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From: "Terry Pannkuk"
To: "ROOTS"
Sent: Saturday, January 17, 2009 8:45 AM
Subject: [roots] Silver Point Tag Protection
Here's a useful tip for removing silver points without breaking off the
purchase tags:
Here's a case where I definitely did not want to drill into and weaken
the silver point tags.
Carbon Steel Endo Explorers (made by Scott Martin) are extremely useful
in in picking away the cement from the points and loosening them so that
they can be removed without breaking
them off:
1. Extend the access so that the points are not wedged beneath pulp
chamber ledges.
2. Drill the access just deep enough until you start seeing a
silver point tag and stop.
3. Use an ultrasonic to pick away surface cement and core just until
you can identify the points without gouging them...then stop!
4. Place the explorer and have your assistant place the ultrasonic tip
on full power against the side of the explorer as you activate it and
chip the cement away from the tight spaces of the points.
5. Flood and irrigate with EDTA to clear chipped debris.
6. Pick away along the side of the point that is easiest to access,
purchase it when it's loose and remove it.
7. Repeat for each remaining point picking the one that is easiest to
access,constantly flooding with EDTA and and clearing with the Stropko.
These points were all cemented very solidly and this technique worked
well. If the tags were not long enough to be purchased I would have
used the tubes and Corepaste. You don't want to try and slip files
along side silver points because they will shred, weaken, and the tags
will break off. The larger silver points usually seem to be the most
firmly wedged and cemented and are the worst ones to try and remove with
files. The narrow silver points are usually floaters because the canals
were usually poorly prepped and there is no cement securing them.
Whenever I see a case with thick silver points I assume it will
require more care and finese. - Terry
Terry, I will probably never retreat a silver point RCT, but it was
nice you replied and shared your knowledge. Just a GP that enjoys Endo.
- Jim Rathfon DDS, FAGD
Thanks for share Terry.
TOUGH CASE !! Through Crown + Ag BU + 4 Thick Silver Points.
I would opted to take out the crown. I donīt think that I would be able
to recover the silver points through the crown.
Even seen the pics itīs difficult to guess how you are able to distinguish
Ag from silver points and freed them through this conservative opening.
I only can appalud you.
Could you send and individual pic of the active point of that endo Explorer
"Carbon Steel Endo Explorer (made by Scott Martin)"? What they add to the
current DG-16 Stainless Steel Endo Explorer ? Really I use it in the same
way you explain to vibrate indirectly. Perhaps, It is skinny?
I want to add a couple of tips in order to loose silver points.
1. If you can purchase the silver point but you note itīs wedged, apply US
in the holder ("silver point forceps" or others), that goes indirectly on
the silver point. it is useful for loose the silver point. NEVER touch the
silver point directly, you know that for sure, but perhaps others no.
2. If you can pass nearby the point with a thin SS K-file 20-25 you can
apply US to the file and it can help to loose the silver point.
All the best,- Nuria Campo
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