Patent Application
20150272704
1. Field of the Invention
The present invention relates to the field of dental surgery. More particularly, the present invention relates to a combination surgical template and false teeth set that fit together to form an implantable denture. The present invention also relates to methods for manufacturing a surgical dental template, methods for installing a denture prosthesis in a partially edentulous patient, and method for reducing jaw bone in a patient.
2. Description of Related Art
The use of dental prostheses with dental implants secured in the upper or lower jawbone is well known in the art. Accurate placement of the implants within the jawbone is a difficult task. The dental surgeon typically has difficulty deciding on a drilling axis for the implants since the ideal position for the implants should be decided with knowledge of the jawbone structure into which the implant is to be inserted, and with knowledge of the position within the jawbone structure of the nerve tissue, the gum surface and the required position and dimensions of the false teeth or dentures to be supported by the dental implant.
The conventional surgical procedure for installing one, implant-supported, prosthetic tooth includes drilling a properly positioned hole in the jawbone of the patient, inserting the implant in the hole, and attaching the prosthetic tooth to the implant. Proper implant positioning is also extremely important to ensure that the implant is anchored within sufficient bone structure in the patient's jawbone.
The most common method for locating a dental implant hole is to visually survey the area and drill the hole in a freehand manner. However, this method can readily result in imperfect bores due to space limitations associated with working inside a patient's mouth. If the drilling axis is not properly chosen, the installed implants might cause damage to the tissues and muscle surrounding the area of implantation and subsequently cause temporary or permanent paresthesia. Furthermore, other problems can result from flawed or imperfect implant holes, such as uneven force distribution, insufficient bone growth around the implant, secondary infections, and ultimately, implant failure.
During a one-stage surgical procedure, a healing abutment assists in the healing, formation, and maintenance of the soft tissue over the implant while bone integration occurs. The healing abutment is immediately placed into the implant well to ensure that the gum line will heal properly and look natural once the final abutment is tapped into the implant.
During a two-stage surgical procedure, a cover screw is initially screwed into the implant well. The tissue surrounding the cover screw is then sutured to protect the implant site while bone integration occurs. Once the bone has integrated, an incision is made in the tissue above the site, at which time integration is checked. Once the bone has healed properly, the cover screw is then removed, and a healing abutment is screwed into the implant well. With the healing abutment securely in place the tissue surrounding the area is sutured. Approximately 4-6 weeks later, the healing abutment can be removed and a final abutment is then placed into the implant. In some surgical cases, a final abutment is immediately placed into the implant well rather than the healing abutment and sutures are not required. In both the one-stage and two-stage surgical procedure, the final abutment supports the final crown or denture.
Many types of surgical guides are on the market today. They can be tooth supported, gum supported, or bone supported. The simplest guides are done in the laboratory. They consist of acrylic templates (or stents), or teeth, both filled with radiopaque markers that provide the position of the teeth in relation to the bone on 2D radiographs. Holes are drilled through these surgical guides at the selected implant sites and the surgeon uses them to make bone perforations. Afterwards, the surgeon needs to raise a flap in order to make the osteotomies. Examples of such guides are shown in
Each surgical stent commonly used is custom-built and these devices are only useful for a single patient, are costly to fabricate, and they require a number of intermediary office and laboratory steps to take an impression of the patient's arch and create a cast model from which the surgical stent is formed.
Superstructures are used as load-bearing elements that interface prosthesis to implants. In the conventional method for the construction of superstructures, a physical model of the patient's gums and dental implant heads is prepared on which the superstructure is built manually using molding and other techniques known in the art. The craftsman or technician skilled at manufacturing such dental superstructures takes into consideration the size and shape of the desired dentures to be placed over the superstructure when crafting the same. The procedure for manufacturing dental implant superstructures as is conventionally known in the art is time-consuming and sometimes results in imperfect structures or defects in the visual appearance of the dentures to be placed over the superstructure.
Therefore, in an effort to reduce costs and the number of steps associated with fabricating a traditional surgical stent, various forms of prefabricated surgical stents and positioning guide systems have been developed to aid the dental surgeon. In International patent application publication no. WO 94/26200, there is described an adjustable guiding device for positioning dental implants in which it is possible for the dental surgeon to adjust a drilling axis for each implant before proceeding to use the guiding device or drill template to guide the surgeon's drill for the purposes of preparing the drill hole for the implant.
