Removing a Retained Root: Technique and Procedure?

This patient presents to your office asking to replace missing teeth # 12-14 with dental implants. During your pre-surgical evaluation, you observe the presence of a (relatively large) retained root in site #12. A CBCT was taken to identify its location relative to the buccal plate.

What surgical technique will you employ to access and remove the retained root? What, if any, regenerative procedures would you perform after the fact? In the event that your plan was executed to perfection, would you consider placing an immediate implant at the time of root retrieval?

Look forward to hearing everyone’s input!

Removing a Retained Root: Technique and Procedure? 1

Removing a Retained Root: Technique and Procedure? 2

Removing a Retained Root: Technique and Procedure? 3

gregkammeyer comments:

Given the very low bone density and the position of the root/calcification, I would prep the osteotomy and curette the remaining segment out.

jramos comments:

When preparing the ostetomy for the implant , the root will be removed during your drilling . You have a ample B-P width . No second surgery is needed . There is no signs of infection .

mccavity comments:

When we first started out the thinking was to remove any potential issues (clear site) then Dr Howard Gluckman etc recommended exactly this - no pathology retain root rests and preserve

drdangober comments:

This is an interesting side discussion. It is true that retained roots or root fragments are not necessarily going to cause pathology- we have all seen retained pieces of roots that are surrounded by healthy mineralized bone and the "socket shield" technique described by Hurzeler ( relies on the fact that the root will not be a source of pathology. But as a methodology I would tend to err on the side of caution and want all pieces of roots removed. Especially in a case like this where the CT scan indicates low-density bone around the root fragment. I would expect there to be granulomatous tissue surrounding the piece of root which I would definitely want out of the implant site.

period comments:

I agree, I would try to do this in a single surgical step removing the retained root through the osteotomy for #12 implant. In low density bone such as this I have no hesitation to place mineralized allograft lining the inside of the osteotomy and then place the implant possibly achieving greater rotational implant stability.

drdangober comments:

It is interesting that most of you opted for retrieving (or obliterating) the root through the osteotomy. That is not an approach that I tend to use. This is a sizable piece of root so it is not so likely that your drilling will necessarily obliterate it. Also, even if your drill does somehow manage to get right to that spot, I am not comfortable with the idea of crushing root fragments and sending them all over the osteotomy that I am placing my implant in. I tend to approach these types of cases differently.