WO2019171381A1 - A system and kit for guiding an oral surgery and method thereof - Google Patents

A system and kit for guiding an oral surgery and method thereof Download PDF

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Publication number
WO2019171381A1
WO2019171381A1 PCT/IL2019/050252 IL2019050252W WO2019171381A1 WO 2019171381 A1 WO2019171381 A1 WO 2019171381A1 IL 2019050252 W IL2019050252 W IL 2019050252W WO 2019171381 A1 WO2019171381 A1 WO 2019171381A1
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WO
WIPO (PCT)
Prior art keywords
surgical
image
drilling
oral anatomy
real
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Application number
PCT/IL2019/050252
Other languages
French (fr)
Inventor
Michel Dadi
Ran Carmeli
Original Assignee
Michel Dadi
Ran Carmeli
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Michel Dadi, Ran Carmeli filed Critical Michel Dadi
Publication of WO2019171381A1 publication Critical patent/WO2019171381A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00163—Optical arrangements
    • A61B1/00193—Optical arrangements adapted for stereoscopic vision
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/24—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the mouth, i.e. stomatoscopes, e.g. with tongue depressors; Instruments for opening or keeping open the mouth
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/12—Arrangements for detecting or locating foreign bodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/46—Arrangements for interfacing with the operator or the patient
    • A61B6/461—Displaying means of special interest
    • A61B6/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/51—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for dentistry
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5235—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/08—Machine parts specially adapted for dentistry
    • A61C1/082—Positioning or guiding, e.g. of drills
    • A61C1/084—Positioning or guiding, e.g. of drills of implanting tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00004—Operational features of endoscopes characterised by electronic signal processing
    • A61B1/00009—Operational features of endoscopes characterised by electronic signal processing of image signals during a use of endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/24—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the mouth, i.e. stomatoscopes, e.g. with tongue depressors; Instruments for opening or keeping open the mouth
    • A61B1/247—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the mouth, i.e. stomatoscopes, e.g. with tongue depressors; Instruments for opening or keeping open the mouth with means for viewing areas outside the direct line of sight, e.g. dentists' mirrors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • A61B2090/365—Correlation of different images or relation of image positions in respect to the body augmented reality, i.e. correlating a live optical image with another image
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/371—Surgical systems with images on a monitor during operation with simultaneous use of two cameras
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • A61B6/032—Transmission computed tomography [CT]

Definitions

  • the present invention relates to the field of dental implants, and particularly to an accessory for use in aiding a dental surgeon to determine the optimum position and angle for dental implants.
  • the present invention also relates to a kit including a plurality of such accessories, and a method for using such accessories in installing dental implants.
  • a determination of the optimum position and angle for the dental implant is critical to the success of the dental implant. If the implant is not installed at the optimum position and angle according to the particular structure of the bone to receive the implant, this can result in failure to provide the required support for the implant which may result in failure of the dental prosthesis supported by the implant. This can also result in a visually perceptible defect in the appearance of the dental prosthesis. Many techniques are therefore used by oral surgeons, including radiographic examination, diagnostic casts, etc., in determining the optimum position and angle for the dental implant.
  • the use of a guidance system is recommended; the principle is to transfer virtual planning to the surgical site.
  • the planning is normally done by virtually positioning the implant/s on a 3D computerized image including the bone, the gum and the teeth.
  • the surgical template including unequivocal path/s for drilling in a specific position, direction and length is manufactured.
  • the NavidentTM tool remains too complicated to use and the lips, teeth and tongue may obstruct the field of view of the video cameras and may interfere severely during the surgery which may occur in the mininavidentTM.
  • a dental implant surgery guidance system for a drilling system comprising:
  • a surgical guiding device comprising:
  • a prefabricated surgical template to be fixedly attached to a patient’s oral anatomy adjacent to a surgical site and comprising at least one video camera mounted on said surgical template, said camera facing the surgical site for obtaining a real-time video thereof together with at least a part of the drilling system and the surgical site surroundings;
  • an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto said real-time video image of the surgical site, to obtain a combined image
  • said combined image provides an image of the drilling system in relation to the oral anatomy for determining the optimum position, angle and drilling depth of the drilling tool for performing the dental implant surgery.
