Atieh et al. [11] examined the intra- and postoperative events associated with the use of piezoelectric devices and conventional rotary instruments for lateral MSA in a systematic review. They included four studies with 178 lateral MSA in 120 participants. The meta-analysis did not show any significant difference between the two surgical techniques. Stacchi et al. [12] analysed the occurrence of intraoperative complications during sinus floor elevation with lateral approach and their correlations with the technique adopted by surgeons. They included 21 RCTs and 11 prospective CCTs. Rotary instruments, piezoelectric osteotomes, and manual bone scrapers were used to perform the lateral antrostomy. They found that ultrasonic devices and bone scrapers had a lower incidence (10.9 and 6.0%) of membrane perforation compared with that of rotating instruments (20.1%). They concluded that the thinning of the lateral wall of the sinus by using ultrasonic instruments or bone scrapers seemed to reduce the incidence of accidental sinus membrane perforations.

Geminiani et al. [13] assessed the difference in the incidence of intraoperative and postoperative complications between the conventional and alternative surgical techniques, during sinus floor augmentation surgery. This meta-analysis included 11 articles, while all compared the incidence of complications in conventional lateral window sinus augmentation surgery versus alternative techniques (osteotome: five articles, piezosurgery: four articles, sonic surgery: one article, trephine: one article). They found no statistically significant difference and concluded that the use of alternative techniques does not significantly reduce the incidence of intraoperative perforation of sinus membrane. Esposito et al. [14] researched in their review the beneficial or harmful effects of bone augmentation compared to no augmentation when undertaking a sinus lift procedure. They referred to the trial of Rickert, who undertook the comparison of rotary instruments versus piezosurgery to open a lateral window in the maxillary sinus, and found no evidence for the superiority of piezosurgery. This manuscript is a potential update exclusively on membrane perforation rate in lateral sinus augmentation procedures using conventional rotary or piezoelectric devices.