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Puzzle Case: Silver Point Retreatment Part 1 and Part 2 (Conclusion)

Terry Pannkuk, DDS, MScDDiagnostic Puzzles, Complications: Advanced Management, Perforations, Retreatment Strategies, Silver Point Removal, Recall Observations, All by Date


15 Month recall radiograph showing complete osseous regeneration and healing (7/13/2015)

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What is your diagnosis, prognosis and treatment plan?

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Hi The mesial canals having silver points need retreating-but why the lesion distally? probably endo-perio due to poor condensation and a possible missed lateral. IMHO retreat all the seen canals, there may be a second distal? Cannot tell until opened up the coronal chamber and investigated. Jan Skrybant

Hi Jan,

The likely cause of the distal bone loss was a lateral canal, but one wasn't obvious after obturation. The fact that this lesion healed suggests that whatever path of sepsis existed was cleared by the cleaning and shaping process, eliminating the disease, leading to osseous regeneration. A lateral canal does not have to be demonstrably filled to lead to a successful result. The root canal system simply needs to be debrided with the critical titer of pathogens reduced below the threshold which causes and perpetuates disease. Cleaner is better which is why I don't understand the current popularity of "minimal access" techniques. If one does not eliminate disease as the first priority there is no reason to restore the tooth.

I completely agree with the treatment except for one key factor: Using Cavit for a temporary fill is very risky at best! All the research I have seen indicates that Cavit is not dependable for more than 2 weeks. But, more importantly, lets look at the "1 month" appointment! How many times has a patient called to reschedule, or the doctor has a change in their schedule? Sometimes, these 2 week, or 1 month appointments turn into 2, or 3 months! For that reason, to be more assured of maintaining sterility, and avoiding unnecessary recontamination, a bonded composite should always be used. My personal belief is that Cavit does not belong in an endodontic office.

Hi John, All the research done with Cavit as a temporary seal uses a cotton pellet spacer which collapses. Cavit has excellent sealing properties if compacted to the pulp chamber floor without a spacer so that it doesn't collapse upon biting pressure.

In another discussion there was talk about using Cavit as a backfilling material instead of gutta percha. I do this for C-Shaped fused roots where the coronal prepared root canal space has large volume. Cavit compacted as a base or coronal half filling of root canal space provides an excellent seal and protection against coronoapical leakage. I'd love to see a study comparing different orifice sealing materials which include bonded flowable composite resin, glass ionomer, and Cavit. I suspect that Cavit would fare very well because it has better sealing properties than IRM and other temporary restorative fillings.

Here's an excerpt from Jensen, Abbott, and Salgado, Interim and temporary restoration of teeth during
endodontic treatment, Australian Dental Journal Supplement 2007;52:(1 Suppl):S83-S99

Kazemi et al.63 carried out an experiment examining the marginal stability and permeability of Cavit, IRM and Tempit. The first part of the experiment was a simple passive dye penetration study with thermocycling whilst, in the second part, the authors attempted to eliminate the possible effects of the hygroscopic setting mechanisms of the materials. Samples were first allowed to set under water before being placed in dye in standardized glass tubes. This study demonstrated that Cavit had a substantial amount of dye diffusion into the body of the material yet this same material exhibited the least overall dye penetration at all times. IRM demonstrated the least body penetration of all three materials but had substantial marginal penetration that was not significantly different from the results of the Tempit material. The setting expansion of Cavit has been noted in many dye/fluid penetration studies as the probable reason for its superior performance in such experiments.

Hi Terry, Hi John, Cavit is certainly interesting, In The climate I worked in I favoured one visit endo, my cleaning regime was strict and the failure rate was zero, having retired I cannot collate the future results but at the time of retirement I was seeing a zero failure rate?

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