WO2016120572A1

WO2016120572A1 - Occlusal and condylar positioning device

Info

Publication number: WO2016120572A1
Application number: PCT/FR2016/050192
Authority: WO
Inventors: Mathieu LAURENTJOYE; Jérôme CHARTON; Pascal Desbarats; Michel MONTAUDON
Original assignee: Université De Bordeaux; Institut Polytechnique De Bordeaux; Centre National De La Recherche Scientifique - Cnrs -; Inserm - Institut National De La Santé Et De La Recherche Médicale; Centre Hospitalier De Bordeaux
Priority date: 2015-01-30
Filing date: 2016-01-29
Publication date: 2016-08-04
Also published as: FR3032109A1; FR3032109B1

Abstract

The occlusal and condylar positioning device (10) comprises: - an occlusal guide (11); - means (12) for attaching the positioning device onto a mandible (2, 3) of a patient to be treated; and - means (13) for linking the occlusal guide to the attachment means. The attachment means include an attachment tab (12) anatomically shaped to match a predetermined portion of a proximal segment (3) of the mandible of the patient to be treated. The attachment tab includes means (124, 125) for clipping the attachment tab onto the predetermined portion of the proximal segment.

Description

OCCLUSAL AND CONDYLIAN POSITIONING DEVICE

The invention relates to an occlusal and condylar positioning device intended to be used during surgical procedures in maxi surgical surgery in order to correct maxi-mandibular dysmorphoses during a surgical procedure. mandibular osteotomy. During maxillary dysmorphoses, the mandible of a patient to be treated is in a bad position relative to the skull and in particular relative to the maxilla. This leads to functional disability in the patient (chewing, articulation, teeth, phonation, sleep, etc.) but also aesthetic. The surgical procedure involves performing a mandibular osteotomy to move the toothed portion (body) of the mandible to position it ideally relative to the toothed portion of the maxillary. Occlusal guides, generally manufactured by a dental technician or printed by a three-dimensional printing process, allow a desired correct positioning of this tooth portion of the mandible. At the same time, the posterior and upper parts of the mandible (called proximal segment after the osteotomy) forming the lower part of the temporomandibular joints, are mobilized. If this mobility is not controlled, it leads to a risk of malposition of the proximal segment. This would result in a significant risk of imprecision on the final occlusion and therefore complications functional occlusal disorder type, and / or a risk of misalignment of temporomandibular joints and therefore functional complications such as temporomandibular dysfunction.

Currently, to precisely control the position of proximal segments, several methods exist. Some methods use a navigation system and condylar positioning devices.

The navigation system is mainly used for positioning the toothed portions or checking their correct position. It is little used for condylar positioning. The principle of such a navigation system is to follow a target attached to the patient's bone using cameras. It is used peroperatively, but it is not readily available, complex, expensive and lengthens the operating time. In addition, its use requires bone drilling and additional incisions on the patent to be treated. All this is detrimental to the latter.

As for the condylar positioning device, the principle is to set up, bilaterally, a plate between the mandible, in particular the proximal segment, and the maxillary in order to locate the position of the mandibular condyle and then to reposition it in this same position. once the toothed portion of the mandible displaced during the mandibular osteotomy. Although accurate, simple and economical, condylar positioning devices have the following drawbacks: - need for two occlusal guides made from dental plaster models by a dental technician;

- need for two plates that must be consistent with the anatomy of the patient to be treated, and this, intraoperatively (time-consuming);

- need for an incision of the maxilla for the placement of the plates;

use of a mandibular transjugal retractor (with skin incision) in order to be able to place the mandibular fixation screws perpendicular to the bone. The establishment of this spacer also leads to a risk for the branches of the facial nerve of the patient to be treated;

- Need to achieve by drilling as many holes as there are screws used.

Again, these disadvantages are detrimental to the patient to be treated.

An object of the invention is to provide an occlusal and condylar positioning device which simplifies and accelerates the previous surgical procedure, to reduce the risks and trauma in the patient to be treated.

To this end, it is provided, according to the invention, an occlusal and condylar positioning device comprising an occlusal guide, fixing means of the positioning device on a mandible of a patient to be treated, and connecting means of the guide. occlusal to the fixing means, the fixing means comprising a fin of fixation anatomically shaped to a predetermined portion of a proximal segment of the mandible of the patient to be treated, the fixing vane comprising means for clipping the fixing vane on the predetermined portion of the proximal segment.

