Immediate Implant Using "Nanobone" Versus "Autogenous Bone" for Treatment of Patients With Unrestorable Single Tooth.
Condition: Immediate Implant With Bone Graft
Study type: Interventional

Summary: 
      A successful implant therapy require appropriate hard and soft tissue, perfect implant
      position, appropriate alveolar ridge architecture and integration of the implant. after tooth
      extraction bone resorption takes place and affect the quantity and quality of the bone
      resulting in inadequate bone volume for implant placement and future prosthetic restoration
      and impair the esthetic, so insertion of implant immediately following tooth extraction
      reduce bone loss and enhance esthetics.the fresh socket of extracted tooth is wider than the
      implant diameter and the distance between the implant and the bone called Peri-implant gap
      which influence the stability, osseointegration of the implants and esthetics. using bone
      graft in this gap between bone and implant enhance osseointegration and post-operative
      healing. autogenous bone graft considered the gold standard graft material for filling
      defects as it is osteogenic,osseoconductive and osseoinductive, however this approach
      obtained from the primary donor site for harvesting bone in the oral cavity which requires
      longer surgical procedure and produce not enough bone volume. there are several
      post-operative complication may happen as donor site morbidity and swelling,discomfort and
      pain, so alternative treatment has been suggested using biomaterials to fill the gap and
      reduce adverse effect of autogenous grafts.Several studies evaluate the success rate of
      implants with "autogenous" bone graft versus other synthetic guided bone regeneration
      materials. Nano porous grafting material as a new synthetic material "nanobone"
      nanocrystalline hydroxyapatite embedded in a porous silica gel matrix has oseoconductive and
      biomimetic properties integrate with the host bone. the sub-micron modification in bone
      substitutes enhance osteogenic property. the objective of this study is to measure surgical
      time, pain, implant stability and marginal bone loss in immediate implant placement with
      using autogenous bone graft versus nanobone graft.
    

Detailed description: 
      Immediate implant placement with Nanobone will offers great advantages for patients with
      unrestorable tooth as regards decrease surgical time, Post-Operative pain and marginal bone
      loss, increase implant stability compared to immediate implant with autogenous bone
      graft.Study is to be conducted in the oral medicine and periodontology department - Cairo
      University, Egypt. Post graduate clinic 1st floor old section. Unit Sirona2with LED light.
      Digital radiographic imaging will be carried out in the Oral Radiology Department, Faculty of
      Oral and Dental Medicine, Cairo University using digital intra-oral x-ray machine as well as
      CBCT imaging. Using CBCT determine the size and length of fixture will be used. After a
      traumatic extraction, using drills to prepare the socket for the implant. Standard drilling
      procedures are performed according to the manufacturer's instructions implant direct. The
      axis of the implant must correspond to the incisal edges of the adjacent teeth or be slightly
      palatal to this landmark. Place the exact size determined previously by CBCT. In the esthetic
      zone, the implant head should be a minimum of 3 mm apical to an imaginary line connecting the
      cemento-enamel junctions of the adjacent teeth and apical to the interproximal and crestal
      bone.The gap between the facial aspect of the implant and the buccal wall was filled with
      NanoBone.The flap will be scored and sutured in place without tension. While in the control
      group, Harvesting of the autogenous bone graft will be done. This group will be subjected to
      the same implant placement protocol as the study group. Postoperative care include; A
      dressing will be applied to the extraoral wound for 24 hours postoperatively in the control
      group, Patients will maintain on oral antibiotics (Amoxicillin/Clavulanic acid 1gm q12h) and
      analgesics (cataflam 50 mg q8h) for 5 more days. Chlorohexidine mouth wash will be prescribed
      for 2 more weeks.
    

Intervention name(s): Immediate implants with nanobone graft; immediate implants with autogenous bone graft
Intervention type(s): Procedure; Procedure
Intervention description(s): Extraction of unrestorable tooth replaced with immediate implant and use nanobone graft to fill the gap.; Extraction of unrestorable tooth replaced with immediate implant and use autogenous bone graft to fill the gap.
Other intervention name(s): Nano-hydroxy apatite bone graft with immediate implants; autograft used with immediate implants.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment