WO2017129869A1 - System and devices for fastening dental implants to the maxilla - Google Patents

Abstract

The invention concerns a device for fastening dental implants to the maxilla of a subject, comprising: • at least one axially elongate implant (51), comprising, in an apical area of said implant, at least four connection areas: (a) an upper end stop, (b) an upper anti-rotation area, (c) a narrowed area normally referred to as the neck, (d) and/or a lower anti-rotation area, and (e) a lower end stop, and, after the face of said lower end stop opposite the lower anti-rotation area, a connection head capable of receiving, with known technical means, the dental implant to be fastened, and • a set of intrasinusal elements comprising: at least one element referred to as the element for increasing the upper anti-rotation surface area (52), abbreviated to EASAS, and/or at least one element referred to as the element for increasing the lower anti-rotation surface area (53), abbreviated to EASAI, and, optionally, at least one wedging or holding member (54) capable of being attached to at least one of the above-mentioned EASAS and EASAI.

Description

 SYSTEM AND DEVICES FOR FIXING DENTAL IMPLANTS ON THE UPPER MAXILLARY

FIELD OF THE INVENTION

 The present invention relates to the field of dentistry, and more particularly to a system and a device for rendering operational and reliable the fixation of dental implants in the maxilla of an individual or subject.

 In men, at the level of the maxillary maxilla, the maxillary sinus descends low enough to encompass the roots of the upper second premolar, as well as the first and second upper molars. This may even extend to the first premolars and the wisdom tooth (third molar).

 In case of tooth extraction in this region, bone melting occurs, which increases with time. Thus, after extraction and scarring in the upper maxilla of the second premolar and molars, there is often too little bone, about 1-8 mm, so that we can put one or more implants in place of teeth extracted.

 We can therefore consider that we are forced once every two to achieve a filling of the sinus before the implantation of implants, because the cortical bone has a thickness of 1-8 mm, while the implants used for this region have a length ranging between 12 and 16 mm.

TECHNOLOGICAL BACKGROUND

At the present time, when one is confronted with this impossibility of placing implants on the upper jaw at the places from which the teeth were extracted, the only possibility is to perform a lifting operation of the sinus membrane, traditionally called "sinus lift". This operation consists of filling the sinus bottom. This is a surgical procedure in which the sinus membrane is lifted, implants are placed and the void created between the membrane, the implants to be placed and the cortical bone is filled with a filling material which, the most often today consists of biomaterials based on hydroxyapatite and β-tricalcium phosphate, among others. This now traditional technique is based on the concept of guided bone regeneration. Indeed, the blood trapped around the biomaterial will make bone after about 4 months.

 This biomaterial, trapped with patient's blood, will surround the implant (s) for a period of 4 to 5 months. To simplify the presentation and its reading, it was agreed to mention "the" implants, even if only one is considered, because what is explained below applies mutatis mutandis in both cases.

 In addition, the implants are placed necessarily through a small bone orifice, which orifice will necessarily have an inflammation, because the bone is traumatized. This inflammatory phase is always accompanied by a destruction of this bone orifice, so the natural bone around the neck of the implants. It is for this reason that implants can be lost about 1 month later, at the beginning of the healing phase, when the bone repair begins, thanks to the return of the bone on the surface of the implants. But during this phase of the first month, it is possible that the implants are expelled either in the oral cavity, or inside the sinus as evidenced by many articles on this subject.

 This longevity possessed by the biomaterial will promote the neoformation of bone that solidifies around the implants which, it should be remembered, are cylindrical, cylindro-conical or conical. After 4-5 months, the implants are activated for the purpose for which they are intended, by the installation of prosthetic abutments and the tightening of the abutment screws under a force between 25 and 35 newtons, which is the norm allowed to then allow the laying of crowns on said pillars. Nevertheless, the neoformed bone does not have the same density or hardness as the natural bone of the patient. It can then arise problems during the implementation of implants during the clamping phase.

These are real problems, which deprive the sinus lift of much of its reliability, despite its many indications. It should also be remembered that the implants have a cylindrical, cylindro-conical or conical shape, and present 2/3 of their volume in the void, under the sinus membrane, which is currently expressed by the image of heels needles embedded in the biomaterial. This then constitutes a dead end, which removes much of its interest in the sinus lift as it is currently practiced, and it remains an unmet need for a reliable possibility of preparation and realization of implant placement in the maxilla of individuals who have undergone tooth extraction at this location.

SUMMARY OF THE INVENTION

 The present invention provides a reliable solution to this problem, by proposing a system and a device having appropriate connections respectively for screwing and / or impacting one or more implants, and a set of connections for stabilizing the implant or implants in the vertical direction. , horizontal (against displacements) and axial (against rotations), the whole being intended for an implantation in an intrasinusian cavity previously carried out to the right of the site of the implantation to be carried out.

 Here, the term "pushing" (in English "push-in") the action of linearly moving an element by percussion thereof by means of a suitable tool, and by "impacting" the resulting operation .

 In other words, the resolution of the problem mentioned above has now been approached by an increase in the volume of this type of implant placed in the sinus, by the provision of at least one intrasinusal fixing element (hereinafter called "fixative EIS") fixed on the implant, on its intrasinus end, laterally and / or axially, so that the biomaterial encircles and traps this new implant to a greater extent, thereby providing means to increase its stability and its fixity to solve the problem mentioned above during the first month of healing, and also to solve the problem of tightening when starting the implant 4-5 months later.

 In addition, the device according to the invention is defined and designed to have numerous cavities allowing the biomaterial to lodge there and thus the future bone to fix. Said device also has the advantage of being compact and allow to lift the sinus membrane only to a limited extent, without aggression.

The present invention thus provides an attractive, effective and ergonomic solution, by making it possible to increase the volume of the implant in the sinus, which gives the biomaterial the ability to effectively encircle and imprison the implant thus equipped, because its volume and the presence of numerous cavities allow the biomaterial to lodge there and thus the future bone to be fixed.

 The device thus designed and described hereinafter with reference to embodiments given solely by way of illustrative and non-limiting examples, makes it possible to avoid the so-called "stiletto" concept of implants placed in the sinus during of a "sinus lift".

 The implants to which the invention applies are of all types, in particular those which are conical, cylindro-conical or cylindrical. In addition, when several implants are placed, one can, through the meeting of the corresponding devices, achieve a contention system that makes this operation even more reliable.

 In the subsequent step of putting implants into operation, prosthetic abutments are placed on them to produce dental prostheses, such as crowns, bridges, etc.). These pillars are tightened at their connecting screw under a force between about 25 and 35 newtons.

 With prior art implants, this considerable force can sometimes detach the implants from the newly formed bone, causing their loss.

 Such an increase in the volume and therefore the contact area available for bone neoformation, as well as the increase in the resistance in the vertical direction (which is by convention the longitudinal direction of the implant) and in the lateral direction of the fact. of the volume thus procured as well as the entanglement of the neoformed bone in the cavities and niches provided by said device, and also in the direction of rotation relative to the implantation orifice, make the implants then stronger and more durable than traditional implants, despite the nature of the neoformed bone, which remains the same.

 Moreover, the resistance to rotational forces during tightening of the prosthetic abutments is greatly increased.

 In addition, in the case where two or more implants are juxtaposed, the contention brings even more resistance and fixity.

It follows in particular that: • during the first months after implant placement and the fixation element (s), the healing of the neoformed bone around the implants proceeds smoothly;

 • after the healing period of 4-5 months, chewing, which involves significant vertical and lateral forces, also proceeds smoothly;

 • after this healing period of 4-5 months, the setting of the prosthetic abutments on these implants by clamping at around 25-35 newtons is carried out without problem;

· The volume provided by the fixing elements increases very significantly the contact surface, especially as, optionally, said fixing elements may have extensions, of various natures and in various directions, thus increasing the volume and the fixity implants with such extensions; and

· When there are several implants, the possibility of bringing together the fixing elements to consider provides a greater fixity, by a restraining effect of the implants.

 The system with which said device according to the invention is implemented advantageously comprises, besides this one, also a drilling guide and a gripping instrument, both of a known classical kind, and both. optional, but strongly recommended for a good precision of the piercing of the cortical bone. Such a system can be presented commercially as a whole and then forms a functional whole useful for the practitioner.

 In an advantageous embodiment, it is possible to present two or more implants connected to one another and which thus benefit from a high quality compression which is free from micro-movements and does not generate inflammations and / or bone loss.

 In addition, the device according to the invention has been found to provide an exceptional antirotational effect, being able to withstand rotational forces delivered during the screwing and unscrewing of conventional prosthetic abutments by mini-screws. These are forces between 20 and 35 newtons.

Indeed, after 4-5 months of healing, the implants can be equipped with such abutments, fixed on the implants by mini-screws with a tightening of 20-35 newtons. This is a considerable improvement compared to attempts to attach implants by the traditional sinus lift technique, which has regularly rotated during screwing / unscrewing of implant abutments that have migrated into the sinus, as they have detached themselves from the weak cortical bone.

