This document pertains generally, but not by way of limitation, to medical devices for the treatment of bone defects, for example, orthopedic and oral maxillofacial disorders such as periodontal disorders, and more particularly to a method and apparatus for augmenting a patient's alveolar ridge or jawbone to receive a dental implant.
Surgical repair and/or reconstruction procedures including those employing implants are widely used in dental and oral surgery for restoration of the jaw anatomy. These procedures are often used to treat bone defects and disorders of the jaw, which may result and/or be caused from periodontal diseases, bone, gum and/or tooth loss, trauma, tumors, infections and other complications. New bone growth is often desired to repair a defect or to build up the jawbone so that enough bone exists to embed and retain an implant.
When an extracted or otherwise missing tooth is not immediately grafted or replaced with an implant, atrophy of the jawbone occurs over time. Consequently, individuals who have been partially edentulous for an extended period of time are left with an atrophic alveolar ridge that cannot securely support a dental implant/prosthesis. Furthermore, the edentulous individual faces deteriorated aesthetics and a compromised ability to chew leaving the quality of the individual's oral life in an unfortunate state.
In some cases, a ridge augmentation procedure is employed to add bone (e.g., bone height) to the jaw so that sufficient alveolar bone exists to place dental implants. Such procedures can employ a device to facilitate bone growth. After new bone has formed, the devices employed during the augmentation are removed. However, the removal of these devices can cause tissue disruption that undesirably exposes new bone and disrupts vascularity leading to associated complications or can be difficult to remove due to bone overgrowth. This disclosure describes an improvement over these prior art technologies.
Generally, to regain alveolar bone a vertical ridge augmentation (VRA) procedure is done to repair (e.g., grow) bone. After bone has healed, dental implant placement can be attempted at the augmentation site. Current VRA treatment and subsequent implant placement can take approximately about twelve to fourteen months. For example, current VRA procedure/implant placement includes a full mucoperiosteal flap is formed by reflecting a flap of mucosal tissue from the bone. After the mucoperiosteal flap is formed, the crestal bone is decorticized, bone graft is placed within a bone void, an incision is performed to gain free mucosa, a membrane is placed across the midline of the graft, and the mucosa is sutured. The graft healing period can last around four to six months. After the graft healing period, another full mucoperiosteal flap is formed, the osteotomy is prepared, the dental implant is inserted, and the mucosal fap is re-appositioned. The implant healing period can last around four to six months. After the implant healing period, another mucoperiosteal flap is formed, a healing abutment is coupled to the dental implant, the mucosa is re-appositioned and sutured around the healing abutment. The mucosal healing period last about three to six weeks. Additionally, the process to fabricate the restorative component can take around three weeks depending on the process used. Thus, the current VRa procedure/implant placement treatment can take between twelve (12) to fourteen (14) months.
There are various disadvantages to the current VRA procedure and subsequent implant placement. The success of the VRA procedure grafting a bone ridge having the shape that was predetermined can he unlikely because of shifting of the graft, material, loss of angiogenesis/osteogenesis, mucosal shrinkage, and poor oxygen permeability through the membrane. The graft material can shift, e.g., by a patient chewing on treatment site and the patient irritating the treatment site, such as with their tongue or other objects. During the grafting surgery, microbes can be inadvertently introduced, which can cause inflammation and halt osteogenesis. Mucosal shrinkage can occur during healing and if the mucosal shrinks this can cause pressure on the graft field altering the predetermined shape of the bone ridge. Finally, if the membrane has poor oxygen permeability, the loss or reduction of oxygen can impede osteogenesis.
The present disclosure provides a bone augmentation system that assists in the ridge augmentation and formation of an implant chamber that receives a dental implant. The bone augmentation system of present disclosure can improve the vertical ridge augmentation success, allow a prosthesis (e.g., dental implant) to be inserted after the graft healing period, and provides immediate and long-lasting functionality.
