Maximising cavitation to clean dental implants

Dental implants are an exciting procedure which replaces a patient's lost teeth. However bacteria in the mouth will grow on the metal surface leading to gum disease. If not removed it will lead to loss of this expensive treatment. It is a huge worldwide problem and currently no methods exist that remove the bacteria effectively. Ultrasonic scalers are an everyday instrument used by dentists to clean teeth. The vibrating metal probe generates bubble activity when used with water. This bubble activity is termed cavitation and could be used to vigourously scrub the implant surface removing the bacteria. Our previous work shows that the bubble activity can work but it is too slow for clinical use. Clinicians like this idea but want it to work quickly and effectively.

To solve current and major problem associated with cleaning of implant surfaces, we have brought together a unique team of dentists and mathematicians which we have called "DENTaMATHics". We have planned three new designs or improvements to the current ultrasound scaler: to improve the tip shape and operation conditions, to implement cavitation prone liquids, and to implement shield-cover design to a scaler tip. The shield-cover will prevent the metal probe from contacting implant surfaces. It will also direct a jet containing oscillating bubbles generated to implant surfaces with the water flowing through the handpiece. These three novel designs will be developed using the state-of-the-art experimental and computational capabilities and together they will dramatically improve the efficacy of ultrasound cleaning. We will call this a non-touch approach. This new design of ultrasonic scaler will be very attractive to industry and before approaching the manufacturers we will patent the idea and set up our own spin out to manufacture our in-house designs. We are confident that these outputs will be used clinically, solving an important global challenge. It will benefit patient treatment and maintain their quality of life provided by the implant treatment.

Dental implant provision is a rapidly growing area in dentistry and is estimated to be worth $ 10,430 Million in 2020. Titanium implants are a replacement for teeth and are designed with specialised roughened surfaces for bonding to the bone. Initially they are buried so that these surfaces are not exposed. It is only the highly polished surfaces including the replacement tooth or bridge that communicate with the oral environment. During clinical use if implants are not cleaned properly then biofilms will form on the exposed and embedded surfaces of the implant. This will lead to inflammation of the surrounding gum and the underlying bone is slowly destroyed. The condition is termed peri-implantitis and occurs in 28% to 56% of subjects. Treatment of the disease requires removal of the biofilm and it is recognised that the present instruments do not remove the biofilm due to problems with access and the blunt nature of the metal probe. We will develop a non-touch approach to clean dental implant surfaces by means of maximising and focussing cavitation bubbles to disrupt the biofilms rapidly and efficiently. Presentation of our preliminary findings has generated enthusiasm amongst clinicians treating such patients and from industry.

Our research will enhance an established technique where the existing technology requires further improvements to effectively manage peri-implantitis. It will therefore provide solutions to a growing healthcare problem and improve the quality of life of patients.

The beneficiaries of the study comprise dentists; clinicians; the NHS; the healthcare industry; patients; the scientific community and the wider public.

The impacts of the project include:

- Meeting clinical needs: The problem of peri-implantitis is increasing especially in the UK where 1% of the population report having implants and therefore a conservative estimate would be that around 3 million patients will have problems with the cleaning of their implants. Successful outcomes from this project will assist in reducing problems for the NHS which is increasingly dealing with the number of implant failures. The work will also provide new insights into cleaning contaminated surfaces that may be applicable to other surgical procedures. We will present our findings to the Ultrasonics Industry Association and use the resulting feedback in the project. The team will consult with industry and other clinicians to ensure that we are providing transformative solutions to the cleaning of dental implants.

- Application and exploitation with industry: Our enhancement of the technology will benefit the healthcare industry (EU figures of healthcare spending will be 93 billion Euros by 2020). This is therefore a potentially a lucrative project that will benefit the UK and international healthcare industry. We will take the project forward to industry or set up our own spin out to manufacture our in-house designs.

- Encouraging interdisciplinary research: This proposal brings together a strong interdisciplinary group of applicants from two different backgrounds. The work builds on the results of preliminary studies that have been reported widely on the Internet including Science Daily and Dentistry Today-USA.

- Furthering public understanding of research: The problem of peri-implantitis and oral health in general are poorly understood by the general public. At Birmingham we have an excellent record of engaging with the public to increase their understanding of oral health, the importance of research and consequent public funding in this area.

- Providing quality multidisciplinary training for early career PDRAs to be engaged in the project with expertise in dentistry, cavitation and applied mathematics and the opportunity for them to engage with industry.

- Providing opportunities for related education and training for post-graduates and undergraduates working at the new Dental School in Birmingham.