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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 127-129

Broken pin in root canal


Department of Pedodontics and Preventive Dentistry, Desh Bhagat Dental College and Hospital, Muktsar, Punjab, India

Date of Web Publication2-Mar-2016

Correspondence Address:
Karanveer Singh Saluja
MIG 315, Phase 1, Dugri, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2454-3160.177951

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  Abstract 

Trauma may lead to fractured teeth with exposed canals in growing children. Some people have a habit of placing foreign objects to remove food plugs from the teeth. These foreign objects may act as a potential source of infection and may later lead to a painful condition. The presence of foreign object in the root canal is one of the challenging occurrences in endodontic therapy. The chance of these foreign objects getting impacted into the tooth is more when pulp chamber is open either because of traumatic injury or large carious exposure. A detailed case history, clinical, and radiographic examinations are required to ascertain the size, position, and likely composition of the object, and also the difficulty involved in its retrieval. This case report describes a self-introduced unusual foreign body and its retrieval from the root canal of upper central incisor by simple orthograde nonsurgical technique.

Keywords: Central incisor, foreign object, nonsurgical technique


How to cite this article:
Saluja KS, Karda B. Broken pin in root canal. Saint Int Dent J 2015;1:127-9

How to cite this URL:
Saluja KS, Karda B. Broken pin in root canal. Saint Int Dent J [serial online] 2015 [cited 2019 Oct 17];1:127-9. Available from: http://www.sidj.org/text.asp?2015/1/2/127/177951

The discovery of a foreign object embedded in a tooth is relatively uncommon. The occurrence of foreign bodies such as staple pins, [1] paper clip, nail, and metal screw have been reported. These cases are diagnosed accidentally on radiographic examination of the tooth, which may be associated with the pulpal exposure. Proper case history, clinical, and radiographic examinations are necessary to help in establishing the technique for retrieval. This report describes the case of a foreign object impacted in maxillary central incisor and its retrieval by employing file braiding technique to facilitate nonsurgical endodontic therapy.


  Case Report Top


A 14-year-old male patient reported with a chief complaint of occasional dull pain in the broken upper left central incisor (21). Although the patient gave a history of trauma and fracture of this tooth, he gave no history of undergoing any treatment for the same. The patient had no significant medical history. Intraoral examination revealed a discolored 21 with an oblique fracture of incisal and middle third of the crown. The pulp chamber of the tooth was open to the oral cavity. Thermal and electric pulp testing failed to elicit any response in the tooth. Intraoral periapical radiograph revealed the presence of an unusual radiopaque linear foreign object in the apical third of the root canal as shown in [Figure 1]. On further history-taking, the patient revealed the habit of using metallic objects to remove food debris stuck in the open pulp chamber. However, he could not recall any incidence of lodgment of a metallic object within the root canal. A diagnosis of nonvital 21 with associated chronic apical periodontitis and foreign body lodgment was made. The patient was then advised to undergo the retrieval of foreign object followed by endodontic therapy. Conservative management of the central incisor was considered under antibiotic cover, and removal of the foreign objects was done by tactile sensation using H-files of size 10-25, with irrigation alternating between sodium hypochlorite and hydrogen peroxide and the evacuation done using high-vacuum suction. Pulp canal was enlarged to gain access to the foreign object. The irrigants passed out of the canal with a blackish color revealing that the metallic objects were corroding. Finally, the root canal was irrigated copiously with saline, then with chlorhexidine and sodium hypochlorite. Retrieval was done by attempting to engage the linear foreign object between ISO no. 20 H-file (Dentsply Maillefer) and canal wall on either side and then twisting the files, pulling it out coronally, which was then grasped with tweezers and was retrieved as shown in [Figure 2]. This file braiding technique dislodged the foreign body into the pulp chamber as shown in [Figure 3]. Subsequently, the canal was obturated by lateral compaction using gutta-percha (Dentsply-Maillefer, Ballaigues, Switzerland) and AH plus sealer (Dentsply, De Trey, Konstanz, Germany) followed by core build up and crown as shown in [Figure 4]. On a follow-up examination after 3 months, the teeth were asymptomatic.
Figure 1: Broken pin in root canal

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Figure 2: Retrieval of pin

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Figure 3: Retrieved pin from root canal

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Figure 4: Post obturation and crown placement

