Source: https://patents.google.com/patent/US8454362B2/en
Timestamp: 2018-07-21 13:54:27
Document Index: 238024382

Matched Legal Cases: ['Application No. 09075153', 'Application No. 09075154', 'Application No. 09075154', 'Application No. 09075155', 'Application No. 09075153', 'Application No. 09075155']

US8454362B2 - Customized dental prosthesis for periodontal- or osseointegration, and related systems and methods - Google Patents
Customized dental prosthesis for periodontal- or osseointegration, and related systems and methods Download PDF
US8454362B2
US8454362B2 US11549782 US54978206A US8454362B2 US 8454362 B2 US8454362 B2 US 8454362B2 US 11549782 US11549782 US 11549782 US 54978206 A US54978206 A US 54978206A US 8454362 B2 US8454362 B2 US 8454362B2
US11549782
US20080090208A1 (en )
A customized dental prosthesis for periodontal or osseointegration is disclosed having a manufactured implant portion shaped to substantially conform to the three-dimensional surface of a root of a tooth to be replaced. Furthermore a CAD/CAM based method of and a system for manufacturing a customized dental prosthesis replacing an extracted tooth is disclosed, where the extracted tooth is scanned regarding its three-dimensional shape and substantially copied using (a) an imaging system in-vitro like a 3D scanner or in-vivo like a cone beam CT system, (b) CNC machinery and (c) biocompatible material that is suitable to be integrated into the extraction socket and at least partially adopted by the existing tissue forming the socket.
Human teeth serve a variety of functions. Not only are they important for chewing food, but they also necessary to pronounce certain consonants properly, especially fizzle- and S-sounds. Furthermore, teeth play a major role in our personal appearance. White, healthy and well aligned teeth are an ideal of beauty and appear as a cosmetic sign of youth and success.
Although various preventive measures, like frequent tooth brushing and flossing, and drinking fluoridized or iodized water are widely accepted and used, the great majority of people sooner or later challenged with dental fillings, restorations implants, and/or prostheses.
Endosteal implants are placed into the bone, like natural tooth roots. They can provide an anchor for one or more artificial teeth. They are the most commonly used type of implants. There are various types of endosteal implants, for example, screws, cylinders, and blades.
In cases where a tooth is not severely damaged, and would be ready to receive a partial restoration, but an intra-oral repair is impossible due to access problems, or a reverse root canal treatment is required, an alternative method is the intentional re-implantation. The tooth is extracted, repaired, and re-integrated into the existing periodontal structure of a dental patient. Nuzzolese et al write in the Journal of Contemporary Dental Practice, Volume 5, No. 3, Aug. 15, 2004: “It is well known dental reimplantation is indicated following traumatic avulsion by the preservation of cellular vitality in the periodontal ligament and under conditions of asepsis. The rate of endodontic success at five years reported in the literature ranges between 70% and 91%. However, intentional dental reimplantation is an effective strategy for the treatment of teeth that would be difficult, if not impossible, to treat using traditional root canal therapy. Different prognoses exist for intentional dental reimplantation and trauma-related reimplantation. This is due to such important variables such as the level of cellular vitality in the periodontal ligament; the degree of trauma to surrounding tissues, and the degree of asepsis when a tooth is removed. Surgical extraction is more favorable in this regard compared to a traumatic avulsion scenario.” Although this method is not yet widely used, the reported success rates are noteworthy. A disadvantage is certainly that the specific tooth still needs an overall reasonable condition and prognosis to justify an intentional re-implantation and that only certain root and root canal deficiencies can be repaired this way.
Various publications reporting that the prognosis of intentional reimplanted or transplanted teeth is significantly better than the reimplantation after a traumatic extraction, since the extraction is surgically controlled and relatively aseptic techniques are utilized. Spouge writes in his Oral Pathology, Mosby, Saint Louis 1973; “The majority of reimplantations however are clinically successful, and the teeth are retained firmly in the socket for the appropriate 5 year period. However, despite the apparent success, most of them show localized ankylosis and gross resorption of the root at the end of this time. The fibrous attachment that develops in the new periodontal ligament area often involves the formation of an immature type of connective tissue whose fibers remain tangential to the root surface rather than becoming physiologically oriented. There is experimental evidence to suggest that formation of a physiologic periodontium is more easily achieved in condition where the viability of the original periodontal ligament is maintained . . . . In keeping with this, the prognosis for clinical successin a reimplanted tooth fall rapidly if is have been completely dislocated from its socket for more than 24 hours.” Wong suggests in Quintessence International, Vol. 33. No. 2, 2002 a surgical “exarticulation” method, where the removal of the tooth from its socket is achieved “(after the incision of the crestal periodontal ligament fibers with micro-blades) with a combination of luxation and gentle, rotary, reciprocating movements” in order to minimize physical trauma to the excising periodontium. Goerig et al recommends in Quintessence International, Vol. 19, No. 8, 1988 a sectioning procedure where a molar tooth is cut in half dividing the roots in order to minimize the damage of the existing periodontal ligament.
