A Comparative Study of The Effectiveness of Platelet Rich Fibrin on Bone Regeneration of Various Grafts in Sinus Floor Augmentation

Peker, Elif

The objective of this study was to evaluate the effectiveness of various grafting materials used for augmentation of the maxillary sinus floor in a rabbit model.

36 adult New Zealand white rabbits were used in this study. Bilateral augmentation of the floor of the maxillary sinus was performed with autogenous bone or other materials. The rabbit maxillary sinuses divided into 4 groups, one of the following was grafted to the maxillary sinus of each rabbit: Demineralized bone matrix (DBM) [Grafton (Osteotech, Eatontown, NJ)] DBM combined with platelet-rich-fibrin (PRF), collagenated heterologous bone graft [Apatos Mix (OsteoBiol®, Tecnoss®, Coazze, Italy)] and collagenated heterologous bone graft combined with PRF. Animals were sacrificed at 2^nd, 4^th and 8^thweeks after surgery. Histological and immunohistochemical examinations were performed to assess biological healing process in the various samples. Hematoxylin-eosin staining was performed for evaluation of bone formation and bone morphogenic protein (BMP) antibody staining was performed for the immunohistochemical evaluation. The data obtained from this study were evaluated with SPSS 20.0 software package. For statistical analysis, Mann Whitney U test and Kruskal Wallis H test with Bonferroni correction were used to examine the differences between the groups.

In all groups new bone formation was seen at 2 to 8 weeks. Statistical analysis of new bone formation revealed no significant differences between PRF+DBM group and PRF+collagenated heterologous bone graft.(p>0.05) According to statistical analysis, total area of residual graft particles and percentage of this area is higher in collagenated heterologous bone graft group than DBM group.(p<0.05) Total new bone area and percentage of this area is higher in the DBM group than collagenated heterologous bone graft group.(p<0.05) According to the immunohistochemical examinations; BMP staining cells are slightly increased in all groups from 2 to 8 weeks, but there is no significant difference in staining of BMP antibody between all groups in the 2^nd, 4^th and 8^thweeks.(p>0.05)

This study showed no positive effect of PRF on new bone formation and BMP expression when combined with demineralized bone matrix and collagenated heterologous bone graft according to the histological and immonuhistochemical evaluation when used in sinus floor augmentation. Demineralized bone matrix improves the outcomes of the sinus augmentation when compared to collagenated heterologous bone graft.

1- Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part V: Histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:299–303.

2- Yu Zhang, Stefan Tangl, Christian D Huber, Ye Lin, Lixin Qiu, Xiaohui Rausch-Fan. 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 Jun;40(4):321-8.