FR3058629A1 - PIEZOELECTRIC SURGICAL INSTRUMENT FOR MAXILLARY BONE CUTTING AND ASSOCIATED SURGICAL SET - Google Patents

Abstract

The present invention relates to a surgical cutting instrument (10), comprising a connecting element (12) and a cutting blade (14) adjacent to one another, a free end (16) of the connecting element comprising means for connection to a piezoelectric surgery apparatus (18) capable of printing ultrasonic vibrations to said surgical instrument. The cutting blade (14) has substantially the shape of a curved strip, a radius of curvature of said strip being substantially constant between a free end (34) of the strip and a joining end (28) with the strip member. bond, said radius of curvature being between 7 mm and 40 mm.

Description

© Publication number: 3,058,629 (to be used only for reproduction orders) (© National registration number: 16 60952 ® FRENCH REPUBLIC

NATIONAL INSTITUTE OF INDUSTRIAL PROPERTY

COURBEVOIE © Int Cl ⁸ : A 61 B 17/14 (2017.01), A 61 B 17/16, A 61 C 3/03, 1/07

A1 PATENT APPLICATION

©) Date of filing: 14.11.16. (© Priority: © Applicant (s): BOMPARD BRUNO— FR. @ Inventor (s): BOMPARD BRUNO. ©) Date of availability of the request: 18.05.18 Bulletin 18/20. ©) List of documents cited in the preliminary search report: See the end of this booklet (© References to other related national documents: ® Holder (s): BOMPARD BRUNO. ©) Extension request (s): (© Agent (s): LAVOIX.

PIEZOELECTRIC SURGICAL INSTRUMENT FOR MAXILLARY BACK CUTTING AND ASSOCIATED SURGICAL ASSEMBLY.

FR 3 058 629 - A1 _ The present invention relates to a surgical cutting instrument (10), comprising a connecting element (12) and a cutting blade (14) adjacent to each other, a free end (16 ) of the connecting element comprising means for connection to an apparatus (18) for piezoelectric surgery capable of imparting ultrasonic vibrations to said surgical instrument.

The cutting blade (14) has substantially the shape of a curved strip, a radius of curvature of said strip being substantially constant between a free end (34) of the strip and a joining end (28) with the element of connection, said radius of curvature being between 7 mm and 40 mm.

Piezoelectric surgical instrument for cutting jawbones and associated surgical set

The present invention relates to a surgical cutting instrument, of the type comprising a connecting element and a cutting blade adjacent to each other, a free end of the connecting element comprising means for connection to a surgical apparatus. piezoelectric capable of imparting ultrasonic vibrations to said surgical instrument.

Such a surgical instrument is described in particular in document EP2233085. Piezoelectric surgery, or piezo-surgery, or even ultrasonic surgery, is widespread in oral surgery, especially for the placement of dental implants. It is a method of bone surgery based on cutting instruments, or inserts, associated with an ultrasound device.

The device consists of a high-voltage, high-sine wave electric field generator. The inserts vibrate at an ultrasonic speed, in a range of 28 to 36 kHz, and cut hard tissue.

Such equipment offers an alternative to rotary instruments and in particular allows longitudinal cuts to be made with precision.

The installation of a dental implant includes the insertion into the jaw bone of a rod, generally threaded, which aims to replace the dental root. After the bone around the stem has healed, a dental crown is assembled to the stem.

FIG. 8 represents a schematic view, in cross section, of a jaw 200 at the level of a missing tooth. A distinction is made between the gum 202 and the alveolar bone 203, in particular the bone cortex 204 surrounding the spongy part 205 of said bone. The alveolar bone 203 also includes the periosteum 206, which is a strong and flexible membrane, surrounding the bone cortex 204.

It is common after tooth extraction for the alveolar bone to shrink, leading to the formation of a thinned mandibular ridge 208.

However, this retraction is generally done from the outside of the jaw, which makes it problematic to place a dental implant. FIG. 8 shows in fine dotted lines the initial contour 210 of the bone before retraction, and in thick dotted lines the desirable location of the dental implant 211. The quantity of bone in which to anchor the implant is manifestly insufficient in the area desired.

