KR102330616B1 - Method for Guiding Dental Implant Surgery - Google Patents

Abstract

An implant surgery guide method that can greatly reduce the possibility of errors and instill confidence that the procedure is being performed correctly by guiding the operator with the image of the placement location, direction, and depth of the fixture during the implant procedure. The implant surgery guide method of the present invention comprises the steps of (a) generating a three-dimensional oral image for a patient in need of implant placement; (b) designing a planned placement position of the implant fixture in the three-dimensional oral image; (c) attaching an oral marker including a first pattern to the jawbone of a patient to which the planned implantation position belongs, attaching a handpiece marker including a second pattern to a dentist's handpiece, and attaching the oral marker and the hand tracking the movement of the oral marker and the handpiece marker while photographing the piece marker with a camera; and (d) estimating the positions of the jawbone and the handpiece based on changes in the positions and directions of the oral marker and the handpiece marker, and the three-dimensional oral image and the handpiece to which information about the planned implantation position is added. and displaying at least a part of the handpiece image representing the on the screen.

Description

How to guide implant surgery {Method for Guiding Dental Implant Surgery}

The present invention relates to a method of generating and displaying a medical image, and more particularly, to a method of generating and displaying an image for supporting treatment in dentistry.

In performing implant surgery, which is a type of dental prosthetic treatment, an implant fixture (hereinafter, abbreviated as 'fixture'), which is an artificial tooth root made of metal such as titanium, is placed in the alveolar bone so that it is fused with bone tissue. After that, an abutment (also called an 'abutment' or 'abutment') is fastened to the implant fixture by an abutment screw, and then an artificial crown, that is, a crown or bridge, is installed on the abutment. will be attached The abutment connects the artificial crown to the fixture, and serves to transmit the force applied to the artificial crown to the jawbone through the fixture.

However, the most expertise required in such implant prosthetic treatment is to accurately determine the fixture placement position, drill to the required depth in the right direction, and place the fixture accurately. If the placement position, direction, or depth of the fixture is slightly wrong, the error can be compensated for by making and using a customized abutment suitable for the patient. and aesthetics may be significantly reduced.

Accordingly, implant treatment is performed only by some experienced dentists, and this phenomenon is acting as an obstacle to lower treatment costs. On the other hand, since even experienced dentists can make mistakes, there is a need for a method for confirming whether the current operation is being performed properly, but there is no such confirmation and/or verification method yet.

The present invention is to solve such a problem, and by guiding the operator with an image of the placement position, direction, depth, etc. of the fixture during implant operation, the possibility of error occurrence is greatly reduced and the operator is confident that the operation is being performed correctly Its technical task is to provide a guide method for implant surgery that can implant

The implant surgery guide method of the present invention for achieving the above technical problem comprises the steps of (a) generating a three-dimensional oral image for a patient in need of implant placement; (b) designing a planned placement position of the implant fixture in the three-dimensional oral image; (c) attaching an oral marker including a first pattern to the jawbone of a patient to which the planned implantation position belongs, attaching a handpiece marker including a second pattern to a dentist's handpiece, and attaching the oral marker and the hand tracking the movement of the oral marker and the handpiece marker while photographing the piece marker with a camera; and (d) estimating the positions of the jawbone and the handpiece based on changes in the positions and directions of the oral marker and the handpiece marker, and the three-dimensional oral image and the handpiece to which information about the planned implantation position is added. and displaying at least a part of the handpiece image representing the on the screen.

In one embodiment, the step (a) comprises: acquiring at least one basic image of the inside of the oral cavity including the jawbone of the patient; producing an oral plaster model of the patient, and obtaining a plaster model image for the oral plaster model; and generating the three-dimensional oral image by combining the at least one basic image and the plaster model image.

In one embodiment, in the step (a), after the impression material is applied to an impression auxiliary tool, which is partially exposed to the outside of the oral cavity, the patient bites the portion to which the impression material is applied with a tooth, and obtains a first basic image to do; acquiring a second basic image with respect to the impression assisting tool to which the impression material is cured and the impression body is attached; and producing a plaster oral plaster model of the patient, and obtaining a third basic image for the oral plaster model. Here, the step (a) may further include; generating the three-dimensional oral image by combining the first to third basic images.

When at least a portion of the first to third basic images is a CT image, a CT image among the first to third basic images is converted into a vector image, and the first to third It is preferable to determine a vector image and generate a three-dimensional oral image by combining the first to third vector images.

In the process of generating a three-dimensional oral image by combining the first to third vector images, the first and second vector images are combined using a portion corresponding to the impression assistance tool in the first and second vector images, The second and third vector images may be combined using surface shape information of the tooth part.

In generating a three-dimensional oral image by combining the first to third vector images,

In the second vector image, it is preferable to transform a vertex with respect to the part of the impression body to convert an intaglio into an embossing, and to combine the tooth part converted into an embossing in the second vector image with a corresponding tooth part of the third vector image.

In designing the location to be implanted, first, teeth according to a predetermined standard tooth model are placed on the three-dimensional oral image, the teeth of the standard tooth model are adjusted, and then the standard tooth model is located at the tooth defect location where the implant fixture needs to be placed. After disposing the standard teeth according to the above, it is preferable to determine the planned placement position of the implant fixture while not interfering with the neural tube in the jawbone and not exposed to the outside of the jawbone. When determining the planned placement location, it is preferable to determine the type of implant fixture to be placed together, and to add design data regarding the planned placement location to the 3D oral image in the form of an image element.

When the oral marker is applied to the patient's oral cavity, it is preferably applied using an oral marker attachment tool having one or more ball joints and one or more links and a marker attachment portion for attaching the oral marker. Also, when attaching the handpiece marker to the handpiece, it is preferable to attach using a handpiece marker attachment tool having one or more ball joints and one or more links and a marker attachment portion for attaching the handpiece marker.

In relation to attaching the oral marker, the step of generating a three-dimensional oral image is (a1) after applying the impression material to the impression assisting tool that is partially exposed to the outside of the oral cavity, the patient uses the tooth to apply the impression material biting and acquiring a first basic image; (a2) acquiring a second basic image with respect to the impression auxiliary tool to which the impression material is hardened impression body is attached; (a3) obtaining a third basic image of the oral gypsum model by manufacturing the oral gypsum model of the patient, mounting the oral gypsum model on a cradle having a predetermined shape and size, and photographing; and (a4) generating the three-dimensional oral image by combining the first to third basic images.

In such a state, in order to precisely display and track the coordinates of each point in the oral or three-dimensional oral image as coordinates, the oral marker is placed on the part of the oral plaster model corresponding to the part where the oral marker is attached in the patient's mouth. It is preferable to attach At this time, it is preferable that the first auxiliary marker is attached to a predetermined position on the cradle. The first auxiliary marker may be attached before and after the time when the oral marker is attached, and before acquiring the third basic image. may be attached.

In a state in which the first auxiliary marker and the oral marker are attached to the oral gypsum model, the first auxiliary marker and the oral marker may be photographed with a camera to determine a spatial relationship between the markers.

When the spatial relationship between the first auxiliary marker and the oral marker is known, when the position and direction of the oral marker are detected, based on the spatial relationship between the first auxiliary marker and the oral marker, It becomes possible to estimate the position.

In displaying the 3D oral image and the handpiece on the screen, the 3D oral image may be rendered from the viewpoint of the camera or the viewpoint of the dentist. At this time, the required movement amount and movement direction of the handpiece, and the necessary rotation amount and rotation direction may be additionally displayed. In addition, the drilled depth or the remaining depth may be additionally displayed on the screen.

