WO2013007657A1

WO2013007657A1 - Bone augmentation in dental implantology

Info

Publication number: WO2013007657A1
Application number: PCT/EP2012/063311
Authority: WO
Inventors: Bernd GIESENHAGEN
Original assignee: YÜKSEL, Orcan
Priority date: 2011-07-08
Filing date: 2012-07-06
Publication date: 2013-01-17
Also published as: JP6031512B2; EP2729089A1; US20140147810A1; DE102011051713B4; KR101726932B1; KR20140056223A; EP2729089B1; JP2014520582A; DE102011051713A1

Abstract

For bone formation in the dental area, an allogeneic or xenogeneic bone transplant (502) with a clearance (106) into which an implant can be introduced, is proposed. The bone transplant has at least one expansion joint (504), the expansion joint (504) being arranged such that the bone transplant (502) can be expanded by introducing the implant into the clearance (106). This improves the retention of the bone transplant in the jawbone. The doctor carrying out the treatment is provided with an extensive set of such bone transplants in a ready form, from which he can take what he needs without delay during the operation. The set also includes bone transplants with more complex geometries, for instance the expansion joints mentioned, that a doctor himself can only produce with difficulty during the operation.

Description

BONE AUGMENTATION IN DENTAL I MPLANTOLOGY

Description

Field of the invention

The invention relates to a bone transplant.

The invention is used in the area of implantology . Implan- tology is a branch of odontology concerned with the insertion of implants or dental implants. An implant is understood as meaning a foreign body inserted into the jawbone. By being us^¬ able as a carrier of a tooth replacement, dental implants as^¬ sume the function of artificial tooth roots. This generally in- volves them being screwed or inserted into the jawbone. Within 3 to 6 months, they bond with the surrounding bone to form a solid carrier unit capable of withstanding loads.

A precondition for introducing an implant is, however, that the jawbone is intact, or at least sufficiently present. After serious accidents, this may not be so. In such cases, before an implant is introduced, the jawbone must be re-formed (this is referred to as augmentation) . For this purpose, bone material is transplanted. A bone transplant restores the jawbone lo^¬ cally, in order to be able to subsequently fix an implant in the bone transplant in the jawbone. Therefore, in recent years, the procedure followed for tooth replacement treatment in the case of a badly damaged jawbone has been as follows:

A bone transplant in the form of a bone ring (to be more precise a hollow cylinder of bone) is prepared for receiving the implant. For receiving the bone ring in the jawbone, the latter is drilled out cylindrically to a suitable size. The bo^¬ ne ring is inserted into the drilled-out location.

Multi-part dental implants have become most widely used. Multi-part implants consist of the body, which is anchored in the bone, the neck part lying in the region of the mucous mem^¬ brane of the mouth, and the head part, which receives the su^¬ perstructure (e.g. a crown as a tooth replacement) . The three parts are generally screwed to one another.

The body of the implant together with the neck part are sub^¬ sequently screwed into the bone ring. In order that the bone ring does not turn together with the body of the implant when the latter is screwed in, the bone ring is held for a short time by a holding instrument.

The drilled-out location in the bone ring has a slightly smaller diameter than the body of the implant to be screwed in. This produces a high primary stability of the body of the im^¬ plant in the bone ring.

After that, the gum is sewn over the wound.

After ten days, the healing of the wound on the gum is usu^¬ ally complete. Depending on the bone quality, this is followed by a phase of incorporation without loading. This phase takes, on average, 2-3 months in the lower jaw and 5-6 months in the upper jaw, since the bone density of the lower jaw and the up- per jaw differs. For this transitional time, a temporary tooth replacement is used.

In the case of a multi-part implant, after the phase of in^¬ corporation, the thread of the implant body is exposed again, the implant neck and head parts are screwed in and the super^¬ structure is produced and fitted.

A distinction is made between transplants of the following types :

- autologous or autogenous transplantation: the donor and the recipient are the same person, in which case the transplant is known as autoplasty,

syngeneic or isogeneic transplantation: the donor is an identical twin, i.e. the donor and recipient are genetically identical,

allogeneic transplantation: the donor is a different indi^¬ vidual, but of the same species; the transplant is known as an allograft,

xenogeneic transplantation: the donor is of a different spe- cies (e.g. bovine bone); the transplant is known as a xeno^¬ graft .