One solution consists in applying the so-called “split bone” method, which consists in cutting a bone flap in the alveolar bone 203, then in sandwiching the dental implant 211 between said bone flap and the remaining bone, the latter being assembled by screws on either side of the implant.

Such a method is nevertheless surgically cumbersome, because it involves beforehand removing the gum 202 and the periosteum 206 from the alveolar bone 203. This method also involves a risk of necrosis of the bone flap, which leads to the loss of implant.

The present invention aims to provide equipment allowing the placement of dental implants in a less invasive and more effective manner than known techniques.

To this end, the subject of the invention is a surgical cutting instrument of the aforementioned type, in which the cutting blade has substantially the shape of a curved strip, a radius of curvature of said strip being substantially constant between a free end of the strip and one end of junction with the connecting element, said radius of curvature being between 7 mm and 60 mm.

According to other advantageous aspects of the invention, the instrument comprises one or more of the following characteristics, taken in isolation or in any technically possible combination:

- a thickness of the cutting blade is less than 1.0 mm between the free end and the junction end;

- a length of the cutting blade, between the free end and the junction end, is between 7 mm and 20 mm;

- the free end of the cutting blade has cutting teeth;

- the cutting blade has visual markers along its length between the free end and the junction end;

- The connecting element has substantially the shape of an elbow, comprising two substantially rectilinear branches and inclined one relative to the other by an angle between 90 ° and 160 °.

The invention further relates to a surgical assembly comprising: at least one surgical instrument as described above, and a piezoelectric surgery apparatus capable of imparting ultrasonic vibrations to said surgical instrument, said apparatus comprising assembly means to the free end of the connecting element.

According to other advantageous aspects of the invention, the assembly includes one or more of the following characteristics, taken in isolation or in any technically possible combination:

- The assembly includes at least two surgical instruments as described above, the cutting blades of said instruments having different radii of curvature;

the assembly also comprises a second surgical instrument, said second surgical instrument comprising means for assembling to the piezoelectric surgery apparatus, said second surgical instrument comprising a plane cutting blade, said blade comprising a curved edge having a radius of curvature analogous to the radius of curvature of the cutting blade of the at least one surgical instrument described above;

- The assembly includes at least two second surgical instruments, the curved edges of said second surgical instruments having different radii of curvature.

- The assembly also includes a luxator, said luxator comprising: a grip handle extending along an axis; and a luxation blade connected to said sleeve, the luxation blade having substantially the shape of a curved strip around an axis not perpendicular to the axis of the handle, a radius of curvature of said strip being analogous to the radius of curvature of the cutting blade of the at least one surgical instrument described above;

- the assembly includes at least two luxators, the luxation blades of said luxators having different radii of curvature.

Another object of the invention is a second surgical instrument as described above, said second surgical instrument comprising a connecting element and a cutting blade adjacent to each other, a free end of the element connection comprising means for connection to a piezoelectric surgery apparatus, the cutting blade being plane and comprising a curved edge, said curved edge having a radius of curvature substantially constant between a free end of the blade and an end of junction with the connecting element, said radius of curvature being between 7 mm and 60 mm.

Another object of the invention is a luxator as described above, said luxator comprising: a grip handle extending along an axis; and a dislocation blade connected to said handle, the dislocation blade having substantially the shape of a curved strip around an axis not perpendicular to the axis of the handle, a radius of curvature of said strip being substantially constant between a free end of the blade and a junction with the handle, said radius of curvature being between 7 mm and 60 mm.

The invention will be better understood on reading the description which follows, given solely by way of nonlimiting example and made with reference to the drawings in which:

- Figure 1 is a side view of a first surgical instrument according to a first embodiment of the invention;

- Figures 2 and 3 are detail views of the first surgical instrument of Figure 1;

Figure 4 is a detail view of a first surgical instrument according to a second embodiment of the invention;

- Figure 5 is a detail view of a surgical tool according to an embodiment of the invention;

- Figures 6 and 7 are detail views of a second surgical instrument according to an embodiment of the invention;

- Figure 8, already described, is a schematic sectional view of a jaw; and

FIGS. 9 to 12 represent different stages of a method of placing a dental implant in said jaw using the instruments of FIGS. 1 to 7.

