WO2025170477A1 - Dental implant guide systems and method of implanting a fixed dental prosthesis - Google Patents

Abstract

The present invention discloses a dental implant guide system comprising a dental implant guide and three variably occurring accessories: a base plate, an index guide, and a transport guide, wherein the components of the dental implant guide system are used in a stackable and modular configuration or a non-stackable and sequential configuration. The dental implant guide herein disclosed consists of a universal tooth-shaped sleeveless implant guide that converts to an immediate fixed dental prosthesis. The method of implanting a fixed dental prosthesis using the dental implant guide systems of the present invention are also herein disclosed.

Description

DENTAL IMPLANT GUIDE SYSTEMS AND METHOD OF IMPLANTING A FIXED DENTAL PROSTHESIS

The present invention falls within the field of dental implantology and discloses dental implant guide systems comprising a dental implant guide and three variably occurring accessories: a base plate, an index guide, and a transport guide. The methods of implanting a fixed dental prosthesis using the dental implant guide systems of the present invention are also herein disclosed.

The dental implant guide herein disclosed consists of a universal tooth-shaped sleeveless dental implant guide that converts to an immediate fixed dental prosthesis. The components of the dental implant guide systems are used in a stackable and modular configuration or a non-stackable and sequential configuration.

Implant surgical guides have revolutionized dental implant surgery, providing increased precision and predictability in the placement of implants. The evolution of these guides can be traced back to the early days of dental implantology, with significant advancements in recent years due to technological improvements such as computer-aided design (CAD) and computer-aided manufacturing (CAM) (D'Souza & Aras, 2012; Van Assche et al., 2012).

The use of Computer Assisted Guided Surgery (CAGS) is becoming more widespread in day-to-day clinical practice (Chen, Li, Lin, & Wang, 2020). This technology allows for the virtual planning of implant placement in a three-dimensional (3D) setting that takes into account future prosthetic considerations (Arisan , Karabuda , & Özdemir, 2010; Vercruyssen et al., 2014).

The most common practice in static CAGS involves the production of templates using either 3D printing or milling methods that can be equipped with cylindrical metallic conduits or sleeves (Joda, Derksen, Wittneben, & Kuehl, 2018; Schneider et al., 2009). During surgery, these sleeves guide the direction and depth of drills, aligning the implant placement with the preoperative virtual plan. These templates can also be fabricated without a metal sleeve.

Studies have suggested that both sleeve and sleeveless templates offer comparable accuracy for implant placement, with potential differences related to specifics of surgical protocol, case features, materials, and techniques (Tallarico M. et al, 2021). In a study by Van Assche et al. (2012), sleeveless guides were found to have a small but potentially clinically significant advantage in terms of accuracy over traditional sleeved guides.

In another study, sleeveless guides demonstrated potentially higher precision and offered cost-effectiveness, as minimal differences in implant deviations suggest cost reductions without sacrificing accuracy (Coleman R. Adams BA et. al, 2022).

CAGS also allows for a less invasive surgical approach by avoiding flap reflection (Malo, de Araujo Nobre, & Lopes, 2007; Vercruyssen et al., 2015), and permits the immediate installation of a prefabricated CAD / CAM prosthesis (Lewis et al., 2015; Sun et al., 2018).

In recent years, the precision of CAGS has been extensively examined, and various factors have been found to influence its accuracy. These factors include the quality of Cone-Beam Computed Tomography (CBCT) images and dental casts/intraoral scans (Lin et al., 2013; Schneider et al., 2009), image superimposition (Cristache & Gurbanescu , 2017; Vercruyssen et al., 2014), the surgical template fabrication method (Bencharit et al., 2018; Van Assche et al., 2012), guide fixation and support (Raico Gallardo et al., 2017), and the inherent inaccuracies of guided surgical kits (Cassetta, Di Mambro, Giansanti, Stefanelli, & Cavallini, 2013; D'Haese et al., 2017), among other variables. Although it's impossible to completely eliminate deviations, sCAGS generally provides significantly better accuracy than freehand methods for both delayed and immediate implant placements (Chen et al., 2018; D'Haese et al., 2012).

As for the best CAGS approach, a meta-analysis suggests that the best accuracy is achieved when a fully guided approach is used, followed by half-guided surgery, with freehand providing the poorest results (Jordi Gargallo et al., 2020).

Another meta-analysis by Al Yafi et al. (2020) demonstrated that freehand surgery had a higher risk of complications and poorer long-term outcomes when compared to fully guided surgery. This approach can result in a more accurate implant placement, leading to better long-term success and reduced risk of complications. Nevertheless, fully guided surgery can be more time-consuming and costly due to the need for additional equipment and planning (Vercruyssen et al., 2014).

Implant surgical guides can be classified based on their support into 3 main types: mucosa- supported, tooth-supported, and bone-supported guides.

Mucosa-supported guides leverage soft tissue for support, suitable for fully edentulous patients due to their less invasive approach (Tahmaseb et al., 2014). However, their accuracy can be compromised by tissue movement during surgery, and they may offer less stability compared to other guide types (Cassetta et al., 2012).

