WO2006006923A1

WO2006006923A1 - Dental implanting system, a device and a method

Info

Publication number: WO2006006923A1
Application number: PCT/SE2005/001110
Authority: WO
Inventors: Johan Sven Anders HOLMSTRÖM; Nils Axel Tomas Saltvik
Original assignee: Astra Tech AB
Current assignee: Astra Tech AB
Priority date: 2004-07-08
Filing date: 2005-07-05
Publication date: 2006-01-19
Anticipated expiration: 2007-01-08
Also published as: SE0401808D0

Abstract

The present invention relates in general to different aspects of the implantation of a dental implant (1) into a pre-drilled bore in the alveolar tissue (100) of a patient. The present invention relates specifically to a dental implanting system, a dental implant insertion device (6), a method of selecting an abutment (51) size from a set (50) of differently sized dental abutments (51), a method of measuring a distance between a dental implant (1) and a dental region located coronally of said implant (1), the use of an implant carrier (6), a depth gauge (30) for measuring the distance between an inserted dental implant (1) and a dental region located coronally of the dental implant (1), and a method of implanting a dental implant (1) into the alveolar bone tissue (100) of a patient.

Description

DENTAL IMPLANTING SYSTEM, A DEVICE AND A METHOD

Field of the Invention

The present invention relates in general to differ¬ ent aspects of the implantation of a dental implant into the alveolar tissue of a patient, such as into a pre- drilled bore in alveolar bone tissue. The present inven¬ tion relates specifically to a dental implanting system, a dental implant insertion device, a method of selecting an abutment size from a set of differently sized dental abutments, a method of measuring a distance between a dental implant and a dental region located coronally of said implant, the use of an implant carrier, a depth gauge for measuring the distance between an inserted den¬ tal implant and a dental region located coronally of the dental implant, and a method of implanting a dental im- plant into the alveolar bone tissue of a patient.

Background of the Invention

Dental implanting systems are widely used for re¬ placing damaged or lost natural teeth. In such systems, one or several implants are placed in the jaw of a pa¬ tient in order to replace the natural tooth roots. After implantation, the implants are left for a period of time for osseointegration with the surrounding bone tissue. An abutment structure comprising one or several parts may, after the implantation, be attached to the implant in or¬ der to build up a core for the part of the prosthetic tooth protruding from the bone tissue, through the soft gingival tissue and into the mouth of the patient. On said abutment, the prosthesis or crown may finally be built up.

The prosthesis must be sized and configured so as to naturally fit with the other teeth or prostheses of the patient, both for functionality and aesthetics.

The procedure normally to be followed from removal of old teeth to the mounting of the new crown on an im¬ plant differs somewhat between different systems, but in short, the procedure can be summarised by the following steps:

• removing any old structures, such as a tooth root

• producing a bore for the new dental implant in the jaw

• inserting the new dental implant into said bore, ^• possibly preceded by the production of threads in said bore

• leaving said implant for osseointegration with the bone tissue in the jaw, and the gingiva to heal around or over the new structure. At this stage, it is common to mount a healing cap on the implant to protect it from any damaging influence from the oral cavity

• mounting a superstructure, such as abutment and crown, as two separate or one single step, on said implant.

The implanting devices for effectuating these steps, such as a drill for drilling the bore and the dental im¬ plant itself, are kept in a sterile surrounding until they are used in connection with the patient in order not to impose any foreign matter into the mouth of the pa¬ tient. Also package material contamination may disturb the osseointegration of the implant into the bone tissue once it has been implanted, further pointing out the ne- cessity for careful handling. Therefore, the requirement for sterile implant surfaces before implantation is strict. In this context, it is thus important to protect the implant surfaces from foreign matter during the com- plete handling procedure, including the transport, the storage and finally the removal of the implant from the ampoule.

For this reason these implanting devices are nor¬ mally packaged and transported in a container assembly or kit. The container maintains the implant in a sterile en¬ vironment during transport and storage and is opened just before the implanting devices are to be used, for example during the surgical implantation procedure. Furthermore, it is preferable that the implanting devices may be eas- ily removed from the container by the person handling them, such as a surgeon or a dentist.

One type of container for a dental implant is a dou¬ ble box container, comprising a primary, outer receptacle being sealable so that its interior can be protected from outer contamination. The outer receptacle is adapted to contain a secondary, inner ampoule containing the steril¬ ised implant. A disclosure of this type of container can be found in the applicant's own patent application WO 02/30315. The double structure of the container provides two levels of cleanness, which is advantageous when handling the container. When the implant is to be implanted, the outer receptacle is initially removed. Thereafter, the inner ampoule is opened to expose the implant, which sub- sequently may be removed and inserted into said bore.

When the implant is put in the container, it may be pro¬ vided with a handling device. The handling device is used for gripping the implant when transferring it from the container to the mouth of a patient. The handle may have the form of a cap that is connected to a so called im¬ plant carrier, which in turn holds the implant within the container. Hence, no extra means are necessary for trans- ferring the implant to the patient. All of these steps can be performed by hand without actually touching the implant, wherein the chain of sterility may remain unbro¬ ken. A screwdriver grabbing the implant carrier, which drives the implant down into the bore and in place, can in a last step replace the cap.

When assemblage of the structure above the implant level is performed, after the osseointegration, it may be suitable to establish the position of the implant in re¬ lation to the surrounding teeth and/or jaw. It may also be suitable to establish the gingival thickness in the area around the implant and the implant axis position in relation to other teeth. By using a known depth gauge, which at a measurement end thereof is adapted to be in¬ serted into the coronal end of the implant, some of these tasks may be performed. Said depth gauge is also provided with depth-measurement marks around its circumference at suitable distances from said measurement end for the measurement of said distances. A disclosure of such a depth gauge can for instance be found in WO99/30631. Based on e.g. measurement of the gingival depth or the muscosal height over the implant, a properly sized and designed abutment may be chosen from a series of differ¬ ently sized abutments. The measured distance is hence pointing out a certain abutment size in said series of abutments. The term "distance" is here and throughout this application used to indicate a spacing or length be¬ tween two locations, and is measured as the shortest length there between. The term "coronal" is here and throughout this ap¬ plication used to indicate a direction towards a head end or trailing end of the component discussed. For example, in a situation where an abutment is connected to an im- plant, the coronal direction of the abutment would be a direction towards the part of the abutment being directed away from the implant. Likewise, the term "apical" indi¬ cates a direction towards an insertion end of the compo¬ nent. For an abutment connected to an implant, the apical direction of the abutment would be a direction towards the implant. Thus, apical and coronal are opposite direc¬ tions. Furthermore, the term "axial direction" is used throughout this application to indicate a direction taken from the coronal end to the apical end or vice versa. From the background description above it should be understood that there are a number of steps performed during an implanting process and that each step may in¬ troduce a risk of contamination or of harmfully influenc¬ ing the healing process of the bone tissue or gingiva. Furthermore, it is on the whole desirable to simplify the implantation procedure, not only to reduce the healing time for the patient but also for performing the proce¬ dure.

The object of the present invention is to, at least to a certain extent, overcome the above-mentioned prob¬ lems and to design a more feasible manner of implanting dental implants into a jaw and finalising the tooth res¬ torations as a whole.

Summary of the Invention

The above object is achieved by means of a dental implanting system, a dental implant insertion device, a β depth gauge, a use of an implant carrier and methods de¬ fined in the independent claims.

The invention is based on the general insight that a device that is used in the process of inserting the im- plant into the alveolar bone may remain engaged with the implant while information related to the distance between the implant and a dental region located coronally of the implant is obtained. The invention is in particular based on the insight that the device, which is used, for in- serting the implant may also be used for indicating a distance and/or selecting a suitable abutment size.

Both the term "fixture" and the term "implant" may be found in literature as meaning the dental component which is to be introduced and anchored into the bone for receiving a superstructure, such as an abutment or a prosthetic crown or both. Throughout this application the term "implant" will be used.

According to a first aspect of the invention a den¬ tal implanting system is provided, comprising: a set of abutments of different sizes for connection to inserted dental implants, a dental implant insertion device comprising an en¬ gagement portion being structured to engage a coronal end portion of a dental implant, said insertion device further comprising gingi- val-depth indicators for indicating the distance between the inserted implant and a gingival region located coron¬ ally of the inserted implant, wherein the indicated dis¬ tance is a selection criterion for determining a suitable abutment size.

One advantage gained with this aspect of the inven¬ tion is that an easy and simple way of determining an abutment size from a set of abutments of different sizes is achieved at a point in time when the implant is im¬ planted into the alveolar bone tissue, i.e. earlier than what is normally the case. Hence, this information exists directly after the implant implantation step and might be used, for example for planning purposes or the like, by the dental technician or dental surgeon .

Furthermore, the dental implant insertion device comprised in the inventive system offers a reduction of the number of steps needed for said implantation and for the choice of abutment size from a set of abutments of different sizes. This is enabled by said engagement por¬ tion, which is being structured to engage a coronal end portion of said dental implant for inserting the dental implant, and which hence guides the implant into a pre- drilled bore in the alveolar bone tissue. The gingival- depth indicators on said device are adapted for the indi¬ cation of the distance between the inserted implant and a gingival region located coronally of the inserted im¬ plant. The number of devices needed for the implantation and for the subsequent procedures are consequently re¬ duced, since a separate depth gauge for selecting an abutment size is superfluous.

