Abstract
Systems and processes are disclosed for providing rapid and accurate dental prosthetic placement on implant abutments with robotic positioning for coping pick-up processing using a provisional fastener. In an embodiment, a dental arch with an open intaglio surface is bonded onto copings that are mounted onto threaded implant abutments with axially separable fasteners through a pick-up process using the same robotic system used to install the implant abutments into bone. The robotic system may apply movement to the prosthesis to aid its removal from abutments after the copings are bonded. The prosthesis with incorporated copings can subsequently be modified for attachment with definitive screws. One embodiment includes a prosthesis with integral robotic attachment features avoiding imaging of fiducial references for proper placement. An embodiment includes temporary arch indexing features between opposing arches to provide proper occlusion during pick-up processing.
Claims
1. A robotic-assisted prosthesis delivery method for coping pick-up comprising: affixing a coping to an implant abutment with a means for provisional fastening, mounting a prosthesis onto a robot, applying a bonding agent to at least one of the coping or the prosthesis, positioning the prosthesis on the coping in a predetermined position, maintaining the relative position of the prosthesis and coping with robotic assistance for a predetermined minimum time for bonding the coping to the prosthesis.
2. A robotic-assisted system for presenting a prosthesis to an implant abutment system comprising: a robotic system, a delivery jig attached to the robot, a prosthesis, wherein the prosthesis is attached to the delivery jig in a known position, and wherein the robotic system is spatially aware of the difference between the current position of the prosthesis to a predetermined mounting position of the prosthesis on the implant abutment system.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0063] FIG. 1 is a top exploded isometric view of a first embodiment of a system for aligning a dental implant abutment, coping and prosthesis for definitive screw-attachment.
[0064] FIG. 2 is a side plan view of a first embodiment of a system for aligning a dental implant abutment, coping and prothesis for definitive screw-attachment.
[0065] FIG. 3 is a top plan view of a first embodiment of a system for aligning a dental implant abutment, coping and prosthesis for definitive screw-attachment.
[0066] FIG. 4 is a side cross-sectional view of the system for aligning a dental implant abutment, coping and prosthesis for definitive screw-attachment along the line indicated in FIG. 3.
[0067] FIG. 5 is a side cross-sectional view of the embodiment of FIG. 4 attached to the jaw and prosthesis prior to the pick-up process.
[0068] FIG. 6 is a side cross-sectional view of the embodiment of FIG. 5 after the pick-up process.
[0069] FIG. 7 is a side cross-sectional view of the embodiment of FIG. 6 showing a drill bit creating a pilot hole for a definitive screw.
[0070] FIG. 8 is a side cross-sectional view of the embodiment of FIG. 7 showing a stepped drill bit creating a clearance for the head and shaft of a definitive screw.
[0071] FIG. 9 is side cross-sectional view of the embodiment of FIG. 8 showing the definitive screw holding the prosthesis to the implant.
[0072] FIG. 10 is an exploded top isometric view of a second embodiment of a system for aligning a dental implant abutment, coping and prothesis for definitive screw-attachment illustrating a single abutment and a temporary screw with breakaway tool.
[0073] FIG. 11 is an exploded side isometric view of the second embodiment of FIG. 10 prior to installation to the implant abutment.
[0074] FIG. 12 is an exploded side isometric view of the embodiment of FIG. 10 with the breakaway tool pushed onto the post and the coping placed on the implant abutment.
[0075] FIG. 13 is an exploded side isometric view of the embodiment of FIG. 10 schematically showing the tool being rotated to screw the post into the implant abutment.
[0076] FIG. 14 is an exploded side isometric view of the embodiment of FIG. 10 schematically showing the tool breaking away from the cap after the coping is secured on the abutment.
[0077] FIG. 15 is an exploded side isometric view of the embodiment of FIG. 10 schematically showing the prosthesis being marked for positioning a clearance hole.
[0078] FIG. 16 is a side isometric view of the marked prosthesis from FIG. 15.
[0079] FIG. 17 is a side isometric view of the marked prosthesis from FIG. 16 with blind clearance hole and boring tool.
[0080] FIG. 18 is an exploded side isometric view of the prepared embodiment of FIG. 17 as adhesive is schematically applied to the coping fixed to the abutment with the temporary screw.
[0081] FIG. 19 is a side view of the prosthesis in position for curing of the adhesive applied in
[0082] FIG. 18.
[0083] FIG. 20 is a bottom side isometric exploded view of the coping incorporated in FIG. 19 being picked up as the prosthesis is removed from the implant abutment.
[0084] FIG. 21 is a top side isometric view schematically showing the post of the temporary screw being unscrewed from the implant abutment.
[0085] FIG. 22 is a top side isometric view of the implant abutment prepared for attachment of a prosthesis with a definitive screw.
[0086] FIG. 23 is a bottom isometric view of the prosthesis with picked-up coping from FIG. 20 being drilled from the bottom to provide clearance for the threaded shaft of a definitive screw following coping pick-up.
[0087] FIG. 24 is a top isometric view of the prosthesis with picked-up coping from FIG. 20 with a drill applied from the top to provide clearance for the definitive screw head.
[0088] FIG. 25 is top exploded isometric view of the prepared prosthesis from FIG. 24 with the definitive screw.
[0089] FIG. 26 is a top isometric view of the prepared prosthesis from FIG. 24 after attachment to the implant abutment with the definitive screw.
[0090] FIG. 27 is a schematic description of a process for aligning dental implant abutments, copings and a prosthesis for definitive screw-attachment.
[0091] FIG. 28 is an exploded bottom isometric view of a third embodiment of a system for aligning a dental implant abutment, coping and prosthesis for definitive screw-attachment with tool oriented for assembly.
[0092] FIG. 29 is an assembled bottom isometric view of the embodiment of FIG. 28 with temporary screw and coping inserted into tool.
[0093] FIG. 30 is a side view of the system of FIG. 29 after assembly with the implant abutment.
