Temperature in the Pulp Chamber During Polishing of
Amalgam Restorations
RAPHAEL GRAJOWER, ELIESER KAUFMAN, and JOSEPH RAJSTEIN
Laboratory of Dental Materials, Department of Oral Diagnosis and Oral Medicine, and
Department of Oral Rehabilitation, Hadassah School of Dental Medicine,
Ein Karem, Jerusalem, Israel
Temperature changes in the pulp chamber
were determined by means of thermocouples
during polishing procedures of Class V amal-
gam restorations. The dependence of the
temperature elevation on the separation be-
tween cavity floor and thermocouple junc-
tion was determined. Temperatures obtained
with rubber cups were higher than those
with cup brushes. Intermittent polishing
caused less heating, by about 30%, than con-
tinuous procedures. Cavity bases and liners,
applied at a thickness of 0.2 to 0.3 mm, had
little influence on the temperatures in the
pulp chamber.
The merits of polishing amalgam restora-
tions, such as the enhancement of marginal
adaptation and the reduction of corrosion,
have been described by several authors.',2
However, the heat generated during polish-
ing procedures could cause damage to the
pulp. In experiments with monkeys,3 it was
demonstrated that the severity of thermally
induced pulpal lesions increased with the in-
trapulpal temperature and that irreversible
damage occurred with a temperature rise of
only 10 F (5.5 C) . These results are in agree-
ment with earlier experiments on rats.4
The temperature elevation in the pulp
chamber during polishing of amalgam res-
torations (henceforth called the polishing
temperature) has been reported for low
speeds of rotary instruments and for rather
long polishing times.5 6 The aim of this in-
vestigation was to determine the polishing
temperatures at higher rotary speeds and
shorter polishing times, as influenced by the
This paper is part of the thesis submitted by E.
Kaufman in partial fulfillment of requirements for the
DMD degree.
Received for publication June 18, 1973.
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thickness of the remaining dentin layer, the
type of polishing operation, and the cavity
base on which the restoration is placed.
Materials and Methods
Four Class V cavities of 4 + 0.5 mm diam-
eter and 1.5 ± 0.1 mm depth were prepared
at the cemento-enamel junction of 14 caries-
free molars. The cavities were prepared in
the buccal, lingual, distal, and mesial sides of
each tooth, and filled with amalgam that
contained an initial mercury-to-alloy ratio of
6:5. The root apexes of the teeth were
ground off until the root canal openings be-
came sufficiently wide for the insertion of a
syringe cannula of 0.5 mm diameter. Holes
of 0.6 mm diameter were drilled at the cen-
ter of the trifurcations. Through these holes,
iron-constantan thermocouples were inserted
and kept in place with small wooden wedges.
The thermocouple junctions were at about
the same height, with respect of the tooth
axes, as the centers of the cavities, and their
place was verified by means of radiographs.
A diluted alginateb suspension in a water-to-
powder ratio of 20:1 was injected through
the root canal openings to permit heat con-
vection in the pulp chamber and to improve
heat exchange with a thermostatic water
bath.
Two groups of seven teeth were attached
to impression trays with impression com-
pound.c The compound covered three sur-
faces of fillings of each tooth and a minimum
of the enamel surface (Fig 1). The angle
between the tooth axes and the tray was
a New True Dentalloy, S. S. White, Dental Products
Co., Philadelphia, Pa.
b Algiflex, Svedia Dental Industri AB, Enkoping, Swed.
e No. 2, Kerr Europe S.p.A.
1189
1190 GRAJOWER, KAUFMAN, & RAJSTEIN
To temperature recorder
A = Thermostatic water-bath
B = Perforated metal plate
C = Water level
D = Impression tray
E = Impression compound
FIG 1.-Experimental arrangement for polishing amalgam restorations.
about 300. The trays were firmly attached to
a waterbath of 37 ± 0.5 C. The root apexes
were beneath the water level and the surface
of one restoration above it. The thermo-
couples were connected to a temperature re-
corderd and the measurements were carried
out at sensitivities of 1.3 C and 3.2 C per cen-
timeter. The restorations were made smooth
