After mobilizing the mucoperiosteal flap, the 3-mm center punch was used to register a guide for the twist drill. The twist drill was used to establish the axial alignment of the implant and to assist in the guidance of the depth drill. The depth drills were sequentially used to create osteotomy to the subcrestal axial depth of 0.5 mm. The conical reamer was used to develop the conical shape of the implant body and to check the osteotomy depth. A counter-clockwise rotation was used to compress the bone in soft bone. The tap or thread cutter was used for dense bone to create the threads in the osteotomy. The thread cutter’s diameter corresponds to the implant diameter. To engage the implant into the implant placement tool, the square faces on the implant fixture mount were aligned with those on the implant placement tool, then pushed together. Using the handle (finger wheel), the implant was pulled out of inner vial and the plastic collar was discarded. The implant placement assembly was transferred to the osteotomy and the implant was secured into the osteotomy site. The implant placement was started with the handle and finally placed using the hand-ratchet. If excessive force was experienced, the osteotomy was rinsed out and the depth was checked by retapping. To disengage fixture mount from implant, the open-ended spanner was used to break the retention force of the fixture mount retention screw. The knurled top of the implant placement tool was turned by hand to fully disengage the fixture mount with the implant. Pushing down on the knurled top of the implant placement tool disengaged the fixture mount.

Suturing

Expected length of the procedure was approximately 1 h. Following placement of the implants, the wound was sutured in layers.