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A tissue-level 7x17 mm implant is placed with insertion torque >60 Ncm (Fig.5 I); a 6x5 mm abutment is immediately placed (A). Osteogen Plug is placed in the buccal gap since it is relatively rigid, while mixture of autogenous bone, allograft and Osteogen is placed in the remaining gap, followed by Collagen Plug (Fig.6 *). An immediate provisional is fabricated and seated without cement to keep the graft in place. Since the implant is placed deeper than desired because of the buccal and lingual recession, the provisional is needed to prevent the mesial and distal gingiva from overgrowth. When the wound heals, the margin of the provisional needs to be adjusted if necessary.
There is bone density change at the mesial and distal crests 3 months postop (Fig.7).
Xin Wei, DDS, PhD, MS 1st edition 12/03/2016, last revision 12/03/2016