After smooth extraction, the apical buccal plate is found to be perforated.  Following debridement, a piece of gauze is placed in the apical defect for hemostasis, while osteotomy is initiated palatal (Fig.2).  The apical defect seems to be extensive (Fig.3 yellow dashed line).  A new trajectory is intended (red arrow) without much success.

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Xin Wei, DDS, PhD, MS 1st edition 05/07/2019, last revision 03/19/2020