Autogenous Demineralized Dentin Graft–Based Strategies With or Without I‐ PRF and Metronidazole for Ridge Preservation in Infected Sockets: A Randomized Clinical Trial

AIM: This pilot randomized controlled trial evaluated the efficacy of demineralized dentin graft (DDG) combined with injectable platelet-rich fibrin (I-PRF) and metronidazole (MTZ) versus DDG with I-PRF and DDG alone in alveolar ridge preservation (ARP) of chronically infected extraction sockets. METHODS: Patients with non-restorable teeth and chronic periapical infection in the maxillary anterior and premolar regions were randomly assigned to three groups (n = 18/group): DDG alone, DDG + I-PRF, and DDG + I-PRF/MTZ. After extraction, graft materials were placed into sockets. Cone-beam CT scans at baseline and 6 months assessed vertical and horizontal ridge dimensions. Virtual implant planning evaluated the need for further augmentation. Pain was recorded daily for 7 days using a visual analogue scale (VAS). Bone biopsies at 6 months were harvested during implant placement for histomorphometric analysis. RESULTS: Fifty-four patients were analyzed. No significant differences were found in vertical and horizontal ridge dimensional changes (p > 0.05). Minimal additional augmentation was needed. The DDG + I-PRF/MTZ group showed significantly the highest mineralized bone percentage (55.02% ± 3.65%), followed by DDG + I-PRF (41.14% ± 7.00%) and DDG alone (30.21% ± 3.72%) (p < 0.05). Soft tissue proportion histologically was significantly lowest in the DDG + I-PRF/MTZ group (p < 0.05). CONCLUSION: All protocols were effective for ARP. Addition of I-PRF with MTZ enhanced bone mineralization. TRIAL REGISTRATION: www. CLINICALTRIALS: gov: NCT06374784.