0099-2399/91/1709-0466/$03.00]0 JOURNAL OF ENDODONTICS Copyright 9 1991 by The American Association of Endodontists

CASE

Printed in U.S.A.

VOL. 17, NO. 9, SEPTEMBER1991

REPORTS

Revisiting the Post Puller David E. Stamos, DDS, MS, and James L. Gutmann, DDS

The removal of an intraradicular post is frequently part of retreatment and the fabrication of a new coronal restoration. This article highlights the use of a post puller for safe and effective removal of an intraradicular post in conjunction with retreatment.

The purpose of this article is to highlight the use of a post puller, demonstrating its simplicity, technique, and advantages. CASE R E P O R T A 59-yr-old white female undergoing full-mouth rehabilitation was referred for root canal retreatment of the maxillary left first premolar. It was requested that the post be removed from the palatal canal and the tooth retreated. The patient had undergone successful retreatment of the adjacent teeth earlier. The medical history was noncontributory and the patient was asymptomatic at the time of treatment. Clinical examination revealed a loose acrylic bridge with localized gingival inflammation. A periapical radiograph showed an intact lamina dura with normal periradicular region (Fig, 1). Local anesthetic was administered for the patient's comfort during the procedure. The post puller, an advanced generation model instrument, developed by Skinner and described by Prothero in 1916 (7) was used to remove the custom post (Fig. 2). The buccal and palatal walls were reduced to the same height and the core was reduced in diameter circumfer-

Nonsurgical root canal retreatment will frequently require the removal of a customized or prefabricated intraradicular post or dowel. This can be difficult and time consuming. Removing a post may require grasping it with either a hemostat or a silver cone forceps and attempting to withdraw the post from the canal without fracturing the root. In difficult cases, an ultrasonic scaler has been used to remove the post (1). Stamos et al. (2) described a technique in which an ultrasonic unit is used to explore the interface between the post and the canal wall. The vibratory action of the file separates the cement from around the post. If a post is fractured within the canal, then the Masserann technique can be used (3). This technique involves cutting a small trench around the post with a handheld trepan bur. Once a trench has been made one third to one half the way down the post, the trepan bur is replaced with the next smaller size, which will grip the end of the post to lift it out of the canal. Gerstein and Weine (4) recommended the use of a specially prepared bur to create a circumferential trench, which enables a forcep to grasp the object and retrieve it. A simplified technique for post removal using a post puller has been described by Warren and Gutmann (5). The post and the tooth are reduced to allow for attachment of the post puller. The first set of jaws of the post puller are securely fasten onto the post while the second set of jaws push away from the tooth in line with the long axis of the tooth lifting the post out of the canal. The advantages of this system include conserving root structure and reducing the risk of root fracture, root perforation, and root torquing. The Gonon post-removing system has been described as being safe and efficient for post removal in the anterior and posterior regions of the mouth (6). It involves the use of a trephine bur to bore and gauge the post to the exact size of a corresponding mandrel which is screwed onto the post. An extracting plier is attached to the mandrel and activated to lift the post out of the canal.

FiG 1. Preoperative radiograph demonstrating custom post in palatal canal of maxillary left first premolar. 466

Vol. 17, No. 9, September 1991

entially (Fig. 3). The jaws of the post puller were then slipped over the core and tightened securely around it (Fig. 4). Turning the top thumbscrew activated the second set of jaws to apply pressure in the direction of the long axis of the tooth against the root face. The post was then slowly removed from the canal (Fig. 5). Gutta-percha was removed from the canals using Xylol as a solvent, followed by a cleansing and shaping of the canal with a #40K file. The canals were obturated using gutta-percha and Grossman's sealer, and post space was prepared in the palatal canal. A cotton pellet and a Cavit temporary filling (Premier Dental Products Co., Philadelphia, PA) were placed in the access cavity (Fig. 6) and the acrylic bridge was recemented. A 1-yr recall revealed an asymptomatic patient, with the tooth in function without any notable radiographic change apically (Fig. 7).