All such restorative and prosthetic options and methodologies are deficient being heavily invasive and limited in their respective scope. There has not been recognition, until now by the Applicant, of the need for a product, systems, and methods related to the integration of dental prosthesis such as artificial tooth, bridges, or segments of the dentition that includes custom-shaped root structures to be osseointegrated or even more beneficial integrated into the existing periodontal structure of an individual patient, having the desirable broad scope and reduced invasive requirements.
In view of the foregoing, embodiments of the present invention beneficially provide a customized dental prosthesis and implant in various embodiments based on a process that includes copying a significant portion of the original root geometry of a human tooth, to be integrated after extraction of the original tooth either in the existing biological cell structure of the periodontal ligament or into the embedding bone structure of the respective jaw. The concept of periodontal integration of an artificial tooth uses the existing human periodontal ligament for integration and is certainly less invasive than the integration of osseointegrated implants. The various embodiments of this invention are not only substitutive but additive to the available options in the field of restorative and prosthetic dentistry with the result that in most cases the need to use removable dentures will be significantly postponed.
In this context, the invention described herein relates to fabricating customized segments of the dentition, single teeth, roots and crowns or parts of those. The artificial reproduction of the original root will be inserted into the alveolus, the natural cavity of the root of the tooth to be replaced. It will either be adopted by the periodontal ligament of the patient or osseointegrated, if the periodontal ligament is no longer functional. The shape of the root will be a substantial copy of the root to be replaced or may be intentionally smaller for example to compensate for measurement or manufacturing tolerances or inaccuracies. The shape of such roots may be a copy of the root to be replaced, or it may be adapted to the alveolar situation. In certain cases it is adventurous according to the invention to modify the shape to be integrated. For instance it may be appropriate to conjoin the two or three roots of a molar to gain additional stability or enable the manufacturing of such. Also, strongly bent root tips may be reduced or left away in order to ease the insertion of the prosthesis.
No approach in dentistry based on design and manufacture of customized teeth including the root, or only roots suitable to be used in conjunction with off-the-shelf or customized components (typically for the visible part like veneers or complete crowns) used in the field of implantology for an individual patient, and design and manufacture of such customized tooth, has been proposed up to date. The implants widely used in dental treatment today are off-the-shelf products. Because teeth have to fit properly for comfort and healing-process after surgery in the periodontal ligament of a patient, some commonly used implants do not constitute an optimal replacement.
Directly after placement, the prosthesis needs to be tied, glued or otherwise fixated for several weeks to adjacent original or artificial teeth or tentative implants like mini-screws.
FIG. 26 shows a dental implant according to prior art
FIG. 2 shows a natural tooth embedded in its socket. The pulp (1020) holds nerves and blood vessels (1070). It is surrounded by dentine (1010), which is covered with enamel (1000). The root portions have a thin layer of cementum (1050) providing connection to the ligament (1040), which serves to anchor the tooth to the bone (1060). The outside of the bone is covered with gum (1030).
According to an embodiment of invention, a dental prosthesis is individually shaped and integrated into the natural extraction socket of an individual patient. The shape of the portions of the prosthesis representing the root substantially copies the natural root of the tooth that was located in the socket. However, the shape may be modified in order better adapt to the natural socket or to ease insertion of the prosthesis. Also, the socket may be surgically adapted for the same reasons. According to the invention, a segmented prosthesis can be used. A segmented, also referred to a segment, prosthesis is one in which a first segment is implanted into the extraction socket and second segment, for example, a portion representing the crown of a tooth is attached to the segmented portion. Accordingly, segment prosthesis includes at least two separate portions which may be manufactured and implanted at separate times. The segment which is implanted into the extraction socket is a representation of the root of the natural tooth and can be manufactured based on 3D imaging data. The segment representing the crown can be manufactured according to standard procedures known in the art.
