Purpose: This retrospective study investigated whether or not implants can be placed successfully without sinus grafts in atrophic posterior maxillary ridges with ¡Ü 4 mm of bone utilizing the localized management of the sinus floor technique as described by Bruschi and coworkers. Materials and Methods: Fifty-eight implants were placed in 34 consecutive patients with an average vertical height of 2.87 mm of residual bone under the sinus. The implants were placed at the time the sinus membrane was elevated. Results: The sinus was ¡°raised¡± an average of 9.12 mm without benefit of bone grafts or membranes. The success rate after 22 months of loading was 91.4%. Discussion: The localized management of the sinus floor (LMSF) technique permits osseointegration of titanium implants by an endosteal-periosteal continuum that is unhindered by the need of graft material to resorb. Conclusion: This preliminary study demonstrated that it is possible to place implants in an atrophic alveolar ridge with ¡Ü 4 mm of bone without the need for a traditional sinus graft.