Timing of Orthodontic Therapy and Regenerative Periodontal Surgery in Advanced Periodontitis Patients With Pathologic Tooth Migration

NCT ID: NCT02761668

Last Updated: 2023-03-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-10-31

Study Completion Date

2023-03-22

Brief Summary

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Pathologic tooth migration (PTM) is a common complication of advanced periodontitis and often motivation for patients to seek orthodontic therapy. An interdisciplinary approach is required to control the periodontal infection, reconstruct the defects and realign the migrated teeth. The optimal timing of active orthodontics after regenerative therapy is a topic of ongoing debate.

There are no data available from RCTs that have compared the effect of the timing of orthodontic tooth movement (early vs. late) on the outcomes of regenerative periodontal surgery in these patients.

It is the aim of the present randomized clinical multicenter trial to compare 2 different treatment protocols of a combined perio-regenerative and orthodontic therapy in advanced periodontitis patients with intrabony defects and pathologic tooth migration in order to establish whether one treatment modality is superior to the other with regard to clinical outcomes. A total of 46 patients will be enrolled and randomized into 2 treatment groups that differ by the time point of initiation of orthodontic therapy (early: 4 weeks vs. late: 6 months following regenerative periodontal surgery).

Primary outcome measure will be the change in clinical attachment level (CAL gain) at 12 months after regenerative therapy. Secondary outcomes will include changes in probing depth BOP, gingival recession, radiographic bone height and patient-centered outcomes.

Detailed Description

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Conditions

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Periodontitis Tooth Migration Intrabony Periodontal Defect

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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ParS+Ortho 4W

Orthodontic alignment starts 4 weeks post surgical

Group Type EXPERIMENTAL

ParS+Ortho 4W

Intervention Type PROCEDURE

Orthodontics 4 weeks post surgical

ParS+Ortho 6M

Orthodontic alignment starts 6 months post surgical

Group Type ACTIVE_COMPARATOR

ParS+Ortho 6M

Intervention Type PROCEDURE

Orthodontics 6 months post surgical

Interventions

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ParS+Ortho 4W

Orthodontics 4 weeks post surgical

Intervention Type PROCEDURE

ParS+Ortho 6M

Orthodontics 6 months post surgical

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Advanced periodontitis
* Presence of intrabony defects at a minimum of 2 and a maximum of 7 adjacent teeth (positions 15-25 or 35-45) in either the maxilla or the mandible with PPD of ≥6 mm at a minimum on one site
* Pathologic tooth migration
* Full mouth plaque index (PI) \<25% at baseline (after initial non-surgical periodontal therapy)
* Full mouth bleeding on probing (FMBP) \<25% at baseline (i.e., following initial non-surgical periodontal therapy)
* Committed to the study and the required follow-up visits

Exclusion Criteria

Any contraindications for oral surgical procedures

* Uncontrolled diabetes or other uncontrolled systemic diseases
* Disorders or treatments that compromise wound healing
* Medical conditions requiring chronic high dose steroid therapy
* Bone metabolic diseases
* Radiation or other immuno-suppressive therapy
* Infections or vascular impairment at the surgical site
* Presence of oral lesions (such as ulceration, malignancy) or mucosal diseases
* History of malignant disease in the oral cavity or previous radiotherapy to the head
* Inadequate oral hygiene or unmotivated for adequate home care
* Current smokers \> 6Cig
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Universidad Complutense de Madrid

OTHER

Sponsor Role collaborator

University of Bonn

OTHER

Sponsor Role lead

Responsible Party

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Karin Jepsen

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Søren Jepsen, Phd

Role: STUDY_CHAIR

Director

Karin Jepsen, Dr

Role: PRINCIPAL_INVESTIGATOR

OA

Andreas Jaeger, Phd

Role: STUDY_CHAIR

Director

Conchita Martin, PhD

Role: STUDY_CHAIR

Faculty of Odontology, UCM

Mariano Sanz, PhD

Role: STUDY_CHAIR

Faculty of Odontology, UCM

Locations

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Poliklinik für Parodontologie, Zahnerhaltung und Präventive Zahnheilkunde

Bonn, North Rhine-Westphalia, Germany

Site Status

Master de Periodoncia Universidad Complutense

Madrid, , Spain

Site Status

Countries

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Germany Spain

References

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Lindhe J, Svanberg G. Influence of trauma from occlusion on progression of experimental periodontitis in the beagle dog. J Clin Periodontol. 1974;1(1):3-14. doi: 10.1111/j.1600-051x.1974.tb01234.x. No abstract available.

Reference Type BACKGROUND
PMID: 4532114 (View on PubMed)

Ericsson I, Thilander B, Lindhe J, Okamoto H. The effect of orthodontic tilting movements on the periodontal tissues of infected and non-infected dentitions in dogs. J Clin Periodontol. 1977 Nov;4(4):278-93. doi: 10.1111/j.1600-051x.1977.tb01900.x. No abstract available.

Reference Type BACKGROUND
PMID: 271655 (View on PubMed)

Re S, Corrente G, Abundo R, Cardaropoli D. Orthodontic treatment in periodontally compromised patients: 12-year report. Int J Periodontics Restorative Dent. 2000 Feb;20(1):31-9.

