WO2022025798A1

WO2022025798A1 - Method for positioning zygomatic implants and laser pointer used in the method

Info

Publication number: WO2022025798A1
Application number: PCT/RU2021/050174
Authority: WO
Inventors: Димитрий Сергеевич АЛЁШИН
Original assignee: Димитрий Сергеевич АЛЁШИН
Priority date: 2020-07-27
Filing date: 2021-07-23
Publication date: 2022-02-03
Also published as: RU2739116C1

Abstract

The group of inventions relates to medicine, and specifically to dentistry, and may be used for positioning zygomatic implants. The method provides improved accuracy of positioning and placement of an implant into the body of the zygomatic bone and reduces the deviation from the ideal anatomical position with the aid of a laser pointer. The laser pointer enables the orientation of cutting instruments during zygomatic implantation by means of a linear laser emitter.

Description

METHOD FOR POSITIONING OF zygomatic implants and LASER POINTER USED IN THE METHOD

Technical field

The invention relates to medicine, namely to dentistry, and is intended to determine the position of implants in the thickness of the zygomatic bone. The method and device can be used both when planning the operation of zygomatic implantation, and after the installation of implants at the stage of patient rehabilitation.

Prior Art

In patients who require zygomatic implantation, it becomes necessary to place the implant in the thickness of the zygomatic bone, taking into account the anatomical features of the individual. Often, the amount of available bone is not so great, which causes additional difficulties in planning, significantly complicates the course of surgical intervention and dramatically increases the likelihood of both intraoperative and postoperative complications.

Too distal placement of the implant can lead to trauma to the temporal process and other deviations from the ideal anatomical position. The most common and dangerous complications include orbital floor penetration: removal of a cutter or implant through the lower wall of the orbit or orbital surface of the zygomatic bone.

The problem of positioning and choosing the ideal direction of the implant bed. Due to very limited visibility, a large amount of exfoliated soft tissues and some other anatomical features, including individual ones, place the implant in advance the position determined using cone beam computed tomography (CBCT) is very difficult.

The difficulty also lies in the fact that it is necessary to set the correct direction of drilling at the very beginning of the preparation of the bed. This should be done with a 60 mm or 80 mm cutter, planning both the entry point on the alveolar process of the upper jaw and the exit point on the lateral surface of the zygomatic bone at the same time.

A known method of dental prosthetics (RF patent for the invention 2494698, CL IPC A61S 8/00, publ. 10.10.2013), including performing computed tomography of the jaw, creating a three-dimensional virtual model of the jaw from a tomogram, manufacturing a prosthesis from a polymer material, designing the position of implants in of the patient's jawbone and creating a template, wherein the prosthesis is wrapped with a layer of radiopaque wax to ensure a snug fit to the surface of the prosthesis, and computed tomography of the jaw is carried out together with the prosthesis installed on the mucous membrane of the oral cavity and jaw, a stereolithographic model of the jaw is prototyped with the installation of guide bushings in it, the position of which corresponds to the virtually spaced dental implants, the prosthesis is fitted onto the prototype jaw model, through the guide bushings of which holes are formed in the prosthesis in the appropriate positions, then the patient's jawbone is drilled through the holes a hole in the prosthesis, which is used as a surgical conductor for drilling the patient's jawbone, while implants are installed in the holes prepared in the above way in the jaw bone tissue, followed by their complete integration. In medicine, the use of laser pointers for correction, stimulation, determination of endurance, training of reflexes is known (RF patents for inventions: 2712285, publ. 01.28.2020; 2699483, publ. models: N°105164, published 06/10/2011; N°125069, published 02/27/2013), as well as to determine the position of the body and its parts in space (RF patent for invention 2235975, published 09/10/2004). Design solutions for devices using a laser pointer are also described, for example, for determining the location of manipulation (RF patent for utility model N°58322, publ. 27.11.2006) or for use in surgical dentistry (RF patent for utility model N°46174, publ. . 06/27/2005). The given technical solutions are far from the claimed method of positioning zygomatic implants and the laser pointer used in it in terms of essential features and areas of use.

