WO2012039017A1 - サージカルガイド作製具及びサージカルガイドの作製方法 - Google Patents
サージカルガイド作製具及びサージカルガイドの作製方法 Download PDFInfo
- Publication number
- WO2012039017A1 WO2012039017A1 PCT/JP2010/066284 JP2010066284W WO2012039017A1 WO 2012039017 A1 WO2012039017 A1 WO 2012039017A1 JP 2010066284 W JP2010066284 W JP 2010066284W WO 2012039017 A1 WO2012039017 A1 WO 2012039017A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- surgical guide
- guide
- gauge body
- display members
- image
- Prior art date
Links
- 238000000034 method Methods 0.000 title description 7
- 239000007943 implant Substances 0.000 claims abstract description 34
- 238000003780 insertion Methods 0.000 claims abstract description 28
- 230000037431 insertion Effects 0.000 claims abstract description 28
- 239000000463 material Substances 0.000 claims description 22
- 238000002360 preparation method Methods 0.000 claims description 18
- 238000004519 manufacturing process Methods 0.000 claims description 16
- 238000005553 drilling Methods 0.000 claims description 5
- 206010044048 Tooth missing Diseases 0.000 claims 1
- 210000000515 tooth Anatomy 0.000 description 50
- 229920003023 plastic Polymers 0.000 description 7
- 238000005520 cutting process Methods 0.000 description 6
- 238000006116 polymerization reaction Methods 0.000 description 6
- 239000011347 resin Substances 0.000 description 6
- 229920005989 resin Polymers 0.000 description 6
- 230000007547 defect Effects 0.000 description 4
- 229910052751 metal Inorganic materials 0.000 description 4
- 239000002184 metal Substances 0.000 description 4
- 238000013170 computed tomography imaging Methods 0.000 description 3
- 238000004458 analytical method Methods 0.000 description 2
- TZCXTZWJZNENPQ-UHFFFAOYSA-L barium sulfate Chemical compound [Ba+2].[O-]S([O-])(=O)=O TZCXTZWJZNENPQ-UHFFFAOYSA-L 0.000 description 2
- 210000004204 blood vessel Anatomy 0.000 description 2
- 210000005036 nerve Anatomy 0.000 description 2
- 239000011343 solid material Substances 0.000 description 2
- 239000012780 transparent material Substances 0.000 description 2
- 241000239290 Araneae Species 0.000 description 1
- -1 Next Chemical compound 0.000 description 1
- RTAQQCXQSZGOHL-UHFFFAOYSA-N Titanium Chemical compound [Ti] RTAQQCXQSZGOHL-UHFFFAOYSA-N 0.000 description 1
- 239000000853 adhesive Substances 0.000 description 1
- 230000001070 adhesive effect Effects 0.000 description 1
- 229910052782 aluminium Inorganic materials 0.000 description 1
- XAGFODPZIPBFFR-UHFFFAOYSA-N aluminium Chemical compound [Al] XAGFODPZIPBFFR-UHFFFAOYSA-N 0.000 description 1
- 229940036348 bismuth carbonate Drugs 0.000 description 1
- 229910000416 bismuth oxide Inorganic materials 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 238000002591 computed tomography Methods 0.000 description 1
- 238000012217 deletion Methods 0.000 description 1
- 230000037430 deletion Effects 0.000 description 1
- 239000004053 dental implant Substances 0.000 description 1
- TYIXMATWDRGMPF-UHFFFAOYSA-N dibismuth;oxygen(2-) Chemical compound [O-2].[O-2].[O-2].[Bi+3].[Bi+3] TYIXMATWDRGMPF-UHFFFAOYSA-N 0.000 description 1
- GMZOPRQQINFLPQ-UHFFFAOYSA-H dibismuth;tricarbonate Chemical compound [Bi+3].[Bi+3].[O-]C([O-])=O.[O-]C([O-])=O.[O-]C([O-])=O GMZOPRQQINFLPQ-UHFFFAOYSA-H 0.000 description 1
- 239000006261 foam material Substances 0.000 description 1
- 210000004195 gingiva Anatomy 0.000 description 1
- 238000010191 image analysis Methods 0.000 description 1
- 210000004871 mandibular tooth Anatomy 0.000 description 1
- 230000003340 mental effect Effects 0.000 description 1
- 239000007769 metal material Substances 0.000 description 1
- 150000002739 metals Chemical class 0.000 description 1
- 239000003973 paint Substances 0.000 description 1
- 239000000049 pigment Substances 0.000 description 1
- 229910001220 stainless steel Inorganic materials 0.000 description 1
- 239000010935 stainless steel Substances 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 239000010936 titanium Substances 0.000 description 1
- 229910052719 titanium Inorganic materials 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
- A61C1/08—Machine parts specially adapted for dentistry
- A61C1/082—Positioning or guiding, e.g. of drills
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- 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
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
- A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
- A61B6/03—Computed tomography [CT]
- A61B6/032—Transmission computed tomography [CT]
