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[Dimensional changes of silver and gallium-based alloy].

Gallium-based dental alloys were created with the aim of solving the problem of toxicity of mercury. The material shows mechanical properties similar to those of dental amalgam, but researches point out two unfavorable characteristics: great corrosion and excessive post-setting expansion, and the latter is capable of cracking dental structures. The aim of this study was to evaluate, during 7 days, the in vitro dimensional alteration of a gallium dental alloy (Galloy, SDI, Australia), in comparison with a dental amalgam containing zinc (F400, SDI, Australia), as a function of the contact with saline solution (0.9% NaCl) during the setting period. The storage experimental conditions were: storage in dry environment, immersion in saline solution and contamination during condensation. Additionally, the effects of contamination during the trituration of dental amalgam and the effects of protecting the surface of the gallium alloy with a fluid resin were studied. Specimens were stored at 37 degrees C +/- 1 degree C, and measuring was carried out, sequentially, every 24 h during 7 days. When the gallium alloy was either contaminated or immersed, an expansion significantly greater than that observed in the other experimental conditions was noticed after 7 days. The application of a fluid resin to protect the surface of the cylinders was able to avoid the increase in expansion caused by superficial moisture. The amalgam alloy did not show significant dimensional alterations, except when it was contaminated during trituration.

Alloys↗

Cyclic contact fatigue of a silver alternative to amalgam.

OBJECTIVE: To purpose of this study was to compare the cyclic contact fatigue resistance of a novel mercury-free silver direct filling material to that of a dental amalgam (Dispersalloy). METHODS: The silver specimens were made by pressing a precipitated powder at room temperature with a pressure of 150 MPa, which can be achieved in clinical hand-consolidation. To simulate clinical contact of restorations against enamel cusps, a cyclic contact fatigue methodology was employed. A spherical indenter was used to repeatedly indent the specimen, while the accumulation of deformation and damage was examined as a function of the number of cycles up to 5 x 10(5). Student's t test, analysis of variance (ANOVA) and Duncan's multiple range test were used to compare the specimen groups for significant differences in flexural strength, indentation impression diameter, and hardness. A type I error of alpha = 0.05 was considered as significant. Subsurface damage was examined by using a bonded-interface technique. RESULTS: As a result of cyclic indentation, microcracks were produced in the amalgam, but no cracks were found in the silver filling material. At fewer numbers of cycles, indentation produced larger impressions in silver (e.g., diameter = [450 +/- 31] microns at 10(2) cycles) than in amalgam ([145 +/- 20] microns) due to a lower hardness of the former. However, with increasing number of cycles, damage accumulated more rapidly in the amalgam, while the silver beneficially work-hardened in repeated indentations. At 5 x 10(5) cycles, the difference in impression diameter between silver and amalgam ([582 +/- 20] microns vs. [568 +/- 42] microns) become insignificant (p > 0.1, Student's t test). SIGNIFICANCE: The mercury-free silver direct filling material is more resistant to microcracking and to cyclic contact fatigue than amalgam, and the indentation impression sizes in the consolidated silver and dental amalgam are not statistically different at large numbers of cycles.

Analysis of Variance↗

Preservation-based approaches to restore posterior teeth with amalgam, resin or a combination of materials.

This review is a systematic assessment, from the literature, of the status quo of dental amalgam, resin-based composite and glass-ionomer restorations for carious lesions as it applies to new concepts, coupled with clinical research. Scientifically based and practical new materials and techniques are recommended to include in contemporary practice throughout the world. Clinical and laboratory studies which have been carried out in light of modern conservative principles, and in light of the current emphasis of treating dental caries as a disease process were reviewed and discussed. An approach to managing carious lesions based upon selected advantages of dental amalgam, resin-based composite and glass-ionomer technology applied to what is termed "preservation-based" approaches to restoring teeth has been synthesized. Researched evidence contradicts the notion of "extension for prevention" in favor of maintaining sound tooth structure which would translate into more patients with healthy dentitions for entire lifetimes.

Composite Resins↗

[Neurotoxic effect of exposure to low doses of mercury].

