Friday, August 07, 2015

Better teeth for better living with EMD/TZP

Just a cursory search of what new options are available for dental implants has produced numerous online references to both EMD (enamel matrix derivative) and TZP (tetragonal zirconia polycrystal). Wikipedia defines EMD as “an extract of porcine fetal tooth material used to biomimetically stimulate the soft and hard tissues surrounding teeth to regrow (in a process known as regeneration) following tissue destruction.” TMZ is described in an article available on the National Center for Biotechnology Information website of the National Library of Medicine as “tetragonal zirconia polycrystal (TZP) displays high biocompatibility with reduced bacterial adhesion and high flexural strength which renders it as an excellent material for implant supported prosthesis.” The referenced article describes the use of dental implants that had been milled from “presintered homogeneous blocks of TZP” using CAD/CAM technology in the case of a particular patient. Another article on the same website explains that EMD “has been successfully employed to restore functional periodontal ligament, cementum and alveolar bone in patients with severe attachment loss.”

My online search resulted from my learning that dental implants use fixtures that resemble wood screws to anchor the prosthetic teeth to the jaw and also learning that the cost for replacing a single tooth can approach $1000 and is not covered by insurance. The price point for the dental implant, an out-of-pocket expense, should be lower; the result would be more procedures being performed and both the doctors and the suppliers realizing an increase in revenue. I also wondered about the use of threaded screw-like anchors to hold the prosthetics in place when natural teeth are held in place just by the roots. Roots don’t have threads, and I wondered how natural teeth could be so firmly anchored to the jaw that dental tools and some effort are needed to extract them. I encountered the term “cementum,” which Wikipedia explains: “Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.” While wondering if exotic new polymers could mimic the adhesion of cementum and the periodontal ligament, which would of course be removed from the socket along with the tooth, I encountered EMD which apparently facilitates the regrowth of cementum and the periodontal ligament. So, I wondered, are threaded anchors necessary?

Provided that regrown tissue can attach to TZP in the same way it attaches to the roots of a tooth, why not make a prosthetic tooth with roots instead of driving a screw into the jaw? This procedure could be employed only in cosmetic dentistry, since a healthy tooth and root canals/sockets would be required. The roots of a diseased tooth and the eroded sockets in the bone may be too compromised for this procedure to work. But for those patients who, for example, would like to replace badly stained but otherwise healthy teeth, this procedure would seem viable. It would be simpler, resulting in lower cost for the patient, and less invasive, resulting in its being more easily tolerated by the patient.

In a nutshell, a healthy tooth would be extracted, a copy of it, with roots, would be milled or molded out of TZP, and the replacement tooth would be inserted with EMD to stimulate the attachment of the tooth to the surrounding periodontium.

In my online search, I haven’t found this solution discussed as a future possibility. So my proposal could provide someone with an opportunity for a new patent and the resultant substantial income stream. Just remember that you heard it here first.

No comments: