JP7483289B2 - Osteotomes for dental treatment, hole forming instruments, test posts, stopper extensions, periodontal ligament guards, water flow tubes - Google Patents

Description

The present invention relates to an osteotome, a hole forming instrument, a test post, a stopper extension, a periodontal ligament guard, and a water flow tube for dental treatment.

For example, in implant treatment, the dentist, who is the operator, usually uses a dental CT scan to obtain three-dimensional image data of the upper and/or lower jaws, including the treatment position of the patient. Based on the three-dimensional image data, the dentist can determine the position of the maxillary sinus of the patient's upper jaw, in addition to the treatment position.
The location of the posterior superior alveolar artery and the greater palatine artery, or the inferior alveolar artery and inferior alveolar nerve of the patient's mandible, is determined prior to the procedure.
In implant treatment, for example, if the treatment target is the maxilla, the dentist performs a procedure so that the tip of a hole forming tool such as a drill does not reach the patient's maxillary sinus mucosa, posterior superior alveolar artery, and greater palatine artery as predetermined non-reachable (non-contact) targets. Also, if the treatment target is the mandible, the dentist performs a procedure so that the tip of a hole forming tool such as a drill does not reach the patient's inferior alveolar artery and inferior alveolar nerve as predetermined non-reachable targets.
For example, in implant treatment, a surgical guide may be used to guide a drill to form a hole in the bone according to a treatment plan. The surgical guide is formed based on three-dimensional image data of the patient's upper and/or lower jaw. The surgical guide is used by fitting it to the patient's teeth and gums. The surgical guide enables a dentist to form a hole for embedding an implant body in a position, direction, diameter, etc. according to the treatment plan during the procedure.

JP 2017-508595 A

For example, a risk in implant treatment is that the locations of unreachable targets, such as arteries and nerves, cannot be visualized during the procedure.
Currently, the creation of treatment plans for implant treatment (including the creation of surgical guides) is often done by engineers of the implant manufacturer using the manufacturer's system, for example, based on the patient's CT image data (DICOM data) obtained by the dentist. The dentist then reviews the treatment plan created by the manufacturer's engineers. However, the dentist is not on-site when the treatment plan is created, and the tools that the dentist can use to revise the treatment plan created by the manufacturer are limited. Because the subject is three-dimensional, it is difficult for the dentist to follow the dentist's intentions in giving detailed instructions on the treatment plan, such as selecting the implant body, making slight adjustments to the inner diameter, position, and angle of the cavity where the implant body will be embedded, and selecting the instruments.
Ideally, dentists should be responsible for everything from creating the implant treatment plan to the actual treatment. However, if there is a mistake in the selection of various parameters for the hole formation tool in the treatment plan created by the manufacturer's technician, it is difficult to eliminate the possibility that the dentist will unknowingly carry out the procedure according to the incorrect treatment plan.

The present disclosure relates to a method for implanting an implant body or an autogenous tooth, for example, in which a treatment plan is prepared and before the actual dental treatment using a procedural tool such as a hole forming tool,
The present disclosure aims to provide a pre-procedure verification system for dental treatment plans, a pre-procedure verification program for dental treatment plans, a manufacturing method for a model for pre-procedure verification of dental treatment plans, and a model for pre-procedure verification of dental treatment plans, which enable a dentist, who is an operator, to verify in advance the positional relationship between the tip position of the procedural instrument when the procedural instrument is used and an unreachable target position such as the maxillary sinus mucosa, the posterior superior alveolar artery, and the greater palatine artery of the maxilla, or the inferior alveolar artery and inferior alveolar nerve of the mandible, and to realize the best treatment plan by, as far as possible, allowing the dentist to design, select instruments, and confirm the safety of the treatment plan himself. In addition, in consideration of various problems that occur when performing treatment to embed an implant body or a treatment to embed an autologous tooth or the like, the present disclosure aims to provide an osteotome, a hole forming instrument, a test post, a stopper extension, a periodontal ligament guard, and a water flow tube for dental treatment that address these problems.

The osteotome according to one aspect of the present invention is an osteotome that is embedded from the surface layer to the depth of a treatment site in a patient's jaw and is used as a tool for applying an impact when expanding or compressing a bone so as to displace a position of a mucous membrane at the back of the treatment site,
A body portion which is a main body portion of the osteotome;
An end portion formed at a tip of the body portion and configured to displace a position of the mucous membrane;
and the diameter of the end is a size suitable for transplanting a home-grown tooth.

The osteotome as described above may have an end diameter larger than that of an osteotome dedicated to an implant.

The diameter of the end of the osteotome as described above may be 5 mm or more.

The osteotome as described above is configured to match the surface shape of the patient's treatment area, and a guided portion may be formed in part of the body portion that is guided along a guide hole formed in a surgical guide that offsets a predetermined amount of a reference position that serves as a guide for the depth during treatment.

Another aspect of the present invention is an osteotome that is implanted from a base end side to a tip end side in a treatment area of a patient's jaw and is used as a tool for applying an impact when expanding or compressing a bone so as to displace a position of a mucous membrane behind the treatment area,
A body portion which is a main body portion of the osteotome;
An end portion formed at a tip of the body portion and configured to displace a position of the mucous membrane;
The osteotome is formed to match the surface shape of the patient's treatment area, and a guided portion is formed in a part of the body portion and is guided along a guide hole provided in the surgical guide that offsets a reference position that serves as a guide for height during treatment by a predetermined amount.

One aspect of the present invention is a hole forming instrument having a drill that advances from the surface to the depth of a treatment site on a patient's jaw and forms a hole for implanting a portion of an implant, the diameter of the drill being of a size suitable for transplanting a home-grown tooth.

The hole forming tool as described above may have a drill diameter larger than that of the buried body when it is an implant body.

The hole forming tool as described above may have a drill diameter of 5 mm or more.

The hole forming instrument as described above may be formed to match the surface shape of the patient's treatment area, and a guided portion may be formed in part of the hole forming instrument that is guided along a guide hole provided in a surgical guide that offsets a predetermined amount the reference position that serves as a guide for height during treatment.

One aspect of the present invention is a test post for image diagnosis, which is formed from a resin material or a ceramic material and is inserted into a hole formed in a treatment area of a patient's jaw for embedding a part of an implant, or into a guide hole formed in a surgical guide that is provided to match the surface shape of the treatment area of the patient and offsets a reference position that serves as a guide for depth during treatment by a predetermined amount, and is imaged in a radiographic image taken in that state to indicate the position of the hole or guide hole.

The above test post may have a stepped shape.

The test post as described above may have an outer diameter portion that is larger than the inner diameter of the guide hole of the surgical guide.

One aspect of the present invention is a cylindrically shaped stopper extension that is inserted into a guide hole formed in a surgical guide that is fitted to the surface shape of the patient's treatment area and offsets a reference position that serves as a guide for treatment depth by a predetermined amount, thereby extending the length of the guide.

The stopper extension as described above may have a stepped shape.

The stopper extension as described above may have an outer diameter portion that is larger than the inner diameter of the guide hole of the surgical guide.

One aspect of the present invention is a periodontal ligament guard that covers all or part of a home-made tooth to be transplanted, excluding the root to be cut, thereby reducing external damage that may be inflicted on the periodontal ligament surrounding the root when the root is cut.

The periodontal ligament guard as described above may be made of a memory foam material.

The periodontal ligament guard as described above may be made of silicone.

One aspect of the present invention is a water flow tube that is embedded in a treatment area of a patient's jaw from the surface layer toward the depth thereof and jets water from a tip portion toward a mucous membrane at the back of the treatment area,
This is a water flow tube for transplantation, the diameter of the tip of which is suitable for transplanting homemade teeth.

The tip of the water flow tube as described above may be formed with a step portion in which the outside diameter increases stepwise from the tip to the base end.

Another aspect of the present invention is a model body formed based on a three-dimensional stereoscopic image of a patient's jaw, and simulating at least a portion of the patient's teeth, gums, and alveolar bone covered by the gums, which are to be treated, in the same size and shape as the teeth, gums, and alveolar bone to be treated;
a target model portion which is formed based on a three-dimensional stereoscopic image of a patient, which is adjacent to or embedded in the alveolar bone of the patient as a treatment target, which imitates a non-contact target with which a tip of a procedural instrument selected from a plurality of instruments should not come into contact during treatment, and which is provided on the model body in the same positional relationship as that between the teeth, gums, and alveolar bone of the patient as a treatment target and the non-contact target;
a hole portion that is formed in the model body at a position that simulates the gums and alveolar bone of the patient's treatment target based on a three-dimensional image of the patient, simulating a hole in which an embedding body for the treatment target can be embedded, and when a procedural instrument in the three-dimensional image of the patient fits into the hole in the three-dimensional image of the patient and the procedural instrument is inserted into the hole in the three-dimensional image, the positional relationship between the procedural instrument and the target can be visually confirmed by a dentist;
Equipped with
This is a model for pre-procedural verification of dental treatment plans, in which a fluid is built into the target model portion to indicate contact if a procedural instrument comes into contact with the target model portion during pre-procedural verification.

With such a model, when a procedural instrument comes into contact with a target model portion that mimics a non-contact target during pre-procedural verification of a dental treatment plan, fluid (e.g., a colored liquid) leaks out, making it easy to visually recognize that the target model portion has been contacted.

