EP2134291A1 - Procédé de contrôle de la préparation d'une dent par cao - Google Patents

Procédé de contrôle de la préparation d'une dent par cao

Info

Publication number
EP2134291A1
EP2134291A1 EP08717731A EP08717731A EP2134291A1 EP 2134291 A1 EP2134291 A1 EP 2134291A1 EP 08717731 A EP08717731 A EP 08717731A EP 08717731 A EP08717731 A EP 08717731A EP 2134291 A1 EP2134291 A1 EP 2134291A1
Authority
EP
European Patent Office
Prior art keywords
preparation
tooth
distance
determined
marked
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Withdrawn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
EP08717731A
Other languages
German (de)
English (en)
Inventor
Paul Weigl
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.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Publication of EP2134291A1 publication Critical patent/EP2134291A1/fr
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00—Dental auxiliary appliances
    • A61C19/04—Measuring instruments specially adapted for dentistry
    • 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
    • A61C5/00—Filling or capping teeth
    • A61C5/70—Tooth crowns; Making thereof
    • A61C5/77—Methods or devices for making crowns
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C9/00—Impression cups, i.e. impression trays; Impression methods
    • A61C9/004—Means or methods for taking digitized impressions
    • A61C9/0046—Data acquisition means or methods
    • A61C9/0053—Optical means or methods, e.g. scanning the teeth by a laser or light beam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1077—Measuring of profiles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/45—For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4538—Evaluating a particular part of the muscoloskeletal system or a particular medical condition
    • A61B5/4542—Evaluating the mouth, e.g. the jaw
    • A61B5/4547—Evaluating teeth
    • 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

  • the invention relates to a method for controlling a preparation of a prepared tooth or a prepared implant with CAD methods, using a first 3D image of the prepared tooth with at least a part of its adjacent tooth.
  • the defects mostly caries-related lesions - are treated either with plastic filling material directly on the tooth. After curing and post-processing of the filling materials (for example surface polishing), no further therapeutic measures are required.
  • the insertion axis is usually selected parallel to the tooth axis in order to keep the loss of hard substance for the design of a slightly conical cone relatively low.
  • the cavity walls are to be prepared with a slight diverging effect.
  • the prepared tooth is the matrix
  • the inlay is the corresponding hands, form-fitting male for the cavity.
  • the conicity or divergence of opposing preparation walls is determined in relation to the insertion axis. Too much conicity or divergence of opposing preparation surfaces causes unnecessary loss of substance and thus an increased risk of devitalization of the tooth. In addition, the tooth experiences a weakening of chewing forces. If mechanically retentive fastening materials are used - eg zinc phosphate cement - the adhesion strength of such fixing cements decreases with increasing conicity or divergence. In particular, metallic restorations do not experience enough adhesion to the tooth and decement themselves after a short time. In the opposite case - with steep or almost parallel opposite surfaces - the inclusion is due to a high frictional resistance between tooth and Restoration makes it difficult or impossible.
  • Another requirement for a preparation derives from the limitation of extra-axial shaping processes (casting, sintering, pressing, grinding, etc.).
  • the edge of the restoration can only be wavy to a certain degree; a jagged border can not be reproduced in a complementary manner to the preparation specification.
  • a precisely fitting transition between the restoration material and the intact tooth surface is a prerequisite for the avoidance of secondary caries and thus essential for a sustainable therapeutic success.
  • a smooth, as far as possible not wavy, but straight running preparation margin and a smooth surface of the preparation directly on the preparation margin are therefore among the main requirements of a preparation for the absorption of indirectly manufactured therapeutic agents.
  • Differentiation of the design of a preparation limitation is additionally influenced by the specific material properties and the associated shaping methods.
  • a third requirement for a preparation is the strength and / or the optical properties of the restoration. defined material. Both parameters require a certain thickness of the material layer, on the one hand to withstand the high chewing loads and / or to be able to achieve an appealing aesthetics of the restoration. In other words, a minimum removal of hard tooth substance (enamel / dentin) is required in order to meet the above criterion of a minimum material layer thickness.
  • a ubiquitous and medically very conflicting conflict of objectives in dentistry is to remove neither too little nor too much hard tooth substance in the design of the preparation. Above all, not necessary too much hard tissue removal endangers both the vitality of the tooth and the mechanical strength of the remaining residual tooth substance.
  • an objective control of a preparation is of high clinical importance for the accuracy of fit and life of the therapeutic agent used on the prepared tooth or implant, such as inlays, onlays, veneers and crowns.
  • the therapeutic agent used on the prepared tooth or implant such as inlays, onlays, veneers and crowns.
  • DE 197 14 526 A1 discloses a control system for assessing the preparations of teeth, dental restorations or dentures.
  • the prepared tooth is measured by a measuring device, and an evaluation device evaluates the preparation as a function of predetermined desired information and the measurement information supplied by the measuring device.
  • the control system is for teaching and training purposes, whereby prepared teeth of a training model are assessed. For this purpose, the teeth can be included in the training model or removed for inclusion in the training model. For assessment, a desired preparation result is superimposed with the measurement information of the measuring device.
  • a disadvantage of this control system is that for the assessment a template of a desired preparation is superimposed with the measured preparation. This requires a database with multiple templates for different preparation types of different sizes. This assessment is useful for teaching purposes, since teeth of the same size are prepared in standardized training models and the desired preparation is clearly known. This procedure is unsuitable for the evaluation of preparations of real teeth, because real teeth differ in their shape and size and the optimal preparation depends on the individual clinical case, whereby several preparation forms within a tolerance range can be clinically indicated. Defective preparation types in particular - such as the inlay preparation - have a large size in terms of their extent and preparation margin Diversity. Therefore, an assessment based on given criteria is a more objective control method.
  • Another disadvantage is that the preparation is not controlled for its position relative to the antagonists and the adjacent teeth, but only to their shape.
