Single Tooth Extraction in Damaged Alveoli and Implant Site Development:TootToo

Single Tooth Extraction in Damaged Alveoli and Implant Site Development Randomized Controlled Clinical Trial Comparing Socket Preservation and Reconstruction Surgery to Spontaneous Healing

It is unclear what is the best approach to implant site development after tooth extraction when the pathology leading to extraction has damaged the alveolus. The main objective of this study is to assess if socket preservation and/or reconstruction surgery provides a clinical benefit in terms of ability to place an implant in a prosthetically guided position in such clinical conditions.

The PICO question therefore is:

In patients requiring single tooth extraction what is the benefit of socket preservation/reconstruction surgery with respect to spontaneous healing in terms of feasibility and ease of implant surgery?

Study Overview

• Status: Completed
• Conditions: Tooth Extraction Status Nos
• Intervention / Treatment: Procedure: Tooth extraction; Procedure: Tooth extraction and socket seal with connective tissue graft; Procedure: Tooth extraction and socket seal with BRG and connective tissue graft and; Procedure: Tooth extraction and socket seal with membrane placement, BRG and connective tissue graft

Detailed Description

This will be a parallel group, standard of care-controlled, assessor-blind, randomized, multicenter, clinical trial.

The statistical design will be a superiority trial in terms of the primary outcome with reference to the standard of care control (spontaneous healing).

Primary outcome:

Possibility to place an implant in a prosthetically driven position with or without bone or soft tissue augmentation 16-20 weeks after tooth extraction, evaluated at planning with cone beam CT and confirmed at surgery.

• Study Type: Interventional
• Enrollment (Actual): 160
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Systemically healthy. No contraindications to elective oral surgery
• All pathologies requiring single tooth extraction with adjacent teeth (or implant) with the presence of at least one third of the alveolus.
• Evidence of subject ability to achieve good oral hygiene and control gingivitis in the whole of the dentition (FMPS<25% and FMBS<25%)
• Ability to understand study procedures and to comply with them for the entire length of the study. Ability and willingness to give informed consent.

Exclusion Criteria:

• Presence of frank purulence or acute abscess at the time of extraction
• Presence of bone resorption of one or more walls of the alveolus extending to the apical third of the socket
• Self reported current smoking exceeding 20 cigarettes/day or pipe or cigar smoking
• Presence of medical contraindications to elective surgery

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Standard of care control; Tooth extraction and spontaneous healing	Procedure: Tooth extraction; Atraumatic tooth extraction without flap elevation
Experimental: Socket seal with CT graft; Tooth extraction and socket sealing with autologous connective tissue graft	Procedure: Tooth extraction; Atraumatic tooth extraction without flap elevation; Procedure: Tooth extraction and socket seal with connective tissue graft; Atraumatic tooth extraction without flap elevation and seal of the alveolar socket with connective tissue graft (microsurgery)
Experimental: Socket seal with CT graft and bone replacement graft; Tooth extraction and socket sealing with autologous connective tissue graft and positioning of bone replacement graft in coronal portion of the socket	Procedure: Tooth extraction; Atraumatic tooth extraction without flap elevation; Procedure: Tooth extraction and socket seal with connective tissue graft; Atraumatic tooth extraction without flap elevation and seal of the alveolar socket with connective tissue graft (microsurgery); Procedure: Tooth extraction and socket seal with BRG and connective tissue graft and; Atraumatic tooth extraction without flap elevation, position of a bone replacement graft into the socket and seal of the alveolar socket with connective tissue graft (microsurgery)
Experimental: Tooth extraction and socket sealing and BRG with membrane; Tooth extraction and socket sealing with autologous connective tissue graft and positioning of bone replacement graft in coronal portion of the socket and positioning of collagen membrane	Procedure: Tooth extraction; Atraumatic tooth extraction without flap elevation; Procedure: Tooth extraction and socket seal with connective tissue graft; Atraumatic tooth extraction without flap elevation and seal of the alveolar socket with connective tissue graft (microsurgery); Procedure: Tooth extraction and socket seal with BRG and connective tissue graft and; Atraumatic tooth extraction without flap elevation, position of a bone replacement graft into the socket and seal of the alveolar socket with connective tissue graft (microsurgery); Procedure: Tooth extraction and socket seal with membrane placement, BRG and connective tissue graft; Atraumatic tooth extraction without flap elevation, position of a collagen membrane and bone replacement graft into the socket and seal of the alveolar socket with connective tissue graft (microsurgery)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Possibility to place dental implant	The possibility to place a dental implant in a prosthetically driven position (with or without bone or soft tissue augmentation) 16-20 weeks after tooth extraction will be evaluated with a dedicated planning software using cone beam CT data and and digital scanning according to standard clinical practice	16-20 weeks
Surgeon's confirmation of the ability to place a dental implant	Confirmation during the surgery of the ability to actually insert the implant in a prosthetically driven position with or without the need for soft or hard-tissue augmentation.	16-20 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Vertical change in bone height at the deepest point in the socket	Bone fill of the socket evaluated at the time of dental implant placement as change in the distance between a customized surgical stent and the bottom of the alveolus using a periodontal probe (difference between baseline and 16-20 week healing)	16-20 weeks
Vertical change in bone height at the buccal bone crest	Bone fill of the socket evaluated at the time of dental implant placement as change in the distance between a customized surgical stent and the bottom of the alveolus using a periodontal probe (difference between baseline and 16-20 week healing)	16-20 weeks
Vertical change in bone height at the crest of adjacent teeth	Harm to bone of adjacent teeth measured by clinical attachment level loss and trans gingival probing.	16-20 weeks
Radiographic bone changes	Bone fill of the socket measured on routine intraoral radiographs	16-20 weeks
Change in keratinized tissue width between baseline and insertion of prosthetic crown	Soft tissue preservation assessed as millimetre of keratinised tissue as measured with a periodontal probe	16-20 weeks
Need for additional bone augmentation at the time of implant placement (and/or implant uncovering, if submerged healing)	Need for additional augmentation assessed by the surgeon during implant placement	16-20 weeks
Wound healing index	Early healing assessed with standardized composite healing index by dentist	1-4 weeks
OHIP-14	Oral health related quality of life standard instrument (questionnaire) - 5 point Likert scale with greater scores indicating better quality of life.	1-2 weeks

Collaborators and Investigators

• Sponsor: The European Research Group on Periodontology (ERGOPerio)
• Collaborators: The University of Hong Kong
• Investigators: Study Director: Pierpaolo Cortellini, MD, Investigator

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2015
• Primary Completion (Actual): September 1, 2017
• Study Completion (Actual): September 1, 2017

Study Registration Dates

• First Submitted: January 11, 2020
• First Submitted That Met QC Criteria: February 8, 2022
• First Posted (Actual): February 10, 2022

Study Record Updates

• Last Update Posted (Actual): April 1, 2022
• Last Update Submitted That Met QC Criteria: March 21, 2022
• Last Verified: March 1, 2022

More Information

Terms related to this study

• Keywords: Dental implant; Alveolar ridge preservation; Tooth extraction
• Other Study ID Numbers: ERGOPerio 15-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data will not be shared

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No