With the final implant (4.5x10 mm, Fig.4) being placed deeper to close the apical space, the cuff of the final abutment increases by 1 mm.  Autogenous bone is used to pack around the implant distobuccally (*).  Although the implant seems to be placed significantly apical to the lingual crest (^), it is at the buccal crest.  There seems to be no bone loss 3 months postop; impression is taken (Fig.5).  When the crown/abutment at #30 is loose 2nd time 1 year 7 months post cementation (Fig.8 taken post retightening), the screw at #19 fractures.  The tooth #2 needs a crown.  The patient cannot use the anterior teeth, since the teeth #8 and 9 have root fracture.  Can extraction and bone graft increase bone height?  The abutment remains incompletely seated 9 months post screw replacement.  It should be fixed soon.

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Xin Wei, DDS, PhD, MS 1st edition 11/10/2020, last revision 02/24/2021