When the osteotome penetrates the bone initially, the latter is going to be condensed and pushed laterally (mesiodistally) and apically (Fig.3 arrowheads). 

As the osteotome advances, some of the bone is brought apically (Fig.3 insert).  

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Xin Wei, DDS, PhD, MS 1st edition 01/08/2013, last revision 01/08/2014