A 65-year-old retired Caucasian male presented to the Western University of Health Sciences Dental Center expressing an interest in implants after consulting with a private practice periodontist and a dentist from a large implant dentistry practice. He had no medical conditions or known allergies, but reported a 40-pack-year history of using tobacco and quit just before attending the Dental Center. No caries or mucosal abnormalities were found during examination other than a combined periodontal endodontic lesion at tooth no. 3 and localized severe periodontitis at no. 31 and no. 30 with complete through-and-through furcation involvement. Tooth no. 18 protruded beyond the occlusal plane, and several areas of shallow facial abfractions were noted on mandibular incisor teeth. (See initial panoramic radiograph, Fig. 1.) For initial disease treatment, teeth no.3, no. 30, and no. 31 were gently extracted and the residual socket of no. 30 grafted with human cortical particulate allograft. While healing was uneventful and ridge width was preserved at no. 30, little bone remained at the no. 3 site (see Fig. 2). On the left side, similar low amounts of available bone prevented implant placement at the no. 14 implant site (see Fig. 3). Given the good overall health of the patient, continued tobacco abstinence, good oral mucosal health after initial therapy, and low amount of sinus anatomy complexity, we suggested lateral window sinus augmentation to the patient, and the patient accepted proposed treatment after explanation of risks, benefits, and alternatives to implant therapy.

All of the following surgeries were carried out under local anesthesia. The patient received one tablet of 0.25 mg triazolam the evening before the surgery appointment and was taking ibuprofen 600 mg every 6 h and amoxicillin 250 mg every 6 h for 1 week starting the evening before the surgery. Starting the second day after surgery, the patient was instructed to rinse twice daily with 0.5 oz. of chlorhexidine gluconate for 30 s after oral hygiene, and the patient was seen at least once 7 days after each surgical procedure for postoperative care and oral hygiene instruction.