WO2022036900A1 - Prothèse combinée d'articulation temporo-mandibulaire et de mandibule - Google Patents

Prothèse combinée d'articulation temporo-mandibulaire et de mandibule Download PDF

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Publication number
WO2022036900A1
WO2022036900A1 PCT/CN2020/129727 CN2020129727W WO2022036900A1 WO 2022036900 A1 WO2022036900 A1 WO 2022036900A1 CN 2020129727 W CN2020129727 W CN 2020129727W WO 2022036900 A1 WO2022036900 A1 WO 2022036900A1
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WO
WIPO (PCT)
Prior art keywords
mandibular
prosthesis
joint
temporomandibular
temporomandibular joint
Prior art date
Application number
PCT/CN2020/129727
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English (en)
Chinese (zh)
Inventor
杨驰
郑吉驷
焦子先
陈敏洁
姜闻博
Original Assignee
上海交通大学医学院附属第九人民医院
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 CN202021763116.8U external-priority patent/CN213963774U/zh
Priority claimed from CN202010849318.2A external-priority patent/CN111938875A/zh
Application filed by 上海交通大学医学院附属第九人民医院 filed Critical 上海交通大学医学院附属第九人民医院
Publication of WO2022036900A1 publication Critical patent/WO2022036900A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints

Definitions

  • the invention relates to the field of medical devices, in particular to a temporomandibular joint and a mandibular joint prosthesis.
  • the temporomandibular joint (TMJ) is located in front of the tragus, adjacent to the base of the skull upward, and extends downward to the ascending mandibular ramus and mandibular body.
  • TMJ temporomandibular joint
  • various lesions cause TMJ-mandibular joint defect or total mandible, it will lead to serious functional impairments such as mastication, swallowing, speech and breathing, and even death.
  • How to repair temporomandibular joint function, mandibular shape and dentition defect simultaneously has always been a difficult point in the field of oral and maxillofacial surgery.
  • the main advantage of this method is that the technology is mature and the surgical operation is relatively fixed, but it has many inevitable disadvantages: (1) the fibula end serving as the head of the condyle is unstable, easy to dislocate and absorb, and cannot effectively restore joint function; (2) autologous bone The amount of alveolar bone is limited, and the height of the alveolar bone cannot be fully restored, which brings difficulties to the later dentition restoration. Compared with autologous bone transplantation, prosthetic repair is less traumatic and more stable in efficacy, which is an internationally recognized development trend.
  • TMJ Concepts in the United States has initially developed a temporomandibular joint-mandibular extension prosthesis, which is used to repair the function of the temporomandibular joint and the shape of the mandible at the same time.
  • the main advantages of this prosthesis are that it does not require autologous bone, the surgical trauma is small, and the function of the temporomandibular joint is well recovered, but it has the disadvantage of being unable to carry out later dental implantation and dentition restoration.
  • the purpose of the present invention is to provide a temporomandibular joint and mandibular joint prosthesis.
  • the temporomandibular joint-mandibular joint prosthesis can be designed according to different defect ranges, which can restore the structure and function of the temporomandibular joint, the shape of the mandible, the height of the alveolar bone, and achieve the joint repair of the temporomandibular joint-mandibular bone-dentition. .
  • the present invention provides a temporomandibular joint and mandibular joint prosthesis, the joint prosthesis at least includes:
  • a temporomandibular joint socket prosthesis, a mandibular bone prosthesis, and a joint head prosthesis comprising a connected zygomatic arch retention portion and a joint socket functional portion, the zygomatic arch retention portion comprising
  • the joint socket function part and the joint head prosthesis are concave and convex to form a core area of joint motion
  • the mandibular prosthesis includes a mandibular ascending ramus and a mandibular extension, and the mandibular ascending ramus and mandibular extension
  • the mandibular prosthesis is connected with the mandibular ascending ramus and at least part of the mandibular body shape; the end of the mandibular prosthesis is fixedly connected with the articular head prosthesis; the bending concave surface of the mandibular prosthesis is the upper part.