Prior art It has been customary until now to source the bone ring for the augmentation of the jawbone from the patient itself, for instance from a different location in the jawbone. Such proce^¬ dures are e.g. described in Khoury (Int J Oral Maxillofac Im^¬ plants. 1999 Jul-Aug; 14 (4) : 557-64) . This causes a further wound for the patient.

In order to avoid this, in some cases foreign bones are also used for the augmentation. Suitable as a basis for obtaining the foreign bone are e.g. bony structures that are extracted during the implantation of a joint prosthesis (allograft) . The use of such allografts is described e.g. by Novell et al . (Im^¬ plant Dent. 2012 Apr; 21 (2) : 129-35) . However, animal bones also come into consideration as a starting material (xenograft) , as reported e.g. by Aldredge & Nejat (Compend Contin Educ Dent. 2011 May; 32 (4) : 66-71) .

In order to avoid a rejection reaction from the recipient during the implantation of the bone transplant, the proteins contained in the bony structures are extracted to the greatest extent possible. Only some collagen is left in the bone, so that it retains a desired elasticity. What remains is an other^¬ wise mineral matrix; see e.g. Gapski et al . (Int J Periodontics Restorative Dent. 2006 Feb; 26 (1) : 59-69) .

Problem

The problem addressed by the invention is that of improving the possibilities of jawbone formation in implantology .

Solution

This problem is solved by the inventions with the features of the independent claims. Advantageous developments of the in- ventions are characterized in the dependent claims. The wording of all the claims is hereby incorporated into this description by reference. The inventions also comprise all meaningful and particularly all mentioned combinations of independent and/or dependent claims.

To solve the problem, an allogeneic or xenogeneic bone transplant with a clearance, into which an implant can be in^¬ troduced, is proposed. The bone transplant is formed such that it can be inserted into a jawbone for augmentation. In this case, the bone transplant is designed such that it can be ex^¬ panded by introducing the implant into the clearance.

The bone transplant may be formed, for example, such that it is hollow-cylindrical, frustoconical or rotationally symmetri- cal with respect to the axis of the clearance, which is the axis of the introduction of the implant. The clearance may pass completely through the bone transplant, but does not have to.

Such a bone transplant can be commercially prefabricated and offered. This avoids the disadvantage of the previous bone aug^¬ mentation, in which the doctor carrying out the treatment had to obtain the bone ring from bone of the patient or the al^¬ lograft or xenograft, or had to shape it, during the operation. In such a case, the doctor was often under great time pressure. Furthermore, under these conditions it was only possible with difficulty to realize more complex geometries, such as those proposed here. This is where the invention comes in.

A quicker and better connection between the bone transplant and the cut-out jawbone is achieved if the bone transplant has at least one expansion joint. In this case, the expansion joint is arranged such that the bone transplant can be made to expand by introducing the implant into the clearance.

The expansion joint must be formed such that the bone trans- plant can expand as a result of the formation of the joint. The expansion joint will therefore extend transversely in relation to the direction in which the implant is introduced from the outside up to the clearance and be open towards at least one end of the bone transplant. The expansion joint will typically extend along at least part of the clearance, generally parallel to the direction in which the implant is introduced (longitudi^¬ nal axis ) .

The expansion joint may at one point separate the bone transplant along its longitudinal axis completely or only par^¬ tially.

In the first-mentioned case, the screwing in of an implant of which the outside diameter is slightly greater than the in- side diameter of the clearance has the effect that the bone transplant is made to expand. It therefore bonds better to the surrounding jawbone.

The expansion joint is in this case only formed at one point, in order that the bone transplant remains in one piece.

In a further development, four expansion joints may be formed, which do not extend along the entire length of the bone transplant, the expansion joints beginning from the end oppo- site to the opening for introducing the implant.