[0094] FIG. 31 is a cross-sectional view of the assembly of FIG. 30 along C-C.
[0095] FIG. 32 is a side view of the assembly of FIG. 28 after the pick-up process showing the removal end of the tool engaging the retained temporary screw post.
[0096] FIG. 33 is a cross-sectional of the assembly of FIG. 32 along D-D.
[0097] FIG. 34 is an exploded isometric view of another embodiment of a temporary screw of a system for aligning a dental implant abutment, coping and prosthesis for definitive screw-attachment.
[0098] FIG. 35 is an isometric view of the temporary screw of FIG. 34 from the screw thread end.
[0099] FIG. 36 is an isometric view of the temporary screw of FIG. 34 from the cap end.
[0100] FIG. 37 is a bottom isometric view of a jaw with multiple abutments in preparation of marking a prosthesis as part of the process for aligning a dental implant abutment, coping and prosthesis for definitive screw-attachment.
[0101] FIG. 38 is a top isometric view of the prosthesis of FIG. 37 showing abutment location markings.
[0102] FIG. 39 is a top isometric view of the prosthesis with clearances milled to receive copings for pick-up.
[0103] FIG. 40 is a bottom isometric view showing installed copings and the assembly of a coping to an implant abutment with a temporary screw and torque driver.
[0104] FIG. 41 is a top isometric view showing adhesive being dispensed in recesses of the prosthesis.
[0105] FIG. 42 is a bottom isometric view of the abutments with attached copings in the process of being positioned into the recesses of the prothesis after adhesive is dispensed.
[0106] FIG. 43 is a top isometric view of the copings attached to the prosthesis after adhesive curing and pick-up.
[0107] FIG. 44 is a bottom isometric view showing the removal of temporary screw posts from the implant abutments after the pick-up process.
[0108] FIG. 45 is a top view of a drill in position to create a pilot hole in the prosthesis of FIG. 43.
[0109] FIG. 46 is bottom view showing the pilot holes from the process of FIG. 45 extending through the prosthesis to exit on the occlusion side.
[0110] FIG. 47 is a bottom isometric view showing a counterbore positioned on the occlusion side of the prosthesis to provide clearance for the definitive screw.
[0111] FIG. 48 is a bottom isometric view illustrating a reamer positioned to clean residue from the bore.
[0112] FIG. 49 is a bottom isometric view of the prepared prosthesis with definitive mounting screws prior to fastening to the abutments.
[0113] FIG. 50 is a top isometric view corresponding to FIG. 49.
[0114] FIGS. 51-52 are top and bottom isometric views schematically illustrating the material removed from an existing denture necessary with inventive concepts disclosed.
[0115] FIGS. 53-54 are top and bottom isometric views schematically illustrating the material removed from an existing denture necessary using prior art impression screw systems.
[0116] FIG. 55 is a top isometric view of a bite fork for holding a prosthesis.
[0117] FIG. 56 is a top isometric view of a prosthesis attached to a bite fork with bonding agent.
[0118] FIG. 57 is a schematic description of a process for preparing and placing a prosthesis for coping pick-up including robotic assistance.
[0119] FIG. 58 is an isometric view of a representative robot for dental implant surgery and prosthesis positioning for coping pick-up.
[0120] FIG. 59 is an isometric view of a robotic reference arm with splint.
[0121] FIG. 60 is an exploded isometric view of a robotic dental handpiece and bite fork.
[0122] FIG. 61 are top and bottom exploded isometric views of a bite fork and interface wafer.
[0123] FIGS. 63-64 are top and bottom assembled isometric views of the robotic prosthesis delivery jig of FIGS. 60-62 with an attached prosthesis.
[0124] FIG. 65 is a top isometric view of an open intaglio surface prosthesis with integral robotic dental handpiece interface.
[0125] FIG. 66 is a top isometric view of an open intaglio surface prosthesis with integral robotic arm interface.
DETAILED DESCRIPTION OF THE INVENTION
[0126] FIG. 1 shows an exploded view of one embodiment of a temporary alignment system 12 for use in a direct coping pick-up process for screw attachment of a prosthesis. Implant 8 has a distal end which may include attachment feature portion 135 illustrated as a screw thread for direct attachment to the patient's jaw and a proximal end with an abutment shaped to accommodate a coping 9. The abutment includes threaded section 18. The coping has a central bore 16 to accommodate screw fastening and may include ridges 17 or other structures or surface treatments to increase retention to the prosthesis with adhesive. The coping and abutment mating surfaces as shown in FIG. 1 are symmetrical. The inventive concepts of this disclosure may also be applied to abutment and coping systems that are keyed to restrict mating orientation. The coping may be mounted onto the abutment through rotation of a temporary adjustment screw comprising a threaded post 10 and cap 11. The cap 11 is mechanically attached to post 10 in a manner that allows relative axial motion with the application of a predetermined force. As illustrated in FIG. 1, cap 11 has a square central bore 13 that is press-fit onto a square portion 14 of post 10. The cap 11 temporarily retains coping 9 onto abutment 8 during the pick-up process of the coping into the prosthesis with a force aligned directly along the same axis as the semi-permanent screw that will be used for definitive prosthesis mounting. The portion of the post engaging the abutment threads also prevents any pick-up material from contacting the abutment screw threads. After the coping is picked-up into the prosthesis, the cap and coping may be released from the abutment by applying an axial force. In the embodiment shown, the post threads 15 remain engaged with abutment threads 18 after the pick-up process. The post can then be removed from the abutment by unscrewing it. The prosthesis with embedded coping can be subsequently processed to accommodate semi-permanent screw attachment as will be described later.
[0127] FIGS. 2 and 3 show a side and top view of the assembled system of FIG. 1; FIG. 4 shows a cross-sectional view along the axis as indicated. As shown in FIG. 4, matching conical surfaces on the exterior of the abutment 8 and the interior of the coping 9 are engaged. The coping is pulled into alignment by an axial force from the lower surface of the cap 11 pushing against the upper surface of the coping from screwing the threads of post 10 into the implant abutment. The distal end of the abutment may be directly attached to the patient's jaw or attached to a separate implant attached to the jaw. The inventive concepts are not dependent upon the nature of the implant, so the distal end attachment feature 135 is represented schematically.
