Radiographic and Histological Assessment of GBR Using DBB Compared to Spontaneous Bone Regeneration of Maxillary Defects , Resulted from Enucleation of Intra-bony Cystic Lesions

NCT ID: NCT06749158

Last Updated: 2024-12-27

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

Clinical Phase

NA

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-11-01

Study Completion Date

2025-11-30

Brief Summary

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Two groups of patients with maxillary defects resulted from enucleation of intra-bony cystic lesions One will be subjected to guided bone regeneration while the other group will be subjected to spontaneous bone regeneration.

Detailed Description

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* Two groups of patients with maxillary cystic lesions indicated for enucleation. One will be subjected to guided bone regeneration while the other will be subjected to spontaneous bone regeneration.
* General pre-operative procedures:

* All patients will undergo appropriate preparation involving periodontal therapy , proper oral hygiene measures in addition to endodontic treatment for the non-vital teeth related to the lesion.

intraoperative procedure: (both groups)

* Scrubbing and draping of the patient will be carried out in a standard fashion using betadine surgical scrub.
* Local anesthesia will be administered (articaine hydrochloride 68 mg/1.7 ml + adrenaline 0.017 mg/1.7 ml injectable solution.
* Flap design: a sulcular incision will be done , extending two teeth beyond the area of interest followed by two oblique incisions on either side of the flap. A full thickness mucoperiosteal flap will be raised to expose the area occupied by the lesion.
* After flap reflection, the exposed bone related to the lesion will need to be removed to provide adequate accessibility before enucleation of the lesion.
* The specimens will be fixed in 10% formalin for pathological examination.

Intra-operative procedures - continued in Study Group (GBR group) The intra-bony defect will be filled with Deproteinized Bovine Bone. In Both groups: Titanium mesh will be tailored with 3mm overlap at the edges to cover the bone window completely and fixed to the bone using mono-cortical titanium screws.

This is followed by:

* proper decompression of soft tissue will be applied to achieve tension-reduced suture.
* Primary closure will be performed using 4-0 vicryl sutures.
* Sutures will be removed one week postoperatively.

Postoperative medications:

For both groups, postoperative antibiotic course of amoxicillin+ clavulanic acid 1 g tab (Augmentin) will be prescribed for one week and isobutylphenylpropionic acid 600 mg tab (Brufen) twice daily for one week. One shot of dexamethasone 8 mg vial will be administered intramuscularly immediately after the surgery together with ketorolac tromethamine 30 mg .

Postoperative care and instructions:

* Cold compresses will be applied for 10 minutes every 30 minutes for the first 24 hours postoperatively replaced by warm fomentation with the same rate for the next two days.
* Patients will be advised to maintain good oral hygiene and oral hygiene rinses using 2% chlorohexidine gluconate mouth rinse for a week starting from the second postoperative day (three times daily)
* Soft diet is recommended for the first 48 hours.
* The patients will be recalled after two days, after one week, at the end of the first month and then at three and six months to monitor the soft tissue healing where the sutures were removed after one week, then at the sixth months to evaluate the bony healing.

Radiographic assessment will be achieved by CBCT scan immediately postoperative to determine the baseline bone density and 6 months postoperatively to evaluate the change in the bone density . A total of three scans will be taken for each patient.

6 months after the surgery ,titanium mesh and the screws will be removed , core biopsy will be taken for histological assessment and implant/s will be placed.

Conditions

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Maxillary Cyst

Keywords

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Guided bone regeneration Spontaneous bone regeneration

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
This trial is considered a randomized single blind clinical trial due to the following:

* The participants will be blinded to the technique that will be used during the surgical procedure.
* The operator will not be blinded for both techniques during the surgical procedure as the two techniques are different.
* The outcome assessor cannot be blinded.

Study Groups

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spontaneous bone regeneration

after cyst enucleation, the intra-bony defect will be covered by Titanium mesh that is fixed by mono-cortical titanium screws.

Group Type ACTIVE_COMPARATOR

spontaneous bone regeneration

Intervention Type PROCEDURE

stage 1 surgery:

1. after administration of Local anesthesia (articaine hydrochloride 68 mg/1.7 ml + adrenaline 0.017 mg/1.7 ml injectable solution), sulcular incision will be done , extending two teeth beyond the area of interest followed by two oblique incisions on either side of the flap
2. after flap elevation, enucleation of the cystic lesion and extraction of the non-restorable teeth related to the lesion will be done.
3. titanium mesh will be tailored with 3 mm overlap at the edges to cover the bone window completely and fixed to the bone using mono-cortical titanium screws.

This will be followed by:

* proper decompression of soft tissue to achieve tension-reduced suture.
* Primary closure will be performed using 4-0 vicryl sutures.
* Sutures will be removed one week postoperatively. stage 2 surgery(after 6 months):

1. titanium mesh and screws will be removed.
2. core biopsy will be obtained for histological assessment
3. implant/s placement.

guided bone regeneration

cyst enucleation will be followed by filling the intra-bony defect with Deproteinized Bovine Bone.

