EP1922015A2 - Procede et poste de travail permettant d'elaborer un modele chirurgical pour guider l'insertion d'implants osteointegres dans les arcades maxillaires - Google Patents

Procede et poste de travail permettant d'elaborer un modele chirurgical pour guider l'insertion d'implants osteointegres dans les arcades maxillaires

Info

Publication number
EP1922015A2
EP1922015A2 EP06795187A EP06795187A EP1922015A2 EP 1922015 A2 EP1922015 A2 EP 1922015A2 EP 06795187 A EP06795187 A EP 06795187A EP 06795187 A EP06795187 A EP 06795187A EP 1922015 A2 EP1922015 A2 EP 1922015A2
Authority
EP
European Patent Office
Prior art keywords
dental
virtual
tracking
cast
real stone
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP06795187A
Other languages
German (de)
English (en)
Inventor
Leonardo Ciocca
Roberto Scotti
Roberto Mingucci
Giovanni Bacci
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Universita di Bologna
Original Assignee
Universita di Bologna
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Universita di Bologna filed Critical Universita di Bologna
Publication of EP1922015A2 publication Critical patent/EP1922015A2/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0089—Implanting tools or instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/08—Machine parts specially adapted for dentistry
    • A61C1/082—Positioning or guiding, e.g. of drills
    • A61C1/084—Positioning or guiding, e.g. of drills of implanting tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0004—Computer-assisted sizing or machining of dental prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0006—Production methods
    • A61C13/0013—Production methods using stereolithographic techniques
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture

Definitions

  • This invention relates to a method and a work station to build a surgical template to guide the insertion of osteointegrated implants into the maxillary arches .
  • the most complicated stage of the implant procedure described above is the perforation of the bony arch in order to position the implant into that same arch, as even tiny errors of positioning of the angle and of the depth of the implant site may compromise the final result of the implant not only from the aesthetic point of view, but also from the functional one (occlusion, masticatory function, and phonetic function) Furthermore, during the perforation of the bony arch it is essential not to compromise the nervous and vascular system present in the bony arch itself.
  • the guide hole of the template for the perforation of the surgical template guide is lined with a calibrated metal sleeve, which was manufactured by the same manufacturer that made the dental implant and which has an internal diameter corresponding to the external diameter of the calibrated surgical bur being used.
  • the above described CAD/CAM technique for making a surgical template guide for the insertion of osteointegrated implants into the maxillary arches requires the making of suitable dental prosthesis which will be inserted into the mouth of the patient and the fixing of radio-opaque markers (gutta percha) in order to define a tracking system within the dental prosthesis.
  • the dental prosthesis is inserted into the mouth of the patient and the first CT (computed tomography) scan of the maxillary arches of the patient is made in order to obtain a three dimensional virtual reproduction of the maxillary zone with specific reference to the bony structure supporting the dental arches.
  • the dental prosthesis is removed from the mouth of the patient and a second CT (computed tomography) scan of the prosthesis is made to obtain a three dimensional virtual reproduction of the negative of the maxillary zone with particular reference to the positioning of the teeth.
  • CT computed tomography
  • the two three dimensional virtual reproductions of the maxillary zone obtained by the two CT (computer tomography) scans are superimposed and integrated so as to obtain a single integrated three dimensional virtual reproduction of the maxillary area.
  • the dental implant and therefore the perforation guide for positioning the dental implant can be virtually planned.
  • the surgical template guide can be created using the integrated three dimensional virtual reproduction of the maxillary zone and the result of the virtual planning of the dental implant, in particular, a virtual reproduction of the surgical template is made and therefore the surgical template guide is produced from the virtual reproduction of the surgical template guide itself using a three dimensional stereo lithographic printer.
  • the CAD/CAM methodology described above is generally more precise than traditional manual methods. Nevertheless, the CAD/CAM methodology described above does not always result in a precision that is significantly greater so as to guarantee an optimal result in the dental implant, in particular, the results are insufficiently precise when metal bridges are present as they screen the area surrounding them during the execution of the CT (computed tomography) scan. Furthermore, the CAD/CAM methodology described above calls for an initial CT (computed tomography) scan of the patient and a second CT (computed tomography) scan of the prosthesis, these CT (computed tomography) scans cannot always be easily performed in the public hospital environments in which the majority of patients undergo X- ray analysis.
  • the aim of the present invention is to provide a method and a work station to produce a surgical template guide for the insertion of an osteointegrated implant into the maxillary arches, in which this method and this work station are free of the inconveniences as described above, and at the same time, are simple and inexpensive to use.
  • a method and a work station to make a surgical template guide for the insertion of an osteointegrated implant in the maxillary arches as claimed in the attached claims.
  • figure 1 shows schematically the principal components of a work station to make surgical template guides in accordance with the present invention
  • figure 2 is a photograph of various markers as used in the work station shown in figure 1
  • - figure 3 is a photograph of a stone cast of the lower dental arch of a patient who must undergo surgery for an oral implant
  • figure 4 is a photograph of a stone cast of the upper dental arch of the patient
  • - figure 5 is a photograph of a surgical template for occlusion of the lower dental arch of the patient
  • figure 6 is a photograph of a surgical template for occlusion of the upper dental arch of the patient
  • figure 7 is a photograph of the stone casts of the dental arches of figures 3 and 4, mounted in an articulator and with the insertion of the two surgical templates for occlusion of figures 5 and 6
  • figures 8 and 9 are two photographs of different surgical templates for occlusion of the lower dental arch for another patient
  • figures 10 and 11 are two photographs
  • figure 1 indicates a work station to create a template 2 guide in resin (illustrated in figure 19) for the insertion of an osteointegrated implant in the maxillary arches.
  • a template 2 guide in resin illustrated in figure 19
  • Work 1 station includes dental 3 casts to make real stone 4 casts (illustrated in figures 3 and 4) or casts in other materials using a standard and well known method that are equivalent to the dental arches of the patient, in particular, a real stone 4 cast of the lower arch
