Amalgam Restoration Process

Preparation and Initial Steps

• Outline Review: Before inserting amalgam, review the cavity preparation outline to form a mental image of its shape. This aids in carving later.
• Amalgam Transfer: Use an amalgam carrier to transfer amalgam to the prepared cavity.
• Condensation:
  • Use a flat-faced condenser to condense amalgam over the pulpal floor.
  • Initial condenser should be small enough for line angles but large enough to avoid poking holes.
  • Condense each portion of amalgam before adding more; each increment should fill 1/3 to 1/2 of the cavity depth.

Surface Margin and Overfilling

• Reaching Surface Margin: Once amalgam reaches the cavosurface margin, overfill by 1mm or more using heavy pressure.
• Final Condensation: Done perpendicular to the enamel surface adjacent to the margins.
• Time Management: Complete condensation within 3-4 minutes to avoid crystallization issues.

Burnishing and Carving

• Immediate Burnishing: Use a large football burnisher with heavy strokes mesio-distally and facio-lingually.
• Carving Process:
  • Start with a sharp cleoid-discoid instrument (larger one first, then smaller for inaccessible areas).
  • Blade edge should be perpendicular to margins, with part of the blade resting on unprepared tooth surface to prevent over-carving.
  • Avoid deep occlusal grooves to prevent weakening.
  • Use a mirror to visualize and assess anatomy.
  • Use the cleoid end for defining primary grooves, pits, and cusps.

Final Adjustments and Evaluation

• Carving Adjustments: Continue carving until contours and occlusion reproduce missing tooth structure.
• Fossa and Margins: Mesial and distal fossa should be slightly deeper than proximal marginal ridges.
• Surface Smoothing: Use a damp cotton ball to smoothen; a small burnisher can also improve smoothness.
• Final Evaluation:
  • Ensure the surface is smooth with no irregularities or scratches.
  • Check margins for evenness.
  • Verify contours and occlusion are correct, patterned after normal occlusal contours.