The effect of autologous platelet concentrates as solely grafting material or with bone graft materials in maxillary sinus augmentation: a meta-analysis of randomized controlled trials.

Objectives: This study compared the effectiveness of adding autologous platelet concentrates (APCs(+)) and sole bone grafting procedures (APCs(-)) in maxillary sinus augmentation (MSA).

Materials and methods: A systematic search was performed to identify randomized controlled trials (RCTs) from electronic database and clinical registers published up to June 1, 2024. Six evaluation indices comprising percentage of new bone formation (NBF%), percentage of residual bone substitute (RBS%), percentage of fibrous tissue (FT%), implant stability quotient (ISQ), bone height (BH) and bone density (BD) were identified.

Results: We analyzed 14 studies involving 268 lifted sinuses and 119 implants. Compared with the APCs(-) group, the APCs(+) group demonstrated a significant advantage regarding NBF% (weight mean difference (MD)= 4.80, 95% confidence interval (CI) (1.82,8.32), p=0.007) and RBS% (MD=-4.48, 95% CI (-6.01,2.96), p<0.01), with no evident superiority in FT% (MD=-0.11, 95% CI (-0.56,0.35), p=0.64), ISQ (MD=-1.68, 95% CI (-6.77,3.40), p=0.52) and BH (standard mean difference (SMD) =-0.11, 95% CI (-3.04,2.83), p=0.94). While APCs(-) group showed a significant benefit in BD compared to the APCs(+) group (MD=-28.34, 95% CI (-48.98,-7.71), p=0.01).

Conclusion: Compared with APCs(-), APCs(+) could be a better option for promoting NBF% and reducing RBS%, whereas we found no evident influence in FT% and ISQ under MSA. Concerning BD and BH results, there were no additional effects with the addition of APCs, which needs to be treated with caution due to the limited number of studies.

Clinical relevance: APCs(+) procedures show promising results, with a higher NBF% and lower RBS%, making them a potential routine MSA strategy.