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    • 专利摘要:
    METHOD FOR PREPARING A SURGICAL GUIDE AND SURGICAL GUIDE SYSTEM FOR A DENTAL IMPLANT PROCEDURE.Method of preparing a surgical guide for positioning a dental implant. The method includes placing a positioning device in relation to a dental arch model, rotating it in a BL direction, adjusting a BL angle around the BL axis of the pivot, corresponding to a desired position of a dental implant, and fixing the position and angle BL, and the height z of the positioning device. A mounting system is fitted to the positioning device and includes a removable rotation block with a guide opening. The mounting system can be rotated in the MD direction while the BL position is fixed. A matrix fixes the mounting system to transfer the positioning information to the patient's mouth. Various aspects of the process can be performed on a computer. The guidance and method of using the guide to perform an implant procedure are also described.
    公开号:BR112012015519A2
    申请号:R112012015519-9
    申请日:2010-12-21
    公开日:2020-08-25
    发明作者:Lambert J. STUMPEL
    申请人:Lambert J. Stumpel；
    IPC主号:
    专利说明:

    =. % 1/59 z METHOD FOR THE PREPARATION OF A SURGICAL GUIDE AND SYSTEM OF
    SURGICAL GUIDE FOR A DENTAL IMPLANT PROCEDURE Cross-references with related requests This application claims priority to US Provisional Patent Application No. 61 / 289,310, filed on December 22, 2009, entitled SURGICAL GUIDE and Provisional Patent Application No. 61 / 349,779, filed on May 28, 2010, entitled GUIDE AND SURGICAL METHOD, whose total contents are incorporated in the present invention for all the purposes of this reference. Background of the invention Field of the invention The present invention relates to a method of positioning a dental implant or surgical device in a desired location. Several aspects of the present invention are related to a method of positioning a dental implant using a dental model, preparing a surgical guide, using it to perform an osteotomy & € and alignment of the dental implant, and intraoral placement of the implant. Several aspects of the present invention are related to a surgical guide for accurately determining the position of the implant and transferring that position in a model, and to the location in an individual where the procedure will be performed. Related technique description Dental implants are a growing popular option for patients. with tooth loss due to extensive tooth decay, bone or gum damage, or accidents that caused physical loss, or the like. Dental implants are an attractive choice over dentures because they look natural and require less
    7 maintenance. Implants also offer a stronger chewing surface and allow patients to return to their normal diets.
    However, compared to dentures, dental implant procedures involve more complex and more expensive surgical work. More specifically, dental implant procedures involve placing an implant or abutment in the underlying dental arch as a foundation, and subsequently attaching a prosthesis to the implant above the gingival line. Generally, a dental osteotomy must be performed to prepare the bone for placement of the implant. The implant is then inserted and fixed on the bone to support the dental prosthesis. An important aspect of implant planning is its correct placement in the bone.
    The most difficult part that requires more skill in the procedure is usually the positioning of the screw to create the opening in the dental arch that will receive the implant. The opening must be made in the precise location in relation to the adjacent tooth for a natural appearance, and to reduce the risk of interference with the proximal tooth. The opening must also be positioned in the appropriate place on the bone to ensure a solid base for the prosthesis. Inaccuracies in the placement of the screw can damage nearby vital structures, such as nerves, blood vessels, sinuses and proximal teeth. It is desirable to reduce the risk of wrong perforation in an incorrect position. Incorrect positioning of the implant opening presents problems for the surgeon when placing the implant on the bone. If at
    "opening is not placed in the proper position in the arch. dental, further drilling may be necessary. Even more problematic, if the bone has been removed improperly, new bone tissue will need to be grafted or added to the site. Due to the need for accommodation of the graft, and tissue healing, the graft requires an additional time of 3-6 months before a new attempt is made. Positioning errors also require new consultations, additional time for completion, and unnecessary discomfort. Implant procedures generally require specialized surgeons, and are not commonly performed by less experienced surgeons and clinicians.
    Many devices and methods have been developed to increase the accuracy, reliability and ease with which the surgeon will perform the drilling. The most popular technique is based on freehand alignment. In the case of freehand drilling, according to his experience, a surgeon establishes the appropriate trajectory and the final location of the implant. This technique not only requires a steady hand, but the surgeon also needs to assess the location of the bone below the surface of the gum. Because the bone is covered by the gingival tissue, and because it is difficult to inspect the site, the surgeon usually has great difficulty in determining the correct site at this early stage.
    The flap opening method is the typical method for overcoming problems in determining the position of the bone below the gingival line. This method involves cutting a flap of the gum close to the
    S implant to determine the position of the arch in relation to the. implant. This method increases the risk of infection and offers more discomfort to the patient.
    Freehand drilling also offers safety hazards and accuracy problems. Although the surgeon can initially determine where to drill, during the procedure, the drill can “jump” or slip. The drill can also "walk" or move before the tip punctures the bone. In addition, freehand drilling allows the surgeon to perform the procedure without a comprehensive view of the oral cavity and the implant site.
    Model-based or laboratory-based methods allow for better positioning by offering less invasive assessment and advanced procedure planning. An example of this technique is in U.S. Patent No. 7,086,860 to Schuman et al. Schuman's method involves using devices to determine the size, angle and position of the implant in a plaster model. The plaster is cut to determine the position of the bone.
    A graph is then drawn on the model and tools are used to transfer the information to the implant site. In the laboratory, the bucco-lingual thickness (“BL”) of the bone is stipulated by assessing the depth of the tissue, as measured in the mouth by probing the bone. If the anatomy is accurately copied, the correct bone thickness value available for implant placement can be determined. The mesial-distal (“MD”) positioning of the implant is derived from the transfer of radiographic information to the model.
    The above methods have several limitations. The already positioning MD in the laboratory is only an estimate. it is not verifiable until it is transferred to the mouth. This method also only allows the surgeon to practice drilling on the model and does not accurately assist in transferring or mapping the drilling position of the model to the implant site on the patient. Finally, the drilling procedure still requires a steady hand and drilling experience. Another technique involves the elaboration of a drilling guide based on the model.
    However, errors can still occur when transferring the model's position to the drill guide. In addition, the drill guide does not allow a controlled adjustment.
    U.S Patent No. 6,971,877 to Harter is directed to a dental device formed by a stent and a bracket with bushing to guide a drill bit. The stent is modeled and configured to fit the patient's arch. The bushing holder fits into an opening in the stent. A spherical joint (ball and socket) allows the user to adjust the guide by screwing the bushing into the support. Harter allows you to transfer the model information to the patient's mouth. This adjustment, however, has the same limitations, because a user adjusts the guide in 3D space with little control.
    In addition, the Harter guide limits the user's ability to make adjustments to the pivot angle without the translation movement. The pivot point at the junction is positioned well above the occlusal plane and at a distance from the arch. Adjustments in the pivot angle above the teeth result in a significant transfer of the entry point i of the drill bit into the arch. Just like the pivots. guides, a correction needs to be made in the transfer. This makes it difficult to obtain precise positioning. There is an ongoing need to reduce costs and complexities associated with existing implant placement procedures. Conventional techniques generally require many steps to be performed by different people. Such additional steps generate undesirable increases in the total cost and time of the procedure.
    Based on what has been said previously, the presentation of a dental implant alignment method and device that overcomes the related disadvantages and others of the known implant placement systems and methods would be advantageous. Therefore, an improved method and device is needed to determine and precisely adjust the trajectory of a guide that will allow the performance of an osteotomy for dental implant and placement of a laboratory analog of an implant. A simple and easy-to-use method and dental guide device is required. A more flexible method of planning and positioning a dental implant is required. A method is needed to allow the performance of several processes at different times and places. A method is needed to reduce implant planning and placement time.
    Brief summary of the invention The invention relates to a surgical guide for positioning a dental implant, such as a dental device, implant or prosthesis. One aspect of the present invention is directed to a method for preparing a surgical guide for bucco-lingual positioning (BL)
    Í and mesio-distal (MD) of a dental implant.
