Efficacy of Antiresorptive and Bone Forming Material on Dental Implants

NCT ID: NCT04140006

Last Updated: 2019-10-25

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 20 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-07-01
• Study Completion Date: 2020-07-01

Brief Summary

Insertion of a metal implant is considered one of the most common surgeries for fracture treatment, joint replacement, and dental implants. The success rate of these implants depends on their fixation which is in turn related primarily on the strength of the bone holding them. Studies evaluating the influence of local application of antiresorptive drugs, like bisphosphonates, on implanted endoprostheses whether orthopedic or dental is increasing annually with more and more experimental studies as well as clinical trials worldwide. On the other hand implants that release medications that enhance bone formation will lead to improved implant fixation and success. The objective of this study was to evaluate the effect of topical application of alendronate sodium gel and recombinant human bone morphogenic protein 2 on dental implant stability and crestal bone level.

Detailed Description

Bisphosphonates (BPs), which are so called because they have two phosphonate (PO3) groups, are structurally similar to natural pyrophosphate (PP), a normal product of human metabolism that has a calcium chelating property. They are used to treat bone metastases, osteoporosis, Paget's disease, and other skeletal disorders.

During bone remodeling, osteoclast bone resorptive action is impeded by BPs which are released into the resorption lacunae. These cells take up BPs from resorption lacunae and the BPs then trigger the osteoclasts to undergo apoptosis. It has been found that an adjunct treatment of implant site with BPs solution might be beneficial to initial osseointegration of immediately or delayed loaded dental implants without interfering significantly with peri-implant bone remodeling over time.

Oral or intravenous administrations are the classical BPs treatment modalities with many studies show their positive effect on peri-implant bone. More efficient delivery systems to the target sites have been investigated to minimize BPs side effects and alter their biodistribution in order to improve their bioavailability; one of those new systems is topical application. Topical application of BPs enhances osseointegration, promote implant-bone contact and increase the amount of bone peripheral to dental implants. Minimal amounts of bisphosphonates was found to improve early implant fixation and to be less prone to cause osteonecrosis of the jaw, this might lead to new possibilities for orthopedic surgery in osteoporotic bones and for dental implants with a smaller risk of such complication in comparison with systemic treatment.

In order to maximize anabolism and minimize catabolism, new coating strategies have been evolved to enhanced bone formation onto the implant surface which is more desired than only reduce bone resorption around it. So to improve implant osseointegration, a dedicated drug-loading ability to locally target bone disorders has been developed to combine antiresorptive and anabolic agents, such as bone morphogenic protein, which for instance and in osteoporotic bone, will improve bone healing process.

With a view to diminishing the side effects caused by the systemic use of BPs, such as oesophagitis and osteonecrosis of the jaw, and to maximize anabolism and minimize catabolism, recent studies have sought alternative systems for local delivery of these agents with or without bone forming agent, either by means of immobilizing on the implant surface (coating or immersion in BPs solution), or by applying the drug directly to the surgical site before implant insertion either as an irrigant or gel.

Conditions

Partial Edentulism

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: FACTORIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Alendronate Gel (ALN)

After preparation, 0.05 ml of the gel containing 100 µg of ALN will be injected in the osteotomy site immediately before fixture insertion (20 fixtures)

Group Type: ACTIVE_COMPARATOR

ALN Gel

Intervention Type: DRUG

Flapped surgery for insertion of dental implant with topical application of ALN gel

Bone Morphogenic Protein Gel (BMP)

After preparation, 0.05 ml of the gel containing 100 µg of BMP will be injected in the osteotomy site immediately before fixture insertion (20 fixtures)

Group Type: ACTIVE_COMPARATOR

BMP Gel

Intervention Type: DRUG

Flapped surgery for insertion of dental implant with topical application of BMP gel

Mixture Gel of ALN and BMP

After preparation, 0.05 ml of mixture gel containing 50 µg of ALN and 50 µg of BMP will be injected in the osteotomy site immediately before fixture insertion (20 fixtures)

Group Type: ACTIVE_COMPARATOR

Mixed Gel

Intervention Type: DRUG

Flapped surgery for insertion of dental implant with topical application of mixed gel of ALN and BMP

Control

After preparation, the fixture will be inserted without topical application of any medication (20 fixtures)

Group Type: SHAM_COMPARATOR

Control

Intervention Type: DRUG

Flapped surgery for insertion of dental implant without topical application of any gel

Interventions

ALN Gel

Flapped surgery for insertion of dental implant with topical application of ALN gel

Intervention Type: DRUG

BMP Gel

Flapped surgery for insertion of dental implant with topical application of BMP gel

Intervention Type: DRUG

Mixed Gel

Flapped surgery for insertion of dental implant with topical application of mixed gel of ALN and BMP

Intervention Type: DRUG

Control

Flapped surgery for insertion of dental implant without topical application of any gel

Intervention Type: DRUG

Other Intervention Names

Alendronate Sodium trihydrate, m.w 325.12, Pharmaceutical Secondary standard, PHR 1599; CowellBMP, recombinant human bone morphogenic protein type 2, rhBMP2; Mixture of Alendronate Sodium trihydrate, m.w 325.12, Pharmaceutical Secondary standard, PHR 1599, and CowellBMP, recombinant human bone morphogenic protein type 2, rhBMP2; No treatment

Eligibility Criteria

Inclusion Criteria

Inclusion criteria Otherwise healthy patients over 18 years or with systemic diseases that do not interfere with bone healing Having single or multiple missing teeth in maxilla and/or mandible Having an alveolar ridge of sufficient vertical and horizontal dimensions and considered straightforward cases according to SAC classification

Exclusion criteria Patients with active or chronic infection or inflammation in the implant zone History of radiotherapy to the head and neck Past or current treatment with oral/intramuscular/intravenous bisphosphonates or other drugs altering bone metabolism Heavy smokers or with sever periodontitis

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Baghdad

OTHER

Sponsor Role: lead

Responsible Party

Dhuha A. Al-assaf

Principal investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Salwan Y Bede

Role: PRINCIPAL_INVESTIGATOR

University of Baghdad

Locations

College of dentistry, University of Baghdad

Baghdad, Bab-Almoadham, Iraq

Countries

Iraq

Other Identifiers

034118

Identifier Type: -

Identifier Source: org_study_id