Customized Dental Prosthesis for Periodontal or Osseointegration, and Related Systems
20180008213 · 2018-01-11
Inventors
Cpc classification
A61C8/0012
HUMAN NECESSITIES
A61L27/36
HUMAN NECESSITIES
A61C8/006
HUMAN NECESSITIES
G16H20/40
PHYSICS
Y02P90/02
GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
A61L27/3804
HUMAN NECESSITIES
A61C8/0075
HUMAN NECESSITIES
B33Y80/00
PERFORMING OPERATIONS; TRANSPORTING
A61C9/0053
HUMAN NECESSITIES
A61C13/082
HUMAN NECESSITIES
International classification
A61C9/00
HUMAN NECESSITIES
A61B5/055
HUMAN NECESSITIES
A61C1/00
HUMAN NECESSITIES
A61L27/36
HUMAN NECESSITIES
A61C8/00
HUMAN NECESSITIES
Abstract
A dental prosthesis to be integrated into a jaw bone cavity of a pre-identified patient. An example of a dental prosthesis includes a first manufactured portion having a surface shaped to substantially dimensionally conform three dimensionally to an undersized shape of the outer three-dimensional surface shape of a root of a tooth to be replaced, and a second manufactured portion shaped to substantially conform to the three-dimensional surface of a crown of the tooth. The outer surface of the root portion can include or be coated with a biocompatible material that is suitable to be integrated into the extraction socket and adopted by existing tissue forming the socket.
Claims
1. A method of designing and manufacturing a dental prosthesis to replace a specific natural tooth of a pre-identified patient, the dental prosthesis to be integrated into a specific receiving jawbone cavity structure of the pre-identified patient corresponding to the specific natural tooth, the dental prosthesis being a finished manufactured product prior to its insertion into the specific receiving jawbone cavity structure, the dental prosthesis comprising a root portion, the method comprising the steps of: receiving in-vivo imaging data describing a three-dimensional surface shape of at least portions of at least one of the following: the specific natural tooth, and the specific receiving jawbone cavity structure; deriving a three-dimensional surface of a virtual reduced-body root portion model from the imaging data; and forming a virtual dental prosthesis model comprising the virtual reduced-body root portion model.
2. The method as defined in claim 1, further comprising: at least partially custom-shaping a dental prosthesis material responsive to the virtual dental prosthesis model comprising the virtual reduced-body root portion model; and at least partially using the dental prosthesis material to make the dental prosthesis a finished manufactured product so that substantial portions of an outer surface of the root portion of the dental prosthesis have a custom three-dimensional surface shape specifically dimensionally matching an undersized three-dimensional surface shape of a corresponding outer surface portion of the three-dimensional surface shape described by the imaging data.
3. The method as defined in claim 1, wherein the step of deriving the three-dimensional surface of the virtual reduced-body root portion model from the imaging data accounts for at least one tolerance selected from the group consisting of: measurement and manufacturing.
4. The method as defined in claim 1, wherein the step of deriving the three-dimensional surface of the virtual reduced-body root portion model from the imaging data accounts for a reduction of approximately 0.2 to 0.3 mm.
5. The method as defined in claim 1, further comprising: configuring the root portion of the dental prosthesis to be substantially integrated into and adopted by a jawbone structure of the pre-identified patient, the jawbone structure defining the receiving jawbone cavity structure.
6. The method as defined in claim 1, further comprising: configuring the root portion of the dental prosthesis to be substantially integrated into and adopted by a periodontal ligament structure of the pre-identified patient, the periodontal ligament structure defining the receiving jawbone cavity structure.
7. The method as defined in claim 1, further comprising: coating a surface portion of the root portion of the dental prosthesis with a biocompatible enhancement comprising at least one of a nano-crystalline diamond coating, cells of a tooth positioned on a surface portion of the root portion, portions of a natural tooth, and a coating of an antibiotic pharmaceutical located on the surface portion of the root portion prior to insertion of the dental prosthesis into the receiving jawbone cavity structure.
8. The method as defined in claim 1, further comprising: coating a surface portion of the root portion of the dental prosthesis with at least one of a gel adapted to form a barrier membrane when sprayed with water, positioned on the surface portion of the root portion prior to insertion of the dental prosthesis into the receiving jawbone cavity structure, a layer of silver, zirconium-oxide, titanium or a titanium alloy, and a ceramic material.
9. A method of designing and manufacturing a dental prosthesis to replace a specific natural tooth of a pre-identified patient, the dental prosthesis to be integrated into a receiving jawbone cavity structure of the pre-identified patient corresponding to the specific natural tooth, the dental prosthesis being a finished manufactured product prior to its insertion into the receiving jawbone cavity structure, the dental prosthesis comprising a root portion, the method comprising the steps of: at least partially custom-shaping a dental prosthesis material responsive to a virtual dental prosthesis model comprising a virtual root portion model; and at least partially using a dental prosthesis material to make the dental prosthesis a finished manufactured product so that substantial portions of an outer surface of the root portion of the dental prosthesis have a custom three-dimensional surface shape specifically dimensionally matching an undersized three-dimensional surface shape of a corresponding outer surface portion of the three-dimensional surface shape
10. The method as defined in claim 9, further comprising: receiving in-vivo imaging data describing the three-dimensional surface shape of at least portions of at least one of the following: the specific natural tooth, and the receiving jawbone cavity structure; deriving the three-dimensional surface of the virtual root portion model from the imaging data; and forming the virtual dental prosthesis model comprising the virtual root portion model.
11. The method as defined in claim 9, further comprising: coating at least a substantial portion of the root portion of the dental prosthesis with a coating material.
12. The method as defined in claim 11, wherein the coating material comprises at least one of engineered tissue comprising non-autologous tissue-engineered material and/or autologous tissue-engineered material, ancestral cells, animal cells, human cells, a matrix protein derivative, a growth protein, a layer of cement, a cement material comprising a layer of between approximately 0.05 mm and 0.2 mm of a resin-modified glass ionomer cement, a glass ionomer cement comprising a calcium-alumino-silicate glass powder and an aqueous solution of an acrylic acid homo- or co-polymer, a layer of mineral trioxide aggregate, a light-activated resin-modified glass ionomer cement, a calcium hydroxide cement, a drug release coating, and an antibiotic pharmaceutical.
13. The method as defined in claim 9, wherein a thickness of the coating material matches the undersizing of the three-dimensional surface shape.
14. The method as defined in claim 9, wherein the step of receiving imaging data describing the three-dimensional surface shape comprises the step of receiving imaging data describing the three-dimensional surface shape of at least portions of the specific natural tooth.
15. The method as defined in claim 9, wherein the step of receiving imaging data describing the three-dimensional surface shape comprises the step of receiving imaging data describing the three-dimensional surface shape of at least portions of the receiving jawbone cavity structure.
16. The method as defined in claim 9, wherein the step of deriving the three-dimensional surface of the virtual root portion model from the imaging data accounts for at least one tolerance selected from the group consisting of: measurement and manufacturing.