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
- A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
- A61B6/51—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for dentistry
- A61B6/512—Intraoral means
-
- 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
- A61C19/00—Dental auxiliary appliances
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
- A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
- A61B6/506—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of nerves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C2201/00—Material properties
- A61C2201/005—Material properties using radio-opaque means
Definitions
- the present invention relates to a surgical guide preparation tool and a surgical guide preparation method used when implanting a dental implant at a predetermined position.
- a drill attached to a drilling device such as a handpiece is used to open an insertion hole for an implant in a missing tooth portion.
- the drill is made so that the insertion hole is in a predetermined position and direction.
- it is usually drilled using a surgical guide.
- a metal guide ring (guide tube) for guiding a drill to a surgical guide supported by a jawbone or the like is fitted.
- CT imaging is performed using an X-ray CT apparatus (Computed Tomography) with a surgical guide (diagnostic stent) mounted on the patient's teeth, and the CT image shows the examination result. Based on this, the insertion direction of the implant is determined.
- the present invention provides a low-cost surgical guide preparation tool and a surgical guide preparation method capable of solving these problems and forming an insertion hole of an implant accurately and simply at a predetermined position. is there.
- a gauge main body having a pair of display members, each of which is provided with a plurality of marks arranged vertically and horizontally at substantially equal intervals recognizable by a CT image.
- a surgical guide production tool in which this gauge body is mounted on a surgical guide body, a predetermined mark is selected from a plurality of marks on the display member, and the direction connecting the selected marks is defined as the direction of the insertion hole of the implant.
- the display member is provided with a support member that supports the display member.
- an artificial tooth having radiopacity that can be recognized by a CT image is detachably mounted inside the gauge body, and the positional relationship between the artificial tooth and the direction of the insertion hole of the implant is confirmed. Is possible.
- the surgical guide manufacturing method of the present invention includes a step of manufacturing the gauge main body, the gauge main body is mounted at a position corresponding to the missing tooth of the surgical guide main body, and the surgical guide main body is mounted on the tooth.
- the obtained CT image is taken into a computer, the position of the mark of both display members corresponding to the insertion direction of the implant is read by analysis by computer operation, the positioner is inserted inside the guide ring, and the guide ring is Inserting a pin in the direction connecting the position of the mark of each display member and the axis of the positioner that is inserted inside the gauge body and reading the insertion direction of the implant, and the guide at the position where the pin is inserted Fix the ring to the surgical guide body, and then position the pin and position Comprising the step of removing or deleting over and gauge body.
- an artificial tooth having radiopacity that can be recognized by a CT image is detachably attached to the inside of the gauge body, and the guide ring is attached to the inside of the gauge body.
- the step of removing the artificial teeth when inserting, and the slit portion of the drill ring for drilling the jawbone form a slit in the guide ring so that it can be inserted from the side surface of the guide ring. And forming an opening having a width that is substantially the same width as that of the slit and extends outward from the slit.
- the above-mentioned surgical guide is a support provided with a guide ring, and there are one that is supported by the jawbone, one that is supported by the gingiva, and one that is supported by the teeth. All of these types of surgical guides are generally made of a plastic material like conventional products. If the surgical guide is made of a transparent material, it becomes easier to see the work site.
