US20230011481A1 - Apparatus for facilitating acquisition of a scan and an intraoral scanning procedure - Google Patents

Apparatus for facilitating acquisition of a scan and an intraoral scanning procedure Download PDF

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Publication number
US20230011481A1
US20230011481A1 US17/753,928 US202017753928A US2023011481A1 US 20230011481 A1 US20230011481 A1 US 20230011481A1 US 202017753928 A US202017753928 A US 202017753928A US 2023011481 A1 US2023011481 A1 US 2023011481A1
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Prior art keywords
scan
implant
implants
patient
side walls
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US17/753,928
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English (en)
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Michael Tuckman
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Implant Solutions Pty Ltd
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Implant Solutions Pty Ltd
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Priority claimed from AU2019904154A external-priority patent/AU2019904154A0/en
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Assigned to Implant Solutions Pty Ltd reassignment Implant Solutions Pty Ltd CORRECTIVE ASSIGNMENT TO CORRECT THE ASSIGNOR'S LAST NAME PREVIOUSLY RECORDED AT REEL: 059734 FRAME: 0442. ASSIGNOR(S) HEREBY CONFIRMS THE ASSIGNMENT . Assignors: TUCKMAN, Michael
Publication of US20230011481A1 publication Critical patent/US20230011481A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/24—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the mouth, i.e. stomatoscopes, e.g. with tongue depressors; Instruments for opening or keeping open the mouth
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0088—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for oral or dental tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0089—Implanting tools or instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C9/00—Impression cups, i.e. impression trays; Impression methods
    • A61C9/004—Means or methods for taking digitized impressions
    • A61C9/0046—Data acquisition means or methods
    • A61C9/0053—Optical means or methods, e.g. scanning the teeth by a laser or light beam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/363—Use of fiducial points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3904—Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
    • A61B2090/3912—Body cavities
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3937—Visible markers

Definitions

  • the present invention generally relates to an apparatus for facilitating acquisition of a scan in a patients mouth and a related intraoral scanning procedure.
  • An implant impression is the main reference of an implants location within a patients mouth and is the foundation for designing and manufacturing any prosthetic framework.
  • the accuracy of the implant impression depends on a number of factors. These factors include the number, the depth, and angulation of the implants, the impression technique selected, and the type of impression material. Deciding on the impression technique involves consideration of various options, including selecting a direct or indirect method, selecting a splinted or non-splinted solution, selecting the design of impression coping used, and selecting the type of impression tray (eg. open/closed).
  • a digital impression becomes an alternative that reduces the possible sources of error associated with conventional implant impression methods.
  • Digital impression systems are becoming more common because they allow the capture of digital data that can then be used to replicate the intraoral hard and soft tissues, replacing the need for impression trays and impression materials.
  • the present invention provides an apparatus for facilitating the acquisition of a scan during an intraoral scanning procedure using an intraoral scanner, including: an elongate body having an attachment portion configured to attach the elongate body with an implant in a patients mouth, the implant having a longitudinal axis, whereby the elongate body is adapted to extend substantially perpendicular to the longitudinal axis of the implant when mounted to the implant; the elongate body having a substantially planar upper surface and one or more side walls extending downwardly away from the upper surface; wherein the upper surface and the one or more side walls are observable in a resulting scan when the intraoral scanner scans the apparatus in a direction perpendicular to the upper surface(s).
  • the apparatus of the present invention can be used to establish an extremely accurate three-dimensional frame of reference for use in the design of dental prosthetics.
  • the present invention is advantageously designed to allow a user to obtain more accurate scan information from digital implant impressions (i.e. from intraoral scanning) for a range of implant cases, including fully edentulous cases where the implants are distributed throughout the full arch of a patient's mouth.
  • the user can accurately model the position and orientation of the implant(s) inserted into the patient's mouth, thereby allowing for more accurate digital implant positional capture and digital design of prosthetic appliances for the patient that utilise the implant location information.
