PATIENT SPECIFIC DYNAMIC NAVIGATION TRACKER ARM MOUNT APPARATUS AND METHOD

Abstract

A system and method for a tracker arm mount for dynamic navigation is provided. The tracker arm mount accurately adapts to the patient's jawbone and is temporarily secured to the bone with screws engaging the full thickness of the bone. The tracker arm supports an occlusal positioning device and a dental prosthesis. The tracker arm mount is based off digital imaging records. The inner surface is fabricated to closely contour the outer surface, or buccal, contour of the patient's jaw bone. Attachment apertures avoid vital structures and may accept reinforcement collars. Fasteners are placed through the attachment apertures to fixate the mount to the patient's jaw bone. Slots accept corresponding tabs from an occlusal positioning device, interim dental prosthesis, or other device.

Claims

1. A dynamic navigation method for oral and maxillofacial surgery using a tracker arm, comprising: acquiring digital data associated with a patient; generating a dental surgery treatment plan; placing a plurality of virtual dental implants: designing a tracker arm, a tracker arm mount and a foundation guide based on the surgery treatment plan; designing a prosthesis and a positioning device for attaching the tracker arm mount to a jawbone of the patient; fabricating the prosthesis and the tracker arm mount positioning device; performing a reflection of a gum tissue of the patient: attaching the tracker arm mount; attaching the tracker arm mount positioning device onto the teeth accurately repositioning the tracker arm mount with the positioning device; and attaching an optical tracking device to the tracker arm mount.

2. The method of claim 1, further comprising removing the teeth; planing the jawbone; placing the dental implants using a dynamic navigation system in communication with the tracker arm; and attaching the prosthesis to the tracker arm mount.

3. The method of claim 1, wherein the step of data acquisition comprises acquiring photographic images, measurements, digital impressions, and 3D x-rays (CBCT) taken of the patient.

4. The method of claim 2, further comprising uploading the patient data acquired into CAD/CAM software; and designing a prosthesis

5. The method of claim 1, wherein in response to designing the prosthesis: ensuring a position associated with the positioning device using dental implant treatment planning software provides an adequate amount of jawbone to support the prostheses.

6. The method of claim 2, further comprising attaching temporary cylinders into the tops of the dental implants.

7. The method of claim 6, further comprising luting the dental implants to the temporary cylinders with dental light cure composite material; detaching the temporary cylinders and the prosthesis; removing the attachments and smoothing and polishing the prosthesis.

8. The method of claim 6, further comprising: removing the tracker arm mount; and reinserting the prosthesis; and attaching the prosthesis into the dental implants.

9. The method of claim 1, wherein optical tracking device is an optical tracking bulb.

10. The method of claim 1, wherein the dental surgery treatment plan is based on a patient surface generation and an anticipated clear field of view of at least one stereotactic detection camera.

11. A dynamic navigation system for oral and maxillofacial surgery, comprising: a tracker arm, a tracker arm mount and a foundation guide; the tracker arm mount comprising a threaded portion attached by a connecting arm to a body; the body comprising a top surface and an inner surface corresponding with an outer surface contour of a jaw bone, a plurality of receiving slots, and a plurality of apertures; the apertures adapted to receive a fastener for attachment of the tracker arm mount to the jawbone.

12. The dynamic navigation system of claim 11, further comprising: a dental device comprising a plurality of tabs, the tabs corresponding to the receiving slots in the body for connecting the dental device to the body.

13. The dynamic navigation system of claim 11, wherein the threaded portion is connected to the body via the tracker arm; the threaded portion being configured to connect to an optical tracking device.

14. The dynamic navigation system of claim 12, wherein the dental device comprises an occlusal positioning device comprising a prosthesis having negative tooth impressions; the tabs extending outward, for connection to the receiving slots the occlusal positioning device having an undersurface; the undersurface comprising contours corresponding with a top surface of a patient's teeth.

15. The dynamic navigation system of claim 14, wherein the occlusal positioning device further comprises a plurality of verification window apertures; the verification window apertures disposed in the occlusal positioning device to ensure proper seating of the occlusal positioning device on the patient's teeth.

16. The dynamic navigation system of claim 15, wherein the tabs are insertable into the corresponding receiving slots via a pin to join the body and the dental device and to seat the dental device onto the patient's teeth; the patient's teeth being partially viewable through the verification window apertures to confirm a predetermined position.

