Do recombinant, purified or concentrated growth factors enhance the regenerative potential of particulate bone graft substitutes in maxillary sinus floor augmentation? A systematic review and meta-analysis.

Abstract

The clinical use of bioactive substances, such as growth factors, have significantly increased, however, potential regenerative effects derived from the addition of different growth factors to bone substitutes on maxillary sinus floor augmentation (MSA) procedures is still controversial. This systematic review (SR) aimed at answering the following question: "Do recombinant, purified and concentrated growth factors enhance the regenerative potential of particulate bone graft substitutes in maxillary sinus floor augmentation?". Human studies comparing histomorphometric data of the outcomes of interest new bone formation, residual graft material, and fibrous tissue ratio following MSA procedures employing particulate bone grafts/substitutes in combination or not with growth factors were retrieved from PubMed/MEDLINE, Web of Science, Cochrane and Scopus online databases and complemented with a hand search. Controlled studies published in English up to December 2022 and reporting on histomorphometric data expressed as percent volume of the outcomes of interest were considered. Risk of bias was assessed, and a meta-analysis (MA) was performed to investigate the effects of supplementary growth factors on new bone formation, remaining graft particles and fibrous tissue ratio. Data of 613 samples from 477 patients reported in 22 publications were included. MA showed PRP or PRF resulted in 49% more new bone formation than in areas in control groups (P=0.004), and those areas supplemented with growth factors presented 57% less residual graft particles after healing (P<0.0001). A significant (P=0.03) 1.85-fold increase in connective tissue formation was noted in areas treated with rhBMP after healing. The MA provided evidence that selective supplementary growth factors may enhance new bone formation and accelerate particulate graft turnover, while rhBMP may significantly increase connective tissue formation in MSA procedures in humans.