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The palatal socket (bony) is shallow and wide (Fig.2 between arrowheads) with the septal wall being lower than the the palatal wall. Osteotomy is initiated with a series of tapered osteotomes, followed by a 4.5x20 mm tap (T, too distal). A new osteotomy is formed mesiobuccal to the earlier one (Fig.3). At this moment, there is bone between these two osteotomies, but the last tap (4.5x20 mm) is not stable. Larger taps have to tried (6x20 mm, 7x17 mm, still not stable). Then these osteotomies have started to merge with the second one too buccal. Effort has been exerted to create a third osteotomy palatally without success; visibility is poor due to hemorrhage from the previous osteotomy sites. In spite of these maneuvers, there is no sign of sinus membrane perforation.
Xin Wei, DDS, PhD, MS 1st edition 08/15/2015, last revision 04/28/2018