Long-Term Retention of a Paper Point in the Periapical Tissues_ a Case Report

8/3/2019 Long-Term Retention of a Paper Point in the Periapical Tissues_ a Case Report

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1995: 9: !2O-123ed in Denmark . At! rights reserved

Copyright Munksgaard 1Endodontics &Dental Traumatolog

ISSN 0109-2502

C a s e r e p

o n g - t e r m r e t e n t io n o f a p a p e r p o in t in t h ee r ia p ic a i t i s s u e s : a c a s e r e p o r t9: 120-123. Munksgaard, 1993.

SEM comparison of the specimen with a similarly treated

C . M . S e d g l e y , H . M e s s e rRoyal Dental Hospital, Melbourne, School of DScience, University of Melbourne, Australia.

Key words: cellulose; foreign body; paper poinperiapicai lesion.H. H. Messer, School of Denfai Science.711 Eiizabefh Sfreef, Melbourne 3000, AusfraAccepfed toi publicafion Ocfober 10, 1992

ulose fibers in periapicai biopsies from cases withirmed (2, 3). Fragments of endodontic paper

The introduction of vegetable materials into theoreign body reaction . An exam ples the periapicai pulse gran ulom a which is associated

The etiology of foreign body reactions to legumes

1,4-linkages. It is not digested to any significextent by man since the digestive tract does contain the enzyme cellulase (8). In addition, man and animal defense systems appear unablebreak dow^n cellulose, resulting in a long lastgranulomatous response (7).In the case to be described, a large-diameessentially intact paper point of 15 mm length wunexpectedly found in the periapicai tissues omaxillary central incisor tooth during periradicusurgery.C a s e r e p e r tA 22-year-old Vietnamese man was referred to Endodontic Unit of the Royal Dental HospitalMelbourne for evaluation and treatment of maxillary incisors. The patient recalled commeing endodontic treatment to the maxillary cenincisors in Vietman nine years previously treatment was completed four years later in Atralia. The patient reported periodic episodesdiscomfort, swelling and drainage from the bue


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Routine orthograde endodontic therapy was

P a p e r p o i n t i n p e r i a p i c a i t i s snishing of the gutta pereha were completed, athe flap replaced and sutured. Healing proeeeduneventfully, and a \2-month review showed clical and radiographical evidence of periradicuhealing despite less than ideal restorations (F2 ) . The paper point (which was remarkably freeadherent tissue) (Fig. 3) was fixed in 10% neutbuffered formalin and divided into two parts. Oportion was embedded in paraffin and sectionthen stained with haematoxylin and eosin aviewed under a light microscope. The other wprocessed for scanning electron microscopy. Fcomparative purposes, a fresh intact paper powas identically treated and examined.Light microscopic examination of the specimshowed fragments of foreign material of a fibl a r ) ' nature (Fig. 4) resembling the cellulose fibdescribed by Koppang et al. (2, 3). The fibers peared as longitudinal and rounded or kidnshaped transversal sections of weakly basophilictranslucent, birefringent foreign bodies with occasional narrow central canal. The soft tisconsisted of necrotic cell debris as well as smfragments of chronically inflamed fibrous conn


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s l e v & i W e s s er

Clinical photograph (with mm scale) of paper point removed from the periapica! area of the left central incisor.ne H&E section (x 100) of portion of the paper point, showing cellulose fibres surrounded by necrotic cell debris g p g p (Routine H&E sect ion (

SEM view of the paper point, showing intact cellulose fibers (white bar= 1 m m ) .Higher power SEM i f i l l l fib { h i t b 0 1 )

point, showing intact cellulose fibers (white bar=w of intact cellulose fibers {white bar = 0 .1 m m ) .

D i s c u s s i o nThe technique of intentionally sealing a med


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P a p e r p e i n t in p e r i a p i c a i t i s s

the diameter of the apical foramenthepoint through the apieal foramend into the periapica i tissues. In this case it ap pearsthe paper point was inadvertently pushedat a subsequent

Koppang et al. (1989) describe postendodontica foreign

s known to initiate a foreign body reaction (7).in this case it is also possible that peri-of adjacent teeth contributed toit isto implicate the paper point as the soleto the persistence of the lesion.of the still intact paper point afterof five years in theperiapicai tissues

R e f e r e n c e s1. WHITE E. Paper point in mental foramen. Report of a cOral Surs 1968; 25 : 630-2.2 . K O P P A N G H S , K O PP A N G R, SOLHEIM T, AARNES H, STO

SO. Identification of cellulose fibers inoral biopsies. SeaDent Rti l%il\ 9S: 165-73.

3 . KOPPANG HS, K O P P A N G R, SOLMEIM T, AARNES H, STOSO. Cellulose fibers from endodontic paper points aetiological factor in postendodontic periapicai granuloand cysts. J Endoion 1989; 15 : 369-72.

4 . MINCE R HH, M C C O Y J M , T UR N ER jE. Pulse granulomthe alveolar ridge. Oral Sm g 1979; 4S : 126-30.3. SIMON JHS, CHIME NT I RA, M I N T Z GA. Clinical significof the pulse granuloma. J Endodon 1982; 8: 116-9.6. TALAGKO AA, RADDEN B G. Orai puise granuloma: cliand histopathological features. A review of 62 cases. IOral Maxilbfac Surg 1988,- 17 : 343-6.7. KNOB LICH R. Pulmonary granulomatosis caused byetable particles. So-cajled lentil pulse pneumonia. AmRespir Dis 1969; 99 : 380-9.8. B E L L GH, EMSLIE-SMITH D, PATERSON CR. Textboophysiology and biochemistry. 9th ed. Edinburgh: Chur

Livingstone, 1976; 30.9. STEWART GG. Rational root canal medication. Dent CAm 1957; .November: 823-34.10. GROSSMAN LI, O L I E T S, D E L R I O CE. Endodontic prac11th ed. Philadelphia: Lea and Febiger, 1988; 230-2.


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Long-Term Retention of a Paper Point in the Periapical Tissues_ a Case Report