RU2739116C1 - Method for positioning bilge implants and a laser pointer used in the method - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, specifically to dentistry. A cone-beam computed tomography is performed to obtain a tomogram. After the tomogram is examined, the approximate length of the implants and the area of their placement are selected. An incision is made through a crest vertex and a soft tissue detachment. That is followed by determining the exit points of the implants. Ideal position of implants relative to zygomatic bone is considered to be most protruding point of lateral surface, located on conditional line connecting lower-lateral edge of eye socket and angle of lower jaw, this point is determined palpatory. An implant line is considered a line connecting the orthopedic correct position of the abutment multi-unit on the alveolar process and the above point on the zygomatic bone. Further, the implant bed is prepared. Linear laser pointer is used to check the correctness of the intended direction. Besides, it is guided not only by bone structures, but also by points of implants on a zygomatic bone. Preparation of bed is completed by drilling of final cutter on entire design depth. Point laser pointer is used to check correctness of finish cutter direction to preset point of tip exit. That is followed by placing the implants, closing the flaps, taking the casts and taking the X-ray control. Laser indicator is used for positioning of bilge implants, representing L-shaped structure formed by horizontal and vertical bars, which is attached to micromotor. Point laser emitter is fixed at the end of the horizontal bar by means of adjustable articulated joint. A linear laser emitter is fixed on the vertical rod with possibility of movement. At that, rods are connected to each other by means of adjustable articulated joint. Method provides higher accuracy of positioning and placement of implant in thickness of zygomatic bone, reduced deviation from ideal anatomical position due to use of laser pointer. Laser indicator provides orientation of cutting tools in bilge implantation due to linear laser radiator.

EFFECT: group can be used for positioning of bilge implants.

5 cl, 11 dwg

Description

Technology area

The invention relates to medicine, namely to dentistry, and is intended to determine the position of implants in the thickness of the zygomatic bone. The method and device can be used both in planning the operation of zygomatic implantation, and after the installation of implants at the stage of patient rehabilitation.

State of the art

In patients who need zygomatic implantation, it becomes necessary to place the implant in the thickness of the zygomatic bone, taking into account the anatomical features of the individual. Often, the amount of available bone is not so great, which brings additional difficulties in planning, significantly complicates the course of surgery, and dramatically increases the likelihood of both intraoperative and postoperative complications.

Too distal position of the implant can lead to injury to the temporal process and other deviations from the ideal anatomical position. The most common and dangerous complications include penetration of the bottom of the orbit: removal of the cutter or implant through the lower wall of the orbit or the orbital surface of the zygomatic bone.

The problem of positioning and choosing the ideal direction of the implant bed. Due to very limited visibility, a large volume of detached soft tissues and some other anatomical features, including individual ones, it is very difficult to position the implant in a predetermined position using cone beam computed tomography (CBCT).

The difficulty lies in the fact that it is necessary to set the correct direction of drilling at the very beginning of the preparation of the bed. This should be done with a 60 mm or 80 mm cutter, planning both the entry point on the alveolar process of the upper jaw and the exit point on the lateral surface of the zygomatic bone at the same time.

The known method of dental prosthetics (RF patent for invention No. 2494698, class IPC A61C 8/00, publ. 10.10.2013), including computed tomography of the jaw, creating a three-dimensional virtual model of the jaw on the tomogram, making a prosthesis from a polymer material, designing the position of implants in the patient's jawbone and creating a template, and the prosthesis is wrapped with a layer of radiopaque wax to ensure a snug fit to the surface of the prosthesis, and computed tomography of the jaw is carried out together with the prosthesis installed on the mucous membrane of the oral cavity and jaw, a stereolithographic model of the jaw is prototyped with the installation of guide sleeves , the position of which corresponds to virtually spaced dental implants, the prosthesis is fitted onto the prototyped model of the jaw, through the guide sleeves of which holes in the prosthesis are formed in the corresponding positions, then the patient's jawbone is drilled through from holes in the prosthesis, which is used as a surgical conductor for drilling the patient's jawbone, while implants are installed in the holes prepared in this way in the jawbone with their subsequent osteointegration.