  • the work 1 station uses impressions 6 in order to make two dental 7 prostheses (illustrated in figures 5 and 6) , one for the upper dental arch and the other for the lower dental arch.
  • the two dental 7 prostheses may be shaped like the bases of the occlusion in such a way that when inserted into the patient's mouth they keep the patient's mandible in a predetermined fixed position (typically the condyle is positioned in the glenoid fossa ) .
  • the dental 7 prostheses may be shaped like the bases of the occlusion and in this case already show the shape of the teeth.
  • the two dental 7 prostheses are made using the impressions 6 and using the real stone 4 casts of the patient's dental arches mounted in the articulator 5.
  • the work 1 station includes a series of markers 8 detectable both by scanning the surfaces and by CT
  • markers 8 are connectable to the real stone 4 casts and/or to the dental 7 prostheses.
  • each marker 8 is a sphere from which protrudes a connecting 10 rod; in this case, each marker 8 is connected to the stone 4 cast of the dental arch, or to the dental 7 prosthesis by inserting the connecting 10 rod of the marker 8 into the body of the real stone 4 cast or into the body of the dental 7 prosthesis.
  • the connecting 10 rod of a marker 8 may be inserted into the body of a real stone 4 cast or of a dental 7 prosthesis while casting the real stone 4 cast or while casting the resin for the dental 7 prosthesis.
  • the connecting 10 rod of the marker 8 may be inserted in the body of a stone 4 cast or a dental 7 prosthesis after creating the real stone 4 cast or the dental 7 prosthesis; in this latter case, the real stone 4 cast or the dental 7 prosthesis must be perforated using a drill to make holes suitable to receive the connecting 10 rod.
  • Figure 2 shows both the spherical titanium markers 8 and the markers 8 to which are fixed the connecting 10 rods and which are made from a coloured plastic material.
  • the work 1 station includes a computer 11 which is directly or indirectly linked to a three dimensional 12 scanner (either laser or optic) , a device 13 to make three dimensional CT (computed tomography) scans of the patient's skull, and a three dimensional stereo lithographic 14 printer.
  • a computer 11 which is directly or indirectly linked to a three dimensional 12 scanner (either laser or optic)
  • a device 13 to make three dimensional CT (computed tomography) scans of the patient's skull and a three dimensional stereo lithographic 14 printer.
  • the dental 7 prostheses are made as the bases for the occlusion, then in the occlusion and in the corrected position of the arch are mounted in the real stone 4 casts of the bases of the occlusion with the teeth on the wax, and each mounting can be duplicated using conventional orthodontic techniques in the dental 7 prosthesis which shows therefore the shapes of the teeth and the occlusion as predetermined in the articulator.
  • a number of markers 8 are attached in such a way as to link the real stone 4 casts with the tracking system 17 (illustrated in figures 3 and 4) .
  • the tracking 17 system includes the markers 8 arranged in such a way as to correspond to each implant site, that is, corresponding to where an implant will be positioned; in particular, each marker 8 is arranged in a locatable position corresponding exactly to the central axis of the tooth.
  • the markers 8 are positioned directly in contact with the dental/gingival surface of the real stone 4 casts of the dental arches.
  • the real stone 4 casts surfaces are scanned by a three dimensional scanner 12 in order to obtain a virtual 18 reproduction of the teeth and/or the dental mucosa (illustrated in figure 14) including the tracking 17 system. It is important to ensure that the virtual 18 reproduction includes not only the teeth, but also some of the dental mucosa in the case of the dentulous patient, whereas for an edentulous patient only the dental mucosa is shown in the virtual 18 reproduction.
  • each marker 8 is externally painted a colour that is opaque and that is also different from the colour of the real stone 4 casts.
  • the dental 7 prostheses are applied onto the real stone 4 casts of the dental arches in order to obtain a negative imprint of the markers 8.
  • the dental 7 prostheses are left attached to the real stone 4 casts of the dental arches until the resin has solidified so as to incorporate the markers 8 so that when the dental 7 prostheses are separated from the real stone 4 casts of the dental arches the markers 8 themselves go with them.
  • the dental 7 prostheses are separated from the real stone 4 casts of the dental arches while the resin is still in a plastic state and into the negative imprints are inserted new markers 8 having the same shape and the same dimensions as the markers 8 attached to the real stone 4 casts of the dental arches; however, this method is slightly less precise than the methodology described above.
  • a CT (computed tomography) scan is made of the maxillary arches of the patient in order to obtain a virtual 19 three dimensional reproduction (illustrated in figures 12 and 13) of the skull including the tracking 17 system.
  • the three dimensional scan of the surfaces of the real stone 4 casts can be done before the CT (computed tomography) scan of the maxillary arches of the patient, or alternatively the CT (computed tomography) scan of the maxillary arches of the patient can be done before the three dimensional scan of the surfaces of the real stone 4 casts.
  • the above described methodology enables us to have at our disposal the real stone 4 casts with the tracking 17 system attached in order to make the three dimensional scan of the surfaces in such a way as to obtain the virtual 18 reproduction of the teeth and/or the dental mucosa.
