Refractory suppurative apical periodontitis due to cellulose fibers in the periapical tissues: case report.

The use of a cotton pellet as a spacer or as a medication carrier in the tooth pulp chamber between root canal therapy appointments is an accepted and common practice. Retaining the pellet in the proper position within the tooth is very important. Cellulose fibers from disposable drapes, gowns and cotton can cause foreign body reactions if left in a surgical wound." In addition, cellulose fibers from paper points, sealed inside the pulp canal, can cause refractory apical periodontitis." The following is a report of refractory suppurative apical periodontitis, apparently secondary to foreign material in the periapical area. It is suspected that the foreign material consisted of cotton fibers that were displaced from the pulp chamber, through the canal, into the periapical area.