WO2011061557A1 - Dispositif de mise en place d'implants dentaires - Google Patents

Dispositif de mise en place d'implants dentaires Download PDF

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Publication number
WO2011061557A1
WO2011061557A1 PCT/IB2009/055123 IB2009055123W WO2011061557A1 WO 2011061557 A1 WO2011061557 A1 WO 2011061557A1 IB 2009055123 W IB2009055123 W IB 2009055123W WO 2011061557 A1 WO2011061557 A1 WO 2011061557A1
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WO
WIPO (PCT)
Prior art keywords
opening
implants
bone
ducts
surgeon
Prior art date
Application number
PCT/IB2009/055123
Other languages
English (en)
Inventor
Constantinus Politis
Serge Schepers
Luc Vrielinck
Original Assignee
Aporis Nv
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 Aporis Nv filed Critical Aporis Nv
Priority to PCT/IB2009/055123 priority Critical patent/WO2011061557A1/fr
Publication of WO2011061557A1 publication Critical patent/WO2011061557A1/fr

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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
    • A61C8/0089—Implanting tools or instruments
    • 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

Definitions

  • the present invention relates to a device for placing dental implants.
  • the invention relates to a device used during the surgical procedure of placing dental implants.
  • prostheses Although the majority of dental prostheses are borne by neighboring tooth or by tissue, an increasing amount of prosthesis are anchored in the mandible, the maxilla, the palate of the patient or even in more distant bones such as the zygomatic bone, or bone structures attached to the skull base, by way of one or more implants screwed into holes drilled in the bony tissue, the so called osteotomies.
  • the surgical procedure and the placement of such anchored prostheses is usually prepared and supported by a tailor made guide template, a shaped element to be placed in the mouth of the patient during the operation, which element guides the drills with respect to their position and orientation .
  • a guide template improves the predictability of the implant surgery and the aesthetic result and decreases the risk of post-operative complications.
  • the preparation of the surgical procedure and also the production of the guide template usually makes use of medical imaging techniques and 3D printing techniques such as stereolithographic modeling.
  • the guide template is positioned on the bone surface in a stable position, and is usually fixed to the bone structure by means of so called osseo-synthesis fixation screws or rigid fixation pins.
  • the osteotomies are drilled, often in various steps with increasing drill diameter, and consecutively the implants are screwed in the osteotomies.
  • the practitioner is hereby guided by the guide template.
  • the guide template is in general provided of a curved shape, according to the bone structure whereon it is applied, and is provided of guiding bores wherein usually metal guiding tubes can be provided. Apart from the guiding bores in line with the implants to be placed, a guide template is usually also provided of guiding bores in line with the fixation screws, which also serve as screw head holders.
  • the implants generally have a cylindrical shape with a threaded external surface.
  • the implants are made of a bio-compatible material and are usually screwed in the jawbone over their complete height.
  • each implant is generally provided of a central threaded cavity for mounting the teeth prostheses .
  • the prosthesis can be mounted immediately after applying the implants in the mandible or the maxilla. Such immediate application of the prosthesis is often referred to as "direct loading".
  • a typical known guide template is made in function of a so called planning of the implants.
  • the planning of the implants is about determining how much implants will be required for appropriate fixation of the replacement teeth, about determining the dimensions of the implants and about determining their positioning and orientation.
  • the planning can be performed on a computer, for example by first scanning the patient with a computed tomography scanner, CT-scanner in short, and by simulating the implants on the CT-scans.
  • a guide template can optionally also serve to assist and guide the dental surgeon during the screwing of the implants .
  • a guide template is often made by means of Rapid Prototyping techniques.
  • the guide template is bone supported, it is adapted to fit on part of the bone of the patient, i.e. after the gums have been opened.
  • the bone may have a very irregular surface.
  • the guide template is designed based on data coming from the CT-scan, the part of the template in contact with the bone will have an inner surface which always follows the shape of the irregular surface very precisely.
  • a guide template enables pre-operative transferral of the drill directions in conformity with the planning of the surgeon .
  • a guide template is optimally designed such that it can be used for all implants.
  • a template is put only once on the patient and is possibly fixed temporarily by means of fixation screws.
  • the physical guiding of the drills is performed by guiding tubes provided in bores in the guide template.
  • the bores often comprise a metallic tube with an internal diameter slightly bigger than the outer diameter of the drill for which they are meant.
  • the osteotomies are generally drilled by two or more drills with incrementing diameter.
  • the bores can be provided of a fixed bush or tube with an internal thread wherein a series of interchangeable bushes or tubes with corresponding external thread but with varying internal guiding diameter can be screwed.
  • a drawback of any of the above known guide templates is that during the operation, the surgeon is not able to observe the drill approaching and entering the bone structure .
