Amalgam Filling Removal

Amalgam is an alloy that consists of 50% mercury, the most toxic non-radioactive element in the periodic table.
When installed in the teeth, amalgam fillings constantly release small amounts of mercury through mechanical abrasion, corrosion and the release of mercury-containing vapors during chewing. These mercury molecules are then absorbed into the body via mucous membranes, ingestion and the lungs and deposited in organs, fatty tissue and nerve tracts.
This results in toxicological and immunological effects, which can have a noticeable impact on the health of those affected.

Amalgam fillings were placed in the mouth for many decades to repair broken teeth. Even today, amalgam is still used in many dental practices around the world because its ease of processing and durability are highly valued.

To find out more about amalgam, please read the article Amalgam fillings.

When removing an amalgam filling, the drilling process naturally results in a drastically increased amount of mercury vapors and amalgam particles, from which both the patient and the practice staff must be effectively protected.
At Alpine BioDental, this is achieved through a whole series of closely coordinated measures that ensure the best possible protection for everyone involved:

The amalgam filling is removed completely in one piece without having to drill into the metal. The formation of amalgam chips, toxic vapors and the final exposure to mercury can thus be reduced to a small fraction. The correct choice of instruments, a great deal of experience on the part of the therapist and a careful, precise approach are prerequisites. Although the technique requires more time, it offers great safety for the patient, dentist and practice staff.

A special suction device, which is placed tightly around the respective tooth with a silicone sleeve, absorbs practically all particles and vapors directly where they are produced when the tooth is drilled out. Care should be taken to use a central suction machine with high performance.

Even if the correct technique and the CleanUp suction device already ensure that virtually no vapors are released that could be inhaled by the patient or the treatment team, the airways of everyone in the room (patient, dentist, assistant) are protected with a gold-coated mask.
Gold has a high binding affinity to mercury. This means that the last mercury molecules not captured by the other measures remain trapped in the gold coating of the mask. Alternatively, FFP3 masks can also be used, but these have a poorer filtration value.

As an additional safety measure, a high-performance HEPA room air filter, which is able to remove particles down to a size of 0.003 micrometers from the air, also runs during amalgam removal. The suction device is positioned above the patient in such a way that an air suction is created away from the patient’s mouth and the treatment field in the direction of the air filter.

Once all amalgam residue has been completely removed from the tooth, the cavity is filled with chlorella algae or activated charcoal to remove any remaining mercury residue on the surface.
bind. After removing the inlay, the cavity is disinfected with ozone. The tooth can then be restored and rebuilt with a high-quality resin filling or a ceramic inlay or partial crown.

A rubber dam is an elastic cloth that is stretched in front of the patient’s mouth using a frame and isolates individual teeth from the rest of the oral cavity. The rubber dam provides a tight, mechanical barrier for all amalgam particles, whereby the protection against mercury vapors is limited. The ability of mercury vapors to penetrate the rubber dam depends on the material, the thickness and the material expansion when stretched over the frame. A latex-free silicone with a thickness of at least 0.5 mm, which is used carefully without much stretching, is therefore preferable. Rubber dam can also influence the effective, dynamic suction of the CleanUp suction cup and, due to its roughness, offers a pronounced adhesion surface for amalgam particles. Furthermore, rubber dam can severely impair visibility and the space for precise work, which makes measure 1 very difficult. All these points lead to so many particles sticking to the rubber dam that it appears silvery and the emission of mercury vapors (the vapors are particularly harmful to health) increases significantly. As rubber dams offer both advantages and disadvantages when removing amalgam, their use is always decided on an individual basis.

To avoid symptoms and side effects after amalgam removal, safety precautions and protective measures are important, as careless removal can result in large amounts of mercury being absorbed into the body and making it ill.
Whether acute or chronic symptoms occur after removal depends largely on the amount of mercury ingested and the patient’s state of health. Weakened, older people with pre-existing conditions are less able to compensate for exposure than a healthy and young person.

If the amalgam fillings are removed under protection, the risk of acute amalgam poisoning with symptoms is very low.

Unfortunately, it is often the case that patients with previous amalgam fillings also have amalgam residues in their jaw. The complete cleaning of the jawbone is also part of the complete amalgam restoration and should not be neglected.

Amalgam residues enter the tissue in different ways:

Amalgam residues in the jaw can pose a massive health risk and should be removed carefully.

After the safe and harmless removal of the amalgam filling, it must be replaced with a high-quality and healthy alternative. Replacing the amalgam filling is important to protect and stabilize the tooth. In most cases, leaving a tooth defect in place is not an alternative.

Healthy alternatives to amalgam fillings are ceramic fillings, plastic fillings or ceramic crowns. The choice should depend on the size of the defect and stabilize the tooth as well as possible.

Ceramic fillings are the ideal choice for small to medium-sized tooth defects in terms of longevity and biology. They are made individually and accurately in the dental laboratory and can precisely restore the shape of the tooth.

It is also important to use the best possible cement or composite when fixing the ceramic filling.

Plastic fillings are a good and inexpensive compromise to ceramic fillings. They can only be considered if the tooth defect is rather small. Above a certain size, it is difficult to restore the tooth shape and tooth contacts, so ceramic fillings should be preferred.

A high-quality, healthy product should also be chosen for the material.

The ceramic crown is the best choice for unstable teeth with large tooth defects. The tooth is encircled by the crown and optimally stabilized.
They are produced by experienced dental technicians in the dental laboratory, taking into account the correct anatomical shape, accuracy of fit and aesthetics.

Once the amalgam has been removed under protection, the body can be gradually detoxified. However, as long as amalgam is present in the oral cavity, detoxification is not possible and can be dangerous because toxins can be redistributed.

There are various ways of removing amalgam.
The most effective detoxification can be carried out with the help of chelating agents such as DMPS, DMSA or EDTA. However, natural substances such as alpha-lipoic acid or glutathione also have good detoxifying properties.
In general, the removal of amalgam or mercury should always be supervised and monitored by an experienced doctor or alternative practitioner.

Many patients carry amalgam fillings around with them for a long time and do not know whether they should decide for or against amalgam removal. Here are some frequently asked questions on the subject.

The information listed contains relevant topics for a better understanding.