OBJECTIVES: To assess early effects on the Central Nervous System due to occupational exposure to low levels of inorganic mercury (Hg) in a multicenter nationwide cross-sectional study, including workers from chloro-alkali plants, chemical industry, thermometer and fluorescent lamp manufacturing. The contribution of non-occupational exposure to inorganic Hg from dental amalgams and to organic Hg from fish consumption was also considered. METHODS: Neuropsychological and neuroendocrine functions were examined in a population of 122 workers occupationally exposed to Hg, and 196 control subjects, not occupationally exposed to Hg. Neuropsychological functions were assessed with neurobehavioral testing including vigilance, motor and cognitive function, tremor measurements, and with symptoms concerning neuropsychological and mood assessment. Neuroendocrine functions were examined with the measurement of prolactin secretion. The target population was also characterized by the surface of dental amalgams and sea fish consumption. RESULTS: In the exposed workers the mean urinary Hg (HgU) was 10.4 +/- 6.9 (median 8.3, geometric mean 8.3, range 0.2-35.2) micrograms/g creatinine, whereas in the control group the mean HgU was 1.9 +/- 2.8 (median 1.2, geometric mean 1.2, range 0.1-33.2) micrograms/g creatinine. The results indicated homogeneous distribution of most neurobehavioral parameters among exposed and controls. On the contrary, finger tapping (p < 0.01) and the BAMT (Branches Alternate Movement Task) coordination test (p = 0.05) were associated with occupational exposure, indicating an impairment in the exposed subjects. Prolactin levels resulted significantly decreased among the exposed workers, and inversely related to HgU on an individual basis (p < 0.05). An inverse association was also observed between most neuropsychological symptoms and sea fish consumption, indicating a "beneficial effect" from eating sea fish. On the contrary, no effects were observed as a function of dental amalgams. CONCLUSIONS: In conclusion, this study supports the finding of early alterations of motor function and neuroendocrine secretion at very low exposure levels of inorganic Hg, below the current ACGIH BEI and below the most recent exposure levels reported in the literature.

Adult↗

Occupational exposure to mercury in dentistry and dentist mortality.

In response to public concern, Health Canada recently conducted a review of amalgam safety and released a position statement entitled The Safety of Dental Amalgam. Essentially, the department has concluded that the levels of mercury absorbed by the body due to the release of mercury vapor from amalgam restorations, while detectable, do not approach those recognized to cause illness. It has therefore confirmed that amalgam restorations can be used safely in most patients, with some notable caveats. Despite Health Canada's position statement in support of amalgam, patient doubts about amalgam safety remain, including the tenuous hypothesized link between amalgam restorations and specific diseases. This article reviews the available studies of dentist mortality to identify possible links between mercury exposure and negative health effects. A lack of evidence to suggest a detrimental health outcome in dentists who are occupationally exposed to higher levels of mercury than their patients, and are known to have higher levels of mercury in their blood, provides an important reassurance concerning the safety of amalgam. The reviewed data indicates that the 10 leading causes of death in the United States and Canada are the same for both dentist and non dentist population groups, and that the percentage of deaths by the same cause are remarkably similar. By 1975, the year of the most recent U.S. study, the average age at death for white male dentists was about three years higher than for all adult white males. Although suicide standard mortality rates are known to be higher for dentists, suicide deaths have also been shown to be a factor in many other occupations, particularly those where there is easy access to drugs. Although updated actuarial data for dentist mortality are needed, the available data indicate no reduction in the life expectancy of practising dentists, nor any specific or disproportionate rates of disease associated with high mercury exposure. In fact, the available mortality studies are generally optimistic about the health of dentists, which should reassure patients about the safety of dental amalgam.

Adult↗

Oral lichen planus: hypersensitivity to dental restoration material.

67 patients with oral lichen planus of the atrophic-erosive or reticular plaque type were examined. Dental amalgam in contact with mucosal lesions was present in 64 patients, and gold fillings in 33. Patch testing with a standard procedure was performed with components of dental fillings. 11 patients (16%) reacted to at least one of the mercury compounds compared to 8% in a reference group. Most positive reactions were caused by elemental mercury and ammoniated mercury. No patient reacted to gold or copper. Readings at days 10-14 did not increase the number of responders. 13 patients were patch tested with palladium; all were negative. It is not clear whether in the mercury-positive patients allergy to dental amalgam is a causative or aggravating factor, or merely on epiphenomenon.

