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
  • A61C8/0001—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
  • 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
  • A61B17/1739—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
  • 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
  • A61C8/009—Implanting tools or instruments for selecting the right implanting element, e.g. templates
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
• • 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

Definitions

• the invention relates to an impression, a BohrSchablone and a method for providing a positional relationship between an implantation parts of a jaw and a 3D Meß schemesat z of the implantation site and a method for creating a BohrSchablone.
• drill templates are known from the prior art, which allow the controlled execution of planned implant bores. Such drilling templates can ensure that a drilling achieved has a planned drilling direction, a planned drilling depth or even a planned drilling diameter.
• DE 199 52 962 A1 discloses a method for producing a drilling aid for a dental implant, wherein first an x-ray of the jaw and then a three-dimensional optical measurement of the visible surface of the jaw and the teeth are performed. The measurement data sets from the X-ray image and the three-dimensional optical image are correlated with each other. On the basis of existing information, such as the type and position of the implant relative to the adjacent teeth, a template is planned and generated, which rests on the adjacent teeth and thus the exact hole of the implant guide hole is made possible. Based on the X-ray data, the implant can be determined and positioned in a known manner.
• an impact lantats disguise in the form of a drilling template are ground using a CAD / CAM unit.
• a CAD / CAM machine is able to produce the drilling template with the negative of the occlusal surfaces and a guide run for the drill.
• a stopper which determines the drilling depth, is transferred to the drilling template.
• WO 99/32045 discloses a method for producing a dental drilling aid for implants, wherein a three-dimensional computer image is modeled using a jaw image with respect to an impression surface, the position and the drilling depth of the drill holes determined and a set of implant bore coordinates in a computer-controlled production machine is fed.
• a drill guide socket is made in the drill body for each of the previously fed borehole coordinate sets with a borehole position and borehole orientation determined according to the jaw section
• a disadvantage of these methods is that most CAD / CAM machines are limited in their degrees of freedom and therefore the production of drilling templates according to the known methods and by means of such a CAD / CAM machine is only possible for a limited range of indications. For this reason, the fabrication of the surgical template in most cases takes place either individually in the laboratory or after prior CAD / CAM planning centrally, for example using a hexapod whose construction allows mobility of the object to be machined in all six degrees of freedom, and by means of a parallelogram.
• CT-DVT stencils, bite plates and jaw models made of gypsum are usually used for central production. These are mounted on the intricately designed Hexapod and adjusted with the aid of several measuring points. This process is very complicated and therefore error-prone.
• the object of this invention is to provide a method which enables the production of any desired drilling template in the simplest and quickest possible way using a conventional production machine with limited degrees of freedom.
• An object of the invention is an impression which comprises on a lower side a negative mold of at least one partial area of a jaw and at least one implantation part lying in this partial area of the jaw.
• the impression can at least partially consist of an X-ray-permeable material and / or a material which is as little as possible visible in an MRI image.
• the impression points in the region of the negative form of the implantation parts on a top side opposite the underside of the implant
• connection part which is formed opposite the top of the impression as a survey and / or a depression.
• This elevation and / or depression has a longitudinal axis in the direction of its elevation or lowering relative to the upper side of the impression.
• the elevation and / or depression has a geometry that is unique with respect to a rotation of the geometry about the longitudinal axis.
• a dental impression is a negative impression of a jaw or part of a jaw, ie a total jaw impression or a partial impression.
• the impression thus has an underside with the negative form of the jaw or a part of the jaw and an upper side opposite the underside. It becomes an initially soft, bares, later hardening material, for example, referred to as the impression material, used, which is applied in the formable state of the jaw or the part of the jaw, so that the shape of the jaw or the teeth located on the jaw reflect as a negative in the moldable material , In this position, the applied material is cured. In the cured state, the impression has a completely solid, non-deformable shape, or at least a shape that always returns to its original shape when an initial shape is deformed.
• the impression according to the invention is characterized in that it is formed, for example, from an X-ray transparent material. Due to the X-ray permeability, an impression according to the invention can not be detected in an X-ray image. This makes it possible to produce an X-ray of a patient's jaw with an impression according to the invention positioned on the jaw, without parts of the jaw and / or remaining teeth being covered by the impression on the X-ray.
• an insulator material for example polyurethanes, polyethylene, polymers or glass fibers, which is generally invisible or poorly visible in an MRI scan. All materials that produce as few signals as possible in an MRI scan and in particular do not cover the signals generated by bones or teeth are suitable. In particular, such a material should have a significantly lower density than the density of the surrounding tissue, such as the jawbone, the teeth and the surrounding soft tissue.
• the impression according to the invention extends over an implantation site and at least one area surrounding the implantation parts, eg adjacent teeth, so that a simple, unambiguous reinsertion of the impression removed from the jaw is possible, for example on the basis of the adjacent teeth.
• Connector means a portion of the impression characterized by a geometry that makes it possible to attach another component to the top of the impression. This may be, for example, a recess into which a further component is at least partially usable.
• the connection part can also be designed as an increase, to which a further component can be placed.
