The present disclosure relates to methods and systems producing an occlusive barrier for bone regeneration and an occlusive barrier obtained by means of said method. More particularly, the present disclosure includes an occlusive barrier in the form of a biomedical device custom made for the patient, designed by computer and manufactured by titanium laser sintering technology, and which adapts to the measurements of the anatomical structure of the patient. The presently disclosed subject matter offers an occlusive barrier for creating a space between bone tissue and gingival tissue to promote bone growth from the layer of stem cells covering the outer surface of the bone (endosteum), which stem cells may form the basis for further tissue formation and bone regeneration.
At present, and for several years now, the treatment of choice to regenerate alveolar bone necessary for the placement of dental implants is called Guided Bone Regeneration (GBR). Guided Bone Regeneration (GBR) can also be defined as a bone regeneration technique by inhibition of soft tissue proliferation, by exclusion with a barrier membrane, after filling the defect with bone grafts or other filling material in order to prevent soft tissue collapse.
Grafts and bone fillings are purported to have a mechanical and biological function. In the host to bone graft interface, there is a complex relationship where multiple factors can intervene for either a successful or for unsuccessful non-incorporation of the graft. Among them, graft vascularization, local factors, systemic factors and biologic compatibility properties (depending on the type, size and shape of the graft used). Adequate bone volume for osseointegration is essential for implant therapy. One of the critical components of the stomatognathic system is the alveolar bone, which is an odonto-dependent structure, since it forms along with the dental elements and holds the teeth while fulfilling their function and resorbs away once the teeth are lost.
Among the materials used for bone regeneration are described those for filling or grafting (biological products that fill the bone defects); and among these materials autologous grafts, allogeneic materials, xenogeneic, bone substitutes, guided bone regeneration techniques and the use of bone morphogenetic proteins are included.
In this sense, the various materials used can work with at least one of known mechanisms or processes:
(a) Osteogenesis: Synthesis of new bone from cells derived from the graft or host. Requires cells capable of generating bone.
(b) Osteoinduction: The process by which osteogenesis is induced and regularly seen in any type of bone healing process. Osteoinduction implies the recruitment of immature cells and the stimulation of these cells to develop into preosteoblasts. In a bone healing situation such as a fracture, the majority of bone healing is dependent on osteoinduction.
(c) Osteoconduction: Osteoconduction means that bone grows on a surface of the graft material. This phenomenon is regularly seen in the case of bone implants. Implant materials of low biocompatibility such as copper, silver and bone cement shows little or no osteoconduction.
(d) Osseointegration is the stable anchorage of an implant achieved by direct bone-to-implant contact. In craniofacial implantology, this mode of anchorage is the only one for which high success rates have been reported. Osseointegration is possible in other parts of the body, but its importance for the anchorage of major arthroplasties is under debate. Ingrowth of bone in a porous-coated prosthesis may or may not represent osseointegration.
It is a process by which the graft material provides a suitable environment, structure or physical material suitable for the apposition of new bone by a predictable pattern, determined by the graft biology and the mechanical environment of the graft-host interface.
Ideal bone grafts and fillings should have properties of these three processes, in addition to being biocompatible and providing mechanical stability. Biocompatibility can be defined when a material is considered compatible and only causes desired or tolerable reactions in the living organism.
In order to achieve some of the processes named above, bone grafts have been studied for more than four decades. Among the different options are autologous or autogenous grafts. With autogenous grafts, bone obtained from the patient and for this reason there is little antigenic capacity. It is obtained from intraoral sites (chin, maxillary tuberosity, ascending branch) that are used for small defects or extra-oral (iliac crest, rib tibia or calvaria) when more is required. The choice of each approach will depend on the type, size and shape of the bone cavity, clinical experience and professional preference.
Allogeneic grafts or allografts: These are from individuals of the same species, but genetically different They may be classified according to their processing as:
(i) Frozen allografts.
(ii) Lyophilized allograft (freeze-dried).
(iii) Freeze-dried and demineralized allografts.
(iv) Irradiated bone.
The advantages of the allograft include its availability in significant amounts, in different shapes and sizes, no sacrificing of host structures and no donor site morbidity. Disadvantages are related to the quality of the regenerated bone tissue, which is not always predictable. A process to eliminate their antigenic capacity is needed.
Heterologous grafts or xenografts: These are of natural origin, from another species (animal) and contain the natural minerals of the bone. For example, bovine bone and coral derivatives (Nu-Oss, Osteogen, Bio-Oss, Interpore).
