Laser-assisted socket seal surgery using bioactive glass for dental implant site development: a randomized clinical trial

Abstract

Preserving the alveolar ridge after extraction is crucial for implants; different biomaterials and techniques allow predictable outcomes. This study aimed to assess laser photo-biomodulation (PBM) as a complement for socket seal surgery (SSS) when extraction sockets are grafted with bioactive glass and sealed by platelet-rich fibrin (PRF) membrane in humans. 45 sites were randomly and equally distributed into 3 groups: Control: PRF membrane for socket seal, with no more interference; it is a unified step in all groups, Test I: bioactive glass, and Test II: received the same as Test I plus PBM-irradiation. Cone-beam computed tomography (CBCT) was used to assess the dimensional changes in height and width measurements of the alveolar ridge at 0 and 9 months postoperatively. Bone samples were obtained from osteotomy sites at the time of implant placement, and then sent for histological staining using hematoxylin and eosin and Masson trichrome stain for assessment of newly formed bone and histomorphometric analysis in terms of percentage (%) of new bone surface area and % of unmineralized bone, respectively. The Control group revealed a significant reduction in alveolar ridge dimensions over time compared to the test groups (P-value < 0.001). Test II has shown less bone reduction over time, with a P-value < 0.001. Histological results revealed that Test II showed large areas of connected, highly mature bone trabeculae without any collagen fibers or immature matrix in between. Compared to the other two groups, Test II provided superior bone quality. PBM can be considered as a promising adjunctive therapy for socket seal approaches when combined with bioactive glass, as evidenced by the better clinical improvement and the remarkable histological findings for bone repair compared with the non-lased group.Trial registration: The current randomized clinical trial was registered at ClinicalTrials.gov (Registration number: NCT06764732) and it was released on 8/1 /2025.