CN110916779B - Three-dimensional accurate positioner of upper jaw bone - Google Patents
Three-dimensional accurate positioner of upper jaw bone Download PDFInfo
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- CN110916779B CN110916779B CN201911257457.XA CN201911257457A CN110916779B CN 110916779 B CN110916779 B CN 110916779B CN 201911257457 A CN201911257457 A CN 201911257457A CN 110916779 B CN110916779 B CN 110916779B
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- middle shaft
- positioner
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- tail end
- sliding rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
Abstract
The invention provides a three-dimensional accurate positioner for maxilla, and relates to the field of oral medical instruments. The positioner comprises cantilevers, a connecting shaft, gaskets and an elastic cap, wherein the threaded shaft is sequentially sleeved with the two cantilevers and the gasket from bottom to top, and the elastic cap is arranged above the gaskets and connected with the threaded shaft; the middle shaft outer sleeve is connected with the limiting cylinder through threads, the middle shaft is arranged in the middle shaft outer sleeve, and a sliding rod and a universal head are sequentially arranged in the limiting tube from the head end to the tail end; the elastic cap is screwed down, the middle shaft keeps the original state, the gasket and the middle shaft outer sleeve move down, the sliding rod and the universal head move outwards, and finally all parts of the positioner are fixed and can not move. The invention also provides orbital plane indicators and sockets for use with the maxillary three-dimensional precision positioner. The invention can ensure that the maxillary occlusal plane is parallel to the orbital-ear plane and the maxillary dentition central line is consistent with the facial central line, thereby avoiding the problem that the occlusal plane and the upper teeth central line are deflected after operation.
Description
Technical Field
The invention relates to the field of oral medical instruments, in particular to a three-dimensional accurate positioner for a maxilla.
Background
The osseous dentofacial deformity is the maladjustment of the maxillofacial morphology and the occlusion relationship caused by the maladjustment of the growth and development of the maxillofacial skeleton, and is mainly characterized by the maladjustment of the volume and the morphology of the jaw bone, the position relationship between the upper jaw bone and the lower jaw bone and the craniofacial bone. The main treatment mode aiming at the severe synostotic dentognathic and maxillofacial deformity of the adult is orthodontic-orthognathic combined correction, namely, the abnormal jaw position relation is corrected through orthognathic surgery, and good occlusion is obtained through orthodontic treatment. In order to realize the diagnosis and treatment target, the positional relationship between the upper and lower jaws needs to be accurately positioned in the orthognathic operation process, the abnormal jaw position is adjusted to the preoperative designed direction and position, and the condition that the upper jaw occlusal plane is parallel to the orbital-ear plane and the central line of the upper dentition is consistent with the central line of the plane is ensured.
The conventional surgical treatment protocol is a bi-maxillo orthognathic surgery, i.e.: le Fort type I osteotomy of the upper jaw + mandibular BSSRO (bilateral mandibular ascending sagittal split) the upper and lower jaws are each freed and moved to the desired position and fixed. An important positioning device, a dental plate, is required during the operation. In the operation, an Le Fort I type surgical free maxilla is used in advance, an unmoved mandible is used as a reference, the occlusion relation of upper teeth and lower teeth is used as a bridge, the position of the maxilla is determined under the assistance of a middle dental lamina, and the moved maxilla is fixed through a titanium plate nail; then, BSSRO technique is performed to free the mandible block, and the direction and distance of the mandible movement are determined with the aid of the final dental plate with reference to the maxilla, and then fixed. In the whole operation process, the two tooth combination plates determine the final positions of the maxilla and the mandible, and the position of the maxilla is the central importance, so that the success or failure of the operation is directly related.
