Guide system for immediate implantation of anterior dental region of oral cavity and use method
Technical Field
The invention relates to the technical field of medical equipment, in particular to a guiding system for immediate implantation of an anterior dental region of an oral cavity and a using method thereof.
Background
Immediate planting refers to a method of implant implantation in the socket after tooth extraction. Compared with the traditional planting technology, the immediate planting method does not need to perform the planting after the wound is recovered 1-6 months after tooth extraction, can reduce the operation times, shorten the treatment course, prevent alveolar bone absorption (atrophy), maintain good soft tissue contour and reduce psychological trauma of patients caused by tooth deficiency, thereby becoming a focus of attention of planting clinicians.
The basic steps of immediate implantation are minimally invasive tooth extraction and tooth extraction wound treatment, implantation of a tooth socket cavity and an implant, bone defect treatment, wound closing and postoperative care. For immediate implantation of the anterior dental zone (aesthetic zone), the difficulties include preparation of an implant cavity with ideal three-dimensional position in the alveolus, good initial stability after implant implantation, adequate thickness of labial bone plate of the implant, etc.
The relative positional relationship between the maxillary anterior tooth root and the alveolar bone has a great influence on the formulation of an immediate implantation surgical plan. It not only affects the initial stability of the implant, but also is one of important parameters for evaluating the morphological characteristics of the bone in the upper anterior dental region, and is closely related to the difficulty of the immediate implantation operation and the postoperative effect. Many scholars have studied the angles of the long axis of the maxillary anterior dental region with the long axis of the alveolar bone. Based on previous research results, the angle between the anterior maxillary tooth and the alveolar bone is approximately 10-20 degrees, and the angle between the cuspid tooth and the alveolar bone is larger than that of the incisor tooth. When the long axis of the upper anterior tooth is consistent with the direction of the alveolar bone or the angle is small (< 10 ゚), the implant can obtain good initial stability by referring to the direction of the natural tooth root in the axial direction. When the long axis of the upper anterior tooth and the long axis of the alveolar process form a certain angle, the labial bone plate is often thinner, a small-diameter implant should be selected, and the implant implantation direction should be slightly deviated from the palate side, so that the bone on the root and palate sides is utilized to obtain initial stability, and the situation of perforation of the labial bone plate and the like is avoided. When the angle between the long axis of the upper anterior tooth and the labial lamina is too large, the labial lamina tends to be thin and accompanied by insufficient bone height, at which time immediate implantation is not recommended.
When the anterior teeth area is planted immediately, in order to preserve soft tissues, part of doctors choose not to turn over the valve operation. Because a certain angle exists between the front tooth root and the alveolar bone, the palate side bone plate is thicker, the bone cortex is compact, and the labial resistance is small and the palate side resistance is large when the hole is prepared, so the bone plate is extremely easy to deviate from the ideal axial direction in the operation, and even is penetrated out from the labial bone plate to cause perforation, thereby causing bad results. How to achieve good implantation sites and axial direction without turning petals and making the labial bone wall invisible to naked eyes is always a difficulty for immediate implantation in the anterior dental region.
At present, the way of instantly planting the operation dental alveolus hole comprises the following steps:
(1) Free hand
After minimally invasive tooth extraction and tooth extraction wound treatment, the drill needle is clung to the palate side bone plate in the direction of direction and is biased to the palate side to prepare holes step by step, so that the left hand palpation can be used in an auxiliary manner, and the space range between the labia and the palate side in the operation area is sensed. When preparing holes, the position and direction of each drill should be detected by using a parallel rod after preparation, and the positions and directions are continuously corrected. In the method, the three-dimensional position and axial control of the planting hole depend on experience and space perception of operators.
(2) Digital guide plate
The digital planting guide plate with personalized design is manufactured by combining CBCT data shot by a patient through methods such as oral cavity scanning or impression making and the like before operation. The patient needs to try through a guide plate before operation, and the patient can put into use after confirmation of proper operation. The traditional Chinese medicine in operation prepares the planting nest by means of a digital planting guide plate, and implants are planted. The method is a better way of accurate planting. However, the design and manufacture of the digital planting guide plate have high requirements on the skills of doctors, special guide plate design, manufacture software, equipment and materials are needed, the scheme in the static guide plate operation can not be changed, the design and manufacture time is long, the number of times of patient treatment is increased, and the planting cost is high.