    The method can. include the positioning of a device in relation to the dental arch adjacent to an edentulous area in a model of a patient's dental arch, including the transfer of the positioning device in BL direction to the desired BL position axis, aligned with the region of the dental arch. arcade, adjusting the BL angle of the positioning device around the BL axis of the pivot corresponding to the desired position of a dental implant to be positioned, with the BL axis of the pivot corresponding to the BL position axis, and / or fixing the BL position and of the BL angle of the device in relation to the model, and elaboration of a mounting system according to the model, including a mounting structure and a provisional receiver block to receive an upper portion of the positioning device, so that the structure presents a fixed BL position and a BL angle in relation to the positioning device, with the system being configured to receive the dental implant.
    The method can also include, before placing the positioning device, the indication of the reference points of the arcade region in the model, where the transfer of the device in the BL direction can be performed based on the reference points.
    The positioning device may include a slot for visual alignment with the BL reference point.
    Placing the positioning device around the BL axis of the pivot may include creating a height z of the positioning device.
    Assembly can include transferring an assembly system from an MD position to a desired MD position
    Í in relation to the arcade region, adjusting an MD angle. preliminary of the system around the MD axis of the pivot, with the axis being co-extensive with the transient receiver block and the upper portion of the positioning device, and / or fixing the assembly structure to a matrix corresponding to the model.
    The matrix can fix the mounting structure in relation to the dental arch in the model.
    The method may also include installing a rotation block in relation to the model, removing the provisional receiver block from the assembly structure, and / or mounting a rotation block on the assembly structure, where the rotation block can be selected from one series of rotation blocks, each including a guide opening that has a predetermined MD position and angle.
    The upper portion of the positioning device can define the MD axis of the pivot, with the mounting frame being configured to rotate around the MD axis of the pivot while the BL position and angle. are fixed.
    The method can also include, after installation, the adjustment of the MD angle of the guide opening, by replacing the rotation block with another one that has a different MD angle.
    The method may also include transferring the matrix, mounting frame and rotation block from the model to the patient's dental arch, and fixing the matrix and mounting frame to the patient's dental arch adjacent to the patient's edentulous area.
    At a minimum, the included rotating blocks and structure can be configured to allow
    Controllable transfer of the rotation block with respect to. structure.
    The positioning device may include a slot to promote BL rotational alignment and offset in the direction from the arch.
    The BL axis of the pivot may be located in an Upper position of the dental arch.
    The model can be a CAD model and the placement of the positioning device can be performed on a computer.
    The assembly system can be obtained by assembling the system in a physical model corresponding to the CAD model.
    The rotation block can be replaced when the matrix and the assembly structure are positioned in the edentulous area of the patient's dental arch.
    A surgical guide system for positioning a dental implant can be prepared according to the methods described above.
    Another aspect of the present invention is directed to a surgical guide system for a dental implant procedure, including a mounting system with a mounting frame and a removable rotation block, with the mounting frame configured to maintain a BL angle and a BL position of the rotation block in relation to at least one tooth adjacent to the edentulous area, based on a dental model, the rotation block including a guide for receiving a dental system and presenting a predetermined MD position and MD angle, where the rotation block can be connected to the mounting structure at a BL point of the pivot, defining the BL angle of the
    1 rotation, with the BL point of the pivot located adjacent to the portion. upper part of a dental arch and corresponding to the upper part of the implant to be implanted.
    The predetermined MD angle can be about 0º, about 3º and about 7º.
    The mounting structure can include rails for preliminary fixation to at least one tooth.
    The guide system may also include a provisional receiver block. Interchangeable with the rotation block, configured to receive a positioning device for placing the mounting structure in a BL position and angle in relation to the model.
    The upper portion of the positioning device can be adjusted on the receiving block, where the positioning device can be lengthened and extended apically towards the receiving block to a position adjacent to the dental arch aligned with the desired path of the dental device.
    The upper portion of the positioning device may include a pivot pin to rotate the positioning device to the model at the BL point of the pivot.
    The rotation block can include a slot defining the MD axis of the pivot of the rotation block in relation to the positioning device, with the rotation block being configured to rotate around the MD axis of the pivot, while the position and angle BL are fixed.
    The positioning device may include a molded slot to facilitate the alignment of its rotation with a BL reference point on the model.
    7 A method of performing an implant procedure. The dental system may include the assembly of a guide system, according to claim 18, in a dental arch, with the guide system defining the edentulous area, inserting a drill bit through the rotation block guide, with the guide configured to maintain the trajectory of the drill in the dental arch, preparing the dental arch with an opening to receive the implant with the aid of a drill, removing the drill from the system, and / or inserting the implant through the guide system through the opening, with the upper part of the implant aligned with the upper part of the dental arch. Another aspect of the present invention is directed to a method of preparing a surgical guide for buccalingual (BL) and mesio-distal (MD) positioning of a dental implant. The method may include placing an assembly system in relation to the dental arch, adjacent to the edentulous area in a model of a patient's dental arch, positioning the assembly system in a desired BL position, which may be aligned with the region of the arcade with a desired BL angle, fixing the position and BL angle of the mounting system in relation to the model, fixing the insertion guide to the mounting system, with the position and BL angle of the insertion point determined in relation to the model by mounting system. The mounting system and the insertion guide form a temporary surgical guide, and have an opening configured to receive the dental implant, and / or to test the surgical guide on the patient's dental arch.
    The assembly system can include a
    'assembly to support the insertion of the guide so that a. BL position and angle of the structure and insert can be fixed in relation to the model.
    Positioning can be achieved by moving the assembly system in the BL direction to the desired BL position, and by separately adjusting the BL angle to the desired BL angle.
    The aforementioned methods may also include, after positioning the BL position and the BL angle, the displacement of the mounting system in the MD direction to a desired MD position in relation to the region of the dental arch; and adjusting the mounting system around the MD axis of the pivot to a desired MD angle.
    The mounting system can be configured to be moved and adjusted in the MD direction while the position and angle BL are fixed.
    The insertion of the guide may include a marker capable of being viewed with at least an X-ray or tomography.
    The aforementioned methods may also include, after the image is taken, the creation of a computerized model of the provisional guide in the patient's dental arch, based on the information provided by the image.
    The aforementioned methods may also include determining the desired MD position and MD angle of the guide opening using the computer model. the aforementioned methods may also include information stored in relation to the surgical guide in a memory.
    The aforementioned methods may also include the manufacture of a surgical guide based on the position and
    'desired MD angle.
    . Yet another aspect of the invention is directed to a program - computerized for use with an operating system. The program product may include a storage medium and a mechanism including instructions for carrying out all of the methods mentioned above.
    The dental quia methods and systems of the present invention have other aspects and advantages that will become clearer or be described in more detail with the attached figures, which are incorporated as part of that specification, and the later detailed description of the invention also helps to explain the principles of the present invention.
    Brief description of the figures FIG.1 is a front view (rear) of a dental guide system positioned on a model according to the present invention.
    FIG. is a top view (occlusal) of the dental guide system of FIG. 1.
    FIG. 3 (a) is a perspective view of the positioning device of figure 1. FIG. 3 (b) is a perspective view of the mounting system positioned in the positioning device of FIG. 1, with the assembly system “including a provisional receiver block and structure. FIG. 3 (c) is a perspective view of the mounting system of FIG. 3 (b), illustrating the removal of the receiver block and installation of a selected rotation block.
    FIG. 4 is a perspective view of a kit for preparing a guide system of FIG. 1, illustrating a
    'plurality of rotation blocks with mesio-distal angles. different and different sizes of the guide openings.
    FIGS. 5, 6, 7, 8, 9, 10, 11 and 12 illustrate The positioning device of FIG.1 being aligned and fixed in a model according to the present invention.
    FIGS. 13 and 14 are sequential views illustrating the method of placing an assembly system on the fixed positioning device of FIG. 12. FIGS. 15, 16, 17, 18, 19 and 20 are sequential views illustrating the method of adjusting the mounting system in the MD direction and adjusting the MD angle while maintaining the BL position and the fixed angle.
