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CASE REPORT
Year : 2009  |  Volume : 27  |  Issue : 3  |  Page : 179-183
 

Foreign objects in teeth: Retrieval and management


Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Narketpally, Nalgonda Dt, Andhra Pradesh, India

Date of Web Publication15-Oct-2009

Correspondence Address:
R Aduri
Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda Dt, Andhra Pradesh - 508 254
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.57100

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   Abstract 

The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, location of the foreign body and the difficulty involved in its retrieval. It is more common to find this situation in children as it is a well-known fact that children often tend to have the habit of placing foreign objects in the mouth. Sometimes the foreign objects get stuck in the root canals of the teeth, which the children do not reveal to their parents due to fear. These foreign objects may act as a potential source of infection and may later lead to a painful condition. This paper discusses the types of foreign objects found in and around the teeth and reports two cases along with their retrieval and associated management of the involved teeth.


Keywords: Foci of infection, foreign bodies, stapler pins in teeth


How to cite this article:
Aduri R, Reddy R E, Kiran K. Foreign objects in teeth: Retrieval and management. J Indian Soc Pedod Prev Dent 2009;27:179-83

How to cite this URL:
Aduri R, Reddy R E, Kiran K. Foreign objects in teeth: Retrieval and management. J Indian Soc Pedod Prev Dent [serial online] 2009 [cited 2019 May 25];27:179-83. Available from: http://www.jisppd.com/text.asp?2009/27/3/179/57100



   Introduction Top


Injury to both the hard and soft tissues may occur as a consequence of child's habit of placing foreign objects into the mouth. Foreign objects may become a potent source of pain and infection. The chance of these foreign objects getting impacted into the tooth is more when the pulp chamber is open either because of traumatic injury or a large carious exposure. Retrieval of foreign objects from the teeth in children is a challenging aspect of pediatric dental practice. These objects can be easily retrieved if they are located within the pulp chamber, but once the object has been pushed apically, their retrieval may be complicated. Apical surgical procedures may sometimes be necessary.

The following case reports describe the retrieval of foreign objects impacted into the teeth and into the periapical region including successful management of such teeth thereafter.


   Case Reports Top


Case 1

The following case describes the successful retrieval of a stapler pin from the palatal root of a permanent maxillary first molar.

A 12-year-old girl reported to the Department of Pedodontics and Preventive Dentistry, Kamineni Institute of Dental Sciences, India with a chief complaint of pain in the left maxillary first molar tooth [Figure 1]. Patient gave a history of pain from the past one month. Radiographic examination of the tooth revealed a radioopaque object resembling a stapler pin overlapping the image of the tooth and a periapical abscess [Figure 2]. Same side Lingual Opposite side Buccal [SLOB] rule was performed to confirm whether the foreign object was lying in the root or in the adjacent soft tissues. The stapler pin was confirmed to lie in the palatal root of 26.

A conventional access cavity was prepared, and the pulp chamber was irrigated with normal saline. A thin, tapering, Diamond fissure bur was used to slightly widen the orifice of the palatal canal and to facilitate access for instrumentation. An ultrasonic scaler was used to clear the debris from the palatal root canal orifice and also to facilitate loosening of the stapler pin. When the stapler pin was adequately visible clinically, it was engaged with a shepherd's hook explorer and removed [Figure 3]. The canal was copiously irrigated with saline, hydrogen peroxide and sodium hypochlorite. After repeated dressings with non-setting calcium hydroxide, the tooth was obturated. Gross destruction of the tooth structure necessitated the placement of a preformed post in the palatal canal to rehabilitate the crown structure [Figure 4].

Case 2

A 10-year-old male patient reported to our department with a history of pain in the upper front tooth [Figure 5]. He had suffered dental trauma two and a half years back. Intra-oral examination revealed a complicated enamel-dentine fracture with a slit-like opening involving the pulp chamber of the tooth 21. The tooth exhibited the following clinical features:

  1. Swelling in the labial vestibule.
  2. Grade 1 mobility.
  3. Tenderness in the labial sulcus.
  4. Pain on percussion and
  5. A draining sinus on the attached gingiva.


An intra-oral periapical radiograph revealed the presence of radio-opaque object in the periapical region of left maxillary central incisor [Figure 6]. History revealed that the patient had the habit of chewing onto stapler pins. A tetanus vaccine booster dose was administered to the patient in the very first appointment. A conventional access cavity was prepared and the pulp chamber was cleared of debris by copious irrigation with saline solution. Routine endodontic procedure followed by dressing with non-setting calcium hydroxide was performed. Once the acute periapical symptoms subsided, obturation of tooth was done. Apicoectomy was planned in the next visit, which involved removal of the foreign object and retrograde restoration of 21 [Figure 7],[Figure 8],[Figure 9].


