Efficacy Of Eggshell-Derived Nanohydroxyapatite Based Mineralized Plasmatic Matrix Versus Xenogeneic Based Mineralized Plasmatic Matrix in Posterior Mandibular Socket Preservation

Condition(s) studied

Investigational drug(s) / intervention(s)

Socket preservation using eggshell-derived nanohydroxyapatite-based mineralized plasmatic matrix along with platelet-rich fibrin (PRF).: A whole venous blood (10 ml) is obtained from the patient to prepare the PRF. The 10 ml are divided into: 5 ml for mixing and 5 ml to be used as a covering membrane. Tooth extraction is done comprising minimal surgical trauma to the surrounding bone using periotomes and remaining root forceps. Then, debriding the socket using bone curette will be done. PRF will be prepared as instructed by (Choukroun et al., 2006) The Blood is obtained from the patient and centrifuged for 3000rpm for 10 min The first (5 ml) of PRF will be mixed with the eggshell nanohydroxyapatite- based matrix (EnHA) and it will be placed inside the socket. The second (5ml) of PRF will be used as a membrane. The suturable membrane formation is prepared from fibrin clot by pressing it in PRF Box. Primary closure is done by appropriate suturing technique (Criss Cross Suture/ Figure of 8.)by using resorbable suture material (Vicryl).

Socket preservation using deproteinized bovine bone mineral (DBBM) xenograft along with platelet-rich fibrin (PRF).: A whole venous blood (10 ml) is obtained from the patient to prepare the PRF. The 10 ml are divided into: 5 ml for mixing and 5 ml to be used as a covering membrane. Tooth extraction is done comprising minimal surgical trauma to the surrounding bone using periotomes and remaining root forceps. Then, debriding the socket using bone curette will be done. PRF will be prepared as instructed by (Choukroun et al., 2006) The Blood is obtained from the patient and centrifuged for 3000rpm for 10 min. The first (5 ml) of PRF will be mixed with Deproteinized Bovine Bone Mineral (DBBM) and it will be placed inside the socket. The second (5ml) of PRF will be used as a membrane. The suturable membrane formation is prepared from fibrin clot by pressing it in PRF Box. Primary closure is done by appropriate suturing technique (Criss Cross Suture/ Figure of 8.) by using resorbable suture material (Vicryl).

Study summary

After tooth extraction, the alveolar bone, which supports the teeth, undergoes a natural resorption process. This bone loss can be significant, especially in the first few months post-extraction, leading to a reduction in both bone height and width (Araújo et al ,. 2005) Generally, the goal of alveolar ridge preservation is to maximize bone formation while maintaining good soft tissue architecture, As socket preservation has proved high clinical efficacy in maintaining alveolar ridge high and width, there are many materials that have been proposed such as: autogenous bone grafts, allografts, xenografts, alloplasts, dentin graft and PRF. Unfortunately, the previously mentioned grafting material has several limitations have more such as high cost, biocompatibility, osteoinductive limitations and the need for a second surgical site. These limitations encouraged the researchers to test alternative materials and techniques to provide comparable or superior outcomes with fewer drawbacks.

One of the newly introduced materials is eggshell derived nanohydroxyapatite (EnHA). Eggshell-derived nanohydroxyapatite (EnHa) represents a novel and potentially superior alternative due to its biocompatible, osteoconductive, and osteoinductive bone substitute. Preliminary studies suggest that this material.

The synergistic effect of PRF when combined with various graft materials has also been extensively studied. when PR combined with bone grafting materials, it results in enhanced osteoconductive properties of graft materials and promotes efficient bone regeneration. (Yilmaz et al., 2017).

However, up till now, there are no sufficient studies on the clinical efficacy of EnHA as a cheaper and readily available alternative which has superior clinical properties especially when combined with PRF compared to standard xenografts.

Eligibility

Primary outcome measure(s)

• Change in bone density — after 4 months postoperatively.
  CBCT scans will be performed at baseline and 4 months postoperatively. Measurements will be taken at both time points using identical reference points and lines. Bone density measured using CBCT radiographs after 4 months later, and a 12\*12 mm² region of measurement used to assess the density in different points (Point A at the socket crest, Point B at the middle of the socket, Point C at the apex). The CBCT taken after 4 months will serve the purpose of superimposing the two scans and assessing the bone density changes after augmentation. These measurements will be denoted as HW-1, HW-3, and HW-5, respectively.

Trial sites (1)

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