RU2273464C2 - Dental implant and method for carrying out inraosseous implantation - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: device has threaded intraosseous part connected to implant head having internal thread by means of threaded connection. Extradental part or implant head has internal threaded hole and internal hexahedron arranged along longitudinal axis. Method involves sequentially creating cylindrical hole under local anesthesia using cylindrical mills through gingiva. The hole diameter is less than implant diameter by a value equal to its thread profile size and to a depth equal to implant length. Drilling in depth is carried out with conic mill equal to pericervical implant part, creating bed for introducing the implant. The implant is introduced to required depth by cutting mating thread by rotating the implant and creating compression in bone tissue. Orthopedic stage is carried out from the first to the thirtieth day.

EFFECT: simplified surgical and orthopedic treatment procedure; uniform load distribution; high strength of primary implant fixation.

17 cl, 7 dwg

Description

This invention relates to medicine, namely to surgical and orthopedic dentistry, and can be used to fix dentures.

The prior art implants (screw, pushed in, plate, etc.), consisting of an intraosseous part and a head (abutment, extraosseous part), which are connected to each other by a threaded connection. Implant heads are also known that have an external thread (threaded portion) for connecting to the implant and an internal thread for fixing the crown, which is also used to insert the head into the implant. A dental implant is known having a head (abutment, extraosseous part) and an intraosseous part containing the cervical part and apical part with a thread pitch of ~ 0.6 mm (US Patent No. 5588838, A 61 C 8/00, 1996). This design has disadvantages: weak primary fixation force in the cancellous bone and the ability to withstand early chewing loads due to the low profile and small thread pitch on the apical part of the implant. Prosthetics using this design is carried out after 3-6 months, which delays the treatment time. The prior art implants are single-stage, having an intraosseous part and a cylindrical polished neck (gingival margin, cervical part) (Paraskevich VL Maksimenko LL. One-stage screw implants. Advantages and disadvantages. // New in Dentistry, 2000, No. 8 , p. 38-45).

Closest to the proposed is a dental implant (Patent RU No. 2204356, A 61 C 8/00, 2001), consisting of interconnected via a landing cone and a threaded connection of the intraosseous part and extraosseous part, while the intraosseous part contains a conical parietal part with a conical multi-thread and apical part with a pitch of 0.75-1.5 mm, and the extraosseous part consistently of the following elements: a truncated landing cone with thread, gingival cone, crown part having a cylindrical Female girdle, circular ledge and truncated cone with internal thread.

Known implant systems have (extraosseous parts) plugs and gingival formers with an internal hexagon, which are inserted into the implant using a hexagonal screwdriver, and also contain an implant head (extraosseous part, abutment) with an internal thread that is inserted into the implant using a special tool (adapter ) The design flaws are that a special tool is needed to introduce the implant head into the implant. The implant head, with its conical crown part, mates with the inner cone of the instrument and is fixed by thread. When changing the size of the implant head, it is necessary to change the size of the instrument for insertion, which complicates the system (set) of implants. To separate the instrument and the head after it is inserted into the implant, it is necessary to use a wrench and ratchet wrenches, which greatly complicates the surgical and orthopedic treatment procedures.

It is known from the prior art that implant placement is performed with or without compression of bone tissue. In the first case, the necessary primary fixation is created, without which it is impossible to perform early prosthetics (from 1 day to 1 month) and direct implantation of a extracted tooth into the well. In the second case, the necessary force of fixation of the implant in the bone tissue is achieved due to secondary fixation - germination of bone tissue, i.e. after 3-6 months. Compression is created if a screw implant is tightened or inserted with self-tapping a mating thread. Creating a metered compression of bone tissue is possible if the implant has a conical cervical part or neck, which is larger than the diameter of the thread of the implant and when tightened, it abuts against the cortical layer. Most screw implant designs have a thread pitch of ~ 0.6 mm, despite the fact that many of them are called self-tapping, it is not always possible to create a mating thread in the cancellous bone with such an implant.

According to the traditional method of implant placement, the implant is inserted with minimal compression of the bone tissue by the implant thread, using a small thread pitch, a low thread profile and preliminary tapping.

Thus, using well-known techniques and designs of implants (one-stage and two-stage), it is not always possible to create sufficient primary force of implant fixation in bone tissue. Prosthetics are carried out after 3-6 months, since only at these times due to the germination of bone tissue (secondary fixation) the necessary force of fixation of the implant is achieved, which delays the treatment time.

