Tooth Fragments Left Behind After Extraction: Proper Protocol before Implant?

Dr. T. asks:
I extracted #3 [maxillary right first molar; 16] and intend to install an implant in the socket. It was a difficult extraction and I left several tooth fragments behind in the healed socket site. The fragments are close to the maxillary sinus. There are no radiolucent lesions or soft tissue swellings or sinus tracts. The site appears to have healed well with the tooth fragments embedded in healthy tissue. If I am going to install an implant in #3 area do I need to go in and remove the tooth fragments prior to or at the time of implant installation? Or should I just ignore the tooth fragments?

15 thoughts on “Tooth Fragments Left Behind After Extraction: Proper Protocol before Implant?

  1. peter fairbairn says:

    Just take them out whilst making the osteotomy , even if there may be no issues just messy for other dentists to see later and not difficult to do. You cannot afford to take the chance of leaving for merely a few minutes more work at the time of placement.

  2. SBoral surgeon says:

    What would you want done in your mouth?
    I’m pretty sure the answer would be
    “have someone with a lot of experience take the fragments out and place the implant”
    GP, OS, Perio- doesnt matter to me.
    It is difficult to remove root fragments through an implant osteotomy.
    It sounds easy, but trust me, it isn’t.
    First step is to be honest with the patient if you haven’t allready told them. The worst thing for you is if they end up someplace else and you have someone critiquing your work.

  3. Dr Chan says:

    Buried roots and tooth fragments don’t osseointegrate and a potential source of infection. You must remove them all. Try not to play Dodge ‘Em with the implant or leave things to chance. Refer or ask for help if necessary. Remove those fragments, graft and wait for healing before implant placement. Always do the right thing and you will sleep better. Good luck.

  4. gerald rudick says:

    I have personally addressed this problem to remove root fragments in a way not to damage the existing bone, not to risk drilling though vital structures or damaging adjacent teeth when using extra long high speed drills to cut around the root remnants, and to avoid the fracture of fragile bone with osseotomes.

    This is a very simple and inexpensive technique presented in tabletop format to meetings of the AAID ,ICOI and IAOI meetings during the last year, and it was well recieved.

    As this technique is in the process of being published, and tools are being developed to make it available in kit form, I am not at liberty to discuss it at present…..but it will definitely eliminate the problem of retained roots.

    Gerald Rudick Montreal

  5. Baker vinci says:

    I maybe waisting my time, because the last thousand words that I have written, have been rejected, but if you new this patient was going to need an implant at this sight, you should have done everything, within reason, to get the root tips out. Even if you had to “swallow ur pride” and send the patient, to an omfs, for completion of the extraction. This is why we graft. Bv

  6. Dr Samir Nayyar says:

    Root fragments should be removed before insertion of implant. If you don’t find good bone after removal of root fragments, then do bone grafting and wait for 6 months and then do implants.

    Best of luck

  7. Baker vinci says:

    Just to be fair, I had a lady with impacted #s 17, 18 and 19. With a cbct, it was obvious that a coronectomy was the safest way to treat the most deeply retained #18 molar and #19 was almost translucent . To avoid the enevitable paresthesia, all but the root apices were taken, at 18. The patient elected to have me leave those root tips. I thought I had removed everything else, to completion. I then grafted with autogenous, bmp, prp and a resorbable membrane. The post op ct showed some retained coronal parts of #19 and secondary to a small infection I went back in and was not able discern tooth from bone at 19 and left the linqual plate alone. A large piece of collagenous foreign body was removed and sent for path and the small purrulence was sent for micro. I’m hoping that the source of the problem was the vehicle, by which we place BMP. After irrigating the area with abx/rinse and packing the wound with clinda impregnated gauze, we regrafted, with banked bone and prp. She is seven days postop, with no symptoms and the gortex sutures will be removed in another week. Has anyone ever had issues with the, bmp carrier? Bv

    • Baker vinci says:

      Yes, I could recommend some articles, but unfortunately most are dated and have been appropriately refuted. As of now bmp, is just a big question mark and while I still use prp to improve the handleing of my autogenous grafts, the only real supportive science now, suggest prp’s only real effects, are associated with improving soft tissue correction . Bv

  8. Baker vinci says:

    There is also some recent literature that suggest grafting with prp, is helpful, if the area is slightly infected and you choose to proceed with the graft. I have personally seen this work, numerous times, but have no way of knowing what effect the prp had. It just worked out, for me and the patients. Bv

  9. Irbad Chowdhury DMD says:

    You can remove the root tip by creating a buccal window. This window will not effect your osteotomy. This is just an alternative since you seem adament about placing this implant. However, I agree with the majority. Remove the roots, graft and place 6 months later. Good luck!

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