Factors affecting changes in sinus graft height between and above the placed implants

Three-dimensional volumetric assessment and stability of simultaneously placed implant following sinus floor augmentation with deproteinized human demineralized tooth matrix or deproteinized bovine bone mineral: a randomized controlled clinical trial

PURPOSE

This study aimed to analyze and compare three-dimensional volumetric bone changes and stability of simultaneously placed dental implants following sinus augmentation using deproteinized human demineralized tooth matrix (dpDTM) and deproteinized bovine bone mineral (DBBM).

METHODS

Twenty-four patients who required lateral maxillary sinus floor augmentation with simultaneous dental implant placement were randomly assigned to receive either dpDTM (n = 12) or DBBM (n = 12). Cone-beam computed tomography and resonance frequency analysis of implant stability were conducted immediately after surgery and 6 months postoperatively. Changes in the graft sinus floor and graft height volumes in the sagittal and coronal views, along with the implant stability quotient (ISQ), were analyzed and compared.

RESULTS

Volumetric graft alteration was comparable between dpDTM (120.33 ± 77.48 mm3) and DBBM (108.51 ± 65.15 mm3) (p = 0.690). Reduction in the average graft height was also comparable: dpDTM group ranged from - 0.59 to - 0.93 mm and the DBBM group ranged from - 0.55 to - 0.82 mm (p > 0.05) at most examined levels. However, greater reduction in the mesial-graft height occurred in the dpDTM group (- 1.08 ± 0.70 mm vs. -0.58 ± 0.39 mm, p = 0.04). The ISQ values increased similarly in both groups to reach 70 at 6 months.

CONCLUSION

dpDTM demonstrated comparable stability in graft volume and height during the healing process compared to DBBM and could serve as a viable alternative to DBBM for sinus floor augmentation with simultaneous implant placement.

The impact of deproteinized bovine bone particle size on histological outcomes in sinus floor elevation: a systematic review and meta-analysis

OBJECTIVES

The main purpose of this study was to evaluate whether large granular bovine bone can be as effective as small granular bovine bone in maxillary sinus floor elevation.

METHODS

A comprehensive online search of eligible articles was conducted using PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science, and a systematic review and meta-analysis was performed from establishment to February, 2023. The outcome indicators were the percentage of connective tissue, the percentage of newly formed bone and the percentage of residual xenograft respectively. The meta-analysis was conducted by using the Stata 15.1 (Stata Conpernarn, USA) and Review Manager software5.4.1.

RESULTS

After careful screening and review, a total of 4 studies were included for systematic review and meta-analysis. The data were extracted to compare the histological performance of bovine bones with different particle sizes after maxillary sinus elevation. No significant differences were found in the percentage of connective tissue, the percentage of newly formed bone, and the percentage of residual xenograft.

CONCLUSION

In this study, a systematically review of the previous literature showed that similar histological results were obtained for both large-particle bovine bone and small-particle bovine bone. Therefore, the large granular bovine bone and the small granular bovine bone were equally effective in maxillary sinus elevation. It is difficult to make conclusion from limited evidence from four studies. More clinical evidence was needed.

Risk factors and longitudinal regenerative outcomes of sinus membrane perforation during lateral window sinus floor elevation: A retrospective analysis up to 9 years

BACKGROUND

Lateral-window sinus floor elevation (LSFE) is a reliable procedure to reconstruct the posterior maxilla for implant therapy. This retrospective study aimed to investigate risk factors associated with Schneiderian membrane perforation (SMP) occurrence during LSFE and longitudinal regenerative outcomes following LSFE up to 9 years.

METHODS

Patients who had LSFE between 2010 and 2019 were included. All demographic and surgical-related data were retrieved from existing electronic health records. Radiographs were used to evaluate the vertical dimensional changes of ridge and graft materials and the potential anatomic factors of SMP.

RESULTS

A total of 122 LSFE procedures in 99 patients were included in the study. Mean ridge height gain and graft shrinkages were 9.5 ± 3.47 and 1.57 ± 2.85 mm. The influence of the healing period on graft shrinkage showed a positive trend; the longer the healing period, the greater the graft shrinkage (p = 0.09). The pathology in the sinus showed a positive correlation with SMP (p = 0.07). However, other anatomical factors did not negatively impact SMP and subsequent ridge height gain (p > 0.05).

