FR2634999A1 - Calibrated dental plate implants, their selection device and their modular device for guided fitting - Google Patents

Abstract

The invention relates to a system comprising a set of calibrated dental plate implants, their selection device and their modular device for guided fitting resulting from this selection. A plate implant comprises a plate delimited by a gingival edge and a basal edge. The plate 1 consists of at least one lobe and the plate implant additionally comprises at least one shaft 2, placed in the plane of the lobe, one end of which is fixed through the gingival edge 20. The devices for selecting the plate implants consist of work gauges. The modular devices for guided fitting of the plate implants comprise cylindrical, wheel, cylindroconical burs and drilling guides for these bone burs. Finally, the invention relates to depth gauges for the lobes and the shafts. Application to dental surgery.

Description

 The present invention relates to a system comprising a set of calibrated dental blade implants, their selection devices, and the modular guided positioning devices which result from this selection.

 More specifically, the invention relates to a system comprising firstly a set of blade implants each having a blade and one or more drums. The blade has a gingival edge and a basal edge.

The gingival border can be flat, concave or convex, matching the curvature of the overlying bone crest. The basal edge is formed by one or more arcs of a circle. Consequently, the blade has one to, for example, three convex lobes. Drums, of various diameters and lengths, intended to receive the prosthetic part, are integral with the blade. These cylindrical, or cylindro-conical barrels, with a flat, round, or conical end, either are oriented perpendicular to the gingival edge of the blade, or form an angle with this gingival edge.

One or more of these barrels can possibly transfix the blade. Cover screws protect, at the gingival end of these barrels, an internal screw pitch, no screw used to receive the various prosthetic screws. Some implants also have a cover screw at the basal end of their barrels. These implants are used at the graft level in bone grafts.

 All of these blade implants are intended to be essentially buried in the bone in total or partial edentulous so that they can receive a prosthesis, once the healing is complete.

These blade implants belong to a range of implants dimensioned to adapt to different curvatures of alveolar or basal ridges of the maxillae, and for each curvature, to different thicknesses, lengths and depths available of said crest.

 Secondly, the system according to the invention comprises, in order to make it possible to choose an appropriate implant, and consequently its modular device for guided placement: a set of working gauges.

To make this selection, the gauges have three goals, at the level of the edentulous, bony and gingival crest
- the selection of a curvature of gauge corresponding best to the curvature of the crest,
- verification of the adequacy of the buccal-lingual thickness of the crest and
- verification of the adequacy of the length of the crest.

 Thirdly, the system according to the invention comprises a modular set of drilling guides for cylindrical bone milling cutters, wheels, cylindrical-conical.

 Fourth, the system includes bone mills.

 The cylindrical bone cutters allow the drilling of the stabilization wells on which the other drilling guides will come to stabilize, serving to create the intraosseous implant housing. The diameter and depth of their active part are determined in advance. The smooth part of their mandrel is used for guiding them.

 The wheel bone cutters are used to dig lobed intraosseous housings in which the lobes of the implant blades will be buried. These strawberries are of varying thickness, diameter, shape. They are all traversed by a mandrel which is the element serving to guide them on the rails of the drilling guides.

 The cylindrical or cylindro-conical bone milling cutters, with flat, round or conical end, are used to hollow out the cylindrical or cylindro-conical intraosseous housings which will accommodate the implant barrels. These strawberries are of varied diameter and length. The smooth part of their mandrel is used for guiding them.

 Fifth, the system according to the invention includes depth gauges for the lobes and for the barrels.

 Sixth, the system includes implants for placing and removing implants, these instruments already existing for other known types of blade feeders.

 So that partial or total toothless, unimaxillary or bimaxillary, can receive a prosthesis, blade implants already exist.

 However, these blade implants present in part or in whole the following drawbacks, drawbacks which we tend to eliminate entirely in the invention presented.

 The curvature of the gingival edge of the blade of these blade implants does not correspond to the curvature of the underlying bone crest. In this case, the long-term prognosis is immediately unfavorable.

 Indeed, bone resorption is always observed after implant placement at the implant site. This bone resorption, according to some authors, is significant in the first year, less significant in the following years.

 In the case of non-correspondence of the curvature of the gingival edge of the blade of the implant with the upper edge of the bone crest, after placement, the resorption would expose part of this gingival edge, first, well before the rest of the blade. This may make it necessary to remove the implant prematurely.

 Known blade implants are generally flat, at their gingival edge, which is very good for flat bone ridges.

 Some blade implants have a curvature at their gingival edge, but the absence of an evaluation gauge and the resulting positioning instrumentation means that this feature is not really taken advantage of.

 The non-calibration of these implants makes their osseointegration risky. It is said that an implant is calibrated, when a cutter having certain shape and dimensions allows the creation of an intraosseous housing of identical shape and dimensions, in order to accommodate an implant of the same shape and dimensions.

 Thus, in the case of a screw implant, a cylindrical bur of the same diameter and length is used, or in the case of a lobe-shaped blade implant, a wheel bur of the same thickness and corresponding diameter is used , the wheel bur only partially penetrating into the bone, due to its mandrel.

In the case of non-calibrated blade implants, we obtain
- non-correspondence and, therefore, non-intimate contact between the intraosseous accommodation and the implant surface, and
- an impossibility of having sufficient anchoring and of immobilizing the implant perfectly in its bone compartment.

 This results in significant chronic inflammation and the formation of fibrous scar tissue, instead of bone tissue, around the implant, a phenomenon which is called "fibrointtegration" by some authors. In this case, the implant must be removed, during the verification, after only a few months.If the implant is not removed, it will show increasing mobility, chronic inflammation, or destruction progressive of the surrounding bone.

 Currently, it is recognized that all implant techniques must tend towards obtaining osseointegration, that is to say an intimate bone / implant contact, the bone heals around the implant guaranteeing its immobility, an absence inflammation, and a good long-term prognosis.

 Failure to guide the work of the bone cutters can contribute to non-calibration of the implants compared to the intraosseous housings produced even when using calibrated bone cutters.

 Indeed, when we want to extend an intraosseous lobed housing in length, by sliding freehand the cutter forward or backward, or we want to make a second lobed housing joined to the first, in order to put the corresponding implant, we no longer have sufficient precision to obtain intimate bone / implant contact. This problem is solved by the drilling guides for wheel bone cutters.

 It can be noted that even for a lobed housing, corresponding to a lobed blade implant of the same dimensions, it is desirable to have a drilling guide allowing the wheel bur of identical dimensions, to work in a vertical axis only, and to stop thanks to its mandrel, at a level determined in advance by the rails of the drilling guide.

 In the so-called non-buried technique, the barrel of the implant extends through the mucosa, either to be loaded immediately using a temporary prosthesis, or to be on hold. In both cases, the surrounding soft tissues and in particular the tongue play a harmful role, because they exert more or less pressure on the barrel and therefore on the bone / implant junction. In addition, chewing promotes this mobilization of the implant. In this case, the local inflammation still present after drilling increases; fibrous tissue forms; the implant becomes more and more mobile. Removal of the implant may be necessary.

 Currently, preference should be given to buried techniques, which allow the implant to rest for several months, the barrel stopping at the level of the bone crest. Osseointegration is then possible.

