Patent Application
20090298008
The invention relates to an apparatus and method for performing a dental procedure relating to replacement of teeth including a dental model of a particular mouth formation of a patient, and an intended dental implant location with respect to the dental model, and more particularly to the production and use of a dental X-ray guide and/or a dental drill guide during a dental procedure relating to replacement of teeth.
The popularity of dental implants has grown greatly in recent years, and the implant placement has become a part of the routine dental work in many dentists' offices. X-ray guides are used to verify the location and the angulations of implants when usage of a CT scan is unjustifiable, and implant drill guides are used at the surgeries to place implants into the desired location with the proper angulation. However, these devices are not often used, especially when a small number of implants are placed in one surgery, even though wrong location, spacing, and angulations of implant placement may compromise the esthetic result of the final dental restoration. The reason of this tendency is thought to be the amount of labor involved in making surgical guide devices and the high price of custom order-made devices.
It is known to take an impression of a particular mouth formation of a patient to create a dental model when preparing for a dental procedure relating to replacement of teeth. The dental model is typically made at a dental laboratory separate from the dental office requiring the patient to make several different appointments with the dentist to complete the necessary procedures. The dental model is drilled at the dental laboratory with a smooth cylindrical aperture in a desired location for implant placement indicated by the dentist. A locator rod is inserted into the smooth cylindrical bore and a drill guide support is located by the locator rod during formation of a drill guide impression tray on the dental model at the dental laboratory. The drill guide support can be of the type illustrated in
It would be desirable to provide a dental implant procedure that could be performed at the dental office while the patient waits to reduce or eliminate repeated return visits by the patient for the complete dental implant procedure. It would be desirable to provide a dental X-ray tray to verify spacing, placement and angulation of each drill guide with respect to the particular patient prior to fabrication of the surgical drill guide tray. It would be desirable to provide a dentist with an option to create an X-ray tray and/or a drill guide in the dentist office without requiring the delay associated with work required to be done in a dental laboratory. It would be desirable to provide a dental procedure with easy adjustment of location and angulation of implant placement with respect to the dental model to accomplish any corrections required as a result of verification checking against the particular mouth formation of a patient.
The invention can be used to create an X-ray guide for verification of locations and angulations of the implant placement, and/or to create an accurate custom drill guide for dental implant placement surgery. The components necessary to make the guides can be used in a dental laboratory or a dentist office for making the X-ray guide and/or drill guide easily and quickly. The components allow a dentist or technician to establish the ideal location, spacing, and angulations of implants on the dental model using a combination of a pin with a sphere at the base of the pin, and to easily create the surgical guide or guides that accommodate all the different size surgical drills used in the surgery by building the guide around the pin.
The components include: (1) a spacing/positioning/orientation sphere and pin combination; (2) a surgical guide and locator attachment that can accommodate a large variety of surgical drills sizes: and (3) a material that can be cured or hardened. The material can be used alone to build an impression tray or can be used in combination with a preformed X-ray impression tray and/or a preformed surgical guide impression tray.
An apparatus and method for performing a dental procedure relating to replacement of teeth includes a dental model of a particular mouth formation of a patient and an intended dental implant location with respect to the dental model. At least one reference member to be supported by a dental model is located in an angulation and dimensional position at an intended dental implant location. A material to be applied around the at least one reference member provides support for the at least one reference member when the material has hardened. The material forms an impression of teeth and gums of a particular mouth formation of a patient and an intended dental implant location with respect to the dental model.
An apparatus and method for performing a dental procedure relating to replacement of teeth includes a dental model made from an impression of teeth and gums of a particular mouth formation of a patient and an intended dental implant location with respect to the dental model. At least one reference member to be supported by the dental model is located in an adjustable angulation and dimensional position at the intended dental implant location. Each reference member includes a base portion having at least a partial spherical surface for engagement within an at least partial spherical aperture formed in the dental model with a round ball drill. The base portion supports an outwardly extending reference pin portion. A material to be applied around the at least one reference member provides support for the at least one reference member when the material has hardened. The material forms an impression of teeth and gums of a particular mouth formation of a patient and an intended dental implant location with respect to the dental model.
