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Controlled Study Comparing REPaiR® and MIST Therapies for Treatment of Periodontitis

Primary Purpose

Periodontal Diseases

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
MIST (minimally invasive surgical therapy)
Sponsored by
McGuire Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Periodontal Diseases

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Subjects 18 to 75 years of age, inclusive.
  • Subjects must be diagnosed with moderate to severe generalized periodontitis (ADA Classification Case Type III or IV) as determined by the investigator.
  • Subjects must have at least one, but up to 2, non-adjacent, qualifying Study Teeth with Pockets (PPD ≥ 6 mm & intrabony vertical ≥ 3 mm, with base of defect ≥ 3 mm coronal to the tooth apex, and defect angle ≥ 25° as defined by radiograph) on non-adjacent teeth.
  • Subjects will have read, understood and signed an institutional review board (IRB) approved Informed Consent Form (ICF).
  • Subjects who are able and willing to adhere to the study visit schedule and other protocol requirements.

Exclusion Criteria:

  • Visual inability to identify cementoenamel junction (CEJ) or other landmark for probing measures.
  • Presence of an acute periodontal abscess at the time of MIST or REPaiR treatment steps
  • Mobility > 1 at the time of MIST or REPaiR treatment steps
  • Use of 3rd molars, defects distal to terminal 2nd molars, and teeth treated endodontically as study teeth.
  • Subjects with healing disorders (such as: diabetes mellitus confirmed HgA1C of > 7 within 6-months of screening, cancer, HIV, bone metabolic diseases or Type IV heart disease) that could compromise wound healing and/ or preclude periodontal surgery; or who are taking medications that compromise wound healing, such as chronic steroid use - either inhaler or systemic, calcium channel blockers with clinical evidence of secondary hyperplastic tissue reactions, anti-seizure medications, medications for bone metabolic diseases, radiation or other immuno-suppressive therapy.
  • Traumatic occlusion of study teeth not addressed by occlusal adjustment or splint therapy during the course of the study prior to conclusion of SRP
  • Subjects taking intramuscular or intravenous bisphosphonates.
  • Subjects smoking >10 cigarettes per day or an equivalent amount of any other nicotine products, such as smokeless chewing tobacco, nicotine patch, vaporizer, gum, pipe, or cigar smoking.
  • Female subjects who are pregnant or lactating, or who intend to become pregnant during the study duration.
  • Anticipated use of systemic antibiotics during the trial or within 30 days of SRP
  • An existing condition that may warrant use of antibiotics during the trial (e.g., ongoing infection noted at Screening Visit, cystic fibrosis or chronic obstructive pulmonary disorder with history of frequent, recurrent lung infections).

Use within 30 days prior to Day 1, or a condition for which use is anticipated during trial: topical oral, nasal and systemic corticosteroids.

  • Anticipated use of the agents known to affect periodontal status during the trial and/or use within 30 days prior to Day 1: immunosuppressants, calcium antagonists or phenytoin- - Participation in another clinical study within 90 days prior to Day 1.
  • Subjects who received oral health treatments/interventions within 90 days of Day 1, which the investigator believes may interfere with the periodontal parameters to be assessed in this study (e.g., significant dental and/or gum/oral tissue work).
  • Untreated moderate to severe periodontitis.
  • Subjects, who in the opinion of the Investigator, for any reason other than those listed above, will not be able to complete the study per protocol

Sites / Locations

  • Medelis Inc

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

MIST - minimally invasive surgical therapy

REPaiR - laser periodontal therapy

Arm Description

Beginning with the "papilla preservation technique" (Takei et al), further improved by Cortellini et al (1995) and combined with minimally invasive approaches (Harrel et al 1995), MIST, using "minimally invasive surgical approaches and micro-surgery instruments," has evolved into a decision tree guideline for treating periodontitis based on periodontal pocket morphology and papilla width/ interdental space (Cortellini P, Tonetti MS (2007) J Clin Periodontol;34(1):87-93).

The REPaiR regimen is a step-by-step protocol for using the Waterlase Express Er,Cr:YSGG laser for periodontitis. The protocol steps and associated laser delivery is controlled by a computer interface that dictates laser tip, energy and associated air and water mixes. Like MIST, REPaiR uses a set, decision tree approach for periodontal therapy, with prescribed steps and laser settings to quantify and standardize treatment. Potential clinical benefit, as with MIST, are not only effective periodontal therapy with reduced recession compared with traditional surgical approaches, but also reduced patient morbidity (Arnabat-Domínguez et al (2010). Lasers Med Sci;25(3):459-64).

