*2.3. Dental Implant Surgery and Biopsy Retrieval*

The dental implants were placed six months after the MSFE procedure. Implant osteotomies were made and biopsies were obtained from the previously grafted area at the planned dental implant positions, using trephine drills with an external diameter of 3.5 mm and internal diameter of 2.5 mm (Straumann® trephine drill) with copious irrigation of sterile saline. In the five patients 11 standard plus, regular neck, soft tissue level Straumann® SLA dental implants with a diameter of 4.1 mm and a length of 10 or 12 mm were placed. (Figure 1F). The dental implants were left to integrate in a non-submerged unloaded fashion. A panoramic radiograph was taken immediately after dental implantation to allow postoperative radiological evaluation. After 10–14 days the Gore-Tex® (W.L. Gore and Associates, Newark, DE, USA) sutures were removed and, if needed, provisional prosthetics were adapted to the new situation. Loading of the dental implants was prohibited for three months. After osseointegration of the implants, a restorative dentist fabricated and placed the superstructures.

**Figure 1.** Maxillary sinus floor elevation (MSFE) procedure using a mixture of autogenous bone from the maxillary tuberosity and a biphasic calcium phosphate (BCP). (**A**) The preparation of the top hinge door in the lateral window of the right maxillary sinus. (**B**) Harvesting of an autogenous bone graft from the maxillary tuberosity with a chisel at the same surgical side and during the same procedure. (**C**) The harvested bone graft is grinded in smaller pieces by means of a bone mill. (**D**) The milled bone graft is mixed with a biphasic calcium phosphate (Straumann® Bone Ceramic 60:40). (**E**) Area between the lifted lid and the maxillary sinus floor is filled with the mixed bone graft. (**F**) Radiograph taken directly after the insertion of two Straumann® SLA dental implants in the augmented right posterior maxilla (6 months after MSFE).