The closest to the invention in terms of technical essence and the achieved effect is a method for determining the position of dental implants at the stages of rehabilitation of a patient with no teeth (RF patent for the invention 2665141, class IPC A61V 5/103, A61C 7/00, publ. 28.08.2018). This method consists in conducting an X-ray examination of the patient, as a result of which an orthopantomogram of the jaws is obtained, the main anatomically stable landmarks for determining the position of dental implants in the bone tissue on the orthopantomogram of the jaws are the points "Dzn" located at the intersection of the line corresponding to the projection of the distal slope of the zygomatic process upper jaw with a shadow of the hard palate, points "C", which are near the lateral walls of the nasal passage and the point "Me" - the lowest point of the symphysis on the chin, on the orthopantomogram of the jaws, as shown in figure 1, mark the points "Dzn" and connect them with a horizontal line, the resulting segment between the points "Dzn""Dzn" is divided into two equal segments and get the point "K", from which the perpendicular is lowered to the intersection with the shadow of the lower edge of the lower jaw and thus the first vertical line is built - the line of the aesthetic center, the distance between the points - from "Dzn" to the point "Dzn" is divided by three equal segments and get the points "C", the distance from the point "Dzn" to the point "C" is divided into three equal segments and the points "M" and "Rg" are obtained, the distance from the point "C" to the point "K" is divided by two equal segments and get the point "I", from the points "Dzn", "M", "Pg", "C" and "I" on each side of the upper jaw, lower the perpendiculars until they intersect with the shadow of the lower edge of the lower jaw, thus, receive landmarks to determine the position of six permanent teeth of the frontal g Groups of teeth on the upper and lower jaws, namely the central incisors, lateral incisors and canines, as well as four permanent teeth of the lateral segment on the upper and lower jaws on the right and left - the first and second premolars, the first and second molars, with the exception of the third permanent molars, due to their high tendency to rudimentary, the positioning of dental implants on the upper and lower jaws relative to the received landmarks on the right and left is carried out as follows: dental implants of the upper and lower central incisors are installed in the bone tissue of the upper and lower jaws between lines K and I , the dental implants of the upper lateral incisors are placed between lines I and C, and the implants of the lower lateral incisors are placed on line I, dental implants of the maxillary canines are placed in the bone tissue on the C line, and implants of the mandibular canines are placed mesial from the C line, dental implants of the first premolars of the upper jaw are installed mesial of the line Pr, and the first premolars of the mandible between the lines Pr and C, dental implants of the second premolars on the upper jaw, they are installed distally from the Pg line, and the implants of the lower second premolars are installed on the Pg line, the dental implants of the first permanent molars of the upper jaw are placed in the bone tissue from the distal side of the M line and tangent to it, and the dental implants of the first permanent molars of the lower jaw are placed on line M, dental implants of the second permanent molars of the upper jaw are installed in the bone tissue from the distal side of the Dzn line and tangent to it, and dental implants of the second permanent molars of the lower jaw - on the Dzn line, thus, these lines are guidelines for the installation of dental implants in the absence and teeth in the upper and lower jaws.

The disadvantage of this method is the relatively low accuracy of positioning and placement of the implant in the thickness of the zygomatic bone, which greatly complicates the course of surgery and dramatically increases the likelihood of complications.

Disclosure of invention

The technical result of the invention is to increase the accuracy of positioning and placement of the implant in the thickness of the zygomatic bone, reduce the deviation from the ideal anatomical position, reduce the likelihood of intraoperative and postoperative complications. The use of a laser pointer for the orientation of cutting instruments during zygomatic implantation provides a significant reduction in the influence of the human factor during the operation.

