Two groups of patients with atrophy in posterior maxilla indicated for sinus lift.~(A) First group will be subjected to open sinus lift with chin bone graft.~All cases will undergo surgery under general anesthesia for sinus lift and other surgery under local anesthesia for implant placement .~Exposure of the anterior wall of maxilla according to standardized surgical approach.~Open sinus lift and bone graft.~After 6 months, implant will be drilled and inserted in the recipient site according to standard protocol.~Loading on implant after 5-6 months.~(B)Second group will be subjected to sinus floor elevation using a bone ring.~All cases will undergo surgery under local anesthesia for implant placement in the mandibular chin and other surgery under general anesthesia for sinus lift using bone ring with the implant.~Exposure of the mandibular chin will be done under local anesthesia using a standardized surgical approach.~Implant will be drilled and inserted in the chin according to standard protocol.~After 3 months, second surgery under general anesthesia to place the implant and surrounding ring in the atrophied posterior maxilla.~The bone ring containing the implant allowed to heal for 5-6 months.~Follow up:~Clinical evaluation will be performed at the first week post-operative.~Three months post-operative second surgery to put the implant with surrounding ring in atrophied posterior maxilla.~Five months post-operative to the second surgery, implant will be loaded with the final restoration.
Two groups of patients with atrophy in posterior maxilla indicated for sinus lift.~First group will be subjected to open sinus lift with chin bone graft. Second group will be subjected to sinus floor elevation using a bone ring.