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WO2019151923A1 - Method for manufacture of a jaw customized guide, system for aiding mounting of tooth implants, jaw customized guide, a radiopaque marker element and software for determining data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants - Google Patents

Method for manufacture of a jaw customized guide, system for aiding mounting of tooth implants, jaw customized guide, a radiopaque marker element and software for determining data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants Download PDF

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Publication number
WO2019151923A1
WO2019151923A1 PCT/SE2019/050045 SE2019050045W WO2019151923A1 WO 2019151923 A1 WO2019151923 A1 WO 2019151923A1 SE 2019050045 W SE2019050045 W SE 2019050045W WO 2019151923 A1 WO2019151923 A1 WO 2019151923A1
Authority
WO
WIPO (PCT)
Prior art keywords
jaw
radiopaque marker
radiopaque
marker element
surface scanning
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/SE2019/050045
Other languages
French (fr)
Inventor
Staffan SÖDERSTRÖM
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to EP19748267.2A priority Critical patent/EP3745996A4/en
Publication of WO2019151923A1 publication Critical patent/WO2019151923A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/51—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for dentistry
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/08—Machine parts specially adapted for dentistry
    • A61C1/082—Positioning or guiding, e.g. of drills
    • A61C1/084—Positioning or guiding, e.g. of drills of implanting tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5235—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5247—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0004—Computer-assisted sizing or machining of dental prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C9/00—Impression cups, i.e. impression trays; Impression methods
    • A61C9/004—Means or methods for taking digitized impressions
    • A61C9/0046—Data acquisition means or methods
    • A61C9/0053—Optical means or methods, e.g. scanning the teeth by a laser or light beam
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y10/00—Processes of additive manufacturing
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y50/00—Data acquisition or data processing for additive manufacturing
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y80/00—Products made by additive manufacturing
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N23/00—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00
    • G01N23/02—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00 by transmitting the radiation through the material
    • G01N23/06—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00 by transmitting the radiation through the material and measuring the absorption
    • G01N23/083—Investigating or analysing materials by the use of wave or particle radiation, e.g. X-rays or neutrons, not covered by groups G01N3/00 – G01N17/00, G01N21/00 or G01N22/00 by transmitting the radiation through the material and measuring the absorption the radiation being X-rays
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing
    • G06T2207/30036—Dental; Teeth

Definitions

  • the present disclosure relates to aid for mounting of permanent tooth implants.
  • An object of the present disclosure is to provide solutions which are suitable for mounting of permanent tooth implants in toothless jaws and jaws with only a few teeth.
  • the present disclosure relates to a method for manufacture of a jaw customized guide arranged to guide mounting of permanent tooth implants in a jaw.
  • the method comprises steps of fastening at least one radiopaque marker element in a gingiva and/or the the jaw and determining data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants based on an image set comprising at least one x-ray image and a 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw.
  • the determination step is computer implemented and comprises processing the image set to identify at least three radiopaque points comprising the at least one fastened radiopaque marker element in the x-ray and 3D surface scanning image, respectively; correlating the x-ray and the 3D surface scanning images to each other based on the identified at least three radiopaque points; forming compiled information comprising information from the correlated x-ray and 3D surface scanning images; and determining the data for manufacture of the jaw customized guide based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images.
  • the solution is time effective both for dentist and patient.
  • the patient will visit the dentist for mounting the radiopaque marker elements and capturing the image set.
  • the tooth implants will be mounted with the aid of the manufactured jaw customized guide.
  • the manufactured jaw customized guide may be removably supported by the radiopaque marker elements.
  • This solution enables correlation of the x-ray and the 3D surface scanning images to each other even when there is not enough information in the images to make such correlation without the mounted radiopaque marker elements.
  • three points which are visible in both the x-ray and 3D scanning surface images are necessary in order to align the images x- ray and 3D scanning surface images to each other.
  • the mounted at least one radiopaque marker element secures that at least three different points which can be used for correlation
  • the x-ray and 3D scanning surface images can be correlated to each other (or in other words aligned) using the mounted radiopaque marker elements as the only or aiding points for making the correlation or alignment.
  • the method may be applied to a jaw with only one or a few teeth, where tooth/teeth present does not provide enough information for making the correlation/alignment.
  • the jaw has one or a plurality of teeth
  • at least one tooth in the jaw forming a radiopaque point may be identified in the x-ray and 3D surface scanning image, respectively.
  • the step of correlating the x-ray and the 3D surface scanning images to each other is also based on the identified at least one tooth.
  • the identified at least one tooth and the at least one identified radiopaque marker element together form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other.
  • At least three radiopaque marker elements are fastened in the gingiva and/or jaw and identified in the x-ray and 3D surface scanning image, respectively. No additional points for correlating/aligning the images are then necessary.
  • the method may accordingly be applied to a toothless jaw.
  • the radiopaque marker element(s) and possible remaining tooth/teeth in the jaw form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other.
  • the use of the radiopaque marker element(s) and possible remaining tooth/teeth in the jaw to form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other, provides for correlation/alignment with high accuracy.
  • the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other also have the characteristic that they extend above the gingiva.
  • the radiopaque marker element(s) and any potential tooth/teeth may in different embodiments act as supporting points for the guide.
  • the guide manufactured based on this method may be designed not to have to abut against the gingiva or mucous membrane, even if the jaw is toothless. If no teeth are present, the guide may be designed to be supported at least substantially only on the radiopaque marker elements. If teeth are present, the guide can be design to be supported also on the present tooth/teeth.
  • the gingiva When the gingiva is anesthetized in preparation for mounting the permanent tooth implants, the gingiva will characteristically swell. It is therefore advantageous that the guide, which was designed when the gingiva was in a not-swelled state, substantially only is arranged to be supported on the radiopaque marker elements and any present tooth/teeth. If the guide on the other hand is intended to be supported by the gingiva, this may cause problems. It may not be possible to correctly fit the jaw customized guide for guiding mounting of the permanent tooth implants in the mouth when the gingiva is anesthetized and swelled. However, in accordance with these embodiments, some abutment against the gingiva/mucous membrane may be considered, for example in a field around the respective radiopaque marker element.
  • the guide when the guide is substantially only supported on the radiopaque marker elements and any present tooth/teeth, this enhances the possibility of adequate irrigation. As the guide substantially is spaced apart from the gingiva/ mucous membrane, fluid is allowed to flow therebetween.
  • the step of determining the data for manufacture of the jaw customized guide comprises determining the geometry and orientation of the radiopaque marker element(s) and any present tooth/teeth and designing the guide based on the determined geometry and orientation so that the guide when mounted substantially is movable in only one direction.
  • the radiopaque marker elements and any present tooth/teeth as supports for the jaw customized guide and designing the guide based on the geometry of the radiopaque marker element(s) and any present tooth/teeth, allows for a design of the guide such that the radiopaque marker element(s) and any present tooth are fitted to the guide in a mounted state such that the guide is immobile in any other direction than a dismounting direction without use of any additional fastening elements.
  • the geometry of the jaw customized guide may be selected such that no additional fastening means for mounting are necessary while at the same time the guide is easily removable.
  • the step of determining data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants is further based on an additional 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw and wherein the additional 3D surface scanning image is captured with a removable denture positioned in place.
  • the removable denture is characteristically a removable denture presently used by the patient.
  • the additional 3D surface scanning image is aligned with the images of the image set.
  • the computer implemented determination step comprises further processing the additional 3D surface scanning image to identify the at least three radiopaque points in the additional 3D surface scanning image, and correlating the additional 3D surface scanning image to the image set based at least on the identified at least three radiopaque points.
