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Amalgam Replacement Issues

Holistic Dentistry

More and more patients are having amalgam fillings replaced in recognition of the potential health risks associated with mercury components of dental amalgam and to achieve a more aesthetic result especially for teeth exposed in a broad smile.

In kind, a growing number of dentists are providing this treatment. Unfortunately there is a simultaneous growing number of complaints of replacement failures, post operative pain, post operative sensitivity and displeasing cosmetic results.

More information about tooth fillings and sensitivity issues along with a demonstration video that shows the procedure on an actual patient can be found here.

Inasmuch as technical errors are perceived to be a growing factor in amalgam replacement failures, the Editorial Staff compiled additional technical information that may be beneficial for consumers to be aware of in the event of a failed treatment.

Existing Amalgam
In general terms, when amalgam restorations start to breakdown and the patient desires to change these into white bonded composite restorations, well tenured mercury replacement dentists tend to be mindful of certain factor prevent sensitivity or discomfort.

  1. Crowns - Overlays versus Resin: If the existing metal restoration width is already about 2/3 the width of the tooth, it is better to have an indirect restoration like an onlay or crown placed on the tooth. Otherwise it is not uncommon for the composite restorations to flex slightly during chewing and eating. The composite resin restorations are indicated for more conservative restorations.

  2. Moisture Control: When placing composite resin restorations, it is essential to isolate the tooth with either a dental dam or cotton rolls to prevent contamination from blood or saliva. In the past, amalgam restorations could be placed even in overly moist or wet conditions with negligible effect on the retentiveness of the filling.

  3. Excavation Step
    Amalgam Removed
  4. Over Etched - Over Dried: The protocols for placing composite restorations are more technique sensitive due to the chemistry that takes place when bonding to tooth structure, unlike amalgam restorations that are locked into place once set. During the stages of bonding, if the tooth is over treated with etchant or over dried after rinsing, the middle layer of the tooth can be dehydrated causing either hot or cold sensitivity and sometimes even tenderness to bite. To prevent this, the clinician usually keeps the preparation slightly moist to not over dry and disrupt the middle layer.

  5. Incremental Layering of New Filling Material: When filling with a composite resin material, it is essential to build up the filling and set it with the dental curing light incrementally. Since there is slight polymerization shrinkage when the material sets, a bulk fill will put added stress to the walls of the preparation. However, if the restoration is incrementally built up and cured at each level, then the shrinkage is much more at a minimum and usually patients donít exhibit sensitivity. Otherwise, with a bulk fill, the material shrinks, pulling on the inside walls of the preparation causing tenderness to bite or even open margins that have opened due to the stress on the edges of the restoration. These fillings usually end up having a black or dark mark at the edges of the filling material.

  6. Successful Resin Replacement
    Treatment Completed
  7. Old Deep Fillings: Most importantly, it is worth mentioning that most adults had their amalgam restorations placed during adolescence and these restorations have been functioning for over 15-20 years in the harsh conditions of the mouth, including hard biting forces, hot and cold changes, and acidic levels that eventually deteriorate most products. If the filling is deep to begin with, preparation for a new filling replacement can increase the risk of sensitivity and potential nerve involvement when the amalgam is removed.

  8. Normal Procedure Sensitivity: Every time a bur (motorized handpiece with grinding attachment) touches a tooth at several hundred thousand rpm... even with water cooling... generalized sensitivity occurs. This sensitivity, however, usually resolves and the tooth becomes asymptomatic over time. The patient can eat and function without discomfort. If tenderness or constant pain persists, it is essential the patient speak with their dental provider to eliminate pain and discomfort.
Editorial Staff

Portions of the technical information and outline provided by:
Ara Nazarian, D.D.S.
Michigan Reconstructive Implant Dentistry
1857 East Big Beaver Road
Troy, Michigan MI 48083
(248) 457-0500

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