In order to maintain the stability, a 4.5x17 mm implant is placed without any further modification.  It is in a less ideal trajectory (Fig.6 I).  But the insertion torque is >60 Ncm.  A 3.5x3 mm abutment is placed (A); an immediate provisional is fabricated and temporarily cemented (^).  *: bone graft, which is mainly placed in the buccal gap.

To place the implant distally, a systemic approach should be adopted as follows.  An osteotomy should be initiated in the distal wall of the socket more coronally (Fig.7) than Fig.4.

Implant Placement without Drill Last Next

Xin Wei, DDS, PhD, MS 1st edition 06/03/2015, last revision 03/04/2018