Transosseous bone plate for reconstruction of fibula flap and dental implants

Abstract

A mandibular reconstruction and dental implant system includes: a first reconstruction template comprising: a body; a first cutting guide and a second cutting guide; a first mandibular basal plate groove template disposed along the body, the first mandibular basal plate groove template being configured to receive an opening therein for a drill; a first bone fastener template disposed along the body, the first bone fastener template being configured to receive the opening therein for the drill; and a first implant template disposed along the body and aligned with the first mandibular basal plate groove template, the first implant template being configured to receive the opening therein for the drill, an axis passing through the first implant template being orthogonal to an axis passing through the first mandibular basal plate groove template; and a reconstruction plate comprising a main support and a first mandibular basal plate projecting orthogonally from the main support, the first mandibular basal plate including an orifice.

Description

[0001] Cross-references to related applications

[0002] This application claims priority to U.S. Application No. 18 / 748,828, filed June 20, 2024, and U.S. Provisional Application No. 63 / 556,156, filed February 21, 2024, the entire contents of each of which are incorporated herein by reference for all purposes. Background of the Invention Technical Field

[0003] This disclosure relates to a custom bone cutting template and reconstruction bone plate for mandibular reconstruction using donor bone with integrated dental implant support. Background Technology

[0004] Some dental implants use root-like analogues to replace missing teeth. These analogues include titanium devices shaped like bone screws, which are surgically inserted into the alveolar structure. A specialized platform protrudes from the top of the alveolar bone to accommodate the dental prosthesis. After the drill is prepared with an osteotomy of appropriate diameter and length to receive the bone screw portion of the dental implant, the implant is screwed into the top of the alveolar bone.

[0005] The foregoing description is intended to generally present the context of this disclosure. The inventors do not expressly or implicitly acknowledge that the work described in the Background section, or any aspects of the description that may not have been qualified as prior art at the time of filing, is prior art relative to this disclosure. Summary of the Invention

[0006] The foregoing paragraphs have been provided by way of general introduction and are not intended to limit the scope of the following claims. The described embodiments and other advantages will be best understood by referring to the following detailed description taken in conjunction with the accompanying drawings.

[0007] In one embodiment, this disclosure relates to a mandibular reconstruction and dental implant system comprising: a first reconstruction template including: a body; a first cutting guide and a second cutting guide disposed at a first edge of the body and at a second edge of the body; a first plantar bone plate groove template disposed along the body and configured to receive an opening therein for a drill; a first bone fastener template disposed along the body and configured to receive the opening therein for the drill; and a first implant template disposed along the body and aligned with the first plantar bone plate groove template, the first implant template being configured to receive the opening therein for the drill, an axis passing through the first implant template being orthogonal to an axis passing through the first plantar bone plate groove template; and a reconstruction bone plate including a main support and a first plantar bone plate projecting orthogonally from the main support, the first plantar bone plate including an orifice.

[0008] In one embodiment, this disclosure additionally relates to a method of reconstructing a mandible, comprising obtaining an image of the mandible including teeth for resection of vestigial portions; attaching a reconstruction template to a donor bone, the reconstruction template comprising: a body; a first cutting guide and a second cutting guide, the first cutting guide being disposed at a first edge of the body and the second cutting guide being disposed at a second edge of the body; a first mandibular basal plate groove template disposed along the body, the first mandibular basal plate groove template being configured to receive an opening therein for a drill; a first bone fastener template disposed along the body, the first bone fastener template being configured to receive an opening therein for the drill; and a first implant template disposed along the body and aligned with the first mandibular basal plate groove template, the first implant template being configured to receive an opening therein for a drill. An opening for receiving a drill bit is created therein, the axis of which passes through the first implant template orthogonal to the axis of which passes through the first mandibular base plate groove template; the opening is formed in the donor bone using the first mandibular base plate groove template, the first bone fastener template, and the first implant template; the donor bone is cut along the first cutting guide and the second cutting guide to generate a first bone segment; a reconstructed bone plate is attached to the first bone segment via the opening corresponding to the first mandibular base plate groove template, the reconstructed bone plate including a main support and a first mandibular base plate orthogonally projecting from the main support, the first mandibular base plate including an orifice; the reconstructed bone plate having the attached first bone segment is attached to the mandible; and a dental implant is attached to the first mandibular base plate via the opening formed corresponding to the implant template through the attached first bone segment. Attached Figure Description

[0009] A more complete understanding of this disclosure and its many accompanying advantages will be readily obtained, and it will be better understood when considered in conjunction with the accompanying drawings by referring to the following detailed description, in which:

[0010] Figure 1 A schematic diagram of a reconstruction template according to an embodiment of this disclosure is shown.

