Everyday we see people with broken teeth and toothaches by old silver fillings that have expanded with temperature and time like the mercury in old thermometers. These teeth now need crowns, root canals or extractions. Frequently, there's decay under the fillings due to the fact that they were done before recent advances in caries (decay) detectors and bonded restoreations to seal out the decay from forming at the margins.
We follow the IAOMT protocol for removal of amalgam fillings. We remove amalgam fillings under a rubber dam for isolation and your protection. We use special air filters and an oxygen mask (with or without nitrous oxide) to help reduce your inhalation of mercury. Generally speaking, teeth that have been prepared for silver fillings have holes that are simply too big or undercut to replace with direct bonded composite fillings. We remove the silver fillings, use a decay detector to eliminate any decay, insulate the tooth, take an impression and fabricate a piece of polymer resin in the laboratory under heat, pressure and light, and then bond it in the same appointment. Rather than "cut the teeth down for crowns", we prefer to put the tooth back together like a jigsaw puzzle with a one-appointment onlay. The more we save of your natural tooth, the better you feel. Of course, in certain circumstances, crowns are necessary.
