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CASE REPORT
Year : 2017  |  Volume : 7  |  Issue : 1  |  Page : 54-57

A passive and conservative technique for the retrieval of foreign bodies in lower second premolar


Alhada Dental Specialist Center, Alhada Armed Forces Hospital, Taif, Saudi Arabia

Date of Web Publication10-Jan-2017

Correspondence Address:
Abdul Rahaman Jarallah Al Ghamdi
Dental Specialist Center, Alhada Armed Forces Hospital, Taif
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5984.197984

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  Abstract 

Metallic obstructions in the root canal space render its removal or negotiation by-passing one of the most challenging procedures encountered in the endodontic retreatment which may jeopardize the tooth structures, several procedures had been advocated. In this case, due to limited available equipment negotiating these obstructions by passive and conservative approach had been implemented.

Keywords: Canal obstruction, Gates Glidden, hand file, nonsurgical endodontic retreatment


How to cite this article:
Al Ghamdi AR. A passive and conservative technique for the retrieval of foreign bodies in lower second premolar. Saudi Endod J 2017;7:54-7

How to cite this URL:
Al Ghamdi AR. A passive and conservative technique for the retrieval of foreign bodies in lower second premolar. Saudi Endod J [serial online] 2017 [cited 2019 Dec 12];7:54-7. Available from: http://www.saudiendodj.com/text.asp?2017/7/1/54/197984


  Introduction Top


Retreatment of endodontically involved tooth may require removal of metallic obstructions from the root canal space or access opening. Metallic obstructions may be silver points, separated instruments, Gutta-percha carriers, or posts. Many devices and methods for metallic obstructions removal have been published in the literature.[1],[2],[3],[4],[5]

The presence of old restoration in the access cavity that is defected may be jeopardizing the treatment outcome if the material slips into the canal space during the procedure. The most desirable technique for removing metal obstructions is one that requires minimal removal of radicular tooth structure to decrease the possibility of lateral root perforation or future vertical root fracture.[6]

The following case report describes successful retrieval of amalgam particles within the canal space of lower second premolar.


  Case Report Top


A 42-year-old female patient referred to Endodontic Department in Al-Hada Specialized Dental Center with pain, swelling, and numbness related to the lower right quadrant. The patient's medical history was not contributory. The dental history revealed that spontaneous pain, followed by swelling had occurred in relation to the mandibular right second premolar (#45) approximately 1 week earlier. The patient had visited a private dental clinic but was unable to recollect the exact treatment procedure that had been carried out. The tooth did not respond to thermal stimuli (cold test) (Hygiene Endo Ice F, Coltene/Whaledent, Germany) in contrary to adjacent teeth. Radiographic examination revealed radiolucency at the apex of #45 and presence of three radiopaque particles blocking the root canal in apical, middle, and coronal thirds that render complicated retreatment [Figure 1].
Figure 1: Periapical radiograph showing three radiopaque particles in the root canal of tooth #45

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The results of the clinical and radiographic examination revealed previously initiated therapy with symptomatic apical periodontitis. The tooth was restored with temporary filling occlusally and amalgam restoration was left on the distal proximal wall as a part of the old restoration. It was decided that an attempt would be made to retrieve the foreign object and complete the endodontic treatment.

Under local anesthesia and application of rubber dam, the amalgam filling in the distal wall was removed. Later, during the same appointment, a conventional access cavity was prepared, and the pulp chamber was irrigated with copious amount of 2.5% sodium hypochlorite, A No, 8 K-type file (Dentsply-Maillefer, Ballaigues, Switzerland) was slowly inserted along the mesial and distal sides of the foreign body to negotiate the root canal. Gates Glidden (Dentsply-Maillefer, Ballaigues, Switzerland) number six and five were used, respectively, to drill the foreign particles in the coronal portion, later with copious irrigation with normal saline (0.9% wt/vol sodium chloride) and 2.5% sodium hypochlorite, the foreign object thereby was loose, it comes out with irrigation and it was confirmed to be amalgam particles. An attempt was made to engage the foreign particles in the middle portion of the canal with a No. 10 and 15 H-type file (Dentsply-Maillefer, Ballaigues, Switzerland) and remove it with a pull-back motion, but this effort failed. Gates Glidden numbers four and three were used, respectively, to drill the particles. Later, the foreign particles thereby were negotiated with files number 10 and 15 H-type till become loose. The particles came out with copious irrigation with normal saline (0.9% wt/vol sodium chloride) and 2.5% sodium hypochlorite.

The working length was estimated, and the particles in the apical third were negotiated with hand files 8, 10, and 15 H and K-type files (Dentsply-Maillefer, Ballaigues, Switzerland) with the help of copious irrigation. The object in the apical portion was freed with a pull-back motion and irrigation [Figure 2]. Pus was discharged during the treatment. The working length was established [Figure 3], and cleaning and shaping were done using crown-down technique using profile NiTi System (Dentsply-Maillefer, Ballaigues, Switzerland). Apical enlargement was made to size 45 taper 0.4 followed by irrigation with 2.5% sodium hypochlorite and dryness with paper points (Dentsply-Maillefer, Ballaigues, Switzerland). Obturation was done with Gutta-percha and AH26 sealer cement (Dentsply, Detrey, Gmbh, Germany) using lateral condensation technique and tooth was restored with light cured resin modified glass ionomer filling (Photacfil, 3M Espe, Seefeld, Germany) [Figure 4]. A 1-year follow-up revealed no clinical signs or symptoms and the radiographic lesion had healed. The tooth was restored with fiber post-RelyX size Blue (3M Espe, Seefeld, Germany) and a composite resin filling material (Z250, 3M Espe, Seefeld, Germany) used for core build-up [Figure 5]a. A full porcelain crown was placed as the definitive restoration [Figure 5]b.
Figure 2: After removal of the particles

