titanium to bone

[stt672]

A doctor called me today and has a patient where they are trying to save a good tooth. Patient has an area where there is bad tissue loss and oral surgeon said crown lengthening is not an option. His question to me was if he does a full contour titanium crown will bone grow to the crown as in implants? The only reason is he will have to use bone as margin. This shouldn't be done using other restoration material. Any thoughts?

 

[Jo Chen]

Unlikely that bone will grow to the crown. Implant surfaces are specially treated and sterilized

 

[stt672]

Unlikely that bone will grow to the crown. Implant surfaces are specially treated and sterilized

Great point, Thanks!

 

[k2 Ceramic Studio]

Unlikely that bone will grow to the crown. Implant surfaces are specially treated and sterilized

In theory if the crown was made in the lab and marked up with a step to indicate a finishing line, then this could be sent off to a specialist implant company to have the surface treated (in acid). Then the crown could be sterilised to implant standards and sent to the surgeon, who in my opinion would need to treat this area as if it were a fenestration, use grafting material then suture the patient. It should if done properly allow the the graft to integrate with the crown and the surrounding bone.

fantastic question, please let us know what happens.

If you want to run with this idea then I can put you in touch with a company who can treat the crown for you and return it to implant sterilisation standards.

 

[nvarras]

The crown would not need to be acid etched. Surface treatments only enhance the implant surface to increase blood flow and speed up bone growth around implants. Machined surfaces (untreated) are still implanted but you must allow more time for the bone to grow around the implant. That being said the crown surface would not need to be treated to be successful only sterilized.

 

[k2 Ceramic Studio]

Good call, but the reason I suggested a treated surface was that it would significantly help with integration and at the end of the day that is what you would be trying to achieve, Etching of the surface increases the surface area by over 300% as opposed to an untreated surface, the fact that you really want as fast a bone integration as possible still makes me feel that etching would be the right course of action, I am not referring to the whole crown just the area that is to be augmented too, You stated "Surface treatments only enhance the implant surface to increase blood flow and speed up bone growth around implants" if this were to be done then in my opinion the sounding bone would be agitated buy the surgeon as to increase blood flow to help with the integration thus surface treatment would be ideal. But at the end of the day this is all hypothetical but very interesting.

Pete

 

[stt672]

Thanks for all the great input. Just trying to think this through, if were etched or not how would the doctor isolate the cement from inside of crown where there will be crown to bone contact?

 

[samii]

hi, i am a graduated technician, i need ur help, where can i find directions about full cerams like procera without use cad/cam? and without press system

 

[nvarras]

I agree that it would be advantageous to acid etch however, the recipe used by each manufacturer (time and temp. of the acid bath, size of grit used in blasting) these variables control the size and shape of the crevices created on the surface and are all proprietary. That being said it is not likely that you will find someone to etch this crown for you unless you have your own 'recipe'. So yes, this is all hypothetical and very interesting.

Is it possible to do a bone graft over the exposed root surface? He can cover with a membrane and graft tissue over the bone? This would avoid having to take the chance of making a crown that extends into this area.

If you start thinking about cost to make this work....it might even be cheaper and more predictable to extract the tooth, graft and insert and implant. I know you are trying to save a natural tooth which should be our priority but when does it stop making economic and statistical sense to do so?

 

[PCDL]

Did the Dr. mention why the bone has receded in that area?? Bad tissue loss is caused by bone loss in the area. Most often due to infection in the area. Crown lengthening is going the wrong way, you want to go coronal, not apical.

You might want to talk bone grafting with a gingival graft in the area to try and bring the bone level back up. Theoretically, the titanium of the crown wouldn't be a hinderance, but I don't think I have ever read of a study that would point to it helping. Additionally, if it did adhere to the crown, when you lost the tooth, you would be ripping all that bone growth out, as it will be attached to the titanium, negating all your hard work. But aside from that...

There isn't a good chance of the bone growing up to the height you are hoping for without doing some grafting. Vertical bone growth, even with grafting, is one of OS's most challenging areas. Remember, osteoblasts work best to form new bone when they have a matrix in which to operate. Think of rose bushes on a trellis. Without that matrix, the osteoblasts can't deliver blood and nutrients as readily, and the growth is stifled.

If it was me, I would weigh the effort and cost of trying to save that tooth vs. extraction, proper grafting, and implant placement. Long term, the implant will probably last longer.