Platelet concentrates in sinus augmentation: The impact of platelet dose and biological characteristics-A systematic review and meta-analysis

This systematic review investigated the osteogenic effects of platelet concentrate (PRF/PRP) when combined with non-autogenous graft materials in sinus lift procedures. Key characteristics assessed included platelet concentration, total platelet dose, leukocyte content, and fibrin-network structure. A comprehensive search of EMBASE OvidSP, PubMed, and the Cochrane Library was conducted in April 2026, resulting in the inclusion of 25 articles. Studies were broadly categorized according to whether they reported enhanced osteogenic outcomes or not: positive studies (n = 15) and negative studies (n = 10). A key finding is that positive studies used a higher total platelet dose than negative studies (8.02 × 10⁹ vs. 3.67 × 10⁹). A subgroup meta-analysis of eight randomized controlled trials (RCTs) found that the five high-dose studies, using approx. ≥10 × 10⁹ platelets, demonstrated a significant increase in new bone formation (effect size: 1.04; p < 0.01). In contrast, the three low-dose studies showed a modest but nonsignificant effect (effect size: 0.49; p = 0.355). However, the difference between the two subgroups was not statistically significant. Available evidence suggests that higher platelet doses, particularly around ≥10 × 10⁹ platelets, may be associated with more favorable osteogenic outcomes. However, this dose should not be interpreted as a clinically validated threshold.