Outcomes

Primary Outcome Measures

CAL (Clinical Attachment Level)
Clinical Attachment Level Measured by Periodontal Probe using PPD and Recession

Secondary Outcome Measures

Radiographic evidence of bone fill
Standardized periapical radiographs

Full Information

First Posted
September 6, 2019
Last Updated
March 28, 2023
Sponsor
McGuire Institute
Collaborators
Biolase Inc
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1. Study Identification

Unique Protocol Identification Number
NCT04169139
Brief Title
Controlled Study Comparing REPaiR® and MIST Therapies for Treatment of Periodontitis
Official Title
A Prospective, Multicenter, Randomized, Blinded and Controlled Study Comparing REPaiR® and MIST Therapies for Treatment of Moderate to Severe Generalized Periodontitis
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
May 18, 2018 (Actual)
Primary Completion Date
May 15, 2020 (Actual)
Study Completion Date
May 15, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
McGuire Institute
Collaborators
Biolase Inc

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
A comparison of laser (REPaiR) compared with minimally invasive surgical therapy for moderate to severe periodontal disease.
Detailed Description
The Trial is a multi-center, randomized, blinded, parallel arm trial of REPaiR therapy (experimental treatment) versus MIST (control therapy) in a maximum of 2 qualifying periodontal study teeth will be treated in each subject. Qualifying teeth will have PPD ≥ 6mm and intrabony vertical ≥ 3 mm, with base of defect ≥ 3 mm coronal to the tooth apex, and defect angle ≥ 25°. For Subjects already in maintenance therapy and having completed scaling and root planing within the previous 6-months, up to 3 Study Teeth will be selected and SRP conducted on just these teeth, and subjects will be randomized to either Test or Control Therapies (Visit 3). For patients already in maintenance therapy and NOT having completed SRP within the previous 6-months, up to 3 qualifying teeth may be selected, and localized SRP in the study teeth quadrants (Visit 2) can be followed after 4-6 weeks by Visit 3 Therapy on up to 2 Study Teeth. Other subjects not in maintenance therapy and with up to 3 qualifying teeth will be selected at the Screening Visit; then 4-6 weeks following SRP, up to 2 Study Teeth will be selected, and subjects will be randomized to either Test or Control Therapies. Follow-up assessments will be conducted on all subjects by a blinded examiner over a 12-month period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Periodontal Diseases

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
randomized, blinded, parallel arm trial, non-inferiority comparison of REPaiR therapy (experimental treatment) versus MIST (control therapy)
Masking
Outcomes Assessor
Masking Description
Examiners are blinded
Allocation
Randomized
Enrollment
54 (Actual)

8. Arms, Groups, and Interventions

Arm Title
MIST - minimally invasive surgical therapy
Arm Type
Active Comparator
Arm Description
Beginning with the "papilla preservation technique" (Takei et al), further improved by Cortellini et al (1995) and combined with minimally invasive approaches (Harrel et al 1995), MIST, using "minimally invasive surgical approaches and micro-surgery instruments," has evolved into a decision tree guideline for treating periodontitis based on periodontal pocket morphology and papilla width/ interdental space (Cortellini P, Tonetti MS (2007) J Clin Periodontol;34(1):87-93).
Arm Title
REPaiR - laser periodontal therapy
Arm Type
Experimental
Arm Description
The REPaiR regimen is a step-by-step protocol for using the Waterlase Express Er,Cr:YSGG laser for periodontitis. The protocol steps and associated laser delivery is controlled by a computer interface that dictates laser tip, energy and associated air and water mixes. Like MIST, REPaiR uses a set, decision tree approach for periodontal therapy, with prescribed steps and laser settings to quantify and standardize treatment. Potential clinical benefit, as with MIST, are not only effective periodontal therapy with reduced recession compared with traditional surgical approaches, but also reduced patient morbidity (Arnabat-Domínguez et al (2010). Lasers Med Sci;25(3):459-64).
Intervention Type
Device
Intervention Name(s)
MIST (minimally invasive surgical therapy)
Other Intervention Name(s)
REPaiR
Intervention Description
REPaiR Periodontal Therapy
Primary Outcome Measure Information:
Title
CAL (Clinical Attachment Level)
Description
Clinical Attachment Level Measured by Periodontal Probe using PPD and Recession
Time Frame
6-months post Sx
Secondary Outcome Measure Information:
Title
Radiographic evidence of bone fill
Description
Standardized periapical radiographs
Time Frame
6-months post Sx
Other Pre-specified Outcome Measures:
Title
Patient Reported Outcome for Pain
Description
Patient Reported Outcomes (PROs) for Pain Using 10-Point scale 0-"no pain at all" to 10-"pain as bad as you can imagine" VAS. A low score would indicate a low level of patient reported post-operative pain.
Time Frame
Daily for 7-days following Sx
Title
Patient Reported Outcome for Satisfaction
Description
Satisfaction with Esthetics and Overall Satisfaction with Procedure Using the following list of response options: Very satisfied (Scored as 1), Somewhat satisfied (Scored as 2), Neither satisfied nor dissatisfied (Scored as 3), Somewhat dissatisfied (Scored as 4), Very dissatisfied (Scored as 5) A low score would indicate a high level of satisfaction with the treatment provided.
Time Frame
1-month, 3-months and 6-months post SX