17. The method as defined in claim 9, wherein the step of deriving the three-dimensional surface of the virtual root portion model from the imaging data accounts for a reduction of approximately 0.2 to 0.3 mm.
18. The method as defined in claim 9, wherein the step of deriving the three-dimensional surface of the virtual root portion model from the imaging data accounts for at least one tolerance selected from the group consisting of: measurement and manufacturing.
19. The method as defined in claim 9, wherein the step of deriving the three-dimensional surface of the virtual root portion model from the imaging data accounts for a reduction of approximately 0.2 to 0.3 mm.
20. The method as defined in claim 9, further comprising: configuring the root portion of the dental prosthesis to be substantially integrated into and adopted by a jawbone structure of the pre-identified patient, the jawbone structure defining the receiving jawbone cavity structure.
21. The method as defined in claim 9, further comprising: configuring the root portion of the dental prosthesis to be substantially integrated into and adopted by a periodontal ligament structure of the pre-identified patient, the periodontal ligament structure defining the receiving jawbone cavity structure.
22. The method as defined in claim 9, further comprising: coating a surface portion of the root portion of the dental prosthesis with a biocompatible enhancement comprising at least one of a nano-crystalline diamond coating, cells of a tooth positioned on the surface portion of the root portion, portions of a natural tooth, and a coating of an antibiotic pharmaceutical located on the surface portion of the root portion prior to insertion of the dental prosthesis into the receiving jawbone cavity structure.
23. The method as defined in claim 9, further comprising: coating a surface portion of the root portion of the dental prosthesis with at least one of a gel adapted to form a barrier membrane when sprayed with water, positioned on the surface portion of the root portion prior to insertion of the dental prosthesis into the receiving jawbone cavity structure, a layer of silver, zirconium-oxide, titanium or a titanium alloy, and a ceramic material.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0044] So that the manner in which the features and advantages of the invention, as well as others which will become apparent, may be understood in more detail, a more particular description of the invention briefly summarized above may be had by reference to the embodiments thereof which are illustrated in the appended drawings, which form a part of this specification. It is to be noted, however, that the drawings illustrate only various embodiments of the invention and are therefore not to be considered limiting of the invention's scope as it may include other effective embodiments as well.
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DETAILED DESCRIPTION
[0096] The present invention will now be described more fully hereinafter with reference to the accompanying drawings, which illustrate embodiments of the present invention. This invention may, however, be embodied in many different forms and should not be construed as limited to the illustrated embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the present invention to those skilled in the art. Like numbers refer to like elements throughout. The prime notation, if used, indicates similar elements in alternative embodiments.
[0097] Current methods for replacing damaged teeth have several disadvantages. For example, conventional bridge implants require healthy teeth to be ground and osseointegrated implants are drastically invasive. Additionally, these prostheses have a limited average lifetime. Removable dentures (800) as shown, for example, in
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[0100] According to an embodiment of invention, a dental prosthesis is individually shaped and integrated into the natural extraction socket of an individual patient. The shape of the portions of the prosthesis representing the root substantially copies the natural root of the tooth that was located in the socket. The shape, however, may be modified in order to better adapt to the natural socket or to ease insertion of the prosthesis. Also, the socket may be surgically adapted for the same reasons. For example, damaged and infected soft tissue, tooth or bone substances would not allow for immediate implantation. Then, a dental laser may be used to remove the damaged structures. The most commonly used dental lasers are diode, carbon dioxide, erbium YAG, erbium YSGG, Nd:YAG, and argon lasers. The applications for each wavelength depend on the absorptions of laser energy by different tissue types. The erbium family can be used for caries removal, bone surgery, mucosal surgery and gum surgery. While other laser families are mainly used in soft tissues surgeries. Benefits in laser assisted dental treatment include decreased morbidity after surgery, hemostasis, and a reduction in the need for anaesthetics in selected cases.
[0101] An Erbium laser, for example, emits light with a wavelength of 2940 nanometers, which is primarily absorbed by water. Decayed material has an extremely high water content so that the laser light energy evaporates the damage and is able to cut very precisely with little or no collateral damage depending on the settings used during the surgery. When used on hard tissues the Erbium laser energy that touches the hard tissue heats up the water within the hard tissue and causes that water to be turned into steam. That causes a mini-explosion to occur and the hard tissue is “ablated” (removed). Diode lasers in general use as an active medium, a semi-conductor P—N junction made in a GaAlAs crystal. A flexible fiber is used to transmit the laser energy to the surgical site.
[0102] According to an embodiment of the present invention, a segmented prosthesis can be used. A segmented prosthesis, also referred to a segment, is one in which a first segment is implanted into the extraction socket and second segment, for example, a portion representing the crown of a tooth is attached to the segmented portion. Accordingly, a segment prosthesis includes at least two separate portions which may be manufactured and implanted at separate times. The segment which is implanted into the extraction socket is a representation of the root of the natural tooth and can be manufactured based on 3D imaging data. The segment representing the crown can be manufactured according to standard procedures known in the art.
[0103] An embodiment of the present invention comprises the following steps: (i) recording and digitizing (scanning) the three-dimensional anatomical shape of a human tooth or dentition; (ii) obtaining a virtual model of the tooth as data record; and (iii) manufacturing of the prosthesis based on the three-dimensional data obtained, for example, by the scan and, if applicable, optimized.
[0104] The data may either be recorded intra-orally from the patient, such as with a 3D camera, a micro laser optical device, a computerized tomography apparatus, or an ultrasound apparatus, or be recorded extra-orally by scanning an extracted tooth, for example. If required, the model can be modified in order to ease insertion or to receive aids for the final correct positioning of the fabricated prosthesis. The prosthesis can be directly produced by milling, grinding or rapid prototyping, for example, at a dentist's office or in a laboratory. It can also be produced using conventional laboratory procedures such as, for example, casting. The implant portion representing the root can be manufactured using CAM methods, based on an acquired virtual model, while other portions of the prosthesis, for example, representing the crown, or bridge, are manufactured using standard procedures known in the art.
[0105] The process of milling or grinding dental crowns and inlays from ceramic material based on digital data was successfully introduced to dentistry approximately twenty years ago by SIEMENS (now Sirona, Bensheim, Germany) under the brand name CEREC. A modification of the SEREC system can provide a suitable similar CAD/CAM and CNC design and manufacture capability. Although conventional prosthesis manufacturing systems, such as the CEREC system, are generally closed systems, one skilled in the art would readily appreciate these closed systems can be modified such that they may be integrated into the methods of the present invention. Furthermore, certain embodiments of the present invention disclosed herein relate to standard off-the-shelf CAD/CAM and CNC components that can be readily integrated into the disclosed methods
[0106] Preferably, at least the customized implant portion of the dental prosthesis is fabricated using a CAD/CAM based method and system, wherein the three-dimensional shape of an extracted tooth is scanned and substantially copied, using a 3D scanner, multi-axes CNC machinery, and biocompatible material or material later to be covered with a thin layer of biocompatible material that is suitable to be integrated into and adopted by the existing periodontal ligament cell structure of an individual patient.
