WO2009020446A1 - Implant dentaire et procédé pour le réaliser et l'installer - Google Patents

Implant dentaire et procédé pour le réaliser et l'installer Download PDF

Info

Publication number
WO2009020446A1
WO2009020446A1 PCT/US2007/017434 US2007017434W WO2009020446A1 WO 2009020446 A1 WO2009020446 A1 WO 2009020446A1 US 2007017434 W US2007017434 W US 2007017434W WO 2009020446 A1 WO2009020446 A1 WO 2009020446A1
Authority
WO
WIPO (PCT)
Prior art keywords
implant
tooth
crown
bone
patient
Prior art date
Application number
PCT/US2007/017434
Other languages
English (en)
Inventor
K. Tim Mount
Original Assignee
Mount K Tim
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 Mount K Tim filed Critical Mount K Tim
Priority to PCT/US2007/017434 priority Critical patent/WO2009020446A1/fr
Publication of WO2009020446A1 publication Critical patent/WO2009020446A1/fr

Links

Classifications

    • 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
    • A61C8/0018—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools characterised by the shape
    • A61C8/0036—Tooth replica
    • 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

Definitions

  • the present invention relates to a method for making a dental implant by obtaining images of the tooth pre-atraumatic tooth extraction and post extraction and using those images to computer generate and mill a titanium alloy replacement implant employing CAD/CAM equipment.
  • CAD/CAM Computer aided design and computer aided machining
  • Patents already exist and the technology has been in use for a number of years for employing a three dimensional optical camera to capture an optical impression (image acquisition) of a subject tooth as well as a tooth on each side of the target tooth.
  • CAD/CAM unit that is used at patient chairside.
  • the unit makes an optical impression, or acquisition, of a prepared tooth and can mill a precise ceramic restoration for the tooth in less than fifteen minutes.
  • Atlantis Components is a company that owns U.S. Patent Nos.
  • Julian Osorio the founder of the company, for essentially the same type of CAD/CAM system. At their facility they custom mill titanium abutments for dental implants that have already been placed in patients' dental arches.
  • a titanium alloy consisting of one part titanium, six part aluminum, and four parts vanadium, i.e. Ti-6AI-4V, represents the best solution for dental implants as well as orthopedic uses. Titanium alloy has demonstrated interfaces described as osseointegrated in humans. Biomechanical strength, biocompatibility and the modulus of elasticity are most optimal when using titanium alloy and this is the best material that biomaterials technology currently offers for tooth and skeletal replacements.
  • surface treatment is done in the regions of the implant body where it is desired to promote bone apposition, or growth to the titanium alloy implant surface, namely the threaded portion and approximately 1-2 mm above the threads. Surface treatment can be an addition or subtraction method, and a number of coating or blasting means have been and continue to be used to achieve the desired surface treatment.
  • Hydroxyapatite is the principal inorganic component of bone and teeth and synthetic HA coatings are added to implants to be placed into less dense or poorer quality bone.
  • Another enhancement method of surface treatment is the addition of a titanium oxide layer which gives texture and porosity to encourage bone growth onto and into the threaded surfaces.
  • Grit blasting or soluble blasting media is a subtraction method which roughens the titanium threaded surfaces of the implant. The same is true for resorbable blast media (RBM).
  • the current procedure for implant replacement of a missing tooth involves essentially the following steps from surgery to restoration of the clinical crown (portion of the tooth seen when looking in the mouth — above the gum): (1) drilling an osteotomy (circular hole to a specified depth) into the alveolar bone ; (2) threading the implant into the osteotomy; (3) attaching a cover screw to the implant body utilizing it's internal threads; so that the cover screw is out of occlusion with the opposing teeth (4) allowing several months for osseointegration to occur; (5) removing the cover screw; (6) placing an abutment on the implant; (7) and then restoring the abutment with a tooth colored clinical crown.
  • the first step of this current procedure involves drilling a circular osteotomy in the alveolar bone using an electric handpiece and associated console.
  • the osteotomy is drilled to the depth required for the manufactured implant to be used in the treatment plan and placed in the position and angulation deemed most appropriate by the dental implant surgeon.
  • the surgeon slowly threads the sterile implant into the osteotomy site. This is again done using the electric handpiece, but at a greatly reduced number of revolutions per minute over that used when creating the osteotomy.
  • the typical protocol was to then place a cover screw into the internal threads of the freshly placed implant body.
  • the implant body with cover screw in place, was allowed to lay dormant for three to nine months while osseointegration, or growth of bone to the titanium implant body, occurred. If bone quality was excellent, a shorter healing time was required. Conversely, if the bone quality was poorer, more healing time was required.
  • the next step was to remove the cover screw and place an abutment onto the implant body. This was done by threading a screw through the top of the abutment and into the internal threads of the implant body. Once the abutment was in place, for the first time there was something above the gingival (gum) level which resembled a tooth that had been prepared to receive a crown. Both the abutment and the implant body were made of titanium alloy.
  • the dentist can restore the abutment with a tooth colored clinical crown just as in the case of a natural tooth which has been prepared or reduced down to receive a new crown by use of the CEREC CAD/CAM or by traditional techniques of laboratory fabrication.
  • the CEREC can produce the crown within fifteen minutes whereas a laboratory produced crown may require two weeks.
  • most crowns are usually made of tooth colored ceramic, they alternately can be constructed of full gold or part ceramic and part gold, etc.
  • Implants placed over approximately the last twenty years were manufactured with a circular upper platform extending just slightly above the threads or neck of the implant. This platform is a flat or horizontal table onto which the abutment seats.
