When a 5x9 mm dummy implant is placed, it is approaching the distal socket wall.  After the last dummy implant is withdrawn, a piece of Osteogen plug is inserted and a 5.5x7 mm implant is placed with less than 20 Ncm (Fig.2).  A 6x4(2) mm abutment is inserted with intention to prevent the implant from dislodging into the sinus in case the implant becomes loose.  Vanilla Graft is used to fill the socket gap (*).  An immediate provisional is fabricated to close the large socket.  The provisional is off 1 month postop, while the abutment is loose and replaced by a healing abutment.  The latter is loose with pain 5 months postop (Fig.3).

Drill Perforation Last Next Xin Wei, DDS, PhD, MS 1st edition 03/14/2018, last revision 09/06/2018