  • the conventional, worldwide applied method is based on a visual control of the preparation directly in the patient's mouth.
  • Dental mirror and dental probe serve as aids for a purely subjective and experience-based assessment of the preparation.
  • a pair of magnifying glasses or an OP microscope improve the detection of compromised surfaces of a prepared tooth.
  • Two-dimensional photographs of the preparations are increasingly being used as an alternative to the aforementioned optical aids. If there are insufficient requirements for a visual assessment, the tooth can be molded and then the negative (impression) or the positive (impression of the impression, jaw model) of the preparation can be evaluated.
  • a parallelometer can also be used to objectively record the preparation angle and any undercuts that may be present. If defective regions of the preparation are discovered and attempted to be removed by re-grinding the tooth, further impression-taking is required for re-examination of the preparation or for the production of the dental restoration on a jaw model.
  • the considerable additional expenditure of time which entails enormous costs and increased burden on the patient. Due to the repeated impressions, the method of impression taking for the control of a preparation is only rarely used in dental practices or dental clinics. However, it is precisely this disadvantageous methodology-an impression of the preparation-that bases all known new CAD-based methods for the evaluation of preparations. The impression is poured out in plaster.
  • CAD-based software for control of preparations reads in the 3D data set of an extraoral scanner and visualizes it on the screen.
  • the software user selects a series of routines to execute the preparations on his own. chose to measure localized area.
  • the interactive measurement of the preparation takes a lot of time due to this procedure.
  • One approach of the above problem is a real-time three-dimensionally recorded dental handpiece during the preparation.
  • the tooth and its neighboring structures are measured three-dimensionally before the preparation is started.
  • the position of the grinding body clamped in the handpiece is correlated and its movements guided by the dentist's hand are recorded three-dimensionally.
  • CAD software now calculates the removal of the tooth virtually in real time.
  • the object of this invention is to provide a method for controlling a preparation of a prepared tooth, which allows in a simple and time-saving manner to objectively judge whether the preparation was performed according to the desired or required specifications and thus the clinical and material-related requirements, in order to be able to fit and fasten an extraorally produced therapeutic agent on the prepared tooth.
  • the method for controlling a preparation of at least one prepared tooth or at least one prepared implant using CAD methods uses a first 3D image of the prepared tooth or prepared implant with at least one part of its adjacent tooth.
  • a preparation margin of the preparation is determined.
  • Distances of the preparation to the neighboring teeth and / or to a desired preparation and / or to a gingiva surface and / or an angle of a preparation wall and / or a roughness of the preparation are determined from the first 3D image.
  • Those partial surfaces of the preparation are marked whose distances from the neighboring teeth, to the desired preparation and / or to a gingival surface and / or their angle and / or their roughness are outside the limits of a respective tolerance range.
  • those preparation margins adjacent to the preparation margin are marked whose ripple is out of tolerance.
  • the preparation can be made on a tooth or a dental implant.
  • the inventive control method can be performed directly in the dental office immediately after preparation. As a result, the preparation and the possibly required correction of the preparation can be carried out during a single dental treatment.
  • the first image depicts the prepared tooth with at least parts of its adjacent teeth.
  • the preparation margin is the limit of the preparation between a non-ground tooth surface and a ground tooth surface. Preparation margins adjacent to the preparation margin are checked for waviness. Preparation margins whose waviness exceeds a specified tolerance range are marked. This ensures an exactly fitting transition between the material of a therapeutic agent and the healthy non-ground tooth surface, which leads to the avoidance of secondary caries. Depending on the manufacturing process, a restoration margin of the therapeutic agent may be present only be made to a certain ripple. For example, a spike containing preparation margin is not complementary reproducible.
  • the measured preparation is compared with a desired preparation in the form of a groove, internally grooved stage and a chamfer for a spring edge, and partial surfaces whose deviations exceed a defined tolerance range are marked.
  • the marked partial surfaces consequently have the stated parameters which lie outside the limits of a respective tolerance range and are therefore unsuitable for attachment of a therapeutic agent to this preparation due to lack of stability, lack of adhesion and / or lack of material-related optical properties of the restoration. If the tooth hard tissue removal is too small, the marked partial surfaces can be corrected by further removal so that the mentioned parameters are within the respective tolerance ranges.
  • Partial surfaces of the preparation are marked, which are either too conical or divergent with respect to the insertion axis, or are prepared too steep to parallel or have undercuts, because these partial surfaces have angles of the preparation walls and distances to a desired preparation, which lie outside the tolerance range.
  • the inventive method for the control of preparations can be used in a dental treatment to ensure the quality of the created dental restorations. Another application of the method is to control the quality of 3D images of preparations from a data library. The data obtained according to the inventive control method can be used as proof of the quality of the prepared preparation. valley for documentation purposes.
  • the inventive method can be used for teaching purposes by checking the correctness of the preparations made by students in dental models. This allows the learner to independently and objectively check the finished preparation for their quality without the help of teaching staff and correct it on the marked partial areas.
  • One advantage is that the fit of the restoration is improved by a corrected preparation and thus the service life of the tooth replacement part is increased.
  • a further advantage is that at follow-up examinations the dentist is allowed to call up the data of the control examination of the corresponding preparation from the data library.
  • a further second 3D image of an impression of the counterbite at the location of the prepared tooth or the prepared implant and at least a part of a neighboring tooth can be used to control the preparation.
  • the first 3D image is correlated with the second 3D image. From the correlated 3D images, a first distance of the preparation of the prepared tooth to the opposing teeth is determined. Those partial surfaces of the preparation are marked whose first distance to the opposing dentition is outside the limits of a tolerance range.
  • the second image captures the dentition or the therapeutic agent used in the opposing dentition at the site of the prepared tooth.
  • impression of the opposing jaw can be created using a dynamic interocclusal regis- ter (impression material), which is applied to the prepared tooth without covering the adjacent teeth. Marked points and structures of the neighboring teeth can then be used to correlate the first 3D image comprising the prepared tooth with the second 3D image encompassing an impression of the antagonist.