  • Implants without the scalloped areas on each side allow bone to die back approximately 1-1.5 mm. With the scalloped design, bone is allowed to keep its natural configuration in three dimensions and this supports the overlying gingival tissue.
  • the triangular area of gingival tissue (papilla) that should exist between a tooth and an implant or between two implants is supported by bone and encouraged to grow normally in a state of health just as occurs between two teeth in a healthy mouth.
  • the extent or degree of scalloping depends on the individual tooth. This is merely a matter of the level at which the enamel ends and the cementum on the root of the tooth begins. It is an irregular shape going around the circumference of the tooth. The cementum on the root portion merely comes up higher between adjacent teeth and allows a triangle of bone to grow between them. As always, with nature it is the body's elegant solution to how to add support for and protect the teeth from the trauma of eating various foods. It allows for a smooth transition from the tooth enamel onto the gingival tissue in an aerodynamic manner.
  • the implant body and abutment are manufactured from a single piece of titanium alloy, thus eliminating any connection point.
  • This new development meshes nicely with the fairly recent trend toward immediate loading of the combined implant and abutment with a provisional or permanent crown.
  • the one-piece combination implant and abutment is placed in the bone and receives a crown on the same appointment.
  • the present invention creates a paradigm shift in patient and dental implant treatment and is a significant departure from the state of the art of current dental implant placement. It allows for custom machined and surface treated implant replacement of a tooth, with as natural an emulation of the original tooth as possible.
  • the present procedure produces better results than previous methods by providing for immediate replacement at the time a tooth is extracted. It can also provide replacement of a previously extracted tooth.
  • an implant By creating a custom osteotomy and utilizating a dental database for the tooth number being replaced, an implant can be created to match this osteotomy. In the same way, it can also provide as replacement for a congenitally missing tooth.
  • the present invention is a dental implant and method for making and installing that dental implant into a patient's mouth.
  • This invention normally employs immediate implant replacement of an extracted tooth and employs prior technology such as the CEREC CAD/CAM equipment which provides the ability to acquire three dimensional images of the tooth and the CAD/CAM capability to machine titanium as is done by the Atlantis Components Company product discussed above.
  • this invention can also be employed to replace teeth that have been extracted much earlier or alternately, to replace congenitally missing teeth.
  • the steps in practicing the present invention when a tooth is to be immediately replaced after extraction are as follows. First, a three dimensional image of the crown of the tooth is acquired prior to extraction. The dentist then administers an anesthetic injection to prevent the patient from experiencing pain. The dentist atraumatically removes the tooth from the patient's mouth by first cutting the upper-most Sharpey's fibers with the fine blade of a periotome and then gentle luxation with extraction forceps. Next, the cementum area of the root of the tooth is cleaned of all Sharpey's fibers and the entire tooth is cleaned and dried. The tooth is then seated crown first in a tooth holder and a three dimensional image of the root structure is acquired.
  • the images of the crown and root of the tooth are next integrated to create a composite three dimensional image of the extracted tooth on the equipment monitor.
  • the dentist then makes any needed modifications in the computer generated implant image seen on the monitor before having the equipment mill a titanium alloy implant, which is based on the composite images acquired earlier.
  • the milled implant will include a scalloped neck interface, polished neck area, chevron retention fins in the root portion, retention grooves and slightly abrading on the crown region, tooth number milled into the facial surface and root surface treatment, i.e. either addition or subtraction, as selected by the dentist.
  • the dentist will decorticate and debride the tooth socket just prior to seating the newly created implant.
  • the implant will be seated Into the socket by gently tapping with a surgical mallet and utilizing a serrated tipped cylinder shaped seating instrument in contact with the implant.
  • a provisional crown will then be cemented to the implant slightly out of occlusion. This crown will serve as an interim restoration until osseointegration of the implant can occur.
  • the provisional crown can be removed and a permanent crown cemented to the implant with the permanent crown in occlusion with the patient's opposing teeth.
  • a Tooth is anchored in the alveolar bone by Sharpey's fibers, collectively known as the periodontal ligament.
  • the Sharpey's fibers run between the root of the tooth and the bone.
  • the upper-most Sharpey's fibers should be severed with the fine blade of a periotome prior to gentle luxation with extraction forceps.
  • By first severing the upper-most Sharpey's fibers many teeth can be removed from the patient's mouth very easily without breakage. Some teeth must be sectioned with a handpiece and bur before they can be removed because of multiple and/or divergent roots.
  • the invention requires that a three dimensional optical image be acquired of the clinical crown of the tooth prior to extraction and of the root of the tooth after it has been extracted and cleaned. Regardless of how much or how little of the original clinical crown portion remains of the tooth to be extracted, an optical acquisition should be made.
  • the software associated with the equipment contains a dental database and can reconstruct the shape of any missing portion of the crown to a close proximity of the original shape of the missing portion of the tooth.
  • the spirit and embodiment of the invention being described encompasses any means of cutting and treating the surface of titanium alloy.
  • the procedure requires an infection free socket for success.
  • the procedure requires a tooth that truly needs to be extracted and is not going to have endodontic (root canal) treatment. If there is an infection, it should be treated with antibiotics and the infection resolved prior to extraction of the tooth.
