Evidence-Based Clinical Efficacy of Leukocyte and Platelet-Rich Fibrin in Maxillary Sinus Floor Lift, Graft and Surgical Augmentation Procedures

Abstract

Bone augmentation techniques have increasingly been indicated for re-creating adequate bone height and volume suitable for dental implant sites. This is particularly applicable in the severely atrophic posterior maxilla where sinus perforation (ruptured Schneiderian membrane) is a very common complication and sinus floor elevation or lift is frequently considered a standard procedure. The augmentation of the maxillary sinus can be performed with or without grafting biomaterials. Herein, numerous biomaterials and bone substitutes have been proposed, primarily to sustain the lifted space. In addition, cytokines and growth factors have been used to stimulate angiogenesis, enhance bone formation as well as improve healing and recovery period, either as the sole filling material or in combination with bone substitute materials. Within such, is the family of autologous blood extracts, so-called platelet concentrates, which are simply the “product” resulting from the simple centrifugation of collected whole blood samples of the patient, immediately pre-surgery. Platelet-Rich Fibrin (PRF), a sub-family of platelet concentrates, is a three-dimensional (3-D) autogenous biomaterial obtained, without including anti-coagulants, bovine thrombin, additives, or any gelifying agents during the centrifugation process. Today, it is safe to say that, in implant dentistry and oral and maxillofacial surgery, PRFs (particularly, the pure platelet-rich fibrin or P-PRF and leukocyte and platelet-rich fibrin or L-PRF sub-classes) are receiving the most attention, essentially due to their simplicity, rapidness, user-friendliness/malleability, and cost-effectiveness. Whether used as the sole “bioactive” filling/additive material or combined with bone substitutes, the revolutionary second-generation PRFs have been very often associated with promising clinical results. Hence, this review aims to provide a 10-years update on the clinical effectiveness of L-PRF when applied/used as the “sole” biomaterial in maxillary sinus augmentation procedures. An electronic search using specific keywords for L-PRF and maxillary sinus augmentation was conducted in three main databases (PubMed-MEDLINE database, Google Scholar and Cochrane library) for the period between January 2009–February 2020. The quest yielded a total of 468 articles. Based on the pre-established strict inclusion/exclusion criteria, only seven articles were deemed eligible and included in the analysis. Surprisingly, of the 5 studies which used de-proteinized bovine bone mineral (DBBM) in combination with L-PRF, 60% acclaimed no significant effects and only 40% declared positive effects. Of the two articles which had used allogenous bone graft, 50% declared no significant effects and 50% acclaimed positive effects. Only one study had used L-PRF as the sole grafting material and reported a positive effect. Likewise, positive effects were reported in one other study using L-PRF in combination with a collagen membrane. Due to the heterogeneity of the included studies, this review is limited by the inability to perform a proper systematic meta-analysis. Overall, most of the published studies reported impressive results of L-PRF application as a grafting material (sole or adjuvant) in maxillary sinus augmentation and dental implant restorative procedures. Yet, distinct technical processing for L-PRF preparation was noted. Hence, studies should be approached with caution. Here in, in sinus lift and treatment of Schneider membrane, the formation of mature bone remains inconclusive. More studies are eagerly awaited in order to prove the beneficial or detrimental effects of PRFs, in general and L-PRFs, in specific; especially in their tissue regenerative potential pertaining to the promotion of angiogenesis, enhancing of cell proliferation, stimulation of cell migration and autocrine/paracrine secretion of growth factors, as well as to reach a consensus or a conclusive and distinct determination of the effect of leukocytes (and their inclusion) on inflammation or edema and pain; a call for standardization in PRFs and L-PRFs composition reporting and regimenting the preparation protocols.

Does Platelet-Rich Fibrin Enhance the Early Angiogenetic Potential of Different Bone Substitute Materials? An In Vitro and In Vivo Analysis

“…It was evaluated if the combination of PRF with BSMs in different clinical approaches not only functions as a signaling protein reservoir for osteoinduction but also allows the bone graft particles to stick together for better clinical handling [ 11 ]. There are emerging data that suggest that this method seems feasible in maxillary sinus floor lift, graft, and surgical augmentation procedures [ 12 ]; for guided bone regeneration methods in dental implantology [ 13 ]; alveolar ridge preservation [ 14 ]; and the treatment of intrabony periodontal defects [ 15 ].…”

“…The ambivalent data may be explained in the different biophysical properties of BSMs and the variety of investigated time points. More basic research is needed to deliver scientific evidence that can be translated into clinical workflow [ 12 ].…”

Fibrina rica em plaquetas e sua utilização na cirurgia de levantamento de assoalho de seio maxilar

“…A utilização de PRF como único material para a estimulação de neoformação óssea e cicatrização tecidual tem resultados promissores. É uma técnica simples, sendo um método fácil e bem-sucedido para cobrir a membrana sinusal ou a janela da osteotomia (Ali et al, 2015;Damsaz et al, 2020;Dominiak et al, 2021).) além de ser segura e econômica (Molemans et al, 2019).…”

“…Mesmo que as membranas de L-PRF sejam particularmente adaptadas à prática diária de cirurgia periodontal, a relevância dessa técnica a longo prazo depende muito da capacidade dos pesquisadores em definir com precisão as melhores indicações, selecionar o tipo e a quantidade adequados de material ósseo a combinar com a L-PRF (Del Corso et al, 2012). A comunidade clínica exige uma padronização dos protocolos de PRF para examinar melhor o benefício da PRF na regeneração de ossos e tecidos moles em estudos reprodutíveis, com um nível científico mais alto de evidência (Damsaz et al, 2020;Ghanaati et al, 2018). A literatura atual não permite tirar conclusões definitivas sobre os vários PRPs e L-PRF e a melhor maneira de usá- Research, Society and Development, v. 10, n. 7, e55410716806, 2021 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v10i7.16806 los para a cicatrização óssea em cirurgia oral e maxilofacial.…”

The Cellular Choreography of Osteoblast Angiotropism in Bone Development and Homeostasis

“…Successful remodelling of the initial fibrin clot into bone tissue recapitulates many of the processes seen during endochondral ossification [ 69 ]. Therefore, fracture and osteotomy studies are used to study both healing and regenerative processes [ 70 , 71 , 72 ].…”