JP2009261526A - Surgical guide and method for positioning drill using same - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical guide allowing an operator to visually observe the distal end of a drill in an implant treatment, preventing the easy inclination of the drill, preventing an occurrence of bone burn by sufficiently supplying cooling water thereto, and capable of responding to various types of drills with different diameters. <P>SOLUTION: A wire 31 is implanted in a mock-up 30 in a direction the same as a direction of embedding a fixture of an implant. A guide member 11 of the surgical guide 10 is fitted to a tooth section and the distal end edge 12c of the wire member is fitted to the distal end 31 of the wire 31 to determine a point of the wire 31. Meanwhile, the proximal end 31b of the wire 31 is determined by another surgical guide. The drill is so positioned that the rotation center of the drill 41 passes through the two positions determined in this way. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a surgical guide for positioning a drill when a guide hole for implanting an implant fixture is opened in an alveolar bone, and a drill positioning method using the surgical guide.

  Dental implants (hereinafter simply referred to as “implants”) used for implant treatment are a fixture (implant body, made of titanium, for example) that is inserted into an alveolar bone that has lost its teeth, and a fixture that is connected to the fixture. And an upper structure (artificial crown) attached to the abutment. In implant treatment using this implant, it is important to accurately drill a guide hole for embedding a fixture in the alveolar bone (for example, see Patent Document 1).

  There are two types of implant treatment: prosthesis-driven type (top-down treatment) and surgery-driven type. The former type of prosthetic-driven type creates mock-ups (full-scale models) of the patient's teeth and jaws and functions. The position of the final prosthesis (superstructure) most suitable for aesthetic and aesthetic purposes is determined, and based on this, the position of the fixture is determined.

  Currently, the fixture placement position is highly accurate on the mock-up (full-scale gypsum model) using CT and other simulation software in consideration of the condition of the patient's alveolar bone. Can be determined.

  However, in order to embed the fixture, a drill hole is drilled in the alveolar bone by a drill in the patient's mouth, but since the drill requires three-dimensional positioning, It is almost difficult to make a guide hole accurately in the embedding position with a free hand. For this reason, various jigs, that is, surgical guides have been devised.

A typical example is a metal guide ring having a guide hole for guiding a drill at a position where the guide hole is opened. By passing a drill through the guide hole of this guide ring and making the drill enter following the guide hole, the guide hole is opened at the insertion position of the alveolar bone.
Japanese Patent Laid-Open No. 2001-170080

However, the above-described surgical guide using a guide ring has the following problems.
(1) Since the surgical field is not visible, the tip of the drill, where the part of the alveolar bone that is actually shaved can not be visually confirmed.
(2) An appropriate gap is required between the drill and the guide hole of the guide ring. However, since the thickness of the guide ring is thin relative to the length of the drill, the gap causes the drill to move from its normal position. There is a risk of tilting unnecessarily,
(3) The alveolar bone to be drilled is covered with the guide ring and the peripheral edge that holds the guide ring, and the guide hole is closed with a drill to form a closed space around the alveolar bone. Therefore, it was difficult to supply sufficient cooling water to the alveolar bone to be cut, causing bone burns.
(4) In order to open the guide holes for embedding fixtures, it is necessary to use several types of drills starting from a pilot drill with a small diameter and gradually increasing in diameter. In combination, several types of surgical guides are required, which increases costs.
There was a problem.

  Therefore, the present invention is capable of visually observing the tip of the drill while having a simple configuration, is difficult to tilt, and can sufficiently supply cooling water to prevent the occurrence of bone burns. And it aims at providing the surgical guide which can respond to several kinds of drills from which diameter differs by one, and the positioning method of a drill using this.

