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Bone ResorptionPhase 1NCT03028038

Using Platelet Rich Plasma in Reducing Alveolar Bone Resorption During Rapid Maxillary Expansion

A Phase 1 study testing Platelet Rich Plasma and No Platelet Rich Plasma in people with Bone Resorption, run by Damascus University at 1 site in Syria.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine if the injection of Platelet-rich plasma (PRP) is effective in reducing alveolar bone loss that happens after each rapid maxillary expansion (RME) on the buccal aspect of the posterior teeth. Read more about this study

Who is it for?
Ages 10 to 16 years
Conditions the study is for
Bone Resorption
What is being tested?
Platelet Rich Plasma and No Platelet Rich Plasma
Could I receive a placebo?
No, everyone receives an active treatment
How many people
16 participants
Where
1 siteSyria
Study dates
Jul 2016to 15 Jul 2018
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 10 to 16 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • 10-16 years old patients
  • Complete emergence of first molars and first premolars
  • Clinical maxillary transverse deficiency
  • Good oral hygiene (Gingival index <1) according to Silness \& loe 1964
  • ( Plaque index <1)

Who cannot join

  • The presence of a medical situations that affects orthodontic treatment and periodontal health
  • The presence of drug therapy affect orthodontic treatment and periodontal health
  • Bad oral hygiene (gingival and plaque index >1)
  • Patient with physical and psychological limitations
  • Metallic restorations or endodontic treatments on the appliance supporting teeth (first molars and first premolars)
  • Craniofacial anomalies
Show all 11Show fewer
  • Previous orthodontic treatment
  • Patients who did not correctly follow the protocol of activation
  • Patients who did not return for control dental appointments
  • Patients whose cementation of the appliance failed
  • Patients whose dental structures were difficult to visualize on the CBCT scans as a result of artifact

Trial locations and contacts

1 site in 1 country.

Syria1 site
  • Damascus University

    Damascus

Other trials in Syria

About this study

Official title: Evaluation of Efficacy of Injectable Platelet-Rich Plasma (PRP) in Reducing Alveolar Bone Resorption Following Rapid Maxillary Expansion (RME): A Cone Beam Computed Tomography (CBCT) Assessment

The purpose of this study is to determine if the injection of Platelet-rich plasma (PRP) is effective in reducing alveolar bone loss that happens after each rapid maxillary expansion (RME) on the buccal aspect of the posterior teeth.

16 patients with a skeletal maxillary constriction aged between 10-16 years old will get into orthodontic treatment to widen the maxilla using Hyrax appliance.

Read more

An amount of patient blood will be withdrawn and centrifuged to get PRP. Then the PRP will be injected in one half of each patient mouth in a split-mouth design, beneath the buccal periosteal of the first molars and first premolars, the halves will be chosen randomly.

High resolution CBCT images will be taken before and after orthodontic treatment to analyze buccal bone thickness and height changes.

Read the detailed description

Correction of the maxillary transverse discrepancy is essential for treatment of various types of malocclusions. Palatal expansion is the most common method used to improve the transverse dimensions of the maxilla especially Rapid maxillary expansion (RME) . RME is associated with intermittent high force systems which cause lateral flexion of the alveolar processes and buccal displacement of the anchorage teeth . Displacement of these teeth outside the alveolar anatomic limits can damage the periodontium and finally compromising tooth longevity.

Several researchers have studied the incidence of buccal dehiscence and fenestrations after RME , using CBCT Images.

From here It was thought about using a method to eliminate these dangerous side effects. It was found that platelet rich plasma (PRP) has the ability to enhance tissue regeneration, accelerate wound healing and inducing stem cells differentiation through its growth factors (GFs).

This is the first study in the world that will use PRP with orthodontic treatment, because of its benefits and easiness of using in dental clinic.

Study sample, that consists of 16 patients, was calculated using (G-power sample size calculator) depending on the buccal alveolar bone thickness changes, with a study power of 95%.

Sample will be chosen from the patients who are coming to Orthodontic department in the Faculty of dentistry - Damascus university.

Allocation of the sides of intervention (PRP injection) and control sides is made by letting the participants to withdraw a closed envelop from a dark black box. Each envelop in the box contain either (R letter) for the right side or (L letter) for the left side that will be the intervention side for that patient.

