Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
  • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
  • A61C1/08—Machine parts specially adapted for dentistry
  • A61C1/082—Positioning or guiding, e.g. of drills
  • A61C1/084—Positioning or guiding, e.g. of drills of implanting tools
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
  • A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
  • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
  • A61B17/176—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the jaw
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00526—Methods of manufacturing
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00831—Material properties
  • A61B2017/00902—Material properties transparent or translucent
  • A61B2017/00915—Material properties transparent or translucent for radioactive radiation

Definitions

• the present invention relates to a drilling tool guide device for placing at least one dental implant.
• This type of guiding device is used when the dentition of a patient is highly degraded and requires the replacement of missing teeth by dental prostheses.
• These dental prostheses are secured to the jaws of the patient using cylindrical dental implants screwed or impacted in housings in the jaw bone of the patient.
• a drilling drill guide device comprising a tubular guide for guiding a drilling tool, the tubular guide being made of radiopaque material and pivotally mounted on a first radially transparent support element about an axis. orthogonal to the axis of the tubular guide to allow adjustment of its inclination.
• the first support member is slidably mounted in a second radiolucent support member to allow adjustment of the position of the tubular guide, the second support member being secured in a gutter adapted to the patient's dental arch substantially at the edentulousness.
• This device is used as follows. First, the dentist adjusts the position and inclination of the tubular guide along an estimated piercing axis.
• an X-ray scan of the patient's jaw with the gutter is performed by a radiologist.
• an image according to an oblique coronal section of the jaw showing the radiopaque tubular guide is reconstituted. From this reconstructed image, the dentist determines an ideal axis of drilling and moves the tubular guide to align the axis of the tubular guide with the determined ideal axis of drilling.
• the tubular guide is then locked in position with a hardenable material to allow the dentist to bear on the latter to pierce a housing in the patient's jaw.
• a first disadvantage is that before blocking the tubular guide with the curable material, the inclination of the latter is only maintained by friction between the first support member and the tubular guide. As a result, the inclination of the tubular guide can be disrupted during transport to perform the X-ray scanner examination and during dental practice. However, such misalignment would result in inaccuracy in the final positioning of the tubular guide and therefore the housing in the maxillary.
• a second disadvantage is that the adjustment of the position of the tubular guide is made, according to a first embodiment, by cooperation of grooves formed on the first support member with ribs formed on the second support member.
• the accuracy of such an adjustment is limited to the spacing between two adjacent ribs, which has the consequence of generating a significant inaccuracy when working in reduced anatomical volumes.
• the adjustment of the position of the tubular guide is achieved by friction between the two support elements, which generates the disadvantages described above.
• a guiding device comprising a gutter adapted to be adapted to at least the teeth adjacent to a toothlessness.
• the gutter comprises guide cylinders of the drill drills respectively arranged so that their axis coincides with the ideal axis of drilling of each housing.
• the guidance device described in this document is made by computer design (CAD) using directly the data from the X-ray scanner examination.
• the use of a guide cylinder involves an insertion of the drill bit along a single axis which is that of the geometric axis of the guide cylinder.
• This low possible deflection of the drill is frequently a disadvantage in case of weak mouth opening of the patient, or in case of use of long drill in the posterior part of the oral cavity, the teeth of the opposing dental arch making in this case often obstacle to the introduction of the drill into the guide cylinder.
• the present invention aims to remedy these disadvantages.
• the technical problem underlying the invention is therefore the realization of a drilling tool guide device for the establishment of at least one dental implant which is simple and inexpensive structure, while allowing accurately and reliably position the dental implant in the maxillary bone.
• the invention relates to a drilling tool guide device for the establishment of at least one dental implant, characterized in that it comprises:
