Silver amalgam fillings are roughly 50% mercury by weight, and they release vapor under the heat and friction of chewing. Drill into one without precautions and the release climbs sharply, right at the moment patient and provider are leaning in closest. SMART exists to close that gap, and Natural Smiles runs it on every single amalgam removal in our St. Petersburg office.
What SMART stands for
SMART is the Safe Mercury Amalgam Removal Technique, certified by the International Academy of Oral Medicine and Toxicology (IAOMT). Certification requires specific equipment, specific procedure, and training on both. Dr. Carlo Litano, DMD holds the certification, and the practice keeps a dedicated mercury isolation room built around the protocol.
SMART protocol, step by step
Isolation comes first. A nitrile dam seals the tooth off from the rest of your mouth, because latex dams pass mercury vapor and nitrile resists it. Your airway gets its own supply: supplemental oxygen flows through a nasal mask for the length of the procedure, so what you breathe never depends on the air over the drill.
Continuous capture at the source
Capture runs continuously. High-volume suction sits at the tooth while a HEPA filtration unit with activated carbon pulls air at the source, catching particulate and binding vapor. The amalgam comes out in large sections rather than being ground away, which keeps the total release low. On the provider side, Dr. Litano and the assistant work in full protective equipment, because a protocol that guards the patient while dosing the team fails the point.
A protocol that guards the patient while dosing the team fails the point.
What replaces the amalgam
BPA-free ceramic composite, color-matched to your enamel and bonded in the same visit. For patients with sensitivity histories, material biocompatibility testing before the appointment reads your reactivity against the exact composite planned. Nothing metal, nothing mercury, nothing your body has to argue with.
SMART removal checklist, at a glance
- Nitrile dam isolation, sealing the tooth off from your mouth
- Supplemental oxygen through a nasal mask for the full procedure
- High-volume suction at the tooth, HEPA filtration with activated carbon at the source
- Amalgam sectioned out in large pieces to keep total release low
- Full protective equipment for Dr. Litano and the assistant
What patients report afterward
One Clearwater patient had four amalgams removed in a single visit and drove home the same afternoon, no headache, no metallic taste. Out-of-state patients pair SMART removal with other work during a single trip, staying in the apartment one floor above the clinic. Reviews on Google and Birdeye mention the protocol by name, and patients name it because they can see every layer of it working.
Booking a SMART removal in St. Petersburg
Start with the new patient exam. The CBCT scan and health history establish the full picture, the written plan prices each removal, and scheduling groups the work sensibly, whether that is one filling or a mouthful. Patients drive in from Tampa, Clearwater, Largo, and Sarasota for exactly this procedure, and the protocol runs identically every time.
Why removal without a protocol backfires
Amalgam sitting undisturbed releases vapor slowly. Drilling without controls converts that slow leak into a spike, aerosolizing particulate at close range while the patient breathes through their mouth inches away. The removal moment is the highest-exposure event in the life of a filling, which is why biological dentistry treats it as an engineering problem with a certified answer rather than a routine drill-out.
Sequencing a mouthful of amalgam
Patients with six or eight amalgams ask whether everything comes out at once. Sequencing is a written-plan decision: quadrant by quadrant grouping, spacing between visits, and coordination with whatever detox support your practitioner runs alongside. The one-visit marathon suits some patients and schedules; others stage it. Both paths run the identical protocol per tooth.
Testing before replacing
Material biocompatibility testing before removal reads your sensitivity against the exact composite planned as the replacement, which matters most for patients whose health picture started the mercury conversation in the first place. The replacement standard stays constant either way: BPA-free ceramic composite, color-matched, bonded the same visit.
