How to remove amalgam quickly?

[toothmonster24]

Hi all! I have found myself having to replace amalgam fillings with composite for my patients for various reasons. It always takes me FOREVER to get amalgam out and it sticks to the walls of the prep. I use a 245 or round bur but I feel like it is too slow. Does anyone else have a different/faster way of doing this!?

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[FutureDent020]

Good lord, not a 245. Use a 1157 or 557, it’ll blow through it. Just let the patient know they’ll hear chipping and clicking as it’s flying out. I will say they are very aggressive, so for GP’s who want to stay away from the pulp, I’m not sure how often y’all use these. It gets large amalgams out in a minute though.

 

[oralcare123]

Diamond bur

 

[HatInTheCat]

You have to be strategic with the removal of amalgam. Using the wrong bur and/or strategy will overheat the amalgam and cause pulpal insult, resulting in RCT. Use a 557 and, if you’re afraid of that, a round nose diamond will work best. Section the amalgam from the periphery and work your way towards the middle of it. That way, you can physically remove the pieces, conserve tooth structure, and refine walls as needed.

Hope that helps!

 

[Alpha Centauri]

Make your goal getting it out in pieces rather than "excavating" like you would decayed tooth structure

 

[LFA20]

Hi all! I have found myself having to replace amalgam fillings with composite for my patients for various reasons. It always takes me FOREVER to get amalgam out and it sticks to the walls of the prep. I use a 245 or round bur but I feel like it is too slow. Does anyone else have a different/faster way of doing this!?

Use a big ass round bur on high speed

 

[Molar Whisperer]

I like Great White GW2 burs. If the existing amalgam looks big and deep, I tell the pt beforehand that the tooth may need RCT and or crown after the new fill. A fresh bur will cut thru like butter. The bur may not survive the 2nd sterilization so I try to save them for the big, nasty cases depending on your budget. Diamond burs may work great but they can be pricey. I tell the pts I will use pulpal protectant medicine (Lime-Lite bioactive liner) to minimize sensitivity so they won't think it is your fault if they do experience it.

 

[Carabelli's Lost Cusp]

Many good answers were given to you already. Here are some of mine:

Fillings:
#557 bur for amalgam
Any diamond bur for removing old composite

Crowns:
Fine (NOT course) diamond bur for zirconia crowns
Any diamond bur for porcelain followed by carbide bur for metal for PFM crowns

Another quick tip:
When removing a PFM, use a #330 bur as you section through the buccal/occlusal/lingual metal. This creates a nice slot to use a crown spreader...anything thicker than a #330 will cause the spreader to "slip" and not allow you to engage the slot to separate the crown.

Hope it helps.

 

[TanMan]

Hi all! I have found myself having to replace amalgam fillings with composite for my patients for various reasons. It always takes me FOREVER to get amalgam out and it sticks to the walls of the prep. I use a 245 or round bur but I feel like it is too slow. Does anyone else have a different/faster way of doing this!?

557 is probably the fastest way. A diamond bur takes a bit longer and generates a lot of debris. A difficult patient will gag and spit and do all sorts of motions if you try a diamond. If you use a 557, don't use a short shank. You want a longer shank, since due to the manufacturing tolerances, it will have a slight off axis rotation which causes the amalgam to chatter and shatter very rapidly. Amalgam will come flying out in seconds if you undermine it on the cavosurface margins.

For crowns, I'd somewhat disagree on the fine bur... fine is better if you have an air driven handpiece and you have minutes to spare. I would use an extracoarse shoulder bur on an electric handpiece with a vertical stroke (or cutting motion along the whole long axis of the bur) or laser to pop zirconia right off.

For bridges, what I like to do is numb the area under the pontic and stick a straight elevator underneath + twist. No need to section abutments, just elevate it like you'd elevate the tooth, and a lot less risk on fracturing the abutment. You're essentially using the alveolar bone as the fulcrum.

Edit: Round bur takes too long. Not a fan of it except for buccal/interproximal gingivectomies. I like a surgical length 557 for lingual gingivectomy/CL.

 

[schmoob]

Hi all! I have found myself having to replace amalgam fillings with composite for my patients for various reasons. It always takes me FOREVER to get amalgam out and it sticks to the walls of the prep. I use a 245 or round bur but I feel like it is too slow. Does anyone else have a different/faster way of doing this!?

Depending on the reason, you may not want to remove the amalgam. If it is a large amalgam with recurrent decay, don’t bother removing and replacing with composite. Just cut a crown using the amalgam as a core material. You are probably going to remove areas of compromised cavosurface margins anyway during your prep without removing excess tooth structure.

 

[setdoc7]

Now And Later, Tootsie Roll, or Twizzlers

 

[gryffindor]

Crosscut fissure bur. I feel like this was definitely a question on a restorative exam. "What is the best bur to remove amalgam?"

 

[allDAT]

I use a 245 and it’s fine. You move the bur around the outline for of the amalgam. They usually dislodged in 2 or 3 large chunks quickly.

 

[jwilson02]

One little tidbit. When using the 245, this is effectively for intents and purposes a side cutting bur. Tilt the bur into the amalgam to engage the cutting edge and then use your depth to make lateral cuts

 

[Rambunctious]

Hi all! I have found myself having to replace amalgam fillings with composite for my patients for various reasons. It always takes me FOREVER to get amalgam out and it sticks to the walls of the prep. I use a 245 or round bur but I feel like it is too slow. Does anyone else have a different/faster way of doing this!?

DOn't listen to anyone here. The best advice you're ever going to hear about removing amalgam is diamond 830 bur, thats it. Cuts like butter, but dont be heavy handed or you'll be changing treatment plan to RCT.

 

[Molar Whisperer]

DOn't listen to anyone here. The best advice you're ever going to hear about removing amalgam is diamond 830 bur, thats it. Cuts like butter, but dont be heavy handed or you'll be changing treatment plan to RCT.

I "agree" that is the best advice. Be sure you inform the pt before you start drilling. Do a few of those and you can afford a new car.

 

[TanMan]

DOn't listen to anyone here. The best advice you're ever going to hear about removing amalgam is diamond 830 bur, thats it. Cuts like butter, but dont be heavy handed or you'll be changing treatment plan to RCT.

A diamond 830 dulls out way too fast for everything but the smallest of all occlusal amalgams. Also, if you're dealing with an overtapered convergent prep with sharp line angles ala GV black, you'll be wasting more time trying to remove it with a diamond 830 than a carbide 557 with lots of water. OPs question was quickly remove amalgam and the quickest is a new 557.

I forgot to mention, use an electric handpiece. Air driven handpieces take too long for anything. NSKs are reliable but lower on the torque, Bien airs have higher torque, but have more reliability issues.

 

[Rambunctious]

A diamond 830 dulls out way too fast for everything but the smallest of all occlusal amalgams. Also, if you're dealing with an overtapered convergent prep with sharp line angles ala GV black, you'll be wasting more time trying to remove it with a diamond 830 than a carbide 557 with lots of water. OPs question was quickly remove amalgam and the quickest is a new 557.

I forgot to mention, use an electric handpiece. Air driven handpieces take too long for anything. NSKs are reliable but lower on the torque, Bien airs have higher torque, but have more reliability issues.

It comes down to what works best in your hands and 830 is my go to. More power to you with whatever you use.