  • the temporomandibular joint and mandibular joint prosthesis of the present invention has the following beneficial effects:
  • the mandibular ascending ramus can effectively repair the contour and shape of the mandibular ascending ramus; its porous structure area is conducive to the attachment of the masseter and medial pterygoid muscles, avoiding the exposure of the prosthesis and restoring the bite force of the patient.
  • the mandibular extension and the autologous bone together restore the height of the mandible and alveolar bone, making it possible for the later dental implantation and dentition defect repair.
  • the porous structure area in the middle is conducive to the attachment of the mandibular hyoid muscle and the platysma, avoiding the exposure of the prosthesis and restoring the corresponding muscle function and facial shape of the patient.
  • the mandibular extension can be individually extended according to the scope and size of the temporomandibular joint-mandibular joint defect, so as to adapt to the repair of various types of joint defects, and even full mandibular reconstruction.
  • the present invention can individually repair various temporomandibular joint-mandibular joint defects of temporomandibular joint function, mandibular bone shape, dentition defects, etc., in order to achieve joint reconstruction of temporomandibular joint-mandibular bone-dentition.
  • FIG. 1 is a schematic structural diagram of a temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 2 is a schematic structural diagram (side view) of a temporomandibular joint socket prosthesis of a temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 3 is a schematic structural diagram (front view) of a temporomandibular joint socket prosthesis of a temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 4 is a schematic diagram of a joint head prosthesis of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 5 is a schematic view of the external side of the mandibular prosthesis of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 6 is a schematic diagram showing the inner side of the mandibular prosthesis of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 7 is a schematic diagram showing the partial structure of the mandibular extension part of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 8 is a schematic diagram showing the partial structure of the mandibular extension of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention (after dental implantation).
  • Fig. 9a is a schematic structural diagram of a mandibular prosthesis with different lengths of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.
  • 9b is a schematic structural diagram of a mandibular prosthesis with different lengths of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 9c is a schematic structural diagram of a mandibular prosthesis with different lengths of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.
  • FIG. 9d is a schematic diagram showing the structure of the mandibular extension part of the temporomandibular joint and mandibular joint prosthesis having the same length as the individual mandibular body according to an embodiment of the present invention.
  • FIG. 10 is a schematic structural diagram of a temporomandibular joint and mandibular joint prosthesis (full mandible) according to an embodiment of the present invention.
  • the temporomandibular joint and mandibular joint prosthesis at least includes:
  • the arch retention part 11 includes a zygomatic arch fitting surface, and the joint socket functional part 12 and the joint head prosthesis 3 cooperate in concave and convex to form a core area of joint motion; as shown in Figures 5 and 6, the mandibular prosthesis 2. It includes a mandibular ascending ramus 22 and a mandibular extension portion 21.
  • the mandibular ascending ramus 22 and the mandibular extending portion 21 are connected to form an individualized simulation of the mandibular ascending ramus and at least part of the mandibular body shape;
  • the end of the branch 22 is fixedly connected with the joint head prosthesis 3;
  • the mandibular prosthesis 2 is divided into an upper part A, a middle part B and a lower part C with the bent concave surface of the mandibular prosthesis 2 as the upper side.
  • the middle part B of the prosthesis 2 is provided with a continuous or discontinuous porous structure region 23 .
  • the zygomatic arch fitting surface is used for fitting with the autologous zygomatic arch.
  • the meaning of "individualization” in the present invention means that the shape of the autologous bone of the user is different, and the combined prosthesis or the components of the combined prosthesis can be adapted to different users.
  • the user's autologous bone can be scanned by techniques such as CT scanning, then a three-dimensional model and a prosthesis prototype can be established, and the combined prosthesis or the components of the combined prosthesis can be obtained by 3D printing and 5-axis finishing.
  • forming the individualized simulated mandibular ramus and at least part of the mandibular body shape means that the shape of the mandibular prosthesis 2 is made by imitating at least part of the structure of the user's own mandible.
  • Ascending mandibular ramus and at least part of mandibular body morphology means: one side is complete mandibular ascending ramus, and part or full length of mandibular body connected to this side mandibular ascending ramus; further, when complete mandibular ramus is included When the ascending ramus, and the full length of the mandibular body connected to the lateral mandibular ascending ramus, may also include the other side partial or complete mandibular ascending ramus.
