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Table of Contents   
CASE REPORT  
Year : 2013  |  Volume : 16  |  Issue : 5  |  Page : 474-476
Endodontic management of an unusual foreign body in a maxillary central incisor


1 Department of Conservative Dentistry and Endodontics, Government Dental College, Thiruvananthapuram, Kerala, India
2 Government Dental College, Thiruvananthapuram, Kerala, India
3 Department of Pedodontics, Azeezia College of Dental Science and Research, Meeyannoor, Kollam, Kerala, India

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Date of Submission11-Feb-2013
Date of Decision05-Mar-2013
Date of Acceptance18-Jul-2013
Date of Web Publication3-Sep-2013
 

   Abstract 

The discovery of foreign bodies in the teeth is often diagnosed accidentally. It is commonly seen in children. These foreign objects may act as a potential source of infection and may later lead to a painful condition. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body, and the difficulty involved in its retrieval. This paper discusses the types of foreign objects found in and around the teeth and reports an unusual case of a stapler pin in the root canal of a tooth, its retrieval, and associated management of the involved teeth.

Keywords: Foreign bodies; source of infection; stapler pins in teeth

How to cite this article:
Chand K, Joesph S, Varughese JM, Nair MG, Prasanth S. Endodontic management of an unusual foreign body in a maxillary central incisor. J Conserv Dent 2013;16:474-6

How to cite this URL:
Chand K, Joesph S, Varughese JM, Nair MG, Prasanth S. Endodontic management of an unusual foreign body in a maxillary central incisor. J Conserv Dent [serial online] 2013 [cited 2019 Jul 21];16:474-6. Available from: http://www.jcd.org.in/text.asp?2013/16/5/474/117496

   Introduction Top


A foreign object found in pulp chamber or root canal of a tooth is often diagnosed accidentally. It is commonly seen in children as they have the habit of placing foreign objects in the mouth. At times, these objects can get lodged in the pulp chamber or root canal of a tooth and can cause a potent focus of infection. Complications can follow if these impacted foci of infection are not eliminated. In some cases, the tooth remains asymptomatic and the presence of the foreign body is revealed only during routine radiographic examination. Presence of these objects prevents thorough instrumentation of root canal system. So, their removal is necessary to re-negotiate the canal and complete the endodontic treatment successfully.


   Case Report Top


A 14-year-old boy presented with the complaint of broken upper front teeth. The patient wanted esthetic restoration of his anterior teeth. He had a history of fall from steps while playing 2 years ago.

Clinical examination revealed a complicated crown fracture (Ellis class III) on upper right central incisor and an Ellis class II fracture on upper left central incisor [Figure 1]a and b. There was a mild discoloration of 11. He had negative history of pain, swelling, or pus discharge. On examination, an open root canal was seen on 11.
Figure 1: (a) Preoperative photograph – labial view, (b)Preoperative photograph – lingual view, (c) IOPA of upper anterior region showing foreign body in the root canal of 11, (d) Stapler pin of dimension 9 mm retrieved from the root canal, (e) Postoperative IOPA of tooth 11 (f) Postoperative photograph – labial view

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An intraoral periapical radiograph revealed the presence of a radio-opaque object (foreign body) inside the root canal of 11, which resembled a bent stapler pin [Figure 1]c. It was present at the junction of middle and cervical thirds of the root canal. There was periapical radiolucency in relation to 11.

Management

The tooth 11 was isolated and a conventional access cavity was prepared. A thin, tapering, diamond fissure bur on an air rotor hand piece was used to slightly widen the orifice to facilitate access for instrumentation. An ultrasonic scaler was used to clear the debris from root canal orifice and also to facilitate loosening of the stapler pin. Root canal was irrigated with 5.2% sodium hypochlorite solution. A no. 20 H file was used to bypass and engage the foreign body. After a series of attempts, the object was moved coronally and pulled out with a mosquito forceps [Figure 1]d. The canal was then irrigated with normal saline, which helped to remove the debris including small wooden pieces. Working length was established and biomechanical preparation done using step-back technique. Calcium hydroxide was used as the intracanal medicament. In the next appointment, obturation of the tooth was done with gutta-percha using lateral condensation technique [Figure 1]e. Final restoration was done with metal ceramic crown. The tooth 21 was restored with composite [Figure 1]f.


   Discussion Top


The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Root canals or pulp chamber of a tooth can be blocked by the presence of broken instruments, canal obturation materials, and in some cases, by foreign objects inserted by the patient himself. It can occur in patients undergoing root canal treatment in which canals have been left open for drainage or after trauma. The presence of foreign body prevents thorough instrumentation of root canal system and adversely affects the outcome of successful endodontic treatment. Various objects have been reported to be lodged in the pulp chamber and root canal of teeth, such as pencil leads, [1] darning needles, [2] metal screws, [3] beads, [4] stapler pins, [5] nails, pins, wooden tooth picks, tooth brush bristles, crayons, and pieces of other plastic and wooden pieces. Actinomycosis following placement of piece of jewelry chain into a maxillary central incisor has been reported by Goldstein. [6]

Basically, the foreign objects lodged in root canal can be classified into metallic and non-metallic objects. Because of their radio-opaque nature, the metallic objects can be readily identified from routine radiographs. McAuliffe [5] summarized various radiographic methods to be followed to localize radio-opaque foreign objects, such as parallax views, vertex occlusal views, triangulation techniques, stereo radiography, and tomography. Specialized radiographic techniques such as radiovisiography and 3D computerized axial tomography (3D CAT) scans can aid in the localization. Microscopy and ultrasonic tips can be used as auxiliary tools. Non-metallic objects, being radiolucent, cannot be identified on radiographs. Hence, upon encountering resistance in a canal that was left open for a long period of time either after trauma or during endodontic treatment, it is recommended to take proper history and do careful instrumentation to prevent apical pushing of the object.


   Conclusion Top


Orthograde removal of foreign objects from root canal is usually a significant challenge to the practitioners. Detailed case history taking and clinical and radiographic evaluation are necessary to come to a conclusion about the nature, size, and location of the foreign body. Careful instrumentation with patience is needed for retrieval of the foreign body. Complicated crown fractures should be managed promptly, and prolonged open drainage is avoided in children if the risks of foreign body impaction are to be minimized. There is a definite need for a proper classification of foreign bodies in and around the teeth and a treatment algorithm to be followed in such clinical situations.

 
   References Top

1.Hall JB. Endodontics-Patient performed. ASDC J Dent Child 1969;36:213-6.  Back to cited text no. 1
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2.Nernst H. Foreign body in the root canal. Quintessenz 1972;23:26.  Back to cited text no. 2
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3.Prabhakar AR, Basappa N, Raju OS. Foreign body in a mandibular permanent molar: A case report. J Indian Soc Pedod Prev Dent 1998;16:120-1.  Back to cited text no. 3
[PUBMED]    
4.Subbareddy VV, Mehta DS. Beads. Oral Surg Oral Med Oral Pathol 1990;69:769-70.  Back to cited text no. 4
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5.McAuliffe N, Drage NA, Hunter B. Staple diet: A foreign body in a tooth. Int J Paediatr Dent 2005;15:468-71.  Back to cited text no. 5
[PUBMED]    
6.Goldstein BH, Sciubba JJ, Laskin DM. Actinomycosis of the maxilla: A review of literature and a report case. J Oral Surg 1972;30:362-6.  Back to cited text no. 6
[PUBMED]    

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Correspondence Address:
Keerthi Chand
Department of Conservative Dentistry and Endodontics, Government Dental College, Thiruvananthapuram
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0707.117496

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
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