Figures 1 and 2 show a first surgical instrument 10 according to a first embodiment of the invention. FIG. 4 represents a first surgical instrument 110 according to a second embodiment of the invention. In the following description, the instruments 10 and 110 will be described simultaneously, the elements common to the instruments 10 and 110 being designated by the same reference numbers.

Instrument 10, 110, or piezo-surgical insert, is intended for cutting bone by piezo-surgery, in particular in the context of oral surgery. The instrument 10, 110 comprises in particular a connecting element 12 and a cutting blade 14, 114, adjacent to each other.

As visible in Figure 1, which shows a side view of the instrument 10, a free end 16 of the connecting element 12 comprises means for connection to a piezoelectric surgery device 18, or handpiece, shown in dotted lines . The apparatus 18 is capable of imparting ultrasonic vibrations to the instrument 10. Alternatively, the apparatus 18 is another type of low amplitude vibration generator, for example using compressed air.

The means for connecting the free end 16 to the device 18 include, for example, a cavity (not shown) into which one end of the device 16 can be inserted, as described in document EP2233085.

The connecting element 12 has substantially the shape of an elbow, comprising a first branch 20 and a second branch 22 substantially rectilinear. The first branch 20 has the free end 16. The first 20 and second 22 branches extend respectively along a first 24 and a second 26 axes, coplanar and inclined relative to each other by an angle a. The angle a is between 90 ° and 160 °, preferably between 110 ° and 150 ° and folds preferably equal to approximately 120 °. Each of the first 20 and second 22 branches has a cross section giving it a certain rigidity, preferably a substantially circular section or in regular polygon.

In the following description, we consider an orthonormal base (X, Y, Z), the plane defined by the first 24 and second 26 axes being parallel to (Y, Z) and the second axis 26 being parallel to Z.

One end of the second branch 22, opposite the first branch 20, forms a junction 28 with the cutting blade 14, 114. Preferably, the connecting element 12 and the cutting blade 14, 114 are formed from a piece, more preferably made of metal.

The cutting blade 14, 114 has substantially the shape of a strip curved around a third axis 30 parallel to Y. A radius of curvature 32, 132 of said strip is substantially constant between a free end 34 of the strip and the junction 28 with the connecting element 12. The radius of curvature 32, 132 is preferably between 7 mm and 60 mm, more preferably between 7 mm and 40 mm. In the examples shown in FIGS. 2 and 4, the radius of curvature 32 of the cutting blade 14 is less than the radius of curvature 132 of the cutting blade 114.

A length of the cutting blade 14, 114, between the free end 34 and the junction 28, is preferably between 7 mm and 20 mm.

A width 36 of the cutting blade 14, 114, measured along Y, is preferably between 2 mm and 5 mm. Preferably, said width is substantially constant over the entire length of the cutting blade 14, 114.

A thickness of the cutting blade 14, 114, measured radially with respect to the third axis 30, is suitable for penetrating a bone under the effect of the ultrasonic vibrations of the device 18. In other words, the thickness of the cutting blade 14, 114 is substantially less than a cross section of the first 20 and second 22 branches of the connecting element 12. Preferably, a thickness of the cutting blade is less than 1.0 mm, more precisely less 0.7 mm, preferably between 0.3 mm and 0.5 mm over its entire length between the free end 34 and the junction 28. Preferably, said thickness is substantially constant over the entire length of the cutting blade 14 , 114.

The free end 34 of the cutting blade 14, 114 has a cutting shape, so as to penetrate a bone frontally under the effect of the ultrasonic vibrations of the device 18. FIG. 3 shows the free end 34 of the blade section 14 of Figures 1 and 2, according to the first embodiment of the invention. The free end 34 has several cutting teeth 38, of substantially triangular shape. In the example shown, the free end 34 has three cutting teeth, this figure being able to vary according to the embodiments and / or the width of the cutting blade. Preferably, the ridges 40 of the cutting teeth 38 are substantially aligned parallel to Y.

