Ridge Preservation Using Xenogenic Bone Graft and Pre-hydrated Collagen Membrane

NCT ID: NCT04955873

Last Updated: 2021-08-10

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-08-31

Study Completion Date

2023-04-01

Brief Summary

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This pilot multicentric randomized controlled clinical trial is aimed at evaluating the composition of the new-formed tissue into the dental socket after 6 months from tooth extraction and the application of a combination of xenograft bone granules and collagen membrane. Extraction sites will be either grafted with Dentsply Symbios Xenograft Granules and covered with Dentsply Symbios pre-hydrated Collagen Resorbable Membrane or grafted with Geistlich Bio-Oss Collagen and covered with Geistlich Bio-Gide membrane. Results will be compared to spontaneous socket healing.

Detailed Description

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Rational

Socket preservation techniques are effective in mitigating the dimensional changes of the alveolar socket that spontaneously occur after tooth extraction (Avila-Ortiz G, et al. 2019). However, there is insufficient information regarding the type and quality of the newly formed tissue at the extraction site before implant positioning.

Study design

This study is a three-arm multicentric randomized trial that will evaluate the bone healing following ridge preservation of extraction sockets using two different combinations of commercially available xenograft bone granules and collagen membranes available in the market. Results will be compared to tissues obtained from spontaneous healing. A total of 45 participants (15 in each arm) is expected.

Study protocol

Patients, satisfying inclusion criteria and having signed study informed consent, will be randomly allocated to three study groups, receiving the following treatments at the time of tooth extraction:

* Group A: grafting of postextraction socket with Dentsply Symbios Xenograft granules covered with Dentsply Symbios pre-hydrated Collagen Resorbable Membrane (Test - Group A)
* Group B: grafting of postextraction socket with Geistlich Bio-Oss Collagen and covering with Geistlich Bio-Gide Collagen membrane (Active comparator - Group B)
* Group C: no further treatment of the postextraction socket (spontaneous healing, Control - Group C) After 6 months from the extraction, radiographic examinations will be performed and the implant surgery will take place.

On the day of the surgery the width of keratinized mucosa at socked site will be registered. Then, following loco-regional anesthesia, a soft tissue sample of 3 mm in diameter will be obtained using a circular punch at the site intended to receive the implant. Subsequently, a flap will be elevated. Using a trephine drill a 3 mm in diameter block of hard tissue with a length of 5- 6 mm will be collected. The preparation of the implant site will be then carried out until the desired diameter and length are reached for the insertion of the corresponding implant. Torque at implant insertion will be registered.

Once the implant has been inserted, the healing abutment will be positioned and soft tissues will be sutured with single sutures. The prosthetic rehabilitation will be completed after osseointegration, approximately 3 months after the implant surgery.

Histological analysis of soft tissue and hard tissue biopsies

Tissue samples will be immediately fixed in formalin after collection. Histological analysis will be performed on formalin-fixed paraffin-embedded tissue sections, to determine the quantity and quality newly formed tissue and the remaining fraction of the implanted biomaterials.

More specifically, the collected tissue biopsies will be fixed in 4% buffered formalin, decalcified into ethylenediaminetetraacetic acid (EDTA) (if necessary), dehydrated and included in paraffin. Serial sections, including the central portion of the biopsy, will be prepared and colored in hematoxylin and eosin. Vascular structures will be identified by CD34 (Cluster of differentiation 34, hematopoietic progenitor cell antigen) antibody. Portions occupied by mineralized bone (lamellar bone, trabecular bone), osteoid (partially mineralized connective tissue matrix rich in collagen), bone marrow (adipocytes and vascular structures), fibrous tissue (unorganized collagen fibers, cells and vessels), biomaterial granules and residual tissue (unidentified tissue elements, preparation artifacts) will be characterized by morphometric measurements performed according to the protocol described by Lindhe et al. (Clin. Oral Impl. Res.2014;25:786-790). Soft tissues characterization will include the analysis of the structural composition of epithelial and connective tissues, the quantification of the amount micro-vessels in connective tissue, the definition of the inflammatory cell types, and the collagen tissue content according to protocols described in Tomasi et al. (J Clin Periodontol. 2016;43:816-24).

Data analysis and statistics

Data analysis will be aimed at detecting statistically significant differences in tissue composition between the group A in respect to the most appropriate of the two remaining groups (e.g. the percentage of bone tissue in the test group will be compared with that of control group C while the percentage of residual biomaterial six months after implantation will be compared with the active control B). Statistically significant differences with p\<0.05 will be considered.

Data normality will be verified with the Shapiro-Wilk test. Outcome variables for each of three groups will be expressed by means of mean ± standard deviation for continuous variables with normal distribution, or by means of median and value at the 25th and 75th percentile for variables with non-normal distribution. Parametric or non-parametric statistical tests will then be applied to compare between groups, according to data normality.

