Root tip in the implant’s path: what would you do?

Dear colleagues, this patient presented with a missing maxillary second premolar with a root tip at its apex.  If this were smaller, I would probably just plan on drilling through it. But it is fairly large and dislocated to the buccal side. Plus, if I extract the root tip, I guess there would be not a lot of bone  left apically to stabilize the implant. What would you do? Extract and graft?

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11 thoughts on “Root tip in the implant’s path: what would you do?

  1. play it safe ext and graft/ eval buccal plate/ wait 3mo and place implant. WHAT ABOUT THE FIRST MOLAR DOES IT REQUIRE ENDO? TAKE CARE OF IT BEFORE PUTTING IMPLANT AT RISK . IMHO

  2. The orientation for the implant to replace this tooth would be well to the palatal. It should be possible to generate the desired channel fairly easily. As the channel is expanded to the final dimension it will almost certainly loosen and dislodge the root fragment, so allowing it to be removed.

    If it does not loosen it, then it should be possible to make a small apical perforation in the labial bone plate and to lever the root tip down into the channel.

    Once the implant is placed, it would be necessary to augment the residual channel deficiency with a bone graft, preferably a slow resorbing one with collagen to ensure the labial wall does not collapse and to help the implant become osseo-integrated.

    Good luck !

  3. Attempt fixture placement and removal of root tip at same time w/ grafting (if stability can be attained).

  4. It would depend on how long the root tip has been there. If it’s been a few yrs, then i would just place an implant aiming slightly logically. If its been only a couple of yrs, either wait to see if it moves over time or take it out, graft it, and see where u get. Playing safe will be better and in my opinion, it’s NOT taking it out and grafting it. You are going to most likely destroy the buccal bone all together.

  5. Remove retained root tip through the implant osteotomy or create small buccal window at time of dental implant procedure. Place bone graft to restore void left from root extraction and use collagen membrane and/or PRF to inhibit soft tissue invagination if a buccal window was needed.

  6. Definitely remove the root tip prior to implant placement. Grafting will been needed, amount to be determined after root removed. Check #14 for vitality.

  7. Dear

    I will remove the root tip through buccal bone then implant replacement and grafting the deficit using bone graft and membrane.

    Take care for #16 badly decades may cause a problem later.

  8. I do not believe that implant drills can efficiently cut a ‘clean’ channel when there is a large root tip in the way. These are bone drills, not diamond drills ; they are designed to drill through bone. My estimate is that you can get drill transportation and too big an osteotomy .. don’t risk it. Remove too, graft,wait and go back and implant
    Cheers

  9. Good point, but drills are not the only way to generate an initial channel, this would be a good situation to start with ultrasonics. This could be used to loosen up the tooth tip, it’s only the final channel drill that counts for implant stability.

    This situation also calls for simultaneous augmentation using a slow resorbing bone graft. Being somewhat endangered “enhanced” bone grafting should also be considered using one of the bio-active modes now readily available

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