The invention includes dental bone grafting devices and magnesium meshes having features that are designed to absorb progressively in order to improve dental bone regeneration, and methods for preparing the meshes. The meshes are particularly useful in dental bone grafting procedures.
Over one million dental bone grafting procedures are performed annually in the United States, most frequently in advance of dental implant placement to restore the function and aesthetics of missing teeth. Dental bone grafting procedures are generally associated with positive outcomes. However, in the thirty percent of cases where there has been a significant amount of bone loss or where patients have comorbidities that make bone regeneration more challenging, the end result can be unpredictable and unreliable resulting in success rates as low as sixty percent requiring revision procedures.
Maximizing dental bone regeneration in these major bone grafting procedures is currently attempted using form-stable barrier membranes or meshes, that can protect the healing site from mechanical insults for up to nine months. Unfortunately, existing form-stable barrier membranes and meshes require an invasive removal procedure prior to dental implant placement and exhibit complication rates of up to forty-four percent, which decreases the likelihood of achieving optimal grafting outcomes.
In general, magnesium-based implants have been explored for many medical applications due to their combination of mechanical strength and bioabsorbable or absorbable properties. Magnesium-based devices have been used clinically for fracture fixation and stabilization, sports medicine applications, and cardiovascular applications. Known magnesium meshes, with geometric designs based on other resorbable or absorbable materials or based on the design of non-resorbable materials (e.g., titanium meshes), are likely to fail in areas of high stress in situ as the magnesium absorbs. These high stress areas include points where the mesh is fixated by a screw, areas where the mesh is bent to adapt to the surrounding bone, and high energy areas containing sharp feature intersections. Additionally, the in-situ environment has complex fluid flows and mechanical insults that result in non-ideal absorption of the magnesium material unlike what is observed in in-vitro or in-silico experiments. These factors combine to threaten the stability of a magnesium mesh used in a guided bone regeneration application, thus jeopardizing bone healing.
Thus, oral surgeons and periodontists lack a form-stable, yet absorbable membrane or mesh that can maximize bone regeneration, reduce the morbidity and time associated with device removal, and ultimately reduce the likelihood that expensive and time-consuming revision procedures are needed. Magnesium's in situ absorption mechanism of surface corrosion requires unique design features not incorporated into non-resorbable meshes or polymers with bulk absorption properties to achieve these clinical properties.
There is a need in the art to develop a magnesium-based mesh that provides the form-stability necessary for optimal bone healing with the absorbability necessary to eliminate the device removal procedure and improve soft tissue response.
In one aspect, the invention provides a dental bone grafting device that includes a mesh, that includes a framework fabricated of a material selected from the group consisting of magnesium metal and a magnesium-based metal alloy; and a geometric design formed within the framework comprising a plurality of design features, that include two or more fixation point openings each having a corresponding fixation connecting feature corresponding thereto; and one or more non-fixation point openings each having a corresponding non-fixation connecting feature corresponding thereto, wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature surrounds and/or connects each of the two or more fixation point openings and the one or more non-fixation point openings, respectively, and wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature has a size that is structured to provide progressive and/or staged corrosion and/or absorption of the mesh.
In certain embodiments, each of the two or more fixation point openings and the one or more non-fixation point openings, and the corresponding fixation connecting feature and the corresponding non-fixation connecting feature corresponding thereto, respectively, has a corresponding size. The size of each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature can be selected from the group consisting of surface area, width, and thickness. The surface area of the corresponding fixation connecting feature of the two or more fixation point openings can be greater than the surface area of the corresponding non-fixation connecting feature of the one or more non-fixation point openings. The corresponding fixation connecting feature that surrounds the two or more fixation point openings can absorb or corrode over a longer period of time as compared to the corresponding non-fixation connecting feature that surrounds the one or more non-fixation point openings.
In certain embodiments, the two or more fixation point openings are structured to receive a fastening device. The fastening device can be selected from the group consisting of a bolt, screw, tack, and pin.
