Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
  • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
  • A61C1/08—Machine parts specially adapted for dentistry
  • A61C1/082—Positioning or guiding, e.g. of drills
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
  • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
  • A61C1/08—Machine parts specially adapted for dentistry
  • A61C1/082—Positioning or guiding, e.g. of drills
  • A61C1/084—Positioning or guiding, e.g. of drills of implanting tools
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
  • A61C13/00—Dental prostheses; Making same
  • A61C13/0003—Making bridge-work, inlays, implants or the like
  • A61C13/0004—Computer-assisted sizing or machining of dental prostheses
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
  • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
  • G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• • 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
  • A61C8/0001—Impression means for implants, e.g. impression coping
• • 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

Definitions

• the invention relates to a method for producing and applying a dental implant in an intraoral implantation field according to the preamble of claim 1.
• dental implant includes both
• Defect fillings in natural tooth crowns, as well as prosthetic implants provided they are firmly inserted into a biological-anatomical structure.
• a biological-anatomical structure can be given, for example, by a tooth crown which has a defect to be filled in the course of caries treatment, or a structure of the jawbone in which prosthetic implants, in particular pin teeth, tooth parts or bridge structures, are anchored.
• the measures necessary for this require an extremely precise shape matching between the dental implant in question and the implantation field.
• the biological and anatomical structures of the implantation field are prepared for later implantation by means of conventional dental processing instruments, for example a dental substance-removing turbine.
• the shape of the implantation field prepared in this way is recorded mechanically or without contact. This is done either by making an impression or by an optical scanning process.
• a shape of the implantation field is obtained by pouring, on which a future implant can be adapted in a dental laboratory.
• the impression obtained is filled with a casting compound, a positive shape of the implantation field being generated in the laboratory.
• German patent DE 44 43 929 Cl proposes to minimize this effort a process for the patient-specific manufacture and supply of prosthetic workpieces, in which a defect impression is taken with a bite registration in a first process step of the intraoral implantation field. From this impression, a planning model is created in a dental laboratory, on which further processing, for example grinding or milling cavities or moldings or the like, is carried out in the course of a simulated treatment in the laboratory. The dental implant is then adapted to this prepared planning model in the following. The state of the planning model is then measured or numerical processing data from the laboratory treatment are saved.
• these processing data or the results of the measurement of the planning model are transmitted to a practice treatment device fixed in the patient's mouth, which intraorally transfers the processed state of the planning model to the real shape of the implantation field. This ensures that the dental implant is precisely matched to the shape of the implantation field. In this way, the patient is spared complex treatment sessions with repeated adjustments of the implantation field and implant.
• a basic idea of the method according to the invention is to provide the intraoral implantation field with location markings in a suitable manner and to make a location-marked impression via the implantation field thus marked.
• anatomical-biological structures of the deep structure of the implantation field are recorded in an imaging tomographic method, the location-marking structures of the immediate implants appearing as contrast structures in the tomogram.
• data are generated for a virtual planning model with the tomographically recorded location markings as reference data points of the virtual planning model.
• a laboratory planning model is created. Treatment planning is then carried out on the basis of the virtual planning model and the laboratory planning model, the virtual planning model allowing a selective analysis of the anatomical-biological depth structure of the implantation field and the laboratory planning model serving to adapt the dental implants to be manufactured.
• the laboratory planning model is then processed in the known manner, using the data from the treatment planning created on the virtual planning model.
• the processing data are recorded and stored numerically.
• the numerical processing data is then transferred to a practice processing device.
• This is equipped with a practice treatment unit, which is fixed on the location-marking immediate implants at the patient's implantation field.
• the numerical processing data serve to control the practice treatment unit, which carries out the corresponding processing on the implantation field, for example drilling or milling work.
• the final dental implant is inserted.
• the method thus combines the physical-manual acceptance and preparation of the laboratory planning model for performing laboratory processing of the model and adapting the dental implant to the model with the creation of a virtual planning model based on diagnostic data.
