When the tooth #3 with severe buccal gingival recession is extracted and implants are placed at #3 and 4 with guide, sticky bone in 2 large pieces is packed between these implants with a previously large defect in a seemingly secure manner (Fig.1 *).  Use of a longer implant at #3 (11.5 mm vs. 10 mm) will reduce the chance of abutment screw loosening in the future.  The implant at #3 is placed in the palatal socket without apparently no sinus lift.  Apparently new bone forms between the implants 4 months postop (Fig.5).   The abutment at #3 may not be completely seated.  In fact it is loose, probably related to buccal gingival and gingival cuff erythema 6.5 months postop (Fig.6).  Large healing abutments are placed to form the interdental (inter-implant) papilla without effect (*).  Provisional crowns will be fabricated for the papilla formation.  When cemented abutments are placed (Fig.7), papilla formation by manipulation of provisional crowns seems unlikely.  Impression is taken.

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Xin Wei, DDS, PhD, MS 1st edition 02/20/2019, last revision 03/05/2020