CONCLUSIONS

With inherent limitation, the findings with up to 9 years of follow-up indicate a consistent ridge remodeling lasting for about 3 years after LSFE procedures. SMP or membrane thickening may not significantly affect the ridge gain following LSFE. The healing period had the most significant influence on graft shrinkage, showing that the longer the healing time between LSFE and implant placement, the greater the graft shrinkage.

Osteoinductive calcium phosphate with submicron topography as bone graft substitute for maxillary sinus floor augmentation: A translational study

OBJECTIVES

The aim of this study was the preclinical and clinical evaluation of osteoinductive calcium phosphate with submicron surface topography as a bone graft substitute for maxillary sinus floor augmentation (MSFA).

MATERIAL AND METHODS

A preclinical sheep model of MSFA was used to compare a calcium phosphate with submicron needle-shaped topography (BCPN , MagnetOs Granules, Kuros Biosciences BV) to a calcium phosphate with submicron grain-shaped topography (BCPG ) and autologous bone graft (ABG) as controls. Secondly, a 10-patient, prospective, randomized, controlled trial was performed to compare BCPN to ABG in MSFA with two-stage implant placement.

RESULTS

The pre-clinical study demonstrated that both BCPN and BCPG were highly biocompatible, supported bony ingrowth with direct bone apposition against the material, and exhibited bone formation as early as 3 weeks post-implantation. However, BCPN demonstrated significantly more bone formation than BCPG at the study endpoint of 12 weeks. Only BCPN reached an equivalent amount of bone formation in the available space and a greater proportion of calcified material (bone + graft material) in the maxillary sinus compared to the "gold standard" ABG after 12 weeks. These results were validated in a small prospective clinical study, in which BCPN was found comparable to ABG in implant stability, bone height, new bone formation in trephine core biopsies, and overall clinical outcome.

CONCLUSION

This translational work demonstrates that osteoinductive calcium phosphates are promising bone graft substitutes for MSFA, whereas their bone-forming potential depends on the design of their surface features. Netherlands Trial Register, NL6436.

Comparison of the effects of three different xenogeneic bone grafts used in sinus augmentation simultaneous with dental implant placement on the survival of the implants and the dimensional changes of the region

BACKGROUND

Xenografts can be produced in various particle sizes by using different bone types. Currently, there is no consensus about the ideal type of xenograft for sinus augmentations, and this choice depends on the personal experience of clinicians. This retrospective study aimed to evaluate the effects of three different xenografts used in sinus augmentation simultaneously with implant placement on the survival of the implants and the dimensional changes of the region.

METHODS

One hundred nine sinus augmentations and 164 implants were evaluated in 76 patients. Three different xenografts were used: 41 Gen-Os^® (250-1000µm, Corticocancellous; Tecnoss, Giaveno, Turin, Italy), 35 Bio-Oss^® (1000-2000µm, Cancellous; Geistlich Biomaterials italia S.r.l., Vicenza, Italy) and 33 Apatos-Cortical^® (600-1000µm, Cortical; Tecnoss). The preoperative, postoperative, and follow-up (21±8.8 month) radiographs were evaluated for the dimensional changes and the implant survivals. The data were statistically analyzed.

RESULTS

Among the implant failures; 3 (5.6%) in 53 implants in Apatos, 2 (3.6%) in 55 implants in Bio-Oss, 9 (16%) in 56 implants in Gen-Os, and 14 (8.5%) total implant failures were observed. This difference between the groups was statistically significant and was due to the high loss rate in the Gen-Os (P=0.044). There was a mean difference of -1.8±1.5mm between the measured bone heights on postoperative day (14.2±2.4mm) and the last follow-up (12.4±2.5 mm). While the loss of height was not affected due to the graft type (P=0.981), the general 12.6% vertical loss was statistically significant (P<0.0001), also the length of implants placed reduced this loss (P=0.036).