Preferably, at least the customized implant portion of the dental prosthesis is fabricated using a CAD/CAM based method and system, wherein, the three-dimensional shape of an extracted tooth is scanned and substantially copied, using a 3D scanner, multi-axes CNC machinery and biocompatible material or material later to be covered with a thin layer of biocompatible material that is suitable to be integrated into and adopted by the existing periodontal ligament cell structure of an individual patient.
An overview of a method for replacing a tooth according to the invention is shown in FIG. 5. First, the tooth to be replaced is extracted (step G) and properly cleaned (step M). Then 3D imaging (step N) is performed in order to obtain 3D data (D) representing the three-dimensional shape of the root of the tooth. The resulting 3D data is imported into CAD software and displayed to an operator (step E). At this point, the 3D data may be modified, for example, to alter the shape of the root of the virtual model. It should be noted that FIG. 5 contemplates possibly interaction with an operator, one skilled in the art would readily appreciate that this functionality may be fully automated. Additional features may be added from a digital library and merged into the 3D root data (step S). The resulting 3D data is converted into IGES format and exported (step H) to a CAM system for fabricating (step I) the prosthesis (J). The fabricated prosthesis is then coated with a substance promoting bone ingrowth (step K). It should be noted that coating the prosthesis is an optional step. The prosthesis is then implanted into the extraction socket (step L).
The STL data describing the solid representing the tooth are then converted to an IGES data format. This is performed using, for example, a software named SolidWorks (SolidWorks Corp., Concord, Mass., USA). The IGES file allows generating a CNC sequence to machine an artificial tooth from a piece of biocompatible material like titanium or a titanium alloy, that consists for example of more than 60% of titanium. FIG. 33 shows an arbitrary example of a portion of such a file. Ceramic material and other biocompatible materials (including but not limited to stainless steel, synthetics, plastics, resin-modified glass-ionomer cement, hybrid-ionomer cement, resin-enforced cement, and other synthetic and plastic materials) are also applicable. For manufacturing the prosthesis for the above mentioned lower left incisor a workpiece having a size of 20 mm×10 mm×10 mm is adequate. For machining, a traditional 5-axis CNC milling device with a high-speed spindle is used. Other workpiece sizes and multi-axes CNC machining devices can be employed in this context by those skilled in the art.
After manually cleaning, removing the excess if applicable, polishing, degreasing, etching rinsing, disinfecting and drying the workpiece, it is ready for insertion. In order to improve the integration of the implant into the bone, further treatments according to prior art are possible. Sand-blasting with ceramic particles for instance creates a rough and thus significantly enlarged surface. Coating the surface with hydroxylapatite stimulates bone formation promoting a physico-chemical bond. Other coatings suitable to facilitate include but are not limited to pharmaceuticals, ancestral cells, and proteins. Instead of coating, the aforementioned substances can be applied by others means including but not limited to adjunction and injection.
Before inserting the prosthesis, the extraction socket will be properly cleaned. In a embodiment, the socket will then be filled with Bioplant (Kerr Corporation, Orange, Calif.). Bioplant is a bone promoting substance. It is hydrated with marrow blood from the extraction socket and then injected into the socket using a special syringe delivered with Bioplant. Bioplant fills any voids present between the socket and the implant. After insertion of the implant, additional Bioplant may be applied in order to fully embed the implant below the hexagon socket. FIG. 34 shows the prosthesis embedded in the extraction socket, the voids being filled with Bioplant (13000). In order to avoid the growth of the gum into the void between the implant and the extraction socket, membrane techniques known to those skilled in the art can be employed. Also, the top of the implant excluding the hexagon has been covered with Bioplant. A healing cap is placed on top of the implant. The implant is then secured to the adjacent teeth for about six weeks by means of a light-curing resin strip known to those skilled in the art.
Another option is to apply nano-crystalline diamond coating. A coating named r-BeSt (Hartstoffbeschichtungs GmbH, Innsbruck, Austria) shows 100% biocompatibility due to the pureness of the diamond coating, an optimal interconnection between substrate and diamond coatings, good tribological properties due to the smoothness of the layer and an active surface for bio-chemical reactions.
In another embodiment of the invention, an unsegmented prosthesis will be fabricated as shown in FIG. 9. The steps of the process are outlined in FIG. 4. The tooth to be replaced is extracted (step G) and properly cleaned (step M). Then 3D imaging (step N) is performed in order to obtain 3D data representing the three-dimensional shape of the complete tooth. The resulting 3D data (D) is imported into CAD software and displayed to the operator (step E). The shape is modified and optimized as needed (step F, see also FIGS. 23 and 24). The resulting 3D data is converted into IGES format and exported (step H) to a CAM system for fabrication of the prosthesis (step I). The finished prosthesis (J) may be coated with a substance promoting bone ingrowth (step K) and is then implanted into the extraction socket (step L). It should be noted that FIG. 4 contemplates possibly interaction with an operator, one skilled in the art would readily appreciate that this functionality may be fully automated.
