Sinus Augmentation Using Platelet-Rich Fibrin With or Without a Bone Graft: What Is the Consensus?

Regenerative therapies with platelets have been widely used in medicine over the past two decades as a means to speed revascularization to damaged/defective tissues. Within the oral cavity, the sinus is one of the least vascularized areas with healing times typically increased to augment lost or missing bone. As a result, attempts have been proposed to combine platelet concentrates with various biomaterials to accelerate new blood flow to these tissues and ultimately facilitate new bone regeneration. While platelet-rich plasma (PRP) was introduced as a first-generation platelet concentrate, more recently platelet-rich fibrin (PRF) has been developed with anticoagulant removal from centrifugation protocols. Unlike PRP, PRF forms a fibrin clot that may further be utilized as a 3-dimensional scaffold containing a concentrated pool of autologous growth factors for tissue regeneration. Over the past decade, PRF has been used both as a sole grafting material and in combination with a bone graft for sinus augmentation procedures. This article highlights the biological and clinical advantages of using PRF with or without a bone grafting material for sinus augmentation procedures and provides guidelines detailing when, where, and why to use PRF alone versus in combination with a bone graft. Furthermore, the use of PRF for the repair of Schneiderian membrane perforations and as a barrier membrane for lateral window closure is discussed.