Tooth Used a Surgical Guide Before Extraction

A 67-year-old man used to have a 3/4 cantilever bridge, which is dislodged (Fig.1).  The anchor tooth has a buccal fistula with apparent furca perforation and mesiobuccal periapical radiolucency (<).  Prior to extraction, the tooth will be used as a surgical guide for implant placement at #4 (Fig.2).  Since the bone density at #4 seems to be low (*), bone expander kit will be used. 

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Xin Wei, DDS, PhD, MS 1st edition 09/25/2017, last revision 04/24/2018