WO2023111609A1

WO2023111609A1 - Bridge restoration as dental implant and cutting guide

Info

Publication number: WO2023111609A1
Application number: PCT/IB2021/000888
Authority: WO
Inventors: Manuel GALEANO; Mohamed FARES
Original assignee: Viax Technologies Europe Sl
Priority date: 2021-12-13
Filing date: 2021-12-13
Publication date: 2023-06-22

Abstract

A dental drill guide (10) includes a guide base (11) and a first flange (12, 13). The guide base is in the form of a dental restoration portion and includes a base hole (15) extending through a thickness of the guide base. The first flange extends from the guide base and is configured for insertion into a first tooth. A mouth of a patient is prepared for a tooth restoration. An implant cavity is drilled through the predefined base hole of the dental drill guide and into a jawbone. The base hole of the dental drill guide is filled with a plastic resin such that the dental drill guide is sufficient to operate as a temporary dental restoration.

Description

BRIDGE RESTORATION AS DENTAL IMPLANT AND CUTTING GUIDE

FIELD

[0001] The present invention relates to devices, systems, and processes for preparing for a tooth restoration, and in particular to temporary tooth restoration devices and the use of same to prepare for permanent tooth restorations.

BACKGROUND

[0002] Millions of people are missing one or more teeth. Reasons for the missing teeth vary widely. Some patients are born without one or more permanent teeth. Other patients lose their permanent teeth whether due to a traumatic event such as a collision or by way of an intentional extraction, whether to create room for other teeth to come through the gum of the patient or due to damage to a tooth from decay, loss of blood flow, or other. Restorations such as crowns and bridges may be inserted into missing tooth spaces to replace missing teeth. For permanent solutions, crowns and bridges are placed onto posts extending from implants inserted into patient’s jawbones.

[0003] Before placing a permanent restoration, a bone hole must be prepared in the jawbone of a patient for receipt of an implant in the form of a bone anchor. The bone hole conventionally is drilled using a drill guide. Today, precision drill guides include a wrap and an aperture or inset for receiving and limiting the movement of a dental drill during drilling into the jawbones of patients. These drill guides are often produced using three-dimensional (3D) printing of plastic resins as 3D printing allows for inner surfaces of the guides to be custom tailored to each patient.

[0004] Implants may be placed in the prepared bone hole immediately following drilling, but the affected region of bone often requires 3-4 months to heal. To maintain the position of adjacent teeth adjacent to the missing tooth space, a temporary crown or bridge including a tooth form may be inserted onto a post extending from the implant. Such provisional, i.e., temporary, crowns and bridges are not patient-specific and are generally chosen from a set of optional shapes of tooth forms. However, as these temporaries are not patient-specific, they are merely a best fit of available options and thus are not aesthetically pleasing to the users of such temporaries or to the dental practitioner who desirably wishes to know how the eventual definitive restoration is going to look in the mouth of the patient.

[0005] Moreover, provisional crowns and bridges are often made of plastic, e.g., acrylic, material. As such, these restorations may break down and need replacement before the permanent restoration is ready for delivery to the patient.

[0006] Accordingly, longer lasting and more aesthetically pleasing provisional restorations are needed.

BRIEF SUMMARY [0007] In accordance with an aspect, a provisional drill guiding dental restoration may have a guide base and a base hole extending through the guide base. The guide base may be generally in the form of a tooth with the exception of the base hole. In some arrangements, the drill guiding dental restoration may include flanges extending from the guide base in opposing directions. In some arrangements, the drill guiding dental restoration may include a guide ring received within the base hole. In some such arrangements, the guide ring may be made of metal or a hard plastic material. In some arrangements, the drill guiding dental restoration may be made of a ceramic material such that the restoration may take the form of a natural tooth.

[0008] In accordance with another aspect, a tooth cutting guide may be placed on a portion of a dental arch of a patient over a missing tooth (or teeth) space. The tooth cutting guide may include one or more wrap portions that may be placed on adjacent teeth adjacent to and on opposite sides of the missing tooth space and a guiding portion of the tooth cutting guide that may be placed over the missing tooth space. Notches may be prepared in the adjacent teeth using a dental cutting tool, which may include a dental handpiece and dental bur inserted in the dental handpiece, in which movement of the dental cutting tool constrained by the tooth cutting guide such that the notches are prepared with predetermined dimensions at predetermined locations within the adjacent teeth. Once the notches are prepared, the guide base, and guide ring when present, of the provisional drill guiding dental restoration may be placed in the missing tooth space and attached, e.g., by dental cement, to the notches by the opposing flanges of the provisional drill guiding dental restoration. With the provisional drill guiding dental restoration in place, a bone cavity may be drilled by passing a dental drill through the base hole, and guide ring when present. A dental implant then may be placed in the bone cavity. A filling material, which may be a plastic or ceramic resin, is then poured into the base hole, preferably without the guide ring present, and cured to form a temporary bridge restoration. After sufficient time for the patient to heal, the temporary bridge restoration is removed from the patient’s dental arch. A permanent restoration, e.g., a dental crown, is then placed into or onto the implant, e.g., onto a post extending from the implant. In some arrangements, dental cement applied in the notches is removed and the notches are filling with an appropriate dental filling material such as a composite filling material known to those skilled in the art for filling tooth cavities.