    FIGS. 21, 22, 23 and 24 are sequential views illustrating the attachment of the assembly structure of FIG. 20 to a matrix corresponding to the patient's model and dental arch, forming an assembly system, and selection of a rotation block.
    FIGS. 25, 26, 27 and 28 are sequential views illustrating the insertion of a dental drill through the guide system of FIG. 24, according to the present invention, illustrating a drill path in the MD and BL planes.
    FIG. 29 is a bottom view of a quia system similar to that of FIG. 1 positioned on the patient's dental arch corresponding to the model, illustrating the use of two rotation blocks with different positions according to the present invention.
    FIG. 30 is a side view of a patient's mouth with a dental guide system of FIG. 29, positioned along the dental arch in the region of the
    : edentate.
    . FIG. 31 is an X-ray of a patient's mouth after placing a radiographic implant in the dental arch using a dental guide system of FIG, 29.
    FIGS. 32 (a) -32 (f) are sequential views illustrating the step-by-step assembly of a guide system similar to that of FIG. 1.
    FIGS. 33 (a) and 33 (b) are seen in perspective of the guide system of FIG. 32.
    FIGS. 34, 35 and 36 are sequential views of a patient's upper arch, illustrating the method for performing an osteotomy and subsequent placement of an implant using a dental guide system in accordance with the present invention.
    FIG. 37 illustrates the correlation of the upper part of the implant with the margin of the dental arch, the pivot point of the positioning device and the adjacent tooth crown.
    FIGS. 38-39 illustrate a CAD model similar to that of FIGS. 5-28 for positioning a guide system according to the present invention. FIGS. 38, 39, 40, 41, 42 and 43 are sequential views illustrating a quia system similar to that of FIG. 28, aligned with the model according to the present invention.
    FIG. 44 is a perspective view of an insertion guide similar to the rotation block of FIG. 1 according to the invention.
    FIG. 45 is a side view of an insertion guide of FIG. 44. FIGS. 46 and 47 are top views of a
    & positioning device is sized and configured to receive a temporary receiver block 54, and subsequently a guide opening 44 in the rotation block
    37. 'In various modalities, the guide opening of the rotation block is configured to receive and orient a dental drill and implant. The guide opening can be configured to receive and guide a variety of dental implants. An optional arm can be provided for removable insertion into the guide opening to allow exchange with different devices. In one embodiment, an internal surface of the guide opening is metallic to prevent the drill bit from damaging the rotation block. In several embodiments, the optional arm is formed of a rigid material to protect the rotation block. The inside diameter of the guide opening of the rotation block can also be dimensioned according to the outside diameter of the drill bit, so that the arm is not necessary. In several embodiments, the guide opening is produced to a minimum size, and the diameter is increased until it fits the selected dental device. In one embodiment, the rotation block has a height of about 4 mm and a diameter of the guide opening of about 5.5 mm. In one embodiment, the guide opening has a smaller diameter at the bottom than the top to allow rotation in the opening. In one embodiment, the guide opening is round and slightly larger than the upper end of the positioning device to allow for additional adjustment after inserting the rotation block.
    the flat and L, respectively, of an assembly system. similar to that shown in FIG. 32. FIGS. 59-67 are seen in perspective of several rotation blocks similar to those shown in FIG. 32. Detailed description of the invention A reference will be made in detail to the various modalities of the invention, examples of which are illustrated according to the attached figures. Although the invention is described together with the various modalities, it should be understood that the invention is not limited to those modalities. Rather, the invention encompasses alternatives, modifications and equivalents, which can be included within the spirit and scope of the invention, as defined in the "appended claims.
    «15 In many respects, the present invention is similar to those described in US Patent Application No. 11 / 870,310, filed October 10, 2007, entitled SURGICAL GUIDE FOR DENTAL IMPLANTS AND METHOD THEREFOR, Provisional Patent Application No. 60 / 850,605, filed on October 10, 2006, entitled IMPLANT POSITIONING SYSTEM MODEL BASED, and Provisional Patent Application No. 61 / 289,310, filed on December 22, 2009, entitled SURGICAL GUIDE, whose contents are incorporated in their entirety in the present invention as a reference.
    "Dental implementation" refers to devices and structures for use with a drill guide, in accordance with the present invention. In many respects, “dental implementation” refers to a drill, radiographic marker, or other devices for use in performing an osteotomy, using the drill in accordance with this
    'invention. In many ways, “dental implementation” is. refers to an implant or dental prosthesis to be placed in a desired location in a patient. The terms “buccal”, “lingual”, “mesial” and “distal” must be understood in the same way that they are used in the clinical, orthodontic and biomedical areas. In several respects, the terms “buccal-lingual” and “BL” generally refer to the buccal (cheek) and lingual (tongue) directions, as determined in a respective location. In several respects, the terms "mesio-distal" and "MD" generally refer to the mesial (through the front tooth) and distal (through the posterior tooth) directions, as determined in a respective location.
    M “osteotomy” must be understood as it is «15 used in the clinical, orthodontic and biomedical fields, and generally involves the modification of bone at an implant site. “Implant location” refers to a region of edentulous area where an implant will be placed.
    “Edentada” and / or “edentada area” must be understood as it is generally used in the clinical, orthodontic and biomedical areas, and generally refers to a gap or space caused by tooth loss. In many respects, an "edentulous area" refers to a desired location where a dental prosthesis will be placed and which is limited by a dental arch and / or tissue at the top and aligned with the adjacent teeth. In many respects, the “edentate area” refers to an area that will be edentulous, including, but not limited to, an area in a model where an edentulous portion will be formed.
    "" Model "refers to physical and virtual objects, | - such as a numerical software model.
    The term “prosthesis” should be understood as it is generally used in the clinical, orthodontic and biomedical fields and includes both the singular and the plural. “Prosthesis” generally refers to a device that is at least partially artificial and replaces a lost body part or assists in the performance of body function.
    In several aspects, the term “prosthesis is used interchangeably with“ dental analog ”,“ dental prosthesis ”and“ restoration ”. In many ways, the term “prosthesis” refers to an artificial tooth to replace a patient's tooth loss. 'The term “implant” should be understood as it is «15 generally used in the clinical, orthodontic or biomedical field, and includes both the singular and the plural.
    In several aspects, the term “implant” is used interchangeably with “abutment” “” and ““ abutment of the prosthetic implant ”, and generally refers to an element or device used to anchor or & u Support a prosthesis in a desired location.
    In several respects, the term “implant refers to a device for connecting bone and / or living tissue to a prosthesis.
    With respect to the figures, the components are designated by numbers, and attention is directed to FIGS. 1-2 that illustrate a surgical chia system, generally designated 30, positioned over an edentulous area 32 of a model based on a patient's mouth.
    The surgical guide system includes a positioning device 33, a mounting system 35, a removable rotation block 37, and a matrix
    '39. The matrix is configured to hold the guide system - on the teeth in the model, and likewise, on the teeth in the patient's mouth. Suitable materials for the matrix include, but are not limited to, orthodontic impression material, expandable foam, and polymers. The die can also be configured with another, faster device to connect to the mounting system and teeth, as will be appreciated by experts in the field.
    As will be described in more detail, the surgical chia system generally allows for an accurate transfer of a configuration based on a dental arch and edentulous area from a model to a patient. The guide system, in accordance with the present invention, allows limiting the adjustment of the guide opening to a single or a limited number of «15 directions, thereby reducing the complexity of positioning the guide in three-dimensional (3D) space.
    The guide mounting system 35 includes a mounting frame 40 and a temporary receiver block 54. As will be described in detail below, in the complete surgical procedure, the mounting frame supports the removable rotation block 37. The mounting frame fixes the rotation block in relation to the matrix. In an intermediate phase, the assembly system includes the receiver block 54, and is configured to be adjusted in the MD plane in relation to the model, and later fixed to the model using the matrix.