Alloplastic or synthetic grafts: These are synthetically manufactured materials. They are found in various shapes, sizes and textures. Biological bone responses will depend on the manufacturing techniques, crystallinity, porosity and degree of resorption.
They may include ceramic, which are the most commonly used, for example synthetic calcium phosphate (hydroxyapatite and tricalcium phosphate). Polymers, such as Bioplan, HTR may be used. Bioactive ceramic glass, composed of calcium and phosphate salts, and sodium and silicon salts (Bioglass, Perioglas, Biogran) may also have use.
All implantation material should trigger a reaction that is as physiologically compatible with the surrounding tissues. It is essential to know the normal biological processes that are triggered in the regeneration and the physical, mechanical and biological characteristics of each material.
At present, to use autologous grafts, a surgical procedure is required at the donor site for its production, with the consequent risk of postoperative morbidity, infection, pain, hemorrhage, muscle weakness, neurological injury, graft necrosis, among others; in addition, the surgical time is considerably increased and in some cases the amount of graft generated may be insufficient.
In the current technique of bone regeneration, the professional must preform by hand the device that he will implant in the patient. When the devices or barriers are preformed, spaces may remain that allow soft tissues to be invaded as well as the entrance of bacteria, with the consequent risk of infection and therefore of treatment failure. This process is seriously lacking in efficiency and accuracy.
At present, in guided bone regeneration (GBR), the time required for the reabsorption of the bone material used for grafting or filling determines the formation of the new tissue. For example, in the case of Cerasorb® tricalcium phosphate (synthetic ceramic graft) the average time for resorption is 24 to 36 months; and in the case of Bio-Oss® (heterologous graft of bovine bone), because it is a ceramic material, it is not absorbed but over time because it forms a mixture between the filling material and bone. In order for implants to be placed, turnover should be less than months for osseointegration, and thus proceed with the patient's dental rehabilitation. GBR processes which use flexible membranes collapse under their own weight is responsible for a decrease in the volume of bone required in the regeneration.
The present disclosure produces an occlusive barrier for bone regeneration and an occlusive barrier obtained by means of the disclosed method. More particularly, the present disclosure includes an occlusive barrier in the form of a biomedical device custom made for the patient, designed by computer and manufactured by titanium laser sintering technology, and which adapts to the measurements of the anatomical structure of the patient. Occlusive barriers belong to the sector that involves additive techniques such as laser sintering and subtractive ones such as computerized machining, as applied in medical sciences such as dentistry.
In one aspect of the disclosure, a method, system, and integrated medical system is disclosed for bone tissue regeneration in association with a predetermined dental bone structure. The disclosure includes the steps of obtaining a computerized tomography scan of a dental bone structure on which to regenerate bone tissue. A three-dimensional model formed from the computerized tomography scan digitally represents the dental bone structure. The method and system present the three-dimensional model on a computer display. A treatment plan corresponds to the three-dimensional model. The method and system receive a design order relating to the treatment plan for forming an occlusive barrier for covering the portion of the dental bone structure whereupon to regenerate bone tissue. An occlusive barrier is formed from a biocompatible material in accordance with said design order. An osteoconductive material is placed within an interior volume of the occlusive barrier for associating with and from which may form fresh and regenerated bone tissue via osteoconduction in association with the portion of the dental bone structure covered by said occlusive barrier. The method and system further requires fixating the occlusive barrier and the osteoconductive material to the dental bone structure for a time period sufficient for regeneration of bone tissue associated with dental bone structure. The occlusive barrier is removed from the dental bone structure upon said bone tissue regeneration reaching a predetermined stage.
The disclosed subject matter further includes an occlusive barrier for osteoconductive bone tissue regeneration in association with a predetermined dental bone structure. The occlusive barrier may be formed by performing the steps of obtaining a computerized tomography scan of a dental bone structure on which to regenerate bone tissue. A three-dimensional model from said computerized tomography scan for digitally represents the dental bone structure. The occlusive barrier may include a plurality of irrigation channels for permitting flushing of said interior volume during regeneration of bone tissue associated with dental bone structure.
The occlusive barrier may be specified using a computer-aided design application and manufactured by a titanium laser sintering process. The occlusive barrier further includes a space between the predetermined dental bone structure tissue and gingival tissue for promoting bone growth from a layer of stem cells covering an outer endosteum outer surface of the dental bone structure. The occlusive barrier may be formed from a plurality of pieces printed for associating into said occlusive barrier covering said portion of the dental bone structure whereupon to regenerate bone tissue. The occlusive barrier is subjected to a heat treatment for alleviating molecular stress and increasing occlusive barrier ductility and strength and may be subjected to a surface sandblasting treatment for forming a surface porosity promoting osteoconduction and blood vessel formation. Furthermore, the occlusive barrier is subjected to an anodizing treatment for cleaning organic and inorganic residues from surfaces of said occlusive barrier.
