Brånemark’s Adamantium

I’m finally going to talk about the coolest dental invention around – implants!

If you recall my previous post Engineers on a Small Scale, I mentioned that a dental bridge is one of the options for replacing missing teeth. The other widely popular option is to go all Wolverine and put a piece of metal in your bone structure.

Image: Marvel Entertainment and 20th Century Fox

However, unlike our mutant friend Logan, our implants support teeth rather than claws.

Just last week, a Swiss-based implant company named Straumann sent some representatives to our school to give us a simple hands-on course on implants. Of course, as BDS undergraduates we’re not expected to know too much about actually placing implants, this hands-on course was just a simple introduction so we know what it’s all about and how to explain to patients about these fancy titanium screws.

Image source

As we can see above, the metal screw is the aforementioned implant. It is surgically placed in the mouth by the dentist, embedded through gum and into the bone. The implant is usually made of titanium, which is a very strong metal that doesn’t corrode and has the ability to make the bone remodel & grow around it. The threads of the implant improves its ability to stay within the bone by increasing its surface area, thus providing strong support for the tooth above. After the implant is placed, a crown or bridge or even a denture can be placed on top of it. You might wonder, if its function is just to replace a missing space, why go through so much trouble moving heaven and earth to plant a screw into bone? Why not just make a bridge that sits on top of the gum?

Bridges, while ingenious, sit only on top of the gum and not within bone. This means that when you bite down on that false tooth, it doesn’t feel REAL. Implants can give that tactile sensation when you bite on it, giving the impression that it’s like a real tooth. Our teeth have the amazing ability to discern even the tiniest objects sitting between them – say, biting down on a grain of sand, or having a small piece of meat stuck between your teeth. This organic sense can never be replicated by bridgework, but implants are able to do so, to a certain extent.

Implants are expensive though. And expertise-demanding. And time-consuming. And not everyone is suitable for it. You’ll need a certain bone density to be able to do it, or else you’ll need a bone graft which in turn leads to more surgery and longer treatments. What I’m trying to say is, while it gets closest to replicating a real tooth and is considered gold standard in many regards, it isn’t a silver bullet (it’s just a titanium screw!)

Here are some pictures of the recent Straumann hands-on workshop:

Straumann’s titanium-zirconium implant held in a sterile environment within a capsule.

The implant removed from its capsule. The blue part is an attachment to a ratchet that I’m holding, the implant itself is the silver-and-gold screw below the blue part. In the background you can see a piece of “bone”, which has a hole surgically prepared specific to this implant’s dimensions.

The implant screwed into the bone. At this stage, it’s nowhere near done. There are a few more stages to do after this, and may take months before a final crown/bridge is made to be placed atop it.

_______________________

I named the title of this blog post after Per-Ingvar Brånemark, a Swedish orthopaedist who is known as the founder of modern dental implants. While dental implants have been used historically as experiments, Brånemark did some landmark studies that proved that titanium could adhere with bone in a process called “osseointegration”.

 

Episode IV

It was a very quick Summer after the end of third year and voila! I’m in fourth year now. I haven’t blogged since June, as I was busy enjoying my Summer holidays back home in KL. I hope my avid readers aren’t bored to death during the hiatus!

We’ve been told by clinical staff in our school that as a fourth year, we are “senior dental students”. Still feels surreal to be known as “senior”, as I feel like it was not long ago when I started first year. Ah, the good old days of first year, studying human anatomy and basic physiology.

Nevertheless, the dentistry is becoming more challenging and rewarding at the same time. I have to say I thoroughly enjoyed third year. First-hand patient contact and performing treatments, third year was a ridiculously good experience. The dean of our school, Professor Burden, said this: “Dentistry is the only undergrad programme where we actually treat real life patients ourselves.” Yes, and it is most enriching.

Just to summarise what I’ve learned in third year:

• Restorative work (fillings, build-ups etc)
• Root canal treatment/endodontics
• Extractions
• Partial denture design & prescription
• Scaling (with ultrasonics and root planing)

And a few things we will learn in fourth year:

• Minor oral surgery
• Suturing
• Crowns
• Complete denture design & prescription
• Adjusting orthodontic appliances
• Treating children (yay!)
• And possibly many more that I don’t know yet…

For the first week of class, we are having a short course in minor oral surgery. Minor oral surgery is undertaken when there are defects present in the oral cavity that needs surgical intervention to remove. So for example, during extraction, a root cracks and a part of it is left in the socket. In some cases the root may be left inside the socket, if it’s small and unlikely to cause infection. However, if it is at risk of developing an infection, the root has to be removed. But how? The root is buried within the bone, which is further covered by gum soft tissue.

