WO2019210373A1 - Système et appareil d'ajustement de prothèses dentaires - Google Patents

Système et appareil d'ajustement de prothèses dentaires Download PDF

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Publication number
WO2019210373A1
WO2019210373A1 PCT/AU2019/050410 AU2019050410W WO2019210373A1 WO 2019210373 A1 WO2019210373 A1 WO 2019210373A1 AU 2019050410 W AU2019050410 W AU 2019050410W WO 2019210373 A1 WO2019210373 A1 WO 2019210373A1
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WO
WIPO (PCT)
Prior art keywords
guide
dental
implants
drilling template
dental prosthesis
Prior art date
Application number
PCT/AU2019/050410
Other languages
English (en)
Inventor
Philip Leong Biow Tan
Original Assignee
Philip Leong Biow Tan
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from AU2018901518A external-priority patent/AU2018901518A0/en
Application filed by Philip Leong Biow Tan filed Critical Philip Leong Biow Tan
Publication of WO2019210373A1 publication Critical patent/WO2019210373A1/fr

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Classifications

    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y80/00—Products made by additive manufacturing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/08—Machine parts specially adapted for dentistry
    • A61C1/082—Positioning or guiding, e.g. of drills
    • A61C1/084—Positioning or guiding, e.g. of drills of implanting tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0004—Computer-assisted sizing or machining of dental prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/225—Fastening prostheses in the mouth
    • A61C13/26—Dentures without palates; Partial dentures, e.g. bridges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/34—Making or working of models, e.g. preliminary castings, trial dentures; Dowel pins [4]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0048—Connecting the upper structure to the implant, e.g. bridging bars
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0089—Implanting tools or instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0093—Features of implants not otherwise provided for
    • A61C8/0095—Total denture implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/176—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the jaw

