1. NAME:ZAIN AYUBCLASS:FINAL YEAR BDSROLL NO:312PRESENTATION TOPIC:COMPLEX AMALGAM RESTORATION

2. COMPLEX AMALGAM RESTORATION Complex amalgam restoration refers to one that involves three or more surfaces of the tooth. In recent years refer to an amalgam restoration that replaces one or more cusps.

3. INDICATIONS They are used: To replace missing tooth structure due to fracture or caries or existing restorative material. When one or more cusps needs capping. When increased resistance and retention forms are needed.

4. INDICATIONS Used as an alternative to indirect restoration. For periodontal and orthodontic patients. Affordability. For old patients Used in tooth that have questionable pulpal prognosis. Can act as a foundation for crown.

5. If conventional retention features are not adequate pins, slots and bonded amalgam are used to enhance retention. As more tooth is lost more auxiliary retentive features required.

6. CONTRAINDICATIONS If patient has occlusal problems. If the tooth cannot be restored properly with direct restoration because of anatomic or functional considerations. If the area to be restored is esthetically important to the patient.

7. ADVANTAGES Conserves tooth structure.(less cutting) Less time required. Resistance and retentive forms significantly increased by pins and slots. Economics.

8. Disadvantages Dentinal micro fractures. Microleakage. Decreased tensile strength of amalgam. Penetration and perforation. Tooth anatomy cannot be replicated like that in indirect restoration.

9. PERFORATION

10. RETENTION AND RESISTANCE FORM Non pin mechanical features Pins Amalgam bonding

11. NON PIN MECHANICAL FEATURES Parallel or convergent walls. Box form. Flat pulpal and gingival floors. Grooves in proximal line angles. Dovetails. Reduction of undermined cusps. Coves/locks. Amalgapins. Slots.

16. PIN 3 types of pins: 1.Self threading pins. 2.Friction locked pins. 3.Cemented pins.

18. PRINCIPALS FOR PLACEMENT OF PINS Pinhole made the diameter of pinhole smaller then diameter of the pin being placed in threaded and friction locked. Craze lines created in dentine (the more the diameter of the pin the more the dentinal craze lines). Depth of the varies from 1.3 to 2 mm depending on the diameter of pin used. Used in addition to non pin retentive features.

19. SELF THREADING PINS Self threading pins commonly used cause of its retentiveness. TMS system used (thread mate system). Threads engages the dentine as it is inserted into the dentine due to elasticity of dentine.

21. FACTORS AFFECTING RETENTION OF THE PIN IN DENTIN AND AMALGAM Type Surface characteristics. Orientation number and diameter. Extension into the dentin and amalgam.

22. TYPE Self threading are the most retentive followed by friction locked and then cemented.

23. SURFACE CHARACTERISTICS The number and dept of elevations (serrations or threads)on the pin influence retention of the pin in the amalgam restoration.

24. ORIENTATION Should be placed in non parallel fashion to increase retentiveness. Bending pins in amalgam is not desirable if bending of the pin is done it should be done with a proper tool and at least 1mm of bulk of amalgam should be there between the pin and external surface of the finished restoration.

26. NUMBER As the number of pins increases the retention in dentin and amalgam increases but the problems created also increases. Chances of 1.Crazing of dentin increases. 2.The amount of available dentin between the pins decreases. 3.The strength of amalgam restoration decreases. Increasing the diameter also increases retention.

27. EXTENSION INTO THE DENTIN AND AMALGAM Pin extension into the dentin and amalgam greater then 2mm is unnecessary for pin retention and is contraindicated to preserve the strength of the dentin and the amalgam. If more the 2mm amalgam or dentin is involved the chances of fracturing of pin increases.

28. PIN PLACEMENT FACTORS AND TECHNIQUES 1.Pin size. 2.Number of pins. 3.location. 4.Pinhole preparation. 5.Pin design. 6.Pin insertion.

29. PIN SIZE Minikin and minim pins are used for severely involved posterior teeth. Minim pins used as a backup if the pinhole is overprepared.

30. NUMBER OF PINS Factors considered when deciding how many pins are required 1.The amount of missing tooth structure. 2.The amount of dentin available to receive pins safely. 3.The amount of retention required. 4.The size of the pins. As a rule, one pin per missing axial line angle should be used.

31. LOCATION Several factors aid in determining pin hole location: 1.Knowledge of the normal pulp anatomy and external tooth contours. 2.A current radiograph of the tooth. 3.A periodontal probe. 4.The patient`s age.

32. LOCATION Pins should not be placed directly under areas of contact with the opposing teeth as the restoration would fracture under the occlusal load. Occlusal clearance should be sufficient to provide 2mm of amalgam over the pin. Pinhole should be positioned no closer than 0.5 to 1mm to the DEJ or no closer than 1 to 1.5mm to the external surface of the tooth. Pinhole should not be positioned very close to vertical wall as it would make condensation of amalgam difficult. Interpin distance should be more for a pin with larger diameter.

34. PIN PLACED CLOSE TO THE VERTICAL WALL

35. PINHOLE PREPARATION(STEP 1)

36. TWIST DRILLS FOR DRILLING A PINHOLE

38. PIN INSERTION Can be done with conventional latch type contra angle hand piece or TMS hand wrenches.

39. PIN INSERTION

40. CEMENTED PINHOLE

41. BONDED AMALGAM RESTORATION Amalgam hydrophobic while dentine and enamel is hydrophilic. 4 meta based resin is used which has hydro philic and hydrophobic ends

44. REFERENCES Principles of operative dentistry By A. J. E. Qualtrough, Julian Satterthwaite, Leean Morrow, Paul Brunton. Lecture by barra eigbynia. Art and science of operative dentistry. Management of broken down teeth by doctor nasrien ateyah.