[0128] The capability for relative axial movement between the cap 11 and temporary attachment post 10 allows separation of the temporary attachment post from the cap without tools after retaining the coping onto the abutment during fitting and bonding of the coping into the prosthesis. These parts are accurately aligned during the bonding process since the temporary post engages the abutment threads to provide an axial force holding the coping to the abutment just like the screw used for final attachment.
[0129] The cap may be sized to have an amount of press-fit mechanical interference to the temporary attachment post to provide an axial retention force of approximately 20 to 900 grams, this force being sufficient to retain coping 9 during assembly while allowing relatively easy pick-up removal of the coping and prosthesis from the temporary attachment post after assembly. The temporary attachment post 10 may include indicators (not shown) in the end by the cap 11 to provide intermediate visual and/or tactile feedback on the depth of threaded engagement of the post during screw attachment of the coping to the abutment.
[0130] In this embodiment, screw driving torque is provided by the square cross-section of the cap aperture and temporary attachment post. In the cross-sectional view of FIG. 4, the post 10 has been screwed in so that only a small, beveled surface of the post extends above the top of the cap when the post threads bottom out in the abutment. During installation, this optional configuration provides feedback to the dental practitioner when the torque increases as the threads bottom. The square drive tool engagement can also be designed to disengage at a pre-designed minimum extension of the square post above the top of the cap. Alternatively, a tool with a specified maximum torque may be used to ensure engagement of the coping and abutment surfaces.
[0131] The screw driving torque function may be accomplished by engaging other features on the temporary attachment post such as hex or spline or asymmetric features. Alternately, the cap may be used to engage a screwdriver or other tool for torquing. For example, in the case of a cylindrical temporary attachment post top portion, driving torque can be provided by the friction of the press-fit between the cap and temporary attachment post. For example, a medium press-fit of a 3 mm diameter 1 mm thick nylon cap onto a 1.3 mm diameter stainless steel cylindrical rod may produce approximately 500 grams of axial retention force and 17 gram-cm driving torque. A typical screw thread size for appliances is m1.4×0.3. The retention/axial force of the cap to the temporary attachment post may be determined by the degree of press-fit and frictional properties between the cap and temporary attachment post, and/or spring features incorporated into the temporary attachment post and/or cap.
[0132] In actual trial installations, polymer caps of approximately 1.2 mm thickness press fit onto posts of approximately 1.4 diameter with cylindrical axial bores have been sufficient for installation and pick-up removal of a single prosthesis from multiple implant abutments in which the axes of the screw threads in the implant abutments are not mutually parallel.
[0133] The separable mechanical attachment means may include any combination of techniques, including frictional forces from interference, adhesives, waxes, chemical bonding, solders, elastically or inelastically deformable spring, snap or interlocking structures, thermally or electromagnetically fusible materials, fracturing structures, etc.
[0134] FIG. 5 through FIG. 9 show example cross-sectional views of some of the different stages of installation of the temporary fastener system into a denture. FIG. 5 shows a cross-sectional view of the assembly of the first embodiment during the initial phase of the coping pick-up process. As illustrated, the implant abutment 8 is attached to a schematic implant 70. The implant 70 has an interface 7 (shown schematically) that is attached to the patient's jawbone 22. The coping 9 is held against the implant abutment 8 through the temporary screw comprising the post 10 and cap 11. A blind clearance hole 5 in the prosthesis 3 is sized to accommodate the coping and temporary screw. Pick-up material 71 is positioned in the clearance hole 5 to capture the coping in proper alignment within the prosthesis. After the pick-up material has set up, the prosthesis 3, coping 9 and temporary screw cap 10 assembly is pulled off the patient's jaw as shown by the arrows in FIG. 6. The coping 9 and cap 11 are released from the abutment 8 and post 10, while the threads of the post 10 keep it engaged in the implant abutment 8. The post 10 is subsequently removed to make the abutment threads 18 available for holding the prosthesis in proper alignment with a definitive screw.
[0135] The prosthesis/coping assembly must be processed after the pick-up process for screw attachment. A pilot hole is drilled with bit 72 from the bottom side of the assembly. As shown in FIG. 7, the diameter of the bit may be selected to use the interior bores of the coping and cap to act as guides for hand processing. Alternately, a drill guide may be employed that engages a portion of the interior of the coping may be used to align the pilot hole. The pilot hole provides guidance for a tool to provide clearance for the definitive screw shaft and head. FIG. 8 shows a stepped drill that cuts both clearances in a single process. Alternatively, the shaft and head clearance may be drilled with two drills in two process steps. If desired, the cap 11 of the temporary screw can be fabricated of a material that is easier to drill than the coping material to provide feedback on the drill position. It has been found that it is possible to distinguish where the drill is positioned by feel at the interfaces between the adhesive and the top of the cap (as shown in FIG. 8) and the bottom of the cap and the top of the coping. Since pick-up material was blocked from entering the coping, drilling resistance decreases rapidly upon breaking through the bottom of the cap and entering the interior channel of the coping. Color differences in the materials can also be detected. Alternatively, a tool can be configured to fit within the bore of the coping to limit the depth of the drill.
[0136] Once clearance for the definitive screw has been made from the top of the prosthesis, the prosthesis is ready for mounting to the implant with definitive screw 75 as shown in FIG. 9. The screw clearance hole in the prosthesis may be filled with Teflon tape and color-matching composite materials for aesthetic purposes. In the illustrated embodiment, the coping bore has a shoulder to engage a flat surface on the underside of head of the screw. Alternate configurations are possible without deviating from the temporary screw system for coping pick-up disclosed.