  • a dental implant surgery guidance system for aiding a surgeon in determining the optimum position, angle and drilling depth of a drilling tool for performing a dental implant surgery.
  • a surgical template which is prefabricated to be fixedly attached to a patient’s oral anatomy adjacent to the surgical implant site.
  • the template is attached to the oral anatomy by means of a dental impression material or any malleable substance engaging the oral anatomy in a fixed fashion.
  • the video images obtained are superimposed on a 3D global image which includes an existing 3D CT scan of the patient’s teeth and bone together with a 3D image of the surgical template inside the patient’s mouth, and possibly the gums as well, obtained by an intraoral scanner.
  • the global image together with the video image constitute a combined image.
  • the surgeon is able to see in real time the drilling system’s position, or a computerized mark, representing the drilling tool, in relation to the surgical site including the bone, during and after the drilling action, and therefore can determine the optimum position and angle of the drilling system working into the bone anatomy, thereby achieving successful dental implant surgery.
  • the camera/s of the surgical template are situated for providing the benefit of not having the tongue or lips block the view of the oral anatomy. Additionally, any movement of the patient’s head will not alter the image obtained.
  • a surgical template having reference points formed thereon in such a location that they are within the visualized frame of the cameras.
  • the reference points may be in any number, shape or size.
  • a surgical template having one camera and a mirror for providing a second view of the drilling system in relation to the references points.
  • the camera provides two-dimensional images, and the imaging tool uses the two views to generate a 3D image.
  • a surgical template having one video camera and a specific predefined aperture and reference points formed thereon.
  • the drilling system drills by passing through the aperture within a median plane-oriented transverse to the gums within the boundaries of the aperture.
  • a surgical template having a sleeve placed into an aperture. While determining the exact implant site, by superimposing the 3D global computerized image to the live video obtained by the camera, the axis of the sleeve can move in the aperture in the median plane and can move in different angles. Once the position and direction of the sleeve is determined, it is fixedly attached to the aperture by a malleable substance which is secondarily hardened by light curing, for example. Such malleable substances may be added by the surgeon or may be included in the aperture surrounding the sleeve. After the sleeve is fixedly attached, the drill bit of the drilling system is inserted through the sleeve and drills a hole into the bone.
  • kits having a number of said surgical templates of different sizes.
  • the kit may include also an accessory in the form of at least one video camera
  • a method for guiding a dental implant surgery comprising:
  • a surgical guiding system for a drilling system comprising:
  • a surgical template to be fixedly attached to a patient ’s oral anatomy adjacent to a surgical site
  • At least one video camera mounted on said surgical template, said camera facing said surgical site for obtaining a real-time video thereof together with at least part of the drilling system and the surgical site surroundings;
  • an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto said real-time video of the surgical site, to obtain a combined image; attaching said surgical template to patient’s oral anatomy;
  • the method includes obtaining a 3D computerized image of said surgical template fixedly attached to the oral anatomy by using an intraoral scanner.
  • inventive accessory, kit and method may be used to present to the oral surgeon a simplified view of the permitted limits for the dental implant without even opening a flap.
  • Fig. 1 shows a perspective view of the surgical guiding device of the present invention having two video cameras capable of filming and transmitting the position and direction of the drilling tool in real time;
  • Fig. 2 shows a perspective view of the surgical guiding device of Fig. 1 having reference points on the surgical template
  • Figs. 3A-B show the surgical guiding device of Fig. 2 including a mirror for providing a second view;
  • Fig. 4 shows a perspective view of the surgical guiding device of Fig. 2 showing a predefined path aperture for driving a drilling axis in an unequivocal plane;
  • Fig. 5 shows a perspective view of Fig. 4 showing a sleeve placed in the specific and pre-defmed aperture.
  • Surgical template 10 which is part of a surgery guiding system 100.
  • Surgical template 10 has arms l la,b fixedly attached along both sides of the patient’s gums 22, over the floor 24 of the mouth, by having neck 9 being mounted on teeth 16 adjacent to surgical implant site 18.
