The Easiest Way to Remove a Fiber Post

[00:00:00]If you're a dentist who'd like to know how to remove fiberglass posts from the canal, then this video is for you.

[00:00:13]If you're new to the channel, my name's Sijo Jacob. I've been a private practitioner in Dubai and Bangalore for the last 25 years. In addition to private practice, I've also been teaching dentists clinical endodontics for the last 25 years. I've mentored thousands of dentists at various stages in their endodontic careers over the last 25 years. This week we're going to talk about how to remove fiberglass posts from the canal.

[00:00:35]Many of you are aware how to remove metal posts. If you still aren't aware, let me know in the comments and I will present another video on how to remove metal posts. But most practitioners do not have a problem with metal posts.

[00:00:46]Where they have a problem is how to remove fiberglass posts from the canal, which is very different from removing metal posts. First, let's look at how most practitioners remove metal posts.

[00:00:56]So, when you have a case where you need to remove a metal post, the first thing we need to do is remove the cement around the metal post. We need to remove the part of the cement that's holding the metal post at least in the coronal part. So, once that is done, all you need to do is insert an ultrasonic tip alongside the metal post. It could be just a regular ultrasonic tip which we use for scaling. We put that tip in contact with the metal post and then go around the metal post and sooner or later the metal post just vibrates out.

[00:01:26]So, it's pretty straightforward. Once you get to do a few cases, it is pretty straightforward. You don't even need any fancy tools or any fancy ultrasonic tips. You can do it with the regular ultrasonic tip that you use in your clinic for scaling. So, it's pretty straightforward. However, when it comes to fiberglass posts, it isn't the same.

[00:01:43]You cannot vibrate out a fiberglass post. It's a little more tricky. This is how a fiberglass post looks like and we cannot insert an ultrasonic tip around these fiberglass posts and expect that it will vibrate out. You have to handle these cases differently and how to handle them is what we're going to show you in this video. By the way, if you are a dental practitioner looking to improve your clinical endodontic skills, I've built something specially for you.

[00:02:08]It's called everyday endodontics. It's my private community. Do check out the link in the description below. You'll get real world practical information that you can use in your clinical practice. No theory, no unnecessary fluff, just pure clinical information that you can use in your clinical practice. Check out the link in the description below. In order to remove fiberglass posts, we need to use long shank micromotor burs like what you see here. This is an example of long shank micromotor burs called Munce burs, but you have similar burs from other companies as well. These are long shank and they are micromotor. How these burs are different is they come in different diameters starting from the larger ones tapered all the way to very small microscopic burs which have a long shank. So, the advantage of having a long shank is that you can see where the tip of the bur is working. So, these are what I use in my clinical practice to remove fiberglass posts and I'll show you a few cases on how we go about doing it.

[00:03:06]So, let's look at a couple of cases where we can illustrate how we go about removing fiberglass posts so you get a very good idea. So, this is an example of a case where a practitioner had done the original endo on a maxillary second premolar. He did the endo, placed two fiberglass posts along with a core and then put a crown and then sent the patient off. After a year, the patient came back to the clinic with acute pain.

[00:03:28]The private practitioner removed the crown and then sent the case to me to retreat. So, this is how I saw the patient to start with. This was the tooth here and there were two fiberglass posts with a composite core and surprisingly a little bit of amalgam as well.

[00:03:41]So, we went in there and one of the challenges we face is initially we have to remove a part of the composite around the fiberglass posts, but when we do so, it gets a little hazy. The debris kind of masks where the fiber post is. So, this is something that is important when you are drilling. When you are drilling and as the debris accumulates inside, you will not be able to differentiate between where the fiberglass post is and where the composite is and you can get lost. So, if you're not on track as you go deeper, you can easily get lost and then it's very difficult to get back on track. So, one needs really good vision, ideally a microscope. As you get deeper in the canal, it becomes very difficult to do this without a microscope. So, if you're using a loop, maybe you could get away in the coronal part, but as you go deeper, it's impossible to do this without a microscope. So, don't do this unless you can clearly see or differentiate between the post and the composite and the tooth structure. So, one of the problems that we have when we drill down fiberglass post is as we drill down the fiberglass post and the debris accumulates and the fiberglass post becomes dry, the dry post cannot be distinguished between the surrounding composite resin as well as the tooth structure. So, you will get an image like what you see here. So, it's important to stop what you're doing, rinse it out, and when it is wet, you can differentiate between the post and the surrounding tooth structure. So, as long as you can differentiate the fiberglass post and the tooth structure, then you can drill selectively into the fiberglass post and not touch the tooth structure.

[00:05:15]So, we use these microscopic tools like what you see here. These microscopic burs, Goldman's burs, we use that to selectively drill down the fiberglass post like that. And the advantage of having a long shank and a small head is that you can very clearly differentiate or selectively drill where exactly you want to drill and not just randomly drill the whole tooth with a large size of bur without knowing the area in which you're drilling on. So, you have to be very selective. So, once we do that, we find the gutta-percha underneath and in this particular case, I removed the gutta percha and then the rest of the procedure is fairly straightforward. I put some calcium hydroxide there, put some sort of a dressing, then I sent the patient back.

