Genotoxicity Assessment of Dental Implants in Gingival Epithelial Cells

Genotoxicity Clinical Trial

Official title:

Genotoxicity Assessment of Dental Implants in Gingival Epithelial Cells

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04540991
• Other study ID #: 003-08/20-03/0005
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: March 10, 2020
• Est. completion date: April 25, 2022

Study information

• Verified date: September 2020
• Source: University of Zagreb
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Due to the strong correlation between genotoxicity and carcinogenesis, it is necessary to clarify the potential genotoxic effects of titanium dental implant systems. As most dental materials release small amounts of several elements into the oral cavity, proper regulations have to guarantee that the concern from genotoxicity/mutagenicity of dental materials is annulated or at the lowest possible level. Thus, further biocompatibility records are needed in order to evaluate the comprehensive risks of these compounds. In a view of the above-mentioned data, the aim of this in vivo study is to evaluate genotoxic and cytotoxic potential of implants and gingiva formers from two different implant systems in gingival epithelial cells.

Exfoliated gingival cells will be taken from 80 participants before and after 90 days of dental implant insertion, and 21 days following gingiva former placement. DNA damage will be analyzed using the micronucleus test. Tested dental implants will be Ankylos and Dentium, with corresponding gingival former.

Description:

Patients are divided into two groups depending on the dental implant system used in the therapy. Ankylos dental implants (Dentsplay Sirona, Charlotte, USA) are used in the first group of patients and Dentium SuperLine (Dentium Co., Seoul, Korea) in the second group.

The implants are placed in accordance with each implant system manufacturer's instructions and the treatment were performed according to the patient's standards and indications. Surgical procedures on all patients are performed by the same operator with the same surgical approach, protocol and instrumentation.

The surgeries are performed under local anesthesia and systemic antibiotics were given according to standard procedure. To ensure post-surgical oral hygiene, patients are advised to rinse the oral cavity with chlorhexidine until the day of sutures' removal. The sutures are removed10 day after implantation. The implants are healing by being submerged for 12 weeks based on the surgeon's clinical judgment, indications given and the need and preference of the patients. After healing, gingiva formers are placed.

Sample collection and a micronucleus assay in gingival epithelial cells To reduce individual variations, patients are observed longitudinally and each subject is served as their own control. Samples of gingival epithelial cells are collected from each participant's implementation site using the swab technique at three different time points: a control swab is taken just before the placement of the dental implant (T0); the second swab is taken 90 days after implantation meaning immediately before placement of the gingiva former (T1); and the third swab is taken 21 days after placement of the gingiva former (T2).

One hour before the sampling, the participants abstain from consuming any food and drinks. After rinsing of the oral cavity 3 times with tepid water to remove exfoliated cells, a T0 swab is taken by gently brushing the gingiva around place indicated for implant placement and later T1 and T2 around implant with a cytobrush (Cytobrush Plus; GmbH. Dietramszell-Linden, Germany). The samples are subsequently applied to coded laboratory glass slides.

The cells applied to microscopic slides are allowed to air-dry and fixed in methanol (80% v/v) at 4°C for 20 minutes. Staining is conducted with 5% Giemsa solution for 10 minutes. Afterward, the slides are rinsed with aqua distillate and air dry. The slides are examined under Olympus CX40 light microscope (Olympus. Tokyo. Japan) with 400× magnification, and each micronucleus and other nuclear anomalies are additionally verified under 1000× magnification. Two replicate slides are prepared for each subject and 1000 epithelium cells per preparation were analyzed for each sampling time.

Nuclear anomalies, such as micronucleus, karyorrhexis (nuclear disintegration indicating apoptosis), karyolysis (dissolution of the nucleus mostly indicating necrosis and apoptosis), pyknosis (nuclear shrinkage due to apoptosis), condensed chromatin (DNA complexed with proteins and apoptosis), nuclear buds (precursors of micronuclei, or high density of DNA repair complexes) and broken eggs (nuclei that appear cinched, binucleated cells (indicating impaired velocity of cell proliferation)) are estimated and qualified.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 80
• Est. completion date: April 25, 2022
• Est. primary completion date: March 20, 2021
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• absence of a single tooth in the mandibular molar or premolar region

• belonging to ASA I or ASA II group

• absence of titanium hypersensitivity

• absence of prosthetic restoration/replacement or orthodontic appliances in the oral cavity, -absence of oral precancerous lesions

• no history of radiation in the head and neck area

• absence of bisphosphonates and corticosteroids used in therapy.

