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Medical Forum / General / Dentistry / September 2007

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Should Old Silver Point RC's Be Redone?

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Frank L - 28 Aug 2007 23:24 GMT
When I had my checkup, my dentist said I should really have these 2 root
canals redone. Teeth 3 and 4 are root canaled with silver points, done
when I was about 25, I am now 60.

Here's what worries me. Tooth 3,4  and 5 are covered with one long
crown. How would the dentist proceed to do this? Is it hard it remove
that piece? Do they bang it off or drill it off? What does he do
then...cover the 3 teeth with 3 temp caps then send me to an
endodontist? I always fear getting a toothache or abscess in one of
these teeth because they can't drill through this one piece crown (or
can they?)

I got this to save money years ago but wish I had gotten individual
crowns. Also, should I have these teeth redone if they're not bothering
me?

I am the one that posted about sinus pain last week and this is the area
that bothers me (but the left side does too at times)...I just wonder if
silver points could last into old age but this dentist feels that things
could be crumbling underneath and there's no way to tell on x-rays. Any
opinions would be appreciated. Money is a factor, this will cost
thousands so I am depressed over this and don't want to do it if it's
not necessary.
Amatus Cremona - 29 Aug 2007 00:19 GMT
Silver points have the potential to last a life-time.  However, they do not do so all the time.  Any movement of the silver point (due to decay or dental treatment) will cause them to leak.  If the silver point extends past the root tip, an oxidation reaction can occur.  General rule of thumb is that *if* a tooth treated with silver point RCT is opened for any reason, you try to remove the silver points and place gutta percha.  Saves a ton of headaches this way.

As to whether or not you need the RCT re-treated????? No way to tell from my desk.  You may desire a second opinion in real life.  A failing RCT is usually easy to diagnose, but not always.  Generally, if the RCT has sat well for 30 years, and you have no decay in the tooth, any failure would be due to fracture of the root.  Root fractures are usually treated with the removal of the fractured root.  

BTW, we can easily cut through any existing crown to treat the RCT.  Some potential for porcelain fracture does exist when this is done.  

I think it is time to get a 2nd and perhaps a 3rd opinion.

Signature

/

Amatus

/

 When I had my checkup, my dentist said I should really have these 2 root
 canals redone. Teeth 3 and 4 are root canaled with silver points, done
 when I was about 25, I am now 60.

 Here's what worries me. Tooth 3,4  and 5 are covered with one long
 crown. How would the dentist proceed to do this? Is it hard it remove
 that piece? Do they bang it off or drill it off? What does he do
 then...cover the 3 teeth with 3 temp caps then send me to an
 endodontist? I always fear getting a toothache or abscess in one of
 these teeth because they can't drill through this one piece crown (or
 can they?)

 I got this to save money years ago but wish I had gotten individual
 crowns. Also, should I have these teeth redone if they're not bothering
 me?

 I am the one that posted about sinus pain last week and this is the area
 that bothers me (but the left side does too at times)...I just wonder if
 silver points could last into old age but this dentist feels that things
 could be crumbling underneath and there's no way to tell on x-rays. Any
 opinions would be appreciated. Money is a factor, this will cost
 thousands so I am depressed over this and don't want to do it if it's
 not necessary.

------------------------------------------------------------------------------
Frank L - 29 Aug 2007 02:08 GMT
I have further questions based on what you said, Amatus. Can you see
this oxidation on an x-ray? You said they try to remove the silver
points (and replace with gutta percha)...are there times when they
can't? Then what happens?

I have had several opinions. My oral surgeon says, "If it ain't broken,
don't fix it" but others say yes. You also said it's easy to go through
a crown but what about in this case where there is one long crown
covering 3 teeth? I imagine I'd want that taken off anyway as the
margins are sticking out of all 3 teeth after all these years. I'm upset
that my dentist said everything could be crumbling under there. The
recent x-rays show no abscess. If silver points can last a lifetime,
maybe I should wait for trouble. If you can answer the question about
how they remove the long crown that covers the 3 teeth, I'd appreciate
it. Sorry for these long posts, this is just bugging me!
Dr Chan - 29 Aug 2007 12:51 GMT
> I have further questions based on what you said, Amatus. Can you see
> this oxidation on an x-ray? You said they try to remove the silver
[quoted text clipped - 11 lines]
> how they remove the long crown that covers the 3 teeth, I'd appreciate
> it. Sorry for these long posts, this is just bugging me!