A technical advantage of the present disclosure includes the ability to obtain a computerized tomography scan of a dental bone structure on which to regenerate bone tissue through an internet web application.
Another technical advantage of the present disclosure includes the ability to form a three-dimensional model from said computerized tomography scan for digitally representing the dental bone structure using a three-dimensional printing software application.
Still a further technical advantage of the present disclosure includes the ability to present the three-dimensional model on a computer display for viewing said three-dimensional model from a multitude of three-dimensional perspectives.
A technical advantage of the present disclosure includes the ability to receive a treatment plan corresponding to said three-dimensional model from a remote location corresponding to a certified dental surgeon office at a remote location through a web portal or smart device
The disclosed subject matter further includes receiving a design order relating to said treatment plan for forming an occlusive barrier for covering the portion of the dental bone structure whereupon to regenerate bone tissue, said design order specifically relating to an individual patient for whom said occlusive barrier may be custom-fabricated.
The present subject matter will now be described in detail with reference to the drawings, which are provided as illustrative examples of the subject matter so as to enable those skilled in the art to practice the subject matter. Notably, the figures and examples are not meant to limit the scope of the present subject matter to a single embodiment, but other embodiments are possible by way of interchange of some or all of the described or illustrated elements and, further, wherein:
The detailed description set forth below in connection with the appended drawings is intended as a description of exemplary embodiments in which the presently disclosed process can be practiced. The term “exemplary” used throughout this description means “serving as an example, instance, or illustration,” and should not necessarily be construed as preferred or advantageous over other embodiments. The detailed description includes specific details for providing a thorough understanding of the presently disclosed method and system. However, it will be apparent to those skilled in the art that the presently disclosed process may be practiced without these specific details. In some instances, well-known structures and devices are shown in block diagram form in order to avoid obscuring the concepts of the presently disclosed method and system.
In the present specification, an embodiment showing a singular component should not be considered limiting. Rather, the subject matter preferably encompasses other embodiments including a plurality of the same component, and vice-versa, unless explicitly stated otherwise herein. Moreover, applicants do not intend for any term in the specification or claims to be ascribed an uncommon or special meaning unless explicitly set forth as such. Further, the present subject matter encompasses present and future known equivalents to the known components referred to herein by way of illustration.
The occlusive barrier is a biomedical device custom made for the patient, designed by computer and manufactured by titanium laser sintering technology, which adapts to the measurements of the anatomical structure of the patient. The object of the occlusive barrier is to create a space between the bone tissue and the gingival tissue to promote bone growth from the layer of stem cells that is covering the outer surface of the bone (endosteum). Its function, therefore, is to maintain the space to support the clot, which ultimately achieves tissue regeneration. This structure or biomedical device makes it possible to maintain stability of the clot and isolated it from the external environment, also avoiding bacterial invasion that would impede the regeneration process.
Accordingly, the occlusive barrier is printed on one or more pieces. With the occlusive barrier being formed of more than one piece, the occlusive barrier comprises a concavity in at least two of the pieces, each of the recesses being configured to partially enclose a tooth and so form the concavities that together surround the tooth. In this way, said pieces are complementary to jointly define at least one through hole into which the tooth may be fitted.
Biocompatibility is defined as the ability of a material to act with a suitable response to the host, in a specific application. This type of material is known as a biomaterial used for the service of medicine, in this case dentistry, to interact with biological systems inducing a specific biological activity.
The reasons for considering titanium as the ideal biomaterial in the making of custom occlusive barriers are numerous. They include the fact that titanium is inert. The oxide covering in contact with the tissues is insoluble, so that no ions that might react with organic molecules are released. Also, titanium in living tissues acts as a surface upon which bone may grow and adhere to the metal.
In
Occlusive barrier 10 possesses the osteoconduction mechanism, since it provides an environment, structure and physical material that triggers a three-dimensional growth of capillaries, perivascular tissue and most important, the recruitment of mesenchymal stem cells in the area, for its subsequent differentiation into osteoblasts modulated by growth factors. This scaffolding allows the formation of new bone through a predictable pattern, determined by the biology and dimensions of thickness and height previously given in the design and approved by the professional.