[0137] FIG. 10 is another exploded isometric view of parts of an embodiment of the invention. In this example, cap 11 is integrated into a breakaway installation tool 18. The tool portion 19 may be used to install the temporary attachment post 10, and then section 19 broken away at mechanically weak separation feature 20, for example, when the post bottoms out in the abutment leaving the cap portion 11 in position. Alternatively, the tool can be designed to increase stress on the separation feature as the top of the post moves axially down relative to the weakened section. As illustrated, after the cap portion 11 breaks away from the tool portion 19, drive feature 21 in the tool portion may be used to remove the post 10 after the pick-up process. One or both ends of the tool may be shaped to subsequently engage and remove the temporary attachment post 10 after installation of coping 9 into the denture.
[0138] FIGS. 11-26 provide in schematic isometric views the process steps for using the elements of an exemplary embodiment introduced in FIG. 10 for a single implant system such as a crown. In FIG. 11, a schematic isometric view of a portion of the patient's jaw 22 is shown with an implant 70 (not shown) installed, and abutment 8 installed into the implant. The coping 9 is placed onto the abutment 8, the top portion of temporary attachment post 10 is assembled onto cap 11. The top portion of temporary attachment post 10 and cap 11 are configured such that there is a means to drive the temporary attachment post into the abutment, while allowing axial movement of the cap 11 relative to the temporary attachment post axis, the cap/temporary attachment post interface having sufficient retention force to keep the coping in place on the abutment during subsequent installation steps, and the temporary attachment post being removable after picking up the coping into the prosthesis. Cap 11 may be attached to a break-away installation/removal tool 18.
[0139] FIG. 12 shows the coping 9 placed on the abutment 8 and the cap/tool 18 installed onto temporary attachment post 10. The coping-abutment surfaces may comprise a conical or spherical concave feature on the coping 9 that mates with a complementary feature on the top of the abutment 8, as illustrated. Alternatively, keying features may be employed to restrict relative rotational orientation, particularly in the case of single implants.
[0140] FIG. 13 shows the temporary attachment post being threaded into the abutment 8, through a clearance hole in the coping 9. The cap abuts the coping to secure the coping to the abutment. The cap 11 is free to move axially along the temporary attachment post with a frictional retaining force of the cap to the temporary attachment post. A known amount of retention force of the coping to abutment is provided by the design and materials used in the cap and temporary attachment post.
[0141] FIG. 14 shows the tool portion of the cap being removed after the cap has broken away; the tool may be used for removal of the temporary attachment post at a later step.
[0142] FIG. 15 shows marking of the position of the coping onto the appliance for drilling a recess for the coping in the prosthesis.
[0143] FIG. 16 shows the prosthesis with coping drilling location marking 23.
[0144] FIG. 17 shows the prosthesis after drilling the cavity for the coping; the cavity for the coping may be accurately drilled slightly larger than the coping, without significant unwanted material removal from the prosthesis.
[0145] FIG. 18 shows pick-up material being applied to the coping and/or prosthesis after confirmation of freedom to provide proper occlusion during dry testing. Although not illustrated, the cavity of the prosthesis or the coping may optionally include features to provide venting of excess pick-up material if desired.
[0146] FIG. 19 shows the bonded coping being picked up into the prosthesis.
[0147] FIG. 20 shows the prosthesis removed from the temporary attachment post; the temporary attachment post/cap design allows removal of the prosthesis from the temporary attachment post. The coping is now incorporated into the prosthesis.
[0148] FIG. 21 shows the temporary attachment post being removed with the tool portion of the cap.
[0149] FIG. 22 shows the abutment installed in the implant with the temporary attachment post removed.
[0150] FIG. 23 shows drilling a small guide-hole (for example 1-2 mm diameter), through the clearance hole of the coping, into and through the prosthesis. This guide hole provides a small reference hole for enlargement of the hole to accommodate the prosthesis retaining screw.
[0151] FIG. 24 shows enlarging the guide hole to a clearance hole for prosthesis retaining screw, approximately the diameter of the head of the retaining screw (e.g. 1.5-2.5 mm). The clearance hole would typically be drilled down to the top surface of the coping.
[0152] FIG. 25 shows the prosthesis being installed onto the implant abutment by placing the prosthesis coping onto the abutment, and installing the prosthesis retaining screw.
[0153] FIG. 26 shows the assembled prosthesis on the implant.
[0154] FIG. 27 contains a summary of a generalized process extending the basic process described above for a prosthesis attached to multiple implant abutments.
[0155] Another embodiment of a prosthesis and implant alignment system and tool are shown in FIG. 28. In this case, the cap is in the form of a hex nut 63 that is press fit onto alignment post 62 to act as the temporary alignment screw. The drive tool 64 includes a concave hex socket 68 that fits temporary post nut 63, and coping retaining portion 69 that retains coping 61 with a slight interference fit. Thus, as shown in FIG. 29, the temporary screw comprising nut 63 with post 62 is engaged with the socket portion of the tool, and the coping 61 is retained in the tool. The coping is seated onto the abutment 60 by using the hex portion of the driver to rotate the nut and engage the threads 66 on the temporary screw post 62. FIGS. 30 and 31 show an exterior and cross-sectional view of the mounting of the coping on the abutment with the tool. The tool may also have an integrated feature for removing the post as shown in FIG. 32, such as the opposite taper-fit end feature 70 shown in cross-sectional view FIG. 33. FIG. 28 illustrates optional undercut 67 for stronger adhesive locking. Optional anti-rotation flat 65 is shown Such an anti-rotation flat may be used on mating surfaces in circumstances in which there is a preferred orientation around the axis of the screw threads.
[0156] Another embodiment of the inventive concepts in which the cap of the temporary screw is shaped to engage the driving tool is shown in FIGS. 34-36. Cap 102 is mechanically attached to alignment post 101 at end portion 101A to form temporary alignment screw 100. This mechanical attachment may result from press-fitting a polymeric cap 102 onto a metal post 101 to provide adequate resistance to rotary slip to temporarily attach the abutment to the implant while still allowing axial movement during the pick-up process. A hexalobular internal (Torx) drive feature is shown in the end of the cap 102, although other bit socket shapes are possible. As previously discussed, other mechanical engagement means besides an interference fit are possible. The post may be made of different materials than these, or even be of unitary construction with weakened sections that fracture under a desired pick-up axial force.