Tooth-supported guides, relying on existing natural teeth, offer high stability and accuracy. They are less invasive than bone-supported guides but are limited to partially edentulous patients with stable remaining teeth (Tahmaseb et al., 2014; Cassetta et al., 2012).

Bone-supported guides, directly interacting with the underlying bone, provide excellent stability and accuracy but require a more invasive approach, requiring large flaps and superior surgical skills (Tahmaseb et al., 2014; Cassetta et al., 2012).

All three guide types, despite their differences, have demonstrated effectiveness for implant placement. The complexity of planning and surgery generally escalates from mucosa to tooth to bone-supported guides. In a Meta-analysis it was found that Muco-supported guides in the Maxilla presented higher post-op implant deviation values, but in all 3 types of surgical guide these values are within clinically accepted limits (M. N. Gerhardt et. al, 2021).

Stackable guides consist of multiple components that can be assembled, disassembled, and replaced during surgery. This approach allows surgeons to adapt and customize the guide based on the specific needs and requirements of each surgical step (Pozzi et al., 2016).

The selection of stackable or non-stackable surgical guides for implant surgeries hinges on the complexity of the case, providing varying degrees of procedural flexibility. Stackable guides, also known as modular guides, have separate components for different surgical stages, offering high adaptability for complex cases involving multiple implants or challenging anatomical situations. These guides, however, may demand additional surgical steps and increased overall procedure time (Pozzi et al., 2016; Van Assche et al., 2012).

On the other hand, non-stackable guides are single-piece entities designed for a simplified sequence of steps. They are more streamlined and straightforward, reducing surgical time and complexity, making them suitable for less complex cases. However, their simplicity may limit their adaptability for more complex clinical situations (Noharet et al., 2019; Widmann & Bale, 2006; Tahmaseb et al., 2018).

The evolution of technologies such as CAD / CAM and 3D printing have revolutionized implant surgical guides, enabling customization with increased precision, and shortened production times (Di Giacomo et al., 2012; Mangano et al., 2016; Almeida et al., 2019).

The present invention provides dental implant guide systems comprising a dental implant guide and three variably occurring accessories: a base plate, an index guide, and a transport guide, wherein the components of the dental implant guide systems are used in a stackable and modular configuration or a non-stackable and sequential configuration.

The dental implant guide herein disclosed consists of a universal tooth-shaped sleeveless implant guide that converts to an immediate fixed dental prosthesis. The methods of implanting a fixed dental prosthesis using the dental implant guide systems of the present invention are also herein disclosed.

While conventional guided dental implant surgery is generally successful, it presents clinical challenges due to its multi-step process that is prone to errors due to its sequential complexity. This makes it a less attractive first choice for dental surgeons.

Prosthetically-driven implantology is a fundamental principle of guided implant treatments. However, current fully guided implant systems are directly driven mainly during the CAD phase. With today’s solutions, guided implant surgery is only indirectly guided by the prosthesis, as it requires a dedicated implant guide. Moreover, the final seating of the prosthesis needs an additional clinical step.

The present invention discloses dental implant guide systems as an innovative approach to guided implant surgery and guided prosthetic restoration. The dental implant guide systems consider the compatibility between the dental implant guide and the prosthesis, being versatile enough to accommodate the guided tubes within the body of the latter without the need for two separate devices.

By providing dental implant guide systems wherein drilling, implant placement and abutment installation all happen within the prosthetic device, the present invention allows clinicians to optimize the planning and execution of the procedure without having to compromise the initial treatment concept.

This compatibility introduces clinical simplicity by eliminating a surgical step compared to current modular or non-modular systems. In turn, this adaptability contributes to the improved accuracy, efficiency, and predictability of the dental implant guide systems herein proposed, ultimately enhancing the overall treatment experience for both the clinician and the patient.

The dental implant guide systems of the present invention represent an innovative advancement in guided dental implantology by integrating a universal tooth-shaped sleeveless implant guide with a dental prosthesis into a one-piece concept.

The design of the proposed dental implant guide systems (which excludes tubes, connectors, and other extensions) represents a significant departure from most previous concepts.

Drilling through the prosthesis harkens back to a straightforward concept in dentistry known as “crown down drilling”, making this system logical and intuitive for most practitioners. Crown down drilling also enhances the prosthetic emergence outcome by more accurately aligning the planned emergence profile with the actual one within the prosthesis.

This invention streamlines the chair-side workflow, allowing the practitioner to immediately pick up the prosthesis right after installing the abutments. Moreover, thanks to its design, this system enables a quicker finishing procedure that can be completed efficiently without compromising the quality of the final product.

Socket seating is another important consideration for a tooth-shaped guide, as extraction sockets can serve as an ideal seating bed for the guide device while trauma is minimized to soft tissue during implant bed preparation and placement. In classical guides, tissues are frequently torn or overly pressed during surgery, as soft tissue level guides struggle with.

In order to facilitate an understanding of the principles according to the embodiments of this invention, reference will be made to the illustrated embodiments in the Figures and the language used to describe them.

