| What is Tissue Engineering?
Tissue Engineering is the science of manipulating cells to regenerate tissues, replacing damaged, diseased or missing tissues and even organs, Although a relatively new technology, it has had significant success in the regeneration of skin bone and cartilage.
- growth factors
Resorbable collagen or polylactate membranes may be tacked in place to secure graft material. The use of membranes permits controlled guided bone and tissue regeneration to create:-
We have been able to demonstrate successful regeneration of the upper jaw using Engineering Assisted Surgery™ techniques.
The wasted upper jaw (Maxillary Atrophy) occurs in patients following an upper dental clearance, and historically has been an extremely difficult problem to solve, often involving major surgery, not without risk for many patients.
Patients with Maxillary Atrophy have a significant disability which significantly impares the quality of life. Upper dentures become extremely loose to the extent that they cannot be worn - not even with the use of denture fixative. The condition may be initiated by the rocking motion of an upper denture in a patient with missing lower posterior teeth, and who does not wear a occlusion balancing lower denture. This rocking motion is produced by the lower anterior incisor teeth, which bite only into the front upper denture. The underlying bone cannot withstand this trauma - and disappears.
The management of this condition has been revolutionised by Engineering Assisted Surgery™ techniques and by Tissue Engineering in particular. Safer treatment options are now possible without recourse to major surgery - or even hospitalisation - as an outpatient procedure in the dental surgery, under local anaesthesia.
Following upper jaw regeneration, upper dentures can be made and stabilised with dental implants, without palatal cover, greatly enhancing the quality of life for patients. A stabilised denture is known as an Overdenture.
Lower overdentures can be very comfortable and effectively stabilised using an inexpensive Mini Dental Implant System. Many patients state that these overdenture solutions produce result which feel as is they have been given back their own teeth.
The cost of this treatment modality is very much reduced, making these treatment options more accessable for patients.
Treatment Plan Guided Bone Regeneration
Platelets are rich in:
These factors increase:
Platelet Rich Plasma (PRP)
Transitional stabilisation was achieved at 3 weeks following grafting with a single Mini Dental Implant placed in the anterior nasal spine.
This implant became loose but still maintained its function of excellent stabilisation of the upper denture for a period of 6 months.
Transitional Stabilisation (6months)
OPT Radiograph 6 months
Radiographs show that the implant has lost its attachment to bone, but the clinical image shows that the implant although submerged is still functioning without any evidence of peri-implantitis.
Transitional Stabilisation at 6 months
Over a 6 month period several Mini Dental Implants were lost and were simply replaced without significant increase in cost.
Outcome - 6 months
Lower Dental Clearance and Provision of New Dentures
A lower clearance was carried out at 6 months with stabilisation of an immediate lower denture.
The upper denture was made without palatal cover.
Note the facial rejuvenation achieved with the overdenture technique.
This has been achieved without recourse to soft tissue enhancement of any kind, and illustrates the importance of the teeth and jaws and lip support achieved by the overdenture in the generation of facial harmony.
This outcome would not have been possible with single tooth implant treatment plan unless combined with major jaw advancement osteotomy surgery, which still would have provided an inferior rejuvenation effect.
Outcome - 5 months post clearance
Outcome @ 2 years
Outcome @ 2 years confirms osseointegration of 4/7 MDI implants in the maxilla. Two implants in the anterior maxilla and one implant in the region of the right premolar (bicuspid) are mobile. Two of the loose implants appear to be tissue integrated - i.e. adherant to soft tissue to the effect that the implants are functioning, and are assisting in a superb retention of the upper palateless denture.
This is an important observation and may have importance in the creation of a tissue integrated system which may function in the absence of bone. Loose implants remain under close review and may be augmented with bicon implants as a two staged technique.
2 year Outcome - Palateless Upper Denture
(despite gingival recession all implants are osseointegrated and functioning)
Outcome: Excellent Retention @ 2 years
Click Image for Patient Comment
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A case of severe maxillary atrophy treated with the same method of grafting as Case 1.
The patient decided to undergo treatment of the maxilla only.
No hospitalisation was required.
An initial plan using Mini Dental Implants was converted to bicon implants http://www.bicon.com following loss of implants (see below).
Bone density was assessed and bicon Implant placement was planned using Simplant 9 software.
Computer Planning - Simplant 9
Bicon Implant Placement - Virtual Reality
Simplant 9 Computer Planning
Bone Density in Grafted Maxilla
Grafted Bone and Misch Grading of Bone Denisty
Click Image for Patient Comment
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In Case 2 initial placement of Mini Dental Implants initially provided excellent retention and were replaced with bicon implants as a two-staged procedure. This resulted in a successful outcome.
It is interesting to note in Case 2 that one of the Mini
Dental Implants fractured in dense bone. This implies that osseointegration
occurred and that the fracture was related to loading of the implant in
dense bone graft with possible compromised elasticity.
In Case 2, a complete inability to retain an upper denture has been solved.
These outstanding outcomes are life changing events, that are now possible without recourse to major surgery.
Dental Prosthetics: Ben Swindell of Crown Ceramics, Ripley, Derbyshire.
The author wishes to acknowledge the input of all colleagues working
in this area, whose input has made this kind of surgery possible - particularly
Professor Robert Marx in the field of Tissue Engineering and Platelet
Rich Plasma research, Dr. Victor Sendax, who developed the MDI Sendax
Mini Dental Implant System and Thomas Driskell the innovator of the
Bicon Dental Implant System, which has been extensively clinically investigated
by Dr Vin Morgan.