WO2009142179A1 - サージカルガイド、及びこれを使用したドリルの位置決め方法 - Google Patents
サージカルガイド、及びこれを使用したドリルの位置決め方法 Download PDFInfo
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- WO2009142179A1 WO2009142179A1 PCT/JP2009/059145 JP2009059145W WO2009142179A1 WO 2009142179 A1 WO2009142179 A1 WO 2009142179A1 JP 2009059145 W JP2009059145 W JP 2009059145W WO 2009142179 A1 WO2009142179 A1 WO 2009142179A1
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- Prior art keywords
- light
- light irradiation
- wire
- tip
- surgical guide
- Prior art date
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- 239000013307 optical fiber Substances 0.000 claims abstract description 58
- 238000005553 drilling Methods 0.000 claims abstract description 16
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- 238000005452 bending Methods 0.000 claims description 7
- 239000004053 dental implant Substances 0.000 claims description 6
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Images
Classifications
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- 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
- 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
- A61C1/088—Illuminating devices or attachments
Definitions
- the present invention relates to a surgical guide for positioning a drill when a guide hole for implanting an implant fixture is opened in an alveolar bone, and a drill positioning method using the surgical guide.
- Implants used for implant treatment are a fixture (implant body, for example, made of titanium) that is embedded in an alveolar bone that has lost teeth, and a fixture that is connected to the fixture. And an upper structure (artificial dental crown) attached to the abutment. In implant treatment using this implant, it is important to accurately drill a guide hole for embedding a fixture in the alveolar bone (see, for example, Patent Document 1).
- prosthesis-driven type top-down treatment
- surgery-driven type There are two types of implant treatment: prosthesis-driven type (top-down treatment) and surgery-driven type.
- the former type of prosthetic-driven type creates a mock-up (actual size plaster model) of the patient's teeth and jaw ridge.
- the shape and position of the prosthesis (superstructure) that is optimally functionally and aesthetically determined is determined, and based on this, the fixture placement position is determined.
- the latter type of surgery is based on the condition of the patient's alveolar bone (width, thickness and density of the alveolar bone, nerve travel, etc.), and the fixture is embedded at a position that is considered optimal surgically and anatomically.
- the entry position is determined.
- the fixture position is prosthetic (functional and aesthetic) in consideration of the condition of the patient's alveolar bone, etc., by using simulation software that applies CT (Computer Tomography). It is also possible to determine the appropriate fixture placement position. In addition, by using a stent containing a contrast medium at the time of CT imaging, it is also possible to display on the mockup the fixture placement position determined on the CT screen.
- CT Computer Tomography
- a typical example is a surgical guide provided with a metal guide ring for guiding a drill at a position where the fixture is embedded.
- the drill is guided through the hole of the guide ring so that the guide hole is drilled at the position where the fixture is to be embedded by following the hole of the guide ring.
- the above-described surgical guide provided with a guide ring has the following problems. (1) Since the surgical field is covered with a surgical guide and cannot be seen, the surgeon becomes anxious because the tip of the drill cannot visually confirm the part of the alveolar bone. (2) A slight gap (play) is required between the drill and the hole in the guide ring, but the thickness of the guide ring is smaller than the length of the drill. The drill may tilt more than necessary and the drilling direction may be inaccurate. (3) Since the alveolar bone to be drilled is covered with the guide ring and the peripheral edge holding the guide ring, and the hole of the guide ring is closed with a drill, and a closed space is formed around the alveolar bone.
- the present invention allows the tip of the drill to be visually observed, prevents the drill from tilting more than necessary, and can sufficiently supply cooling water, hardly causes bone burns, and can be used alone. It is an object of the present invention to provide a surgical guide capable of dealing with several types of drills having different diameters and a drill positioning method using the surgical guide.
- a mock-up imitating a patient's oral cavity is shown in order to show the position and direction of a drill when drilling a guide hole for embedding a dental implant fixture in the patient's oral cavity.
- the present invention relates to a surgical guide used to reproduce the position and direction of a standing wire in a patient's mouth.
- the surgical guide according to the present invention is: (1) A detachable guide member fitted to a tooth portion of the mock-up and a patient's tooth portion corresponding to the tooth portion of the mock-up, (2) a light irradiation device including a light emitting unit that generates light and a light irradiation unit that irradiates the light generated by the light emitting unit toward the tip of the wire as a spot beam-like light beam; (3) The proximal end side is attached to the guide member, and at the distal end side, at least the light irradiation unit of the light irradiation device is irradiated from the light irradiation unit toward the distal end of the wire, and A support member that supports the irradiation angle in an adjustable manner, It is characterized by that.
- the light irradiation device in the surgical guide according to the first aspect, includes a laser module as a light emitting unit and an optical fiber that guides light generated by the laser module,
- the light irradiation unit is configured by bending the tip.
- the light irradiation device includes a laser module as a light emitting unit, and an optical fiber that guides light generated by the laser module.
- the light irradiating unit is configured by providing an inclined surface serving as a total reflection surface at the tip.
- the light irradiation device is provided at a laser module as a light emitting unit, an optical fiber that guides light generated by the laser module, and a tip of the optical fiber. And a prism constituting the light irradiation unit.
- the light irradiating device in the surgical guide according to the first aspect, includes a laser pointer attached to an intermediate portion of the support member as a light emitting portion, and light emitted from the laser pointer. And a prism that constitutes the light irradiating unit that irradiates the tip of the wire.
- the invention according to claim 6 is characterized in that in the surgical guide according to claim 5, the laser pointer is attached adjacent to the prism.
- the invention according to claim 7 is the surgical guide according to claim 1, wherein the surgical guide is supported by the tip side of the support member, and emits light and emits the emitted light toward the tip of the wire. It is characterized by having a laser diode.
- the invention according to claim 8 is characterized in that, in the surgical guide according to claim 1, the support member is constituted by a plastically deformable wire member.
- the light irradiation device includes a laser module as a light emitting unit and an optical fiber that guides light generated by the laser module.
- the light irradiating unit is configured by a hollow pipe to be included, and a lens and a prism which are provided at the tip of the optical fiber and attached to the tip of the hollow pipe.