Other applications of the present invention will become apparent to those skilled in the art when the following description of the best mode contemplated for practicing the invention is read in conjunction with the accompanying drawings.
The description herein makes reference to the accompanying drawings wherein like reference numerals refer to like parts throughout the several views, and wherein:
Referring now to
Suitable material 20 is available commercially under different names from various manufacturers. By way of example and not limitation, a suitable heavy body PVS material 20 can include FRESH® from Exacta Dental Direct of Clinton Township, Mich.; AQUASIL-SMART WETTING® impression material from Dentsply of Burlington, N.J.; or IMPRINT™ II Penta from 3M ESPE of Saint Paul Minn. By way of example and not limitation, a suitable light cured composite material 20 can include TRIAD® custom tray material from Dentsply Prosthetics of York, Pa.; or FASTRAY LC™ from Bosworth of Skokie, Ill.
Referring now to FIGS. 1,2 and 4A-4C, each reference member can include a base member or ball portion 22 having at least a partial spherical surface 24 for engagement within an aperture 26 formed in the dental model 12 with a round ball drill. The base portion 22 can include a pin-receiving aperture 28. A pin 30 can be engaged within the pin-receiving aperture 28 of the base member 22. The base member 22 can be substantially spherically shaped if desired. The pin 30 is releasibly engageable within the pin-receiving aperture 28. The pin 30 can be engaged within the base member by a threaded connection or with a friction fit connection. It should be recognized that the ball 22 and pin 30 can be formed as a single member, if desired. It should further be recognized that the if a separate ball portion 22 is provided, that the ball portion 22 can include an outwardly projection stub for attachment of the pin 30 in place of the pin-receiving aperture 28, where the pin includes a corresponding stub-receiving aperture, or a mating collar can couple the stub and pin together, if desired.
An adhesive 32 is provided for releasibly securing each reference member 16 in the desired angulation and dimensional position l 8 with respect to the dental model 12. A suitable adhesive 32 is available commercially from various manufacturers under different names. By way of example and not limitation, a suitable adhesive 32 can include ZAPIT® from Dental Ventures of Corona, Calif.; or SUPER GLUE® from Renpert of Saint Charles, Ill.
An adhesive release agent can be applied to the dental model 12 to release a reference member 16 for readjustment of the angulation and dimensional position 18 or for removal of the reference member 16. A suitable release agent is available commercially from various manufacturers under different names. By way of example and not limitation, a suitable release agent can include acetone, or a nail polish remover.
The pins 30a, 30b, 30c illustrated in
Referring now to
Suitable impression trays 34 are available commercially under different names from various manufacturers. By way of example and not limitation, suitable impression tray 34 can include a disposable plastic impression tray from Patterson Dental of Saint Paul, Minn.; an impression tray from Miradent of Boston, Mass.; or a BORDER-LOCK™ implant tray from Accu-liner Products of Woodinville, Wash.
When used in combination with a preformed impression tray 36, an appropriate portion 38 of the tray 36 is cut back to expose the intended dental implant location 14 with respect to the dental model 12. The material 20 can be applied to the preformed impression tray 36 prior to placement on the dental model 12. Additional material 20 is applied within the cut back portion 38 of the preformed impression tray 36 to support each reference member 16 with the material has hardened or cured.
When the impression tray 34 to be formed is an X-ray guide impression tray 40, at least one X-ray visible or opaque reference member 42 is substituted for the pin portion 30 of each reference member 16. The X-ray visible reference member 42 is supported by the hardened or cured material 20 applied within the cut back portion 38 of the preformed impression tray 36. It should be recognized that the X-ray visible reference member 42 can also be supported by the hardened or cured material 20, when the material 20 has been used to create the entire impression tray 34 without a preformed tray 36. While each X-ray visible reference member is supported by the material 20, the X-ray guide impression tray 40 is transferred to the mouth of a patient for X-ray confirmation of the angulation and dimensional position 18 of the at least one X-ray visible reference member 42.
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By way of example and not limitation, the following description describes various possible configurations of the complementary shaped replaceable portions for interlocking engagement between the anchor or base portion 102 and the locator guide portion 104 and/or the drill guide portion 106.