Advantageously, but optionally, the positioning device according to the invention has at least one of the following additional technical characteristics:

- The fastening fin comprises a fin body and at least two ends comprising the clipping means and located on either side of the fin body;

- The fastening fin comprises three to four ends distributed on either side of the fin body;

the fin body is a spiral strip of material arranged to be wound around the predetermined portion of the proximal segment;

the clipping means comprise a hook;

the connection means comprise a link branch;

- The connecting branch is integral with the fixing fin;

- The positioning device comprises a fixing system for removably mounting the connecting branch on the fastening fin;

- The fastening system comprises a clip provided on the connecting branch and a receiving member of the clip provided on the fin; and

the positioning device is produced by a three-dimensional printing process. Other features and advantages of the invention will become apparent from the following description of a preferred embodiment of an occlusal and condylar positioning device according to the invention. In the accompanying drawings:

Figure 1 is a partial side view of an occlusal positioning device and condylar according to the invention in place on a patient to be treated and comprising a first embodiment of a fixing fin;

FIG. 2 is a three-dimensional view of an occlusal and condylar positioning device according to the invention comprising a second embodiment of a fastening fin;

Figure 3 is a three-dimensional view of a mandible on which are fixed fixing fins according to the second and third embodiments of the latter and forming part of an occlusal positioning device and condylar according to the invention;

Figure 4 is a partial sectional view illustrating the clipping of the fastening fin of an occlusal and condylar positioning device according to the invention;

Figure 5 is a three-dimensional view of the fixing fin according to the third embodiment of the latter of Figure 3;

FIGS. 6A to C are three-dimensional views of fixing fins according to, respectively, a fourth, the second and first embodiments of a fastening fin for a occlusal and condylar positioning device according to the invention;

FIGS. 7 and 8A to C are three-dimensional views illustrating an embodiment of a system for fixing the various elements of the occlusal and condylar positioning device to each other.

FIG. 1 illustrates an occlusal and condylar positioning device 10 according to the invention in position on a patient to be treated, which is represented here by his skull 1 and his mandible 2,3,4. Is illustrated in Figure 1, a situation after achievement of the mandibular osteotomy and osteosynthesis 4 after repositioning of the toothed portion 2, in the particular case of a dystrophy type rétromandibul ie.

The occlusal and condylar positioning device 10 according to the invention comprises an occlusal guide 11 positioned between the toothed portion of the maxillary and the toothed portion 2 of the mandible in order to correctly position the latter relative to the toothed portion of the maxilla. The occlusal and condylar positioning device 10 according to the invention further comprises fastening means 12 on a proximal segment 3 of the mandible. Here, the fastening means are a fastening fin 12 according to a first embodiment of the latter. The fastening fin 12 has clipping means 124, 125 on a predetermined portion of the proximal segment: in the case illustrated in FIG. 1, a first clipping means 124 is positioned on the outer oblique line of the mandible, a second clipping means 124 is positioned on the anterior edge of the mandibular ramus at the retro-mandibular trigone, a third clipping means 125 is positioned on the dorsal edge of the mandibular ramus, above of the mandibular angle, and the fourth clipping means 125 is positioned on the basilar edge of the mandibular body, in front of the mandibular angle.

The occlusal and condylar positioning device 10 according to the invention further comprises connecting means 13 of the occlusal guide 11 to the fixing means 12. Here, the connecting means comprise a connecting branch 13 fixed at its ends to the guide occlusal 11 and the fastening means 12, respectively, through a fastening system 20 whose principle will be described in more detail with reference to Figures 7 and 8. The fastening system 20 further allows mounting so removable of the two elements concerned. Figure 2 illustrates two situations of the fastening system 20: the fastening means here comprise two fastening fins 14 according to a second embodiment of the latter; the left fixing fin 14 in FIG. 2 is mounted on the end of the connecting branch 13 by means of the fastening system 20; the right fastening fin 14 is separated (or not mounted) on the end of the other connecting branch 13, the fastening system 20 comprising elements 21 (placed on the fastening fin 14) and 22 ( placed on the end of the connecting branch 13) cooperating with each other to removably mount the the fixing vane 14 with the connecting branch 13. It should be noted that this fixing system 20 is here used to removably mount the other end of the connecting branches 13 on the occlusal guide.

As an alternative embodiment, the connecting branch 13 is integral with the fixing fin. In another variant embodiment, the connecting branch is integral with the occlusal guide 11. In another variant embodiment, the occlusal and condylar positioning device 10 according to the invention is in one piece, the fixing fins, the branches connecting and the occlusal guide being integral with each other.

