To reduce heat-induced bone necrosis at #19, osteotomy is conducted slowly with copious irrigation with cold saline.  Bone density is felt while a 5x10 mm implant is being placed after using cortical tap to the 2nd line of the implant driver.  The implant needs to be reverse torqued several times before reaching its final depth (Fig.1 (~50 Ncm)).  Since the residual roots are superficially positioned, the immediate implant looks as a delayed one.  Although the implant is placed mesial to the septum clinically, its position in X-ray seems to be normal.  Because of severe wear and lack of vertical height, a 6.8x5 mm healing abutment is placed.  Retention of bone graft placed in the distal socket (Fig.1 *) is maintained by spreading setting acrylic into the edentulous undercut areas.  The bone graft placed in the distal socket appears to have been converted to the native bone 3.5 months and 4 months postop (Fig.4,6).

High Torque Last Next Xin Wei, DDS, PhD, MS 1st edition 02/18/2019, last revision 08/03/2019