    The positioning device 33 defines a position and an angle of the mounting structure in the BL direction as will be described in detail below. The positioning device is elongated. An upper portion 42 of the
    the positioning device is dimensioned and configured z to receive a temporary receiver block 54, and subsequently a guide opening 44 in the rotation block
    37.
    In various embodiments, the opening opening of the rotation block is configured to receive and guide a dental drill and implant. The chia opening can be configured to receive and guide a variety of dental implants. An optional arm can be provided for removable insertion into the guide opening to allow exchange with different devices. In one embodiment, an internal surface of the guide opening is metallic to prevent the drill bit from damaging the rotation block. In various embodiments, the optional arm is formed of a - 15 rigid material to protect the rotation block. The inside diameter of the guide opening of the rotation block can also be dimensioned according to the outside diameter of the drill bit, so that the arm is not necessary. In several embodiments, the guide opening is produced to a minimum size, and the diameter is increased until it fits the selected dental device. In one embodiment, the rotation block has a length of about 4 mm and a diameter of the guide opening of about 5.5 mm. In one embodiment, the guide opening has a smaller diameter at the bottom than the top to allow rotation in the opening. In one embodiment, the guide opening is round and slightly larger than the upper end of the positioning device to allow for additional adjustment after inserting the rotation block.
    'With respect to FIGS. 1-2, The surgical guide system. it is prepared based on a 46 dental model of the patient. The model is prepared by molding the patient or using other conventional techniques. A portion of the positioning device 33 is attached to the model (see, for example, FIG. 9), and a portion of the mounting system 35 is attached to the model, based on the position of the positioning device (see, for example, FIG. 20).
    According to the present invention, the surgical guide system 30 is configured to guide a drill bit during a dental osteotomy to prepare the arch to receive the abutment. The exemplary guide system is also configured to guide the abutment to the prepared site in the dental arch. The «15 surgical guide system can be used for a variety of procedures and can be configured to guide a variety of tools & devices and devices depending on the procedure to be performed.
    With respect to FIGS. 3 (a), 3 (b), 3 (c) and 4, The surgical guide system, according to the present invention, includes several components, with some intended for exclusive use during the intermediate stages of the elaboration of the guide system. The various components illustrated in FIG. 4 constitute a kit for use to be provided to the surgeon or other clinician.
    As shown in FIG. 3 (a), The positioning device 33 is elongated with the tongue 47 in the upper portion 42. A pin 49 is projected out of a central position of the positioning device. A portion of the positioning device includes a slot
    '51.
    . As shown in FIG. 3 (b), the positioning device 33 is configured to receive and position a mounting system 35. The tongue 47 of the positioning device 33 is configured to be inserted into a receiver within an opening 53 of a temporary receiver block 54. The receiver opening is sized and configured to form an adjustment with the tongue 47, firm enough that the receiver block and the mounting structure cannot move in the BL direction in relation to the positioning device. In one embodiment, the receiving opening is sized and configured to reduce or prevent BL rotation in relation to the positioning device.
    «15 The mounting frame 40 includes rails 56 at each end of the provisional receiver block 54. Each rail includes a longitudinal section 58, which extends in the MD direction and a vertical section 60. The rails are configured to allow the block to be stapled to the teeth in the model.
    Other configurations can be used in the assembly structure to mount the receiver block and / or rotation block on the model's teeth. The assembly structure can be configured for fixation on the teeth by mechanical means (such as fasteners, adhesives, clamps, suction, and friction), ionic, chemical, or other means mentioned above, understood by experts in the field.
    FIG. 3 (c) illustrates an assembly structure 35 after placing the provisional receiver block with a selected rotation block 37. As shown in FIG, 4, the “kit” includes a number of rotation blocks and blocks
    7 provisional receivers, each with openings - guides and receiving openings, respectively, with predetermined angles. The term “predetermined angle” means that the opening has a fixed path angle.
    In one embodiment, the group of rotation blocks includes blocks that have diameters different from the guide openings, with each group having MD angles of about 0º, about 3º, and about 7º. The groups of the rotation blocks have different size guide openings. In one embodiment, the diameters of the guide openings are about 4.1 mm, about 5.05 mm and about 6.25 mm. In one embodiment, the sizes of the guide openings correspond to the standard sizes provided by manufacturers of - 15 common implants, such as Nobel Biocare from Zurich, Switzerland, Biomet 3i from Warsaw, Indiana and Straumann from Basel, Switzerland. Other suitable groups can be provided.
    Examples of mounting structure 40, temporary receiver blocks 54, and rotation blocks 37 are formed of non-reactive polymers. An example of positioning device 33 is formed from a non-reactive metal, such as titanium, stainless steel, or gold. Suitable materials for these and other components of the guide system include, but are not limited to, metallic materials, ceramics and stereolithographic material. In several modalities, the assembly structure is injection molded plastic. It is concluded that several components of the surgical guide can be optionally coated or treated for a predetermined biological response. For example, components can be treated with a training agent
    'thrombogenic or platelet formation to promote a. faster healing. The components can also be treated to reduce unwanted biological responses and risk of infection. The receiver and / or rotation block can be fixed to the assembly structure using mechanical, ionic, or other means, as understood by experts in the field from what has been said previously.
    The method of preparing the surgical guide system for flap-lingual (BL) and mesio-distal (MD) positioning of a dental implant, according to the present invention, will be described with reference to FIGS. 5-28. The preparation of the surgical chia system requires the determination of an Ú site of the dental arch to receive an implant. In several * 15 modalities, the method includes creating a model of the impression of the patient's mouth. A physical model can be used to plan and subsequently assemble the surgical guide. The model is manufactured from an ACCUTRACº base supplied by Coltene / Whaledent Inc. of Cuyahoga Falls, Ohio. Alternatively, a plaster model can be made.
    Conventional techniques, such as drilling, can be used to determine the overall contour of the arch in relation to the teeth. Once the base model is prepared, measurements of the soft tissue depth can be transferred to the plaster model, and the model is reduced in this way. For example, the model can be cut along a BL plane through the edentulous area and a contour 61 can be provided in model 46, as shown in FIG. 5. Reference points are drawn on the model
    : corresponding to the region of the dental arch and depth - of the soft tissues. “Reference points” refer to lines, points and other items. It can be understood that other techniques can be used to demarcate the region of the dental arch in the model.
    In several ways, the reference points influence the final location of the guide system in the BL plane. The clinician uses the model to determine exactly where the implant should be positioned in the arch. A BL axis line is marked on the model to show where the implant should be positioned based on the arch and the location of the soft tissues. As will be described below, in several modalities, the clinician establishes the reference points for preparing the surgical guide. Since each step in the - 15 process stipulates the reference points, the final surgical guide probably does not need to be readjusted, which could lead to error. In several modalities, the surgical guide is prepared without using reference points on the model. Other techniques can be used to determine the desired location for the implant.
    After determining the desired implant location and creating reference points in the model, a hole for pivot 63 is drilled in the model based on the optional reference points, as shown in FIG. 5. The pivot hole is made in the arcade region or adjacent and defines a BL point of the pivot. In several modalities, The pivot hole corresponds to the location of the upper part of the implant that will be implanted. An example of a pivot orifice is positioned along the axis of the BL position extending through the arch (best seen in FIG.6).
    'In several modalities, the point of the pivot BL is located: adjacent to the upper portion of the arch and aligned with a lower portion of the crown of one or more adjacent teeth. The pin 49 of the positioning device 33 is inserted into the hole of the pivot 63 to rotatively attach the positioning device to the model, as shown in FIG. 7. The positioning device is moved in the BL direction until the pivot pin is fixed to the hole. The pivot pin secures the positioning device to the BL plane, but allows BL rotation. Then, the BL position is fixed initially and then the BL rotation can be adjusted. In one embodiment, the position of the positioning device in the model determines the resulting Ú BL position and the BL angle of the implant. This positioning device - «15 remains horizontally against the cut surface of the model, thus providing a preliminary positioning of the MD angle.