17. The dynamic navigation system of claim 16, further comprising an ultraviolet light source, a patient tracker, an instrument tracker, at least one stereotactic camera, and a dynamic navigation unit; wherein the tracker arm mount is fixated to the jawbone and the tracker arm is secured onto the tracker arm mount; the ultraviolet light source is reflected off of the patient tracker and the instrument tracker; the patient tracker and the instrument tracker in data communication with the at least one stereotactic cameras to generate camera data; the stereotactic camera data configured to transmit the camera data to a dynamic navigation unit.

18. The dynamic navigation system of claim 17, further comprising a monitor in data communication with a processor of the dynamic navigation system; the monitor configured to display the camera data.

19. The dynamic navigation system of claim 17, wherein the tracker arm mount is based on one of an intra oral scan or a digital tooth impression; and having a guide tube for accepting a fixation screw to provide anchorage into the underlying jawbone.

20. A dynamic navigation system for oral and maxillofacial surgery, comprising: a tracker arm and a tracker arm mount; the tracker arm mount comprising a threaded portion for receiving an optical tracking device; the tracker arm mount having at least one aperture for receiving a fastener for attachment to a jawbone.

Description

BRIEF DESCRIPTION OF THE FIGURES

[0037] The application will become more fully understood from the following detailed description, taken in conjunction with the accompanying figures, wherein like reference numerals refer to like elements, in which:

[0038] FIG. 1 is a front view of an exemplary tracker arm mount of the present invention.

[0039] FIG. 1A is a top view of the tracker arm mount of FIG. 1.

[0040] FIG. 2 is a right side perspective view of an occlusion positioning device.

[0041] FIG. 2A is a bottom view of the occlusion positioning device of FIG. 2.

[0042] FIG. 3 shows a front view of an interim dental prosthesis.

[0043] FIG. 4 is an image of a jawbone.

[0044] FIG. 5 is an assembled view of the tracker arm mount attached to the occlusal positioning device disposed on the jawbone.

[0045] FIG. 6 is a tracker arm mount affixed to the jawbone.

[0046] FIG. 7 shows the teeth removed and the jaw bone planed flush with the tracker arm mount.

[0047] FIG. 8 shows a prosthesis attached to the tracker arm mount.

[0048] FIG. 9 is an alternate arrangement with a tracker arm that does not incorporate a top surface used as a bone leveler.

[0049] FIG. 10 is an exemplary configuration for a dynamic navigation system.

[0050] FIG. 11 is a tooth and soft tissue born tracker arm mount.

[0051] FIG. 12 is a workflow showing the steps of the workflow for dynamic navigation with the tracker arm mount.

DETAILED DESCRIPTION OF THE EXEMPLARY EMBODIMENTS

[0052] Before turning to the figures which illustrate the exemplary embodiments in detail, it should be understood that the application is not limited to the details or methodology set forth in the following description or illustrated in the figures. It should also be understood that the phraseology and terminology employed herein is for the purpose of description only and should not be regarded as limiting.

[0053] The present invention provides a patient specific solution to tracker arm mounting for dynamic navigation surgery. This invention could be used in any dynamic navigation surgical system requiring a patient tracker arm to be fixated into surrounding hard tissue.

[0054] In regard to dental implant surgery, the patient specific tracker arm can be planned in manner to be secure, avoid vital structures, and avoid planned dental implant placement locations. It can also be incorporated into a more complex foundation guide to offer a teeth in a day dental implant full arch oral rehabilitation solution possibly consisting of a tracker arm mount/bone foundation guide with corresponding temporary teeth which can be stacked or attached to said guide for accurate placement of the teeth to be picked up or secured onto the corresponding dental implant attachments.

[0055] Referring to FIGS. 1-11, The present invention 10 discloses a tracker arm mount that can accommodate and support an occlusal positioning device 20 and subsequent interim dental prosthesis 30. The tracker arm mount 10 is designed based on digital imaging records from the patient (not shown.)

