Retained Root Tip: Should I Expect Complications?
Dr. M. from Ontario asks:
I treatment planned a patient for a wide platform dental implant in the mandible to replace a second molar. Near the projected implant site, there was a 3mm long root tip left from a prior extraction I did 3 months prior. The area has been asymptomatic and the radiographic appearance is of an isolated root tip without any evidence of a radiolucent lesion or other pathology.
It appears as though the channel I prepared for the implant is a bit closer than I wanted to the root tip and the dental implant is close to the root tip. Should I expect complications? If the root tip had not been so deep and so close to the Inferior Alveolar Nerve I would have attempted to remove it but the risks seemed far more weighty than the benefits. What are your thoughts?
16 Comments on Retained Root Tip: Should I Expect Complications?
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Dr Ziv Mazor
8/22/2007
If the root is asymptomatic I think it can stay like that indefinately.Do not expect to have cementum creeping on the Implant...
Anyhow there is no reason to digout the root tip and cause potential problems.
Dr.Ralph Mosery
8/22/2007
That root tip although "asymptomatic" should have been addressed by the oral sutgeon 3 months ago.If the OS determined not to retrieve then fine(I doubt it). NOW 3 months later you decide to place an implant near this and you're wondering? Get the pt to the oral surgeon to remove the root tip.By the way did you advise pt that you left this root tip in at the time of the extraction? You were required to do so.
Ivan berger
8/22/2007
Would have been best to refer patient to an oral surgeon for root tip removal prior to placement of implant. Have potential problem if root tip becomes symptomatic. Your extraction completed only 3 months ago and have risk factor of becoming nidus for infection.
Alan Romano
8/23/2007
Most likely you won't have any complications but let your patient be aware of it...
Dr. Bill Woods
8/23/2007
My thoughts are that if anything happens to the implant, you are going to have an inplant/root tip/IAN problem all-in-one in a major way. If you stay 2mm away from the tip, then you may be too short to place an implant worth anything. Personally, I think I would get that tip out first. IAN or not. You can certainly get a CT and find out where the tip is in relation to the canal. If you place an implant next to the tip, you can expect no integration there. I personally bank roots to preserve bone and get full tissue coverage for primary closure later (its a free St graft!), but thats not with an inplant there yet. Get the tip out before placement. Its just the thing to do. JMHO. Bill
Salah Abd El Fattah
8/24/2007
leaving root tip close to implant may lead to failure and it happened to me.I encountered two more cases with remaining root tip at sites I am going to insert implants.I managed these cases by doing the osteotomy for implant as usual then I removed the root tips through the osteotomy hole and then inserted the implant
Dr. Posada
8/25/2007
Once I had the experience where extracting the root apical portion, for it's position and morphology, required an extense oeteotomy that could compromise the bucal plate. I decided to refer to the endodontist who in a first procedure repeat the endo treatment of the remanent portion. After a few weeks, I placed a Biohorizons 15mm implant which apex contact the root tip. That was about a year ago, and right now the implant is loaded and fully integrated.
Dr. Bill Woods
8/25/2007
Why place an implant here anyway?
Laurie
8/26/2007
If the implant contacted the root tip you will definately lose the bone on that aspect of the implant and most likely the implant. I have seen too many of these as second opinions. It usually takes 1 year to surface, so moniter this one carefully.
Kelly
11/30/2007
A week ago I had a molar extracted. The dentist thought I only had one root. I was seen today, because I have some minor aching....the only discomfort I have had after the extraction. After x-rays today, it was realized that I had a total of three roots. Two roots were left behind. Do these roots need to be removed? If they do need to be removed, what is the procedure? Will this be more painful?
ellen
9/26/2008
i recently had a root tip removed and had an absess with it --ive been on 3 different antibiotics since 9-11-08 and im still not getting any better--ive had everything from a sore throat,lost my voice to haveing the sniffles and now a cough from that, i wa sfine before, any suggestions on what to do next???
R. Hughes
9/27/2008
Dear Ellen, This sounds like you mostlikely had a concomitant resoitatory infection. I had the same thing about the same time as you, but without the root tip removal and abscess. A goodly number of my patients had similar respiratory symptoms.
Kat
10/9/2010
Have you seen the new Root Tip Remover by InventDent.com? This is a new instrument to the market, and it will remove broken off root tips in 2 minutes without removing any of the surrounding bone. You will be able to leave the ridge completely in tact. It's great when placing an implant because the healing response is more predictable. You will no longer be forced to leave those root tips behind.
franky
10/11/2010
Ellen
if the extractionsite has no healed in now 2 month your dr. must take a biopsy with a culture and senstivity test
William
1/25/2011
I reviewed the InventDent root tip remover. It's getting a lot of buzz in our office and in Southern California. I think their website is inventdent.com. What puzzles me is why this product was not available sooner. More than anything quick removal of root tips without cutting the jaw bone should have been this easy long before now. It appears that the reports of this product are sound. I notice Kat above agrees.
Stupid Marketting
11/1/2011
To Kat and William who are clearly just a dude trying to get some shoddy product placement, dentists have been doing this for year. It's called an H-file, and it doesn't cost $250 USD.
