INTRODUCTION:Hydrodynamic piezoelectric surgery is a sophisticated approach to internal sinus elevation that uses a transcrestal technique to reduce postoperative complications such as sinus floor perforation, bleeding, and implant malfunction. AIM OF THE STUDY:The goal of this study stood to assess how the minimally invasive hydrodynamic piezoelectric internal sinus elevation procedure performed with or without bone grafting and simultaneous implant insertion and the affected clinical outcomes. MATERIALS AND METHODS:A sum of 30 maxillary sinuses were chosen to meet a set of inclusion and exclusion criteria (patients with missing molars or premolars). A computer mechanism randomly separated the participants into three groups. At all surgical sites, cone beam CT (CBCT) was used to assess the residual bone height present between the crest of the alveolar bone and the floor of the sinus, as well as the bone breadth needed for the proper implant size and placement. All groups had an elevated transcrestal mucoperiosteal flap. Both study groups A and B had sinus lifting surgeries with and without bone grafts, as well as simultaneous implant installation with a hydrodynamic piezoelectric lift. A sinus floor elevation surgery was performed on the control group C, and implant implantation at the same time. In each group, the bone height obtained following sinus augmentation was measured using (CBCT). RESULTS: Piezoelectric sinus lift revealed good significant difference p<0.05* in the bone height gained after the Schneiderian membrane elevation with minimal postoperative complications concerning pain, edema and membrane perforation compared to the conventional osteotomes. The conflicts between the two study groups and the other control group were confirmed to be statistically significant.