Anterior Teeth Case Study

ABSTRACT

Managing trauma to anterior teeth in children is a challenge for dentists. It can be further complicated by the presence of a foreign body in the root canal which act as an additional nidus of infection. This foreign body is often diagnosed accidentally after radiographic evaluation. Thorough and careful clinical and radiographic assessments are required for complete retrieval of foreign body without much damage to the tooth structure. This paper presents a case series of two case reports where successful complete retrieval of foreign objects was performed from the root canals of permanent incisors followed by aesthetic management of the involved teeth.

Keywords: trauma, foreign body in the root canal , endodontic therapy INTRODUCTION

Sometimes these objects may break or get stuck into the traumatically or cariously exposed pulp chambers or root canals of tooth where they can act as a nidus of infection . These objects can also be inserted during trauma or iatrogenic breakage of instruments during root canal treatment. In the past, foreign objects like screws, finger nails, staple pins, pencil leads, nails and tooth picks were observed by the authors .1-3The situation is more problematic in cases where these objects are causing perforation in any portion of root or are located beyond the apex of root like in young permanent teeth with immature apex further complicating the endodontic therapy. Retrieval of foreign object from the canals depends on its location, size, shape and nature. The attempt of removal of foreign objects from the root canal is a complicated procedure which can damage the normal canal physiology or cause root perforation. Although no standardized procedure exists for successful removal of unusual foreign objects even in difficult cases, but different authors used a number of different techniques, such as Stieglitz pliers, small mosquito haemostat and ultrasonic instruments.4-6This case series describes two clinical cases of retrieval of foreign object from the root canals of permanent teeth through both the surgical and non-surgical

Thorough history revealed trauma due to fall 1 year back , which resulted in the fracture of upper front tooth. The patient had visited the dentist for the treatment, but discontinued it in between. Clinical examination revealed a fracture (Ellis class IV #) and associated greyish black discoloration of the crown of tooth 21(Fig 1a) and the vitality test revealed 22 as non vital. An intraoral periapical radiograph revealed the presence of a radio-opaque object inside the root canal extruding periapically, approximately 4 mm from the apex with periapical radiolucency involving 21 and extending to the root of 22 (Fig 1b). After considering the clinical and radiographic findings, an attempt to retrieve the foreign object using H files and thereafter completing the root canal treatment nonsurgically was planned. But the needle was snugly fitted inside the canal and its removal became difficult even after repeated attempts. Therefore, surgical intervention was planned after hematological investigations and written consent form from the parents . After the administration of the bilateral infraorbital block along with nasopalatine nerve block, a crevicular incision was given from mesial of 12 to distal of 23 followed by two releasing incisions. A mucoperiosteal full thickness flap was raised and