  • the step of forming compiled information comprises forming the compiled information also from the additional surface scanning image. Further, the data for manufacture of the jaw customized guide based on the compiled information is determined based also on the additional 3D scanning image. The data for manufacture of the jaw customized guide based on the compiled information may then be determined also from information in the additional 3D surface scanning image. This includes identifying the location of the teeth of the removable denture in the additional 3D surface scanning image and to use this information as data for the data for manufacture of the jaw customized guide. This has the advantage that an indication of suitable positions of the permanent tooth implants is provided from the additional 3D surface scanning image and that the jaw customized guide may be designed accordingly.
  • the removable denture is provided with recesses arranged to accommodate the radiopaque marker elements before capturing the additional 3D surface scanning image.
  • the removable denture in relation to the positions of the radiopaque points may be accurately determined.
  • the additional 3D surface image is preferably captured while the removable denture is fitted in place without exerting pressure on the radiopaque marker elements.
  • the method further comprises a step of preparing the removable denture for use as a protection during healing of permanent tooth implants.
  • the removable denture may be used by the patient during healing of mounted permanent tooth implants to protect the implanted teeth during heeling and thereby reduce discomfort for the patient.
  • the removable denture is then supported by the radiopaque marking element(s). Substantially no pressure is then exerted on the tooth implants as the removable denture is supported by the radiopaque elements and further forms a cover protecting the healing tooth implants.
  • the present disclosure further relates to a radiopaque marker element for aiding mounting of a permanent tooth implant in a jaw.
  • the radiopaque marker element may be used in the methods as described above.
  • the radiopaque marker element comprises a first part being fastenable in the jaw and/or a gingiva.
  • the radiopaque marker element comprises further a second part arranged to extend from a surface of the gingiva, wherein at least the second part has a radiopaque contrast corresponding to the radiopaque contrast of a tooth.
  • the second part may be detachable from the first part.
  • the jaw customized guide may be designed to be supported on the radiopaque marker element.
  • the jaw customized guide is then preferable designed to be supported on the second part.
  • the jaw customized guide may be designed to be supported on the first part.
  • permanent tooth implants may comprise detaching the respective second part from the rest of each radiopaque marker element mounted to the jaw and mounting the second part(s) in the recess(es) of the removable denture.
  • the mounting of the second part(s) in the recess(es) may comprise adding a material having adhesive properties in the recess(es) and positioning the second part in the recess. The second part will then be secured in the recess by means of the added material. Thereafter the removable denture may be fastened in the mouth by attaching the respective radiopaque marker element first part to its corresponding second part secured to the removable denture.
  • the radiopaque marker element may comprise a pin for fastening to a gingiva and/or the jaw.
  • the pin may be made of a material suitable for fastening in bone. Such pin is accordingly suitable for being fastened in the jaw.
  • the pin may be made of a material suitable for fastening in soft tissue. Such pin is suitable for being fastened in the gingiva.
  • At least a first mounting part of the pin may be threaded and arranged to be screwed into the jaw. This example is very suitable when the jaw customized guide is designed to be supported on the radiopaque marker element.
  • the pin may be made of titan. Titan is a material suitable for being mounted in the jaw.
  • the radiopaque marker element may further comprise a cover part arranged to be mounted on the second part of the pin arranged to extend from a surface of the gingiva.
  • the at least one cover part may have a radio radiopaque contrast substantially corresponding to the radiopaque contrast of a tooth.
  • the at least one cover part may be funnel shaped.
  • the pin may comprise a second mounting part for mounting of the cover part to the pin.
  • the present disclosure further relates to a system for aiding mounting of permanent tooth implants in a jaw.
  • the system comprises at least one radiopaque marker element and an image processor arranged to process an image set comprising at least one x-ray image and 3D surface scanning images of a jaw with the at least one radiopaque marker element fastened in a gingiva or the jaw.
  • the image processor is arranged to identify at least three radiopaque points comprising the at least one radiopaque marker element in the x-ray and 3D surface scanning image, respectively, to correlate the x-ray and the 3D surface scanning images to each other based on the identified at least three radiopaque points and to form compiled information comprising information from the correlated x-ray and 3D surface scanning images.
  • system further comprises a processing element arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images.
  • the processing element is further arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the positions of the radiopaque marker elements so that the at least one radiopaque marker element provides a support for the jaw customized guide in the jaw, wherein the at least one radiopaque marker element preferably is fastened in the jaw.
  • the processing element is arranged to obtain the determined data for manufacture of a jaw customized guide in a format suitable for a 3D printer.
  • the system as defined above may be used for aiding mounting of permanent tooth implants in a jaw.
  • the present disclosure further relates to a jaw customized guide for guiding mounting of permanent tooth implants in a jaw.
  • the jaw customized guide has one or a plurality of recesses for reception of a radiopaque marker element mounted to the jaw for securing positioning of the guide in the jaw, and one or a plurality of openings for insert of tooth implants into the jaw.
  • the Jaw customized guide may comprise parts arranged to be spaced apart from a gingiva and mucous membrane when mounted to allow for irrigation.
  • Figure 1 is a flow chart disclosing different examples of methods for manufacture of a jaw customized guide.
  • Figure 2 is a flow chart discloses different examples of a step for determining data for manufacture of the jaw customized guide in a method for manufacture of a jaw customized guide for example according to figure 1.
  • Figure 3 is a block scheme illustrating an example of a system for aiding mounting of permanent tooth implants in a jaw.
  • Figure 4 illustrates an example of the configuration of a two-part radiopaque marker element comprising a pin and a cover part.
  • Figure 5 illustrates an example of a gingiva with radiopaque marker elements positioned therein.
  • Figure 6 illustrates a first view of an example of a jaw customized guide.
  • Figure 7 illustrates a second view of an example of a jaw customized guide.
  • Figure 8 illustrates yet another example of a jaw customized guide.
  • FIG 1 different examples of methods for manufacture of a jaw customized guide are illustrated.
  • the jaw customized guide is arranged to guide mounting of permanent tooth implants in a jaw.
  • the jaw customized method is especially suitable for are suitable for mounting of permanent tooth implants in toothless jaws and jaws with only a few teeth.
  • the method comprises a step of fastening SI at least one radiopaque marker element in a gingiva and/or the jaw.
  • at least three radiopaque marker elements are fastened in the gingiva and/or the jaw.
  • the method is then suitable to be applied to a toothless jaw.
  • the method further comprises a step of capturing S2 an image set comprising at least one x-ray image and a 3D surface scanning image of the jaw. Characteristically, the x-ray image forms a 3D representation of the bone. Characteristically, the 3D surface scanning image forms a 3D surface scanning image of soft tissue.
  • the image set is captured with the at least one radiopaque marker element fastened in the gingiva and/or jaw.
  • the method may further comprise a step of providing S3 a removable denture with recesses arranged to accommodate the radiopaque marker elements.
  • the method may further comprise a step of positioning S4 of the removable denture in place in the mouth of the patient.
  • the method may further comprise a step of capturing S5 an additional 3D surface scanning image.
  • the additional 3D surface scanning image is characteristically captured with the removable denture positioned in place.
  • the method further comprises a step of determining S6 data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants.
  • the data is determined based on the image set comprising the at least one x-ray image and the 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw.
  • the determination step characteristically is computer implemented. Examples for carrying out the determination step S6 will be further described in relation to Figure 2.
  • the method may further comprise a step of manufacturing S7 the jaw customized guide.
  • the manufacture is performed based on the determined data for the manufacture of the jaw customized guide for guiding permanent tooth implants.