CONCLUSIONS

Within the limits of this retrospective study, it can be concluded that: 1) The sinus augmentation procedures with thicker particle size grafts achieved higher success rate; and 2) over the time, 12.6% loss may occur in the height of grafted area.

Fixation screw minimizes bone graft loss following autogenous lateral block graft augmentation: An experimental in vivo study

PURPOSE

Assess the role of tenting screws in the remodeling processes of autogenous bone blocks used for mandibular lateral augmentation in rabbits.

METHODS

Eighteen rabbits, approximately 3.5-4.0 kg of weight and 4-5 months of age, were included in this study. One lateral side of the angle of the mandible was augmented with block autografts. Animals were euthanized after 7, 20 and 60 days of healing, respectively. Biopsies were taken for each period and specimens underwent microtomographic scanning. The total volume (TV, mm³), bone volume (BV: residual graft plus new bone, mm³), periimplant bone volume (PIBV), bone implant contact (BIC) along the screw and linear bone gain at five vertical points symmetrically dispersed from the fixation screw in the midline were measured. ANOVA and the t-test were performed.

RESULTS

The total volume (TV) of autografts decreased between 7 and 60 days from 258.13±15.3 mm³ to 107.2 ± 17.5 mm³ (p < 0.05). Contraction rates of 58.5% were observed. BV was 52.8 ± 7.7 mm³, 27.2 ± 11.1 mm³, and 33.1 ± 2.8 mm³ after 7, 20, and 60 days of healing, respectively. PIBV and BIC remained unchanged along time demonstrating no contraction around the screw. Total linear bone gain demonstrated a total of 18% linear contraction after 60 days. Point 1, demonstrated no changes along time representing no resorption along time. Points 2 and 4 demonstrate a minimum linear contraction (10-15%) with borderline significance. Resembling the total results, contraction starts after 20 days. Points 3 and 5 demonstrate a statistically significant contraction (p<0.05) of 35-40% starting at 20 days.

CONCLUSION

Tenting screws may reduce bone resorption symmetrically in a model of lateral block augmentation.

Combination of an allogenic and a xenogenic bone substitute material with injectable platelet-rich fibrin - A comparative in vitro study

The aim of the in vitro study was a comparison of an allogenic (ABSM) and a xenogenic bone substitute material (XBSM) with and without injectable platelet-rich fibrin (ABSM-i-PRF & XBSM-i-PRF) on cell characteristics of human osteoblasts (HOB). Here, ABSM and XBSM (+ i-PRF = test; - i-PRF = control) were incubated with HOB for 3, 7 and 10 days. HOB viability, migration, proliferation and differentiation (RT-PCR on alkaline phosphatase (AP), bone morphogenetic protein 2 (BMP-2) and osteonectin (OCN)) were measured and compared between groups. At day 3, an increased viability, migration and proliferation was seen for ABSM-i-PRF. For viability and proliferation (days 7 and 10) and for migration (day 10), ABSM-i-PRF/XBSM-i-PRF showed higher values compared to ABSM/XBSM with maximum values for ABSM-i-PRF and minimum values for XBSM. At days 3 and 7, the highest expression of AP was detected in ABSM-i-PRF/XBSM-i-PRF when compared to ABSM/XBSM, whereas at day 10, AP expression levels were elevated in ABSM-i-PRF/ABSM. The highest BMP-2 expression was seen in ABSM-i-PRF whereas OCN expression showed higher levels in ABSM-i-PRF/XBSM-i-PRF at days 3 and 7 with lowest expression for ABSM. Later on, elevated OC levels were detected for ABSM-i-PRF only. In conclusion, i-PRF in combination with ABSM enhances HOB activity when compared to XBSM-i-PRF or untreated BSM in vitro. Therefore, addition of i-PRF to ABSM and - to a lower extent - to XBSM may influence osteoblast activity in vivo.

