WO2015107520A1

WO2015107520A1 - Dental guiding system and method

Info

Publication number: WO2015107520A1
Application number: PCT/IL2015/050046
Authority: WO
Inventors: Gershon HOROWICZ
Original assignee: Horowicz Gershon
Priority date: 2014-01-15
Filing date: 2015-01-13
Publication date: 2015-07-23

Abstract

There are provided computerized methods for dental surgery navigation. The computerized methods comprise receiving computerized three dimensional (3D) images of a dental treatment area. The methods further comprise computing positions and orientations using computerized first navigational elements attached in proximity to the dental treatment area. The methods further comprise registering between an image coordinate system of 3D images and navigation coordinate systems of computerized first navigational elements. The methods further comprise computing positions and orientations from a second computerized navigational element located in close proximity to drill holes into the dental treatment area during pause of a drilling and removal of drill tool, one position and orientation for each one of the drill holes. The methods further comprise indicating positions and orientations on the 3D images using a computerized user interface, for dental surgery navigation.

Description

DENTAL GUIDING SYSTEM AND METHOD

FIELD AND BACKGROUND OF THE INVENTION

The present invention, in some embodiments thereof, relates to medical procedures and, more particularly, but not exclusively, to navigation systems and methods for dental surgery.

Most existing navigation systems for dental surgery reply on electro-optical systems for detection of a position and orientation of both the patient and the surgical tools. These systems require large optical reflectors attached to objects being tracked and line-of-sight clearance between reflectors and electro-optical transceiver.

Surgical guide frames, or dental jigs, for dental implant hole drilling are prepared preoperatively based on three dimensional images of a treatment area or impressions taken from a treatment area, and have drill guides at positions needed for alignment of a drill tool and drill bit.

A method and system for facilitating the placement of a dental implant has been described in United States patent application number 13/678,020. This invention describes using radar for localization of relative positions between a dental appliance and a dental tool.

A surgical navigation system for oral and maxillofacial surgery, termed Osteomark, has been described by Bouchard published in Int. J. Oral Maxillofac. Surg. From date 2012 February volume 41(2) pages 265-270. This system uses a navigational sensor attached at the tip of a pencil-shaped instrument and a reference sensor attached to the treatment area to allow localization of drill hole entry point positions in the treatment area. SUMMARY OF THE INVENTION

According to some embodiments of the present invention, there are provided computerized methods for dental surgery navigation. The computerized methods comprise receiving one or more computerized three dimensional (3D) images of a dental treatment area. The methods further comprise computing one or more positions and orientations using one or more computerized first navigational elements attached in proximity to the dental treatment area. The methods further comprise registering between an image coordinate system of one or more 3D images and navigation coordinate systems of one or more computerized first navigational elements. The methods further comprise computing one or more positions and orientations from a second computerized navigational element located in close proximity to one or more drill holes into the dental treatment area during pause of a drilling and removal of drill tool, one position and orientation for each one of one or more drill holes. The methods further comprise indicating one or more positions and orientations on the 3D images using a computerized user interface, for dental surgery navigation.

Optionally, the registering action comprises calculating using a computer two or more computerized positions from one or more computerized navigational elements located such that two or more computerized positions are visible on one or more 3D images. The computerized registering action further comprises locating two or more computerized positions on one or more 3D images. The registering action further comprises computing a transformation matrix between the image coordinate system and navigation coordinate system using a computer.

Optionally, additional one or more computerized navigational elements are attached to a drilling tool, and additional one or more navigational elements monitor positions and orientations of the drilling tool on one or more 3D images.

Optionally, one or more computerized first navigational elements are combined with a dental implant surgical jig that limits a position and orientation of one or more drill holes.

Optionally, one or more computerized first navigational elements are one or more annular elements comprising one or more stationary parts attached to a treatment area and one or more tiltable parts that incorporate one or more navigational elements and enables varying an orientation of one or more drill holes, thereby enabling one or more navigational elements to detect the orientation of one or more drill holes.

Optionally, one or more annular elements further comprise one or more annular sleeve third parts that are capable of changing an annular inner diameter to match an outer diameter of a drill bit.

Optionally, one or more tiltable parts of one or more annular elements are capable of adjusting an annular inner diameter to match an outer diameter of a drill bit. Optionally, one or more tiltable parts of one or more annular elements are replaceable thereby enabling an annular inner diameter to change to match an outer diameter of a drill bit by replacing one or more tiltable parts of one or more annular elements without removing one or more stationary parts fixed to a treatment area.

Optionally, a further step computes one or more virtual positions, and one or more virtual positions are indicated on one or more 3D images.

Optionally, a further step computes one or more distances between a leading edge of one or more drill holes and an anatomical landmark along a projection of the orientation of the drill hole, one or more distances used to prevent the leading edge from reaching the anatomical landmark.

Optionally, the anatomical landmark is a boundary of a sinus.

According to some embodiments of the present invention, there are provided computerized methods for producing a surface map of a dental treatment area. The computerized methods comprise receiving two or more computerized positions from one or more computerized navigational elements located in close proximity to one or more dental treatment areas. The methods further comprise computing one or more computerized surface maps of one or more dental treatment areas from two or more computerized positions. The methods further comprise outputting one or more computerized surface maps of one or more dental treatment areas.

Optionally, one or more computerized surface maps are used to create one or more dental implant casts.

Optionally, one or more computerized surface maps are used to create one or more dental implant surgical jigs.

Optionally, one or more dental implant surgical jigs are created from one or more molds of one or more dental implant surgical jigs using one or more surface maps.

Optionally, one or more computerized surface maps are created after one or more modifications of the treatment area.

Optionally, one or more computerized positions are created by automatically guiding operator so as to complete one or more computerized surface maps.

Optionally, one or more dental implant casts are produced with a system attached three dimensional printer. Optionally, one or more dental implant surgical jigs are produced with one or more automatically positioned drill guides.

Optionally, one or more dental implant surgical jigs are produced with one or more manually positioned drill guides.

According to some embodiments of the present invention, there are provided annular devices for dental surgery navigation, comprising one or more stationary parts for fixation to treatment area. The annular devices further comprise one or more moveable parts with incorporated navigational elements and annular guides for directing a drill bit during drilling of a hole in dental surgery, where the element determines position and orientation of drill hole.

Optionally, one or more moveable parts are adjustable for orientation of annular guides.

