Study Comparing Appearance and Function of Three Different Dental Implant Designs When Placed in Front Region of Upper Jaw

Study Overview
=================
Brief Summary
-----------------
The primary objective is to compare the gum response to three different dental implant designs when placed in the front region of the upper jaw. The changes from baseline to one year after will be compared. The null-hypothesis is that the buccal soft tissue (gum) changes from baseline to one year after are equal for all three implant-abutment interface settings.

Official Title
-----------------
Prospective, Comparative Assessment of Single-tooth Replacement in Different Implant-abutment Settings

Conditions
-----------------
Jaw, Edentulous, Partially

Intervention / Treatment
-----------------
* Device: OsseoSpeed™
* Device: NobelSpeedy™ Replace®
* Device: NanoTite™ Certain® PREVAIL®


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Provision of informed consent At least 18 years In need of one or more single implants replacing missing or non-restorable teeth in the maxilla within region 14 to 24 The following should be considered at inclusion but can not be fulfilled until at Visit 2: Edentulous for at least 5 months at study site A buccal-lingual bone width at study site of at least 5.5 mm A mesial-distal bone level distance between adjacent teeth at study site of at least 5.5 mm A keratinized mid-buccal mucosal height of at least 2 mm at study site Teeth adjacent (mesial and distal) to study site must consist of two stable teeth on natural roots without signs of periodontal bone loss (>1 mm) and/or significant soft tissue loss Teeth adjacent (mesial and distal) to study site must demonstrate a stable occlusal guidance that will allow non-functional disclusion in all eccentric positions An opposing dentition with teeth, implants or prosthesis Exclusion Criteria: Insufficient interocclusal distance for implant placement and restoration at study site Tooth adjacent (mesial and/or distal) to study site is ankylosed More than 2 mm vertical bone loss at study site as measured from the mid-buccal crest of bone on the adjacent teeth Site development (bone tissue) performed at less than 5 months before Visit 2 at study site Untreated rampant caries and/or uncontrolled periodontal disease Class II division 2 malocclusion (Edward Hartley Angle) Use of tobacco within last 6 months Uncontrolled diabetes (subjects history does not reveal the absence of control of insulin-dependent/non-insulin dependent Diabetes Mellitus) Current alcohol or drug abuse Systemic or local disease or condition that would compromise post-operative healing and/or osseointegration Use of any substance that will influence bone metabolism Need for systemic corticosteroids or any other medication that would influence post-operative healing and/or osseointegration History of radiation in the head and neck region Known pregnancy, pregnancy tests will be performed as per local requirements. Unable or unwilling to return for follow-up visits for a period of 5 years Unlikely to be able to comply with study procedures according to Investigators judgement Involvement in the planning and conduct of the study (applies to both Astra Tech staff or staff at the study center) Previous enrollment or randomization of treatment in the present study.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: A<br> | Device: OsseoSpeed™<br>* OsseoSpeed™ implant<br>|
| Active Comparator: B<br> | Device: NobelSpeedy™ Replace®<br>* NobelSpeedy™ Replace® implant<br>|
| Active Comparator: C<br> | Device: NanoTite™ Certain® PREVAIL®<br>* NanoTite™ Certain® PREVAIL® implant<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Buccal Soft Tissue (Gum) Changes, Measured as Mid-buccal Gingival Zenith (GZ) Scores. | Soft tissue response was evaluated by measuring it clinically and by evaluating it from clinical photographs using image analysis. Clinical evaluations of gingival zenith were performed at time of loading (permanent restoration) and at the 5-year follow-up after loading. The vertical distance from the most apical aspect of the soft tissue margin to the incisal edge of implant crown was measured using a standardized periodontal probe to the nearest half millimeter using the surgical loupe. The changes in the gingival zenith was calculated for each study position and the average for each treatment group was calculated for the evaluation period. | Evaluated at time of loading (permanent restoration) and at the 5-years follow-up after loading | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Marginal Bone Level Alterations | Marginal Bone Level determined from radiographs and expressed as the difference from a reference point on the implant to the most coronal bone-to-implant contact on the mesial and distal aspect of the implant. Marginal Bone Level expressed in millimeters at the 5-year follow-up visit compared to values obtained at time of implant placement. | Evaluated at time of implant installation and at the 5-year follow-up visit. | 
| Evaluation of the Periimplant Mucosa Condition - By Assessment of PPD | Condition of the periimplant mucosa by assessment of probing pocket depth (PPD). Change in pocket depth expressed in millimeters at the 5-year follow-up visit, compared to values obtained at delivery of permanent restoration, i.e. loading (baseline). Negative value = increased pocket depth. | Measured at time of loading of permanent restoration and at the 5-year follow-up. | 
| Evaluation of the Periimplant Mucosa Condition - By Assessment of Change in BoP. | Condition of the periimplant mucosa by assessment of Bleeding on Probing (BoP). Presented as change in proportion of surfaces that show presence of BoP, measured from implant loading to the 5-year follow-up visit. | Measured at the implant loading and at the 5-year follow-up after loading. |