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As planned, osteotomy starts at #4 prior to #3 extraction (Fig.1,2). In fact the bone density at the edentulous area is high. Drills (2 mm in Fig.2) are used to finish placing a 4x17 mm tissue-level implant (Fig.3).
A challenge associated with #3 extraction is large amount of granulation tissue apical to the mesiobuccal root (MB, Fig.2 (inset: red dashed line)). To remove the granulation tissue (*) apical to the septum (S), the septum between the buccal roots has to be chiseled. The remaining septum for osteotomy becomes less.
Xin Wei, DDS, PhD, MS 1st edition 09/26/2017, last revision 04/24/2018