Alveolar Ridge Enlargement, Bone Loss, Alveolar, Dehiscence
Conditions
Brief summary
The primary aim of the present study is to compare the Sub-periosteal Peri-implant Augmented Layer (SPAL) technique and soft tissue augmentation (STA), performed simultaneously to implant placement, in terms of (i) implant survival rate and (ii) health/disease condition of the peri-implant tissues at 6 and 12 months following implant loading. The secondary aim of the project will be to compare the SPAL technique and STA in terms of intra- and post-operative morbidity. The study is designed as a single-blind, parallel-arm, randomized clinical trial. Patients will be recruited and treated at the Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.) of Ferrara, Italy, and one University center (Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Italy). Each patient will contribute the study with one sextant (experimental sextant). Each eligible patient will be randomly assigned to receive SPAL technique or STA according to a computer-generated randomization list. Surgical procedures will be performed by experienced periodontal and implant surgeons. Two calibrated, blinded examiners will take care of the assessment of clinical and radiographic parameters, Case Report Form (CRF) filling, as well as data extraction from CRFs for the preparation of the study database. The proportion of patients free from peri-implantitis at 12 months following loading will be the primary outcome variable of the study. The proportion of patients with complete resolution of the bone dehiscence (BD), dimensional variations and 12-months characteristics of BD, and patient-reported outcome measures will be the secondary outcomes. The design will test two hypotheses, with a non-inferiority trial in terms of primary outcome and a superiority trial in terms of secondary outcomes.
Interventions
PROCEDURESub-Periosteal Peri-implant Augmented Layer technique
In patients assigned to the SPAL group, the management of the soft tissues will be performed according to the SPAL technique as originally described by Trombelli et al. (2018). Implant site preparation will be performed using a set of calibrated guided surgery steel burs under copious sterile saline irrigation. Implants will be placed, and a healing abutment will be positioned and screwed. The space underneath the periosteal layer will be then filled with a deproteinized bovine bone mineral (DBBM) graft. A sterile viscoelastic gel (SVG) based on polynucleotides and hyaluronic acid (REGENFAST®, Mastelli Srl, Sanremo, Italia) will be combined with the bone graft. The periosteal layer will be then secured to the oral flap by mean of 6/0 resorbable internal mattress sutures. SVG wil be placed underneath the mucosal layer and the latter will be coronally advanced and stabilized a using 6/0 resorbable internal mattress and sling sutures.
PROCEDURESoft tissue augmentation
In patients assigned to the STA group, flap management will be performed as described by Stefanini et al. (2016). Implant site preparation will be performed according to the same procedures described for the SPAL group. SVG will be placed underneath the buccal flap and the latter will be then released from tension by means of periosteal and muscular incisions, and will be coronally advanced and adapted to the healing abutment with a 6/0 resorbable sling suture. Interrupted sutures will be used to accomplish primary intention closure in the interproximal areas.
Sponsors
Azienda USL Ferrara
Università degli Studi di Ferrara
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
The assignment of eligible patients to treatment will be recorded using sealed envelopes and will be disclosed to each clinical operator at the end of the screening appointment. The examiners will be kept blinded as to treatment allocation.
Intervention model description
The study is designed as a single-blind, parallel-arm, randomized trial.
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient-specific inclusion criteria * age≥21years; * good physical status (ASA1 and ASA2 according to Physical Status Classification System) (American Society of Anesthesiologists, 2010); * systemic and local conditions compatible with implant placement and experimental procedures; * indication to a fixed, implant-supported prosthetic rehabilitation with hard or soft tissue reconstructive procedures as part of the comprehensive oral rehabilitation plan; * patient willing and fully capable to comply with the study protocol. Sextant-specific inclusion criteria To be considered as experimental, a sextant will have to fulfill all the following criteria: * including at least one healed (i.e., ≥ 6 months elapsed from tooth loss) edentulous site; * horizontal dimension of the edentulous ridge compatible with the primary stability of an implant of at least 3.5 mm in diameter; * expected peri-implant buccal BD characterized by a height (measured as the apico-coronal height of the exposed implant surface) ≤ 5 mm or a thin (\< 1 mm) peri-implant buccal bone plate as diagnosed on tridimensional planning for guided implant placement. Patient will not be eligible for the study if presenting at least one of the following
Exclusion criteria
Patient-specific
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients free from peri-implantitis | 12-month visit | Proportion of patients free from peri-implantitis (diagnosed according to the criteria described by Berglundh et al. 2018) at 12 months following loading |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complete resolution of bone dehiscence (BD) | 12-month visit | Proportion of patients with complete resolution of BD as evaluated on CT/CBCT scan at 12 months following surgery |
| Changes in height and width of bone dehiscence (BD) | Pre-surgery and 12-month visits | Variations in height and width of bone dehiscence (BD) (as evaluated on CT/CBCT scan) occurred between pre-surgery visit 12-month visits |
| Height and width of the residual bone dehiscence (BD) | 12-month visit | Height and width of bone dehiscence (BD) as evaluated on CT/CBCT scan at 12-month visit |
| Pain | Day 0, +1, +2, +3, +4, +7 and +14 following surgery | Level of pain recorded in the evening at day 0, +1, +2, +3, +4, +7 and +14 on a 100-mm visual analogue scale (VAS) ranging from 0-no pain to 100-worst pain imaginable |
| Dose of rescue anti-inflammatory drug | First 14 days following surgery | Dosage of rescue anti-inflammatory drug (i.e. number of ibuprofen 600 mg tablets) and other types of medications taken from the day of surgery to the 14th postoperative day, as recorded daily on a medication diary. |
| Discomfort | Day 0, +1, +2, +3, +4, +7 and +14 following surgery | Level of discomfort, as recorded at day 0 (evening), +1, +2, +3, +4, +7 and +14 on a 5-point rating scale ranging from no discomfort to very high discomfort |
| Limitations in daily functions | Day 0, +1, +2, +3, +4, +7 and +14 following surgery | Limitations in daily functions (i.e., swallowing, continuing daily activities, eating, speaking, opening the mouth, sleeping), as recorded at day 0 (evening), +1, +2, +3, +4, +7 and +14 on a 5-point rating scale ranging from no limitations to unable to eat a lot of types of food (for the eating item), and from not at all difficult to extremely difficult (for the other items) |
| Incidence of postoperative signs and symptoms | Day 0, +1, +2, +3, +4, +7 and +14 following surgery | Incidence of postoperative signs and symptoms (i.e., swelling, nausea, bruising, bad taste/smell) at day 0 (evening), +1, +2, +3, +4, +7 and +14 |
| Willingness to undergo the same type of surgery | Day +14 following surgery | Willingness to undergo the same type of surgery, recorded at day +14 on a 4-point rating scale ranging from no problem to repeat surgery if needed to I will never undergo this type of surgery again. |
Countries
Italy
Outcome results
None listed