  • the present invention relates to a device for placing dental implants which aims to eliminate the constraints related to the known guide templates of the prior art.
  • the object of the invention is a device for placing dental implants, which device comprises one or several ducts for guiding one or several drills for applying one or several osteotomies in a bone structure of a patient and/or for guiding the insertion of one or more implants, whereby the device, at least for one of the ducts, is provided of an opening that allows the surgeon to access or inspect the bone structure at the point where, and at the time that the drill enters the bone structure.
  • Such an opening in a duct can be of any shape or any size and is preferably positioned lateral to the drilling direction and/or implant insertion direction.
  • lateral is used in the present text, it should be interpreted as being lateral with respect to the drilling axis and/or with respect to the corresponding centreline of the implant, which is generally also the line along which the implant is inserted in a drilled osteotomy.
  • a lateral opening can be positioned at any side of the duct.
  • the opening and the lateral access can be positioned and/or oriented in different ways, be it anterior, posterior, lateral, lingual or any other direction.
  • Such an opening that allows the surgeon to access or inspect the bone structure at the point where, and at the time that the drill enters the bone structure, allows the surgeon to modify his initial treatment plan according to new findings encountered during the surgical intervention .
  • a device according to the invention improves direct inspection of the bone as the surgeon can visually follow the procedure evolving and follow the insertion of a drill and/or the insertion trajectory of the implant.
  • the open accessibility of the bone also allows for copious rinsing during the drilling procedure, allowing optimized cooling of the drills and as such prevent undesired heating of the drills.
  • the opening is mainly provided at the height where the drill enters the bone .
  • the opening is provided at the side that allows the surgeon optimal visible inspection during the operation .
  • the optimal side for such an opening that allows visual inspection is the buccal side, i.e. the side of the cheeks, although occasionally, visual inspection and follow up of the surgical procedure may be easier from the lingual or palatal side.
  • the opening is provided at both the buccal and the lingual side, which leaves all options open and which allows to arrange for a stream of cooling and/or rinsing liquid.
  • the device when more than one duct is provided, the device also comprises rigid connection means between the said ducts in order to guarantee a rigid whole.
  • the rigid connection means can be of any form and are provided to guarantee a rigid device, which will not break or bend during the surgical intervention.
  • the ducts and the rigid connection means are integrally formed in one piece.
  • the rigid connection means and the ducts are generally so connected that the global shape of the device corresponds the arc shape of the portion of the mandible or of the maxilla on which it is applied.
  • the device is provided of one or more support structures which are designed to fit and find support in the mouth of the patient for which the device is designed.
  • the device may take support on the patient's jawbone, but according to the clinical needs, additional support can be taken on the mucosa of the patient, neighbouring teeth or even on earlier placed implants or screws, or on any combination of these.
  • the purpose of the support is to offer a guarantee to the surgeon that the device is placed as precise as possible.
  • a support structure consists of discrete supports, optionally saddle shaped in case they are meant to be provided on the bone structure.
  • Such discrete supports as opposed to the known continuous support which stretches over the complete course of the known guide templates, allow to provide a free space between major portions of the guide template and the jawbone, which improves visibility on the jawbone and introduces flexibility.
  • discrete supports are optimally positioned at a distance from the ducts. At least it is useful not to provide a support in line with a duct at the most visible side for the surgeon.
  • a traditional support to be positioned on the bone is generally provided of a central through going hole through which a screw or a stainless steel rod can be provided. Thanks to the anchorage of the guide template to the bone, such a support is generally said to be active .
  • a support to be positioned on teeth or mucosa are generally not provided of anchorage means and are therefore often called passive supports.
  • a support on an earlier provided implant or screw can be either active or passive.
  • the supporting structures are so defined to provide the surgeon with a device which can easily be placed in a reproducible way.
  • the number of supporting points may vary according to the clinical situation, but the aim is to provide a good stabilization so that the device will not displace, bend or tilt during the surgical procedure.
  • the opening that allows the surgeon to access or inspect the bone structure is extended such that it takes away a portion of the mantle that surrounds the corresponding duct .
  • this extended opening is stretched up till the free extremity or the so-called collar of the duct, the border line of the mantle surrounding the duct distal from the support side of the device.
  • the duct shows a lateral opening and an open collar which, in case it is wide enough, may permit lateral access for the drills.
  • a duct with such a wide lateral opening stretching up till the collar of the duct may drastically improve the accessibility for the drills during the surgical operation, and/or may further improve visual inspection and accessibility to the bone for the surgeon.
