The posterior maxilla presents with limitations due to the presence of the maxillary sinus as well as overall poor bone quality due to decreased bone density. As a result, procedures such as sinus and ridge augmentations are often required following tooth loss to prepare future implant sites for dental implant placement. The methods that are available for sinus augmentation involve the lateral (direct) approach and the crestal (indirect) approach. While a number of studies find comparable results for bone gain after sinus augmentation, the lateral approach presents with limitations including post op morbidity, and limited access for single tooth areas as well as higher potential of Schneiderian membrane damage. As a result, the crestal approach has been advocated. A number of modifications have been made to the approach to improve its efficacy since it was described by Summers in 1994 and the goal of this article is to review some of these improvements and how they have affected overall success of the technique.