However, many problems remain to be solved in the prior art, and one of the most important is how to determine that the occlusal plane after surgery is parallel to the orbital-ear plane. The background to this problem is as follows: a plane formed by the mesial incisor angle of the maxillary central incisor and the mesial lingual cusps of the first molars of the maxillary on two sides is called as a occlusal plane; the imaginary plane formed by the connecting line of the lowest point of the lower edge of the two lateral orbits and the upper edge of the external auditory canal is called the orbital-ear plane, and the occlusal plane and the orbital-ear plane of a normal person are parallel. The malocclusion of a patient often has various deviations or inclinations in the occlusal plane, and correcting the occlusal plane is also one of the targets of orthognatic surgery. However, since the jaw bone is positioned by two separate dental plates during the operation, there is no other reference object to help the physician to determine whether the two dental plates are located exactly at the pre-operative designed position, so there are cases in which the inclination of the occlusal plane is aggravated after the orthognathic operation. Once the occlusal plane is inclined, the teeth need to be pulled out or pressed down for correction in subsequent orthodontic treatment, and the two movements can cause oppression and absorption on the apical tissues of the teeth and even cause the apical blood circulation disorder to further cause the pulp necrosis. The maxillary dentition central line and the facial central line are ensured to be consistent while the occlusal plane is ensured to be parallel to the orbital-ear plane, otherwise, the face appearance of the postoperative patient is greatly sacrificed. Therefore, there is a need for a device that can guide the relative relationship between the upper and lower jaws and check whether the occlusal plane is deviated and the maxillary dentition centerline is aligned with the facial centerline.
Disclosure of Invention
The invention aims to provide a three-dimensional accurate positioner for maxilla, which can ensure that a maxillo jaw plane is parallel to an orbital-ear plane and a maxillo dentition midline is consistent with a facial midline in a maxilla operation.
It is another object of the present invention to provide an orbital plane indicator for use with the three-dimensional precision positioner for the maxilla.
It is still another object of the present invention to provide a socket for use with the three-dimensional precision positioner for maxilla.
The purpose of the invention is realized by adopting the following technical scheme:
a three-dimensional accurate positioner for maxilla comprises two cantilevers, a connecting shaft, a gasket and an elastic cap, wherein the connecting shaft is provided with a threaded shaft and a base consisting of a boss and a base from top to bottom; the gasket is provided with an upper circular column and a lower circular column from top to bottom; the cantilever comprises a middle shaft, a sliding rod, a universal head, a middle shaft outer sleeve and a limiting cylinder, wherein the middle shaft is in a hollow cylindrical shape, and the side surface of the middle shaft is provided with a spherical surface-shaped recess; the main body of the sliding rod is columnar, and the two ends of the sliding rod are respectively a spherical head end and a tail end with a spherical recess; the universal head comprises a spherical head end, a connecting rod and a flaky tail end which are sequentially connected; the middle shaft outer sleeve comprises a tubular main body and a side pipe connected with the tubular main body, and the side pipe is vertical to and communicated with the tubular main body; the limiting cylinder is a hollow pipe, the head end of the limiting cylinder is provided with external threads, and the tail end of the limiting cylinder is in an outward convex arc surface shape and is provided with an opening; the side tube of the middle shaft outer sleeve is connected with the head of the limiting cylinder through threads, the middle shaft is arranged in the middle shaft outer sleeve, a sliding rod and a universal head are sequentially arranged in the limiting cylinder from the head end to the tail end, a connecting rod of the universal head and a flaky tail end extend out of the limiting cylinder from an opening, the head end of the sliding rod is opposite to the spherical depression of the middle shaft, and the spherical head end of the universal head is opposite to the tail end of the sliding rod; the elastic cap is screwed down, the middle shafts of the two cantilevers are kept in the original state, the gasket and the middle shaft outer sleeves of the two cantilevers move downwards, the sliding rod and the universal head move outwards, finally, the boss of the connecting shaft completely enters the middle shaft outer sleeves, the gasket is clamped on the middle shaft above the middle shaft outer sleeves, the middle shaft, the sliding rod and the universal head abut against each other in sequence, and all parts of the positioner are fixed and cannot move.
In a preferred technical scheme, the middle shaft outer sleeve main body is matched with the middle shaft.
In a preferred technical scheme, the spherical concave of the middle shaft is matched with the head end of the sliding rod.
In a preferred technical scheme, the tail end of the slide rod is matched with the head end of the universal head ball.
In a preferred embodiment, the end of the elastic cap is provided with a hand-held portion for tightening the elastic cap.
In a preferred technical scheme, the lower circular column of the gasket is matched with the end part of the middle shaft.