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  Discussion Top


Children have the habit of placing foreign objects in the oral cavity. The chance of these foreign objects getting impacted into the tooth is more when pulp chamber is open either because of traumatic injury or large carious exposure. Impaction of foreign bodies in the teeth can cause pain, bleeding, and infection. [2] During emergency root canal treatment, practitioners leave the pulp chamber open where pus discharges through the canal. Such a procedure may place the patient at risk for foreign body lodgment, as suggested by Cohen and Brown. [2] Dislodged restorations are another common cause for the foreign body lodgment. During emergency root canal treatment, 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. As the patient in this case report gave no history of previous endodontic treatment, the probable reason may be the patient's habit of using metallic objects to remove food debris from the pulp chamber. Radiographs also aid in the retrieval of foreign object. There are various radiographic methods among which the most preferred method is the parallax view. The other diagnostic techniques are vertex occlusal view, triangulation technique, stereoradiography, and tomography. [3] Simple intraoral periapical radiograph revealed the presence of a foreign object in the apical third of the root in this case. Various factors can play an important role in selecting a technique for the retrieval of foreign objects within the root canal. For retrieval of foreign objects lying in the pulp chamber or canal using ultrasonic instruments, [4] the Masserann kit, [5] modified Castroviejo needle holders, [6] and Stieglitz forceps [7] have been used. Ethylenediaminetetraacetic acid has been suggested as a useful aiding, lubricating the canal when attempting to remove the foreign object. [7] The use of an operating microscope along with ultrasonic, provides the clinician to visualize any intraradicular metallic obstructions. In this case report, the remaining radicular dentin was thin, and the foreign object could easily be bypassed, file braiding or multiple file technique was employed to engage and dislodge it. This technique first described by Glick consists of inserting multiple H-files and twisting them around the foreign body. H-files are preferred in this as their flute design is suitable for engaging the body. The braided multiple H-files would exert a gripping force that aids in the removal of the foreign body. [8] Masserann kit would have led to further weakening of the already thin radicular structure, and the use of ultrasonics has the potential to push the foreign body beyond the apex. Stieglitz forceps are used to grip and retrieve foreign objects which are clinically visible in the coronal access. In this case, the foreign body was not accessible for gripping by the beaks of Stieglitz forceps as it was not projecting into the pulp chamber. Nonetheless, retrieval of the object may be difficult when it is lodged in periapical region. Periapical surgery or intentional reimplantation [9] should be considered to remove such objects. EDTA has been the most suggested aid in lubricating the canal along with saline and sodium hypochlorite. The foci of infection, if not eliminated at the earliest can lead to complications such as biofilm formation, which may be difficult to eliminate later. Actinomycosis following the placement of a piece of jewelry chain into a maxillary central incisor and chronic maxillary sinusitis of dental origin developed due to pushing of foreign bodies into the maxillary sinus [10] has been reported. Hence, prompt attempts at their retrieval should be initiated. Calcium hydroxide and the topical use of triple antibiotic paste, a mixture of ciprofloxacin, metronidazole, and minocycline, has been used and shown to be very effective in eliminating endodontic pathogens. We used calcium hydroxide as intracanal medicament and sodium hypochlorite as an irrigant which proved to be successful in eliminating the infection in subsequent visits. Once the endodontic therapy was completed, the composite build-up was done followed by porcelain fused to the metal crown to esthetically restore the tooth.


  Conclusion Top


If foreign objects are found in the root canal, prompt, but cautious attempts should be made to retrieve it first by simple, nonsurgical means, but once the object has been pushed apically, apical surgical procedures may sometimes be unavoidable. Patience, care, and appropriate techniques may be helpful in retrieving foreign bodies and avoiding periapical surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rao A, Sudha P. A case of stapler pin in the root canal - Extending beyond the apex. Indian J Dent Res 1999;10:104-7.  Back to cited text no. 1
[PUBMED]    
2.
Cohen AS, Brown DC. Orofacial dental pain emergencies: Endodontic diagnosis and management. In: Cohen S, Burns RC, editors. Pathways of the Pulp. 8 th ed. St. Louis: Mosby; 2002. p. 31-75.  Back to cited text no. 2
    
3.
McAuliffe 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. 3
    
4.
Meidinger DL, Kabes BJ. Foreign object removal utilizing the Cavi-Endo ultrasonic instrument. J Endod 1985;11:301-4.  Back to cited text no. 4
[PUBMED]    
5.
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. 5
[PUBMED]    
6.
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. 6
[PUBMED]    
7.
Lumley PJ, Walmsley AD. Removal of foreign objects from root canals. Dent Update 1990;17:420-3.  Back to cited text no. 7
    
8.
Gutmann JL, Dumsha TC, Lovdahl PE, editors. Problem solving challenges in the revision of previous root canal procedure. In: Problem Solving in Endodontics; Prevention, Identification and Management. 4 th ed. St Louis, Missouri: Elsevier Mosby; 2006. p. 239-79.  Back to cited text no. 8
    
9.
Srivastava N, Vineeta N. Foreign body in the periradicular area. J Endod 2001;27:593-4.  Back to cited text no. 9
    
10.
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 8;2:37.  Back to cited text no. 10
    


    Figures

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



 

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