A further improvement of the bonding between the bone trans^¬ plant and the jawbone is achieved if the clearance has a region tapering in the direction in which the implant is introduced. If the clearance is formed cylindrically with a circular cross section, which is usually likely to be the case, in this devel^¬ opment the cross-sectional area tapers in the direction in which the implant is introduced. The insertion of a substan^¬ tially cylindrical implant then makes the bone transplant ex- pand and presses it against the wall of the milled-out region in the jawbone.

In this development, at least one expansion joint may be formed, from the end opposite to the opening for introducing the implant, so as to begin at least partially in the tapering region. This leads to the bone transplant acting in the manner of a straddling dowel, since it is effectively pressed apart by introducing a substantially cylindrical implant. The described bone transplant is used in the augmentation of a jawbone. The problem is also solved by a set with a plurality of al^¬ logeneic or xenogeneic bone transplants. The bone transplants each have a clearance into which an implant can be introduced. They are formed in such a way that they can be inserted into a jawbone for augmentation. The geometrical form of at least a first of the bone transplants differs from the geometrical form of at least a second of the bone transplants.

If the bone transplants have the form of hollow cylinders, a set may include various hollow cylinders, in which case the three typical parameters for describing a hollow cylinder are varied. These parameters are the length of the hollow cylinder, the inside diameter of the clearance and the outside diameter of the hollow cylinder. Hollow cylinders of different lengths or hollow cylinders with different outside diameters may be provided, for example.

In this way, the doctor carrying out the treatment can be provided with the typically required sizes of bone transplants, in particular bone rings, optionally also with more complex ge- ometries, ready-prepared for the operation. For the doctor car^¬ rying out the treatment, the workload is reduced and the oper^¬ ating procedure is accelerated.

With such a prefabricated set of bone transplants, the doc- tor carrying out the treatment can also be provided in particu^¬ lar with the special configurations of the bone transplants with their improved bonding in the jawbone that are described above. He then finds not only bone transplants of the required size but also with the particularly advantageous geometries that he would not be able to produce himself during the opera^¬ tion. It is generally of interest if the geometrical form of at least a first of the bone transplants represents a scaling of the geometrical form of at least a second of the bone trans^¬ plants, that is to say if the set comprises bone transplants of different sizes. Scaling in this case refers to a proportional change in size.

The sets of the various bone transplants are used in the augmentation of jawbones.

The object of the invention is also achieved by a method for augmenting a jawbone. In what follows, individual steps of this method will be described in more detail. The steps do not nec^¬ essarily have to be performed in the order given in the text. Also, further steps not explicitly stated may be part of the method. The method for augmenting a jawbone comprises the fol- lowing steps:

An allogeneic or xenogeneic bone transplant as described above is provided. A cylindrical recess of a size suitable for inserting the bone transplant into the jawbone is drilled out in said jawbone. The bone transplant is subsequently inserted into the drilled out recess in the jawbone. A dental implant is introduced into the clearance of the bone transplant, thus ex^¬ panding the bone transplant. It therefore bonds better to the surrounding jawbone. Further details and features emerge from the following de^¬ scription of preferred exemplary embodiments in conjunction with the dependent claims. The respective features may be real^¬ ized here on their own or together in combination. The possibilities of solving the problem are not restricted to the exem- plary embodiments. The exemplary embodiments are schematically represented in the figures. The same reference numerals in the individual fig^¬ ures thereby designate elements that are the same or function^¬ ally the same or correspond to one another with regard to their functions. Specifically:

Fig. 1 shows a longitudinal section of a bone transplant; Fig. 2 shows a first bone transplant in a perspective repre^¬ sentation;

Fig. 3 shows the cross sections A-A and B-B for the first bo^¬ ne transplant;

Fig. 4 shows the cross sections A-A and B-B for a second bone transplant ;

Fig. 5 shows a third bone transplant;

Fig. 6 shows the cross section A-A of the third bone trans^¬ plant ;

Fig. 7 shows the cross section B-B of the third bone trans^¬ plant; and

Fig. 8 shows a longitudinal section of a third bone trans- plant.