The implant surgery guide method of the present invention may be implemented based on a program that is loaded on a recording medium and executed by a data processing device.

According to the present invention, by guiding the operator to the placement position, direction, depth, etc. of the fixture during implant operation, the possibility of error occurrence is greatly reduced and the operator can instill confidence that the operation is being performed correctly.

As a result, it is possible to perform an accurate procedure, and to increase the number of dentists who can perform implant surgery, to increase the treatment productivity of each dentist, and to expect a reduction in treatment cost. .

Hereinafter, preferred embodiments of the present invention will be described in more detail with reference to the accompanying drawings. in drawing,
1 is a block diagram showing an embodiment of an implant image guide system according to the present invention;
Fig. 2 is a block diagram of an embodiment of a design program executed in the design PC shown in Fig. 1;
Fig. 3 is a block diagram of one embodiment of the camera sensor shown in Fig. 1;
Fig. 4 is a block diagram of an embodiment of a surgical guide program executed in the surgical guide PC shown in Fig. 1;
Figure 5 is a flowchart schematically showing the overall process of the implant surgery guide method according to a preferred embodiment of the present invention;
6 is a photograph showing an embodiment of an impression assisting tool;
7 is a flowchart specifically showing an embodiment of a process of acquiring a patient basic image;
8 is a screen shot showing an example of a first CT image;
9 is a photograph showing an example of an impression assisting tool to which an impression body is attached;
FIG. 10 is a screen shot showing an example of a second CT image of the structure of FIG. 9 ;
11 is a photograph showing an example of an oral plaster model;
12 is a photograph showing an example of a state in which an oral gypsum model for the mandible is placed on a cradle for the third CT image in one embodiment;
13A is a screen shot showing an example of a third CT image of the mandible;
13B is a screen shot showing that only a tooth part is extracted from the third CT image;
14 is a flowchart specifically showing an embodiment of an image combining process;
15A and 15B are screen shots showing an example of a combined image of a first vector image and a second vector image. FIG. 15A is a screen shot of an image related to the entire appearance including a face, and FIG. 15B is an impression. Screen shot of an image in which only the layer related to the auxiliary tool is extracted;
16 is a screen shot showing an example of a combined image of a second vector image and a third vector image;
17 is a flowchart specifically illustrating an embodiment of a surgical design process;
18 is a screen shot showing an example of a screen displayed by superimposing teeth according to a standard tooth model on a three-dimensional oral image of a patient;
19 is a screen shot showing an example of a screen for determining the target position and direction of the implant fixture;
20 is a flowchart specifically showing an embodiment of an image guide process for implant fixture placement surgery;
21 is a view showing examples of patterns of markers used in a preferred embodiment of the present invention;
22 is a photograph showing an embodiment of an oral marker attachment tool for attaching an oral marker to an oral cavity;
23 is a photograph showing an example of an oral marker attachment tool to which an impression body is attached;
24 is a photograph showing one embodiment of a handpiece marker attachment tool for attaching a handpiece marker to a handpiece;
25 is a photograph showing an example of a state in which the handpiece marker is attached to the handpiece via the handpiece marker;
26 is a flow diagram illustrating an embodiment of a method for determining a spatial relationship between an oral cavity and an oral marker and a spatial relationship between a handpiece and a handpiece marker;
27 is a photograph showing a state in which the oral plaster model is seated on the cradle to which the first auxiliary marker is attached, and the oral marker is attached to the oral plaster model by an oral marker attachment tool;
28 is a photograph showing an example of a state in which the second auxiliary marker is attached to the handpiece;
29 is a photograph showing an example of a state in which the handpiece marker and the second auxiliary marker are attached to the handpiece;
30 is a screen shot showing an example of the images captured by the camera sensor 150 and displayed on the screen in the marker registration process just before the implantation operation and the markers therein;
31 is a flowchart showing a bone positioning and rendering process during an operation in an embodiment in which only the spatial relationship between the first auxiliary marker and the oral marker is recorded during marker registration;
32 is a flowchart showing a bone positioning and rendering process during operation in an embodiment in which the coordinates for the jawbone and other oral structures described as the coordinate system of the first auxiliary marker during marker registration are rewritten as the coordinate system of the oral marker. ;
33 is a flowchart showing a modified embodiment of a method for determining the spatial relationship between the oral cavity and the oral markers shown in FIG. 26 and the spatial relationship between the handpiece and the handpiece marker;
34 is a screen shot showing an example of an output image for a surgical image guide; and
35 is a screen screenshot showing another example of an output image for a surgical image guide.

Implant image guide system

1, the implant image guide system according to an embodiment of the present invention includes a basic image acquisition unit 100, a storage device 110, a design PC 120, a camera sensor 150, A surgical guide PC 160 is provided.

The basic image acquisition unit 100 acquires a basic patient image of the patient's jawbone and the inside of the oral cavity prior to implant fixture placement surgery (hereinafter, referred to as 'placement operation'). In an embodiment, the basic image acquisition unit 100 includes a computed tomography (CT) scanner, and the basic patient image acquired by the basic image acquisition unit 100 is a CT image of the entire head including the patient's jawbone. includes In addition, the patient basic image may include a CT image of the oral gypsum model produced based on the impression obtained from the patient's mouth. Here, the CT image data may follow a data format conforming to a digital imaging and communications in medicine (DICOM) standard. Meanwhile, the basic image acquisition unit 100 may additionally include, for example, an optical camera type 3D scanner in addition to the CT scanner. The 3D scan image data output by the 3D scanner may be in a vector-based stereolithography (STL) format.

The storage device 110 receives and stores image data for a patient basic image (hereinafter, referred to as 'basic image data'), ie, CT image and/or 3D scan image data, from the basic image acquisition unit 100 . As mentioned above, the basic image data may be in a DICOM format, and at least a part thereof may be in an STL format. Meanwhile, the storage device 110 receives and stores the implantation design data designed by the design PC 120 as will be described later. The implantation design data is preferably in an STL format, but is not necessarily limited thereto.

The design PC 120 is used to design the placement position and direction of the implant fixture based on the basic image data stored in the storage device 110 . The design PC 120 stores and executes the design program according to the present invention. The design program converts the format of the data in the DICOM format among the basic image data stored in the storage device 110 to the STL format, and combines two or more images to generate a three-dimensional oral image. For example, the design PC 120 combines a CT image or a three-dimensional scan image of a dental plaster model with a head CT image including information on the jawbone and gum bone, so that the precise tooth shape is reinforced in the head CT image. A three-dimensional oral image is formed. The oral image data for the three-dimensional oral image is stored in the storage device (110). The oral image data is preferably in STL format, but is not limited thereto. On the other hand, although it is executed on the PC 120 for design for the purpose of simplifying the system configuration, the above image format conversion and combination work is not a part of the design process, but rather a basic task of arranging the acquired patient basic image data. have.

In addition, the design PC 120 allows to design the placement position and direction of the implant fixture based on the three-dimensional oral image. In one embodiment, for the design of the placement position and direction, a designer places a virtual tooth by referring to a standard tooth model in a three-dimensional oral image, selects an appropriate one from various fixtures, and a graphic element for the selected fixture This is done by arranging in an appropriate direction at an appropriate location on the three-dimensional oral image. However, in a modified embodiment, design work such as placement of virtual teeth, selection of fixtures, and placement of graphic elements may be performed automatically by a design program.