BRIEF DESCRIPTION OF THE DRAWINGS

 The invention will be better understood, and other objectives, advantages and characteristics thereof will appear more clearly, in the light of the detailed description below of the preferred embodiments, given purely by way of illustration and in no way limiting, while appended to the said description are plates of annexed drawings, in which:

 FIGS. 1 to 5 illustrate a first embodiment, while FIGS. 6 to 16, FIGS. 17 to 25 and FIGS. 26 to 29 relate to and respectively illustrate variants described here respectively as first, second and third variants of said first embodiment. embodiment of the present invention.

 In Figs. 1 to 5, which relate to a first embodiment: FIG. 1 represents, in partial schematic vertical section, an embodiment of a device according to the invention, implanted in a sinus cavity and ready to receive two implants according to the invention;

 Fig. 2 is a successively top-down view of a front view of a roof for EIS, the base of the same EIS, and an implant member, and a top view of said implant member, for a unitary implant;

 Fig. 3 shows, successively from top to bottom, a front view of a roof for EIS intended for two vicinal implants, the base of the same EIS in two parts, and two implants;

 Fig. 4 represents, from top to bottom, a body of EIS for two implants: in top view, in cavalier perspective, and in view from below; and

Fig. 5 represents a sole or bar that can fit on the head of two implants as shown in FIG. 3, to constitute, after implantation, an assembly corresponding to that which is schematically represented in FIG. 1, successively from top to bottom in view of above, in side view and in cavalier perspective. In Figs. 6 to 16, for a first variant of the invention:

 Fig. 6 shows, in diagrammatic and exploded perspective view, an embodiment of a device according to the invention, with separate representation of two intra-sinus elements to be inserted on the implant;

 Fig. 7 is a diagrammatic front view in section of an implant head comprising two fixing elements according to the invention;

 Fig. 8 represents separately the intrasinusic element C intended to be introduced laterally;

 Fig. 9 is a partial schematic sectional view of a set of two implants of which only the head and a part of the body are shown, each provided with a set of two fixing elements according to the invention, while the fixing element to be inserted. laterally is designed and arranged to secure the two implants simultaneously;

 Fig. 10 shows, in a cavalier perspective, the lateral insertion fixing element for the embodiment described in FIG. 9;

 Fig. 11 is a perspective view of a screw-in implant whose head is arranged to receive a fixing element (EIS) as shown exploded above said head;

 Fig. 12 shows a perspective view of a screw-in implant and two upper fixing elements according to a variant of Figure 10, the upper fixing member being secured to a lower fixing member. The connection between the upper element and the lower element is performed by one or more connecting pieces, such as for example one or more bars (only one being shown in Fig. 12). The lower fixative element, which is truncated annular shape, is pushed through the narrowed portion such that the two fixing elements have their common axis with that of the implant. Downward axial movement drives the assembly to its locking position on the implant;

 Fig. 13 is a perspective view of the variant according to Figure 11, with the upper fixing elements EIS introduced from above;

Fig. 14 is a perspective view of an exploded view showing an implant according to the invention and, separately, two elements respectively designed for lateral insertion and for axial insertion, from above, these two elements being able to be nested one in the other; Fig. 15 shows, in partial schematic section, the head and the threaded part of the body of an implant according to the invention and, in their final position on said implant, the cross section of the two fixing elements forming a fastening securing assembly of implant according to the invention; and

 Fig. 16 is a top view in a cavalier perspective of a double fixing element, laterally insertable by pushing transversely to the longitudinal axis of two vicinal implants, said element being provided with slots for the insertion of the descending lateral tab of each two complementary elements adapted to be inserted by downward translation from the top of the head of their respective implant.

 N.B .: In Figures 6 to 16, the mark 28 or 38 represents a fixing hole by tenon or screw, passing through the fixing EIS and the implant to ensure fixation. In Figs. 17 to 25 concerning a second variant embodiment:

 Fig. 17 is a front view in elevation of an embodiment of an implant according to the invention, ready for insertion into an intrasinus cavity, into which the parts of the head of the implant that are ready to receive the EASA elements and the hold wedge;

 Fig. 18 represents, from the front (in the direction of insertion) and in elevation, an implant according to FIG. 17 equipped with EASAS and EASAI elements and the spacer;

 Fig. 19 shows schematically, from the back (view opposite to that of the direction of insertion) and in elevation, an implant according to FIG. 17 equipped with EASAS and EASAI elements and the spacer;

 Fig. 20 is a top view of an EASAS or EASAI element according to the invention having a notched circular shape and a polygonal internal contour inscribed in a circle;

 Fig. 21 shows, in front view and in perspective, a holding wedge according to the invention;

Fig. 22 represents, in cavalier perspective, the three distinct parts that can be, according to the invention, an implant without the elements reported (Fig. 22a), an EASAS element (Fig. 22b), and a profiled support wedge (Fig. 22c).

 Fig. 23 shows, in three successive stages of implementation, in perspective from above, the installation according to the invention of an EASAS element and a holding wedge on an implant.

 Fig. Fig. 24 shows, in perspective view, an upper or lower EASA element (Fig. 24a), a lower or upper element (Fig. 24b) and a holding wedge (Fig. 24c) for a device according to the invention.

 Fig. Fig. 25 is a diagrammatic perspective view of an implant according to the invention without its additional elements (Fig. 25a), in a bent variant (Fig. 25b), with insertion in progress of an EASAS element and a wedge of holding (Fig. 25c), and once the insertion of these elements has been completed (Fig. 25d).

 In Figs. 26 to 29 concerning a third variant embodiment of the device according to the present invention:

 Fig. 26 shows an implant body (61) according to the invention, schematically side view;

 Fig. 27 is a diagrammatic section (a) and a perspective view (b) of a cap for capping the intrasinous end threaded portion of the implant;

 Fig. 28 is a diagrammatic section (a) and a perspective view (b) of an element intended to be threaded onto said end portion on the body of the implant, as shown in FIG. 29; and

 Fig. Fig. 29 is a composite view (partly in front of the implant body and partly in schematic section for the parts of Fig. 27 and 28.

DETAILED DESCRIPTION OF THE INVENTION

 It has indeed been found that the above-mentioned objectives, as well as others, can be achieved with a system and its essential constituent devices for fixing dental implants on the upper jaw of a subject, in which, in a first form of realization:

 the system basically involves:

• a device (hereinafter called Intra-Sinusian Element, or abbreviated EIS) intended to be introduced into an intrasinusic cavity previously consisting of the realization of a bone window through the lateral cortical bone and by lifting of the lower and lateral membrane of the maxillary sinus, thus allowing the fixation of implants in the intrasinus cavity, in line with the site on which one or more implants must be fixed, and

 At least one axially elongate implant, comprising at least four zones of connectors designed to be able to firmly connect said at least one implant to said EIS and to the cortical bone,

as well as,

· Optionally a device for drilling or drilling guidance (called a drill guide), provided with drill bits or drill bits suitable for drilling of appropriate dimensions at the site of the desired bone cortical in the relevant portion of the maxillary jaw; and

• optionally a device (called gripping device) intended to facilitate the gripping of the EIS and its solidarity with the implant (s), as well as

 • while the implant (s) have at least four zones of connectivity:

 . a threaded or unthreaded end, to secure the implant with the EIS,

 . a cylindrical or frustoconical neck whose average diameter is substantially greater than that of the hole resulting from the drilling in the cortical bone for stable implant fixation,

 . between said neck and said end, an intermediate portion extending axially and having, in cross-section, a non-cylindrical, polygonal, preferably hexagonal geometry, and

 . at the end of said neck opposite to said intermediate portion, a connector head for receiving, with known technical means, the dental prosthesis to be fixed.

 The present invention also relates to a new implant, as defined in the present description.

The present invention also relates to a kit of elements for fixing dental implants on the upper jaw of a subject, in an intrasinus cavity previously made for this purpose, said kit comprising the elements constituting the aforesaid system. More specifically, the invention relates to a system and device for attaching implants to the upper jaw of a subject, wherein said device comprises the essential functional elements of the aforesaid system, except the drill guide and the delivery system. gripping.

 In a first embodiment (see Figs 1 to 11), said device is arranged to allow the attachment of several (preferably two) vicinal implants, and it then advantageously comprises a connecting piece 9, said sole or bar, connecting between them by elements 15 the respective heads of each of the aforementioned implants connector elements, at the distal end intended to remain outside the sinus cavity after implantation.

 In a variant of said embodiment, said device is arranged to allow fixation of an implant to be screwed without intermediate portion, and it then comprises an EIS pierced with a single threaded or partially tapped hole, and optionally a hole of which the bore has a shape adapted to that of the gripping tool used for its implementation.

 In an advantageous embodiment, the aforesaid system or device comprises an EIS designed in two parts intended to be joined together, and respectively constituting the body 10 of the EIS and a roof or hat 12 intended to be supported on said EIS body and to be secured therewith by pushing through the intermediate portion of the implant.