• connection part is according to the invention characterized in that it has a longitudinal axis which extends in the direction of increasing or lowering the connection part relative to the surface of the impression and that the outer contour of the connection part is asymmetrical in a plane perpendicular to this longitudinal axis.
• longitudinal axis which extends in the direction of increasing or lowering the connection part relative to the surface of the impression and that the outer contour of the connection part is asymmetrical in a plane perpendicular to this longitudinal axis.
• the impression can be integrally formed with the connection part.
• This can be a particularly simple production variant to provide an impression according to the invention.
• a separate component may be present, which encloses a connection part which corresponds at least partially to a negative of the connection part of the impression and which at least partially into the connection part the impression can be introduced or placed on the connector part.
• connection part of the impression allows a simple and precise arrangement of a further component on the impression, for example by the on or touchdown, to which the further component also has a connection part.
• the connection part of the separate component is an area or part of the component which is suitable for attaching or for connecting the separate component to the impression.
• the connection part of the component for example, the negative form of the connection part of the impression, so that it can be positively connected with this.
• the connection part of the separate component only partially corresponds to the negative form of the connection part of the impression, whereby only a partial positive fit is achieved.
• the component may be formed as a one-piece or a multi-part auxiliary element, which consists at least partially of a radiopaque and / or from a recognizable in an MRI recording material.
• An auxiliary element according to the invention is a component which, in contrast to the impression, can be recognized at least partially in an X-ray image or an MRI image.
• the auxiliary element consists at least partly of radiopaque material.
• Images is a material suitable, for example, has a significantly different from the density of the jawbone, the teeth and the surrounding soft tissue density or significantly different spin-lattice relaxation times.
• conductive materials such as certain metals are suitable.
• the elevation or depression of the connection part has at least one side wall adjoining the upper side of the impression. Such side walls are particularly suitable for holding the further component by positive engagement.
• the depression of the connection part has a base which is lowered relative to the upper side of the impression or the elevation of the connection part has a roof which is raised in relation to the upper side of the impression.
• the position of a component to be attached in the direction of the elevation or depression can be defined as the depth stop. This can be done, for example, by inserting the component to be attached into the connection part of the impression or placing it on the connection part of the impression until contact of a surface of the component suitable for this purpose with the floor or roof is made.
• the invention further relates to a drilling template for a bore to be performed on an implantation part, which consists of an impression according to the invention and at least one drilling aid for guiding a drill.
• the drilling aid has a connection part for connection to the impression, which at least partially corresponds to a negative of the connection part of the impression.
• the drilling aid further has a passage opening which defines a drilling direction relative to the connection part.
• connection part of the drilling aid can be produced by milling or grinding.
• milling or grinding This is a particularly simple way of manufacturing.
• conventional milling and grinding machines have only a limited number of degrees of freedom with respect to the machining directions.
• the drilling aid according to the invention is therefore designed so that it can also be produced with a conventional milling or grinding machine with limited degrees of freedom.
• the drilling aid on a support surface for resting on the top of the impression.
• a bearing surface can, for example, constitute a depth stop for a drilling aid insertable into a connection part of an impression designed as a recess or also for a drilling aid which can be placed on an attachment part of an impression designed as an elevation, and thus the position at least with respect to one in the direction of the increase or depression set the running direction.
• the passage opening of the drilling aid is cylindrical and has a diameter corresponding to a fixed bore diameter.
• the through hole of the drilling aid in particular in the state attached to the impression, can serve to guide a drill.
• the drilling aid comprises at least one
• the adapter has a cylindrical passageway Having a diameter corresponding to a predetermined bore diameter, and having an outer geometry with a at least partially positively in the through hole of the drilling aid in a matching area and a subsequent to this area, not in the passage opening in matching end portion.
• the passage opening of the adapter can be used to guide a drill, wherein the adapter is partially introduced into the through hole of the drilling aid, so that the drill aid comprising the adapter in conjunction with the impression forms a drilling template according to the invention for guiding a drilling tool.
• the passage opening of the drilling aid or the adapter of the drilling aid can be designed for an implant bore or a pilot bore.
• the diameter of the passage opening of the drilling aid itself or, in the case of an adapter comprising a drilling aid of the through opening of the adapter depends on the diameter of the drill to be used, as is generally already known from the prior art for drilling aids.
• at least one bore, designated as a pilot bore is made with the smallest possible bore diameter before the implant bore, that is, a bore with a bore diameter corresponding to the implant to be inserted, is performed.
• a stop for a drilling tool can be provided at an end of the drilling aid facing away from the connection part, wherein the length of the
• Passage opening the drilling depth can be specified.
• a stop here a defined surface or edge of the drilling aid is called, which causes a depth stop, so further penetration of a drill or
• Drilling insert of the drilling tool used in the drilling aid prevented. As a result, a drilling depth can be specified.
• a longitudinal axis of the passage opening of the drilling aid with the longitudinal axis of the connection part of the drilling aid form an angle which is preferably greater than 0 ° and less than or equal to 60 °. In this way it can be ensured that the passage opening extends in the direction of a desired drilling direction.