  • a tooth can be extracted that is infected and once the infection has abated, the patient can be brought in, the socket decorticated and thoroughly debrided of any residual ligamental attachments or epithelial tissue and have the implant placed at that time. This could occur within approximately a two week period, with the implant already milled and ready for placement based on the previously extracted tooth.
  • the patient must receive an anesthetic injection to have an extraction procedure done.
  • the duration of anesthesia will be approximately 2 hours for 2% lidocaine and can be longer (up to 6 hours) depending upon the anesthetic chosen.
  • the entire implant manufacturing and placement can occur and the crown can be placed. This entire procedure can be accomplished in one patient visit and will take approximately 1 -1 1 /4 hours to complete.
  • the tooth should have all remnants of Sharpey's fibers removed from the cementum area of the root.
  • the tooth should be cleaned and dried and then placed crown first into a holder for root image acquisition.
  • any type of holder that will hold the tooth securely will work, one type that works well is a holder that has a rubber diaphragm with an X-shaped opening cut into the diaphragm and through which the crown portion of the tooth is inserted.
  • the tooth is seated crown first into the diaphragm down to just above where the enamel ends and the cementum begins, the cementoenamel junction (CEJ).
  • CEJ cementoenamel junction
  • the extent or degree of scalloping at the CEJ depends on the individual tooth being imaged by the three dimensional camera.
  • the immediate implant that is milled by the CAD/CAM unit will be as close a replica of the tooth that was just extracted as the technology will permit.
  • the invention takes into consideration that we should emulate nature and create an implant with a root treated surface that is scalloped in shape just like the irregular scalloped cementum area on the root of the tooth.
  • the tooth involved is multirooted and required sectioning, it can be bonded back together by a variety of common dental means such as using wax, acrylic, etc.
  • the software takes all this into account and can design an implant replacement that can be seated back into the socket by gentle tapping with a surgical mallet and associated serrated tipped seating instrument.
  • the software automatically creates a random pattern of chevron retention fins on the root portion of the implant.
  • chevrons act somewhat like threads on conventional implants but do not create a spiral threading motion when placing the implant. They allow for bone compression as the implant seats but are one directional and will not allow the implant to come back out of the socket. This eliminates micro-movement of the implant at the time of placement and thus encourages bone growth to the titanium alloy surface treated root portion of the implant.
  • the dentist can rotate the three dimensional image of the proposed one-piece combination implant and abutment on the equipment monitor to check all aspects of the one-piece unit and can override the automatic computer design by eliminating a chevron or making any modification that he feels is an improvement on the computer solution. Once the dentist is satisfied with the design that is shown on the monitor, the "mill" command is selected and manufacturing of the milled implant is completed within approximately fifteen minutes.
  • the milled implant may not have a root portion exactly like the extracted tooth but it will be essentially the same and will be modified enough to allow it to seat to place in the patient's socket. Any voids remaining between the patient's socket and the implant after the implant has been placed will simply fill in over time with new bone growth.
  • the implant design will not be exactly the same shape as the original tooth because if it were, the implant could not be seated to place in the socket. However, the design and milled result will have chevrons that will ensure a tight secure fit that is free from micro-movement.
  • the CAD system will integrate images of the root and crown portions of the tooth and produce a design that can be seated into the extraction socket; and the abutment portion will automatically be milled and ready to receive a crown on the same appointment as the extraction.
  • a before image and an after image would be the minimum required.
  • the before image acquisition is of the tooth's crown portion prior to extraction. Normally, only one view would probably be required. However, more views could be acquired.
  • the after image is of the root structure and could conceivably require several views, especially for a multi-rooted tooth.
  • the software is able to map the images and integrate the data points to create a composite three dimensional image on the monitor of the entire tooth prior to milling operations.
  • the CAM portion of the equipment will surface treat the milled titanium alloy implant just before completion of the manufacturing process.
  • the root portion being analogous to the cementum area on the tooth root, will receive the chevron retention fins in a random pattern and have either an addition or subtraction surface treatment.
  • the dentist has the option of selecting the type of surface treatment needed based on the patient's bone quality. An icon is selected to indicate this to the computer at the same time of after selecting the mill icon.
  • the density of bone is largely dependent on the area of the mouth where the extraction was performed and is classified using Misch bone density classifications D1-D4. The clinical judgment of the practitioner comes into play in evaluating the individual patient and the extraction site and determining the appropriate surface treatment to be employed on the implant for that particular patient.
  • the degree of so called scalloping in the neck region of the implant will be based on duplication of the natural tooth that was just extracted, or alternately, based on a dental database if the tooth is not available for imaging in the situation of replacing a previously extracted tooth which is no longer available or a tooth that is congenitally missing.
  • Bone is expected to grow on the surface treated root region of the implant. Directly above the surface treated root region will be a polished neck area for the region of gingival fiber formation.
  • the gingival fiber is a circumferential band of gingival tissue that forms around the implant to provide a biologic seal. This prevents migration of bacteria and endotoxins into the underlying bone.
  • the milling unit will produce a crown cementation region that is prepared for a crown.
