WO2022036900A1 - Temporomandibular joint and mandible combined prosthesis - Google Patents

Abstract

A temporomandibular joint and mandible combined prosthesis, at least comprising a temporomandibular joint socket prosthesis (1), a mandibular prosthesis (2) and a joint head prosthesis (3). The mandibular prosthesis (2) comprises a mandibular ascending branch (22) and a mandibular extension part (21), the mandibular ascending branch (22) and the mandibular extension part (21) being connected to form an individualized simulated form of the mandibular ascending branch and at least part of the mandibular body; a tail end of the mandibular ascending branch (22) of the mandibular prosthesis (2) is fixedly connected to the joint head prosthesis (3); and by using a bending concave surface of the mandibular prosthesis (2) as an upper side, the middle part (B) of the mandibular prosthesis (2) is provided with a continuous or discontinuous perforated structure area (23). Temporomandibular joint function, mandibular form, dentition defects and other various types of temporomandibular joint-mandible combination defects can be individually repaired at the same time, so as to achieve the combined reconstruction of the temporomandibular joint-mandible-dentition.

Description

A temporomandibular joint and mandibular joint prosthesis technical field

The invention relates to the field of medical devices, in particular to a temporomandibular joint and a mandibular joint prosthesis.

Background technique

The temporomandibular joint (TMJ) is located in front of the tragus, adjacent to the base of the skull upward, and extends downward to the ascending mandibular ramus and mandibular body. When various lesions cause TMJ-mandibular joint defect or total mandible, it will lead to serious functional impairments such as mastication, swallowing, speech and breathing, and even death. How to repair temporomandibular joint function, mandibular shape and dentition defect simultaneously has always been a difficult point in the field of oral and maxillofacial surgery.

For temporomandibular joint-mandibular joint defects and total mandibular lesions, there are two main ways to repair and reconstruct them: autologous bone transplantation and prosthetic repair, and the former is the most widely used method at present. For autologous bone grafting, the mainstream approach is repair with vascularized or nonvascularized ilium, fibula, and reconstructed titanium plates. The main advantage of this method is that the technology is mature and the surgical operation is relatively fixed, but it has many inevitable disadvantages: (1) the fibula end serving as the head of the condyle is unstable, easy to dislocate and absorb, and cannot effectively restore joint function; (2) autologous bone The amount of alveolar bone is limited, and the height of the alveolar bone cannot be fully restored, which brings difficulties to the later dentition restoration. Compared with autologous bone transplantation, prosthetic repair is less traumatic and more stable in efficacy, which is an internationally recognized development trend. At present, TMJ Concepts in the United States has initially developed a temporomandibular joint-mandibular extension prosthesis, which is used to repair the function of the temporomandibular joint and the shape of the mandible at the same time. The main advantages of this prosthesis are that it does not require autologous bone, the surgical trauma is small, and the function of the temporomandibular joint is well recovered, but it has the disadvantage of being unable to carry out later dental implantation and dentition restoration.

SUMMARY OF THE INVENTION

In view of the above-mentioned shortcomings of the prior art, the purpose of the present invention is to provide a temporomandibular joint and mandibular joint prosthesis. The temporomandibular joint-mandibular joint prosthesis can be designed according to different defect ranges, which can restore the structure and function of the temporomandibular joint, the shape of the mandible, the height of the alveolar bone, and achieve the joint repair of the temporomandibular joint-mandibular bone-dentition. .

The present invention provides a temporomandibular joint and mandibular joint prosthesis, the joint prosthesis at least includes:

A temporomandibular joint socket prosthesis, a mandibular bone prosthesis, and a joint head prosthesis, the temporomandibular joint socket prosthesis comprising a connected zygomatic arch retention portion and a joint socket functional portion, the zygomatic arch retention portion comprising On the zygomatic arch fitting surface, the joint socket function part and the joint head prosthesis are concave and convex to form a core area of joint motion; the mandibular prosthesis includes a mandibular ascending ramus and a mandibular extension, and the mandibular ascending ramus and mandibular extension The mandibular prosthesis is connected with the mandibular ascending ramus and at least part of the mandibular body shape; the end of the mandibular prosthesis is fixedly connected with the articular head prosthesis; the bending concave surface of the mandibular prosthesis is the upper part. On the side, the middle part of the mandibular prosthesis is provided with a continuous or discontinuous porous structure area.