  • Surgical template 10 includes a malleable substance 19 which enables it to be fixedly attached to the oral anatomy, which is defined herein as a tooth or several teeth, or gums, or all of these together.
  • Malleable substance 19 may be for example, a dental impression material engaging the subjacent oral anatomy and being molded to it.
  • Neck 9 of surgical template 10 has two video cameras 12, 14 mounted on it (for obtaining a 3D image), directed towards surgical implant site 18.
  • a contra angle (not shown) which is part of a drilling system controlling drill bit 20, is positioned above surgical site 18, for the purpose of drilling a hole into the bone.
  • Video cameras 12, 14 obtain and transmit 3D video images of surgical site 18, at least a part of the drilling system, which may be drill bit 20, and tooth 26 adjacent to surgical site 18 and opposite to cameras 12, 14.
  • the cameras 12, 14 use the teeth adjacent to surgical site 18 as reference points.
  • an imaging software tool superimposes the live 3D images of the teeth contour and of the drilling system, obtained by cameras 12, 14, onto a 3D global computerized image of the oral anatomy of the patient, thereby obtaining a combined image.
  • the surgical template 10 and cameras 12, 14 are situated so as to provide the benefit of not having the tongue or lips block the view of the teeth and surgical site 18. Additionally, any movement of the patient’s head will not alter the image obtained.
  • Surgical template 10 may be disposable since cameras 12, 14 are inexpensive.
  • the surgeon is able to view in real-time the drilling system’s position in relation to surgical site 18 including the bone, and therefore can determine the optimum position and angle of the drilling system working into the bone anatomy, thereby achieving successful tooth implantation.
  • FIG. 2 there is shown surgical template 10 fixedly attached to patient’s gums 22, having a shoulder 17, extended from each arm l la and l lb, hanging over gums 22 near implant site 18 having reference points 28 formed thereon in such a location that they are in the visualized frame of cameras 12, 14.
  • Reference points 28 may be in any shape or size.
  • a 3D computerized image of the surgical template fixedly attached to the oral anatomy is obtained.
  • Cameras 12, 14 visualize and transmit the position and direction of the drilling tool, which is a part of a drilling system including a contra angle and drill bit 20, related to reference points 28 in real time.
  • the real time videos are computerized and matched to the 3D global image comprising the CT scan of the mouth and the 3D computerized image coming from the intraoral scanner.
  • the surgeon is able to see, on a live computerized video, the drill bit 20 of the drilling system working into the bone anatomy.
  • FIG. 3 A there is shown a surgical template 10 having reference points 28 and including only one video camera 12 and a mirror 30 for providing a second view of the drilling system in relation to references points 28.
  • Fig. 3B there is shown surgical template 10 fixedly attached to the patient’s oral anatomy.
  • the live images provided by single camera 12 are two-dimensional and show the position and angle of at least a part of the drilling system, in relation to reference points 28.
  • Mirror 30 is situated in a position that allows a second view of the drilling system.
  • the imaging tool processes the video images resulting in 3D images.
  • the 3D global computerized image allow for the planning of the position of at least one implant.
  • Camera 12 may film and transmit two different views of the position and direction of at least a part of the drilling system related to reference points 28 in real time.
  • the real time videos are computerized and superimposed onto the existing 3D CT scan and 3D intraoral scan, thereby allowing the surgeon to view on a live, computerized video the drilling system working into the bone anatomy in surgical site 18.
  • surgical template 10 at least partially pre- defined to be fixedly attached to the patient’s oral anatomy, having one video camera 12 and a specific predefined aperture 32 for driving the axis of the drilling in the median plane of said aperture and reference points 28 formed thereon.
  • the drill bit 20 drills by passing through aperture 32, within a median plane- oriented transverse to gums 22 within the boundaries of aperture 32.
  • a 3D image of the surgical template 10 fixedly attached to the patient’s mouth is computerized, and by superimposing the teeth contour of the 3D image with the existing 3D computerized image comprising the bone and teeth anatomy a global 3D computerized image is obtained.
  • the planning of the position of an implant is done in a way that the axis of the planned implant is included into the median plane 36 of specific aperture 32 of surgical template 10.