- the guide ring attached to the surgical guide is made of titanium, aluminum, other metals, or a hard plastic material.
- the inner diameter is about 4 mm to 9 mm and the outer diameter is about 5 mm to 10 mm so as to correspond to the diameter of the guide member of the drill. However, it is not limited to these dimensions.
- a slit is provided on the side of the guide ring so that the tip of an implant medical device such as a drill blade, an implant, or an adapter for implant insertion can be inserted from the side, and a surgical guide corresponding to the slit.
- An opening having a width substantially corresponding to the width of the slit or a width extending outward from the slit is also provided at the position of the main body.
- the width of the slit is generally a little larger than the maximum diameter of the implant to be used, since the diameter of the drill blade is about 2 mm to 5 mm according to the diameter of the implant. It is manufactured to about 4 mm to 6 mm. However, the width of the slit is not limited to this dimension. If the upper portion of the guide ring is spread outward on the taper, the drill can be guided easily.
- the gauge body is attached to the surgical guide body.
- the gauge main body has a pair of opposed display members, and the surface shape of the display member can be a square, a rectangle, a circle, an ellipse, a trapezoid, or other shapes.
- the size of the gauge body is about 10 to 20 mm in height and width, about 10 to 30 mm in height, and about 1 to 2 mm in thickness if it is for one tooth defect, but is limited to these dimensions. It is not a thing. If it is for the defect
- the pair of display members of the gauge main body On the surfaces of the pair of display members of the gauge main body, marks arranged vertically and horizontally at equal intervals that can be recognized by CT images are provided. This mark may also be provided on the side surface of the display member.
- an X-ray transparent member for example, an X-ray transparent plastic material
- an X-ray opaque material for example, barium sulfate, bismuth oxide, Next, bismuth carbonate and the like are applied to form lattice-like lines and grooves, and the intersections of these lines and grooves are used as marks, or a radiopaque material is formed on the surface of the display member in the form of lattices or dots. It is buried and the intersection or point of the grid is used as a landmark. In this case, it becomes easier to see if the X-ray-impermeable material is mixed with a pigment, paint or the like and colored.
- a small hole is provided at the intersection point, and a larger hole is provided in a part of the small hole (small hole at the center of the display member or small hole at the end of the display member). can do.
- the size of the small hole is about 1 mm in diameter, but other diameters may be used.
- a pair of display members is made of a radiopaque material, for example, a plastic material mixed with a metal material or a radiopaque material, as described above, at the position where the lattice-like line intersects. Small holes and reference holes are provided and used as marks. In this case, it is preferable to display grid lines on the surfaces of the pair of display members so that the grid lines can be visually observed.
- the position of the mark is not limited to a grid line. If the position is recognizable by a CT image, it can be an intersection of lines having an appropriate shape such as a spider web or a ripple pattern. Further, a metal mesh material can be used as the display member, and in this case, the mesh hole is the mark position.
- the distance between the marks is about 1 to 2 mm. However, the distance between the marks may be other than that, and the mark may be formed with a depth of about 0.5 to 1 mm. Good.
- an artificial tooth corresponding to a tooth defect portion can be inserted into the space.
- This artificial tooth is temporarily fixed to the display member, the support member, or the like below the gauge body with a polymerization resin or the like.
- the surface of the artificial tooth can be recognized by a CT image by applying a radiopaque material on the surface of the artificial tooth or by integrally manufacturing it with the radiopaque material. Yes.
- a CT image is obtained using CT.
- This CT image is taken into a computer and analyzed using CT image analysis software (for example, software such as One Volume Viewer: J.Morita MFG.CORP.), And the positions of the marks and the artificial teeth on each display member of the gauge body The position of the mark corresponding to the insertion position and direction of the implant is determined.
- the CT image is temporarily stored in a recording medium such as a CD or DVD, and is later read by a computer, or an X-ray CT apparatus and a computer are connected, and the CT image is directly read by a computer.
- the surgical guide preparation tool is removed from the patient, and a pin made of stainless steel, other metal, or strong plastic is passed through the small hole of the mark of each display member determined as described above. If the small hole is not open, use a sharp pin. The direction of this pin is the predetermined insertion direction of the implant.