As mentioned above, the temporomandibular joint and mandibular joint prosthesis of the present invention has the following beneficial effects:

(1) Its temporomandibular joint socket prosthesis and joint head prosthesis can effectively repair the normal anatomical structure of the temporomandibular joint, and restore the patient's chewing, speech, movement and other functions;

(2) The mandibular ascending ramus can effectively repair the contour and shape of the mandibular ascending ramus; its porous structure area is conducive to the attachment of the masseter and medial pterygoid muscles, avoiding the exposure of the prosthesis and restoring the bite force of the patient.

(3) The mandibular extension and the autologous bone together restore the height of the mandible and alveolar bone, making it possible for the later dental implantation and dentition defect repair. The porous structure area in the middle is conducive to the attachment of the mandibular hyoid muscle and the platysma, avoiding the exposure of the prosthesis and restoring the corresponding muscle function and facial shape of the patient.

(4) The mandibular extension can be individually extended according to the scope and size of the temporomandibular joint-mandibular joint defect, so as to adapt to the repair of various types of joint defects, and even full mandibular reconstruction.

Based on this, the present invention can individually repair various temporomandibular joint-mandibular joint defects of temporomandibular joint function, mandibular bone shape, dentition defects, etc., in order to achieve joint reconstruction of temporomandibular joint-mandibular bone-dentition.

Description of drawings

FIG. 1 is a schematic structural diagram of a temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 2 is a schematic structural diagram (side view) of a temporomandibular joint socket prosthesis of a temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 3 is a schematic structural diagram (front view) of a temporomandibular joint socket prosthesis of a temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 4 is a schematic diagram of a joint head prosthesis of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 5 is a schematic view of the external side of the mandibular prosthesis of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.

6 is a schematic diagram showing the inner side of the mandibular prosthesis of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 7 is a schematic diagram showing the partial structure of the mandibular extension part of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 8 is a schematic diagram showing the partial structure of the mandibular extension of the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention (after dental implantation).

Fig. 9a is a schematic structural diagram of a mandibular prosthesis with different lengths of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.

9b is a schematic structural diagram of a mandibular prosthesis with different lengths of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 9c is a schematic structural diagram of a mandibular prosthesis with different lengths of a temporomandibular joint and a mandibular joint prosthesis according to an embodiment of the present invention.

FIG. 9d is a schematic diagram showing the structure of the mandibular extension part of the temporomandibular joint and mandibular joint prosthesis having the same length as the individual mandibular body according to an embodiment of the present invention.

FIG. 10 is a schematic structural diagram of a temporomandibular joint and mandibular joint prosthesis (full mandible) according to an embodiment of the present invention.

Component label description

1 Temporomandibular joint socket prosthesis

11 Zygomatic arch retention

12 articular glenoid function department

13 Bone surface of the joint socket

14 The motor function surface of the joint socket

2 mandibular prosthesis

21 Jaw extension

211 Jaw retention

22 Ascending mandibular ramus

23 The porous structure region

24 Contact layer

3 articular head prosthesis

4 nail holes

A Upper part

B middle

C lower part

5 Autologous bone

6 teeth

detailed description

The embodiments of the present invention are described below by specific embodiments, and those skilled in the art can easily understand other advantages and effects of the present invention from the contents disclosed in this specification.