The implantation design data represents information on specifications, accurate implantation target positions, and target directions according to the type of fixture, and this data is stored in the storage device 110 so as to be utilized for image guides in the surgical process. In an embodiment, the implantation design data is data added to the three-dimensional oral image in the form of one layer, and thus may constitute a part of the oral image after design. However, for the convenience of explanation so as to increase the understanding of the present invention and the present specification, in the following description, if necessary, the implantation design data will be described as if it were separate from the three-dimensional oral image.

The camera sensor 150 continuously detects the position and direction of the oral marker 200 attached to the patient's teeth, jawbone, or face during implantation surgery. At the same time, the camera sensor 150 continuously detects the position and direction of the handpiece marker 220 attached to the dentist's handpiece 199 . The camera sensor 150 provides the position and direction information of the oral marker 200 and the handpiece marker 220 to the surgical guide PC 160, so that the surgical guide PC 160 tracks the jaw bone movement and the handpiece movement. makes it possible

The surgical guide PC 160 receives the three-dimensional oral image to which the implantation design data is added from the storage device 110 and stores it in a storage medium such as a hard disk or SSD provided in itself. The surgical guide PC 160 is based on the position and direction information of the oral marker 200 and the handpiece marker 220 from the camera sensor 150 in a state where the three-dimensional oral image to which the design data is added is displayed on the screen. By updating and displaying the positions of the oral cavity and handpiece in real time and providing additional information, the dentist guides the placement operation through images.

The surgical guide PC 160 stores and executes the surgical guide program according to the present invention. The surgical guide program displays a three-dimensional oral image on the monitor 190 by overlapping the target arrangement shape of the fixture according to the implantation design data. And based on the position and direction information of the handpiece marker 220 from the camera sensor 150, the surgical guide program allows the handpiece to be displayed overlaid on the 3D oral image displayed on the monitor 190. In addition, the surgical guide program moves and/or rotates the jaw bone displayed on the monitor 190 in real time in response to the position and direction information of the oral marker 200 , and monitors in response to the position and direction information of the handpiece marker 220 . By moving and/or rotating the handpiece displayed at 190 in real time, the image displayed on the monitor 190 can accurately reflect the movement of the jawbone and the handpiece.

FIG. 2 shows an embodiment of the design program 130 executed in the design PC 120 . In the illustrated embodiment, the design program 130 includes a data conversion unit 132 , an image combining unit 134 , and an implantation design unit 136 . Also, the design program 130 may include a standard tooth model table 142 and a fixture information table 144 . The standard tooth model table 142 stores statistical standard model information about the relative positional relationship or arrangement between the teeth, the size of each tooth, and the axial direction of each tooth, which are defined in advance through statistics. Here, the statistical standard model may be a model that is anthropologically and anatomically confirmed and commonly accepted in the dental academia, or it may be a model empirically accumulated by the system operator of the present invention. The fixture table 144 stores information about the inner diameter and length of commercially available fixtures.

The data converter 132 constantly converts the format of the patient's basic image data stored in the storage device 110 into, for example, an STL format. Accordingly, all CT data in the DICOM format may be converted into the STL format. In addition, if a part of the basic image data is obtained by a 3D scanner and is in a format other than STL, such data may also be converted into an STL format.

The image combining unit 134 combines two or more 3D images in the STL format into one. As described above, image combination combines a precision image of a dental plaster model with a head CT image containing information on the jaw and gum bones, and a 3D oral image with reinforced precise tooth shape on the head CT image. will form The purpose and specific examples of image combining will be described in detail below.

Based on the three-dimensional oral image of the STL format, the placement design unit 136 determines the placement form of the implant fixture after placement without touching the nerve while considering the position and thickness of the gingival bone. In particular, the placement design unit 136 considers the correspondence relationship between the patient's tooth arrangement and the standard tooth model 142, arranges a virtual tooth at the position of the tooth to be treated, selects an appropriate one from various fixtures, and selects the selected fixture. The graphic elements for the 3D oral image will be placed in an appropriate position and in an appropriate direction. In this process, the placement design unit 136 makes it possible to determine the size or type of the implant fixture within the range of product information in the fixture information table 144 . The design data for the post-implantation arrangement of the implant fixture is stored in the storage device 110 in a form including information on specifications, implantation target position, and target direction according to the type of the fixture.

In one embodiment, the design program 130 performs format conversion of an image, image combination, and design work based on a command input of a designer. However, in another embodiment, the design program may automatically perform image format conversion, image combining, and design work.

FIG. 3 shows an embodiment of the camera sensor 150 shown in FIG. 1 . In the illustrated embodiment, the camera sensor 150 includes a first image sensor 152 , a second image sensor 154 , a marker detection unit 156 , and a position/direction calculation unit 158 . In a preferred embodiment, the first and second image sensors 152 and 154 constitute a stereoscopic camera, but the present invention is not necessarily limited thereto. The first and second image sensors 152 and 154 are installed to include the oral marker 200 attached to the patient and the handpiece marker 220 attached to the dentist's handpiece 199 within the angle of view during the surgical procedure. , and continuously photograph the oral marker 200 and the handpiece marker 220 accordingly. The marker detection unit 156 detects the oral marker 200 and the handpiece marker 220 from the output images of the first and second image sensors 152 and 154 . The position/direction calculation unit 158 calculates the position and direction of the oral marker 200 and the handpiece marker 220 . As time elapses, the camera sensor 150 repeats the above photographing, marker detection, and calculation, and provides the position and direction information of the oral marker 200 and the handpiece marker 220 calculated through this in real time. For example, it is transmitted to the surgical guide PC 160 through a USB cable. On the other hand, although not shown in the drawings, it is preferable to provide infrared illumination to the camera sensor 150 in order to resolve the sensitivity difference according to the illuminance.

FIG. 4 shows an embodiment of the surgical guide program 170 executed in the surgical guide PC 160 shown in FIG. 1 . In the illustrated embodiment, the surgical guide program 170 includes a position matching unit 172 , a rendering unit 174 , a mode selection unit 176 , a screen display unit 178 , and a voice alarm unit 180 . In addition, the surgical guide program 170 may include a handpiece information table 182 that stores information on the size and specifications of commercially available handpieces and 3D image data.

The position matching unit 172 integrates the three-dimensional oral image and the handpiece image of the patient into one coordinate system, for example, the camera sensor coordinate system, in the initial stage of the implantation operation, so that all the image objects displayed on the monitor 190 are related to a single coordinate system. It allows the coordinates to be displayed uniformly. The rendering unit 174 displays the three-dimensional oral image to which the design data is added on the monitor 190 . Here, it is preferable that the monitor 190 displays an enlarged portion of the patient's oral cavity centered on the jaw bone where the implantation surgery is performed. And the rendering unit 174 is based on the handpiece 3D image data stored in the handpiece information table 182 and the position and direction information of the handpiece marker 220, the 3D image on the 3D oral image on the monitor 190. It allows the handpiece image to be displayed overlaid. Also, the rendering unit 174 moves and/or rotates the jaw bone displayed on the monitor 190 in real time in response to the position and direction information of the oral marker 200 , and responds to the position and direction information of the handpiece marker 220 . Thus, by moving and/or rotating all the handpieces displayed on the monitor 190 in real time, the movements of the jawbone and the handpiece are accurately reflected in the image displayed on the monitor 190 .

