Efficacy of platelet-rich albumin and fibrin gel in two-stage lateral sinus lift: a prospective study

Abstract

Background

Maxillary sinus lift procedures require biomaterials that combine osteogenic potential with structural stability. This study evaluates Albumin-Platelet-Rich Fibrin (Alb-PRF), a novel autologous material, as a standalone graft alternative in two-stage lateral sinus lifts, addressing limitations of rapid resorption in traditional platelet concentrates.

Methods

A prospective study was conducted on nine patients (mean age: 48.5 years) with residual bone height <5 mm. Alb-PRF was prepared by heat-treating platelet-poor plasma to form an albumin gel, combined with PRF. The gel was placed via lateral window technique without supplemental grafts. Cone-beam computed tomography (CBCT) assessed vertical bone gain (VBG) and density at 6 months. Statistical analysis used paired t-tests (SPSS v22, α = 0.05).

Results

Mean VBG was 5.07 ± 1.78 mm (range: 2.2–7.9 mm), with significant improvement from baseline (3.58 ± 1.2 mm to 8.65 ± 1.75 mm, *P* < 0.001). Radiographic bone density averaged 322.7 ± 36.4 Hounsfield units, indicating homogeneous osteogenesis. One membrane perforation occurred (11.11%), with no postoperative complications.

Conclusion

Alb-PRF achieved clinically significant bone gain without traditional grafts, leveraging prolonged scaffold stability (4–6 months) and growth factor release. Its autologous nature and low complication profile make it a promising alternative, though larger studies are needed to validate long-term implant outcomes.

Introduction

The lateral sinus lift is a well-established, effective, and widely employed method for vertical bone augmentation in the posterior maxilla^[1]. This procedure is specifically designed to correct bone loss in this region caused by maxillary sinus expansion and bone resorption after tooth extraction^[1-3]. The procedure entails making a small bone window in the lateral wall of the sinus, carefully dissecting the Schneiderian membrane in a minimally invasive manner, and placing a bone graft into the space created under the membrane^[3]. Dental implants can be inserted either during the same session (one-stage sinus lift) or postponed until new bone has formed (two-stage sinus lift), with the timing determined by the initial bone height below the sinus floor^[3].

HIGHLIGHTS

• First prospective study evaluating Albumin-Platelet-Rich Fibrin (Alb-PRF) as a standalone graft in two-stage lateral sinus lifts.

• Novel biomaterial synergy: Combines prolonged scaffold stability (4–6 months) of heat-treated albumin gel with the osteogenic growth factors of PRF, addressing rapid resorption limitations of conventional platelet concentrates.

• Clinical feasibility: Demonstrated low complication rates (1 perforation in 10 procedures) and homogeneous osteogenesis (mean density: 322.7 ± 36.4 HU), supporting Alb-PRF’s safety and efficacy.

• Autologous advantage: Eliminates donor-site morbidity and risks of allografts/xenografts, offering a cost-effective, patient-specific alternative for sinus augmentation.

• Rigorous methodology: CBCT-based volumetric analysis and standardized protocols (ethical approval No. 4210) ensure reproducible outcomes for translational surgical practice.

A variety of bone graft materials, such as autologous^[4], allogeneic^[5], xenograft^[6,7], and synthetic options^[8], are utilized in this procedure. Additionally, the application of first- and second-generation platelet concentrates has been widely documented in medical research. Platelet-rich plasma (PRP) and other first-generation platelet concentrates have been successfully integrated with bone grafting materials, with studies showcasing their capacity to promote bone regeneration in the region due to the growth factors contained within the platelets^[9]. Subsequently, second-generation platelet concentrates were employed in external sinus floor elevation techniques, either independently^[10] or in conjunction with bone graft materials^[2]. The concept of sticky bone emerged to describe the combination of bone grafting materials with platelet-rich fibrin (PRF)^[11–13]. When the liquid phase of the platelet concentrate comes into contact with the calcium found in the bone grafts, it triggers the conversion of fibrinogen into a fibrin mesh^[11–13]. This mesh encapsulates the bone graft molecules, creating a unified, stable, and uniform structure with a viscous, gel-like consistency that can be shaped to conform to the bone defect^[12]. Additionally, it safeguards the bone graft molecules from displacement and secures them in position^[2,11,12]. Nevertheless, it has its limitations, with the primary concern being the rapid biodegradation of the fibrin network within approximately 3 weeks. This short duration may not be optimal for guided bone regeneration processes and clinical interventions necessitating prolonged stability^[14,15].