It should also be understood that there is no intention to limit the scope of the invention to the content of the Figures and that modifications to the inventive features illustrated herein, as well as additional applications of the illustrated principles and embodiments, which would normally occur to a person skilled in the art having possession of this description, are considered within the scope of the claimed invention.

Fig.1

represents the components of the stackable and modular dental implant guide system according to the first embodiment of the present invention, wherein (A) represents the base plate, (B) represents the index guide, (c) represents the dental implant guide, and (D) represents the transport guide.

Fig.2

represents the components of the non-stackable and sequential dental implant guide system according to the second embodiment of the present invention, wherein (A) represents the index guide, (B) represents the dental implant guide, and (C) represents the transport guide.

Fig.3

is an inclined top view of the base plate duly adapted to the baseline according to the first embodiment of the present invention.

Fig.4

is a top view of the base plate duly adapted to the baseline according to the first embodiment of the present invention.

Fig.5

is an inclined top view of the index guide duly assembled to the base plate according to the first embodiment of the present invention.

Fig.6

is a top view of the index guide duly assembled to the base plate according to the first embodiment of the present invention.

Fig.7

is an inclined top view of the dental implant guide in situ secured by the transport guide duly assembled to the base plate according to the first embodiment of the present invention.

Fig.8

is a top view of the dental implant guide in situ secured by the transport guide duly assembled to the base plate according to the first embodiment of the present invention.

Fig.9

is an inclined top view of the implant guide duly placed in the jaw according to the first embodiment of the present invention.

Fig.10

is a top view of the implant guide duly placed in the jaw according to the first embodiment of the present invention.

Fig.11

is an inclined top view of the index guide duly adapted to the baseline according to the second embodiment of the present invention.

Fig.12

is a top view of the index guide duly adapted to the baseline according to the second embodiment of the present invention.

Fig.13

is an inclined top view of the dental implant guide in situ secured by the transport guide according to the second embodiment of the present invention.

Fig.14

is a top view of the dental implant guide in situ secured by the transport guide according to the second embodiment of the present invention.

Fig.15

graphically represents the method of assembling and disassembling the stackable and modular dental implant guide system according to the first embodiment of the present invention.

Fig.16

graphically represents the method of assembling and disassembling the non-stackable and sequential dental implant guide system according to the second embodiment of the present invention.

The present invention discloses dental implant guide systems comprising a dental implant guide (1) and three variably occurring accessories: a base plate (2), an index guide (3), and a transport guide (4). The components of the dental implant guide systems are used in a stackable and modular configuration or a non-stackable and sequential configuration.

In a first embodiment of the present invention and as shown in , the stackable and modular dental implant guide system comprises:

– a dental implant guide (1);

– a base plate (2);

– an index guide (3); and

– a transport guide (4),

wherein the base plate (2) comprises a first anterior arch (20) connected to a first posterior arch (21) by at least a first connection bridge (22); wherein the first anterior arch (20) and the first posterior arch (21) comprise, each, at least three first rings (23), two arranged sideways and one arranged in the front, for fitting first skeletal fixation pins (5), and at least two second rings (24), arranged sideways, which are configured to be connected to corresponding rings from the index guide (3) and transport guide (4) for fitting second skeletal fixation pins (6) that simultaneously fixate the index guide (3) or the transport guide (4) to the base plate (2), and at least three first male-female connectors (25), which are configured to be connected to at least one of the index guide (3) or the transport guide (4);

wherein the index guide (3) comprises a second anterior arch (30) connected to a second posterior arch (31) by at least a second connection bridge (32); wherein the second anterior arch (30) and the second posterior arch (31) comprise, each, at least two third rings (33), arranged sideways, for fitting second skeletal fixation pins (6), and at least three second male-female connectors (35), which are configured to be connected to the base plate (2);

wherein the transport guide (4) comprises a third anterior arch (40) connected to a third posterior arch (41) by at least a third connection bridge (42); wherein the third anterior arch (40) and the third posterior arch (41) comprise, each, at least two fourth rings (43), arranged sideways, for fitting second skeletal fixation pins (6), and at least three third male-female connectors (45), which are configured to be connected to the base plate (2); and

wherein the dental implant guide (1), the base plate (2), the index guide (3) and the transport guide (4) are assembled and disassembled in a sequence deemed to clinically reproduce previously planned fixtures and prosthetic elements.

In the first embodiment of the present invention, the connection between the index guide (3) and the base plate (2) is performed by fitting the second skeletal fixation pin (6) into the third ring (33) of the index guide (3) and into the second ring (24) of the base plate (2). Optionally, a second connection between the index guide (3) and the base plate (2) is performed by fitting the respective first and second male-female connectors (25, 35). The connection between the index guide (3) and the base plate (2) is shown in Figures 5 and 6.

Also in the first embodiment of the present invention, the connection between the transport guide (4) and the base plate (2) is performed by fitting the second skeletal fixation pin (6) into the fourth ring (43) of the transport guide (4) and into the second ring (24) of the base plate (2). Optionally, a second connection between the transport guide (4) and the base plate (2) is performed by fitting the respective first and third male-female connectors (25, 45). The connection between the transport guide (4) and the base plate (2) is shown in Figures 7 and 8.