• the invention further relates to a method for correlating an implantation part of a jaw and an SD measurement data set of the implantation parts.
• the method provides for a footprint comprising at least one partial area of a jaw and at least one implantation part located in this partial area of the jaw made of a radiopaque material and / or of insulator material having at least one at least partially radiopaque and / or partial to provide a visible auxiliary element in MRI images.
• the auxiliary element has a connection part which is mounted in the area of the negative form of the implantation parts on an upper side of the impression opposite the underside of the impression. It will be at least one
• connection part of the at least one auxiliary element relative to the implantation parts in the 3D measurement data z is determined.
• a connection part corresponding to the negative of the connection part of the at least one auxiliary element is provided in the position which can be positioned on the implantation part at a position matching the position of the connection part of the auxiliary element determined in the measurement data set.
• connection between the implantation site to be supplied in the mouth of a patient and a 3D data record is provided by means of a connection part for connecting further building parts, which is arranged in the mouth on an impression positionable on the jaw and whose position in the 3D data set is known.
• an auxiliary element is attached to an impression arranged at the implantation site and measured in an X-ray image or an MRI image.
• the auxiliary element is characterized in that it is at least partially radiopaque and thus recognizable in the X-ray image and / or recognizable in an MRI image, while the impression of X-ray permeable and / or insulating material in the X-ray and / or the MRI image not visible.
• the implantation site can be seen in the X-ray image or the MRI image, so that the relative position of the X-ray image or the MRI image is determined from the data of the X-ray image or the MRI image Radiopaque or visible in the MRI image areas of the auxiliary element can be determined to the implantation parts.
• the auxiliary element has a connection part, which denotes a region which is characterized by a geometry which makes it possible to attach the auxiliary element to the upper side of the impression.
• This may, for example, be an elevation which can be attached to the impression in such a way that it is at least partially enclosed by the impression.
• the attachment part of the auxiliary element formed as an elevation can, for example, be pressed into a not yet hardened impression compound, which was attached to the implantation part to produce the impression, and remain there during the curing of the impression compound.
• the connection part is positioned as far as possible in the region of the implantation parts on the side of the impression mass which produces the upper side of the impression.
• connection part of the auxiliary element can also be designed, for example, as a depression.
• a depression can, for example, be connected to the impression by applying it to a suitable increase in the impression.
• additional impression compound can be applied to the upper side of the impression and the connection part of the auxiliary element can be impressed onto this additional impression compound so that the additional impression compound at least partially fills the depression of the connection part of the auxiliary element.
• the auxiliary element is removed after the X-ray exposure of the impression, so that at least partially a negative mold of the connecting part of the auxiliary element remains on the impression.
• This area is again referred to as a connection part of the impression, since it is suitable for connecting a further component which has a connection part corresponding to the auxiliary element to the impression.
• connection part of the impression is designed as a depression corresponding at least partially to the negative of this elevation.
• a further subject matter of the invention is a method for correlating an implantation part of a jaw and a 3D measurement dataset of the implantation site, wherein an impression having at the bottom a negative mold of at least a partial area of a jaw and at least one implantation part located in this partial area of the jaw a material partially transparent to X-rays and / or made of insulator material with at least one X-ray opaque and / or visible in MRI images, wherein the impression in the region of the negative form of the implantation on a top side opposite the underside of the impression has a connection part and the positional relationship between the radiopaque and / or visible in MRI images area and the connection part is known.
• At least one X-ray image and / or MRI image of at least the partial region of the jaw, the at least one implantation part located in this partial region and the impression used on the implantation part is produced and a 3D measurement data z from the at least one X-ray image. take and / or generates at least one MRI recording.
• the position of the radiopaque and / or visible area of the impression relative to the implantation parts in the 3D measurement datum z is determined and the relative position of the attachment part of the impression to the implantation site due to the relative position of the radiopaque and / or in the MRT. Acceptable area is determined.
• this method establishes a connection between an implantation site in the mouth of a patient and a 3D data set.
• the attached to the impression connector the location of which is known in the 3D data set, can serve as an orientation aid for the transmission of positions and directions from the 3D data set in the real space in the mouth of the patient.
• an X-ray image and / or an MRI image of an impression arranged on the implantation part is generated.
• the impression has a connection part, ie an area which is suitable for attaching a further component to the impression.
• the impression consists to the largest possible extent of a radiolucent material which is not recognizable in the X-ray image, and / or of an isolator, which is not visible in the MRI image. Only a smaller area should consist of an X-ray-opaque material, which is therefore visible in the X-ray image, and / or of a material, for example a conductive material, which can be identified in the MRI image.
• a further subject matter of the invention is a method for correlating an implantation part of a jaw and a 3D measurement dataset of the implantation site, wherein an impression having at the bottom a negative mold of at least a partial area of a jaw and at least one implantation part located in this partial area of the jaw a radiolucent material and / or insulator material is provided. Furthermore, at least one optical auxiliary element is provided, which has a connection part which penetrates the impression in the region of the negative form of the implantation parts on the impression of a top surface opposite the underside of the impression and extends beyond the underside of the impression and at the end projecting beyond the underside of the impression has at least one fixed or removable arranged Finde emotions.
