Sammenligning af dimensionsændringer efter ekstraktion efter kantkonservering ved hjælp af autogene delvist og fuldstændigt demineraliserede dentintransplantater versus autogent heltandstransplantat
Sammenligning af dimensionsændringer efter ekstraktion efter kantkonservering ved brug af autogene delvist og fuldstændigt demineraliserede dentintransplantater versus autogent heltandstransplantat: et randomiseret kontrolleret klinisk forsøg
For alveolar ridge preservation after extraction of a non-restorable maxillary non-molar tooth, will the use of Autogenous partially or completely demineralized dentin grafts result in similar ridge dimensions compared to Autogenous whole-tooth graft?
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
One inevitable consequence of tooth loss is alveolar ridge resorption, which is progressive, irreversible, chronic, and cumulative. For implant placement, adequate dimensions of the alveolar ride housing are essential for proper implant positioning to provide for both implant stability and esthetics. Various procedures have been developed to limit post-extraction dimensional alterations or to restore normal bone dimensions, among which is ridge preservation. Numerous materials have been introduced and compared, nevertheless the best option is yet to be determined. Autogenous bone remains the gold standard for bone grafting, however one cannot ignore its unavoidable drawbacks, with donor site morbidity and the need for additional surgery having the biggest impact, as well as the limited amount that can be harvested and the unpredictable resorption rate. Several other options have been introduced with the aim of overcoming these disadvantages.
promising results have been reported, and the use of autogenous tooth bone graft (ATBG) is gaining popularity, since this material has a structure that closely resembles bone, especially the dentin which is composed of similar inorganic and organic elements, and also has osteoinductive and osteoconductive capacity.
Some studies using mineralized dentin matrix have shown that the material possesses excellent biocompatibility but is less effective than bone derived products in bone formation. On the other hand, several basic animal studies have shown that completely demineralized dentin matrix to be not only biocompatible, but also osteo-inductive, similar to demineralized bone matrix. The degree of demineralization is critical for optimal dentin regeneration; the partially demineralized dentin matrix is thought to have optimal conditions for dentin regeneration. Partial demineralization results in the elimination of the major part of the mineral phase and immunogenic components while retaining a very low fraction of minerals (5-10 wt%), providing an osteoconductive and osteo-inductive scaffold containing several growth factors.
It is agreed upon that nowadays optimizing protocols of demineralization of dentin grafts is necessary for standardization and further studies are required to determine the most suitable conditions of demineralization and particle sizes of dentin grafts for clinical application in implant dentistry. Additionally, more research is required to investigate whether graft preparation in its simplest form is sufficient or whether enhancing the graft with demineralization will result in any clinical significance.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
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-
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Cairo, Egypten
- Cairo University
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Cairo, Egypten
- Faculty of Dentistry, Cairo University
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
Individuals aged 18 years or older with no systemic health conditions
A single non-restorable tooth located in the maxillary esthetic region (between the first premolars)
Presence of a Type I extraction socket
Buccal bone plate remains intact after tooth extraction
Exclusion Criteria:
Any systemic condition known to impair bone healing (e.g., diabetes)
Use of drugs that influence bone metabolism (e.g., bisphosphonates)
Prior treatment with chemotherapy or radiotherapy
Active tobacco users
Presence of untreated periodontal disease
Inadequate oral hygiene, defined as plaque and bleeding scores exceeding 15%
Active endodontic infection at or near the extraction site
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Dobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Eksperimentel: Ridge preservation by filling the socket with autogenous partially demineralized dentin graft
2% HNO3 partial demineralization for 10 minutes |
Socket preservation |
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Eksperimentel: Ridge preservation by filling the socket with autogenous completely demineralized dentin graft
0.6N HCl for 30 minutes for complete demineralization |
Socket preservation |
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Aktiv komparator: Ridge preservation by filling the socket with autogenous whole-tooth graft (AWTG).
After cleaning the tooth, it will be ground using bone mill and AWTG particles will be prepared by immersing tooth particles in basic ethanol for 10 min for disinfection , then washed twice in saline and dried using sterile gauze. |
Socket preservation |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Alveolar ridge width and height changes
Tidsramme: After 4 months from alveolar ridge preservation
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Difference in alveolar ridge width and height linear measurements in millimeters between baseline and final CBCT scans after 4 months |
After 4 months from alveolar ridge preservation
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Histological and Histomorphometric Analysis
Tidsramme: 4 months after alveolar ridge preservation
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Biopsies (n=9) will be collected and analyzed by a blinded pathologist. Tissue sections will be stained (H&E and Masson's Trichrome) to assess bone formation. ImageJ software will be used to quantify the percentage of new bone, residual graft, and soft tissue in standardized regions. Immunohistochemistry will assess expression of osteogenic proteins Osteopontin (OPN) and Dentin Matrix Protein-1 (DMP-1). |
4 months after alveolar ridge preservation
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Primary and Secondary Implant Stability
Tidsramme: Measurements will be performed by a single calibrated and blinded examiner at two timepoints: immediately post-placement (primary stability) and after 2 months (secondary stability).
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Implant stability will be evaluated using resonance frequency analysis (RFA) with the Osstell Beacon device (Osstell AB, Gothenburg, Sweden). A SmartPeg Type 05 will be attached to the implant, and RFA readings will be taken in bucco-palatal and mesio-distal directions with the probe held 2-4 mm from the SmartPeg at a 45° angle. The Implant Stability Quotient (ISQ; scale 0-100) will be recorded, and the mean of both directional values will be used for analysis. |
Measurements will be performed by a single calibrated and blinded examiner at two timepoints: immediately post-placement (primary stability) and after 2 months (secondary stability).
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Patient-reported pain score
Tidsramme: Within the first postoperative week
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Pain intensity will be measured using a 100-mm horizontal visual analogue scale (VAS), with endpoints labeled "No pain" (0) and "Worst imaginable pain" (10). Participants will mark the scale to indicate the maximum pain experienced during the first postoperative week. Pain scores will also be categorized as: No pain (0), Mild (1-3), Moderate (4-6), and Severe (7-10). |
Within the first postoperative week
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
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