Optionally, one or more moveable parts are adjustable for position of annular guides.

Optionally, one or more moveable parts are adjustable manually.

Optionally, one or more moveable parts are adjustable automatically by computer.

Optionally, one or more moveable parts provide haptic feedback when orientation is erroneous.

According to some embodiments of the present invention, there are provided dental probe devices for navigation in dental surgery. The dental probe devices comprise a probe tip, a navigational element positioned at a known position and orientation relative to tip, and a handle for positioning probe tip at a patient location.

Optionally, the tip is any from the list of a pointed tip, a flat tip, a hemispherical tip, a round tip, a conical tip, a textured tip, a shaped tip, and the like.

Optionally, the probe tip has a round diameter less than but close to a diameter of a drilled hole.

Optionally, the probe tip has an adjustable diameter between 2 and 10 millimeters.

Optionally, the navigational element is located at a distance of between 0.5 and

60 millimeters from the probe tip. Optionally, the probe tip has a round diameter of a first size less than a diameter of the navigational element near the probe tip, and a second size larger than the diameter of the navigational elements near the navigational element, enabling the probe tip to enter a drill hole that is smaller in diameter than the diameter of the navigational element.

According to some embodiments of the present invention, there are provided computerized devices for dental navigation, comprising one or more navigational transceiver interfaces for determining one or more positions and orientations of one or more navigational elements. The devices further comprise one or more navigational element interfaces. The computerized devices further comprise one or more processing units configured for receiving one or more three dimensional images of a treatment area, receiving one or more positions and orientations, registering one or more image and navigation coordinate systems, computing one or more virtual positions on one or more three dimensional images. The computerized devices further comprise one or more user interfaces configured for displaying one or more three dimensional images, one or more at positions and orientations, and one or more virtual positions.

Optionally, the navigational element is a passive navigational marker for determining position of the navigational element.

Optionally, the navigational element is an active navigational transmitter for determining position of the navigational element.

Optionally, the navigational element is an active navigational sensor for determining position of the navigational element.

According to some embodiments of the present invention, there are provided medical methods for drilling a dental surgery hole. The medical methods comprise affixing a navigational element in close proximity to a treatment area. The medical methods further comprise commanding a navigational device to load a 3D image of a treatment area. The medical methods further comprise commanding a navigational device to register the coordinate systems of the navigational element and the 3D image using two or more registration points. The medical methods further comprise drilling one or more dental surgery holes, such that the dental surgery hole is incomplete during a pause in the surgery. The medical methods further comprise locating a second navigational element into one or more dental surgery holes. The medical methods further comprise confirming correct position and orientation of one or more dental surgery holes. The medical methods further comprise drilling of the dental surgery hole to completion.

Unless otherwise defined, all technical and/or scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention pertains. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of embodiments of the invention, exemplary methods and/or materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and are not intended to be necessarily limiting.

Implementation of the method and/or system of embodiments of the invention can involve performing or completing selected tasks manually, automatically, or a combination thereof. Moreover, according to actual instrumentation and equipment of embodiments of the method and/or system of the invention, several selected tasks could be implemented by hardware, by software or by firmware or by a combination thereof using an operating system.

For example, hardware for performing selected tasks according to embodiments of the invention could be implemented as a chip or a circuit. As software, selected tasks according to embodiments of the invention could be implemented as a plurality of software instructions being executed by a computer using any suitable operating system. In an exemplary embodiment of the invention, one or more tasks according to exemplary embodiments of method and/or system as described herein are performed by a data processor, such as a computing platform for executing a plurality of instructions. Optionally, the data processor includes a volatile memory for storing instructions, data and/or a non-volatile storage, for example, a magnetic hard-disk and/or removable media, for storing instructions and/or data. Optionally, a network connection is provided as well. A display and/or a user input device such as a keyboard or mouse are optionally provided as well. BRIEF DESCRIPTION OF THE DRAWINGS

Some embodiments of the invention are herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of embodiments of the invention. In this regard, the description taken with the drawings makes apparent to those skilled in the art how embodiments of the invention may be practiced.

In the drawings:

FIG. 1 is a flowchart of a method for surgical navigation during dental surgery, according to some embodiments of the invention;

FIG. 2 is a schematic illustration of a dental probe navigational element for surgical navigation during dental surgery, according to some embodiments of the invention;

FIG. 3 is a schematic illustration of an annular dental probe navigational element for surgical navigation during dental surgery, according to some embodiments of the invention;

FIG. 4 is a schematic illustration of a computerized device for surgical navigation during dental surgery, according to some embodiments of the invention; and

FIG. 5 is a schematic illustration of a user interface display for surgical navigation during dental surgery, according to some embodiments of the invention.

FIG. 6 is a flowchart of a method for creating a surface map used in dental surgery, according to some embodiments of the invention;

DESCRIPTION OF EMBODIMENTS OF THE INVENTION

Existing navigation systems for dental surgery may rely on electro-optical methods to locate the patient and one or more tools, requiring line of sight exposure of all navigational sensors and transmitters attached to tools and patient during a treatment. These navigational sensors and transmitters may be large in size relative to a treatment area and may make these methods cumbersome to perform a surgery in a treatment area as there are multiple apparatuses, devices, tools and/or sensors surrounding a patient hindering access by a surgeon to the treatment area. Other methods may include passive magnetic markers which are susceptible to electromagnetic interference caused by a drill tool and drill bits. Additionally, previous systems and methods such as Osteomark or those described in United States patent application number 13/678,020 may be used for detecting only the positions for treatment, but not for measuring the direction of drill holes, verifying the correct position and orientation of future extrapolation of the drill hole, and monitoring the entry of the drill hole into sensitive regions.

According to some embodiments of the present invention there are provided computerized methods and devices, that efficiently, simply, inexpensively and accurately localizes in three dimensions surgical drill holes and implant placement during dental surgery. Using a dental probe with attached navigational element in close proximity to the probe tip, referred to herein as a navigational probe, the position of the probe tip and orientation of a drill hole may be more accurately determined than conventional methods. The methods described herein may overcome electromagnetic interference of a drilling tool and drill bit which are both made of metal, and may be designed to avoid interference with surgical procedures by fitting naturally into surgical environment and complementing a wide range of typical surgical treatments. The navigational probe may be easy to use as the probe does not require expensive equipment to implement, does not interfere with dental implant procedures and dental treatments, fits in naturally with existing equipment used in dental implant procedures and dental treatments, and does not require large increases in treatment times.