  • the spatial allocation of the antagonistically related teeth or dental therapeutic agent in the dynamic occlusion of the patient is determined by means of the correlation of the first with the second 3D images.
  • the impression of the opposing dentition at the site of the prepared tooth is produced by placing the impression compound in the place of the prepared tooth and biting the molding compound so that the adjacent teeth of the prepared tooth come into contact with the respective counter teeth and one Impression of the opposing dentition in the region of the prepared tooth is produced in the molding material.
  • Partial surfaces of the preparation are marked whose distance to the antagonist (antagonist) lies outside the tolerance range. Too small a distance would result in a restoration with a small material thickness that would not achieve the required strength and / or aesthetic optical property.
  • a third 3D image of the tooth to be prepared can be used before the preparation and at least part of a neighboring tooth.
  • the first 3D image is correlated with the third 3D image. From the correlated 3D images are determined a distance of the preparation to the surface of the tooth before dissecting perpendicular to the surface of the preparation. Those partial surfaces of the preparation are marked whose distance from the tooth prior to preparation is outside the limits of a tolerance range.
  • the distance of the preparation to the tooth or implant can be determined before the preparation and the partial surfaces whose distance exceeds the permissible tolerance range can be marked.
  • the correlation of the third with the first 3D recording takes place as in the correlation of the second with the first 3D recording over at least three matching prominent points.
  • the preparation can be designed to be supplied with a full crown, an onlay, an inlay, a veneer or a bridge.
  • the preparation to be controlled can therefore be used for extraorally produced therapeutic agents such as full crowns, inlays, onlays, anterior veneers and bridges.
  • the preparations are called full crown preparation, onlay preparation, inlay preparation, veneer preparation and bridge preparation.
  • the partial surfaces of the preparation outside the limits of a respective tolerance range can be automatically marked computer-assisted.
  • the inventive control method can be carried out fully automatically by marking and displaying subareas whose named measurement parameters lie outside the respective tolerance ranges without the intervention of the user.
  • the first, the second and / or the third 3D image intraoral in an oral cavity of a patient or a phantom head takes place.
  • the prepared tooth can be picked up in the phantom head without having to remove it from the phantom head.
  • the waviness of preparation edge surfaces adjoining the preparation edge can be determined and those preparation edge surfaces are marked whose preparation edge has points.
  • preparation marginal areas are marked which are unsuitable for use of a therapeutic agent, such as a crown, precisely fitting the preparation margin.
  • the preparation may have an insertion axis.
  • a first distance of an occlusal surface of the preparation to the impression surface of the opposing dentition along the insertion axis can be determined and partial surfaces can be marked whose first distance is outside a tolerance range by a predetermined desired first distance.
  • the insertion axis represents a connection axis between the preparation and the crown.
  • This insertion axis can be defined as the axis of symmetry to the preparation walls of the preparation by determining the insertion axis via the sum vector of individual vectors that run parallel to the determined preparation walls.
  • Too short a first distance leads to a lack of stability of the crown, because the crown can be detached from the preparation, especially at lateral load.
  • Too long a first distance leads to the fact that the upper occlusal surface of the crown has to be made thin-walled and can break faster under load.
  • the first distance in full crown preparation with respect to the opposing teeth and onlay preparation with respect to a preparation base must be within a tolerance range between 1.0 mm and 2.5 mm.
  • Roughness characteristic values of a preparation surface of the preparation can advantageously be determined and partial surfaces whose roughness characteristic values are outside a tolerance range around a specified desired roughness characteristic value can be marked.
  • roughness characteristics for example, the average roughness, the square roughness and the average roughness depth can be used.
  • the roughness characteristic values are determined indirectly by means of computer-assisted methods from the optical second 3D image and not directly at the preparation surface.
  • the roughness characteristics are checked to determine if they are within a specified tolerance range. This tolerance range is set so that the desired stability of a crown is ensured. Too smooth faces reduce the adhesion of the cementum to the connection of the preparation with the crown, whereas too rough faces at the edge of the restoration lead to a clinically intolerable fit inaccuracy.
  • the roughness characteristics of the preparation walls should be at least 90% of the roughness characteristics of intact non-ground tooth surfaces.
  • a roughness parameter can be determined on a surface of a healthy neighboring tooth in order to to serve as a reference value for the determination of the roughness characteristics of the preparation surface.
  • a roughness index is determined before the measurement on a healthy tooth surface, such as the occlusal surfaces of the adjacent teeth, and used as a reference value. In this way, at least one relative measurement of the roughness can be made to determine if the subareas being examined are smoother or rougher than the surface of healthy, non-ground adjacent teeth.
  • a functional dependence in the form of a characteristic curve of the roughness characteristic values from the evaluation of the optical second 3D image and the actual roughness can be determined experimentally, so that the roughness characteristics can be assigned to an actual roughness and possible camera artifacts are not interpreted as actual roughness.
  • the determined measured value is set in relation to the known actual roughness of healthy tooth surfaces.
  • a second distance which is perpendicular to the preparation surface of the finished preparation, between the preparation surface and the surface of a desired preparation can be determined and partial areas can be marked whose second distance is outside the limits of a tolerance range.
  • a desired preparation may, for example, have the form of a tangential, chamfer or step preparation.
  • the user can select a desired preparation type from a database with different 3D models of preparation types and size them to the tooth to be prepared. fit. The type of preparation is selected depending on the requirements for the preservation of the tooth substance, the aesthetic impression and the stability. If the finished preparation deviates from the desired preparation, these requirements can not be met.
  • a third distance which is aligned perpendicular to the insertion axis, between the preparation wall and the surface of the adjacent tooth can be determined and partial surfaces can be marked, the third distance is outside the limits of a tolerance range.
  • the required for the use of the therapeutic agent along the insertion axis third distance to the adjacent teeth is controlled.
