JP2006141562A - Resin sheet used for manufacture of ct imaging assist mouthpiece, manufacturing method of ct imaging assist mouthpiece and preoperative diagnosis method for dental implant treatment - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a resin sheet 30 capable of manufacturing a CT imaging assist mouthpiece 31 clearly displaying the outer surface of the gingiva part 62 of a jaw on CT images 50, 60 and 70. <P>SOLUTION: This resin sheet 30 for manufacturing the CT imaging assist mouthpiece 31 to be covered over a tooth and the gingiva of the jaw when CT-imaging the jaw of a patient is formed by mixing an X-ray non-transmitting contrast agent to a base resin composed of a thermoplastic resin. When the CT imaging is performed with the mouthpiece 31 manufactured using this resin sheet 30 put on the jaw to provide a transverse CT image 60 composed of a cross section orthogonally crossing with the central line 51 of the dental arch in the jaw, a shadow along the outer surface of the gingiva part 63 is clearly displayed on the CT image 60 by the contrast agent mixed in the mouthpiece 31. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a resin sheet used for manufacturing a CT imaging support mouthpiece, a CT imaging support mouthpiece manufacturing method, and a preoperative examination method for dental implant treatment.

  In the field of dentistry, there is known an implant treatment in which a denture is firmly planted in a defective portion of a tooth.

  In this implant treatment, an implant (artificial tooth root) is embedded in the jawbone, and a denture is attached to the implant via an abutment. In order to make this implant treatment successful, it is necessary to appropriately grasp the position and direction of implantation by performing a preoperative examination.

  Conventionally, preoperative examinations have used images taken with a panoramic X-ray imaging apparatus. This panoramic X-ray image is like a flat image acquired for each predetermined range of the jaws arranged side by side, and because there are many overlapping images, a very advanced decoding technique is required and it may not be decoded .

  In recent years, it has been considered that various tomographic planes related to a tooth defect portion of a jaw to be subjected to implant treatment are imaged with an X-ray CT (Computed Tomography) apparatus. With this X-ray CT apparatus, it is possible to image any tomographic plane such as a tomographic plane at the occlusal portion between the upper jaw and the lower jaw and a tomographic plane orthogonal to the center line of the dental arch of the jaw.

  However, at present, since X-ray CT apparatuses are expensive, it can be said that it is difficult to install them in all privately operated dental clinics. In addition, in the CT image taken by the X-ray CT apparatus, although the teeth, jawbone, nerves and the like can be clearly visually confirmed, it is difficult to visually confirm the outer surface of the gingival part.

  By the way, in order to observe the inside of a patient's mouth, there is one in which a patient is wearing a mouthpiece and photographed with a video scope using a CCD (see Patent Document 1). This mouthpiece blocks light such as external light, and thereby enables accurate observation of the inside of the oral cavity.

Also, a drill guide is considered as a support jig for guiding a drill in order to make it possible to perform the insertion hole of the implant with a drill as easily as possible and appropriately (see Patent Document 2). .) This drill guide, for example, is placed on the teeth on both sides of the tooth defect portion, and a transparent acrylic resin or the like is crowned on the tooth shape created based on the impression (female die) acquired about the tooth row including the tooth defect portion of the patient. The guide tube (a drill passage guide for forming an implant insertion hole in the jawbone) is provided at a predetermined position.
JP 2004-305429 A European Patent No. 1043960

  In the imaging using the above-described conventional mouthpiece, the X-ray CT apparatus is not used, and it is not considered that the outer surface of the gingival part can be clearly copied in the captured image.

  In addition, in order to manufacture the conventional drill guide, it is necessary to create a guide body to be arranged between the upper jaw and the lower jaw and to form an implant insertion hole in the lower jaw tooth mold, etc. It is pointed out that it takes time and effort.

  An object of the present invention is to provide a resin sheet that can manufacture a mouthpiece for CT imaging support that can clearly display the outer surface of a gingival part of a jaw on a CT image. Another object of the present invention is to provide a method for easily and high-quality manufacturing of a CT imaging support mouthpiece capable of clearly displaying the outer surface of the gingival portion of the jaw on a CT image. Furthermore, an object of the present invention is to provide a preoperative examination method for dental implant treatment that makes it easy to appropriately grasp the position and direction of implantation of an implant.