The base plate (2) is configured to serve as a stable spatial framework, allowing for the assembly and disassembly of the exchangeable guides (1, 3, 4) without losing skeletal references during surgical and prosthetic procedures.

As disclosed and as shown in Figures 3 and 4, the base plate comprises at least three first rings (23), at least two second rings (24) and at least three first male-female connectors (25) which provide extra anchorage for the index guide (3) and the transport guide (4).

In a second embodiment of the present invention and as shown in , the non-stackable and sequential dental implant guide system comprises:

– a dental implant guide (1);

– an index guide (3); and

– a transport guide (4),

wherein the dental implant guide (1) is a universal tooth-shaped implant guide comprising a plurality of channels (10) with a flat round plate around it;

wherein the index guide (3) comprises a second anterior arch (30) connected to a second posterior arch (31) by at least a second connection bridge (32); wherein the second anterior arch (30) and the second posterior arch (31) comprise, each, at least three third rings (33), arranged sideways, for fitting skeletal fixation pins (5);

wherein the transport guide (4) comprises a third anterior arch (40) connected to a third posterior arch (41) by at least a third connection bridge (42); wherein the third anterior arch (40) and the third posterior arch (41) comprise, each, at least two fourth rings (43), arranged sideways, for fitting skeletal fixation pins (5); and

wherein the dental implant guide (1), the index guide (3) and the transport guide (4) are assembled and disassembled in a sequence deemed to clinically reproduce previously planned fixtures and prosthetic elements.

In view of the ease understanding of the second embodiment of the present invention, the first skeletal fixation pins (5) are simply called skeletal fixation pins (5), since no second skeletal fixation pins (6) are used.

In the second embodiment of the present invention, the fixation of the index guide (3) to the patient dentition and jaw is performed directly via at least three skeletal fixation pins (5), as shown in Figures 11 and 12. This will set the ground for the fixation of the dental implant guide (1) via the transport guide (4), following dental extractions, as shown ins Figures 13 and 14. The latter will take the dental implant guide (1) to the pre-planned spacial position using the same skeletal fixation perforations previously drilled through the index guide (3).

In both embodiments of the present invention, the dental implant guide (1) is a universal tooth-shaped implant guide comprising a plurality of sleeveless channels (10) with a flat round plate around it and is configured to ensure that implant bed preparation, implant installation, abutment placement, and acrylic fixation to titanium cylinders take place within it.

The dental implant guide (1) varies based on the specific needs of the patient and the treatment plan, wherein its design is facially-driven and focused on optimizing esthetics, function, and phonetics.

From a prosthetic point of view, the dental implant guide (1) is a pontic-design prosthesis with no artificial gingiva, thus suitable for FP1 and FP2 full-arch implant prosthesis approach (i.e., prosthesis that seat directly onto fresh extraction sockets). From a biological point of view, this design easily adapts to post-extraction sockets, facilitating the soft tissue management and healing processes.

In preferred embodiments of the present invention, the dental implant guide (1) presents a sleeveless cylinder-shaped channel for each implant location, as well as a flat round plate that works as a vertical stop for each drill (thus ensuring both drill and implant depth to be according to plan).

In some embodiments of the present invention, the implant fixtures geometry is tapered with aggressive self-screwing threads in at least one section to increase peri-implant bone density and have an active apex. Such design features aim to increase bone-to-implant contact (BIC) and improve the chances of achieving high insertion torque for sufficient primary stability.

In some embodiments of the present invention, the abutment type is conical, which allows for easier prosthetic management and optimal angulation correction of a screwed-retained bridge. Moreover, the neck of such abutments is narrow to increase thickness of soft tissue collar around abutments. The use of narrow multi-unit conical abutments enables the prosthetic rehabilitation to be performed immediately after implant placement and facilitates passive fit of the prosthetic framework, while maximizing the quality of peri-implant soft tissues.

In some embodiments of the present invention, the implant-to-abutment connection should ensure adequate seal and minimal micro-movement between the implant and soft tissue level abutment, as well as guarantee enough horizontal space to accommodate more soft tissue growth around it. In preferred embodiments of the present invention, the implant-to-abutment connection type is a Cone Morse or indexed Conical connection with Platform Switch.

It is important to emphasize that the threads, abutment types and implant-to-abutment connections are well-known to a person skilled in the art. The dental implant guide system of the present invention allows the use of generic components and dental implants and the examples cited are mere recommendations.

The number of implants and their distribution are to be determined based on the specific clinical case and patient's anatomical conditions and vary from 1 to 10. The anteroposterior (A-P) spread should be maximized to ensure adequate support and stress distribution on the prosthesis and implants and vary from 1 implant to 1,5 teeth to 1 implant to 3 teeth.

The index guide (3) is configured to establish proper skeletal fixation using the pre-existing dentition as a reference.

