RU2798668C1 - Method of accurate insertion of a microimplant during orthodontic or dental operations, a device for its implementation and an individual device template - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to a method of introducing a microimplant during orthodontic or dental operations, a device for its implementation and an individual device template. When implementing the method, computed tomography is performed, a 3D model of the jaw is built, according to which a cap-shaped template is made, equipped with a guide hole for inserting a microimplant. A template is installed in the oral cavity and a microimplant is inserted through the guide hole due to the rotation of the implant driver. The rotation of the implant driver and the insertion of the microimplant is stopped as a result of the electrical circuit closing, which occurs when the surface of the implant driver comes into contact with the contact metal pad, automatically or in manual mode when a light and/or sound signal occurs as a result of the circuit. The device is equipped with a power source, a signal or disconnecting element and contact wires.

EFFECT: maximum accuracy in the installation of implants or microimplants is achieved simultaneously in direction and depth during orthodontic or dental operations.

7 cl, 9 dwg

Description

SUBSTANCE: invention relates to medicine, namely to dental surgery, and can be used for accurate placement of microimplants, including orthoimplants or dental implants, using an implant driver, in the treatment of patients with dental anomalies.

Dental surgery usually involves the placement of a dental micro-implant. A dental microimplant can be a dental implant or, for example, a mini-screw for attaching orthodontic appliances. Placement of a dental microimplant requires a high degree of accuracy in terms of final location, axial orientation, and depth of final microimplant placement.

For accurate installation of a dental microimplant in the patient's oral cavity, a surgical template is used, adapted to the patient's oral cavity and equipped with a protrusion with a guide hole to accommodate, for example, an implant driver. At the same time, it is important to observe the specified screwing depth of the dental microimplant. Usually this is achieved due to the fact that the implant driver, with which the dental microimplant is screwed, is provided with a ledge that abuts against the end of the protrusion of the guide hole in a predetermined position.

The greatest difficulty is caused by the limited space of the surgical operation, as well as the difficulty of visual observation by the doctor performing the operation. The moment of touching the ledge of the implant driver with the protrusion of the guide hole usually has to be determined either tactilely, which sharply reduces accuracy, or visually, which is often inconvenient. If the surgeon stops the rotation of the implant driver before the moment of touching, the dental microimplant will be screwed in to a depth less than required, if the surgeon continues to rotate the implant driver after touching, the dental microimplant will either be screwed in to a depth greater than required, due to axial displacement relative to the implant driver, or it will scroll in place and excessively destroy the bone, working like a cutter.

Patent CN 211834804 (prior. 12/13/2019) proposes a "Replaceable Bone Drilling Guide for Dentist", which, for the purpose of observing depth, contains a positioning guide tube and is characterized in that one side of the positioning guide tube is provided with a movable locking structure on one side of the outer surface. The second outer surface of the positioning guide cylinder is provided with a second movable locking structure, and the outer surface of the front end of the positioning guide cylinder is provided with a depth observation device, which is essentially a longitudinal groove located on the wall of the guide cylinder. The disadvantage of the proposed design is the need for visual observation of the positioning depth of the instrument screwed into the bone, determined by the depth scale located on the device, which is often difficult. Also, the accuracy of the axial positioning of the guide hole is very low, as it depends on the attachment of the device to adjacent teeth.

The closest analogue, selected as a prototype for the claimed invention, is a utility model according to the patent of the Russian Federation No. 177272 (Prior: 09/04/2017, publ.: 02/14/2018), which describes a surgical template for installing implants, containing a splint, an inner surface which is congruent to the surface of the teeth of the corresponding jaw of the patient and the mucous membrane of the alveolar process adjacent to them. At the same time, the splint is made in accordance with the anatomical features of the patient's teeth by 3D prototyping based on preliminary computer planning of implant placement according to computed tomography data and with the possibility of rigid fixation on the patient's teeth. The tire has holes, the number of which and the location corresponds to the implant installation plan. At the same time, guide metal bushings are installed in the holes, positioned in accordance with the results of computer planning. Moreover, the tire is made for the entire dentition. On the vestibular side of the tire, in each guide bushing and in the corresponding part of the tire, a common vertical recess is made, which is limited from below by a semi-cylinder with a generatrix length equal to 1 mm, and the guide bushings are made with the possibility of placing replaceable bushings in them.

