes to cavity
floor.
Check the cavity floor, walls and surrounding tooth surface for any cracks
chipped piece, or grass fractures.
T1REAE PIN TEC1NI8UE:
Indications:
It is used for vital teeth
)entin engage the pin is primary or secondary dentin properly hydrated
**
&vailable pin location is at least .+mm from )0F
1aximum retention of pin to dentin and restoration is needed for one
reason or another.
*+
Proced%re:'
Two instruments are available for insertion of threaded pins A !
conventional latch/type contrangle hand piece and #! T17 hand wrench.
The conventional latch type hand piece is recommended for the insertion of
link series and link plus pins. The hand wrench is recommended for
insertion of standard pins.
"hen using the latch type hand piece, insert a link series or a link plus into
the hand piece and place it in pin hole. &ctivate the hand piece in the slow
speed until the plastic sleeve shears from the pin. Then remove the pin and
discard it.
(or low speed hand piece, low gear is used. @ow gear increases the tor%ue
and increases the tactile sensation. It also reduces the stripping the threads
in the dentin once the pin is in place.
& standard design is placed in the appropriate wrench and slowly threaded
clockwise into the pinhole until a definite resistance is felt. "hen the pin
reaches the bottom of the hole. The pin should then be rotated one %uarter
or half turn counterclockwise to reduce the dentinal stresses at the end of
the pin pressing the dentin.
If the hand wrench is used without rubber dam, a gau,e throat shield is
placed and a strand of dental tape approximately # to + inch ?$: to +:cm!
in length should be securely tied to the end of the wrench. This will reduce
the chances of accidental swallowing or aspiration of the hand wrench.
*-
>nce the pins are placed their length is evaluated. &ny length of pin greater
than #mm should be removed. &lso it is desirable to have at least #mm
thickness of amalgam occlusal to the end of pin to prevent unnecessary
weakening of the restoration.
To remove excess length of the pin use a sharp 8o. 6*, 9 or B-@ bur at
high speed and oriented perpendicular to the pin. If oriented otherwise, the
rotation of the bur may loosen the pin by rotating it counterclockwise.
)uring the removal of the excess pin the assistant should constantly apply a
steady stream of air and have a evacuator tip positioned to remove the pin
segment. &lso during the removal of the pin stabili,e the pin with the
hemostat or cotton pliers.
Gsing a mirror determine if any pin need to be bent to position them with
the anticipated contour of the final restoration and to provide ade%uate bulk
of amalgam between the pin and external surface.
'ins are not to be bent to make them parallel or to increase their
retentiveness. Bending a pin may be necessary to allow for condensation of
amalgam occlusogingival.
"hen pin re%uire bending T17 bending tool must be used. The bending
tool should be placed on the pin where the pin is to be bent, and firm
controlled pressure, the bending tool should be rotated until the desired
amount of bend is achieved.
Gse of the bending tool allows placement of the fulcrum at the same point
along the length of the exposed pin. & hand instrument such as Black spoon
*2
excavator should not be used to bend pin because the location of the
fulcrum will be at the orifice of the pin hole.
These hand instruments may cause cra,ing or fracture of the dentin and the
abrupt or sharp bend that usually result, increase the chance of breaking the
pin. &lso the operator has less control when pressure is applied with hand
instrument, and chance of slipping is increased.
& slotted discoid 6 cleoid, or large excavator which are prepared with the
help of corborundum disk can be used for the bending of pins.
,ACTORS A,,ECTING RETENTION O, PIN IN ENTIN:
Retention of pins in dentin indicated by the following factors./
! Type of pins./ 'rovided pins are of e%ual diameter and depth of dentinal
engagement, self threading pins will be +/- times more retentive than cemented
pins. (riction grip pin will be #/$ times relative than cemented pins.
#! )epth of pin engagement in dentin./ &ccording to 1offa a graph is plotted
between the depth of the dentinal engagement in dentin and tensile forces
needed to create a failure at the pin/cement/dentin complex.
a. (or cemented pins./ & linear relationship without a plateau exists.
(ailure occurs at cement dentin ;unction.
b. (or friction grip. 8o increase in resistance to failure after # mm of
dentinal engagement. (ailure occurs at pin dentin interface.
c. (or small threaded pins. There is no resistance to failure after #mm of
the dentinal engagement. (ailure occur within pin themselves.
*4
d. (or large threaded pins./ & plateau occurs after the .+ A #.: m of
dentinal engagement. The failure occurs usually in dentin itself.
$! 'in channel circumferential shape relative to that of pin./ It stands to a reason
that the greater the no difference of these two shapes is, the better will be the
retention. The ideal arrangement can be obtained by truly centrically rotating
drill that will provide a rounded pin channel circumference to accommodate a
pin with a circular cross section. This will make for continuous contact
between the pin and dentin thereby increasing the frictional retention.