The specified technical result is achieved by the fact that the method of positioning the zygomatic implants is carried out as follows: a cone-beam computed tomography is performed, as a result of which a tomogram is obtained, after studying which the approximate length of the implants and the area of their placement are selected; make an incision through the top of the ridge and detachment of soft tissues; then the exit points of the implants are determined; The ideal position of the implants relative to the zygomatic bone is considered to be the most protruding point of the lateral surface, located on a conditional line connecting the inferolateral edge of the orbit and the angle of the lower jaw, this point is determined by palpation; the direction of the implants is considered to be a line connecting the prosthetically correct position of the multi-unit abutment on the alveolar process and the above-described point on the zygomatic bone; then proceed to the preparation of the implant bed; using a linear laser pointer, check the correctness of the intended direction; moreover, they are guided not only by the bone structures, but also by the exit points of the implants on the zygomatic bone; bed preparation is completed by drilling with a finishing cutter to the entire estimated depth; with the help of a point laser pointer, the correctness of the direction of the finishing cutter to the pre-designated exit point of the implant tip is checked; then implants are placed, flaps are sutured, casts are taken, X-ray control is carried out.

Immediately before the operation, to determine the projection of the implant exit point, an additional cone-beam computed tomography with pre-applied X-ray contrast marks.

To improve the visualization of the projection of certain exit points of the implants, it is possible to apply marks on the skin of the face, the direction of the implant bed can be applied in the form of a mark on the amveolar process and the canine fossa. Marks can be applied with a marker or cosmetic pencil or brilliant green solution.

This technical result is achieved by the fact that when positioning the zygomatic implants, a laser pointer is used, which is an L-shaped structure formed by horizontal and vertical rods, which is attached to the micromotor, at the end of the horizontal rod, a point laser emitter is fixed by means of an adjustable swivel joint, on a vertical rod with a linear laser emitter is fixed with the possibility of movement, and the rods are connected to each other by means of an adjustable swivel joint.

Brief description of the drawings

In FIG. 1 shows a structural diagram of a laser pointer.

In FIG. Figure 2 shows options for focusing the radiation of a laser pointer depending on the shape of the laser beam: a) a laser beam in the form of a plane: a light spot in the form of a line; b) laser beam in the form of a beam: a light spot in the form of a point.

In FIG. 3 shows 3D-images, in which the laser line shows the surgeon the projection of the working part of the cutter on the surface of the bone structures.

In FIG. 4 shows a 3D image, in which the laser line shows the surgeon the projection of the working part of the cutter on the soft tissues of the face.

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SUBSTITUTE SHEET (RULE 26) In FIG. 5 is a 3D image in which the laser beam points exactly at the tip of the cutter.

In FIG. 6 shows photos of the stages of the operation: a) incision through the top of the ridge; b) detachment of soft tissues. In FIG. 7 is a 3D image showing the definition of implant exit points.

In FIG. 8 shows photos of the stages of the operation and 3 D-images: a) drawing the direction of the implant bed; b) preparation of the implant bed; c) checking the correctness of the direction; d) additional orientation by exit points; e) drilling with a finishing cutter; f) checking the exit projection point.

In FIG. 9 shows 3D images of checking the correct direction of drilling by deflecting the laser beam.

In FIG. 10 shows: a) a photo of the stage of the operation and b) a control x-ray.

In FIG. 11 shows a photo and 3D images of the use of X-ray contrast marks: a) the appearance of the application with X-ray contrast marks; b) location on the patient; c) CT images with X-ray contrast marks; d) additional orientation by mark. The following designations are adopted in the figures: 1 - vertical rod, 2 - horizontal rod, 3 - adjustable swivel, 4 - linear laser emitter, 5 - point laser emitter, 6 - rod 1 fastening to micromotor 7, 8 - surgical handpiece, 9 - mill for zygomatic implantation. Implementation of the invention

The solution to the problem of positioning zygomatic implants is achieved using a laser pointer that shows

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SUBSTITUTE SHEET (RULE 26) projection of the cutter onto the bone structures and soft tissues of the face, and also projects the exit point of the implant tip.

The laser pointer is an L-shaped structure formed by horizontal 2 and vertical 1 rods, which is attached to the micromotor 7; laser emitter, and the rods 1 and 2 are interconnected by means of an adjustable swivel 3.

The L-shaped design of the laser pointer with two types of lasers, reliable fastening 6 of the pointer to the micromotor 7, allow not only to securely fix the pointers, but also provides for the possibility of attaching additional tools and video equipment.

