RU2794845C1 - Method for virtual simulation of navigational surgical guide for alveolar bone reduction - Google Patents

Abstract

FIELD: medicine; surgical dentistry.

SUBSTANCE: invention relates to medicine, specifically to a method for virtual simulation of a navigational surgical guide for alveolar bone reduction. Convert STL file from the DICOM file of the cone beam computed tomography of the jaw. Simulate radiographic template with teeth support for fixing navigational surgical guide for reduction of alveolar bone in oral cavity. Virtually insert dental implants and fixing pins. Perform virtual teeth removal. Then design a guide and virtually reduce alveolar bone. Make adjustments according to the level of alveolar bone reduction, while the upper edge of the guide must correspond to the level of alveolar bone reduction. Then the lodgements are simulated, which are the support for counterparts on the radiographic template and on the navigational surgical guide on the dental prostheses. Then, print guide for alveolar bone reduction with lodgements, radiographic template with counterparts, navigational surgical guide for shaping areas for dental implants insertion with counterparts with a 3D printer, and survey dental prostheses with counterparts.

EFFECT: increased accuracy of alveolar bone reduction, reduced risk of intraoperative complications, reduced time of surgical intervention, facilitated postoperative period for the patient.

1 cl, 16 dwg

Description

The invention relates to medicine, namely to surgical dentistry, and can be used in the treatment of patients using a navigational surgical template.

The result of the influence of phylogenetic factors is the reduction of the masticatory apparatus. In the course of evolution, the individual parts of a functional system must change together. When the elements of the dentoalveolar system are reduced at different rates, this leads to the formation of various anomalies due to the discrepancy between the number and size of teeth and the size of the jaws. (P.V. Ivanov, O.V. Kalmin, I.V. Malanin, L.A. Zyulkina, G.V. Emelina, E.N. Shastin THE RELEVANCE OF THE STUDY OF ODONTOMETRIC INDICATORS AND THE PROBLEMS OF REDUCTION OF THE MUSTERING APPARATUS DEPENDING ON SOMATO - AND CEFALOTYPE AMONG THE POPULATION OF THE PENZA REGION // Modern problems of science and education. - 2009.)

It is generally accepted that after extraction, up to 40-60% of the original width and height of the alveolar process are lost, and a large resorption occurs in the first year after extraction (50% of the vestibulo-oral size, and the loss from the vestibular side is twice as much as from the palatine).

Before prosthetics, the irregularities of the alveolar ridge are removed or the shape of the jawbone is changed for prosthetic and cosmetic purposes. During this surgical procedure, the bony edges of the alveolar process and the structures surrounding it are smoothed, modified or restored in such a way that an aesthetic prosthesis can be made. This surgical procedure prepares the oral cavity for the installation of an aesthetic prosthesis, improves the strength characteristics of the prosthetic construction and the quality of the supporting parts so that they can provide support, better retention and stability of the prosthesis.

There is a known method of reducing the alveolar ridge during the restoration of the dentoalveolar complex with simultaneous dental implantation, where the mucous membrane is peeled from the alveolar ridge to the required level, then the teeth are removed, then the alveolar ridge is reduced, after which dental implantation is performed followed by the installation of an orthopedic structure (patent RU 2777401, A61C 8/00, 08/03/2022).

The disadvantages of this method are the duration and inaccuracy of the reduction of the alveolar process, the inability to achieve a high aesthetic effect.

A known method of reduction of the alveolar process using a surgical navigation template when restoring the dentoalveolar complex with simultaneous dental implantation, with temporary prosthetics, while before installing dental implants, teeth are removed, then a template for reduction is installed, then the alveolar ridge is reduced. (Simplifying Full-Arch Treatment With In-House 3D-Printed Surgical Guides and Immediate Fixed Provisional Prostheses Using Only CBCT Data, Rick Ferguson, DMD, November 15, 2020 Issue - Expires Sunday, December 31st, 2023 Compendium of Continuing Education in Dentistry) .

