Surgical Guides and Implants Having Registration Members

Abstract

A surgical guide used in computer-aided orthognathic or similar bone surgery, the guide being structured to properly locate the osteotomy marking members and implant fixation screw-receiving holes on the bone surfaces of the patient, and/or the cutting of the osteotomy or the drilling of implant fixation screw-receiving holes. The guide has a bone-conforming member and a dental-interface member connected by a bridging member, the inner surfaces of the bone-conforming member and the dental interface member conforming to the topographical surfaces of the patient's bone and teeth. The dental-interface member abuts the front and sides of the teeth. A similarly designed fixation implant may also be provided.

Claims

1. A surgical osteotomy and drilling guide configured by computer-aided design comprising: at least one bone-conforming member having a bone-conforming inner surface conforming to the surface topography of a bone of a patient, the at least one bone-conforming member comprising an osteotomy marking or cutting structure and drill guide apertures; at least one dental-interface member having a tooth-conforming inner surface conforming to the surface topography of a tooth of the patient, the at least one dental-interface member adapted to laterally abut the facial, mesial and distal sides but not the upper surface of the tooth of the patient; and a bridging member connecting the bone-conforming member to the dental-interface member; wherein the at least one bone-conforming inner surface and the at least one tooth-conforming inner surface are customized to fit the patient.

2. The guide of claim 1, wherein the at least one dental-interface member comprises a U-shaped main body, a pair of arm members and a facial abutting portion.

3. The guide of claim 1, wherein the at least one dental-interface member comprises a W-shaped main body, a mesial abutting portion, a distal abutting portion, a central gap abutting portion, and first and second facial abutting portions.

4. The guide of claim 3, further comprising an extension arm and abutment member extending from the mesial portion.

5. The guide of claim 2 wherein the at least one dental-interface member consists of two dental-interface members.

6. A kit comprising the guide of claim 1 and a bone fixation implant configured by computer-aided design, the implant comprising: at least one implant bone-conforming member having an implant bone-conforming inner surface conforming to the surface topography of the bone of the patient; at least one implant dental-interface member having an implant tooth-conforming inner surface conforming to the surface topography of the tooth of the patient, the at least one implant dental-interface member adapted to laterally abut the facial, mesial and distal sides but not the upper surface of the tooth of the patient; and an implant bridging member connecting the implant bone-conforming member to the implant dental-interface member; wherein the at least one implant bone-conforming inner surface and the at least one implant tooth-conforming inner surface are customized to fit the patient.

7. The kit of claim 6, wherein the at least one dental-interface member comprises a U-shaped main body, a pair of arm members and a facial abutting portion, and wherein the at least one implant dental-interface member comprises a U-shaped main body, a pair of arm members and a facial abutting portion.

8. The kit of claim 6, wherein the at least one dental-interface member comprises a W-shaped main body, a mesial abutting portion, a distal abutting portion, a central gap abutting portion, and first and second facial abutting portions, and wherein the at least one implant dental-interface member comprises a W-shaped main body, a mesial abutting portion, a distal abutting portion, a central gap abutting portion, and first and second facial abutting portions.

9. The kit of claim 8, the guide further comprising an extension arm and abutment member extending from the mesial portion, and the implant further comprising an extension arm and abutment member extending from the mesial portion.

10. The kit of claim 7, the guide wherein the at least one dental-interface member consists of two dental-interface members, and the implant wherein the at least one implant dental-interface member consists of two implant dental-interface members.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0013] FIG. 1 illustrates the interior side of one embodiment of the guide, the guide being configured as a genioplasty guide and having a pair of dental-interface members, each of which is structured to abut a single, non-adjacent tooth on the facial, mesial and distal surfaces.

[0014] FIG. 2 is a view of the guide of FIG. 1 as positioned on a mandible.

[0015] FIG. 3 is a perspective view of a guide similar to the embodiment of FIG. 1.

[0016] FIG. 4 illustrates the interior side of an alternative embodiment of the guide, the guide being configured as a mandibular guide and having a dental-interface member structured to abut two adjacent teeth.

[0017] FIG. 5 is a view of the exterior side of the guide of FIG. 4 as positioned on a mandible.

[0018] FIG. 6 is a view of the upper side of the guide of FIG. 4 as positioned on a mandible.

[0019] FIG. 7 illustrates the interior side of an alternative embodiment of the guide, the guide being configured as a maxillary guide and having a dental-interface member structured to abut two adjacent teeth.

[0020] FIG. 8 is a view of the exterior side of the guide of FIG. 4 as positioned on a maxilla.

[0021] FIG. 9 illustrates the interior side of an alternative embodiment of the guide, the guide being configured as a maxillary guide and having a dental-interface member structured to abut two adjacent teeth and extend across a gap to a third tooth.

