My first molar on my bottom right jaw is loose and also has an infection (currently taking antibiotics). I had a root canal done to this tooth over 10 years ago. Last week, I went to 2 periodontists to get their opinions. Here is what they told me:

Periodontist #1: He said I have gum disease and require scaling and root-planing (deep-cleaning). He also said I needed bone-grafting as my bone line was too low for the implant. Therefore, his recommended treatment plan was:
(a) Tooth extracton
(b) Scaling of all 4 quadrants in my mouth
(c) Bone-grafting
(d) After 6-9 months, perform dental implant
(e) After another 3-6 months, peform abutment and crowning.
Total time: about 12-15 months.

Periodontist #2: He did not mention that I needed scaling. I asked him specifically if I needed bone-grafting and he said it looked like I had enough bone for the implant. But he would only be able to know definitively after he extracted the tooth and was able to see inside the gums. Therefore, his recommended treatment plan
was:
(a) Do just basic teeth cleaning with oral hygenist
since I had not cleaned them for over 2 years (no
scaling required).
(b) Tooth extraction and placement of implant on same
day (said he liked to limit number of surgical procedures).
(c) After 3-6 months, perform abutment and crowning.
Total time: about 3-6 months.

I would consider my general oral hygiene and gum health as not good. Bleeding gums, tartar buildup, etc. Hardly flossed on regular basis.

I'm having difficulty deciding which of these two treatment plans I should go with.

It would seem that Perio #1 is taking a more conservative approach, get the tooth out, clean up any residual infection near site and rest of mouth, make sure I get enough bone in there (bone-graft), and then do the actual implant afterwards, when the area has healed up properly.

On the other hand, Perio #2 has alot quicker treatment time of 3-6 months. However, is he being less careful (since I'm still taking antibiotics for my infection) or just have more updated techniques or maybe lower success rate by doing the implant without bone-grafting first.

I guess my main issue is do I need bone-grafting or not? Why does one tell me yes and the other no? Will the success rate for both be the same, but it's just a matter of personal style in terms of the treatment plan?

I would appreciate any expert opinions on this, as I hope to decide in the next couple days.

Thanks in advance for your help.

Difficult to determine what is best without x-rays to see what both specialists are speaking about.

As to the implant, was the plan to anchor it to the mandible itself, or was it to anchor it to the "dental bone". What are the risks of the implant hitting the mandibuluar nerve canal and creating problems.

My preference is for conservative approach because you are looking for something that is going to be a long term solution. Also placing an implant immediately, seems to be creating a situation where the implant can shift as the area heals, which might make it more difficult for the final restoration to be placed with best results.

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