Removal of root tip after extraction?

I performed an extraction of tooth #30. The tooth was endodontically treated and badly broken down but without a periapical lesion. During the extraction I sectioned the tooth and took off the distal root. The mesial root was broken and I took it out in multiple pieces. After I finished the extraction I took a PA radiograph and I did not notice the presence of a remaining root tip. I grafted the site and and dismissed the patient and prescribed antibiotics for 10 days. At the next week follow up visit, healing was within normal limits, but when I reviewed the PA radiograph I noticed the root tip. I informed the patient about what happened and I feel so badly about it. I did not want to interrupt the healing at that time so I did not try to remove it. My question do I have to remove the tip and if so when is the best time?  What is the best technique for removing the root tip? Will it be possible to just drill it out when I prepare the osteotomy site?  What do you recommend?

15 thoughts on “Removal of root tip after extraction?

  1. Dr. JL says:

    You could leave the root and not do an implant. If you and the patient are wanting to place an implant then you will need to re-enter and remove the root. As soon as possible. If it were me (and it has been before), I would remove the root no matter what…

  2. Dr Bruce Hirshorn says:

    Based on the X-ray, little bone around root. Would re-enter as soon as possible and try to remove with root tip picks. Also, root tip not necessarily where future implant will be placed. If it remains, could get infected in future and jeopardize implant placed.

  3. Dr. JE says:

    Through the years I have removed many endodontically treated molars. These extractions are often difficult. I have had to leave root tips, but have always gone back to remove them-they are a residual source of infection.

  4. Luis Fabelo, WWW, MAGD says:

    I agree with the above suggestions. Sometimes the root tip can be taken out with just a very thin root tip pick or periotomes. Other times you have to create use bur to create space to deliver the root tip.

    • Charles L Consky DDS FRCDC says:

      There are a few questions that should be answered. First, is that the best radiograph that you can get? Second, what was the reason for the extraction of the molar; just a non restorable tooth or was it symptomatic and infected.

      If it’s the first, then the antibiotic therapy for ten days was excessive, and the need to remove the apical, inert piece of tooth is questionable. It is out of the way of your intended osteotomy.

      If it’s the second, then removal of the root tip should be performed as soon as possible, before the graft matures, as it will become next to impossible to find the root once it does mature. Bone destruction to find the root will be excessive. Alternatively, because of the infected area the graft itself will fail to take. In both cases you will be worse off in your timeline for implant replacement surgery.

  5. Dipika says:

    You informed the patient, told him consequences if left alone verses removing it. Let patient decide and sign. Lesson to learn is whenever we remove root tips in pieces, always take post op XR before grafting. I just did similar extraction last week and saw medial root tip at the end and removed it, was not easy. Looks like it may be away from your osteotomy and may not be easy to remove even at that time. Either it will stay where it is- keep taking routine X-RAY for observation or may work itself out.

  6. Daniel Mayeds says:

    Grind the root tip with a straight #8 round bur. You will remove some bone and the area should heal well and be ready for an implant in 4 months.

  7. K prudhvi says:

    I think you can drill out the tip at the time of implant placement there is a technique called socket shield technique where we intentionally leave buccal part of root and place implant there are also case reports where implants are placed through impacted roots but one thing we should take care is there should be no Peri apical infection of left root

  8. GBOral Surgeon says:

    I can understand your feeling .

    I am sorry I do not know how the soviet eas looking after the extraction was finished . I mean how good was the bony socket ?

    You have many options .

    Refer to an oral surgeon who can remove the root tip and carry out site augmentation at the same time .

    After carrying out thousands of these procedures , I tend to leave it and tend not to traumatise the area . I do not see any particular pathology around the root although X-ray is not very clear .

    If you plan to place an implant there is no harm drilling through the root remnant which is better than loss of bone volume that you would have if you started drilling to get there .

    Another option is to try and use piezo tips to disengage the tip .

    You are the best person to decide what is best for your patient .

    Best wishes

    • François says:

      Take a scan See where root tip is Bucco-lingually.
      if it is the mesial root it is very buccal.
      Raise a buccal flap ans access root tip through buccal plate. Just like dooing an apicoectomy.
      No sweat.

  9. BH says:

    If there is a fresh extraction site, I see no reason to strip periosteum off of the buccal plate and remove buccal bone to retrieve the root. Go through the socket once you have localized the tip.

  10. Hari Hunjan says:

    If you intent to place an implant then remove the root tip asap before the graft matures or gets infected. Antibiotics for 10 days is excessive.

  11. Navdeep Saini says:

    Well you should have taken an X Ray after grafting also and posted both. Further as you have informed that there was no periapical pathology, it is not advisable to traumatise the area for removing that small piece of root unless it can be in way of implant placement position. We deliberately leave roots in bone in socket shield / root submergence techniques and also these days ground tooth material is used as graft. So just relax and reassure your patient also.

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