Leukocyte-Platelet-Rich Fibrin Combined With Demineralized Bovine Bone Mineral for Maxillary Sinus Augmentation: A...

Maxillary sinus augmentation is considered the gold standard procedure for increasing bone volume to support dental implant placement. However, the added benefit of leukocyte-platelet-rich fibrin (L-PRF) when combined with deproteinized bovine bone mineral (DBBM) remains uncertain. This systematic review and meta-analysis aimed to evaluate the histomorphometric outcomes of L-PRF combined with DBBM compared to DBBM alone. A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central was conducted from inception through May 2025 to identify randomized controlled trials (RCTs) comparing the combination of L-PRF and DBBM versus DBBM alone in patients undergoing lateral maxillary sinus augmentation. Primary outcomes included the percentage of new bone formation and residual bone graft. Secondary outcomes were the percentage of soft tissue and the Implant Stability Quotient (ISQ) at the implant loading stage. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. All analyses were performed using STATA MP version 18 (StataCorp LLC, College Station, TX, US). Five RCTs involving 140 patients were included. The combination of L-PRF and DBBM significantly increased new bone formation (MD = 7.07; 95% CI: 2.20 to 11.93; p < 0.001; I² = 36.86%, p = 0.07) and reduced residual graft material (MD = -7.93; 95% CI: -11.20 to -4.66; p < 0.001; I² = 0%, p = 0.91) compared to DBBM alone. In conclusion, the adjunctive use of L-PRF with DBBM enhances histomorphometric outcomes in maxillary sinus augmentation. Further high-quality, long-term RCTs with standardized protocols are needed to confirm these findings.