In both embodiments, the index guide (3) comprises a second anterior arch (30) connected to a second posterior arch (31) by at least a second connection bridge (32); wherein the second anterior arch (30) and the second posterior arch (31) comprise, each, at least two third rings (33), arranged sideways, for fitting skeletal fixation pins (5). In the first embodiment of the present invention, the index guide (3) further comprises at least three second male-female connectors (35), which are configured to be connected to the base plate (2).

The transport guide (4) is configured to use the skeletal fixations to place the dental implant guide (1) in a pre-planned spatial position.

In both embodiments, the transport guide (4) comprises a third anterior arch (40) connected to a third posterior arch (41) by at least a third connection bridge (42); wherein the third anterior arch (40) and the third posterior arch (41) comprise, each, at least two fourth rings (43), arranged sideways, for fitting skeletal fixation pins (5). In the first embodiment of the present invention, the transport guide (4) further comprises at least three third male-female connectors (45), which are configured to be connected to the base plate (2).

The design of the index guide (3) and the transport guide (4) should ensure proper positioning and stability during the surgical and prosthetic phases.

The materials used for the dental implant guide systems of the present invention should provide adequate strength and durability for the immediate loading phase.

In preferred embodiments of the present invention, the dental implant guide (1) is milled, printed, or injected in acrylic resin, polyetheretherketone (PEEK), pecton, composite resin or ceromer. The base plate (2), the index guide (3) and the transport guide (4) are made of an acrylic resin, preferably polymethylmethacrylate (PMMA) or copolymers or composites thereof. Optionally, the base plate (2), the index guide (3) and the transport guide (4) are made of sintered metal or alloys selected from the group consisting of stainless steel, cobalt-chromium, nickel-titanium, zirconium, tantalum, magnesium, gold and platinum.

In preferred embodiments of the present invention, the fabrication process combines digital and analog techniques, including 3D printing and milling technologies, intraoral scanning, and relining with acrylic resin.

In a second aspect of the present invention and as shown in , it is disclosed a method of implanting a fixed dental prosthesis using the stackable and modular dental implant guide system comprising the steps of:

a. adapting the base plate (2) to the baseline;

b. adapting the index guide (3) onto the base plate (2);

c. drilling and placing the skeletal fixation pins (5);

d. removing the index guide (3) by dissassembling the non-dedicated skeletal fixation pins (6) and making dental extractions;

e. adapting the implant guide (1);

f. adapting the transport guide (4) onto de implant guide (1);

g. reattaching the non-dedicated skeletal fixation pins (6);

h. drilling and placing the implant fixtures;

i. screwing the abutments and metal cylinders;

j. performing prosthetic procedures to convert the dental implant guide (1) into the fixed dental prosthesis;

k. unscrewing the fixed dental prosthesis; and

l. removing the base plate (2).

In the method of implanting a fixed dental prosthesis using the stackable and modular dental implant guide system of the present invention, the skeletal fixation pins (5) may remain in place throughout the procedure or can be removed and reinserted when the guides are changed.

Even though the pins are exactly the same, the dedicated skeletal fixation pins which remain in place throughout the procedure are called first skeletal fixation pins (5) and the non-dedicated skeletal fixation pins which are removed and reinserted during procedure are called second skeletal fixation pins (6).

In another aspect of the present invention and as shown in , it is disclosed a method of implanting a fixed dental prosthesis using the non-stackable and sequential dental implant guide system comprising the steps of:

a. adapting the index guide (3) to the baseline;

b. drilling and placing the skeletal fixation pins (5);

c. removing the index guide (3) and making dental extractions;

d. adapting the implant guide (1) with the transport guide (4);

e. reattaching the skeletal fixation pins (5);

f. drilling and placing the implant fixtures;

g. screwing the abutments and metal cylinders;

h. performing prosthetic procedures to convert the dental implant guide (1) into the fixed dental prosthesis;

i. removing the skeletal fixation pins (5) and the transport guide (4); and

j. unscrewing the fixed dental prosthesis.

The methods of implanting a fixed dental prosthesis using the dental implant guide systems of the present invention are not surgical methods. Rather, they represent a new and inventive way of using a new and inventive system to place implants.

Although the dental implant guide systems of the present invention are used in the context of a surgery, it is possible to perform the same surgery without using the present invention. The dental implant guide systems herein disclosed act as a facilitator of the implant procedure, wherein the components fit onto models or onto other components in order to guarantee the reproduction of a prosthetic plan on a human being, as designed in CAD software.

The prosthetic procedures are not an object of the present invention. By means of information only, such prosthetic procedures are performed by relining the space around the metal cylinders with acrylic resin thus binding them with the dental implant guide (1), converting it into a fixed implant-supported dental prosthesis.