with a finishing bur and subsequently pol-
ished by various methods that involved wet
abrasives, which cause less heating than dry
ones.5.6 Polishing procedures were started
at temperatures between 33 C and 36 C and
the temperature elevations were recorded
during these procedures. The rotary speed
of the polishing instruments was 7,500 + 500
rpm, as measured with an optical tachom-
etere on the driving wheel of the handpiece.
A mechanical stop on the dental engine'
rheostat allowed for a relatively constant
speed. The variations in speed were caused
by the different pressures exerted during
polishing.
The polishing operations were carried out
by two methods. With the continuous (C)
method a slurry of abrasive powder and
water was placed on the restoration, which
subsequently was polished for 15 seconds.
d Model D.E., Cambridge Instruments Co., Ltd.,
London, Eng.
e Type 2607 Photo Tachometer, Yokogawa Electric
Works, Tokyo, Jap.
f Bench Engine 92-N, Emesco Dental Co., New York,
NY.
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j Dent Res September-October 1974
F = Tooth
G = Amalgan
H = Ground off root canal openings
I = Thermocouple junction
The intermittent (I) method consisted of
placing a new portion of slurry on the filling
after every three seconds of polishing. A net
polishing time of 15 seconds was obtained
in this manner during about 20 seconds. On
one group of seven teeth the following se-
quence of polishing operations was carried
out on every restoration: flame-shaped finish-
ing bur,9 C; prophylactic cuph with flour of
pumice,i C and I; prophylactic cup with zinc
oxide,j C; soft rubber polishing cupk with
pumice, C and I; and soft cup brush with
pumice, C and I. Zinc oxide is used clin-
ically as an abrasive for final polishing
stages.7
After one restoration of each tooth on the
tray was polished, the tray was removed from
the water bath. The impression compound
was heated so that the teeth could be turned
by 900 and reembedded in the compound.
The tray then was replaced in the water
bath to polish the second restoration of each
tooth. Similar procedures were carried out
for the third and fourth restorations. The
sequence of polishing operations described
was reversed for the third and fourth restora-
'Hager and Meiser, No. 5 (Amer. No. 245), Dussel-
dorf, Ger.
h Type SN-1, The Denticator Co., San Francisco,
Calif.
Baker and Adamson, New York, NY.
Laboratory Reagent, B.D.H. Poole, Eng.
k Type RA, Produits Dentaires, Vevey, Switz.
l Junior Alpine Bristle Brushes, Amalgamated Den-
tal, London, Eng.
Vol 53 No. 5
tions of the teeth, except for the finishing
bur, which was always used as the first step.
The polishing operations were carried out by
three clinicians. After one dentist polished
all the fillings of the set, they were carefully
removed from the cavities with a low-speed
bur. New restorations were placed in the
same cavities and were polished by a second
dentist, and so forth.
The distance that separated the cavity floor
and the thermocouple, henceforth called the
separation, was measured on occlusal radio-
graphs. These measurements were verified
with a caliper gauge on the teeth, after pol-
ishing, by grinding down the teeth crowns
until the thermocouples became visible. The
accuracy of the results was estimated to be
+0.5 mm. The data that related to the de-
pendence of the polishing temperatures on
the separation were grouped accordingly in
intervals of 0.5 mm.
The purpose of the experiments on the
second group of teeth was to establish the in-
fluence of cavity bases and liners on the pol-
ishing temperatures. The polishing temper-
atures measured on teeth with fillings that
consisted of amalgam only were compared
with the temperature obtained for fillings
placed on different materials. After a polish-
ing sequence with one material was com-
pleted, the fillings were removed and new
amalgam restorations were placed on a dif-
ferent material in the same cavities. The ma-
30 - x
LU
O \\x X ~~~~+PROP~-
a~~~~~
20
LU
20 +~~~~~
< X~~~~~~
UJ
z
0~~~~~~~~~
H- 10
0~
FIG 2.-Dependence of polishing temperature on separation between
thermocouple and cavity floor for four arbitrarily chosen polishing operations.
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TEMPERATURE DURING AMALGAM POLISHING 1191
