WO2001093775A1

WO2001093775A1 - Subgingival joining device

Info

Publication number: WO2001093775A1
Application number: PCT/DE2001/002103
Authority: WO
Inventors: Wilfried Engelke
Original assignee: Wilfried Engelke
Priority date: 2000-06-09
Filing date: 2001-06-07
Publication date: 2001-12-13
Also published as: DE20121531U1

Abstract

The invention relates to a subgingival joining device of rotationally symmetrical dental implants provided with a joining element, whereby a central implant, which can support a dental prosthesis via suitable devices, can be joined in a non-positive manner and via the joining element to at least one satellite implant, which, at a distance, can be transversally arranged with regard to the alveolar ridge. The invention also relates to a set for immediately providing patients with a tight-fitting dental prosthesis. The set consists of a joining element, a central implant, an occlusal screw and of several satellite implants.

Description

Subgingival connecting device

Be honored

The invention relates to a subgingival connecting device of rotationally symmetrical dental jaw implants with a connecting element.

Immediate restoration with functional dentures is the goal of implantology treatment. Even in the pioneering days of implantology, implants were immediately loaded with dentures. Pruin (1974) described the use of needle implants, while Kanitz (1982) reported subperiosteal framework implants, which were also immediately loaded. Chercheve (1962) described a transmandibular implantation technique in which screw-shaped implants for anchoring dentures were connected by an extra-oral access with stabilization via a submandibularly attached metal plate. The immediate restoration on titanium screw implants with an immediately established bar connection was published by Lederman (1979) and more recently taken up by Friadent (1999).

Single tooth restorations on screw implants that are immediately loaded are recommended by Sandalli and Grafel ann (1999).

Undisputedly, the success of implants loaded immediately depends to a large extent on whether the primary stability of the implant or the complex of several implants connected to one another fulfills the prerequisites for primary bone fracture healing, in particular whether an implant is adequately anchored in cortical bone Macro movement of the implants relative to the bone bed in the healing phase can definitely be excluded. According to recent E p- recommendations (Friadent, 1999) if the implants can be inserted with a torque of 30 N / cm. The subsequent primary blocking of the implants prevents physical overloading of individual implants by chewing forces which are introduced into the implants via the dentures. For immediate restoration, 4 implants in the anterior lower jaw or 3 implants in a free-end situation are currently recommended (Friadent, 1999).

Temporary auxiliary implants (Bohsali et al. 1999, Zubery et al. 1999) as an alternative to the use of immediate implants have apparently limited success, while various methods of stabilizing implants in the area of the maxillary sinus floor [Katzenbeisser (1990), Khoury (1996), Sendax ( 1996)] have so far not been able to establish themselves.

For the treatment of the atrophied mandibular posterior region, Teichmann (1993) described a subperiosteal implant with reference to the previously described subperiosteal and combined endosseous - periosteal implants, which can be individually adjusted due to slight deformation and anchored in the compact with screws. It is a one-piece, plate-like design with receptacles for screws and a threaded bushing for attaching the dental supra structure.

US Pat. No. 5,513,989 describes a U-shaped saddle-shaped stabilizer for dental implants which is intended to distribute the force of chewing forces when using shorter implants in the lower jaw molar region. Both inventions have so far found only limited resonance in the literature and are limited in their use to areas of the atrophied lateral jaw section that are suitable for this purpose.

If one assumes that the anchoring of an implant in the healing phase with immediate chewing takes place predominantly in the cortex, remodeling processes, in contrast, primarily affect the enossal space and subperiosteal loading. affecting rich people [asynchronous turn-over-rate of different bone structures (Parfitt, 1993)], an increase in primary implant stability can only be achieved by additional cortical enlargement and must bridge the period of time required for endosseous osseointegration of the implant. With a cortex thickness of 2 mm, chewing forces of the order of 300 N can be compensated for using 1.25 mm screws (You et al. 1994). Engelke et al. (1996) were able to show that primarily unstable implants with tensile straps are successfully and predictably integrated with micro osteosynthesis.

DE 199 36 061 A1 discloses a device for inserting implants in the sinus area of the upper jaw of a living being. The known device has a connecting element which is arranged in the longitudinal direction of the alveolar ridge and connects several implants to one another. The connecting element is fixed to the bone using fixation screws. This temporary device is not suitable for immediate restoration with functional dentures, but serves to enable bone formation. After the bone has been built up, the implants used are replaced by implants with dentures at a later date.

