FR3047164A1 - SYSTEM AND DEVICES FOR FIXING DENTAL IMPLANTS ON THE UPPER MAXILL - Google Patents

Abstract

The invention relates to a device for attaching dental implants to the upper jaw of a subject, characterized in that it comprises an Intra-Sinus Element (EIS), intended to be introduced into an intrasinus cavity for the fixation of dental implants. at least one implant (6) in the intrasinus cavity, in line with the site on which one or more implants are to be fixed, and at least one axially elongate implant, comprising at least four connection zones designed to be able to firmly connect said at least one implant EIS audit and cortical bone, while the EIS is preferably in two parts.

Description

SYSTEM AND DEVICES FOR FIXING DENTAL IMPLANTS ON THE UPPER MAXILLARY

FIELD OF THE INVENTION

The present invention relates to the field of dentistry, and more particularly to a system and a device for rendering operational and reliable the fixation of dental implants in the maxilla of an individual or subject.

In men, at the level of the maxillary maxilla, the maxillary sinus descends low enough to encompass the roots of the upper second premolar, as well as the first and second upper molars. This may even extend to the first premolars and the wisdom tooth (third molar).

In case of tooth extraction in this region, bone melting occurs, which increases with time. Thus, after extraction and scarring in the upper maxilla of the second premolar and molars, there is often too little bone, about 1-8 mm, so that we can put one or more implants in place of teeth extracted.

We can therefore consider that we are forced once every two to achieve a filling of the sinus before the implantation of implants, because the cortical bone has a thickness of 1-8 mm, while the implants used for this region have a length ranging between 12 and 16 mm.

BACKGROUND ART At the present time, when one is confronted with this impossibility of placing implants on the upper jaw at the places from which the teeth were extracted, the only possibility is to perform a membrane lifting operation. sinus, traditionally referred to as "sinus lift". This operation consists of filling the sinus bottom. This is a surgical procedure in which the sinus membrane is lifted, implants are placed and the void created between the membrane, the implants to be placed and the cortical bone is filled with a filling material which, the most often today consists of biomaterials based on hydroxyapatite and β-tricalcium phosphate, among others.

This now traditional technique is based on the concept of guided bone regeneration. Indeed, the blood trapped around the biomaterial will make bone after about 4 months.

The major problem then encountered in the classical sinus lift 5 is insurmountable: it is that of the residual residual thickness of the residual cortical bone, which is only 1-8 mm. This bone is most often insufficient to guarantee the success of the sinus lift operation. It is therefore practiced only by few practitioners, who are themselves obliged to reserve it for the cases they have previously selected as the most favorable.

This is a stalemate, which removes much of the interest from the sinus lift, and there remains an unmet need for a reliable possibility of preparing and performing implant placement in the maxillary of individuals who have undergone extraction. dental at this .5 place.

SUMMARY OF THE INVENTION

The present invention provides a reliable solution to this problem, by proposing a system and a device having appropriate connections respectively to screw and / or impact one or more implants and a connection to stabilize the implant or implants in the vertical direction, horizontal (against displacement) and axial (against rotations), the whole being intended for implantation in an intrasinusian cavity previously made to the right of the implantation site to perform. Here is meant by "impact" (in English "push-in") the action of linearly moving an element by percussion thereof by means of a suitable tool, and by "impacting" the operation which results.

The system with which said device according to the invention is implemented advantageously comprises, besides this, also a drilling guide and a gripping instrument, both of a known conventional kind, and the one and the other optional, but strongly recommended for a good precision of the piercing of the cortical bone.

In an advantageous embodiment, it is possible to connect two or more implants which thus benefit from a high quality compression, which is free from micromovements and does not generate inflammations and / or losses. bone.

In addition, the device according to the invention has been found to provide an exceptional antirotational effect, able to withstand rotational forces delivered during the screwing and unscrewing of conventional prosthetic abutments by mini-screws. These are forces between 20 and 35 newtons.

