Abstract
A bone plate for reconstruction or trauma treatment of a bone which comprises first and second ends, a first contact surface for contacting and securing on a first region of the bone, and a plurality of receiving mechanism each having at least one opening for receiving at least one securing element. At least two adjacent wings extend at least from the first end of the main section, each has a second contact surface for contacting and securing to a second region of the bone, as well as at least one receiving mechanism having at least one opening for each receiving a securing element. A minimum bending stiffness of the main section, in relation to an axis (x) running perpendicular to the first contact surface, is greater than the minimum bending stiffnesses of the wings, but smaller than the total minimum bending stiffness of all wings extending from the first end.
Claims
1-19. (canceled)
20. A bone plate for reconstruction or trauma treatment of a bone, said bone plate including a main portion having: a first end and a second end, a first contact surface for contacting and fastening on a first region of the bone, and a plurality of receiving means each with at least one opening for receiving, in each case, at least one fastening element, wherein at least two wings which are arranged side by side extend at least from the first end of the main portion, which wings each comprise: a second contact surface for contacting and fastening on a second region of the bone, and at least one receiving means, each receiving means with at least one opening, each opening for receiving at least one fastening element, wherein the main portion and the at least two wings are realized in such a manner that the main portion has a first minimum bending rigidity with reference to an axis which extends perpendicular to the first contact surface and each of the at least two wings has a respective second minimum bending rigidity with reference to an axis which extends perpendicular to the second contact surface, and the first minimum bending rigidity is greater than each of the second minimum bending rigidities, but smaller than the minimum overall bending rigidity of all of the wings which extend from the first end.
21. A bone plate for reconstruction or trauma treatment of a bone, said bone plate including a main portion having: a first end and a second end, a first contact surface for contacting and fastening on a first region of the bone and a plurality of receiving means with in each case at least one opening for receiving, in each case, at least one fastening element, wherein at least two wings which are arranged side by side extend at least from the first end of the main portion which wings, in each case, comprise a second contact surface for contacting and fastening on a second region of the bone, and at least one receiving means, each receiving means with at least one opening, each opening for receiving at least one fastening element, wherein the main portion comprises a truss structure.
22. The bone plate as claimed in claim 21, wherein the bone plate is a bone plate for the reconstruction or trauma treatment of a human mandible, the first contact surface is for contacting and fastening on a corpus of the mandible and the second contact surface is for contacting and fastening on an ascending ramus of the mandible.
23. The bone plate as claimed in claim 21, wherein at least one wing does not comprise a truss structure.
24. The bone plate as claimed in claim 21, wherein the main portion is delimited, at least on one side, by at least one frame structure which comprises an outer edge which extends in a substantially rectilinear manner.
25. The bone plate as claimed in claim 21, wherein the main portion has a width within a range of between 2 mm and 20 mm.
26. The bone plate as claimed in claim 21, wherein the length, measured along a center line of the main portion, is within a range of between 25 mm and 300 mm.
27. The bone plate as claimed in claim 21, wherein at least one wing comprises a length which is within a range of between 10 mm and 60 mm.
28. The bone plate as claimed in claim 21, wherein at least one wing comprises a width within a range of between 2 mm and 10 mm.
29. The bone plate as claimed in claim 21, wherein at least one wing comprises a width which is at most 80% of a width of the main portion
30. The bone plate as claimed in claim 21, wherein said bone plate, perpendicular to the contact surfaces, comprises a thickness which is within a range of between 1 mm and 3 mm.
31. The bone plate as claimed in claim 21, wherein said bone plate is substantially planar and the main portion is deformable, out of a plane defined by the contact surface, into an anatomical form in which it is fastenable on at least part of a mandible substantially only as a result of bending.
32. The bone plate as claimed in claim 21, wherein said bone plate consists of a biocompatible implant material.
33. A bone plate including at least one opening for receiving, in each case, at least one bone screw, wherein an opening penetrates the bone plate along a longitudinal axis from a top surface to an oppositely situated bottom surface, on the top surface the opening opens out into a first receiving region which is realized for receiving and fixing of a blocking element of a bone screw in a first direction, on the bottom surface, the opening opens out into a second receiving region which is realized for the receiving and fixing of the blocking element in a second direction, and the second direction is substantially opposite the first direction.
