- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05844540
L- Shape Symphyseal Autogenous Bone Block for Alveolar Ridge Augmentation in Anterior Maxilla and Mandible
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
A total of 11 partially edentulous patients needing extensive horizontal and vertical bone augmentation in the anterior maxilla or mandible were included in this study. The patients were recruited from the Outpatient Clinic of Oral and Maxillofacial Department, Faculty of Dentistry, Mansoura University.
Before the surgical operation, all patients were informed about the treatment options, the nature of the operation, and the probable postoperative sequelae. An informed consent was signed from each patient.
Preoperative assessment
- Patients' medical status were carefully evaluated.
- A thorough intraoral examination was done to evaluate oral hygiene, occlusion, and mucosa that covers the recipient and donor sites.
- Preoperative CBCT was done for each patient to evaluate bone width and height in both the recipient and donor sites.
Surgical procedures Prophylactic antibiotic 600 mg Clindamycin (Clindam, Sigma, Egypt) was administered 1 hour before surgery. A thorough mouth rinsing using Chlorhexidine mouth wash (Hexitol, Adco, Egypt) for about 1 min was done immediately before surgery.
Harvesting procedure of the symphysis bone block:
Under local anesthesia, a sulcular incision was performed between lower right and left second premolars with an oblique incision distal to each one. After that, a full thickness mucoperiosteal flap was elevated to expose the anterior mandible including the entire symphysis and both mental nerves. By using piezo-surgery unit, a rectangular bone block was harvested from the symphysis about 8mm in depth and 2mm wider than the recipient site to allow for contouring. The bone cuts were performed 5mm far from the apices of the anterior teeth, mental foramina, and inferior border of the mandible. Finally, thin curved osteotomes was used to detach the bone blocks. The harvested bone block was trimmed to form L-shape block and kept in normal saline. After hemostasis, the flap was closed with 4/0 vicryl interrupted sutures.
Recipient site preparation:
At the maxillary recipient site, after induction of local anesthesia, a mid-crestal incision that continued in the sulcus for two teeth on either side of the defect with bilateral oblique incisions were performed. After that, the full thickness mucoperiosteal flap was elevated. While for mandibular recipient site, it was the same flap used for harvesting symphyseal bone block. For both upper or lower recipient sites, perforations (bone marrow penetration) were done to the recipient site by using a fissure surgical bur. The L-shape block graft was trimmed to obtain optimal adaptation to the recipient site, then it was fixed to the residual ridge with two 1.5mm self-tapping titanium screws. After attaining graft stability, any sharp edges were smoothed and any gap between the graft and underlying alveolar bone was filled with particulate bone curetted from the donner site. Finally, the flap was relaxed by periosteal incisions and blunt muscle dissection from the anterior maxilla or mandible to obtain a primary tension free closure using 4/0 vicryl interrupted and horizontal mattress sutures.
Postsurgical instructions:
Patients were instructed to avoid any wound trauma, and apply ice packs on the host and recipient surgical sites 20min/ hour for the first day after surgery. Proper oral hygiene should be maintained by mouth rinsing with chlorhexidine mouth wash 3times/ day for 1 week. Diclofenac potassium 50mg (Cataflam, Novartis, Switzerland) anti-inflammatory analgesic was prescribed as needed. Clindamycin 300mg twice daily was prescribed for 7days.
Implant insertion:
After 6months, the surgical site was opened to remove fixation screws and insert dental implants, and the final restoration was done 4months after implant insertion.
Evaluation: the patients were scheduled at 3days, 14days, 3months, and 6months postoperatively to evaluate:
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Eldakahlia
-
Mansoura, Eldakahlia, Egypt, 35516
- Faculty of Dentistry, Mansoura University
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Missed one or more upper or lower anterior teeth.
- alveolar ridge with horizontal and vertical bone loss (class III according to Seibert et al(1983) classification).
- age 18 to 45 years.
- healthy oral mucosa, at least 3 mm keratinized mucosa.
- no systemic diseases or drugs that affect bone healing.
- no systemic or local conditions that contraindicate bone grafting or surgery.
Exclusion Criteria:
- Patients with disturbed occlusion, inadequate inter-arch space.
- patients with parafunction habits as bruxism or clenching.
- pregnancy.
- smokers.
- poor oral hygiene.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: harvesting and augmentation of bone block
autogenous bone block was harvested from the symphysis, trimmed to L-shape and used to augment the anterior maxilla or mandible horizontally and vertically.
|
Under local anesthesia, a sulcular incision was performed between lower right and left second premolars with an oblique incision distal to each one.
After that, a full thickness mucoperiosteal flap was elevated to expose the anterior mandible including the entire symphysis and both mental nerves.
By using piezo-surgery unit (Surgic Touch, Woodpecker, China), a rectangular bone block was harvested from the symphysis about 8mm in depth and 2mm wider than the recipient site to allow for contouring.