Indeed, after 4-5 months of healing, the implants can be equipped with such abutments, fixed on the implants by mini-screws with a tightening of 20-35 newtons. This is a considerable improvement over the attempts to attach implants by the traditional sinus lift technique, which regularly gave rotations when screwing / unscrewing the abutments of the implants that migrated inside the sinus because they have detached themselves from the weak cortical bone. 5

DETAILED DESCRIPTION OF THE INVENTION

It has indeed been found that the aforesaid and other objectives can be achieved with a system and its essential constituent devices for attaching dental implants to the upper jaw of a subject, wherein: the system comprises fundamentally: a device (hereinafter referred to as the Intra-Sinusic Element, or abbreviated EIS) intended to be introduced into an intrasinusic cavity previously constituted by the production of a bony window through the lateral cortical bone and by lifting of the lower and lateral membrane of the maxillary sinus, thus allowing the fixation of implants in the intrasinus cavity, in line with the site on which one or more implants must be fixed, and at least one axially elongated implant, comprising at least four zones of connectors adapted to be able to firmly connect said at least one implant to said EIS and the cortical bone, as well as, • optionally a device for the guidance of drilling or drilling (called drilling guide), provided with drills or drill bits appropriate to allow drilling of appropriate dimensions on the site of the desired cortical bone in the relevant portion of the upper jaw; and • optionally a device (called a gripping device) intended to facilitate the grip of the EIS and its attachment to the implant (s), and • while the implant (s) have at least four connection zones:. a threaded end or not, to secure the implant with the EIS,. a cylindrical or frustoconical neck whose average diameter is substantially greater than that of the hole resulting from the drilling in the cortical bone for stable fixation of the implant, between said neck and said end, an axially extending intermediate portion having, in cross-section, a non-cylindrical, polygonal, preferably hexagonal geometry, and at the end of said neck opposite to said intermediate portion, a connector head for receiving, with known technical means, the dental prosthesis to be fixed.

The present invention also relates to a new implant, as defined in the present description.

The present invention also relates to a kit of elements for fixing dental implants on the upper jaw of a subject, in an intrasinus cavity previously made for this purpose, said kit comprising the elements constituting the aforesaid system. More specifically, the invention relates to a system and device for attaching implants to the upper jaw of a subject, wherein said device comprises the essential functional elements of the aforesaid system, except the drill guide and the delivery system. gripping.

In a preferred embodiment, said device is arranged to allow the attachment of several (preferably two) vicinal implants, and it then advantageously comprises a connecting piece 9, said sole or bar, interconnecting by elements 15 heads respective of each of the aforementioned implants connector elements, at the distal end intended to remain outside the sinus cavity after implantation.

In an alternative embodiment, said device is arranged to allow attachment of an implant to be screwed without intermediate portion, and 11 then comprises an EIS pierced with a single threaded or partially tapped hole, and optionally a hole of which Bore has a shape adapted to that of the gripping tool used for its implementation.

In an advantageous embodiment, the aforesaid system or device comprises an EIS designed in two parts intended to be joined together, and respectively constituting the body 10 of the EIS and a roof or cap 12 intended to bear on said body EIS and to be secured therewith by pushing through the intermediate portion of the implant.

In a variant, the device according to the invention comprises a system and a device in which: the system basically comprises: • a device (hereinafter referred to as the Intra-Sinus Element, or abbreviated EIS) as aforesaid, intended to be introduced in an intrasinusic cavity previously constituted by the production of a bony window through the lateral cortical bone and by lifting of the lower and lateral membrane of the maxillary sinus, thus allowing the fixation of implants in the intrasinus cavity, in line with the site on which one or more implants must be attached, and • at least one implant having at least four zones of connectors designed to be able to firmly connect the at least one implant to said EIS, to the cortical bone and to the bone neoformed from the biomaterial, and to receive the prosthesis to be implanted.

In preferred and / or advantageous embodiments, which are in no way limiting, the system or device according to the invention optionally comprises, in combination or separately, as far as is technically possible, one and / or more of the following features and / or features: • The Intrasinusian element (hereinafter abbreviated EIS) comprises two disjointed and interlocking parts 10,12; the first part is a block of oblong shape and having any contours, advantageously smooth and preferably with rounded edges, perforated by bores 13 (through holes) longitudinal suitable for the crossing of the implants to be fixed, and a bore (hole through) or a blind hole 14 transverse to facilitate the gripping of said EIS to make it easier to set up, while the second part of said EIS is a roof piece or cap casing above said first part, and comprises several, advantageously two blind hole holes having a polygonal transverse profile axially corresponding substantially to the polygonal contour of the aforementioned intermediate portion of the implant.

