Photoactivated Disinfection Versus Laser Disinfection of Infected Sockets on the Success of Immediate Implant Placement

Alexandria University9 enrolled

Overview

Background: Dental implantology offers reliable tooth replacement options, but infections in extraction sockets can compromise osseointegration. Conventional disinfection methods, such as chlorhexidine, often fail to completely eliminate pathogenic microorganisms and may impair tissue healing. Photoactivated disinfection (PAD) and laser disinfection have emerged as promising alternatives. PAD employs a light-activated photosensitizer to generate reactive oxygen species (ROS), effectively disrupting bacterial membranes while preserving host cell viability. In parallel, laser disinfection utilizes focused light energy to eliminate bacterial biofilms and contaminated tissue with minimal thermal damage. In this study, we specifically utilize the Er,Cr:YSGG laser, which operates at a water-absorbing wavelength to induce micro-explosions that mechanically disrupt biofilms and promote a cleaner socket environment for improved osseointegration. Aim of the study: To compare the effectiveness of photoactivated disinfection (PAD), Er,Cr:YSGG laser disinfection, and conventional disinfection with chlorhexidine in decontaminating infected extraction sockets prior to immediate implant placement, promoting bone healing, and improving the osseointegration and stability of immediate implants placed in infected extraction sockets.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Infected Extraction Sockets

Interventions

Photoactivated disinfectionOTHER

Standard treatment + Toluidine blue + Light activation + Immediate implant placement

Er,Cr:YSGG laser disinfectionOTHER

Standard treatment + Er,Cr:YSGG laser application + Immediate Implant placement

Chlorohexidine disinfectionOTHER

Standard treatment + Chlorohexidine Irrigation + Immediate Implant placement

Eligibility

Sex: ALLMin age: 20 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients having posterior tooth/teeth indicated for extraction * Patients must exhibit radiographic evidence of infection, defined as chronic periapical pathology (radiolucency) * The extraction site should have intact surrounding alveolar bone * There must be at least 2 mm of sound bone beyond the root apex * Patients must be in overall good health and free from uncontrolled systemic conditions Exclusion Criteria: * History of radiation therapy in the head and neck region * Pregnant or lactating women * Patients on long-term antibiotic therapy, as it could influence the outcomes * Heavy Smoking: More than 10-15 cigarettes per day. * Significant bruxism or parafunctional habits affecting implant stability.

Outcomes

Primary Outcomes

implant stability

Resonance Frequency Analysis (RFA) using Osstell ISQ: Implant Stability Quotient (ISQ) values will be recorded at 6 months after implant placement. Values from 1 to 100, the higher the ISQ, the higher the stability of the implant.

Time frame: 6 months

change in bone density

Bone density assessment using radiographs immediately post-operative and at 6 months.

Time frame: baseline and 6 months

change in marginal bone loss

Marginal Bone Loss (MBL) assessment using radiographs immediately postoperative and at 6 months.

Time frame: baseline and 6 months

Secondary Outcomes

change in pain scores

Post-operative pain will be assessed through a 10-point visual analogue scale (VAS). (0-1 = No pain, 2-4 = mild pain, 5-7 = moderate pain, 8-10 = severe pain).

Time frame: up to 7 days

change in post-operative edema

Post-operative edema will be assessed as follows None (no swelling), Mild (intra oral swelling confined to surgical field), Moderate (extra oral swelling in the surgical zone), Severe (extra oral swelling spreading beyond the surgical zone)