After use of a 3.2 mm drill (underprep, normal drill size (3.7 mm)), a 4.5x15 mm implant is placed with insertion torque > 50 Ncm (Fig.3).  The implant is further torqued until the implant plateau is 3 mm apical to the buccal gingival margin; a 5.5x5(3) mm abutment is placed (Fig.5 A).  Osteogen plug is inserted into the apex of the socket, while the rest of gap is filled with mineralized cortical allograft and Osteogen.  An immediate provisional (P) is fabricated to keep the graft in place, followed by periodontal dressing.

Three months postop, the provisional is dislodged (Fig.7).  The mesial gingiva is hypertrophic buccally and lingually.  There appears to biologic width violation (Fig.5 arrowhead).  The abutment should be changed to the one with smaller in diameter and longer in cuff (4.5x5(4) mm) with the buccal margin reduction.

Deep Placement

Xin Wei, DDS, PhD, MS 1st edition 04/24/2016, last revision 04/24/2016