A Clinical Trial of Dental Implants in Titanium-zirconium Alloy

Endosseous Dental Implant Failure Clinical Trial

Official title:

A Randomized Controlled Clinical Trial of Dental Implants in Titanium-zirconium Alloy

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT02681250
• Other study ID #: TiZir
• Status: Recruiting
• Phase: N/A
• Start date: February 1, 2015
• Est. completion date: July 2021

Study information

• Verified date: November 2019
• Source: Vastra Gotaland Region
• Contact: Kristina Hultin, Dentist
• Phone: 010-4419590
• Email: kristina.e.hultin[@]vgregion.se
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A Randomized controlled Clinical trial which aim is to investigate the clinical outcome of dental implants in titanium-zirconium alloy compared to traditional titan-4 implants. The hypothesis is set to no difference in the clinical outcome for the two types of implants. Preliminary estimation of 96 patients needed. A pilot study will provide us with further data in order to more accurately specify the sample number."

Description:

Background

Implants have been used for the purpose of replacing lost teeth since the 1960s. Since then, the treatment of edentulism with dental implants has been implemented in a large scale. The main reason for this is that research has shown that treatment with implants are very predictable in terms of implant survival. The accumulated knowledge, as seen from 15 and 20 year follow-ups, has been based on prerequisites that are not always followed today. One of them is that the implants used in the aforementioned studies are manufactured in titanium that has good rigidity and is used as the main implant material today. In addition, the studies have examined implants with a turned surface. This standard revised in the mid 1990s when a series of studies showed increased and accelerated osseous ingrowth of implants with a moderate raw surface that had been achieved by blasting. The related biological events describing this process have been described in detail in the literature.

Today, other materials are being explored as an alternative to the well documented implant material titanium with a focus on finding a material with higher stiffness combined with equivalent biological characteristics. A stiffer material theoretically gives possibilities for implants installations without bone augmentation in cases with reduced bone volumes.

An alternative implant material which has reached the clinic is titanium-zirconium alloy. It has been shown to have an increased rigidity in comparison with titanium and comparable biological characteristics but the documentation consists mainly of animal studies and short term clinical follow-up in the form of case-series. Since it has been demonstrated that the choice of implant material may influence osseointegration, it is necessary to evaluate the implants made of titanium-zirconium in a clinical controlled study with long-term follow-up in which the emphasis is put on the clinical outcome.

Aims

The aim of the study is to compare the clinical outcome of implants made of titanium-zirconium with a proven implants made of titanium.

The scientific question in this project is if there are differences in the clinical outcomes of an implant made of titanium and a corresponding implants in titanium-zirconium alloy.

Materials and Methods

Patients referred for implant treatment at the Department of Prosthodontics, Specialisttandvården Borås will be asked to participate in the study and provide written consent after review of delivered information sheet. Implants will be installed by two well experienced surgeons at Oral Maxillofacial Surgery att Borås Regional Hospital according to the protocol used for dental implant surgery and recommended by the manufacturer.

Two groups, matched for age and gender, will be defined after block randomisation for smoking. The test group will receive titanium-zirconium implants and the control group titanium implants. For a power of 80% and for p < 0.05, (SD = 1.66 according to previous studies, estimates made from 1 mm difference in margin bone level between the groups), the size of the groups has been defined as 44 patients per group. The investigators anticipate a loss of approximately 10% and therefore, the investigators have increased each patient group to 48 individuals. The data collection is completed when the number of patients has been reached.

The evaluation will involve no additional clinical or radiological examinations as compared to the usual procedures. Normally, this means examination and therapy planning, surgical examination, implant installation, impression, placement of prosthetic restoration, baseline X-ray, control/follow-up tightening of prosthetic screw/hygiene monitoring. No additional time or costs arises in connection with participation in the study, the cost of both groups are equivalent.

National guidelines will be followed regarding possible need of antibiotic prophylaxis. Registration will be done with regard to history of periodontal disease, smoking, medication, and implant position in the jaw.

The data collection will take place at four different times: in connection with the placement of the prosthetic construction (baseline) and after 1.3 and 5 years. Standard x-ray examinations will be carried out to check the marginal bone level which will take place through individualized x-ray holders that will be produced by impression material (Putty). Registration of pocket depth, bleeding on probing, amount of keratinized mucosa and measurements on x-ray will be done by the same person. Prosthetic complications and possible total implant loss will be registered.