In certain embodiments, the magnesium-based alloy includes from about 0.85 to about 1.4 weight percent zinc; from about 0.2 to about 0.5 weight percent calcium; from about 0.2 to about 0.5% weight percent manganese; and a balance of magnesium based on a total weight percent of the magnesium-based alloy.
In certain embodiments, the framework is a magnesium foil. The magnesium foil can have a thickness from about 0.15 to about 0.55, or about 0.35 mm.
In certain embodiments, the two or more fixation point openings are positioned along the perimeter of the framework. The size of the corresponding fixation connecting feature of the two or more fixation point openings can be greater at the interface of the fastening device and the magnesium framework as compared to another portion of the two or more fixation point openings. There can be at least two different sizes of the corresponding fixation connecting feature and/or corresponding non-fixation connecting mesh to promote a progressive and/or staged corrosion and/or absorption profile.
In another aspect, the invention includes a method of making a dental bone grafting device. The method includes fabricating a mesh, which includes preparing a framework composed of a material selected from the group consisting of magnesium metal and a magnesium-based metal alloy; and forming a geometric design within the framework comprising a plurality of design features, including two or more fixation point openings each having a corresponding fixation connecting feature corresponding thereto; and one or more non-fixation point openings each having a corresponding non-fixation connecting feature corresponding thereto, wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature surrounds and/or connects each of the two or more fixation point openings and the one or more non-fixation point openings, respectively, and wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature has a size that is structured to provide progressive and/or staged corrosion and/or absorption of the mesh.
In another aspect, the invention includes a mesh that includes a framework fabricated of a material selected from the group consisting of magnesium metal and a magnesium-based metal alloy; and a geometric design formed within the framework comprising a plurality of design features, including two or more fixation point openings each having a corresponding fixation connecting feature corresponding thereto; and one or more non-fixation point openings each having a corresponding non-fixation connecting feature corresponding thereto, wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature surrounds and/or connects each of the two or more fixation point openings and the one or more non-fixation point openings, respectively, and wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature has a size that is structured to provide progressive and/or staged corrosion and/or absorption of the mesh.
In yet another aspect, the invention includes a method of making a mesh. The method includes preparing a framework composed of a material selected from the group consisting of magnesium metal and a magnesium-based metal alloy; and forming a geometric design within the framework comprising a plurality of design features, including two or more fixation point openings each having a corresponding fixation connecting feature corresponding thereto; and one or more non-fixation point openings each having a corresponding non-fixation connecting feature corresponding thereto, wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature surrounds and/or connects each of the two or more fixation point openings and the one or more non-fixation point openings, respectively, and wherein each of the corresponding fixation connecting feature and the corresponding non-fixation connecting feature has a size that is structured to provide progressive and/or staged corrosion and/or resorption of the mesh.
A full understanding of the invention can be gained from the following description of the preferred embodiments when read in conjunction with the accompanying drawings, as follows:
The invention relates to dental bone grafting devices and meshes constructed or composed of a magnesium material that exhibit features, which are designed to corrode and/or absorb progressively or in stages, in order to improve dental guided bone regeneration. The magnesium material is selected from magnesium metal and magnesium metal alloys (e.g., magnesium-based alloys) or any combination thereof. In certain embodiments, the magnesium material is a magnesium metal alloy including magnesium as the base metal in combination with other metals (alloying elements), such as, but not limited to, zinc, calcium and manganese or any combination thereof. In certain embodiments, the magnesium metal alloy includes from about 0.85 to about 1.4 weight percent zinc, from about 0.2 to about 0.5 weight percent calcium, from about 0.2 to about 0.5 weight percent manganese, and a balance of magnesium based on the total weight of the alloy.
