Mesial Root of #30 is Retained and in the way of Osteotomy: Any Suggestions?
Dr. A asks:
I’m a board certified periodontist with extensive implant experience. I received a case from a GP recently that has me perplexed and would like to share it with you. The GP extracted #30 three months ago and sent me the patient for an implant consult. When I first saw the ridge in #30 I was very glad, it is one of the widest ridges I have seen. In fact I wanted to do this flapless. However when I looked at the radiograph I noticed the mesial root of #30 is retained (about one third of it) and it is directly in the way of my potential osteotomy. I thought about drilling through the root and trying to obliterate it but I’m not sure I can drill the whole root out. Does anyone have any ideas/suggestions? Thanks.
6 Comments on Mesial Root of #30 is Retained and in the way of Osteotomy: Any Suggestions?
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Sb oms
12/13/2010
Okay, this is simple, especially for an experienced periodontist.
Raise flap
Remove root fragment
If possible, place implant
If implant not possible, graft
Suture flap and return in 3-4 months to place implant.
This is basic.
It sounds to me like the problem you are having is telling the patient that the piece of tooth will delay things, and possibly add another surgery.
Do not "drill out piece with implant drills" while placing implant. This is a blind procedure and could seed bacteria. In addition, you are turning something really simple into a stressful procedure with a lower procedure rate. Yes you can get away with it sometimes, but it could come back and haunt you.
Be honest with your patient and make things easy and predictable for yourself, while protecting your referral at the same time. Have you told the referral about the fragment.? He will probably be thankful that you are fixing his over site.
TOBooth
12/14/2010
Hi,
piezo the root out and augment wait 6/12 then implant
V.Assadi
12/14/2010
Dear colleague
You've better take that fragment out surgically (which is described by sb oms precisely). After that, you must currette the socket carefully, rinse it copiously, and use widest fixture possible (eg. Bicon) trying to strart at a more distal point (put your pilot drill in the place where distal root was). I am almost sure you would have a very good primary stability. Graft the socket using valuable huge amount of bone you can harvest (if you used Bicon), place mambrane and suture it.
truly yours
Robert Horowitz
12/15/2010
You have a few choices. If you want to place an implant, you can either avoid the root (need a cone beam scan to verify), remove the root, or if there's no pathology, drill up to and/or through it. You can look in the literature and Dr. Serge Smuckler-Moncler (and others) have published an article on that subject. I know the concept seems a bit far-fetched, but I have 2 implants placed in contact with retained roots and/or teeth. One has been in function for over a year, the other has not been loaded as of this time.
Tooraj
12/15/2010
If there is no periapical pathology just drill it out and place your implant .
Wish you all the best
Paul
12/21/2010
Agree with the first response. I would not even consider leaving the root.
