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Complex Amalgam Restorations Guide

This document discusses complex amalgam restorations, which are used to restore missing tooth structure from caries, fractures, or replacing existing restorations. They provide increased retention and resistance forms compared to simple amalgam restorations. Complex amalgams use retentive features like slots, locks, coves, or cusp coverage to compensate for lost tooth structure. They may also use crown lengthening, pins, or bonded amalgam systems. While they conserve more tooth structure than indirect restorations and require only single appointments, complex amalgams can be more difficult to achieve normal tooth anatomy and resistance forms with. The document describes the various retentive features and types of pins used in complex amalgam restorations.

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Samridhi Srivastava
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48 views4 pages

Complex Amalgam Restorations Guide

This document discusses complex amalgam restorations, which are used to restore missing tooth structure from caries, fractures, or replacing existing restorations. They provide increased retention and resistance forms compared to simple amalgam restorations. Complex amalgams use retentive features like slots, locks, coves, or cusp coverage to compensate for lost tooth structure. They may also use crown lengthening, pins, or bonded amalgam systems. While they conserve more tooth structure than indirect restorations and require only single appointments, complex amalgams can be more difficult to achieve normal tooth anatomy and resistance forms with. The document describes the various retentive features and types of pins used in complex amalgam restorations.

Uploaded by

Samridhi Srivastava
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

COMPLEX AMALGAM RESTORATIONS

1. INDICATIONS
a. Tooth structure is missing d/t cusp fracture,
b. Severe caries (2 or more tooth surfaces missing),
c. More retention and resistance forms needed or
d. Replacement of existing restorative material is necessary.
e. Thus complex amalgams may be used as-
i. Definitive/ final rest
ii. Foundation rest.
iii. Control rests for teeth with questionable pulpal or periodontal
prognosis
1. To protect pulp from oral cavity
2. Provide anatomic contour that is consistent with gingival
health
3. Control acidogenic biofilm and resultant caries risk
4. Resist tooth fractures.
iv. Interim restoration.
2. CONTRAINDICATIONS
a. If direct rest needed d/t anatomic or functional considerations or both.
b. Esthetics.
3. To compensate the lost tooth structure, one of the following retentive features
should be used
a. Slots
b. Locks
c. Coves
d. Cusp coverage copmplex amalgams
e. Crown lengthening
f. Pins
g. Amalgampin
h. Bonded amalgam system
4. ADVANTAGES
a. Conservation of tooth structure- more conservative than indirect rest.
b. Appointment time- single appointments.
c. Inc resistance and retention
d. Reduced cost
5. DISADVANTAGES
a. Tooth anatomy- normal type difficult to achieve
b. Resistance form more difficult to achieve
6. SLOTS
a. Def- horizontal retetntive grooves in dentin
b. Placed in gingival floor of a prep with no 330 bur
c. 1 mm wide, 2-4 mm deep.
d. Position- 0.5-1 mm inside DEJ
7. LOCKS
a. Def- vertical retentive grooves in direct rests
b. Extend upto the pulpal floor along axiolingual or axiofacial line angle.
8. COVES
a. Small horizontal grooves prepared using the 1/4 bur.
9. CUSP COVERAGE
a. indications
i. Extensive caries
ii. Facial or lingual extension exceeds 2-3rds the distance from
primary fiussure towards cusp tip.
b. Procedure- reduce damaged cusp and cover with rest.
c. Final objective- to ensure that final rest has restored cusps with minimal
thickness of 2 mm oif amalgam for functional cusps and 1.5 mm for non-
functional cusps.
10. CROWN LENGTHENING
a. In moderate to severe tooth loss
b. Lengthening of clinical crown by electrosurgery.
11. PINS
a. If all above features fail, pin supported rests used
b. Def- any rest which requires placement of pins in dentin in order to
provide sufficient retention and resistance form to the rest.
c. INDICATIONS
i. Badly broken down or mutilated teeth - loss of 4 mm or more
vertical heiught.
ii. Controlled rests
iii. As foundation rest
iv. Economics
v. Age and health of patient
d. CONTRAINDICATIONS
i. Occlusal problems
ii. Ant teeth - esthetics
iii. In class V horizontal groove in gingival and occlusal aspects, d/t
difficulties in accessing these areas.
e. Advantages- common
f. Disadva
i. Dentinal micro-fracture or crazing - max with self-retained pins
ii. Microleakage around pins
iii. Decreased strength of amalgam
iv. Perforation of pulp or ext tooth structure.
g. TYPES OF PARAPULPAL RETENTION PINS - based on material
i. INDIRECT/ parallel pins - cast gold/ wrought metal
ii. DIRECT / NONPARALLEL - stainless steel, silver, titanium etc.

8. TYPES OF PARAPULPAL RETENTION PINS - based on mechanism


Feature Cemented pins Friction locked Self-threading pins
pins
Aka Markley pins Tapping pins 

Given by Markley, 1958 Goldstein, 1966 Going, 1966


Pinhole 0.025-0.05 mm 0.025 mm 0.03-0.10 mm smaller than
diameter more than dia smaller than pin pin
of pin
Retentive Least 2-3 times more 3-6 times more than
ability than cemented cemented pins
pins
Mechanism Any luting agent Pins tapped into Threads engage dentin,
used to cement place, retained ratined by ellastic dentin.
pin in hole by resilient Gold plated hence no
dentin. corrosion.
Example Thread mate system (TMS)
- MC
o Types of pin size - minuta, minikin, minim, regular pins.
o Factors affecting retention of pins
 Pin type - self threading > friction > cemented
 Surface characteristics- no. and depth of elevations
 Pin number- one pin per missing cusp.
 Pin dia - within limits, inc in dia helps in retention.
o Pin orientation - nonparallel pins- more retentive
o Pin shape- - retentive cleats, square or pear shaped heads on pins- more
retentive

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