The scan of the root and of the crown are then loaded into MAGICS and manually maneuvered to a best fit using the overlapping areas of both scans, and merged into one STL data file. In order to increase accuracy, software detecting best fit for two independent surfaces can also be used. After—if required—manually removing outliers of the scanned measurement data and identifying and correcting deficient triangles and adding missing parts, the resulting STL surface data forms a three-dimensional solid representing the overall shape of the extracted tooth.
The STL data is then converted to an IGES data format. For fabricating the above mentioned lower left incisor, a piece of calcium phosphate ceramic having a size of approx. 25 mm×10 mm×10 mm using a traditional 5-axis CNC milling device with a high-speed spindle (about 60.000 rpm), a spherical diamond cutter having a diameter of the tip f the cutter of 1 mm and water cooling. The ceramic workpiece is clamped to the machine table of the milling machine. After teaching the machine the position and inclination of the workpiece, dialing in the machine and process parameter and overlapping the physical workpiece with the virtual shape a first portion representing the root shape of the lower left incisor is machined by grinding down layer by layer the workpiece to the shape of interest. Then a fixture is made for that specific workpiece to clamp the workpiece at the already machined first portion, for instance by grinding a portion of the geometrical negative shape of the fist portion into the receiving part of the fixture.
Another option is coating the portion to be implanted with Ca(OH)2-cement. This is a well known substance in dentistry also used to fill root canals. After setting, EMDOGAIN (Institut Straumann AG, Basel, Switzerland) will be applied, a substance containing the enamel matrix protein Amelogenin. EMDOGAIN is resorbed naturally during the normal healing process, leaving only a residue of enamel matrix protein on the coated surface. This natural and insoluble surface layer encourages the population of cementum-forming cells from the surrounding tissues. The newly created surface also functions as an interface between the tooth and the surrounding tissues, preventing down-growth of the epithelial tissues. Again, instead of coating, all the aforementioned substances can be applied by others means including but not limited to adjunction and injection. It may be advisable to prescribe antibiotic pharmaceuticals to reduce the infection risk during the healing process.
In another embodiment an undersized customized root representation of a ceramic prosthesis is coated with a thin layer of mineral trioxide aggregate (ProRoot MTA, Dentsply) while potential socket irregularities are prepared with calcium sulphate (Capset, Lifecore Biomedical) in order to promote the selective formation of new periodontal tissue (i.e., cementum, periodontal ligament, Sharpey's fibers amd alveolar bone) and to build a barrier against an overgrowth by gingival tissue. The thickness of the coating layer should match the undersizing of the root shape and would preferably be chosen to be about 0.2 to 0.3 mm. It would furthermore be advantageous to insert the prosthesis into the socket as soon as possible but no more than 24 hours (see respective reference re: Spouge, Oral Pathology, Mosby, Saint Louis, 1973 above) after extraction.
In order to assure that only the desired portions of the prosthesis are adopted by the periodontal tissue, other portions, like the surface intended to carry the crown later to be attached to the implant, may be covered with a substance preventing such adoption. Silver is for instance a biocompatible material suitable for that purpose. The Fraunhofer Institute for Manufacturing Technology and Applied Materials Research (IFAM) has developed a nanocomposite plasma coating technology that can be used for applying a thin layer containing silver.
In yet another embodiment of the invention, original portions of the natural tooth will be integrated into the implant. Especially portions of the root still being covered with cementum will greatly improve adoption into the ligaments of the extraction socket. On order to integrate those natural portions, they will be cleaned and prepared for imaging as described further above. The resulting 3D imaging data will be imported into MAGICS and processed like the data of a complete tooth. The three-dimensional virtual body will then be placed at the proper location with respect to the virtual body representing the shape of the implant to be produced. Using boolean functions of MAGICS, the body representing the natural portion(s) of the tooth will be subtracted from the body representing the implant, thus creating a cavity in the implant having the exact size and shape of the natural portion(s) of the tooth to be integrated into the implant. After the implant has been fabricated and processed, the natural portions of the tooth are cemented into the implant.
