A tooth may need to be extracted from the mouth for a variety of reasons. For example, in some situations it may be desirable to extract a tooth that is decayed, damaged or loose. Other times, teeth may be extracted for ‘orthodontic’ reasons, such as to provide room for other teeth, enable other teeth to grow, etc.
In its most basic form, a tooth includes a crown, which is the upper, visible portion of the tooth, and a root structure, which is hidden from view in the boney substructure of alveolar bone comprising the socket. A tooth is secured in place by a combination of factors, including the structural relationship between the root structure and the alveolar bone of the gums and the periodontal ligaments connecting the tooth root structure to the alveolar bone.
Depending on the type of extraction, removal of a tooth may require the skills of dentists, oral surgeons or similar professionals. As used herein, such professionals are referred to as dental professionals. It should be appreciated that the term dental professional should be read broadly to include any individual trained or skilled to extract teeth from a human or animal.
When a tooth includes a sufficient amount of sturdy crown to enable a dental professional to grip the tooth, the tooth may be removed by rocking the tooth until it is released from the socket. The rocking motion accomplishes at least two purposes. First, the rocking motion expands the alveolar bone in the region circumscribing the tooth socket. This rocking motion changes the structural relationship between the tooth root structure and the alveolar bone. Prior to rocking the tooth, the root structure and the alveolus are associated such that the alveolar bone provides a substantial amount of the retentive force on the tooth. The rocking motion compresses the alveolar bone surrounding the root structure, expanding the tooth socket away from the root structure.
Additionally, the rocking motion stretches the periodontal ligaments that extend from the root structure to the alveolar bone. The stretching of the ligaments may break some or all of the periodontal ligaments from the bone. In other cases, the periodontal ligaments may be stretched, but still intact, after completing the rocking motion to expand the tooth socket. In these cases, the dental professional may be able to break the tooth free from the ligaments by pulling on the tooth.
While the rocking technique allows a dental professional to remove a tooth, the procedure is not ideal. The procedure typically requires the dental professional to exert a great deal of force on the tooth to compress the alveolar bone. Additionally, the limited space in the mouth in which the dental professional must complete this rocking technique complicates the procedure. Furthermore, in some circumstances, the rocking motion can be applied with too much force damaging the crown of the tooth before the socket is sufficiently expanded or resulting in damage or breaks in the alveolar bone. If the crown is sufficiently damaged, the tooth may need to be treated as a surgical extraction to accomplish the removal. A surgical extraction traditionally required the removal of bone utilizing a rotary instrument or chisel. Further, broken alveolar bone may complicate the installation of a dental implant immediately after extraction, sometimes requiring bone grafts and subsequent implant placement at a later date.
The rocking procedure briefly described above may be difficult to perform when there is little or no crown for the dental professional to grip. For example, in some patients, the crown may be sufficiently deteriorated, or not sufficiently extended above the alveolar bone to enable a dental professional to grip the crown. In these cases, specialized tools may be used to remove bone to allow gripping of the remaining tooth structure. For example, a drill may be used to drill into the alveolar bone in the space surrounding the tooth being removed to expose more of the tooth. Drilling the bone may result in undesired bone removal. In some cases, the drilled out bone material must then be replaced with graft material and the patient must wait for the damaged alveolar bone to heal. For example, when a patient is to receive a dental implant, the patient may have to return after the tooth socket has healed to receive the implant. The pain and potential complications associated with the bone graft procedure and the delay in installation of the implant may be undesirable for both the patient and the dental professional.
Some dental professionals use manual periotomes during extraction of a tooth. Manual periotomes may be configured with a shaped tip disposed at an end of a shaft. In use, the tip may be placed at the base of the crown adjacent the periodontal ligament space. The dental professional then applies force on the shaft to force the tip into the periodontal space. A great amount of force may be required to use the manual periotome and the dental professional's hand and arm may be fatigued by the process.
