SMART Removal

Safe Mercury Amalgam Removal Technique

What is SMART removal?

SMART stands for Safe Mercury Amalgam Removal Technique. This technique was developed by the International Academy of Oral Medicine and Toxicology (IAOMT) to minimize the patient’s exposure to mercury during the removal of silver amalgam fillings.

Our Protocol

Patient does a pre-rinse with activated charcoal
Patient protective equipment is applied: safety glasses, face barrier, full body barrier, hair covering
Operator protective equipment is applied: Glasses/face shield, charcoal mask, operator mask, gown, hair cover, gloves
Non-latex rubber dam applied
Bite block and saliva ejector are placed under rubber dam
External oxygen source is administered
Windows are opened during procedure (weather permitting)
Den Air Vac oral aerosol vacuum placed close to patient’s mouth
Filling removed using chunking technique
During removal, constant water spray and use of additional high speed suction
Laser used to remove debris from dentin tubules
Once amalgam is removed, the rubber dam is removed and mouth is rinsed thoroughly with water
Patient rinsed with activated charcoal
The office uses an amalgam separator and air purifier at all times to minimize environmental exposure

Facts about mercury

Mercury is toxic.
Mercury is known to be released during placement, replacement, and removal of dental amalgam fillings.
Dental amalgam fillings are made of a mixture of mercury, silver, copper, tin and sometimes zinc. All dental amalgam fillings are 45-55% elemental mercury.
Dental mercury and its vapor have been scientifically linked to a number of health risks which demonstrate the danger of dental amalgam mercury fillings.
Individual response to mercury varies, and factors known to potentially impact response include allergies, diet, gender, genetic predispositions, the number of amalgam fillings in the mouth, and exposure to other toxic chemical such as lead.
Pregnant women, children, dentists, and dental personnel who routinely work with dental amalgam are known susceptible populations.

Before: Leaky amalgam filling with recurrent decay

After amalgam was removed, there was extensive staining and recurrent decay

After decay was removed some staining still remains

After laser disinfection. Laser helps clean out dentin tubules that the drill cannot reach and helps remove stain without trauma to the pulp of the tooth

After: New filling was placed using Admira Fusion ceramic based material

Dr. Aronson discusses SMART removal

Hours

Monday to Thursday
8am to 5pm

The information provided on this site is not intended as medical or dental advice and should not be interpreted as such. The intent is to provide as much scientific information as possible on different dental materials and aspects of dentistry where controversy exists and scientific clarification would be of benefit to patients, staff, dentists, physicians and scientists in making informed judgements. If you seek medical or dental advice, please consult with a health care professional. You must always exercise your own best judgement when using the services of any health care practitioner