After ensuring of the patients compliance with the terms and conditions of this study, the purpose and methods of the study will be explained to the patients using Information Sheet . In case of approval to participate the patients asked to sign the Informed Consent.

Extra \& Intra-oral photographs , impressions and clinical examination will be made.

High resolution CBCT will be taken before the beginning of treatment (T0). Hyrax appliance will be applied on the first molars and first premolars and cemented using GIC.

After one day of cementation, 20ml of patients' blood will be withdrawn and centrifuged to get 4 ml of PRP.

The buccal soft tissue will be anesthetized (sub-mucosal) in the intervention side , then the PRP will be injected at the buccal area of the first molar and first premolar in that side using insulin syringe , 2 ml for each tooth mentioned in two points. The first point place is in the middle of the attached gingiva over the mesial root of the first molar and buccal root of the first premolar. The second point is in the mucosal-gingival junction over the same root of each tooth.

Starting of expansion will be done in the same day of injection, twice a day until getting an over correction of 2-3 mm.

After one week, the injection of prp will be repeated in the same way (T1) High resolution CBCT for the maxilla will be taken 3 months after the beginning of treatment (T2).

All measures will be analyzed before and after treatment between two sides. A questionnaire will be given to the patients to study pain level accompanying PRP injection compared to the control side . Pain will be assessed using Visual Analogue Scale (VAS) 1 (No Pain) - 10 (Worst Pain).

A questionnaire will be given to the patients to study their acceptance of new treatment approach with comprehensive orthodontic treatments.

Conditions
Bone Resorption
Being tested
Platelet Rich Plasma, No Platelet Rich Plasma
Keywords
Platelet-rich plasma, Rapid maxillary expansion, Buccal bone thickness, Alveolar bone loss, Alveolar bone resorption
Medical subject headings
Bone Resorption, Alveolar Bone Loss

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Platelet Rich PlasmaDrug

    Also called PRP

    Platelet Rich Plasma (PRP) will be injected beneath the buccal periosteal of the first molar and premolar in one mouth side with a split-mouth design before the beginning of Rapid Maxillary Expansion and after 7 days of it.

    High resolution cone beam computed tomography (CBCT) will be taken before treatment and after 3 months when the Hyrax is removed.

  • No Platelet Rich PlasmaDrug

    Also called No PRP

    No Platelet Rich Plasma (PRP) will be injected in the other mouth side with a split-mouth design during Rapid Maxillary Expansion.

    High resolution cone beam computed tomography (CBCT) will be taken before treatment and after 3 months when the Hyrax is removed.

Study groups in NCT03028038
Study groupRoleWhat they receive
Platelet Rich PlasmaExperimentalPlatelet Rich Plasma (PRP) will be injected beneath the buccal periosteal of the first molar and premolar in one mouth side with a split-mouth design before the beginning of Rapid Maxillary Expansion and after 7 days of it.
Receives: Drug: Platelet Rich Plasma
No Platelet Rich PlasmaExperimentalNo Platelet Rich Plasma (PRP) will be injected in the other mouth side with a split-mouth design during Rapid Maxillary Expansion.
Receives: Drug: No Platelet Rich Plasma

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes in buccal alveolar bone height loss and thickness reduction amount

    Buccal alveolar bone height loss and thickness reduction amount (The incidence of Dehiscence) as a result of RME (On the intervention compared to non-intervention side) before and after expansion. Assessment will be done using CBCT before treatment (T0) and after 3 months (T2)

    Measured: Evaluation before and after RME. (after 3 months)

Secondary outcomes (3)
  1. Changes in the appliance supporting teeth inclination

    The changes in the appliance supporting teeth inclination before and after 3 months of orthodontic expansion. Assessment will be done using CBCT before treatment (T0) and after 3 months (T2)

    Measured: Evaluation before and after RME. (after 3 months)

  2. Pain levels

    Pain levels accompanying new treatment approach within orthodontic treatment. A questionnaire will be given to the patients on the first day after PRP first injection and after 3 days , 7 days, after 3 months

    Measured: 3 months

  3. Patient acceptance

    Patient acceptance of the PRP injection during comprehensive orthodontic treatments.A questionnaire will be given to the patients on the first day after Prp first injection and after 3 days , 7 days, after 3 months

