Amalgam as a Restorative Material:

Is There Anything New?

W’illiiini \-. Yoridelis. PI1.D. ‘k

The properties of a new, dispersed-phase amalgam containing admixed indium

(Indisperse) are reviewed. Laboratory tests show that the addition of indium
significantly improves the strength and the resistance to creep and corrosion of the
amalgam, and that mercury release from the amalgam is markedly reduced. A 5-
year clinical study shows a lower frequency for marginal breakdown for Indisperse
compared to other dispersed-phase amalgam containing no admixed indium.

T he use of amalgam as a restorative material in

dentistry is so well established and commonplace,
and the literature on the subject so abundant and
DISPERSALLOY
widely disseminated, that yet another article on amal- Dispersed-phase alloys are essentially admixtures
gam would seem to be totally superfluous. For the of two alloy powders, viz.. a conventional alloy powder
practicing dentist, however, because of the very enor- approximating Blacks composition, which forms the
mity of the literature and the relatively recent explosion matrix, and a spherodized silver-28 percent copper
in the number of amalgam alloys now available on the alloy powder, which forms the dispersion phase. When
market (in a recent issue of Dental Advisor, which the powder composite is amalgamated, the silver-cop-
periodically rates amalgam alloys, 25 were listed), an per alloy spheres remain essentially intact and dis-
update on what’s new in dental amalgams is needed persed throughout the matrix. The dispersed-phase
and timely. amalgam represented a marked improvement over con-
ventional amalgam in clinical performance, particularly
HISTORICAL PERSPECTIVE with respect to corrosion4 and marginal breakdown of
restorations resulting from creepV5 which is attributed
The use of silver-base amalgam for filling cavities in to the virtual absence of the gamma 2 phase (mercury-
carious teeth dates back to the early nineteenth cen- tin compound) that is present in conventional amalgam.
tury, but the first scientific and systematic study on Mahler and co-workers have shown that corrosion and
amalgam as a restorative material in dentistry did not creep6 are directly related to the amount of gamma 2
occur until several decades later. In 1895 Black re- phase present, and that in dispersed-phase amalgam,
ported that an alloy containing 72.5 percent silver and the copper in the dispersion particles combines prefer-
27.5 percent tin, of which up to 5 percent copper could entially with the tin in the matrix to prevent the forma-
replace an equivalent amount of silver, gave the best tion of gamma 2.
clinical results. Except for minor incremental improve-
ments to Blacks original formulation, there was no INDISPERSE
significant advance in dental amalgam development
until 1962, when Youdelis and Innes reported their
investigation on a dispersed-phase amalgam Followingthe developmentof Dispersalloy,Youdelis
The commercial alloy resulting from this research directed his efforts to improving the dispersed-phase
was named Dispersalloy and was first produced and alloy, particularly with respect to reducing the release
marketed in Edmonton, Alberta, in 1963. In 1974 of environmentally hazardous and biologically toxic
Johnson & Johnson acquired worldwide rights to its mercury from the amalgam. Indium powder was se-
production and marketing, and the rapid acceptance of lected as the third admix component to the dispersed-
dispersed-phase amalgam alloy by the dental profes- phase composite alloy powder. Indium increases the
sion is now history. wetability of mercury substantially, so that less is
required to give the required plasticity for the amalgam
*Professor of Engineering Materials. University of Windsor. Windsor. when packing into the cavity.’ More importantly, indium
Ontario. Canada reduces the thermodynamic activity of mercury in
Address reprint requests to W. V. Youdelis. Ph.D.. University of Windsor. amalgam,*which decreases the release of both mercury
Windsor. Ontario. Canada N9B 3P4
0 1992 Decker Periodicals Inc. vapor and solubilized (ionic)mercury from the amalgam

61
JOURNAL OF ESTHETIC DENTISTRY VOLUME 4. NUMBER 2 March/Aprll 1992

restoration. The end result of this research led to the

development of the commercial alloy Indisperse, recog-
nized for the amalgam’s low mercury release, high 200
strength, and low creep behavior, which translates into
a higher resistance to marginal breakdown of restora-
tions.
Mercury Release
h
Cr)
The marked reduction in mercury release from
Indisperse amalgam compared to other commercial 8.
bo
amalgams is shown in Figure 1. which is data taken Y
a
from the results of a study by Powell et al.9The addition of M 100
5:
only 5 percent indium reduces mercury released in the
first 150-minute time period after trituration by 60-75
percent compared to other commercial alloys, and a 14
percent indium addition almost eliminates mercury
release. It is generally, but erroneously, assumed that
fully hardened amalgams release no mercury. The
U
0 r
release of mercury from an amalgam restoration de-
creases progressively to very low values as the amalgam
hardens: however, even in fully hardened amalgams
there is a small but flnite rate of mercury release. A unperturbed brushed
sigmficant discovery of amalgam behavior must now be
emphasized, and that is that a perturbation of the pieUre 2. Mercury vapor release from fully hardened, dis-
amalgam restoration, such as experienced when chew- persed-phase amalgams (measured 14 days after trituration).
ing or brushing teeth, markedly increases mercury

release to significantlevels. Figure 2 shows that there is

Indiloy approximately a 10-fold increase in the rate of mercury
vapor release from the fully hardened amalgams (meas-
Valiant urements taken 14 days after preparation of the amal-
gam) after a perturbation such as normal brushing.’O
Dirperralloy The dispersed-phase amalgam containing 10 percent
indium (IND 10%).however, shows one third or less
lndisp - 0% In mercury release than the amalgam containingno indium
(IND 0%). The advantage to the patient and to the
2% In environment of the reduced mercury release from
Indisperse, initially during preparation and placing of
4% In the restoration, and in the long term (from mastication
and brushing) is left to others to judge.
6% In