  The present invention is a resin sheet for manufacturing a mouthpiece for CT imaging support that covers the teeth and gums of the jaw when CT imaging is performed on a patient's jaw, and includes a base resin made of a thermoplastic resin, X It is characterized by mixing a radiopaque contrast agent.

  In this case, if a mouthpiece that covers the teeth and gingiva of the patient's jaw with the resin sheet is manufactured, the patient can be positioned and mounted almost without shaking. Also, when this mouthpiece is attached to the jaw and CT imaging is performed to obtain a transverse CT image consisting of a tomographic plane orthogonal to the center line of the dental arch in the jaw, this CT image is mixed with the mouthpiece. The shadows along the outer surface of the gingival part are clearly displayed by the contrast medium.

  The present invention relates to a cross-sectional CT image comprising a tomographic plane perpendicular to the center line of the dental arch in the jaw with an X-ray CT apparatus in a preoperative examination of an implant treatment in which an implant is embedded in a jaw bone corresponding to a tooth defect portion of a patient. A resin sheet for manufacturing a CT imaging support mouthpiece that covers the teeth and gums of the jaw when imaging a radiograph, and a radiopaque contrast agent is applied to a base resin made of a thermoplastic resin. It is characterized by being mixed.

  In this case, if a mouthpiece that covers the teeth and gingiva of the patient's jaw with the resin sheet is manufactured, the patient can be positioned and mounted almost without shaking. Also, when this mouthpiece is attached to the jaw and CT imaging is performed to obtain a transverse CT image consisting of a tomographic plane orthogonal to the center line of the dental arch in the jaw, this CT image is mixed with the mouthpiece. The shadows along the outer surface of the gingival part are clearly displayed by the contrast medium. Therefore, by using this CT image, it becomes possible to appropriately grasp the implantation position and direction of the implant in the preoperative examination of the implant treatment.

  The present invention relates to a method of manufacturing a mouthpiece for CT imaging support that covers the teeth and gums of a jaw when CT imaging is performed on a patient's jaw, which is radiopaque to a base resin made of a thermoplastic resin. A step of heat-softening a resin sheet mixed with a contrast agent, and then pressing the resin sheet so as to cover the outer surface of the tooth mold created based on the impression of the jaw including the gingiva; and the tooth mold and the resin sheet covering the tooth mold By vacuuming the space between and deforming the resin sheet into a shape along the outer shape of the tooth mold, and cooling and solidifying the resin sheet while keeping the resin sheet in contact, And cutting the solidified resin sheet so as to leave a region corresponding to the gingival part of the tooth mold and removing it from the tooth mold.

  In this case, the mouthpiece can be easily and quickly formed into a shape faithful to the patient's jaw, which can contribute to the reduction of manufacturing costs.

  The present invention relates to a preoperative examination method for appropriately examining the implantation position and direction of the implant in performing an implant treatment in which an implant is implanted in a jawbone corresponding to a dental defect portion of a patient, the dental defect of the patient Creating a dental mold based on the impression of the jaw including the portion, the teeth and the gingival part, molding a resinous CT imaging support mouthpiece into a shape along the outline of the dental mold, and the CT imaging support mouse Obtaining a transverse CT image comprising a tomographic plane perpendicular to the center line of the dental arch in the jaw by performing CT imaging with the piece placed on the patient's jaw, and obtaining a transverse CT image in the tooth defect portion of the jaw The same size as the subject is printed and cut out, the tooth defect portion of the tooth mold is cut corresponding to the transverse CT image, and the transverse CT image is cut on the cut surface of the tooth mold. A step of attaching a cut-out, and a position mark representing the placement position by grasping an appropriate implant placement position and placement direction based on a cut-out of a transverse CT image attached to the tooth mold, and indicating a position mark of the tooth mold Attaching the direction mark indicating the embedding direction to the cutout of the transverse CT image and forming the mouthpiece for CT imaging support, wherein the step of molding the CT imaging support mouthpiece includes adding X to a base resin made of a thermoplastic resin. A step of heat-softening a resin sheet formed by mixing a radiopaque contrast medium and then pressing the resin sheet so as to cover the outer surface of the tooth mold; and in a space between the resin sheet in the state and the tooth mold The resin sheet is deformed into a shape that conforms to the outer shape of the tooth mold by vacuuming, and the adhered object remains in that state. Were allowed to 却固 reduction, it is characterized in that cut into so as to leave the region corresponding to the gingival portion of the tooth form in the solidified object including the step of removing from the tooth die.