• the latter model in particular provides the option of carrying out treatment planning in a more detailed and selective manner than is the case with the known methods.
• tomographic imaging methods are minimally invasive and gentle on the soft tissue and therefore do not require any surgical opening of the implantation field. This is particularly advantageous when dental implants are to be inserted into a jaw structure, which is usually hidden under a soft tissue layer.
• Tomographic image data show a clear contrast between the soft tissue and the bone tissue and, in conjunction with the generation of a three-dimensional virtual model, represent the possibility of selectively planning interventions on the jawbone.
• the virtual and the laboratory planning model can be linked with one another, so that computer-assisted planning and execution of laboratory processing takes place on the laboratory planning model.
• the numerical processing data determined in the process can be transmitted directly to a practice treatment unit in the patient's mouth, which is also clearly marked on the immediate implants there. A new scan of the This eliminates the need for a laboratory planning model, streamlining the procedure, making treatment planning more precise and selective, and reducing the overall invasiveness of the procedure. An otherwise necessary bone structure can be omitted.
• Suitable location-marking immediate implants are, in particular, implants introduced into the jawbone, each with a head part protruding into the oral cavity, the head part containing rotationally secure receptacles with impression sleeves arranged thereon.
• the impression sleeves remain in a negative form of the impression material as laboratory location markings and are transferred to the model in a location-specific manner when the laboratory planning model is created using laboratory implants.
• the head parts, the receptacles and / or the impression sleeves, or the implant parts located in the jawbone are made of one
• Material executed that when performing the tomographic acquisition on the tomography images, location markings in the form of a contrast, shadow or the like are generated further easily detectable reference shape structure. It is possible to fix an imaging sensor on or over the implants for the acquisition, e.g. to reduce patient stress during X-ray analysis and to achieve a higher resolution.
• the sensor can have a toothed splint shape and enable multidimensional image acquisition.
• the laboratory planning model is expediently generated by filling the negative form of the impression with a plastic material, the impression sleeves being transferred to the laboratory planning model when the hardened plastic material is removed. The position of the impression sleeves is then measured on the laboratory planning model. This happens at the most moderate by capturing prominent points in a laboratory coordinate system.
• a plastic model can be produced from the existing data, for example from a laser-crosslinkable material.
• the virtual planning model is generated from the tomographically acquired data, scaling variables of the virtual planning model being adapted to one another by comparing the location markings of the laboratory planning model and the shape structures of the virtual planning model.
• characteristic shapes of the reference shape structures can be used to correct distortions and changes in size, or to align the virtual planning model with a laboratory coordinate system.
• Treatment planning can then be carried out on the virtual planning model, with the extensive range of functions of known tomography evaluation software being able to be used.
• the laboratory planning model is now processed in the laboratory by means of a laboratory processing device, in particular a drilling, milling or similar device, control data being used on the basis of the biological-anatomical data or the data of the treatment plan.
• control data being used on the basis of the biological-anatomical data or the data of the treatment plan.
• the numerical data about the machining process are stored and then transmitted to a practice machining device.
• the treatment of the intraoral implantation field takes place in the dental practice under control on the basis of the numerical data from the laboratory processing.
• an intraoral processing device for example a drilling, milling or the like machining unit on the provisori ⁇ 's immediate implants will be locally precisely fixed and executed processing of the intra-oral ⁇ implantation field on the patient.
• the numerical processing data of the laboratory planning model are mirrored.
• the mirrored processing data are stored on a laboratory milling machine.
• Direction for producing an implant workpiece transmitted, which then produces a defect implant from a block of material.
• a bite can also be removed by means of a bite to mark the location.
• the bite fork forms a clear location fixation for the laboratory planning model and location-specific fixation of the patient's intraoral implantation field on the practice treatment apparatus for an intraoral treatment device.
• the first application example an implantation of a dental implant to be inserted into the jawbone is described.
• the second application example describes the implantation of a defect implant in a tooth crown.
• the particular task of implantation is to adapt the dental implant, for example a post part sitting in the jawbone, to the shape of the jawbone, the jawbone generally being covered by soft tissue.
• the shape of the jawbone in the implantation field to detect an opening and partial removal of the soft tissue without, a tomographic method is applied, wherein ortsmark Schlude provisional immediate implants of the field implantation can be used at appropriate locations in the vicinity '.
