Integrated preparation method of implant-supported transitional restoration and mucosal pressure plate

Abstract

The present invention provides an integrated preparation method of an implant-supported transitional restoration and a mucosal pressure plate, comprising: step S1, blocking the buccal and lingual soft tissues of the patient in the area of ​​the reconstructed jaw transplant bone segment; step S2, scanning CBCT and reproducing a plaster model; step S3, obtaining plaster optical model data, reconstructing CBCT hard tissue and implant models, and matching them with the plaster optical model data, and obtaining a 3D digital model and position information with implants, vestibule grooves, soft tissues, bone tissues and high-precision dentition information; step S4, performing ideal morphological shaping simulation on the surface mucosa of the bone segment in the implant area on the 3D digital model, and preparing a mucosal pressure plate integrated with the patient's implant-supported transitional restoration. The beneficial effect is that the present invention can ensure that the patient's normal chewing function can be restored to a certain extent in the early stage of treatment, shorten the patient's toothless time, improve the patient's quality of life, and reduce the shrinkage rate after free keratinized gingival transplantation.

Description

Technical Field

[0001] The present invention relates to the technical field of peri-implant soft tissue augmentation, and in particular to a method for preparing an integrated implant-supported transitional restoration and a mucosal pressure plate. Background Art

[0002] Dental implants are a method of restoring missing teeth that uses a lower structure implanted in bone tissue to support and retain the upper dental restoration. It is currently the preferred treatment method for patients with missing teeth.

[0003] The commonly used implant system is mainly composed of implants, abutments and superstructures. Implants, that is, artificial tooth roots, are cylindrical or conical structures that replace fallen tooth roots and have the function of supporting and transmitting occlusal forces. The abutments are the parts of the implant system that are installed on the intraosseous implant platform and are used to connect, support and / or fix the superstructure of the implant.

[0004] Submerged implant surgery requires two operations. The first stage of surgery is implant placement. After the healing period, the second stage of surgery is performed to expose and remove the covering screws, install the healing abutment, perform necessary soft tissue treatment, form the implant gingival cuff, and remove the healing abutment after the gums heal to install the upper restoration structure. For non-submerged implants, the healing abutment is installed when the implant is placed to avoid secondary surgery, but it has high requirements for the patient's oral hygiene. After the implant is completed, the repair method can be divided into immediate repair, early repair and delayed repair according to the intraoperative conditions, the location of the missing teeth, and the patient's requirements.

[0005] The long-term stability of implants depends on good bone integration and the influence of soft tissue attachment around implants. The mucosal attachment or transmucosal attachment formed by the peri-implant mucosal tissue achieves biological closure and is an important barrier to isolate the bone tissue around the implant and the oral environment. Long-term edentulousness of patients will lead to alveolar bone resorption. The tough and fixed attached gingiva on the surface of the alveolar bone will gradually be replaced by soft and active non-keratinized alveolar mucosa, which is not conducive to the formation of biological closure, leading to the occurrence of peri-implantitis and then implant failure. In 2017, the expert consensus of the Osteology Foundation believed that good plaque control around implants requires a keratinized mucosa width of at least 2 mm. If the width is insufficient, scholars generally recommend keratinized mucosa widening surgery.

[0006] The most common keratinized mucosa widening surgery in clinical practice is free gingival transplantation. Free gingival transplantation refers to the transplantation of healthy autologous keratinized gingival tissue to the affected area to widen the attached gingiva and deepen the vestibule groove. The current method of fixing free gingival flap in clinical practice relies on periodontal suturing technology. However, this method requires high suturing skills from the surgeon. The stability of the sutured free gingiva is poor and it is easy to move with the traction of the muscles during oral and maxillofacial functional movements, so it cannot be close to the recipient bed, which leads to necrosis of the transplanted flap.

[0007] The existing devices for widening soft tissue around implants are dental implant gum transplantation fixing guides and dental implant gum transplantation fixing systems. The fixing guide has a screw hole structure for the healing cap screw to pass through, and the bottom surface of the guide matches the bone surface of the alveolar bone of the gum to be transplanted. The dental implant gum transplantation fixing system includes a fixing guide, a guide fixing member and an implant. The guide fixing member includes a screw rod and a cap. The screw rod of the guide fixing member passes through the screw hole of the guide plate and is screwed to the implant. When the guide plate fixing member and the implant are screwed in place, the cap of the guide plate fixing member abuts against the guide plate, and the distance between the guide plate and the alveolar bone is about 3 mm.