[0157] In a preferred embodiment the post 101 is made from stainless-steel or titanium, and the cap of polymer such as PEEK or acetal. The short length of the post and threaded fastener in this embodiment allows separation at high degrees of angularity of the assembled parts in use. This tolerance for off-axial removal has been found to be particularly advantageous when the prosthesis is to be definitively screw mounted to multiple implant abutments.
[0158] The general process for converting an existing removable denture for definitive screw attachment onto four implants with this embodiment is illustrated in FIGS. 37-50. This prosthesis may be, for example, a removable denture that was used prior to implant surgery or a duplicate of such an existing denture as described in U.S. Provisional Patent Application 62/774,402 incorporated herein in its entirety.
[0159] FIG. 37 shows a schematic representation of a human jaw portion 106 with implant abutments 107 installed. It does not matter for this discussion if the abutments are separable from the implanted portion of the implant or not. Prosthesis 103 is shown with occlusion side 104 and intaglio side 105. Pick-up marking caps 108 are installed onto abutments 107. The location of abutments 105 is marked onto the prosthesis using customary methods by mating the prosthesis with the abutments. FIG. 38 shows the abutment positions 109 marked onto prosthesis 104. FIG. 39 shows drilling of blind holes 110 slightly larger than copings 112 in marked locations, with burr tool 111.
[0160] FIG. 40 shows the installation of copings 112 onto abutments 107 using separable fastener assembly 100, and torque driver 113. The torque driver 113 prevents over-tightening of temporary screw 100 and possible separation of the cap 102 from the post 101 due to rotary motion. The cap 102 and/or post 101A of the separable fastener 100 may be mechanically captured or adhered to the coping 112, or may be designed to loosely fit into the bore of the coping as illustrated with axial force from tightening the separable fastener holding the coping to the abutment 107. The prosthesis is placed over the mounted copings to ensure proper fit.
[0161] FIG. 41 shows application of acrylic or other adhesive into cavities 110 of prosthesis 103, which is subsequently fitted onto copings 112.
[0162] FIG. 42 shows prosthesis 103 being mated with copings 112. After the adhesive sets, the separable fasteners allow easy removal of the prosthesis from the abutments with the copings incorporated into the prosthesis. The angular tolerance for removing the prosthesis from multiple abutments allows applying pick-up forces sequentially around the edge of the prosthesis to work the caps 102 off the posts 101. The caps 102 remain in the prosthesis with the copings 112, while the posts 101 remain in the abutments.
[0163] FIG. 43 shows the prosthesis with incorporated copings 112 after the pick-up process.
[0164] FIG. 44 shows the removal of the threaded post 101 from the implant abutment with removal tool 115. This allows the implant abutment threads to be accessible for subsequent definitive screw attachment.
[0165] FIG. 45 shows the drilling of the small pilot hole 117 (e.g. using a drill bit 116 of approximately 1.4 mm diameter), from the intaglio side 105 of the prosthesis out through the occlusion side 104. It has been found that the bore of the coping 112 and the bore of the cap provide adequate guidance for this hole, although a tooling guide could readily be designed to mate with the particular coping used. The pilot hole is drilled completely through the prosthesis to the occlusion side 104 as shown in FIG. 46.
[0166] FIG. 47 shows enlarging of the pilot hole 117 to allow clearance for a prosthetic mounting screw 121. The clearance holes 119 are drilled down to the top of the coping using counterbore drill 118. This requires only a small diameter enlargement (for example, approximately 2.4 mm).
[0167] FIG. 48 shows a step of a final hand reaming with reamer 120 of the coping bore to clean out any debris or remaining material from the cap that would interfere with the definitive screw.
[0168] FIGS. 49 and 50 show the final installation of prosthesis 103 onto abutments 107 using definitive prosthetic screws 121. The screw holes may be subsequently filled to use the modified prosthesis depending upon the anticipated use as a short-term or more permanent prosthesis. This sequence of process steps essentially follows the material provided in FIG. 27.
[0169] Note that in the above procedure very little material is removed from the prosthesis during the coping pick-up installation process. The boring process in FIG. 39 need only be sufficient to provide clearance for the coping and temporary screw. Angular variation in the axes of the implant abutments does not appreciably increase the size of the cavity boring required in this closed tray process compared to the additional prosthesis material that must be removed with relatively long impression screws and sleeves in a conventional open tray conversion process for definitive screw attachment. FIGS. 51-52 provide a schematic comparison of the size of the recess borings required using the concepts disclosed compared to the prior art conversion process with larger through holes in FIGS. 53-54. In addition to the stubby embodiment shown in FIGS. 34-36, the parent U.S. patent application Ser. No. 15/596,361 incorporated by reference in its entirety includes other separable fastener embodiments and associated tools that may be beneficially used with the processes described in the present application. These are not the only examples of means for provisional coping attachment. The inventive concepts disclosed are not meant to be restricted to a temporary attachment post with standard screw threads that both engage and disengage the threads in the implant abutment through rotations. For example, alternate separable temporary attachment screw posts embodiments are possible providing features that allow the post to removably hold the coping to the abutment by other means than a separable cap. Other means for provisional coping attachment are also known in the industry including various forms of snap-on devices that are not used with definitive screw attachment. Embodiments presented that do not specifically rely upon means for provisional attachment to an implant abutment using screw attachment should also be considered to be within the scope of the inventive concepts.
[0170] A desirable feature of disclosed embodiments is the relatively small size possible for the separable fastener itself as well as the coping and implant abutment. This relatively small size reduces the amount of material that must be removed from the converted prosthesis for clearance not only from angular variation in the axis, but also in the width and length of the components. In the case of preparing a new denture for coping pick-up and screw attachment, smaller dimensions may provide more efficient cycle times for milling the smaller clearance bore in a new custom or stock denture for the pick-up.