• At least one X-ray image and / or one MRT image of at least the partial region of the jaw and the at least one implantation part located in this partial region is created and a 3D measurement data z is generated from the at least one X-ray image and / or the at least one MRI image.
• at least one optical recording of the underside of the impression with the optical auxiliary element inserted and projecting beyond the underside of the impression is created with the at least one finder body attached to the protruding connecting part of the auxiliary element, and a further 3D measuring data z from the at least one optical image. me generated.
• a correlation measurement data set is generated by correlation, and the position of the connection part of the at least one auxiliary optical element relative to the implantation parts in the correlation data z is determined.
• a connection part corresponding to the negative of the connection part of the at least one auxiliary optical element is provided at the position in the impression used at the implantation point at a position matching the position of the connection part of the optical auxiliary element determined in the correlation data set.
• this method establishes a connection between an implantation part in the mouth of a patient and a measurement dataset.
• an X-ray image and / or an MRI image of an impression arranged on the implantation part and an optical image of a lower side of the impression are correlated.
• the X-ray and / or MRI image is taken from the region of the jaw which comprises the implantation parts and whose negative mold is impressed on the optically to be measured underside of the impression.
• an auxiliary optical element is attached to the impression, which has a connection part which extends from the upper side of the impression through the impression, so that it protrudes beyond the underside of the impression.
• At least one finder body is arranged at the end projecting beyond the underside during the optical recording.
• a finder body is characterized in that it has a specific outer shape, which in an optical Image is clearly visible, so that the exact position of the finder body in the optical relative to the recorded O- ber Solutions the underside of the impression in the optical recording can be determined. From the known relative position of the finder body to the connection part of the auxiliary optical element, it is thus possible to deduce the position of the connection part of the auxiliary optical element in the optical receptacle, even if it is partly in the impression and therefore can not be seen on the optical receptacle itself.
• the generation of the correlation data set can be carried out according to a method known from the prior art for the correlation of X-ray data and optical data, for example the method described in DE 199 52 962 A1.
• a further subject matter of the invention is a method for producing a drilling template for a bore to be made at an implantation site, for which purpose an impression having at least one partial area of a jaw and at least one implantation portion located in this partial area of the jaw with at least one attachment with known Rangeo- is provided, wherein the connection part is arranged in the region of the negative mold of the implantation parts on a top side opposite the underside of the impression and its positional relation to the jaw is known in the imprint positioned on the implantation parts.
• a drilling direction for at least one implant relative to the connection part of the impression is determined on the basis of a 3D measurement data set of the jaw containing the implantation parts and at least one drilling aid with a connection part of a block with one along a
• the connecting part at least partially corresponds to the negative of the connecting part of the impression and wherein the connecting part is arranged at an angle to the passage opening, which corresponds to an angle of the drilling direction to the connecting part of the impression.
• the at least one drilling aid is attached to the impression, whereby a correct orientation of the drilling aid on the impression is ensured by means of the connecting parts.
• a Bohrschablone invention is created from an impression and a drill.
• the impression has a lower side with a negative mold, a partial region of a jaw, wherein the partial region comprises at least one implantation part.
• the impression of a connection part which is arranged in the region of the implantation parts on an upper side of the impression opposite the underside.
• the attachment part is a region of the impression which has a known geometry which is suitable for attaching a further component to it. It may be, for example, a depression, in which a further component is at least partially inserted.
• the connection part can but also be designed as an increase to which another component can be plugged. Furthermore, the position of the connection part to the jaw is known.
• the parameters of the implant borehole are determined, in particular, the drilling direction, but also the bore diameter and / or drilling direction and drilling depth.
• a drilling aid is produced by arranging a connection part on a block, wherein the block already has an opening running along a longitudinal axis.
• the connecting part to be produced is characterized in that it is arranged along the longitudinal axis of the block at one end of the block and with respect to a longitudinal axis of the connecting part at an angle to the longitudinal axis of the block.
• the attachment part has a shape which at least partially corresponds to the negative of the attachment part of the impression, so that the drilling aid can be attached to the impression by connecting the attachment parts.
• This connection can be achieved by an at least partial positive locking. For example, it may be a plug connection.
• the block is held on a holder during the manufacture of the connection part, it is separated from it after completion of the production along an opening at an angle to the plane, so that a component with a connection geometry and a passage opening is provided as a drilling aid.
• the angle between the attachment part of the drill guide to be made and the opening of the drill guide used Blocks are chosen to match the angle of the specified drilling direction to the attachment of the impression.
• the passage opening of the drilling aid runs after the onset of the drilling aid in the impression according to the specified drilling direction.
• the directional course and the position of the plane at which the block is separated from a holder or the end of the block facing away from the connecting part can predetermine the drilling depth, for example by a stop on the drill to be used or at least constitute a check option. It is possible, for example, to provide a depth stop or stop for a drilling tool by means of the surface or edge created after the separation or by means of the closing surface of the block, which prevents further penetration of the drill and thus defines a maximum drilling depth.