In certain embodiments, the magnesium material is in the form of a magnesium foil. The thickness of the magnesium foil varies and, in certain embodiments, is from about 0.15 to about 0.55 mm, or about 0.35 mm. In certain embodiments, the thickness of the magnesium material, e.g., magnesium foil, is uniform. In certain other embodiments, the thickness of the magnesium material, e.g., magnesium foil, is non-uniform. In general, the greater the thickness of the magnesium material, e.g., foil, the longer the amount of time for corrosion and absorption to occur when, for example, placed and fixed in a human body, e.g., for dental bone regeneration applications. A thick or thin magnesium foil is selected for an overall long or short absorption time, respectively; in addition, geometric design features are applied or incorporated to provide a progressive or staged absorption profile and maintain structural integrity and stabilization for a long and/or short period throughout the absorption process.
The progressive or staged corrosion and/or absorption of the magnesium material is controlled or tuned by the geometric design and/or features of the mesh. For instance, by changing, specifying and/or modulating the geometric design and/or features, the corrosion and/or absorption profile is controlled or tuned. Corrosion and/or absorption of the mesh is not uniform. For those parts or portions of the magnesium mesh where slow absorption is desired or beneficial, the geometric design and/or features of the specific mesh part or portion is designed to result in slower absorption as compared to other specific parts or portions. Specifically, the surface area (i.e., width) of a feature is increased when slower corrosion (and slower absorption) is desired as compared to other features, and decreased when faster corrosion (and faster absorption) is desired as compared to other features.
The meshes according to the invention are placed and fixed around a tooth and/or dental implant, or a completely edentulous area. The meshes include high stress areas, which include (i) points (e.g., fixation points) where the mesh is fixed to a substrate (such as surrounding bone) by a fastening device (e.g., one or more screws, tacks, pins, and the like), (ii) areas where the mesh is bent to adapt to the surrounding bone, and (iii) high energy areas containing sharp feature intersections. Additionally, the in-situ environment has complex fluid flows and mechanical insults that result in non-ideal absorption of the magnesium material, unlike what is seen in-vitro or in-silico. These factors combine to threaten the stability of a magnesium mesh used in a bone regeneration application, thus jeopardizing bone healing. In applications where resorbable or absorbable implants may be used (e.g., fracture fixation), the total resorption or absorption time of the device may be extended to provide mechanical stability for a longer (e.g., long) time period. In dental bone grafting procedures, the area where meshes are implanted are most frequently surgically re-entered six to nine months later for the placement of a dental implant. Thus, devices intended for use as resorbable or absorbable dental regenerative materials (e.g., meshes and screws) must balance maintaining structural integrity for long enough to support bone regeneration while not adversely impacting the second surgical re-entry for dental implant placement. The mesh design in accordance with the invention ensures that the structural stability and fixation of the mesh is maintained throughout bone healing, and allows points for fixation of the mesh to surrounding bone. In addition, the mesh design permits adaption to complex three-dimensional geometries observed in alveolar ridge regeneration.
The progressive corrosion and/or absorption of the magnesium material provides the ability for certain parts, portions, and/or features of the mesh to absorb faster or slower, e.g., in a shorter or longer period of time, respectively, than certain other parts, portions, and/or features of the mesh. In some embodiments, it is beneficial for absorption of the periphery or perimeter or circumference of the mesh to occur over a longer time period as compared to the center portion and/or features of the mesh (which is surrounded or encompassed by the periphery or perimeter or circumference). It is typical for multiple, e.g., two or more, fixation points to be located/positioned along the periphery or perimeter or circumference of the mesh. When the periphery or perimeter or circumference of the mesh is intact for a longer time period, it provides a stable-form to maintain the structural integrity of the mesh and prevents early structural failure of the mesh, such as, in dental bone regeneration applications.