terials used were a cavity varnish,m a liner
that contained zinc oxide-eugenol,n zinc
oxide-euegenol,o zinc phosphate cementP
and a calcium hydroxide liner.q The varnish
was applied to all the cavity walls in two
thin layers. The other materials were ap-
plied to the cavity floors only, in layers 0.2
to 0.3 mm thick. The following polishing
operations were carried out on all the fillings
by one operator during 15 seconds of con-
tinuous polishing: finishing bur, prophylac-
tic cup with pumice, rubber cup with pum-
ice, and cup brush with pumice.
As the criterion for the significance of our
results, the 95% confidence limits of the
mean were adopted. These limits are given
by the formula8
± 1.96{f(x,- x)2/N(N - l)}1/2,
where xi, x, and N represent, respectively,
the data, the mean of the data, and the num-
ber of data.
Results
The temperature elevation in the pulp
chamber is shown in Figure 2 as a function
of the separation between the thermocouple
m Clear Dental Varnish, Dental Filling Ltd., London,
Eng.
o Cavitec, Kerr Mfg. Co., Romulus, Mich.
ORiedel-de Haen A.G. Seelse-Hannover, Ger.
P Improved Cement Type I., S. S. White, Dental
Products Co., Philadelphia, Pa.
q Dycal, L. D. Caulk Co., Milford, Del.
0 FINIS-
X CUP E
PROPF
X
mm SEPARATION
1192 GRAJOWER.. KAUFMAN, & RAJSTEIN
LU
Cr
LU
0~
0 2
mm
FIG 3.-Average dependence of polishing temperature on separation, as
determined from 24 polishing operations. Vertical bars represent 95% con-
fidence limits of mean.
and the cavity for four sets of measurements.
These sets were arbitrarily chosen from the
measurements of one operator. The data
from the application of the finishing bur and
the cup brush were multiplied by four and
two, respectively, The shapes of the curves
obtained in this manner are rather similar,
although the polishing temperatures that re-
sult from applying the rubber cup are about
four times higher than those from the finish-
ing bur. These results and those from other
operations and operators indicate that the
dependence of the relative temperature ele-
vation on the separation is similar for all
operations. A curve (Fig 3) for the average
dependence of the polishing temperatures on
the separation was therefore computed from
24 sets of measurements, which involved
eight polishing operations, each of which
was carried out by three operators. For this
purpose the average polishing temperature of
each set was calculated as well as normaliza-
tion constants to render these averages equal.
The individual data of the sets were then
multiplied by the appropriate normalization
constants. A point on the curve represents
the average of the normalized data for one
interval of separations. Because the volume
of the tooth pulp is much greater than that
of a thermocouple junction, the larger valves
of separation do not represent possible dis-
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J Dent Res September-October 1974
3 4 5
SEPARATION
tances between cavity floor and the pulp in
the tooth.
The polishing temperatures caused by dif-
ferent methods of polishing are presented in
Figure 4, as calculated for a separation of 1
mm. Correction factors, based on the recip-
rocal values of Figure 3, were used to give
the same statistical weight to measurements
carried out at various separations. This pro-
cedure also reduces the standard errors of
the means, by cancelling the effect of the sep-
aration, which is a measurable variable.
Figure 5 shows the effect of various cavity
bases and liners on the polishing temper-
atures. The data were treated similarly to
those of Figure 4 with respect to the dis-
tance. Furthermore, because the results were
obtained from four different polishing op-
erations, correction factors based on the re-
ciprocal values of the corresponding oper-
ations given in Figure 4 were used.
Discussion
The polishing temperatures obtained in
our experiments when rubber cups and wet
pumice were used were significantly higher
than those reported by other investigators
who used the same abrasive. Aplin, Soren-
son, and Cantwell,5 who used an intermit-
tent polishing technique during 45 seconds
at a pressure of 4 ounces (113 gm) and with
Vol 53 No. 5 TEMPERATURE DURING AMALGAM POLISHING 1193