34. The bone plate as claimed in claim 33, wherein the first receiving region is delimited by a first inside wall, the second receiving region is delimited by a second inside wall, in each case at least one recess is formed both in the first inside wall and in the second inside wall, and in each of said recesses a distance away from the respective inside wall increases in dependence on the angle of rotation about the longitudinal axis.
35. The bone plate as claimed in claim 34, wherein both the first inside wall and the second inside wall are realized in an at least approximately spherical, paraboloid, ellipsoid or hyperboloid manner in a region of each of the respective recesses.
36. A surgical set including at least one bone plate as claimed in claim 33, as well as at least one bone screw having a screw shank and a blocking element, wherein the blocking element is receivable electively in the first receiving region or in the second receiving region of the opening and fixable.
37. The surgical set as claimed in claim 36, wherein the blocking element is a screw head which protrudes outward above the screw shank.
38. The surgical set as claimed in claim 36, wherein the blocking element is provided with a circumferential outside surface which extends substantially in the direction of the longitudinal axis of the bone screw and comprises at least one clamping surface which, when viewed along an azimuth plane perpendicular to a longitudinal axis, widens outward in a wedge-shaped manner away from the longitudinal axis.
39. The surgical set as claimed in claim 38, wherein the circumferential outside surface of the locking element is realized in an at least approximately spherical, paraboloid, ellipsoid or hyperboloid manner, at least in the region of the clamping surface.
40. A reconstruction set for the reconstruction of the mandible including at least one bone plate as claimed in claim 33 as well as at least one of the following further elements: at least one connecting plate which comprises means for connecting to at least one of the bone plates or to part of one of the bone plates, at least one mandibular joint prosthesis, wherein the mandibular joint prosthesis comprises means for connecting to at least one wing which extends from the first end of the main portion of the bone plate.
41. The reconstruction set as claimed in claim 40, wherein the connecting plate comprises, in at least one end region, at least two openings which, at the same time, are movable to coincide with at least two corresponding openings of at least one of the bone plates or of at least part of one of the bone plates.
Description
[0074] The invention is explained in detail below by way of several exemplary embodiments, in which:
[0075] FIG. 1: shows a panoramic X-ray view of a human mandible with a first bone plate according to the invention fastened thereon;
[0076] FIG. 2: shows a panoramic X-ray view of a human mandible with a second bone plate according to the invention fastened thereon;
[0077] FIG. 3a: shows a panoramic X-ray view of a human mandible with a third bone plate according to the invention fastened thereon;
[0078] FIG. 3b: shows a perspective sectional view along the cutting line marked in FIG. 3a;
[0079] FIG. 4a: shows a perspective view of the second bone plate according to the invention according to FIG. 2;
[0080] FIG. 4b: shows a perspective view of a detail of the second bone plate according to the invention;
[0081] FIG. 5a: shows a top view of the second bone plate according to the invention;
[0082] FIG. 5b: shows a sectional view of the second bone plate according to the invention along the cutting line E-E shown in FIG. 5a;
[0083] FIG. 6a: shows a perspective view of a first bone screw of a surgical set according to the invention;
[0084] FIG. 6b: shows a top view of the first bone screw of a surgical set according to the invention;
[0085] FIG. 7: shows two views of a first reconstruction set according to the invention with a first bone plate according to the invention, a second bone plate according to the invention and a connecting plate;
[0086] FIG. 8: shows a second reconstruction set according to the invention with three bone plates according to the invention, a bone plate which is not according to the invention, a connecting plate, a right and a left mandibular joint prosthesis, a carrier element for holding one of the mandibular joint prostheses, four connecting screws for connecting the mandibular joint prostheses to the carrier element, four connecting screws for electively connecting one of the bone plates to the carrier element or to the connecting plate and one mandibular joint stabilizing element;
[0087] FIGS. 9a-i: show nine panoramic X-ray views of human mandibles with diverse defects and elements of the reconstruction set according to FIG. 8;
[0088] FIG. 10: shows a further overview of human mandibles with diverse defects and elements of the reconstruction set according to FIG. 8;
[0089] FIGS. 11a and b: show two views of a second bone screw with a screw head and a blocking element arranged at the tip;
[0090] FIGS. 12a and b: show two views of a third bone screw without a screw head, but with a blocking element arranged at the tip;
[0091] FIGS. 13a to c: show three perspective views of a surgical set according to the invention with a bone plate according to the invention and four bone screws;
[0092] FIG. 14a: shows a perspective view of a bone plate according to the invention without bone screws;
[0093] FIG. 14b: shows a perspective view of the bone plate according to the invention according to FIG. 14a with four bone screws inserted therein;
[0094] FIGS. 15a to c: show three views of a detail of a further bone plate with an opening with two receiving regions;
[0095] FIGS. 16a to c: show three views of a detail of yet another bone plate with an opening with two receiving regions;
[0096] FIGS. 17a to c: show three views of a detail of yet another bone plate with an opening with two receiving regions;
[0097] FIGS. 18a to c: show three views of a detail of yet another bone plate with an opening with two receiving regions.
