DE19814785A1 - Dental instrument for sinus elevation procedures - Google Patents

Abstract

One end of the instrument body (2) has a lengthways convexly hemispherical head (3) so body and/or head present a circular section in which the body (2) has a smaller maximum diameter than the head (3). A guide sleeve (6) enclosing part of the body length towards the rim area is 70-90% of body length and the main body (2) has markings (5) notably grooves at its non-head end and is shaped at this end to fit into a separate handle. In a combination instrument, with circular section body and end convex head plus guide sleeve, the first and second instruments provide for sequential dental work such as sinus lifts for implant bedding, using a specified membrane (15) in cap form adapted to the shape of the body (2) head (3) and with a membrane thickness of 0.2-0.5 mm. An Independent claim is included for the membrane. The membrane is made of bio-compatible resorbable material, either homogous or heterologous native material.

Description

The invention relates primarily to a dental surgeon cal instrument, which is particularly suitable for use in a so-called sinus elevation is provided and a langge has stretched base body.

Missing individual teeth or entire edentulous jaw sections have become increasingly so-called implants in recent years supplied, on which then single, partial or full dentures can be attached. The implant technique is not only with total tooth loss, but also with rehabilitation tion of partially toothed jaw sections of increasing importance tung.

It is known that a so-called implant is used in implant technology Bearing created in the jawbone to the one to be used Implant is adapted in shape and dimensions. in the Lower jaw represents the creation of such implant sites for Dentists or oral surgeons using the implant technique are familiar, usually pose no difficulty. This is mainly due to the fact that the lower jaw (Mandible) solid bones with bone qualities of class I  and II (according to Brånemark, classes I to IV). Furthermore the bones of the lower jaw are comparatively broad Bone ridges or bone crests.

The situation is different with implantological care of the upper jaw (maxilla). It is usually there to comparatively soft bones with bone qualities of Classes III or IV. In addition, the bone ridges are ver relatively narrow. Therefore, the implant bearing in the upper jaw, as usual in the lower jaw, with the help of drills (drilling preparation) created, this leads to relationship moderately often to an unsatisfactory ingrowth of the implant tats in the maxilla.

To improve this comparatively poor osseointe Ration in the upper jaw was suggested by R. B. Summers gene, the implant site in the upper jaw with the help of Osteoto men (bone chisels) to create. It can be used for a Aufboh ren, with the bone material is discharged and thus ver loren is going to be largely dispensed with. Obviously manually driving the osteotome into the maxilla Advantage that the existing bone material around the implant camp around compacted and thus begin the osseointegration is increased. The osteotomes used by Summers and the technology used are for example in Compend. Contin. Educ. Dent., Vol. XV, No. 6, 698-708, 1994 in detail wrote. The osteotomes according to Summers are around cone-shaped chisels with plate-shaped, d. H. concave Essays.

Prepares further when placing implants in the Upper jaw difficulties that in the upper jaw the bone height is often less than 10 mm or even less than 7 mm. In many cases, therefore, it becomes a so-called cranial augmenta tion carried out with the help of a deeper implant bearings can be made available in the maxillary sinus  can. This allows longer implants to be inserted and achieve better osseointegration. This augmentation of the antrum is accompanied by a manual palpative elevation of the Maxillary sinus floor, including the maxillary sinus skin connected with the so-called Schneiderian membrane. Man speaks here of the so-called sinus lift or sinus elevation. The basically already known procedure for the Anhe Exercise of the maxillary sinus floor is also already in progress given by Summers' publication, namely with and without inserting additional augmentation material.

The increase of the cutting edge associated with the sinus elevation der'sche membrane carries the risk that this during the Intervention is destroyed or at least perforated. Episode are then the immediate termination of the surgery and the need for a second operation. The risk of being Damage / perforation of the Schneiderian membrane is itself for surgeons with extensive experience in implants planting considerable.