Definitions

  • the present invention relates to dental prostheses. More specifically, the invention relates to a method and system for aligning dental implants to fit with a dental prosthesis. The method and system are applicable to fitting dental prostheses in the upper jaw and the lower jaw.
  • the typical process involves planning the size,
  • the patient treatment process typically also involves preparing the prosthesis site by removing teeth, stripping back the gums and trimming the underlying bone to fit neatly with the prosthesis.
  • the next step is to fix implants in the bone at the intended locations and orientations thus completing the surgical phase of treatment.
  • Measurements are then taken of the actual implant locations and orientations once they are fixed in the bone. These measurements are used to prepare the dental prosthesis so that the fixing points on the prosthesis accurately align with the dental implants.
  • the step of measuring the actual location and orientation of the dental implant is required because the fixing points on the dental prosthesis need to be aligned accurately, typically within 10 pm, of the required location and orientation. If the dental implant is not prepared precisely enough, the screws passing through the fixing points on the prosthesis and into the dental implants will impart internal tension in the dental prosthesis and on the dental implants which can affect the healing process and long-term health.
  • the planning stage involves preparing a drilling template that includes a series of drill guides.
  • the drill guides are located and oriented to guide a drill operated by a surgeon so that the drill forms a pilot hole at the required location in the bone for fixing a dental implant at an intended location and orientation according to the plan.
  • Each drill guide comprises a short metal tube, such as a titanium alloy tube, having a standard internal circumference.
  • a drill sleeve is located within the drill guide and a drill bit passes through the drill sleeve and into the bone. It follows that the location and orientation of the drill guide controls the location and orientation of a hole formed by the drill.
  • the drill guides are incorporated into the drilling template, which typically comprises a material that is different to the titanium alloy of the drill guides.
  • the body of the template may be formed of milled titanium alloy or 3-D printed plastics.
  • the template body is formed to match landmark features (e.g. teeth) around the site of the dental prosthesis so that the drill guides can be located at the intended locations according to the plan.
  • the applicant has recognized that there are two challenges to ensure accurate placement of dental implants.
  • the first challenge relates to the relationship between the dental implants and the dental prosthesis. This is a function of the inter-implant spatial relationship.
  • the second challenge relates to the relationship between the dental implants and the patient’s mouth. This is a function of the global implant spatial relationship.
  • the first challenge inter-implant spatial relationship
  • poor alignment between the fixing points on the prosthesis and the dental implant may cause the screws on the prosthesis passing through the fixing points not to match with the dental implants and, as a subsequence, failure of the prosthesis to be secured to the implants.
  • One option for addressing the problem of misaligned drill guides has been to form the dental prosthesis with larger holes through the fixing points to provide a small amount of freedom when the screws and their corresponding abutment are tightened in the implant to fix the dental prosthesis.
  • the freedom allows a dental prosthesis to be accurately positioned and to avoid internal tensions, but the freedom must be resolved by applying glue to the abutment and screws in the fixing points to securely fix the dental prosthesis once it is properly located. There is a risk that the glue will work loose overtime and, therefore, will make the dental prosthesis at least uncomfortable and possibly ineffective. There is also a risk that the placement of the glue could contaminate the dental implant and cause failure of the dental implant to achieve integration with the bone. The addition of the glue also adds time to the procedure which can create additional opportunity for complications with the anesthetic used during the surgery. Therefore, such dental prosthesis does not fulfil the requirements for longer term use.
  • the adjustable connection comprises a variable washer located on the top and bottom of each fixing point, where each washer comprises the first annular part having a domed shape and a complementary annular seat that receives the domed shape of the first annual apart.
  • the adjustable connections are not suitable for dealing with the more complex arrangements of dental implants in the upper jaw where the orientation of the implants varies significantly from one to the next.
  • the dental prostheses prepared with the adjustable connections are limited to a maximum of three fixing points. Again, this makes the adjustable connections unsuitable for dental prostheses for the upper jaw where three fixing points is the minimum number for achieving the correct alignment of the dental prosthesis and with the fixing forces spread relatively evenly amongst the dental implants.
  • this technique requires the adjustable component to be welded to lock the dental prostheses into place prior to being fully functional. This adds an additional step to the process making the process inconvenient for the patient.
  • the second challenge to ensure accurate placement of dental implants and prosthesis is the correct positioning of the dental implants within the patient’s mouth (global implant spatial relationship) so that the dental prosthesis has the correct 3D relationship to any remaining teeth, the jaw bone and the soft tissue structures such as the gums, and the face.
  • Obtaining an incorrect relationship of the dental implants within the patient could lead to the dental prosthesis not having the correct dental occlusion or the incorrect vertical dimension for the face or a dental prosthesis misalignment may result in a smile with crooked or canted teeth. It is imperative, therefore, to correctly translate the overall location of the dental implants within the patient.
  • the drilling guides are mass produced and, therefore, do not always have a consistent internal circumference that fits snugly with the drill sleeves with one result being that there can be a degree of freedom of movement between the sleeves and the drilling guide and the drill bit is not always accurately aligned with the longitudinal axis of the drilling guide.