  • the upper surface(s) and the one or more side walls observable in the scan are used as references that can be ultimately compared with stored information contained within a library on a computer, the stored information including precise models and measurements of the apparatus. From this, the known measurements of the apparatus can be assigned to the scan, thereby allowing the location and orientation of the implants relative to the soft tissue of the patients mouth to be accurately determined. Having this information in a digital model allows for the digital design of a best-fit implant framework, for example, a partial or full arch implant bar, whereby the determined location and orientation of the implant(s) can be used to define suitable fixing positions of the implant framework, the framework also fitting the soft tissue of the arch.
  • a best-fit implant framework for example, a partial or full arch implant bar
  • the one or more side walls surround all or a substantial portion of the periphery of the upper surface, all being viewable from above the upper surface.
  • the apparatus provides a plurality of reference points and surfaces around the upper surface that can be used in the post-processing steps discussed above and in greater detail below. For example, separate scans of the apparatus can be taken during the intraoral scanning procedure and then aligned with one another during the post-processing stage using the reference points and surfaces situated around the periphery of the upper surface, along with the upper surface itself. This provides for more accurate alignment between scans, and greater confidence in the accuracy of the scans when the precise measurements of the location and the orientation of the implant(s) are determined.
  • the upper surface and a lower surface of the elongate body define elongated hexagons, each with its elongated sides extending substantially in parallel from a first end to a second end.
  • the pair of shorter hexagonal sides at the first end of both the upper surface and the lower surface may be longer in length relative to the pair of shorter hexagonal sides at the second end of both the upper surface and the lower surface.
  • These faces may therefore define a relatively acute angle between the pair of sides at the first end, whereas they meet at a larger, relatively obtuse angle at the second end.
  • These faces may therefore be of substantially trapezoidal shape.
  • the one or more side walls taper inwardly towards the upper surface of the elongate body, thus providing a sloped skirt depending from the upper surface.
  • the angle of this tapering may be selected as desired for best results.
  • each of the one or more side walls is substantially planar.
  • one or more of the side wall(s) may be of curved form.
  • a plurality of side walls, defining a plurality of interconnected facets, is provided, each facet observable by the intraoral scanner when scanning in a direction substantially perpendicular to the upper surface.
  • the facets may be substantially planar and inclined from the direction perpendicular to the upper surface by an angle between about 15° and about 40°, preferably around 25°.
  • the elongate body includes a first end and a second end, both ends having generally pointed end shapings, each defined by two meeting facets.
  • the apparatus includes a fiducial marker mounted to or integral with the upper surface.
  • the incorporation of the fiducial marker can assist in the alignment between separate scans because the marker acts as a further point of reference for accurately aligning the scanned apparatus, particularly for alignment in the vertical direction. This is because the marker has known dimensions and is provided in a known position and orientation relative to the elongate body.
  • the fiducial marker provides an additional source of 3-D information in the scan data capture that can be used for vertical corrections between scans that may be required during the post-processing stage.
  • the fiducial marker may be of any suitable shape.
  • the fiducial marker is spherical, but other shapes such as triangular, square, conical, cylindrical, oval, etc. may be used.
  • the fiducial marker may be mounted to the upper surface of the elongate body in any suitable manner.
  • the fiducial marker may be integral with the upper surface by either manufacturing the fiducial marker with the elongate body as one integrally formed component, or by permanently fixing the fiducial marker to the elongate body, such as by welding or other suitable process.
  • the attachment portion may be configured to receive a fastening element, such as a prosthetic screw, in order to fixedly attach the elongate body to an implant in the patients mouth (or to some other intermediate component(s) between the implant and the elongate body).
  • a fastening element such as a prosthetic screw
  • the apparatus may then be removable from the implant (eg. following unscrewing the prosthetic screw) once the scanning is complete.
  • the upper surface of the elongate body includes an aperture or recess configured to receive an indicator element that is identifiable in a resulting scan.
