1. Pamela Nicoara DDS Sinus Elevation Open Sinus Elevation with Lateral Ridge Augmentation

2. Pamela Nicoara DDS Fractured abutment #11 and recurrent decay abutment #13. Bridge to be sectioned and #15 temporarily used as temporary RPD abutment. Note large pneumatized sinus in area of proposed implants.

3. Pamela Nicoara DDS Note lack of osseous density in area of extraction sites.

4. Pamela Nicoara DDS Note severely resorbed ridge in canine/premolar region.

5. Pamela Nicoara DDS Lateral sinus access and elevation, filled with bone grafting material.

6. Pamela Nicoara DDS Ridge also augmented with bone grafting material and a membrane used to maintain bone grafting material in the proper location.

7. Initial 6 month Recall Pamela Nicoara DDS

8. Note augmented ridge and sinus, with tacks and membrane still in place.

9. Pamela Nicoara DDS Precision surgical guide fabricated to assist in accurate implant placement.

10. Pamela Nicoara DDS

11. Initial Pamela Nicoara DDS

15. Closed Sinus Elevation Sinus Elevation

16. Pamela Nicoara DDS Patient presents with prior extraction and simultaneous bone graft site #4. Perforation of sinus is anticipated when placing appropriate length implant. Flapless implant placement and sinus elevation is planned.

17. Pamela Nicoara DDS Osteotome used to elevate sinus floor.

18. Pamela Nicoara DDS

19. Note osseous sinus floor appropriately tented over implant apex.

20. Thank You! 3125 Colby Avenue, Suite H Everett WA 98201 T: 425-374-5380 F: 425-374-5382 16030 Bothell Everett Hwy, Suite 260 Mill Creek WA 98012 T: 425-224-8199 F: 425-338-7062 www.NICOARAperio.com NICOARAperio@gmail.com Pamela A Nicoara DDS MSD PLLC