In
The X-ray guide kit can include: (1) a clear X-ray guide impression tray; (2) a positioning/orientation ball and pin combination; and (3) an X ray pin of metal or X-ray opaque material to confirm spacing/positioning/orientation with respect to the patient prior to constructing the drill guide. The X-ray guide impression tray can be used to define a frame of an X-ray guide body. The impression tray is used for convenience, and it should be recognized that an X-ray guide body can be made without using an X-ray guide impression tray if desired. Different commercially available materials can be used to create the frame of the X-ray guide body if desired.
The positioning/orientation ball and pin combination can include various size locator spheres with a removable pin longer than an X-ray pin (2.2 millimeters or other set diameter with 2 millimeter or other set diameter insertion section and 20 millimeter or other set length). The locator sphere is used for positioning and spacing of implants; so the diameter of the locator sphere can be determined by the implant size. The pin is used to determine the angulations of the implant placement. Various material and combination of materials can be used for the ball and pin combination. The sphere and pin can be made as a single integral part, or an insertion portion of the pin can be threaded or friction fit into the sphere portion. An X-ray pin can be made of metal, or any other radio opaque material can be used. The X-ray pin can be 10 millimeters or other set length (i.e. shorter than the positioning/orientation pin and 2.2 millimeters or other set diameter (i.e. the same as the positioning/orientation pin but without an insertion portion to interact with the sphere). The X-ray pin sits on top of the sphere or ball, and is not inserted into the ball.
A procedure for creating an X-ray guide according to the invention can include the following steps: (1) take an impression of the patient's mouth, and create a dental model; (2) mark the dental model to locate the ideal positioning of implant or implants for the best esthetic result; (3) use a pilot drill, drill a pilot hole in the dental model at the marked position, then, make the pilot hole larger and deeper using a round ball drill with a diameter corresponding with the implant size; (4) cut back a tray to expose a desired implant placement area; (5) use a set of positioning/orientation sphere and pin, and set orientation of the implant insertion esthetically ideal for the dental restoration; (6) apply impression material (clear PVS is desirable) on X-ray guide impression tray, firmly place the implant/impression tray on the dental model, put PVS material around the pin(s), and the tray; (7) when the material around the pin(s) hardens, detach the spacing/positioning/orientation pin(s) from the sphere(s), and pull out the pin(s) from the tray keeping the tray in the same position, replace the positioning/orientation pin(s) with X-ray pin(s), make sure the X-ray pin(s) sit(s) on top of the sphere(s) (i.e. the top of sphere corresponds to a gum line of the patient); (8) place the tray in the patient's mouth hold an X-ray film or a digital device against the flat wall of the X-ray tray (adhesive can be used to attach the film in place), and take X-ray photos; and (9) evaluate the positioning and the angulations of the pin(s), if the positioning is satisfactory, place the positioning/orientation pin(s) back into the spheres on the dental model. The verified model can be used as a device to create a surgical guide as described in greater detail below. (10) If the positioning needs adjustment, remove PVS material around the X-ray pin(s); release positioning/orientation sphere(s) from the model, attach positioning/orientation pin(s) to the sphere(s), and re-mount the sphere(s) in a new adjusted, corrected position. Repeat steps 6 to 9 until the desired result is achieved.
The surgical guide kit can include (1) a surgical guide impression tray; (2) a spacing/positioning/orientation sphere and pin (needed if an X-ray guide has not previously been made as described above); and (3) at least one surgical guide attachment. The surgical guide impression tray can be used to define a frame of a surgical guide body. The impression tray is used for convenience, and it should be recognized that a surgical guide body can be made without using a surgical guide impression tray if desired. Different commercially available materials can be used to create the frame of the surgical guide body if desired.
A spacing/positioning/orientation sphere and pin can be provided as described in greater detail above with respect to the X-ray guide impression tray kit. The sphere and pin combination can be the same ones as used to create the X-ray guide as described above, when proceeding with the creation of a surgical guide after completion of the X-ray guide. An additional sphere and pin combination is needed only if X Ray Guide was not previously made.