  • the third distance for full crown, onlay and inlay preparations should be at least 0.5 mm.
  • the preparation may have an insertion axis.
  • An angle between a preparation wall and the insertion axis is determined in the cervical or the mastic region. Subsequently, faces are marked whose angles lie outside a tolerance range by a specified desired angle. This ensures the accuracy of fit and stability of the restoration, because partial surfaces with too steep or too low an angle could lead to a reduction of the stability of the restoration. If the angle is too low, the static friction opposite to the insertion axis is too low, in order to avoid the adhesion of the dental cement between the preparation and the crown. ter Bayn. If the angle is too steep, the shear forces on the preparation walls are too high to ensure trouble-free insertion of the restoration to the exact final position of the restoration in the tooth.
  • the angle is determined for the mastic area directed to the occlusal surface of the preparation or for the cervical area directed to the cervical area. In the cervical area, the desired angle is steeper than in the mastic area.
  • the tolerance range of the angle is between 4 ° and 9 °. For onlay and inlay preparation, this tolerance range is between 6 ° and 15 °.
  • points are selected on a nearly flat surface and linearly approximated.
  • the points can be selected at a predetermined distance from the preparation margin parallel to the insertion axis.
  • the points can be selected automatically at defined intervals, so that an objective assessment of different preparations is possible.
  • the points on a nearly flat surface can be automatically selected computer-assisted and linearly approximated. This saves manual selection of the points and thus accelerates the inventive method.
  • the fourth distance between partial surfaces above the preparation margin and the gingival surface can be determined. Subareas above the preparation margin are marked, the fourth distance of which is outside a tolerance range around a specified desired fourth distance.
  • portions of the preparation that are too close or too far from the gingival surface are determined. If the preparation margin is too far from the gingival surface, the transition from the prepared tooth to the artificial crown with different colors may affect the visual impression of the dental prosthesis. If the preparation margin is too close to the gingival surface, the lower edge of the artificial crown can lead to inflammation of the gums.
  • the fourth distance should have a so-called equi- gingival preparation course with a tolerance range of -0.2 mm to +0.2 mm or a supragingival gingival course with a fourth distance of at least 0.2 mm.
  • the fourth distance should have a so-called subgingival preparation course with a tolerance range of -0.5 mm to -1.5 mm below the gingiva.
  • the partial surfaces can be marked in color and the color intensity increase with the distance to the desired value within the limits of the respective tolerance range.
  • the marked partial areas in the display by means of a display device, such as a Monitor, highlighted and perceptible to the viewer.
  • the increase in color intensity within the tolerance range indicates the distance to the desired value. Subareas with the desired value are therefore not marked.
  • the partial surfaces can be marked in color whose distances to the desired value are outside the limits of the respective tolerance range.
  • the first 3D image can be generated from a plurality of images recorded from different directions. At least one of the recordings takes place parallel to an insertion axis of the preparation and serves as a reference receptacle for the definition of a coordinate system.
  • the orientation of the camera in the insertion axis is made possible by a simultaneous, two-dimensional video image.
  • the camera must be aligned until the entire preparation margin is imaged on this 2D image, eg in full-crown preparations, the entire preparation surface can be seen in onlay or inlay preparations, or the entire labially smoothed tooth surface is detected in veneer preparations becomes.
  • Multiple images from different directions are assembled to the second 3D image using image processing algorithms.
  • One of the recordings can be made in the direction of the slide-in axis and the slide-in axis can be automatically set as, for example, the Z-axis of a Cartesian coordinate system. If no recording in the direction of the insertion axis must be a Insertion axis either fully automatically calculated or set interactively to evaluate the images.
  • the insertion axis can be determined via the sum vector of individual vectors that run parallel to the determined preparation walls.
  • a fully automatic calculation of the insertion axis is based on a CAD system identification of preparation walls and the identification of an occlusal surface of the preparation.
  • the occlusal surface of the preparation is a plane which is parallel to the occlusal surface of a neighboring tooth or parallel to the middle plane of two occlusal surfaces of the two adjacent teeth.
  • the preparation walls are automatically segmented by the CAD system based on edges and represented by a single vector, which is aligned parallel to the segmented preparation wall and whose magnitude is correlated with the area size. All individual vectors that are aligned in the tolerance range of ⁇ 30 ° parallel to the occlusal surface of the preparation are discarded. The remaining vectors are summed. The sum vector defines the calculated insertion axis of the preparation.
  • the individual vectors representing the preparation walls of the abutment teeth prepared for a crown can be compared with one another.
  • the correlation of the at least two 3D images can be automatically computer-assisted by: at least a portion of the neighboring tooth is detected and superimposed in the at least two 3D images.
  • the correlation of the at least two 3D images can be performed manually by selecting and matching at least three similar points in the subarea of the neighboring tooth in the at least two 3D images by the user.
  • the manual correlation is performed because the user chooses striking similar points, and the different sections are not considered for the correlation, unlike the computer-crashed method.
  • the preparation margin of the preparation can be automatically determined by selecting a point on the preparation margin automatically or by the user and by means of edge tracking the remaining course of the preparation margin is determined.
  • the preparation can be prepared for a whole crown. In a full crown, all surfaces of the tooth are sheathed. These crowns are usually made of ceramic materials.
  • the full-crown preparation is subject to various requirements which must be met in order to achieve the desired durability and the desired optical properties. To ensure shafts of the full crown. These requirements are controlled according to the present invention and marks partial surfaces whose parameters are outside the predetermined tolerance ranges.
  • the first distance is an interocclusal distance between the partial surface of the preparation facing the opposing dentition and the surface of the opposing dentition.
  • the tolerance range of this distance is between 1.0 mm and 2.5 mm.
  • the preparation walls should have an angle to the insertion axis, the so-called preparation angle, which lies within a tolerance range between 4 ° and 9 °.
  • the preparation walls should be at least 0.5 mm away from the neighboring teeth.