The object of the present invention is to show a connecting device which is suitable for enabling the immediate loading of the conventional rotationally symmetrical dental central implant placed at a prosthetically defined position, namely by optimizing the primary stability by means of additional insertion in the surrounding cortex.

This object is achieved in connection with the preamble of claim 1 in that a central implant, which can carry dentures via suitable devices, can be non-positively connected to at least one satellite implant via the connecting element. The non-positive connection between the central implant and the satellite implant, which is established via the connecting element, enables primary blocking of the central implant with the aim of immediate loading. The dental central implants placed according to the prosthetic and tooth-related and occlusion-related are surrounded by satellite implants in the size of small bone screws for cortical anchoring of the dental central implants, the dental central implant being connected subgingivally to the satellite implant via the connecting element. The entire complex as a subgingival connection can thus be compared directly with the supragingival primary blocking, the latter allowing an immediate loading of dentures, as the first mentioned. The subgingival device or the connecting element and the satellite implants can subsequently either be removed during the manufacture of the definitive denture or left in the sense of additional stabilization. The device according to the invention has the following advantages, in particular with regard to its use in partially edentulous jaws:

Satellite implants can be attached variably where there is sufficient compact. The place of insertion of the satellite implants is not occupied by the central implant. There are no aesthetic problems in the case of an exposed connecting element. Furthermore, there is no undesired contact of the connecting element with the tooth-neck area or the root structures of the neighboring teeth. Immediately adjacent to the approach to the central implant, a shaping zone can be provided, as well as a retentive zone peripherally thereof for anchoring the satellite implants.

According to a preferred embodiment of the invention, the at least one or the satellite implants can be arranged at a distance transversely to the center of the alveolar ridge. In particular, central implants and satellite implants can be arranged together on an imaginary grid, consisting of the middle of the alveolar ridge and the perpendicular in the approximal spaces, the central implant between the nodes of the grid and the satellite implants can be placed on approximal grid lines. This arrangement thus takes into account the fact that the space occupied by the central implant defined by the position of the tooth crown cannot be occupied for satellite implants, but rather the interimplant proximal space and the cortex adjoining it basally. The longitudinal axis of the grid corresponds approximately to the center of the dental arch, respectively. Alveolar ridge. The nodes of the grid are the center of the approximal spaces, from where grid lines extend at right angles to the jaw base in the oral and vestibular direction. The shape of the induction element is such that an arrangement of the satellite implants and central implants on the said grid is made possible, whereby central implants can be placed between the nodes, satellite implants on the nodes and the right-angled proximal grid lines described above. This ensures that the central implants can be placed individually according to the individual requirements without the basic arrangement of all implants on the imaginary grid being hindered when several central implants and corresponding connecting elements are arranged.

According to a further preferred embodiment of the invention, the connecting element, when projected onto its main extension plane, corresponds to at least part of an H-like basic shape, the crossbar of which forms a central section that can be screwed to the central implant and one to four subgingival extensions for anchoring satellite implants at the roots are arranged on the two opposite longitudinal beams of the H. The connecting element follows the above-mentioned lattice structure with the corresponding advantages. In addition, the connecting element has a simple and inexpensive structure and is relatively easy to implant.

All extensions consist of a web that attaches to the central section of the connecting element and the individual Adaptation is used, and from peripheral sections with perforations or holes that accommodate one or more satellite implants. The bores can be elongated according to the perforations of a tension belt plate or as so-called compression holes. The extensions have a thickness or height that is approximately 0.5 to 2 mm. Deviations are possible depending on the material and intended use. However, a thickness or overall height of <1 mm is preferred. In the simplest case, cutting the basic structure to length creates a connecting element with only one deformable web and a receptacle for a satellite implant. The sections of the extensions directly adjacent to the central implant - the webs - are used to form the connecting element onto the shape of the alveolar ridge. They therefore have no holes for satellite implants and are flat in cross-section. These shaping zones can be designed to be flat relative to the retentive zones or can be prefabricated in various curvatures or radii of curvature corresponding to the shape of the alveolar ridge, the convexity of the curvature facing away from the implant. By tapering or reducing the overall height, a specific specification for the main direction of deformation can be made. This prevents the connection to the central implant from deforming.