In medicine, the use of laser pointers for correction, stimulation, determination of endurance, training of reflexes is known (RF patents for inventions: No. 2712285, publ. 01/28/2020; No. 2699483, publ. 09/05/2019; No. 2489131, publ. 08/10/2013: patents RF for useful models: No. 105164, publ. 10.06.2011; No. 125069, publ. 27.02.2013), as well as to determine the position of the body and its parts in space (RF patent for invention No. 2235975, publ. 09.10.2004). Also described are the design solutions of devices using a laser pointer, for example, to determine the location of the manipulation (RF patent for a useful model No. 58322, published on November 27, 2006) or for use in dental surgery (RF patent for a useful model No. 46174, publ. 27.06 .2005). The technical solutions presented are quite far from the claimed method of positioning zygomatic implants and the laser pointer used in it in terms of essential features and areas of use.

The closest to the invention in terms of the technical essence and the achieved effect is a method for determining the position of dental implants at the stages of rehabilitation of a patient with missing teeth (RF patent for invention No. 2665141, class IPC A61B 5/103, A61C 7/00, publ. 28.08.2018) ... This method consists in performing an X-ray examination of the patient, as a result of which an orthopantomogram of the jaws is obtained; the upper jaw with a shadow of the hard palate, points "C", which are located near the lateral walls of the nasal passage and point "Me" - the lowest point of the symphysis on the chin, on the orthopantomogram of the jaws, as shown in figure 1, mark points "Dzn" and connect them a horizontal line, the obtained segment between the points "Dzn" "Dzn" is divided into two equal segments and the point "K" is obtained, from which the perpendicular is lowered until it intersects with the shadow of the lower edge of the lower jaw and thus the first vertical line is built - the line of the aesthetic center, distance between the points - from "Dzn" to the point "Dzn" divide into three equal segments and points "C" are obtained, the distance from point "Dzn" to point "C" is divided into three equal segments and points "M" and "Pr" are obtained, the distance from point "C" to point "K" is divided into two equal segments and get the point "I", from the points "Dzn", "M", "Pr", "C" and "I" on each side of the upper jaw, the perpendiculars are lowered until they intersect with the shadow of the lower edge of the lower jaw, thus , get guidelines for determining the position of the six permanent teeth of the frontal group of teeth on the upper and lower jaws, namely the central incisors, lateral incisors and canines, as well as four permanent teeth of the lateral segment on the upper and lower jaws on the right and left - the first and second premolar , the first and second molars, with the exception of the third permanent molars, due to their high tendency to rudimentarity, the positioning of dental implants on the upper and lower jaws relative to the obtained landmarks on the right and left is carried out as follows: dental implants of the upper and lower central incisors are placed in the bone tissue of the upper and lower jaws between lines K and I, dental implants of the upper lateral incisors are placed between lines I and C, and implants of the lower lateral incisors are placed on line I, dental implants of the upper jaw canines are placed in the bone tissue on line C, and implants of the canines of the lower jaw mesially from line C, dental implants of the first premolars of the upper jaw are placed mesially from the line Pr, and the first premolars of the lower jaw between lines Pr and C, dental implants of the second premolars on the upper jaw are placed distal from the line Pr, and implants of the lower second premolars are placed on the Pr line, dental implants of the first permanent molars of the upper jaw are placed in the bone tissue from the distal side of the M line and tangent to it, and dental implants of the first permanent molars of the lower jaw are placed on the M line, dental implants of the second permanent molars of the upper jaw installed in the bone tissue neither on the distal side of the Dzn line and tangent to it, and dental implants of the second permanent molars of the lower jaw - on the Dzn line, thus, these lines are landmarks for the installation of dental implants in the absence of teeth on the upper and lower jaws.

The disadvantage of this method is the relatively low accuracy of positioning and placement of the implant in the thickness of the zygomatic bone, which greatly complicates the course of surgery and sharply increases the likelihood of complications.

Disclosure of invention

The technical result of the invention is to improve the accuracy of positioning and placement of the implant in the thickness of the zygomatic bone, reduce deviation from the ideal anatomical position, reduce the likelihood of intraoperative and postoperative complications. The use of a laser pointer to orient the cutting instruments during zygomatic implantation provides a significant reduction in the influence of the human factor during the operation.

