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retreatment case: silverpoints, missed anatomy - Courtesy ROOTS

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From: Maarten Meire
Sent: Sunday, October 25, 2009 1:36 AM
Subject: [roots] retx + recall

This was a fun retreatment case: silverpoints, missed anatomy. 
Could not retrieve the distal silver point entirely,
but this seemed not to affect periapical repair! -  Maarten

Hi Maarten, Brilliant job and excellent documentation! - Amir how did you remove the silver points can you explain in detail. i have a case pending,i hope it will be use full to me. - Dr.kishore nallapati. Excellent case Maarten. It was to be expected that the silverpoint would break apically. - RafaŽl Hello Raf, although it was expected, I was still disappointed at that time! - Maarten Hi Maarten ! Nice healing for 8 months already ! very beautiful clinical images. Probably the first dentist really wanted to preserve a lot (almost all mesial) tooth wonder one canal was completely missed. I keep staring at the shape of that amalgam filling through which an endodontic treatment was performed. And to be completely illogical and against any evidence we have, the root with the lesion was distal not mesial :-))) Do you think the non treated canal was full of biofilm ? I think yes. Than how can we explain than the lack of apical lesion (at least on radiological level) ? - Roberto Hi pavan, First you have to create a good access to all canal entrances (in this case extension of the access cavity) thereby taking care not to damage the silver points. Preservation of the part of the silver point extending in the pulp chamber is crucial. Then I remove as much as possible the crap around the points (filling materials, cement, sealer, gutta) with US tips. Use a non-abrasive US tip to trough around each point and gently apply US energy to the point. In many cases, they will come out like that. If not I try to grab the point with a small forceps (eg Steiglitz), or I use the IRS (Instrument removal system), mostly in combination with US. - Maarten

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