Dear Dr Moore, I hope you may be able to find the time to advise me. I live in Moscow and following recent inflammation was medicated by my dentist for a gum infection which was spreading to the bone. The cause is the unreplaced removal of a maxillary second premolar. This was done 3 years ago and I was unaware of the consequences of inaction. Surrounding teeth have been spreading and my indecision urgently needs to be replaced by an implant. I have consulted with a dental surgeon practising at the same hospital, have had a CBVT scan, and been confirmed as suitable. The language barrier has been heightened by the practitioners not wanting to deal with my detailed inquiries about the procedure. I have researched techniques online, including on this site, and while confident in his abilities by referral from my excellent dentist, feel in need of some reassurance. You will not be surprised to hear that there has been some loss of bone height. I believe there is 6.5mm of healthy bone which he intends to increase to 10mm by grafting. This sounded okay to me but then I heard that he intends to complete the entire procedure in one session; grafting, root form implant and immediate loading, in an estimated 20 mins. It seems to me that he is pushing the envelope in every direction, would you agree? He gave me an 80% estimate of success considering the bone loss, but it appears to me as a layman that that would be increased by a more staged approach, am I wrong? I hope I am not presenting ethical concerns, but I feel in need of a second opinion. Thanks and regards.