Abstract
Background:
The rehabilitation of the posterior maxilla utilizing dental implants is often constrained by diminished residual bone height and suboptimal bone quality. Transcrestal (indirect) sinus floor augmentation has been proposed as a method to promote bone formation; however, comprehensive three-dimensional evidence comparing autologous and synthetic grafting strategies remains scarce.
Objective:
To evaluate and compare three-dimensional endo-sinus bone volume and regional bone density following indirect sinus floor augmentation utilizing blood clot alone, venous blood, injectable platelet-rich fibrin (I-PRF), and an alloplastic graft material.
Methods:
This prospective, parallel-arm, randomized controlled clinical trial involved 64 participants with a posterior maxillary residual ridge height of 4–6 mm. Participants were randomly assigned through computer-generated block randomization into four groups (n = 16 per group): (1) blood clot (no graft), (2) venous blood, (3) I-PRF, and (4) alloplastic graft (NovaBone® dental putty). All subjects underwent crestal indirect sinus floor elevation utilizing the CAS kit with concurrent implant placement. A standardized volume of 0.5 cc of the allocated material was administered prior to the insertion of the implant.
The three-dimensional endo-sinus bone volume, which involves coronal and sagittal segmentation across consecutive CBCT slices, and regional bone density, evaluated in Hounsfield units at designated apical, buccal, and palatal sites, were assessed at six months utilizing Planmeca Romexis® software by a blinded examiner. The sample size was determined through an a priori power analysis. Intergroup comparisons were conducted using one-way ANOVA coupled with Tukey's post-hoc tests (α = 0.05).
Results:
Significant differences were observed among groups for coronal and sagittal bone volume (P < .001), with the alloplastic graft group demonstrating the highest volumetric bone formation. Regional bone density differed significantly at apical, buccal-apical, and palatal-apical regions (P < .001), with higher density values in the alloplastic group. No statistically significant differences were observed in mid-sinus regions. Venous blood and I-PRF showed modest increases compared with blood clot alone, with no significant difference between these two groups in most regions.
Conclusion:
Alloplastic graft-assisted indirect sinus floor augmentation exhibited a statistically significant increase in three-dimensional bone volume and superior apical bone density at six months when compared to autologous techniques and blood clot alone. These findings suggest a potential advantage of synthetic grafting materials; however, further research is required to evaluate long-term clinical outcomes.
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