  In this case, in the preoperative examination of the implant treatment, a dental mold that is a replica of the patient's jaw is used, and a cross-sectional CT image cut out is used. Therefore, the examiner can easily visually confirm the dental mold by hand. In addition, since CT imaging is performed using a mouthpiece made of a resin sheet containing a contrast medium, the outer surface of the gingival part can be clearly displayed on the transverse CT image. From these facts, it is advantageous in appropriately performing the implant treatment for each patient, such as being able to examine the implant placement position and the implantation direction quickly and accurately.

  Preferably, a longitudinal CT image composed of a tomographic plane along the center line of the dental arch is obtained by the CT imaging, and a planar developed CT in a state where the longitudinal CT image is planarly developed from the front of the dental arch by image processing. The method further includes a step of creating an image, and the plane developed CT image can be referred to in addition to the cutout of the transverse CT image in grasping the embedding direction.

  In this case, it becomes possible to grasp the implantation direction of the implant more appropriately.

  According to the resin sheet of the present invention, it is possible to manufacture a CT imaging support mouthpiece capable of clearly displaying the outer surface of the gingival portion of the jaw on the CT image.

  Further, according to the method for manufacturing a CT imaging support mouthpiece of the present invention, a CT imaging support mouthpiece capable of clearly displaying the outer surface of the gingival portion of the jaw on the CT image can be manufactured easily and with high quality. It becomes possible.

  Furthermore, according to the preoperative examination method of the present invention, it becomes easy to appropriately grasp the implantation position and implantation direction of the implant, and the implant treatment can be appropriately performed for each patient.

  Hereinafter, an embodiment of the present invention will be described with reference to FIGS.

  As shown in FIG. 2, in the implant treatment, an implant (artificial tooth root) 2 is attached to the patient's jawbone 1, an abutment 3 is attached to the upper end of the implant 2, and a denture (prosthesis) is attached to the abutment 3. 4 is installed.

  In such an implant treatment, it is necessary to drill the insertion hole 5 of the implant 2 in the jaw bone 1 of the patient, and in order to be able to form the insertion hole 5 as easily and appropriately as possible, The surgical guide 10 is used as a support jig for guiding the drill.

  The surgical guide 10 includes a guide body 11 and a guide tube 12 as shown in FIG. In this embodiment, the case where the target of the implant treatment is the lower jaw is taken as an example, and the shape of the surgical guide 10 is also taken as an example corresponding to that.

  The guide body 11 is placed on the tooth row and the gingival part including the patient's tooth defect part, and is created based on the impression of the jaw including the patient's tooth and tooth defect part.

  The guide body 11 is made of, for example, a thermoplastic resin. Examples of the thermoplastic resin include vinyl chloride resin, vinyl acetate resin, polystyrene, ABS resin, acrylic resin, polyethylene, polypropylene, fluororesin, polyamide resin, acetal resin, polycarbonate, and fiber plastic. In view of the manufacturing process of the surgical guide 10, it is preferable to select a transparent or translucent one.

  The guide tube 12 serves as a guide for the formation position of the embedding hole 5 and the drilling direction of the implant 2 and is provided at an appropriate position of the guide body 11 according to the patient's tooth defect state. The guide tube 12 is made of a metal such as stainless steel.

  Next, with reference to FIG. 3, the manufacturing method of the surgical guide 10 mentioned above is demonstrated. In order to manufacture this surgical guide 10, first, it is necessary to perform a preoperative examination (steps 1 to 4).

  (Step 1) For example, the lower jaw dental mold 20 as shown in FIG. 4 is created.

