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The removal of difficult silver cones
0099-2399/83/0905-0210/$02.00/0 JOURNAL OF ENDODONTICS Copyright 9 1983 by the American Association of Endodontists
Printed in U.S.A.
VOL. 9, NO. 5, MAY 1983
CLINICAL AID The Removal of Difficult Silver Cones Manuel I. W e i s m a n , DDS, FACD, FICD
The removal of a silver c o n e from an existing root canal can be very difficult and sometimes an impossible task. Various methods have been suggested to aid the operator with this problem. The use of the Stieglitz f o r c e p s is advocated by some authors ( 1 , 2 ) . The problem with this type of f o r c e p s is that often the coronal c i r c u m f e r e n c e of the a c c e s s opening is too small to permit the manipulation and grasping of the end of the silver cone.
~1 B L A D F S SAN[)t D
FiG 2. The locking of the hemostat about half way up on the Perry plier after grasping the silver cone,
I
FIG 1. The use of the smooth-sided 669 or 700 bur to countersink the dentin to expose the coronal end of a silver cone. Generally, there are two main problems in the removal of a silver cone: (a) o b t a i n i n g e n o u g h of the existing coronal of the cone to grasp and (b) getting a firm p u r c h a s e on this small stub in a restricted space to loosen. Weine (3) and Gerstein and Weine (4) have suggested a very efficient m a n n e r to increase the length of the coronal end of the cone. T h e y advocate the use of a smooth-sided tapered 6 6 9 or 7 0 0 bur to c o u n t e r sink around the cone into the dentin to give the operator an end to grasp (Fig. 1 ). There still rernains the problem of securing some sort of firm hold on this butt end to remove it from the
FIG 3. The silver cone is locked into the Perry plier by the hemostat and removed.
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Vol. 9, No. 5, May 1983
Removal of Silver Cones
canal. S t a n d a r d c o t t o n p l i e r s a n d h e m o s t a t s a r e g e n e r a l l y t o o l a r g e to m a n i p u l a t e in this small o p e n i n g . TECHNIQUE
O b t a i n a small 5 - i n c h P e r r y g o l d foil p l i e r a n d a h e m o s t a t . T h e P e r r y p l i e r has a v e r y small s e r r a t e d b e a k and can often be p l a c e d e a s i l y on the c o n e e n d . T h e p r o b l e m is that t h e r e is not e n o u g h p r e s s u r e to k e e p the plier from s l i p p i n g off. T o c o r r e c t this, l o c k the small plier with a h e m o s t a t a b o u t half w a y as illustrated (Fig. 2). T h i s will a f f o r d a tight g r i p o n t h e c o n e and a l s o g i v e the o p e r a t o r an a d d i t i o n a l h a n d l e in w h i c h to e x e r t an e x t r i c a t i n g force. T h e use of s o l v e n t s to d i s s o l v e the s e a l e r is a l s o helpful. F i g u r e 3 illustrates silver c o n e c o m p l e t e l y lifted out.
211
SUMMARY
T h e r e m o v a l of e x i s t i n g s t u b b o r n silver c o n e s f r o m existing c a n a l s can be e x c e e d i n g l y difficult. T h e use of the small P e r r y plier with a h e m o s t a t c l a m p can e n a b l e t h e o p e r a t o r to o b t a i n a p u r c h a s e o n t h e c o n e to r e m o v e it from the canal. Dr. Weisman is an associateprofessor of endodonticsat the Medical Collegeof Georgiaand is in privatepracticeof endodontics.Addressrequests for reprintsto Dr. Weismanat 1519Laney-WalkerBlvd.,Augusta,GA30904. References
1. CohenS. Burns R. Pathwaysof the pulp. 2nd ed. St. Louis:CV Mosby Co,, 1980:193. 2. Grossman LI. Endodonticpractice. 10th ed. Philadelphia:Lea & Febiget, 1981:318. 3. Weine FS. Endodontic therapy. 3rd ed. St. Louis: CV Mosby Co., 1982:406-7. 4. GersteinH, WeineFS. Speciallypreparedburs to removesilvercones and fractured dowels. J Endodon1977;3:408.
