The Smart Magazine About Medical Technology Innovations
Innovations With Teeth
Open wide! But just your eyes. This new issue of MedicalExpo e-mag focuses on dental innovations. Read why Stratasys thinks 3D printing permanent teeth remains the biggest challenge. You’ll also learn about the competition among new dental implant materials and surgical navigation systems. We also describe the history of dental extractors but don’t worry—we won’t pull any of your teeth while you’re busy reading.
Last but not least, and in an entirely different domain, we offer a simple explanation of the revolutionary genome editing method, CRISPR-Cas9, and why it’s generating so many ethical questions.
About eight years ago, Stratasys, a global leader in 3D printing technology, created its first 3D printers for dentistry. The past four years have seen an explosion of innovations in this sector. Eric Erickson, Dental Business Manager for Europe at Stratasys, explained what today’s 3D dental printers can do and the...
A promising development is emerging in the area of dental implants. New materials—including zirconia and plastics—are being used in addition to time-tested titanium.
In the 1967 film classic The Graduate, there’s a famous scene at a party for the new graduate in which a family friend offers him some advice about the future. “I want to say one word to you. Just one word,” says the friend. A pause: “Plastics.”
“Plastic implants are becoming interesting. For example, those made out of PEEK (polyether ether ketone) are suitable for the minimally invasive flapless method (insertion without mucoperiosteal flaps). In the future, related materials could also gain in significance, namely PEKK (polyether ketone ketone). In addition to the pure ceramics and pure plastics, hybrid materials that attempt to combine the best of both worlds are also exciting,” wrote IDS organizers in a press release.
Dr. James Rutkowski, a Pennsylvania dental implant specialist, is editor of the Journal of Oral Implantology published by the American Academy of Implant Dentistry. In his opinion, plastics offer some possibilities for dental implants, but are not yet ready for prime time. “PEEK shows some promise, but not a lot,” he told us. He believes it has demonstrated its benefits in orthopedic spinal fusion, “but currently does not withstand the environment of the oral cavity well.” Rutkowski added that PEKK is very new and may be useful in temporary restorations. “PEEK and PEKK need further development,” he said.
Zirconia Is Popular for Cosmetic Reasons
Zirconia implants (Courtesy of Chaldentistry)
One alternative is zirconium dioxide, a white crystalline substance known as zirconia.
Rutkowski said zirconia, which is considered a ceramic and not a metal, is especially popular for cosmetic reasons. “The upside to zirconia implants is that there is no dark color. It is white or more tooth-colored as it emerges from the gum,” he said. “The aesthetics are better, so it’s better for the front of the mouth.”
Traditionally, zirconia implants come in one-piece models. “However, various two-piece alternatives should be available in time for IDS 2017—optionally with an adhesive bond or a screw connection,” noted the IDS announcement.
“[The new zirconia implants] are devised to enable a closed healing, which is as a rule not possible with one-piece implants. If it ‘only’ comes down to the aesthetics, a host of ready-made ceramic abutments for titanium implants are available as a further option. Alternatively, individual abutments can be made using the CAD/CAM technology.”
It All Started With Gold
Dental implantology has seen its materials evolve. “Since the beginning of mankind, humans have used dental implants in one form or another to replace missing teeth,” said Celeste Abraham, DDS, in The Open Dentistry Journal. Abraham is associate professor in the Department of Periodontics and Stomatology Center at Texas A&M University in Dallas.
Ancient Egyptians bound teeth using gold wire and plates (Courtesy of Museum of Artifacts)
It all started with gold in 2500 BCE in Egypt and moved through ivory and stone to bits of shell used by the Maya. There were even some dubious attempts to replace missing teeth involving grave robbers. The modern era for implants began in the 1930s. After noting that orthopedic surgeons used Vitallium (a chromium-cobalt alloy) in hip bones, researchers produced a Vitallium screw to anchor and support replacement teeth.
Refinements in design and materials continued. Cobalt and stainless steel implants were used, but there were problems. “The stainless steel corroded, and the chrome cobalt leaked some of its minerals,” Rutkowski said. “It is referred to as ‘stain-less,’ not stain impossible.”
The real breakthrough was implants made from titanium and titanium alloys.