  As is well known, first, an impression of the patient's lower jaw is acquired, and based on this impression, a dental mold 20 for the patient's lower jaw is created. In the dental mold 20 of FIG. 4, 21 is a tooth, 22 is a gingival part, and 23 is a tooth defect part.

  (Step 2) A mouthpiece 31 for CT imaging support as shown in FIG. 6 having a shape along the outer shape of the tooth mold 20 formed in Step 1 is formed.

  In this embodiment, in order to form the mouthpiece 31, for example, a vacuum forming apparatus 40 as shown in FIG. 5 is used. As a material for the mouthpiece 31, a resin sheet 30 is used.

  The resin sheet 30 is made of a base resin made of a thermoplastic resin mixed with a radiopaque contrast agent. Examples of the thermoplastic resin include vinyl chloride resin, vinyl acetate resin, polystyrene, ABS resin, acrylic resin, polyethylene, polypropylene, fluororesin, polyamide resin, acetal resin, polycarbonate, and fiber plastic.

  In addition, about the base resin in the resin sheet 30 for forming the mouthpiece 31, it is preferable to select a comparatively flexible thing among thermoplastic resins arbitrarily. This is because the mouthpiece 31 is worn in a just-fit state on the lower jaw of a patient with a clear consciousness at the time of CT imaging described below, and the patient complains of discomfort if it is hard. Examples of the contrast agent include those that do not adversely affect the human body, such as barium sulfate and iodine. The thickness of the resin sheet 30 is set to 1 mm to 4 mm, preferably 1 mm to 2 mm. The mixing ratio of the contrast agent to the base resin in the resin sheet 30 is set to, for example, 20 to 30 wt%, preferably 25 wt%.

  The vacuum forming apparatus 40 includes a lower mold 41, an upper mold 42, and a vacuum pump 43. The lower die 41 has a rectangular flat mounting portion 41a on the upper portion, and a large number of suction holes 41b are provided in a dot matrix form throughout the mounting portion 41a. The upper mold 42 includes a pair of pressing members 42 a and 42 b that can be moved up and down along the guide rail 44. The pressing members 42a and 42b are formed of a rectangular frame, and are set so that the resin sheet 30 is sandwiched between them. The inner sides of the frames of the pressing members 42 a and 42 b are set to a size that surrounds the tooth mold 20. The vacuum pump 43 is connected to the lower mold 41 and sucks outside air from the suction hole 41 b of the lower mold 41.

  Specifically, first, as shown in FIG. 7, the resin sheet 30 as the material of the mouthpiece 31 is set between the pressing members 42a and 42b of the upper mold 42, and the pressing members 42a and 42b of the upper mold 42 and the lower The mounting part 41 a of the mold 41 is heated with a heater or the like (not shown), and the tooth mold 20 is mounted on the upper surface of the lower mold 41.

  Then, the resin sheet 30 is softened by heating the pressing members 42a and 42b with a heater or the like (not shown), and then the resin sheet 30 is pressed against the tooth mold 20 by lowering the pressing members 42a and 42b.

  In this state, the vacuum pump 43 is driven to evacuate the space surrounded by the mounting portion 41 a of the lower mold 41 and the resin sheet 30, thereby deforming the resin sheet 30 into a shape along the outer shape of the tooth mold 20. And make close contact. Thereafter, the resin sheet 30 in close contact with the tooth mold 20 is solidified by cooling.

  In this solidified molded product, as shown in FIG. 8, it is carefully cut along a cutting line (one-dot chain line) 33 so as to leave a part covering the gingival part 22 of the tooth mold 20. Thereby, the mouthpiece 31 shown in FIG. 6 is obtained.

  (Step 3) An image of a tomographic surface of a tooth defect portion, that is, a portion to be implanted is obtained on the jaw of a patient to be subjected to an implant treatment.

  Specifically, an image is taken with an X-ray CT (Computed Tomography) apparatus with the mouthpiece 31 mounted on the lower jaw of the patient. By this imaging, an occlusal CT image 50 shown in FIG. 9, a transverse CT image 60 shown in FIG. 10, and a flat developed CT image 70 shown in FIG. 11 are obtained. In each CT image 50 to 70 of FIGS. 9 to 11, 61 indicates a tooth, 62 indicates a jawbone, 63 indicates a gingival portion, and 64 indicates a nervous system.

