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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 11  |  Issue : 3  |  Page : 156-159

Endodontist's dilemma: Retreat or extract?


Department of Conservative Dentistry and Endodontics, School of Dentistry, D. Y. Patil University, Navi Mumbai, Maharashtra, India

Date of Submission24-Jun-2020
Date of Acceptance20-Aug-2020
Date of Web Publication15-Oct-2020

Correspondence Address:
Dr. Girija Abhijeet Kolarkar
Department of Conservative Dentistry and Endodontics, School of Dentistry, D. Y. Patil University, Sector 7, Nerul, Navi Mumbai - 400 706, Maharashtra
India
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DOI: 10.4103/srmjrds.srmjrds_54_20

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  Abstract 

The retreatment in endodontics, when correctly incorporated, permits the conservation of dental components. The removal of different substances from root canal such as gutta-percha, fractured endodontic instruments, and silver points is the remedy to a successful retreatment of teeth with failed primary endodontic treatment. It is often required to take out metal posts placed in the root canals in teeth showing great loss of the clinical crown. Their removal is of specific importance for evaluating endodontic space, cleaning, and disinfection of root canal. The intention of this case report is to introduce techniques and armamentarium for removing metal posts placed in the root canal of right maxillary second premolar with mutilated clinical crown requiring retreatment. This manner of intracanal metal post removal and retreatment is well recommended and successful since the teeth remained with good signs of prognosis after the treatment.

Keywords: Disinfection, FiberSite post, retreatment, ultrasonic


How to cite this article:
Kolarkar GA, Nilker V, Padhye L. Endodontist's dilemma: Retreat or extract?. SRM J Res Dent Sci 2020;11:156-9

How to cite this URL:
Kolarkar GA, Nilker V, Padhye L. Endodontist's dilemma: Retreat or extract?. SRM J Res Dent Sci [serial online] 2020 [cited 2020 Oct 25];11:156-9. Available from: https://www.srmjrds.in/text.asp?2020/11/3/156/298266


  Introduction Top


Incorrect mechanical debridement, constant presence of microorganisms in the canals and apical portion, faulty obturation condition, over- and underextension of the root canal filling, untreated canals, and coronal leakage are various frequently applicable reasons of endodontic failure.[1],[2]

For inhibiting further complications from unsuitable endodontic treatment in a tooth with intraradicular post, immediate opening of root canal and retreatment becomes a necessity. Strictly, whole tooth, with or without the pulp vitality, is important for the stomatognathic system.[3]

It continues to be challenging to retreat the teeth restored with intracanal posts nonsurgically because of complications encountered during retrieval of post without weakening, perforating, and destroying the remaining root structure.[4]

This report discusses the removal of an intraradicular post and core accompanied by endodontic retreatment in the maxillary right second premolar tooth.


  Case Report Top


A 35-year-old female patient came to the conservative and endodontics department having complaint of continuous extreme pain in tooth no. 15, with previous root canal treatment history done 2 years ago.

Tooth showed composite restoration with faulty margins, the absence of post endodontic crown [Figure 1]a, inflamed mucosa seen in the periapical region, sensitivity to apical palpation, and pain on vertical percussion. The character and type of pain was sharpshooting and continuous, relieved for short duration on taking medication.
Figure 1: (a) Preoperative diagnostic radiograph, (b) Complete removal of coronal restoration of tooth 15, (c and d) After removal of screw metal post from the canal, (e) E3D ultrasonic tip, (f) E5D ultrasonic tip

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Radiographic examination revealed slight distention of periodontal ligament space in the apex of tooth, poor obturation (approximately 2–2.5 mm short of apex), metal post in the pulp chamber and almost two-thirds of root canal, and radiopaque post endodontic filling with faulty margins [Figure 1]a.

At first visit, cement and the post was removed with slight pressure in counterclockwise motion using ultrasonic tip (E5D NMD) and (E3D NMD) (Nexus Medodent, Mumbai) [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f. This tip worked with low power of the device and without water. I-superTip (Prime dental) was carried into the canal to remove the cement which loosened the post. The ultrasonic vibration from the instrument tip was passed on to metal post that proceeds to loosen the surrounding cement till the post loosened and was withdrawn with slightest Retracting energy. Leftover gutta-percha and sealer were taken out from the canal by GP solvent and Mani H-file (Delhi) [Figure 2]a, [Figure 2]b, [Figure 2]c. Working length was calculated by 20# Mani k-file using electronic apex locator and radiovisiography [Figure 2]d. Circumferential filling was done and the apical third of the canal was prepared up to ProTaper F3 (Dentsply Sirona, Switzerland). Saline, 17% ethylenediaminetetraacetic acid, and 3% sodium hypochlorite were used for copious irrigation and disinfection.
Figure 2: (a) Screw metal post removed from the canal, (b) Gutta-percha visible through the canal orifice, (c) After complete removal of gutta-percha from the canal, (d) Working length determination (suspected of two canals, but there was only one), (e) Master cone selection, (f) Obturation

