As the diameter of osteotomes increases, not only the larger portion of the septum is being lifted, but also the bone is also being pushed gradually to the higher position (Fig.5). 

Ultimately, an implant as large as 7x14 mm is placed (Fig.6 green area).  Its apical portion is covered by the lifted bone (*, although maybe thin due to continuous compression), whereas the side of the apical portion of the implant contacts the original socket walls (i.e., the side of the inferior extension of the sinus floor).  In all, the contact area of the implant is expected to increase; so will be the insertion torque.  No bone graft is needed over the sinus lift, while it may be placed in the sockets (pink circles).

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Xin Wei, DDS, PhD, MS 1st edition 05/18/2013, last revision 05/18/2014