attempted internal sinus lift, perforation with 2.2mm drill, options: 1) abort and graft 2) place shorter and wider implant but already, palatal bone loss, limited B-L width of bone 3) sinus augmentation. proceeded with option 3, lateral window prepared with rotary and piezo instrumentation, challenging due to height and thickness of bone, no further perforation of membrane, collatape placed against membrane, bone placed in window, good pushback, implant placed.