Teeth in one hour

LSUHSC dentists are developing better biomaterials for fillings.

By Leslie Capo

Bryon Cornelison, the Director of the Preservation Resource Center's Rebuilding Together Program in New Orleans, recently had a little rebuilding of his own-in his mouth-thanks to a new clinical research study at LSU Health Sciences Center in New Orleans' School of Dentistry.

The study, which is still enrolling participants, is evaluating the success of placing a dental implant and a temporary crown at the time of tooth extraction.

"The traditional method has been to extract the tooth, place a graft material into the site, and wait four months before placing an implant," says Michael Block, DMD, professor of oral and maxillofacial surgery, who is also the study's principal investigator. "However, recent clinical work has revealed that the success rate may be as good with immediate 'tooth' replacement. And certainly for the patient, walking out with your mouth intact is much better than having a missing front tooth. This study will compare the new method to the traditional one."

"The study examines a problem encountered by many patients on a daily basis," adds co-principal investigator Penwadee Limkangwalmongkol, assistant professor of prosthodontics at LSUHSC. "What should we do when extracting a tooth? The key question is which treatment method will provide the least morbidity (pain, lack of function) and at the same time the most efficient therapy."

Participants qualify for the Phase II Clinical Trial if they are in good health and have no significant dental problems other than an upper front or side tooth that needs to be extracted.

Cornelison qualified for the study but with a somewhat unusual reason for needing to have a tooth extracted. Even at the age of 41, he still had some of his baby teeth.

"Some of my adult teeth never came in on the upper right side of my mouth," said Cornelison. "The one below it was gone, and this one was in bad shape and needed to go."

While not as bad as having an upper tooth missing right in the front of the mouth, Cornelison says it still made him a little insecure. "If I smiled really wide, it would show, so I tried not to smile really wide. It also showed in pictures sometimes, so taking pictures made me a little self-conscious."

"Once accepted for the study, dental models are made and a mockup of the planned tooth is made in clear plastic," explains Markus Blatz, assistant professor of prosthodontics.

Participants are randomly divided into two groups. Group 1 has the traditional technique-tooth extraction, graft placement and, four months later, placement of the implant and crown. Group 2 participants have the implant and crown placed immediately following tooth extraction as a one-step procedure.

Cornelison was randomly assigned to Group 2. In an hour and a half, his nagging problem was solved and he had a new "adult" replacement tooth.

"It sounds a little scary to have a tooth screwed into your jaw, but it was really simple and painless," he said. "I would recommend it over bridge work."

Participants must pay a surgical fee of $500 for the surgical extraction and implant placement and $650 for the crown. The fees are deeply discounted; they're about a third of the typical cost for these procedures.

After the final crown is placed, participants are asked to return for evaluation every six months for at least two years. However, every six months, the participant's teeth will be cleaned by a dental hygienist, free of charge, and participants will be compensated at the rate of $50 per follow-up visit.

"We believe that the bone level on the implant will be the most critical factor in evaluating long-term results when placing teeth in fresh extraction sockets," says Block. "After removing a tooth, the bone naturally heals and thus may change shape and height. Some believe that immediate implant placement will lessen the natural process of bone loss from remodeling. Others believe that grafting the fresh extraction socket will create a better environment in the long-term."

For patients, of course, the other principle concern is esthetic.

"We will also be correlating the effect of bone levels on the gingiva (gums) to see if there are esthetic changes that are meaningful," says another of the study's co-principal investigators, assistant professor of prosthodontics Paulino Castellon, DDS. "We always want the final result to look like a tooth, not an implant crown."