Implant assistance assembly for implanting a jaw implant

p0001The invention relates to a Implantierungshilfsanordnung for implanting a jaw implant in a patient's jaw, wherein the jaw implant implanted serves for fixing a dental prosthesis to the patient's jaw, and to a method of drilling a bore implant.

p0002In the whole process, which precedes the actual implanting a Kleterimplantats, in particular the spatially accurate drilling of the implant hole in the patient's jaw is of great importance, for drilling the implant bore, therefore, templates are used which are placed on the patient's jaw and a guide bore for drilling the implant bore have in the shell duck jaw. Known Implantierungshifsanordnungen and method for producing a template for drilling an implant hole in the patient's jaw are relatively complex, imprecise, error-prone and difficult to handle.

p0003Out <patcit id="pcit0001" dnum="WO2010097405A1"><text>WO 2010/097405 A1</text></patcit> is a modular Implantierungshilfsanordnung known comprising a Kleferadapter and a separate template for drilling a final guide bore in the jaw adapter. For drilling of the implant hole in the patient's jaw, the template is removed from the jaw adapter again.

p0004Out <patcit id="pcit0002" dnum="EP2072018A1"><text>EP 2072018 A1</text></patcit> is a Impiantierungshilfsanordnung known which consists of a jaw adapter, which is formed from a plate by a CAD machine and provided with corresponding guide holes to finally stand in this way as Implantierungshilfsanordnung for drilling an implant hole available.

p0005From the subsequently <patcit id="pcit0003" dnum="EP2425796A1"><text>EP 2425796 A1</text></patcit> is a multi-part Implantierungshilfsanordnung known which comprises a jaw adapter and a separate template, wherein the jaw adapter having an access opening.

p0006Object of the invention is in contrast to provide an easy to use Implantierungshilfsanordnung for drilling the implant hole in the patient's jaw.

p0007This object is achieved by a Implantierungshilfsanordnung according to claim 1 or. 2

p0008The Implantierungshilfsanordnung invention consists of at least one set of two parts, namely a jaw adapter and a separate template.

p0009The jaw adapter has a non-visible radiographically individual molding which is adaptable or adapted to the patient's jaw. The patch on the patient's jaw Individual molding provides the patient's jaw forth a positive fit, so that the jaw adapter rests reproducible and always in the same position and orientation on the patient's jaw. The jaw adapter establishes a spatially explicit reference to the patient's jaw. The jaw adapter preferably has no prosthetic tooth.

p0010The jaw adapter has a radiologically visible coupling connector, which allows the coupling sleeve of the surgical guide a spatially reproducible positive coupling. Under a Kupplungsbuchse all components are understood to enable a spatially explicit and reproducible coupling of the drilling template to the jaw adapter. The coupling plug or said complementary coupling sleeve can be designed as a single complex component which fulfills this task, however, can also each consist of several components or elements, together exert the function of a connector or a connector socket.

p0011The jaw adapter has a radiologically visible three-dimensional 3-D marker which a spatially unique location and orientation determination of the 3-D marker or the jaw adapter allows in its three-dimensional radiological detection. The 3-D markers may be a single complex component that allows a spatially unique position and orientation- determination. However, it may also be provided a plurality of individual 3-D marker elements, which together form the 3-D markers and are formed for example as radiographically visible small spheres each having a diameter of 0.5 to about 3 mm. If the jaw adapter is placed on the patient's jaw, is a clear spatial relationship between the patient's jaw and the jaw adapter produced in this way or made radiographically visible because of the patient's jaw in particular the jawbone is also radiologically visible.