Closest to the proposed is the method of intraosseous implantation (RU 2202982, A 61 C 8/00, dated 12/20/2001), in which a two-stage (two-phase) implantation technique and implant design are used.

Known designs of one-stage implants do not have a combination of tapered thread on the cervical part and thread with a profile height of 0.4-1.0 mm (screw) on the apical part, therefore, they cannot create sufficient fixation force in the bone tissue and long-term (2-4 weeks) , dosed compression on the spongy bone tissue before exposure to functional loads.

Implants having a cylindrical polished edge (neck) do not create a uniform load distribution over the entire thickness of the cortical bone.

The aim of this invention is to simplify the insertion of the extraosseous part into the implant, increase the strength of the primary fixation of the implant in the bone tissue, shorten the treatment time, simplify the introduction of the implant, and the formation of an optimal gingival margin.

The technical result is the simplification of surgical and orthopedic treatment procedures, the creation of a metered compression of bone tissue, an even distribution of loads and an increase in the primary fixation force of the implant.

The technical result is achieved due to the fact that the dental implant, consisting of interconnected intraosseous part and extraosseous part or head, contains extraosseous part - implant head, which is made with a conical gingival part, internal thread (threaded channel, blind hole with thread) and internal hexagon to insert the head into the implant.

The technical result is also achieved through the use of two types of thread on the intraosseous surface of the implant: multi-thread on the cervical part and thread in increments of 0.7 to 2.0 mm, with a profile height of 0.3-1.2 mm, on the apical part, moreover, the threading of the cervical part is equal to the threading of the apical part, while the diameter of the thread of the apical part is less than the diameter of the neck of the implant.

The technical result is also achieved due to the fact that a dental implant, consisting of an intraosseous part, containing an apical part with a thread, a cervical part with multi-threading and an extraosseous part - a head, is made integral (integral), i.e. the intraosseous part is made at the same time as extraosseous.

The technical result is also achieved due to the fact that a dental implant, consisting of an intraosseous part with a thread and an internal landing hole (conical or cylindrical), has internal slots on the walls of the landing hole for introducing the implant into the bone tissue.

The technical result can also be achieved due to the fact that a dental implant having a bevel slanted at an angle of 45 ° is made with a belt from 5 to 85 ° (the angle can have a value in the range from 0 to 90 °), below which there is a second conical belt ( neck). The belt can be polished or sandblasted.

The technical result is also achieved through the use of the method of single-phase (single-stage) implantation, without peeling of the mucoperiosteal flap, compression injection into the bone tissue of a single-stage implant with a pitch of 0.7-1.6 mm, with a thread profile height of 0.4-1, 0 mm on the apical part and the conical cervical part with multi-thread, containing the implant head with the gingival part and prosthetics in the period from 1 to 30 days after implantation.

The invention is illustrated in Fig.1-7.

The implant consists of intraosseous 1 and extraosseous 2 parts (Figure 1). The intraosseous part may consist of apical 3 and cervical 4 parts. The intraosseous part of the implant or its apical part is made in the form of a screw with a thread pitch from 0.7 to 2.0 mm, with a profile height of 0.3-1.2 mm, while the apical part is usually made in the form of a self-tapping screw. The height of the thread profile can be changed by changing the angle of the thread profile and thread contour. The thread on the apical (intraosseous) part of the implant can be made of a triangular or special profile, it can be persistent or trapezoidal, or conical, or metric.

The threaded protrusion 5 can be performed with an incomplete profile, a truncated profile, with a bevel, with a rounding at the apex and at the base or dulled. The implant may have an incomplete thread profile and a tapered portion at the end of the apical portion. The end of the apical part 6 is rounded, can be made flat, can have a hole, anti-rotation chamfers (sections selected by the mill).

The intraosseous part of the implant or its apical part can be made conical or cylindrical. The cervical part 4 is usually conical in shape, with multiple threads, has a beveled girdle 7 and the second girdle 8 (neck, cervical part) conical or cylindrical, which can be polished or sandblasted. The belt can be polished or sandblasted to a larger or smaller part or half around its circumference.

The beveled girdle 7 usually has a bevel angle of 5 to 85 ° (it can have a value from minimally close to 0 to as close as possible to 90 °). The belt can be polished or sandblasted. The belt can be polished or sandblasted to a larger or smaller part or half around its circumference. The angle of the bevel and the method of processing the girdle allow you to control the depth of immersion of the implant in the bone, which allows you to form the optimal shape of the soft tissues (gingival margin) and the aesthetic appearance of the prosthesis. Inside the implant has a landing (Figure 5) hole - conical (landing cone) 9 or cylindrical. On the walls of the landing hole (cone) 9 are made slots 10, which can be triangular, rectangular, rounded, and also in the form of a trapezoid.