20F-

45

o _-

5
d d1 d jv

I..
eI1.
FINISHING
BUR. CUP
C.P.
NIE--U u
CUP
IP
-j Li
PROPHYLACTIC PROPHYLACTIC PROPHYLACTIC
CUP
CZ.
L-URUBBER
LLL-
CUP
CP.
I
RUBBER
CUP
I,P.
O ...LCUP BUSH0 l CUP
C, P
LEJ U
BRUSH
I.P

FIG 4.-Relative polishing temperatures for various polishing operations as

calculated for separation of 1 mm. Three narrow bars in which 95% con-
fidence limits are indicated represent results of individual clinicians; wide
bars show average of these results. Operations were carried out at 7500 -+-
500 rpm and during 15 seconds of net polishing time; P. wet pumice; Z, wet
zinc oxide; C, continuous operation; and 1, intermittent operation.

a dentin layer of 0.4 mm between thermo-

couple and restoration, reported temper-
ature elevations of 5.31 F (2.95 C) and 7.37 F
(4.1 C) at 2,700 rpm and 4,700 rpm, respec-
tively. Christensen and Dilts6 observed pol- iooH
ishing temperatures of 3.7 F (2.05 C) during -
60 seconds of operation with a pressure of
55 gm, a separation of 1.24 mm, and at 2,600 75
rF
rpm. The difference between these and our
results may be attributed to the higher rotary ni
speed used by us and probably also to higher U,
I
a
0

uj
J
pressures. It may be seen from Figure 4 z 50
that the same polishing operations, when I
z
carried out by different clinicians, gave rise 0. _w 2
2
n9w w
to temperatures that varied greatly. These O0
x
u
O
variations, as well, may be attributed to dif- 25 a a
x
1- z 0
ferences in applied pressure. J
w
t
z E u
z
41
2
Because we adopted 5 C as the maximum i
X

permissible temperature elevation in the pulp,

it follows from the results that various pol-
ishing procedures generate sufficient heat to
cause damage to the pulp. This is especially
the case for deep cavities, where the thermal
insulation provided by the remaining dentin
layer is inadequate. However, the heat dis-
ol I I
FIG 5.-Relative polishing temperatures as ob-
tained with restorations placed on different cav-
ity bases and liners. Thickness of insulating ma-
terials, except that of varnish, was 0.2 to 0.3 mm.
Ninety-five percent confidence limits of the mean
are indicated.