(3) Shield operation
In 2010, foreign scholars Hu rzeler and the like propose a shield operation, namely, the blood supply of a labial bone plate is maintained and the alveolar bone volume is preserved by reserving a part of labial tooth root and a healthy bundle bone-periodontal ligament complex during tooth extraction. The proposed procedure is ① to a level equal to the gingival, ② to cut the root in mesial-distal direction in half along the root canal direction using a long-handled drill, and remove the lingual/palate side root, ③ to check if the remaining root pieces are loose and carefully clean the remaining root pieces, ④ to trim the coronal side of the remaining root pieces to an arc shape about 1mm above the crest of the alveolar ridge with a round-headed drill, and ⑤ to implant an implant on the palate side of the remaining root pieces. The operation technology of shield operation is different due to different conditions of clinic judgment of doctors and planting of patients, and the preparation method of the tooth root slice still lacks clear standard. The technique can avoid the interference of the tooth extraction form and the perforation of the labial side to a certain extent, but the preparation of the planting hole still depends on the experience of the operator after the palate side root slice/root is extracted. And the long-term reliability of the technology is not supported by high-quality research evidence with long follow-up time and large queue number.
(4) Dynamic navigation technology
The dynamic navigation technology is a computer-aided implantation surgery technology based on medical images, implantation-aided software and industrial rapid prototyping technology. The principle of the method is mainly an image three-dimensional visualization technology, a registration technology and a space positioning technology. The operation flow is that firstly, a patient wears a registration device with a radiation blocking marker in an operation area to shoot CBCT, the obtained three-dimensional image is guided into a navigation system to carry out preoperation design, then the same registration device is worn again in operation, and the real situation in the mouth of the patient in operation is combined with the three-dimensional image in a navigation display screen by matching registration marker points of the three-dimensional image in the operation area and the navigation system, so that the registration of the preoperation design and the real operation area is finally completed. The implantation precision of the implant by the dynamic navigation technology is higher than that of a free hand, and the implant can navigate in real time in the operation, thereby being beneficial to correcting the axial direction of the implant in time. However, the navigation equipment is expensive, the operation flow before and after the operation is complex, and the application of the navigation has a learning curve, so that a planting doctor is required to have stronger hand-eye coordination capability when the preoperative design is successfully transferred into the mouth of a patient.
Disclosure of Invention
Aiming at the defects of the prior immediate anterior dental implant technology, namely the difficulty and the preparation mode of the cavity preparation, the invention aims to provide a guiding system for immediate anterior dental implant and a use method thereof, and the system and the method are adopted for preparing the implant cavity, so that the problem that the implant cavity deviates from an ideal position due to the sliding of a drill needle in the prior art can be solved.
In order to solve the technical problems, the application provides the following technical scheme:
The guide system for immediate implantation of the anterior dental zone of the oral cavity comprises a scale indication drill needle and an angle guide ring, wherein the angle guide ring consists of a guide plate platform positioned above and a guide post positioned below, the cross section of a labial part of the guide plate platform is semicircular, the cross section of a palate part of the guide plate platform is rectangular, the diameter of the labial part of the guide plate platform is equal to the width of the palate part of the guide plate platform, the guide post is cylindrical and positioned below the center of the junction of the labial part and the palate part of the guide plate platform, and the central axis of the guide post is positioned on the symmetrical plane of the angle guide ring;
the guide plate channel penetrates through the guide plate platform and the guide post, and is cylindrical or inclined cylindrical, and the central axis of the guide plate channel is positioned on the symmetrical plane of the angle guide ring;
when the guide plate channel is in a diagonal cylindrical shape, the upper opening is close to the labial side, and the lower opening is close to the palate side.
Further, the diameter of the guide plate channel is 2mm, and the included angle between the central axis of the guide plate channel and the vertical line is 10 degrees.