  • incorporating the pre-formed drilling guides into the drilling template introduces inaccuracies because the act of embedding the drilling guides in another material is difficult to control and can result in the drilling guides being misaligned from their planned location and orientation within the drilling template.
  • inaccuracies arise from the milling and 3-D printing of the drilling template so that it is not a precise representation of the plan.
  • dental prostheses are typically made on machines that are different to the machines that prepare the drilling template. It follows that the inaccuracies introduced into the drilling template are not replicated in the dental prosthesis, but instead different inaccuracies are introduced which compound the misalignment of fixing points and dental implants.
  • dental prostheses may be formed by
  • incorporating preformed metal guides having a specific location and orientation which aligns with the dental implants.
  • the applicant has found that incorporating preformed materials into another material is very difficult to do with a high level of precision required for aligning dental prosthesis with dental implants.
  • some implant systems provide the implant delivery mount equipped only with visual indicators for the vertical position. These visual systems rely upon the visual acuity of the surgeon, which is not consistent from surgeon to surgeon. Additionally, these visual systems do not take in account requirements for different implant locations. For example, it is easier to visualize reference points at the front of the mouth compared to the back of the mouth. Inconsistencies in visual evaluation will then lead to inconsistencies in vertical positioning, which in turn will affect the inter- implant spatial relationship.
  • the software program used for planning the virtual position of the implants is different from the software program used to design the dental prosthesis and its fixing points. While the software may be supplied by the same manufacturer, there may be differences between the virtual dental implant position and dental prosthesis fixing point because the programs were created by different individuals or teams of individuals. The software programs may also be written in a different computer language which could further impart subtle changes. These changes could affect different implants to a different degree. Again, compensations need to be made to negate the effect of these differences.
  • the applicant has realized that the high degree of precision can be provided by using two surgical guides and additional optional accessories depending on the implant system used.
  • the invention provides a method of aligning dental implants to fit a prefabricated dental prosthesis, the method comprising:
  • the method may comprise mounting a first guide on a patient’s jaw, releasably securing the first guide to a patient’s jaw with at least one anchor pin received in at least one reference hole of the first guide and preparing the patient’s jaw for the insertion of the implants.
  • the drilling template may be at least partially embedded in a carrier to form a second guide, the carrier comprising at least one reference hole for receiving at least one anchor pin therein for releasably secure the carrier to a patient’s jaw, and wherein the at least one reference hole of the first guide and of the second guide are substantially in the same position relative to the patient’s jaw.
  • the first guide is used for marking reference holes and guiding bone reduction to ensure global implant spatial relationships are correct.
  • the second guide utilizes the same reference hole position and adds additional channels for guidance of the dental implants for the correct inter-implant spatial relationship.
  • the method comprises:
  • the second guide may comprise the carrier and the drilling template formed as a unitary body of the one material.
  • the method according to the first aspect may include prefabricating the dental prosthesis based on the intended location and orientation for the implants.
  • Prefabricating the dental prosthesis may comprise:
  • the bridge (i.e. a chassis) of the dental prosthesis may also be formed as a unitary body of the one material.
  • the applicant proposes forming the drilling template and the bridge without utilizing preformed drill guides or inserts. This enables the fabrication process for the drilling template and the bridge to utilize a higher degree of precision in preparing the drill guides and the fixing points.
  • the materials of the drilling template and the bridge may be the same or different materials.
  • the applicant anticipates contributing to the higher degree of precision by forming the drilling template and the bridge on the same machinery so that the same system inaccuracies are
  • the invention also provides a drilling template for aligning dental implants to fit a prefabricated dental prosthesis, the drilling template comprising a unitary body which includes guide channels that guide drilling of pilot holes with sufficient accuracy to place the implants at the intended locations and orientations for fitting a prefabricated dental prosthesis.
  • drilling template as a unitary body of the same material avoids the need to incorporate one material into a body formed of a different material and, therefore, avoids misalignment of the materials with respect to each other. In other words, inaccuracies associated with aligning the copper alloy guide tube into the drilling template are avoided.
  • the drilling template may be prepared by 3-D printing metal.
  • the metal is preferably a
  • the metal may be titanium or titanium alloy.
  • the drilling template may be incorporated in a carrier that is shaped to fit landmark features on the upper or lower jaw
  • the 3-D printed template may be further prepared by milling the drilling template to the required dimensions. This way, the drilling template can be customized to suit particular dental implants, e.g. brand variations, and/or to suit particular drills.
  • the carrier may be formed of plastics material and the drilling template may be incorporated into the carrier. Optionally, the carrier is formed by 3-D printing.
  • any misalignment between the drilling template and the carrier is not critical because it will only affect the location of the group of the drilled holes for the dental implants. It will not affect the locations of the dental implants relative to each other and, therefore, will not affect whether the dental implants align with fastening points on the dental prosthesis.
  • the misalignment may, however, affect the global spatial relationship between the implants as a group and the patients mouth. This would have the effect of shifting the position of the final bridge.
