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
  • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
  • A61B6/03—Computed tomography [CT]
  • A61B6/032—Transmission computed tomography [CT]
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/12—Arrangements for detecting or locating foreign bodies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/40—Arrangements for generating radiation specially adapted for radiation diagnosis
  • A61B6/4064—Arrangements for generating radiation specially adapted for radiation diagnosis specially adapted for producing a particular type of beam
  • A61B6/4085—Cone-beams
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
  • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
  • A61B6/51—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for dentistry
• • 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
  • A61C1/088—Illuminating devices or attachments
• • 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
  • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
  • A61C8/0001—Impression means for implants, e.g. impression coping
• • 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
• • 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 present invention relates to a method for planning a dental prosthesis implant assembly.
• dental implant arrays are planned by first making a real model of the dentition using an impression of a patient's dentition.
• the real model largely reproduces the positional relationships of the teeth (so-called occlusion) as well as the topography of the gums.
• occlusion positional relationships of the teeth
• topography topography of the gums.
• wax modeling so-called "wax-up" - a preliminary planning of the dental prosthesis implants is made.
• the wax model thus provides a first impression of how the missing natural teeth of the patient can be replaced by dental replacement implants.
• the wax model serves as a template for the creation of another model made of material, which provides a sufficiently good contrast in radiographs, so-called radioopaque material.
• the model of radiopaque material is placed in the patient and, if necessary, adjusted. With the model inserted, a computer tomography (CT) or a dental volume tomography (DVT) is made from the patient's jaw. The data obtained provides information on how the model lies relative to the teeth and the jaw. Based on the data, a final planning of the implant positions and, in particular, the precau- bores for anchoring the implant or implants.
• CT computer tomography
• DVD dental volume tomography
• Another disadvantage of the method described above is that it can be decided only after performing the CT or the DVT, whether the surgical procedure for implantation of the dental prosthesis implantation can actually be performed as planned, since only then it is clear what the condition of the jaw bone , It may be necessary to revise the model, which requires a repetition of the above steps.
• the method comprises using a reference arrangement which has at least one alignment arrangement which can be used as an aid for determining the position of the reference arrangement.
• the reference arrangement is releasably attached to a patient, in particular to the dentition of the patient or to the patient's jaw in spatially fixed auxiliary points.
• auxiliary points may for example be temporary auxiliary implants for fixing the reference arrangement.
• the attachment of the reference assembly to the bit or to the auxiliary points ensures that said components are in fixed spatial relationship to one another.
• the spatial position of the reference arrangement is aligned by means of an alignment of the alignment arrangement relative to an external reference system.
• the patient's jaw and jaw are ultimately brought into a defined position.
• the dentition and the jaw are simultaneously detected three-dimensionally and a corresponding data record is generated. Based on the generated data set, a virtual model of the dentition and / or the jaw is generated.
• the virtual model is clearly within the scope of the prior alignment of the reference array with respect to an external reference system Space oriented and can therefore be used for further planning a dental prosthesis implant assembly.
• data are thus obtained by a simultaneous detection of the bit and the jaw by means of a suitable method, which reproduce the anatomical conditions in the area of the patient's bit and jaw.
• the data form a dataset that forms the basis for a virtual model of the dentition and / or the jaw.
• the virtual model is calculated from the generated data record.
• the virtual model is generated directly based on the generated data set. That except for transformations of the data set, e.g. possibly required transformations of the data format, are no complicated intermediate steps between the data acquisition and the
• the term "dental prosthesis implant arrangement” can be understood both individual dental implant implants as well as arrangements and combinations of several individual dental implant implants.
• an extraoral region of the patient in particular a section of the patient's face in the area of the jaw, is detected three-dimensionally. This makes it possible, for example, to consider aspects of extraoral aesthetics when planning the dental implant placement.
• a three-dimensional detection of characteristic elements of the reference arrangement takes place simultaneously with the three-dimensional detection of the extraoral region of the patient.
