Failures In

Amalgam
Restorations

Presented by
01/13/10 Arpita Pareek
ARPITA PAREEK
I. FAILURES OF DENTAL AMALGAM
Dental amalgam is one of the most
frequently used restorative materials for
restoration of posterior teeth. In routine
properly restored silver amalgam may not
• last for more than ten years.
Early restored teeth appear excellent but
• gradually peculiar things begin to happen
• altering the technical details of the
restoration.
• These may lead to fracture of’ restoration,
• tooth fracture, recurrent caries,
discoloration, corrosion, loss of restoration
• and etc.
• The observed amalgam failures are most
likely because of factors other than the
• material itself. The success of the amalgam
• restoration depends upon the control and
attention to many variables.
• The different types of failure in an amalgam
restoration are -
• I. At visual level
• Secondary caries
• Marginal fracture
• Bulk fracture
• Tooth fracture
• Dimensional change
• II. At the microstructural level
• Corrosion and tarnish
• Stresses associated with masticatory forces
• III. Pain following amalgam restoration
• IV. Pulp and/or periodontal involvement
•  

• Failures in an amalgam restoration
can be studied in detail under two
main headings:
• Failures due to faulty cavity
preparation
• Failures due to poor matrix
adaptation
• Failures due to faulty amalgam
manipulation

• I. Faulty Cavity Preparation
• Most clinical studies have concluded that improper cavity preparation leading to
recurrence of caries and fracture is the greatest single factor responsible for
failure.
• Healey and Philips (1949)40 evaluated 1521 defective amalgam restorations and
reported that 56% of the failures were because of improper cavity
preparation and 42% of the failures were because of faulty manipulation of
amalgam.
• The different causes of failure that can occur at various steps while preparing a
cavity for amalgam are as follows:
• Inadequate occlusal extension : On the occlusal surface the preparation should
be extended to include all the susceptible pits and fissures while terminating
the margins in areas that can be finished.
• b) Inadequate extension of the proximal box
• If the proximal box walls are not adequately extended into the embrasures they
are not amenable to brushing & cleaning by mastication which predisposes
to secondary caries
• c) Overextension of the cavity preparation walls:
• The ideal facio-lingual width of the cavity preparation for amalgam should be
1/4th the intercuspal distance.
• If the cavity preparation extends to half of the intercuspal distance,
consideration should be given to capping of the cusps.
• If the cavity preparation extends to 2/3rds of the intercuspal distance cusp
capping becomes mandatory.
• If the remaining cusps are not capped in large amalgam restorations, there are
chances that the cusps can fracture. This is because amalgam restoration
on acts as a wedge and tends to split the exposing cusps apart.
• During cusp capping amalgam should be present in a minimum thickness of 2
mm over functional cusps and minimum thickness of 1.5 mm over non-
functional cusps to give it adequate strength.
• d)Amalgam cavity preparations should have a
minimum depth of 1.5 mm to provide it
bulk .Hence resistance to fracture.
• e) If pulpal floor of the cavity preparation flat
but curved the restoration produces wedging
effect thus increasing the chances of fracture
of tooth.
• To assure strong junctions between amalgam
and tooth regardless of its location, butt joints
created particularly in those regions where
occlusal stresses to be encountered.
• Cavosurface angle is acute there are chances of
fracture of the tooth margins whereas if the
cavosurface angle is obtuse the acute
marginal amalgam is likely to collapse under
occlusal stress.
• The cavity margins should be adequately
finished to remove any unsupported enamel
rods, which are susceptible to fracture leading
• g) Failure to round off the axio-pulpalline angle as well as
internal line angles and point angles can lead to
concentration of stresses and fracture of the tooth or
restorative material.
• h) Occasionally, fracture may be seen at the isthmus
portion of the proximo-occiusal restoration, which may
be because of a very narrow isthmus or inadequate
proximal retention form.
• i) Failure to diverge the mesial and distal walls of the
occlusal cavity preparation. When the mesio-distal
extension of the cavity is extensive it can cause fracture
because of the undermining of the mesial and distal
marginal ridge enamel.
• j) Retentive devices should be prepared entirely in dentin
without undermining the enamel.
• k) Incomplete removal of carious tooth structure leads to
failure of amalgam restoration.
• l) Flat pulpal floor should be provided around the excavation
site of caries. If this is not possible at least three flat
seats should be provided to resist the forces directed
along long axis of the tooth
• m) Post operative pain can also be a routine failure. The
dentist should use high speed rotary instruments, with
intermittent cutting and adequate cooling of tooth
• II. Poor matrix adaptation


• The areas and relationship of contacts, the

anatomical design ofthe marginal ridges, the
marginal continuity of the restoration all play
important roles in assuring that the tissues of
the periodontium will maintain a state of
health.
• The matrix should be very stable after it has
been applied. Instability of a matrix results in
a distorted restoration, gross marginal
excesses and an uncondensed soft amalgam.
• The cervical excesses can irritate the
periodontium, gradually and progressively
destroying the periodontum.
• Establishing a proper contacts and contours
with the help of matrices are fundamental to
the successful amalgam.