• a drilling diameter for at least one implant relative to the attachment part of the impression is determined, and a block with a cylindrical opening with a diameter according to a specified drilling diameter is used.
• the diameter of the opening of the block to be used may be selected to suitably correspond to the desired bore diameter, as already known for drilling templates, in order to ensure safe guidance of a drill in the drilling template.
• a bore diameter for at least one implant relative to the attachment portion of the impression is defined and a block having an opening with a diameter greater than the fixed bore diameter is used to make the drilling aid, the drilling aid being used in conjunction with an adapter will, one Having a region corresponding to the negative of the opening of the block outer geometry, a closing area adjoining this area and a through hole having an inner diameter according to the fixed Bohr matmesser and on the the connecting part of the
• Drill side facing away from the drilling aid made from the block in the through hole of the drilling aid is at least partially used.
• the adapter has a passage opening with the desired diameter, for example the bore diameter or a diameter suitable for a pilot bore, and an outer shape which makes it possible for the adapter to be at least partially inserted into the passage opening of the drilling aid in such a way that the passage opening of the adapter parallel to the passage opening of the drilling aid and partially extends within the passage opening of the drilling aid.
• This provides a drill template of impression and drill aid with adapters with a desired bore diameter. It is also possible, by providing a plurality of adapters with different diameters of the passage opening, to provide a drilling template which can be used in a simple manner, namely by dipping the adapter for a first pilot bore and also for further bores or the implant bore.
• At least the attachment part of the drilling aid is milled or ground from the block.
• the block is held on a holder at least during the manufacture of the connection part and separated from the holder before being inserted along a separation surface running perpendicular or obliquely to the longitudinal axis of the block.
• the directional course and the position of the plane at which the block is separated from a holder, to which it is held during the manufacture of the connection geometry, can be adjusted to a specified drilling depth.
• a depth stop or stop for a drilling tool by means of the surface or edge formed after the separation, which prevents further penetration of the drill and thus defines a maximum drilling depth.
• FIG. 1 shows an impression according to the invention an implantation site and a part of an adjacent jaw with an auxiliary element
• Fig. 3 shows the impression of Fig. 1, the
• Fig. 4 shows a drilling aid for a drilling template according to the invention
• Fig. 5 shows an adapter
• Fig. 6 shows schematically the production of a drilling aid from a block
• Fig. 7 shows a further variant of a to be produced from a block drilling aid
• Fig. 8 shows a drilling template according to the invention
• FIG. 9 shows an optical auxiliary element according to the invention
• FIG. 10 shows an optical measurement obtained from FIG
• a jaw 1 shows a part of a jaw 1, here by way of example a lower jaw, comprising an implantation part 2, ie a point in the jaw 1 or an area of the jaw 1, to which an implant in the jaw 1 is to be attached.
• the implantation part 2 shown is located in a switching gap on the lower jaw 1, in the region of which at least one implant bore for at least one implant should be applied.
• Switching gap is understood to be a tooth gap defined by other teeth.
• it could also be an implantation part 2 on the mandibular bone 1 or else one of a plurality of implantation sites 2 in a completely edentulous jaw 1 or a clearance gap, ie a tooth gap which is limited only on one side by other teeth.
• An impression 3 is formed from a surface of the jaw 1 which comprises the implantation parts 2 and which is at least in the solidified state radiopaque and / or insulating impression material.
• the impression compound can be fast-curing. It is essential that the impression mass in the solidified form, that is, as an impression 3, no longer deforms or alternatively elastically returns to its original shape upon deformation from an initial shape. Another important feature is that the impression in an X-ray or in an MRI scan is not recognizable.
• the impression material is at least in the solidified state radiolucent or made of an insulating material. Insulating materials such as polyethylenes, polyurethanes, polymers or glass fibers are usually not visible in an MRI image.
• the impression 3 has an underside 3 "with a negative form of the area of the jaw 1 encompassing the implantation parts 2 and one of the undersides 3" opposite
• an auxiliary element 4 is at least partially introduced into the impression compound in the area of the planned implant at the side of the impression facing away from the lower jaw 1 or the implantation site 2, ie at the upper side 3 'of the impression 3 Impression material attached. This can be done for example by subsequent pressing into the already applied, but not yet cured impression mass or by placing and then encapsulating or kneading with further impression mass.
• an auxiliary element 4 is at least partially introduced into the impression mass or attached to the impression mass.
• the procedure is as described here by way of example for a planned implant.
• the auxiliary element 4 which is shown in Fig. 2 in detail, has at least one radiopaque or in one MRT recording recognizable area 6 and a connection part 5 for attachment to the impression 3.
• the auxiliary element can, for example, consist in part of a material which can be identified in MRT images, for example an electrically conductive material such as metal.
• connecting part 5 is understood to mean a region of the auxiliary element 4 which, because of its geometry, is suitable for attaching the auxiliary element to the impression 3. This geometry of the connection part 5 is known. Furthermore, the positional relationship of the connecting part 5 of the auxiliary element 4 to the radiopaque and / or visible in an MRI scan area 6 of the auxiliary element 4 and the geometry of the radiopaque region itself is also known.