With reference to FIG. 6C, a first embodiment of a fastening fin 12 for an occlusal and condylar positioning device 10 according to the invention will be described in more detail. The fixing fin 2 comprises a fin body 121, which here has a general shape of "X". At each end of the branches of the "X" formed by the fin body 121, here at the number of four ends, the fastening fin 12 comprises clipping means 124,125. Here, the clipping means comprise a hook 124,125 facing rearward in the figure. The four hooks 124, 125, and consequently the four ends, are thus distributed on either side of the fin body 121. The fin body 121, on a front face in the figure, comprises a 21 of the elements 21, 22 of the fastening system 20. In a variant, instead of the element 21, the fastening fin 12 comprises a connecting branch 13 integral with the fin body 121 and projecting from said front face. A use of the fastening fin 12 is illustrated in Figure 1 where the fin body 121 is in contact with the mandibular angle.

With reference to FIG. 6B, we will describe a second embodiment of a fastening fin 14 for an occlusal and condylar positioning device 10 according to the invention. In this embodiment, the fastening fin 14 has a fin body 141 which has a general "Y" shape (reversed in the figure). Again, at each of the ends of the branches of the "Y" formed by the fin body 141, here at the number of three ends, the fastening fin 14 comprises clipping means 144, 145. Here, the clipping means comprise a hook 144,145 facing rearward in the figure. The three hooks 144, 145, and consequently the three ends, are thus distributed on either side of the fin body 141. The fin body 141, on a front face in the figure, comprises a 21 of the elements 21, In a variant, instead of the element 21, the fastening fin 14 has a connecting branch 13 integral with the fin body 141 and which projects from said front face. An assembly of the fixing vane 14 on a mandible is illustrated in FIG. 3: the hook 145 is situated on the mandibular angle while the two hooks 144 are positioned respectively on the anterior edge of the mandibular ramus and on the mandibular oblique line or on the retro-mandibular trigone, the fin body 141 being in contact with an outer face of the mandibular ramus. Referring now to Figure 5, we will describe a third embodiment of a fastening fin 15 for an occlusal and condylar positioning device 10 according to the invention. In this third embodiment, the fastening fin 15 comprises a fin body 151 which has a general band shape. The vane body 151 is spiraled in the manner of a spiral spring and has a front portion (in the figure) 153 and a back portion (in the figure) 152, the rear portion 152 being in the continuity of the part. before 153. Again, at each end of the strip that forms the fin body 151, here at the number of two ends, the fastening fin 15 comprises clipping means 154,155. Here, the clipping means comprise a hook 154,155 oriented towards the inside of the spiral formed by the fin body 151. The two hooks 154,155, and consequently the two ends, are thus distributed on either side of the body The vane body 151, at the "junction" between the front 153 and rear 152 and on one side external to the spiral, comprises a 21 of the elements 21,22 of the fastening system 20. Alternatively, instead of the element 21, the fastening fin 15 comprises a connecting branch 13 integral with the fin body 151 and which protrudes from said outer face. An assembly of the fixing vane 15 on a mandible is illustrated in FIG. 3: the fixation vane 15 is positioned around the proximal portion of the mandibular ramus, the hook 155 being engaged with the dorsal edge of the mandibular ram and the hook 154 being in engagement with the mandibular incisure, the rear portion 152 being in contact with the inner face of the mandibular ramus under the neck of the condyle and the front portion 153 being in contact with an outer face of the mandibular ramus, the "junction" between these two front portions 153 and rear 152 being at the anterior edge of the mandibular ramus.

Now, with reference to FIG. 6A, we will describe a fourth embodiment of a fastening fin 16 for an occlusal and condylar positioning device 10 according to the invention. In this new embodiment, the fastening fin 16 comprises a fin body 161 which has a general shape of quadrilateral, here in particular trapezium. Again, at two ends of the quadrilateral formed by the fin body 161, here two ends respectively located on two opposite edges of the quadrilateral, the fastening fin 16 comprises clipping means 164,155. Here, the clipping means comprise a hook 164,155 facing rearward in the figure. The two hooks 164, 165, and therefore the two ends, are thus distributed on either side of the fin body 161. The fin body 161, on a front face in the figure, comprises a 21 of the elements 21.22 of the fastening system 20. In a variant, instead of the element 21, the fastening fin 16 has a linkage branch 13 integral with the fin body 161 and projecting from said front face. Alternatively, instead of the element 21, the fastening fin 16 has a connecting leg 13 integral with the fin body 161 and projecting from said front face. An assembly or use of the fastening fin 16 is similar to the assembly or use described above in connection with the other embodiments of the fastening fin.

