The patient is extremely nervous about implant placement at #14.  Access is obtained with a 4 mm tissue punch, which appears to be the least traumatic.  Since the gingiva is ~ 5 mm thick, vision is poor and it is difficult to change osteotomy buccally.  It seems a 6 mm tissue punch is more appropriate for this case.  The initial osteotomy depth is 14 mm (Fig.1).  Since the tooth #15 is nonsalvageable because of furca caries and bone loss (Fig.1 *), the distal osteotomy at #14 is apparently acceptable.  It may be otherwise if an implant will be placed at #15.  The impacted tooth #16 may be an interference.

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Xin Wei, DDS, PhD, MS 1st edition 04/19/2018, last revision 09/16/2018