According to some embodiments of the present invention there are provided computerized methods and devices for determining a position, depth and/or orientation of drill holes in dental surgery.

A medical three dimensional (3D) image of a treatment area may be acquired and transferred to a navigation device and/or computerized dental navigation system. A navigation device and/or computerized navigation system may include two or more navigational elements and a navigational transceiver, After attaching a navigational element in proximity and rigidly to a treatment area, referred to herein as a navigational reference, a 3D image is registered to a navigation system using a navigational probe. A registration is performed by touching a navigational probe to three or more positions that are both accessible to a navigational probe and visible on a 3D image, referred to herein as registration points. For each registration point, a surgeon may indicate on a 3D image the coordinates of a registration point and that a navigational probe tip is touching that registration point. When three or more registration points have been indicated, a computerized system may automatically register a 3D image coordinate system to that of a navigation system. Optionally, one or more navigation points may be used to register the two images if the navigational probe has degrees of freedom of 4 or more, the anatomical locations is a surface, and a flat part of the probe is resting against the surface so as to measure the orientation of the surface.

Once drilling has started, but prior to drilling completion, a navigational probe may be inserted into a drill hole to determine dental drill hole position, depth and orientation, together referred to as a dental drill hole pose. An extrapolation of a drill hole may be automatically computed and all information on a drill hole indicated to a surgeon on a 3D image, who may correct a drill hole pose as required. This method may enable accurate and efficient real-time tracking of tools, anatomy, and/or drill holes during treatment, thereby improving the accuracy of the tissue modifications and/or the results of the surgery.

Optionally, one or more imaging fiducial markers are attached to an exposed and rigid position relative to a treatment area prior to 3D image acquisition. For example, an imaging fiducial marker is used as a registration point.

Further optionally, one or more exposed naturally occurring anatomical locations and/or surfaces, rigidly connected to a treatment area and visible on a 3D image, are used as registration points, and referred to herein as anatomical landmarks.

Optionally, a navigational element is a passive navigational marker that emits a magnetic field.

Optionally, a navigational element is an active navigational transmitter that emits electromagnetic waves.

Optionally, a navigational element is an active navigational sensor that senses electromagnetic waves and converts these to electronic signals.

Optionally, a navigational element uses electromagnetic waves to determine position and/or orientation.

Optionally, a navigational element uses magnetic fields to determine position and/or orientation.

According to some embodiments of the present invention there are provided computerized methods and devices for a navigational element to be incorporated on a drill hole guide that includes two degrees of rotational freedom, referred to herein as a navigational drill guide. For example, a drill bit is inserted into an annular drill guide, a surgeon orients a drill tool in different directions, and a surgeon receives indication of an orientation of a drill bit and/or extrapolated drill bit hole on a 3D image.

Optionally, a navigational drill guide includes two or more degrees of translational freedom. For example, a drill hole position is chosen by a surgeon adjusting a translational position of a drill hole guide, prior to monitoring of a drill hole orientation and/or extrapolation.

Optionally, a navigational reference is attached to one or more drill hole guides in a superstructure designed to attach to a patient's teeth, bones and/or gums, referred to herein as dental drill jig. For example, a navigational reference is attached to a dental implant drill guide, as described in European patent number EP 1364625 B l, which is incorporated herein by reference in its entirety.

Optionally, a drilling tool and/or drill bit is modified to prevent a drill hole edge from physically exceeding a desired depth and/or orientation. For example a drill guide is of a smaller diameter than the base of a drill bit, so that once a drill bit has reached the desired depth, the drill bit base will abut against the drill guide preventing the drill bit from penetrating further.

Optionally, a dental drill tool and/or drill bit have an attached navigational element, and a drill bit cutting edge is continuously tracked during an operation of a drill tool. For example, a navigational element is placed at the base of a dental drill tool, at the distal end from the cutting edge of a drill bit, and a navigation system monitors a position, depth and/or orientation of a drill hole during drilling. A method and system may indicate when a desired orientation and/or drill depth has been reached.

Optionally, the dental probe is used to acquire a 3D surface of a tooth to be fitted with a crown and/or bridge, and the 3D surface is used to prepare a crown and/or bridge for general dentistry use. For example, the probe is placed along the surface of a tooth being prepared for a crown and/or bridge above and/or below the gums, the navigation system creates a 3D surface map of the prepared tooth, the 3D surface map is sent to a 3D printer or the like, and the crown is prepared using the 3D printer or the like. Optionally, the surface scan is used to produce a crown and/or bridge together with one or more additional 3D imaging scans. Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not necessarily limited in its application to the details of construction and the arrangement of the components and/or methods set forth in the following description, illustrated in the drawings and/or the Examples. The invention is capable of other embodiments or of being practiced or carried out in various ways.

Reference is now made to FIG. 1, which is a flowchart a method for surgical navigation during dental surgery, according to some embodiments of the invention. A navigational reference may be attached as at 102 as close as possible to and/or near a treatment area, such that a navigational reference is attached to a treatment area during surgery. For example, a navigational reference is affixed to a treatment area using screws, dental and/or bone glue, clamping mechanisms, and the like. A method may receive a 3D image data as at 101 used for navigation, which may be acquired prior to a dental surgery treatment.

An imaging reference and/or fiducial marker may be incorporated into a 3D image acquisition to assist in registration of the coordinate systems of a 3D image to one or more navigational elements. This imaging reference and/or fiducial may be located on a part of a patient's anatomy that is stationary and rigidly located relative to a treatment area, such as a lower mandible when a dental surgery procedure is to be performed on a patient's lower mandible, or a patient's upper mandible and/or skull when a dental surgery procedure is to be performed on a patient's upper mandible. For example, when any fiducial markers are located in a 3D image, these fiducial markers are marked using a navigational probe as at 104 until all fiducial markers have been marked. When enough registration points have been located using a navigational probe as at 106, then a computerized method may automatically register as at 107 between a coordinate system of a 3D image and a coordinate system of a navigational element. When there are not enough fiducial markers to register coordinate systems, then a method may automatically request additional reference points for registration by requesting a surgeon to mark an anatomical landmark and/or surface as at 105, and indicate a corresponding landmark and/or surface on a 3D image. When there are sufficient points for registration of coordinate systems, a method may indicate so to a surgeon and may automatically perform registration. Optionally, a surgeon locates additional anatomical landmarks and/or surfaces as above to increase the accuracy of registration, and/or confirm a previously computed registration.

