Ultrasonic bone surgery was recently introduced as an osteotomic technique; however, documentation is scarce. This article reports on the application of ultrasonic bone surgery for 53 bone-augmentation procedures in the posterior maxilla in 34 patients over 5 years. The initial residual bone height under the sinus varied between 1 and 9 mm (mean: 3.7 mm). Distribution according to residual bone height classes was 7.7% for Class B, 39.3% for Class C, and 53.0% for Class D. The procedures included bony window opening of the sinus, cortical and cancellous bone harvesting, and activation of the sinus wall. During the sinus approach, 2 of 53 membranes (3.8%) were perforated and covered with a membrane made of platelet-poor plasma. Bone grafting was carried out with autologous bone at 22 implant sites (18.8%), with a mixture of autologous bone and anorganic bovine bone mineral (Bio- Oss) at 29 sites (24.8%), and with Bio-Oss alone at 66 sites (56.4%). The perforated membranes healed uneventfully. At second-stage surgery, four implants failed. The survival rate of the 117 placed implants was 96.6%. No implant failed after loading. Performing the sinus grafting procedure with ultrasonic bone surgery limited the occurrence of membrane perforation; by changing the tips, all surgical steps were performed safely and comfortably.