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Jaw, EdentulousNCT01909999

Release of Osteogenic Markers in Immediately and Non-loaded Dental Implants

A study testing Osteogenic markers Evaluation, Clinical parameters evaluation and Implant instalation in people with Jaw, Edentulous, run by Renato Correa Viana Casarin at 1 site in Brazil.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The aim of this study was to compare the release of the osteoprotegerin (OPG), transforming growth factors (TGF-α), osteocalcin (OCN), osteopontin (OPN), and parathyroid hormone (PTH) during osseointegration of dental implants with and without immediate loading. Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
Conditions the study is for
Jaw, Edentulous
What is being tested?
Osteogenic markers Evaluation, Clinical parameters evaluation and Implant instalation
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteBrazil
Study dates
Mar 2010to Dec 2012
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • patients with mandibular and/or maxillary edentulous arch indicated for rehabilitation with dental implants
  • extractions had to occur at least 4 months prior to treatment
  • good oral hygiene (plaque index < 20%) (Ainamo \& Bay, 1975)
  • age between 18-65 years

Who cannot join

  • presence of systemic disease (including diabetes, arthritis, hypothyroidism, osteoporosis, etc) or use of medication (six months prior to the study) that contraindicated placement or alter implants osseointegration
  • use of anti-inflammatory three months before surgery
  • patients submitted to bone grafts in the site selected for the implant
  • pregnant or breastfeeding women
  • smokers or ex-smokers

Trial locations and contacts

1 site in 1 country.

Brazil1 site
  • Faculty of Dentistry - Paulista University

    São Paulo, São Paulo, 04026-002

Other trials in Brazil

About this study

The aim of this study was to compare the release of the osteoprotegerin (OPG), transforming growth factors (TGF-α), osteocalcin (OCN), osteopontin (OPN), and parathyroid hormone (PTH) during osseointegration of dental implants with and without immediate loading. Forty patients were selected and randomly divided into: Group IM - implant and prosthesis placement within 72 hours; and Group NL - implant insertion and no prosthesis placement during 120 days. Peri-implant crevicular fluid (PICF) was collected immediately after implant insertion and with 7, 15, 30, 60, 90, and 120 days after surgery and were evaluated levels of OPG, TGF-α, OCN, OPN and PTH using Luminex assay. Clinical aspects (Sulcus bleeding and peri-implant probing depth) were also assessed. The data were compared using the ANOVA/Tukey and Friedman/Mann-Whitney tests (α=5%).

Read the detailed description

This was a prospective, parallel and controlled clinical-laboratory trial. The population evaluated in this study was selected at the Graduate Clinic in Dental Implantology - UNIP-SP.

The selected patients were randomly allocated (by a computer generated list) into:

Group IM - (n = 20) - patients who received placement of implants and prosthesis within a period of 3 days, characterizing immediate loading implants protocol; Group NL - (n = 20) - patients who received single-stage dental implants with no placement of dental prostheses within a period of 4 months, characterizing non-loading implants;

The surgeries, as well as all postoperative follow-up, were performed at the dental clinic of UNIP-SP. Surgical areas were anesthetized (2% mepivacaine with 1:100,000 epinephrine) and mucoperiosteal incisions in the alveolar ridge mucosa were made. The surgical sequence follow the protocol described by the implant company supplier of implants (SIN - São Paulo, SP, BR). In all cases, for maxilla rehabilitation, 6 implants were installed, while, for mandible, 5 were used. Soft-tissue was sutured with simple interrupted sutures using absorbable polygalactin 910 suture. Postoperative care were: amoxicillin 500 mg (8-8 hours/7 days); sodic dipyrone 500mg (6-6 hours/3 days); 0.12% Chlorhexidine mouthwash (12-12 hours/10 days).

The patients in the IM Group received Brånemark full arch prosthesis within 3 days after the implant. All prosthesis used straight mini-abutments (SIN, São Paulo, SP) and received occlusal adjustment and a monthly clinical monitoring (including modified bleeding on probing and peri-implant probing depth).

Evaluation of osteogenic markers The collection of peri-implant crevicular fluid (PICF) was performed immediately after implant insertion (Baseline) and after 7, 15, 30, 60, 90 and 120 days. The site to be collected was dried and isolated with sterile gauze. PICF was collected at four sites per implant using absorbent paper strips (Periopaper, Oralflow, Smithtown, New York). The volume of fluid was measured immediately with the aid of Periotron (Oraflow, Smithtown, New York) and conditioned at 400uL of PBS buffer + 0.05% Tween and then frozen at -80°C.