The number of slots can be from 1 to 12, the combination of slots can form polygonal shapes (Fig.6, 7) (triangle, square, hexagon, etc.). Usually, four slots are made on the walls of the landing cone, below the outer edge, equidistant from each other. Slots can be used to insert an implant into bone tissue, as well as to connect with implant heads having reciprocal slots or a hexagon.

The implant may have two slots located opposite each other for insertion with a flat slotted screwdriver.

The implant may have four slots located crosswise for insertion with a cruciform and flat slotted screwdriver (tool).

As an embodiment, the implant may have, on the walls of the landing hole, below the outer edge, equidistant slots of a triangular shape, forming a figure (triangle, square and other polyhedrons) in the cross section.

The implant can be made with a landing cone, on which there is a tapered thread for connection with the extraosseous part. For insertion into the bone tissue below the landing cone, a hexagon (hexagonal channel) can be made, the dimensions of which coincide (may coincide) with the dimensions of the internal hexagon of the implant head (extraosseous part).

The extraosseous part 2 (Figure 2) consists of the following elements: a crown truncated cone 16 with a cylindrical girdle 15, a ledge 14, a gingival cone 13, a truncated landing cone 12 and an external thread 11 (a threaded rod), inside has a thread 17 under which the hexagon 18 is made, i.e. the extraosseous part has a central (blind) hole along the longitudinal axis, which is first made with an internal thread 17, and then ends with an internal hexagon (hex channel) 18. Thread diameter from 1.6 to - 2.5 mm; the size of the hexagon is from 1 mm to - 2.5 mm. The extraosseous part can be performed with a coronal landing cone 6, which starts directly from the landing cone 12, while the beveled girdle 7 acts as a step and can be performed with a bevel or at right angles to the longitudinal axis of the implant

The extraosseous part can be performed with an internal hexagon above the thread, while the size of the hexagon is larger than the diameter of the thread. The length of the gingival cone can vary from 0.5 to 5 mm by changing the angle of the cone, which allows you to select the implant head depending on the thickness of the gums. To fix the crown, a fixing screw with an internal hexagon is used, the dimensions of which coincide with the dimensions of the internal hexagon of the implant head.

The extraosseous part can be detachable with a fixing screw. The implant and extraosseous parts are made of VT1-0, VT1-00, VT6 grade titanium alloys according to GOST 19807, as well as Gradel-GradeIV - ASTM F67-89 and ISO 5831 / II. The intraosseous surface of the implant can be sandblasted or otherwise modified with a surface or coating (hydrocapatite).

The implant is also in the form of a one-stage design (Figure 3). In this case, the implant consists of an intraosseous 1 part, made at the same time with an extraosseous 2 part (connected by an integral connection). The intraosseous part consists of the apical 3 and cervical 4 parts. The apical part is made in the form of a self-tapping screw (screw) with a thread pitch from 0.7 to 2.0 mm, with a profile height of 0.3-1.2 mm. The height of the thread profile can vary due to the angle of the thread profile and the thread contour. The threaded protrusion 5 can be performed with an incomplete profile, a truncated profile, with a bevel, with a rounding at the top and bottom or with blunting. The end of the apical part 6 is made flat, can be rounded, with a blunt, have a hole on the end, anti-rotation chamfers. The apical part can be made conical or cylindrical in shape. The cervical part 4, usually conical in shape, can have a girdle girdle 8 (neck, cervical part). On the cervical part, a conical or cylindrical multi-thread is made.

The extraosseous part usually has a gingival part 19 (rounded or conical) with a ledge 14, a cylindrical part 15, a crown landing cone 16, with an internal thread 17 along the longitudinal axis and hexagon 18. The length of the gingival part is from 0.5 to 6 mm, which allows you to select implant depending on the thickness of the gums.

The extraosseous part (implant head) can be detachable above the gingival cone, with a fixing screw, which allows you to select the length of the crown part depending on the interalveolar distance.