The respective lengths of the different successive parts are preferably adapted to those of the bores of the two parts of the EIS, while advantageously reserving the faculty of a back-sliding of the distal part on the intermediate part when the screwing has been performed. of the distal part of the implant on the threaded bore of the part of the EIS forming the roof. Thus, existing blocking functions are added to existing blocking functions between them by an additional blocking capability of the roof part on the EIS base piece by coinciding their respective polygonal profiles and sliding up to the base part of the EIS. at a natural position of wedging by support of the two parts of the EIS one on the other. By this variant, thus obtaining an even better rigidity of the assembly formed by the EIS and the implant.

In a particular embodiment (not shown), the body of the EIS comprises in its interior a female antirotational structure that can slide freely and without blocking on the male antirotational structure of the roof of the EIS, and can slide and lock in. limit switch on the male antirotational structure of the body of the implants, this non-cylindrical antirotational structure being constituted, if one refers to an axial section, by a polygonal and / or sawtooth geometry, and / or by means of grooves, or growths, or a regular or asymmetrical geometry chosen to suit this purpose.

BRIEF DESCRIPTION OF THE DRAWINGS The invention will be better understood, and other objects, advantages and features thereof will appear more clearly, in the light of the following detailed description of the preferred embodiments, given for illustrative purposes only and in no way limiting, while appended to the said description are plates of drawings in which:

Figure 1 shows, in partial schematic vertical section, an embodiment of a device according to the invention, implanted in a sinus cavity and ready to receive two implants according to the invention;

FIG. 2 shows, successively from top to bottom, a front view of a roof for EIS, of the base of the same EIS, and of an implant element, and a view from above of said implant element. , for a unitary implant;

Figure 3 shows, in succession successively from top to bottom, a front view of a roof for EIS for two vicinal implants, the base of the same EIS in two parts, and two implants;

Figure 4 represents, from top to bottom, a body of EIS for two implants: in top view, in cavalier perspective, and in view from below; and

FIG. 5 represents a sole or bar that can fit on the head of two implants as shown in FIG. 3, to constitute, after implantation, an assembly corresponding to that which is schematically represented in FIG. 1, successively from top to bottom in order to from above, in side view and in cavalier perspective.

In one embodiment as shown in Figure 1 for purely illustrative and non-limiting, implanted in an intrasinus cavity 4 previously made in and above the cortical bone portion 2 of the site 1 concerned, and below the sinus membrane raised 3 different potential constituent parts of the system and the device according to the invention, the entire device once mounted then being embedded in a conventional granular filling material 5, able to harden in the surrounding physiological conditions. The device comprises two implants 6 each having a body 7 and a neck 8 and whose respective heads are connected by a sole or bar 9 fixed under each of the heads 11 of the implants, whose proximal portion is itself trapped in an EIS in two parts 10,12 whose elements are detailed in Figures 3, 4 and 5.

With the implants thus produced in accordance with the invention, a compression is achieved by the combination of the effects of the filler material of the lower back of the maxillary sinus of the paired subject and of the intrasinusic element (EIS). ) which, while providing its own effects, increases the contact area between the implant and said filling material. This effect can not be achieved with current sinus lift techniques.

In the present invention, it is recommended that the intrasinusal element be of elongate shape, with its largest dimension oriented in the vertical direction for a single implant, and in the anteroposterior direction in the case of multiple implant placement jointly in the same sinus cavity.

As a general rule, it should, except in other preferred cases which will be determined case by case by the practitioner, substantially the shape of a parallelepiped, preferably a rectangular parallelepiped, whose volume and morphology must be adapted according to the volume of the intrasinus cavity created under the membrane, and also to take into account the dimensions of the lateral access bone window.

This EIS may have artifices capable of increasing its retention in the filler material, such as grooves, cavities, bores, provision of structures other than the body of the EIS, such as filaments, etc.

The body of the EIS can also be formed in several interconnected parts, revealing empty spaces that will be filled by the filling material, and therefore by the future bone that will result after its formation; it should be emphasized in this connection that said EIS can also have holes to let pass transfixation screws able to anchor on the bone wall that separates the maxillary sinus surrounding elements.

