Non-Instrumented Silver Point Retreatment Using the GentleWave Procedure: A Maxillary Central Incisor Case Report
Introduction: Apicoectomies are indicated for endodontically treated teeth when biological or technical factors such as non-healing periapical lesions, persistent clinical symptoms, separated instruments or silver points and the presence of long posts are present and other treatment options are not recommended. Background: A 67-year old female patient was referred for possible apicoectomy after previous endodontic treatment with a large post placement and silver point obturation within the apical third. The patient presented with mild pain of the upper jaw and a periapical lesion. Methods: Following conservative endodontic access, the previously placed post was removed utilizing a Roto-Pro™ Rotosonic Scaler Tip and the silver point was removed utilizing a thin ultrasonic tip without touching the canal walls. In an attempt to preserve tooth structure, maintain as much of the original canal anatomy as possible, and reduce the possibility of complications associated with standard endodontic treatment, no instrumentation was utilized. The GentleWave® Procedure was used to remove pulp tissue remnants, debris, smear layer, and bacteria from the entire root canal system. Single cone obturation was completed with gutta-percha and BC Sealer™. Results: Post-GentleWave Procedure cone fit radiographs depict a patent canal and post-obturation radiographic assessment displays clinically significant obturation of the non-instrumented canal. Discussion: This case report demonstrates the ability of the GentleWave Procedure to clean previously endodontically treated anterior teeth without the use of instrumentation, thereby conserving the natural tooth structure and decreasing the chance of intra-procedure complications as seen in standard endodontic treatment.