Have More Than Eight Dental Fillings?

Have More Than Eight Dental Fillings?

It could increase the mercury levels in your blood

Dental Fillings Silver Spring & Baltimore Maryland | Dr. Sammy NoumbissiDental surface restorations composed of dental amalgam, a mixture of mercury, silver, tin and other metals, significantly contribute to prolonged mercury levels in the body, according to new research from the University of Georgia’s department of environmental health science in the College of Public Health.

This research, which analyzed data from nearly 15,000 individuals, is the first to demonstrate a relationship between dental fillings and mercury exposure in a nationally representative population. The results were published online last week and will be available in the print edition of the journal Ecotoxicology and Environmental Safety in December.

“Tooth decay is one of the most prevalent chronic diseases,” said Lei Yin, a scientist in the department of environmental health science and the study’s lead author. “I think a majority of people have experienced dental fillings, but the kind of materials the dentist uses isn’t something that’s really discussed.”

Mercury exposure from dental fillings is not a new concern, but previous studies were inconsistent and limited, according to Xiaozhong “John” Yu, assistant professor of environmental health science and co-author of the study.

“This study is trying to provide the most accurate levels of exposure, which will form the scientific basis to make future risk assessment,” Yu said, adding that the study was the first to also control for age, education, ethnicity, race, gender, smoking and seafood consumption, which is a known contributor to mercury levels in the body.

The researchers further analyzed exposure by specific types of mercury and found a significant increase in methyl mercury, the most toxic form of mercury, related to dental fillings. Yu said this result suggests the human gut microbiota, a collection of microorganisms living in the intestines, may transform different types of mercury.

Dental amalgam has been the go-to dental filling material for more than 150 years, because it’s affordable and durable. However, about half of the compound contains mercury, a heavy metal known to be toxic at high levels, causing brain, heart, kidney, lung and immune system damage. New research suggests that methyl mercury may cause damage even at low levels.

“As toxicologists, we know that mercury is poison, but it all depends on the dose. So, if you have one dental filling, maybe it’s OK. But if you have more than eight dental filings, the potential risk for adverse effect is higher,” Yu said. People with numerous dental fillings who are also exposed to mercury from other sources, such as seafood or work environments, are most at risk.

The results show that individuals with more than eight fillings had about 150 percent more mercury in their blood than those with none. The average American has three dental fillings, while 25 percent of the population has 11 or more fillings.

According to its website, the U.S. Food and Drug Administration considers dental amalgam fillings safe for adults, but says, “pregnant women and parents with children under six who are concerned about the absence of clinical data as to long-term health outcomes should talk to their dentist.”

The study also looked at dental composite resins, a mercury-free alternative for dental fillings that can release small amounts of bisphenol A, or BPA, which may cause developmental or reproductive damage. The results found no association between dental fillings and urinary BPA, but further research is needed to understand BPA exposure from resin-based materials.

“It’s important for doctors and patients to be informed in their selections,” Yin said. “We now have an excellent starting point to evaluate the potential risk of dental material on human health.”

Europe’s Long Positive History With Ceramic Implants

Europe’s Long Positive History With Ceramic Implants

Europe's Long Positive History With Ceramic Implants | Dr. Sammy NoumbissiPeople have a surprisingly long history of permanently replacing missing teeth with artificial prosthetics.  While this is generally thought of as a modern practice, there is evidence of people at least attempting this medical endeavor which dates back thousands of years. Astoundingly, the earliest evidence we have of the osseointegration of dental implants dates back to 600 AD.

Those ancient implants were made of sea shell.  From a medical standpoint, that material was as effective as any other implant material human beings could come up with, until the first titanium dental implants were placed in patients during the 1960s.  At that point titanium had already been used in various other surgical implant procedures due to its propensity to integrate with bone structure.

While titanium implants had unprecedentedly high success rates, it does have some less than ideal attributes as a dental implant material. One is the manner in which titanium decays, as it results in titanium oxide particles being dispersed into the soft tissue, the bone, and the blood stream.  People have varying levels of sensitivity to titanium in their body.  Titanium oxide contamination in the body can cause myriad health complications, but some people’s sensitivity to the metal is so acute that it causes their body to reject the implant itself.  Additionally, people with especially visible implants often find that the grey titanium post can be seen through their tooth colored crown.

Today there are currently about 600 different dental implant systems produced by over 140 different manufacturers around the world. Virtually all of those implant systems are made with either titanium or zirconia.  Zirconia-based ceramic material was first created in 1975 by a British physicist named Ron Garvie.  It was found to be a highly biocompatible material, and a few years later it was being used to make hip joint replacements.  It wasn’t long before people were looking to zirconia as a potentially superior dental implant material to titanium.  Zirconium dioxide, or zirconia, was first used as a dental implant material by professor Sami Sandhaus in Geneva, Switzerland.