The disadvantages of this method are the inaccurate positioning of the template for reduction, since with this method there is no positioning template that accurately positions the template for reduction.

The problem to be solved by the invention is to eliminate the defects of the alveolar ridge and give higher aesthetic indications when installing an orthopedic structure using a surgical navigation template for reduction.

The technical result of the invention is to increase the accuracy of the reduction of the alveolar process, the method is carried out without damaging the important anatomical structures of the patient, in this regard, the risk of intraoperative complications is reduced, the time of surgical intervention is reduced, the postoperative period is facilitated in the patient, the aesthetics of the orthopedic structure are improved. A fixed orthopedic structure is installed on the day of surgery.

The specified technical (therapeutic) result in the claimed method of modeling a navigational surgical template for the reduction of the alveolar process when restoring a complete dentition in one day is achieved by using a program from a cone beam computed tomography (DICOM file) of the jaw to receive an STL file, then virtually model tooth-supported positioning template for fixing the navigational surgical template in the correct position for reduction of the alveolar process in the oral cavity. Then, dental implants and fixators of the navigational surgical template for pina reduction are virtually installed, virtual teeth are extracted, then the navigational surgical template is virtually designed, then the alveolar process is virtually reduced, taking into account the anatomical features of the jaw and the position of the virtually installed dental implants. According to the level of reduction of the alveolar process, the navigational surgical template is corrected, while the upper edge of the navigational surgical template must correspond to the level of reduction of the alveolar process, after which the lodgements are virtually modeled, which are the support for the mating parts on the positioning template, on the navigational surgical template, on the orthopedic structure. A 3D printer is used to print a template for reduction of the alveolar process with cradles, a positioning template with mates, a navigational surgical template for forming cavities for the installation of dental implants with mates, after which an orthopedic structure with mates is milled. A fixed orthopedic structure is installed on the day of surgery.

This method is illustrated with images reflecting

the sequence of the proposed method, where:

Fig. 1 - cone beam computed tomography (DICOM file);

Fig. 2 - STL file of the jaw;

Fig. 3 - positioning template based on teeth;

Fig. 4 - virtual installation of dental implants and pins fixing the template;

Fig. 5 - virtual extraction of teeth;

Fig. 6 - virtual design of the navigational surgical template;

Fig. 7 - virtual reduction of the alveolar process;

Fig. 8 - correction of the navigational surgical template;

Fig. 9 - modeling of lodgements;

Fig. 10 - positioning template;

Fig. 11 - navigational surgical template;

Fig. 12 - orthopedic structure;

Fig. 13 - template for the reduction of the alveolar process with lodgements;

Fig. 14 - positioning template with counterparts;

Fig. 15 - navigational surgical template for the formation of lodges for the installation of dental implants with mating parts;

Fig. 16 - orthopedic structure with counterparts.

In practice, the method is carried out as follows.

Using the program from the cone beam computed tomography (DICOM file) (Fig. 1), the jaws receive an STL file (Fig. 2), then a positioning template (Fig. 3) is virtually modeled with support on the teeth to fix the navigational surgical template in the correct position for the reduction of the alveolar process in the oral cavity. The dental implants are then virtually placed and the fixation of the navigational surgical template for the reduction of the pina (Fig. 4). Virtual tooth extraction is performed (Fig. 5), then a virtual design of a navigational surgical template is performed (Fig. 6), then the alveolar process is virtually reduced (Fig. 7), taking into account the anatomical features of the jaw and the position of the virtually installed dental implants. According to the level of reduction of the alveolar process, the navigational surgical template is corrected (Fig. 8), while the upper edge of the navigational surgical template must correspond to the level of reduction of the alveolar process, after which the lodgements are virtually modeled (Fig. 9), which are the support for the mating parts on the positioning template ( Fig. 10), on the navigational surgical template (Fig. 11), on the orthopedic structure (Fig. 12). The following is printed on a 3D printer: a template for the reduction of the alveolar process with lodgements (Fig. 13), a positioning template with mates (Fig. 14), a navigational surgical template for forming beds for the installation of dental implants with mates (Fig. 15), after which mill the orthopedic structure with counterparts (Fig. 16).

