A 4.5x10 mm dummy implant is placed with high torque after 4x7.3 mm drill with 3 mm stopper so that 4.5x7.3 mm drill with 1 mm stopper is used before placement of a 5x8.5 mm final implant with ~ 35 Ncm (Fig.6-7).   There is no pain when a 5.2x4(2) mm cemented abutment is torqued at 30-35 Ncm before impression (Fig.8).  *: bone graft in the sinus.

But the patient feels pain when the crown is cemented 2-3 weeks later.  Occlusal adjustment alleviates the discomfort.

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Xin Wei, DDS, PhD, MS 1st edition 01/23/2020, last revision 06/01/2020