If you have read some of my implant posts you may know that I am a big fan of immediate molars. Its easy to “sell” to patients as they are coming in with a non restorable tooth, and usually don’t want to wait an extra 3 months on top of the extraction and graft, for the implant to osseointegrate. But that being said, they are hard to do. Once the tooth is removed, there is bone in left where the furcation used to be. Usually this bone is sharp and causes your drill to deviate. Well try this, drill about a 3mm hole into the furcation of the tooth. Leave the roots in place and drill with the first two drills of your implant sequence. The roots are more dense than the bone in the furcation, so your drill will stay put! Now just for fun, text or email the radiograph to your friendly neighborhood endodontist and tell them to help you patch the furcation and retreat the endo. You usually get a phone call within minutes!!
Its hard to measure working length, so use a drill stop. In this case I went up to a 3.4mm drill through the tooth as I had a nice wide hunk of bone in the furcation. Removed the roots and curated out any soft tissue. Grafted with MFDBA and used a placental membrane with resorbable sutures. May not be your first immediate implant, but a lot easier than extraction first.