The proposed utility model allows to solve the problem of reducing the requirement for the width of the mouth opening by the patient while ensuring the fixation of the position of the cutting tool, and improve the accuracy of the axial positioning of the guide hole by making an individual template for a particular patient. However, there remains a disadvantage associated with the difficulty in determining the moment when the rotation of the implant driver stops, since the installed metal tubes make it difficult to visualize the operation process, which does not guarantee the exact insertion of microimplants in depth during orthodontic or dental operations.

The objective of the invention is to simplify the technology for the precise insertion of implants or microimplants in depth during orthodontic or dental operations.

The technical result is the achievement of maximum accuracy in the installation of implants or microimplants simultaneously in direction and depth during orthodontic or dental operations.

The problem is solved, and the technical result is achieved by the fact that for the precise introduction of microimplants during orthodontic or dental operations, a method is used, which consists in performing a computed tomography of the patient. A 3D model of the patient's jaw is built, according to which an individual template is made in the form of a cap, equipped with at least one guide hole for introducing a microimplant, located and directed in accordance with the treatment plan chosen by the doctor. The template is installed in the patient's oral cavity. A microimplant is inserted through the guide hole by rotating the implant driver installed on the microimplant. In this case, the rotation of the implant driver and the insertion of the microimplant stops as a result of the electrical circuit closing, which occurs when the protruding surface of the implant driver comes into contact with the contact metal plate located on the end surface of the protrusion of the template with the guide hole located in it for inserting the microimplant, automatically. Or the insertion of the microimplant is stopped when a light and/or sound signal occurs as a result of a short circuit.

Also, the problem is solved, and the technical result is achieved by the fact that the device for implementing the method of inserting a microimplant during orthodontic or dental operations contains an individual template in the form of a kappa, made according to a 3D model of the patient's jaw. The individual template is made with the possibility of installation in the oral cavity and is provided with at least one guide hole for introducing a microimplant, located and directed in accordance with the treatment plan chosen by the doctor. Also, the device contains an implant driver, made with the possibility of placement in the guide hole and intended for the introduction of microimplants. In this case, the device is provided with electrically interconnected power source of the device, a signal or disconnecting element and contact wires connecting the electrically conductive end of the implant driver and a metal plate located on the end surface of the template protrusion with a guide hole located in it for introducing the microimplant.

In a particular case, an apex locator can be used as a current source and a signaling device emitting a light and sound signal.

Also, a light source or a sound source can be used as a signaling device.

Also, the problem is solved, and the technical result is achieved by the fact that the individual template of the device for implementing the method of inserting a microimplant during orthodontic or dental operations is made in the form of a cap according to a 3D model of the patient's jaw, with the possibility of fixing it in the patient's oral cavity. The individual template is provided with at least one guide hole for introducing the microimplant, located and directed in accordance with the treatment plan chosen by the doctor. At the same time, on the end surface of the protrusion of the template with a guide hole located in it for inserting a microimplant, a metal plate is installed, made with the possibility of connecting a contact wire to it.

In a particular case, the guide hole for introducing the microimplant is provided with a longitudinal groove located in the wall of the guide hole.

The use in the proposed method of an individual template, equipped with at least one guide hole for introducing a microimplant, located and directed in accordance with the treatment plan chosen by the doctor, makes it possible to simplify the procedure for inserting a microimplant.

The insertion of a microimplant along the guide hole made in the template due to the rotation of the implant driver makes the insertion procedure much easier, for example, in comparison with the mechanical insertion of the microimplant.

Termination at the moment of receiving a signal about the contact of the protruding end of the implant driver with a contact metal plate located on the end surface of the guide hole, allows you to almost instantly stop the rotation of the implant driver and the insertion of the microimplant. Thus, the microimplant is installed simply and as accurately as possible in depth and direction in accordance with the treatment plan chosen by the doctor.

It should be noted that the rotation of the implant driver can be stopped and the microimplant can be inserted both by a sound and/or light signal received as a result of contact of the protruding end of the implant driver with a contact metal plate located on the end surface of the guide hole, and in automatic mode, for example, when using a relay , opening the power supply circuit of the implant driver.