[0107] An overview of a method for replacing a tooth according to an embodiment of the present invention is shown in
[0108] The tooth to be replaced, a lower left incisor (having an envelope volume of approximately 7 mm×8 mm×23 mm), for example, is extracted in a surgical environment and then disinfected and cleaned in a solution of hydrogen peroxide. The three-dimensional shape (scan) of the extracted tooth may be obtained using, for example, a light-based scanner such as, for example, the ATOS II SO (gom GmbH, Braunschweig, Germany). In a first step, the root of the tooth is scanned. To achieve an optimal surface for optical scanning, the root is covered with a thin layer of TiO.sub.2 powder (e.g., CEREC powder from Sirona, Bensheim, Germany) that is applied with an atomizer using compressed air. Other coatings are also applicable that can, for example, be applied by air-brush painting or a regular brush. For example, it is possible to “shake-up” TiO.sub.2 powder in alcohol and apply a uniform thin layer of TiO.sub.2 by airbrushing to thereby generate high-precision data during scanning. A portion of the crown of the tooth can be attached to the turntable of the scanner using a removable adhesive material (like, e.g., wax used in dental laboratories).
[0109] The turntable is then rotated in 15° increments step by step for a 360° view. The scanner scans at each of the 15° degree increments the optically accessible root surface of the tooth, and can thus, generate and export digital surface data representing the scanned portions of the three-dimensional shape of the surface of the root. The turntable is controlled by the software delivered with the scanner.
[0110] The digital surface data consists of multiple measurement data points each having an x, y, and z coordinate and together having a density better than 0.1 mm and an accuracy noise of less than 0.05 mm. Alternatively, other resolutions, accuracies, and coordinate systems including, but are not limited to cylindrical or spherical coordinate systems, can be employed by those skilled in the art. The data points are then exported in STL format according to this exemplary embodiment of the present invention. This widely used file format describes a surface or portions of a surface by interconnected triangles. STL files can be encoded either binary or in ASCII format.
[0111] Reference elements that are fixed to the turntable can additionally be scanned at each increment. The ATOS II scanner software is able to detect such reference elements in the STL data of each incremental scan. Based on the reference elements it automatically transforms, superimposes, and combines the incremental scans. The result is a comprehensive STL file describing the surface of the root of the tooth.
[0112] Other suitable imaging methods include, but are not limited to CT, CBCT, MRT, ultra sound, destructive scanning, active triangulation, passive triangulation, confocal scanning, and Time of Flight (TOF). Such methods generate either surface descriptions, for example, in STL-format, or volumetric data, for example, in a so called “voxel”-format that can be transformed into surface data by generally available software applications known to those skilled in the art, and vice versa.
[0113] The scan of the root is then loaded into a CAD software application called MAGICS (Materialise, Leuven, Belgium), for example. Using the cutting features of MAGICS, the occlusal facing edge of the virtual root model (
[0114] In a next step, the so-called “stitching” functionality of MAGICS can be used to close the gap (19010) between the virtual root and the virtual socket and, if applicable, also other gaps that may be a result of incomplete scanning. The outcome of this step is a virtual representation of a solid. In this context, a three-dimensional solid is an unambiguous numerical description of the surface of the geometrical shape of a three-dimensional object, with the numerical description showing no holes and clearly identifying the inside and the outside of the surface.
[0115] The hexagon socket of the actual prosthesis may also have an inside thread (
[0116] The STL data describing the solid representing the tooth are then converted to an IGES data format. This is performed using, for example, software named SolidWorks (SolidWorks Corp., Concord, Mass. USA). The IGES file allows generating a CNC sequence to machine an artificial tooth from a piece of biocompatible material like titanium or a titanium alloy (like Ti6Al4V), that consists, for example, of more than 60% of titanium.
[0117] After cutting the thread that will be located in the center of the hexagon of the finished prosthesis, the workpiece is screwed to an adapter on the machine table of the milling machine by using said thread. The adapter is either shaped so that it leaves sufficient clearance for the milling spindle and the cutter, or a disposable adapter is used so that portions of the adapter itself may be milled off After teaching the machine the position and inclination of the workpiece, entering the machine and process parameters, and overlapping the physical workpiece with the virtual shape, the root shape of the left lower incisor can be machined by grinding the workpiece down layer-by-layer to the desired shape.
[0118] After manually cleaning, removing the excess, if applicable, polishing, degreasing, etching rinsing, disinfecting and drying the workpiece, it is ready for insertion. In order to improve the integration of the implant into the bone, further treatments known to those skilled in the art are possible. Sand-blasting with ceramic particles, for example, creates a rough and thus significantly enlarged surface. Other porous-surfacing technologies can be used in this context too. Coating the surface with hydroxylapatite stimulates bone formation, promoting a physico-chemical bond. Other coatings suitable to facilitate include, but are not limited to, pharmaceuticals, ancestral cells, and proteins. Instead of coating, the aforementioned substances can be applied by others means including, but not limited to, adjunction and injection.
[0119] Before inserting the prosthesis, the extraction socket will be properly scraped out or curetted and cleaned. In another embodiment of the present invention, the socket will then be filled with Bioplant (Kerr Corporation, Orange, Calif.). Bioplant is a bone promoting substance. It is hydrated with marrow blood from the extraction socket and then injected into the socket using a special syringe delivered with Bioplant. Bioplant fills any voids present between the socket and the implant. After insertion of the implant, additional Bioplant may be applied in order to fully embed the implant below the hexagon socket.
[0120] After the implant is healed in, standard procedures known to those skilled in the art can be performed. After an alginate impression has been taken, a customized tray is fabricated, reinforced, and perforated where the implant is located. An impression post is screwed onto the implant, and the customized tray is placed onto the dentition. The void between the perforation in the tray and the impression post is filled with impression putty. After the putty has set, the screw attaching the impression pin to the implant is unscrewed, and the impression is removed from the patient's dentition and sent to a specialized laboratory. Based on the impression and an impression of the opposing jaw, the technician can fabricate a crown. When the crown is delivered, the abutment is screwed to the implant, and the crown is cemented onto the abutment.
[0121] Another substance suitable to promote bone regeneration is CERASORB DENTAL (curasan AG, Kleinostheim, Germany). It consists mainly of pure phase beta-tricalcium phosphate (beta-TCP). CERASORB is completely resorbed and replaced by natural bone structure. Collagen fibers and blood vessels invade the interconnecting micro-pores of the CERASORB granules (micro-pores) and the inter-granular cavities (macro-pores). The primary-grain size of 10-63 μm does not provoke phagocytosis by macrophages.
[0122] U.S. Patent Application Publication No. 2005/0084513, which is hereby incorporated by reference in its entirety, discloses a coating for an implant surface. The coating promotes characteristics on the implant surface such as reducing protein unfolding, preventing inflammatory and fibrotic cell accumulation, reducing the number of such cell attachment sites and preventing other adverse biological reactions. The coating may be applied on material via physical and/or chemical binding. It may also be used for in vitro purposes.