• the shape of the implant can be individualized according to the respective bone supply.
• the exact shape and the material to be used of the location-marking immediate implants depends on the structure of the jawbone at the location of the application of the immediate implants, on the position of the implantation area within the dentition structure (e.g. anterior, canine or molar area) and on the tomographi ⁇ used in each case procedures.
• the immediate implant is positioned at the provisional implantation site against displacement and loosening.
• the immediate implant then sits with its rider-shaped post part on the jaw and is covered with gum tissue, a mandrel with a rotation-safe cross-section protruding from the gum in the direction of the oral cavity.
• the length, the cross-section and the diameter of the mandrel must be planned so that it is not deformed due to loads caused by the chewing action. So its length can be designed so that it does not exceed the height of the crowns of adjacent teeth.
• the immediate implant is made of tissue-compatible and contrast-generating materials for a tomography process.
• the arbor and the post part have a shape that is clearly recognizable in the tomography image.
• Computer tomography CT or magnetic resonance tomography MRI are used as the tomographic method.
• the MRI procedure prevents radiation exposure to the patient.
• the MRI method is suitable for a high-resolution display of the smallest anatomical-biological structures in the jaw area, since physically the different water concentration in the gum or bone tissue is detected and displayed in this method. Since the immediate implant is water-free and also made of a material that has no magnetic resonance, the shape and position of the location-marking immediate implant is clearly apparent in the image data obtained by MRI tomography.
• the tomographic data are assembled in the computer in the known manner to form a three-dimensional virtual model of the implantation field, the vir tual ⁇ planning model, this model can be handled by means of the usual loan image and data processing software.
• an impression of the implantation area including the location-marking immediate implants, is recorded.
• receptacle sleeves are fitted on the mandrels of the provisional implants in a rotationally secure manner.
• the receiving sleeves are pulled off the plastic impression material from the holding mandrels and transferred into the resulting negative form.
• a negative mold is created in which the impression sleeves are contained like a series of position names. So-called laboratory implants are inserted into these impression sleeves.
• the laboratory implants When filling the negative form with a plastic material, the laboratory implants are enclosed with the filling material, so that the resulting positive form contains the laboratory implants at precisely defined locations.
• the position of the laboratory implants corresponds exactly to their intraoral jaw position, as well as their position in the virtual planning model.
• the virtual planning model is now used for treatment planning.
• image processing software it is now possible to virtually extract the data of the jawbone tissue from the data of the gum tissue, to assess the anatomical-biological structure of the jawbone in the implantation field and to determine which optimal preparations are to be carried out on the bone tissue.
• the dentist therefore not only has an external copy of the implantation field, but also a complete data set about the entire deep structure of the bone.
• the dentist then carries out the treatment planning on the virtual planning model, with appropriate software means making it suitable for him
• Basic solutions for example, a particular milling or drilling direction, or depth, and may be proposed -large that are inserted into the image data of the vir tual ⁇ planning model.
• the assessment of the virtual Pla ⁇ voltage model can be obtained by means to a quasi three-dimensional representation, examples play, 3-D goggles, or a two-color process to be supplemented.
• the implants are then individually planned, designed and milled depending on the bone availability determined.
• the positions and angular positions of the receiving sleeves in the laboratory planning model are recorded and measured in a first calibration step with respect to a laboratory coordinate system.
• the laboratory coordinate system is mapped to the virtual coordinate system of the virtual planning model.
• This process can be carried out by fixedly fixing the laboratory planning model in a measuring device and transferring the measurement data obtained into the storage device of the virtual planning model.
• the accompanying coordinate tripod of the virtual planning model is moved translationally and rotatoryly via virtual rotation and displacement operations until striking measuring points, for example certain image points of the receiving sleeves in the virtual planning model, match the coordinate positions of the laboratory planning model.
• the translational or rotary virtual movement of the virtual planning model is followed by a form calibration of the virtual planning model to the laboratory planning model.
• the shape calibration is carried out on the basis of the shape contrast of the pixel quantity of the receiving sleeves or the immediate implants in the virtual planning model.
