Tooth Loss, Dental Diseases, Wound Heal
Conditions
Keywords
soft tissue regeneration, soft tissue graft, dental implant, imaging
Brief summary
This study aims to characterize the healing pattern following soft tissue augmentation procedure concomitant to implant placement.
Detailed description
This study will characterize, for the first time, the healing pattern of soft tissues around dental implants in case of soft tissue augmentation and in comparison, to normal healing. An innovative and comprehensive geometric/thermal imaging analysis will be employed that is non-contact and non-invasive to patients and will allow to characterize the healing process in a 2D-3D dimensional and volumetric way. This approach, combined with LSCI and clinical and radiographic outcomes, will provide new data on the biology and critical phases of soft tissue healing around implants, as well as on the stability and aesthetics of the peri-implant tissues with different grafts. Patient-reported outcome measurements (PROMs) will also be used to assess the level of pain and discomfort associated with soft tissue augmentation procedures.
Interventions
PROCEDURESoft tissue augmentation surgery with CTG
An epithelial-connective tissue graft of approximately 2-3 mm of thickness and adequate length will be taken from the palate or retromolar region of the patient and de-epithelialized with a scalpel (ideally a thickness of 1.5-2.0mm). The connective tissue graft (CTG) obtained will then be positioned buccally to the dental implant and sutured to the internal side of the flap so to provide soft tissue bulk at the level of the neck of the implant and simulate a root prominence for the missing tooth.
PROCEDURESoft tissue augmentation surgery with Fibro-Gide
Fibro-Gide will be used to obtain buccal soft tissue augmentation. Fibro-Gide will be trimmed with a scalpel and adjusted in size and thickness to better adapt to the area buccal to the implant. In particular, the graft will be shaped in order to obtain a graft of approximately 2-3 mm of thickness and adequate length. Fibro-Gide will then be sutured to the inner side of the buccal flap, before repositioning the flap and suturing it in a tension-free way.
PROCEDURENo soft tissue augmentation
During implant placement surgery, no soft tissue augmentation will be performed
Sponsors
Geistlich Pharma AG
Queen Mary University of London
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Due to the nature of the intervention, both participants and clinicians performing the surgical intervention will be un-blinded. Conversely, outcome examiners will be blinded to treatment allocation throughout the whole study duration.
Intervention model description
The study will includes 3 groups randomised in parallel.
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Age between 20 and 80 years. * Good medical and psychological health. * Absence of untreated caries lesions and untreated/uncontrolled periodontal disease. If patients require periodontal treatment (non-surgical and/or surgical), this has to be arranged outside the study protocol and completed at least 30 days prior to the enrolment. * Need of a single-tooth replacement in the aesthetic (incisor, canine or premolar) region. * Presence of adequate bone for implant placement without need for significant bone regeneration. In particular, the patients should have a bucco-palatal residual alveolar width of at least 6 mm at the central and crestal aspect of the single tooth gap to ensure complete embedding of an implant by bone (De Bruyckere et al., 2018). * A residual alveolar height \>8 mm, enough inter-arch space for a crown and a minimum distance of 6 mm from the adjacent teeth. * The width and height will be confirmed after x-ray examination in Visit 1 (or extra visit). Cases of small apical fenestration (≤ 25% of implant length) after implant placement will not be excluded, but will be treated according to the GBR principle (collagen membrane associated with a deproteinized bovine bone graft) to re-establish the bone contour and without over contouring. * At least 8 weeks of post-extraction socket healing had occurred in the edentulous site. * Willingness to sign the informed consent form.
