Because of high density, a 4.5x13 mm drill has to be used prior to placement of the same sized immediate implant (Fig.5).  For most of immediate implants, osteotomy should be under prep. 

The apical space (between arrowheads) is finally closed by seating the implant lower (Fig.6).

When he returns 2nd time (4.5 months postop), the implant appears to have osteointegrated (Fig.7).

Bone density increases 6 months post cementation (12 months postop) (Fig.15).

Immediate Implant in Hard Bone

Xin Wei, DDS, PhD, MS 1st edition 09/03/2015, last revision 01/19/2018