The upper layer in the tube, known as platelet-poor plasma (PPP), comprises approximately 60% albumin^[16]. Studies have revealed that subjecting this layer to a temperature of 75°C for 10 mininduces denaturation, leading to the breakdown of weak bonds between protein molecules and their reassembly into a denser structure with longer protein chains. Subsequently, the albumin transitions into an insoluble state, resulting in the formation of a gel^[16]. While the heat treatment of PPP and the creation of an albumin gel enhance its longevity and slow down its biodegradation, this material does not foster tissue regeneration as it lacks cells or growth factors^[17]. To address this limitation, a proposed solution involves combining the heat-treated albumin gel with the second layer of PRF, known as the buffy coat, which is rich in leukocytes and growth factors. This mixture is referred to as Alb-PRF^[17].

Alb-PRF represents the cutting-edge advancement in platelet concentrates. This injectable complex marries the benefits of the extended-release albumin gel (lasting 4–6 months) with PRF, enriched with growth factors. Compared to earlier generations, the Alb-PRF structure exhibited elevated levels of growth factors, showing a remarkable up to 10-fold rise in TGF-β release, alongside heightened levels of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). These enhancements play a crucial role in supporting tissue regeneration and the healing process^[16,17].

The primary goal of this study was to assess the effectiveness of Alb-PRF in two-stage maxillary sinus lift procedures. Specifically, the study aimed to investigate the intrasinus vertical bone gain in lateral sinus floor lift procedures utilizing Alb-PRF. This work is fully compliant with the STROCSS 2025 criteria^[18].

Materials & methods

Study design and patient selection

This prospective study was conducted on patients receiving treatment at the Department of Oral and Maxillofacial Surgery at Latakia University Hospital and the outpatient clinics at the Faculty of Dentistry at Latakia University from January 2023 to July 2024. The study followed the ethical guidelines outlined in the Declaration of Helsinki for human research and obtained approval from the Latakia University Ethics Committee under No. 4210 on 4 July 2023. Patients were fully informed about the surgical procedures, and all participants provided written consent before enrolling in the study. This work is fully compliant with the STROCSS 2025 criteria^[18].

Inclusion and exclusion criteria

The study included patients aged 18 years and above who had missing teeth in the posterior region of the maxilla and an initial bone height below the sinus floor of less than 5 mm. Patients with a significant interocclusal space or contraindications to surgical procedures were excluded from the sample.

Preparation of Alb-PRF gel

Ten milliliters of venous blood were extracted from the patient’s forearm and placed into a single plastic tube, followed by immediate centrifugation at 700 g for 8 min [Fig. 1]. Subsequently, 2 mL of PPP were extracted and underwent further centrifugation at 70°C for 10 min to induce denaturation of the serum albumin, resulting in the creation of an albumin gel [Fig. 2]. Once the gel was formed, it was allowed to cool for 2 min before being blended with PRF fluid. The resulting mixture was deemed ready for immediate use after thorough mixing.

Figure 1.

After centrifugation, note the PPP at the top of the tubes.

Figure 2.

Platelet-rich albumin and fibrin gel.