 In another variant, the device according to the invention comprises a system and a device in which:

 the system basically involves:

 • a device (hereinafter called Intra-Sinusian Element, or abbreviated EIS) as aforesaid, intended to be introduced into an intrasinus cavity previously constituted by the production of a bone window through the lateral cortical bone and by lifting of the lower and lateral membrane of the maxillary sinus, thus allowing the fixation of implants in the intrasinus cavity, at the right of the site on which one or more implants must be fixed, and

At least one implant comprising at least four zones of connectors designed to be able to firmly connect said at least one implant EIS audit, cortical bone and bone neoformed from the biomaterial, and to receive the implant prosthesis. .

 In preferred and / or advantageous embodiments, which are in no way limiting, the system or device according to the invention optionally comprises, in combination or separately, as far as is technically possible, one and / or more of the characteristics and / or particularities:

 • The intrasinusian element (hereinafter abbreviated EIS) comprises two parts 10,12 disjoined and nestable; the first part is a block of oblong shape and having any contours, advantageously smooth and preferably with rounded edges, perforated by bores 13 (through holes) longitudinal suitable for the crossing of the implants to be fixed, and a bore (hole through) or a blind hole 14 transverse to facilitate the gripping of said EIS to make it easier to set up, while the second part of said EIS is a roof piece or cap casing above said first part, and comprises several, advantageously two blind hole holes having a polygonal transverse profile axially corresponding substantially to the polygonal contour of the aforementioned intermediate portion of the implant.

 The respective lengths of the different successive parts are preferably adapted to those of the bores of the two parts of the EIS, while advantageously reserving the faculty of a back-sliding of the distal part on the intermediate part when the screwing has been performed. of the distal part of the implant on the threaded bore of the part of the EIS forming the roof. Thus, existing blocking functions are added to existing blocking functions between them by an additional blocking capability of the roof part on the EIS base piece by coinciding their respective polygonal profiles and sliding up to the base part of the EIS. at a natural position of wedging by support of the two parts of the EIS one on the other. By this variant, thus obtaining an even better rigidity of the assembly formed by the EIS and the implant.

In a particular embodiment (not shown), the body of the EIS comprises in its interior a female antirotational structure that can slide freely and without blocking on the male antirotational structure of the roof of the EIS, and can slide and lock in. end of race on the male antirotational structure of the body of the implants, this non-cylindrical antirotational structure being constituted, if one refers to an axial section, by a polygonal and / or sawtooth geometry, and / or by means of grooves, or of excrescences, or of a regular or asymmetrical geometry chosen to suit this purpose.

 In one embodiment as shown in Figure 1 for purely illustrative and non-limiting, implanted in an intrasinus cavity 4 previously made in and above the cortical bone portion 2 of the site 1 concerned, and below the sinus membrane raised 3 different potential constituent parts of the system and the device according to the invention, the entire device once mounted then being embedded in a conventional granular filling material 5, able to harden in the surrounding physiological conditions. The device comprises two implants 6 each having a body 7 and a neck 8 and whose respective heads are connected by a sole or bar 9 fixed under each of the heads 11 of the implants, whose proximal portion is itself trapped in an EIS in two parts 10, 12 whose elements are detailed in Figures 3, 4 and 5.

 With the implants thus produced in accordance with the invention, a compression is achieved by the combination of the effects of the filler material of the lower back of the maxillary sinus of the paired subject and of the intrasinusic element (EIS). ) which, while providing its own effects, increases the contact area between the implant and said filling material. This effect can not be achieved with current sinus lift techniques.

 In the present invention, it is recommended that the intrasinusal element be of elongate shape, with its largest dimension oriented in the vertical direction for a single implant, and in the anteroposterior direction in the case of the placement of several implants together. in the same sinus cavity.

As a rule, it should, except in other preferred cases which will be determined case by case by the practitioner, substantially the shape of a parallelepiped, preferably a rectangular parallelepiped, whose volume and morphology must be adapted according to the volume of the cavity intrasinusal created under the membrane, and also to account for the dimensions of the access lateral bone window.

 This EIS may have artifices likely to increase its retention in the filling material, such as grooves, cavities, holes, provision of structures other than the body of the EIS, such as filaments, etc.

 The body of the EIS can also be formed in several interconnected parts, revealing empty spaces that will be filled by the filling material, thus the future bone that will result after its formation; it should be emphasized in this connection that said EIS can also have holes to let pass transfixation screws able to anchor on the bone wall that separates the maxillary sinus surrounding elements.

 This EIS, whether one-piece or not, has cavities, or vertical or horizontal functional holes, and can be achieved by machining, casting, or frying, or by computer-aided design operations, or by 3D printing.

 The biomaterial used for filling the intrasinus cavity can be chosen from the synthetic materials conventionally used in this field (calcium, hydroxy apatite β-tricalcium phosphate, etc.), those of animal origin (bovine, porcine, etc.). of human origin (despecified if it comes from another person) or originated from the same person, or mixtures of these.

 If desired, such a biomaterial can be enriched with biological or biochemical osteogenic substances.

 As for the implants, they may have the form of either traditional implants to be screwed, or implants known to impact. In any event, according to the present invention, it is advantageous that the chosen implants have:

 A neck of larger dimensions than their body, in order to make it possible to stabilize the neck in a slightly smaller bore of the thin cortical bone, and / or

A modified end, in order to enable them to be fixed in the EIS, for example by axial screwing, transverse screwing, cementing or gluing, or by friction, or by a combination of these means, and / or • a non-cylindrical body intended to allow locking in axial antirotation with the EIS (eg regular or asymmetrical polygonal body, grooves, saw teeth, etc.).

 As for the mode of placement of such implants, it should be emphasized that these implants should simply be fixed "free" to the EIS, which is easily done, because the planned drilling allows the free passage of the body of the implant in the bore concerned. Once attached to the EIS, the implant (or each of the implants in case of plurality) is put in place appropriate impacts or percussion, the collar of the implant then stably housed in the undersized hole compared to the neck of the implant. The skilled person may in this regard use one of the connectivity among the dozen existing on the market for implants-pillars for prosthesis on the market.

 Traditional cylindrical or conical screw-in implants may be included in the EIS. Once secured, the implant / EIS assembly can be impacted with a mallet. This procedure will be facilitated if the neck of the implant is oversized relative to the body of the implant.

 With regard to the guide for drilling the lower cortical bone of the sinuses, it is optional as indicated above, but useful to guarantee the precision of the holes for the neck of the implant, and therefore the primary stability of the whole EIS / implants. In practice, a suitable drilling guide is integral with the replica of the EIS, and placed in the intrasinus cavity previously formed, for a satisfactory adaptation, while known drilling tools or the like, such as drills or drill bits, are used and implemented to achieve the holes.

In another optional variant, intended to secure even more securely the attachment of the entire implant, so the prosthesis that it is intended to support, is shifted upward through the central through bore for gripping the body of the EIS, such that this horizontal bore opens on the upper face of the body 10 of the EIS and allows an upper longitudinal opening of this bore and the penetration into said oblong bore of the filling material which, hardening during The healing of the site further stiffens the entire implant structure for dental prostheses. In addition, the roof of the EIS can then also be completed by an extension on its underside, turned towards the upper face of the base of the EIS, such as for example a vertical bar or bar elongated in the transverse direction, for the durability of the spacing. In another embodiment, constituting a first variant of the device and its accessories according to the first embodiment described above, it has been established that the aforementioned objectives, ie the exceptional reliability of the implant. by the addition of fixative EIS elements during the compression phase and after the healing phase, as well as others, can be achieved with a device and its essential components for fixation, on the upper jaw of a subject of dental implants using the devices and fixative elements described herein.

 In general, the device intended to ensure the fixation of one or more dental implants on the upper maxillary of a patient fundamentally comprises, for fixing in an intrasinus cavity made on said patient:

 At least one axially elongated implant 21 having, in the vicinity of its head, at least one connector zone 25 of advantageously circular, triangular, square, diamond-shaped, or polygonal cross-section designed to be able to receive by lateral sliding ( that is to say substantially perpendicular to the longitudinal axis of said implant) at least one fixing element 23, and also by axial sliding (that is to say parallel to the axis of the implant) at least one fixing element 22, as well as:

At least one fixing element comprising at least one element chosen from fixing elements 22 and 23 (hereinafter referred to as Intraspinal Elements, or abbreviated EIS) intended to be introduced into an intrasinusic cavity previously constituted by the production of a bone window through the lateral cortical bone and by lifting the lower and lateral membrane of the maxillary sinus, thus allowing the fixation of implants in the intrasinus cavity, at the right of the site on which one or more implants 21 must be fixed,

while said one or more fixative elements are selected from the group consisting of: Fixing EIS elements 23 designed and arranged to be able to be inserted by lateral sliding and tightly applied on at least a part of the lateral surface of an implant,

 Fixative EIS elements 22 designed and arranged to be able to be inserted by axial sliding and tightly applied on or near at least a portion of the head of an implant, and

 A combination of fixing EIS elements 22, 23 able to be interconnected, and which are configured and / or arranged so that they can be fixed to one another and possibly to one or more respective positions of the implant itself .

 Combinations of fixing EIS elements chosen from those of the types referenced 22, (22, 23) (23, 22) and 23, and any other combinations of fixing EIS are conceivable, with the further possibility that they are connectable. between them or not.