The thickness of occlusive barrier 10 ranges between 0.3 and 0.6 millimeters. Lower values hinder the ability to maintain the space, but higher values make it difficult for the patient to accept the occlusive barrier in the corresponding fixation area.
c, 6 and 7 show the occlusive barrier that is the object of the present disclosure according to yet another preferred embodiment.
The presently disclosed occlusive barrier formation and use system includes the design and formation of the implantable occlusive barrier 10 and a jaw model used to demonstrate the system and facilitate ordering dentist or physician proper fit of occlusive barrier 10 to the patient specific jaw anatomy. However, the jaw CT scan-based model does not come in patient contact at any point. Occlusive barrier 10 is to be implanted in dental/oral tissues and removed in four to eight months after appropriate bone healing per dentist/physician's professional diagnosis. Occlusive barrier 10 is a single use product and provided non-sterile to the dentist or physician, to be steam sterilized on-site per a physician's office procedures for steam sterilization prior to implant.
The orifices, which may be seen in
Occlusive barrier 10 may be partial or total. These are defined as a function of their longitudinal extension upon the alveolar bone. Examples of the occluding barriers may be seen in
Occlusive barrier can be printed in one piece, as is seen in
Occlusive barrier 10 may be printed on one piece or on at least two pieces. With the occlusive barrier formed by more than one piece, the occlusive barrier comprises a concavity in at least two of the pieces, each of these recesses being configured to partially surround one of the teeth. In this case, the recesses together define a through hole according to the outer contour of the tooth to cover the bone while taking the tooth into account. The occlusive barrier is printed on several pieces mainly because the patient, on occasion, despite suffering from the defect or bone wear, still retains the tooth or the teeth of the affected area. The present method of manufacturing makes it possible to obtain the pieces in the most optimal form, in accordance with each case.
The pieces forming the occlusive barrier are obtainable in a complementary way to cover the all or part of the alveolar bone leaving the space corresponding to the teeth located in the area intended to house the occlusive barrier free, further leaving the corresponding gap free. In the exemplary embodiment shown in
The titanium used in the creation of the occlusive barrier is a material designed to interact safely and effectively with biological systems. Biomaterial-host interactions do not present any type of safety problem for the patient, i.e., it is one hundred percent compatible. The titanium used is preferably a titanium alloy called Ti64 or Ti6Al4V, having a density of 4.43 gicm3.
Beneficial properties of medical titanium are numerous. For instance, titanium is inert, the oxide covering in contact with the tissues is insoluble, so that no ions that might react with organic molecules are released. Also, titanium in living tissue acts a surface upon which the bone grows and adheres to the metal, forming an ankylotic anchor, also called osseointegration. This reaction normally only occurs in materials called bioactive and is the best base for functional dental implants.
Titanium also demonstrates good mechanical properties. Titanium tensile force is very similar to that of the stainless steel used in surgical prostheses that are load bearing. It is much stronger than dentine or any cortical bone, thus making it possible for the implants to withstand heavy loads. Moreover, the metal is soft and malleable, which helps absorb shock loads.
Titanium is a biocompatible metal (biomaterial) because the body's tissues tolerate its presence without any allergic reactions from the immune system. This biocompatibility property of titanium coupled with its mechanical qualities of hardness, lightness and strength have made a large number of medical applications possible, not only dental implants, but also hip and knee prostheses, bone screws, anti-trauma plates, components for manufacturing heart valves and pacemakers, surgical instruments, etc.
Characteristics of occlusive barrier 10 of the present disclosure are beneficial and numerous. Occlusive barrier 10 provides cellular occlusion that has the property of being isolated from the gingival tissue of the flap that opens during surgery, from the maturation of the fibrin clot in the wound space.
In addition, occlusive barrier 10 demonstrates space holding capacity and has the ability to withstand its own collapse determined by its rigidity. That is, occlusive barrier 10 possesses the physical property of being able to withstand its own collapse determined by its rigidity, guaranteeing the predetermined bone volume in the design of the biomedical device. Tissue integration is also desirable, in that the occlusive barrier should become as integrated as possible to the tissue where it is placed.
The next step 46 includes visor creation at stage 46. The visor is formed at point 48 by the barrier manufacturer, OP, which then sends the completed visor to BC. BC then s the visor to the doctor treating the patient. Next, OP sends the completed visor to the BC, at which point the BC transmits the visor to the treating doctor. At stage 50, the treatment plan and design order are generated by the doctor, who then transmits the treatment plan and design order, at step 52, to BC for review.
