In my practice, I frequently deal with challenging root tip retrievals when teeth fracture during extraction. It's inevitable if you're taking out teeth. I want to share my approach to managing these painful cases.
First, I recognize high risk extractions in advance based on the radiographs. Curved, dilacerated, or endodontically treated roots often break. Vertical fractures, decay to the bone level, missing PDL space, and apex shape can also foreshadow issues. Knowing the challenges ahead of time allows me to set proper patient expectations, assemble the right armamentarium upfront, and decide if I should refer the case out.
When issues do occur, I focus on creating space around the fragment by removing local bone or reducing the fragment size itself. Good initial tooth loosening helps. For big pieces, I first try straight elevators or use purchase points on the fragment to lift it out. Small tips often require round burs to create a slot I can spin against to retrieve it or endo files to snare it. If the piece is very small, I'm okay leaving it in place sometimes after ensuring it's disinfected and clearly documenting it for the patient.
Pushing fragments into nerves or the sinuses causes bigger issues, so it’s best to abort the procedure if complications ensue. The key is avoiding self-criticism, as we all deal with root tips. Learning creative solutions to remedy them is an important skill in our work removing teeth. I'm always interested in learning new techniques, so please email me if you have tips to share.

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