After extraction without drilling, a 4x11 mm dummy implant is placed as a tap drill with satisfactory stability (Fig.5).  To get subcrestal placement, a shorter (4x9 mm) implant is inserted with insertion torque of >35 Ncm (Fig.6).  In retrospect, a larger implant (4.5 mm) would be better in term of primary stability.  After allograft placement into the buccal and lingual gaps, a 4.5x4(4) mm abutment is placed for an immediate provisional.  The sinus floor is penetrated by the implants without bone graft for sinus lift.  There is a peri-implant gap 7 months postop (Fig.7<) .  When the loose abutment is being retightened, the patient feels pain, although the gingiva appears healthy (Fig.8).  A larger implant should have been used; the abutment should have been removed.

The implant dislodges while the abutment is untightened 8 months postop.  The osteotomy is found intact.  A 4.5x11 mm dummy implant is placed 2 mm subgingival with 20 Ncm (Fig.9).  When a 4.5x11 mm definitive implant is placed 3 mm subgingival (Fig.10,11), torque reaches 50 Ncm.  A 5.5x3 mm healing abutment is placed.  Three months postop, the implant is stable (Fig.12,13) and impression is taken.

No Drill Osteotomy 1st Year

Xin Wei, DDS, PhD, MS 1st edition 11/26/2016, last revision 01/19/2018