FIG. 1 is a block diagram of a dental treatment plan advance verification system according to a first embodiment and a second embodiment. FIG. 2 is a schematic diagram showing an example of an implant body. FIG. 2 is a schematic diagram showing an example of a hole forming tool. FIG. 2 is a schematic diagram showing a model for pre-verification of a dental treatment plan according to the first embodiment. FIG. 4B is a schematic diagram showing the model as viewed from a different direction than FIG. 4A. FIG. 13 is a schematic diagram showing a model for verifying a dental treatment plan in advance according to a modified example of the first embodiment. FIG. 1 is a schematic diagram showing a surgical guide according to a first embodiment. 1 is a flowchart showing a treatment plan for implant treatment. 7 is a flowchart showing the treatment plan for implant treatment following FIG. 6 . 13 is a diagram showing a state in which third three-dimensional image data in which the positions of non-reach targets are marked are superimposed on first three-dimensional image data showing the lower alveolar bone. FIG. FIG. 8 is a diagram showing a state in which fourth three-dimensional image data of the implant body is further superimposed. FIG. 9 is a diagram showing a state in which second three-dimensional image data of the teeth and gums and fifth three-dimensional image data of the hole forming tool are further superimposed. A figure showing sixth three-dimensional image data of a surgical guide. Schematic diagram showing the gums, teeth, inferior alveolar bone, implant body and non-reached targets with the surgical guide attached to the mandible. Schematic diagram showing the gums, teeth, inferior alveolar bone, cavity preparation instruments, and non-reach targets with the surgical guide attached to the mandible. FIG. 9 is a diagram showing a state in which sixth three-dimensional image data of a surgical guide is further superimposed. FIG. 15 is a diagram showing a state in which the first three-dimensional image data and the second three-dimensional image data have been removed from FIG. 14 . 13A to 13C are diagrams showing surface image data of parts of the second three-dimensional image data, the third three-dimensional image data, the fourth three-dimensional image data, and the fifth three-dimensional image data. 17 is a diagram showing a surface image obtained by superimposing the surface image data shown in FIG. 16 and then subtracting the fourth three-dimensional image data and the fifth three-dimensional image data. Schematic diagram showing the state in which a hole forming instrument is inserted into the guide hole of the surgical guide after the surgical guide is combined with the model. 1 is a schematic diagram showing the gums, teeth, lower alveolar bone, a hole forming instrument including a handle, and a non-reach target with a surgical guide attached to the mandible according to a first modified example. A figure showing the second modified example in which third three-dimensional image data in which the position of a non-reachable target is marked on first three-dimensional image data showing the lower alveolar bone, fourth three-dimensional image data of an autogenous tooth, and fifth three-dimensional image data of a hole forming instrument are superimposed. FIG. 11 is a diagram showing a state in which fourth three-dimensional image data of an implant body and fifth three-dimensional image data of a hole forming tool are superimposed on first three-dimensional image data showing the superior alveolar bone, maxillary sinus, posterior superior alveolar artery, and greater palatine artery of the maxilla in the second embodiment. FIG. 13 is a diagram showing the state in which the first to fourth three-dimensional image data of the upper jaw are superimposed. 23 is a diagram showing a state in which sixth three-dimensional image data is superimposed on the diagram shown in FIG. 22 and the first three-dimensional image data is removed. 13A to 13C are diagrams showing surface image data of parts of the first three-dimensional image data, the second three-dimensional image data, the third three-dimensional image data, the fourth three-dimensional image data, and the fifth three-dimensional image data. FIG. 25 is a diagram showing a surface image obtained by overlaying the surface image data shown in FIG. 24 and then subtracting the fourth three-dimensional image data and the fifth three-dimensional image data. 26A and 26B are views of the upper jaw shown in FIG. 25 from different angles. Schematic diagram showing the positional relationship between the teeth and the maxillary sinus when performing the procedure of embedding an implant body in the maxilla. 28 is a schematic diagram following Figure 27 showing the positional relationship between the teeth and the maxillary sinus when performing the procedure of embedding an implant body in the maxilla. 23 is a diagram showing the state in which the mucosa of the floor of the maxillary sinus is superimposed on the second three-dimensional image data in FIG. 22 . FIG. 13 is a diagram showing an example of an osteotome in a third embodiment. FIG. 2 is an enlarged view of a portion of an osteotome. FIG. 13 is a partially enlarged view of the osteotome with the bar portion shifted toward the base end. This is a cross-sectional view taken along line XXXI-XXXI in Figure 30B. FIG. 13 is a diagram showing an example of a bar portion having a large diameter at one end. FIG. 2 shows a surgical guide fitted to the teeth and gums adjacent to the treatment area on the patient's jaw. 13A and 13B are diagrams showing how a hole is formed at a treatment site using a hole forming tool. FIG. 13 is a diagram showing the state after the hole forming tool is removed after the recess is formed. 13A and 13B show how a larger hole is formed at the treatment site using a larger diameter hole forming tool. FIG. 13 shows the state after a larger hole has been formed and the hole forming tool has been removed. 13 is a diagram showing the state in which the surgical guide is fitted again and the osteotome is inserted into the guide hole of the surgical guide. FIG. 13 is a diagram showing how the end of an osteotome is embedded into the surface layer of a large depression formed in a treatment area, displacing the position of the mucosa at the back of the treatment area. FIG. FIG. 13 shows the state after the osteotome and surgical guide have been removed after displacing the position of the mucosa. FIG. 13 is a diagram showing an osteotome with a large end diameter attached together with a surgical guide. FIG. 13 shows how an osteotome with a larger end diameter is used to further displace the position of the mucosa at the back of the treatment area. FIG. 13 shows the state after further displacement of the mucosa and then removal of the osteotome and surgical guide. FIG. 13 shows an osteotome with a larger end diameter attached together with a surgical guide. FIG. 13 shows how an osteotome with a larger end diameter is used to further displace the position of the mucosa deeper in the treatment area. FIG. 13 shows the state after further displacement of the mucosa and then removal of the osteotome and surgical guide. FIG. 13 shows the state in which the water flow tube is attached together with the surgical guide after further displacement of the mucosa. FIG. 13 is a diagram showing how the position of the mucosa is displaced by water jetted from a water flow tube. FIG. 13 is a diagram showing a state in which the position of the mucosa is further displaced by water jetted from a water flow tube. This is a diagram showing the state in which a homemade tooth was transplanted into the cavity after the position of the mucosa was further displaced by water spurting from a water flow tube. This is an image showing an actual example where the buried object was misaligned. 1 is an image showing an example of a test post. FIG. 13 is a diagram showing another example of a test post. FIG. 13 is a diagram showing an example of a surgical guide actually created based on image data. FIG. 1 shows a surgical guide with test posts attached. FIG. 13 is a diagram showing an example of a CT image taken when a surgical guide with test posts attached thereto is attached to a patient. FIG. 13 is a diagram showing an example of a stopper extension. FIG. 13 shows the stopper extension attached to the handle and holding the shank of the hole forming tool. 13A shows a state in which a portion of the stopper extension attached to the handle and holding the shank of the hole forming instrument is inserted into the guide hole of the surgical guide. FIG. For reference, this is a diagram showing an example of a homemade tooth before it is covered with a periodontal ligament guard. FIG. 1 shows a homemade tooth covered with a periodontal guard. A diagram showing a home-made tooth covered with a periodontal ligament guard held between fingers.

A pre-procedure verification system for dental treatment plans (a model making system for verifying a dental treatment plan before a procedure after the dental treatment plan has been created) 10 according to an embodiment is a part of a series of operations, for example, from acquiring various data of a certain patient, creating a treatment plan for implant treatment, to performing a procedure on the patient. This system 10, for example, acquires data on the affected area of a certain patient, creates a dental treatment plan for the certain patient, and creates a model of the actual patient (a model for pre-procedure verification of a dental treatment plan) 1.
The output of the model 100 is used to carry out a series of operations for pre-procedure verification of a dental treatment plan. The acquisition of data on the affected area of a patient and the output of the model 100 may be carried out by a system other than the system 10.

First Embodiment
In the first embodiment, a case will be described in which the system 10 is used in an implant treatment in which an implant body 30 (see FIG. 2) as an implant body selected from a large number of bodies is embedded in a patient's mandible.

As shown in FIG. 1, a pre-procedure verification system for dental treatment planning (hereinafter, simply referred to as the system)
The system 10 includes a control device 12, a first scanner 14, a second scanner 16, a display unit 18, an operation unit (instruction input unit) 20, a memory device 22, a 3D printer 24, and a milling machine 26.

The control device 12 includes a first scanner 14, a second scanner 16, a display unit 18, and an operation unit 20.
, the storage device 22, the 3D printer 24, and the milling machine 26.
The control device 12 includes, for example, a processor such as a CPU or an MPU, a RAM, a ROM, and an I/O interface.
In the control device 12, for example, one or more processors such as CPUs load a control program stored in a memory such as a ROM into a RAM, and execute appropriate processing for the display unit 18, the operation unit 20, the storage device 22, the first scanner 14, the second scanner 16, the 3D printer 24, and the milling machine 26. Alternatively, in the control device 12, for example, one or more processors such as CPUs read out a program via a network, and execute appropriate processing for the display unit 18, the operation unit 20, the storage device 22,
, and executes appropriate processing for the first scanner 14, the second scanner 16, the 3D printer 24, and the milling machine 26. The control device 12 realizes, by software, the functions of controlling each part and performing processing such as image processing by having the processor read and execute programs pre-stored in the memory.

The first scanner 14 is, for example, a dental CT scanner. The first scanner 14 acquires three-dimensional image data (for example, DICOM data) of, for example, the teeth, bones, and interior of the bones of the patient's mandible, and outputs the data to the control device 12. The control device 12 stores the three-dimensional image data of, for example, the teeth, bones, and interior of the bones of the patient's mandible in the storage device 22. The second scanner 16 is, for example, an intraoral scanner. The second scanner 16 acquires three-dimensional image data (for example, STL data) of, for example, the teeth and gum surfaces of the patient's mandible, and outputs the data to the control device 12. The control device 12 stores the three-dimensional image data of, for example, the teeth and gum surfaces of the patient's mandible in the storage device 22.

The display unit 18 is, for example, a liquid crystal display, an organic electroluminescence display, or any other type of display. The display unit 18 displays images of the patient acquired by the first scanner 14 and the second scanner 16 and output to the control device 12, as well as various types of information. The control device 12 reads out the three-dimensional image data of the patient stored in the storage device 22 and displays it on the display unit 18.
may be displayed on the

The operation unit 20 inputs instructions to the control device 12. The operation unit 20 includes devices such as a keyboard and a mouse.

The storage device 22 stores various data of a patient (e.g., three-dimensional image data (DICOM data) of the mandibular teeth, bones, and the inside of the bones, and three-dimensional image data (e.g., STL data) of the surfaces of the patient's mandibular teeth and gums). The storage device 22 stores, for example, various three-dimensional image data (implant body data) 22a of the implant body 30 shown in FIG. 2 and various three-dimensional image data (hole forming tool set data) 22b of a hole forming tool 40 such as a drill shown in FIG. 3.

The control device 12 receives various three-dimensional image data 2 of the implant body 30 via a network.
When reading out the various three-dimensional image data 22b of the hole forming instrument 40, it may be unnecessary to store the various three-dimensional image data 22a of the implant body 30 and the various three-dimensional image data 22b of the hole forming instrument 40 in the storage device 22. That is, the control device 12 may use, for example, a database (implant body data 22a and hole forming instrument set data 22b) on a server instead of the storage device 22. The control device 12 can read out various data from the server.

As shown in FIG. 3, the actual hole forming tool 40 has, for example, a body 42 for forming a hole, a shank 44, a sleeve 46, and a stopper 48.
The body 42 and the shank 44 are integrally formed, for example, as a single piece. The shank 44 is fixed to a handpiece (not shown). Therefore, the body 42 and the shank 44 rotate around a predetermined rotation axis.
The sleeve 46 covers the outside of the body 42 and holds an auxiliary instrument 2 such as a surgical guide, which will be described later.
00 guide hole (through hole) 210. The end face 48a of the stopper 48 on the body 42 side abuts against a defining surface 220 that defines the guide hole 210 of the auxiliary instrument 200, for example, in a state in which the distance from the handpiece is defined.

The 3D printer 24 creates a model 100 for pre-treatment verification, as shown in Figures 4A and 4B, based on the 3D image data of the patient's lower jaw and the 3D image data created by the dentist. It is preferable that the 3D printer 24 is owned by, for example, the dentist himself and operates the 3D printer 24, but a professional company or the like may receive data for the 3D printer from the dentist or the like and output the model.

The model 100 has a model body 110, a target model portion 120, and a hole portion 130. The model body 110 is shaped to have the same size and shape as the actual treatment target portion of the patient's mandible and its surroundings. The model body 110 and the target model portion 120 are formed in the same positional relationship as the positional relationship between the actual treatment target portion of the patient's mandible and the target (non-contact target or contact target). The same positional relationship means that the portion related to the procedure of the treatment target portion is formed to have the same size and shape as the actual treatment target portion of the patient's mandible and its surroundings. The hole portion 130 is determined by various parameters of the implant body 30 and the hole forming tool 40 described later. The hole portion 130 is determined by the implant body 30 to be embedded in the hole portion 130 of the treatment target portion.
Or, the hole is formed according to the setting of parameters related to the shape (for example, length, outer diameter), angle, and position of the hole forming tool 40 .

