Histologic and Histomorphometric Evaluation of Lateral Maxillary Sinus Augmentation With or Without Platelet-Rich Fibrin

This study was designed as a prospective randomized split-mouth clinical investigation to assess bone regeneration following lateral maxillary sinus augmentation using two different grafting approaches.

Patients presenting with bilateral posterior maxillary edentulism and requiring sinus floor elevation prior to dental implant placement were enrolled. Each patient received demineralized freeze-dried bone allograft (DFDBA) alone on one side and DFDBA combined with platelet-rich fibrin (PRF) on the contralateral side, with treatment allocation determined randomly.

All sinus augmentation procedures were performed using a standardized lateral window technique. Platelet-rich fibrin was prepared from autologous venous blood immediately before surgery according to established centrifugation protocols. A fixed healing period of six months was observed prior to implant placement.

During implant surgery, bone core specimens were harvested from the grafted sinus regions using trephine burs. Histologic and histomorphometric analyses were conducted in a blinded manner to quantify tissue composition, including newly formed bone, residual graft material, and connective tissue.

The study aimed to compare the regenerative outcomes of the two grafting strategies and to evaluate the adjunctive role of PRF when combined with an osteoinductive allograft material in lateral maxillary sinus augmentation.

Inclusion criteria

• Adults aged 18 to 70 years.
• Patients requiring bilateral lateral maxillary sinus augmentation for dental implant placement.
• Adequate residual alveolar bone height allowing for lateral sinus floor elevation.
• Good general health (ASA I or II).
• Ability to understand the study procedures and provide written informed consent.

Exclusion criteria

• Presence of systemic diseases affecting bone metabolism (e.g., uncontrolled diabetes, osteoporosis).
• History of head and neck radiotherapy.
• Use of medications known to affect bone healing (e.g., bisphosphonates, corticosteroids).
• Active sinus pathology or chronic sinusitis.
• Heavy smoking (>10 cigarettes per day).
• Pregnancy or lactation.
• Poor oral hygiene or untreated periodontal disease.