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26 I I case report _ endo-implant algorithm then grafted with a mixture of DBX and MCP using a marshmallow technique. This grafting mixture helps the site produce its own bone in terms of mineral and collagenfromtheDBX,anditprovidesabetterscaffold effectfromtheMCP.TheareawascoveredwithaPTFE membrane, slightly tucked under the periosteum (not morethan2mm).Suturesweredonewithpolyglycolic acidusingacriss-crossfour-xcornertechnique(Fig.3). _Removing the sutures The sutures were removed two weeks later. Two weeks after suture removal, the patient was seen againfortheremovalofthemembrane.Thiswasdone by gently picking at the membrane with cotton pliers and exerting pull on it—there is often no need for anaesthesia. The benefit of using this allograft cock- tail is that the waiting period for re-entry was ap- proximately four to six months versus six to nine had a xenograft been used. The quantity and the quality of the bone appeared to be much better with the use of this allograft cocktail. At the time of re-entry, the patient’s blood pres- sure was 113/69 with a heart rate of 64 (Figs. 4 & 5). Under local anaesthetic (Lidocaine 2 per cent HCl withepinephrine1/50,000x2cpl),atissuepunchac- cess was done using a 3.8 tissue punch XiVE drill (DENTSPLY Friadent). The pilot drill from the ANKYLOS implant system (DENTSPLYFriadent)wasthenusedtodrill6mm,just short of the sinus floor (Fig. 6). A series of XiVE os- teotomes, from size 2.0 up to 3.4, were used to per- form a sinus lift using the Summer’s technique. The osteotomy was prepared to a depth of 11mm (Fig. 7). A Valsalva test was performed to ensure that the sinus had not been perforated. An ANKYLOS implant A11 (3.5mm x 11mm) was placed and primary stabil- itywasobtained.Thedensityoftheboneperceivedas D-3 during the drilling stage, likely changed to D-2 with the use of the osteotomes. The implant-transfer mount was removed, as was the cover screw that came pre-mounted inside the implant, and a 1.5mm sulcusformer(healingabutment)wasplacedintothe implant (Figs. 8 & 9). This case clearly demonstrates one of the reasons that endodontists are becoming increasingly in- volved in implant dentistry. They are able to provide a comprehensive evaluation of the tooth in question, and they are able to present the patient with the best options based on clinical assessment._ roots1_2010 DrJoseM.Hoyograduated fromtheUniversityofPuerto RicoSchoolofDentistryin 1984.HereceivedhisCer- tificateofAdvancedGradu- ateStudiesinEndodontics fromBostonUniversity’s HenryM.GoldmanSchoolof GraduateDentistryin1994. HepracticesasaspecialistinEndodonticsand ImplantdentistryinsouthernMassachusettsandcan becontactedatdrjhoyo@aol.com. _about the author roots Fig. 8_Radiograph of implant with sulcus former (healing abutment); the apical portion of the implant is under the Schneiderian membrane. Fig. 9_Bitewing X-ray showing sub-crestal placement of implant with sulcus former in place. Fig. 8 Fig. 9