Praxis Hamann

Amalgam replacement
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Amalgam in everyone's mouths

This equivocal sentence describes the problem confronting dental medicine during the past years. As a result of public discussions, patients are aware and unnerved about the risks concerning the application of amalgam as a dental-medical filling material.

Since amalgam was traditionally used exclusively and without limitation as a filling material, the majority of the population feels directly affected. More and more amalgam fillings are now being exchanged with other filling materials.

This is partially due to cosmetic reasons, as amalgam is a very dark material and so impairs a “beaming white smile”. In addition amalgam is composed out of different metals, which makes patients question whether or not it might jeopardize their health. Furthermore, dentists recommend the exchange of amalgam for clearly defined reasons – for example over sized, under sized or broken fillings. Other possibilities are to use different kind of synthetic fillings and inlays made of ceramics or gold.

Reasons for the exchange of amalgam fillings - patient's wishes

Patients themselves sometimes prefer the exchange of the amalgam fillings for cosmetic reasons, meaning they prefer not to have dark fillings as they value an all round “white” smile or because they favor a high quality therapy.

Some patients also express health-related worries concerning the exchange: They fear that different metal fillings may lead to micro streams, with the result of health damages. Other patients fear that amalgam is the reason for their health discomfort.

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Amalgam fillings

Reasons for the exchange of amalgam fillings – dental-medical recommendation

An amalgam exchange can occur, in certain cases, on the recommendation of the dentist. The reasons can be over sized, under sized or broken fillings, fillings without contact to the recumbent or opposite tooth, those with cavaties on the edge or ones which have been "repaired"several times, fillings which are visible when the patient smiles or with patients who suffer from mercurial idiosyncrasy (extremely sensitive to mercury).
The exchange of amalgam is performed under individually necessary precautions and ranges from strong water application with good suction up to putting on a so-called suitcase dam (elastic rubber protection). A variety of synthetic fillings and ceramic or gold inlays are possible substitutes.
In some cases an amalgam removal is also possible in a medicinal way.
What is this material really all about?

Amalgam is a substance consisting a metal powder and mercury (HG). If a silver-tin-copper-powder is mixed with mercury, a knead-able malleable paste arises: the dental-medical amalgam. Extensive and intensive mixing of the components is decisive for the qualities of the amalgam. Approximately 10 - 30 minutes remain afterward for the dentist to apply the filling material in the tooth and to mold the suitable form for the desired bite. After one hour, the filling is able to withhold a certain load - after 24 hours it has reached the expected firmness.

The advantages of the material are based on the following points

  • all in all an easy, inexpensive and quick filling technology is possible,
  • it is usable in a variety of ways and easy to process
  • no high demand appears in relation to a form of the dental defect
  • high breaking and pressure resistance
  • long durability and clinically tested

However, the disadvantages are

  • aesthetically unattractive color
  • not usable in the front teeth area
  • fractures give way to possibility of renewed caries formation
  • discolorations of the tooth
  • indispensability of an under filling
  • health danger for the dentist if not processed correctly
  • potential allergic and toxic danger by - even if low – an additional burden of the organism by mercury.

From copper amalgam, very seldom from noble amalgam, mercury (Hg) can penetrate the organism in the smallest amounts. Indeed, it can be spoken of an Hg endangerment, yet not of an Hg poisoning.

  • copper amalgam should cease to be used
  • the correct processing of the amalgam is important in order keep the Hg delivery as low as possible; noble amalgam seldom dissolves

Application restrictions

  • retrograde root fillings, since the material comes in direct contact with the bone tissue
  • construction fillings under poured crowns, as the meeting of two different metals causes electric conductivity

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