How to remove amalgam fillings correctly?
Perhaps you have noticed that you have some amalgam fillings in your mouth that over the years have become darker, or with shades very different from the color of your natural teeth, and surely you have wondered: How can my dentist remove fillings? Metals correctly, changing them to white fillings, and when should you do it?
Stay with us! That in this article, we tell you everything you need to know.
First, we should discuss a few facts about dental amalgam as a material. Since the beginning of contemporary dentistry in the 19th century, dental amalgam has been a widely used material by dentists worldwide.
Due to their longevity, strength, adaptability in posterior cavities, and low market cost, amalgam restorations, also known as amalgam fillings, have been a material of choice for dental professionals for many years.
Made up of a combination of metals, including mercury, silver, and tin, dental amalgam has been extremely useful to the dentist for over 100 years, especially when back teeth require broad and robust fillings and also when it is tough to keep the area dry, and the dentist needs to restore quickly.
Nowadays, it is not uncommon to find people with multiple amalgam fillings in their mouth, some of them with restorations up to 10 or 15 years old, and even more.
However, despite all the benefits of amalgam, and its widespread use for so many years, mercury fillings have three significant disadvantages: the lack of aesthetics of the material, the need to repair the tooth (requiring the removal of healthy dental tissue in some cases):) and the negative impact of mercury on the environment and the patient.
There are two completely conflicting ideas on this subject. On the one hand, many people think that amalgam fillings are toxic to the body due to the continuous release of mercury.
On the other hand, contrary to what many people think, according to the US Food and Drug Administration (FDA), the Council of European Dentists, and the Council of Dentists of Spain, dental amalgam is a reliable and safe material for patients. Defending that, when the mercury is combined with the other elements, it becomes a homogeneous and stable material, incapable of causing damage to the body—emphasizing that there is not a single reported and proven case of poisoning or illness from having amalgam fillings to date. Amalgam continues to be a material of choice for certain particular circumstances in certain countries. However, since July 2018, its use has been prohibited in the European Union for certain patients to ensure adequate waste management of this material and limit its environmental contamination.
Currently, the leading cause for removing and replacing mercury fillings is lack of aesthetics, which is an important aspect required by most patients, followed by fractures of the material that are generally associated with the age of the filling and exposure to high masticatory forces.
Another significant disadvantage of amalgam fillings is the color they acquire after a couple of years. Unlike filling resins, which are white to match the natural color of your teeth, metal fillings turn dark and often require even more tooth tissue to be removed when they need to be replaced.
On the other hand, thanks to the American Dental Association (ADA) publications, countries such as Canada and Germany recommend removing amalgam fillings correctly before pregnancy. A series of studies have shown the relationship of possible complications of the fetus with the mother’s mercury fillings.
Given the considerations as mentioned earlier, we understand that dental amalgam continues to be a valuable material for the dentist, with aesthetic limitations for patients, which requires special care at the time of its removal and replacement, by composite materials or other polymers of proven quality, as well as adequate management of waste to avoid environmental contamination.
Now, when the patient requires the replacement of the restoration, and the dentist decides to remove the metal filling, he must do so according to specific criteria, with adequate care to guarantee not only the complete removal of the material, which must be eliminated, but also that you must do it correctly so as not to remove healthy dental tissue and thus place a new aesthetic, lasting, and successful filling.
The dentist must study and plan each patient’s case carefully and rigorously. Most failed metal fillings are identified through clinical oral examination or radiographic and tomographic studies. This is because the dentist usually does not know how deep or wide a restoration made by another professional can be, so taking all precautions is the best thing to do.
During the removal of the mercury filling, the dentist must be very careful with the remains of the material that is being removed, taking care of the tongue, cheeks, throat, and the patient in general through the use of cotton rolls and a correct high suction cannula at all times.
Finally, when removing the amalgam filling, the professional verifies that there is no affected or diseased dental tissue and prepares the tooth surface to receive an aesthetic restoration made of composite resin or ceramic materials, providing the best results—esthetics required by the patient.