The mode selection unit 176 allows the dentist or hygienist to adjust the view of the image displayed on the screen, and allows the user to select additional information to be displayed on the screen. When the rendering unit 174 generates an image to be displayed on the screen, the screen display unit 178 stores the generated image data in a frame memory (not shown), and displays the image corresponding to the frame memory on the monitor 190 . make it possible The voice alarm unit 180 outputs a warning sound or a guide sound during the operation according to the operation mode. The voice alarm unit 180 may be, for example, a speaker, a headphone, or a headset.

In FIG. 1 , the camera sensor 150 and the surgical guide PC 160 are installed in a dental hospital where implantation surgery is performed. In one embodiment, the basic image acquisition unit 100, the storage device 110, and the design PC 120 are also installed in a dental hospital performing implantation surgery, so that the patient's jaw bone state data acquisition and design process are performed. It can be performed at a dental hospital where implantation surgery is performed. However, in another embodiment, the design PC 120 may be installed in an external design center. In this case, the design work is performed by a professional designer, and the dental hospital can accept the design data through the network. there will be In addition, at least a portion of the basic image acquisition unit 100, for example, a CT scanner may be provided in a separate radiology hospital or a centralized CT imaging center. In this case, the design PC 120 may receive the CT image data from the CT scanner online through the network.

Hereinafter, the implant surgery guide method according to a preferred embodiment of the present invention will be described in detail.

the whole process

Figure 5 schematically shows the overall process of the implant surgery guide method according to a preferred embodiment of the present invention.

The implant surgery guide method is based on image information such as a 3D image of the skull. However, in the case of a CT scan of the skull including teeth and jaw bones, the CT image has information about the overall skull structure and the shape of the jawbone, but it may be difficult to extract detailed positions and contours of individual teeth from them. According to the present invention, although teeth are one of the most important factors in CT images, they may not be clearly displayed with sufficient precision in CT images. This is because a phenomenon may also occur, which may interfere with precise shooting. Accordingly, it may be difficult to obtain necessary information with only one CT scan. Accordingly, according to a preferred embodiment, a three-dimensional oral image including teeth and jawbone is generated by acquiring a plurality of patient basic images and combining them.

In the first step 300, a basic image of the jawbone and the inside of the oral cavity of the patient to be implanted is acquired. The patient basic image may be obtained by, for example, imaging the jawbone and the inside of the oral cavity of the patient by means of a CT scanner. In this case, some of the images may be acquired by a 3D scanner instead of a CT scanner. Next, a three-dimensional oral image is generated by combining a plurality of images constituting the basic image (step 302).

Then, by using the design PC 120 to determine the type of the fixture and determine the target arrangement shape of the fixture, the placement design process is performed to determine the type of fixture, the target location for placement, and the target direction. (Step 304).

When the placement design is completed, while the implant fixture is placed for the patient, the handpiece image is displayed along with the three-dimensional oral image on the screen, and the movement of the oral marker 200 and the handpiece marker 220 is tracked while A surgical guide for updating the screen display is performed according to the movement of the markers 200 and 220 (step 306).

In FIG. 5 , steps 300 to 304 may be referred to as pre-preparation work of generating basic data for a surgical guide prior to implantation surgery.

Acquisition of patient basic images

According to an embodiment, a plurality of CT images are acquired as the patient basic images. At this time, in order to facilitate the process of acquiring an impression of the patient's teeth during the CT imaging process and later combining a plurality of CT images into one image, an impression assisting tool is used.

6 is a photograph showing an embodiment of an impression assisting tool.

The impression assisting tool 320 of FIG. 6 is manufactured based on an impression tray used to obtain an impression when manufacturing a dental prosthesis in a dentistry, and an impression material receiving unit 330 configured to correspond to the teeth; A handle 340 extending outwardly from the impression material receiving part 330 is provided.

The impression material receiving portion 330 has an arcuate horizontal cross section and has an inner wall 332 extending in the vertical direction, spaced apart from the inner wall 332, and similarly has an arcuate horizontal cross section and extends in the vertical direction. and a screen 336 connecting the upper and lower midpoints of the outer wall surface of the inner wall 332 and the upper and lower midpoints of the inner wall surface of the outer wall 334 . Due to the inner wall 332 and the outer wall 334 and the screen 336, the impression material accommodating part 330 has a 'U-shaped' and an 'inverted U-shaped' cross-sectional structure to accommodate the impression material. By forming the upper and lower channels in the upper and lower jaws, it is possible to simultaneously take impressions of the entire dentition of the maxilla and mandible.

Ribs extending in the vertical direction are formed on the outer wall surface of the inner wall 332 and the inner wall surface of the outer wall 334 to minimize the movement or separation of the impression material or distortion during the pulling process. The screen 16 acts as a holding base for the impression material, and may be made of a sufficiently thin soft plate, such as a non-woven fabric woven from a material such as cotton gauze, nylon mesh, or polyether. It minimizes the possibility of interfering with the patient's teeth during occlusion for occlusion and does not interfere with accurate occlusion of the impression material.

The handle 340 is attached to the outer wall surface of the outer wall 334 of the impression material receiving portion 330 . It is preferable that the corners of the handle 340 include symmetrical elements and asymmetrical elements, and straight lines and curves so that a plurality of CT images can be easily combined into one image later. For example, in FIG. 6 , a ring-shaped protrusion 342 is formed to protrude left and right from the rectangular parallelepiped-shaped handle body. In the image combining process to be described later, the curved and straight edges of the handle 340 act as characteristic elements for recognizing the spatial position and direction of the surfaces in the CT image. However, it should be noted that the shape of the handle 340 is not limited to that shown in FIG. 6 .

7 shows an embodiment of a process of acquiring a basic patient image in more detail.

First, a first CT image of the head is taken while taking impressions of the maxilla and the mandible using the impression assisting tool 320 shown in FIG. 6 (step 360). The most basic thing in the basic patient image is a 3D image of the patient's jawbone. In a preferred embodiment, a three-dimensional image of the jawbone is acquired by taking a CT image of the entire skull including the jawbone.

In taking the first CT image, the image is taken while taking an impression of the patient's oral cavity by using the impression assisting tool 320 in consideration of the combination with other images. When taking an impression using the impression aid tool 320, the impression material is sufficiently applied to the screen 336 in the upper channel and the lower channel of the impression aid tool 320 to make an impression on the maxilla and the mandible at the same time. do. In this case, as the impression material, all suitable impression materials, including those already commercially available or known, such as alginate, polyvinyl siloxane, polyether, and super-hydrophilic VPS, may be used together.

The first CT image may be taken after the impression material is cured, or may be performed during the curing process, that is, during the impression taking process. Meanwhile, the patient does not have to bite the impression aid tool 320 so that the handle 340 of the impression aid tool 320 faces forward in the impression process, but may bite in an oblique direction. 8 shows an example of a first CT image. As shown, the first CT image is an image of the face in a state in which the patient is biting the impression assisting tool 320 , and if necessary, only the skull except for the skin tissue may be extracted from the face part due to the structure of the conventional CT image.

Then, after a sufficient time has elapsed for the impression material to harden, the impression assisting tool 320 is removed from the patient's oral cavity. As shown in FIG. 9 , an impression body in which the patient's upper and lower teeth and gums are engraved is attached to the separated impression assisting tool 320 . In step 362, a second CT image is separately taken for the impression auxiliary tool to which the impression body is attached. 10 shows an example of a second CT image of an impression assisting tool to which an impression body is attached.

