Volumetric Efficacy of Alveolar Ridge Preservation (ARP)
Comparative Efficacy of Three Alveolar Ridge Preservation Techniques for Volumetric Tissue Maintenance Following Tooth Extraction
The goal of this clinical trial is to compare the effectiveness of four post-extraction socket management approaches in preserving alveolar ridge dimensions following tooth extraction in adults requiring implant-supported rehabilitation in posterior regions.
The main questions it aims to answer are:
- Which treatment approach provides the greatest preservation of hard- and soft-tissue dimensions 12 weeks after tooth extraction?
- Does the use of a dense polytetrafluoroethylene (d-PTFE) membrane improve alveolar ridge preservation compared with approaches that do not use a membrane?
- Are there differences among the treatment groups regarding postoperative healing, complications, pain, and bone regeneration?
Researchers will compare spontaneous socket healing, autologous blood clot with d-PTFE membrane, autologous blood clot with leukocyte- and platelet-rich fibrin (L-PRF), and autologous blood clot with L-PRF plus d-PTFE membrane to determine which approach provides the best preservation of alveolar ridge dimensions and tissue healing.
Participants will:
- Undergo tooth extraction and be randomly assigned to one of four treatment groups.
- Receive clinical examinations, intraoral scans, photographs, and cone-beam computed tomography (CBCT) imaging at scheduled follow-up visits.
- Complete assessments of postoperative pain and oral health-related quality of life.
- Undergo implant placement 12 weeks after tooth extraction, including collection of a bone biopsy for histomorphometric analysis.
- Attend follow-up visits to evaluate peri-implant tissue health, marginal bone stability, and implant success up to 24 months after implant loading.
Visão geral do estudo
Status
Condições
Descrição detalhada
Alveolar ridge dimensional changes following tooth extraction are a well-documented biological phenomenon that may compromise future implant placement and prosthetic rehabilitation. These alterations are primarily associated with physiological bone modeling and remodeling processes, particularly affecting the buccal bone plate, which is often thin and highly susceptible to post-extraction resorption.
Alveolar ridge preservation (ARP) procedures have been developed to reduce post-extraction hard- and soft-tissue volume loss. Numerous techniques have been described, including the use of barrier membranes, platelet concentrates, and grafting materials. However, substantial controversy remains regarding the necessity of membrane utilization, the role of leukocyte- and platelet-rich fibrin (L-PRF), and the optimal approach for maintaining alveolar ridge dimensions while minimizing treatment complexity and costs.
Dense polytetrafluoroethylene (d-PTFE) membranes have been proposed as an effective barrier for preserving extraction socket architecture, whereas L-PRF has been suggested to enhance soft-tissue healing and tissue regeneration through the release of autologous growth factors. Despite the widespread clinical use of both approaches, evidence comparing these treatment strategies remains limited.
This randomized controlled clinical trial aims to compare four post-extraction socket management protocols: spontaneous healing, autologous blood clot combined with a d-PTFE membrane, autologous blood clot combined with L-PRF, and autologous blood clot combined with both L-PRF and a d-PTFE membrane. The study will evaluate their effects on hard- and soft-tissue dimensional preservation, clinical healing, postoperative outcomes, histomorphometric bone formation, patient-reported quality of life, and long-term implant-related outcomes.
The findings of this study are expected to contribute to the development of evidence-based protocols for alveolar ridge preservation and to improve clinical decision-making in implant dentistry.
Tipo de estudo
Inscrição (Estimado)
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
- Nome: Claudio M Claudio Miranda, DDS, Director
- Número de telefone: +56 (2) 2327 9110
- E-mail: clmirandacar@gmail.com
Estude backup de contato
- Nome: Dusan M Dusan Marinkovic, DDS
- Número de telefone: +56 (2) 2327 5256
- E-mail: dusan.marinkovic@udd.cl
Locais de estudo
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Santiago Metropolitan
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Santiago, Santiago Metropolitan, Chile, 7610315
- Recrutamento
- Universidad del Desarrollo (UDD)
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Contato:
- Claudio m Claudio miranda, dds
- Número de telefone: +56 (2) 2327 9110
- E-mail: clmirandacar@gmail.com
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Contato:
- Dusan M Marinkovic, DDS
- Número de telefone: +56 (2) 2327 9110
- E-mail: dusan.marinkovic@udd.cl
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Investigador principal:
- Claudio M Miranda, DDS
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Subinvestigador:
- Francisca c Collao, DDS
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Subinvestigador:
- Dusan M Marinkovic, DDS
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
Inclusion Criteria:
- Adults aged 18 years or older.
- Requirement for tooth extraction with the possibility of subsequent implant-supported rehabilitation in the maxillary or mandibular premolar or molar regions.
- Extraction sockets classified as Class I to Class Va according to the modified Cardaropoli classification.
- American Society of Anesthesiologists (ASA) Physical Status I or II.
- Ability to understand the study procedures and provide written informed consent.
Exclusion Criteria:
- Current treatment with bisphosphonates or systemic corticosteroids.
- History of head and neck radiotherapy.
- Metabolic bone disorders.
- Teeth presenting with acute infectious pathology at the time of extraction.
- Pregnancy or breastfeeding.
- Inability or unwillingness to attend scheduled follow-up visits.
- Any medical or psychological condition that, in the opinion of the investigators, could interfere with study participation or data interpretation.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Comparador Ativo: Spontaneous Healing
Following atraumatic tooth extraction, the socket is left to heal spontaneously without the use of alveolar ridge preservation materials or barrier membranes.
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Following atraumatic tooth extraction, the extraction socket is left to heal naturally without the use of alveolar ridge preservation materials, grafting biomaterials, platelet concentrates, or barrier membranes.
Healing occurs through spontaneous blood clot formation and physiological post-extraction tissue repair.