Gabor Balogh, DDS, who practices in Vancouver, Canada, said, “Today’s modern day dental implants developed through an accidental discovery in medical research back in 1952. A Swedish doctor found that when titanium was placed into contact with bone and left undisturbed, the bone grew right against the surface, making the titanium objects un-removable without cutting out the bone around the titanium. This developed into today’s implants.”
When titanium was placed into contact with bone and left undisturbed, the bone grew right against the surface.
Still, researchers and manufacturers have continued to explore alternatives. Arun Garg, DMD, a former professor of surgery in the Division of Oral/Maxillofacial Surgery at the University of Miami now in private practice, said some patients resist the idea of putting metal in their mouths, fearing autoimmune diseases.
Garg stressed that there is no proof that titanium causes any health problems. “Since titanium dental implants have been in use, there has not been one report of an allergy or reaction to the metal itself. Nevertheless, there are some people who have either an allergy or sensitivity to other metals (e.g., prevalence of nickel allergy is about 5%) and/or simply have concerns about any metals within the body,” said Balogh.
The revolutionary genome editing method, CRISPR-Cas9, broadens horizons immeasurably in the health field. Discovered four years ago, it makes it possible to rapidly, efficiently and cheaply modify the DNA of plants, animals and humans to correct genetic anomalies. However, changing the genetic code of human embryos to...
New dental navigation systems offer dentists what GPS provides for drivers. The benefits are substantial, particularly increased efficiency and volume. Same-day planning and surgery are now commonplace, dramatically cutting the time spent providing dental implants.
By 2022, the dental implant market in the United States and Europe is projected to reach $4.2 billion, according to The American Academy of Implant Dentistry.Dental implants are expected to replace an increasing percentage of the millions of crowns and bridges used, the traditional treatment of choice for missing teeth. It’s no wonder that the dental implant navigation market, which can expedite planning and implantology, is proliferating.
Typically, dental implant navigation systems provide mobile technologies that include cameras, motion-tracking software, handpiece and jaw attachments, as well as instantaneous calculation and instrument display. When used with compatible cone beam computed tomography (CBCT) provided by separate vendors, dentists can purchase a cheaper imaging solution that also benefits patients by lowering radiation dosage. Considerable research and development of novel navigation systems is making the field increasingly competitive.
Planning and Putting the Tooth in Perfect Position
Ed Marandola, President and CEO of X-Nav Technologies, told MedicalExpo e-mag that the company’s X-Guide Dynamic 3D Navigation System allows the surgeon to “plan and put the tooth in perfect position with good aesthetics, with ten times greater accuracy than planning from models.”
X-guide implant plan with intraoral scanner (Courtesy of X-Nav Technologies)
Key benefits of the system include enhanced efficiency, the possibility of intraoperative changes, full-field visualization and verification of accuracy. The X Guide system is currently approved as a medical device in the United States, Canada, Australia, Israel and carries European Union CE certification.
Marandola was previously involved in a company that developed cone beam CT and considers navigation as a logical extension of this technology. Turn-by-turn guidance provides a 360-degree view during implant surgery, permitting precise visualization of the handpiece during osteotomy and more accurate implant placement. The surgeon guides implant position, angle and depth using a single view.
The camera in the cart facilitates real-time control of the drill, as well as implant placement through patient imagery. Color tracking of drill depth is also possible using X-Nav’s innovative X-Point technology (patent pending). Another important benefit is that these systems are less invasive, requiring a much smaller incision than previous implant technologies.
In September, the Canadian company ClaroNav received 510(k) clearance to market its Navident Dental Navigation System in the United States. The system has been sold throughout Europe, Asia, and Canada for at least 18 months.
Jason Pardo, Global Vice President of ClaroNav’s Sales and Marketing Division, said that Navident was developed in close collaboration with the University of Toronto’s Faculty of Dentistry. Essential components of the navigation system include a small notebook computer, the Drill Tag handpiece attachment and a customizable patient jaw attachment, called JawTag. There is also an optical position sensor that detects the patterns printed on the Drill Tag and Jaw Tag, as well as micron tracker software.
Dentist using Navident (Courtesy of Claronav)
Dental surgeons use the Navident CBCT image to plan where implants should be placed, and software permits tracking the drill and the patient’s jaw. According to Pardo, Navident clinical use studies show an average implant placement accuracy of about 1.0 mm at the entry point and apex of the implant.