  • the manufacturing may be performed at least partly by means of a 3D printer.
  • the method may further comprise a step of preparing S8 the removable denture for use as a protection during healing of permanent tooth implants.
  • the removable denture may be used by the patient during healing of mounted permanent tooth implants to protect the implanted teeth during heeling and thereby reduce discomfort for the patient.
  • the removable denture is then supported by the radiopaque marking element(s). Substantially no pressure is then exerted on the tooth implants as the removable denture is supported by the radiopaque elements and further forms a cover protecting the healing tooth implants.
  • step S6 for determining data for manufacture of a jaw customized guide in a method for manufacture of a jaw customized guide are illustrated.
  • the steps illustrated herein may be performed in another order than the illustrated.
  • the determination is performed at least partly in software.
  • the determination S6 of data for manufacture of a jaw customized guide step comprises a step of processing the image set to identify S61 at least three radiopaque points comprising at least one fastened radiopaque marker element in an x-ray and in a 3D surface scanning image.
  • the method will not require identification of radiopaque markers in the form of teeth.
  • the at least three radiopaque points may further be identified S63 in an additional 3D surface scanning image.
  • the additional 3D surface scanning image is processed to identify S63 the at least three radiopaque points in the additional 3D surface scanning image.
  • the additional 3D surface scanning image is characteristically captured with a removable denture positioned in place in the mouth.
  • the x-ray image, the 3D surface scanning image and the possible additional 3D surface scanning image of the image set are correlated S62, S64 to each other based on the identified at least three radiopaque points.
  • the correlation S62, S64 of the x-ray image, the 3D surface scanning image and the possible additional 3D surface scanning image of the image set to each other may also be based on an identified at least one tooth.
  • the identified at least one tooth and the at least one identified radiopaque marker element then together form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images of the image set to each other.
  • Compiled information is then formed S65 comprising information from the correlated x-ray image, the 3D surface scanning image and the possible additional 3D surface scanning image of the image set.
  • Data for manufacture of the jaw customized guide is then determined S66 based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set.
  • the data for manufacture of the jaw customized guide may be determined by determining the geometry and orientation of the radiopaque marker element(s) and any present tooth/teeth and designing the guide based on the determined geometry and orientation so that the guide when mounted substantially is movable in only one direction.
  • the determination S66 of data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants may further be based on the additional 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw, wherein the additional 3D surface scanning image is captured with the removable denture positioned in place.
  • the location of the teeth of the removable denture may be determined from the additional 3D scanning image. This information may be used as data for the data for manufacture of the jaw customized guide.
  • the determining the data for manufacture of the jaw customized guide is based on the positions of the teeth of the removable denture in relation to the positions of the radiopaque points is improved.
  • FIG. 3 a system 300 for aiding mounting of permanent tooth implants in a jaw is illustrated.
  • the system 300 comprises a set of radiopaque marker elements 301.
  • the radiopaque marker elements 301 have a contrast substantially corresponding to the radiopaque contrast of a tooth. Examples of radiopaque marker elements are described in relation to Figure 4.
  • the system 300 comprises further an image processor 312.
  • the image processor is arranged to process an image set comprising at least one x-ray image and 3D surface scanning images of a jaw with the at least one radiopaque marker element fastened in a gingiva or the jaw.
  • the image processor 312 is arranged to identify at least three radiopaque points comprising the at least one radiopaque marker element in the x-ray and 3D surface scanning image, respectively, to correlate the x-ray and the 3D surface scanning images to each other based on the identified at least three radiopaque points and to form compiled information comprising information from the correlated x-ray and 3D surface scanning images.
  • the system 300 further comprises a processing element 311 arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images.
  • the processing element 311 may further be arranged to determine data for manufacture of a jaw customized guide forguiding mounting of permanent tooth implants based on the positions of the radiopaque marker elements so that the at least one radiopaque marker element provides a support for the jaw customized guide in the jaw, wherein the at least one radiopaque marker element preferably is fastened in the jaw.
  • the processing element 311 may be arranged to obtain the determined data for manufacture of a jaw customized guide in a format suitable for a 3D printer.
  • the system 300 may further comprise a memory 380.
  • the memory may be arranged to store captured image sets comprising at X-ray images and 3D surface scanning images.
  • the memory may further be arranged to store correlation information correlating the images of the respective image sets.
  • the memory may further be arranged to store the compiled information related to the respective image set.
  • the memory may further be arranged to store the determined data for the manufacture of the jaw customized guide.
  • the image processor 312, the processing element 311 and the memory are formed in a computing device 310.
  • the system 300 may further comprise an X-ray image capturing element 390 arranged to capture the X-ray images.
  • the system 300 may further comprise a 3D surface scanning image capturing element 330 arranged to capture the 3D surface scanning images.
  • the system 300 may further comprise a 3D printer 320 arranged to print the jaw customized guide based on the determined data.
  • the X-ray image capturing element 390, 3D surface scanning image capturing element 330 and the 3D printer 320 are connectable to the computing device 312 by means of an interface 360.
  • the radiopaque marker element 400 for aiding mounting of a permanent tooth implants in a jaw is illustrated.
  • the radiopaque marker element 400 has a first part 401 fastenable in a gingiva or the jaw.
  • the first part may be made of a material suitable for fastening in bone or a material suitable for fastening in soft tissue.
  • the first part 401 is threaded and arranged to be screwed into the jaw.
  • the radiopaque marker element further has a second part 402, 404 arranged to extend from a surface of the gingiva. At least parts of the second part has a radiopaque contrast corresponding to the radiopaque contrast of a tooth.
  • the radiopaque marker element 400 comprises a pin 403 for fastening in the gingiva and/or the jaw.
  • the first part 401 fastened in the gingiva or jaw is in the illustrated example formed in the pin 403.
  • the pin further comprises a second part 402 arranged to extend from a surface of the gingiva.
  • the pin 403 may be made of a material suitable for fastening in bone.
  • the pin 403 may be made of a material suitable for fastening in soft tissue.
  • the radiopaque marker element 400 comprises in the illustrated example further a cover part 404 arranged to be mounted on the second part 402 of the pin 403.
  • the cover part 404 has characteristically the radiopaque contrast corresponding to the radiopaque contrast of a tooth.
  • the cover part 404 is in the illustrated example funnel shaped.
  • the second part 402 of the pin 403 and the cover part 404 may comprise corresponding mounting parts for mounting of the cover part 404 to the pin 403.
  • the mounting parts are in one example arranged to be mounted to each other in a detachable manner.
  • the upper radiopaque marker elements are in the detached state while the lower radiopaque marker elements are in the attached state.
  • the second part 402 of the pin 403 comprises an insert part 405 for insert in a corresponding recess 406 in the cover part 404.
  • the insert part 405 and the corresponding recess 406 have a square shaped cross section.
  • other cross section shapes may be considered. It may be advantageous that the cross section is shaped to prevent rotation of the cover part 404 in relation to the pin 403, when attached.
  • the insert part 405 and the corresponding recess 406 comprises respective form fitting means 408, 409.
  • the form fitting means 408, 409 has a geometrical fit securing the mounting of the cover part 402 on the pin.
  • the form fitting means 408, 409 comprises a circumferential recess 408 in the insert part 405 arranged to fit a corresponding circumferential projection 409 in the cover part 404.
  • the circumferential recess may be formed in the cover part 404 and the circumferential projection may be formed in the insert part.
  • the insert part 405 has a width larger than the diameter of the first part 401.
  • the cover part 404 may be detachable from the insert part 405 by means of a tool.