The gingival-depth indicators are suitably provided such that they follow said implant in the apical direc- tion during the actual insertion step. However, as an al¬ ternative, they may be placed in position after the im¬ plant has been inserted, e.g. by being arranged on a portion of the implant insertion device which is dis- placeable relative to the rest of the implant insertion device.

It should be noted that the term "indicated dis¬ tance" may be directly expressed in a unit of measure¬ ment, such as in millimetres. However, said term may al- tentatively be interpreted as providing only a simple guidance as to the position of the sought gingival re¬ gion, without actually specifying the number of millime¬ tres. For instance, one may find that the gingival region is nearer to a first indicator than to a second indica¬ tor, in which case this piece of information may be enough for selecting a properly sized abutment, without knowing the exact distance in millimetres from the im¬ plant to said fist indicator. The second aspect of the invention is based on this type of correspondence between indicators and abutment sizes.

Thus, according to a second aspect of the invention a dental implant insertion device is provided, comprising an engagement portion structured to engage a dental im¬ plant at a coronal end portion thereof, said insertion device further comprising, for selecting from a set of differently sized abutments a suitably sized abutment to be mounted on said coronal end portion, two or more gin- gival-depth indicators being mutually spaced in the axial direction of said insertion device, wherein each indica¬ tor corresponds to a respective abutment size in said set.

An advantage gained with this second aspect of the present invention is that the number of operative steps for the implantation and the subsequent choice of an abutment from a set of abutments of different sizes is reduced and the actual steps are simplified, consequently reducing both the risk and the possible distress for the patient.

Furthermore, while other aspects of the inven¬ tion may be related to a general indication of a distance or of information related to the selection of an appro- priate abutment, this second aspect has the additional advantage that each indicator corresponds to a respective abutment. If, for instance, the gingival level is closer to one of the indicators than to the others, it could suggest that an abutment of the corresponding abutment size be connected to the implant. This correspondence be¬ tween each indicator and a respective abutment may also be present in embodiments of other aspects of the inven¬ tion, or alternatively some of the indicators may di- rectly correspond to the differently sized abutments, while other indicators may not. Instead these other indi¬ cators may correspond to for example precise distances.

According to a third aspect of the invention, there is provided a method of selecting an abutment size from a set of differently sized dental abutments, the method comprising: inserting a dental implant into the alveolar bone tissue of a patient by an implant insertion device engag- ing the dental implant; using said implant insertion device, while being en¬ gaged with the dental implant, for determining a distance between the inserted implant and a gingival region lo¬ cated coronally of said implant; and selecting an abutment size based on the determined distance.

One advantage gained by this aspect of the invention is that two procedural acts may be performed while the implant insertion device is engaged with the implant, namely both the insertion and the distance determination. This in turn allows also the actual selection of abutment size to be performed while the implant insertion device is still connected, if desired. Thus, the method avoids the hassle of removing the implant insertion device be¬ fore said determination of distance is obtainable.

According to at least one embodiment of this aspect of the invention the determination of the distance is ob- tainable by using the mutual positional relationship be¬ tween the implant and the implant insertion device. Since the implant insertion device is engaging the dental im¬ plant, said device is following said implant during its implantation into a pre-drilled bore in the alveolar bone tissue of a patient. There is hence a known positional relationship between said implant and said device, which is exploited when the installation is completed and said implant is fully implanted into said bore. This known po¬ sitional relationship is usable for determining a dis- tance between the inserted implant and a gingival region located coronally of said implant.

It is advantageous that the positional relationship between said device and said implant is known, since the final position of said implant in said bore would possi- bly not always be similar when installed by different dental surgeons. A known positional relationship between the said two means is consequently overcoming this prob¬ lem. This way the determination of the distance becomes an accurate measurement of said distance. Finally, said determined distance is used as selec¬ tion criterion for the selection of an appropriately sized abutment. Another advantage with at least this as¬ pect of the invention is that an accurate measurement is achievable, which enables a more accurate selection of said abutment size, and in turn might enable a more exact and aesthetically appealing design of the crown. According to a fourth aspect of the invention, there is provided a method of measuring a distance between a dental implant and a dental region located coronally of said implant, the method comprising inserting a dental implant by an implant insertion device engaging the dental implant; and using said implant insertion device for measuring said distance, while said insertion device is still en¬ gaged with said implant. One advantage gained by this aspect of the invention is that, at the stage of implant implantation into the alveolar bone tissue of a patient, a simple and easy way of measuring a distance between a dental implant and a dental region located coronally of said implant is cre- ated. Said dental region may e.g. be the apical part of the gingival or of the surrounding teeth. Such measure¬ ments may be needed in order to establish later required characteristics of the oral cavity of said patient. This measurement step is furthermore performed at a point in time when the implant is implanted into the alveolar bone tissue, i.e. earlier than what is normally the case. Hence, this relevant information exists directly after, or even during, the implant implantation step and might be used for example for planning purposes or the like by the dental technician or dental surgeon.

According to a fifth aspect of the invention there is provided a use of an implant carrier, which is adapted for carrying a dental implant in a transporting container or a package, as a depth gauge for selecting an abutment from differently sized abutments, which selected abutment is to be connected to said dental implant. The prior art implant carrier is hence given an ad¬ ditional technical structural feature enabling an additional function and hence the number of operative steps for the implantation and the subsequent choice of an abutment from a set of abutments of different sizes are reduced and the steps performed are simplified, con¬ sequently reducing both the risk and the possible dis¬ tress for the patient. The prior art implant carrier has so far been used to connect the implant to the transpor- tation container. The transportation container with the implant and the implant carrier is subsequently trans¬ ported to the implantation site. The prior art implant carrier is furthermore used to hold the implant during the implantation step.- An implantation device is in turn used to grip the implant carrier and to perform the in¬ stallation of the implant into the pre-drilled bore.

According to a sixth aspect of the invention, there is provided a depth gauge for measuring the distance be- tween an inserted dental implant and a dental region lo¬ cated coronally of the dental implant, comprising two or more indicators at mutually spaced positions in the insertion direction of the dental implant, and an implant engagement portion for engaging in a ro- tationally fixed manner a coronal end portion of the den¬ tal implant during the insertion thereof.

This inventive depth gauge is hence given an addi¬ tional technical structural feature enabling an addi¬ tional function compared to the prior art depth gauges, and hence the number of operative steps for the implanta¬ tion and the subsequent choice of an abutment from a set of abutments of different sizes is reduced and the steps performed are simplified, consequently reducing both the risk and the possible distress for the patient. The prior art depth gauges have so far only been configured and used to measure a distance between an inserted dental im¬ plant and a dental region located coronally of the dental implant. In this aspect of the invention, said depth gauge is further used at the implantation stage of the implant into the alveolar bone tissue of a patient. The depth gauge according to this aspect of the invention can consequently be used at a point in time when the implant is implanted into the alveolar bone tissue, i.e. earlier than what is normally the case. Hence, the information gained from the use of the depth gauge exists directly after, or even during, the implant implantation step and might be used for example for planning purposes or the like by the dental technician or dental surgeon.

According to a seventh aspect of the inventive con¬ cept, there is provided a method of implanting a dental implant into the alveolar bone tissue of a patient, com- prising inserting a dental implant into the alveolar bone tissue of a patient by an implant insertion device engag¬ ing the dental implant, using said implant insertion device, while being en- gaged with the dental implant, for determining a distance between the inserted implant and a gingival region lo¬ cated coronally of said implant, selecting an abutment size based on the determined distance, and removing said dental implant insertion device from said implant.

This inventive method adds the advantage that, dur¬ ing the implantation of a dental implant, a simple and easy way of determining a distance between a dental im¬ plant and a gingival region located coronally of said im¬ plant is created. Such measurements may be needed in or¬ der to establish later required characteristics of the oral cavity of said patient. This measurement step is furthermore performed at a point in time when the implant is implanted into the alveolar bone tissue, i.e. earlier than what is normally the case. Hence, this relevant in¬ formation exists directly after, or even during, the im- plant implantation step and might be used for example for planning purposes or the like by the dental technician or dental surgeon.

From the above it should be clear that any aspect of the invention has the potential to reduce the number of devices and steps necessary for inserting an implant. In particular each aspect of the invention combines the in¬ sertion of the implant with an information acquiring, said information being e.g. distance indication or abut- ment size indication.

An implant insertion device according to the inven¬ tion may be in the form of an implant carrier, a screw driving hand piece, a screw driving bit and the like, which will be described more in detail with reference to the enclosed drawings. The following description of the implant insertion device also applies to the inventive depth gauge which, in accordance with the sixth aspect of the invention, is specifically adapted to be engaged with an implant during the insertion thereof.

It should be noted that an implant insertion device according to any aspect of the invention may suitably be engaged with the implant until the implant is in its fully inserted position in the bone. However, it may also be conceivable that the distance indication, abutment size selection or abutment selection is made before the implant has reached its fully inserted position. For in¬ stance, there may remain one or more turns of a screw be¬ fore the fully inserted position is reached, but it may still be enough to provide a satisfactory distance indi¬ cation. Furthermore, it should also be noted that the im- plant insertion device need not necessarily be engaged with the implant at the beginning of the insertion proce¬ dure, but may be connected to the implant when it is al¬ ready partly inserted in the bone.

