Many people have old amalgam fillings which have broken down and need to be replaced. In other cases, advice from naturopathic doctors or other medical personal acts as a catalyst for patients to ask for amalgam to be removed. Sometimes they are replaced because a patient does not like the esthetics of the metal. These fillings are still considered safe according to the Canadian and American Dental Associations and St. Lawrence Dentistry does not recommend removing them just on the basis that they are metal fillings. St. Lawrence Dentistry has not placed amalgam fillings in many years however Dr. Hawryluk Jr. routinely removes them. There are a few key steps which are followed at our clinic to ensure these fillings are removed safely and without precipitating injury to the tooth nerve.
Dental amalgam fillings have been around for over 150 years and historically were considered the dental material of choice. There use has significantly declined in North America and Europe and St. Lawrence Dentistry phased out placing these fillings years ago. However, there are still millions of people in Canada which have amalgam fillings in their teeth . Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. Approximately 50% of dental amalgam is elemental mercury by weight. The chemical properties of elemental mercury allow it to react with and bind together the silver/copper/tin alloy particles to form an amalgam. (FDA.gov).
Dr. Hawryluk Jr. uses a Global Dental Microscope to remove deep amalgam fillings and believes simple dental loupes do not offer enough acuity in certain situations such deep fillings in the very back molars. A global dental microscope is superior in both magnification and resolution in these situations over simple magnifying glasses. Magnification is the ability to make small objects seem larger. Resolution is the ability to distinguish two objects from each other. When you have proper magnification and resolution the dentist will not micro gouge the underlying tooth which can injure the dental pulp.
A dental dam should be used when removing amalgam fillings. The dam will act as a ‘safety net’ to ensure no pieces of the metal are being swallowed as the pieces are removed and also gives the dentist a better view of the tooth. They are easy to place and most patients actually find them very comfortable and are at ease knowing no metal bits are going into their mouth. When you combine the use of the dental dam with the microscope the field of view for the dentist is at its ideal.
The removal of the amalgam should be done with very light pressure. If the dentist tries to speed up the process by pushing harder on the amalgam the underlying tooth can be overheated. The metal pieces really should just be flaked of ‘little by little’. A brand new carbide bur must be used (as opposed to a bur previously used and sterilized). A sharp bur means less pressure needs to be applied by the dentist. Sometimes multiple new burs need to be used per patient if several fillings are being removed at once. In addition to the efficacy of using brand new burs it is also more hygienic and safer (than re-sterilized burs).
Two high volume suction tips should be used in the removal process. Dr. Hawryluk Jr. has found that just having one suction tip next to the amalgam being removed is not necessarily enough to ensure all pieces and vapor from the removal process are successfully collected. At St. Lawrence Dentistry we use one large suction and one smaller tip. The smaller tip can be placed right next to the tooth and bur without inhibiting the view of the dentist. Using two suctions at once also means the offices suction motor must be strong enough to accommodate the increased suction power needed to operate in this scenario while supporting the other operatories in use.
After the amalgam is removed it is time to place a new composite resin filling. A few extra steps here can ensure your tooth is not left sensitive from the process. A copious amount of bonding agent must be used and it must be judiciously burnished into the tooth (opposed to just scantly applied). At St. Lawrence Dentistry we use G-Premio BOND which is a universal, 8th generation bonding agent from GC Corporation. This patented formula reduces sensitivity issues when placing fillings and ensures a strong bond of the new composite filling to your tooth. Finally the new composite filling must be properly packed in small increments and cured the ideal amount to ensure a solid composite filling.
As you can see there are several steps to consider for safely removing old metal fillings and obtaining a long-lasting and sensitive free new fillings.
If you live in the Mississauga/Toronto area and would like to discuss this removing amalgam fillings please contact St. Lawrence Dentistry.