[0123] Another option is to apply nano-crystalline diamond coating. A coating named r-BeSt (Hartstoffbeschichtungs GmbH, Innsbruck, Austria) shows 100% biocompatibility due to the pureness of the diamond coating, an optimal interconnection between substrate and diamond coatings, and good tribological properties due to the smoothness of the layer and an active surface for bio-chemical reactions. Another option is to apply inert coating with pyrolyt-carbon, which includes isotropic and non-isotropic structures.
[0124] In yet another embodiment sputter technologies are used to apply, for example, zircon-oxide surface on a custom-made titanium body to prepare adventurous surface features. For example, it is known that zirconium-oxide is tissue friendly. Sputter technologies include ion sputtering, plasma sputtering and other sputtering technologies used under vacuum.
[0125] In another embodiment of the present invention, an unsegmented prosthesis can be fabricated as shown in
[0126] The prosthesis according to this exemplary embodiment, is preferably made from a material supporting osseointegration, such as porous calcium phosphate ceramic. This material provides a scaffold for bony ingrowth. In order to fabricate a complete prosthesis, the shape of the crown must also be available. Therefore, after the imaging of the root portion has been completed, as described above, for example, with respect to
[0127] The scan of the root and of the crown are then loaded into MAGICS and manually maneuvered to a best fit using the overlapping areas of both scans, and merged into one STL data file. In order to increase accuracy, software detecting a best fit for two independent surfaces can also be used. After manually removing outliers of the scanned measurement data, if required, and identifying and correcting deficient triangles and adding missing parts, the resulting STL surface data forms a three-dimensional solid representing the overall shape of the extracted tooth.
[0128] The STL data is then converted to an IGES data format. To fabricate the above mentioned lower left incisor, a piece of calcium phosphate ceramic having a size of approximately 25 mm×10 mm×10 mm using a traditional 5-axis CNC milling device with a high-speed spindle (about 60.000 rpm), a spherical diamond cutter having a diameter of the tip of the cutter of 1 mm and water cooling, can be used. The ceramic workpiece is clamped to the machine table of the milling machine. After teaching the machine the position and inclination of the workpiece, dialing in the machine and process parameters, and overlapping the physical workpiece with the virtual shape, a first portion representing the root shape of the lower left incisor is machined by grinding down layer-by-layer the workpiece to the shape of interest. Then a fixture is made for that specific workpiece to clamp the workpiece at the already machined first portion, for example, by grinding a portion of the geometrical negative shape of the fist portion into the receiving part of the fixture.
[0129] After teaching the machine position and inclination of the reoriented workpiece clamped into that customized fixture, entering machine and process parameters and overlapping the physical second part of the workpiece with the virtual shape of the second portion to be machined, the crown shape of the left lower incisor is machined by grinding the workpiece down layer-by-layer to the desired shape. After properly cleaning, removing the excess, and degreasing, the prosthesis is ready for insertion into the extraction socket. After the implantation, the artificial tooth is fixed substantially to the same position and inclination of the extracted tooth by being bonded with light curing resin strip to the adjacent teeth.
[0130] An advantage of this embodiment of the invention is that the complete replacement of the natural tooth can be performed in one appointment. After the prosthesis has healed in, only the resin strip initially securing the prosthesis to the adjacent teeth must be removed. A significant amount of laborious steps can thus be avoided.
[0131] Using computer networks, all process steps may be carried out by different and independent parties. The imaging part can, for example, be performed at the dentist's office, at a hospital or at a location specialized in imaging. The imaging data can then be transferred to a location where the imaging data are further processed in order to ready them for manufacturing. After the design is finished, the data can again be transferred to the dentist for further optimization and/or approval. Consulting a remote specialist in difficult cases using data transfer may also be applicable. Such a remote specialist may be a clinician or an expert in manufacturing or laboratory procedures. Then, the data can be transferred to a remote manufacturing location. All these data transfers can, for example, be performed via the Internet, using preferably Virtual Private Network channels to secure privacy, or through a local area network.
[0132] In yet another embodiment shown in
[0133] In another embodiment of the present invention, the prosthesis is made from stabilized tetragonal zirconium oxide polycrystalline or another aluminum oxide or zirconium oxide material known to those skilled in the art (inCoris ZI, inCoris AL, VITABLOCS, and CEREC Blocs distributed by and Ivoclar Vivadent and SIRONA). Alternatively, the prosthesis can be made of titanium or a titanium alloy and surface coated with zirconium oxide, for example, in sputtering technologies (as offered by Clinical House Europe GmbH).
[0134] In case of the osseointegration of a prosthesis according to an embodiment of the present invention disclosed herein, INFUSE® Bone Graft (Medtronic Sofamor Danek) can be applied to stimulate bone formation. INFUSE® Bone Graft consists of two parts—a solution containing rhBMP-2 (recombinant human bone morphogenetic protein 2) and the ACS (absorbable collagen sponge). The protein is a genetically engineered version of a natural protein normally found in small quantities in the body. The stimulation of bone formation can be key to developing osseointegration and to fill voids in between the extraction socket and the actual prosthesis in an accelerated manner. Other growth aiding proteins like bone morphogenetic protein (BMP), dentin matrix protein (DMP), platelet-derived growth factor (PDGF) and/or other bone growth stimulating proteins may be applied or otherwise used additionally or instead in order to facilitate integration, healing, and rebuild of the bone structure of the patient.
[0135] In yet another embodiment of the present invention, the prosthesis will not be osseointegrated, but adopted by the ligament of the extraction socket. In this case the prosthesis can be coated, for example, with a material promoting periodontal adoption. According to an exemplary embodiment of the present invention, a thin layer of about 0.05 mm to 0.2 mm of resin-modified glass-ionomer cement (
[0136] Glass ionomer cement is composed of a calcium-alumino-silicate glass powder and an aqueous solution of an acrylic acid homo- or co-polymer. It is a biocompatible material widely used, for example, for tooth restorations and provides good adhesion to the ligament. Resin-modified glass ionomer cement can be light-cured. The light activates a catalyst in the cement that causes it to cure in seconds. After curing, the artificial tooth is implanted and integrated into the existing periodontal tissue formation of that lower left incisor of the patient and fixed substantially into the same position and inclination of the extracted tooth by being bonded with light curing resin strips to the adjacent teeth.
