After using a 4 mm RT osteotome 11 mm deep (Fig.4), a 4x14 mm gingival level implant was placed below the sinus floor (Fig.5).

Probably due to lack of peri-op antibiotic and Chlorhexidine mouth rinse, flapless technique (blind manipulation and entrapment of the epithelium), over preparation with the 4 mm RT (Fig.4) and without sinus floor (cortical bone) locking (lift), the implant was found to be infected a month postop.  When the implant was removed, the buccal plate was found thin.

The possible causes of the failure were addressed when the implant was placed for the second time.

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Xin Wei, DDS, PhD, MS 1st edition 07/16/2013, last revision 07/17/2014