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Class II Amalgam Restoration

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Overview

Occlusal

 all centric and excursive contacts on the restoration are consistent in size, shape, and intensity with such contacts on other teeth in that quadrant

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Proximal
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marginal ridge should be at the appropriate height

proximal contour and contact area should be correct

Overview

Armamentarium

Instruments and Materials

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Armamentarium
Video Demo

Video Demonstration

Procedure

Procedure

Review the preparation procedure checklist

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  • 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 

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Place the Tofflemire matrix band around the tooth

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

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

  • Insert the wedge from the lingual using the forceps

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

Instrument suggestions: ball burnisher, amalgam condenser 


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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  

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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


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

  • Work swiftly as amalgam sets fairly quickly


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

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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 

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


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Slightly overfill preparation with amalgam

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

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Firmly burnish the amalgam with the round end of the burnisher


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


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​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


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 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 

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Burnish the margins circumferentially 

 

Instrument options: small ball burnisher

Clean and smooth the restoration surface with a wet cotton pellet

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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


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Remove the isolation

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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 

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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 

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Clean, dry, and examine the restoration 

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

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  • 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

     

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Checklist

Checklist

Common Mistakes

*Hover for summary details

Common Mistakes

Common 

Mistakes

contact

Proximal Contact

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Marginal Integrity

Common Mistakes

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Marginal Ridge

References

Hilton, T. J., Ferracane, J. L., & Broome, J. C. (2013). Summitt's fundamentals of operative dentistry a contemporary approach. Quintessence Publishing Co. Inc. 
Ritter, A. V., Boushell, L. W., Walter, R., & Sturdevant, C. M. (2019). Sturdevant's art and Science of Operative Dentistry. Elsevier. 

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