Or the diameter of the guide plate channel is 3mm, and the included angle between the central axis of the guide plate channel and the vertical line is 10 degrees.
Or the diameter of the guide plate channel is 2mm, and the included angle between the central axis of the guide plate channel and the vertical line is 15 degrees.
Or the diameter of the guide plate channel is 3mm, and the included angle between the central axis of the guide plate channel and the vertical line is 15 degrees.
Or the diameter of the guide plate channel is 2mm, and the included angle between the central axis of the guide plate channel and the vertical line is 0 degree.
Or the diameter of the guide plate channel is 3mm, and the included angle between the central axis of the guide plate channel and the vertical line is 0 degree.
Further, the diameter of the labial part of the guide plate platform is 5mm, the palate part of the guide plate platform is 4.5mm multiplied by 5mm rectangle, and the thickness of the guide plate platform is 1mm;
The diameter of the guide post is 4mm, the height of the guide post is 3mm, the distance between the outer side surface of the guide post close to the labial side and the outer side surface of the guide plate platform close to the labial side is 1mm, and the distance between the outer side surface of the guide post close to the palate side and the outer side surface of the guide plate platform close to the palate side is 2mm.
Further, the scale indicates that the working end of the drill needle is a flat-head 10-edge tungsten steel drill bit with the diameter of 2mm and the length of 5mm, the scale is arranged on the side face of the drill bit, the scale division value of the scale is 1.0mm, a black area is marked at the position 3-4mm away from the tip of the drill bit, and a black line mark is made every 1mm within the range of 3mm of the tip of the drill bit.
The application method of the guiding system for immediate implantation of the anterior dental region of the oral cavity comprises the following steps:
1) Cone beam CT shooting is carried out on a patient to be planted immediately, so that CT data of the oral cavity of the patient are obtained;
2) The method comprises the steps of observing CT data of affected teeth of a patient by an anamorphic surface, judging the position relation between tooth roots and alveolar bones, and selecting angles of corresponding guide rings;
When the direction of the long axis of the upper front tooth is consistent with the direction of the alveolar bone or the angle is less than 10 ゚, a guide ring with the angle of 0 DEG is used, when the long axis of the upper front tooth forms a certain angle with the long axis of the alveolar process, the guide ring with the angle of 10 ゚ or 15 ゚ can be selected according to specific conditions, and when the clamping angle of the long axis of the upper front tooth and the labial bone plate is overlarge, the immediate implantation operation is not recommended;
3) Cutting the affected tooth, namely grinding off the affected tooth crown until the affected tooth crown is flush with the gingival margin, and enabling the section to be 90 ゚ with the upper section of the root canal;
4) Preparation of neck of tooth root:
① The fixed point is that the tissue midpoint of the palate side of the root canal orifice is taken as the center point;
② Setting depth, namely setting the lower edge of a black block of the scale indicating drill needle as a preparation depth along the long axis direction of the affected tooth;
③ Expanding the hole, namely gradually expanding the hole along the long axis direction of the tooth body by using the scale indication drill needle until the aperture is 4mm;
④ Trimming the cavity, namely reserving tooth tissue with the thickness of 2mm on the side wall of the root canal lip to form a cylindrical cavity with the diameter of 4mm on the palate side and the depth of 3 mm;
5) The guide ring is held by hand, and is inserted into the prepared hole, if the guide ring can be smoothly inserted and kept stable, the tooth root preparation is finished, and if the guide ring is blocked, the drill needle is continuously used for preparation;
6) Preparation of planting holes:
① Thoroughly washing to remove the scraps. The sterilized angle guide ring is used for standby, namely, the guide ring with the diameter of 2mm and 3mm is selected for standby under the same angle;
② Guiding by using a guide ring with the diameter of 2mm, positioning by using a long-handle drill needle along a guide ring channel, cutting the middle lower part of a tooth root, preparing a hole by using a pioneer drill, and paying attention to cooling;
③ Replacing a guide ring with the diameter of 3mm for guiding, cutting the middle lower part of the tooth root along a guide ring channel by using a long-handle drill needle, preparing a hole by using a pioneer drill, and paying attention to cooling;
7) Minimally invasive tooth removal, scraping of tooth sockets, flushing with a large amount of physiological saline, and thoroughly cleaning residual periodontal ligament and granulation tissue;
8) And preparing holes by using a final reamer matched with the planting system, implanting an implant with a corresponding diameter, screwing in a covering screw, filling bone powder into gaps between bones around the implant, and closing the wound.
