A case of orthodontic splint ingestion misclassified as a sharp/pointed foreign body in a child: A case report

Rationale: Foreign body (FB) ingestion is common, particularly among children. While most FBs pass through the gastrointestinal tract without complications, some cases can lead to morbidity or even mortality. Management strategies depend on the size, sharpness, toxicity, and location of the FB. Plain radiographs are essential for diagnosis, treatment planning, and follow-up, especially for radiopaque FBs. Ingestion of dental-related FBs is rare, with reported cases involving orthodontic wires, braces, retainers, and other dental materials. Composite resin-wire splints are commonly used in orthodontics to manage dental traumatic injuries. We present a case of a patient who ingested a composite resin-wire splint, initially misclassified as a sharp FB, leading to unnecessary aggressive treatment. Patient concerns: A 2-year-old girl presented to the emergency department after accidentally ingesting a FB of dental origin. She had a recent traumatic dental injury and displayed no symptoms of ingestion. Initial radiographs revealed a dental wire in the stomach. Diagnoses: Ingestion of orthodontic splint (composite resin-wire splint). Interventions: Considering the pointed tip of the wire, the emergency department physician transferred her to the endoscopy specialist for endoscopic removal. However, given the expected passage into the small bowel after a proper fasting period for endoscopy, close observation with follow-up radiographs was chosen amid parental anxiety. Outcomes: Follow-up imaging showed FB migration to the ascending colon without perforation. Stool inspection revealed the dental wire and 4 composite resins, with the sharp tips covered by the resin, classifying it as a blunt FB. A retrospective review of radiographs revealed faint oval-shaped, mid-level radiopacities at each end of the wire covering the sharp/pointed tips. Lessons: In evaluating orthodontic splints as FBs, identifying faint composite resin on radiographs is crucial for planning milder treatment and alleviating parental anxiety.