Exclusion criteria
* Self-reported pregnancy and lactation. * Any known systemic disease affecting bone metabolism (e.g. Cushing's syndrome, crohn's disease, rheumatoid arthritis, osteoporosis, diabetes type I and uncontrolled diabetes type II), systemic infections or recent surgical procedures within 30 days of study initiation. * Chronic treatment (i.e., 2 weeks or more) with any medication known to affect oral status (e.g., phenytoin, dihydropyridine, calcium antagonists and cyclosporine) or bone metabolism (e.g. bisphosphonates, hormone replacement therapy, immunosuppressants) within 1 month before baseline visit. * HIV or viral hepatitis. * Physical handicaps that would interfere with the ability to perform adequate oral hygiene. * Self-reported alcoholism or chronic drug abuse. * Heavy smokers (\>10/cigarettes per day). * Patients suffering from a known psychological disorder or with limited mental capacity or language skills such that study information could not be understood, informed consent could be obtained or simple instructions could be followed. * Full-mouth bleeding (BOP) and plaque (PI) scores \>30% or sites with periodontal pocket depth \>5 mm at the completion of the pre-treatment phase. * Very thin or very thick biotypes that according to the clinician's judgement would either risk to have complications or would not benefit from receiving a graft. * \<2 mm KT buccally (from the mucogingival junction to the coronal aspect of the crestal soft tissue).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 3D intra-oral volume changes in mucosal soft tissue following augmentation | Immediately after implant placement. | Those changes will be assessed by capturing 3D intra-oral scans at the different time-points. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| soft tissue aesthetics | At implant loading and at 12 months after loading. | Papilla Fill Index and Pink Aesthetic Score |
| Changes in gingival thickness | implant placement to 12 weeks after implant placement | Changes in gingival thickness from the time of implant placement (with or without graft) and 12 weeks after implant placement assessed by a caliper |
| 3D extra-oral volumetric changes | baseline, immediately after implant placement, 7, 14 and 30 days after implant placement | 3D extra-oral morphometric changes assessed with a facial scanner |
| 2D-3D intra-oral thermal changes | baseline to 1, 3, 7, 14 and 30 days after implant placement | 2D-3D intra-oral thermal changes using an infrared, contact-free, thermal camera |
| changes in height of keratinised tissue | baseline to 30 days, 12 weeks and 16 weeks after implant placement and 12 months post loading | changes in height of keratinised tissue measured with a probe |
| Patients' reported outcomes (PROMS) in oral impact on Daily Performances (OIDP) questionnaire (OIDP) | At basline, 3 months (visit2, 3 and 4), 1 week from visit 2, 2 weeks form visit 2, 1 month from visit 2. | The OIPD is a well validated and frequently used PROMs in studies of oral health. It is a composite measure of the impacts of oral health on the quality of life of people. The OIDP focuses on the impact of oral health on the quality of life of people. The OIDP focuses on the impact that the conditions of the teeth and social wellbeing of the person. More specifically, it assesses the impact of oral conditions on basic daily life activities and behaviours (eating, speaking, cleaning teeth, going out, relaxing, smiling, major work or role, emotional stability, social contact). For each performance, both the frequency and severity of oral impacts are assessed. The overall OIDP score ranges from 0 to 100, with higher scores indicating worse quality of life. |
| PROMs based on the evaluation of global changes in quality of life | At basline, 3 months (visit2, 3 and 4), 1 week from visit 2, 2 weeks form visit 2, 1 month from visit 2. | Global ratings on health and quality of life will be provided through two methods: 1. The Visual Analogue Scale (VAS) included in the EQ5D questionnaire. 2. Through the following question: 'how would you rate the quality of your life'? The response will be scored on a six-point scale as: 1. Excellent 2. Very good 3. Good 4. Fair 5. Poor 6. Very poor |
| PROMs based on the evaluation of patient's perception about therapy | At basline, 3 months (visit2, 3 and 4), 1 week from visit 2, 2 weeks form visit 2, 1 month from visit 2. | The extent of discomfort and/or pain experienced will be evaluated using a 100-mm horizontal visual analogue scale (VAS). The anchors for each end of the scales will be designated as none and extreme. Patients will be also instructed to quantify the analgesic medication taken. In addition, the extent of discomfort, root hypersensitivity, oedema, hematoma, high fever and interference in daily activities during the first post-therapy week will be evaluated in the same way. |
| Post-operative swelling and oedema | At basline, 3 months (visit2, 3 and 4), 1 week from visit 2, 2 weeks form visit 2, 1 month from visit 2. | A series of subtracted images from the baseline will accurately identify the area and magnitude of the swelling, changes in facial shape, volume and temperature to monitor/quantify the healing. For every patient, a person specific template of postoperative facial swelling/oedema pattern will be created for sequential swelling/thermal changes or oedema volume measurements that will be applied on a unique alignment of the patient's specific consecutive imaging surfaces (self-defined positioning based on patients facial features). |
| changes in vascularisation | before and immediately after implant placement, and at post-operative days 1, 3, 7, 14, and 30 | Changes in revascularization in the area of the implant surgery with laser speckle contrast imaging |
Countries
United Kingdom
Outcome results
None listed