Love Your Patients, Save their Teeth
February 14, 2020
The Case of the Separated File
February 28, 2020
Silver points can sometimes be an endodontist’s worst nightmare.
There is a reason why we don’t use them anymore. In fact, the AAE recommends against the continued use of silver points, since it has been shown to be clinically problematic.
Silver points can corrode in the presence of blood and or serum and can cause staining of the tooth and tissues. The corrosion products cause periradicular inflammation and also have the potential to cause inflammatory root resorption.
A Silver Point Case
Let’s take a look at some radiographs in a silver point case.
Looking at the radiographs, I could tell that this root canal was done years ago—actually, decades ago.
Unfortunately, this tooth had many problems besides just the silver point. There was a missed MB2, and a prior apical surgery was done to address the persistent infection caused by that missed MB2. And the infection is still there years later, as was evidenced by the patient’s draining sinus tract. I was able to diagnose this patient as Previously Treated with Chronic Apical Periodontitis.
So, in cases like these, I know that retreatment is the best answer. But I must let the patient know about what could happen during treatment.
I informed the patient about the potential risks.
Since silver points corrode, sometimes when you are trying to remove them, they break, and then you can’t grab them or vibrate them out. If they break upon removal, they now act like a separated file, and now you have an obstruction in the tooth that could change your treatment plan.
So, I make sure that my patients are well aware that the treatment plan could change in the middle of the procedure to an apicoectomy or even an extraction, depending on the case and what happens.
The result was a positive outcome.
Luckily in this case, the silver point was swimming in a sea of gutta percha. So, once I was able to dissolve the gutta percha a bit, the silver points vibrated right out of the canals with an ultrasonic.
Make sure you don’t run that ultrasonic too high, or you will definitely break that point while you are trying to remove it.
I cleaned up the chamber, troughed a bit apically, and found the missing MB2 canal. I instrumented all the canals to patency and finished the case!!
Now it’s just a waiting game to see that bone fill in!!!
I’ll definitely let you know if I have any updates.
-Sonia
6 Comments
Dr. Chopra,
Thanks for sharing your cases! I think that many docs would have condemned this tooth and your end result looks great and will probably serve the patient well for years! I do a fair amount of endo and enjoy seeing your posts that are very inspirational and educational.
Than you so much, Dr. Darling! Yes, I’m so glad the tooth didn’t have to be condemned for extraction!
– Sonia
Hi, Dr.Sonia
My Inqurie about my tooth problems, Anterior lateral Incisor in between premolar be block to the baby tooth that l taught, but Dentistry x-ray for me told that was a baby tooth.
posterior premolar 29 grow at Side 28 premolar lingual
cause my premolar 26 & 27 grow side way.
I have this problem 25 yrs, current 50yr old. For case it’s need do surgery extract the 11.
Wish can get advise from you, Doc. Sonia
Hi Rossane, I’m so sorry you are experiencing this. Unfortunately, at this time I am not doing any virtual consults. And without the proper diagnostic tools, I do not feel comfortable giving out clincial advice just yet. This is something that I am working on for the future, but for now I suggest you speak with a local dental practitioner. I hope you’re able to resolve this!
-Sonia
In the ’70s I got a root canal and it was with a silver tip point in the ’90s I had gotten a apicoectomy which I wish I never got The dentist said he never got the point out although that’s what he was trying to do and clean up the route so somewhere in my body in my head I probably still have this silver to point he also caused my whole left side of my face to go numb and might throat I have issues with my sinus because it’s all numb on that side it’s a real mess is there any way to fix all this and what could be happening with the silver tip point still floating around somewhere
Hi Patricia, we recommend that you get a second opinion from a Gentlewave provider. You can find a directory on their website.