  The invention according to claim 1 is set up in a mock-up that imitates the inside of the patient's mouth and reproduces the position of the wire in the patient's mouth with respect to the wire indicating the position of the dental implant fixture. In the surgical guide, the detachable guide member fitted to the tooth part of the mock-up and the actual tooth part of the patient corresponding to the tooth part of the mock-up, and the proximal end side are attached to the guide member And a first indicating member whose distal end side points to one point of the protruding portion of the wire protruding from the mock-up, a proximal end side attached to the guide member, and a distal end side pointing to the other point of the protruding portion of the wire. A second indicating member.

  According to a second aspect of the present invention, in the surgical guide according to the first aspect, the one point indicated by the first indication member is a proximal end portion of the protruding portion of the wire, and the other point indicated by the second indication member The point is the tip of the protruding portion of the wire.

  According to a third aspect of the present invention, in the surgical guide according to the second aspect, the length of the protruding portion of the wire is determined from the length of the drill attached to the contra head to open the hole for the fixture. It is characterized by the length obtained by subtracting the thickness of the mucous membrane at this site measured from the screen.

  The invention according to claim 4 is the surgical guide according to any one of claims 1 to 3, wherein the first indicating member and the second indicating member are formed of a plastically deformable wire member. It is characterized by that.

  The invention according to claim 5 is the surgical guide according to any one of claims 1 to 3, wherein the first indicator member and the second indicator member are respectively attached to different guide members, The first indicator member is formed of a resin integral with the guide member, and the second indicator member is formed of a plastically deformable wire member.

  The invention according to claim 6 is a guide member, a first indicating member, and a second indicating member that are implanted in a mock-up that imitates the inside of a patient's oral cavity and indicate the position of the dental implant fixture. The position of the said wire is reproduced in the oral cavity of a patient, and the positioning method of positioning a drill is used. In the positioning method according to the present invention, the guide member of the surgical guide is attached to the tooth portion of the mock-up, and the mock-up in the wire is caused by the distal end side of the first indicating member attached to the guide member on the proximal end side. A proximal end portion of the projecting portion protruding from the up position, and a proximal end side of the second indicating member attached to the guide member indicates a distal end portion of the protruding portion of the wire, and the first indicating member And the guide member together with the second indicating member is removed from the tooth portion of the mock-up, the guide member together with the first indicating member and the second indicating member is mounted on the actual tooth portion of the patient, and the first indicating While the drill attached to the contra head is rotating, two points on the space indicated by the tip of the member and the tip of the second indicating member are being rotated. , Or as extension passes thereof for positioning of the drill, it is characterized in that.

  According to the invention of claim 1, by removing the surgical guide from the mock-up and attaching it to the patient's tooth, a straight line connecting the two points of the distal end side of the first indicating member and the distal end side of the second indicating portion is It becomes the position of the rotation center of the drill when drilling the fixture hole. That is, the position of the mock-up wire can be reproduced with high accuracy in the oral cavity.

  According to the invention of claim 2, since the two points are determined by the length between the proximal end portion and the distal end portion of the protruding portion of the wire, that is, the maximum length of the protruding portion, the accuracy at the time of reproduction can be improved. it can.

  According to the invention of claim 3, since the length of the protruding portion of the wire is set to a length obtained by subtracting the thickness of the mucous membrane at this portion measured from the CT screen from the length of the drill, Since the drill can be inserted between the point on the bone surface from which the mucous membrane has been removed at the point indicated by the first indicating member and the point indicated by the second indicating member when mounted in the oral cavity, the position of the drill Can be accurately positioned.

  According to the invention of claim 4, since the first indicating member and the second indicating member are formed of a plastically deformable wire member, when the tip of the first indicating member is aligned with one point of the wire and released, The tip portion holds its position. Similarly, when the tip portion of the second indicating member is aligned with the other point of the wire and the hand is released, the tip portion can hold the position.

  According to the fifth aspect of the present invention, the position corresponding to the proximal end portion of the wire in the oral cavity of the patient can be positioned by a resin (for example, an immediate polymerization resin) integrated with the guide member. can do.

  According to the invention of claim 6, the position of the mock-up wire can be reproduced with high accuracy in the oral cavity.