The marginal bone level for each implant will be presented as the average of the mesial and distal bone level (primary outcome). The mean value of pocket depth will be recorded for each implant at a 4-point measurement. The hypothesis is to be tested with the independent samples t-test.

The impact of restoration distance from the bone level, the effect of implant type, margin bone level, bleeding on probing and pocket depth will be controlled using regression analysis. SPSS is used for statistical analysis.

The hypothesis is that there are no differences in the clinical outcomes between the two types of implants.

Potential benefits of the Project

The investigators can conclude that the materials are equivalent if there is no difference between implant types available. Since, titanium-zirconium alloy has a higher stiffness than titan, the investigators will be able to provide patients with thinner implant and thus costly and painful treatments to optimize the width of the bone in the installation area should be avoided.

From a social perspective, if it turns out that titan-zirconium have equal or better clinical performance than titanium, can unnecessary healthcare costs for surgery for modulation of the surgical site in the form of augmentation or sinus elevation associated with implant treatment should be avoided. If optimizing surgery can be avoided, this means even shorter therapy times and increased availability by the released health time which can be used to more quickly treat other patients as possible had standing in line for their treatment. Limits can be found in the study's applicability in general dentistry because all operations are carried out at specialist clinic in which case the patient clientele and the processor's level of expertise is not fully comparable with the general dentist.

Research ethical considerations

Treatment with dental implants in titanium is a known treatment that has helped to restore good chewing function for many patients and years all over the world and can be thought of as a safe treatment with high success rates. The study protocol calls for no difference in the x-ray examination or the surgical protocol as compared to the procedures followed in regular treatment basis. In previous studies, there is no listing of suspected allergy to titanium-zirconium alloy.

Patient information and storage of personal data in accordance with the recommendations of the Board of ethical review.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 96
• Est. completion date: July 2021
• Est. primary completion date: December 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Inclusion Criteria:

• All patients in need for implant treatment

Exclusion Criteria:

• None

Related Conditions & MeSH terms

• Endosseous Dental Implant Failure

Intervention

Procedure:
• Titanium-zirconium
Titanium-zirconium implants will be installed according to the protocol earlier described in the detailed description.
• Titanium
Titanium implants will be installed according to the protocol earlier described in the detailed description.

Locations

Country	Name	City	State
Sweden	Specialisttandvården Borås	Borås

Sponsors (1)

Lead Sponsor	Collaborator
Vastra Gotaland Region

Country where clinical trial is conducted

Sweden, 

References & Publications (18)

Barter S, Stone P, Brägger U. A pilot study to evaluate the success and survival rate of titanium-zirconium implants in partially edentulous patients: results after 24 months of follow-up. Clin Oral Implants Res. 2012 Jul;23(7):873-81. doi: 10.1111/j.1600-0501.2011.02231.x. Epub 2011 Jun 24. — View Citation

Benic GI, Gallucci GO, Mokti M, Hämmerle CH, Weber HP, Jung RE. Titanium-zirconium narrow-diameter versus titanium regular-diameter implants for anterior and premolar single crowns: 1-year results of a randomized controlled clinical study. J Clin Periodontol. 2013 Nov;40(11):1052-61. doi: 10.1111/jcpe.12156. Epub 2013 Sep 8. — View Citation

Berglundh T, Abrahamsson I, Lang NP, Lindhe J. De novo alveolar bone formation adjacent to endosseous implants. Clin Oral Implants Res. 2003 Jun;14(3):251-62. — View Citation

Bougas K, Jimbo R, Vandeweghe S, Hayashi M, Bryington M, Kozai Y, Schwartz-Filho HO, Tovar N, Adolfsson E, Ono D, Coelho PG, Wennerberg A. Bone apposition to laminin-1 coated implants: histologic and 3D evaluation. Int J Oral Maxillofac Surg. 2013 May;42(5):677-82. doi: 10.1016/j.ijom.2012.11.008. Epub 2012 Dec 8. — View Citation

