Amalgam tips?

[Faux]

Just looking for some general tips/suggestions regarding amalgams?


I guess my main concerns are smoothness and subtle catches in the restoration. I'm using the ball burnisher, but perhaps I'm not using it long/hard enough?

Any tips would be great. Would getting an extremely small paint brush help with that?

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[distressstudent]

ball burnisher would only work at the margins. that alone wouldn't be good enough. packing with acorn carver and then using hollenbeck. then smooth out with a wet cotton esp for class fives

catches as in extra material or pockets in the restoration?

 

[Faux]

ball burnisher would only work at the margins. that alone wouldn't be good enough. packing with acorn carver and then using hollenbeck. then smooth out with a wet cotton esp for class fives

catches as in extra material or pockets in the restoration?

Pits between amalgam and enamel. I feel I'm packing enough and using the ball burnisher enough, but obviously the results aren't showing that. Perhaps I'm not working fast enough? Is there a lotted time for ball burnishing, carving, ect?

Do you ball burnish after wet cotton?

 

[dyesht]

ball burnisher would only work at the margins. that alone wouldn't be good enough. packing with acorn carver and then using hollenbeck. then smooth out with a wet cotton esp for class fives

catches as in extra material or pockets in the restoration?

You can't really polish immediately after right, like with composite?

 

[THS]

You can't really polish immediately after right, like with composite?

Not supposed to, since the patient is numb and the heat generated from polishing could transfer through the very conductive amalgam and kill their pulp without them realizing.
You need them to feel when it gets hot so they can tell you when to slow down and irrigate.

 

[bigbadvorlon]

The pitting between the enamel and restoration i.e. Cavosurface margin is typically due to poor condensing or packing technique. Pretty well all problems from amalgam placement aside from saliva contamination and band/wedge issues, stem from poor condensing. If you have problems with chipping or fracturing during carving and finishing, it is due to poor condensing. Always slowly pack the base layer with smallest condenser. Large condenser can be use to spread initial aliquot of amalgam and do initial pack but must be followed by thorough pack down by small condenser. Continue until filled but still use small condenser to densely pack at cavosurface margin. Once you figure this out amalgams are easy!


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[Faux]

The pitting between the enamel and restoration i.e. Cavosurface margin is typically due to poor condensing or packing technique. Pretty well all problems from amalgam placement aside from saliva contamination and band/wedge issues, stem from poor condensing. If you have problems with chipping or fracturing during carving and finishing, it is due to poor condensing. Always slowly pack the base layer with smallest condenser. Large condenser can be use to spread initial aliquot of amalgam and do initial pack but must be followed by thorough pack down by small condenser. Continue until filled but still use small condenser to densely pack at cavosurface margin. Once you figure this out amalgams are easy!


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thank you very much for the input!
what about the ball burnishers ?

i have two instruments. one is two sided ball burnisher, one large and one small


and another instrument, that has an even smaller ball burnisher on it.

 

[UCSFx2017]

I think you're having trouble with condensing the amalgam. The trick should be to overpack at least 1 mm above the matrix band. You need to put enough force with the condenser that your hand should feel fatigued. Start with the small end condenser and end with the largest one.

Here's what I do when carving:
(1) I set the amalgamator to create a soft consistency in my amalgam. Not hard and not crumbling. This makes carving easier.
(2) I pack excessive amalgam above the matrix band. About 1 mm above the height of the adjacent crown.
(3) Acorn - The trick to using acorn instrument is to press down hard. For mandibular molars, press hard and go straight M to D to create the central groove, dividing the crown into equal B and L halves. Then press hard and move B to L to divide into even M and D halves. Move from central groove to DL. Lastly, move from central groove to DB to create DB groove. The outline should look similar to the body of a stick figure man.
(3) Walls Carver - This is my work horse for carving. I use the sharp acute angle on the walls carver to accentuate the deep grooves that I created with the acorn instrument. Then I use the flat end of walls carver to lower my occlusal height and to contour the B and L cusps. For mandibular molars, the angle of the walls carver can be used to accentuate the B and L grooves that separate the M and D cusps.

(4) Interproximal carver - I use the IPC to make secondary anatomy and grooves and to exaggerate the grooves that I've already created. I also use it to get rid of any overhangs.

Here's what it looks like after polishing it. I make the anatomy only with carving.

 

[free99]

Nice anatomy @UCSFx2017 -- did you place pins for retention in those? Seems like a lot of amalgam bulk without much retentive features. Or was this just an exercise to learn how to manipulate and carve amalgam?

 

[UCSFx2017]

Nice anatomy @UCSFx2017 -- did you place pins for retention in those? Seems like a lot of amalgam bulk without much retentive features. Or was this just an exercise to learn how to manipulate and carve amalgam?

Thanks free99. I just did these for practice and clinic points. No pins. I bore a huge hole in the center to mimic an amalgam core for a NSRCT tooth.

 

[resiliens]

I'm also struggling creating anatomy for amalgams; if anyone has suggestions, I'd love to hear them.

I think part of the issue might be getting the timing down right. I keep hearing drastically different timeframes for working with the material from different people. Some are saying to take your time pre-carve burnishing (15 minutes or so) and others say that's way too long.

Also, how long do you guys blend the amalgam for in the amalgamator?

Thanks fam

 

[TanMan]

The amalgam you use is key... There are some amalgams that are way easier to work with than others. I don't use amalgam in my office, but IIRC, spherical amalgam sets a lot faster, sets a lot harder initially, and way easier to carve. If you can get Tytin FC - made my life way easier than the admixed stuff. Easier to condense, stronger, less likely to fracture, and easy to polish. Sometimes, to get the perfect margin, you have to do a little enameloplasty along the occlusal margins.

Also, in real practice, anatomy with secondary and tertiary grooves are overrated. It is more for us, than the patient. From personal experience, I told my friend to take out the anatomy after he made this awesome looking restoration in my mouth... unfortunately, those secondary and tertiary grooves ended up acting as irritating food traps.

Carving it... there's this instrument a long time ago that I used to use. Looks like a spade. Don't recall what it is called. Then there's the acorn to "draw" grooves". Depending on the amalgam that you use, you can get away using a football carbide with tons of irrigation to do a quickcarve as long as you are moving your handpiece in the right direction. Otherwise, you'll gouge your amalgam. Another easy polish tool is a FG arkansas stone shaped like a football. If you're looking for board quality shininess, you could use dialite/diamond impregnated rubber wheels. It may ruin the wheels, generate a ton of heat, cause pulpitis, but it'll look really really shiny for the boards.

 

[toothdriller2k17]

mentioning amalgam is sacrilegious at my school. you can only use it if you can't get proper rubber dam isolation.

with that said, those onlays seem nonsensical/outdated to me, but dang they look good @UCSFx2017

 

[resiliens]

mentioning amalgam is sacrilegious at my school. you can only use it if you can't get proper rubber dam isolation.

with that said, those onlays seem nonsensical/outdated to me, but dang they look good @UCSFx2017

Are you at NYU?

 

[toothdriller2k17]

Are you at NYU?

was. i graduated