As described above, a variety of special tools and techniques have been developed to improve tooth extraction. Such tools may be specialized for single purpose use. For example, in a tooth extraction and implantation procedure, separate instruments may be required to extract the tooth, collect the bone graft material, prepare the implant site and install the implant. This variety of tools may require the dental professional to be familiar with and own multiple different instruments. More than just inconvenient, the use of several different instruments may be expensive for the dental professional.
A powered surgical instrument is provided. In some embodiments, the powered surgical instrument includes a housing having a proximal end and a distal end, wherein the distal end is configured to receive an expander adapted to expand the tooth socket. The instrument further may include a user-adjustable actuator disposed within the housing configured to move the expander from a first position to a second position, where the second position is linearly offset from the first position.
It should be noted that the drawings depict a plurality of embodiments for the powered surgical instrument and that reference characters may refer to corresponding elements throughout multiple views. Similarly, the drawings are intended to illustrate exemplary embodiments that depict a variety of elements and subelements. It is within the scope of the disclosure that these elements and subelements may be selectively embodied in devices according to the present invention alone or in combination with one or more other elements and/or subelements, regardless of whether the particular selected element, subelement, or combination thereof is specifically illustrated in the figures. For example, the powered surgical instrument disclosed herein may include any of the described and/or illustrated actuation controls, actuators, power supplies, tips, etc., regardless of the particular combination shown in a specific figure.
As shown in
Housing 12 may include a proximal end 14 and a distal end 16. Distal end 16 may be configured to receive an expander 18. In some embodiments, distal end 16 may be configured to selectively receive one of a plurality of tools configured to perform one or more surgical functions. Expander 18, as well as, the plurality of selectively receivable tools will be described in more detail below.
Powered surgical instrument 10 may also include a receiver 20 within housing 12 adapted to selectively receive an expander. In some embodiments, receiver 20 may be adapted to receive one or more of a variety of tools of different dimensions and configurations. A locking mechanism may be incorporated in distal end 16 of housing 12 or into receiver 20 to accommodate receipt and securement of the various tools to the instrument. For example, and not by limitation, housing 12 or receiver 20 may include a locking mechanism similar to the adjustable chuck customarily used on power drills in the hardware industry. Additionally, distal end 16 or receiver 20 may include other clamping mechanisms that will be recognized as suitable for securing differently-sized tools.
With reference to
Actuator 22 may be any suitable linear driving device. For example, actuator 22 may be a solenoid actuator, a pneumatic actuator, a mechanical actuator, or other actuator capable of causing linear motion.
Solenoid actuator 26 may be configured to reciprocatingly move plunger 30 in the forward direction 32 and the reverse direction 34. Such a configuration may be achieved by using a biasing member to drive the plunger in the reverse direction. Any suitable biasing mechanism may be used, including, but not limited to, a spring, a bumper, such as a gasket, a reversal of the polarity of the solenoid coil, or by other means. In the embodiment illustrated in
In some embodiments, a bi-directional solenoid may be incorporated within the housing. The bi-directional solenoid may decrease the fatigue experienced by a dental professional and may allow for increased functionality of the instrument. In an embodiment of surgical instrument 10 where the solenoid is bi-directional, solenoid actuator 26 may be operatively coupled to expander 18 such that the reverse motion of plunger 30 also pulls expander 18 in the reverse direction 34.
Actuator 22 may be configured to linearly drive expander 18 to enable a dental professional to more easily remove a tooth or perform other surgical functions. For example, expander 18 may be configured to be positioned along the periodontal ligament space. In some embodiments, expander 18 may be sized such that it is slightly larger than the periodontal ligament space.