See Figures 1 through 10. It should be noted that the structures, proportions, sizes, etc. shown in the drawings in this specification are only used to cooperate with the contents disclosed in the specification, so as to be understood and read by those who are familiar with the technology, and are not used to limit the implementation of the present invention. Restricted conditions, it does not have technical substantive significance, any structural modification, proportional relationship change or size adjustment, without affecting the effect that the present invention can produce and the purpose that can be achieved, should still fall within the present invention. The disclosed technical content must be within the scope of coverage. At the same time, the terms such as "up", "down", "left", "right", "middle" and "one" quoted in this specification are only for the convenience of description and clarity, and are not used to limit this specification. The implementable scope of the invention, and the change or adjustment of the relative relationship thereof, shall also be regarded as the implementable scope of the present invention without substantially changing the technical content.

As shown in FIG. 1 , the temporomandibular joint and mandibular joint prosthesis according to an embodiment of the present invention at least includes:

A temporomandibular joint socket prosthesis 1, a mandibular bone prosthesis 2 and a joint head prosthesis 3, the temporomandibular joint socket prosthesis includes a zygomatic arch retention part 11 and a joint socket functional part 12 connected, the zygomatic arch-retaining part 12 The arch retention part 11 includes a zygomatic arch fitting surface, and the joint socket functional part 12 and the joint head prosthesis 3 cooperate in concave and convex to form a core area of joint motion; as shown in Figures 5 and 6, the mandibular prosthesis 2. It includes a mandibular ascending ramus 22 and a mandibular extension portion 21. The mandibular ascending ramus 22 and the mandibular extending portion 21 are connected to form an individualized simulation of the mandibular ascending ramus and at least part of the mandibular body shape; The end of the branch 22 is fixedly connected with the joint head prosthesis 3; the mandibular prosthesis 2 is divided into an upper part A, a middle part B and a lower part C with the bent concave surface of the mandibular prosthesis 2 as the upper side. The middle part B of the prosthesis 2 is provided with a continuous or discontinuous porous structure region 23 .

The zygomatic arch fitting surface is used for fitting with the autologous zygomatic arch.

The meaning of "individualization" in the present invention means that the shape of the autologous bone of the user is different, and the combined prosthesis or the components of the combined prosthesis can be adapted to different users. Optionally, the user's autologous bone can be scanned by techniques such as CT scanning, then a three-dimensional model and a prosthesis prototype can be established, and the combined prosthesis or the components of the combined prosthesis can be obtained by 3D printing and 5-axis finishing.

Further, forming the individualized simulated mandibular ramus and at least part of the mandibular body shape means that the shape of the mandibular prosthesis 2 is made by imitating at least part of the structure of the user's own mandible. Ascending mandibular ramus and at least part of mandibular body morphology means: one side is complete mandibular ascending ramus, and part or full length of mandibular body connected to this side mandibular ascending ramus; further, when complete mandibular ramus is included When the ascending ramus, and the full length of the mandibular body connected to the lateral mandibular ascending ramus, may also include the other side partial or complete mandibular ascending ramus.

The length of the mandibular prosthesis 2 can be flexibly set as required. It can be set according to the size of the mandibular defect of the user. Specifically, the mandible of the human body includes the ascending mandibular ramus and the mandibular body. Taking the central axis of the human body (dotted line in Fig. 9a) as a reference, as shown in Fig. 9a, the length of the mandibular prosthesis 2 may be the same as the following length Identical: The length of the user's mandible extending from the ascending ramus to the mandibular body of the midline of the human body. As shown in Fig. 9b, the length of the mandibular prosthesis 2 may be less than the length of the user's mandible extending from the mandibular ramus to the mandibular body, which is the central axis of the human body. As shown in Fig. 9c, the length of the mandibular prosthesis 2 may be greater than the following lengths: the length of the user's mandibular ascending ramus extending to the mandible of the mandibular body part of the central axis of the human body; The length of the mandible extending to the ascending ramus of the mandible on the other side of the central axis of the body.