The model body 110 has a defining surface 135 that forms the edge of the hole 130.
is the surface of the gums or the lower alveolar bone. When the end surface 46a of the sleeve 46 abuts against the defining surface 135, the body 42 of the hole forming instrument 40 is restricted from moving from that position toward the back side of the gums and the lower alveolar bone. Therefore, the position to which the tip of the hole forming instrument 40 reaches is defined by the defining surface 135 of the model main body 110.

The target model portion 120 is preferably supported by the model body 110.
The target model portion 120 is supported by a base portion (foundation) 140 provided on the opposite side to the model body 110 , and further includes a support 150 connecting the model body 110 and the base portion 140 .

The milling machine 26 mills out an auxiliary instrument (surgical guide) 200 shown in FIG. 5 based on three-dimensional image data of the patient's lower jaw and three-dimensional image data created by the dentist. The milling machine 26 is owned by, for example, the dentist himself.
However, a specialist may receive data for the milling machine 26 from a dentist or the like and output the auxiliary tool 200.

The auxiliary tool 200 actually used during dental treatment is medically approved and made of a resin material having durability sufficient for dental treatment. The auxiliary tool 200 used during dental treatment may be produced by the 3D printer 24. In this case, the auxiliary tool 200 is made of a medically approved material. Note that the auxiliary tool 200 that is not used during dental treatment and is used together with the model 100 for confirmation by the dentist is preferably made of the same material as the model 100, for example. Since the model 100 is not used in actual treatment, it may be made of an appropriate material with appropriate accuracy as long as the relationship between the definition surface 135 and the target model portion 120 is maintained.

The auxiliary tool 200 is formed to match the surface shape of the treatment area of the patient.
is fixed with a screw to the teeth, gums, or jawbone near the gums of the patient at the treatment site, and then fitted into place. The auxiliary tool 200 is fixed to the lower jaw in a state in which it is prevented from rattling relative to the lower jaw. The auxiliary tool 200 is used to form a recess in the gums and alveolar bone, and to accurately form a recess into which the implant body 30 set in the recess is to be inserted, using the body 42 of the hole forming tool 40.

The auxiliary device 200 has a main body 205 and a guide hole 210.

As described above, the auxiliary appliance 200 is used by being fixed with a screw to the teeth, gums, and jawbone near the gums of the patient's treatment area and then fitted to the teeth, gums, and jawbone, so the body 205 is used as a position determining part that determines a reference position with respect to the teeth, gums, and jawbone. Although an example in which the body 205 is fixed to a region of the patient's oral cavity, for example, along one or more teeth, may be illustrated, the patient's mandibular side may be completely edentulous. For example, the body 205 may be configured to connect to a smaller portion of the patient's oral cavity, such as only one or two teeth, only bone, or any combination thereof.

The guide hole 210 defines the direction, shape (length, outer diameter), angle, position, etc. of the recess formed by the body 42 of the hole forming tool 40 when the main body 205 is properly attached to the teeth and gums of the patient's mandible.
0. The regulation surface 220 is the surface opposite to the surface facing the gums or the lower alveolar bone. When the end surface 48a of the stopper 48 abuts against the regulation surface 220, the body 42 of the hole forming instrument 40 is restricted from moving toward the back side of the gums and the lower alveolar bone from that position.
The tip reaching position of the hole forming tool 40 is defined by the definition surface 220 of 0.

In addition, the guide hole 210 of the auxiliary instrument 200 may be capable of receiving not only the hole forming instrument 40 but also other procedural instruments such as an electric scalpel for hemostasis.
The auxiliary instrument 200 regulates the insertion direction, angle, position, etc. of the electric scalpel. Therefore, the regulating surface 220 can be used not only as a regulating surface for the hole forming instrument 40 but also as a regulating surface for the procedural instrument. Therefore, the auxiliary instrument 200 is used as a position regulating body for the procedural instrument.

In addition, in the system 10 according to this embodiment, a dentist can create auxiliary instruments as three-dimensional image data (data representing a three-dimensional shape), and can use the 3D printer 24 or milling machine 26 to create an actual object that matches the shape and size of the patient's lower jaw.

The control device 12 according to this embodiment stores an image display program, an image processing program, an output program, and the like.

The image display program displays data acquired by the first scanner 14 and the second scanner 16 on the display unit 18. The image processing program superimposes the image data displayed by the image display program and various data stored in the storage device 22 based on the same coordinate axes. The image display program displays the data superimposed based on the same coordinate axes using the image processing program on the display unit 18. The image display program also displays three-dimensional image data created based on the dentist's intentions on the display unit 18. The output program is
The image processing program is used to output three-dimensional image data created based on the dentist's intentions and surface data (which refers to data expressing a three-dimensional shape (three-dimensional image data), hereinafter referred to as surface data) of an object (e.g., model 100 and auxiliary instrument 200). The output program is capable of outputting surface data that allows the 3D printer 24 or milling machine 26 to model an actual object.

The dentist inputs various instructions to the control device 12 using the operation unit 20, and creates a treatment plan for the implant treatment, for example, following the flows shown in FIGS.

The dentist uses a first scanner 14, such as a dental CT scanner, to obtain three-dimensional image data (e.g., DICOM data) of the patient's lower jaw teeth, bones, and the inside of the bones, and stores this data in the storage device 22. This data is referred to as the first three-dimensional image data. The dentist also uses a second scanner 16, such as an intraoral scanner, to obtain three-dimensional image data (e.g., STL data) of the surfaces of the teeth and gums, and stores this data in the storage device 22. This data is referred to as the second three-dimensional image data (
The dentist uses appropriate software (application)
The first three-dimensional image data and the second three-dimensional image data are input (step S1
The software includes a first three-dimensional image data 51 and a second three-dimensional image data 52.
Even if the data formats of the first three-dimensional image data 51 and the second three-dimensional image data 52 are different, it is possible to read both of the data.

The dentist displays, for example, a first three-dimensional image 51 based on the first three-dimensional image data on the display unit 1.
The dentist checks the results on the display screen of 8 and makes a comprehensive judgment on the feasibility of implant treatment at the treatment site of a certain patient based on various other conditions (step S2). The following describes the operations when the dentist judges that implant treatment is possible (S2-Yes). When the dentist judges that implant treatment is not possible (S2-No),
The treatment plan creation process is completed.

In addition, when the second three-dimensional image data is not used for determining whether or not the implant treatment is performed,
Acquisition of three-dimensional image data (e.g., STL data) of the surfaces of the teeth and gums using the scanner 16 may be performed after the process of step S2.

The dentist creates a first image showing the mandibular bone (lower alveolar bone) on the software, as shown in FIG.
In the three-dimensional image 51, the recess 7 in which the implant body 30 is embedded during implant treatment is
In order to make the non-reachable (non-contact) target that the tip of the body 42 of the hole forming tool 40 does not reach when forming the hole 0, the positions of the inferior alveolar artery and the inferior alveolar nerve are specified. Then, the dentist marks the position of the non-reachable target on the software (step S3, first process). At this time, the dentist marks the feature points of the non-reachable target so that the non-reachable target is formed three-dimensionally on the software. Then, the dentist creates the non-reachable target as third three-dimensional image data (fourth surface data) 53.

9, the dentist sets or installs the shape (e.g., length, outer diameter), angle, position, etc. of the implant body simulating the implant body 30 at the treatment position on the software (step S4). The term "installation" refers to, for example, the dentist importing three-dimensional data acquired by using a 3D scanner or the like into the system 10. The angle of the implant body refers, for example, to the installation direction with respect to the treatment position of the patient.

In addition, as the implant body, three-dimensional image data is used that corresponds one-to-one to the implant body and contains information on the same shape and dimensions as the implant body 30 that has actually been approved for medical treatment.
The dentist considers the relationship between the shape of the tooth and the shape of the superstructure (crown part).
The control device 12 selects one implant body that matches the setting contents from the three-dimensional image data 22a of the implant body stored in the storage device 22. The fourth three-dimensional image data (second surface data) 54 of the implant body selected by the dentist is provided, for example, by the manufacturer of the implant body 30. If the fourth three-dimensional image data 54 is not provided by the manufacturer of the implant body 30, the dentist may create the fourth three-dimensional image data 54 of the implant body by himself/herself. The control device 12 stores the fourth three-dimensional image data 54 of the implant body created by the dentist in the storage device 22.
The dentist selects the implant body 30 himself and inserts the implant body 30 into the mandibular bone.
The angle, position, etc. of the implant can be optimally set to suit the patient. At this time, the dentist can easily reselect the implant body and test the compatibility of implant bodies with different lengths and outer diameters for the patient's treatment target.

As shown in Fig. 10, the dentist selects an appropriate hole forming tool from one or more drill sets used in the treatment of the patient according to the depth, diameter, angle, and position of the recessed hole 70 for embedding the selected implant body (second process). As the hole forming tool, three-dimensional image data is used that corresponds one-to-one to the hole forming tool and contains information of the same shape and dimensions as the hole forming tool 40 that has actually been medically approved. The dentist can usually select the hole forming tool 40 recommended by the manufacturer of the selected implant body 30, but other hole forming tools 40 may also be used. The dentist selects one hole forming tool 40 that matches the settings from the three-dimensional image data 22b of the hole forming tool that imitates the hole forming tool 40 stored in the storage device 22.
Fifth three-dimensional image data (third surface data) 55 of the hole forming tool 40 selected by the dentist
is provided, for example, by the manufacturer of the hole forming tool 40. If the fifth three-dimensional image data 55 is not provided by the manufacturer of the hole forming tool 40, the dentist may create the fifth three-dimensional image data 55 himself/herself. The control device 12 stores the fifth three-dimensional image data 55 created by the dentist in the storage device 22.

Generally, the diameter of the hole 130 formed by the actual hole forming tool 40 is slightly smaller than the outer diameter of the actual implant body 30. This relationship is also the same in the software. The difference between the outer diameter of the hole forming tool and the outer diameter of the implant body is set as a parameter by the dentist on the operation unit 2.
By inputting 0, it can be set appropriately.

The dentist aligns the coordinate axes of the first to fifth three-dimensional image data 51-55 on the software, and aligns the first three-dimensional image data 51, the third three-dimensional image data 53, and the fourth three-dimensional image data 54.
The second three-dimensional image data 52 is superimposed on the first three-dimensional image data 54 and/or the fifth three-dimensional image data 55 in a predetermined coordinate system with the same coordinate axes (step S5). For this purpose, the dentist displays the surfaces of the lower teeth and gums and the
The positional relationship between the arteries and nerves inside the alveolar bone is clearly indicated using software.

11, the dentist creates three-dimensional image data of an auxiliary instrument (surgical template) in accordance with the shape of the patient's lower jaw on the software displayed on the display unit 18 (step S6). That is, the dentist creates the auxiliary instrument as a sixth three-dimensional image 56.

The auxiliary tool 200 shown in Fig. 5 guides the body 42 of the hole forming tool 40 at the treatment site and covers the gums. When the dentist determines the treatment plan, the dentist outputs three-dimensional image data (e.g., STL data) of the auxiliary tool 200 for the 3D printer 24 or the milling machine 26,
The auxiliary tool 200 is formed by a 3D printer 24 or a milling machine 26.
00 can be fitted or engaged with the model 100 (see FIGS. 4A and 4B ) created by the 3D printer 24. The resin material used for the auxiliary instrument 200 differs depending on whether or not the auxiliary instrument 200 will actually be used during treatment. When a resin material approved for medical use is used for the auxiliary instrument 200, the auxiliary instrument 200 can be used as is.
When a resin material not approved for medical use is used, the auxiliary tool 200 cannot be used for actual treatment as it is. In this case, the auxiliary tool 200 is fitted to the model 100 as described below, and the tip of the hole forming tool 40 is placed at a predetermined position and the target model part 1 is inserted into the model 100.
It is used to verify the created treatment plan before the procedure, such as by checking that there is no contact with 20.

