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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 29  |  Issue : 1  |  Page : 74-77

Endoesthetic management of a traumatized central incisor with an embedded screw


1 Department of Pedodontics, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
2 Department of Periodontics, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
3 Department of Pedodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication25-May-2017

Correspondence Address:
Harveen Singh Kalra
13, New Jawahar Nagar, Jalandhar - 144 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-7212.207009

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  Abstract 

Foreign objects in the pulp chamber or root canal are not unusual findings in teeth undergoing root canal treatment or in root canal treated teeth. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body. This kind of situation is more likely to occur in children due to their habit of placing foreign objects in the mouth. The foreign objects may act as a potential source of infection and may later lead to a painful condition. This case report describes a clinical case in which a screw embedded in the root canal of a fractured anterior tooth was removed through nonsurgical approach. Screw was retrieved followed by removal of old gutta-percha from the canal. Later, the apical third of the tooth was filled with mineral trioxide aggregate followed by post and core. Porcelain crown was placed with gingival margin of the crown replaced with pink porcelain.

Keywords: Esthetics; embedded screw; mineral trioxide aggregate.


How to cite this article:
Khurana H, Kalra HS, Pandey RK. Endoesthetic management of a traumatized central incisor with an embedded screw. Endodontology 2017;29:74-7

How to cite this URL:
Khurana H, Kalra HS, Pandey RK. Endoesthetic management of a traumatized central incisor with an embedded screw. Endodontology [serial online] 2017 [cited 2019 May 25];29:74-7. Available from: http://www.endodontologyonweb.org/text.asp?2017/29/1/74/207009




  Introduction Top


A great variety of metallic objects broken by dentist or even by the patients have been discovered in root canal. These foreign objects usually get embed in teeth undergoing root canal treatment or root canal treated teeth with lost coronal filling or fractured teeth as the result of trauma. Traumatic dental injuries are common occurrences affecting worldwide approximately 20%–30% of the permanent dentition that often leads to compromised esthetics and function.[1] More than 20% of children experience damage to their permanent dentition by 14 years of age, with men outnumbering women with the ratio of 2:1 and peak incidence at 8–10 years of age.[2] The most susceptible tooth is the maxillary central incisor, which sustains approximately 80% of dental injuries followed by the maxillary lateral and the mandibular central and lateral incisors.[3],[4]

These traumatic injuries place the patient at risk of foreign body lodgment in the chamber or canal, and this incident is seen most commonly in children as compared to adults. Such foreign objects may become a source of persistent pain and infection causing the patient to report to the dentist.[5]

The present case represents the above-said condition in which the screw got embedded in the root canal treated incisor which was fractured earlier.


  Case Report Top


A 14-year-old male child reported to the Department of Paediatric and Preventive Dentistry, King George's Medical University, Lucknow (Uttar Pradesh, India) with a chief complaint of blackish discoloration in the upper front tooth region. Patient's parent gave a history of dental trauma as the patient had fallen from stairs leading to fractured upper anterior teeth 4 years back. The patient had undergone root canal treatment of the fractured teeth that were later capped with temporary crowns. Both the crowns dislodged after 1 year, and they did not contact the dentist as there was no pain. Now due to unaesthetic appearance, the patient reported. Clinical examination revealed grossly decayed upper right central incisor and fractured upper left central incisor [Figure 1]. Intraoral periapical radiograph depicted a radiopaque object embedded in the root canal of the upper right central incisor [Figure 2]. The patient was not aware of the presence of a foreign object in his tooth. The object was removed from the tooth with the help H-files Dentsply and spoon excavator and was found to be a metallic screw [Figure 3]. The technique employed was able to preserve the dental structure without the necessity of a surgical approach in a tooth that before had suffered an injury due to a dental trauma.
Figure 1: Preoperative intraoral photograph

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Figure 2: Preoperative radiograph

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Figure 3: Embedded screw recovered from the root canal

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Since the upper right central incisor was grossly decayed, it was decided to redo the root canal treatment. As the postobturation restoration of the treated upper left central incisor was retained as depicted clinically and radiographically, crowning of both the affected teeth was planned.

All carious and softened part of upper right central incisor was removed followed by complete cleaning of the root canal and removal of the old gutta-percha. Since there was no apparent apical constriction, the apical one-third was filled with mineral trioxide aggregate (MTA) to obtain the good apical seal and tooth was closed with moist cotton placed in the canal followed by temporary filling. After 24 h the canal was again opened, moist cotton removed and was checked for good apical seal. The remaining canal was filled with appropriate sized fiber postfollowed by core build up and tooth preparation [Figure 4]. In upper left central incisor also crown cutting was performed for porcelain fused to metal crown. The gingival margin of the porcelain crown of upper right central incisor was replaced with pink porcelain for good aesthetic appearance [Figure 5].
Figure 4: Intraoperative radiograph depicting apexification with mineral trioxide aggregate, followed by post and core build-up in URCI

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Figure 5: Postoperative intraoral photograph

