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

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