• the simultaneous three-dimensional detection of the dentition and the jaw comprises a simultaneous three-dimensional detection of characteristic elements of the reference arrangement.
• a reference arrangement is used in which at least one characteristic element-in particular three characteristic elements-is arranged on the extraorally arranged alignment arrangement of the reference arrangement.
• a reference arrangement in which at least one characteristic element is designed such that it is optically detectable.
• the characteristic elements - or at least a subset of the characteristic elements - each have a spherical reference body which is connected to a shaft, wherein the shaft, in particular releasably connected to the reference arrangement is.
• Such elements are easily detectable and allow exact referencing of the recorded data of the patient.
• By releasably attaching the characteristic elements these can be attached to the reference arrangement as needed, for example in different positions.
• it allows reuse of the characteristic elements in an exchange of the reference arrangement.
• a computer-assisted virtual preliminary planning of the dental prosthesis implant arrangement is carried out on the basis of the virtual model.
• the virtual model generated from the data set is fed into a suitable planning program.
• the referencing of the data set can be done easily.
• the determination of the spatial position of the characteristic elements of the reference arrangement makes it possible to assign the data points of the acquired data record on the basis of the desired position of the characteristic elements, which is stored or can be stored as a reference system in such planning programs. In other words, these elements create a unique frame of reference to which the data points can be "hooked". Data sets collected using other imaging methods can be easily integrated on the basis of this reference system.
• the program plans which implants are used where.
• the shape and position of the dental implant implant Order can be adapted and optimized on the basis of the spatially clearly referenced virtual model.
• the virtual model is used directly for pre-planning. That is, except for minor transformations of the data set, eg, possibly required transformations of the data format, no costly intermediate steps are required in order to use the virtual model for pre-planning.
• the virtual model is such that it can essentially serve directly as a basis for pre-planning.
• a virtual tooth replacement implant model and / or a virtual model of the oral cavity of the patient can be created, which can serve as a basis for further planning steps.
• the virtual dental prosthesis implant model and / or the virtual model of the oral cavity of the patient - or at least a model of part of the oral cavity - can be presented to the patient comparatively quickly after completing the three-dimensional acquisition of the dentition and the jaw, so that the preliminary planning - and thus essential Parts of the planning of the dental implant placement - can already be performed during a session.
• the existence of the virtual tooth replacement implant model and / or the virtual model of the patient's oral cavity further makes it easy to make changes to the model that can be instantly visualized.
• a cost estimate can already be made based on the available data so that the patient can quickly be provided with all the information that is essential for making a decision.
• datasets of the dentition and the jaw can be combined with data sets of the extraoral jaw region of the patient in order to be able to take into account the influence of the virtually determined dental implant arrangement on the extraoral aesthetics of the patient already in the virtual pre-planning phase.
• the electronically present data of the dental prosthetic implant model directly - the term "directly" in this context includes pure transformations of the data set, such as a transformation of the data format - can be provided to suitable machines or devices, thus making the required components is guaranteed without time and / or precision losses.
• the detection of the dentition, the jaw and the characteristic elements of the reference arrangement can take place with the aid of a computer tomography or a dental volume tomography. The aforementioned imaging methods provide an exact replica of the present situation. The corresponding data records can be quickly and easily electronically processed further.
• the detection of the extraoral region of the patient and / or of extraorally arranged characteristic elements of the reference arrangement can be carried out optically. It can be provided that at least one component of the external reference system, in particular a reference plane, is projected onto the reference arrangement by a light beam, in particular by a laser beam. The orientation of the reference arrangement may be based on the reference plane. Once alignment has been completed, the reference arrangement is arranged in a predefined position relative to the reference plane, the position of which in turn is known and is clearly defined, for example, with respect to the gantry of a CT device. For example, the reference arrangement is brought into a substantially horizontally arranged reference plane. A positioning of the reference arrangement within the reference plane and / or parallel thereto can be effected, for example, by aligning a prominent point in the head region of the patient relative to a further marking, in particular a laser marking.
