Ridge Deficency Clinical Trial
Official title:
Periosteal Inhibition Technique for Ridge Preservation A Prospective Study
The efficacy of the Periosteal Inhibition technique for socket preservation is studies against a control group in which the extraction sockets are allowed to heal without a socket preservation procedure.
Socket preservation procedures have been shown to significantly reduce the loss of ridge
dimension of an extraction socket. These procedures involve filling the empty socket with a
bone graft material, which, serves as scaffold to limit horizontal and vertical ridge
alterations. In order to contain the graft material, an occlusive barrier such as an
autogenous soft tissue graft, resorbable or non-resorbable membrane, is often required. As
yet, no one socket preservation technique has been proven superior to another, and none have
proven totally effective in preserving ridge morphology. A net reduction of 1.5 mm in ridge
width and 0.5 mm in ridge height is often observed after socket preservation procedures,
which may necessitate additional hard or soft tissue augmentation to fully restore the ridge
dimension.
In an animal histologic study in 2005, Araujo and Lindhe demonstrated that trauma and loss of
periodontal ligament triggered an osteoclastic activity causing loss of bundle bone and
modeling of the cortical bone plate. Osteoclasts are multi-nucleated cells that are
responsible for bone resorption and are found on the outer layer of bone, beneath the
periosteum. Osteoclasts are thought to be derived from pluripotent hematopoietic stem cells.
When stimulated, these mononuclear precursors, the smallest of which is 9.5 microns in
diameter, proliferate and attach to the bone surface to be resorbed, and only then fuse to
form large mature multinucleated osteoclasts.
High-density polytetrafluoroethylene (d-ptfe) membranes have been used in socket preservation
procedures as an occlusive barrier to contain the bone graft
material.Polytetrafluoroethylene, a stable polymer and highly biocompatible, has a membrane
porosity of less than 0.3 microns. It is impervious to bacteria and thus is recommended for a
socket preservation technique, where a membrane is intentionally exposed.
In the present study, a high-density polytetrafluoroethylene (d-ptfe) membrane is placed
between the periosteum and the buccal bone plate of an extraction socket where it will stay
for a duration of 4 months, the time needed for the completion of bone forming within the
socket. The goal of the non-resorbable d-ptfe membrane is to prevent the migration of
precursor cells to the bone surface and thus their fusion to form osteoclast. The authors
hypothesize that the passage of the precursor cells from the periosteum to the bone surface
is inhibited by the small-diameter pores in the non-resorbable d-ptfe membrane. Osteolytic
activity on the outer surface of the socket is thereby prevented as the precursor cells
cannot form osteoclasts. The author coins the term "Periosteal Inhibition technique" for this
socket preservation procedure.The study will compare dimension changes between extraction
socket treated using the Periosteal Inhibition technique and those allowed to heal without a
socket preservation procedure.
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