  • the recess may be provided by a bore through the elongate body, the bore serving the engagement of the elongate body with the implant.
  • the indicator element may be in the form of a plug, configured to be retained in the recess when the apparatus is being scanned. This can be useful during post-processing, as the indicator element can be used to identify a characteristic of the apparatus or of the scan. For example, if a plurality of apparatus are being scanned (for example as part of the scanning of a full arch), the element may be placed in the recess of the first apparatus to be scanned, thereby indicating the starting position of the scan path. Such information can assist in conveying information about the scanning path. This information can be important as generally the scan data of an apparatus scanned at the beginning of a scan path will be more accurate than that of an apparatus scanned towards the end of the scan path.
  • one or more side walls adjacent the attachment portion include at least one cut-out portion configured to enable the scanner to retrieve data to assist in defining the longitudinal axis of the implant.
  • the cut-out portion(s) preferably extend towards the attachment portion, thereby enabling visualisation of a surface of the attachment portion beneath the elongate body.
  • the cut-out portion(s) when viewed from the direction perpendicular to the upper surface by the scanner, enable a view of a convex surface associated with a bore of the attachment portion, which is to be attached to the implant.
  • the cut-out portion(s) can act as a smooth transition path that joins surfaces created by the scanner by connecting the observable surfaces of the apparatus and surfaces of underlying tissue as a complete scan. This is achieved without the need to tilt the head of the scanner in a direction perpendicular with the longitudinal axis of the implant in the way conventional scan apparatus require.
  • one or more of the upper surface and side walls include an identifier which enables identification of the apparatus in a resulting scan.
  • the identifier is provided on the upper surface.
  • the identifier may be of any suitable form, such as one or more projections, one or more recesses, a scannable medium (e.g. barcode), etc.
  • the identifier can convey different types of information about the apparatus, such as height, length, width or dimensional tolerance, etc. This is particularly important when the apparatus is used in conjunction with other similar apparatus as part of a scanning procedure.
  • the present invention provides a method of performing an intraoral scanning procedure, including inserting one or more implants into a patients jaw, each of the one or more implants having a longitudinal axis, mounting the above-defined apparatus to the one or more implants in the patients mouth, and scanning the apparatus and at least a part of the soft tissue in the patients mouth, thereby producing a set of scan data for use in determining the relative position and orientation of the one or more implants relative to the soft tissue.
  • the method may further include selecting one or more modular forms of said apparatus from a plurality of different modular forms of the apparatus, in order to best fit a space to be scanned in the patient's mouth.
  • the method further includes mounting each apparatus to its respective implant in a way resulting in a substantial elongate overlap transition from each apparatus to each adjacent apparatus, across the space to be scanned.
  • the second aspect of the invention can include any of the features defined with respect to the first aspect of the invention.
  • the present invention provides a kit including a plurality of items of the above-defined apparatus, including items of different dimensions to each other, such that a plurality of items may be selected for a particular patient's mouth in accordance with the area of the patient's mouth to be scanned and/or in accordance with relative positions of one or more existing implants.
  • the different dimensions can include different lengths and/or heights. Different heights can be provided to accommodate the depth of a given implant relative to the surrounding tissue. For example, undue pressure exerted by the tissue on the underside of one item can be avoided by using an item with a greater height. Further, an item of suitable height can be used to ensure the depth of field of the scanner head is closer to the tissue, without touching the tissue, thereby improving accuracy of the scan and hence better stitching between the scan data. In a similar fashion, different lengths can be provided to accommodate different distances between implants.
  • each unique item in the kit is measured and the measurements are stored in a digital library for post-processing of a resulting scan.
  • the third aspect of the invention can include any of the features defined with respect to the first or second aspect of the invention.