At stage 54, a review occurs with both the OP and BC. Once the treatment plan and design order are accepted by OP and BC, process flow continues at 56 top point 60, whereupon BC sends the approved design order to the doctor for signature. Alternatively, if the design order is rejected by OP, required changes occur and process returns to point 52 for further review and ultimate acceptance.
At stage 64, the doctor signs the design order and then returns it to BC. Then, BC transmits the design order to OP. Then, at step 68, occlusive barrier 10 production begins by OP. At stage 70, the production of occlusive barrier 10 includes PP step 72, oven step 74, and quality control or QC step 76. Once stage 70 is completed, process flow continues to point 78, where OP manufacturers and delivers the finished product of occlusive barrier to BC for distribution. At step 80, patient surgery occurs with the doctor and the process of bone regeneration can begin.
Certain aspects of occlusive barrier process 40 are important to consider. For example, as the tomography is obtained, and it is then sent to the BC. There, noise is cleaned up and the CT scan is converted into a three-dimensional file that can be inserted into any CAD modeling software. Once this CAD file is obtained, it is imported into the modeling software, where it is located and drawn upon, to define the area of the occlusive barrier and to generate a surface that will become the occlusive barrier. Once approved and corrected by the doctors, the occlusive barrier is exported for manufacturing.
For manufacturing, the exported design file is used and is made into a post-processed file in a CAM software, which converts it into layers for titanium printing. Occlusive barrier 10 is printed in layers of 30 or 60 microns thick and, once printed, is passed to a machining stage. In this phase, occlusive barrier 10 is initially subjected to a heat treatment to alleviate the molecular stress and to make the occlusive barrier more ductile and strong, and then subjected to a surface sandblasting treatment which makes it possible for the occlusive barrier to have the optimum characteristics for osseointegration. By sandblasting the surface, a porosity is achieved to promote osteoconduction and the formation of blood vessels around occlusive barrier 10. In this way, occlusive barrier 10 with a mean arithmetic roughness (Ra) of 9-12 μm and a mean roughness range (Rz) of 40-80 μm is obtained.
Finally, the thicknesses, the orifices, and dimensions in occlusive barrier 10 are checked in a highly accurate optical gauge, to ensure that the occlusive barrier has the geometric characteristics initially defined. From there it goes to a sterilization treatment to be packed and sent to the customer.
Occlusive barrier 10 is subjected to an anodizing treatment. By means of this anodizing treatment, both organic and inorganic residues are cleaned from the surface, thus obtaining better resistance against corrosion, a decrease in the release of titanium ions to the physiological medium, greater surface hardness, improvement in the properties of osteoconduction and a coloration similar to that of the gums. Coloration is important in cases where the occlusive barrier is exposed after placement in the patient to reduce the associated visual impact.
BBS design involves acquisition of patient CT data. A dentist/physician acquires CT imaging of patient jaw/oral anatomy per their standard protocols. Then, the process includes exporting of DICOM files (0.16-0.2 mm voxel sizes). This includes transmission of patient CT data (DICOM) to the occlusive barrier designer. A dentist/physician orders an occlusive barrier and jaw model for manufacture per the patient specific CT imaging.
This includes transmission of patient CT data (DICOM) with physician directed treatment plan from the occlusive barrier designer to an occlusive barrier manufacturer who generates a three-dimensional model using already 510(k) cleared software. The occlusive barrier contract manufacturing uses already 510(k) cleared software (e.g., 3matic, k060950 branded algorithms) in conversion of patient's CT images and design of proposed barrier and jaw model.
Final authorization is by the dentist/physician to begin build the patient's occlusive barrier. The build model is communicated to occlusive barrier designer and then back to ordering dentist/physician. If the order is accepted by dentist/physician, the contract manufacturing finalizes design files for additive manufacturing and manufactures, post-processes products (occlusive barrier and jaw model). If the order is not accepted by dentist/physician, changes requested are communicated to the barrier designer and then back to the contract manufacturer. These steps may be repeated until order acceptance occurs. Once the occlusive barrier design is accepted, manufacturing occurs, as well as the assignment of individualized patient implant order marking, packaging and shipment.