• a light beam in the sense used above means a beam of any geometry.
• the light steel may, for example, have a circular, oval or rectangular cross-section.
• the light beam can be fanned out, for example by suitable means - for example by a moving mirror - to produce the desired reference plane.
• a diaphragm arrangement By a diaphragm arrangement, a flat light beam can also be generated, which can be used as a reference plane.
• the reference arrangement is releasably attached to the jaw of the patient by means of an impression compound and / or directly or indirectly on the patient's jaw.
• the invention further relates to a reference arrangement for detachable connection to a denture and / or a jaw of a patient, comprising: a connection unit for producing a releasable connection of the reference arrangement with the denture and / or with the patient's jaw in spatially fixed connection auxiliary points .
• an alignment arrangement disposed in a position of use extraorally, which is rigidly connected to the connection unit and which is configured such that the reference arrangement can be aligned specifically in a defined position relative to an external reference system
• the reference elements form a fixed reference system, which in turn can be coupled with the aid of the alignment arrangement with an external reference system. Due to the detachable connection of the connection unit with the patient and the denture and / or the jaw are placed in a fixed spatial reference.
• the reference arrangement makes it possible to align a denture and / or a jaw of a patient in a three-dimensional manner in a known spatial position and to be able to use the corresponding data for further treatment steps and / or planning of a dental prosthesis implant arrangement.
• the alignment arrangement serves as an aid with which the reference arrangement can be brought into the desired position or with which the position of the reference arrangement relative to the external reference system can be verified.
• the reference elements is arranged on the connection unit. All reference elements can also be provided there.
• the reference elements in the position of use are at least partially arranged intraorally.
• the spatial proximity of the reference elements to the dentition or to the jaw allows a more precise definition of the position of the individual components of the dentition or of the jaw relative to the reference system defined by the reference elements.
• the alignment arrangement has, in particular, two surfaces which are arranged at an angle to one another and which are designed such that they are suitable for aligning the reference arrangement relative to at least one reference plane of the reference system.
• the surfaces include, for example, an angle between about 30 ° and 150 °, preferably an angle between see about 60 ° to 120 °, a.
• the surfaces can be arranged substantially vertically in the position of use, in particular in a sitting or standing position of the patient.
• the surfaces are designed in such a way that they can be optically projected onto at least one reference plane in such a way that the reference plane on the surface can be optically read in order to make it possible to align the reference arrangement relative to the reference plane. It is advantageous if the nature of the surfaces is designed so that the optical projection of the reference plane is clearly visible. For example, the surface is roughened for this purpose.
• a reference plane can be easily projected by a laser.
• the reference plane generated by the laser can be used to align a mark provided on the surfaces, that is, for example, the position of the reference arrangement is changed until the projection of the reference plane and the mark come to cover or are aligned parallel to each other.
• a stroke, notch or edge may act as a marker.
• the alignment arrangement may be designed handle or handle-like.
• the alignment arrangement biases a plane which is arranged substantially horizontally in the position of use or in an aligned position.
• the aforesaid surfaces may be attached to outer surfaces of the alignment assembly, i. be arranged in the position of use facing away from the patient's face.
• the alignment arrangement can have on its upper and / or lower side in the position of use a marking, in particular a notch, which runs essentially in the anterior-posterior direction.
• a marking in particular a notch, which runs essentially in the anterior-posterior direction.
• the notch may be oriented to be placed between the anterior teeth, if any.
• a compact construction of the reference arrangement results when the alignment arrangement and the connection unit are arranged substantially in one plane and / or have substantially the same thickness.
• connection unit can therefore have a receptacle for the impression mass.
• the receptacle comprises a depression which is delimited at least in sections by an edge boundary.
• the edge boundary may be at least partially provided with an undercut.
• the receptacle may additionally or alternatively have retention openings which extend from an upper position in the use position to a lower side of the connection unit or the reference arrangement in the position of use. In other words, the retention openings pass through the connection unit.
