A prosthodontist was recently called by a dentist who was asking for advice about a patient who was anaesthetized and lying in the chair at that time. The patient was partially dentate in the mandible, with severe periodontal disease and over-eruption of the remaining six anterior teeth. These were opposed by a complete maxillary denture. The patient had been unable to tolerate a mandibular partial denture resulting in development of a classical combination syndrome. The dentist planned to extract the remaining teeth and at the same time insert six implants in each arch. These were going to be immediately loaded with complete over-dentures, and later restored with two fixed implant supported prostheses. As a new implant system was to be used, the company representative had volunteered to assist with the instrumentation, componentry and surgical placement. However, once the teeth were extracted, neither the dentist nor the representative could decide on the best position, length and diameter implants to use in each arch. They were also concerned that the anterior maxillary ridge seemed to be severely resorbed and flabby, while posteriorly it was enlarged and encroaching on the restorative space.