The invention therefore has the general task of to further improve the implantation technique in the maxilla. In particular, dental surgical instruments should Be provided where the creation of the Im plantat camp and the possibly required sinus elevation atraumatic as possible for the patient and as accurate and be carried out as safely as possible for the surgeon can. Accidental damage, perforation or Destruction of the mucous membrane towards the maxillary sinus, in particular the Schneiderian membrane, should either be prevented can or be repairable.

This task is solved by the dental surgeon instrument with the features of claim 1 and the instrument tenset with the features of claim 10. Special Ausge The instrument or instrument set are in  dependent claims 2 to 9 and 11 to 14. The invention also includes the dental membrane according to An pronoun 15 including their in the dependent claims 16 to 19 illustrated embodiments. The wording of all Claims are hereby incorporated by reference into the content of these Description made.

The dental or surgical instrument according to the invention sits an elongated body, at one end a longitudinally convex head section is formed. The elongated base body is usually the Have the shape of a rod or pin. "Convex head down cut "essentially means that the body one end of which is curved outwards in the longitudinal direction Head area has, as in connection with the drawing tion is still explained.

Although other convex configurations of the head section are generally possible, the head section is preferred formed by a spherical section. This means that the head section on its outer circumference is a constant crumb mung. Accordingly, the head section can also be described as dome-like. In particular, the Head section formed by a hemisphere.

The base body and / or its head section have in particular especially a circular cross-sectional area (in the right win angle to the longitudinal axis), since implants are normally related to their longitudinal axis, also rotationally symmetrical are. Accordingly, the associated implant bearings created with circular cross-sectional areas. The The diameter of the instruments according to the invention is the half usually more than 1 mm, ranges between 2 and 8 mm, in particular 3 to 5 mm, are preferred.  

In a further development, the base body can have a lower maxi paint diameter than the head section. At übli Chen circular cross-sectional areas thus protrudes the head section radially beyond the base body. The advantages Such explanations go from the description below forth.

In further preferred embodiments, the head down cut to the base body bounded by an edge section, which is designed in particular in the embodiments, where the head section has a larger maximum through has a knife than the base body. In these cases preferably a cylindrical edge portion is formed, the on the one hand a possibly sharp-edged transition at the Avoids edge between head section and base body and on the other hand, a certain lead over its cylindrical surface guaranteed in the implant site.

The total length of the instrument according to the invention is Range of the usual length of surgical hand instruments. The will usually be more than 10 cm and may be preferred range between 15 and 20 cm.

The dental instrument according to the invention is preferred further characterized by a so-called. guide sleeve, the Base body on its outer surface over at least part essentially completely encloses its length. That did physical design of the guide sleeve is not critical, as long as the actual management function is fulfilled. To can the length of the guide sleeve in preferred designs at least 50%, preferably 70 to 90% of the length of the Base body. If you prefer the above The length of the entire instrument is based on preferred lengths for the guide sleeve from 13 to 15 cm.  

Furthermore, the guide sleeve on its outer surface be designed that the manageability of the instrument overall is made easier for the user. Accordingly can be used for manual handling of the instrument on the Guide sleeve recessed grips or surface structures such as Rif Felungen, coatings and the like may be provided to to ensure good graspability of the instrument as a whole Afford.

In addition, on the instrument, in particular on the base body, at least one marking may be provided. Such markings conditions are preferably in the area of the head section turned end of the body and serve for example, the user of the instrument during surgery the intervention depth of the instrument in the Display pine. The markings can be for example around groove-shaped depressions or around bulge act increases on the outer circumference of the base body. Such markings can be radially on the entire outer circumference of the Basic body run. Such marks are preferred stations provided at a regular interval, preferably at a distance of several millimeters, especially at a distance of 2 mm. The markings can be easily recognized be colored, with successive ones in particular Markers have a different color.