*! 8umber of pins./ 'in proximity and location relative to displacing forces
affects the retention. The number of the pins per tooth donIt much affects the
retention. 'ins placed closer than #mm to each other in one tooth will result in
loss of pin retention in dentin. This may be caused by micro cracks occurring
during placement of pins, which then become continuous with each other prior
to or as a result of functioning.
+! Type of cement./ In case of cemented pins, copper phosphate cement ?which is
only used in non/vital teeth! is the most retaining cement. This is followed by
Ln'>*, polycarboxylate and Lo0 in that order. Gsing varnish with ,inc
phosphate cement reduces its retention up to *:3.
-! Type of involved dentin./ Moung resilient, primary dentin is most retaining
type of dentin followed by tubular secondary dentin. 5yper minerali,ation
?sclerosis and calcification! and dehydration ?non/vitality! of dentin will
drastically reduce the pin/retaining power.
*B
2! 7urface roughness of the pins./ 'ins with surface serrations or threading will
have increased retention in dentin, especially in case of cemented pin
techni%ue.
4! The ratio of dentinal engagement of the pin to their protruding lengths in cavity
preparation. The ideal ratio for the pin retention in dentin during furction is # .
. & higher ratio will increase the pin retention and lower ratio will decrease
the retention.
B! 1ode of shortening the pins after insertion./ Ideally pin should not be
manipulated after insertion, but fre%uently it is necessary to shorten them after
they are engaged within the dentin. The least distributing method to retention
of pin is to clip the excess with the cutting pliers. In many cases access will
prevent using pliers, then rotary instruments are used for cutting the excess pin.
a. Gse the smallest carbide bur applicable preferably a < round or -BB bur.
b. &pply pressure in a clockwise direction in case of threaded pin i.e.
direction of threading pins.
c. 5old the pin with a haemostat ?plier or holding instrument! while
applying the lateral cutting pressure.
d. )uring all these acts use light intermittent pressure at the highest speed
possible to minimi,e vibration that may disengage the pin from the
dentin.
e. 8ick the pin at the designated level of shortening.
:!Bulk of dentin around the pin./ The greater that the cross/section of dentin
separately the pins from the pulp, tooth and root surface is greater will be its
retention.
+:
PINS AN RESTORATI9E MATERIALS:
A" E&&ect o& #ins on t+e strengt+ o& amalgam and com#osite resins:
'ins effect the compressive and tensile strength of restorative materials.
Compressive strength./ 'ins do not increase the compressive strength of
restorative material. They only help in retaining it mechanically. In fact there will
be drop in the compressive strength of these restorations if,
a! The cavity end of the pin is chisel or wedge shaped or irregularly shaped.
This situation will lead to creation of shear lines enhancing fatigue failure
of restoration under compression.
b! 'ins are closer than #mm to each other. This situation will drastically affect
the restorative material strength due to increased chances of voids and
decreased bulk between the pins. The pins will actually segment the
restorative material.
c! 'in protrudes through or approximates the surface of the restoration. This
situation leads to segmentation and separation of the restorative material
with less bulk and more interfaces.
d! @ess than .+ mm to #.:: mm exists between the pin surface and restoration
surface. In this circumstances restorative material bulk will be less than the
minimum bulk for amalgam or composite.
e! There is non/adaptability of restorative material to the pin due to improper
wetability. This increase in the number of voids lead to movement of the
restorative material independent of the pin induce intolerable stresses
within the restorative material.
+
(or this reasons failure rate of composite is more than amalgam in pin
restoration because amalgam offers less voids and more adaptability around pins
than composite resin do.
Tensile strengt+:
The same factors which reduce the compressive strength of the restorative
reduces the tensile strength of the restorative materials. In addition,
a! There will be severe reduction ?$:/*:3! of tensile strength of the
restorative material if the pin is placed at right angles to the direction of
tensile stresses induced during function.
b! & moderate reduction ?:3! of tensile strength can be expected if the pins
are placed at *+3 to the direction of the induced stresses in the restoration
during function.
c! 8o reduction of the tensile strength if pins are placed parallel to the
direction of the tensile stresses of the restoration.
,actors a&&ecting retention o& #ins in restorative materials:
The following factors control pin retention to the restorative material./
! Type of pin./ (riction grip pins are least retentive for amalgam and
composite resin due to their smooth surfaces. Cemented pins and threaded
pins are four times more retentive than friction grip, mainly due to threaded
roughness of their surfaces.
#! 'in length in restorative materials./
/ (or friction grip retention is directly proportional to length of pin in
restorative material without any plateau.
+#
/ (ailure will almost occur in pin restorative material interface.
