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.

Intraop Modification of Immediate Provisional Next

Xin Wei, DDS, PhD, MS 1st edition 07/30/2015, last revision 02/09/2020