Implant Case: Radiolucent Halo around a Central Radioopaque Core

most likely a root fragment with sub-acute / chronic infection. there is clearly an osteo-lytic process here. 9.5 times out 10 this is a retained root fragment. This should be opened, cleaned, grafted, and allowed to heal prior to implant placement. any tissue should be submitted for pathologic analysis just to be on the safe side.

DEAR DR S From my experience the image upabouve is a fragment of root that was left without knolege there.The reaction of organism was a cronical one-therefore the ostoblasts put some "new bone" around First ,before the implant -make a flap and take the rood out Thank you

Most likely its a fragment of tooth, calculus or such that got trapped in the extraction socket and the site healed around it. Would suggest using a trephine to prep the site to remove the item then continue with implant drills, currette out the area then place the implant should be fine

It's Should be Apex of the root as a Sb oms mentioned. Because socket of the root it's get closed, so apex would be 2 mil or less with no infection. However, if you are going to place an implant, you should place wide diameter implant than defect area,apex root and defect will be osteotom while you placing an implant with no proablem.Remember radiolucent is not infected. Good Luck to you. Dr. Vaziri from Tehran Iran

I am in agreement with SB. This person had the extraction 6 years ago, waiting 3-6 months to place an implant is a lower risk than immediate placement. I like low risk. Clean it out, let it heal, then implant.

I think because there is potentionally effect of osteolytic cells in the region , you need before putting implant , remove the lusent region .

Root fragment. Extract, graft and then place implant after 4-6 months

Most probably remaining tooth fragment.My choice of treatment would be to remove and decontaminate with laser, wait 2-3 months for bone growth(without graft) then place implant.

I would be prepared to bet you're all wrong. Doesn't look like a piece of tooth root to me. Mark you I have no idea what it is! It would be fascinating to see a sectional CT of this area of the jaw.

I am according with john. I think it is a post extraction residual graft well incorporated. for an implant execution it is clear that this cistic graft must be removed. well it is only a good hipothesis.

it not look like a tooth fragment, it could be a residual cyst,its better to to curation&removal of the cyst& make sure there is no resident of it then start to do the steps of making fixed replacement,which start s by put a bone graft on the affected site after complete healing then put the implant.

what ever it is remaining root or other , it should be cureted and augmented , 4 month later implant drilling i think this is better.

It is obviously an UHO.... an Unidentified Haloed Object... and therefore must be treated with respect. It can be anything, ranging from an artifact to a tumour. Medical and dental history followed by a CBVT scan should make things clearer. Finally, the only sure way to identify it is via histopathology. A biopsy is essential. Everything else is guesswork, no matter how educated. I would do an osteotomy for a large diameter implant, curette the bottom, take an xray and if clear, place the implant and close up. If there is any doubt, I would wait for the histopath report first.

Definitely not a tooth root as the trabeculae are too evident.Probably nothing more than an area of reactive osteosclerosis caused by the tooth that was there originally. Do you have access to the pre-extraction xray? The so-called 'halo' is likely nothing more than an area of less mineralised bone made more apparent by a superbly contrasted radiograph.

The image does appear to have trabeculae, so it might be sclerotic bone. Nevertheless, if you look at the roots of the adjacent molar, they also seem to have the trabeculated pattern on them, so the image could also be a root fragment or apex that was left behind after the extraction. Either way, an exploratory surgery and biopsy of this lesion is the responsible way to deal with this case, because it could very well be a tumor. After the clinical or histopathological diagnosis, restorative and surgical plans can be drawn.

This is the image you get with foreign body encapsulation in bone. I don't think it is a root tip. The radioopaque mass has a granular pattern of higher density surrounded by a halo of lower density. This is an image you see when areas are grafted with material containing either human or animal proteins. The bone mineralizes the foreign proteins and shuts down metabolism in order to isolate the foreign proteins but the area surrounding the mass is poorly mineralized and highly vascularized. I would take a buccal lateral approach to remove the mass and curette the lesion. I would place the implant at the same time and graft the site. Be cautious when removing the poorly mineralized bone in order to stop before you reach the nerve. I would advise mixing Regen Biocement with a resorbable beta tricalcium phosphate granules in order to ensure integration at the graft site. If you want place the tissue in a biopsy bottle we will do the histology send you a photomicrograph of the tissue for you to do a follow-up post and diagnosis. If it is anything other than a foreign body reaction I will have it reviewed by a pathologist. Greg Steiner Steiner Laboratories.

Ithink that this region was cronic cyst and the bone around it cortical bone wall to protect the jaw from extending the leasion then after extraction the healing start in region and start replacement by trabicular bone so i think that u can put implant in this site without any complication beacuse u have normal bone

I think its not rootpiece,probably encapsulated graft or bony spicule,segmental CT scan of that area is required theorotically,or sraight away procede for implant oseotomy,at the time of drilling explore that area if required currate and place graft along with implant

i think its a root piece a very small and the reaction has been chronic one so there is some osteoblastic activity around it.. if u r plannin for implants then go ahead with ur drilling with good trephine irrigation and when u reach the depth of this lesion try doing a good curetage and achive desired depth and place ur implants.. i think it should be fine..