*4.5. Patient No.5*

A 64-year-old male with no known allergies or medical or toxicological history of interest came to the clinic to assess rehabilitation of the second edentulous posterior quadrant by placing implants. CBCT was performed (Figure 18A) to assess bone availability in the area. It was observed that it was necessary to perform a sinus lift with a lateral window to have sufficient bone availability for the dental implant placement of 26 (3.6 mm height). It was decided to use Bond Apatite® as the bone graft material. On the day of surgery, the manufacturer's protocol was followed, detachment of the mucoperiosteal flap, preparation of the window and detachment of the sinus membrane, activation of the Bond Apatite® syringe and waiting for 1 min, placement of Bond Apatite® in the mesial area and compression with a periosteotome wrapped in a dry and sterile gauze, placement of Bond Apatite® in the distal and medial area until the cavity is filled, compression with a dry and sterile gauze from the outside of the window, reposition of the flap and suture under tension (Figure 19). Two syringes of Bond Apatite® were used. No intraoperative complications occurred and a CBCT was performed immediately after surgery (Figure 19) where a bone height gain of 12.6 mm was observed. Postoperative recommendations and pharmacological regimens were delivered. Periodic monthly check-ups were performed and at 4 months a new CBCT was requested (Figure 18C) of the area for implant planning, where good healing and bone height gain of 5.6mm were observed, a surprising result since it means that, after 4 months, more than 50% had been lost on the day of surgery. On the day of implant placement, a trephine biopsy was taken in the regenerated area for histopathological analysis (Figure 20) and a 4.25 × 10 mm Microdent® Genius implant was placed at 26 following the drilling protocol of the commercial house. The same pharmacological regimen was prescribed as on the day of the sinus lift, and monthly follow-up visits were scheduled. Three months after the placement of the implant, the second surgical phase was carried out, and prosthodontic rehabilitation is currently being carried out.

**Figure 18.** (**A**) Preoperative CBCT; (**B**) Immediate postoperative CBCT; (**C**) Postoperative CBCT after 4 months.

**Figure 19.** Intraoperative photographs.

**Figure 20.** Abundant newly formed bone in (**A**) at 50× and in (**B**) at 200×. Total bone length is 7.2 mm and newly formed bone is 5.4 mm.

#### *4.6. Patient No.6*

A 46-year-old man with no known allergies or relevant medical or toxicological history came to the clinic to assess rehabilitation of the edentulous second posterior quadrant by placing implants. CBCT was performed (Figure 21A) to assess bone availability in the area. It was observed that it is necessary to perform a sinus lift with a lateral window to have sufficient bone availability for implant placement since there was 6 mm in the 2.4 mm area and 2.8 mm in the 26 area. It was decided to use Bond Apatite® as the bone graft material. On the day of surgery, the manufacturer's protocol was followed, detachment of the mucoperiosteal flap, preparation of the window and detachment of the sinus membrane, activation of the Bond Apatite® syringe and waiting for 1 min, placement of Bond Apatite® in the mesial area and compression with a periosteotome wrapped in a dry and sterile gauze, placement of Bond Apatite® in the distal and medial area until the cavity is filled, compression with a dry and sterile gauze from the outside of the window, reposition of the flap and suture under tension. Two syringes of Bond Apatite® were used (Figure 22). No intraoperative complications occurred and a CBCT was performed immediately after surgery (Figure 21B) where a bone height gain of 6mm was observed in the mesial area and 9mm in the most distal part. Postoperative recommendations and pharmacological regimens were delivered. Periodic monthly check-ups were performed and at 4 months a new CBCT of the area was requested (Figure 21C) for implant planning, where good healing and bone height gain of 6mm in the mesial area and 9mm in the distal area were observed. Currently, the patient must undergo implant placement surgery and subsequently a second surgical phase and definitive prosthodontic rehabilitation. The results of the bone biopsy are shown in Figure 23.

**Figure 21.** (**A**) Preoperative CBCT at level 24, 25, and 26; (**B**) Immediate postoperative CBCT at level 24, 25, and 26; (**C**) Postoperative CBCT after 4 months at level 24, 25, and 26.

**Figure 22.** Intraoperative photographs.

**Figure 23.** Abundant newly formed bone and some trabeculae of devitalized bone in (**A**) at 50× and in (**B**,**C**) at 200×. Total bone length of 3.56 and newly formed bone of 3.01 mm.