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Subjects 18 to 75 years of age, inclusive. Subjects must be diagnosed with moderate to severe generalized periodontitis (ADA Classification Case Type III or IV) as determined by the investigator. Subjects must have at least one, but up to 2, non-adjacent, qualifying Study Teeth with Pockets (PPD ≥ 6 mm & intrabony vertical ≥ 3 mm, with base of defect ≥ 3 mm coronal to the tooth apex, and defect angle ≥ 25° as defined by radiograph) on non-adjacent teeth. Subjects will have read, understood and signed an institutional review board (IRB) approved Informed Consent Form (ICF). Subjects who are able and willing to adhere to the study visit schedule and other protocol requirements. Exclusion Criteria: Visual inability to identify cementoenamel junction (CEJ) or other landmark for probing measures. Presence of an acute periodontal abscess at the time of MIST or REPaiR treatment steps Mobility > 1 at the time of MIST or REPaiR treatment steps Use of 3rd molars, defects distal to terminal 2nd molars, and teeth treated endodontically as study teeth. Subjects with healing disorders (such as: diabetes mellitus confirmed HgA1C of > 7 within 6-months of screening, cancer, HIV, bone metabolic diseases or Type IV heart disease) that could compromise wound healing and/ or preclude periodontal surgery; or who are taking medications that compromise wound healing, such as chronic steroid use - either inhaler or systemic, calcium channel blockers with clinical evidence of secondary hyperplastic tissue reactions, anti-seizure medications, medications for bone metabolic diseases, radiation or other immuno-suppressive therapy. Traumatic occlusion of study teeth not addressed by occlusal adjustment or splint therapy during the course of the study prior to conclusion of SRP Subjects taking intramuscular or intravenous bisphosphonates. Subjects smoking >10 cigarettes per day or an equivalent amount of any other nicotine products, such as smokeless chewing tobacco, nicotine patch, vaporizer, gum, pipe, or cigar smoking. Female subjects who are pregnant or lactating, or who intend to become pregnant during the study duration. Anticipated use of systemic antibiotics during the trial or within 30 days of SRP An existing condition that may warrant use of antibiotics during the trial (e.g., ongoing infection noted at Screening Visit, cystic fibrosis or chronic obstructive pulmonary disorder with history of frequent, recurrent lung infections). Use within 30 days prior to Day 1, or a condition for which use is anticipated during trial: topical oral, nasal and systemic corticosteroids. Anticipated use of the agents known to affect periodontal status during the trial and/or use within 30 days prior to Day 1: immunosuppressants, calcium antagonists or phenytoin- - Participation in another clinical study within 90 days prior to Day 1. Subjects who received oral health treatments/interventions within 90 days of Day 1, which the investigator believes may interfere with the periodontal parameters to be assessed in this study (e.g., significant dental and/or gum/oral tissue work). Untreated moderate to severe periodontitis. Subjects, who in the opinion of the Investigator, for any reason other than those listed above, will not be able to complete the study per protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Donald Clem, DDS
Organizational Affiliation
Regenerative Solutions
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medelis Inc
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37215
Country
United States

12. IPD Sharing Statement

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Controlled Study Comparing REPaiR® and MIST Therapies for Treatment of Periodontitis

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