MANAGEMENT OF

BADLY BROKEN DOWN

TEETH (II)

Dr. Nasrien Ateyah

 PIN-RETAINED AMALGAM
RESTORATION

Defined as any restoration requiring the
placement of one or more pins in the
dentin to provide adequate resistance and
retention forms.

Used → whenever adequate resistance and
retention forms cannot be established
with slots, locks, or undercuts only.

It has a greater retention than those using
boxer or relying solely on bonding system.
 PIN-RETAINED AMALGAM
RESTORATION

It is indicated for tooth with

extensive caries or fractures.

Rarely used in anterior teeth

(Bonding Technique).

In class V is rare (horizontal groove

in the gingival & occlusal aspect).
 ADVANTAGE

Conservation of tooth structure

Save time vs. cast restoration

Economic

Provide ↑ resistance & retention form

 DISADVANTAGE

Dentinal microfracture or crazing

Microleakage around pin

↓ strength of amalgam

Perforation of the pulp or external tooth

structure
 TYPE OF PINS
1. Cemented
• Larger than other pin
• Use Zn Ph cem or Zn Polycar cem

2. Friction – locked pins

• Smaller
• Retained by resilience of dentin
• ↑ retentive than cemented pin
With time dentin relax → loose pin
 TYPE OF PINS
3. Self-threading pin (TMS)
• Different size
• Threads engage dentin
• Depend on elasticity of dentin
• Most retentive (3-6 times)
• No corrosion (gold plated)
• Create horizontal & vertical stress
• Cause dentinal craze line (size of pin)
MOST CURRENTLY MARKED PINS
HAVE:

Metal thread separated

Wider dentinal thread → retained well in

dentin

Shoulder stop (to prevent putting stress

at the end of pin channel)
 TMS PIN (THREAD MATE SYSTEM)

Regular 0.031 inch diameter

Minim 0.024 inch diameter

Minikin 0.019 inch diameter

Minuta 0.017 inch diameter

 TMS PIN (THREAD MATE SYSTEM)
Available in

Double shear (two pins in one)

Gold plated, stainless steel or

titanium alloy

Inserted manually or with low-speed,

latch-type handpiece
 FACTORS AFFECTING THE
RETENTION OF THE PIN IN DENTIN
AND AMALGAM
Type of pin

Self-threading – most retentive

Friction-locked – intermediate

Cemented – least

Surface characteristics

Number & depth of the elevation on the pin
(serration or thread)

Shape of self-threading pin – greatest retention
 FACTORS AFFECTING THE RETENTION OF
THE PIN IN DENTIN AND AMALGAM

Orientation, number and diameter

Non-parallel pin - ↑ retention

Bending of pin – not desirable
• Interfere with condensation of amalgam

• Weaker pin, fractured dentin

↑ no. of pin - ↑ retention

• ↑ crazing & fracture
• ↓ amount of dentin available
• ↓ amalgam strength
 FACTORS AFFECTING THE RETENTION OF THE PIN
IN DENTIN AND AMALGAM
↑ diameter of pin →↑ retention

↑ no. , diameter, depth →
• Danger of perforation on pulp or
external tooth surface
• Interfere with condensation of amalgam
and adaptation to pins

Extension into dentin and amalgam

Retention is not increase when depth of the pin ↑
2mm in dentin → fracture of dentin

If ↑ 2mm in amalgam → fractured amalgam
 PIN PLACEMENT FACTORS AND
TECHNIQUES

Pin Size

Depend on the amount of dentin available and
amount of retention desired.

TMS – pin of choice is Minikin (0.019 inch)

and Minim (0.024)
Minikin → ↓ risk of:

Dentin crazing

Pulpal penetration

Potential perforation
 PIN PLACEMENT FACTORS AND
TECHNIQUES

Number of Pins
Several factors must be considered:

Amount of tooth structure

Amount of dentin available to receive pin

safely

Amount of retention required

Size of the pin

 PIN PLACEMENT FACTORS AND
TECHNIQUES

Number of Pins

As a rule → one pin/missing axial line angle

should be used

Excessive number of pins

→ fracture the tooth
→ weaken the amalgam restoration
PIN PLACEMENT FACTORS AND
TECHNIQUES

Location
Several factors aid in determining pinhole
location:
1. Knowledge of normal pulp anatomy &
external tooth contour
2. Current radiograph of the tooth
3. Periodontal probe
4. Patient’s age
 SOME CONSIDERATIONS:

Occlusal clearance should be sufficient to

provide 2mm of amalgam over the pin.

Pinhole should be located halfway

between the pulp and DEJ
(0.5-1 mm inside DEJ)

At least 1 mm of sound dentin around the

circumference of the pinhole.