- the light irradiation device includes a laser module as a light emitting unit, and an optical fiber that guides light generated by the laser module.
- the light irradiating unit is configured by a lens and a hollow pipe provided at the tip, and a prism attached to the tip of the hollow pipe.
- the support member is configured by a jig capable of moving and adjusting at least the light irradiation unit to an arbitrary position and angle in the light irradiation device. It is characterized by that.
- the invention according to claim 12 is a mock-up that imitates the patient's oral cavity in order to show the position and direction of the drill when drilling the guide hole for implanting the dental implant fixture into the patient's oral cavity.
- the present invention relates to a drill positioning method using a surgical guide for reproducing the position and direction of a standing wire in the oral cavity of a patient.
- the drill positioning method includes: (1) A detachable guide member fitted to a tooth portion of the mock-up and a patient's tooth portion corresponding to the tooth portion of the mock-up, (2) a light irradiation device including a light emitting unit that generates light and a light irradiation unit that irradiates the light generated by the light emitting unit toward the tip of the wire as a spot beam-like light beam; (3) The proximal end side is attached to the guide member, and at the distal end side, at least the light irradiation unit of the light irradiation device is irradiated from the light irradiation unit toward the distal end of the wire, and A surgical guide provided with a support member that supports the irradiation angle in an adjustable manner; (4) The guide member is fitted into the tooth portion of the mock-up, and the light irradiation portion supported by the support member is moved and adjusted to align the spot beam-like light beam with the central axis of the wire
- a guide member of a surgical guide is fitted to a tooth portion of a mock-up, and the position and angle of the light irradiation unit are appropriately moved and adjusted by the support member, and the light beam irradiated from the light irradiation unit.
- the optical axis of is aligned with the central axis of the wire.
- the guide member of the surgical guide is removed from the tooth part of the mockup and fitted to the patient's tooth part, and drilling is performed by aligning the center axis of the drill with the optical axis of the light beam emitted from the light irradiation part.
- a guide hole can be accurately drilled in the oral cavity at the same position and direction as the wire on the mockup.
- the alveolar bone can be cut while visually checking the tip of the drill. Further, cutting can be performed while visually checking so that the drill does not tilt more than necessary, that is, the drill axis does not deviate from the optical axis. Furthermore, since cooling water can be sufficiently supplied, it is difficult to cause bone burns. Moreover, the same surgical guide can be used even when drills having different diameters are used. There are the above effects.
- FIG. 1 is a perspective view showing a state where the surgical guide 10 is fitted to a mock-up (gypsum model) 30.
- FIG. 2 is a schematic diagram for explaining the positioning of the drill 41.
- FIG. 3 is an enlarged longitudinal sectional view of the light irradiation unit 16.
- FIG. 4A is a perspective view showing a state in which another surgical guide 20 is fitted to the mock-up 30, and
- FIG. 4B is a view of FIG.
- FIG. 5 is a schematic diagram illustrating a first modification of the light irradiation unit 16 according to the first embodiment.
- FIG. 6 is a schematic diagram illustrating a second modification of the light irradiation unit 16 according to the first embodiment.
- FIG. 10 is a longitudinal sectional view for explaining the implant 70.
- FIG. 11 shows the principle of reproducing the planting position and planting direction of the wire 31 planted in the mockup 30 as the position and direction of the drill 41 (embedding position and implantation direction of the fixture 71) in the oral cavity. It is a figure explaining.
- FIG. 17A is a view for explaining the first positioning step
- FIG. 17B is a view for explaining the second positioning step.
- the implant 70 will be described with reference to FIG. After the teeth (not shown) are removed, the bone 62 composed of the soft sea surface bone 60 and the hard cortical bone 61 and the mucosa 63 covering the bone 62 remain.
- the implant 70 includes a fixture 71 embedded in a bone 62 with an embedding hole (guide hole) 42, an abutment 72 connected to the fixture 71 and serving as an abutment, and an upper portion attached to the abutment 72. And a structure 73.
- the mock-up 30 shown in FIG. 1 is a full-scale model of the upper jaw made by taking (impression) from the inside of the patient's mouth, and is made of plaster.
- the upper right two back teeth are removed.
- wires 31 and 32 are planted in a straight line at positions substantially corresponding to the center of each back tooth. These wires 31 and 32 indicate the embedding position and the embedding direction of the fixture 71 when performing the implant treatment, respectively.
- the lengths of the protruding portions 31a and 32a protruding from the mockup 30 in the wires 31 and 32 that is, the lengths from the respective base end portions 31b and 32b to the distal end portions 31c and 32c.
- the length is set by subtracting the thickness of the mucous membrane 63 at this portion measured from the CT screen from the length of the drill (pilot drill) 41 for embedding hole drilling attached to the contra head 40 shown in FIG.
- the positions of the wires 31 and 32 are determined as follows, for example. The mutual positional relationship between the implantation position and orientation of the fixture 71 (see FIG.
- a surgical guide 10 shown in FIG. 1 includes a guide member 11, a wire member (support member) 12 attached to the guide member 11, and a light irradiation device 13.
- the guide member 11 is formed by using a resin (for example, an instant polymerization resin) as a material in accordance with the remaining dentition of the patient.
- the guide member 11 is detachable with respect to the tooth portion of the mockup 30 corresponding to the patient's remaining dentition, and is fitted when fitted, and a wire member to be described later with respect to the tooth portion of the mockup 30. Twelve positions can be determined. Moreover, it is detachable with respect to a patient's remaining dentition, and when it is mounted
- the wire member 12 shown in FIG. 1 is formed of the same wire as the wires 31 and 32 described above, and can be plastically deformed.
- the wire member 12 is bent in a crank shape, and its base end side (base end portion) 12a is attached (fixed) to the guide member 11, and the intermediate portion 12b is erected almost vertically, and the tip end side (
- the distal end portion 12 c extends substantially horizontally toward the wires 31 and 32, and the distal end edge 12 d is located above the distal end portion 31 c of the wire 31.