  • the region that is prepared to receive the crown will include two or more retention grooves that are automatically placed by the computer but the region can have more or less as determined by the dentist.
  • This crown cementation region will be finished off with a slightly abraded surface as would be created with a course diamond dental cutting instrument.
  • the tooth number (1-32) will be placed into the facial surface (toward the lip) of this crown cementation region.
  • the number has two functions. First, the location of the number designates the way the implant needs to be oriented while it is being seated into the patient's tooth socket. Second, the tooth number designates where the implant is to be placed in the mouth. This is important when the dentist has extracted more than one tooth and would prevent interchanging two or more similar implants.
  • the socket Prior to placement of the CAD/CAM produced titanium one-piece scalloped implant, milled in the shape of the natural tooth root structure, the socket must be decorticated and principally all remnants of Sharpey's fibers must be removed. This is done using various sizes of sharp curettes which are shaped like miniature ice cream scoops. This debridement should scrape the socket bone thoroughly and create bleeding. This should be done after the implant is manufactured and just prior to seating the implant.
  • the implant is placed in the socket so that the number on the implant corresponds with the tooth placement in the mouth and so that the surface of the implant where the number appears faces the patient's lip.
  • the implant is then gently tapped into place with a surgical mallet utilizing a cylinder shaped serrated tipped seating instrument in contact with the implant.
  • a provisional crown is then cemented on the implant by traditional methods so that the crown is slightly out of occlusion with the opposing teeth. After several months when the implant becomes osseointegrated, the provisional crown can be replaced with a permanent crown that is in occlusion with the opposing teeth. This method can also be used to replace a tooth that was previously extracted months or years earlier.
  • the dentist uses the same basic procedure as described previously for a tooth that is extracted and immediately replaced with an implant. In this situation, the dentist creates an osteotomy at the site where a tooth had been removed months or years earlier.
  • the surgeon can generate a custom milled single or multi-rooted titanium alloy implant via the CAD/CAM system by means of traditional precision impression making. After a single rooted or multi-rooted osteotomy with a common alveolar bone and gingival tissue opening has been created, a traditional technique of precision impression making is completed for the osteotomy. This renders an exact negative replica of the osteotomy form that has been created.
  • the so called scalloped interproximal areas on the custom implant will encourage bone growth between the implant and adjacent teeth or between adjacent implants. Even if bone does not exist at the time of such implant placement, bone grafting can be done to promote the proper natural anatomical osseous form and thus formation of a natural overlying gingival tissue between the teeth and/or implants. Therefore, the triangular shaped natural papilla is encouraged to grow between the teeth and/or implants just as is found in the normal healthy mouth.
  • the present system allows for replacement of a missing tooth that may have been recently extracted or may have been missing for many years, it also allows for placement of an implant where there is a congenitally missing tooth. It allows the dentist to be in complete control of the depth, size, and overall shape of the osteotomy. As noted, the osteotomy can be created as single or multi-rooted. The only criterion is that the computer and the dentist design and ultimately manufacture a custom implant that can be tapped to place using a surgical mallet and seating instrument in contact with the implant. The osteotomy created for the missing tooth does not necessarily need to be, nor should it be, circular in nature. The invention takes into account that the dentist can create an osteotomy site that is as much like the natural tooth root shape and size as the available bone will permit.
  • the cervical area where the implant emerges through the alveolar bone can and should be as much like the anatomical shape and size of the natural missing tooth as available bone permits. This not only requires use of the traditional circular osteotomy drills but requires a variety of bone milling and grinding burs that can be in an array of shapes and sizes.
  • FIGURE 1 is a perspective view of an upper tooth that is to be removed from a patient's mouth while a CAD/CAM unit is being employed to obtain a three dimensional image of the clinical crown prior to extraction of the tooth.
  • FIGURE 2 is the tooth of Figure 1 shown with an anesthetic syringe being used to administer a local anesthetic injection to the patient's mouth to prevent the feeling of pain.
  • FIGURE 3 is the tooth of Figure 2 shown with a periotome blade being used to cut, or sever, the upper-most Sharpey's fibers that surround the tooth and secure the tooth to the bone.
  • FIGURE 4 is the tooth of Figure 3 shown after it has been removed from its socket in the patient's mouth and has been cleaned of Sharpey's fibers.
  • FIGURE 5 is the tooth of Figure 4 shown inserted upside down into a tooth holder and a three dimensional image is being made of the root of the tooth employing a CAD/CAM unit.
  • FIGURE 6A is a composite image of the proposed implant as it appears on the CAD/CAM unit monitor.
  • FIGURE 6B is an enlarged view of the proposed implant of Figure 6A.
  • FIGURE 6C is an enlarged view of one of the chevron fins contained within the broken circle of Figure 6B.
  • FIGURE 6D is a side view of the proposed implant taken along line 6D- 6D.
  • FIGURE 7 is the milled and root surface treated implant that has been created by the CAD/CAM unit and that is now ready for implantation into the patient's tooth socket.
  • FIGURE 8 shows the tooth socket that has been decorticated and debrided just prior to seating the newly created implant.
  • FIGURE 9 shows the implant being secured in the tooth socket.
  • FIGURE 10 shows a provisional crown that has been placed on the implant.
  • FIG. 1 there is shown a tooth 10 that is about to be extracted from a tooth socket 12 in a patient's mouth 14 and, as shown in Figure 10, replaced with an implant 16 according to a preferred embodiment of the present invention.
  • the present invention is a dental implant 16 and method for making and installing that dental implant 16 into a patient's mouth 14.