At least one surgical guide attachment is placed with respect to the surgical guide body and is used to establish the location and angulation of a surgical guide with a locator attachment, or to guide different sizes of surgical drills for implant placement with a guide attachment. The different parts of the surgical guide can be made from different materials and/or different combination of materials, by way of example and not limitation metal, plastic, ceramic, and any combination thereof The attachments are provided in three different types or styles: (1) a fixed attachment with various size drill guide apertures embedded in material defining the surgical guide body; (2) a removable attachment with various widths and various size drill guide apertures interchangeable with complementary shaped base portions secured to the surgical guide body; and (3) a removable attachment with fixed widths and various size drill guide apertures interchangeable with complementary shaped base portions secured to the surgical guide body.
A fixed attachment can be buried in the surgical guide body in a non-removable manner. Multiple guides can be made to accommodate different size surgical drills required for the implantation procedure. This type of fixed attachment is provided with different diameter guide pins and with different complementary insertion portions to fit with respect to a positioning/orientation sphere or with different complementary guide tube portions to fit with respect to a spacing/positioning/orientation pin. The diameter of the pins corresponds with the surgical drills necessary for the implantation procedure for a particular patient. This type of attachment does not require a locator attachment, since the fixed attachment is not interchangeable after being embedded in the material forming the surgical tray and an aperture formed in each fixed attachment acts as the drill guide during the surgical dental implantation procedure. A distance between a back surface of each attachment and a center of the corresponding aperture or slot is not critical, since positioning of each attachment is verified with the positioning/orientation pin on the dental model during creation of the particular surgical tray.
A procedure with fixed attachment can include some or all of the following steps as required depending on the previous steps, if any, and depending on the particular dental implant surgery drill guide requirements. First, if a dental model with verified spacing/positioning/orientation sphere and pin combination has not been made as described above, prepare the dental model as described above for the X-ray guide. Second, take an impression of the dental model with a surgical guide tray, and cut out a portion of the tray so that an area of implant placement is exposed. The tray can be cut back before PVS application if desired. If an X-ray guide is being made, a surgical guide impression should be taken at the same time the X-ray guide impression is taken. In case a spacing/positioning/orientation sphere and pin combination has already been placed on the dental model, cut out the tray before applying PVS material. Third, set orientation of the implant insertion with a spacing/positioning/orientation sphere and pin combination like described above in the procedure for the X Ray Guide, if it has not been done yet. Fourth, take impressions with as many surgical guide trays as the number of surgical drills that will be used for the implant placement. Fifth, replace spacing/positioning/orientation pin(s) with the smallest guide pin with the size of the smallest surgical drill used for the implant placement. Sixth, firmly place the surgical guide impression tray on the dental model, place the guide attachment for the same guide pin(s) in position so that the attachment(s) would rest on the spacing/positioning/orientation sphere. Put acrylic, light cure composite, or PVS or other suitable material around the attachment(s) and the tray, encapsulate the attachment(s), and make sure the attachments are secure in place. When the material hardens, take out the guide pin(s), and remove the surgical guide from the dental model. Seventh, place the next size guide pin(s) into the positioning/orientation sphere, and repeat the above procedure with a new surgical guide impression tray and the next size surgical guide. Make as many surgical guides as needed for the particular dental implant surgery for the patient.
A removable attachment having a fixed width can be provided with different width size sets. A small width set can be used for anterior region implant placement, and a medium width set and/or a large width set can be used for posterior region implant placement. Each removable attachment set has a fixed width regardless of the size of locator aperture or drill guide slot. These types of attachments can be used to create a guide with removable attachments, and are designed to encapsulate the attachment for additional stability. These attachments include three parts: (1) a drill guide attachment body having an aperture or a slot; (2) a first complementary attachment portion, either male or female, connected to the attachment body; and (3) a second complementary attachment portion, either male or female, sometimes referred to herein as an anchor portion or base portion to be buried in a body of the surgical guide. The attachment body and first complementary attachment portion are fixed together or can be formed as one piece or separate pieces assembled together. Each attachment body has a uniform fixed height independent of the drill guide aperture or slot size. The complementary male and female attachments can be any desired configuration, by way of example and not limitation, T-shaped portion and slot, Y-shaped portion and slot, single bayonet shaped portion and slot, a plurality of bayonet shaped portions and slots, and any combination thereof.