[0009] In accordance with another aspect, a dental cutting guide for limiting the movement of a dental cutting tool to prepare a predetermined bone cavity when the dental cutting tool is received in the dental cutting guide and the dental cutting guide is placed onto teeth of a patient may include a guide base and a first flange. The guide base may be in the form of a dental restoration portion and may include a base hole extending through a thickness of the guide base. The first flange may extend from the guide base and may be configured for insertion into a first tooth. [0010] In some arrangements, the dental cutting guide may be a dental drill guide and the dental cutting tool may be a dental drill.

[0011] In some arrangements, the guide base may be in the form of a tooth portion intended to be replaced by the guide base. When the dental cutting guide is placed in a mouth of a patient such that the guide base is arranged in a normal orientation of the tooth portion intended to be replaced by the guide base, the first flange may extend from a mesial or distal portion of the base.

[0012] In some arrangements, a second flange may extend from the guide base. In some such arrangements, the guide base may be configured for placement in a missing tooth space of a patient. In such arrangements, the second flange may oppose the first flange such that the second flange is configured for insertion into a second tooth opposite the first tooth in which the first tooth and the second tooth may be on opposite sides of the missing tooth space.

[0013] In some arrangements, the guide ring may be received in and attached to the base hole.

[0014] In some arrangements, the guide base may include an interior step. The guide ring may be seated on the interior step. In some arrangements, the guide ring may be attached to the guide base by an interference fit between the guide ring and the guide base. In some arrangements, the guide ring may be attached to the guide base by an adhesive.

[0015] In some arrangements, the guide base may be made of either one or both of plastic and metal. In some such arrangements, the guide base may be made of ceramic or porcelain.

[0016] In accordance with another aspect, a tooth restoration preparation system includes a tooth cutting guide and a dental cutting guide in accordance with any of the foregoing. The tooth cutting guide may be configured for receiving a portion of a tooth cutting tool. The tooth cutting guide may be configured for limiting movement of the tooth cutting tool to remove an adjacent tooth portion of an adjacent tooth adjacent to a missing tooth space of a patient and thereby form an adjacent tooth cavity when the tooth cutting tool is received in the tooth cutting guide. The first flange of the dental cutting tool may be configured for receipt in the adjacent tooth cavity.

[0017] In some arrangements, the first flange may have the same dimensions as the adjacent tooth cavity such that the first flange may fill the adjacent tooth cavity when properly placed in the adjacent tooth cavity.

[0018] In some arrangements, the tooth restoration preparation system further may include the dental cutting tool.

[0019] In some arrangements, the tooth restoration preparation system further may include a dental implant configured for receipt in a jawbone of the patient and may have approximately the same outer diameter as an inner diameter of the base hole.

[0020] In accordance with another aspect, a tooth restoration preparation system may include a dental drill guide and a dental implant. The dental drill guide may include a guide base in the form of a dental restoration portion and a base hole extending through a thickness of the guide base. The dental implant may be configured for receipt in a jawbone of the patient and may have approximately the same outer diameter as an inner diameter of the base hole. The dental drill guide and the dental implant may be configured for attachment via a threaded connection.

[0021] In some arrangements, a guide ring may be received in the base hole.

[0022] In some arrangements, the tooth restoration preparation system may include a threaded post. In such arrangements, the threaded connection may be one either between the dental drill guide and the post or between dental implant and the post.

[0023] In accordance with another aspect, a dental drill guide combination for use with a dental drill in preparing a hole in a jawbone may include a dental drill guide and a guide wrap. The dental drill guide may include a guide base in the form of a dental restoration portion and may include a base hole extending through a thickness of the guide base. The guide wrap may include a first wrap portion that may be configured for placement onto at least a first adjacent tooth. The first wrap portion may include a first wrap inner surface that may have a first wrap inner shape and first wrap inner dimensions corresponding to an outer shape and outer dimensions of the first adjacent tooth, respectively. The guide wrap may be configured for placement against the dental drill guide to maintain the dental drill guide in a fixed position relative to the first adjacent tooth during drilling, by the dental drill extended through the base hole of the dental drill guide, into a jawbone of a patient to form a cavity in the jawbone when the first wrap portion is placed onto the first adjacent tooth.

[0024] In some arrangements, the guide base may be configured to fill a missing tooth space and may include a second wrap portion configured for placement onto at least a second adjacent tooth. The first adjacent tooth and the second adjacent tooth may be adjacent teeth of the missing tooth space.

[0025] In some arrangements, the guide wrap further may include a cover portion attached to the first wrap portion. The cover portion may have a cover surface that may be configured for contact with the dental drill guide to hold the dental drill guide in the fixed position relative to the first adjacent tooth when the first wrap portion is placed onto the first adjacent tooth. In some arrangements, the cover surface may have a cover inner shape and cover inner dimensions corresponding to an outer shape and outer dimensions of the dental drill guide.