  • Camera 12 may obtain and transmit the position and direction of the drilling tool in real time, to be matched to the CT scan slice image corresponding approximately to the median plane 36 of aperture 32 of surgical template 10.
  • the surgeon can view, on a live computerized video, drilling system working into the bone anatomy.
  • the inventive surgical template may be supplied to the oral surgeon in the form of a kit having a number of such templates of different sizes.
  • FIG. 5 there is shown surgical template 10 having aperture 32 with reference points 28 formed thereon and single video camera 12.
  • a sleeve 34 is placed into aperture 32. While determining the exact implant site, by superimposing the 3D global computerized image to the live video obtained by camera 12, the axis of sleeve 34 can move in aperture 32 in the median plane 36 and can move in different angles.
  • a malleable substance which is secondarily hardened by light curing, for example. Such malleable substances may be added by the surgeon or may be included in aperture 32 surrounding sleeve 36.
  • drill bit 20 is inserted through sleeve 36 and drills a hole into the bone.
  • reference points 28 may be formed in any appropriate and suitable shape, size and number.

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Abstract

A kit, a method and a dental implant surgery guidance system for a drilling system, including a surgical guiding device having a prefabricated surgical template to be fixedly attached to a patient's oral anatomy adjacent to a surgical site, and at least one video camera mounted on the surgical template facing the surgical site and its surroundings for obtaining a real-time video image thereof together with at least a part of the drilling system, and an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto the real-time video image, to obtain a combined image, where the combined image provides an image of the drilling system in relation to the oral anatomy for determining the optimum position, angle and drilling depth of the drilling tool for performing the dental implant surgery.

Description

A SYSTEM AND KIT FOR GUIDING AN ORAL SURGERY AND METHOD THEREOF
FIELD OF THE INVENTION
The present invention relates to the field of dental implants, and particularly to an accessory for use in aiding a dental surgeon to determine the optimum position and angle for dental implants. The present invention also relates to a kit including a plurality of such accessories, and a method for using such accessories in installing dental implants.
BACKGROUND OF THE INVENTION
When an oral surgeon installs a dental implant for a dental prosthesis, a determination of the optimum position and angle for the dental implant is critical to the success of the dental implant. If the implant is not installed at the optimum position and angle according to the particular structure of the bone to receive the implant, this can result in failure to provide the required support for the implant which may result in failure of the dental prosthesis supported by the implant. This can also result in a visually perceptible defect in the appearance of the dental prosthesis. Many techniques are therefore used by oral surgeons, including radiographic examination, diagnostic casts, etc., in determining the optimum position and angle for the dental implant.
To obtain a more predictable and a safe result of teeth implants, the use of a guidance system is recommended; the principle is to transfer virtual planning to the surgical site. The planning is normally done by virtually positioning the implant/s on a 3D computerized image including the bone, the gum and the teeth.
There are two known approaches for guided implant surgery:
- a static method using a surgical guide template positioned fixedly over the surgical site.
- a dynamic dental implant navigation using an electro optical system such as Navident™ and mininavident™
Once the planning and design of the surgical template are done, by means of a 3D printer, the surgical template including unequivocal path/s for drilling in a specific position, direction and length is manufactured.
There are some disadvantages associated with guided implant surgery. For example, this approach requires longer initial treatment times and increased initial setup costs due to template fabrication. Also, because of the bulk of the template and instrumentation, posterior implant placement is often difficult and additional efforts must be made to ensure proper cooling during osteotomy preparation. Despite the disadvantages associated with guided implant surgery, historically, the advantages can often outweigh the costs.
If the navigation system has the general advantage of flexibility, the Navident™ tool remains too complicated to use and the lips, teeth and tongue may obstruct the field of view of the video cameras and may interfere severely during the surgery which may occur in the mininavident™.
There is a need for a device and method for simplifying the process of determining the optimum position and angle for the dental implant, and more importantly, for accurately doing so.
SUMMARY OF THE INVENTION
Accordingly, it is a principal object of the present invention to overcome the limitations of prior art guided dental implant devices and methods.
