Lower Anterior Implants: immediate insertion a possibility?

If this was me I would extract, throughly qurette, as I'm sure you'll find lots of granulation tissue and dead bone particles due to the advanced perio, graft with a membrane to try to regain as much alvelolar crest height as possbie, and revisit in 4-6 months. Make the patient a flipper in the meantime, making sure you employ its gingival surface to guide healing contour.

I suggest extractions of the mandibular incisors, degranulation and give the site tincture of time. Then graft after the infection has resolved, using the bone ring technique or narrow body implants at both lateral incisor sites and restore with a four unit FPD or a conventional six unit FPD from cuspid to cuspid, without implants. Remove the infection and do not over complicate the case.

In cases with defects this big and when vertical bone loss at this degree and implant collars would have to be placed at the mid height of neighboring teeth, I can't see how you can do immediate placement without significantly compromising the outcome. Say, if you place immediately and If you want en aesthetic appearance you would have to place thin long implants with several millimeters of exposed threads and then do a graft procedure. This far you can do it controlled but then the healing period comes in and that may alter the region more than what we sometimes imagine. I would personally try to graft first, maybe with a combination/mix of slow resorbing material and autologous bone in a titanium mesh technique. Good luck!

I certainly would extract and wait 2 weeks. depending on scan info i would then graft or decide to go immediate. Unfortunately we do not see bucco-lingual thichness on your scan. usually the implants need to be placed quite apically, and to avoid loosing mesial bone on the cuspids you would place the implants between 41-42 and 31-32. two implants close to the midline, allowing for a gradual slope of the bone from the cuspids mesial to the good bone thichness where the imppants are placed, having removed the bundle bone that will be lost anyway. On these 2 implants you would cement or screw an FP3 and not loose bone on 33-43.

Hi... the mandibular incisors are hopeless and removed , a temporary essix or RBB could be placed. Allow it to heal for soft tissue closure. I'm looking at the coloured reconstruction and estimate the midfacial bone level to be 6-7 mm from CEJ & there are proximal peaks for the mandibular canines. Maybe then , after adequate soft tissue healing, place 2 implants in lateral position ( set them 4mm apical to your intended CEJ/Gingival margin for incisors) . Augment with your preferred bone graft , and consider titanium/collagen membranes for GBR both horizontal and vertical. Your essix/RBB will put no pressure to your surgical site. Leave .... wait 3months + 4 weeks per 1mm of vertical bone grafting ( just a guide only) , before considering prosthetics..... Of course you can , just prepare 3-3 and place a 6 unit bridge. They last a long time.....

do the extractions on the 3 incisors,tp graft and let heal. In the meantime take care of the wisdom teeth as well as the upper 1st decayed molar. Do all the needed periodontal therapy. Immediate p/l in the interim. BTW mounted study models. nite guard !