According to one embodiment, like the blade 14 shown in FIG. 2, the curvature of the blade 14 is tangent to the second axis 26 at the junction 28 with the connecting element 12. According to another embodiment, as the strip 114 shown in FIG. 4, the tangent to the said strip forms a non-zero angle with the second axis 26 at the junction 28.

According to one embodiment, as shown in FIG. 1, the blade 14, 114 has visual markers 42, or graduations, along its length between the free end 34 and the junction 28.

FIG. 5 represents a surgical tool 50 according to an embodiment of the invention. The surgical tool 50, or luxator, is intended to be handled by a practitioner. The luxator 50 is described below according to the same orthonormal base (X, Y, Z) as the first surgical instruments 10, 110.

It is considered that the luxator 50 comprises a connecting element 12, as described above, and a curved blade 54. However, the end 16 of the connecting element 12 is connected or able to be connected to a grip handle ( not shown) and not to an apparatus 18 for piezoelectric surgery.

Analogously to the cutting blade 14, 114 of the first instrument 10, 110, the curved blade 54 of the luxator 50 is connected to the second branch 22 of the connecting element 12 and has substantially the shape of a curved strip around of an axis 56 parallel to Y. In the embodiment of FIG. 5, a radius of curvature 32 of said strip is substantially identical to the radius of curvature 32 of the cutting blade 14.

However, a thickness of the curved blade 54, measured radially with respect to the axis 56, is substantially greater than that of the cutting blade 14. In addition, said thickness is substantially increasing between a free end 58 of the curved blade 54 and a junction with the connecting element 12. Thus, the curved blade 54 has a high rigidity.

As an indication, the thickness of the curved blade 54 is of the order of 0.5 mm at the free end 58 and of the order of 1.5 mm to 2 mm at the junction with the connecting element 12.

In addition, the curved blade has a substantially tapered or “pie server” shape. More specifically, a width of the curved blade 54, measured along Y, is of the order of 1 to 2 mm at the free end 58 and of the order of 3 to 5 mm at the junction with the connecting element 12.

Figures 6 and 7 show a second surgical instrument 60 according to an embodiment of the invention. Like the first instrument 10, 110, the second surgical instrument 60 is a piezo-surgical insert.

The second surgical instrument 60 comprises a connecting element 12, as described above, and a flat blade 64. As described in the case of the first instrument 10, 110, the connecting element 12 comprises means for connection to the device 18 of piezoelectric surgery.

The flat blade 64 is substantially arranged in a plane (X, Z) and has substantially the shape of a curved strip, lying between two concentric circles. Said strip is preferably rounded at its free end 66. Preferably, a curved edge 68 of said strip has cutting elements 70, such as teeth, in particular at the level of said free end 66.

A width of the flat blade 64, measured radially, is substantially between 1.5 mm and 4 mm. In the embodiment of Figures 6 and 7, a median radius of curvature 32, equidistant from the concentric circles defining the flat blade 64, is substantially identical to the radius of curvature 32 of the cutting blade 14. Alternatively, another radius of curvature is chosen to adapt to the shape of cortex 204.

A thickness of the flat blade 64, measured along Y, is suitable for penetrating a bone under the effect of the ultrasonic vibrations of the device 18. Preferably, said thickness is less than 1.0 mm.

A method of using the first 10 and second 60 surgical instruments for placing a dental implant 211 is as follows. First, a practitioner assembles the first instrument 10 to an apparatus 18 for piezoelectric surgery as described above. The radius of curvature 32 of the cutting blade 14 of said instrument 10 is chosen by the practitioner, according to criteria which will be described below.

The apparatus 18 is configured to impart ultrasonic vibrations to the instrument 10, so as to oscillate the cutting blade 14 and the second branch 22 of the connecting element 12 around the second axis 26. Under the effect of these vibrations, the free end 34 moves in three dimensions, in particular along Y, with a movement of small amplitude but of high frequency.

FIG. 9 represents the jaw 200 of FIG. 8. More specifically, only the alveolar bone 203 is shown. The mandibular ridge 208 is considered to extend substantially in the Y direction.

In a first step of the dental implant placement process, the gum 202 and the periosteum 206 are incised with a scalpel, in direction Y, at the top of the mandibular crest 208. The gum is very slightly detached from the alveolar bone 203 so that said mandibular ridge 208 is clearly visible.

