Dental Caries Clinical Trial
Official title:
The Caries Prevention Effect of Surface Pre-reacted Glass-ionomer Filler Incorporated in Denture Base Resins on Edentulous Elderly People
The purpose of this study is to determine whether a novel material of S-PRG fillers containing in a daily-used resin denture base and their capability of fluoride release and recharge to elevate the salivary fluoride level and prevent dental caries in Thai middle-aged patients between 35-60 years of age who wear the resin denture.
The study design is a 1.5-year, double blind randomized clinical trial, with 150 volunteers
between 35-60 years of age wearing palatal removable partial denture containing with/without
S-PRG fillers. This study will be performed in 3 local government hospitals located around
Bangkok metropolitan, Ministry of Public Health, Thailand. The subjects will be assigned to
the control group; resin denture base containing without S-PRG fillers and the experimental
group; resin denture base containing 20% by weight of S-PRG fillers. Two parameters we can
measure are; (1) Salivary fluoride level, accessed at different time point; on day 1, 14, 15
and at 3, 12 months after wearing the denture, and (2) Caries incidence using ICDAS-II, taken
at 18 months.
Regarding an agreement with the participating dentists and dental assistants in the
hospitals, patients in the waiting list of removable partial denture are screened according
to our eligible criteria. If they meet eligibility criteria, a complete description is
follow:
"If you agree to participate in the study, at today's visit we will ask you some questions
about your medical and dental health such as what medication that you are presently taking,
and whether you use fluoride supplement except for toothpaste. You do not have to answer
every question. The dentist will do a brief examination of your mouth looking to see if you
have any decay. You will not be able to participate in this study if you have obvious
untreated tooth decay.
Following completion of the questionnaire and examination, we will do a simple test on your
saliva. We will collect stimulated saliva by having you to chew a piece of wax for 5 minutes.
You will spit all the saliva formed during those 5 minutes into a cup. We will measure the
volume of the saliva produced. You will have to have a normal flow rate to participate.
Collecting this information, doing the saliva test, and completing the dental examination
will take about 30 minutes of today's appointment. You may refuse to participate in any of
the saliva test or answer any question or item in the questionnaire. If that is the case, you
will not qualify for the study. If you do qualify and agree to take part, the dentist will
take a mold of your mouth to make an upper resin denture to replace your missing teeth for
you to wear. This is a routine dental procedure. Some subjects may gag while the mold is
being taken for the denture. The dentist has methods to help you control the gagging reflex.
Depending on which group you are assigned, your resin denture will be made from standard
material or the standard material containing some new type of biological material. This new
material we are testing is being used in the formulation of dental product as filling
materials.
At the next appointment, approximately two week later, you will come in to have the denture
fitted for you. Slight discomfort may occur at the gum margin where the denture can pinch.
The plate will be adjusted to relieve any pinching. On rare occasions, allergy to the resin
denture base may occur. We will stop your participation in the study if you have an allergy
to the resin denture.
We will give you the resin denture and need you to wear it all day excluding when you sleep
at night. You must take it out to brush your teeth. You may clean the denture with water and
the same toothbrush that you use to brush your teeth before keeping the denture in the
denture storage box. We do not want you to use anything else on the denture except material
we supply. You will receive a box for keeping your denture, toothbrush and toothpaste to
brush your teeth at home.
At the first 14 days once you receive the denture, we do want you to soak your denture in a
denture storage box containing tap water every night when you sleep. After that we will
supply you a tube of fluoride gel for storing the denture instead of tap water. We will ask
you to apply the gel (approximately 1 cm of length) to the denture and spread out totally on
both side of the denture before keeping in the denture box during sleeping every night for
1.5 years.
After wearing the denture, you will be asked to return to the clinic for check-up and recall.
We will collect your saliva while wearing the denture periodically for a total of six times
within one year according to our schedule for the analysis of the fluoride level.
At 1.5 years, you will be asked to return to the clinic and the dentist will do a dental
examination for follow-up. That will conclude your participation in the study.
We will assess the salivary fluoride at different time point during 1 year. The fluoride
level of saliva will show us the capability of the new material on the fluoride release and
recharge. The follow up period will be extended for 6 more months. The caries information
collected at 1.5 years will show us the incidence of new caries. All procedures will be done
at the dental clinic of the hospital. The subjects will be identified by a number assigned
only. The principle investigator and the project coordinator will have to access to the code
which will remain locked at all time. The saliva collected from the subjects will be
discarded immediately after complete analysis.
The sample size assessment is considered based on the long term outcome, caries incidence,
and the short term outcome, salivary fluoride concentration, of the study. The optimal sample
size to address both outcomes in the study and allow for a 20% drop out rate would be 75
subjects per group (150 total) to provide sufficient statistical power to detect the
difference in mean caries incidence between the control and the intervention group.
Collected data will be entered into a computer database and analyzed with STATA software
version 12 for Windows. The statistical significance level will be set at α = 0.05.
The analysis plan for salivary fluoride level at each phase of follow up is based on
two-sample t test and linear regression adjusting for confounders (age, number of remaining
teeth).
Data analysis for caries incidence will be recorded per surface using ICDAS-II severity
scores at 1.5 years. The caries outcome is defined as score 1 to 6 and 1 to 2 for root
caries. Two-sample t test or linear regression with adjusting for age will be performed to
assess the different between the control and the intervention group in the mean number of new
surface caries (dmfs) ± standard deviations at 1.5 years follow-up examination.
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