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Case Selection and Treatment Protocol for Immediate Dental Implants in the Esthetic Zone

Primary Purpose

Jaw, Edentulous, Partially, Acquired Absence of Single Tooth

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
SLActive implant
Sponsored by
The University of Texas Health Science Center at San Antonio
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Jaw, Edentulous, Partially focused on measuring Dental implants, Esthetic score, Immediate implants, Gingival biotype

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. The patient is 18 years or older.
  2. Ability to understand and provide informed consent before starting the study.
  3. Ability and willingness to comply with all study requirements.
  4. The patient, if of child-bearing potential, has a negative urine pregnancy test.
  5. Adequate oral hygiene to allow for implant therapy consistent with standards of care.
  6. Adequate bone volume to accommodate the planned endosseous dental implant placement according to immediate placement protocols utilizing Straumann Bone Level implants RC (Regular Crossfit) 4.1mm or Bone Level Implant NC (Narrow Crossfit) 3.3 mm at 8, 10,12 or 14mm in length.
  7. One tooth in the anterior maxilla (first pre-molar to first pre-molar) requiring extraction resulting in a single- tooth gap planned to be restored with a dental implant as determined by the patient's dental provider.
  8. The site to be treated is surrounded by two natural teeth.
  9. Except the site to be treated, none of the maxillary incisors, canines and first pre-molars display marginal soft tissue recession.
  10. Following extraction, intact extraction socket bony walls are present.
  11. Primary stability of implant consistent with standards of care is achieved at the time of implant placement.
  12. Patient must be able to pay for fees related to the surgical implant placement related to extraction, grafting of the implant site, and half of the cost of the crown at the time of implant placement.

Exclusion Criteria:

  1. Patient reports tobacco use within the last five years. Tobacco use for this study is defined as a current smoking habit with moderate or heavy smoking (more than 10 cigarettes per day) or tobacco chewing use.
  2. History of alcoholism or drug abuse within the past 5 years.
  3. Severe wear with an etiology of bruxism or clenching habits.
  4. Patient has significant untreated periodontal disease (grade III or IV), caries, or clinical or radiographic signs of infection within two adjacent tooth positions of implant area.
  5. History of HIV infection, Hepatitis B or C.
  6. Patients with a history of systemic disease that precludes standard dental implant therapy or alters daily activities to a level consistent with ASA (American Society of Anesthesiologists) III classification (including cardiovascular, hepatic, renal, gastrointestinal, metabolic, neurologic, pulmonary, endocrine, autoimmune, or psychiatric disorders).
  7. Presence of local inflammation or mucosal diseases such as lichen planus.
  8. Patient history consistent with high risk for subacute bacterial endocarditis.
  9. Current hematological disorder or warfarin (or similar) therapy.
  10. Patient has a disease that affects bone metabolism, such as, but not limited to, osteoporosis, hyperthyroidism, hyperparathyroidism, congenital connective tissue disorders (e.g., osteogenesis imperfecta), or Paget's disease.
  11. Patient is taking medications or having treatments known to have an effect on bone turnover, including: thiazide diuretics, calcitonin, systemic steroids, bisphosphonates, vitamin D (>800 IU/day), estrogen or progesterone therapy.
  12. Current steroid treatment: defined as any person who within the last two years has received for two weeks a dose equivalent to 20 mg hydrocortisone.
  13. Patient currently undergoing chemotherapy.
  14. Patient history of radiation treatment to the head or neck.
  15. Physical or mental handicaps that would interfere with patient's ability to exercise good oral hygiene on a regular basis.
  16. Use of any investigational drug or device within the 30 day period immediately prior to implant surgery.
  17. Patient is pregnant.
  18. Extraction sites having anatomic conditions that preclude immediate implant placement.

Sites / Locations

  • Graduate Periodontics, Dental School, UTHSCSA

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Type 1 implant and thin biotype

Type 1 implant and thick biotype

Arm Description

In this group, immediate implant placement (SLActive implant) is performed in patients with thin tissue biotype. In addition to implant placement bone grafting of the void between the implant and the fresh extraction socket, bone grafting the buccal aspect of the buccal plate (overcontouring) and soft tissue grafting (connective tissue) are performed.

In this group, immediate implant placement (SLActive implant) is performed including bone grafting of the void between the implant and the fresh extraction socket.

Outcomes

Primary Outcome Measures

Mid Facial Mucosal Level at Implant Site
Baseline will be at the time of crown delivery. Thereafter, the mid facial mucosal level at implant site will be recorded at 3, 6, 12 months after crown delivery.

