When a root tip has fracture, closed approaches of tooth removal have been unsuccessful, open approach maybe excessively traumatic, the surgeon may consider leaving the root in place. As with any surgical approach, the surgeon must balance the risk and benefit of surgery.In some situation removing small root tip may outweigh the benefits.
There are three conditions must exist for leaving root fragments:
1. The root fragment must be small in size, usually no more than 4 to 5 mm
2. The root must be deeply in embedded in bone (not superficial). This to prevent subsequent bone resorption from exposing tooth root and interfering prosthesis.
The surgeon should seriously consider leaving the root tip in place if:
Ø The risk must be considered to be greater than the benefit for leaving root fragments, like excessive destruction of surrounding tissue, excessive bone removal to reach root tip .
Ø The risk will endangers vital structures inferior alveolaris nerve, mental foramen or along the course of the canal.
Ø Root tip removal may result a permanent or a prolonged temporary anesthesia of the inferior alveolar nerve.
Ø If the risks overweigh the benefits,like root tooth which can displace into tissue spaces or maxillary sinus. (radiograph shows that the bone between sinus and teeth is thin) likewise, roots of the mandibular M2 and M3 can be displaced into the submandibular space.
The patient must be informed that leaving the root in its position will do less harm than surgery. In addition, the patient must be instructed to contact the surgeon if any problems developed and recalled for several periodic follow ups to track the fate of this root.