  • the length of the mandibular prosthesis 2 can be flexibly set as required. It can be set according to the size of the mandibular defect of the user.
  • the mandible of the human body includes the ascending mandibular ramus and the mandibular body. Taking the central axis of the human body (dotted line in Fig. 9a) as a reference, as shown in Fig. 9a, the length of the mandibular prosthesis 2 may be the same as the following length Identical: The length of the user's mandible extending from the ascending ramus to the mandibular body of the midline of the human body. As shown in Fig.
  • the length of the mandibular prosthesis 2 may be less than the length of the user's mandible extending from the mandibular ramus to the mandibular body, which is the central axis of the human body. As shown in Fig. 9c, the length of the mandibular prosthesis 2 may be greater than the following lengths: the length of the user's mandibular ascending ramus extending to the mandible of the mandibular body part of the central axis of the human body; The length of the mandible extending to the ascending ramus of the mandible on the other side of the central axis of the body.
  • the combined prosthesis includes two temporomandibular joint socket prostheses 1 and two joint head prostheses; the mandibular prosthesis 2 includes two mandibular ascending ramus 22, the mandibular prosthesis
  • the length of the extension portion is the same as that of the individualized mandibular body, and one end of each mandibular ascending branch 22 is connected to both ends of the mandibular body respectively to form an individualized simulated bilateral temporomandibular joint and full mandibular shape.
  • Each joint head prosthesis is respectively fixedly connected with the end of the mandibular ascending branch 22 of the mandibular prosthesis 2 .
  • the joint socket functional part 12 includes a joint socket bone surface 13 that can fit with autologous bone and a joint socket motor function surface 14 for concave-convex matching with the joint head prosthesis 3.
  • the joint socket motion function surface 14 is an arc surface.
  • the bone surface 13 of the joint socket is designed to fit the human joint socket and joint nodules individually; the joint socket motion function surface 14 cooperates with the joint head prosthesis, and the joint head can be in the joint socket part.
  • the movement functional surface 14 performs relative movement.
  • the arc of the joint socket motion function surface 14 may be 5°-30°.
  • the joint socket function part and the joint head are used to restore the motion function of the temporomandibular joint.
  • the joint socket part and the zygomatic arch retention part are used for repairing the joint socket of the human body, and the joint head is used for repairing the human body's condyle.
  • the main function of the porous structure area is to reduce the weight of the prosthesis, facilitate the expansion of the muscles, restore part of the bite force, and facilitate the attachment of the masseter, medial pterygoid muscle, and platysma muscle.
  • the upper and lower parts of the mandibular ascending branch 22 are solid, and the middle part of the mandibular ascending branch 22 is provided with a continuous or discontinuous porous structure area 23; and/or, the mandibular extension part
  • the upper and lower parts of 21 are solid, and the middle part of the mandibular extension 21 is provided with a continuous or discontinuous porous structure region 23 .
  • porous structure region 23 of the mandibular ascending branch is provided on the side close to the mandibular extension 21 .
  • the middle portion B of the mandibular extension portion 21 is provided with a continuous porous structure region 23 , which is continuous with the porous structure region of the mandibular ascending branch portion 22 .
  • the porous structure region 23 includes a hollow structure formed by many through holes, and the pore size of the through holes is 400-800 ⁇ m.
  • the volume of the mandibular prosthesis occupied by the porous structure area may be set as required, for example, it may be 1/3 of the volume of the mandibular prosthesis. It is guaranteed to reduce the weight of the prosthesis and facilitate muscle expansion, and restore part of the occlusal force.
  • the shape of the through hole of the porous structure region is not limited, for example, it can be a circular hole or a polygonal hole. Such as quadrilateral holes, pentagonal holes, hexagonal holes, etc.
  • the lower part of the mandibular prosthesis is solid, which is a simulation design of the lower edge of the mandible of the human body, which is beneficial to the shape restoration of the face.
  • a mandibular retaining portion 211 is connected to the end of the mandibular extension portion 21 of the mandibular prosthesis 2 .
