Placement of an implant in the posterior maxilla often relies heavily on a variety of procedures that increase the vertical dimensions of available bone. With numerous bone graft substitutes now available and recent advancements having been made in technique, the question arises of whether residual bone height still remains an absolute indicator for simultaneous implant placement in lateral wall sinus grafting. In addition to reviewing the literature, the authors present a case in which a direct sinus lift procedure was performed with simultaneous implant placement. The case report demonstrates how implants can be placed in a severely atrophic posterior maxilla and be successful.