[0098] FIG. 1 shows a human mandible 113 with a corpus 142 and two ascending ramuses 112. For clearer representation, a projection similar to a dental panoramic X-ray view has been chosen where the outside surface of the mandible 113 has been shifted to the drawing plane. A first bone plate 101 according to the invention is contacted and fastened on the mandible 113. The bone plate 101 includes a main portion 109 which has a first end 143 and an oppositely situated second end 148 and extends along a center line M from the first end 143 to the second end 148. The main portion 109 additionally has a first contact surface 141 which cannot be seen here and on which the main portion 109 is contacted and fastened on the corpus 142 (see FIG. 4a in this respect). In addition, the main portion 109 has a plurality of receiving means 108, 108′ with in each case a circular opening 102, 102′ for receiving in each case one bone screw 301 which is not shown here (see FIGS. 6a and 6b in this respect).
[0099] Two wings 110, which are arranged side by side, extend from both the first end 143 and from the second end 148 of the main portion 109. Said wings have in each case a second contact surface 144, which is not shown here (see FIG. 4a also in this respect), for contacting and fastening on an outside surface of one of the ascending ramuses 112. In addition, the wings 110 have receiving means 145 with, in each case, one circular opening 146 for receiving, in each case, one bone screw 301 which is not shown here (see FIGS. 6a and 6b in this respect).
[0100] The main portion 109 comprises a first minimum bending rigidity in a cross sectional plane, which is not shown here (see FIG. 3b for the representation of a cross sectional plane of another bone plate), with reference to an axis which extends perpendicular to the first contact surface 141 (and consequently also perpendicular to the drawing plane). Each wing 110 comprises a respective second minimum bending rigidity in respective cross sectional planes, which are also not shown here, with reference to axes which extend perpendicular to the respective second contact surface 144 (and consequently also perpendicular to the drawing plane). In this case, according to the invention, the first minimum bending rigidity is greater than each of the second minimum bending rigidities, but smaller than the minimum overall bending rigidity of all the wings 110 which extend from the first end 143 and also smaller than the minimum overall bending rigidity of all of the wings 110 which extend from the second end 148.
[0101] The main portion 109 comprises a truss structure. Namely, it has struts 104 which extend transversally with respect to the center line M. The openings 102 are arranged on a first side of the center line M, and the openings 102′ are arranged on a side of the center line M which is situated opposite the first side. The receiving means 108, 108′ with the circular openings 102, 102′ are arranged here at the nodes of the truss structure. As an alternative to this, however, nodes without screw holes are also conceivable. In the exemplary embodiment shown here, the wings 110 do not comprise any such truss structure.