Hereinafter, the best embodiment of the present invention will be described in detail with reference to the drawings. In addition, in each drawing, the member etc. which attached | subjected the same code | symbol are the same structures, The duplication description about these shall be abbreviate | omitted suitably. Moreover, in each drawing, members and the like that are not necessary for the description are omitted as appropriate.
<Embodiment 1>

  A surgical guide 10 and a drill positioning method according to the present invention will be described with reference to FIGS. Among these, FIG. 1 is a perspective view showing a state in which the surgical guide 10 is fitted to a mock-up (gypsum model) 30. FIG. 2A is a perspective view showing a state in which another surgical guide 20 is fitted to the mock-up 30, and FIG. 2B is a view of FIG. FIG. 3 is a schematic diagram for explaining the positioning of the drill 41. FIG. 4 is a diagram schematically illustrating a surgical guide 10 </ b> D in which the first indicating member is configured by the wire member 17 and the second indicating member is configured by the wire member 12. FIG. 5 is a diagram schematically illustrating another example of the second indicating member. FIG. 6 is a diagram schematically illustrating a surgical guide 10 </ b> B in which the first pointing member is constituted by the laser pointer 16. FIG. 7 is a diagram schematically illustrating still another example of the first indicating member and the second indicating member. FIG. 8 is a longitudinal sectional view for explaining the implant 70. In the following description, a case where implant treatment is performed at a position where there are two back teeth on the upper right of the patient will be described as an example.

  The implant 70 will be described with reference to FIG. After the teeth (not shown) are removed, the bone 62 composed of the soft sea surface bone 60 and the hard cortical bone 61 and the mucosa 63 covering the bone 62 remain. The implant 70 includes a fixture 71 embedded in the bone 62 with an insertion hole (guide hole), an abutment 72 connected to the fixture 71 as a support, and an upper structure 73 attached to the abutment 72. It is constituted by.

  The mock-up 30 shown in FIG. 1 is a full-scale model of the upper jaw made by shaping from within the oral cavity of a patient, and is made of plaster. In the example shown in the figure, the upper right two back teeth are removed. Wires 31 and 32 are respectively planted at positions corresponding to substantially the centers of the respective back teeth in the portion where the back teeth are removed. The wires 31 and 32 indicate the implantation position and the implantation direction of the fixture 71 when implant treatment is performed. Further, in the example shown in the figure, the lengths of the protruding portions 31a and 32a protruding from the mockup 30 in the wires 31 and 32, that is, the lengths from the respective base end portions 31b and 32b to the distal end portions 31c and 32c. The length is set by subtracting the thickness of the mucous membrane 63 at this portion measured from the CT screen from the length of the drill (pilot drill) 41 for embedding hole drilling attached to the contra head 40 shown in FIG. Has been. The positions of the wire 31 and the wire 32 are determined as follows, for example. Measure the positional relationship between the embedding position and embedding direction of the fixture 71 (see FIG. 8) determined by the simulation software applying CT and the CT imaging template containing the contrast medium on the CT screen, Based on this value, a mark indicating the direction in which the fixture is to be embedded is attached to a CT imaging template containing a contrast medium, and this mark is attached to the mockup 30. Two holes of about 10 mm are formed, and the wire 31 and the wire 32 are planted in each. Thereby, the embedment direction of the simulated fixture 71 can be displayed as the planting direction of the wires 31 and 32 on the mockup 30. In other words, drilling may be performed by the drill 41 attached to the contra head 40 in the same direction as the wires 31 and 32 in the oral cavity of the patient.

  A surgical guide 10 shown in FIG. 1 includes a guide member 11 and a wire member (second indicating member) 12 attached to the guide member 11. The guide member 11 is formed according to the patient's remaining dentition using, for example, an instant polymerization resin. The guide member 11 is detachable with respect to the tooth portion of the mockup 30 corresponding to the patient's remaining dentition, and is fitted when fitted, and the position of the wire member 12 to be described later with respect to the mockup 30 Can be determined. Moreover, it is detachable with respect to a patient's remaining dentition, and when it is mounted | worn, it can be fitted and the position of the wire member 12 with respect to a remaining dentition can be determined.

