Effect of platelet-rich plasma on sinus lifting: a randomized-controlled clinical trial.
OBJECTIVE
The combination of anorganic bovine bone (ABB) with platelet-rich plasma (PRP) has been widely used in bone regeneration procedures although its benefits are still unclear. The purpose of this study was to evaluate whether or not PRP improves the efficacy of ABB in sinus floor augmentation. In addition, we have investigated the effect of residual bone height and tobacco on implant survival in sinus augmentation procedures.


METHODS
Eighty-seven patients recruited for this study underwent 144 sinus floor augmentation procedures using ABB alone or ABB plus PRP (ABB+PRP) in a randomized clinical trial. A total of 286 implants were placed in the augmented bone, and their evolution was followed up for a period of 24 months. In order to investigate on a histological level and any adjunctive effects, we performed an ancillary study in five edentulous patients with a symmetrical severely resorbed maxilla. In these patients, a bilateral sinus augmentation was randomly performed using ABB or ABB+PRP in a split-mouth design, and after 6 months, bone biopsies were taken from the implant sites for histological and histomorphometric analysis.


RESULTS
Overall, 96.2% of ABB and 98.6% of ABB+PRP implant success were obtained during the monitoring period and differences were not found between sites grafted with and without PRP in the 87 patients studied. Densitometry assessments and graft resorption were similar in both experimental groups. However, the histological and histomorphometrical analysis in the five edentulous patients revealed that bone augmentation was significantly higher in sites treated with ABB+PRP (p <or= 0.05). Another outcome from our study is that the lack of initial bone support (p <or= 0.05) and smoking (p=0.05) appeared to have a negative effect on the treatment success, which was accentuated when both circumstances coincided.


CONCLUSIONS
PRP is not a determining factor for implant survival in sinus lifting procedures. However, this study revealed that PRP can improve the osteoconductive properties of ABB by increasing the volume of new bone formed. Moreover, in sinus augmentation procedures the implant's survival rate appears to be more influenced by the residual bone height or by tobacco than by the type of bone graft.
Torres
Jesús
J
Ciencias de la Salud III, Universidad Rey Juan Carlos, Alcorcón, Spain. jesus.torres@urjc.es
Tamimi
Faleh
F
Martinez
Pedro-Pablo
PP
Alkhraisat
Mohammad Hamdan
MH
Linares
Rafael
R
Hernández
Gonzalo
G
Torres-Macho
Juan
J
López-Cabarcos
Enrique
E
D000368:Aged; D016301:Alveolar Bone Loss / Q000473:pathology / Q000601:surgery; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D000818:Animals; D001706:Biopsy; D015519:Bone Density / Q000502:physiology; D001857:Bone Matrix / Q000637:transplantation*; D001861:Bone Regeneration / Q000502:physiology; D018786:Bone Substitutes / Q000627:therapeutic use*; D002417:Cattle; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007575:Jaw, Edentulous / Q000473:pathology / Q000601:surgery; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008443:Maxillary Sinus / Q000601:surgery*; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use*; D010012:Osteogenesis / Q000502:physiology; D053657:Platelet-Rich Plasma; D016037:Single-Blind Method; D012907:Smoking / Q000503:physiopathology; D016896:Treatment Outcome
C077540:Bio-Oss; D018786:Bone Substitutes; D015921:Dental Implants; D008903:Minerals