Such location ensures proper stress
distribution of occlusal force

Pinhole:

Should be located near the line angles
of the tooth

Should be parallel to the adjacent

external surface of the tooth
(not closer than 1 - 1.5 mm)

Should be prepared on a flat surface


If three or more pinholes
are placed:

Should be located at different vertical
levels on the tooth (↓ stress if pin in same
horizontal plane)

Inter-pin distance depend on the size of

the pin to be used

For Minikin (0.019 inch) → 3mm

For Minim (0.024 inch) → 5 mm

Maximal inter-pin distance results in

lower level of stress in dentin.
 EXTERNAL PERFORATION MAY
RESULT FROM PINHOLE PLACEMENT
1. Over the prominent mesial concavity
of the maxillary first premolar.

2. At the midlingual and midfacial

bifurcations of mandibular
first & second molars.

3. At the midfacial, midmesial,

mid-distal furcations of maxillary
first and second molars.
 PULP PENETRATION MAY RESULT
FROM PIN PLACEMENT
At mesiofacial corner of:

Maxillary first molar

Mandibular first molar

When possible, location of pinholes on:

Distal surface of mandibular, molars

Lingual surface of maxillary molars
Should be avoided
 PINHOLE PREPARATION:

No. ¼ bur used to prepare a pilot hole

(dimple) →

To permit more accurate placement
of the twist drill

Prevent the drill from crawling once

it has began to rotate

Optimal depth of the pinhole into the

dentin is 2mm
(Omni-Depth gauge used)
 PINHOLE PREPARATION:

The hole should be prepared on flat

surface and the drill perpendicular to
it.

Place flat thin-bladed hand instrument

into the crevice and against the
external surface of the tooth
→ To indicate the proper
angulations for the drill
 PINHOLE PREPARATION:

Place the drill tip in its proper position

Hand piece rotating at very low speed

Apply pressure to the drill

Prepare pinhole in one or two movement

until the depth-limiting portion is reached

Remove the drill from pinhole

Using more than one or two
movements, tilting the hand
piece →
too large pinhole

The drill should never stop

rotating →
to prevent the drill from
breaking while in the pinhole
 PINHOLE PREPARATION:

Dull drill →

↑ frictionalheat

Cracks in the dentin

To bend the pin → TMS bending tool

 INTERNAL STRESS CAUSE BY THE
PIN ↓ BY:
1. ↑ space between pins

2. Channel 2mm deep

3. Pins parallel to occlusal force

The success of all amalgam restoration depend on
→ stability of the matrix
Matrix:
Tofflemire

Double matrix

Copper

Auto matrix
 FAILURE OF PIN-RETAINED RESTORATION

Occur at any of five different location:

1. Restoration fracture (failure within rest)
2. Pin restoration separation (at the interface
between the pin and restorative material)
3. Pin fracture (within the pin)
4. Pin dentin separation (at the interface
between the pin and dentin)
5. Dentin fracture (within the dentin)

Failure is more likely to occur at the

pin dentin interface
 PROBLEMS THAT ARISE DURING PIN-
RETAINED RESTORATION:
1. Broken drills and pins
• Twist drill will break if:

Stressed laterally

Allowed to stop rotating before
removing from the pinhole

Dull (20 holes)

• Pin will break

During pending

Over - screwed in the hole

Solution: Leave it in place.

Do another hole 1.5mm from
broken item
 PROBLEMS THAT ARISE DURING PIN-
RETAINED RESTORATION:
2. Loose pins
• Due to:

Loosened while shortened with bur

Pinhole prepared too large

Solution:
• Remove pin , pinhole prepared with next largest
size drill , appropriate pin inserted

• Drill another hole 1.5mm from original pinhole,

close the other one with
amalgapins or cement the pin
 PROBLEMS THAT ARISE DURING PIN-
RETAINED RESTORATION:
3. Penetration into the pulp and perforation of the
external tooth surface:

• Either penetration is obvious if there is hemorrhage in the

pinhole
• Radiograph can help sometimes.

• Pulpal penetration treated as a pinpoint exposure

→ Ca OH and prepare another hole

• If patient complains of pain after that →

endodontic treatment
 PROBLEMS THAT ARISE DURING PIN-
RETAINED RESTORATION:

Lateral Perforation:
Occlusal to gingival attachment

Pin cut-off flush with the tooth surface.

Pin cut-off and cast restoration extend gingivally.