[0171] Reduced material removal to convert the existing prosthesis to accommodate the smaller separable fasteners retains more of the structural integrity of the prosthesis through the milling and fitting processes. Avoiding distortions in the prosthesis from handling helps maintain proper occlusion and soft-tissue contact of the original system. Since the disclosed separable fasteners allow the converted denture to be used in a closed-tray pick-up process, additional structural support during milling or the pick-up process can be provided with the arch bar or bite fork 150 shown in FIG. 55. The bite fork 150 illustrated is an arched plate constructed of sheet metal or other stiff material including titanium, cobalt chromium, stainless steel, PEEK, PEK, PMMA or other metals, alloys or resins with known processing techniques such as additive or subtractive machining, molding, casting, etc., sized to support a prosthesis. A user grip 153 is provided on the end for the dentist. As shown in FIG. 56, the prosthesis 103 can be temporarily affixed to bite fork 150 with an adhesive 152. The adhesive 152 provides a temporary bonding between the prosthesis 103 and the bite fork 150. Any of the temporary fixing or impression materials known in orthodontics may be used to temporarily hold these elements together for processing. The assembly formed by bonding these elements together stabilizes the denture and prevents it from distorting during the milling process that creates clearance for the implant abutments 107, copings 112 and temporary fasteners 100. After milling, the optimum sequence of separation of the components during the overall conversion and pick-up process may be chosen depending upon particular circumstances of the case. That is, the prosthesis and bite fork assembly can be removed from the patient's mouth together, or the bite fork can be removed before the prosthesis is removed through the release of the separable fastener. Obviously, the prosthesis would need to be removed from the bite fork and adhesive to check proper occlusion with opposing natural or prosthetic teeth.
[0172] A bite fork with attached prosthesis may also be advantageously employed as a delivery jig in robotic assisted dental implant surgery and immediate new prosthesis fitting. The processes for fitting a prosthesis for multi-abutment screw attachment described above and summarized in FIG. 27 may include a dependency on the alignment skills of the dental practitioner. The fitting of the prosthesis to the implant abutments for the pick-up process requires that clearances are sufficiently large to provide passivity, but not so large that the prosthesis is not in the ideal position for the patient. This tradeoff in proper clearance may cause multiple trial fittings until enough prosthesis material is removed. A method to reduce the human element to reduce chair time for the patient and improve alignment outcomes with a modified pick-up process with the separable fasteners is provided in FIG. 57.
[0173] The embodiment described is an extension of a digital workflow planning and processing using robotic assistance systems for implant placement and prosthesis design such as the Yomi System from Neocis. FIG. 58 shows a 6-axis robotic system 220 used in robotic-assisted dental surgery, such as in the for drilling and placement of dental implants. A dental handpiece base 203 is attached to robotic actuator arm 201 with handpiece arm interface 202. As shown in FIG. 60, handpiece base 203 generally has a detachable/interchangeable head assembly 204 to allow varied torques, speeds and tool attachment. Cutting tools and bits are installed into the end 205 of head-assembly 204. A common interface standard for dental handpiece tools such as burrs or drills, etc. is a 3/32″ diameter latch-lock shank. The form of attachment between these tools and delivery jigs described below is a design choice, but generally, the translational and rotational spatial relationship of tools relative to the robot must be known by design or measurement after attachment. Attachment of devices to the robot may be done with mechanical, magnetic, pneumatic or other techniques known in the machine tool industry.
[0174] For robot/patient planning and positioning, some current procedures utilize a splint 301 shown in FIG. 59 rigidly fixed to the patient's jaw 303 with a removable radiopaque fiducial plate (not shown) attached to the splint to reference and track placement of surgical procedures and planning and compensate for movement of the patient during the procedure. The splint 301 is attached to the patient's jaw and to a reference arm 221 in communication with the robotic system at separable interface 222. Cone-beam computed tomography (CBCT) scans are made with the splint 301 and fiducial array in place, thus providing a reference for digital design and location-tracking. A feedback positioning linkage with fixed mounting replaces the fiducial plate and attaches to the splint 301 and robot system 220 through the reference arm 221 to provide location and tracking of the patient's movement and orientation and guiding of tools attached to the actuator arm 201. For example, splint position encoders 302 shown schematically in FIG. 59 may provide information to the robotic system on the current position and orientation of the splint 301 which provides direct information on the position of the patient's jaw 303. In this way, the robot is spatially aware of the position of the jaw in real time to properly apply tools affixed to the dental handpiece 203. The inventive concepts may also be adapted to other systems that use alternate techniques to fix or dynamically monitor patient position relative to the actuator arm such as some form of dynamic imaging. For convenience, the description describes a process for placing a mandibular prosthesis, but can be equally applied to placing a maxillary prosthesis. While robotic assistance with haptic or other sensory feedback is described, autonomous processing of one or more steps by the robotic system is an obvious variation considered to be part of the inventive concepts disclosed.
[0175] FIG. 60 shows how the dental handpiece base 203 may be adapted to position a prosthesis delivery jig for pick-up processing using the spatial awareness of the robotic system. The prosthesis delivery jig illustrated in FIG. 60 comprises a bite fork 155 with an adapter block 305 for attachment to the handpiece end 205. Features in the adapter block 305 for repeatable alignment can include alignment hole 306 for interface pin 304 and attachment screws 307.
[0176] For some processes, the robotic assistance and spatial awareness may depend upon the operator first providing input to the robot. For example, the operator may guide the actuator arm of a robot through a path in virtual or real space for presenting a prosthesis delivery jig into rough position in a dry fit process. In the subsequent actual pick-up process, the robot could provide assistance by constraining movement to an envelope around this path relative to the actual patient position. Another form of robotic assistance from motion constraint that may be employed is preventing the operator from moving the prosthesis after presentation to the coping being picked-up until a prescribed time has elapsed necessary for bonding agents to set.