Crown landing cone 16 with a thread 17 and a hexagon 18 can begin directly from the intraosseous part (Figure 4), while the beveled girdle 7 acts as a step and can be performed with a bevel or at right angles to the longitudinal axis of the implant. For insertion of the implant into the bone tissue, the extraosseous part usually contains a straight or cruciform slot 20 on the coronal landing cone; may have an external hexagon at the base of the crown cone, as well as chamfers on the surface of the cone. The implant and extraosseous parts are made of VT1-0, VT1-00, VT6 grade titanium alloys according to GOST 19807, as well as Gradel-GradeIV - ASTM F67-89 and ISO 5831 / II. The intraosseous surface of the implant can be changed by sandblasting or other method (modification) of surface treatment or coating.

Implantation method using an implant and a head

When performing intraosseous implantation in the toothless area of the alveolar ridge, the formation of the implant bed is performed with or without peeling of the mucoperiosteal flap - through the gum. First, a hole in the gum is formed using a mucotome or a milling cutter, then a hole is formed in the bone tissue, successively starting from a smaller diameter and ending with a milling cutter having a diameter equal to the diameter of the implant shaft, creating a cylindrical hole to a depth equal to the length of the implant. Then, a conic cutter having a diameter smaller than the diameter of the implant by the size of the thread profile is drilled to a depth equal to the length of the cervical part of the implant, thus creating a bed for the implant. The implant is inserted into the bone tissue, cutting the response thread by rotation of the implant, due to which, due to the fixation (stop) of the conical cervical part and the neck of the implant in the cortical bone (in the conical bed of the cortical bone), a metered compression is created in the bone tissue.

Method of using the implant head

According to the traditional method, the installation of the head is carried out during the orthopedic stage, i.e. after installing the gingiva former and healing the mucosa. However, when carrying out early prosthetics, the installation of the gingiva former in most cases is not mandatory and only delays the treatment time. With early loads, in general, the difference between the one-stage and two-stage methods practically does not exist. Therefore, the use of an implant head with a conical contour of the gingival part allows its installation during the second surgical stage, which reduces the time and cost of treatment. Through a small hole created in the gum, an implant plug is screwed out using a hex screwdriver, then the implant head is installed using the same tool. The conical gingival part of the implant head promotes rapid adaptation and the formation of an optimal soft tissue contour. The presence below the threaded channel of the head of the internal hexagon, equal in size to the hexagon on the plug of the implant, simplifies the installation (insertion) of the head and reduces the number of tools in the set of implants.

To fix the crown, a fixing screw with an internal hexagon is used, the dimensions of which (hexagon) coincide with the dimensions of the internal hexagon of the implant head.

One-stage implantation technique (surgical stage)

Since the proposed implant design has sufficient primary fixation force, intraosseous implantation is performed with an early load (early prosthetics) from 1 day to 8 weeks. (A one-stage or two-stage implant design with a head is used).

Under conduction or local anesthesia, without making an incision and peeling of the mucoperiosteal flap with a guide drill, a guide channel in the bone tissue is created through the gum.

Next, cylindrical cutters (drills, reamers), sequentially starting with a smaller diameter and ending with a mill having a diameter equal to the diameter of the implant shaft, create a cylindrical hole having a diameter smaller than the diameter of the implant by the size of its thread profile and by a depth equal to the length of the implant. Then, a conic cutter having a cone angle equal to the cone angle of the cervical part of the implant and a diameter smaller than the diameter of the implant by the size of the thread profile on the cervical part is drilled to a depth equal to the length of the cervical part of the implant, thus creating a bed for the implant. Using a screwdriver (hexagonal or slotted) or adapter, a one-stage implant design is introduced into the bone tissue, creating a metered compression of the bone tissue, cutting the response thread by rotation of the implant and by fixing (stop) the conical cervical part and the neck of the implant into the cortical bone (in the conical bed of the cortical bones). By changing the thread pitch and profile height, compression can be dosed for different types of bones.

When introduced, the implant is immersed in the bone tissue to a predetermined depth, and the ledge of the implant head is at or slightly below the level of the oral mucosa. Then, in the period from 1 to 30 days, an orthopedic stage is carried out, in which casts are taken and the crown is fixed with a screw and / or cement.

As an embodiment, the opening in the gum is first created by a punch (mucotome) or using an electrocoagulator or laser, or using a cutter of maximum diameter, and then drilling and forming the implant bed in the bone tissue is carried out.

If necessary, the method can be performed with peeling of the mucoperiosteal flap, which, after the implant is inserted, is sutured at the level of the gingival part of the implant head.

The use of "tightness" - excessive tightening of the implant will lead to uncontrolled stresses in the cortical and cancellous bone tissue due to excessive immersion of the implant in the bone tissue and the mismatch of the size of the formed bed and the implant.