In U.S. Pat. No. 5,401,170, there is disclosed a method and apparatus for measuring by camera image the implant heads of the implants in the patient's mouth for the purposes of cutting a frame on which the prosthetic teeth will be arranged and baked. In the method disclosed, the construction of the frame or superstructure is carried out in the absence of a reference to the shape and position of the patient's ideal tooth position.
Thus, as the dentures or artificial teeth are crafted on the frame or superstructure, care would be required during the manual process to ensure that the position of the teeth on the frame will match the opposed set of teeth in the patient's mouth.
It would thus be desirable to provide a drill guide system comprising components fabricated prior to the actual surgery that may be used more than once for the same patient, for any restoration configuration, and that enables precise implant spacing, and also ensures that the implant holes are drilled at the proper angle and orientation.
One embodiment of the invention comprises a dental device comprising a surgical template having one or more sites for drilling osteotomies in the maxillary or mandibular jaw and a false teeth set. For such dental device, the surgical template and false teeth set may be configured to fit together to form a denture prosthesis that may be implanted in a patient to provide for the appearance of natural teeth.
In embodiments, the surgical template may be configured to fit over an edentulous patient's maxillary or mandibular gum tissue, and a portion of the surgical template may have the appearance of gum tissue.
In embodiments, the one or more sites may be openings each providing a channel for drilling an osteotomy into the maxillary or mandibular jaw. Further, each opening may comprise a cylindrical wall having a height which is capable of limiting the drilling depth of the osteotomy. In additional embodiments, the false teeth set comprises one or more openings configured to overlap the one or more openings of the surgical template when the template and false teeth set are fit together.
In embodiments, the surgical template and false teeth set may have male and female portions capable of interlocking. In one embodiment, the surgical template comprises a male portion configured to interlock with a female portion on one of the teeth of the false teeth set. In another embodiment, the surgical template comprises a ledge configured to fit the false teeth set.
In additional embodiments, the surgical template comprises one or more sets of drill holes configured to provide a guide for reducing jaw bone when the surgical template is positioned on the maxillary or mandibular jaw during use.
In additional embodiments, a wall of the surgical template is configured to form one or more pin holes. The one or more pin holes may be configured as projections extending outward from a wall of the surgical template. The device may further comprise pins passing though each of the pin holes. Each pin may have a handle portion extending outward from each projection and a tapered portion extending inward through each projection. In additional embodiments, the surgical template may comprise one or more flanges extending outward from the template.
Another embodiment of the invention comprises a dental device comprising a surgical template configured to fit the interior of a maxillary or mandibular jaw over an edentulous patient's maxillary or mandibular gum tissue and a false teeth set. In embodiments the surgical template and false teeth set may be configured to fit together. The surgical template may comprise one or more openings each providing a channel for drilling an osteotomy into the maxillary or mandibular jaw. Further, the false teeth set may comprise one or more openings configured to overlap the one or more openings of the surgical template when the template and false teeth set are fit together. Further, a wall of the surgical template may be configured to form one or more pin holes and the device may further comprise pins passing though each of the pin holes.
Another embodiment of the invention comprises a dental device comprising a surgical template configured to fit over the gum tissue of a partially edentulous jaw missing one or more incisors, the surgical template having one or more openings each providing a channel for drilling an osteotomy into the maxillary or mandibular jaw at the site of the missing incisors and one or more removable false teeth configured to fit the surgical template at each opening. In embodiments, the surgical template and one or more removable false teeth provide a partial or complete bridge between the left and right cuspids when implanted into a patient's jaw. In embodiments, the surgical template may be configured to partially wrap around the left and right cuspids.
Another embodiment of the invention comprises a method for creating a surgical dental template, comprising performing a CT scan on a patient, transferring one or more CT scan images into treatment planning software, virtually placing implants in one or more positions on the CT scan using the treatment planning software, and creating a surgical template based on the positions on the CT scan that provide one or more sites for drilling osteotomies in the maxillary or mandibular jaw for installing the implants. In embodiments, the CT scan slices implant or anchor sites by size and diameter per zone into the jaw bone.