When the work is done with the turbine, the cutting speed is too high. This results in overheating of the bone, even if the strawberry is constantly irrigated. Consequently, necrosis of the bone is obtained at the level of the intraosseous accommodation. Osteointegration may not happen. '
The disadvantages of known blade implants can be summarized as follows.

For titanium blade implants
- absence of curvature of the gingival edge of the implants,
- total absence of calibration by using uncalibrated cutters. Indeed, here we only use a cylindrical or cylindrical bur to create an intraosseous housing that can accommodate a blade and
- turbine work.

For ceramic blade implants:
- absence of regular curvature at the gingival edge of these implants. In any case, there is no gauge, to assess the curvature and choose appropriate drilling guides,
- imperfect and insufficient calibration due to the absence of a drilling guide from the creation of the first intraosseous housing. In fact, the first intraosseous housing is produced with a wheel bone cutter calibrated only from the point of view of thickness, by making the cutter work freehand along the bone crest. On the other hand, there is a drilling guide for calibrated cylindrical cutters, in order to create housings for the barrels. But, since the first housing in which this drilling guide will come to stabilize is not calibrated, the second accommodation which will follow will also be imperfect and
- these blade implants are used with a buried technique.

Regarding other titanium blade implants
the gingival edge of these implants is flat, which limits the field of application to flat bone ridges,
- the calibration is imperfect, even if the installation is done in a guided way. In fact, a vertically guided cylindrical cutter is used here. The meeting of these cylindrical housings constitutes a trench of well determined length and depth, being able to accomodate an implant-blade of the same length and Prcfonde-r. Y.ais, it results in a bad aaaptation, from the point of view of the thickness. At the level of each intraosseous cylindrical housing, the most vestibular and most lingual edges are distant from the surface of the blade of the implant,
- these implants are used with a non-buried technique.

 The present invention therefore aims to overcome the drawbacks of known systems.

 It firstly relates to an implant-blade comprising a blade delimited by a gingival edge and a basal edge characterized in that the blade consists of at least one lobe and in that it further comprises at least one barrel placed in the plane of the lobe and one end of which transfers the gingival border.

 When the blade is formed by at least two lobes, the lobes can be located in the same plane, or in parallel planes, cu in planes making between them a given angle and they result from arcs of circle of different diameters or identical. A lobe can be single or double.

 Each barrel is of cylindro-conical or cylindrical shape with a flat, round or conical end, these barrels possibly being able to transfer the basal edge.

 It further relates to a working gauge making it possible to choose an implant-blade according to the invention most suited to the chosen implant site, characterized in that it consists of a blade of generally parallelepipedal shape having in the mesial direction- distal a zero curvature, concave or convex and comprising at least one vestibulo-lingual extension.

 The invention also relates to a cylindrical bone milling cutter making it possible to drill the stabilization wells intended to receive the stabilization feet of the drilling guides for wheel bone milling cutters and cylindrical-conical or cylindrical bone milling cutters, characterized in that it includes an active part, a smooth part, and a stopper; as well as a drilling guide for this cylindrical bone milling cutter and for a blade implant according to the invention characterized in that it comprises a support for at least two hollow cylinders cooperating with the smooth part of the milling cutter to ensure its guidance and with the stop of the cutter to prevent it from sinking into the bone after a certain depth of penetration and allowing the screwing of at least one stabilizing foot, and a screw pitch located between the two hollow cylinders, to receive a replica transmucosal ring.

 The invention then relates to a wheel bone cutter making it possible to produce the lobed intraosseous housing for a lobe of a blade implant according to the invention, characterized in that it comprises a mandrel passing through a wheel containing the active part of the cutter and supporting stops arranged on each side of the wheel, as well as a drilling guide for this wheel bone cutter and for an implant-blade according to the invention, characterized in that it comprises two stabilization feet and at least one first substantially parallelepiped and hollow part, the vestibular and lingual walls of which have guide rails perpendicular to the lower and upper faces of said first part.

 The mandrel of the bone bur can move in these guide rails. These have stops which allow the insertion of the mandrel to stop at a determined level of the wheel bone cutter.

 The drilling guide may further comprise a second substantially parallelepipedal and solid part, located in the extension of the first part or forming an angle with the latter, and which supports on its underside a stabilizing fin and a stabilizing foot placed at the level of a lateral face of the drilling guide, the other stabilizing foot being placed on the underside of the first part at the level of the other lateral face of the drilling guide; and a wedge of substantially parallelepiped shape supporting on its underside a stabilizing fin and a stabilizing foot.

 The invention also relates to a cylindrical or cylindro-conical bone milling cutter ensuring the drilling of intraosseous wells intended to receive at least the barrel of the blade implant according to the invention characterized in that it comprises an active cylindrical or cylindro part -conical, a smooth part and a stop; as well as a drilling guide for this cylindrical or cylindro-conical bone milling cutter and for a blade implant according to the invention, characterized in that it is constituted by a structure of substantially parallelepiped shape which comprises a cylindrical recess, at at least one stabilizing fin and at least one stabilizing foot fixed to the underside of said structure.

 When the cylindrical recess is located substantially in the center of the structure, the guide comprises two stabilizing fins and two stabilizing feet located on either side of the central recess.

 When the cylindrical recess is situated on the side of a lateral face of the structure, the stabilization fin and the stabilizing foot are situated on the side of the other lateral face.

 The guide may further comprise a wedge of substantially parallelepiped shape and supporting on its lateral face a stabilizing fin and a stabilizing foot.

 The invention finally relates to a depth gauge for checking the depth of the intraosseous housings produced by a wheel bone milling cutter or a cylindrical or cylindro-conical bone milling cutter according to the invention characterized in that it comprises a lobed part or a part cylindrical or cylindro-conical, with flat, round or conical tip.

