The number of Direct Sinus Lift procedures have drastically reduced because of minimally invasive crestal sinus lift procedures, improvised protocols and surgical kits. The presence of a septum in the maxillary sinus hindering the crestal bone elevation as well as residual bone height as less as 2mm is one of the indication for 'Direct Sinus Lift'. Here we present a case with residual bone height of 6mm on the right side but with the presence of a septum in the maxillary sinus, necessitating a lateral window for grafting. On the left side, the sub sinus residual bone height is only 2mm which is also an indication for sinus lift. Simultaneous placement of dental implants were made possible with deep threaded, knife edged, macro design of AnyRidge implants from MegaGen. The upper and lower first molar implants were placed through surgical guides which gave the ideal placement even in this compromised clinical situation. Piezo Surgeries - R2Gate - MegaGen AnyRidge - WATCH THE VIDEO!!