After the bone regeneration stage, the denture may be removed to show the growth of the gingival tissue 160 over occlusive barrier 120, as per
Prior to implant procedure, steam sterilization per facility protocols. Barrier must be steam sterilized prior to implant per facility protocols. Prior to implant procedure consideration of patient condition to ensure still acceptable for Barrier implant. Be sure that the patient's dentition and jaw has not changed since the CT was taken. New restorations that will affect the seating of the barrier. Drifting or tooth movement. Periodontal disease. Unanticipated procedures (bone grafting, osseous resection, orthognathic surgery, traumatic event).
Here described is the procedure for implanting occlusive barrier 10. The patient's intra and extra oral environment should be disinfected with chlorhexidine or some antiseptic. A full-thickness flap is exposed in the augmentation area. Wide access is needed for complete access 3-4 mm beyond the margin of the occlusive barrier. This may include reflecting 3 teeth beyond the augmentation area and/or placing vertical releasing incisions. Any residual soft tissue should be removed via curettes, back-action hoes, or a piezoelectric device. Cortical perforation to expose the trabecular bone is not recommended.
After opening of the sterile pouch under continuous sterile conditions, the barrier fit is verified. Be sure there is no or minimal movement of the barrier when seated. The blood clot is place on the ridge and against the intaglio surface of the barrier and re-seated.
Fixation screws are placed according to manufacture directions. The irrigation canal should be sealed with Teflon plug. The flap is approximated, starting from the most distal and mesial edges of the flap. No periosteal releasing incisions are needed because complete flap closure is not necessary. Non-resorbable or slowly-resorbing suture is recommended with minimal bacterial wicking-suture material such as e-PTFE, Polypropylene, or poliglecaprone 25.
Post-implantation of occlusive barrier 10 follow-up on patient. Post-operative visits should be scheduled at day 3, week 1, week 3, week 6, week 8, week 12, and week 16. The site should be irrigated with chlorhexidine or 30% hydrogen peroxide around the flap margins beginning on day 3 but not in the irrigation canal until week 6. The irrigation canal should be irrigated into on weeks 6, 8, 12, and 16.
Determination of when healing sufficient to remove Barrier. Depending on the patient's level of hygiene and compliance, the barrier should remain for a minimum of 4 months. If the patient experiences pain with putrid suppuration (plasmatic flow of clear liquid is normal). Antibiotic combination of Amoxicillin (or Clindamycin) with Metronidazole should be used. More frequent post-operative visits may be indicated with Chlorhexidine/Hydrogen peroxide into the canal.
Early removal of the barrier may be indicated. Removal of the barrier can usually be accomplished with infiltration of local anesthesia. Remove the fixation screws being sure to all the screws are accounted for. The barrier can be removed with a periosteal elevator or curette by gently lifting each edge. Debris and materia alba underneath the barrier is normal and can be easily rinsed away. If additional augmentation is desired, the barrier can be re-sterilized and replaced with another clot and new, larger screws.
The residual buccal and lingual flap can be contoured by denuding the inner flap and sutured together over the ridge. The barrier should be disposed of in biomaterial waste. Four to six months is observed to allow for soft and hard tissue maturation. The unkeratinized tissue on the new ridge will keratinized during this time. Laser contouring of the residual flap can be done at the time of implant placement, if indicated. The implant(s) should be placed via flapless technique as to avoid interruption of endosteal bone maturation.
The method of the present disclosure is characterized by requiring a single surgery at the receiver site of occlusive barrier 10, with no need for bone filler or graft of any type. Because it does not require any fillings, the osteoconductive capacity of titanium allows the blood vessels to construct scaffolding for the osteogenic cells in the clot, giving the proper conditions for the growth of the new bone.
Likewise, in the absence of any filler, biological mechanisms do not require foreign body resorption. Therefore, the new bone formation is commenced once the occlusive barrier is placed, i.e., the time needed for tissue regeneration is much shorter.
By the technology used in the design and manufacturing process of the biomedical device, it makes it possible to understand the anatomy of the surgical field in its three dimensions prior to the surgery, even making possible the operation in a virtual way.
As described, the present disclosure provides the use of digitalized design and manufacturing processes (CAD-CAM), the software required for printing the occlusive barrier customized for the patient. Since the occlusive barrier is a custom-manufactured device, the adaptation and the peripheral seal will completely prevent the entry of soft tissue and bacteria, a situation that makes it possible to guarantee the success of the treatment.
The present disclosure is characterized by the possibility of placing the implants at the same surgical moment as the occlusive barrier, so that new bone tissue is formed at the same time as the osseointegration thereof is carried out with the implants, leading to a very significant gain in time for the initiation of patient rehabilitation.