• a gutter adapted to be adapted to at least the teeth adjacent to an edentulum or to the oral mucosa in case of total edentulousness; an at least partially radiopaque marker inserted in the gutter along a reference axis; insert having a housing opening into the face of the gutter opposite to the oral mucosa,
• a piercing guide comprising first and second portions connected to each other, the first portion being intended to be inserted into the housing formed in the locating insert, the second portion being comprising means for guiding the drilling tools according to a determined drilling axis, and
• drilling tool is meant a tool for housing housings in the jaw bone of a patient, for example drilling drills or osteotomes.
• the drilling guide Due to the presence of the guiding and locking means of the first portion in the housing of the insert, the drilling guide is perfectly held in place in the insert. As a result, the dentist can provide a housing in the maxilla according to the drilling axis determined with great precision using the guide means of the drilling tools.
• the guiding device comprises a pad of radio-opaque material intended to be removably mounted in the housing formed in the locating insert.
• the presence of the partially radiopaque insert allows the radiologist to ensure that the acquisition is performed according to a plane comprising the geometric axis of the insert, identifying by transparency when the lower and upper faces of the insert are orthogonal to the plane of view,
• the radio-opaque stud mounted in the insert is visible on the images of the jaw reconstituted from the radiographic views obtained and materializes the reference axis.
• the guide means of the drilling tools comprise a groove of substantially semicircular section formed in the second portion and of axis coinciding with the determined drilling axis.
• This structure of the guide means of the drilling tools facilitates the drilling of the maxillary according to the drilling axis determined by the fact that it facilitates the insertion of the piercing tool into the guide means. Indeed, the dentist can tilt the piercing tool to bring it to the level of the groove and then tilt the latter so that it comes into contact with the groove. Thus, in case of engagement of a long drill in the groove with a small mouth opening, it is possible to bypass a tooth of the opposing dental arch and then apply the drill against the groove, which is impossible when the drilling guide is tubular.
• the guide means of the drilling tools comprise a main cylindrical tube of axis coinciding with the determined drilling axis. It should be noted that this alternative guiding means is usable only when the oral opening of the patients is sufficient.
• the guiding means comprise at least one second cylindrical tube complementary to the main cylindrical tube and intended to be engaged in the latter, the second cylindrical tube having an internal diameter corresponding to the diameter of a tool piercing used.
• the guide means comprise a series of cylindrical tubes of internal diameters corresponding to the diameters of the various drilling tools used, the different tubes being able to be nested within each other.
• the inner profile of the housing formed in the insert is at least partially complementary to the outer profile of the first portion, the inner and outer profiles forming the guiding and locking means of the first portion.
• the locking and guiding means of the first portion comprise at least one groove formed on the inner profile of the housing formed in the insert or on the outer profile of the first portion intended to cooperate with a rib of complementary shape formed respectively on the outer profile of the first portion or on the inner profile of the housing formed in the insert.
• the reference axis is oriented substantially along the assumed geometric axis of a missing tooth.
• the locating insert is fixed in a housing formed in the gutter along the reference axis and opening into the face of the gutter opposite to the oral mucosa.
• the insert is cylindrical and the housing formed in the insert is coaxial with the axis of the insert.
• the insert has a recess opening into the outer surface of the insert and into the housing formed in the insert and extending over at least a portion of the thickness of the insert. substantially parallel to the insertion direction of the first portion in the housing.
• the present invention also relates to a method of manufacturing a drilling tool guide device for the placement of at least one dental implant, characterized in that it comprises the steps of:
• a gutter adapted to be adapted to at least the teeth adjacent to edentulousness or on the oral mucosa in case of total edentulence, - arrange an at least partially radiopaque marker insert in the gutter along a reference axis, the insert having a housing opening into the face of the gutter opposite to the oral mucosa,
• a drill guide having first and second portions connected to one another in the housing formed in the locating insert, the first portion being inserted and held in position in the housing formed in the locating insert.
