JOURNAL OF ENDODONTICS Copyright 2001 by The American Association of Endodontists

Printed in U.S.A. VOL. 27, NO. 9, SEPTEMBER 2001

CASE REPORT Foreign Body in the Periradicular Area

Nikhil Srivastava, MDS, and N. Vineeta, MDS

A 12-yr-old child reported to the outpatient department of D.A.V. (C) Dental College & Hospital with a history of trauma 412 yr earlier with pain and swelling now present in the upper anterior area for 3 days. A radiograph showed the presence of a foreign object in the periapical area of a fractured and discolored maxillary central incisor. Reported here is an unusual case of a straight pin lying in the periradicular area.

Foreign objects in the pulp chamber or root canal are not unusual findings in patients undergoing root canal treatment in which canals have been left open for drainage (1). These can be easily removed with care not to push the objects apically, but once the object has been pushed to periapical area, the case becomes very difficult especially when the root end is immature. The presence of a foreign body increases the difficulty of eliminating infection by intracanal treatment alone (2). The options left are either periapical surgery (3) or international replantation to remove the foreign objects in addition to canal filling.

FIG 1. A radiopaque object which appears to have been introduced into periapical tissues through the open canal of a maxillary central incisor.

CASE REPORT A 12-yr-old male presented to the Department of Pedodontics with pain and swelling in the upper anterior region for 3 days. Parents gave a history of trauma 412 yr earlier. On examination a central incisor was fractured (class III), discolored, and tender to percussion. The vitality test was negative. A radiograph was taken that showed an immature apex and the presence of what appeared to be a straight pin in the periapical area with the head of the pin near the root apex (Fig. 1). When asked how it happened the child refused to admit anything; but on further questioning he admitted to having pushed in the pin a few days earlier while studying. He also tried to remove it but could not succeed. He did not inform the parents about the pin due to fear of scolding. Considering the case as an emergency immediate periapical surgery was planned. After giving an infraorbital block and infiltration anesthesia, a mucoperiosteal flap was raised and the buccal cortical plate was pierced using a bur and adequate coolant. After gaining access to the peripical area the head of the straight pin was identified
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and gently removed. It was lying almost parallel to the palatal bone. The canal was obturated and a retrograde filling placed. Antibiotics and analgesics were prescribed. DISCUSSION Pain and swelling in the upper anterior area were probably due to the presence of the contaminated pin in the periapical area. It might have pushed deep beyond the apex in an attempt by the child to remove it from the root canal. The parents said that the tooth was asymptomatic for the last 412 yr, and due to a low economic status and unwillingness to extract the tooth they did not seek treatment. Children often have a tendency to keep foreign objects in the mouth especially when concentrating (e.g. while studying and when watching TV). Many times these objects may inadvertently lacerate the oral mucosa, may go into the pharynx, or as in this case may even be pushed into the canal of a tooth that has been left open (1, 4).

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Srivastava and Vineeta

References

Journal of Endodontics

It is therefore wise to recommend that parents and children should be warned against such type of activities. It is also important that a routine dental and oral checkup every 6 months should be made mandatory by school authorities so that such cases can be avoided.
Dr. Srivastava is a reader with the Department of Pedodontics & Preventive Dentistry and Dr. Vineeta is a reader with the Department of Conservative Dentistry & Endodontics, D.A.V. (C) Dental College & Hospital, Yamuna Nagar 135001, Haryana State, India. Dr. Nikhil Srivastava, 205, Shakti Nagar, Model Town, Yamuna Nagar 135001, Haryana State, India.

1. Kalra N, Jha S. Foreign body in the pulp chamber. Endodontology 1996;8:65. 2. Grossman LI, Oliet S, Del Rio CE. Endodontic practice. 11th ed. Bombay: Verghese Publishing House, 1998:96 7. 3. Cohen S, Burns RC. Pathways of the pulp. 6th ed. Harcourt Brace & Company, Asia Pvt. Ltd., 1994. 4. Shah N. Radioopaque bodies in the periapical area of a non-vital central incisor. Endodontology 1993;5:13 4.