Here, in an actual procedure, the dentist cannot check how many millimeters they have dug from the gum surface (not the alveolar bone) when forming a hole in the patient's treatment area, but they can check in advance how many millimeters they have dug from the alveolar bone surface and the distance from the alveolar bone surface to the artery using the tools they will actually be using.

12 and 13 show schematic diagrams of a mandible 310 including alveolar bone 312, teeth 314, gums 316, foramen 318, and non-reached targets 320 of the inferior alveolar artery and inferior alveolar nerve.
As shown in FIG. 12, in an actual implant treatment, a hole 318 is formed in the lower alveolar bone 312 and the gums 316 using the auxiliary instrument 200 and the hole forming instrument 40.
18 is a distance D1 from the top of the lower alveolar bone 312 to the bottom of the recess 318 and a distance D2 from the top of the lower alveolar bone 312 to the bottom of the recess 318.
Distance (offset value) from the top (defined surface) 335 of the auxiliary device 200 to the defined surface 220 of the auxiliary device 200
That is, when the auxiliary device 200 is used, the depth of the recess 318 is offset from the top of the lower alveolar bone 312 to the prescribed surface 220 of the auxiliary device 200.

In this case, as shown in Figures 12 and 13, the dentist selects the hole forming tool 40 and the implant body 30 so that (length H1 of the drill body 42 below the upper end 46b of the drill sleeve 46) - (height H2 of the stopper 48) = (length D1 of the implant body 30 used in surgery) + (offset value D2 when the auxiliary tool 200 is used).
The recess 318 is formed so that the recess 70 and the implant body 30 are spaced apart, and the implant body 30 is embedded in the recess 318. That is, the dentist sets the shape (e.g., outer diameter), position, and angle of the implant body 30 or the inner diameter, position, and angle of the recess 70 as parameters, and sets the above-mentioned parameters H1, H
The dentist inputs D2, D1, and D2 as appropriate using the operation unit 20, and creates an optimal treatment plan while checking the condition of the patient's treatment target area. Setting or installing the parameters H1 and H2 includes the dentist selecting the optimal hole forming tool 40.

As shown in Fig. 14, the dentist superimposes the first three-dimensional image 51 of the mandibular bone, the second three-dimensional image 52 of the surfaces of the teeth and gums, the third three-dimensional image 53 of the unreached target, the fourth three-dimensional image 54 of the implant body and/or the fifth three-dimensional image 55 of the hole forming tool, and the sixth three-dimensional image 56 of the auxiliary tool on a predetermined coordinate system (step S7, fifth process). Then, as shown in Fig. 15, the dentist checks the arrangement of the sixth three-dimensional image 56, the fourth three-dimensional image 54 or the fifth three-dimensional image 55, and the third three-dimensional image 53 on the display unit 18. That is, the dentist clearly indicates the positional relationship between the auxiliary tool, the implant body, the hole forming tool for forming a hole for embedding the implant body, and the unreached target on the software.
It should be noted that steps S3 to S7 are processed using an image processing program, and the image is displayed on the display unit 18 using an image display program.

Then, the dentist shapes the auxiliary instrument 200 using the 3D printer 24 or the milling machine 26 (step S8).

The dentist checks whether there are any corrections to be made to the treatment plan on the software. If there are any problems, they are corrected. If there are no problems, the second three-dimensional image data 52 and the third three-dimensional image data 53 shown in FIG.
The first three-dimensional image data 53, the fourth three-dimensional image data 54, and the fifth three-dimensional image data 55 are superimposed on a predetermined coordinate system (step S9). At this time, the second three-dimensional image data 52, the third three-dimensional image data 53, the fourth three-dimensional image data 54, and the fifth three-dimensional image data 55 are superimposed on the predetermined coordinate system by software for creating a treatment plan. Alternatively,
If the data is compatible, the dentist may import these three-dimensional image data into, for example, 3D CAD software other than the software for creating the treatment plan, and superimpose these three-dimensional image data. At this time, the fifth three-dimensional image data 55 of the hole forming instrument is imported by excluding the body and shank, and importing only an image of, for example, the sleeve (guide tube) (fifth three-dimensional image data 55a related to the sleeve).

17, the dentist removes the fourth three-dimensional image data 54 relating to the implant body and the fifth three-dimensional image data 55a relating to the sleeve in the software (step S10, third process). That is, the dentist removes the three-dimensional image data 11 of the model body 110 having the through-hole 130 simulating the recess for embedding the tooth and the implant body in the software.
0a, and 3D image data 120a for the 3D printer 24 of the target model unit 120
A three-dimensional image data (fifth surface data) 100a of the model 100 is created, which includes the above.

Steps S9 and S10 are processed using an image processing program, and the image is displayed on the display unit 18 using an image display program.

After the dentist checks the data for the 3D printer 24, the 3D printer 24 controlled by the control device 12 prints the teeth, implant bodies 3, etc., in response to an operation input instruction by the dentist to the operation unit 20.
A model 100 (see Figures 4A and 4B) of the patient's treatment area is created, including a target model portion 120 simulating the gums and inferior alveolar artery, having a through hole 130 simulating the recess 70 for embedding the endodontic implant 0 (step S11, fourth process).

At this point, the dentist temporarily stops the process of creating a treatment plan using the system 10.

In this manner, the operation unit 20 of the above-described system 10 has three inputs for the patient to the control device 12.
The operation unit 20 inputs to the control device 12 a processing instruction for identifying a treatment target area of the patient and a non-reached target in the three-dimensional stereoscopic image data, and a processing instruction for setting various parameters of an implant body to be embedded in a treatment target area or installing data acquired by a dentist using a 3D scanner or the like to set a hole simulating a recess for embedding an implant body in the three-dimensional stereoscopic image data of the patient. In addition, the operation unit 20 inputs to the control device 12 a processing instruction for superimposing the first surface data (data related to a surface image), the second surface data or the third surface data, and the fourth surface data on a predetermined coordinate system (coordinate conversion instruction), and a processing instruction for subtracting the second surface data and the third surface data from the first surface data to create fifth surface data indicating the positional relationship between the treatment target area including the hole and the fourth surface data.
That is, the operation unit 20 inputs to the control device 12 a processing instruction (coordinate conversion instruction) for superimposing the first surface data, at least one of the second surface data and the third surface data, and the fourth surface data on a predetermined coordinate system, and a processing instruction for subtracting the second surface data and the third surface data from the first surface data to create fifth surface data indicating the positional relationship between the treatment target area including the hole and the fourth surface data, and these are processed by the control device 12. Note that if the second surface data is not used in the coordinate conversion instruction, it is not necessary to subtract the second surface data when creating the fifth surface data. If the third surface data is not used in the coordinate conversion instruction, it is not necessary to subtract the third surface data when creating the fifth surface data.

As shown in Fig. 18, the dentist fits, for example, the auxiliary tool 200 into the model 100 created by the 3D printer 24. The dentist further inserts the body 42 of the hole forming tool 40 into the guide hole 210 of the auxiliary tool 200. At this time, the hole forming tool 40 uses a sleeve 46 and a stopper 48. The dentist visually checks the positional relationship between the tip of the body 42 of the hole forming tool 40 and the target model portion 120. Specifically, when the hole forming tool 40 is fitted into the guide hole 210 of the auxiliary tool 200, the dentist checks whether the tip of the body 42 of the hole forming tool 40 is in the correct position.
When the hole forming instrument 40 is inserted into the through hole 130 in order to make a recess for embedding the implant body 30 in step 2, it is confirmed that the body 42 of the hole forming instrument 40 faces in the desired direction and that the tip of the body 42 is maintained away from the target model portion 120 such as an artery and a nerve.

Alternatively, it is recommended that the tip of the hole forming tool 40 be spaced 3 mm or more from the inferior alveolar nerve or the inferior alveolar artery.
0 toward the defined surface 135 by, for example, 3 mm or more, compared to the actual target, and a treatment plan can be created so that the tip of the hole forming instrument 40 does not abut and separate.
5 side, the tip of the body 42 of the hole forming tool 40 contacts the target model portion 12
Based on the positional relationship between the position where the target model portion 120 abuts against the end surface 48 a of the stopper 48 of the hole forming tool 40 on the body 42 side, the dentist can determine whether or not the hole forming tool 40 can actually be used on a patient.
It is also possible to form the target as a reach (contact) target.

In this way, the dentist can use the system 10 to create a model 100 of the same size and shape as an actual patient using the three-dimensional images 51, 52 of the patient and the three-dimensional images 54, 55 of the implant body and hole forming tool, thereby using the hole forming tool 40 to be actually used to perform a pre-verification of the procedure for creating a recess in which to embed the implant body 30. If no problems are found in the pre-verification, the dentist performs the procedure on the actual patient according to the treatment plan. If a problem occurs in the pre-verification, the dentist modifies the treatment plan as necessary, re-creates the model 100 and auxiliary tool 200, and performs a pre-verification of the procedure. If necessary, the dentist repeats this process until no problems are found in the pre-verification.
When forming the model 100, the dentist may selectively use the three-dimensional images 54, 55 of the implant body and the hole forming tool.

The position, size, angle, etc. of the through hole 130 of the model main body 110 are formed to the final size for fitting the implant body 30. In an actual procedure, a dentist starts with a small hole, gradually increasing the hole diameter and digging deeper. For this reason, when forming a recess in an actual procedure, a dentist starts with a drill body 42 that is short and has a small diameter,
The procedure is carried out by gradually changing the diameter and thickness of the implant body 3 to a larger diameter. In the system 10, the dentist can describe, as a treatment plan, what kind of hole forming tool will be used to form the recessed hole.
It is possible to set a final size of the hole in which a zero can be embedded.

By using the model 100, the dentist can also use the model 100 to perform a preliminary verification of the procedure while gradually changing the drill diameter from a small and short one to a large and long one.
In addition, various procedural tools used during the creation of the recesses can also be verified in advance. Examples of procedural tools used during the creation of the recesses include a bone filling material, a fibrin gel containing platelet equivalents separated from collected blood, or an injection tool for injecting a mixture of these into the treatment target site.

Currently, dentists may calculate various parameters such as the length of the body 42 of the hole forming tool, the height of the stopper 48, and the offset value during the actual procedure depending on the implant body 30 to be used. If the dentist makes a mistake in any one of the parameters, there is a possibility that an instrument different from the one that should be used will be used.
By using the model 100 according to this embodiment,
The dentist can verify in advance the appropriateness of the use of each procedural tool until the dentist forms a cavity of the final size in an actual procedure.
In addition, the creator of the treatment plan in the system 10, such as a dentist, may make mistakes in various parameters such as the length of the body 42 of the hole forming tool 40, the height of the stopper 48, and the offset value when creating the treatment plan. The creator of the treatment plan may overlook the mistakes in the various parameters and end the creation of the treatment plan. Even in this case, if the dentist performs a pre-verification of the treatment plan using the model 100 and the actual hole forming tool 40, he or she may be able to notice the setting mistakes of various parameters in the treatment plan. Then, the dentist can use the model 100 to consider how to change the parameters such as the length of the body 42 of the hole forming tool 40 to be used, the height of the stopper 48, and the offset value to perform the procedure well. At this time, hole forming tools other than the hole forming tool 40 of the manufacturer set when creating the treatment plan can also be tried as appropriate. Therefore, the dentist can use the model 100 to appropriately select the hole forming tool 40 from the tools he or she owns.
Therefore, it is essential that a dentist uses the model 100 described in this embodiment to verify the procedure in advance as part of the implant treatment.
The dentist can use the model 100 to verify the procedure in advance, and then use the hole forming tool 40 as necessary.
By appropriately changing the model 100 according to the present embodiment, the dentist can perform optimal treatment. Of course, the dentist may modify the treatment plan using the system 10. Therefore, by using the model 100 according to the present embodiment, the safety of the implant treatment can be significantly improved.