 Once they are properly inserted on the implant, said fixative EIS elements make it possible to prevent, resorb or reduce any displacement by rotation, translation and / or instability of fixation of said implant.

 Reference is made hereinafter to the embodiment shown in Figs. 6-10 of the accompanying drawings.

 In the following, "medial connectivity" means a connector which is neither on the head of the implant, nor at the opposite end thereof, but simply at any point along the body of said implant, even close to the head of said implant.

 The actual implants may be on a conventional basis. They are advantageously chosen from implants comprising an oblong, threaded, non-threaded or partially threaded body, and the implants comprising an oblong body, having grooves or the like allowing them to be impacted by means of a mallet.

In one embodiment, said implants may optionally, towards their distal end or head, that is to say the end that enters the sinus cavity, a structure having on its periphery, successively, two or more of two peripheral beads 24 succeeding along the side wall of said implant 21, said beads having any section and being intended to serve as a limit or abutment to receive the fixing element 22 and the fixing element or elements 23 intended to be inserted by lateral sliding movement, that is to say substantially transversely to the axis of the implant 21.

 At their distal end or head, said implants 21 advantageously have a flat or substantially flat cross section. A flat section has the advantage that it avoids protrusions directed towards the sinus membrane, and / or that it makes it possible to obtain a substantially flat surface during its opening at the surface of the upper plane, surrounding said distal end , the fixing element 22, once it is inserted on this distal portion of the implant, by sliding or translation along the longitudinal axis of the implant.

 In the direction from the distal end to the proximal end, the following two optional beads or pairs of beads 24 serve to delimit the zone in which the sliding or sliding of a fixing element 23 is to be effected. inserted laterally, over and along the appropriate section of the implant 21.

 The peripheral geometry of the zones thus defined between the aforementioned beads may be arbitrary. In practice, it is advantageous if it is a polygonal geometry or preferably of square cross section or even triangular, especially but not exclusively between the second and third of the aforementioned beads, although any other geometry suitable for a suitable sliding of the fixer element is also suitable.

 The said implants may be screw-type or impact type (that is to say arranged to be implemented by means of a mallet, by a striking action with it).

 The said implants may be made of various materials, in particular of metal, ceramic or zirconia, of polyetheretherketone type material called Peek (semi-crystalline thermostable thermoplastic polymer marketed by ICI), or others, in particular of any other material, biocompatible to be usable in the sinuses.

The fixing EIS element 22 is intended to be inserted by longitudinal sliding from top to bottom, that is to say parallel to the longitudinal axis of implant 21, from the distal end and in the direction of the proximal end thereof.

 In general, the first and second elements 22, 23 above are not a priori permutable. They may, however, be, provided that each comprises two male elements 26 distant, each to one of the two ends of the element forming the oblong implant, and in this case the nipple or extension (cylindrical, cylindrical- conical, or triangular cross-section, square, polygonal, or circular) of one of said elements is able to slid into one of the two respective cavities 27 of the other element, while in the other case the nipple or cylindrical extension of the other element remains free after insertion of said element by sliding on the appropriate area of the implant, which provides the additional synergistic advantage that said nipple or cylindrical extension remaining free can be inserted into the mass of material used for bone neoformation mentioned above.

 The device according to the invention may comprise a single implant 21, and a fixing element 22 and / or a fixing element 23 each single, or even only one of the two types of fixing elements only.

 The device according to the invention may, as a variant, comprise a set of several implants 21, as well as a fixing element 22 and / or a fixing element 23 that is multiple, or each single, or even only one of the two types of implant. fixative elements only.

 As an illustration, in the present description and the accompanying drawings, the number 28 represents orifices, through or blind, circular or polygonal, threaded or not, and which are adapted to receive fastening lugs or fixing screws.

 The assemblies thus recommended are, for example, joints of the tenon-mortise type, or more generally assemblies between male-female parts.

Said fixative EIS elements may have any shape, but they are preferably substantially parallelepipedal and have the specificities illustrated in the figures, in particular the protuberances 26 of connection and the recesses respectively through A and non-through C, as well as the orifices 28. In the present description and the appended drawings, the term "fixation" or "fixer" means the technical effect consisting of a firm retention of the parts concerned, either with each other or with respect to another part or part of the device according to the invention. However, these terms also mean and complementarily a positive retention and aggregation effect of the biomaterial powder subsequently distributed around the device according to the invention and in the anfractuosities thereof, which positively contributes to the integrity. and the stability of the whole.

 In the present description, the term "closely applied" is understood to mean the state in which the wall of the fixing element intended to be applied by lateral or longitudinal sliding on a suitable wall portion of the implant concerned, has a shape and an orientation adapted to closely match the shapes and orientations of the wall portion of the implant on which this sliding application will take place.

 To make all the elements 21 to 23 of this embodiment of the device according to the present invention functional, the implant 21 placed in a sinus cavity is inserted on the head B of the implant 21, depending on the options by lateral introduction an EIS 23 and or by axial insertion of an EIS 22. In doing so, the EIS 22 having a through orifice A of appropriate shape, size and orientation is slid over the head zone B of the implant 21 until it abuts on the appropriate face of the EIS 23 previously slidably placed on the implant 21, with the appropriate orientation. The protuberances 26 of the EIS 22 may be of any shape, but preferably cylindrical, cylindro-conical, or of triangular, square, polygonal or other cross section. The insertion of these protuberances 26 in the housings 27 of the EIS 23 can be performed by friction or clipping, among other securing means. These EIS elements can also be fixed with tenons and / or screws.

 Once such an assembly is made, cavities and niches appear, the presence of which is beneficial for the deployment and fixation on larger surfaces of the biomaterial for osteogenesis.

In the embodiment having two or more twin implants, the EIS inserted by lateral insertion can be secured, thus achieving effective and beneficial restraint. It should be noted here, and the following description will mount in more detail (with reference to the accompanying drawings) that, according to the embodiments envisaged, it is expected that one or other of the aforementioned fixing elements, or both of them are called to slide on the host wall of the implant (see in particular Figs 11-13). It should then be ensured that the receiving implant has an adequate wall, smooth or rough depending on the intended function, ranging from a simple fixation to a fixation with osseointegration, as well as the right of completion of the initial slide that the right displacement of the same fixing element by a further sliding along the wall of the implant (31), in one or other of the directions relative to the head thereof.

 In practice, said shape and orientation correspondences of the respective walls of the implant and of a fixing element intended to allow said walls to be applied closely to each other, are realized by an identity or a similarity of the shapes that are either flat, either concave or convex, and their orientations.

 More concretely and for purely illustrative purposes, in such a first embodiment of the invention, the implants have on their body and their ends at least one zone which may be, for example, non-cylindrical, of triangular cross-section. , square, rhombus, symmetrical or asymmetric polygonal, intended to receive a fixative element which can be inserted on the implant either axially (in the axis of the implant), or laterally (see Fig. 6 ), while each element 32 and 33 has an outer surface that can cooperate perfectly with the surface of the corresponding zone on the implant 31.

 The fixing element can be fixed on the implant by means such as, for example, tenons (for example transfixants, self-locking, etc.), or screws or others.

For a unitary implant, once the sinus membrane has been lifted, the implant is placed in the little bone of the sub-sinus cortex, most of the implant being exposed in the intrasinus cavity. . The implant is positioned so that the fixation hole looks at the bone window made in the lateral bone. Referring now to Figs. 11-13 which illustrate another alternative embodiment of the object of the present invention, it is seen that an implant 31 of known type is composed of a body and a cylindro-conical threaded head and provided with grooves or grooves or else substantially longitudinal slots 39 along a plurality of lines which are suitably distributed over the periphery of the head of the implant 31. According to the invention, a first fixing element 33 is introduced by lateral sliding, which is itself surmounted by an element for fixing from the top, along a longitudinal introduction axis with respect to the longitudinal axis of symmetry of the implant 31. In this case, the lateral fastening element 33 is advantageously "open", c ' that is to say that its peripheral wall is incomplete, preferably on a part of its periphery which corresponds substantially to 1/4 - 1/3 of the perimeter of said element. The implant itself then comprises a non-threaded narrowed zone 35 to allow the passage on its periphery of at least one laterally inserted open fixing EIS element and / or a longitudinal insertion fixing element, which are then longitudinally slid to reach the locking position resulting from the widening of the sliding wall, in practice of cylindro-conical shape.

 In the embodiment shown in FIG. 11, the assembly thus constituted, comprising the fixing elements 33 and 32 held together by one or more connecting bars 40, is thus introduced laterally, so that the upper member 32 passes laterally slightly above the vertex of the head of the implant 31. Once the element 33 is introduced to surround, but with play, the periphery of said implant over most of its surface intended to be applied to said implant, is lowered the the set of two fixing EIS elements 32, 33 and their connecting member 40, to a position ensuring a stability of the assembly, thus its stiffening.

