- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05191082
Manufacturing, Characterization and Evaluation of the Effect of Silk Fibroin Membranes, Loaded or Not With Neurotensins on Open Wounds in the Palate
January 12, 2022 updated by: Mauro Pedrine Santamaria, Universidade Estadual Paulista Júlio de Mesquita Filho
Manufacturing, Characterization and Evaluation of the Effect of Silk Fibroin Membranes, Loaded or Not With Neurotensins on Open Wounds in the Palate: Randomized Clinical Study
The aim of the present study will be to manufacture and characterize silk fibroin membranes loaded or not with neurotensin and to evaluate clinical, patient-centered and immunological parameters the effect of using these membranes on open wounds on the human palate.
Study Overview
Status
Recruiting
Conditions
Detailed Description
Surgical procedures for the reconstruction of gingival and peri-Implant tissues with the purpose of restoring function and aesthetics are commonly used in the dental practice.
The use of free gingival graft (FGG), despite being considered the gold standard, causes great morbidity and postoperative pain.
Thus, in order to reduce these complications, some biomaterials have been explored to accelerate healing and bring greater comfort to the patient.
The present study aims to: 1. manufacture silk fibroin membranes (SF), loaded or not with neurotensin (NT); 2. evaluate, clinically and immunologically, the effect of the membranes on open wounds at palate sites.
After the manufacture of the membranes they will be characterized by visual aspect, thickness, mechanical properties, surface texture, water vapor permeability, enzymatic degradation and swelling.
Posteriorly, sixty six (n = 66) patients requiring exodontia and ridge preservation for future implant placement will be randomly assigned into three groups: Control - Free Gingival Graft (n = 22): extraction and Free Gingival Graft for sealing the alveolus entrance; Group SF - Fibroin membrane (n = 22): extraction and Free Gingival Graft for sealing the alveolus entrance and placement of the fibroin membrane at the palatal wound site; Group SF + NT - Free Gingival Graft + Neurotensin-loaded Fibroin Membrane (n = 22): extraction and Free Gingival Graft for sealing the alveolus entrance and placement of neurotensin-loaded fibroin membrane at the palatal wound site.
The repair of the palatine donor area will be evaluated by clinical parameters such as remaining wound area, tissue thickness, re-epithelialization and early-wound healing index at baseline, 7, 14, 21, 30, 45, and 90 days after the procedure; and patient-centered outcomes by post-operative discomfort, tissue edema and number of analgesic pills used for 14 days after the procedure.
In addition, inflammatory cytokines and growth factors will be assessed using the palatal wound inflammatory exudate 3 and 7 days after surgery.
For the descriptive statistics, the mean ± standard deviation will be used; Normality: Shapiro-Wilk test; Clinical trials: ANOVA for intra and inter group calculations + Tukey test for multiple comparisons when the Shapiro-Wilk p value ≥ 0.05.
If p Shapiro-Wilk <0.05, will be analyzed using the Friedman test (intragroup) and Mann-Whitney tests (intergroup); Parameters centered on patients: T test.
Study Type
Interventional
Enrollment (Anticipated)
66
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Mauro P Santamaria
- Phone Number: +55 1239479062
- Email: mauro.santamaria@unesp.br
Study Locations
-
-
Sao Paulo
-
São José Dos Campos, Sao Paulo, Brazil, 12245000
- Recruiting
- Mauro Pedrine Santamaria and Ana Carolina Ferreira Bonafe
-
-
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 65 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patients at least 18 years old, healthy systemically, with good oral hygiene, assessed by means of a plaque index and gingival index less than 25% (O'Leary et al., 1972)
- Patients with no morphological or pathological changes in the donor palatal region;
- Patients who have an indication for extraction and with an indication to preserve the socket for future implant installation;
- The tooth included in the study, as well as the adjacent teeth, must not have loss of periodontal insertion.
Exclusion Criteria:
- Patients with systemic problems (cardiovascular changes, blood dyscrasias, immunodeficiency, diabetes, among others), who contraindicate the surgical procedure;
- Patients who use medications that interfere with wound healing;
- Pregnant or lactating patients;
- Patients who present opportunistic oral lesions, mainly colonizing the palate region;
- Smoking patients;
- Patients undergoing orthodontic treatment;
- Patients already submitted to periodontal surgery in the area of interest in the present study;
- Patients with a history of allergy to any type of material used in the present study.
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: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Sham Comparator: Control Group (CG)
The palatal wound area will not receive any treatment
|
With the goal to harvest the free gingival graft (FGG), an 8mm diameter scalpel will be used to ensure standardized wounds.
Thereafter, a 2-mm thick FGG will be removed.
