Fig.1: preop; Fig.4: 3.5x11 mm drill; Fig.5': 4.5x11 mm tap; Fig.6: 4.5x11 mm implant.  Red line: original mesial apical outline of osteotomy.  It shows that it is possible to change trajectory at late stage of osteotomy by changing angulation and position of burs, paying attention of orientation of tap and implant while inserting them.

Although there is no bone graft, implant placement apparently leads to sinus lift (Fig.6 arrowheads).

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Xin Wei, DDS, PhD, MS 1st edition 01/15/2013, last revision 01/16/2014