  • the present invention provides a method of performing an intraoral scanning procedure for determining the position and orientation of one or more implants in a patient's mouth, each implant having a longitudinal axis, the method using one or more scannable bodies and including providing a scannable body on each of the one or more implants, the scannable body extending substantially perpendicular to the longitudinal axis of the respective implant, the scannable body having a substantially planar first surface facing in a direction away from the soft tissue of the patient's mouth, and one or more further surfaces extending from the first surface, wherein the one or more further surfaces are viewable from a direction perpendicular to the first surface, scanning the one or more scannable bodies, thereby producing a set of scan data associated with the intraoral scanning procedure, and assigning information from a set of stored data to the scan data, and determining from the scan data and the assigned information the position and orientation of the one or more implants.
  • the fourth aspect of the invention can include any of the features defined with respect to the first, second, and third aspects of the invention.
  • FIG. 1 illustrates a perspective view of an apparatus according to an embodiment of the present invention
  • FIG. 2 illustrates a front elevation view of the apparatus of FIG. 1 ;
  • FIG. 3 illustrates a plan view of the apparatus of FIG. 1 :
  • FIG. 4 illustrates a side elevation view of the apparatus of FIG. 1 ;
  • FIG. 5 illustrates a bottom plan view of the apparatus of FIG. 1 ;
  • FIG. 6 illustrates a plan view of a plurality of apparatus according to an embodiment of the present invention inserted into the mouth of a patient:
  • FIG. 7 illustrates an example of resulting scans in software during a post-processing step in a method in accordance with an embodiment of the present invention
  • FIG. 8 illustrates an upper perspective view of an apparatus in accordance with another embodiment of the invention.
  • FIG. 9 illustrates a plan view of the apparatus of FIG. 8 ;
  • FIG. 10 illustrates a front elevation view of the apparatus of FIG. 8 ;
  • FIG. 11 illustrates a kit including a plurality of apparatus of different dimensions in accordance with an embodiment of the invention.
  • a scan abutment (or scan gauge) 10 is configured to be attached directly or indirectly to an implant in a patient's mouth, eg. an implant pin (ie. dental implant) surgically implanted to the patient's mandible or maxilla.
  • scan abutment 10 can be attached to an intermediate adaptor (not shown) such as a multi-unit adaptor (as known in the art), which is attached to the implant.
  • references to the implant can include (where the context permits) reference to the intermediate adaptor.
  • references herein to a vertical direction refers to the vertical direction as generally understood in the anatomical position (i.e. patient upright).
  • References herein to upper and lower are to be understood in relation to the scan abutment as viewed in the accompanying drawings. However, as will be understood, depending on whether the scan abutments are used in the upper or lower arch of the patient's mouth (ie. with a maxillary or mandibular implant, respectively), the terms upper and lower may be reversed. In the depicted embodiment, the scan abutments are used in the lower arch of the patients mouth (ie. attached to mandibular implants), so the terms ‘upper’ and ‘lower’ will be used from that viewpoint.
  • the scan abutment 10 includes an elongate prismatic body 11 having a first end 12 and a second end 14 .
  • Body 11 is preferably a solid body, but can instead be a hollow body.
  • Body 11 further includes a planar upper surface 16 , a planar lower surface 17 and a plurality of side walls 18 extending between the peripheral edges of the upper surface 16 and the peripheral edges of the lower surface 17 .
  • the upper and lower surfaces 16 , 17 are in the form of similarly shaped elongated hexagons, each with its elongated sides extending in parallel from the first end 12 to the second end 14 .
  • the pair of shorter hexagonal sides at the first end 12 of both the upper surface 16 and the lower surface 17 are longer in length relative to the pair of shorter hexagonal sides at the second end 14 of both the upper surface 16 and the lower surface 17 .
  • These faces therefore define a relatively sharp, acute angle between the pair of sides at the first end 12 , whereas they meet at a larger, obtuse angle at the second end 14 .
  • This difference in morphology arises from a need to minimise lateral overlap (and the creation of associated shadowing) which can adversely impact on scanning accuracy.
  • Prismatic body 11 therefore has the form of a stretched hexagonal frusto-pyramid, with a single plane of symmetry running along the longitudinal centreline.