  • the second part 402 of the pin 403 comprises further a circumferential shoulder 407 separating the first part 401 from the insert part 405.
  • the circumferential shoulder 407 has a tapered, such as funnel shaped, cross section.
  • the cross section of the circumferential shoulder 407 coincides at its end facing the first part 401 the cross section of the first part.
  • the cross section of the circumferential shoulder 407 has at its end facing the insert part 405 a cross section large enough to accommodate the entire insert part 405.
  • the pin 403 may be made of a material suitable to be threaded into the human body. Titan is an example of such material. Titan is an inexpensive, ontological material. Further the radiopaque properties of titan are also such that they do not give rise to a too high contrast and thus do not compromise the images.
  • FIG 5 an example wherein a plurality of radiopaque marker elements 400 which have been fastened to a toothless jaw 500 is illustrated.
  • the radiopaque marker elements have been evenly distributed over the toothless jaw.
  • four radiopaque marker elements 400 are used.
  • a jaw customized guide 600 for guiding mounting of permanent tooth implants in a jaw is illustrated.
  • the jaw customized guide 600 is illustrated positioned in place in a mouth by means of radiopaque marker elements (not illustrated).
  • the jaw customized guide is designed and manufactured as disclosed herein.
  • the jaw customized guide 600 comprises a plurality of recesses 610 for reception of the radiopaque marker elements mounted to the jaw for securing positioning of the guide in the jaw.
  • the jaw customized guide comprises a plurality of openings 611 for guiding insert of tooth implants into the jaw.
  • the jaw customized guide 600 comprises parts 612 arranged to be spaced apart from a gingiva and mucous membrane when mounted to allow for irrigation.
  • the gingiva When the gingiva is anesthetized in preparation for mounting the permanent tooth implants, the gingiva will characteristically swell. It is therefore advantageous that the guide, which was designed when the gingiva was in a not-swelled state, substantially only is arranged to be supported on the radiopaque marker elements and any present tooth/teeth. If the guide on the other hand is intended to be supported by the gingiva, this may cause problems. It may not be possible to correctly fit the jaw customized guide for guiding mounting of the permanent tooth implants in the mouth when the gingiva is anesthetized and swelled.
  • some abutment against the gingiva/mucous membrane may be considered, for example in a field around the respective radiopaque marker element.
  • the guide when the guide is substantially only supported on the radiopaque marker elements and any present tooth/teeth, this enhances the possibility of adequate irrigation. As the guide substantially is spaced apart from the gingiva/ mucous membrane, fluid is allowed to flow therebetween.
  • FIG 8 another design of a jaw customized guide for guiding mounting of permanent tooth implants in a jaw is illustrated.
  • a clinical workflow in accordance with the present disclosure may comprise at least some of the following.
  • This overview x-ray image may form basis for a decision related to where to fasten the at least one radiopaque marker element.
  • the cover part of the radiopaque marker element may be mounted.
  • step 8 Importing the surface scanning image(s) from step 4 and possible step 6 and the 3D x- ray image from step 7 to a CAD program for surgical planning of installation of the permanent tooth implants and for design of the jaw customized guide arranged to guide mounting of the permanent tooth implants in the jaw. This involves aligning the CBCT x-ray and surface scanning images using the radiopaque marker elements. If the additional surface scanning image from step 7 is present, use this image for optimizing the positioning of the permanent tooth implants. Further, the jaw customized guide may be designed for support on the radiopaque marker element(s) and possible present tooth/teeth.
  • This step may be performed with the cover part of the radiopaque marker element mounted.
  • Adaptation of removable denture to comprise fixation against the cover part of the radiopaque marker element is then used as a temporary replacement for the permanent tooth implants during healing of the permanent tooth implants.

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Abstract

The present disclosure relates to a method for manufacture of a jaw customized guide arranged to guide mounting of permanent tooth implants in a jaw. The method comprises the stepsof fastening at least one radiopaque marker element in a gingiva and/or the jaw, anddetermining data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants based on an image set comprising at least one x-ray image and 3D surface scanning images of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw. The determination step is computer implemented and comprises processing the image set to identify at least three radiopaque points comprising the at least one fastened radiopaque marker element in the x-ray and 3D surface scanning image, respectively, correlating the x-ray and the 3D surface scanning images of the image set to each other based on the identified at least three radiopaque points, andforming compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set, anddetermining the data for manufacture of the jaw customized guide based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set. (Fig 1)

Description

Method for manufacture of a jaw customized guide, system for aiding mounting of tooth im customized guide, a ue marker element and software for determining data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants
TECHNICAL FIELD
The present disclosure relates to aid for mounting of permanent tooth implants.
BACKGROUND ART There are methods known in the art for mounting of permanent tooth implants.
SUMMARY
An object of the present disclosure is to provide solutions which are suitable for mounting of permanent tooth implants in toothless jaws and jaws with only a few teeth. The present disclosure relates to a method for manufacture of a jaw customized guide arranged to guide mounting of permanent tooth implants in a jaw. The method comprises steps of fastening at least one radiopaque marker element in a gingiva and/or the the jaw and determining data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants based on an image set comprising at least one x-ray image and a 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw. The determination step is computer implemented and comprises processing the image set to identify at least three radiopaque points comprising the at least one fastened radiopaque marker element in the x-ray and 3D surface scanning image, respectively; correlating the x-ray and the 3D surface scanning images to each other based on the identified at least three radiopaque points; forming compiled information comprising information from the correlated x-ray and 3D surface scanning images; and determining the data for manufacture of the jaw customized guide based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images.
This solution provides for reduced discomfort for the patient in relation to known methods.
Further, the solution is time effective both for dentist and patient. The patient will visit the dentist for mounting the radiopaque marker elements and capturing the image set. In a next step, the tooth implants will be mounted with the aid of the manufactured jaw customized guide. The manufactured jaw customized guide may be removably supported by the radiopaque marker elements.
This solution enables correlation of the x-ray and the 3D surface scanning images to each other even when there is not enough information in the images to make such correlation without the mounted radiopaque marker elements. Generally, three points which are visible in both the x-ray and 3D scanning surface images are necessary in order to align the images x- ray and 3D scanning surface images to each other. In a toothless jaw or a jaw with only a few or not optimally positioned placed teeth, the mounted at least one radiopaque marker element secures that at least three different points which can be used for correlation
/alignment are visible in both the x-ray and 3D scanning surface images. Thus, the x-ray and 3D scanning surface images can be correlated to each other (or in other words aligned) using the mounted radiopaque marker elements as the only or aiding points for making the correlation or alignment. Thus, the method may be applied to a jaw with only one or a few teeth, where tooth/teeth present does not provide enough information for making the correlation/alignment.
In practice, when the jaw has one or a plurality of teeth, at least one tooth in the jaw forming a radiopaque point may be identified in the x-ray and 3D surface scanning image, respectively. Accordingly, the step of correlating the x-ray and the 3D surface scanning images to each other is also based on the identified at least one tooth. The identified at least one tooth and the at least one identified radiopaque marker element together form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other.
In different embodiments, at least three radiopaque marker elements are fastened in the gingiva and/or jaw and identified in the x-ray and 3D surface scanning image, respectively. No additional points for correlating/aligning the images are then necessary. The method may accordingly be applied to a toothless jaw.
Thus, in accordance with these embodiments, the radiopaque marker element(s) and possible remaining tooth/teeth in the jaw form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other.
The use of the radiopaque marker element(s) and possible remaining tooth/teeth in the jaw to form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other, provides for correlation/alignment with high accuracy.
