Advice regarding implant size selection in LR6 site?

I am planning to place and implant in LR6 site in a healed ridge. My choice is Straumann bone level length 8 mm but I wonder whether 4.1 or 4.8 in diameter will be better. The site has buccal bone loss and will need bone grafting as well. Thank you for your opinions.

MWJ DDS, MS comments:

This would actually be a perfect indication for an Astra 4.8mm Profile implant. The head of the implant is beveled to follow the bone pattern, eliminating the need for a bone graft. You may want to check out the implant!

Tim comments:

There is no absolute right answer since both options provide for adequate strength and emergence profile. My intent is not to sound critical but as someone who has been involved with graduate dental education for over 15 years now I find it very disturbing that you would be asking such a question at this point in the process. I do understand if you are someone that orders implants on a case by case basis rather than maintain an inventory but in this case do yourself a favor and have both options available.

Tom comments:

Take a breath

MW comments:

I would sink the implant a little deeper. If you are not comfortable with this, then I would graft the area first and then come back later.

Matt W DMD comments:

You look like you could safely go deeper, but as you are already content with grafting, then I see no issues

HD comments:

Your placing implants in the mandibular area and have CBCT views , but you do not know what size to place . In my humble opinion I would take some CE classes before your really hurt your patient

Tim comments:

I tried to be kind but you are exactly right. Anyone with the capabilities to produce such images should not be inquiring about such a question. I would suggest more CE but I am of the opinion that the manufacturer sponsored implant education out there will leave successful program graduates with the same lack of knowledge. Do everyone a favor and refer. By the time this is posted I am sure someone will be posting about some nifty new incredibly unnecessary bone grafting technique to go along with a long winded answer to the original question of "What Size to place"

Mihai comments:

Smaller is better. More bone less titan.

Narkhede DDS, MDS comments:

Along with Astra, check out Bicon implants too. In this case with 8 mm length I would prefer. 4.8 mm. Will keep both size in stock. Submerge little more. If not comfortable, use a piezo with diamond head tip and increase the depth slowly. The buccal area will need grafting & membrane. You may use the bone extracted from the receptor site with slow speed. Primary closure then. In such cases I like configurations like Astra, Bicon and also Noris Tuff. Good Luck

Adrian Acosta comments:

Wider implant will give a better emergence profile which will be better for the patient. Implant planning looks ideal. IF you are experienced with bone grafting and you know how to release a flap appropriately then my opinion is this is a straightforward contour grafting case. If you are not, then the Astra Profile implant would work here, but in my opinion not be as ideal. I've placed Astra Profile implants in the past when I was not as experienced with grafting techniques and they work well in the right situations. But becoming comfortable with many grafting techniques opens up many more opportunities to not only place implants ideally, but also improve the soft tissue profile in many situations. Clinical photos would potentially show this to be the case here. But very nice planning.

BroMike BroMike comments:

Apart from less ideal soft tissue profile, are there any other potential shortcomings of using Astra Profile implant?

Greg Kammeyer, DDS, MS comments:

Learn GBR and get comfortable with one implant system.