Designing protocol:

The steps for obtaining the dental implant guide systems are as follows:

a. Import intra-oral scans, DICOM files and facial photos or scans;

b. Superimposition of data;

c. Design of facially driven dental design that will digitally convert to the dental implant guide using a generic dental CAD design software in a subsequent step;

d. Export design as a 3D file;

e. Import DICOM data, the scan data and the facially driven dental design into a generic implant planning software;

f. Virtual planning of implants and skeletal fixation pins respecting the patient anatomy but having the facially driven dental design as a spatial reference;

g. Export all relevant planning elements as separate 3D files;

h. Import 3D files including the facially driven dental design into a generic open-source CAD software;

i. Merging the facially driven dental design with the 3D elements exported from the generic implant planning software and converting it into the dental implant guide systems using generic open-source CAD software;

j. for the first embodiment of the present invention, design the base plate using the baseline model as a template;

k. Design the index guide using the baseline model and the base plate (solely in the first embodiment of the present invention) as a template;

l. Design the transport guide using the baseline model and the dental implant guide as a template;

m. Export and 3D print the base plate (solely in the first embodiment of the invention), index guide, transport guide and control models, wherein the control models represent the baseline and the tooth extractions and are used to check the proper placement of the base plate (in the stackable embodiment) and the other guides (in both embodiments);

n. Export the dental implant guide systems file into a CAM software and mill it using a dedicated milling machine;

o. Perform lab work finish of all components; and

p. Test all printed / milled parts.

Similar to other implant surgical guide planning workflows, data collection should include 3 separate datasets: intra-oral scan data of patient mouth, DICOM data of patient jawbone and patient facial data (2D photos or 3D facial scan).

The 3 separate datasets are matched to create a digital twin of the patient. Matching occurs in a dedicated planning software capable of facially driven data integration via registration of two or more triangular meshes. If a 2D photo is used for facial data, the software should also allow for its superposition to the 3D scan data from the mouth of the patient.

A combination of open software and dedicated dental planning software is used to design the dental implant guide of the present invention and the additional auxiliary guides (base plate, index guide and transport guide).

Example using the non-stackable and sequential dental implant guide system

A 65-year-old female patient presented a terminal upper and lower dentition. In the upper jaw, teeth 13, 14, 15, 16, 17, 23, 26 and 27 were missing, and, in the lower jaw, she was missing teeth 34, 36, 37, 46, 47 and 48.

The patient further presented a generalized horizontal bone resorption pattern with tooth mobility on 16, 17, 32, 31, 41, 42 and 35. She was under tight monitoring and control of her periodontal condition and after discussing all treatment alternatives, she expressed the desire to restore the missing teeth with a full arch dental implant bridge.

The patient reported no significant medical history, allergies, or contraindications for implant therapy. Clinical and radiographic examination revealed adequate bone volume and quality for full arch implant treatment.

Preoperative planning:

A cone-beam computed tomography (CBCT) scan was taken to evaluate the patient’s bone volume, adjacent teeth, and vital anatomical structures. A digital impression of the patient’s arch was obtained using an intraoral scanner. The CBCT data and digital impression were merged, and computer-aided design (CAD) software was used to create a facially driven dental design.

The implant position, angulation, and dimensions were determined using a specialized implant planning software (BlueskyPlan, Blueskybio inc.), using the planned facially driven dental design as a spatial reference. A narrow neck straight Multi-Unit abutment was chosen for this case to facilitate immediate prosthetic rehabilitation with the dental implant guide system of the present invention.

Surgical guide fabrication:

The virtual implant plan and the 3D design of the facially driven dental design were exported to a third-party open-source software (Autodesk Meshmixer). The dental implant guide, the index guide and the transport guide were designed using the protocol previously described and then 3D printed using a biocompatible resin material.

Pre-surgical preparation:

The patient was instructed to rinse with 0.12 % chlorhexidine mouthwash for 1 minute prior to surgery. Local anesthesia was administered using 2 % lidocaine with 1:100,000 epinephrine.

Surgical procedure:

The surgical procedure followed the clinical protocol previously described. A flapless approach was chosen in post extraction sockets to minimize tissue trauma and accelerate the healing process. As for edentulous areas, a modified palatal incision was made and a flap was reflected and kept under the buccal aspect of the transport guide and the dental implant guide, bilaterally.

The index guide was adapted, and fixation pins were drilled and tried in prior to palatal incisions and flap reflection. This ensured maximum adaptation of index guide, duplicating that of the simulation on the control model. This flap design enabled an adequate volume of soft tissue underneath the fixed dental prosthesis, eliminating the need for additional soft tissue grafting procedures at these sites.

After placement of the dental implant guide, a drilling protocol for each implant was performed according to the manufacturer instructions, until the implant reached the desired position and primary stability. The dental implant guide stabilization during the procedure was ensured due to placement of extra fixations, provided by the screwable guided implant drivers of the brand. These were strategically placed in the molar and incisor area, also sequentially.

Prosthetic phase:

Following implant placement, the dental implant guide was converted into a long-term screwable fixed implant prosthesis, using the following procedure: narrow neck straight Multi-Unit abutments were directly installed through the prosthesis using a long multi-unit screwdriver, temporary titanium cylinders were screwed using a similar rationale, auto-curing PMMA resin was loaded into a syringe and injected between the prosthesis and the temporary cylinders.