In any aspect of the invention contemplating an im¬ plant insertion device, including in the form of the ex¬ amples above, the indicators of the implant insertion de¬ vice may suitably have spaced positions in relation to the implant. For instance, when the implant insertion de- vice is engaged with said implant, the indicators are suitably located at a respective predetermined distance from the coronal end of the implant. An indicator in the direct vicinity of the coronal end of the implant does usually not add much valuable information. The coronal end of the implant in itself may provide the same infor¬ mation.

It has been found even more suitable to provide the indicators within a range of approximately 1 - 10 mm, preferably 1 to 6 mm from the coronal end of the implant, in said engaged position, since most parts within the oral cavity of a patient that may need measuring are lo¬ cated within this range. For instance, the depth of the gingiva may vary from person to person, but is generally in the order of 1 to 6 mm. It is to be understood that even though this specified indicator range is suitable to use when the coronal end of the implant is to be levelled with the alveolar bone ridge, other ranges may be suit¬ able for implants which are not levelled. For instance, a smaller range, such as 0.5 to 5 mm, may be enough in con¬ nection with implants that are to extend out of the al¬ veolar bone ridge.

According to at least one embodiment of any aspect of the invention, the implant insertion device includes at least a first, a second and a third indicator, wherein the distance between the first and the third indicators are equal to the distance between the first and the sec¬ ond indicators multiplied by k/2, in which k is an inte¬ ger greater than 2. This embodiment contemplates several known abutment series. In at least some of said known abutment series the differences in size between the abut- ments are generally about 1 mm or 0.5 mm or multiples thereof. Further explanation of this relationship is given in the description of Fig. 4a.

Since in most cases, the indicators are to be used as a selection criterion for the selection of a suitable abutment size, it is advantageous to arrange the mutual spacing or distance between neighbouring indicators to correspond to a difference in size, preferably a differ¬ ence in length, between two abutments from a set of dif- ferently sized abutments. For this and other reasons, it may furthermore be suitable that the spacing between two neighbouring indicators is approximately 2 mm or less, more preferably by 1.5 mm or less, and most preferably by 1 mm or less. The indicator spacing may consequently be chosen to correspond to a respective abutment size dif¬ ference.

According to at least one embodiment of any aspect of the invention, one or more of said indicators has an extension, which is parallel with the coronal end plane of the dental implant when it is engaged to the implant insertion device. Some implants have coronal end planes presenting an essentially straight profile, e.g. the cor¬ onal end plane is perpendicular to the axial or insertion direction of the implant. In this case, the implant in¬ sertion device, which is adapted to be engaged with the implant, may have indicators which lie in a plane that is perpendicular to said axial direction.

An alternative straight profile may be an angled or inclined coronal end plane, i.e. it is not perpendicular to said axial direction, but rather forms an angle less than 90 degrees to said axial or insertion direction. In this case the indicators on the corresponding implant in¬ sertion device would also be provided at such inclina¬ tion. This type of implant having inclined coronal end is sometimes inserted non-perpendicularly relative the al¬ veolar bone and is therefore used with an abutment that is not directed in the axial direction of the implant, i.e. the abutment will, when installed, become angled in relation to the axial or insertion direction of the im¬ plant. However, this type of implant may also be used with abutments that are to be aligned with the axial or insertion direction of the implant. In such cases, it is preferable that one or more of the indicators has its main extension in a respective geometrical plane, which plane is perpendicular to said insertion direction of the implant.

According to at least another embodiment, one or more of the indicators has a profile, which corresponds to a coronal end of the engaged dental implant. Thus, if the implant insertion device is adapted to be engaged to an implant having a non-linear coronal end, e.g. a cor¬ onal end which corresponds to the profile of the alveolar bone ridge, then the or each indicator may also have such a non-linear profile.

Regardless of the plane of extension of the indica¬ tors, according to at least another embodiment of any as- pect of the invention, the indicators are in the form of either visual markings or tactile markings, or possibly both. Furthermore, it should be noted that the indicators do not need to completely surround the implant insertion device, at least not as one unbroken shape for each indi¬ cator. The extension of at least one or more indicators is however preferably along the circumference of the im¬ plant insertion device, like in the embodiments shown in the enclosed drawings. For the ease of use, the indica¬ tors should preferably be perceivable regardless of the rotational position of the implant insertion device.

Any aspect of the invention allows various types of indicators to be provided on the implant insertion de¬ vice. For example, one or more indicators may be formed by an indentation and/or protrusion of the implant inser- tion device. Another example is that the indicators are formed by edges of one or more band-like areas of the im¬ plant insertion device. Two or more such band-like areas may suitably be circular and of the same diameter, and/or have the same width in the insertion direction of the im¬ plant, such as e.g. a width of 1 mm. Yet another example is that one or more of said indicators may have a surface character, or be formed by an edge of a portion that has a surface character, which differs from the surface char¬ acter of the surrounding surface of the implant insertion device. Such different surface characters may e.g. be differences in colour. Any of these examples may be com¬ bined, e.g. an indicator being the edge of a band-like protrusion of the implant insertion device. A more de¬ tailed description of different indicators is given in connection with Figs . 6a - βf with reference to an im¬ plant insertion device in the form of an implant carrier. However, the corresponding indicators may equally be pro- vided on other types of implant insertions devices.

According to at least another embodiment of any as¬ pect of the invention, use is made of body fluid, such as blood, for effecting visibility of the indicators. In this embodiment one or more of the indicators is adapted to receive body fluid in such manner that an indication of the received body fluid is distinguishable. The recep¬ tion of the body fluid may be effected by e.g. a groove, preferably by means of capillary force. This means that, instead of providing the implant insertion device with colour markings by e.g. laser-etching during manufactur¬ ing of the device, it is possible to after the manufac¬ turing provide it with "in vivo" colour markings in the form of body fluid.

Brief Description of the Enclosed Drawings

Figs . Ia to Ic show dental devices according to prior art, of which Figs Ia is an elevation of a dental implant in a jaw of a patient,

Fig. Ib is an elevation of a set of abutments,

Fig. Ic is a perspective view of a depth gauge. Figs. 2 - 5 show dental devices according to the present invention, of which

Fig. 2a is a perspective view of an implant inser¬ tion device, in this embodiment in the form of an implant carrier, connected to a dental implant, Fig. 2b is an exploded and partially cut view of the implant carrier and dental implant of Fig. 2a,

Fig. 3 is an exploded perspective view of an implant connected to an implant carrier according to the present invention in a prior art transportation container, Fig. 4a is a partial section of a generalised im¬ plant with implant carrier,

Fig. 4b is an elevation of a set of abutments and an implant carrier,

Fig. 5 is an elevation of an implant in a jaw of a patient, in which measurement of gingival depth is in progress .

Figs, βa to βf show in elevation different embodi¬ ments of distance indicating portions 24 of an implant insertion device according to the present invention, in the form of the implant carrier β, of which

Fig. βa is showing band-like indicators of the kind that have alternating indentations and protrusions along the insertion direction,

Fig. βb is showing colour indicators of the etched type,

Fig. βc is showing line-like indicators protruding from the surface, Fig. 6d is showing line-like indicators that are in¬ dentations in the surface,

Fig. βe is showing band-like indicators whose apical edges constitute the actual markings, and Fig. 6f is showing indicators that have a profile that corresponds to the profile of a coronal end of a dental implant.

Figs. 7a and 7b show alternative embodiments, of which Fig. 7a is showing a screw driving bit, and

Fig. 7b is showing a screw driving hand piece.

Detailed Description of the Drawings

At first, a short description of prior art is appro- priate. Fig. Ia is an elevation of a dental implant 1 im¬ planted into a jaw 100 of a patient. The implant 1 may be implanted in either the mandible or the maxilla. The so- called alveolar bone tissue of the jaw 100 of said pa¬ tient is covered by gingival tissue 101. In the shown ex- ample, the head of the implant 1 is not protruding from the bone tissue 100, but is aligned with the outmost part thereof, the so called cortical bone. In order to be able to receive a crown, an abutment 51 is inserted into a coronal opening in the implant 1 and is adapted to re- ceive the tailor-made crown 103 as replacement for the missing tooth in between two adjacent teeth 102.

Even though the implant 1 shown in Fig. Ia is not protruding from the bone, other types of dental implant may indeed be protruding from the bone. In such cases, it is not always necessary to use a separate abutment 51.

The implant itself may be provided with structures corre¬ sponding to an abutment 51 which are being used corre¬ spondingly. Typically, the abutment 51 is used for connection of a dental prosthesis or crown 103 to the implant 1. How¬ ever, during the procedure of manufacturing the final prosthesis, the abutment 51 may also be used for connect- ing other components to the implant 1, such as for exam¬ ple impression copings, healing caps or a temporary pros¬ thesis. The abutment 51 and the implant 1 may be made of a suitable material for dental components to be perma¬ nently installed in the mouth, such as for example a metal as titanium and certain ceramic materials, for ex¬ ample zirconium oxides.

