Silver points retreatment
19/02/2024
Fellow
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Endodontic obturation with silver points, introduced in the 1930s, was historically popular due to its ease of handling, ductility, radiopacity, and some antibacterial properties. However, the use of silver points has significantly declined over the past decades, since silver points fail to provide a satisfactory three-dimensional seal, corrode over time and do not adapt well to root canal walls or seal accessory canals.
In clinical practice, encountering endodontically treated teeth with silver points is not uncommon. When such teeth exhibit treatment failure, the necessity arises to eliminate the metallic obstruction for successful nonsurgical retreatment. Various methods propose creating and enlarging a space around the obstruction to facilitate its loosening before retrieval. Numerous removal techniques exist, including the use of appropriate burs, specialized forceps, ultrasonic tips, Hedstrom files, microtube delivery through mechanical/adhesion techniques, the wedging-tube technique, and the loop technique This article presents a case report on the nonsurgical retreatment of a maxillary first molar obturated with silver points and details the utilization of the grasping feature of the microtube for silver point removal.
Fig. 1
A 54-year-old male patient reported to the clinic with a chief complaint of mild pain in right maxillary first molar since 2 month and gave history of root canal treatment done 25 years ago
Fig. 2
Clinical examination revealed that the right maxillary first molar (tooth no 16) was tender on percussion, discolored, periodontal probing within normal limits (<3 mm) and no mobility. Fractured amalgam restorations were observed as shown in Figure 2.
Fig. 3
Silver Points exposed after removing the filling
Fig. 4
Removed silver points
Fig. 5
After shaping
Fig. 6
Master Cone Radiograph
Fig. 7
Obturation with GP + BC Sealer
Fig. 8
Restoration
Fig. 9
post operative radiograph shows adequate obturation of the root canal systems
Complete procedure
Fig. 10
About the author:
• Dr. Amin Helani graduated in 2014 from the University of Aleppo in Syria.
• In 2021, he received a specialist degree in Endodontics from the German Society of Endodontics.
• He works as a Microscopic Endodontist for advanced root canal treatment in Braunschweig, Germany.
• He has been offering lectures, webinars, and hands-on courses to both general dentists and endodontists.
• He is a member of the German Society for Endodontology and Traumatology.
• He is a fellow member of Style Italiano Endodontics.
Conclusions
In summary, silver points do not adequately achieve a proper seal of the apical foramen, corrode over time, resulting in elevated levels of leakage. This inherent flaw contributes to a significant failure rate in root canal therapy, frequently requiring retreatment for affected teeth. The challenge of occasionally irretrievable silver points further reduces the overall prognosis. Consequently, the use of silver points as an obturation material is contraindicated in clinical practice, underscoring the imperative use for alternative and more effective materials to ensure the success of endodontic treatments.
Bibliography
Seltzer S, Green DB, Weiner N, DeRenzis F. A scanning electron microscope examination of silver cones removed from endodontically treated teeth. Oral Surg Oral Med Oral Pathol 1972:33:589-605.
Cohen S, Hargreaves K. Pathways of the Pulp (9th ed). St Louis, Missouri: Elsevier Mosby 2006;522-24.
Nehme WB. Elimination of intracanal metallic obstructions by abrasion using an operational microscope and ultrasonics. J Endod 2001;27(5):365-67.
Ruddle CJ. Microendodontic nonsurgical retreatment: Silver point removal. Dent Today 1997 Feb;16(2):64-69.