  • the upper surface 16 and lower surface 17 need not necessarily have the same shape as depicted in this embodiment, but can take on any other suitable shape such as rectangular, oval, triangular, polygon, etc. However as will be evident from the discussion below, a series of straight edges and associated planar side wall facets are preferred. Further, the overall shape of the body 11 does not necessarily require the upper surface 16 and the lower surface 17 to have the same shape, with variations in the overall shape to that shown in the present embodiment also possible.
  • the side walls 18 include a number of distinct facets, in the depicted example six facets 18 a - 18 f , that extend between the respective edges of the upper surface 16 and the lower surface 17 around the whole periphery thereof.
  • the peripheral edge of the lower surface 17 includes a chamfered transition lip 19 , from which facets 18 a - f extend upwardly towards upper surface 16 .
  • the facets 18 a - f generally taper inwardly from the chamfered transition lip 19 to the upper surface 16 , thereby defining a series of interconnected planar sloped walls.
  • the slope of the side walls 18 a - f can be selected as desired. Ideally, this slope is between 15° and 40° to the vertical (ie.
  • the side walls may be curved, or a single curved side wall may extend from and surround the entire upper surface 16 .
  • planar facets are preferred.
  • the scan abutment 10 when the scan abutment 10 is viewed by the scanning head of an intraoral scanner in a direction substantially above and perpendicular to the upper surface 16 (with scan abutment 10 mounted to the proximal end of an implant in the patient's mouth), the six facets 18 a - 18 f and the upper surface 16 are all directly observable in the scan (as illustrated in the plan view of FIG. 3 ). In this way, all seven facets can act as reference surfaces when aligning separate scans taken of the scan abutments 10 within the patient's mouth. This provides full 3-D reference information concerning the relative position and orientation of the scan abutment, and thus the position and orientation of the implant relative to the soft tissue in that area of the patients mouth.
  • transition lip 19 provides that the scan abutment 10 has a relatively sharp lower edge detail to side walls 18 . This assists in reducing the risk of tissue overlap of the lower portions of the side walls 18 .
  • the lower edge detail also assists in more precisely defining the implant/tissue boundary. This can improve scan accuracy by minimising interpolation errors that can arise, for example when tissue is mistaken for implant.
  • the scan abutments 10 Whilst it is advantageous for the scan abutments 10 to include side walls that are visible around the whole periphery surrounding the upper surface 16 , this need not be the case. For example, having side walls that are visible around only a portion of the periphery of upper surface 16 can still provide sufficient reference surfaces for use in providing a suitable data set and in comparing and aligning separate scans of the scan abutments 10 . However, it will be apparent to a person skilled in the art that the more points and facets of reference that are visible, the greater the accuracy and usefulness of the scan.
  • the first end 12 and the second end 14 of the scan abutment 10 terminate in pointed ends, provided by the meeting of facets 18 a ; 18 f and 18 c ; 18 d , respectively.
  • the benefit that arises from using scan abutments with these pointed ends is best appreciated in scenarios where multiple scan bodies are placed in the mouth of the patient (for example, when scanning a full or partial arch).
  • scan abutments 10 are placed adjacent one another in order to take the most accurate scan of the desired scanning region.
  • Having the scan abutments in close proximity means that if the ends of the scan abutments were, for example, curved, some of the surfaces of the side walls may be obscured by a directly adjacent scan abutment, thus limiting the detail available for the post-processing stage. Having relatively pointed ends reduces the likelihood of such overlap when the scan abutments are in close proximity.
  • the elongate body 11 includes a bore 22 extending between the upper surface 16 and the lower surface 17 , adjacent the first end 12 .
  • the bore 22 is configured to accommodate the proximal end of an implant (or intermediate adaptor) and to receive a prosthetic screw to secure the scan abutment 10 to the implant
  • Extending vertically from the lower surface 17 is a cylindrical attachment portion 26 configured to sit over the implant when the scan abutment 10 is attached thereto.