  • This invention normally involves replacement of a tooth 10 with an implant 16 immediately after the tooth 10 is extracted.
  • the process employs prior technology such as the CEREC CAD/CAM equipment that is illustrated in Figures 1 , 5, and 6A.
  • This CAD/CAM equipment 18 provides the ability to acquire three dimensional images of the tooth 10 via a camera 18B that is part of the equipment 18 and the capability to machine a titanium implant 16.
  • this invention can also be employed to replace a tooth or teeth that have been extracted much earlier, or alternately, to replace congenially missing teeth.
  • the drawings provided are designed to illustrate the extraction and immediate replacement of a tooth 10. The procedure for replacing previously extracted teeth and congenitally missing teeth will be described following a detailed discussion of the procedure for immediate replacement of an extracted tooth 10.
  • a three dimensional image of the clinical crown portion 20 of the tooth 10 is acquired prior to extraction employing the CAD/CAM equipment 18. This three dimensional image is stored in the equipment 18 and will later be used to help create an implant 16 that will replace the tooth 10. It is desirable to obtain a three dimensional optical image of the clinical crown portion 20 of the tooth 10 prior to extraction and of the root 28 of the tooth 10 later after the tooth 10 has been extracted and cleaned. Regardless of how much or how little of the original crown portion 20 remains of the tooth 10 to be extracted, an optical acquisition should be made.
  • the software associated with the equipment 18 contains a dental database and can use that database to reconstruct the shape of any missing part of the crown portion 20 to a close proximity to the original shape of the missing part of the tooth 10.
  • the present procedure requires an infection free tooth socket 12 for success.
  • the present procedure requires a tooth 10 that truly needs to be extracted and is not going to have endodontic treatment. If there is an infection, the infection should be treated with antibiotics and the infection resolved prior to extraction of the tooth 10. Alternately, a tooth 10 that is infected can be extracted and once the infection has abated, the patient can be brought in, the socket decorticated and thoroughly debrided of any residual ligamental attachments or epithelial tissue and have the implant 16 placed at that time, according to the process that will be more fully explained hereafter.
  • the implant 16 normally will be placed within approximately a two week period following extraction of the tooth 10, with the implant 16 already milled and ready for placement based on the previously extracted tooth 10.
  • the dentist uses an anesthetic syringe 22 to administer an injection to the patient's mouth 14 to prevent the sensation of pain, as shown in Figure 2.
  • the patient must receive an anesthetic injection to have the extraction procedure done.
  • the duration of anesthesia will be approximately 2 hours for 2% lidocaine and can be longer (up to 6 hours) depending upon the anesthetic chosen.
  • the entire manufacturing and placement of the implant 16 can occur and a provisional crown 48 can be placed. This entire procedure can be accomplished at one patient appointment visit and will take approximately 1 - VA hours to complete.
  • the dentist atraumatically removes the tooth 10 from the patient's mouth 14.
  • a tooth 10 is anchored in the bone 30 by Sharpey's fibers 26, collectively known as the periodontal ligament.
  • the Sharpey's fibers 26 run between the root 28 of the tooth 10 and the bone 30.
  • the dentist will generally first use a periotome 24. Once those Sharpey's fibers 26 that can be reached with a periotome 24 have been severed, the dentist then gently luxates the tooth 10 with extraction forceps.
  • the tooth 10 can be bonded back together after it has been cleaned and dried in order to obtain the necessary image of the root 28, as will be more fully described hereafter.
  • the cementum area 32 of the root 28 of the tooth 10 is cleaned of all Sharpey's fibers 26.
  • the cleaned tooth 10 is then dried of surface moisture.
  • the clean, dry tooth 10 is then seated crown first in an appropriate tooth holder 33 so that a three dimensional image of the root structure 28 of the tooth 10 can be acquired, as shown in Figure 5.
  • the tooth 10 involved is multi-rooted and required sectioning to remove it from the patient's mouth 14, the tooth 10 can be bonded back together by a variety of common dental means such as using wax, acrylic, etc. Jf the roots 28 are divergent, dilacerated or hooked in the apical region 29 the software employed by the CAD/CAM equipment 18 takes this into account and can design an implant 16 replacement that can be seated back into the tooth socket 12 by gentle tapping with a surgical mallet (not illustrated) and cylinder shaped serrated tipped instrument (not illustrated) in contact with the implant. Many common dental instruments, even the handle of a mouth mirror (with the mirror portion unscrewed), could serve as the seating instrument in contact with the implant.
  • any such seating instrument should be made of titanium to prevent dissimilar metal contamination. Any small surgical mallet would also serve well in the seating process.
  • holder 33 that will hold the tooth 10 securely will work, one type that works well is the holder 33 that is illustrated in Figure 5.
  • This holder 33 has a rubber diaphragm 35 into which an X-shaped opening has been cut.
  • the crown portion 20 of the tooth 10 is inserted through the X- shaped opening in the diaphragm 35.
  • the tooth 10 is seated crown portion 20 first into the diaphragm 35 down to just above where the enamel 36 ends and the cementum area 32 begins i.e., the cementoenamel junction or CEJ which is indicated in the drawings in association with numeral 39.
  • the extent or degree of scalloping at the CEJ 39 depends on the individual tooth 10 being imaged by the three dimensional camera 18B.
  • the implant 16 that is immediately milled by the CAD/CAM unit 18 will be as close a replica of the original tooth 10 that was just extracted as current technology will permit.
  • the present invention takes into consideration that nature should be emulated by creating an implant 16 with a surface treated root 43 that is provided with a scalloped shaped CEJ 39 just like the irregular scalloped interface between the cementum area 32 on the root 28 of the tooth 10 and the enamel 36 of the crown portion 20 of the tooth 10.
  • the usual protocol of acquiring a three dimensional optical image is now completed for the root 28 of the tooth 10 and this image is also stored in the CAD/CAM computer 18.
