WO2016177381A2 - Nouvelle technique pour stents chirurgicaux assistés par ordinateur - Google Patents

Nouvelle technique pour stents chirurgicaux assistés par ordinateur Download PDF

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Publication number
WO2016177381A2
WO2016177381A2 PCT/EG2015/000024 EG2015000024W WO2016177381A2 WO 2016177381 A2 WO2016177381 A2 WO 2016177381A2 EG 2015000024 W EG2015000024 W EG 2015000024W WO 2016177381 A2 WO2016177381 A2 WO 2016177381A2
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WO
WIPO (PCT)
Prior art keywords
orienter
zero
stent
mount
implant
Prior art date
Application number
PCT/EG2015/000024
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English (en)
Other versions
WO2016177381A3 (fr
Inventor
Heba Ezzeldin Abdelrehim KHORSHID
Original Assignee
Khorshid Heba Ezzeldin Abdelrehim
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 Khorshid Heba Ezzeldin Abdelrehim filed Critical Khorshid Heba Ezzeldin Abdelrehim
Priority to PCT/EG2015/000024 priority Critical patent/WO2016177381A2/fr
Publication of WO2016177381A2 publication Critical patent/WO2016177381A2/fr
Publication of WO2016177381A3 publication Critical patent/WO2016177381A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis

Definitions

  • the goal of computer-aided implant planning and placement system is the achievement of the maximal safety, allows implant placement in less time, less postoperative bleeding and discomfort, accelerated recovery for the patient, fewer changes in crestal bone level and avoiding esthetic failures.
  • the use of such technique raised important questions such as: How accurate is the computer -guided implant placement? Is this technique efficient and effective to be used in routine clinical settings? The accuracy of the entire procedure can be measured by the " deviation between the position of the actual implant and the planned one". This deviation usually happen as result of the sum of errors that accumulate throughout the computer-aided cascade, starting from scanning, processing, planning, till the surgical and prosthetic phase.
  • This Invention consists of three main components:
  • This Invention consists of three main components:
  • Orienters there are two types of Orienters; the first type is that designed for lower arches (designated with the letter "L” engraving) while the second type is that designed for upper arches (designated with the letter “U” engraving).
  • the Upper and Lower Orienters are generally identical except for the side on which the magnets are attached. For each type, three sizes are available: Small Medium and Large to fit all arch sizes and forms.
  • Orienters have a letter engraved on each side; "O" or Occlusal side and “M” or Mucosa side.
  • the orienter is always attached to the Radiographic template with the "O" side facing the occlusal aspect of the teeth in the Radiographic template to make it easier for users to attach the Orienter to the radiographic template in the right position.
  • ⁇ Components of the Orienter There are two main parts of the Orienter: a.
  • the Intra-Oral "I" Part which consists of a horse-shoe bar. This bar has several components within:
  • Cone shaped retentive aids on the inside/ lingual aspect of the Orienter With the use of sticky wax or medical grade adhesive, the retentive aids in the orienter are first secured to the facial aspect of the radiographic template. Self-cured acrylic resin is then filled in the space between the Orienter and the facial side of the CAS. These cones thus help add mechanical means of retention between the orienter and the CAS.
  • a cross-shaped male extension which is used to Position the Orienter over the Orienter Mount. This will automatically bring the Orienter in a zero-zero-zero x-y ⁇ z position.
  • Rectangular shaped Magnets which help secure the Orienter to the Orienter mount preventing any movement of the Orienter (due to for example movement of the patient's head). It is important to note that any movement in the patient's head would lead to an error in the automatic registration procedure. However, the radio -opaque markers can still be used to double check the accuracy of the zero-zero-zero x-y-z position. If any deviation occurred, conventional registration procedure is performed.
  • the Extra-oral or "E” part of the Orienter has been created to simplify the registration procedure and add to the accuracy of the final outcome of this procedure.
  • the projecting Extra-oral male portion of the Orienter is secured over the orienter mount which consists of a female counterpart and is attached to the bite block slot of the CBCT machine.
  • the male portion has inbuilt magnets that will automatically and securely attach to the magnet keepers inbuilt in the female portion of the orienter mount.
  • the orienter mount is calibrated using a sensitive digital laser water balance at a zero-zero-zero x-y-z position.
  • the red midline laser beam of the CBCT machine should exactly coincide with a midline groove engraved on the projecting male portion of the orienter.
  • the Female Counterpart where the projecting Extra-oral male portion of the Oiienter is attached to.
  • the male portion has inbuilt magnets that will automatically and securely attach to the magnet keepers inbuilt in the female portion of the orienter mount.
  • the orienter mount is calibrated using a sensitive digital laser water balance at a zero-zero-zero x ⁇ y ⁇ z position.
  • the red midline laser beam of the CBCT machine should exactly coincide with a midline groove engraved on the projecting male portion of the orienter.
  • this orienter mount is to automatically place the orienter at a zero-zero-zero x ⁇ y-z position thus negating the need to do any registration as we already know the orientation of the orienter.
  • the Radiographic template /orienter complex is seated securely in the patient's mouth and stabilized in place by biting on the occlusal index.
  • the patient's chin should at the same time be secured over the chin positioner available in the CBCT machine.
  • NB The incorporation of a specially designed slot, other than the bite block slot available in most CBCT machines can be proposed, to CBCT machine manufacturers.
  • This specially designed slot can be manufactured specifically to fit the Orienter mount as well as allow it to slide in an upward and downward manner to fit all facial sizes and types. Care must be given that this slot should be accurately and precisely produced so as not to alter the calibrated zero -zero-zero x-y-z orientation.
  • a specially designed digital water balance may also be incorporated within the orienter mount to always ensure the accuracy of the calibration.
  • the Fixation Plane which consists of a horse- shoe bar. This bar has several components within:
  • the Fixation plane is attached to a disc that fits exactly within the clamp of CAD/CAM milling machines.
  • the disc is approximately 10cm in diameter and contains several projections that will fit the clamp of each CAD /CAM machine available in the market. This means that a fixation plane metal disc should be manufactured individually for each CAD/CAM machine available in the market.
  • the Fixation plane disc demonstrated in this report is that for the Roland machine DWX 50.
  • the Fixation Plane metal disc is designed with a hollow area in its centre to accommodate the computer aided stent.
  • the purpose of the four holes in the fixation plane is to attach it with the OnenteiV radiographic template.
  • Four metal bolts used in conjunction with four nuts are used to anchor the Orienter with the fixation plane.
  • the fixation plane has been fabricated using a Saxis milling machine out of a chrome-cobalt alloy which precisely fit the clamp found in any CAD/ CAM machine.
  • the outer aspect of the metal disc contains minute projections that aid in an anti-rotation movement of the disc within the clamp.
  • a specific disc (with the fixation plane attached within) is fabricated to fit accurately within the projections of the clamp. This helps secure the Fixation plane metal disc to the clamp in the CAD/ CAM machine.
  • the pre- surgical preparation required the construction of conventional upper and lower complete dentures. If the patient's old denture is judged satisfactory regarding the tissue adaptation, occlusion and esthetics, construction of a new denture is skipped.
  • the radiographic template is then tried in the patient's mouth to check proper seating, extension, retention and stability.
  • An occlusal index is constructed by guiding the patient to close in centric using a putty silicone material separating the opposing teeth from the stent. After setting of the latter, the stent is removed and the index is checked and the excess is trimmed.
  • the Orienter contains several rectangular shaped engravings which should be filled with composite resin.
  • the composite resin is then light cured in a conventional fashion.
