SMART Protocol for the Safe Removal of Dental Amalgams
Technology, protection, and personalized care for your oral health
At Instituto Dental Madrid, we believe that removing a dental amalgam deserves careful planning and specific protective measures. For this reason, we apply the SMART protocol (Safe Mercury Amalgam Removal Technique), developed by the International Academy of Oral Medicine and Toxicology (IAOMT), to reduce exposure to mercury particles and vapors during amalgam removal.
Our goal is for every patient to understand what we will do, why we use these protective measures, and how we plan tooth reconstruction. How we perform the treatment is just as important as the result.
What are dental amalgams and why are protective measures used?
Dental amalgams are restorations used for decades to treat cavities. They contain a metal alloy with approximately 50% mercury by weight. A hardened amalgam can release small amounts of mercury vapor; release varies by circumstance and can temporarily increase with manipulation of the material.
During removal, cutting and heating can transiently increase the release of particles and vapors. Therefore, we apply dedicated isolation, high-volume suction, cooling, and respiratory protection.
Prior Diagnosis & Restoration Status
Before removing an amalgam, we examine the tooth and evaluate restoration integrity, cavities, cracks, wear, marginal leakage, and remaining tooth structure. When indicated, we complement the examination with radiographs and consider relevant medical history to plan individually.
Marginal Leakage & Secondary Caries
Over time, some restorations may show wear, fractures, marginal deterioration, or loss of adaptation between the material and the tooth. When gaps appear at that interface, bacteria can enter and promote secondary caries. Diagnosis lets us evaluate tooth condition and select its reconstruction.
How we apply the SMART protocol
Clinical Evaluation & Planning
We examine the tooth, review relevant medical history, plan the procedure, and explain each stage of treatment to the patient.
Patient Protection
We isolate the operative field using a dental dam and appropriate protective barriers, alongside measures to limit particle and vapor contact, including respiratory protection under SMART.
Dental Team Protection
Both the dentist and dental assistant wear dedicated respiratory protection, eye and face shields, gloves, and appropriate clinical protective attire.
High-Volume Suction & Vapor Control
We use high-volume evacuation and capture systems positioned close to the operative field to reduce dispersion of debris, aerosols, and vapors.
Copious Cooling & Controlled Sectioning
We apply abundant water irrigation to limit heating. Whenever technically possible, we section and remove the amalgam in chunks to minimize grinding.
Clean-Up & Waste Management
We thoroughly clean the operative field and collect amalgam-containing waste using dedicated separators and procedures in accordance with current regulations.
Tooth Reconstruction
Once the amalgam is removed, we select the restoration based on remaining tooth structure: direct composite reconstruction, inlay/onlay, or dental crown depending on restoration size, tooth strength, and masticatory function.
Review & Maintenance
We verify marginal adaptation, restoration integrity, and dental function, recommending individualized checkups to support long-term preservation.
What the patient can expect
Before starting, we explain the procedure and answer any questions. During removal, isolation, suction, and specific protection are used. Afterward, we reconstruct the tooth as planned. We want every patient to feel informed and supported at every step.
Our experience and commitment
Dra. Mariana Espinassi, founder and scientific director of Instituto Dental Madrid, has over 25 years of clinical experience in dentistry and oral surgery and is a member of the IAOMT. The clinic team applies SMART protective measures as part of an individualized biological, preventive, and oral-systemic approach.
This protocol is designed to reduce exposure during removal; it does not guarantee zero exposure. Amalgam replacement must not be presented as a proven treatment to prevent or cure systemic diseases.
Request an evaluation
If you would like to know the condition of your amalgam restorations and available reconstruction options, our team can perform a personalized dental evaluation and explain the procedure.
Instituto Dental Madrid · Calle Goya 99, escalera A, 1.º derecha · 28009 Madrid · Tel. 91 919 40 40 · WhatsApp 672 129 881