Influence of Timing of Implant Placement on Early Healing Molecular Events

Official title

Influence of Timing of Implant Placement on Early Healing Molecular Events: A Two-centre, Parallel Group, Pilot Study

Overview

Dental implants have been on the market for several years and they are routinely used to replace single/multiple missing teeth with a high success rate. However, there is still a limited number of studies comparing the influence of timing of implant placement on wound healing. In addition, there is no data available on the signaling pathways and the expression of healing biomarkers involved in the early stages of osseointegration after immediate implant placement (IP) or delayed implant placement (DP). The primary objective of this study is to describe changes in the expression of inflammatory, angiogenesis and osseous biomarkers of saliva at 1, 3, 7, 15 and 30 days and of PICF at 3, 7, 15 and 30 days after immediate implant placement (IP) compared with delayed placement (DP).

Detailed description

This is a two-centre prospective, parallel-group pilot study which will consist of 10 to 11 visits over a minimum period of 16 months. The study will take place at the Centre for Oral Clinical Research (COCR), at the Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (main centre), United Kingdom and at the Implant Research Centre, School of Dental Medicine, University of Belgrade, in accordance with local guidelines and procedures/ interventions detailed below.

Interventions

• Other Immediate implant placement and guided bone regeneration (Test)
  In this group, immediately after tooth extraction, a tapered bone level implant (Straumann BLX Implant System, Roxolid, Straumann AG, Basel, Switzerland) will be placed in an ideal prosthetically oriented position to achieve primary stability following the manufacture's guidelines. A prefabricated surgical template based on 3D pre-extraction planning will be used to place the implant. The jumping distance between the implant and the residual buccal bone will be measured and filled with slow reso
• Other Late implant placement and guided bone regeneration (Control)
  A tapered bone level implant (Straumann BLX Implant System, Roxolid, Straumann AG, Basel, Switzerland) will be placed after complete bone healing (4 - 6 months after tooth extraction) in an ideal prosthetically oriented position to achieve primary stability following the manufacture's guidelines. Guided bone regeneration (GBR) will be performed simultaneously with the aim to re-establish the bone contour and treat any fenestration/dehiscence if needed. A bovine osteoconductive graft (Bio-Oss®, G

Primary outcome measures

• Changes in the expression of inflammatory, angiogenesis and osseous biomarkers of PICF and saliva [Time frame: 1, 3, 7, 15 and 30 days after immediate or delayed implant placement]

Secondary outcome measures (12)

• Blood flow changes [Time frame: immediately after, 1, 3, 7, 15 and 30 days after immediate or delayed implant placement]
• Soft tissue volume changes [Time frame: immediately after,1, 3, 7, 15, 30 days and 3 months after immediate or delayed implant placement, at loading and 6 months after implant loading]
• Peri-implant bone level [Time frame: 6 months after implant loading]
• Full mouth plaque score (FMPS) [Time frame: 6 months after implant loading]
• Full mouth bleeding score (FMBS) [Time frame: 6 months after implant loading]
• Probing pocket depth (PPD) [Time frame: 6 months after implant loading]
• Gingival recession (REC) [Time frame: 6 months after implant loading]
• Clinical attachment level (CAL) [Time frame: 6 months after implant loading]
• Suppuration [Time frame: 6 months after implant loading]
• Patient satisfaction at 6 months after loading [Time frame: 6 months after implant loading]
• Changes in the pink esthetic score (PES) [Time frame: 6 months after implant loading]
• Changes in the white esthetic score (WES) [Time frame: 6 months after implant loading]

Eligibility criteria

Inclusion criteria

• Age ≥25 years old
• Good/controlled medical and psychological health
• Good oral hygiene (FMPS≤20%)
• Presence of a tooth in the aesthetic region (from incisor to second premolar) in need of extraction and further oral rehabilitation with a single dental implant.
• For the IP group, the extraction socket should fulfil the following parameters, as described by the 5th ITI consensus \[46\]: intact socket wall; facial bone wall ≥1mm in thickness; no acute infection at the site; availability of bone apical and palatal to the socket to provide primary stability.
• At least one neighbouring natural tooth.
• A functional occlusion with a minimum of four occlusal units (i.e., pairs of occluding posterior teeth).
• Willingness to read and sign a copy of the Informed Consent Form (ICF) after reading the Patient Information Sheet (PIS), and after the nature of the study has been fully explained and potential questions fully answered.

Exclusion criteria

• Any known systemic disease severely affecting bone metabolism (e.g., Cushing's syndrome, Crohn's disease, rheumatoid arthritis, osteoporosis or diabetes type I and uncontrolled diabetes type II).
• Self-reported HIV or viral hepatitis.
• Self-reported alcoholism or chronic drug abuse.
• Smokers (including current smokers or former smokers who had quit for < 3 months); patients reporting use of vape/e-cigarettes will also be excluded.
• Self-reported pregnancy or lactation (this criterion is due to oral tissue changes related to pregnancy and nursing, which can affect interpretation of study results).
• Chronic treatment (i.e., 2 weeks or more) with any medication known to affect oral status or bone metabolism (e.g., bisphosphonates, hormone replacement therapy, immunosuppressants) within 1 month before baseline visit.
• Chronic treatment with anticoagulants (including Aspirin), corticosteroids, immunosuppressants or other medications that may influence blood coagulation/count.
• Antibiotic or anti-inflammatory therapy during the month preceding the baseline exam.
• Untreated caries lesions and untreated/uncontrolled periodontal disease; If patients require periodontal treatment (non-surgical and/or surgical), this will be arranged outside the study protocol and completed prior to enrolment;
• Inadequate keratinized tissue width (<2 mm) in the mid-buccal aspect of the area to be treated in the study.
• Physical handicaps that would interfere with the ability to perform adequate oral hygiene in the area of implant placement.
• Patients requiring maxillary sinus lift surgery before implant placement.
• Self-reported bruxism.
• Patients not willing to receive animal-derived biomaterials for GBR.
• Patients suffering from a known psychological disorder or with limited mental capacity or language skills such that study information could not be understood, informed consent could not be obtained, or simple instructions could not be followed.
• Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with trial participation or may interfere with the interpretation of trial results and, in the judgement of the investigator, would make the subject inappropriate for entry into this trial.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Other

Study locations

United Kingdom · 1 center

• Centre for Oral Clinical Research — London

Identifiers

NCT: NCT06276335 · IRAS:322440

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