As already stated, the instrument according to the invention can by the user directly on the body, preferably wise at the end facing away from the head section the. If there is a guide sleeve, the user usually attack this guide sleeve. In next education it is possible to use the lower one (the head fig cut away) end of the base body so that the instrument can be used in another facility is. This can be a separate one, for example Handle part act like a handle. Preferably, the  Basic body can be inserted into a handle in this way. If necessary, suitable locking means for Set the lower end of the body in the additional Chen device may be provided.

In principle, the instrument according to the invention can be made from any suitable material should be built, which is the one for his necessary strength and durability. in the Usually the instrument is made of steel, especially V4A Be made of steel or from another, in the dental surgery usual material.

The invention further comprises an instrument set or a comm bination instrument for dental surgery. This points at least two of the described inventive instru mentions. This is preferably at least a first and at least a second such instrument, the in a dental surgery, especially in implantological care including Sinuseleva tion, used together. In particular, these are first instrument and this second instrument at each other the following procedural steps of such an intervention reversible.

An instrument set according to the invention preferably comprises a first instrument with an elongated body and a convex head section at one end of the base body, in which the base body is preferably a circular cross has cutting surface and the head section from a ball cut is formed. Next is the maximum diameter of the head section larger than the maximum diameter of the Base body and at the end of the base body facing Head section is a preferably cylindrical edge section trained. If necessary, are in the Be rich of the end of the base facing away from the head section pers circumferential groove-shaped depressions that a markie  have a function of Regarding the design of the first instrument is based on the previous description referenced and referenced.

Furthermore, the instrument set according to the invention preferably comprises wise a second instrument with an elongated Body and a convex head section at one end of the base body, in which the base body is preferably a has circular cross-sectional area. This second Instrument is the head section of a spherical section, preferably a hemisphere. In particular, the Radius of the hemisphere is the radius of the cross sectional area of the Correspond to the basic body. Again, if necessary, in the area of the end of the base body facing away from the head section running groove-shaped depressions as markings to be seen. Explanation is also based on the previous Parts of the description referenced and referenced.

In other preferred embodiments, the instrument set at least one guide sleeve for the first and / or include second instrument. As already described, the Guide sleeve designed such that it the basic body of the respective instrument over at least a part essentially completely enclose its length. The guide sleeve can be a (loose) component of the In instrument sets, d. H. be included separately in this. In In these cases, the guide sleeve is only used when the first or second instrument applied to this. The Guide sleeve can, however, already on the instrument set be applied first or the second instrument, so that the each instrument can be used without prior assembly is. If necessary, every first or every second Instrument in the instrument set already with its own be provided. This may also be captive be connected to the appropriate instrument.  

In further training, the first can with the instrument set and second instruments in terms of their shape, dimensions and the like to be adapted to each other so that they ver different, especially successive procedures steps of a dental surgery like the sinus be used for elevation. This means, for example, that the diameter of the respective base body can be the same NEN, so that a common guide sleeve for both instru element is usable. Also the diameter of the corresponding one Head sections (at right angles to the longitudinal direction of the In instruments) can be the same, so in the same implant store the respective first and the respective second instrument can be used sequentially. This will come together Hang described with the drawing. The lengths of each instruments, especially the respective basic body per as well as the location and distance of any markings conditions can also be the same in order to to enable casual work.

The instrument set according to the invention can not only first and second instruments of different design for ver different procedural steps of a dental surgical operation handles, but also preferably instruments of the same or similar shape with different dimensions, in particular have different diameters. Such instruments can in particular with a successive preparation of a Implant bearings are used one after the other. Finally can the instrument set according to the invention further usual Instruments for dental surgery included, such as wise osteotomes, stoppers, curettes and the like a.

The invention further includes a ver in dental surgery reversible membrane, particularly in implantology Supply can be used. This membrane is like a Molded cap. The advantages that can be achieved with this, in particular those with sinus elevation, will be explained.  

