The aim of this study was to macroscopically and microscopically evaluate different methods of indirect sinus floor elevation regarding elevation heights of 10 mm. Four different methods of indirect sinus floor elevation-osteotome sinus floor elevation (OSFE), bone added osteotome sinus floor elevation (BAOSFE), piezo- surgical sinus floor elevation (PSFE), and sinus floor elevation with an inflatable balloon, balloon-lift-control system (BLC) - were macroscopically and microscopically investigated ex vivo using 36 bisected pigs' heads. OSFE and BAOSFE perforated the Schneiderian membrane, whereas the inflatable balloon caused no laceration. PSFE elevated the mucosa without laceration as well, but was technically restricted to an elevation height of 5 mm. BAOSFE, PSFE, and BLC separated the mucosa, leaving the periosteum on the bone. OSFE completely lifted the soft tissue from the bone, including the periosteum. The results of this study indicate that balloon elevation of the sinus floor may extend the indication for indirect sinus floor elevation for elevation heights of up to 10 mm. The histological elevation layer seems to be non-uniform in the different sinus floor elevation methods. Further in vivo experiments have to prove these findings as well as their relevance regarding the clinical outcome of sinus floor augmentation. © 2009 Wiley Periodicals, Inc.