WO2000041637A1 - Dispositif de distraction alveolaire - Google Patents

Dispositif de distraction alveolaire Download PDF

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Publication number
WO2000041637A1
WO2000041637A1 PCT/IB2000/000039 IB0000039W WO0041637A1 WO 2000041637 A1 WO2000041637 A1 WO 2000041637A1 IB 0000039 W IB0000039 W IB 0000039W WO 0041637 A1 WO0041637 A1 WO 0041637A1
Authority
WO
WIPO (PCT)
Prior art keywords
threading
thruster
distraction
bushing
distraction device
Prior art date
Application number
PCT/IB2000/000039
Other languages
English (en)
Inventor
Achille Minen
Alberto Cigada
Claudio Migliaresi
Giacomo Urbani
Original Assignee
Plan 1 Health S.R.L.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Plan 1 Health S.R.L. filed Critical Plan 1 Health S.R.L.
Priority to AU18867/00A priority Critical patent/AU1886700A/en
Publication of WO2000041637A1 publication Critical patent/WO2000041637A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
    • A61B17/66—Alignment, compression or distraction mechanisms
    • A61B17/663—Alignment, compression or distraction mechanisms for jaw bones, e.g. subcutaneous distractors with external access
    • A61B17/666—Alignment, compression or distraction mechanisms for jaw bones, e.g. subcutaneous distractors with external access for alveolar distraction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive

