Clinical Techniques For

Amalgam restorations class 3 & Others

Presentation By: Harshita
 Introduction
01.
About Amalgam Restoration

Class III

Agenda 02. About Class III Restoration Techniques

Class IV
03. About Class IV Restoration Techniques

04. Conclusion
01. INTRODUCTION
• Dental amalgam is a metal-like restorative material composed of a mixture of
silver-tin-copper alloy and mercury.

• Initially, amalgam restorations were made by dentists filing silver coins and
mixing the filings with mercury, creating a putty-like mass that was placed into
the defective tooth. As knowledge increased and research intensified, major
advancements in the formulation and use of amalgam occurred

• During the past 20 years, the number of amalgam restorations has decreased by
approximately 60% in the United States.' Concerns about the use of amalgam
restorations relate to poor esthetics, weakening of the tooth by removal of more
tooth structure, recurrent caries, and lack of adhesive bonding benefits (unless
the amalgam restoration is bonded).

• Amalgam restorations are still well suited for restoring many defects in teeth.

• The ability to restore a tooth in a reasonably simple and economical manner has
resulted in the continued use of amalgam by many U.S. dentists, even though
most dentists have also increased their use of composite
01. AMALGAM RESTORATIONS

• Amalgam functions as a direct restorative

material by easily being inserted into a tooth
preparation and, once hardened, restoring the
tooth to proper form and function.

• Amalgam restorations may be bonded or

nonbonded. Nonbonded amalgam restorations
are still predominantly used, even though more
bonded amalgam restorations are now being
done.

• Both nonbonded and bonded amalgam

restorations require a specific tooth
preparation form into which the amalgam
material is inserted.

• The tooth preparation form must not only

remove the fault in the tooth and remove
weakened tooth structure, but it also must be
formed to allow the amalgam material to
function properly.
02.
CLASS III
AMALGAM RESTORATION
02. CLASS III AMALGAM RESTORATION
INDICATIONS:

It is generally reserved for the distal surface of maxillary and mandibular canines if:
• the preparation is extensive with only minimal facial involvement,
• the gingival margin involves primarily cementum, or
• moisture control is difficult.

For esthetic reasons, amalgam is rarely indicated for the proximal surfaces of incisors and the
mesial surface of canines.
02. Initial Tooth Preparation
• Usually, a No. 2 bur is used for the entry cut on the
distolingual marginal ridge.

• However, a No. 1/2 or No. 1 bur should be used when

the tooth or carious lesion is small.

• The bur is positioned so that the entry cut will

penetrate into the carious lesion, which is usually
gingival to the contact area.

• Ideally the bur is positioned so that its long axis is

perpendicular to the lingual surface of the tooth but
directed at a mesial angle as close to the adjacent
tooth as possible. This conserves the marginal ridge
enamel.
02. Initial Tooth Preparation
• In addition, penetration should be at a limited initial
axial depth (i.e., 0.5 to 0.6 mm) inside the DEJ or at
a 0.75- to 0.8- mm axial depth when the gingival
margin will be on the root surface (in cementum)

• This 0.75- mm axial depth on the root surface will

allow a 0.25 mm distance (the diameter of the No.
1/4 bur is 0.5 mm) between the retention groove
(which will be placed later) and the gingival
cavosurface margin.

• Infected dentin that is deeper than this limited initial

axial depth is removed later during final tooth
preparation.

• For a small lesion, the facial margin is extended 0.2

to 0.3 mm into the facial embrasure (if necessary),
with a curved outline from the incisal to the gingival
margin (resulting in a less visible margin).
02. Initial Tooth Preparation
• The lingual outline blends with the incisal and gingival margins in a smooth curve, creating
a preparation with little or no lingual wall.

• The cavosurface angle should be 90 degrees at all margins. The facial, incisal, and gingival
walls should meet the axial wall at approximately right angles (although the lingual wall
meets the axial wall at an obtuse angle or may be continuous with the axial wall)

• If a large, round bur is used, the internal angles will be more rounded.
02. Initial Tooth Preparation
• Incisal extension to remove carious tooth structure may eliminate the proximal contact.
When possible, it is best to leave the incisal margin in contact with the adjacent tooth.

Distofacial ( A) and incisal ( B) views of canine to show

curved proximal outline necessary to preserve distoincisal
corner of tooth. Incisal margin of this preparation example
is located slightly incisally of proximal contact
02. Initial Tooth Preparation
• Complete the initial tooth preparation by using a No. 1/2 bur to accentuate the axial line
angles, particularly the axiogingival angle.