  • the full-crown preparation may be a tangential preparation, a chamfer preparation or a step preparation.
  • the desired preparation form has a continuous transition between the ground preparation surface and the untrimmed tooth.
  • the advantage of this preparation form is a minimal removal of the enamel, but has disadvantages in the durability and accuracy of fit of the crown.
  • the chamfer preparation has a counterbored groove, the radius of curvature and design of which depends on the material and the shape of the abrasive article.
  • the step preparation has at the preparation edge a step-shaped recess, which runs as far as possible at right angles to the preparation walls, namely within a tolerance range between 90 ° and 100 °.
  • An onlay can be described as a full crown with its preparation margin just below the occlusal surface is positioned so that the onlay covers the entire occlusal surface up to the cusp tips.
  • the preparation margin is predominantly vestibular and labial at the level of the proximal contact with the adjacent teeth. Mesial and distal is usually due to frequently occurring approximal arranged between the teeth caries additionally prepared for cervical spreading box.
  • the two walls of a box should have a conically divergent shape and their angles to the insertion axis of the entire preparation should be within a tolerance range between 6 ° and 15 °.
  • the difficulty of such an onlay preparation lies above all in the relative measurement of the two walls of the mesial box to the two walls of the distal box.
  • the four walls must be prepared conically symmetrical to the insertion axis of the entire preparation, so that the insertion axes of the distal and the mesial box are as parallel as possible.
  • Ceramic onlays may generally only be designed with a step or chamfer preparation, i. a tangential preparation is unsuitable for this material.
  • Metal onlays can also be designed in the approximal region with a tangential preparation.
  • the two proximal placed boxes are usually connected to an isthmus, which has a conical and box-like shape and runs perpendicular to the insertion axis of the entire preparation.
  • the tolerance ranges of the first distance, the distance to the neighboring teeth and the shape of the preparation margin for the different preparation forms are identical to the full-crown preparation.
  • the preparation can also be prepared for an inlay.
  • An inlay preparation in contrast to a full crown preparation, is a defect-oriented preparation, i.
  • the extent of the preparation depends mainly on the extent of the previous caries, the filling or the cavity.
  • a cervical-spreading box should be prepared at the approximal area, if there is already a cavity due to caries or filling.
  • the two walls of this box are designed to be conically divergent and should have an angle to the insertion axis between 6 ° and 15 °.
  • a mesial and a distal box can be prepared in the inlay preparation of greater extent as in the onlay preparation.
  • the difficulty of such an inlay preparation lies above all in the relative measurement of the two walls of the mesial box to the two walls of the distal box.
  • the four walls must be conical and symmetrical to the insertion axis, i.
  • the insertion axes of the mesial and distal boxes should be as close as possible to the insertion axis of the entire preparation.
  • Inlays made of ceramic may generally be designed only with a step or chevron preparation, i. a tangential preparation is unsuitable for this material.
  • Inlays made of metal can be designed especially in the approximal region with a tangential preparation.
  • the edge in the approximal region can also be prepared with spring edge, ie with a chamfer. If a caries cavity or filling cavity is already present in the central occlusal surface area, an isthmus is prepared, ie a conically shaped cavity.
  • such an occlusal isthmus or cavity must have a minimum distance between the two opposing preparation walls in order to achieve the required strength of the restoration.
  • the minimum distance thus depends on the later used material from which the inlay is made. This distance should be at least 1.5 mm.
  • a minimum distance of the preparation base to the surface of the opposing dentition is required in order to achieve the required strength. This distance should be at least 1.5 mm.
  • the occlusal box (isthmus) should have a bevel with an angle of 45 ° to the insertion axis and a width of between 0.5 mm and 1.0 mm.
  • the distance between the preparation walls and the neighboring teeth should be at least 0.5 mm, as in the case of full crown preparation.
  • the cavity of the tooth is created in a 3D optical image after removal of the carious tissue or after removal of an existing dental filling.
  • a computer-aided optimization algorithm calculates an inlay preparation that fulfills two properties at the same time.
  • the proposed inlay preparation is as close as possible in its dimension
  • minimum clearances of the preparation walls in the occlusal isthmus area as well as the distance of the preparation floor in the isthmus area are taken into account. Subsequently, the user can use the determined optimal inlay preparation as a guideline for the preparation of the preparation.
  • This inlay preparation calculated by means of an optimization algorithm and thus ideally designed, now defines the desired master preparation which is used for comparison with the inlay preparation actually created by the user, whereby partial areas of the preparation from the first 3D image are marked Differ from master preparation.
  • a desired preparation form constructed by the user himself can also be used.
  • veneer preparation generally has an intact anterior tooth with caries-related lesions or an anterior tooth completely restored with a filling.
  • the difficulty of a veneer preparation consists essentially in the fact that an ablation of the intact, labially oriented tooth surface is to be carried out with a uniform layer thickness in order to meet the requirement of minimal inefficiency.
  • the layer thickness namely the propriety of the labial preparation wall to the labial tooth surface of the anterior tooth prior to preparation, should be between 0.3 mm and 0.8 mm.
  • the labial wall of a veneer preparation should therefore have the same curvature as the intact labial tooth surface before preparation. It is only possible to deviate from this requirement if the tooth position is corrected by means of veneer shells.
  • the third 3D optical image captures the intact tooth surface of the anterior tooth prior to dissection, as well as the marginal gingival margin and papilla.
  • a computer-aided optimization procedure calculates an ideal veneer preparation with uniform layer thickness and with a groove or an internally rounded step that meets two requirements at the same time. On the one hand, it has a uniform distance to the intact labial tooth surface prior to preparation, on the other hand, an ideal preparation edge is calculated which runs along the gingival margin or below the gingival margin.
  • the user himself can plan a desired veneer restoration.
  • the calculated optimal Venner preparation or user-specified veneer preparation defines a master preparation to be used for comparison with the veneer preparation actually created by the user, with partial surfaces of the preparation being marked from the first 3D image obtained from differ from the desired master preparation.
