After 4x11.5 mm drill with 10.5 mm offset for bone-level implant at #19, a 4.5x14 mm tissue-level tapered tap is used with high torque. The same sized implant is placed in-completely with apical space (Fig.1 ^). Following reuse of the guide and 4.5x7.3 mm drill, the implant is placed deeper easily (Fig.2-4). The implant threads are subcrestal buccally (B (L: lingual plate), as compared to design in Fig.3'). Later the implant is placed a little deeper with insertion torque of 25 Ncm. There is no crestal bone loss 4 months postop (Fig.5). Waterlase is used for gingivectomy without anesthesia or burn after placing a 4x5 mm abutment. The access is difficult due to severe bone loss.
Xin Wei, DDS, PhD, MS 1st edition 08/08/2019, last revision 12/19/2019