Root Fragment: Removal and Grafting of Defect

Case Presented By: Daniel Gober, DDS - Marine Park Periodontics and Implantology
A patient presented with a chief complaint of a bad taste and pain localized to the UR posterior area of her implant-supported prosthesis which was placed a few years ago.
Case Photos for Root Fragment: Removal and Grafting of Defect
Additional Details

A patient presented with a chief complaint of a bad taste and pain localized to the UR posterior area of her implant-supported prosthesis which was placed a few years ago. A periapical radiograph suggested the presence of a root fragment adjacent to implant # 5.

A palatal full thickness flap confirmed our suspicion. The root fragment was removed, the defect was degranulated, and the implant surface was decontaminated with a Nd:Yag laser. DALI cortical cancellous particulate bone 3 was grafted within the defect and around the implant surface and a Neomem Collagen Membrane 4 was positioned over the graft extending onto adjacent native bone. The flap was replaced with chromic gut sutures and the area will be monitored for resolution of symptoms and regeneration of the bone defect.

References

Implant Periapical Lesion: Clinical and Histological Analysis of Two Case Reports Carried Out with Two Different Approaches
Bioengineering (Basel, Switzerland). Volume: 9, Issue: 4, 2022 - Roberto Luongo , Fabio Faustini , Alessandro Vantaggiato , Giuseppe Bianco , Tonino Traini , Antonio Scarano , Eugenio Pedullà , Calogero Bugea
The apical portion of the fixture on the other hand was affected by an inflammatory process detectable on radiography as a radiolucent area. The presence of a probable root fragment, detectable as an imprecise radiopaque mass in the zone where the implant was later placed, confirms the probable bacterial etiology of this case of IPL. On the other hand, in case number 2, the presence of IPL around the fixture was solved by surgically removing the implant apical third as well as the adjacent tooth apex. It may be concluded from our histological examination that removal of the apical portion of the fixture should be considered an effective treatment for IPL since the remaining implant segment remains optimally osseointegrated and capable of continuing its function as a prosthetic abutment. Careful attention, however, is required at the implantation planning stage to identify in advance any sources of infection in the edentulous area of interest which might compromise the final outcome.
Simultaneous Retrieval of Root Fragment, Sinus Lifting With Particulated Bone Graft, and Immediate Dental Implant Insertion
The Journal of craniofacial surgery. Volume: 27, Issue: 3, 2016 - Muhammed Isa Kara , Saim Yanik , Fatih Sari , Seyfi Kelebek
The aim of these 3 patient reports is to demonstrate a new technique for the reconstruction of the posterior maxilla in patient of a displaced root fragment. The retrieval of root fragments, sinus floor augmentation procedures with a particulated graft, and an implant insertion were performed in the same operation.
Window Approach for Simultaneous Root Fragment Removal and Implant Placement: Two Case Reports
Clinical advances in periodontics. Volume: 12, Issue: 3, 2022 - Yi-Chu Wu , Gretel G Pellegrini , Leonard Garfinkel , Philip Kang
Through the buccal window, sufficient access was provided to remove RF atraumatically with maximal retention of surrounding bone that led to predictable implant placement.