Unusual foreign object in the root canal

Case Report - Unusual foreign object in the root canal
CASE REPORT
Unusual foreign object in the root canal
Gibi Paul 1, Sobha Kuriakose 2, Sreejith KR 2
1
Department of Conservative Dentistry and Endodontics,
Department of Pedodontics
Sri Sankara Dental College Akathamuri, Trivandrum, Kerala
2
Correspondence to: gibi.paul@yahoo.co.in
Abstract
In dental practice it is not uncommon to come across foreign body entrapment in the root canal.
The object may have been accidently lodged as a result of traumatic injury, iatrogenically during
treatment or it may be a self inflicted injury, especially in the case of children. Often the patient
reports only when pain occurs and the foreign object is discovered during radiographic
examination. In this article we present a case report of a metal wire impacted in a maxillary
central incisor which was successfully removed surgically.
Introduction
The presence of a foreign body can present a
great challenge during endodontic therapy.
A detailed history is required to reveal the
nature of injury that led to the blockage of
the root canal. Good radiographs are
essential to help determine the nature and
size of object, to assess the prognosis and
decide the treatment plan . Removal of the
foreign body is not very difficult if it is
confined to the root canal. However if it has
been pushed periapically, the procedure
becomes more complicated. The case
presented here required a more invasive
treatment since the object was protruding
way beyond the root apex.
Case report
A 11 year old girl reported to the
Department of Pedodontics, Sri Sankara
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Dental College with chief complaint of
recurrent pain and swelling in relation to the
upper anterior teeth. The patient gave a
history of incomplete root canal treatment
for a maxillary central incisor fractured as a
result of traumatic injury 1 year back.
Intraoral examination revealed an Ellis Class
III # of 11. The tooth was discoloured, with
an access opening already prepared (Figure
1a). Vitality tests indicated that it was non
vital but the adjacent teeth were vital.
An intraoral radiograph revealed the
presence of a radio-opaque object in the root
canal projecting into the periapical tissues
(Figure 1b). Since the apical extent was not
clearly visible, another radiograph was taken.
This revealed that the object was protruding
periapically much more than expected,
reaching up to the nasal floor (Figure 1c). It
appeared to be a metal wire which had been
twisted and pushed into the root canal
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Case Report - Unusual foreign object in the root canal
1a
1b
1c
Figure 1 a. Fractured maxillary central incisor 1b. Radiograph showing foreign object in root
canal 1c. Apical extent of the object
On further enquiry the child admitted to
frequently poking some metal wires into the
tooth to help alleviate the pain. She had no
clear recollection of having being unable to
retrieve the same. It was decided to try and
remove the object through the access
opening before performing apical surgery.
The patient was put on antibiotics and
asked to report for treatment after three
days.
After administering local anaesthesia, the
access opening was flared and copious
irrigation done to flush out the debris in the
canal. Instrumentation of the canal was
unable to remove the foreign body in toto
though tiny bits and pieces were noticed
among the debris.
A full thickness
mucoperiosteal flap was elevated (Figure 2a).
The surgical site was cleared using saline and
high volume suction. A long thin metal
wire was retrieved (Figure 2b). It was
assumed that part of the wire had undergone
corrosion and hence been flushed out with
the debris . Another radiograph was taken
to confirm the absence of any radiopaque
material
in the canal and periapical area (Figure 2c).
2a
2b
2c
Figure 2 a. Mucoperiostal flap reflected 2b. Metal wire retrieved from apical area
Radiograph confirming removal of metal wire from root canal
2c.
After ensuring that bleeding at the operating site had been controlled,the root canal was dried ,
obturation compleled and access cavity sealed . The root end was prepared and retrograde root
canal filling done . The flap was sutured and post obturation radiograph taken( Figure 3a).
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Case Report - Unusual foreign object in the root canal
The sutures were removed after 1 week. The operative site showed good healing (Figure 3b). The
tooth was restored with composite (Figure 3c).
3a
3b
3c
Figure 3a. Radiograph showing root canal obturation 3b. Healed operative site 3c. Composite
restoration
Discussion
During dental treatment foreign objects may
be unintentionally impacted in the root
canal and periapical area like restorative
materials, obturating materials, fractured
instruments.1
Numerous cases of self
inflicted injuries leading to lodgement of
foreign bodies in the root canal have also
been reported. The objects included darning
needles2, staple pin3, conical metal objects4,
beads5, hat pins6. Harris7 reported the
placement of various objects like pins,
wooden tooth pick, pencil tip, plastic
objects, tooth brush bristles in root canals of
anterior teeth. Retrieval of pencil tips,
toothpick, absorbent paper point, tomato
seed has been reported by Grossman and
Heaton8. These troublesome incidents
mainly involve children especially if carious
exposure, traumatic injury or dislodged
restorations have resulted in an open pulp
chamber. Food impaction may the reason
the children insert objects into these teeth
which then becomes a habit over a period of
time. These objects can get wedged within
the canal and may be pushed into the
periapex. The exogenous material acts as a
focus for infection and may cause tissue
irritation.1 Intracanal treatment alone may
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not solve the problem and apical surgery
may be required.
Conclusion
Foreign bodies may be lodged in the root
canal because of self inflicted injury and this
can lead to complications at a later date.
This is commonly seen in carious teeth
which have been left untreated or in teeth
which have dislodged restorations. Many of
the patients do not seek treatment as long as
the tooth is asymptomatic. Proper
counselling is required to ensure that dental
treatment is provided at the earliest and that
it is completed so that such untoward
incidents may be avoided.
References
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Journal 2006;39:249-281.
2. Nernst H. Foreign body in the root
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1972;3:33-34.
3. McCartiff N, Drage NA, Hunter B.
Staple diet a foreign body in a tooth.
International Journal of Paediatric
Dentistry 2005;15:468-471.
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Case Report - Unusual foreign object in the root canal
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