The tooth colored ceramic immediately proved a better cosmetic option for front teeth replacement.  Soon the material was being used to create durable, tooth colored crowns that were attached to existing tooth structure.  It was quickly discovered that, unlike titanium, zirconia facilitated the growth of soft tissue as well as bone.  Zirconia implants are also less susceptible to corrosion, and the material is commonly used in spaceship construction due to its resistance to fracture and heat damage.

While zirconia quickly proved in various clinical trials to have multiple short term advantages over titanium as an implant material, some American skeptics have pointed to a lack of long term data regarding the success rate of ceramic dental implants.  While zirconia implants have only had FDA approval since 2007, the ceramic material has been used to make dental implants in Europe since 1987.  Just as technology and methods have evolved with metal implants and indeed the field of dentistry at large, many adaptations have been implemented to the concept of ceramic implants that have significantly improved the standard of care.  Even without adjusting for these improvements, however, there is more than enough long term data from Europe to attest to the long-term viability of zirconia dental implants, even by conservative standards.

Three million people in the U.S. currently have dental implants, and that number is growing by an estimated half a million people each year.  Since an increasingly large number of these patients opting for metal free implants over recent years, the amount of long term data from the U.S. will soon increase dramatically, and there is no reason to believe that the results will be notably different from the positive outcomes observed in Europe.  Fortunately for prospective implant patients, the number of doctors who are gravitating toward and being trained in ceramic implant technology is also increasing rapidly.

Interview: “Consumers Are Pushing Dentists Toward Metal-Free Implantology”

To read this interview in its entirety, Click Here

A great deal of progress has been made in terms of materials, techniques and design of dental implants since the beginnings of modern implantology over 50 years ago. While titanium and titanium alloys have always been in use, the search for metal-free implantable materials began in the late 1960s and early 1970s, and during the last decade, zirconia has emerged as the most reliable implantable bioceramic. The International Academy of Ceramic Implantology (IAOCI) is an organization entirely dedicated to ceramic and metal-free alternatives to metal implants. It was founded in 2011 by Dr. Sammy Noumbissi, with whom Dental Tribune Online had the opportunity to speak about the mission and vision of the IAOCI, as well as the state of ceramic implantology today.

Dental Tribune Online: Dr. Noumbissi, could you please provide some background information on the development of ceramic implants?

Dr. Sammy Noumbissi: The use of dental implants to replace teeth has increased very rapidly in the last 15 or more years. With this increase in dental implant procedures, the number of manufacturers has increased too. Also, we have witnessed the introduction of various alloys of titanium over time.

Now, just like with any pharmaceutical or medical product, the increase in demand and changes in production methods come with problems and challenges. Although initially anecdotal, reports of titanium and titanium alloy intolerance have increased and are increasingly being investigated and demonstrated in the scientific dental literature. Based on the body of research available today, this intolerance of implant alloys can in great part be attributed to the release of metal ions in the host bone and surrounding tissue as a result of the breakdown and corrosion of metal alloys in the presence of body fluids and the oral environment in particular. Such facts have been established and widely recognized in orthopedics.

In the late 1960s, pioneers in ceramic implantology and notably Professor Sami Sandhaus began the search for modern non-metal implantable ceramic materials. However, many of the early ceramic implants were monocrystalline in their structure and could not survive the demands of the oral environment. Then came the use of polycrystals and in the early 2000s Yttria-stabilized zirconia bioceramic emerged as the material of choice for metal-free intrabony implantation in dental implantology.

How did you become involved in research on ceramic dental implants?
My interest in ceramic implants came about in two ways. First, on a personal level, when I discovered that the metal fillings and implant I had in my own mouth were determined to be the source of some of the health problems I had experienced. Second, on a professional level, where a few of the patients to whom I had provided metal implants returned for check-ups or more implants, and upon reviewing their medical and dental history, it was also determined that the implants were at least in part responsible for the health problems they were experiencing. I then began to actively look for alternatives and at the scientific literature, including case reports in both medical orthopedics and dental implantology. It was clear that bioceramics in the last two decades had established themselves in both medicine and implant dentistry as the most bio-inert implantable material available. In 2011, two colleagues and I decided to create the IAOCI.

What is the primary aim of the IAOCI?
Associations and academies exist around various types of trades and industries. The common purpose of such groups is to organize and create a supportive environment for those involved in the respective area. The IAOCI was created with the same spirit, not only to organize metal-free implantology but also to provide the profession as a whole with quality and high-level continuing implant education on bioceramics as implantable materials. The IAOCI is also a resource for the public seeking practitioners who have experience with ceramic implants.

In your opinion, what are the dangers of metal implants?
Metal and most particularly titanium implants have been very successful. Their use has grown exponentially and with that manufacturers have multiplied, as well as manufacturing protocols. As a result, we have observed a steady increase in the alloy elements mixed with titanium during the manufacturing process. The problems begin when the metal implant highly alloyed or not, once placed is subjected to functional stresses, galvanism, body fluids and the harsh oral environment. The combination of mechanical, chemical and electrical events induces cracks and pitting of the metal, as well as breach in the oxide layer, and the implant undergoes corrosion attack. The corrosion attack, which is essentially an oxidation process, leads to the release of metal ions that studies have shown to be found in the surrounding bone, lymphatics, spleen, liver and in some cases crossing the blood–brain barrier.

