RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE- II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
DR. NEETHA DONTHNENI 1. NAME OF THE CANDIDATE THE OXFORD DENTAL COLLEGE HOSPITAL AND ADDRESS AND RESEARCH CENTER,
HOSUR ROAD, BOMMANAHALLI,
BANGALORE -560068
NAME OF THE INSTITUTION THE OXFORD DENTAL COLLEGE 2.
HOSPITAL AND RESEARCH CENTER,
BANGALORE.
MASTER OF DENTAL SURGERY, 3. COURSE OF THE STUDY AND SUBJECT
PERIODONTICS
MAY 28, 2007
4. DATE OF ADMISSION TO COURSE
HEALING OF DEHISCENCE TYPE DEFECTS 5. TITLE OF THE TOPIC AROUND IMPLANTS MANAGED WITH GUIDED
BONE REGENERATION :A CLINICAL AND
RADIOLOGICAL EVALUATION 6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Edentulous jaw restoration with artificial endosteal anchorage has revolutionized dental practice in past 25 years. The advent of osseointegration and advances in biomaterials and techniques has contributed to increased application of dental implants in restoration of partial and completely edentulous patients. However, insufficient height and width of the alveolar bone at implantation site as a result of trauma, extraction of teeth with periodontal disease or apical lesions, hinders the feasibility of such procedures. Placement of implants or conventional fixed prosthesis without careful treatment planning and due considerations of hard and/or soft tissue defects may lead to a compromise in functional, structural or esthetic aspects of final prosthesis. Guided bone regeneration is indicated for augmentation of various osseous defects in maxilla and mandible. Successful guided bone regeneration depends on creation and maintenance of a space beneath the material to support cell migration. Bone grafting materials are used to help establish a space beneath the membrane. The one stage method of combining implant placement with guided bone regeneration has been applied much more frequently in clinical practice than two stage method using guided bone regeneration prior to implantation. The benefits of simultaneous approach are reduced number of surgical interventions, shortened treatment time, ideal implant placement and reduction of treatment costs. The purpose of present study is to evaluate clinically and radiologically, healing of dehiscence type defects around implants placed in conjunction with bone graft and barrier membrane. 6.2 REVIEW OF LITERATURE
Several techniques have been developed to increase bone volume for overcoming anatomic limitations of residual jaw bone crest, which frequently preclude the ideal placement of dental implants1. Animal studies have indicated that guided bone regeneration technique can be applied to defects associated with placement of dental endosseous implants and histological analysis revealed osseointegration in the area of newly formed bone2. Human studies showed overall survival rate of implants placed in horizontally augmented sites (fenestrations and dehiscences with immediate implants, horizontal augmentation with delayed implant placement) was 98%3. A multi-center study evaluated implants with dehiscence defects treated with guided bone regeneration. The cumulative survival rate was 85% in maxilla and 95% in mandible after two years of follow up4. In a comparative clinical study of healing of dehiscence type defects in implants placed together with different barrier membranes showed significant reduction of bony defects5. A study evaluating clinical and radiographic parameters of dental implants placed in combination with guided bone regeneration with barrier membranes demonstrated stable periimplant conditions upto 5 years after membrane protected osseous regeneration, with no significant differences in the radiographic bone level in regard to region, jaw or bone graft. The newly formed bone appeared to be able to withstand functional loading for upto 60 months6.
6.3 OBJECTIVES OF THE STUDY :
This study envisages the following objectives:
1- To evaluate clinically and radiologically bone gain in Garber’s class II or III ridge defects at 6 months. 2- To evaluate soft tissue healing at 6 months. MATERIALS AND METHODS 7.
7.1 SOURCE OF DATA
Ten patients aged between 25 to 45 years visiting Department of Periodontics, The Oxford Dental College Hospital and Research center, Bangalore requiring replacement of teeth will be taken up for a period of 1 year.
7.2 METHOD OF COLLECTION OF DATA
Inclusion criteria-
Patients aged between 25 to 45 years. Patients with adequate plaque control. Sound general health. Patients with maxillary and mandibular Garber’s class II or III localized alveolar ridge defects. Tooth or teeth extracted more than 3 months ago.