  • the acquired images of the crown portion 20 and the root 28 of the tooth 10 are next integrated by the CAD portion of unit 18 to create a composite three dimensional image of the proposed implant 34 that appears on monitor 18A provided on the equipment 18, as shown in Figures 6A.
  • a composite three dimensional image of the proposed implant 34 that appears on monitor 18A provided on the equipment 18, as shown in Figures 6A.
  • at least one before-extraction image of the clinical crown portion 20 of the tooth 10 would be obtained prior to extraction of the tooth 10 and also at least one after-extraction image of the root 28 of the tooth 10 would be obtained.
  • the CAD system 18 will integrate the images and produce the image of a proposed design 34 for an implant 16 that would be suitable to be seated into the extraction socket 12.
  • the dentist can rotate the three dimensional image 34 of the proposed one-piece combination implant and abutment 34 on the monitor screen 18A of the equipment 18 to check all aspects of the proposed one-piece implant and can override the automatic computer generated design by eliminating a retention fin 42 or making any modification that he feels is an improvement on the computer solution.
  • the dentist is satisfied with the design image 34 that is shown on the monitor 18A, he selects the "mill" command on the equipment 18 and manufacturing of the milled titanium implant 16 is completed within approximately fifteen minutes based on the final composite image 34.
  • the implant 16 will include a crown region 44 that is ready to receive a clinical provisional crown 48 on the same appointment as the extraction.
  • Current technology permits a titanium implant 16 to be cut by mechanical means such as burs, lasers, etc.
  • the present invention encompasses any means of cutting or creating the implant 16.
  • the milled implant 16 will include a scalloped neck interface 38 that duplicates the scalloped contours found on the tooth 10 that the implant 16 is to replace.
  • the degree of scalloping in the neck interface 38 will preferably be a duplication of the scalloping found on the natural tooth 10 that was just extracted. Alternately, the degree of scalloping will be based on a dental database if the tooth 10 is not available for imaging, as is the case when replacing a previously extracted tooth 10 that is no longer available to the dentist or when replacing a tooth 10 that is congenitally missing. Bone is expected to grow on the surface treated root portion 43 of the implant 16.
  • the scalloped interproximal areas or scalloped neck interface 38 on the custom implant 16 will encourage bone growth between the implant 16 and adjacent teeth or between adjacent implants 16. Even if bone 30 does not exist at the time ⁇ f the implant 16 is placed in the patient's mouth 14, bone grafting can be done to promote the proper natural anatomical osseous form and thus formation of a natural overlying gingival tissue between the teeth and/or implants 16. Therefore, the triangular shaped natural papilla is encouraged to grow between the teeth and/or implants 16 just as is found in the normal healthy mouth 14.
  • a polished neck area 40 for the region of gingival fiber formation and attachment to the implant 16.
  • the gingival fiber is a circumferential band of gingival tissue that forms around the implant 16 to provide a biologic seal for the implant 16. The gingival fiber helps to prevent migration of bacteria and endotoxins into the underlying bone 30.
  • the software of the CAD/CAM equipment 18 automatically creates a random pattern of chevron-shaped retention fins 42 on the root portion 43 of the implant 16.
  • the retention fins 42 are angled in the direction of the crown region 44 of the implant 16 so that when the implant 16 is installed in the patient's mouth 14, the fins 42 engage the bone 30 and secure the implant 16 to the bone 30.
  • These chevron-shaped retention fins 42 act somewhat like the threads provided on conventional implants but instead do not create a spiral threading motion when placing the implant 16.
  • the retention fins 42 allow for compression of the bone 30 surrounding the tooth socket 12 as the implant 16 seats and because they are one directional, will not allow the implant 16 to come back out of the socket 12. This eliminates micro-movement of the implant 16 at the time of placement and thus encourages bone growth to the titanium alloy, surface- treated root portion 43 of the implant 16.
  • a crown cementation region 44 that is prepared for a crown 48.
  • the crown region 44 will include two or more retention grooves 46A, 46B, 46C and 46D that are automatically placed circumferentially on the crown region by the equipment 18. The number of retention grooves 46A, 46B, 46C and 46D can be determined by the dentist.
  • This crown cementation region 44 will be finished off with a slightly abraded surface as would be created with a course diamond dental cutting instrument. The abrading allows a crown 48 to be more securely attached thereto.
  • a tooth number 47 is also milled into the facial surface 50 i.e., on the surface of the implant that faces the patient's lip, of the crown region 44 of the implant 16.
  • the tooth number 47 is assigned according to the standard tooth numbering system employed in dentistry i.e., employing tooth numbers 1-32.
  • the tooth number 47 serves two functions. First, the location of the tooth number 47 on the facial surface 50 of the implant 16 designates the way the implant 16 needs to be oriented while the implant 16 is being seated into the patient's tooth socket 12. Second, the tooth number 47 indicates the location within the patient's mouth 14 where the tooth 10 was originally located and where the implant 16 will be installed.
  • the tooth number 47 of the implant 16 is particularly important when the dentist is working with a patient who has had more than one tooth extracted to prevent the dentist from accidentally getting the implants interchanged.
  • the tooth number 47 will later be concealed by a crown 48 which will cover the crown region 44.
  • the CAD/CAM equipment will surface treat the root portion 43 of the milled titanium alloy implant 16 at the completion of the implant manufacturing process.
  • the surface treatment with be either of an addition type or of a subtraction type, as selected by the dentist.
  • the root portion 43 of the implant 16 is analogous to the cementum area 32 on the tooth's root 28. It will receive the chevron retention fins 42 in a random pattern and will receive an appropriate surface treatment.