Surgical procedures

All surgeries were conducted under local anesthesia with 2% lidocaine and 1:100,000 epinephrine. A full-thickness mucoperiosteal flap was raised to expose the entire alveolar ridge [Fig. 3a]. Subsequently, a bony window was made on the lateral wall of the maxillary sinus utilizing 1 mm rounded diamond burs. The lower edge of the window was situated approximately 3 mm above the sinus floor [Fig. 3b].

Figure 3.

Surgical procedure: (A) Exposure of the alveolar ridge. (B) Creation of a lateral bone window. (C) Application of platelet-rich albumin and fibrin gel into the resulting space.

Subsequently, the maxillary sinus membrane was gently dissected from the bony walls and elevated apically. The condition of the maxillary sinus membrane was assessed through direct observation, with any perforations noted. The Alb-PRF gel was carefully placed into the created space between the maxillary sinus membrane and the sinus floor [Fig. 3c].

No bone graft or barrier membrane was utilized in these procedures. The incision was sutured with 4-0 silk using an interrupted suture method. Patients were given amoxicillin/clavulanate 875/125 mg twice daily for 5 days and diclofenac potassium 50 mg as required. Surgical sutures were removed 1 week post-surgery.

Radiographic analysis

Cone-beam computed tomography (CBCT) was utilized preoperatively and at 6 months postoperatively to assess vertical bone gain and radiographic bone density. Imaging was performed using a CS9600 CBCT machine (Carestream Dental), with standardized settings (8 mA, 120 kVp, 0.2 mm voxel size) to ensure consistency across scans.

Initial bone height

The measurement from the maxillary sinus floor to the alveolar bone crest at the midpoint of the anterior–posterior space at the bone graft site [Fig. 4a].

Figure 4.

Radiographic variables: (A)Initial bone height. (B) Bone height after 6 months, radiographic bone density.

Bone height at 6 months

The measurement from the alveolar bone crest to the new sinus floor at the midpoint of the anterior–posterior space at the bone graft site [Fig. 4b].

Vertical bone gain

Calculated as the difference between the initial bone height and the bone height at 6 months.

Radiographic bone density measurement

Three regions of interest (ROIs) were selected within the augmented area at the midpoint of the sinus lift site, avoiding adjacent native bone or artifacts. Each ROI had a standardized circular area of 3 mm² to ensure uniformity.

All measurements were performed using Carestream software for DICOM viewing by a single-calibrated examiner who was blinded to the patient identity and timepoint of imaging. To assess inter-rater reliability, a second independent examiner, also blinded to the study groups, repeated measurements on a randomly selected subset of 30% of the sample.

Intraclass correlation coefficients (ICC) were calculated to evaluate agreement between raters. An ICC value of 0.94 (95% CI: 0.89–0.97) was obtained, indicating excellent inter-rater reliability . Intra-rater reliability was also assessed by repeating measurements after 2 weeks, yielding an ICC of 0.96 (95% CI: 0.91–0.98) [Fig. 4c].

Statistical analysis

The statistical analysis was performed using SPSS version 22 software (SPSS Inc., IL, USA). Descriptive statistics were utilized, including the mean and standard deviations, to evaluate the initial bone height (IBH), bone height after 6 months (BH 6), and intra-sinus bone gain (IBG). The differences in bone height between the two time periods were evaluated using a paired t-test. Intra-sinus bone gain outcomes were compared with unpaired t-test. The level of significance considered was 5% (α = 0.05).

Results

Patients characteristics

This prospective study included 9 patients (6 males, 3 females) with a mean age of 48.5 ± 10.2 years (range: 28–62 years) who underwent 10 lateral sinus lift procedures. The primary causes of bone defects were long-term tooth loss (n = 6, 66.7%) and periodontitis (n = 3, 33.3%). Residual bone height ranged from 1.9 to 4.8 mm (mean: 3.58 ± 1.2 mm), with implant sites distributed across the posterior maxilla (#14–#27). Smoking history was reported in 5 patients (55.6%: 2 current smokers [8–15 pack-years], 3 former smokers [5–12 pack-years]). No systemic conditions affecting bone metabolism (e.g., diabetes) were present in the cohort. One patient (ID#4) required bilateral procedures (#16 and #17), while others received single-site augmentation [Table 1].

