One of the things we are often called on to do is to remove obstructions from the root canal system.
These obstructions can be any number of things. They can be carrier based filling material, posts, silver points, rotary files or something else (lentulospirals come to mind).
There are a few principles in dealing with these obstructions.
First, if at all possible, gain visual access to the item to be removed. Being able to see the obstruction will help you direct your retrieval process at the item itself, hopefully sparing the surrounding tooth structure.
Second, loosen the item. Usually this is achieved by the use of ultrasonic energy. The process of bypassing obstructions using hand files also often achieves the same thing.
Third, once you have visible mobility (a microscope helps here) grasp and remove the item. This can be done in a number of ways. You can use an assortment of small pliers and forceps, IRS or other tube like removal systems, or post pullers. If you are able to bypass the obstruction in more than one area, you can also use file braiding.
Some creativity in approaching the situation is helpful as well. Sometimes you can remove the obstruction orthograde:
I customized a small tip that I usually use for expressing Calcium hydroxide. I press fit it to grab the post and removed it from the canal.
Other times it is best done retrograde:
I was able to use Ultrasonic energy to loosen the silver point prior to removal.
The way you think about removing these obstructions is the biggest barrier to success. With some experience, the assistance of an operating microscope and a dash of creativity, we can often snatch victory from the jaws of defeat.
“You can’t depend on your eyes when your imagination is out of focus.”
-Mark Twain