Compared with the prior art, the guiding system for immediate implantation of the anterior dental zone of the oral cavity and the using method thereof at least have the following
The beneficial effects are that:
(1) The guiding system for immediate implantation of the anterior dental region of the oral cavity utilizes the palate side part of the natural tooth root as guiding of the implant site, which is beneficial to avoiding axial deviation of the implant to the labial side, thereby reducing the occurrence of complications such as labial gingival retraction, bone absorption and the like;
(2) When the neck of the tooth root is prepared, the labial thick dental tissue with the thickness of 2mm is reserved, and the principle that the distance from the labial side of the implant to the alveolar bone wall is at least more than 2mm required by immediate implantation is adopted, so that the thickness of the labial bone plate is ensured to be enough after the implant is implanted.
(3) The traditional immediate planting step is to perform minimally invasive tooth extraction and then prepare holes. When the back-up hole of the tooth is extracted, the labial resistance is small, the palate resistance is large, and the operation is easy to deviate from the ideal axial direction, so that adverse effects are caused. In the guiding system, the steps of preparing the hole and then minimally invasive tooth extraction are adopted, so that the influence of unbalanced resistance on the labial and palate sides is weakened, and the situation of perforation of a labial bone plate and the like is avoided.
(4) The angle guide ring of the present invention is provided with 3 different angles, 10 ゚, 15 ゚ and 0 ゚, respectively. These 3 different angular settings are applicable to the upper anterior tooth long axis at an angle (about 55.8%) and coincident angle (about 9.5%) with the alveolar bone long axis, totaling 65.3%. The major axis of the tooth and the major axis of the alveolar bone form a larger angle, which is about 34.7%, and this part of the population does not recommend immediate implantation. The setting of the 3 angles is scientific and reasonable and is suitable for most of immediate implantation surgery in clinic. Under the guidance of the angle guide ring, the preparation of the cavity at the ideal three-dimensional position is facilitated, the technical sensitivity of the immediate anterior dental implant operation is reduced, the immediate anterior dental implant operation is more controllable and has more definite curative effect, the procedures of manufacturing and fitting the guide plate before the operation are reduced, the treatment efficiency is improved, and the economic burden of a patient is reduced.
The guiding system for immediate implantation of the anterior dental zone of the oral cavity and the method of use of the present invention are further described below with reference to the accompanying drawings.
Drawings
Fig. 1 is a front view of a scale indicating drill point.
FIG. 2 is a schematic view of the structure of the guide ring (channel diameter 2mm, angle 10 ゚).
FIG. 3 is a top view of the guide ring (channel diameter 2mm, angle 10 ゚).
FIG. 4 is a longitudinal section view of the guide ring (channel diameter 2mm, angle 10 ゚).
FIG. 5 is a longitudinal section view of the guide ring (channel diameter 3mm, angle 10 ゚).
FIG. 6 is a longitudinal section of the guide ring (channel diameter 2mm, angle 15 ゚).
FIG. 7 is a longitudinal section of the guide ring (channel diameter 3mm, angle 15 ゚).
FIG. 8 is a longitudinal section view of the guide ring (channel diameter 2mm, angle 0 ゚).
FIG. 9 is a longitudinal section view of the guide ring (channel diameter 3mm, angle 0 ゚).
Fig. 10 is a schematic diagram of a method of preparation for a patient's teeth. Wherein, the left side is labial side and the right side is palate side in the figure.
Wherein, 1-baffle platform, 2-guide pillar, 3-baffle passageway.
