After 1.6 mm drill, Magic Expanders are used to finish osteotomy, followed by insertion of a 5x11 mm dummy implant with low stability (Fig.2).   ^: mesial bony defect, which will be filled with bone graft after placement of a 5.5x11 mm implant (Fig.3 ^).  The wound dehisces 12 days postop (Fig.6 ^), which may be related to loss of graft meisally 3 months postop (Fig.7 <).  It seems less likely for the wound to dehisce if a large abutment is placed, because of less tension.  The crown is dislodged <1 month post cementation.  It appears that the abutment screw fractures.  Is there a specific kit to remove the screw?

In fact the crown and abutment dislodgement is due to screw loosening.  After tightening, the crown is stable.  Occlusion is adjusted. After 2nd retightenting, the patient reduces mastication force and implant crown delivery at #3, screwing loosening does not recur.  Bone density around the implant appears to increase (Fig.9 (9 months post cementation)) and continues to do so 2 years 2 months post cementation (Fig.10 *).  However the crown looks too large for the implant.  In fact the crown dislodges 3 years 6 months post cementation (no bone loss), because of a lollipop (small and long, angled) abutment; after abutment composite build up, the crown is incompletely cemented with slightly open distal contact (Fig.11).  The crown will be redone once it dislodges again.

Implant 2nd Placement with Further Bone Graft Last Next Xin Wei, DDS, PhD, MS 1st edition 11/06/2020, last revision 11/06/2020