• the radiopaque and / or visible in an MRI scan area 6 is an arbitrarily ausgestalteter and arbitrarily arranged area of the auxiliary element 4, which is characterized in that it is radiopaque, so on an X-ray visible.
• the region 6 can be made up of several, e.g. three balls of radiopaque and / or in an MRI recording recognizable material, which are arranged side by side on the connecting part 5 of the auxiliary element 4 or on a subsequent to the connecting part 5 region of the auxiliary element 4.
• the region 6 can also extend over the connection part 5. It would be possible, for example, for the radiopaque and / or visible region 6 visible in an MRI scan to extend over the entire auxiliary element 4, ie this region is completely radiopaque or visible in an MRI scan.
• the connecting part 5 is formed as a survey with a longitudinal axis A extending in the direction of the survey.
• the elevation has several sides parallel to the longitudinal axis. tenston 5 '', which together form a pentagonal cross-section and are closed by a flat perpendicular to the longitudinal axis A of the connecting part 5 extending bottom 5 '.
• the longitudinal axis A corresponds to the attachment direction of the auxiliary element 4, ie the mounting or insertion direction, along which the connection part 5 of the auxiliary element 4 is introduced into the impression 3.
• the sides of the pentagonal cross-section have different lengths, so that the connecting part 5 designed as an elevation has an angularly unique geometry with respect to the longitudinal axis A. If the auxiliary element is removed from the impression and reinserted, the angularly unique geometry prevents a twisted insertion.
• connection part 5 of the auxiliary element 4 could, for example, also be formed as a recess with a longitudinal axis extending in the direction of the lowering.
• the connection part 5 could also have only a single side wall 5 ", which is, for example, egg-shaped in cross section.
• the side walls may also extend at an angle with respect to the longitudinal axis of the connection part 5.
• the geometry of the connection part has an area with a geometry which is angularly unambiguous with respect to its longitudinal axis A.
• the connecting part could be designed as a punch with an oval cross-section.
• the cross section could, for example, also taper in the direction away from the rest of the auxiliary element 4, as a result of which it can be more easily detached from the impression.
• the auxiliary element 4 shown in FIG. 2 has a radiopaque region 6, which is designed as a radiopaque elevation with a geometry similar to the connection part 5 and is shown as a dotted area.
• the auxiliary element 4 shown in FIG. 2 furthermore has a plate-shaped region 5.1 arranged between the connection part 5 and the X-ray opaque and / or visible in an MRI recording 6.
• the plate-shaped area 5.1 terminating the connection part can serve as a bearing surface on the upper side 3 'of the impression 3 and thus as a kind of stop for the insertion depth of the auxiliary element 4.
• An auxiliary element 4 according to the invention need not have such a plate-shaped region 5.1.
• the auxiliary element 4 can, as in the case shown, be formed in one piece. It is also possible to form the auxiliary element 4 in several parts. It is possible, for example, to construct the auxiliary element 4 from two components which can be plugged together, of which one component comprises the connection part 5 and the other component has, for example, at least one radiopaque and / or visible region 6 in an MRI recording. As a result, it would be possible, for example, first to position only the part comprising the connection part 5 in the impression compound of the impression 3 in the patient's mouth and to leave it in the mouth during the curing of the impression material.
• this first part for example alone, does not protrude so far beyond the upper side 3 'of the impression compound or the impression 3
• displacement of the positioned part of the auxiliary element 4 by the tongue of the patient in the not yet cured state of the impression compound is prevented.
• connection part 7 which corresponds to the negative of the connection part 5 of the auxiliary element 4.
• connection part 7 designed as a depression with respect to the upper side 3 'of the impression forms with a longitudinal axis A running in the direction of the depression, a bottom 7' and an angularly unambiguous one with respect to the longitudinal axis A. Geometry on. As a result, an angularly unique use of a fitting in the connector part 7 of the impression 3 component is ensured.
• connection part 5 of the auxiliary element 4 completely breaks through the impression 3 in the direction of the longitudinal axis A of the connection part 7 forming in the impression 3, so that the connection part 7 of the impression 3 has no bottom 7 '.
• connection geometry 7 formed as a negative of this connection geometry 5 can be formed on the upper side 3 'of the impression 3, for example, by applying an excess of impression material to the upper side 3' of the impression 3 and placing it on the connection geometry 5 of the auxiliary element 4 is formed.
• the forming as a survey terminal part 7 then has a roof instead of a floor.
• the imprint 3 with the connection part 7 with known geometry positioned on the implantation part 2 serves as an orientation aid by establishing a connection between the implantation site 2 on the jaw 1 and a 3D measurement dataset z 21 of the implantation part 2.
• a 3D measurement dataset z 21 of the implantation part 2. For this purpose, at least one X-ray image and / or MRI recording of the implantation parts 2 with the impression 3 positioned there and the auxiliary element 4 attached thereto are generated.
• the impression 3 is not recognizable in the at least one 3D data record 21 determined from the at least one X-ray recording and / or MRT recording. Recognizable in the 3D data set 21 are both the implantation parts 2 and the at least one X-ray opaque region or region 6 of the auxiliary element 4 visible in an MRI image, as shown schematically in FIG.