Once the coordinate systems are registered to each other, a surgeon may begin drilling a dental implant attachment hole as at 108 and insert a navigational probe into a drill hole to identify an implant drill hole position, depth and/or orientation, together referred to as pose, as at 110. A surgeon may confirm accuracy of a drill hole relative to a surgical plan as at 111, and proceed with dental surgery procedure. At any time a surgeon may wish to check the progress of a drill hole, and may repeat actions 109 thru 112 as needed. Once a surgeon has confirmed that all drill holes are accurately located using steps 109 thru 111, a surgeon may complete a dental surgery procedure as at 113.

Reference is now also made to FIG. 3, which is a schematic illustration of a navigational drill guide for surgical navigation during dental surgery, according to some embodiments of the invention. One or more navigational elements as at 305 may be located in an annular drill guide of two or more parts, such that one part is fixed to a treatment area as at 301 and another part is moveable as at 302. Orientation of a moveable drill guide is changed to follow the orientation of a drill bit inserted into the guide, and a moveable part contains one or more navigational elements as at 305. For example, a moveable part may rotate around one axis using two pivotal bearings as at 303 to give a drill bit one degree of rotational freedom, and have a second pair of pivotal bearings perpendicular to a first pair as at 304 giving a drill guide a second rotational degree of freedom. During treatment a fixed part of a navigational drill guide may be positioned using a navigational device and may be attached using medical bone screws, dental glue, bone glue, surgical clamps and the like. For example screws are attached through screw holes as at 306. Once a fixed part is attached, a surgeon may place a drill bit attached to a drill tool into a drill bit guide located on a moveable part as at 307, and rotate until a navigational device user interface gives an indication indicates that a correct orientation is achieved. At this point a surgeon may begin drilling, and may stop one or more times to measure a drill hole depth, position and/or orientation. A navigation device may monitor a drill depth and orientation, and may give a surgeon an indication when an orientation is off of a planned course and/or a planned drill depth has been achieved. A navigational element as at 305 may be connected to a navigation device using a cable as at 308. Optionally, one or more navigational elements are attached to a treatment area and contain one or more drill guides and/or jigs to position a drill bit in a correct pose for drilling one or more drill holes, referred to herein as a navigational dental jig. For example, a navigational dental jig has multiple drill hole diameters and attached to a treatment area so that a correct diameter drill hole is oriented in a desired drill hole position and/or orientation. For example, a treatment jig is manufactured to match a patient's anatomy, containing one or more drill guides for drill holes needed for treatment, and a cavity for incorporating one or more navigational elements. Optionally, one or more navigational elements are already embedded in a navigational dental jig during fabrication. Optionally, one or more drill guides of a navigational dental jig have adjustable orientation, with two degrees of rotational freedom, and a navigational element is attached to a fixed part and/or a moveable part.

Reference is now also made to FIG. 4, which is a schematic illustration of a computerized device for surgical navigation during dental surgery, according to some embodiments of the invention. A computerized device consists of a housing as at 401, one or more processing units as at 402, one or more interfaces for navigation elements as at 406 and 408, one or more user interfaces as at 409, and one or more interfaces for one or more navigational transceivers as at 407. One or more processing unit is configured to receive one or more 3D image and one or more sets of pose information from navigational elements and/or navigational transceivers as at 404, perform registration between the coordinate systems of a 3D image and a navigation elements as at 403, compute one or more virtual positions on a 3D image coordinate system as at 405, and indicate these on a 3D image.

Optionally, a 3D image used for navigation is acquired at a dental surgery site, prior to initiation of a dental surgery treatment.

Optionally, a 3D image used for navigation is acquired by any imaging modality capable of producing a 3D representation of a bone structure of a treatment area. For example, a 3D image is acquired by computed tomography (CT), cone beam CT, fan beam CT, multislice CT, magnetic resonance imaging, 3D ultrasound, projection reconstruction radiographs, optical imaging, optical surface scan imaging, and the like.

Optionally, a 3D image is acquired before and/or after a dental treatment according to embodiments of the invention, and the 3D image is used to perform together with the navigation system for the dental treatment and/or to assess the success of the dental treatment.

Optionally, additional navigational elements and/or navigational references are attached to other locations visible in a 3D image to assist in a dental navigation. For example, two navigational references are located laterally from each other, one on a right mandible and another on a left mandible, so that a navigational transceiver detects both navigational references concurrently. When there is electromagnetic interference to one navigational reference, the other navigational reference may continue working so as to avoid disruption of a dental surgery procedure.

Optionally, navigational references are attached to a fixed and rigid position relative and in proximity to the treatment area. For example, the navigational reference is located on a part of a patient's anatomy that is stationary and rigidly located relative to a treatment area, such as a lower mandible when a dental surgery procedure is to be performed on a patient's lower mandible, or a patient's upper mandible and/or skull when a dental surgery procedure is to be performed on a patient's upper mandible.

Reference is now also made to FIG. 2, which is a schematic illustration of a navigational probe for surgical navigation during dental surgery, according to some embodiments of the invention. A navigational probe may be similar to a typical dental probe, in that the probe may have a probe tip as at 201 and a probe handle as at 203. The navigational probe may have a navigational element close to the tip as at 202 and a cable for a navigational element as at 204. For example, close to the tip of the probe refers to a distance between 0.5 and 60 millimeter, such that the navigational element will be as close as possible to the probe tip given the size and shape of the probe tip. The closer the navigational element may be to the probe tip the smaller the errors may be in computing the location and orientation of the drill hole, and the location of the leading edge of the drill hole. Optionally, this cable as at 204 exits the handle of a probe. Optionally, this cable interface is replaced with a wireless interface and has one or more batteries located within a probe. For example, one or more batteries are located in a probe handle.