In Fig. Ib a set 50 of abutments is shown. Each abutment 51 in said set 50 comprises an apical implant engaging portion, a coronal portion and an intermediate portion 41. The different sizes of the abutments 51 de¬ pend on the size, i.e. length in the axial direction, of said intermediate portion 41, which in the depicted set

50 has a length of 0 - 7 mm. The different length nor¬ mally corresponds to different thickness of the gingiva 101, which may vary from person to person. The abutment

51 may have many different configurations and the shown set 50 is only one example of many. It should be noticed that the abutment 51 might be a single piece abutment, as in Fig. Ib, or a multiple piece abutment. The most common multiple piece abutment comprises two parts, of which one elongate screw type piece is surrounded by, and attach¬ ing, a post. The post being the actual abutment 51 pro¬ truding through the gingival tissue 101 for the above mentioned purposes. The choice of abutment 51 is among other things af¬ fected by the gingival depth in the area surrounding the implant 1, in contrast to the implant 1, which is nor¬ mally mainly affected by the size and geometry of the re- placement crown 103, and of the size and geometry of the jaw 100 in the area of the missing tooth in the gingival depth direction, or in other words, in the axial direc¬ tion of the implant 1. The reason for the gingival 101 depth influence on the abutment 51 size is i.a. that the abutment 51 needs to protrude through the gingiva 101 to be a good support for the new crown 103.

In order to determine the above described gingival 101 depths, a depth gauge 30 is often used, see Fig. Ic. Said depth gauge 30 is provided with a measuring end 31 and at the opposite end a handle 32. Said measuring end 31 is normally taking at least partly the form of the frustum of a cone. Said cone at usage being adapted to protrude into a bore in the coronal end of an implant 1 when it has been fully implanted into the alveolar bone tissue 100 of a patient. The dimension of said protrusion is known. Said measuring end 31 has in turn several band- shaped markings 33 for said measurement of which the ac¬ tual distance between the coronal end of said implant 1 and each marking 33 are being known. Each band is in the shown case 1 mm wide. From the position of adjacent den¬ tal features, such as gingival 101 depths, in relation to the markings 33, an abutment 51 in said set 50 of abut¬ ments can be chosen.

The description is now turning to the present inven¬ tion and some illustrated embodiments. Any prior art de¬ vices in this part are distinctly recognised as such. Fig. 2a is a perspective view of an implant insertion de- vice 6, which in this embodiment is in the form of an im¬ plant carrier or an implant-engaging depth gauge, the im¬ plant insertion device being engaged with an exemplary prior art dental implant 1 for the installation into the jaw 100 or, in other words, the alveolar bone tissue 100 of a patient. There may be many different types of dental implants 1 on which the present invention may be suit¬ able. Not only the threaded type implant, but also types of the kind that are inserted into a bore in the alveolar bone tissue 100 by longitudinal movement, which implant may be provided with cavities of voids into which said bone tissue after some time is growing in for osseointe- gration. There may also be many other types. The implant 1 has a coronal end 2 and an apical end 3 and - in this embodiment - at least partly a threaded outer surface 4 there between. In the coronal end 2 there is a blind bore 5 for receiving other dental devices, at the installation of the implant 1 or thereafter. Such other devices may be the above-described abutments 51.

The implant carrier 6 according to the present invention is releasably connected to said implant 1 in said bore 5 as the implant 1 and the implant carrier 6 are depicted at the time of installation into the bone tissue 100. Said implant carrier 6 is connected to the implant at the time of production or at least at the time of assembling the implant 1 and implant carrier 6 in a transportation container 7 (see Fig. 3) prior to sales and distribution to for example dental surgeons. It is contemplated that the implant 1 and implant carrier 6 can be sold and dis¬ tributed as separate parts as well.

Said implant carrier 6 comprises two main parts: a carrier screw 8 and a carrier sleeve 9. The implant car¬ rier 6 and the implant 1 are shown in an exploded and partially cut view in Fig. 2b. At the top of the figure the carrier screw 8 is shown, having a coronal end 15 and an apical end 16. The carrier screw 8 is furthermore pro¬ vided with gripping means 10 at the coronal end 15, and with cylindrical journal means 11 at the apical end of said gripping means 10. Said journal means 11 are parted into three portions: (starting from said gripping means 10 and going towards the apical end 16 of said carrier screw 8) a first threaded portion 12, a smooth portion 13, and a second threaded portion 14. The outer diameter of the threads of the second threaded portion 14 is less than the diameter of the first threaded portion 12, and of the smooth portion 13. Turning now to the carrier sleeve 9, it has a cor¬ onal end 17 and an apical end 18. The carrier sleeve 9 has a cylindrical through bore 19 from said coronal to said apical end, 17 and 18 respectively. The through bore 19 is in turn tripartite: (starting from said coronal end 17 and going towards said apical end 18) a first smooth portion 27, a threaded portion 22 and a second smooth portion 23. Said first smooth portion 27 has a diameter that is approximately equal to the largest diameter of the threaded portion 22. The second smooth portion 23 has a diameter which is similar to the smallest diameter of the threaded portion 22.

The outer surface of the carrier sleeve 9 is also tripartite: (starting from said coronal end 17 and going towards said apical end 18) gripping means 40, a distance indicating portion 24 provided with indicators 26, and a conical portion 25 tapering towards said apical end 18. Said indicators 26 may also be seen as distance indicat¬ ing markings 26. Said conical portion 25 may also be pro¬ vided with indicators 26 and at least partly be a part of said distance indicating portion 24. Said gripping means 40 are here hexagonal for easy gripping by for instance a torque wrench. Said gripping means 40 could also have for instance a square cross section or other polygonal de- sign. The gripping means 40 are in this embodiment pro¬ vided with one indicator 26 in the form of an indentation in the six protruding parts of the hexagon.

Also the gripping means 10 of the carrier screw 8 may be provided with indicators 26.

The distance indicating portion 24 in this embodi¬ ment is stepwise cylindrical and provided with three uni¬ formly shaped regions. Each region or "band" is 1 mm wide in the axial direction, i.e. the insertion direction of the implant 1, and each band is shifted approximately 0.2 mm in relation to the adjacent bands and in a direction perpendicular to the axial direction. In other words, one band has an outer diameter of approximately 4 mm and its adjacent band an outer diameter of approximately 3.6 mm, making a difference of approximately 0.4 mm on diametri¬ cal basis and hence an approximate 0.2 mm shift between said bands. In this embodiment each shift between bands or regions, represent one indicator 26 for the measurement of gingival depth. It should be noted that also an entire band 26 may be regarded as an indicator, as an alterna¬ tive to the apical and/or coronal edge of a band.

The function, use and different types of said indi¬ cators 26 are further elucidated below. It is however no¬ ticed in relation to Fig. 2a that the indicators 26 are visible also when the implant carrier 6 is releasably connected to said implant 1.

The threads of the second threaded portion 14 of the carrier screw 8 are right-handed threads, i.e. when the threads are meeting corresponding threads in the implant 1, a turn of the carrier screw 8 in the right-hand direc¬ tion, or in other words in the clock-wise direction, the design of the threads are effectuating that the carrier screw 8 is screwed onto the implant 1. The threads of the first threaded portion 12 however, are reversed in comparison to the threads of the second threaded portion 14. The threads of the first threaded portion 12 are hence left-handed threads, i.e. when the threads are meeting corresponding threads in the carrier sleeve 9, a turn of the carrier screw 8 in the left-handed direction, or in other words, in the counter clock-wise direction, the design of the threads are effectuating that the car¬ rier sleeve 9 is screwed onto the carrier screw 8. It should be noted that the threads of the outer part of the implant 1 that are screwed into the bone tissue 100 are right-handed threads .

At usage of the implant carrier 6, the carrier sleeve 9 is passed onto the carrier screw 8 by making use of the threaded portion 22 of the carrier sleeve 9 and of the first threaded portion 12 of the carrier screw 8. See Fig. 2a for the assembled implant carrier 6. The reason for the above described smaller diameter of the second threaded portion 14 in relation to the first threaded portion 12 of the carrier screw 8 hereby becomes clear when also taking the different directions of the two threaded portions into account. It is necessary to be able to pass the implant sleeve 9 over and past the sec¬ ond threaded portion 14, since the threads of the first and second threaded portions, 12 and 14 respectively, have reversed threads .

When implanting an implant 1 into the alveolar bone tissue 100, the implant carrier 6 is releasably fastened in the blind bore 5 by means of the threads of said threaded second portion 14 of the carrier screw 8 and the corresponding threads in said blind bore 5 of the implant 1. The carrier sleeve 9 is inserted into said blind bore 5 as far as the conical portion 25 allows for, i.e. to the extent that the diameter of the blind bore 5 and the taper of the conical portion 25 correspond to each other. This way a rotationally fixed engagement between said im¬ plant 1 and said implant carrier 6 is created in the ro- tational direction that corresponds to the rotational in¬ sertion of the implant 1 into the bore 5, i.e. in this case the right-handed direction. The carrier sleeve 9 keeps this position throughout the implantation step and hence the distance indicating portion remains in a fixed position in relation to the implant 1 during this step. Between the coronal end 17 of the carrier sleeve 9 and the apical end of the gripping means 10 of the car¬ rier screw 8 there is left an open distance 28 of the magnitude of approximately 1 - 2 mm. This open distance is best seen in Fig. 5. This open distance 28 could be seen as either a limitation of the insertion depth of the carrier screw 8 in said blind bore 5, or as a length de¬ termining feature of said carrier screw 8 in relation to at least said carrier sleeve 9. This distance is not fixed but limited by the following reasons. This inter¬ space 28 has two main purposes: At the time of transpor¬ tation in a transportation container 7, the interspace 28 is used to fasten the implant carrier 6 and the implant 1 in said transportation container 7. See Fig. 3. Further- more, the interspace 28 is desirable for the easy inser¬ tion of a threaded implant 1 into a hole in a mandible or maxilla 100. See Fig. 5 for an explanation of the modus operandi of the implant carrier 6.