- the light irradiation device 13 includes a laser light source (laser module) 14 as a light emitting unit, an optical fiber 15 having a base end portion 15a coupled to the laser light source 14, and a light irradiation unit provided at a distal end portion 15b of the optical fiber 15. 16.
- a laser light source laser module
- optical fiber 15 having a base end portion 15a coupled to the laser light source 14
- a light irradiation unit provided at a distal end portion 15b of the optical fiber 15.
- the laser light source (laser module) 14 is composed of, for example, a semiconductor laser (laser diode) and an APC (automatic output control device), and has a wavelength of 532 to 670 nm toward the proximal end portion 15a of the optical fiber 15, for example. About a laser beam L is emitted.
- the optical fiber 15 As the optical fiber 15, a general one having a diameter of about 1 mm is used, and the light L emitted from the laser light source 14 is guided to the light irradiation unit 16.
- FIG. 3 shows an enlarged longitudinal sectional view of the light irradiation unit 16.
- the light irradiator 16 includes a cap 16a over the tip 15b of the optical fiber 15, an inclined surface 16b formed at the tip of the optical fiber 15, and a collimator disposed below the inclined surface 16b.
- the processing portion (or collimating lens) 16c and the dot aperture 16d provided below the collimating processing portion (or collimating lens) 16c are configured.
- the cap 16a has an inner diameter of about 1 mm, for example, and an opening 16e into which the distal end portion 15b of the optical fiber 15 is inserted is formed on the base end side (right side in the figure).
- the tip of the cap 16a is closed by a lid 16f.
- the inclined surface 16b forms a total reflection surface by cutting off the front end edge of the optical fiber 15 at 45 degrees with respect to the horizontal plane and mirror-finishing it.
- the laser beam L (see optical axis C) guided through the optical fiber 15 from the base end portion 15a to the tip end portion 15b is totally reflected by the inclined surface 16b and changes its direction substantially downward.
- the collimation processing part (or collimating lens) 16c makes the totally reflected laser light L into a cylindrical shape (beam shape).
- the dot aperture 16d is for narrowing the diameter of the laser beam L, and is a through-hole having a diameter of about 0.1 mm through which the laser beam L passes.
- the dot aperture 16d is formed in a circular window portion 16g formed in the cap 16a.
- the light irradiation unit 16 is attached (fixed) to the distal end side 12 c of the wire member 12 with the dot aperture 16 d slightly protruding from the distal end edge 12 d of the wire member 12. .
- the part disposed along the distal end side 12 c of the wire member 12 in FIG. Alternatively, it may be lightly fixed to the distal end side 12c.
- the laser light L is collimated (cylindrized) after passing through the collimating portion (or collimating lens) 16c, and then further passed through the dot aperture 16d, thereby reducing the diameter, thereby causing a spot beam-like light beam.
- the entire light irradiation unit 16 is moved to an arbitrary position by deforming the wire member (support member) 12 based on the fact that the wire member (support member) 12 can be plastically deformed. When the hand is released, the position is held.
- collimation process part or collimating lens
- dot aperture 16d it may replace with the above-mentioned collimation process part (or collimating lens) 16c and the dot aperture 16d, and you may use what vapor-deposited the metal directly on the surface of the collimating lens and formed the dot aperture.
- the drill 41 is positioned in the oral cavity as follows.
- the guide member 11 of the surgical guide 10 shown in FIG. thereby, the light irradiation part 16 supported by the wire member 12 is located substantially above the tip part 31 c of the wire 31 planted in the mockup 30.
- the laser light source (light emitting unit) 14 is turned on, and the laser light L emitted from the laser light source (light emitting unit) 14 is guided to the light irradiating unit 16 by the optical fiber 15, and the direction is changed by approximately 90 degrees. Then, it irradiates toward the tip 31c of the wire 31 below.
- the light irradiation unit 16 is moved to finely adjust the irradiation position and irradiation angle of the light beam L emitted from the light irradiation unit 16, and the light irradiation unit so that the light beam L coincides with the central axis of the wire 31. 16 is positioned (first positioning step) (see FIG. 17A).
- the guide member 11 While maintaining this positioning state, the guide member 11 is removed from the mock-up 30 and is fitted to the patient's teeth. At this time, the irradiation position and the irradiation angle of the light beam L irradiated from the light irradiation unit 16 are determined according to the position and direction in which the fixture 71 is embedded, that is, the drill 41 when the insertion hole (guide hole) 42 is opened. Position and direction. Here, the position irradiated with the light beam L on the mucosal surface of the patient is marked with an electric knife (not shown) or the like.
- a mark (entrance point) M is attached to the bone surface with a marking bar (not shown). Thereby, the position of the tip 41a of the drill 41 when the embedding hole (guide hole) 42 of the fixture 71 is drilled by the drill 41 is determined.
- drilling is performed by attaching a drill 41 to the contra head 40.
- the tip 41 a of the drill 41 is aligned with the mark M, and the center of the base end portion 41 b of the drill 41 is irradiated with the light beam L from the light irradiation unit 16.
- the rotation center of the drill 41 can coincide with the light beam L, that is, coincide with the central axis of the wire 31 (second positioning step) (see FIG. 17B).
- the embedding hole (guide hole) 42 is set at a predetermined position. And it can puncture with high precision in a predetermined direction.
- FIG. 11 shows the principle of these series of operations.
- Another embedding hole (guide hole) 42 corresponding to the other wire 32 is opened.
- the other embedding holes (guide holes) 42 can be made with high accuracy. .
- the tip of the drill 41 can be visually observed even though the surgical guide 10 has a simple configuration, the drill 41 is less likely to tilt than necessary, and cooling water can be sufficiently supplied. Thus, the occurrence of bone burns can be prevented, and the single surgical guide 10 can cope with several types of drills 41 having different diameters.
- the portion of the light irradiation unit 16 that emits the light beam L is covered with the cap 16a and the glass plate 16h and is in a hermetically sealed state, so that the collimation processing unit (or collimating lens) 16c.
- the collimation processing unit or collimating lens 16c.
- the light irradiation device 13 is divided into a light irradiation unit 16 that can be configured relatively compactly and a light emitting unit 14 that tends to be relatively large (compared to the light irradiation unit 16). These are connected by an optical fiber 15.