[0026] In accordance with another aspect, a tooth restoration preparation system may include the dental drill guide combination in accordance with any of the foregoing and a dental implant. The dental implant may be configured for receipt in a jawbone of the patient and may have approximately a same outer diameter as an inner diameter of the base hole.

[0027] In some arrangements, the dental drill guide and the dental implant may be configured for attachment via a threaded connection. In some such arrangements, the tooth restoration preparation system may further include a threaded post in which the threaded connection may be one either between the dental drill guide and the post or between the dental implant and the post. In some such arrangements, the dental implant or the dental drill guide may include the post. In some such arrangements, the post may be separate from the dental implant and the dental drill guide.

[0028] In accordance with another aspect, preparation for a tooth restoration may involve a process. In this process, an implant cavity may be drilled through a predefined base hole of a dental drill guide and into a jawbone. The base hole of the dental drill guide may be filled with a plastic or ceramic resin such that the dental drill guide is sufficient to operate as a temporary dental restoration. [0029] In some arrangements of this process, the temporary dental restoration may be a crown restoration or a bridge restoration. In some such arrangements, the temporary dental restoration m may be made of ceramic.

[0030] In some arrangements of this process, a dental implant may be inserted into the implant cavity.

[0031] In accordance with another aspect, preparation for a tooth restoration may involve a process. In this process, a guide may be contacted with a drill, during a single visit, to drill an implant cavity in a jawbone of a patient at a predetermined location and with a predetermined diameter. A permanent restoration may be received, during the single visit, in an implant received in the implant cavity.

[0032] In some arrangements of this process, the permanent restoration may be at least partially made of ceramic.

[0033] In some arrangements of this process, the permanent restoration may be a crown or a bridge.

[0034] In some arrangements of this process, the permanent restoration may be received in a missing tooth space of a patient. In some such arrangements, flanges of the permanent restoration may be received within respective opposing notches of opposing adjacent teeth adjacent to the missing tooth space.

[0035] In some arrangements of this process, the opposing notches may be formed at predefined locations of the opposing adjacent teeth with a dental cutting tool by limiting the movement of the dental cutting tool with a dental cutting guide such that the dental cutting tool forms the opposing notches at the predefined locations when the dental cutting tool is moved within the dental cutting guide to all maximum extents permitted by the dental cutting guide.

BRIEF DESCRIPTION OF THE DRAWINGS

[0036] A more complete appreciation of the subject matter of the present technology and the various advantages thereof may be realized by reference to the following detailed description which refers to the accompanying drawings, in which: [0037] FIG. 1 is a perspective view of a dental bridge with drill guide placed on a stone model of a portion of teeth of a patient in accordance with an embodiment;

[0038] FIG. 2 is a perspective view the dental bridge with drill guide of FIG. 1 placed on the stone model of FIG. 1 after modification of the dental bridge with drill guide into a molar tooth form in accordance with another embodiment;

[0039] FIG. 3A is a plan view of a tooth preparation cutting guide for preparing teeth to receive a dental bridge as known in the prior art;

[0040] FIG. 3B is an elevation view of a dental cutting tool received in the tooth preparation cutting guide of FIG. 3A and as known in the prior art;

[0041] FIG. 4 is a process flow diagram of a process for inserting a dental implant into a jawbone of a patient, placing the dental bridge with drill guide of FIG. 1 into the mouth of the patient, and modifying the dental bridge with drill guide in accordance with another embodiment; and

[0042] FIG. 5 is a process flow diagram of a process for placing a definitive crown into the dental implant inserted in the process of FIG. 3 and of optionally filling notches, prepared in the process of FIG. 3, of adjacent teeth adjacent to a missing tooth space in accordance with another embodiment. DETAILED DESCRIPTION

[0043] Referring now to FIG.l, provisional dental bridge with drill guide 10 includes guide base 11, mesial flange 12, and distal flange 13. As shown, a substantial portion, indeed in this example a majority, of guide base 11 is in a form of a tooth to mimic a substantial portion of a natural tooth. In the particular example shown, an outer surface of guide base 11 with the exception of an occlusal portion of the guide base is in the form of a molar, although in other arrangements, an outer surface of the guide base with the exception of an occlusal portion of the guide base may be in the form of other types of teeth, e.g., incisors, canines, premolars. Mesial flange 12 and distal flange 13 each extend from guide base 11 such that when dental bridge with drill guide 10 is properly installed in the mouth of a patient, mesial flange 12 points in a mesial direction of the teeth of the patient and distal flange 13 points in a distal direction of the teeth of the patient, which is consistent with their orientation in the stone model shown. Guide base 11, mesial flange 12, and distal flange 13 preferably are made of any one or any combination of ceramic, e.g., porcelain, and metal. Guide base 11, mesial flange 12, and distal flange 13 preferably are integral with each other such that they may not be separated from each other without fracture of any one or any combination of the guide base, the mesial flange, and the distal flange.