  • the markers 8 are not connected directly to the dental 7 prosthesis, but are inserted into semi-spherical housing 20 seats (shown in figures 9 and 10) and sunk well into their interior so that they become embedded into the dental 7 prosthesis; preferably the housing 20 seats are made of Teflon or a similar material having a certain elasticity such that they retain the markers 8 securely and yet permit the insertion/extraction of the markers 8 into/out of the same housing 20 seats.
  • the titanium spherical markers 8 of the dental 7 prosthesis are substituted with plastic markers 8 (for scanning the surfaces it is not necessary to use titanium, which is much more expensive than plastic) having connecting 10 rods which protrude from the dental 7 prosthesis (as illustrated in figures 10 and 11) , in this way, the connecting 10 rods of the markers 8 are submerged into the body of the copy of the real stone 4 cast and when the copy of the real stone 4 cast is separated from the dental 7 prosthesis the markers 8 remain in the copy of the real stone 4 cast and separate from the dental 7 prosthesis.
  • the graphic design software 15 is used to elaborate the virtual 19 three dimensional reproduction of the skull with the virtual 18 reproduction of the teeth and/or the dental mucosa so as to superimpose the images of the tracking 17 system present in the virtual 19 three dimensional reproduction of the skull with the tracking 17 system present in the virtual 18 reproduction of the teeth and/or the dental mucosa.
  • the result of the CT (computer tomography) scan is combined with the result of the scan of the surfaces, in such a way as to have exact conformation of the bone structure (computed tomography) with exact conformation of the surfaces of the dental arch (scan of surfaces) .
  • Figure 14 shows a virtual 19 three dimensional reproduction of the skull integrated with the virtual 18 reproduction of the teeth and/or the dental mucosa.
  • CT computed tomography
  • the scan must be made with a step of no less than about lmm.
  • the scan of the surfaces of the real stone 4 casts of the dental arches allows a very accurate and precise reproduction of the teeth and the above all, of the dental mucosa.
  • the integration of the virtual 19 three dimensional reproduction of the skull with the virtual 18 reproduction of the teeth and/or the oral mucosa gives a final result that is extremely faithful and reduces to a minimum the unavoidable load of radiation to which the patient is exposed.
  • the integrated image of the virtual 19 three dimensional reproduction of the skull and the virtual 18 reproduction of the teeth and/or the dental mucosa is sectioned lengthwise on a vertical plane, in this way it becomes easy to identify the axis 21 of insertion of the implant (figure 18) and subsequently to choose the length and the size of the implant from amongst the commercially available alternatives (figure 18).
  • the metal 22 roots of the implant can be virtually positioned inside the integrated image of the virtual 19 three dimensional reproduction of the skull and the virtual 18 reproduction of the teeth and/or the dental mucosa.
  • a virtual surgical template 2 guide is created, which reproduces in negative the shape of the dental arches and/or the dental mucosa; and finally, the virtual surgical template 2 guide is perforated by a virtual guide 23 hole, which is co-axial to the axis 21 of insertion of the implant and has a diameter that receives without play the calibrated metal guide 24 sleeve (illustrated in figure 19) appropriate to the chosen implant .
  • the real surgical template 2 guide is made by using the virtual surgical template 2 guide and the three dimensional stereo lithographic 14 printer, and subsequently, into the guide 23 holes of the real surgical template 2 guide are inserted the calibrated metal guide 24 sleeves (illustrated in figure 19) belonging to the chosen implant.
  • the virtual surgical template 2 guide may be used to drive a numerically controlled machine tool in such a way as to obtain the real surgical template 2 guide from a block of resin.
  • Figure 20 shows part of the three dimensional image of the skull of the patient of figure 14 sectioned lengthwise on the vertical plane and with the addition of part of the virtual template 2 guide containing the virtual 24 sleeves.
  • Figures 21 and 22 show two three dimensional reproductions of the virtual template 2 guide of figure 20; in figure 21 the guide holes 23 and the relative axes 21 are indicated, while in figure 22 the virtual guide 24 sleeves are indicated.
  • figures 23 and 24 are shown two three dimensional reproductions of the virtual template 2 guide of figure 20 overlaying a virtual 18 reproduction of the teeth and/or dental mucosa as obtained by scanning the surfaces of the stone 4 cast of the upper dental arch shown in figure 4.
  • Figure 23 shows the guide 23 holes and the images of the markers 8, while figure 24 shows the virtual sleeves 24.
  • a template 2 guide such as the one described above can be used in combination with various surgical intervention methods; for example, it can be used in the "flap surgery” technique for positioning implants; in “one-stage” surgical technique; in the “transmucosal implants” surgical technique; and in the “minimal intervention” surgical technique.
  • the calibrated metal guide 24 sleeves are made from titanium and must protrude from the edge of the surgical template 2 guide towards the mucosa and have the contour of a circular scalpel, such as determines the first incision of a gingival operculum.