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FIG 4. Jaws of post puller tighten around core.

DISCUSSION Whereever possible, nonsurgical root canal retreatment is preferred over surgical retreatment. However, if a post is present a surgical approach is often chosen. Surgical procedures usually do not address the problem posed by the post,

FIG 5. Post being removed from the canal with the forces being exerted in the long axis of the tooth.

FIG 2. Post puller.

FiG 6. Postoperative radiograph demonstrating completion of retreatment with post space prepared in palatal canal.

FIG 3. Buccal and palatal walls reduced to same height and core reduced circumferentiatly.

such as coronal leakage along a poorly cemented restoration or unclean portions of the canal system, and can result in an unfavorable crown to root ratio and unesthetic gingival contours. If anatomical or medical considerations rule out a

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little internal tooth structure needs to be sacrificed and the danger of root fracture is significantly diminished. Because of the size of the post puller used in this case, it is mainly used in the anterior and premolar regions. The only potential contraindications for using the post puller are screw posts and posts that have deep serrations. Although the current use of ultrasonics to remove posts has been successful, the use of a post puller, to safely and efficiently remove an intraradicular post, can now be considered another treatment modality and can provide the practitioner with an alternative to facilitate retreatment. Dr. Stamos is associate clinical professor, Department of Endodontics, University of Missouri-Kansas City School of Dentisty and maintains a full-time private practice in Kansas City, MO. Dr. Gutmann is professor and chairman, Department of Endodontics, Baylor College of Dentistry, Dallas, TX. Address requests for reprints to Dr. David E. Stamos, 4240 Blue Ridge Blvd., Suite 216, Kansas City, MO 64133. FIG 7. One-year postoperative radiograph.

References

surgical procedure, then removal of the post is the treatment of choice. During post removal several problems could occur. Root perforation, root fracture, and unnecessary removal of tooth structure are c o m m o n with unorthodox and unsafe methods of removal. The post puller is a safe and effective instrument for post removal. However, it is a relatively obscure instrument that has received little attention for nonsurgical retreatment. During its use, the forces exerted during removal of the post are evenly distributed along the long axis of the tooth,

1. Gaffney JL, Lehman JW, Miles MJ. Expanded use of the ultrasonic scaler. J Endodon 1981 ;7:228-9. 2. Stamos DG, Haasch GC, Chenail B, Gerstein H. Endosonics: clinical impressions. J Endodon 1985;11:181-7. 3. Williams VD, Bjorndal AM. The Masserann technique for the removal of fractured posts in endodontically treated teeth. J Prosthet Dent 1983;49:468. 4. Gerstein H, Weine FS. Specially prepared burs to remove silver cones and fractured dowels. J Endodon 1977;3:408-10. 5. Warren SR, Gutmann JL. Simplified method for removing intraradicular posts. J Prosthet Dent 1979;42:353-6. 6. Machtou P, Sarfati P, Cohen AG. Post removal prior to retreatment. J Endodon 1989; 15:552-4. 7. Prothero JH. Prosthetic Dentistry. 2nd ed. Chicago: Medico-Dental Publishing Co., 1916:868.

You Might Be Interested to Know Medical historian S often trace the success of present day surgical procedures to three crucial advances: anesthesia, infect!on control, and transfusion. The recent concern about the spread of disease by means of infected blood prdducts has engendered discussion of the risk/benefit ratios associated with transfusion. The AMA now reports that Chagas' disease--South American trypanosomiasis--must be added to the list of disorders transmissible by blood transfusion, and that there are now about 100,000 recent immigrants in this country who may be chronically infected with this disease but asymptomatic. Just one more thing to worry about. Zachariah Yeomans

Revisiting the post puller.

The removal of an intraradicular post is frequently part of retreatment and the fabrication of a new coronal restoration. This article highlights the ...
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