- the light irradiation part 16 inserted into the patient's oral cavity together with the guide member 11 and the wire member 12 can be configured in a compact manner, so that the patient can be inserted into the oral cavity. Can reduce the burden of opening a big mouth. Therefore, this embodiment is suitable not only when the implant 70 is applied to the molar portion but also the anterior tooth portion and the premolar portion.
- the mark M is attached to the portion irradiated with the light beam L from the light irradiation unit 16, but instead of this, a surgical guide 20 as shown in FIGS. 4A and 4B is used. You may make it attach the mark M using it as a jig
- a resin for example, an instant polymerization resin
- the wire guide 22 is formed so as to cut out the left half side of the guide member 21 in the width direction (left and right direction in (b)), and corresponds to the wires 31 and 32.
- the guide member 21 is attached to and fitted to the tooth portion of the patient, and the position corresponding to the proximal guides 22a and 22b on the mucosal surface is marked with an electric knife (not shown) or the like.
- a mark (entrance point) M is attached to the bone surface with a marking bar (not shown).
- the position of the tip 41a of the drill 41 when the embedding hole (guide hole) 42 of the fixture 71 is drilled by the drill 41 is determined.
- the light beam L from the light irradiation part 16 hits the center of the base end part 41b similarly to the above-mentioned.
- FIG. 5 shows a first modification of the present embodiment.
- the light irradiation unit 16 is constituted by a prism 16j and a collimating lens 16k.
- the distal end portion 15b of the optical fiber 15 is cut so as to be orthogonal to the optical axis C, a prism 16j is applied to the cut portion, and a collimating lens 16k is disposed on the lower surface of the prism 16j.
- the laser beam L guided by the optical fiber 15 is irradiated toward the lower wire 31 (see FIG. 1).
- the light irradiation unit 16 can be configured by welding the prism 16j to the end face of the optical fiber 15 having a diameter of about 2 mm and further welding the collimator lens 16k to the lower surface of the prism 16j.
- the light irradiation unit 16 is fixed to the distal end side 12 c of the wire member 12.
- the prism 16j and the collimator lens 16k can be arranged in reverse. In this case, it is possible to perform collimation processing on the end face of the optical fiber 15 instead of the collimating lens 16k.
- FIG. 6 shows a second modification of the present embodiment.
- the laser beam L guided by the optical fiber 15 is irradiated toward the wire 31 by providing the bending portion 16 m at the distal end portion 15 b of the optical fiber 15. If the radius of curvature R of the curved portion 16m is too small, the optical fiber 15 breaks. For example, when the diameter of the optical fiber 15 is about 1 mm, the curved portion is set so that the radius of curvature R is 2.5 mm or more. It is good to form 16m.
- the tip of the optical fiber 15 is subjected to collimating lens processing 16n following the shape of the collimating lens. This processing can be performed by cutting or melting.
- the light irradiation unit 16 is configured by an extremely simple method by deformation or processing of the optical fiber 15 itself, such as the bending portion 16m and the collimating lens processing 16n, without using other members.
- the light irradiation part 16 is being fixed to the front end side 12c of the wire member 12 so that the shape of the bending part 16m may not deform
- FIG. 7 is a schematic diagram illustrating the light irradiation device 13 of the second embodiment.
- FIG. 8 is a schematic diagram illustrating a modification of the light irradiation unit 16 according to the second embodiment.
- the laser pointer (laser module with collimating lens) 17 as the light emitting unit and the prism 16o as the light irradiation unit 16 are divided and configured in the same manner as in the first embodiment.
- the two are not connected by an optical fiber, but the laser light L emitted from the laser pointer 17 reaches the prism 16o across the space.
- a columnar laser pointer 17 is fixed near the intermediate portion 12 b on the distal end side 12 c of the wire member 12.
- a prism 16o is fixed in the vicinity of the tip edge 12d on the tip side 12c.
- the distal end side 12c of the wire member 12 is not deformed, the positional relationship between the laser pointer 17 and the prism 16o is maintained, and the laser light L emitted from the laser pointer 17 is incident on the prism 16o, and the prism 16o It is designed to irradiate downward from. Therefore, in the present embodiment, even when the position and angle are finely adjusted by moving the prism 16o, the distal end side 12c of the wire 12 is not deformed, and the positional relationship between the laser pointer 17 and the prism 16o is maintained. It is configured. In the present embodiment, when the position of the prism 16o is moved, the inclination angle and the inclination direction of the intermediate portion 12b of the wire member 12 are mainly changed.
- the prism 16o is attached as the light irradiation unit 16 in the vicinity of the distal end edge 12d of the wire member 12.
- FIG. 7 corresponds to a structure in which the attachment position of the laser pointer 17 shown in FIG. 7 is moved to the distal end edge 12d side of the distal end side 12c of the wire member 12 to be adjacent to the prism 16o.
- a prism 16p is attached to the tip of a thin laser pointer 18 having a small thickness as a light emitting unit, and the light irradiation unit 16 is configured by both.
- the light irradiation unit 16 constitutes the light irradiation device 13.
- a reflecting mirror can be used instead of the prism 16p (or 16o).
- FIG. 9 is a schematic diagram illustrating the light irradiation device 13 of the third embodiment.
- the ultra-small laser diode 16q and the collimating lens 16r are integrated to form the light irradiation unit 16, and this constitutes the entire light irradiation device 13 as it is.
- the light irradiation unit 16 is attached to the distal end edge 12 d of the wire member 12.
- the laser light L emitted from the laser diode 16q is irradiated toward the wire 31 (see FIG. 1) through the collimating lens 16r disposed below.
- the laser diode 16q is connected via, for example, a current control type APC (automatic output control device) 19. Connected to power.
- APC automatic output control device
- a laser pointer built-in collimator lens and APC
- the required degree of opening of the patient increases, making it difficult to use the molar portion.
- the diameter of the laser beam L can be reduced by attaching a dot aperture to the tip.
