SUBPERIOSTEAL JAW IMPLANT

Abstract

In a jaw implant for oral, subperiosteal placement over the alveolar ridge of the maxilla or of the mandible, the implant forms a body which in cross-section, in the condition in which it has been placed on the alveolar ridge transverse to the alveolar ridge, has been formed concave towards the alveolar ridge, wherein in or near a first portion forming the base of the body, in particular forming the base of the J, L or U, the body has been provided with one or more supporting areas for support members, such as pillars, for extending through the gingiva, the support members forming a support for an exo-prosthesis, wherein the supporting areas have been connected to the rest of the body via relatively weakened areas of the body, in particular have been connected to the rest of the body via those relatively weakened areas of the body only.

Claims

1-54. (canceled)

55. Jaw implant for oral, subperiosteal placement over the alveolar ridge of the maxilla or of the mandible, wherein the implant forms a body which in cross-section, in the condition in which it has been placed on the alveolar ridge transverse to the alveolar ridge, has been formed concave towards the alveolar ridge, such as J-shaped, L-shaped or U-shaped, wherein in or near a first portion forming the base of the body, in particular forming the base of the J, L or U, the body has been provided with one or more supporting areas for support members, such as pillars, for extending through the gingiva, in particular passing through it, said supporting areas being integrally formed with the body, said support members forming a support for an exo-prosthesis, such as a dental prosthesis or dentures, characterized in that the supporting areas have been connected to the rest of the body via relatively weakened areas of the body, in particular have been connected to the rest of the body via those relatively weakened areas of the body only.

56. Implant according to claim 55, wherein each supporting area has been connected to the rest of the body via its own weakened areas.

57. Implant according to claim 56, wherein, at least at the location of the supporting areas, the body has an open structure such as a framework or grid.

58. Implant according to claim 57, wherein the weakened areas have been restricted to within the bars or strips of the grid or framework.

59. Implant according to claim 55, wherein the relatively weakened areas have been formed by porous areas, wherein the pores may have a cross-section that is smaller than 1 mm, for instance in the order of a few tenths of one mm, such as 0.5 mm.

60. Implant according to claim 55, wherein the weakened areas are formed by hollow bar sections or hollow strip sections.

61. Implant according to claim 55, wherein the relatively weakened areas are formed by areas having a relatively reduced wall thickness.

62. Implant according to claim 55, wherein the relatively weakened areas are formed by areas having perforations in the material of the body, wherein the perforations have a cross-section that is smaller than the thickness of the body at that location.

63. Implant according to claim 55, manufactured by means of 3D printing, preferably made of titanium, tantalum or an alloy thereof.

64. Implant according to claim 55, wherein the body has been provided with attachment holes for screws for attaching the implant to the jawbone, wherein the holes have been provided on a second portion of the body in question abutting a side of the alveolar ridge, wherein, preferably, the second portion has been formed for attachment to the buccal side of the jawbone in question.

65. Implant according to claim 55, wherein the body has been provided with attachment holes for screws for attaching the implant to the jawbone, wherein the body has been provided with extensions, provided with one or more of the attachment holes, wherein the body has been configured for placement on the mandible wherein the body has been provided with such an extension for attachment to the corpus mandibulae and/or with such an extension for attachment to the ramus ascendens mandibulae, in particular for attachment to the frontal edge (trigonum retromolare) of the ramus ascendens mandibulae, over the trigonum retromolare in the direction of the processus coronoideus, or lateral from the ascending branch of the mandible, dorsally extending.

66. Implant according to claim 55, wherein the body has been configured for placement on the maxilla, wherein the body has been provided with extensions, provided with one or more of the attachment holes for screws for attaching the implant, wherein the body has been provided with such an extension for attachment adjacent to the apertura piriformis and/or has been provided with such an extension for attachment to the zygomatic pillar and/or the zygoma.

67. Implant according to claim 55, wherein the supporting areas at the convex side of the body in question have been provided with elevations which, at their end facing away from the body, have been provided with a means for attaching an exo-prosthesis thereto, either with or without the interposition of an intermediate pillar, wherein the elevations have been integrally formed with the body in question.

