Q. What are some of the more important methods to remove silver points?
A. The first thing I consider when removing silver points is careful access. In many instances a silver point extends out of the canal and into the pulp chamber. Clinicians need to thoughtfully perform access so as not to inadvertently foreshorten a silver point which could result in making it more difficult to grasp and pull out. It’s important to remove all circumferential material surrounding the silver point to facilitate loosening and removal. A grasping tool such as the Stieglitz pliers (Henry Schein) can generally get a strong purchase on the coronal end of a silver point and then, utilizing the concept of fulcrum mechanics, elevate the silver point out of the canal.
Indirect ultrasonics is another important method to remove silver points. It is not wise to place any ultrasonic instrument directly on the silver point because it will rapidly erode away this soft material. Rather, first engage the silver point with a grasping instrument and then place an ultrasonic instrument, such as a ProUltra Endo Tip #1 (Dentsply Tulsa Dental), on the pliers to indirectly vibrate it loose. Since most canals are irregular in their cross-sectional dimensions and since silver points are round, then theoretically, space exists between the wall of the canal and the silver point. Files, solvents, and chelators can be utilized to eliminate sealer thus undermining and loosening the silver point so it can be removed. The hedstroem displacement technique is an invaluable technique for removing silver points or silver point segments. Finally, microtubes can be utilized to engage and remove certain silver points. The Post Removal System (PRS, SybronEndo) has small microtubular taps, allowing the clinician to mechanically tap and engage any silver point that is 0.6 mm or greater in diameter and whose most coronal extent extends into the pulp chamber. For further technique information on the removal of silverpoints, see also the Ruddle on Retreatment
DVD entitled "Nonsurgical Removal of Gutta Percha, Silver Points, Carriers & Paste Fillers".