  The occlusal portion CT image 50 is a top view of the tomographic plane of the occlusal portion between the upper jaw and the lower jaw.

  The transverse CT image 60 is a cross-sectional view of a line 52 perpendicular to the center line 51 of the lower dental arch in FIG. A plurality of the transverse CT images 60 are taken at a predetermined pitch on the center line 51 of the dental arch.

  The planar developed CT image 70 is obtained by obtaining a longitudinal CT image consisting of a tomographic plane along the central line 51 of the lower dental arch in FIG. 9, and developing the planar CT image by performing image processing on the longitudinal CT image. It is seen from the front (arrow 54 direction).

  (Step 4) The position and direction where the implant 2 should be placed are examined.

  Specifically, among the photographed transverse CT images 60, the transverse CT image 60 at the tooth missing portion of the jaw is printed on paper or the like with the same size as the subject, and the tooth missing from the printed paper as shown in FIG. The region including the gingival portion 63 and the jawbone 62 is accurately cut out. At this time, cutting is performed along the outer surface of the gingival portion 63 shown in the transverse CT image 60. Since the mouthpiece 31 is a mixture of contrast medium, the mouthpiece 31 can be imaged so that the outer surface of the gingival portion 63 can be clearly distinguished from other portions in the transverse CT image 60. Therefore, when the transverse CT image 60 is cut out, it becomes easy to cut out accurately along the outer surface of the gingival portion 63.

  On the other hand, as shown in FIG. 13, the tooth mold 20 is cut at a location corresponding to the cutout 65 of the transverse CT image 60, and the cutout 65 of the transverse CT image 60 is associated with the cut surface 24 and pasted. To do. The members cut and separated in the tooth mold 20 can be attached and detached by the concave / convex fitting of the pin 25 and the hole 26.

  An appropriate position and direction in which the implant 2 is to be implanted are examined using the dental mold 20 and the flat developed CT image 70 as described above.

  Specifically, as shown in FIG. 14, a position mark 27 indicating an appropriate implantation position of the implant 2 is written at a predetermined position of the tooth defect portion of the tooth mold 20 using the cutout 65 of the transverse CT image 60.

  On the other hand, the implantation direction of the implant 2 is comprehensively determined based on the cut-out 65 of the transverse CT image 60 and the flat developed CT image 70. First, as shown in FIG. 14, a direction mark 28 indicating the inclination θ1 in the tomographic plane perpendicular to the center line 51 of the dental arch is written in the cut-out 65 of the transverse CT image 60, and further, FIG. A direction mark 29 representing the inclination θ2 in the tomographic plane along the center line 51 of the dental arch is written in the flat developed CT image 70 shown in FIG. 11 and 13, the inclination angles θ1 and θ2 of the direction marks 28 and 29 with respect to the vertical line 55 in the tomographic plane are measured.

  The reason why the inclination θ1 in the tomographic plane orthogonal to the center line 51 of the dental arch is necessary is because, for example, it is necessary to prevent the implant 2 from contacting the nervous system 64. Further, the reason why the inclination θ2 in the tomographic plane along the center line 51 of the dental arch is necessary is that, for example, the thickness of the jawbone 62 of the tooth defect portion generally tends to be thin, and in such a case This is because it is necessary to implant the implant 2 toward the jaw bone 62 side of the portion where the tooth 61 exists.

  (Step 5) A surgical guide 10 as shown in FIG. 1 is manufactured based on the result of the preoperative examination described above.

  First, the guide body 11 of the surgical guide 10 is manufactured in the same manner as the mouthpiece 31 described in step 2 above.

  As for the material of the guide body 11, a resin sheet 30 mixed with a contrast agent can be used as in the mouthpiece 31, but a resin sheet not mixed with a contrast agent may be used.

