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When osteotomy is done with the last drill 4x11.5 mm, there will be no deviation because of even counteraction between the buccal root and the lingual plate (Fig.6'). Then the root will be removed. But the 4.5x11.5 mm implant may be deviated buccal because of implant engagement into the lingual plate without buccal counteraction. Therefore, a 4x13 mm implant will be placed following 3.5x13 mm (last) drill.
Xin Wei, DDS, PhD, MS 1st edition 06/03/2020, last revision 06/13/2020