Since there is no buccal plate atrophy at 4, or 8, socket shield is not attempted at #13.  Extraction turns out to be difficult because of tooth fracture.  The buccal and palatal flaps have to be elevated minimally for tooth sectioning and purchase point formation.  More surprising, a 4.5 mm implant appears to be too wide for the space; a 4x17 mm implant achieves insertion torque >60 Ncm (Fig.1,2).  Because of the seal with the immediate provisional, the bone graft remains in place 1 month postop (Fig.5).  There is no bone loss 5.5 months postop (Fig.6,7).

4 mm Implant Last Next Xin Wei, DDS, PhD, MS 1st edition 04/20/2019, last revision 09/13/2019