The last drill is 4.3 mm, followed by 4.8 mm Magic Expander since the palatal wall of the osteotomy is thin after the last drill.  A 5x13 mm IBS implant is placed with ~ 45 Ncm.  The apical portion of the 3 sockets is filled with Osteogen plug and the coronal portion with autogenous bone (harvested from MD), mixed with allograft and Osteogen (Fig.4 * as well as collagen plug in the most superficial portion of the sockets).  A 6.5x4(4) mm pair abutment (Fig.4 A) is placed to hold an immediate provisional in place.

There is no bone loss 3 months postop (Fig.6,7).  The screw needs to be retightened 9 months post cementation (Fig.8).  In fact the abutment is incompletely seated, leading to hex fracture 3 years 9 months post cementation.  After removal of the hex, a new abutment is placed with apparent complete seating (Fig.10).

Larger Abutment Last Next Xin Wei, DDS, PhD, MS 1st edition 11/04/2020, last revision 11/21/2020