Exclusion Criteria:

• presence of systemic disease (e.g. uncontrolled diabetes, oral mucosal diseases, untreated gingivitis and periodontitis, endodontic lesions)

• pocket depths = 4 mm on adjacent teeth

• bruxism

• poor oral hygiene

• pregnant and lactating women

• taking of antibiotics in the last three months

• taking any other pharmaceutics that have been proved to elevate DNA damage,

• underwent medical radiation diagnostics

• using mouthwash that contain alcohol

• history of radiation in the head and neck area.

Related Conditions & MeSH terms

• Genotoxicity

Intervention

Procedure:
• implant placement
The implants are placed in accordance with each implant system manufacturer's instructions and the treatment were performed according to the patient's standards and indications. Surgical procedures on all patients are performed by the same operator with the same surgical approach, protocol and instrumentation.
• gingiva former placement
Gingiva former are placed in accordance with each implant system manufacturer's instructions and the treatment were performed according to the patient's standards and indications. Surgical procedures of oppeninf implant cower and gingiva former placement on all patients are performed by the same operator with the same surgical approach, protocol and instrumentation.

Diagnostic Test:
• Collecting gingival epithelial cellsusing the swab technique
Samples of gingival epithelial cells are collected from each participant's implementation site using the swab technique at three different time points: a control swab is taken just before the placement of the dental implant (T0); the second swab is taken 90 days after implantation meaning immediately before placement of the gingiva former (T1); and the third swab is taken 21 days after placement of the gingiva former (T2).

Locations

Country	Name	City	State
Croatia	School of Medicine, University of Split	Split

Sponsors (1)

Lead Sponsor	Collaborator
Daniel Jerkovic

Country where clinical trial is conducted

Croatia, 

References & Publications (22)

Ankylos | Dentsply Sirona [Internet]. Dentsplysirona.com. 2020 [citirano 21.6.2020]. Dostupno na: https://www.dentsplysirona.com/enus/categories/implantology/ankylos.html

Berglund F, Carlmark B. Titanium, sinusitis, and the yellow nail syndrome. Biol Trace Elem Res. 2011 Oct;143(1):1-7. doi: 10.1007/s12011-010-8828-5. Epub 2010 Sep 1. — View Citation

Brånemark PI, Hansson BO, Adell R, Breine U, Lindström J, Hallén O, Ohman A. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl. 1977;16:1-132. — View Citation

Broggini N, McManus LM, Hermann JS, Medina R, Schenk RK, Buser D, Cochran DL. Peri-implant inflammation defined by the implant-abutment interface. J Dent Res. 2006 May;85(5):473-8. — View Citation

Camacho-Alonso F, Sánchez-Siles M, Gilbel-del Águila O. No Evidence of Genotoxic Damage in a Group of Patients with Titanium Dental Implants and Different Metal Restorations in the Oral Cavity. Clin Implant Dent Relat Res. 2015 Aug;17(4):811-21. doi: 10.1111/cid.12163. Epub 2013 Oct 17. — View Citation

de Barros Lucena GA, de Molon RS, Moretti AJ, Shibli JA, Rêgo DM. Evaluation of Microbial Contamination in the Inner Surface of Titanium Implants Before Healing Abutment Connection: A Prospective Clinical Trial. Int J Oral Maxillofac Implants. 2018 Jul/Aug;33(4):853-862. doi: 10.11607/jomi.5817. — View Citation

Harris BH, Kohles SS. Effects of mechanical and thermal fatigue on dental drill performance. Int J Oral Maxillofac Implants. 2001 Nov-Dec;16(6):819-26. — View Citation

Holland N, Bolognesi C, Kirsch-Volders M, Bonassi S, Zeiger E, Knasmueller S, Fenech M. The micronucleus assay in human buccal cells as a tool for biomonitoring DNA damage: the HUMN project perspective on current status and knowledge gaps. Mutat Res. 2008 Jul-Aug;659(1-2):93-108. doi: 10.1016/j.mrrev.2008.03.007. Epub 2008 Apr 11. Review. — View Citation

