Ortega-Mejia Holmes, Estrugo-Devesa Albert, Saka-Herrán Constanza, Ayuso-Montero Raúl, López-López José, Velasco-Ortega Eugenio
Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08970 Barcelona, Spain.
Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, 08970 Barcelona, Spain.
Materials (Basel). 2020 Jan 30;13(3):622. doi: 10.3390/ma13030622.
Sinus augmentation can be performed with or without grafting biomaterials, and to date, there is no quality evidence regarding the augmentation of the sinus floor using only platelet concentrates, which can improve the healing period and enhance bone regeneration by stimulating angiogenesis and bone formation. The main objective of this paper was to assess the effect of the sole use of platelet concentrates in sinus augmentation in terms of newly formed bone, augmented bone height, and clinical outcomes and to assess the additional beneficial effects of platelet-rich fibrin (PRF) in combination with other grafting biomaterials.
A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Pooled analyses were performed with the Review Manager software.
For sinus elevation only using platelet concentrates, 11 studies met the inclusion criteria and were included for qualitative synthesis. Only one study was a clinical trial, which reported improved outcomes for the allograft group compared to the titanium-PRF (T-PRF) group. A total of 12 studies where PRF was used in addition to grafting biomaterials met eligibility criteria and were included in the review. Results from meta-analyses provided no additional beneficial effects of PRF in sinus augmentation in terms of bone height and percentage of soft tissue area. There was a statistically significant lower percentage of residual bone substitute material in the PRF (+) group compared to the PRF (-) group. The percentage of newly formed bone was slightly higher in the PRF (+) group, but this was not statistically significant.
There is no robust evidence to make firm conclusions regarding the beneficial effects of the sole use of platelet concentrates in sinus augmentation. However, studies have shown favorable outcomes regarding implant survival, bone gain, and bone height. The use of PRF with other grafting biomaterials appears to provide no additional beneficial effects in sinus lift procedures, but they may improve the healing period and bone formation. Well-conducted randomized clinical trials (RCTs) are necessary to confirm the available results to provide recommendations for the clinical practice.
鼻窦增高术可在使用或不使用生物材料移植的情况下进行，迄今为止，尚无关于仅使用血小板浓缩物进行鼻窦底增高的高质量证据，血小板浓缩物可通过刺激血管生成和骨形成来缩短愈合期并促进骨再生。本文的主要目的是评估仅使用血小板浓缩物进行鼻窦增高术对新形成骨、增高骨高度和临床结果的影响，并评估富血小板纤维蛋白（PRF）与其他移植生物材料联合使用的额外有益效果。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价。使用Review Manager软件进行汇总分析。
对于仅使用血小板浓缩物的鼻窦提升术，11项研究符合纳入标准并纳入定性合成。只有一项研究是临床试验，该试验报告同种异体骨移植组的结果优于钛-PRF（T-PRF）组。共有12项在使用生物材料移植的同时还使用了PRF的研究符合纳入标准并纳入本综述。Meta分析结果显示，PRF在鼻窦增高术中对骨高度和软组织面积百分比没有额外的有益效果。与PRF（-）组相比，PRF（+）组中残留骨替代材料的百分比在统计学上显著更低。PRF（+）组中新形成骨的百分比略高，但无统计学意义。
尚无有力证据就仅使用血小板浓缩物进行鼻窦增高术的有益效果得出确凿结论。然而，研究表明在种植体存活、骨增量和骨高度方面有良好的结果。在鼻窦提升手术中，PRF与其他移植生物材料联合使用似乎没有额外的有益效果，但它们可能会改善愈合期和骨形成。需要进行精心设计的随机临床试验（RCT）来证实现有结果，以便为临床实践提供建议。