[0044] Base hole 15 extends through a thickness of guide base 11 in an apical direction of the guide base when dental bridge with drill guide 10 is properly installed in the mouth of a patient. Preferably, as in the example shown, drill guide 10 further includes guide ring 14 received in base hole 15. Base hole 15 of guide base 11 may define an interior step (not shown) configured such that guide ring 14 rests on the interior step and extends from the interior step in an occlusal direction along an upper interior surface (not shown) of the guide base. Guide ring 14 may extend to or approximately to occlusal surface 16 of guide base 11 when the guide ring is received in base hole 15. In this manner, a dental drill inserted into guide ring 14 may contact the guide ring and be prevented from contacting occlusal surface 16 during insertion of the dental drill into the guide ring and during drilling by the dental drill through the guide ring. As further shown in FIG. 1 , ring interior surface 17 of guide ring 14 acting as a guide hole may be in the form of a cylinder having an inner diameter smaller than an inner diameter of lower interior surface 18 of guide base 11 extending in an apical direction from interior step 16 of the guide base. In this manner, a dental drill inserted into guide ring 14 may contact the guide ring and be prevented from contacting lower interior surface 18 of guide base 11 during insertion of the dental drill into the guide ring and during drilling by the dental drill through the guide ring. In some alternative arrangements using guide ring 14, the lower interior surface of the guide base may be modified to have at most an inner diameter such that lower interior surface is coextensive with ring interior surface 17 of guide ring 14.

[0045] Still referring to FIG. 1, in some arrangements, guide ring 14 may be inserted loosely into base hole 15 such that the guide ring is removable in an occlusal direction without resistance with the exception of the force of gravity. However, preferably, guide ring 14 is subject to some resistance from the base hole in the occlusal direction such that the guide ring does not move in the occlusal direction during use and pullout in the occlusal direction of a dental drill. Guide ring 14 preferably may be made of a metal or rigid plastic. In some such arrangements, guide ring 14 may be, but is not limited to being, made of either one or both of a metal, e.g., brass, stainless steel, or titanium, or a rigid plastic harder than the material used for guide base 11, e.g., high density polyethylene (HDPE), polycarbonate (PC), acetal, or acrylonitrile butadiene styrene (ABS).

[0046] With reference to FIG. 2, when placed in the mouth of a patient as described further herein, base hole 15 of dental bridge with drill guide 10 is filled by rigid plastic, which may be in the form of a resin, or ceramic materials and allowed to cure or otherwise harden to form temporary dental bridge restoration 10 A. The filler is shaped to form a complete occlusal surface of the dental bridge into the tooth form of the tooth being replaced or substituted. Prior to filing base hole 15, guide ring 14 preferably may be removed from the base hole.

[0047] Referring now to FIGS. 3A-5, tooth preparation and dental bridge installation process 50 begins at a first visit (not shown) to the office or laboratory of a dental practitioner, e.g., oral surgeon. During this first visit, a scan or impression is taken of the patient’s teeth as known to those skilled in the art. Based on this scan or impression and prior to a second visit, tooth preparation cutting guide 20 for preparing teeth to receive a dental bridge is prepared. Guide 20 may be but is not limited to being a FIRSTFIT® tooth preparation cutting guide for a dental bridge as shown in FIG. 3A or a tooth preparation cutting guide for a dental bridge in the form of an arrangement like that of FIG. 1 or FIG. 14 of U.S. Patent No. 11,033,356, the disclosure of which is hereby incorporated by reference herein. Preparation cutting guide 20 may be prepared by, for example, three-dimensional (3-D) printing. As shown in FIG. 3A, cutting guide 20 includes guide portion 21 and wrap portion 22 extending from the guide portion. The process for preparing tooth preparation cutting guide 20 may be but is not limited to being one described in U.S. Patent Application Publication No. 2018/0263726 Al, now U.S. Patent No. U.S. Patent No. 11,007,035 B2, International Publication No. WO 2018/170278 A2, and International Patent Application No. PCT/US2021/032272, the disclosures of which are hereby incorporated by reference herein. If needed by a dental practitioner, dental cutting tool 23, such as the one shown in FIG. 3B known to those in the art, may be fabricated for delivery to the requesting dental practitioner prior to the patient’ s second visit to the office of the practitioner, along with tooth preparation cutting guide 20.

[0048] Dental bridge with drill guide 10 is also prepared prior to the patient’s second visit. In preparing dental bridge with drill guide 10, guide base 11 may be prepared in the same manner that bridge restorations, for example FIRSTFIT® bridge restorations, are prepared. In some arrangements, a mold, which may be a patient-specific mold, may be prepared by filling a cavity in the form planned using computer-aided design (CAD) modeling. The mold may be prepared using 3D printing as known to those skilled in the art. Ceramics may then be used to fill the mold. Once hardened, the mold is removed from the formed coarse guide base. Additional carving or other finishing steps then may be undertaken on the formed coarse guide base to form guide base 11. In some alternative arrangements, the coarse guide base may be formed by milling, e.g., using a computer numerically controlled (CNC) mill, and then finishing steps may be undertaken on the coarse guide base to form guide base 11.

[0049] Guide ring 14 is then inserted into guide base 11, and in some arrangements, onto an interior step. To incorporate the resistance between guide ring 14 and guide base 11, in some arrangements, the guide ring may be attached to the guide base by an interference fit, e.g., via either one or both of tolerancing or a Morse taper, between the guide ring and the guide base. In some arrangements, such resistance may be incorporated by attaching guide ring 14 to guide base 11 by an adhesive, e.g., a dental resin-based composite as known to those skilled in the art, which may be but is not limited to being a composite composed of a bisphenol A-glycidyl methacrylate (BISGMA), urethane dimethacrylate (UDMA) or semi-crystalline polyceram (PEX), and an inorganic filler such as silicon dioxide (silica).

