Both the mesial and distal sockets are large with a thin septum in between.  Osteotomy is established at the base of the septum, slightly toward the mesial socket, as evidenced by a 5x20 mm tap in place (Fig.2).  The septal bone is dense.  High speed handpiece and fissure bur have to be used to make a slot in the septum so that drill/reamers (instead of osteotomes) can be used to form osteotomy slightly mesial to the septum.   The mesial socket (M) is more radiolucency than the distal one (D), probably due to loss of the mesiobuccal plate.

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Xin Wei, DDS, PhD, MS 1st edition 07/19/2013, last revision 07/19/2014