The prior art transportation container 7 shown in Fig. 3 may of course be of a different kind in order to operate the implant 1 and the implant carrier 6 according to the present invention. It is however used as a demon- stration of the easy to use design of the implant carrier

6. The transportation container 7 is arranged to contain a device, here in the form of a prior art dental implant 1, an implant carrier 6 according to the present inven- tion and prior art manipulating means 79. The container 7 in the form of a sealable box is adapted to receive an elongated protective housing 71 and a device holder 72 that is arranged to support the implant 1. The device holder 72 is connected to the protective housing 71 and movable between a device storage position and a device removal position. The protective housing 7 comprises guide means 73 arranged to define a predetermined path 74 for device holder 72 relative to the protective housing

71. In order to keep the sterility within the container 7, the container 7 has a lid 75 to seal off the contents of the container 7 from the surrounding atmosphere.

The predetermined path 74 is arranged so that the device 1, 6 and 79, when supported by the device holder

72, is kept distant from the protective housing 71. In the storage position, the protective housing 71 effec¬ tively protects the implant 1 that is held by the device holder 72, during transport and storage.

In this embodiment, the removal position is a posi¬ tion in which the device 1, 6 and 79 held by the device holder 72 is free from the protective housing 71 and, thereby, easily accessible and extractable from the con¬ tainer 7. The device 1, 6 and 79 is separated from the device holder 7 in the direction indicated by the arrow 76. It is notable that the implant 1 will be moved in a first direction (along the predetermined path) in order to reach the removal position, and then in a second di- rection, being transverse to the first direction, to be removed from the container 7.

The device holder 72 supports the device 1, 6 and 79 by means of a cradle structure 77. Said cradle structure 77 comprises two protruding claws that are designed to firmly but resiliently grip around the implant carrier 6 at the interspace 28 between the carrier sleeve 9 and the carrier screw 8. One claw 77 on each side of said implant carrier 6, leaving an opening between said claw 77 tips for the easy separation of said device 1, 6 and 79 from said container 7.

The manipulating means 79 is to be used when remov¬ ing the implant 1 and implant carrier 6 from the con¬ tainer 7, and at the first stage of implanting the im- plant 1 into the jaw 100 of a patient. The dental surgeon holds the manipulating means 79 by his/her hand. The den¬ tal surgeon does hence not need to touch the implant, thereby keeping its sterility until placing it in the bore 5. The manipulating means 79 has the form of a plas- tic cap that is passed onto the gripping means 10 of the implant carrier 6 and is held in place by the tight, but yet resilient fit between the two parts.

The manipulating means 79 may furthermore be used in the first implantation stage of the implant 1 into the alveolar bone tissue 100. If, as in the present embodi¬ ment, the implant 1 is a screw-type of implant, the ma¬ nipulating means 79 may be used in the first turns of the implant 1 in relation to the alveolar bone tissue 100. Most likely the manipulating means 79 will not be able to guide the implant 1 all the way into its fully implanted stage. The reason for this would be that the connective forces between the manipulating means 79 and the gripping means 10 would not be sufficiently torque resistant. How- ever, if desired, this could be overcome by using a more rigid plastic or other material in the manipulating means 79. If the manipulating means 79 would not be capable of guiding the implant 1 fully into place, it would normally be replaced by for instance a prior art torque wrench.

It should be noted herewith that the implant carrier 6 may be left attached to the implant 1 during the whole step of implantation into the alveolar bone tissue 100, regardless of whether the manipulating means 79 is re- placed or not. The full understanding of the present in¬ vention now becomes apparent, since the measurement for which the present invention has been designed, now fol¬ lows making use of the indicators 26 of the distance in¬ dicating portion 24 on the implant carrier 6. Such meas- urements do hence not need to be performed as a separate step, and the prior art depth gauge 30, which has been used for this purpose, is hence made uncalled for.

Turning now to describe the modus operandi of the indicators 26, Fig. 4a is a generalised partial elevation of said indicators 26 on an implant carrier 6 or other similarly used implant insertion device inserted in an implant 1, and Fig. 4b is an overview of one embodiment of a set 50 of abutments of different sizes in relation to an implant carrier 6 or implant-engaging depth gauge according to the present invention. It should be noted that the embodiment of Fig. 4a is not a preferred embodi¬ ment, but an exemplary generalisation, yet possible em¬ bodiment, for the description of the indicators 26. The indicators 26 on the implant carrier 6 are suit¬ able to use for the determination of which abutment 51 to choose from a set 50 of differently sized abutments. The indicators 26 are also suitable for the determi¬ nation, or measurement, of gingival 101 depth around an implant 1 at the time of implantation of said implant 1 into the maxilla or mandible 100 of a patient, if this feature is needed in a stand-alone action. Furthermore, the indicators 26 are suitable to measure a distance be¬ tween for example the coronal end 2 of an implanted im¬ plant 1 and any dental feature in the oral cavity of a patient. Fig. 4a shows the coronal end 2 of a prior art den¬ tal implant 1 having a blind bore 5 into which an implant carrier 6 according to the present invention is inserted. What can be seen of the implant carrier 6 is the carrier sleeve 9, the thereon provided distance indicating por- tion 24 and parts of the conical portion 25 which are partially protruding into said blind bore 5. The distance indicating portion 24 is provided with three indicators: a first indicator 26a, a second indicator 26b and a third indicator 26c. The first indicator 26a being the closest one to the apical end 18 of the carrier sleeve 9, the second indica¬ tor 26b being the second closest one to said apical end 18 and, consequently, the third indicator 26c being the farthest away from said apical end 18. This numbering could be reversed, but is used throughout this applica¬ tion for the sake of clarity.

The distance between the first and the second indi¬ cators, 26a and 26b, is denoted a, the distance between, the second and the third indicators, 26b and 26c, is de- noted b, the distance between the first and the third in¬ dicators, 26a and 26c, is denoted c, and finally, the distance between the first indicator 26a and the coronal end 2 of the dental implant 1 is denoted d, i.e. distance between the first indicator 26a and an implant level 42.

This last distance, d, is normally only used in the first modus operand!.

In the embodiment of Fig. 4a the referred distance are in numerals: a = 1 mm b = 2 mm c = a + b = 3 mm d = 1 mm The distance between the first and the third indica¬ tors, 2βa and 26c resp., is thus c/a = 3/1 = 3 times as long as the distance between the first and the second in¬ dicators 26a and 26b resp.

According to the present invention, it is preferable that the distance c between the first and the third indi¬ cators, 26a and 2βc resp., is equal to the distance a be¬ tween the first and the second indicators, 26a and 26b resp., multiplied by k/2, in which k is an integer greater than 2. I.e. k is equal to 3 or 4 or 5 and so on. In mathematical terms, the calculation of said dis¬ tances can be represented with the following formula:

In the embodiment of Fig. 4a (it should be noted that this drawing is not completely to scale) k hence equals 6

) which is an integer greater than 2.

Another example: If k equals 3 and the distance a between the first and the second indicators, 26a and 26b resp., is 1 mm, the distance c becomes 1.5 mm, which is equal to the distance between the first and the third in¬ dicators, 26a and 26c resp. This means that the distance b between the second and third indicators, 26b and 26c resp., is 0.5 mm. In yet another example, a equals 1 mm and k equals 4, making the distance b between the second and the third indicators, 26b and 26c resp., equal to 1 ram, because the distance c according to the formula equals c=1-4/2=2 and the distance b equals c - a = 2 - 1 = 1 mm. In this example each indicator 26 has an even distribution over the distance indicating portion 24.

Naturally, there may be more than three indicators 26 which are preferably distributed according to the de¬ scribed principle. If there would be a fourth indicator 26d, the distance e between the first indicator 26a and the fourth indicator could hence be equal to the distance a between the first and the second indicators, 26a and 26b resp., multiplied by k/2, in which k is an integer greater than 2, and also greater than k for the distance c between the first and the third indicators, 26a and 26c resp. That is, if J: is equal to 3 for the third indicator 26c, k must, if following the intended principle, be greater than 3, consequently at least 4 or higher for the fourth indicator. Any fifth indicator must according to this principle consequently be calculated using a k of a cumulative order in comparison to the k of the fourth in¬ dicator. The k need notably not be increased by 1 for each step to a higher numbered indicator 26, but may leap one or several consecutive integers. The reason for using this preferred embodiment of the indicator distribution is that it is simple and easy to remember, not forcing the user to for instance check a conversion table on the side.

The distance between the conical end 2 of the im- plant 1 and the first indicator 26a, named d above, is one manner of defining the distance between the distance indicating portion 24 and the implant 1. There may be others, such as knowing the distance from one of the other indicators 26 and the coronal end 2 of the implant

1. By knowing the distance d and the relative position between the indicators 26, all information is present to determine the position of any dental region in the neighbourhood of the implant carrier 6.

