A Comparative Evaluation of Advanced Platelet-Rich Fibrin and Titanium Platelet-Rich Fibrin in Maxillary Sinus Augmentation Using the Crestal Approach.

Aim and objectives The present clinical investigation aimed to evaluate and compare the influence of advanced platelet-rich fibrin (A-PRF) and titanium platelet-rich fibrin (T-PRF) on implant stability and peri-implant bone density, following maxillary sinus augmentation through the crestal approach utilizing a bovine-derived xenograft. Both biomaterials are autologously derived and are increasingly used in implantology due to their regenerative potential. However, comparative data regarding their clinical performance in sinus lift procedures remain limited. Materials and methods This prospective, randomized in vivo clinical trial included 21 systemically healthy patients requiring bilateral crestal sinus augmentation, resulting in the placement of 42 dental implants. Each patient received two implants, one on each side of the maxilla, allocated using the Sequentially Numbered, Opaque, Sealed Envelope (SNOSE) method to ensure randomization and eliminate selection bias. Group A sites were treated with a combination of T-PRF and bovine xenograft (Bio-Oss; Geistlich Pharma AG, Wolhusen, Switzerland), while Group B received A-PRF, combined with the same xenograft material. Both types of PRF were prepared from the patients' autologous blood, using their respective centrifugation protocols. Patients were monitored for three months after sinus augmentation and implant placement. Implant stability was evaluated using resonance frequency analysis (RFA), expressed as the Implant Stability Quotient (ISQ). Bone density at the grafted sites was assessed using Hounsfield Units (HU) on cone-beam computed tomography (CBCT). All data were statistically analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, NY, USA), and intergroup comparisons were made using paired or independent t-tests. For all analyses, results with p-values less than 0.05 were regarded as statistically significant. Results The findings demonstrated that both A-PRF and T-PRF were effective in enhancing implant stability and promoting bone regeneration. However, T-PRF (Group A) showed significantly higher ISQ values and bone density measurements compared to A-PRF (Group B) at the three-month evaluation point. The improved clinical outcomes observed in the T-PRF group were consistent across all age groups, suggesting a more robust biological response. The denser fibrin matrix and longer-lasting release of growth factors associated with T-PRF may have contributed to its superior performance in terms of osseointegration and bone maturation. Conclusions The results of this study support the use of T-PRF as a more effective adjunct in sinus augmentation procedures via the crestal approach. When used in combination with a bovine xenograft, T-PRF leads to improved implant stability and greater bone density, compared to A-PRF. These findings suggest that T-PRF can enhance clinical outcomes and may serve as a preferred biomaterial in procedures aimed at achieving predictable and accelerated bone regeneration in the posterior maxilla. Further research, with larger cohorts and long-term follow-up, is recommended to validate these results and optimize treatment protocols.