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Aim: To compare implant survival and complication rates between shorter and standard‐length implants with sinus augmentation and restored with single crowns, at 10 years of loading. Materials and Methods: One‐hundred and one patients (137 implants) with a ridge height of 5–7 mm in the posterior maxilla were randomly assigned to two treatment modalities: shorter implants (6 mm) (group short [GS]) or standard‐length implants (11–15 mm) with sinus grafting (group graft [GG]). Following the insertion of final restorations, patients were regularly recalled for up to 10 years. Assessed outcomes encompassed implant survival, marginal bone levels (MBLs), biological and technical parameters and patient‐reported outcome measures (OHIP‐49 = Oral Health Impact Profile). Non‐parametric statistical analysis was used to analyse the data. Results: For the 5‐ to 10‐year follow‐up period, 77 patients with 105 implants (GS: 36 patients/48 implants; GG: 41/57) were available for re‐examination (drop‐out rate 21%). Implant survival rates at the patient level were 96.0% (GS; 2 failures) and 100% (GG) (inter‐group p =.24). Median MBLs amounted to 0.00 mm (min 0.00; max 3.25; GS) and 0.00 mm (min 0.00; max 4.55; GG) (inter‐group p =.73). Technical complications predominantly occurred within the first 5 years (inter‐group p >.05). Peri‐implantitis rates were 4.2% (GS) and 13.3% (GG) (intergroup p =.37). Median OHIP‐49 scores were 7.00 (0.00; 39.00; GS) and 9.00 (0.00; 196; GG) (inter‐group p =.61) at 10 years. Conclusions: Based on similar 10‐year implant survival rates, reduced patient morbidity and lower costs, the use of shorter dental implants might well serve as an alternative treatment concept to longer implants placed in conjunction with sinus grafting for patients with a limited ridge height in the posterior maxilla. Study register: https://clinicaltrials.gov/ct2/show/NCT01030523. [ABSTRACT FROM AUTHOR]