If it's one long "crown" covering 3 teeth, then the "crown" is
probably a bridge. I would agree with your oral surgeon.
Amatus Cremona - 04 Sep 2007 14:33 GMT
Hey "Chan", peak at the x-ray image before you commit to an opinion.  :-)

Signature

/

Amatus

/

>> I have further questions based on what you said, Amatus. Can you see
>> this oxidation on an x-ray? You said they try to remove the silver
[quoted text clipped - 14 lines]
> If it's one long "crown" covering 3 teeth, then the "crown" is
> probably a bridge. I would agree with your oral surgeon.
Newbie - 29 Aug 2007 15:33 GMT
>I have further questions based on what you said, Amatus. Can you see
>this oxidation on an x-ray? You said they try to remove the silver
>points (and replace with gutta percha)...are there times when they
>can't?
Yes. But most endodontists are rather adept at removing Ag points.

>Then what happens?
More involved procedures, or sometimes nothing

>I have had several opinions. My oral surgeon says, "If it ain't broken,
>don't fix it" but others say yes.

Tend to agree, but suggest again, a consultation with an endodontist.

The "things may be crumbling" line sounds like a tatctic.

Hey, the stock market may go down, so what ?
It may go up.

Am with Amatus, get a second, third opinion before you jump
into a "maybe" situation. You teeth may be fine and you
have a sinus condition, or maybe not. Can't tell from here.

Any chance you could post x-rays ?
Frank L - 29 Aug 2007 19:18 GMT
Newbie, I can post x-rays but not as an attachment but right on the
screen. I have an antiquated system (webtv). I don't know if that's
allowed on this newsgroup and not sure if I can post them clearly, but
if I am allowed, please let me know as I do have recent periapical x
rays of that area.
Newbie - 30 Aug 2007 19:27 GMT
>Newbie, I can post x-rays but not as an attachment but right on the
>screen. I have an antiquated system (webtv). I don't know if that's
>allowed on this newsgroup and not sure if I can post them clearly, but
>if I am allowed, please let me know as I do have recent periapical x
>rays of that area.

You can post them however you may or you can e-mail
them to me and I will post for you.

wubbabubbazG@rbageyahoo.com

Take out the G'rbage
Frank L - 29 Aug 2007 19:24 GMT
Newbie...also thank you so much for your kind help, I really appreciate
you taking the time to answer all of my questions.
Newbie - 30 Aug 2007 19:28 GMT
>Newbie...also thank you so much for your kind help, I really appreciate
>you taking the time to answer all of my questions.

No problemo amigo,

My special area of interest is endodontics.
Frank L - 01 Sep 2007 03:09 GMT
Thanks so much, newbie. I will send them to you, have to try to scan
them somehow in daylight against the light (they are not digital on
paper). p.s. I am an amiga, not an amigo LOL, not that you'd be able to
tell from my name or teeth :-)
Amatus Cremona - 04 Sep 2007 14:35 GMT
Tape the film to a window and shoot a digital photo image.

This NG does not allow attachments.  Up-load to a binary NG and tell us where it is, or post it to a web-page.  Alternately, Newbie could cc it to most of us.  He has our real email addresses.

Signature

/

Amatus

/

 Thanks so much, newbie. I will send them to you, have to try to scan
 them somehow in daylight against the light (they are not digital on
 paper). p.s. I am an amiga, not an amigo LOL, not that you'd be able to
 tell from my name or teeth :-)

------------------------------------------------------------------------------
Newbie@bix.nex - 05 Sep 2007 05:02 GMT
>Tape the film to a window and shoot a digital photo image.
>
>This NG does not allow attachments.  Up-load to a binary NG and tell us where it is, or post it to a web-page.  
>Alternately, Newbie could cc it to most of us.  He has our real email addresses.