In accordance with a preferred embodiment of the present invention, there is provided a dental implant surgery guidance system for a drilling system, said guidance system comprising:
a surgical guiding device, said device comprising:
a prefabricated surgical template to be fixedly attached to a patient’s oral anatomy adjacent to a surgical site and comprising at least one video camera mounted on said surgical template, said camera facing the surgical site for obtaining a real-time video thereof together with at least a part of the drilling system and the surgical site surroundings;
and
an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto said real-time video image of the surgical site, to obtain a combined image,
wherein said combined image provides an image of the drilling system in relation to the oral anatomy for determining the optimum position, angle and drilling depth of the drilling tool for performing the dental implant surgery.
In accordance with the preferred embodiments of the present invention there is provided a dental implant surgery guidance system for aiding a surgeon in determining the optimum position, angle and drilling depth of a drilling tool for performing a dental implant surgery. In accordance with another preferred embodiment of the present invention, there is provided a surgical template which is prefabricated to be fixedly attached to a patient’s oral anatomy adjacent to the surgical implant site. The template is attached to the oral anatomy by means of a dental impression material or any malleable substance engaging the oral anatomy in a fixed fashion.
According to an additional preferred embodiment of the present invention, there are two cameras mounted on the neck of the surgical template in order to obtain 3D video images of the surgical site and its surroundings, including at least a part of the drilling system. The video images obtained are superimposed on a 3D global image which includes an existing 3D CT scan of the patient’s teeth and bone together with a 3D image of the surgical template inside the patient’s mouth, and possibly the gums as well, obtained by an intraoral scanner. The global image together with the video image constitute a combined image.
By using the above, the surgeon is able to see in real time the drilling system’s position, or a computerized mark, representing the drilling tool, in relation to the surgical site including the bone, during and after the drilling action, and therefore can determine the optimum position and angle of the drilling system working into the bone anatomy, thereby achieving successful dental implant surgery.
The camera/s of the surgical template are situated for providing the benefit of not having the tongue or lips block the view of the oral anatomy. Additionally, any movement of the patient’s head will not alter the image obtained.
According to another preferred embodiment of the present invention, there is provided a surgical template having reference points formed thereon in such a location that they are within the visualized frame of the cameras. The reference points may be in any number, shape or size.
According to yet another preferred embodiment of the present invention, there is provided a surgical template having one camera and a mirror for providing a second view of the drilling system in relation to the references points. The camera provides two-dimensional images, and the imaging tool uses the two views to generate a 3D image.
According to another preferred embodiment of the present invention, there is provided a surgical template, having one video camera and a specific predefined aperture and reference points formed thereon. The drilling system drills by passing through the aperture within a median plane-oriented transverse to the gums within the boundaries of the aperture.
According to yet another preferred embodiment of the present invention, there is provided a surgical template having a sleeve placed into an aperture. While determining the exact implant site, by superimposing the 3D global computerized image to the live video obtained by the camera, the axis of the sleeve can move in the aperture in the median plane and can move in different angles. Once the position and direction of the sleeve is determined, it is fixedly attached to the aperture by a malleable substance which is secondarily hardened by light curing, for example. Such malleable substances may be added by the surgeon or may be included in the aperture surrounding the sleeve. After the sleeve is fixedly attached, the drill bit of the drilling system is inserted through the sleeve and drills a hole into the bone.
According to an additional preferred embodiment of the present invention, there is provided a kit having a number of said surgical templates of different sizes. The kit may include also an accessory in the form of at least one video camera
According to yet another preferred embodiment of the present invention, there is provided a method for guiding a dental implant surgery, said method comprising:
providing a surgical guiding system for a drilling system, said guiding system comprising:
a surgical template to be fixedly attached to a patient’s oral anatomy adjacent to a surgical site;
at least one video camera mounted on said surgical template, said camera facing said surgical site for obtaining a real-time video thereof together with at least part of the drilling system and the surgical site surroundings;
an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto said real-time video of the surgical site, to obtain a combined image; attaching said surgical template to patient’s oral anatomy;
obtaining real-time images from said at least one video camera, displaying at least a part of the drilling system (drill and contra angle) in relation to the oral anatomy;
superimposing said real-time images to said three-dimensional global image of the oral anatomy via said imaging tool; and
determining the optimum position, angle and drilling depth of the drilling tool for performing the dental implant surgery while viewing said combined image.