In the case of an H-shaped structure of the connecting element, the zones of low material thickness or the shaping zones expediently run parallel to the transverse beam of the H. The sections of the extensions located distal to the shaping zones or the webs at the end of the extension carry one or more perforations or bores with a diameter of approx. 1 to 4 mm for anchoring satellite implants. Small bone screws made of metal, preferably titanium, can be used as satellite implants. In order to avoid a removal operation, the satellite implants and also the connecting elements can be made of resorbable plastics. In this case, the resorption time must not be less than the osseointegration period of the central implants. Partial production of the connecting element, especially its A retentive part made of resorbable, biocompatible plastic is possible.

According to a further preferred embodiment of the invention, the connecting element on its upper side facing away from the central implant has a removable abutment associated with the central implant, which can be connected to the central implant by an occlusal screw. The central section of the connecting element has two opposing shoulders on the upper side, into which the abutment on the lower side of the post facing the upper side engages in a form-fitting manner. The shoulders are arranged in approximal sectors along the jaw ridge.

According to a further preferred embodiment of the invention, the upper side of the connecting element facing the dental prosthesis has a structure that can be ground and is provided for anchoring dental prostheses as an anchor for artificial dentures. The structure for the connection to the tooth crown can thus be part of the connecting element, i. H. on its upper side facing away from the central implant, the connecting element has a tooth-stump-like structure which can be individualized by grinding. This post is centrally provided with a receptacle for the occlusal screw reaching into the implant. In this case, the abutment can be molded directly and the tooth crown subsequently cemented, if necessary, a temporary can also be fabricated directly. If removable posts are to be used with special transfer posts and subsequent fabrication of the dental prosthesis in the laboratory with higher accuracy and quality on so-called laboratory implants, the abutment described above is required. In this case, special structures serving as a safe mechanical anchoring are provided on the surface of the connecting element according to an anatomical model.

According to a further embodiment of the invention, there is a set for the immediate care of patients with fixed dentures provided that consists of a connecting element, a central implant, an occlusal screw and several satellite implants. Possibly. the set can also have a construction post.

Further details of the invention will become apparent from the following detailed description and the accompanying drawings, in which preferred embodiments of the invention are illustrated, for example.

The drawings show:

FIG. 1: a schematic top view of an arrangement of dental central implants and satellite implants on the section of a dental arch,

FIG. 2: an approximal side view of a subgingival connecting device in section,

FIG. 3: a transverse section through an alveolar extension with a subgingival connecting device adapted to the anatomical shape,

FIG. 4: a further side view of a subgingival connecting device in section,

FIG. 5: a top view of a connecting element with an H-shaped arrangement and assignment to the central implant,

FIG. 6: a top view of a further H-shaped connecting element,

FIG. 7: a top view of a further connecting element,

FIG. 8: a top view of a further connecting element with a satellite implant, FIG. 9: a plan view of a further H-shaped connecting element,

FIG. 10: a bottom view under a connecting element in the tear,

FIG. 11: a side view of the connecting part from FIG. 10, cut along the line XI - XI,

FIG. 12: a bottom view under a connecting element with a conical body in the tear,

FIG. 13: a side view of the connecting element from FIG. 12, cut along the line XIII-XIII,

FIG. 14: a bottom view under a connecting element with a cylindrical body in the tear,

FIG. 15: a side view of the connecting element of FIG. 14 cut along the line XV-XV,

Figure 16: a side view of a subgingival connecting device with a post and occlusal screw in section and

FIG. 17: a top view of the connecting element from FIG. 16.

A subgingival connecting device 1 essentially consists of a central implant 2, a connecting element 3 and a satellite implant 4.