The at least three radiopaque points for correlating the x-ray and the 3D surface scanning images to each other also have the characteristic that they extend above the gingiva. Thus, the radiopaque marker element(s) and any potential tooth/teeth may in different embodiments act as supporting points for the guide.
Accordingly, the guide manufactured based on this method may be designed not to have to abut against the gingiva or mucous membrane, even if the jaw is toothless. If no teeth are present, the guide may be designed to be supported at least substantially only on the radiopaque marker elements. If teeth are present, the guide can be design to be supported also on the present tooth/teeth.
When the gingiva is anesthetized in preparation for mounting the permanent tooth implants, the gingiva will characteristically swell. It is therefore advantageous that the guide, which was designed when the gingiva was in a not-swelled state, substantially only is arranged to be supported on the radiopaque marker elements and any present tooth/teeth. If the guide on the other hand is intended to be supported by the gingiva, this may cause problems. It may not be possible to correctly fit the jaw customized guide for guiding mounting of the permanent tooth implants in the mouth when the gingiva is anesthetized and swelled. However, in accordance with these embodiments, some abutment against the gingiva/mucous membrane may be considered, for example in a field around the respective radiopaque marker element.
Further, when the guide is substantially only supported on the radiopaque marker elements and any present tooth/teeth, this enhances the possibility of adequate irrigation. As the guide substantially is spaced apart from the gingiva/ mucous membrane, fluid is allowed to flow therebetween.
In different embodiments, the step of determining the data for manufacture of the jaw customized guide comprises determining the geometry and orientation of the radiopaque marker element(s) and any present tooth/teeth and designing the guide based on the determined geometry and orientation so that the guide when mounted substantially is movable in only one direction.
Thus, using the radiopaque marker elements and any present tooth/teeth as supports for the jaw customized guide and designing the guide based on the geometry of the radiopaque marker element(s) and any present tooth/teeth, allows for a design of the guide such that the radiopaque marker element(s) and any present tooth are fitted to the guide in a mounted state such that the guide is immobile in any other direction than a dismounting direction without use of any additional fastening elements. Accordingly, the geometry of the jaw customized guide may be selected such that no additional fastening means for mounting are necessary while at the same time the guide is easily removable.
In different embodiments, the step of determining data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants is further based on an additional 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw and wherein the additional 3D surface scanning image is captured with a removable denture positioned in place. The removable denture is characteristically a removable denture presently used by the patient. The additional 3D surface scanning image is aligned with the images of the image set. Thus, the computer implemented determination step comprises further processing the additional 3D surface scanning image to identify the at least three radiopaque points in the additional 3D surface scanning image, and correlating the additional 3D surface scanning image to the image set based at least on the identified at least three radiopaque points. The step of forming compiled information comprises forming the compiled information also from the additional surface scanning image. Further, the data for manufacture of the jaw customized guide based on the compiled information is determined based also on the additional 3D scanning image. The data for manufacture of the jaw customized guide based on the compiled information may then be determined also from information in the additional 3D surface scanning image. This includes identifying the location of the teeth of the removable denture in the additional 3D surface scanning image and to use this information as data for the data for manufacture of the jaw customized guide. This has the advantage that an indication of suitable positions of the permanent tooth implants is provided from the additional 3D surface scanning image and that the jaw customized guide may be designed accordingly.
Preferably, the removable denture is provided with recesses arranged to accommodate the radiopaque marker elements before capturing the additional 3D surface scanning image.
Thereby the removable denture is better fitted and the positions of the teeth of the
removable denture in relation to the positions of the radiopaque points may be accurately determined. The additional 3D surface image is preferably captured while the removable denture is fitted in place without exerting pressure on the radiopaque marker elements.
The recesses may for example be provided by means of drilling or grinding. In different embodiments, the method further comprises a step of preparing the removable denture for use as a protection during healing of permanent tooth implants.
Thus, the removable denture may be used by the patient during healing of mounted permanent tooth implants to protect the implanted teeth during heeling and thereby reduce discomfort for the patient. The removable denture is then supported by the radiopaque marking element(s). Substantially no pressure is then exerted on the tooth implants as the removable denture is supported by the radiopaque elements and further forms a cover protecting the healing tooth implants.
The present disclosure further relates to a radiopaque marker element for aiding mounting of a permanent tooth implant in a jaw. The radiopaque marker element may be used in the methods as described above. The radiopaque marker element comprises a first part being fastenable in the jaw and/or a gingiva. The radiopaque marker element comprises further a second part arranged to extend from a surface of the gingiva, wherein at least the second part has a radiopaque contrast corresponding to the radiopaque contrast of a tooth. The second part may be detachable from the first part.
The jaw customized guide may be designed to be supported on the radiopaque marker element. The jaw customized guide is then preferable designed to be supported on the second part. However, the jaw customized guide may be designed to be supported on the first part. When the jaw customized guide is designed to be supported on the radiopaque marker element, in an option where the second part of the radiopaque marker element is detachable, a step of preparing the removable denture for use as a protection during healing of
permanent tooth implants may comprise detaching the respective second part from the rest of each radiopaque marker element mounted to the jaw and mounting the second part(s) in the recess(es) of the removable denture. The mounting of the second part(s) in the recess(es) may comprise adding a material having adhesive properties in the recess(es) and positioning the second part in the recess. The second part will then be secured in the recess by means of the added material. Thereafter the removable denture may be fastened in the mouth by attaching the respective radiopaque marker element first part to its corresponding second part secured to the removable denture.
The radiopaque marker element may comprise a pin for fastening to a gingiva and/or the jaw.
The pin may be made of a material suitable for fastening in bone. Such pin is accordingly suitable for being fastened in the jaw.
The pin may be made of a material suitable for fastening in soft tissue. Such pin is suitable for being fastened in the gingiva.
At least a first mounting part of the pin may be threaded and arranged to be screwed into the jaw. This example is very suitable when the jaw customized guide is designed to be supported on the radiopaque marker element.
The pin may be made of titan. Titan is a material suitable for being mounted in the jaw. The radiopaque marker element may further comprise a cover part arranged to be mounted on the second part of the pin arranged to extend from a surface of the gingiva. The at least one cover part may have a radio radiopaque contrast substantially corresponding to the radiopaque contrast of a tooth.
The at least one cover part may be funnel shaped.
The pin may comprise a second mounting part for mounting of the cover part to the pin.
The present disclosure further relates to a system for aiding mounting of permanent tooth implants in a jaw. The system comprises at least one radiopaque marker element and an image processor arranged to process an image set comprising at least one x-ray image and 3D surface scanning images of a jaw with the at least one radiopaque marker element fastened in a gingiva or the jaw. The image processor is arranged to identify at least three radiopaque points comprising the at least one radiopaque marker element in the x-ray and 3D surface scanning image, respectively, to correlate the x-ray and the 3D surface scanning images to each other based on the identified at least three radiopaque points and to form compiled information comprising information from the correlated x-ray and 3D surface scanning images.
In different embodiments, the system further comprises a processing element arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images.
In different embodiments, the processing element is further arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the positions of the radiopaque marker elements so that the at least one radiopaque marker element provides a support for the jaw customized guide in the jaw, wherein the at least one radiopaque marker element preferably is fastened in the jaw.
In different embodiments, the processing element is arranged to obtain the determined data for manufacture of a jaw customized guide in a format suitable for a 3D printer. The system as defined above may be used for aiding mounting of permanent tooth implants in a jaw.