This EIS, whether integral or not, has cavities, or vertical or horizontal functional holes, and can be made by machining, casting, or sintering, or by computer-aided design operations, or by 3D printing.

The biomaterial used for filling the intrasinus cavity can be chosen from the synthetic materials conventionally used in this field (calcium, hydroxy apatite β-tricalcium phosphate, etc.), those of animal origin (bovine, porcine, etc.). , of human origin (despecified if it comes from another person) or originating from the same person, or mixtures of these.

If desired, such biomaterial can be enriched with biological or biochemical osteogenic substances.

As for the implants, they may have the form of either traditional implants to be screwed, or implants known to impact. Nevertheless, according to the present invention, it is advantageous that the implants chosen have: · a neck of larger dimensions than their body, in order to make it possible to stabilize the neck in a hole of slightly smaller dimension of the thin bone cortical bone, and / or • a modified end, in order to enable them to be fixed in the EIS, for example by axial screwing, transverse screwing, cementing or gluing, or even by friction, or by a combination of these means. , and / or • a non-cylindrical body intended to allow axial anti-rotation locking with the EIS (eg regular or asymmetric polygonal body, grooves, sawtooth, etc.) ·

As for the mode of implementation of such implants, it should be emphasized that these implants should simply be fixed "free" to the EIS, which is easily done because the planned drilling allows the free passage of the body of the implant in the bore concerned. Once attached to the EIS, the implant (or each of the implants in case of plurality) is put in place appropriate impacts or percussion, the neck of the implant then being housed in a stable manner> 0 in the piercing under -Dimensioned with respect to the neck of the implant. The person skilled in the art may in this respect make use of one of the connectivity connectors among the dozen existing on the market for implants and abutments for prosthesis on the market.

Traditional cylindrical or conical screwdrivers can be included in the EIS. Once secured, the implant / EIS assembly can be impacted with a mallet. This procedure will be facilitated if the neck of the implant is oversized relative to the body of the implant.

With regard to the guide for drilling the lower cortical bone of the sinuses, it is optional as indicated above, but useful for guaranteeing the precision of the holes for the neck of the implant, and therefore the primary stability of the implant. EIS set / implants. In practice, a suitable drilling guide is integral with the replica of the EIS, and placed in the intrasinus cavity previously formed, for a satisfactory adaptation, while known drilling tools or the like, such as drills or drill bits, are 35 used and implemented to achieve the holes.

In another optional variant, intended to secure even more securely the attachment of the entire implant, so the prosthesis that it is intended to support, is shifted upward through the central through bore for gripping the body of the EIS, such that this horizontal bore opens on the upper face of the body 10 of the EIS and allows an upper longitudinal opening of this bore and the penetration into said oblong bore of the filling material which, hardening during The healing of the site further stiffens the entire implant structure for dental prostheses. In addition, the roof of the EIS can then also be completed by an extension on its lower face, turned towards the upper face of the base of the EIS, such as for example a transversely elongated blade or bar in the transverse direction, for the durability of spacing. As an illustration, in a preferred embodiment of the implementation technique implementing a system or a device according to the invention, the implementation / installation steps advantageously comprise the following phases: a. In order to implement the surgical procedure described id, a bone window is made through the lateral cortical bone without damaging the lateral membrane of the maxillary sinus (this technique is known and constitutes the beginning step for a sinus lift. Through this bony window, the lower (and lateral) membrane is gently lifted with known instruments .. The volume and configuration of the intrasinus cavity created is assessed, and a few replicas of EIS are tested. in order to suit each case encountered, and then place the chosen replica, provided with its cortical drill guide e.The drilling (s) is carried out with drills or known drill bits f) The chosen EIS is placed in the intrasinus cavity by means of its grasping instrument g) The implants are fixed freely to the EIS, with regard to the diameter of drilling greater than the diameter of the body of the implant (s). then an external bar on the implants to orient the implant and EIS body rotation anti-rotation system, and slide the EIS body onto the body of the flat part (s), resulting in blockage of the set (in antirotation). i. The EIS / implant (s) assembly is impacted either with a manually operated surgical mallet or with an automatic mallet that is actuated by a motor. j. The filling material is packed gently and carefully. k. If desired, the fixation can be completed by using one or more screws ensuring the transfixation between the EIS and the surrounding bone of the sinus.