As the actuator moves expander 18 linearly, the alveolar bone surrounding the tooth socket is compressed or compacted, thus expanding the socket along the periodontal ligament space. Expander 18 is thus adapted to expand the tooth socket. The linear driving motion of the powered surgical instrument operates with sufficient force to compress the bone surrounding the tooth socket. As a byproduct of the compression of the bone surrounding the tooth socket, the periodontal ligaments may be severed or otherwise broken. Once the bone is sufficiently compressed and the socket is sufficiently expanded, the tooth may be gripped and removed. The linear motion of the powered surgical instrument facilitates the expansion of the tooth socket while minimizing the fatigue which would occur if such a procedure was attempted manually.
With reference to
Surgical instrument 10 may also include a power control 38. Regardless of how power is supplied to surgical instrument 10, power control 38 may be configured to allow the dental professional to turn the instrument on or off. Surgical instrument 10 may be considered to be “on” when power is flowing from power supply 36 to another component of powered surgical instrument 10, such as actuator 22. Power control 38 may be disposed on housing 12 as shown in
Surgical instrument 10 may also include an actuation or reciprocation control 40. Actuation control 40 may be disposed on or within housing 12 or it may be external to housing 12, such as on an external control box, as will be seen in other embodiments described below. It should be understood that actuation control 40 is in communication with actuator 22. Actuation control 40 may be configured to enable a user, such as the dental professional, to selectively adjust one or more properties of the actuator or other operational element of the surgical instrument 10.
Actuation control 40 may include a variety of user interfaces and controls, including analog systems and/or digital systems. Actuation control 40 may be a mechanical controller and/or an electronic controller. For example, in
It should be appreciated that actuation control 40 may include other control systems, including, but not limited to, analog systems incorporating dials and electrical circuitry rather than digital processing, combinations of analog and digital systems, etc. For example, actuation control 40 may include a combination of digital and analog systems working cooperatively to enable a user to selectively control or adjust the linear motion as generated by actuator 22. Examples of these and other alternative embodiments will be better understood with reference to the description below.
Actuation control 40, in whatever embodiment it is implemented, may be configured to adjust the linear motion induced by actuator 22. For example, actuation control 40 may control one or more of the following characteristics or other like characteristic: the frequency of the linear motion, the intensity of the linear motion, the stroke-length of the linear motion, or some other characteristic of the motion. With continued reference to the embodiment shown in
As an illustration of the use of actuation control 40 to enable a user to selectively control characteristics of the motion generated by actuator 22, the following examples are provided.
In some embodiments, actuation control 40 may allow a user to select the frequency at which actuator 22 drives expander 18. In some embodiments, the range of selectable frequencies may range from about 0 Hz to about 40.0 kHz, or anywhere there between. In some embodiments, the upper frequency limit may be 20 kHz, 10 kHz, or 1.0 kHz. Embodiments with a narrower range of selectable frequencies may also be configured. For example, in some embodiments, the selectable range of frequencies may span from about 0 Hz to about 100 Hz. In still other embodiments, the selectable range may span from about 0 Hz to about 60 Hz. Actuation control 40 may be configured to allow a user to select a desired frequency in the range. Alternatively, actuation control 40 may be indexed so that a user can select from a collection of predetermined frequencies within the range.
Additionally, actuation control 40 may allow a user to select the intensity at which actuator 22 drives expander 18. In some embodiments, the actuator may drive the expander with up to about 1.5 pounds of force. A user may be able to select an intensity ranging from 0 pounds-force to about 1.5 pounds-force. Alternatively, actuation control 40 may provide an index of selectable intensities within this range. In other embodiments, actuator 22 may drive expander 18 with a lower maximum force, such as 0.75 pounds-force or 1.0 pounds-force.
In some embodiments, actuation control 40 may enable a user to select the stroke-length that actuator 22 provides expander 18. As described above, in the embodiments where a solenoid actuator is used, actuation control 40 may adjust the stroke-length by modifying the extent to which plunger 30 is driven in the forward direction (represented by arrow 32), by modifying the amount of rebound force provided by a biasing force, or by adjusting the position of the solenoid actuator 26 within housing 12. In some embodiments, the user may be able to select a stroke-length ranging from about 0.01 mm to about 1.0 mm or anywhere there between. In other embodiments, the stroke-length may be selectable within a range from about 0.01 mm to about 0.5 mm.