   Discussion Top


Various foreign objects were reported to be lodged in the root canals and the pulp chamber, which ranged from pencil leads [1] , darning needles [2] , metal screws [3] , to beads [4] and stapler pins. [5] Grossman [6] reported retrieval of indelible ink pencil tips, brads, a tooth pick, adsorbent points and even a tomato seed from the root canals of anterior teeth left open for drainage. Toida [7] have reported a plastic chopstick embedded in an unerupted supernumerary tooth in the premaxillary region of a 12-year-old Japanese boy.

Zillich and Pickens [8] and Turner [9] cited cases wherein hat pins and dressmaker pins that were used to remove the food plugs from the root canals of maxillary and mandibular incisors undergoing endodontic treatment had eventually fractured inside the root canals of these teeth. Gelfman [10] and colleagues reported a case where in a 3-year-old child had inserted two straws into the root canal of a primary central incisor, which was later extracted. Harris [11] reported the placement of varied objects within the root canals of maxillary anterior teeth. These included pins, wooden toothpick, a pencil tip, plastic objects, toothbrush bristles and crayons. The patients had inserted these objects in the root canal to remove food plugs from the teeth. Placements of beads, a paper clip and a stapler pin in the root canals of maxillary incisors were reported. Lamster and Barenie [12] reported insertion of a conical metallic object in the distal root of the primary left first molar.

A conventional practice employed during emergency root canal treatment involves leaving the pulp chamber open where pus continues to discharge through the canal and cannot be dried within a reasonable period of time. Weine [13] recommends that the patient remains in the office with a draining tooth for an hour or even more and finally ending the appointment by sealing the access cavity. With the access cavity closed, no new strains of microorganism system are introduced and food debris and foreign body lodgment within the tooth can be avoided [14].

A radiograph can be of diagnostic significance especially if the foreign body is radioopaque. McAuliffe [5] summarized various radiographic methods to be followed to localize a radioopaque foreign object as Parallax views, Vertex occlusal views, Triangulation techniques, Stereo Radiography and Tomography. Vertex occlusal view is no longer favored because of relatively high radiation exposure to the lens of the eye and because the primary beam is aimed towards the abdomen. Triangulation is by the use of two views right angle to one another. Interpretation is difficult because of the superimposition of the other incisor teeth over the root. Stereographic views and tomography were not considered since the availability of the facilities in a dental operatory is very minimal. Specialized radiographic techniques such as radiovisiography, 3D CAT scans can play a pivotal role in localization of these foreign objects inside the root canal.

For retrieval of foreign objects lying in the pulp chamber or canal using ultrasonic instruments [15] , the Masserann kit [16] , modified Castroveijo needle holders [17] have been used. Ethylenediaminetetraacetic acid has been suggested as a useful aid in lubricating the canal when attempting to remove the foreign object. The Steglitz forceps have also been described for use of removal of silver points from the root canal. There is a description of an assembly of a disposable injection needle and thin steel wire loop formed by passing the wire through the needle being used. This assembly was used along with a mosquito hemostat to tighten the loop around the object. [18] Nehme [19] had recommended the use of operating microscope along with ultrasonic filing to eliminate intra-canal metallic obstructions. Srivastava and Vineeta [20] have suggested periapical surgery or intentional reimplantation to remove such objects.

McCullock [21] suggested that access to the foreign object is improved by removal of small amount of tooth structure. According to Walvekar [22] et al, if the foreign object is snugly bound in the canal, the object may have to be loosened first; it should then be removed with minimal damage to internal tooth structure to prevent perforation of the root.

Complications can follow if these impacted foci of infection are not eliminated at the right time. Actinomycosis following placement of piece of jewelry chain into a maxillary central incisor has been reported by Goldstein.[23] Chronic maxillary sinusitis of dental origin developed due to pushing of foreign bodies into maxillary sinus through the root canals was reported by Costa.[24]


   Summary Top


The above case reports discuss the management of teeth with impacted foreign objects in and around the tooth. In the first case the removal of a stapler pin from the palatal root canal was accomplished with a simple technique using commonly used instruments like tapered diamond bur, ultrasonic scaler and a shepherd's hook explorer. In the second case, a chewed stapler pin lodged in the periapical portion of 21 with an immature apex was discovered on radiographic examination of a patient with a complicated crown fracture. Eventually, after the acute periapical symptoms subsided, routine endodontic treatment was completed and the object was retrieved by Apicoectomy. There is a definite need for a proper classification of foreign bodies in and around the teeth and a treatment algorithm to be followed in such clinical situations.

