This randomized controlled trial will be conducted to evaluate bone density in posterior maxilla in patients treated with dental implants alone, dental implants with 1% metformin gel coating and dental implants with 1% metformin gel coating along with concentrated growth factors (CGF).

 Total 42 sites will be included in the study which will be divided into following groups:

Group I (Control Group): Delayed implant placement without any coating in posterior maxilla.        (n= 14 Sites)

Group II (Test Group 1): Delayed implant placement with 1% metformin gel coating in posterior maxilla. (n= 14 Sites)

Group III (Test Group 2): Delayed implant placement with 1% metformin gel coating along with CGF in posterior maxilla. (n= 14 Sites)

All patients  will go thorough clinical evaluations, and case histories will be recorded. Cone-beam computed tomography (CBCT) will be  performed prior to the surgery to evaluate the quantity and quality of bone as well as to mark the important anatomical landmarks. Additionally, complete blood analyses, including, estimations of blood glucose levels, bleeding and clotting times, and viral screening for HIV, hepatitis B virus, and hepatitis C virus will be carried out.

Metformin gel preparation will be done using appropriate methods.

Crestal and sulcular incisions will be performed and a full-thickness mucoperiosteal flap will be raised and reflected. The osteotomy site will be prepared using drills in sequential order.

 In the Group I (Control group), implants will be inserted without any coating in the prepared osteotomy while in Group II (Test group 1) implants will be inserted along with a thin layer of 1% MF gel coating and in Group III (Test group 2) implants will be inserted along with a thin layer of 1% MF gel coating along with CGF. The flaps will be sutured with 3-0 nonabsorbable silk sutures.

Standard postoperative instructions will be given, along with antibiotics and analgesics. Suture removal will be done at  7th day. Follow-up visits will be scheduled at 3 and 9 months, postoperatively.

The following clinical  parameters will be evaluated:

1.       Mombelli’s modified Plaque index (mPI),

2.       Mombelli’s modified sulcular bleeding index (mSBI)

3.       Implant sulcus depth – will be measured using periodontal implant probe.

4.       Ridge width measurement- It will be done using Bone Gauge at 2mm and 4mm from  alveolar crest.

5.       Gingival thickness- will be done using endodontic spreader with rubber stopper.

   Following radiographic parameters will be evaluated using CBCT at baseline and 9 months.

1.       Bone density (BD)– Assessment of bone density will be done on Image J software.

2.       Crestal bone height (CBH)

3.       Buccal bone thickness (BT)- At the crest, 5mm from crest and 10 mm from crest will be assessed using CBCT. 

4.       Ridge width (RW) – Bucco-lingual dimension of osseous ridge will be assessed.

5.       Vertical distance (VD) between 1st radiographic bone implant contact and 1st implant thread on mesial and distal sides and amount of bone loss on mesial and distal side.

Buccal and Palatal gingival thickness measurement  will also be done.