The fact that the claimed device is equipped with electrically interconnected power source of the device, a signaling device and contact wires connecting the electrically conductive end of the implant and a metal plate located on the end surface of the guide hole of the individual template, allows you to use a technology that most simply introduces microimplants in depth during orthodontic or dental operations. Connected between the power source of the device, the signaling device and the contact wires attached to the electrically conductive end of the implant driver and the metal plate located on the end surface of the guide hole, make it possible to create an electrical circuit and receive the necessary signal about the contact between the end of the implant driver and the metal plate. And the specified contact allows you to determine that the microimplant has reached the depth of location specified in accordance with the treatment plan chosen by the doctor.

It is convenient and easy to use the apex locator as a current source and a signaling device that emits a light and sound signal, since this device is already equipped with everything necessary, and it is only necessary to connect its contact wires to the electrically conductive end of the implant driver and the metal plate located on the end surface of the guide hole.

The use of an individual template in a device for implementing the method for accurate insertion of microimplants during orthodontic or dental operations fixed in the patient's mouth, made according to the model of the patient's jaw in the form of a cap, also makes it possible to simplify the technology for accurate insertion of microimplants in depth. Each guide hole for microimplant insertion, pre-made in an individual template, is located and directed in accordance with the treatment plan chosen by the doctor. A metal pad with a tap for connecting a contact wire to it is installed on the end surface of the guide hole. This allows you to create an electrical circuit necessary for the operation of the proposed device, and receive a signal about the contact of the end face of the implant and the metal lining.

A longitudinal groove located in the wall of the guide hole for inserting microimplants makes it possible to simplify the process of installing a microimplant, since the patient does not need to open his mouth wide when inserting a microimplant with an implant driver into the guide hole.

In the following, the claimed invention is explained by a detailed description of a specific, but not limiting, present solution, an example of its implementation and the accompanying drawings, in which:

- figure 1 - a variant of the device for implementing a method for the precise introduction of microimplants in orthodontic or dental operations;

- fig. 2 - a variant of an individual device template for implementing the method;

- fig. 3 - a variant of an individual device template for implementing the method;

- fig. 4 - a variant of an individual device template for implementing the method;

- fig. 5 - scheme of operation of the device for implementing the method of precise insertion of microimplants during orthodontic or dental operations;

- fig. 6 - electric circuit of the device when using light signaling;

- fig. 7 - electric circuit of the device operation when using a sound alarm;

- fig. 8 - electric circuit of the device when using light and sound signaling;

- fig. 9 - electrical diagram of the device with automatic opening of the power circuit of the implant driver.

One of the possible variants of the device for implementing a method for the precise introduction of microimplants during orthodontic or dental operations, in a specific case using an apex locator as an executive signaling device, is shown in Fig.1.

The device shown in figure 1, consists of an individual template 1 with a metal plate 2, the implant 3, the first contact wire 4 connected to terminal 5 (shown in figure 5) of the metal plate 2, the second contact wire 6 connected to the implant 3 through the contra-angle, and the executive signaling device 7, which in the presented version is the apex locator. Here and in the following description, implant driver 3 means an assembled system consisting of a rotating device, which in a specific example is a contra-angle, with implant driver 3 installed in it, and these elements have a conductive connection.

In FIG. 2 and 3 shows an individual template 1 with two guide holes 8 located side by side, on the ends of which there is one metal plate 2. In FIG. 4 shows a variant of an individual template 1 with two spaced guide holes 8, at the ends of each of which there is a metal plate 2.

Each guide hole 8 in the presented variants is provided with a longitudinal groove 9 located in the wall of the guide hole 8, which makes it possible to simplify the process of installing the microimplant 10, since the patient does not need to open his mouth wide when inserting the microimplant 10 with the implant driver 3 into the guide hole 8. This action produced by lateral insertion of the microimplant 10 through the groove 9.

A detailed description of the manufacturing process of the individual template 1 is given below and is illustrated in FIG. 5.

In Fig.5, the letters indicate:

d is the diameter of the working part of the implant driver 3;

D is the diameter of ledge 11 of implant driver 3;

L is the length of the working part of the implant driver 3 (from its end face with the installed microimplant 10 to the ledge 11 of the implant driver 3);

S is the thickness of the metal lining 2 of template 1;

D ₂ is the outer diameter of the protrusion 12 with the guide hole 8 of the template 1;

d ₁ is the inner diameter of the metal lining 2 of template 1;

D ₁ is the outer diameter of the metal lining 2 of template 1.