The cooperation the orbital plane indicator that three-dimensional accurate positioning ware of maxilla used, orbital plane indicator includes that an inserting groove arm and an instruction arm and two arm contained angles are 120, the end of inserting groove arm have with the slot of the first slice tail end looks adaptation of universal, it is terminal that the instruction arm has the chevron shape.
The slot that cooperation three-dimensional accurate positioning ware of maxilla used, the slot with the flaky tail end of universal head looks adaptation.
The invention relates to a 'occlusal space' which is a special word in stomatology and represents the occlusion relation between the upper jaw and the lower jaw.
The invention is suitable for adult moderate and severe cases of the osseous dentognathic face deformity needing single upper jaw or upper and lower jaw orthognathic operation, and has the following beneficial effects: (1) the invention effectively solves the defect that the traditional positioning method can not accurately determine the three-dimensional space position of the maxilla in the operation, can ensure that the maxilla occlusal plane is parallel to the orbital-ear plane and the maxilla dentition central line is consistent with the facial central line, and avoids the problem that the occlusal plane and the upper teeth central line are deflected after the operation. (2) The positioner is provided with two sets of relatively independent free rotation systems, and can rotate to a required angle in a three-dimensional direction at will. (3) The positioner has excellent flexibility, so that the positioner has good adaptability to various malformed patients and meets the requirements of most cases; the structure of the apparatus is simplified, and the application range is enlarged.
Drawings
FIG. 1 is a schematic view of the bottom bracket axle, wherein A is a front view of the bottom bracket axle, B is a top view of the bottom bracket axle, 1-bottom bracket axle, 11-spherical recess.
FIG. 2 is a schematic view of the structure of a slide bar, 2-slide bar, 21-tail end, 22-head end.
FIG. 3 is a schematic view of the structure of a limiting cylinder, 3-limiting cylinder, 31-head end, 32-tail end and 33-opening.
FIG. 4 is a schematic view of the structure of a universal head, wherein 4-universal head, 41-bulbous head end, 42-connecting rod, 43-lamellar tail end.
FIG. 5 is a schematic diagram of the structure of the middle shaft outer sleeve, 5-middle shaft outer sleeve, 51-tubular body, 52-side tube.
FIG. 6 is a schematic view of the structure of the connecting shaft, 6-connecting shaft, 61-threaded shaft, 62-boss, 63-base.
FIG. 7 is a schematic diagram of the cantilever structure, 1-middle shaft, 2-slide bar, 3-limiting cylinder, 4-universal head, 5-middle shaft outer sleeve, 9-cantilever.
FIG. 8 is a schematic diagram of the gasket, wherein 7-the gasket, 71-the upper annular column, and 72-the lower annular column.
FIG. 9 is a simplified schematic of the retainer, 6-connecting shaft, 7-spacer, 8-tension cap, 9-cantilever.
Fig. 10 is a schematic view of the structure of the socket.
Fig. 11 is a simplified schematic of orbital flat indicator configuration, wherein 12-orbital flat indicator, 121-socket, 122-socket arm, 123-indicator arm, 124-chevron tip.
Fig. 12 is a state of use diagram of the present invention, with 9-cantilever, 26-locator, 12-orbital plane indicator.
Detailed Description
The structures of the maxillary three-dimensional accurate positioner, the slot and the orbital plane indicator are respectively described in the attached drawings of the specification.
