Is an Implant possible or should we wait?

I agree, if you place an implant it would be angled too far labially and would be restorative hell. I would place a graft and membrane and wait a few months Good luck. Challenging case.

It is best to do CBCT after minimum 8 weeks to assess for implants. If grafted, 4 -6 months. I suggest waiting another 6 weeks. Re-do CBCT, follow up with full digital implant planning to assess bone and implant direction.

Wait. Too many dentists get in a hurry and either let the patient set the pace or want to rush to get an implant in. The older I get the less I jump into implanting too soon.

I would give this case to an oral surgeon that you don't like and let him fail at it. Kidding aside, I would refer this case out ... might not worth it for you considering all the issues.

This case needs a ridge augmentation first. Also high or low lip line? Definitely membrane, tacks, graft material and a connective tissue graft over the implant at time of placement to further augment. Don’t let this scare you, it’s a great opportunity for you and your patient. Just make sure you do it correctly. One last thing no flipper! Essix or a bonded Maryland bridge during healing phases.

I agree, this is headache that if it fails it would your fault because you did not refer and if it fails with an specialist, it was meant to be. Overall. It is going to be expensive case, a three unit bridge is much easier and predictable. I just like predictable outcomes

This is a good block graft case. Follow the established timing and materials and technique protocols.

This case will require both bone AND tissue grafting for long term stability.

Twisted idea of the inexperienced (me!) - place fixture now, the whole buccal of fixture may be exposed - overpack the exposed implant surfaces with bone graft and cover with membrane, 2 stage surgery of course. Theoretical discussion, The hope is for osseointegration of the fixture. If fixture does not integrate (manufacturer will replace free of charge anyway) , consider the fixture as socket former in a ridge augmentation procedure. Debriding the the socket formed by the fixture, and inserting a bigger ( maybe, and longer) fixture should be technically simple. My background is not perio or surgery. My mentor for implants cringed but said if it works, implantology will be greatly simplified. What say the experts, especially the periodontists here?

There are a lot of good suggestions given above; however whatever route you decide to take, both you and your patient must be prepared to undergo multiple procedures to obtain an acceptable result...….all the suggestions will probably work, but there will be many steps in fine tuning to get an acceptable result …..good luck to you and your patient....and after it is completed, do us all a favor, and publish an article on it....this is how we all learn.

Once Carl Misch said that patients needed teeth not implants. The bone has a massive defect . Half of the root is exposed in adjacent teeth, therefore grafting might have unpredictable outcome which could make the case not restorable. Have you considered any simple prosthetic solution with the patient without implant insertion?