The present invention will be better understood and other objects, advantages and characteristics thereof will appear more clearly on reading the following description of embodiments of the invention given without limitation and to which the drawings are annexed on which ones
FIG. 1 represents a side view of an implant according to the invention, monolobed with a barrel, with flat gingival edge,
FIG. 2 represents a side view of an implant according to the invention, monolobed with two barrels, with flat gingival edge,
FIG. 3 represents a side view of an implant according to the invention, monolobed with three barrels, with flat gingival edge,
FIG. 4 comprises FIGS. 4a to 4f which each represents a front section of an implant according to an alternative embodiment of the invention, at the level of a barrel,
- Figure 5 includes Figure 5a which shows a side view of an implant according to the invention bilobed with two barrels and with flat gingival edge and Figure 5b which represents the implant of Figure 5a seen in section on Vb-Vb ,
FIG. 6 comprises FIGS. 6a and 6b which each represents a sectional view of a bilobed implant with two drums according to an alternative embodiment of the invention,
- Figure 7 includes Figures 7a and 7b, Figure 7a shows a side view of a bilobate implant with three barrels and gingival flat edge according to an alternative embodiment of the invention, and Figure 7b shows a top view of the implant of FIG. 7a,
- Figures 8 to 21 each represent a family of implants according to the invention, each of Figures 8, 10, 12, 14, 16, 18 and 20 comprises Figures 8a to 8c, 10a to 10c, 12a to 12c, 14a to 14c, 16a to 16c, 18a to 18 and 20a to 20c which represent examples of implants belonging respectively to the same socket,
- Figure 22 includes Figures 22a, 22b and 22c, Figure 22a, respectively Figure 22b, respectively Figure 22c, shows a top view of a drilling guide for cylindrical bone bur according to the invention for an implant monolobed, respectively a bilobed implant, respectively a trilobed implant,
FIG. 23 represents a side view of the drilling guide represented in FIG. 22a,
FIG. 24 includes FIGS. 24a and 24b, FIG. 24a represents a side view of a working gauge according to the invention and FIG. 24b represents a top view of the working gauge of FIG. 24a,
FIG. 25 represents a perspective view of a first drilling guide for wheel bone cutters and a wheel bone cutter according to the invention,
FIG. 26 represents a side view of the first guide and of the cutter of FIG. 25,
FIG. 27 represents a perspective view of a second and a third drilling guides for wheel bone cutters according to the invention,
FIG. 28 represents a side view of the second and third guides of FIG. 27,
FIG. 29 includes FIGS. 29a to 29d which each represents a stabilization fin according to an alternative embodiment, intended for a drilling guide,
FIG. 30 represents a side view of a third drilling guide for wheel bone cutters and a wheel bone cutter according to the invention,
FIG. 31 represents a perspective view of a first drilling guide for strawberries with cylindrical-conical or cylindrical bones, according to the invention, intended for drilling central drums,
FIG. 32 represents a sectional view of the first drilling guide represented in FIG. 31,
FIG. 33 represents a perspective view of a third drilling guide for strawberries with cylindrical-conical or cylindrical bones according to the invention, intended for drilling eccentric drums,
FIG. 34 represents a side view of the third drilling guide represented in FIG. 33,
FIG. 35 represents a side view of a fifth drilling guide for strawberries with cylindrical-conical or cylindrical bones according to the invention,
- Figure 36 includes Figures 36a and 36b, Figure 36a shows the housing of a partially formed single-lobe implant and the two stabilization barrels and Figure 36b represents the housing of a single-lined implant in a central barrel, and both stabilization drums,
- Figure 37 includes Figures 37a and 37b, Figure 37a shows the housing of a partially made bilobed implant and the first and third stabilization wells and Figure 37b shows the housing of a bilobed implant with two central drums and the first and third stabilization wells,
FIG. 38 includes FIGS. 38a and 38b, FIG. 38a represents the housing of a partially produced trilobed implant and the first and fourth stabilization wells, and FIG. 38b represents the housing of a trilobed implant with three central drums and the first and fourth stabilization wells,
FIG. 39 represents a monolobed implant with three barrels and a concave gingival edge and the two stabilization wells,
FIG. 40 represents a monolobed implant with three parallel drums presenting an angle relative to the gingival edge of the blade and the two stabilization wells,
- Figure 41 shows a monolobed implant with three barrels and a convex gingival edge and the two wells. stabilization,
FIG. 42 represents an alternative embodiment of the second drilling guide for a wheel bone cutter for an angled bilobed implant,
FIG. 43 includes FIGS. 43a to 43d which show examples of embodiment of depth gauges and
- Figure 44 includes Figures 44a to 44d, Figure 44a shows a donor blade implant and a recipient blade implant, - Figures 44b to 44d show the screws used for these two blade implants.

 The elements common to the different figures will be designated by the same references.

 We will now see in detail the various elements making up the system according to the invention with reference to the figures.

 Referring to Figures 1 to 21, the blade implant is composed of two parts: the blade 1 and at least one barrel.

 The blade, delimited by a gingival edge 20 and a basal edge 21, is composed of one or more lobes coming from arcs of identical or different circles, which varies their length and their depth. Thus, FIGS. 1 to 3 illustrate an implant blade which is composed of a single lobe, this lobe comes from the same arc of a circle in FIGS. 1 and 2 and from a different arc of a circle in FIG. 3.

 FIG. 5a shows an implant blade which is composed of two lobes 23 and 24 which come from arcs of different circles.

 The gingival edge 20 can be flat, convex or concave. Figures 1 to 21 show blades whose gingival edge 20 is flat.

Figures 39 and 40 illustrate a blade with a concave gingival edge and Figure 41 a blade with a convex gingival edge. The basal edge 21 is composed of one or more arcs of a circle.

As shown in Figures 4a to 4d, the lobes can also vary, from the point of view of
- vestibulo-lingual thickness,
- the shape and thickness in the vertical direction.

 Thus, FIGS. 4a and 4b show two lobes of different buccal-lingual thickness. FIG. 4c illustrates a lobe whose thickness varies discontinuously and FIG. 4d illustrates a lobe whose thickness decreases continuously from the gingival edge 20 to the basal edge 21.

 These lobes can be single as illustrated in FIGS. 4a to 4d or double as illustrated in FIG. 4f.

 In the case of a blade comprising at least two lobes, they can be located in the same anteroposterior plane as shown in FIG. 5b, or offset laterally in planes parallel to each other as in FIG. 6a . They can also form an angle between them, as in the example shown in Figure 7b.

 Vents can be made in the blade to create bony bridges which contribute to better anchoring of the blade.

 The intraosseous housings of these lobes are produced by wheel cutters.

 The barrels are intended to receive screws which will fix the dental prosthesis on the implant either directly, or by means of a metallic device. Before fixing the prosthesis, cover screws are screwed into the barrels. Each barrel is placed in the plane of a lobe making up the blade 1. Their intraosseous accommodation is achieved by cylindrical-conical burs with flat, round or conical end or by cylindrical burs, which will be described later. These barrels are therefore cylindrical-conical with a flat end, like the barrels 2 and 8 of Figures 1 and 5a, round like the barrels 3, 4 of Figure 2 and 10, 11, 12 of Figure 7a, or conical like the barrels 5, 6, 7 in FIG. 3 and 9 in FIG. 5a, or cylindrical like the drums 13, 14, 15 in FIGS. 39 and 41 and 16 to 18 in FIG. 40.

 They can optionally transfix the implant like drums 2 and 4, Figure 2; 5 and 7, Figure 3; 9, Figure 5a; 10 to 12, Figure 7a.

They can also be positioned in various places on the blade.

There are barrels
- central to the lobe, for example bole 2, figure 1 or 6, figure 3,
- interlobes at the junction between two adjacent lobes, like the bole 11, figure 7a, or 8, figure 5a,
- mesial, for example barrel 3, Figure 2; 5, figure 3 or 10, figure 7a,
- distals, for example the barrel 4, FIG. 2; 7, Figure 3; 9, figure Sa or 12 figure 7a.

 They are parallel to each other and can be vertical and perpendicular to the gingival edge, commuted in FIGS. 1 to 39 and 41 or have an angle different from 902 relative to the gingival edge of the blade, as illustrated in FIG. 40.

Thus, by using two diameters of wheel bone cutters, 14 families of implants illustrated by FIGS. 8 to 21 are obtained for implants of one to three lobes, characterized by the number, the length and the depth of the lobes. The members of each family present similarities as regards the number, the length and the depth of the lobes in lateral view, and of the variants (in thickness, shape, ...) arising
- different possibilities for the number, diameter, depth, arrangement of the drums,
- different possible variants of the lobes, from the point of view of the thickness and the shape in the vertical and mesio-distal direction, of the angles which the lobes present between them or the lateral offset in parallel planes or even of the existence of double lobes.

 If we multiply the diameters of the wheel cutters used, we would obtain a larger number of families of implants.

 Thus, each of FIGS. 8 and 9 illustrates a family of implants with a lobe, but originating from a first and second different arcs of a circle.