Table 1.

The descriptive statistics of radiographic variables

	IBH	BH 6	VBG	BD
Mean	3.58	8.65	5.07	277
SD	1.2	1.75	1.78	380
Min	1.9	5.7	2.2	322.7
Max	5	10.6	7.9	36.4

Clinical analysis

One membrane perforations were observed in out of 10 procedures (10 %). No other intraoperative complications were noted, and there were no postoperative complications observed.

Radiographic analysis

The IBH varied from 1.9 to 5 mm, with an average of 3.58 ± 1.2 mm. The BH 6 ranged from 5.7 to 10.6 mm, averaging 8.65 ± 1.75 mm. Intra-sinus bone gain ranged from 2.2 to 7.9 mm, with a mean of 5.07 ± 1.78 mm [Table 2]. The difference between the IBH and the BH 6 exhibited a statistically significant variance (P < 0.001) [Table 3].

Table 2.

Increase in bone height after 6 months.

Initial bone height	Bone height after 6 months	Paired T-Test	P-value
3.58 ± 1.2	8.65 ± 1.75	−9.003	< 0.001

Table 3.

Baseline characteristics of study participants undergoing sinus lift with Alb-PRF

Patient ID	Age	Gender	Cause of bone defect	Smoking status	Residual bone height (mm)	Implant site
1	52	M	Long-term tooth loss	Former (10 PY)	4.2	#16
2	45	F	Periodontitis	Never	3.8	#26
3	62	M	Periodontitis	Current (15 PY)	1.9	#17
4	28	F	Long-term tooth loss	Never	4.8	#16, #17
5	49	M	Long-term tooth loss	Former (5 PY)	3.7	#27
6	56	M	Periodontitis	Current (8 PY)	2.9	#17
7	42	F	Long-term tooth loss	Never	4.5	#27
8	53	M	Long-term tooth loss	Never	3.2	#26
9	50	M	Long-term tooth loss	Former (12 PY)	3.3	#26

The radiographic bone density (BD) of newly bone formation varied from 277 to 380 HU, with an average of 322.7 ± 36.4 HU [Table 2]. The relatively low standard deviation indicates homogeneity in the quality of new bone among patients.

Discussion

The sinus lift procedure remains a cornerstone in oral surgery, particularly for restoring bony dimensions necessary for dental implant placement in the atrophic posterior maxilla^[19,20]. Over time, various grafting materials and techniques have emerged, each offering unique advantages and drawbacks. Autografts, though considered the gold standard due to their osteogenic potential and low immunogenicity, require additional surgical sites for harvesting, increasing patient morbidity and recovery time^[21]. This has driven ongoing efforts to identify optimal alternatives that maintain biological activity without the need for secondary donor sites. In this context, our study introduces Alb-PRF gel as a promising autologous material, demonstrating a mean vertical bone gain of 5.07 ± 1.78 mm 6 months postoperatively, with radiographic bone density averaging 322.7 ± 36.4 Hounsfield units (HU). These findings support Alb-PRF’s potential to serve as an effective standalone graft material for maxillary sinus augmentation.

The rationale for exploring Alb-PRF stems from well-documented limitations of conventional materials. PRF, despite its rich growth factor profile – including TGF-β, VEGF, and PDGF – undergoes rapid biodegradation within approximately 3 weeks, often insufficient for complete bone maturation^[16,17]. In contrast, heat-treated albumin gel maintains structural integrity for 4–6 months, providing prolonged space maintenance critical for new bone formation^[16,17]. When combined with PRF, this hybrid scaffold synergistically delivers sustained angiogenic and osteogenic signals while ensuring dimensional stability. Our results align with those reported by Kobayashi^[16], who observed extended growth factor release from Alb-PRF, and are supported by histological evidence from pilot cases showing mature bone formation without fibrous encapsulation – a common limitation of rapidly resorbing grafts.

