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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 4  |  Page : 210-213

Successful retrieval of metal post and nonsurgical retreatment of maxillary canine using minimum armamentarium


1 Department of Conservative Dentistry and Endodontics, Subbaiah Institute of Dental Sciences, Shimoga, Karnataka, India
2 Department of Conservative Dentistry and Endodontics, Mahsa University, Bandarsaujana Putra, Selangor, Malaysian
3 Senior Dentist and Consultant Oral Pathologist, Solapur, Maharashtra, India

Date of Submission08-Jun-2020
Date of Decision12-Jun-2020
Date of Acceptance20-Jun-2020
Date of Web Publication30-Nov-2020

Correspondence Address:
Thimmanagowda N Patil
Department of Conservative Dentistry and Endodontics, Subbaiah Institute of Dental Sciences, Purle, Shimoga - 577 222, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_61_20

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  Abstract 


Removal of the different materials from the root canal in a failed endodontic treatment is a prime requisite for endodontic retreatment. Complete removal of the materials such as gutta percha, broken instruments, or post is of particular importance for accessing endodontic space, cleaning, shaping, and disinfection of the root canal. Intraradicular post removal poses a challenge to the clinician with associated risks. This case report focuses on removal of the metal post and endodontic retreatment of the maxillary canine with minimum armamentarium to enhance the longevity of the tooth.

Keywords: Intraradicular post, nonsurgical retreatment, post removal, ultrasonics


How to cite this article:
Patil TN, Penukonda R, Pattar HA. Successful retrieval of metal post and nonsurgical retreatment of maxillary canine using minimum armamentarium. J Dent Res Rev 2020;7:210-3

How to cite this URL:
Patil TN, Penukonda R, Pattar HA. Successful retrieval of metal post and nonsurgical retreatment of maxillary canine using minimum armamentarium. J Dent Res Rev [serial online] 2020 [cited 2021 Jan 18];7:210-3. Available from: https://www.jdrr.org/text.asp?2020/7/4/210/302055




  Introduction Top


The incidence of the need for endodontic retreatment has been estimated at 8%–15% of all endodontic procedures. The reason may be that new pathology has developed or the restoration has failed.[1] Root canal-treated teeth with posts are more frequently encountered in the routine clinical practice. In a failed tooth treated endodontically, there is a need to retrieve the radicular post to assist in nonsurgical repeat root canal treatment and improve the style or design, technique, and functional esthetics of a new restoration successfully.[1],[2]

Hence, this case report emphasizes the clinical approach to successful removal of metal post and subsequent retreatment of maxillary canine without any modern equipment such as endodontic microscope, Masserann's kit, or post removal system. It also provides an insight to practitioners for the effective management of a challenging case in a clinical setup with minimum armamentarium.


  Case Report Top


A 45-year-old female patient reported to the Department of Conservative Dentistry and Endodontics complaining of pain in the upper front teeth region. On clinical examination, restoration was found with respect to 21, 22 and crown with respect to 23, which was tender to percussion. On radiographic examination, there was inadequately obturated canal of 23 and a post underneath the crown associated with periapical radiolucency [Figure 1].
Figure 1: Preoperative radiograph showing the periapical radiolucency, post, and inadequately obturated 23

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After thorough clinical and radiographic examination, treatment was planned and decision was taken for post retrieval and nonsurgical retreatment. Procedure was explained to the patient with possible risks including the fracture of tooth during post removal, before commencing the treatment and informed consent was obtained.

Treatment was initiated with crown removal of 23. Access cavity was modified and space was created by removing the restorative material in and around the post using number 2 round bur. On clinical examination, it was found that the post was not placed in a right angulation. Tapered diamonds were used to refine in gentle brushing movement and also to remove roughness, giving flaring along the walls axially to accomplish the modification in access cavity shape to gain adequate space around the post for easy removal. Restricted space between the post and the axial was instrumented using ultrasonic tips (ED 4D, ED5: DTE D5 Guilin Woodpecker Medical Instrument Co., LTD.,), which are meant to be used for these purposes. Principally, ultrasonic instrument which is parallel was made use of below the orifice level and lateral to the radicular post in an irregularly cleaned and shaped canal with clear field of vision.

Attempt was made to unscrew the post, which was done using the wrench and the artery forceps. May be due to the mechanical interlocking, restorative material, and incorrect angulation of the post, the post fractured and a fragment of the post retained within the dentin [Figure 2].
Figure 2: Radiograph showing fragment of post retained

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With the fragment of the post within the dentin, orifice was located on palatal aspect and was enlarged carefully using Sx file (Protaper System). Careful observation of the access cavity revealed the buccal orifice adjacent to the post buccally. Then, the orifice was located, enlarged, and GP removal was done. Radiograph was taken to confirm the working length [Figure 3]. The canals were carefully instrumented till Protaper F2 file. Complete removal of the restorative material, orifice enlargement, and the use of ultrasonics lead to loosening of the post, which was removed using small artery forceps with anticlockwise rotation and gentle pull motion [Figure 4].
Figure 3: Working length radiograph