[0102] Proceeding from the named bending characteristics and the truss structure, the advantages of the bone plate 101 according to the invention, which have already been explained in detail above, are as follows:
[0103] In the initial state, in particular in the delivery state, the bone plate 101 can be substantially planar, which simplifies production, transport and storage. In order to be able to mold the bone plate 101 to the individual anatomy of a patient, substantially only the wings 110, not however also the main portion 109, are able to be bent as a result of suitably chosen bending torques inside the plate plane. As a result, substantially only the wings 110 in the plate plane can be molded to the individual anatomy of a patient, for example to the angle between corpus 142 and rising ramus 112. The main portion 109 can only be deformed into an anatomical form in which it can be fastened on the mandible 113 substantially by bending out of the plane defined by the contact surface 141.
[0104] As has been shown in studies, where there is suitable shaping of the bone plates, deforming the main portion 109 inside the plate plane is also not even necessary in order to be able to mold the bone plate 101 to the corpus 142 of a plurality of human mandibles 113. Instead, the advantage of the slight deformability of the main portion 109 inside the plate plane is that the bone plate 101 is stable in relation to forces and bending torques acting in said plate plane.
[0105] If the bone plate 101 is then fastened to the mandible 113, the two wings 110 are also fixed relatively to one another such that the minimum overall bending rigidity of said wings 110 in said implanted state is relevant. As said overall bending rigidity is greater than the first minimum bending rigidity of the main portion 109, even the wings 110 are hardly able to be deformed inside the plate plane in the implanted state, which also results in greater stability in said region in relation to forces and bending torques acting in the plate plane. If the bone to be treated is a mandible, the requirement that the overall bending rigidity is greater than the first bending rigidity is due to the real force distribution in the mandible: the load on the bone when chewing/biting is greater in the vicinity of the joint than toward the chin.
[0106] The main portion 109 is delimited on both sides S.sub.1, S.sub.2 by a frame structure 105, which comprises an outer edge 107, which extends in a substantially rectilinear manner. As a result, it is possible to avoid edges which could result, for example, in injuries to the body tissue.
[0107] The main portion 109 has a width b.sub.1 of 10 mm and a length l.sub.1, measured along the center line M, of 145 mm. The wings 110 have a width b.sub.2 of 7 mm. The shorter wings 110 shown in the upper position in FIG. 1 have a length l.sub.2 of 19 mm, and the longer wings 110 shown in the bottom position in FIG. 1 have a length l.sub.2′ of 26 mm. Consequently, each wing 110 comprises a width b.sub.2 which is at most 80% of the width b.sub.1 of the main portion 109.
[0108] The bone plate consists of a biocompatible implant material, such as, for example, titanium and its alloys, implant steel, implantable plastics material or implantable ceramic.
[0109] FIGS. 2 and 3a show a human mandible 113 with two further bone plates 101′ and 101″, respectively, according to the invention. The main portions 109 thereof comprise two wings 110 in each case only on a first end 143. In each case, only one single wing 110 is arranged on the oppositely situated second end 148. The main portion 109 of the third bone plate 101″ according to the invention shown in FIG. 3a is longer than the main portion 109 of the second bone plate 101′ according to the invention shown in FIG. 2. Consequently, the third bone plate 101 according to the invention shown in FIG. 3a is able to cover a larger region of the corpus 142, as will be made clear again below in conjunction with FIGS. 9a to 9i and 10.
[0110] FIG. 3b shows a cross sectional view along the cutting line in FIG. 3a. The cross sectional plane extends perpendicular to the center line M of the main portion 109. It is, however, not necessarily the one at which the minimum bending rigidity of the main portion 109 is present. Marked is a Cartesian coordinate system, the origin of which is formed by the common center P of the area of the three part cross sectional surfaces A.sub.1, A.sub.2 and A.sub.3. The x-axis is perpendicular to the contact surface 141, and the y-axis extends substantially parallel to the center line M. The x-axis and the z-axis together span the part cross sectional surfaces A.sub.1, A.sub.2 and A.sub.3. The axial geometrical moment of inertia can be determined arithmetically by the integral
[00002]
of the squared z-coordinate over the cross sectional surface A which is composed of the three part cross sectional surfaces A.sub.1, A.sub.2 and A.sub.3. For each of the three integrals, in this case, a common coordinate system is used, the coordinate origin being in the center of the overall surface and not in the centers of the surfaces of the part cross sectional surfaces. The bending rigidity is produced as a product of said axial geometrical moment of inertia with the modus of elasticity of the bone plate 101″. As has been explained above, it is not, however, absolutely necessary for determining whether the bone plate 101″ meets the above-explained bending characteristics according to the invention to know the first minimum bending rigidity of the main portion 109, the second minimum bending rigidities of the wings 110 and the minimum overall bending rigidity of the wings 110 in a precise, numerical manner.
