After extraction at #15 with 9 mm offset, a 12 mm bone trimmer is used to create a dimple in the septum. When a 4x7.3 mm drill is done according to drill sequence, initial osteotomy has no palatal wall.  A 4.5x10 mm dummy implant cannot engage for sinus lift.  DIO Sinus Approaching drill cannot enter IS green metal sleeve.  When a 4x8.5 mm drill is finished, the sinus floor is intact.  This is not the case when a 2.2x10 mm drill is used.  Water membrane lifter does not seal the osteotomy (palatal defect).  The 4.5x10 mm dummy implant is used for sinus lift, followed by 2-3 Amalgam carriers of allograft (not so distinct) lifted with the same implant (Fig.1,2).  After 4x10 mm drill and 2-3 carriers of Vanilla graft, a 5x11.5 mm implant is placed >55 Ncm with immediate placement of a 5.7x4(2) mm abutment (Fig.3).

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Xin Wei, DDS, PhD, MS 1st edition 09/03/2019, last revision 06/07/2020