After waiting for the time of set according to manufacturer instructions, the prosthesis was unscrewed, and temporary cylinders inspected to ensure no micro-mobility was present. The fixed dental prosthesis was then finished using a chair-side procedure with more PMMA resin followed by a 2-step mechanical polishing procedure.

Postoperative care:

The patient was prescribed an 8-day course of amoxicillin 500 mg every 8 hours and 3-day course of ibuprofen 600 mg every 12 hours, combined with paracetamol 1g as SOS if needed for pain management. The patient was instructed to continue rinsing with chlorhexidine mouthwash twice daily for two weeks and to maintain a soft diet for the first two weeks.

Follow-up and final restoration:

After a healing period of 3 months, the patient returned for the final restoration. The patient situation was digitalized with the following scans: jaw scan with provisional, jaw scan without provisional and with scan-markers for Multi-unit abutments, provisional scan, jaw scan of antagonist and bite registration.

Also, an abutment-level analog impression with PVS material was performed to ensure adequate digital analog position. The design of the definitive prosthesis in the software (Exocad) followed the initial plan and an adequate volume of tissue was present ensuring natural emergence profile of pontics.

A screw-retained full arch zirconia bridge was fabricated and milled from a Zr blank. The abutment and crown were torqued to the manufacturer’s recommended values, and the screw access hole was sealed with a composite resin. The patient was satisfied with the esthetic and functional outcome of the treatment.

The above-described subject matter is provided as an illustration of this invention and should not be interpreted in a limiting sense. The terminology used to describe preferred embodiments of this invention should not be construed to limit the invention to those particular embodiments.

As used in the description, definite and indefinite articles, in their singular form, are intended to encompass plural forms unless the context of the description explicitly indicates otherwise.

The indefinite articles “a” or “an” should generally be interpreted as “one or more” unless the sense of a singular embodiment is clearly defined in a specific situation.

It will be understood that the terms “comprise” and “include”, when used in this description, specify the presence of stated features, elements, components, steps, and operations but do not preclude the presence or addition of one or more other features, elements, components, steps, and operations.

As used throughout this patent application, the term “or” is used in an inclusive sense rather than an exclusive sense unless the exclusive sense is clearly defined in a specific situation. In this context, a phrase such as “X utilizes A or B” should be interpreted as including all relevant inclusive combinations.

All changes, as long as they do not modify the essential characteristics of the following claims, should be considered within the scope of protection of this invention.

a dental implant guide (1);

a base plate (2);

an index guide (3);

a transport guide (4),

a first skeletal fixation pin (5) or skeletal fixation pin (5),

a second skeletal fixation pins (6),

a sleeveless channel (10),

a first anterior arch (20)

a first posterior arch (21)

a first connection bridge (22)

a first ring (23)

a second ring (24)

a first male-female connector (25)

a second anterior arch (30)

a second posterior arch (31)

a second connection bridge (32)

a third ring (33)

a second male-female connector (35)

a third anterior arch (40)

a third posterior arch (41)

a third connection bridge (42)

a fourth ring (43)

a third male-female connector (45)

The citation list is as follows:

Non-Patent Literature

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Claims (14)