[0011] Figure 2 A schematic diagram of a reconstruction template attached to bone during clinical surgery according to an embodiment of the present disclosure is shown.

[0012] Figure 3A A schematic diagram of a reconstruction template attached to the fibula, having a view along the top, is shown according to an embodiment of the present disclosure.

[0013] Figure 3B A schematic diagram of a bone segment formed using a reconstruction template 900 according to an embodiment of the present disclosure is shown.

[0014] Figure 3C A schematic diagram of a reconstructed bone plate (also known as a bone plate) according to an embodiment of the present disclosure is shown.

[0015] Figure 3D A schematic diagram of a transalveolar implant (TDI) system comprising a dental post having a threaded apex therein, according to an embodiment of the present disclosure, is shown.

[0016] Figure 4A The illustration shows a mandibular basal plate inserted into a bone groove and fixed using a locating pin, according to an embodiment of the present disclosure.

[0017] Figure 4B A schematic diagram of a positioning pin fixed to the mandibular basal plate according to an embodiment of the present disclosure is shown.

[0018] Figure 4C A schematic diagram of a first bone segment attached to a reconstructed bone plate 999 according to an embodiment of the present disclosure is shown.

[0019] Figure 4D A schematic diagram of a dental implant mounted in bone fragments according to an embodiment of the present disclosure is shown.

[0020] Figure 4E A schematic diagram of a bone template 900 with removable parts according to an embodiment of the present disclosure is shown.

[0021] Figure 5 A schematic diagram of a reconstructed mandible according to an embodiment of the present disclosure is shown.

[0022] Figure 6A A schematic cross-sectional view of plane A according to an embodiment of the present disclosure is shown.

[0023] Figure 6B A schematic cross-sectional view of plane B according to an embodiment of the present disclosure is shown. Detailed Implementation

[0024] As used herein, the term “a” is defined as one or more. As used herein, the term “multiple” is defined as two or more. As used herein, the term “another” is defined as at least a second or greater. As used herein, the terms “comprising” and / or “having” are defined as encompassing (i.e., open language). Throughout this document, references to “an embodiment,” “certain embodiments,” “implementation,” “specific embodiment,” “example,” or similar terms mean that a particular feature, structure, or characteristic described in connection with that embodiment is included in at least one embodiment of this disclosure. Therefore, such phrases appearing throughout the specification do not necessarily refer to the same embodiment. Furthermore, specific features, structures, or characteristics may be combined in any suitable manner without limitation in one or more embodiments.

[0025] Mandibular resection is a surgical procedure that removes all or part of the jaw (mandible). It can be performed to remove tumors, lesions, and / or necrosis affecting the jaw. Notably, bone from another part of the body or a donor site can be used to reconstruct or replace the removed portion of the jaw. For example, the donor site can be a segment of the fibula, along with surrounding muscles, soft tissues, skin, veins, and arteries, also known as a free fibular flap.

[0026] In surgical procedures involving the removal and reconstruction of a portion of the mandible, a segment of the fibula may be cut into multiple pieces and adjusted to fit the removed portion of the mandible. This piece is then attached to a supporting structure, which is fixed to the remaining mandibular stump located on the side of the removed portion. However, the process of aligning, stabilizing, and attaching the fibular segment to the supporting structure can often be cumbersome, inconsistent, and time-consuming.

[0027] In addition, after mandibular reconstruction, patients often opt for another procedure to place dental implants along the reconstructed area. This may require additional invasive work and another recovery period for the patient. This can also be a significant expense for patients, as usually only mandibular reconstruction is covered by health insurance, while implant surgery itself incurs costs.

[0028] Therefore, this paper describes an apparatus, system, and method for a custom transosseous reconstruction plate for use with a free fibular flap and dental implant reconstruction after mandibular resection.