A three-dimensional accurate positioner 26 for maxilla comprises two cantilevers 9, a connecting shaft 6, a gasket 7 and an elastic cap 8, wherein the connecting shaft 6 is provided with a threaded shaft 61 and a base consisting of a boss 62 and a base 63 from top to bottom; the gasket is provided with an upper circular column 71 and a lower circular column 72 from top to bottom; the cantilever comprises a middle shaft 1, a sliding rod 2, a universal head 4, a middle shaft outer sleeve 5 and a limiting cylinder 3, wherein the middle shaft 1 is in a hollow column shape, and the side surface of the middle shaft is provided with a spherical recess; the main body of the sliding rod 2 is columnar, and the two ends are respectively a spherical head end 22 and a tail end 21 with a spherical recess; the universal head comprises a spherical head end 41, a connecting rod 42 and a flaky tail end 43 which are connected in sequence; the middle shaft outer sleeve comprises a tubular main body 51 and a side pipe 52 connected with the tubular main body, and the side pipe is vertical to and communicated with the tubular main body; the limiting cylinder is a hollow pipe, the head end 31 is provided with external threads, the tail end 32 is in an outward convex arc shape and is provided with an opening 33; the side pipe of the middle shaft outer sleeve is provided with internal threads and is connected with the head of a limiting cylinder through threads, the middle shaft 1 is arranged in the middle shaft outer sleeve, a sliding rod 2, a universal head, a connecting rod of the universal head and a flaky tail end sequentially arranged in the limiting cylinder from the head end to the tail end extend out of the limiting cylinder from an opening, the head end of the sliding rod 2 is opposite to a spherical recess 11 of the middle shaft 1, and the spherical head end of the universal head is opposite to the tail end of the sliding rod 2; the elastic cap is screwed down, the middle shafts of the two cantilevers are kept in the original state, the gasket and the middle shaft outer sleeves of the two cantilevers move downwards, the sliding rod 2 and the universal head move outwards, finally, the boss of the connecting shaft completely enters the middle shaft outer sleeves, the gasket is clamped on the middle shaft above the middle shaft outer sleeves, the middle shaft, the sliding rod 2 and the universal head abut against each other in sequence, and all parts of the positioner are fixed and cannot move.
The threaded shaft of the connecting shaft is a cylinder with an external thread at one end. The base and the boss of the connecting shaft are cylindrical, and the diameter of the base is larger than that of the boss.
The tail end of the limiting cylinder can be hollowed out.
The middle shaft outer sleeve main body is matched with the middle shaft.
The spherical surface-shaped concave of the middle shaft is matched with the head end of the sliding rod 2.
The tail end of the slide rod 2 is matched with the head end of the universal head ball.
The end of the elastic cap is provided with a hand-held part for screwing the elastic cap.
The lower circular column of the gasket is matched with the end part of the middle shaft.
The orbital plane indicator 12 used in cooperation with the maxilla three-dimensional precise positioner comprises a slot arm and an indicating arm, wherein the included angle between the two arms is 120 degrees, the tail end of the slot arm 122 is provided with a slot 121 matched with the tail end of a universal head sheet, and the indicating arm 123 is provided with a chevron-shaped tail end 124. The slot is the metal box-like of one end open-ended, and the open end is used for inserting universal head slice tail end, and universal head slice tail end can insert in sweeping the slot.
The slot 10 used in cooperation with the three-dimensional accurate maxillary positioner is in the shape of a metal box with an open end, and the open end is used for inserting the universal head sheet-shaped tail end.
The installation method comprises the following steps: the tail end of the universal head is inserted into the head end of the limiting cylinder and penetrates out of the tail end of the limiting cylinder, the connecting rod and the flaky tail end of the universal head are exposed outside, and the head of the universal head is clamped at the tail end of the limiting cylinder. The tail end of the slide bar is inserted into the limiting cylinder until the tail end of the slide bar is abutted against the spherical head of the universal head. The middle shaft is inserted into the tubular main body of the middle shaft outer sleeve, the side tube of the middle shaft outer sleeve is connected with the limiting cylinder through threads, at the moment, the spherical depression 11 of the middle shaft is opposite to the head end of the sliding rod, and the head end of the universal head is opposite to the tail end of the sliding rod, so that the cantilever is obtained. Another cantilever was mounted using the same method. And finally, connecting the elastic cap with the threaded shaft of the connecting shaft through threads to obtain the locator.
The use principle of the invention is as follows: before the elastic cap is screwed, each cantilever of the positioner can freely rotate around the connecting shaft, the occlusal plane position recorded by the dental lamina is related to the orbital-ear plane position, and the positions of the cantilevers of the positioner are adjusted, so that the upper jaw and the lower jaw are kept at the required three-dimensional positions after being moved respectively. When the elastic cap is screwed down, the middle shafts of the two cantilevers keep the original state, the gasket and the middle shaft outer sleeves of the two cantilevers move downwards, the sliding rod and the universal head move outwards, finally, the boss of the connecting shaft completely enters the middle shaft outer sleeves, the gasket is clamped on the middle shaft above the middle shaft outer sleeves, the middle shafts, the sliding rod and the universal head are abutted in sequence, and all parts of the positioner are fixed and cannot move.