To achieve a long living prosthesis the size and the shape of the root and the socket needs to be appropriate to enable solid anchorage in the bone. If for example a root is too small to absorb the normal chewing forces it may be necessary to expand the size of the socket before designing and manufacturing the customized root. Other patients may not have enough bone material, so that the thickness of the bone gingivally and labially is not sufficient for the anchorage of an implant. In such a case, the root may be shaped like a clamp so that the corticalis is used for the anchorage. This approach is known as “juxtaosseous” method (the implant adapts to the bone and not the bone to the implant). If an appropriate material like Titanium in combination with biological ossifying substance is used, the bone adapts to the implant and so the implant becomes an osseointegrated implant. For abutments this is already successfully being used by the San Babila Day Hospital in Italy. Even more solidity can be achieved by a “multi-legged” root shape combining an artificial root and clamp shaped outer part for the adaptation to the corticalis. This approach significantly increases the stability of the anchorage because no hollow or less stabile areas remain in the bone. If crown and root are manufactured as one part, the crown may be coated with an enamel-colored layer for aesthetic reasons. During the healing process appropriate measures need to be put in place to avoid early exposure of the implant to forces (bite bumpers, partials positioners, etc.).
The meaning of “Rapid Prototyping” shall include but shall not be limited to all technologies qualified for manufacturing of copies of virtual three-dimensional objects and also technologies qualified for mass customization or the mass production of copies of customized or adapted geometries to the needs of an individual patient.
The meaning of “periodontal ligature” or “periodontal ligament” shall include but shall not be limited to the fibrous connective tissue interface usually located between a human tooth and the anatomical structure of the jaw of a human being.
The meaning of “periodontal integration” shall include but shall not be limited to the integration into the periodontal ligament structure.
The meaning of “extraction socket” shall include prepared or unprepared extraction sockets. The meaning of “prepared” shall include but shall not be limited to being surgically pared or surgically abraded.
1. A dental prosthesis to be integrated into a jaw bone cavity of a pre-identified patient, the prosthesis being a finished manufactured product prior to its insertion into the jaw bone cavity, the prosthesis comprising:
a root portion configured to be positioned in and integrated into a jaw bone cavity of a specific pre-identified patient and having an outer surface, the outer surface having a custom three-dimensional surface shape specifically dimensionally matching a three-dimensional surface shape of corresponding outer surface portions of a root of a natural tooth of the pre-identified patient removed from the jaw bone cavity of the pre-identified patient, the root portion further comprising a biocompatible enhancement selected from the group comprising:
a cured cement forming substantial portions of the outer surface of the root portion, the cured cement having a composition to enhance integration of the root portion into and adoption by a periodontal ligament cell structure within the jaw bone cavity receiving the root portion and being selected from the group consisting essentially of calcium hydroxide cement, glass-ionomer cement, resin-modified glass-ionomer cement, and light-activated resin-modified glass ionomer cement, and
a layer of mineral trioxide aggregate forming substantial portions of the outer surface of the root portion.
2. A dental prosthesis as defined in claim 1, wherein the root portion comprises a root main body portion, the root main body portion comprising one of the following: a ceramic and a biocompatible metal, having portions of the natural tooth integrated therewith.
3. A dental prosthesis as defined in claim 1, wherein the biocompatible enhancement further comprises ancestral cells located on the outer surface of the root portion.
4. A dental prosthesis as defined in claim 1, wherein the biocompatible enhancement further comprises cells of a tooth positioned on the outer surface of the root portion.
5. A dental prosthesis as defined in claim 4, wherein the cells of a tooth are human cells.
6. A dental prosthesis as defined in claim 1, wherein the root portion comprises a root main body portion having a root main body outer surface, the dental prosthesis further comprising:
a permanent crown portion connected to the root portion of the dental prosthesis to form a unitary prosthetic structure existing as the unitary prosthetic structure; and
an enamel-colored layer of surface material abuttingly contacting a substantial portion of the outer surface of the permanent crown portion, wherein
the biocompatible enhancement comprises a biocompatible coating material comprising the cured cement abuttingly contacting a substantial portion of the root main body outer surface of the root main body.
7. A dental prosthesis as defined in claim 1, wherein the biocompatible enhancement comprises the cured cement forming substantial portions of the outer surface of the root portion.
8. A dental prosthesis as defined in claim 7, wherein the cured cement comprises calcium hydroxide cement.
9. A dental prosthesis as defined in claim 7, wherein the cured cement comprises glass-ionomer cement.
10. A dental prosthesis as defined in claim 7, wherein the cured cement comprises the resin-modified glass-ionomer cement, the resin-modified glass-ionomer cement formed of a calcium alumino-silicate glass powder and an aqueous solution of an acrylic acid homo- or co-polymer.
