When the patient returns for implant placement 1.5 years after the last treatment (SRP), the tooth #25 has exfoliated, whereas the tooth #24 is severely displaced.  In fact the buccolingual plates are found to be lost after extraction, corresponding to the 7.5 mm gingival thickness (Fig.3 arrow). 

Initial osteotomy with 1.2 mm drill is parallel to the terminal branches of the Incisive Canal (Fig.4 arrowheads).  The likelihood of intraoperative excessive hemorrhage is minimal.

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Xin Wei, DDS, PhD, MS 1st edition 08/05/2017, last revision 09/03/2018