The specified technical result is achieved in that the method for positioning the zygomatic implants is as follows: conduct cone-beam computed tomography, as a result of which a tomogram is obtained, after studying which the approximate length of the implants and the area of their placement are selected; an incision is made through the apex of the crest and soft tissue detachment; then determine the exit points of the implants; The ideal position of the implants relative to the zygomatic bone is considered the most protruding point of the lateral surface, located on the conditional line connecting the lower-lateral edge of the orbit and the angle of the lower jaw, this point is determined by palpation; the direction of the implants is the line connecting the orthopedically correct position of the multi-unit abutment on the alveolar ridge and the above-described point on the zygomatic bone; then proceed to the preparation of the implant bed; using a linear laser pointer, check the correctness of the intended direction; and they are guided not only by bone structures, but also by the points of exit of implants on the zygomatic bone; the preparation of the bed is completed by drilling with a finishing mill to the entire calculated depth; using a dot laser pointer, check the correct direction of the finishing cutter to the predetermined exit point of the apex of the implant; then implants are placed, flaps are sutured, casts are taken, and X-ray control is performed.

Immediately before the operation, to determine the projection of the exit point of the implants, it is possible to perform additional cone-beam computed tomography with a pre-applied application of X-ray contrast marks.

To improve visualization of the projection of certain implant exit points, it is possible to apply marks on the skin of the face, the direction of the implant bed can be applied in the form of a mark to the amveolar process and canine fossa. Marks can be applied with a marker or a cosmetic pencil or brilliant green solution.

The specified technical result is achieved by the fact that when positioning the zygomatic implants, a laser pointer is used, representing an L-shaped structure formed by horizontal and vertical rods, which is attached to the micromotor, a point laser emitter is fixed at the end of the horizontal rod with the help of an adjustable hinge connection, on the vertical rod with a linear laser emitter is fixed to be movable, and the rods are connected to each other by means of an adjustable articulated joint.

Brief Description of Drawings

FIG. 1 shows a structural diagram of a laser pointer.

FIG. 2 shows the options for focusing the radiation of the laser pointer depending on the shape of the laser beam: a) laser beam in the form of a plane: a light spot in the form of a line; b) laser beam in the form of a beam: a light spot in the form of a point.

FIG. 3 shows 3D images, in which the laser line shows the surgeon the projection of the working part of the cutter on the surface of the bone structures.

FIG. 4 shows a 3D image, in which the laser line shows the surgeon the projection of the working part of the cutter on the soft tissues of the face.

FIG. 5 is a 3D view in which the laser beam points exactly to the tip of the cutter.

FIG. 6 shows a photo of the stages of the operation: a) an incision through the apex of the ridge; b) detachment of soft tissues.

FIG. 7 is a 3D view showing the determination of the implant exit points.

FIG. 8 shows a photo of the stages of the operation and 3D images: a) drawing the direction of the implant bed; b) preparation of the implant bed; c) checking the correctness of the direction; d) additional orientation by exit points; e) drilling with a finishing mill; f) checking the projection point of the exit.

FIG. 9 shows 3D images of checking the correct drilling direction by deflecting the laser beam.

FIG. 10 shows: a) a photo of the stage of the operation and b) a control X-ray.

FIG. 11 shows a photo and 3D images of the use of X-ray contrast marks: a) the appearance of the application with X-ray contrast marks; b) location on the patient; c) CT scans with X-ray contrast marks; d) additional orientation by the label.

In the figures, the following designations are adopted: 1 - vertical bar, 2 - horizontal bar, 3 - adjustable hinge, 4 - linear laser emitter, 5 - point laser emitter, 6 - bar 1 fastening to the micromotor 7, 8 - surgical handpiece, 9 - cutter for zygomatic implantation.

Implementation of the invention

The solution to the problem of positioning zygomatic implants is achieved with the help of a laser pointer, which shows the projection of the cutter onto the bone structures and soft tissues of the face, and also projects the exit point of the apex of the implant.

