Bone-Regenerative Ability of Platelet-Rich Plasma Following Sinus Augmentation with Anorganic Bovine Bone: A Systematic Review with Meta-Analysis

Abstract

Background: The objective of this systematic review is to assess the effect of the adjuvant use of platelet-rich plasma (PRP) and its type on new bone formation by anorganic bovine bone during maxillary sinus floor augmentation procedure. Methods: PubMed, Cochrane Central Register of Controlled Trials, and Ovid databases were searched for relevant studies published up to 16 September 2021. Randomized clinical trials (RCTs) and non-randomized controlled clinical trials (CCTs) that reported data on the new bone formation (measured by histomorphometric analysis) were considered. Risk of bias and quality assessment of included studies were evaluated following the Cochrane Handbook for Systematic Reviews of Interventions and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Strength of evidence was assessed following the approach of the Agency for Healthcare Research and Quality (AHRQ) through its evidence-based practice center (AHRQ EPC). The meta-analysis was based on the primary outcome of newly formed bone, for which the standard mean difference was calculated. Results: After the application of eligibility criteria, six clinical trials (three RCTs and three CCTs) covering 85 maxillary sinus floor elevation procedures were included. The pooled new bone formation value for PRP was 1.67 (95% CI: −0.15 to 3.49; I2: 86%), indicating the absence of significant effect. Plasma rich in growth factors (PRGF) was the pure PRP tested in five of the included studies. When sub-group (type of PRP) meta-analysis was performed, significantly higher new bone formation was observed in the PRGF group [2.85 (95% CI: 0.07 to 5.64; I2: 88%)] in comparison to the control group. Conclusions: A beneficial effect on new bone formation after maxillary sinus floor elevation can be obtained when anorganic bovine bone is mixed with PRGF.

Adjunctive Plasma Rich in Growth Factors in the Treatment of Osteomyelitis and Large Odontogenic Cysts Prior to Successful Implant Rehabilitation: Case Report

“…When placed in an osseous defect, cells will invade and migrate along the PRGF scaffold [ 21 , 36 , 37 , 38 ], to achieve healing [ 38 , 39 ]. PRGF has been demonstrated to support re-vascularization of mucosa and bone, modulate the inflammation, significantly speed bone healing, and maintain bone volume after surgical interventions [ 35 , 40 , 41 , 42 , 43 ]. For example, impaired angiogenesis by bisphosphonates plays a pivotal role in the inhibition of cell proliferation and the development of MRONJ [ 44 , 45 ].…”

Effectiveness of Autologous Platelet Concentrates in the Sinus Lift Surgery: Findings from Systematic Reviews and Meta-Analyses

“…With similar results, pooled analysis of Ortega-Meja [52] showed a slightly higher percentage of NBF in the PRF group when compared to graft materials alone. Anitua et al [36] discussed that most of the included studies indicated a higher new bone formation in the P-PRP group while only one study showed no differences [64].…”

“…The number of primary studies included in each SR ranged between two (2) and forty-two (42). Fourteen ( 14) SRs were integrated with a meta-analysis [34][35][36]39,40,46,47,50,51,[54][55][56]60]. Most of the SRs included as primary study clinical controlled studies (CCTs) and randomized clinical trials (RCTs), but eight (8) SRs also included non-controlled studies, case series and case reports [32,34,38,49,52,53,56,59].…”

“…Twenty-seven reviews include articles regarding the use of APCs in combination with other grafting materials [7,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][49][50][51][52][53][54][55][56][57][58]. Among these, eight SRs [33,38,42,49,52,53,56,60] also included articles regarding APCs alone vs. blood clot while twenty-one SRs only included articles regarding APCs in combination with other biomaterials and biomaterials alone as control [7,32,[35][36][37][39][40][41][43][44][45][46]…”