  • the scale of the misalignment is less than 0.5 mm, it is usually not noticeable by the patient and it can be adjusted.
  • the method may comprise a step of collecting information on the patient’s bone and teeth structures and wherein that information may be used in step (a) to determine the intended location and orientation for the implants.
  • the step of collecting information may include obtaining imaging, such as photos and radiographic imaging, obtaining impressions and altering teeth to provide better reference points for accurately determining locations and orientations.
  • the invention provides a prefabricated dental prosthesis comprising:
  • a bridge formed as a unitary body having integral fastening points that are located and oriented with sufficient accuracy to co-operate with dental implants such that the longitudinal axes of the fastening points are substantially co-axial with the longitudinal axes of respective dental implants;
  • the same advantages outlined above in respect of preparing a drilling template are applicable to preparing a prefabricated dental prosthesis.
  • the main advantage which flows from those mentioned advantages is that the dental prosthesis can be prefabricated and fitted in a single procedure, namely the same procedure in which the dental implants are fitted.
  • the applicant anticipates improving the precision of the location and orientation of the fastening points by forming the bridge with small channels and then incrementally enlarging the channels until an internal circumference is reached that is substantially aligned with the longitudinal axis of the dental implants.
  • Such precise alignment reduces and possibly eliminates internal stresses in the bone caused by fastening together the fastening point and the dental implant when their longitudinal axes are misaligned.
  • the bridge may be prepared by 3-D printing metal.
  • the metal is preferably a dimensionally stable metal.
  • the metal may be titanium or titanium alloy.
  • the bridge is over-moulded with ceramic or hard resin material in the shape of one or more teeth and gums and the over-moulding includes access holes through which fasteners may be directed through the fastening points.
  • the 3-D printed bridge may be further prepared by milling the bridge to the required dimensions. This way, the bridge can be customized to suit particular dental implants, e.g. anodized implants and non- anodized implants.
  • the invention provides a dental prosthesis system comprising:
  • Figure 1 shows a diagram of an embodiment of the method of aligning dental implants to fit a prefabricated dental prosthesis according to the present invention
  • Figures 2, 3, 4 and 5 are a bottom view, a top view, a front view and a perspective view of an embodiment of the first guide according to the present invention
  • Figure 6 is a perspective view of the first guide of Figures 2 to 5 positioned on a patient
  • Figure 7 is a top view of a drilling template in the form of a guide bar which has been formed in accordance with an embodiment of the invention
  • Figures 8 and 9 are top and bottom views of a carrier which incorporates the guide bar shown in Figure 1;
  • Figures 10, 11, 12 are a bottom view, a top view and a perspective view of an embodiment of the second guide according to the present invention.
  • Figure 13 is a perspective view of the second guide of Figures 10 to 12 positioned on a patient;
  • Figure 14 is a perspective view of an embodiment of the second guide according to the present invention.
  • Figures 15 to 17 show bottom views of an embodiment of the second guide according to the present invention, where Figure 15 shows a first part of the guide, Figure 16 shows a second part of the guide and Figure 17 shows the combination of the first part and the second part;
  • Figures 18 and 19 are top and bottom views of a bridge which is being formed in accordance with an embodiment of the invention.
  • Figure 20 is a front view of a dental prosthesis in which a bridge shown in Figures 18 and 19 is embedded and to which dental implants are attached as if they are fixed in a patient’s upper jaw;
  • Figures 21 A to 21E show the steps of fitting the drilling template to an upper jaw for drilling holes that receive dental implants, fitting the dental implants and attaching the bridge shown in Figures 18 and 19;
  • Figures 22A to 22F show the steps of fitting the implants and a prosthesis to an upper jaw of a patient
  • Figures 23 and 24 show a top view and a front view of an embodiment of a drilling template in the form of a bar formed of the present invention
  • Figures 25 (a) and (b) are a front view and a cross section of an embodiment of an abutment according to the present invention
  • Figures 26 (a) and (b) are a front view and a cross section of an embodiment of a dental screw according to the present invention.
  • Figures 27 (a) and (b) are a front view and a cross section of a carrier for the abutment of Figures 25 (a) and (b);
  • Figures 28 (a) and (b) are a front view and a cross section of an assembly of the abutment of Figures 25 (a) and (b), the dental screw of Figures 26 (a) and (b) and of the abutment carrier of Figures 27 (a) and (b); and
  • Figure 29 is a perspective view of the abutment carrier of Figures 27 (a) and (b).
  • the method involves, firstly, collecting the relevant patient information 101. This may include photographs, videography, impressions, intra-oral scans, CT or CBCT radiology.
  • the patient information is collated and the final prosthesis position is determined based on the collated information.
  • This process is typically done is a commercially available software by an appropriately skilled individual 102.
  • the dentist and the patient review the final prosthesis position, make necessary changes and agree to continue with the final prosthesis position.
  • the process of verification of prosthesis position may be purely based on reviewing virtual representation. The process of verification may also be done based on constructing a prototype of the prosthesis position and positioning it within the patient for a physical representation 102.
  • the dentist and/or surgical specialist will determine the appropriate dental implant location in order to meet biological and mechanical criteria for success. This is simulated in commercially available computer software which allows the dental implant position to be visualized within the context of the other patient information 104.