Exclusion criteria-
Extremely atrophic ridges (2 mm or less). Tobacco abuse (more than 15 cigarettes per day) Patients taking drugs known to interfere with wound healing like corticosteroids, anti-cancer drugs and immune modulators. Patients with systemic diseases like diabetes mellitus and anemia, infectious diseases like hepatitis, tuberculosis. STUDY DESIGN
MATERIALS:
Titanium biocompatible screw type endosseous implants.(Hi-Tec systems, Lifecare Devices) Surgical kit. Bilayer resorbable collagen membrane (PRO-GIDE)TM. Hydroxyapatite tricalcium phosphate alloplast (OSSIFI)TM
METHOD:
After patient selection, initial treatment plan will be established; basic periodontal therapy will be provided. Surgery is performed under local anesthesia. Ridge will be exposed with suitable incisions, a full thickness flap elevated. Implant osteotomy sites will be prepared by sequential cutting burs according to a surgical stent with reduced low speed and internally and/or externally irrigated drills. Implants will be placed into prepared sites with primary stability. Bone graft will be applied over exposed implant surfaces and covered with a membrane. Primary soft tissue closure will be achieved either by coronal advanced flap with periosteum nick or palatal advanced flap7. Sutures will be placed without tension. Clinical evaluation of soft tissue and alveolar ridge height and width measured by bone mapping8 with adjunctive use of intraoral periapical and panoramic radiographs at base line and at 6 months. All patients will be recalled every month with a total follow up period of 6 months. The results will be analyzed statistically by paired student t-test and ANOVA ( analysis of variance)
7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animals?
Yes, Routine blood investigations, radiological investigations like intraoral periapical and panoramic radiographs.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, a certificate attached. LIST OF REFERENCES: 8. 1) Roccuzzo M, Ramieri G, Bunino M, Berrone S. Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: a controlled clinical trial. Clin. Oral Impl. Res. 2007; 18: 286-294. 2) Dahlin C, Sennerby L, Lekholm U, Linde A, Nyman S. Generation of new bone around titanium implants using a membrane technique: An experimental study in rabbits. Int J Oral Maxillofac Implants 1989;4: 19- 25. 3) Chipasco M, Zaniboni M, Boisco M. Augmentation procedures for rehabilitation of deficient edentulous ridges with oral implants. Clin. Oral Impl. Res. 2006; 17: 136-159. 4) Dahlin C, Lekholm U, Becker W, Becker B, Higuchi K, Callans A, vanSteenberghe D. Treatment of fenestration and dehiscence bone defects around oral implants using the guided bone regeneration technique: A prospective multicenter study. Int J Oral Maxillofac Implants. 1995; 10: 312-318. 5) Moses O, Pitaru S, Artzi Z, Nemcovsky CE. Healing of dehiscence-type defects in implants placed together with different barrier membrane: a comparative clinical study. Clin. Oral Impl. Res. 2005; 16: 210-219. 6) Lorenzoni M, Pertl C, Polansky RA, Jakse N, Wegscheider WA. Evaluation of implants placed with barrier membranes. Clin.Oral Impl.Res. 2002; 13:274-280. 7) Goldstein M, Boyan BD, Schwartz Z. The palatal advanced flap: a pedicle flap for primary coverage of immediately placed implants. Clin. Oral Impl. Res. 2003; 13: 644-650. 8) Allen F, Smith DG. An assessment of the accuracy of ridge mapping in planning implant therapy for the anterior maxilla. Clin. Oral Impl. Res. 2000; 11: 34-38. 9. Signature of the Candidate
10. Remarks of the Guide
11. Name & Designation of DR. C. D. DWARAKANATH,
11.1 Guide PROFESSOR AND HEAD
DEPARTMENT OF PERIODONTICS.
11.2 Signature
11.3 Co-Guide
11.4 Signature DR.C.D. DWARAKANATH,
PROFESSOR AND HEAD
11.5 Head of Department DEPARTMENT OF PERIODONTICS.
11.6 Signature
12. 12.1 Remarks of the Chairman & Principal
12.2 Signature