Asymptomatic root tip in implant site: options?

I'm planning this case. There is residual, asymptomatic root tip in implant site. I see three options: Removing the root tip. But, that seems very invasive. Do the osteotomy thru root tip, Position implant 6-7 mm to the adjacent tooth - may have bad crown profile, possible food trap. I see some case reports with implants that are positioned through left root fragments, the condition is fragment to be immobile and no sign of inflammation. Interested to hear you thoughts, and practical experience in such cases Best regards

Matt DMD comments:

Make a guide that will precisely drill out the root, then if you like that position for your implant place it, if not bone graft and go back later. I have placed implants close to old root fragments but in your case the mesial cantilever effect could be too much for comfort

Dr Saad Yasin MSc comments:

Remove the root tip It might cause infection later on Accordi g to Dr Resnik advise

Andy K comments:

Don’t wake up a sleeping Lion. Don’t forget the mental nerve nearby. You have plenty bone to angle the implant or implants. Short implants (Bicon or and 5/6 mm height implants) are the better option for molar area. I would take a good 3D CT Scan and if there is no sign of infection around root tip, I will place implant 2/3mm away from it. Angle abutment will eliminate the food trap. If you do this case without 3D CT Scan, it’s substandard treatment, IMHO.

Jeffrey Brook comments:

I feel you need to remove the root tip. This doesn't appear to be an emergency situation that necessitates a compromise which would justify placing an implant in a less than ideal position. Get whatever scans you need. Graft the area. If you are worried about the mental foramen, refer that part of the case to someone who can extract the root tip safely. Place the implant as you would want it placed in your mouth. At the end of the case, you want the implant-supported crown to be as close to what the natural tooth should be as possible. I always try to remember that I will not be the last dentist to look at this case, and I want the next guy to say "Nice implant" rather than, "Why did he or she leave the root tip?"

Carlo Coiana Italy comments:

I wouldn’t be so scared in placing the implant in the ideal position even if the root remnant will be touched since the fragment appears well integrated in the bone. The dentine is also used as the best natural regenerative material and very similar to dense bone. The literature support this approach (Pohl JOMI 2017, Schwarz JCP 2018, Mazor IJPRD 2019, Amato IJPRD 2019

Greg Kammeyer, DDS, MS comments:

Remove the root tip if you feel confident. I suspect you are worried about it, and if so, a referral is in order. Personally, I would do it as a combined procedure, buccal approach for the root tip and remove some bone around it, as in my experience that bone will be mushy. and not healthy bone. Good luck.

Andreas DDS CY comments:

Do not take the risk. Remove the tip.

Richard Waghalter, DDS comments:

My experience tells me that a long standing root tip without any radiolucency will remain dormant if not disturbed. In other words, stay away from it. Ideally the new implant would not violate that premise if it were placed directly under the opposing palatal cusp. Another option: Place the center of the implant 15mm away from the distal marginal ridge of lower bicuspid and make a three unit bridge from natural tooth to the implant. Yes some will say 'No" because the bridge will eventually fail because implant and natural teeth react differently to occlusal forces. The implant will not drift and create an open contact in this situation. The need for meticulous occlusal adjust and correct cusp/fossa placement will extend the life of the bridge even if the patient is a bruxer. This will not be true if immediate cuspid rise is not established.