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After 4.0x10 mm drill with 9 mm offset for 4.5x10 mm bone-level implant at #19, a 4.5x17 mm tissue level tap is inserted with apparently low torque (probably without reaching the depth). When a 4.5x14 mm tissue level implant is placed with high torque, a 4.5x7.3 mm drill is used for ~ 6.5 mm. The implant loses the primary stability with over-insertion (Fig.1). When an abutment is placed, the implant is critically loose. Mixture of autogenous bone, Osteogen and allograft is placed in the osteotomy. The implant regains stability with better placement level for restoration (Fig.2). In fact the bone density around the implant increases (Fig.2 *). Retrospectively, a 5x14 mm implant should be placed.
Xin Wei, DDS, PhD, MS 1st edition 08/13/2019, last revision 04/13/2020