  • the implant or suitably attached intermediate adaptor can provide a male connection portion complementarily shaped to fit within bore 22 , with the lower end of the attachment portion 26 resting upon a planar lower surface of the implant or adaptor.
  • the male connection portion may be in the form of a cylindrical cap that permits a snug fit between the bore and male connection portion.
  • the depicted embodiment provides for a screw connection between the scan abutment 10 and the implant
  • other means of connecting the scan abutment 10 with the implant are also possible.
  • the scan abutments may include internal threading that can be mated with the implant bearing corresponding threading external, or bore 22 may connect to the proximal head of the implant in a snap-fit arrangement.
  • Bore 22 may serve an additional function to receive an indicator element that can convey additional information in a scan.
  • the indicator element is in the form of a plug (not shown) that fits within and covers the upper end of bore 22 .
  • the indicator element may, for example, be used to indicate the direction in which a scan has been taken. For example, if the scan is taken of a plurality of scan abutments from left to right, the indicator element may be placed on the left-most scan abutment, providing an indication in the scan data that the left-most scan abutment was scanned first.
  • Recording the direction of a scan in this way can be particularly helpful as, ordinarily, when the scan head travels from the start to the end of a scan path, the information provided at the start of the path is likely to be more accurate than that provided towards the end of the path. This difference in accuracy arises from errors that accumulate as the scan head traverses a scan path from start to finish. Errors are minimised by overlapping the left-to-right scan with the right-to-left scan using the perpendicular lengths of several markers. This yields a combination of several scans that can be suitably grouped together and used to assist in weighting the acquired image data.
  • the indicator element could be used in any other way that can convey suitable information in the resulting scan to the end user.
  • the scan abutment 10 includes a fiducial marker (not shown) mounted to or integral with the elongate body 11 .
  • the fiducial marker is preferably in the form of a three-dimensional shape such as a sphere, prism, etc.
  • the fiducial marker is of known dimensions and known position/orientation relative to scan abutment 10 , thus providing further 3D reference information that can be used in the post-processing steps of aligning separate scans, particularly for alignment in the vertical direction.
  • the scan abutments 10 can be provided to an operator as a kit 1000 (illustrated in FIG. 11 ) with an assortment of elements of different dimensions that can be selected by the operator to suit the size and shape of the patient's mouth, so to provide the amount of coverage required for the scan procedure. In most cases, a plurality of scan abutments 10 will be used to span the space between multiple implants inserted in the patient's mouth, each scan abutment 10 attached to a separate implant. As will be understood, greater flexibility is provided by having scan abutments of different dimensions.
  • suitable dimensions for the scan abutments 10 can include an overall length ranging from about 10 mm to about 30 mm, and overall heights (ie. viewed in elevation) ranging from about 3 mm to about 10 mm. However, these dimensions are only exemplary, as a scan abutment can be manufactured to any suitable size.
  • the scan abutments 10 are typically fabricated from Titanium Grade 5. However, other suitable materials may be used, such as an alternative suitable metal or a plastics material.
  • Scan abutments 10 are generally designed in CAD/CAM software and then manufactured on suitable 5-axis CNC machines. As the precision of the manufactured scan abutments is critical for the scanning procedure, after the manufacture of each scan abutment, a coordinate measuring machine (CMM) is used to precisely measure all the relevant dimensions of the scan abutment. This information is stored on a database so that it can be called upon during the assignment step in the method, as described in detail below.
  • each individual kit can also include its own unique digital library, with precise measurements of each scan abutment 10 of the kit stored in the library. The digital library for each kit of scan abutments will thus be unique to that kit.
  • kit identifier (such as a kit number) can be assigned to each kit and therefore to each scan abutment within the kit. This ensures that the assignment step of the method described below produces the most accurate representation of the scan bodies and hence the precise positions of the implants (as well as the other scanned data points) in a patient's mouth.