Adult↗

Amalgam--resurrection and redemption. Part 2: The medical mythology of anti-amalgam.

Mercury-containing amalgam restorative material has come under attack for its alleged harmful effects on systemic health. A literature search revealed that amalgam restorations release small quantities of mercury but apparently not enough to cause systemic health problems. Mercury from dental amalgam restorations cannot be linked to kidney damage, Alzheimer's disease, multiple sclerosis, other central nervous system diseases, "amalgam disease," mental disorders, damage to the immune system, increases in antibiotic resistance, or harmful reproductive effects. Dentists occupationally exposed to mercury have not been shown to suffer harmful reproductive or other systemic health effects, provided proper mercury hygiene is used. There are legitimate health concerns about alternative restorative materials, including resin composite. According to the latest scientific information available, dental amalgam remains a safe and effective restorative material.

Animals↗

Oral lichenoid reactions related to mercury sensitivity.

Lichen planus is a common disorder of unknown aetiology. It has been proposed that in some cases it represents a form of allergic reaction to the metals contained in dental amalgam, particularly mercury. Twenty-nine consecutive dentate patients who had lichen planus of the oral mucosa were patch-tested to the range of metals contained in dental amalgam. Ten out of 29 (34%) showed an allergic reaction to mercury and all of these patients had amalgams greater than 5 years old. The amalgams were poorly contoured and had corroded, resulting in continued release of mercury ions. Six patients had their amalgams replaced with composite or glass ionomer materials resulting in resolution of ulcerated lesions. In a follow-up of 3-24 months, one patient had a recurrence of ulcerated areas and another, despite resolution of the oral lesions had persistent discomfort.

Adult↗

The location of zinc in dental silver amalgam.

The phases in amalgams prepared from alloys of varying zinc content and with varying alloy-to-mercury ratios have been determined by means of X-ray diffraction. By measuring lattice constants of the phases in these amalgams it has been established that the major part of the zinc is dissolved in the gamma1 phase.

Dental Alloys↗

Lubricating coolants for high-speed dental handpieces.

Cutting studies were performed on tooth enamel, dental amalgam, and composite resin through use of carbide burs and diamond stones with three irrigants. A mixture of water, alcohol, and glycerol significantly increased the rate of material removal when enamel was cut with diamonds and when dental amalgam was cut with diamonds and carbide burs. In contrast, the rate of material removal for composite resin was significantly faster with use of carbide burs than diamond stones, and the irrigant improved the cutting action for carbide burs. The studies indicate that chemomechanical effects operate with dental substrates, but the effect varies with the material being cut and the cutting tool used. The chemomechanical effects observed here significantly improve the rate of material removal with diamond stones and carbide burs.

Carbon↗

The physical properties of a gallium alloy restorative material.

OBJECTIVES: This study was conducted to compare the physical properties of a gallium alloy restorative material and a widely used mercury-containing dental amalgam. METHODS: Although the specimens were not prepared according to ISO specifications, specimens of both materials were subjected to ISO standard (ISO 1559; 1986) tests. The results were analyzed by ANOVA, Mann-Whitney U test and Student's t-test. RESULTS: The gallium alloy showed setting expansion which was greater than that for the other amalgam and greater than the upper limit set by the ISO standard. For other properties, gallium alloy performed as well as, and in the case of creep, was superior to that of the amalgam. SIGNIFICANCE: The gallium alloy proved difficult to manipulate even when using the PTFE coated instruments recommended by the manufacturer. It is suggested that while the material may prove to be a viable alternative to conventional dental amalgam, a considerable improvement in its handling characteristics would be required before it would gain widespread acceptance for clinical use.

Alloys↗

Lymphocyte levels in subjects with and without amalgam restorations.

The claim that mercury from dental amalgam produces "reduced immunocompetence" was examined by measuring the levels of the three major populations of lymphocytes on 37 subjects--21 with amalgam restorations and 16 without. The results of this study show no indication that amalgam restorations affect the human immune system nor do they support the "reduced immunocompetence" claim.

Adult↗

Clinical evaluation of marginal fracture of amalgam restorations: one-year report.