  • the implant locations are then used for the design and manufacture of three components: i) the first guide (surgical guide), which is used for positioning the anchor pins in the correct 3D spatial relationship to the patient, this first guide may also be used for guiding the amount of bone to be removed from specific locations 106; ii) the second guide (placement guide) which utilizes the same anchor pin locations as a reference and is used for placement of the dental implants in the correct 3D spatial relationship relative to each other 107; iii) the dental prosthesis which will be fitted onto the dental implants or an associated dental abutment 108.
  • the first guide surgical guide
  • placement guide which utilizes the same anchor pin locations as a reference and is used for placement of the dental implants in the correct 3D spatial relationship relative to each other 107
  • the dental prosthesis which will be fitted onto the dental implants or an associated dental abutment 108.
  • the manufacturing of the first guide and the second guide include 3D printing and milling 109, 110 as discussed in the Summary section.
  • a model of the patient is made 111 and the guides are used to simulate the surgical process and the dental prosthesis is fitted to the prosthesis to verify that all components have been correctly manufactured.
  • the dental implants and the prothesis are fitted to the patient in a single surgical visit 112.
  • Figure 2, 3, 4, 5 and 6 show an embodiment of the first guide 1 according to the present invention.
  • the first guide 1 utilizes the presence of pre-existing oral structures (such as gum and teeth and bone) for correct location.
  • the first guide 1 is composed of a unitary body with a surface that approximates the patient’s palate, gum and/or teeth.
  • the first guide 1 fits over the patients gum 7 and teeth 8 in a set position ( Figure 6).
  • the first guide 1 is comprised of reference holes 3 for anchor pins that will be used initially to guide the drilling of holes in the bone and then to guide the placement of the pins.
  • the first guide 1 is also comprised of holes 4 for guiding bone removal that are used to mark the planned height remaining bone.
  • the first guide 1 is typically made with 3D CAD/CAM techniques either additive or subtractive technologies involving materials such as resin, metal or polymers.
  • the first guide 1 may include sleeves 5 in the position of the reference holes if required by the material used for manufacture.
  • the sleeves may have different shapes and configurations or may also not be present.
  • the surgeon can use the marks as a reference of taking away areas of unwanted bone.
  • the second guide 2 as mentioned above, is used for the placement of the dental implants.
  • the second guide 2 includes a drilling template, shown in Figures 7 in the form of a bar 10, as a unitary body which includes guide channels, in the form of a drill guides 12.
  • the drill guides 12 guide drilling of pilot holes with sufficient accuracy to place the dental implants at the intended locations and orientations for fitting a prefabricated dental prosthesis.
  • the next step is to manufacture the bar 10 for the second guide 2 and the bridge 30 for the dental prothesis 60.
  • the bar 10 and the bridge 30 are manufactured using the same manufacturing technique.
  • that technique involves initially 3-D printing the bar 10 and the bridge 30 on the same 3-D printing machine so that any systematic inaccuracies in the 3-D printing apply to both of the bar 10 and the bridge 30. Both are printed in titanium or titanium alloy to take advantage of its biocompatibility.
  • other suitable materials may be used to print the bar 10 and the bridge 30, provided that the material has sufficient rigidity so that the relative spacing between the guide channels 12 and the fasting points remains the same during the procedure to fit the dental prosthesis.
  • the bar 10 includes guide sky channels in the form of drill guides 12 which each comprise a circular bore 14.
  • the relative spacing of the bores 14 and the orientation of the longitudinal axes of the respective bores 14 is selected so that the dental implants can be located with the assistance of the bar 10 at their intended respective locations and orientations.
  • the 3-D printing process does not provide sufficient precision in the formed bar 10 because of the resulting product as a relatively rough surface. Accordingly, this embodiment involves precision milling of the bar 10 to accurately define the location and orientation of the respective drill guides 12.
  • the printing step involves forming in the bores 14 with the relatively narrow internal circumference and then incrementally increasing the internal circumference via the milling step until the bores 14 are honed to an accurate location and orientation that is substantially consistent with the intended location and orientation determined during the planning step.
  • substantially consistent is taken to mean that a dental implant that is positioned with the aid of the bar 10 is located within 10 pm of the intended location and orientation.
  • the gradual increase in the internal circumference of the bore 14 is also done to ensure a more snug fit with a drill sleeve that is located in the bore 14 and which guides the drill bit because the fit with the drill sleeve is important for reducing inaccuracies associated with any free play in the fit between the sleeve and the bore 14.
  • the bar 10 is incorporated into a carrier 20 which itself is prepared as a 3-D printed plastics material.
  • the carrier 20 ( Figures 8 and 9) is formed with formations that fit with the landmark features of the patient’s jaw so as to facilitate more accurate location of the carrier 20 on the jaw.
  • the orientation and the location of the bar 10 incorporated into the carrier 20 is not critical because any misalignment that may occur does not create internal stress in the jawbone upon fasting the prosthesis to the dental implants.
  • the carrier 20 includes anchor points 26 through which screws or anchor pins are drilled into the underlying bone to anchor the carrier 20 whilst drilling pilot holes for the dental implants occurs. Any shifts in the location of the carrier 20 during drilling of the pilot holes will lead to misalignment of the dental implants.
  • the carrier 20 is designed and manufactured so that the reference holes 3 of the first guide 1 are in the same position of the reference holes 25 of the second guide, located at the anchor point 26, where anchor pins are inserted to position the second guide (formed by the carrier 20 and the drilling template 10) over the patients gum and bone. Designing the first guide 1 and the second guide 2 with matching reference holes 3,25 assure a correct inter-implant spatial relationship.
  • the second guide 2 is a unitary body of one material that has a copy of the reference holes 25 of the first guide 1 (thus ensuring exact alignment) for the insertion of anchor pins.