If excessive compression (compression) of the cancellous bone is not very noticeable, then excessive stress in the cortical bone can lead to a fracture of the alveolar process or jaw.

Therefore, compression is dosed by the parameters of the implant thread and the dimensions (with an appropriate tolerance) of the cutter (drill), with which the implant bed is formed.

The total load should be within the physiological functional loads acting under normal conditions.

So, according to I.S.Rubinov (1970), the compressive force of intact dentitions in the molar region is 80 kgf, and in the region of the front teeth is 40 kgf. According to L.I. Linkow (1990), the average load force is 20 kgf, and the ultimate - 68 kgf. The optimal (for the cancellous bone) thread pitch of the apical part of the implant is 0.75-1.6 mm, the profile height is 0.4-1.0 mm (depending on the type of bone). These thread parameters are optimal for obtaining the necessary fixation force (not less than the force of the acting functional loads) of the implant in the bone tissue.

Claims (17)

1. Dental implant, consisting of interconnected by means of a threaded connection between the intraosseous part with the thread and the extraosseous part or the head of the implant with the internal thread, characterized in that the extraosseous part or the head of the implant contains an internal threaded hole and an internal hexagon along the longitudinal axis. 2. The dental implant according to claim 1, characterized in that the internal hexagon is made at the end of the threaded hole. 3. The dental implant according to claim 1, characterized in that the internal hexagon is made at the beginning of the threaded hole. 4. The dental implant according to claim 1, characterized in that the diameter of the internal hole with a thread has a size of from 1.6 to 2.5 mm, and the size of the hexagon from 1 to 2.5 mm. 5. Dental implant, consisting of interconnected by a threaded connection of the implant head and the intraosseous part, containing the cervical part with the external thread and the apical part made in the form of a self-tapping screw, characterized in that the apical part is made with a thread pitch from 0.7 to 2 , 0 mm and a profile height of 0.3 to 1.2 mm, on the cervical part the thread is multi-start, and the thread progress of the cervical part is equal to the thread course of the apical part, inside the implant on the walls of the landing cone, below the outer edge I made slots, the implant head is made with internal thread and internal hexagon. 6. The dental implant according to claim 5, characterized in that the thread on the apical part is made resistant. 7. The dental implant according to claim 5, characterized in that the thread on the apical part is made trapezoidal. 8. The dental implant according to claim 5, characterized in that the bevel angle of the beveled neck of the cervical part has a value ranging from 0 to as close as possible to 90 °. 9. The dental implant according to claim 5, 6, 7, or 8, characterized in that the intraosseous part has a conical girdle-neck, while the diameter of the thread of the apical part is less than the diameter of the neck of the implant. 10. The dental implant according to claim 5, characterized in that for introducing the intraosseous part into the bone tissue below the landing cone, a hexagon is made. 11. A dental implant consisting of an intraosseous part containing a tapered cervical part with a thread, an apical part made in the form of a self-tapping screw and an extraosseous part with an internal thread, characterized in that the intraosseous part is made integral with the extraosseous, while the apical part is made in the form a self-tapping screw with a pitch of 0.7 to 2.0 mm and a profile height of 0.3 to 1.2 mm, the cervical part contains a multi-thread, the intraosseous part has a crown crown with a female thread al longitudinal axis and internal hexagon. 12. The dental implant according to claim 11, characterized in that the extraosseous part has a gingival part with a step and a crown cone with a straight or cross-shaped slot for introducing the implant into the bone tissue. 13. A dental implant, consisting of an intraosseous part with a thread, containing an internal landing hole and an internal thread, characterized in that slots are made on the walls of the landing hole. 14. The dental implant according to item 13, characterized in that it has two slots located opposite each other. 15. The dental implant according to item 13, characterized in that it has four slots located crosswise. 16. The dental implant according to item 13, or 14, or 15, characterized in that the slots on the walls of the landing cone are made below the outer edge of the hole. 17. The method of intraosseous implantation, characterized in that under local anesthesia, cylindrical cutters through the gum create a cylindrical hole sequentially having a diameter less than the diameter of the implant by the size of its thread profile and by a depth equal to the length of the implant, then drill with a conic cutter to a depth equal to length the cervical part of the implant, creating a bed into which the implant is inserted, cutting the counter thread by rotating the implant and creating compression in the bone tissue, while the implant is immersed to a predetermined depth, then in the period from 1 to 30 days, an orthopedic stage is carried out, in which casts are taken and the crown is fixed.

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