In another embodiment, the method includes obtaining a 3D computerized image of said surgical template fixedly attached to the oral anatomy by using an intraoral scanner. As will be described more particularly below, the inventive accessory, kit and method may be used to present to the oral surgeon a simplified view of the permitted limits for the dental implant without even opening a flap.
Further features and advantages of the invention will be apparent from the description below.
BRIEF DESCRIPTION OF THE DRAWINGS
For a better understanding of the invention with regard to the embodiments thereof, reference is made to the accompanying drawings, in which like numerals designate corresponding sections or elements throughout, and in which:
Fig. 1 shows a perspective view of the surgical guiding device of the present invention having two video cameras capable of filming and transmitting the position and direction of the drilling tool in real time;
Fig. 2 shows a perspective view of the surgical guiding device of Fig. 1 having reference points on the surgical template;
Figs. 3A-B show the surgical guiding device of Fig. 2 including a mirror for providing a second view;
Fig. 4 shows a perspective view of the surgical guiding device of Fig. 2 showing a predefined path aperture for driving a drilling axis in an unequivocal plane; and
Fig. 5 shows a perspective view of Fig. 4 showing a sleeve placed in the specific and pre-defmed aperture.
It is to be understood that the foregoing drawings, and the description below, are provided primarily for purposes of facilitating an understanding of the conceptual aspects of the invention and various possible embodiments thereof, including what is presently considered to be a preferred embodiment. In the interest of clarity and brevity, no attempt is made to provide more details than necessary to enable one skilled in the art, using routine skill and design, to understand and practice the described invention. It is to be further understood that the embodiments described are for purposes of example only, and that the invention is capable of being embodied in other forms and applications than described herein. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
It is a principal object of the present invention to provide an oral surgery guiding system for determining the optimum position, angle and drilling depth for dental implanting, enabling simple and successful implanting.
Referring now to Fig. 1, there is shown a surgical template 10 which is part of a surgery guiding system 100. Surgical template 10 has arms l la,b fixedly attached along both sides of the patient’s gums 22, over the floor 24 of the mouth, by having neck 9 being mounted on teeth 16 adjacent to surgical implant site 18. Surgical template 10 includes a malleable substance 19 which enables it to be fixedly attached to the oral anatomy, which is defined herein as a tooth or several teeth, or gums, or all of these together. Malleable substance 19 may be for example, a dental impression material engaging the subjacent oral anatomy and being molded to it. Neck 9 of surgical template 10 has two video cameras 12, 14 mounted on it (for obtaining a 3D image), directed towards surgical implant site 18. A contra angle (not shown) which is part of a drilling system controlling drill bit 20, is positioned above surgical site 18, for the purpose of drilling a hole into the bone.
Video cameras 12, 14 obtain and transmit 3D video images of surgical site 18, at least a part of the drilling system, which may be drill bit 20, and tooth 26 adjacent to surgical site 18 and opposite to cameras 12, 14. The cameras 12, 14 use the teeth adjacent to surgical site 18 as reference points. During surgery, an imaging software tool superimposes the live 3D images of the teeth contour and of the drilling system, obtained by cameras 12, 14, onto a 3D global computerized image of the oral anatomy of the patient, thereby obtaining a combined image.
The surgical template 10 and cameras 12, 14 are situated so as to provide the benefit of not having the tongue or lips block the view of the teeth and surgical site 18. Additionally, any movement of the patient’s head will not alter the image obtained.
Surgical template 10 may be disposable since cameras 12, 14 are inexpensive.
By using the above, the surgeon is able to view in real-time the drilling system’s position in relation to surgical site 18 including the bone, and therefore can determine the optimum position and angle of the drilling system working into the bone anatomy, thereby achieving successful tooth implantation.