In implant treatment, for example, an auxiliary tool 200 is prepared, and a dentist performs treatment by forming a hole of a predetermined size at a desired position on the patient's lower jaw and embedding an implant body 30 in the hole.
In the past, there was no way for a dentist to visually and actually check before the procedure whether the tip of the body 42 of the model 100 reaches a non-reachable target by selecting a hole forming tool of another manufacturer based on his own ideas in relation to the relationship between the model 100 and the auxiliary tool 200. According to this embodiment, the dentist can verify the relationship between the model main body 110 including the treatment target part of the patient, the target model part 120, the auxiliary tool 200, and the hole forming tool 40 or the implant body 30 before the procedure using the model 100 and the actual hole forming tool 40 or the implant body 30. That is, the dentist can verify the created treatment plan in advance before the actual procedure. Therefore, the dentist can perform the actual procedure after verifying the safety of the procedure using the hole forming tool 40 in advance. During the actual procedure, the dentist can reduce the time required for the procedure because the dentist knows in advance the reach position of the tip of body 42 of hole forming tool 40 relative to the unreachable target in model 100, i.e., the separation distance or contact state between the unreachable target and the tip of body 42 of hole forming tool 40. Therefore, by performing the procedure according to the treatment plan, the dentist can perform the procedure with less invasiveness on the patient.

A dentist can use the system 10 to create a treatment plan between the medical procedure of acquiring patient data using the first scanner (CT scan) 14 and the second scanner (intraoral scanner) 16 and the medical procedure of actually performing a procedure on a patient. In this embodiment, an example in which a dentist creates a treatment plan by himself/herself has been described. The process of creating a treatment plan is as follows:
Although this does not actually treat or diagnose the patient, it is an extremely important process that leads to the medical procedure of embedding the implant body 30 in the mandible. For this reason, the dentist creates a treatment plan using the system 10, and prepares the model 100 and auxiliary instruments 20 based on the treatment plan.
To verify the procedure in advance using 0 is an extremely effective process for ensuring the safety of implant treatment. For this purpose, it is extremely useful for dentists to use the system 10 that allows them to create an optimal treatment plan for each patient in order to ensure the safety of treatment.

As described above, the creation of the treatment plan itself may be performed by a person unqualified for dental treatment, such as a manufacturer's engineer or a dental technician. Even in this case, the dentist can receive the created data of the treatment plan, review the treatment plan in the system 10, and instruct or modify the treatment plan himself/herself. In any case, the dentist can verify the safety of the treatment in advance using the model 100, the hole forming tool 40, the implant body 30, and the auxiliary tool 200 immediately before performing the actual procedure.

When modifying the above-mentioned treatment plan and recreating the model 100, the dentist can perform a series of operations by himself using the system 10, thereby reducing the time required for communication with manufacturers and other vendors.
When outputting 0, a significant time saving, such as a week, can be achieved compared to using a professional. Therefore, the dentist can prepare the patient for the procedure sooner.
When a dentist uses the system 10, the dentist can take the initiative and create an optimal treatment plan through trial and error.
Even if the output of the model is entrusted to a professional, it is possible to reduce the number of times the auxiliary tool 200 and the model 100 need to be corrected. Therefore, the dentist may be able to prepare the patient for the procedure earlier.

Conventionally, the cost of making an auxiliary tool (surgical guide) is relatively high, for example at least 35,000 yen, and is not always necessary, so even if a dentist uses the auxiliary tool 200, it can be difficult to get the patient to pay the cost of making it. For this reason, it is difficult to say that the use of auxiliary tools is necessarily widespread in current implant treatments. However, if a dentist himself designs the auxiliary tool 200 using the system 10 according to this embodiment and prints it on a 3D printer 24 owned by the dentist,
Alternatively, by outputting the auxiliary tool 200 using the milling machine 26, it is possible to significantly reduce the cost of producing the auxiliary tool 200. Therefore, by using the system 10 according to the present embodiment, it is possible to popularize the use of auxiliary tools such as surgical guides among dentists during implant treatment.

Therefore, by using the system 10, the creation of treatment plans can be shifted to the dentist's initiative as much as possible, the cost of creating treatment plans including the auxiliary instruments 200 can be reduced, and safer treatments using the auxiliary instruments 200 can be made more widespread.

As described above, according to the present embodiment, when performing implant treatment of an embedded body such as an implant body, it is possible to provide a pre-procedural verification system 10 for a dental treatment plan, a pre-procedural verification program for a dental treatment plan, a manufacturing method for a model 100 for pre-procedural verification of a dental treatment plan, and a model 100 for pre-procedural verification of a dental treatment plan, which enable a dentist to verify in advance the positional relationship between the tip position of a procedural instrument such as an actual hole forming instrument 40 when using the procedural instrument and target positions such as the inferior alveolar artery and inferior alveolar nerve of the patient's mandible before dental treatment using the procedural instrument.

In the model 100 shown in Figures 4A and 4B, there is no portion corresponding to the lower alveolar bone of the patient. As shown in Figure 4C, the resin material of the model 100 created by the 3D printer 24 may be transparent or semi-transparent, and the portion corresponding to the lower alveolar bone may be present as a membrane-like body 145 that allows the dentist to visually confirm the target model portion 120. When the resin material of the model 100 is transparent or semi-transparent, for example, the model 100 is formed in a state in which the fourth three-dimensional image 54 of the implant body and the fifth three-dimensional image 55 of the hole forming tool are removed from the lower left diagram in Figure 10. The portion corresponding to the lower alveolar bone may be formed in a mesh shape as long as the positional relationship between the hole forming tool 40 and the target model portion 120 can be visually confirmed.

The auxiliary tool 200 has a guide hole 210 for forming a recessed hole for embedding the implant body 30. The guide hole 210 and the recessed hole 70 are circular holes when they are formed by a rotary drill as the hole forming tool 40. Depending on the hole forming tool 40, the guide hole 210 and the recessed hole 70 may form non-circular holes not formed by a rotary drill.

In the present embodiment, an example has been described in which two scanners, the first scanner 14 and the second scanner 16, are used. For example, the first three-dimensional image data 51 and the second scanner 16 are scanned by one scanner.
If it is possible to acquire three-dimensional image data 52, multiple scanners may not be necessary.

The first scanner 14 and the second scanner 16 are owned by a dentist, and the dentist acquires three-dimensional image data of a patient's jaw. The modeling of the model using the 3D printer 24 may be performed by a suitable company. For example, the first scanner 14 and/or the second scanner 16
Since the first scanner 1 may acquire three-dimensional image data of the patient in advance using
4 and/or the second scanner 16 may preferably not be included in the system 10.
It is also preferred that the D printer 24 and/or the milling machine 26 are not included in the system 10.

In the present embodiment, an example has been described in which the auxiliary tool 200 is created and used in an actual procedure in the system 10. The auxiliary tool 200 may not necessarily be required depending on the selection of the hole forming tool 40, for example.

(First Modification)
A system 10 according to a first modified example of the first embodiment will be described with reference to Fig. 19. Here, differences in parameter settings when using a hole forming tool 40 different from the hole forming tool 40 shown in Fig. 3 will be described.

Fig. 19 shows a first modified example of the hole forming tool 40 different from that shown in Fig. 3. The hole forming tool 40 shown in Fig. 19 has a handle 50 in addition to the body 42, the shank 44, the sleeve 46, and the stopper 48. The lower end of the stopper 48 abuts against the handle 50. Therefore, the position of the tip of the body 42 of the hole forming tool 40 is adjusted according to the height of the handle 50. For example, when the height of the handle 50 is increased, the bottom of the recessed hole 318 is closer to the unreachable target 32.
is moved away from 0.

As shown in FIG. 19, the dentist determines the length D1 of the implant body 30 plus the auxiliary instrument 2
The hole forming tool 40 and the implant body 30 are selected so that the offset value D2 when using the drill sleeve 46 is equal to the length H1 of the drill body 42 below the upper end of the drill sleeve 46 minus the height H2 of the stopper 48 minus the height H3 of the handle 50. In this manner, the dentist sets various setting values in accordance with the various hole forming tools 40.

That is, the dentist uses the shape (length, outer diameter), position, and angle of the implant body 30 as parameters, and inputs the above-mentioned parameters H1, H2, H3, D1, and D2 appropriately using the operation unit 20 to create an optimal treatment plan while checking the condition of the patient's treatment target site. Setting or installing the parameters H1, H2, and H3 includes the dentist selecting an optimal hole forming tool 40.

(Second Modification)
In the first embodiment, as shown in FIG. 12, the implant body 30 is inserted into a recess 3 formed in the mandible.
In the above, the implant body 30 is embedded in the recess 318. For example, even in the case of forming a recess in which an autogenous tooth 400 is embedded as an embedded body as shown in Fig. 20 instead of embedding the implant body 30 in the recess 318, a treatment plan can be created using the system 10 described in the first embodiment.

The dentist can create three-dimensional image data (second surface data) of the autogenous tooth 400 in the same manner as creating three-dimensional image data of the implant body 30.
The three-dimensional image data of the natural tooth 400 may be acquired using various devices. The three-dimensional image data of the natural tooth 400 may be acquired using the second scanner 16, for example.

The dentist uses the shape, position, and angle of the patient's own tooth 400 as parameters, and inputs the above-mentioned parameters H1, H2, H3, D1, and D2 appropriately using the operation unit 20, and creates an optimal treatment plan while checking the condition of the patient's treatment target area. Parameter H1
The setting or installation of H1, H2, and H3 includes the dentist selecting the most suitable hole forming tool 40. The shape of the autogenous tooth 400 differs from that of the implant body 30, which can be a ready-made product, to each patient. For this reason, when the autogenous tooth 400 is embedded in the mandible, the shape of the autogenous tooth 400 is different from that of the implant body 30, which can be a ready-made product.
In some cases, two or three holes are drilled to fit the shape of the material.
An auxiliary tool 200 may be used. When creating the recesses, for example, multiple hole forming tools 40a, 40b, which may be the same or different, may be used in sequence.

In addition, when performing regenerative medicine using, for example, dental stem cells instead of an autologous tooth, it may be possible to perform treatment by embedding dental stem cells cultured in vivo or ex vivo into the cavity. In this case, when creating a treatment plan in the system 10, the dentist uses the shape, position, and angle of the cell tissue (e.g., a cell tissue aggregate) as the embedded body in the regenerative medicine as parameters, and appropriately controls the above-mentioned parameters H1, H2, H3, D1, and D2 on the operation unit 2.
0, and an optimal treatment plan is created while checking the state of the patient's treatment target area. Setting or installing the parameters H1, H2, and H3 includes the dentist selecting the optimal hole forming tool 40. In this way, the dentist can use the above-mentioned system 10
When performing regenerative medicine using the dental treatment plan, it may be possible to create a treatment plan and create a model for pre-procedure verification of the dental treatment plan.

