The longest (12 mm) bone trimmer seems not to work over the guide at #15.  When osteotomy finishes, the guide is removed.  The sinus floor happens to have been removed, whereas the sinus membrane remains intact.  After partial insertion of a piece of PRF membrane (due to hemorrhage) and Vanilla graft for sinus lift, a 5x10 mm implant is placed with 15 Ncm.  The implant appears to be short and placed deep (Fig.1,2).  When an implant is not too large, it can be placed ~ 1 mm subcrestal (vs. 2-3 mm for this case) in spite of the palatal wall defect.  A cover screw is used, followed by allograft (Fig.1 *).  The latter is covered with another piece of PRF membrane, collagen membrane and periodontal dressing.扭力有时是假象，如果植体卡在硬点（例如骨皮质）而产生高扭力之后骨坏死，植体可能松动。

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Xin Wei, DDS, PhD, MS 1st edition 09/29/2018, last revision 01/31/2021