The socket looks large when osteotomy is finished for a 3.8 mm implant.  Without further osteotomy, a 4.5x14 mm SM implant is placed with primary stability (Fig.2).  Without much attention, the coronal end of the implant is gradually deviated buccal, although the buccal gap is still 2 mm.  The bone graft seems to have disappeared 3.5 months postop; the implant appears to have not been placed deep enough (Fig.6).  In fact the implant plateau is < 2 mm subgingival palatal.  An anterior immediate implant should be placed deep to reduce periimplantitis.  There is reduced risk associated with abutment screw loosening, as compared to the posterior.  Luckily the patient has used water pik since implant placement.  On the other hand, water pik may be related to loss of bone graft.  Therefore, water pik should be used 1 month post bone graft associated with immediate implant.  The bone graft remains around the abutment cuff 4 months postop (Fig.7; immediately
post cementation).

Palatal Osteotomy Last Next Xin Wei, DDS, PhD, MS 1st edition 07/18/2019, last revision 07/19/2019