- the pin is once pulled out, the positioner is inserted into the guide ring, the guide ring is inserted into the internal space of the gauge body, and the pin is again passed through the small hole of the mark and the center hole of the positioner.
- a fixing material such as a polymerization resin is filled around the guide ring, and the guide ring is fixed to the surgical guide body. After the fixing material is cured, the surgical guide is completed by removing the pin and removing or deleting the gauge body and the positioner.
- the positioner is usually made of a plastic material (including a foam material), but may be made of other materials.
- the present invention can accurately match the position and direction of the guide ring attached to the surgical guide as described above with the insertion position and direction of the implant, so that the accuracy of implant treatment can be improved and at a low cost. Can be provided.
- the preparation tool and the preparation method of the present invention it is possible to improve the safety of implant surgery and shorten the operation time, reduce the mental burden of patients, surgeons, medical staff, improve treatment results, Economic burden on patients and clinics can be reduced.
- the surgical guide 1 shown in FIG. 1 has a guide ring 4 for guiding the guide member 3 of the drill 2 shown in FIG.
- the guide ring 4 is attached to the surgical guide body 6 so that the attachment position and direction thereof coincide with the insertion position and direction of the implant.
- the mounting is performed using a surgical guide preparation tool 7 in which a gauge body 5 (shown in FIG. 2) is attached to a surgical guide body 6 (shown in FIG. 4).
- a mandibular model 8 of a patient and an artificial tooth 9 corresponding to a missing tooth are prepared and passed through a hole 67 in the center of the artificial tooth 9 in a position and direction considered to be appropriate.
- the artificial tooth 9 is temporarily fixed to the lower jaw model 8 by passing the pin 10 through the hole 68 of the opened lower jaw model 8.
- a radiopaque material is applied to the surface of the artificial tooth 9.
- the surgical guide body 6 is produced using the lower jaw tooth model 8.
- a hole 11 is formed in a portion corresponding to the missing tooth of the surgical guide body 6 so that a part of the upper portion of the artificial tooth 9 appears.
- the gauge body 5 includes an upper display member 12, a lower display member 13, and a support member 14 that couples the pair of display members.
- the gauge body 5 is integrally made of a plastic material having radiopacity.
- a grid-like line 15 is displayed on the surface of the pair of display members 12 and 13, and a small hole 16 is opened at the intersection of the lines.
- the small hole in the center of the display member is formed as a hole having a diameter larger than that of the small hole 16 and serves as a reference hole 17.
- the artificial tooth 9 and the pin 10 are removed from the lower jaw model 8, and the artificial tooth 9 is inserted into the internal space 18 of the gauge body 5 and placed on the lower display member 13. .
- the position of the gauge body 5 is determined by passing the pin 35 through the reference hole 17 of the gauge body 5, the hole 67 at the center of the artificial tooth, and the hole 68 of the lower jaw model 8.
- the support member 14 of the gauge main body 5 hits the side surface of the surgical guide main body 6, a part of the side surface portion of the surgical guide main body 6 is deleted.
- the lower part of the artificial tooth 9 is deleted in advance by the thickness of the lower display member 13 so that the lower display member 13 of the gauge body 5 can be inserted below the surgical guide body 6.
- the artificial tooth 9 is temporarily fixed at a predetermined position using a polymerization resin or an adhesive.
- the surgical guide main body 6 and the gauge main body 5 are fixed with a fixing material 38 such as a polymerization resin, and the pin 35 is pulled out to complete the surgical guide preparation tool 7.
- the surgical guide preparation tool 7 manufactured in this way is attached to the patient's teeth, and CT imaging is performed using the X-ray CT apparatus 19 to obtain a CT image 20.
- this CT image 20 is taken into a computer 21 (having a monitor 22, a keyboard 23, and a mouse 24), and image analysis is performed using CT image analysis software stored in the computer 21.