  • the second guide 2 is designed and manufactured so that the reference holes 3 of the first guide 1 are in the same position of the reference holes 25 of the second guide 2 and the same anchor pins are used to position the first guide 1 and the second guide 2 over the patients gum and bone.
  • sleeves 28 surround the reference holes 25, similarly to sleeves 5 in the first guide.
  • the sleeves may have different shapes and configurations or may also not be present.
  • the second guide 2 does not need to contact any gum or bone as it fully relies on the anchor pins for stability.
  • the second guide 2 contains the guide channels 12 that surround bores 14
  • This second guide 2 is constructed of materials that are stable over time and do not distort.
  • the materials used have enough strength and other physical properties to prevent deformation when subjected to the forces typically involved in the surgery process.
  • the materials used are typically titanium, titanium alloy, carbon fibre or polymer. However, other suitable material may be used.
  • the fabrication process of the second guide 2 substantially incorporate the same fabrication process used for the dental prosthesis 60 so that the same potential errors are produced but are rendered inconsequential.
  • the design of the second guide 2 may be smaller in size and configured to allow greater access around the second guide 2 for visualization of the dental implants and access to the gum and jawbone for the surgical procedure.
  • This second guide 2 comprises the same functional features of the embodiments described above, such as guide channels 12 surrounding bore 14 for insertion of the implants in the correct position and reference hole 25 matching the position of the reference holes 3 of the first guide 1.
  • the materials used are typically titanium, titanium alloy, carbon fibre or polymer. However, other suitable material may be used.
  • the second guide 2 comprises multiple components: body parts 82 containing the reference holes 25 for the positioning of the anchor pins; and drilling template 84 which contains the channels 12 surrounding bores 14 corresponding to the intended location and orientation of the dental implants. Once again reference holes 25 match the position of the reference holes 3 of the first guide 1.
  • the drilling template 84 and in particular the channels 12 are manufactured to fit precisely with the components from the implant company whose dental implants are being placed.
  • the materials used are typically titanium, titanium alloy, carbon fibre or polymer. However, other suitable material may be used.
  • the two components may be constructed of the same material or of different materials. The combination of the two component is shown in Figure 17.
  • body parts 82 includes sleeves 28 surrounding the reference holes 25, similarly to sleeves 5 in the first guide. The sleeves may have different shapes and configurations or may also not be present.
  • the manufacture the second guide 2 and the bridge 30 may use the same manufacturing technique in order to minimize the systematic inaccuracies between the two objects.
  • Methods of manufacture may include, not limited to, 3D printing polymer or 3D milling polymer or 3D milling metal or a combination of 3D printing and milling polymer or metal.
  • the bridge 30 is prepared in the same way as the bar 10 in that it is initially printed in titanium or titanium alloy and is subsequently precision milled to define accurately oriented and located features.
  • the bridge 30 includes a series of fastening points of 32 which comprise an aperture 38 extending from a top site 34 of the bridge 32 and underside 36.
  • the apertures 38 extend from a plateau 40, through the bridge 30 and through a spacer 42 which has a stepped conical shaped ( Figure 19).
  • the number of fastening points 32 formed in the bridge 30 corresponds with the number of implants located in the jaw of a patient.
  • the longitudinal axis of the aperture 38 is located and oriented to align with the longitudinal axes of the corresponding bores 14 in the bar 10.
  • a fastening screw passing through the bridge 30 and into the bar 10 can be tightened so that tension in the screw is coaxial with the longitudinal axes of both the bore 14 and the aperture 38. If the longitudinal axes are misaligned, that tension imparts of a transverse force on the bone, thereby creating internal tension in the bone and disrupting the healing process and long-term well-being of the patient.
  • Inaccuracies in the alignment between the bridge 30 and the bar 10 are reduced by precision milling of the aperture 38 to have a location and orientation that aligns with a longitudinal axis of the dental implants.
  • the inaccuracies are also reduced by producing the bridge 30 on the same machinery that is used to produce the bar 10.
  • the materials used for the manufacturing of the bridge 30 is typically titanium, titanium alloy, carbon fibre or polymer. However, other suitable material may be used. Preferably, the material would have enough strength and other physical properties to prevent deformation when subjected to the forces typically involved in daily use of the prosthesis 60.
  • the bridge 30 is subsequently over-molded with a hard material 50, such as a ceramic material, to form a dental prosthesis 60 having at least one tooth and/or gum.
  • a hard material 50 such as a ceramic material
  • the material used for the over molding is selected from a variety of dental materials such as, but not limited to, acrylic resins, resin composites, ceramics, hybrid ceramic/resins or polymers.
  • the over-molding is typically coloured to resemble tooth and or gum colours to provide the necessary aesthetic qualities.
  • FIG. 20 An example of such a dental prosthesis 60 is shown in Figures 20.
  • Four dental implants 52 are attached to the dental prosthesis 60 as if they are implanted in the jaw of a patient. In practice, however, the dental implants 52 are implanted in the patient first and then the dental prosthesis 60 is fastened to the dental implants 52. Access holes (not shown) are formed in the over-moulding 50 to enable fastening screws to be inserted through the apertures 38 and into the implants 52.
  • Steps of the procedure for fitting the dental prosthesis 60 are describe below with reference to Figures 21 A to 21E in which a model 54 is used in place of an actual patient.
  • the site for the dental prosthesis is prepared by removing teeth and stripping gums to expose underlying bone.
  • the underlying bone is trimmed to provide a suitable surfacing which the implants 52 can be placed.
  • Next pre-made carrier 20 is located at the intended site for the dental prosthesis 60 ( Figure 21B) and is anchored in position by drilling fastening screws into the underlying bone through anchor points 26.