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Figure 4: (a) Fragment and GP removal radiograph. (b) Both the fragments of post after removal

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The patient was recalled after 2 weeks of intracanal medication and with the absence of symptoms the obturation was completed and the crown buildup was done using a fiber post and with composite [Figure 5] and [Figure 6].
Figure 5: Post obturation radiograph

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Figure 6: Radiograph depicts the placement of fiber post and composite buildup

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  Discussion Top


Nonsurgical repeat root canal treatment in endodontics is an extensive area which includes dismantling the crown, exploring and identifying canals that are missed in previous endodontic treatment, gutta percha removal, managing obstructions, negotiating blocks, perforation repair, bypassing ledges, fractured tooth treatment planning and retrieving radicular posts and separated instruments.[3]

Prior to any treatment procedure, considering the available options for the given condition and choosing the best for the clinical scenario is vital. With the best option of nonsurgical retreatment endodontics in this case, the aim was to regain the access into the radicular pulp chamber, retrieve gutta percha, and post from the root canal chamber space and if there was any obstructions, defects that are pathologic or iatrogenic in origin were intended to be repaired.[3] After the procedures of coronal disassembly, reshaping cleaning of the radicular pulp chamber is done and the tooth is three-dimensionally obturated.[4],[5],[6]

Intraradicular posts used most commonly are prefabricated metal posts. They can be cylindrical-conical, screw, or cemented with a circular cross-section. Their radiopacity is similar to gutta percha and fixing cement and they have a module of elasticity different from that of the dentin. Intraradicular metal posts may produce tension, while in the active points, overload arises in the course of the thread leading to a risk of root fracture.[7],[8]

Several various factors impact removal of the post, such as decision of the operator, ability, experience, choosing with using the best available technologies and method to be used plays important role. To a greater extent, the operator's knowledge of internal and external anatomy, familiarity of variations in the internal anatomy of root canal associated with each tooth is essential. Furthermore, knowledge can be attained by different angulated preprocedural treatment radiographic evaluation which can aid in determining the length, extension, and diameter with the angle of the radicular post. Intraradicular posts retained, screwed, and micromechanical bonding into the radicular chamber with resin composite or chemical bonding with glass ionomers poses difficulty in retreatment procedure.[3]

Post removal can be performed by various commercially available systems such as Masserann's kit, post removal system, endodontic extractors, ultrasonics, and a combination of tube extractors with cyanoacrylate. Abbott reported that post removal is a predictable procedure, if appropriate techniques and devices are used. He advocated the use of Masserann's kit, ultrasonics, Eggler post removal, and unscrewing of the threaded screw posts.[9]

In the present case, we were not at disposal of any magnification device such as endodontic microscope or any modern equipment such as Masserann's kit. Hence, conventional ultrasonic tips were used followed by the use of wrench and artery forceps for unscrewing the posts. Lack of modern equipment presents the case with a higher challenge but allows a clinician to innovatively think and treat the case with the available equipment.

Within the limitations, with minimum equipment, the post was removed for successful nonsurgical retreatment to alleviate the pain and eliminate the periapical infection.


  Conclusion Top


Successful post removal is possible only if there is proper operator judgment, training, experience, and most importantly the clinician's ability to use the available instruments in a clinical setup. Clinicians need to weigh risk versus benefit for every treatment decision that is made so they may best serve the patients who entrust them with their care.

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.
Gupta R, Dhingra A, Bhullar HK, Kalkhande S. Endodontic retreatment by removal of metallic post: A case report. IJSS Case Rep Rev 2015;1:16-8.  Back to cited text no. 1
    
2.
de Rijk WG. Removal of fiber posts from endodontically treated teeth. Am J Dent 2000;13:19B-21B.  Back to cited text no. 2
    
3.
Ruddle CJ. Non-surgical retreatment: Post and broken instrument removal. J Endod 2004;6:1-23.  Back to cited text no. 3
    
4.
Ruddle CJ. Microendodontic nonsurgical retreatment in: Microscope in endodontics. Dent Clin North Am 1997;41:429-54.  Back to cited text no. 4
    
5.
Schilder H. Cleaning and shaping the root canal. Dent Clin North Am 1974;18:269-96.  Back to cited text no. 5
    
6.
Schilder H. Filling root canals in 3 dimensions. Dent Clin North Am 1967;11:725-44.  Back to cited text no. 6
    
7.
Mironova J, Vasileva R. Modern approaches in the use of intraradicular posts. Dent Med 2008;90:137-41.  Back to cited text no. 7
    
8.
Ruddle CJ. Broken instrument removal: The endodontic challenge. Dent Today 2002;21:70-2,74,76.  Back to cited text no. 8
    
9.
Abbott PV. Incidence of root fractures and methods used for post removal. Int Endod J 2002;35:63-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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