Landscapes

  • Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Apparatus For Radiation Diagnosis (AREA)

Abstract

L'invention concerne un procédé et un poste de travail (1) permettant d'élaborer un guide chirurgical (2). Selon le procédé de l'invention, un moule en plâtre (4) des arcades maxillaires est effectué; un système de suivi est relié (17) au moule en plâtre (4) en effectuant un balayage tridimensionnel des surfaces du moule en plâtre (4) afin d'obtenir une reproduction virtuelle (18) des dents et/ou de la muqueuse dentaire avec le système de suivi (17), lequel est relié audit moule en plâtre (4) et appliqué sur le patient; un tomodensitogramme est ensuite effectué afin d'obtenir une reproduction virtuelle tridimensionnelle (19) d'au moins une partie du crâne laissant apparaître le système de suivi (17). La reproduction virtuelle tridimensionnelle (19) est ensuite intégrée à la reproduction virtuelle (18) des dents et/ou de la muqueuse dentaire afin de mettre en place l'implant dentaire dans un environnement virtuel, et de créer le guide chirurgical (2) au moyen des résultats de la mise en place virtuelle.
EP06795187A 2005-08-02 2006-08-01 Procede et poste de travail permettant d'elaborer un modele chirurgical pour guider l'insertion d'implants osteointegres dans les arcades maxillaires Withdrawn EP1922015A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT000542A ITTO20050542A1 (it) 2005-08-02 2005-08-02 Metodo e stazione di lavoro per realizzare una mascherina guida per la inserzione di un impianto osteointegrato nei mascellari
PCT/IB2006/002091 WO2007015140A2 (fr) 2005-08-02 2006-08-01 Procede et poste de travail permettant d'elaborer un modele chirurgical pour guider l'insertion d'implants osteointegres dans les arcades maxillaires

Publications (1)

Publication Number Publication Date
EP1922015A2 true EP1922015A2 (fr) 2008-05-21

Family

ID=37497026

Family Applications (1)

Application Number Title Priority Date Filing Date
EP06795187A Withdrawn EP1922015A2 (fr) 2005-08-02 2006-08-01 Procede et poste de travail permettant d'elaborer un modele chirurgical pour guider l'insertion d'implants osteointegres dans les arcades maxillaires

Country Status (3)

Country Link
EP (1) EP1922015A2 (fr)
IT (1) ITTO20050542A1 (fr)
WO (1) WO2007015140A2 (fr)

Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8011927B2 (en) 2008-04-16 2011-09-06 Biomet 3I, Llc Method for pre-operative visualization of instrumentation used with a surgical guide for dental implant placement
EP2266490A1 (fr) * 2009-06-24 2010-12-29 Rodrigo Martinez Orcajo Procédé de fabrication d'implants dentaires et utilisation de tels modèles sur des patients partiellement édentés
EP2797512A4 (fr) * 2011-12-30 2015-09-09 Philip D Gole Dispositifs et techniques d'évaluation médicale de superposition d'images
CN102551892A (zh) * 2012-01-17 2012-07-11 王旭东 一种用于颅颌面外科手术的定位方法
US11612462B2 (en) * 2020-08-24 2023-03-28 Dio Corporation Method of implanting dental restoration

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5967777A (en) * 1997-11-24 1999-10-19 Klein; Michael Surgical template assembly and method for drilling and installing dental implants
DE69724669T2 (de) * 1997-12-18 2004-07-08 Technique D'usinage Sinlab Inc., Blainville Verfahren zur herstellung einer zahnimplantatsuprastruktur
US20020160337A1 (en) * 2001-04-30 2002-10-31 Michael Klein Method of using computer data to modify or alter an existing cast or model
US6671539B2 (en) * 2001-10-03 2003-12-30 Board Of Regents University Of Texas System Method and apparatus for fabricating orthognathic surgical splints
US7044735B2 (en) * 2003-05-02 2006-05-16 Leo J. Malin Method of installing a dental implant
KR101235320B1 (ko) * 2004-09-14 2013-02-21 오라티오 비.브이. 미적인 임플란트 어버트먼트를 가지는 세라믹 치아임플란트의 제조방법 및 설치방법

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO2007015140A2 *

Also Published As

Publication number Publication date
WO2007015140A2 (fr) 2007-02-08
WO2007015140A3 (fr) 2007-04-12
ITTO20050542A1 (it) 2007-02-03
WO2007015140A8 (fr) 2008-01-31

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