CASE REPORT A Case Report with Literature Review of Managing a Foreign Object in the Root Canal of the Permanent Tooth Mohandoss Suganya 1 , Shivayogi Hugar 2 , Murugaboopathy Vikneshan 3 , Sriram Kaliamoorthy 4 A BSTRACT Young children are more explorative with all the objects they encounter and they develop the habit of inserting them into their mouth. In some cases, the object can injure the child’s oral cavity. And it could be associated with self-injurious behavior of the child. Hence, a proper diagnosis of it is important. There are several reports on various foreign objects embedded in the root canal, which acts as a constant source of pain and infection in the oral cavity. The case report describes a 14-year-old boy with a foreign object in his maxillary left frst premolar and the conservative management of the same. The boy was diagnosed to have no such self-injurious/deliberate self-harm behavior from the detailed history taken. The paper reviews the various management strategies for the removal of foreign objects from the root canal. Keywords: Foreign object, Root canal, Self-injurious behavior. Journal of Scientifc Dentistry (2019): 10.5005/jp-journals-10083-0904 I NTRODUCTION Insertion of foreign objects in the root canal is a common clinical problem especially among children. Some children do it as a habit whereas in others it is associated with self-injurious behavior. Children explore their fractured teeth by use of various objects like staple pins, tooth picks or any sharp objects like pencil leads, sewing needles, wooden tooth picks, plastic chopsticks, fnger nail, etc. Children do this when they concentrate on watching TV and while studying. These objects when they embed in the root canal can act as a source of infection and may lead to pain, swelling, and fracture of the tooth. 1 The discovery of foreign objects in the root canal is rare sometimes and requires various diagnostic aids to find the composition and location of the object. 2 This case report describes the presence of a foreign object in the root canal and its conservative management, along with the review on various management strategies for the removal of foreign objects from the tooth. C ASE D ESCRIPTION A 14-year-old boy was brought to the Department of Pediatric and Preventive Dentistry, KLE VK Institute of Dental Sciences, with a chief complaint of pain in the left upper back tooth region since 2 months. The patient gave a history of continuous, nonradiating pain since 1 week associated with the same region. On clinical examination, there was a deep and open carious lesion in 24 (Fig. 1), dental caries with 36, 47, attrited 46. The patient maintained a poor oral hygiene due to pain. Radiographic examination of the painful tooth revealed a radiopaque foreign object in the root canal of 26 (Fig. 2). On detailed history, it was found that the patient had a habit of biting pins and other sharp objects that he encounters. Direct examination of the foreign body confrmed that it was a staple pin (Fig. 3). The pin was removed using a probe (Figs 4 and 5) as it was visible and easily accessible, following which thorough irrigation of the canal with povidone iodine and saline was carried out. The patient was recalled for root canal treatment with 24. The working length was estimated and the canals were then obturated using the gutta percha and the AH plus sealer (Fig. 6). D ISCUSSION Root canal procedures are sometimes complicated by the blockages in root canals. Blockages can be due to broken dental instruments during the procedure and sometimes by foreign objects that are inserted by the patients themselves. The teeth involved may be associated with pain and infection. Mostly these foreign objects in root canals are detected accidentally on preoperative diagnostic radiographs. 3 Otherwise, they go unnoticed. Various radiographic methods have been suggested to localize a radiopaque foreign object. They are vertex occlusal views, parallax views, stereo radiography, triangulation techniques, and tomography. 3 These specialized radiographic techniques play a vital role to localize the foreign objects inside the root canal. 2 These techniques are of signifcance if the object is radiopaque. Whereas in case of a radiolucent object, authors recommend to take a proper case history regarding the oral habits and other 1 Department of Pediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (a Deemed University), Pillayarkuppam, Puducherry, India 2 Department of Pediatric and Preventive Dentistry, KLE Vishwanath Katti Institute of Dental Sciences, KLE Deemed University, Belagavi, Karnataka, India 3 Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (a Deemed University), Pillayarkuppam, Puducherry, India 4 Department of Dentistry, Vinayaka Mission’s Medical College, Vinayaka Mission’s Research Foundation (Deemed to be University), Puducherry, India Corresponding Author: Mohandoss Suganya, Department of Pediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (a Deemed University), Pillayarkuppam, Puducherry, India, Phone: +91-8148385152, e-mail: drsuganyamohandoss@gmail.com How to cite this article: Suganya M, Hugar S, Vikneshan M, Kaliamoorthy S. A Case Report with Literature Review of Managing a Foreign Object in the Root Canal of the Permanent Tooth. J Sci Dent 2019;9(1):15–18. Source of support: Nil Confict of interest: None © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons. org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.