Endo Treated Tooth with an Apical Cyst: Implant Placement?

Immediate probably not a good idea. CBCT is necessary to determine if there is enough bone apical to the socket to facilitate enough stability for the implant. With the size of the lucency my guess is there probably isn't enough bone before the floor of the nose. The implant will be pretty proclined as well once placed, would the patient tolerate ortho prior to placement?

As per radiograph showing cystic lesion wrt 21 and 22 area of tooth. you can go for CBCT to find out the offending tooth and the extent of lesion (it may have bone loss either in buccal side or palatal side). if lesion invlove only 21 then you open up flap elevation (to the side of bone loss either palatal or buccal),extract the tooth,thoroghly curratage the area,remove the cyst, scrap little bit healthy bone, place Implant, Place bone graft in the clean lesion, place GTR membrane and suture it. Give more healing time 6 to 9 month. after that you can think about prosthetic part. If 22 tooth also involve then you can perform root canal treatment on it.

What about attempting to treat the tooth ???

Dear Perio Master, How can you plan prosthetic after the implant has been placed and osseointegrated?

No one seems to be concerned that the apex of tooth 22 may also very well be in the cyst and, therefore, 22 may need an RCT also. AND, has everyone become so narrow-minded that they ONLY see implants? Step 1: Approach the case AS A WHOLE! Step 2: Do a CBCT and determine the status of 22 to establish if it needs RCT! Step 3: Consider an apicoectomy and restoration of existing root of 21, specially if the 22 also needs RCT. You can do the apicoectomy on both 21 and 22 at the same time (after you do the RCT on 22, naturally). Step 4: LEARN to be CONSERVATIVE! A natural root is still the best implant! There is NO reason a properly restored post/core/crown on 21 should not be viable, provided, of course, that the apico was properly done and is sucessful. Step 5: Learn to stop rushing just to please the patient! Placing an immediate implant at the time of extraction is generally contraindicated in the case of such a large cyst, as it can set the implant up for failure! If an implant is to be placed, it is much wiser to extract the21 root, currette the cyst completely, debride thoroughly, and allow the bone to fill in naturally, without placing any bone augmentation in the site of the cyst. Re-evaluate bone volume and implant size with a CBCT once healing has occured. Step 6: Advise the patient that, regardless of how you restore (conservative or impLant), his malocclusion (see the labial-version of 31-32 and 22) as well as his bruxism (clearly evidenced by the wear-facets) must be addressed. 22, 31 and 32 are all in traumatic occlusion! 31-32 likely contributed not only to the fracture of 21 but, quite possibly, to the formation of this cyst, specially if the RCT on 21 done 1.5 years ago was caused by direct blunt trauma. (Remember Step 1?) Step 7: Advise the patient that a PERFECT aesthetic result (and long term dental health) cannot be achieved without closing all the interdental spaces, either with porcelain laminates or crowns on all upper anteriors! Step 8 -- and the safest: refer the case out and get yourself some serious continuing education courses, or perhaps a residency, because it sure sounds like you need it! You have completely failed to diagnose this traumatic occlusion and bruxism, which unaddressed WILL lead to failure of this case, regardless of how you elect to treat it! Don't worry, you'll learn in time.