I have been dying to try out the Densah Burs by Versah. These work in reverse to compact spongy bone. In this case we have a lot of decay and OH issues, but he really wants an implant in #11, so we had to choose our battles. #9 has a very large PARL so we did endo and an Emax crown in Bio Copy.
By Bio Horizons and soon to be released Universal kit fir the dense burs really well. You start with a 2mm pilot running clockwise, then everything else in run in reverse to compact the bone. Interestingly enough we used a 3.7mm diameter Legacy 2, we compacted the bone with a 2.3 and I tried to insert my implant and it would not go down!! The bone was too compacted! So I switched to the 3.5 which was too big for the 3.4mm key. I used it free hand at 800 RPM. Think about that! I placed a 3.7mm implant using a 3.5mm drill, you only see that in D1 bone!! I measured from my hand piece head to the apex of the drill at 24mm and subtracted 1mm to get a D2 of 23mm.
I placed the implant through the guide to roughly get in in then removed the mount and got it in the rest of the way. Note the very subcrestal placement. You can see how much lower we are on the buccal and I am sure many would argue that I should have left threads exposed and grafted. I am more comfortable living without papilla (he has none) and having a longer tooth with such a low lip line than risking that the bone does not take. Especially with the oral hygiene issues, which is also why I did this as a two stage surgery.