- the positions of the marks of the pair of display members 12 and 13 corresponding to the insertion direction are read. That is, as shown in FIG. 7, an axial section 25, a panoramic section 26 and an ortho-radial section 27 of the gauge body 5 are displayed by operating the computer 21, and these positions are confirmed while confirming the position of each display member of the gauge body.
- the panoramic cutting line 29 and the ortho-radial cutting line 30 are moved in the directions in which the implants are to be inserted into the respective sections. Then, it is confirmed that there are sufficient jawbones in the direction of the panoramic cutting line 29 and the orthoradial cutting line 30 in the panoramic section 26 and the orthoradial section 27, and that the nerves and blood vessels 31 and 32 are not present at the positions.
- This direction is determined as the insertion direction of the implant.
- the marks 33 and 34 of the display members located at the intersections of the cutting lines are read as marks corresponding to the insertion direction of the implant. At this time, the positions of the marks 33 and 34 can be read from the reference hole 17 by a small hole or scale on the CT screen.
- the pin 35 is inserted into the two holes formed in the marks 33 and 34 of the read display members. Insert.
- the positioner 36 shown in FIG. 9 is inserted into the guide ring 4 shown in FIG. 10, and the guide ring 4 is inserted into the internal space 18 of the gauge body 5.
- the pin 35 is passed through the hole 37 at the center of the positioner 36.
- funnel-shaped concave surfaces 69 are formed on both end surfaces or one of the surfaces of the positioner 36, and the tip portions of the pins 35 are guided by the concave surfaces 69 to easily enter the center hole 37 of the positioner 36. Yes.
- the guide ring 4 is filled with a solid material 38 such as a polymerization resin, and the guide ring 4 is connected to the surgical guide body 6 and integrated. Thereafter, the pin 35, the positioner 36 and the gauge body 5 are removed or deleted, and the surgical guide 1 is completed as shown in FIG. In addition, after removing the gauge main body 5 etc., solid materials, such as a polymerization resin, are supplemented to the connection part of the said guide ring 4 and the surgical guide main body 6 as needed.
- a recess 39 and a projection are provided, thereby preventing the guide ring from rotating.
- the surgical guide 1 is formed with an opening 41 that spreads outward so as to have a width larger than the width of the slit 40 of the guide ring.
- the width of the slit 40 is such that the dental blade portion 59 shown in FIG. 14 can pass through, and the inner diameter of the guide ring is such that the guide member 3 of the drill 2 is slidably guided. It is.
- the gauge body 5 shown in FIG. 11 is of an assembly type, and includes an upper member 42 in which an upper display member 12 and a support member 14 are integrally formed, a lower display member 13 with a support plate 43, and artificial teeth 9. It has the base plate 44 to support.
- the upper member 42 has a support frame 45 extending from a lower end portion thereof, and the support frame 45 is engaged with a dovetail groove 47 formed by a protrusion 46 provided on the lower display member 13. Further, the base plate 44 is engaged with a dovetail groove 48 of a protrusion 46 provided on the lower display member 13.
- marks 49 drawn in a lattice shape with a radiopaque material are displayed.
- the base plate 44 is provided, but when the artificial tooth 9 is directly supported by the lower display member 13, the base plate 44 is omitted.
- the gauge body 5 shown in FIG. 12 shows another assembly type, and an upper frame member 52 in which an upper display member 12, an upper frame 50 that supports the upper display member 12, and one support member 51 are integrally formed.
- the upper display member 12 is engaged with a dovetail groove 60 provided in the upper frame 50
- the lower display member 13 is engaged with a dovetail groove 61 provided in the lower frame member 55.
- One support member 51 of the upper frame member 52 and the other support member 54 of the lower frame member 55 are coupled by engaging a ridge 56 and a groove 57 formed on these support members.
- the upper frame member 52 and the lower frame member 55 are made of a transparent material, and a mark 58 is provided on the upper frame 50 and the lower frame 53 at the position of the mark 58 obtained by analysis of the CT image. 52 and the lower frame member 55 are used as consumables, and the upper display member 12 and the lower display member 13 are reused as master pieces.
