Vanilla graft with Osteogen is placed after fabrication of an immediate provisional (Fig.6 *). The patient returns for impression 5 months postop (4 months post implant back up, Fig.7).  The patient has had the similar complaint 9 months postop; it appears that there is radiolucency distally (Fig.8 >, as compared to radiopaque mesially (*)).  The distal gingiva is tender.  With a remade permanent crown, oral hygiene instruction is provided.  If necessary, CBCT is taken with possible bone graft.

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Xin Wei, DDS, PhD, MS 1st edition 06/18/2018, last revision 02/23/2019