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.

No Drill Osteotomy 1st Year

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