Optimizing sinus lift: the contribution of L-PRF in question

In the posterior maxillary sector, residual bone atrophy represents a major challenge for implant-supported rehabilitation. While sinus floor elevation is a proven technique for restoring the necessary volume, the integration of platelet concentrates aims to secure and accelerate the biological healing processes. This narrative literature review examines the use of leukocyte- and platelet-rich fibrin (L-PRF) as a specific biological adjuvant for sinus lift procedures.

Objectives and scope of the analysis

The objective of this synthesis is to evaluate the clinical indications, preparation protocols, and real benefits of L-PRF in the context of sinus lift. The authors analyze its role in stimulating angiogenesis, clot stabilization, and its effectiveness as an adjuvant to bone grafting biomaterials. The review also questions the reproducibility of clinical results in the face of the heterogeneity of reported centrifugation protocols, while identifying the complications and current limitations of this technique in implant surgery.

Review methodology

This study is a narrative review of the scientific literature. The authors analyzed data from national and international publications regarding the use of leukocyte- and platelet-rich fibrin (L-PRF) in the specific context of maxillary sinus lift for implant rehabilitation.

The analysis protocol targeted the following areas:

• Clinical indications: Identification of posterior bone atrophy cases requiring sinus augmentation.
• Technical parameters: Study of preparation protocols (centrifugation) and clinical application methods of L-PRF.
• Biological evaluation criteria: Analysis of the impact of platelet concentrate on tissue healing, stimulation of angiogenesis, clot stability, and its role as an adjuvant to bone regeneration.
• Safety and limitations: Identification of potential complications and constraints related to the lack of standardization.

The synthesis is based on a corpus including randomised clinical trials, meta-analyses, and histomorphometric studies (notably the works of Choukroun, Miron, and Pichotano cited in the review) to evaluate the efficacy of L-PRF, whether used alone as a filling material or combined with bone substitutes (graft biomaterials).

Summary of clinical performance of L-PRF

This narrative review, based on the analysis of meta-analyses and randomized controlled trials (RCTs), highlights the role of L-PRF as a major biological adjuvant in maxillary sinus lift. The authors report that the integration of L-PRF optimizes tissue healing and stimulates angiogenesis, which are critical factors for the success of guided bone regeneration.

Compiled data indicate improved clot stability and accelerated bone remodeling, particularly when L-PRF is combined with bone grafting biomaterials. However, the review highlights significant heterogeneity in quantitative results (magnitude of effects), attributed to variability in centrifugation protocols (e.g., 2700 rpm vs. other parameters).

• Angiogenic potential: Included studies confirm a sustained release of growth factors facilitating graft revascularization.
• Histology: Analyses (notably Irdem et al.) show an increased presence of newly formed bone tissue in groups using platelet concentrates.
• Complications: The review notes that the use of L-PRF could reduce the incidence of immediate post-operative complications, although standardized studies are still required to quantify this reduction.

Despite these clear qualitative benefits, the authors specify that the lack of strict standardization in L-PRF preparation (centrifugation time and speed) limits the possibility of establishing a systematic statistical superiority on final bone height gain compared to conventional techniques alone.

Review analysis: the biological impact of L-PRF in sinus lift

The authors of this narrative review emphasize that L-PRF is not limited to a simple filling material, but acts as a true biological adjuvant. By compiling data from national and international literature, the synthesis shows that this second-generation concentrate promotes angiogenesis and clot stability. For the practitioner, its use in addition to grafting biomaterials appears to optimize tissue healing kinetics and bone regeneration in the sinus area.

However, the analysis reveals a major limitation: the heterogeneity of the reported results. This variability is not necessarily due to the inefficiency of the technique, but rather to the lack of standardization in preparation (centrifugation) and clinical application protocols. Although promising, L-PRF is presented here as a complementary resource rather than a standalone substitute, requiring more rigorous protocols to ensure reproducible clinical efficacy.

Compared to the conventional approaches mentioned (such as biomaterial grafts alone), the addition of L-PRF provides added value to the biological and vascular component, which is essential in posterior maxillary areas where bone height is initially insufficient.

Summary of results

This narrative review highlights that L-PRF optimizes angiogenesis and clot stability during sinus lifts, particularly in synergy with bone grafting biomaterials. However, the authors report heterogeneity in clinical performance directly linked to the variability of current centrifugation protocols.

In concrete terms, for the practitioner:

• Systematically combine L-PRF with your bone substitutes to accelerate graft revascularization and stabilize the grafted volume.
• Use L-PRF membranes as a biological barrier to protect the Schneiderian membrane and optimize the healing of peri-implant soft tissues.
• Standardize your preparation parameters (time and speed) rigorously at the practice to limit the therapeutic uncertainty induced by the variability of platelet concentrates.

Technical Lexicon of the Study

L-PRF (Leukocyte- and Platelet-Rich Fibrin): Second-generation platelet concentrate obtained by autologous centrifugation without anticoagulants, forming a dense fibrin matrix that traps cytokines and growth factors for sustained release.

Maxillary Sinus Lift: Surgical procedure for sinus floor elevation aimed at increasing residual bone height in the posterior maxillary sector, a prerequisite for the placement of dental implants.

Angiogenesis: Critical neovascularization process stimulated by growth factors contained in L-PRF, ensuring the metabolic supply necessary for the survival of the bone graft.

Clot Stability: Mechanical property of the fibrin matrix that secures the coagulum within the sinus, thus facilitating the migration of osteoprogenitor cells and the structuring of granulation tissue.

Biomaterials: Bone grafting materials (allografts, xenografts or synthetic substitutes) whose biological integration is optimized by the addition of L-PRF to accelerate bone formation.

Platelet Concentrates: Biological preparations derived from the patient's blood, used to concentrate platelets and leukocytes in order to catalyze natural healing and regeneration mechanisms.

Tissue Healing: A complex biological response including haemostasis, inflammation, proliferation, and remodelling, which L-PRF positively modulates to reduce post-operative healing times.

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