The method proposed by the authors allows to accurately carry out the pre-planned reduction of the jaw without damaging the important anatomical structures of the patient, in this regard, the risk of intraoperative complications is reduced, the time of surgical intervention is reduced, and the postoperative period in the patient is facilitated. This surgical procedure prepares the oral cavity for the installation of an aesthetic prosthesis, improves the strength characteristics of the prosthetic construction and the quality of the supporting parts so that they can provide support, better retention and stability of the prosthesis.

The essence of the invention is illustrated by clinical examples.

Clinical example No. 1.

Patient L., 49 years old, came to the clinic on February 10, 2022 with a complaint of

partial absence of teeth, tooth decay aesthetic defect A comprehensive examination was carried out. With the help of the program from the cone-beam computed tomography, an STL file was obtained, then a positioning template based on the teeth was virtually modeled to fix the navigational surgical template for the reduction of the alveolar process in the oral cavity in the correct position, then the dental implants and fixing the navigational surgical template for reduction were virtually installed pins, carried out a virtual extraction of teeth, then carried out a virtual design of a navigational surgical template, then a virtual reduction of the alveolar process was carried out, taking into account the anatomical features of the jaw and the position of the virtually installed dental implants; according to the level of reduction of the alveolar process, the navigation surgical template was corrected, after which the lodgements were virtually modeled, which are the support for mating parts on the positioning template, on the navigation surgical template, on the orthopedic structure, the following was printed on a 3D printer: a template for the reduction of the alveolar process with lodgements, positioning a template with mates, a navigational surgical template for the formation of beds for the installation of dental implants with mates, an orthopedic structure with mates is milled. The patient was given local anesthesia. Holes were formed in the bone tissue using a template for forming holes for the installation of pins and this template was removed. Spent exfoliation of the mucous membrane from the alveolar ridge on the lower jaw to the required level. After that, the reduction template with lodgements was positioned using the tooth-supported positioning template, after which this template was removed. Low-traumatic extraction of teeth 3.5, 3.4, 3.3, 3.2, 3.1, 4.3, 4.4, 4.5, 4.6 was performed. The reduction of the lower jaw was carried out according to the level of the modeled template. A template for the formation of lodges and the installation of dental implants to the template for reduction with lodgements using mating parts is fixed. The bone tissue was drilled in order to prepare the beds and install dental implants, after which this template was removed. Dental implants are installed in positions 3.4, 3.2, 4.2, 4.4. After that, a reduction template with lodgements was removed from the oral cavity. Healing took place without complications. On the day of the operation, a fixed orthopedic structure was installed.

Clinical example No. 2.

Patient M., 58 years old, came to the clinic on 01/08/2022 with a complaint of

partial absence of teeth, tooth decay and aesthetic defect. A comprehensive examination has been carried out. Using the program, an STL file was obtained from cone-beam computed tomography, then a positioning template was virtually modeled based on the teeth to fix the navigational surgical template in the correct position for reduction of the alveolar process in the oral cavity. Then, dental implants and fixators of the navigational surgical template for pina reduction were virtually installed, virtual tooth extraction was performed, then the navigational surgical template was virtually designed, then the alveolar process was virtually reduced, taking into account the anatomical features of the jaw and the position of the virtually installed dental implants. According to the level of reduction of the alveolar process, the navigational surgical template was corrected, after which the lodgements were virtually modeled, which are the support for the mating parts on the positioning template, on the navigational surgical template, on the orthopedic structure. The following was printed on a 3D printer: a template for the reduction of the alveolar process with lodgements, a positioning template with mates, a navigational surgical template for the formation of beds for the installation of dental implants with mates, and an orthopedic structure with mates was milled. The patient was given local anesthesia. Holes were formed in the bone tissue using a template for forming holes for the installation of pins and this template was removed. Spent exfoliation of the mucous membrane from the alveolar ridge on the lower jaw to the required level. After that, the reduction template with lodgements was positioned using the tooth-supported positioning template, after which this template was removed. A low-traumatic extraction of teeth 1.6, 1.4, 1.1, 2.3, 2.7 was performed. The lower jaw was reduced according to the level of the modeled template. The template for the formation of lodges and the installation of dental implants was fixed to the template for reduction with lodgements using mating parts. The bone tissue was drilled in order to prepare the beds and install dental implants, after which this template was removed. Dental implants are installed in positions 1.4, 1.2, 2.2, 2.4. After that, a reduction template with lodgements was removed from the oral cavity. Healing took place without complications. On the day of the operation, a fixed orthopedic structure was installed.