  • the drills can be positioned without the need for lifting the drill tip over the upper border of the guiding bore of known guide templates of the prior art, as in a guide template according to the last preferred embodiment, the drill can be brought in position through the lateral opening.
  • the implants can be placed anywhere where bone can be reached starting from the intra oral position, such as the zygoma, skull bone, pterygoid bone, temporal bone, sphenoid bone, etc.
  • the guide template according to the invention can be used for guiding the drills and/or for guiding the insertion of the implants.
  • a lateral opening stretching up till the collar of the duct will facilitate greatly the insertion of the corresponding drills which can be up to 70mm long.
  • the ducts can protrude up to 30mm from the supporting structure, so as to provide a long and secure guiding for the drills.
  • the lateral opening allows the drill to be inserted under a range of angles, sometimes preferred because of the sharply shaped top surface of the bone which may complicate initial insertion of the drill.
  • the drill is reoriented according to the planned orientation as defined by the duct.
  • the initial drilling guided by means of a device according to the invention preferably performed with a small drill diameter, must not necessary be performed exactly according to the line of insertion of the implant to be placed. This flexibility will be appreciated by the dental surgeon. He/she is aware of the fact that only the last drilling operation, performed with largest drill diameter mainly corresponding the outer diameter of the implant, should be guided by the duct thereto provided in the guide template.
  • the present invention is also about a device for placing dental implants provided of fiducial reference points or structures which will allow the surgeon to verify the correct positioning of the device compared to a foreseen position of device when the implants were planned and the device designed.
  • the fiducial structures could eventually allow the surgeon to check if the position of the device accords to the peroperat ively planned position.
  • the position of the fiducial structure is not fixed and can be placed anywhere on the device.
  • figure 1 represents a perspective view of a device for placing dental implants according to the invention
  • figure 2 represents a top view according to arrow F2 in figure 1;
  • figure 3 represents the device of figure 1, fixed on a patient's jawbone.
  • the guide template 1 here designed for application on the mandible of a patient, mainly consists of an arc shaped body 2 mainly forming a plain with in this case a downward oriented support side 3 and an upward oriented tool side 4 for the drills.
  • the support side 3 is here provided of three discrete saddle shaped supports 5 of which the shape and their positions are in accordance with the shape of the mandible whereon the guide template 1 is meant to fit.
  • This arc shaped body 2 is further provided of four half- open cylindrical ducts 6 for guiding the drills.
  • the guide template 1 can also be seen as ducts 6 which are interconnected by means of rigid connection means.
  • the rigid connection means and the ducts 6 are so connected that the global shape of the device corresponds the arc shape of the portion of the mandible on which it is applied.
  • the height of the ducts is here 10 mm.
  • the lateral openings 7 of the ducts 6 are in the given embodiment, as preferred, all oriented towards the outer or buccal side 8 of the arc shaped bode 2 of the guide template 1.
  • the guide template 1 shows no material portions at it's outer side 8 in line with the ducts 6.
  • Each of the saddle shaped supports 5 is provided of a through going bore 12.
  • the application and the functioning of a guide template 1 according to the invention is simple and as follows.
  • the guide template 1 represented and described above is, in this case, made by means of a 3D-printing technique and is a so-called "bone supported" guide template 1.
  • the saddle shaped supports 5 fit on the bone 13 of the patient, as shown in figure 3.
  • the bone 13 may have a very irregular surface.
  • the guide template 1 is designed based on data coming from a scanner, for example a CT- scan or a conebeam scan, the saddle shaped supports 5 will have an inner surface corresponding the shape of the irregular surface very precisely.
  • said guide template 1 can be provided with a contact part which is not or not solely designed to be supported on the bone 14, but (also) cooperates with parts of the gums and/or remaining teeth of the patient.
  • This guide template 1 can be screwed down temporarily to the patient.
  • the through going bores 12 guide the drills for preparing the holes wherein the osseo-synthesis fixation screws are screwed, and they also serve as screw holders of these screws .
  • fixation screws are situated in the centerline of the saddle shaped supports 5.
  • the osteotomies are often drilled in various steps with drills of increasing diameter.
  • the ducts 6 can be provided of replaceable half-open inserts with incrementing internal diameter, not represented in the drawings.
  • inserts may be made of an appropriate metal and may be provided of holding ribs parallel to the drilling axis.
  • Such ribs which fit in grooves in the arc shaped body 2 guarantee that the inserts are maintained in position during the drilling, but allow the inserts to be placed or removed easily by forcing the ribs to slide in and out the grooves in the body 2.
  • a drill can be provided with a staged diameter profile such that one drill and one duct 6 diameter suffices.
  • the guide template 1 enables pre-operative transferral of the drill directions in conformity with the planning of the surgeon.
  • the guide template 1 has been designed such that it can be used for all implants. After the osteotomies are drilled, optionally a thread is tapped in the bone 14, and consecutively the implants are screwed in the osteotomies. Also during the screwing procedure of the implants, the ducts 6 act as a guide for the accurate screwing of the implants .
