The largest osteotome is 4.8 mm.  When a 5x13 mm implant is placed, it has low torque (Fig.8,9).   It is also deeper than necessary.  It will be backup 2-3 months postop when the bone starts to heal.  Without anesthesia, try to turn the abutment screw.  If there is no pain when the abutment is removed, try to counterclockwisely turn the implant gently.  Administer local anesthetic if deemed necessary.  Take PA to confirm implant level.

In fact, the implant is reversely torqued (1 month postop) and ~ 2 mm more coronally.  It becomes looser.  A healing screw is placed.  With insertion of collagen plug, sutures are placed.  Five days postop, the wound appears to be healing with sutures being dissolved.  Four months later (5 months post placement), the patient returns asymptomatic.  The wound heals.  The implant appears to have osteointegrated and is at the crestal level (Fig.13).

Overprep

Xin Wei, DDS, PhD, MS 1st edition 08/28/2016, last revision 01/23/2017