p0012In this embodiment, the 3-D markers or marker elements are provided captively or non-detachably to the jaw adapter. Alternatively, a separate marker plate is provided, which comprises the 3-D markers. The jaw adapter can have in this way the 3-D markers only temporarily, since the marker plate can be removed after the radiological detection of pine image including the jaw adapter and the marker plate of the individual form part of the jaw adapter. The marker plate has the radiologically visible three-dimensional 3-D marker of a spatially unique position and orientation determination of the 3-D marker and with it rigidly and clearly connected parts allowed in its three-dimensional radiological detection. The 3-D markers may be a single complex component that allows a spatially unique position and orientation determination. However, there may also be several individual 3-D marker elements are provided which are formed for example as radiographically visible small spheres each having a diameter of 0.5 to about 3 mm. If the marker plate coupled to the jaw adapter and the jaw adapter is placed on the patient's jaw, is a clear spatial relationship between the patient's jaw and the jaw adapter produced in this way or made radiographically visible. The marker plate has a preferred radiologically nonvisible coupling sleeve which is spatially clearly zusammenkuppelbar with the coupling plug of the jaw adapter.

p0013The separate drill guide has a guide hole for drilling the implant hole in the patient's jaw or into the jaw bone of the patient's jaw. The template includes a coupling sleeve which is coupled to the coupling plug of the jaw adapter to a clutch arrangement spatially clearly defined and together.

p0014The jaw adapter has in the region of the patient's jaw where the denture is planned, an access opening. This access opening is aligned in each case with the implant to be drilled bore, and coincides with the area of ​​the template having the guide hole. The area of ​​the template having the guide hole, closing the access opening of Kleferadapters when the template is placed on the jaw adapter. By jaw adapter access opening, it is possible to use the template directly as an implant bore template. It eliminates drilling a pilot hole in the jaw adapter using the drilling template. Through the access opening in the jaw adapter is the final stencil consisting of the jaw adapter and the drilling template, very compact, and in particular has a low height.

p0015Particularly preferably, the template projects in particular with her the guide hole having the area into the form of a paragraph in the access opening of the prosthesis plate, so that the overall height of the thus prepared implant bore template with sufficient axial length of the guide bore can be kept very low.

p0016According to a preferred embodiment of the Implantierungshilfsanordnung a prosthesis plate is provided, which comprises at least one radiographically visible prosthetic tooth and a coupling bush which is uniquely oriented zusammenkuppelbar with the coupling connector of the jaw adapter. The prosthesis plate is placed on the radiological detection of a pine image on the jaw adapter. The prosthetic tooth is radiologically visible and constitutes a planning aid during the virtual planning and construction of the dental prosthesis.

p0017Preferably, the jaw adapter can have a standardized coupling plate with the coupling plug, the clutch plate is attached to the Individualformtell after the impression of the jaw adapter on the individual molding. Also, the drill guide is preferably a standardized Bohrschablonenplatte which has the coupling plug corresponding coupling socket. The property "standardized" means in this context that the clutch plate and the Bohrschablonenplatte are mutually zusammenkuppelbar in only one and known location and orientation. Because they are linked to each other and set is known, the individual molding, the clutch plate and the Bohrschablonenplatte can be radiologically-visible formed. Further, it is hereby possible, the guide bore by means of generated in the virtual denture planning implant bore location information by a machine tool at a location remote from the treatment site location, ie at a location remote from the patient's jaw and the jaw adapter place to produce, and only after the to send production to the treatment site.

p0018Preferably, the access opening of the standard clutch plate is also standardized. The access opening is therefore already provided in the standard clutch plate, and does not have to be made manually in the clutch plate. The clutch plate can also have several standardized access openings, however, used by those for treatment or only a few will be respectively.

p0019The access openings may be preferably closed by easily removable access opening cover. Only the cover of the access opening required for the treatment is removed. All access unused openings remain closed during treatment by the cover in question. It can be opened in this way also readily standardized two adjacent access openings of the clutch plate, can be so that with a single jaw adapter for two different locations of the patient's jaw planned and each used a template. The clutch plate may comprise a single over the entire arch extending arch-opening, which is closed by a plurality of serially immediately adjacent access opening cover. To expose the access opening only the lid or are only the cover removed, the or the closing or closing the access opening required. The remaining cover manufacture required for the radiological detection of mechanical stability of the clutch plate or the jaw adapter.