  • the preparation of several teeth can also be prepared for a bridge.
  • a bridge preparation contains all the requirements of a full-crown preparation on the preparations of the individual teeth, which have already been described in detail above.
  • a bridge preparation adds another requirement.
  • the preparation walls of each prepared abutment tooth are conical and define an insertion axis of this abutment tooth.
  • the preparation walls should consequently have such an angle to the insertion axis of the entire bridge preparation that the insertion axes of the individual prepared abutment teeth are parallel to the insertion axis of the entire bridge preparation.
  • Fig. 3 is a second 3D image for determining the preparation margin
  • Fig. 4 is a sectional view along the section line AA of FIG. 3 correlated with the first SD recording of FIG. 2 for determining a first distance
  • Fig. 5 is a sectional view as in Fig. 4 for determining a second distance
  • the Fig. 6 is a part of the sectional view of Fig. 4 for determining an angle
  • Fig. 7 is a 3D view of the sectional view of FIG. 4 for
  • Fig. 8 is a sketch of the recording from three different directions, the
  • FIG. 11 shows a first 3D image of an inlay preparation
  • FIG. 12 shows a first 3D image of a veneer preparation
  • a tooth 1 to be prepared is shown before its preparation with its adjacent teeth 2 and 3.
  • a molding compound 5 is attached between the tooth 1 to be prepared and a counterbite 4, so that an impression 6 of the counterbite 4 is produced with an occlusal surface 7 at the location of the tooth 1 to be prepared.
  • This impression 6 can also be made after the preparation by the molding compound 5 between an already prepared tooth 1 and the counterpart 4 is attached.
  • an impression 6 after preparation has the disadvantage that parts of the molding compound 5 would lead to contamination of a prepared tooth.
  • the adjacent teeth 2 and 3 have the occlusal surfaces 8 and 9.
  • FIG. 2 shows a first 3D image 10 and a second 3D image 11.
  • the first 3D capture 10 is generated by optically sensing the impression 6 of FIG. 1 and portions of the adjacent teeth 2 and 3.
  • the impression 6 has an impression surface 12, which represents a counter surface to the occlusal surface 7 of FIG. 1 of the counterbite 4.
  • the impression 6 must be dimensioned such that the occlusal surfaces 8, 9 of the adjacent teeth 2, 3 remain as uncovered as possible in order to be recognizable on the first receptacle 10 for correlation.
  • the second 3D image 11 comprises the prepared tooth 13 with the preparation 14 and parts of the adjacent teeth 2, 3 with their occlusal surfaces 8, 9.
  • the second 3D image 11 was produced after the removal of the molding compound 5 and the preparation.
  • the first 3D image 10 is correlated with the second 3D image 11 by superimposing the matching parts of the occlusal surfaces 8, 9 of the adjacent teeth 2, 3 in both SD images 10, 11.
  • the correlation can be made automatically by recognizing and superimposing the parts of the occlusal surfaces 8, 9 by means of a computer. If the automatic correlation can not be done because the occlusal surfaces 8, 9 are not recognized as such, a manual correlation is performed.
  • manual correlation at least three prominent points 15, 16 and 17 on the occlusal surface 8 in the first 3D model 10 and subsequently to the points 15, 16 and 17 corresponding three points 15 ', 16' and 17 'on the Occlusal surface 9 of the second 3D model 11 selected by a user.
  • the points 15, 16 and 17 are brought into agreement with the points 15 ', 16' and 17 'and thus the correlation of the two 3D images 10, 11 determined to each other.
  • FIG. 3 shows the second 3D receptacle 11 with the prepared tooth 13 and its neighboring teeth 2, 3 as shown in FIG. 2.
  • the preparation 14 has a preparation margin 20 which separates the processed preparation surface 21 of the preparation 14 from the unprocessed surface 22 of the prepared tooth 13.
  • the preparation margin 20 is determined manually or automatically from the second 3D image 11. In the manual determination, the preparation margin 20 is marked by means of an input means, such as a computer mouse. In the automatic determination, a point 23 on the preparation margin 20 is selected by the user or automatically detected computer crashed, and starting from this point 23, the remaining course of the preparation margin 20 is determined by means of computer-traced edge tracking.
  • the first 3D image 11 is used to control the surface finish of the preparation 14, wherein the preparation 14 is examined for unevenness, which can result from a faulty grinding process or from a strong carious involvement of the tooth to be prepared.
  • Roughness characteristics at the preparation surface 21 are measured by computer-aided methods. Patches 24 with roughness characteristics that exceed a specified tolerance range by a desired quiescent value are highlighted in red. Sections 25 that fall below the tolerance range are highlighted in green.
  • a value on a healthy tooth surface such as on the occlusal surfaces 8, 9 of the adjacent teeth 2, 3, in order to serve as a reference value for determining the relative roughness.
  • the functional dependence of the roughness characteristics from the first 3-D image to the actual roughness is determined experimentally so that camera artifacts are not interpreted as actual roughness.
  • the roughness characteristics must be within a specified tolerance range in order to ensure the stability of a crown, which is placed on the preparation 14 with a perfect fit and connected by means of dental cement. If the partial surfaces 25 and 31 and 32 of FIG. 4 are too smooth, the adhesion of the dental cement to the connection of the preparation 14 with the crown is reduced, whereas rough partial surfaces of the preparation surface 21 at the edge of the restoration lead to clinically intolerable fit inaccuracies.
  • a roughness parameter is determined before the measurement on a healthy tooth surface, such as the occlusal surfaces 8, 9 of the adjacent teeth 2, 3, and used as a reference value. In this way, at least a relative measurement of the roughness can be made to determine if the examined faces 24, 25 and 31, 32 of Figure 4 are smoother or rougher than the surface of healthy, non-ground adjacent teeth.
  • preparation margins 26 are present.