  However, in the case of the guide body 11, it is preferable to arbitrarily select a relatively hard one of the above-described thermoplastic resins. This is because the surgical guide 10 is attached to the lower jaw of an unconscious patient by anesthesia at the time of implant treatment, and the patient does not complain of discomfort. It is preferable to make it hard for importance.

  Here, when the guide body 11 is molded and removed from the dental mold 20, the cut-out position after molding differs from the mouthpiece 31, and for example, as shown in FIG. Cut along the current incision line (dashed line) 14. Thereby, the guide body 11 as shown in FIG. 16 is obtained.

  Next, as shown in FIG. 17, the guide body 11 is mounted on the tooth mold 20 used in step 4 above, and the guide body 11 is guided to a position corresponding to the position mark 27 written at a predetermined position of the tooth mold 20. A through hole 13 for temporary positioning of the tube 12 is formed.

  Thereafter, the guide tube 12 is assigned to the through hole 13 of the guide body 11, and the inclination angle θ1 of the direction mark 28 written on the cut-out 65 of the transverse CT image 60 pasted on the tooth mold 20 is set to the posture of the guide tube 12. Then, an adjustment is made based on the inclination angle θ2 of the direction mark 29 written in the flat developed CT image 70, and the adhesive 15 is applied on the guide body 11 so as to surround the outer periphery of the guide tube 12 as shown in FIG. . As the adhesive 15, one having quick drying properties, for example, various generally known room temperature polymerization resins can be used. If such a quick-drying adhesive 15 is used, the posture of the guide tube 12 is less likely to be out of order, which is advantageous in positioning the guide tube 12 with high accuracy. Then, the necessary number of guide tubes 12 are fixed to a predetermined position of the guide body 11 in a predetermined posture as described above. Thereby, the surgical guide 10 is completed.

  Using the surgical guide 10 thus manufactured, an implant treatment is performed on the patient.

  This treatment is performed by a generally known method. An example of this will be briefly described below.

  After the surgical guide 10 manufactured as described above is sterilized by gas, the surgical guide 10 is placed on the patient's lower jaw. The jawbone is exposed by incising the gingival part of the patient's mandibular portion along the anterior heel of the guide body 11 of the surgical guide 10.

  Next, as shown in FIG. 19, a drill 80 is inserted into the guide tube 12 of the surgical guide 10 to form the implant embedding hole 5 in the exposed jawbone. Thereafter, the surgical guide 10 is removed from the patient's lower jaw, the implant 2 is mounted in the implant insertion hole 5, the incised gingival portion is sutured, and the primary operation is completed.

  Then, after the joint period between the implant 2 and the jawbone 1 elapses, a secondary operation for attaching the abutment 3 to the upper end of the implant 2 is performed, and after the elapse of a predetermined period, a denture (prosthesis) is applied to the abutment 3. ) Prosthetic treatment for wearing 4 is performed.

  As described above, in the preoperative examination of the implant treatment, the dental mold 20 which is a replica of the patient's jaw is used with the cutout 65 of the transverse CT image 60 attached, so the examiner holds the dental mold 20 in his hand. It becomes easy to confirm visually, and it becomes possible to examine the implant placement position and placement direction quickly and accurately.

  In particular, since the mouthpiece 31 to be attached to the patient when the transverse CT image 60 is obtained is formed of the resin sheet 30 containing a contrast medium, the outer surface of the gingival part 63 is clearly different from the other parts in the transverse CT image 60. It becomes possible to shoot in an identifiable manner. Therefore, when the transverse CT image 60 is cut out, it becomes easy to cut out accurately along the outer surface of the gingival portion 63, so that the cut out 65 can be made to exactly match the cut surface 24 of the tooth mold 20. Therefore, the cutout 65 of the transverse CT image 60 can be accurately attached to the cut surface 24 of the tooth mold 20, so that the implantation position and direction of the implant 2 can be grasped more appropriately.

  Further, since the dental mold 20 used for the preoperative examination is used in manufacturing the surgical guide 10, the attachment position and direction can be easily and clearly recognized when the guide tube 12 is attached to the guide body 11. So that it can be easily and accurately installed.

