Mandibular Molar Implant: plan?

Please send a radio-graph that can be read. This one is too dark.

Not sure if it's the image, but I am seeing a lot of endo/perio issues that need to be resolved before considering an implant.

General rule : stay 2 mm away for IAN .do not make measurements on PAN , PA or CBCT are more accurate Good luck

At this moment: no implant is indicated. Solve first the periodontal/ endodontic diseases and keep in mind that betel nut chewers are prone to oral cancer... cloud-shaped aspect of bone in the lower jaw?

Implants are totally contraindicated in patients with that oral hygiene and habits. Good luck!!

The best thing you can do for this patient is to extract all of his teeth. That way he won't be able to chew that betel nut, anymore. You may just save his life. If he continues to chew it, he will develop SCCa. Its not a question of if, but only when.

You're a few months away from April 1st :)

Stabilise the gum Consent for high risk of failure due to his gum disease. If he agreed, then place short implant 5x6

I would consider and advise patient on a few options: (None of them would be an implant sat this stage: 1. Full Lower Clearance - placement of immediate denture for 6 months care. 2. Full clearance of Upper Arch - immediate denture for 6 months 3. Do both upper and lower clearance together - maybe consider lower first as patient's concern is LL6 molar 4. A year later assess the bone levels and consider 6 upper implants and 4 lower implants - (if not possible due to economic and health factors that may prevent this then go to option 5. 5. Reconstruct F/F dentures which may now become better fitting. 6. Refer out of your practice and sleep well....you will enjoy Xmas and April 1st..

FIRST, and foremost, the radiolucency in the anterior mandible is most suspicious! Refer out for accurate diagnosis. The possible presence of cancer -- and need for surgical cure -- may preempt all treatment planning at this stage. Second, if no malignancy is diagnosed, address all the failing RCT's and the perio first. Third, since implant prognosis is poor (due to lack of oral hygiene/bad habits), consider a bridge instead of an implant -- IF the perio is stabilized and there is no mobility in the abutment teeth. Fourth, I'd advise referring this case out altogether. You'll sleep better and have a Happy-er New Year!

CBCT asap. No implants. At the least a mandibular full denture. Make sure whoever does the extractions has the ability to evacuate the infection and achieve some ridge augmentation. Anticipate biopsy. Expect that a finalized mand. full denture is going to require some time. Don't push it my friend.

This case is of a high failure risks. Need to control primary oral diseases ( caries, perio, TSL from chewing habit & perhaps bruxism, correction of ledgy restorations. PerioEndo lesions ....etc in addition to a good oral hygiene control & to stop this chewing habit which is a possible risk of oral cancer. Obviously patient must follow your instructions, agrees on your treatment plan, motivated to a good oral hygiene control & to stop his habit. Then regular review until all controlled & to make sure your instructions followed. Only then and after a good period of time you may plane for implant treatment.