Radiographically, the bone formed using Alb-PRF compares favorably with existing literature. The mean bone gain of 5.07 mm surpasses values reported for PRF alone (3–4 mm) and approaches those of xenografts (4–6 mm), even when used without supplemental grafting materials. Bone density measurements (322.7 HU) closely match Tajima’s (2013)^[22] findings for PRF-mediated regeneration (323 HU) and exceed those reported for blood clot grafts (203 HU) or certain autograft protocols (194 HU). These data challenge assertions by Olgun et al. (2018)^[23] that platelet concentrates are unsuitable as standalone materials, while supporting Karagah et al’s (2022)^[24] observations regarding their efficacy. Discrepancies with studies reporting higher densities (e.g., 634.8 HU for allografts) may reflect differences in remodeling timelines, as Alb-PRF’s gradual resorption could delay full mineralization at 6 months.

Mechanistically, Alb-PRF’s success likely arises from its dual-phase action: the denatured albumin gel provides a slowly resorbing scaffold that prevents graft collapse, while the PRF component delivers sustained growth factor release to stimulate osteoprogenitor cell recruitment and angiogenesis. This synergy mirrors the “sticky bone” concept but extends the critical support period from weeks to months. Histological evidence from our pilot case showed mature bone formation at 6 months without fibrous tissue, reinforcing this model. Furthermore, the material’s radiolucency initially obscures radiographic assessment, but subsequent density increases confirm active osteogenesis rather than residual graft persistence, distinguishing it from radiopaque synthetic materials^[16,17].

Clinically, Alb-PRF offers several notable benefits. As an autologous material, it eliminates risks associated with allografts or xenografts, including disease transmission and immune reactions. Its preparation requires only venous blood centrifugation and heat treatment – simple, cost-effective steps that yield sufficient quantities for clinical use. In our cohort, these advantages translated into a low complication rate (one membrane perforation in nine procedures) and consistent bone formation, evidenced by the narrow standard deviation in radiographic density measurements (36.4 HU). This homogeneity suggests reliable performance across patients, addressing a key criticism of platelet concentrates – their variable outcomes in earlier studies.

While Alb-PRF demonstrates significant promise as a standalone graft material for sinus augmentation, its clinical positioning should be contextualized alongside minimally invasive alternatives like short implants, which have shown comparable success rates in cases with limited residual bone height (RBH <5 mm), particularly for elderly or medically compromised patients^[25]. Short implants (≤6–8 mm) offer reduced morbidity and faster rehabilitation by avoiding grafting procedures altogether, with systematic reviews reporting survival rates exceeding 90% in atrophic maxillae^[25,26]. However, Alb-PRF remains indispensable when substantial vertical bone gain (>5 mm) is required or when delayed implant placement is necessitated by poor bone quality, as its autologous scaffold provides prolonged stability (4–6 months) and osteogenic potential without the immunogenic risks of allografts or xenografts^[24,27]. Future studies should explore hybrid approaches combining Alb-PRF with short implants to optimize outcomes in complex cases^[25].

Hyaluronic acid (HA) has also gained attention as a scaffold for maxillofacial bone regeneration due to its excellent biocompatibility, handling properties, and ability to enhance osteoblast activity^[28]. D’Albis et al (2022) highlighted HA’s role in improving graft manipulation and promoting uniform bone formation in sinus augmentation procedures when combined with xenografts or allografts^[29]. However, HA-based systems typically require commercial products supplemented with growth factors or other additives, increasing procedural costs and complexity^[29,30]. In contrast, Alb-PRF offers several distinct advantages: (1) complete autologous origin eliminates concerns about batch-to-batch variability or regulatory approvals; (2) inherent incorporation of growth factors within the PRF component avoids the need for supplemental biologics; and (3) the albumin gel provides comparable structural support to HA scaffolds without requiring additional carriers^[31]. Our radiographic density measurements suggest equivalent bone quality formation to HA-mediated regeneration, while the autologous nature of Alb-PRF may reduce postoperative inflammation risks associated with exogenous materials^[29,32].

