salam alikum. How are you? Here is a new case. Comments and discussion is very welcomed. Wish you a good day (Bicortical anchorage) A 42 years old male showed up with missing upper right 1st and 2nd premolars. Teeth were extracted several years ago due to non-restorable deep cavities. Clinical examination and radiographic examinations were performed. The radiographic examination showed expected bone quality of D5 bone, and bone height of 12.5 mm at the area of tooth 15 and height of 18 mm at area of tooth 45 before reaching the maxillary sinus floor. Bone width buccolingually was 4.3mm and 5.1mm respectively. Clinical examination showed narrow ridge at area of extracted teeth in comparison to neighboring teeth. Patient was informed with procedures needed to place dental implants and installation of restorations to restore missing teeth. Topical anesthesia gel was applied 3 minutes prior to local anesthesia injection. Local anesthesia injection was administered buccally C3514, C4514 Trate single piece Compressive implants (Bäch, Switzerland) were selected for use to replace teeth 14 and 15 respectively. A high speed handpiece with a diamond stone was used to do the first drill through gingiva and bone to a depth that is just to pass the cortical bone. This was to point the area to drill through and to reduce resistance over the implant drill. Implant site preparation was performed according to manufacturer’s instruction at are of tooth 15, a drill corresponding to the chosen implant size was used in each implant site, drilling was performed in a total flapless technique directly into bone through the ginigva, with drilling 2mm more than desires height to compensate the gingival thickness. Drilling was performed with speed of 800 RPM, Torque of 30 Ncm and normal saline irrigation. This was followed by the corresponding compressive screw. Compressive screw was not inserted to the end of screw desired height in order to use implant self-tapping criterion to increase primary stability. At area of tooth 14 a small sized compressive screw that is related to Microdent, Spain was used to prepare a small osteomtomy to receive the implant, and the implant would continue inside with self-tapping; to compensate low bone quality as suspected by CBCT. An implant was placed in each missing tooth site. Implant was screwed primarily in place using the plastic implant mount until it reached reasonable torque that enabled to remove the plastic mount and the use of the torque wrench with insertion tool to insert the implant in bone. Implant insertion with the torque wrench was continued until the margin of abutment part of the implant was inside gingiva with 1mm; in order to enable the placement of restoration margin subgingivally. Implant site preparation and implant placement was done for each tooth separately. Insertion torque exceeded 50 Ncm as shown by the torque wrench. Placing the implant for tooth 14 with engagement of palatal plate of bone, and placing the implant for tooth 15 with last 2 mm engaging the base of the maxillary sinus; in order to reach a reasonable primary stability. Implants at area of 14 was bent in palatal direction with use of torque wrench and insertion tool to fit in the desired teeth alignment. Impression transfers were placed over the implants. Rubber base addition silicone impressions were taken, then implant analogues were placed. Impressions were sent immediately to lab to manufacture the temporary restorations. Temporary PFM crowns with flat tops and out of occlusion were made within 4 days after impressions were taken. Temporary crowns were cemented with use of temporary cement. Crowns were then checked for occlusion and were put either out of occlusion or in light occlusion mode; in order to decrease destructive occlusal stresses over implants. CBCT radiographs were recorded showing the bending angles of the placed implant. Patient was instructed for use of (Augmentin 625 mg tab t.d.s.) and Ketolac 10 mg tab bis (KETOROLAC TROMETHAMINE, Surav Chemicals limited, Cairo, Egypt)) for six days. Immediate postoperative periapical radiographs were recorded. Patient was scheduled for final impressions and restorations to be after 2 months of implant insertion. According to schedule, patient was recalled. Temporary crowns were removed and implant stability were checked with surgeon hand. Addition silicone impressions (with aid of impression transfers and implant analogues), were taken and sent to lab. Separate porcelain-fused-to-metal restorations were manufactured, occlusion was checked and they were cemented with use of glass ionomer.