• Rounded internal preparation angles reduce stress concentration in the tooth, thereby
reducing the potential of restoration fracture.

• The No. 1/2 bur may also be used to smooth any roughened, undermined enamel produced
at the gingival and facial cavosurface margins
02. Final Tooth Preparation
Prepare the gingival retention groove by placing a No. 1/4 bur (rotating at low speed) in
the axiofaciogingival point angle.

It is positioned in the dentin to maintain 0.2 mm of dentin between the groove and the DEJ.

Move the bur lingually along the axiogingival line angle, with the angle of cutting generally
bisecting the angle between the gingival and axial walls.

Ideally, the direction of the gingival groove is slightly more gingival than axial
02. Final Tooth Preparation
• If less retention form is needed, two gingival coves may be used

• One each may be placed in the axiogingivofacial and axiogingivolingual point angles.

• Prepare an incisal retention cove at the axiofacioincisal point angle with a No. 1/4, bur in
dentin, being careful not to undermine the enamel.

• It is directed similarly into the incisal point angle and prepared to 1/2 the diameter of bur

A, Position of No. 1/4 bur in axioincisal point angle.

B, Completed incisal cove.
02. Final Tooth Preparation
A lingual dovetail is not required in small or moderately sized Class III amalgam
restorations. It may be used in large preparations, especially those with excessive incisal
extension in which additional retention form is needed.

However, the dovetail may not be necessary (even in large preparations) if incisal
secondary retention form can be judiciously and effectively accomplished

The lingual dovetail should be conservative, generally not extending beyond the
mesiodistal midpoint of the lingual surface.

The gingival margin trimmer may be used to bevel (or round) the axiopulpal line angle

The lingual convergence of the dovetail's external walls (prepared with the No. 245 bur)
usually provides sufficient retention form.
02. Final Tooth Preparation

Initial cut in beginning Bur moved to most Incisal and gingival

dovetail Completed lingual
mesial extent of extensions of dovetail
dovetail.
dovetail
02. Final Tooth Preparation
However, retention coves, one in the incisal corner and one in the gingival
corner, may be placed in the dovetail with a No. 33 1/2 bur to enhance
retention if the axial wall of the dovetail is in dentin.

Remove any unsupported enamel, smooth enamel walls and margins, and
refine the cavosurface angles

The hoe is recommended for finishing minimally extended margins

If the gingival margin is in enamel, a slight bevel (approx 20 degrees) is

necessary to ensure full-length enamel rods forming the cavosurface
margin.

All the walls of the preparation should meet the external tooth surface to
form a right angle

The completed tooth preparation should be carefully inspected and cleaned

before restoration.
02. CLASS III PREPARATION IN MANDIBULAR INCISOR
The use of a Class III amalgam restoration for a mandibular incisor is rare.
Amalgam can be used for mandibular incisors if:
• access and visibility are limited,
• the gingival margin in primarily in cementum, and
• moisture control is difficult.

To prepare the outline form, enter the tooth from the lingual, when possible, or facial,
when necessary. The choice of lingual or facial approach depends on the position of the
tooth, the location of the carious lesion, and esthetics.

The initial and final tooth preparation technique is the same as described previously for
the distal surface of a maxillary canine.
02. Final Tooth Preparation

Entering tooth from Finishing facial, Placing incisal and Position of bibeveled Completed tooth
lingual approach. incisal, and gingival gingival retention hatchet 3-2-28 to place preparation with
enamel margins with forms with No. ¼ bur incisal retention cove retention groove.
an 8-3-22 triple angle
hoe
02.
CLASS IV
AMALGAM RESTORATION
02. CLASS IV AMALGAM RESTORATION
• Access is gained through incisal or inciso- lingual
direction

• Access is facilitated by removing undermined

enamel using chisel

• Preliminary preparation of the cavity done by No.

169 bur

• Using apical pressure and faciolingual dragging,

prepare gingival, labial, lingual and axial walls

• Gingival grooves prepared as described in Class III

• Facial and lingual grooves in prepared using ¼

round, 168 or 33 ¼ bur, as described in the
conservative cavity design of Class II
Thank You !
Sources
• https://codental.uobaghdad.edu.iq/wp-content/uploads/sites/14/2019/09/LEC-6-CL-III.pdf

• https://www.researchgate.net/figure/Stylization-of-the-occlusion-maps-using-the-Y-technique-for-posterio
r-teeth-Left-The_fig1_365795046