Conditions

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Alveolar Bone Resorption Edentulous Alveolar Ridge

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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Test - Group A - Dentsply biomaterials

Dental extraction socket treated with the combined use of the xenogenic bone granules "Dentsply Sirona Symbios Xenograft Granules" and the resorbable collagen membrane "Dentsply Sirona Symbios Collagen Membrane SR".

Group Type EXPERIMENTAL

Treatment of the dental extraction socket using newly-released biomaterials

Intervention Type DEVICE

Treatment of the dental extraction socket with the combined use with the combined use of a newly-released xenogenic bone granules and a resorbable collagen membrane.

Active comparator - Group B - Geistlich biomaterials

Dental extraction socket treated with the combined use of the xenogenic bone granules "Geistlich Bio-oss Collagen" and the resorbable collagen membrane "Geistlich BioGide".

Group Type ACTIVE_COMPARATOR

Treatment of the dental extraction socket using well-known biomaterials

Intervention Type DEVICE

Treatment of the dental extraction socket with the combined use of a well-known xenogenic bone granules and a resorbable collagen membrane

Control - Group C - Spontaneous healing

Spontaneous postextraction alveolar healing

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Treatment of the dental extraction socket using newly-released biomaterials

Treatment of the dental extraction socket with the combined use with the combined use of a newly-released xenogenic bone granules and a resorbable collagen membrane.

Intervention Type DEVICE

Treatment of the dental extraction socket using well-known biomaterials

Treatment of the dental extraction socket with the combined use of a well-known xenogenic bone granules and a resorbable collagen membrane

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* have at least one tooth (from the central incisor to the second permanent molar) to be extracted and replaced with an endosseous implant;
* no need of a temporary prosthesis;
* availability to participate to the follow-up;
* sign the study informed consent and consent to data treatment;

Exclusion Criteria

* less than 20 years;
* known allergy to collagen or bone graft material;
* contraindications to implant therapy;
* ongoing bisphosphonate-based therapy;
* ongoing high-dose corticosteroid therapy;
* relevant co-morbidities of the maxillary bones that interfere with bone remodeling (degenerative bone diseases, osteomyelitis at the extraction site or surrounding areas, subacute mandibular osteitis, local microvascular disorders);
* smoking;
* pregnancy;
* metabolic diseases (diabetes, hyperparathyroidism);
* systemic bone diseases;
Minimum Eligible Age

20 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dentsply Sirona Implants and Consumables

INDUSTRY

Sponsor Role collaborator

Fondazione Bruno Kessler

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Francesco Tessarolo, PhD

Role: PRINCIPAL_INVESTIGATOR

Bruno Kessler Fundation, Trento Italy

Paolo Ghensi, DDS, PhD

Role: PRINCIPAL_INVESTIGATOR

Università degli Studi di Trento

Locations

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Studio Odontoiatrico Maia Dentis

Merano, Bolzano, Italy

Site Status RECRUITING

Studio Medico Dentistico Dott. Mandelli

Pioltello, Milano, Italy

Site Status RECRUITING

Studio Dentistico Bressan Associati Di Bressan Eriberto - Bressan Giuseppe - Bressan Paolo

Chions, Pordenone, Italy

Site Status RECRUITING

Studio Dentistico Associato Tomasi-Ghensi-Varotto

Cembra, Trento, Italy

Site Status ENROLLING_BY_INVITATION

Studio Dentistico Donati Di Donati Andrea & Mauro

Perugia, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Paolo Ghensi, DDS, PhD

Role: CONTACT

+39 0461 282775

Francesco Tessarolo, PhD

Role: CONTACT

+39 0461 282775

Facility Contacts

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Antonio Bonaccorso, MD

Role: primary

Federico Mandelli, MD

Role: primary

Eriberto Bressan, MD, Prof.

Role: primary

Mauro Donati

Role: primary

References

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Avila-Ortiz G, Chambrone L, Vignoletti F. Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis. J Clin Periodontol. 2019 Jun;46 Suppl 21:195-223. doi: 10.1111/jcpe.13057.

Reference Type BACKGROUND
PMID: 30623987 (View on PubMed)

Lindhe J, Cecchinato D, Donati M, Tomasi C, Liljenberg B. Ridge preservation with the use of deproteinized bovine bone mineral. Clin Oral Implants Res. 2014 Jul;25(7):786-90. doi: 10.1111/clr.12170. Epub 2013 Apr 4.

Reference Type BACKGROUND
PMID: 23556467 (View on PubMed)

Tomasi C, Tessarolo F, Caola I, Piccoli F, Wennstrom JL, Nollo G, Berglundh T. Early healing of peri-implant mucosa in man. J Clin Periodontol. 2016 Oct;43(10):816-24. doi: 10.1111/jcpe.12591. Epub 2016 Jul 28.

Reference Type BACKGROUND
PMID: 27329966 (View on PubMed)

Other Identifiers

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I-BI-16-004

Identifier Type: -

Identifier Source: org_study_id

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