Bone Regrowth and Healing of Periapical Lesions Nine Months after Removal of Silver Points and Retreatment with the GentleWave Procedure

Introduction: Endodontists occasionally encounter patients who were treated with silver points from prior root canal therapy (RCT). Obturation with silver points became part of endodontic therapy in the 1930s, however they are no longer recommended as they do not provide complete obturation and have been shown to be associated with negative clinical sequelae. When silver points begin to fail or produce correlated pathological changes, retreatment is indicated. Objective: This case report describes an elderly patient who presented for retreatment due to a failing silver point RCT. The patient was experiencing biting tenderness in the lower right quadrant, and radiographic examination revealed prior silver point RCT with periapical lesions on the mesial and distal roots of the right mandibular first molar. Based on the clinical and radiographic findings, a diagnosis of acute apical periodontitis was made. The treating endodontist chose to provide retreatment with the GentleWave Procedure, which uses multisonic energy to clean and disinfect the root canal system and any anatomical complexities. This procedure was chosen as the optimal choice for the prevention of reinfection and for the removal of any residual bacteria after the silver point removals. Results: The patient was successfully retreated and post-procedure paper points did not show the typical residue and metallic debris that is seen after silver point removal. Nine-month follow-up examination and diagnostic imaging showed full resolution of the apical periodontitis with significant bone regrowth. Conclusion: Root canal retreatment can prevent unnecessary extraction of a root-filled tooth with apical periodontitis. In this case report, the treating endodontist provided retreatment to an elderly patient with acute apical periodontitis due to failing RCT with silver point obturation. Retreatment using the GentleWave Procedure led to a successful outcome and resolution of the apical periodontitis with significant bone regrowth over a 9-month recall period.