[0137] Another option is coating the portion to be implanted with Ca(OH)2-cement. This is a well known substance in dentistry also used to fill root canals. After setting, EMDOGAIN (Institut Straumann AG, Basel, Switzerland), a substance containing the enamel matrix protein Amelogenin, can be applied. Beneficially, EMDOGAIN is resorbed naturally during the normal healing process, leaving only a residue of enamel matrix protein on the coated surface. This natural and insoluble surface layer encourages the population of cementum-forming cells from the surrounding tissues. Other proteins aiding the growth of dentin, bone or tissue structures like bone morphogenetic protein (BMP), dentin matrix protein (DMP), platelet-derived growth factor (PDGF) and/or or other tissue growth stimulating proteins may be applied or otherwise used additionally or instead in order to facilitate integration, healing, and rebuild of the periodontal ligament. The newly created surface also functions as an interface between the tooth and the surrounding tissues, preventing down-growth of the epithelial tissues. Again, instead of coating, all the aforementioned substances can be applied by others means including, but not limited to, adjunction and injection. It may be advisable to prescribe antibiotic pharmaceuticals to reduce the infection risk during the healing process. In another embodiment of the present invention, the root portion(s) of the prosthesis are coated with a drug releasing surface that releases the aforementioned proteins and anti-biotic and other inflammation reducing substances or any combination thereof over time. The drug releasing surfaces can be made, for example, of materials that can be completely resorbed and replaced by natural bone structure or soft tissue. Especially in the context of periodontal integration, it might be advisable to utilize an absorbable collagen membrane to separate the faster gum growth from the healing process of the periodontal ligament.
[0138] In another embodiment of the present invention, an undersized customized root representation of a ceramic prosthesis is coated with a thin layer of mineral trioxide aggregate (ProRoot MTA, Dentsply) while potential socket irregularities are prepared with calcium sulphate (Capset, Lifecore Biomedical) in order to promote the selective formation of new periodontal tissue (i.e., cementum, periodontal ligament, Sharpey's fibers and alveolar bone) and to build a barrier against an overgrowth by gingival tissue. The thickness of the coating layer should match the undersizing of the root shape and would preferably be chosen to be about 0.2 to 0.3 mm. It would furthermore be advantageous to insert the prosthesis into the socket as soon as possible, but preferably no more than 24 hours after extraction (see respective reference re: Spouge, Oral Pathology, Mosby, Saint Louis, 1973 above).
[0139] Periodontal integration (see, e.g.,
[0140] In another embodiment of the present invention, suitable pre-determined generic root shapes can be selected and employed fabricating the portion of the implant to be osseointegrated or integrated into the periodontal ligament. A variety of generic shapes may be stored on a computer-readable media and accessed by the CAD/CAM system.
[0141] Another product that is helpful in adapting an implant into the extraction socket is Atrisorb (CollaGenex Pharmaceuticals, Inc., Newtown, Pa.). Atrisorb helps regrow healthy bone and soft tissues and forms a barrier creating a space in which tissue can grow. Atrisorb is applied as gel and forms a barrier membrane when sprayed with sterile water. It maintains structural integrity for approximately six months. Complete bioabsorption, however, is achieved within nine to twelve months.
[0142] In order to assure that only the desired portions of the prosthesis are adopted by the periodontal tissue, other portions, like the surface intended to carry the crown later to be attached to the implant, may be covered with a substance preventing such adoption. Silver is, for example, a biocompatible material suitable for that purpose. The Fraunhofer Institute for Manufacturing Technology and Applied Materials Research (IFAM) has developed a nano-composite plasma coating technology that can be used for applying a thin layer containing silver.
[0143] In yet another embodiment of the present invention, the crown of the extracted tooth or the tooth to be extracted is not only subject to 3D imaging, but additional color data are obtained. Depending on the scanning method, color data can already be contained in the scan data, or a separate imaging is performed to record the color of the crown. It is possible to obtain a uniform overall color representing the average color of the crown, or alternatively different shadings for different portions of the crown can be recorded. Based on the color data, the color of the crown can be adapted to the color of the original tooth. The lab technician manufacturing an artificial crown can, for example, be provided with the color data and select the most appropriate color for the prosthesis. If a complete prosthesis is manufactured using CAM methods, a material best fitting the original color can be used, or a coating can be selected that matches the original color.
[0144] In another embodiment of the present invention, no fixture is used to manufacture the second portion of the artificial tooth. Instead, dedicated features elements will be added to the shape of the root, such as small holes or posts sticking out, allowing for precise positioning of the artificial tooth for the second step, which includes manufacturing the crown portion. These dedicated features will be removed or closed after the complete tooth has been fabricated.
[0145] In yet another embodiment of the present invention, a rapid prototyping process is used for fabricating the dental prosthesis from hybrid materials. The rapid prototyping process may build the prosthesis layer-by-layer. For example, a powdery layer of a substance can be applied on top a workpiece, and then portions of the new layer are hardened by a controlled laser beam, while the other unhardened portions are later be removed. In this manner, different substances having different properties (stiffness, hardness, biological properties etc.) can be applied and therefore different portions of the workpiece be made from different materials. In an embodiment of the present invention, the crown is made from a material different from the one used for the crown. In yet another embodiment of the present invention, the portions representing dentine are made from a material different from the one used for the portions representing enamel.
[0146] In another embodiment of the present invention, the three-dimensional data used to fabricate the dental prosthesis is not acquired from an extracted tooth, but obtained intra-orally, the tooth to be replaced still in place. The advantage of this embodiment is that the complete digital preparation and also the manufacturing steps of the artificial replacement can be performed prior to the extraction. That is, according to such embodiment, only when the artificial tooth or segment to be implanted is ready for insertion, is the original tooth extracted. Immediately after extraction, the artificial tooth can be implanted. This contributes to a better healing of the trauma.
[0147]
[0148] A NewTom 3G-MF12 Cone Beam CT (NewTom Deutschland AG, Marburg, Germany) can be used to acquire the imaging data. The accuracy of the measurement data will be better than 0.2 mm, and therefore, highly sufficient for the process. A spline CT with a small envelope dedicated to dentistry like the Morita can deliver 3D data with even better resolution.
[0149] The in-vivo structures represented by CT raw data (for example, in DICOM format) can be analyzed by voxel-based software platforms (IVS Solutions AG; Germany) where 3D objects are separated to be distinguished from “grey scale” data. In another embodiment, adaptable algorithms can be used to analyze the dental structures of interest. Such adaptable algorithms can use known data of generic shapes, for example, to drive the adoption of “grey scale” filters.
[0150] Further, methods for intra-oral imaging include, but are not limited to CT, CBCT, MRT, ultra sound, active triangulation, passive triangulation, confocal scanning, and Time of Flight (TOF). The anatomical structures obtained by intra-oral imaging include, but are not limited to, periodontal structure, the alveolus, and the jaw bone of the patient.
[0151] Using intra-oral 3D imaging, it is even possible to perform a scan of a patient long in advance of treatment and to file the personal imaging data of the dentition of the patient. In case of an injury or accident where teeth get lost or damaged or are not available for a scan for any other reason, a fabrication of individual prostheses can be initiated immediately, using the previously collected imaging data.