p0020Preferably, the access opening cover each have a radiologically visible markers cover. This cover-markers can also form elements of the 3-D marker of the clutch plate. The lid markers have the purpose in the radiological Pine image based on the lack of cover-markers, the lid removed, and thus to make the location and the size of the access opening recognizable. The size and location of the access opening is important for the selection or the preparation of the template may, especially when the drilling template has a shoulder, which extends into the access opening.

p0021In use, the jaw adapter Individual molding is first molded by the patient's jaw or a real patient jaw model, for example by means of a quick-hardening plastic. Then the coupling plug is attached to the individual molding, for example, by a standard coupling plate including the coupling plug is connected to the individual molding, for example, glued, is. The individual molding with the coupling plug or with the clutch plate forms the jaw adapter. The coupling plug had already has a standardized access opening. If the

p0022Molding the individual molding the access opening has not been released in the access opening must be it manually cut into the individual molding in the individual molding after fixing the clutch plate.

p0023Subsequently, the jaw adapter is placed on the patient's jaw. This situation is then detected radiologically in three dimensions in the form of a corresponding digital three-dimensional jaw image in three dimensions, in the pine image substantially the patient's jaw, and in this case substantially the jawbone, and the 3-D markers and possibly the denture tooth of the prosthesis plate are visible. The quality, accuracy and resolution of Kleferbildes can be further improved by further imaging.

p0024Using the thus obtained three-dimensional jaw image a virtual dental prosthesis, the jaw implant for this and the necessary for the jaw implant implant bore is at a computer designed and specified, and stored with respect to the implant hole in the form of implant bore location information.

p0025Then the implant bore location information are sent to a digitally controlled machine tool. The tool drills with the help of the implant bore location information the guide bore in the drilling template. Subsequently, the drill guide is mounted on the jaw adapter by plugging the Bohrschabfonen coupling sleeve with the jaw adapter coupling connector.

p0026Then the jaw adapter including mounted drilling template is inserted into the patient's jaw, and then the implant hole drilled into the patient's jaw in alignment with the surgical guide guide bore. Think of the jaw adapter with the drilling template provided already directly represents the implant bore template.

p0027As an interim step before planning the denture, a denture plate are placed on the patient's jaw, the denture plate having a radiologically visible prosthetic tooth. The visible in the maxillary denture tooth image is a planning aid, especially in the planning of the dental prosthesis.

p0028In the following, two embodiments of the invention will be explained in more detail with reference to the drawings.

p0029Show it:<ul><li><figref idrefs="f0001">figure 1</figref> a sagittal plane section of a first embodiment of a Implantierungshilfsanordnung which is formed by a jaw adapter, a drill and a denture plate,</li><li><figref idrefs="f0002">figure 2</figref> a plan view of the patch on the patient's jaw jaw adapter Implantierungshilfsanordnung the <figref idrefs="f0001">figure 1</figref>.</li><li><figref idrefs="f0003">figure 3</figref> a sagittal plane section of a second embodiment of a Implantierungshilfsanordnung which is formed by a jaw adapter, a drill, a marker board and a denture plate, and</li><li><figref idrefs="f0004">figure 4</figref> a plan view of the patch on the patient's jaw jaw adapter Implantierungshilfsanordnung the <figref idrefs="f0003">figure 3</figref>,</li></ul>

p0030In the <figref idrefs="f0001">figure 1</figref> is a Impiantierungshiffsanordnung 10 which is essentially formed by a jaw adapter 22 and a separate template 34th Additionally, but not the Implantierungshilfsanordnung a prosthesis plate must still have 10 60th Further, in the<figref idrefs="f0001">figure 1</figref> a patient's jaw 12 shown having a jawbone 18, gum 20 and not be replaced, so "healthy" teeth 14,15,16. Further, on the patient's jaw 12 virtual denture 61 '62' 63 'indicated.

p0031The jaw adapter 22 consists of a radiologically-visible individual molding 24 and an attached, for example bonded, standardized and radiologically-visible hitch plate 26 with a plurality of coupling plugs 28. The jaw adapter 22 is made ​​by first the individual molding 24 of the patient's jaw 12 or real model of the patient's jaw 12 by means of a quick-hardening plastic abgefo is rmt. Here, the access opening 46 of the individual molding is possible, already provided for, that is, it is recessed in the molding of the area in which the dental prosthesis 61 ', 62', 63 'or the implant bores 51, are planned 52.53.