Occlusive barrier 10 provides a temporarily, non-resorbable, implantable material for use as a space-making barrier in the treatment and augmentation of alveolar ridge in accordance with guided tissue regeneration principle. The BBS is supplied non-sterile and must be steam sterilized per facility protocol prior to implantation. The BBS may only be installed by Presently disclosed-trained personnel.
Occlusive barrier 10 is part of the concept of guided tissue regeneration and is related to the exclusion of tissues, called compartmentalization. Quicker growing soft tissues eliminate any chance of hard tissue growth. By completely excluding soft tissues from the site of augmentation, bone will be allowed to regenerate in a protected environment. Additionally, the custom-fabricated barrier is rigid for stabilized bone growth.
Extensive research has shown that bone graft materials underneath the occlusive barrier may impede natural bone growth. However, the addition of extracellular matrix has shown benefit as a bio scaffold. Depending on the severity of bone loss, early woven bone will form in four to six months. Once the barrier is removed, the formed bone will mature for implant placement in four to six months.
The method and system of the present disclosure provide for blood collection such as with vacutainers with clot activators (Gold, Red/Black, Red plastic, Orange or Grey/Yellow). To aid timely clot formation, the tube can be heated either with a warm bath (40° C.) or body temperature. Per the design envelope noted above, are there any type of patients who would be excluded for user dentist/physician. Exclusion criteria is based on the dentist/physician's clinical judgment, as would normally preclude the patient from surgical therapy (i.e., non-compliance, poor oral hygiene, medically compromised) patients that would be precluded from ridge augmentation surgery, uncut to make the barrier difficult to seat, mobile teeth, existing infection or periodontal medical problems that would contraindicate surgical therapy, poor home care and non-compliance, case selection that would normally contraindicate surgery.
Minimal size is likely to treat a single tooth, but may need to be at least the size of three teeth (i.e., eight mm). The maximum size would be used for a full arch (maxillary) ridge around 40 mm. Accessories include sterile techniques and universal precautions must be observed as with any invasive surgical procedure. No additional armamentarium is needed beyond instruments used for guided bone regeneration and fixation. Implant screws include any fixation screw system can be used. The specifications for diameter must be given by the ordering dentist/physician so that the appropriately rendered access hole can be incorporated into the CAD. The recommended diameter of the screw should be 1.5-2.75 mm. The length of the screw is based on the surgeon's clinical judgement, as to avoid critical structures.
With the drawing complete, the occlusive barrier formation software allows three-dimensional modeling in rotation of the jaw CT scan and occlusive barrier configuration so that all participating doctor designer and manufacturer can see that the design will work as needed. The three-dimensional viewing is seen in
Here, the user can click on the name for more information about the case: 3D models, tracking information, treatment plan. This is for Solid Model 3D Treatment Planning. The DICOM is e-mailed to presently disclosed and converted for 3D viewing using a PC, Android, or iPad. Simple, relevant drawing tools are available for the user. The DICOM is e-mailed to the occlusive barrier designer and converted for three-dimensional viewing. Clicking on icons will give users basic color choices. Drawing is as simple as using a finger or stylus.
The three-dimensional modeling can be rotated and zoomed. Measurements can still be done. Submit for Review. User can submit for final review with presently disclosed or back to drawing. Submit for Review. Various tabs will appear when barrier design and screws are placed. Measurement tool will give presently disclosed treatment plan objectives. We can also give feedback about clinical realities and issues like interocclusal distance. Once the preliminary drawing is done, three-dimensional merging can be done at a click. At this point the drawing is complete.
In addition to the occlusive barrier process 40 software for the design of the occlusive barrier, the present method and system further include a web-based interface whereby patients and professionals can communicate with the plan and design for conducting the surgery and placement of the occlusive barrier 10 for bone regeneration. Thus,
At
Because of the highly-specialized technology, only surgeons with extensive experience and training will be able to order presently disclosed barriers. Interested surgeons must apply and be approved to take the certification course. After mentored cases are completed with documentation, the surgeon will be certified to order the barriers. Please visit our certified section for more information. Surgeons must apply and be approved to take the certification course. After review, course information will be sent to you by e-mail. Final certification will allow the surgeon to order presently disclosed barriers using a personalized protected portal which is HIPPA-compliant.
Patients that have severe atrophy of the jaw bones who are not candidates for traditional rehabilitation with implants now have hope. Our doctors and engineers custom design each case for the certified surgeon's approval.
