A Short Case Study: A Large Overextended Silver Point with Periapical Pathology

Rico D. Short, DMD


A patient came in with discomfort on tooth No. 8. He had a draining sinus tract with slight swelling (figure 1, left). He did not want to have apical surgery or an implant. I took a large field-of-view (LFOV) 3-D image of the area and decided to retreat the case (Figure 1, right).

I accessed the tooth on the lingual through the porcelain crown, but I could not get any micro-forceps on the silver point to pull it out (Figures 2 and 3). I irrigated it with sodium hypochlorite (NaOCl) and used many small files to loosen it up.

I then used the braided file technique (Figure 4). I placed a size 15, 20, and 25 file around the silver point and braided or twisted it tightly. Next, I used a pair of hemostats to pull up on the files as they engaged the silver point, and it popped out (Figure 5).

Figure 2. The LFOV CBCT provided a sagittal view of tooth No. 8.  Figure 3. I accessed the tooth through the crown to retrieve the silver point.  
Figure 4. I used the braided or twisted file technique to remove the silver point.  Figure 5. The silver point was removed. 
Figure 6. A cone fit was performed.  Figure 7. Using the sandwich technique, I placed bioceramic putty and sealer at the apex. 

Figure 8. I completed the case with gutta percha and bioceramic sealer.

Notice the corrosion at the tip (Figure 4, again). Silver points are known to fail due to leakage and corrosion.

I cleaned and shaped the canal, using a sandwich technique with bioceramic putty and sealer at the apex because it was perforated due to the overextension of the large silver point (Figures 6 and 7). I obturated the rest of the canal with gutta percha and bioceramic sealer (Figure 8).

Now the tooth is ready for the final restoration, and the prognosis is favorable. #WorthSaving

Dr. Short attended the Medical College of Georgia School of Dentistry to attain a DMD degree in 1999. In 2002, he earned his post-doctorate degree in endodontics from Nova Southeastern University and then became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry, author, speaker, and assistant clinical professor at the Dental College of Georgia in Augusta. His private practice, Apex Endodontics PC, is located in Smryna, Ga. He can be reached at dr.short@yahoo.com.

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