  Further, since the surgical guide 10 is configured such that the guide body 11 is placed on the teeth and gingiva of the patient's lower jaw in a just-fit state, most of the surgical guide 10 is positioned without rattling, and the guide tube 12 has a tooth defect. In the portion, it is positioned accurately at the implant placement position. Moreover, when the implant insertion hole 5 is formed, the formation position and the formation direction of the implant insertion hole 5 are appropriately determined by simply inserting the drill 80 straight into the guide tube 12. Therefore, it is possible to appropriately perform the treatment for forming the implant placement hole 5 in a short time even if the surgeon does not have special know-how and skill level.

  Hereinafter, other embodiments of the present invention will be described.

  (1) In the above embodiment, the mouthpiece 31 and the guide body 11 of the surgical guide 10 are manufactured separately. However, the mouthpiece 31 is used as it is as the guide body 11 of the surgical guide 10. Alternatively, the guide tube 12 may be mounted in the same manner as in step 5 above. In this case, it is preferable to select a relatively hard thermoplastic resin as a material for the mouthpiece 31. This is advantageous in reducing the manufacturing cost of the surgical guide 10.

  (2) Needless to say, the external shapes of the mouthpiece 31 and the surgical guide 10 vary depending on the tooth defect state of the patient.

  (3) In the above embodiment, the guide body 11 of the surgical guide 10 may be manufactured using an existing optical or mechanical CAD / CAM system.

  (4) In the above embodiment, the example in which the guide tube 12 is directly fixed to the guide body 11 when the surgical guide 10 is manufactured has been described. Although not shown, first, for example, a pin is implanted from the guide body 11 across the tooth mold 20 based on the implantation position and direction of the implant 2 grasped by the preoperative examination, and the guide tube 12 is attached to the pin. An outer fitting is applied, and an adhesive 15 is applied so as to surround the outer periphery of the guide tube 12. After the adhesive 15 is solidified, the surgical guide 10 is completed by removing the pins. This is advantageous in that the guide tube 12 can be easily positioned before the guide body 11 is fixed.

It is a perspective view which shows one Embodiment of the surgical guide manufactured through the preoperative examination which concerns on this invention. It is sectional drawing which shows the state which attached the denture using the implant to the jawbone. It is a flowchart which shows the procedure of the preoperative examination which concerns on this invention, and the manufacturing procedure of a surgical guide. It is a perspective view which shows the tooth | gear type | mold used for manufacture of the surgical guide of FIG. It is a perspective view which shows the vacuum forming apparatus which shape | molds the guide body and mouthpiece of the surgical guide of FIG. It is a perspective view which shows the mouthpiece for CT imaging assistance which concerns on this invention. It is a perspective view which shows a mode that a resin sheet is set to a vacuum forming apparatus, when shape | molding the mouthpiece of FIG. FIG. 8 is a perspective view showing a state in which the resin sheet is molded along the tooth mold in FIG. 7 and showing a cutting line of the molded product. It is a figure which shows a patient's occlusion part CT image in the preoperative examination which concerns on this invention. It is a figure which shows the transverse CT image of a tooth defect part in the preoperative examination which concerns on this invention. It is a figure which shows the planar expansion CT image of a tooth defect part in the preoperative examination which concerns on this invention. It is a figure which shows a mode that the crossing CT image of FIG. 10 is cut out. It is a perspective view which shows the state which cut | disconnected the tooth type | mold shown in FIG. 4 in the tooth defect site | part. It is a perspective view which shows the state which stuck the crossed CT image cut out in FIG. 12 on the cut surface of the tooth type | mold of FIG. It is the perspective view which shows the state which shape | molded the guide body of the surgical guide using the tooth type | mold of FIG. 14, and shows the cutting line of a molded article. It is a perspective view which shows the guide body removed from the tooth type | mold of FIG. It is a perspective view which shows a mode that a guide tube is attached to the guide body of FIG. FIG. 18 is a perspective view showing a state where the guide tube is fixed to the guide body in FIG. 17. It is a perspective view which shows a mode that an implant embedding hole is formed in a jawbone using the surgical guide shown in FIG.