Karahalil B, Kadioglu E, Tuzuner-Oncul AM, Cimen E, Emerce E, Kisnisci RS. Micronucleus assay assessment of possible genotoxic effects in patients treated with titanium alloy endosseous implants or miniplates. Mutat Res Genet Toxicol Environ Mutagen. 2014 Jan 15;760:70-2. doi: 10.1016/j.mrgentox.2013.10.005. Epub 2013 Nov 1. — View Citation

Makihira S, Mine Y, Nikawa H, Shuto T, Iwata S, Hosokawa R, Kamoi K, Okazaki S, Yamaguchi Y. Titanium ion induces necrosis and sensitivity to lipopolysaccharide in gingival epithelial-like cells. Toxicol In Vitro. 2010 Oct;24(7):1905-10. doi: 10.1016/j.tiv.2010.07.023. Epub 2010 Aug 1. — View Citation

Maloney WJ, Smith RL, Castro F, Schurman DJ. Fibroblast response to metallic debris in vitro. Enzyme induction cell proliferation, and toxicity. J Bone Joint Surg Am. 1993 Jun;75(6):835-44. — View Citation

Okuda-Shimazaki J, Takaku S, Kanehira K, Sonezaki S, Taniguchi A. Effects of titanium dioxide nanoparticle aggregate size on gene expression. Int J Mol Sci. 2010 Jun 7;11(6):2383-92. doi: 10.3390/ijms11062383. — View Citation

Oshida Y, Tuna EB, Aktören O, Gençay K. Dental implant systems. Int J Mol Sci. 2010 Apr 12;11(4):1580-678. doi: 10.3390/ijms11041580. Review. — View Citation

Piraccini BM, Urciuoli B, Starace M, Tosti A, Balestri R. Yellow nail syndrome: clinical experience in a series of 21 patients. J Dtsch Dermatol Ges. 2014 Feb;12(2):131-7. doi: 10.1111/ddg.12216. Epub 2013 Oct 18. — View Citation

Pjetursson BE, Zarauz C, Strasding M, Sailer I, Zwahlen M, Zembic A. A systematic review of the influence of the implant-abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin Oral Implants Res. 2018 Oct;29 Suppl 18:160-183. doi: 10.1111/clr.13362. — View Citation

Sidambe AT. Biocompatibility of Advanced Manufactured Titanium Implants-A Review. Materials (Basel). 2014 Dec 19;7(12):8168-8188. doi: 10.3390/ma7128168. Review. — View Citation

Souza JCM, Henriques M, Teughels W, Ponthiaux P, Celis JP, Rocha LA. Wear and corrosion interactions on titanium in oral environment: literature review. J Bio Tribo Corros. 2015;1:1-13.

Superline | Products | Dentium [Internet]. Dentiumusa.com. 2020 [citirano 21.6.2020.]. Dostupno na: http://dentiumusa.com/products/dentalimplant/superline.htm

Thomas P, Bandl WD, Maier S, Summer B, Przybilla B. Hypersensitivity to titanium osteosynthesis with impaired fracture healing, eczema, and T-cell hyperresponsiveness in vitro: case report and review of the literature. Contact Dermatitis. 2006 Oct;55(4):199-202. Review. — View Citation

Thomas P, Holland N, Bolognesi C, Kirsch-Volders M, Bonassi S, Zeiger E, Knasmueller S, Fenech M. Buccal micronucleus cytome assay. Nat Protoc. 2009;4(6):825-37. doi: 10.1038/nprot.2009.53. Epub 2009 May 7. — View Citation

Visalli G, Baluce B, La Maestra S, Micale RT, Cingano L, De Flora S, Di Pietro A. Genotoxic damage in the oral mucosal cells of subjects carrying restorative dental fillings. Arch Toxicol. 2013 Dec;87(12):2247-8. doi: 10.1007/s00204-013-1155-9. Epub 2013 Nov 16. — View Citation

Wang JJ, Sanderson BJ, Wang H. Cyto- and genotoxicity of ultrafine TiO2 particles in cultured human lymphoblastoid cells. Mutat Res. 2007 Apr 2;628(2):99-106. Epub 2006 Dec 15. — View Citation

* Note: There are 22 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Cytotoxic and/or genotoxic	Evaluation of the cytotoxic and genotoxic alterations in gingival epithelial cells after application of titanium-based dental implant system	1 year