A 65-year-old man with idiopathic thrombocytopenic purpura and type 1 diabetes underwent a sinus floor elevation procedure. Using progressively larger burs, the surgeon safely lifted the sinus membrane 2-3 mm and deposited an autogenous bone graft. A layer of leukocyte- and platelet-rich fibrin was added to protect the membrane and accelerate healing before bone grafting. The osteotomy was filled with a composite graft and a dental implant was placed, achieving 6-8 mm of sinus elevation and good implant stability. A follow-up 3 months later showed improved stability.

1. 65 y/o M: ITP and Type I diabetes. Platelet count 111,000 after injection steroid and Blood Glucose 112
3-4 mm RSBH site #3
Dr. Michael Toffler NY,NY

2. After pilot drill used (3 mm depth) to 1 mm below sinus floor, the first
densifying bur VT1525 (2mm) with 4 mm Verban stop is used CCW at 1200
RPM with irrigation to the floor
VT1525, 4 mm stop

3. 2nd Bur VT2535 (3mm), 4mm Verban stop CCW at 1200
RPM with irrigation
VT2535, 4 mm stop

4. 3rd Bur VT3545, 4 mm Verban stop in CCW at 1200 RPM with irrigation.
Apical displacement cortical bone, a small area of membrane now exposed ( )
VT3545, 4 mm stop

5. VT3545, 6 mm Verban stop in CCW at 1200 RPM with irrigation
for further sinus floor elevation/membrane exposure
VT3545, 6 mm stop

6. 4th Bur VT4555, 6 mm stop in CCW at 1200 with irrigation
VT4555, 6 mm stop

7. At this point, I have safely lifted the sinus 2-3 mm and deposited an autogenous bone graft underneath
the sinus membrane. L-PRF is then added to the condensed osteotomy to further protect the membrane
and accelerate sinus healing prior to bone grafting.

8. The osteotomy is filled with L-PRF Block®(PRF, BioOss, MFDBA) and use theVT4555 bur at 200
RPM CCW with no irrigation to gently, apically displace the graft (done 3 times)

9. VS5258 (5.5) CCW 1200 RPM, 4 mm stop to finalize prep and facilitate full seating of a 6.0 x
9.5 mm Thommen Element RC (1 mm polished collar). Insertion with ISQ 78-80 and 6-8 mm of
sinus elevation
VS5258, 4 mm stop

10. 3 MONTHS: ISQ 84PREOP PLACEMENT ISQ 78