[0056] Referring next to FIGS. 1 and 1A, a tracker arm mount 10 includes a threaded portion 26 attached by a connecting arm 24 to a body 28. Receiving slots 16 on body 28 are arranged to receive tabs 22 (FIG. 2) Apertures 14 are provided for receiving attachment devices or fasteners 52. A top surface 18 of body 28 may be used as a reference for bone leveling as described below. The inner surface 12 is designed and fabricated to closely contour the outer surface, or buccal, contour of the patient's jaw bone. Attachment apertures 14 are planned in a manner to avoid vital structures and may optionally be configured to accept reinforcement collars (not shown). Fasteners are inserted through the attachment apertures 14 to temporarily fixate the mount 10 to the patient's jaw bone as described in greater detail below. Slots 16 accept corresponding tabs 22 from a dental device, e.g., an occlusal positioning device 20 (FIG. 2), interim dental prosthesis 30 (FIG. 3), or any other dental device or component that may be added. The top surface 18 could be digitally planned in a manner to be used as a reference for bone leveling. The arm 24 connects the body 28 of tracker arm mount 10 to the threaded portion 26 to accept an optical tracking device or bulb 27 (FIG. 11)

[0057] Referring next to FIGS. 2 and 2A an occlusal positioning device 20 includes a prosthesis 30 having negative tooth impressions with verification window apertures 34. Tabs 22 connected to the prosthesis 30 extend outward, generally in a perpendicular plane for connection to slots 16 on tracker arm body 28. The occlusal positioning device 20 is designed based of patient imaging records to have an undersurface 31 that closely contours the top surface of the patient's teeth 32. Verification window apertures 34 are placed to ensure proper seating of the occlusal positioning device 20. Tabs 22 are designed to be inserted into the slots 16 of the tracker arm mount.

[0058] Referring next to FIGS. 3 and 4, prosthesis 30 is shown with a tooth portion 36 and gingival portion 38 on an interim prosthesis 30. An actual dentition 40 of a patient for removal is shown with a malocclusion and in this example, a space for a missing tooth, along with the patient's jawbone surface 42. The interim dental prosthesis 30 has a tooth portion 36 and gingival portion 38 with corresponding tabs 22 which insert into the slots 16 of the tracker arm mount. The interim dental prosthesis 30 is designed based of patient imaging records.

[0059] A summary of a typical use is described as below:

[0060] Referring next to FIG. 5 an assembled view of the tracker arm mount 10 attached to the occlusal positioning device 20 disposed on the jawbone is shown. FIG. 6 shows a detail of the tracker arm mount affixed to the jawbone. 56 During surgery, the patient's buccal surface 42 of the jawbone 56 is visualized. The occlusal positioning device 20 tabs 22 may be inserted into the slots 16 of the tracker arm mount 10 and temporarily fixated with pins 54. The joined device is seated onto the patient's teeth 32 and verified to be in correct position through the verification window apertures 34. Fasteners 52 are placed through the attachment apertures 14 to fixate the tracker arm mount 10 to the outer surface of the jaw bone 42 for the length of the surgery. The pins 54 are removed to allow for the removal of the occlusal positioning device 20. The optical tracker bulb 27 (see, e.g., FIG. 11) is secured to the threaded portion 26 of the tracker arm mount 10. The teeth 32 are removed with surgical instruments (not shown) and the bone above the level of the tracker arm mount 56 is removed with surgical instruments (not shown). Dental implant surgery is performed in the area 70 of the reduced bone 50 and attached tracker arm mount 10 collectively seen in FIG. 7.

[0061] Once dental implant surgery is performed, an interim dental prosthesis 30 may be stacked and pinned 54 to the tracker arm mount slots 16. A “pick up” whereby dental implant components can be luted onto the interim dental prosthesis 30 can occur which allows the interim dental prosthesis to be secured to the inserted dental implants in a retrievable type fashion.

[0062] The fasteners 52 are removable to allow for removal of the tracker arm mount 10 and the surgical area is closed in a standard fashion. A prosthesis 30 is attached to the tracker arm mount 10, as shown in FIG. 8.

[0063] Referring next to FIG. 9 shows an alternate embodiment of a tracker arm 90 that does not incorporate a top surface used as a bone leveler. The tracker arm mount 90 may be used in a manner that does not incorporate a top surface to be used as a bone leveler nor without attachment apertures for other associated fixtures 92. It is designed to contour the patient's bone in the planned area 94.

[0064] Referring next to FIG. 10, an exemplary embodiment of the dynamic navigation system 100 of the present invention is shown. The tracker arm mount 104 is fixated to the jaw bone 108 with fixation screws 106. The tracker 102 is secured onto the tracker arm mount. Ultraviolet light 110 is emitted from a UV source 112 that reflects off the patient tracker 102 and instrument tracker and is read by stereotactic cameras 116. The stereotactic camera data is relayed to and processed by a dynamic navigation unit 118 and displayed onto a monitor (not shown).

[0065] Referring to FIG. 11, a tooth and soft tissue born tracker arm mount 120 is designed from a patient's intra oral scan, or digital tooth impression 122. A guide tube 124 that accepts a corresponding fixation screw 126 is planned in manner as to provide adequate anchorage into the underlying jaw bone.