The wound area will receive 4.0 silk sutures.
|
Experimental: Silk Fibroin Film - SF
The palatal wound area will receive silk fibroin film as a dressing
|
With the goal to harvest the free gingival graft (FGG), an 8mm diameter scalpel will be used to ensure standardized wounds.
Thereafter, a 2-mm thick FGG will be removed.
The wound area will receive 4.0 silk sutures.
With the goal to harvest the free gingival graft (FGG), an 8mm diameter scalpel will be used to ensure standardized wounds.
Thereafter, a 2-mm thick FGG will be removed.
The wound area will receive a silk fibroin film and 4.0 silk sutures.
|
Experimental: Neurotensin-loaded Silk Fibroin Film - SF + NT
The palatal wound area will receive a neurotensin-loaded silk fibroin film as a drug delivery system
|
With the goal to harvest the free gingival graft (FGG), an 8mm diameter scalpel will be used to ensure standardized wounds.
Thereafter, a 2-mm thick FGG will be removed.
The wound area will receive 4.0 silk sutures.
With the goal to harvest the free gingival graft (FGG), an 8mm diameter scalpel will be used to ensure standardized wounds.
Thereafter, a 2-mm thick FGG will be removed.
The wound area will receive a silk fibroin film loaded with neurotensin and 4.0 silk sutures.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in the Remaining Wound Area (RWA)
Time Frame: baseline, 7, 14, 21, 30, 45 and 90 days after surgery
|
For this, standardized photographs will be taken.
As a reference, a scale will be used to measure this area.
These photographs will be exported to image software (Image J - National Institute of Health -NIH, Bethesda, USA), the area of the wound will be measured in square millimeters (Dias et al. 2015)
|
baseline, 7, 14, 21, 30, 45 and 90 days after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Tissue Thickness
Time Frame: baseline, 45 and 90 days after the procedure
|
An endodontic spacer (Dentsply-Maillefer Instruments S.A. - Switzerland) with a rubber cursor will be placed in contact with the area until the palatal bone is reached, without pressing the tissue.
The distance between the tip of the spacer and the cursor will be measured using a digital caliper (Dias et al., 2015).
|
baseline, 45 and 90 days after the procedure
|
Scar and Tissue Colorimetry
Time Frame: 7, 14, 21, 30, 45 and 90 postoperative days
|
The presence or absence of scar or keloid in the operated area will be analyzed.
In addition, the tissue color similarity of regions adjacent to the operated area and postoperative images will be analyzed through photographs.
The photographs will be exported to image software (Adobe Photoshop, München, Germany), using two areas, the wound and one adjacent.
The comparison (ΔE) of the areas will be made using brightness parameters (L), red-green chroma scale and blue-yellow chroma scale (b) according to the following equation (Knösel et al., 2009): ΔE =[(L.wound - L.adjacent)2 + (a.wound - a.adjacent)2 + (b.wound - b.adjacent)2] 1/ 2
|
7, 14, 21, 30, 45 and 90 postoperative days
|
Epithelialization
Time Frame: baseline, 3, 7, 14 and 30 days after the procedure
|
The wound will be colored with Shirley's solution and the epithelialized area will be quantified in the Image J. program.
Then, with the total wound area, the % epithelialization will be calculated (Ozcelik et al., 2008).
|
baseline, 3, 7, 14 and 30 days after the procedure
|
Early wound healing index
Time Frame: 7 and 14 days after surgery
|
Any changes in wound healing will be evaluated, with five different degrees:
|
7 and 14 days after surgery
|
Tissue edema
Time Frame: 7 days after the surgical procedure
|
It will be evaluated with the score: 1 = absent; 2 = slight; 3 = moderate; or 4 = severe (Sanz-Moliner et al. 2013).
|
7 days after the surgical procedure
|
Postoperative discomfort
Time Frame: 7, 14, 21, 30, 45 and 90 days after the surgical procedure
|
Sensitivity will be measured by air spray for 5 s over the palatal region.
After the air spray, patients will be required to use a 100 mm visual analog scale (VAS) to assess discomfort, where the extremes of the scale will be "none" and "extreme" to report the discomfort of this measure (Dias et al. 2015)
|
7, 14, 21, 30, 45 and 90 days after the surgical procedure
|
Number of analgesics
Time Frame: until 14 days after surgery
|
Patients will be given a postoperative diary in which they will note their pain intensity on a visual analog scale (VAS) 100 mm and the number of painkillers used (Tonetti et.
al 2017).
|
until 14 days after surgery
|
Immunologic Analysis - cytokines
Time Frame: 3 and 7 days after surgery
|
The inflammatory exudate present in the palate open wound region will be collected.
