In fact the bone density at the edentulous area (#4) is high.  Drills are used to finish placing a 4x17 mm tissue-level implant (Fig.3).  No allograft is used for sinus lift at this site.

With proper manipulation, a 6x14 mm implant is placed at #3 with primary stability (Fig.3).  The sinus membrane is perforated at #3, which is repaired with Osteogen plug without bone graft prior to implantation.  Vera Graft (*) is used for closure of the socket spaces.  No gap exists 7 months postop (Fig.6).  The implants are placed close to each other, vulnerable to periimplantitis if oral hygiene is not maintained.

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Xin Wei, DDS, PhD, MS 1st edition 09/26/2017, last revision 04/24/2018