- a gauge body 5 shown in FIG. 13 includes an upper display member 12, an upper frame 63 that has a support 62 and supports the upper display member 12, a lower display member 13, and a lower frame that supports the lower display member 13. 64 and artificial teeth 9.
- the upper display member 12 is engaged with a dovetail groove 65 provided in the support portion 62 of the upper frame 63
- the lower display member 13 is engaged with a dovetail groove 61 provided in the lower frame 64.
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Abstract
Description
このサージカルガイドには、顎骨等に支持するサージカルガイドにドリルを案内するための金属製のガイドリング(ガイドチューブ)が嵌入されている。
ドリルをガイドリングに案内して穿孔する場合には、インプラントの挿入孔を形成する部分に十分な骨量が存在し、またその部分に神経や血管が存在していないことが必要である。
そこで、これらの条件を満たすように、一般にはサージカルガイド(診断用ステント)を患者の歯に装着した状態でX線CT装置(Computed Tomography)を用いてCT撮影し、そのCT画像による検査結果に基づいてインプラントの挿入方向を決定している。
例えば、欧州特許第1043960号明細書に記載されているように、X線CT装置と、このCTに連動する数値制御穴加工機を備え、この数値制御穴加工機によってインプラントの挿入孔を加工する方法である。
この方法は、このように別途、数値制御穴加工機を用いるものであるから、装置全体が大掛かりとなり、作業に熟練を要する上にコスト高になっている。
また、特開2006-141561号公報に示すように、歯の欠損部分の顎骨区帯のCT画像を印刷し、この印刷部分より歯の欠損部分を切り抜き、この切抜き部分を歯型模型に貼着した後に、貼着した切抜き部分にインプラントの挿入位置及び方向を示すマークを付し、このマークに沿ってインプラントの挿入孔を加工する方法が考えられている。
しかし、この方法は、上記のように多くの手間を要するものであり、また、そのマークを目視しながらインプラントの挿入孔を加工するようにしたものであるから、インプラントの挿入孔を正確に加工することができないおそれがある。
ガイドリングの側面には、ドリルの刃部やインプラント、インプラント挿入用アダプター等のインプラント医療用器具の先端部が側方より挿入できるようにスリットが設けられており、このスリット部に対応するサージカルガイド本体の位置にも、スリットの幅にほぼ相当する幅またはスリットより外方に向けて広がる幅の開口部が設けられている。
スリットの幅は、一般的にはインプラントの径に合わせてドリルの刃部の径が約2mm~5mmほどに製作されているので、これに相応して使用されるインプラントの最大径より少し大きな径である4mm~6mm程度に製作されている。しかし、このスリットの幅は、この寸法のみに限定されるものではない。
なお、ガイドリングの上部をテーパー上に外方に広げておくと、ドリルが案内し易くなる。
一対の表示部材は、これをX線透過性の部材、例えばX線透過性のプラスチック材で作製した場合、これらの表示部材の表面にX線不透過性の材料(例えば硫酸バリウム、酸化ビスマス、次炭酸ビスマス等)を塗布して格子状の線や溝を形成し、これらの線や溝の交点を目印としたり、表示部材の表面にX線不透過性の材料を格子状や点状に埋設しその格子の交点や点を目印としたりする。この場合、上記X線不透過性の材料に顔料や塗料等を混合して着色させておくと一層見易くなる。
一方、一対の表示部材としてX線不透過性の材料、例えば金属材やX線不透過性材を混入したプラスチック材を用いた場合は、格子状の線の交点となる位置に上記のように小孔や基準の孔を設けてこれらの孔を目印とする。この場合、上記格子状の線が目視できるように、一対の表示部材の表面に格子状の線を表示しておくとよい。
目印の間隔は、約1~2mmに形成されるが、それ以外の間隔としてもよく、また、目印の深さは約0.5~1mmに形成されるが、それ以外の深さにしてもよい。