  • the Orienter also contains cone shaped retentive aids on its inner/lingual aspect.
  • the orienter is first secured to the facial aspect of the radiographic template.
  • the centre of the orienter should coincide with the midline of the radiographic template.
  • the orienter is always placed with the "O" side facing the occlusal aspect of the Radiographic template.
  • a roll of baseplate pink wax is then adapted on the "M" side of the orienter and facial aspect of the radiographic template to protect the "M" surface of the orienter from any acrylic resin contamination.
  • a thin mix of self -cured clear acrylic resin is then poured to fill the space between the orienter and the facial aspect of the radiographic template. After complete setting, the baseplate wax is removed and the radiographic stent and orienter should be now secured together very firmly.
  • Radiographic template/orienter complex is seated securely in the patient's mouth and stabilized in place by biting on the occlusal index.
  • the patient's chin should at the same time be secured over the chin positioner available in the CBCT machine.
  • the projecting Extra-oral male portion of the Orienter is secured over the orienter mount which consists of a female counterpart and is attached to the bite block slot of the CBCT machine.
  • the male portion has inbuilt magnets that will automatically and securely attach to the magnet keepers inbuilt in the female portion of the orienter mount.
  • the orienter mount is calibrated using a sensitive digital laser water balance at a zero-zero-zero x-y-z position.
  • the red midline laser beam of the CBCT machine should exactly coincide with a midline groove engraved on the projecting male portion of the orienter.
  • this orienter mount is to automatically place the orienter at a zero-zero-zero x-y-z position thus negating the need to do any registration as we already know the orientation of the orienter.
  • the patient's maxilla or mandible is radiographed using Cone Beam
  • the resultant images are obtained as Dicom data on a compact disc.
  • An STL file of the Virtual Orienter/Fixation plane is imported into the patient's project loaded on the Mimics software.
  • the Orienter and Fixation plane as mentioned before, were initially designed and created by a software called Rhinoceros 1 .
  • the Orienter and Fixation plane were already designed and created in a zero-zero-zero x-y-z position such that when imported into any Mimics project, all that must be done is dragging it manually along with the virtual rectangular markers over the radio-opaque rectangular composite markers or automatically registering it using the STL registration tool available in the Mimics software.
  • the virtual Orienter and fixation plane are temporarily attached together to ensure that their exact relationship is maintained during any manual dragging or registration procedure. If the same CBCT machine is used with all patients, the orienter is automatically positioned in the same target location every time a new CBCT is taken (even with different patients) which negates the need for any dragging or registration procedures.
  • the implant planning is performed using the Mimics 10.01 software 2 .
  • This software is designed to manipulate CT images and to grow 3D virtual volumes out of them.
  • a data base library of the virtual implant models used for implant planning is available and consists of intra and supra bony portions with a clearance space in between.
  • the intra bony portion of the implant model is an accurate reproduction of the length; diameter and taper of the intra bony portion of the implant system to be used.
  • the supra bony portion consists of a hollow cylinder with 7.05mm outer diameter, 5.05mm inner diameter, 6mm in height and a lmm internal ledge on its top aspect.
  • the desired implant sites are identified through the radiolucent channels previously prepared in the radiographic templates at the prosthetic teeth centres.
  • the bone height, width and density at each of the potential sites are evaluated and accordingly, the suitable virtual implant width and diameter are chosen from the data base.
  • Virtual Implants are then placed in the desired implant sites with the prosthetically and aesthetically satisfactory angulation, depth and parallelism.
  • the supra bony portions are then all united together using the Boolean union operation tool.
  • the virtual Orienter and Fixation plane are then separated using the split tool.
  • the United supra bony (sleeves) portions are then united with the fixation plane using Boolean operation tools.
  • the resultant union object is exported as an STL file extension from the mimics program.
  • Radiographic template at this point of work is now nominated or designated as the computer aided surgical stent. This is considered to be the most important advantage of this invention as we have eliminated the need for the fabrication of a new surgical stent using proto-typing or milling machinery thus saving time, money and energy as well as gaining the advantage of utilizing the accuracy of fit, adaptation, retention and stability already achieved in the radiographic template.
  • fixation plane metal disc has been fabricated using a 5axis milling machine out of a chrome-cobalt alloy which precisely fit the clamp found in any CAD /CAM machine.
  • the outer aspect of the metal disc contains minute projections that aid in an anti- rotation movement of the disc within the clamp.
  • a specific disc with the fixation plane attached within is fabricated to fit accurately within the projections of the clamp.
  • the Fixation plane is oriented within the disc with the following criteria: The midline of the fixation plane should coincide with the midline of the disc.
  • the inner (lingual) aspect of the fixation plane midline is placed 10 mm away from the disc border accordingly the outer (facial) aspect would be 4mm away from the disc border, (the Fixation plane is 6mm in width)
  • the base of the fixation plane is placed on the lower most border of the disc.
  • This position is saved in a file within the CAM software of each machine such that with each new case, the fixation plane is automatically superimposed over this saved position.
  • the CAM software will begin generating a cascade of tasks that will be sent to the milling machine. In the intervening time, manual cancellation of all the operations to be done is performed while leaving only the vector holes of the supra-bony sleeves.
  • the new orienter module could be given these orders to perform automatically each time a new case is loaded in to this module.
  • the resultant task sent to the A4illing machine is just drilling of the vector holes within the previously called radiographic stent; meanwhile the Computer aided surgical guide (CAS). Fixation guide holes could also be performed by the same manner.
  • the Roland DWX50 CAD/CAM machine almost took from 3-6 minutes for drilling each vector hole. This saved so much time on the machine as a normal stent would take at least 5-6 hours to be completely produced on this same machine. This means that we saved about 98% time as well as energy with no need for any extra material.
  • Rectangular shaped boxes (Twelve 12 in number)
  • Cylinder which fits in the slot for the bite block available in the CBCT machine.
  • Figures 1',2',3',4',5',6',7'3 ⁇ 8' are duplicates of l,2,3,4,5,6,7and8 (just different viewing options) > THE ORIENTER + RADIOGRAPHIC TEMPLATE + ORIENTER MOUNT + CBCT MACHINE + PATIENT (Fig. 9)
  • Implant vector holes after drilling These will exactly accommodate the metal sleeves.
  • FIG. 12 A showing the Computer guided stent before drilling
  • FIG. 12 B showing the Computer guided stent during drilling

