The septum is thin and the buccal crest is low after extraction (Fig.3 * (mesial root vertical fracture)).  Osteotomy will be initiated in the much larger mesial socket immediately against the septum.  Due to angulation, the fact that the mesial socket is much larger than the distal one is not shown. 

Two pieces of gauze thread is removed later.  The gauze was used to disinfection and hemostasis.

Initially an osteotomy is created lingually (in the mesial socket) using 1.5 mm drill for 17 mm against the septal crest.  In fact the lingual plate is perforated because of severe undercut (slope in the submandibular gland fossa).  A new more buccal osteotomy is then made with change in trajectory buccolingually.  It appears that the lingual plate perforation does not recur.  The perforation is not intentionally repaired.  A shorter osteotomy should avoid the lingual perforation.  Preop CT is also helpful.

Bone Shorter Than Expected Last Next

Xin Wei, DDS, PhD, MS 1st edition 12/07/2017, last revision 08/25/2018