  • the preparation margins 26 must not exceed a defined waviness, because a restoration margin of a crown which fits complementary to the preparation margins 26 can only be produced up to a certain waviness.
  • a pruning preparation margin 20 is not complementary to reproduce. bar.
  • Preparation margins 26 with ripples outside a specified tolerance range are marked and can be resharpened for correction.
  • FIG. 4 shows a sectional view along the section line AA from FIG. 3 with the preparation 14 and the adjacent teeth 2, 3.
  • the impression surface 12 from the first 3D image 10 is shown in FIG.
  • the impression surface 12 represents the occlusal surface of the counterbite 4 at the location of the preparation 14.
  • the preparation 14 has an insertion axis 30, which is determined as the axis of symmetry of the lateral preparation walls 31 and 32.
  • a matching crown is placed on the preparation 14 along this insertion axis 30.
  • a first distance 33 between an occlusal surface 34 of the preparation 14 and the impression surface 12 of the counterbite 4 is determined parallel to the insertion axis 30.
  • the first distance 33 can be calculated automatically computer-aided.
  • the distance vectors for the distance 33 are all parallel to the insertion axis (ie parallel to the z-axis in the SD coordinate system).
  • Sections 34 and 35 having a first distance 33 which is greater than the predetermined tolerance range 36 with a minimum first distance 37 and a maximum first distance 38 are marked in red.
  • Subareas 39 with a first distance 33, which is smaller than the defined tolerance range 36 with a minimum distance 37 and a maximum distance 38, are marked in green.
  • the color intensity of the green is changed or coded in accordance with the proximity to the interval boundaries 37 and 38.
  • the color intensity of partial areas with a first distance 33 can be within the tolerance range 36 of the desired first distance 40 to the boundary values 37, 38 of the tolerance range 36 towards increase.
  • the tolerance range 36 is determined by a desired first distance 40 which ensures the stability of a crown connected to the preparation 14.
  • the position of the tolerance zone 36 in the z-direction is defined by a desired first distance 40, which is required for optimum mechanical stability and for the desired optical properties of the crown.
  • the preparation walls 31 and 32 have distances 31.2 and 32.2 to the adjacent teeth 2 and 3. Too small distances
  • FIG. 5 shows a sectional view of the prepared preparation 14 and the adjacent teeth 2, 3 as shown in FIG. 4.
  • a desired preparation 50 has a second distance 51 from the prepared preparation 14, the second distance 51 being measured perpendicular to the preparation surface 21 of the preparation 14.
  • Partial surfaces of the preparation surface 21 with a second distance 51, which is outside a specified tolerance range 52, are marked in color.
  • Partial surfaces 53 of the preparation surface 21 whose second distance 51 exceed the first limit 54 of the tolerance range 52 toward the preparation 14 are marked in red.
  • Partial surfaces 55 of the preparation surface 21 whose second distance 51, the second boundary 56th of the tolerance range 52 away from the preparation 14 are marked in green.
  • FIG. 6 shows part of the sectional view of the preparation 14 from FIG. 4 and includes the preparation wall 31.
  • a method step for checking an angle 60 between the preparation wall 31 and the insertion axis 30 is shown. This method step is computer-aided automatically. For reasons of clarity, a parallel 30 'to the insertion axis 30 has been shown.
  • the angle 60 is determined by respectively selecting two points 63, 64 and 65, 66 on surface areas 67 and 68 which are as flat as possible in the first step are linearly approximated and in the second step, the angle 60 between the linear approximations 69, 70 and the insertion axis 30 is determined.
  • more than two points can also be selected, so that an orientation of an uneven surface can also be determined.
  • Sections whose angles 60 are outside a tolerance range are highlighted in red.
  • the tolerance range includes a desired angle for the respective subarea 61 or 62.
  • the points 63, 64, 65 and 66 are selected at fixed intervals 71, 72, 73 and 74 from the preparation edge 20, which are measured parallel to the insertion axis 30. This allows an objective evaluation of various preparations with respect to the angle 60.
  • the linear approximation is performed automatically by computer.
  • a further method step for checking a third distance 75 between the preparation margin 20 and a gingiva surface 76 is shown. If the fourth distance 75 is less than the lower limit 77 of the specified tolerance range, then the partial surfaces 78 between the preparation margin 20 and the lower limit 77 are marked in red. Patches having a third distance greater than the upper limit 79 are highlighted in green.
  • FIG. 7 shows a 3D view of the preparation 14 and the counterbite 4 from FIG. 4.
  • the CAD method used makes it possible to select and display sectional representations at any point of the counterbite 4.
  • the CAD method used allows points on displayed surfaces to be selected and the distance between these points to be determined.
  • a point 80 on the occlusal surface 34 and a point 81 on the impression surface 12 were selected and marked in red.
  • a distance 82 between points 80 and 81 was determined and displayed as a blue dash.
  • the distance 82 is not parallel to the insertion axis 30. This makes it possible to manually check whether certain distances are within their tolerance range. For example, the distance 51 of the preparation 14 to the desired preparation 50 from FIG. 5 as well as the distance 33 from FIG. 4 can be checked manually.
  • the second 3D image 11 with the preparation 14 and parts of adjacent teeth 2, 3 is created by producing an optical recording device 90 from three different directions 91, 92 and 93 images, which are used to create the second 3D Receiving 11 be assembled.
  • One of the recordings in the direction 92 takes place parallel to the insertion axis and serves as a reference receptacle for the definition of a coordinate system 94.
  • the insertion axis 30 can be defined as the Z-axis. If none of the images is taken in the direction of the insertion axis 30, the insertion axis 30 must subsequently be fixed in the second 3D image 11 in order, for example, to be able to measure the first distance 33 from FIG. 4 along the insertion axis 30.
  • FIG. 9 a shows a third 3D optical image 100 of the tooth 101 before preparation and its adjacent teeth 2 and 3.
  • the neighboring teeth have prominent points 15, 16 and 17.