  The wire member 12 shown in FIG. 1 is formed of the same wire as the wires 31 and 32 described above, and can be plastically deformed. The wire member 12 is bent in a crank shape, and its proximal end portion 12a is attached (fixed) to the guide member 11, and the distal end portion 12b is fitted to the distal end portions 31c and 32c of the wires 31 and 32. Is bent. That is, the distal end portion 12c of the wire 32 is aligned with the distal end portion 31c of the wire 31, and the distal end portion 32c of the wire 32 is located at a point (part) 12d inside the distal end edge 12c of the distal end portion 12b of the wire member 12. Are combined. This point 12d is marked. Thereafter, the surgical guide 10 is removed from the mockup 30.

  As shown in FIGS. 2 (a) and 2 (b), the surgical guide 20 includes a guide member 21 and a wire guide (first indicating member) 22, for example, using an immediate polymerization resin as a material, It is formed integrally with the wires 31 and 32. As shown in (b), the wire guide 22 is formed such that the left half side of the guide member 22 in the width direction (left and right direction in (b)) is cut out, and corresponds to the wires 31 and 32. Are semicircular base end guides 22a and 22b.

  Using the surgical guides 10 and 20 described above, the drill 41 is positioned in the oral cavity as follows.

  First, the surgical guide 20 is removed from the mock-up 30 and attached to the patient's teeth, and the position corresponding to the proximal guides 22a and 22b on the patient's mucosal surface is marked with an electric knife (not shown) or the like. Thus, the base end portions 31b and 32b of the wires 31 and 32 in the mockup 30 can be reproduced in the oral cavity of the patient. After removing the mucous membrane 63 of the marked part by punching or flap, a mark (entrance point) is marked on the bone surface with a marking bar (not shown). As a result, one point through which the rotation center of the drill 41 passes when the insertion hole of each fixture 71 is drilled by the drill 41 is determined.

  Next, the surgical guide 20 is removed from the patient's teeth, and the surgical guide 10 shown in FIG. 1 is attached to the patient's teeth. Thus, the bone surface mark (entrance point) M corresponding to the above-described proximal guide 22a is set as one point, and the two points are set as one point and the distal end edge 12c of the wire member 12 of the surgical guide 10 as other points. The position and direction of the imaginary straight line H to be connected is the direction in which the embedding position and embedding direction of the fixture 71, that is, the rotation center of the drill 41 is aligned. As shown in FIG. 3, by aligning the rotation center of the drill 41 with the virtual straight line H and making a hole for the fixture 71 with the drill 41, high positional accuracy can be ensured for the hole. In the present embodiment, as described above, the protruding lengths of the protruding portions 31a and 32a of the wires 31 and 32 are subtracted from the length of the drill 41 and the thickness of the mucous membrane 63 at this portion calculated from the CT screen. Therefore, when the tip 41a of the drill 41 is aligned with the mark (entrance point) M on the bone surface corresponding to the proximal guide 22a, the proximal end portion 41b of the drill 41 is almost the tip of the wire member 12. Since it is possible to match with the edge 12c, this can improve the accuracy of drilling by the drill 41.

  Next, another embedding hole is made. The portion marked by the bone surface mark (entrance point) M corresponding to the proximal guide 22b is taken as one point, and this one point and the point 12d of the wire member 12 of the surgical guide 10 are taken as other points. The position and direction of the imaginary straight line to be connected is the direction in which the embedding position and embedding direction of the fixture 71, that is, the rotation center of the drill 41 is aligned. By aligning the virtual straight line with the drill 41 and making a hole for the fixture 71, high positional accuracy can be ensured for the hole. In addition, when making another embedding hole, you may make it excise the part of the front end side from the part 12d of the wire member 12. FIG. Thereby, an embedding hole can be made like the case where the above-mentioned first embedding hole is made.

