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After extraction, the buccal plate is found to be lower than the lingual. Because of this and severe distal defect, the osteotomy is initiated in the mesiolingual socket. It appears to be overdone (Fig.2, close to the distal root of the 1st molar (red dashed line)). Then the osteotomy is moved distally.
The osteotomy is enlarged with reamers 2.5-4.5 mm. A 5.9 mm tap is tried without binding to the bone, while 6.4 mm one has some degree of engagement to the osteotomy (Fig.3).
Yellow dashed line: upper border of the Inferior Alveolar Canal
Xin Wei, DDS, PhD, MS 1st edition 04/22/2015, last revision 08/04/2019