Definitions

  • the invention is used in the field of dental or stomatological implants of the endosseous type to perform alveolar distractions of the mandibular or maxillary bone; it is of the type which can be removed once the distraction cycle is finished, so that the dental implant device, on which the dental prosthesis is then made, can be applied.
  • the state of the art includes the technique whereby supporting elements or implants are applied in the dental alveoli, that is to say, in the excavations in the mandibular or maxillary- bone, to support dental prostheses.
  • Such supporting elements generally consist of small metal screws which are inserted into the dental alveolus to a depth which will guarantee that they are sufficiently anchored and therefore they have the desired stability and support for the prosthesis to be applied.
  • the thickness of the mandibular/maxillary bone in correspondence with the dental alveolus is insufficient for an adequate penetration of the supporting elements, and therefore it is necessary to intervene to increase the thickness.
  • endosseous alveolar distraction provides to subject the mandibular/maxillary bone to axial traction by means of appropriate devices, each of which comprises at least a screw-type thruster element, which can be inserted axially inside a bushing element threaded internally and externally, and co-operating at the end with a lower element.
  • the first approach provides to perform the distraction and, at the end, leave the whole relative system "in situ", substantially like a dental implant, where once the desired degree of distraction has been achieved the prosthetic crown or bridge is then anchored to the system itself, protruding from the endosseous cavity.
  • a first disadvantage is that, as the screw is made to rotate during the distraction cycle, the traction of the spirals causes a sleeve of connective tissue to form, which is generated around the screw itself; this causes the risk of fiber integration, instead of the desired osseous integration.
  • a second disadvantage is that, using the same system to perform the distraction and also for the dental implant, the ideal position assumed by the distraction device may not be the optimal position for the dental implants in relation to the specific requirements of the prosthesis.
  • the second approach provides to completely remove the whole system used for the distraction operation once the desired result has been obtained.
  • a new surgical operation is performed to position the endosseous screw and, subsequently, to achieve the structure of the prosthesis.
  • the intervention provides initially to cut and remove some osseous material (osteotomy) in a horizontal direction from an intermediate section of the mandibular/maxillary bone, and to make vertical holes connecting the dental alveolus with this horizontal cut and extending in depth beyond the latter.
  • the bushing elements, or screw bodies are introduced in correspondence with each of the holes; inside the bushing elements, or screw bodies, the screw-type thruster elements, also called simply screws, are subsequently inserted in such a manner that they can act on the lower elements with an axial thrust .
  • Vertical or oblique channels are also made connecting the ends of the horizontal cut with the dental alveoli, in order to weaken the part of the bone on which the distraction is made, and to make it movable.
  • the thruster elements are adjusted in a gradual and pre-defined manner; that is, they are progressively unscrewed at generally constant intervals (normally every day) , which, with every adjustment, causes a distancing of the outer part of the bone according to how much the thruster element is unscrewed, normally some tenths of a millimetre or some millimetres each time.
  • the lower elements are clamped in the bone and cannot move, and therefore the thruster elements cause a progressive axial traction of the part of the bone subjected to distraction.
  • the positioning operation is particularly difficult due to the limited dimensions of the lower elements, which make them difficult to manipulate, the limited visibility due to the location where the work is done, the operating conditions and the position of the seating wherein the lower elements have to be arranged.
  • the purpose of the invention is to provide an endosseous alveolar distraction device of the type suitable to be removed at the end of the distraction cycle, which is simple to use and inexpensive, can be applied and removed quickly and accurately according to substantially conventional means, allowing a substantially optimum axial traction by the thruster element.
  • the device according to the invention comprises, substantially as in the alveolar distraction devices of a conventional type, three components co-operating with each other: a screw-type thruster element, a bushing element threaded internally and externally, also called screw body, and a lower element equipped with an internal threading.
  • the bushing element is of the self-threading type, and is suitable to screw directly into the relative vertical hole made in the alveolus without needing to do the previous tapping thereof .
  • the thruster element has two lengthwise threadings with contrary screwing directions.
  • a first threading, developing in the middle-upper segment of the thruster element, is suitable to screw inside the bushing element and is directed in the same direction as the internal threading of the latter.
  • the second threading arranged in correspondence with the middle-lower segment of the thruster element, is suitable to screw into the threading of the lower element .
  • the components of the device according to the invention are suitable to be assembled in a functional manner before the distraction device, thus assembled in the endosseous cavity, is applied.
  • the components are stably constrained together, that is, the thruster element acts as a connection element between the bushing element and the lower element and can never be unconstrained therefrom.
  • the device according to the invention is prepared for application by screwing the thruster element to the bushing element and the lower element, so as to take its point to abut, or to the end-of-travel , inside the latter, maintaining the bushing element and lower element in a position of substantial reciprocal contact, or close proximity.
  • the device is then introduced, in a single piece, into the relative vertical hole, which has previously been made in the mandibular/maxillary bone, and the bushing element is screwed into the walls of the hole to attach it.
  • the lower element clamps into its supporting seating on the bottom of the vertical hole.
  • the technician acts on the thruster element to perform progressive unscrewing operations which make the thruster element act in axial thrust on the lower element, thus achieving the traction on the bone.
  • the thruster element screws onto the internal threading of the bushing element with its upper threading, while it screws onto the internal threading of the lower element with its lower threading.
  • the lower element always remains stably constrained to the thruster element and is therefore unable to go sideways or incline; this allows the technician to apply the device rapidly and precisely and ensures an extremely efficacious action by the thruster element .
  • the whole distraction device is removed simply by unscrewing the bushing element, since the lower element and the thruster element are constrained stably thereto.
  • the lower threading of the thruster element has a narrower pitch than the upper threading, so that it is possible to use a lower element with a lower height than that of the bushing element.
  • the lower element is made in bio-reabsorbable material and, if so desired, may be left in place at the end of the operation.
  • the number of instruments used to apply and remove the device according to the invention is therefore smaller than those needed for conventional devices, as it is not necessary to use specific instruments to position and remove the lower element .
  • Fig. 1 shows the preparation of a mandibular bone for the operation of alveolar distraction
  • Fig. 2 shows schematically two distraction devices according to the invention applied to the mandibular bone shown in Fig . 1
  • Fig. 3 shows the distraction device of Fig. 2 at an intermediate step of the operation
  • Fig. 4 shows the distraction device of Fig. 2 in the final step of the operation;
  • Fig. 5a is a cross section of a first form of embodiment of a distraction device according to the invention in its non-assembled condition;
  • Fig. 5b shows a second form of embodiment of the distraction device according to the invention;
  • Fig. 6 is a view from below of the bushing element of the distraction device shown in Fig. 5a;
  • Fig. 7 is a view from above of the thruster element of the distraction device shown in Fig. 5a;
  • Fig. 8a is a view from below of the lower element of the distraction device shown in Fig. 5a;
  • Fig. 8b is a view from above of the lower element of the distraction device shown in Fig. 5b.
  • DETAILED DESCRIPTION OF PREFERRED EMBODIMENT With reference to the attached drawings, the number 10 denotes each of the two distraction devices according to the invention applied, in this case, to a mandibular bone 11.
  • Each of the distraction devices 10 comprises a screw-type thruster element 12 which is associated, or can be associated, with a bushing element 14 and a lower element 15 which is axially hollow and equipped with a bottom part which is partly closed and has an axial through hole.
  • the thruster element 12 comprises a rod 12a on which there are two threadings , a first upper threading 13a and a second lower threading 13b, which have contrary threads, that is, one right-hand and one left-hand.
  • the first threading 13a develops in the middle-upper part of the rod 12a and is suitable to screw into a mating internal threading 24 of the bushing element 14.
  • the second threading 13b develops in the middle-lower part of the rod 12a, and is suitable to screw into a corresponding internal threading 25 of the lower element 15, in this case developing only in the upper segment of the latter.
  • the overall length of the threadings 13a and 13b is greater by a desired value than the increase in thickness of the mandibular bone 11 which the whole distraction operation has to obtain.
  • the thruster element 12 can be associated with/dis-associated from the bushing element 14 and the lower element 15.
  • the thruster element 12 is always stably constrained to the bushing element 14 and the lower element 15, and can be screwed/unscrewed, but not disassociated, with respect thereto.
  • the bushing element 14 has a greater outer diameter than the lower element 15 and comprises an external threading 16, with the same direction as its internal threading 24, by means of which it is suitable to anchor itself to the mandibular bone 11.
  • the pitch of the external threading 16 is advantageously greater than the pitch of the threadings 13a and 13b.
  • the bushing element 14 has a head 17 suitable to abut against the mandibular bone 11 and a coupling raised part 18, in this case hexagonal, on which a mating screwing/unscrewing instrument 19 is suitable to grip .
  • the lower element 15 has at the upper part two projections 27, diametrically opposite each other, suitable to lock into two mating cavities 28 made on the lower part of the bushing element 14.
  • the mandibular bone 11 is subjected to osteotomy with a horizontal cut 20 made to a defined depth, according to conventional methods.
  • two vertical dead holes 21 are then made, with a diameter substantially the same as that of the lower element 15 and extending for several millimetres beyond the horizontal cut 20 (Fig. 1) .
  • two oblique channels 22 are made connecting the ends of the horizontal cut 20 with the upper surface of the mandibular bone 11 and with the function of making the portion of bone which is to be distracted movable.
  • the distraction devices 10 are then prepared by screwing, substantially to the end-of-travel, the thruster element 12 inside the bushing element 14 and inside the lower element 15 respectively by means of the threadings 13a and 13b; in this way the bushing element 14 and lower element 15 are taken substantially into contact and, in the embodiment shown in Figs. 5a and 5b, the projections 27 are inserted inside the cavities 28, preventing reciprocal rotation.
  • the thruster element 12 has a concave shaping 29 at the lower part which facilitates a slight peripheral deformation in its terminal segment when it is screwed into the lower element 15, causing a more stable anchorage thereto.
  • this shaping 29 may also be omitted .
  • each device 10 is anchored to the mandibular bone 11 in correspondence with the relative vertical hole 21.
  • the lower element 15 is introduced until it clamps against the bottom 21a of the vertical hole 21 and the bushing element 14 is screwed into the vertical hole 21 with its own external threading 16 by means of the instrument 19 (Fig. 2), and becomes solid with the part of the bone 11 to be distracted.
  • the bushing elements 14 are of the self-threading type and are suitable to be screwed directly onto the walls 21b of the vertical holes 21.
  • the vertical holes 21 are previously subjected to tapping, in order to achieve, on the walls of said holes 21, the thread which allows the bushing elements 14 to be screwed in.
  • the components of the distraction device 10 are associated stably and securely due to the reciprocal constraint defined by the threadings 13a, 13b.
  • the lower elements 15 have a circular, stepped conformation (Fig. 5a) or an indentation 15a (Fig. 5b) on the lower part by means of which they penetrate slightly into the mandibular bone 11, resting more stably thereon and prevented from rotating even when there are torsion-type stresses caused by the unscrewing of the thruster element 12.
  • the distraction process is started, progressively unscrewing the thruster element 12 at regular intervals by means of an appropriate instrument which is not shown here, and which axially penetrates into the axial hole of the bushing element 14.
  • each thruster element 12 has a hexagonal hole 26 at the upper part inside which a mating instrument to perform the progressive unscrewing operations is suitable to be inserted.
  • the portion of bone is then subjected to axial traction, being progressively distanced from the remaining part of the mandibular bone 11 and widening the horizontal cut 20 and the oblique channels 22, which are gradually closed by the biological regeneration 23 of the mandibular bone 11 (Fig.
  • the distraction devices 10 are completely removed in an extremely simple manner, by using the same instrument 19 used to apply them.
  • Each bushing element 14 is unscrewed from the relative vertical hole 21 by means of the instrument 19, allowing the entire device 10 to be removed with a single operation (Fig.
  • the lower elements 15 are made of re-absorbable material, that is to say, which dissolves in time, and therefore are suitable to be left on the bottom 21a of the relative vertical holes 21 at the end of the operation, if so desired.
  • the thruster element 12 has its second threading 13b shorter than the first threading 13a, so that when the thruster element 12 is completely unscrewed from the lower element 15 it remains in any case constrained to the bushing element 14.
  • the removal can be carried out by means of simple threaded extractors .
  • the diameter of the bushing element 14 varies from 2.5 to 6.5 mm and the length varies from 2.5 to 12 mm.
  • the total length of the device 10 varies preferentially from 4 to 18 mm .
  • the pitch of the second threading 13b of the thruster element 12 may be less than that of the first threading 13a, thus allowing to use a lower element 15 which is shorter than the bushing element 14.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
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Abstract