Another embodiment of the invention comprises a method for implanting a denture prosthesis in a patient, comprising creating a treatment planning protocol according to the treatment planning software and implanting the surgical template in the patient according to the treatment planning protocol.
In embodiments, the surgical template is configured to fit over an edentulous patient's maxillary or mandibular gum tissue. In embodiments, a portion of the surgical template has the appearance of gum tissue.
In embodiments, the one or more sites are openings each providing a channel for drilling an osteotomy into the maxillary or mandibular jaw. Each opening may comprise a cylindrical wall having a height which is capable of limiting the drilling depth of the osteotomy
In embodiments, the one or more CT scan images are in the form of DICOM files.
In embodiments, the surgical template may be manufactured from a nanoceramic composite.
In embodiments, the surgical template is manufactured through CNC milling.
In embodiments the patient is fully edentulous, and the CT scan is performed with the patient wearing a denture with radio-opaque markers. In other embodiments, the patient is partially edentulous, and the CT scan is performed with the patient wearing a radiographic guide. In other embodiments, the patient is partially edentulous, and the CT scan is performed with the patient not wearing a radiographic guide.
In embodiments, the method further comprises making a set of full arch impressions from the patient's jaw; performing a CT scan on the arch impressions; and creating a surgical template based on the CT scan of the arch impressions.
In embodiments, the surgical template is configured to fit with a false teeth set to form a denture prosthesis.
In embodiments, the false teeth set comprises one or more openings configured to overlap the one or more openings of the surgical template when the template and false teeth set are fit together.
Another embodiment of the invention comprises a method for implanting or installing a denture prosthesis in a partially edentulous patient. The method may first comprise providing a surgical template and a false teeth set. The surgical template is configured to fit over the gum tissue of an edentulous jaw of a patient and has one or more sites for drilling osteotomies, and the surgical template and false teeth set are configured to fit together to form a denture prosthesis. The surgical template is then positioned over the gum tissue of an edentulous jaw of a patient at a first position and the false teeth may be inserted and set into the surgical template. The false teeth set may be fixed into the surgical template with a composite. The patient is then instructed to bite down on the false teeth set with natural teeth of the jaw opposite the edentulous jaw. The surgical template is repositioned, and the steps are repeated until the patient confirms occlusion between the natural teeth and false teeth set. The surgical template is finally fixed over the gum tissue of the patient's edentulous jaw at a second position.
In embodiments, a wall of the surgical template is configured to form one or more pin holes, the surgical template comprising pins passing though each of the pin holes, and the pins are used to fix the surgical template over the gum tissue of the patient's edentulous jaw.
In embodiments, the method further comprises drilling osteotomies into the edentulous jaw based on the drilling sites and installing implants at the osteotomies and securing the surgical template through the implants. The implants can be secured with a fastener.
In embodiments, the surgical template and false teeth can be finished or converted to provide the appearance of a dental prosthesis by removing one or more of a boundary line between the surgical template and false teeth set, one or more pin holes in the surgical template, and one or more flanges in the surgical template. The boundary line and one or more pin holes can be removed by filling with composite.
Another embodiment of the invention comprises a method for reducing jaw bone. A surgical template configured to fit the interior of a maxillary or mandibular jaw over an edentulous patient's gum tissue is installed in a patient. The surgical template has one or more sets of drill holes. Next, osteotomies may be perforated through the drill holes in the surgical template to define markings in the jaw bone forming a boundary for reducing bone. The surgical template is removed and the jaw bone is exposed though an incision to reveal the osteotomies. Finally, a surgical instrument is used to remove jaw bone based on the boundary formed by the markings.
The device of the invention when implanted and converted to a denture prosthesis provides for the appearance of natural teeth while being fixed in the jaw, providing aesthetic benefits for an edentulous or partially edentulous patient. Further, the invention may provide for shorter surgery times for implantation of the device as well as greater precision in placement compared to conventional devices. In addition, the device may be converted to a temporary or final prosthesis. The device can be used with a variety of implants for implantation into jaw bone.
The accompanying drawings illustrate certain aspects of embodiments of the present invention, and should not be used to limit the invention. Together with the written description the drawings serve to explain certain principles of the invention.
The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
Reference will now be made in detail to various exemplary embodiments of the invention. It is to be understood that the following discussion of exemplary embodiments is not intended as a limitation on the invention. Rather, the following discussion is provided to give the reader a more detailed understanding of certain aspects and features of the invention.
