Peri-implant Soft Tissue Healing
Conditions
Keywords
Freeze-dried amniotic membrane, Collagen membrane, Dental implants, Early Healing Score, Visual Analog Scale, Amniotic Membrane, Collagen Barrier Membrane
Brief summary
The goal of this clinical trial is to learn whether Freeze-Dried Amniotic Membrane (FD-AM) or Collagen Membrane (CM) provides better soft tissue healing after Stage I dental implant surgery with particulate bone grafting in adults requiring implant treatment in bilateral posterior maxillary edentulous sites. It will also evaluate postoperative pain associated with the two membrane types. The main questions it aims to answer are: Does FD-AM result in improved early soft tissue healing compared with CM as assessed by the Early Healing Score (EHS)? Does FD-AM reduce postoperative pain compared with CM as assessed by the Visual Analogue Scale (VAS)? Researchers will compare FD-AM and CM placed over grafted implant sites to determine whether one membrane provides superior healing outcomes and patient comfort. Participants will: Undergo Stage I implant surgery with particulate bone grafting. Receive FD-AM at one implant site and CM at the contralateral implant site according to the study randomization protocol. Attend follow-up visits for assessment of soft tissue healing and postoperative pain. Complete questionnaires related to pain and healing outcomes during the postoperative period.
Detailed description
This prospective interventional in vivo study was conducted in the Department of Advanced Dental Sciences, Rajas Dental College and Hospital, to compare the effectiveness of Freeze-Dried Amniotic Membrane (FD-AM) and Collagen Membrane (CM) in promoting soft tissue healing following Stage I implant surgery with particulate bone grafting. A total of 10 partially edentulous patients with bilateral posterior maxillary edentulous sites meeting the predefined inclusion and exclusion criteria were recruited. The study employed a split-mouth design in which each patient contributed two implant sites, allowing direct within-patient comparison of the two membrane types. One site received FD-AM and the contralateral site received CM according to a randomization protocol based on a simple coin toss performed by an independent individual not involved in surgery or outcome assessment. The study included patients aged 25-55 years presenting with bilateral posterior maxillary edentulous areas, immediate implant placement requirements following extraction, or delayed implant placement in ridge defects requiring grafting. Patients with smoking history, pregnancy, systemic diseases affecting bone metabolism, active periodontal disease, infectious diseases, vitamin D deficiency, or known allergies to study materials were excluded. All surgical procedures were performed under aseptic conditions using standard implant surgical protocols. Following implant placement, xenogeneic demineralized bone matrix graft material (Osseograft) was placed around the implant site as required. Platelet-Rich Fibrin (PRF) was prepared from autologous venous blood and used to enhance the regenerative environment. Barrier membranes were adapted over the grafted sites to facilitate guided bone regeneration and were followed by primary wound closure using interrupted sutures. The primary outcome measure was soft tissue healing assessed using the Early Healing Score (EHS) by a blinded examiner. Secondary outcome assessment included postoperative pain evaluation using a Visual Analogue Scale (VAS) and structured questionnaires administered during follow-up visits. The study aimed to determine whether FD-AM provides comparable or superior soft tissue healing compared with conventional collagen membranes. The results demonstrated favorable healing responses with both membrane types, characterized by adequate hemostasis, absence of significant inflammatory signs, and satisfactory epithelialization during the early healing period. The findings suggest that both FD-AM and CM are effective barrier membranes for supporting early soft tissue healing and guided bone regeneration around dental implants.
Interventions
DEVICEFreeze-Dried Amniotic Membrane (FD-AM)
Freeze-Dried Amniotic Membrane (FD-AM) was placed over the particulate bone grafted implant site following Stage I implant surgery. The membrane was trimmed and adapted to cover the grafted area, serving as a barrier membrane for guided bone regeneration and promoting soft tissue healing during the postoperative period.
DEVICECollagen Membrane (CM)
Collagen Membrane (CM) was placed over the particulate bone grafted implant site following Stage I implant surgery. The membrane was trimmed and adapted to cover the grafted area, serving as a barrier membrane for guided bone regeneration and supporting soft tissue healing during the postoperative period.
Sponsors
RAJAS DENTAL COLLEGE AND HOSPITAL
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Soft tissue healing was assessed by a blinded independent examiner who was unaware of the allocation of Freeze-Dried Amniotic Membrane and Collagen Membrane at the implant sites.
Intervention model description
This study employed a randomized split-mouth crossover design in which each participant contributed two bilateral posterior implant sites. Following implant placement and particulate bone grafting, one site received Freeze-Dried Amniotic Membrane (FD-AM) and the contralateral site received Collagen Membrane (CM) according to a simple coin-toss randomization protocol. This design allowed each participant to serve as their own control, minimizing inter-individual variability and enabling direct comparison of soft tissue healing and postoperative pain outcomes between the two membrane types.
Eligibility
Sex/Gender
ALL
Age
25 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 25-55 years. * Male and female participants. * Bilateral posterior maxillary edentulous area in the premolar region (Bedrossian Zone 2 classification). * Patients with teeth requiring extraction and eligible for immediate implant placement in the bilateral posterior maxillary region. * Patients with ridge defects classified as Siebert Class II or Class III and eligible for delayed implant placement in the bilateral posterior maxillary region.
Exclusion criteria
* Current smokers. * History of systemic diseases affecting bone turnover, including hyperthyroidism (T4 outside 5.0-12.0 μg/dL or T3 outside 80-220 ng/dL), Type I diabetes mellitus (HbA1c \> 6%), Cushing's disease, or hyperlipidemia. * Pregnant women. * Lactating mothers. * Presence of periodontal disease. * Known allergy to study materials or medications. * Blood-borne infectious diseases, including HIV or HBsAg positivity. * Vitamin D level \< 30 ng/mL.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Early Healing Score | 1 week and 2 weeks | Assessment and comparison of soft tissue healing around bone-grafted implant sites covered with Freeze-Dried Amniotic Membrane (FD-AM) and Collagen Membrane (CM) following Stage I implant surgery using the Early Healing Score (EHS). The EHS evaluates wound healing based on three clinical parameters: Clinical Signs of Re-epithelialization (CSR): 0 = visible distance between incision margins; 3 = incision margins in contact; 6 = merged incision margins. Clinical Signs of Haemostasis (CSH): 0 = bleeding at incision margins; 1 = presence of fibrin ; 2 = absence of fibrin. Clinical Signs of Inflammation (CSI): 0 = redness involving \>50% of incision length and/or pronounced swelling; 1 = redness involving \<50% of incision length; 2 = absence of redness along incision length. The EHS is calculated as the sum of CSR, CSH, and CSI scores , where 0 represents the poorest healing and 10 represents ideal wound healing. Higher scores indicate better soft tissue healing outcomes. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Assessment Using Visual Analogue Scale (VAS) | 1 week and 2 weeks | Assessment and comparison of postoperative pain at bone-grafted implant sites covered with Freeze-Dried Amniotic Membrane (FD-AM) and Collagen Membrane (CM) using the Visual Analog Scale (VAS). Participants rate pain intensity on a scale from 0 to 10, where 0 = no pain and 10 = worst imaginable pain. Higher scores indicate greater pain severity and a worse outcome. |
Countries
India
Contacts
STUDY_CHAIRAlex M Muruppel, MDS
RAJAS DENTAL COLLEGE AND HOSPITAL
Outcome results
None listed