Maxillary sinus surgery and use of fibrin-rich plasma: a systematic review

Abstract

Introduction: In around 25% of all maxillary sinuses, there is an accessory bone that is located in a lower portion than the main ostium, and all the mucus produced and the particles trapped in this mucus are directed through the ciliary beat to the ostium. When a dental element is lost in the posterior region of the maxilla, there is natural reabsorption of the alveolar process and at the same time, pneumatization of the maxillary sinus occurs. Objective: It was to carry out a systematic review to elucidate the main clinical approaches to the use of fibrin-rich plasma in the bone regeneration process in maxillary sinus surgeries. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 115 articles were found, 40 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=55.5%<50%. It was concluded that to improve osseointegration and bone anchorage, surface modifications can be chemical, such as calcium phosphate (Ca-P), or physical impregnation, being related to the microtopography of the implant. Several variables affect the biological activity of FRP preparations, such as the number of centrifuges used, centrifugation speed, and other protocols that result in preparations with various volumes, platelet numbers, amount of growth factors, and concentration of fundamental white blood cells and erythrocytes. Some researchers recommend avoiding tissue exposure to FRP-containing leukocytes, arguing that an inflammatory reaction may occur. On the other hand, other authors have described beneficial effects due to increased immunological and antibacterial resistance, although there is no clinical evidence to support its effect. FRP has gained prominence in the scientific community because it does not require the addition of an activator or anticoagulant, making the product more autologous, and featuring a fibrin network that protects growth factors, keeping them in place for longer.