In step 364, an oral plaster model is manufactured and a third CT image is taken. The oral plaster model may be made using an impression body manufactured in the process of acquiring the first and second CT images. However, the impression body may not perfectly reflect the teeth due to various reasons. For example, the patient's teeth may be moved or distorted while taking impressions and CT scans at the same time, and the impression material may be insufficiently filled, especially in the molars at the edges, in the process of simultaneously making impressions on the maxilla and mandible. Accordingly, the impression body manufactured in the process of acquiring the first and second CT images may have low precision. In view of this, in a preferred embodiment, a new impression is taken on the entire tooth in the maxilla or mandible or around the tooth requiring treatment by using a separate impression tray. Then, an oral gypsum model is produced using the newly produced impression body, and a CT scan is performed. 11 shows an example of an oral plaster model manufactured using the newly acquired impression body. In FIG. 11, the left side shows a plaster model for the upper jaw, and the right side shows a plaster model for the lower jaw.

On the other hand, in one embodiment, in the CT imaging of the oral gypsum model, it may be photographed in a state placed on a predetermined cradle. 12 shows an example of a state in which the oral plaster model for the mandible is placed on the cradle. The shape and size of the holder 370 is preferably stored in the design PC 120 shown in FIG. 1 in the form of a three-dimensional image. It is preferable that an auxiliary marker 202 is attached to one point of the cradle 370 . The portion of the holder 370 to which the auxiliary marker 202 is attached is very similar in shape to the handle 340 in the impression assistance tool 320 of FIG. This is because the shape of (370) is made the same for convenience in order to be easily processed in the 3D printer, and both are not necessarily the same.

Also, the cradle 370 does not have to have a specific shape. However, for the convenience of recognition in the design PC 120, it is preferable that the shape of the cradle is kept constant. In addition, as will be described later, for the convenience of location registration or coordinate integration in the initial stage of the surgical guide, it is preferable that the auxiliary marker 202 is accurately attached to a predetermined position between each cradle. On such a cradle 370, the operator attaches and fixes the plaster model with plaster or other adhesive at an arbitrary position, and then performs a CT scan. As such, in a preferred embodiment, the object to be photographed in step 364 becomes a plaster model attached to the cradle 370 to which the auxiliary marker 202 is attached to one side, and at this time, at least a portion of the cradle 370 is attached together. is filmed The use of auxiliary markers and additional functions of the cradle are described in detail below in relation to image coupling and surgical image guidance.

13A shows an example of a third CT image of the mandible taken in the same state as in FIG. 12 . And, FIG. 13B shows that the cradle part is removed and only the tooth part is extracted from the third CT image. As shown, in the third CT image, the teeth and gums of the mandible are displayed.

video combination

14 shows an embodiment of an image combining process in detail.

In the design PC 120 , the data conversion unit 132 of the design program 130 converts the format of the basic image data of the patient stored in the storage device 110 into, for example, an STL format (step 380 ). Accordingly, all CT data in the DICOM format may be converted into the STL format. As in the above-described embodiment, if the first to third CT images are in the dicom format, the data converter 132 converts all the formats of the first to third CT images to the stl format. In the following description, images in which the first to third CT images are converted to the stl format will be referred to as first to third vector images, respectively.

Next, the image combining unit 134 of the design program 130 combines the first to third vector images into one 3D image (step 382).

The second vector image and the third vector image are combined using information on the surface shape of the tooth. First, in the second vector image, since the teeth and gums are indented inside the impression body and are reflected as engravings, the vertices of the teeth and gums are converted to be embossed. Accordingly, for example, in the case of the mandible and mandible teeth, in the second vector image before transformation, they are indented upward from the bottom of the impression body toward the inside of the impression body. . Accordingly, the second vector image after the vertex transformation is similar to the third vector image in the tooth and gum portions, and there is a difference only in the precision of surface curvature and the shape of the edge. Accordingly, the second vector image and the third vector image after vertex transformation can be combined using a surface curvature, that is, a surface shape. In this case, vertices, that is, feature points and vectors are mainly used for combining, but it is also possible to combine using characteristic edges or curves together or by using only them.

On the other hand, the first vector image and the second vector image are combined using the commonality of the handle 340 portion, since the portion of the handle 340 of the impression assistance tool 320 shown in FIG. 6 is common.

15A and 15B show an example of a combined image of a first vector image and a second vector image. FIG. 15A is an image regarding the entire appearance including the face, and FIG. 15B is only a layer related to the impression assistance tool 320. This is an extracted video. 16 shows an example of a combined image of a second vector image and a third vector image.

In an embodiment, after combining the second and third vector images in consideration of the vertex transformation process of the second vector image, the second vector image is combined with the first vector image. However, the order of combining the first to third vector images is not limited thereto, and which two images are first combined may be arbitrarily determined. That is, instead of combining the second and third vector images and combining them with the first vector image, the third vector image may be combined after combining the first and second vector images.

Finally, unnecessary parts including the handle 340 of the impression assisting tool 320 are deleted from the combined image, and a three-dimensional oral image is completed (step 384).

In the 3D oral image, facial skin, skull, maxilla and mandible, teeth, gums and gum bones are displayed. And, in the 3D oral image, the facial skin, skull, maxilla, mandible, and neural tube may be divided into separate layers and displayed selectively or may be selectively excluded from the display. As described above, a CT image of the skull alone may not be sufficient to extract the detailed positions and contours of individual teeth. It has accurate tooth information reinforced through the 3D data of the plaster model.

And in the 3D oral image, it is possible to display arbitrary positions in the oral cavity and skull including the jawbone, that is, the maxilla and/or mandible, teeth, gums, and gingival bones as coordinates by a single coordinate system. The center of the single coordinate system and the direction of each axis may be arbitrarily determined. For example, if a certain size and shape is used as the holder 370 and the auxiliary marker 202 is attached to a predetermined position in the holder 370 as described above, the auxiliary marker 202 is also used for describing the oral structure. It is located in a certain position and direction in a single coordinate system, and it is also possible to set the center of the auxiliary marker 202 or any other point on the auxiliary marker 202 as the center of the coordinate system.

implantation surgical design

17 specifically shows an embodiment of a design process for implant fixture placement surgery.

First, teeth according to the standard tooth model are placed on the patient's three-dimensional oral image, and the dentition of the standard tooth model is adjusted according to the patient's remaining teeth and/or gum bones (step 380). 18 shows an example of a screen displayed by superimposing teeth according to a standard tooth model on a three-dimensional oral image of a patient. Adjustment of the teeth of the standard tooth model may be performed by dragging the vertices or control points shown in FIG. 18 with a mouse.

Next, the standard tooth at the corresponding position on the standard tooth model is placed at the position of the tooth defect requiring implant placement (step 382).

Next, the position of the neural tube in the jawbone is checked (step 384). The position of the neural tube can be confirmed from the first CT image, and as described above, it is divided into layers separate from the facial skin, skull, maxilla, and mandible in the three-dimensional oral image and can be selectively displayed or selectively excluded from the display. have.

In step 386, the target position and direction of the implant fixture is determined. The determination of the target position and direction of the implant fixture is made by moving or rotating the implant fixture in the screen. In determining the target position and direction, the central axis of the fixture must coincide with the central axis of the standard tooth arranged in step 382, or at least not deviate significantly from the standard teeth, and the fixture must not touch the neural tube; , it should be stably implanted in the jawbone without being exposed to the inner or outer walls of the jaw. Change the thickness and/or length of the fixture if the jaw bone is thin or there is a high probability of interfering with the neural canal. 19 shows an example of a screen for determining the target position and direction of the implant fixture. In the figure, green indicates a neural tube, and a red cylinder indicates an implant fixture.