• the retention openings have a conical cross section.
• the receptacle can be provided with spacers which extend from a bottom of the receptacle and which are in particular web-shaped in order to prevent large-area contact between parts of the dent and the bottom of the receptacle.
• the reference elements may be detachably connected to the reference arrangement. On the one hand, this allows the reuse of the reference elements, on the other hand, they can be used at different points in the Reference arrangement can be positioned, for example, to realize different reference systems.
• the reference elements in particular each have a spherical reference body which is connected to a shaft, wherein the shaft can be inserted into a corresponding bore on the reference arrangement.
• the spherical configuration of the reference body allows a precise determination of the position of the corresponding reference element.
• connection unit and the alignment arrangement are formed in one piece.
• the reference arrangement is made of plastic, in particular Plexiglas.
• the reference arrangement can be provided for single use.
• the present invention further relates to the use of a reference arrangement according to at least one of the embodiments described above in at least one of the embodiments of the inventive method described above.
• Fig. 2 shows the reference arrangement of Fig. 1 in a plan view
• Fig. 3 and 4 is a front view and a side view of the reference arrangement of Fig. 1 and Refe
• Fig. 5 shows an embodiment of a reference element.
• 1 shows a centering spoon 10 with an alignment section 12 and a spoon body 14.
• the alignment section 12 serves to align the spatial position of the centering spoon 10 relative to an external reference system when the centering spoon 10 is attached to a dentition and / or a jaw of a patient ,
• a receptacle 16 which is designed as a depression of the spoon body 14, provided with an impression mass, in which the dentition and / or the jaw of the patient is pressed.
• the centering spoon 10 can be used both on the lower jaw and on the upper jaw of the patient.
• the Zentrierlöffel 10 is thus spatially fixed to the patient. Subsequently, the patient's head is aligned relative to an external reference system, as will be explained in more detail below.
• the centering spoon 10 is simultaneously positively connected to the centering spoon 10, since it has penetrated into undercuts 18 in an edge section 20 laterally delimiting the receptacle 16 and hardened there.
• retention openings 22 are provided which traverse the bucket body 14 and which have a conical shape in a cross section which widens toward the side of the bucket body 14 facing away from the impression mass. The retention openings 22 thereby act in a similar form as the undercuts 18.
• the spoon body 14 may be flattened and / or made narrower, in particular in the retromolar area. For example, a lowering of the edge portion 20 may be provided.
• the bucket body 14 has a plurality of reference element bores 28 into which reference elements to be described below can be inserted. To establish a reference system, it is not necessary lent that all holes 28 are equipped with reference elements. The targeted placement of certain holes 28 different reference system can be defined.
• the holes 28 penetrate the bucket body 14, so that the reference elements can be inserted into the bucket body 14 both from the top and from the bottom.
• the alignment section 12 of the centering spoon 10 has a shape symmetrical with respect to a notch 30.
• the notch 30 extends in a position of use of the centering spoon 10 substantially in an anterior-posterior direction. In positioning the centering tray 10, the notch 30 is oriented to extend approximately between the anterior teeth of the patient, thereby defining a sagittal plane.
• the notch 30 can also be provided on the underside of the centering spoon 10, which is not visible in FIG. 1, as can be seen in FIG.
• a V-shaped recess 31 additionally facilitates the correct positioning of the centering spoon 10 with respect to the
• the head of the patient is aligned by projecting a reference plane on perpendicular to the notch 30 extending end faces 32 of the handle or handle-like alignment portion 12.
• the reference plane is also projected onto side surfaces 34 of the alignment section 12.
• the surfaces 32, 34 are arranged substantially vertically in the position of use of the centering spoon 10.
• the surfaces 32, 34 enclose an angle other than zero or 180 °.
• an alignment does not necessarily have to be based on the named edges.
• markings in the form of lines and / or notches may be provided on the surfaces 32, 34.
