Abstract
Introduction To assess the efficacy of the autologous platelet concentrates (APCs) combined with autologous bone or bone substitute for the maxillary sinus floor lifting by a meta-analysis. Materials and Methods Electronic databases (PUBMED, Web of Science, EMBASE through OVID, and Cochrane Library) were searched until Dec 31, 2019, and only randomized controlled trials (RCTs) in English were identified. Outcome variables included histologic evaluation, the implant stability quotient values, and radiographic evaluation. Data were analyzed by Revman5.3; the estimate of effect sizes was expressed as the 95% confidence interval; and the risk of bias was evaluated using the Cochrane Collaboration tool. Results 11 RCTs involving 141 patients (214 sites) were included in our meta-analysis, which indicated that the differences in the percentage of contact length among newly formed bone (2.61%, 95% CI, -1.18% to 7.09%), soft tissue area (-0.15%, 95% CI, -0.54% to 0.24%), and residual bone substitute material (-5.10%, 95% CI, -10.56% to 0.36%) in the APC group lacked statistical significance. Besides, there was the same effect on the implant stability quotient (ISQ) values of APC group who underwent implant placement 4 months after sinus augmentation and control group who received implant placement 8 months after sinus augmentation (-0.48, 95% CI, -1.68 to 0.72). No significant effect of APCs on the bone density was found (1.05%, 95% CI, -1.69% to 3.82%). Conclusions The use of APCs in sinus augmentation may be further shorten the time required for bone graft maturation and allow earlier implant placement, but cannot enhance the bone formation in the long term. It is not currently recommended for routine use APCs as an osteoinductive material to bone grafting in sinus augmentation.
Highlights
To assess the efficacy of the autologous platelet concentrates (APCs) combined with autologous bone or bone substitute for the maxillary sinus floor lifting by a meta-analysis
The results showed that the use of APCs determined no significant gain of residual bone substitute material when added to osteoconductive materials during the maxillary sinus augmentation (Figure 4), with an mean difference (MD) of -5.10%, and there were no statistical improvement between the test and control in the subgroup of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP), with an MD of -3.98% and an MD of -8.19%
The results showed that APCs exerted 2.96% less new bone formation when added to osteoconductive materials in the maxillary sinus augmentation compared with osteoconductive materials alone (Figure 3), but there was no significant difference
Summary
To assess the efficacy of the autologous platelet concentrates (APCs) combined with autologous bone or bone substitute for the maxillary sinus floor lifting by a meta-analysis. The use of APCs in sinus augmentation may be further shorten the time required for bone graft maturation and allow earlier implant placement, but cannot enhance the bone formation in the long term It is not currently recommended for routine use APCs as an osteoinductive material to bone grafting in sinus augmentation. There are different kinds of osteoconductive materials to elevate the maxillary sinus floor, including autografts, freezedried bone allografts (FDBA), deproteinized bovine bone mineral (DBBM) xenografts, and alloplastic materials (hydroxyapatite, HA, and beta-tricalcium phosphate, β-TCP) [7]. These materials may cause the new bone formed to lack osteoinductive properties and osteogenic capacities, prolong the healing time, and trigger immune responses, etc. Some osteoinductive materials have none of these disadvantages and can enhance bone regeneration, such as autologous platelet concentrates (APCs), bone morphogenetic protein-2 (rhBMP-2), and mesenchymal stem cells (MSCs)
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