The present disclosure provides systems and methods for treating bone defects such that bone augmentation and the dental implant chamber are created simultaneously. The bone augmentation system includes a non-osseous spacer (also referred to herein as “the spacer”) and an anchor. The anchor is a bioresorbable scaffold that can receive/retain bone graft material and be placed in the bone craft cavity. For example, the bone graft material can be layered on, in, around, above, and below the anchor. The anchor is configured to he securely positioned within the bone graft cavity along a surgical site in a patient's jaw such that a position of the anchor within the surgical site can he maintained. The anchor includes a spacer retention portion that is configured to receive and/or engage the non-osseous spacer in a predetermined position within the bone graft cavity. The non-osseous spacer is positioned into the spacer retention portion of the anchor such that a top surface ascends to just above a desired level of the crestal bone. Any remaining voids are filled with the bone graft material and the bone graft cavity is covered with a membrane, if desired. The mucosa is closed to allow for healing during a healing period.
As discussed herein, the non-osseous spacer is a non-osseous fixating body that minimizes/prevents osseointegration with the surrounding bone and with new bone as it is formed. During the healing period, as new bone grows around the non-osseous spacer, the non-osseous spacer forms the implant chamber by preventing bone growth within the area that the non-osseous spacer occupies. After the healing period, the site is opened, the non-osseous spacer is removed revealing the dental implant chamber, and a dental implant is inserted into the dental implant chamber. A diameter of the dental implant can have a diameter such that threads on the dental implant are greater than a width of the dental implant chamber such that the threads carve into the new bone of the newly restored ridge and screw into the bone. The compression of the threads and the implant fixation in the bone provide immediate fixation and stability.
In one example, an implant placement assist (“IPA”) system is provided. The IPA system is a bone augmentation system that simultaneously can promote grow bone and form a dental implant chamber during healing. The IPA system includes an anchor and a non-osseous spacer. The anchor is formed from a bioresorbable material and includes a spacer retention portion to maintain a position of the non-osseous spacer within the bone graft cavity. As discussed herein, the anchor can take on various shapes and configurations. The shape/configuration of the anchor and retention mechanism used to maintain the position of the anchor can vary based on a variety of factors, e.g., size of surgical site, material, location in the mouth, etc. As discussed herein, the anchor can be retained within/coupled to the bone graft cavity via, e.g., fasteners and/or interference fit (i.e., press fit or friction fit). The non-osseous spacer can have a similar shape (e.g., cylindrical, tapered) of the dental implant intended to be implanted into the patient. Further, the non-osseous spacer has a surface roughness that does not promote/minimizes osseointegration with surrounding bone or new bone growth.
The invention comprises the systems and methods possessing the construction, combination of elements, and arrangement of parts which are exemplified in the following detailed description. For a fuller understanding of the nature and objects of the invention, reference should be made to the following detailed description taken in connection with the accompanying drawings.
This Overview is intended to provide non-limiting examples of the present subject matter it is not intended to provide an exclusive or exhaustive explanation. The Detailed Description below is included to provide further information about the present apparatuses and methods.
In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.
As discussed above, the present application relates to an implant placement assist system and methods for treating bone defects to be able to receive a dental implant. In one example, bone defects are treated so that bone augmentation occurs while an implant chamber is formed. Therefore, once the bone augmentation is completed, the implant chamber that has formed in the new bone is ready to receive a dental implant. While not shown, other examples using similar systems, devices, and methodologies are contemplated. This includes, but is not limited to, other medical implants for other areas of the body such as shoulder, hips, hands, feet, and the like.
As discussed herein, the bone graft material is packed around the non-osseous spacer 24 and the anchor 26 to promote new bone growth within the bone growth cavity 13. Any bone graft material, such as autogenous bone or synthetics, alone or mixed with autogenous bone (e.g., Bioglass® or Bio Oss®), may be utilized as the bone graft material. Bone graft material is utilized in oral implant surgery and in osseous alveolar and sinus augmentation procedures and is available from numerous sources including, but not limited to, Zimmer Biomet (which supplies Puros® Allograft Particulate, RegenerOss® Synthetic, and Endobon® xenograft granules) and numerous other suppliers.
In one embodiment, the bone graft material can he granular or powder-like, so that it may he packed into irregularly shaped sockets, cavities or other sites in bone formations. The granular bone graft material therefore should be held in place in the patient's site (e.g., bone graft cavity 13) until it matures into a solid plug of host bone into which an implant such as a dental implant can be secured. To facilitate true bone formation, nutrients, oxygen and blood should be able to access the bone graft material, while preventing the soft tissue/gingival around the site from growing into the bone graft material 21.