Brånemark PI, Adell R, Breine U, Hansson BO, Lindström J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg. 1969;3(2):81-100. — View Citation

Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: A systematic review and meta-analysis. J Dent. 2015 May;43(5):487-98. doi: 10.1016/j.jdent.2015.03.003. Epub 2015 Mar 14. Review. — View Citation

Ekelund JA, Lindquist LW, Carlsson GE, Jemt T. Implant treatment in the edentulous mandible: a prospective study on Brånemark system implants over more than 20 years. Int J Prosthodont. 2003 Nov-Dec;16(6):602-8. — View Citation

Gottlow J, Dard M, Kjellson F, Obrecht M, Sennerby L. Evaluation of a new titanium-zirconium dental implant: a biomechanical and histological comparative study in the mini pig. Clin Implant Dent Relat Res. 2012 Aug;14(4):538-45. doi: 10.1111/j.1708-8208.2010.00289.x. Epub 2010 Jun 25. — View Citation

Hermann JS, Cochran DL, Nummikoski PV, Buser D. Crestal bone changes around titanium implants. A radiographic evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. J Periodontol. 1997 Nov;68(11):1117-30. — View Citation

Jemt T, Ahlberg G, Henriksson K, Bondevik O. Changes of anterior clinical crown height in patients provided with single-implant restorations after more than 15 years of follow-up. Int J Prosthodont. 2006 Sep-Oct;19(5):455-61. — View Citation

Jemt T. Single implants in the anterior maxilla after 15 years of follow-up: comparison with central implants in the edentulous maxilla. Int J Prosthodont. 2008 Sep-Oct;21(5):400-8. — View Citation

Kobayashi E, Matsumoto S, Doi H, Yoneyama T, Hamanaka H. Mechanical properties of the binary titanium-zirconium alloys and their potential for biomedical materials. J Biomed Mater Res. 1995 Aug;29(8):943-50. — View Citation

Nicolau P, Korostoff J, Ganeles J, Jackowski J, Krafft T, Neves M, Divi J, Rasse M, Guerra F, Fischer K. Immediate and early loading of chemically modified implants in posterior jaws: 3-year results from a prospective randomized multicenter study. Clin Implant Dent Relat Res. 2013 Aug;15(4):600-12. doi: 10.1111/j.1708-8208.2011.00418.x. Epub 2011 Dec 15. — View Citation

Weber HP, Buser D, Fiorellini JP, Williams RC. Radiographic evaluation of crestal bone levels adjacent to nonsubmerged titanium implants. Clin Oral Implants Res. 1992 Dec;3(4):181-8. — View Citation

Wen B, Zhu F, Li Z, Zhang P, Lin X, Dard M. The osseointegration behavior of titanium-zirconium implants in ovariectomized rabbits. Clin Oral Implants Res. 2014 Jul;25(7):819-25. doi: 10.1111/clr.12141. Epub 2013 Feb 21. — View Citation

Wennerberg A, Albrektsson T, Andersson B. Bone tissue response to commercially pure titanium implants blasted with fine and coarse particles of aluminum oxide. Int J Oral Maxillofac Implants. 1996 Jan-Feb;11(1):38-45. — View Citation

Wennerberg A, Albrektsson T, Johansson C, Andersson B. Experimental study of turned and grit-blasted screw-shaped implants with special emphasis on effects of blasting material and surface topography. Biomaterials. 1996 Jan;17(1):15-22. — View Citation

Wennerberg A, Albrektsson T, Lausmaa J. Torque and histomorphometric evaluation of c.p. titanium screws blasted with 25- and 75-microns-sized particles of Al2O3. J Biomed Mater Res. 1996 Feb;30(2):251-60. — View Citation

* Note: There are 18 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in bone loss measured on X-ray (mm)		Baseline and 1 year
Secondary	Change in bleeding on probing (Yes/No)		Baseline and 1 year
Secondary	Change in amount of Clinical Mucosa (mm)		Baseline and 1 year
Secondary	Change in Pocket depth (mm)		Baseline and 1 year
Secondary	Change in Prosthetic Complications (Yes/No)		Baseline and 1 year

External Links

•   Allander SV et al. Recommendations for the use of profylactic antibiotics in dentistry