68. Implant according to claim 67, wherein the elevations protrude from the body in question up to a distance that is sufficient for their circumferential surface to extend above the gingiva after having been placed.

69. Implant according to claim 67, wherein the elevations are pillar-shaped and at their outer ends have been provided with a means for direct attachment of an exo-prosthesis thereon.

70. Implant according to claim 69, wherein at their outer ends the elevations have been provided with a means for attaching an intermediate pillar thereto, which intermediate pillar at its opposite end has been provided with a means for attaching an exo-prosthesis thereon.

71. Method for manufacturing a subperiosteal jaw implant according to claim 55, wherein a scan is made of a jaw for which the implant is intended, on the basis of which scan a design of the implant is made, the design is entered as a CAD file into the operating system of a 3D printer which is fed with a bio-compatible printing material suitable for subperiosteal implants, after which the designed implant is printed by the 3D printer using the printing material, in accordance with the design in the CAD file.

72. Method according to claim 71, wherein the supporting areas at the convex side of the body in question have been provided with elevations which, at their end facing away from the body, have been provided with a means for attaching an exo-prosthesis thereto, either with or without the interposition of an intermediate pillar, wherein the elevations have been integrally formed with the body in question, and wherein the elevations are provided in a number that is an excess of the required number for the attachment of the exo-prothesis.

73. Method for intervening in cases of imminent onset of or full-blown peri-implantitis in the area of a support column forming the connection between a subperiosteal jaw implant and an exo-prosthesis, wherein a relatively weakened area forming the connection between the support column in question and a concave body of the implant placed against the jawbone is broken and the support column is removed.

74. Method according to claim 73, wherein the exo-prosthesis is placed back again after removal of the elevation.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0070] The invention will be elucidated on the basis of a number of exemplary embodiments shown in the attached drawings, in which:

[0071] FIG. 1 shows a bottom view of a jaw implant according to the invention placed on a maxilla;

[0072] FIG. 1A shows a vertical cross-section of the implant of FIG. 1, according to plane 1A;

[0073] FIG. 2 shows a side view of a jaw implant according to the invention placed on a mandible;

[0074] FIG. 2A shows a vertical cross-section of the implant of FIG. 2, according to plane 2A;

[0075] FIG. 3 shows a side view of an implant according to the invention placed on a maxilla;

[0076] FIG. 4 shows an oblique top/front view of an implant according to the invention placed on a mandible;

[0077] FIGS. 5A and 5B show examples of a pillar structure in an assembly of a jaw implant according to the invention and a prosthesis;

[0078] FIG. 6A shows a bottom view of a jaw implant according to the invention placed on a maxilla;

[0079] FIG. 6B shows vertical cross-section of the implant of FIG. 1, according to plane 6B;

[0080] FIG. 6C shows a side view of an assembly according to the invention with a segment of the jaw implant according to FIG. 6A;

[0081] FIG. 7A shows an oblique top/front view of an assembly according to the invention placed on a mandible;

[0082] FIG. 7B shows a vertical cross-section of a segment of the implant of the assembly of FIG. 7A, according to plane 7B;

[0083] FIG. 7C shows a top view of a bridge part of two-part dentures for an assembly according to the invention that slightly differs from FIG. 7A for a mandible, like in FIG. 7D; and

[0084] FIG. 7D shows a side view of an assembly according to the invention for a mandible.

DETAILED DESCRIPTION OF THE DRAWINGS

[0085] The subperiosteal jaw implant 1 of FIG. 1 has been placed against the alveolar ridge of the maxilla. For reasons of an illustrative nature, the implant 1 is shown folded out slightly flat. The implant 1 is formed by a body 2 formed as one unity of titanium or tantalum, or an alloy thereof.