The present disclosure further relates to a jaw customized guide for guiding mounting of permanent tooth implants in a jaw. The jaw customized guide has one or a plurality of recesses for reception of a radiopaque marker element mounted to the jaw for securing positioning of the guide in the jaw, and one or a plurality of openings for insert of tooth implants into the jaw.
The Jaw customized guide may comprise parts arranged to be spaced apart from a gingiva and mucous membrane when mounted to allow for irrigation.
BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a flow chart disclosing different examples of methods for manufacture of a jaw customized guide.
Figure 2 is a flow chart discloses different examples of a step for determining data for manufacture of the jaw customized guide in a method for manufacture of a jaw customized guide for example according to figure 1.
Figure 3 is a block scheme illustrating an example of a system for aiding mounting of permanent tooth implants in a jaw.
Figure 4 illustrates an example of the configuration of a two-part radiopaque marker element comprising a pin and a cover part. Figure 5 illustrates an example of a gingiva with radiopaque marker elements positioned therein.
Figure 6 illustrates a first view of an example of a jaw customized guide.
Figure 7 illustrates a second view of an example of a jaw customized guide.
Figure 8 illustrates yet another example of a jaw customized guide. DETAILED DESCRIPTION
In figure 1, different examples of methods for manufacture of a jaw customized guide are illustrated. The jaw customized guide is arranged to guide mounting of permanent tooth implants in a jaw. The jaw customized method is especially suitable for are suitable for mounting of permanent tooth implants in toothless jaws and jaws with only a few teeth.
In the illustrated example, the method comprises a step of fastening SI at least one radiopaque marker element in a gingiva and/or the jaw. In accordance with an example, at least three radiopaque marker elements are fastened in the gingiva and/or the jaw. The method is then suitable to be applied to a toothless jaw. The method further comprises a step of capturing S2 an image set comprising at least one x-ray image and a 3D surface scanning image of the jaw. Characteristically, the x-ray image forms a 3D representation of the bone. Characteristically, the 3D surface scanning image forms a 3D surface scanning image of soft tissue. The image set is captured with the at least one radiopaque marker element fastened in the gingiva and/or jaw. The method may further comprise a step of providing S3 a removable denture with recesses arranged to accommodate the radiopaque marker elements.
The method may further comprise a step of positioning S4 of the removable denture in place in the mouth of the patient.
The method may further comprise a step of capturing S5 an additional 3D surface scanning image. The additional 3D surface scanning image is characteristically captured with the removable denture positioned in place.
The method further comprises a step of determining S6 data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants. The data is determined based on the image set comprising the at least one x-ray image and the 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw. The determination step characteristically is computer implemented. Examples for carrying out the determination step S6 will be further described in relation to Figure 2. The method may further comprise a step of manufacturing S7 the jaw customized guide. The manufacture is performed based on the determined data for the manufacture of the jaw customized guide for guiding permanent tooth implants. The manufacturing may be performed at least partly by means of a 3D printer. The method may further comprise a step of preparing S8 the removable denture for use as a protection during healing of permanent tooth implants. Thus, the removable denture may be used by the patient during healing of mounted permanent tooth implants to protect the implanted teeth during heeling and thereby reduce discomfort for the patient. The removable denture is then supported by the radiopaque marking element(s). Substantially no pressure is then exerted on the tooth implants as the removable denture is supported by the radiopaque elements and further forms a cover protecting the healing tooth implants.
In Figure 2, different examples of a step S6 for determining data for manufacture of a jaw customized guide in a method for manufacture of a jaw customized guide are illustrated. The steps illustrated herein may be performed in another order than the illustrated. The determination is performed at least partly in software.
The determination S6 of data for manufacture of a jaw customized guide step comprises a step of processing the image set to identify S61 at least three radiopaque points comprising at least one fastened radiopaque marker element in an x-ray and in a 3D surface scanning image. When at least three radiopaque marker elements are fastened in the gingiva and/or jaw, the method will not require identification of radiopaque markers in the form of teeth.
The at least three radiopaque points may further be identified S63 in an additional 3D surface scanning image. Thus, the additional 3D surface scanning image is processed to identify S63 the at least three radiopaque points in the additional 3D surface scanning image. The additional 3D surface scanning image is characteristically captured with a removable denture positioned in place in the mouth.
The x-ray image, the 3D surface scanning image and the possible additional 3D surface scanning image of the image set are correlated S62, S64 to each other based on the identified at least three radiopaque points. When at least one tooth in the jaw forming a radiopaque point is identified in the x-ray and 3D surface scanning image, respectively, the correlation S62, S64 of the x-ray image, the 3D surface scanning image and the possible additional 3D surface scanning image of the image set to each other may also be based on an identified at least one tooth. The identified at least one tooth and the at least one identified radiopaque marker element then together form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images of the image set to each other.
Compiled information is then formed S65 comprising information from the correlated x-ray image, the 3D surface scanning image and the possible additional 3D surface scanning image of the image set.
Data for manufacture of the jaw customized guide is then determined S66 based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set.
The data for manufacture of the jaw customized guide may be determined by determining the geometry and orientation of the radiopaque marker element(s) and any present tooth/teeth and designing the guide based on the determined geometry and orientation so that the guide when mounted substantially is movable in only one direction.
The determination S66 of data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants may further be based on the additional 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw, wherein the additional 3D surface scanning image is captured with the removable denture positioned in place.
The location of the teeth of the removable denture may be determined from the additional 3D scanning image. This information may be used as data for the data for manufacture of the jaw customized guide.
When the removable denture if provided with recesses arranged to accommodate the radiopaque marker elements before capturing the additional 3D scanning image, the determining the data for manufacture of the jaw customized guide is based on the positions of the teeth of the removable denture in relation to the positions of the radiopaque points is improved.
In Figure 3, a system 300 for aiding mounting of permanent tooth implants in a jaw is illustrated.
The system 300 comprises a set of radiopaque marker elements 301. The radiopaque marker elements 301 have a contrast substantially corresponding to the radiopaque contrast of a tooth. Examples of radiopaque marker elements are described in relation to Figure 4.
The system 300 comprises further an image processor 312. The image processor is arranged to process an image set comprising at least one x-ray image and 3D surface scanning images of a jaw with the at least one radiopaque marker element fastened in a gingiva or the jaw. In detail, the image processor 312 is arranged to identify at least three radiopaque points comprising the at least one radiopaque marker element in the x-ray and 3D surface scanning image, respectively, to correlate the x-ray and the 3D surface scanning images to each other based on the identified at least three radiopaque points and to form compiled information comprising information from the correlated x-ray and 3D surface scanning images. The system 300 further comprises a processing element 311 arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images.
The processing element 311 may further be arranged to determine data for manufacture of a jaw customized guide forguiding mounting of permanent tooth implants based on the positions of the radiopaque marker elements so that the at least one radiopaque marker element provides a support for the jaw customized guide in the jaw, wherein the at least one radiopaque marker element preferably is fastened in the jaw.
The processing element 311 may be arranged to obtain the determined data for manufacture of a jaw customized guide in a format suitable for a 3D printer.
The system 300 may further comprise a memory 380. The memory may be arranged to store captured image sets comprising at X-ray images and 3D surface scanning images. The memory may further be arranged to store correlation information correlating the images of the respective image sets. The memory may further be arranged to store the compiled information related to the respective image set. The memory may further be arranged to store the determined data for the manufacture of the jaw customized guide.
In the illustrated example, the image processor 312, the processing element 311 and the memory are formed in a computing device 310. The system 300 may further comprise an X-ray image capturing element 390 arranged to capture the X-ray images.