Bone Formation in Grafts with Bio-Oss and Autogenous Bone at Different Proportions in Rabbit Calvaria

Background

The aim of this study was to assess the volumetric stability and bone formation in grafts with Bio-Oss and autogenous bone at different proportions in rabbit calvaria. Material and Methods. Ten rabbits received four titanium cylinders in their calvaria and randomly divided into the following groups: Group I: Bio-Oss (100%), Group II: Bio-Oss (75%) + autogenous bone (25%), Group III: Bio-Oss (50%) + autogenous bone (50%), and Group IV: autogenous bone (100%). After twelve weeks, the animals were euthanized, and samples were collected for clinical and histological analysis.

Results

Clinical analysis showed that Groups I (90.43 ± 8.99) and II (90.87 ± 7.43) had greater dimensional stability compared to Group IV (P=0.0005). Histologically, Groups I, II, and III showed areas of bone formation with particles of biomaterial remaining in close contact with the newly formed bone. However, there were no significant differences between the groups regarding the newly formed bone area.

Conclusion

It was concluded that the use of Bio-Oss either alone or associated with the autogenous bone at a proportion of 25% showed superior dimensional stability compared to the use of autogenous bone in the proposed experimental model.

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6–9 months of healing time. Mean follow-up was 17.5 months, range 12–36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

The impact of graft remodeling on peri-implant bone support at implants placed concomitantly with transcrestal sinus floor elevation: A multicenter, retrospective case series

OBJECTIVES

To evaluate the impact on peri-implant bone support (as assessed on periapical radiographs) of the remodeling dynamics of varying graft biomaterials used for transcrestal sinus floor elevation (tSFE).

METHODS

The study is a multicenter, retrospective series of cases undergone tSFE (performed according to the Smart Lift technique) and concomitant implant placement. At operator's discretion, tSFE was performed with bone core (BC) alone or supplemented by deproteinized bovine or porcine bone mineral (DBBM and DPBM, respectively), synthetic hydroxyapatite in a collagen matrix (S-HA), or ß-tricalcium phosphate (ß-TCP). Immediately after surgery, at 6-12 months post-surgery, and at later (≥24 months) follow-up intervals, the percentage proportion of the implant surface in direct contact with the radiopaque area was calculated for the entire implant surface (totCON%). Also, the height of the graft apical to the implant apex (aGH) was assessed.

RESULTS

At 6-12 months following tSFE, median totCON% was 100%, with a median aGH of 1.4 mm. A tendency of aGH to decrease in height was observed at later follow-up intervals for sites treated with all grafting procedures. In all treatment groups, the majority of the implant surface was still surrounded by the radiopaque area at the longest follow-up visits.

CONCLUSIONS

Although the height of the peri-implant radiopaque area apical to the implant apex tends to reduce overtime at sites which have received tSFE, the peri-implant bone support seems to be maintained long term irrespective of the graft material used.

Radiographic outcomes of transcrestal and lateral sinus floor elevation: One-year results of a bi-center, parallel-arm randomized trial

OBJECTIVES

To comparatively evaluate the radiographic outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively) when applied concomitantly with implant placement.

MATERIALS AND METHODS

Patients with at least 1 edentulous site with residual bone height (RBH) of 3-6 mm were enrolled in a bi-center, parallel-arm, randomized trial. Both tSFE and lSFE were associated with a bovine-derived xenograft, and implants were inserted concomitantly. In lSFE group, the antrostomy was covered with a resorbable collagen membrane. Marginal bone loss and the maturation of the grafted area were evaluated on periapical radiographs at 6 and 12 months. Twelve-month CT/CBCT was used to assess the effect of grafting procedures circumferentially around the implant. A per-protocol analysis was performed.

RESULTS

The per-protocol study population consisted of 26 patients in the tSFE group and 28 patients in the lSFE group. At 12 months, the median proportion of the implant surface in contact with the peri-implant radiopaque area was 100% in both groups, with no significant inter-group difference. Suboptimal bone-to-implant contact was observed in 13% and 3.6% of tSFE and lSFE cases, respectively. In both groups, marginal bone loss was minimal (≤1 mm) and infrequent, and the radiographic aspect was suggestive of an advanced stage of maturation.

CONCLUSIONS

At sites with RBH of 3-6 mm where implants are placed concomitantly with sinus floor elevation, tSFE and lSFE are both highly predictable in obtaining an implant surface completely embedded in a radiopaque area at 12 months post-surgery. (ClinicalTrials.gov ID: NCT02415946).

