VST vs Modified Periosteal Inhibition Technique

Summary

Losing a tooth in the upper front of the mouth is common, and many people choose a dental implant to replace it. When a tooth is removed, the thin layer of bone in front of the socket - the buccal, or front, bone - often shrinks as the area heals. If this bone shrinks, the final implant can look less natural and the gum can recede. The problem is greater when part of the front bone is already missing at the time the tooth is taken out; this type of socket is harder to treat.

This study compares two surgical techniques that aim to protect the front bone and gum while a dental implant is placed on the same day the tooth is removed. In Vestibular Socket Therapy (VST), a thin bone membrane is inserted through a small incision high in the gum fold to cover the front bone, and bone graft material is packed into the socket. In Modified Periosteal Inhibition (MPI), a thin bone membrane is placed against the outside of the front bone and held in place with a tissue glue, and the socket is filled with a collagen sponge.

Adults aged 20 to 50 with a non-restorable upper front tooth (canine to canine) and partial loss of the front bone can take part. Participants are randomly assigned to one of the two techniques and receive an implant immediately after the tooth is removed, then are followed for 12 months. Using cone-beam CT scans, intraoral scans, and an esthetic (appearance) score taken at the start and at 6 and 12 months, the investigators measure the thickness of the front bone, the level and thickness of the gum around the implant, and the overall appearance.

The study tests whether one technique preserves or increases the thickness of the front bone and produces better gum and esthetic results than the other.

Conditions

• Alveolar Bone Loss

Interventions

PROCEDURE

VST

Immediate implant placement with Vestibular Socket Therapy. Following atraumatic extraction and socket debridement, a submucoperiosteal tunnel is prepared from the facial socket orifice to a vestibular access incision made 3-4 mm apical to the mucogingival junction. The implant is placed via a computer-guided surgical template (shoulder 3-4 mm apical to the labial gingival margin). A xenogenic cortical bone membrane is trimmed to the facial socket wall, inserted through the vestibular incision, and fixed with bone tacks; particulate xenograft is placed in the socket. The socket is sealed with a customized healing abutment and the vestibular incision closed with non-resorbable sutures.

PROCEDURE

Mucoperiosteal inhibition

Immediate implant placement with the Modified Periosteal Inhibition technique. Following atraumatic extraction and socket debridement, a conservative full-thickness flap is raised (extending one tooth mesial and distal), and the labial periosteum is detached from the labial bone plate. The implant is placed via a computer-guided surgical template (shoulder 3-4 mm apical to the labial gingival margin). A resorbable xenogenic bone membrane is inserted between the labial periosteum and the labial bone plate and fixed with cyanoacrylate tissue adhesive; a collagen sponge is placed in the socket. The socket is sealed with a customized healing abutment and the flap closed with non-resorbable sutures.

Sponsors & Collaborators

• Tanta University

  lead OTHER

Principal Investigators

• Sahar Ghoraba, PhD · Professor of Oral Medicine and Periodontology

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

99 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2026-09-01

Primary Completion

2027-04-01

Completion

2027-04-10