The bottom of the socket is sensitive.  For safety, block anesthesia is not attempted at this moment.  Instead, local anesthetic (2% Lidocaine with 1:100,000 Epinephrine) is injected into the socket bone without leakage (30 gauge needle).  It works!  The patient allows us to finish osteotomy 2-3 mm deep into new bone (2 mm pilot drill, 2.5-4.0 mm reamers) with minimal pain.  Finally a 8x17 mm tap is able to bind to the socket (Fig.4, about 3 mm to IAC, blue line). 

The osteotomy is initiated in the bottom of the mesial socket (not in the mesial slope of the socket as planned).   When the tooth is extracted, there is minimal septum between the mesial and distal sockets.

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Xin Wei, DDS, PhD, MS 1st edition 09/30/2014, last revision 09/30/2014