• lll. Faulty amalgam manipulation
• It has been stated that more amalgam restorations fail because of
poor manipulation than because of the use of poor alloys.
Successful restoration can be relieved when variables are kept
under strict control. The basic principle of all these
manipulative procedures is to produce a well-prepared
amalgam with the mercury content in the amalgam under
control.
• a) Mercury alloy ratio
• A serious loss of strength occurs when the residual mercury is in
excess of 55% in the restoration. The clinical result of excess
residual mercury includes reduced crushing strength, increased
flow and increased susceptibility to tarnish and corrosion
• It is preferable to use a minimal mercury technique with
dispensers used for the correct proportioning.
• Mulling is a continuation of the trituration process and is done to
assure that all alloy particles are duly coated with mercury. It
can be done manually or mechanically. While doing it manually,
moisture can be incorporated into the material if bare hands
are used. Mechanically, mulling is done in the amalgamator
• Both under trituration and over trituration can lead to failures of
amalgam restoration. Under trituration leads to soft powdery
non-coherent mix whereas overtrituration may break the
already forming matrix.

• b) Condensation
• The rationale of condensation is to reduce residual mercury
content, to ensure amalgam reach all parts of the preparation
and to obtain a homogenous restoration devoid of voids.
• Freshly prepared amalgam has more desirable working properties.
The effectiveness of removing residual mercury from the
restoration is possible only if the amalgam is used within 4
minutes of trituration.
• If a larger cavity demands that the working time of the amalgam
exceeds 3-4 minutes, the use of multiple mixes will allow the
operator to handle plastic amalgam throughout the
condensation procedure and ensure building a homogenous
restoration.
• There are limits to the removal of mercury also. Certain amount of
mercury is necessary to bind the mass together in a
homogenous form. Elimination of mercury by excessive
squeezing may induces a laminated effect and seriously
reduces the strength of the restoration. The end result is similar
to working with a partially crystallized or set amalgam. The
critical reduction of mercury levels below 55% is however
obtained during packing.
• Condensation can be carried out either manually or mechanically.
Condensation should be done using the stepping process to
drive away any voids from the restoration.
Small increments should be design of the marginal
• ridges, the marginal continuity of the restoration all
play important roles in assuring that the tissues of
the periodontium will maintain a state of health
• Instability of a matrix results in a distorted restoration,
gross marginal excesses and an uncondensed soft
amalgam.
The cervical excesses can irritate the periodontium,
gradually and progressively destroying the
periodontium.
• Establishing a proper contacts and contours with the
help of matrices are fundamental to the successful
amalgam.
• Condensation pressure used should be adequate.
•  
• Contamination
• Contamination of the amalgam mix during trituration,
mulling and condensation, by moisture weaken
amalgam restoration especially with zinc containing
alloy. There occurs delayed expansion, which could
possibly result in marginal flaws, tarnish, pitting,
corrosion and blistering etc. Expansion may also
lead to pain.
• Finishing and polishing
• The amalgam should be finished gently.
• During finishing excess amalgam at the margins is
dressed down to thin flakes or spur like overhangs,
which can fracture from the restoration sooner or
later, leaving susceptible crevices.
• Overcarving the restoration to create normal, deep
anatomic features should be avoided. An over
carved restoration will reduce the thickness of
amalgam and increase chances of fracture.
• Amalgams that have a greater tendency for tarnish
and corrosion do not retain surface polish for a long
time.
• Failure to polish may accelerate corrosion because of
surface irregularities. Also the restoration surface is
rough promoting plaque accumulation and gingival
irritation.
• When temperatures above 65°C are generated,
mercury s released from the amalgam leading to
defective restoration.
•  

• Post-operative pain
• This may occur following an amalgam restoration because
of hyper occlusion lead to inflammation of the apical
periodontium.
• Cracks in tooth: Such cracks cause pain during chewing
because of expansion & contraction of tooth structure
with every bite.
• Galvanism not only the adjacent/antagonist dissimilar metal
restorations lead to galvanism, but in poorly condensed
silver amalgam, variation in silver concentration at
different areas of the same restoration, also leads to it.
• Delayed expansion is peculiar with zinc containing alloys
• Failure in the form of pain may occur if inadequate pulp
protection is present. Amalgam is a good conductor of
heat. If a base is not given, heat may be conducted to
the pulp resulting in its damage.
• Varnish should be routinely applied under amalgam
restorations. Failure to apply proper varnish layer can
lead to continuous leakage around the restoration. This
leakage may cause postoperative sensitivity and
amalgam blues due to penetration of corrosion products
into dentinal tubules.
• The restoration fracture may occur if the patient does not
follow the instructions properly and bites on restoration