When a 4.5x13 mm implant is being placed, it is
deviated buccally. With the implant being removed, the osteotomy is moved
lingually
with Lindamann bur and 4 and 4.5x13 mm drills. When the implant is placed
for the second time, the buccolingual position is acceptable; the depth is a
little shallow (Fig.6). Further adjustment of the depth appears to be
acceptable (Fig.7). After placing an abutment, an immediate splint
provisional is fabricated between #18-20. Three months postop, the split
ridge appears to have healed with formation of apparent lamina
dura distally
(Fig.8 arrowheads). Clinically the margin of the abutment (A) is
supragingival. A shorter cuff abutment should be used prior to impression.
There is no bone loss 5 months post cementation (Fig.9). The 2-staged
ridge split seems to be safer in term of bone resorption than the
1-staged one (2,3).
Xin Wei, DDS, PhD, MS 1st edition 03/12/2016, last revision 08/13/2020