Samples will be obtained by placing strips of filter paper for 40 s (PerioPaper, Oraflow, New York, USA) in contact with the open wound.
After the volume measurements (Periotron 8000, Oraflow, New York, USA), the strips will be placed in sterile tubes containing 300 ml of phosphate buffered saline (PBS) with 0.05% Tween-2 and stored immediately at -80 ° C. Strips contaminated with visible blood will be discarded.
The following cytokines will be evaluated: Interleukin-1β (IL1β), Interleukin-4 (IL4), Interleukin-5 (IL5), Interleukin-6 (IL6), Interleukin-9 (IL9), Interleukin-10 (IL10), Interleukin-17A (IL17A), and tumor necrosis factor alpha (TNFα).
|
3 and 7 days after surgery
|
Immunologic Analysis - growth factors
Time Frame: 3 and 7 days after surgery
|
The inflammatory exudate present in the palate open wound region will be collected.
Samples will be obtained by placing strips of filter paper for 40 s (PerioPaper, Oraflow, New York, USA) in contact with the open wound.
After the volume measurements (Periotron 8000, Oraflow, New York, USA), the strips will be placed in sterile tubes containing 300 ml of phosphate buffered saline (PBS) with 0.05% Tween-2 and stored immediately at -80 ° C. Strips contaminated with visible blood will be discarded.
The following growth factors will be evaluated: Epidermal growth factor (EGF), Transforming growth factor beta (TGF-β), Platelet-derived growth factor (PDGF), Fibroblast growth factors (FGF), and Vascular endothelial growth factor (VEGF).
|
3 and 7 days after surgery
|
Immunologic Analysis - matrix metalloproteinases
Time Frame: 3 and 7 days after surgery
|
The inflammatory exudate present in the palate open wound region will be collected.
Samples will be obtained by placing strips of filter paper for 40 s (PerioPaper, Oraflow, New York, USA) in contact with the open wound.
After the volume measurements (Periotron 8000, Oraflow, New York, USA), the strips will be placed in sterile tubes containing 300 ml of phosphate buffered saline (PBS) with 0.05% Tween-2 and stored immediately at -80 ° C. Strips contaminated with visible blood will be discarded.
The following Matrix metalloproteinases will be evaluated: matrix metalloproteinase 9 (MMP-9), matrix metalloproteinase 2 (MMP-2), and Tissue inhibitors of metalloproteinases 1 and 2 (TIMP-1/TIMP-2).
|
3 and 7 days after surgery
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Study Director: Mauro P Santamaria, Sao Paulo States University - Brazil
- Principal Investigator: Ana Carolina F Bonafe, Sao Paulo States University - Brazil
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Kamalathevan P, Ooi PS, Loo YL. Silk-Based Biomaterials in Cutaneous Wound Healing: A Systematic Review. Adv Skin Wound Care. 2018 Dec;31(12):565-573. doi: 10.1097/01.ASW.0000546233.35130.a9.
- Dias SB, Fonseca MV, Dos Santos NC, Mathias IF, Martinho FC, Junior MS, Jardini MA, Santamaria MP. Effect of GaAIAs low-level laser therapy on the healing of human palate mucosa after connective tissue graft harvesting: randomized clinical trial. Lasers Med Sci. 2015 Aug;30(6):1695-702. doi: 10.1007/s10103-014-1685-2. Epub 2014 Nov 6.
- Zheng Z, Liu Y, Huang W, Mo Y, Lan Y, Guo R, Cheng B. Neurotensin-loaded PLGA/CNC composite nanofiber membranes accelerate diabetic wound healing. Artif Cells Nanomed Biotechnol. 2018;46(sup2):493-501. doi: 10.1080/21691401.2018.1460372. Epub 2018 Apr 13.
- Pereira da Silva L, Miguel Neves B, Moura L, Cruz MT, Carvalho E. Neurotensin decreases the proinflammatory status of human skin fibroblasts and increases epidermal growth factor expression. Int J Inflam. 2014;2014:248240. doi: 10.1155/2014/248240. Epub 2014 Aug 11.
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 (Actual)
September 1, 2020
Primary Completion (Anticipated)
June 21, 2022
Study Completion (Anticipated)
July 1, 2022
Study Registration Dates
First Submitted
December 23, 2021
First Submitted That Met QC Criteria
January 12, 2022
First Posted (Actual)
January 13, 2022
Study Record Updates
Last Update Posted (Actual)
January 13, 2022
Last Update Submitted That Met QC Criteria
January 12, 2022
Last Verified
January 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- UEPJMF 12
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
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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