What alternatives to metal dental implants are currently available on the market?
Today, the well-researched and proven alternative material to metal for dental implants is zirconium dioxide, also known as zirconia. This is also a well-proven fact in medical orthopedics. Zirconia is the crystal phase of zirconium and as such it is not a metal. There are different manufacturing protocols for zirconia for dental implantation and they all lead to a variety of polycrystal bioceramics, such as zirconia-toughened alumina, hot isostatic-pressed zirconia and Yttria-stabilized zirconia. The common and most important properties of these bioceramics are inertness in the bone and oral environment, structural stability, absence of electrical activity, extremely low plaque retention and superior aesthetics.

Is the success rate of metal-free implants comparable with that of titanium implants?
In the early days, there were challenges. The materials were monocrystalline with very highly polished and glassy surfaces, which made the early implants prone to fracture, poor attachment of bone-forming cells and low bone–implant contact. The manufacturing protocols, design, surface modification techniques and technologies of zirconia implants have evolved to a point where bone integration is ensured and comparable results are obtained.

Are ceramic alternatives the future of dental implantology?
Every industry projection one sees about implants signals good news for the future. Implants are now and will continue to be widely accepted by patients and the profession. Both groups agree that this is state-of-the-art treatment. However, owing to technology, the public is much more informed about health issues and therapies. We are in a similar situation today to that of Invisalign braces a few years back, in that consumers are pushing dentists toward metal-free implantology for the most part. In five years’ time, I believe that the number of ceramic implants being placed will double.

Bio-inert materials are the future of any type of implantable device. I believe bioceramics have taken hold and will be around for a long time because there has been a strong shift toward providing health care with the minimum risk and invasiveness over the last few years, as well as in a way that is more integrated, natural and biological. Furthermore, manufacturers have rapidly evolved and adapted the material and implant designs to clinical needs and demands. We now have a wide variety of implant designs, surface microstructures, components and prosthetic connections, making ceramic implants applicable to an extensive range of tooth replacement situations.

Dentists may have concerns about the reliability of ceramic implants. How does your organization address this?
Even within specialties, there is a need for organized groups because in today’s world research and application of discoveries are moving at lightning speed compared with 20 years ago. Therefore, once one has an environment in which much of the time and energy is spent tracking, learning and sharing innovative techniques and materials, members have a forum where they can obtain the information, training and skills to deliver the best of care to their patients in an evidence-based and organized manner.

As a matter of fact, our membership has doubled in the last two years and when prospective or new members are asked why they want to join or joined the academy, the most common response is that they are seeking a forum where they can obtain structured information and training.

Another frequent reason is that dentists have had patients challenge or inform them on the use and occasionally the existence of ceramic implants. Through technology and the ease of access to information, the public obtains information faster than we busy clinicians.

The IAOCI will be hosting its Fifth Annual Winter Congress in Montego Bay, Jamaica. What can people expect from the event?

The theme in 2016 will be the last decade in ceramic implantology. We will have 14 speakers from seven different countries who will share their experiences with a variety of ceramic implant systems over the last ten years. One of our guest speakers has over 15 years of documented experience with zirconia implants. We will also have workshops on different implant systems, ceramic regenerative products and revolutionary soft-tissue- and hard-tissue-enhancing protocols proven to optimize implant integration and long-term stability.

Drs. Noumbissi & Luettmann Zirconia Implantology Workshop At The 36th Annual Asia Pacific Dental Congress: APDC 2014 Dubai, UAE

Dear Colleagues, Friends and Patients,

On Monday June 16, 2014, Drs. Sammy Noumbissi and Ralf Luettmann of Hamburg Germany conducted a full day Workshop in Advanced Implantology at the 36th Annual APDC meeting. There was a combination of lectures and hands on where all 12 attendees were able to perform placement of Zirconia dental implants in artificial jaw models. This program was the first of its kind at the APDC and in the Middle-East.

Loma Linda University Graduate Implant Program Alumni Symposium. June 9, 2014

Zirconia Implantology Lecture At Loma Linda University’s Graduate Program In Implant Dentistry

A great professor and mentor Dr. Alejandro Kleinman is retiring from Loma Linda University’s Graduate Program in Implant Dentistry. Prof. Kleinman was instrumental in Dr. Noumbissi’s decision and selection to attend the program in 1999. In his honor the Robert A. James Society of Implant Dentistry is hosting an Implant Dentistry Alumni Symposium that will take place at Loma Linda University in the Randall’s Visitor Center on Monday June 9, 2014.  Dr. Noumbissi was invited and accepted to speak at this event along with other graduates of the program.