The twist drill preparation at fixture installation confirmed the persistence of the sclerotic margin with increased cutting torque at the former apex. The image confirms penetration of the apical sclerotic bone (Figure 2).

Autogenous graft bone was required on the axial walls of the osteotomy for all of the former tooth root length. The patient experienced an acute transitory inflammation on day 4 and 5 post fixture installation, but little or no pain before or since. It is our contention that this fixture osseointegrated because the fixture apex was placed at a length which exceeded the former root length, being definitively superior to the persistent sclerotic border presenting at osteotomy. The primary stability was obtained by engaging the superior nasal cortex (Figure 3).