[0177] After the patient has been scanned with the splint and fiducial array and the relation of the fiduciary array with the software completed, a digitized prosthesis is imported and positioned in the ideal position as prescribed by the restorative team. The digitized prosthesis can be from a digital library of off-the-shelf dentures 206 as shown in FIGS. 63 and 64. The schematically illustrated denture 206 is a representative example of an open intaglio surface prosthesis which has been selected to require minimal or no material removal due to interference with the implants and copings for pick-up. Only a limited number of mass-produced impression tray sizes and shapes are needed to fit a large population of patients. In a similar manner, the disclosed process provides increased standardization of mass-produced prostheses for rapid processing for screw attachment after coping pick-up processing.
[0178] While no clearance boring is necessary in the extreme case of a prosthesis with an intaglio surface resembling an impression tray, there are still advantages in adapting this process when more solid standardized or custom prostheses are used. In these cases, the position and size of the clearance bores does not need to be as accurate since the robot is placing the prosthesis. The clearance customization of the prosthesis can be prepped in advance of implant surgery based upon the robotic workflow planning software. Inaccuracies introduced in the actual implant positions relative to the digital plan can be considered in oversizing the bores in preparation of the prosthesis. Final prosthesis position in the patient's mouth will depend upon the inherent accuracy of the robotic positioning, not the nesting of elements held in place by human judgement. Mechanical uncertainties in a loose nesting of bore holes and inaccuracies in actual versus planned abutment placement may be compensated by the displacement and flow of the bonding material before it sets.
[0179] The process of FIG. 57 exploits the known position of the robot actuator arm relative to the splint-attached robot reference arm that remains attached to the patient that was used for the implant surgery. Mass-produced dentures may be mounted in a known position by indexing features of the delivery jig, or a digitized custom prosthesis may be mounted and then scanned by intra- or extra-oral scanner for determining position on the delivery jig. The requirement is of course that the prosthesis is mounted onto the robot arm, by some means, in a known position and orientation relative to the robot's known position with final accuracy sufficient for the pick-up procedure (approximately within a tolerance zone of 0.5 mm). A prosthesis 206 is mounted to the bite fork 155 in a pre-determined position or may be imaged with fiducial markers fixed in the prosthesis or bite fork assembly to determine position. By mounting the bite fork with prosthesis on the robot actuator arm in a known position, the robotic system can determine where the prosthesis is located relative to the robotic actuator position in the same way that the system knows how a drill or implant is positioned relative to the robotic actuator arm.
[0180] Note that the robot reference arm 221 does not need to be removed from the splint 301 unlike a process using the robot to bore clearance holes of sufficient size in a known position in a prosthesis to accommodate the implant abutments, copings and temporary fasteners for the pick-up process. This boring process necessarily requires that the reference arm be disconnected from the patient and attached to the bite fork in order to process the prosthesis through a material removal process. The prior art describes how these clearance borings could be used to manually fit the prosthesis in place. The clearance holes must be sized to allow for uncertainties in actual implant position versus planned implant position and actual bore size versus planned bore size. More accurate positioning may be accomplished by also using the robotic system to position the prosthesis by using the robotic actuator arm to position the prosthesis in the patients mouth and using the pick-up bonding agent to accommodate implant or boring tolerances. While this robotic assisted positioning could be done with a prosthesis with material removed for abutment, coping and separable fastener clearance, the process in FIG. 57 in which material is added to an open intaglio surface prosthesis though the pick-up process provides additional benefits in cycle times and standardization.
[0181] Through the patient position information through the reference arm splint, the position of the prosthesis relative to the patient can be determined. As a result of this positional information, the robotic system can be used to place the prosthesis on the copings for pick-up without any dependence on human judgement and without a dependency upon the close nesting of pick-up copings in complimentary bore holes in the prosthesis. Even in a prosthesis conversion or fitting process in which material removal is necessary to avoid mechanical interferences, less precision is required since final prosthesis positioning in the patient's mouth is not dependent upon accurate milling of clearance bores for tight nesting with the abutment assemblies for coping pick-up.
[0182] FIGS. 60-64 illustrate an embodiment of a prosthesis delivery jig for robotic positioning of a prosthesis 206 for pick-up processing. In an illustrative embodiment, the delivery jig comprises a bite fork 155 and robot attachment adapter block 305. In this example, adapter block 305 mechanically attaches to the handpiece end 204 that is mounted to the robot actuator arm 201. FIG. 60 shows the adapter block 305 assembly and bite fork 155 prior to being attached to the handpiece end 204. The handpiece in this example is attached to the robotic arm in a known position and orientation for use by the robotic system software and hardware. In this example, adapter block 305 is located and retained onto handpiece end 204 using a contoured surface that fits the body of the handpiece end 204, and a latch-lock pin 304 that installs and locks into the normal tool holder/collet 205 of the handpiece and fits into alignment hole 306. Attachment screws 307 may be used to further lock the adapter block 305 to handpiece 204. The bite fork 155 is attached to the robot in a known position through the adapter block 305. A pattern of locating holes 154 may be included on the bite-fork for registration of the prosthesis onto the bite-fork or to provide imaging reference points. The bite fork and adapter block assembly may made as one piece from polymers and or metallic materials. Alternately the bite fork 155 may be removably attached to adapter block 305.
[0183] Through design data or through imaging, the position of the bite fork 155 and adapter block 305 assembly are known relative to the existing position and coordinate system of the robot and handpiece, allowing for guiding and placement of the prosthesis. To facilitate the use of off-the-shelf prefabricated arches, interface wafers 308 shown in FIGS. 61-64 may be utilized. The interface wafers 308 provide a similar functionality to the prosthesis adhesive 152 shown in FIG. 56 in fixing a prosthesis to a bite fork delivery jig. The wafers 308 include locating features 309 that mate with reference features on the bite-fork. These locating features may be used with adhesive attachment or may incorporate snap fit features. On the opposite side of the wafers 308, tooth interface features 310 may be used to locate and retain the arch during the pick-up procedure. Thus, by installing an interface wafer 308, the position of the arch relative to the bite fork is known, and the interface wafer retains the denture to the bite fork during the pick-up procedure. In this manner, the same bite fork 155 and adapter block 305 assembly can be used with a universe of different prostheses by using the appropriate interface wafer for each prosthesis.