/ (or cemented and small threaded pins, the retention of the restoration
material is directly proportional to the length of the pin in the material
up to the length of #mm whereas plateau is reached. Gsually failure
occurs in the pin itself.
/ (or large threading pins, the plateau for retention in the restorative
material will occur at pin length of .+mm within the restorative
material. (ailure occur in the restorative material itself.
$! 'in diameter./ There is a gradual increase in the pin retention to restorative
material with increasing pin diameter up to :.:$+C. &ny diameter layer than
this will not have significant increase in retention.
*! Interpin distance./ Bridging pins closer to each other will increase retention
up to a distance of #mm. Interpin distance closer this will cause definite
reduction in the pin retention.
+! 'roximity of restorative material to pin surface./ The greater that will be the
wetting ability of the restorative material to pin surface is, the greater will
be the adaptability and conse%uently the frictional retention component.
-! 7urface material of pins./ If the surface layer of the pin can chemically
combine with the restorative material or one of its phase, an ideal mode of
retention will exist at this phase.
Gnfortunately the gold and silver plating of stainless steel pins is not as
effective as would be expected. &malgam mercury will combine with the silver
veneering layer found in some pins, dissolving it and reacting it with some pins. If
the pins are gold plated it is not possible.
+$
PINS AN TOOT1 STRUCTURE:
A" Stressing Ca#a)ilities o& Pins:'
7tresses are always induced in dentin substance as a result of pin insertion.
If these stresses exceed the elastic limit of the dentin permanent plastic
deformation will occur.
These stresses might concentrate to a point exceeding the dentinIs limit,
resulting in macroscopic 6or microscopic dentinal cracks i.e. interrupted and
continuous fractures of the dentin substance.
0ither can lead to pulpal, surface and a periodontal involvement with their
se%uelae ?cracked tooth syndrome! gross fracture of the tooth or part of the tooth,
loose restoration etc.!. There are many factors in pin techni%ues and materials that
can increase or decrease these stresses.
!" T/#e o& #ins:'
The smaller that the diameter of the pin is relative to that of the pin channel,
the less will be the amount and concentration of stresses in the dentin during the
insertion of the pin. There is cemented pin techni%ues, there are little or no
stresses.
1aximum stresses are associated with the friction locked pins where in
addition to the relative diameter of pin and pin channel, the impact forces
introduced during insertion can magnify these stresses. The threaded pin techni%ue
introduces stresses intermediate to other techni%ues.
The threading acts dissipate and consume some of the insertion energy by
cutting part of the pin channel in dentin walls. In threaded pin/techni%ue greater
+*
than differences between the pin diameter and pin channel diameter, the greater
will be the stresses. &lso the blunter threads produces more dentinal stresses. &lso
the less distance between the threads produced more concentration of stresses.
This is because the intervening dentin will be of lesser dimensions, while the
number of shearing threads per pin increases.
3" iameter o& #ins:'
The greater that the diameter of a pin is, the greater will be induced
stresses.
4" Pin de#t+ and dentinal engagement:'
The greater that the depth of the pin channel is, the greater will be the
stresses. This situation is most marked in threaded and friction grip pin techni%ues
which is due to greater dentinal involvement.
"ith threaded pins, the deeper that the engagement of the pin is into the
surrounding dentin, the more will be the stresses. Thus to reduce stresses the
modern pins have a lesser number of the threads with the greater distance between
these threads.
The threads are designed to be self/tapping and sharp extending very short
distance laterally. 'in diameter themselves have been scaled down.
5" (%l- o& dentin:'
The greater that the bulk of dentin pulpally or toward the surface from the
pin is, the greater will be amount of stresses per unit volume of dentin.
++
6" T/#e o& dentin:'
Regular, primary dentin of young teeth is the least affected by stresses
induced by pin techni%ues because of its high elastic and plastic limit i.e. the
modulus of resilience. The greater that the minerali,ation and dehydration of the
dentin is, the greater that the obliteration of the dentinal tubules is, the less the
dentin will be able to tolerate stress without some eventual microfracture.
&ccordingly the se%uence of different types of dentin in decreasing order is,
secondary dentin N sclerosed dentin N tertiary dentin N calcific barrier. Therefore,
it is a basic principle not to use threaded pins in the endodontically treated teeth.
:" Inter#in distance:'
The closer that the pins are inserted to each other, the greater will be the
possibility of stress concentration beyond the tolerable limits of the dentin. It is
advisable to not insert pins closer than *mm when using the threaded pins. (or
cemented pins the interpin distance is #mm.
;" Non'coinciding eccentricit/ in #ins or #in c+annel circ%m&erences:'
0ccentricity is due to non/centrically running drills causing the elliptical or
irregularly shaped pin channels to occur that are not in conformance with the pin
shape. The pin will be contacting the surrounding dentin at only one or two points,
there bay concentrating stresses that should be distributed evenly over the dentin.
