|Year : 2014 | Volume
| Issue : 3 | Page : 154-157
Management of foreign object in the root canal of central incisor tooth
Mothanna Alrahabi, Hani Gabban
Department of the Restorative Dental Sciences, College of Dentistry, Taibah University, Medina, Saudi Arabia
|Date of Web Publication||6-Aug-2014|
Department of the Restorative Dental Sciences, College of Dentistry, Taibah University, Medina
Source of Support: None, Conflict of Interest: None
There are several reports describing the impaction of foreign objects into the exposed pulp chambers and canals by patients, especially children as they often have the habit of inserting foreign objects in the oral cavity. These objects will become a potent source of infection.This case report describes the retrieval of a foreign object impacted into the root canal of a 12-year-old male patient who was referred to the endodontic specialty clinic at Taibah University College of Dentistry. The patient's chief complaint was a pain in the upper left central tooth. Clinical examination revealed a complicated enamel-dentin fracture with a large caries cavity. A periapical radiographic image showed a radiopaque object in the root canal system. Stainless steel Hedstrom files were used to retrieve the object from the canal. Following a proper cleaning and shaping of the root canal system, an intra-canal calcium hydroxide dressing was placed for 1 week. The root canal system was then filled with sealer and gutta-percha using the lateral compaction technique and the tooth received an aesthetic restoration.
Keywords: Foreign object, non-surgical root canal treatment, open apex, retrieve broken instrument
|How to cite this article:|
Alrahabi M, Gabban H. Management of foreign object in the root canal of central incisor tooth. Saudi Endod J 2014;4:154-7
| Introduction|| |
Embedment (impaction) of foreign objects in the oral cavity is one common habit among children.  However, these foreign objects may be, sometime, inserted into the wide root canals of teeth with pulps exposed to the oral cavity with a potential of complete block of the root canal system. These foreign objects become a potent focus of infection. , Actinomycosis following placement of piece of jewelery chain into a maxillary central incisor has been reported.  In addition, foreign bodies pushed through root canal into the sinus are one of the causes of chronic maxillary sinusitis of dental origin.  These foreign objects varies from paper clip,  nail,  sewing needle,  incense stick  metal screws,  beads,  to stapler pins. ,,
Several techniques for retrieval of separated endodontic instruments can be used to remove the foreign objects from the root canal.  The removal of these foreign objects from the root canal system, especially when it is extensively engaged with the root-canal walls, is a challenge and little information is available concerning management of foreign objects.
The following case report describes removal of a foreign object impacted into the root canal system of a maxillary central incisor with wide apex using H-Files.
| Case Report|| |
A 12-year-old male patient refereed to the endodontic specialty clinic at the College of Dentistry, Taibah University (Saudi Arabia) with a history of pain in the maxillary left central incisor (#21). The tooth had dental trauma 3 years ago. A root canal treatment was initiated previously in a private general dental practice 6 months before he presented to the College of Dentistry clinics, however, the patient did not complete the treatment, 2 months later he suffered severe pain in the upper anterior area with a painful response to biting and percussion. Intraoral examination revealed oblique crown fracture [Figure 1]a] with extensive caries and pain on percussion. The panoramic radiograph revealed linear radiopaque objects in the root canal [Figure 1]b].
|Figure 1: Preoperative picture of fractured tooth #21 (a). Panoramic radiograph reveal foreign objects in the root canal (b). Periapical film reveals the root canal after retrieving foreign object (c). The foreign objects removed from the root canal which like staple pins (d)|
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The diagnosis of this case is: Previously initiated therapy with symptomatic apical periodontitis. 
| Materials and Methods|| |
Local anesthesia was administered and the tooth was isolated by rubber dam. Following complete removal of caries, access cavity into the pulp chamber was performed using 014 round carbide and Endo Z burs (Dentsply Maillefer, Ballaigues, Switzerland). The pulp chamber was irrigated copiously with 2.5% sodium hypochlorite solution. The root canals were explored by K-file ISO No. 10 (Dentsply Maillefer, Ballaigues, Switzerland) with a lubricant (Glyde Dentsply Maillefer, Ballaigues, Switzerland). After several attempts the object was bypassed, a path glide was created by using K-Flexofiles ISO No. 15, 20, and 25 (Dentsply Maillefer, Ballaigues, Switzerland), then the Hedstrom files ISO No. 25, 30, 35 and 40 (Dentsply Maillefer, Ballaigues, Switzerland), used to retrieve the objects [Figure 1]c] which were like staple pins [Figure 1]d]. The root canals was shaped with F5 ProTaper rotary instrument (Dentsply Maillefer) with copious irrigation of 2.5% sodium hypochlorite solution and filled with calcium hydroxide paste (META BIOMED Co., Ltd.) then the tooth was sealed with temporary restoration.