• the second portion comprising means for guiding the drilling tools according to the determined drilling axis.
• the manufacturing method comprises a step of removably mounting a pad of radio-opaque material in the housing formed in the locating insert.
• the step of determining a piercing axis for positioning the dental implant from the radiographic views obtained comprises several steps consisting in: reconstituting from the radiographic views obtained an image of the jaw showing the marker insert partially radiopaque, determining and materializing on the reconstituted image a drilling axis for positioning the dental implant,
• the image of the reconstituted jaw is an image of the jaw according to an oblique coronal section.
• the image of the reconstituted jaw is an image of the jaw in 3 dimensions.
• the step of arranging the locating insert in the gutter comprises several steps consisting of:
• the housing opening into the face of the gutter opposite to the oral mucosa - Fix the insert in the housing formed in the gutter.
• the geometry of the drilling guide is determined so that the relative orientation and position of the geometric axis of the first portion of the drill guide relative to the geometric axis of the second portion correspond to the relative orientation and position of the geometric axis of the registration insert relative to the determined drilling axis.
• the reference axis of the housing formed in the gutter is made substantially along the assumed geometric axis of a missing tooth.
• the manufacturing method comprises a step of providing a recess in the insert opening into the outer surface of the insert and in the housing formed in the insert, the recess extending over at least a portion of the insert. thickness of the insert substantially parallel to the insertion direction of the first portion in the housing.
• the piercing guide is chosen from a defined number of piercing guides made available to the dentist.
• the drilling guide is made to measure after determining the drilling axis.
• the invention will be better understood with the aid of the description which follows with reference to the attached schematic drawing showing, by way of nonlimiting example, an embodiment of this guiding device.
• Figure 1 is a perspective view of a gutter adapted to the jaw of a patient with partial edentation.
• Figure 2 is a sectional view of the gutter of Figure 1.
• Figure 3 is a perspective view of the locating insert.
• Figures 4 and 5 are perspective views of two drilling guides according to a first embodiment of the invention and two registration inserts machined to receive the respective drilling guide.
• Figure 6 is a perspective view of a drill guide according to a second embodiment of the invention and a registration insert machined to receive the drill guide.
• Figure 7 is a schematic view of an oblique coronal section from the X-ray scanner examination of the jaw of a patient equipped with the gutter.
• a method of manufacturing a drill bit guide device for the placement of at least one dental implant according to the invention comprises a first step which consists in producing a transparent resin channel 2 (shown in FIGS. 2) intended to be adapted to the adjacent teeth 3 to an edent 4 and having a replica 5 of the missing tooth.
• the method comprises a second step of providing a through housing 6 of circular section in the gutter substantially along the assumed geometric axis of the missing tooth.
• the method comprises a third step which consists in fixing by gluing a cylindrical registration insert 7, shown more particularly in FIG. 3, in the housing 6 formed in the trough 2 so that its end facing the oral mucosa is flush with the latter when the gutter is in place in the patient's mouth.
• the insert 7 is made of partially radiopaque synthetic material and has an outer diameter corresponding to the diameter of the housing 6 formed in the gutter.
• the insert 7 comprises an axial through housing 8 of circular section and four longitudinal grooves 9 of semicircular section formed on its inner surface defining the housing, the four grooves being regularly spaced.
• two opposite grooves are oriented in the vestibo-lingual direction.
• the outer diameter of the locating insert is 6 mm while the diameter of its housing is 3 mm.
• the housing formed in the insert is of triangular or square section.
• the method comprises a fourth step which consists in removably mounting a cylindrical pad 22 of radio-opaque material in the housing formed in the locating insert, the pad being of circular section and frictionally held in the housing.
• the method comprises a fifth step which consists of:
• step of determining a piercing axis for positioning the dental implant from the radiographic views obtained comprises several steps of:
• obtaining a radiographic type of visualization can be obtained by performing an X-ray scanner examination of the jaw of the patient equipped with the gutter and that the radiographic views can be constituted by scanner sections.
