This study seeks to assess the clinical, radiographic, and patient-reported outcomes of root amputation versus implant over a 12 months period, generating robust evidence to guide clinical decision-making and enhance patient care.

This trial aims to compare periodontal stability, functional outcomes, complications, and patient-reported satisfaction of root amputation versus extraction followed by implant-supported single-tooth restoration. Twenty- eight patients (14 per arm) aged 20-50 with Maxillary first or second molars exhibiting Grade II-III furcation, adequate adjacent bone, and good oral hygiene will be enrolled; exclusions include uncontrolled systemic disease, heavy smoking. Participants will be randomized 1:1 Group A will receive endodontic therapy as indicated, surgical root amputation, while Group B will undergo extraction, and implant placement per standard protocols, and implant crowns. The primary outcome is survival at 12 months; secondary outcomes , clinical attachment level, radiographic bone level, peri-implant/peri-root and prosthetic complications, masticatory function, with clinical and standardized radiographic assessments at 1,3, 6 and 12 months. Data will be statistically analyzed using appropriate tests with significance set at p ≤ 0.05.

Inclusion Criteria:

• Patients will be illegible for root amputation if they one or more of the following criteria:
• Severe vertical bone loss affecting only Mesio-buccal root of Maxillary molar.
• Through-and-through furcation involvement
• Vertical root fracture confined to a Mesio-buccal root of Maxillary molar.
• Extensive root caries affecting Mesio-buccal root of Maxillary molar.
• Endodontic failure or non- treatable perforation in Mesio-buccal root of Maxillary molar
• Extensive internal or external non- treatable root resorption related to Mesio-buccal root of Maxillary molar.
• Patients who do not meet the above criteria and present with Maxillary molars in more severely compromised conditions will be directed for extraction followed by dental implant placement.

Exclusion Criteria:

• - Uncontrolled systemic disease, immunosuppression, recent bisphosphonate use, head and neck radiotherapy.
• Patient non-compliance or poor oral hygiene.
• Heavy smoking or inability to commit to maintenance.
• Root anatomy or interradicular bone that precludes predictable root amputation; insufficient bone for implant placement that cannot be reasonably augmented.