FIG. 1 shows an arrangement of the dental central implant 2 and the satellite implant 4 on the section of a dental arch 5. A straight section 6 merges into the curved section 7. The perpendicular to the middle of the alveolar ridge 8 runs in the approximal spaces, which form approximate grid lines 9, on which satellite implants 4 are arranged. FIG. 2 shows an approximal view, which corresponds to a cross section through the alveolar ridge, of a subgingival connecting device 1. The connecting element 3 has a central section 10 with a cylindrical body 11 on its underside 12. The cylindrical body 11 forms a rotationally symmetrical body, which establishes the connection to the central implant 2. On the upper side 13 facing away from the underside 12, two opposing shoulders 31 of the central section 10 are arranged, which serve to secure rotation and connect to an abutment 15, which is connected to the central implant 2 by means of a central occlusal screw 16. The dashed lines show examples of preformed basal concave extensions 17 of the connecting elements 3. A concave curvature can already exist at the extension 17 at the central section 10 in order to reproduce the anatomical curvature of the alveolar ridge present there.

FIG. 3 shows a transverse section through an alveolar extension 18. A central implant 2 is inserted in a prosthetically defined position and provided with an anchor for dentures 19. The connecting element 3 is adapted to the anatomical shape of the alveolar process 18 by cold working. The satellite implants 4 are inserted individually in the angled axial direction in the approximal space. The connecting element 3 and the satellite implant 4 lie below the gingival surface 20 in the implanted state. The underside 12 of the connecting element 3 lies on the bone surface 34.

FIG. 4 shows a connecting element 3, which has a firm mechanical bond with the central implant 2, which extends into the cortical and cancellous bone space 21 in the jawbone. The satellite implant 4, which is guided through a recess or bore, is anchored exclusively in the cortex. The connecting element is arranged laterally on the upper edge of the central implant 2, so that a bearing on the given alveolar bone without impairing the insertion of a Aufbauppostens 15 is made possible. The cortical boundary 35, the bone surface 34 and the gingival surface 20 are shown as schematic lines.

FIG. 5 shows a plan view of a connecting element 3 with an H-shaped arrangement of the extensions 17. The arrangement of the extensions 17 in relation to the alveolar ridge section 22 occupied by the central implant 2 is shown in the plan view or projection from the occlusal direction. Dotted sections 23 are provided for adaptation. A preforming in the sense of a concavity to the central implant 2 can be specified in these sections. Possible tapering 24 of webs 25 of extensions 17 and height reduction zones 26 are attached to two extensions 17 by way of example. The taper 24 and the overall height reduction zone 26 thus form zones of lesser material thickness 24, 26.

Further possible connecting elements 3 are shown by way of example in FIGS. 6 to 8.

FIG. 9 shows a plan view of a further connecting element 3 with an H-shaped arrangement of the extensions 17. The four extensions 17 are each connected to the central section 10 via a web 25 assigned to them. In the distal retentive portion 27 of the extension 17 facing away from the web 25, perforations or bores 33 are arranged for connection to the satellite implants 4.

FIGS. 10 and 11 show the design of the connecting element 3 to the central implant 2 for implants with a flat cervical boundary or with a central external rotation protection. The central bore 28 serves as a receptacle for the occlusal screw 16.

FIGS. 12 and 13 show a connecting element 3 with a conical rotating body 29 for central implant 2, which have a cone. FIGS. 14 and 15 show a connecting element 3 with a cylindrical rotating body 30 on its underside 12. Without the use of rotation-securing elements, the cylindrical rotating body 30 engages as a cylindrical pin for stabilization in a corresponding central implant 2 and is screwed into the occlusal force-fitting manner with an occlusal screw 16.

FIG. 16 shows a side view in section of a connecting device 1 in the view from the vestibular side with approximal shoulders 31. The proximal shoulders 31 are arranged opposite one another on the upper side 13 of the connecting element 3. The abutment post 15 engages in the approximal shoulders 31 with its post underside 32 facing the upper side 13 with corresponding formations. The shoulders 31 are arranged along the proximal sectors located to the alveolar ridge. In the case of lying or implanted satellite implants 4, the abutment 15 can be exchanged for impression posts or gingiva formers, for example, and enables the anatomically optimized high-quality design of dentures.

Claims

claims

1. Subgingival connecting device of rotationally symmetrical dental jaw implants with a connecting element, characterized in that a central implant (2), which can carry dentures via suitable devices, can be non-positively connected to at least one satellite implant (4) via the connecting elements t (3).