Fig. 1 shows a longitudinal section of a hollow-cylindrical bone transplant 102. The bone transplant 102 has been intro^¬ duced into a jawbone 104. A clearance 106 extending in the mid- die of the bone transplant 102, along the longitudinal axis thereof, serves the purpose of receiving an implant.

Transplants 102 of the type represented in Fig. 1 may be part of a set with a plurality of bone transplants 102. In or^¬ der to provide a respectively suitable bone transplant 102 for the augmentation of damaged locations of a jawbone 104, the heights 108 and/or the outside diameters 110 of the bone trans^¬ plants 102 contained in the set vary. In particular, the set may contain bone transplants 102 with different outside diame- ters 110. This makes it possible for damaged locations of dif^¬ ferent extents to be augmented. For adaptation to the depth of the damaged location, the heights 108 of the bone transplants 102 contained in the set may also vary.

A first hollow-cylindrical bone transplant 102 with a longi^¬ tudinal section that is represented in Fig. 1 is shown in Fig. 2. The cross sections A-A and B-B (cf. Fig. 1) of the first bo^¬ ne transplant 102 are represented in Fig. 3. The solid form of the wall of the bone transplant 102 can be seen here. As a re^¬ sult of this, the first bone transplant 102 cannot be made to expand when an implant is introduced. The outer form of the bo- ne transplant 102 does not change when this happens. Therefore, a sufficiently load-bearing connection between the bone transplant 102 and the jawbone 104 only comes about when the bone transplant 102 has grown together with the jawbone 104. The cross sections A-A and B-B (cf . Fig. 1) of a second bone transplant 102 are represented in Fig. 4. This is similar in longitudinal section to the first bone transplant 102. There^¬ fore, the longitudinal sectional representation in Fig. 1 also applies to the second bone transplant 102.

As a difference from the first bone transplant 102, the sec^¬ ond bone transplant 102 has an expansion joint 402. This ex^¬ tends along the longitudinal axis over the entire height 108 of the bone transplant 102. The length of the expansion joint 402 therefore corresponds to the height 108 of the bone transplant 102. The expansion joint 402 is correspondingly present not only in the cross sections A-A and B-B chosen by way of example but in all the cross sections of the second bone transplant The expansion joint 402 extends orthogonally in relation to the longitudinal axis, or within the plane of representation of Fig. 4, from the clearance 106 to the jawbone 104.

The expansion joint 402 enables the bone transplant 102 to expand when the surgeon introduces an implant into the clear^¬ ance 106. When this happens, the outside diameter 110 of the bone transplant 102 increases. Similarly, the width of the ex^¬ pansion joint 402 increases. This is caused by the side sur^¬ faces of the bone transplant 102 that form the expansion joint 402 moving apart.

The expansion has the effect that the bone transplant 102 is pressed against the jawbone 104. As a result of this, a fric- tional connection between the bone transplant 102 and the jaw^¬ bone 104 is formed. This improves the fixing of the bone trans^¬ plant 102 in the jawbone 104 and consequently shortens the in^¬ corporation time, i.e. the time until the bone transplant 102 is certain to withstand loading.

A third bone transplant 502, represented in Figs. 5 to 7, has four expansion joints 504. However, these do not extend over the entire height 108 of the bone transplant 102, as for instance in the case of the second bone transplant 102 (the bo^¬ ne transplant 102 would then be in four pieces) . Instead, the length of the expansion joints 504 is smaller than the height of the bone transplant 502.

Figs. 6 and 7 illustrate this . In the cross section A-A, the profile of which is shown in Fig. 8, the bone transplant 502 is solid. Consequently, there is no expansion joint at the height of the cross section A-A.

By contrast, as can be seen in Fig. 7, the two expansion joints 504 extend through the cross section B-B (cf . Fig. 8) . The expansion joints 504 end in a region located between the cross sections A-A and B-B (cf . Fig. 8) . Consequently, the ex^¬ pansion joints 504 also extend through every cross section of the bone transplant 502 below this region. There is correspond^¬ ingly no expansion joint in the cross sections of the bone transplant 502 above this region.

