Today, the sinus floor elevation procedure is not only being used on a routine basis, but clinicians are reporting high success rates. The sinus floor graft has become an important option in the treatment of the edentulous posterior maxilla, where vertical bone height is less than ideal. A review of maxillary sinus floor elevation as an integral part of restoring the posterior maxillary is discussed. The related anatomy of the area and current osteotomy techniques are reviewed. This article describes a trephine osteotomy, which is an alternative technique to the existing lateral antrostomy approach currently being used.