<" Loose #in:'
& loose pin within its pin channel could result in pin retained restoration
that is partially or completely mobile. Conse%uently the pin will definitely more
+-
inside its pin channel with every movement of the restoration. The stresses will be
directly proportional to the amount and degree of pin movement within the dentin.
=" *edge> c+isel or irreg%larl/ s+a#ed dentinal and o& #ins:'
Irregularly shaped pin/ends can happen during pin manufacturing, or pin
ad;ustments prior to the insertion procedure. This situation can invite
concentration of stresses at small cross/section of dentin which may result in
stresses beyond its tolerance.
!?" Ratio o& de#t+ o& t+e #in in dentin to t+at #rotr%ding into t+e cavit/
#re#aration:'
The ideal dentinal engagement, pin protrusion is # . . &lthough . is
tolerable, a lower ratio will make the dentinal portion of the pin.
!!" N%m)er o& #ins in one toot+:'
It is not only the number of pins per tooth that will dictate the type and
amount of induced stresses, but also the number of volume of dentin.
!3" T2ist drill varia)ilit/:'
Blunt edged drills vibrating drills or a twist drill used with laterally applied
forces can magnify the induced stresses in the dentin to a greater level than will be
consumed in pin channel cutting.
!4" Over t+reading or over driving o& #ins into t+e #in c+annel:'
These situations can magnify and induce unnecessary stresses in the
underlying of involved dentin.
+2
!5" Stresses ind%ced d%ring s+ortening #ins inside t+e cavit/ #re#aration:'
&fter the dentinal engagement, any energy not consumed in cutting the pin
can induce intolerable stresses in the involved dentin.
+! Bending or aligning pins after their dentinal engagement and induce
intolerable stresses.
-! Retentive features in the remaining portion of the cavity. 'ins should be used
only as the auxillary means of retention.
!;" Inserting #ins in a stress concentration area o& t+e toot+:'
In stress concentration areas ?e.g. the axial angle or incisal angle the
;unction between the clinical crown and clinical root! inserting pins will
complicate pre/existing stress patterns, if the bulk of the tooth has been already
reduces.
POSSI(LE PRO(LEMS *IT1 PINS:
&! (ailure of pin/retained restorations./ The failure of pin retained restorations
might occur at any five different locations. (ailure can occur ?i! within the
restoration ?ii! at the interface between pin and restorative material, ?iii! within
the pin, ?iv! within the dentin.
B! Broken drills and broken pins./ 7ometimes a twist drill will break if it stressed
laterally or allowed to stop rotating before being removed from the pinhole.
Gse of sharp twist drills helps eliminate the possibility of drill breakage. The
standard pin usually breaks if turned more than needed to reach the bottom of
the pin hole. 'uss may also break during the bending, if care is not exercised.
+4
Treatment of both broken drill and pin is to choose an alternate location, at
least .+mm remote from the problem item and prepare another hole.
C! @oose pins./ 7elf threading pin sometimes does not properly engage the dentin
because the pin hole was inadvertently prepared to large or a self shearing pin
failed to shear, resulting in stripped out dentin. The pin should be removed and
pin with the next larger si,e is inserted.
)! 'enetration into the pulp and perforation of external tooth surface./ "hen
penetration or perforation has occurred there is an abrupt loss of resistance of
the drill to hand pressure. &lso if a standard or link series pin continue to threat
into the tooth beyond the #mm depth of the pin hole, this is an indication of a
penetration or perforation.
Radiographs are not very helpful in detecting the pulpal penetration as there
can be chances of superimposition of the pulp and pin. But they are helpful in
detecting the external surface exposure.
If the pulpal penetration occurs in asymptomatic teeth the treatment is same
as any other small mechanical exposure. If mechanical exposure has occurred
control the haemorrhage and place Ca?>5!
#
in the hole and prepare a hole .+ to
#mm away from the previous pinhole.
&n external perforation might be suspected if an unanaestheti,ed patient
senses pain when pinhole is being prepared or a pin being placed in tooth that has
had endodontic therapy. 'erforation can occur occlusal or apical to gingival
attachment.
+B
Three options if perforation occurs above the epithelial attachment./
'in can be out of and flush off with the tooth surface and no further treatment.
'in can be cut off flush with the tooth surface and preparation for cast
restoration extended gingivally beyond the perforation.
'in can be removed and external aspect of the pin hole can be restored with the
amalgam.
Two options available if perforation occurs apical to the attachment./
! Reflect the tissue surgically, remove the necessary bone, the pinhole slightly
and restore it with amalgam.
#! 'erform a crown lengthening procedure and then place the cast metal
restoration of margins below the perforation.
-: