The bone is long enough to hold a 11.5 mm long implant.  There is no difficulty in inserting the corresponding drill (4.5x11.5 mm) into the metal sleeve, but the lower right posterior teeth prevent the implant handpiece from going downward completely when the handpiece accesses lingually.  Because of the extra manipulation, a 5x10 mm implant achieves insertion torque of ~ 20 Ncm (Fig.2).  <: apical space.  When the implant is placed initially according to the protocol/design, the implant is slightly supracrestal buccally.  The implant is then seated apically ~.5 mm, which is unnecessary retrospectively.  The bone density mesial to the implant (Fig2 *) increases 5 months postop (Fig.4), whereas that distal to the implant remains low 9 months postop (Fig.5).  Bitewings taken 2.5 months post cementation (1 year postop, Fig.6,7) show subcrestal placement of the implant (advantage of guided surgery).  The implant appears to be well protected; the crestal bone seems to cover the implant plateau.  There will be little chance of thread exposure over years of use.

Limiting Factor Last Next Xin Wei, DDS, PhD, MS 1st edition 06/21/2019, last revision 06/22/2019