Thus, the neck of the implant or of each implant is maintained by the cortical bone because the diameter of the bone piercing is less than the diameter of the neck of the implant. The EIS can be of any form. In practice, a parallelepipedic EIS is preferred, advantageously chamfered or rounded at its edges and / or on one or more of its edges. k. If desired, the fixation can be completed by using one or more screws for transfixing between the EIS and the implant provided with appropriate orifices.

In practice, it is advantageous for the diameter of the neck of the implants to be greater by a few tenths of a millimeter than the diameter of the bore of the cortical bone.

Referring to a non-limiting example of the embodiment illustrated in FIG. 2, it is recommended for a unitary implant the following operating steps consisting in: • arranging the two parts 10 and 11 of the EIS • place the assembly in the sinus, for example by means of a forceps, • screw "freely" the implant, • align the flats between the EIS and the implant, and slide the EIS by sliding on the body 7 of the implant, • impact the necks of the implants in the cortical bone, • if desired, put a wedge to perfect the blockage between the two parts 10 and 11 of the EIS, and • fill the cavity sinus with the biomaterial.

For two or more implants, a ') place the roof and body of the EIS in the sinus cavity with a forceps, b') screw the implants freely to the EIS (roof), c ') place the bar or soleplate to align the anti-rotation systems of the EIS body and the implant body, and slide the body of the EIS on the implant body, to impact the EIS / implant / bar assembly with a mallet, e ') introduce the biomaterial to fill the residual vacuum in the sinus.

On the basis of the foregoing indications and of its own knowledge, the skilled person is able to choose and / or adapt the constituent elements of the device and the system, their dimensions and their constituent materials, as well as their accessories and connection elements. to meet different needs and the specific implementation conditions that it may be confronted with, in the context of the system and devices according to the invention. Those skilled in the art will readily understand that the implementation of the present invention provides undeniable advantages and significant progress over the techniques currently known and practiced in the field concerned.

Thus, by means of the technique according to the invention, it is possible to achieve substantial savings, to simplify the procedures involved in the phases of the process, and to achieve dental implants particularly remarkable, exceptionally stable and durable.

Claims (16)