    With reference to FIG. 7, the position of the pivot orifice 63 determines the height z of the positioning device, which in turn determines the height of the implant in relation to the upper part of the dental arch crest. Therefore, it can be important to accurately position the pivot hole in the BL position and the z height in the model to avoid further adjustments to the patient's mouth. In several embodiments, the height of the pivot hole is slightly above, aligned, or slightly below the upper crest of the dental arch. In addition to the position of the external contours of the arch, the BL pivot hole. it can also be determined based on the location of the nerves in the dental arch. The lower arch presents a nervous channel protecting a
    . great nerve. When implanting a device in the lower arch, it may be important to determine the position that does not interfere with the nerve canal.
    Because positioning is performed on a model, the orifice location can be changed until the desired position is discovered without affecting the patient. The model and reference points allow the user to easily determine if the positioning device is in the desired position. Other methods according to the present invention can be used to guide the positioning device to the desired BL position and height z. For example, a gap or gap can be provided for adjustable translation in the BL position, height z or both. The 'slot can be configured with the teeth or according to - 15 other aspects to provide travel and fine adjustment.
    After attaching the positioning device 33 to the model, the EL angle is adjusted. The BL angle is adjusted by rotating the positioning device around the BL axis of the pivot, defined by its pin. Although this modality includes a pin / hole configuration, other configurations can be used to allow the fixation of the BL position and the subsequent BL rotation in the model.
    The model can be used together with indicators and the like to assist in placing the positioning device. For example, a guide device can be used to allow the user to determine the angle of the positioning device in relation to the z axis. In various modes, the user creates indicator openings at measured rotational angles to assist in adjusting the BL angle.
    'In several modalities, the BL axis of the pivot corresponds to. desired position of the top of the implant to be positioned. The positioning device is rotated so that it aligns with the BL reference line on the model. The BL reference line is designed by the user and represents a desired trajectory of the implant or EL axis in the dental arch. In several modalities, the BL axis is determined based on the center of the dental arch region. In several modalities, the BL axis is selected in the thickest (that is, deep) part of the dental arch. The BL axis can also be based on the position of adjacent teeth and / or other factors.
    Examples of positioning devices 33 include 'slots 51. In various embodiments, the slot promotes visual alignment of the positioning device with the BL reference line. As shown in FIGS. 7 and 8, the positioning device can be rotated until the reference line BL in the model is visible through the slot.
    After proper alignment of the alignment device with the dental arch on the model, it is optionally fixed so that the BL position and the BL angle cannot be changed. In other words, the positioning device is fixed in a two-dimensional (2D) plane defined by the model's cutting plane. The positioning device can be fixed in place using orthodontic glue and the like (shown in FIG. 9).
    With respect to FIGS. 11 and 12, the model is reproduced as a positioning device on site. With model
    'reproduced, a user can check whether the BL and O position. angle of the positioning device in relation to the arch are adequate. The process can be repeated if adjustments are necessary.
    With respect to FIGS. 13 and 14, the mounting system 35 including the provisional receiver block 54 is positioned over the positioning device 33. The tongue 47 is inserted into the receiving opening 53 of the receiver block
    54. The positioning device and the receiving block are fixed so that the BL position of the receiving block is based on the BL position and angle of the positioning device. The mounting frame 40 is connected to the receiver block for temporary support. The rails 56 of the mounting frame can be reduced and adjusted, if necessary, to accommodate the mounting frame on the teeth (see, for example, FIG. 14). Therefore, it can be understood that the positioning device acts as an intermediate tool to determine a position of the surgical guide set in the BL plane.
    In the following, and with reference to FIGS. 15-18, the assembly set is adjusted in the MD direction while it is fixed in the BL position by the positioning device. As shown in FIGS. 16-18, the mounting frame 40 and Receiver block 54 can be rotated in the MD direction and rotated about the MD axis, while being held in the positioning device. Alternatively, the positioning device and / or receiver block can be configured to allow adjustment of only one translation and rotation at a time. In one embodiment, the mounting system is rotated until it remains aligned
    'between adjacent teeth and the edentulous area.
    . The mounting system is then rotated to a desired MD angle around the MD axis extending through the receiving opening 53 of the receiver block (see, for example, FIGS. 16-18). Adjusting the MD angle can be aided by using reference points on the model. In several modalities, the assembly structure is configured to assist in MD alignment. In one example, the rails of the mounting frame extend at angles of the receiving block, so that the user can visually determine the angle of the mounting frame in the occlusal plane.
    In various embodiments, the MD axis of the pivot is generally U co-extensive with the provisional receiver block and with the upper 15 portion of the positioning device. As noted above, the upper portion 42 of the positioning device provided the MD axis of the pivot of the mounting system. The mounting frame is rotated about the MD axis of the pivot while the BL position and angle are fixed. Therefore, a user only has to worry about adjusting in one direction at a time. In several embodiments, slot 51 is configured to define the MD axis of the pivot of the receiver block. The slot is configured to allow the positioning device to slide up and down in the z direction, meaning the apical-coronal (AC) direction. In various embodiments, the receiving opening 53 is a groove to allow MD translation of the mounting structure with respect to the positioning device. With respect again to FIGS., 19-21, since the
    37/59 z -.
    and the dental arch. The axis of rotation of the guide opening in the rotation block is smaller compared to conventional guide devices. This tends to increase the accuracy of the orientation process because the rotation of the guide opening results in a relatively minimal translation in the BL and MD positions.
    The assembly structure 40, the matrix 39 and the selected rotation block 37 together form the surgical guide system 30. The surgical guide system is ready to be transferred to the patient. As described above, the matrix and mounting frame are configured to accurately transfer the position of the model to the patient's dental arch. The mounting frame is removed from the model and the guide is transferred to the patient's dental arch. : The patient's dental arch must be correlated to the model used previously; however, variations can occur. Therefore, it may be necessary to make some adjustments. In this case, the rotation block can be replaced with a new rotation block, while the matrix and the assembly structure are positioned in the edentulous area of the patient's dental arch. In several modalities, the The guiding system is configured to allow fine adjustment of the rotation block. In one example, the rotation block allows adjustment of one or more BL positions, MD position, BL angle, MD angle, and z height of the rotation block through a narrow range of motion. In some cases, it may be necessary to adjust the position of the mounting system after selecting the rotation block. It will be considered from what was said earlier, that a user can adjust the w. 38/59
    And it's dimensions and configuration of the assembly structure - for example, by cutting, scraping, compensation, and the like - for fine adjustment of the position of the assembly structure. The mounting structure can also be configured to allow for traditional fine adjustments, for example, by including a slot for MD translation of the rotation block. The final position is configured by fixing the mounting structure in position using adhesives, fasteners or similar methods.
    A radiographic replica of the implant (RIR) can optionally be used after any of the steps above to check the alignment and orientation of the guide system (see, for example, FIG.31). The RIR acts as a visual marker on a CT or X-ray scanner.
    In summary, the method for preparing the guide system described above starts with a model representing a patient's dental arch, and continues with the preparation of a guide system for orienting the implant in the patient's dental arch. The model is used to determine the relative positions of teeth, arch and tissue depth. A positioning device is aligned with a path for the dental implant, and determines the BL position, the z height and the BL angle. A mounting frame system is precisely attached to the positioning device via. of a receiver block, in such a way that the BL position, the height z and the angle BL are transferred, in general, from the positioning device to the mounting system. The MD position and MD angle of the guide opening for receiving the dental implant are then adjusted by the movement and rotation of the mounting system.
