Background: The use of hydrodynamic piezoelectric techniques for trans crestal / internal sinus lift with simultaneous implant placement has gained popularity as a safe and minimally invasive technique for managing the posterior edentulous maxilla, particularly in cases with sinus pneumatization. This method offers a controlled elevation of the Schneiderian membrane while reducing the risk of perforation compared to conventional techniques. Additionally, it minimizes postoperative discomfort and oedema, leading to better acceptance and satisfaction by the patients. In contrast to traditional osteotome tapping procedures, the hydrodynamic piezoelectric technique enhances surgical outcomes while preserving vital anatomical structures, making it a superior alternative in implant dentistry. This study aims to evaluate the use of the hydrodynamic piezoelectric technique in internal sinus lifting with simultaneous implant placement in comparison to the conventional osteotome technique.

Inclusion Criteria:

• Patients with edentulous free end or bounded posterior maxilla that require implant supported restoration.
• Patients indicated to internal sinus lifting, where insufficient residual alveolar bone height from the alveolar crest to the floor of the maxillary sinus is found.
• Patients with residual alveolar bone height that ranges from 5-7 mm according to the tomographic radiographic examination.
• A good standard of oral hygiene.

Exclusion criteria:

• Patients with residual alveolar bone height less than 5 mm according to the tomographic radiographic examination.
• Patients with residual alveolar bone height more than 8 mm according to the tomographic radiographic examination, which is not indicated to sinus lifting.
• Patient with active sinus infection or sinus pathology.
• History of Oral or intravenous bisphosphonate therapy or any treatments with other medications that may interfere with bone metabolism within the past 12 months.
• Heavy smokers.
• Medically compromised patients that are burdened with systemic conditions that contradicts implant placement and interfere with wound healing.

Exclusion Criteria:

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