What is ignored is the mesial deviation of the initial osteotomy (Fig.2 <).  The osteotomy shifts to the mesial socket with the next drill.  The severity of the deviation is not found until a 5x11.5 mm implant is placed (Fig.3).  While Osteogen plug is placed in the apical socket (P), Vanilla (allograft) mixed with Osteogen in the coronal socket (*).  Because of tight schedule and partial flap (to remove fractured roots), periodontal dressing is applied around the immediately placed abutment (for retention).   An angled abutment may be required before final impression because of the deviated implant.  The implant seems to have osteointegrated 3.5 months postop (Fig.6, a month post abutment dislodgement).

Osteotomy Deviation Last Next

Xin Wei, DDS, PhD, MS 1st edition 09/10/2018, last revision 09/10/2018