In order to successfully use said indicators 26 and perform this measurement, it is preferable to know the distance between the distance indicating portion 24 and the implant 1 at the time of implantation. However, it is depending of the type of indicators 26 that is used. For instance it would not be needed to explicitly know such a distance in the case of colour indicators 26 or the like, if said colour indicators 26 are corresponding to equally colour coded abutments 51. On the other hand, if a meas- urement would be performed, this distance should be known in order to be able to transform the indicator- information into an explicit number of millimetres.

In Fig. 4b a set 50 of abutments of different sizes is shown in conjunction with two different embodiments, 6a and 6b, of an implant carrier 6 according to the -pre¬ sent invention. The implant carrier 6 may also be re¬ garded as an implant-engaging depth gauge, which in con¬ trast to the prior art depth gauge not only comes in contact with an inserted implant but also engages the im- plant for insertion thereof. These embodiments of the present invention are used directly in the first and third aspects, i.e. when determining which abutment 51a to 51e to choose from a set 50 of abutments, either di¬ rectly or by contemplating an abutment 51 size first, based on gingival 101 depth in the area around an implant 1. However, the set 50 is indirectly involved also in the second and fifth aspects of the present invention. The indicators 26 on the implant carriers 6a and 6b of Fig. 4b are especially depicted in relation to the corresponding abutments 51a to 51e. As an example, one indicator 26 of the implant carrier 6a is especially marked as corresponding to the third abutment 51c in the set 50 of in total five differently sized abutments. In other words, each indicator 26 of the implant carrier 6a is mutually spaced in the insertion direction of said im¬ plant 1 and hence each indicator 26 corresponds to a re- spective abutment size in said set 50 of abutments. How¬ ever, as previously mentioned, even though this correspondence is advantageous, in a dental implant sys¬ tem according to the invention there may be provided an implant insertion device (e.g. an implant carrier 6) hav- ing indicators 26 for indicating a gingival depth. The indicators 26 may e.g. be differently spaced than in the embodiment of the implant carrier 6a shown in Fig. 4b. The information regarding the gingival depth may then be used for selecting a suitable abutment size. Thus, in such case there does not have to be a direct relationship or correspondence between indicators and abutment sizes, which will be further discussed in the following. This latter case is depicted as the implant carrier 6b in Fig. 4b. In Fig. 5, the step of determination of gingival 101 depth in the area around the implant 1, or the choice of an appropriately sized abutment 51 is illustrated. The figure depicts in an elevation a newly implanted implant 1 with the implant carrier 6 still remaining after the implantation step in the blind bore 5. The coronal end of the gingiva 101 ends up in the proximity of one of the indicators 26, see arrow 43. Said one indicator 26 is a measure or representation of either which abutment 51 to choose or which abutment 51 size to choose from said set

50 of abutments according to the first, second, third, fifth and seventh aspects of the present invention, or of how thick the gingiva 101 is in the area surrounding the implant 1 according to the fourth and sixth aspects of the present invention. In the latter case, each indicator 26 is thus representing a relationship between two dental features, i.e. between the implant 1 and the coronal end of the gingiva 101. This relationship is an explicit dis- tance, for instance expressed in millimetres according to the Si-unit system.

It has already been discussed the different types of implants 1 that one may come across. It should be noted however, that all implants 1 need not align with the bone tissue 100, but may protrude somewhat there from. The dental surgeon performs the above mentioned measurement in a similar manner regardless of if the implant 1 is protruding from the bone tissue 100 or not. The manner, in which the sought distance is being reached, may how- ever be slightly different.

In the first case, i.e. an implant 1 aligning with the bone tissue 100, the implant carrier 6 is connected to the implant 1. When measuring the gingival depth, the position of each indicator 26 becomes a direct measure of said depth.

In the second case, i.e. an implant protruding from the bone tissue 100, the implant carrier 6 is also con¬ nected to the implant 1. When measuring the gingival depth, the position of each indicator 26 may become an indirect measure of said depth, since the indicators 26 still may relate to the distance from the coronal end 2 of the implant 1. The height of the implant 1 that is protruding from the bone tissue 100 is usually known, e.g. due to a known depth of the bore hole in the bone, and hereby the gingival depth is a summation of the dis¬ tance between the coronal end of the gingiva 101 and the coronal end 2 of the implant 1, and the height of the protruding part of the implant 1. Nevertheless, the indi¬ cators 26 may still relate to the coronal end of the bone tissue 100 and, consequently, the position of each indi¬ cator 26 again becomes a direct measure of said depth as in the first case above. If the position of other dental features than the gingiva 101 depths within the oral cavity of the patient in relation to the implant 1 is desired, the implant car¬ rier 6 may also be used for this. Depending on the posi¬ tion of such dental features in relation to the implant 1, the size of the implant carrier 6 and the configura¬ tion of the indicators 26 may need some alteration,. Natu¬ rally, the indicators 26 on the implant carrier 6, on ei¬ ther one or on both of the carrier screw 8 and on the carrier sleeve 9, should be positioned in the close prox- imity of the feature to be measured in order to be able to perform said measurement.

After said measurement has been performed, the im¬ plant carrier 6 has served its purposes and should be re¬ moved. In order to limit the risk that the implant car- rier 6 has been so firmly tightened during the implantation step that it may also unscrew the implant 1 when removed, the implant carrier 6 is given the two-part design that has earlier been described.

During the implantation of the implant 1 into the bone tissue 100, the right-handed threads of the implant 1 in combination with the right-handed threads of the second threaded portion 14 of the carrier screw 8 is driving the implant 1 down into the bore 5 of the jaw 100. The carrier sleeve 9 is left mainly unaffected at this stage.

The removal procedure of the implant carrier 6 may start by very gently trying to unscrew the implant car- rier 6 by trying to turn the carrier screw 8 in the re¬ versed direction, i.e. in the left direction. If the car¬ rier screw 8 is easily loosened from the implant 1, the implant carrier 6 is just as easily removed, bringing also the carrier sleeve 9. On the other hand, if the carrier screw 8 were tightly jammed in the implant 1, a reversed rotation of the carrier screw 8 could possibly also bring the implant 1 back up again. This would be very undesirable since it could damage the bone tissue 100 around the implant 1. If it would be possible to hold the implant 1 in a rotation- ally fixed position relative to the bone 100 using a suitable tool, this would not be a problem. However, the implant 1 is fully implanted into the bone tissue 100 and cannot be manipulated. Instead, the carrier sleeve 9 sup- plies the necessary fixation of the implant 1. The left- handed threads of the carrier sleeve 9 in combination with the conical portion 25 of said sleeve 9 are used to remove the implant carrier 6 only, and leave the implant 1 in the jaw 100. Using a tool to hold the carrier sleeve 9 by its gripping means 23 hence starts the removal procedure of the implant carrier 6 in this case. The carrier sleeve 9 is thereby held in a rotationally fixed position in rela¬ tion to the implant 1 and the carrier screw 8 is turned in the left-handed direction. Since the carrier sleeve 9 has left-handed threads, the turning action will lead to a narrowing movement of the carrier sleeve 9 and the car¬ rier screw 8. This will also cause the carrier screw 8 to be unscrewed from the carrier sleeve 9 and as a conse¬ quence, to be unscrewed from the implant 1.

If this sequence of effects for the removal of the implant carrier 6 is to be successful, it is a prerequi- site that the interspace 28 between the conical end 17 of the carrier sleeve 9 and the apical end of the gripping means 10 of the carrier screw 8 exists. If the interspace 28 did not exist, the rotationally fixed position of the carrier sleeve 9 would completely prevent the turning of the carrier screw 8.

In the hitherto described figures, the differentia¬ tion between the separate indicators 26, i.e. the actual reading of said indicator-information, may be done in many different ways . Figs . βa - 6e show elevations of the distance indicating portions 24 of the carrier sleeve 9 according to the present invention. Fig. 6f shows an im¬ plant carrier 6 connected to an implant 1 and implanted into bone tissue 100 according to the present invention. As can be understood from Figs. 6a - 6f there may be dif- ferent number of indicators on different implant carri¬ ers. This is also true for any other type of implant in¬ sertion device according to the invention.

Fig. 6a depicts the elevation of the already de¬ scribed preferred embodiment, having alternating indenta- tions and protrusions along the insertion direction of the implant 1. The protrusions are here representing uni¬ formly shaped, band-like indicators of 1 mm width in the insertion direction of the implant 1. Each band-like in¬ dicator 26 is circular in cross-section. In this embodi- ment two band-like indicators 26 are having similar di¬ ameter. In other words, the indicators 26 are formed by said band-like areas that are created by the indentations and/or protrusions. The indicators 26 could possibly in- stead be formed by the edges of the band-like areas formed by the indentations and/or protrusions. One ex¬ pected prerequisite is nevertheless, that what determina¬ tion principle to use should be decided upon prior to the use of the implant carrier 6. Notwithstanding any of said determination principles, said edges and said band-like areas may be used simultaneously. Such a case may be when the distance between two adjacent indicators 26 is too wide and "half-distances" need being used. In Fig. 6b colour indicators of the etched type are depicted. Here, one indicator is a band of etched sur¬ face, and the adjacent bands of non-etched surfaces. Other types of colour indicators, such as differently painted lines, or alternating surfaces of different sur- face-character, such as different surface textures, may be used. Also in this case the indicators may be uni¬ formly sized, band-like indicators. The indicators 26 are thus formed by said band-like areas, or alternatively, by the edges of said band-like areas. In Fig. 6c the indicators 26 are narrow lines or line-like shapes protruding from a smooth surface. The indicators 26 are thus each formed by one protrusion.