Further, as shown in Fig. 9d, the combined prosthesis includes two temporomandibular joint socket prostheses 1 and two joint head prostheses; the mandibular prosthesis 2 includes two mandibular ascending ramus 22, the mandibular prosthesis The length of the extension portion is the same as that of the individualized mandibular body, and one end of each mandibular ascending branch 22 is connected to both ends of the mandibular body respectively to form an individualized simulated bilateral temporomandibular joint and full mandibular shape. Each joint head prosthesis is respectively fixedly connected with the end of the mandibular ascending branch 22 of the mandibular prosthesis 2 .

As shown in FIG. 2 and FIG. 3 , the joint socket functional part 12 includes a joint socket bone surface 13 that can fit with autologous bone and a joint socket motor function surface 14 for concave-convex matching with the joint head prosthesis 3. The joint socket motion function surface 14 is an arc surface. The bone surface 13 of the joint socket is designed to fit the human joint socket and joint nodules individually; the joint socket motion function surface 14 cooperates with the joint head prosthesis, and the joint head can be in the joint socket part. The movement functional surface 14 performs relative movement. The arc of the joint socket motion function surface 14 may be 5°-30°.

The joint socket function part and the joint head are used to restore the motion function of the temporomandibular joint. The joint socket part and the zygomatic arch retention part are used for repairing the joint socket of the human body, and the joint head is used for repairing the human body's condyle.

The main function of the porous structure area is to reduce the weight of the prosthesis, facilitate the expansion of the muscles, restore part of the bite force, and facilitate the attachment of the masseter, medial pterygoid muscle, and platysma muscle.

In a preferred embodiment, the upper and lower parts of the mandibular ascending branch 22 are solid, and the middle part of the mandibular ascending branch 22 is provided with a continuous or discontinuous porous structure area 23; and/or, the mandibular extension part The upper and lower parts of 21 are solid, and the middle part of the mandibular extension 21 is provided with a continuous or discontinuous porous structure region 23 .

Further, the porous structure region 23 of the mandibular ascending branch is provided on the side close to the mandibular extension 21 .

Optionally, the middle portion B of the mandibular extension portion 21 is provided with a continuous porous structure region 23 , which is continuous with the porous structure region of the mandibular ascending branch portion 22 .

Further, the porous structure region 23 includes a hollow structure formed by many through holes, and the pore size of the through holes is 400-800 μm.

The volume of the mandibular prosthesis occupied by the porous structure area may be set as required, for example, it may be 1/3 of the volume of the mandibular prosthesis. It is guaranteed to reduce the weight of the prosthesis and facilitate muscle expansion, and restore part of the occlusal force.

The shape of the through hole of the porous structure region is not limited, for example, it can be a circular hole or a polygonal hole. Such as quadrilateral holes, pentagonal holes, hexagonal holes, etc.

The lower part of the mandibular prosthesis is solid, which is a simulation design of the lower edge of the mandible of the human body, which is beneficial to the shape restoration of the face.

Optionally, a mandibular retaining portion 211 is connected to the end of the mandibular extension portion 21 of the mandibular prosthesis 2 . For fixation with the mandible.

Preferably, as shown in FIG. 5 and FIG. 6 , the side of the mandibular prosthesis that adheres to the autologous bone is the inner side, and the upper and/or lower inner side of the mandibular ascending ramus 22 is the contact layer 24 , so The contact layer is a porous layer or a rough surface.

The contact layer can be obtained by surface treatment techniques such as sandblasting, or directly printed by 3D printing.

Further preferably, as shown in FIG. 5 and FIG. 6 , the inner surface of the upper part of the mandibular extension part 21 is the contact layer 24 . As shown in FIGS. 7 and 8 , the porous layer allows the prosthesis to form firm osseointegration with the autologous bone 5 . The height of the mandible and the alveolar bone is jointly restored by the implanted autologous bone and the combined prosthesis, which is beneficial to the later stage of dental implantation and dentition restoration.

Optionally, the inner surface of the mandibular retaining portion 211 is the contact layer 24 .

Optionally, when the contact layer 24 is a porous layer, the thickness of the contact layer 24 is 0.5-1 mm. Conducive to the formation of firm osseointegration between the prosthesis and the autologous bone.

