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Bonded amalgams and their use in clinical practice

From Volume 38, Issue 4, May 2011 | Pages 222-230

Authors

Stephen J Bonsor

BDS(Hons) MSc FHEA FDS RCPS(Glasg) FDFTEd FCGDent GDP

The Dental Practice, 21 Rubislaw Terrace, Aberdeen; Hon Senior Clinical Lecturer, Institute of Dentistry, University of Aberdeen; Online Tutor/Clinical Lecturer, University of Edinburgh, UK.

Articles by Stephen J Bonsor

Abstract

There has been a move in recent years for operative dentists to use the benefits of adhesive technology when placing dental amalgam restorations. This paper describes the potential advantages of the bonded amalgam technique. These benefits include decreased microleakage between the cavity wall and the restorative material. This, in turn, may decrease post-operative sensitivity, pulpal inflammation and the incidence of recurrent caries. Extra retention for the restoration may also be provided and the need for cavities to rely on traditional retention and resistance form may be decreased or even eliminated, thus conserving precious tooth tissue. If the restoration is bonded then flexure during function in teeth may be decreased and, in the case of teeth exhibiting a cracked cusp, this may alleviate or eliminate symptoms. Bonding may also provide support to weakened tooth tissue which otherwise would have to be removed, so rendering cavities more conservative, and may increase the fracture resistance of the tooth. Clinical examples are included to illustrate some of these benefits.

Clinical Relevance: The use of adhesives to bond amalgam to tooth tissue offers potential advantages, although some of the current evidence is equivocal about their routine use.

Article

Dental amalgam is a mixture of a silver alloy with mercury.1 It has been used in dentistry since the 1800s2 and, through scientific investigation, the composition of the constituents of the alloy have been refined to produce a material with today's optimized clinical handling and performance. Traditional amalgam alloys suffered from a lack of strength, exhibited flow and creep and were susceptible to corrosion owing to the presence of the γ2, tin-mercury phase.2 Furthermore, amalgam on its own does not bond to tooth structure and cannot provide a complete seal or be retained in the tooth without some form of mechanical retention, such as undercuts.3 More recently, attempts have been made to reduce or even eliminate the γ2 phase by increasing the copper content in the alloy to above 13%.4 This modification of the setting reaction has resulted in some important changes in the properties of the amalgam, namely:

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