Tooth Fragments Left Behind After Extraction: Proper Protocol before Implant?

Just take them out whilst making the osteotomy , even if there may be no issues just messy for other dentists to see later and not difficult to do. You cannot afford to take the chance of leaving for merely a few minutes more work at the time of placement. Peter

Why did you leave them behind in the first place? Are you new?

What would you want done in your mouth? I'm pretty sure the answer would be "have someone with a lot of experience take the fragments out and place the implant" GP, OS, Perio- doesnt matter to me. It is difficult to remove root fragments through an implant osteotomy. It sounds easy, but trust me, it isn't. First step is to be honest with the patient if you haven't allready told them. The worst thing for you is if they end up someplace else and you have someone critiquing your work.

Buried roots and tooth fragments don't osseointegrate and a potential source of infection. You must remove them all. Try not to play Dodge 'Em with the implant or leave things to chance. Refer or ask for help if necessary. Remove those fragments, graft and wait for healing before implant placement. Always do the right thing and you will sleep better. Good luck.

No real options here. Remove and place the implant. if not possible, graft nad at a later date place the implant. luck

I have personally addressed this problem to remove root fragments in a way not to damage the existing bone, not to risk drilling though vital structures or damaging adjacent teeth when using extra long high speed drills to cut around the root remnants, and to avoid the fracture of fragile bone with osseotomes. This is a very simple and inexpensive technique presented in tabletop format to meetings of the AAID ,ICOI and IAOI meetings during the last year, and it was well recieved. As this technique is in the process of being published, and tools are being developed to make it available in kit form, I am not at liberty to discuss it at present.....but it will definitely eliminate the problem of retained roots. Gerald Rudick Montreal

Elevate the root tips with a root tip pick or periotombe. If this fails you can use a #4 round surgical length bur in an Impact Air handpiece to destroy the tooth fragment with minimal bone loss.

Remove the root tips first, then treat as needed. Do not make this harder than what it has to be!

I maybe waisting my time, because the last thousand words that I have written, have been rejected, but if you new this patient was going to need an implant at this sight, you should have done everything, within reason, to get the root tips out. Even if you had to "swallow ur pride" and send the patient, to an omfs, for completion of the extraction. This is why we graft. Bv

Hello Root fragments should be removed before insertion of implant. If you don't find good bone after removal of root fragments, then do bone grafting and wait for 6 months and then do implants. Best of luck

Just to be fair, I had a lady with impacted #s 17, 18 and 19. With a cbct, it was obvious that a coronectomy was the safest way to treat the most deeply retained #18 molar and #19 was almost translucent . To avoid the enevitable paresthesia, all but the root apices were taken, at 18. The patient elected to have me leave those root tips. I thought I had removed everything else, to completion. I then grafted with autogenous, bmp, prp and a resorbable membrane. The post op ct showed some retained coronal parts of #19 and secondary to a small infection I went back in and was not able discern tooth from bone at 19 and left the linqual plate alone. A large piece of collagenous foreign body was removed and sent for path and the small purrulence was sent for micro. I'm hoping that the source of the problem was the vehicle, by which we place BMP. After irrigating the area with abx/rinse and packing the wound with clinda impregnated gauze, we regrafted, with banked bone and prp. She is seven days postop, with no symptoms and the gortex sutures will be removed in another week. Has anyone ever had issues with the, bmp carrier? Bv

could you please recommend some articles out of Gothenburg which endorse PRP, BMP's, ect. ?

There is also some recent literature that suggest grafting with prp, is helpful, if the area is slightly infected and you choose to proceed with the graft. I have personally seen this work, numerous times, but have no way of knowing what effect the prp had. It just worked out, for me and the patients. Bv

You can remove the root tip by creating a buccal window. This window will not effect your osteotomy. This is just an alternative since you seem adament about placing this implant. However, I agree with the majority. Remove the roots, graft and place 6 months later. Good luck!