The levels of the peri-implant osteogenic markers (OPG, OCN, OPN, TGF-α, and PTH) were determined using the LUMINEX/Magpix system (HBN1A-51K and HCCBP1MAG-58K, Millipore Corporation, Billerica, MA, USA). The samples were analyzed individually and the levels were estimated using a 5-parameter polynomial curve in the Xponent® software (Millipore Corporation, Billerica, MA). The concentration values were expressed in pg/ml.

Statistical Analysis The null hypothesis considered in the study was the absence of difference in the peri-implant osteogenic markers concentration between the different loading protocols. For data analysis, the statistical program was used (SAS release 9.1, 2003, SAS Institute Inc., Cary, NC, USA). The demographic and clinical data were compared between the groups using Student's t-test (age), and Fisher's Exact test (gender and site of implants). The data on the levels of osteogenic markers were first analyzed for homogeneity using the Shapiro-Wilk test, which indicated non-normal distribution. Thus, the nonparametric tests - Friedman for intragroup and Mann-Whitney for intergroup analysis, were performed. All the analysis considered α=5%.

Conditions
Jaw, Edentulous
Being tested
Osteogenic markers Evaluation, Clinical parameters evaluation, Implant instalation, Prosthesis installation, Suture
Keywords
Dental Implants, Osseointegration, Immediate Dental Implant Loading, Bone formation
Medical subject headings
Jaw, Edentulous

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Osteogenic markers EvaluationProcedure or surgery

    Also called Osteoprotegerin, Osteopontin, Osteocalcin, PTH

    The collection of peri-implant crevicular fluid (PICF) was performed immediately after implant insertion (Baseline) and after 7, 15, 30, 60, 90 and 120 days. The site to be collected was dried and isolated with sterile gauze. PICF was collected at four sites per implant using absorbent paper strips (Periopaper, Oralflow, Smithtown, New York). The volume of fluid was measured immediately with the aid of Periotron (Oraflow, Smithtown, New York) and conditioned at 400uL of PBS buffer + 0.05% Tween and then frozen at -80°C.

    The levels of the peri-implant osteogenic markers (OPG, OCN, OPN, TGF-α, and PTH) were determined using the LUMINEX/Magpix system (HBN1A-51K and HCCBP1MAG-58K, Millipore Corporation, Billerica, MA, USA).

  • Clinical parameters evaluationProcedure or surgery

    Also called Peri-implant probing depth, Bleeding index

    The following parameters were assessed:

    1. Peri-implant sulcus depth (PISD): distance from the margin of the peri-implant mucosa to the bottom of the peri-implant sulcus;
    2. Modified Bleeding on Probing Index: the presence or absence of bleeding after 10 seconds on probing around implants.
  • Implant instalationProcedure or surgery

    Also called Dental implants, Jaws rehabilitation

    The surgeries, as well as all postoperative follow-up, were performed at the dental clinic of UNIP-SP. Surgical areas were anesthetized (2% mepivacaine with 1:100,000 epinephrine) and mucoperiosteal incisions in the alveolar ridge mucosa were made. The surgical sequence follow the protocol described by the implant company supplier of implants (SIN - São Paulo, SP, BR). In all cases, for maxilla rehabilitation, 6 implants were installed, while, for mandible, 5 were used.

  • Prosthesis installationProcedure or surgery

    Also called Brånemark protocol, Full arch rehabilitation, Implant supported prosthesis

    The patients in the IM Group received Brånemark protocol prosthesis within 3 days after the implant. The implants were first molded and the models sent for prosthesis confection (LABDENTAL, São Paulo, SP, Brazil). All prosthesis used straight mini-abutments (SIN, São Paulo, SP), that ranged from 1mm to 4mm in height, whose were tightened with 20N of torque, followed by occlusal adjustment and clinical monitoring

  • SutureProcedure or surgery

    Soft tissues sutures were done using absorbable polygalactin 910 suture.

  • Post-operative careDrug

    Postoperative care were: amoxicillin 500 mg (8-8 hours/7 days); sodic dipyrone 500mg (6-6 hours/3 days); 0.12% Chlorhexidine mouthwash"

Study groups in NCT01909999
Study groupRoleWhat they receive
Immediate loading implantsExperimentalThe clinical and immunological comparisons compared implants that received Immediate loading prosthesis, i.e., full arch Branemark protocol prosthesis installed within 3 days after surgery, with unloaded implants.
Receives: Procedure: Osteogenic markers Evaluation; Procedure: Clinical parameters evaluation; Procedure: Implant instalation; Procedure: Prosthesis installation; Procedure: Suture; Drug: Post-operative care
Unloaded ImplantsActive comparatorThe variables, immunological and clinical, obtained in immediate loading groups were compared to unloaded implants, i.e., no prosthetic rehabilitation during osseointegration.
Receives: Procedure: Osteogenic markers Evaluation; Procedure: Clinical parameters evaluation; Procedure: Implant instalation; Procedure: Suture; Drug: Post-operative care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Ostegenic markers concentration

