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In maxillary sinus floor elevation, the least invasive technique capable of achieving equivalent regenerative outcomes
should be preferred, and this choice is primarily dictated by sinus anatomy. Among anatomic variables, sinus width,
more than residual bone height, should guide the approach: narrow sinuses, regardless of access (lateral or crestal),
inherently permit rapid vascular ingrowth from opposing walls and stable clot organization. The key difference lies in
sinus membrane detachment: indirect transcrestal elevation yields a predictable, uniform elevation only in narrow
sinuses; in wide sinuses, the lateral window is more reliable.
Using injectable grafts in narrow sinuses via a small crestal osteotomy permits fast and controlled hydrodynamic
membrane elevation and excellent space adaptation. However, when injectable materials are used, immediate
placement is strongly recommended to provide a tenting effect that counteracts sinus pressure and helps maintain graft volume during healing. Radiographic follow-ups of illustrative clinical cases demonstrate significant vertical bone gain, while histology at implant placement shows mature, well-vascularized regenerated bone. When case selection is performed appropriately on the basis of a thorough preoperative diagnosis, particularly sinus width assessment, transcrestal sinus elevation is a truly minimally invasive alternative to the lateral window, achieving equivalent regenerative outcomes with significantly improved patient comfort.