Economically, graft selection plays a crucial role in clinical decision-making. Commercial HA products and other processed biomaterials often carry substantial costs that may limit accessibility, particularly in resource-constrained settings^[29,32]. Alb-PRF’s preparation relies solely on standard centrifugation equipment and patient blood collection, representing a potentially significant cost reduction. Moreover, HA’s efficacy as a standalone graft remains debated; a 2024 meta-analysis found no statistically significant improvement in new bone formation when HA was added to xenografts, underscoring the need for further optimization^[32]. In contrast, Alb-PRF’s dual-phase action – combining sustained scaffold stability (4–6 months) with endogenous growth factor release—addresses the rapid resorption limitations observed in both HA and traditional platelet concentrates^[31,33].

To fully realize the translational potential of Alb-PRF, future research must integrate cutting-edge technologies, particularly artificial intelligence (AI), which is revolutionizing biomaterial development and personalized medicine. AI tools like AlphaFold can simulate protein interactions within Alb-PRF’s fibrin–albumin matrix, predicting optimal denaturation temperatures or growth factor release profiles to guide laboratory protocols^[34]. Machine learning algorithms could also standardize Alb-PRF production by correlating patient-specific variables (e.g., blood platelet counts, bone morphology) with outcomes, reducing variability in clinical efficacy^[35]. Additionally, AI-powered image analysis of CBCT scans could automate assessments of bone density and graft integration, reducing subjectivity in radiographic evaluations^[36].

The integration of AI with Alb-PRF research aligns with broader trends in regenerative dentistry, where AI-driven predictive modeling and image analysis are transforming diagnostics and treatment planning. For example, convolutional neural networks (CNNs) have demonstrated high accuracy in detecting periodontal bone loss and optimizing scaffold designs for tissue engineering^[34,37]. By adopting these technologies, Alb-PRF development can benefit from data-driven insights, accelerating its translation from bench to bedside. Future interdisciplinary collaborations should prioritize large-scale trials, AI-assisted protocol optimization, and mechanistic studies to unlock Alb-PRF’s full potential in regenerative dentistry and beyond^[35,38].

Despite its promising profile, Alb-PRF’s development trajectory shares similarities with thrombopoietin receptor agonists (TPO-RAs), which evolved through iterative collaboration between academia, industry, and clinical stakeholders to optimize formulations and expand indications^[39]. Like TPO-RAs – which transitioned from laboratory discoveries to FDA-approved therapies for thrombocytopenia through industry-sponsored trials and interdisciplinary research—Alb-PRF requires a similar integrative framework to standardize preparation protocols and validate its efficacy in diverse clinical scenarios, such as maxillofacial reconstruction^[40]. For instance, TPO-RAs like romiplostim and eltrombopag benefited from large-scale clinical trials and industrial partnerships to refine pharmacokinetics and explore off-label uses (e.g., chemotherapy-induced thrombocytopenia)^[40]. Similarly, Alb-PRF’s autologous nature and prolonged scaffold stability (4–6 months)^[16] could be leveraged for broader applications, including craniofacial defects or trauma repair, but this demands coordinated efforts to address scalability and regulatory hurdles.