- the dot aperture can be manufactured by making a hole with a diameter of about 0.1 mm in a thin metal plate or plastic plate, or by directly depositing metal on a collimating lens or prism.
- FIG. 12A is a perspective view showing a state in which the surgical guide 10 is attached to the mockup 30, and FIG. 12B is a perspective view showing a state in which the surgical guide 10 is attached to the oral cavity of the patient.
- FIG. 13 is a schematic diagram (cross-sectional view) illustrating the light irradiation unit 16 of the light irradiation apparatus 13 according to the fourth embodiment.
- the light irradiation unit 16 of the light irradiation device 13 includes a pipe 16 s that covers the tip 15 b of the optical fiber 15 and a collimator lens that is disposed at the tip of the tip 15 b of the optical fiber 15. 16t and a prism 16u disposed at the tip of the collimating lens 16t.
- the pipe 16s has, for example, a hollow pipe shape with an inner diameter of about 0.5 to 1 mm, and an opening portion 16v into which the distal end portion 15b of the optical fiber 15 is inserted on the proximal end side (right side in the figure). have.
- a circular window portion 16w is drilled at the tip of the pipe 16s at a position corresponding to the horizontal surface (lower surface) of the prism 16u.
- a cylindrical GRIN lens having an extremely small outer diameter of 0.5 to 1 mm is used as the collimating lens 16t.
- the laser beam L guided through the optical fiber 15 from the proximal end portion 15a to the distal end portion 15b passes through the collimating lens 16t to become a beam-like light beam L, totally reflected by the inclined surface of the prism 16u, and 90 degrees downward. The direction is changed and the light is emitted from the window portion 16w of the pipe 16s.
- the light irradiation part 16 is attached (fixed) so that the base end side of the pipe 16s may come to the intermediate part 12b vicinity of the wire member 12 with respect to the front end side 12c of the wire member 12, as shown in the figure. Yes.
- the length of the distal end side 12c of the wire member 12 is set to a length that is necessary and sufficient to maintain the position and angle of the pipe 16s.
- the pipe 16s extremely thin by adopting a cylindrical GRIN lens having an extremely small outer diameter, and further, the tip side 12c of the wire member 12 can be shortened.
- the size of the portion of the surgical guide 10 that is inserted into the back of the patient's oral cavity can be made extremely small, and is particularly suitable for implant treatment of the molar portion.
- FIG. 14A is a perspective view showing a state in which the surgical guide 10 is attached to the mockup 30, and FIG. 14B is a perspective view showing a state in which the surgical guide 10 is attached in the oral cavity of the patient.
- FIG. 15A is a schematic diagram (cross-sectional view) illustrating the light irradiation unit 16 of the light irradiation apparatus 13 according to the fifth embodiment
- FIG. 15B illustrates a modification of the light irradiation unit 16.
- FIGS. 16A and 16B are three views of a support 50 that is a support member different from the wire member 12, wherein FIG. 16A is a top view, FIG. 16B is a side view, and FIG.
- the support member 50 is used in place of the wire member 12 as the support member.
- the support tool 50 has a cylindrical shaft holder 55 attached to the guide member 11 shown at the lower end of FIG.
- a shaft 56 is inserted into the shaft holder 55 from above.
- the lower end side of the shaft 56 is fixed to the shaft holder 55 with a knurled screw 57.
- a block-shaped base member 58 is attached to the upper end of the shaft 56.
- a female screw is screwed into the base member 58 in the left-right direction in FIG. 16C, and the holder 59 is fixed by screwing the male screw N1 into this female screw.
- the holder 59 is a member that holds a light irradiation unit 16 (cover 16A) of the light irradiation device 13 to be described later, and is formed by bending or bending a strip-shaped metal plate. That is, in FIG. 16C, the holder 59 has a vertical portion fixed by the male screw N1 curved in a circular shape following the outer periphery of the light irradiation unit 16 (cover 16A), and then extends downward and is again a male screw. It is formed to be fixed by N1.
- the support member 50 configured as described above can move and adjust the light irradiation unit 16 to an arbitrary position and angle. That is, the height can be adjusted by loosening the knurled screw 57 and moving the shaft 56 in the vertical direction.
- the rotation direction around the axis C1 can be adjusted by loosening the knurled screw 57 and rotating the shaft 56 around the axis C1.
- the male screw N1 adjustment of the rotation direction around the axis C2 that is, swinging in the vertical direction is possible.
- the holder 59 can be moved in the direction of the axis C3 by loosening the male screw N1.
- the rotational direction around the axis C3 can be adjusted by loosening the male screw N1.
- the support tool 50 can move and adjust the light irradiation unit 16 to an arbitrary position and angle by appropriately combining the above-described movement and adjustment functions, and simultaneously fix the light irradiation unit 16.
- the position and angle can be maintained.
- the light irradiation unit 16 of the light irradiation apparatus 13 is arranged at the cover 16 ⁇ / b> A that covers the tip 15 b of the optical fiber 15 and the tip of the tip 15 b of the optical fiber 15.
- the cover 16A has a hollow pipe shape with an inner diameter of about 3 to 4 mm, and is held by the holder 59 of the support 50 described above.
- the pipe 16C has a hollow pipe-like shape with an inner diameter of about 0.5 to 1 mm, and a circular window 16E is drilled at the tip corresponding to the horizontal surface (lower surface) of the prism 16D.
- the laser light L guided from the base end portion 15a to the tip end portion 15b in the optical fiber 15 passes through the collimating lens 16B to become a beam-like light beam L, travels straight through the pipe 16C, and reaches the vertical surface of the prism 16D ( Incident on the side surface), totally reflected by the inclined surface of the prism 16D, turned downward by 90 degrees, and emitted from the window portion 16E of the pipe 16C.
- the light irradiation unit 16 in the fifth embodiment achieves the same size without using an expensive GRIN lens, but on the other hand, even with a small pipe 16C.
- the beam-like light beam L that has passed through the collimating lens 16B does not enter the vertical surface (side surface) of the prism 16D. Therefore, in the fifth embodiment, when moving and adjusting the position and angle of the light irradiation unit 16, it is necessary to prevent stress from being applied to the pipe 16C. Therefore, a support member such as the support tool 50 is indispensable.