    'a connecting section covering the central portion of the area | edentate and the positioning device, allowing significant access to the edentulous area. The receiver block 37 is then connected to the mounting frame 40 of the mounting system 35. Because the matrix 39 securely supports the mounting frame 40, the rotation block 37 can be attached and removed from the mounting frame without affecting or impairing the orientation of the assembly structure with respect to the matrix or the teeth. As described above, in several modalities, the rotation block has a guide opening with a predetermined MD angle. A series of rotation blocks with different MD angles are provided, so that the user can try different blocks until they find an appropriate - 15. The series of rotation blocks can also be supplied with different BL angles; however, the adjustment of the positioning device on the model, e.g. .. transferring the information to the assembly system, as described above, will generally prevent or reduce the need for further adjustment to the BL position or angle at this stage.
    The desired location of the implant and the associated guide path can be determined as they are understood by those skilled in the art, from the description of the present invention. In several modalities, the guide opening and / or receiving opening are compensated by a predetermined distance from a center of the respective block. In several modalities, the desired location of the implant is completely inserted into the arch, so that the bone fully surrounds the implant. In others
    In words, the implant is covered by bone. In various ways, the desired location of the implant is based on an insertion depth of about 5 mm or more. In several modalities, the desired implant location is based on obtaining one or more of the following criteria:. about 1.5 mm from the implant to the adjacent tooth, about 3 mm between the adjacent implants and about 1 mm from the implant to the lateral surface of the arch. The position of the implant can be important to obtain mechanical stability and / or a desired biological reaction.
    The use of a rotational block with fixed positions provides quantifiable positional information. Therefore, the user will always know the last position, and can] return to the previous position if desired. This too - 15 allows the user to move gradually. The rotational block and the guide system, according to the invention, also allow the user to adjust the alignment only in the desired MD direction, while keeping the alignment fixed in all other directions.
    As shown in FIGS. 24, 25, 26 and 27, a drill bit or guide device is inserted through the selected rotation block while it is mounted on the model to determine if the quia is in the desired position. If the user wishes to change the MD angle, a new rotation block can be fixed in place on the assembly frame.
    In one embodiment, each rotation block has a unique MD position to allow easy adjustment of the MD position. The series of rotation blocks includes blocks with MD angles of about 0, about 3 and about 7 °, as shown in FIGS. 26, 27 and 28, respectively. The
    The rotation blocks are also configured to be "rotated (for example, with 180º rotation in relation to the vertical axis) and fixed to the structure so that angles of about -3º and about -7º can also be obtained.
    The rotation block and the mounting structure can be modified to increase or decrease the possibilities of adjustment and precision. For example, it may be desirable to allow fine adjustment of the MD angle. In several embodiments, the rotation block includes a guide opening configured to allow controllable adjustments in one or more directions for refinement.
    Although the installation of the rotation block is described in the model, it will be considered that the replacement of the provisional receiver block with a selected rotation block - 15 can be performed after the transfer of the guide system to the patient's dental arch. The assembly structure includes a quick fixer for the user to provide tactile feedback, confirming that the rotation block is fixed in place, thereby reducing the risk of any part falling into the patient's mouth. After selecting a rotation block, the chia 30 system (including mounting structure 40 and rotation block 37) with matrix 39 is transferred from the model to the patient's dental arch. The rotation block is generally connected to the mounting frame 40 at or near the point of the pivot BL of the mounting frame (corresponding to the opening of the pivot BL 63). As illustrated in the figures and described above, the mounting structure is placed on the external surface of the teeth, which allows the rotation block 37 to be mounted in the edentated area, above or adjacent
    AN— 37/59: dental arch. The point of rotation axis of the guide opening t in the rotation block is smaller compared to conventional guide devices. This tends to increase the accuracy of the orientation process because the rotation of the guide opening results in a relatively minimal translation in the BL and MD positions.
    The mounting frame 40, the matrix 39 and the selected rotation block 37 together form The surgical guide system 30. The surgical guide system is ready to be transferred to the patient. As described above, the matrix and the mounting frame are configured to accurately transfer the model position to the patient's dental arch, The mounting frame is removed from the model and the guide is transferred to the * 15 patient's dental arch. .
    The patient's dental arch must be correlated to the model used previously; however, variations can occur. Therefore, it may be necessary to make some adjustments. In this case, the rotation block can be replaced with a new rotation block, while the matrix and the assembly structure are positioned in the edentulous area of the patient's dental arch. In several ways, the guide system is configured to allow fine adjustment of the rotation block. In one example, the rotation block allows adjustment of one or more BL positions, MD position, BL angle, MD angle, and z length of the rotation block through a narrow range of motion. In some cases, it may be necessary to adjust the position of the mounting system after selecting the rotation block. It will be considered from what has been said previously, that a user can
    PP 38/59 c adjust the dimensions and configuration of the mounting frame - for example, by cutting, scraping, compensation, and the like - for fine adjustment of the position of the mounting frame. The mounting structure can also be configured to allow for traditional fine adjustments, for example, by including a slot for MD translation of the rotation block. The final position is configured by fixing the mounting structure in position using adhesives, fasteners or similar methods.
    A radiographic replica of the implant (RIR) can optionally be used after any of the steps above to check the alignment and orientation of the quia system (see, for example, FIG.31). The RIR acts as a visual marker in a CT or X-ray scanner.
    , 15 In summary, the method for preparing the quia system described above starts with a model representing a patient's dental arch, and continues with the preparation of a guide system for orienting the implant in the patient's dental arch. The model is used to determine the relative positions of teeth, arch and tissue depth. A positioning device is aligned with a path for the dental implant, and determines the BL position, The length 2 € The BL angle. A mounting frame system is precisely attached to the positioning device via a receiver block, such that the BL position, the length z AND the angle BL are transferred, in general, from the positioning device to the mounting system . The MD position and the MD angle of the guide opening for receiving the dental implant are then adjusted by the movement and rotation of the mounting system.
    : about an upper portion of the positioning device.
    The BL and MD stroke settings are then configured by creating a matrix to hold the mounting system in place.
    The receiver block is then replaced with a rotation block that has a selected path angle for fine adjustment of the MD and / or BL angle.
    The resulting assembly system and the matrix express the orientation information and allow the transfer to a dental arch corresponding to the model.
    The matrix allows easy removal of the model and placement in a precise position in the patient's mouth.
    Optional fine adjustments can then be made to obtain a more accurate surgical guide orientation. 'The use of the exemplary surgical guide system 30,' 15 according to the present invention, can be described.
    Returning to figures 34-36, the surgical guide system is positioned on the patient's dental arch.
    The guide system includes the rotation block 37 with the guide opening 44. The surgical guide system is certified in the patient's mouth so that the guide is fixed in relation to the dental arch.
    The guide system is attached to the edentulous area so that the rotation block and the guide are positioned immediately above the dental arch and tissue.
    In one embodiment, the site is prepared prior to connecting the surgical guide as will be understood by those skilled in the art from the description of the present invention.
    Preparations can include drilling a hole in the tissue and moving the soft tissue away from the desired location (as shown in FIG. 35). The exemplified guide includes a 5.05 mm opening
    . diameter.
    A drill bit 65 is inserted through the opening »of the guide 44 of the rotation block and directed to the dental arch.
    A user then activates the drill to create an opening in the arch to receive the implant while the drill is held in position by the guide system.
    The guide is rigid enough to maintain the drill's path in the arcade during the drilling operation.
    The drill is then removed from the drill guide.
    In some cases, the guiding system is removed from the patient's mouth, and healing of the arch and surrounding tissue is expected.
    Alternatively, it may be desirable to place the implant on the same day as the osteotomy.
    The guide system is positioned again on the dental arch.
    The implant (abutment) is inserted through the guide - 15 44. If the implant is smaller than the opening of the guide 44, an adhesive or other material can be used to fix the implant to the guide.
    As the orientation of the guide opening 44 was maintained at each stage of the process, the implant will be easily directed into the opening created in the arch.
    This reduces the risk of the implant being delivered away from the opening in the dental arch.
    FIG. 37 is an X-ray of a dental arch after using the guiding system as previously described.
    The x-ray illustrates the placement of an implant 67, also called an abutment, in a patient's dental arch.
    The implant can be formed from a variety of materials including, but not limited to, titanium, surgical steel and gold.