p0032After the material sets the Individual form part 24 of the patient's jaw 12 and the real model can be removed therefrom, and is the standard clutch plate 26 bonded to the individual molding 24th

p0033The clutch plate 26 has a plurality of 3-D marker elements 36 in the form of radiographically visible metal balls, are poured into the plastic body and the clutch plate have a diameter of about 1.0 mm. All marker elements together form a 3-D marker 36th

p0034The jaw adapter 22 is provided with an access opening 40 in the area in which the dental prosthesis, and therefore the implant holes 51,52,53 are provided in the patient's jaw 12, see <figref idrefs="f0002">figure 2</figref>, The access opening 40 can as a standardized, prefabricated thus, be provided in the coupling plate 26 access opening. In order to provide an appropriate standardized coupling plate including standardized access openings available for the patient's jaw different sizes and shapes and for different implant areas of the patient's jaw, the dentist can 40 provided a full set of clutch plates of different sizes and shapes, as well as arranged at different positions standardized access openings available will.

p0035However, in order to keep the size of a clutch plate set as low as possible, each clutch plate 26 in its coupling plate body 82 a in plan view approximately U-shaped opening 80 which extends over the entire arch. The clutch plate opening 80 is closed by a plurality of serially concatenated cover 70-79, which are connected for example the material diluted predetermined breaking points 84 or force elements together and to the body Kuppfungsplatten 82nd The required access opening 40 of the clutch plate 22 is prepared by removing the lid or of the relevant 77th Each cover 70-79 each has a radiologically visible cover marker 38th

p0036If in the preparation of individual piece 24 of the area of ​​the dental prosthesis 61 ', 62', 63 'or the implant bores 51, 52,53 could not be cut out, this portion of the individual piece 24 must be removed manually. Also, the individual mold part 24 thus has in the region of the implant bores 51,52,53, an access opening 46, 26 is aligned with the respective access opening 40 of the clutch plate.

p0037Optionally, an intermediate step may be provided before the radiological detection, namely the use of the prosthesis plate 60, the plurality of prosthetic teeth 61,62,63 having on the prosthesis plate body 66 as a planning aid that are radiologically visible. The prosthesis plate 60 is placed on the jaw adapter 22, and only the combination of the prosthesis plate 60 and jaw adapter 22 is placed on the radiological detection of the patient's jaw 12th

p0038Basically, the use of the prosthesis plate 60 may be omitted, however, for example, and in particular if the to be replaced by dentures original teeth are still in the patient's jaw 12 in the radiological detection of pine image. In the prosthesis plate 60 may also be dispensed with if the virtual denture 61 ', 62', 63 'solely by means of the Pine image are designed on a computer, and the virtual denture 61', 62 ', 63', for example, obtained from a virtual library will.

p0039The jaw adapter 22, which is optionally supplemented with the denture plate 60 is placed on the patient's jaw 12 to radiological detection. Subsequently, the patient's jaw is 12 detected radiologically in three dimensions with the mounted jaw adapter 22 and possibly the attached prosthesis plate 60 by means of a DVT device. Optionally additional imaging techniques can be used in addition to create the resulting jaw image with higher redundancy, resolution and accuracy. In the radiologically detected in this way three-dimensional jaw image are of the jaw adapter 22 in particular, the 3-D marker elements 36, the cover-markers 38 and possibly the denture teeth 61-63, and of the patient's jaw 12 in particular the jawbone 18 and the teeth 14-16 to see.

p0040After acquiring the three-dimensional image Kiefer virtual denture 61 ', 62', 63 'and the associated jaw implants are planned at a computer in the Pine tree. The virtual denture 61 ', 62', 63 'arise either from the visible into the jaw picture denture teeth 61,62,63 of the prosthesis plate 60, from the visible to the Pine tree still existing and to replace original teeth or virtual three-dimensional dental images from an appropriate library.

