Title	Water-Lift Balloon System For Sinus Augmentation Results In Less Perforations Than Traditional Lateral Approach With Piezoelectric Surgery
Clinical Question	Does the crestal approach with water-lift balloon system result in less sinus perforations than the lateral approach using piezoelectric surgery?
Clinical Bottom Line	For sinus augmentations, the water-lift system reduces the number of sinus perforations compared to traditional lateral window with piezo surgery, (0/25 vs. 6/25). Additional randomized controlled trials are needed to validate the above finding. Future studies performed at institutions without ties to the author, who is the inventor of the sinus infiltration device, are needed.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 21592728 Bensaha/2011 50 patients requiring sinus augmentation prior to implant placement Randomized Controlled Trial Key results There was a statistically significant difference in the number of perforations between the two techniques: Water-lift = 0/25, Lateral approach with piezoelectric surgery= 6/25 (p=0.01).
Evidence Search	("nasal mucosa"[MeSH Terms] OR ("nasal"[All Fields] AND "mucosa"[All Fields]) OR "nasal mucosa"[All Fields] OR ("schneiderian"[All Fields] AND "membrane"[All Fields]) OR "schneiderian membrane"[All Fields]) AND ("water"[MeSH Terms] OR "water"[All Fields]) AND ("lifting"[MeSH Terms] OR "lifting"[All Fields] OR "lift"[All Fields])
Comments on The Evidence	This randomized controlled trial had similar group distribution at the onset of the study with 100% completion rate. 50 subjects were followed during the course of sinus augmentation. Patients were randomized into 2 groups: 25 subjects treated via lateral approach with piezoelectric surgery, 25 treated via crestal approach with water-lift infiltration. Membrane integrity was evaluated by having the patient perform a Valsalva maneuver at the time of surgery (the effectiveness of this test is under debate). The author of this study is the inventor of the sinus infiltration device.
Applicability	The study included adult patients,
Specialty	(Oral Surgery) (Periodontics)
Keywords	Schneiderian membrane, water lift, sinus augmentation, dental implants
ID#	2110
Date of submission	09/09/2011
E-mail	frostn@uthscsa.edu
Author	Natalie A. Frost
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Guy Huynh-Ba, DDS
Faculty mentor e-mail	HuynhBa@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Jesse Gonzalez, Keaton Shin (San Antonio) on 11/28/2017 The PubMed database was searched for the above terms on 11/27/17, and the article discussed in the CAT was confirmed to be the highest level of evidence published on this topic. There was additional support for the conclusion provided by an article published in 2016(PMID 28298833) and in another 2012 publication(PMID 20586782). In the Dhandapani case series it was presented that the technique might represent a viable alternative to conventional sinus lift, but the results need to be validated by a larger sample size. In the Kim preliminary clinical study it was confirmed that the water lift system effectively reduce the risk of Schneiderian membrane perforation during the sinus membrane lifting operation.