Reference Type BACKGROUND
PMID: 11203546 (View on PubMed)

Ghezzi C, Masiero S, Silvestri M, Zanotti G, Rasperini G. Orthodontic treatment of periodontally involved teeth after tissue regeneration. Int J Periodontics Restorative Dent. 2008 Dec;28(6):559-67.

Reference Type BACKGROUND
PMID: 19146051 (View on PubMed)

Cardaropoli D, Re S, Manuzzi W, Gaveglio L, Cardaropoli G. Bio-Oss collagen and orthodontic movement for the treatment of infrabony defects in the esthetic zone. Int J Periodontics Restorative Dent. 2006 Dec;26(6):553-9.

Reference Type BACKGROUND
PMID: 17243328 (View on PubMed)

Jepsen K, Jaeger A, Jepsen S. Esthetic and functional rehabilitation of a severely compromised central incisor: an interdisciplinary approach. Int J Periodontics Restorative Dent. 2015 May-Jun;35(3):e35-43. doi: 10.11607/prd.2345.

Reference Type BACKGROUND
PMID: 25909531 (View on PubMed)

Ghezzi C, Viganò VM, Francinetti P, Zanotti G, Masiero S. Orthodontic treatment after induced periodontal regeneration in deep infrabony defects. Clinical Advances in Periodontics 2013; 3(1), 24-31

Reference Type BACKGROUND

Cortellini P, Tonetti MS. Clinical concepts for regenerative therapy in intrabony defects. Periodontol 2000. 2015 Jun;68(1):282-307. doi: 10.1111/prd.12048.

Reference Type BACKGROUND
PMID: 25867990 (View on PubMed)

Tietmann C, Bröseler F, Axelrad T, Jepsen S. Regenerative procedures and orthodontics in the treatment of severe intrabony defects. A retrospective clinical cohort study. Int Poster J Dent Oral Med 2013; 15 Suppl. Poster 690.

Reference Type BACKGROUND

Attia MS, Shoreibah EA, Ibrahim SA, Nassar HA. Regenerative therapy of osseous defects combined with orthodontic tooth movement. J Int Acad Periodontol. 2012 Jan;14(1):17-25.

Reference Type BACKGROUND
PMID: 22479985 (View on PubMed)

Araujo MG, Carmagnola D, Berglundh T, Thilander B, Lindhe J. Orthodontic movement in bone defects augmented with Bio-Oss. An experimental study in dogs. J Clin Periodontol. 2001 Jan;28(1):73-80. doi: 10.1034/j.1600-051x.2001.280111.x.

Reference Type BACKGROUND
PMID: 11142670 (View on PubMed)

Brunsvold MA. Pathologic tooth migration. J Periodontol. 2005 Jun;76(6):859-66. doi: 10.1902/jop.2005.76.6.859.

Reference Type BACKGROUND
PMID: 15948679 (View on PubMed)

Cardaropoli D, Gaveglio L, Abou-Arraj RV (2014). Orthodontic movement and periodontal defects: rationale, timing, and clinical implications. Semin Orthod, 20: 177-187.

Reference Type BACKGROUND

Cortellini P, Stalpers G, Mollo A, Tonetti MS. Periodontal regeneration versus extraction and prosthetic replacement of teeth severely compromised by attachment loss to the apex: 5-year results of an ongoing randomized clinical trial. J Clin Periodontol. 2011 Oct;38(10):915-24. doi: 10.1111/j.1600-051X.2011.01768.x. Epub 2011 Jul 21.

Reference Type BACKGROUND
PMID: 21777268 (View on PubMed)

Sanz M, Martin C (2015). Tooth movement in the periodontally compromised patient. In: Clinical periodontology and implant dentistry. Eds: Niklaus P. Lang, Jan Lindhe, pp1297-1324, Wiley

Reference Type BACKGROUND

Ogihara S, Wang HL. Periodontal regeneration with or without limited orthodontics for the treatment of 2- or 3-wall infrabony defects. J Periodontol. 2010 Dec;81(12):1734-42. doi: 10.1902/jop.2010.100127. Epub 2010 Jul 14.

Reference Type BACKGROUND
PMID: 20629545 (View on PubMed)

Re S, Corrente G, Abundo R, Cardaropoli D. Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report. Int J Periodontics Restorative Dent. 2002 Apr;22(2):138-45.

Reference Type BACKGROUND
PMID: 12019709 (View on PubMed)

Martin C, Tietmann C, Wenzel S, Luengo M, Gaveglio L, Cardaropoli D, Kutschera E, Sanz-Sanchez I, Wullenweber P, Jepsen S, Jepsen K. RCT on orthodontic timing post-periodontal regeneration: root resorption and tooth movement outcomes. Eur J Orthod. 2025 Sep 17;47(5):cjaf078. doi: 10.1093/ejo/cjaf078.

Reference Type DERIVED
PMID: 41074768 (View on PubMed)

Other Identifiers

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PARO/KFO-15-249

Identifier Type: -

Identifier Source: org_study_id

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