The meshes according to the invention include a framework (substrate or matrix) fabricated of the magnesium material (magnesium metal or a magnesium-based alloy), such as, a magnesium foil. A geometric design and/or features are formed within the framework. The methods and apparatus employed to form the geometric design and/or features include those known in the art for such purpose. In certain embodiments, the mesh is produced using laser cutting, extrusion, sintering, or expanded metal manufacturing. The geometric design and/or features include multiple, e.g., two or more, fixation points, each having an opening (i.e., fixation point opening) formed in the framework, e.g., to receive a fastening device, and one or more non-fixation point openings formed in the framework to enable easy adaptation to complex three-dimensional bone defects. In certain embodiments, the geometric design and/or features include more than two fixation points. The openings are cut into, e.g., cut through, the framework (e.g., magnesium foil) such that a part, portion, or feature of the framework surrounds each of the fixation point openings and the non-fixation point openings, e.g., corresponding fixation connecting feature and corresponding non-fixation connecting feature, respectively, and connects each of the two or more fixation point openings and the one or more non-fixation point openings. In certain embodiments, the fixation point openings are formed along the periphery or perimeter of the framework, and a plurality of non-fixation point openings are formed within the interior portion of the framework that is surrounded by the fixation point openings. The corresponding fixation and/or corresponding non-fixation connecting features have varying surface areas, e.g., horizontal widths, surrounding the openings such that it is structured to provide the progressive/staged corrosion or absorption of the mesh.
The fixation points of the mesh are effective to maintain the mesh in a fixed location or position and therefore, the occurrence of slow corrosion or absorption is advantageous at these fixation points. The fixation points include, for example, bolts, screws, tacks, pins or other fastening devices that are used to connect the mesh to a surface, e.g., surrounding human bone or tissue. It is typically beneficial for the fixation points to corrode and absorb at a slower rate as compared to other parts, portions, or features, e.g., the interior parts, portions, or features, in order to prevent mechanical failure of the device. Thus, in certain embodiments, the features that extend around and/or between the fixation points/fixation point openings (e.g., the corresponding fixation connecting features) have a larger surface area (or horizontal width) as compared to the corresponding non-fixation connecting features that surround and/or connect non-fixation point openings in the mesh. For a larger surface area (or horizontal width), when forming the openings, they are spaced a farther distance apart; whereas for a smaller surface area (or horizontal width), when forming the openings, they are spaced a closer distance apart.
Each of the two or more fixation point openings and the one or more non-fixation point openings, and the corresponding fixation connecting features and the corresponding non-fixation connecting features corresponding thereto, has a corresponding size. The size of the corresponding fixation connecting features or the corresponding non-fixation connecting features consists of one or more of its surface area, width (horizontal thickness), and height (vertical thickness). In certain embodiments, the width (horizontal thickness) of the corresponding fixation connecting features of the two or more fixation points/fixation point openings is greater than the width (horizontal thickness) of the corresponding non-fixation connecting features of non-fixation point openings. The corresponding fixation connecting features that surround the two or more fixation points/fixation point openings corrodes and/or absorbs over a longer period of time as compared to the corresponding non-fixation connecting features that surround the non-fixation point openings. The two or more fixation point openings are structured to receive a fastening device that includes those that are known in the art for such a purpose, including but not limited to a bolt or screw.
In certain embodiments, the two or more fixation points/fixation point openings are positioned along the perimeter of the mesh. The size of the corresponding fixation connecting features that surrounds and/or connects each of the two or more fixation points/fixation point openings is greater at the interface of the bolt/screw and the framework, as compared to another portion of the two or more fixation points.
In certain embodiments, there are at least two different sizes of the corresponding fixation connecting features and/or corresponding non-fixation connecting features that surround the fixation point openings and non-fixation point openings present in the framework, in order to promote a progressive/staged corrosion or absorption profile. For instance, the corresponding fixation connecting features that surround the fixation point openings are greater than the corresponding non-fixation connecting features that surround the non-fixation point openings.
As shown in
The magnesium meshes include redundant features (e.g., multiple corresponding fixation connecting features attaching fixation points, and multiple corresponding non-fixation connecting features attaching non-fixation point), such that the loss of mechanical integrity of a single feature (as occurs naturally during resorption) does not solely contribute to loss of stability of the entire membrane.