2. Subgingival connection device according to claim 1, characterized in that the satellite implant (4) in one

Distance can be arranged transversely to the center of the alveolar ridge (8)

3. Subgingival connecting device according to claim 1 or 2, characterized in that central implants (2) and satellite implants (4) can be arranged together on an imaginary grid consisting of the middle of the jaw ridge (8) and perpendicular in the approximal spaces and that the central implants (2) between nodes of the grid and the satellite implants (4) can be placed on approximal grid lines (9).

4. Subgingival connecting device according to one of claims 1 to 3, characterized in that the connecting element (3) is designed as a flat base body made of a biocompatible material and has a low overall height, which is its subgingival application and an adaptation to the bone surface by plastic Deformation allowed.

5. Subgingival connecting device according to one of claims 1 to 4, characterized in that the connecting element (3) is formed from a bioabsorbable material.

6. Subgingival connection device according to one of claims 1 to 5, characterized in that the satellite implants (4) are made of a bioabsorbable material.

7. Subgingival connecting device according to one of claims 1 to 6, characterized in that the connecting element (3) has a central section (10) which can be screwed to the central implant (2).

8. Subgingival connecting device according to one of claims 1 to 7, characterized in that the connecting element (3) in projection onto its main extension plane corresponds to at least part of an H-like basic shape, the crossbar of which forms the central section (10) starting from one to four subgingival extensions (17) for anchoring satellite implants (4) are arranged on the two opposite longitudinal beams of the H.

9. Subgingival connection device according to claim 7 or 8, characterized in that the connection to the central implant (2) is made freely rotatable by means of an annular flat support of the central section (10), the connection element (3) via an occlusal screw (16 ) can be non-positively connected to the central implant (2) in a central receptacle.

10. Subgingival connecting device according to one of claims 1 to 9, characterized in that on the central implant (2) facing the underside (12) of the connecting element (3) freely rotatable rotationally symmetrical body (29,30) are arranged, which in recordings of the respective Intervene with the central implants (2).

11. Subgingival connecting device according to one of claims 8 to 10, characterized in that a web (25) with a flat cross section as an extension (17) attaches to the central section (10) of the connecting element (3), which adjusts the possibility of deformation for adaptation contains the individual alveolar ridge structure and that the peripheral sections of the extensions (17) have bores (33) for receiving satellite implants (4).

12. Subgingival connecting device according to claim 11, characterized in that the extensions (17), in particular in the region of the flat web (25), have zones of lesser material thickness (24, 26) which, in adjacent typical regions of strong curvature of the alveolar ridge, are targeted to the central implant (2) allow concave deformation of the extensions (17) with maximum curvature in a transverse plane arranged transversely to the alveolar ridge.

13. Subgingival connecting device according to claim 12, characterized in that the zones of lesser material thickness

(26) can be achieved by reducing the thickness of the extensions (17) running perpendicular to the plane of propagation.

14. Subgingival connecting device according to claim 12, characterized in that the zones of lesser material thickness (24) are achieved by tapering the width of the extensions (17) extending in the plane of propagation.

15. The subgingival connecting device as claimed in one of claims 8 to 14, characterized in that the extensions (17) have concave curvatures which are pre-shaped towards the alveolar ridge and which are adapted to certain alveolar ridge sections (22).

16. Subgingival connecting device according to one of claims 1 to 15, characterized in that the connecting element (3) on its upper side facing away from the central implant (2) (13) associated with the central implant (2) has a removable abutment post (15) which can be connected to the central implant (2) by an occlusal screw (16).

17. Subgingival connecting device according to claim 16, characterized in that the central section (10) of the connecting element (3) on the top (13) has two mutually opposite shoulders (31) into which the abutment post (15) on its top (13) facing the bottom of the post (32) engages with corresponding form-fitting.

18. Subgingival connecting device according to claim 17, characterized in that the shoulders (31) are arranged in approximal sectors lying along the alveolar ridge.

19. Subgingival connecting device according to one of claims 1 to 18, characterized in that the upper side (13) of the connecting element (3) facing the dental prosthesis has a grindable structure provided as an anchor (19) for artificial dental prostheses for anchoring dental prostheses.

20. Set for immediate care of patients with fixed dentures according to one of claims 1-19, characterized in that it consists of a connecting element (3), a central implant (2), an occlusal screw (16) and several satellite implants (4).

21. Set for immediate care of patients with fixed dentures according to claim 20, characterized in that the

Set has a mounting post (15).