In one embodiment, the present invention is a two-part denture prosthesis or device comprising a surgical template or guide and removable false teeth set for both the mandibular and maxillary jaw. The surgical template and false teeth set may be configured to fit together in an interlocking configuration. The surgical guide may exist as two components that are each configured to fit the top (maxilla) or bottom (mandible) portion of a patient's jaw when placed inside the mouth. The surgical guide may have one or more holes that may serve as drilling sites. The holes may be positioned so that osteotomies may be drilled downward in the mandible or upward in the maxilla. The holes in the guide can comprise a cylindrical wall (also known herein as a depth stop) that is raised or lowered to accommodate a target depth of the osteotomy. The surgical guide may have one or more pin holes for securing or clamping the guide to the jaw during surgery. During surgical placement of the guide, pins can be set through the pin holes in the guide through the bone to secure the guide in place until it is permanently fixed with the abutments or implants. In embodiments, the pin holes are located laterally on the guide and spaced apart to secure the sides and central portion of the guide.
In embodiments, the surgical guide has a removable false teeth set configured to interlock with the surgical guide. The removable teeth may exist as two additional components (e.g., one for the maxillary jaw and one for the mandibular jaw) each configured to fit the top maxillary portion or bottom mandibular portion of the surgical guide. The removable false teeth set allows the oral surgical guide to be simultaneously used as a prosthesis. In addition, the removable false teeth are useful in helping to confirm the fit of the surgical guide through occlusion. The removable teeth may fit on the surgical guide above or below the drill holes and may have access holes that complementarily fit the drill holes. Ultimately, the surgical guide and teeth component are secured as one piece to the implant(s) placed in the jaw though a fastener such as screws.
The surgical guide may be manufactured to fit the individual patient's mouth based on a CT scan of the maxilla and mandible. The surgical guide may be manufactured from a nanoceramic composite or other suitable material through CNC milling or 3D printing.
In another embodiment, the invention is a method for performing oral surgery. The method comprises placing a surgical guide of the invention in a patient's mouth, setting one or more pins through the holes of the guide to secure the guide to the jaw, placing a set of teeth on the guide, instructing the patient to bite down on the teeth to confirm the fit of the guide through occlusion, if necessary, releasing the guide with the pins and readjusting the fit of the guide based on the occlusive bite, and securing the guide with the pins, drilling osteotomies through the holes, and securing the guide to the jaw through implants or abutments placed in the osteotomies. The methods may further comprise using a pre-surgical bite registration index based on the patient's bite. The methods may further comprise cutting off insertion pin holes and flanges on the guide and filling the border between the surgical guide and false teeth set with composite to provide for a natural look.
In another embodiment, the invention is a method of placing a dental prosthesis in the mouth of a patient. The method comprises placing a surgical guide in the mouth of a patient, performing guided surgery based on drill holes in the surgical guide, inserting abutments through the surgical guide, retrieving the surgical guide and reducing excess material, inserting a complementary false teeth set into the surgical guide, drilling a guided screw channel into the surgical guide, and finishing the surgical guide.
Various embodiments of a device of the invention are shown in
As will be shown below, the false teeth sets 112, 118 and guides 105, 125 may include features that allow corresponding components to fit into place. These may include at least one male component on the guides 105, 125 and at least one female component on the teeth or vice versa. In one embodiment, the guides 105, 125 have a male component having an appearance of a molar tooth structure that interlocks with a molar tooth structure of the corresponding false teeth sets 112, 118. In other embodiments, the guides 105, 125 have a ledge or gulley that is configured to accept a protruding portion of the corresponding false teeth sets 112, 118. Once they are fit together, false teeth sets 112, 118 and guides 105, 125 may be permanently fixed together through an adhesive such as a composite.
Turning now to
Now referring to
1. Guided surgery
2. Abutment (not shown) insertion and bonding, through surgical guide still installed
3. Surgical guide retrieval and excess material reduction
4. Surgical guide parts assembly and bonding
5. Guided screw channel drilling
6. Finishing
In embodiments, the device of the invention may be used as a temporary prosthesis until a more permanent prosthesis is put into place.