Second Embodiment
In the second embodiment, a case where the system 10 is used in an implant treatment in which an implant body 30 selected from a large number of implant bodies 30 (see FIG. 2) is embedded in the upper jaw of a patient will be described with reference to FIG. 21 to FIG. 29. Descriptions of matters common to those described in the first embodiment will be omitted as appropriate.

The first scanner (dental CT scan) 14 acquires first three-dimensional image data (e.g., DICOM data) 551 of, for example, the teeth, bones, and inside of the bones of the patient's upper jaw, and outputs the data to the control device 12. The control device 12 stores the first three-dimensional image data 551 in the storage device 22.
A second scanner (intra-oral scanner) 16 scans a second portion of the patient's teeth and gums, e.g., of the upper jaw.
The control device 12 then acquires the second three-dimensional image data (for example, STL data) 552 and outputs it to the control device 12. The control device 12 stores the second three-dimensional image data 552 in the storage device 22.

As shown in Fig. 21, the dentist uses the first three-dimensional image 551 showing the upper alveolar bone, maxillary sinus, posterior superior alveolar artery, and greater palatine artery obtained by the first scanner 14 to specify the positions of the posterior superior alveolar artery, greater palatine artery, and maxillary sinus floor mucosa (see Figs. 27 to 29) as non-reach targets when setting the recess 70 for embedding the implant body on the software. Then, the dentist marks the feature points of the non-reach targets so that the non-reach targets are formed three-dimensionally on the software (step S3). Then, the dentist creates the non-reach targets as third three-dimensional image data 553a, 553b, and 553c. The posterior superior alveolar artery, greater palatine artery, and maxillary sinus floor mucosa are adjacent to the upper alveolar bone.

In the right-hand diagram of FIG. 21, a three-dimensional image 551a of the maxillary sinus and the posterior superior alveolar artery are shown.
3a and a three-dimensional image 553b of the area of the greater palatine artery.

The three-dimensional image data 553c corresponding to the maxillary sinus floor mucosa may be created like a part of an egg shell, or may be formed as a whole into, for example, a spherical shape (see FIG. 29). This is because, when a treatment plan is pre-verified using a model, the area that affects the reach of the tip of the body 42 of the hole forming instrument 40 is the area that corresponds to the maxillary sinus floor mucosa, and the remaining areas do not affect the reach of the tip of the body 42 of the hole forming instrument 40.

As shown in Fig. 21, the dentist sets or installs the length, outer diameter, angle, position, etc. of the implant body simulating the implant body 30 at the treatment position on the software (step S4). At this time, the dentist sets or installs the length, outer diameter, angle, position, etc. of the implant body 30 as described in the first embodiment.
The outer diameter, position, angle, and various parameters (including the selection of the hole forming tool 40) of the hole forming tool 40 are appropriately set to optimize the treatment plan.

22, the dentist aligns the coordinate axes of the first to fifth three-dimensional image data 551, 552, 553a-553c, 54, and 55 on the software, and superimposes the second three-dimensional image data 552 on the first three-dimensional image data 551, the third three-dimensional image data 553a-553c, and the fourth three-dimensional image data 54 and/or the fifth three-dimensional image data 55 on a predetermined coordinate system (step S5). For this reason, the dentist clearly indicates on the software the positional relationship between the surfaces of the maxillary teeth and gums and the artery inside the upper alveolar bone.

As shown in Figure 23, the dentist adjusts the shape of the patient's upper jaw on the software.
An auxiliary tool (surgical template) is created (step S6). That is, the dentist creates the auxiliary tool as the sixth three-dimensional image data 556.
In step S7, the dentist checks the arrangement of the sixth three-dimensional image data 556, the fourth three-dimensional image data 54 or the fifth three-dimensional image data 55, and the third three-dimensional image data 553a and 553b (step S8). Then, the dentist outputs the auxiliary tool (step S8).

The dentist checks whether there are any corrections to be made to the treatment plan on the software. If there are any problems, they are corrected. If there are no problems, the dentist transfers the first three-dimensional image data 551 showing the teeth and upper alveolar bone, the second three-dimensional image data 552 showing the teeth and gums, the third three-dimensional image data 553a and 553b of the unreached target, and the fourth three-dimensional image data 553b of the implant body, as shown in FIG.
4. The fifth three-dimensional image data 55 of the hole forming tool 40 is superimposed on a predetermined coordinate system (step S9). At this time, the same software as that for creating the treatment plan is used to superimpose the fifth three-dimensional image data 55 of the hole forming tool 40 on a predetermined coordinate system (step S9).
The second three-dimensional image data 552, the third three-dimensional image data 553a and 553b, and the fourth three-dimensional image data
The first three-dimensional image data 54 and the fifth three-dimensional image data 55 are superimposed on a predetermined coordinate system.

The dentist removes the fourth three-dimensional image data 54 related to the implant body 30 and the fifth three-dimensional image data 55a related to the sleeve in the software (step S10). That is, as shown in Fig. 25 and Fig. 26, data for the 3D printer 24 of the teeth, the gums having through holes simulating recesses for embedding the implant body 30, and non-reachable targets (surface data of the model) are created in the software.

After the dentist has confirmed the data for the 3D printer 24, the 3D printer 24, which is controlled by the control device 12 based on the dentist's instruction input, creates a model of the patient's treatment area, which includes teeth, gums having through holes that mimic the recesses for embedding the implant body 30, and the posterior superior alveolar artery and greater palatine artery, which are non-reachable targets (step S11).

Here, Fig. 27 shows the relationship between the alveolar bone 712, teeth 714, and maxillary sinus 730 of the maxillary jaw 710. Fig. 28 shows the state in which the implant body 30 is fixed to the maxillary sinus 710 using a maxillary sinus floor lifting procedure, such as a sinus lift (socket lift) procedure. When the implant body 30 is embedded in the upper alveolar bone 712 of the maxillary jaw 710, the thickness of the upper alveolar bone 712 shown in Fig. 27 may not be sufficient. In this case, maxillary sinus floor lifting is performed to push up the maxillary sinus floor mucosa 730a of the maxillary sinus 730 shown in Fig. 28 using an artificial bone filler 740. When performing maxillary sinus floor lifting,
The maxillary sinus floor mucosa 730a of the maxillary sinus 730, along with the posterior superior alveolar artery and the greater palatine artery, are also non-reachable targets of the drill body 42 serving as the hole forming instrument 40.

When performing maxillary sinus floor augmentation, a recess 718 for embedding the implant body 30 is formed in the upper alveolar bone 71.
2. At this time, for example, a recess 718 is opened up to the vicinity of the bottom of the maxillary sinus 730, but the mucous membrane 730a of the maxillary sinus floor is not penetrated. The upper alveolar bone 712 is penetrated not with the hole forming instrument 40 but with an osteotome or the like. A bone filler 740 is filled between the mucous membrane 730a of the maxillary sinus 730 and the upper alveolar bone 712. In this state, the implant body 30 is embedded. At this time, the bone filler 740 and the implant body 30 do not break the mucous membrane 730a of the maxillary sinus floor.

In this case, as a model for pre-procedure verification of a dental treatment plan, for example, in the same way as in the first embodiment in which the lower alveolar bone is not formed, as shown in FIG. 29, the upper alveolar bone is not formed, and the teeth,
A model is created that mimics the gums, the posterior superior alveolar artery, the greater palatine artery, and the mucosa of the floor of the maxillary sinus. When the model is created in this way, the hole forming tool 4 selected for the guide hole of the auxiliary tool and the through hole of the model is inserted.
The dentist can check the positional relationship between the tip of the body 42 of the hole forming instrument 40 and the maxillary sinus floor mucosa 730a when the hole forming instrument 40 is fitted with the tip of the body 42. In other words, the dentist can verify in advance the dental treatment plan whether or not the dental treatment can be performed safely.

In addition, when the area corresponding to the teeth and gums is used as the model body of the upper jaw model, it is preferable that, for example, the maxillary sinus floor mucosa 730a is supported by a support, as in the model 100 described in the first embodiment.

Just as with the use of the system 10 on the mandible, the use of the system 10 on the maxilla can provide the same benefits as those achieved on the mandible.

As described above, according to the present embodiment, it is possible to provide a pre-procedural verification system 10 for dental treatment plans, a pre-procedural verification program for dental treatment plans, a manufacturing method for a model for pre-procedural verification of dental treatment plans, and a model for pre-procedural verification of dental treatment plans, which enable a dentist to verify in advance the positional relationship between the tip position of a procedural instrument when using an actual procedural instrument for performing dental treatment to embed an implant body, etc., and a target position such as the position of the posterior superior alveolar artery and greater palatine artery of the patient's maxilla and the maxillary sinus mucosa, prior to dental treatment using the actual procedural instrument.
In the system 10 according to the second embodiment, instead of the implant body 30,
The autogenous tooth 400 or cell tissue described in the modified example of the first embodiment can be used.

According to the first and second embodiments including the above-described modified examples, for example, before performing a treatment to embed an implant body 30 or an autologous tooth, a dentist uses the system 1 for pre-dental treatment verification.
0 and a hole forming tool (
Using the procedural tool 40 and the implant body 30 or the patient's own tooth 400, it is possible to verify in advance before the procedure whether there are any problems with the treatment plan, including the selection of various treatment tools. This prevents the dentist from becoming suspicious about whether the tool to be used during the procedure (e.g., the hole forming tool 40) can be used to perform the prescribed treatment according to the treatment plan on the patient's treatment target area, which can result in the treatment taking too long and placing a burden on the patient. For this reason, the first embodiment including the above-mentioned modified examples is
By using the system 10 and model 100 according to the embodiment and the second embodiment, and further the hole forming tool 40 set in the treatment plan, dental treatment can be performed on the patient in a less invasive manner.

Furthermore, by using the system 10 in this manner, the work of creating a treatment plan up to the creation of three-dimensional image data of the model 100 is checked and confirmed by the dentist who will actually perform the treatment, rather than by a professional, treatment for embedding an implant body 30 or an autologous tooth, for example, can be performed more safely.

Furthermore, if the dentist owns the 3D printer 24 and the milling machine 26, the time required for delivery of the three-dimensional image data and the time required for transporting the model 100 can be omitted, and the time required for a series of operations from creating a treatment plan to verifying dental treatment in advance using the model 100 can be shortened. Also, when revising a treatment plan, the time required for a series of operations from revising the treatment plan to verifying dental treatment in advance using the model 100 can be shortened.

Third Embodiment
A third embodiment of the present invention relates to an osteotome for implantation. The osteotome 60 comprises:
The osteotome 60 is embedded in the jaw of a patient from the surface to the depth of the treatment area, and is used as a tool for applying impact when expanding or compressing the bone so as to displace the position of the mucous membrane at the back of the treatment area. The osteotome 60 of this embodiment includes a body portion 61, a bar portion 62, an end portion 63,
The guided portion 64, the stopper portion 65, the display window 66, and the screw 67 are provided (see FIG. 30).
See A etc.).

The body portion 61 is the main body of the osteotome 60 and has a shape that is easy for a dentist to hold and operate. The body portion 61 has a hollow portion 61 for mounting the bar portion 62.
a is formed (see FIG. 31, etc.).