An anchor or base portion can have a complementary shape, either male or female, with respect to a locator attachment and/or a guide attachment to be connected thereto. A locator attachment can have a complementary shape, either male or female, with respect to the corresponding base or anchor portion, an aperture formed in the locator attachment with the same diameter as the spacing/positioning/orientation pin, and the same width as guide attachments of the same size set. A drill guide attachment can have a slot with half circle stop. The diameter of the half circle or slot width varies, but the overall width of the attachment for different size drills is the same within a particular set. A width of the guide attachment is approximately 4.8 millimeters for a small size set, and approximately 6.2 millimeters for a large size set. The length of the attachments varies, but a distance between a back surface of the locator attachment and corresponding drill guide attachment for the particular set size and a center of the aperture or slot is the same.
A removable attachment has various widths depending on the size of locator aperture or drill guide slots. The attachment includes three parts: (1) a drill guide attachment body having an aperture or a slot; (2) a first complementary attachment portion, either male or female, connected to the attachment body; and (3) a second complementary attachment portion, either male or female, sometimes referred to herein as an anchor portion or base portion to be buried in a body of the surgical guide. The attachment body and first complementary attachment portion are fixed together or can be formed as one piece or separate pieces assembled together. Each attachment body has a uniform fixed height independent of the drill guide aperture or slot size. The complementary male and female attachments can be any desired configuration, by way of example and not limitation, T-shaped portion and slot, Y-shaped portion and slot, single bayonet shaped portion and slot, a plurality of bayonet shaped portions and slots, and any combination thereof. A locator attachment can have an aperture with the same diameter as the spacing/positioning/orientation pin, by way of example and not limitation, such as a 4 millimeter or other set dimension. A guide attachment can have a slot with a half circle stop. The diameter of the half circle or the slot width varies, and corresponds with a diameter of the surgical drills to be used for implant placement during the surgical procedure. Since multiple size drills can be used to place an implant, multiple guide attachments can be used for a single surgery. A width of the guide attachment can be 2 millimeters larger than a size of a width of a drill guide slot, by way of example and not limitation, such as approximately 1 millimeter wall on each side of the slot. The length of the attachment can be varied, but for the entire set of a particular size of the attachments, the length between a back surface of each attachment and a center of the drill guide aperture or slot is the same.
A procedure with a removable attachment can include some or all of the following steps as required depending on the previous steps, if any, and depending on the particular dental implant surgery drill guide requirements. First, if a dental model with verified spacing/positioning/orientation sphere and pin combination has not been made, prepare the dental model as described above with respect to the procedure for an X Ray Guide. Second, take an impression of the dental model with a surgical guide tray, and cut out the tray so that an area of implant placement is exposed. The tray can be cut back before PVS application if desired. If an X-ray guide is being made, a surgical guide impression should be taken at the same time as the X-ray guide impression is taken. In case a spacing/positioning/orientation sphere and pin combination has been already placed on the dental model, cut out the tray before applying PVS material. Third, set orientation of the implant insertion with a spacing/positioning/orientation sphere and pin combination as described above with respect to the procedure for an X-ray guide, if it has not been done yet. Fourth, firmly place the implant/impression tray on the dental model, place locator attachment(s) in position so that the attachment(s) would rest on the positioning/orientation sphere. Put acrylic, light cure composite, or PVS, or other suitable material, around the attachment(s) and the tray, and secure the attachment(s). If the attachments are removable, apply the material only on the anchor or base attachment portions and along a back surface of the attachment body or bodies. Do not surround either side of the body of locator attachment(s) with the material. When the material hardens remove the positioning/orientation pins. Now, the locator attachment(s) can be replaced with drill guide attachment(s) of various sizes as required for the particular dental implant surgery procedure.
While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiment, it is to be understood that the invention is not to be limited to the disclosed embodiments but, on the contrary, is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims, which scope is to be accorded the broadest interpretation so as to encompass all such modifications and equivalent structures as is permitted under the law.