The laser pointer is an L-shaped structure formed by horizontal 2 and vertical 1 rods, which is attached to the micromotor 7, at the end of the horizontal rod 2 by means of an adjustable articulated joint 3, a point 5 laser emitter is fixed, on the vertical rod 1, a linear 4 is fixed with the possibility of movement laser emitter, and the rods 1 and 2 are connected to each other by means of an adjustable hinge 3.

The L-shaped design of the laser pointer with two types of lasers, reliable fastening 6 of the pointer to the micromotor 7, allow not only to securely fix the pointers, but also provide for the possibility of attaching additional tools and video equipment.

The method for positioning the zygomatic implants is as follows.

Cone-beam computed tomography is performed, as a result, a tomogram is obtained, after studying the tomogram, the approximate length of the implants and the area of their placement are selected. Next, an incision is made through the apex of the ridge and the detachment of soft tissues (see Fig. 6); then the exit points of the implants are determined (see Fig. 7).

The ideal position of the implants relative to the zygomatic bone is considered the most protruding point of the lateral surface, located on the conditional line connecting the lower-lateral edge of the orbit and the angle of the lower jaw; this point is determined by palpation.

The direction of the implants is the line connecting the orthopedically correct position of the multi-unit abutment on the alveolar process and the above-described point on the zygomatic bone (see Fig. 7a). Next, they begin to prepare the implant bed: using a linear laser pointer, check the correctness of the intended direction; and they are guided not only by the bone structures, but also by the points of exit of the implants on the zygomatic bone.

The preparation of the bed is completed by drilling with a finishing mill to the entire calculated depth. Using a point laser pointer, the correct direction of the finishing cutter to the predetermined exit point of the apex of the implant is checked (see Fig. 7). Then implants are placed, flaps are sutured, impressions are taken, and X-ray control is performed.

Immediately before the operation, to determine the projection of the exit point of the implants, it is possible to carry out additional cone-beam computed tomography with a pre-applied application of X-ray contrast marks (see Fig. 11).

To improve the visualization of the projection of certain implant exit points, it is possible to apply marks on the skin of the face, the direction of the implant bed can also be applied as a mark to the amveolar process and canine fossa. Such marks are applied to the skin with a marker, a cosmetic pencil, a solution of brilliant green, they are drawn on the bone either with a special chemical pencil, or with a simple sterile pencil or a solution of brilliant green.

Variants of using laser pointers during operations for the installation of zygomatic implants - according to the average anatomical indicators.

After studying the CBCT, the approximate length of the implants and the area of their placement are selected. An incision is made through the apex of the ridge (Fig. 6a), detachment of soft tissues (Fig. 6b), determination of the exit points of the implants (Fig. 7).

In most cases, the ideal position of the implants relative to the zygomatic bone is the most prominent points of the lateral surface, located on a conditional line connecting the lower-lateral edge of the orbit and the angle of the lower jaw. These points are determined by palpation and further serve as a guide.

The direction of the implants will be the line connecting the orthopedically correct position of the multi-unit abutment on the alveolar process and the above-described point on the zygomatic bone.

To improve visualization during the operation, it is recommended to apply projections of the points of exit of the implants defined by palpation with a marker, cosmetic pencil, brilliant green solution, or any other available method (Fig. 7).

You can also use this technique - to outline the direction of the implant bed with a sterile pencil directly on the amveolar process and canine fossa (Fig. 8a). Then proceed to the preparation of the implant bed (Fig. 8b). At this stage, the linear pointer helps the surgeon to check the correctness of the intended direction and adhere to it (Fig. 8c).

Moreover, you can navigate not only by bone structures, but also by marks on the skin in the projection of the points of exit of the implants on the zygomatic bone (Fig. 8d).

The preparation of the bed is completed by drilling with a finishing mill to the entire calculated depth. This is the most crucial moment. For complete control at this stage, a point laser pointer is used (Fig. 8e). The Dot Pointer will help you to accurately guide the Finisher to a predetermined projection point for the apex exit.

But no less important, the dot index can practically exclude intraoperative complications, such as penetration of the bottom of the orbit, trauma to the temporal process, etc. To reduce the time of intervention, improve the prognosis of the operation.

