Teeth with curved, fused, or brittle roots often fracture during extraction attempts, especially in posterior or endodontically treated teeth.

Incomplete removal may lead to root tip retention, infection, or sinus communication.

Referral is indicated when:

- Tooth fracture occurs and the remaining root cannot be accessed easily.

- There is suspicion of sinus perforation or proximity to anatomical structures.

- Surgical access is limited due to restricted mouth opening or dense bone.

Oral and maxillofacial surgeons use specialised elevators, bone windows, and sectioning techniques to ensure complete, atraumatic removal.

CBCT can confirm root position, while sterile protocols reduce post-operative complications.

When to refer: Any failed extraction attempt, visible root fragment on OPG, or upper molar close to the sinus floor.