Extraction of the affected 2nd premolar is easy; the apical bone is so hard that drill (2 mm) and reamers (2.5 and 3 mm) have to be used for osteotomy, followed by insertion of a 4.5 mm tap with stability (Fig.1 T).  The sinus floor (^) is lifted. There is no sinus membrane perforation.

There is no sign of sinus membrane perforation before placement of a 4.5x14 mm implant (Fig.2 I); sinus lift is performed (*, with mixture of autogenous bone (from reamers), allograft and Osteogen). Arrowheads: remaining mesial and distal sockets, which will be bone grafted after provisional fabrication.

Bone density in the mesial and distal sockets increases after bone graft (Fig.4: arrowheads).

The distal threads appear not covered by the bone, with mild distal crestal, 2.5 months postop (Fig.11 >).

Intraop Modification of Immediate Provisional    Last    Next

Xin Wei, DDS, PhD, MS 1st edition 07/30/2015, last revision 03/21/2020