  • the guide template 1 not showing any material portion at it's outer or buccal side 8 in line with the ducts 6, generously provides an opening 7 that allows the surgeon to access and inspect the bone structure 13 at the point where, and at the time that a drill and/or an implant enters the bone structure 13.
  • a device according to the invention improves direct inspection of the bone as the surgeon can visually follow the procedure evolving and follow the insertion of a drill and/or the insertion trajectory of the implant.
  • the exposition of the bone 13 will prevent remnants of soft tissue to be impinged during drilling or implant placement.
  • the open accessibility of the bone 13 also allows for copious rinsing during the drilling procedure, allowing optimized cooling of the drills and as such prevent undesired heating of the drills.
  • the ducts 6 are in this case embodied as half-open ducts 6, of which the lateral openings 7 are oriented towards the outer or buccal side 8 of the arc shaped body 2 of the guide template 1, i.e. towards the outside space of the patient's mouth.
  • This embodiment is mostly suitable for bringing the drills or the tools in position according to a first direction, and thereafter drilling the osteotomies or screwing the implants according to a second direction mainly perpendicular to the first direction. There is no need for lifting the drills or the tools over the tool side 4 of the guide template 1.
  • the outer side 8 delivers lateral access to the drills and tools in order to put them in operational position .
  • the characteristic of the guide template 1 showing no material portions at it's outer side 8 in line with the ducts 6 results in the crucial advantage for the surgeon having improved visibility on his actions at the level of the jawbone 14.
  • the lateral openings 7 also leave space for flexibility.
  • the dental surgeon can consider slight amendments in his approach as compared to the planning. He/she is not tight to the planning made. The preparation and planning are reduced to the essence of their function. If the practitioner, prepared for the surgical operation, realizes at the moment of the operation that a slightly different approach would be more convenient, he/she has the freedom to do so.
  • inserts are provided in the ducts, these can be placed and removed, for example by a sliding movement where ribs cooperate with grooves, according to the needs of the practitioner.
  • a first template is provided for guiding the drills, and that a second template is provided for guiding the insertion of the implants .
  • Such a dedicated guide template for guiding the surgeon during the insertion of the implants may have smaller "inspection" opening or openings in the duct, resulting in an optimal support for the implant and/or for the tools during the insertion of the implant, and allowing sufficient visible feedback through the somewhat smaller opening or openings .
  • Such a second template uses the same position of the fixation screws or fixation pins as the first template for guiding the drills.
  • an opening provided in a device according to the present invention may be oriented under an appropriate inclination with respect with the drilling or implant insertion axis.
  • the opening can be oriented towards the view position of the surgeon which is not necessary perpendicular to the drilling or implant insertion axis.
  • the lateral openings 7 of the half-open ducts 6 can alternatively also be provided at the internal or lingual side of the arc shape body 2, or at the anterior or posterior side, or at any side or sides which might be appropriate. This can for example be useful for implants in the back of the mouth, where access is easier from the internal side of the arc shaped body 2.
  • the guide template 1 ideally doesn't show material portions at it's internal side in line with the ducts 6, in order to have a free access for the tools and a good visibility on the jawbone 13 for the surgeon, at least on the place of entry of the drills and of the implant .
  • a lateral opening can be of any size and any shape.
  • a lateral opening can take away only a small portion of the mantle of a duct 6, it can be narrow or wide, stretched or short .
  • the height of the ducts 6 preferably is situated in the range of 6mm to 14mm, and ideally between 8mm and 12mm.
  • a duct 6 may have a smaller height of for example 5mm or even 4mm, and of course of values in between these examples, but the smaller the height, the less support is found during the drilling and/or during the insertion of the implants.
  • a guide template 1 can have lateral openings 7 in the ducts 6 which do not reach till the tool side 4.
  • the upper contour of the mantle defining the duct 6 is not interrupted, taking away the advantage of easier access for the tools, but still providing the improved visibility for the surgeon on the place where the drill enters the bone 14.
  • the guide template 1 can be bone 13 supported or can be supported by the mucosa, by the teeth, by earlier placed implants or screws or a combination of these possible supports.
  • New imaging techniques based on for example MRI or optical scanning techniques may allow further development.
  • the device according to the present invention can be applied in combination with various drilling techniques.
  • drills or drilling techniques it is meant to comprise all possible techniques that allow to remove bone tissue, such as for example the piezo drill which removes tissue by means of vibration energy.
  • the invention is in no way limited to the embodiments described above and represented in the appended drawings, as a device for placing dental implants according to the invention can be realized in various ways without departure from the scope of the invention.