It should be noted that, in practice, the fixing EIS elements 32 and 33 are, in this embodiment, preferably of annular shape (open with regard to the EIS intended to be introduced laterally) and advantageously provided on their inner side of pins (preferably four pins judiciously distributed) to facilitate the sliding and the maintaining the orientation of the fixing elements in functional combination with the longitudinal grooves or slots.

 Again, the EIS can be provided with orifices 38 for locking, intended to receive a stud or a screw that can pass through and reach a suitable hole provided in the implant 31.

 In an embodiment of the same type as the previous one, but comprising a set of two vicinal implants, a set of two fixing elements 32 joined together by a bracket on which is fixed, or which includes, an extension itself, is recommended. provided with through holes for easy gripping and placement, while said extension also provides an increase in volume to the EIS element fixer concerned. In this variant, the stability of the implants is thus reinforced by the dual and combined action of several fixing elements 32 introduced longitudinally (compression effect).

 In yet another embodiment illustrated in Figs. 14-15, the assembly according to the invention comprises an implant 31, and two fixing elements respectively 33 (for lateral introduction) and 32 (for axial insertion). The element 33 comprises a slot 37 intended to receive by introduction from top to bottom the tab 36 of the element 32, which itself comprises a through-hole, of square cross-section, intended to slide it on the head of the implant 31, whose dimensions must be adapted.

 As to the element shown in FIG. 16, it is an alternative embodiment of the element 33 of FIG. 14, which as seen is intended to group two fixing elements on the same bracket that joins two implants 31 vicinal. The securement of the fixing element 32 on one or the other of the two implants or both, as well as on this stem is then optional.

 The invention also relates to fixing elements or intrasinusal parts as described above, for lateral and / or axial insertion in relation to the respective devices and implants to which they are more particularly intended.

In general and in summary, the present invention makes it possible to: • during the bone neoformation phase of a duration of 4 to 5 months, - to increase the volume, increase the contact area,

 increase fixity

 implants, be they conical, cylindro-conical, or cylindrical, and thus obtain that the implants do not detach from the biomaterial used for bone neoformation, or even the low natural bone volume present at the neck of the implants, which is weak as indicated above;

• after the bone neoformation phase,

 increase the resistance to the rotational forces applied during the tightening of the prosthetic abutments,

 increase resistance to vertical and lateral chewing forces,

 increase the fixity of the implant (s).

 It follows that:

 the healing of the neoformed bone around the implants goes smoothly;

 the traction of the prosthetic abutments on these implants under a tightening of 25-35 newtons also goes smoothly;

 mastication involving large, vertical and lateral forces does not cause problems;

 the volume provided by the implant and its fixing elements increases very significantly the contact area with bone neoformation;

 when several implants are combined, the possibility of joining the bodies of these makes it possible to achieve a greater fixity by a restraining effect of the implants.

 Fixing elements may also have optional extensions (see Fig. 13 ref 41 and Fig 14, ref 36) which may be of various shapes, of various natures, and oriented in various directions. These extensions increase the volume and the ability to fix (or fix) implants.

In yet another embodiment of the subject of the invention, constituting a second variant of the device and its accessories as described above, it has been established that: Improvements to the above and other objects can be achieved with a system, a device and their essential components for attaching dental implants to the upper jaw of a subject, wherein the system or device includes (In addition to an optional device for drilling or drilling guidance - called a drill guide - with appropriate drills or drill bits to allow drilling of appropriate dimensions at the desired bone cortical site in the relevant portion of the maxilla; optionally a device (referred to as a gripping device) intended to facilitate the gripping of the EIS, also called EASA) and its joining with the implant (s):

 At least one axially elongated implant 51, comprising at least four zones of connectors designed to be able to firmly connect said at least one implant to said EASA and to the cortical bone,

while said at least four zones of connectors comprise, in the apical zone of said implant:

 (a) an upper stopper,

 (b) an upper antirotational zone,

 (c) a narrowed area usually referred to as a neck, of cylindrical, oval, square, polygonal or other cross-section, suitable for sliding insertion of the aforementioned EASAS and / or EASAI elements,

 (d) and / or a lower antirotational zone, and

 (e) and a lower stopper,

as well as, after the face of said lower stop stop opposite to the lower antirotational zone, a connector head capable of receiving, with known technical means, the dental prosthesis to be fixed, and

A set of intra-sinus elements (abbreviated EIS or EASA, respectively EASAS, 52 and EASAI, 53) able to be introduced into an intrasinusic cavity previously constituted by the production of a bone window through the lateral cortical bone and by lifting the lower and lateral membrane of the maxillary sinus, and secured to appropriate areas of said implant, so as to allow secure fixation of implants in the intrasinus cavity, at the site right on which one or more implants must be fixed, so as to be secured to said implant,

while said set of intra-sinus elements intended to be secured to the implant by mechanical anchoring and / or osteointegration, comprises:

 At least one element called Upper Antirotation Surface Enhancement Element 52 (abbreviated to EASAS),

 And / or at least one element called Lower Antirotation Surface Augmentation Element 53 (abbreviated E AS AI),

And, optionally, at least one wedging or holding element 54 capable of being attached to at least one of the aforementioned EASAS and EASAI, preferably interposed between them or attached to one of these, by lateral sliding along the face of said EASAS or EASAI opposite to that pressing on a stop or blocking stop (a, e),

 while said elements 52, 53 known as EASAS and EASAI are designed to be laterally slidingly insertable, then radially displaceable towards the distal end of the implant for EASAS or towards the proximal end of the implant. implant for the EASAI, with reference to the longitudinal axis of said implant, until they are locked against an abutment respectively towards the distal end and the proximal end of the implant, so as to leave a space which is able to be filled by the wedging element 54 aforesaid.

 In such a device, the EASA (ie EASAS and EASAI) thus fit first in the lateral direction, and then in the vertical or axial direction, within the limits of the space between the extreme holding stops against which they remain blocked.

 Alternatively, EASAS and EASAI elements can be interconnected directly and simply by reciprocal sliding and / or casing.

 The device thus described in broad outline falls within the scope of the general definition of the object described in the aforementioned prior French patent application.

More specifically, the invention relates to a system and device for enabling the attachment of implants to the upper maxillary of a subject, wherein said device comprises the functional elements. essential of the aforesaid system, except the drill guide and the gripping system.

 The invention also relates to a subset consisting of one or more units of each or some of the elements constituting one or other of the variants and embodiments of the device according to the present invention (advantageously, but not exclusively, combined in kits), including appropriate implant variants, as well as varieties of EASAS and / or EASAI and / or holding wedges, and if necessary various embodiments of an implant as described herein and have different angles of deflection or curvature (in practice between 5 and 30 ° angle, for the inclination of the longitudinal axis of the implant (see Fig. 25b) for better adaptation to individual situations to which the practitioner strives to provide the most appropriate solution.It should indeed be noted in this regard that, in some cases, the establishment of the implant can be generating, in the absence of special precautions s, deviations of the orientation angle of the implant, compared to the other teeth of the individual concerned. In these cases, it is therefore advantageous that, in accordance with the present invention, it is possible both to place an implant at the desired location, but also that the orientation of said implant can be controlled. so that one can control the orientation of the dental prosthesis thus installed on this implant, including the cases referred to here, which are the most delicate, where it is the upper maxillary.

 It should be noted that implants so angulated can be at their body, but not at the connection with the pillar near the gum.

 Indeed, unlike known implants with angulations of 10 ° to 30 ° at the connection with the abutment, implants thus angulated at their body according to the present invention make it even easier to install the device according to the invention in 50% of cases, even in the sinus cavity.

 In one embodiment of the present invention, the preferred implant has, compared with conventional or standard implants, five original parts in the apical zone, namely:

(a) an upper stopper; (b) an upper antirotational zone;

 (c) a narrowed zone, intended for the passage of the elements EASAS and / or EASAI, respectively, and whose length of the diameter or the greatest dimension in cross-section is less than the diameter of said elements, whether these are cylindrical, or of any other cross-sectional shape;

(d) a lower antirotational zone;

 (e) a lower stopper.

 This set of connection elements is, optionally, supplemented by one or more holding blocks 54, to be inserted by lateral sliding on the free face of the EASAS element and / or the EASAI element (52, 53). or simply on the free side of one of the two in the case where only one of them is used, in a simplified embodiment. Said holding wedge 54 is all the more effective if it has a U-shaped geometry suitable for allowing it to be slidably inserted around the narrowed zone (c) above, and this efficiency is advantageously reinforced by a slight taper, d appropriate orientation and scope, such as those skilled in the art will readily define on a case-by-case basis.

 As a variant, this taper facilitating and reinforcing the blocking of the aforementioned elements can be carried on the face of the EASAS and / or the EASAI receiving said holding wedge 54.

 Said holding wedge may further comprise, optionally, on one or both of its faces or both, grooves of any type (including slots, geometric structures such as square, triangular, rectangular structures, diamond-shaped, or other) selected as being able to cooperate with excrescences of the same shape and appropriate dimensions provided on the EASAS and / or EASAI (52, 53).

