BSNS: Comparison of the Use of Natural and Synthetic Bone Substitutes in Dental Implants
Study Details
Study Description
Brief Summary
The goal of this clinical trial is to compare the effectiveness of a natural and synthetic bone substitute in preserving the alveolar ridge (bone) of a single- rooted tooth after an extraction.
The main question it aims to answer:
Is there a difference between natural (Bio-Oss®) and synthetic (Bonalive®) bone substitutes in preserving the alveolar ridge dimensions based on changes in the width of the alveolar ridge (expressed in millimetres) from augmentation (baseline) to 24-week follow-up (post augmentation)?
Participants will have a tooth extraction and a bone substitute will be inserted into their socket immediately after. Participants will be divided into two equal groups and those in group A will receive Bio-Oss® while those in group B will receive Bonalive®. In both groups measurements of the alveolar bone will be taken when the bone substitute is inserted and 24 weeks after the insertion of the bone substitute. These measurements will be used to compare the effectiveness of Bio-Oss® and Bonalive in preserving the alveolar bone of a tooth after an extraction.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
It is a pilot single-blind two-arm parallel randomised control trial that aims to assess the differences between two bone substitutes, natural versus synthetic. The study will mimic the routine practice, and patients will be randomly allocated to receive either natural (control) or synthetic (intervention) bone substitutes. The patient follow-up period will be 24 weeks from the baseline data collection point.
The University of Central Lancashire will lead the study in collaboration with Imperial College London and dental clinics in Midlands, Southeast and Northwest England. We will recruit 34 patients who require tooth extractions and divide them into two equal groups. Patients in group A will receive Bio-Oss® , while those in group B will receive Bonalive® For both groups, the bone substitute will be inserted immediately after an extraction, and the socket will be sealed with a membrane sutured in place. Patients in both groups will be reviewed after 2 weeks to remove the suture. Patients will have another review at 24 weeks, during which the researcher will take a scan or mould, a photograph, and a small biopsy sample of the area where the bone substitute was placed. Measurements obtained at the 24-week follow-up will be used to evaluate the effectiveness and differences between natural and synthetic bone substitutes in preserving the bone supporting a tooth after an extraction.
The results of this pilot study will inform the design and implementation of a full-scale randomised controlled trial to investigate the effectiveness of bioactive glass-derived bone compared with bovine-derived bone in preserving the alveolar bone of a tooth after an extraction
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Group A (Bonalive®) The test bone substitute is Bonalive®, bioactive glass S53P4, which contains SiO2, Na2O, CaO, and P2O5 (granule size 0.5-0.8mm). Bonalive® is osteoconductive, meaning that it has the ability of promoting bone growth across the granules and the grafting area and slowly replace it with new bone over time. Bonalive® is osteostimulative and has antibacterial properties |
Other: Bonalive
Bonalive® is a bioactive glass synthetic bone substitute material that has been shown to have a low substitution rate and antibacterial properties. It has been used successfully in the orthopaedics, craniofacial and ear nose and throat (ENT) specialities for the treatment of osteomyelitis, sinusitis and bony cyst cavities. There have also been a few maxillofacial surgery case reports on its usage in the jaws.
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| Active Comparator: Group B ( Bio-Oss®) The comparator is Bio-Oss®, deproteinized bovine bone granules (granule size 0.25- 1mm). Bio-Oss® is osteoconductive, which means it acts as a scaffold only for new bone to grow. |
Other: Bio-Oss®
Bio-Oss® is a bovine xenogeneic bone graft substitute that is widely used in regenerative dentistry. Bio-Oss® is very similar to human bone in its structure and chemical make-up. The material's porosity allows for vascularisation and new bone formation.
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Outcome Measures
Primary Outcome Measures
- Primary outcome measure is the change in the width of the alveolar ridge [Outcome data will be collected at baseline and week 24]
The change in the width of the alveolar ridge is expressed in millimetres and it will be obtained using intra-oral scanners (this does not involve radiographs) or impressions and clinical photographs.
Secondary Outcome Measures
- Change in height of the alveolar bone. [This outcome data will be collected at baseline and at week 24]
The change in height of the alveolar bone expressed in millimetres. Assessment will be done using the periapical radiographs taken pre-extraction and at 24-week follow-up and intra-oral scanners (this does not involve radiographs) or impressions and clinical photographs.
- Changes in the vertical crestal bone level [This outcome data will be collected at baseline and at week 24]
The change in the vertical crestal bone level is expressed in millilitres and it will be assessed with periapical radiographs taken pre-extraction and 24-week post augmentation.
- Presence of bone around the alveolar ridge Concentration (in nanograms) of gene expression for bone markers [Outcome data will be obtained at week 24]
The presence of bone around the alveolar ridge will be assessed using histology (qualitative assessment of bone infiltration) A Polymerase Chain Reaction (PCR) test will be done to determine the concentration (in nanograms) of gene expression for bone markers (including osteopontin, osteocalcin) at 24-week post augmentation.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adult patients (age >18) in need of extraction of a single-rooted tooth attending the clinics selected for the study
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Single units in a dentate patient
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Non-surgical extraction - no flap raised, and no bone removed Intact socket walls post-extraction
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Bleeding sockets
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Stable periodontal health
Exclusion Criteria:
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Multiple adjacent extractions
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Presence of active periodontal disease
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Socket walls not intact - >50% bone loss in any of the four walls
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Sclerotic sockets post-extraction - the socket does not fill up with blood post-extraction
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Denture wearer - the extraction socket site under the load of a denture
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Patients on medication that can affect bone healing e.g., bisphosphonates (oral or intravenous), selective serotonin reuptake inhibitors (SSRI), methotrexate, proton pump inhibitors (PPI)
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Uncontrolled diabetes Smokers Immunosuppressed Patients
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Patients with a history of myocardial Infarction in the last year ASA Class > II patients
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Central Lanchashire | Preston | Lancashire | United Kingdom | PR1 2HE |
| 2 | Devonshire House Dental Practice | Cambridge | United Kingdom | CB1 7PN | |
| 3 | St Faith's Dental Clinic, | East Grinstead | United Kingdom | RH19 1PN | |
| 4 | Halesowen Dental | Halesowen | United Kingdom | B63 3NQ | |
| 5 | Imperical College,London | London | United Kingdom | SW7 2AZ | |
| 6 | UCLan community Dentists | Preston | United Kingdom | PR1 2HE |
Sponsors and Collaborators
- University of Central Lancashire
- Imperial College London
Investigators
- Study Chair: Ihtesham Rehman, PhD, University of Central Lancashire
Study Documents (Full-Text)
More Information
Publications
- Rignon-Bret C, Hadida A, Aidan A, Nguyen TH, Pasquet G, Fron-Chabouis H, Wulfman C. Efficacy of bone substitute material in preserving volume when placing a maxillary immediate complete denture: study protocol for the PANORAMIX randomized controlled trial. Trials. 2016 May 20;17(1):255. doi: 10.1186/s13063-016-1380-7.
- Solakoglu O, Gotz W, Heydecke G, Schwarzenbach H. Histological and immunohistochemical comparison of two different allogeneic bone grafting materials for alveolar ridge reconstruction: A prospective randomized trial in humans. Clin Implant Dent Relat Res. 2019 Oct;21(5):1002-1016. doi: 10.1111/cid.12824. Epub 2019 Aug 19.
- HEALTH 01032
- IRAS ID: 316275