Referring now to Fig. 2, there is shown surgical template 10 fixedly attached to patient’s gums 22, having a shoulder 17, extended from each arm l la and l lb, hanging over gums 22 near implant site 18 having reference points 28 formed thereon in such a location that they are in the visualized frame of cameras 12, 14. Reference points 28 may be in any shape or size.
Using an intraoral scanner a 3D computerized image of the surgical template fixedly attached to the oral anatomy is obtained. Cameras 12, 14 visualize and transmit the position and direction of the drilling tool, which is a part of a drilling system including a contra angle and drill bit 20, related to reference points 28 in real time. The real time videos are computerized and matched to the 3D global image comprising the CT scan of the mouth and the 3D computerized image coming from the intraoral scanner. The surgeon is able to see, on a live computerized video, the drill bit 20 of the drilling system working into the bone anatomy. By thereby obtaining a computerized 3D combined image, the position planning of at least one tooth implant may be done.
Referring now to Fig. 3 A there is shown a surgical template 10 having reference points 28 and including only one video camera 12 and a mirror 30 for providing a second view of the drilling system in relation to references points 28.
Referring now to Fig. 3B there is shown surgical template 10 fixedly attached to the patient’s oral anatomy. The live images provided by single camera 12 are two-dimensional and show the position and angle of at least a part of the drilling system, in relation to reference points 28. Mirror 30 is situated in a position that allows a second view of the drilling system.
The imaging tool processes the video images resulting in 3D images.
The 3D global computerized image allow for the planning of the position of at least one implant. Camera 12 may film and transmit two different views of the position and direction of at least a part of the drilling system related to reference points 28 in real time. The real time videos are computerized and superimposed onto the existing 3D CT scan and 3D intraoral scan, thereby allowing the surgeon to view on a live, computerized video the drilling system working into the bone anatomy in surgical site 18.
Referring now to Fig. 4, there is shown surgical template 10 at least partially pre- defined to be fixedly attached to the patient’s oral anatomy, having one video camera 12 and a specific predefined aperture 32 for driving the axis of the drilling in the median plane of said aperture and reference points 28 formed thereon.
The drill bit 20 drills by passing through aperture 32, within a median plane- oriented transverse to gums 22 within the boundaries of aperture 32. By means of an intraoral scanner, a 3D image of the surgical template 10 fixedly attached to the patient’s mouth is computerized, and by superimposing the teeth contour of the 3D image with the existing 3D computerized image comprising the bone and teeth anatomy a global 3D computerized image is obtained. The planning of the position of an implant is done in a way that the axis of the planned implant is included into the median plane 36 of specific aperture 32 of surgical template 10. Camera 12 may obtain and transmit the position and direction of the drilling tool in real time, to be matched to the CT scan slice image corresponding approximately to the median plane 36 of aperture 32 of surgical template 10. Using the method described herein, the surgeon can view, on a live computerized video, drilling system working into the bone anatomy.
The inventive surgical template may be supplied to the oral surgeon in the form of a kit having a number of such templates of different sizes.
Referring now to Fig. 5, there is shown surgical template 10 having aperture 32 with reference points 28 formed thereon and single video camera 12. A sleeve 34 is placed into aperture 32. While determining the exact implant site, by superimposing the 3D global computerized image to the live video obtained by camera 12, the axis of sleeve 34 can move in aperture 32 in the median plane 36 and can move in different angles. Once the position and direction of sleeve 34 is determined, it is fixedly attached to aperture 32 by a malleable substance which is secondarily hardened by light curing, for example. Such malleable substances may be added by the surgeon or may be included in aperture 32 surrounding sleeve 36. After sleeve 36 is fixedly attached, drill bit 20 is inserted through sleeve 36 and drills a hole into the bone.
It will be understood that reference points 28 may be formed in any appropriate and suitable shape, size and number.
Although particular embodiments of the invention have been described and illustrated herein, it is recognized that modifications and variations may readily occur to those skilled in the art and consequently, it is intended that the claims be interpreted to cover such modifications and equivalents.

