For more than 30 years the maxillary sinus augmentation graft has been a mainstay of implant-directed maxillary reconstruction. The purpose of this article is to review the fundamentals of maxillary sinus reconstruction including anatomy and physiology of the sinus, indications for surgery, preoperative evaluation, surgical techniques, and management of complications. While there are some relative contraindications for the procedure, there are almost no absolute contraindications. With preparation, education, and experience, the maxillary sinus augmentation/elevation graft is a procedure that greatly benefits the patient, with a predictable outcome. Copyright © 2012 Elsevier Inc. All rights reserved.