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  Discussion Top


A comprehensive review of literature has shown cases of various foreign objects being embedded in the open pulp chamber or root canal especially in teeth when their pulp chamber were wide open caused by large carious lesion, trauma or in a tooth undergoing endodontic treatment. The objects that have been found in the root canals or pulp chamber can range from pencil leads sewing needles and beads to metal screws stapler pins and paper clips. Harris reported the placement of various objects within the root canals of maxillary anterior teeth.[6],[7],[8],[9],[10],[11],[12] These included pins, needles, a wooden toothpick, a pencil tip, plastic objects, toothbrush bristles, and crayons. Grossman reported placement of indelible ink pencil tips, brads, a toothpick, absorbent points, and even a tomato seed in the root canals of anterior teeth that had been left open for drainage.[13] Gelfman et al. reported a case wherein a 3-year-old child had inserted two straws into the root canal of a primary central incisor. In all these cases, the patients had inserted the objects in the root canals to remove food plugs from the teeth. In the present case also, a screw was recovered from the root canal of the anterior teeth of which the patient was completely unaware. Since the screw was rusted, tooth around the screw was decayed along with black pigmentation.[14]

Treatment of canals with open apices and necrotic pulp includes:

  • Apexification with Ca(OH)2 which may take months for the formation of hard tissue barrier. It has been reported by Sheehy and Roberts that the use of calcium hydroxide for apical barrier formation was successful in about 74%–100% of cases and the average time for apical barrier formation was ranging from 5 months to 20 months [15]
  • One day apexification with MTA [16]
  • Pulp revascularization with tri antibiotic paste.[17]


But since our tooth was already root canal treated we chose the most convenient 1 day apexification procedure with MTA.

Other treatment options of the present case could be:

  • Extraction of Upper right central incisor followed by space maintainer till the implant placement, but this will severely affect the alveolar bone height and width
  • Complete decoronation of upper right central incisor can be done, making it subgingival. The idea behind this protocol is to preserve the alveolar height for implant placement after the growth period ceases [18]
  • Custom made post and core followed by crown placement [19]
  • Orthodontic traction of the upper right central incisor to expose the finish line followed by post and core build up and crown placement.[20]



  Conclusion Top


Foreign object lodgment in root canal of teeth is preventable but if it occurs, is treatable depending upon the position of the foreign body in the root canal. Thus, parents and patients should be informed about the possibility of lodgment of objects inside the pulp chamber or root canals of teeth, to avoid such a sequel.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bourguignon C, Sigurdsson A. Preventive strategies for traumatic dental injuries. Dent Clin North Am 2009;53:729-49, vii.  Back to cited text no. 1
    
2.
Moule AJ, Moule CA. Minor traumatic injuries to the permanent dentition. Dent Clin North Am 2009;53:639-59, v.  Back to cited text no. 2
    
3.
Järvinen S. Fractured and avulsed permanent incisors in Finnish children. A retrospective study. Acta Odontol Scand 1979;37:47-50.  Back to cited text no. 3
    
4.
York AH, Hunter RM, Morton JG, Wells GM, Newton BJ. Dental injuries in 11- to 13-year-old children. N Z Dent J 1978;74:218-20.  Back to cited text no. 4
    
5.
Nagaveni NB, Umashankara KV. Unusual habit ending as a foreign body lodgment: A report of case series. J Cranio Maxillary Dis 2012;1:119-25.  Back to cited text no. 5
    
6.
Hall JB. Endodontics – Patient performed. ASDC J Dent Child 1969;36:213-6.  Back to cited text no. 6
    
7.
Nernst H. Foreign body in a root canal. Quintessence Int (Berl) 1972;3:33-4.  Back to cited text no. 7
    
8.
Subbareddy VV, Mehta DS. Beads. Oral Surg Oral Med Oral Pathol 1990;69:769-70.  Back to cited text no. 8
    
9.
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. 9
[PUBMED]    
10.
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. 10
    
11.
Cataldo E. Unusual foreign objects in pulp canals. Oral Surg Oral Med Oral Pathol 1976;42:851.  Back to cited text no. 11
    
12.
Harris WE. Foreign bodies in root canals: Report of two cases. J Am Dent Assoc 1972;85:906-11.  Back to cited text no. 12
    
13.
Grossman LI. Endodontic case reports. Dent Clin North Am 1974;18:509-27.  Back to cited text no. 13
    
14.
Gelfman WE, Cheris LJ, Williams AC. Self-attempted endodontics – A case report. ASDC J Dent Child 1969;36:283-4.  Back to cited text no. 14
    
15.
Sheehy EC, Roberts GJ. Use of calcium hydroxide for apical barrier formation and healing in non-vital immature permanent teeth: A review. Br Dent J 1997;183:241-6.  Back to cited text no. 15
    
16.
Gawthaman M, Vinodh S, Mathian VM, Vijayaraghavan R, Karunakaran R. Apexification with calcium hydroxide and mineral trioxide aggregate: Report of two cases. J Pharm Bioallied Sci 2013;5 Suppl 2:S131-4.  Back to cited text no. 16
    
17.
Thibodeau B, Trope M. Pulp revascularization of a necrotic infected immature permanent tooth: Case report and review of the literature. Pediatr Dent 2007;29:47-50.  Back to cited text no. 17
    
18.
Malmgren B. Ridge preservation/decoronation. J Endod 2013;39 3 Suppl:S67-72.  Back to cited text no. 18
    
19.
Mishra L, Kumar M, Nishant. Rehabilitation of fractured tooth by a custom made fibre reinforced composite post. Int J Odontostomatol 2012;6:323-6.  Back to cited text no. 19
    
20.
Kulkarni VK, Sharma DS, Banda NR, Solanki M, Khandelwal V, Airen P. Clinical management of a complicated crown-root fracture using autogenous tooth fragment: A biological restorative approach. Contemp Clin Dent 2013;4:84-7.  Back to cited text no. 20
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    Figures

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



 

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