 Figure 8 shows some variants of implants belonging to the same family: Figure 8a, the implant has a central barrel; Figure 8b, the implant has a mesial barrel and a distal barrel and Figure 8c, the implant has a distal barrel, a mesial barrel and a central barrel.

 Each of Figures 10 to 13 illustrates a family of implants with two lobes: in Figures 10 and 11, the lobes come from the same arc, the first figure 10, the second figure 11; Figures 12 and 13, the lobes are from the first and second arc, the position of the two lobes in the distal-mesial direction differs in the two figures.

 Figures 10 and 12 show some examples of implants belonging to the same family: Figures 10a and 12a, the implant has two central drums; Figures 10b and 12b, the implant has a mesial barrel and a distal barrel and Figures 10c and 12c, the implant has two central barrels, a distal barrel and a mesial barrel.

Each of Figures 14 to 21 illustrates a family of three-lobe implants
- In Figures 14 and 15, the three lobes are from the same arc, the first figure 14, the second figure 15;
- in FIG. 16, respectively in FIG. 17, two lobes coming from the first arc of a circle, respectively from the second arc of a circle are placed in the mesial and central positions, a lobe coming from the second arc of a circle, respectively from the first arc of a circle is placed distally
- in FIG. 18, respectively in FIG. 19, two lobes coming from the first circular arc, respectively from the second circular arc are placed in mesial and distal positions, a lobe coming from the second circular arc, respectively from the first circular arc is placed in the central position
- in FIG. 20, respectively in FIG. 21, two lobes coming from the second arc of a circle, respectively from the first arc of a circle are placed in the central and distal position, a lobe coming from the first arc of a circle, respectively from the second arc of a circle is placed in mesial position.

Figures 16, 18, 20 show some variants of implants belonging to the same family
- in FIGS. 16a and 18a, 20a, the implant has three central drums,
- In Figures 16b, 18b and 20b, the implant has a mesial barrel, a distal barrel and a central barrel.

The working gauges, an example of which is illustrated in FIG. 24, make it possible to assess, at the level of the gingival and bone crest
- the mesio-distal curvature,
- the mesio-distal length necessary to place each type of implant, and
- the vestibulo-lingual thickener necessary to accommodate the blade and the barrels.

 With reference to FIG. 24, the gauge consists of a blade 31 of generally parallelepiped shape and the section of which in a lateral plane is defined by two parallel curves and two parallel straight sections. These curves can be straight lines, or arcs of a circle with different centers and radii so that the gauges can have a zero curvature, notch as in Figure 24, or convex.

 The blade 31 has at least one vestibulo-lingual extension; by way of example in FIG. 24, the blade 31 has three vestibulo-lingual extensions 32, 33 and 34.

 The vestibulo-lingual extensions have a length corresponding to the diameters of the barrels.

 Reference 35 designates a part of the device allowing the practitioner to hold the working gauge.

As will be seen more precisely below, these gauges allow
- choose a blade implant whose gingival edge has substantially the same curvature,
- to use a set of drilling guides for cylindrical bone milling cutters, wheels and cylindrical-conical, so that the lower edge of these guides best matches the curvature of the bone crest, the drilling guides for strawberries bone will be described later.

 The length of the gauges is such that they materialize in the mesio-distal direction the space necessary for the placement of the drilling guides for cylindrical bone milling cutters.

 At the places supposed to receive the barrels, the vestibulo-lingual extensions allow to better appreciate the necessary thickness of the bone crest in these places. This blade with its vestibulo-lingual extensions makes it possible to visualize the sinking of the future implant, since each implant has its own working gauge. It is therefore possible to determine the orientation of the blade implant before surgery.

 The cylindrical bone milling cutters and the drilling guides for cylindrical bone milling cutters, of which exemplary embodiments are represented in FIGS. 22 and 23, make it possible to produce several intraosseous stabilization wells in which the stabilization feet of the other drilling guides for strawberries bone (wheels, cylindrical-conical and cylindrical), which will be described later, will be inserted for the purpose of maintaining and stabilizing these guides in a position chosen at the start.

 Each guide is intended for a specific implant-blade. However, the guides intended for implant-blades having the same standard number, arrangement of the lobes can be classified in the same family.

A drilling guide for a monolobed implant, an exemplary embodiment of which is shown in FIGS. 22a and 23, comprises a support 36 for
- two hollow cyl-indres 37, 38 allowing, on the one hand the guided work of a cylindrical cutter 40, and on the other hand the screwing of a stabilizing foot 130 and
a thread 39 between the two hollow cylinders 37, 38.

A cylindrical bone bur, an example of which is shown in Figure 23, is made up of three parts
a cylindrical active part 41 ensuring the drilling of the stabilization wells intended to receive the stabilization feet of the drilling guides for bones with wheel bones and cylindro-conimaes,
a smooth part 42 guiding the cutter,
- A stop 43 for stopping the cutter cooperating with the upper part of the corresponding hollow cylinder and preventing it from sinking into the bone after a certain depth of penetration.

 The cylindrical bone cutters are driven by means well known to those skilled in the art and which are not shown in FIG. 23.

 The thread 39 makes it possible to fix on the drilling guide a replica of a transmucosal ring, this replica being in the position and the orientation of the implant implant (s) or future (s) determined using the working gauge. This is to be able to replace the replica in the chosen position and orientation of the barrel. In addition, this replica materializes the volume and the height of the future transmucosal ring, as well as its position and its orientation relative to the opposing arch. The use of this replica will be explained during the description of the operating mode.

 The cylindrical bone bur and its drilling guide make it possible to make two stabilization wells on either side of what will be the intraosseous monolobed housing.

 In FIG. 23, a stabilization well 46 is shown.

 A drilling guide for a bilobed implant, an example of which is shown in FIG. 22b. includes a support 36 for three hollow cylinders 3 ′, 38, 44 and a screw thread 39 located between the cylinders 38 and 37. It makes it possible to produce three stabilization wells. The first and second wells are located on either side of the first lobed intraosseous housing. The first and third wells are located on either side of the two lobed housings.

 A drilling guide for a three-lobed implant, an exemplary embodiment of which is shown in FIG. 22c, comprises a support 36 for four hollow cylinders 37, 38, 44 and 45 and a thread 39 located between the cylinders 37 and 38. It makes it possible to make four stabilization wells. The first and second wells are located on either side of the first lobed intraosseous housing. The first and third wells are located on either side of the two lobed intraosseous housings. The first and fourth wells are located on either side of the three lobed intraosseous housings.

 Each guide family has variants, in particular for implants with lobes angled therebetween, or for implants with lobes offset between them laterally.

The wheel bone cutters and the drilling guides for wheel bone cutters, examples of which are shown in FIGS. 25 to 30, make it possible to produce intraosseous lobed housings intended to receive the lobes of the implants. These guides allowing the passage of wheel cutters of precise diameters are, when one limits oneself to implants-blades having at most three lobes, of three kinds
the first drilling guide, which is shown in FIGS. 25 and 26, is intended for drilling the intraosseous housing of a monolobe implant or of the first lobe of a bilobed or trilobed implant,
the second drilling guide, which is shown in FIGS. 27 and 28, is intended for drilling the intraosseous housing of the second lobe of a bilobed or trilobed implant,
- The third drilling guide, which is shown in Figure 30, is intended for drilling the intraosseous housing of the third lobe of a three-lobed implant.

