Management Of Gap Distance Around Immediate Implants With Topical Melatonin Gel and Hyaluronic Acid ( A Randomized Clinical Trial)

Abstract

Background: Immediate post extraction implants are currently widely used; with this surgical technique a dental implant is placed after extraction of teeth in a fresh socket without waiting for any bone or soft tissue healing to reduce the treatment periods. Melatonin is physiologically existing in saliva, and it was found to influence both bone regeneration and fibroblast activation as well as hyaluronic acid which distributed widely throughout neural, connective, and epithelial tissues. Aim:The aim of the present study was to evaluate the effect of topically delivered melatonin gel and hyaluronic acid on dental implants placed into fresh extraction sockets clinically and radiographically. Subjects and Methods:Patients were eligible for the present study if they needed one immediate implant placement (IIP) replacing a tooth to be extracted within the maxillary premolar area. Thirty two adult patients were randomly allocated into four equal groups Group (A): Each patient in this group received immediate implant placement (IIP) with no filling material around the implant .Group (B) : Each patient in this group received IIP simultaneously with topical hyaluronic acid as a filling material into bone gaps around implant .Group (C) : Each patient in this group received IIP with topical melatonin gel plus topical hyaluronic acid to fill the bone gaps around implant .Group (D) : Each patient in this group received IIP with melatonin gel to fill the bone gaps around implant . Clinical and radiographic assessments were performed before IIP (baseline) and 6 months after implant placement. Clinical assessment includes bleeding index (BI), gingival index (GI) and probing depth (PD) while the radiographic assessment were performed using CBCT. Results:The results of this present study showed that local delivery of 1.2% hyaluronic acid and melatonin gel improve the clinical parameters around immediate implants but did not prevent bone loss as assessed by cone beam computed tomography analysis (CBCT). Conclusions:The short term follow up of 6 months of IIP in the maxillary premolar area showed successful clinical outcomes as assessed by clinical parameters and CBCT. IIP with or without simultaneous topical melatonin gel application and hyaluronic acid in the gap distance around the immediate implants did not prevent bone loss.