[0111] FIG. 4a shows a perspective view of the second bone plate 101′ according to the invention according to FIG. 2. The main portion 109 has a first contact surface 141 for contacting and fastening on the corpus 142, and the two wings 110 include in each case a second contact surface 144 for contacting and fastening on the ascending ramus 112.
[0112] Each of the openings 102, 102′ and 146 has a structure which can be seen in the view of a detail according to FIG. 4b. The opening 102 serves for receiving a first bone screw 301 which is shown in FIGS. 6a and 6b. The opening 102 passes through the bone plate 101 along a longitudinal axis L from a top surface 202 of the bone plate 101 to an oppositely situated bottom surface 203 of the bone plate 101. On the top surface 202, the opening 102 opens out into a first receiving region 204 which is delimited by a first inside wall 205. On the bottom surface 203, the opening 102 opens out into a second receiving region 206 which is delimited by a second inside wall 207.
[0113] Three recesses 208 are formed in the circumferential direction in the first inside wall 205. In each of said three recesses 208, the distance to the first inside wall 205 increases in dependence on the angle of rotation about the longitudinal axis L. In addition, in the exemplary embodiment shown here, the first inside wall 205 is realized in a spherical manner in the region of each of the recesses 208. As an alternative to this, however, the first inside wall 205 can also be realized, for example, in a paraboloid, ellipsoid or hyperboloid manner. In an analogous manner, three recesses 209 are formed in the circumferential direction in the second inside wall 207. In each of said three recesses 209, the distance to the second inside wall 207 increases in dependence on the angle of rotation about the longitudinal axis L. In addition, in the exemplary embodiment shown here, the second inside wall 207 is realized in a spherical manner in the region of each of the recesses 209, but, as an alternative to this, could also be realized, for example, in a paraboloid, ellipsoid or hyperboloid manner. The first receiving region 204 also includes a spherical depression 210 for receiving a connecting element, in particular a screw head, of a bone screw which is not shown here. In addition, the first recess 204 has an outlet contour 212 which serves for removing a bone screw.
[0114] The two receiving regions 204, 206 are realized for a blocking means which rotates in the same direction. More precisely, both receiving regions 204, 206 are realized for a right-rotating blocking means. A blocking element of a bone screw can therefore be fixed both in the first receiving means 204 in the direction of view from the top surface 202 to the bottom surface 203 by rotating the bone screw clockwise and can be fixed in the second receiving region 206 in the direction of view from the bottom surface 203 to the top surface 202 by rotating the bone screw anticlockwise.
[0115] FIG. 5a shows a top view of the second bone plate 101′ according to the invention. As can be seen in the sectional view according to FIG. 5b, the second receiving region 206 also includes a spherical depression 211 and an outlet contour 213.
[0116] FIGS. 6a and 6b show a first bone screw 301 which can be inserted at a variable angle in each of the openings 102, 102′ and 146. Said bone screw 301 is identical to the one disclosed in WO 2004/086990. It comprises a screw shank 320 with a thread 321 as well as a screw head 310 which is realized as a blocking element and protrudes outward above the screw shank 320 and the thread 321. The screw head 310 comprises an engagement contour 311 in which, for example, a screwdriver can be inserted in order to insert or remove the bone screw 301. In addition, the screw head 310 is provided with a circumferential outside surface which extends substantially in the direction of a longitudinal axis K of the bone screw 301 and comprises three clamping surfaces 330 which are distributed uniformly in the circumferential direction. When viewed in an azimuth plane perpendicular to the longitudinal axis K, the clamping surfaces 330 widen outward in a wedge-shaped manner and away from the longitudinal axis K. The outside surface is realized in a spherical manner in the region of the clamping surface 330. Said clamping surfaces 330 make it possible for the screw head 310 to be able to be blocked electively with the first inside wall 205 or the second inside wall 207, just as is described in detail in WO 2004/086990 (which simply discloses, however, an opening with one single receiving region as disclosed here).