 The first guide is constituted by a structure 50 of substantially parallelepiped and hollow shape which supports on its underside at each side wall a stabilizing foot 87, 88, these stabilizing feet 87, 88 are accommodated in stabilization wells cylindrical which have been previously drilled.

 The reference 89 designates a part of the device allowing the practitioner to hold the first drilling guide.

 The vestibular and lingual walls of the structure 50 have guide rails 51 and 52 perpendicular to the lower and upper faces and on which stops 53 and 54 are provided at the level of the lower face.

 The second guide is constituted by a structure 60 of substantially parallelepiped shape, which comprises a part similar to the first guide, hollow and having guide rails 61 and 62 with stops 63 and 64, and another part, solid and supporting a fin stabilization 65.

 It has two stabilizing feet 68 and 69 on its lower face at the level of each side wall. These stabilization feet are intended to be placed in the cylindrical stabilization wells which have been previously drilled.

 The intraosseous stabilization flap is intended to be placed in a part of the intraosseous housing of the first lobe of a bilobed implant or the second lobe of a trilobed.

 The reference 79 designates a part of the device allowing the practitioner to hold the second drilling guide.

 The third drilling guide is formed by the second drilling guide and an Independent shim 70.

 This wedge 70 has a substantially parallelipiped shape and supports on its underside a cylindrical stabilizing foot 71 and a stabilizing fin 72.

 The fin 72 is fixed on the wedge so as to be slightly projecting with respect to a side wall of the wedge, the stabilizing foot 71 being fixed at the level of the other side wall.

 In the projecting part of the fin and substantially in the extension of the side wall of the wedge, a bore 73 is made which is intended to receive the stabilizing foot 68 of the second drilling guide.

 A thread 78 is provided in this case in the second guide and a corresponding thread 74 is made in the shim 70. A screw 75 makes it possible to fix the shim 70 and the second drilling guide, the stabilizing foot 68 being previously placed in bore 73.

 A stabilizing fin has an internal part 76, 66 and an external part 77, 67 which are inscribed in arcs of precise circles corresponding to the diameters of the wheel bone cutters used in the system.

 The external part 67 fits into the intraosseous housing of the first lobe of a bilobed implant, or comes into contact with the internal part 76 of a fin fixed to a wedge in the case of a trilobed implant, in which case the external part 77 comes to register in the first intraosseous housing. The internal part 66 allows the work of the corresponding wheel bone cutters and the internal part 76 the fixing of the external part 67 of the fin of a second drilling guide.

 Thus, by using bone wheel cutters of two different diameters, for example 8 and 10 mm, four possible variants of the stabilizing fin are obtained. In FIGS. 29a and 29d, the four variants of the stabilization fin are shown, intended to be fixed on independent wedges 70.

 Variants of the second and third drilling guides can be envisaged for the implants which are angled at the interlobe level.

 Thus, is shown in Figure 42, an example of a second drilling guide for a bilobed implant having an angle between the two lobes, like that shown in Figure 7b.

 This second drilling guide comprises two sclidary parts 110 and 120 which have between them an angle corresponding to that existing between the two lobes of the implant for which the guide is intended.

 Part 110 is similar to the first drilling guide, substantially parallelepiped, hollow, having guide rails 111 and 112 with stops 113 and 114 and supporting on its lower face at the level of its lateral face opposite to that attached to part 120 a stabilizing foot 115.

 The part 120 is substantially parallelepiped and full. It supports, on its underside, a stabilizing foot 116 at its lateral face opposite to that attached to the part 110 and a fin 117 comprising an external part 118 intended to be inserted in a part of the intraosseous housing of the first lobe of the bilobed implant and an internal part 119 perpendicular to the underside of the part 120.

 It can be noted that the shape of the external part 118 is such that the aileron 117 occupies a larger part of the intraosseous housing of the first lobe of the angulated bilobed implant than the ailerons described previously for non-angulated implants, this to ensure a better stability of the drilling guide intended for an angled implant.

The wheel bone cutters of which exemplary embodiments are represented in FIGS. 25, 26, 28 and 30 are composed of three parts
- a wheel 80,
- a mandrel 81,
- stops 82 to 85.

 The wheel 80, containing the active part of the cutter, is crossed by the mandrel 81 which is smooth and cylindrical and which supports stops 82 to 85 arranged in pairs on either side of the wheel 80.

 These burs ensure the drilling of lobed intraosseous housing intended to receive the implant lobes. The work is done on the circumference of the wheel 80 which has sawtooth irregularities. The mandrel 81 slides on the guide rails 51, 52, 61, 62, 111, 112 of the drilling guides for bones with wheel bones. Consequently, the wheel bur is guided by the mandrel in the vertical direction.

 The stops 53, 54, 63, 64, 113, 114 which are provided on the vestibular and lingual rails of the drilling guides make it possible to stop the sinking of the mandrel, at a determined level of the wheel bone milling cutter. Preferably, the low point of the rails corresponds to the top of the bone crest.

The stops which are arranged in pairs 82, 83; 84, 85, on each side of the wheel are used to
- stabilize the position of the wheel in the vestibulolingual direction,
- possibly shift the wheel, either vestibularly or lingually.

 This possibility of shifting the wheel leads to two variants of wheel bone cutters. These two variants of wheel bone cutters allow, for the same drilling guide, whether it be a second or a third drilling guide, to produce offset intraosseous lobed housings, and therefore implants with offset lobes, as shown in FIG. Figure 6a.

 These milling cutters can be double, of different thicknesses, of different diameters, have variations in shape and thickness in the vertical and mesio-distal directions, giving variants of implants in each family, as shown in FIGS. 4a to 4f.

 Preferably, the work is carried out in an increasing order of thickness of the active part of the wheel, in order to avoid overheating of the bone.

The cylindrical-conical bone milling cutters and the drilling guides for cylindrical-conical bone milling cutters, of which exemplary embodiments are shown in FIGS. 31 to 35, make it possible to produce intra-cylindrical-conical wells with flat, round, conical ends. , depending on whether you are using cylindrical-conical bones with flat, round or conical tips. When we limit ourselves to blade implants with at most three lobes, there are five types of drilling guide for cylindrical-conical bone milling cutters
- the first and second drilling guides are intended for drilling central drums,
- the third and fourth drilling guides are intended for drilling eccentric drums.

 - the fifth drilling guide is intended for drilling central and eccentric drums.

The first drilling guide, which is shown in FIGS. 31 and 32, is constituted by a structure 90 of substantially parallelepiped shape which has a central cylindrical recess 91 and which supports
two cylindrical stabilization feet 92, 93 which are intended to be housed in the cylindrical intraosseous stabilization wells previously drilled, and
- two stabilizing fins 94, 95 which are intended to be placed in a corresponding lobed intraosseous housing.

 Reference 97 designates a part of the element allowing the practitioner to hold the first drilling guide.

 The second drilling guide is constituted by the first drilling guide 90 and an independent shim 70, as previously described, fixed thereon. In this case a thread 97 is provided in the first drilling guide.

The third drilling guide, an alternative embodiment of which is shown in FIGS. 33 and 34, consists of a substantially parallelepipedal structure 100 which comprises on the side of a lateral face a cylindrical lateral recess 101 and which supports
a cylindrical stabilizing foot 102 which is fixed to the underside of the structure 100 at the level of the lateral face oppc to that where the recess 101 is located, and
- a stabilization fin 103.

