Platelet‐Rich Fibrin (PRF) Promotes Maxillary Sinus Bone Regeneration: A Randomised Clinical Trial and Proteomic Analysis

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AIM: To compare the percentage of new bone formation as the primary outcome of bone regeneration at 6 months after maxillary sinus floor elevation (MSFE) using platelet-rich fibrin (PRF) combined with deproteinised bovine bone mineral (DBBM) versus DBBM alone, and to explore the molecular mechanisms through which PRF modulates osteogenesis in the maxillary sinus. MATERIALS AND METHODS: Forty patients undergoing MSFE were randomly allocated to two groups: DBBM alone or PRF + DBBM. Six months post MSFE, bone core samples were harvested during implant placement. Clinical outcomes included implant stability and postoperative complications. Radiographic analyses quantified graft height and volumetric changes. Bone regeneration was evaluated by micro-computed tomography (micro-CT) and histomorphometry, while osteogenic marker expression was examined using RT-qPCR and immunofluorescence. Proteomic profiling, followed by Western blot validation, was performed to identify signalling pathways associated with PRF-induced osteogenesis. RESULTS: The PRF + DBBM group (n = 20; 42 implants) showed significantly higher primary implant stability (71.85 ± 4.96 vs. 67.65 ± 5.19, p < 0.05). Histological analysis revealed a significantly greater amount of newly formed bone with improved quality, as indicated by higher new bone formation (28.81% ± 4.41% vs. 22.44% ± 4.40%, p < 0.001) and increased bone maturity (57.05% ± 7.76% vs. 49.17% ± 7.09%, p < 0.01) compared to the DBBM group (n = 20; 45 implants). Molecular assays showed up-regulated osteogenic gene and protein expression, with activation of TGF-β, PI3K-Akt and complement and coagulation cascade pathways. CONCLUSION: PRF combined with DBBM resulted in improved new bone formation in the maxillary sinus compared to DBBM alone and showed superior healing outcomes, potentially mediated by key growth factors and the complement protein C1q.

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