  • the exemplary method includes providing a plurality of implants within the mouth of a patient, being screwed pins fixed into the maxillary or mandibular bone in a conventional surgical procedure.
  • the suitable number and positioning of the implants will depend on the particular circumstances and the prosthesis required.
  • four implants provide sufficiently high predictability, with clinicians often placing six implants. Whilst it may be ideal in many cases for the implants to be placed parallel to one another, due to surgical or structural limitations this is often not achieved.
  • a plurality of scan abutments are then provided, each attached to the proximal head of an implant. This attachment is achieved by engaging the bore 22 of the scan abutment 10 over the head of the implant and attaching thereto by a prosthetic screw accessed from the upper end of the bore.
  • the scan abutments 10 are selected and positioned to substantially cover the full area of the arch, with an example implementation shown in FIG. 6 .
  • the scan abutments should be positioned in proximity to each other, but they do not need to touch and it is considered preferable to have an overlap transition from around the midpoint of one abutment to the midpoint of the next (when viewed in elevation—see FIG. 6 ).
  • the implementation shown in FIG. 6 is only one example of positioning the scan abutments. Care should be taken when arranging the scan abutments so that most and preferably all of the upper surfaces and side walls of the scan abutment will be visible from above (and thus to the scanner head). Care should also be taken to avoid significant gaps between adjacent scan abutments as much as possible, as these gaps can provide sources of error. Further, a head-to-tail arrangement of the scan abutments as shown in FIG. 6 is considered preferable for acquiring maximum information and minimising sources of error.
  • the operator begins the intraoral scanning procedure using a conventional intraoral scanner.
  • the practitioner may first place an indicator element in the bore 22 of a selected scan abutment, so as to provide an indication of which scan abutment was the first scanned during the procedure.
  • the operator will then begin to scan from one end of the arch to the other, preferably manoeuvring the scanner in a generally zig-zag path as shown in FIG. 6 .
  • the operator will only need to manoeuvre the scan head in a limited range of movements (as discussed above), avoiding the need for any rotational movement of the scan head.
  • the operator will then scan the scan abutments along the opposite direction to the initial scan (i.e.
  • each set of scan data takes the form of an STL file containing raw point cloud data.
  • This scan data is then passed to post-processing.
  • the received STL files which contain the separate scans of the arch with the scan abutments are compared and aligned with one another.
  • FIG. 7 One example of this process is shown in FIG. 7 , where using computer software the sets of scan data of the various scans are aligned with one another and the discrepancies between the respective scans highlighted. For example, if during this alignment stage the discrepancies between the respective scans is in excess of 50 ⁇ m, the inaccurate scan may be omitted from the alignment process.
  • the alignment process provides a measure as to how well each of the scan abutments align between the separate scans.
  • Each scan abutment can be appropriately aligned in each scan using the known key surfaces (the upper surface and the side walls). Ideally, all seven facets of scan abutments are used. However, if one or more of the key surfaces may be determined to be inaccurate it can be omitted from further processing. This can be due to being obscured in the scan in some way, or to an inaccuracy that has arisen in the scan which has prevented the surface from being aligned with the corresponding surface in another scan. This will be apparent if the surface of the scan abutment has a discrepancy relative to the other scans that is higher than an allowable threshold (such as a facet deviation between scans larger than 10 microns).
  • an allowable threshold such as a facet deviation between scans larger than 10 microns.
  • this surface or these surfaces may be omitted from consideration during the alignment stage and only the more accurately aligned surfaces taken into account in an averaging process between the (non-rejected) information from the different scans.
  • the actual marker measurements can be used to re-scale up or down to allow accurate comparison of data sets.
  • the scan abutments can be separated in the software from the rest of the scanned elements (the soft tissue information), and a file of the now averaged scan saved for use in the subsequent steps.
  • the stored digital files of the respective scan abutments can now be accessed and used to assign the exact measurements of the respective scan abutments to the averaged scan.