    The collection of peri-implant crevicular fluid (PICF) was performed immediately after implant insertion (Baseline) and after 7, 15, 30, 60, 90 and 120 days. The site to be collected was dried and isolated with sterile gauze. PICF was collected at four sites per implant using absorbent paper strips (Periopaper, Oralflow, Smithtown, New York). The volume of fluid was measured immediately with the aid of Periotron (Oraflow, Smithtown, New York) and conditioned at 400uL of PBS buffer + 0.05% Tween and then frozen at -80°C.

    The levels of the peri-implant osteogenic markers (OPG, OCN, OPN, TGF-α, and PTH) were determined using the LUMINEX/Magpix system (HBN1A-51K and HCCBP1MAG-58K, Millipore Corporation, Billerica, MA, USA). The samples were analyzed individually and the levels were estimated using a 5-parameter polynomial curve in the Xponent® software (Millipore Corporation, Billerica, MA). The concentration values were expressed in pg/ml.

    Measured: The osteogenic markers were assessed immediatelly after implant installation until 120 days after prothesis instalation

Secondary outcomes (2)
  1. Peri-implant sulcus depth (PISD)

    The PISD parameter is part of the clinical examination done at implants included in this research. PISD was performed using a plastic probe (Colorvue, Hu-Friedy, Chicago, USA) by a single examiner (AJP), at the 2 most anterior implants in the protocol. For its determination 4 regions per implant - mesial-buccal (MB), mesial-lingual (ML), disto-buccal (DB) and disto-lingual (DL) regions - were used. The calibration of the examiner was performed on 2 different days, at least 24 hours apart, by peri-implant examination (peri-implant probing depth) in 10 non-participating subjects. The intraclass correlation index for this variable was 85%.

    The Peri-implant sulcus depth (PISD) was defined as: distance from the margin of the peri-implant mucosa to the bottom of the peri-implant sulcus;

    Measured: The PISD was assessed from 30 days after implants installation until 120 days after implant/prothesis installation

  2. Modified Bleeding on Probing Index (MBPI)

    The same examiner performing PISD did the Modified Bleeding on Probing Index, determined as the presence or absence of bleeding after 10 seconds on probing around implants.

    Measured: The MPBI index was evaluated from 30 days after implants/prothesis installation and at 60, 90 and 120 days.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jul 2013 (estimated)
  2. Study startMar 2010
  3. Primary completionOct 2012
  4. Study completionDec 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Screening
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01909999
Sponsor's protocol ID
AJP2012
Status last verified
Jul 2013
First submitted
22 Jul 2013
Last updated
29 Jul 2013
Results posted
No
Data monitoring committee
No

Publications

  • Sato R, Matsuzaka K, Kokubu E, Inoue T. Immediate loading after implant placement following tooth extraction up-regulates cellular activity in the dog mandible. Clin Oral Implants Res. 2011 Dec;22(12):1372-8. doi: 10.1111/j.1600-0501.2010.02118.x. Epub 2011 Mar 8.

    PubMed 21382088
  • Reile H, Birnbock H, Bernhardt G, Spruss T, Schonenberger H. Computerized determination of growth kinetic curves and doubling times from cells in microculture. Anal Biochem. 1990 Jun;187(2):262-7. doi: 10.1016/0003-2697(90)90454-h.

    PubMed 2382827
  • Branemark PI, Engstrand P, Ohrnell LO, Grondahl K, Nilsson P, Hagberg K, Darle C, Lekholm U. Branemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res. 1999;1(1):2-16. doi: 10.1111/j.1708-8208.1999.tb00086.x.

    PubMed 11359307
  • Prati AJ, Casati MZ, Ribeiro FV, Cirano FR, Pastore GP, Pimentel SP, Casarin RC. Release of bone markers in immediately loaded and nonloaded dental implants: a randomized clinical trial. J Dent Res. 2013 Dec;92(12 Suppl):161S-7S. doi: 10.1177/0022034513504951. Epub 2013 Oct 24.

    PubMed 24158337

Questions about this trial

What is this clinical trial studying?

A study testing Osteogenic markers Evaluation, Clinical parameters evaluation and Implant instalation in people with Jaw, Edentulous, run by Renato Correa Viana Casarin at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jul 2013. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Ostegenic markers concentration (time frame: The osteogenic markers were assessed immediatelly after implant installation until 120 days after prothesis instalation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01909999, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2013.

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