[0086] As can be seen in the cross-section of FIG. 1A, the body 2 has a gentle U-shape having a portion 3 abutting the crest of the alveolar ridge and portions 4a, 4b that are formed as one unity therewith and abut the palatal (palate) sides and the buccal (cheek) and labial (lip) sides, respectively, of the alveolar ridge. The implant 1 can for instance have an arc length suitable for dentures having teeth of the group consisting of the right premolars and molars and teeth of the group consisting of the left premolars and molars. The body 2 is frame-shaped or grid-shaped, having main bars or main strips 5, 5a, 5b, that are circumferential, and auxiliary bars or auxiliary strips 6. The bars 5a and 5b are intended to abut the labial and the palatal sides, respectively, of the alveolar ridge. Spacious holes 10 through which tissue can grow have been left open between the bars 5, 5a, 5b and bars 6. Supporting areas 8, in this case having integrally formed column-shaped elevations 9 for connection to an exo-prosthesis that is not shown, are surrounded by holes 10 and are connected to the rest of the body by the bars 6 only. Weakenings 7 (as discussed above) have been formed in the material of the body, approximately halfway the bars 6. Each column 9 therefore has its own supporting area 8, which has been provided with a weakening 7 in each connection 6 to the rest of the body 2.

[0087] The body 2 has furthermore been provided with integrally formed attachment lips 11 and 12, which have been provided with attachment holes 13 for osteosynthesis screws 14. The lips 11 are intended/configured for attachment to zygomatic pillars, the lips 12 are intended/configured for attachment to the bone adjacent to the apertura piriformis.

[0088] In FIG. 2 a subperiosteal jaw implant 101 has been placed against the left alveolar ridge of the mandible. The implant 101 is formed by a body 102 formed as one unity of titanium or tantalum, or an alloy thereof.

[0089] As can be seen in the cross-section of FIG. 2A, the body 102 is U-shaped having a portion 103 abutting the crest of the alveolar ridge and two pending portions 104a,b formed as one unity therewith, which portions abut the buccal and lingual sides, respectively, of the left alveolar ridge. The body 102 is grid-shaped, having main bars or main strips 105 that are circumferential, and auxiliary bars or auxiliary strips 106. Holes 110 through which tissue can grow, have been left open between the bars 105 and the bars 106. Supporting areas 108 having integrally formed supports 109 for columns or pillars that have not been shown, for an exo-prosthesis are surrounded by holes 110 and are connected to the rest of the body by the bars 106 only. The bars 106 have been formed with weakenings 107 in the material of the body.

[0090] The body 102 has furthermore been provided with integrally formed attachment lip 115, which has been provided with attachment holes 113 for osteosynthesis screws 114. The lips 115 are intended/configured for attachment to the frontal edge (trigonum retromolare) of the ramus ascendens mandibulae. Portion 105a has been provided with attachment holes 116, also for osteosynthesis screws 114.

[0091] FIG. 3 shows another embodiment of a subperiosteal jaw implant 201 for a maxilla. Parts that are similar to the implant 1 of FIG. 1 have the same reference numbers increased by 200. Lip 211 is for attachment to the zygomatic pillar and lip 212 is for attachment to the bone adjacent to the apertura piriformis.

[0092] FIG. 4 shows another embodiment of a subperiosteal jaw implant 301 for a mandible. Parts that are similar to the implant 101 of FIG. 2 have the same reference numbers increased by 200. The implant 301 has been formed like a continuous body 302 to be placed on both sides of the jaw and the portion situated in between. Attachment holes 316 have been provided for osteosynthesis screws for attachment.

[0093] FIG. 5A schematically shows an example of attaching an exo-prosthesis to an example of an implant according to the invention. The column-shaped elevation 9 forms a support member for an exo-prosthesis and is step-shaped having a foot 9a and a column 9b, which has such a length as to extend above the crest t of the gingiva. In the upper end the column 9b has been provided with a bearing surface which has a screw hole in there for screw 20 in order to secure prosthesis 30.

[0094] In FIG. 5B the elevation 9 is narrower and shorter, and extends to below the crest t of the gingiva. For supporting dentures at the correct height, an intermediate pillar 25 has been placed on the elevation 9. In its lower side the intermediate pillar 25 has been provided with an accommodation space 25a in order for it to fit on the elevation 9 therewith and to be secured thereto by means of a screw. In the upper side the intermediate pillar has been provided with a screw hole 25b for screw 20 in order to secure prosthesis 30. Here, the prosthesis is attached indirectly to the elevation 9 on a support member that is composed of elevation 9 and intermediate pillar 25.

