Implant in Septum or Not

A 40-year-old lady had severe 2nd caries after RCT at #14 seven years ago (Fig.1).  Now the tooth has been destroyed so severely that only residual roots are left (Fig.2).  Bone density at mesial (M in Fig.1) and distal (D) crests and the septum (S) had been decreased 7 years ago.   Now with residual roots, bone resorption is seemingly more severe (Fig.2 *, D), especially at septum (^).  After extraction, the socket(s) will be treated with Metronidazole.  If the septum is large, place a relatively small bone-level (Fig.3) or tissue-level (Fig.4 (as well as Tatum 1-Piece)) implant.  If the septum is destroyed and the socket is single and large (Fig.5 black area), use taps to form osteotomy and place an implant as large as possible (Fig.6 green outline) without invading the buccal or palatal wall.  Pack bone graft in the remaining socket gaps.  This patient appears to form bone normally following immediate 1-Piece implant at #19.  Prepare IBS kits for sinus lift.  CBCT taken 8 months earlier shows implant design of bone-level (Fig.7,8) and tissue-level (Fig.9,10) coronally (Fig.7,9) and sagittally (Fig.8,10). Return to Upper Molar Immediate Implant, IBS Xin Wei, DDS, PhD, MS 1st edition 12/06/2015, last revision 11/04/2018