Implant rehabilitation in the posterior maxilla poses critical clinical difficulties due to alveolar ridge resorption following tooth loss and progressive pneumatization of the maxillary sinus. Maxillary sinus floor elevation (SFE) is the established, highly predictable surgical modality utilized to reconstruct deficient vertical subantral bone height. This comprehensive review synthesizes the full scope of SFE, including maxillary sinus anatomy, histophysiology of the Schneiderian membrane, diagnostic imaging (panoramic, periapical, and CBCT), and established classification systems (Misch, Wang & Katrangi ABC, Davarpanah 3D, and Tavelli presurgical risk index). The manuscript provides an in-depth comparative analysis of the lateral window antrostomy versus transcrestal/osteotome approaches, along with graft-free osteogenic tenting and diverse biomaterials (autogenous, allografts, xenografts, alloplasts). Technological advancements—including piezoelectric surgery, balloon elevation, hydraulic/gel pressure systems, calcium phosphosilicate putty (MITSA), and osseodensification—are systematically explored. Furthermore, intraoperative and postoperative complications (Schneiderian membrane tears, vascular injury to the alveolar antral artery, sinus infections, graft/implant displacement) and evidence-based management strategies are detailed alongside comprehensive postoperative regimens and prosthetic considerations..