The free end 34 of the instrument 10 is then placed opposite the mandibular ridge 208, then brought closer to said ridge in the direction Z. The cutting blade 14, subjected to the ultrasonic vibrations of the device 18 , begins bone cortex 204 at said crest.

The cutting blade is then moved along Y, in a back and forth movement in order to make a substantially rectilinear incision 212 in the mandibular ridge 208.

According to an alternative embodiment, this first incision 212 of the alveolar bone 203 at the level of the mandibular crest 208 is made with an instrument similar to the instrument 10, 110 but comprising a flat cutting blade and not curved.

In a second step, shown in FIG. 10, the free end 34 of the blade 14 is inserted into the mandibular ridge 208 in the incision 212 previously made. The blade 14 being subjected to the ultrasonic vibrations of the device 18, back and forth movements along Y are printed on said device 18 by the practitioner who, at the same time, pushes the blade into said incision 212. The blade 14 thus cuts the spongy part 205 along a curved line 213, corresponding to the curvature of the cutting blade 14, and this over the entire length of the incision 212. The visual markers 42 along said blade 14 allow the practitioner to estimate the length of the blade inserted into the bone 203.

The insertion of the cutting blade 14 is continued until the free end 34 penetrates the bone cortex 204 through the interior of the bone 203, along a fourth axis 218 substantially parallel to Y and located outward from the jaw. The partial penetration of the bone cortex 204 is determined by the practitioner, when touched through the gum 202. The insertion of the cutting blade 14 is stopped before the free end 34 completely crosses the bone cortex 204.

The cutting blade 14 is then extracted from the alveolar bone 203, following the curved outline of the cutout 213.

In a fourth step, represented in FIG. 11, the practitioner assembles the second surgical instrument 60 to the apparatus 18. Then, he introduces the free end 66 of the flat blade 64 at a first end of the incision 212. The flat blade 64 being subjected to the ultrasonic vibrations of the device 18, the practitioner then pushes said blade 64 into the alveolar bone 203 along the curved cut 213. The bone cortex 204 is sectioned vertically from the top of the mandibular crest 208 and through the interior of the bone 203, at the first end of the incision 212. The same operation is repeated at a second end of the incision 212.

These two sections are preferably made so as not to enter the periosteum 206, which covers the bone cortex 204.

Each of the sections of the bone cortex 204 thus produced extends between the incision 212 and the fourth axis 218. Said sections and the incision 212 define a bone flap 220, shown in FIG. 9 and partially detached from the rest of the alveolar bone 203. Said flap 220 is however linked to the bone cortex 204 along the fourth axis 218. The periosteum 206, not sectioned, also connects said flap 220 to the rest of the bone cortex 204.

In a fifth step, the curved blade 54 of the luxator 50 is introduced into the incision 212, then the practitioner exerts a rotational movement on said blade, around the second axis 26. The tapered shape of the curved blade 54 makes it possible to distribute the luxation forces of the flap over its entire height.

The curved blade 54 is thus used to separate the bone flap 220 from the rest of the alveolar bone 203, by rotation of said flap around a hinge formed by the weakening of the bone cortex 204 along the fourth axis 218. The periosteum 206 stretches and loosens slightly from the cortical bone 204 on either side of the flap 220, allowing the spacing of said flap.

If the luxator 50 is used, not in rotation, but with an outward rocking movement, the force generated is exerted essentially at the top of the bone crest with the risk of a fracture of the bone flap above the fourth axis 218. In fact, the cortex generally has a variable thickness, which may have areas of weakness.

With the bone flap 220 removed, the incision 212 gives way to a cavity 222 overlooking the spongy part 205 of the bone. In a sixth step, represented in FIG. 12, a dental implant 211 is introduced into said cavity and screwed into said cancellous part 205. The elasticity of the periosteum 206 tends to restore the bone flap 220 to its initial position by rotation around the fourth axis 218. The dental implant is therefore partially held in place by the bone flap 220.

The dental implant 211 is thus anchored in the alveolar bone 203 by a method which did not require prior detachment of the gum 202.