The bar portion 62 is an elongated member that is attached to the hollow portion 61a of the body portion 61.
The end portion 63 is formed so as to displace the position of the mucous membrane of the patient.
2 is formed to be slidable in the longitudinal direction along the hollow portion 61a, and the amount of protrusion to the end portion 63, and therefore the overall length of the osteotome 60, can be freely changed (
See Figures 30A, 30C, etc.). In addition, a plurality of engagement grooves 62a are formed in the bar portion 62 at predetermined intervals along the longitudinal direction (see Figure 30B, etc.). These engagement grooves 62a are formed so that the tip of the screw 67 can engage with the engagement grooves 62a when the screw 67 is turned. In this way, the tip of the screw 67 is engaged with the engagement grooves 62a to lock the bar portion 62, and the body portion 61 is fixed.
The bar portion 62 can be positioned relative to the end 63 (see FIG. 31). The bar portion 62 is also provided with an information display portion 62b that displays information regarding the amount of protrusion to the end 63 when positioned by the screw 67 or information regarding the embedding depth (see FIG. 30B, etc.). For example, in this embodiment, the information is displayed numerically (
See FIG. 30B ), this is just one example, and the specific method of presenting information by the information presenting unit 62b is not particularly limited.

The end 63 is the tip of the bar 62, and is formed in a shape suitable for contacting the mucous membrane of a patient to displace the position (see FIG. 30B, etc.).
The diameter of the end 63 may be made larger to proceed with the procedure on the patient, depending on the case where the size is to be made suitable for transplantation of a dental implant, etc. In this embodiment, multiple types of bar parts 62 with different diameters of the end 63 are prepared in advance, and the diameter of the end 63 can be changed by replacing the bar parts 62. At least one of the multiple bar parts 62 has a diameter of the end 63 larger than the end diameter of an osteotome dedicated to implants. The diameter of the end 63 of such a bar part 62 is, for example, 5 mm or more. The bar parts 62 with the above-mentioned size (diameter) of the end 63 can be particularly suitably used for transplanting a home-made tooth 400,
It can be said that this has not been used in conventional osteotomes for implants.

The guided portion 64 is a portion that is guided along the guide hole 210 of the surgical guide 200, and is formed in a part of the body portion 61 to match the size and shape of the guide hole 210 (see FIG. 30B, etc.). As described above, the surgical guide 200 is provided to match the surface shape of the treatment site of the patient, and is formed to offset a reference position that serves as a guide for the depth during treatment by a predetermined amount. In this embodiment, the osteotome 60 is moved while the guided portion 64 is aligned with the guide hole 210 of the surgical guide 200, thereby reducing variations that may occur when embedding the osteotome in the treatment site due to differences in the skills of each dentist and differences in the conditions of the treatment site for each patient, and improving reproducibility and accuracy (see FIG. 34A, etc.).

The stopper portion 65 is a portion formed to contact the surgical guide 200 and restrict the movable range of the osteotome 60. In this embodiment, the base end side of the guided portion 64 is formed in a stepped shape having a larger diameter than the guided portion 64, and the stepped portion functions as the stopper portion 65 (see FIG. 30B, etc.).

The display window 66 is formed in the body 61 so that the information on the information presenting portion 62b on the bar 62 can be visually confirmed (see FIG. 30B, etc.). For example, in this embodiment, a part of the body 61 is cut out in a window shape to serve as the display window 66, and the information (e.g., numerical values) on the information presenting portion 62b of the bar 62 attached inside the display window 66 can be visually confirmed (see FIG. 30B, etc.).
See B etc.).

The screw 67 is a member used as a locking tool for locking the bar portion 62 at a predetermined position on the body portion 61. The screw 67 provided on the body portion 61 is tightened,
By engaging the tip of the screw 67 with the engagement groove 62a of the bar portion 62, the bar portion 62 can be locked in a predetermined position. On the other hand, by turning the screw 67 in the reverse direction to loosen it, the locked state of the bar portion 62 is released, and the bar portion 62 can be slid in the longitudinal direction.
In the osteotome 60 of this embodiment, two screws 67 are arranged, for example, to sandwich the bar portion 62 (see FIG. 31). By arranging at least two screws 67, even if one of the screws loosens, the bar portion 62 can be prevented from moving unexpectedly during the procedure, thereby ensuring safety. In this embodiment, engagement grooves 62a are provided on at least both sides of the bar portion 62, so that both of the two screws 67 arranged to sandwich the bar portion 62 can be engaged with the engagement grooves 62a. These two screws 67 may be arranged with their positions shifted along the longitudinal direction (
See Figure 31.

The osteotome 60 of this embodiment having the above-mentioned structure has the following advantages.
- Because the overall length is variable, for example, when performing a procedure on a treatment area of a patient's upper jaw, the overall length can be adjusted so that part of the osteotome 60 does not come into contact with the lower jaw.
The information displayed on the information display section 62b of the bar section 62 can be checked at a glance through the display window 66.
By moving the osteotome 60 while aligning the guided portion 64 with the guide hole 210 of the surgical guide 200, it becomes easier to realize the recess 70 at the planned position, direction, and depth.

The osteotome 60 described above is merely one suitable example. For example, when the osteotome 60 having the size (diameter) of the end 63 exceeding a predetermined value is used for transplanting a home-made tooth 400, if the position of the mucosa is displaced freehand, so to speak, without using the surgical guide 200 described above, it is also possible to use an osteotome 60 that does not have a guided portion 64. Although not particularly shown, a screw type bar portion 62, i.e., a structure in which a spiral unevenness is formed around the periphery, may be adopted, and the unevenness may be screwed into a spiral unevenness formed on the inner wall of the hollow portion 61a of the body portion 61. By rotating the bar portion 62, the bar portion 62 can be moved along its central axis direction to change the amount of protrusion from the body portion 61.

Fourth Embodiment
The fourth embodiment of the present invention relates to a hole forming tool 40 for transplantation. The hole forming tool 40 is a tool having a drill part 41 that advances from the surface layer toward the depth of the treatment site of the patient's jaw and forms a hole for embedding a part of the implant (see Fig. 33B, Fig. 33D, etc.). In the hole forming tool 40 of this embodiment, the diameter of the drill part 41 is a size suitable for transplanting a home-made tooth 400 (
See FIG. 33D). The diameter of the drill portion 41 suitable for transplanting a home-made tooth 400 is at least larger than the drill diameter of a hole forming tool for an implant, and specifically, is at least 5 mm. The hole forming tool 40 having the above-mentioned diameter of the drill portion 41 is particularly suitable for transplanting a home-made tooth 400, and has not been used in conventional hole forming tools for implants.
In the above, reference numeral 42 denotes a body, reference numeral 42A denotes a tip of the body 42, reference numeral 42B denotes a tip of the body 42,
The base ends of the respective

In addition, a guided portion 43 and a stopper 48 are formed in a portion of the hole forming tool 40 of this embodiment. The guided portion 43 is formed so as to be guided along the guide hole 210 of the surgical guide 200, and in this embodiment, the hole forming tool 40 is moved while the guided portion 43 is aligned with the guide hole 210 of the surgical guide 200 as described above, thereby reducing variations that may occur when embedding the tool in the treatment area due to differences in the skills of each dentist and differences in the conditions of the treatment area for each patient, and improving reproducibility and accuracy (see FIG. 33D, etc.).

(An example of a procedure using the osteotome of the third embodiment, the hole forming instrument of the fourth embodiment, etc.)
The hole forming instrument 40 as in this embodiment and the osteotome 60 as in the third embodiment described above
Then, a water flow tube 700 is used to insert a cavity 70 for implanting the homemade tooth 400 into the patient's jaw.
The sequence of procedures performed by a dentist when forming the above-mentioned is described below with reference to the drawings (FIGS. 33A to 35).
See E.

Once the surgical guide 200 is fitted to the jaw (e.g., the upper jaw) of the patient (see FIG. 33A), a hole forming tool 40 is used to form a recess 70 (see FIG. 33B). At this time, the hole forming tool 40 is moved while guiding the guided portion 43 into the guide hole 210 of the surgical guide 200, thereby embedding the tip of the hole 70, which is located at the planned position, in the planned direction, and at the planned depth.
When the stopper 48 abuts against the surgical guide 200 (see 33B), the hole forming tool 40
(See FIG. 33C).

Next, a hole forming tool 40 having a larger diameter drill portion 41 is used to form a larger recess 7.
Although not shown in detail in the figure, a drill part (drill head) 41 that is detachable from a shank 44 is used, and the shank 44 is inserted into a guide hole 210.
After the drill bit 4 is inserted, the drill part 41 is attached to the tip of the shank 44.
It is possible to realize the state shown in FIG. 33D (wherein the drill portion 41, which is larger than the inner diameter of the guide hole 210, is present between the surgical guide 200 and the patient's jaw).

After forming the recess 70 of a size suitable for transplanting the homemade tooth 400, the surgical guide 20 is
The surgical guide 200 is then fitted back onto the patient's jaw (see FIG. 33E). In this example, two different drill diameters are used to form a hole 70 of a size suitable for transplanting the homemade tooth 400 in a two-step procedure (see FIG. 33F).
3B, 33D), this is a simplified example, and it goes without saying that three or more different drill diameters may be used to form a hole 70 of a size suitable for transplanting a home-made tooth 400 using three or more procedures.

Next, the position of the mucosa at the back of the recessed hole 70 is displaced using an osteotome 60 or the like. First, the bar portion 62 of the osteotome 60 is inserted into the guide hole 210 of the surgical guide 200 from its end 63 side, and the base end side of the body portion 61 is repeatedly struck with the head 802 of the hammer 800, gradually displacing the position of the mucosa with the end 63 (see FIG. 34A). The procedure using the osteotome 60 (displacing the position of the mucosa) is continued until the stopper portion 65 abuts against the surgical guide 200 (see FIG. 34B). Note that in FIG. 34A and the like, the osteotome 60 is inserted into the guide hole 210 of the surgical guide 200.
30 is shown in a simplified form, but this is merely to show the basic structure and is not intended to illustrate osteotomes with different structures.
4B, the length of the shaft (bar portion) of the osteotome 60 is different, which indicates that the amount of protrusion to the end 63, and therefore the overall length of the osteotome 60, is appropriately changed by sliding the bar portion 62 longitudinally along the hollow portion 61a.

When the stopper portion 65 comes into contact with the surgical guide 200 (see FIG. 34B), the osteotome 60 and the surgical guide 200 are temporarily removed (see FIG. 34C). Then, an osteotome 60 with a larger diameter at the end 63 is used to displace the position of the mucosa at the back of the recessed hole 70 over a wider range (see FIGS. 34D and 34E). Although not shown in detail in the figures, if the bar portion 62 is replaced and the base end side of the bar portion 62 is inserted into the guide hole 210 of the surgical guide 200, and then the bar portion 62 is attached to the body portion 61, the bar portion 62 can be attached to the body portion 61 as shown in FIG.
(where the end 63, which is larger than the inner diameter of the guide hole 210, is between the surgical guide 200 and the patient's jaw).

Thereafter, the surgical guide 200 and the osteotome 60 are removed (see FIG. 34F).
Using an osteotome 60 with an end 63 having a larger diameter, the position of the mucosa at the back of the cavity 70 is displaced over a wider range (see Figs. 34G and 34H). After the position of the mucosa at the back of the cavity 70 has been displaced to a degree suitable for transplanting the home-made tooth 400, the surgical guide 200 is
and remove the osteotome 60 (see FIG. 35A ). Note that, in this example, osteotomes 60 having end portions 73 of three different sizes are used, and an example is shown in which the position of the mucosa is displaced in a three-stage procedure (see FIGS. 34B , 34D , 34H , etc.), but this is a simplified example, and it goes without saying that osteotomes 60 having end portions 63 of four or more different sizes may be used, and the position of the mucosa may be displaced in four or more stages.

