- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05753917
Piezo-surgery Versus Conventional Drills
Histomorphometric and Immunohistochemical Evaluation of Bone Healing Around Implants Placed Using Piezosurgery Versus Conventional Drills: a Split Mouth Randomized Clinical Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This was a pilot, parallel-group, doble-blinded, split-mouth, randomized clinical trial.
The study included six patients with bilateral partial edentulism, having in total 12 maxillary or mandibular edentulous alveolar ridges. All patients had been referred to the Unit of Oral and Maxillofacial Surgery, Alma Mater Studiorum, University of Bologna, Italy.
The alveolar ridges were randomized into two groups using a computer-generated method: Group A included six regions where implant sites were prepared by piezosurgery, and Group B six regions prepared by conventional drilling.
Surgical and prosthetic protocol In Group A, all implant sites were prepared with a piezoelectric device with IM1, IM2, IM2-3, or IM3 piezo-inserts according to the manufacturer's protocol (Piezosurgery, Mectron Medical Technology, Carasco, Italy). One or two implants were placed in each edentulous ridge along with an additional 3.3 x 8.5 mm implant, termed a "study fixture", in an adjacent area. In Group B, all implant sites were prepared with conventional drills according to the manufacturer's protocol (Premium, Sweden & Martina, Due Carrare, Padova, Italy); similarly to group A, one or two implants were placed in each edentulous ridge, and an additional 3.3 x 8.5 mm "study-fixture" was placed in the adjacent area.
After cover screw placement, a parallel periapical radiograph was taken and the flap was sutured with 4-0 Vicryl. After surgery, antibiotic therapy (1 g amoxicillin and clavulanic acid every 8 h for 4 days), analgesic therapy (nimesulid 200 mg/day for 2 days, continued if pain persisted), and antiseptic therapy (chlorhexidine 0.2% [w/v] three times daily), were prescribed.
- Clinical procedure II - Re-entry Surgery At 28 days after surgery (T1), all "study-fixtures" in both groups were explanted using a trephine drill, taking care to explant the fixture with 0.5 mm of circumferential peri-implant bone tissue. The timing of re-entry surgery (T1) was fixed to be 28 days based on a previous animal study 12. All retrieved implants with bone tissue biopsies were fixed in 4% (v/v) formalin prior to histological analysis (Figure 7,8).
- Clinical procedure III - Prosthetic restoration At 3 months after surgery (T2), a mid-crestal horizontal incisions of keratinized tissue, without vertical incisions, was performed to expose the submerged implants and place healing screws. One month later (T3), implant-supported, metal-ceramic fixed restorations were delivered to the patients to allow functional loading.
- Data collection During surgery and at all postoperative visits (T0, T1, T2, and T3), clinical and radiographic data were recorded by a single operator (E.V.). Histological, histomorphometric, and immunohistochemical data were recorded on the same forms after bone biopsy and laboratory analyses (T1).
- Laboratory data
All specimens were fully analyzed in terms of the percentages of necrotic bone area (NBA%) and newly-formed bone area (nFBA%), and the ratios of these values to total bone area (TBA). For each specimen, the authors identified three different areas proceeding from the surface of the fixture toward the border of the biopsy: zone 1, necrotic bone undergoing remodeling; zone 2, woven and newly formed bone; and zone 3, native bone. For each zone, we recorded:
- Absolute and relative areas: Zone areas were expressed as absolute values (mm2) and relative values (%) with respect to the total areas.
- Inflammatory infiltrates: The presence and type of inflammatory infiltrate (if present) was classified; we scored inflammation as absent (no inflammatory cells), minimal (< 5 cells/mm2), or present (> 5 cells/mm2).
- CD31 (a vascular endothelium differentiation and neo-osteogenesis marker): CD31 expression was recorded as the number of positive vessels/mm2
- SATB2 (a osteoblastic cell differentiation and osteogenesis marker): SATB2 expression was recorded as the number of positive spots/mm2.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Criteria: Inclusion Criteria:
- bilateral edentulous sites in mandibles or maxillae that did not require bone regeneration prior to implant placement;
- American Society of Anesthesiologists (ASA) status 1;
- the capacity to understand and accept the conditions of the study;
- continuing participation for at least 1 year of follow-up.
Exclusion Criteria:
- Previous bone augmentation of the sites to be treated;
- poor oral hygiene;
- smoking > 10 cigarettes/day;
- abuse of alcohol or drugs;
- pregnancy;
- acute local or systemic infection;
- uncontrolled diabetes or other metabolic disease;
- severe hepatic or renal dysfunction;
- HIV, HBV, or HCV infection;
- chemotherapy or radiotherapy within the past 5 years;
- current immunosuppressive therapy;
- an autoimmune disorder;
- bisphosphonate therapy
Study Plan
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 |
---|---|
Experimental: Group A
piezoelectric device with IM1, IM2, IM2-3, or IM3 piezo-inserts according to the manufacturer's protocol (Piezosurgery, Mectron Medical Technology, Carasco, Italy).