  • a mandibular retaining portion 211 is connected to the end of the mandibular extension portion 21 of the mandibular prosthesis 2 .
  • the side of the mandibular prosthesis that adheres to the autologous bone is the inner side, and the upper and/or lower inner side of the mandibular ascending ramus 22 is the contact layer 24 , so
  • the contact layer is a porous layer or a rough surface.
  • the contact layer can be obtained by surface treatment techniques such as sandblasting, or directly printed by 3D printing.
  • the inner surface of the upper part of the mandibular extension part 21 is the contact layer 24 .
  • the porous layer allows the prosthesis to form firm osseointegration with the autologous bone 5 .
  • the height of the mandible and the alveolar bone is jointly restored by the implanted autologous bone and the combined prosthesis, which is beneficial to the later stage of dental implantation and dentition restoration.
  • the inner surface of the mandibular retaining portion 211 is the contact layer 24 .
  • the thickness of the contact layer 24 is 0.5-1 mm. Conducive to the formation of firm osseointegration between the prosthesis and the autologous bone.
  • the contact layer 24 when the contact layer 24 is a porous layer, the contact layer 24 includes many blind holes, and the pore size of the blind holes is 400-800 ⁇ m.
  • the contact layer 24 has a rough surface
  • the contact layer 24 has an uneven surface
  • Ra is between 1.5-3.0 ⁇ m.
  • the upper part of the mandibular prosthesis is in a shape that can fit the autologous bone individually.
  • the upper, middle and lower parts of the mandibular prosthesis and the autologous bone of the upper inner side jointly restore the height of the mandible and provide sufficient bone height and width for post-implantation repair.
  • the zygomatic arch retaining portion 11 and the articular socket functional portion 12 are integrally connected, the zygomatic arch retaining portion 11 is made of titanium alloy, and the articular fossa functional portion 12 is made of ultra-high molecular weight Polyethylene material.
  • the zygomatic arch retaining portion 11 is made of titanium alloy
  • the articular fossa functional portion 12 is made of ultra-high molecular weight Polyethylene material.
  • the zygomatic arch retaining portion 11 and the joint socket functional portion 12 are integrally connected, and both are made of polyethylene.
  • the upper part of the mandibular prosthesis is provided with a nail hole 4 for fixing with autologous bone.
  • the number of the nail holes 4 is 8-14.
  • the mandibular retaining portion 211 is provided with a nail hole 4 for fixing with the mandible.
  • the number of the nail holes 4 is 4-5.
  • the zygomatic arch retaining portion is provided with a nail hole 4 for fixing with the zygomatic arch.
  • the number of the nail holes 4 is 5-7.
  • the joint head prosthesis is a hollow cylindrical structure.
  • the diameter of the joint head prosthesis may be 8-12mm; the height may be 10-14mm.
  • the hollow structure can reduce weight. Taking the connecting end of the joint head prosthesis 3 and the mandibular ascending branch as the bottom end, the bottom surface area of the hollow cavity of the joint head prosthesis 3 is larger than the area of the upper surface of the joint head prosthesis, and the taper can be 8-10°
  • the joint head prosthesis and the end of the mandibular ascending branch are nested and connected. Taper connections can be used.
  • the combined prosthesis includes two temporomandibular joint socket prostheses 1 and two articular head prostheses;
  • the mandibular prosthesis 2 includes two mandibular ascending branches 22 , the length of the mandibular extension is the same as the length of the individual mandibular body, and one end of each mandibular ascending branch 22 is connected to the two ends of the mandibular body respectively to form an individualized simulated bilateral temporomandibular joint and full mandibular shape.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne une prothèse combinée d'articulation temporo-mandibulaire et de mandibule, comprenant au moins une prothèse d'emboîture d'articulation temporo-mandibulaire (1), une prothèse de mandibule (2) et une prothèse de tête articulaire (3). La prothèse de mandibule (2) comprend une partie ascendante de mandibule (22) et une partie d'extension de mandibule (21), la partie ascendante de mandibule (22) et la partie d'extension de mandibule (21) étant reliées pour constituer une forme simulée individualisée de la partie ascendante de mandibule et d'au moins une partie du corps mandibulaire ; une extrémité arrière de la partie ascendante de mandibule (22) de la prothèse de mandibule (2) est reliée de manière fixe à la prothèse de tête articulaire (3) ; et en utilisant une surface concave de flexion de la prothèse de mandibule (2) comme côté supérieur, la partie centrale (B) de la prothèse de mandibule (2) est pourvue d'une zone de structure perforée continue ou discontinue (23). La fonction de l'articulation temporo-mandibulaire, la forme de la mandibule, les défauts de la dentition et d'autres types de défauts de la combinaison articulation temporo-mandibulaire-mandibule peuvent être corrigés individuellement et simultanément, de manière à obtenir une reconstruction combinée de l'articulation temporo-mandibulaire-mandibule-dentition.
