Condition of Surrounding Bone
Careful examination of the periapical radiograph indicates the density of the bone surrounding the tooth to be extracted. Bone that is more radiolucent is likely to be less dense, which makes the extraction easier. On the other hand, if the bone appears to be radiographically opaque (indicating increased density) with evidence of condensing osteitis or other sclerosis like processes, it will be more difficult to extract.
The surrounding bone should also be examined carefully for evidence of apical pathology. Teeth that have nonvital pulps may have periapical radiolucencies that represent granulomas or cysts. It is important to be aware of the presence of such lesions, because they should be removed at the time of surgery (Fig. 7-16).