In certain embodiments, the fixation points are the features of the mesh framework that are designed to corrode and/or absorb the slowest. Accordingly, the corresponding fixation connecting features corresponding to the fixation points/fixation point openings have a large size, e.g., surface area and/or width.
The following mesh features corrode and/or absorb slowest to fastest (from a. to e., respectively):
In accordance with the invention, the geometric designs reduce sharp edges which harm soft tissue and serves as a nitus for early corrosion.
In certain embodiments, there are at least two distributions of corresponding fixation connecting features and/or corresponding non-fixation connecting feature sizes to promote a progressive/staged resorption profile with concomitant loss of mechanical integrity: (i) smaller or minor sized corresponding non-fixation connecting features that lose mechanical integrity in 4-6 weeks following placement; and (ii) larger or major corresponding fixation connecting features that lose mechanical integrity in 12-16 weeks following placement.
The above design concepts can be applied to a variety of overall mesh framework shapes and sizes. For example, mesh frameworks ranging from 10 mm×20 mm, to 40 mm×50 mm are currently clinically used. The designs according to the invention introduce new connections of the above features to account for changes in framework size while preventing early loss of structural integrity.
The above design concepts are applicable to different thicknesses and geometries of magnesium mesh for different clinical applications. For example, smaller bone regeneration procedures necessitate shorter periods for regeneration. In certain embodiments, the above design concepts are applied such that minor features lose mechanical integrity in 2-4 weeks and major features lose mechanical integrity in 8-12 weeks.
While specific embodiments of the invention have been described in detail, it will be appreciated by those skilled in the art that various modifications and alternatives to those details could be developed in light of the overall teachings of the disclosure. Accordingly, the particular arrangements disclosed are meant to be illustrative only and not limiting as to the scope of the invention which is to be given the full breadth of the claims appended and any and all equivalents thereof.
Mesh designs in accordance with certain embodiments of the invention were prepared using an alloy including 0.85 to 1.4 weight percent zinc, 0.2 to 0.5 weight percent calcium, 0.2 to 0.5 weight percent manganese, and a balance of magnesium based on the total weight of the alloy. The alloy was in the form of a magnesium-based foil, which had a uniform thickness (height) of 0.35 mm.
Meshes constructed with a geometry similar to that of
Data generated in an in-vivo test bed validated that the thinner (horizontally narrower) corresponding non-fixation connecting features absorbed faster than the thicker (horizontally wider) corresponding fixation connecting features, enabling the structural integrity and fixation of the mesh to bone blocks to be sustained. Additionally, data generated in a canine ridge augmentation model also validated this finding. Fixation of the mesh to the bone was maintained throughout twelve weeks of healing, and there was no loss of structural integrity throughout the early healing phase.
Corrosion testing was conducted for magnesium foil mesh frameworks with screws (corresponding to chart label 1033-01-0003-04) in accordance with certain embodiments of the invention, including those designs in
Although data was generated using specific design parameters, the geometric design frameworks and meshes disclosed herein are applicable to other thicknesses of magnesium foil and other alloying systems. For example, a thicker magnesium foil may be selected for an overall longer corrosion or absorption time. The geometric design features are applied to provide the staged corrosion or absorption profile and maintain structural integrity and stabilization for a longer period throughout the absorption process.
This patent application claims the benefit of U.S. Provisional Patent Application Ser. No. 63/223,774 filed on Jul. 20, 2021, and entitled “A Magnesium Mesh with Features Designed to Resorb Progressively to Improve Dental Bone Regeneration”, the contents of which are incorporated herein by reference.
The invention was made with government support under DE026915 awarded by the National Institutes of Health (NIH). The government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind |
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PCT/US2022/037461 | 7/18/2022 | WO |
Number | Date | Country | |
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63223774 | Jul 2021 | US |