[0095] The embodiment of FIG. 5A has the advantage of a transition in the exterior surface situated below the crest of the gingiva being absent, thus reducing the risk of contamination.

[0096] The implant is placed in the patient by exposing the alveolar ridge by making a few incisions in the gingiva. The implant is placed on the alveolar ridge and attached to permanent jaw material using osteosynthesis screws. The gingiva is placed back again over the implant and sutured. The columns extend to above the gingiva.

[0097] Finally, the exo-prosthesis is placed on the columns.

[0098] After a while the implant will get osseointegrated with the bone membrane and with the gingiva. If the weakened areas 7, 107, 207, 307 have been formed by an incision at the bone side or have a porous surface at that location, this will be conducive to osseointegration. The forces resulting from chewing motions can be absorbed by the jaw via the various screw attachments. The motions of the implant relative to the gingiva and bone membrane will then remain within limits.

[0099] If a column extending through the gingiva has a mechanical problem or when there is question of peri-mucositis at said column, it is possible, after having detached the exo-prosthesis and cutting the gingiva around the column in question open in flaps, to detach the column 9 including its supporting area 8 from the body 2 of the subperiosteal implant 1, 101, 201, 301 through a machining action at the location of the weakened areas 7, 107, 207, 307. In case the body has been made of titanium or tantalum, or an alloy thereof, the machining action can be executed more easily than would be the case with the chromium-cobalt-molybdenum type alloys.

[0100] It is noted that the columns 9 can alternatively be executed as separate elements, and are then securely attached to the supporting areas 8, et cetera, inseparable therefrom.

[0101] Manufacturing using 3D printing enables shaping the weakenings in any wanted way, such as by porous areas, for instance with pores having a maximum cross-section of 0.5 mm, hollow areas, incisions, or perforations having a diameter that is smaller than the thickness of the body at that location.

[0102] FIG. 6A shows a jaw implant 1 according to the invention, divided into segments, placed against the alveolar ridge of the maxilla. For reasons of an illustrative nature, the implant segments or bodies 2a,b are shown folded out slightly flat, just like in FIG. 1. The implant segments or bodies 2a,b have been formed as one unity per se, made of titanium or tantalum, or an alloy thereof.

[0103] As can be seen in the cross-section of FIG. 6B, the bodies 2a,b are slightly U-shaped having a portion 3 abutting the crest of the alveolar ridge and portions 4a, 4b that are formed as one unity therewith and abut the palatal (palate) sides and the buccal (cheek) and labial (lip) sides, respectively, of the alveolar ridge. The bodies 2a,b are frame-shaped or grid-shaped, having main bars or main strips 5, 5a, 5b that are circumferential, and auxiliary bars 6. The bars 5a and 5b are intended to abut the respective palatal sides of the alveolar ridge. Holes 10 through which tissue can grow have been left open between the bars 5, 5a, 5b and bars 6. Supporting areas 8, in this case having integrally formed column-shaped elevations 9 that are connected thereto in an angularly rigid manner, for an exo-prosthesis that is not shown yet (see FIG. 6C), are surrounded by holes 10 and are connected to the rest of the body by the bars 6 only. Each column 9 therefore has its own supporting area 8.

[0104] Like in the preceding examples, weakenings 7 have been formed in the material of the body approximately halfway the bars 6, in accordance with what has been discussed above. Each column 9 therefore has its own supporting area 8, which has been provided with a weakening 7 in each connection 6 to the rest of the body 2.

[0105] The bodies 2a,b have furthermore been provided with integrally formed attachment lips 11 and 12, which have been provided with holes 13 for osteosynthesis screws 14. The lips 11 are intended for attachment to the zygomatic pillars and the zygoma, the lips 12 for attachment adjacent to the apertura piriformis. In FIG. 6C the lips have been executed slightly different from those in FIG. 6A.