The manufacturing process of an individual template 1 consists of the following sequential steps.

Select the required size of microimplants 10, their position on the jaw and the depth of their screwing, based on the shape of the patient's jaw, computed tomography data.

Select the size of the implant driver 3. According to the selected size, the parameters d, D, L are determined.

The position of the ledge plane 11 of the implant guide 3 is set in accordance with the required position of the microimplant 10. The plane of the ledge 11 of the implant guide 3 is offset by L from the end face of the implant guide 3, which is in the final position with the microimplant 10 inserted into it.

Choose the dimensions of the metal plate 2 template 1:

d ₁ = d + 2Δ ₁ , where Δ ₁ is the required gap between the working part of the implant driver 3 and the metal plate 2 of the template 1, from 0.2 to 0.5 mm.

D ₁ \u003d D + 2Δb, where Δb is the margin of the width of the metal lining 2 of template 1. As a result, the width of the metal lining 2 of template 1 equal to (D ₁ - d ₁ ) / 2 must be at least 1.5 ... 2 mm.

The thickness S of the metal lining 2 is selected based on the method of its manufacture and the specific metal so that it has sufficient strength and rigidity.

The position of the metal plate 2 of the template 1 is set in accordance with the required position of the microimplants 10 so that they are coaxial with the microimplant 10 and, accordingly, with the implant driver 3, and also that they come into contact with the ledge 3 of the implant driver 3.

Set the dimensions of the protrusion 12 of template 1:

D ₂ \u003d D ₁ + 2Δ2, where Δ2 is the margin for the width of the ends of the protrusion 12 of template 1. Δ2 can be zero, but it must be borne in mind that the resulting size D ₂ must provide sufficient wall thickness for the protrusion 12 of template 1. Thus, the size D ₂ can be choose to ensure the strength of the protrusion 12 of the template 1 and check that it will not be less than D ₁ .

The position of the protrusion 12 of the template 1 is set, based on the fact that the protrusion 12 of the template 1 is located coaxially with the microimplant 10 and its working end is aligned with the lower end of the metal plate 2 of the template 1. final position and from the outer surface of the metal lining 2 of the template 1 by the value S.

The custom template 1 can be designed and manufactured based on specific patient data obtained by, for example, magnetic resonance imaging (MRI), x-ray computed tomography (X-ray computed tomography) or cone-beam computed tomography (CBCT). Based on the data obtained, an accurate 3D image of the bone and/or jawbone and/or dentition and/or oral tissues of the patient is built, which can be used for planning a surgical operation, namely to determine the desired position, orientation and depth of the microimplant. Based on the data obtained, the position of the protrusion 12 with the guide hole 8 located in it is determined.

Thus, using a computer program, a 3D model of the template 1 body adjacent to the teeth and/or mucous membrane is created and combined with the calculated position of the protrusion 12 of the template 1.

According to the obtained 3D model, template 1 is produced from the polymer.

The fixation of the metal lining 2 of the template 1 can be carried out, for example, using pins located on their back side, in contact with the end face of the protrusion 12 of the template 1, not shown in the drawings. For these pins, holes are made at the end of the protrusion 12 of template 1. If there are two or more pins, the metal plate 2 of the protrusion 12 of the template 1 will be positioned in the desired position. Its fixation is carried out due to the fact that the holes at the end of the protrusion 12 of the template 1 make it smaller than the nominal diameter of the pins. The pins of the metal lining 2 of the template 1 are pressed into the holes at the end of the protrusion 12 of the template 1.

Variants of electrical circuits of the executive signaling device 7 are shown in Fig.6, 7, 8 and 9. Fig.6 shows a diagram with a light signaling device, which, for example, can be used as an LED 13. Fig.7 shows a diagram with a sound a signaling device, which, for example, can be used as a piezoelectric emitter 14. Figure 8 shows a diagram with light and sound signaling devices installed in parallel. An example would be an apex locator.

In all the described schemes, the signal occurs when the first contact wire 4 connected to terminal 5 of the metal plate 2 is closed, and the second contact wire 6 connected to the implant driver 3 through the contra-angle.