 In preferred and / or advantageous embodiments, which are in no way limiting, the system or device according to the invention optionally comprises, in combination or separately, as far as is technically possible, one and / or more of the characteristics and / or particularities:

In one embodiment, the stop abutments (a) above have a substantially constant diameter, and they are cylindrical (slices of cylinder). In another embodiment, the aforementioned stop abutments have a frustoconical cylindrical shape. In this case, the diameter of the section of the truncated cone on which the EASA element comes to bear after its displacement may advantageously be substantially identical to the diameter of the EASAS element and / or EASAI cooperating with this stop.

 As we have just mentioned, in either case, the stops have one or more outside diameters greater than that of the antirotational zone. Two possible diameters are mentioned here for a stop, when it can be of frustoconical shape, and in this case the diameter of the section of the truncated cone on which said EASA comes to bear after its longitudinal displacement ascending or descending. can be substantially identical to the smallest outside diameter of this stop.

 Said EASAS and EASAI elements respectively have substantially the shape of a wafer (see Fig. 18), in particular configured as that represented in FIG. 22b, optionally having protuberances.

 In an advantageous embodiment, said EASAS and / or EASAI have a notch through their thickness, but semi-through in the plane perpendicular to their main axis. In other words, these elements comprise a notch of sufficient width so that they can be threaded over the narrowed area intended for the passage of these elements, and said notch widens at its inner end (i.e. around the center of the EASAS or EASAI element concerned, so as to take a shape similar to that of the cross section of the antirotational zone cooperating with this element and dimensions slightly greater than those of the antirotational zone concerned).

• To promote at a lower cost an almost automatic blocking and nevertheless effective and easy to practice, EASAS and EASAI said elements, as well as the at least one holding wedge, it is recommended that at least one of the elements cooperating in this functionality has at least one suitable conicity, thus allowing a smooth progressive locking, by progressive jamming. • Stop abutments and associated antirotational zones can be confused, having a complementary conicity, if each has a conical cross-section and the smallest diameter of the abutment stop is identical to the diameter of the associated antirotational zone .

· The zone (c) can have a regular diameter and thus be of cylindrical shape, which then contributes to guiding the holding wedge, or on the contrary it can be non-cylindrical and in this case it helps to block the wedge holding in an antirotational position.

 In order to facilitate osseointegration, it is recommended to give the above-mentioned elements 52 and 53 dimensions (ie diameter and thickness) and / or extensions sufficient for the material used for this osteo- integration. integration can find a sufficiently large or complex geometry so that the particles generating this phenomenon can operate in the best way, and thus generate the most solid and efficient ossification possible.

 It is also preferred that the elements 54 have an outside diameter that is significantly smaller than that of the elements 52 and 53, in order to disengage a housing which also promotes osseointegration. As for the elements 52 and / or 53, it is possible to further increase their size and complexity by giving them larger contours and having overflows and / or roughnesses relative to their mean plane, thereby making them thicker and more eye-catching. Similarly, it is advantageous to increase the thickness of the abutment portion (a).

 In yet another embodiment of a secure implant according to the invention, illustrated in Figs. 26 to 29 herewith appended and providing a third variant of the object described above, the implant of the type of those described or mentioned above comprises:

 An implant 61, a portion 62 of which has a non-circular configuration, for example hexagonal, at the posterior end (that is to say opposite to that intended to penetrate the first inside the sinus cavity) the narrowed diameter portion 63 of the implant 61;

A hat-shaped piece 64 (views a and b in Fig. 27) intended to cap the intrasinus end of the implant 61 and comprising a central thread complementary to that of said intrasinus end of said implant, while the same piece 64 comprises, on its face intended to be turned towards the threaded head of the implant to the mounting, an extension of material in a direction perpendicular to its mean plane, of non-circular cross section and advantageously in the form of a parallelepipedal flat surface 66 (preferably in the form of a matchbox whose connection face under said cap or roof is a narrow side, traversed at its center by the same threaded hole which passes through the piece 64 at its center and is intended to receive by screwing the threaded end of the implant 61); and

A piece 65 as shown in schematic section and in perspective view in FIG. 28 (a and b), having a substantially cylindrical geometry, wider than high, that is to say a diameter greater than its height. It may optionally be cylindro-conical in the inner part of its periphery (in order to facilitate locking it on the implant 61 if desired), by locking on the non-cylindrical part and of corresponding geometric shape 62, reserved for this insertion. Alternatively, the taper intended to facilitate said blocking can be provided by the outer profile of the implant having a narrowed diameter and a non-circular perimeter adapted.

 This piece 65 preferably has the general shape of a hollow cylinder, possibly slightly flared due to a suitable conicity provided by a generatrix slightly inclined relative to the longitudinal axis of said cylinder, while its flat transverse face intended to lock on the aforesaid portion 62 (hexagonal in the example shown) is full, with the exception of the central cutout 67 (having the same profile as the portion 62 of the implant), while the periphery of the cylinder is advantageously perforated by less a cutout 68, of any shape and size, intended to facilitate the desired bone formation.

 Optionally, the hat member 64 may have a rounded edge or cut sides, to provide on its upper face or the peripheral portion thereof a convex profile to prevent this element 64 harm in any way either to the sinus membrane.

Optionally, the free circular edge of the hat member 64 can be lowered on a circular ring between its inner diameter and a median diameter, to define outside of this ring a flange for accommodating the lid or roof aforesaid, provided that the diameter outside of the piece 64 is in this case equal to or slightly less than the median diameter aforesaid.

 Blockage in rotation of the workpiece 64 is fully completed once the bone formation induced after implantation in a patient is accomplished.

In general, for the implementation of the device object of the invention, one operates substantially as indicated below.

 In general and for illustrative purposes, in one embodiment of the implementation technique implementing a system or a device according to the invention, the implementation / installation steps advantageously comprise the following phases:

at. In order to implement the surgical procedure described here, a bone window is made through the lateral cortical bone without damaging the lateral membrane of the maxillary sinus (this technique is known and constitutes the beginning step for a sinus lift).

b. Through this bone window, the lower (and lateral) membrane is gently raised with known instruments.

vs. The volume and configuration of the created ntrasinus cavity are evaluated.

d. We test some replicas of EIS, developed so that they are suitable for each case encountered, and then place the chosen replica, provided with its cortical drilling guide.

e. The piercing (s) is carried out with drills or known drill bits. f. The selected EIS is placed in the intrasinus cavity by means of its grasping instrument.

boy Wut. The implants are freely attached to the EIS, with regard to the drilling diameter greater than the diameter of the body of the implant (s).

h. An external bar is then placed on the implants to orient the implant and EIS body rotation system, and the body of the EIS is slid over the body of the flat part (s). blockage of the assembly (in antirotation).

i. The EIS / implant (s) assembly is impacted either with a manually operated surgical mallet or with an automatic mallet that is actuated by a motor. j. The filling material is packed gently and carefully, k. If desired, the fixation can be completed by using one or more screws ensuring the transfixation between the EIS and the surrounding bone of the sinus.

 Thus, the neck of the implant or of each implant is maintained by the cortical bone because the diameter of the bone piercing is less than the diameter of the neck of the implant.

 The EIS can be of any form. In practice, a parallelepipedic EIS is preferred, advantageously chamfered or rounded at its edges and / or on one or more of its edges.

k. If desired, the fixation can be completed by using one or more screws for transfixing between the EIS and the implant provided with appropriate orifices.

 In practice, it is advantageous for the diameter of the neck of the implants to be greater by a few tenths of a millimeter than the diameter of the bore of the cortical bone.

 Referring to a nonlimiting example of the embodiment illustrated in FIG. 2, the following steps are recommended for a unitary implant:

 • arrange the two parts 10 and 11 of the EIS,

· Place the assembly in the sinus, for example by means of a forceps,

• screw "freely" the implant,

 Aligning the flats between the EIS and the implant, and sliding the EIS by sliding on the body 7 of the implant,

 • impact the necks of the implants in the cortical bone,

· If desired, set a wedge to complete the blockage between the two pieces 10 and 11 of the EIS, and

 • fill the sinus cavity with the biomaterial.

 For two or more implants,

a ') placing the roof and the body of the EIS in the sinus cavity with a forceps,

b ') freely screw the implants to the EIS (roof),

c ') placing the bar or footing to align the antirotational systems of the EIS body and the implant body, and slide the body of the EIS on the body of the implant,

d ') impact the EIS / implant / bar assembly with a mallet, e ') introduce the biomaterial to fill the residual vacuum in the sinus.

With the implants thus produced in accordance with the invention, a compression is achieved by the combination of the effects of the filler material of the lower back of the maxillary sinus of the paired subject and of the intrasinusic element (EIS). or EASA) which, while providing its own effects, increases the contact area between the implant and said filling material. This effect can not be achieved with current sinus lift techniques.

 The EASA can thus, by combining several interconnected elements, reveal empty spaces that will be filled by the filling material, thus by the future bone that will result after its formation; it should be emphasized in this connection that said EASA may also have holes intended to let pass transfixation screws able to anchor on the bone wall that separates the maxillary sinus surrounding elements.

 These EASA, whether monobloc or not, have cavities, or vertical or horizontal functional holes, and can be made by machining, casting, or sintering, or by computer-aided design operations, or by 3D printing.

