The Influence of Second-Generation Platelet Concentrates on Acceleration of Graft Maturation and Bone Formation in the Maxillary Sinus: A Systematic Review and Meta-Analysis Publisher

Summary: Could platelet-rich fibrin speed dental implants? A review found uncertain final bone gains but possibly faster sinus-graft maturation. #DentalImplants #BoneHealing

Shahvali N ; Bagherianlemraski M ; Hooshiar M H ; Mottaghi M ; Masoumzadeh M ; Damsaz M
Source: Journal of Maxillofacial and Oral Surgery Published:2026

Abstract

Purpose: The clinical effectiveness of second-generation platelet concentrates (PRF derivatives) in maxillary sinus augmentation remains uncertain. This systematic review and meta-analysis evaluated whether PRF derivatives improve histomorphometric bone formation and implant outcomes. Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library and Embase was performed from 2006 to April 15, 2026. Randomized and controlled clinical trials comparing PRF derivatives (e.g., L-PRF, A-PRF) with conventional grafting were eligible. The primary outcome was percentage new bone formation (histomorphometry); secondary outcomes included implant stability (ISQ) and graft maturation time. Random-effects meta-analysis was used to pool standardized mean differences (SMD). Results: Seven controlled studies (six RCTs) comprising 142 patients and 185 sinus augmentations met inclusion; four RCTs (n = 86 sinuses) contributed to the meta-analysis. The pooled effect favored PRF derivatives (SMD = 0.79; 95% CI − 0.21 to 1.80) but did not reach statistical significance; heterogeneity was moderate (I² = 44.7%). Individual trials provided conflicting results: some reported greater new bone percentages with PRF+DBBM, while others showed no difference. A more consistent finding across studies was suggestive evidence of accelerated graft maturation with PRF, potentially allowing earlier implant placement in selected protocols (e.g., 4 vs. 8 months) without compromising final stability. Conclusions: Current evidence does not conclusively demonstrate that PRF derivatives increase final bone volume in sinus augmentation, but they may accelerate graft maturation and could shorten treatment timelines in selected cases, although this finding is based on limited evidence with methodological limitations. Heterogeneity in PRF protocols and high risk of performance bias limit firm recommendations. Larger, standardized RCTs are needed. © The Association of Oral and Maxillofacial Surgeons of India 2026.