11. A dental prosthesis as defined in claim 7, wherein the cured cement comprises the light-activated resin-modified glass ionomer cement, activated prior to insertion into the root portion of the jaw bone cavity of the pre-identified patient.
12. A dental prosthesis as defined in claim 1, wherein the biocompatible enhancement comprises:
a first layer of biocompatible material comprising one or more of the following: a layer of between 0.05 mm and 0.2 mm of the resin-modified glass ionomer cement, the glass ionomer cement comprising a calcium-alumino-silicate glass powder and an aqueous solution of an acrylic acid homo- or co-polymer, the layer of mineral trioxide aggregate, the light-activated resin-modified glass ionomer cement, and the calcium hydroxide cement; and
a second layer of biocompatible material suitable to be integrated into and adopted by the periodontal ligament structure when the dental prosthesis is positioned in the jaw bone cavity.
13. A dental prosthesis as defined in claim 12, wherein the second layer of biocompatible material comprises a matrix protein applied to the first layer of biocompatible material prior to insertion of the root portion of the dental prosthesis into the jaw bone cavity.
14. A dental prosthesis as defined in claim 12, wherein the first layer of biocompatible material comprises the layer of mineral trioxide aggregate.
15. A dental prosthesis as defined in claim 1,
wherein the root portion of the dental prosthesis comprises a root main body portion and a root surface layer portion;
wherein the root main body portion has the outer surface shape matching a three-dimensional undersized representation of the three-dimensional surface shape of corresponding outer surface portions of the root of the natural tooth of the pre-identified patient; and
wherein the root surface layer portion comprises the biocompatible enhancement comprising a layer of biocompatible material abuttingly contacting the outer surface of the root main body portion and is shaped so that outer surface portions thereof dimensionally match the three-dimensional surface shape of corresponding outer surface portions of the root of the natural tooth of the pre-identified patient.
16. A dental prosthesis as defined in claim 15, wherein the layer of biocompatible material comprises the layer of mineral trioxide aggregate having a thickness of between 0.2 mm and 0.3 mm.
17. A dental prosthesis as defined in claim 1, wherein the biocompatible enhancement comprises a nano-crystalline diamond coating forming substantial portions of the outer surface of the root portion.
18. A dental prosthesis as defined in claim 1, the dental prosthesis further comprising:
a permanent crown portion connected to the root portion of the dental prosthesis to form a unitary prosthetic structure;
19. A dental prosthesis to be integrated into a jaw bone cavity of a pre-identified patient, the prosthesis being a finished manufactured product prior to its insertion into the jaw bone cavity, the prosthesis comprising:
a root portion configured to be positioned in and integrated into a jaw bone cavity of a specific pre-identified patient and having an outer surface, the outer surface having a custom three-dimensional surface shape specifically dimensionally matching an undersized three-dimensional surface shape of corresponding outer surface portions of a root of a natural tooth of the pre-identified patient removed from the jaw bone cavity of the pre-identified patient, the root portion further comprising a biocompatible enhancement selected from the group comprising:
20. A dental prosthesis as defined in claim 19, wherein the biocompatible enhancement comprises the layer of mineral trioxide aggregate forming substantial portions of the outer surface of the root portion.
21. A dental prosthesis as defined in claim 19, wherein the biocompatible enhancement further comprises one or more of the following:
ancestral cells located on the outer surface of the root portion immediately prior to and during final placement of the dental prosthesis into the jaw bone cavity, and
portions of a natural tooth.
22. A dental prosthesis as defined in claim 19, wherein the biocompatible enhancement further comprises cells of a tooth.
23. A dental prosthesis as defined in claim 19, wherein the biocompatible enhancement further comprises a nano-crystalline diamond coating forming substantial portions of the outer surface of the root portion.
24. A dental prosthesis as defined in claim 19, wherein the biocompatible enhancement comprises the cured cement, the cured cement comprising the resin-modified glass-ionomer cement, the resin-modified glass-ionomer cement formed of a calcium alumino-silicate glass powder and an aqueous solution of an acrylic acid homo- or co-polymer.
25. A dental prosthesis as defined in claim 19, wherein the biocompatible enhancement comprises the cured cement, the cured cement comprising the light-activated resin-modified glass ionomer cement, activated prior to insertion into the root portion of the jaw bone cavity of the pre-identified patient.
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