Effects Of Autologous Growth Factors Derived From Platelet Concentrates On Maxillary Sinus Floor Lifting Procedure:a Meta-analysis

Objective:The purpose of this meta-analysis was to assess the effect of autologous growth factors derived from platelet concentrates on the clinical and bone histomorphometric outcomes of maxillary sinus floor lifting.Material and methods:A systematic search of using PubMed, Embase, Web of Science and the Cochrane Library, CNKI, VIP, CBM database was performed to screen the randomized controlled trials and non-randomized controlled trials concerning the effects of autologous growth factors on maxillary sinus augmentation, with restriction of English and Chinese language and publication date from 2000 to October 2014. A manual searching of the relevant journals was also performed. The effect size of three outcome measures (implant survival rate, new bone formation fraction and residual graft particles fraction) were pooled and analyzed using Review Manager 5.3 software. The pooled effect size of dichotomous variable was calculated by relative risk (RR) with 95% confidence interval (95%CI), and standardized mean difference (SMD) was calculated for continuous variable. The result of the meta-analysis was shown by using forest plots. The statistical significance of pooled effect was estimated by the P value. The funnel plots showed the literature publication bias. Sensitivity analysis was performed to evaluate whether the result of this Meta-analysis was stable and reliable. At the same time, subgroup analysis was also conducted to assess if confounding factors would affect the outcomes of this meta-analysis.Results:8 randomized controlled trials and 5 controlled clinical trials with 479 sinus floor elevation surgery and 988 implants in 285 patients were included. Implant survival rate based on lifted sinus showed no significantly statistical difference in the intervention group treated with autologous growth factors compared to the control group (RR:1.01,95% CI:0.96 to 1.07, P=0.57; P=0%, P=0.95). There were also no apparent statistical effects of autologous growth factors on new bone formation (SMD: 0.33,95% CI:-0.38 to 1.04, P=0.36; P=86%, P<0.00001) or residual grafts particles fraction (SMD:-0.29,95% CI:-0.66 to 0.09, P=0.13; P= 0%, P=0.46) in maxillary sinus augmentation procedure with a median healing period of 6 months for biopsy. Sensitivity analysis and subgroup analysis showed that the Meta analysis result is relative stable and reliable.Conclusion:The transplanted autologous growth factor derived from platelet concentrates may just facilitate osteogenesis and reduce the healing time of sinus augmentation at the early stage and may have little or no effect in the long term. Platelet concentrates is worth for clinical application, because of producing simple, relatively inexpensive, good biological performance and so on.