#15c Blade fracture in Bone Expansion

The crest at #14 is narrow not only mesiodistally, but also buccopalatally.  After making an incision mesiodistally, the #15c blade is used to start bone expansion as deep as ~ 8 mm.  Bone density is moderate.  The tip fractures while the blade is withdrawn.  The incision is extended; surgical handpiece is used to remove the bone surrounding the blade tip.  After finishing osteotomy using 3 mm reamer for 11 mm, a 4.5x14 mm tap is applied (Fig.1).  When the latter is removed, there is no sinus membrane perforation.  After placing .5-1 mm allograft with Osteogen (Fig.3 *), a 4.5x14 mm implant is placed with insertion torque of >55 Ncm.  A 4x3 mm abutment is placed (Fig.2 A) for an immediate nonfunctional provisional.  There is no bone loss crestally 4 months postop (Fig.4).  There is bone modification at the crest 11 months post cementation (Fig.5).  Porcelain addition to decrease the gingival embrasure (Fig.6) appears to reduce food impaction.  Return to Upper Molar Immediate Implant, IBS, #10 Xin Wei, DDS, PhD, MS 1st edition 11/10/2016, last revision 11/18/2019