The present disclosure further includes a software application that is fully digital and seamless. This application is easy for surgeons to treatment plan and order our product. The application takes advantage of various familiar platforms (iOS, Android, Google, etc.). Payment is easy because credit card authorization will be linked to each account. It will also allow for pre-paid bulk purchases. The customer can track the progress of each case.
In particular,
In summary, the present disclosure provides a method, system, and integrated medical system for bone tissue regeneration in association with a predetermined dental bone structure, comprising the steps of obtaining a computerized tomography scan of a dental bone structure on which to regenerate bone tissue. A three-dimensional model formed from the computerized tomography scan digitally represents the dental bone structure. The method and system present the three-dimensional model on a computer display. A treatment plan corresponds to the three-dimensional model. The method and system receive a design order relating to the treatment plan for forming an occlusive barrier for covering the portion of the dental bone structure whereupon to regenerate bone tissue. An occlusive barrier forms from a biocompatible material in accordance with said design order. An osteoconductive material is placed within an interior volume of the occlusive barrier for associating with and from which may form flesh and regenerated bone tissue via osteoconduction in association with the portion of the dental bone structure covered by said occlusive barrier. The method and system further include fixing the occlusive barrier and the osteoconductive material to the dental bone structure for a time period sufficient for regeneration of bone tissue associated with dental bone structure. The occlusive barrier is removed from the dental bone structure upon said bone tissue regeneration reaching a predetermined stage.
The disclosed subject matter further includes an occlusive barrier for osteoconductive bone tissue regeneration in association with a predetermined dental bone structure. The occlusive barrier formed by performing the steps of obtaining a computerized tomography scan of a dental bone structure on which to regenerate bone tissue. A three-dimensional model from said computerized tomography scan for digitally representing the dental bone structure. The occlusive barrier may include a plurality of irrigation channels for permitting flushing of said interior volume during regeneration of bone tissue associated with dental bone structure.
The occlusive barrier may be specified using a computer aided design application and manufactured by a titanium laser sintering process. The occlusive barrier further includes a space between the predetermined dental bone structure tissue and gingival tissue for promoting bone growth from a layer of stem cells covering an outer endosteum outer surface of the dental bone structure. The occlusive barrier may be formed from a plurality of pieces printed for associating into said occlusive barrier covering said portion of the dental bone structure whereupon to regenerate bone tissue. The occlusive barrier is subjected to a heat treatment for alleviating molecular stress and increasing occlusive barrier ductility and strength and may be subjected to a surface sandblasting treatment for forming a surface porosity promoting osteoconduction and blood vessel formation. Furthermore, the occlusive barrier may be subjected to an anodizing treatment for cleaning organic and inorganic residues from surfaces of said occlusive barrier.
The detailed description set forth herein in connection with the appended drawings is intended as a description of exemplary embodiments in which the presently disclosed subject matter may be practiced. The term “exemplary” used throughout this description means “serving as an example, instance, or illustration,” and should not necessarily be construed as preferred or advantageous over other embodiments.
This detailed description of illustrative embodiments includes specific details for providing a thorough understanding of the presently disclosed subject matter. However, it will be apparent to those skilled in the art that the presently disclosed subject matter may be practiced without these specific details. In some instances, well-known structures and devices are shown in block diagram form in order to avoid obscuring the concepts of the presently disclosed method and system.
The foregoing description of embodiments is provided to enable any person skilled in the art to make and use the subject matter. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the novel principles and subject matter disclosed herein may be applied to other embodiments without the use of the innovative faculty. The claimed subject matter set forth in the claims is not intended to be limited to the embodiments shown herein, but is to be accorded the widest scope consistent with the principles and novel features disclosed herein. It is contemplated that additional embodiments are within the spirit and true scope of the disclosed subject matter.
This application claims the benefit of the following non-provisional application, all of which is here expressly incorporated by reference in their entirety: Ser. No. 15/511,218 entitled “METHOD FOR PRODUCING AN OCCLUSIVE BARRIER FOR BONE REGENERATION AND AN OCCLUSIVE BARRIER OBTAINED BY MEANS OF SAID METHOD,” filed on Mar. 14, 2017 with Attorney Docket No. IRON001USN; PCT/ES2016/070289 entitled “Meted de Fabricacion de Una Barrera Oclusiva Para Regeneracion Osea y la Barrera Oclusiva Obtenida Mediante Dicho Metodo,” filed Apr. 21, 2016, claiming priority to Spanish application serial no. P201500309, filed on Apr. 23, 2015.
Number | Date | Country | |
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Parent | 15511218 | Mar 2017 | US |
Child | 16028663 | US |