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.

The patient returns for final restoration 6 months postop.  The apical socket radiolucency remains without ill effect (Fig.10 *).  No bone graft was attempted to be placed in the apical socket, since the graft may interfere with implant insertion.

Implant Placement without Drill Last Next

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