The method of positioning the zygomatic implants is carried out as follows.

A cone-beam computed tomography is performed, as a result, a tomogram is obtained, after studying the tomogram, the approximate length of the implants and the area of their placement are selected. Next, an incision is made through the top of the ridge and detachment of soft tissues (see Fig. 5); then determine the exit points of the implants (see Fig. 6).

The ideal position of the implants relative to the zygomatic bone is considered to be the most protruding point of the lateral surface, located on the imaginary line connecting the inferolateral edge of the orbit and the angle of the mandible, this point is determined by palpation. The direction of the implants is considered to be a line connecting the prosthetically correct position of the multi-unit abutment on the alveolar process and the above point on the zygomatic bone (see Fig. 7a). Next, proceed to the preparation of the implant bed: using a linear laser pointer, check the correctness of the intended direction; moreover, they are guided not only by the bone structures, but also by the exit points of the implants on the zygomatic bone.

The preparation of the bed is completed by drilling with a finishing cutter to the entire estimated depth. With the help of a dotted laser pointer, the correctness of the direction of the finishing cutter to the predetermined exit point of the implant tip is checked (see Fig. 7). Then implants are placed, flaps are sutured, casts are taken, X-ray control is carried out.

Immediately before the operation, to determine the projection of the exit point of the implants, it is possible to conduct additional cone-beam computed tomography with pre-applied X-ray contrast marks (see Fig. 10).

To improve the visualization of the projection of certain exit points of the implants, it is possible to apply marks on the skin of the face, the direction of the implant bed can also be applied in the form of a mark on the amveolar process and the canine fossa. Such marks are applied to the skin with a marker, cosmetic pencil, brilliant green solution, or drawn on the bone with a special chemical pencil, or with a simple sterile pencil or brilliant green solution.

Options for the use of laser pointers during operations for the installation of zygomatic implants - according to the average anatomical parameters. After studying the CBCT, the approximate length of the implants and the area of their placement are selected. An incision is made through the top of the ridge (Fig. 6a), detachment of soft tissues (Fig. 66), determination of the exit points of the implants (Fig. 7).

In most cases, the ideal position of implants relative to the zygomatic bone is the most protruding points of the lateral surface, located on a conditional line connecting the inferolateral edge of the orbit and the angle of the mandible. These points are determined by palpation and further serve as a guide.

The direction of the implants will be the line connecting the prosthetically correct position of the multi-unit abutment on the alveolar process and the above-described point on the zygomatic bone.

To improve visualization during the operation, it is recommended to apply projections of the implant exit points determined by palpation with a marker, cosmetic pencil, brilliant green solution, or any other available method (Fig. 7).

You can also use this technique - to outline with a sterile pencil the direction of the implant bed directly on the amveolar process and the canine fossa (Fig. 8a). Then proceed to the preparation of the implant bed (Fig. 86). At this stage, the linear indicator helps the surgeon to check the correctness of the intended direction and stick to it (Fig. 8c).

Moreover, one can navigate not only by the bone structures, but also by the marks on the skin in the projection of the exit points of the implants on the zygomatic bone (Fig. 8d).

The preparation of the bed is completed by drilling with a finishing cutter to the entire estimated depth. This is the most crucial moment. For a complete

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SUBSTITUTE SHEET (RULE 26) control at this stage, a point laser pointer is used (Fig. 8e). The dot pointer will help you accurately guide the finishing cutter to the pre-designated point of the projection of the exit of the apex of the implant.

But no less important, a dotted pointer can virtually eliminate intraoperative complications such as orbital floor penetration, temporal process injury, etc. Reduce the intervention time, improve the prognosis of the operation.

As shown in FIG. 9, any deviations in the direction of drilling can be immediately tracked by the deviation of the laser beam from the projection point marked on the skin. And the surgeon will be able to change the direction of drilling in time

The implant beds are prepared in pre-planned positions (Fig. 10a). It remains only to place the implants, suture the flaps, take casts, and prepare the structures for immediate loading. Carry out x-ray control (Fig. 106).