p0041Especially when planning the computer each, the position and orientation of the jaw implants in relation to the patient's jaw 12 are determined. Here, also the location information of the associated implant holes 51,52,53 in the patient's jaw 12 respectively in the jawbone 18 are defined or determined and stored. Furthermore, the position of the access opening 40 is known based on the missing in the jaw picture cover marker of distant cover 78th

p0042The implant bore location information and the location of the access opening 40 is then sent to the place to be drilled at the appropriate using the implant bore location information management holes 41,42,43 in the drilling template 34 by a digitally controlled drill. The template 34 is essentially formed by a full-area plastic body 35, the coupling bushes 30 has on its jaw adapter 22 facing side, by means of which a positive coupling with the coupling plugs 28 of the jaw adapter 42 can be produced.

p0043The guide holes 41,42,43 are drilled in such a way in the drilling template, 34, that these are aligned with the planned implant holes 51,52,53 when the surgical guide 34 mounted on the jaw adapter 22 and the jaw adapter 22 would be placed on the patient's jaw 12th can then, however, do not have to, cylindrical metal guide sleeves 48 are inserted into the guide holes 41,42,43.

p0044Then the dimensions are 34 attached to the guide holes 41,42,43 in the Bohrschabfonen body 35 on the jaw adapter 22, and this assembly is placed on the patient's jaw 12th

p0045Then the implant holes are with a drill 70 manually 51,52,53 drilled in alignment with the jaw adapter guide holes 41,42,43 in the patient's jaw 12 or into the jawbone 18, and the jaw adapter 22 eventually removed from the patient's jaw 12th Then the jaw implants can be screwed into the implant inserted holes 51,52,53, for example.

p0046The surgical guide 34 may extend into the access opening 40 of the jaw adapter 22 toward patient's jaw 12 with a shoulder 32 in particular with their guide bores 41,42,43 having area so that together coupled combination of the jaw adapter 22 and the template 34 is very compact , The paragraph 32 may be standardized so that it form-fitting fits into the standardized recess 40 of the coupling plate 26th The appropriate template 34 is chosen from a set of standardized drill guides that the standardized paragraph 32 corresponding to the access opening 40th

p0047In an alternative embodiment, the coupling plate on several standardized size and position separate openings 34 fit in the paragraphs 32 of the surgical guide, form-fitting. In this way, the recesses 40 coupling bushes and paragraphs can make 32 Coupling plugs, which make separate coupling sockets and coupling plug expendable.

p0048In the <figref idrefs="f0003">figures 3</figref> and <figref idrefs="f0004">4</figref> is a second embodiment of a Impfantierungshiffsanordnung 10 'shown by a relative to the first embodiment of simplified pine adapter 90, a separate marker plate 96, a prosthesis plate 60 substantially' is formed and a drilling template 34 '. The reference numerals of corresponding with the first embodiment, parts are optionally provided with an apostrophe ( ').

p0049In contrast to the first embodiment 'of the second embodiment, the separate marker plate is provided in addition 96, in which the jaw adapter 90 is simplified in that the 3-D marker elements 36' is in the Implantierungshilfsanordnung 10 are not provided in captive fashion on the jaw adapter, but only on the separate and removable from the jaw adapter 90 marker plate 96th

p0050The marker plate 96 is placed exclusively for radiological imaging of the jaw adapter body 91, and is removed again after the radiological imaging of the jaw adapter body 94th For the unique spatial arrangement of marker plate 96 to the jaw adapter 90, the marker plate corresponding coupling bushings 96 30 'on which the coupling plugs 28' of the jaw corresponding adapter 90th

p0051The jaw adapter 90 has an access opening 94 in the area in which the dental prosthesis and the implant holes 51,52,53 are provided in the patient's jaw 12, see <figref idrefs="f0003">figure 3</figref>, The jaw adapter 90 is presently shown as a single body 91, but may also be composed of a Individualforimteil and a standardized coupling plate, as shown in the first embodiment,