[0029] In one embodiment, the profile of the bone plate can be configured to align and fix the fibular segment to reconstruct the mandibular defect. The bone plate can be formed via additive manufacturing, for example, using a material such as titanium. The bone plate may include a mandibular basal bone plate feature with a width and length of approximately 8 mm × 8 mm and a thickness of 2 mm, and may project horizontally from the inner surface of the bone plate and insert into an osteotomy groove precisely formed in the fibular segment to facilitate segment alignment. The mandibular basal bone plate may include an orifice, such as a threaded orifice with a diameter of 2.5 mm, and this orifice is oriented to align with a planned dental implant osteotomy on the top of the fibula for reconstructing the fibular mandible with a dental implant to support the dental prosthesis and thereby immediately restore function.

[0030] The drilling guide device can be used for alignment and drilling of dental implant osteotomy. After osteotomy, a post with a threaded apex feature can be screwed into the fibula-mandible and locked into the mandibular basal plate feature of the bone plate. The dental implant can be inserted through the orifice and locked into the mandibular basal plate, further fixing the fibular segment and providing a dental implant platform for immediate functional dental prosthesis reconstruction.

[0031] to this end, Figure 1 A schematic diagram of a reconstruction template 900 according to an embodiment of the present disclosure is shown. In one embodiment, the reconstruction template 900 includes a first template segment 901, a second template segment 902, and a third template segment 903, but may also include any number of template segments, such as only the first template segment 901. When the reconstruction template 900 includes more than one template segment, the template segments can be connected by a template segment connector 925. As shown, the template segment connector 925 can connect the first template segment 901, the second template segment 902, and the third template segment 903 together. The first template segment 901, the second template segment 902, and the third template segment 903 may each be configured to reversibly attach to a portion of bone (such as a fibular segment) and provide assistance for guiding the cutting, drilling, and adjustment of the bone to which the reconstruction template 900 is attached. For example, the first template segment 901 may include a mandibular base plate bone groove template 905, a bone fastener template 910, an implant template 915, and a cutting guide 920. In one embodiment, the first template segment 901, the second template segment 902, and the third template segment 903 may each be generally cylindrical in shape and hollow to receive bone. As shown, the first template segment 901, the second template segment 902, and the third template segment 903 may include an axial or cylindrical body with flared edges (described below). Of course, based on the obtained medical image of the target bone to which the reconstruction template 900 will be attached, the shapes of the first template segment 901, the second template segment 902, and the third template segment 903 may be customized to better fit the target bone in the medical image.

[0032] In one embodiment, the material of the reconstruction template 900 is reversibly deformable (elastic), and the shapes of the first template segment 901, the second template segment 902, and the third template segment 903 may be C-shaped to allow the C-shape to deform or open when pushed onto the bone, and then deform back or close onto the bone to secure the reconstruction template 900 to the bone. The described shape may be a cross-sectional shape taken orthogonal to the axis of the bone (or a hollow portion of the reconstruction template 900 when the bone is not positioned therein). In one embodiment, the material of the reconstruction template 900 is rigid, and the first template segment 901, the second template segment 902, and the third template segment 903 may comprise multiple sections, each of which can open, be arranged on the bone, and then close and reversibly remain in a closed state until the bone is successfully cut, drilled, or otherwise adjusted. For example, each of the first template segment 901, the second template segment 902, and the third template segment 903 may include two halves (a split C-shape, or two hemispheres for a completely circular closed shape), which are fixed to each other by a push-fit lock, twist lock, fastener, clamp, etc.

[0033] For example, each of the first template segment 901, the second template segment 902, and the third template segment 903 may include two halves, and the first half of the two halves may include a first magnet configured to attract a second complementary magnet in the second half of the two halves to reversibly couple the first half to the second half. The first magnet and the second complementary magnet may have sufficient magnetic strength when coupled to maintain the first template segment 901 (or any other template segment) closed around any bone segment disposed therein during surgery for bone segment repositioning. In one embodiment, the first magnet and / or the second complementary magnet may be electromagnets and configured to generate a magnetic field in response to an electric current. In this example, the reconstruction template 900 may include a power supply, circuitry, and switches (not shown) for each template segment to switch the electromagnet between an on or off state, thereby coupling or decoupling the two halves by adjusting the current flowing to the electromagnet.