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  • 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

La présente invention concerne un dispositif de mise en place d'implants dentaires, ledit dispositif comprenant un ou plusieurs canaux (6) destinés à guider un ou plusieurs forets permettant de pratiquer une ou plusieurs ostéotomies dans une structure osseuse (13) d'un patient et/ou destinés à guider l'introduction d'un ou de plusieurs implants. Ledit dispositif est caractérisé en ce qu'au moins pour l'un des canaux (6), une ouverture (7) est prévue pour permettre au chirurgien d'accéder ou d'inspecter la structure osseuse (13) à l'endroit et au moment où un foret et/ou un implant pénètre à l'intérieur de la structure osseuse (13).
PCT/IB2009/055123 2009-11-17 2009-11-17 Dispositif de mise en place d'implants dentaires WO2011061557A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/IB2009/055123 WO2011061557A1 (fr) 2009-11-17 2009-11-17 Dispositif de mise en place d'implants dentaires

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/IB2009/055123 WO2011061557A1 (fr) 2009-11-17 2009-11-17 Dispositif de mise en place d'implants dentaires

Publications (1)

Publication Number Publication Date
WO2011061557A1 true WO2011061557A1 (fr) 2011-05-26

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2425695A1 (es) * 2012-04-11 2013-10-16 Software Nemotec, S.L. Guía quirúrgica monobloque
CH708017A1 (de) * 2013-04-16 2014-10-31 Dominik Meier Bearbeitungssystem für orale Implantologie.

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005120385A1 (fr) * 2004-05-04 2005-12-22 Obl (Societe Anonyme) Guide chirurgical implantaire sur mesure et fraise associée, leur procédé de fabrication et leur utilisation
US20060257817A1 (en) * 2005-05-12 2006-11-16 Robert Shelton Dental implant placement locator and method of use
WO2007104842A1 (fr) * 2006-03-15 2007-09-20 Obl Dispositif de guidage d'un foret implantaire et procede de pose d'un implant axial mettant en œuvre ce dispositif
WO2008149288A1 (fr) * 2007-06-04 2008-12-11 Jean Capsal Procédé pour produire un dispositif d'assistance de foret pour au moins un trou d'implant dans une structure osseuse et dispositif obtenu

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005120385A1 (fr) * 2004-05-04 2005-12-22 Obl (Societe Anonyme) Guide chirurgical implantaire sur mesure et fraise associée, leur procédé de fabrication et leur utilisation
US20060257817A1 (en) * 2005-05-12 2006-11-16 Robert Shelton Dental implant placement locator and method of use
WO2007104842A1 (fr) * 2006-03-15 2007-09-20 Obl Dispositif de guidage d'un foret implantaire et procede de pose d'un implant axial mettant en œuvre ce dispositif
WO2008149288A1 (fr) * 2007-06-04 2008-12-11 Jean Capsal Procédé pour produire un dispositif d'assistance de foret pour au moins un trou d'implant dans une structure osseuse et dispositif obtenu

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2425695A1 (es) * 2012-04-11 2013-10-16 Software Nemotec, S.L. Guía quirúrgica monobloque
CH708017A1 (de) * 2013-04-16 2014-10-31 Dominik Meier Bearbeitungssystem für orale Implantologie.

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