Implant for 47: Immediate or delayed?

There may be more issue than you think. In addition to the concerns you have, it is important that there be a buccal and lingual wall of bone. Removing this tooth should be easy enough. Then the site needs extensive degranulation and maybe bone penetration to get good blood flow into the socket. The nerve seems quite deep so you can establish stability for an implant down deeper than the roots of the tooth in an ideal M-D and B-L position. It's good to place the platform of the implant down below the buccal and lingual bone walls. Then you will need to fill in around the implant with bone augmentation and cover with a graft material of one form or another. Flaps do not need to be advanced but should be tight up around and over the membrane. Perhaps you could check out the second premolar at the same time. Much the same principles might apply there as well except that the nerve seems really close to the apex of the tooth. Best wishes : Peter

I would suggest to take first of the periodontal status first. There are many bone vertical loss to be treated and considered. A perfect Implant Surgery could fail if bacterial activity is high. Besides, the 46 has apical radiolucency, and must be treated before placing and implant. Hope it might be helpful

What are you intending to do with 44, 45, 46? All three teeth look to be unrestorable and best removed. If so you need to formulate an overall treatment plan replacing 44 to 47, not just a single implant at #47

John T is correct. Remove all 3 teeth, graft, then 3 implants will give you the best bone-implant connection, the best occlusion, the best tissue and the best overall long term results. That will also give you time to assess the patient's hygiene compliance before implant placement. This patient has a long term history of bad habits with hygiene. That must be corrected and reconditioned in their lifestyle before the implants will be successful.

If 47 were the only concern my suggestion would be extraction and grafting followed by implant placement after tissue maturation. Unfortunately this patient has such severe bone loss and periodontal disease that the more relevant question may be conventional removable prosthodontics versus overdenture versus fixed hybrid. Good luck!

i agree withbthe others, adding that 21 seems to have internal resorption. We so often at times become hyper-focused on the obvious problem presented on the xray and miss the ither stuff. By reading the xray from the outside in and than from the inside out than going tooth by tooth our eyes “see more”. thank you

I will go for the staged, at least. It is not esthetic zone and seems like there are things need to be done before the implant placement. So it would be a good time for both patient and clinician to discuss about the benefit and risk of the implant treatment. And also periodontal issue will be addressed during the time. I will go through the basic perio treatment and will do the extraction with ridge preservation with Bio-Oss and Bio-Guide.

Taking into consideration the bone loss on the mesial root ,besides that this loss will increase after extraction because the roots are attached so I preferto extract deal with the periodotal issue bone graft wait 4 to 6 months and then do the implant,no reason to rush .