The using method of the invention is as follows:
(1) the fabrication process of dental laminate is similar to the traditional method, and the main differences are as follows: when the self-setting plastic of the middle dental plywood is in a dough period, namely before the self-setting plastic is solidified, a separating agent is smeared in an inserting groove matched with the positioner for use, then the inserting groove is inserted into the center of the front part of the dental plywood, the cutting end of the front tooth is arranged, the middle dental plywood is pulled out after the self-setting plastic of the middle dental plywood is solidified, and at the moment, the front part of the middle dental plywood is provided with a depression matched with the shape of the inserting groove;
(2) taking down the manufactured intermediate dental laminate, grinding and polishing, and trying on in advance. During trial wearing, inserting the sheet tail end of one universal head in the positioner into the recess of the middle dental lamina, inserting the sheet tail end of the other universal head in the positioner into the slot of the socket arm of the orbital plane indicator, adjusting the vertical rods on two sides of the E-shaped tail end of the orbital plane indicator to be abutted against the orbital bottoms on two sides of a patient, abutting the middle vertical rod against the nasal root to determine the relationship between the middle dental lamina and the orbital-ear plane, screwing the elastic cap, and fixing the positions and angles of all components in the positioner;
(3) and (3) manufacturing a final dental plate in the same step, inserting the inserting groove matched with the positioner in the invention into the final dental plate according to the same method in the step (1) just before the self-setting plastic is solidified, and then inserting the positioner with the shape fixed in the step (2) into the same position of the final dental plate corresponding to the sheet tail end of the middle dental plate. At the moment, the final dental plates are also parallel to the orbital ear planes, and the grooves formed by the slots in the front parts of the two dental plates are also the same;
(4) the two denticles and the positioner are disinfected and sterilized by a conventional method for operation;
(5) in the operation, the maxilla Le Fort I type operation is performed according to the preoperative design to free the maxilla. Using the positioner, the orbital plane indicator and the middle dental plate with the fixed shapes in the step (2), adjusting the orbital plane indicator to the bottoms of the two lateral orbits, acquiring the orbital plane position, inserting the sheet tail end of the universal head of the positioner into the middle dental plate with the slot, inserting the sheet tail end of the other universal head of the positioner into the slot of the orbital plane indicator, fitting the free maxilla with the middle dental plate according to the occlusion relation, wherein the maxilla position at the moment is the position of the maxilla adjusted by the occlusal plane;
(6) the position of the maxilla relative to the skull at the moment is fixed by implanting titanium plate titanium nails;
(7) BSSRO surgery was performed to obtain free mandibular bone pieces. And replacing the middle dental plate with the final dental plate, determining the position of the free mandible block by the same method, fixing the titanium plate with a titanium nail, and adjusting the position of the mandible block by the occlusal plane.