The membrane according to the invention is further characterized thereby net that they have at least the shape of the head section one of the instruments already described after the Erfin dung is adapted or at least adaptable. This leaves the membrane on the upper part of the instrument bring ("plug") and with this into the implant site bring in. Preferably, the membrane cap does not include only the area of the actual head section, but also part of the adjoining the head section eating body.

The membrane described preferably consists of an übli Chen biocompatible material, this in particular to is additionally absorbable. It can be native biological material and preferably homologous (from the same species) or heterologous (from a different one a species) material. As a source of heterologous matter beef and pork should be mentioned primarily. Reason however, synthetic materials also come for the Production of the membrane cap in question. Only as a case games are here as usable materials collagen, poly saccharide and lyophylized dura (homologous material) ge called.

The membrane according to the invention is preferably made of one moisture-loving and / or adhesive material, accordingly a good contact with biological Material allows. The thickness of the membrane used is basically not critical, with sufficient flexi balance should be guaranteed. Accordingly, the Values for the membrane thickness usually between 0.1 and 2 mm, in particular between 0.2 and 0.5 mm.

Finally, the invention comprises a new method for Implantological care in the upper jaw under implementation a so-called sinus elevation. This procedure ends  the creation of the implant site, especially in the last step of elevation, the sinus with great care and Puncture defined (controlled) penetration, whereby the Danger of damage / perforation of Schneider's Membrane is largely avoided. This procedure will through certain designs of those already described Instruments that can be part of an instrument set, enables.

In addition, the method according to the invention can provide that a possibly damaged Schneiderian membrane is replaced by a (repair) membrane, which with the help another instrument already described is brought. As already mentioned, the (first) Instruments for piercing the sinus floor and the (second) Instruments for inserting the membrane / membrane cap in the form and dimensions largely matched. The be The procedure described also enables a membrane / Preventively insert the membrane cap into the implant site bring to. This eliminates the need for time-consuming investigations into whether the Schneiderian membrane when piercing the bottom of the Implant bearing was not damaged after all. The precautionary The introduction of a membrane is particularly indicated if additional augmentation material for better osseoin tegration is introduced into the implant site. Through the Membrane, the (possibly injured) mucous membrane is covered and the implantation can be continued and completed. With the help of the instruments described, an exact one succeeds Position the membrane in the bottom area of each Implant bearing.

The described features and other features of the invention result from the following description of preferred th embodiments in connection with the subclaims and the drawings. Here, the individual characteristics  individually or in combination with each other be realized. The drawings show:

Fig. 1 is a schematic representation of a first dental surgical instrument according to the invention, and

Fig. 2 is a schematic representation of a second dental surgical instrument according to the invention including the membrane cap according to the invention.

The (first) shown in FIG. 1, consisting of two parts de dental instrument 1 has as the first component an elongated base body 2 and a head section 3 convex in the longitudinal direction of the base body 2 . This first part can also be called an elevation stamp. The convex head section 3 is formed like a dome from a circular section of constant curvature at one (here the upper) end of the base body 2 . On its side facing the base body 2 , the head section 3 has a cylindrical edge section 4 . Both the base body 2 and the head section 3 are constructed rotationally symmetrically with a circular cross-sectional area. The maximum diameter water of the head section 3 or its associated Randab section 4 is larger than the diameter of the base body 2 . This creates a circumferential recess at the transition of the head section 3 into the base body 2 .

In the region of its lower end, the base body 2 has several markings 5 in the form of circumferential groove-shaped depressions. In the case shown, these are arranged at regular intervals.

Next, FIG. 1 as the second component of the instrument 1, a guide sleeve 6 of its length completely encloses the base body 2 over a portion. On the outer circumference of the guide sleeve 6 , corrugations 7 are indicated in the drawing, which enable better handling of the instrument 1 by the user.

