The combination of inadequate bone volume, poor bone quality, and elevated occlusal forces contributes to the posterior maxilla being the least predictable site for implant survival. Osteotomes are surgical instruments that have been designed in an attempt to improve bone quantity and quality. Conflicting reports in the literature compare the percentages of bone-to-implant surface contact between the implants placed using osteotomes and conventional drills. However, some studies use different osteotomes that may be harmful to the bone. Innovative pilot intermediary osteotomes used in conjunction with divergent sequential osteotomes to ensure parallelism, expand narrow ridges predictably, safely and significantly internally elevate the sinus, aid in future site development, and assist in immediate implant placement are introduced. The hypothesis is that the quality of bone is simultaneously enhanced, but controlled clinical studies are needed to prove this theory. Keywords: bone quality, implant sites, osteotomes, trephine-osteotome sinus lift