Other forms of fixing fin may be provided for an occlusal and condylar positioning device 10 according to the invention.

FIG. 4 illustrates the manner in which a fastening fin conforms to the predetermined portion of the proximal segment 3. The example shown is based on the second embodiment of the fastening fin 14. It can be applied, mutatis mutandis, to all other embodiments of the fixing vane for an occlusal and condylar positioning device 10 according to the invention. The fixing vane 14 is anatomically shaped to the predetermined portion of the proximal segment 3 on which the fixing vane 14 is intended to be positioned. This anatomical conformation of the fixing vane 14 allows that the contact is optimal between the hooks 144,145 and the vane body 141, on the one hand, and, on the other hand, said predetermined portion. This ensures good adequacy and excellent holding in place of the fixing vane 14, and therefore the occlusal positioning device and condylar 10 according to the invention, during the procedure. We will now describe in more detail the fastening system 20 for an occlusal and condylar positioning device 10 according to the invention, with reference to FIGS. 7 and 8. In these figures is illustrated the principle of the fastening system 20, the shape of the elements 21 and 22 is purely illustrative and must be adapted to the parts of the occlusal positioning device and condylar 10 according to the invention that the fastening system 20 connects, that is to say fixing vane / connecting arm 13 and / or occlusal guide 11 / connecting branch 13.

The connecting system 20 comprises a first element 22 forming a clip. The clip 22 has a clip body 222 bulged upwardly in Figure 8B and taped downward in Figure 8B at a free end. Still upwards in FIG. 8B, the clip 22 has a constriction 223 surmounting the bulged part of the clip body 222, then a connecting portion 221 with a first part of the occlusal and condylar positioning device 10 according to the invention to be connected. , as the end of the connecting branch 13.

The fastening system 20 comprises a second element 21 said receiving. This receiving member 21 will, in use, receive the clip 22 to removably mount. For this purpose, the receiving element 21 comprises a receiving cavity 213 delimited by two deformable branches 212 and open on top in FIG. 8A. The shape of this cavity is complementary to the shape of the clip body 222 and the strangulation 223 of the clip 22. The branches 212 can be deformed by the presence of lateral slots 211 which laterally separate the branches 212 from the rest of the receiving element 21. The receiving element 21 is mounted on a second part of the occlusal positioning device and condylar 10 according to the invention to be connected, such as the fixation wing or the occlusal guide 11.

Alternatively, the receiving member 21 is provided on the connecting leg 13 and the clip on the fixing fin and / or the occlusal guide.

During assembly, the free end of the clip body 223 is inserted between the branches 212 in the receiving cavity 213, then, the movement continues, the free ends of the branches 212 move apart, deforming the branches 212 of the the introduction of the bulging portion of the clip body 223. Once the clip body 223 is introduced into the receiving cavity 213, under the effect of the restoring forces due to the elastic deformation of the branches 212, the free ends of the branches 212 come closer and close on the throat 223 of the clip 22. This keeps the clip 22 in the element 21. The separation of the clip of the receiving element 21 is done in the opposite way by applying a force on the sufficient clip to release the free ends of the branches 212 of the constriction 223 and release the clip body 223 from the receiving cavity 213. The anatomical compliance of the occlusal positioning device and condylar 10 selo n the invention, and in particular that of the fastening fin is possible by the method of manufacture used to make said occlusal and condylar positioning device 10 according to the invention. This method of manufacture comprises the following steps:

- Computed tomography or computed tomography computed tomography (CBCT) acquisition of open millimeter millimeters of mouth at least 3 mm;

Mesh reconstruction of the bone surface from the sections acquired with a "Neighborhood Based" surface extraction algorithm

Marching Cube "(NBMC) - from the publication: S.

Gueorguieva and P. Desbarats, "Reconstruction of topology valid boundary of discrete obiects from 3D range images", In Reconstruction of topology valid boundary of discrete obiects from 3D range images, pages

388_393, Spain, 2005;

deleting metal artifact peaks on the mesh obtained in the previous step;

placement of the mandible in the position chosen for the initial position of the condyle;

planning the surgical procedure with displacement of the toothed portion 2 by not modifying the proximal segments 3 by searching for an optimal position of occlusion;

design of the occlusal and condylar positioning device 10 according to the invention by Boolean operation on the teeth and the mandibular bone surfaces, with the following conditions:

o Dental cusps and grooves should be included in the occlusal guide 11 but not the orthodontic material; o the fixation wings must measure 4 mm +/- 2 mm thick and have a return on the bone reliefs of the predetermined part of the reconstructed bone surface or will be placed the fixing fins;

the fins may be on the outer surface of the proximal, inner or both; o The connecting branches 13 connecting the fixing fins to the occlusal guide 11 are provided non-compulsorily removable (optional):

^■ Technique of fixing the connecting branches 13 on the occlusal guide 11 with a fastening system 20;

^■ second fixing of the connecting branch 13 to the fixing fins with a fastening system 20;

manufacture of the occlusal and condylar positioning device 10 according to the invention thus designed by a three-dimensional printing method with a three-dimensional printer.