[0050] As shown in FIG. 4, during the patient’s second visit with the dental practitioner as part of tooth preparation and dental bridge installation process 50, notches are formed in mesial and distal teeth immediately adjacent to a missing tooth space of the patient at step 51 in the manner of notches 51A, 51B shown on the stone model in FIGS. 3A, 3B. The notches are formed by placing tooth preparation cutting guide 20 over and around teeth adjacent to the missing tooth space and then sliding dental cutting tool 23 to the maximum extent within a slot of the tooth preparation cutting guide such that the cutting guide limits the movement of the cutting tool to form the notches. At step 52 of process 50, mesial flange 12 and distal flange 13 of provisional dental bridge with drill guide 10 are fully inserted into the formed notches of the respective mesial and distal teeth immediately adjacent to the missing tooth space. An appropriate amount temporary dental cement known to those skilled in the art, e.g., a eugenol-based, non-eugenol based, resin-based, or glass ionomer temporary cement may be applied to enhance the fixation of flanges 12, 13 in the formed notches, but preferably no cement is used when the flanges are sufficiently tight in the formed notches without the cement to provide the most accurate positioning of drill guide 10 in the missing tooth space. In this manner, guide base 11 and guide ring 14 are placed at predetermined positions within the missing tooth space. [0051] At step 53 of process 50, a cutting portion of a dental drill is inserted through ring interior surface 17 of guide ring 14 and base hole 15 of guide base 11. A bone cavity then is drilled, e.g., using an implant motor with a drill bit as known to those skilled in the art, into the jawbone of the patient with the cutting portion of the dental drill in which movement in a lateral direction perpendicular to a central axis of the cutting portion of the dental drill is limited by ring interior surface 17 of guide ring 14. In some arrangements, the drill bit may be one of a series of drill bits in which the dental drill is passed through guide ring 14 and base hole 15 with sequentially larger drill bits. The dental drill contacts an occlusal end of guide ring 14 to limit a depth of the dental drill. In this manner, the bone cavity is formed in the jawbone of the patient at a predetermined location and with a predetermined diameter and depth.

[0052] At step 54 of process 50, a dental implant in the form of a bone anchor is inserted in the drilled cavity of the jawbone of the patient in a manner known to those skilled in the art. In some arrangements, the dental implant could be inserted into the drilled cavity through ring interior surface 17 of guide ring 14. Then, two optional sets of steps may be undertaken. In the first option, at step 55A, mesial and distal flanges 12, 13 of guide 10 are reinserted into and adhered, e.g., by dental cement, to the respective notches of the adjacent teeth immediately adjacent to the missing tooth space. Next, at step 56A and after removing guide ring 14 from base hole 15 of guide base 11, a resin filling material, which may be a composite resin such as but not limited to polymethyl methacrylate (PMMA) temporary resin acrylic, is poured into the base hole to fill such hole with the resin. The resin filling material is preferably of the same color as dental bridge with drill guide 10. The resin is cured, e.g., by air drying or through the use of ultraviolet (UV) light, at step 57 A to form dental bridge temporary restoration 10A. By applying the resin while guide 10 is inserted into the missing tooth space and the notches of the adjacent teeth, the resin may fill the space between the guide and the inserted implant to substantially reduce or eliminate undesirable agents such as food debris and bacteria as well as protect internal threads of the dental implant.

[0053] In the second option, at step 56B, after removing guide 10 from the mouth of the patient and removing guide ring 14 from base hole 15 of guide base 11, the resin filling material described above with respect to step 56A or other material preferred by the dental practitioner, e.g., a plastic or a ceramic resin, may be poured into the base hole to fill such hole with the resin. As guide 10 is removed from the mouth of the patient, resins that require heat that would otherwise be harmful to the patient, e.g., heat or warming-approved composites, may be used. In this option and still during the second visit, guide base 11 may be placed in a mold preformed based on the original scan or impression of the patient and then the resin material may be injected into the mold. When a ceramic resin is used, an entirety of dental bridge temporary restoration 10A may be made of the same material. Next, the resin is cured, e.g., by ambient temperature or heat drying or through the use of ultraviolet (UV) light, at step 57B to form dental bridge temporary restoration 10A. Then, at step 55B, mesial and distal flanges 12, 13 of restoration 10A may be inserted into the respective notches of the adjacent teeth immediately adjacent to the missing tooth space. At step 58 of process 50, regardless of which of the two optional routes is taken, the jawbone of the patient is allowed time to heal until a third visit of the patient to the office of the dental practitioner.

