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| Title |
Leukocyte Platelet-Rich Fibrin (L-PRF) Shows Potential to Improve Sinus Bone Regeneration |
| Clinical Question |
In partially edentulous adults requiring maxillary sinus augmentation, does closed sinus augmentation using PRF alone, compared with PRF combined with DBBM, affect bone morphology and volumetric changes at 6 months post-procedure? |
| Clinical Bottom Line |
L-PRF alone can support bone gain and new bone formation after closed sinus augmentation, but current evidence is insufficient to establish 6-month morphologic or volumetric outcomes compared with PRF+DBBM. The strongest direct evidence for L-PRF alone is an uncontrolled 110-patient case series in which osteotome-mediated sinus floor elevation produced a mean 3.4 mm increase in site height and 97.8% early implant survival; a two-case histologic report also confirmed new bone formation with PRF alone. Chen et al. provides stronger randomized evidence that PRF+DBBM increases new bone formation versus DBBM alone, but it does not directly compare PRF+DBBM with L-PRF alone, so a superior protocol cannot be established. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 20881816 | Toffler, 2010 | 110 patients; 138 implants | Case series | | Key results | Residual subantral bone height was 4-8 mm (mean 6.6 mm); osteotome-mediated crestal sinus floor elevation was performed using L-PRF alone with simultaneous implant placement. Mean implant-site height increased 3.4 mm (range 2.5-5 mm) after osteotome-mediated sinus floor elevation with L-PRF alone. Three of 138 implants failed before loading, for an early implant survival rate of 97.8%. Ninety-seven implants had been restored and in function for an average loading time of 5.2 months; mean healing time before abutment insertion was 4 months. However, no statistical analysis was conducted, the study was not blinded, and a variety of implants were used. Thus, these results, while showing promise, are not conclusive. | | #2) 41708135 | Chen, 2026 | 42 adults randomized; 40 analyzed (20/group) | Randomized Controlled Trial | | Key results | Posterior maxilla with RBH <4 mm; DBBM alone vs PRF+DBBM. At 6 months, PRF+DBBM produced significantly greater new bone formation than DBBM alone (28.81% ± 4.41% vs. 22.44% ± 4.40%, p<0.001) and greater bone maturity (57.05% ± 7.76% vs. 49.17% ± 7.09%, p<0.01). Micro-CT demonstrated greater bone volume fraction (26.72% ± 2.66% vs. 22.76% ± 2.51%, p<0.001), greater trabecular number and thickness, and lower trabecular separation and residual graft volume (p<0.05). Net graft volume gain was also significantly greater with PRF+DBBM (p<0.05), while graft height change did not differ between groups (p>0.05). | | #3) 27795860 | Aoki, 2016 | Two patients with atrophic posterior maxilla treated with PRF as the sole graft material | Case report | | Key results | Case 1 used a crestal approach with simultaneous implant placement (RBH 2.2-2.7 mm); Case 2 used a lateral two-stage approach with RBH <2 mm. Histologic examination confirmed new bone formation in both cases using PRF alone. In the crestal case, CT at 6 and 12 months showed increasing radiopacity around the implant to the elevated sinus region, and a biopsy obtained at 24 months showed mature lamellar bone. In the lateral two-stage case, biopsy at 3 months showed woven and lamellar new bone, and the subsequently placed implants osseointegrated. These observations are descriptive and were not compared with a control group. | |
| Evidence Search |
(("maxillary sinus" OR "sinus floor elevation" OR "sinus augmentation") AND ("platelet-rich fibrin" OR "L-PRF" OR PRF OR "bone graft" OR "bone grafts" OR xenograft OR allograft) AND (bone OR morpholog* OR volume OR height OR resorption)) |
Comments on
The Evidence |
Chen et al. provides the strongest internal validity: computer-generated randomization, concealed allocation, blinded laboratory analysts/statistician, comparable baseline groups, and only 2/42 withdrawals. However, it evaluates PRF+DBBM versus DBBM alone and therefore does not directly test L-PRF alone. Toffler et al. is the most directly applicable study to the closed/crestal intervention and includes 110 patients and 138 implants, but it is an uncontrolled early case series with no comparator or randomization, no histologic or 3D volumetric analysis, and relatively short functional follow-up. Aoki et al. provides histologic confirmation that PRF alone can be replaced by new bone, including one crestal/closed case, but it consists of only two heterogeneous cases with different surgical approaches and biopsy times. Overall, direct evidence for L-PRF alone is clinically encouraging but low-level, whereas the stronger randomized evidence evaluates PRF as an adjunct to DBBM rather than as a sole graft material. |
| Applicability |
Toffler et al. is highly applicable to selected patients undergoing closed/transcrestal sinus elevation because L-PRF alone was used with simultaneous implants at sites with 4-8 mm residual subantral bone height (mean 6.6 mm). This supports feasibility when enough residual bone exists for implant stabilization and the implant can help maintain the elevated membrane. Aoki et al. extends biologic plausibility to more severe atrophy and confirms histologic new bone formation, but only one of the two cases used a closed approach, and the sample is too small to establish predictability. Chen et al. studied PRF+DBBM in sites with RBH <4 mm, so its improvements in new bone formation cannot be assumed for L-PRF alone. Thus, L-PRF alone may be considered in carefully selected closed-sinus cases, but current evidence is insufficient to predict 6-month morphology or volume or to claim equivalence or superiority to PRF+DBBM. |
| Specialty/Discipline |
(Oral Surgery) (Periodontics) (Prosthodontics) |
| Keywords |
maxillary sinus augmentation; sinus floor elevation; platelet-rich fibrin; L-PRF; bone regeneration; dental implants; graft volume; transcrestal sinus augmentation
|
| ID# |
3775 |
| Date of submission: |
10/22/2026 |
| E-mail |
mallari@uthscsa.edu |
| Author |
Moriah Mallari |
| Co-author(s) |
Kyle Harris |
| Co-author(s) e-mail |
harrisk6@uthscsa.edu |
| Faculty mentor/Co-author |
Dr. Charles Powell |
| Faculty mentor/Co-author e-mail |
Powellc2@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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