The ridge looks wide clinically 4 months post implant removal and socket preservation.  In fact, the graft bone is soft and the ridge is narrow after incision.  It appears that an angled 1 piece implant is an indication.  A 1.2 mm pilot drill is used to start osteotomy.  At approximately 17 mm, the patient feels pain.  The nasal floor perforates?  A 2 mm osteotome is utilized to enlarge the osteotomy.  At 17 mm, the osteotome is stable (Fig.1), but the nasal floor appears out of view.  Review of the preop PA shows that the distance between the gingival margin and the nasal floor (arrowheads) is ~22 mm (Fig.2).  It should be safe and necessary to place a 3x20 mm 1-piece implant with 15° angulation.

Return to Apparent Nasal Floor Perforation Last Next Xin Wei, DDS, PhD, MS 1st edition 03/27/2015, last revision 02/03/2019