Implant 46 with GBR: Recommendations?

Just by the fact that you have given us a CTCone Beam scan to look at, shows that you are a very consciensceous dentist....... and that being said, when you are going to build a beautiful house, I am sure you would want a good lot with proper drainage in order to place a solid foundation.......implant dentistry is no different. .... first correct the problems with the land, before you start to build. If you start this way, you will encounter unnecessary problems....... the materials that you mention for GBR are excellent, now either use tenting screws and a membrane, or my choice would be a saddle shaped titanium mesh sitting over the ridge, with the grafting particulate underneath....give it 5-6 months to develop and mineralize, and then place the implant...you will have a very nice house....with good drainage!! The crown will sit in a nice and healthy environment.

Agree with Dr. Rudick above 100%. The topography of residual bone currently is too concave and you may be compromising the prosthetic result of the crown if you place the implant and do concurrent GBR. I think Tooth 4.6 was lost after a prolonged chronic infection, hence the major defect. At the very least, the Crown: Implant ratio may be skewed and/or a food trap will exist mesial and distal to the implant crown. GBR first, and then place the implant after 4-5 months in regenerated bone for a totally satisfying result. Sleep better at night!

Thank you for good comments. Your suggestions are the optimal clinical decision. If the implant is placed in correct prosthetic position in this situation, probably 2-3 mm of the implant will be fully exposed , do GBR and have primary closure, patient has good biotype, what are chances of success? Probably less predictable?

Always think what you would want in YOUR mouth...don't do a procedure just because you can...there needs to be sound biology behind it