[0008] The steps of the method for making a dental implant gingival transplantation fixed guide are as follows:

[0009] (1) CT scanning to obtain the patient's oral CT data before the second-stage gingival transplantation surgery, and to establish the patient's three-dimensional alveolar bone data, where the alveolar bone has healed implants;

[0010] (2) Pick up the alveolar bone surface where the gingiva needs to be transplanted, thicken the alveolar bone surface, and form a preliminary model of the guide plate;

[0011] (3) Screw holes are opened on the preliminary model to form a fixed guide plate model. The screw holes are aligned with the internal screw holes of the implant, and the size of the screw holes matches the size of the internal screw holes of the implant;

[0012] (4) Establish a three-dimensional model of the guide plate fixture. The screw of the guide plate fixture is meshed with the internal thread of the implant. The screw length of the guide plate fixture is determined. When the guide plate fixture and the implant are screwed into place, the guide plate fixture is against the top surface of the fixed guide plate, and the distance between the guide plate and the alveolar bone is about 3 mm.

[0013] (5) Copying the fixed guide plate model, unfolding the bottom surface of the fixed guide plate model into a plane, and forming a mucosal guide plate model;

[0014] (6) The fixed guide plate model is formed into a solid fixed guide plate, the mucosal removal guide plate model is formed into a solid mucosal removal guide plate, and the three-dimensional model of the guide plate fixing part is formed into a solid guide plate fixing part.

[0015] Since the existing dental implant gum graft fixation system is only used to fix free gingiva, it has the disadvantage of not being able to repair transitional dentures at the same time, which limits the value and flexibility of the dental implant gum graft fixation system in clinical applications. During the entire process of grafted gingiva healing, patients need to wait for a long time before the next step of missing tooth repair, delaying the recovery of oral and maxillofacial function, which prolongs the entire treatment cycle and increases the inconvenience of patients.

[0016] Since only CT scanning is used to obtain alveolar bone data during the design of the gingival transplantation fixation system, the distance between the designed guide and the alveolar bone is about 3 mm, there is a lack of soft tissue data, and the known gingival thickness is not considered, which may cause the guide to fail to produce uniform pressure on the transplanted gingiva, which is not conducive to the healing of the free transplanted gingival flap. This technology uses CBCT data and model scanning to establish a 3D digital model and position information with implants, vestibule grooves, soft tissues, bone tissues and high-precision dentition information in a unified three-dimensional coordinate system, which can effectively improve the shortcomings of the existing technology. Summary of the invention

[0017] The technical problem to be solved by the present invention is to reduce the shrinkage rate of free keratinized gingival transplantation, ensure that the patient's normal chewing function can be restored to a certain extent in the early stage of treatment, shorten the patient's toothless time, improve the patient's quality of life, and save clinical costs. In order to overcome the defects of the above-mentioned prior art (or related technology), the present invention provides an integrated preparation method of an implant-supported transitional restoration and a mucosal pressure plate.

[0018] The present invention provides a method for preparing an integrated implant-supported transitional restoration and a mucosal pressure plate, comprising:

[0019] Step S1, using silicone rubber to prepare a lip or buccal-lingual baffle in the patient's reconstructed jaw transplant bone segment area to block the patient's buccal and lingual soft tissues and obtain a stable occlusal relationship;

[0020] Step S2, after the patient wears the lip or cheek-tongue baffle, using cone beam computed tomography (CBCT) to obtain data of reconstructed jaws, implants, and soft tissues, and based on the data, using alginate to make a plaster model, and obtaining a bite record at the same time;

[0021] Step S3, scanning the plaster model to obtain plaster optical model data, reconstructing the CBCT hard tissue and implant model through oral implant design software, matching it with the plaster optical model data, and obtaining a 3D digital model and position information with implant, vestibular groove, soft tissue, bone tissue and high-precision dentition information in a unified three-dimensional coordinate system;

[0022] Step S4, based on the position information, simulate the ideal shape of the mucosa on the surface of the bone segment in the implant area on the 3D digital model, and prepare a mucosal pressure plate to be integrated with the patient's implant-supported transitional restoration.

[0023] In a possible embodiment, step S1 needs to be performed at least 6 months after the implant is implanted in the patient and after it is confirmed through clinical and imaging evaluation that the implant has formed bone integration in the fibula segment of the patient.

[0024] In a possible implementation, in step S4, the spatial distance between the mucosal pressure plate and the alveolar ridge of the patient is 3.5 mm.