8% In

10% In

12% In

14% In

0 1 2 3 4 5

Hg Vapor (pug) INDISPERSE DISPERSAUOY INDISPERSE DISPERSAWY

FSgure 1. Total mercuryvapor released from dental amalgams eigurC 3. Mechanical properties of dispersed-phase amal-
during a 15O-mlnute time period, beginning 5 minutes after gams.
trituration (from Powell et d?.

62
 Amalgam as a Restorative Material

FREQUENCY
20 t in dispersed-phase amalgam results in increased
compressive strength, reduced dimensional change on
setting, and improved resistance to creep and corrosion
compared to amalgams without indium. A 5-year clini-
cal study shows dispersed-phase amalgam containing
indium has a higher resistance to marginal breakdown
of the restorations than dispersed-phase amalgams not
containing admixed indium. A significant biologic and
environmental advantage of amalgam containing ad-
mixed indium is the marked decrease in mercury
release from the restoration.
0‘
l.5 2.5
1 2
MARGINAL FRACTURE SCALE
3
REFERENCES
Black GV. Physical characteristics of the human teeth.
Figure 4. Frequency distribution of marginal fracture at 5 Dent Cos 1895; 37:553-571 (July),637-661 (Aug).
years. Youdelis WV. Innes DBK. Dispersion hardening of dental
amalgams. IADR (Abstr) 1962; 40:M37.
Innes DBK, Youdelis WV. Dispersion strengthened amal-
gams. J C a n Dent Assoc J 1963: 29(9):587-593.
Mechanical Properties Sarkar NK. Greener EH. Detection and estimation of y,
phase in dispersalloy by electrochemical techniques. J
and Clinical Results Dent Res 1972; 51(6):1675.
5. Mahler DB, Terkla LG. Van Eysden J. Marginal fracture vs.
The use of admixed indium in dispersed-phase mechanical properties of amalgam. J Dent Res 1970:
alloy permits a significantly higher amount of dispersed 496):1452-1457.
phase that can be used in the preparation of the Mahler DB, Adey J D , Marek M. Creep and corrosion of
amalgam restoration,’ which significantly improves the amalgam. J Dent Res 1982; 61(1):33-35.
amalgam’s mechanical properties. Johnson’ reports YoudelisWV.Effect ofindium on dispersion-type amalgam.
that Indisperse (containing 5%indium) is higher in (24 J Can Dent Assoc 1979; 2:64-66.
hr) compressive strength by 16 percent, lower in creep Hiroshi W.Optical measurement of mercury activity in an
In-Hg alloy. J p n J AppI Phys 1969; 8 1268.
(ADA flow) by 40 percent, and has a lower dimensional Powell LV, Johnson GH. Bales DJ. Effect ofadmixed indium
change on setting when compared to Dispersalloy (Fig. on mercury vapour release from dental amalgam. J Dent
3). Also, Indisperse shows the total absence of gamma Res 1989: 68(8): 1231-1233.
2 phase. The low creep rate of Indisperse is particularly 10. Youdelis WV.Indium in dispersed phase amalgams-effect
significant, since marginal breakdown of restorations is on properties and mercury vapour release. In: Exner HE,
directly related to creep rate.5 Schumacher V, eds. Advanced materials and processes.
The ultimate test of any product is performance, Oberursel.Germany: DGM Informationagesellschaft, Verlag.
1989: 2:785-790.
which means clinical performance for amalgams. Be- 11. Johnson GH. A laboratory evaluation of two new dental
fore clinical testing, the nontoxicity of amalgams con- amalgam alloys. lADR FYog & Abstr 1985; 64:Microfilmed
taining indium was established. Biologic tests con- Paper 92 1 of the Dental Materials Group.
ducted by Faucher et all2 showed dispersed-phase 12. Faucher RR. Townsend J D , Hamilton AI. Histologic evalu-
amalgam containing 10 percent admixed indium was ation of subcutaneous implants of an indium-containing
no more cytotoxic or hemolytic, nor did it induce any amalgam. AADR h o g & Abstr, 1983; 62: Microfilmed Paper
greater tissue reaction than standard A.D.A. certified 473 of the Dental Materials Group.
alloys. A 5-year clinical study by Johnson et d,13in 13. Johnson GH. Bales DJ. Powell LV. Effect of admixed indium
which a total of 25 subjects were treated with a total of on the clinical success of amalgam alloys. IADR Prog &
Abstr. 1991; 69: Microfilmed Paper 622 of the Dental
172 Indisperse and Dispersalloy restorations, showed
Materials Group.
Indisperse to have a sigmfkantly lower frequency for
marginal breakdown than Dispersalloy (Fig. 4).

SUMMARY
Laboratory and clinical studies have shown that
admixed indium sigmflcantly improves the properties
of dental amalgam. m e incorporationof admixed indium

63