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Intracanal dressing of calcium hydroxide was repeated twice at intervals of 5 days each. At the second visit, the canal was obturated using gutta-percha and sealer (zinc oxide-eugenol) by lateral condensation technique and temporary restoration done [Figure 2]e and [Figure 2]f. At subsequent visit, except for apical 5 mm of the canal, rest of the gutta-percha was removed using Peeso reamers no. 1 and 2 and canal walls smoothened with “H” files [Figure 3]a. Dentee FiberSite post (Palermo Italy) was selected. The choice of pin was determined by the mesiodistal diameter at the root's neck. X-ray was used as a guide to determine the correct size of the bur for canal preparation. Rubber dam was applied. Pin was inserted in the root to verify its correct position. Etching and bonding procedures were carried out in the canal and coronal portion of tooth [Figure 3]b, [Figure 3]c, [Figure 3]d, [Figure 3]e, [Figure 3]f. Pin and canal were coated with dual-cure composite resin (Coltene ParaCore) and light cured [Figure 4]a and [Figure 4]b. A full ceramic crown was given as final restoration [Figure 5]a and [Figure 5]b.
Figure 3: (a) Post space preparation, (b) Rubber dam application, (c) Caliber with measuring pin in zero position. (d) Caliber is pushed toward the root and read at the extremity amount to be removed. Here, it is approximately 2 mm. (e) Insert the pin on the ruler, mark, and cut the excessive part, (f) After cutting the excessive 2 mm part, then the corrected pin is inserted in the root

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Figure 4: (a) Verification of the position of FiberSite post, (b) FiberSite post cemented into the canal

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Figure 5: (a) All-ceramic crown cementation (front view in occlusion) - tooth 15 (b) All-ceramic crown cementation (side view in occlusion) - tooth 15

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  Discussion Top


The prevalence of endodontic treatment failure in teeth presenting intraradicular post and crowns is high. The radiographic examination is an important auxiliary method in determining the quality of endodontic treatment; it is capable of suggesting the normality or abnormality of tooth periapex, the quality of the canal obturation at the apical limit, and the filling material condensation.[4]

It is essential to have knowledge about tooth anatomy as well as the length, circumference dimension, and curvature of root.[5] Intraradicular posts used most commonly are prefabricated metal posts. They can be cylindrical-conical, screw, or cemented posts with circular cross-section.[4] Retention of posts with cements like ZnPh (zinc phosphate) can normally be removed; but, posts bonded with materials such as composite resins or glass ionomers are more tough to take out.[6],[7] In general, removal of posts turns out to be more difficult going from anterior to posterior teeth.[5]

Piezoelectric technology in conjunction with ultrasonic instruments provides the first line of treatment to remove a post.[5],[7] Ultrasonics are best used with gentle brush-cutting motion and on peripheral edge of a segmented core to chip, break off, and scrape away materials such as cement, composite, and amalgam. Furthermore, the most active distal end of suitably shaped ultrasonic instrument is kept in close proximity with the post and carried around the post in circumferential direction and up and down to its exposed length to increase transfer of energy and to encourage cement/bond failure. Eliminating materials from pulp chamber leads to decrease in post retention.[8] If ultrasonic procedures are to be performed for greater time periods, then the field should be often rinsed with water to decrease the buildup of heat and its transfer to the attachment apparatus.[5]

FiberSite post is an innovative fiberglass pin with preshaped abutment to restore already devitalized and coronally destructed tooth.[9] It revolutionizes the actual method for rehabilitation of single-rooted teeth and also simplifies partial reconstruction of multirooted teeth. They match up the mesiodistal diameters with neck of all single-rooted teeth in order to guarantee a perfect match between abutment and root.

The advantage of a FiberSite post is that the bur guide creates perfect site to insert the abutment post with an integrated abutment thus reducing the functional stress and risk of root fracture.


  Conclusion Top


Improved visualization plus a more conserving approach when specifically removing tooth structure, offers benefits that are not feasible with standard/regular treatment. This case highlights the successful use of Ultrasonics and a novel post system in the successful retreatment of maxillary premolar.

Acknowledgment

We acknowledge the material support of Department of Prosthetic Dentistry, D Y Patil School of Dentistry, Navi Mumbai in the management of this case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent 2016;10:144-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Iqbal A. The factors responsible for endodontic treatment failure. J Clin Diagn Res 2016;10:146-8.  Back to cited text no. 2
    
3.
Allgayer S, Vanni JR, Allgayer S. Intraradicular post and core removal followed by endodontic retreatment: Thirteen-year follow-up. Rev Sul-bras Odontol 2011;8:99-104.  Back to cited text no. 3
    
4.
Radeva EN. Removal of metal posts in retreatment of teeth with failed endodontic treatment (clinical cases). Int J Sci Res 2015;4:2084-8.  Back to cited text no. 4
    
5.
Ruddle CJ. Nonsurgical endodontic retreatment. J Calif Dent Assoc 2004;32:474-84.  Back to cited text no. 5
    
6.
Hauman CH, Chandler NP, Purton DG. Factors influencing the removal of posts. Int Endod J 2003;36:687-90.  Back to cited text no. 6
    
7.
Chandler NP, Qualtrough AJ, Purton DG. Comparison of two methods for the removal of root canal posts. Quintessence Int 2003;34:534-6.  Back to cited text no. 7
    
8.
Gaffney JL, Lehman JW, Miles MJ. Expanded use of the ultrasonic scaler. J Endod 1981;7:228-9.  Back to cited text no. 8
    
9.
Özlek E, Neelakantan P, Matinlinna JP, Belli S, Ugur M, Kavut I. Adhesion of two new glass fiber post systems cemented with self-adhesive resin cements. Dent J (Basel) 2019;7:80.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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