[0025] In a possible implementation, in step S4, when preparing the mucosal pressure plate, the volume, height and surface irregularity of the transplanted bone segment in the patient's reconstructed mandible are taken into consideration.

[0026] In a possible implementation, in step S4, when the edge of the mucosal pressure plate is extended, it is extended to at least 6 mm outside the cheek of the implant neck edge.

[0027] In a possible implementation, the hole position and shape of the mucosal pressure plate are consistent with the neck shape of the implant-supported transitional restoration.

[0028] In a possible implementation, in step S4, the mucosal pressure plate is made of a transparent resin material through a 3D printing process.

[0029] Compared with the prior art, the integrated preparation method of the implant-supported transitional restoration and the mucosal pressure plate of the present application has the following advantages:

[0030] 1) Promote the rapid healing of free gingival flaps after peri-implant mucosal transplantation and reduce the shrinkage rate: In this application, by closely fitting autologous tissues such as free gingiva with the periosteum of the implanted area and applying appropriate pressure, the healing process of the soft tissues around the implant can be accelerated and the shrinkage rate of free keratinized gingival transplantation can be reduced;

[0031] 2) Early restoration of occlusal relationship: This application is based on digital technology design. While performing mucosal transplantation, the occlusal relationship is immediately restored, ensuring that the patient's normal chewing function can be restored to a certain extent in the early stage of treatment;

[0032] 3) Shorten the time of missing teeth for patients: This application significantly shortens the time of missing teeth for patients and improves the quality of life of patients by immediately restoring the occlusal relationship during the treatment process;

[0033] 4) Saving clinical costs: After the gingival healing is completed, the mucosal pressure plate can be removed, and the remaining transitional restoration can continue to be used. This method avoids the need for repeated production of restorations, thereby saving clinical costs. BRIEF DESCRIPTION OF THE DRAWINGS

[0034] Figure 1 is a flow chart of the steps of the present invention;

[0035] Figure 2 is a schematic diagram of the mandibular 3D digital model of the present invention;

[0036] Figure 3 Schematic diagram of the mucosal pressure plate of the present invention. DETAILED DESCRIPTION

[0037] First, those skilled in the art should understand that these implementations are only used to explain the technical principles of the embodiments of the present application, and are not intended to limit the protection scope of the embodiments of the present application. Those skilled in the art can make adjustments to them as needed to adapt to specific application scenarios.

[0038] The present application is further described in detail below with reference to the accompanying drawings and specific embodiments.

[0039] See also Figure 1 The present application discloses an integrated preparation method of an implant-supported transitional restoration and a mucosal pressure plate. The timing of designing and making a digital implant-supported mucosal pressure plate is: at least 6 months after implantation, and after confirming that the implant has formed bone integration in the fibula segment through clinical and imaging evaluation, and ensuring the stability of soft and hard tissues; the specific process of designing and making the mucosal pressure plate is:

[0040] In the area of ​​the reconstructed jaw transplant bone segment, a lip / cheek-tongue baffle was made of silicone rubber to block the buccal and lingual soft tissues and obtain a stable occlusal relationship. After the patient wore the lip / cheek-tongue baffle, cone beam computed tomography (CBCT) was performed to obtain the data of the reconstructed jaw, implants, and soft tissues. Alginate was used to take a mold, a plaster model was made, and a bite record was obtained at the same time.

[0041] The plaster model was scanned with a dental optical scanner (3shape, USA) to obtain the plaster optical model data. The CBCT hard tissue and implant models were reconstructed using oral implant design software (Six Dimensions Medical, China). The models were matched with the plaster optical model data to obtain a 3D digital model and position information with implants, vestibular grooves, soft tissues, bone tissues, and high-precision dentition information in a unified three-dimensional coordinate system. The 3D digital model was Figure 2 As shown;

[0042] The ideal shape of the mucosa on the surface of the bone segment in the implant area is simulated on the 3D digital model, and the mucosal pressure plate (such as Figure 3 A) in the figure follows the following principles: ① Within the physiological range, the thickness of the space between the mucosal pressure plate and the alveolar ridge is adjusted to 3.5 mm; ② The tissue surface of the mucosal pressure plate should refer to the volume, height and surface irregularity of the transplanted bone segment in the reconstructed mandible; ③ The extension of the edge of the mucosal pressure plate should take into account the shrinkage of FGG after transplantation, which is between 37% and 70%, that is, the edge of the mucosal pressure plate should be extended at least 6 mm outside the buccal part of the implant neck edge. For patients who have not removed the titanium plate, the edge should be designed to be located at the mucosal turning point as deep as possible from the upper edge of the reconstructed titanium plate; ④ Finally, along the long axis of the implant, the guide post hole (such as Figure 3 in BP).