The horizontal broken lines in Fig. 1 show that the base body 2 and the guide sleeve 6 can actually be longer than shown. This shows that the overall length of the base body 2 is (substantially) larger than the dimension of the head section 3 . At its lower end facing away from the head section 3 , the base body 2 is designed in the manner of a cone in order to make it easier to insert into the sleeve 6 or to use an additional device such as a hand or the like.

The (second) dental instrument 11 shown in FIG. 2 sits a base body 12 and a head portion 13 convex in the longitudinal direction of the base body 12 . This head from section 13 is formed by a spherical section with a constant curvature, namely a hemisphere, at one (here the upper) end of the base body 12 . Base body 12 and head section 13 are rotationally symmetrical with a circular cross-sectional area. In the present case, the radius of the hemisphere forming the head section 13 and the radius of the cross-sectional area of the base body 12 match.

The instrument according to FIG. 2 shows 12 markings 14 in the lower end of the base body 12 facing away from the head section 13 . Reference is made to the corresponding description of the markings 5 in FIG. 1. This also applies to the horizontal break lines and the conical lower end of the base body 12 .

A guide sleeve corresponding to the guide sleeve 6 in FIG. 1 is not shown for the instrument 11 in FIG. 2.

In principle, an identical guide sleeve can be used. With the same diameter of the instruments 1 and 11 or their base bodies 2 and 12 , the same sleeve can be used for both instruments, as will be described in the following.

Finally, FIG. 2 shows a membrane cap 15 according to the invention, the shape of which is adapted to the head section 13 and the adjoining upper end of the base body 12 . Regarding the thickness of the membrane and the possible materials that can be used, reference is made to the description.

As a comparison of FIGS. 1 and 2 shows, the shape and dimensions of the instruments 1 and 11 are largely matched to one another. This enables their (successive) use in the same dental surgery, in particular a so-called sinus elevation.

The dentist or oral surgeon can do the following:
The implant bearing for an implant in the upper jaw is pre-processed in a known manner using a drill or preferably using an osteotome (preferably according to Summers). In this context, reference can be made to the Summers publication already cited. Before pushing through the sinus floor, the instruments according to the invention, the membrane cap according to the invention and the method according to the invention are used. Of course, the following FIGS. 1 and 2 are only to be understood as examples.

The dental instrument 1 according to FIG. 1 is used to pierce the sinus floor. The convex design of the head section 3 enables a defined and controlled penetration of the sinus floor. The zylinderför shaped edge region 4 enables the instrument 1 to be guided in the pre-machined implant bearing. The sleeve 6 , into which the base body 2 is possibly inserted before use (from above), serves as a grip part for the surgeon and is placed with its upper end on the upper jaw bone. The markings 5 serve the surgeon to check how far he has inserted the instrument 1 into the implant site.

By combining the design features of Instru ment 1 damage to the mucous membrane or perforation of the Schneiderian membrane is largely prevented, so that the insertion of the implant including any necessary augmentation material can be performed in one operation. With regard to the subsequent procedural steps, reference can again be made to the publication of Summers (OSFE or BAOSFE techniques).

The instrument 11 of FIG. 2 is used either independently of the instrument 1 to repair a damaged / perforated mucous membrane / Schneiderian membrane or (also in connection with instrument 1 ) for the precautionary introduction of a membrane. In the event that the instrument 11 does not have its own guide sleeve from the outset, this is subsequently inserted (from above) into one, possibly the same as in FIG. 1. Before or after this step, a membrane cap 15 according to the invention is then placed on the hemispherical head section 13 of the instrument 11 . This membrane cap 15 is then inserted with the aid of the instrument 11 through the implant bearing previously created. Due to its moisture-loving adhesive properties, the membrane cap 15 attaches to the damaged mucous membrane / Schneiderian membrane (or prophy lactically to the intact). The seal of the implant bearing against the maxillary sinus is (again) secured. The implant can then be introduced in the known manner (see publication by Summers).

