Purpose: This case series aimed to evaluate the clinical outcome of a crestal approach technique in sinus floor elevation surgery with insertion of an alloplastic material. Material and methods: A total of 50 edentulous patients received 64 implants and sinus floor elevation in posterior maxillae with residual crestal height 1.2 to 9.8 mm, and larger than 7 mm in width. Drilling perforation was performed until the sinus floor was felt. The sinus mucosa was then lifted. Hydroxyapatite granules were placed and implants were immediately inserted. Three months later, definitive crowns were cemented and patients were followed up for 18 months. Outcome measures were implant failures, complications and radiographic bone height gain measured 18 months after prosthetic loading. Results: No patient dropped out and all implants were successfully osseointegrated. Only minimal postoperative patient discomfort was reported. Only one complication occurred: a minor perforation of the sinus membrane with no negative consequences. At the time of implant insertion, the residual bone height mean value was 6.20 mm (±2.22). After surgery and at the last follow-up, the mean height of bone was 15.26 (±3.19) and 15.40 mm (±4.21), respectively. Conclusion: The procedure was able to obtain sinus elevation and implant osseointegration. Keywords: dental implant, sinus floor elevation