  According to this embodiment, although it is the surgical guides 10 and 20 of simple structure, the front-end | tip of the drill 41 can be visually observed, the drill 41 is hard to incline, and cooling water can fully be supplied. Bone burns can be prevented, and a small number of drills with different diameters can be handled.

  In the above-described embodiment, the wire guide 22 of another surgical guide 20 is used to reproduce the positions of the base end portions 31b and 32b of the wires 31 and 32. Instead, as shown in FIG. Further, the surgical guide 10 may be provided with a wire member 17 similar to the wire member 12, and the position of the base end portions 31 b and 32 b of the wires 31 and 32 may be indicated by the wire member 17. The wire member 12 is bent in a crank shape, and its proximal end portion 17a is attached (fixed) to the guide member 11, and the distal end portion 17b is fitted to the proximal end portions 31d and 32d of the wires 31 and 32. So that it is bent. That is, the distal end edge 17 c of the wire member 17 is aligned with the proximal end portion 31 d of the wire 31, and the proximal end portion of the wire 32 is positioned at a point (part) 17 d inside the distal end edge 17 c of the distal end portion 17 b of the wire member 17. 32 dc is combined. This point 17d is marked. Thereafter, the surgical guide 10 is removed from the mockup 30. According to this example, the position of the wires 31 and 32 can be reproduced by one surgical guide 10D.

  Further, as shown in FIG. 5, the wire member (second indicating member) 13 attached to the guide member 11A of the surgical guide 10A is rotated so that its proximal end portion 13a can be rotated, that is, the distal end edge 13b is substantially swung in the vertical direction. Even if the drill 41 attached to the contra head 40 opens the embedding hole 42 and the position of the drill 41 is lowered by attaching the weight 14 to the wire member 13 as appropriate, Since the tip edge 13b of the wire member 13 is lowered following this, if the base end portion 41b of the drill 41 is aligned with the tip edge 13b, the embedding hole 42 can be formed almost accurately. Actually, the trajectory of the distal end edge 13b draws an arc centered on the proximal end portion 13a. However, considering that the wire member 13 is long with respect to the depth of the embedding hole 42, it is almost linear approximation. Can be made.

  Further, as shown in FIG. 6, a laser pointer 16 as a first indicating member may be attached to the distal end of the wire member 15 to which the proximal end portion 15a is attached to the guide member 11B of the surgical guide 10B. . The part where the light L from the laser pointer 16 hits the mucosal surface is marked with an electric knife (not shown), and the mucous membrane 63 at this part is removed by punching or flap, and then the mark M is marked on the bone surface with a marking bar (not shown). And the tip 41a of the drill 41 is aligned with this mark M. As shown in the figure, the laser pointer 16 does not need to be removed during actual drilling as long as the laser beam 16 strikes the drill 41 obliquely as shown in FIG.

  Further, as shown in FIG. 7, the surgical guide 10C may be configured by attaching the wire member 20 and a laser device that generates planar light to the guide member 11C. In the figure, the mucous membrane 63 is omitted. The wire member 20 has its proximal end portion 20a fixed to the guide member 11C and its distal end portion 20b bent so as to be parallel to the wire 31 (see FIG. 1). After the tip 20b at this time, it is separated from the wire 31 a little so as not to interfere with the drill 41 later. On the other hand, the laser device 21 is attached to the guide member 11C by adjusting the position so that the planar laser beam irradiates the wire 31 from the proximal end portion 31b to the distal end portion 31c side by line. The surgical guide 10C is attached to the patient's tooth, the drill 41 is positioned so that the laser beam irradiates the proximal end side from the tip of the drill 41 in a line shape, and the drill 41 is connected to the tip 20b of the wire member 20. Position so that it is parallel to. Drilling is performed while maintaining this state.