Referring back to the figures, in some embodiments, housing 12 may be configured with an operational control 39. Operational control 39 may be disposed on housing 12 to provide additional control and convenience to the dental professional performing the surgical procedure. For example, operational control may be configured to temporarily halt the motion of expander 18 without requiring the dental professional to modify other settings or reach for other controls. The operational control may be configured to cooperate with a portion of actuator 22 or with a portion of expander 18 or both. It should be appreciated that in some embodiments, operational control 39 may cooperate with power control 38 or with actuation control 40. Although shown at the distal end 16 of housing 12, operational control 39 may be disposed on any suitable location on the housing of the instrument or accessible component of the instrument.
Referring now to
As in
The embodiment shown in
Surgical instrument 110 incorporating pneumatic actuator 126 may also include a compressed air supply 144 in communication with pneumatic actuator 126. Compressed air supply 144 may supply a stream of compressed air to an actuation control 140. For example, as shown in
Air from compressed air supply 144 may be directed into instrument 110. For example, as shown in
As shown in
When powered surgical instrument 110 is pneumatically driven as in
For example, foot pedal 260 may be configured to allow a user to adjust the frequency of the motion by applying more or less pressure. In some embodiments, powered surgical instrument may be provided with more than one pressure sensitive device, such as a foot pedal and a touch pad. The pressure sensitive device that may be a component of powered surgical instrument 210 may be adapted to cooperate with actuation control 240 to allow adjustment up to set maximum. For example, when foot pedal 260 is used to adjust the frequency of linear motion, actuation control 240 may be adapted to allow a user to set a maximum frequency and foot pedal 260 may be configured to allow the user to vary the frequency between 0 Hz and the maximum frequency set on actuation control 240.
The procedure for installing a dental implant often begins with extraction of the natural tooth to make way for the implant. However, the natural tooth socket is generally not naturally prepared to receive a dental implant. For example, the alveolar bone material around the tooth socket may not be able to securely hold the implant or the tooth socket may not be properly shaped to receive the implant.
Exemplary steps for preparing a dental implant site are summarized in box 370 of
As illustrated in
Expander 372 may be used to extract the tooth from the tooth socket, as discussed above. For example, expander 372 may be configured to have a width slightly larger than the width of the periodontal ligament space. When expander 372 is slightly larger than the periodontal ligament space, the linear motion of the expander compresses or compacts the alveolar bone surrounding the tooth socket expanding the socket. Additionally, as the socket expands and expander 372 is moved further into the periodontal ligament space, expander 372 may be adapted to cut or sever the periodontal ligaments. Embodiments of expander 372 are illustrated in
Alternatively, expander 372 may have a contoured distal end as shown in
Additionally, expander 372 may be configured with a bayonet tip as shown in
It should be understood that expander 372 may include a variety of devices configured to facilitate removal of a tooth and/or preparation of a tooth socket for a dental implant. Expander 372 is adapted to expand the periodontal ligament space and may be configured to have width at the distal end greater than the width of the periodontal ligament space. On average, the periodontal ligament space ranges from 0.25 mm to 0.4 mm. Expanders 372 of the present disclosure may have a width at the distal end ranging from about 0.25 mm to about 0.75 mm.
With continued reference to
Harvester 374 may be received within the powered surgical instrument described herein such that the harvester is driven in a collection direction (e.g. toward the housing) to coincide with the configuration of scrapers 388. However, harvester 374 may also be used in cooperation with a surgical instrument configured to drive in a forward direction if scrapers 388 were configured accordingly. The driven motion of harvester 374 coinciding with the configuration of scrapers 388 allows the harvester to collect bone graft material with less effort and fatigue for the dental professional.
