Title Addition of Platelet-Rich Fibrin (PRF) to Bone Graft Material Does Not Improve Soft Tissue Healing in Patients Undergoing Maxillary Sinus Augmentation
Clinical Question For systemically healthy patients in need of maxillary sinus augmentation, does the addition of PRF to bone graft material improve soft tissue healing?
Clinical Bottom Line For otherwise healthy patients undergoing maxillary sinus augmentations, the addition of PRF to bone graft material does not significantly improve soft tissue healing or post-operative complications versus control.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
32019255Ortega-Mejia/2020246 patients from 12 studiesSystematic review of randomized trials
Key resultsOnly 2 out of 12 included studies evaluated soft tissue healing. Gurler et al. showed no statistically significant differences (p > 0.05) between the L-PRF + MinerOss group compared to control (MinerOss) with regard to postoperative pain, swelling, sleeping, eating, phonetics, activities of daily living, and missed work days. Del Fabbro el al. reported “significant reduction” in perceived pain but with Bio-Oss + plasma rich in growth factors (PRGF), a similar but different platelet concentrate derivative.
30058532Dragonas/2019147 patients from 8 studiesSystematic review of randomized trials
Key resultsThe same article by Gurler et al. was cited with the result being superior, but not statistically significant, soft tissue healing index (tissue color, response to palpation, presence/absence of granulation tissue, and incision margin opening) in sites that used L-PRF compared to a collagen membrane alone.
31008111Liu/2019133 patients from 5 RCT studiesMeta-Analysis
Key resultsOnly one article (Tatullo et al.) concluded that PRF reduced healing time from 150 to 120 days based on histologic analysis. Quantitative analysis could not be conducted for the outcome of soft tissue healing.
Evidence Search (PRF) AND (maxillary sinus) AND (augmentation)
Comments on
The Evidence
Validity: The two systematic reviews and the meta-analysis provided the highest level of evidence, with adequate sample size (526 patients) from the 25 included studies. However, only articles in English were included. Additionally, only three of the articles cited were relevant to the clinical question. Studies by Gurler et al., Del Fabbro et al. and Tatullo et al. were all randomized controlled trials but have a high risk of bias due to lack of blinding of participants or investigators. Significant heterogeneity also exists among the studies. Perspective: While data is limited on PRF’s effect on soft tissue healing in sinus augmentation procedures, the evidence is consistent with findings in ridge augmentation/ridge preservation procedures. There is no statistically significant benefit to using PRF as an adjunct in any of these procedures.
Applicability Though PRF and other platelet derivatives have been considered for use in sinus augmentation procedures due to their high concentration of growth factors and release of anti-inflammatory cytokines, the evidence of their effectiveness is limited and thus not recommended for routine use. Drawing blood adds to the patient’s discomfort and preparation of PRF is time-consuming and may prolong what is already a long procedure. However, PRF’s relatively low cost and easy handling properties may make it attractive to be used as a membrane or as a matrix to hold graft particulates together.
Specialty (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Platelet Rich Fibrin, PRF, Sinus Augmentation, Sinus Lift
ID# 3435
Date of submission 12/10/2020
E-mail TranLV@livemail.uthscsa.edu
Author Loc V. Tran, DDS
Co-author(s) Brandon Breard, DDS
Co-author(s) e-mail Breard@uthscsa.edu
Faculty mentor Angela A. Palaiologou-Gallis, DDS, MS
Faculty mentor e-mail PalaiologouA@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available