Root tip in the implantation site: recommendations?

IMHO the site is fully healed with no issues around the root fragment. I would treat this like a PET approach most likely drilling for the osteotomy will remove most of it and I would treat this like its not there and place your implant ideally

Plan your graft and implant with customary protocols and don't worry about the root fragment. It is a non issue.

Drs Hacker and Kurtzman are correct.

Thanks for all the answers. However, I am going to inform the patient about the X-ray findings and ask her for informed consent. Implant site preparation I plan to do with piezosurgical unit.

I recently have explanted failed implant, and the fixture was placed in exposed root. And it was functioned for 8 years before it lead to failure. Anyhow the point is, it lasted for 8 years even the adjacent root tip was exposed state intraorally. Professor Kim young kyun have published an article about implant survival rate of fixture adjacent to buried, and big root fragment. And overall long term survival rate was over 85%.... I need to find accurate stats, but the point is, I guess small tip does not make a big problem. Megagen even strated to offer root membrane kit. The kit preps and leaves labial part of intact root of Mx incisor part in order to use as 'shield' against labial bone resorption. In turn, buried root fragment rarely affects osteointegration. Just informed consent is good enough and lead to a favorable decision by telling long delay of treatment when you excavate trivial root tip.

Be sure they know that the root tip doesn't appear to have infection yet could. What is your plan for the hopless tooth ahead of the space?

While it should not be an issue I had 2 failures within the last couple of years occur adjacent to retained asymtomatic root tips. Because of this I am now of the mind set that they should be removed. Usually they can be removed as the osteotomy is prepared

Anything that can sit up against an implant surface that is not bone, a small airspace or graft should be removed. If you grind up the root during the osteotomy no problem, otherwise watch for it's position during surgery and if necessary, remove it ( curette ) if you can reach it.

In my work I always suppose the worst, as being asymtomatic doesn't exclude problems. So I recommend you to do surgical removal of the RR through a lateral window followed by drilling the implant osteotomy then graft the lateral window. Good Luck

Place your implant as usual , and do not pay any attention to the root , as if it is not there , provided that there is no pathosis . Drilling can remove most of the root also .

Piezo surgery sounds interesting as it would be a safer approach. Using conventional burs could project the root tip into the IAN canal or lingual space during drilling sequence. If any fragment remains after implant preparation, it could be forced apically into the IAN canal during final toquing of the implant.

I think that no problem for implant beacouse no infection in site and root is very particul

I totally agree with dr kurtzman..