[0054] In some alternative arrangements, following insertion of the dental implant at step 54 and prior to step 56A, 56B, a temporary healing abutment known to those skilled in the art optionally may be inserted, e.g., screwed into threads, of the implant if such properly sized device is available to the dental practitioner during the second visit and is able to be positioned properly to be aesthetically acceptable to the patient. In some such alternative arrangements, the temporary healing abutment may be inserted through base hole 15 of guide base 11 after removal of guide ring 14 if the abutment is inserted while guide 10 remains inserted into the notches of the adjacent teeth. This alternative process then proceeds to step 56A, 56B. When the process proceeds to step 56A, the resin poured into base hole 15 of guide base 11 is poured around and over the healing abutment as well. [0055] In some other alternative arrangements, following insertion of the dental implant at step 54 and prior to step 55A, 56B, guide 10 optionally may be removed from the notches of the adjacent teeth and then a sealing cap known to those skilled in the art may be placed into or over the implant to close off a threaded hole within the implant and thereby prevent resin from being injected into the threaded hole of the implant. The open gums then may be sutured around the implant and sealing cap. Afterward, provisional dental bridge with drill guide 10 may be replaced back into the missing tooth space with flanges 12, 13 received in the notches of the adjacent teeth. This alternative process then proceeds to step 55A, 56B. [0056] In still other alternative arrangements, following insertion of the dental implant at step 54 and prior to step 55 A, 56B, guide 10 optionally may be removed from the notches of the adjacent teeth and a healing cap may be inserted into the threads of the implant if such properly sized device is available to the dental practitioner during the second visit and is able to be positioned properly to be aesthetically acceptable to the patient. The healing cap may facilitate shaping of the gums around the implant as the gums of the patient heal. Insertion of the healing cap into the threads of the implant may prevent resin from being injected into the threaded hole of the implant. If this alternative route is undertaken, then the notches are then filled, e.g., by a dental composite, or other material known to those skilled in the art for filling cavities in teeth. This alternative process then proceeds to step 58, without any of steps 55A-57A and 55B-57B, of process 50 as dental bridge with drill guide 10 is no longer used.

[0057] In yet still other alternative arrangements, following insertion of the dental implant at step

54 and prior to step 55A, 56B, guide 10 optionally may be removed from the notches of the adjacent teeth and replaced by a new dental bridge restoration, which may be a FIRSTFIT® bridge restoration with a central tooth form and mesial and distal flanges extending from the central tooth form, to act as a temporary. In a variation, a dental bridge having an outer surface in the form of the dental bridge restoration may be attached directly to the dental implant while the flanges of the restoration are cemented to the adjacent teeth adjacent to the missing tooth space such that this dental bridge may be a permanent restoration for the patient. Use of the dental bridge with drill guide 10 enables the placement of this permanent bridge restoration since the position and diameter of the bone cavity drilled in the jawbone has been limited by the guiding features of the dental bridge with drill guide 10, e.g., ring interior surface 17 of guide ring 14, while flanges 12, 13 of the dental bridge with drill guide are received in the notches of the adjacent teeth, ensuring alignment between the bone cavity for the dental implant and the notches and thereby alignment between the inserted implant and the inserted permanent bridge restoration. Anchoring of the permanent bridge restoration in the notches and to the dental implant distributes the load forces on the permanent restoration. Moreover, such anchoring of the permanent bridge restoration to the dental implant which is fixed to bone compensates for movement by the adjacent teeth due to the shock absorption provided by the linking of the adjacent teeth to the jawbone via the periodontium. In this manner, the permanent bridge restoration may be placed in the missing tooth space during the second visit to the offices of the dental practitioner and thus prior to the healing of the jawbone discussed further herein.

[0058] As shown in FIG. 5, during the third visit as part of process 50, at step 59, dental bridge temporary restoration 10A is removed from the notches of the adjacent teeth adjacent to the missing tooth space or, if the healing cap is used instead, then the healing cap is removed. If a healing abutment or sealing cap are used, then the healing abutment or sealing cap must be removed at this step prior to removing restoration 10A. In some instances, restoration 10A may break upon removal such that broken pieces of the restoration need to be removed as well. At step 60, the dental cement is removed from the notches, and any remaining resin used to fill base hole 15 of guide base 11 and the region around the implant is also removed. At step 61, the jawbone and area around the implant are checked to ensure they are sufficiently healed. If not, then at step 61 A a new dental bridge temporary restoration, which may be a FIRSTFIT® bridge restoration, is inserted and cemented into the cleaned-up notches of the adjacent teeth, and the process returns to step 58 to allow for further healing. Alternatively, a standard temporary restoration, e.g., a temporary crown or bridge as appropriate, could be employed and the notches filled. If, however, the healing of the jawbone and area around the implant is considered to be sufficiently complete, then at step 62 a permanent crown is inserted into the dental implant anchored into the bone. At step 63, the notches are then filled, e.g., by a dental composite, or other material known to those skilled in the art for filling cavities in teeth. In alternative arrangements, steps 62 and 63 may be reversed as further shown in FIG. 5.

