Retained root tip: Recommendations?

I extracted a left maxillary first bicuspid #12 (24) today.  The plan was to place an immediate implant after extraction.  However, the extraction turned out to be very difficult because the tooth had very slim roots, extremely thin buccal plate that fractured during elevation of the buccal root tip, and a minor oroantral communication was noted on the palatal root. Upon cleaning the socket a third slim root was identified and I luxated the root and decided to graft the area and postpone implant placement after dealing with oroantral communication. I completed the procedure by placing a membrane over the graft and suturing the flap.  The final x-ray showed that the root tip of the disto-buccal root remained in the bone.  Due to time constraint and patient commitment to a family event, I couldn’t reopen the surgical site today to remove the root tip. The patient will be seen this coming Friday.  My questions are as follows:

1. Should I reopen and retrieve the root tip on the next visit and re-graft?
2. Should I leave the root tip and remove it at the time of implant placement?
3. Should leave the root tip in place and deal with complications if they arise?

I am sorry I couldn’t upload x-rays because they were sent in an incompatible format to my email

Your feedback would be most helpful and appreciated.  What do you recommend?

5 thoughts on “Retained root tip: Recommendations?

  1. Frank says:

    If it is the buccal root that was left in place you could acces it with a buccal flap at the moment of implant placement.
    It would be sad to reopen and regraft now.
    A CBCT will help you make that decision.
    Good luck!

  2. Doc says:

    I agree with Frank – a CBCT would be very useful in deciding on your next step. The only option I would not consider is option 3. Hindsight is 20/20 – taking a radiograph after a difficult extraction and before bone grafting could help for future cases. These bicuspids are super tricky because of their slim roots.

  3. Craig Wright says:

    Xrays would be helpful but I do have one comment for future bicuspid ext’s. I have started using a Benix extractor by Meissinger! It has been a savior in about 70% of my cases. It does not always work but when it does, my procedure is over quickly and will little collateral damage. I always attempt luxators and forceps first but resort to the Benix before I go to periotomes.

    • Segin Chandran Dr says:

      Warm regards
      Try root membrane technique to avoid such mishaps
      CBCT guided planned root resection and buccal shield maintains the thin buccal bone and protects the Implant
      Palatal cortex engages the Implant
      Try next time
      Literatures are freely available on web


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