In Fig. 6d, the indicators are instead indentations or grooves in said smooth surface. The indicators 26 are thus each formed by one indentation. It should be noted that one indicator 26 is placed on the conical part of the implant carrier 6 in the proximity of the conical part 2 of the implant 1 when the two are assembled.

In this case, the indicators 26 may have an advan- tage that is not obvious at a first glace. If the indica¬ tors 26 are thin, narrow indentations or grooves in said smooth surface, blood from the patient may collect in the indicators 26, due to capillary forces, making the indi- cators 26 visually distinct in comparison to the overall surface of the implanting device. The geometry, i.e. for example the width in the axial direction, of said indica¬ tors 26 should be chosen so as to allow for blood to en- ter by means of said capillary forces.

In Fig. 6e, the indicators 26 are band-like areas that extend essentially in the insertion direction of the implant 1 and the indicators 26 are respective edges of said band-like areas. Fig. 6f depicts a type of dental implant 1 that has a coronal end 2 that is designed to follow the coronal end of the bone tissue 100. The bone tissue of the jaw 1 is usually not a plane surface, but a slightly convex one and slightly irregular. The gingiva 101 is overlying the bone tissue 100 and is also following this convex pro¬ file. As a result, it is sometimes advantageous, for the sake of for instance aesthetics, to alter the implant de¬ sign correspondingly. In order to perform the inventive measurement or to make the inventive choice of abutment 51, it may also be advantageous to consequently give the indicators 26 a profile that corresponds to the profile of the coronal end 2 of said implant 1. In this case, the implant carrier 6 may be given indexing features corre¬ sponding to indexing features on the implant 1 in order to correctly be in agreement with the curvature of the coronal end of the implant 1 and of the curvature of the bone 100 and gingiva 101. This being so, a measurement of gingival depth can be accurately performed around the whole implant 1 or abutment 51. In an alternative embodi- ment, the indicators 26 may be given the profile accord¬ ing to the curved implant carrier 6 in Fig. 6f, but the implant carrier 6 may still be used in connection with an implant 1 that has a coronal end 2 that is flat according to, for example, the implant 1 in Fig. Ia.

According to alternative embodiments of the dental implanting system as described above, the implant carrier 6 may be replaced by a screw driving bit, a screw driving hand piece, or some other type of implant engaging depth gauge. These different embodiments may be summarised by one term: dental implant insertion devices. Fig. 7a depicts one embodiment of such a screw driv¬ ing bit, and Fig. 7b one embodiment of a screw driving hand piece, both according to the present invention. The screw driving bit may be used in connection either with a hand tool or a motor driven tool. The screw driving bit of Fig. 7a and the screw driving hand piece of Fig. 7b can both be used instead of the implant carrier 6 when installing the implant 1 in the bore 5. The indicators 26 of the distance indicating portion 24 of said two alter¬ native embodiments are positioned similarly in relation to the coronal end 2 of the implant 1 as has been dis¬ cussed above when the screw driving bit or the screw driving hand piece are assembled with the implant 1. Con¬ sequently, the function and the use of the indicators 26 follow the same principles as has already been discussed in detail in relation to the implant carrier 6.

It is to be understood that various modifications, alterations and adaptations may be made by those skilled in the art without departing from the spirit and scope of this invention. The manifestations of the form in the figures of the dental implant insertion devices according to the present invention are only schematic representa¬ tions .

Claims

1. A dental implanting system, comprising: a set (50) of abutments (51) of different sizes for connection to inserted dental implants (1), a dental implant insertion device (6) comprising an engagement portion being structured to engage a coronal end portion of a dental implant (1), said insertion device (6) further comprising gingi- val-depth indicators (26) for indicating the distance be- tween the inserted implant (1) and a gingival region lo¬ cated coronally of the inserted implant (1), wherein the indicated distance is a criterion for determining a suit¬ able abutment (51) size.

2. A dental implanting system as claimed in claim 1, wherein said gingival-depth indicators (26) are mutually spaced in the axial direction of said insertion device (6), wherein each indicator (26) corresponds to a respec¬ tive abutment (51) size in said set (50) .

3. A dental implanting system as claimed in claim 1 or 2, wherein, when said implant insertion device (6) is engaged with the dental implant (1) , said indicators (26) are located at a respective predetermined distance from a coronal end (2) of the implant (1) .

4. A dental implanting system as claimed in any one of claims 1 - 3, wherein, when said implant insertion de¬ vice (6) is engaged with the dental implant (1), said in- dicators (26) are located at a respective predetermined distance within a range of approximately 1 to 10 mm, preferably 1 - 6 mm from the coronal end (2) of the im¬ plant (1) .

5. A dental implanting system as claimed in any one of claims 1 - 4, wherein said indicators (26) include at least a first indicator (26a), a second indicator (26b) and a third indicator (26c) , the distance between the first and the third indicators (26a, 26c) being equal to the distance between the first and the second indicators (26a, 26b) multiplied by k/2, in which k is an integer greater than 2.

6. A dental implanting system as claimed in any one of claims 1 - 5, wherein the spacing between two neighbouring indicators (26) is approximately 2 mm or less, more preferably 1.5 mm or less, and most preferably 1 mm or less.

7. A dental implanting system as claimed in claim 6, wherein the mutual spacing between said neighbouring in¬ dicators (26) corresponds to a difference in size, pref- erably a difference in length, of two abutments (51) of said set (50) of differently sized abutments (51) .

8. A dental implanting system as claimed in any one of claims 1 - 7, wherein said dental implant insertion device (6) comprises a conical portion (25) tapering api- cally towards the dental implant (1) when engaged, wherein one or more of said indicators (26) is provided on said conical portion (25) .

9. A dental implanting system as claimed in any one of claims 1 - 8, wherein, when said implant insertion de¬ vice (26) is engaged with the dental implant (1) , one or more of said indicators has a profile which corresponds to the profile of a coronal end (2) of the dental implant

(D •

10. A dental implanting system as claimed in any one of claims 1 - 9, wherein, when said implant insertion de¬ vice (6) is engaged with the dental implant (1), one or more of said indicators (26) has an extension which is parallel with the coronal end plane of the dental implant

(D •

11. A dental implanting system as claimed in any one of claims 1 - 10, wherein one or more of the indicators

(26) has its main extension in a geometrical plane which is perpendicular to the insertion direction of the im- plant (1) .

12. A dental implanting system as claimed in claim any one of claims 1 - 11, wherein one or more of the in¬ dicators (26) extends along the circumference of the den- tal implant insertion device (6) .

13. A dental implanting system as claimed in any one of claims 1 - 12, wherein one or more of said indicators (26) is formed by an indentation and/or a protrusion of the implant insertion device (6) .

14. A dental implanting system as claimed in any one of claims 1 - 13, wherein said indicators (26) are formed by edges of one or more band-like areas of the implant insertion device (6) .

15. A dental implanting system as claimed in claim 14, wherein said one or more band-like areas is formed by one or more indentation and/or protrusion of the implant insertion device (6) .

16. A dental implanting system as claimed in claim 14 or claim 15, wherein said band-like areas extend es¬ sentially in the insertion direction of the dental im¬ plant (1) , wherein said indicators (26) are respective apical edges of the band-like areas.

17. A dental implanting system as claimed in any one of claims 14 - 16, wherein two or more of said band-like areas are circular and have the same diameter.

18. A dental implanting system as claimed in any one of claims 14 - 17, wherein two or more of said band-like areas have the same width in the insertion direction of the implant (1) .

19. A dental implanting system as claimed in any one of claims 14 - 18, wherein said one or more band-like ar¬ eas have a width of approximately 1 mm in the insertion direction of the implant (1) .

20. A dental implanting system as claimed in any one of claims 1 - 19, wherein one or more of said indicators

(26) has a surface character, or is an edge of a portion that has a surface character, which differs from the sur¬ face character of the surrounding surface of the implant insertion device (6) .

21. A dental implanting system as claimed in claim 20, wherein said different surface characters are differ¬ ences in colour, such as laser-etched areas and non- laser-etched areas, preferably in the form of band-like areas .

22. A dental implanting system as claimed in any one of claims 1 - 21, wherein one or more of said indicators

(26) is in the form of a groove for receiving body fluid, such as blood, preferably by means of capillary force, for effecting a change of the visual perception of said indicator (26) .

23. A dental implanting system as claimed in any one of claims 1 - 22, wherein said engagement portion is adapted to engage the coronal end portion of the dental implant (1) in a rotationally fixed engagement, prefera- bly by means of cooperating threads, so that, when en¬ gaged, a rotation of the implant insertion device (6) around an axis coinciding with the insertion direction causes an equal rotation of the engaged implant (1) around said axis.

24. A dental implanting system as claimed in any one of claims 1 - 23, further comprising a package (7) and said dental implant (1), wherein said implant insertion device (6) is sup- plied in a state in which it is releasably engaged with said dental implant (1), and is arranged together with said dental implant (1) inside said package (7) .

25. A dental implanting system as claimed in any one of claims 1 - 24, wherein said implant insertion device

(6) is one of an implant carrier (6) which is adapted to carry said implant (1) from a sterile package to an implanta¬ tion site, a screw driving bit, a screw driving hand piece, and a depth gauge (30) .