 Reference 104 designates a part of the device allowing the practitioner to hold the third drilling guide.

 The fourth drilling guide consists of the third drilling guide 100 and an independent shim 70, as described above, fixed on this one. In this case, a thread 105 is provided in the third drilling guide.

 The stabilization fins 94, 95, 103 have an external part 98, 106, 108 whose shape depends on the wheel bone cutters previously used to make the lobed intraosseous housings and an internal part 99, 107, 109 perpendicular to the underside of structure 90.

FIG. 35 shows a fifth drilling guide which is made up of a structure 100 'substantially parallelepipedal comprising a cylindrical lateral recess 101' and supporting
a cylindrical-conical stabilizing leg 102 ′, fixed at the level of the lateral face opposite to that where the recess 101 ′ is located, and
- a stabilizing fin 103 '.

The cylindrical-conical bone milling cutters of which exemplary embodiments are represented in FIGS. 32, 34 and 35 are composed of three parts
- a cylindrical-conical active part 106, with a flat, round or conical end, ensuring the drilling of the corresponding intraosseous housings, intended to receive the implant barrels,
a smooth part 107 intended for guiding the cutter,
a stop 128 intended for stopping the insertion of the cutter as a function of the determined length of the implant barrel.

 These cutters are intended to be placed, as shown in FIGS. 32 and 34, in the central cylindrical recess 91 or lateral 101, the smooth part of the cutter cooperating with the wall of the recess to guide the cutter. The stop 108 of the cutter cooperates with the upper wall of the drilling guide 90, 100 to ensure the stopping of the insertion of the cutter as a function of the determined length of the implant barrel.

 These strawberries are used in increasing diameter order to limit the heating of the bone.

 There are variants that are flat, round or tapered cylindrical bone milling cutters. In this case, the housings produced are cylindrical, and the implant barrels are cylindrical, with a flat, round or conical end, as illustrated in FIGS. 39 to 41.

The set of drilling guides for bone milling cutters exists in several versions, depending on the following parameters
- difference in curvature of the bone crest in the mesiodistal direction,
- angulated orientation of the barrels relative to the gingival edge of the implant blade,
- implants with angled lobes between them.

 The depth gauges, of which exemplary embodiments are represented in FIGS. 43a to 43d, make it possible to check the depth of the intraosseous housings produced by means of the cutters.

 There are two types of gauges, the first for barrels and the second for lobes.

 Thus, Figures 43a to 43b illustrate gauges for a cylindro-conical intraosseous well with a flat end, a round end or a conical end.

They include a part 121, 123, 124 cylindro-conical with flat end, round end or conical end.

 FIG. 43d illustrates a gauge for a lobed intraosseous housing which comprises a lobed part 125.

 All the gauges further include an element 122 of which only part is shown and which allows the practitioner to hold the gauge.

 These gauges, which are specific to a determined intraosseous housing, make it possible to verify the correct level of drilling of this housing before possibly proceeding to the drilling of another intraosseous housing in order to avoid errors.

 The irrigation for all these bone cutters is done either internally, externally, or mixed, to eliminate as much as possible the harmful heating in the bone. When the irrigation is internal, the bone cutters are hollow in the middle of their mandrel, to let pass a sterile liquid, liquid which leaves at the level of the active part of the strawberries, ensuring their cooling. The active parts of these cutters are preferably made of titanium, to avoid the problems of contamination of the intraosseous housings with another metal.

 We will now describe the method used to place the blade implants. This method first requires selecting a blade implant and the corresponding placement system.

Before the surgical intervention, following a clinical and radiological examination, an implant, and, consequently, its delivery system, is chosen, according to four parameters
- the curvature of the bone crest at the implant site,
- the available length of this crest, depending on the regularity of this crest,
- the bone depth available at this ridge,
- the thickness of this crest in the vestibulo-lingual direction.

 Since we want to maintain bone parameters, without exposing the bone, at this stage, the procedure is as follows.

 An implant site is delimited, at the level of the gingival crest, by marking it with a mesial marker and a distal marker. This shows a more or less regular peak length.

 Work gauges are then used, an exemplary embodiment of which has been previously described with reference to FIG. 24.

Working gauges, of different curvatures, are placed on this crest length, and we choose the gauge which has the most suitable curvature, to accommodate the curvature of the gingival crest. This is verified at the bone level, thanks to x-rays, the bone and gingival ridges may have different curvatures. These x-rays also indicate the depth of bone available, considering the anatomical obstacles (nerves, arteries,
Having determined an implant space in a vertical plane, thanks to these three parameters (length, curvature, depth), one determines the usable blade implant (s), and, consequently, their corresponding working gauges.

 Thanks to these new working gauges, a new sorting will be carried out. These gauges are placed on the gingival crest, and it is examined whether the buccal-lingual thickness of this crest would make it possible to receive, on the one hand the blades of thickness chosen over their entire length, and on the other hand barrels, the diameter of these barrels being indicated by the vestibulo-lingual extensions on the working gauges. This is checked at the bone level using x-rays.

It is also necessary to take into account for the choice of gauges the orientation of the future implant barrels. The barrels having to receive the dental prosthesis, either directly, or via the transmucosal rings, it is necessary to make sure that their orientation is compatible with the opposing arch for a correct function of the implant. A certain number of working gauges is thus retained.

 After anesthesia, the incision is made, either on the crest, or at a distance from the crest. A flap, of total thickness, is raised on both sides in the first case, and on one side in the second case. This gives good access to the implant bone site.

The working gauge is positioned on the bone crest, and it is ensured that
- the curvature of the gauge corresponds to the curvature of the bone crest,
- the buccal-lingual thickness of the bone crest allows the correct burial of the blade and of the barrel (s) of the implant blade, this in the axis of penetration chosen before the intervention, and that
- The upper edge of the bone ridge in the vestibulolingual direction is substantially perpendicular to the axis of penetration of the implant.

 At this stage, in order to perfect these three points, we can possibly slightly modify the axis of penetration of the implant, and / or perform a minor osteotomy, because the thickness of the bone crest widens in s moving away from its upper edge.

 A good correspondence is thus obtained between the curvature of the bone crest and, on the one hand the lower edge of the different drilling guides corresponding to the chosen blade implant, on the other hand the gingival edge of the chosen blade implant .

 The drilling guide for cylindrical bone burs, examples of which have been previously described with reference to FIGS. 22 and 23 and which corresponds to the chosen blade implant, is placed on the bone crest1 and, after checking its correct position and orientation by virtue of the transmucosal ring replica, a first intraosseous stabilization well 46 is produced by the guided work of a cylindrical bone bur 40 placed in the hollow guide 37 of the drilling guide.

 This drill guide is removed from the mouth; then a stabilizing foot 85 is screwed onto the hollow cylinder which served to guide the cutter. The drilling guide is replaced on the bone crest in the same position and orientation, stabilizing it using this stabilization foot which comes to fit in the first intraosseous stabilization well 46.

 The second intraosseous stabilization well, which is not shown in FIG. 23, is produced by guiding by the hollow cylinder 38 of the cylindrical bone milling cutter.

 In the case of a monolobed implant, two stabilization wells are sufficient, the drilling guide shown in FIGS. 22A and 23 is used.