Successful Use of Leukocyte Platelet-Rich Fibrin in the Healing of Sinus Membrane Perforation: A Case Report

PURPOSE

The aim of this case report was to demonstrate the repair of a large sinus membrane perforation related to a sinus floor augmentation procedure, using leukocyte platelet-rich fibrin (L-PRF), for subsequent rehabilitation of a partially edentulous patient.

MATERIALS AND METHODS

The patient presented the absence of teeth numbers 18, 17, and 16, associated with insufficient bone height because of the maxillary sinus pneumatization. A maxillary inlay bone graft was proposed, however, during the sinus floor augmentation procedure, a large portion of the sinus membrane was ruptured. To avoid interruption of the surgical procedure, membrane mending was proposed using L-PRF and collagen membranes.

RESULTS

After 8 months, 2 external hexagon connection dental implants were placed in the 16 and 17 teeth regions, and a screw-retained implant-supported prosthesis was installed.

CONCLUSION

The use of L-PRF associated with collagen membrane was efficient for the sealing of the sinus membrane perforation and enabled bone formation for subsequent implant installation.

Maxillary Sinus Augmentation for Dental Implant Rehabilitation of the Edentulous Ridge: A Comprehensive Overview of Systematic Reviews

OBJECTIVES

The objective of this systemic review was to perform a comprehensive overview of systematic reviews and meta-analyses of the maxillary sinus augmentation procedure for implant rehabilitation in humans. The following were evaluated in this overview: (1) anatomic variables affecting sinus augmentation, (2) histomorphometric analysis of the grafted sinus, (3) volumetric changes after sinus grafting, and (4) implant survival beyond 1 year.

MATERIAL AND METHODS

Electronic databases were searched for systematic reviews and meta-analyses of implant-related sinus augmentation published from 1976 to September 2015. The studies selected must identify itself as a systemic review or meta-analysis in the title or abstract and must pertain to sinus augmentation.

RESULTS

Thirty-three publications fulfilled the review criteria. The AMSTAR ratings for the 33 chosen reviews scored greater than 3 of 11, with 8 reviews scoring greater or equal to 8 of 11.

CONCLUSION

The outcome of this overview suggested that the following will increase the success of sinus augmentation and survival of implants placed in the grafted sinus: (1) the use of barrier membranes over the lateral window when using a lateral approach to graft the sinus, (2) the use of particulate autogenous bone with or without other substitute graft materials, (3) sinus augmentation without the use of grafting materials may be considered provided that the space between the sinus membrane and floor can be maintained, (4) the use of rough-surfaced implants, (5) simultaneous implant placement with residual bone height greater than 4 mm, and (6) the cessation of smoking.

Maxillary sinus lift using osteoinductive simvastatin combined with β-TCP versus β-TCP - a comparative pilot study to evaluate simvastatin enhanced and accelerated bone formation

PURPOSE

The aim of this study was to evaluate available bone quality and quantity after performing sinus augmentation using simvastatin/β-TCP combination versus β-TCP alone.

MATERIALS AND METHODS

This study included eight sinus lift procedures conducted on six patients. The sinuses were divided into two equal groups. The patients were recalled one, two weeks two, five, nine months post-operatively for post-operative evaluation. Radiographic evaluation involved cone beam computed tomography (CBCT) radiographs taken for every patient one week and nine months post-operatively to evaluate the changes in bone height, while histomorphometric evaluation involved transcortical bone biopsies taken after nine months during the second-stage surgery for implant placement.

RESULTS

The histomorphometric results showed that the amount of newly formed bone was higher in the simvastatin group when compared to the β-TCP group nine months after the surgery; the difference between the two groups was statistically significant. On the other hand, the radiographic evaluation showed that the rate of resorption of the simvastatin group was found to be higher than the control group; however, the difference between both groups was statistically insignificant.

CONCLUSION

These results showed that Simvastatin is safe to be used in sinus lift with promising osteoinductive capacity, yet further studies using larger sample size is needed.