- FIG. 15B shows a modification of the light irradiation unit 16 in the fifth embodiment.
- the light irradiation unit 16 in this modification is obtained by replacing the optical fiber 15 in the light irradiation unit 16 shown in FIG. 15A with a small laser diode (or laser module) 14b (light emitting unit).
- the small laser diode 14b is connected to a power source via an APC (automatic output control device) 14c.
- APC automatic output control device
- Other configurations are the same as those of the light irradiation unit 16 described above.
- the light irradiation unit 16 directly constitutes the light irradiation device 13.
- a reflecting mirror can be used instead of the prism.
- the beam diameter of the laser light L can be reduced by attaching a dot aperture to the tip.
- the dot aperture can be manufactured by making a hole with a diameter of about 0.1 mm in a thin metal plate or plastic plate, or by directly depositing metal on a collimating lens or prism. Is possible. However, depending on the wavelength of light and the diameter of the dot aperture, interference fringes due to light diffraction may occur. In this case, the outline of the bright spot (beam spot) of the light is clear when the dot aperture is not attached.
- the attachment position of the light irradiation unit 16 with respect to the guide member 11 can be lowered, and the burden of opening a large mouth during surgery can be reduced. Therefore, it is particularly convenient for implant treatment of the molar portion.
- a semiconductor laser used for the laser light source 14 there is a DPSS laser (diode-excited solid laser) in addition to the above laser diode, and the wavelength can be selected from 405 to 780 nm. An output of about 1 to 10 mW is appropriate.
- optical fiber 15 an optical fiber of any mode of multimode, single mode, PM mode (polarization preserving mode) having an outer diameter of about 0.5 to 1.5 mm can be used.
- PM mode polarization preserving mode
- a coupler 14a (see FIG. 12) is required for coupling (coupling) between the laser light source 14 and the optical fiber 15.
- the guide member 11 of the surgical guide 10 the guide member 21 of the surgical guide 20, and the wire guide 22, in addition to the above-described resin, it can be molded according to the mock-up 30 by a vacuum press (not shown).
- Polycarbonate sheets can be used. In this case, the sheet thickness is suitably 1.5 mm to 2 mm.
- wire thicker than the wires 31 and 32 for the wire member 12 it is possible to further increase the rigidity as the support member, and to reduce the possibility of inadvertently deforming the wire member 12. In this case, however, a tool such as a plier is required to plastically deform the wire member 12.
- the surgical guide 10 is attached to the mockup 30 from which the wire 31 and the wire 32 have been removed, and on the mockup 30, the orientation of the contra head 40 is adjusted to align the center axis of the drill 41 with the optical axis of the light beam L
- the orientation of the contra head 40 is adjusted to align the center axis of the drill 41 with the optical axis of the light beam L
- FIGS. 1 to 6 and 17 are diagrams for explaining the first embodiment.
- FIG. 1 is a perspective view showing a state in which the surgical guide 10 is fitted to a mock-up (gypsum model) 30. . It is a schematic diagram explaining positioning of the drill 41.
- FIG. 3 is an enlarged vertical sectional view of a light irradiation unit 16.
- FIG. (A) is the perspective view which shows the state which made another surgical guide 20 fit to the mockup 30,
- (b) is the figure which looked at (a) from the arrow A direction.
- It is a schematic diagram explaining the 1st modification of the light irradiation part 16 in Embodiment 1.
- FIG. 1 is a perspective view showing a state in which the surgical guide 10 is fitted to a mock-up (gypsum model) 30. .
- FIG. 3 is an enlarged vertical sectional view of a light irradiation unit 16.
- FIG. (A) is the perspective view which shows the state which made another surgical guide
- FIG. 3 is a longitudinal sectional view for explaining an implant 70.
- FIG. 4 It is a figure explaining the surgical guide 10 in Embodiment 4, (a) is a perspective view which shows the state which attached the surgical guide 10 to the mockup (gypsum model) 30, (b) is a surgical in the oral cavity of a patient. It is a perspective view which shows the state which attached the guide. It is a schematic diagram (sectional drawing) explaining the light irradiation part 16 of the light irradiation apparatus 13 in Embodiment 4.
- FIG. It is a figure explaining the surgical guide 10 in Embodiment 5, (a) is a perspective view which shows the state which attached the surgical guide 10 to the mockup (gypsum model) 30, (b) is a surgical in the oral cavity of a patient.
- FIG. is a perspective view which shows the state which attached the guide.
- (A) is a schematic diagram (cross-sectional view) explaining the light irradiation part 16 of the light irradiation apparatus 13 in Embodiment 5
- (b) is a schematic diagram (cross-sectional view) explaining the modification of the light irradiation part 16.
- FIG. is there. It is a three-view figure of the support tool 50, (a) is a top view, (b) is a side view, (c) is a front view. It is a figure explaining the positioning method in Embodiment 1, (a) is a 1st positioning process, (b) is a figure explaining a 2nd positioning process.