In order to secure the bone graft material 21 within the bone graft cavity 13 and prevent the soft tissue 20 from growing into the bone graft material 21, an optional membrane 28 can be used. As shown in
As discussed herein, the membrane 28 prevents the bone graft material 21 from migrating out of the bone graft cavity 13, while allowing oxygen, blood, and other applied medicaments to access the bone graft material 21. In one example, the membrane 28 is formed from a bioresorbable membrane. For example, the membrane 28 can be selected from, but not limited to, OsseoGuard®, OsseoGuard Flex®, Biomend®, Biomend Extend™, and CopiOs® Pericardium membranes from Zimmer Biomet or other similar membranes.
As discussed herein, the non-osseous spacer 24 can prevent or minimize osseointegration with surrounding bone or new bone growth such that the non-osseous spacer 24 can be removed, after a healing period where the new bone is formed, without disruption of the surrounding bone. In one example, the non-osseous spacer 24 has a surface roughness between about 0 Ra and about 1 Ra. One example, the non-osseous spacer 24 has a surface roughness less than about 0.03 Ra. While other means for preventing/minimizing osteointegration are contemplated, the surface of the non-osseous spacer 24 should allow for removal from newly formed bone without adversely damaging or disrupting the newly formed bone. The force required to remove the non-osseous spacer 24 should be minimized since the osteointegration is minimized by the surface of the non-osseous spacer 24.
As shown in
In one example, the non-osseous spacer 24 includes a bore 32 having a first portion 44 and a second portion 42. In one example, the second portion 42 is threaded and is configured to optionally mate with an attachment member such as a healing abutment (shown in
In one example, the first portion 44 of the bore 32 has a non-rotational shape that is configured to mate with a non-rotational shape of a removal tool, e.g., removal tool 170 shown in
Whereas the body portion 48 of the healing abutment 46 can be used to shape soft tissue and in some embodiments extend through the membrane and the soft tissue, the body portion 55 of the cover screw 54 can be positioned beneath at least the soft tissue and in some embodiments beneath both the soft tissue and the membrane.
In one example, the anchor 26 includes two elongated legs 74 that extend from the body 65 at the proximal end 63 to the apical end 64. In one example, the elongated legs 74 at the apical end 64 can include a flange 76. That flanges 76 can extend away from the elongate legs 74 to help stabilize the anchor 26 within the bone graft cavity 13.
In an example, the anchor 26 is formed from a bioresorbable material and will degrade within the patient's jaw over time while new bone is formed within the bone graft cavity 13. As discussed herein, the non-osseous spacer 24 has a surface that does not promote osseous fixation such that after the healing period, the anchor 24 can be removed from the surgical site 12 with minimal torque. The space remaining after the non-osseous spacer 24 is removed is the dental implant chamber (i.e., osteotomy) that can receive the dental implant. As the new bone forms, the bioresorbable material is resorbed into the patient's bone. In an example, the anchor can be formed from materials including, but not limited to, polymers such as PLGA and copolymers such as PGA:PLLA, ceramics such as βTCP, and composites such as u-HA/PLLA.
In addition to being bioresorbable, the anchor 26 can be malleable such that the anchor 26 can be manually manipulated to have the best fit within the bone graft cavity 13. In one example, the anchor 26 can maintain a position within the bone graft cavity 13 via mechanical engagement between the anchor 26 and the patient's jaw. For example, fasteners, such as fasteners 70, can be used to secure the anchor 26 to the patient's bone 18. In that instance, the fasteners 70 can extend through apertures 68 to couple the anchor 26 to the bone 18. In other examples, the anchor 26 can have an interference fit within the bone graft cavity 13 to maintain the position of the non-osseous spacer 24 within the bone growth cavity 13. Additionally, mechanical engagement and interference fits can be used separately or together to securely position the anchor 26 within the bone graft cavity 13. The condition, shape, and other patient considerations can be taken into account in determining how best to secure the non-osseous spacer 24 within the bone growth cavity 13.
In one example, the anchor 26 can include a plurality of pores 72. The pores 72 enable the bone graft material to become tightly packed and entwined with the anchor 26 to minimize any gaps in the newly forming bone. The size and shape of the pores 72 can be based on the size and shape of the anchor 26 and/or the bone graft material being used to maximize the interaction between the anchor 26 and the bone graft material while still maintaining sufficient rigidity of the anchor 26.
