Evaluation of L‐PRF combined with deproteinized bovine bone mineral for early implant placement after maxillary sinus augmentation: A randomized clinical trial

Abstract

Purpose To investigate the effectiveness of adding leukocyte and platelet‐rich fibrin (L‐PRF) to deproteinized bovine bone mineral (DBBM) for early implant placement after maxillary sinus augmentation. Materials and Methods Twelve patients requiring two‐stage bilateral maxillary sinus augmentation were enrolled to the study. The elevated sinus cavities were randomly grafted with DBBM + L‐PRF (test) or DBBM alone (control) in a split‐mouth design. Implants were placed in the augmented sites after 4 months in the test group and 8 months in the control group. Bone biopsies were collected during implant placement for histomorphometric evaluation. Resonance frequency analysis was performed immediately after implant placement and at implant loading in both groups. Cone‐beam computed tomography was obtained preoperatively and postoperatively for evaluation of graft volume changes. Results Both procedures were effective for maxillary sinus augmentation. Cone‐beam computed tomography analysis did not reveal differences in graft volume between test and control group at any of the evaluated time points (P > .05). Histological evaluation demonstrated increased percentage of newly formed bone for the test group (44.58% ± 13.9%) compared to the control group (30.02% ± 8.42%; P = .0087). The amount of residual graft in the control group was significantly higher (13.75% ± 9.99%) than in the test group (3.59 ± 4.22; P = .0111). Implant stability quotient (ISQ) immediately after implant placement was significantly higher in the control group (75.13 ± 5.69) compared to the test group (60.9 ± 9.35; P = .0003). The ISQ values at loading did not differ between the groups (P = .8587). Implant survival rate was 100% for both groups. Conclusion The addition of L‐PRF to the DBBM into the maxillary sinus allowed early implant placement (4 months) with increased new bone formation than DBBM alone after 8 months of healing.

Platelet-Rich Plasma in Maxillary Sinus Augmentation: Systematic Review

“…Another review, which analysed 81 patients, reported a short-term improvement in densitometry values and new bone formation, but its clinical relevance is unclear [40]. The use of PRP in combination with Beta-Tricalcium Phosphate (β-TCP), which was studied in 35 patients [30], or xenografts, in 127 patients [41,42], appears to show no additional clinical benefits. The addition of PRF to deproteinized bovine bone mineral (DBBM) has also not shown further benefits [30,41,42].…”

“…The use of PRP in combination with Beta-Tricalcium Phosphate (β-TCP), which was studied in 35 patients [30], or xenografts, in 127 patients [41,42], appears to show no additional clinical benefits. The addition of PRF to deproteinized bovine bone mineral (DBBM) has also not shown further benefits [30,41,42]. However, in vivo animal studies have shown that the sole use of platelet concentrates in sinus augmentation achieves a mean height of newly formed bone of up to 3.6 mm [43,44], and recent clinical studies have reported that they could be a successful procedure in sinus augmentation on residual ridges <5 mm [45] and achieve a mean height of newly bone of up to 4 mm when implants are simultaneously placed [46,47].…”

“…There were 18 maxillary sinus elevations, with no reported complications and 37 implant placements in a delayed protocol (Table 2). Among the 12 studies, two were retrospective studies [69,70], one was a CCT [71], and nine were RCTs [41,42,45,[72][73][74][75][76][77], of which three had a split mouth design [41,42,74]. Follow-up ranged from one week to two years.…”

“…Only one study allocated patients in an early, intermediate, or late protocol for implant placement [76]. The majority of the studies combined PRF with bovine bone mineral (Bio-Oss) [41,42,69,73,74,76,77], while two combined PRF with alloplastic grafts [71,72], two combined PRF with bone allograft [70,75], and one used titanium-PRF as the only grafting biomaterial [45]. Summary descriptive characteristics of included studies are shown in Table 2.…”

“…These studies also did not specify their methods for allocation concealment, and some did not report the methods for random sequence generation, potentially introducing selection bias. One study was assessed as having an unclear risk of bias [74], and only one study was assessed as having a low risk of bias [42].…”