Explanation of symbols

1 jawbone
2 implants
5 Implant insertion hole 20 Dental mold 24 Cut surface 27 Implant insertion position mark 28, 29 Implant insertion direction mark 30 Resin sheet 31 Mouthpiece 50 Occlusal CT image 51 Dental arch centerline 60 Transverse CT image 62 Jaw bone of each CT image 63 Gingival part of each CT image 65 Cutout of transverse CT image 70 Planar developed CT image

Claims (5)

A resin sheet for manufacturing a CT imaging assisting mouthpiece that covers the teeth and gums of the jaw when CT imaging is performed on a patient's jaw,
A resin sheet used in the manufacture of a mouthpiece for CT imaging support, wherein a base resin made of a thermoplastic resin is mixed with a radiopaque contrast medium. When a cross-sectional CT image of a tomographic plane perpendicular to the center line of the dental arch in the jaw is taken with an X-ray CT apparatus in a preoperative examination of an implant treatment in which an implant is implanted in a jaw bone corresponding to a tooth defect portion of a patient A resin sheet for manufacturing a mouthpiece for CT imaging support that covers the teeth and gums of the jaw,
A resin sheet used in the manufacture of a mouthpiece for CT imaging support, wherein a base resin made of a thermoplastic resin is mixed with a radiopaque contrast medium. A method of manufacturing a CT imaging support mouthpiece that covers the teeth and gums of the jaw when CT imaging is performed on a patient's jaw,
A resin sheet made by mixing a radiopaque contrast agent with a base resin made of a thermoplastic resin is heated and softened, and then covered on the outer surface of the tooth mold created based on the impression of the jaw including the gingiva. Step to press
Depressing the inside of the space between the tooth mold and the resin sheet covering it to deform the resin sheet into a shape that conforms to the outer shape of the tooth mold; and
And cooling and solidifying the resin sheet in a state where the resin sheet is in close contact, and then cutting the resin sheet to leave a region corresponding to the gingival part of the tooth mold and removing the resin sheet from the tooth mold. A method for manufacturing a CT imaging support mouthpiece, which is characterized. A preoperative examination method that appropriately examines the implantation position and orientation of the implant when implanting the implant into the jawbone corresponding to the tooth defect portion of the patient,
Creating a tooth mold based on the impression of the jaw including the patient's tooth defect part, tooth and gingival part, and molding a resin CT imaging support mouthpiece into a shape along the outer shape of the tooth mold; and
Obtaining a transverse CT image comprising a tomographic plane perpendicular to the center line of the dental arch in the jaw by performing CT imaging while the CT imaging assisting mouthpiece is placed on the patient's jaw; and
A transverse CT image at the tooth defect portion of the jaw is printed with the same size as the subject and cut out, and the tooth defect portion of the dental mold is cut corresponding to the transverse CT image, and the transverse surface is cut on the cut surface of the tooth mold. Affixing a CT image clipping;
Based on the cut-out of the transverse CT image attached to the tooth mold, an appropriate implant placement position and implantation direction are grasped, and a position mark representing the placement position is attached to the tooth defect portion of the tooth mold and the transverse cross section. Attaching a direction mark indicating the embedding direction to a cutout of a CT image,
The step of molding the CT imaging support mouthpiece comprises:
Heating and softening a resin sheet obtained by mixing a radiopaque contrast agent with a base resin made of a thermoplastic resin, and then pressing the resin sheet so as to cover the outer surface of the tooth mold;
Depressing the inside of the space between the resin sheet in the state and the tooth mold to deform the resin sheet into a shape that conforms to the outer shape of the tooth mold;
The solidified object is cooled and solidified in that state, and then cut to leave a region corresponding to the gingival part of the tooth mold in the solidified object and removed from the tooth mold. A preoperative examination method for dental implant treatment. A longitudinal CT image composed of a tomographic plane along the center line of the dental arch is obtained by the CT imaging, and a plane developed CT image in a state where the longitudinal CT image is planarly developed from the front of the dental arch is created by image processing of the longitudinal CT image. Further comprising:
5. The preoperative examination method for dental implant treatment according to claim 4, wherein, in grasping the embedding direction, the planar developed CT image is also referred to in addition to the cutout of the transverse CT image.

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