    Measured: 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jan 2017 (estimated)
  2. Study startJul 2016
  3. Primary completionMay 2017
  4. Study completion15 Jul 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
16 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03028038
Sponsor's protocol ID
UDDS-Ortho-04-2016
Status last verified
Jul 2018
First submitted
18 Jan 2017
Last updated
30 Jul 2018
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Agarwal A, Gupta ND. Platelet-rich plasma combined with decalcified freeze-dried bone allograft for the treatment of noncontained human intrabony periodontal defects: a randomized controlled split-mouth study. Int J Periodontics Restorative Dent. 2014 Sep-Oct;34(5):705-11. doi: 10.11607/prd.1766.

    PubMed 25171042
  • Akin M, Baka ZM, Ileri Z, Basciftci FA. Alveolar bone changes after asymmetric rapid maxillary expansion. Angle Orthod. 2015 Sep;85(5):799-805. doi: 10.2319/090214.1. Epub 2014 Dec 5.

    PubMed 25478739
  • Albanese A, Licata ME, Polizzi B, Campisi G. Platelet-rich plasma (PRP) in dental and oral surgery: from the wound healing to bone regeneration. Immun Ageing. 2013 Jun 13;10(1):23. doi: 10.1186/1742-4933-10-23.

    PubMed 23763951
  • Baysal A, Uysal T, Veli I, Ozer T, Karadede I, Hekimoglu S. Evaluation of alveolar bone loss following rapid maxillary expansion using cone-beam computed tomography. Korean J Orthod. 2013 Apr;43(2):83-95. doi: 10.4041/kjod.2013.43.2.83. Epub 2013 Apr 25.

    PubMed 23671833
  • Dhurat R, Sukesh M. Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective. J Cutan Aesthet Surg. 2014 Oct-Dec;7(4):189-97. doi: 10.4103/0974-2077.150734.

    PubMed 25722595
  • DurmuSlar MC, Alpaslan C, Alpaslan G, Cakir M. Clinical and radiographic evaluation of the efficacy of platelet-rich plasma combined with hydroxyapatite bone graft substitutes in the treatment of intra-bony defects in maxillofacial region. Acta Odontol Scand. 2014 Nov;72(8):948-53. doi: 10.3109/00016357.2014.926023. Epub 2014 Jul 9.

    PubMed 25005628
  • Geramy A, Shahroudi AS. Fixed versus Removable Appliance for Palatal Expansion; A 3D Analysis Using the Finite Element Method. J Dent (Tehran). 2014 Jan;11(1):75-84. Epub 2014 Jan 31.

    PubMed 24910679
  • Gunyuz Toklu M, Germec-Cakan D, Tozlu M. Periodontal, dentoalveolar, and skeletal effects of tooth-borne and tooth-bone-borne expansion appliances. Am J Orthod Dentofacial Orthop. 2015 Jul;148(1):97-109. doi: 10.1016/j.ajodo.2015.02.022.

    PubMed 26124033
  • Lin L, Ahn HW, Kim SJ, Moon SC, Kim SH, Nelson G. Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence. Angle Orthod. 2015 Mar;85(2):253-62. doi: 10.2319/030514-156.1. Epub 2014 Dec 9.

    PubMed 25490552
  • Martinez CE, Gonzalez SA, Palma V, Smith PC. Platelet-Poor and Platelet-Rich Plasma Stimulate Bone Lineage Differentiation in Periodontal Ligament Stem Cells. J Periodontol. 2016 Feb;87(2):e18-26. doi: 10.1902/jop.2015.150360. Epub 2015 Sep 14.

    PubMed 26367495
  • Alomari EB, Sultan K. Efficacy of injectable platelet-rich plasma in reducing alveolar bone resorption following rapid maxillary expansion: A cone-beam computed tomography assessment in a randomized split-mouth controlled trial. Angle Orthod. 2019 Sep;89(5):705-712. doi: 10.2319/091018-661.1. Epub 2019 Mar 28.

    PubMed 30920874

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Platelet Rich Plasma and No Platelet Rich Plasma in people with Bone Resorption, run by Damascus University at 1 site in Syria.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 Jul 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Syria. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in buccal alveolar bone height loss and thickness reduction amount (time frame: Evaluation before and after RME. (after 3 months)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03028038, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Jul 2018.

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