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There is nearly 8 mm between the apices of the 1st lower molar and the Inferior Alveolar Nerve (Fig.2). Approximately 4-5 mm new bone can be gained for an immediate implant. Our plan is to use a relatively long and narrow bone-level implant (5.3x14 mm). Too large implant (6-8 mm) may break off the thin lateral septal wall and slide into the socket. The drawback using the smaller implant is that more bone graft is going to be used (Fig.2 red circles; collagen plug or membrane (green squares)).
First of all, use a sharp small pilot drill (1.2, 1.5 or 2.0 mm) 3 mm shy of the extended length. For this case, the initial depth will be 14 mm from the gingival margin (Fig.3: red long arrow). If the drill is straight and in the middle of the septum (1st intraop PA), keep drilling for the next 3 mm.
Xin Wei, DDS, PhD, MS 1st edition 04/15/2015, last revision 04/15/2015