1. A stackable and modular dental implant guide system characterized by comprising:
   – a dental implant guide (1);
   – a base plate (2);
   – an index guide (3); and
   – a transport guide (4),
   wherein the dental implant guide (1) is a universal tooth-shaped implant guide comprising a plurality of sleeveless channels (10) with a flat round plate around it;
   wherein the base plate (2) comprises a first anterior arch (20) connected to a first posterior arch (21) by at least a first connection bridge (22); wherein the first anterior arch (20) and the first posterior arch (21) comprise, each, at least three first rings (23), two arranged sideways and one arranged in the front, for fitting first skeletal fixation pins (5), and at least two second rings (24), arranged sideways, which are configured to be connected to corresponding rings from the index guide (3) and transport guide (4) for fitting second skeletal fixation pins (6) that simultaneously fixate the index guide (3) or the transport guide (4) to the base plate (2), and at least three first male-female connectors (25), which are configured to be connected to at least one of the index guide (3) or the transport guide (4);
   wherein the index guide (3) comprises a second anterior arch (30) connected to a second posterior arch (31) by at least a second connection bridge (32); wherein the second anterior arch (30) and the second posterior arch (31) comprise, each, at least two third rings (33), arranged sideways, for fitting second skeletal fixation pins (6), and at least three second male-female connectors (35), which are configured to be connected to the base plate (2);
   wherein the transport guide (4) comprises a third anterior arch (40) connected to a third posterior arch (41) by at least a third connection bridge (42); wherein the third anterior arch (40) and the third posterior arch (41) comprise, each, at least two fourth rings (43), arranged sideways, for fitting second skeletal fixation pins (6), and at least three third male-female connectors (45), which are configured to be connected to the base plate (2); and
   wherein the dental implant guide (1), the base plate (2), the index guide (3) and the transport guide (4) are assembled and disassembled in a sequence deemed to clinically reproduce previously planned fixtures and prosthetic elements.
2. The stackable and modular dental implant guide system according to claim 1 characterized by the fact that the index guide (3) is connected to the base plate (2) by fitting the second skeletal fixation pin (6) into the third ring (33) of the index guide (3) and into the second ring (24) of the base plate (2).
3. The stackable and modular dental implant guide system according to claim 1 or 2 characterized by the fact that, optionally, the index guide (3) is connected to the base plate (2) by fitting the respective first and second male-female connectors (25, 35).
4. The stackable and modular dental implant guide system according to any of claims 1-3 characterized by the fact that the transport guide (4) is connected to the base plate (2) by fitting the second skeletal fixation pin (6) into the fourth ring (43) of the transport guide (4) and into the second ring (24) of the base plate (2).
5. The stackable and modular dental implant guide system according to any of claims 1-4 characterized by the fact that, optionally, the transport guide (4) is connected to the base plate (2) by fitting the respective first and third male-female connectors (25, 45).
6. The stackable and modular dental implant guide system according to any of claims 1-5 characterized by the fact that the dental implant guide (1) is milled, printed, or injected in acrylic resin, polyetheretherketone (PEEK), pecton, composite resin or ceromer.
7. The stackable and modular dental implant guide system according to any of claims 1-6 characterized by the fact that the base plate (2), the index guide (3) and the transport guide (4) are made of an acrylic resin or sintered metal or alloys selected from the group consisting of stainless steel, cobalt-chromium, nickel-titanium, zirconium, tantalum, magnesium, gold and platinum.
8. A non-stackable and sequential dental implant guide system characterized by comprising:
   – a dental implant guide (1);
   – an index guide (3); and
   – a transport guide (4),
   wherein the dental implant guide (1) is a universal tooth-shaped implant guide comprising a plurality of channels (10) with a flat round plate around it;
   wherein the index guide (3) comprises a second anterior arch (30) connected to a second posterior arch (31) by at least a second connection bridge (32); wherein the second anterior arch (30) and the second posterior arch (31) comprise, each, at least three third rings (33), arranged sideways, for fitting skeletal fixation pins (5);
   wherein the transport guide (4) comprises a third anterior arch (40) connected to a third posterior arch (41) by at least a third connection bridge (42); wherein the third anterior arch (40) and the third posterior arch (41) comprise, each, at least two fourth rings (43), arranged sideways, for fitting skeletal fixation pins (5); and
   wherein the dental implant guide (1), the index guide (3) and the transport guide (4) are assembled and disassembled in a sequence deemed to clinically reproduce previously planned fixtures and prosthetic elements.
9. The non-stackable and sequential dental implant guide system according to claim 8 characterized by the fact that the fixation of the index guide (3) to the patient dentition and jaw is performed directly via at least three skeletal fixation pins (5).
10. The non-stackable and sequential dental implant guide system according to claim 8 or 9 characterized by the fact that the fixation of the dental implant guide (1) occurs via the transport guide (4).
11. The non-stackable and sequential dental implant guide system according to any of claims 8-10 characterized by the fact that the dental implant guide (1) is milled, printed, or injected in acrylic resin, polyetheretherketone (PEEK), pecton, composite resin or ceromer.
12. The non-stackable and sequential dental implant guide system according to any of claims 8-11 characterized by the fact that the base plate (2), the index guide (3) and the transport guide (4) are made of an acrylic resin or sintered metal or alloys selected from the group consisting of stainless steel, cobalt-chromium, nickel-titanium, zirconium, tantalum, magnesium, gold and platinum.
13. Method of implanting a fixed dental prosthesis using the stackable and modular dental implant guide system as disclosed in any of the claims 1-7, characterized by the fact that it comprises the steps of:
    a. adapting the base plate (2) to the baseline;
    b. adapting the index guide (3) onto the base plate (2);
    c. drilling and placing the skeletal fixation pins (5);
    d. removing the index guide (3) and making dental extractions;
    e. adapting the implant guide (1);
    f. adapting the transport guide (4) onto de implant guide (1);
    g. reattaching the non-dedicated skeletal fixation pins (5);
    h. drilling and placing the implant fixtures;
    i. screwing the abutments and metal cylinders;
    j. performing prosthetic procedures to convert the dental implant guide (1) into the fixed dental prosthesis;
    k. unscrewing the fixed dental prosthesis; and
    l. removing the base plate (2).
14. Method of implanting a fixed dental prosthesis using the non-stackable and sequential dental implant guide system as disclosed in any of the claims 8-12, characterized by the fact that it comprises the steps of:
    a. adapting the index guide (3) to the baseline;
    b. drilling and placing the skeletal fixation pins (5);
    c. removing the index guide (3) and making dental extractions;
    d. adapting the implant guide (1) with the transport guide (4);
    e. reattaching the skeletal fixation pins (5);
    f. drilling and placing the implant fixtures;
    g. screwing the abutments and metal cylinders;
    h. performing prosthetic procedures to convert the dental implant guide (1) into the fixed dental prosthesis;
    i. removing the skeletal fixation pins (5) and the transport guide (4) and
    i. unscrewing the fixed dental prosthesis.