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Dental Implants – Teeth with Titanium P7

Question back there, sir.

Okay.  So, two separate questions.  First one is what is titanium?  Titanium is in the periodic table.  It’s an element.  It’s not an alloy.  It’s found as titanium.  Tons of it.  It’s found all over the place.  It’s not a very expensive metal.  Just getting titanium in a pure form is what’s difficult.  Titanium has different grades.  So, there’s medical-grade titanium, also referred to as commercially pure 99.9%.  That’s what’s making it expensive because you’re taking it and processing into that.

The stem cell part of research is interesting.  There were people talking about trying to take roots and put oxide layer of titanium on it to see if anything would happen.  The other side of stem cell research is not so much on the titanium part but where I showed you the upper jawbone or these cancer patients who had no bone at all, and we’ve actually taken a bone from their leg or their hip, transfer it using stem cells to grow the bone first.  Then, putting the implant there.

Next week on Wednesday, I have a meeting with the MediCare folks because with MediCare, we’re having trouble for them covering implants for our cancer patients who didn’t lose teeth because of not taking care of their teeth.  They’ve lost those teeth from cancer, and if they can pay for breast cancer reconstruction, why can’t they pay for oral reconstruction which is not for cosmetics?  It’s for function and chewing.

So, we do have means, but the basic reason is it’s expensive.  It’s just outrageously expensive, and the insurance companies can’t just see.  Most dental insurance companies have limits of $1500 a year or something like that.

Okay, very good question.  So, if you have a piece of titanium in your jawbone, like all my cancer patients I showed you, you can do an MRI with the screw in the bone because the density of titanium is so low that it’s non-magnetic.  It doesn’t even interfere, but the teeth that are made on top, I have to remove those every time a patient has to go for an MRI. Those are so dense that they would interfere.

An MRI, it’s not magnetic, but because it creates a field that you don’t see exactly adjacent to it what’s going on, you get an artifact area.  So, we always remove those before we do a scan. The screw that’s in the bone, it does it not interfere MRI.  If somebody’s had cancer, you had implants in your jaw, and you ended up needing radiation for treating cancer.  That titanium doesn’t even interfere with the delivery of radiation because it’s not dense enough to interfere with the path of radiation.

So, the question is, do heat and cold affect, like you eat ice cream and you get a cold sensation on your tooth.  If you have titanium are you going to suddenly jump up?  I don’t think so.  I’m not so sure I’ve heard anybody say that.

Correct, so the question is, if you don’t have enough bone available for us to put an implant in, is grafting the only alternative?  Yes, and if you start going further on that question, the grafts are varied.  You could have autogenous bone graft.  This bone is going to come from your body.  You could have bone graft from another animal.  You could have bone taken from a cadaver.  It all depends how much bone is needed and what procedure the surgeon is going to use to grow a bone in that area.

The latest in that area is actually to take a liquid of what is called growth factors or bone morphogenic protein in TGF-beta which are proteins that help stimulate your cells to grow a bone.  Basically, if you took those and put it in a muscle somewhere in your body, it would still grow a bone.  Rather than all the other processes, you’re taking bone cells and having bone come there.  That’s where working on the latest because you don’t have to compromise any other site.

Pretty much, if you don’t have bone, we can’t put an implant there.  It’s not going to work.  You need to have enough bone to put an implant in.  Typically, for a single implant in the upper jaw, you need an implant that’s at least 13mm long.  So, if you want a 13mm-long implant, you’re going to need about 15mm of bone.  In the lower jaw, the minimum that we would work with is 10mm because the bone is denser so it’s got more stability to it.

So, if you are a grinder of your teeth or a bruxer, is that detrimental to implants?  That’s an interesting thing to your ligament question before because if you are a grinder, you’re putting more stress on the implant, and if you had a natural tooth with a ligament, the ligament allows the tooth to move a little bit.  So, you’re not fatiguing the system as much.  You’re fatiguing the ligament, and you could get gum disease after that, but you’re not going to have the tooth crack, so to say.

With an implant, you run the risk, not so much of a failing implant, but maybe breaking the porcelain or breaking the screw that’s holding it in there.  So, for patients who have a history of grinding their teeth, our recommendation is to give them a night guard or a mouth piece that they wear at night to protect that from happening.  The night guards are made out of plastic, so it’s like have that shock absorber now over the teeth so the teeth are not hitting each other.