Next, the surgical guide 200 with the water flow tube 700 attached is fitted to the jaw (for example, the upper jaw) of the patient, and the tip 702 of the water flow tube 700 is aligned with the recessed hole 70 (see FIG. 35B). At this time, it is preferable that the step 704 formed on the tip 702 is in contact with the inner wall of the recessed hole 70 (see FIG. 35B).
The detailed structure of the water flow tube 700 will be described in a later embodiment.

Once the tip 702 of the water flow tube 700 is facing the recess 70 (see FIG. 35B), water is sprayed from the tip 702 to further displace the position of the mucosa at the back of the recess 70 (see FIG. 35C). Once the mucosa has been displaced to a state suitable for transplantation (see FIG. 35D), the water flow tube 700 and the surgical guide 200 are removed, and the homemade tooth 400 is transplanted into the recess 70 (see FIG. 35E).

Fifth Embodiment
The fifth embodiment of the present invention relates to a test post 410. The test post 410 is a specimen used in image diagnosis, which is inserted into a hole at a predetermined location and is imaged in a radiographic image taken in that state to indicate the location of the hole. The hole at the predetermined location referred to here refers to, for example, a hole formed to embed a part of an embedded body (the implant body 30 or the homemade tooth 400) in a treatment location of a patient's jaw, or the guide hole 210 formed in the above-mentioned surgical guide 200.

In light of previous examples of actually performing the procedure described above, the position of the implant (e.g., the white part near the center in FIG. 36A ) may be different from the planned target position (e.g., the white part near the center in FIG. 3
It is possible that the position of the marker may shift from the frame shown in Figure 36A (the framed area near the center of the marker).
A). Considering this, possible reasons include mismatching, distortion of impression material, expansion of gypsum, distortion of scanning, distortion when CT data is converted to three-dimensional data, etc. In any case, in light of the fact that such situations occur with a certain frequency, it is important to check in a timely manner whether the procedure is proceeding as planned or whether it is possible to proceed. The test post 410 of this embodiment, which was devised in consideration of such actual situations and circumstances, makes it possible to check in a timely manner as described above.

A specific example of the test post 410 will be described. The test post 410 of this embodiment is made of a material that forms an image in a radiographic image, such as a resin material or a ceramic material such as zirconia (see FIG. 36B). The specific size of the test post 410 is not particularly limited, and it may be formed to a size corresponding to the recess 70 of the treatment site that is the target of position detection and the guide hole 210 of the surgical guide 200.

In this embodiment, a test post 410 is used in which a flange-shaped stepped portion 412 is formed so that the outer diameter changes midway (see FIG. 36B). In addition, the portion of the outer diameter portion 414 of the test post 410 that is the maximum diameter (in the case of the test post 410 shown in FIG. 36B, the stepped portion 4
12) may have a diameter larger than the inner diameter of the guide hole 210 of the surgical guide 200. In such a case, the outer diameter portion 414 functions as a stopper that abuts against the surgical guide 200, and the surgical guide 200 can be imaged in a state where it is positioned at a predetermined position in the guide hole 210.

Another mode of use of test post 410 will now be described (see Figures 36C to 36F).
In this example, the test post 41 is attached to the surgical guide 200 that is actually created based on the sixth three-dimensional image 56 of the auxiliary tool (the three-dimensional image of the surgical guide 200) (see FIG. 36D).
0 is attached (see FIG. 36E), and the surgical guide 200 is actually attached to a patient with the test post 410 attached, and a CT image is taken (see FIG. 36F). By checking the position of the test post (indicated by the reference symbol 410') in the CT image, it is possible to check the deviation (difference, divergence) from the design of the actually created surgical guide 200. For such a purpose, a test post 410 having a relatively long axial length of the outer diameter portion 414, which is the maximum diameter, can be used (see FIG. 36C).

Sixth Embodiment
The sixth embodiment of the present invention relates to a stopper extension 500. The stopper extension 500 is inserted into the guide hole 210 of the surgical guide 200 and is configured as a member for extending the guide length (see FIGS. 37A to 37C).

The stopper extension 500 of this embodiment is a stepped member made of, for example, resin and formed into a cylindrical shape (see FIG. 37A). The outer diameter of the stopper extension 500 is formed to a size corresponding to the inner diameter of the guide hole 50a at the tip of the handle 50.
It can be attached to the handle 50 by inserting a part of it (a part excluding the stepped portion 502) into the guide hole 50a (see FIG. 37B). The inner diameter of the stopper extension 500 is set to a size corresponding to the diameter of the shank 44 of the hole forming instrument 40 to be used. The outer diameter portion of the stopper extension 500, which is the larger diameter (corresponding to the stepped portion 502 in the case of the stopper extension 500 of this embodiment), is set to a predetermined size, for example, a diameter larger than the inner diameter of the guide hole 210 of the surgical guide 200, or a diameter larger than the inner diameter of the guide hole 50a at the tip of the handle 50 (FIG. 37B,
See Figure 37C).

With the stopper extension 500 configured in this manner, the axial guide length can be made longer than when the hole forming instrument 40 or the like is guided by the handle 50 alone, so that when a procedure is performed using the hole forming instrument 40, lateral movement of the hole forming instrument 40 can be reduced and straightness can be improved.

Furthermore, the stopper extension 500 can function not only as a member for extending the guide length, but also as a member for changing the position at which a stopper (e.g., the stopper 48 of the hole forming instrument 40 or the stopper portion 65 of the osteotome 60) abuts. As one example, if the thickness of the flange-shaped stepped portion 502 is set to a predetermined value (e.g., 1 mm), the position at which the stopper abuts can be displaced in units of a predetermined value.

Seventh Embodiment
The seventh embodiment of the present invention relates to a periodontal ligament guard. The periodontal ligament guard 600 is a member that covers a part or all of the part of the home-made tooth 400 to be transplanted, excluding the tooth root to be cut (see Figs. 38A to 38C). By using such a periodontal ligament guard 600,
It is possible to reduce damage caused by external factors (for example, heat that may occur when cutting, water flow or oil used when cutting, etc.) that may be given to the periodontal ligament surrounding the tooth root when cutting the tooth root. Such a periodontal ligament guard 600 may be made of a low-resilience material. With the periodontal ligament guard 600 made of such a material, when the home-made tooth 400 wrapped in the periodontal ligament guard 600 is held between fingers, the periodontal ligament guard 600 can be freely deformed to a shape that is easy to hold, making it easier to perform operations such as cutting the tooth root (see FIG. 38C, etc.). From this perspective, the periodontal ligament guard 600 may be made of silicone, etc. Although not particularly shown, it is also possible to use the periodontal ligament guard 600 to cover the entire home-made tooth 400 and cut the tooth root together with the periodontal ligament guard 600.

Eighth embodiment
The eighth embodiment of the present invention relates to a water flow tube. The water flow tube 700 is an instrument that is embedded from the surface layer to the depth of a treatment site (such as a recess 70) in the jaw of a patient, and jets water from a tip portion 72 toward the position of the mucous membrane at the back of the treatment site. In this embodiment, the diameter of the tip portion 702 of the water flow tube 700 is set to a size suitable for transplanting a homemade tooth 400, more specifically, to a size that matches the size of the recess 70, which is generally larger than that when an implant body 30 is embedded (see FIG. 35B, etc.). Furthermore, in this embodiment, a step portion 704 is formed in the tip portion 702 of the water flow tube 700, the outer diameter of which increases stepwise from the tip to the base end (see FIG. 35C, etc.). The step portion 704 can be formed, for example, by a flange-shaped protruding portion having multiple steps made of an elastic material (such as a rubber material). Such a step portion 70
According to the embodiment of the present invention, since the adhesiveness with the recessed hole 70 is further improved by the moderate elastic deformation, it is possible to further improve the efficiency of displacing the mucous membrane with the sprayed water (FIG. 3).
5C, Figure 35D, etc.).

The present invention is not limited to the above-mentioned embodiment, and various modifications can be made in the implementation stage without departing from the gist of the invention. The embodiments may be implemented in combination as appropriate as possible, and in that case, the combined effects can be obtained. Furthermore, the above-mentioned embodiment includes inventions at various stages, and various inventions can be extracted by appropriate combinations of the disclosed constituent elements.

10... Pre-procedure verification system for dental treatment plan 12... Control device 18... Display unit 20... Operation unit 30... Implant body (embedded body)
40... Hole forming tool 41... Drill part 42... Body 42A... Tip of body 42B... Base end of body 43... Guided part 44... Shank 46... Sleeve (drill sleeve)
48: stopper 48a: end surface of stopper 48 on the body 42 side 50: handle 50a: guide hole of handle 51: first three-dimensional image data (sixth surface data)
52: Second three-dimensional image data (first surface data)
53...Third three-dimensional image data (fourth surface data)
54...Fourth three-dimensional image data (second surface data)
55...Fifth three-dimensional image data (third surface data)
56... Sixth three-dimensional image 60... Osteotome 61... Body portion 61a... Hollow portion 62... Bar portion 62a... Engagement groove 62b... Information presentation portion 63... End portion 64... Guided portion 65... Stopper portion 66... Display window 67... Screw (fastening device)
70... Hole 100... Model 100a... Three-dimensional image data (fifth surface data)
110... Model body 110a... Three-dimensional image data 120... Target model portion 120a... Three-dimensional image data 130... Hole portion (through hole)
200...Surgical guide (auxiliary device)
210... Guide hole 220... Reference surface 310... Lower jaw 312... Alveolar bone 314... Tooth 316... Gums 318... Hole 320... Non-reachable target 400... Own tooth (homemade tooth)
410...Test post 412...Stepped portion 414...Outer diameter portion 500...Stopper extension 502...Stepped portion 504...Outer diameter portion 600...Periodontal ligament guard 700...Water flow tube 702...Tip portion 704...Step portion 800...Hammer 802...Head H1...Length from base end (46b) of drill sleeve to tip of drill body (42) H2...Length from base end (46b) of drill sleeve to tip stopper (48) D1...Length of implant body (30) or autogenous tooth D2...Value of offset amount due to use of surgical guide

Claims (2)

A dental treatment instrument including: a hole forming instrument having a drill part which advances from the surface layer of a treatment area of a patient's jaw toward a deeper part and forms a hole for embedding a part of an embedding body; and a surgical guide which is formed according to the surface shape of the treatment area of the patient and is fitted to the patient's jaw to offset a reference position serving as a guide for height during treatment by a predetermined amount,
The diameter of the drill portion is a size suitable for transplanting home-grown teeth,
A guided portion that is guided along a guide hole provided in the surgical guide is formed in a part of the hole forming instrument,
The surgical guide and the guide hole are one piece,
The guide hole is a hole through which the guided portion is inserted and whose side is not cut out,
The diameter of the drill portion is larger than the diameter of the guided portion and is also larger than the diameter of the drill portion when the buried body is an implant body,
A dental treatment instrument, comprising a stopper formed to abut against the surgical guide and restrict the range of motion of the hole forming instrument. The dental treatment instrument according to claim 1, wherein the diameter of the drill portion is 5 mm or more.

Images