Alveolar Ridge Collapse Clinical Trial
Official title:
Post-extraction Volumetric Analysis of Alveolar Ridge Contour Using Subepithelial Connective Tissue Graft in Esthetic Zone: A Randomized Controlled Clinical Trial
This study will monitor the effect of soft tissue augmentation using sub-epithelial connective tissue graft buccal to extraction sockets in anterior maxilla in thin dento-alveolar phenotype; and will evaluate whether it will enhance the alveolar ridge contour and improve the gingival phenotype following atraumatic extraction compared with no treatment at all in terms of Ridge contour Preservation for future esthetically acceptable fixed prothesis.
The aim of this study is to assess the alveolar ridge contour after soft tissue augmentation
using sub-epithelial connective tissue graft buccal to fresh extraction sockets in patient
with thin buccal bone, versus atraumatic extraction with no soft tissue augmentation.
Group A: Patients receiving atraumatic extraction with soft tissue augmentation by
sub-epithelial connective tissue graft buccal to extraction sockets.
Group B: Patients receiving normal atraumatic extraction with no soft tissue augmentation
Clinical examination:
- Evaluation of the patient's general condition of the oral cavity, to make sure it
complies with the criteria required to be enrolled in the study in terms of oral hygiene
and pathological conditions.
- Evaluation of the buccal bone thickness using CBCT as diagnostic aid. (After CBCT if the
patient was excluded because of thick buccal bone, he/she will be referred for implant
placement)
- Evaluation of gingival phenotype before extraction using visual technique via
periodontal probe.
- After patient enrollment, full mouth scaling to be done first and home oral hygiene
measures to be done by patient. At the day of the surgery, immediately before
extraction, an impression will be taken using alginate material and wax molded stock
tray for recording the original ridge contour as the baseline data. casts will be made
with dental extra hard stone.
Surgical procedure:
After administration of local anesthesia, the tooth will be extracted without raising flaps,
as atraumatic as possible without disturbing the papillary tissues. After the extraction of
the tooth, the socket will be carefully cleaned to excavate the granulation tissue in the
marginal and apical regions.
Group A will receive atraumatic extraction and soft tissue augmentation using SCTG harvested
from palatal tissue by single line incision technique blade will be oriented perpendicular to
the palatal tissue surface. A single incision will be made down to the bone in a horizontal
direction approximately 2 to 3 mm apical to the gingival margin of the maxillary teeth. A
partial thickness dissection will then be made within the single incision, leaving an
adequate thickness of the palatal flap intact to minimize the chance of sloughing of the
overlying tissue. Careful manipulation of the graft with tissue forceps will be required and
care must be taken to prevent compression or tearing of the graft.
The fatty tissue (yellow in color) will be eliminated and some contouring of the graft will
be done to fit the prepared envelope. The harvested SCTG will be placed at the extraction
sites in a supra-periosteal partial dissection (pouch II technique) prepared at the buccal
aspect without using vertical incisions and without flap elevation. Sutures will be used to
stabilize the graft in its desired place.
Pouch II technique:
A SCTG with a minimum thickness of 1.5 mm will be harvested from the palate. Following
extraction, a full-thickness envelope flap will be created between the facial bone plate and
the overlying gingiva. The SCTG will be inserted into the prepared envelope and secured with
resorbable suture material. The apico-coronal dimension of the SCTG will be standardized
throughout all the cases.
Group B will receive atraumatic extraction with no soft tissue augmentation.
(All patients assigned to the study will be referred to receive Prosthesis after treatment.)
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