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Published: 2022-05-15

Investigation of the main clinical findings of maxillary sinus surgery with platelet-rich fibrin: a systematic review

UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
UNORTE - University Center of Northern São Paulo - Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil / UNIPOS - Post graduate and continuing education, Dentistry department, Sao Jose do Rio Preto, Sao Paulo, Brazil
Maxillary sinus Maxillary sinus surgery Maxillary sinus augmentation Platelet-rich fibrin. Biomaterials


Introduction: The maxillary sinus is the largest of the paranasal sinuses and its function is to contribute to phonation resonance, conditioning the air we breathe and aiding in the production of mucus in the nasal cavity. Around 25% of all maxillary sinuses, there is an accessory bone that is located in a lower portion than the main ostium. Aiming to increase the bone formation potential of these grafts, combinations have been proposed to obtain better regenerative conditions through volume preservation and induction of cell migration differentiation. Objective: Conducted a systematic review of the main clinical findings of maxillary sinus surgery using Platelet-rich fibrin. Methods: The present study followed a systematic review model (PRISMA). Experimental and clinical studies were selected, involving retrospective, prospective and randomized studies. The online databases consulted were PubMed, Scopus, Ovid,, and Google Scholar. Results and Conclusion: A total of 59 articles were found involving the surgery of the maxillary sinuses using plasma rich in fibrin. A total of 34 articles were fully evaluated and 24 were included and discussed in this study. Studies have shown that PRF has the characteristic of polymerizing. The incorporation of circulating cytokines increases in the fibrin network, implying a longer life for these cytokines, as they will be released and used only in the remodeling of the initial scar matrix, which is long-term. PRF is based on protecting growth factors from proteolysis that can maintain their activity for a longer period and stimulate bone regeneration more efficiently. Another study indicated the use of fibrin membranes obtained from PRF to seal the perforations. In the presence of perforations larger than 10.0 mm, the surgery must be aborted and re-entry performed after 60 to 90 days. Furthermore, the combination of biomaterial and PRF significantly improved bone regeneration in the peri-implant area. Therefore, although the results do not seem to confirm that PRF is better than other biomaterials, it is suggested that its use can result in a decrease in the total healing time, around 104 days, and improve the handling of the graft material.