[0152] Instead of 3D imaging and digitally processing imaging data, copy milling or copy grinding from the original tooth or parts or the tooth, can be performed. The root can also be shaped according to an impression made directly from the alveolus of the extracted teeth as shown in
[0153] In some cases, the shape of the original roots can present difficulties with the insertion of the artificial replacement. In such cases, a proper modification and optimization of the shape of the artificial root according to
[0154] There are more reasons to modify the shape of the implant with respect to the original root. To ease insertion into the extraction socket, the shape of the implant may be slightly undersized as shown in
[0155] In yet another embodiment of the present invention, original portions of the natural tooth will be integrated into the implant. Especially portions of the root still being covered with cement will greatly improve adoption into the ligaments of the extraction socket. On order to integrate those natural portions, they will be cleaned and prepared for imaging as described further above. The resulting 3D imaging data can be imported into MAGICS and processed like the data of a complete tooth. The three-dimensional virtual body can then be placed at the proper location with respect to the virtual body representing the shape of the implant to be produced. Using Boolean functions of MAGICS, the body representing the natural portion(s) of the tooth can be subtracted from the body representing the implant, thus creating a cavity in the implant having the exact size and shape of the natural portion(s) of the tooth to be integrated into the implant. After the implant has been fabricated and processed, the natural portions of the tooth are cemented into the implant.
[0156] In yet another embodiment of the present invention, firm anchoring of the implant is achieved by expanding the portion being located in the extraction socket in order to support osseointegration and improve physical stability after the implantation. By expanding the implanted portion, forces are applied to the alveolus or bone. In this embodiment of the present invention, the artificial root is shaped to form an expansion anchor. Expansion can be achieved by either using a material changing its shape due to temperature changes after insertion like SMA (shape memory alloy) or by using a material like shape memory polymers activated by electromagnetic radiation. Expansion can also be achieved mechanically by placing a dowel inside the artificial root. This is demonstrated in
[0157] To achieve a long living prosthesis the size and the shape of the root and the socket needs to be appropriate to enable solid anchorage in the bone. If, for example, a root is too small to absorb the normal chewing forces, it may be necessary to expand the size of the socket before designing and manufacturing the customized root. Other patients may not have enough bone material, so that the thickness of the bone gingivally and labially is not sufficient for the anchorage of an implant. In such a case, the root may be shaped like a clamp so that the corticalis is used for the anchorage. This approach is known as “juxtaosseous” method (the implant adapts to the bone and not the bone to the implant). If an appropriate material like titanium in combination with biological ossifying substance is used, the bone adapts to the implant and so the implant becomes an osseointegrated implant. For abutments, this is already successfully being used by the San Babila Day Hospital in Italy. Even more solidity can be achieved by a “multi-legged” root shape combining an artificial root and clamp shaped outer part for the adaptation to the corticalis. This approach significantly increases the stability of the anchorage because no hollow or less stabile areas remain in the bone. If crown and root are manufactured as one unitary part, the crown can be coated with an enamel-colored layer or multiple layers for aesthetic reasons. Such layer(s) can be, for example, translucent to certain extent. During the healing process, appropriate measures need to be put in place to avoid early exposure of the implant to forces (bite bumpers, partials positioners, etc.).
[0158] The various embodiments of the present invention are not limited to the replacement of a single tooth. It is possible to manufacture dental bridges, the lateral teeth having root features that can readily be implanted into an existing socket. Conventional dental bridges (15000) as displayed in
[0159] Due to the ability of the suggested manufacturing processes, various embodiments of the present invention allow the fabrication of prostheses representing crowns, roots, bridges, segments or any combination thereof, and also the entirety of a dentition.
[0160] In another embodiment of the present invention, off-the-shelf abutments can be integrated into the artificial root using the intended connection method recommended by the manufacturer, such as, for example, screwing them into the artificial root with or without drilling a hole, clicking them onto a counter shape, or others.
[0161] In yet another embodiment of the present invention, the components will be molded directly into the artificial root.
[0162] In yet another embodiment of the present invention, the artificial root can comprise a feature on its occlusal-facing surface shaped in a way that it allows for assembly of a conventional veneer or a pre-manufactured veneer or crown to the root. The occlusal-facing surface can also be shaped to provide an interlocking connection to the crown as shown in
[0163] In yet another embodiment as shown, for example, in
[0164] In another embodiment of the present invention, the time needed for the adoption into the periodontal ligament can be reduced and/or the strength and/or the life-time of the connection to the surface of the artificial root can be optimized by increasing the surface by sandblasting, adding a mesh or other suitable means, and/or pharmaceutics or other substances supporting the integration of the chosen material of the artificial root into the periodontal ligament like the protein amelogenin. These pharmaceutics can be applied by all conventional or state-of-the-art methods like dry or liquids suspensions to be painted onto the artificial roots before integration, or by injection with a hypodermic needle or intra-orally through pills. Also ancestral cells can be used to support the rebuilding of the periodontal ligament. Membrane techniques may also be used to protect the area dedicated to the relatively slow growing periodontal ligaments from the fast growing gingival epithelium.
[0165] In another embodiment of the present invention, decreasing the time needed for the osseointegration and/or to increasing the strength and/or the life-time of the connection to the surface of the artificial root can be achieved by increasing the surface by sandblasting, adding a mesh or other suitable means, and/or pharmaceutics supporting the integration of the chosen material of the artificial root into the bone. These pharmaceutics can be applied by conventional or state-of-the-art methods like dry or liquid suspensions to be painted onto the artificial roots before integration, or by injection with a hypodermic needle or intra-orally through pill and/or ray treatment.
[0166] In another embodiment of the present invention, the shape of the artificial root may not completely reflect the shape of the root to be replaced. In order to strengthen the connection with the periodontal ligament or the bone, the shape can be modified. If, for example, the three roots of a molar are located very close to each other, the three roots can be replaced by only one root which will comprise parts of the original shape of the three original roots. There is a great deal of software readily available on the market that allows for easy and intuitive modification of 3D shapes. Both previously mentioned programs MAGICS and SolidWorks are suitable for this task.
[0167] In another embodiment of the present invention, the closure of remaining gaps between the artificial root and the socket used for implantation can be accelerated by suitable pharmaceutics and/or ray treatment.
[0168] In yet another embodiment of the present invention, the prosthesis is an assembly of one or more parts where the interfaces between such parts are sealed in order to provide a barrier against bacteria infiltration. The sealing can include, for example, a labyrinth feature.
[0169] In another embodiment of the present invention, the root portion of the prosthesis is an assembly that is configured to extend one or more barbed hooks, which in an embodiment of the present invention, are each connected to the root body with a hinge and activated by a leave spring.
[0170] Conventional two-piece implants such as, for example, those shown in
[0171] In contrast, the prosthesis according to an embodiment of the present invention is manufactured in all its parts or as a single piece in its entirety before being integrated into the dental anatomy of the patient of interest.
[0172] In yet another embodiment of the present invention, the prosthesis is an assembly of two or more parts, as shown, for example, in
[0173] In another embodiment of the present invention as shown in
[0174] In another embodiment of the present invention, the crown portion of the prosthesis is fabricated in an undersized shape compared to the final shape of the crown. Single or multiple layers of translucent ceramics are added in a laboratory process to gain esthetic performance compared to the appearance of a natural tooth.