• the relative position of the connection part 5 of the auxiliary element 4 is determined to the recognizable in the 3D data set implantation parts 2. Since the position of the connection part 5 of the auxiliary element 4 attached to the impression 3 coincides with the position of the connection part 7 of the impression 3, the positional relationship of the connection part 7 of the impression 3 to the implantation site 2 is also known.
• the impression 3 positioned at the implantation site 2, by means of its connecting part 7 after removal of the auxiliary element 4 represents an orientation aid which produces a connection between the implantation parts 2 on the lower jaw 1 and the at least one 3D measurement data 21.
• a drilling aid 8 according to the invention can be produced, as shown in FIG. 4.
• the drilling aid 8 according to the invention has a passage opening 9 and a connection part 10 for connection to the impression 3.
• the connection part 10 of the drilling aid 8 shown in FIG. 4 is designed for this purpose as a negative mold of the connection part 7 of the impression 3 and thus as an elevation and has a longitudinal axis A extending in the direction of the elevation.
• connection part 10 of the drilling aid 8 is only partially formed as a negative mold of the connection part 7 of the impression 3, wherein it is to be ensured that the connection part 10 of the drilling aid 8 with respect to the longitudinal axis A fits angularly uniquely to the connection part 7 of the impression and that the drilling aid can be connected without shaking to the impression. Only by preventing a twisted insertion and a blur-free connection can it be ensured that the passage opening 9 of the drilling aid runs in the direction in the direction of the drilling direction defined in the 3D data set relative to the jaw in the impression positioned on the jaw.
• the passage opening 9 is formed as a cylindrical opening with a following the course of the opening longitudinal axis B and its course shown in Fig. 4 by dashed lines.
• the passage opening 9 is aligned with the connection part 10 of the drilling aid 8 so that the longitudinal axis B of the passage opening 9 with the longitudinal axis A of the connection part 10 of the drilling aid 8 forms an angle which corresponds to the determined angle between the planned drilling direction and the connection part 7 of the impression 3 , Furthermore, the longitudinal axis B is angularly aligned relative to the longitudinal axis A of the connection part 10 of the drilling aid 8. tet, as it was determined for the planned drilling direction with respect to the longitudinal axis of the connection part 7 of the impression 3.
• connection part 10 of the drilling aid 8 is inserted into the connection part 7 of the impression 3 or onto the connection part
• the through hole 9 serves as a guide for a drill and are thus used in the impression 3 inserted drilling aid
• the passage opening 9 of the drilling aid 8 can, as shown in Fig. 4, have a cylindrical geometry, the diameter of which is based on a diameter of a drill to be used for implant drilling that safe guidance of the drill during implant drilling possible is.
• the drilling aid 9 may also include an adapter 12, as shown in Fig. 6.
• the through-opening 9 can have a cylindrical cross-section into which one or more adapters 12 can be inserted.
• Such an inventive adapter 12 has for this purpose an external geometry Rie with a in the through hole 9 of the drilling aid 8 fitting in the elongated end 13 and a final plate 14 this end.
• the plate 14 In a plane which runs perpendicular to a longitudinal axis C of the through-opening 9 of the drilling aid 8 in the end 13, the plate 14 has a diameter which is greater than the corresponding diameter of the end 13. This results in a maximum penetration depth of the adapter 12th realized when introduced into the through hole 9 of the drilling aid 8.
• the adapter 12 has a passage opening 15 which runs along the longitudinal axis C and which has a diameter which corresponds to the drill diameter of a planned bore.
• a plurality of adapters 12 with different diameters of the through-opening 15 can be provided in order, for example, to carry out a pilot bore by means of a first adapter 12 and subsequently an implant bore by means of a further adapter 12.
• the cross section of the passage opening 9 of the drilling aid 8 can have any shape, wherein the at least one adapter 12 has an end 13 with a corresponding external geometry.
• the passage opening 9 of the drilling aid 8 may, for example, have a square cross section and the adapter 12 may have an end 13 with a corresponding quadrangular external geometry.
• FIGS. 7 and 8 the production of the drilling aid 8 according to the invention for a drilling template 11 from a block 16 is shown schematically.
• the block 16 held on a holder 17 has, along a longitudinal axis D of the block 16, an opening 18 which corresponds to the passage opening 9 of the drilling aid 8 to be produced.
• connection part 10 of The drilling aid 8 to be produced is produced by means of a grinding or milling tool 19 by machining at an end of the block facing away from the holder 17, by forming the side walls 10 '' of the connection part 10 flat and parallel to an axis E, the axis E to the longitudinal axis D of the opening 18 of the block 16 is aligned so that the planned drilling direction along the longitudinal axis A of the connecting part 7 of the impression 3 extends.
• the bearing surfaces 20 may be formed with respect to the longitudinal axis of the connecting part 10. But you can also include an angle with the longitudinal axis. It is essential that they ensure a defined depth stop.
• a depth stop can be ensured, for example, by the transition between the connecting part 10 and the support surface 20, in that the edge forming at the transition is positively locked, for example, in the transition from the side walls 7 "of the connection part 7 of the impression 3 and the upper side 3 'of the Impression 3 trained shoulder ter is placed.