Optionally, the navigational element is less than 0.5 millimeter from the probe tip to achieve a position accuracy of no more than 0.05 millimeter and an orientation accuracy of no more than 0.5 degrees. Optionally, the navigational element is between 0.5 millimeter and 1 millimeter from the probe tip to achieve a position accuracy of no more than 0.1 millimeter and an orientation accuracy of no more than 1 degree. Optionally, the navigational element is between 1 millimeter and 2 millimeter from the probe tip to achieve a position accuracy of no more than 0.15 millimeter and an orientation accuracy of no more than 1.5 degrees. Optionally, the navigational element is between 2 millimeter and 5 millimeter from the probe tip to achieve a position accuracy of no more than 0.25 millimeter and an orientation accuracy of no more than 2 degrees. Optionally, the navigational element is between 5 millimeter and 15 millimeter from the probe tip to achieve a position accuracy of no more than 0.2 millimeter and an orientation accuracy of no more than 2 degrees. Optionally, the navigational element is between 15 millimeter and 60 millimeter from the probe tip to achieve a position accuracy of no more than 0.25 millimeter and an orientation accuracy of no more than 2 degrees.

Optionally, the probe tip has a smaller diameter than the navigational element, and the region of the probe tip that contains the navigational element is thicker in diameter. For example, a probe tip is 1 millimeter in diameter to fit a 1 millimeter drill hole that is 2 millimeter deep, and 2.5 millimeter from the probe tip the diameter increases to 2 millimeter so that a 1.5 millimeter navigational element may be enclosed in the larger diameter portion of the probe as close as possible to the probe tip, given the drill hole depth being measured. Such a navigational probe may measure the location of the drill hole and/or leading edge of the drill hole with no more than 0.25 millimeter accuracy, and the drill hole orientation with no more than 2 degrees accuracy.

Optionally, a drill bit is removed from a drill hole and a navigational probe inserted into drill hole to check a position, depth and orientation of a drill hole.

Optionally, a navigational probe has a flat head to locate drill hole depth.

Optionally, a navigational probe has a probe tip diameter equal or smaller than a drill hole diameter, such that probe is used to measure an orientation of a drill hole.

Optionally, a navigational probe has a probe diameter that is adjustable to a drill hole diameter.

Optionally, multiple navigational probes are used that have varying probe tip diameters so that one probe tip fits any drill hole diameter.

Optionally, a navigational probe has a pointed head to locate anatomical landmark. Optionally, a dental probe is made of non-conducing one or more materials and has incorporated near the probe tip a computerized navigational element. For example, the probe tip is made of ceramic material with the probe tip shaft and probe handle made out of medical-grade plastic.

A navigational probe may fit into drill holes of various diameters, and have a known distance from navigational probe tip so that when inserted into a dental drill hole a navigational probe may locate the leading edge of the drill hole using a navigational transceiver.

Optionally, a navigational probe is inserted for a first time after a drill hole has reached a hole depth between 1 and 20 millimeters.

Optionally, a drill bit contains one or more navigational elements that are a fixed and known distance to a cutting edge of a drill bit, enabling real time monitoring of a drill hole position, orientation, and/or depth.

Optionally, a drill bit contains a non-rotating navigational element as a drill bit sleeve for monitoring a tool pose on a 3D image coordinate system using a computerized navigation device.

Optionally, a navigational element is attached to a drill tool for monitoring a tool pose on a 3D image coordinate system using a computerized navigation device and/or system.

Optionally, a navigational reference sleeve is used to calibrate a drill bit cutting edge to a navigation system with a navigational element attached to a drill tool, such that a sleeve contains a drill sleeve with a drill stop at known depth and navigational element attached a known distance from a drill stop.

Reference is now also made to FIG. 6, which is a flowchart of a method for creating a surface map used in dental surgery, according to some embodiments of the invention. The surface map may be created after registration of the 3D image and the navigation coordinate systems as at 601.

Optionally, a surface map is created above and/or below the gums. For example, the surface of the tooth and/or mandible is created below the gum line for the preparation of a crown and/or bridge.

Optionally, a surface map is created of one or more teeth and/or bone surfaces. For example, the surface map is a tooth surface above the gums. According to some embodiments of the present invention there are provided computerized methods and devices for using the navigational probes as a computerized device that automatically maps the surface of the patient treatment area and creates a topographic surface map of the implant area and/or surrounding region. Specifically, the navigational probe may be moved over the treatment region and the navigational system may record the x, y, and z coordinates of the probe tip that describe the mucosa and/or the bone and /or the teeth surface locations as at 602. This computerized map may give similar information to the one obtained using a dental imprint. From this computerized map, a cast may be produced from plaster or other materials, to create a negative form and/or mold. Using this form and/or mold, an acrylic implant guide may be produced to guide an implant treatment.

Optionally, an implant guide is produced directly from the computerized map using computer aided manufacturing, rapid prototyping systems and/or devices attached to the navigational system, such as 3D printers.

Optionally, a navigational probe tip is a pointed tip to better track surface indentations. Optionally, a navigational probe tip is a rounded tip to better track surface indentations.

During the process of computerized 3D surface data acquisition, a reconstruction of the scanned surface area may be displayed on a user interface so that the operator may immediately know when the surface scan is complete or when more points covering the surface of interest should be added as at 603. When assistance is required in suggesting new probe positions as at 605, the computerized method may suggest points that may complete the surface as at 606, and the dentist may add these points as at 602. This is an advantage relative to the current method were the 3D cast shape may only be reviewed once the final cast is ready. The operator may at any moment during the mapping check the adaptation of the virtual cast surface to the working area and also may interactively design the drilling channels on the user interface. Once all points have been have been added to define the surface, the surface may be computed using mesh generating techniques as at 604. The one or more drilling channel may be added by the user as at 609 based on the CT scan, the surface map, or may be identified automatically by a computerized application as at 608. Adding manual or automatic drill holes are options that may be enabled or disabled by the operator as at 607 and 610. Optionally, a user freely adapts and changes the model on the control screen or adds more data by scanning more points by moving the navigational probe. Once the 3D model of the working area surface is ready the data may be formatted as at 611 to a 3D printer format and the cast may be printed in the clinic. This process has the advantage over the existing process that the 3D data may be reviewed and changed during the acquisition process by the dentist. The dentist may simulate the virtual cast shape and drilling guides at any location and may adjust the drill hole guides when needed. This process has the further advantage over the existing process that when the surface scan is ready, the 3D surface scan may be printed to form a cast in the office and thereby may avoid the need for extra actions, cost, and time of manufacturing of the 3D scan offsite. This process has the advantage over the existing process that as the scanning data is on a computer readable medium, such as 3D coordinates and graphical data, the data may be sent to review or manufacturing by standard electronic infrastructure means, which is not possible with glue casts.