PCT/CN2020/129727 2020-08-21 2020-11-18 Prothèse combinée d'articulation temporo-mandibulaire et de mandibule WO2022036900A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
CN202021763116.8U CN213963774U (zh) 2020-08-21 2020-08-21 一种颞下颌关节及下颌骨联合假体
CN202010849318.2 2020-08-21
CN202010849318.2A CN111938875A (zh) 2020-08-21 2020-08-21 一种颞下颌关节及下颌骨联合假体
CN202021763116.8 2020-08-21

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Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN2850560Y (zh) * 2005-07-12 2006-12-27 北京蒙太因医疗器械有限公司 钉螺型髋臼假体的金属杯
CN102065916A (zh) * 2008-04-17 2011-05-18 华沙整形外科股份有限公司 刚性骨移植替代品
US20140358237A1 (en) * 2012-06-11 2014-12-04 Saad Touleimat Adjustable Mandible Joint System
WO2014195404A1 (fr) * 2013-06-07 2014-12-11 Obl Sa Prothèse d'articulation temporomandibulaire
CN205626192U (zh) * 2016-02-18 2016-10-12 上海交通大学医学院附属第九人民医院 关节窝一体式个性化全颞下颌关节假体
WO2017045028A1 (fr) * 2015-09-15 2017-03-23 Tmj Orthopaedics Pty Ltd Prothèse mandibulaire et ancrage temporo-mandibulaire pour reconstruction de la mâchoire
CN207125817U (zh) * 2017-01-20 2018-03-23 北京爱康宜诚医疗器材有限公司 一种可术中调节下颌支位置的下颌关节假体
CN210644250U (zh) * 2019-06-25 2020-06-02 上海交通大学医学院附属第九人民医院 下颌骨缺损修复体
CN111938875A (zh) * 2020-08-21 2020-11-17 上海交通大学医学院附属第九人民医院 一种颞下颌关节及下颌骨联合假体

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN2850560Y (zh) * 2005-07-12 2006-12-27 北京蒙太因医疗器械有限公司 钉螺型髋臼假体的金属杯
CN102065916A (zh) * 2008-04-17 2011-05-18 华沙整形外科股份有限公司 刚性骨移植替代品
US20140358237A1 (en) * 2012-06-11 2014-12-04 Saad Touleimat Adjustable Mandible Joint System
WO2014195404A1 (fr) * 2013-06-07 2014-12-11 Obl Sa Prothèse d'articulation temporomandibulaire
WO2017045028A1 (fr) * 2015-09-15 2017-03-23 Tmj Orthopaedics Pty Ltd Prothèse mandibulaire et ancrage temporo-mandibulaire pour reconstruction de la mâchoire
CN205626192U (zh) * 2016-02-18 2016-10-12 上海交通大学医学院附属第九人民医院 关节窝一体式个性化全颞下颌关节假体
CN207125817U (zh) * 2017-01-20 2018-03-23 北京爱康宜诚医疗器材有限公司 一种可术中调节下颌支位置的下颌关节假体
CN210644250U (zh) * 2019-06-25 2020-06-02 上海交通大学医学院附属第九人民医院 下颌骨缺损修复体
CN111938875A (zh) * 2020-08-21 2020-11-17 上海交通大学医学院附属第九人民医院 一种颞下颌关节及下颌骨联合假体

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