L'invention concerne un dispositif de distraction alvéolaire (10) du type intraosseux, ce dispositif étant destiné à être utilisé dans des traitements par distraction sur certaines parties du maxillaire inférieur/maxillaire supérieur (11). Ce dispositif, qui est conçu pour être inséré dans un trou borgne (21) sensiblement vertical ménagé dans la partie de l'os destinée à être soumise à la distraction, comprend un élément poussoir à filetage extérieur et un élément inférieur axialement creux à filetage intérieur, lequel est apte à s'accrocher au fond (21a) du trou vertical (21) et à loger au moins un segment inférieur dudit élément poussoir. Un noyau cylindrique axialement creux d'une vis est également prévu, ce noyau présentant un filetage extérieur lui permettant d'être fixé aux parois intérieures (21b) dudit trou vertical (21), un filetage intérieur étant par ailleurs capable de coopérer avec le filetage d'un segment supérieur dudit élément poussoir. La partie longitudinale de cet élément poussoir (21) présente un premier segment central-supérieur avec un premier filetage (13a) dans un sens correspondant à celui d'un second filetage (24) dudit noyau cylindrique (14), et un second segment central-inférieur avec un second filetage (13b) dans un sens contraire à celui du premier filetage (13a), mais correspondant à celui du filetage intérieur (25) dudit élément inférieur (15).
PCT/IB2000/000039 1999-01-18 2000-01-14 Dispositif de distraction alveolaire WO2000041637A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU18867/00A AU1886700A (en) 1999-01-18 2000-01-14 Alveolar distraction device