[0059] In an alternative to a combination of steps 59 and 63, dental flanges 12, 13 may be carefully cut from the rest of dental bridge temporary restoration 10A. If it is determined that the jawbone of the patient and the area around the implant have sufficiently healed, flanges 12, 13 may be left in the notches and ground down by a skilled clinician at their severed edges to create a smooth continuous surface on the portion of the adjacent teeth facing the missing tooth region. Otherwise, the flanges 12 and 13 may be removed from the notches and modified process proceeds to step 61A. [0060] In an alternative arrangement, provisional dental bridge with drill guide 10 may be replaced by provisional dental crown with drill guide. The provisional dental crown with drill guide may be the same as or substantially similar to provisional dental bridge with drill guide 10 with the exception that the provisional dental crown with drill guide excludes mesial and distal flanges 12, 13. In light of the excluded flanges, in this arrangement, a separate tooth wrap may be prepared prior to the second visit to the offices of the dental practitioner. The wrap may be substantially similar to and function in a substantially similar way to wrap portion 22 of tooth preparation cutting guide 20 described previously herein. In this manner, the wrap may have inner surfaces that substantially conform to outer surfaces of adjacent teeth adjacent to the missing tooth space. Additional inner surfaces of the wrap further may substantially conform to outer surfaces of the provisional dental crown with drill guide such that the provisional dental crown with drill guide may be held within the tooth wrap. A wrap hole extending through the tooth wrap may be aligned with ring interior surface 17 of guide ring 14 inserted in the provisional dental crown with drill guide. In this manner, with the provisional dental crown with drill guide held within the wrap and the wrap placed over the adjacent teeth adjacent to the missing tooth space, a position of the provisional dental crown with drill guide may be maintained while drilling a cavity into the jawbone of a patient. [0061] In some arrangements, a provisional drill guiding dental bridge may be a multi-tooth form dental bridge. In such arrangements, the provisional dental bridge includes one or more drill guides within corresponding ones of the false tooth forms within the provisional dental bridge. In one example, such drill guiding dental bridge may include opposing tooth forms on the ends of the dental bridge which each have drill guides for drilling bone cavities and further may include a central tooth form, i.e., a pontic, that is between the opposing tooth forms and that lacks a drill guide. Like provisional dental bridge with drill guide 10, the provisional drill guiding dental bridge with the multi-tooth forms includes mesial and distal flanges on the respective mesial and distal ends of the multi-tooth form bridge for insertion into mesial and distal teeth adjacent to a missing tooth space into which the multi-tooth form bridge is placed. In this arrangement, holes of the multi-tooth form bridge may be filled such that the multi-tooth form bridge may be used as a temporary bridge between the second and third visits to the offices of the dental practitioner.

[0062] While this invention has been described in conjunction with the specific embodiments outlined above, it is evident that many alternatives, modifications, and variations will be apparent to those skilled in the art. Indeed, the disclosure set forth herein includes all possible combinations of the particular features set forth above, whether specifically disclosed herein or not. For example, where a particular feature is disclosed in the context of a particular aspect, arrangement, configuration, or embodiment, that feature can also be used, to the extent possible, in combination with and/or in the context of other particular aspects, arrangements, configurations, and embodiments of the invention, and in the invention generally. Moreover, the disclosure set forth herein includes the mirror image, i.e., mirror configuration, taken from

[0063] any perspective of any drawing or other configuration shown or described herein. Accordingly, the preferred embodiments of the invention as set forth above are intended to be illustrative, not limiting. Various changes may be made without departing from the spirit and scope of the inventions as defined in the following claims.

[0064] In addition, citation or identification of any document in this application is not an admission that such document is available as prior art to the present invention.

Claims

1. A dental cutting guide for limiting the movement of a dental cutting tool to prepare a predetermined bone cavity when the dental cutting tool is received in the dental cutting guide and the dental cutting guide is placed onto teeth of a patient, comprising: a guide base in the form of a dental restoration portion and including a base hole extending through a thickness of the guide base; and a first flange extending from the guide base and configured for insertion into a first tooth.

2. The dental cutting guide of claim 1, wherein the guide base is in the form of a tooth portion intended to be replaced by the guide base, and wherein when the dental cutting guide is placed in a mouth of a patient such that the guide base is arranged in a normal orientation of the tooth portion intended to be replaced by the guide base, the first flange extends from a mesial or distal portion of the base.

3. The dental cutting guide of claim 1, further comprising a second flange extending from the guide base.

4. The dental cutting guide of claim 3, wherein the guide base is configured for placement in a missing tooth space of a patient, and wherein the second flange opposes the first flange such that the second flange is configured for insertion into a second tooth opposite the first tooth, the first tooth and the second tooth being on opposite sides of the missing tooth space.

5. The dental cutting guide of claim 1, further comprising a guide ring received in and attached to the base hole.

6. The dental cutting guide of claim 5, wherein the guide base includes an interior step, and wherein the guide ring is seated on the interior step.

7. The dental cutting guide of claim 5, wherein the guide ring is attached to the guide base by an interference fit between the guide ring and the guide base.

8. The dental cutting guide of claim 5, wherein the guide ring is attached to the guide base by an adhesive.

9. The dental cutting guide of claim 1, wherein the guide base is made of either one or both of plastic and metal.

10. The dental cutting guide of claim 9, wherein the guide base is made of ceramic or porcelain.

11. A tooth restoration preparation system, comprising: a tooth cutting guide configured for receiving a portion of a tooth cutting tool, wherein when the tooth cutting tool is received in the tooth cutting guide, the tooth cutting guide is configured for limiting movement of the tooth cutting tool to remove an adjacent tooth portion of an adjacent tooth adjacent to a missing tooth space of a patient and thereby form an adjacent tooth cavity; and the dental cutting guide of claim 1 , wherein the first flange is configured for receipt in the adjacent tooth cavity.