In one example, the anchor 80 includes two elongated legs 90 that extend from the body 82 at the proximal end 86 to the apical end 88. In on example, the elongated legs 90 at the apical end 88 can include apertures 92 configured to receive fasteners (such as fasteners 70 shown in
b illustrate an additional example of an anchor 118. The anchor 118 in
As discussed herein, after the healing period where the new bone has formed within the bone graft cavity, the non-osseous spacer needs to be removed from the bone graft cavity. The space remaining after the non-osseous spacer is removed is the dental implant chamber that is immediately ready to receive a dental implant. Since the non-osseous spacer has prevented/minimized osseointegration with the surrounding bone, minimal torque is required to loosen and remove the non-osseous spacer from the bone graft cavity, which now has newly formed bone. Various removal tools can be used to remove the non-osseous spacer.
In one example, there can be a sufficient interference fit between the working end 176 and the first portion 44 of the bore 32 such that after the rotational force is applied, a linear force be applied to the tool end 174 that is translated to the non-osseous spacer such that the non-osseous spacer is removed from the bone graft cavity.
However, in certain instances, a second tool may be needed to remove the non-osseous spacer. For example,
If the removal tool 170 has been used to loosen the non-osseous spacer, the removal tool 180 can be used to couple with the second portion 42 of the bore 32 such that when a linear force is applied to the working end 184, the linear force is translated to the working end 186 and to the non-osseous spacer such that the non-osseous spacer is removed from the hone graft cavity that now includes newly formed bone.
If the removal tool 170 was not used, the rotational force used to engage the threads of the removal tool 180 and the second portion 42 of the bore 32 can continue until the rotational force is translated to the non-osseous spacer to loosen the non-osseous spacer within the bone graft cavity. Once loosened, the linear force can be applied to remove the non-osseous spacer from the bone graft cavity.
In one non-limiting example, the healing period for allowing the bone growth cavity to form new bone can be about 6 months. After the healing period, the non-osseous spacer can be removed. For example, the surgical site can he reopened and the non-osseous spacer removed as discussed herein.
After the non-osseous spacer has been removed, an endosseous implant can be immediately placed within the dental implant chamber 20. The endosseous implant can be wider than the dental implant chamber 20 such that threads of the dental implant carve into the newly restored ride and is screwed into the bone.
In one embodiment, the healing abutment 206 can be scanned or an impression such that a 3D model of the patient's mouth including the healing abutment can be generated. Based on information from the healing abutment 206, the position and orientation of the dental implant 204 within the patient can be determined and the final prothesis can be designed, fabricated, and coupled to the dental implant.
As discussed herein, the present invention can generate new bone and form the dental implant chamber simultaneously over a healing period of about six (6) months. After the healing period, a dental implant can be immediately placed and coupled to a healing abutment for a second healing period of about 2-3 weeks, after which a scan or impression of the patient's mouth can be taken to design the final prosthesis.
Thus, as compared to the current VRA procedure/implant placement treatment that can take twelve (12) to fourteen (14) months, the present invention can grow new bone, implant a dental implant, and couple the dental implant to a final prosthesis is about half the time.
Example 1 is a method of forming a dental implant chamber in an alveolar ridge of a jawbone of a patient. The method includes positioning an implant placement assist (IPA) system within a bone graft cavity of the jawbone of the patient, the IPA system including: a non-osseous spacer having surface that does not promote osseointegration; and an anchor configured to stabilize the spacer within the bone graft cavity; inserting a bone graft material around the IPA system in the bone graft cavity where augmentation is desired; and removing, after a healing period, the non-osseous spacer from the jawbone creating the dental implant chamber.
In Example 2, the subject matter of Example 1 optionally includes where the non-osseous spacer has a surface roughness value (Ra) equal to or less than 1 Ra such that osseointegration is not promoted.
In Example 3, the subject matter of any one or more of Examples 1-2 optionally includes where the non-osseous spacer has a surface roughness value (Ra) about 0.03 Ra
In Example 4, the subject matter of any one or more of Examples 1-3 optionally includes where the anchor is formed of a bioresorbable material.