The bone cuts were performed 5mm far from the apices of the anterior teeth, mental foramina, and inferior border of the mandible.
Finally, thin curved osteotomes was used to detach the bone blocks.
The harvested bone block was trimmed to form L-shape block and kept in normal saline.
After hemostasis, the flap was closed with 4/0 vicryl interrupted sutures.
Other Names:
At the maxillary recipient site, after induction of local anesthesia, a mid-crestal incision that continued in the sulcus for two teeth on either side of the defect with bilateral oblique incisions were performed.
After that, the full thickness mucoperiosteal flap was elevated.
While for mandibular recipient site, it was the same flap used for harvesting symphyseal bone block.
For both upper or lower recipient sites, perforations (bone marrow penetration) were done to the recipient site by using a fissure surgical bur.
The L-shape block graft was trimmed to obtain optimal adaptation to the recipient site, then it was fixed to the residual ridge with two 1.5mm self-tapping titanium screws.
After attaining graft stability, any sharp edges were smoothed and any gap between the graft and underlying alveolar bone was filled with particulate bone curetted from the donner site.
Implant insertion: After 6months, the surgical site was opened to remove fixation screws and insert dental implants, and the final restoration was done 4months after implant insertion. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
numerical rating scale for pain measurement
Time Frame: 3 days post-surgery
|
Pain intensity was measured at three days after surgery on a 0 to 10 numerical rating scale in which 0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, 7-9 = severe pain, and 10 = the worst pain imaginable.
|
3 days post-surgery
|
infection and dehiscence of soft tissue
Time Frame: with in 6 months
|
This was determined clinically by presence=1 or absence=0, of pus formation or graftb exposure.
|
with in 6 months
|
questionnaire for sensory disturbance
Time Frame: with in 6 months
|
This was assessed by patients' complaint (patient questionnaire) to determine any change in subjective sensation in the lower lip, chin and mental area.
if there is pain or not.
if there is numbness or not.
|
with in 6 months
|
width of the alveolar ridge
Time Frame: immediate post-operative and after 6 months
|
CBCT cross section view was used for evaluation of alveolar ridge width and preoperatively, immediate postoperative (within one week after grafting), and at 6 months after grafting.
|
immediate post-operative and after 6 months
|
height of the alveolar ridge
Time Frame: immediate post-operative and after 6 months
|
CBCT cross section view was used for evaluation of alveolar height preoperatively, immediate postoperative (within one week after grafting), and at 6 months after grafting.
|
immediate post-operative and after 6 months
|
Collaborators and Investigators
Sponsor
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 (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- A015010222
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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 Atrophic Anterior Alveolar Ridge
-
Mansoura UniversityCompletedAlveolar Ridge AugmentationEgypt
-
Cairo UniversityNot yet recruitingSocket Preservation, Alveolar Ridge Deficiency, Alveolar Ridge Preservation
-
University of Alabama at BirminghamCompletedAlveolar Ridge Preservation | Alveolar Ridge AugmentationUnited States
-
Cairo UniversityUnknownAtrophy of Edentulous Maxillary Alveolar RidgeEgypt
-
Cairo UniversityNot yet recruitingAlveolar Ridge PreservationEgypt
-
Hams Hamed AbdelrahmanActive, not recruiting
-
Orton Orthopaedic HospitalTampere University; Biomendex Oy; Oral Hammaslääkärit Oy, Qmedical Pikku HuopalahtiTerminated
-
University of BernCompletedAlveolar Ridge AugmentationSwitzerland
-
University of KentuckyCompleted
-
Ugur GULSENCompletedAlveolar Ridge Augmentation
Clinical Trials on harvesting bone block
-
Second Affiliated Hospital, School of Medicine,...West China Hospital; Tongji Hospital; Werner Wicker KlinikRecruiting
-
Jordanian Royal Medical ServicesThe Ministry of Higher Education and Scientific Research, JordanRecruiting
-
Marmara UniversityCompleted
-
Cairo UniversityNot yet recruitingMaxillary Sinus Floor Elevation
-
University of MilanCompletedGingival Recession | Palate; WoundItaly
-
Medical University InnsbruckRecruitingCoronary Artery DiseaseAustria, Germany, Switzerland
-
Boston Scientific CorporationHerzzentrum DresdenTerminatedCoronary Artery DiseaseGermany
-
UPECLIN HC FM Botucatu UnespFaculdade de Medicina do ABC; IEP São Lucas - Instituto de Ensino e Pesquisa; Hemocentro São Lucas and other collaboratorsUnknownChronic Obstructive Pulmonary Disease (COPD)Brazil
-
Meshalkin Research Institute of Pathology of CirculationCompletedAutovenous Conduit for Coronary Artery Bypass Grafting
-
Kerckhoff KlinikCompletedCABG Graft IntegrityGermany