-Titanium mesh will cover the bone window completely and will be fixed to the bone using mono-cortical titanium screws.

Group Type EXPERIMENTAL

guided bone regeneration

Intervention Type PROCEDURE

stage 1 surgery after cyst enucleation and extraction of the non-restorable teeth related to the lesion, The intra-bony defect will be filled with Deproteinized Bovine Bone.

* Titanium mesh will be tailored with 3mm overlap at the edges to cover the bone window completely and fixed to the bone using mono-cortical titanium screws. This will be followed by:
* proper decompression of soft tissue will be applied to achieve tension-reduced suture.
* Primary closure will be performed using 4-0 vicryl sutures.
* Sutures will be removed one week postoperatively. stage 2 surgery(6 months later) :

1. titanium mesh will be removed.
2. core biopsy will be obtained for histological assessment.
3. implant/s placement.

Interventions

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spontaneous bone regeneration

stage 1 surgery:

1. after administration of Local anesthesia (articaine hydrochloride 68 mg/1.7 ml + adrenaline 0.017 mg/1.7 ml injectable solution), sulcular incision will be done , extending two teeth beyond the area of interest followed by two oblique incisions on either side of the flap
2. after flap elevation, enucleation of the cystic lesion and extraction of the non-restorable teeth related to the lesion will be done.
3. titanium mesh will be tailored with 3 mm overlap at the edges to cover the bone window completely and fixed to the bone using mono-cortical titanium screws.

This will be followed by:

* proper decompression of soft tissue to achieve tension-reduced suture.
* Primary closure will be performed using 4-0 vicryl sutures.
* Sutures will be removed one week postoperatively. stage 2 surgery(after 6 months):

1. titanium mesh and screws will be removed.
2. core biopsy will be obtained for histological assessment
3. implant/s placement.

Intervention Type PROCEDURE

guided bone regeneration

stage 1 surgery after cyst enucleation and extraction of the non-restorable teeth related to the lesion, The intra-bony defect will be filled with Deproteinized Bovine Bone.

* Titanium mesh will be tailored with 3mm overlap at the edges to cover the bone window completely and fixed to the bone using mono-cortical titanium screws. This will be followed by:
* proper decompression of soft tissue will be applied to achieve tension-reduced suture.
* Primary closure will be performed using 4-0 vicryl sutures.
* Sutures will be removed one week postoperatively. stage 2 surgery(6 months later) :

1. titanium mesh will be removed.
2. core biopsy will be obtained for histological assessment.
3. implant/s placement.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Pathological Maxillary intra-bony defects with diameter ranging from 1.5 to 4.0 cm.
* patients indicated for implant placement after teeth extraction.
* Age range from 20-50 years.
* Patients free from any systemic conditions and bone metabolism diseases that might interfere with the surgical intervention, soft tissue or hard tissue healing.
* No evidence of acute inflammation.
* Regular attendance at control visits.

Exclusion Criteria

* Pregnancy or lactation.
* Systemic conditions that compromise bone healing such as : uncontrolled diabetes mellitus, history of chemotherapy or radiotherapy or Hematological disorders.
* Patients taking bisphosphonates, glucocorticoids or other drugs that may interfere with bone metabolism.
* presence of infection at the surgical site.
* infected cysts and odontogenic keratocyst.
Minimum Eligible Age

20 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cairo University

OTHER

Sponsor Role lead

Responsible Party

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Alaa Mohamed Abdelzaher

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohamed A Abdelrasoul, PhD

Role: STUDY_DIRECTOR

faculty of oral and dental medicine, Cairo university

Locations

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faculty of oral and dental medicine, Cairo university

Cairo, Giza Governorate, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Alaa M Abdelzaher, BSc

Role: CONTACT

Phone: +201124716475

Email: [email protected]

Mohamed A Abdelrasoul, PhD

Role: CONTACT

Phone: +20 1009612708

Email: [email protected]

Facility Contacts

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Alaa M Abdelzaher, BSc

Role: primary

Mohamed A Abdelrasoul, PhD

Role: backup

Alaa M Abdelzaher, BSc

Role: backup

Related Links

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https://pubmed.ncbi.nlm.nih.gov/35576245/

Radiographic bone volume alteration after jaw cyst enucleation with or without simultaneous bone grafts: A prospective randomized study

https://pubmed.ncbi.nlm.nih.gov/33380722/

Review Int J Oral Sci . 2020 Dec 30;12(1):37. doi: 10.1038/s41368-020-00107-z. Titanium mesh for bone augmentation in oral implantology: current application and progress

https://pubmed.ncbi.nlm.nih.gov/21890372/

Jaw cysts - filling or no filling after enucleation? A review

https://pubmed.ncbi.nlm.nih.gov/34070157/

Bone Grafts and Substitutes in Dentistry: A Review of Current Trends and Developments

https://pubmed.ncbi.nlm.nih.gov/36499315/

Barrier Membranes for Guided Bone Regeneration (GBR): A Focus on Recent Advances in Collagen Membranes

Other Identifiers

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CEBO-CU.2024

Identifier Type: -

Identifier Source: org_study_id