Preferably, one end of the dental implant 211 is flush with the top of the mandibular crest 208 and is therefore in the thickness of the gum 202. An additional element, or healing abutment (not shown), can be screwed to the dental implant 211 to allow healing of said gum. After said healing, said abutment is removed and replaced by a dental crown.

A particular embodiment of the invention relates to an assembly comprising an apparatus 18 for piezoelectric surgery, as described above, and at least two first surgical instruments 10, 110 as described above, including the cutting blades 14, 114 have different radii of curvature 32, 132. Such an assembly allows the practitioner to select the radius of curvature so that the hinge of the bone flap 220 is formed at an appropriate distance from the mandibular ridge 208.

Preferably, such an assembly further comprises a second surgical instrument 60 as described above. More preferably, such an assembly comprises several second surgical instruments 60 as described above, whose edges 68 have different radii of curvature.

Preferably, said assembly comprises several first 10, 110 and / or second 60 surgical instruments whose blades 14, 114, 64 are oriented on one side or the other of the plane passing through the first 24 and second 26 axes, of so as to allow the treatment of the right and left parts of the same jaw.

Preferably, such an assembly further comprises a luxator 50 as described above. More preferably, such an assembly comprises several luxators 50 as described above, whose curved blades 54 have different radii of curvature and / or different orientations relative to the plane passing through the first 24 and second 26 axes.

According to a variant not shown, the connecting element 12 of the first surgical instrument 10, 110 and / or of the second surgical instrument 60 and / or of the luxator 50 has substantially an S shape, materialized by two successive elbows. Such a shape can allow better accessibility in the mouth.

Claims (10)

1, - First surgical cutting instrument (10, 110), comprising a connecting element (12) and a cutting blade (14, 114) adjacent to each other, a free end (16) of the connecting element comprising means for connection to a piezoelectric surgery apparatus (18) capable of imparting ultrasonic vibrations to said surgical instrument, characterized in that the cutting blade (14, 114) has substantially the shape of a curved strip, a radius of curvature (32, 132) of said strip being substantially constant between a free end (34) of the strip and an end of junction (28) with the connecting element, said radius of curvature being between 7 mm and 60 mm. 2, - The first surgical instrument according to claim 1, wherein a thickness of the cutting blade is less than 1.0 mm between the free end (34) and the junction end (28). 3, - The first surgical instrument according to claim 1 or claim 2, wherein a length of the cutting blade, between the free end and the joining end, is between 7 mm and 20 mm. 4, - First surgical instrument according to one of the preceding claims, in which the free end (34) of the cutting blade comprises cutting teeth (38). 5, - First surgical instrument according to one of the preceding claims, in which the cutting blade (14, 114) has visual markers (42) along its length between the free end (34) and the junction end ( 28). 6, - First surgical instrument according to one of the preceding claims, wherein the connecting element (12) has substantially the shape of an elbow, comprising two branches (20, 22) substantially rectilinear and inclined relative to one another to the other by an angle (a) between 90 ° and 160 ° 7, - Surgical cutting unit, comprising: - at least one first surgical instrument (10, 110) according to one of the preceding claims, and - an apparatus (18) for piezoelectric surgery capable of imparting ultrasonic vibrations to said surgical instrument, said apparatus comprising means of assembly at the free end (16) of the connecting element (12). 8. An assembly according to claim 7, comprising at least two first surgical instruments (10, 110) according to one of claims 1 to 6, the cutting blades (14, 114) of said instruments having radii of curvature (32 , 132) different. 9. The assembly of claim 7 or claim 8, further comprising a second surgical instrument (60), said second surgical instrument comprising means for joining to the piezoelectric surgery apparatus (18), said second surgical instrument comprising a flat cutting blade (64), said blade comprising a curved edge (68) having a similar radius of curvature 15 at the radius of curvature (32, 132) of the cutting blade (14, 114) of the at least one first surgical instrument (10, 110). 10.- assembly according to claim 9, comprising at least two second surgical instruments (60), the curved edges (68) of said second instruments 20 surgical with different radii of curvature. ο ο ο National registration number FA 831499 FR 1660952