In the scheme shown in Fig. 9, when the first contact wire 4, connected to the output 5 of the metal plate 2, and the second contact wire 6, connected to the implant driver 3 through the contra-angle, are closed, the signal is sent to the relay 15, which, when triggered through the actuating element 16, breaks the circuit supplying the motor 17 , for example, a physiodispenser that rotates the implant driver 3.

For accurate insertion of the microimplant 10 during orthodontic or dental operations using the proposed device, it is necessary to perform the following operations, see Fig.1. In the specific example shown in figure 1, an apex locator is used as an actuating signaling device 7.

Insert the microimplant 10 into the implant driver 3. Fix the second contact wire 6 on the contra-angle, into which the implant driver 3 is inserted.

Install individual template 1 in the patient's mouth.

Attach the first contact wire 4 of the signaling device 7 to terminal 5 of the metal patch 2. Press the template 1 against the patient's teeth to make sure that the individual template 1 is correctly installed.

Insert the microimplant 10 through the longitudinal groove 9 into the guide hole 8 and center the implant driver 3 in the guide hole 8. disabling the physiodispenser rotating the implant driver 3.

Remove the implant guide 3 from the guide hole 8 of the individual template 1.

If there is more than one guide hole 8 or two paired guide holes 8 with combined metal plates 2, install the microimplants 10 in the still free guide holes 8 of the individual template 1 in the same way.

The method proposed in the invention for the precise insertion of microimplants, as well as the device for its implementation and the individual template of the device, can be used in various orthodontic or dental operations, such as:

- for the installation of palatal mini-screws for fixing orthodontic appliances;

- to install miniscrews in the retromolar area and between the roots of the teeth;

- for the installation of dental implants.

The invention as a whole makes it possible to simplify the technology of accurate insertion of microimplants in depth during orthodontic or dental operations.

At the same time, the set technical result is guaranteed to be achieved, namely, the maximum accuracy of the installation of microimplants simultaneously in direction and depth during orthodontic or dental operations.

Claims (7)

1. The method of introducing a microimplant during orthodontic or dental operations, which consists in performing a computed tomography of the patient, building a 3D model of the patient's jaw, which is used to make an individual template in the form of a cap, equipped with at least one guide hole for introducing the microimplant, located and directed in accordance with the treatment plan chosen by the doctor, a template is installed in the patient's oral cavity and a microimplant is inserted through the guide hole due to the rotation of the implant driver installed on the microimplant, characterized in that the rotation of the implant driver and the insertion of the microimplant stops as a result of an electrical circuit that occurs when the protruding surface comes into contact of the implant driver with a contact metal plate located on the end surface of the template protrusion with a guide hole for microimplant insertion located in it, automatically, or the insertion of the microimplant is stopped when a light and/or sound signal occurs as a result of a short circuit. 2. A device for implementing a method for introducing a microimplant during orthodontic or dental operations according to claim 1, containing an individual template in the form of a mouth guard, made according to a 3D model of the patient's jaw, configured to be installed in the oral cavity and equipped with at least one guide hole for insertion a microimplant located and directed in accordance with the treatment plan chosen by the doctor, an implant driver capable of being placed in the guide hole and intended for the introduction of microimplants, characterized in that the device is equipped with an electrically interconnected power source of the device, a signal or disconnecting element and contact wires, connecting the electrically conductive end of the implant and a metal plate located on the end surface of the protrusion of the template with a guide hole located in it for introducing the microimplant. 3. The device according to claim 2, characterized in that an apex locator is used as a signal element. 4. The device according to claim 2, characterized in that a light source is used as a signal element. 5. The device according to claim 2, characterized in that a sound source is used as a signal element. 6. An individual device template for implementing the method of inserting a microimplant during orthodontic or dental operations according to claim 1, made in the form of a cap according to a 3D model of the patient's jaw, with the possibility of fixing in the patient's oral cavity, equipped with at least one guide hole for inserting a microimplant, located and directed in accordance with the treatment plan chosen by the doctor, characterized in that on the end surface of the protrusion of the template with a guide hole located in it for introducing the microimplant, a metal plate is installed, made with the possibility of connecting a contact wire to it. 7. An individual template according to claim 6, characterized in that a longitudinal groove is located in the wall of the guide hole for introducing the microimplant.

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