  • the surface treatment that the dentist selects will be based on the quality of the patient's bone 30.
  • the density of bone 30 is largely dependent on the area of the mouth 14 where the extraction was performed and is classified using Misch bone density classifications D1— D4.
  • the clinical judgment of the practitioner comes into play in evaluating the individual patient and the extraction site and determining the appropriate surface treatment to be employed on the implant 16 for that particular patient.
  • the present invention includes any type of surface treatment of the root portion 43.
  • the surface treatment is designed to encourage growth of bone 30 around the implant 16 i.e., osseointegration of the implant 16.
  • the milled implant 16 may not have a root portion 43 exactly like the root 28 of the extracted tooth 10 but it will be essentially the same and will be modified enough to allow it to seat to place in the patient's socket 12. Any voids remaining between the patient's socket 12 and the implant 16 after the implant 16 has been placed will simply fill in over time with new bone growth.
  • the design of the implant 16 will not be exactly the same shape as the original tooth 10 because if it were, the implant 16 could not be seated to place in the socket 12. However, the designed and milled implant 16 will have its chevron-shaped retention fins 42 that will ensure a tight secure fit with the bone 30 that is free from micro-movement.
  • the dentist will first decorticate the tooth socket 12 to remove principally all remnants of Sharpey's fibers 26. This is done using various sizes of sharp curettes which are shaped like miniature ice cream scoops. After decorticating the tooth socket 12, the dentist will next debride the tooth socket 12. This debridement should scrape the socket bone 30 thoroughly and create bleeding. This final step should be done after the implant 16 is manufactured and just prior to seating the implant 16.
  • the implant 16 will be sterilized prior to installation. Then, as shown in Figure 9, the new implant 16 will be placed in the socket 12 of the tooth number 47 appearing on the implant 16 with the tooth number 47 facing the patient's lip. Finally, the implant 16 is secured into the socket 12 by gently tapping a seating instrument held firmly against the implant using a surgical mallet until the implant 16 is installed at the proper depth within the socket 12. Tapping the implant 16 with a seating instrument against the implant and using a surgical mallet is indicated by arrow A in Figure 9
  • a provisional crown 48 will then be secured to the crown region 44 by cementation so that the provisional crown 48 is slightly out of occlusion with the opposing teeth. This provisional crown 48 will stay in place until osseointegration of the implant 16 can occur. Osseointegration can take several months.
  • the provisional crown 48 can be removed and a permanent crown (not illustrated) can be secured to the implant as a replacement for the provisional crown 48.
  • the permanent crown will be placed in occlusion with the patient's opposing teeth (not illustrated) according to traditional methods.
  • This method can also be used to replace a tooth 10 that was previously extracted months or even years earlier.
  • the dentist uses the same basic procedure as described previously for a tooth 10 that is extracted and immediately replaced with a sterilized implant 16. However, in this situation, the dentist creates an osteotomy or artificial tooth socket 12 at the site where the tooth 10 had been removed months or years earlier. After a single rooted or multi-rooted osteotomy 12 with a common alveolar bone and gingival tissue opening has been created, a traditional technique of precision impression making is completed on the osteotomy 12. This renders an exact negative replica of the osteotomy form that has been created. The surgeon treats this impression much like the extracted tooth 10 and makes a three dimensional optical acquisition of it.
  • the same computer and dentist design options are exercised as previously described above and then the titanium alloy is milled as a one-piece combination implant and abutment 16.
  • the same chevron retention fins 42 are created on the implant 16 as taught above along with the scalloping of the neck interface in the interdental areas 38 just as found in natural teeth.
  • the topography of the tooth's crown portion 20, the scalloping pattern of the cementoenamel junction 39 and the abutment configuration of the crown region 44 of the implant 16 will come from a standard dental database and will be based on the tooth number being replaced i.e., tooth number 1-32.
  • the computer generated composite image 34 can be modified by the dentist based on clinical judgment regarding the patient's needs.
  • the present system can also be employed to install an implant 16 in a patient's mouth 14 where there is a congenitally missing tooth. It allows the dentist to be in complete control of the depth, size, and overall shape of the osteotomy or artificially produced tooth socket 12. As noted, the osteotomy 12 can be created as single or multi-rooted. As outlined previously, the computer generates an implant design 34 that can be seated in the osteotomy site 12. The dentist can make limited modifications such as adding or removing chevron retention fins 42. He also selects the addition or subtraction method of surface treatment for the root portion 43 of the implant 16. The same method of seating the previously sterilized implant 16 into the osteotomy 12 is used as noted previously i.e., using a seating instrument in contact with the implant and gentle tapping with a surgical mallet.
  • the osteotomy 12 created for the missing tooth does not necessarily need to be, nor should it be, circular in nature.
  • the invention takes into account that the dentist can create an osteotomy site 12 that is as much like the shape and size of a natural tooth root 28 as the available bone 30 will permit.
  • the cervical area of the osteotomy 12 where the implant 16 emerges through the alveolar bone 30 can and should be as much like the anatomical shape and size of the natural missing tooth 10 as available bone 30 permits. This not only requires use of traditional circular osteotomy drills but requires a variety of bone milling and grinding burs that can be in an array of shapes and sizes.
  • the osteotomy 12 was created by the dentist, there is no need to decorticate the osteotomy prior to installing the implant 16 since the osteotomy 12 will not contain any Sharpey's fibers 26. However, the normal procedure of debriding the osteotomy 12 prior to installing the implant 16 should be performed.

