Suggestions to restore lower dentition?

What kind of prosthesis are you planning, anyone can measure the bone that's the easy part.

I would consider placing one more fixture in the left first Mandibular molar area since there's no adequate bone for wider and longer implant in 37. On the right side I'd put those two implants parallel and closer together so you could fit 2 premolar size crowns. Check occlusion and over erupted first maxillary molars.

Obviously this patient has been wearing a lower partial denture for many years...... Map out a final prosthetic plan on a study model, by placing wooden sticks in the edentulous areas and hand fabricating three acrylic temporary prosthesis that will be secured on your model by the sticks......make sure you remove the two fragile incisors...... Drill holes in the plastic crowns where you would like implants......two on the lower right, two in the anterior areas ( where you will extract the incisors) and three well spaced in the lower left posterior area. Place the implants.......put healing collars on each one, and ream out the partial denture and apply CoeComfort to engage the healing collars......the implants will stabilize the lower partial denture.......while you are waiting for final osseointegration........you can put ball attachments on the implants, and use the same partial or build a new one...if the patient is satisfied using a partial denture, the job is done....... is he/she wants fixed bridges you can go ahead with it.

It looks like you are planning to put more than four implants, and I agree that the patient would be best served by planning enough implants to support a fixed prosthesis. One option would be to place five implants with the most distal implant on the left side at an angle with emergence close to the first molar, and restore with a fixed prosthesis that could be immediately loaded. Another option could be six implants with a short implant in the left molar area. Even a third option would be five implants with a cantilevered molar in the left. All these options are fixed options and would provide the patient the greatest amount of comfort and function. The removable alternatives are the next choice. I agree with Dr. Pilidis and would recommend to the patient correction of the over-erupted maxillary molars. Great case! Thanks for posting.

Can't understand the motivation to save six periodontally hopeless lower anterior/bicuspid teeth and compromise a good implant result by trying to "work around" them? Then, when done, the doc is obligated to "fix" the prosthesis to replace the teeth which will be lost one after the other. Even the retained molars are not in the best of shape. Remove the teeth (or at least the six periodontal snags), and fabricate a quality implant retained locator denture or hybrid (that doesn't involve the molar teeth).

I agree. Clear out all the teeth. Fixed bridge hybrid. Can place some tilted implants just anterior to the mental nerve.

The best option I've thought of is 3 fixed bridges as follow: 1. 2 implants in the right posterior side then extracting the last molar before 2nd stage surgery & replace it with a cantilever bridge. Its preservation till 2nd surgery is to serve as a vertical stopper. 2. 4 implants in the anterior area involving the 2 fragile lateral incisors, the left periodontally weak canine & one of the lost centrals, mostly left one according to CBCT. Implant in one lost central area is to get more support & tolerance for the long span brige as the space is greater than replacing only the 2 lost centrals, the patient had large diastema previously! 3. 3 implants in the left posterior side for both premolars & another for 2nd molar, also retaining the badly tilted 3rd molar for future vertical stopper then extracting it before 2nd surgery. Your thoughts?