The socket shield at #11 is apparently incomplete, since the apical gutta percha (Fig.2 <) and the apex of the root (Fig.2,3 R) are not removed.  The bone is hard when a 1.6 mm drill is being used (Fig.2) as the apical native bone is almost exclusively composed of the cortices.  Two of the apical threads of 3.5x13 mm implant are bent, while the implant is placed deeper than the osteotomy (Fig.3,7).  After placement of a 4.5x15 degrees A (2mm) angled abutment and Vanilla graft (Fig.7 *), an immediate provisional is fabricated.  There is smooth transition from the grafted bone to the native bone 4.5 months postop (Fig.10).  Low Magnification,  High Magnification of Fig.7,10.

Hard Bone Last Next Xin Wei, DDS, PhD, MS 1st edition 02/15/2019, last revision 02/18/2019