[0106] Prior to placing the segments 2a,b the alveolar ridge has been exposed by making a few incisions in the gingiva. Despite the presence of the rather long extensions 11 and 12, the segments 2a,b have in a controlled manner been successively introduced into the patient's mouth, and placed at the correct location on the maxillary alveolar ridge. See FIG. 6C for segment 2a. If so desired, the segments 2a,b can be kept in their place for the time being using a few temporary screws. These screws only need to be put in a number of places and can be shorter than the osteosynthesis screws that will ultimately be placed.

[0107] Then the dentures 20 can be placed. In FIG. 6C the dentures are substantially one-part, having a base part 20a made of metal forming a bending-rigid bridge part continuing in dental arc direction/alveolar ridge direction, and a dental part 20b in polymer or PMMA modelled thereon having molars 21, premolars 22, canines 23 and incisors 24. The dentures comprise teeth of the group consisting of the premolars and molars and extend on both sides of the median plane M. The bridge part 20a has been provided with holes 27 for snugly fitting accommodation of the outer ends of columns 9, and the dental part 20b has been provided with holes 25 for entry of screws 26 the screw thread of which engages with the screw thread in the columns 9. The head of the screw 26 fits into the hole 25, wherein in the bottom of the hole 25 is an opening to the hole 27 for fitting passage of the screw shank. The screws 26 create an angularly rigid connection of bridge part 20a to segments 2a,b. The holes 25 are filled later on by a suitable filler.

[0108] The bridge part 20a then connects both segments 2a,b rigidly, wherein the stability of the segments is enhanced, which is advantageous for fixating the segments after that.

[0109] Subsequently the segments 2a,b are permanently fixated at intermediate distance from one another, to the labial/buccal side of the maxillary alveolar ridge using osteosynthesis screws 14, and are also attached to the zygomatic pillar and adjacent to the apertura piriformis using the osteosynthesis screws 14. The gingiva is placed back again, around the columns 9 and over the implant, and sutured. The columns 9 extend to above the gingiva.

[0110] In FIG. 7A a subperiosteal jaw implant 101 has been placed against the mandible. The implant 101 is constituted of three segments or bodies 102a-c each formed as one unity made of titanium or tantalum, or of an alloy thereof.

[0111] As can be seen in the cross-section of FIG. 7B for segment or body 102c, each segment or body 102a-c is U-shaped having a portion 103 abutting the crest of the alveolar ridge and two pending portions 104a,b that are formed as one unity therewith, and abut the labial and lingual sides, respectively, of the alveolar ridge or, for bodies 102a,b, abut the buccal and lingual sides of the left and right alveolar ridge. The bodies 102a-c are grid-shaped, having holes 110 through which tissue can grow and screw holes 113 for osteosynthesis screws 114 and with supporting areas 108 having integrally formed columns 109 for an exo-prosthesis in the form of dentures 120.

[0112] The segments or bodies 102a,b have furthermore been provided with integrally formed attachment lips or extensions 115a,b that have been provided with holes 113 for osteosynthesis screws 114. The lips 115a,b are intended for attachment to the lateral side of the ramus ascendens mandibulae, dorsally extending.

[0113] Despite the rather long extensions 115a,b, the segments or bodies 102a,b have in a controlled manner been successively introduced into the patient's mouth and placed at the correct location on the alveolar ridge. If so desired, the segments 102a,b could be kept in their place for the time being using a few temporary screws. After this has successively been done for both, the segment 102c is placed, optionally also by means of a temporary screw, in order to realize the situation of FIG. 2A, in which the segments are situated at intermediate distances from each other.

