Gutta-percha piece present: can I do an Implant?

This 30-year old patient came to our clinic with the missing 11 (Rt upper central Incisor). The tooth was extracted about a year ago. On examination, I can see what seems to be a piece of gutta-percha(2mm) in that region. There is no infection or radiolucency in that region. Patient does not have any problems either in that region. If I have to do implant should I remove the gutta-percha and wait for 3 months or with the drilling (implant drilling) will the gutta-percha come out? Any other thoughts on how to proceed in this case?

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15 thoughts on “Gutta-percha piece present: can I do an Implant?

  1. It would be best to remove the GP at osteotomy time with a facial fenestration type access. Use measurements taken from the CBCT for an exact access. If you leave the GP there is a risk for bacterial colonization of the implant surface. Do not risk a failure.
    Dennis Flanagan DDS MSc

  2. The gutta percha is inert and if there is no infection associated with the material then you can just proceed as if it was not there.

  3. There is a significant chance that when you drill the implant site you will drill directly into the gutta percha and in doing so it will be removed. Trying to remove it surgically through the buccal plate may cause a bigger problem then a small amount of an inert material.

  4. Don’t wake up sleeping lion. Just treat normally as if there is no gutta percha. Nice landmark to notify you when to stop / continue drilling.

  5. It is difficult to give an opinion on a situation when a lot of important information is missing……why did tooth #11 fail following endodontic treatment and have to be extracted?
    If the extraction was necessary because of a failed endo treatment…then possibly there is bacterial contamination which could affect the outcome of the implant placement. Was the tooth extracted because of a root fracture…which would have almost certainly created a bacterial invasion…….
    It would probably be best to remove the gutta percha….. since an osteotomy has to be prepared, with careful monitoring of the depth being drilled…. it would probably be very simple to insert an extra long large diameter endodontic broach and snag the gutta percha……..come on guys…. this is easy stuff…… let the implant sit in a nice clean site, and it will be successful

  6. I placed an implant 3 years ago in a bony bed that had embedded pieces of amalgam that had been left when the tooth extracted. Pieces were positioned right in the middle of planned osteotomy. All pieces disappeared after osteotomy. Follow up shows normal functioning well integrated implant .

  7. looks like a root fragment to me,
    like the apical 2mm
    Anyone else see that?

    I would make my osteotomy palatal anyway-
    I think its okay to leave.
    watch while you drill, you may see it and be able to remove it

    i would not make a buccal fenestration-
    no infection present. no reason to create trauma

    1. Looks like a root tip may still remain. It is hard to tell with the added info over the image.
      It should not be difficult to remove when doing the osteotomy.

  8. In my opinion mostly the apex of the extracted tooth is very close to the buccal plate.
    If you drill far palatally you would be far enough and it won’t touch the implant.
    If duriring drilling you hit the remaining GP it would disappear.
    Try to place the implant in palatal direction and don’t worry since there’s no sign and symptoms anyway.
    Good luck.

  9. I’ve had similar and even worse bits of GP exactly in the ideal osteotomy site.
    One case, not dissimiliar to yours, I prepared the osteotomy as if nothing was there, took a PA after and found a clean bed so I placed the implant- excellent aesthetics and function 10 years later.

    DON’T go through the buccal plate!

    Finally, inform patient that they may have to have a delayed procedure if site doesn’t look too good- I’ve had to do this a couple of times and patients are ALWAYS grateful that you’re proceeding in a professional manner with their best interests in mind.

  10. I’d proceed as there’s no GP. There’s a great chance to GP comes out when drilling. Drill, irrigate and try to place your implant in palatal direction. Good luck!

  11. Mostly the GP will be removed during drilling sequence if not try to remove it in some cases it may cause infection in future dont risk the implant

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