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Figure 3: Working length determination

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Figure 4: Canal obturation

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Figure 5: (a) Post and composite build-up. (b) Final restoration with porcelain crown

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  Discussion Top


Retreatment of endodontic cases sometimes poses difficult technical problems. The ability to remove foreign obstructions from the root canal in a safe and efficient manner is a prime factor in the selection of any instrument or technique. The success of nonsurgical obstruction removal depends on several factors. Among them are the length and site of the fragment, the diameter and curvature of the root canal, and the friction and impaction of the instrument fragment into the canal wall.[7] The removal of old restoration whether it is extracoronal such as crowns or intracoronal such as amalgam or other restoration for several reasons will facilitate the root canal treatment. In addition, it will help in determining the restorability of the remaining tooth structure, presence of fracture, the need for crown lengthening, tooth isolation, increase visibility and simplifies the search for all canals.[8] Care should be taken to avoid pushing the coronal filling inside the root canal. High-volume section should be used during the removal of the coronal filling.

Several authors have proposed techniques for retrieval of foreign objects. Fors and Berg propose a technique to the involved removal of a considerable amount of tooth structure.[9] Roige-Greene described a simple device involve the usage of gauge 25 disposable needle, a thin segment of stainless steel wire and a mosquito forceps to remove a broken silver points.[10] Williams and Bjorndal used the Masseran kit to retrieve broken post.[11] Ultrasonic scaler and Cavi-Endo instrument also have been used to remove objects from canals.[12] Other technique involved the use of Gates Glidden series to access the object. Careful usage is advisable since there was a risk of perforation in the thin area of the root. In the other hand, the dentin thickness after the Gates Glidden usage might be compromised.[13]

Success of removing foreign objects obstructing root canals can be attributed to different factors as anatomical factors, technical aspects, and the skill of the operator. In the present case, only Gates Glidden, K and H-files were used to remove the foreign objects as described in a previously report case.[14] This technique was selected as it did not need any special equipment and exhibited a more conservative approach to remove the amalgam parts from inside the canals. The straight and the relatively wide canal, the small size of the foreign objects favored the use of aforementioned technique. In addition, the presence of back pressure created by the pus darning from the apical area which helps to move up the small piece that was located apically. Hence, the apical diagnosis was changed to acute apical abscess. Indeed, the anatomy of the lower premolars particularly in this case increases the possibility of the amalgam particles to go deep in the root; moreover, it helps to use the Gates Glidden and allows for passive retrieval of them later on.


  Conclusion Top


Careful assessment of the coronal status of the teeth undergoing root canal treatment is mandatory. The presence of well-maintained restoration is important to add in the isolation. However, loose restoration may endanger the situation, especially with wide and large canals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cohen S, Burns RC. Pathways of the Pulp. 6th ed. St. Louis: Mosby; 1994. p. 715-24.  Back to cited text no. 1
    
2.
Friedman S, Stabholz A, Tamse A. Endodontic retreatment – Case selection and technique. Part 3. Retreatment techniques. J Endod 1990;16:543-9.  Back to cited text no. 2
    
3.
Hülsmann M. Removal of fractured instruments using a combined automated/ultrasonic technique. J Endod 1994;20:144-7.  Back to cited text no. 3
    
4.
Hülsmann M. Removal of silver cones and fractured instruments using the Canal Finder System. J Endod 1990;16:596-600.  Back to cited text no. 4
    
5.
Machtou P, Sarfati P, Cohen AG. Post removal prior to retreatment. J Endod 1989;15:552-4.  Back to cited text no. 5
    
6.
Spriggs K, Gettleman B, Messer HH. Evaluation of a new method for silver point removal. J Endod 1990;16:335-8.  Back to cited text no. 6
    
7.
Hülsmann M, Schinkel I. Influence of several factors on the success or failure of removal of fractured instruments from the root canal. Endod Dent Traumatol 1999;15:252-8.  Back to cited text no. 7
    
8.
Ruddle CJ. Nonsurgical retreatment. In: Cohen S, Burns RC, editors. Pathways of the Pulp. 8th ed. St. Louis: CV Mosby; 2002. p. 875-929.  Back to cited text no. 8
    
9.
Fors UG, Berg JO. A method for the removal of broken endodontic instruments from root canals. J Endod 1983;9:156-9.  Back to cited text no. 9
    
10.
Roig-Greene JL. The retrieval of foreign objects from root canals: A simple aid. J Endod 1983;9:394-7.  Back to cited text no. 10
    
11.
Williams VD, Bjorndal AM. The Masserann technique for the removal of fractured posts in endodontically treated teeth. J Prosthet Dent 1983;49:46-8.  Back to cited text no. 11
    
12.
Gaffney JL, Lehman JW, Miles MJ. Expanded use of the ultrasonic scaler. J Endod 1981;7:228-9.  Back to cited text no. 12
    
13.
Kuttler S, McLean A, Dorn S, Fischzang A. The impact of post space preparation with Gates-Glidden drills on residual dentin thickness in distal roots of mandibular molars. J Am Dent Assoc 2004;135:903-9.  Back to cited text no. 13
    
14.
Alrahabi M, Gabban H. Management of foreign object in the root canal of central incisor tooth. Saudi Endod J 2014;4:154-7.  Back to cited text no. 14
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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