[0175] In yet another embodiment, the prosthesis is at least partially made of one of the following: titanium, titanium alloy that consists of more than about 60% of titanium, cement, zirconium oxide, ceramics, synthetics, elastics, plastics, stainless steel, glasiomer cement, resin-ionomer cement, hybrid-ionomer cement, resin-enforced cement, and acrylic based photopolymer, or any combination thereof. In a further improvement the prosthesis includes a drug releasing surface, releasing over time medical substances. Such substances include, for example, one of the following: Antibiotic or other infection suppressing pharmaceuticals, growth promoting substances (for example, ancestral cells, proteins, and cell parts of a human or animal tooth) or any combination thereof.
[0176] In yet another embodiment, a prosthesis is fabricated based on imaging data of the patient's dental anatomy, which includes three-dimensional representations of one tooth or two or more teeth. Each tooth includes a crown portion and root portion. The imaging data can be made either prior to or after extraction of the tooth or teeth to be replaced. The imaging data can include in-vivo data or data made in-vitro from one tooth or two or more teeth after extraction. Other imaging data are derived from physical impressions made of a dental anatomy. Dental anatomy includes the occlusion, the articulation, and the geometrical (spatial) relationship between the teeth within one arch or between upper and lower arch of a patient, or parts thereof. The dental anatomy also includes the structures holding the tooth/teeth which include soft tissue structures and bone structures and any combination thereof. Imaging data can include two dimensional representations such as, for example, X-ray films, facial photos, etc., or three-dimensional representations such as, for example, CT or MRT data and the like. The imaging data can be any portion of the aforementioned data and/or any combination thereof. All these imaging data can be merged, overlaid and combined to derive shape data of a design of the prosthesis.
[0177] In another embodiment of the present invention shown, for example, in
[0178] In the context of the aforementioned custom splint,
[0179] In yet another embodiment of the present invention, the dental prosthesis is segmented and such segments are fabricated using different manufacturing technologies.
[0180] A specific implementation of the processes of
[0181] In another embodiment of the present invention, the custom splint is fabricated in an indirect method, for example, by lost-wax investment casting.
[0182] In yet another embodiment of the present invention, the custom splint is perforated or prepared with retention features on the bonding surface (like a mesh) for better light curing capabilities and better bonding strength.
[0183] In another embodiment of the present invention, the clinical process of integrating the prosthesis is performed as shown in
[0184] The immediate implantation of a manufactured prosthesis designed and fabricated based on in-vivo imaging data (i.e., obtained prior to the extraction of one or more tooth/teeth of interest) performed directly after extraction may be challenged by non-healthy developments of bone or soft tissue in the extraction cavity.
[0185] In yet another embodiment of the present invention, the healing and integration of a prosthesis is facilitated after insertion by using ultrasonic or other vibrations applied to the prosthesis by special dental devices.
[0186] Beneficially, the integration of the prosthesis described herein can be facilitated and actually accelerated by techniques of surface coating based on tissue engineering.
[0187] In another embodiment of the present invention, human periodontal ligament (HPDL) fibroblasts are used and a prosthesis, according to other embodiments of the present invention, is placed in tissue culture clusters, whereby an amount of 1 ml of HPDL fibroblast cell suspension is placed over the root portion of the prosthesis and then placed into an incubator at 37° C. and 100% humidity for 72 hours. With that, the cells of HPDL fibroblast are extending and attaching firmly to the prosthesis surface by cytoplasmic extension of the lamellipodia and microvilli to extend into porous (micro) surface structures.
[0188] In yet another embodiment of the present invention, stem cells can be used to produce HPDL fibroblast or other acellular and cellular structures of the human dental anatomy such as, for example, acellular and cellular cementum, which is mineralized tissue covering the root dentin that serves to anchor periodontal ligament fibers, and/or cementoblast, which are cells found on the surface of cementum being responsible for its synthesis.
[0189] Alternatively, to the aforementioned use of autologous material, human allogenic bone, root or tissue substances can be used. Alternatively, to the use of human bio material tooth, animal-derived bone or tissue material, for example, bovine cells or even synthetic materials, can be used for in the various process steps of tissue engineering.
[0190] In yet another embodiment of the present invention, the tissue engineering techniques include the coating of the root portion(s) of the prosthesis with collagen incorporating growth factor substance, for example, platelet-derived growth factor (PDGF).
[0191] The aforementioned tissue engineering technologies may employ in the aforementioned context, for example, living cells of various kinds such as engineering materials, autologous cells, which are obtained from the same individual to which they will be reimplanted, mouse embryonic stem cells, allogenic cells, which come from the body of a donor of the same species, xenogenic cells, which are isolated from individuals of another species, syngeneic or isogenic cells, which are isolated from genetically identical organisms, such as twins, clones, or highly inbred research animal models, primary cells from an organism, secondary cells are a cell bank, and stem cells. In this context, tissue engineering shall also include the use of artificial structures capable of supporting three-dimensional tissue formation, called scaffolds, of various natural and synthetic, biodegradable and permanent materials, for example, collagen and aliphatic polyesters, on which cells are generally implanted or “seeded” into to allow cell attachment and migration, to deliver and retain cells and biochemical factors, to enable diffusion of vital cell nutrients and expressed products, or to exert certain mechanical and biological influences to modify the behavior of the cell phase, or any combination thereof.
[0192] Several figures and several process steps described therein show a prosthesis or parts thereof configured, for example, as a single tooth prosthesis and being manufactured and shaped from all sides (see, e.g.,
[0193] Note, it should be understood that one of ordinary skill in the art should understand that the various aspects of the present invention, as explained above, can readily be combined with each other.
[0194] The meaning of “CAD” shall include, but shall not be limited to, any and all technology of computer aided design.
[0195] The meaning of “CAM” shall include, but shall not be limited to, any and all technology of computer aided manufacturing.
[0196] The meaning of “CNC” shall include, but shall not be limited to, any and all technology of computer numerical control as it relates to manufacturing machinery and systems, including but not limited to rapid prototyping devices and systems.
[0197] The meaning of “rapid prototyping” shall include, but shall not be limited to, technologies qualified for manufacturing of copies of virtual three-dimensional objects and also technologies qualified for mass customization or the mass production of copies of customized or adapted geometries to the needs of an individual patient. Rapid prototyping in this context shall include, but not be limited to, manufacturing technologies based on the digital data, by a process that includes depositing material, in accordance with the digital data, layer-by-layer in a plurality of layers each constituting a two-dimensional cross section of a solid object having an edge defined by data of the three-dimensional surface, the layers being stacked in a third dimension to form the solid object having a three-dimensional surface defined by the data. Such rapid prototyping technologies can be directed to actually manufacturing the part of interest, for example, by selective laser sintering or indirect by fabricating first e.g., a resin or wax sample of the part of interest, and second using, for example, “lost-wax” casing to duplicate such sample and fabricate therewith the part of interest. It also includes sintering techniques where the “green” body is printed in response to computerized numerical controlled (CNC) data and sintered it to its final material properties. Sintering in this context includes pressure and heat.
[0198] The meaning of “body” of an artificial tooth shall include, but shall not be limited to, the part of the prosthesis representing a root structure for periodontal or osseointegration or the combined part of the prosthesis representing a root structure for periodontal or osseointegration and a support structure for a crown or a bridge.