Due to the shortened expansion joints 504, the upper part of the bone transplant 502 cannot be expanded. The diameter of the implant is consequently restricted by the diameter of the clearance 106 in the upper part of the bone transplant 102. In order that the bone transplant 102 can nevertheless be made to expand in the lower part, the clearance 106 has a tapering re^¬ gion 802, as represented in Figure 8. In this region 802, the diameter of the clearance 106 is reduced from the top to the bottom (with respect to the representation of Figure 8) . A screwed-in implant then makes the lower region of the bone transplant 502 expand like a straddling dowel.

Reference numerals

102 Bone transplant

104 Jawbone

106 Clearance

108 Height

110 Outside diameter

502 Bone transplant

504 Expansion joint

802 Tapering region

References Cited

Non-patent literature

Aldredge W. A., Nejat R. : "Delayed implant procedure using de- proteinized bovine bone mineral: A report of 109 consecutive cases." in Compend. Contin. Educ. Dent. 2011 May; 32(4): 66-71

Khoury F.: "Augmentation of the sinus floor with mandibular bone block and simultaneous implantation: a 6-year clinical in^¬ vestigation." in Int. J. Oral Maxillofac. Implants 1999 Jul- Aug; 14 (4) :557-64

Novell J., Novell-Costa F., Ivorra C, Farinas 0., Munilla A., Martinez C: "Five-year results of implants inserted into freeze-dried block allografts." in Implant. Dent. 2012 Apr; 21 (2) : 129-35

Gapski R., Neiva R., Oh T. J., Wang H. L.: "Histologic analyses of human mineralized bone grafting material in sinus elevation procedures: a case series." in Int. J. Periodontics Restorative Dent. 2006 Feb; 26(l):59-69

Claims

Patent claims

1. Allogeneic or xenogeneic bone transplant (102; 502) with a) a clearance (106), into which an implant can be intro^¬ duced;

b) the bone transplant being formed such that it can be in^¬ serted into a jawbone (104) for augmentation;

characterized

c) in that the bone transplant (102; 502) is designed such that it can be expanded by introducing the implant into the clearance (106) .

2. Bone transplant (102; 502) according to the preceding claim,

characterized by

at least one expansion joint (402; 504),

the expansion joint (402; 504) being arranged such that the bone transplant (102; 502) can be expanded by introducing the implant into the clearance (106) .

3. Bone transplant (102) according to the preceding claim, characterized

in that the expansion joint (402) in one region completely separates the bone transplant (102) along the direction in which the implant is introduced.

4. Bone transplant (502) according to claim 2,

characterized by

four expansion joints (504),

wherein the four expansion joints (504) do not extend along the entire length of the bone transplant (502); and wherein the expansion joints (504) begin from the end opposite to the opening for introducing the implant.

5. Bone transplant (502) according to one of the preceding claims ,

characterized

in that the clearance (106) has a region (802) tapering in the direction in which the implant is introduced.

6. Bone transplant (502) according to the preceding claim, characterized

in that at least one expansion joint (504) is formed, from the end opposite to the opening for introducing the implant, so as to begin at least partially in the tapering region (802) .

7. Use of a bone transplant (102; 502) according to one of the preceding claims for the augmentation of a jawbone (104) .

8. Set with a plurality of allogeneic or xenogeneic bone transplants (102; 502) according to any of claims 1 to 6,

wherein the geometrical form of at least a first of the bone transplants (102; 502) differs from the geometrical form of at least a second of the bone transplants (102; 502) .

9. Set according to the preceding claim,

characterized in that

the geometrical form of at least a first of the bone trans^¬ plants (102; 502) represents a scaling of the geometrical form of at least a second of the bone transplants (102; 502) .

10. Use of a set according to one of the claims directed to a set for the augmentation of a jawbone (104) .

11. Method for augmenting a jawbone, comprising the following steps:

a) providing an allogeneic or xenogeneic bone transplant (102; 502) according to any of claims 1 to 5;

b) drilling out a cylindrical recess to a size suitable for inserting the bone transplant (102; 502) in the jawbone;

c) inserting the bone transplant (102; 502) into the drilled out recess in the jawbone (104); and

d) expanding the bone transplant by introducing a dental im^¬ plant into the clearance (106) of the bone transplant.