Comparative evaluation of dimensional changes achieved and osteopontin level in peri-implant crevicular fluid after sinus crestal floor elevation using piezosurgery and concentrated growth factor with or without allograft: a randomized clinical trial

Abstract

Background: Limited residual bone height in the posterior maxilla often necessitates sinus floor elevation before implant placement. Piezosurgery-assisted crestal sinus floor elevation offers a minimally invasive approach with reduced membrane-related complications. Concentrated growth factor (CGF) has been proposed to enhance bone regeneration; however, the additional benefit of combining CGF with allograft remains unclear. This randomized clinical trial compared radiographic, clinical, and biochemical outcomes following crestal sinus floor elevation using CGF with or without demineralized freeze-dried bone allograft (DFDBA). Methods: Twenty posterior maxillary implant sites requiring indirect sinus floor elevation were randomly allocated into two groups (n=10 each): group A, piezosurgery-assisted crestal sinus elevation with CGF + DFDBA; and group B, CGF alone. Simultaneous implant placement was performed in all sites. Vertical bone height (VBH) and bucco-palatal width (BPW) were assessed using cone-beam computed tomography at baseline and 6 months. Implant stability quotient (ISQ) was measured at baseline and 3 months. Osteopontin (OPN) levels in peri-implant crevicular fluid were evaluated at 15, 45, and 90 days using enzyme-linked immunosorbent assay. Results: Both groups demonstrated significant increases in vertical bone height and implant stability over time (p<0.05). Group A showed significantly greater vertical bone gain at 6 months compared with group B (p<0.05). Bucco-palatal width remained relatively stable in both groups, although a significant reduction was observed in group B. OPN levels increased progressively in both groups during healing and were significantly higher in group A at all-time intervals (p<0.05). Conclusions: Piezosurgery-assisted crestal sinus floor elevation using CGF, with or without allograft, resulted in favorable clinical and radiographic outcomes. The addition of DFDBA to CGF yielded greater vertical bone gain and higher OPN levels, suggesting enhanced regenerative activity during early healing.