[0117] In this way, the bone screw 301 is able to be inserted both through the opening 102 from the top surface 202 in the direction of the bottom surface 203 and be fixed in this manner at a variable angle on the bone plate and inserted through the opening 102 from the bottom surface 203 in the direction of the top surface 202 and be fixed in this manner at a variable angle on the bone plate. Consequently, both the top surface 202 and the bottom surface 203 can serve electively as contact surfaces which are contacted onto the bone. The bone plates can consequently be used electively and according to requirement for left-sided or right-sided defects without having to dispense with fixing at a variable angle. This clearly reduces the range of bone plates to be held ready.
[0118] The reconstruction set according to the invention shown in FIG. 7 includes the two bone plates 101′ and 101″ according to the invention shown in FIGS. 2 to 3b as well as a connecting plate 131 which is shown here twice in two different views. As means for connecting to a bone plate, for example one of the bone plates described above, the connecting plate 131 includes several openings 132 for receiving a fastening element, such as, for example, a connecting screw 163 which is shown in FIG. 8. For connection, the connecting screw 163 can pass through one of the openings 102, 102′ or 146 of the bone plates according to the invention or also an opening in another bone plate, and its thread can engage a thread which is situated in the connecting plate. This allows for variable lengthening or even for coupling between two plates for adapting to the individual anatomy or rather to the individual bone defect.
[0119] FIG. 8 shows a second reconstruction set according to the invention. This includes [0120] the bone plates 101, 101′ and 101″ according to the invention according to FIGS. 1 to 3b; [0121] a bone plate 101′″ which is not according to the invention and only has one single wing 110 at each end of the main portion 109; [0122] a connecting plate 131 as reproduced in FIG. 7; [0123] one mandibular joint prosthesis 160 each for the left and the right side; [0124] a carrier element 161 for holding and height-variable adjusting of one of the mandibular joint prostheses 160 and for fastening on a bone plate or for directly fastening on the bone (as an alternative to this, the reconstruction set can also include several carrier elements 161); [0125] connecting screws 162 (four screws in the exemplary embodiment shown here) for connection of one of the mandibular joint prostheses 160 to the carrier element 161; [0126] connecting screws 163 (four screws in the exemplary embodiment shown here) for connection of the carrier element 161 to one of the wings 110 or for connection of the connecting plate 131 to one of the bone plates; [0127] a mandibular joint stabilizing element 164 for cross connection of two wings 110 by means of connecting screws 163 (as an alternative to this, the reconstruction set can also include several mandibular joint stabilizing elements 164).
[0128] FIGS. 9a to 9i show how the reconstruction set according to FIG. 8 can be used for a plurality of bone defects: [0129] According to FIGS. 9a and 9b, smaller bone defects can be treated by means of the shorter bone plate 101′. [0130] FIG. 9c shows how a larger defect can be treated using the longer bone plate 101″. [0131] A mandibular joint can also be replaced by means of a shortened bone plate 101″, the carrier element 161, a mandibular joint prosthesis 160 and a mandibular joint stabilizing element 164 as well as the associated connecting screws 162 and 163, as shown in FIG. 9d. [0132] FIG. 9e shows the use of the bone plate 101 for a large central defect. [0133] FIG. 9f shows once again a use of the bone plate 101′ where the defect is even larger than in FIGS. 9a and 9b. [0134] In the situation according to FIG. 9g, two bone plates 101′ and 101″, which have been connected by means of the connecting plate 131, have been used. Whilst the bone plate 101′ has been trimmed in the region of the chin, this has been effected in the case of the bone plate 101″ in the region of the chin and of the ascending ramus. In addition, a mandibular joint prosthesis 160, the carrier element 161 and the mandibular joint stabilizing element 164 with the associated connecting screws 162 and 163 have also been used here. [0135] FIG. 9h once again shows a use of the longer bone plate 101″. [0136] The use of the bone plate 101′″ can be seen finally in FIG. 9i.
