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

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

  1. rsdds says:

    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…

    (0)
    • Bernie Gryfe says:

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

      (0)
  2. Francis says:

    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

    (0)
  3. Mihai says:

    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.

    (0)
  4. SCMdds says:

    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.

    (0)

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