The patient came in for implants 19, 30. Had both extracted a year ago and the dentist who did it said exts went well and packed bone, but these look like retained roots to me?.

How would you approach this?

1- Extract and wait on healing

2-Buccal treph, elevate roots out and then drop immediate implant and bone? or

3- Do osteotomy through and leave roots to preserve bone?

4- Any other options?

Patient is 20 Y O and healthy.

So there’s a couple things to think of when going through those options that you listed.

1. Extract and wait on healing — if you decide to go for this option, I would bone graft at the time of extraction. Try to visualize how much bone you have to take away and where.

2. Buccal treph, elevate roots out, immediate, and bone. — I try to do everything I can to preserve the buccal plate. Yes, there are situations where it becomes compromised, but if I can choose other treatment options where I don’t have to compromise that plate, I try to do so.

As for the rest of this option, this would actually be my primary choice. It’s a little tough to tell exactly from the screenshots you included, but it looks like the septum between the fragments is in good shape, with thin retained roots on either side.

In that case, you can get those roots out (you’ll only really be drilling exactly where they are, great thing about CBCTs!) and then place an implant which will be almost totally encased in bone in the septum area. Then you can graft any gap and your implant is on its way to a successful outcome!

3. Do osteotome through and leave roots — I don’t like to do this because I want to create the best top notch site for my implants. The last thing you want to do is place the implant, and then have some complication with the root contact and need to go to additional steps.

Just to provide some interesting context to option 3, I would like to drop a couple of articles that discuss placing implants into or near retained roots.