Secondary Outcome Measures

PES/WES (Pink Esthetic Score, White Esthetic Score).
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 12 months after crown delivery. The PES (Pink Esthetic Score) and WES (White Esthetic Score) scales are 10 point scales, made up of 5 categories, each with a 2 point value. Each category is scored out of 2, and the scores totaled to give an optimal score out of 10, and then the two scores (PES and WES) added to give a total score out of 20, with 20 being the highest possible score (best outcome) and 0 being the worst outcome.
Probing Depth
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline, 3 and 12 months after crown delivery. The measurement of the pocket around the implanted tooth, measured with a graduated probe. A healthy pocket depth is around 3 mm with no bleeding during the measurement process. The values are totaled and a mean score of all the readings is reported.
Modified Plaque Index
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Measurement of amount of plaque build-up on teeth, using a scale of 0 (no plaque detection), to 3 (an abundance of soft matter). The scores are totaled and a mean score reported.
Modified Bleeding Index
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Bleeding from the gums is measured on probing the gum and measured on scale of 0 to 5, with 0 being the best outcome, with no bleeding, and 5 being the worst outcome, with spontaneous bleeding. The scores are totaled and a mean score reported.
Radiographic Bone Level
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline 3, and 12 months after crown delivery. Radiographic bone measurements recorded following final restoration placement (baseline), after 3 and 12 months of loading, and change between these time points. A positive value indicates bone loss and a negative value indicates bone gain. BIC (Bone implant contact)= Distance from implant shoulder to first bone to implant contact.

Full Information

First Posted
May 30, 2014
Last Updated
July 3, 2019
Sponsor
The University of Texas Health Science Center at San Antonio
Collaborators
ITI International Team for Implantology, Switzerland
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1. Study Identification

Unique Protocol Identification Number
NCT02154581
Brief Title
Case Selection and Treatment Protocol for Immediate Dental Implants in the Esthetic Zone
Official Title
Case Selection and Treatment Protocol for Immediate Dental Implants in the Esthetic Zone: A Controlled Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Completed
Study Start Date
January 2013 (undefined)
Primary Completion Date
April 28, 2018 (Actual)
Study Completion Date
April 28, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The University of Texas Health Science Center at San Antonio
Collaborators
ITI International Team for Implantology, Switzerland

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
In this study a tooth that needs to be extracted will be replaced by an implant (artificial root) placed at the same appointment as the extraction. The investigators want to observe how the gums change shape with healing in two different scenarios: If the soft tissue around your tooth is thin, following extraction and implant placement an extra soft tissue graft (taken from your palate) in the area in order to increase the thickness of your gums after healing. If the soft tissue around your tooth is thick, the implant will be placed without a soft tissue graft. Previous studies have shown that both methods work and can give good results. In fact the two methods are used routinely but they have never been compared objectively to one another in the same research study. The main purpose of this study is to evaluate if there is any difference in terms of esthetic outcomes between these two treatment modalities after a crown has been placed on the implant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Jaw, Edentulous, Partially, Acquired Absence of Single Tooth
Keywords
Dental implants, Esthetic score, Immediate implants, Gingival biotype

