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?

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

  1. 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…

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

  2. 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

  3. 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.

  4. 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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