One or Two 1-Piece Implants?

A 53-year-old woman (WX) had several missing teeth with a lower flipper (Fig.1,2, conditions 2 years ago).  Recently the tooth #24 fractured equigingival (Fig.2 saw-toothed line).  The edentulous area at #25 is narrow buccolingually (Fig.4a).  Start osteotomy lingually (L, Fig.4b red circle).  As the osteotomy increases (Fig.4c red circle) and a 2 or 2.5 mm 1-piece DIO implant is placed (Fig.4d green circle), the weaker buccal (B) plate is being expanded buccally. 

A 3 or 3.5 mm 1-piece implant is placed at #24 (Fig.3) after Metronidazole socket soaking.  The larger one is chosen (3.5 mm (Tatum)) if the implant at #25 fails to be placed.  A dummy implant is placed partially to test trajectory.  If the latter is bad, use an angled 1-piece one (Tatum).  The composite overhang (Fig.2 *) is to be trimmed (Fig.3 red line).  Take preop photos to show the concave buccal plate (Fig.4a) and intra- and post-op ones to show bone expansion (Fig.4b-d).

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Xin Wei, DDS, PhD, MS 1st edition 07/26/2016, last revision 01/27/2019