  • the next step involves drilling pilot holes for receiving the implants 52 by drilling into the underlying bone under the guidance provided by the bores 14 in the bar 10.
  • the implants 52 are then screwed into the pilot holes (figure 21C) so that the implants 52 have a longitudinal axis that aligns with the longitudinal axis of the bores 14 ( Figure 21D).
  • the carrier is then removed by removing the fastening screws from the anchor points 26.
  • the dental prosthesis 60 is then fitted onto the implants 52 by passing fastening screws through the access holes in the over-moulding 50, through the apertures 38 of the bridge and into the implants of 52.
  • the fastening screws are then tightened in a specific order known to a skilled person to ensure that the dental prosthesis 60 is properly secured to the implants 52 with little or no internal tension in the dental prosthesis 60.
  • This arrangement is shown in figure 21E, although the over-molding 50 of the dental prosthesis 60 is not shown so that the alignment of the bridge 30 with the dental implants 52 can be seen.
  • FIG. 22A shows the site for the dental prosthesis.
  • the site for the dental prosthesis is prepared by stripping back the gum, placing the first guide 1 and placing the anchor pins 27 through the holes to stabilize the first guide 1 ( Figure 22A). Marks are placed on the bone to indicate the necessary level for bone removal. After the first guide 1 and any necessary teeth are removed the excess bone is also removed to the level of the marks.
  • Figure 22C shows placement of the second guide using the same anchor pins 27 and anchor pins location used to releasably secure the first guard to the patient’s jawbone.
  • Figure 22C shows the first implant 52 being placed after the necessary bone drilling has occurred.
  • Figure 22D shows four implants having been placed through the second guide 2.
  • Figure 22E shows the second guide having been removed and the dental prosthesis being placed with the surgeon tightening a screw to secure the dental prosthesis to the dental implants.
  • Figure 22F shows the dental prosthesis secured in place to the dental implants at the completion of surgery.
  • the patient data must also be complete and accurate in order to achieve successful results.
  • Determination of the final tooth position and dental prosthesis location is essential. This may require 3D modelling and, in certain occasions, the construction of a template to verify the correct final tooth position and dental prosthesis location.
  • 3D internal data of the patient must be collected (e.g. CBCT scan, CT scan, MRI, ultrasound) in order to correct visualize and locate critical anatomical structures such as nerves, blood vessels, cavities, soft tissue thickness and bone.
  • 3D external data of the patient must be collected (e.g. dental impressions, digital intra-oral scans, photographs, videography, 3D facial scans) in order to correctly visualize and locate critical anatomical structures such as teeth, gingiva, facial features, dental occlusion (inter and intra arch relationships), vertical dimension in both static and dynamic postures.
  • Correct handling of the data within the dental software is also critical. It is important, for example, that the implant locations is accurately and exactly copied between different virtual models.
  • the implants used for constructing the guides and the dental prosthesis also needs to be standardized.
  • a drilling template in the form of a bar 70 is formed according to the methods described above. However, the bar is not incorporated into a carrier 20 because it is formed with recesses 72 through which screws are passed and secured into the existing implants 52 for accurately locating the bar 70.
  • the bar 70 still incorporates a drilling guide 12 to assist with accurate placement of an additional new implant 52.
  • a prefabricated dental prosthesis is then fitted to the existing implants and the new implant.
  • an intermediate dental element such as an abutment
  • an intermediate dental element is used between the dental implant 52 and the dental prosthesis 60, for example, when implants 52 are at significantly different angles relative to one another.
  • the intermediate dental abutment positioned into the implants changes the angle and allows the bridge of teeth to be put into place.
  • the challenge is that this intermediate part locks into an internal anti-rotation mechanism inside the implant. To get a perfect fit it is necessary to get the depth of the implant in the bone and the orientation of the anti-rotation mechanism correct. This is almost impossible.
  • the solution therefore, is to produce intermediate parts that do not engage the anti-rotation mechanism.
  • the intermediate parts such as abutments 90, are mounted in a carrier 92 to ensure that they have the correct rotational position and then transferred onto the implants 52. Once the abutments 90 are secured to the implants 52, the carrier 92 is removed and the dental prosthetic is inserted.
  • FIG. 25(a)and (b) An example of dental abutment 90 is shown in Figures 25(a)and (b).
  • Figures 26 (a) and (b) show a prosthetic screw 98 that, in use, is fastened to the dental abutment 90 by means of a dental abutment carrier 92 shown in Figures 27(a)and (b) and Figure 29.
  • the dental abutment carrier 92 is used for the correct placement of the dental abutment 90 either in unison with the dental implant 52 or subsequent to the placement of the dental implant 52 to ensure the exact position of the dental implant.
  • the dental abutment carrier 92 shown in Figure 27(a)and (b) includes a channel 94 in the centre with a screw seat 96 for a prosthetic screw 98.
  • the carrier includes an interface 97 which matches the shape of the corresponding dental abutment 90 and a connection that allows rotation of the dental abutment carrier around its long axis.
  • the dental abutment carrier 92 and dental abutment 90 are fitted together and fastened with a prosthetic screw 98 at low torque ( Figures 28(a) and (b)).
  • the assembly is then placed onto the dental implant 52 partially inserted into the patient and the screw further tightened to attach the dental abutment to the dental implant 52.
  • the dental abutment carrier 92 is then rotated causing, in turn, the rotation of the dental implant 52. In this way, the dental implant 52 insertion and 3D positioning is completed.
  • the dental abutment 90 is then stabilized while the prosthetic screw 98 and the dental abutment carrier 92 are removed.
  • the interfacing parts of the bridge 30 that contact the implant 52 with a material that will deform under high load and seal any residual spaces.
  • a material that will deform under high load and seal any residual spaces.
  • gold in the form of gold-plating.