It is possible to use additional methods in the complex of planning the setting of zygomatic implants, such as preoperative X-ray control with the application of X-ray contrast marks (see Fig. 10).

The method is especially indicated for use in patients in whom, due to structural features, it is impossible to apply the method of anatomical average indicators described above to determine the direction of the implant and its exit point on the vestibular surface of the zygomatic bone.

At the planning stage, a diagnostic CT scan is performed to assess the condition of the bone tissue and draw up a treatment plan. Immediately before the operation, a repeated CT scan is performed with a special application of X-ray contrast marks to accurately determine the projection of the point implant exit. Next, the surgeon in the program-scheduler places the zygomatic implant in the most anatomically advantageous position. After that, it is possible to determine which of the X-ray contrast marks the axis of the implant goes to. You can make a mark on the skin or plater with a cosmetic pencil, brilliant green solution or in any other way. During the operation, the surgeon can focus on the mark made and “aim” the laser pointer at it.

The described method significantly increases the accuracy of creating a zygomatic implant bed, giving the surgeon a reliable and clear guide during the operation. And practically negates the possibility of intraoperative complications associated with incorrect positioning of the implant.

Thus, the use of the claimed method and device provides an increase in the accuracy of positioning and placement of the implant in the thickness of the zygomatic bone, a decrease in deviation from the ideal anatomical position; reducing the likelihood of intraoperative and postoperative complications; as well as a significant reduction in the influence of the human factor during the operation.

A comparative analysis of the claimed method and device shows that the totality of their essential features is unknown from the prior art and, therefore, corresponds to the condition of patentability "Novelty".

In the prior art, no features were identified that coincide with the distinctive features of the claimed method and device and affect the achievement of the claimed technical result, therefore, the claimed invention meets the condition of patentability "Inventive step". The information provided confirms the possibility of using the claimed method and device in dentistry, both when planning the operation of zygomatic implantation, and after installing implants at the stage of patient rehabilitation, and therefore complies with the patentability condition "Industrial applicability".

Claims

Claim

1. A method for positioning zygomatic implants, which consists in performing a cone-beam computed tomography, as a result of which a tomogram is obtained, after studying which the approximate length of the implants and their placement area are selected, an incision is made through the top of the ridge and detachment of soft tissues, then the points are determined exit of the implants, the ideal position of the implants relative to the zygomatic bone is considered to be the most protruding point of the lateral surface, located on the conditional line connecting the inferolateral edge of the orbit and the angle of the lower jaw, this point is determined by palpation, the direction of the implants is considered to be the line connecting the orthopedically correct position of the multi-unit abutment on the alveolar process and the above point on the zygomatic bone, then proceed to the preparation of the implant bed, using a linear laser pointer, check the correctness of the intended direction, and they are guided not only by the bone structures, but also by the exit points of the implant on the zygomatic bone, the preparation of the bed is completed by drilling with a finishing cutter to the entire estimated depth, using a point laser pointer, the correctness of the direction of the finishing cutter to the predetermined exit point of the implant tip is checked, then implants are placed, the flaps are sutured, impressions are taken, X-ray control is carried out.

2. The method according to claim 1, characterized in that immediately before the operation, to determine the projection of the exit point of the implants, an additional cone-beam computed tomography is performed with a pre-applied X-ray contrast marks.

3. The method according to paragraphs. 1, 2, characterized in that to improve the visualization of the projection of certain exit points of the implants, marks are applied to the skin of the face, the direction of the implant bed is applied in the form of a mark on the amveolar process and the canine fossa.

4. The method according to claim 3, characterized in that the marks are applied with a marker or a cosmetic pencil, or with a brilliant green solution.

Fig. 5. Laser pointer used for positioning zygomatic implants, representing an L-shaped structure formed by horizontal and vertical rods, which is attached to the micromotor, a point laser emitter is fixed at the end of the horizontal rod using an adjustable swivel joint, a linear laser emitter is fixed on the vertical rod with the possibility of movement a laser emitter, and the rods are interconnected by means of an adjustable swivel.