1. RESTORATIVE MATERIALS
DA 130 Dental Materials and Anatomy and
Physiology

2. HISTORY OF DENTAL AMALGAM
 Has been in use for over 150 years in dentistry
 “Amalgam” actually means a mixture of metals
 Consists of Mercury: Alloy
 Alloy made up of varying percentages of silver, tin,
copper and zinc
 Percentages of alloy and mercury were once
mixed by the hand of the dental assistant
 Research soon discovered that mercury was a
hazardous material, so standards of handling were
developed

3. WHEN DO WE USE DENTAL
AMALGAM?
 Dental amalgam is still considered a safe and
effective means to restore a tooth
 Amalgam is often used for:
 Primary and permanent teeth
 For stress bearing areas of the mouth (usually
posterior)
 For areas where moisture contamination is not a
concern
 For cost purposes
 When aesthetics is not a concern

4. MERCURY HAZARDS?
 Although dental amalgam contains mercury,
when it is mixed with the alloy, the chemical
composition changes, and it becomes harmless
 Mercury on it’s own is liquid metal, and
considered hazardous
 Premeasured capsules prevent dental personnel from
handling mercury in it’s liquid state

5. HOW TO HANDLE DENTAL
AMALGAM
 There is still a risk to healthcare workers
regarding dental amalgam; therefore:
 We use PPE when handling
 We use premeasured capsules
 We make sure we close the door of the triturator
when mixing amalgam
 Always use the suction during application to prevent
patient aspiration, which could lead to potential
toxicity
 Have a mercury spill kit handy if a spill should occur,
do not vacuum up!
 Have an amalgam scraps container to place excess
amalgam, do not throw in garbage!

6. TRITURATOR AKA AN
AMALGAMATOR

7. WHEN TO USE CAUTION WITH
DENTAL AMALGAM:
 When mixing the dental amalgam
 Mercury vapors will be released
 Keep door to triturator closed during mixing
 When handling amalgam
 Use a no-touch technique (even with gloves on)
 Use instruments to pass material, never touch with bare
hands!
 When restoring a tooth with an existing amalgam
restoration
 Be sure to use your PPE, vapors are given off when
handpiece is in use
 When cleaning amalgam after completion of
procedure
 Place in a amalgam scraps container
 A container with a tight lid and keep either dry or with a small
amount of radiographic fixer

8. ADDITIONAL PRECAUTIONS:
 Do not sterilize extracted teeth with amalgam
restorations
 Waste haulers will remove for a fee
 Replace amalgam traps at regular intervals
 Use a mercury spill kit if you have scraps or loose
mercury

9. AMALGAM ARMAMENTARIUM
 Basic set-up (mirror, explorer and college pliers)
 Spoon excavator
 Tofflemire and wedges (if needed)
 Amalgam carrier
 Amalgam well
 Condenser or plugger
 Carvers
 Hollenback
 Cleoid/Discoid
 Burnishers
 Acorn / Ball
 Articulating paper forceps
 Triturator

10. PROCEDURE STEPS:
 Patient is given local anesthesia
 Tooth is prepared – with a high speed and low
speed handpiece
 Tofflemire is placed – if there is interproximal
involvement)
 Medicaments placed (if necessary) – bases or
liners
 Amalgam is mixed – with triturator
 Amalgam is packed – into a
carrier

11. PROCEDURE STEPS:
 Amalgam is transferred – into the tooth
 Amalgam is condensed – using condenser
 Anatomy is carved – into amalgam with hollenback and
cleoid/discoid
 Tofflemire is removed
 Restoration is smoothed – using burnishers
 Tooth height is checked – using articulating paper
 Adjustments may be
necessary – return back to
carvers and burnishers
 Give patient post-operative
instructions

12. COMPOSITE RESTORATIVE
PROCEDURE:
 Composite has been the restorative material of
choice for some time now
 The growing concern of the public in regards to
the safety of dental amalgam created the demand
for high strength, aesthetically pleasing
composite resin

13. COMPOSITION OF COMPOSITE
RESINS:
 Resin matrix:
 Dimethacrylate aka BIS-GMA: a fluid monomer (liquid)
 Fillers: quartz and silica (minerals and crystal
compounds)
 Macrofilled: larger particles found in resin, known for high
strength
 Microfilled: smaller particles in resin, known for aesthetic
qualities and ability to polish
 Hybrid: most commonly used today, provide high strength and
aesthetically pleasing results
 Flowable: used in a syringe, this variation of composite is used for
it’s flowable consistency
 Dentist’s will often use this to place on floor of preparation
 Sealant composites: similar to flowable, but consistency is even
thinner to allow flow into pits and fissures of occlusal surfaces

14. THE RIGHT SHADE:
 Critical to creating a cosmetic final result
 Use a universal shade guide
 Unless a lab provides the office with a separate one
 Take shade in natural light
 Turn dental light off
 Use a hand mirror, and have patient approve
shade prior to use
 Documentation of approval and selected shade is also
necessary

15. TECHNIQUE SENSITIVE:
 Composite is affected by a number of factors,
many of which the dental assistant can control:
 Moisture contamination
 Saliva
 Light sensitive
 Composite will begin to set if exposed to any light
 Considerations for use with other materials
 Certain dental materials cannot be used with composite:
 Eugenol based medicaments
 Fluoride treatments
 Dental sealers (varnish)

16. MEANS OF ISOLATION:

17. ETCH AND BONDING AGENTS
 Composite fillings are not created with
mechanical retention, chemical retention is
necessary
 Acid etch – phosphoric acid
 Used to open enamel rods and dentin tubules
 Similar to sandpaper on wood
 Tooth should appear chalky white when properly
done.
 Primer is used to condition tooth and aids in
bonding
 Bonding agent unifies the tooth and material

18. MICROSCOPIC IMAGES OF ENAMEL
RODS
 Before etching  After etching

19. MICROSCOPIC IMAGES OF DENTIN
TUBULES
 Dentin and nerve
tissue
 Enamel and dentinal
tissue

20. ARMAMENTARIUM:
 Basic set-up
 Spoon excavator
 Plastics instrument
 Condenser
 Burnisher
 Articulating paper forceps
 Matrix strips
 Composite/dispensing unit
 Acid etch
 Prime and Bond system
 Curing light

21. PROCEDURE STEPS:
 Dentist administer local anesthesia to the
patient
 Shade is taken
 Always prior to preparation
 Tooth is prepared – with dental handpieces
 Tooth is isolated – meaning, protecting the
tooth from moisture and contaminants
 Cotton rolls, dri-angles and rubber dam are indicated
 Acid-etch is placed – creates porosities on the
tooth surface
 Usually for 20-40 seconds
 Thoroughly rinse for 20 seconds
 Replace wet cotton rolls

22. ETCH FIRST, THEN APPLY BONDING
AGENTS

23. PROCEDURE STEPS
 Dry tooth
 Place primer – conditions tooth to receive bond
 Dry tooth
 Place bonding agent – allows for unification of tooth and
composite material
 Cure
 With light for 20 seconds
 Place composite material
 Flowable first on floor of prep
 Hybrid placed in layers and cured in increments
 Final details are created
 Final cure – 40-60 seconds

24. FINAL STEPS
 After completion of the procedure, the dentist
will check the occlusion (how the patient bites)
 Once optimal occlusion is achieved, the dentist
will polish the restoration