[0043] Continue to see Figure 1 , explain the technical abbreviations appearing in this application:

[0044] CBCT: Cone beam Computer Tomography Oral and maxillofacial cone beam CT is a medical imaging technique consisting of X-ray computed tomography, in which the X-rays diverge to form a cone. CBCT is becoming increasingly important in treatment planning and diagnosis in the fields of oral implantology, otolaryngology, orthopedics and interventional radiology (IR). CBCT now has many uses in the dental field, such as oral surgery, endodontics and orthodontics.

[0045] FGG: Free gingival graft, which uses a free autologous healthy gingival flap to be transplanted onto the periosteum wound surface after vestibule groove plasty and fixed to the surrounding tissue to achieve the purpose of widening the keratinized mucosa and deepening the vestibule groove.

[0046] CAD / CAM: computer-aided design & computer-aided manufacturing Computer-aided design (CAD) and computer-aided manufacturing (CAM) is a process in which non-digital data is captured, converted to a digital format, edited as needed, and then converted back into a physical form with the exact dimensions and materials specified in the digital design process, usually through 3D printing or milling. CAD / CAM is used for the design and fabrication of dental restorations, including crowns, crown-to-veneers, veneers, inlays and onlays, fixed bridges, implant-supported restorations, removable dentures, and orthodontic appliances. CAD / CAM technology can provide patients with dentures that fit well, are aesthetically pleasing, and are durable.

[0047] Continue to see Figure 3The design requirements of the ideal mucosal pressure plate in the 3D digital model are shown in (A); the vestibular groove depth in the original state of the mucosa in the 3D digital model is shown in (B red five-pointed star) and the ideal vestibular groove depth is shown in (C yellow five-pointed star). The vestibular groove depression depths of implants No. 1, 2, and 3 are 6.4mm (G), 4.9mm (K), and 5.1mm (O), respectively; the mucosal pressure plate and implant coronal structure are inversely designed according to the ideal mucosal state (C, F, J, N) (D, H, L, P).

[0048] Continue to see Figure 1 As a mucosal pressure plate fixing device, the implant-supported transitional restoration is designed to meet the following requirements: ① The neck of the restoration should fit the implant abutment; ② The shape of the neck of the restoration should be consistent with the position of the hole of the mucosal pressure plate to ensure that the fixed position of the pressure plate is relatively stable; ③ The restoration should not hinder the normal occlusal movement relationship.

[0049] Continue to see Figure 1 The transitional restoration is made of polymethyl methacrylate (PMMA) through CAM cutting, and the mucosal pressure plate is made of transparent resin material through 3D printing technology. Both are pre-installed and adjusted extraorally on the working model to detect the match between the temporary tooth and the pressure plate and the fit between the pressure plate and the working model surface, eliminate interference, and polish the edge of the pressure plate to make it round and blunt.

[0050] Continue to see Figure 1 The present application establishes a 3D digital model and position information of implants, vestibule grooves, soft tissues, bone tissues and high-precision dentition information in a unified three-dimensional coordinate system through CBCT data and 3Dshape model scanning, thereby realizing the close fit of the mucosal pressure plate and autologous tissues such as free gingiva in the precisely designed lower jaw, achieving appropriate pressure on the favorable gingiva in the implanted area, and greatly promoting the rapid healing between the transplant flap and the implant bed; since the combination of an implant-supported transitional restoration and a mucosal pressure plate is adopted, the effect of shortening the patient's toothless time and restoring the patient's oral and maxillofacial function at an early stage is achieved; since the implant-supported transitional restoration can be removed after the mucosal pressure plate fixation time is reached, and can continue to be used in the oral cavity to perform the occlusal function through retention methods such as screws or adhesive retention, the goal of reducing related treatment costs and improving treatment efficiency is achieved.

[0051] Continue to see Figure 1If the synchronous digital design of the transitional restoration cannot be achieved during the preoperative design process and the transitional restoration is completed before the operation, a phased treatment plan can be adopted. During the mucosal transplantation operation, only the mucosal pressure plate is inserted during the operation. After the healing of the transplanted mucosa is stable, the transitional restoration is made in the second phase. This plan can effectively reduce the cost and time of the initial design and production, perform peri-implant soft tissue augmentation surgery at an early stage, and make the restoration according to the patient's recovery after the soft tissue augmentation surgery, retaining the flexibility of adjustment according to the treatment response.