[0034] In one implementation, the first template segment 901, the second template segment 902, and the third template segment 903 may be semi-circular or smaller in shape, and the reconstruction template 900 may be held in place by the operator against the bone.

[0035] In one embodiment, the mandibular basal plate groove template 905 may be an opening in the first template segment 901. The shape of the opening may have a cross-sectional shape that can be designed to receive corresponding features having similar or complementary cross-sectional shapes. As shown, the cross-sectional shape of the mandibular basal plate groove template 905 may be rectangular, and the mandibular basal plate groove template 905 may be configured to receive corresponding features with complementary rectangular cross-sectional shapes inserted therein. For example, as will be described herein, the mandibular basal plate groove template 905 may be configured to receive the mandibular basal plate. The cross-sectional shape may be selected to ensure a specific orientation of the corresponding feature inserted therein, such as a unique shape or a shape that does not have rotational symmetry. Thus, the mandibular basal plate groove template 905 may be configured to receive instruments or tools therein when attached to the bone for cutting, drilling, or otherwise adjusting the bone via the opening that serves as the mandibular basal plate groove template 905. Although the first template segment 901 is shown as having two mandibular basal plate bone groove templates 905, the first template segment 901 may have any number n mandibular basal plate bone groove templates 905, such as only one mandibular basal plate bone groove template 905, three mandibular basal plate bone groove templates 905, etc.

[0036] In one embodiment, the bone fastener template 910 may be an opening in the first template segment 901. The opening may have a cross-sectional shape designed to receive corresponding features having similar or complementary cross-sectional shapes. As shown, the cross-sectional shape of the bone fastener template 910 may be circular, and the bone fastener template 910 may be configured to receive corresponding features with complementary circular cross-sectional shapes inserted therein. For example, as will be described herein, the bone fastener template 910 may be configured to receive fasteners, such as bone screws. Thus, the bone fastener template 910 may be configured to receive instruments or tools therein when attached to bone to cut, drill, or otherwise adjust bone via the opening serving as the bone fastener template 910. For example, the bone fastener template 910 may receive a drill bit that can remove material from the bone to provide a guide hole for a bone screw. Although the first template segment 901 is shown as having two bone fastener templates 910, the first template segment 901 may have any number n of bone fastener templates 910, such as only one bone fastener template 910, three bone fastener templates 910, etc. As shown, the mandibular basal plate bone groove template 905 and the bone fastener template 910 are arranged on the first template segment 901 relatively proximally along the same line. The mandibular basal plate bone groove template 905 and the bone fastener template 910 can be aligned with the same rotation angle regarding the axis through the length of the bone. It is understood that the arrangement of the mandibular basal plate bone groove template 905 and the bone fastener template 910 does not need to be aligned and can be at different rotation angles relative to each other.

[0037] In one embodiment, the implant template 915 may be an opening in the first template segment 901. The opening may have a cross-sectional shape designed to receive corresponding features having similar or complementary cross-sectional shapes. As shown, the cross-sectional shape of the implant template 915 may be circular, and the implant template 915 may be configured to receive corresponding features with complementary circular cross-sectional shapes inserted therein. For example, as will be described herein, the implant template 915 may be configured to receive a dental implant post. Thus, the implant template 915 may be configured to receive instruments or tools therein when attached to bone to cut, drill, or otherwise adjust the bone via the opening serving as the implant template 915. For example, the implant template 915 may receive a drill bit that can remove material from the bone to provide a guide hole in the mandibular abutment bone plate groove template 905 for insertion of the dental implant post and connection to the mandibular abutment bone plate. Although the first template segment 901 is shown as having two implant templates 915, the first template segment 901 may have any number n of implant templates 915, such as only one implant template 915, three implant templates 915, etc. As shown, the arrangement of the implant templates 915 can be orthogonally rotated with the mandibular basal plate bone groove template 905. That is, the bone fastener template 910 and the implant template 915 can be arranged orthogonally rotated with respect to the axis passing through the length of the bone. It is understood that the arrangement of the mandibular basal plate bone groove template 905 and the implant template 915 does not need to be in any specific alignment or orthogonality, and can be rotated at different angles to each other.

