Evaluation of Hyaluronic Acid in Addition to Xenograft in Immediate Implant Placement Within Maxillary Esthetic Zone

Study design:

The present study will be carried out on two groups of patients.

A-Patients Sample:

Twenty patients selected from the department of Oral Medicine, Periodontology, Oral Diagnosis and Radiology, Faculty of Dentistry, Mansoura University for replacement of non restorable maxillary anterior and/or premolar teeth within esthetic zone by immediate implant. A written informed consent will be obtained from all patients before their participation in this study.

i. Group (1): Comprised of ten patients with hopeless non-restorable maxillary anterior and/or premolar tooth within the esthetic zone will be extracted and replaced by an immediately placed dental implant in conjunction with Bovine bone mineral graft material( cerabone®,Botiss biomaterial) followed by healing abutment.

ii. Group (2): Comprised of ten patients with hopeless non-restorable maxillary anterior and/or premolar tooth within the esthetic zone will be extracted and replaced by an immediately placed dental implant in conjunction with Bovine bone mineral with sodium hyaluronate graft material (cerabone®plus,Botiss biomaterial) followed by healing abutment.

Inclusion criteria

• Patients who are medically free from any systemic diseases.

• Patients with good oral hygiene and regular maintenance.

• Age of patients will be >20 years.
• Presence of at least single non restorable maxillary anterior and/or premolar tooth due to caries, root resorption, endodontic failure, root fracture or tooth with open apex.
• No acute infection is present within both periodontal and/or peri-apical area within the tooth of concern and/or adjacent teeth.
• Patients with extraction socket type I.
• Free from history of clenching, tapping and bruxism.
• Patients prepared to co-operate and comply with the follow-up and maintenance program.

Exclusion criteria

• Patients taking medications known to influence bone metabolism ( such as heparin, warfarin, corticosteroid).

• Smoking and alcoholic patients.

• History of radiation in the head and neck region.
• Insufficient interocclusal distance for implant placement and restoration.
• Patient with lack of stable posterior occlusion.
• Pregnant, lactating and post-menopausal female patients. Complete medical history, dental history will be taken to all of patients in the study.

Materials:

A. Dental Implants: Conventional 2 pieces screw type dental implants. B. Bone substitute: Bovine bone graft material (cerabone®,Botiss biomaterial) and Bovine bone substitute with sodium hyaluronate graft material (cerabone®plus,Botiss biomaterial).

C. Trephine bur: to create intentional bony defect in experimental rabbits. D. Ostell: to measure the primary and secondary stability of the implant.

Methods:

• Pre-operative measurements:

A. Photographs: for all items under research. B. Preoperative Radiographs: CBCT will be taken for clinical patients before treatment.

C. Antibiotic administration for both patients and rabbits before implant placement.

• Surgical Procedures:

• Clinical sample (patients) :

• Atraumatic removal of remaining root or tooth will be performed using periotome, appropriate forceps and elevators in an attempt to preserve the buccal plate of bone and soft tissue.

• Implant will be placed in fresh socket using implant motor with saline coolant after curettage and its size is determined according to pre-operative CBCT within both groups.

• Group (1): Bovine bone graft (cerabone®,Botiss biomaterial)will be added to the implant.
• Group (2): Bovine bone substitute with sodium hyaluronate graft (cerabone®plus,Botiss biomaterial) will be added to the implant.
• followed by healing abutment.
• Post-operative care: The patients will be instructed to consume soft food for eight weeks Patients will be maintained on amoxicillin twice a day for six days and Ibuprofen 400mg 2 to 4 times daily
• loading will begin at three to four months from surgical intervention.

3-Evaluation of study:

A. Patients evaluation:

All patients will be seen at regular time interval for evaluation at the visit of surgical intervention , follow up of clinical parameter will be recorded monthly then three , six months postoperative and six month after loading(with twelve month follow up study).

• Clinical evaluation:

i. Soft tissue evaluation: This will be done in both groups where, soft tissue evaluation will be done using probing depth(PD) and pink esthetic score (PES) around dental implant.

ii. Implant stability evaluation: Using Osstell implant stability will be assessed in both groups soon after implant placement to assess primary implant stability then three , six and twelve months after surgery to assess secondary implant stability.

• Radiographic evaluation:

Radiographic assessment will be held preoperative ,six and twelve months after implant placement for evaluation of:

• Marginal bone loss(MBL).

Statistical Analysis:

All data will be collected and statistically analyzed.

Inclusion criteria

• • Patients who are medically free from any systemic diseases.

• Patients with good oral hygiene and regular maintenance.
• Age of patients will be >20 years.
• Presence of at least single non restorable maxillary anterior and/or premolar tooth due to caries, root resorption, endodontic failure, root fracture or tooth with open apex.
• No acute infection is present within both periodontal and/or peri-apical area within the tooth of concern and/or adjacent teeth.
• Patients with extraction socket type I.
• Free from history of clenching, tapping and bruxism.
• Patients prepared to co-operate and comply with the follow-up and maintenance program.

Exclusion criteria

• • Patients taking medications known to influence bone metabolism ( such as heparin, warfarin, corticosteroid).

• Smoking and alcoholic patients.
• History of radiation in the head and neck region.
• Insufficient interocclusal distance for implant placement and restoration.
• Patient with lack of stable posterior occlusion.
• Pregnant, lactating and post-menopausal female patients. Complete medical history, dental history will be taken to all of patients in the study.