What Happens During SMART Amalgam Removal? A Step-by-Step Guide

If you have older silver fillings and are considering having them replaced, you may have heard that removing amalgam requires special precautions. Dental amalgam contains mercury. During removal, drilling into an amalgam restoration can generate mercury vapor and small particles. This is why some patients specifically seek a dentist trained in mercury-safe amalgam removal rather than having the filling removed using conventional techniques.

At Phoenix Biological Dentistry, we follow the Safe Mercury Amalgam Removal Technique (SMART) developed by the International Academy of Oral Medicine and Toxicology (IAOMT). Here is what patients should know about the process.

What Is a Dental Amalgam Filling?

Dental amalgam has been used to restore teeth for generations. It is commonly called a "silver filling" because of its appearance, but it is actually made from a combination of metals. Mercury makes up a significant portion of dental amalgam and binds the other metals together to form a durable restorative material.

Phoenix Biological Dentistry does not place new amalgam fillings. Instead, we offer metal-free restorative materials when clinically appropriate. We also see patients who already have amalgam fillings and want to discuss whether they should be replaced.

Should You Remove Your Amalgam Fillings?

Having an amalgam filling does not automatically mean it needs to be removed. There are several reasons someone may consider replacement. A filling may be cracked, leaking, deteriorating, or surrounded by decay. A tooth may also require a different restoration because its condition has changed.

Other patients have amalgam restorations that are functioning but prefer to replace them with metal-free materials. The decision should be made individually. Removing any dental restoration requires working on the tooth, and replacing a filling should not be treated as a completely risk-free procedure. A dental examination can help determine the condition of the restoration and what options are available.

What Is SMART Amalgam Removal?

SMART stands for Safe Mercury Amalgam Removal Technique. The protocol was developed by the IAOMT to reduce exposure to mercury vapor and amalgam particles during the removal process. Instead of treating amalgam removal like the removal of any other filling, SMART incorporates additional protective measures for the patient, dental team, and treatment environment.

What Happens During SMART Amalgam Removal?

The exact appointment varies depending on the number, size, and location of the fillings being removed, but the SMART process incorporates several important precautions.

1. The Treatment Area Is Prepared

Before the filling is removed, protective measures are put in place to help control particles and vapor generated during the procedure. The dental team also uses appropriate protective equipment as part of the SMART protocol.

2. The Patient Is Protected

Protective barriers are used to limit the patient's exposure to particles produced during removal. The goal is to isolate the treatment area as much as reasonably possible while keeping the patient comfortable throughout the procedure.

3. A Rubber Dam Is Used to Isolate the Tooth

A rubber dam creates a physical barrier around the tooth being treated. This helps prevent pieces of amalgam and other debris from entering the rest of the mouth during removal.

4. High-Volume Suction and Air Filtration Are Used

Controlling mercury vapor and particles is an important part of SMART amalgam removal. High-volume evacuation is positioned close to the tooth to capture material as the restoration is removed. Additional air filtration and evacuation equipment may also be used to help control the treatment environment.

5. Water Is Used During Removal

Water helps keep the filling cool while it is being removed. Heat can increase mercury vapor release, so maintaining cooling during the procedure is another component of reducing exposure.

6. The Amalgam Is Sectioned Into Larger Pieces

Rather than unnecessarily grinding the entire filling away, the dentist can section the restoration and remove larger pieces when possible. This reduces the amount of drilling directly through the amalgam material.

7. The Tooth Is Cleaned and Evaluated

Once the amalgam has been removed, the tooth underneath can be evaluated. This step is important because the condition of the tooth cannot always be completely determined before an old restoration is removed. There may be decay, cracks, or weakened tooth structure underneath or around the filling. The final restoration is selected based on what the tooth actually needs.

What Replaces an Amalgam Filling?

Removing the amalgam is only half of the treatment. The tooth still needs to be properly restored. The best restoration depends on how much healthy tooth structure remains. A smaller area may be restored with tooth-colored composite. Teeth with larger restorations or weakened areas may benefit from a ceramic inlay or onlay. In other situations, a ceramic crown may provide the support the tooth needs.

At Phoenix Biological Dentistry, we focus on metal-free restorative options while preserving healthy natural tooth structure whenever possible.

What Should You Expect After Amalgam Removal?

Your experience after treatment depends largely on the tooth and the type of restoration placed. Some patients experience temporary sensitivity to temperature or pressure after dental work. This often improves as the tooth settles. If your bite feels uneven or the tooth remains uncomfortable, contact the dental office. A minor bite adjustment may sometimes be needed. Your dentist will provide instructions based on the specific procedure and restoration you received.

Can All of Your Amalgam Fillings Be Removed at Once?

For some patients, treating several teeth during one visit may be reasonable. For others, dividing treatment into multiple appointments makes more sense. A treatment plan should be developed after examining the teeth rather than deciding based only on the number of amalgam fillings present.

Why Does the Removal Technique Matter?

Patients sometimes focus entirely on what material will replace their amalgam fillings, but the removal process matters too. Drilling through amalgam can generate mercury vapor and particles. SMART provides a structured protocol intended to reduce exposure during that process. The condition of the tooth also matters. Once the old filling is removed, the dentist needs to restore the tooth in a way that protects the remaining structure and provides a durable result. For patients interested in mercury-safe dentistry, both parts of the procedure are important.

SMART Amalgam Removal in Phoenix

If you have silver amalgam fillings and are considering replacing them, the first step is to evaluate the teeth and discuss your options. At Phoenix Biological Dentistry, we provide SMART amalgam removal for patients seeking a mercury-safe approach to replacing existing amalgam restorations. We also offer metal-free restorative options, including composite and ceramic restorations, depending on the needs of the individual tooth.

Contact our Phoenix office to schedule an evaluation and learn whether amalgam replacement is appropriate for you.

Frequently Asked Questions

Is SMART amalgam removal safe?

SMART incorporates specific protective measures designed to reduce exposure to mercury vapor and amalgam particles during removal. As with any dental procedure, treatment should be evaluated based on the individual patient and tooth.

Does removing amalgam release mercury vapor?

Drilling an amalgam restoration can generate mercury vapor and particles. SMART uses measures such as water cooling, isolation, high-volume evacuation, and sectioning the restoration to reduce exposure during removal.

How long does SMART amalgam removal take?

Appointment length varies based on the size, number, and location of the fillings being treated and the restorations needed afterward.

Can all of my amalgam fillings be removed in one appointment?

Sometimes, but not always. The appropriate schedule depends on the number and condition of the teeth and the amount of restorative treatment required.

What replaces an amalgam filling?

Depending on the tooth, options may include tooth-colored ceramic filling, a ceramic inlay or onlay, or a ceramic crown.

Does dental insurance cover SMART amalgam removal?

Coverage varies by insurance plan and why the restoration is being replaced. Patients should review their individual dental benefits to determine what may be covered. Phoenix Biological Dentistry is an out of network provider.