The Adjunctive Effect of Soft Tissue Augmentation Procedures on the Surgical Treatment of Moderate-severe Peri-implantitis: A Randomized Controlled Clinical Trial.
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- Enrollment
- 120
- Locations
- 3
- Primary Endpoint
- Absence of bleeding/ suppuration on probing
Study Overview
Brief Summary
The key objective of the study is to compare the effects of soft tissue augmentation using a volume stable collagen matrix or autogenous connective tissue graft or no soft tissue augmentation in addition to bone grafting/implantoplasty in patients who undergo surgical therapy of peri-implantitis with respect to clinical resolution of the infection.
Detailed Description
The global burden of periimplantitis is expected to rise with the increasing popularity of dental implants as a replacement option. While many therapeutic interventions have been proposed, none have been proven superior. Surgical therapy is often indicated to gain access to the plaque infected implant threads and bone defects. Implantoplasty of suprabony defects have shown good results although adverse effects like soft tissue recession are common.
Thin mucosa results in compromised outcomes following various surgical interventions around implants with increased recession and aesthetic failures. It has also been associated with increased marginal bone loss and severity of periimplantitis. Application of autogenous connective tissue grafts during surgical therapy of periimplantitis to increase the keratinised mucosa widths or attenuate post-implantoplasty recession showed promising results.
No randomized controlled clinical trials investigating the effects of additional soft tissue augmentation with implantoplasty on periimplantitis lesions have been done so far. In addition, few have evaluated patient reported outcome measures, included non-European subjects and none reported on soft tissue alterations. The effect of soft tissue substitutes on surgical periimplantitis therapy remains unknown.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Masking Description
Masking is not possible for the intended interventions, as the harvest of the SCTG requires an additional surgical site at the palate, which will be recognized by the patient. The investigators will also be aware of the type of procedure, as both follow different operation procedures.
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Age > 18 years old (UZH, FRA) or > 21 years old (SIN), male and female.
- •Diagnosed with periimplantitis of at least 1 implant in function for at least 1 year Diagnostic criteria
- •Presence of bleeding and/or suppuration on gentle probing.
- •Probing depths of ≥6 mm.
- •Bone levels ≥3 mm apical of the most coronal portion of the intraosseous part of the implant.
- •Periodontal health (including previously treated periodontitis patients with reduced but healthy periodontium)
- •Good oral hygiene (full mouth plaque score <25%)
- •Adequate control of inflammation (full mouth BOP <25%)
- •Signed informed consent form
Exclusion Criteria
- •Pregnant or lactating female patient at inclusion
- •Allergy or objection to porcine and bovine implantable biomaterials
- •Allergy to Penicillin or NSAIDs
- •Known or suspected non-compliance, drug or alcohol abuse
- •Inability to follow the procedures of the study, e.g. due to language/ comprehension problems, psychological disorders, dementia, etc. of the participant
- •Smoking > 15 cigarettes a day
- •Active periodontal disease
Arms & Interventions
Subepithelial connective tissue group (SCTG)
A SCTG will be harvested from the patient's palate with a dimension dependent on the size of the peri-implant osseous defect. The technique of harvesting a soft tissue grafting is well described and established in the literature. Following the administration of local anesthesia, the SCTG will be harvested using a single incision technique. The periosteum will be left intact. The thickness of the SCTG will be at least 1.5mm. A cross suture will be used to close the palatal incision.
The SCTG will be placed on the buccal exposed implant threads (above the DBBM-C) exceeding 1mm in a coronal and apical direction, 3mm in a mesial and distal direction and then immobilized using a horizontal mattress connecting it to the lingual or palatal flap. The flaps are then closed primarily and tension-free following a horizontal periosteal releasing incision.
Intervention: Subepithelial connective tissue (Procedure)
Volume stable Collagen Matrix group (VCMX)
A VMCX (FibroGide®) will be hydrated in sterile saline, trimmed and adjusted to a dimension dependent on the size of the osseous peri-implant defect. The VCMX will then be placed as described above and then immobilized using a horizontal mattress connecting it to the lingual or palatal flap. The flaps are then closed primarily and tension-free following a horizontal periosteal releasing incision.
Intervention: Volume stable Collagen Matrix (Procedure)
No soft tissue augmentation (GBR)
No barrier membranes will be placed. After filling the defect with the bone substitute, the flaps are closed primarily and tension-free following a horizontal periosteal releasing incision.
Intervention: No soft tissue augmentation (Procedure)
Outcomes
Primary Outcomes
Absence of bleeding/ suppuration on probing
Time Frame: 6 months after surgery
A parameter for monitoring periodontal conditions
Increase in probing depth ≤ 1mm
Time Frame: 6 months after surgery
A parameter for monitoring periodontal conditions
Absence of additional bone loss after therapy of more than 5mm from radiographic baseline
Time Frame: 6 months after surgery
A parameter for monitoring periodontal conditions
Secondary Outcomes
- Radiographic evaluation of the amount of hard tissue(5 years after surgery)
- Oral Health Impact Profile-14(5 years after surgery)
- Profilometric changes around the treated implant(5 year after surgery)
- Early wound healing(2 month after surgery)
- Profilometric changes around the treated implant(6 months after surgery)
- Profilometric changes around the treated implant(1 year after surgery)
- Profilometric changes around the treated implant(3 year after surgery)
- Early wound healing(1 month after surgery)
- Radiographic evaluation of the amount of hard tissue(6 months after surgery)
- Radiographic evaluation of the amount of hard tissue(1 year after surgery)
- Radiographic evaluation of the amount of hard tissue(3 years after surgery)
- Oral Health Impact Profile-14(6 months after surgery)
- Oral Health Impact Profile-14(1 year after surgery)
- Oral Health Impact Profile-14(3 years after surgery)
Investigators
Nadja Naenni
PD Dr. med. dent
University of Zurich