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Non-Randomized
Enrollment
41 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Type 1 implant and thin biotype
Arm Type
Active Comparator
Arm Description
In this group, immediate implant placement (SLActive implant) is performed in patients with thin tissue biotype. In addition to implant placement bone grafting of the void between the implant and the fresh extraction socket, bone grafting the buccal aspect of the buccal plate (overcontouring) and soft tissue grafting (connective tissue) are performed.
Arm Title
Type 1 implant and thick biotype
Arm Type
Active Comparator
Arm Description
In this group, immediate implant placement (SLActive implant) is performed including bone grafting of the void between the implant and the fresh extraction socket.
Intervention Type
Device
Intervention Name(s)
SLActive implant
Other Intervention Name(s)
Straumann, Dental Implants, Type 1 implant placement
Primary Outcome Measure Information:
Title
Mid Facial Mucosal Level at Implant Site
Description
Baseline will be at the time of crown delivery. Thereafter, the mid facial mucosal level at implant site will be recorded at 3, 6, 12 months after crown delivery.
Time Frame
Change from Baseline to 3 months
Secondary Outcome Measure Information:
Title
PES/WES (Pink Esthetic Score, White Esthetic Score).
Description
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 12 months after crown delivery. The PES (Pink Esthetic Score) and WES (White Esthetic Score) scales are 10 point scales, made up of 5 categories, each with a 2 point value. Each category is scored out of 2, and the scores totaled to give an optimal score out of 10, and then the two scores (PES and WES) added to give a total score out of 20, with 20 being the highest possible score (best outcome) and 0 being the worst outcome.
Time Frame
Approximately 1 year after baseline
Title
Probing Depth
Description
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline, 3 and 12 months after crown delivery. The measurement of the pocket around the implanted tooth, measured with a graduated probe. A healthy pocket depth is around 3 mm with no bleeding during the measurement process. The values are totaled and a mean score of all the readings is reported.
Time Frame
Up to 1 year after baseline
Title
Modified Plaque Index
Description
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Measurement of amount of plaque build-up on teeth, using a scale of 0 (no plaque detection), to 3 (an abundance of soft matter). The scores are totaled and a mean score reported.
Time Frame
Up to 1 year after baseline
Title
Modified Bleeding Index
Description
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Bleeding from the gums is measured on probing the gum and measured on scale of 0 to 5, with 0 being the best outcome, with no bleeding, and 5 being the worst outcome, with spontaneous bleeding. The scores are totaled and a mean score reported.
Time Frame
Up to 1 year after baseline
Title
Radiographic Bone Level
Description
Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline 3, and 12 months after crown delivery. Radiographic bone measurements recorded following final restoration placement (baseline), after 3 and 12 months of loading, and change between these time points. A positive value indicates bone loss and a negative value indicates bone gain. BIC (Bone implant contact)= Distance from implant shoulder to first bone to implant contact.
Time Frame
Up to 1 year after baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: The patient is 18 years or older. Ability to understand and provide informed consent before starting the study. Ability and willingness to comply with all study requirements. The patient, if of child-bearing potential, has a negative urine pregnancy test. Adequate oral hygiene to allow for implant therapy consistent with standards of care. Adequate bone volume to accommodate the planned endosseous dental implant placement according to immediate placement protocols utilizing Straumann Bone Level implants RC (Regular Crossfit) 4.1mm or Bone Level Implant NC (Narrow Crossfit) 3.3 mm at 8, 10,12 or 14mm in length. One tooth in the anterior maxilla (first pre-molar to first pre-molar) requiring extraction resulting in a single- tooth gap planned to be restored with a dental implant as determined by the patient's dental provider. The site to be treated is surrounded by two natural teeth. Except the site to be treated, none of the maxillary incisors, canines and first pre-molars display marginal soft tissue recession. Following extraction, intact extraction socket bony walls are present. Primary stability of implant consistent with standards of care is achieved at the time of implant placement. Patient must be able to pay for fees related to the surgical implant placement related to extraction, grafting of the implant site, and half of the cost of the crown at the time of implant placement. Exclusion Criteria: Patient reports tobacco use within the last five years. Tobacco use for this study is defined as a current smoking habit with moderate or heavy smoking (more than 10 cigarettes per day) or tobacco chewing use. History of alcoholism or drug abuse within the past 5 years. Severe wear with an etiology of bruxism or clenching habits. Patient has significant untreated periodontal disease (grade III or IV), caries, or clinical or radiographic signs of infection within two adjacent tooth positions of implant area. History of HIV infection, Hepatitis B or C. Patients with a history of systemic disease that precludes standard dental implant therapy or alters daily activities to a level consistent with ASA (American Society of Anesthesiologists) III classification (including cardiovascular, hepatic, renal, gastrointestinal, metabolic, neurologic, pulmonary, endocrine, autoimmune, or psychiatric disorders). Presence of local inflammation or mucosal diseases such as lichen planus. Patient history consistent with high risk for subacute bacterial endocarditis. Current hematological disorder or warfarin (or similar) therapy. Patient has a disease that affects bone metabolism, such as, but not limited to, osteoporosis, hyperthyroidism, hyperparathyroidism, congenital connective tissue disorders (e.g., osteogenesis imperfecta), or Paget's disease. Patient is taking medications or having treatments known to have an effect on bone turnover, including: thiazide diuretics, calcitonin, systemic steroids, bisphosphonates, vitamin D (>800 IU/day), estrogen or progesterone therapy. Current steroid treatment: defined as any person who within the last two years has received for two weeks a dose equivalent to 20 mg hydrocortisone. Patient currently undergoing chemotherapy. Patient history of radiation treatment to the head or neck. Physical or mental handicaps that would interfere with patient's ability to exercise good oral hygiene on a regular basis. Use of any investigational drug or device within the 30 day period immediately prior to implant surgery. Patient is pregnant. Extraction sites having anatomic conditions that preclude immediate implant placement.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Guy Huynh-Ba, DDS, MS
Organizational Affiliation
UTHSCSA Department of Periodontics
Official's Role
Principal Investigator
Facility Information:
Facility Name
Graduate Periodontics, Dental School, UTHSCSA
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States

12. IPD Sharing Statement

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Case Selection and Treatment Protocol for Immediate Dental Implants in the Esthetic Zone

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