One week later, the patient recalled for the completion of root canal treatment. Local anesthesia was administered and the tooth was isolated with rubber dam. The Calcium hydroxide was removed, the canal was dried and a gutta-percha (Dentsply Maillefer, Ballaigues, Switzerland), custom master cone (No. 120) to the full working length was radiographically confirmed [Figure 2]a]. Then the canal was obturated with lateral compaction technique [Figure 2]b] by using the AH26 Sealer (Dentsply Maillefer, Ballaigues, Switzerland), and the tooth was restored with composite resin [Figure 2]c].
|Figure 2: Periapical film to confirm master cone (a). Root canal obturation (b). Postoperative picture with final coronal restoration (c)|
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This case report was reviewed and approved by the Research Ethics Committee of College of Dentistry, Taibah University.
| Discussion|| |
Insertion of foreign objects into root canals was mentioned by several reports. Although there is no specific technique to manage foreign objectives into root canals, the special techniques of retrieving separated endodontic instruments can be used to remove the foreign objects from the root canal.  These techniques include: ultrasonic, endodontic forceps, endodontic files, hollow tube-based extractor systems. , The most important factor in retrieving foreign objectives and fracture instrument is the location of the fragment and its relationship with the curvature of the canal. When the fragment is positioned coronally to the curvature of the canal the possibility of removing the fragment increase on the other hand when the fragment is situated at or beyond the curvature of the canal the possibility of removing the fragment will be reduced or it will be impossible. ,,
However, the foreign objects into root canal need high skills and advanced techniques to remove from the root canal although in this case we used stainless steel files (K and H) to retrieve the foreign objects without damaging the internal tooth structure.
The root canal treatment-in this case-was initiated in a private clinic after trauma but the patient did not complete the treatment and after several days the temporary filling was lost, resulting in impaction of food debris into the root canal system. This will cause infection of the root canal and the periradicular area. Leaving the root canal open can make an acute problem become chronic and can cause repeated flare-ups during further attempts to close it.
The patient used stapler pins to remove the impacted food and debris but he was not aware and fracture the stapler pins into the canal. So it is preferable to use strong restorative material as temporary filling that can seal the access cavity for acceptable period such as glass ionomer cement. 
Calcium hydroxide dressing was used after removing the foreign object and cleaning the root canal. The use of a root canal dressing has been recommended in teeth with necrotic pulp with or without periapical lesions where infected areas not accessible by instrumentation can be reached. 
In this case the apical foramen is open and a canal is large therefore we need to fabricate a custom cone, this permits the adaptation of the cone to the canal walls, reduces the potential for extrusion of the core material, and may improve the seal. ,
Immature teeth exhibiting pulp necrosis or teeth with open apex traditionally were treated with calcium hydroxide to establish an apical barrier (apexification) before obturation to prevent extrusion of materials into the periradicular tissues.  This procedure usually takes long time. Studies have demonstrated that teeth treated with calcium hydroxide for prolonged periods are more susceptible to fracture. ,
Mineral trioxide aggregate (MTA) has been successfully employed as an apical barrier material before obturation.  Another option for treating immature teeth with pulp necrosis involves regenerative techniques including revascularization. ,
The success of retrieving foreign objects influenced by different factors: technical aspects, anatomical factors and skills of the operator. ,,
| Conclusion|| |
In the present case, foreign objects lodged in the root canal were removed successfully by using a simple nonsurgical procedure. Sealing the access cavity with good filling will secure the root canal system from new strains of microorganisms, food debris and foreign body.
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[Figure 1], [Figure 2]