## 2 Case Report
### Surgical and Clinical Procedures  
All patients were administered 2.0 g of amoxicillin orally 1 h before the surgery. Following local anesthesia, a full-thickness flap was reflected to expose the lateral wall of the maxilla. A bony access window was prepared using a round blur. The SM was gently elevated using sinus curretes (Genoss, Suwon, Korea). The elevated SM was punctured using a 21-gauge aspiration needle (Figure 1a). The punctured area was slightly enlarged with a tweezer and a blade. Inflammatory tissue was removed via the punctured area as much as possible. The purulent exudate was then thoroughly drained using saline irrigation multiple times (Figure 1b-d). The removed inflammatory tissues were immersed in a 10% formalin solution for histological examination.  
Implant placement and bone grafting were performed, as described in a previous study [11]. Briefly, a Prichard elevator to the sinus cavity along the upper border of the access window was placed, followed by making osteectomies for implant placement, grafting synthetic bone substitute material (Osteon III, Genoss, Suwon, Korea) in the space between the sinus floor and the elevator, and placing the implants (Implantium or Superline, Dentium, Suwon, Korea) (Figure 1e,f). During bone grafting, care was taken not to displace the material into the punctured area by inserting the material only in the space  
\begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline \multirow{2}{*}{**Patient**} & \multirow{2}{*}{**Sev/Age** (years)} & \multirow{2}{*}{**Smoking**} & \multirow{2}{*}{**Residual Bone** **Height (mm)**} & \multirow{2}{*}{**Implant Sites**} & \multirow{2}{*}{**Implant** **Baseline and Length (mm)**} & \multirow{2}{*}{**Follow-Up** ** **after Final**} & \multirow{2}{*}{**Postoperative** **(Pre-operative/at the Presothesis Insertion** **[mm])**} \\  & & & & & & & & & \\ \hline \multirow{3}{*}{1} & \multirow{3}{*}{Male/39} & \multirow{3}{*}{Yes} & 4.0 & 24 & 3.8 \(\times\) 12.0 & \multirow{3}{*}{23} & Pain, nasal bleeding, and wound deblicence & \multirow{3}{*}{41.7/9.1} \\  & & & 4.0 & 26 & 4.8 \(\times\) 10.0 & & & \\ \cline{3-8}  & & & 3.5 & 27 & 4.8 \(\times\) 10.0 & & & \\ \hline \multirow{3}{*}{2} & \multirow{3}{*}{Male/47} & \multirow{3}{*}{Yes} & 2.0 & 17 & 5.0 \(\times\) 10.0 & \multirow{3}{*}{12} & Pain, nasal bleeding, and wound deblicence & \multirow{3}{*}{32.5/8.5} \\  & & & 1.5 & 15 & 4.5 \(\times\) 10.0 & & & \\ \hline \multirow{3}{*}{3} & \multirow{3}{*}{Male/49} & \multirow{3}{*}{Yes} & 4.0 & 17 & 4.8 \(\times\) 10.0 & \multirow{3}{*}{36} & Pain, nasal bleeding & \multirow{3}{*}{38.3/5.8} \\  & & & 0.8 & 16 & 6.0 \(\times\) 10.0 & & & \\ \cline{3-8}  & & & 31 & 14 & 3.8 \(\times\) 10.0 & & & \\ \hline \hline \end{tabular}
\end{table}
Table 1: Demographic and specific notes of the patients included in this study.  
below the Prichard elevator. After implant placement, bone substitute material was further grafted in the sinus to cover the implants completely. The bony window was covered with a collagen membrane (Genoss collagen membrane, Genoss, Suwon, Korea).  
A systemic antibiotic (Ciprofloxacinacin 500 mg, Ildong Pharmaceutical Co. Seoul, Korea) and a non-steroidal anti-inflammatory drug (Etodol(r) 200 mg; Micronized Etodolac, Yuhan Co. Seoul, Korea) were administered three times a day for 14 days. Patients were instructed to rinse the mouth with 0.12% chlorhexidine solution (Hexamedine, Bukwang Pharmaceutical, Seoul, Korea) twice a day for one week and were instructed not to blow their noses at least for one month. After 7-10 days, the sutures were removed. Uncovering for connecting healing abutments was performed after 4-6 months.  
All patients were carefully monitored. The final prosthesis was inserted two months after the healing abutment connection. Panoramic radiographic images and CBCT scans were taken immediately after sinus augmentation, at the time of final prosthesis insertion, and during the follow-up visit.