 The biomaterial used for filling the intrasinus cavity can be chosen from the synthetic materials conventionally used in this field (calcium, hydroxy apatite β-tricalcium phosphate, etc.), those of animal origin (bovine, porcine, etc.). of human origin (despecified if it comes from another person) or originated from the same person, or mixtures of these.

 If desired, such a biomaterial can be enriched with biological or biochemical osteogenic substances.

 As for the implants, they may have the form of either traditional implants to be screwed, or implants known to impact.

 Said implants and the associated functional devices may be made of titanium, titanium alloy, ceramic, zirconia, Peek, or any other biocompatible and osteo-integrable material.

Traditional cylindrical or conical screw-in implants can be screwed onto the EASA. Once secured, the implant / EASA assembly can be impacted by means of a mallet. This procedure will be facilitated if the neck of the implant is oversized relative to the body of the implant. With regard to the guide for drilling the lower cortical bone of the sinuses, it is optional as indicated above, but useful to guarantee the precision of the holes for the neck of the implant, and therefore the primary stability of the whole EASA / implants. In practice, a suitable drilling guide is integral with the EASA replica, and placed in the previously formed intrasinus cavity, for satisfactory adaptation, while known or similar drilling tools, such as drills or drill bits, are used and implemented to make the holes.

 In practice, it is advantageous for the diameter of the neck of the implants to be greater by a few tenths of a millimeter than the diameter of the bore of the cortical bone.

 On the basis of the foregoing indications and of its own knowledge, the skilled person is able to choose and / or adapt the constituent elements of the device and the system, their dimensions and their constituent materials, as well as their accessories and connection elements. to meet different needs and the specific implementation conditions that it may be confronted with, in the context of the system and devices according to the invention.

 Those skilled in the art will readily understand that the implementation of the present invention provides undeniable advantages and remarkably significant progress over the techniques currently known and practiced in the field concerned.

 Thus, by means of the technique according to the invention, it is possible to achieve substantial savings, to simplify, and to make the procedures involved in the process phases particularly ergonomic, and to achieve particularly remarkable, exceptionally stable dental implants. and durable.

Claims

 Device for the fixation of dental implants on the upper jaw of a subject comprising a device hereinafter referred to as the Intra-Sinusic Element, or abbreviated EIS, intended to be introduced into an intrasinusic cavity (4) previously constituted by the production of a bone window through the lateral cortical bone (2) and by lifting the lower and lateral membrane (3) of the maxillary sinus, thus allowing the fixation of implants in the intrasinus cavity (4), in line with the site on which one or more implants must be attached,

 characterized in that the elongate implant (6; 21; 31; 51; 61) comprises at least four zones of connectors adapted to be able to firmly connect said at least one implant to said EIS and the cortical bone, said at least four implant connector areas including:

 . a threaded end or not, to secure the implant with the EIS,. a cylindrical or frustoconical neck (8) whose average diameter is substantially greater than that of the hole resulting from the drilling in the cortical bone for the stable fixation of the implant,

 . between said neck and said end, an axially extending intermediate portion (7; 25; 51c; 62) having in cross-section a non-cylindrical, polygonal, preferably hexagonal geometry, and at the end of said collar opposite to said intermediate portion, a connector head (11) for receiving, with appropriate technical means, the dental prosthesis to be fixed.

Device according to claim 1, characterized in that it comprises:

At least one axially elongated implant (21) having, in the vicinity of its head, at least one connector zone (25) designed to be able to receive by lateral sliding at least one fixing element (23), and / or by axial sliding at least one fixing element (22), as well as:

At least one fixing element comprising at least one element chosen from fixing elements, abbreviated EIS fixators, (22) and (23) intended to be introduced into an intrasinusic cavity previously consisting of the realization of a bone window through the lateral cortical bone and by lifting of the lower and lateral membrane of the maxillary sinus, thus allowing the fixation of implants in the intrasinus cavity, in line with the site on which one or more implants (21) must be attached,

 while said one or more fixative elements are selected from the group consisting of:

 Fixing EIS elements (23) designed and arranged to be able to be inserted by lateral sliding and tightly applied on at least a part of the lateral surface of an implant (21),

 Fixing EIS elements (22) designed and arranged to be able to be inserted by axial sliding and tightly applied on or near at least a portion of the head of an implant (21), and

A combination of fixable EIS elements (22, 23) capable of being interconnected, and which are configured and / or arranged to be able to be fixed to one another and possibly to one or more respective positions of the implant (21) proper.

Device according to claim 1, characterized in that it comprises: • at least one implant (51) axially elongated, comprising at least four zones of connectors designed to be able to firmly connect said at least one implant to an Augmentation Element of the Antirotation Surface, called EASA and the cortical bone, while said at least four zones of connectors comprise, in the apical zone of said implant:

 (a) an upper stopper,

 (b) an upper antirotational zone,

 (c) a narrowed area usually referred to as a neck, of cylindrical, oval, square, polygonal or other cross-section, suitable for sliding insertion of the aforementioned EASAS and / or EASAI elements,

 (d) and / or a lower antirotational zone,

 (e) and a lower stopper,

as well as, after the face of said lower stop stop opposite to the lower antirotational zone, a connector head adapted to receive, with appropriate technical means, the dental prosthesis to fix, and

 A set of intra-sinus elements, abbreviated as EIS or EASA, respectively EASAS (52) and EASAI (53), capable of being introduced into an intrasinusic cavity previously constituted by the production of a bony window through the cortex lateral bony and by lifting the lower and lateral membrane of the maxillary sinus, and secured to appropriate areas of said implant, so as to allow secure fixation of implants in the intrasinus cavity, at the site where one or more implants must to be fixed, so as to be secured to said implant,

while said set of intra-sinus elements intended to be secured to the implant by mechanical anchoring and / or osteointegration, comprises:

 At least one element referred to as the Greater Antirotation Surface Augmentation Element (52), abbreviated EASAS,

 And / or at least one element referred to as the Lower Antirotation Surface Augmentation Element (53), abbreviated EASAI,

while said elements (52, 53) called EASAS and EASAI are designed to be laterally slidable and then radially displaceable towards the distal end of the implant for EASAS or towards the proximal end of the implant for EASAI, with reference to the longitudinal axis of said implant, until they are locked against an abutment respectively towards the distal end and the proximal end of the implant, so as to leave a space which is able to be filled by the wedging element (54) aforesaid.

Device according to claim 1, characterized in that it comprises:

An implant (61), a portion (62) of which has a non-circular, e.g., hexagonal, configuration at the posterior end of the narrowed diameter portion (63) of the implant (61);

A hat-shaped piece (64) intended to cap the intrasinus end of the implant (61) and having a thread central, complementary to that of said intrasinus end of said implant,

while the same piece (64) comprises, on its face intended to be turned towards the threaded head of said implant assembly, an extension of material in a direction perpendicular to its mean plane, of non-circular cross section and advantageously in the form of a parallelepipedal flat (66) traversed at its center by the same threaded hole which passes through the workpiece (64) at its center and is intended to receive by screwing the threaded end of the implant (61); and

A part (65) having a substantially cylindrical geometry, of diameter greater than its height, said part (65) having the general shape of a hollow cylinder, while its flat transverse face intended to lock on the part (62) aforesaid is full, with the exception of the central cutout (67) having the same profile as the portion (62) of the implant, while the periphery of the cylinder is advantageously perforated by at least one cutout (68), of shape and of any size, to facilitate bone neoformation.

Device according to claim 1, characterized in that it comprises several, preferably two implants (6) vicinal and a connecting piece (9), said sole or bar, interconnecting the respective heads (11) of each of said implants, at the distal end intended to remain outside the sinus cavity (4) after implantation.

Device according to claim 1, characterized in that it is arranged to allow the attachment of a single implant (6), and it comprises an EIS pierced with a single threaded or partially tapped hole.

Device according to any one of claims 1, 5 and 6, characterized in that it comprises an EIS designed in two parts (10,12) intended to be joined together, and respectively constituting the body of the EIS and a roof or cap intended to bear on said body of EIS and to be secured thereto by thrusting through the intermediate portion of the EIS and the continuation of said pushing into the corresponding threaded or partially tapped bore provided in the roof / cap of said EIS.

Device according to any one of claims 1 and 5-7, characterized in that the EIS intrasinusien element comprises two parts (10,12) disjoint and nestable, the first part being a block of oblong shape and having any contours, advantageously smooth and preferably with rounded edges, perforated by longitudinal bores suitable for traversing the implants to be fixed, and a bore or a transverse blind hole intended to facilitate the gripping of said EIS, while the second part of said EIS is a roof piece or cap by fitting above said first portion, and comprises one or more blind hole holes having a polygonal cross section corresponding axially substantially to the polygonal contour of said intermediate portion of the implant.

Device according to claim 8, characterized in that the respective lengths of the different successive parts of said implant are adapted to those of the bores of the two parts of the EIS, while reserving the faculty of a back-sliding of the distal part on the intermediate part when screwing the distal part of the implant to the threaded bore of the part of the EIS forming roof.

