Never begin an extraction relying purely on hope. Every pre-operative radiograph requires a systematic four-point audit:

• Root Morphology: Check for hypercementosis, bulbous dilacerations, and convergent vs. divergent root paths.

• Bone Density: Evaluate the ratio of cortical to trabecular bone. Dense, sclerotic bone in older patients eliminates natural socket expansion.

• Proximity to Vital Structures: Trace the inferior alveolar canal cortical boundary, the mental foramen, and the floor of the maxillary sinus.

• CBCT Threshold: If the root apex overlaps the superior border of the mandibular canal on a 2D periapical film with loss of the canal’s cortical line, stop. Order a focused small-volume CBCT scan before proceeding.