Healing of Post-ext Sites Using Bovine Bone Mineral: a CBCT and Histologic RCCT

September 1, 2016 updated by: Proed, Torino, Italy

Healing of Post-extraction Sites Using Bovine-bone Mineral: a CBCT and Histologic Randomized Controlled Clinical Study

Aim of the present investigation will be to evaluate the role of a bovine-bone mineral and a collagen membrane as ridge augmentation procedure following tooth extraction. 20 consecutive adult patients, requiring tooth extraction in the frontal area of the upper and lower arch maxilla (from second premolar to second premolar), will be enrolled into the study.

After tooth extraction, sockets will be randomized and divided into two groups: in Group A the socket will be grafted with Bio-Oss Collagen , in Group B the sockets will be grafted with BioOss granules (small granules). The graft will be covered with porcine collagen membrane (BioGide). Then, the flap will be sutured.

MEASUREMENTS:

The end of the study will be fixed at the 6 months evaluation after tooth extraction. Impression will be taken before tooth extraction and after 6 months in order to create cast models. On the cast models, using reference PVC (polyvinylchloride) guides, the horizontal dimension of the soft tissues will be measured. One measurement per tooth will be recorded, at T0 (before extraction) and T2 (after 6 months).

A 3D radiological image, using the CBCT technique, will be obtained at the end of the surgical stage T1 (extraction + bone graft) and after 6 months of healing. Superimposition will be performed in order to measure hard tissue remodelling.

After six months (T6), a a biopsy specimen will be also harvested for that augmented extractions sockets on which an implant installation has been previously planned.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Both animal and human studies have clearly demonstrated that the healing of post extraction sites usually results in pronounced alveolar ridge resorption, that mostly stabilized after 4 to 6 months. The marked tri-dimensional alterations of the ridge volume may jeopardize patients' aesthetics and create anatomical difficulties for further implant placement.

Aim of the present investigation will be to evaluate the role of a bovine-bone mineral and a collagen membrane as ridge augmentation procedure (intended as "increase of the ridge volume beyond the skeletal envelope existing at the time of extraction") following tooth extraction. Furthermore, the authors aim to evaluate as the collagen membrane acts when used for "open-healing".

20 consecutive adult patients, requiring tooth extraction in the frontal area of the upper and lower arch maxilla (from second premolar to second premolar), will be enrolled into the study.

After local anesthesia, a buccal full thickness flap will be elevated, and then the hopeless teeth will be gently extracted. All granulation tissue will be removed from the alveolus, that will be rinsed with saline. At this time the post-extraction sockets will be randomized and divided into two groups: in Group A the socket will be grafted with Bio-Oss Collagen , in Group B the sockets will be grafted with BioOss granules (small granules) using the Bio-Oss Pen device.

The graft will be covered with porcine collagen membrane (BioGide). Then, the flap will be sutured. The sutures (single sutures) will involve only the interdental gingival tissue, and no attempt will be done to reach a complete soft tissue closure of the sockets: in the alveolus area BioGide will be mostly left exposed, intended as "open healing" for second intention wound healing.

The patient swill assume antibiotics per 6 days (Amoxicillin + Clavulanate 1gr), and will rinse with Digluconate Chlorhexidine 0.20% per 14 days. At day 14 the sutures will be removed. If, at this moment, the gingiva over the graft will not be completely closed, the patient will use Digluconate Chlorhexidine 0.20% until the secondary closure will be completed.

MEASUREMENTS:

The end of the study will be fixed at the 6 months evaluation after tooth extraction (corresponding to the planned time for implant installation).

Impression will be taken before tooth extraction and after 6 months in order to create cast models. On the cast models, using reference PVC guides, the horizontal dimension of the soft tissues (measured perpendicular to the tangent of the dental arch at the midpoint of the extraction site as the distance between the most prominent points buccally and orally) will be measured. One measurement per tooth will be recorded, at T0 (before extraction) and T2 (after 6 months).

A 3D radiological image, using the CBCT technique, will be obtained at the end of the surgical stage T1 (extraction + bone graft) and after 6 months of healing. Using a diagnostic software, superimposition will be performed in order to measure hard tissue remodelling.

After six months (T6), a a biopsy specimen will be also harvested for that augmented extractions sockets on which an implant installation has been previously planned, with the purpose of an histologic and histomorphometric evaluation (measurement of new bone formation and measurement of remaining BioOss granules). The biopsy will be taken exactly in the area where dental implants will be placed.

Study Type

Interventional

Enrollment (Actual)

20

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Italy
    • TO
      • Torino, TO, Italy, 10129
        • PROED, Institute for Professional Education in Dentistry

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 90 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Healthy adult patients with one or more teeth to be extracted, from premolar to premolar

Exclusion Criteria:

  • Heavy smokers (more than 10 cig per day)
  • Current Pregnant patients
  • History of malignancy
  • History of radiotherapy or chemiotherapy in the past 5 years
  • Long term steroidal or antibiotic therapy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: BBM+collagen
Ridge Augmentation After tooth extraction, edentulous sockets will be filled with BioOss Collagen and covered with Bio-Gide
Procedure: Ridge Augmentation
After tooth extraction, the sockets will be filled with bovine bone mineral and covered with a porcine collagen membrane
Active Comparator: BBM granules
Ridge Augmentation After tooth extraction, edentulous sockets will be filled with Bio-Oss Granules, 0-25-1 mm, and covered with Bio-Gide
Procedure: Ridge Augmentation
After tooth extraction, the sockets will be filled with bovine bone mineral and covered with a porcine collagen membrane

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Clinical horizontal width
Time Frame: 6 months after tooth extraction
On the cast models, using reference PVC stants, the horizontal dimension of the soft tissues (measured perpendicular to the tangent of the dental arch at the midpoint of the extraction site as the distance between the most prominent points buccally and orally) will be measured.
6 months after tooth extraction

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Radiological horizontal width
Time Frame: 6 months after tooth extraction
A 3D radiological image, using the CBCT technique, will be obtained at the end of the surgical stage T1 (extraction + bone graft) and after 6 months of healing. Using a diagnostic software, superimposition will be performed in order to measure hard tissue remodelling.
6 months after tooth extraction

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Proed, Torino, Italy

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

February 1, 2013

Primary Completion (Actual)

December 1, 2014

Study Completion (Actual)

December 1, 2014

Study Registration Dates

First Submitted

February 25, 2013

First Submitted That Met QC Criteria

February 26, 2013

First Posted (Estimate)

February 27, 2013

Study Record Updates

Last Update Posted (Estimate)

September 2, 2016

Last Update Submitted That Met QC Criteria

September 1, 2016

Last Verified

September 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 01.2013.POST-EXT.PROED

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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