  1. Wang J, Sun X, Lv H, Du L, Wang L, Zhou Y. Endoscope-Assisted Maxillary Sinus Floor Elevation with Platelet-Rich Fibrin Grafting and Simultaneous Implant Placement: A Prospective Clinical Trial. Int J Oral Maxillofac Implants. 2021 Jan-Feb;36(1):137-145. doi: 10.11607/jomi.8723. PMID: 33600535.
  2. Irdem HO, Dolanmaz D, Esen A, Ünlükal N, Şimsek S. Evaluation of the Effectiveness of Liquid Platelet-Rich Fibrin and Deproteinized Bovine Bone Mineral Mixture on Newly Formed Bone in Maxillary Sinus Augmentation: A Split-Mouth, Histomorphometric Study. Niger J Clin Pract. 2021 Sep;24(9):1366-1372. doi: 10.4103/njcp.njcp_692_20. PMID: 34531351.
  3. Abdel-Kader MA, Abdelazeem AF, Ahmed NEB, Khalil YM, Mostafa MI. Oral rehabilitation of a case with regional odontodysplasia using a regenerative approach-A case report and a review of literature. Spec Care Dentist. 2019, May;39(3):330-339. doi: 10.1111/scd.12378. Epub 2019 Apr 16.
  4. Arab H, Shiezadeh F, Moeintaghavi A, Anbiaei N, Mohamadi S. Comparison of Two Regenerative Surgical Treatments for Peri-Implantitis Defect using Natix Alone or in Combination with Bio-Oss and Collagen Membrane. J Long Term Eff Med Implants. 2016;26(3):199-204. doi: 10.1615/JLongTermEffMedImplants.2016016396.
  5. Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24 Suppl: 237-59.
  6. Choukroun J, Diss A., Simonpieri A, Girard MO. Schhoffler C, Dohan SL, et al. Platelet-rich-fibrin (PRF): a second generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod 2006: 101 (3): e 56 – 60.
  7. Diana C, Mohanty S, Chaudhary Z, Kumari S, Dabas J, Bodh R. Does platelet-rich fibrin have a role in osseointegration of immediate implants? A randomized, single-blind, controlled clinical trial. Int J Oral Maxillofac Surg. 2018 Sep;47(9):1178-1188. doi: 10.1016/j.ijom.2018.01.001. Epub 2018 May 7.
  8. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJJ, Mouhyi J, et al. Platelet-rich-fibrin (PRF); A second generation concentrate. Part I: Tecnological concepts and evolution. Oral Sugery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. 2006; 101 (3): e 37- e 44.
  9. Jeong SM, Lee CU, Son JS, Oh JH, Fang Y, Choi BH. Simultaneous sinus lift and implantation using platelet-rich-fibrin as sole grafting material. J. Craniomaxillofac Surgery. 2014; 42 (6): 990 – 4.
  10. Li P, Zhu H, Huang D. Autogenous DDM versus Bio-Oss granules in GBR for immediate implantation in periodontal postextraction sites: A prospective clinical study. Clin Implant Dent Relat Res. 2018 Dec;20(6):923-928. doi: 10.1111/cid.12667. Epub 2018 Sep 19.
  11. Momen-Heravi F, Peters SM, GArfinkle L, Kang P. Acellular Dermal Matrix as a Barrier for Guided Bone Regeneration of Dehiscence Defects Around Dental Implants: A Clinical and Histological Report. Implant Dent. 2018 Aug;27(4):521-524 [doi: 10.1097/ID.0000000000000796].
  12. Moreira, A.C., Silva, J.R., Samico, R.P., Nishioka, G.N.M., Nishioka, R.S. Application of Bio-Oss in tissue regenerative treatment prior to implant installation: literature review. Braz Dent Sci. 22(2), 2019.
  13. Nícoli, L. G., Pigossi, S. C., Araújo, R.F. d S.B., Marcantonio, C., Marcantonio, E., Marcantonio, JR. E. Multidisciplinary approach to oral rehabilitation with dental implants after gunshot injury. A clinical report. The Journal of Prothestic Dentistry. 2018; 119 (3): 329 – 33.
  14. Nizam N, Eren G, Akcali A, Donos N. Maxillary sinus augmentation with leukocyte and platelet-rich fibrin and deproteinized bovine bone mineral: A split-mouth histological and histomorphometric study. Clin Oral Implants Res. 2018 Jan;29(1):67-75 [doi: 10.1111/clr.13044. Epub 2017 Aug 8].
  15. Pichotano EC, De Molon RS, Freitas De Paula LG, De Souza RV, Marcantonio EJR, Zandim-BArcelos DL. Early Placement of Dental Implants in Maxillary Sinus Grafted With Leukocyte and Platelet-Rich Fibrin and Deproteinized Bovine Bone Mineral. J Oral Implantol. 2018 Jun;44(3):199-206. doi: 10.1563/aaid-joi-D-17-00220. Epub 2018 Feb 19.
  16. Starch-Jensen T, Aludden H, Hallman M, Dahlin C, Christensen AE, Mordenfeld AA. Systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation. Int J Oral Maxillofac Surg. 2018 Jan;47(1):103-116. doi: 10.1016/j.ijom.2017.05.001. Epub 2017 May 22.
  17. Strauss FJ, Stähli A, Gruber R. The use of platelet-rich fibrin to enhance the outcomes of implant therapy: A systematic review. Clin Oral Implants Res. 2018 Oct;29 Suppl 18:6-19. doi: 10.1111/clr.13275.
  18. Tajima N, Ohba S, Sawase T, Asahima I. Evaluation of sinus floor augmentation with simultaneous implant placement using platelet-rich-fibrin as sole grafting material. Int J Oral Maxillofac Implants 2013;28(1):77- 83.
  19. Tatullo M, Marrelli M, Cassetta M, Pacifici A, Stefanelli LV, Scacco S, Dipalma G, Pacifici L, INchingolo F. Platelet Rich Fibrin (PRF.) in reconstructive surgery of atrophied maxillary bones: clinical and histological evaluations. Int J Med Sci. 2012;9(10):872-80 [doi: 10.7150/ijms.5119. Epub 2012 Nov 7].
  20. Wu IH, Bakhshalian N, Galaustian R, Naini RB, Min S, Freire M, Zadeh HH. Retrospective Analysis of the Outcome of Ridge Preservation with Anorganic Bovine Bone Mineral: Marginal Bone Level at Implants Placed Following Healing of Grafted Extraction Sockets. Int J Periodontics Restorative Dent. 2019 Jan/Feb;39(1):131-140. doi: 10.11607/prd.3308.
  21. Xuan F, Lee CU, Son JS, Jeong SM, Choi BH. A comparative study of the regenerative effect of sinus bone grafting with platelet-rich fibrin-mixed Bio-Oss® and commercial fibrin-mixed Bio-Oss®: an experimental study. J Craniomaxillofac Surg. 2014 Jun;42(4):e47-50 [ doi: 10.1016/j.jcms.2013.05.029. Epub 2013 Aug 2].
  22. You JS, Kim SG, Oh JS, Kim JS. Effects of Platelet-Derived Material (Platelet-Rich Fibrin) on Bone Regeneration. Implant Dent. 2019 Mar 8 [doi: 10.1097/ID.0000000000000877.
  23. Zhang Y, Tangl S, Huber CD, Lin Y, Qiu L, Raush-Fan X. Effects of Choukroun’s platelet-rich-fibrin on bone regeneration in combination with deproteinized bovine bone mineral in maxillary sinus augmentation: a histological and histomorphometric study. J Craniomaxillofac Surg. 2012; 40 (4): 321 -8.
  24. Zhou J, Li X, Sun X, Qi M, Chi M, Yin L, Zhou Y. Bone regeneration around immediate placed implant of molar teeth with autologous platelet-rich fibrin: Two case reports. Medicine (Baltimore). 2018 Nov;97(44):e13058. doi: 10.1097/MD.0000000000013058.

How to Cite

Mello, Álvaro A. de, Esteves, . E. da S., & Manzini, R. (2022). Investigation of the main clinical findings of maxillary sinus surgery with platelet-rich fibrin: a systematic review. MedNEXT Journal of Medical and Health Sciences, 3(S3).