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When a 4x11 mm implant is being placed, it tends to deviate distally. The implant is backed up twice: initially it appears to lean mesially, but as it is seated deeper, it is deviated distally again (Fig.3). Insertion torque is > 60 Ncm, probably due to under preparation, as compared to over preparation associated with the 1st placement. Bone next to the implant (*) is denser than before.
An immediate provisional has to be fabricated to prevent the space from further narrowing. A 3.5x3 mm abutment is placed. The mesial surface of the tooth #14 (Fig.4 (illustration) black area) is trimmed for restoration.
Xin Wei, DDS, PhD, MS 1st edition 01/14/2015, last revision 01/14/2015