Device according to any one of claims 1 and 5-9, characterized in that the EIS intrasinusal element is of elongated shape, with its largest dimension oriented in the vertical direction for a single implant, and in the anteroposterior direction. in the case of placing several implants together in the same sinus cavity.

Device according to any one of claims 5-10, characterized in that the intrasinusian element EIS has substantially the shape of a parallelepiped, preferably a rectangular parallelepiped. Device according to any one of claims 1 and 5-11, characterized in that said EIS has artifices, such as grooves, cavities, holes and providing structures such as filaments, intended to increase its retention in the filling material.

Device according to any one of claims 1 and 5-12, characterized in that said EIS further has holes for passing through the transfixation screws capable of anchoring on the bone wall which separates the maxillary sinus of the bony palate of the subject after implantation.

Device according to any one of claims 1 and 13, characterized in that it is monobloc and / or has cavities, or vertical or horizontal functional holes, and is produced by techniques selected from: machining, casting, sintering, computer-assisted design operations, or 3D printing.

Device according to any one of claims 1 and 13, characterized in that the body of the EIS comprises in its interior a female antirotational structure that can slide freely and without blocking on the male antirotational structure of the roof of the EIS, and can slide and lock at the end of the race on the male antirotational structure of the body of the implants (6), this non-cylindrical antirotational structure being constituted by a polygonal and / or sawtooth geometry, and / or by means of grooves, or excrescences, or a regular or asymmetrical geometry.

Device according to Claim 2, characterized in that it comprises combinations of fixing EIS elements chosen from those of the referenced types (22) and (22, 23) and (23, 22) and (23).

Device according to any one of claims 2 and 16, characterized in that said connection zone (25) has a circular, triangular, square, diamond or polygonal cross section. Device according to any one of claims 2 and 16-17, characterized in that the implants (21) have on their body and / or their ends at least one zone which may be non-cylindrical, of triangular cross section, square, in rhombus or polygonal, symmetrical or asymmetrical, intended to receive a fixing element which can be inserted on the implant (21) either axially or laterally.

Device according to any one of claims 2 and 16-18, characterized in that the implants (21) have optionally, towards their distal end or head, that is to say the end which enters the sinus cavity , a structure comprising on its periphery, successively, two or three peripheral beads (24) succeeding one another along the side wall of said implant, said beads having any section and being intended to serve as limit or abutment for receiving a fixing element (23) to be inserted by lateral sliding movement, that is to say substantially transversely to the axis of the implant (21).

Device according to any one of claims 2 and 16-19, characterized in that said implants have from their distal end at least three beads (24) constituted by a first peripheral bead at a suitable distance to serve as a stop. a fastener element (22) inserted axially, said first bead being followed by at least two other peripheral beads defining two by two zones (25) into which insert elements (23) are inserted laterally.

Device according to claim 20, characterized in that the peripheral geometry of the zones (25) thus defined between said beads (24) is polygonal, preferably of square or triangular cross section.

22. Device according to any one of claims 2 and 16-21, characterized in that said implants are metal, ceramic or zirconia, or polyetheretherketone type material, which is a thermostable thermoplastic semicrystalline polymer.

23. Device according to any one of claims 2 and 16-22, characterized in that the possible assemblies between fixing elements are of the type mortise-tenon, or assemblies between parts male-female.

24. Device according to any one of claims 2 and 16-23, characterized in that the implant and / or the fixing elements comprise orifices, through or blind, circular or polygonal, threaded or not, said orifices being adapted to receive fastening lugs or fixing screws. 25. Device according to any one of claims 2 and 6-24, characterized in that the implant (31) comprises a non-threaded narrowed area (39) to allow the passage on its periphery of at least one fixing element (33) open introduced laterally. 26. Device according to any one of claims 2 and 16-25, characterized in that said fixing elements are substantially parallelepiped and provided with protrusions (36) of connection and recesses respectively through (A) and non-through (C ), as well as orifices (38).

27. Device according to any one of claims 2 and 16-26, characterized in that the implant (31) host has a wall (35) adequate, smooth or rough according to the intended function, ranging from a fixation simple to fixation with osseointegration, both at the completion of the initial sliding and the right of displacement of the same fixing element by additional sliding along the wall of the implant (1), in one or the other of the directions relative to the head of it. Device according to claim 3, wherein said device further comprises at least one wedging or holding element (54) adapted to be attached to at least one of the EASAS and EASAI above, preferably interposed between them or attached to the one of these, by lateral sliding along the face of said EASAS or EASAI opposite to that pressing a stop or stop block (a, e).

Device according to claim 28, wherein said EASAS and EASAI elements are interconnected directly and simply by reciprocal sliding and / or casing.

Apparatus according to any one of claims 3 and 28-29, wherein the implant has five parts in the apical zone, namely:

(a) an upper stopper;

 (b) an upper antirotational zone;

 (c) a narrowed zone, intended for the passage of the elements EASAS and / or EASAI, respectively, and whose length of the diameter or the greatest dimension in cross-section is less than the diameter of said elements, whether these are cylindrical, or of any other cross-sectional shape;

 (d) a lower antirotational zone;

 (e) a lower stopper.

Device according to any one of claims 3 and 28-30, wherein said set of connection elements is completed by one or more holding blocks (54) to be inserted by lateral sliding on the free face of the EASAS element. and / or the EASAI element (52, 53), or simply on the free face of one of the two in the case where only one of them is used.

Apparatus according to any one of claims 3 and 28-31, wherein said holding wedge (54) has a U-shaped geometry suitable to allow its sliding insertion around the narrowed area (c) above, possibly with a slight taper, of appropriate orientation and magnitude to facilitate blocking.

Device according to any one of claims 3 and 28-31, wherein said holding wedge comprises, on one or both of its two faces, grooves of any type, in particular slots, geometric structures such as square, triangular, rectangular, diamond-shaped or other structures chosen to be able to cooperate with protuberances of the same shape and appropriate dimensions provided on the EASAS and / or EASAI (52, 53).

Device according to claim 3, wherein said stoppers have a frustoconical cylindrical shape.

Device according to claim 3, in which said stops and the associated anti-rotating zones merge, having a complementary conicity, each having a conical cross section and the smallest diameter of the stopper being identical to the diameter of the associated antirotational zone.

Device according to any one of claims 3 and 28-35, wherein, in order to facilitate the osseointegration, the elements (52) and (53) have dimensions, that is to say diameter and thickness, and / or extensions capable of allowing the particles generating this phenomenon to generate solid and efficient ossification.

Device according to any one of claims 3 and 28-36, characterized in that said implant and its associated elements are made of titanium, titanium alloy, ceramic, zirconia, Peek, or any other biocompatible and osteointegrable material.

38. Device according to claim 4, wherein the hat member (64) has a rounded edge or cut-off. Device according to one of claims 4 or 38, wherein the free circular edge of the cap member (64) is lowered on a circular ring between its inner diameter and a median diameter, to define outside of this crown a flange for receiving the cap, provided that the outer diameter of the piece (64) is in this case equal to or slightly less than the aforesaid median diameter.

Device according to any one of claims 1 to 39, characterized in that said elements intended for fixing intrasinusian element comprise means for enabling them to prevent, reduce or reduce any displacement by rotation, translation and / or instability of fixing said implant.

Apparatus according to any one of claims 1 to 40, wherein said implant has bending or bending angles at the body between 5 and 30 ° of angle, preferably between 10 and 30 ° of angle, for the inclination of the longitudinal axis of the implant for better adaptation to individual situations.

Device according to any one of claims 2 and 41, characterized in that it comprises a single implant (31), and a fixing element (32) and / or a fixing element (33) each unique.

System according to any one of claims 1 to 42, characterized in that it further comprises:

 A device for guiding drilling or drilling, called a drill guide, provided with drills or drill bits suitable to allow drilling of appropriate dimensions on the site of the desired bone cortex in the relevant portion of the upper jaw; and or

A device, called a gripping device, intended to facilitate the gripping of the EIS and its attachment to the implant (s). Implant of the device according to any one of claims 1 and 5- 42 or the system according to claim 43, characterized in that said implant (6) comprises at least one element chosen from:

 A neck (8) of larger dimensions than their body (7), in order to make it possible to stabilize the neck in a slightly smaller bore of the thin cortical bone,

 A modified end, in order to enable them to be fixed in the EIS, for example by axial screwing, transverse screwing, cementing or gluing, or by friction, or by a combination of these means,

 A non-cylindrical body (7) intended to allow axial anti-rotation locking with the EIS, in particular by means of a regular or asymmetrical polygonal body, grooves and / or saw teeth.

Kit of elements for fixing dental implants on the upper jaw of a subject, characterized in that it comprises a device according to any one of claims 1 to 42, and a biomaterial (5) used to the filling of the intrasinus cavity (4) and chosen from synthetic materials such as calcium, hydroxyapatite Ca ₄ (Ca, F) (PO ₄ ) ₃ , etc.), those of animal origin or those of human origin, despecified if it comes from another person or originates from the same person, or mixtures of these.