• the virtual planning model is given a precisely defined size scale and any distortions in the representation of the virtual planning model are compensated for by deformation operations of pixel quantities, for example stretching or compressing. Subsequently, it may be necessary to recalibrate the position of the virtual coordinate system of the virtual planning model. In general, the distortions of the virtual planning model are small, so that a position calibration and a size calibration of the virtual planning model are generally sufficient.
• the spatial data of the virtual planning model are transmitted to a laboratory processing device, which processes the laboratory planning model on the basis of this data, for example carries out drilling, milling or comparable processing of the laboratory planning model.
• the numerical machining data are read out and saved.
• the treatment planning data from the virtual planning model can also be the basis of the stored numerical processing data.
• the structure of the dental implant is subsequently adapted to the processed laboratory planning model.
• the numerical processing data are then transmitted to a practice treatment apparatus.
• This contains an intraoral processing unit with devices for performing drilling and / or milling work on the jaw of the implantation field.
• the intraoral processing unit is placed on the mandrels of the provisional, location-marking immediate implant.
• the position of the location-marking immediate implants clearly defines the position of the intraoral processing unit and corresponds precisely to the virtual or laboratory processing model of the implantation field.
• the intraoral processing unit subsequently mills the jawbone cavities that are necessary for the admission of the dental implant.
• the individually manufactured dental implant can be inserted into the prepared implantation field and the previously completed superstructure can be used.
• the numerical processing data can be mirrored, the mirrored data being transmitted to a laboratory milling device which at least partially mills a dental implant corresponding to the cavities of the laboratory planning model from a corresponding block of material.
• a laboratory milling device which at least partially mills a dental implant corresponding to the cavities of the laboratory planning model from a corresponding block of material.
• the implantation field is formed by a cavity in a tooth crown.
• the cavity is cleaned of all filling residues or carious tooth material.
• a defect impression of the cavity is made using a spoon.
• the dentition position on the patient is recorded using an axiography. This can also be done automatically.
• a defect model is produced in the laboratory as a planning model and encrypted with a laboratory articulator based on the data obtained in practice.
• the model of the tooth to be processed is fixed in place in a scanner device via the bite fork.
• the defect of the tooth to be treated is detected on the defect model by means of mechanical or optical scanning using a camera, a laser beam or similar devices.
• treatment planning analogous to the exemplary embodiment already mentioned above.
• an outline of the preparation is planned individually for the patient at a data processing facility, or certain standard treatment plans are retrieved from a database and applied to the specific individual case.
• the cavity is milled on the defect model according to the planning parameters.
• the processing data generated during this process are saved and copied into a practice treatment apparatus.
• the previously described mirroring of the processing data and the manufacture of the defect implant are carried out on a laboratory milling machine from a block of material.
• the blank of the dental implant is fitted on the processed defect model and, if necessary, individualized in color.
• the patient is clearly fixed with respect to a milling unit using the bite fork previously made.
• the patient's tooth crown as a real implantation field is now in the same position as the defect model with respect to the laboratory processing unit or the laboratory measurement unit.
• the dental practice treatment unit for example the practice milling machine is in the mouth of the
• a laser can be used as a diagnostic aid for caries diagnosis.
• the condition of the teeth is examined using the laser. If carious material is found, it is possible to remove this diseased material. This is followed by. rebuilding the tooth, e.g. using special plastics. This can be done manually, but also through a cannula that releases a corresponding application material. Afterwards, using the method according to the invention, the built-up tooth is ground to the desired dimension. This grinding can be done using a personal computer, which documents the respective treatment progress.

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• Health & Medical Sciences (AREA)
• Oral & Maxillofacial Surgery (AREA)
• General Health & Medical Sciences (AREA)
• Epidemiology (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Animal Behavior & Ethology (AREA)
• Life Sciences & Earth Sciences (AREA)
• Dentistry (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Surgery (AREA)
• Urology & Nephrology (AREA)
• Engineering & Computer Science (AREA)
• Medical Informatics (AREA)
• Primary Health Care (AREA)
• Dental Prosthetics (AREA)
• Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

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Applications Claiming Priority (4)

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Citations (1)

• 2003
  • 2003-09-02 AU AU2003271578A patent/AU2003271578A1/en not_active Abandoned
  • 2003-09-02 WO PCT/EP2003/009754 patent/WO2004032787A2/fr not_active Application Discontinuation

Patent Citations (1)

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