[0022] FIG. 10 is a view of the guide of FIG. 9 as positioned on a maxilla.

DETAILED DESCRIPTION OF THE INVENTION

[0023] In general, the invention in various embodiments is a customized surgical guide 10 or bone fixation implant 50, alone or in a kit, used in computer-aided orthognathic surgery, or similar bone repair or bone modification surgery, the guide 10 or implant 50 comprising a bone-conforming member or plate 13 and a registration or dental-interface member 11 connected by a bridging member 12.

[0024] The bone-conforming member 13 comprises a bone-conforming inner surface 14 created and configured through computer-aided design that conforms to the bone surface topography of a particular patient at the desired placement location on the bone or tissue of the patient. The bone-conforming member 13 of guide 10 further comprises an osteotomy marking or cutting structure 32, such as an edge or a slot, and/or drill guide apertures 33.

[0025] The dental-interface member 11 comprises a tooth-conforming inner surface 15 created and configured through computer-aided design to laterally abut the front and sides of the exposed surfaces of a tooth 91 (i.e., facial, mesial and distal sides) or adjacent teeth 91 of the particular patient. In one embodiment the dental-interface member 11 may comprise a generally U-shaped main body 21 with opposing arm members 22 and a facial abutting portion 23, for abutment with a single tooth 91. In other embodiments the dental-interface member 11 may comprise a generally W-shaped main body 40 with a central gap abutting portion 43, a mesial abutting portion 41, a distal abutting portion 42, and first and second facial abutting portions 44/45, and possibly an extension portion 46 extending across a missing tooth gap to another tooth 91. The arm members 22, central gap abutting portions 43, mesial abutting portions 41, and distal abutting portions 42 are sized and configured so as not to envelop or encircle the back half of the teeth 91, such that these elements can be inserted into only the front portion of the gap or valley between adjacent teeth 91 a sufficient distance to properly register or locate the bone-conforming member 13. In this manner the dental-interface member 11 abuts the tooth or teeth 91 but does not grip or retain the tooth 91, and can be easily retraced from the tooth 91.

[0026] The bridging member 12 may be configured to serve as a grip or handle. For an implant 50, the bridging member 12 is sized, configured and composed of a material that enables easy separation of the bridging member 12 and dental-interface member 11 once the body-conforming member 13 has been affixed to the bone segments.

[0027] In one representative embodiment for a surgical guide 10, shown as a genioplasty (chin) guide in FIGS. 1 through 3, the dental-interface member 11 has a generally U-shaped or semicircular body 21 positioned about a single tooth, the dental-interface member 11 having a facial abutting portion 23 configured to abut against the facial or buccal (i.e., frontal outer) surface of the tooth crown 91 and having a pair of curved or hooked arm members 22 which reside adjacent to and abutting the mesial and distal (i.e., lateral) surfaces of the tooth 91. The combination of the arm members 22 and facial abutting portion 23 define a tooth-conforming inner surface 15 that because of computer-aided design conforms to the surface topography of the tooth 91 to which it is abutted. This feature in combination with the bone-conforming inner surface 14, also created by computer-aided design, insures that the guide 10 will properly positioned for the marking or cutting of the bone.

[0028] In an alternative embodiment, shown as a mandibular guide 10 in FIGS. 4 through 7, the guide 10 has a dental-interface member 11 comprising a W-shaped main body 40 adapted to abut adjoining teeth 91. The W-shaped main body 40 comprises a pair of tooth-conforming surfaces 15, one defined by the combination of a mesial abutting portion 41, a first facial abutting portion 44 and a central gap abutting portion 43, and the other defined by the central gap abutting portion 43, a second facial abutting portion 45 and a distal abutting portion 42. The dental-interface member 11 is connected to a bone-conforming member 13 by a pair of bridging members 12, the bone-conforming member 13 comprising a bone-conforming inner surface 14, an osteotomy marking or cutting structure 32 and drill guide apertures 33. As shown in FIGS. 5 and 6, the dental-interface member 11 abuts the front side of a pair of adjoining teeth 91 such that the central gap abutting portion 43 rests between the two teeth 31, the distal abutting portion 42 abuts the distal side of the most distal tooth, the mesial abutting portion 41 abuts the mesial side of the most mesial tooth 91, and the two facial abutting portions 44/45 conform and abut to the facial surfaces of the teeth 91. The mesial abutting portion 41, central gap abutting portion 43 and distal abutting portion 42 extend less than halfway into the gaps between the teeth 91, such that placement and removal is easily accomplished. The combination of the tooth-conforming inner surfaces 15 of the dental-interface member 11 and the bone-conforming inner surfaces 14 of the bone-conforming member 11, further in combination with the relative configuration of the dental-interface member 11, bridging member 12 and bone-conforming member 13, all designed and manufactured through computer-aided design to match the surface topography of the bones and teeth of the patient, provide for the stable and fixed placement of the guide 10.