[0137] As an alternative to this, however, a reconstruction set is also conceivable and is within the framework of the invention where a mandibular joint prosthesis can be connected directly, that is to say without an additional carrier element, to one of the bone plates.
[0138] FIG. 10 once again shows an overview of a plurality of bone defects according to the conventional HCL classification: [0139] The L defects (lateral continuity defects) can be treated with the shorter bone plate 101′ which has two wings only at one end. Only defects on the right side of the patient are shown, the analogous application of the same bone plate 101′ on the left side of the patient is also possible on account of the above-described double receiving regions of the openings. [0140] The longer bone plate 102′ which also includes two wings only on one end, can be used for CL defects (lateral and central continuity defects). Only defects on the right side of the patient are shown, the analogous application of the same bone plate 102′ on the left side of the patient is also possible on account of the above-described double receiving regions of the openings. [0141] C defects (central continuity defects) can be treated using the bone plate 101′″ which, in the realization shown here, does not have any wings on either of the two ends. Plates for C defects with two wings on one side or on both sides are, however, conceivable. [0142] For the treatment of LCL defects (double lateral and central continuity defects), the bone plate 101 (top four representations) or the bone plates 101′ or 101″ can be used together with the connecting plate 131 (bottom six representations). [0143] For H defects (hemi-mandibular continuity defects), it is possible to use either only one mandibular joint prostheses 160 with carrier element 161 or additionally the mandibular joint stabilizing element 164 and one of the bone plates. In the case of the application shown at the very top in column “H”, no bone plate is inserted; instead of which the carrier element 161 is fastened directly on the bone. Here too, only the use on the right side of the patient is shown (see above). [0144] For CH defects (hemi-mandibular and central continuity defects), a combination of bone plate 101″ trimmed to the wings 110, mandibular joint stabilizing element 164, carrier element 161 and mandibular joint prostheses 160 can be used. Here too, only the use on the right side of the patient is shown (see above).
[0145] All in all, it is shown that all bone defects can be treated with a comparatively small reconstruction set. This is brought about, among other things, by the ability to use both sides of the bone plates which is traced back to the double receiving regions according to the invention of the openings.
[0146] FIGS. 11a and 11b show a second bone screw 340. This includes a screw head 341 with an engagement contour 342, a screw shank 343 with a thread 347 and a blocking element 345 which is arranged on an end 344 of the bone screw 340 which is situated opposite the screw head 341. Said blocking element 345 includes three clamping surfaces 346 which are distributed uniformly in the circumferential direction and are realized as disclosed in WO 2004/086990.
[0147] FIGS. 12a and 12b show a third bone screw 350 which, however, does not comprise a screw head. On a first end 351 it has an engagement contour 352 and on a second end 354 which is situated opposite the first end 351 it comprises a blocking element 355 which has three clamping surfaces 356 just as the blocking element 345 shown in FIGS. 11a and 11b. A screw shank 353 with a thread 357 extends between the first end 351 and the second end 354.
[0148] FIGS. 13a to 13c show the bone plate 101′ according to the invention from FIG. 2 with two bone screws 340 which are shown in FIGS. 11a and 11b as well as two bone screws 301 which are shown in FIGS. 6a and 6b.
[0149] In the view according to FIG. 13a, the shorter bone screws 301 according to FIGS. 6a and 6b are inserted from the top surface 202 of the bone plate 101′ in the direction of the bottom surface 203 and pass through the openings 102′. The bone screws 340 according to FIGS. 11a and 11b are directed with their ends 344 toward the bottom surface 203, but are not yet in contact therewith. In the position according to FIG. 13b, the bone screws 340 are inserted and fixed in the openings 102 by means of the blocking elements 345. FIG. 13c includes a perspective view of the top surface 202 of the bone plate 101′.
[0150] If sufficient fixing cannot be achieved just with the bone screws 301, the bone screws 340 can provide additional stability. For example, the shorter bone screws 301 can pass through the bone plate 101′ and then from the outside into a mandible, and the longer bone screws 340 can pass through the mandible completely from inside to outside and then engage in the bone plate 101′. A conceivable indication is the degradation of a bone which can occur, for example, as a result of previous radiotherapy.