2 is a perspective view showing a state in which a surgical guide 10 is fitted to a mock-up (gypsum model) 30. FIG. (A) is the perspective view which shows the state which made another surgical guide 20 fit to the mockup 30, (b) is the figure which looked at (a) from the arrow A direction. It is a schematic diagram explaining positioning of the drill 41. FIG. It is a figure which illustrates typically the surgical guide 10D which comprised the 1st indicator member with the wire member 17, and comprised the 2nd indicator member with the wire member 12. FIG. It is a figure which shows the other example of a 2nd instruction | indication member typically. It is a figure which illustrates typically the surgical guide 10B which comprised the 1st instruction | indication member with the laser pointer 16. FIG. It is a figure which shows typically another example of a 1st instruction | indication member and a 2nd instruction | indication member. 3 is a longitudinal sectional view for explaining an implant 70. FIG.

Explanation of symbols

10, 10A, 10B, 10C, 10D, 20
Surgical guide 11, 11A, 10B, 11C, 11D, 21
Guide members 12, 13
Wire member (second indicating member)
12a, 13a
Base ends 12b, 13b
Tip 16 Laser pointer (first indicating member)
17 Wire member (first indicating member)
22 Wire guide (first indicating member)
30 Mock-up 31, 32 Wire 31a, 32a
Wire protrusions 31b, 32b
Wire proximal ends 31c, 32c
Wire tip 41 Drill (pilot drill)
70 Implant (Dental Implant)
71 Fixture

Claims (6)

In the surgical guide to reproduce the position of the wire in the patient's oral cavity with respect to the wire indicating the implantation position of the dental implant fixture, implanted in a mockup simulating the patient's oral cavity,
A detachable guide member fitted to a tooth part of the mock-up and an actual tooth part of a patient corresponding to the tooth part of the mock-up;
A first indicating member that is attached to the guide member on the proximal end side and points at one point of a protruding portion that protrudes from the mock-up on the wire;
A proximal end side is attached to the guide member, and a distal end side includes a second indicating member indicating the other point of the protruding portion of the wire,
Surgical guide characterized by that. The one point indicated by the first indicating member is a base end portion of the protruding portion of the wire,
The other point indicated by the second indicating member is a tip of the protruding portion of the wire.
The surgical guide according to claim 1, wherein: The length of the protruding portion of the wire is the length obtained by subtracting the thickness of the mucous membrane at this site measured from the CT screen from the length of the drill attached to the contra head to open the hole for the fixture. is there,
The surgical guide according to claim 2, wherein: The first indicator member and the second indicator member are formed of a wire member that can be plastically deformed.
The surgical guide according to any one of claims 1 to 3, characterized in that: The first indicating member and the second indicating member are respectively attached to different guide members,
The first indicator member is formed of a resin integral with the guide member;
The second indicating member is formed of a plastically deformable wire member,
The surgical guide according to any one of claims 1 to 3, characterized in that: A surgical guide having a guide member, a first indicating member, and a second indicating member is used for a wire that is implanted in a mock-up that imitates the inside of a patient's mouth and indicates the position of a dental implant fixture. In the positioning method for positioning the drill by reproducing the position of the wire in the oral cavity of the patient,
Attach the guide member of the surgical guide to the tooth part of the mockup,
The proximal end side indicates the proximal end portion of the protruding portion protruding from the mock-up in the wire by the distal end side of the first indicating member attached to the guide member,
The proximal end side indicates the distal end portion of the protruding portion of the wire by the distal end side of the second indicating member attached to the guide member,
Removing the guide member together with the first indicating member and the second indicating member from the tooth portion of the mockup;
Attaching the guide member together with the first indicating member and the second indicating member to an actual tooth part of a patient,
The rotation center of the drill attached to the contra head or its extension passes through two points on the space indicated by the tip portion of the first indicator member and the tip portion of the second indicator member. Positioning the drill,
A positioning method characterized by the above.

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