 
   References Top

1.Hall JB. Endodontics - Patient performed. J Dent Child 1969;36:213-6.  Back to cited text no. 1      
2.Nernst H. Foreign body in the root canal. Quintessenz 1972;23:26.  Back to cited text no. 2  [PUBMED]    
3.Prabhakar AR, Basappa N, Raju OS. Foreign body in a mandibular permanent molar: A case report. J Indian Soc Pedod Prev Dent 1998;16:120-1.   Back to cited text no. 3  [PUBMED]    
4.Subba Reddy VV, Mehta DS. Beads. Oral Surg Oral Med Oral Pathol 1990;69:769-70.  Back to cited text no. 4      
5.Macauliffe N, Drage NA, Hunter B. Staple diet: A foreign body in a tooth. Int J Paediatr Dent 2005;15:468-71.  Back to cited text no. 5      
6.Grossman JL, Heaton JF. Endodontic case reports. Dent Clin North Am 1974;18:509-209-27.  Back to cited text no. 6      
7.Toida M, Ichihara H, Okutomi T, Nakamura K, Ishimaru JI. An unusual foreign body in an unerupted supernumerary tooth. Br Dent J 1992;173:345-6.  Back to cited text no. 7  [PUBMED]    
8.Zillich RM, Pickens TN. Patient-included blockage of the root canal: Report of a case. Oral Surg Oral Med Oral Pathol 1982;54:689-90.  Back to cited text no. 8  [PUBMED]    
9.Turner CH. An unusual foreign body. Oral Surg Oral Med Oral Pathol 1983;56:226.  Back to cited text no. 9  [PUBMED]    
10.Gelfman WE, Cheris LJ, Williams AC. Self attempted endodontics: A case report. J Dent Child 1969;36:283-4.  Back to cited text no. 10      
11.Harris WE. Foreign bodies in root canals: Report of two cases. J Am Dent Assoc 1972;85:906-11.  Back to cited text no. 11  [PUBMED]    
12.Lamster IB, Barenie JT. Foreign objects in the root canal: Review of literature and report of 2 cases. Oral Surg Oral Med Oral Pathol 1977 ;44:483-6.  Back to cited text no. 12  [PUBMED]    
13.Weine FS. Endodontic therapy. 6 th ed. 2004.  Back to cited text no. 13      
14.Nair PN. On the causes of persistent apical periodontitis: A review. Int Endod J 2006;39:249-81.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]  
15.Meidinger DL, Kabes BJ. Foreign object removal utilizing the caviendo ultrasonic instrument. J Endod 1985;11:301-4.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]  
16.Williams VD, Bjourndal AM. The Masseran technique for the removal of fractured posts in endodontically treated teeth. J Prosthet Dent 1983;49:46-8.  Back to cited text no. 16      
17.Fros UG, Berg JO. A method for the removal of broken endodontic instruments from the root canals. J Endod 1983;9:156-9.  Back to cited text no. 17      
18.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. 18  [PUBMED]  [FULLTEXT]  
19.Nehme WB. Elimination of intracanal metallic obstruction by abrasion using an operational microscope and ultrasonics. J Endod 2001;27:365-7.  Back to cited text no. 19  [PUBMED]  [FULLTEXT]  
20.Srivastava N, Vineeta N. Foreign body in the periradicular area. J Endod 2001;27:593-4.  Back to cited text no. 20  [PUBMED]  [FULLTEXT]  
21.McCullock AJ. The removal of restorations and foreign objects from root canals. Quintessence Int 1993;24:245-9.  Back to cited text no. 21  [PUBMED]    
22.Walvekar SV, Al- Duwari Y, Al-Kandri AM, Al-Quoud OA. Unusual foreign objects in the root canal. J Endod 1995;21:526-7  Back to cited text no. 22      
23.Goldstein BH, Scuibba JJ, Laskin DM. Actinomycosis of the maxilla: A review of literature and a report case. J Oral Surg 1972;30:362-6.  Back to cited text no. 23      
24.Costa F, Robiomy M, Toro C, Sembronio S, Politi M. Endoscopically assisted procedure for the removal of a foreign body from the maxillary sinus and contemporary endodontic surgical treatment of the tooth. Head Face Med 2006;8:37.  Back to cited text no. 24      


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]


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