[0184] FIGS. 63-64 show a prefabricated arch 206, installed using interface wafer 308 onto the bite fork 155 and adapter block 305, and the adapter block installed onto handpiece end 204. Discrete interface wafers may be fabricated to align all the available prefabricated arches. The interface wafers 308 may be injection-molded, cast, printed etc. from polymers or elastomeric materials. For custom dentures or other prosthetics, a compliant curable registration material may be applied to the bite fork and the prosthetic occlusal surfaces indexed to the fork while the registration material sets similar to the description of FIGS. 55-56. In order to reference the custom denture to the bite fork, the locating features 154 or other fiducial features may be imaged along with the denture. This scanned information can be imported and processed through methods known in the robotics dental industry to both digitally simulate and physically manipulate the denture relative to the patient. A bite fork, or similar fixture plate, may be used with auxiliary mounting fixtures to help locate the arch in a known position with respect to the bite fork and with respect to the robot.
[0185] Alternatively, the custom prosthetic can be designed in a design software in relation to the bite fork and a custom interface wafer designed to include features that would index the custom prosthetic to the bite fork, for example, by including posts that fit into locating holes 154. The designed prosthesis, wafer and digital bite fork can be exported from design software and imported into implant planning software. The bite fork may be fixed or detachable but indexed to the attachment apparatus to maintain a consistent re-positioning of the bite fork. The bite fork may be made of a metal or high-performance polymer intended for re-use. The interface wafers may be intended for single use, but may also be made of a re-usable material (e.g. stainless steel, polyetheretherketone, etc.) The posts 309 may include snap features to lock onto the bite fork 155.
[0186] FIGS. 63-64 illustrate how the denture 206 is held on the bite fork 155 by the interface wafer 308 and the implant handpiece 203 used as the positioning reference to position the prosthesis in patient's mouth in the correct vertical and anteroposterior positioning, along with the correct pitch, roll and yaw. With the use of the haptic technology to position the prosthesis, the implant components can be picked up utilizing separable fastener technology while the robot arm maintains the proper position of the prosthesis during the curing of the pick-up material.
[0187] Once the pick-up material is cured, the sequence of releasing the prosthesis from the bite fork assembly and the prosthesis from the implant abutments is a design choice. In some cases, it may be desirable to allow the prosthesis to be retained on the abutments temporarily before completing the modification for screw attachment using the latter process steps from FIG. 27 at a future appointment. In this case, the prosthesis must release from the interface wafer with a lower force than would cause the separable fastener to separate. Although a single prosthesis attached to the delivery jig has been described, extending the process to robotically position mating prosthesis simultaneously is possible. For proper occlusion, however, the bite fork plate would need to be removed from between occluding teeth. The structural support for the jig would need to be located inside the arch and in the gum of the prosthesis for aesthetic reasons. The positioning relative to the patient of the assembly would be controlled by the side with the splint and robotic arm reference, while the patient would close on the other side. The two prostheses would be held in proper occlusion at least until the bonding agent sets.
[0188] While the discussion above has focused on how the robotic system and integrated workflow can be used to properly position and hold a prosthesis for a coping pick-up process more accurately than human judgement, the robot may also be used to help release the prosthesis from the implant abutments after the copings are bonded. The robotic system can guide the release of the separable fasteners by determining the appropriate force vector direction. The robot can also be programmed to restrict the range of motion so that upon release, the prosthesis and bite fork do not move more than necessary. In that sense, the robot can apply a controlled braking force when the separable fastener connection releases. In addition to these human-assisted benefits, the robotic actuator can be programmed to rock or vibrate in any direction to assist in the separation of the separable fasteners. The frequency and amplitude of these motions can directed more accurately and be much faster in frequency and smaller in amplitude than can be done by a human. The optimum movement will depend upon the geometry of the implant array and the mechanical and material properties of the separable fasteners and the fit of the copings and implant abutments.
[0189] FIG. 65 shows an example of an arch with an integral frame 219. Shown is a handpiece retention feature 311 with latching and orientation features similar to adapter block 305. In this embodiment the position of the prosthesis to the robotic arm interface is known from the manufacturing of the assembly. The frame may be integrally fabricated with the arch for example through a molding process. After pick-up processing, the frame may be cut away or include break-away or other features to support separation of the prosthesis portion 314 from the support portion 312. A variant of this embodiment is shown in FIG. 66 in which an integral prosthesis and delivery jig 315 includes a delivery jig arm interface portion 316 that is attached to the robot arm 201 at the same position that dental handpiece arm interface 202 is attached in FIG. 58 Other combinations of elements having known physical relationships may also be used with the robotics positioning for pick-up described above and are considered within the scope of this disclosure.
[0190] The embodiments of systems and methods to mechanically locate the arch by attachment to the existing handpiece for the pick-up procedure have been provided to illustrate inventive concepts. Other methods of locating arches relative to a robot arm and patient include optical scanning, contact probe measurement, real-time radiographic imaging (e.g. x-ray, NMR), electromagnetic field sensors, embedded integrated circuit position and movement sensors, passive sensors such as electromagnetic field sensors, embedded RFID type devices, etc. The delivery jig, bite fork, prosthesis, interface wafer and any other component used in the systems and methods may include geometric features, radio-opaque elements, or other elements to increase imaging contrast to assist determining spatial relationships through scanning.
[0191] Various embodiments have been described to illustrate the disclosed inventive concepts, not to limit the invention. Combining inventive elements of one or more of the embodiments with known materials, components and techniques in dental science to create further embodiments using the inventive concepts is considered to be part of this disclosure.
