Unusual foreign object in the root canal
Transcription
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: [email protected] 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 Health Sciences 2013;4(2):JS009 1 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 An Open Access Peer Reviewed E-Journal 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). Health Sciences 2013;4(2):JS009 2 An Open Access Peer Reviewed E-Journal 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 Health Sciences 2013;4(2):JS009 3 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 1. Nair PNR. On the causes of persistent apical periodontitis: a review. International Endodontic Journal 2006;39:249-281. 2. Nernst H. Foreign body in the root canal. Quintessence International 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. An Open Access Peer Reviewed E-Journal Case Report - Unusual foreign object in the root canal 4. Lamster IB, Barenie JT. Foreign objects in the root canal. Review of literature and report of 2 cases. Oral Surgery, Oral Medicine, Oral Pathology 1977;44:483-486. 5. Subba Reddy VV, Mehta DS. Beads. Oral Surgery, Oral Medicine, Oral Pathology 1990;69:769-770. 6. Zilich RM, Pickers TN. Patient induced blockage of the root canal- Health Sciences 2013;4(2):JS009 4 report of a case. Oral Surgery, Oral Medicine, Oral Pathology 1982;54;689-690. 7. Harris WE. Foreign bodies in root canal - report of 2 cases. The Journal of the American Dental Association 1972;85:906-9011. 8. Grossman JL, Heaton JF. Endodontic case reports. Dental Clinics of North America 1974;18:509-527. An Open Access Peer Reviewed E-Journal