core build up and amalgam bonding 12 th october. learning outcomes to know the definition of a core...
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Core build up and Amalgam bonding
12th October
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Learning outcomes To know the definition of a core build
up. To understand the advantages and
disadvantages of amalgam as a restorative material
To understand the aims of amalgam bonding
To know the clinical stages to perform a bonded amalgam
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Core Definition
'that part of a preparation for an indirect restoration consisting of restorative material'.
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Types of Core Materials
Amalgam Composite Glass Ionomer Resin Reinforced Glass Ionomer Compomer
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AMALGAM
Advantages
Not especially technique sensitive Strong in bulk section Sealed by corrosion products
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Disadvantages
Best left to set for 24 hours before tooth preparation
Weak in thin section Mercury content may be of concern to some
patients and dentists Potential electrolytic action between core and
metal crown Not intrinsically adhesive
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How is the amalgam retained as the core?
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Retention Form
Resistance Form
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How is the amalgam retained as the core?
Mechanical Retentive grooves and notches
Pin Placement Adhesion
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Amalgam BondingA technique to bond amalgam to the cavity.
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Aims Behind ‘Bonded Amalgams’ Conserve more tooth structure by
reducing the need to remove sound tooth tissue for mechanical retention.
Increased Amalgam retention. Reduce marginal leakage Reduce the need for dentine pins. Potentially reduce sensitivity Improve fracture resistance Improved amalgam margins
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Materials for Amalgam Bonding
Resin Cements ( Panavia) Adhesive Bonding Agents
-initially designed for composites
-OptiBond solo-Amalgambond-Scotchbond multipurpose
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OptiBond solo
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How do they work?
Etching dentine opens up dentinal tubules enabling adhesive resin to flow into dentine and is retained micromechanically
Adhesive resin adheres to amalgam roughness micromechanically and by 4-META adhesive
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Claimed Advantages of Amalgam Bonding Techniques
Decreased microleakage YES
Increased amalgam retention YES, if cavity lacks mechanical
retention Avoids risk of using pins
YES, 20% of pins perforate, 80oC rise
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Claimed Advantages of Amalgam Bonding Techniques
Improved amalgam margins Depends on adhesive used. Panavia
weakens amalgam at margins Technique may reduce incidence of
ditching Tooth reinforcement
YES, if large cavity NO, if small cavity
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Clinical Indications Not recommended for routine amalgam
cavities with sufficient mechanical retention and undercuts. No evidence of increased benefit to balance increased costs.
Useful for large multisurface amalgams to avoid use of pins
Useful for amalgam repairs Some easier to use than others
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Bonding Agents Technique Place matrix band ( lightly vaselined) Etch 10% phosphoric acid Wash and dry Apply adhesive ( Kerr Optibond solo) Blow off excess solvent Light cure Pack amalgam
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Limitations of Technique
Increased cost of restoration Technique sensitive? Not in use long enough to permit
adequate evaluation of clinical performance
Adhesion may breakdown over time
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Amalgam Bonding
Summary Amalgam is an excellent core build-up
material for posterior teeth Excellent interim restoration for posterior
teeth Adhesives can be used to improve
retention in large amalgam restorations and cores
Adhesives and preparation features can often substitute for pin retention for cores
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References R. W. Wassell, E. R. Smart G. St. George. Crowns
and other extra-coronal restorations: Cores for teeth with vital pulps. BDJ 2002 May,192(9): 499-509
Setcos J.C, Staninec M, Wilson N.H.FThe development of resin-bonding for amalgam restorations. BDJ 1999 Apr, Vol186 (7): 328-330
Staninec M, Setcos Bonded amalgam restorations: current research
and clinical procedure.Dent Update. 2003 Oct;30(8):430-4, 436