[0066] Referring next to FIG. 12 a flow diagram of an exemplary method and workflow for surgery using the tracker arm mount 10 of the present invention is shown. The invention and method describes an example of a patient specific tracker arm mount use for a dental full arch rehabilitation surgery.

[0067] The method 200 begins at step 201 with data acquisition. Data associated with the patient includes pertinent photos, measurements, digital impressions, and 3D x-rays (CBCT) which are taken of the patient prior to surgery. Next, the method proceeds at step 202 2 to perform treatment planning. The patient data acquired in step 201 is uploaded into appropriate CAD/CAM software to design a prosthesis, i.e., a new set of teeth. After the teeth are designed, dental implant treatment planning software is used to virtually place the dental implants to ensure their position into adequate amounts of bone and in a manner to support the new teeth in an esthetic, hygienic, and structural manner.

[0068] Next, at step 203 the tracker arm mount and foundation guide are designed. Front, rear, top, bottom, left side profile, and right-side profile views of an exemplary design are shown in FIGS. 1 and 1A. From step 203, the method proceeds at step 204 to designing and fabricating the prosthesis and fabricating the tracker arm mount positioning device as described above with respect to FIGS. 2 and 3 FIG. 2 shows front, rear, top, bottom, left side profile, and right side profile views of the design prosthesis. FIG. 3 shows front, rear, top, bottom, left side profile, and right-side profile views of the tracker arm mount positioning device.

[0069] Next, the method proceeds at step 205 to performing reflection of the gum tissue and temporary mounting of the tracker arm mount. FIG. 4 is an example of the underlying jaw bone and corresponding teeth to be removed. FIG. 5 shows how the tracker arm mount positioning device fits securely onto the teeth to accurately position the tracker arm mount. FIG. 6 shows the tracker arm mount and jaw bone with the positioning device removed.

[0070] At step 206 an optical tracker bulb is attached to the tracker arm mount 10, 90. and the dynamic navigation system is calibrated. The surgeon removes the teeth and planes the bone to the top 18 of the foundation guide (FIG. 7.)

[0071] Next at step 207 the surgeon uses the dynamic navigation system to place the dental implants (not shown.) Implant attachments, temporary cylinders, are screwed into the tops of the dental implants in the manner which is well-known to persons of skill in the art.

[0072] Finally, at step 208 the prosthesis is attached to the tracker arm mount and is luted to the temporary cylinders with dental light cure composite material. Once set, the cylinders are unscrewed and the prosthesis and connected temporary cylinders may be removed from the mouth. The attachments are removed, and the prosthesis is smoothed, polished. The tracker arm mount 10, 90 is then removed. The prosthesis is reinserted, screwed into the dental implants. The gum tissue is repositioned and sutured closed.

[0073] In an exemplary embodiment the steps for designing the described tracker arm mount 10, tracker arm 24 and various components is described below.

[0074] First, patient data such as CBCT, digital impressions of the maxillary and mandibular teeth, important facial and intraoral measurements, and patient photos are acquired.

[0075] Next, a virtual wax up of the desired new teeth and gums is created in dental CAD/CAM software. in one embodiment the software may be, exocadDentalCAD by Evident Labs of Vancouver Canada, or similar software. The design is based on the existing occlusion of the maxillary and mandibular teeth, important measurements, and intra and extra oral patient photos. The virtual wax up is saved in a Standard Tessellation Language (STL) format.

[0076] Then a dental implant virtual treatment plan is created in dental implant treatment planning software. A non-limiting example of the planning software used is X-Guide treatment planning software by Nobel Biocare. The patient CBCT is uploaded into the dynamic navigation treatment planning software. The virtual wax up, in stl file format, is aligned, or meshed onto the patients CBCT. The dental implants are placed in a manner to provide optimal support of the prosthesis, allow anchorage in bone of sufficient quantity and quality, and be clear of any and all vital structures. Dental implants are available in varying widths and lengths to allow the designer and surgeon flexibility in implant placement.

[0077] Next, the position of the CBCT, planned implants, and designed prosthesis are exported as one stl file.

[0078] A case is created in a dental implant treatment planning software which allows for design of static guides. Examples of such software include: exoplan, by exocad GmBH, RealGuide by 3DIEMME Company, and 360DPS. by 360Imaging The tracker arm mount is designed on based on such variables as implant positioning and planned bone leveling. An occlusal positioning jig is designed based on the patient's existing teeth position and planned tracker arm mount. A soft tissue format of the patient's CBCT is generated allowing visualization of the patient's extraoral facial characteristics. The tracker arm mount and CBCT soft tissue format are saved and exported as stl file formats.