Optionally, the surface scan data may be transferred to a 3D printer, a computerized lathe, a computer controlled cutting machine, a computerized numerical control (CNC) router, a computerized numerical control milling machine, and the like. For example, a dental implant, a dental crown, a dental bridge and the like is created by transferring the scan data to a CNC router. For example, an implant drill guide is created on a 3D printer by transferring a surface scan adapted to represent a drill guide to the 3D printer. Optionally, the surface scan data may be transferred to a 3D printer and used with a 3D image to assist a dental treatment, such as to produce a crown, bridge, implant, jig, drill guide, and the like for a dental treatment and/or surgery.

According to some embodiments of the present invention there are provided computerized methods and devices for using the navigational probes to scan and/or surface map the bone, teeth and/or mucosa surface area after conditioning, cleaning and/or surface adjustments to the area prior to the implantation and final casting of the Acrylic implant guide. This may correct misalignments that were possibly introduced during the modifications to the treatment region.

Optionally, a navigational element is connected to a navigation device wirelessly.

Optionally, navigational elements are positioned with one or more physical connector links so that they are outside any potential electromagnetic interference from a patient, surgical tools and/or drill bits. Optionally, connector links contain rigid and/or flexible portions, with each portion being monitored by positional sensors to determine a relative orientation and position of the flexible parts so that a navigational element at the distal end remains registered to a 3D image coordinate system. For example, a positional sensor is a piezoelectric sensor that is not affected by electromagnetic interference.

Optionally, any navigational element has between two and six degrees of freedom (DOF) to determine pose.

Optionally, an anatomical landmark and/or surface are imaging fiducial, dental anatomy, prior dental treatment, and/or any other image feature visible on a 3D image of treatment area.

Optionally, an imaging fiducial marker contains one or more navigational elements that are fixed or removable. For example, a navigational element contained in a fiducial marker remains fixed to a treatment area during a 3D image acquisition and during a surgical treatment. In another example, a navigational element contained within a fiducial marker is removed after fixing a navigational reference to a treatment area.

Optionally, an imaging fiducial marker contains one or more navigational elements with a visible orientation on a 3D image so that one or more processing units automatically registers between coordinate systems of a 3D image and a navigational element.

Optionally, one or more imaging fiducial markers are connected to teeth, gums, dental jig, and/or mandibles.

Optionally, one or more 3D images of treatment region are acquired prior to dental surgery and/or during surgery, with or without a jig containing one or more fiducial markers.

Optionally, a virtual drill hole pose is computed by extrapolation of a current drill hole pose in the direction of drilling to confirm a final pose of a drill hole.

Optionally, a virtual drill hole centerline axis is computed by extrapolation of a current drill hole centerline axis in the direction of drilling to confirm a final centerline axis of a drill hole.

Optionally, a distance is measured along a virtual drill hole centerline axis from the leading edge of the drill hole to an anatomical landmark on the three dimensional image. For example, the distance from the current leading edge of the drill hole to a sinus is measured and displayed to the surgeon, so as to prevent the drill bit from penetrating into the sinus cavity. The limitation of the drill hole depth may be done using a special drill bit with a depth limitation, or adding a drill bit guide to the drill bit that will limit the drilling depth.

Optionally, an erroneous drill hole position, depth and/or orientation is detected using a navigational probe and/or a navigational monitoring, and is corrected using a navigation method.

Optionally, regions are marked manually by user and/or automatically by computer on a 3D image and a warning is indicated to surgeon when drill hole edge reaches those regions.

Optionally, regions are marked manually by user and/or automatically by computer on 3D image and a critical error is indicated to surgeon when a drill hole reaches those regions.

Optionally, regions are marked manually by user and/or automatically by computer on 3D image and various levels of warnings are indicated to surgeon when a drill hole reaches those regions.

Optionally, a number of treatments, a time of treatments and/or other treatment metrics are monitored for billing purposes.

Optionally, a current drill hole, a planned drill hole, and/or an extrapolated drill hole are indicated to a surgeon and when drill depth is beyond a planned drill depth an additional indication is given to a surgeon.

Optionally, two or more treatment locations for dental surgery of a patient are performed by repositioning a navigational reference and appropriate re-registration of the navigational sensors and 3D image coordinate systems when needed.

Optionally, two or more treatment locations for dental surgery of a patient are performed without repositioning a navigational reference.

Optionally, a drill bit contains a larger diameter region so that a drill bit is physically prevented from drilling a hole that is deeper than planned.

Optionally, an annular drill guide and navigational element arrangement has an adjustable drill bit stop. For example an annular drill guide and navigational element arrangement has a drill bit stop adjustable by a threaded helical mechanism, such that turning the drill stop adjusts the linear depth of a drill hole. Optionally, an annular drill guide and navigational element arrangement has an adjustable drill bit stop adjusted automatically by a computer to a required drill stop depth.

Optionally, an annular drill guide and navigational element arrangement has an actuator that assists in directing a drill bit orientation by haptic feedback.

Optionally, an annular drill guide and navigational element arrangement has micro-robotic actuator that assists in directing a drill bit orientation by movement of a drill bit guide.

Optionally, an annular drill guide and navigational element arrangement has one or more adjustments for both planar position and/or orientation so that the guide is used for multiple treatments of multiple patients.

Optionally, an annular drill guide and navigational element arrangement has one or more adjustments for both planar position and/or orientation so that the guide is used for multiple treatments of the same patient.

Optionally, a navigational dental jig has one or more adjustments for both planar position and/or orientation so that the same navigational dental jig is used for multiple treatments.

Optionally, a navigational dental jig is fabricated from a dental impression. Optionally, a navigational dental jig is fabricated from a 3D image of a treatment area.

Optionally, a navigational dental jig is fabricated at or near a dental surgery site. Optionally, a navigational dental jig is fabricated at or near a dental surgery room.

Optionally, a navigational dental jig is fabricated prior to or during dental surgery.

Optionally, a navigational dental jig is fabricated using rapid prototyping methods.

Optionally, a navigation system and method enables performing dental surgery with or without a mouth prop, dental mirror, cheek retractor, tongue retractor lip retractor, any other retractor, clamp and/or dental surgery tool.

Optionally, a navigational dental jig and/or navigational drill guide are held by hand during dental surgery. Optionally, a navigational dental jig is fabricated so as to cover the complete upper and/or lower teeth.

Optionally, a navigational dental jig is fabricated so as to cover part of the upper and/or lower teeth.