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  • Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Dentistry (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Chemical & Material Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Manufacturing & Machinery (AREA)
  • Materials Engineering (AREA)
  • Dental Prosthetics (AREA)

Abstract

L'invention concerne un procédé d'alignement d'implants dentaires pour ajuster une prothèse dentaire préfabriquée, le procédé comprenant les étapes consistant à : déterminer les emplacements prévus et l'orientation prévue pour les implants ; et préparer un gabarit de forage sous la forme d'un corps unitaire qui comprend des canaux de guidage qui guident le forage de trous pilotes avec une précision suffisante pour placer les implants aux emplacements prévus et selon les orientations prévues pour ajuster une prothèse dentaire préfabriquée.
PCT/AU2019/050410 2018-05-03 2019-05-03 Système et appareil d'ajustement de prothèses dentaires WO2019210373A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AU2018901518 2018-05-03
AU2018901518A AU2018901518A0 (en) 2018-05-03 Implant method and apparatus

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WO2019210373A1 true WO2019210373A1 (fr) 2019-11-07

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
IL293799A (en) * 2022-06-09 2024-01-01 Krausz Ronen Support and guidance system for dental implants
EP4371523A1 (fr) * 2022-11-21 2024-05-22 Biotech Dental Guide chirurgical pour la pose d'implants dentaires

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100092911A1 (en) * 2001-07-06 2010-04-15 Dental Vision B.V.B Method for manufacturing a suprastructure and a corresponding drill jig
US20150150684A1 (en) * 2012-06-05 2015-06-04 Dental Vision B.V.B.A. Method for manufacturing a template to adapt the shape of a bone defect in a jaw to a bone superstructure
US20160157967A1 (en) * 2014-12-05 2016-06-09 Dio Corporation Method for manufacturing surgical guide and crown, abutment in mouth for dental implant
US20170112592A1 (en) * 2011-09-16 2017-04-27 Randall C. Groscurth Method of using an endentulous surgical guide
WO2017143107A1 (fr) * 2016-02-16 2017-08-24 Jason Watson Système de guide chirurgical dentaire séquentiel et procédés associés
WO2018213817A1 (fr) * 2017-05-18 2018-11-22 Jason Watson Base de fixation et guides pour installation de prothèse dentaire

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100092911A1 (en) * 2001-07-06 2010-04-15 Dental Vision B.V.B Method for manufacturing a suprastructure and a corresponding drill jig
US20170112592A1 (en) * 2011-09-16 2017-04-27 Randall C. Groscurth Method of using an endentulous surgical guide
US20150150684A1 (en) * 2012-06-05 2015-06-04 Dental Vision B.V.B.A. Method for manufacturing a template to adapt the shape of a bone defect in a jaw to a bone superstructure
US20160157967A1 (en) * 2014-12-05 2016-06-09 Dio Corporation Method for manufacturing surgical guide and crown, abutment in mouth for dental implant
WO2017143107A1 (fr) * 2016-02-16 2017-08-24 Jason Watson Système de guide chirurgical dentaire séquentiel et procédés associés
WO2018213817A1 (fr) * 2017-05-18 2018-11-22 Jason Watson Base de fixation et guides pour installation de prothèse dentaire

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
IL293799A (en) * 2022-06-09 2024-01-01 Krausz Ronen Support and guidance system for dental implants
EP4371523A1 (fr) * 2022-11-21 2024-05-22 Biotech Dental Guide chirurgical pour la pose d'implants dentaires
FR3142079A1 (fr) * 2022-11-21 2024-05-24 Biotech Dental Guide chirurgical pour la pose d’implants dentaires

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