[0079] A standard CAD software is then opened and the soft tissue format and tracker arm mount are imported. One example of suitable CAD software is Meshmixer. Using the soft tissue surface as a reference, a previously designed tracker array and its corresponding attachment threads having the same dimensions as the actual patient tracker array, is virtually placed in a manner as to provide the optimal direct view with the overhead stereotactic cameras during the actual dental implant surgery. This position is ideally selected with input from the performing surgeon. The tracker array and threads are saved as separate stl files.

[0080] Next, a case is created in the exocad PartialCAD and the tracker arm mount, soft tissue format, tracker array, and tacker array threads, files are imported. Other software which may be used include any organic type CAD application such as Geomagic. The arm is designed connecting the tracker arm mount to the threads which accept the tracker array.

[0081] The previously created Meshmixer case is then opened and the completed foundation mount, occlusal positing jig, and virtual wax up are imported to the previously saved objects. Struts and attachments are designed allowing the occlusal positioning jig and virtual wax up to be secured to the underlying foundation mount with pins. The completed foundation mount, occlusal positioning jig, and virtual are exported as individual stl file.

[0082] Finally, the objects described as above are fabricated with materials per their intended use in either an additive or subtractive type manner.”

[0083] While the exemplary embodiments illustrated in the figures and described herein are presently preferred, it should be understood that these embodiments are offered by way of example only. Accordingly, the present application is not limited to a particular embodiment, but extends to various modifications that nevertheless fall within the scope of the appended claims. The order or sequence of any processes or method steps may be varied or re-sequenced according to alternative embodiments.

[0084] The present application contemplates methods, systems and program products on any machine-readable media for accomplishing its operations. The embodiments of the present application may be implemented using an existing computer processors, or by a special purpose computer processor for an appropriate system, incorporated for this or another purpose or by a hardwired system.

[0085] It is important to note that the construction and arrangement of the dynamic navigation tracker arm mount apparatus and method as shown in the various exemplary embodiments is illustrative only. Although only a few embodiments have been described in detail in this disclosure, those skilled in the art who review this disclosure will readily appreciate that many modifications are possible (e.g., variations in sizes, dimensions, structures, shapes and proportions of the various elements, values of parameters, mounting arrangements, use of materials, colors, orientations, etc.) without materially departing from the novel teachings and advantages of the subject matter recited in the claims. For example, elements shown as integrally formed may be constructed of multiple parts or elements, the position of elements may be reversed or otherwise varied, and the nature or number of discrete elements or positions may be altered or varied. Accordingly, all such modifications are intended to be included within the scope of the present application. The order or sequence of any process or method steps may be varied or re-sequenced according to alternative embodiments. In the claims, any means-plus-function clause is intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. Other substitutions, modifications, changes and omissions may be made in the design, operating conditions and arrangement of the exemplary embodiments without departing from the scope of the present application.

[0086] As noted above, embodiments within the scope of the present application include program products comprising machine-readable media for carrying or having machine-executable instructions or data structures stored thereon. Such machine-readable media can be any available media which can be accessed by a general purpose or special purpose computer or other machine with a processor. By way of example, such machine-readable media can comprise RAM, ROM, EPROM, EEPROM, CD-ROM or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to carry or store desired program code in the form of machine-executable instructions or data structures and which can be accessed by a general purpose or special purpose computer or other machine with a processor. When information is transferred or provided over a network or another communications connection (either hardwired, wireless, or a combination of hardwired or wireless) to a machine, the machine properly views the connection as a machine-readable medium. Thus, any such connection is properly termed a machine-readable medium. Combinations of the above are also included within the scope of machine-readable media. Machine-executable instructions comprise, for example, instructions and data which cause a general purpose computer, special purpose computer, or special purpose processing machines to perform a certain function or group of functions.

[0087] It should be noted that although the figures herein may show a specific order of method steps, it is understood that the order of these steps may differ from what is depicted. Also two or more steps may be performed concurrently or with partial concurrence. Such variation will depend on the software and hardware systems chosen and on designer choice. It is understood that all such variations are within the scope of the application. Likewise, software implementations could be accomplished with standard programming techniques with rule based logic and other logic to accomplish the various connection steps, processing steps, comparison steps and decision steps.