Abstract
Description
(1)術野がサージカルガイドで覆われて見えないため、ドリルの先端が歯槽骨を削っている部分を目で確認することができないので術者が不安になる、
(2)ドリルとガイドリングの孔との間には、わずかな間隙(遊び)が必要であるが、ドリルの長さに比べて、ガイドリングの厚さが薄いため、この間隙(遊び)によってドリルが必要以上に傾斜し、穿孔方向が不正確になるおそれがある、
(3)穿孔の対象となる歯槽骨が、ガイドリング及びこれを保持する周縁部によって覆われ、さらにドリルによってガイドリングの孔が塞がれて、歯槽骨周辺には閉空間が形成されるため、削られる歯槽骨に対して、冷却水を十分に供給することが困難となり、骨火傷を起こしてしまうおそれがある、
(4)フィクスチャーを埋入するためのガイド孔を穿孔するには、直径が小さいパイロットドリルから始まって、徐々に直径が大きくなる数種類のドリルを使用することになるため、それぞれのドリルの直径に合わせたガイドリングを設けた数種類のサージカルガイドが必要となり、その分、コストがかさむ、
という問題がある。
(1)前記モックアップの歯部、及び前記モックアップの歯部に対応する患者の歯部に嵌合される着脱自在なガイド部材と、
(2)光を発生させる発光部と前記発光部で発生された光をスポットビーム状の光線として前記ワイヤの先端に向けて照射する光照射部とを有する光照射装置と、
(3)基端側が前記ガイド部材に取り付けられ、先端側において前記光照射装置のうちの少なくとも前記光照射部を、前記光照射部から前記ワイヤの先端に向けて照射された光線の照射位置及び照射角度を調整可能に支持する支持部材と、を備える、
ことを特徴としている。
(1)前記モックアップの歯部、及び前記モックアップの歯部に対応する患者の歯部に嵌合される着脱自在なガイド部材と、
(2)光を発生させる発光部と前記発光部で発生された光をスポットビーム状の光線として前記ワイヤの先端に向けて照射する光照射部とを有する光照射装置と、
(3)基端側が前記ガイド部材に取り付けられ、先端側において前記光照射装置のうちの少なくとも前記光照射部を、前記光照射部から前記ワイヤの先端に向けて照射された光線の照射位置及び照射角度を調整可能に支持する支持部材と、を備えたサージカルガイドを使用し、
(4)前記ガイド部材を前記モックアップの歯部に嵌合させ、前記支持部材に支持された前記光照射部を移動及び調整して前記スポットビーム状の光線を前記ワイヤの中心軸に合わせる第1位置決め工程と、
(5)前記ガイド部材を前記モックアップの歯部から取り外して前記患者の歯部に嵌合させ、前記スポットビーム状の光線に前記ドリルの中心軸を合わせる第2位置決め工程と、を有する、
ことを特徴としている。
<実施形態1>
ガイド部材11は、レジン(例えば、即時重合レジン)を材料として、患者の残存歯列に合わせて形成されている。ガイド部材11は、患者の残存歯列に対応した、モックアップ30の歯部に対して着脱自在であり、装着された際には嵌合されて、モックアップ30の歯部に対する後述のワイヤ部材12の位置を決定することができる。また、患者の残存歯列に対して着脱自在であり、装着された際には嵌合されて、残存歯列に対するワイヤ部材12の位置を決定することができる。
<実施形態2>
<実施形態3>
本実施形態では、超小型のレーザーダイオード16qとコリメートレンズ16rとが一体となって光照射部16を構成し、これがそのまま光照射装置13全体を構成することになる。光照射部16は、ワイヤ部材12の先端縁12dに取り付けられる。レーザーダイオード16qから出射されたレーザー光Lは、下方に配置されたコリメートレンズ16rを通って、ワイヤ31(図1参照)に向けて照射される。なお、本実施形態においては、レーザーダイオード16qから出射されるレーザー光Lの光量を適宜に制御するために、レーザーダイオード16qは、例えば、電流制御型のAPC(自動出力制御装置)19を介して電源に接続されている。
<実施形態4>
<実施形態5>
(1)術野が見えるため、ドリル41の先端が歯槽骨を削っている部分を目で確認しながら、ドリリングを行うことができるので術者が不安にならずにすむ、
(2)光線Lがドリル41の基端部41bの中心を外れることなく照射しつづけるようにコントラヘッド40の向きを調整しながらドリリングを行うことにより、ドリル41が必要以上に傾斜するのを避けることができる、
(3)穿孔の対象となる歯槽骨にたいして冷却水を十分に供給できるので、骨火傷を起こすおそれが少ない、
(4)フィクスチャー71を埋入するためのガイド孔を穿孔するには、直径が小さいドリル(パイロットドリル)41から始まって、徐々に直径が大きくなる数種類のドリル41を使用することになるが、それぞれの直径のドリル41に対して同一のサージカルガイドを使用することができ、その分、コストを抑制することができる、
(5)粘膜を剥いで骨面を大きく露出させるフラップ法、パンチングによってフィクスチャーが入るだけの孔を粘膜にあけるフラップレス法のいずれにも同様に適用することができる、
(6)従来は、ガイドリングがドリルに接触していたために、ドリルの振動によってガイド部材が外れやすかったり不安定になったりしたが、このようなことがない、
(7)ワイヤ31およびワイヤ32を取り去ったモックアップ30にサージカルガイド10を取り付け、モックアップ30上において、コントラヘッド40の向きを調整してドリル41の中心軸を光線Lの光軸に合わせる練習をしてみることにより、実際のオペとほぼ同じ状況でオペをイメージ(シミュレート)することが可能になる、
等の効果がある。
11,21 ガイド部材
12 ワイヤ部材(支持部材)
12a 基端側(基端部)
12b 中間部
12c 先端側(先端部)
12d 先端縁
13 光照射装置
14 レーザー光源(発光部としてのレーザーモジュール)
14a カプラー
14b 小型のレーザーダイオード(又はレーザーモジュール)
14c APC
15 光ファイバー
15a 光ファイバーの基端部
15b 光ファイバーの先端部
16 光照射部
16a キャップ
16b 傾斜面
16c、16k、16n、16r、16B、
コリメートレンズ
16d ドットアパーチャー
16e、
キャップの開口部
16f キャップの蓋
16g キャップの窓部
16h ガラス板
16i ガラス板の表面
16j、16o、16p、16u、16D
プリズム
16m 湾曲部
16q 超小型のレーザーダイオード
16s、16C
パイプ
16t コリメートレンズ(GRINレンズ)
16v パイプの開口部
16w、16E
パイプの窓部
17 レーザーポインタ
18 薄型レーザーポインタ
19 電流制御型のAPC
30 モックアップ(石膏模型)
31,32 ワイヤ
31a,32a
ワイヤの突出部
31b,32b
ワイヤの基端部
31c,32c
ワイヤの先端部
40 コントラヘッド
41 ドリル(パイロットドリル)
41a ドリルの先端
41b ドリルの基端部
42 埋入孔(ガイド孔)
50 支持具(支持部材)
63 粘膜
70 インプラント(デンタルインプラント)
71 フィクスチャー
L 光,レーザー光,光線
M マークM
R 曲率半径
Claims (12)
- デンタルインプラントのフィクスチャーを患者の口腔内に埋入するためのガイド孔をあける際のドリルの位置及び方向を示すべく、患者の口腔内を模したモックアップに植立されたワイヤに対し、そのワイヤの位置及び方向を患者の口腔内で再現するために使用されるサージカルガイドにおいて、
前記モックアップの歯部、及び前記モックアップの歯部に対応する患者の歯部に嵌合される着脱自在なガイド部材と、
光を発生させる発光部と前記発光部で発生された光をスポットビーム状の光線として前記ワイヤの先端に向けて照射する光照射部とを有する光照射装置と、