As shown in FIG. 9, any deviations in the drilling direction can be immediately followed by the deviation of the laser beam from the projection point on the skin. And the surgeon will be able to change the drilling direction in time

The implant bed is prepared in pre-planned positions (Fig. 10a). All that remained was to place the implants, suture the flaps, take impressions, and prepare the structures for immediate loading. Carry out X-ray control (Fig.10b).

It is possible to use additional methods in the complex of planning the setting of zygomatic implants, such as preoperative X-ray control with the application of X-ray contrast marks (see Fig. 11).

The method is especially indicated for use in patients in whom, due to the structural features, it is impossible to apply the above-described method of average anatomical indicators to determine the direction of the implant and its exit point on the vestibular surface of the zygomatic bone.

At the planning stage, a diagnostic CT scan is performed to assess the condition of the bone tissue and draw up a treatment plan. Immediately before the operation, a second CT scan is performed with a special application of X-ray contrast marks to accurately determine the projection of the implant exit point. Further, the surgeon in the planning program places the zygomatic implant in the anatomically most favorable position. After that, it is possible to determine which of the X-ray contrast marks the axis of the implant goes to. You can mark the skin or platter with a cosmetic pencil, brilliant green solution, or any other method. During the operation, the surgeon can be guided by the mark made and "aim" with the laser pointer at it.

The described method significantly increases the accuracy of creating the zygomatic implant bed, giving the surgeon a reliable and clear guideline during the operation. And it practically negates the possibility of intraoperative complications associated with incorrect positioning of the implant.

Thus, the use of the claimed method and device provides an increase in the accuracy of positioning and placement of the implant in the thickness of the zygomatic bone, a decrease in deviation from the ideal anatomical position; reducing the likelihood of intraoperative and postoperative complications; as well as a significant reduction in the influence of the human factor during the operation.

Comparative analysis of the claimed method and device shows that the totality of their essential features is unknown from the prior art and, therefore, meets the requirement of patentability "Novelty".

In the prior art, no features have been identified that coincide with the distinctive features of the claimed method and device and affect the achievement of the claimed technical result, therefore, the claimed invention complies with the patentability condition "Inventive level".

The above information confirms the possibility of using the claimed method and device in dentistry both when planning a zygomatic implantation operation and after installing implants at the stage of patient rehabilitation, and therefore meets the patentability condition "Industrial applicability".

Claims (5)

1. A method of positioning zygomatic implants, which consists in the fact that a cone-beam computed tomography is performed, as a result of which a tomogram is obtained, after studying which the approximate length of the implants and the area of their placement are selected, an incision is made through the apex of the ridge and the detachment of soft tissues, then the points are determined the exit of implants, the ideal position of implants relative to the zygomatic bone is considered the most protruding point of the lateral surface, located on a conditional line connecting the lower-lateral edge of the orbit and the angle of the lower jaw, this point is determined by palpation, the direction of the implants is the line connecting the orthopedically correct position of the multi-unit abutment on the alveolar ridge and the above-described point on the zygomatic bone, then proceed to the preparation of the implant bed, using a linear laser pointer, check the correctness of the intended direction, and they are guided not only by bone structures, but also by the points of implant exit on the zygomatic bone, the preparation of the bed is completed by drilling with a finishing cutter to the entire design depth, using a point laser pointer, check the correct direction of the finishing cutter to the predetermined exit point of the implant apex, then place the implants, suture the flaps, take impressions, carry out X-ray control. 2. The method according to claim 1, characterized in that immediately before the operation to determine the projection of the exit point of the implants, an additional cone-beam computed tomography is performed with a pre-applied application of X-ray contrast marks. 3. The method according to PP. 1, 2, characterized in that to improve visualization of the projection of certain points of exit of the implants, marks are applied to the skin of the face, the direction of the implant bed is applied in the form of a mark to the amveolar process and canine fossa. 4. The method according to claim 3, characterized in that the marks are applied with a marker or a cosmetic pencil or a brilliant green solution. 5. Laser pointer used for positioning zygomatic implants, representing an L-shaped structure formed by horizontal and vertical rods, which is attached to the micromotor, a point laser emitter is fixed at the end of the horizontal rod by means of an adjustable hinge connection, a linear laser emitter is fixed on the vertical rod with the possibility of movement laser emitter, and the rods are connected to each other by means of an adjustable swivel joint.

Images