Enter minor oral surgery. This would involve cutting a gum flap with a scalpel right down to the bone, and peeling back the soft tissue. This reveals the bone. The bone is drilled with some burs to reveal the leftover root in its socket. The root is pried out with some instruments, and the gum flap sutured (stitched) back into place. I’ve had a go at this on phantom heads, it is mighty interesting. I’ve even learned the technique of suturing, but it would take a lot of practice to be proficient at it.

I will update when I learn more stuff from school. For now, bye peeps! Here’s to fourth year of dentistry!

Self-Extraction

Posted on Mashable:

If you already know how to remove your teeth, why not just cut out the middle man and do it yourself?

Jesper Ryltoft is a dental student at the Aarhus School of Dentistry in Denmark. And apparently, students there go balls-out when it comes to dental procedures — because Ryltoft just did a DIY removal of his own wisdom teeth.

Full disclosure: The video is a little unpalatable for the squeamish. Ryltoft comments on the video that this is definitely not something to attempt on your own at home: “I am a dental student and had professional equipment and a dentist present when doing this.”

Props to you on your dedication, Ryltoft — but we’ll probably just let somebody else rip out our teeth for us.

 

Just thought I’d share this. It’s quite interesting to see one inject himself with local anaesthesia, let alone extract his own tooth!

Your Toothache Could Kill You! Here’s How

Not many people out there relate dentistry to anything lethal. I’m here to convince you that a dental infection could actually lead to your demise – and that you need to keep your teeth clean to stop that from actually happening!

As explained in an earlier post about tooth decay, a decay that persists and spreads into the tooth nerve (pulp) will eventually result in an irreversible infection of the pulp. This is called an irreversible pulpitis (-itis means inflammation) and results in a “dead tooth” and will require either root canal treatment or a surgical extraction.

But why though? Why treat it or remove it when it’s already dead? If the nerve is dead, so that means there should be no pain sensation, right? Just leave it be!

WRONG! This will kill you!

LUDWIG’S ANGINA

Ludwig’s angina is the result of a dental infection that goes untreated/unextracted. Ludwig is the name of the German doctor who first described this disease. Angina stems from the Greek word ankhon which refers to the feeling of being strangled.

Whoa! That escalated quickly. From a mere toothache to being strangled? Here’s how it works:

1. A dental infection causes pus formation in the pulp and the area surrounding the roots. Pus is a collection of dead white blood cells and bacterial cells after a drawn-out battle. Think of pus as the body count after a war. This pus collected inside your tooth causes toothache – and this is the part where you NEED to seek help from a dentist to prevent it from getting any worse.

Image source

Look at the left side of the above diagram. Looks terrible, yes? Abscess is the collection of pus.

2. The infection remains active, bacteria multiply and further destroy your tissues surrounding the tooth. From the pulp, the infection spreads to other parts of your face and neck.

3. As the region around your mouth and face are so widely interconnected, the infection spreads rapidly from the tooth to the muscle, fat, blood vessels and soft tissues. Pus formation and inflammation causes your neck and face to swell up.

4. If the infected tooth is an upper tooth, Ludwig’s angina is highly unlikely. However the spreading infection will affect your sinuses and your nose. However, infection spreading from a lower tooth may result in Ludwig’s angina and will proceed to kill you if left untreated! This spreading infection will cause swelling of the tissues around your airway – constricting it and causing the “strangling” effect described by angina.

5. The constricted airway obstructs your breathing. And you’re dead.

NOT ALL DOOM AND GLOOM

By today’s standard of medicine (in the developed world), we can save lives much more easily. Antibiotics such as penicillin be used to stop the infection spreading and kill the bacteria. If hospitalised, the doctors can insert a tube down your throat to keep the airway open so that you can continue breathing. The culprit tooth causing all the damage must be extracted. Incisions must be made to drain the pus out of your face – and the swelling will diminish after some time.

Prior to the introduction of antibiotics, mortality (death) rates of Ludwig’s angina was more than 50%. [1] I suppose it was thought of as an incurable disease. As of 2010, the mortality rate is around 5%. [2] Yay to the advancement of science!

Remember to keep your teeth clean, people!

 

References

[1] Evidence-Based Diagnosis and Management of ENT Emergencies

[2] Newlands C, Kerawala C (2010). Oral and maxillofacial surgery. Oxford: Oxford University Press. pp. 374–375. ISBN 9780199204830.