[0151] FIGS. 14a and 14b show the same bone plate 101′, in the openings 102, 102′ of which, however, according to FIG. 14b, four of the shorter bone screws 301 can be inserted. In this case, a first bone screw 301 and a second bone screw 301 pass through the bone plate 101′ from the top surface 202 to the bottom surface 203, the first bone screw 301 passing through an opening 102 and the second bone screw 301 passing through an opening 102′. A third bone screw 301 and a fourth bone screw 301 pass through the bone plate 101′ from the bottom surface 203 to the top surface 202, the third bone screws 301 passing through an opening 102 and the fourth bone screw 301 passing through an opening 102′.
[0152] In a possible application, a first part of the bone plate 101′ could be screwed in the region of a mandibular joint from the oral cavity, whilst a second part of the bone plate 101′ could be screwed in the corpus region from the outside.
[0153] FIGS. 15a to 15c show details of a further bone plate 360, a perspective view of which is shown in FIG. 15a, a top view of which is shown in FIG. 15b and a sectional view of which is shown in FIG. 15c along the cutting line which is marked in FIG. 15b. The bone plate 360 includes an opening 361 which opens out into a first receiving region 364 on a top surface 362 of the bone plate 360 and opens out into a second receiving region 366 on a bottom surface 363. Both the first receiving region 364 and the second receiving region 366 include a cone-shaped internal thread 367 or rather 368 which widens in the direction of the top surface 362 or rather the bottom surface 363. In said exemplary embodiment, both internal threads 367, 368 are identical to one another.
[0154] FIGS. 16a to 16c show details of a further bone plate 370, a perspective view of which is shown in FIG. 16a, a top view of which is shown in FIG. 16b and a sectional view of which is shown in FIG. 16c along the cutting line which is marked in FIG. 16b. The bone plate 370 includes an opening 371 which opens out into a first receiving region 374 on a top surface 372 of the bone plate 370 and opens out into a second receiving region 376 on a bottom surface 373. Both the first receiving region 374 and the second receiving region 376 include a cone-shaped internal thread 377 or rather 378 which widens in the direction of the top surface 372 or rather the bottom surface 373. In said exemplary embodiment, only the opening angles of the two internal threads 377, 378 are identical; the first internal thread 377, however, is higher than the second internal thread 378.
[0155] FIGS. 17a to 17c show details of a further bone plate 380, a perspective view of which is shown in FIG. 17a, a top view of which is shown in FIG. 17b and a sectional view of which is shown in FIG. 17c along the cutting line which is marked in FIG. 17b. The bone plate 380 includes an opening 381 which opens out into a first receiving region 384 on a top surface 382 of the bone plate 380 and opens out into a second receiving region 386 on a bottom surface 383. Both the first receiving region 384 and the second receiving region 386 are realized in the shape of a circular cylinder, but do not include any internal threads. An equally circular-cylinder-shaped intermediate region 389 is present between the two receiving regions 384, 386, the radius of which, however, is smaller than that of the receiving regions 384, 386.
[0156] FIGS. 18a to 18c show details of a further bone plate 390, a perspective view of which is shown in FIG. 18a, a top view of which is shown in FIG. 18b and a sectional view of which is shown in FIG. 18c along the cutting line which is marked in FIG. 18b. The bone plate 390 includes an opening 391 which opens out into a first receiving region 394 on a top surface 392 of the bone plate 390 and opens out into a second receiving region 396 on a bottom surface 393. Both the first receiving region 394 and the second receiving region 396 are realized in a cone-shaped manner and widen in the direction of the top surface 392 or rather the bottom surface 393. A circular-cylinder-shaped intermediate region 399 is present between the two receiving regions 394, 396, the radius of which, however, is smaller than the smallest radius of the receiving regions 394, 396.
[0157] Bone screws with a slotted screw head (such as, for instance, in CH 669 105 A5) or with a spherical screw head (such as for instance in CH 675 531 A5) can be inserted into the openings 361, 371, 381, 391 of the bone plates 360, 370, 380, 390 which are shown in FIGS. 15a to 18c.
