|Year : 2015 | Volume
| Issue : 2 | Page : 107-110
The unintended obturation: Thrusting bizarre in the root canals!
Shivani Mathur1, Rahul Chopra2
1 Department of Pedodontics and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, Uttar Pradesh, India
2 Department of Periodontics, ITS-CDSR, Muradnagar, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||11-Dec-2015|
Department of Pedodontics and Preventive Dentistry, ITS-CDSR, Muradnagar, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
A wide array of habits is found in children; of these inserting foreign objects in the oral cavity is a common practice among children. Children often tend to insert sharp objects mainly in the open carious lesions to relieve pain caused due to food lodgment. The objects sometimes break and get embedded in the root canals. Sometimes, the patients do not reveal this to parent out of fear and ultimately are diagnosed accidently by the dentists when the symptoms appear or while diagnosing some other lesion. These foreign objects may act as a possible cause of infection. Early diagnosis and treatment are mandatory in such cases to avoid further complications. Thorough case history, clinical, and radiographic examinations are essential to determine the nature, size, location of the foreign body, and the difficulty involved in its retrieval. This paper discusses series of three such case reports where the foreign objects were diagnosed, retrieved, and treatment was followed.
Keywords: Foreign objects, obturation, root canals
|How to cite this article:|
Mathur S, Chopra R. The unintended obturation: Thrusting bizarre in the root canals!. J Dent Allied Sci 2015;4:107-10
| Introduction|| |
The habit of inserting foreign objects such as coins, screws, staple pins, toothpicks, and pencil leads. In the oral cavity, unknowingly by the way of habit or in some instances, to relieve dental pain in the open carious lesions is a common practice among children. They often do not reveal it to their parents due to fear. These foreign objects may act as a source of infection and thus may lead on to painful condition. The dentist can encounter such cases in his/her practice. A detailed case history, clinical as well as a through radiographic examination is necessary to lead on to conclusive diagnosis about nature, size, location, and thus the difficulty or ease of its retrieval or removal. The following are the three such cases which came with the chief complaint of pain and pus discharge and were diagnosed to be having accidently lodged foreign objects.
| Case Reports|| |
An 8-year-old female patient reported to the department with the chief complaint of irritation in the right lower back tooth since 2 months. On further questioning patients' mother revealed that the child often pokes her tooth with some sharp objects such as a matchstick and stapler pin. On examination, the deciduous right mandibular first molar (84) was carious and was a "pink tooth" [Figure 1]. Intraoral periapical radiographic showed the presence of a stapler pin which was lying vertically and had perforated the floor of the tooth [Figure 2]. The tooth was ultimately extracted under local anesthesia [Figure 3].
A boy 6 years of age reported to the department with the chief complaint of pain and pus discharge from the upper front tooth. On examination, the deciduous right maxillary lateral incisor (52) was carious [Figure 4]. A sinus was present in relation to the tooth. Radiographic examination revealed the presence of a foreign object in the tooth [Figure 5]. Extraction of the tooth was done and revealed the presence of a graphite tip of the pencil and a half broken stapler pin [Figure 6].
An 11-year-old male patient reported to the department with the chief complaint of pain and irritation in the upper front tooth region since 1 month. The patient gave the history of trauma 4 years back after which did not get any treatment done. On examination, Ellis Class III fracture was seen in relation to permanent maxillary left central incisor (21) along with draining sinus. Radiographic examination showed the presence of foreign bodies in the canal of the tooth and the presence of an open apex [Figure 7]. The foreign objects were thus removed from the canal using H-file and were found to be metal fragments along with pieces of congress grass. The canal was cleaned, shaped, and prepared [Figure 8]. Antibiotics and analgesics were prescribed. Calcium hydroxide was put inside the canal for a week, and apexification was done with mineral trioxide aggregate after which it was obturated [Figure 9]. The tooth showed uneventful healing when the patient was recalled after 3, 6, and 12 months period.
|Figure 7: Preoperative radiograph showing fractured 21with radio-opaque fragments|
Click here to view
|Figure 9: Mineral trioxide aggregate placed and canal obturated i.r.t 21|
Click here to view
| Discussion|| |
Of a wide array of secrets kept by children, their secrets do lie in their teeth too. A variety of foreign objects has been reported to be lodged in the root canals such as pencil lead, needles, metal screws, beads, and pins. Grossman reported retrieval of indelible ink pencil tips, brads, toothpick, absorbent points, and tomato seed from the root canal of anterior teeth.  Various other authors have reported the presence of, a plastic chopstick embedded in an unerupted supernumerary tooth and hat pins, dressmaker pins, toothbrush bristles, and crayons fractured inside the root canals of the teeth. , These foreign bodies inside the tooth eventually lead to infection resulting in pain, bleeding, and swelling.
