A 35-year-old female with a 10-year history of partial acquired edentulism at site numbers 3 and 4 presented to our clinic for dental implant evaluation. Preoperative clinical examination revealed a reproducible intercuspation, well-delineated band of keratinized tissue, and decreased inter-occlusal clearance to allow for optimal dimension of prosthetic crowns (Fig. 1). Radiographs demonstrated excessive pneumatization of the antrum in the respective area. The preoperative planning included fabrication of two surgical splints. The first splint was fabricated for transmucosal positioning of the implant osteotomy sites in the existing alveolus position. The second splint was fabricated from the predetermined augmented vertical position of the dentoalveolar segment with ideal inter-occlusal clearance. Our surgical treatment began with a horizontal incision 3 mm apical to the mucogingival junction, a full thickness mucoperiosteal flap was created exposing the anterior and posterior boundaries of the proposed segmental osteotomy (Fig. 2). Similar to alveolar distraction techniques, minimal mucosa was elevated off of the transport or movable segment to maintain adequate blood supply. A lateral sinus window technique was used to access the antrum, and the associated Schneiderian membrane was elevated and completely cleared from all boundaries of the respective dentoalveolar segment (Fig. 3). A right angle piezosurgery blade (Piezosurgery Inc., Piezosurgery3 Unit, OT1 insert, OT2 insert) was used to initially create the horizontal/apical osteotomy, which was followed by crestally diverging full thickness vertical osteotomies at the mesial/anterior and distal/posterior areas of the edentulous dentoalveolar segment at site numbers 3 and 4. Before mobilization of the osteoperiosteal flap, the predetermined implant osteotomies were made using the initial surgical splint, and the respective implants (Nobel Biocare, NobelReplace Tapered Groovy) were placed into the predetermined location. Mobilization of the osteoperiosteal flap with a T-handle osteotome confirmed successful separation from the maxillae proper. With the sinus membrane lifted and protected, the vertical repositioning of the osteoperiosteal flap with the positioned implants was accomplished using the second prefabricated splint. In an effort to control torque movement of the mobile segment, we placed the implant placement driver and with the shaft coming through the pilot drill holes of the second guide. The mobile segment was then secured to the anteriorly and posteriorly intact lateral wall of the antrum using an eight-hole 0.6 mm profile curvilinear plate (KLS Martin 1.5 mm, 0.6 mm profile) (Fig. 4). The region under the lifted sinus membrane was then packed with mineralized allograft (Medtronic Sofamor Danek, 0.6–1.25 mm cortical and cancellous chips) in a routine manner. A resorbable membrane (Geistlich Bio-Gide) was then placed over the grafted sinus and fixation mini-plate. The platform of the respective transmucosal placed implants were tactically interrogated to confirm approximation with the alveolar crest. The cover screws were then placed (Fig. 5), and the patient underwent a 4-month healing period. Normal progression to healing abutments and final prosthesis was accomplished (Fig. 6). Pt was followed up 2 years after loading of the implant without any untoward sequelae and radiographic evidence of osseointegrated dental implants (Fig. 7).