12. The tooth restoration preparation system of claim 11, wherein the first flange has the same dimensions as the adjacent tooth cavity such that the first flange fills the adjacent tooth cavity when properly placed in the adjacent tooth cavity.

13. The tooth restoration preparation system of claim 11, further comprising the dental cutting tool.

14. The tooth restoration preparation system of claim 11, further comprising a dental implant configured for receipt in a jawbone of the patient and having approximately the same outer diameter as an inner diameter of the base hole.

15. A tooth restoration preparation system, comprising: dental drill guide including a guide base in the form of a dental restoration portion and a base hole extending through a thickness of the guide base; and a dental implant configured for receipt in a jawbone of the patient and having approximately the same outer diameter as an inner diameter of the base hole, wherein the dental drill guide and the dental implant are configured for attachment via a threaded connection.

16. The tooth restoration preparation system of claim 15, further comprising a guide ring received in the base hole. 16

17. The tooth restoration preparation system of claim 15, further comprising a threaded post, wherein the threaded connection is one either between the dental drill guide and the post or between dental implant and the post.

18. A dental drill guide combination for use with a dental drill in preparing a hole in a jawbone, comprising: a dental drill guide including a guide base in the form of a dental restoration portion and including a base hole extending through a thickness of the guide base; and a guide wrap including a first wrap portion configured for placement onto at least a first adjacent tooth, the first wrap portion including a first wrap inner surface having a first wrap inner shape and first wrap inner dimensions corresponding to an outer shape and outer dimensions of the first adjacent tooth, respectively, wherein the guide wrap is configured for placement against the dental drill guide to maintain the dental drill guide in a fixed position relative to the first adjacent tooth during drilling, by the dental drill extended through the base hole of the dental drill guide, into a jawbone of a patient to form a cavity in the jawbone when the first wrap portion is placed onto the first adjacent tooth.

19. The dental drill guide combination of claim 18, wherein the guide base is configured to fill a missing tooth space and includes a second wrap portion configured for placement onto at least a second adjacent tooth, wherein the first adjacent tooth and the second adjacent tooth are adjacent teeth of the missing tooth space.

20. The dental drill guide combination of claim 18, wherein the guide wrap further includes a cover portion attached to the first wrap portion, and wherein the cover portion has a cover surface configured for contact with the dental drill guide to hold the dental drill guide in the fixed position relative to the first adjacent tooth when the first wrap portion is placed onto the first adjacent tooth.

21. The dental drill guide combination of claim 20, wherein the cover surface has a cover inner shape and cover inner dimensions corresponding to an outer shape and outer dimensions of the dental drill guide.

22. A tooth restoration preparation system comprising: the dental drill guide combination of claim 18; and 17 a dental implant configured for receipt in a jawbone of the patient and having approximately a same outer diameter as an inner diameter of the base hole.

23. The tooth restoration preparation system of claim 22, wherein the dental drill guide and the dental implant are configured for attachment via a threaded connection.

24. The tooth restoration preparation system of claim 23, further comprising a threaded post, wherein the threaded connection is one either between the dental drill guide and the post or between the dental implant and the post.

25. The tooth restoration preparation system of claim 24, wherein the dental implant or the dental drill guide includes the post.

26. The tooth restoration preparation system of claim 25 , wherein the post is separate from the dental implant and the dental drill guide.

27. A method of preparation for a tooth restoration, comprising: drilling an implant cavity through a predefined base hole of a dental drill guide and into a jawbone; and filling the base hole of the dental drill guide with a plastic or ceramic resin such that the dental drill guide is sufficient to operate as a temporary dental restoration.

28. The method of claim 27, wherein the temporary dental restoration is a crown restoration or a bridge restoration, the temporary dental restoration being made of ceramic.

29. The method of claim 27, further comprising inserting a dental implant into the implant cavity.

30. A method of preparation for a tooth restoration, comprising: contacting a guide with a drill, during a single visit, to drill an implant cavity in a jawbone of a patient at a predetermined location and with a predetermined diameter; and receiving, during the single visit, a permanent restoration in an implant received in the implant cavity. 18

31. The method of claim 30, wherein the permanent restoration is at least partially made of ceramic.

32. The method of claim 30, wherein the permanent restoration is a crown or a bridge.

33. The method of claim 30, wherein the permanent restoration is received in a missing tooth space of a patient, further comprising receiving flanges of the permanent restoration within respective opposing notches of opposing adjacent teeth adjacent to the missing tooth space.

34. The method of claim 33, further comprising forming the opposing notches at predefined locations of the opposing adjacent teeth with a dental cutting tool by limiting the movement of the dental cutting tool with a dental cutting guide such that the dental cutting tool forms the opposing notches at the predefined locations when the dental cutting tool is moved within the dental cutting guide to all maximum extents permitted by the dental cutting guide.