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ITUD99A000012 1999-01-18
ITUD990012 IT1310985B1 (it) 1999-01-18 1999-01-18 Dispositivo distrattore alveolare.

Publications (1)

Publication Number Publication Date
WO2000041637A1 true WO2000041637A1 (fr) 2000-07-20

Family

ID=11422829

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB2000/000039 WO2000041637A1 (fr) 1999-01-18 2000-01-14 Dispositif de distraction alveolaire

Country Status (3)

Country Link
AU (1) AU1886700A (fr)
IT (1) IT1310985B1 (fr)
WO (1) WO2000041637A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1184001A1 (fr) * 2000-08-25 2002-03-06 Friadent GmbH Dispositif pour la distraction de segments osseux

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2440856A1 (de) * 1974-08-26 1976-03-11 Hans Dr Boretzky Schiene fuer die kieferchirurgie
WO1999001080A1 (fr) * 1997-07-02 1999-01-14 Stucki Mccormick Suzanne U Implant dentaire a distraction combinee et son mode d'utilisation

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE2440856A1 (de) * 1974-08-26 1976-03-11 Hans Dr Boretzky Schiene fuer die kieferchirurgie
WO1999001080A1 (fr) * 1997-07-02 1999-01-14 Stucki Mccormick Suzanne U Implant dentaire a distraction combinee et son mode d'utilisation

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1184001A1 (fr) * 2000-08-25 2002-03-06 Friadent GmbH Dispositif pour la distraction de segments osseux

Also Published As

Publication number Publication date
IT1310985B1 (it) 2002-02-27
ITUD990012A1 (it) 2000-07-18
AU1886700A (en) 2000-08-01

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