Claims

CLAIMS:
1. A dental implant surgery guidance system for a drilling system, said guidance system comprising:
a surgical guiding device, said device comprising:
a prefabricated surgical template to be fixedly attached to a patient’s oral anatomy adjacent to a surgical site; and
at least one video camera mounted on said surgical template, said camera facing the surgical site and its surroundings for obtaining a real-time video image thereof together with at least a part of the drilling system;
and
an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto said real-time video image, to obtain a combined image,
wherein said combined image provides an image of the drilling system in relation to the oral anatomy for determining the optimum position, angle and drilling depth of the drilling tool for performing the dental implant surgery.
2. The system of claim 1, wherein said three-dimensional global image comprises a three- dimensional CT scan of the teeth and bone superimposed on a three-dimensional image of at least said surgical template positioned fixedly on the oral anatomy obtained by an intraoral scanner.
3. The system of claim 1, wherein said surgical template further comprises reference points formed thereon for use by said imaging tool for directing the drilling system.
4. The system of claim 1, wherein said imaging tool uses the patient’s teeth as reference points for directing the drilling system.
5. The system of claim 1, wherein said surgical template comprises two video cameras mounted thereon, providing said real-time video image as a three-dimensional video image.
6. The system of claim 1, wherein said surgical template further comprises one video camera and a mirror for providing a second view of the drilling tool to said imaging tool.
7. The system of claim 1, wherein said surgical template defines a predetermined aperture situated above said surgical site, such that motion of the drilling system occurs within a median plane oriented transverse to the gums within the boundaries of said aperture.
8. The system of claim 7, wherein said aperture comprises at least two reference points formed thereon for identifying the position of said aperture relative to the bone, teeth and optionally gums, by said imaging tool matching said three-dimensional global image of the oral anatomy to said real-time image obtained from said at least one video camera.
9. The system of claim 7, wherein said surgical template comprises a sleeve placed within said aperture, wherein the axis of said sleeve can move within said aperture in said median plane and can move in different angles and wherein when said sleeve position is determined, it is fixedly attached to said aperture by using a dental impression material.
10. The system of claim 1 for use with at least one tooth implant.
11. The system of claim 1, wherein said surgical template is disposable.
12. The system of claim 1 provided as a kit including a plurality of said surgical templates.
13. A method for guiding a dental implant surgery, said method comprising:
providing a surgical guiding system for a drilling system, said guiding system comprising:
a prefabricated surgical template to be fixedly attached to a patient’s oral anatomy adjacent to a surgical site and comprising at least one video camera mounted on said surgical template, said camera facing said surgical site for obtaining a real- time video thereof together with at least part of the drilling system and the surgical site surroundings; and
an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto said real-time video of the surgical site, to obtain a combined image;
and
attaching said surgical template to patient’s oral anatomy; obtaining real-time images from said at least one video camera, displaying at least a part of the drilling system in relation to the oral anatomy;
superimposing said real-time images to said three-dimensional global image of the oral anatomy via said imaging tool; and
determining the optimum position, angle and drilling depth of the drilling tool for performing the dental implant surgery while viewing said combined image.
14. A method for guiding a dental implant surgery, said method comprising:
providing a surgical guiding system for a drilling system, said guiding system comprising:
a prefabricated surgical template to be fixedly attached to a patient’s oral anatomy adjacent to a surgical site and comprising at least one video camera mounted on said surgical template, said camera facing said surgical site for obtaining a real- time video thereof together with at least part of the drilling system and the surgical site surroundings; and
an imaging tool capable of superimposing a three-dimensional global image of the oral anatomy onto said real-time video of the surgical site, to obtain a combined image;
and
attaching said surgical template to patient’s oral anatomy;
obtaining a 3D computerized image of said surgical template fixedly attached to the oral anatomy by using an intraoral scanner;
obtaining real-time images from said at least one video camera, displaying at least a part of the drilling system in relation to the oral anatomy;
superimposing said real-time images to said three-dimensional global image of the oral anatomy via said imaging tool; and
determining the optimum position, angle and drilling depth of the drilling tool for performing the dental implant surgery while viewing said combined image.
PCT/IL2019/050252 2018-03-07 2019-03-07 A system and kit for guiding an oral surgery and method thereof WO2019171381A1 (en)

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