Safely Removing Amalgam Fillings

Many people have old amalgam fillings that have broken down and need replacement.

In other cases, advice from naturopathic doctors or other medical personnel catalyzes patients to ask for amalgam removal. Sometimes amalgam fillings are replaced because a patient does not like the aesthetics of the metal.

However, according to the Canadian and American Dental Associations, these filings are still considered safe, and St. Lawrence Dentistry does not recommend removing them because they are metal fillings. St. Lawrence Dentistry has not placed amalgam fillings in many years; however, Dr. Hawryluk Jr. routinely removes them. Our clinic follows critical steps 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. Their use has significantly declined in North America and Europe, and St. Lawrence Dentistry phased out, placing these fillings years ago. However, millions of people in Canada still 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.

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 as 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 can avoid ‘micro gouging’ the underlying tooth, injuring the dental pulp.

For the health and safety of our patients, Dr. Hawryluk Jr. uses a dental dam when removing amalgam fillings. This barrier will act as a “safety net” to ensure no accidental swallowing of the metal while being removed from your tooth. The dam also increases Dr. Hawryluk’s view of the tooth, further improving the accuracy of the procedure. In addition, they are easy to place, and most patients find the dental dam very comfortable and are at ease, knowing no metal bits are going into their mouths. All in all, proper magnification and dental dam use are the two fundamental keys to safe amalgam removal.

Dr. Hawryluk Jr. accomplishes the amalgam removal using only very light pressure. If a dentist tries to speed up the process by pushing harder on the amalgam, they can overheat the underlying tooth. Instead, Dr. Hawryluk explains a dentist should flake the metal pieces out “little by little”. A brand new sterilized carbide bur must be used (instead of a bur previously used). A sharp bur means less pressure needs to be applied by the dentist. Sometimes multiple new carbide burs need to be used per patient if the patient has several amalgam fillings to be removed. In addition to the efficacy of using brand new burs, it is also more hygienic and safer (than re-sterilized burs).

Dr. Hawryluk Jr. uses two high-volume suction tips in the removal process. He has found that just having one suction tip next to the amalgam is not 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. Dr. Hawryluk can place the smaller tip right next to the tooth and bur without inhibiting the view of the dentist. Using two suctions at once also means the office’s 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 removal, it is time to place a new composite resin filling. Here, a few extra steps can ensure your tooth is not left sensitive from the process. First, a copious amount of bonding agent is critical, and it must be judiciously burnished into the tooth (as opposed to just scantly applied). At St. Lawrence Dentistry, we use G-Premio BOND, a universal, 8th generation bonding agent from GC Corporation. This patented formula reduces sensitivity issues when filling and ensures a strong bond of the new composite filling to your tooth. Finally, the new composite filling must be packed appropriately 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 long-lasting and sensitivity-free new fillings. If you live in the Mississauga/Toronto area and would like to discuss removing amalgam fillings, please contact St. Lawrence Dentistry.