[0114] In this example the dentures 120 to be placed are one-part like in FIG. 7C, that means that the bridge part 120a and dental part 120b form one unity with each other and therefore are placed as a unit. The dentures 120 comprise teeth of the group consisting of the premolars and molars and extend on both sides of the median plane M. The dental part 120b with the teeth (premolars/molars and incisors/canine(s)) is made of polymer or PMMA. Downwardly oriented holes or accommodation spaces 127 are present in the metal bridge part 120a for snugly fitting accommodation of the columns 109. While placing the dentures on the columns 109, the holes 127 are able, if necessary, to orient the columns 109 and thus the segments that are rigidly connected to the columns. Holes or accommodation spaces 125 have been arranged in the upper side of the dentures 120, in which holes or accommodations spaces screws 126 are inserted and via a hole in the bottom of said holes can be screwed into the columns 109 in order to fixate the bridge part 120a and thus the dentures 120 and the segments to each other.

[0115] The screws 126 now also realize an angularly rigid connection of bridge part 120a to the segments 102a, 102b and 102c. The holes 125 are filled later on by a suitable filler.

[0116] The bridge part 120a then rigidly connects the three segments or bodies 102a,b,c, thus enhancing the stability of the segments placed on the alveolar ridge, at least until they have been fixated to the lateral side of the ramus ascendens mandibulae and to the alveolar ridge using osteosynthesis screws 114 in all holes 113. The gingiva can subsequently be placed back again and sutured.

[0117] In FIGS. 7C and 7D the embodiment is slightly different. The segment 102c extends onwards along the alveolar ridge to the left side. Furthermore, the dentures 120 are two-part, in this case having a separate bridge part 120a and a separate dental part 120b, to be placed successively. As can also be seen in top view in FIG. 7C, the bridge part 120a at the side of the dental part 120b has been provided with two types of holes, namely holes or accommodation spaces 125 for screws 126 with which the bridge part 120a can be screwed onto the columns 109, and holes 134 for screws 133 with which the dental part 120b can be screwed onto the bridge part 120a.

[0118] The way of placement largely corresponds with placing the assembly of FIG. 7A, however, not until after the bridge part 120a itself has been fixated to the columns 109 and the segments have been fixated to the alveolar ridge using osteosynthesis screws 114, will the dental part 120b be detachably attached to the bridge part 120a using the screws 133 that can be inserted into the holes/accommodation spaces 132 in the dental part 120b for screw engagement into the holes 134.

[0119] After a while the implant segments will get osseointegrated with the bone membrane and with the gingiva. Until that time the bridge part ensures stabilization of the segments.

[0120] In one embodiment each segment has been provided to be ideally positioned by means of the precision attachment between the subperiosteal segments and the supra structure, which spatially define the segments in their ideal configuration relative to each other and relative to the jawbone.

[0121] Manufacturing the implants according to the invention, either in the segmented embodiment or not, can take place as follows. The patient is in need of an exo-prosthesis, yet due to an atrophied jawbone they have insufficient material to attach and anchor endosseous implants. Bone reconstruction using the patient's own bone or donor bone or using synthetic bone is not an option and neither is bone grafting. In such cases a subperiosteal implant may be the solution.

[0122] A three-dimensional image is made of the jaw or the jaw part in question of the patient's, which reveals the specific contours and condition of the jawbone. This is done using a 3D scanner, in particular a CT scanner, more in particular a CBCT scanner.

[0123] The 3D image is stored and made available to a designer of subperiosteal implants. The designer designs an optimal design of the subperiosteal implant for the patient using a CAD program. The designer then also decides on the locations of attachment by means of screws and the design of the weakenings and/or the division into segments. The scan also provides information about the locations where the bone is sufficiently thick to serve as location of attachment. Based on the scan, the designer is able to decide on the use of, the location and the shape of extensions/lips.

[0124] The design can be stored in a design file suitable for operating a 3D printer. The 3D printer in configured for printing medical implants made of biocompatible materials such as titanium or tantalum or alloys thereof.

[0125] The operating system of the 3D printer reads the design file and has the 3D printer print the body or the bodies in accordance with the design. The body obtained then forms the subperiosteal implant or the bodies obtained together form the subperiosteal implant constituting of segments. If required the body or the bodies/segments can be further finalized (such as finishing the threading), for instance in a CNC process.

[0126] The above description is included to illustrate the operation of preferred embodiments of the invention and not to limit the scope of the invention. Starting from the above explanation many variations that fall within the spirit and scope of the present invention will be evident to an expert.