ここで、一旦ピンを抜き、ポジショナーをガイドリング内に挿入し、このガイドリングをゲージ本体の内部空間に挿入して、再度、ピンを上記目印の小孔と上記ポジショナーの中心の孔に通す。この状態でガイドリングの周囲に重合レジン等の固定材を充填してガイドリングをサージカルガイド本体に固定する。
固定材の硬化後に、ピンを抜き、ゲージ本体及びポジショナーを除去または削除すると、サージカルガイドが完成する。なお、上記ポジショナーは、通常、プラスチック材(発泡材を含む)で製作されるが、その他の材料で製作してもよい。
図1に示すサージカルガイド1は、図14に示すドリル2の案内部材3を案内するガイドリング4を有する。このガイドリング4は、その取り付け位置及び方向がインプラントの挿入位置及び方向に一致するように、サージカルガイド本体6に装着される。その装着は、以下に示すように、ゲージ本体5(図2に示す)をサージカルガイド本体6(図4に示す)に取り付けたサージカルガイド作製具7を用いて行われる。
次に、下顎歯型模型8を用いてサージカルガイド本体6を作製する。このサージカルガイド本体6の欠損歯に相当する部分には、図4に示すように、人工歯9の上部の一部が現われるように穴11が形成されている。
この一対の表示部材12、13の表面には、格子状の線15が表示されており、この線の交点に小孔16が開けられる。表示部材の中央部にある小孔は、上記小孔16より大きい径の孔に形成されていて基準の孔17とされる。
この場合、ゲージ本体5の下部表示部材13がサージカルガイド本体6の下側に挿入できるように、人工歯9の下部を下部表示部材13の厚み分ほど予め削除して人工歯9の取り付け高さを調整し、人工歯9を所定の位置に重合レジンや接着剤等用いて仮固定する。その後に、サージカルガイド本体6とゲージ本体5を重合レジン等の固定材38で固定し、ピン35を引き抜くことによってサージカルガイド作製具7が完成する。
図15に示すように、このCT画像20をコンピュータ21(モニター22、キーボード23、マウス24を備えている)に取り込み、コンピュータ21に格納されたCT画像解析用ソフトを用いて画像解析し、インプラントの挿入方向に相当する一対の表示部材12、13の目印の位置を読み取る。
即ち、図7に示すように、コンピュータ21操作により、ゲージ本体5部分のアキシャル断面25、パノラマ断面26及びオルソラジアル断面27を表示し、そのゲージ本体の各表示部材の位置を確認しながら、これらの断面にそれぞれインプラントを挿入しようとする方向にパノラマ切断線29及びオルソラジアル切断線30を移動する。そしてこのパノラマ断面26及びオルソラジアル断面27におけるパノラマ切断線29及びオルソラジアル切断線30の方向に十分な顎骨が存在し、かつその個所に神経及び血管31、32が存在していないことを確認し、この方向をインプラントの挿入方向と決定する。
この決定された方向において、アキシャル切断線28を移動することによって上記各切断線の交点に位置する各表示部材の目印33、34をインプラントの挿入方向に相当する目印として読み取る。その際、これらの目印33、34の位置は、上記基準の孔17からの距離をCT画面上の小孔または目盛りにより読み取ることができる。
上記ガイドリング4の周囲には、凹部39や凸部が設けられており、これによってガイドリングの回動が阻止される。
4 ガイドリング
5 ゲージ本体
6 サージカルガイド本体
8 下顎歯型模型
9 人工歯
12 上部表示部材
13 下部表示部材
14 支持部材
16 小孔
17 基準の孔
19 X線CT装置
20 CT画像
21 コンピュータ
33、34、49、58 目印
35 ピン
36 ポジショナー
40 スリット
41 開口部
Claims (11)
- 一対の表示部材を有するゲージ本体を備え、このゲージ本体の表示部材にそれぞれCT画像で認識可能なほぼ等間隔で縦横に配置する複数の目印を設け、このゲージ本体をサージカルガイド本体の欠損する歯に相当する位置に装着したサージカルガイド作製具。
- 一対の表示部材を所定の間隔で連結する支持部材を設けた請求項1に記載のサージカルガイド作製具。
- 一対の表示部材の表面にCT画像で認識可能なX線不透過性を有する格子状線を設け、この格子状線の交点を目印とした請求項1または2に記載のサージカルガイド作製具。
- 目印に小孔を設け、この小孔の一部に小孔より大きい径の基準の孔を設けた請求項1ないし3のいずれかに記載のサージカルガイド作製具。
- 一対の表示部材をCT画像で認識可能なX線不透過性を有するメッシュ材で形成し、このメッシュ材の孔部を目印とした請求項1または2に記載のサージカルガイド作製具。
- ゲージ本体の内側にCT画像で認識可能なX線不透過性を有する人工歯を取外し可能に装着した請求項1ないし5のいずれかに記載のサージカルガイド作製具。
- 支持部材の一方または双方の端部から表示部材の延出する方向に延びる支持枠を設け、この支持枠に上記表示部材を案内し支持する案内溝を設けた請求項2ないし6のいずれかに記載のサージカルガイド作製具。