When the design is completed, implantation design data indicating information on specifications, accurate implantation target positions, and target directions according to the type of fixture is stored in the storage device 110 . Here, the information on the implantation target position and the target direction is added to the three-dimensional oral image in the form of one layer, and thus constitutes a part of the three-dimensional oral image after design.

surgical guide

20 specifically shows an embodiment of an image guide process for implant fixture placement surgery.

First, in step 400, an oral marker is attached to an oral structure such as a patient's teeth or jawbone or a face (hereinafter, referred to as a 'mouth'), and a spatial relationship between the oral cavity and the oral marker is determined. And in step 402, a handpiece marker is attached to the handpiece used by the dentist, and a spatial relationship between the handpiece and the handpiece marker is determined.

21 shows examples of patterns of markers used in a preferred embodiment of the present invention. In this embodiment, all of the markers have a form in which a plurality of dots are arranged within a square frame. Each marker has a different dot placement pattern, and it is predefined which pattern of the marker is used as the oral marker, the handpiece marker, and the first and second auxiliary markers described below. In each marker, the center of the square is set as the origin, the x-axis passing through the origin and parallel to one corner is the x-axis, the direction in which the x-axis is rotated 90 degrees around the origin is the y-axis, and the direction from the marker can be defined as the z-axis to determine the coordinate system of each marker.

In order to use such a marker as an oral marker and a handpiece marker, it is necessary not to interfere with the work of the dentist and the hygienist in attaching the marker to the oral cavity and the handpiece, respectively. In view of this, according to a preferred embodiment of the present invention, the oral marker and the handpiece marker are respectively attached to the oral cavity and the handpiece using separate tools.

22 shows an embodiment of an oral marker attachment tool for attaching an oral marker to an oral cavity. In the illustrated embodiment, the oral marker attachment tool 600 includes a coupling part 602 attached to the patient's teeth, and extending outwardly from the coupling part 604 to be partially exposed outside the patient's lips. one or more ball joints 606 and 610 connecting the protrusion 604 and the marker attachment panel 612 to which the oral marker 200 is attached; The above link 608 is provided. A plurality of through-holes 602a are formed in the coupling portion 602 . This oral marker attachment tool 600 is preferably processed with a plastic material to minimize the weight.

In attaching such an oral marker attachment tool 600 to the oral cavity, after the impression material is applied to one surface of the coupling part 602, the jaw bone to be operated in the patient's oral cavity (eg, the tooth region for implant treatment is the maxilla). In the case of the upper jaw, and the mandible in the case of the lower jaw), it is placed in close contact with the teeth in a position spaced apart from the surgical site, and then hardened. After the impression material is cured, the impression material in which the impression material is hardened is firmly attached to the coupling part 602 and does not fall off. The coupling force between the sieve and the coupling part 602 is further increased. And, since the adhesion between the teeth and the impression body is high, the oral marker attachment tool 600 maintains the state attached to the teeth through the impression body, unless it is intended to separate by intentionally applying an external force. In addition, even if the oral marker attachment tool 600 is detached and attached to the teeth again, the adhesion state can be maintained, and the adhesion state can be maintained even if it is attached to the corresponding position of the oral gypsum model rather than the teeth. 23 shows a state separated from the teeth of the oral marker attachment tool 600 to which the impression body is attached. On the other hand, after applying the impression material to the oral marker attachment tool 600, instead of directly attaching it from the patient's mouth, it may be attached to the oral gypsum model and transferred to the oral cavity after curing is completed.

After the oral marker attachment tool 600 with the impression body is attached to the oral cavity, the ball joints 606 and 610 and the link 608 are adjusted so as not to interfere with the work of the dentist or hygienist or the operation of the system according to the present invention. Thus, the optimal position state can be selected. Accordingly, the oral marker 200 or the oral marker attachment tool 600 obstructs the dentist's view, prevents access or use of the handpiece, prevents the hygienist from using the inhaler, or the oral marker 200 There is an advantage in that it can be prevented from moving by being pushed by the patient's lips, can be easily separated in an emergency, and can be easily seen by the camera sensor 150 .

24 shows one embodiment of a handpiece marker attachment tool for attaching a handpiece marker to a handpiece. In the illustrated embodiment, the handpiece marker attachment tool 620 includes a clip 622 attached to the side of the handpiece, a marker attachment panel 628 to which the handpiece marker 220 is attached, and the clip 622 . ) and at least one link 624 and at least one ball joint 626 connecting the marker attachment panel 628 . It is also preferable to process the handpiece marker attachment tool 620 from a plastic material to minimize the weight. Such an oral marker attachment tool 600 can be easily attached by inserting it on the outer surface of the handpiece. 25 shows an example of a state in which the handpiece marker is attached to the handpiece via the handpiece marker.

After the handpiece marker 220 is mounted on the handpiece by the handpiece marker attachment tool 620, the link 624 and the ball joint ( 626) to select an optimal position state. Accordingly, the handpiece marker 220 or the handpiece marker attachment tool 620 obstructs the dentist's view, obstructs the access or use of the handpiece, prevents the hygienist from using the inhaler, or the oral marker ( 200) can be prevented from moving by being pushed to the lips of the patient, can be easily separated in an emergency, and has the advantage of being well visible to the camera sensor 150 .

In this way, in the state where the oral marker 200 and the handpiece marker 220 are attached, by tracking the handpiece marker 220, it is possible to precisely track where the handpiece is located, and the oral marker 200 It is possible to track the movement of the jawbone during which surgery is performed by tracking the operation, and the handpiece and jawbone reflecting the movement can be displayed on the screen in real time.

To this end, first, a three-dimensional oral image to which the implantation design data is added is displayed on the monitor 190 screen of the surgical guide PC 160 (step 404).

When the operation is started, the camera sensor 150 continuously detects the positions and directions of the oral marker 200 and the handpiece marker 220 and provides them to the surgical guide PC 160 (step 406). In one embodiment, the data provided by the camera sensor 150 to the surgical guide PC 160 is a three-dimensional position for each of the oral marker 200 and the handpiece marker 220, that is, the x-axis and the y-axis. , the position in the z-axis direction, and the three-dimensional direction, i.e., the x-axis, the y-axis, and the z-axis are six pieces of data of rotation angles. The surgical guide program executed on the surgical guide PC 160 determines the precise jawbone that reflects the movement of the jawbone from the position and direction of the oral marker 200, that is, the position of the maxilla or mandible where surgery is performed, and updates the displayed image on the screen. In addition, the precise handpiece position reflecting the movement of the handpiece is determined from the position and direction of the handpiece marker 220, and the display for the handpiece portion on the screen is updated (step 408).

In addition to displaying on the screen while tracking the movement of the patient's mouth and the dentist's handpiece, the required movement amount and required rotation amount of the handpiece may be actively guided through the screen or through the screen and the headset speaker ( step 410).

On the other hand, in order to track the jawbone and the handpiece by tracking the oral marker 200 and the handpiece marker 220 as described above, as mentioned in relation to steps 400 and 402 of FIG. 20 , the oral and oral markers It should be possible to clearly understand the spatial relationship between the handpiece and the handpiece marker.

26 shows an embodiment of a method for determining a spatial relationship between an oral cavity and an oral marker and a spatial relationship between a handpiece and a handpiece marker.

According to the illustrated embodiment, first, with the first auxiliary marker attached in a state where the positional relationship with the oral gypsum model can be clearly seen, the oral marker is attached to the oral gypsum model in the same manner as attaching the oral gypsum ( step 420).

