Implant placement for recently extracted site?

I assume you are referring to upper and lower full arch "all-on-four" bridgework. This requires a high degree of skill in order to achieve an accurate occlusion, vertical dimension and cosmesis, and a high degree of cooperation from your patient to maintain good oral hygiene. With respect, the questions you have asked are rather fundamental to any implant supported bridgework, let alone full mouth fixed prostheses. Are you sure you have the experience to undertake this work?

Is the patient wearing dentures? Is the patient happy with the tooth position? Is there adequate lip support? Is the vertical dimension stable and acceptable? Once you can answer yes, then get a scan a start looking for good implant sites. A-P spread should be maximized, and that's where tilted implants and angled abutments come into place. You can't just free hand the case. Sounds like your a beginner. You need guides and a plan. I would look into the Nsequence technique. You'll need a scan. It will guide you through bone reduction, implant placement, and abutment selection. Either that, or do the case with someone who has experience. These cases are more than just drilling 4 holes. Plan, plan,plan. Steep and very rewarding learning curve.

OK, if you've done "a couple of full mouth cases" what makes you think that makes you qualified to be an implant surgeon on the most difficult restorative case you can possibly dream up? 1) you have way too much bone in the mandible. How much are you going to reduce? Why wait after tooth extractions? most "all on 4" treatment is done at time of tooth removal. If you've taken out the teeth then my surgeons usually wait 6 weeks for tissue healing before going back in. How much bone reduction on the maxilla? What materials are you going to use? You're only asking basic questions; there are so many unanswered questionsas outlined above. 2) may I kindly suggest you not tackle this case? You should refer to specialists and watch what they do. Are you ready to take on the liablility of a very expensive treatment? Would you want a beginner doing this treatment on you and asking the "experts" on the internet how to treat you? 3) I hate to be an *** but, as a prosthodontist, I've had to redo these big treatments too many times and the poor patient is the one that suffers. So get trained before you leap.

I really think that dr johnson's comments are not in the spirit of this website. We all have begun our implant journey at some point on the implant continuum either thru specialty training or thru self guided learning. My concept of this site is to have a forum where seekers can feel safe to post cases and ask questions. I have seen too many responses that are critical and not at all helpful to the posting DDS. I am a strong believer in continuous learning and strongly support any effort to help our dental colleagues improve their skills and understanding of implant dentistry.

As there are so many extraction sites, you may wait 6 months, for the bone to level up on its own. After a ct scan, I would do more than 4 implants on each jaw, for a fixed prosthesis; it seams there is enough vertical space. Anyway, don t let other comments bring you down. Just prepare youself..

These are questions, not a comment. I hope it will be accommodated. 1] In bone and soft tissue grafting protocol in immediate implant do we have to place a barrier membrane over the bone graft before the soft tissue graft, at the same time? Or is it advisable to place the bone graft and membrane first,then to do the soft tissue graft a little later? 2] Can bone recession around an implant in a ridge that was augmented during or after implant placement be treated with bone augmentation instead of removing the implant?