基端側が前記ガイド部材に取り付けられ、先端側において前記光照射装置のうちの少なくとも前記光照射部を、前記光照射部から前記ワイヤの先端に向けて照射された光線の照射位置及び照射角度を調整可能に支持する支持部材と、を備える、
ことを特徴とするサージカルガイド。 - 前記光照射装置は、発光部としてのレーザーモジュールと、前記レーザーモジュールで発生された光を導く光ファイバーとを有し、
前記光ファイバーの先端を湾曲させて前記光照射部を構成する、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記光照射装置は、発光部としてのレーザーモジュールと、前記レーザーモジュールで発生された光を導く光ファイバーとを有し、
前記光ファイバーの先端に全反射面となる傾斜面を設けることで前記光照射部を構成する、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記光照射装置は、発光部としてのレーザーモジュールと、前記レーザーモジュールで発生された光を導く光ファイバーと、前記光ファイバーの先端に設けられて前記光照射部を構成するプリズムと、を有する、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記光照射装置は、発光部として前記支持部材の中間部に取り付けられたレーザーポインタと、前記レーザーポインタで発光された光を前記ワイヤの先端に向けて照射する前記光照射部を構成するプリズムと、を有する、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記レーザーポインタが前記プリズムに隣接して取り付けられている、
ことを特徴とする請求項5に記載のサージカルガイド。 - 前記支持部材の先端側に支持されて、光を発光するとともに発光した光を前記ワイヤの先端に向けて照射する光照射装置としてのレーザーダイオードを有する、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記支持部材が塑性変形可能なワイヤ部材によって構成されている、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記光照射装置は、発光部としてのレーザーモジュールと、前記レーザーモジュールで発生された光を導く光ファイバーとを有し、
前記光ファイバーを内包する中空のパイプと、前記光ファイバーの先端に設けられ前記中空のパイプの先端に取り付けられたレンズ及びプリズムとによって前記光照射部を構成する、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記光照射装置は、発光部としてのレーザーモジュールと、前記レーザーモジュールで発生された光を導く光ファイバーとを有し、
前記光ファイバーの先端に設けられたレンズ及び中空のパイプと、前記中空パイプの先端に取り付けられたプリズムとによって前記光照射部を構成する、
ことを特徴とする請求項1に記載のサージカルガイド。 - 前記支持部材が、前記光照射装置のうち少なくとも前記光照射部を任意の位置及び角度に移動及び調整可能な治具によって構成されている、
ことを特徴とする請求項1に記載のサージカルガイド。 - デンタルインプラントのフィクスチャーを患者の口腔内に埋入するためのガイド孔をあける際のドリルの位置及び方向を示すべく、患者の口腔内を模したモックアップに植立されたワイヤに対し、そのワイヤの位置及び方向を患者の口腔内で再現するためのサージカルガイドを使用したドリルの位置決め方法において、
前記モックアップの歯部、及び前記モックアップの歯部に対応する患者の歯部に嵌合される着脱自在なガイド部材と、
光を発生させる発光部と前記発光部で発生された光をスポットビーム状の光線として前記ワイヤの先端に向けて照射する光照射部とを有する光照射装置と、
基端側が前記ガイド部材に取り付けられ、先端側において前記光照射装置のうちの少なくとも前記光照射部を、前記光照射部から前記ワイヤの先端に向けて照射された光線の照射位置及び照射角度を調整可能に支持する支持部材と、を備えたサージカルガイドを使用し、
前記ガイド部材を前記モックアップの歯部に嵌合させ、前記支持部材に支持された前記光照射部を移動及び調整して前記スポットビーム状の光線を前記ワイヤの中心軸に合わせる第1位置決め工程と、
前記ガイド部材を前記モックアップの歯部から取り外して前記患者の歯部に嵌合させ、前記スポットビーム状の光線に前記ドリルの中心軸を合わせる第2位置決め工程と、を有する、
ことを特徴とするドリルの位置決め方法。
Priority Applications (2)
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JP2010513012A JP5410420B2 (ja) | 2008-05-20 | 2009-05-18 | サージカルガイド |
US12/992,670 US8678819B2 (en) | 2008-05-20 | 2009-05-18 | Surgical guide, and a method for positioning a drill using the surgical guide |
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JP2008131613 | 2008-05-20 | ||
JP2008-131613 | 2008-05-20 |
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US (1) | US8678819B2 (ja) |
JP (1) | JP5410420B2 (ja) |
WO (1) | WO2009142179A1 (ja) |
Cited By (2)
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JP2012075697A (ja) * | 2010-10-01 | 2012-04-19 | Akira Takebayashi | サージカルガイド及び埋入孔穿孔具 |
RU2570094C2 (ru) * | 2010-04-23 | 2015-12-10 | ДЕНТСПЛИ Интернешнл Инк. | Способ и устройство для ввода излученного светодиодами излучения |
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US10064700B2 (en) * | 2013-02-14 | 2018-09-04 | Zvi Fudim | Surgical guide kit apparatus and method |
RU2739116C1 (ru) * | 2020-07-27 | 2020-12-21 | Димитрий Сергеевич Алёшин | Способ позиционирования скуловых имплантов и лазерный указатель, используемый в способе |
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Also Published As
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JP5410420B2 (ja) | 2014-02-05 |
US20110117516A1 (en) | 2011-05-19 |
US8678819B2 (en) | 2014-03-25 |
JPWO2009142179A1 (ja) | 2011-09-29 |
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