1. Device for attaching dental implants to the upper jaw of a subject, characterized in that it comprises: • a device, hereinafter referred to as the Intra-Sinusian Element, or abbreviated EIS, intended to be introduced into an intrasinus cavity (4) previously constituted by the production of a bone window through the lateral cortical bone (2) and by lifting the lower and lateral membrane (3) of the maxillary sinus, thus allowing the fixation of implants (6). ) in the intrasinus cavity (4), in line with the site on which one or more implants are to be fixed, and • at least one axially elongate implant (6), comprising at least four connection zones designed to be able to firmly connect said at least one implant EIS audit and cortical bone, said at least four implant connector areas comprising:. a threaded end or not, to secure the implant with the EIS,. a cylindrical or frustoconical neck (8) whose average diameter is substantially greater than that of the hole resulting from the drilling in the cortical bone for stable implant fixation, between said neck and said end, an axially extending intermediate portion (7) having, in cross-section, a non-cylindrical, polygonal, preferably hexagonal geometry, and at the end of said neck opposite said intermediate portion, a head of connector (11) intended to receive, with known technical means, the dental prosthesis to fix. 2. Device according to claim 1, characterized in that it comprises several, preferably two implants (6) vicinal and a connecting piece (9), said sole or bar, interconnecting the respective heads (11) of each of said implants, at the distal end intended to remain outside the sinus cavity (4) after implantation. 3. Device according to claim 1, characterized in that it is arranged to allow the attachment of a single implant (6), and it comprises an EIS pierced with a single tapped hole or partially tapped. 4. Device according to claim 3, characterized in that it comprises a hole whose bore has a shape adapted to that of the gripping tool used for its introduction. 5. Device according to claim 1, characterized in that it comprises an EIS designed in two parts (10,12) intended to be joined together, and respectively constituting the body of the EIS and a roof or hat intended to take support on said body EIS and to be secured thereto by means of a pushing through the intermediate portion of the EIS and the continuation of said pushing into the threaded bore or partially tapped corresponding provided in the roof / hat of the said EIS. 6. Device according to any one of claims 1 to 5, characterized in that the EIS intrasinusien element comprises two parts (10,12) disjoint and nestable, the first part being a block of oblong shape and having any contours, advantageously smooth and preferably with rounded edges, perforated by longitudinal bores suitable for traversing the implants to be fixed, and a bore or a transverse blind hole intended to facilitate the gripping of said EIS, while the second part of said EIS is a roof piece or cap by fitting above said first portion, and comprises one or more blind hole holes having a polygonal cross section corresponding axially substantially to the polygonal contour of said intermediate portion of the implant. 7. Device according to any one of claims 1 to 6, characterized in that the respective lengths of the different successive parts of said implant are adapted to those of the bores of the two pieces of the EIS, while reserving the faculty of a retro -dash of the distal portion on the intermediate portion when the screwing of the distal portion of the implant on the threaded bore of the portion of the EIS forming roof. 8. Device according to any one of claims 1 to 7, characterized in that the EIS intrasinusian element is of elongate shape, with its largest dimension oriented in the vertical direction for a single implant, and in the anteroposterior direction. in the case of placing several implants together in the same sinus cavity. 9. Device according to any one of claims 1 to 8, characterized in that the EIS intrasinusien element has substantially the shape of a parallelepiped, preferably a rectangular parallelepiped, whose volume and morphology are adapted to the volume of the Intrasinus cavity created under the membrane, and the dimensions of the lateral access bone window. 10. Device according to any one of claims 1 to 9, characterized in that said EIS has artifices, such as grooves, cavities, holes and providing structures such as filaments, intended to increase its retention in the filling material. 11. Device according to any one of claims 1 to 10, characterized in that said EIS further has holes for passing through the transfixation screws capable of anchoring on the bone wall which separates the maxillary sinus of the bony palate. of the subject after implantation. 12. Device according to any one of claims 1 to 11, characterized in that it is monobloc and / or has cavities, or vertical or horizontal functional holes, and is achieved by techniques selected from: machining, casting, sintering, computer-aided design operations, or 3D printing. 13. Device according to any one of claims 1 to 12, characterized in that the body of the EIS comprises in its interior a female antirotational structure which can slide freely and without blocking on the male antirotational structure of the roof of the EIS, and being able to slide and lock at the end of the stroke on the male antirotational structure of the body of the implants (6), this non-cylindrical antirotational structure being constituted by a polygonal and / or sawtooth geometry, and / or by means of grooves, or growths, or a regular or asymmetrical geometry. 14. System for fixing dental implants on the upper jaw of a subject, characterized in that it comprises a device according to any one of claims 1 to 13 and furthermore: a device for guiding the piercing or borehole, referred to as a drill guide, provided with drills or drill bits suitable to allow drilling of appropriate size at the site of the desired bone cortical in the relevant portion of the maxillary jaw; and / or • a device, called a gripping device, intended to facilitate the gripping of the EIS and its securing with the implant (s). 15. Implant of the device according to any one of claims 1 to 13 or the system according to claim 14, characterized in that said implant (6) comprises at least one element selected from: • a neck (8) of larger dimensions that their body (7), in order to make it possible to stabilize the neck in a slightly smaller bore of the bone cortical bone, • a modified end, in order to enable them to be fixed in the EIS, for example by axial screwing, transverse screwing, cementing or gluing, or by friction, or by a combination of these means, • a non-cylindrical body (7) intended to allow axial anti-rotation locking with the EIS, in particular by means of a regular polygonal body or asymmetrical, grooves and / or saw teeth. 16. Kit of elements for fixing dental implants on the upper jaw of a subject, characterized in that it comprises a device according to any one of claims 1 to 13, and a biomaterial (5) used for filling the intrasinus cavity (4) and selected from synthetic materials such as calcium, hydroxyapatite Ca4 (Ca, F) (PO4) 3, etc.), those of animal origin or those of human origin, despecified if it comes from another person or originates from the same person, or mixtures of these.