Endodontic remnants are found more than other radiopacities in proposed implant sites

Abstract

Background: Foreign bodies may be a cause of concern in dental implant failure.

Purpose: The aim of the present study was to assess the occurrence and to evaluate the types of radiopacities in dental extraction sites using cone beam computed tomography (CBCT).

Materials and methods: The incidence, location, and types of radiopacities were evaluated in 180 CBCT scans.

Results: Different radiopaque structures could be noted in 84 scans. Foreign bodies and remaining roots were frequently seen. Most of the radiopacities were attributed to remaining endodontic filling in upper and lower jaws in 25 scans in different locations. Remaining roots could be detected in 20 scans. Focal and diffuse radiopaque bony lesions were observed in 16 scans. Tissue response in the form of radiolucency could be seen more with endodontic foreign bodies. Tissue reactions to radiopaque filling remnants were seen in 6.11% of cases.

Conclusions: Foreign body remnants, mostly of endodontic fillings, were frequently seen in CBCT in upper and lower jaws. Evidence of tissue reactions to extraction remnants could be found. Endodontic filling remnants could be seen more in the upper jaw. Thorough examination of implant site for the presence of endodontic foreign body remnants should be stressed. Debridement of the extraction socket should be done carefully in endodontically treated teeth.

Keywords: Cone beam computed tomography; Extraction socket healing; Foreign body; Overfilling; Radiopaque lesion; remaining root.

Fig. 1

Different forms of radiopacities related to extraction sites are seen in the following forms: a fractured piece of bone or remnants of tooth, b remnants of endodontic filling with or without bony tissue reactions fragments of bone, c pathological lesion, impacted, or supernumerary tooth, d fractured implant screw or fixation screws or plates, e focal or diffuse bony calcifications or related to resorptive reaction, f a nearby clasp of a removable prosthesis, rhinoliths in maxillary sinus, or a salivary gland stone

Fig. 2

Different forms of remnants of endodontic fillings radiopacities related to extraction sites: a small radiopacity deep in maxillary extraction sites, b radiopacities in mandibular extraction sites with or without evidence of tissue reaction, c remnants of filling radiopacities at the periphery of bone in maxilla and mandible, d radiopacities near implant sites in mandible and maxilla, e two radiopacities in the same extraction site, f more than 2 radiopacities in different sites or in the same extraction site

Fig. 3

Different radiopaque forms of endodontic filling remnants were frequently seen related to implant fixtures: a small radiopacities in maxillary extraction sites away from the implant fixture, b radiopacities in close proximity to implant fixture with no evidence of tissue reaction, c remnants of filling radiopacities at the periphery of bone near implant fixture

Fig. 4

Implant failure due to the presence of a radiopacity of endodontically treated remaining root with a fractured endodontic file. a The radiopacity deep in close proximity to the mandibular implant. b The radiopacity after removal of the implant with evidence of tissue reaction. c Radiographic examination of the removed remaining root with endodontic filling remnants and the broken file. d A photograph of the removed implant and the remaining root fragments. e Preparation of the site for a longer and wider new implant fixture. f The new fixture in place

Fig. 5

A case showing how to handle the problem of the presence of a radiopacity at the implant site. a Initial drilling showing the radiopacity near the small drill. b Preparation with a larger drill to include the site of the radiopacity. c The final drill is including the radiopacity site. d The implant fixture in place with no evidence for the presence of any radiopaque remnants