[0052] Continue to see Figure 1 , this application has the following technical key points:

[0053] 1) Modular design: Through precise design using digital technology, the implant-supported transitional restoration and the mucosal pressure plate are designed as a whole that can be combined through a specific connection mechanism, and can be modularly split for flexible split applications, which can simultaneously achieve the widening of the soft tissue around the implant and the restoration of the occlusal relationship;

[0054] 2) Rapid healing and reduced shrinkage of free gingival grafts: The digitally precisely designed mucosal pressure plate fits tightly with the free gingival flap and applies appropriate pressure to the implant bed, promoting rapid healing of the mucosa and reducing the shrinkage rate of the gingival flap;

[0055] 3) Immediate occlusal restoration: The design of this application allows the occlusal relationship to be restored at the same time as the gum graft, which not only speeds up the treatment process, but also significantly improves the patient's comfort and satisfaction;

[0056] 4) Simplified operation and high efficiency: By integrating the mucosal pressure plate and transitional restoration into one system, the complex production and installation steps in traditional treatment are simplified, the efficiency and accuracy of the operation are improved, and the transitional denture can continue to be used after the mucosal pressure plate is removed, reducing the economic cost for patients.

[0057] In the description of the present application, the description with reference to the terms "one embodiment", "some embodiments", "in the present embodiment", "specific example", or "some examples" etc. means that the specific features, mechanisms, materials or characteristics described in conjunction with the embodiment or example are included in at least one embodiment or example of the present application. In this specification, the schematic representations of the above terms do not necessarily refer to the same embodiment or example. Moreover, the specific features, mechanisms, materials or characteristics described may be combined in a suitable manner in any one or more embodiments or examples. In addition, those skilled in the art may combine and combine the different embodiments or examples described in this specification and the features of the different embodiments or examples, without contradiction.

[0058] The above is only a specific implementation of the present application, but the protection scope of the present application is not limited thereto. Any changes or substitutions that can be easily thought of by a person skilled in the art within the technical scope disclosed in the present application should be included in the protection scope of the present application. Therefore, the protection scope of the present application shall be based on the protection scope of the claims.

Claims

1. A method for preparing an integrated implant-supported transitional restoration and a mucosal pressure plate, characterized in that: The following steps are involved: Step S1, using silicone rubber to prepare a lip or buccal-lingual baffle in the patient's reconstructed jaw transplant bone segment area to block the patient's buccal and lingual soft tissues and obtain a stable occlusal relationship; Step S2, after the patient wears the lip or cheek-tongue baffle, using cone beam computed tomography (CBCT) to obtain data of reconstructed jaws, implants, and soft tissues, and based on the data, using alginate to make a plaster model, and obtaining a bite record at the same time; Step S3, scanning the plaster model to obtain plaster optical model data, reconstructing the CBCT hard tissue and implant model through oral implant design software, matching it with the plaster optical model data, and obtaining a 3D digital model and position information with implant, vestibular groove, soft tissue, bone tissue and high-precision dentition information in a unified three-dimensional coordinate system; Step S4, based on the position information, simulate the ideal shape of the mucosa on the surface of the bone segment in the implant area on the 3D digital model, and prepare a mucosal pressure plate to be integrated with the patient's implant-supported transitional restoration.

2. The integrated preparation method according to claim 1, characterized in that: The step S1 needs to be performed at least 6 months after the implant is implanted in the patient and after it is confirmed through clinical and imaging evaluation that the implant has formed bone integration in the patient's fibula segment.

3. The integrated preparation method according to claim 1, characterized in that: In step S4, the spatial distance between the mucosal pressure plate and the alveolar ridge of the patient is 3.5 mm.

4. The integrated preparation method according to claim 1, characterized in that: In step S4, when preparing the mucosal pressure plate, the volume, height and surface irregularity of the transplanted bone segment in the patient's reconstructed mandibular bone are taken into consideration.

5. The integrated preparation method according to claim 1, characterized in that: In step S4, when the edge of the mucosal pressure plate is extended, it is extended to at least 6 mm outside the cheek of the implant neck edge.

6. The integrated preparation method according to claim 1, characterized in that: In step S4, the hole position and shape of the mucosal pressure plate are consistent with the neck shape of the implant-supported transitional restoration.

7. The integrated preparation method according to claim 1, characterized in that: In the step S4, the mucosal pressure plate is made of transparent resin material through a 3D printing process.

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