An implant socket between teeth is made according to the same surgical dictates as in a totally edentulous ridge. The socket is initiated slightly palatal to the center of the crest and inclined to leave more bulk on the labial side of the ridge.

Bone density will determine how deep the socket should be made. The socket should be drilled to its fullest depth (10) with a 700 XXL bur if the bone is dense. In a more porous ridge, 2-3 millimeters of bone may be left (11) to be interrupted by the legs of the implant. However, in the anterior maxillary arch the bone may progress from porous at the crest to very dense under the nasal vestibulum. Increasing resistance to the bur in deeper bone indicates this, and may necessitate using a fresh bur to avoid excessive friction. When the socket is acutely angled it is drilled to its entire depth, even in porous bone, to facilitate insertion in difficult seating situations.

The implant is tried in the site, and the post's angulation compared with that of the teeth to be prepared and included in the restoration. The neck must be bent to parallel the post (12) with these teeth, not necessarily perpendicular (13) to the arch — as in the totally edentulous maxilla. If the socket is angled across the dental arch line, the neck must be twisted (14) to follow the arch

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The single-headed inserting instrument is used with the narrow, single-tooth implant. Because the post is parallel to prepared teeth in most short-span situations, it is not usually acutely angled. Therefore, it is relatively easy to direct the taps along the axis of the socket with the single-headed inserting instrument.

As a normal operative precaution, gentle taps are appropriate. A supporting finger safeguards the labial plate, and both fingers should brace a narrow ridge or one in which the implant will closely approach either plate.

The implant is correctly seated when all faces of the bottom of the post meet the crest. Countersinking is usually unnecessary because the implant post is aligned with the teeth, and thus to the axial inclination of the ridge.

However, in a few cases only the palatal face of the post may touch the crest, and a notch should be made in the crest to correctly seat the post. As the operator gains experience, he will be able to predict the necessity for countersinking and make the necessary socket adjustment with the implant out of the mouth, prior to tapping.

Caution: If the implant remains in its socket during countersinking,

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