- 一対の表示部材の表面にそれぞれCT画像で認識可能なほぼ等間隔で縦横に配置する複数の目印を設けたゲージ本体を作製するステップと、
サージカルガイド本体の欠損する歯に相当する位置に上記ゲージ本体を装着し、このサージカルガイド本体を歯に装着した状態で得られるCT画像をコンピュータに取り込み、コンピュータ操作による解析によってインプラントの挿入方向に相当する上記各表示部材の目印の位置を読み取るステップと、
ガイドリングの内側にポジショナーを挿入し、このガイドリングを上記ゲージ本体の内側に挿入し、上記インプラントの挿入方向が読み取られた各表示部材の目印の位置と上記ポジショナーの軸心を結ぶ方向にピンを挿入するステップと、
このピンを挿入した位置で上記ガイドリングをサージカルガイド本体に固定し、その後に上記ピンとポジショナー及びゲージ本体を除去または削除するステップを備えた
サージカルガイド作製方法。 - 一対の表示部材が所定の間隔で対向するように、これらの表示部材を支持部材で連結するステップを備えた請求項8に記載のサージカルガイド作製方法。
- ゲージ本体の内側にCT画像で認識可能なX線不透過性を有する人工歯を取外し可能に装着し、ガイドリングをゲージ本体の内側に挿入する際に上記人工歯を除去するステップを備えた請求項8または9に記載のサージカルガイド作製方法。
- 顎骨穿孔用のドリルの刃部がガイドリングの側面より挿入可能にガイドリングにスリットを形成し、このスリットに対応するサージカルガイド本体の位置にスリットとほぼ同幅またはスリットの幅より外方に向けて広がる幅の開口部を形成するステップを備えた請求項8ないし10のいずれかに記載のサージカルガイド作製方法。
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AU2010361200A AU2010361200C1 (en) | 2010-09-21 | 2010-09-21 | "Gauge body and method for preparing surgical guide" |
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US13/819,749 US8920167B2 (en) | 2010-09-21 | 2010-09-21 | Surgical guide preparation tool and method for preparing surgical guide |
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- 2010-09-21 EP EP10857512.7A patent/EP2620122A4/en not_active Withdrawn
- 2010-09-21 AU AU2010361200A patent/AU2010361200C1/en not_active Ceased
- 2010-09-21 JP JP2012534837A patent/JP5429390B2/ja active Active
- 2010-09-21 CN CN201080068711.2A patent/CN103096831B/zh not_active Expired - Fee Related
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Also Published As
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CN103096831A (zh) | 2013-05-08 |
AU2010361200C1 (en) | 2015-04-16 |
US20130171587A1 (en) | 2013-07-04 |
EP2620122A1 (en) | 2013-07-31 |
KR20130126450A (ko) | 2013-11-20 |
AU2010361200B2 (en) | 2014-10-09 |
JP5429390B2 (ja) | 2014-02-26 |
CA2798950C (en) | 2016-09-20 |
KR101721720B1 (ko) | 2017-03-30 |
US8920167B2 (en) | 2014-12-30 |
CA2798950A1 (en) | 2012-03-29 |
AU2010361200A1 (en) | 2012-11-29 |
CN103096831B (zh) | 2016-06-08 |
JPWO2012039017A1 (ja) | 2014-02-03 |
EP2620122A4 (en) | 2014-05-07 |
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