Clinical example No. 3.

Patient Yu., 65 years old, came to the clinic on March 1, 2022 with a complaint of

partial absence of teeth, tooth decay and aesthetic defect. A comprehensive examination has been carried out. Using the program, an STL file was obtained from cone-beam computed tomography, then a positioning template was virtually modeled based on the teeth to fix the navigational surgical template in the correct position for reduction of the alveolar process in the oral cavity. Then, dental implants were virtually installed and fixing the navigational surgical template for pina reduction, virtual tooth extraction was performed. Then, a virtual design of the navigational surgical template was carried out, then the alveolar process was virtually reduced, taking into account the anatomical features of the jaw and the position of the virtually installed dental implants. According to the level of reduction of the alveolar process, the navigational surgical template was corrected, after which the lodgements were virtually modeled, which are the support for the mating parts on the positioning template, on the navigational surgical template, on the orthopedic structure. The following was printed on a 3D printer: a template for the reduction of the alveolar process with lodgements, a positioning template with mates, a navigational surgical template for the formation of beds for the installation of dental implants with mates, after which the orthopedic structure with mates was milled. The patient was given local anesthesia and formed holes in the bone tissue using a template for the formation of holes for the installation of pins and this template was removed. Spent exfoliation of the mucous membrane from the alveolar ridge on the lower jaw to the required level. After that, the reduction template with lodgements was positioned using the tooth-supported positioning template, after which this template was removed. A low-traumatic extraction of teeth 4.3, 4.2, 4.1, 3.1, 3.2, 3.3, 3.4, 3.7 was performed. The reduction of the lower jaw was carried out according to the level of the modeled template. A template for the formation of lodges and the installation of dental implants to the template for reduction with lodgements using mating parts is fixed. The bone tissue was drilled in order to prepare the beds and install dental implants, after which this template was removed. Dental implants are installed in positions 4.6, 4.4, 4.2, 3.2, 3.4, 3.6. After that, a reduction template with lodgements was removed from the oral cavity. Healing took place without complications. On the day of the operation, a fixed orthopedic structure was installed.

Claims (1)

A method for virtual simulation of a navigational surgical template for reduction of the alveolar process when restoring a complete dentition, which consists in the fact that using a program from a DICOM file of cone-beam computed tomography of the jaw, an STL file is obtained, then a positioning template is virtually simulated based on teeth to fix the navigational surgical template for reduction of the alveolar process in the oral cavity, then dental implants and fixing the navigational surgical template for pina reduction are virtually installed, virtual tooth extraction is performed, then the navigational surgical template is virtually designed, then the alveolar process is virtually reduced taking into account the anatomical features of the jaw and the position virtually installed dental implants; according to the level of reduction of the alveolar process, the navigational surgical template is corrected, while the upper edge of the navigational surgical template must correspond to the level of reduction of the alveolar process, after which the lodgements are virtually modeled, which are the support for the mating parts on the positioning template, on the navigational surgical template on the orthopedic structure, after which a 3D printer prints a template for reduction of the alveolar process with cradles, a positioning template with mates, a navigational surgical template for the formation of beds for the installation of dental implants with mates, and mills an orthopedic structure with mates, a fixed orthopedic structure is installed on the day of surgery.

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