The system 300 may further comprise a 3D surface scanning image capturing element 330 arranged to capture the 3D surface scanning images.
The system 300 may further comprise a 3D printer 320 arranged to print the jaw customized guide based on the determined data.
In the illustrated example the X-ray image capturing element 390, 3D surface scanning image capturing element 330 and the 3D printer 320 are connectable to the computing device 312 by means of an interface 360.
In Figure 4, an example of a radiopaque marker element 400 for aiding mounting of a permanent tooth implants in a jaw is illustrated. The radiopaque marker element 400 has a first part 401 fastenable in a gingiva or the jaw. The first part may be made of a material suitable for fastening in bone or a material suitable for fastening in soft tissue.
In the illustrated example, the first part 401 is threaded and arranged to be screwed into the jaw. The radiopaque marker element further has a second part 402, 404 arranged to extend from a surface of the gingiva. At least parts of the second part has a radiopaque contrast corresponding to the radiopaque contrast of a tooth.
In the illustrated example, the radiopaque marker element 400 comprises a pin 403 for fastening in the gingiva and/or the jaw. The first part 401 fastened in the gingiva or jaw is in the illustrated example formed in the pin 403. The pin further comprises a second part 402 arranged to extend from a surface of the gingiva. The pin 403 may be made of a material suitable for fastening in bone. The pin 403 may be made of a material suitable for fastening in soft tissue.
The radiopaque marker element 400 comprises in the illustrated example further a cover part 404 arranged to be mounted on the second part 402 of the pin 403. The cover part 404 has characteristically the radiopaque contrast corresponding to the radiopaque contrast of a tooth. The cover part 404 is in the illustrated example funnel shaped.
The second part 402 of the pin 403 and the cover part 404 may comprise corresponding mounting parts for mounting of the cover part 404 to the pin 403. The mounting parts are in one example arranged to be mounted to each other in a detachable manner. In the illustrated example, the upper radiopaque marker elements are in the detached state while the lower radiopaque marker elements are in the attached state.
In the illustrated example, the second part 402 of the pin 403 comprises an insert part 405 for insert in a corresponding recess 406 in the cover part 404. In the illustrated example, the insert part 405 and the corresponding recess 406 have a square shaped cross section. However, other cross section shapes may be considered. It may be advantageous that the cross section is shaped to prevent rotation of the cover part 404 in relation to the pin 403, when attached.
In the illustrated example, the insert part 405 and the corresponding recess 406 comprises respective form fitting means 408, 409. The form fitting means 408, 409 has a geometrical fit securing the mounting of the cover part 402 on the pin. In the illustrated example, the form fitting means 408, 409 comprises a circumferential recess 408 in the insert part 405 arranged to fit a corresponding circumferential projection 409 in the cover part 404. Alternatively, the circumferential recess may be formed in the cover part 404 and the circumferential projection may be formed in the insert part.
In the illustrated example, the insert part 405 has a width larger than the diameter of the first part 401.
The cover part 404 may be detachable from the insert part 405 by means of a tool.
In the illustrated example, the second part 402 of the pin 403 comprises further a circumferential shoulder 407 separating the first part 401 from the insert part 405. The circumferential shoulder 407 has a tapered, such as funnel shaped, cross section. The cross section of the circumferential shoulder 407 coincides at its end facing the first part 401 the cross section of the first part. The cross section of the circumferential shoulder 407 has at its end facing the insert part 405 a cross section large enough to accommodate the entire insert part 405.
The pin 403 may be made of a material suitable to be threaded into the human body. Titan is an example of such material. Titan is an inexpensive, ontological material. Further the radiopaque properties of titan are also such that they do not give rise to a too high contrast and thus do not compromise the images.
In figure 5, an example wherein a plurality of radiopaque marker elements 400 which have been fastened to a toothless jaw 500 is illustrated. The radiopaque marker elements have been evenly distributed over the toothless jaw. In this example four radiopaque marker elements 400 are used.
In figures 6 and 5, a jaw customized guide 600 for guiding mounting of permanent tooth implants in a jaw is illustrated. The jaw customized guide 600 is illustrated positioned in place in a mouth by means of radiopaque marker elements (not illustrated). The jaw customized guide is designed and manufactured as disclosed herein.
The jaw customized guide 600 comprises a plurality of recesses 610 for reception of the radiopaque marker elements mounted to the jaw for securing positioning of the guide in the jaw.
The jaw customized guide comprises a plurality of openings 611 for guiding insert of tooth implants into the jaw.
The jaw customized guide 600 comprises parts 612 arranged to be spaced apart from a gingiva and mucous membrane when mounted to allow for irrigation.
When the gingiva is anesthetized in preparation for mounting the permanent tooth implants, the gingiva will characteristically swell. It is therefore advantageous that the guide, which was designed when the gingiva was in a not-swelled state, substantially only is arranged to be supported on the radiopaque marker elements and any present tooth/teeth. If the guide on the other hand is intended to be supported by the gingiva, this may cause problems. It may not be possible to correctly fit the jaw customized guide for guiding mounting of the permanent tooth implants in the mouth when the gingiva is anesthetized and swelled.
However, in accordance with these embodiments, some abutment against the gingiva/mucous membrane may be considered, for example in a field around the respective radiopaque marker element.
Further, when the guide is substantially only supported on the radiopaque marker elements and any present tooth/teeth, this enhances the possibility of adequate irrigation. As the guide substantially is spaced apart from the gingiva/ mucous membrane, fluid is allowed to flow therebetween.
In figure 8, another design of a jaw customized guide for guiding mounting of permanent tooth implants in a jaw is illustrated.
In practice, a clinical workflow in accordance with the present disclosure may comprise at least some of the following.
1. Obtaining an overview x-ray image, for example a two dimensional panorama x-ray image. This overview x-ray image may form basis for a decision related to where to fasten the at least one radiopaque marker element.
2. Providing anaesthesia
3. Fastening of the at least one radiopaque marker element
4. Surface scanning. In this step, the cover part of the radiopaque marker element may be mounted.
5. Processing of the removable denture by removal of material (for example by means of grinding) so that the radiopaque marker element(s) is identifiable in a surface scanning image captured with the removable denture in place in the mouth.
6. Surface scanning with the removable denture, possible processed, positioned in place in the mouth.
7. Obtaining 3D x-ray image, such as a Cone Beam Computed Tomography, CBCT 3D x-ray image
8. Importing the surface scanning image(s) from step 4 and possible step 6 and the 3D x- ray image from step 7 to a CAD program for surgical planning of installation of the permanent tooth implants and for design of the jaw customized guide arranged to guide mounting of the permanent tooth implants in the jaw. This involves aligning the CBCT x-ray and surface scanning images using the radiopaque marker elements. If the additional surface scanning image from step 7 is present, use this image for optimizing the positioning of the permanent tooth implants. Further, the jaw customized guide may be designed for support on the radiopaque marker element(s) and possible present tooth/teeth.
3D printing of jaw customized guide
Surgery aided by the jaw customized guide supported by the radiopaque marker element(s) and possible present tooth/teeth. This step may be performed with the cover part of the radiopaque marker element mounted.
Adaptation of removable denture to comprise fixation against the cover part of the radiopaque marker element. The removable denture is then used as a temporary replacement for the permanent tooth implants during healing of the permanent tooth implants.
Completion of permanent implant supported structure in accordance with known methods or in a digital work flow.

