1. Bilateral Maxillary Sinus Lift Right side is planned as a staged sinus lift procedure with the surgical removal of the second bicuspid Right side is planned as a staged sinus lift procedure with the surgical removal of the second bicuspid Left side planned for sectioning of fixed bridge, removal of fractured premolar, left antral graft and immediate placement of three osseointegrated tapered screw vent implants Left side planned for sectioning of fixed bridge, removal of fractured premolar, left antral graft and immediate placement of three osseointegrated tapered screw vent implants

2. First Surgical Procedure: Right Side This is a 40 year old patient scheduled for prosthetic reconstruction of maxillary arch This is a 40 year old patient scheduled for prosthetic reconstruction of maxillary arch Opposing fixed mandibular bridge work Opposing fixed mandibular bridge work No posterior maxillary dentition No posterior maxillary dentition Our goal was to place 2, long, tapered screw vent implants on the right side (13mm) Our goal was to place 2, long, tapered screw vent implants on the right side (13mm) Implant length is important in younger patients to insure long term, proper function against opposing fixed bridgework Implant length is important in younger patients to insure long term, proper function against opposing fixed bridgework

3. Staged Sinus Lift The right side was staged due to the lack of bone and the desire to augment the right antrum with 8-10mm of bone The right side was staged due to the lack of bone and the desire to augment the right antrum with 8-10mm of bone As with all of our bone grafting procedures, the grafts are augmented using platelet concentrate As with all of our bone grafting procedures, the grafts are augmented using platelet concentrate

4. Second Surgery: bilateral procedure 2 tapered screw vent implants are placed into the right antral graft 2 tapered screw vent implants are placed into the right antral graft On the left side we sectioned the fixed bridge distil to the maxillary left canine On the left side we sectioned the fixed bridge distil to the maxillary left canine The left first bicuspid was surgically removed The left first bicuspid was surgically removed 3 tapered screw vent implants were placed in the left quadrant 3 tapered screw vent implants were placed in the left quadrant The anterior implant was immediately placed in the extraction site of the first bicuspid The anterior implant was immediately placed in the extraction site of the first bicuspid An antral sinus lift was performed on the left side for the posterior implant An antral sinus lift was performed on the left side for the posterior implant 11.5mm implant placed immediately into left antral graft 11.5mm implant placed immediately into left antral graft

5. Surgical Notes Notice complete osseous healing of buccal window 4 months after staged antral graft on the right side Notice complete osseous healing of buccal window 4 months after staged antral graft on the right side The right sinus lift graft enabled the placement of a 4.7, 13mm & 3.7, 13mm implants into the second bicuspid and first molar sites The right sinus lift graft enabled the placement of a 4.7, 13mm & 3.7, 13mm implants into the second bicuspid and first molar sites

6. Surgical Notes Note buccal defect associated with anterior implant placed immediately into the first bicuspid extraction site Note buccal defect associated with anterior implant placed immediately into the first bicuspid extraction site Sinus window and schneiderian membrane visible with parallel pin in distil implant site Sinus window and schneiderian membrane visible with parallel pin in distil implant site Graft applied to left antrum as well as buccal defect Graft applied to left antrum as well as buccal defect Note the neat isolation and containment of graft material due to the use of platelet rich plasma Note the neat isolation and containment of graft material due to the use of platelet rich plasma

7. Final Notes Note radiopaque areas in the right and left sinus cavities indicating organization and ossification of sinus grafts Note radiopaque areas in the right and left sinus cavities indicating organization and ossification of sinus grafts This patient was treated in 2 efficiently planned surgical procedures with the aid of general anesthesia This patient was treated in 2 efficiently planned surgical procedures with the aid of general anesthesia