After use of 4.5x8.5 mm guide drill at #19, a 5x8.5 mm implant is placed with guide in place. When the latter is removed, the implant is found to be placed shallow.  Following use of 4.5x10 mm drill for ~.75 mm deeper, the implant returns with deeper placement (Fig.1,2), confirmed after guide removal.  Later the implant is turned 3 more times before placement of a 5.5x5(3) mm healing abutment.  Autogenous bone graft is placed between the gingiva and the abutment to reduce chance of periimplantitis.  The patient reports more severe pain (bone burn?) than free-hand placement at #30.  In fact there is no bone loss around the implant 10.5 months postop (Fig.3).

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Xin Wei, DDS, PhD, MS 1st edition 09/24/2019, last revision 09/24/2019