Claims (19)

1. Dental surgical instrument, in particular for use in a sinus elevation, with a elongated base body, characterized in that at one end of the base body ( 2 ; 12 ) forms a convex head section ( 3 ; 13 ) in the longitudinal direction of the base body. 2. Instrument according to claim 1, characterized in that the head portion ( 3 ; 13 ) of a spherical section, preferably before a hemisphere, is formed. 3. Instrument according to claim 1 or claim 2, characterized in that the base body ( 2 ; 12 ) and / or the sen head portion ( 3 ; 13 ) have a circular cross-sectional area. 4. Instrument according to one of the preceding claims, characterized in that the base body ( 2 ) has a ge ringere maximum diameter than its Kopfab section ( 3 ). 5. Instrument according to one of the preceding claims, characterized in that the head portion ( 3 ) to the base body ( 2 ) from an edge portion ( 4 ), before preferably a cylindrical edge portion, is limited. 6. Instrument according to one of the preceding claims, characterized by a guide sleeve ( 6 ) which substantially completely surrounds the base body ( 2 ) over at least part of its length. 7. Instrument according to claim 6, characterized in that the length of the guide sleeve at least 50%, preferred as 70% to 90% of the length of the base body. 8. Instrument according to one of the preceding claims, characterized in that on the base body ( 2 ; 12 ), preferably in the area of the head portion ( 3 ; 13 ) from the opposite end of the base body, markings ( 5 ; 14 ), in particular in the form of groove-shaped depressions are provided. 9. Instrument according to one of the preceding claims, there characterized in that the base body at its the End portion facing away from the head portion is formed such that the instrument in an additional facility, before preferably in a separate handle for the instru ment can be used. 10. Instrument set or combination instrument for the Dental surgery, characterized in that it minde at least one first and at least one second instrument according to at least one of claims 1 to 9. 11. Instrument set according to claim 10, with a first instrument, which has the following features:

• an elongated base body, preferably with a circular cross-sectional area,
• a convex head section at one end of the base body, preferably a head section formed by a Kugelab,
  in which
• the maximum diameter of the head section is larger than the maximum diameter of the base body,
• - A preferably cylindrical edge section is formed at the end of the head section facing the base body, and
• - If necessary, circumferential groove-shaped depressions are provided as markings in the region of the end of the base body facing away from the head section.

12. Instrument set according to claim 10 or claim 11, with a second instrument having the following features:

• an elongated base body, preferably with a circular cross-sectional area,
• a convex head section at one end of the base body,
  in which
• the head section is formed by a spherical section, preferably a hemisphere,
• the radius of the hemisphere preferably corresponds to the radius of the cross-sectional area of the base body,
  and
• - If necessary, circumferential groove-shaped depressions are provided as markings in the region of the end of the base body facing away from the head section.

13. Instrument set according to one of claims 10 to 12, there characterized by that there is at least one guide comprises sleeve for the first and / or second instrument, wherein the guide sleeve is designed such that it  the main body of the instrument over at least one Partially completely enclose part of its length can eat. 14. Instrument set according to one of claims 10 to 13, there characterized in that the first and the second In instruments with regard to their shape and dimensions and, if applicable, their other design are so matched to one another, that they are in successive procedural steps a dental surgery, especially in the sinus elevation, can be used. 15. Membrane for dental surgery, in particular for implantological care, characterized in that the membrane ( 15 ) is shaped like a cap. 16. Membrane according to claim 15, characterized in that their shape at least to the head section of a Instruments adapted according to one of claims 1 to 9 or is customizable. 17. Membrane according to claim 15 or claim 16, characterized ge indicates that they are made from a biocompatible, pre preferably a biocompatible resorbable material is constructed. 18. Membrane according to one of claims 15 to 17, characterized ge indicates that they are from a homologous or hetero logen native material is built. 19. Membrane according to one of claims 15 to 18, characterized ge indicates that the thickness of the membrane between 0.1 and 2 mm, in particular between 0.2 and 0.5 mm.