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A 2 mm pilot drill is used to start osteotomy ~17 mm from the gingival margin, followed by 2.5 mm reamer ~ 17 mm, and 3 for 14 mm. If the socket looks small (mesiodistally), the goal is to place 4.1x14 (Fig.3) or 13 mm (Fig.4) implant. Otherwise use 4.5x17 mm Tatum tapered tap at 14 mm and plan to place a 4.5x13 or 14 mm implant. If it is difficult to insert an implant, use one size smaller drill from its original cassette or use 5x17 mm tap at 11 mm (to open up the entrance of the osteotomy). If the implant or tap is being deviated buccally while it is placed, use a Lindermann bur from Bicon Restorative plastic box to remove the bone from the palatal wall. When the side-cutting drill is cleaned, keep it in the Bicon Surgical Cassette. If the bone density turns out to be low, osteotomy depth will be 20 mm instead (Fig.5).
Pink: abutment; red: root apex.
In fact the osteotomy is created in the palatal wall. There is enough new bone to support the immediate implant, even though it is shorter than the root.
Xin Wei, DDS, PhD, MS 1st edition 09/05/2015, last revision 01/19/2018