Printed in U.S.A.
VOL. 9, NO. 5, MAY 1983
CLINICAL AID The Removal of Difficult Silver Cones Manuel I. W e i s m a n , DDS, FACD, FICD
The removal of a silver c o n e from an existing root canal can be very difficult and sometimes an impossible task. Various methods have been suggested to aid the operator with this problem. The use of the Stieglitz f o r c e p s is advocated by some authors ( 1 , 2 ) . The problem with this type of f o r c e p s is that often the coronal c i r c u m f e r e n c e of the a c c e s s opening is too small to permit the manipulation and grasping of the end of the silver cone.
~1 B L A D F S SAN[)t D
FiG 2. The locking of the hemostat about half way up on the Perry plier after grasping the silver cone,
I
FIG 1. The use of the smooth-sided 669 or 700 bur to countersink the dentin to expose the coronal end of a silver cone. Generally, there are two main problems in the removal of a silver cone: (a) o b t a i n i n g e n o u g h of the existing coronal of the cone to grasp and (b) getting a firm p u r c h a s e on this small stub in a restricted space to loosen. Weine (3) and Gerstein and Weine (4) have suggested a very efficient m a n n e r to increase the length of the coronal end of the cone. T h e y advocate the use of a smooth-sided tapered 6 6 9 or 7 0 0 bur to c o u n t e r sink around the cone into the dentin to give the operator an end to grasp (Fig. 1 ). There still rernains the problem of securing some sort of firm hold on this butt end to remove it from the
FIG 3. The silver cone is locked into the Perry plier by the hemostat and removed.
210
Vol. 9, No. 5, May 1983
Removal of Silver Cones
canal. S t a n d a r d c o t t o n p l i e r s a n d h e m o s t a t s a r e g e n e r a l l y t o o l a r g e to m a n i p u l a t e in this small o p e n i n g . TECHNIQUE
O b t a i n a small 5 - i n c h P e r r y g o l d foil p l i e r a n d a h e m o s t a t . T h e P e r r y p l i e r has a v e r y small s e r r a t e d b e a k and can often be p l a c e d e a s i l y on the c o n e e n d . T h e p r o b l e m is that t h e r e is not e n o u g h p r e s s u r e to k e e p the plier from s l i p p i n g off. T o c o r r e c t this, l o c k the small plier with a h e m o s t a t a b o u t half w a y as illustrated (Fig. 2). T h i s will a f f o r d a tight g r i p o n t h e c o n e and a l s o g i v e the o p e r a t o r an a d d i t i o n a l h a n d l e in w h i c h to e x e r t an e x t r i c a t i n g force. T h e use of s o l v e n t s to d i s s o l v e the s e a l e r is a l s o helpful. F i g u r e 3 illustrates silver c o n e c o m p l e t e l y lifted out.
211
SUMMARY
T h e r e m o v a l of e x i s t i n g s t u b b o r n silver c o n e s f r o m existing c a n a l s can be e x c e e d i n g l y difficult. T h e use of the small P e r r y plier with a h e m o s t a t c l a m p can e n a b l e t h e o p e r a t o r to o b t a i n a p u r c h a s e o n t h e c o n e to r e m o v e it from the canal. Dr. Weisman is an associateprofessor of endodonticsat the Medical Collegeof Georgiaand is in privatepracticeof endodontics.Addressrequests for reprintsto Dr. Weismanat 1519Laney-WalkerBlvd.,Augusta,GA30904. References
1. CohenS. Burns R. Pathwaysof the pulp. 2nd ed. St. Louis:CV Mosby Co,, 1980:193. 2. Grossman LI. Endodonticpractice. 10th ed. Philadelphia:Lea & Febiget, 1981:318. 3. Weine FS. Endodontic therapy. 3rd ed. St. Louis: CV Mosby Co., 1982:406-7. 4. GersteinH, WeineFS. Speciallypreparedburs to removesilvercones and fractured dowels. J Endodon1977;3:408.