 In the case of a bilobed implant, a drilling guide is used as shown in FIG. 22b, and which contains a third hollow cylinder 44 which allows the production of a third stabilization well, this after having screwed a foot of stabilization in each of the first two stabilization wells and put the assembly back on the bone crest.

 In the case of a trilobed implant, a drilling guide is used as shown in FIG. 22c which includes a fourth hollow cylinder 45 which allows a fourth stabilization well to be produced this after a third stabilization foot has been screwed on the guide.

 The drilling guide for wheel bone cutters, examples of which have been previously described with reference to FIGS. 25 to 30 and corresponding to the chosen blade implant, is placed on the bone crest, thanks to its stabilizing feet. which fit into the previously drilled stabilization wells.

 The first drilling guide shown in FIGS. 25 and 26 allows the guided work of a corresponding wheel bone cutter 80, in order to produce an intraosseous lobed housing, the stabilization feet 87, 88 having been previously placed in the stabilization wells. 46, 47.

 This intraosseous lobed housing constitutes the only housing of a monolobed implant as shown in FIG. 36a and the first housing of a bilobed or trilobed implant as shown in FIG. 37a and 38a.

 In the case of a bilobed implant, the second drilling guide shown in FIGS. 27 and 28 is put in place, thanks to two stabilizing feet 68 and 69 which are inserted into the first and third intraosseous stabilization wells 46 and 48, and thanks to the stabilization fin 67 which is anchored in the first intraosseous housing produced. The guided work of the corresponding wheel milling urn 80 makes it possible to produce the second lobed intraosseous housing.

 In the case of a bilobed and angled implant, a second drilling guide is used, an embodiment of which has been described previously with reference to FIG. 42, comprising an angle between the two constituent parts 110 and 120 identical to that present between them the two lobes of the chosen blade implant.

 The drilling guide is put in place thanks to these two stabilization legs 115 and 116 which are placed in the first and third intraosseous stabilization wells previously drilled and thanks to the stabilization fin 117 which is placed in the first intraosseous housing produced. .

 The guided work of a corresponding wheel bur 80 makes it possible to produce the second lobed intraosseous housing.

 In the case of a three-lobed implant, this second lobed intraosseous housing is only one step for producing the third lobed housing, thanks to the third drilling guide.

 The stabilization feet 71 and 69 of the third drilling guide are inserted in the first and fourth intraosseous stabilization wells 46 and 49, and the two stabilization fins 67 and 77 are anchored in the first and second lobed intraosseous housings . The 9 bone wheel mill 80 conespondante.is guided to achieve the last lobed housing of a trilobed implant.

 The depth of the housings made is checked by means of appropriate lobed depth gauges as previously described.

 The drilling guides for cylindrical-conical bone milling cutters, of which exemplary embodiments have been previously described with reference to FIGS. 31 to 35, are used lastly for producing the intraosseous cylindrical-conical housings for implant drums, thanks to the work guided strawberries with cylindrical bones.

 Since these barrels can be positioned either in the middle of the lobe, or at its ends, or between two lobes, several variants are obtained, examples of which are illustrated in FIGS. 36b, 37b and 38b.

 Figure 36b shows a single lobed implant with a central barrel. The drilling guide used is the first drilling guide 90 described with reference to FIGS. 31 and 32.

 The stabilization feet 92 and 93 are placed in the cylindrical stabilization wells 46 and 47 and the fins 94 and 95 are placed in the lobed housing that is already made. The bone bur is placed in the central cylindrical recess 91 and makes the central barrel.

 A monolobed implant with two eccentric drums illustrated in FIG. 8c will be produced using the third drilling guide 100 described with reference to FIG. 33, which is used in one direction then in the other.

 In the case of a monolobed implant with a central barrel and two eccentric barrels, as shown in FIG. 8c, in a first step, the central cylindrical-conical housing is produced, using the first drilling guide, then the two housings eccentric, thanks to the third drilling guide.

 Figure 37b shows a bilobed implant with two central drums.

To make them, a second drilling guide is used, in one direction, then in the other direction.

 For a bilobed implant with two eccentric drums, as shown in FIG. 10b, a fourth drilling guide is used, in one direction, then in another direction.

 For a bilobed implant with two central drums and two eccentric drums, as shown in FIG. 10c, a fourth drilling guide is used first in one direction, then in the other direction, to produce the two eccentric housings. Then, using the fifth guide described with reference to FIG. 35, in one direction, then in the other direction, the two central housings are produced.

 Figure 38b shows a three-lobed implant with three central drums.

 A second drilling guide is used to make the three cylindrical-conical housings. We start with the central housing of the mesial lobe and the distal lobe. We finish with the central housing of the central lobe.

 For a three-lobed implant with a central barrel and two eccentric barrels, illustrated in FIG. 16b, the third drilling guide is used to make the central housing. Then, for the eccentric housings, the fifth drilling guide is used, using it in one direction, then in the other.

 For a three-lobed implant with three central drums and two eccentric drums, as shown in FIG. 20c, a second drilling guide is used for the central housings.

 For the eccentric housings, the fifth drilling guide is used.

 When the housings are made, their depth is checked using the depth gauges previously described.

 The housing thus produced to accommodate the blade and the barrel (s) of the implant, this implant is put in place, along the axis of its / its barrel (s). The implant is pushed in by gentle friction, using an implant holder, and sometimes it will be necessary to drive in the last millimeters by impaction on the cover screw (s) of the barrels. These cover screws are used to protect the internal threads of the barrels, no screws intended to receive screws ensuring the connection between the implant and the prosthetic part.

 The flap is then repositioned and sutured at the level of the incision line. The implant will remain several months at rest, in order to be either osseointegrated if pure titanium or other bio-compatible materials are used, knows biointegrated if hydroxyapatite is used as covering material for the surface of the implant. It is essential to have these perfect aseptic conditions during the surgical phase.

 Once integration is achieved, the cover screws are updated and removed. Transmucosal healing rings are screwed in place. The prosthetic phase can begin.

 The previously described blade implants can also be used in the context of bone grafts, when the quantity of bone available in the edentulous area is insufficient.

 In this case, a first blade implant is placed in the bone crest, called the recipient bone and a second blade implant in the donor bone, in both cases by the method described above.

 The second blade implant, placed in the donor bone, has two particular characteristics: all the barrels of the blade implant transfix the basal edge of the blade implant and at their basal end a cover screw such as illustrated in Figure 44c.

 FIG. 44a illustrates a donor blade implant 126 placed on a recipient blade implant 127.

 FIG. 44b represents a cover screw intended to be placed at the gingival or upper end of the blade implant to protect the internal screw pitch.

 Once integration has been obtained, the bone graft containing the second blade implant is removed from the donor bone and the cover screws placed at the two ends of the second implant as well as the one placed at the gingival end of the first implant are removed.

The second blade implant is placed on the first so that the drums of the two implants are facing each other, and screws as shown in Figure 44d are placed in the drums so as to fix the two implants - blades to each other.

 These screws comprise an upper part 127 intended to receive the prosthesis.

 The reference signs inserted after the technical characteristics set out in the claims, have the sole purpose of facilitating the understanding of the latter and can in no case have the effect of limiting the intervention to the particular embodiment which has just been described .