Multidisciplinary approach to oral rehabilitation with dental implants after gunshot injury: A clinical report

This clinical report describes a multidisciplinary approach to treat a patient with edentulism and a severe anatomic defect in the mandible caused by a gunshot injury by using an implant-fixed complete dental prosthesis. An immediate loading interim implant-fixed complete dental prosthesis in the mandible associated with a maxillary removable complete denture prosthesis was initially provided to restore the intermaxillary relation. Nasal floor elevation and maxillary sinus augmentation were subsequently performed to increase the maxillary bone volume. Definitive implant-fixed complete dental prostheses were placed in both arches in order to rehabilitate this initially compromised anatomic condition, which ensured patient satisfaction and improvement in masticatory function and esthetics.

Maxillary sinus lift surgery-with or without graft material? A systematic review

The purpose of this systematic review was to perform a comparative analysis of the use or not of graft material in maxillary sinus lift surgery. Relevant studies published in the last 10 years were identified through a search of the PubMed/MEDLINE, ScienceDirect, and Cochrane Library databases and were assessed against the study inclusion and exclusion criteria. The initial search resulted in 1037 articles. After applying the inclusion and exclusion criteria, 16 articles remained. Four hundred and thirty-six patients were followed up over a postoperative period ranging from 6 months to 11 years. In total, 868 implants were installed in 397 maxillary sinuses. The implant survival rate was 96.00% for surgeries performed without graft material and 99.60% for those in which biomaterial was used, within a follow-up period of 48 to 60 months. In conclusion, maxillary sinus lift surgery, with or without graft material, is a safe procedure with a low complication rate and predictable results.

Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Systematic Review

The aim of this study was to systemically assess the efficacy of platelet-rich fibrin (PRF) on maxillary sinus augmentation using the lateral approach. A PubMed search and a hand search of relevant journals and the bibliographies of selected articles were performed. Clinical studies using PRF with open maxillary sinus augmentation were included. The search provided 290 titles; only 8 studies fulfilled the inclusion criteria. Identified studies showed heterogeneity regarding surgical technique, grafting material, implant placement time, protocol, outcome measures, healing time for biopsy, and implant placement, as well as follow-up period. From the 8 identified studies, 3 studies used PRF as a sole filling material, whereas the other 5 studies used PRF with bone substitutes. PRF showed promising results as a sole filling material for sinus lift with simultaneous implant placement, and PRF seemed to accelerate maturation of a demineralized freeze dried bone allograft. Conversely, it had no effect on deproteinized bovine maturation. PRF fibrin membranes represent an easy and successful method to cover the sinus membrane or osteotomy window.

Sinus Augmentation With Platelet-Rich Fibrin in Combination With Bovine Bone Graft Versus Bovine Bone Graft in Combination With Collagen Membrane

The purpose of this study was to compare the efficacy between the use of bovine bone graft material and platelet-rich fibrin (PRF) mixture (test group) and bovine bone graft material and collagen membrane combination (control group) in 2-stage maxillary sinus augmentation. According to specific inclusion/exclusion criteria, patients treated between 2008 and 2012 were selected. Panoramic radiographs were used for radiologic assessments. To evaluate the relationship between sinus-graft height and each implant, the bone level (BL) was divided by implant length (IL). To evaluate the change in the height of grafted sinus, the grafted sinus floor above the lowest part of the original sinus height (GSH) was divided by the original sinus height (OSH). Samples taken during implant surgery were used for histologic and histomorphometric analyses. Twenty-five patients, 32 augmentation surgeries, and 66 one-stage implants were included in the study. No implant loss or complication was observed in either group. There were no statistical differences according to new bone formation (P = .61) and biomaterial remnant (P = .87). During the evaluation period, the test group showed statistically less change in the BL/IL ratio (P = .022). The difference of GSH/OSH ratio was found to be insignificant between groups (P = .093). It was observed that the grafted sinus covering the implant apex and sinus floor was above the original sinus height in both groups. It may be concluded from this study that both combinations can be successfully used for sinus augmentation. Further studies evaluating different graft materials and PRF combinations in the early phases of healing would be beneficial.