A lateral sinus window is created with a round diamond bur in high speed handpiece with copious irrigation (Fig.3 W).  The sinus membrane is lifted without tear.  With the membrane protected with 2x2 gauze, an osteotomy (<) is developed at the site of the tooth #14 with the help of a surgical stent.

The window is made between the apicies of #14 and 15.  The latter may need internal sinus lift later.

The buccal plate is thinner than the palatal one.  This photo is taken probably following usage of 5x11 tap.  Osteotomy is moved palatally slightly using a Lindermann bur.  When a 6x11 mm tapered implant is being placed, the buccal plate is undergoing cracking.  The implant is not inserted as deep as it is supposed to be to avoid further bone cracking.

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Xin Wei, DDS, PhD, MS 1st edition 04/19/2013, last revision 04/20/2014