Fiber Post Drill-Out on an Abscessed Bicuspid with a New Crown

Terry Pannkuk, DDS, MScD Retreatment Strategies, Dismantling, Recall Observations

Nonsurgical Versus Surgical Endodontic Retreatment on Teeth With Posts?

Patient: 65 year-old female with Hashimoto’s Disease and managed hypercholesterolemia

Chief Complaint: swelling on gums

Dental History: The patient reported a past history of root canal treatment (not recent) and a new crown on the maxillary left second bicuspid (less than a year). She started to notice some swelling associated with the area 3 weeks before the endodontic consultation.

Significant Findings (Tooth #13): a fluctuant buccal mass was noted opposite the said tooth which yielded slight discomfort when palpated. A periapical radiograph revealed a large periapical radiolucency and previous root canal treatment. The less radiopaque column of material in the coronal half of the root suggested a bonded fiber post. Clinical tests demonstrated Class 1 mobility, moderate percussion sensitivity, and periodontal findings within normal limits.

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Commenting Guidelines Please make scholarly cited references or expert opinions suitable for publication. The comments can either be "pro" or "con" with references to the treatment philosophy. We encourage objectivity and detailed demonstration of knowledge/literature.
John Stropko commented 8 years ago.

I hate to sound like a broken record, but I can't understand why Cavit is used (with, or without cotton), instead of a bonded composite! What if the patient, or the doctor, had a change in schedule, and the next visit may un-expectantly be several months away. Isn't that of concern? Besides that, how do you make sure the occlusion is correct when using Cavit? Cavit just doesn't fit in to a plan for a predictable outcome.

Terrell Pannkuk commented 8 years ago.

A deep column of compacted Cavit seals very adequately as a temporary for a month or even two months for an intact crown with good margins. If the margins are questionable and there is fear of loosening, I would generally place a GIC or resin modified GC which seals without the same degree of shrinkage as a composite which poses the C-factor problem pulling away from walls. . If the patient doesn't come back for two months there are bigger problems with neglecting to finish the endo and having the crown weakened without a luted fiber post. It just seems like attempting to etch bond, gain clean surfaces with CH, etc. etc. using an extravagant material instead of a proven well-sealing temp for a routine occlusal access requiring no strength properties is an unnecessary exercise, no? The working cusps are generally not within the occlusal endodontic access outline and there would be no disruption of occlusion. In many instances you want to take the tooth completely out of occlusion while it is being treated to avoid unnecessary discomfort. Why do you want precise occlusion during the interim period of treatment? The occlusion is put back in with the final restoration after the treatment.

Terrell Pannkuk commented 8 years ago.

Hi John, Please quote some studies showing the inadequacy of Cavit as temp during the routine interim of two step endo treatment. We need them for the references here.

Michael G Stevens commented 8 years ago.

I switched to sponges one year ago. They compact much better.

Terrell Pannkuk commented 8 years ago.

I agree much better than cotton, even better is no sponge spacer at all! it's very simple to remove deep Cavit with a safe ended bur (eg. Pulp Shaper bur)

M Shoaib Siddiqui commented 1 year ago.

Great case Terry. You shared a link to your protocol for removal of post (metal). I understand the same staging will apply to fiber posts too. However, I am interested to know how you removed this fiber post. I use a size 1 (purple) or sometimes 1/2 (grey) Munce burs to drill through the fiber post. The color and texture of post is pretty evident compared to the surrounding restoration and dentin. I drill in bit my bit, air blowing to remove the dust, sometimes flushing with EDTA and drying with a coarse paper point, and making sure I am centered within the post. I do this under the microscope and continue till I see gutta percha. The dust from post drilling is quite different from dentin dust. I was hoping to hear from you on your technique to fiber post removal. PS. I apologize if you mentioned your technique somewhere and I missed it. Thanks for sharing your work and educating the readers.

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