Here, according to a preferred embodiment, the oral plaster model on the cradle 370 described in relation to FIG. 12 is utilized. That is, as shown in FIG. 12 , in a state where the oral plaster model is mounted on the cradle 370 , if the shape is the same between the cradles and the first auxiliary marker 202 is accurately attached to a predetermined position, the third CT image or the second 3 It is possible to detect the exact position and shape of the gypsum model with respect to the cradle 370 in the vector image, and since the relationship between the cradle 370 and the first auxiliary marker 202 is clear, the cradle 370 is Thus, the spatial relationship between the oral gypsum model and the first auxiliary marker 202 can be uniquely determined and can be clearly identified. In this state, as shown in FIG. 22, the oral marker attachment tool 600 to which the impression body is attached is attached in close contact with the oral gypsum model. 27 shows a state in which the oral plaster model is seated on the cradle 370 to which the first auxiliary marker 202 is attached, and the oral marker 200 is attached to the oral plaster model by the oral marker attachment tool 600. .

Referring back to FIG. 26, in step 422, the second auxiliary marker is attached to the handpiece in a state where the positional relationship with the handpiece can be clearly identified. For example, as shown in FIG. 28 , the second auxiliary marker 222 may be attached to the upper surface of the handpiece that meets the extension line of the central axis of the drilling tool in the handpiece. In particular, it is preferable to temporarily couple the auxiliary marker attachment tool 640 to which the second auxiliary marker 222 is attached by fitting to the front end of the handpiece. In this state, the handpiece marker 220 is mounted on the handpiece by the handpiece marker attachment tool 620 . 29 shows an example of a state in which the handpiece marker 220 and the second auxiliary marker 222 are attached to the handpiece.

Referring back to FIG. 27 , in step 424 , the oral marker 200 , the handpiece marker 220 , and the first and second auxiliary markers 202 and 222 , the stereoscopic camera of the camera sensor 150 or the two Detection is performed by photographing with an image sensor, and the spatial relationship between the oral marker 200 and the first auxiliary marker 202 and the spatial relationship between the handpiece marker 220 and the second auxiliary marker 222 are determined. More specifically, the camera sensor 150 identifies which marker each marker is according to an arrangement pattern of dots in the marker. Then, the camera sensor 150 restores the points in the marker in three dimensions for each marker, calculates the position and direction of the marker based on the camera coordinate system, and provides the position data and direction data for each marker as a surgical guide. transmitted to the PC 160 . The surgical guide PC 160 determines the spatial relationship between the oral marker 200 and the first auxiliary marker 202, that is, the distance and the amount of rotation, and the distance between the handpiece marker 220 and the second auxiliary marker 222 and It also determines the amount of rotation. Calculation of the spatial relationship between the markers may be performed in the camera sensor 150 instead of the surgical guide PC 160 .

When the spatial relationship between the oral marker 200 and the first auxiliary marker 202 is determined, since the spatial relationship between each structure in the oral cavity and the first auxiliary marker 202 is already established, the oral and oral marker 200 The spatial relationship between them can be found. For example, when each structure in the oral cavity is described in the coordinate system of the first auxiliary marker 202, each structure in the oral cavity is expressed using the spatial relationship between the oral marker 200 and the first auxiliary marker 202. It is described in the coordinate system of , and it can be rendered with the camera viewpoint or other viewpoints while reflecting the movement of the jawbone.

Similarly, when the spatial relationship between the handpiece marker 220 and the second auxiliary marker 222 is determined, since the spatial relationship between the handpiece and the second auxiliary marker 222 has already been established, the handpiece and the handpiece marker It is possible to know the spatial relationship between (220). For example, when each point on the handpiece is described in the coordinate system of the second auxiliary marker 222 , each point on the handpiece is mapped to the handpiece marker using the spatial relationship between the handpiece marker 220 and the second auxiliary marker 222 . It is described in the coordinate system of 220, and the handpiece can be rendered with a camera viewpoint or other viewpoint while reflecting the movement of the handpiece.

Steps 420 to 424 of FIG. 26 may be simply performed as a procedure for positioning markers or registering a marker immediately before a fixture placement operation for a patient. 30 shows images captured by the camera sensor 150 and displayed on the screen during the marker registration process just before the implantation operation and markers therein. In the drawing, the left side shows an image acquired by the first image sensor, and the right side shows an image acquired by the second image sensor. In each image, markers 0 to 4 indicate the first auxiliary marker 202 , the oral marker 200 , the second auxiliary marker 222 , and the handpiece marker 220 , respectively. As described above, the direction of each marker and the spatial relationship between the markers can be detected using the two images.

When registering a marker, only the spatial relationship between the two markers to be matched may be detected, and the coordinate system describing the oral cavity or the handpiece may be changed along with this. Depending on the contents of the work performed at the time of registering the marker, the object positioning and rendering process according to the detection of the marker when tracking the jawbone or the handpiece may be slightly different.

31 shows the spatial relationship between the first auxiliary marker 202 and the oral marker 200 at the time of marker registration, that is, only the distance and direction difference (rotation angle) is detected and recorded and then ended, determining the position of the jawbone during surgery and rendering process. In this case, when the position of the oral marker 200 is determined in the surgical process (step 440), a vector corresponding to the process of determining the virtual position of the second auxiliary marker 202 corresponding to the position of the oral marker 200 After the operation is performed (step 442), the jawbone position corresponding to the virtual position of the second auxiliary marker 202 is determined and rendered (step 444).

32 shows not only detecting the distance and direction difference (rotation angle) between the first auxiliary marker 202 and the oral marker 200 during marker registration, but also the jawbone and others described in the coordinate system of the first auxiliary marker 202. In the embodiment in which the coordinates for the oral structure are re-described as the coordinate system of the oral marker 200, the jaw bone positioning and rendering process during the operation is shown. In this case, when the position of the oral marker 200 is determined in the surgical process (step 460), the position of the jaw bone corresponding to the position of the oral marker 200 is immediately determined by using the position information re-described on the position of the jaw bone, and It becomes possible to render (step 462).

33 shows a modified embodiment of the method for determining the spatial relationship between the oral cavity and the oral marker and the spatial relationship between the handpiece and the handpiece marker shown in FIG. 26 .

According to this embodiment, the oral marker 200 is attached to the oral gypsum model in the same way as attaching to the oral cavity (step 480). That is, as shown in FIG. 22, the oral marker attachment tool 600 to which the impression body is attached is attached in close contact with the oral gypsum model, and is attached to a position corresponding to the attachment position in the oral cavity.

Then, by taking a stereoscopic camera or two image sensors of the camera sensor 150 with respect to the oral gypsum model to which the oral marker 200 is attached, coordinates for a plurality of points on the oral gypsum model of the oral marker 200 It is described in a coordinate system, and the coordinates for the entire oral cavity are described in the coordinate system of the oral marker 200 using the correspondence between the oral plaster model and the oral cavity (step 482).

Then, the handpiece marker is attached to the handpiece using the handpiece marker attachment tool 620 shown in FIG. 24 (step 484).

Next, the handpiece to which the handpiece marker 220 is attached is photographed with a stereoscopic camera or two image sensors of the camera sensor 150 , and coordinates for a plurality of points on the handpiece are obtained from the handpiece marker 220 . It is described in a coordinate system (step 486).

The output image for the surgical image guide of the surgical guide program 170 may be in various forms.

For example, the screen may be divided into a plurality of viewports to display a perspective view, a front view, a plan view, and a side view in each viewport, or only a perspective view may be displayed in a single viewport. When only one perspective view is displayed in a single viewport, the rendering viewpoint may be the camera viewpoint, the program may automatically detect and set it, or the dentist may set the viewpoint.

