If an amalgamate filling is not tight, then it must be removed – removal of amalgamate fillings.

As a patient, you should be able to see the black gap (shown by the black arrows) between tooth and filling, a sign that it is not tight.

Fortunately, it is not necessary to remove the entire filling, a cross section cut is usually enough for parts of the filling to break out. In this picture you can see the cuts – shown by the black lines – drilling here allows large portions of the filling to fall out. This procedure results in less mercury exposure for you and the doctor.

In order to reduce this exposure even more, it is advisable to use a metal drill (seen to the right in the picture) – known as an amalgam jetter – instead of a diamond drill (to the left in the picture).

This video shows this type of amalgamate removal, the dark areas underneath the amalgamate filling are in part discolorations, but also secondary cavities. Most of the mercury is released during the drilling and depositing of the fillings – in the form of vapors. The coffer dam does not protect against these vapors, but it prevents pieces of the filling from entering the air pipes, which would cause a more severe complication. The fine amalgamate sand is also kept in check by the rubber membrane.
Without a coffer dam, the amalgamate sand spreads throughout the mouth and is swallowed.