Gutta percha apical socket: Remove gutta or Place shorter implant?

Last Updated: Apr 13, 2017

I have treatment planned a patient for an implant in #30 site to replace a mandibular first molar that I extracted because of failed root canal treatment and failed attempts at re-treatment. When I extracted the tooth, I placed a cortical bone graft. Four months later when the patient returned, I took a CBCT and noted fragments of gutta percha remaining in the cancellous bone from a prior gutta percha overfill. I had planned to place a 5×11.5mm implant. But if I do that, I will come into contact with the gutta percha fragments. Should I attempt to remove the gutta percha fragments at the time of the osteotomy? Should I use a shorter implant, like a 5x10mm? Or should I just go ahead and place the implant and just observe if there is a complication associated with the gutta percha fragments?

7 Comments on Gutta percha apical socket: Remove gutta or Place shorter implant?

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rsdds

04/18/2017

you will most likely drill it out . Watch out for concavity in the last xray study case well since you're placing a wide diameter implant.. good luck...

Bernie Gryfe

04/18/2017

I've placed implants in these area over the years and have never had a problem with interference in healing due to GP fragments.

Pankaj Narkhede

04/18/2017

Yes! You would probably drill it out. BUT, if you see any after the final drill you can certainly attempt to remove them - you are not very close to the nerve

Dr Al

04/18/2017

5x8 placed 1 mm sub crestal with conical connexion will do it

Francis

04/18/2017

You will drill it out while performing osteotomy. After osteotomy , take x ray and check if any left you may be able to excavate it manually prior to implant placement. Good luck

Mihai

04/19/2017

I had a simmilar situation, but was a root apex. I did the osteotomy, but it is difficil(or impossible) to see through a hole of 10/12 mm if there is any guta left. Do the osteotomy longer than the guta level, use long chiurette to clean the apex, have a sferical long bur if you need to clean extra the apex area, and make rx prior to implant placement.

SCMdds

04/19/2017

The distal piece of extruded material will not likely be in the osteotomy area for a centrally placed implant and if its near the apex area and distal, its hard to dig around and get it out. I always try to remove this debris if its practical but I've never had a problem during 25+ years when its left behind. A residual root fragment may be different.

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