In Example 5, the subject matter of Example 4 optionally includes where the bioresorbable material is selected from at least one of polymers, copolymers, ceramics, and composites.
In Example 6, the subject matter of any one or more of Examples 1-5 optionally further including coupling an attachment member to the non-osseous anchor.
In Example 7, the subject matter of Example 6 optionally includes where the attachment member is selected from one of a cover screw and healing cap.
In Example 8, the subject matter of any one or more of Examples 1-7 optionally further including covering the bone graft cavity including the bone graft material and the IPA system with a membrane for a healing time period.
In Example 9, the subject matter of Example 8 optionally includes where the membrane covers at least a portion of the non-osseous spacer.
In Example 10, the subject matter of any one or more of Examples 1-9 optionally includes where the membrane is formed form a bioresorbable material.
In Example 11, the subject matter of any one or more of Examples 1-10 optionally includes, after removing the non-osseous spacer from the jawbone, the method further includes implanting the dental implant within the dental implant chamber.
In Example 12, the subject matter of Example 11 optionally further includes attaching a final prosthesis to the dental implant restrict axial movement of the platform along a longitudinal axis of the housing.
In Example 13, the subject matter of Example 12 optionally further includes attaching, prior to attaching a final prosthesis to the dental implant, a healing abutment to the dental implant for a second healing period.
In Example 14, the subject matter of Example 13 optionally further includes scanning the healing abutment and designing the final prosthesis to be coupled to the dental implant,
Example 15 is an implant placement assist (IPA) system for forming a dental implant chamber in a jawbone of a patient, The IPA system includes a non-osseous spacer having a surface that does not promote osseointegration; and an anchor configured to stabilize the spacer within a bone graft cavity of the patient.
In Example 16, the subject matter of Example 15 optionally includes where the non-osseous spacer has a surface roughness value (Ra) equal to or less than 1 Ra such that osseointegration is not promoted.
In Example 17, the subject matter of any one or more of Examples 15-16 optionally includes where the non-osseous spacer has a surface roughness value (Ra) of about 0.03 Ra.
In Example 18, the subject matter of any one or more of Examples 15-17 optionally includes wherein the anchor is formed of a bioresorbable material.
In Example 19, the subject matter of Example 18 optionally includes where the bioresorbable material is selected from at least on of polymers, copolymers, ceramics, and composites.
In Example 20, the subject matter of any one or more of Examples 15-19 optionally includes wherein the anchor includes a plurality of pores.
In Example 21, the subject matter of any one or more of Examples 15-20 optionally includes where the anchor is malleable to form a shape sufficient to stabilize the non-osseous anchor within the bone cavity of a patient.
In Example 22, the subject matter of any one or more of Examples 15-21 optionally includes wherein the anchor further includes a plurality of fasteners configured to engage surrounding bone and secure the anchor to the jawbone of the patient.
In Example 23, the subject matter of any one or more of Examples 15-22 optionally further includes bone graft material to be inserted with the bone graft cavity and around the non-osseous spacer and the anchor.
In Example 24, the subject matter of Example 23 optionally further includes a bioresorbable membrane configured to be positioned over the bone graft cavity including the non-osseous spacer, the anchor, and the bone graft material for a healing period.
In Example 25, the subject matter of any one or more of Examples 15-24 optionally further includes at least one of a cover screw, and a healing cap, the cover screw and the healing cap configured to be coupled to the non-osseous anchor during a healing period.
In Example 26, the systems or methods of any one of or any combination of Examples 1-25 are optionally configured such that all elements or options recited are available to use or select from. Each of these non-limiting examples can stand on its own, or can be combined in various permutations or combinations with one or more of the other examples.
It will be readily understood to those skilled in the art that various other changes in the details, material, and arrangements of the parts and method stages which have been described and illustrated in order to explain the nature of the inventive subject matter can he made without departing from the principles and scope of the inventive subject matter as expressed in the subjoined claims.
The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.
In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls.
In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.
The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted. with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 62/935,297, filed on Nov. 14, 2019, the benefit of priority of which is claimed hereby, and which is incorporated by reference herein in its entirety.
Number | Date | Country | |
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62935297 | Nov 2019 | US |