Claims

1. Method for manufacture of a jaw customized guide arranged to guide mounting of permanent tooth implants in a jaw, said method comprising the steps: fastening (SI) at least one radiopaque marker element comprising a pin in a gingiva and/or the jaw, and determining (S6) data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants based on an image set comprising at least one x-ray image and 3D surface scanning images of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw, wherein said determination (S6) step is computer implemented and comprises processing the image set to identify (S61) at least three radiopaque points comprising the at least one fastened radiopaque marker element in the x-ray and 3D surface scanning image, respectively, correlating (S62) the x-ray and the 3D surface scanning images of the image set to each other based on the identified at least three radiopaque points, and forming (S65) compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set, and determining (S66) the data for manufacture of the jaw customized guide based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set,
wherein the determination of data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants is based on the positions of the radiopaque marker elements so that the at least one radiopaque marker element provides a support for the jaw customized guide in the jaw, wherein the at least one radiopaque marker element preferably is fastened in the jaw.
2. Method according to claim 1, wherein at least three radiopaque marker elements are fastened in the gingiva and/or jaw and identified in the x-ray and 3D surface scanning image, respectively.
3. Method according to claim 1 and 2, wherein at least one tooth in the jaw forming a
radiopaque point is identified in the x-ray and 3D surface scanning image, respectively, wherein the step of correlating the x-ray and the 3D surface scanning images of the image set to each other is also based on the identified at least one tooth, and wherein the identified at least one tooth and the at least one identified radiopaque marker element together form the at least three radiopaque points for correlating the x-ray and the 3D surface scanning images of the image set to each other.
4. Method according to any of the preceding claims, wherein the step (S66) of determining the data for manufacture of the jaw customized guide comprises determining the geometry and orientation of the radiopaque marker element(s) and any present tooth/teeth and designing the guide based on the determined geometry and orientation so that the guide when mounted substantially is movable in only one direction.
5. Method according to any of the preceding claims, wherein the step of determining data for manufacture of the jaw customized guide for guiding mounting of permanent tooth implants is further based on an additional 3D surface scanning image of the jaw with the at least one radiopaque marker element fastened in the gingiva and/or jaw, wherein the additional 3D surface scanning image is captured with a removable denture positioned in place, and wherein said determination step is computer implemented and comprises processing the additional 3D surface scanning image to identify the at least three radiopaque points in the 3D surface scanning image, and correlating the additional 3D surface scanning image to the image set based at least on the identified at least three radiopaque points, wherein the step of forming compiled information comprises forming the compiled information also from the additional 3D surface scanning image, and wherein the data for manufacture of the jaw customized guide based on the compiled information is determined based also on the additional 3D scanning image.
6. Method according to claim 5, wherein determining the data for manufacture of the jaw customized guide based on the compiled information comprises determining from the additional 3D scanning image the location of the teeth of the removable denture in the respective images and to use this information as data for the data for manufacture of the jaw customized guide.
7. Method according to claim 5 or 6, further comprising a step of providing the removable denture with recesses arranged to accommodate the radiopaque marker elements before capturing the additional 3D scanning image, wherein the step of determining the data for manufacture of the jaw customized guide is based on the positions of the teeth of the removable denture in relation to the positions of the radiopaque points.
8. Method according to any of the preceding claims, further comprising a step of preparing the removable denture for use as a protection during healing of permanent tooth implants.
9. System (300) for aiding mounting of permanent tooth implants in a jaw, said system comprising at least one radiopaque marker element (301) and an image processor (312) arranged to process an image set comprising at least one x-ray image and 3D surface scanning images of a jaw with the at least one radiopaque marker element fastened in a gingiva or the jaw, wherein the image processor is arranged to identify at least three radiopaque points comprising the at least one radiopaque marker element in the x-ray and 3D surface scanning image, respectively, to correlate the x-ray and the 3D surface scanning images to each other based on the identified at least three radiopaque points and to form compiled information comprising information from the correlated x-ray and 3D surface scanning images and wherein the system further comprises a processing element (311) arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images and wherein the processing element (311) is further arranged to determine data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants based on the positions of the radiopaque marker elements so that the at least one radiopaque marker element provides a support for the jaw customized guide in the jaw, wherein the at least one radiopaque marker element preferably is fastened in the jaw.
10. System according to claim 9, wherein the at least one radiopaque marker element comprises a pin.
11. System according to claim 10, wherein the pin is made of titan.
12. System according to claim 10 or 11, wherein the pin is threaded and arranged to be screwed in place.
13. System according to any of the claims 10 - 12, wherein the pin is made of a material suitable for fastening in bone.
14. System according to any of the claims 10 - 12, wherein the pin is made of a material suitable for fastening in soft tissue.
15. System according to any of the claims -10-14, wherein the radiopaque marker element further comprises a cover part fastened or fastenable to at least one of the pins.
16. System according to claim 15, wherein the at least one cover part is funnel shaped.
17. System according to claim 15 or 16, wherein the at least one cover part has a radio radiopaque contrast substantially corresponding to the radiopaque contrast of a tooth.
18. System according to any of the claims 9-17, wherein the processing element (311) is arranged to obtain the determined data for manufacture of a jaw customized guide in a format suitable for a 3D printer.
19. Jaw customized guide (600) for guiding mounting of permanent tooth implants in a jaw, said jaw customized guide having one or a plurality of recesses (610) for reception of a radiopaque marker element mounted to the jaw for securing positioning of the guide in the jaw, and one or a plurality of openings (611) for insert of tooth implants into the jaw.
20. Jaw customized guide according to claim 19, comprising parts 612 arranged to be spaced apart from a gingiva and mucous membrane when mounted to allow for irrigation.
21. Radiopaque marker element (400) for aiding mounting of a permanent tooth implants in a jaw, said radiopaque marker element having a first part (401) being fastenable in the jaw and/or a gingiva and a second part arranged to extend from a surface of the gingiva, wherein at least the second part has a radiopaque contrast corresponding to the radiopaque contrast of a tooth, wherein the radiopaque marker element comprises a pin (403) for fastening to a gingiva and/or the jaw.
22. Radiopaque marker element according to claim 21, wherein at least a first mounting part of the pin is threaded and arranged to be screwed into the jaw.
23. Radiopaque marker element according to claim 21 or 22, wherein the pin is made of titan.
24. Radiopaque marker element according to any of the claims 21 to 23, further comprising a cover part (404) arranged to be mounted on the second part of the pin arranged to extend from a surface of the gingiva.
25. Radiopaque marker element according to claim 24, wherein the at least one cover part is funnel shaped.
26. Radiopaque marker element according to claim 24 or 25, wherein the pin (403) comprises a second mounting part for mounting of the cover part to the pin.
27. Software for determining data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants, said software being arranged to
process an image set comprising an x-ray image and a 3D surface scanning image to identify at least three radiopaque points comprising at least one fastened marker element in the x-ray and 3D surface scanning image, respectively, correlate the x-ray and the 3D surface scanning images of the image set to each other based at least on the identified at least three radiopaque points, and form compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set, and determine the data for manufacture of the jaw customized guide based on the compiled information comprising information from the correlated x-ray and 3D surface scanning images of the image set, wherein the determination of data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants is based on the positions of the radiopaque marker elements so that the at least one radiopaque marker element provides a support for the jaw customized guide in the jaw, wherein the at least one radiopaque marker element preferably is fastened in the jaw.
PCT/SE2019/050045 2018-01-31 2019-01-23 Method for manufacture of a jaw customized guide, system for aiding mounting of tooth implants, jaw customized guide, a radiopaque marker element and software for determining data for manufacture of a jaw customized guide for guiding mounting of permanent tooth implants Ceased WO2019151923A1 (en)

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SE1850111-4 2018-01-31

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