Abstract

Introduction : l'objectif d'une planification et d'une mise en place d'implant assistés par ordinateur est de garantir une sécurité maximale au cours de la chirurgie implantaire. Toutefois, la somme d'erreurs qui s'accumulent tout au long de la cascade assistée par ordinateur provoque généralement une déviation de l'implant par rapport aux positions préalablement planifiées. Idée : dans cette innovation, le stent clair radiographique est transformé en CAS en forant simplement les trous des vecteurs d'implants dans le stent au moyen d'une quelconque machine CAO/FAO au lieu d'utiliser la technologie de prototypage rapide. Ce résultat est obtenu au moyen des trois composants principaux de cette innovation que sont l'orienteur, le support d'orienteur et le disque métallique de plan de fixation. Objectif : l'objectif principal de l'orienteur est de corréler la position spatiale exacte des implants planifiés par rapport à lui-même et au plan de fixation. Le support d'orienteur aide à maintenir l'orienteur dans une position zéro-zéro-zéro x-y-z et permet ainsi d'éviter une procédure d'alignement complexe. Une fois que le complexe CAS/orienteur est fixé au disque métallique de plan de fixation, le fraisage des trous de vecteurs d'implants est effectué par la machine CAO/FAO. Conclusion : cette nouvelle technique innovante permet non seulement de diminuer sensiblement les coûts et d'économiser du temps, de l'énergie et des matériaux, mais également d'aider à éliminer les erreurs inutiles en réduisant simplement les nombreuses étapes qu'implique la construction d'un quelconque stent chirurgical conventionnel assisté par ordinateur.
PCT/EG2015/000024 2015-05-03 2015-05-03 Nouvelle technique pour stents chirurgicaux assistés par ordinateur WO2016177381A2 (fr)

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PCT/EG2015/000024 WO2016177381A2 (fr) 2015-05-03 2015-05-03 Nouvelle technique pour stents chirurgicaux assistés par ordinateur

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PCT/EG2015/000024 WO2016177381A2 (fr) 2015-05-03 2015-05-03 Nouvelle technique pour stents chirurgicaux assistés par ordinateur

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WO2016177381A3 WO2016177381A3 (fr) 2017-09-14

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109199603A (zh) * 2018-08-31 2019-01-15 浙江大学宁波理工学院 一种椎弓根螺钉最优置钉点的智能定位方法

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US20060281046A1 (en) * 2003-09-04 2006-12-14 Mjrad Co., Ltd. Stent for guiding the location/direction of implant, and production method thereof
US7835811B2 (en) * 2006-10-07 2010-11-16 Voxelogix Corporation Surgical guides and methods for positioning artificial teeth and dental implants
DE102010031018A1 (de) * 2010-07-06 2012-01-12 Sirona Dental Systems Gmbh Verfahren und Spannvorrichtung zur Herstellung einer zahnmedizinischen Bohrschablone
US8750590B2 (en) * 2011-02-03 2014-06-10 Greenberg Surgical Technologies, Llc Removable handle scan body for impression trays and radiographic templates for integrated optical and CT scanning
WO2013056219A1 (fr) * 2011-10-13 2013-04-18 Huffman Ronald E Systèmes et procédés de modélisation dentaire sans impression
DE102012201744A1 (de) * 2012-02-06 2013-08-08 Wieland Dental + Technik Gmbh & Co. Kg Werkstücksystem
EP2964128A1 (fr) * 2013-03-08 2016-01-13 Trophy Guide chirurgical partiel

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109199603A (zh) * 2018-08-31 2019-01-15 浙江大学宁波理工学院 一种椎弓根螺钉最优置钉点的智能定位方法

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