[00:05:56]Two weeks later, the patient came back and we replaced the gutta percha filling, the root canal filling obturation, as well as new posts. And then that's how the patient walked out of the clinic. You can see that's the pre-op and that's the post-op. And you can clearly see the advantage of having vision along with microscopic tools is that we can accomplish this without removing any additional tooth structure.

[00:06:18]Now, let's look at another case where the fiberglass post is way more deeper than the previous case. So, this will give you a very good idea as to how to proceed step by step. So, if you look at this case, this patient had an endodontic therapy done and a ceramic crown. And the patient came to the clinic with acute pain and swelling.

[00:06:36]When we took a radiograph, we could see there's a pretty large lesion here. We took a CBCT in this case and we found that the lesion was restricted to the palatal root. There was no lesion in the mesiobuccal and the distobuccal root.

[00:06:48]So, after discussion with the patient, we decided to do a selective endodontic therapy or what we call image-guided endodontics where we didn't do disassembly and retreat all the canals.

[00:06:58]We decided to retreat only the canal which was causing the problem, which was the palatal canal. So, we decided to keep the crown as it is, make a selective opening into the tooth, remove the fiberglass post. You can see how deep the fiberglass post is. So, it's very deep compared to the previous case.

[00:07:15]So, it gives you a very good case to illustrate how we went about removing the fiberglass post while maintaining visibility.

[00:07:22]So, you can see here that's how we started. So, you have your ceramic crown there. This is a zirconia crown. So, we made an access on the palatal surface through the zirconia crown. And as you go there, you can clearly see that's the fiberglass post and that's the composite resin inside and this is the ceramic crown on the outside. So, as you go deeper, this is a challenge. When the debris accumulates, we can no longer differentiate which is the fiberglass post and which is the composite resin.

[00:07:49]It comes as one large mass. So, if you keep drilling this entire mass, then you can easily lose track of where the fiberglass post is and you can go in the wrong direction. And once you go in the wrong direction deeper in the root, then it's very difficult to get back on track and then you end up in perforations. So, when you go deeper like this and you get lost, the easiest thing to do is put some water in the canal, scrub out the debris, and put some water. When the fiberglass post is dry, the vision disappears. But, when you put water back in, the vision reappears. So, this is the same picture. You can see it's dry here now. But, the minute you put some water, it becomes visible again. So, you can clearly see where the fiberglass post is.

[00:08:29]So, what we do is whenever we feel that we can't see the fiberglass post, we put we dip a micro brush in a bit of water and then coat the surface and you can see the fiberglass post becomes visible again as a dark shadow there. So, we know exactly where to drill. We avoid drilling around in this area. We stick to only this central area.

[00:08:50]And as you go deeper, you can see we keep repeating this so that we are always on track. We can clearly see where the fiberglass post is. Whenever we lose vision, we wet a micro brush and put it back in there again and we keep repeating this step by step. As we go deeper and deeper, you can see at one stage the fiberglass post starts thinning down and then finally it gives way. In this particular case, the minute we removed the fiberglass post and reached the gutta-percha, pus started oozing out from that area. So, we know we are on track and you can see that that's the gutta-percha and that's pus around the gutta-percha there.

[00:09:25]So, we flushed out all the pus there and you can see the gutta-percha there and once we see the gutta-percha, we inserted a K file into the palatal canal and then removed the gutta-percha and we got a lot more drainage from the canal.

[00:09:38]And then we kept irrigating till all the drainage settled down, and then we put calcium hydroxide in the canal, waited for some time for the lesion to heal, and then we obturated the canal.

[00:09:48]You can see here, that's the gutta-percha, that's the new fiberglass post, and we restored the access with a composite resin as well. And that's the post-op. Yes, there could be an argument for retreating, but remember we said we discussed those options with the patient, and we found that this was the best way out, and you can see the lesion's healed there.

[00:10:06]So, I hope that clears up some doubts that you may have, so that when you get a case where you need to remove a fiberglass post in your clinic, you know exactly what to do.

[00:10:15]If you're a clinician who just watched this video, and you're thinking to yourself, "Wouldn't it be nice if I have someone I can turn to for advice like this every time I'm stuck with some difficult problem in my clinic, some endodontic case that I don't really know what to do?" Then do check out my community. It's called Everyday Endo.

[00:10:32]I've put the link in the description below. It's a community where you can ask me any questions you have, and I personally answer all your doubts. Apart from me, you have other brilliant clinicians as well who can help you in your endodontic problems. Do check out the link in the description below. And you can support our channel by clicking on that subscribe button, so that you get notified every time I upload a new video, which is usually every Saturday.

[00:10:54]And if you want to watch more content that I've already uploaded on this channel, then do check out some of these [music] videos that are coming out here.

[00:11:00]I'll see you next week with another video. Till then, take care. Thanks for watching.

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