The bone density of initial osteotomy until 3.5x7.3 mm drill seems to be soft (Fig.1,2).  Underprep is decided for the remaining osteotomy (Fig.3).  The last drill is 3.5x10 for 4.5x10 mm implant (Fig.4).  In fact initial insertion torque is >55 Ncm.  The implant has to be backed up several times to get final torque ~ 35 Ncm.  Retrospectively the bone density of the lower portion of the osteotomy is higher than that of the upper one (compare Fig.2,3). 

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Xin Wei, DDS, PhD, MS 1st edition 04/09/2019, last revision 04/13/2019