Implants same day as extraction or should I wait?

First of all you need a panorex or CBCT to evaluate the situation further. It seems like you are early on in the training process. Take more CE and I suggest a mentor for your first few cases. It's not fair to the patient.

Without a panoramic radiograph showing generalized bone levels, it is difficult to assess periodontal status in this case. What is the occlusion on the upper arch? In my opinion, at least have the chewing restored till the first molar in all quadrants. So, with that thought in mind, I would place two implants in the lower left with space in between, and then make a bridge from implant to implant and two adjacent placed implants on lower right and maybe splinted crowns on lower right. I prefer immediate implants when possible, including here, just don't give the body a chance to take away bone from the site. Even three months can prove costly sometimes. Remember to curette out any granulation at the osteotomy site. Chronic periodontitis usually leaves behind the nasty stuff. Curette well. Short 8mm implants may be required here, or plan more accurately using a CBCT first.

Am not sure you have sufficient height to place implants especially on the left without grafting to gain lost crest height

In extraction cases (except molars) I like to do immediate placement whenever possible. In your case however, I would do delayed placement, where you extract the tooth, debride the socket and wait for complete soft tissue coverage and eliminate the periodontal pathogens, then go back in and place the implants. Considering that you need to go a few millimeters past the apex to get fixation and stabilization for the apical half of the implant in bone, and how close the alveolar canal looks in one of the periapical films, it might be prudent to graft and wait until more bone is available. I would not attempt a wider body implant to fill the gap. A regular width implant would be my choice. Good luck!

Always an immediate implant (non molar or molar) and always a screw retained temp crown. The purpose of immediate implant gets defeated if temp crown is not placed on the implant. It needs more skill and labor but the results are unsurpassable compared to traditional implant dentistry. No cuts and no stitches and Px gets numbed only once and Px leaves with no open wound. Never lift gum from the bone and you have to believe in it. Once u see the results, you would always want to do immediate implant. In office CT scan is a must. Buy a CT scan today and it will change your life as a dentist. Sam Jain, DMD Center For implant Dentistry Fremont, CA

The protocol I use always is a delayed immediate at 3 weeks post extraction when we have soft tissue closure and before the real hard tissue modelling starts for optimal host results. BUT this case has other issues , the IAN the fact that there is a predisposition to bone loss with poor oral hygiene etc So there are risks involved without even going into medical history or smoking .. Peter

Wow! This patient has advanced periodontal disease and we are talking immediate implants? Let us get the horse and the cart lined up before beginning a complicated treatment plan. Full mouth examination, radiographs, probings, etc. It is always wise to do a diagnosis before initiating treatment.

I agree, you need a panorex or CBCT to evaluate the situation further. Take more CE and I suggest a mentor that you can trust for your first few cases. It’s not fair to the patient. Don't let some company rep talk you into something,