Objective To compare the clinical effects of spiral self-tapping and osteotome-mediated transalveolar maxillary sinus floor elevation with simultaneous implantation. Methods A total of 64 patients with insufficient maxillary vertical bone height who were treated in the Dental Implant Center of Affiliated Stomatological Hospital of Suzhou Vocational Health College from January 2024 to June 2025 were selected. According to the random number table method, they were divided into the control group and the experimental group, with 32 patients in each group. The control group received osteotome-mediated transalveolar maxillary sinus floor elevation with simultaneous implantation, and the experimental group received spiral self-tapping transalveolar maxillary sinus floor elevation with simultaneous implantation. The operation time, implant stability, sinus crest distance, mesiodistal elevation height of the maxillary sinus, pain improvement and implant aesthetics were compared between the two groups. Results The operation time of the experimental group was longer than that of the control group (P<0.05). There was no statistically significant difference in the ISQ value between the two groups (P>0.05). There were no statistically significant differences in the sinus crest distance, mesial elevation height and distal elevation height between the two groups (P>0.05). The VAS score of the experimental group after operation was lower than that of the control group (P<0.05). The improvement of pain in the experimental group was better than that in the control group (P<0.05). The implant aesthetics of the experimental group was better than that of the control group (P<0.05). Conclusion Both spiral self-tapping and osteotome-mediated transalveolar maxillary sinus floor elevation withsimultaneous implantation achieve good clinical efficacy in the treatment of insufficient vertical bone height in the maxillary molar region. Among them, the spiral self-tapping transalveolar maxillary sinus floor elevation has higher patient comfort and better implant aesthetics compared with the osteotome-mediated approach.