Claims (8)
1. The three-dimensional accurate maxillary positioner is characterized by comprising two cantilevers, a connecting shaft, a gasket and an elastic cap, wherein the connecting shaft is provided with a threaded shaft and a base consisting of a boss and a base from top to bottom; the gasket is provided with an upper circular column and a lower circular column from top to bottom; the cantilever comprises a middle shaft, a sliding rod, a universal head, a middle shaft outer sleeve and a limiting cylinder, wherein the middle shaft is in a hollow cylindrical shape, and the side surface of the middle shaft is provided with a spherical surface-shaped recess; the main body of the sliding rod is columnar, and the two ends of the sliding rod are respectively a spherical head end and a tail end with a spherical recess; the universal head comprises a spherical head end, a connecting rod and a flaky tail end which are sequentially connected; the middle shaft outer sleeve comprises a tubular main body and a side pipe connected with the tubular main body, and the side pipe is vertical to and communicated with the tubular main body; the limiting cylinder is a hollow pipe, the head end of the limiting cylinder is provided with external threads, and the tail end of the limiting cylinder is in an outward convex arc surface shape and is provided with an opening; the side tube of the middle shaft outer sleeve is connected with the head of the limiting cylinder through threads, the middle shaft is arranged in the middle shaft outer sleeve, a sliding rod and a universal head are sequentially arranged in the limiting cylinder from the head end to the tail end, a connecting rod of the universal head and a flaky tail end extend out of the limiting cylinder from an opening, the head end of the sliding rod is opposite to the spherical depression of the middle shaft, and the spherical head end of the universal head is opposite to the tail end of the sliding rod; the elastic cap is screwed down, the middle shafts of the two cantilevers are kept in the original state, the gasket and the middle shaft outer sleeves of the two cantilevers move downwards, the sliding rod and the universal head move outwards, finally, the boss of the connecting shaft completely enters the middle shaft outer sleeves, the gasket is clamped on the middle shaft above the middle shaft outer sleeves, the middle shaft, the sliding rod and the universal head abut against each other in sequence, and all parts of the positioner are fixed and cannot move.
2. The three-dimensional precise maxillary positioner of claim 1 wherein the central shaft outer sleeve body is adapted to the central shaft.
3. The three-dimensional precise maxillary positioner of claim 1 or 2, wherein the spherical recess of the central shaft is adapted to the head end of the slide rod.
4. The three-dimensional precise maxillary positioner of claim 3 wherein the tail end of the slide bar is fitted with the ball-shaped head end of the universal head.
5. The three-dimensional accurate maxillary positioner of claim 4 wherein the distal end of the elastic cap is provided with a hand-held part for tightening the elastic cap.
6. The three-dimensional precise maxillary positioner of claim 5 wherein the lower circular column of the spacer is fitted to the end of the middle shaft.
7. The orbital plane indicator for use with the maxilla three-dimensional precision positioner of claim 1, wherein the orbital plane indicator comprises a socket arm and an indicating arm, the two arms form an included angle of 120 °, the socket arm has a slot at its distal end for mating with the universal head plate-like tail end, and the indicating arm has a chevron-shaped distal end.
8. A socket for use with the three dimensional precision maxillary positioner of claim 1 wherein the socket is adapted to the universal head plate like tail end.
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WO2023151549A1 (en) * | 2022-02-08 | 2023-08-17 | 上海时代天使医疗器械有限公司 | Method and system for determining facial midline, method and system for determining dental correction position, and manufacturing method and system |
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CN200942115Y (en) * | 2006-08-29 | 2007-09-05 | 四川大学华西口腔医学院 | Mandibular defect reconstruction stretch device |
CN206403810U (en) * | 2016-11-11 | 2017-08-15 | 中国医学科学院整形外科医院(整形外科研究所) | A kind of tractor for skull and jaw bone |
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DE4211018C2 (en) * | 1992-04-02 | 1995-06-22 | Kaltenbach & Voigt | Dental facebow |
US20040166467A1 (en) * | 2003-02-25 | 2004-08-26 | Crow Nathaniel David | Dental marking film holder |
CN201082199Y (en) * | 2007-09-30 | 2008-07-09 | 秦德川 | Novel support groove positioner |
CN107115155B (en) * | 2017-06-16 | 2022-07-15 | 温州医科大学附属口腔医院 | Method for accurately describing basic bone arch line and dental arch curve |
CN107736914B (en) * | 2017-10-30 | 2020-02-28 | 吉林大学 | Accurate positioner for upper jaw movement |
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CN1065989A (en) * | 1991-04-22 | 1992-11-11 | 张圣平 | Dentognathic plummet appliance |
US6296481B1 (en) * | 1999-12-31 | 2001-10-02 | Hee M. Kyung | Indirect bonding bracket positioner for correction of irregularities of the teeth |
CN200942115Y (en) * | 2006-08-29 | 2007-09-05 | 四川大学华西口腔医学院 | Mandibular defect reconstruction stretch device |
CN206403810U (en) * | 2016-11-11 | 2017-08-15 | 中国医学科学院整形外科医院(整形外科研究所) | A kind of tractor for skull and jaw bone |
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