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A 59-year-old man is a bruxer, fracturing the teeth #8 and 9. Now the tooth #2 seems to have fractured. Since the apices appear to protrude into the sinus, either 7x14 mm tissue-level (Fig.2) or 6.9x10 mm bone-level (Fig.3) implant will most likely penetrate the sinus floor.
Since X-ray was taken more than 2 years, it would be nice to retake one immediately preoperatively for defect boundary. Take another one when a large expander or tap is stable inside the socket (Fig.1'' red arrow). The latter must be single, since the roots appear to fuse apicodistally (Fig.1'). Start osteotomy with Magic Expanders or RP in the middle of the mesial slope (Fig.1'').
Xin Wei, DDS, PhD, MS 1st edition 01/27/2017, last revision 01/27/2017