Would be glad to oblige.

However you can post binaries here, have done it many times.
It's just that some of you guys have crappy servers that don't
propagate the attachment.

Ya'll could sign up for Terranews
One time setup fee of $9.95
4MB/day DL limit.

It may not be a "premium" news server but it beats alot
of ISPs news servers by a country mile.
Amatus Cremona - 04 Sep 2007 14:32 GMT
Just returned last night from a few days at the Beach.

The "oxidation" is like a layer of fine "tarnish".  It turns the silver black, and is not visible on an x-ray image until some of the bone is broken down (early abscess).  

Sometimes, silver points are very tight (as they should be), and attempting to pull them out simply results in the points breaking off.  Not a big deal if the tips are not "tarnished".  Tough, if the dentist was planning to place a post (seldom really necessary).  Some unique ultrasonic devices exist to try to loosen these stubborn points, but nothing is guaranteed.  

Crowns are easy to cut holes in and easy to remove, if needed.  If the tooth has decay, final results are questionable--depending on the amount of decay.  Sometimes it is impossible to know until the crown has been removed.  I prefer to slice the side of crowns which need to be removed and peel them off.

Gee whiz, don't worry about one tiny little thing so much.  Find a dentist you trust, and advance forward.  Sounds like your case is "fence-sitter".  Could go either way.  If that is the case, either treatment choice would be equally right.

Signature

/

Amatus

/

 I have further questions based on what you said, Amatus. Can you see
 this oxidation on an x-ray? You said they try to remove the silver
 points (and replace with gutta percha)...are there times when they
 can't? Then what happens?

 I have had several opinions. My oral surgeon says, "If it ain't broken,
 don't fix it" but others say yes. You also said it's easy to go through
 a crown but what about in this case where there is one long crown
 covering 3 teeth? I imagine I'd want that taken off anyway as the
 margins are sticking out of all 3 teeth after all these years. I'm upset
 that my dentist said everything could be crumbling under there. The
 recent x-rays show no abscess. If silver points can last a lifetime,
 maybe I should wait for trouble. If you can answer the question about
 how they remove the long crown that covers the 3 teeth, I'd appreciate
 it. Sorry for these long posts, this is just bugging me!

------------------------------------------------------------------------------
Newbie - 29 Aug 2007 15:14 GMT
>When I had my checkup, my dentist said I should really have these 2 root
>canals redone. Teeth 3 and 4 are root canaled with silver points, done
>when I was about 25, I am now 60.

Have seen "well done" silver point endo last that long and longer.

>Here's what worries me. Tooth 3,4  and 5 are covered with one long
>crown. How would the dentist proceed to do this?
That really depends.

> Is it hard it remove
>that piece?
Again that depends, but know this;
These teeth are likely to be very brittle now.

> Do they bang it off or drill it off?

Wouldn't 'bang' it off, risk of root fracture too high.
You can cut off the structure with a bur however.

Another option is to go through the crown from the top.

> What does he do
>then...cover the 3 teeth with 3 temp caps then send me to an
>endodontist?

Think that a consult with an endodontist should be the first step.

>I always fear getting a toothache or abscess in one of
>these teeth because they can't drill through this one piece crown (or
>can they?)

Yes, that can be done.

>I got this to save money years ago but wish I had gotten individual
>crowns. Also, should I have these teeth redone if they're not bothering
>me?

I would be reluctant to wake a sleeping bear.

>I am the one that posted about sinus pain last week and this is the area
>that bothers me (but the left side does too at times)...I just wonder if
[quoted text clipped - 3 lines]
>thousands so I am depressed over this and don't want to do it if it's
>not necessary.

Don't be depressed.
Go get a second opinion from an endodontist.

American Association of Endodontists
has some good info.
www.aae.org
 
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