The success of TPO-RAs underscores the importance of translational medicine frameworks that bridge basic science and clinical application. Early-phase trials for TPO-RAs incorporated mechanistic insights from in vitro models and animal studies, followed by adaptive trial designs to optimize dosing^[39,40]. Alb-PRF’s development could adopt this phased approach: (1) preclinical optimization of heat-treated albumin gel formulations^[16], (2) multicenter clinical trials to establish standardized protocols (e.g., centrifugation parameters, gel concentration), and (3) post-marketing surveillance to monitor long-term outcomes, akin to the post-approval studies conducted for TPO-RAs^[39]. Furthermore, TPO-RA research highlighted the role of industry–academia partnerships in accelerating innovation – such as the collaboration between pharmaceutical companies and hematology consortia to expand indications^[16]. For Alb-PRF, partnerships with biomedical firms could facilitate the development of commercial kits for chairside preparation, ensuring reproducibility across clinical settings.

While AI offers transformative potential, its application in Alb-PRF research faces challenges, including data privacy concerns, algorithmic bias, and the need for large, high-quality datasets for training models^[41,42]. Collaborative efforts between academia, industry, and regulatory bodies are essential to establish standardized protocols and validate AI tools in clinical settings. Future studies should explore:

• AI-Enhanced Biomaterial Design: Using generative adversarial networks (GANs) to simulate novel Alb-PRF composites with enhanced osteoinductive properties^[41].

• Real-World Validation: Implementing AI-powered monitoring systems to track long-term outcomes of Alb-PRF-augmented implants in diverse patient populations^[43].

• Interdisciplinary Synergy: Combining AI with 3D bioprinting to create patient-specific Alb-PRF scaffolds for complex bone defects^[36].

Our study contributes to the growing body of evidence supporting Alb-PRF as a viable alternative to traditional grafting materials. However, limitations include a modest sample size (9 patients) and a 6-month follow-up period. While the results are statistically significant, larger cohorts and longer observation intervals would strengthen conclusions regarding implant success rates and long-term stability. Comparative studies directly pitting Alb-PRF against autografts or xenografts are also warranted to establish its relative efficacy. Nevertheless, our findings align with systematic reviews by Otero et al^[44] and clinical data from Kempraj et al (2020)^[45], reinforcing the viability of Alb-PRF as a graft alternative.

In conclusion, Alb-PRF merges the regenerative potential of platelet concentrates with the structural longevity of modified albumin, addressing key limitations of existing sinus lift materials. Our results demonstrate its capacity to generate consistent vertical bone gain (2.2–7.9 mm) with homogeneous density, while minimizing complications and donor-site morbidity. As the field moves toward minimally invasive and patient-specific approaches, Alb-PRF represents a compelling option that warrants further refinement and validation through multicenter trials. Future research should explore optimized preparation protocols, combination therapies with low-dose grafts, and extended follow-ups to assess implant survival in Alb-PRF–augmented bone.

Conclusion

This prospective study demonstrates that Alb-PRF is an effective, biocompatible material for two-stage maxillary sinus lifts, achieving significant vertical bone gain (5.07 ± 1.78 mm) without traditional grafts. Its autologous nature, prolonged stability, and osteogenic properties make it a promising alternative, though larger studies are needed to validate long-term outcomes and implant success rates.

Ethical approval

This retrospective study was approved by the Ethics Committee of Latakia University, Syria (Ethical Permission No. 4210 on 4 July 2023) and was conducted in accordance with the Declaration of Helsinki, revised in 2013.

Consent

Written informed consent was obtained from the patient for publication of this study.

Sources of funding

This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

M.B.: Conceptualization, Data curation, Methodology, Project administration, Software. Writing. A.K.: Investigation, Methodology, Supervision. Z.A.: Data curation Writing – review & editing.

Conflict of interest disclosure

The authors declare no conflict of interest, financial or otherwise.

Guarantor

Ziad Albash MSc in oral and maxillofacial surgery, oral and maxillofacial surgery department, Faculty of Dentistry, Tishreen University, Lattakia, Syria. Address: sakan aliatiba’i, almashrue alsaabieu, Lattakia, Lattakia government, Syria. Email: zeyadalbash@yahoo.com. Tel: +963966492897

Provenance and peer review

Not commissioned, externally peer reviewed.

Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.