[0199] The meaning of “prosthesis” shall include any substantially artificially shaped part of any natural and artificial material. In this sense a dental prosthesis for periodontal integration would have to be distinguished to any human tooth used for intentional re-implantation.
[0200] Whenever the context requires, the word “prosthesis” shall be deemed to include the word “implant” and vice versa.
[0201] 3D″ shall mean three-dimensional.
[0202] The meaning of “CT” shall include, but shall not be limited to, any and all technology of computed tomography.
[0203] CBCT″ shall mean cone beam computed tomography.
[0204] The meaning of “MRT” shall include, but shall not be limited to, any and all technology of magnetic resonance tomography.
[0205] The meaning of “TOF” shall include, but shall not be limited to, any and all technology employing time of flight procedures.
[0206] The meaning of “imaging” and “scanning” shall include, but shall not be limited to, any and all technology of acquiring two-dimensional and/or three-dimensional data of physical objects or parts of a human body.
[0207] The meaning of clinical “imaging data” shall include, but shall not be limited to, in-vivo and in-vitro processes that result in any anatomical data of the anatomy of a human being. In this context the term data shall include, but shall not be limited to, two-dimensional and three-dimensional data.
[0208] The meaning of three-dimensional data shall include, but shall not be limited to, surface (e.g., triangulated data) and volumetric (e.g., voxel) data.
[0209] The meaning of “periodontal tissue” shall include, but shall not be limited to, any soft tissue surrounding a tooth.
[0210] The meaning of “periodontal ligature”, “ligament” or “periodontal ligament” shall include, but shall not be limited to, the fibrous connective tissue, e.g., human gingival fibroblasts, interface usually located between a human tooth and the anatomical structure of the jaw of a human being.
[0211] The meaning of each one of the following: “periodontal integration”, “parodontal integration”, “integration into the periodont”, “integration into the parodont”, “integration into the dental soft-tissue”, “integration into the dental ligament” and like word constructions shall include, but shall not be limited to, the integration into the periodontal ligament structure or any other biological structure of the human dental anatomy except osseointegration. In this sense, the term periodontal integration shall include, but shall not be limited to, the integration of the prosthesis to be adopted and held by periodontal ligament tissue of a human being.
[0212] In this sense a prostheses for periodontal integration would have to be distinguished from any osseointegrated implant.
[0213] The meaning of “cavity” shall include, but shall not be limited to, the periodontal cavity, a cavity of the jaw bone structure, a cavity of the alveolus or a combination thereof.
[0214] The meaning of “extraction socket” shall include prepared or unprepared extraction sockets. The meaning of “prepared” shall include, but shall not be limited to, being surgically pared, abraded, scraped or curetted by mechanical instruments or laser technology based devices.
[0215] The meaning of “replacement”, “to replace”, “to be replaced” shall include, but shall not be limited to, any substitution, where one object fills the former position of another object. In the context of the foregoing such substitution can be performed at any time, so that, for example, the term replacement shall not be limited to a replacement in a timely manner.
[0216] The meaning of a “manufactured one-piece” object shall not be limited to homogeneous objects, and shall include, but shall not be limited to, manufactured assemblies, objects that are coated, objects that are consisting of more than one pieces or materials bonded together or any combination thereof.
[0217] The meaning of a “clinical one-step” process or a “clinical one-step” method shall include, but shall not be limited to, a series clinical process or method steps performed in one or more clinical events as long as no further iteration is required that includes clinical process or method steps and process or method steps that cannot be performed chair-side.
[0218] The meaning of “immediate load” of an implant shall include, but shall not be limited to, any all integration concepts of implants where the occlusal portion of the implant (e.g., the crown portion facing the opponent jaw) is not protected against the alternate load of mastication by additional protective means.
[0219] The meaning of “configured to be integrated into the existing occlusion of the patients dentition” shall include, but shall not be limited to, any shaping of a crown or a crown-like portion of a prosthesis that contacts or otherwise substantially fills the gap between adjacent crowns, and any shaping that contacts or otherwise substantially interacts with the opponent crowns of the dentition in the process of masticating food.
[0220] In dentistry, the term occlusion is used to refer to the manner in which the teeth from upper and lower arches come together when the mouth is closed. The meaning of “occlusion” shall mean, but shall not be limited to, the manner the teeth of the upper or lower arch are fitting and coming in contact with each other while the mouth is closed or during chewing (articulation). It shall also include the fit and contact of adjacent teeth within one arch. The meaning of “integrated into the occlusion” shall include, but shall not be limited to, the configuration and integration of the fit and contact situation of a prosthesis within the existing or new build occlusion within the same and the opponent arch.
[0221] The words used in this specification to describe the various exemplary embodiments of the present invention are to be understood not only in the sense of their commonly defined meanings, but to include by special definition in this specification structure, material or acts beyond the scope of the commonly defined meanings. Thus, if an element can be understood in the context of this specification as including more than one meaning, then its use in a claim must be understood as being generic to all possible meanings supported by the specification and by the word, itself.
[0222] The various embodiments of the present invention and aspects of embodiments of the invention disclosed herein are to be understood not only in the order and context specifically described in this specification, but to include any order and any combination thereof. Whenever the context requires, all words used in the singular number shall be deemed to include the plural and vice versa. Words which import one gender shall be applied to any gender wherever appropriate. Whenever the context requires, all options that are listed with the word “and” shall be deemed to include the world “or” and vice versa, and any combination thereof. The titles of the sections of this specification and the sectioning of the text in separated paragraphs are for convenience of reference only and are not to be considered in construing this specification.
[0223] Insubstantial changes from the claimed subject matter as viewed by a person with ordinary skill in the art, now known or later devised, are expressly contemplated as being equivalent within the scope of the claims. Therefore, obvious substitutions now or later known to one with ordinary skill in the art are defined to be within the scope of the defined elements.
[0224] The present application is a continuation of U.S. patent application Ser. No. 12/763,001, titled “Customized Dental Prosthesis for Periodontal or Osseointegration, and Related Systems and Methods,” filed on Apr. 19, 2010, which is a continuation-in-part of and claims priority to and the benefit of U.S. patent application Ser. No. 11/724,261, titled “Customized Dental Prosthesis for Periodontal- or Osseointegration and Related Systems and Methods,” filed on Mar. 15, 2007, which is a continuation-in-part of and claims priority to and the benefit of U.S. patent application Ser. No. 11/549,728, filed on Mar. 16, 2006, titled “Customized Dental Prosthesis for Periodontal- or Osseointegration and Related Systems and Methods,” each incorporated herein by reference in its entirety.
[0225] In the drawings and specification, there have been disclosed embodiments of the present invention, and although specific terms are employed, the terms are used in a descriptive sense only and not for purposes of limitation, the scope of the invention being set forth in the following claims. The invention has been described in considerable detail with specific reference to the illustrated embodiments. It will be apparent, however, that various modifications and changes can be made within the spirit and scope of the invention as described in the foregoing specification.