• the alignment section 12 of the Zentrierlöffels 10 allows, despite its structurally simple design exact alignment of the Centering spoon 10 with respect to the reference plane. Since the alignment portion 12 is formed integrally with the bucket body 14, positioning errors due to improper mounting can be eliminated, which can occur in multi-part centering spoons.
• the Zentrierlöffel 10 may for example be a cost-effective and designed as a disposable plastic part. In particular, acrylic glass is a suitable material for producing the centering spoon 10.
• Holes 28 ' which can likewise be equipped with reference elements, if necessary, are arranged on the alignment section 12.
• FIG. 2 shows a plan view of the centering spoon 10 in order to illustrate the relative position of the surfaces 32, 34.
• the angle is slightly over 105 °. It is understood that this angle can be varied as needed. It is only decisive that the surfaces 32, 34 are not parallel, since otherwise no clear alignment of the centering spoon 10 with respect to the reference plane can take place.
• the contours of the undercuts 18 are indicated by dashed lines. In the region of the alignment section 12, the dashed lines indicate the position of the bores 28 '.
• FIG. 3 shows a front view of the centering spoon 10.
• the reference plane R extends both parallel to an upper edge 36 and parallel to a lower edge 38 of the surfaces 32, 34th
• the centering spoon 10 is of a flat design, ie the alignment section 12 and the spoon body 14 are arranged in one plane.
• the alignment portion 12 and the bucket body 14 also have a substantially same vertical extent. This can also be seen in FIG. 4, which shows a side view of the centering spoon 10.
• FIG. 5 shows a reference element 40, which has a spherical reference body 42 and a shaft 44.
• the shaft 44 is inserted into one of the bores 28, 28 '.
• a frusto-conical intermediate portion 46 determines how far the shaft 44 can be inserted into the respective bore 28, 28 ', so that the position of the center of the reference body 42 with respect to the Zentrierlöffel 10 is clearly defined.
• the shape of the intermediate section 46 tapering towards the reference body 42 leads to a constriction 48, so that the spherical shape of the reference body 42 can be easily recognized in a CT or DVT examination and, consequently, the position of the center point of the reference body 42 can be determined exactly can.
• the positions of the reference bodies 42 determined by the abovementioned examinations can also be compared with corresponding desired values, for example, in order to validate the data obtained by the examinations and - if necessary - to correct them.
• the reference elements 40 form a reference system that allows a simple fusion of data sets obtained by different methods.
• the teeth and the jaw can be precisely recorded with the aid of suitable programs and displayed accurately.
• a suitable planning software can also be an embodiment of the required dental prosthesis implants be planned virtually with great precision.
• a preview of the dentition and the jaw can be made showing a situation after implantation of the dental prosthesis implants.
• the computer-aided data acquisition of the actual state of the oral cavity of the patient, the virtual pre-planning of the dental prosthesis implant arrangement on the basis of the recorded data and the representation of a preview of the situation after completion of treatment can be performed in a simple manner and quickly compared to conventional methods.
• the patient can therefore be presented with a virtual model of the dentition already after the first treatment. If necessary, the model can also be adapted virtually with little effort.
• a cost estimate can also be quickly created based on the available data.
• a more precise planning can be entered based on the available data, which for example includes a more precise virtual determination of the drill holes to be made for the placement of the implants.
• the available data can also be used to produce patient-specific implants.
• a physical model by the method according to the invention leads to a reduction of the required work steps and thus to a reduction of the treatment costs.
• the patient can be given a better impression of how his teeth look after completion of the treatment.
• those involved are free to use the data they already have to create such a physical model.
• Such a model can also be created based on the impression of the dentition of the patient in the impression mass.

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• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Medical Informatics (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Dentistry (AREA)
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• Biophysics (AREA)
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• Dental Prosthetics (AREA)

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• 2011
  • 2011-03-21 DE DE102011014555A patent/DE102011014555A1/de not_active Withdrawn
• 2012
  • 2012-03-21 WO PCT/EP2012/054943 patent/WO2012126924A2/fr active Application Filing
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