Detailed Description
As shown in fig. 1-9, a guide system for immediate implantation of an anterior dental region of an oral cavity includes a scale indicating drill point and an angle guide ring. As shown in figure 1, the scale indicates that the working end of the drill needle is a flat-head 10-edge tungsten steel drill bit with the diameter of 2mm and the length of 5mm, the scale is arranged on the side face of the drill bit, the scale division value of the scale is 1.0mm, the position 3-4mm away from the tip of the drill bit (ideal depth) is marked as a black area, and each 1mm of the position 3mm away from the tip of the drill bit is marked as a black line. The arrangement can enable an operator to directly read the numerical value according to the color of the position where the drill bit is immersed in the teeth, and determine whether the predetermined depth is reached. When the anterior teeth area is planted immediately, the implant shoulder is positioned at the position 3-4mm above the gingival margin root of the prosthesis in the direction of the coronal root, and the black block area arranged by the drill needle is 3-4mm, so that the position of the subsequent implant shoulder can be prejudged while visual reading is facilitated during tooth preparation.
The angle guide ring provides a convenient and quick direction indication for the preparation of the planting hole. The angle guide ring consists of a guide plate platform 1 positioned above and a guide post 2 positioned below, wherein the cross section of a labial part of the guide plate platform 1 is semicircular, the cross section of a palate part is rectangular, the diameter of the labial part of the guide plate platform 1 is equal to the width of the palate part of the guide plate platform 1, the guide post 2 is cylindrical and positioned below the center of the junction of the labial part and the palate part of the guide plate platform 1, and the central axis of the guide post 2 is positioned on the symmetrical plane of the angle guide ring.
The angle guide ring is internally provided with a guide plate channel 3, the guide plate channel 3 penetrates through the guide plate platform 1 and the guide post 2, the guide plate channel 3 is cylindrical or inclined cylindrical, and the central axis of the guide plate channel 3 is positioned on the symmetry plane of the angle guide ring. When the guide plate channel 3 is in a diagonal cylindrical shape, its upper opening is close to the labial side and its lower opening is close to the palate side.
The guide ring platform mainly plays a role in stopping, and controls the guide ring on the prepared dental neck part to prevent sinking and displacement. The guide ring channel provides direction and angle guidance for the prepared drill point of the planting hole. A triangular mark is arranged at the semicircular top end of the guide plate platform 1 to indicate the direction. In use, the triangular tip is aligned with the labial side of the implant site.
The diameter of the labial part of the guide plate platform 1 is 5mm, the palate side part of the guide plate platform 1 is 4.5mm multiplied by 5mm rectangle, and the thickness of the guide plate platform 1 is 1mm.
The diameter of the guide post 2 is 4mm, the height of the guide post 2 is 3mm, the distance between the outer side surface of the guide post 2 close to the labial side and the outer side surface of the guide plate platform 1 close to the labial side is 1mm, and the distance between the outer side surface of the guide post 2 close to the palate side and the outer side surface of the guide plate platform 1 close to the palate side is 2mm.
According to the different size and inclination, the angle guide ring is divided into 6 kinds altogether:
The diameter of the guide plate channel 3 is 2mm, and the included angle between the central axis of the guide plate channel 3 and the vertical line is 10 degrees.
2 Nd, the diameter of the guide plate channel 3 is 3mm, and the included angle between the central axis of the guide plate channel 3 and the vertical line is 10 degrees.
3 Rd, the diameter of the guide plate channel 3 is 2mm, and the included angle between the central axis of the guide plate channel 3 and the vertical line is 15 degrees.
4 Th, the diameter of the guide plate channel 3 is 3mm, and the included angle between the central axis of the guide plate channel 3 and the vertical line is 15 degrees.
The diameter of the guide plate channel 3 is 2mm, and the included angle between the central axis of the guide plate channel 3 and the vertical line is 0 degrees.
The diameter of the guide plate channel 3 is 3mm, and the included angle between the central axis of the guide plate channel 3 and the vertical line is 0 degrees.