Optionally, when the contact layer 24 is a porous layer, the contact layer 24 includes many blind holes, and the pore size of the blind holes is 400-800 μm.

When the contact layer 24 has a rough surface, the contact layer 24 has an uneven surface, and Ra is between 1.5-3.0 μm.

The upper part of the mandibular prosthesis is in a shape that can fit the autologous bone individually.

The upper, middle and lower parts of the mandibular prosthesis and the autologous bone of the upper inner side jointly restore the height of the mandible and provide sufficient bone height and width for post-implantation repair.

In one embodiment, the zygomatic arch retaining portion 11 and the articular socket functional portion 12 are integrally connected, the zygomatic arch retaining portion 11 is made of titanium alloy, and the articular fossa functional portion 12 is made of ultra-high molecular weight Polyethylene material. For details, please refer to 201620127314.2.

In one embodiment, the zygomatic arch retaining portion 11 and the joint socket functional portion 12 are integrally connected, and both are made of polyethylene.

As shown in FIG. 1 , the upper part of the mandibular prosthesis is provided with a nail hole 4 for fixing with autologous bone. Optionally, the number of the nail holes 4 is 8-14.

As shown in FIG. 1 , the mandibular retaining portion 211 is provided with a nail hole 4 for fixing with the mandible. Optionally, the number of the nail holes 4 is 4-5.

Optionally, as shown in FIG. 1 , the zygomatic arch retaining portion is provided with a nail hole 4 for fixing with the zygomatic arch. Optionally, the number of the nail holes 4 is 5-7.

Optionally, as shown in FIG. 4 , the joint head prosthesis is a hollow cylindrical structure. Can be cylindrical.

The diameter of the joint head prosthesis may be 8-12mm; the height may be 10-14mm.

The hollow structure can reduce weight. Taking the connecting end of the joint head prosthesis 3 and the mandibular ascending branch as the bottom end, the bottom surface area of the hollow cavity of the joint head prosthesis 3 is larger than the area of the upper surface of the joint head prosthesis, and the taper can be 8-10°

The joint head prosthesis and the end of the mandibular ascending branch are nested and connected. Taper connections can be used.

When in use, fit the zygomatic arch retention part and the mandibular retention part to the surface of the human zygomatic arch and mandible respectively, insert the bone nails through the nail holes for fixation, match the joint head prosthesis with the functional part of the joint socket, and use the mandibular prosthesis. Then fix the lower human autologous bone in the corresponding position.

In one embodiment, as shown in FIG. 10 , the combined prosthesis includes two temporomandibular joint socket prostheses 1 and two articular head prostheses; the mandibular prosthesis 2 includes two mandibular ascending branches 22 , the length of the mandibular extension is the same as the length of the individual mandibular body, and one end of each mandibular ascending branch 22 is connected to the two ends of the mandibular body respectively to form an individualized simulated bilateral temporomandibular joint and full mandibular shape.

When in use, fit the zygomatic arch retention part and the mandibular retention part to the surface of the human zygomatic arch and mandible respectively, insert the bone nails through the nail holes for fixation, match the joint head prosthesis with the functional part of the joint socket, and use the mandibular prosthesis. Then fix the lower human autologous bone in the corresponding position.

The above-mentioned embodiments merely illustrate the principles and effects of the present invention, but are not intended to limit the present invention. Anyone skilled in the art can modify or change the above embodiments without departing from the spirit and scope of the present invention. Therefore, all equivalent modifications or changes made by those with ordinary knowledge in the technical field without departing from the spirit and technical idea disclosed in the present invention should still be covered by the claims of the present invention.

