Guided Bone Regeneration of Peri-implant Defects Comparing Submerged Versus Non-submerged Healing

Study Overview
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Brief Summary
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Objective: the objective of the present randomized clinical trial is to compare changes in radiographic peri-implant bone defect fill after regeneration of peri-implant intrabony defects with a submerged versus a non-submerged protocol. Material and Methods: this project is a randomized controlled clinical trial, double blind, with a parallel groups design. Thirty-six patients presenting with peri-implantitis subsidiary of regenerative treatment will be recruited. After subjects have been given informed consent, they will be randomized to test or control group. All patients will undergo a session of non-surgical peri-implantitis therapy consisting on prostheses removal and implant debridement with ultrasounds, curettes and air-abrasive under local anaesthesia. Patients in test group will have their prostheses removed and the mucosa surrounding the affected implants will be let heal covering the implants, while patients in control group will have their prostheses installed again after the non-surgical therapy. Six to eight weeks later, all subjects will undergo regenerative treatment with the use of a bone substitute, a collagen membrane and fixation pins, and in control group tissues will heal following the non-submerged protocol, meanwhile subjects in test group will undergo submerged healing. Six months later, subjects in test group will have their prostheses reconnected to the regenerated implants. All patients will undergo periodontal and peri-implant maintenance therapy every three months during follow-up. Radiographic assessment of vertical bone level changes (primary outcome), clinical status of peri-implant tissues, changes in soft tissues margin, patient related outcomes and adverse events will be assessed at 3, 6 and 12 months after peri-implantitis regenerative surgery.

Official Title
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Guided Bone Regeneration of Peri-implant Defects Comparing Submerged Versus Non-submerged Healing: a Randomized Controlled Clinical Trial

Conditions
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Peri-Implantitis

Intervention / Treatment
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* Procedure: Submerged healing
* Procedure: Non-submerged healing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients diagnosed of peri-implantitis requiring surgical therapy The periapical radiographic study demonstrates an intra-bony component greater than 3 mm at the affected implant There is at least 2 mm of keratinized mucosa around the affected implant Intrasurgically, peri-implant defects must be type Ia, Ib, Ic and Ie (according to Schwarz et al. 2007) Affected implants must be two-piece implants to allow for the submerged protocol Affected implant supported restorations must be screw-retained or cemented, and should allow for prostheses removal Exclusion Criteria: Patients with untreated periodontitis Medical conditions requiring prolonged use of steroids and/or medications that can interfere with bone metabolism Metabolic disorders such as osteoporosis History of uncontrolled endocrine disorders History of leukocyte dysfunction and deficiencies History of immunodeficiency syndromes History of neoplastic disease requiring the use of radiation of chemotherapy History of renal failure Physical handicaps that would interfere with the ability to perform adequate oral hygiene Alcoholism or drug abuse Smokers of more than 10 cigarettes per day, cigar equivalents or tobacco chewers Any other condition or circumstance that, in the opinion of the investigator, would prevent completion of study participation or interfere with the analysis of the study results, such as history of non-compliance or unreliability

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Submerged healing<br>Bone regeneration of peri-implantitis defects following a submerged healing | Procedure: Submerged healing<br>* Bone regeneration of peri-implantitis defects using a bone xenograft and a resorbable collagen membrane, with flap suturing using a submerged healing protocol<br>|
| Active Comparator: Non-submerged healing<br>Bone regeneration of peri-implantitis defects following a non-submerged healing | Procedure: Non-submerged healing<br>* Bone regeneration of peri-implantitis defects using a bone xenograft and a resorbable collagen membrane, with flap suturing using a non-submerged healing protocol<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in radiographic bone fill | Changes in radiographic bone fill measured from the implant shoulder to the first bone to implant contact with ImageJ software, in parallelized periapical x-rays with individual silicone bite blocks | Baseline, 3 months, 6 months and 12 months post-surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in pocket probing depth | Depth of the peri-implant sulcus/pocket measured in millimeters with a 15-UNC (University of North Carolina) periodontal probe, at six sites per implant without the crown | At baseline, after non-surgical therapy, 6 months and 12 months post-surgery | 
| Changes in bone probing depth | Distance from the mucosal margin to the peri-implant bone measured in millimeters with a 15-UNC (University of North Carolina) periodontal probe under local anesthesia, at six sites per implant without the crown | At baseline, after non-surgical therapy and 12 months post-surgery | 
| Changes in modified plaque index | Presence or absence of plaque assessed at six sites per tooth/implant in the whole mouth, excluding third molars | At baseline, after non-surgical therapy, 6 months and 12 months post-surgery | 
| Changes in full mouth bleeding scores | Presence or absence of bleeding after probing with a 15-UNC (University of North Carolina) periodontal probe, assessed at six sites per tooth/implant in the whole mouth, excluding third molars. The presence of bleeding in each site will be scored 1, and the absence of bleeding will be scored 0. Full mouth bleeding score will be expressed in percentage and calculated as follows: number of sites bleeding / number of sites explored ^ 100 | At baseline, after non-surgical therapy, 6 months and 12 months post-surgery | 
| Soft tissue healing scores | Extent of soft tissue healing after surgery following Landry et al. Healing Index (1988): Healing index 1 - Very Poor Healing index 2 - Poor Healing index 3 - Good Healing index 4 - Very good Healing index 5 - Excellent | 1 week, 2 weeks and 4 weeks post-surgery | 
| Pain assessment | Participants´ subjective pain assessed using a Visual Analogue Scale (VAS) with ratings from 0-10, whereof 0 = no pain and 10 = very intense. | 1 week, 2 weeks and 4 weeks post-surgery | 
| Oral Health Impact Profile (OHIP-14) | Self-reported dysfunction, discomfort and disability attributed to the participants´ oral condition | Baseline, 3 months, 6 months and 12 months post-surgery | 
| Adverse events´ occurrence | Occurrence of any untoward, undesired or unplanned event in the form of signs, symptoms, disease, or laboratory or physiologic observations occurring in a subject participant in the clinical investigation. The event does not nee to be casually related to the cliinical investigation | Up to 12 months post-surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Peri-Implantitis, Peri-Implant Diseases, Bone Regeneration, Submerged Healing, Non-Submerged Healing, Dental Implants