One or two implants were placed in each edentulous ridge along with an additional 3.3 x 8.5 mm implant, termed a "study fixture", in an adjacent area
|
piezo-surgery: Group A (piezoelectric device with IM1, IM2, IM2-3, or IM3 piezo-inserts according to the manufacturer's protocol (Piezosurgery, Mectron Medical Technology, Carasco, Italy) Conventional drill: Group B (conventional drills according to the manufacturer's protocol (Premium, Sweden & Martina, Due Carrare, Padova, Italy)
|
Active Comparator: Group B
In Group B, all implant sites were prepared with conventional drills according to the manufacturer's protocol (Premium, Sweden & Martina, Due Carrare, Padova, Italy); similarly to group A, one or two implants were placed in each edentulous ridge, and an additional 3.3 x 8.5 mm "study-fixture" was placed in the adjacent area.
|
piezo-surgery: Group A (piezoelectric device with IM1, IM2, IM2-3, or IM3 piezo-inserts according to the manufacturer's protocol (Piezosurgery, Mectron Medical Technology, Carasco, Italy) Conventional drill: Group B (conventional drills according to the manufacturer's protocol (Premium, Sweden & Martina, Due Carrare, Padova, Italy)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Zone 1 (necrotic bone undergoing remodeling)
Time Frame: after 28 days of healing
|
Hystological sections were screened at high magnification (400×), and areas of necrotic bone lacking live osteocytes were automatically outlined with a pointer and photographed using a digital Peltier-cooled camera (Q-color 3; resolution 1,376 x 1,032 pixels; Olympus).
Histological and histomorphometric analyses were performed on the central regions of each sample and Image J software (NIH, Bethesda, MD, USA) was used to determine the presence and type of inflammatory infiltrate, and to quantify morphometric parameters.
Value expressed as percentage
|
after 28 days of healing
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Zone 2 (woven and newly formed bone)
Time Frame: after 28 days of healing
|
Hystological sections were screened at high magnification (400×), and areas of newly formed bone were automatically outlined with a pointer and photographed using a digital Peltier-cooled camera (Q-color 3; resolution 1,376 x 1,032 pixels; Olympus).
Histological and histomorphometric analyses were performed on the central regions of each sample and Image J software (NIH, Bethesda, MD, USA) was used to determine the presence and type of inflammatory infiltrate, and to quantify morphometric parameters.
Value expressed as percentage
|
after 28 days of healing
|
Zone 3 (native bone)
Time Frame: after 28 days of healing
|
Hystological sections were screened at high magnification (400×), and areas of native bone were automatically outlined with a pointer and photographed using a digital Peltier-cooled camera (Q-color 3; resolution 1,376 x 1,032 pixels; Olympus).
Histological and histomorphometric analyses were performed on the central regions of each sample and Image J software (NIH, Bethesda, MD, USA) was used to determine the presence and type of inflammatory infiltrate, and to quantify morphometric parameters.
Value expressed as percentage
|
after 28 days of healing
|
CD31 (marker of vascular endothelium differentiation and neo-osteogenesis)
Time Frame: after 28 days of healing
|
An automated microscope running "dot slide" software (Olympus Europa SE & Co. KG, Hamburg, Germany) was used to scan all CD31 immunostained slides at 10× magnification to obtain VSI (Virtual Slide Image) files, and the numbers of cells positive for CD31 were counted.
CD31 expression was recorded as the number of positive spots/mm2
|
after 28 days of healing
|
SATB2
Time Frame: after 28 days of healing
|
An automated microscope running "dot slide" software (Olympus Europa SE & Co. KG, Hamburg, Germany) was used to scan all SATB2 immunostained slides at 10× magnification to obtain VSI (Virtual Slide Image) files, and the numbers of cells positive for SATB2 were counted.
SATB2 expression was recorded as the number of positive spots/mm2
|
after 28 days of healing
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Alessandro Cucchi, GBR Academy
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 16053
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Contact the authors at the following email addresses:
Alessandro Cucchi: dr.cucchi@hotmail.com Elisabetta Vignudelli: elisabetta.vignudelli@unibo.it
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Bone Formation
-
Medical University of ViennaRecruitingDental Implant | Sinus Elevation | Bone FormationAustria
-
VA Office of Research and DevelopmentRecruitingExercise | Bone Resorption | Bone FormationUnited States
-
Prince of Songkla UniversityRecruitingGuided Bone Regeneration | Bone Formation | Bone VolumeThailand
-
Cairo UniversityRecruitingBone Formation Around Implant After Crestal Sinus LiftingEgypt
-
National Heart, Lung, and Blood Institute (NHLBI)CompletedVascular FormationUnited States
-
Silq Technologies CorporationActive, not recruiting
-
Denver Health and Hospital AuthorityMcNeil Consumer & Specialty Pharmaceuticals, a Division of McNeil-PPC, Inc.Completed
-
Institut National de la Santé Et de la Recherche...Completed
-
Tanta UniversityRecruitingEfficacy of Combined Scaffolds and Sodium Hypochlorite in Regenerative Endodontics of Immature TeethIncomplete Root Formation of Anterior TeethEgypt
-
Michigan State UniversityCompletedWound FormationUnited States
Clinical Trials on Piezo-surgery insert OR Conventional Drills
-
University of BelgradeCompleted
-
City of Hope Medical CenterNational Cancer Institute (NCI)Active, not recruitingProstate CancerUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)Active, not recruitingBreast Cancer | brca1 Mutation Carrier | brca2 Mutation CarrierUnited States
-
University of Maryland, BaltimoreSyndax PharmaceuticalsTerminatedStage I Breast Cancer | Stage II Breast Cancer | Stage IIIA Breast Cancer | Triple-negative Breast Cancer | Estrogen Receptor-negative Breast Cancer | Progesterone Receptor-negative Breast Cancer | HER2-negative Breast CancerUnited States