[0038] In one embodiment, although the mandibular basal plate groove template 905, the bone fastener template 910, and the implant template 915 are shown as openings with a thickness equal to the thickness of the axis forming the body of the first template segment 901, the second template segment 902, and the third template segment 903, the mandibular basal plate groove template 905, the bone fastener template 910, and the implant template 915 may be protrusions or extrusion features with substantially greater thickness (and hollowed out at both ends of the opening) to further aid in guiding the drill bit inserted therein. This ensures the desired drilling angle relative to the axial arrangement of the first template segment 901, the second template segment 902, and the third template segment 903. For example, the axis through the extrusion opening may be orthogonal to the axis through the bone and to a plane tangent to the location of the opening (mandibular basal plate groove template 905, bone fastener template 910, or implant template 915).

[0039] In one embodiment, the cutting guide 920 may be a flared edge of a first template segment 901 having a plane. The plane may be configured to facilitate guiding an instrument or tool to cut the bone. For example, a blade may press against the cutting guide 920 on one side of the bone to which the reconstruction template 900 is attached, and then translate to cut through the bone while pressing against the cutting guide 920, resulting in a planar cut. As shown, the cutting guide 920 along the left edge of the first template segment 901 may be orthogonal to the axis of the bone (or the axis of the cylindrical shape of the first template segment 901), while the cutting guide 920 along the right edge of the first template segment 901 may have a predetermined angle. Therefore, the resulting planes of the cut bone edges do not need to be parallel to each other. This helps in the final fit of the cut bone segments when they are arranged together in the mandible to form any desired curve. In one embodiment, the angle may be customized based on a medical image of the mandible obtained. When multiple bone fragments are needed to reconstruct the mandible, multiple angled cutting guides 920 can be customized for each template segment in the template segment, such as for forming curved mandibular portions.

[0040] Figure 2 A schematic diagram of a reconstruction template 900 attached to bone during clinical surgery according to an embodiment of the present disclosure is shown. In one embodiment, a segment of the patient's fibula (or, for simplicity, also referred to as the "fibula") can be used as a donor site for the bone required to reconstruct the patient's mandible. Thus, as shown, the patient's leg can be cut open to expose the fibula, and the reconstruction template 900 can be applied to or attached to the fibula.

[0041] Figure 3A A schematic diagram of a reconstruction template 900 attached to the fibula, having a top view, is shown according to an embodiment of the present disclosure. In one embodiment, fibular bone segments can be cut via the reconstruction template 900 for each template segment, and each of the mandibular abdominus bone plate groove template 905, bone fastener template 910, and implant template 915 can be used to drill or adjust the corresponding bone segment. Here, a perspective view of the implant template 915 is shown to illustrate the connection from the implant template 915 to the mandibular abdominus bone plate groove template 905 when the bone has been drilled, wherein the final mandibular abdominus bone plate can be inserted into the bone segment via the mandibular abdominus bone plate groove template 905, and the dental implant can be inserted and connected to the mandibular abdominus bone plate via the implant template 915.

[0042] Figure 3BA schematic diagram of a bone segment formed using a reconstruction template 900 according to an embodiment of the present disclosure is shown. In one embodiment, the reconstruction template 900 can be used to generate a first bone segment 901a, a second bone segment 902a, and a third bone segment 903a. Each of the first bone segment 901a, the second bone segment 902a, and the third bone segment 903a may include a mandibular abdominus bone plate groove 905a, a bone attachment opening 910a, and a dental implant opening 915a. As shown, two mandibular abdominus bone plate groove templates 905 can be used to form corresponding two mandibular abdominus bone plate grooves in the mandibular abdominus bone plate grooves 905a, three bone fastener templates 910 can be used to form corresponding three bone attachment openings in the bone attachment openings 910a, and two implant templates 915 can be used to form corresponding two dental implant openings in the dental implant openings 915a. Based on Figure 1 and Figure 2 The angled cutting guide 920 of the reconstruction template 900 shown includes a first bone segment 901a with an angled incision along its right side, a second bone segment 902a with angled incisions along both its left and right sides, and a third bone segment 903a with an angled incision along its left side. Furthermore, the dental implant opening 915a formed via the implant template 915 is shown traversing the bone segment to meet the mandibular abdominus bone plate groove 905a, which can be configured to receive the mandibular abdominus bone plate.

