Tissue reactions to implanted dental amalgam, including assessment by energy dispersive x-ray micro-analysis.

Dental amalgam, either in the form of a solid rod or as a fine powder was implanted subcutaneously into guinea-pigs and the tissue reactions were examined after varying time periods. The solid rods were enclosed by fibrous capsules within which only extremely limited breakdown occurred. This appears to result from electrolytic corrosion of the gamma 2 (SnHg) phase of the rod's surface. Powdered amalgam induced granulomata and most of the particles of amalgam were actively digested by macrophages and giant cells. This resulted in the progressive loss of mercury and tin from the lesion and the formation of minute particles containing silver and sulphur which became widely distributed throughout the lesion, being associated with basal lamina, collagen and elastic tissue and giving rise to the formation of a tattoo. In contrast, some particles of amalgam, too large to be interiorised, were encapsulated by collagen and persisted almost unchanged. Intracellular small amalgam particles and aggregates of fine particles, resulting from their degradation, were seen within lymph node macrophages. It is extremely likely that the sequence of events leadng to the formation of an amalgam tattoo of the oral mucosa in Man are the same.