    The upper part of the inserted implant is aligned with the upper part of the arch and slightly below
    * 7 s + - 46/59 z: and the guide system with or without the rotation block. In other words, such a computerized model can be used in place of any or all of the physical steps described above, using the digital model, such as the initial alignment of the assembly guide to the 46c model.
    With respect to FIGS. 44-47, another guide system 30d similar to the guide system 33a and 33c is known. The guide system 30d includes a guide for insertion 75 produced based on the computerized planning process. The insertion guide corresponds to the rotation block 37 except that the insertion guide 75 is an ordered part. Adjustments are made on the computer so that the product of the final guide system does not require further adjustment. The guide system, however, can optionally be configured to allow fine adjustments.
    The insertion guide is configured to connect to the rails or matrix 39 (shown in FIG. 23). The insertion guide 75 is dimensioned to extend through the rail space 56 to the rail 56. The insertion guide includes a guide opening 44d which corresponds to the guide opening 44 of the rotation block 37.
    The planning and manufacture of the guide for insertion 175 and guide system 30d are elaborated in the same way as the The guide system 30 described previously. A physical plaster model or virtual model is built based on the patient's dental arch. The BL position and angle, height z for the final guide system are determined using positioning device 33, freehand positioning, or computerized techniques.
    “. pain TREO 47/59 2 * 2 Next, the mounting frame 40 is positioned on the model. The general information BL and the height z of the guide for insertion are determined from the position of the mounting frame on the model.
    After placing the assembly structure in position, the user produces a 39d vacuum matrix for the model. The matrix is cut to offer space in the edentulous area for the eventual guide system.
    Next, the tracks 56 (shown in FIG. 23) are fixed to the matrix 39d to form a provisional guide system 30d in the model 46d. The insertion guide 75 is attached to the matrix to complete the provisional guide system, in the same way as the system shown in FIG. 13. A user then establishes the position and angle MD using the provisional guide system in a similar way as described above and shown in FIGS. 15-22. After positioning, the guide system is fixed to the model using an adhesive or other means. However, unlike the guide system 30, after assembling the matrix, most of the planning process for the guide system 30d is performed on a computer. As will be considered from the discussion below, the BL positioning of the matrix does not need to be as precise with the described technique, because other adjustments can be easily performed on the computer. In addition, the depth of the tissue does not need to be determined using the computerized technique, because the depth of the bone and tissue can be accurately determined from the computerized image. The following planning process involves linking
    'It will be considered that the planning and preparation of the guide system can be carried out in another way. In various embodiments, a CAD model 46c is used in place of a physical plaster model 46. With reference to FIGS. 38-43, a method of preparing a surgical guide together with a computerized system and the device of the present invention is demonstrated. Numbers were used to describe the components of the guide system.
    The model 46c is prepared in several ways and used in the same way as the model 46 to form the guide system. The patient's mouth is inspected and mapped on a computer. The computer processes specialized software that allows the user to view bi (2D). and three-dimensional (3D) of the mouth and teeth. Various software options are available that offer a variety of 'aspects for implant planning. An example of such a software application is NobelProcera ", sold by Nobel Biocare of Zurich, Switzerland. It will be understood from the description that the software application can be used in accordance with the present invention.
    In various modalities, all the steps described above from the creation of the model to the alignment of the assembly guide in the BL and MD plans are performed on a computer in the same way as in the method based on the physical model described above. The software can be loaded with data representing the various guide components, so that positioning and alignment of the positioning device and mounting system can be performed virtually using the CAD model. Model 46c is used to determine the region of the edentulous area and
    = in virtual space. For example, the mounting system and insertion guide can be modeled on the computer.
    the computer is preloaded with data related to the insertion guide, so that the insertion can be superimposed on the 3D model representing the patient's mouth. Based on information about the insertion and the matrix, the software can accurately determine the position of the insertion based on the location of the radiographic material in the insertion. The position of the matrix in the teeth can then be obtained from the insertion position information.
    Once the computer model has been designed with the insertion guide, the implant planning phase can be continued. A virtual guide opening is created in the computerized model of the guide for insertion. the positioning of the insertion guide 75 is carried out in a manner similar to the process described above. Although position, angle BL and height z are largely fixed at this stage, minor adjustments can be made if necessary. In various embodiments, the desired implant site is at an insertion length of about 5 mm or more. With the guide for insertion exemplified, the desired location of the implant is about 9 mm below the opening of the guide. The system includes computerized memory to store information related to the surgical guide and its position at various stages of the process.
    After determining the final position for the insertion guide 75, the final product of the insertion guide can be manufactured. The insertion guide can easily be manufactured using Computerized data. The insertion guide 75 is manufactured by stereolithography. Others
    —— AA TO 45/59 * After finalizing the positioning, a matrix and virtual 39c for fixing the guide system in position is mapped on the digital model.
    A guide system is then 'built from the model data.
    In various modalities, the software and / or applications create a data file (for example, an STL or DWG file extension) generates a three-dimensional (3D) object, in which a computer-created model (CAM) can be produced.
    The computerized data can then be used to produce the physical guide system 30c and matrix 39c, using conventional forms of manufacture.
    FIG. 43A illustrates a computer model containing the adjustment information.
    A physical object can then be manufactured from the computer-based model, as shown in FIG. 43B.
    In an exemplified modality, the 'physical object is produced using stereolithography.
    In the exemplified modality, the computer-based object is | the corresponding physical object includes retentive rails | 56c similar to the mounting frame 40. A block of | rotation 37c can then be positioned on the rails of | structure.
    Rotation block 37c can be selected in a similar way to rotation block 37. A user can add and remove multiple rotation blocks from a kit until the rotation block is identified and offers the desired guide path.
    Alternatively, the block | rotation can be selected or adjusted on the computer and manufactured as an ordered part, which is then placed on the mounting frame.
    It will be considered that the computerized model can be used in place of any physical stage of manufacture
    : of the guide system with or without the rotation block. In other words, such a computerized model can be used in place of any or all of the physical steps described above, using the digital model, such as the initial alignment of the assembly guide to the 46c model.
    With respect to FIGS. 44-47, another guide system 30d similar to the guide system 33a and 33c is known. The guide system 30d includes a guide for insertion 75 produced based on the computerized planning process. The insertion guide corresponds to the rotation block 37 except that the insertion guide 75 is an ordered part. Adjustments are made on the computer so that the. product of the final guide system does not require further “15 adjustments. The guide system, however, can optionally be 'configured to allow fine adjustments.
    The insertion guide is configured to connect to the rails or matrix 39 (shown in FIG. 23). The insertion chute 75 is dimensioned to extend through the space of the rail 56 to the rail 56. The insertion guide includes a guide opening 44d which corresponds to the guide opening 44 of the rotation block 37.
    The planning and manufacture of the guide for insertion 75 and guide system 30d are elaborated in the same way as the guide system 30 described previously. A physical plaster model or virtual model is built based on the patient's dental arch. The BL position and angle, the z length for the final guide system are determined using the positioning device 33, freehand positioning, or computerized techniques. THE
    It's in that copy.
    The model can be a physical model or a model based on the .computer.
    The model is a computer model.
    Next, the BL position of the guiding system is planned in a similar way to the one described above.
    In S2, an assembly system is created based on the model.
    The arcade region is determined as discussed above, and the assembly guide is positioned in relation to the arcade region and edentulous area.
    In S3, the mounting system is positioned in the desired BL position.
    The BL position is aligned with the arcade region.
    The mounting system is also positioned on the z axis at S3. In several modalities, the z-axis and the O-positioning Bl are performed simultaneously.
    In the example method, the positioned z axis is realized with the BL positioning.
    Then, in S4, the BL angle is adjusted and fixed. | In S5, the mounting system is fixed in position.
    In the example method, the BL position, the BL angle, and the z height of the mounting system are fixed by mechanical means, such as applying a dental adhesive or fixers.
