Scientific Activities: TRIP System


Statement of the problem

The natural and esthetically pleasant appearance of a natural or artificially restored smile (i.e. with porcelain crowns and bridges) is the result of the balance existing between the gingival component (soft tissues or gums) and the dental component (teeth).

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In a situation of oral health, that is also the most esthetically pleasing, the relationship between these two components produces gingival extensions or offshoots between adjacent teeth. These interdental (between teeth) gingival extensions are called papillae, and convey a festooned appearance to the dental component. Normally, in periodontal health conditions (health of the supporting tissues for the teeth, such as gingiva, bone , periodontal ligament), the tip of the interdental papillae reaches the contact point in between teeth, totally obliterating the interdental space.

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The absence of interdental papillae in a smile is often sign of a pathological condition (inflammation of soft and hard tissues, i.e. alveolar bone) and causes the formation of interdental “black holes”.

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Interdental black holes not only deface the smile from an esthetical point of view , but create discomfort for the patient as well by causing:

  1. food and bacterial plaque entrapment at the interdental spaces
  2. altered speech due to air flowing in between open interdental spaces
  3. passage of saliva through open interdental spaces during phonation

The gingiva, and therefore the interdental papillae as well, do not have a pre determined shape, but they take the shape and configuration of the underlying bone they cover. Therefore, in order to have a festooned appearance of the gingiva (presence of interdental paillae) it is necessary that the underlying bone shows a festooned appearance or anatomy (shape), meaning interdental osseous peaks.

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When in pathological conditions (periodontitis) or following dental procedures (i.e. periodontal surgery) the bone resorbs , looses its festooning, flattens out, and recedes , even the gingival flattens out and recedes loosing interdental festooning and therefore the papillae. As a result the teeth appear longer, the roots are uncovered, and interdental black holes become evident.

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Interdental papilla height determinants are mainly two:

  1. lateral compression exerted by the teeth adjacent to the papilla
  2. underlying osseous peaks

Between the two determinants, the underlying bone plays a fundamental role. That is why it is of utmost importance to prevent iatrogenic resorption of interdental osseous peaks following dental procedures such as:

  1. tooth extraction (single or multiple)
  2. substitution of missing teeth by mean of dental implants (single or multiple)
  3. periodontal surgery (performed on periodontal tissues)

As of today there are no predictable and repeatable techniques, described in the scientific literature, for the maintenance of interdental peaks and therefore of the paillae, even though special emphasis is reserved to this subject in both scientific publications and lectures presented at national and international dental meetings.

Some Authors suggested sophisticated surgical procedures with scarce success for the preservation or for the regeneration of the papilla, others suggested the meticulous preservation of interdental bone peaks through atraumatic dental procedures, and others suggest avoiding the papilla during surgical procedures, when possible, in order to prevent undesired retraction. As of today no one has hypothesized preserving the interdental bone peaks, and therefore the papillae, through the insertion of a biocompatible material.

The substitution of a missing tooth with a titanium implant (artificial root replacing that of a natural extracted tooth) represents a successful technique made possible by the high compatibility of pure titanium its alloys with bone.

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Few months after the surgical placement, bone and titanium implant establish an indirect contact through titanium oxide. This process, called osseointegration, gives stability to the implant which can be restored with a prostheses or a crown.

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It is known that the presence of implants in the jaws of patients who lost their teeth not only allows for the insertion of artificial teeth anchored to the bone, but avoid further bone resorption over time, at the site where they have been placed.

This important characteristic of titanium, its alloys, and other biocompatible materials can be utilized to counteract interdental bone peaks resorption.

This application can be extremely useful, but not only, for the following clinical situations:

  1. maintenance of interdental bone peaks between adjacent implants
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  2. maintenance of interdental bone peaks between ovate pontics
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  3. maintenance of interdental bone peaks between teeth and implants
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Object Description (T.R.I.P. System)

The Titanium Reinforced Interdental Peaks System (T.R.I.P. System) requires the surgical insertion, within the thickness of the interdental bone, of bars made of any biocompatible material such as titanium (pure or alloy). TRIP System

The surgical insertion should be performed before any dental procedure which may cause interdental bone peak resorption leading to loss of papillae (tooth extraction; implant placement; periodontal surgery). TRIP System

Following insertion, the biocompatible material bar will osseointegrate preserving over time the original height of interdental bone peaks. TRIP System

Once the osseointegration process of the bar is complete, it will be possible to proceed with the previously planned dental procedure, such as tooth extraction, without the risk for interdental peak resorption and papilla retraction. TRIP System TRIP System

Biocompatible bar dimensions can vary according to the size of receiving interdental bone peaks. The prototype shown below has the following dimensions: 0.7mm width x 1.0mm height x 5.0mm length.

Length, width, and height can all vary according to the indications. TRIP System TRIP System TRIP System

The bar can be made out of:

  1. Pure titanium
  2. Titanium alloy (any composition)
  3. Ceramic
  4. Carbonium
  5. Any other biocompatible material

Bar surface can have any geometry or treatment:

  1. Smooth or machined
  2. Acid etched
  3. Plasma sprayed
  4. HA coated
  5. Air borne particle abraded (sandblasted)
  6. Roughned by any other technique
  7. Coated with any other coating

Bar section can have any shape, such as , but not only:

  1. rectangular
  2. square
  3. round
  4. lenticular
  5. ovoid
  6. hourglass shaped
  7. bilobed
  8. etc.
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Bar profile can have any shape, such as , but not only:

  1. rectangular ( solid; micro-macro hollowed; fissured)
  2. biconcave (solid; micro-macro hollowed; fissured)
  3. biconvex (solid; micro-macro hollowed; fissured)
  4. crescentic (solid; micro-macro hollowed; fissured)
  5. etc
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Bar edges can be, but not only:

  1. smooth
  2. serrated
  3. corrugated
  4. etc.

In general, the instrument kit for the surgical insertion of the bars is composed by:

  1. piezoelectric surgical burs calibrated to the dimensions of the bar to be inserted.
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  2. caliper with the dimensions of the bar, for the intra-operatory check of the size of the osteotomy
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  3. pliers for handling of the bar
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  4. biocompatible bars to be inserted into the osteotomy sites cut within the thickness of the interdental bone peaks.
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  5. chisel with metallic (titanium, steel, etc) or Teflon tip for the deep insertion of the bar inside the osteotomy.
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  6. surgical mallet with metallic (titanium, steel, etc) or Teflon end for the percussion of the chisel.
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  7. collagen resorbable membranes to cover the bone graft used as a filler of the osteotomies.
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Instrument Kit

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