The use method of the guiding system comprises the following steps:
1) Cone beam CT shooting is carried out on a patient to be planted immediately, so that CT data of the oral cavity of the patient are obtained;
2) The method comprises the steps of observing CT data of affected teeth of a patient by an anamorphic surface, judging the position relation between tooth roots and alveolar bones, and selecting angles of corresponding guide rings;
The angle between the anterior maxillary tooth and the alveolar bone is approximately between 10-20 deg., and the angle between the cuspid tooth and the alveolar bone is larger than that of the incisors. When the upper anterior long axis coincides with the alveolar bone direction or the angle is small (< 10 ゚), it is recommended to use guide rings with an angle of 0 (5 th and 6 th). When the upper anterior long axis is at an angle to the alveolar process long axis, 10 ゚ or 15 ゚ guide rings (1 st to 4 th) can be selected according to the specific circumstances. When the angle between the long axis of the upper anterior tooth and the labial lamina is too large, immediate implantation is not recommended.
3) The affected crown (figure 10C) is ground off the affected crown to flush the gingival margin so that the cross section is 90 ゚ with the upper segment of the root canal (neck 1/3);
4) Preparation of neck of tooth root:
① The fixed point is that the tissue midpoint of the palate side of the root canal orifice is taken as the center point;
② Setting depth, namely setting the lower edge of a black block of the scale indicating drill needle as a preparation depth along the long axis direction of the affected tooth;
③ Expanding the hole, namely gradually expanding the hole along the long axis direction of the tooth body by using the scale indication drill needle until the aperture is 4mm;
④ Trimming the cavity, namely retaining tooth tissue with the thickness of 2mm on the lateral wall of the root canal lip to form a cylindrical cavity with the diameter of 4mm on the palate side and the depth of 3mm (figure 10D);
5) The guide ring is held by hand, and is inserted into the prepared hole, if the guide ring can be smoothly inserted and kept stable, the tooth root preparation is finished, and if the guide ring is blocked, the drill needle is continuously used for preparation;
6) Preparation of planting holes:
① Thoroughly washing to remove the scraps. The sterilized angle guide ring is used for standby, namely, the guide rings with diameters of 2mm and 3mm are selected for standby at the same angle (for example, the 1 st and 2 nd standby are selected when the angle is selected to be 10 ゚ th, the 3 rd and 4 th standby are selected when the angle is selected to be 15 ゚ th, and the 5 th and 6 th standby are selected when the angle is selected to be 0 th);
② Guiding by using a guide ring with the diameter of 2mm, positioning by using a long-handle drill needle along a guide ring channel, cutting the middle lower part of a tooth root, preparing a hole by using a pioneer drill, and paying attention to cooling;
③ Replacing a guide ring with the diameter of 3mm for guiding, cutting the middle lower part of the tooth root along a guide ring channel by using a long-handle drill needle, preparing a hole by using a pioneer drill, and paying attention to cooling;
7) Minimally invasive tooth removal, tooth socket scraping, flushing with a large amount of physiological saline, and thoroughly cleaning residual periodontal ligament, granulation tissue and the like;
8) And preparing holes by using a final reamer matched with the planting system, implanting an implant with a corresponding diameter, screwing in a covering screw, filling bone powder into gaps between bones around the implant, and closing the wound. The way of closing the wound is to make an upper temporary prosthesis, place a healing abutment for healing by passing through gingiva, graft and seal connective tissue, etc.
The guiding system for immediate implantation in the front dental region of the oral cavity is simple and convenient to use, is beneficial to an operator to accurately control the direction and depth of the cavity when preparing the cavity, and the rest tooth root part of the affected tooth after preparing the cavity is beneficial to preventing the influence of irregular tooth extraction on cavity preparation. The method is beneficial to reducing the technical sensitivity of the immediate implantation operation of the anterior dental region, so that the immediate implantation operation of the anterior dental region is more controllable and the curative effect is more definite. Meanwhile, compared with the prior art of digital guide plates, navigation and the like, the method shortens the design time of the scheme, reduces the economic cost, and reduces the economic burden of the patient while providing more efficient and high-quality medical services for the patient.
The above examples are only illustrative of the preferred embodiments of the present invention and are not intended to limit the scope of the present invention, and various modifications and improvements made by those skilled in the art to the technical solution of the present invention should fall within the scope of protection defined by the claims of the present invention without departing from the spirit of the present invention.