## 4 Discussion  
To prevent alveolar bone loss and reduce the total time period of treatment, immediate implant installation after tooth extraction has been suggested [26; 27]. After tooth extraction following periodontal disease, alveolar bone gradually decreases in height and width. Alveolar bony defects cause problems for immediate implant installation. Tooth biomaterial composition is similar to that of bone consisting of hydroxyapatite and calcium phosphate minerals. Various growth factors like bone morphogenetic protein, insulin-like growth factor, platelet-derived growth factor, fibroblast growth factor, and transforming growth factor are found in the tooth [28]. In this study, tooth biomaterial and PRF were used in the self-created peri-implant bony defects. The tooth biomaterial groups (groups 1 and 2) showed higher new bone formation, bone-to-implant contact area (Table 1), and lower Periodest values (Table 2). The histomorphometric results indicated that bone formation in groups 1 and 2 was greater than the unfilled control. Only a single cut from a histologic section can be observed for osseointegration rather than full geometric information. Measurement of implant stability further helps in evaluating osseointegration. Implant stability in groups 1 and 2 was significantly higher as compared to the control group. Dense cortical bone offers greater support for dental implants in comparison to cancellous bone. In addition, it exhibits increased removal torque [29]. An implant surrounded with cancellous bone exhibits lower holding strength than an implant which is connected by a few threads [30]. Due to lack of exercise in caged lab animals, the middle of the tibia lacks thick cortical bone [31]. a bicortically installed implant exhibits significantly greater removal torque as compared to monocortically installed implant [32]. The experimental group showed a higher stability value, possibly because of coronal cortical bone regeneration. Bone grafting biomaterials and cellular therapy have been studied to regenerate bone in peri-implant defects. Bone grafting biomaterials such as bioactive glass have been used to restore peri-implant defects and showed beneficial results [33]. \begin{table}
\begin{tabular}{l c c} \hline \hline
**Group** & **Regenerated Bone Area (\%)** & **Bone to Implant Contact (\%)** \\ \hline
1. Tooth biomaterial + PRF & \(53.87\pm 7.60\) & \(43.67\pm 2.50\) \\
2. Tooth biomaterial & \(51.56\pm 6.45\) & \(41.07\pm 2.59\) \\
3. PRF & \(18.45\pm 1.34\) & \(21.45\pm 1.25\) \\
4. Control & \(11.57\pm 1.12\) & \(16.57\pm 2.83\) \\ \hline \hline \end{tabular} Data are presented as the mean \(\pm\) standard deviation.  
\end{table} 
Table 1: Histomorphometric analysis. \begin{table}
\begin{tabular}{l c c} \hline \hline  & **Group** & **Periodest Values** \\ \hline
1. & Tooth biomaterial + PRF & \(-3.40\pm 0.31\) \\
2. & Tooth biomaterial & \(1.25\pm 0.07\) \\
3. & PRF & \(4.79\pm 0.93\) \\
4. & Control & \(5.97\pm 0.81\) \\ \hline \hline \end{tabular} Data are presented as the mean \(\pm\) standard deviation.  
\end{table} 
Table 2: Measurement of implant stability. No effect was observed in peri-implant bone healing when a prepared socket was embedded with cells seeded with growth factor [34]. This may be due to the higher solubility of growth factor, and difficulty in achieving therapeutic concentration for a longer time period. PRP showed significant results for restoring peri-implant defects when applied in combination with different bone grafts [35]. In bone graft techniques, PRF may be a good reservoir as a biomaterial. PRF is not related to immune reactions because it can be obtained from autogenous donors. Platelets release various cytokines like platelet-derived and insulin-like growth factors [36; 37]. PRP promotes osteoblast proliferation and may be clinically applicable for bone graft procedures in implant dentistry [38]. PRF can induce bone healing and may induce bone regeneration. [PERSON] et al. successfully repaired peri-implant defects by application of PRF alone [39].