[0043] to this end, Figure 3C A schematic diagram of a reconstructed bone plate 999 (also referred to as a bone plate) according to an embodiment of the present disclosure is shown. In one embodiment, the reconstructed bone plate 999 may be a support structure configured to connect with a first bone segment 901a, a second bone segment 902a, and a third bone segment 903a. The reconstructed bone plate 999 may have a shape based on the removed portion of the mandible. Figure 3C As shown, the reconstructed bone plate 999 may include a main support 930, and the main support 930 may be curved. The reconstructed bone plate 999 may be formed by, for example, additive manufacturing, molding, stamping, and CNC machining. The reconstructed bone plate 999 may include a mandibular basal bone plate 935 or multiple mandibular basal bone plates 935, and the mandibular basal bone plate 935 may include an aperture 940. The mandibular basal bone plate 935 may be a projection from the main support 930 and has a rectangular shape or any complementary shape for insertion into a mandibular basal bone plate groove 905a. The mandibular basal bone plate 935 may be single or multiple for attachment to bone fragments. Figure 3CThe reconstructed bone plate 999 shown can be coupled to a bone fragment having two mandibular basal plates 935 connected to a bone fragment having two mandibular basal plate grooves 905a, or to a single mandibular basal plate 935 connected to a bone fragment having only one mandibular basal plate groove 905a. The length of the mandibular basal plate 935 can be, for example, 2 mm to 20 mm, or 4 mm to 15 mm, or 6 mm to 10 mm, or approximately 8 mm. The width of the mandibular basal plate 935 can be, for example, 2 mm to 20 mm, or 4 mm to 15 mm, or 6 mm to 10 mm, or approximately 8 mm. The thickness of the mandibular basal plate 935 can be, for example, 0.5 mm to 5 mm, or 1 mm to 4 mm, or approximately 2 mm. The diameter of the orifice 940 can be, for example, 1 mm to 5 mm, or 2 mm to 4 mm, or approximately 2.5 mm.

[0044] Figure 3D A schematic diagram of a transalveolar implant (TDI) system according to an embodiment of the present disclosure is shown, comprising a post having a threaded apex engaging therein. In one embodiment, the TDI system may include a TDI post 212 having a threaded apex for in-situ frictional locking into a corresponding threaded orifice of a previously positioned and attached TDI bone plate 205. In one embodiment, the TDI bone plate 205 may include two portions: a first portion 242 may be a planar portion 242, and a second portion 244 may be a wavy portion 244. Notably, the planar portion 242 may resemble a mandibular basal plate 935, including an orifice 940 resembling an orifice 940 of the mandibular basal plate 935. Similarly, the TDI post 212, mounted in the orifice of the planar portion 242, may be mounted in the orifice 940.

[0045] In a clinical setting, attaching bone fragments to a reconstruction plate 999 via the mandibular basal plate 935 may be easier than attaching bone fragments to a reconstruction plate lacking the mandibular basal plate 935. That is, once a bone fragment, such as a first bone segment 901a with two mandibular basal plate grooves 905a, has been cut from the donor bone, the first bone segment 901a can be easily attached to the reconstruction plate 999 by inserting the mandibular basal plate 935 into the mandibular basal plate grooves 905a. Once attached, the range of motion of the first bone segment 901a can be significantly reduced, thus preventing slippage of the first bone segment 901a relative to the reconstruction plate 999. As previously mentioned, this part of the reconstruction process represents one of the most cumbersome, inconsistent, and time-consuming steps, as the operator typically attempts to stabilize the bone fragment by hand while simultaneously trying to attach it to the reconstruction plate, as fasteners need to be inserted into the reconstruction plate at right angles. Furthermore, mishandling of the bone fragment is amplified by fluids (such as blood) around the donor site and on the bone fragment. Therefore, the insertion of the mandibular basal plate 935 into the mandibular basal plate groove 905a restricts all ranges of motion except for one range of motion, which can be further restricted by applying temporary fasteners.

[0046] to this end, Figure 4A A mandibular abdominus plate 935, inserted into a bone groove 905a and secured using a locating pin 945, is shown according to an embodiment of the present disclosure. In one embodiment, the shaft of the locating pin 945 is insertable and passes through a dental implant opening 915a, and the tip of the locating pin 945 is engageable with an orifice 940 of the mandibular abdominus plate 935.