Optionally, a navigational dental jig is fabricated so as to connect to the teeth, gums, and/or mandibles.

Optionally, a navigational dental jig is tightly coupled with treatment area so that only one position is available for jig placement and registration of dental jig and 3D images is done automatically by navigation device.

Optionally, a computerized navigation device is configured so that one or more processors are located within a navigation subunit module that includes interfaces for the transceiver and one or more navigational elements, and is interfaced with a processing unit using any digital interface type. For example, such interfacing type is one from a list of USB, serial, parallel, GPIB, Ethernet, firewire, thunderbolt and the like.

Optionally, a 3D image used for navigation is received from a compact disk, digital video disk, digital image and communications (DICOM) server, internet, and/or any medium capable of transporting a 3D image from an acquiring scanner to a navigation device.

Optionally, a navigational transceiver uses alternating current electromagnetic waves to assist in localization of a navigational element.

Optionally, an electromagnetic navigational transceiver uses direct current electromagnetic waves to assist in localization of a navigational element.

Optionally, a navigational transceiver is located near a treatment area, next to a cheek or head of a patient in such a way as to not interfere with a surgical treatment and/or procedure. For example, a transceiver is placed on a contralateral side of a patient from a treatment side. Another example is placing a navigational transceiver posterior to a patient, so that treatment is performed without obstruction on anterior, lateral aspects of upper and/or lower mandibles.

Reference is now also made to FIG. 5, which is a schematic illustration of a user interface display for surgical navigation during dental surgery, according to some embodiments of the invention. To enable a surgeon to perform a dental surgery using a navigation method, a user interface display may indicate information to a surgeon and accept commands that are communicated to a processing unit to perform changes of a display and/or initiate processing steps. A user interface may consist of a menu region on a display as at 501, a command icon display as at 502, a 3D image and positions display region as at 503, an information indication region as at 504, a coordinate system display region as at 505, and a quick view selection and/or user defined toolbar region as at 506.

For example, a surgeon initiates a registration action by clicking a registration icon on a command icons region, a displayed information, image and coordinates regions indicate that registration is in progress, a user indicates by clicking on a computerized pointing device a 3D image position of a fiducial or anatomical landmark and/or surface to register, then a surgeon positions the navigational probe at this anatomical location, a surgeon and/or user presses a physical and/or screen button to indicate a registration of this feature to a 3D image, and this process is repeated for each fiducial and/or anatomical feature. Once sufficient features have been individually registered, a computerized device may automatically perform a registration and may indicate a registration of the coordinate systems on a user interface display. When a user wishes to confirm and/or further refine a registration, they may do so using a similar process and adding new registration points. Similarly, once a drill hole has been drilled, a surgeon may perform similar actions to locate a drill hole pose and a user interface will indicate a location of this drill hole on a 3D image and coordinate system regions.

In the above examples and embodiments, the surgeon, user, and/or operator are used interchangeably, to mean any or all actors of the system and/or dental surgery treatment such as a doctor, surgeon, nurse, technician, assistant, secretary, and/or any other person capable and/or qualified to perform the actions described.

A computerized device may include a graphical user interface (GUI) showing positions of one or more navigational elements on a 3D image, and may further show virtual locations on a 3D image, computed by one or more processors. For example, a user interface shows one or more actual and/or desired drill trajectory, actual and/or desired drill depth, number of potential future treatment areas, number of potential future drill locations, and the like. A set of virtual locations may form a line, surface and/or solid structure to be displayed on a GUI. Optionally, a computerized navigation device is used for presurgical planning of dental surgeries. For example, receiving a 3D image, designing implants, and performing automatic computerized biomechanical computations of an implant's attachment strength based on different choices of future drill sizes and/or poses.

Optionally, a navigation device contains a numerical display to display one or more drill hole positions, depths, and/or orientations.

Optionally, a navigation device contains a graphic display to display one or more drill hole positions, depths, orientations and/or extrapolations on a 3D image of a treatment area.

Optionally, a graphical user interface is incorporated into a pair of virtual reality eye glasses so that a surgeon sees an overlay of one or more extrapolated drill hole end point positions, depths, and orientations on a patient treatment area directly, without having to look concurrently at a patient treatment area where surgery is being performed and a graphical user interface.

As used herein the term "about" refers to ± 10 %.

The terms "comprises", "comprising", "includes", "including", "having" and their conjugates mean "including but not limited to". This term encompasses the terms "consisting of" and "consisting essentially of".

The phrase "consisting essentially of" means that the composition or method may include additional ingredients and/or steps, but only if the additional ingredients and/or steps do not materially alter the basic and novel characteristics of the claimed composition or method.

As used herein, the singular form "a", "an" and "the" include plural references unless the context clearly dictates otherwise. For example, the term "a compound" or "at least one compound" may include a plurality of compounds, including mixtures thereof.

The word "exemplary" is used herein to mean "serving as an example, instance or illustration". Any embodiment described as "exemplary" is not necessarily to be construed as preferred or advantageous over other embodiments and/or to exclude the incorporation of features from other embodiments.

The word "optionally" is used herein to mean "is provided in some embodiments and not provided in other embodiments". Any particular embodiment of the invention may include a plurality of "optional" features unless such features conflict. Throughout this application, various embodiments of this invention may be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.

Whenever a numerical range is indicated herein, it is meant to include any cited numeral (fractional or integral) within the indicated range. The phrases "ranging/ranges between" a first indicate number and a second indicate number and "ranging/ranges from" a first indicate number "to" a second indicate number are used herein interchangeably and are meant to include the first and second indicated numbers and all the fractional and integral numerals therebetween.

It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination or as suitable in any other described embodiment of the invention. Certain features described in the context of various embodiments are not to be considered essential features of those embodiments, unless the embodiment is inoperative without those elements.

Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims.

All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention. To the extent that section headings are used, they should not be construed as necessarily limiting.

Claims

WHAT IS CLAIMED IS:

1. A computerized method for dental surgery navigation, comprising:

receiving at least one computerized three dimensional (3D) image of a dental treatment area;

computing at least one position and orientation using at least one computerized first navigational element attached in proximity to said dental treatment area;

registering between an image coordinate system of said at least one 3D image and a navigation coordinate system of said at least one computerized first navigational element;

computing at least one position and orientation from a second computerized navigational element located in close proximity to at least one drill hole into said dental treatment area during pause of a drilling and removal of drill tool, one position and orientation for each one of said at least one drill hole; and

indicating said at least one position and orientation on said 3D image using a computerized user interface, for dental surgery navigation.