• the method comprises a sixth step of custom-making a metal drill guide 15 (shown in FIGS. 4 and 5) having first and second portions 16, 17 connected to each other whose geometry is determined so that that the relative orientation and position of the geometric axis of the first portion 16 of the drill guide relative to the geometric axis of the second portion 17 of the drill guide correspond to the orientation and the relative position of the geometric axis of the marker insert 14 relative to the piercing axis determined 12.
• the first portion 16 is generally cylindrical in shape and is intended to be inserted and held in position in the housing 8 formed in the locating insert 7.
• the first portion 16 has a diameter outside corresponding to the inside diameter of the housing formed in the insert and comprises four longitudinal ribs 18 formed on its outer surface intended to cooperate with the grooves 9 formed on the insert.
• the first portion therefore has an outer profile complementary to the inner profile of the housing formed in the insert.
• the guiding device comprises means for guiding and locking the first portion 16 in the housing 8 of the insert 7 imposing a relative orientation of the first portion relative to the insert in a transverse plane to the direction of insertion, these guiding and locking means being formed by the inner profile of the housing 8 formed in the insert and the outer profile of the first portion 16.
• the second portion 17 is connected to the first portion 16 by a connecting portion 19 oriented in the buccolingual direction in the mounted position of drilling guide. It should be noted that the second portion 17 is directly connected to the first portion 16 when the differences between the orientations and the relative positions of the first and second portions are minimal.
• the second portion 17 comprises a semi-cylindrical portion comprising means for guiding the drill bits according to the determined drilling axis, this axis corresponding to the ideal axis of drilling for positioning the dental implant.
• the drilling drill guide means comprise a groove 20 of substantially semicircular section arranged longitudinally in the semi-cylindrical part and of axis coinciding with the determined drilling axis 12.
• the method comprises a seventh step of firstly providing in the insert a recess 21 opening into the outer surface of the insert and into the housing formed in the insert and extending longitudinally over the entire thickness of the insert. the insert, and on the other hand arrange a recess in the gutter to allow the insertion of the piercing guide into the insert.
• the method comprises an eighth step of inserting the first portion 16 of the drill guide 15 into the housing 8 of the insert 7, to adapt the gutter 2 to the jaw 1 1 of the patient and to achieve with the guide Drill a housing in the jaw of the patient to receive a dental implant.
• FIG. 6 represents a drilling guide 15 according to a second variant embodiment of the invention.
• the drilling drill guide means comprise a main cylindrical tube 23 of axis coinciding with the determined drilling axis 12.
• the guide means also comprise a second 24 and a third 25 cylindrical tubes.
• the second tube 24 is complementary to the main tube 23 and can be engaged in the latter while the third tube 25 is complementary to the second cylindrical tube 24 and can be engaged in the latter, these different tubes for guiding drilling drills of different diameters.
• the tube 25 allows the guiding of a drill bit 26 of diameter corresponding to the inside diameter of the tube 25.
• the piercing guide is obtained by stereolythographically performing an intermediate piercing guide of calcinable material and then casting a metal piercing guide by the lost wax method.
• the step of making a drill guide is replaced by a step of choosing a drill guide from a defined number of drilling guides made available to the dentist.
• the reference axis is oriented arbitrarily, without taking into account the dental anatomy.
• two opposite grooves formed in the insert are oriented in the mesiodistal direction.
• the locating insert is overmolded with the gutter or the gutter is made around the insert.
• the invention provides a great improvement to the existing technique by providing a guiding device which is simple in structure and inexpensive, while allowing to obtain accurate and reliable results.

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• 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)
• Dental Prosthetics (AREA)

Applications Claiming Priority (2)

Publications (1)

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• 2006
  • 2006-01-24 FR FR0600623A patent/FR2896403B1/fr not_active Expired - Fee Related
• 2007
  • 2007-01-22 EP EP07730840A patent/EP1976448A1/de not_active Withdrawn
  • 2007-01-22 WO PCT/FR2007/000120 patent/WO2007085719A1/fr active Application Filing

Non-Patent Citations (1)

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