Claims (36)

 1.-Implant-blade comprising a blade delimited by a gingival edge and a basal edge, characterized in that said blade (1) is constituted by at least one lobe and in that it further comprises at least one ftt (2 ), placed in the plane of said lobe.  2. Implant-blade according to claim 1, characterized in that said lobe comes from an arc of a circle.  3. Implant blade according to any one of claims 1, 2, characterized in that said blade (1) is constituted by at least two lobes.  4. Implant blade according to any one of claims 1 to 3, characterized in that the barrel (2) transfixes the gingival edge (20) of the blade (1).  5. Implant-blade according to any one of claims 1 to 4, characterized in that the barrel (2) transfixes the basal edge (21) of the blade (1).  6. Implant blade according to any one of claims 1 to 5, characterized in that it comprises at least as many barrels (2) as lobes.  7. Implant blade according to any one of claims 1 to 6, characterized in that an fQt (2) has an angle different from 90 "with the gingival edge (20) of the blade (1).  8. Working gauge for choosing an implant blade according to any one of claims 1 to 7 most suitable for the chosen implant site, characterized in that it consists of an element (30) of generally parallelepiped shape.  9. Working gauge according to claim 8, characterized in that the element (30) is crossed by a blade (31) which comprises at least one vescibulo-lingual extension (32, 33, 34).  10. Bone milling cutter such as cylindrical bone milling cutter or cylindrical bone milling cutter making it possible to drill stabilization wells intended to receive the stabilization feet of drilling guides for wheel bone milling cutters and bone milling cutters such as bone milling cutters cylindrical or cylindrical-conical bone milling cutters, for a blade implant according to any one of claims 1 to 7, characterized in that it comprises an active part (41), a smooth part (42), and a stop d '' judgment (43).  11. Drilling guide for bone milling cutter such as cylindrical bone milling cutter or cylindrical-conical bone milling cutter making it possible to drill stabilization wells intended to receive the stabilization feet of drilling guides for wheel bone milling cutters: and milling cutters with bones such as cylindrical bone milling cutters or cylindrical-conical bone milling cutters, for a blade implant according to any one of claims 1 to 7, characterized in that it comprises a support (36) and at least two hollow cylinders (37.38).  12. Drilling guide according to claim 11, characterized in that it further comprises a thread (39) located between the two hollow cylinders (37, 38).  13. Drilling guide according to claim 11, characterized in that it comprises a third hollow cylinder (44).  14. Drilling guide according to claim 11, characterized in that it comprises a third and a fourth hollow cylinder (44, 45).  15. Wheel bone cutter making it possible to produce a lobed intraosseous housing for a lobe of a blade implant according to any one of claims I to 7, characterized in that it comprises a mandrel (81) passing through a wheel (80) containing the active part of the cutter and supporting stops (82, 83, 84, 85) arranged in pairs on each side of the wheel (80).  16. Drilling guide for wheel bone cutter making it possible to produce a lobed intra-osseous housing for a lobe of an implant-blade according to any one of claims I to 7, characterized in that it comprises in the poins a foot stabilization (87, 88; 68, 69; 71, 69; 115, 116) and at least one first hollow part (50, 112) whose vestibular and lingual walls have guide rails (52, 53; 62 , 63, 111, 112).  17. Drilling guide according to claim 16, characterized in that it comprises two stabilizing feet (87.88; 68.69; 71.69; 115.116).  18. Drilling guide according to any one of claims 16,17 characterized in that the guide rails (52, 53; 62, 63; 111, 112) have stops (53, 54; 63, 64; 113, 114).  19. Drilling guide according to any one of claims 17,18 characterized in that it further comprises a second part (60, 120) which supports a stabilizing fin (67, 117) and a stabilizing foot (68 , 116), the other stabilizing foot (69, 115) being placed on the first part (50, 112).  20. Drilling guide according to claim 19, characterized in that it further comprises a wedge (70) supporting a stabilizing fin (77) and a stabilizing foot (71).  21. Drilling guide according to claim 20, characterized in that the stabilization fin (77) protrudes slightly relative to a side wall of the wedge (70), the stabilization foot (71) being fixed at the level from the other side wall thereof.  22. Drilling guide according to claim 21, characterized in that in the projecting part of the stabilization fin (77) is made a bore (73) which can receive the stabilization foot (68) fixed on said second part (60, 120).  23. Drilling guide according to claim 22, characterized in that at least one thread (78) is provided in said second part (60, 120) and another thread (74) is provided opposite in said shim (70), the two threads (78, 74) being intended to receive a screw (75) fixing said shim (70) to said second part (60, 120).  24. Drilling guide according to any one of claims 19 to 23, characterized in that a stabilization fin (65, 72) comprises an internal part (66) and an external part (77) defined by the diameter of the cutters bone used.  25. A bone cutter such as a cylindrical bone cutter or a cylindrical-conical bone cutter ensuring the drilling of intraosseous wells intended to receive at least said barrel of the blade implant according to any one of claims 1 to 7, characterized in that it comprises an active part (106), a smooth part (107) and a stop (108).  26. Drilling guide for bone milling cutter such as cylindrical bone milling cutter or cylindrical-conical bone milling cutter ensuring the drilling of intraosseous wells intended to receive at least said barrel of the blade implant according to any one of claims 1 to 7, characterized in that it is constituted by a structure (90, 100) which comprises a cylindrical recess (91, 101), at least one stabilizing fin (94, 95, 103) and at least one foot stabilization (92, 93, 102).  27. Drilling guide according to claim 26, characterized in that said cylindrical recess (91) is located substantially in the center of said structure (90), and in that it comprises two stabilizing fins (93, 94) and two stabilization feet (92, 93) located on either side of this central recess (91).  28. A drilling guide according to claim 26, characterized in that said cylindrical recess (101) is located on the side of a lateral face of said structure (100), said stabilization flap and said stabilization foot being located on the side of the other side face.  29. Drilling guide according to any one of claims 26 to 28, characterized in that at least one of the stabilization feet (92, 93, 102) which it comprises is fixed on its underside.  30. Drilling guide according to any one of claims 26 to 29, characterized in that it further comprises a wedge (70) supporting a stabilizing fin (77) and a stabilizing foot (71).  31. Drilling guide according to claim 30, characterized in that the fin (77) protrudes slightly relative to a side wall of the wedge (70), the stabilizing foot (71) being fixed at the level of the 'other side wall.  32. Drilling guide according to claim 31, characterized in that in the projecting part of the fin (77) is made a bore (73) which can receive a stabilizing foot (92, 102) of said structure (90 , 100).  33. Drilling guide according to claim 32, characterized in that a thread (97, 105) is provided in said structure (90, 100) and in that another thread (74) is provided opposite screws in said shim (70), the two threads (97, 105, 74) being intended to receive a screw (75) fixing said shim (70) to said structure (90, 100).  34. Drilling guide according to any one of claims 16 to 24 and 26 to 33, characterized in that at least one of the stabilizing feet (87, 88; 68.69; 71, 69 115, 116; 92 , 93, 102) which it comprises is cylindrical.  35. Drilling guide according to any one of claims 16 to 24 and 26 to 33, characterized in that at least one of the stabilizing feet (87, 88; 68, 69; 71, 69; 115, 116; 92, 93, 102) which it comprises is cylindroconical.  36. Depth gauge for checking the depth of the intraosseous housings produced by a wheel bone cutter according to claim 15, characterized in that it comprises a lobed part (125).