In Europe and Canada, ClaroNav has used a network of Master Clinical Trainers to conduct ongoing training sessions. Purchasers of the navigation system can attend sessions at the home office in Toronto, but ClaroNav also sends training staff to dental offices.
Little is known about the history of dental extractors. These devices, also known as elevators or forceps, are often featured in pop culture, along with dental drills, as instruments of torture. But they were actually intended to relieve pain and disease, not to cause it.
“Prior to the introduction of analgesics and anesthetics, in theory, the quicker the tooth could be removed the less pain would be inflicted on the patient,” according to U.K. dentists M.A. Bussell and R.M. Graham. Bussell, clinical dental officer at Oldham Primary Care Trust, and Graham, specialist registrar, North Manchester General Hospital, explored the history of commonly used dental elevators in the British Dental Journal in November 2008.
The first drawings of extractors can be tracked to Arab Muslim surgeon Abū al-Qāsim Khalaf ibn al-Abbās az-Zahrāwī (936–1013), who lived in Andalusia. Albucasis or Abulcasis, his Latinized name, has been called the “father of surgery.” In the 16th century, elevators came into common use and were referred to as punches or levers. One example is the “Geissfuss” (goat’s foot), so called because of its appearance. A variant was the “Geissfuss mit Haken” (goat’s foot with a claw), said Bussell and Graham.
Examples of early elevators. The fourth one is the “Goat’s foot” elevator (Reproduction by courtesy of the British Dental Association)
In 1754, the French dentist Louis Lécluze (1711–1792) introduced an elevator with a design that some believe was curved. “The latter is likely to be very similar to some of the elevators that are in use today,” explained the authors.
Evolution of the Material
Elevators were accepted in general dental practice in the 1880s. The authors said that the materials used to manufacture dental elevators have evolved. Early devices were made from iron or brass. In the 18th and 19th centuries, elevators had ivory and ebony handles.
“Over recent years, the awareness of cross-infection control and the introduction of sterilization methods, including the use of steam, has influenced the materials used. Currently, elevators are made of stainless steel,” Bussell and Graham noted.
Eco-friendly, safer and connected, some of the ambulances displayed at EMS World Expo 2016 in early October have embraced innovation.
Sustainability was a keyword at the New Orleans trade show. Though not new, solar panels are appearing on more and more ambulance roofs. For example, the redesigned Crestline Icon 2.0, winner of the 2016 EMS World Innovation Award, features PV panels to power onboard equipment and recharge batteries.
Another smart feature is REV Ambulance Group’s use of Stealth Power technology. This auxiliary electrical system powers defibrillators, electrocardiographs and other key medical equipment requiring constant power. The company claims their system could save more than US$16,000 per year, per ambulance by enabling medics to turn off the vehicle’s engine when stationary.
Oxygen cylinder lift (Courtesy of Braun)
Among other innovations displayed at EMS World Expo, Braun Ambulance E-Z 02 Lift is an extremely simple, clever oxygen cylinder lift and storage unit which could prevent numerous back injuries.
Braun has placed a lot of emphasis on personnel safety. Not only did the company display three new ambulances at the Expo, but it also released new crash test footage, explaining how it used the test data to improve safety.
Protecting medics against poor work practices was extensively discussed in New Orleans. Companies like Crestline are using audio alert technologies such as Zoll’s Roadsafety. Installed in an ambulance, the device collects speed, braking, acceleration, turn signal and other data. If the vehicle approaches predefined limits, audio warnings sound. They increase in intensity if the driver does not modify his/her behavior.
However, the most fascinating piece of ambulance technology displayed at the EMS fair may well have been the “Batmobile”. This is how George Barlow Brown and Capt. Adam Brickeen, both of the New Orleans Office of Homeland Security, nicknamed their creation.
Rather than adapting an existing ambulance, they decided to build their own advanced emergency response vehicle using off-the-shelf technologies. This white paper (PDF) explains its features, including:
An advanced LED light bar providing 360° high-intensity illumination
A unique control head, grouping all internal switches on a single platform
A Tesla-like tablet able to accept both IT and video input in place of the central PC
A 360° networked camera system able to stream footage to headquarters