Class II Amalgam Restoration

#29 DO

Overview

Occlusal
Proximal
 

Armamentarium

Instruments and Materials

 
 

Video Demonstration

 

Procedure

Review the preparation procedure checklist

  • Cavosurface margin smooth 

  • Pulpal and axial walls smooth 

  • Buccal and lingual walls occlusally convergent

  • Mesial and axial walls occlusally divergent 

  • Proximal, buccal, and lingual contacts broken

  • Reverse S curve present 

  • Prep at least 1mm wide BL

Evaluate the preparation for adequate dimensions 

Place the Tofflemire matrix band around the tooth

  • Ensure the matrix band rises 1mm over the marginal ridge

Secure the matrix band by placing a wedge in the buccal and lingual embrasures

  • Insert the wedge from the lingual using the forceps

Burnish the matrix band against the adjacent tooth in the contact area

Instrument suggestions: ball burnisher, amalgam condenser 


Triturate the amalgam for approximately 7-9 seconds or according to amalgam manufacturer's instructions

  • Properly triturated amalgam: homogenous consistency 

  • Over triturated amalgam: hot, shiny, soupy, stick to the wall of the capsule, and will set quickly 

  • Under triturated amalgam: dry and crumbly  

Open the amalgam capsule and place the triturated amalgam into an amalgam well or onto a clean, circular cloth

  • Caution: do not touch amalgam with bare hands


Use both sides of the amalgam carrier to pick up the amalgam

  • Work swiftly as amalgam sets fairly quickly


Extrude the amalgam from the amalgam carrier into the most gingival area of the prep

Use the smallest condenser to vertically and laterally compress amalgam into the preparation

  • Begin condensing in the proximal box 

  • Apply sufficient force when condensing amalgam 

Use the amalgam carrier and condenser to incrementally fill and compress amalgam into the preparation


Slightly overfill preparation with amalgam

  • Use the larger amalgam condenser when the amalgam fill reaches the occlusal surface 

Firmly burnish the amalgam with the round end of the burnisher


Use the explorer tip at a 45 degree angle to the matrix band to remove excess amalgam from the marginal ridge


​Carefully remove the matrix band

  1. Loosen the short swivel to release the matrix band from the matrix band holder
  2. Remove the interproximal wedge with forceps 

  3. Remove the matrix band from the side opposite of the proximal box 

  4. Lightly hold down the amalgam with an instrument and carefully remove the remaining portion of the matrix band in the bucco-occlusal or linguo-occlusal direction  

    • Removing the matrix band in the occlusal direction may dislodge the restoration


 Carve anatomy into the restoration  

  • Remove excess amalgam from the proximal aspect and overhang at the gingival margin 

 

Instrument options: explorer, proximal carver

  • Develop occlusal anatomy by guiding the instruments along the remaining tooth structure to create grooves and correct cuspal inclines

 

Instrument options: acorn burnisher, cleoid-discoid, Hollenback carver 

  • Ensure that the marginal ridge is rounded and the height is consistent with that of the adjacent tooth  

 

Instrument options: explorer, Hollenback 

Burnish the margins circumferentially 

 

Instrument options: small ball burnisher

Clean and smooth the restoration surface with a wet cotton pellet

Use floss to check the proximal contact

  • Floss in the gingival direction and pull laterally through embrasure to avoid dislodging the restoration

  • Proper contact should give light resistance and create slight "snap" sound


Remove the isolation

Using articulating paper, check the occlusion of the restoration

  • Areas of hyperocclusion will mark heavily with the articulating paper 

  • Adjust areas where the restoration is "high"

 

Instrument options: amalgam carver or cleoid-discoid 

Optional: Polish the restoration 

  • Polishing is performed after amalgam has set, according to the manufacturer's instructions

  • Smooth the surface using rotary instruments (slow speed)

Bur options: rubber cup and pumice, Duragreen polishing bur or Brownie polishing bur

  • Shine the surface using rotary instruments (slow speed)

Bur options: Greenie polishing bur 

Clean, dry, and examine the restoration 

  • Use the explorer to ensure that there is a smooth transition between the restoration and remaining tooth structure 

  • Material flush to cavosurface margin with no pits, steps, and/or voids

  • Consistent occlusal contacts in the arch

  • Smooth transition from restoration to tooth structure

  • Occlusal anatomy includes correct grooves, cusp inclines, and accurate embrasure spaces

  • Marginal ridge is rounded and height is consistent with that of the adjacent tooth

  • Closed interproximal contact

  • Correct interproximal contour

  • No overhang

     

IMG_2722.jpeg

Checklist

 

Common Mistakes

*Hover for summary details

 

Common 

Mistakes

Proximal Contact

Marginal Integrity

Common Mistakes

Marginal Ridge

My Dental Key

  • YouTube
  • Facebook
  • Instagram
© 2021 by My Dental Key

Our mission is to democratize access to clinical information and supplement dental education by bringing learners online, accessible, trusted resources.

Testimonials