The magnification of the image may be dynamically changed according to the stage of operation or the range of movement of the handpiece, or a fixed magnification may be maintained. Also, in rendering the handpiece, the entire handpiece may be rendered, but only the drilling tool portion may be rendered concisely.

Additional reference information may also vary according to screen settings and user input. For example, the required movement amount and movement direction of the handpiece, and the required rotation amount and rotation direction may be displayed. In addition, while drilling is being performed, the depth at which the drilling has been performed and/or the remaining depth may be displayed. If necessary, a warning sound or a guide sound may be output, and such sound information may be output only through earphones, headphones, or a headset to relieve the patient's anxiety.

34 shows an example of an output image. In this output image, the screen is divided into 4 viewports, and a perspective view, a front view, a top view, and a side view are displayed in each viewport. And for a simple screen composition, only the drilling tool part of the handpiece is rendered.

35 shows another example of an output image. In this output image, the screen includes only a single viewport, and a perspective view from the camera's point of view or the dentist's point of view is displayed in this viewport. In the image, the required movement amount and movement direction of the handpiece, and the necessary rotation amount and rotation direction are displayed.

Although preferred embodiments of the present invention have been described above, the present invention may be modified in various ways and implemented in other specific forms without changing the technical spirit or essential characteristics thereof.

For example, although the above description has been focused on an embodiment in which the camera sensor 150 includes two image sensors, the present invention is not limited thereto, and the camera sensor may include only one image sensor.

The design program 130 executed in the design PC 120 may be a collection of several programs, not a single program. And, some process steps may be performed by a known commercial program. For example, the operation of combining the first to third vector images may be performed using an existing image processing program having a merging function, for example, a DAVID program manufactured and sold by David Vision System GmbH of Germany. Also, converting the dicom format image to the stl format may be performed by a program used for CT image processing.

Therefore, it should be understood that the embodiments described above are illustrative in all respects and not restrictive. The scope of the present invention is indicated by the following claims rather than the above detailed description, and all changes or modifications derived from the meaning and scope of the claims and their equivalent concepts should be interpreted as being included in the scope of the present invention. do.

100: basic image acquisition unit, 110: storage device
120: design PC, 150: camera sensor
160: surgical guide PC
199: handpiece
200: oral marker, 202: first auxiliary marker
220: handpiece marker, 222: second auxiliary marker
320: impression aid tool, 330: impression material receiving unit
332: inner wall, 334: outer wall, 336: screen
340: handle
370: oral plaster model holder
600: oral marker attachment tool, 602: coupling portion
604: protrusion, 606, 610: ball joint, 608: link
612: marker attachment panel
620: handpiece marker attachment tool, 622: clip
624: link, 626: ball joint
628: marker attachment panel

Claims (21)

An implant surgery guide method performed by a program running on an implant surgery guide computer system, comprising:
(a) A three-dimensional oral image of the patient by combining a CT image of the inside of the oral cavity including the patient's jawbone and a plaster model image taken by placing the oral plaster model of the patient on a cradle having a predetermined shape and size creating a;
(b) designing a target arrangement state including a target position and a target direction of the implant fixture based on the three-dimensional oral image;
(c) mounting the oral gypsum model on the cradle to which the first auxiliary marker is attached, attaching an oral marker to be attached to the patient's jawbone to the gypsum model, and attaching the first auxiliary marker, the holder, and the oral marker to the gypsum model After capturing an image including determining a spatial relationship between the oral marker and the jaw bone in the three-dimensional image;
(d) attaching the oral marker to the jawbone of the patient, determining the spatial relationship between the oral marker and the jawbone in the three-dimensional image as the spatial relationship between the oral marker and the jawbone, and including a second pattern attaching a handpiece marker to a dentist's handpiece, and determining a spatial relationship between the handpiece marker and the handpiece; and
(e) estimating the positions and orientations of the jawbone and the handpiece based on changes in the positions and directions of the oral markers and the handpiece markers while tracking the movements of the oral markers and the handpiece markers; displaying a jawbone image portion and a handpiece image portion reflecting real-time position/direction change of the handpiece on the screen;
Implant surgery guide method comprising a. The method according to claim 1, wherein the step (a)
after applying an impression material to an impression auxiliary tool partially exposed to the outside of the oral cavity, causing the patient to bite the portion to which the impression material is applied with a tooth, and acquiring a first basic image, which is the CT image;
obtaining a second basic image with respect to the impression auxiliary tool to which the impression material is cured and the impression body is attached;
obtaining a third basic image that is the oral plaster model image; and
generating the three-dimensional oral image by combining the first to third basic images;
Implant surgery guide method comprising a. 3. The method according to claim 2,
Step (a) is
converting a CT image from among the first to third basic images into a vector image, and determining first to third vector images from the first to third basic images;
generating the three-dimensional oral image by combining the first to third vector images;
Implant surgery guide method comprising a. The method according to claim 3, wherein in the step of generating the three-dimensional oral image by combining the first to third vector images, the first and second vector images are the impression assistance tool within the first and second vector images. An implant surgery guide method for combining using a portion corresponding to , and combining the second and third vector images using surface shape information of the tooth portion. The method according to claim 4, wherein the step of generating the three-dimensional oral image by combining the first to third vector images
converting intaglio into embossed with respect to the part of the impression body in the second vector image; and
combining the tooth portion converted into relief in the second vector image with the corresponding tooth portion of the third vector image;
Implant surgery guide method comprising a. The method according to claim 1, wherein the step (b)
arranging teeth according to a predetermined standard tooth model on the three-dimensional oral image and adjusting the dentition of the standard tooth model;
disposing a standard tooth according to the standard tooth model at a tooth defect location requiring placement of the implant fixture;
determining the target placement state of the implant fixture while not interfering with the neural tube within the jawbone and not exposed to the outside of the jawbone;
Implant surgery guide method comprising a. The method according to claim 6, wherein the step of determining the target arrangement
determining a type of the implant fixture; and
adding design data regarding the target arrangement state to the three-dimensional oral image as a part of the three-dimensional oral image;
Implant surgery guide method comprising a. The method according to claim 1, wherein in step (d), the portion where the oral marker is attached to the patient's jawbone is located in step (c).
The implant surgery guide method corresponding to the position where the oral marker is attached to the site of the oral gypsum model. The method according to claim 1, wherein the step (e)
detecting the position and orientation of the oral marker;
based on the spatial relationship between the first auxiliary marker and the oral marker, determining the position and direction of the jawbone from position data and direction data of the oral marker;
Implant surgery guide method comprising a. The implant surgery guide method according to claim 1, wherein in step (e), the three-dimensional oral image is rendered from a viewpoint of a camera that captures the oral marker and the handpiece marker or a viewpoint of the dentist. The implant surgery guide method according to claim 1, wherein in the step (e), the required movement amount and movement direction of the handpiece, and the necessary rotation amount and rotation direction are additionally displayed on the screen. The implant surgery guide method according to claim 11, wherein the drilling progressed depth or the remaining depth is additionally displayed on the screen. The method according to claim 1, wherein the step (d)
describing the spatial arrangement of at least one of the jawbone and the oral marker and at least one of the handpiece and the handpiece marker as coordinates in a single coordinate system;
Implant surgery guide method comprising a. A computer-readable recording medium recording a program for executing the method of any one of claims 1 to 13 in a computer. delete delete delete delete delete delete delete

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