When teeth have been removed and socket preservation procedures are not performed within the first year, the bone volume in the extraction site will be reduced by up to 45%. In the upper jaw, this reduces the vertical and horizontal distance between the floor of the sinus and the crest of the alveolar ridge. In some cases, this leaves inadequate bone to place an implant. The sinus is lined with a membrane that separates the sinus cavity from the bone lining the floor of the sinus. It is possible to make selective openings through the bony floor of the sinus and mechanically separate the membrane from the bone and place bone grafting through these openings. With each additional amount of bone that is added, the membrane is elevated until the desired height required for the implant is reached. This is much like the way a tent is raised when the tent poles are placed. At times, the implant can be placed at the same appointment as the grafting. This procedure allows patients who previously had inadequate bone to have implants predictably placed. This procedure is performed in our office using a local anesthetic. Of course, IV or oral sedation is available for these procedures.