[0029] Still another embodiment is depicted in FIGS. 7 and 8, which in this case is a maxillary guide 10. It is structurally similar to the mandibular guide 10, comprising a dental-interface member 11 and bone-conforming member 13 connected by a bridging member 12. The guide 10 has a dental-interface member 11 comprising a W-shaped main body 40 adapted to abut adjoining teeth 91. The W-shaped main body 40 comprises a pair of tooth-conforming surfaces 15, one defined by the combination of a mesial abutting portion 41, a first facial abutting portion 44 and a central gap abutting portion 43, and the other defined by the central gap abutting portion 43, a second facial abutting portion 45 and a distal abutting portion 42. The dental-interface member 11 is connected to a bone-conforming member 13 by a pair of bridging members 12, the bone-conforming member 13 comprising a bone-conforming inner surface 14, an osteotomy marking or cutting structure 32 and drill guide apertures 33. the dental-interface member 11 abuts the front side of a pair of adjoining teeth 91 such that the central gap abutting portion 43 rests between the two teeth 31, the distal abutting portion 42 abuts the distal side of the most distal tooth, the mesial abutting portion 41 abuts the mesial side of the most mesial tooth 91, and the two facial abutting portions 44/45 conform and abut to the facial surfaces of the teeth 91. The mesial abutting portion 41, central gap abutting portion 43 and distal abutting portion 42 extend less than halfway into the gaps between the teeth 91, such that placement and removal is easily accomplished. The combination of the tooth-conforming inner surfaces 15 of the dental-interface member 11 and the bone-conforming inner surfaces 14 of the bone-conforming member 11, further in combination with the relative configuration of the dental-interface member 11, bridging member 12 and bone-conforming member 13, all designed and manufactured through computer-aided design to match the surface topography of the bones and teeth of the patient, provide for the stable and fixed placement of the guide 10.

[0030] FIGS. 9 and 10 illustrate another embodiment of a guide 10, in this case a maxillary guide similar to the maxillary guide illustrated in FIGS. 7 and 8. In this embodiment, the dental-interface member 11 comprises a dental-interface member 11 comprising a W-shaped main body 40 adapted to abut adjoining teeth 91. The W-shaped main body 40 comprises a pair of tooth-conforming surfaces 15, one defined by the combination of a mesial abutting portion 41, a first facial abutting portion 44 and a central gap abutting portion 43, and the other defined by the central gap abutting portion 43, a second facial abutting portion 45 and a distal abutting portion 42, and further comprises an extension arm 46 extending from the mesial abutting portion 41, the extension arm 41 ending in an abutment shoulder 47. This embodiment is suitable for circumstances where one or more teeth or missing, such that the extension aim 46 crosses the gap such that the abutment shoulder 47 can abut the next proximal tooth 91 to better stabilize the guide 10.

[0031] A bone fixation implant 50 is designed and manufactured through computer-aided methods in similar manner to the guide 10 such that the bone-conforming member 13 and the dental-interface member 11 have, respectively, a bone-conforming inner surface 14 and a tooth-conforming inner surface 15, and are connected by one or more bridging members 12. The difference is that the bone-conforming member 12 of the implant 50 is not provided with an osteotomy marking or cutting structure, since the osteotomy has been performed prior to fixation of the bone-conforming member 13 to the patient's bone segments. Once affixed, the bridging member 12 and dental-interface member 11 is cut or otherwise separated from bone-conforming member 13 and removed.

[0032] Because of the reduced structure of the dental-interface member 11 in comparison to the splint portion of the plastic guides, it is necessary to produce the guides 10 of the invention in a much more rigid material, such as titanium for example.

[0033] To use the guide 10, the surgeon positions the dental-interface member or members 11 on the crown or crowns such that the bone-conforming member rests on the bone surface of the maxilla, mandible or chin. The surgeon marks the osteotomy location using the marking/cutting edge 31 and marks the location for the bone screw receiving holes, or alternatively drills the holes using the drill guide apertures 33. Alternatively, the surgeon may first mark or drill the holes using the drill guide apertures 33 and then use the marking/cutting edge 31 to perform the osteotomy. The guide 10 is then removed from the patient, the bone segments repositioned into the desired configuration, and the fixation implant 50 is affixed to the bone segments. The bridging member 12 and dental-interface member 11 is cut or otherwise separated from bone-conforming member 13 and removed.