Remove pin , enlarge hole and restored with

amalgam.
Apical to gingival attachment

Surgically remove the bone after

reflecting the tissue, enlarge
pinhole, restored with amalgam

Crown lengthening and cast

restoration cover the
perforation.
Resin Bonded Amalgam
Restoration
 RESIN BONDED AMALGAM
RESTORATION

An amalgam restoration that has been

“bonded” to the existing tooth structure
through the placement of a resin dentin
bonding agent followed by a viscous resin
(or glass ionomer) liner into which the
fresh amalgam is condensed while the
liner is still unset.
 AMALGAM ATTRIBUTES

Proven clinical longevity despite being non-

adhesive

Various resistance/retention forms have

been successful even in large restorations

Long - term seal

 AMALGAM DEFICIENCIES

Amalgam is not adhesive

Restorations are passive and do not significantly

strengthen remaining tooth structure

Mechanical retention/resistance form is provided

at the expense of tooth structure

Microleakage is present until corrosion seals the

cavo - surface interface
(process is much slower in high-copper amalgams)
 ADVANTAGES OF RESIN BONDED
AMALGAM
1. Minimize or eliminate microleakage
2. Enhance traditional resistance and
retention methods
3. Increase the fracture resistance of the
restored tooth
4. Permit more conservative restorations
5. Decrease marginal breakdown and
ditching
6. Reduced incidence of postoperative tooth
sensitivity
 INDICATION
Used for:
Supplementing mechanical resistance feature in
large, complex amalgam restorations
especially those replacing cusps.

When an improved initial seal is needed, such as

after a direct or indirect pulp capping
procedure in tooth being restored.
 BONDING MECHANISM
Dentin Interface – micromechanical
(formation of hybrid layer)

Amalgam Interface – micromechanical

(interlock between viscous
resin and fresh amalgam)

Weak Links – resin/amalgam interface and

resin/dentin interface
 SOME COMMERCIAL SYSTEMS
All bond 2 with -Resin bonding agent
-Liner F
-Resinomer (BISCO)

Amalgam bond plus (HPA) (Parkell)

Multipurpose resin bonding agents

- Optio-bond (Kerr)
- Scotchbond
multipurpose plus (3M)
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION

Rubber dam isolation is essential for the best clinical

results.
Clean preparations and apply
conditioner (etchant) to enamel and
dentin following the manufacturers’
recommendations.

Rinse and dry lightly. Do not desiccate

the tooth. This step should be done
prior to Matrix band placement.
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION

Apply dentin primer/sealer following

manufacturer’s recommendations.

Apply the chemically-cured resin

bonding liner manufacturer’s
instructions.
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION

Condense the amalgam immediately into the

wet liner before it cure. The resin will have
a tendency to stick to metal condensers
and you may need to wipe them frequently.
You will find the bonding material will
ooze out at the cavosurface margins and
some of this excess can be removed before
the material is completely set. Do carving
as you can at this stage to minimize the
finishing time. Try to keep excess resin off
of adjacent tooth structure.
 CLINICAL TECHNIQUE FOR RESIN BONDED AMALGAM
RESTORATION
Remove the wedge and matrix band carefully. If
you have lubricated the band properly, this
step should not present problems.

Check inter proximal and cervical first.

Scalpels and sharp chisels will help carve any

resin at margins. Resin at Occlusal margins
can be carefully removed with rotary finishing
burs. Occlusal anatomy can be refined with
carvers and rotary instrumentations.
 CLINICAL TECHNIQUE FOR RESIN BONDED AMALGAM
RESTORATION

Remove rubber dam and check and adjust

occlusions as necessary
 DISADVANTAGES

Extra steps and expense
(both time and materials)

Technique sensitive and messy

Adhesive may stick to matrix,
instruments and adjacent tooth
structure

Carving more difficult

Finishing usually requires rotary
instrumentation
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION

1. Rubber dam isolation is essential for the best

clinical results.

2. Current recommendations are to execute

conventional amalgam preparation following
traditional guidelines. It is possible to be
somewhat conservative, but you must remember
that the bulk of the restoration will be dental
amalgam and that you cannot treat these as
preparations for composite resin.
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION

3. Clean preparations and apply

conditioner (etchant) to enamel and
dentin following the manufacturers’
recommendations.

Rinse and dry lightly. Do not desiccate

the tooth. This step should be done
prior to Matrix band placement.
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION

4. Carefully lubricate (very thin coat of

Vaseline) matrix band and wedge. Do not
contaminate conditioned tooth surface.
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION
5. Apply dentin primer/sealer following
manufacturer’s recommendations.

NOTE:
in systems that have a separate dentin bonding agent
that is placed before the more viscous bonding
liner is applied,
apply that dentin bonding agent prior to matrix band
placement
 CLINICAL TECHNIQUE FOR RESIN BONDED
AMALGAM RESTORATION
6. Apply the chemically-cured resin bonding liner
manufacturer’s instructions.

Current research indicates that the best attachment

between amalgam and liner occurs with the more
viscous materials. In addition, it has been suggested
that systems that have a fluoride release mechanism
may be advantageous

The use of adhesive resins to
increase the retention,
resistance, and
marginal seal of amalgam
restorations
has gained much popularity

The use of adhesive resins to increase the
retention, resistance, and marginal seal of
amalgam restorations has gained much
popularity

Several posterior teeth have anatomic
features that may preclude
safe pinhole placement

• Fluted & Fureal areas should be

avoided.