[0047] Figure 4B A schematic diagram of a locating pin 945 fixed to a mandibular basal plate 935 according to an embodiment of the present disclosure is shown. In one embodiment, when the locating pin 945 is engaged with the mandibular basal plate 935, a first bone segment 901a can be fixed to a reconstructed bone plate 999, and all ranges of motion of the first bone segment 901a can be restricted. For example, the tip of the locating pin 945 may be threaded, and the orifice 940 may have complementary threads. For example, the tip of the locating pin 945 may be push-fitted into the orifice 940, which has a size, shape, or dimension configured to fix the tip of the locating pin 945 in the orifice 940. For example, the tip of the locating pin 945 may be twist-fitted into the orifice 940, which has a size, shape, or dimension configured to fix the tip of the locating pin 945 in the orifice 940. For example, the tip of the locating pin 945 may be substantially friction-fitted into the orifice 940. For example, the tip of the locating pin 945 may be magnetic, and the aperture 940 may include a complementary magnet configured to attract the magnetic tip of the locating pin 945.

[0048] Figure 4CA schematic diagram of a first bone segment 901a attached to a reconstruction plate 999 according to an embodiment of the present disclosure is shown. In one embodiment, the first bone segment 901a (or the second bone segment 902a or the third bone segment 903a) may be connected to the reconstruction plate 999 as previously described by inserting a mandibular abdominus bone plate 935 into a mandibular abdominus bone plate groove 905a, and the first bone segment 901a may be temporarily secured to the reconstruction plate 999 by a locating pin 945 inserted through a dental implant opening 915a and into an aperture 940 of the mandibular abdominus bone plate 935. Once temporarily secured to the reconstruction plate 999, the first bone segment 901a may be secured to the reconstruction plate 999 via a bone attachment opening 910a using fasteners 955 (or a plurality of fasteners 955). The fasteners 955 may be, for example, bone screws. As shown in the figure, the main support 930 of the reconstructed bone plate 999 may include various openings or fastening locations through which fasteners 955 can be inserted and subsequently engaged with the first bone segment 901a. At this point in the procedure, the reconstructed bone plate 999 can be secured to the lateral mandibular stump, and the first bone segment 901a (and any additional bone fragments) can be attached to the reconstructed bone plate 999. The procedure can optionally end with the locating pin 945 in place, or be removed by covering or filling the dental implant opening 915a with alternative features. Additionally or alternatively, the procedure can proceed to implant the dental implant into the dental implant opening 915a.

[0049] to this end, Figure 4DA schematic diagram of a dental implant mounted in a bone fragment according to an embodiment of the present disclosure is shown. In one embodiment, mandibular reconstruction may further include implanting a dental implant 950 in a first bone segment 901a. As previously described, after mandibular reconstruction and full recovery, the patient may opt for another follow-up procedure to place the dental implant along the reconstructed portion. This may require additional invasive work and another separate recovery period for the patient. This can also be costly for the patient, as mandibular reconstruction is typically the only procedure covered by health insurance. Therefore, an implant template 915 may be used to form a dental implant opening 915a through which the dental implant 950 can be inserted and connected to the mandibular abdominal plate 935 via orifice 940 in the same procedure. As shown, the apex of the dental implant 950 may include fastening features. For example, the tip of the dental implant 950 may be threaded, and the orifice 940 may be threaded. For example, the tip of the dental implant 950 may be pushed into an aperture 940, the size, shape, or dimension of which is configured to secure the tip of the dental implant 950 within the aperture 940. Alternatively, the tip of the dental implant 950 may be twisted into an aperture 940, the size, shape, or dimension of which is configured to secure the tip of the dental implant 950 within the aperture 940. For example, the apex of the dental implant 950 may typically be frictionally fitted into the aperture 940. For example, the tip of the dental implant 950 may be magnetic, and the aperture 940 may include a complementary magnet configured to attract the magnetic tip of the dental implant 950. The end of the dental implant 950 opposite the tip may be configured to receive additional dental devices and prostheses, such as replacement teeth. The dental implant 950 does not need to immediately receive additional dental devices and prostheses and can be quickly attached to the dental implant 950 at a later time (without additional invasive surgery).