  • Shown in Figure 9b is the first 3D image 11 of the prepared tooth 14, which was correlated to the third 3D image 100 of Figure 9a using the matching landmark points 15 ', 16', and 17 '. From the correlated image, consisting of the first 3D image 11 and the third 3D image 100, a distance 102 between the surface of the preparation 21 and the tooth surface 103 of the tooth 101 can be determined before preparation, wherein the distance 102 is perpendicular to the preparation surface is determined.
  • FIG. 9 a shows a third 3D optical image 100 of the tooth 101 before preparation and its adjacent teeth 2 and 3.
  • the neighboring teeth have prominent points 15, 16 and 17.
  • Shown in Figure 9b is the first 3D image 11 of the prepared tooth 14, which was correlated to the third 3D image 100 of Figure 9a using the matching landmark points 15 ', 16', and 17 '
  • the onlay preparation 110 includes a distal case 111, a mesial case 112, and an occlusal case 113 (isthmus).
  • the distal box 111 has the preparation walls 114, 115 and 116.
  • the mesial box 112 has the preparation walls 117, 118 and 119.
  • the occlusal box 113 (isthmus) has the lateral preparation walls 120 and 121.
  • the lateral preparation walls 114, 115 and 116 of the distal box 111 form an insertion axis 122 of the distal box.
  • the lateral preparation walls 117, 118 and 119 form the insertion axis 123 of the mesial box and the lateral preparation walls 120 and 121 form the insertion axis 124 of the occlusal box.
  • the preparation walls must be designed in their inclination so that the insertion axes 122, 123 and 124 of the distal box 111, the mesial box 112 and the occlusal box 113 match as possible to allow insertion of an onlay along a common insertion axis.
  • FIG. 11 shows the first optical 3D image 11 of a preparation 130 for an inlay.
  • the illustrated inlay preparation 130 is arranged labially and has the conically running preparation walls 131, 132 and 133.
  • the inlay preparation 130 has a preparation base 134.
  • the first 3D image 11 of the inlay preparation 130 is correlated with the third image 100 of the tooth prior to preparation from FIG.
  • the lateral preparation walls 131, 132 and 133 form an insertion axis 135 of the inlay preparation 130 and must have an angle to this insertion axis 135, which lies within a tolerance range between 6 ° and 15 °. Subareas 136 whose Angles outside this tolerance range are marked.
  • Another requirement for the inlay preparation 130 is that the distance 102 between the preparation base 134 and the tooth surface 102 of the tooth before preparation is at least 1.5 mm. In the case of metal inlays, a further requirement of the inlay preparation 130 must be met, namely that the opposite preparation walls 131 and 133 have at least a spacing of 1.5 mm.
  • the main requirement for the veneer preparation 144 is that the labial tooth surface 103 of the anterior tooth 141 to the preparation surface 21 has a distance 102 which lies within a tolerance range between 0.3 mm and 0.8 mm.
  • FIG. 13 shows a first 3D image 11 of the preparation 14 of the tooth 1, a second preparation 150 of the adjacent tooth 2 and a third preparation 151 of the adjacent tooth 3.
  • the first 3D image 11 of the three preparations 14, 150 and 151 is correlated with the third 3D image 100 of the teeth 1, 2 and 3 prior to preparation, the third 3D image 100 being shown by dashed lines.
  • the preparations 14, 150 and 151 together form a preparation 152 for a bridge.
  • the individual preparations 14, 150 and 151 must meet the requirements for a full-crown preparation, which have been explained in FIGS. 4 to 7.
  • the preparation walls 31 and 32 of the full crown preparation 14 form an insertion axis 30.
  • the preparation walls 153 and 154 form an insertion axis 155 of the full crown preparation 150 and the preparation walls 156 and 157 form the insertion axis 158 of the full-crown preparation 151.
  • a main requirement for the bridge preparation 152 is that the insertion axes 30, 155 and 158 of the individual preparations 14, 150 and 151 are parallel to one another and to a common insertion axis 159 of the bridge preparation 152 are aligned. As a result, the introduction of an undivided bridge along a common insertion axis 159 is made possible.
  • FIG. 14 shows an implant 160 in the jawbone 161.
  • An implant assembly 163 beyond a gingiva surface 162 has a full crown preparation 14 as in FIG. 3.
  • Implant assembly 163 may be an abutment separable from the implant or may be a non-separable extension of the implant.
  • the full-crown preparation 14 of the implant 161 has an insertion axis 30. According to the present invention, the illustrated preparation 14 of an implant 161 can be judged according to the same criteria as illustrated in FIGS. 4 to 7.
  • Distal box 112 Messialer box 113 Occlusal box 114, 115 and 116 lateral preparation walls of the distal box 112th

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Abstract

L'invention concerne un procédé de contrôle de la préparation (14) d'une dent préparée (13) par CAO, à l'aide d'un premier logement 3D (11) pour la dent préparée (13) et au moins une partie de sa dent adjacente (2, 3). Sont marquées, les surfaces partielles (24, 25, 53, 55, 78) de la préparation (14, 110, 130, 140, 152), dont les distances (31.2, 32.2, 51, 75) vers les dents adjacentes (2, 3), la préparation (50) souhaitée et/ou la surface gingivale (76) et/ou dont les angles (60) et/ou la rugosité se situent hors des limites (54, 56, 77, 79) d'une plage de tolérance (52) respective.
EP08717731A 2007-03-13 2008-03-13 Procédé de contrôle de la préparation d'une dent par cao Withdrawn EP2134291A1 (fr)

Applications Claiming Priority (2)

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DE102007012584A DE102007012584A1 (de) 2007-03-13 2007-03-13 Verfahren zur Kontrolle einer Präparation eines präparierten Zahns mit CAD-Verfahren
PCT/EP2008/052987 WO2008110594A1 (fr) 2007-03-13 2008-03-13 Procédé de contrôle de la préparation d'une dent par cao

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