Landscapes

  • Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Dental Prosthetics (AREA)

Abstract

L'invention concerne un procédé pour réaliser un implant dentaire en obtenant des images de la dent avant une extraction atraumatique de la dent et après l'extraction et utiliser ces images pour générer par ordinateur et broyer un implant de remplacement en titane en utilisant un équipement CAD/CAM. L'implant comprend une interface à col festonnée similaire à la jonction émail-cément festonnée de la dent remplacée, une zone de col polie entre une partie racine et une partie couronne, et le numéral du nombre de la dent imprimé sur la surface faciale de l'implant. Des ailettes de rétention à chevrons sont fournies sur la partie formant racine pour permettre la mise en prise de l'os de l'alvéole de dent ou une ostéotomie quand l'implant est enfoncé en position. Des sillons de rétention sont fournis sur la partie couronne, sur lesquels une couronne provisoire est scellée légèrement hors occlusion au moment où l'implant est placé. La couronne provisoire sera remplacée par une couronne permanente après ostéo-intégration de l'implant.
PCT/US2007/017434 2007-08-06 2007-08-06 Implant dentaire et procédé pour le réaliser et l'installer WO2009020446A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/US2007/017434 WO2009020446A1 (fr) 2007-08-06 2007-08-06 Implant dentaire et procédé pour le réaliser et l'installer

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2007/017434 WO2009020446A1 (fr) 2007-08-06 2007-08-06 Implant dentaire et procédé pour le réaliser et l'installer

Publications (1)

Publication Number Publication Date
WO2009020446A1 true WO2009020446A1 (fr) 2009-02-12

Family

ID=40341544

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2007/017434 WO2009020446A1 (fr) 2007-08-06 2007-08-06 Implant dentaire et procédé pour le réaliser et l'installer

Country Status (1)

Country Link
WO (1) WO2009020446A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012059747A3 (fr) * 2010-11-01 2012-08-23 Denpros Design Company Limited Implant dentaire

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3628248A (en) * 1969-07-22 1971-12-21 Dentsply Int Inc Process for forming artificial implants
US3717932A (en) * 1970-03-19 1973-02-27 Vitredent Corp Tooth replacement
US4474556A (en) * 1982-10-13 1984-10-02 Carbomedics, Inc. Dental implant
US6174167B1 (en) * 1998-12-01 2001-01-16 Woehrle Peter S. Bioroot endosseous implant
US6406295B1 (en) * 2001-07-13 2002-06-18 Brian A. Mahler Identification of dental implant components
US6666387B2 (en) * 2000-11-28 2003-12-23 Nissan Motor Co., Ltd. Fuel injector of internal combustion engine

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3628248A (en) * 1969-07-22 1971-12-21 Dentsply Int Inc Process for forming artificial implants
US3717932A (en) * 1970-03-19 1973-02-27 Vitredent Corp Tooth replacement
US4474556A (en) * 1982-10-13 1984-10-02 Carbomedics, Inc. Dental implant
US6174167B1 (en) * 1998-12-01 2001-01-16 Woehrle Peter S. Bioroot endosseous implant
US6666387B2 (en) * 2000-11-28 2003-12-23 Nissan Motor Co., Ltd. Fuel injector of internal combustion engine
US6406295B1 (en) * 2001-07-13 2002-06-18 Brian A. Mahler Identification of dental implant components

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012059747A3 (fr) * 2010-11-01 2012-08-23 Denpros Design Company Limited Implant dentaire

Similar Documents

Publication Publication Date Title
US20070264612A1 (en) Dental implant and method for making and installing same
US11497583B2 (en) Methods of designing and manufacturing customized dental prosthesis for periodontal or osseointegration and related systems
US7708557B2 (en) Customized dental prosthesis for periodontal- or osseointegration, and related systems and methods
JP6055488B2 (ja) 軟部組織保存式の歯科インプラント構成体
US8602780B2 (en) Customized dental prosthesis for periodontal or osseointegration and related systems and methods
US20170156824A1 (en) Customized Dental Prosthesis For Periodontal or Osseointegration and Related Systems
US8425231B1 (en) Soft-tissue preservation temporary (shell) immediate-implant abutment method and device
US20080090208A1 (en) Customized dental prosthesis for periodontal- or osseointegration, and related systems and methods
WO2009020447A1 (fr) Implant dentaire et procédé pour le réaliser et l'installer
Krauser Hydroxylapatite-coated dental implants: Biologic rationale and surgical technique
Rohrer et al. Postmortem histologic evaluation of mandibular titanium and maxillary hydroxyapatite-coated implants from 1 patient.
WO2017021010A1 (fr) Prothèse d'implant alvéolaire ostéo-intégré
US20230031165A1 (en) Methods of Designing and Manufacturing Customized Dental Prosthesis For Periodontal or Osseointegration and Related Systems
US20140030674A1 (en) Prefabricated immediate no-drill dental implant
Shapoff et al. Clinical Use of Laser-Microtextured Abutments: A Case Series.
WO2009020446A1 (fr) Implant dentaire et procédé pour le réaliser et l'installer
RU2146901C1 (ru) Способ формирования естественного контура мягких тканей, окружающих непосредственный имплантат, и индивидуальный заживляющий колпачок для его осуществления
Fugazzotto et al. Developing treatment algorithms for restoration or replacement of the compromised tooth
Assadawy Immediate Dental Implant Practical Steps at Your Fingertips
González et al. Extraction of a malpositioned maxillary anterior implant and simultaneous flapless ridge augmentation: a case report.
Lozada et al. Osteointegrated dental implants
Prithviraj et al. Development of Root Analogue Implants–A Review Study
Devigus The International Journal of Esthetic Dentistry
Gazmawe Step by step procedure of implant treatment
Schiroli IAR SINCIPI00III REPLACEMENT I/IN, AM0VEI (ERAMICHIST0RATIVE SSTEM RESI ITST03ll ll0NTIIS

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 07811082

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 07811082

Country of ref document: EP

Kind code of ref document: A1