A retained root tip is an oral condition where the crown of the tooth is no longer present but the root tip remains in the jaw bone.
As you can see in the image above, a brown/yellow piece of a tooth is still embedded in the gums/jaw bone. Although you're probably most curious about whether you need to do anything about the retained root tip. Unfortunately the answer to that would be that it depends on your specific condition.
Table of contents:
Overview
A retained root tip is essentially a partial tooth that is still left behind in your jaw. Other descriptions for this condition would be a "residual root tip" or a "left behind root tip."
What it looks like:
The crown of the tooth is missing and no longer present in the mouth.
The root of the tooth is still embedded within the jaw bone.
If the retained root tip is close to the surface of the gums, you may be able to see it. What it would look like in this state would be similar to a broken down or rotten tooth. However, if the tip of the root is not close to the surface of the gums, you will not be able to visually see it. The only way to detect it would be with a dental x-ray.
The x-ray above shows a left over root tip of a molar after a tooth extraction. The location of it is deep within the jaw bone so the patient was not even aware that they had a retained root tip. However, it can be easily identified and detected on this periapical x-ray.
Causes
The four main causes of a retained root tip are:
Extraction complication
Coronectomy
Tooth decay
Tooth fracture
Extraction complication
One of the most common reasons to have a retained root tip is a result of a complication after a tooth extraction. As a matter of fact, studies have shown that this may happen in 11-37% of extractions which means it is fairly common.
It's not that your dentist is intentionally leaving the root tip behind but there are many situations where it is almost inevitable. There are certain risk factors which increases the possibility of this complication from occurring.
Risk factors:
Curved roots
Impacted teeth
Extremely long tooth roots
If you have any of the above risk factors, there is a good chance you may end up with a residual piece of your root still stuck in the jaw.
Coronectomy
A coronectomy is a surgical dental procedure where the crown is removed but the root tip is intentionally left behind. This is often done for impacted lower wisdom teeth which have a high risk for nerve injury if it was fully removed.
Drs Welch and Sweeney showcased this procedure with wonderful diagrams below.
The series of x-rays above show what the before and after of what a coronectomy looks like.
The main reasons for performing this procedure rather than taking the tooth out completely is due to potential for nerve injury. Sometimes the tooth could be too close to the inferior alveolar nerve and extracting it may result in permanent facial numbness.
Due to the risk involved, it is preferable to intentionally leave the tip of the root behind. Yes, it is a legitimate dental procedure.
Tooth decay
Untreated tooth decay can also result in a retained root tip in the mouth. Essentially the cavity will destroy the entire crown of the tooth thus leaving only the tip of the root behind.
This is a very gradual process where you may notice pieces of your decayed tooth slowly fall out over time. Eventually, the entire clinical crown is missing due to decay. Of crouse, this is considered late stage decay because this condition is very serious.
Tooth fracture
Unfortunately, if you happen to bite into hard food the wrong way, you can accidentally fracture the crown of the tooth resulting in a cracked tooth. Essentially the part above the gum line can be sheared off thus leaving a residual root tip behind in the gums.
The x-ray above shows a root canal tooth that broke off at the gum line. The crown is gone but the residual root tip with the root canal is still stuck in the gums.
This is a dental emergency and is often painful so most people don't leave this type of retained root tip in their mouth for long. Replacement for this situation would most likely be a dental implant.
Treatment
Depending on the etiology of the retained root tip in your jaw, treatment may or may not be required at all.
When treatment is necessary:
After a tooth fracture.
Decayed tooth.
Presence of dental abscess.
When treatment is unnecessary:
After a coronectomy.
Curved roots where full removal may cause more harm.
If treatment is necessary, your dentist would be left with no choice but to go back into the jaw bone and attempt to extract the residual tooth root. They may need to open up the gums and drill through bone in order to reach it. Yes, it will be a very involved surgical procedure.
Alternatively, if it is asymptomatic, sometimes your dentist can leave the tip of the root alone. Gradually over time, the root tip may erupt on its own until it gets to the surface of the gums. If this happens, it will be a lot easier for your dentist to remove it at that time.
What should I do?
If you have a retained root tip in your mouth you need to decide what you want to do with it. You must take into account the cause for it and whether or not you're having pain or infection.
Below is a simple decision tree to help guide you along the process as to what you may expect for it.
Nonetheless, we highly recommend scheduling a consultation with your dentist so that they can take the appropriate dental radiographs along with performing a clinical assessment. That is the only way to have a complete picture of your condition.
Until you do that, everything is just a "good guess." So what are you waiting for? Go schedule that appointment already. Our dentists in Long Island City can remove residual root tips near the surface!
