6-11 Removal and Implant placement, Temporization?

I would love to give you some ideas, but I need to see proper xrays and photos...please resubmit your post

Need a little more info as stated. I use Essix temps which work well, simple to make and are patient accepted without many complaints.

I tend to favor the cuspid/central positions. I would avoid a fixed immediate provisional as it increases the risk of implant failure: without anterior contact the posterior teeth have to take the forces of anterior guidance and lateral excursions. Yes, if you want to do implant treatment, PA's are well below the standard of care due to elongation or foreshortening of the image for implant length measurement. Arguably a CBCT is the diagnostic standard yet I believe most implants are still placed with a pano. I agree, an essix is an effective provisional. Have the lab make 2 as some people will chew them up and you don't want your patient breaking it during something important and not having a backup. Good luck.

Also the key to using this implant distribution, is that the strongest teeth you are replacing have implants at those sites. The challenge is getting a midline papilla. Keep the implants 4mm apart at the crest and avoid the nasopalatine foramen.

I think that I would not be wrong by saying that the guideline should be to place the largest implant both diameter wise and lengthwise keeping in mind the need to provide as much bone as possible on the labial and lingual. The amount of bone around the implant is in direct proportion to the successful retention of the implant long term. Every other analysis is secondary.

Looks like a straightforward immediate load implant case to me (depending on a few factors). We perform a lot of these cases each year in our practice with little complications. From the limited radiographs presented, (I can only see 8,9,10,11) my only concern is #11. #11 looks to me like it should stay right were it is. I would only extract it if it’s 100% necessary. Assuming great apical bone on 8 and 9, I would recommend extracting 8, 9, 10 and replacing only 8 and 9 with long and wide implants immediate loaded with cantilever for 10. Can’t comment on right side because I don’t see any radiographs for right side. Few cases can be performed without conescan, this is definitely not one of those cases. This is of course depending on bone quality, implant placement torque at time of surgery and if any bone defects. I would also recommend at least 3mm of distance between implants to maintain papilla integrity. Lots of bong grafting as well to maintain the emergence profile for 8, 9, 10. Also, make sure temp is out of occlusion (must have balanced posterior bilateral occlusion) and you lecture patient about chewing and hygiene. We usually tell all our patients no more sandwiches for a few months and fork and knife for all their meals. Cases like this are usually fun for us and the patient. They get to have a nice smile the same day and limited pain. The temp usually covers over the surgical sight and post op pain is limited. Keep us updated when you get the conescan. Best of luck.

Get a bite load capability, if its less than 150N then it may be safe to immediately load

Good idea to post proper xrays, so we can give you the proper advice

This is an age-old argument that CTs are/are not the standard of care. Believe me, go before a jury on a case without one and you wish you had one standard of care or not! I am amazed at how many times I take a CT scan on a seemingly routine implant to find aberrant nerves, blood vessels anomalies in the bone that impact my implant placement. Do NOT do an implant without a CBCT. Those of you that attend TDIC seminars on risk prevention can hear a well-renowned attorney Art Curley that states that CT scans are ABSOLUTELY standard of care in implant placement. I value Dr. Peter Moy's opinions he is an excellent clinician as we all know but he is not a lawyer!