The Case of the Missing Root Tip

The following Case Challenge is provided in conjunction with the American Academy of Oral and Maxillofacial Pathology.

This case challenge presents a patient with complications associated with the removal of a maxillary first molar. This image is one of two periapical radiographs taken at the patient’s post-surgical visit to the Department of Oral Radiology at the University of Lund, Sweden.

A 43-year old female had her left maxillary first molar removed by her dentist.  Upon examining the tooth following the extraction, he discovered the distobuccal root was fractured. Inspection of the extraction site revealed the missing root remained in its alveolus. When attempts were made to remove the root, it suddenly disappeared. To our knowledge, no further efforts were made to locate the root. In the ensuing weeks, the patient’s dentist inserted a three-unit bridge to fill the space created by the removal of the first molar.

Two months after the extraction, the patient was referred to the Department of Oral Radiology at the University of Lund, Sweden, with a request for help in locating the lost root.

After you have finished reviewing the available diagnostic information, make the diagnosis.