Claims (12)

A temporomandibular joint and mandibular joint prosthesis, characterized in that the joint prosthesis at least comprises: A temporomandibular socket prosthesis (1), a mandibular prosthesis (2), and a articular head prosthesis (3), the temporomandibular socket prosthesis (1) including an adjoining zygomatic arch retainer (11) ) and a joint socket functional part (12), the zygomatic arch retention part (11) includes a zygomatic arch fitting surface, and the joint socket functional part (12) and the joint head prosthesis (3) cooperate in concave and convex form to form a joint Movement core area; the mandibular prosthesis (2) includes a mandibular ascending branch (22) and a mandibular extension (21), and the mandibular ascending branch (22) and the mandibular extension (21) are connected to form an individualized artificial mandibular ascending the shape of the mandibular ramus and at least part of the mandibular body; the end of the mandibular ascending ramus (22) of the mandibular prosthesis (2) is fixedly connected with the articular head prosthesis (3); The folded concave surface is the upper side, and the middle part of the mandibular prosthesis (2) is provided with a continuous or discontinuous porous structure region (23). The temporomandibular joint and mandibular joint prosthesis according to claim 1, characterized in that the upper and lower parts of the mandibular ascending ramus (22) are solid, and the middle part of the mandibular ascending ramus (22) is provided with continuous or irregular A continuous porous structure region (23); and/or, the upper and lower parts of the mandibular extension (21) are solid, and a continuous or discontinuous porous structure region (23) is provided in the middle of the mandibular extension (21) ). The temporomandibular joint and mandibular joint prosthesis according to claim 1 or 2, wherein the porous structure region (23) comprises a hollow structure formed by many through holes, and the pore size of the through holes is 400-800 μm . The temporomandibular joint and mandibular joint prosthesis according to claim 2, characterized in that, a continuous porous structure area (23) is provided in the middle of the mandibular extension (21), and is connected with the mandibular ascending branch (21). 22) The porous structure region is continuous. The temporomandibular joint and mandibular joint prosthesis according to claim 1, characterized in that, the mandibular extension part (21) end of the mandibular prosthesis (2) is connected with a mandibular retaining part (211). The temporomandibular joint and mandibular joint prosthesis according to claim 1, characterized in that, the upper part of the mandibular ascending ramus (22) and/ Or the inner side of the lower part is a porous layer (24). The temporomandibular joint and combined mandibular prosthesis according to claim 1, wherein the inner surface of the upper part of the mandibular extension (21) is a contact layer (24), and the contact surface is a porous layer or a rough surface surface. The temporomandibular joint and mandibular joint prosthesis according to claim 5, wherein the inner surface of the mandibular retaining portion (211) is a contact layer (24). The temporomandibular joint and mandibular joint prosthesis according to any one of claims 6-8, further comprising one or more of the following features: 1) When the contact layer (24) is a porous layer, the thickness of the contact layer (24) is 0.5-1 mm; 2) When the contact layer (24) is a porous layer, the contact layer (24) includes many blind holes, and the pore size of the blind holes is 400-800 μm; 3) When the contact layer (24) is a rough surface (24), the contact layer (24) is an uneven surface, and Ra is 1.5-3.0 μm. The temporomandibular joint and combined mandibular prosthesis of claim 1, further comprising one or more of the following features: 1) the upper part of the mandibular prosthesis (2) is provided with a nail hole (4) for fixing with autologous bone; 2) The mandibular retaining portion (211) is provided with a nail hole (4) for fixing with the mandible; 3) the zygomatic arch retaining portion (11) is provided with a nail hole (4) for fixing with the zygomatic arch; 4) The length of the mandibular prosthesis (2) is set according to the range of the mandibular defect to be used. The temporomandibular joint and mandibular joint prosthesis according to claim 1, wherein the joint head prosthesis (3) is a hollow structure. The temporomandibular joint and mandibular joint prosthesis according to claim 1, characterized in that, the joint prosthesis comprises two temporomandibular joint socket prostheses (1) and two joint head prostheses; The prosthesis (2) comprises two mandibular ascending branches (22), the length of the mandibular extension is the same as the length of the individual mandibular body, and one end of each mandibular ascending branch (22) is respectively connected to two ends of the mandibular body to form an individual Simulation of bilateral temporomandibular joints and full mandibular morphology.

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