Implant positioning: your recommendation?

In my experience, simple is always the best. It appears that this patient has both perio and decay issues, which do not typically happen to this degree in the well maintained mouth. The lower arch that we can see appears to be in trouble as well. Perhaps we can assume that the rest of the mouth is also in trouble? Why not consider a CUD immediate, clean up the perio , get disease under control and then reevaluate the entire case. I always ask myself... "am I replacing natural failing teeth with implants that are at high risk of failure because primary disease has not been dealt with? This is just my 35 years of experience talking.

I think what you are proposing is fine. An additional implant could be considered for placement at the 26 site as well. This would increase the load distribution area. Your prosthetics could be individual crowns or splinted.

I agree with Dr Janzen. The pt. May be a candidate for all on 4. btw

Do you have a Pano? I agree with Dr. Janzen. Get the infection under control.

Planning for any implant case, need a thorough examination, DIAGNOSIS, Planning & preparation, & then execution to achieve the best dental care for the patient. You really need to start dealing & controlling of (Primary Oral Disease) which are: Dental caries, periodontal disease, bruxisim, overhang & condition of existing filling ......etc. In addition to consideration to vital structures which in this case is the sinuses. Any way good luck.