• Has a UL1 denture and hates it
• Does not like the margin on the UR1
• Does not want a fixed bridge UR1 to UL2 

• Peri-apical lesion UR1 seen on radiograph
• RCT carried out 10 years ago
• Asymptomatic
• No clinical signs
• Is the UR1 restorable? 

• Should we ignore the UR1 infected site and place an implant UL1?
• Further endodontic treatment and restoration UR1 
• Extraction of the UR1 and place 2 single implants?
• Is the lesion healing vs active disease?
• Strict criteria is no periapical area present after rct. The meta-analyses had indicated that using strict criteria for judging treatment success, a minimum follow-up period of 3 years (Ng et al., 2007)
• What is the risk/difficulty of placing an implant in the UR1 extraction site?

• Place 2 single implants – but more challenging in the extracted site and may need a more complex/expensive grafting procedure. This has been shown to put some patients off (Chiapasco and Zaniboni, 2009)
• Immediate implant placement in the UR1 extraction area would be highly risky due to previous infection and skill required to place implant in the correct restorative position
• We took into account the age of the patient and failure in the UL1 site may allow the UR1 site to be used in the future
• Also risk of bone loss between 2 implants  if not placed >3mm apart
•     (Tarnow, Cho and Wallace, 2000) 
•  

    The patient has a high lip line and aesthetic outcome was important