​The dental plug, which is 3D-printed and naturally biodegrades, includes a material that promotes bone growth.

A clinical trial is underway to test an improved second-generation 3D dental plug, which helps patients grow their own bone for a dental implant.

If it does well, this dental plug will revolutionise the dental implant (replacement tooth) treatment process and cut costs significantly.

The procedure using the dental plug is to preserve bone for dental implants.

The plug is inserted into the socket of an extracted tooth and degrades as the bone grows there. Bone in the socket is essential for a dental implant to be fixed.

The clinical trial is currently recruiting 138 patients and will be completed by 2021. It is conducted by the National Dental Centre Singapore (NDCS) with the Singapore Clinical Research Institute and local medical technology company, Osteopore. The dental plugs, originally developed by engineers from the Nanyang Technological University, will be manufactured by Osteopore.

The newer model

A first-generation plug was tested on 13 patients in 2016 and approved for mass production by the Health Sciences Authority. It uses a material called polycaprolactone, which can be broken down and absorbed by the body over time.

This second-generation plug goes further. In addition to design modifications, it has tricalcium phosphate added to it, which helps bone grow faster while reducing the time for the plug to degrade. This allows implants to be placed three to six months earlier than before, said Clinical Associate Professor Goh Bee Tin, Director, Research and Education, NDCS, who is leading the trial.

“Polycaprolactone on its own takes about 18 months to degrade, which is a bit too long. With tricalcium phosphate, the degradation time is cut to 12 months. As the plug degrades, natural bone grows in the tooth socket,” said Prof Goh.

No need for bone grafts

After a tooth is extracted, if a patient wants a tooth implant, he usually needs to wait about two to three months for bone to grow in the tooth socket. If the bone tissue has shrunk too much, a bone graft may be needed.

For large grafts, bone is surgically taken from the patient’s own chin, jaw, skull or hip. If a small graft is needed, animal-derived bone can be used, but this is a costly option and may not be acceptable for religious reasons.

It takes five to 14 days to recover from a bone graft, and patients may suffer complications such as pain, swelling and infection following the surgery. Also, it takes six months for the graft to heal before an implant can be put in.

Some patients back out of having implants because they were not expecting such invasive surgery, said Prof Goh.

With the plug, the procedure is less painful because patients can avoid the bone graft, since the plug is designed to be inserted into the tooth socket immediately after a tooth extraction.

How the plug works

The plug acts like a scaffold to prevent shrinkage in the jaw bone that supports the tooth, and promotes bone growth so that a dental implant can be inserted.

“Like a building’s scaffolding, it forms the foundation for the bone cells to attach to,” she said.

Prof Goh said that when the plug becomes available this year, it will be the first such 3D-printed scaffold, which is porous enough to allow blood and bone cells to penetrate through the plug.

The plug also has wider applications beyond dentistry. It has since attracted interest from surgeons in various fields overseas, including Germany, Turkey, Malaysia, the US, and India.

Associate Professor Goh Bee Tin is spearheading a clinical trial that will revolutionise the dental implant treatment process.