A compacter 376 may also be received within the disclosed powered surgical tool. Compacter 376 may be configured to perform one or more functions. For example, compacter 376 may be configured to pack bone graft material into a tooth socket. Additionally, compacter 376 may be configured to compress bone material surrounding the tooth socket to increase the density of the bone to implant interface to better receive an implant. As mentioned above, an empty tooth socket is not generally naturally prepared for receipt of an implant. Bone graft material is often used to provide the dental professional with material to form a more preferred implant site. The graft material may be compacted into place, such as by repeated impacts from compacter 376.
A shaper 378 may also be received within powered surgical tool 318. Shaper 378 of
Once the graft material is compacted into the socket or when graft material is not used, it may still be desirable to shape the tooth socket. A natural tooth socket may be oblong or elliptical and many dental implants are circular. Accordingly, dental implant site preparation may include forming the tooth socket to correspond with the dental implant. For example, bone graft material may be compacted into a socket leaving a socket opening that may be smaller than required to receive the implant. A hole the size of the implant may be drilled into the graft material but the edges of the hole may not be dense enough or stable enough to secure an implant.
A compression and expansion process may be used to form the tooth socket for receiving an implant and to increase the density of socket. In such a process, a hole smaller than the diameter of the implant may be drilled to start the forming process. For example, the dental implant may have a diameter of 5.0 millimeters and a 2.0 millimeter hole may be drilled in the filled-in tooth socket. Subsequently, a 3.5 mm diameter shaper 392 may be driven into the 2 mm hole. Each of the shapers 392, 394, 396 may have a tapered distal end to allow the larger compactor to start into the hole prepared by the smaller compacter. The impact of the larger diameter shaper into the hole compresses the bone graft material outwardly, densifying the bone and forming the implant site. Shaper 392 may be driven by powered surgical instrument in a forward direction or in reciprocating motion to reduce the fatigue on the dental professional. Shaper 392 will form a 3.5 mm hole in the filled-in tooth socket. Shaper 394 may then be driven into the filled-in tooth socket by the surgical instrument. Shaper 394 may have a 4.3 mm diameter and may compress the bone enlarging the tooth socket to 4.3 mm in diameter. This process of expanding a hole in the filled-in tooth socket may continue until the hole reaches the desired diameter. For example, shaper 396 may have a diameter of 5.0 mm to prepare a dental implant site for a 5.0 mm diameter implant.
Another dental implant site preparation device 318 is illustrated in
Tack driver 350 may facilitate the securement of the protective material through the repetitive linear motion of the powered surgical instrument disclosed herein. Tack driver 350 may be configured to have a blunt head 352 as shown in
Although the present disclosure includes specific embodiments, specific embodiments are not to be considered in a limiting sense, because numerous variations are possible. The subject matter of the present disclosure includes all novel and nonobvious combinations and subcombinations of the various elements, features, functions, and/or properties disclosed herein. The following claims particularly point out certain combinations and subcombinations regarded as novel and nonobvious. These claims may refer to “an” element or “a first” element or the equivalent thereof. Such claims should be understood to include incorporation of one or more such elements, neither requiring nor excluding two or more such elements. Other combinations and subcombinations of features, functions, elements, and/or properties may be claimed through amendment of the present claims or through presentation of new claims in this or a related application. Such claims, whether broader, narrower, equal, or different in scope to the original claims, also are regarded as included within the subject matter of the present disclosure.
Reference in the specification to “one embodiment” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the invention. The appearances of the phrase “in one embodiment” in various places in the specification are not necessarily all referring to the same embodiment and such features, structures and/or characteristics may be included in various combinations with features, structures and/or characteristics of other embodiments.
In the foregoing specification, the invention has been described with reference to specific embodiments thereof. It will, however, be evident that various modifications and changes can be made thereto without departing from the broader spirit and scope of the invention. The specification and drawings are, accordingly, to be regarded in an illustrative rather than a restrictive sense.