26. A dental implanting system as claimed in any one of claims 1 - 25, wherein one or more of said abutments (51) comprises an apical implant engaging portion, a cor¬ onal portion and possibly an intermediate portion (41) , wherein said different sizes depend on the size of the intermediate portion (41), which preferably has a length in the range of 0 - 7 mm.

27. A dental implant insertion device (6), compris¬ ing an engagement portion structured to engage a dental implant (1) at a coronal end portion thereof, said device (6) further comprising, for selecting from a set (50) of differently sized abutments (51) a suitably sized abut¬ ment (51) to be mounted on said coronal end portion, two or more gingival-depth indicators (26) being mutually spaced in the axial direction of said implant insertion device (6), wherein each indicator (26) corresponds to a respective abutment (51) in said set (50) .

28. A dental implant insertion device (6) as claimed in claim 27, wherein, when said implant insertion device (6) is engaged with said coronal end portion of said a dental implant (1) , said indicators (26) are located at a respective predetermined distance from the coronal end (2) of said implant (1) .

29. A dental implant insertion device (6) as claimed in any one of claims 27 - 28, wherein, when said implant insertion device (6) is engaged with the dental implant (1) , said indicators (26) are located at a respective predetermined distance within a range of approximately 1 to 10 mm, preferably 1 - β mm from the coronal end (2) of said implant (1) .

30. A dental implant insertion device (6) as claimed in any one of claims 27 - 29, wherein said indicators

(26) include at least a first indicator (26a) , a second indicator (26b) and a third indicator (26c) , the distance between the first and the third indicators (26a, 26c) be¬ ing equal to the distance between the first and the sec- ond indicators (26a, 26b) multiplied by k/2, in which k is an integer greater than 2.

31. A dental implant insertion device (6) as claimed in any one of claims 27 - 30, wherein the spacing between two neighbouring indicators (26) is approximately 2 mm or less, more preferably 1.5 mm or less, and most preferably 1 mm or less.

32. A dental implant insertion device (6) as claimed in any one of claims 31, wherein the mutual spacing be¬ tween said neighbouring indicators (26) corresponds to a difference in size, preferably a difference in length, of two abutments (51) of said set (50) of differently sized abutments (50) .

33. A dental implant insertion device (6) as claimed in any one of claims 27 - 32, further comprising a coni¬ cal portion tapering apically towards the dental implant (1) when engaged, wherein one or more of said indicators

(26) is provided on said conical portion.

34. A dental implant insertion device (6) as claimed in any one of claims 27 - 33, wherein, when said implant insertion device (6) is engaged with the dental implant (1), one or more of said indicators (26) has a profile which corresponds to the profile of a coronal end (2) of the dental implant (1) .

35. A dental implanting insertion device (6) as claimed in any one of claims 27 - 34, wherein, when said implant insertion device (6) is engaged with the dental implant (1) , one or more of said indicators (26) has an extension which is parallel with the coronal end plane of the dental implant (1) .

36. A dental implant insertion device (6) as claimed in any one of claims 27 - 35, wherein one or more of the indicators (26) has its main extension in a respective geometrical plane which is perpendicular to the insertion direction of the implant (1) .

37. A dental implant insertion device (6) as claimed in claim 36, wherein one or more of the indicators (26) extends along the circumference of the implant insertion device (6) .

38. A dental implant insertion device (6) as claimed in any one of claims 27 - 37, wherein one or more of said indicators (26) is formed by an indentation and/or a pro¬ trusion of the implant insertion device (6) .

39. A dental implant insertion device (6) as claimed in any one of claims 27 - 38, wherein said indicators (26) are formed by edges of one or more band-like areas of the implant insertion device (6) .

40. A dental implant insertion device (6) as claimed in claim 39, wherein said one or more band-like areas is formed by one or more indentation and/or protrusion of the implant insertion device (6) .

41. A dental implanting insertion device (6) as claimed in claim 39 or claim 40, wherein said band-like areas extend essentially in the insertion direction of the dental implant (1), wherein said indicators (26) are respective apical edges of, the band-like areas.

42. A dental implant insertion device (6) as claimed in any one of claims 39 - 41, wherein two or more of said band-like areas are circular and have the same diameter.

43. A dental implant insertion device (6) as claimed in any one of claims 39 - 42, wherein two or more of said band-like areas have the same width in the insertion di¬ rection of the implant (1) .

44. A dental implant insertion device (6) as claimed in any one of claims 39 - 43, wherein said one or more band-like areas has a width of approximately 1 mm in the insertion direction of the implant (1) .

45. A dental implant insertion device (6) as claimed in any one of claims 27 - 44, wherein one or more of said indicators (26) has a surface character, or is an edge of a portion that has a surface character, which differs from the surface character of the surrounding surface of the implant insertion device (6) .

46. A dental implant insertion device (6) as claimed in claim 45, wherein said different surface characters are differences in colour, such as laser-etched areas and non-laser-etched areas, preferably in the form of band- like areas.

47. A dental implant insertion device (6) as claimed in any one of claims 27 - 46, wherein one or more of said indicators (26) is in the form of a groove for receiving body fluid, such as blood, preferably by means of capil- lary force, for effecting a change of the visual percep¬ tion of said indicator (26) .

48. A dental implant insertion device (6) as claimed in any one of claims 27 - 47, wherein said an implant en- gagement portion is adapted to engage said coronal end portion of a dental implant (1) in a rotationally fixed engagement so that, when engaged, a rotation of the im¬ plant insertion device (6) around an axis coinciding with the insertion direction causes an equal rotation of the engaged implant (1) around said axis.

49. A dental implant insertion device (6) as claimed in any one of claims 27 - 48, wherein, prior to implanta¬ tion, said implant insertion device (6) is provided in a releasably engaged state with the implant (1) to be in¬ serted, wherein, in said engaged state, both of them are preferably provided in a sterile package (7) .

50. A dental implant insertion device (6) as claimed in any one of claims 27 - 49, wherein said implant inser¬ tion device (6) is one of an implant carrier (6) which is adapted to carry said implant (1) from a sterile package (7) to an implan¬ tation site, a screw driving bit, a screw driving hand piece, and a depth gauge (30) .

51. A method of selecting an abutment (51) size from a set (50) of differently sized dental abutments (51) , comprising: inserting a dental implant (1) into the alveolar bone tissue (100) of a patient by an implant insertion device (6) engaging the dental implant (1) ; using said implant insertion device (6), while being engaged with the dental implant (1) , for determining a distance between the inserted implant (1) and a gingival region located coronally of said implant (1); and selecting an abutment (51) size based on the deter¬ mined distance.

52. A method as claimed in claim 51, wherein said implant insertion device (6) is used for determining said distance before it is removed from said dental implant (D •

53. A method as claimed in claim 51 or claim 52, wherein, during the insertion of the dental implant (1) , the engagement between the implant insertion device (6) and the implant (1) is rotationally fixed, and wherein the insertion further comprises screwing the dental im¬ plant (1) into the bone tissue (100) by applying a torque to the implant insertion device (6) .

54. A method as claimed in any one of claims 51 -

53, wherein the distance indication further comprises de¬ termining the distance by means of at least two indica¬ tors (26) provided on the implant insertion device (6) at mutually spaced positions in the insertion direction of the dental implant (1) .

55. A method as claimed in any one of claims 51 -

54, further comprising removing said implant insertion device (6) from the dental implant (1); and engaging an abutment (51) of the selected abutment (51) size to a coronal end portion of the dental implant (D •

56. A method as claimed in any one of claims 51 -

55, in which an implant insertion device (6) according to any one of the claims 27 - 50 is used.

57. A method of measuring a distance between a den- tal implant (1) and a dental region located coronally of said implant (1) , comprising the steps of inserting a dental implant (1) by an implant inser¬ tion device (6) engaging the dental implant (1); and using said implant insertion device (6) for measur- ing said distance, while said insertion device is still engaged with said implant (1) .

58. Use of an implant carrier, which is adapted for carrying a dental implant (1) in a transporting container (7) or a package (7), as a depth gauge (30) for selecting an abutment (51) from differently sized abutments (51), which selected abutment (51) is to be connected to said dental implant (1) .

59. A depth gauge for measuring the distance between an inserted dental implant (1) and a dental region lo- cated coronally of the dental implant (1), comprising two or more indicators (26) at mutually spaced posi¬ tions in the insertion direction of the dental implant (1), and an implant engagement portion for engaging in a ro- tationally fixed manner a coronal end portion of the den¬ tal implant (1) during the insertion thereof.

60. A method of implanting a dental implant (1) into the alveolar bone tissue (100) of a patient, comprising: inserting a dental implant (1) into the alveolar bone tissue (100) of a patient by an implant insertion device (6) engaging the dental implant (1) ; using said implant insertion device (6), while being engaged with the dental implant (1), for determining a distance between the inserted implant (1) and a gingival region located coronally of said implant (1) ; selecting an abutment (51) size based on the deter¬ mined distance; and removing said dental implant insertion device (6) from said implant (1) .

61. A method of implanting a dental implant (1) as claimed in claim 60, further comprising the steps of selecting a properly sized abutment (51) from a set

(50) of differently sized abutments (51) based on said abutment (51) size; and coupling said abutment (51) to said implant (1) .

62. A method as claimed in any one of claims 60 - 61, in which an implant insertion device (6) according to any one of the claims 27 - 50 is used.