• FIG. 7 provides that the attachment part 10 of the drilling aid 8 to be produced rests on the upper side 3 of the impression 3 'by means of the support surfaces 20, wherein the attachment part 10 of the drilling aid is located between the side surfaces 7 "of the attachment part 7 of the impression 3 be guided without the connection part 10 of the drilling aid 8 with the bottom 7 'of the connection part 7 in contact comes.
• the parallel to the axis E extending side walls 10 '' and the support surfaces 20 must be worked out of the block.
• the variant shown in FIG. 8 provides that the attachment part 10 of the drilling aid 8 to be produced attaches to the impression 3 both with the support surface 20 on the upper side 3 'of the impression 3 and with the base 10' on the bottom 7 'of the Connecting part 7 of the impression 3 comes into contact.
• the bottom 10 'of the connecting part must also be produced by appropriate machining of the block.
• connection part 10 of the drilling aid 8 in such a way that it makes contact with the bottom 7 'and the side walls 7 "of the connection part 7 of the impression, without, however, resting on the upper side of the impression with bearing surfaces 20.
• connection part 10 of the drilling aid 4 is completely manufactured, then the block holder 17 and possibly a part of the holder-side end of the block 16 are separated along a plane F extending perpendicularly to the opening 18 or to the longitudinal axis D of the block 16.
• the drilling aid 8 can now be attached to the impression 3 in order to form together with it the drilling template 11 according to the invention.
• the drilling depth can also be used to control or predetermine the drilling depth by means of the drilling template 11 according to the invention.
• a drilling depth for the implant bore relative to the jaw 1 is determined in the 3D data set 21 in addition to the drilling direction. Accordingly, the drilling direction for the resulting
• a position relative to the connection part 7 of the impression 3 are determined.
• This position can be determined, for example, relative to the bottom 7 'of the connection part 7 of the impression 3 or relative to a n the top 3' of the impression 3 adjacent edge or shoulder of the connection part 7.
• This can be limited by the length of the through hole 9 of the drilling aid 8, the penetration depth of a drill to be used.
• the length may be from the bottom 10 'of the connection part 10 of the drilling aid 8 or from the support surfaces 20 of the connection part 10 of the drilling aid 8 or from the see at the transition between the side walls 10''of the connection part 10 and the support surface 20 of the drilling aid 8 forming edge measured or set to the end of the drilling aid facing away from the connection geometry. It is essential that the support point or the bearing surface of the drilling aid 8 with the impression 3 is known.
• the drilling depth can therefore be regulated for a drill with a suitable stop on the drill itself by means of the length of the through hole 9 of the drilling aid through the BohrSchablone invention.
• a shoulder fixedly attached to the drill on a fixed length relative to the drill bit can serve as a stop, whereby the drill can penetrate through the passage opening 9 of the drilling aid 8 until the shoulder at least partially rests on the side of the drilling aid 8 facing away from the connection geometry.
• the penetration depth of the drill can be determined by reading a value on the drill used at the level of the connection geometry facing away from the side of the drilling aid 8 due to the knownness of the length of the passage opening 9 of the drilling aid 8 relative to the connection part 7 of the impression 3 ,
• an optical auxiliary element 22 instead of a radiopaque and / or auxiliary element 4 which can be seen in an MRI image and in addition to a X-ray and / or an MRI scan to perform an optical survey.
• An auxiliary optical element 22 which is shown by way of example in FIG. 10, has, as already described
• auxiliary optical element 22 is further formed so as to completely penetrate the impression 3, i. the optical auxiliary element 22 penetrates into the impression 3 on the upper side 3 'and also breaks through the underside 3 "of the impression 3 opposite the upper side 3', so that a part of the optical auxiliary element 22 projects beyond the underside 3" of the impression 3 ,
• At least one finder body 24 is arranged at the end of the auxiliary optical element 22 exiting at the bottom 3 ", which is characterized in that it has a specific geometry with distinct surfaces by means of which the exact position of the finder body 24 can be determined in an optical image ,
• a finder body 24 may be formed, for example, as a tetrahedron.
• the finder body 24 can be attached to the auxiliary element 22 so that the relative position of the finder body 24 or the individual surfaces of the finder body 24 to the connection geometry 23 of the auxiliary element 22 is known.
• the underside 3 'of the impression 3 with the auxiliary element 22 with finder body 24 is optically measured and removed from the optical system. would create a 3D data set 25, as shown by way of example in FIG. 11.
• This 3D data record 25 is correlated with the 3D data record generated from the X-ray image or the MRT image, for example from tooth surfaces which can be recognized in both measured data sets.
• the correlation data set 25 generated in this case the relative position of the finder body 22 to the implantation parts 2 can be determined and from this the position of the connection part 23 of the optical auxiliary element can be derived, which in turn makes known the position of the connection part 7 of the impression.

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• 2011
  • 2011-02-03 DE DE102011003561A patent/DE102011003561A1/de not_active Withdrawn
• 2012
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