Fourteen dental amalgam alloys were used in this study. After 1 year, amalgam restorations were evaluated for fracture at the margins. The clinical results indicated that Dispersalloy, Indiloy, a high-copper blend by Syntex, Cluster, and Unison had the least marginal failure. This was followed by Premalloy, Cupralloy, Tytin, Cupralloy ESP, and Contour. Velvalloy and Sybraloy and Orosphere II were the third major grouping with Summalloy having the most fracture at the margins. Different batches of the same alloy performed similarly. The correlation between creep and ridit means (fracture at the margins) was not found to be statistically significant.

Dental Amalgam↗

Effect of iodine on mercury concentrations in dental-unit wastewater.

OBJECTIVE: This study was undertaken to determine whether iodine used to control bacteria in dental unit waterlines could increase mercury concentrations in dental wastewater. METHODS: The study was conducted in four parts. Part 1. Solutions containing iodine in concentrations ranging from zero (control) to 20 mg/L were mixed with ground and sieved dental amalgam and then allowed to equilibrate by settling. Cold vapor atomic absorption spectrometry was used to determine mercury levels in the settled supernatants at 24 h and at 7 days. Part 2. Deionized water was pumped through an iodine-releasing water-treatment cartridge, collected, and mixed with ground and sieved dental amalgam. Mercury levels in settled supernatants were measured at 24 h and at 7 days. Part 3. Iodine in water from two commercial iodine-releasing cartridges was measured using Inductively Couple Plasma Mass Spectrometry. Part 4. Baseline mercury levels in settled supernatants from wastewater collected from two dental chairs were compared to samples taken from chairs equipped with iodine-releasing cartridges. RESULTS: Part 1. A linear correlation between iodine and mercury concentration (r2=0.9167 and 0.9459, respectively, both P<0.001) was seen at both 24 h and 7 days. Part 2. Mean mercury levels in 24h samples were 3.0 times higher than the controls (0.2864 mg/L compared with 0.0939mg/L for the 24 h controls). Mean mercury levels in the 7-day samples were 5.9 times higher than the 7-day controls (0.2048 mg/L compared with 0.0348 mg/L for the 7-day controls). Part 3. The effluent from two iodine-releasing cartridges showed iodine concentrations averaging 3.2 mg/L (n=10, SD=0.8, range=2.5-4.6). Part 4. Data from the clinical study showed a statistically significant 2.5-fold increase in mercury levels with iodine-containing samples compared to baseline (0.0853 mg/L, n=18, SD=0.0441 and 0.0345 mg/L, n=18, SD=0.0145, respectively; P<0.001). SIGNIFICANCE: Data suggest that iodine can increase concentrations of dissolved mercury in dental unit wastewater.

Dental Amalgam↗

The comparative leakage behavior of reverse filling materials.

This study compares the in vitro apical seal achieved with thermoplasticized gutta-percha used with and without a sealer cement and that achieved with dental amalgam and a varnish liner following an apicoectomy and a Class I preparation of single root teeth. The teeth were immersed in methylene blue dye for 10 days, were sectioned longitudinally, and the amount of leakage was determined. No difference in leakage was found between the apical seals achieved with thermoplasticized gutta-percha used with a sealer cement and that obtained with dental amalgam with varnish. The leakage found with thermoplasticized gutta-percha used without a sealer cement was significantly greater.

Dental Amalgam↗

Mercury content in amalgam tattoos of human oral mucosa and its relation to local tissue reactions.

Mucosal biopsies from 48 patients with and 9 without amalgam tattoos were analysed with respect to their mercury content, distribution of mercury in the tissue, and histological tissue reactions. The distribution of mercury was assessed by autometallography (AMG), a silver amplification technique. The mercury content was determined by energy dispersive X-ray fluorescence (EDXRF), a multielemental analysis. Mercury was observed in connective tissue where it was confined to fibroblasts and macrophages, in vessel walls and in structures with the histological character of nerve fibres. A correlation was found between the histopathological tissue reaction, the type of mercury deposition, the intensity of the AMG reaction, and the mercury content. Mercury was also found in patients with amalgam dental fillings but without amalgam tattoos.

Adult↗