Osteotomy at #3 is performed last (Fig.1,2); as planned, a 4 mm cortical tap is used with guide for sinus lift.  Unfortunately the sinus membrane is perforated.  Implant placement is aborted.  Instead Osteogen plug is inserted into the osteotomy, which is fixed in place by acrylic extending from the provisional at #4.  Osteotomy for #3 implant will be attempted with control of the depth in 4 months.  The patient has allergy to Amoxcillin (rash).  When switching to Clindamycin, she develops diarrhea and loses 10 pounds.  There is no abnormality at the site of #3 or 4 nearly 3 months postop (Fig.3).  The next surgery will be most likely conducted without antibiotic.

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