In embodiments, the surgical guide may include one or more retaining pins and drill holes located on the denture which serve as a surgical guide for bone reduction. The bone reduction guide assists the user to reduce bone to the necessary thickness in order for the denture to be placed at the right height, and may be determined from a CT scan of the patient's jaw. The retaining pins and drill holes allow for a boundary on the jaw to be marked when the surgical guide is placed in the jaw as the jaw may be marked by drilling though the drill holes. When the guide is placed the jaw may be exposed through an open flap incision, allowing the oral surgeon to see the holes. The jaw may be reduced by sawing down the jaw until the holes are no longer visible.
Now referring to
As shown in
The following provides specifications of a Demo Case:
Master cylinder=Green
Drill guide=Green, 4.1 mm internal diameter (final)
Implant=4.6 mm×10.5 mm Tapered
Internal Implant=Drill 21 mm length, 4.1 mm diameter (final)
Implant driver and depth position=Tapered Internal 4.6, SP2
In another embodiment, the present invention is a method of creating a two-part dental prosthesis comprising a surgical guide and false teeth set. The method comprises performing a CT scan on a patient, transferring the scan (such as in the form of a Digital Imaging and Communications in Medicine (DICOM) file) into treatment planning software. The CT scan slices implant or anchor sites by size and diameter per zone into the jaw bone. From the CT scan, a surgical guide is created based on one or more anchor or implant sites to create a surgical template. The surgical guide may be created by a trained biomedical engineer or oral surgeon who virtually places the implants in position on the CT scan, taking into account the bone quality and quantity and the presence of nerves. The surgical guide is then milled based on the template that provides one or more holes that may serve as drilling sites to place the implants which secure the guide into the jawbone. The drilling sites are created so that the implants are placed at consistent angles to provide for an even pressure distribution on the surgical guide when it is secured in the jaw. A treatment protocol may also be produced from the treatment planning software which instructs a dental surgeon how to place the surgical guide, including the drilling depth. Based on the CT scan, sites in the jaw bone may be identified that may be used to secure one or more implants. The implants may provide a means for securing the device in place with a fastener such as a screw. The device may be attached to the jaw through the implants according to the implant manufacturer's instructions.
In embodiments, the CT scan may be performed in a variety of ways, depending on whether the jaw is fully or partially edentulous and whether metal restorations or amalgams are present. For a partially edentulous jaw, if there is good teeth support, and no metal restorations or amalgams, then the CT scan may be performed without a radiographic guide. If there is good teeth support and amalgams or metal restorations are present, then the CT scan may be performed with a radiographic guide. For a partially edentulous jaw without good teeth support or for a fully edentulous jaw, the CT scan may be performed with a gum-supported surgical guide (denture with markers).
The present invention has been described with reference to particular embodiments having various features. In light of the disclosure provided above, it will be apparent to those skilled in the art that various modifications and variations can be made in the practice of the present invention without departing from the scope or spirit of the invention. One skilled in the art will recognize that the disclosed features may be used singularly, in any combination, or omitted based on the requirements and specifications of a given application or design. When an embodiment refers to “comprising” certain features, it is to be understood that the embodiments can alternatively “consist of” or “consist essentially of” any one or more of the features. Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention.
It is noted in particular that where a range of values is provided in this specification, each value between the upper and lower limits of that range is also specifically disclosed. The upper and lower limits of these smaller ranges may independently be included or excluded in the range as well. The singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise. It is intended that the specification and examples be considered as exemplary in nature and that variations that do not depart from the essence of the invention fall within the scope of the invention. Further, all of the references cited in this disclosure are each individually incorporated by reference herein in their entireties and as such are intended to provide an efficient way of supplementing the enabling disclosure of this invention as well as provide background detailing the level of ordinary skill in the art.
The present application relies on the disclosure of and claims priority to and the benefit of the filing dates of U.S. Provisional Application No. 61/971,804 and U.S. Provisional Application No. 61/971,810, both filed on Mar. 28, 2014, and U.S. Provisional Application No. 62/052,988, filed Sep. 19, 2014, the disclosures of which are hereby incorporated by reference herein in their entireties.
| Number | Date | Country | |
|---|---|---|---|
| 61971804 | Mar 2014 | US | |
| 61971810 | Mar 2014 | US | |
| 62052988 | Sep 2014 | US |