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1194 GRAJOWER, KAUFMAN, & RAJSTEIN
sipation caused by the blood circulation in
the vital tooth pulp reduces the polishing
temperatures more effectively than the ther-
mal contact with a water bath in our ex-
periments. The influence of the blood cir-
culation is nevertheless not likely to be ap-
preciable in as short a polishing time as 15
seconds. Because the polishing operations
that were used in our experiments are rather
common in dental practice, it may seem sur-
prising that very few patients complain about
pain caused by these operations. It has been
reported, however, that extensive pulp dam-
age can occur after which the patient ex-
periences no postoperative discomfort,9 and
that the degree of inflammatory response is
in no way related to the pain produced.10
The highest polishing temperatures re-
sulted from the application of rubber instru-
ments (that is, prophylactic cups and rubber
cups). No significant difference was observed
in the heat generated by slurries of pumice
and zinc oxide. Intermittent polishing re-
duced the polishing temperatures by about
30%. It is to be expected that the relative
temperature elevation caused by intermittent
polishing of vital teeth will be even lower
because the heat dissipation by blood circu-
lation will be more effective during a longer
polishing time. In agreement with earlier
investigations,6 we observed that polishing
with rotary brushes gave rise to lower polish-
ing temperatures than with rubber appli-
ances. It has been shown2 that excessive
steps in polishing with progressive instru-
mentation may not appreciably enhance sur-
face characteristics and that the surface of
amalgam restorations can be polished to the
same degree of smoothness with soft brushes
as with rubber cups. Considering this and
the high temperatures generated by rubber
cups, the merit of using rubber appliances
becomes questionable.
According to Smith,"l the thermal prop-
erties of various cements are only slightly dif-
ferent than dentin. He therefore estimated
that a layer of at least 1 mm of lining ma-
terial is necessary to provide effective insula-
tion against transient temperature changes,
which are transmitted through metallic res-
torations. Braden12 poured hot water on
the surface of amalgam restorations that
were 4 mm deep and were placed on a zinc
phosphate cement layer of 0.2 mm thickness.
His results showed that within 15 seconds
the temperature at the dentin-base interface
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j Dent Res September-October 1974
reached 80%; of the original temperature dif-
ference between tooth and water. Because
some heat is dissipated to the side walls of
these rather deep cavities, only little thermal
insulation is provided by the base when ap-
plied at this clinically common thickness.
Our measurements, as presented in Figure
5, are in agreement with these observations.
Only two materials (zinc phosphate cement
and a liner that contained calcium hydrox-
ide) caused a significant but small reduction
in the polishing temperatures, when applied
in a layer of 0.2 to 0.3 mm.
The damage, which is inflicted on the pulp
during the polishing of restorations or while
consuming drinks of extreme temperatures,
occurs under transient thermal conditions.
Braden12 suggested, therefore, that the ther-
mal diffusivity rather than the conductivity is
the more important parameter of a material
for thermal insulation in the oral cavity. It
is seen from our results that zinc phosphate
cement, which has a lower thermal diffusivity
than zinc oxide-eugenol, has a more pro-
nounced effect on the polishing temperature.
Clinical experience indicates that a rup-
tured cement layer may cause excessive sensi-
tivity to temperature changes. Because of the
small area of dentin exposed to the amalgam
in these cases, the heat conduction to the
pulp will be altered only to a small extent
by this rupture. It could be suggested, there-
fore, that this sensitivity is caused by sensa-
tion in the dentin itself, as during cavity
preparation.'0
Conclusions
In view of the reported3.4 sensitivity of the
dental pulp to heat, we studied the temper-
ature elevations in the pulp chamber that
occur during polishing of amalgam restora-
tions. The polishing temperatures decreased
sharply with an increase of the separation
between the cavity floor and the pulp cham-
ber. Higher temperatures were observed with
continuous polishing and with polishing ap-
pliances made of rubber than with inter-
mittent polishing and cup brushes. The re-
sults suggest that the temperatures generated
by various polishing procedures may cause
irreversible damage to the pulp. For routine
clinical practice it is suggested that polishing
should be carried out intermittently at low
speeds and without the use of rubber ap-
pliances or excessive steps with progressive
instruments. Cavity bases and liners, when
Vol 53 No. 5
applied in layers 0.2 to 0.3 mm thickness
provided little protection to the pulp from
thermal shock.
References
1. CHARBENEAU, G.T.: A Suggested Technique
for Polishing Amalgam Restorations, J Mich
State Dent Assoc 47: 320-325, 1965.
2. SKINNER, E.W., and PHILLIPS, R.W.: The
Science of Dental Materials, 6th ed, Phila-
delphia: W. B. Saunders Co., 1968, p 345.
3. ZACH, L., and COHEN, G.: Pulp Response to
Externally Applied Heat, Oral Surg 19: 515-
530, 1965.
4. POHTO, M., and SCHEININ, A.: Microscopic
Observations in Living Dental Pulp II, Ef-
fect of Thermal Irritants on Circulation of
the Pulp in the Lower Rat Incisor, Acta
Odont Scand 16: 315-327, 1958.
5. APLIN, A.W.; SORENSON, F.M.; and CANTWELL,
K.R.: Temperature Change in Dental
Polishing, J Dent Res 46: 325-330, 1967.
6. CHRISTENSEN, G.J., and DILTS, W.E.: Thermal
Downloaded from jdr.sagepub.com at PENNSYLVANIA STATE UNIV on May 11, 2016 For personal use only. No other uses without permission.
TEMPERATURE DURING AMALGAM POLISHING 1195
Change During Dental Polishing, J Dent Res
47: 690-693, 1968.
7. HAMPSON, E.L.: Textbook of Operative
Dentistry, London: William Heineman Med-
ical Bookes Ltd, 1961, p 60.
8. SPIEGEL, M.R.: Theory and Problems of
Statistics, New York: Schaum Publishing Co.,
1961, pp 156-160.
9. SHOVELTON, D.S.: The Maintenance of Pulp
Vitality, Br Dent J 133: 95-101, 1972.
10. SELTZER, S., and BENDER, I.B.: The Dental
Pulp, Philadelphia: J. B. Lippincott Co.,
1965, pp 76, 126.
11. SMITH, D.C.: Dental Cements, in Symposium
on Dental Materials, Dent Clin N Am,
Philadelphia, W.B. Saunders Co., January
1971, pp 3-32.
12. BRADEN, M.: Heat Conduction in Teeth and
the Effect of Lining Materials, J Dent Res
43: 315-322, 1964.
13. CIVJAN, S.; BARONE, J.J.; REINKE, P.E.; and
SELTING, W.J.: Thermal Properties of Non-
metallic Restorative Materials, J Dent Res
51: 1030-1037, 1972.