Endodontic management of an unusual foreign body in a maxillary central incisor
A 14-year-old boy presented with the complaint of broken upper front teeth. The patient wanted esthetic restoration of his anterior teeth. He had a history of fall from steps while playing 2 years ago.\nClinical examination revealed a complicated crown fracture (Ellis class III) on upper right central incisor and an Ellis class II fracture on upper left central incisor [Figure and ]. There was a mild discoloration of 11. He had negative history of pain, swelling, or pus discharge. On examination, an open root canal was seen on 11.\nAn intraoral periapical radiograph revealed the presence of a radio-opaque object (foreign body) inside the root canal of 11, which resembled a bent stapler pin []. It was present at the junction of middle and cervical thirds of the root canal. There was periapical radiolucency in relation to 11.\nThe tooth 11 was isolated and a conventional access cavity was prepared. A thin, tapering, diamond fissure bur on an air rotor hand piece was used to slightly widen the orifice to facilitate access for instrumentation. An ultrasonic scaler was used to clear the debris from root canal orifice and also to facilitate loosening of the stapler pin. Root canal was irrigated with 5.2% sodium hypochlorite solution. A no. 20 H file was used to bypass and engage the foreign body. After a series of attempts, the object was moved coronally and pulled out with a mosquito forceps []. The canal was then irrigated with normal saline, which helped to remove the debris including small wooden pieces. Working length was established and biomechanical preparation done using step-back technique. Calcium hydroxide was used as the intracanal medicament. In the next appointment, obturation of the tooth was done with gutta-percha using lateral condensation technique []. Final restoration was done with metal ceramic crown. The tooth 21 was restored with composite [].