Apex Surgery: Concerns About Silver Powder and Alternatives

Apicoectomy

First: My endodontist did not inform me in advance and used silver powder for retrograde filling, but I have concerns about the silver powder.
If I want to remove the silver powder, can the root tip be resected again and filled with other materials, or is extraction the only option? Second, I have another tooth that requires apicoectomy to remove the silver powder.
Are there alternative materials that can be used? What is the approximate cost, and what is the expected lifespan of these materials? Third, how many units can a dental bridge consist of? Does having more units increase the stress on the bridge? Approximately how many teeth can it support?

Lin Yun, 40~49 year old female. Ask Date: 2020/09/28

Dr. Huang Tingfang reply Dentistry

Dear Mr.
Lin Yun,
Hello! The use of silver powder for retrograde filling in apical surgery is a commonly employed technique.
MTA can also be used, with costs ranging from 5,000 to 10,000 NTD.
The longevity depends on the condition of the tooth.
When it comes to dental bridges, avoid overloading them; for example, if you have three teeth, do not support them with just two.
Take care! Wishing you peace and success!
Sincerely,
Director Huang Ting-Fang, Dentistry

Reply Date: 2020/09/28

More Info

When it comes to apex surgery, particularly regarding the use of silver powder for retrograde filling, there are several important considerations to address your concerns.

1. Removal of Silver Powder
If you have reservations about the use of silver powder in your apex surgery, it is indeed possible to remove it. The process would typically involve a surgical procedure where the dentist or oral surgeon would access the root tip again, remove the silver powder, and then fill the space with a different material. This does not necessarily mean that extraction of the tooth is the only option. The decision will depend on the condition of the tooth and surrounding structures. If the tooth is otherwise healthy and salvageable, retreatment is a viable option. However, if the tooth has significant structural damage or if there are other complications, extraction may be considered.

2. Alternatives to Silver Powder
For your second tooth that requires apex surgery, there are several materials that can be used as alternatives to silver powder. Common materials include:
- Mineral Trioxide Aggregate (MTA): This is a biocompatible material that promotes healing and is often used in endodontic procedures. It has excellent sealing properties and is known for its durability.

- Calcium Silicate-based Cements: These materials are also biocompatible and have similar properties to MTA.

- Resin-based Composites: These can be used in some cases but may not offer the same level of sealing as MTA or calcium silicate.

The cost of these materials can vary widely based on geographic location, the specific dental practice, and the complexity of the procedure. Generally, MTA can range from $100 to $300 per procedure, while other materials may be less expensive. The longevity of these materials can also vary; MTA, for example, is known to last many years, often exceeding a decade if placed correctly.

3. Dental Bridges
Regarding dental bridges, the number of units (teeth) that can be connected in a bridge can vary. Typically, a bridge can span 3 to 5 units, but it is possible to create longer bridges. However, as the number of units increases, the stress on the supporting teeth also increases. This can lead to complications such as loosening or fracture of the bridge or the supporting teeth. Generally, it is advisable to limit bridges to 3-4 units for optimal stability and longevity. If more teeth need to be replaced, alternative solutions such as partial dentures or implants may be considered.

Conclusion
In summary, if you have concerns about the use of silver powder in your apex surgery, it is important to discuss these with your dentist or oral surgeon. They can provide you with options for removal and alternative materials that may be more acceptable to you. Additionally, understanding the limitations and considerations regarding dental bridges will help you make informed decisions about your dental health. Always consult with your dental professional to tailor the treatment plan to your specific needs and preferences.

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