Outros nomes:
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Experimental: Arm 2: Blood Clot + d-PTFE Membrane
Following atraumatic tooth extraction, the socket is allowed to fill with an autologous blood clot and is covered with a dense polytetrafluoroethylene (d-PTFE) membrane to promote alveolar ridge preservation.
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Following atraumatic tooth extraction, the socket is allowed to fill with an autologous blood clot and is covered with a dense polytetrafluoroethylene (d-PTFE) membrane to protect the socket and support alveolar ridge preservation during healing
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Experimental: Arm 3: Blood Clot + L-PRF
Following atraumatic tooth extraction, the socket is treated with autologous leukocyte- and platelet-rich fibrin (L-PRF) in combination with the natural blood clot to support tissue healing and alveolar ridge preservation.
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Following atraumatic tooth extraction, the socket is allowed to fill with an autologous blood clot and is covered with a dense polytetrafluoroethylene (d-PTFE) membrane to protect the socket and support alveolar ridge preservation during healing
Autologous leukocyte- and platelet-rich fibrin (L-PRF) prepared from the participant's peripheral blood and placed within the extraction socket to promote tissue healing and support alveolar ridge preservation through the sustained release of growth factors.
Outros nomes:
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Experimental: Blood Clot + L-PRF + d-PTFE Membrane
Following atraumatic tooth extraction, the socket is treated with autologous leukocyte- and platelet-rich fibrin (L-PRF) and covered with a dense polytetrafluoroethylene (d-PTFE) membrane to enhance tissue healing and alveolar ridge preservation.
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Autologous leukocyte- and platelet-rich fibrin (L-PRF) prepared from the participant's peripheral blood and placed within the extraction socket to promote tissue healing and support alveolar ridge preservation through the sustained release of growth factors.
Outros nomes:
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Change in Alveolar Ridge Dimensions
Prazo: 12 weeks after tooth extraction
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Change in hard- and soft-tissue dimensions of the extraction site between baseline (T1) and 12 weeks after tooth extraction (T3), assessed through three-dimensional volumetric analysis using superimposed CBCT and intraoral scan datasets.
Hard-tissue measurements include horizontal ridge width at 1, 3, and 5 mm apical to the alveolar crest (HW-1, HW-3, HW-5), buccal plate width, and socket depth.
Soft-tissue measurements include tissue thickness at 1, 3, and 5 mm apical to the alveolar crest (TH-1, TH-3, TH-5) and total occlusal soft-tissue height.
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12 weeks after tooth extraction
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Histomorphometric Bone Formation
Prazo: 12 weeks after tooth extraction
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Percentage of newly formed bone, residual biomaterial, and connective tissue/marrow spaces measured in bone biopsy specimens obtained during implant placement.
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12 weeks after tooth extraction
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Postoperative Pain
Prazo: 21 days after tooth extraction
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Patient-reported postoperative pain assessed using a 100-mm Visual Analogue Scale (VAS).
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21 days after tooth extraction
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Postoperative Complications
Prazo: Up to 12 weeks after tooth extraction
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Frequency and severity of soft-tissue dehiscence, membrane exposure or displacement, localized infection, and uncontrolled acute pain.
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Up to 12 weeks after tooth extraction
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Keratinized Tissue Width
Prazo: Baseline to 12 weeks after tooth extraction
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Change in the width of keratinized tissue measured clinically in millimeters.
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Baseline to 12 weeks after tooth extraction
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Oral Health-Related Quality of Life
Prazo: Baseline to 24-28 weeks after tooth extraction
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Change in Oral Health Impact Profile (OHIP-14) scores between baseline and definitive implant-supported restoration.
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Baseline to 24-28 weeks after tooth extraction
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Bleeding on probing
Prazo: 12 and 24 months after implant loading
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Percentage of peri-implant sites presenting bleeding on probing.
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12 and 24 months after implant loading
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Peri-implant probing depth
Prazo: 12 and 24 months after implant loading
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Mean peri-implant probing depth measured in millimeters using a calibrated periodontal probe.
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12 and 24 months after implant loading
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Radiographic marginal bone level
Prazo: 12 and 24 months after implant loading
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Mean marginal bone level measured radiographically in millimeters around implants.
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12 and 24 months after implant loading
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Diretor de estudo: Francisca c Collao, DDS, Universidad del Desarrollo
- Investigador principal: Claudio M Miranda, dds, Universidad del Desarrollo
- Cadeira de estudo: Dusan M Marinkovic, DDS, Universidad del Desarrollo
Publicações e links úteis
Publicações Gerais
- Marinkovic D, Collao F, Tello C, Miranda C, et al. (2025) Alveolar Ridge Preservation Using Clot and Dense Polytetrafluoroethylene Membrane (PTFE-d): A Novel Surgical Protocol and Clinical Case Report. Int J Oral Dent Health 11:173 doi.org/110.23937/2469-5734/1510173
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Estimado)
Conclusão Primária (Estimado)
Conclusão do estudo (Estimado)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Doenças Periodontais
- Doenças bucais
- Doenças estomatognáticas
- Doenças de dente
- Perda de dente
- Técnicas de investigação
- Técnicas de laboratório clínico
- Técnicas e procedimentos de diagnóstico
- Diagnóstico
- Contagem de células
- Técnicas citológicas
- Testes hematológicos
- Fenômenos fisiológicos celulares
- Fenômenos fisiológicos do sangue
- Fenômenos fisiológicos circulatórios e respiratórios
- Contagem de células sanguíneas
- Contagem de leucócitos
Outros números de identificação do estudo
- 2025-115
- IDREF Research Grants (Número de outro subsídio/financiamento: International Congress of Oral Implantologists)
Plano para dados de participantes individuais (IPD)
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