Patient Specific Implants (PSIs) for the Decompression of Odontogenic Cysts

NCT ID: NCT06688851

Last Updated: 2024-11-29

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

RECRUITING

Total Enrollment

20 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-11-26

Study Completion Date

2028-01-31

Brief Summary

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This study aims to assess the feasibility of the decompression of odontogenic cysts using Patient Specific Implants anchored subperiosteally using osteosynthesis screws.

Detailed Description

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Preoperative Imaging and PSIs The digital impression of the dentition or the edentulous jaw is captured using an intraoral scanner and a CBCT scan is performed for each patient enrolled in the study.

Standard Tessellation Language (STL) and Digital Imaging and Communications in Medicine (DICOM) files are imported and registered in the software used for designing the Patient Specific Implants (PSI). The PSI consists of a plate that enables the fixation of the appliance subperiosteally on the bone using osteosynthesis screws and a tube allowing the continuous discharge of the cystic liquid into the oral cavity. The decreased pressure within the cyst enables bone regeneration during the decompression period.

The PSI is produced using Selective Laser Melting (SLM) technology with Titanium. Before the surgical procedure, the PSI undergoes disinfection and sterilization.

Surgical Interventions Under local anesthesia, a full-thickness flap is prepared and cystostomy is performed. A sample of the cyst lining is sent for histological diagnosis. The PSI is fixed on the surface of the bone using osteosynthesis screws. The flap is sutured around the tube of the PSI. After one week the sutures are removed.

Patients are recalled monthly for controls and panoramic X-rays are performed to monitor the decompression.

A post-operative CBCT scan is conducted six months after cystostomy to assess whether the cyst volume has sufficiently decreased for enucleation to be performed with minimal risk of damaging anatomical landmarks.

Under local anesthesia, a full-thickness flap is raised and the PSI is removed by unscrewing the osteosynthesis screws. The wall of the cyst is completely enucleated and the flap is sutured. The residual cyst lining is sent for histopathologic examination.

Data acquisition The complications are documented in the patient's chart after surgical interventions and during follow-up appointments. The volume of the cyst is measured on the CBCT reconstructions before and after decompression to evaluate the effectiveness of the approach described.

Conditions

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Odontogenic Cysts Odontogenic Keratocyst

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Management of the odontogenic cyst using a Patient Specific Implant (PSI)

Patients diagnosed with odontogenic cysts are included in this study. Cone Beam Computed Tomography (CBCT) and Intraoral Scans are performed and registered in a software for the design of Patient Specific Implants (PSI). A customized implant is designed and manufactured using Selective Laser Melting (SLM). Under local anesthesia, cystostomy is performed, and the wall of the cyst is sampled for histological diagnosis. The PSI is anchored subperiosteally on the bone using osteosynthesis screws. After a 6-month-long decompression period a CBCT scan is performed to determine whether enucleation of the cyst is feasible. Enucleation of the cyst is performed and the remaining cyst lining is sent for histopathological examination.

Preoperative Cone Beam Computed Tomography (CBCT) scan

Intervention Type DIAGNOSTIC_TEST

A CBCT scan is performed before the surgical intervention.

Cystostomy

Intervention Type PROCEDURE

Under local anesthesia, a full-thickness flap is prepared and cystostomy is performed.

Histology to confirm the initial diagnosis

Intervention Type DIAGNOSTIC_TEST

A sample of the cyst lining is sent for histologic diagnosis.

Patient Specific Implant

Intervention Type DEVICE

The PSI is fixed on the surface of the bone using osteosynthesis screws.

Cyst decompression

Intervention Type PROCEDURE

The PSI enables the discharge of the cystic liquid into the oral cavity. The resulting decrease in cystic pressure induces bone healing. Patients are recalled monthly for controls and panoramic X-rays are performed to monitor the decompression.

CBCT

Intervention Type DIAGNOSTIC_TEST

Post-operative CBCT is performed six months after cystostomy to assess whether the cyst volume has been sufficiently reduced for enucleation, minimizing the risk of damage to anatomical landmarks.

Enucleation

Intervention Type PROCEDURE

Under local anesthesia a full-thickness flap is raised and the PSI is removed by unscrewing the osteosynthesis screws. The wall of the cyst is completely enucleated and the flap is sutured.

Histology performed on the entire lining of the cyst

Intervention Type DIAGNOSTIC_TEST

The residual cyst wall is sent for histopathologic examination.

Interventions

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Preoperative Cone Beam Computed Tomography (CBCT) scan

A CBCT scan is performed before the surgical intervention.

Intervention Type DIAGNOSTIC_TEST

Cystostomy

Under local anesthesia, a full-thickness flap is prepared and cystostomy is performed.

Intervention Type PROCEDURE

Histology to confirm the initial diagnosis

A sample of the cyst lining is sent for histologic diagnosis.

Intervention Type DIAGNOSTIC_TEST

Patient Specific Implant

The PSI is fixed on the surface of the bone using osteosynthesis screws.

Intervention Type DEVICE

Cyst decompression

The PSI enables the discharge of the cystic liquid into the oral cavity. The resulting decrease in cystic pressure induces bone healing. Patients are recalled monthly for controls and panoramic X-rays are performed to monitor the decompression.

Intervention Type PROCEDURE

CBCT

Post-operative CBCT is performed six months after cystostomy to assess whether the cyst volume has been sufficiently reduced for enucleation, minimizing the risk of damage to anatomical landmarks.

Intervention Type DIAGNOSTIC_TEST

Enucleation

Under local anesthesia a full-thickness flap is raised and the PSI is removed by unscrewing the osteosynthesis screws. The wall of the cyst is completely enucleated and the flap is sutured.

Intervention Type PROCEDURE

Histology performed on the entire lining of the cyst

The residual cyst wall is sent for histopathologic examination.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

-Patients of the Department of Public Dental Health, Semmelweis University, presenting with odontogenic cysts of the jaws that involve anatomical landmarks are included in the study.

Exclusion Criteria

* Patients who have uncontrolled major systemic diseases as classified by the American Society of Anesthesiologists (ASA grades III-IV)
* Cancer of the oral cavity
* History of irradiation therapy in the head and neck region within the previous five years,
* History of uncontrolled psychiatric disorders,
* Unwillingness to return for follow-up appointments.
* Patients on medications interfering with bone metabolism, including steroid therapy and antiresorptive medication
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Semmelweis University

OTHER

Sponsor Role lead

Responsible Party

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Marton Kivovics

associate professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Márton Kivovics, Doctor of Dental Medicine

Role: PRINCIPAL_INVESTIGATOR

Department of Public Dental Health, Semmelweis University

Locations

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Department of Public Dental Health

Budapest, Budapest, Hungary

Site Status RECRUITING

Countries

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Hungary

Central Contacts

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Márton Kivovics, Doctor of Dental Medicine

Role: CONTACT

003614591500 ext. 60732

Márk Répási, Doctor of Dental Medicine

Role: CONTACT

003614591500 ext. 60759

Facility Contacts

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Márton Kivovics, Doctor of Dental Medicine

Role: primary

003614591500 ext. 60732

Márk Répási, Doctor of Dental Medicine

Role: backup

003614591500 ext. 60759

Márton Kivovics, Doctor of Dental Medicine

Role: backup

Other Identifiers

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SEDCD55

Identifier Type: -

Identifier Source: org_study_id