A radiograph can be of diagnostic significance especially if the foreign body is radioopaque. Macauliffe et al. have reported five radiographic methods to localize metallic foreign body in oral cavity Parallax views (either horizontal or vertical), vertex-occlusal views, triangulation techniques, stereo radiography, and tomography. ,
In the cases presented here, the diagnosis was made by taking intraoralperiapical radiographs, which clearly revealed the presence of stapler pin in the first case in relation to 84 and metallic object inside the root canal of 52 in the second case while in the third case metal fragments and grass pieces were retrieved from the root canal of the maxillary permanent central incisor.  To remove these kind of foreign objects from the root canal, Barbed broach, H-file or the Masserman kit or Steglitz forceps used for the removal of silver points from the root canal can be used or in some cases tooth might have to be extracted. , Thus, a through clinical and radiographic examination is a must, and the decision of retrieval of these foreign objects should be done with precision by a specialist.
In the present case report, the first case was an 8-year-old, having pink discoloration of deciduous mandibular right first molar associated with draining sinus. A radiograph revealed an erupting first premolar. Hence, a decision was made to extract the tooth after taking the parents' consent. The similar treatment plan of extraction of the primary tooth was taken in the second case as the deciduous right lateral incisor was grossly decayed and was associated with draining sinus. In the third case, the foreign bodies seen on the intraoral periapical were present in the apical third of the permanent maxillary left central incisor which were retrieved using H-file and was finally obturated.
Early diagnosis and management of foreign object embedded in the tooth are mandatory. The habit of putting various objects in the teeth usually develops in order to relieve pain caused due to food lodgment in open carious lesions. Management of open carious lesions hence should be done as early as possible to avoid further complications. Various complications may result if the foreign objects are not retrieved and removed early. Goldstein reported the development of actinomycosis due to a piece of jewelry chain which was embedded into a maxillary central incisor.  In another case, Costa reported the development of chronic maxillary sinusitis due to pushing of foreign bodies into maxillary sinus through the root canals. ,
| Conclusion|| |
Foreign bodies have been reported previously in the permanent teeth deciduous and less commonly in the deciduous dentition as well. This paper highlights the importance of early diagnosis, by the way of proper clinical and thorough radiographic examination and management of teeth where foreign objects are embedded in the canal in both primary and permanent dentition. More so, there is a need of adequate counseling to emphasize the early dental intervention before severe complications develop.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Grossman JL, Heaton JF. Endodontic case reports. Dent Clin North Am 1974;18:509-27.
Zillich RM, Pickens TN. Patient-induced blockage of the root canal. Report of a case. Oral Surg Oral Med Oral Pathol 1982;54:689-90.
Harris WE. Foreign bodies in root canals: Report of two cases. J Am Dent Assoc 1972;85:906-11.
Macauliffe N, Drage NA, Hunter B. Staple diet: A foreign body in a tooth. Int J Paediatr Dent 2005;15:468-71.
Pinky C, Ravi KS, Krishna A, Vanka A. Fingernails - Foreign objects in root canals. J Clin Exp Dent 2011;3 Suppl 1:e386-9.
Holla G, Baliga S, Yeluri R, Munshi AK. Unusual objects in the root canal of deciduous teeth: A report of two cases. Contemp Clin Dent 2010;1:246-8.
Lumley PJ, Walmsley AD. Removal of foreign objects from root canals. Dent Update 1990;17:420-3.
Kalyan SR, Sajjan G. Endodontic management of a foreign body. Contemp Clin Dent 2010;1:180-2.
Goldstein BH, Sciubba JJ, Laskin DM. Actinomycosis of the maxilla: Review of literature and report of case. J Oral Surg 1972;30:362-6.
Costa F, Robiony M, Toro C, Sembronio S, Politi M. Endoscopically assisted procedure for removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth. Head Face Med 2006;2:37.
Yadav RK, Tikku AP, Chandra A, Rathinavel C, Shakya V, Bharti R. Endodontic Management of foreign body in the root canal: a case series. Int J Sci Res Publ 2015;5:1-3.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]