Thus, the occlusal and condylar positioning device 10 according to the invention is made specifically for the patient to be treated, in a very simple and inexpensive manner, and makes it possible to perform both the displacement of the toothed portion 2 and the positioning of the two segments. proximal 3.

During the surgical procedure, the operative technique is very simple:

- Mandibular incision performed classically;

- classic mandibular osteotomy; - Implementation of the occlusal positioning device and condylar 10 according to the invention: first introduction of the occlusal guide (with maximum locking 11 o -mandibu 1 ai re) and the fixing fins with the connecting branches 13 which allow to position the proximal segment 2 quickly and simply;

- Achievement of osteosynthesis;

- Ablation of the occlusal positioning device and condylar 10 according to the invention.

The advantages of the occlusal and condylar positioning device 10 according to the invention are as follows:

- Only one occlusal guide is needed;

- It is perfectly adapted to the patient anatomy and very precise because it reproduces the positioning of the teeth and, in negative, the surfaces of the teeth and the bone surfaces of the predetermined part on which are fixed the fixing fins, eliminating, by the same occasion, the potential errors of the traditional manual method;

- there are no unnecessary maxillary and cutaneous incisions;

- there is no conformation of the plate intraoperatively;

- there is no bone milling or use of screws;

it requires a very simple method of manufacture and use;

it allows an operating time saving of about 20 minutes compared to the use of plates to be consistent with the anatomy of the patient to be treated intraoperatively;

it is economical; it allows an accuracy of the final positioning of the toothed portion 2.

Thus, the use of an occlusal and condylar positioning device 10 according to the invention makes it possible to position in a single step the toothed portion 2 of the mandible and the two proximal segments 3 right and left, thanks to the presence of fins anatomically shaped fasteners which are clipped onto selected predetermined portions of the anatomical reliefs of the mandible without further incisions, without bone milling and without the use of additional osteosynthesis material. It allows an operating time saving compared to the condylar positioning plates of the prior art. The possible presence of fastening systems 20 of the various parts of the occlusal and condylar positioning device 10 according to the invention facilitates intraoperative manipulations. In addition, the occlusal and condylar positioning device 10 according to the invention can be used for any type of mandibular osteotomy in order to correct various dysmorphoses: advanced, recoil, derotation, rotations hourly or counterclockwise, lateral rocking of the occlusal plane, etc.

Of course, it is possible to bring to the invention many modifications without departing from the scope thereof.

Claims

1. Occlusal and condylar positioning device comprising an occlusal guide, fixing means of the positioning device on a mandible of a patient to be treated, and means for connecting the occlusal guide to the fixing means, characterized in that the means fasteners comprise a fastening vane shaped anatomically to a predetermined portion of a proximal segment of the mandible of the patient to be treated, the fixing vane comprising means for clipping the fixing vane on the predetermined portion of the proximal segment.

Positioning device according to claim 1, characterized in that the fastening fin comprises a fin body and at least two ends comprising the clipping means and located on either side of the fin body.

Positioning device according to claim 2, characterized in that the fixing vane has three or four ends distributed on either side of the fin body.

Positioning device according to claim 2, characterized in that the fin body is a web of spiral material arranged to be wound around the predetermined portion of the proximal segment.

Positioning device according to one of claims 1 to 4, characterized in that the clipping means comprise a hook.

6. Positioning device according to one of claims 1 to 5, characterized in that the connecting means comprise a connecting branch.

7. Positioning device according to claim 6, characterized in that the connecting branch is integral with the fixing fin.

8. Positioning device according to claim 6, characterized in that it comprises a fixing system for removably mounting the connecting branch on the fastening fin.

9. Positioning device according to claim 8, characterized in that the fastening system comprises a clip provided on the connecting branch and a receiving member of the clip provided on the fin.

10. Positioning device according to one of claims 1 to 9, characterized in that it is achieved by a three-dimensional printing process.