2. The method of claim 1, wherein said registering comprises:

computing using a computer a plurality of computerized positions from at least one computerized navigational element located such that said plurality of computerized positions are visible on said at least one 3D image;

locating using a computer said plurality of computerized positions on said at least one 3D image; and

computing a transformation matrix between said image coordinate system and navigation coordinate system using a computer.

3. The method of claim 1, wherein an additional at least one computerized navigational element is attached to a drilling tool, and said additional at least one navigational element monitors a position and orientation of said drilling tool on said at least one 3D image.

4. The method of claim 1 , wherein said at least one computerized first navigational element is combined with a dental implant surgical jig that limits a position and orientation of said at least one drill hole.

5. The method of claim 1, wherein said at least one computerized first navigational element is at least one annular element comprising at least one stationary part attached to a treatment area and at least one tiltable part that incorporates at least one navigational element and enables varying an orientation of said at least one drill hole, thereby enabling said at least one navigational element to detect the orientation of said at least one drill hole.

6. The method of claim 5, wherein said at least one annular element further comprising at least one annular sleeve third part that is capable of changing an annular inner diameter to match an outer diameter of a drill bit.

7. The method of claim 5, wherein said at least one tiltable part of said at least one annular element is capable of adjusting an annular inner diameter to match an outer diameter of a drill bit.

8. The method of claim 5, wherein said at least one tiltable part of said at least one annular element is replaceable thereby enabling an annular inner diameter to change to match an outer diameter of a drill bit by replacing said at least one tiltable part of said at least one annular element without removing said at least one stationary part fixed to a treatment area.

9. The method of claim 1, wherein a further step computes at least one virtual position, and said at least one virtual position is indicated on said at least one 3D image.

10. The method of claim 1, wherein a further step computes at least one distance between a leading edge of said at least one drill hole and an anatomical landmark along a projection of said orientation of said drill hole, said at least one distance used to prevent said leading edge from reaching said anatomical landmark.

11. The method of claim 10, wherein said anatomical landmark is a boundary of a sinus.

12. A computerized method for producing a surface map of a dental treatment area, comprising:

receiving a plurality of computerized positions from at least one computerized navigational element located in close proximity to at least one dental treatment area; computing at least one computerized surface map of said at least one dental treatment area from said plurality of computerized positions; and

outputting said at least one computerized surface map of said at least one dental treatment area.

13. The method of claim 12, wherein said at least one computerized surface map is used to create at least one dental implant cast.

14. The method of claim 12, wherein said at least one computerized surface map is used to create at least one dental implant surgical jig.

15. The method of claim 14, wherein said at least one dental implant surgical jig is created from at least one mold of at least one dental implant surgical jig using said at least one surface map.

16. The method of claim 12, wherein said at least one computerized surface map is created after at least one modification of the treatment area.

17. The method of claim 12, wherein at least one of said plurality of computerized positions is created by automatically guiding operator so as to complete said at least one computerized surface map.

18. The method of claim 13, wherein said at least one dental implant cast is produced with a system attached three dimensional printer.

19. The method of claim 14, wherein said at least one dental implant surgical jig is produced with at least one automatically positioned drill guides.

20. The method of claim 14, wherein said at least one dental implant surgical jig is produced with at least one manually positioned drill guides.

21. An annular device for dental surgery navigation, comprising:

at least one stationary part for fixation to treatment area; and

at least one moveable part with incorporated navigational element and annular guide for directing drill bit during drilling of a hole in dental surgery, where said element determines position and orientation of drill hole.

22. The device of claim 21, wherein said at least one moveable part is adjustable for orientation of annular guide.

23. The device of claim 21, wherein said at least one moveable part is adjustable for position of annular guide.

24. The device of claim 21, wherein said at least one moveable part is adjustable manually.

25. The device of claim 21, wherein said at least one moveable part is adjustable automatically by computer.

26. The device of claim 21, wherein said at least one moveable part provides haptic feedback when orientation is erroneous.

27. A dental probe device for navigation in dental surgery, comprising:

a probe tip;

a navigational element positioned at a known position and orientation relative to tip; and

a handle for positioning probe tip at a patient location.

28. The device of claim 27, wherein said tip is any from the list of a pointed tip, a flat tip, a hemispherical tip, a round tip, a conical tip, a textured tip, a shaped tip, and the like.

29. The device of claim 27, wherein said probe tip has a round diameter less than but close to a diameter of a drilled hole.

30. The device of claim 27, wherein said probe tip has an adjustable diameter between 2 and 10 millimeters.

31. The device of claim 27, wherein said navigational element is located at a distance of between 0.5 and 60 millimeters from said probe tip.

32. The device of claim 27, wherein said probe tip has a round diameter of a first size less than a diameter of said navigational element near said probe tip, and a second size larger than the diameter of said navigational elements near said navigational element, enabling the probe tip to enter a drill hole that is smaller in diameter than the diameter of the navigational element.

33. A computerized device for dental navigation, comprising:

at least one navigational transceiver interface for determining at least one position and orientation of at least one navigational element;

at least one navigational element interface;

at least one processing unit configured for receiving at least one three dimensional image of a treatment area, receiving said at least one position and orientation, registering said at least one image and navigation coordinate systems, computing at least one virtual position on said at least one three dimensional image; and at least one user interface configured for displaying said at least one three dimensional image, said at least one position and orientation, and said at least one virtual position.

34. The method of each of claim 1, wherein said navigational element is a passive navigational marker for determining position of said navigational element.

35. The method of each of claim 1, wherein said navigational element is an active navigational transmitter for determining position of said navigational element.

36. The method of each of claim 1, wherein said navigational element is an active navigational sensor for determining position of said navigational element.

37. A medical method for drilling a dental surgery hole, comprising the actions of: affixing a navigational element in close proximity to a treatment area;

commanding a navigational device to load a 3D image of a treatment area;

commanding a navigational device to register the coordinate systems of the navigational element and the 3D image using a plurality of registration points;

drilling at least one dental surgery hole, such that said dental surgery hole is incomplete during a pause in the surgery;

locating a second navigational element into said at least one dental surgery hole; confirming correct position and orientation of said at least one dental surgery hole; and

drilling of said dental surgery hole to completion.