    In S6, a guide for insertion is connected to a guide system forming a provisional guide system.
    The insertion guide includes a guide opening corresponding to a dental implant.
    In one embodiment, the guide for insertion is connected to the guide system before releasing the model, or, before fixing the BL position and / or height z of the mounting system.
    The insertion guide is made of a material whose image is captured with a CT or X-ray scanner.
    Will be ; it is considered that the insertion guide can be connected in a similar way to the rotation block 37.
    + In S7, the image of the surgical guide is captured in the dental arch of the. patient.
    In the example method, an X-ray of the patient's mouth is performed.
    The X-ray information is superimposed on an image of the patient's mouth on the computer, which is obtained from an X-ray or an initial tomography.
    The computerized model includes virtual objects corresponding to the guide system.
    Optional S8 includes the creation of a computer model 'based on information related to the position of the provisional system, including the guide for insertion.
    Conventional imaging technology and software can be used as will be seen from the description of the present invention.
    Optional S9 is the MD positioning of the provisional guide system.
    The MD positioning is performed entirely on the computer.
    The MD position can be determined as will be understood by experts in the field.
    However, unlike conventional techniques, the MD position can be adjusted and checked easily because it is computer based.
    In addition, because the BL position has already been configured, MD positioning can be done independently.
    Next, the MD angle is determined at s10. In step Sl11, height z, position and angle L, and position and angle MD were precisely determined.
    In optional S11, information related to height z, position and angle BL, angle MD and a combination of these is stored in the computer's memory. 'In the final step, Sl12, a physical guide system is manufactured based on the model information on the computer.
    权利要求:
    Claims (18)
    [1]
    1. Method for preparing a surgical guide for buccalingual (BL) and mesio-distal (MD) positioning of one. dental implant, CHARACTERIZED by understanding: the positioning of a positioning device in relation to a dental arch adjacent to an edentulous area in a patient's dental arch model, including: the transfer of the positioning device in a BL direction for an axis of desired BL position that is aligned with the region of the dental arch, the adjustment of a BL angle of the positioning device around a BL axis of the pivot, corresponding to a desired position of an upper portion of the dental implant to be positioned, with the BL axis of the pivot located on the BL position axis, and the fixation of the BL position and the BL angle of the positioning device in relation to the model; and the assembly of a mounting system in relation to the “model, the mounting system including a mounting frame and a provisional receiver block for receiving an upper portion of the positioning device, so that the frame has a fixed BL position and a BL angle in relation to the positioning device, with the mounting system being configured to receive the dental implant.
    [2]
    2. Method, according to claim 1, CHARACTERIZED by the fact that it also includes, before positioning the positioning device, indicating the reference points in the region of the dental arch in the
    -. : 2/5. 7 “model, where the transfer of the positioning device, in the BL direction, is performed based on the reference points.
    [3]
    3. Method, according to claim 1, CHARACTERIZED by the fact that the positioning of the positioning device around the BL axis of the pivot includes the creation of a height z of the positioning device.
    [4]
    4. Method, according to claim 1, CHARACTERIZED by the fact that the assembly comprises: transferring the assembly system in an MD direction to a desired MD position, in relation to the region of the dental arch, by adjusting a preliminary MD angle of the mounting system around the MD axis of the pivot, with the MD axis of the pivot being co-extensive with the provisional receiver block and with the upper portion of the positioning device, and fixing the mounting structure to a matrix corresponding to the model. '|
    [5]
    5. Method, according to claim 4, CHARACTERIZED by the fact that it also comprises: the installation of a rotation block in relation to the model by removing the temporary receiver block from the assembly structure, and by the removable mounting of a rotation block on the assembly structure, where the rotation block is selected from a set of rotation blocks, each including a guide opening that has a predetermined MD position and MD angle.
    [6]
    6. Method, according to claim 5, CHARACTERIZED by the fact that the upper part of the device v o 3/5 2 za of positioning defines the MD axis of the pivot, with the assembly structure being configured to rotate around the MD axis of the pivot while the BL position and the BL angle are fixed.
    [7]
    7. Method, according to claim 5, CHARACTERIZED by the fact that it also includes, after installation, the adjustment of the MD angle of the guide opening, by replacing the rotation block with another rotation block that has a different MD angle .
    [8]
    8. Method, according to claim 1, CHARACTERIZED by the fact that the BL axis of the pivot is located adjacent to an upper position of the dental arch.
    [9]
    9. Method, according to claim 1, CHARACTERIZED by the fact that the model is a CAD model and the positioning of the positioning device is performed on a computer.
    [10]
    10. Method, according to claim 1, CHARACTERIZED by the fact that the rotation block is replaced when the matrix and the assembly structure are positioned in the edentulous area of the patient's dental arch.
    [11]
    11. Surgical guide system for a dental implant procedure, CHARACTERIZED by the fact that it comprises: an assembly system including a mounting frame and a removable rotation block, with the frame | in . assembly configured to maintain a BL angle and BL position of the rotation block in relation to at least one tooth adjacent to the edentulous area, based on a dental model, with the rotation block including a guide for receiving a dental device and presenting a v 4/5% the predetermined MD position and MD angle; where the rotation block is connected to the mounting structure at a BL point of the pivot that defines the BL angle of the rotation block, with the BL point of the pivot being adjacent to an upper portion of a dental arch and corresponding to an upper portion of the implant to be implanted.
    [12]
    12. Guide system, according to claim 11, CHARACTERIZED by the fact that the predetermined MD angle is one of about 0º, about 3º and about 7º.
    [13]
    13. Guide system according to claim 11, CHARACTERIZED by the fact that it also includes a temporary receiver block interchangeable with the rotation block, the temporary receiver block being configured to receive a positioning device for positioning the mounting structure in a BL position and a BL angle in relation to the model.
    [14]
    14. Guide system according to claim 13, CHARACTERIZED in that the upper portion of the positioning device is received in the receiving block, in which the positioning device is elongated and extended in an apical direction to the receiving block to an adjacent position to a dental arch aligned with the desired path of the dental device.
    [15]
    15. Guide system according to claim 14, CHARACTERIZED by the fact that the upper portion of the positioning device includes a pivot pin to rotationally fix the positioning device to the model at point BL of the pivot.
    [16]
    16. Guide system according to claim 14,
    "and. 5/5 a: ê ss FEATURED by the fact that the rotation block comprises a slot defining an MD axis of the rotation block in relation to the positioning device, with the rotation block being configured to rotate around the MD axis of the pivot , while the BL position and the BL angle are fixed.
    [17]
    17. Guide system, according to claim 11, CHARACTERIZED by the fact of the device. positioning comprise a molded slot to promote the rotational alignment of the positioning device with a BL reference point on the model.
    [18]
    18. Method of preparing a surgical guide for buccal-lingual (BL) and mesio-distal (MD) positioning of a dental implant, CHARACTERIZED by the fact that it comprises: the assembly of an assembly system in relation to a dental arch adjacent to an edentulous area in a model of a patient's dental arch; positioning the mounting system in one position | Desired BL, which is aligned with the dental arch region and at a desired BL angle; i fixing the BL position and the BL angle of the mounting system in relation to the model; and the removable attachment of an insertion guide to the mounting system, with the BL position and BL angle of the insertion guide fixed in relation to the model by the mounting system, with the mounting system and the insertion guide forming a provisional surgical procedure, and the guide presenting an opening configured to receive the dental implant through it.
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    US9519749B2|2016-12-13|
    EP2515787A1|2012-10-31|
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    WO2011087794A1|2011-07-21|
    US20140244016A1|2014-08-28|
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    法律状态:
    2020-09-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2020-09-24| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2021-01-12| B11B| Dismissal acc. art. 36, par 1 of ipl - no reply within 90 days to fullfil the necessary requirements|
    2021-11-23| B350| Update of information on the portal [chapter 15.35 patent gazette]|
    优先权:
    申请号 | 申请日 | 专利标题
    US28931009P| true| 2009-12-22|2009-12-22|
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