  • the accurate dimensions for each facet of the scan body are assigned to the averaged scan and from this the precise positioning and orientation of each of the implants are determined, relative to the precise form of the soft tissue.
  • This information in combination with the scan taken without the scan bodies (showing all the underlying soft tissue) allows an end user to digitally construct an implant framework for mounting to the implants by using the position and orientation of the implants as the corresponding mounting points of the implant framework.
  • peripheral soft tissue data captured in the scan body can be matched with the underlying soft tissue scan in order to identify structures common to the two scans. In turn, these identified common structures can be used in operations such as merging multiple scans.
  • a scan of the existing prosthesis e.g. an upper arch
  • a full bite scan can then be acquired, the bite scan providing information relating to both the upper and lower arches.
  • the pre-existing prosthesis is removed. Once removed, the implants (or intermediate adaptor) are now visible.
  • scan abutments 10 of suitable dimension are selected and fixed to the implants. In a similar manner to that described above, the scan abutments 10 are scanned, and a further scan is taken of the underlying tissue with the scan abutments 10 removed.
  • the present method includes acquiring a 360° scan of the existing prosthesis outside of the mouth.
  • cylindrical caps 50 (included in the kit, as shown in FIG. 11 ) of known dimension can be attached to fixing formations on the existing prosthesis before the scan is taken. These caps 50 effectively simulate the precise location of the implants (or intermediate adaptors) and therefore provide a geometric shape of known dimension that are fully visible in the scan.
  • This scan can be used with the acquired scan of the scan abutments to generate an accurate model of the location of the implants in the patients mouth.
  • caps 50 can be provided along with scan abutments 10 as part of kit 1000 .
  • FIGS. 8 - 10 depict a slightly modified form of scan abutment 100 .
  • Scan abutment 100 includes several common features to scan abutment 10 , and therefore these features will not be described in any detail again. Common features between scan abutment 10 and scan abutment 100 will be provided with a ‘100’ series reference numeral when referencing scan abutment 100 .
  • scan abutment 100 includes part-cylindrical cut-out portions 130 provided in opposed side walls adjacent bore 122 .
  • two cut-out portions 130 are provided, one in side wall 118 e and one in side walls 118 b , as shown in FIG. 9 .
  • the cut-out portions 130 enable direct visualisation, when viewed from above, of part of outer surfaces 132 of the attachment portion 126 around concentric bore 122 .
  • attachment portion 126 sits over the implant when the scan abutment 100 is attached thereto (aligned with the longitudinal centreline of the implant), visual access to surfaces 132 enables the scanner to acquire additional data along the longitudinal axis of the implant. This additional information can assist during post-processing to correct any vertical direction discrepancies that may otherwise arise from the scan, as well as provide further information of the location of the implant relative to the underlying tissue.
  • the outer surfaces 132 of attachment portion 126 act as a smooth transition path between scanned data representing the observable surfaces of the scan abutment 100 and surface features of the underlying tissue. This is achievable without the need to tilt the head of the scanner in a direction perpendicular with the longitudinal axis of the implant so to view the surfaces of attachment portion 126 .
  • the contiguous scan information in the transition from scan abutment 100 to the underlying tissue can significantly mitigate the risk, inherent in conventional post-processing software, that physically separated or otherwise mutually inconsistent scan data is treated as noise and is automatically deleted from the dataset.
  • Cut-out portions 130 may be formed by a milling step undertaken during manufacture of scan abutment 100 .
  • cut-out portions 130 may be formed by other manufacturing methods, such as provided as recessed portions in a casting of the scan abutment.
  • Scan abutment 100 further includes an identifier marking, shown as a pair of circular recesses 140 formed in the upper surface 116 , on opposite sides of bore 122 .
  • the identifier markings are intended to be visible in the resulting scan and provide dimensional and tolerance information concerning the given scan abutment 100 . These markings are useful during the assigning step of the above described method in order to indicate which scan abutment (from a plurality of scan abutments) has been used.

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US20230139288A1 (en) 2023-05-04
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