Titanium was accidentally discovered in this process, and because of all the other implants that I showed you before, they used all sorts of metals including gold.  None of them worked.  There are some people that say that the magic is not the titanium.  The magic is really the process of doing it in two stages rather than putting a tooth on it right away, but nobody wants to try that.  It works with titanium so why are we going to try some other alloy?

Titanium is standard. In fact, orthopedic surgery (all the knees and hips) are now almost all titanium because they used to be stainless steel.  When they were stainless steel hips, when they were put in, in order to hold the stainless steel there, they used what was called bone cement, and that bone cement was really plastic resin.  After 15, 20 years, you had instances where those actually separated.  So, a lot of orthopedic devices are made with the same idea that the bone is actually going to grow on the surface of that.

Just by how much bone you have below it.  If your maxillary sinus is coming way down, how much bone do you have between your mouth and the maxillary sinus?  If you don’t have 13mm, it’s not going to work.  So, one of the things, if you have to graft that area, you actually graft into the sinus.  It’s called a sinus lift procedure where you take the membrane the sinus, and you lift it up.  You’re creating a bone graft on that end.

Okay, the question is if that medical student who was playing basketball had the tooth knocked out, if he came to me right away, could be put the tooth right back like we do on little children?  That only works in kids.  In adults it doesn’t work so well, and most of these accidents that happen in adults, the tooth is also fractured.  It’s not like a young child.  They fall, and the tooth comes out.  They say, put it in milk and get it to your doctor as fast as you can so they can put it back in because their cells are healthy and more capable of regenerating.

Actually, that young girl that I showed you who had the resorption process, that happened to her.  Her tooth was a lost, knocked out when she was a little girl and put back in, and they’ll take for a while.  Eventually, that nerve still dies on the inside.  So the nerves die but the tooth is sticking, and they end up cracking, fracturing.  She’ll get 15, 20 years out of it, and then they’re eventually going to be lost.  In an adult, that doesn’t work very well.  So, if I was to fall, knock my tooth out, and put it back in, it’s probably not going to work.

Sir.

Correct.  So you have a screw, and you have a tooth that sits on top. The screw is in the bone, and a tooth is sitting on top of that screw.  To hold it there, you have to have a screw that’s going through the middle of that that’s tightening it down in place, and you just put a little filling.  If you don’t want the hole to show, if I was in Southern California, always make fun of South Orange, and didn’t want to show this hole, then I would make a metal post that would be screwed in.  Then, I would make a separate crown that would get cemented onto that post.  So, you cover it up, basically.

It would be like a thimble.  So, if you have that hole that I showed you, it would be beneficial in terms of retrievability.  That’s definitely an advantage, and most people, that’s what we would recommend.

Why would you want to retrieve it?

If there’s any problem.  If a screw or something chips, cracks, breaks, you don’t want to go through the whole process of having a crown made up all over again.  It’s expensive, and even the screw sometimes can just turn loose.  See, over years, right?  If you have a screw that’s holding the post inside and it turns loose, you’ve got crown cemented on top, you can’t get the darn thing off.

One of my mentors said, if you screw anything together, eventually it’s going to turn loose.  That’s why cars are welded together, not screwed to place.  So, we want the access.  If it’s loose, you just drill out that filling, put it back in and tighten it.

You have a question, sir.  We’ll take that, and that’s the last one.

Okay.  Very, very good question actually.  There’s some interesting research that’s coming out in Scandinavia that they’re looking at it and saying, “How many teeth do we actually need to have a normal masticatory efficiency, or how many teeth do we have to lose to get to a point where chewing is compromised?”

We all know of us having 32 teeth, but these wisdom teeth, they’re gone. Most people today have 28 or less.  If kids have braces, they pull for teeth out, so you’re like, “I’ve got 24 because I had four teeth pulled to have braces when I was a teenager.”  My wisdom teeth are either out or somewhere in there.  So, I’m left with 24 teeth.

They say, as long as I have 20 chewing surfaces, my masticatory efficiency should not be compromised.  So, if you’re missing just one molar at the back, you don’t need that replaced just to get you to chew normally.  Now, what people are talking about are if you have just one lower molar missing and the upper tooth is there, that tooth may come down.

Teeth want to be in contact.  So, if you have nothing opposing them, teeth are going to want to move.  If I have one molar missing in the middle, and there’s a molar at the back, that molar’s going to drift forward.  It’s going to tip in.  So, you want to be able to do something to keep that space.  You’re doing it for that reason more than making you chew better.

Alright, thank you all for coming.  We hope that you learned something tonight.

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