Monday, 19 September 2011

New dental implant technology


The day before my brothers wedding celebration, the junction between my crown and the tooth - my upper front right tooth, broke.

I braved my way through the proceedings and started looking into my options.
  1. dentures
    I'm not crazy about putting a piece of plastic in my mouth, maybe it's just me
  2. implants
    from the research I've done it seems that 1 in 50 down to 1 in 20 of these fail at some time.
    I don't like those odds.
So I started looking into alternatives, and there are some
  1. grow new teeth
    This should be available at the end of 2012 in the US at least.
  2. come up with some other way

some other way

The existing implant process ignores the tooth socket, drills a hole in the jaw/skull and screws a bolt into it, on top of which goes the implant crown.

The reason that 1 in 50 down to 1 in 20 of these implants fail is because sometimes osseointegration doesn't happen - the bond fails and the bolt becomes loose.

My idea was to reuse the socket and construct an implant from multiple interconnecting parts, assembled in the socket and secured by a pin, instead of a bolt.

This lets the socket take the load like it did before and any movement of the implant/tooth would be just like the old tooth did.

Yes, our teeth do move around slightly when we chew.

The pin serves as no more than a tether. I'm not certain it would even be needed for molars as their shape inside the bone, in combination with atmospheric pressure, prevents the tooth from falling out on its own.

I figured that the preservation of the tooth socket was vital for this so the existing tooth root would have to be scanned to get it's 3D shape before being destroyed in the socket with ultrasound, and removed in pieces.

Is what I'm proposing medically viable? The best answer I got was from Carsten Engel on LinkedIn, which was that he couldn't find anyone else who had tried this approach.

I still don't know exactly what holds teeth in their sockets, but suspect it's a combination of gum tissue, the shape of the socket preventing the tooth working itself free, and the air seal.

The air seal of the gum around the tooth acts like a cork in a bottle - you need to act against atmospheric pressure to extract it.

I've also heard that our teeth have a coating that assists in the seal-forming process, but as a layman in this field, I need more to go on.

If it is then the pieces fall quickly into place:
  1. MRI scanning - how expensive is it? Are there alternatives that can achieve <50 microns of resolution?
  2. Software - process the scan to determine the dimensions of the tooth/teeth
  3. Software - fragment each tooth model so it can be assembled inside the socket. I don't know exactly what holds incisors in place - it's not the socket shape which is a sort of cone - fragmentation isn't always needed.
  4. Manufacture/rendering - there are plenty of commercial units that can do this and I'm working on my own as well.
  5. Existing tooth removal - I've heard that ultrasound can be used, but any approach that preserves the socket will do.
  6. In-situ replacement construction - the replacement will be composed of interlocking segments that, once in place, can be secured together using a locking bolt, ring or nut, depending on the fragmenting scheme used.
I'm currently in discussions with Local Enterprise Office.

I met with Brian Davitt and he subsequently shared a link with me about regeneration of ligament tissue, which looks promising.

Later on I thought that a material that could maintain the tooths position while the ligament formed and be later absorbed into the body might be an avenue worth exploring - see this article about Dr Marion McAfee.

Brian's going to Sligo soon anyway so there's hope that some networking might happen!

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