Endoscope-assisted Flapless Approach Versus Papillary Preservation Technique in Periodontal Regeneration.
- Conditions
- PeriodontitisPeriodontal Regeneration, Clinical and Radiographic Results, Modified Minimal Invasive SurgeryPeriodontal Regeneration
- Registration Number
- NCT06978036
- Lead Sponsor
- The University of Hong Kong
- Brief Summary
The standard of care for regeneration of lost periodontal tissue from disease at contained defect sites non-responding to non-surgical periodontal therapy is periodontal regenerative surgery. The classical practice of periodontal regeneration involves an open flap surgical approach with the the application of biologics (Enamel matrix derivatives EMD) and biomaterials after root surface debridement. EMD, derived from porcine, has been well documented for its safety and efficacy and widely used in periodontal regeneration. There is some evidence demonstrating promising treatment outcome of the flapless application of periodontal regenerative biologics after nonsurgical subgingival debridement. Endoscopic-Assisted Subgingival Debridement EASD with a high magnification up to 40X has been shown to be a non-inferior nonsurgical treatment alternative to open flap debridement with shorter operation times and better early wound healing. We hypothesize that EASD could be integrated into flapless periodontal regeneration to improve clinical performance, patient comfort and acceptance to regenerative procedures. Hence, the focus of this study is to investigate whether flapless application of EMD as an adjunct to EASD can achieve non-inferior clinical results compared to classical open-flap periodontal regeneration using Papilla Preservation Surgical Technique PPT in managing residual periodontal intrabony defects 1 year after intervention. Half of the patients will be randomized to recieve EASD and flapless regneration with EMD, while the other half of the patient will receive classical regeneration with PPT and EMD.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 56
- Stage III - Stage IV Periodontitis patients, 3-4 months after completing steps I & II periodontal therapy.
- At least 1 tooth presented with 1 site with >5mm residual PPD and ≥6mm CAL, with ≥3mm intra-osseous defect presented involving predominantly the interdental space of the tooth and presented on paralleling periapical radiographs and/or CBCT.
- Presence of a periodontally stable tooth with PPD≤3mm immediate adjacent to the intra-bony defect of the investigated tooth
- Good Oral Hygiene, with Full Mouth Plaque Score ≤25% at baseline and with good plaque control at proposed surgical field.
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Pre-study period
- Any systemic condition which prevents following the study protocol;
- Any systemic condition which may affect healing outcomes of patients, e.g. uncontrolled or poorly controlled diabetes, unstable or life-threatening conditions or those requiring antibiotic prophylaxis;
- Patients under long-term analgesic medication;
- Current smokers;
- Self-reported pregnancy;
- Systemic antimicrobial therapy within 3 months;
- Teeth that concurrently present with a buccal and a lingual intrabony defect component;
- Tooth with hopeless prognosis or questionable prognosis associated with endodontic lesions, or subgingival restorations that preclude clinical measurements, or excessive uncontrolled mobility;
- Any factors which prohibit regular performance of plaque control around surgical sites;
- Inadeduate oral hygiene with full mouth plaque score >25%
- Furcation involved surfaces
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During study period -Non-compliance with study protocol
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method ΔCAL - 12 months 12 months Change of Clinical Attachment Level measured in millimetres
- Secondary Outcome Measures
Name Time Method ΔCAL - 6 months 6 months Change of Clinical Attachment Level, measured in milimetres
ΔCAL - 9 months 9 months Change of Clinical Attachment Level, measured in milimetres
FMPS 3, 6, 9, 12 months Modified O'Leary Full Mouth Plaque Score, measured in percentage
FMBOP 3, 6, 9, 12 months Full Mouth Bleeding On Probing (excluding teeth under investigation), measured in percentage
ΔREC 3, 6, 9, 12 months Change in Recession , measured in milimetres
ΔPPD 6, 9, 12 months Change in Periodontal Pocket Depth, measrued in millimetres
Mob 3, 6, 9, 12 months Tooth Mobility Index (Miller 1938), the higher the number the greater the mobility
EWHI 3, 6, 9, 12 months Early Wound Healing Index (Wachtel et al., 2003), a lower score signifies a better healing
ΔINFRA 3, 6, 9, 12 months Change of depth of the intrabony defect , measured on radiographs in millimetres.
TIME Measured throughout procedure Time for the surgery , measured in minutes
% of sites achieving therapeutic endpoints 6, 9, 12 months % of sites achieving therapeutic endpoints (i.e. no PPD \> 4mm with bleeding and no deep residual pocket PPD \>5mm)
Patient-reported outcome measurements Baseline, 3, 6, 9, 12 months Subjects will be assessed with a questionnaire on condition-specific Health-related quality-of-life instrument and perceptions of oral health-related quality of life will be assessed using validated translations of the OHIP-14 questionnaire into the native language of all participants. A lower value indicates a more favourable patient-reported outcome.
Intra-operative Discomfort 14 days 100mm Visual Analog Scale is used to measure the intra-operative pain and discomfort during the test/control therapy.
Daily intake of analgesia 14 days Daily intake of analgesia will be recorded on the first 14 days after the operation.
Trial Locations
- Locations (1)
The University of Hong Kong
🇭🇰Hong Kong, Hong Kong