[0050] In one implementation, bone fragments may be retained in the bone template 900 for easier handling during the attachment of bone segments to the bone plate. For this purpose, Figure 4EA schematic diagram of a bone template 900 with removable parts according to an embodiment of the present disclosure is shown. In one embodiment, for each template segment, the bone template 900 may include one or more separate portions 970 indicated by dashed lines passing through the template segment. For example, as shown, a first template segment 901 includes a first separate portion 970a. The one or more separate portions 970 may be material segments formed as a part of the first template segment 901 and configured to be separate from the first template segment 901. In this example, the first bone fragment 901a may have a mandibular basal plate bone groove template 905 inserted through the first template segment 901 into the mandibular basal plate bone groove 905a while still disposed in the first template segment 901. For example, an operator may hold the template segment connector with one hand and manipulate the first template segment 901 (in which the first bone segment 901a is disposed) with the other hand to insert the mandibular basal plate bone plate 935 through both the mandibular basal plate bone groove template 905a and the mandibular basal plate bone groove 905a. While the mandibular basal plate 935 is fully inserted into the mandibular basal plate groove 905a to prevent unwanted movement of the first bone segment 901a, the first separation portion 970a can be separated and removed from the first template segment 901. For example, the first separation portion 970a may be attached to the first template segment 901 at multiple connectors configured to easily break during surgery to separate the first separation portion 970a from the remainder of the first template segment 901. For example, the operator may use a small drill or saw to cut through the multiple connectors. The bone template 900 may be made of polymer or metal. The bone plate 900 may be manufactured via, for example, additive manufacturing (e.g., 3D printing), injection molding, CNC machining, die casting, or similar methods.

[0051] As shown in the figure, for example, the first edge of the first separating portion 970a may extend through the middle of the mandibular basal plate bone groove template 905a. Therefore, removing the first separating portion 970a allows the first template segment 901 to be released or separated from the mandibular basal plate 935 and the bone plate 999. It is worth noting that when the bone fastener template 910 is aligned with the mandibular basal plate bone groove template 905a, the fastener 955 (described below) can also be partially fastened through the bone fastener template 910 at this stage to further prevent unwanted movement of the first bone segment 901a and to begin attaching the first bone segment 901a to the bone plate 999. Again, since the first edge of the first separating portion 970a extends through the middle of the bone fastener template 910, removing the first separating portion 970a allows the first template segment 901 to be released or separated from the fastener 955 and the bone plate 999. Once the first separated portion 970a is removed, the mandibular basal plate 935 can be fully inserted into the mandibular basal plate groove 905a. At this time, the fastener 955 can also be fully secured to the first bone segment 901a.

[0052] When the first bone segment 901a is not yet secured to the bone plate 999 using fastener 955, a locating pin 945 may be used to temporarily connect the first bone segment 901a to the mandibular abdominus bone plate 935. The locating pin 945 may be inserted through the implant template 915 into the dental implant opening 915a. The first template segment 901 may include a second separation portion 970b, wherein a first edge of the second separation portion 970b extends through the middle of the implant template 915. Therefore, removing the second separation portion 970b allows the first template segment 901 to be released or separated from the locating pin 945, while allowing the locating pin 945 to remain connected to the mandibular abdominus bone plate 935.

[0053] As previously described, the template segment may include two halves (a split C-shape, or two hemispheres for a completely circular closed shape), which are secured to each other via, for example, a push-fit lock, a twist lock, a fastener, a clamp, magnetism, etc. Thus, in a similar manner to the above, the first bone fragment 901a, while still disposed within the first template segment 901, may have a mandibular basal plate 935 inserted into the mandibular basal plate groove 905a via the mandibular basal plate template 905 of the first template segment 901. The two halves can then be separated from each other, the first template segment 901 can be released from the mandibular basal plate 935 (and the bone plate 999), and the mandibular basal plate 935 can be fully inserted into the mandibular basal plate groove 905a. For example, a sufficient force can be used to pull the push-fit lock to unlock it and separate the two halves. For example, a switch can be activated to disconnect the power to the electromagnet that secures the two halves to each other, thereby reducing the attractive force of the electromagnet. Furthermore, a set of adjacent edges of the two halves can extend through the middle of the mandibular basal plate bone groove template 905 of the first template segment 901. Therefore, separating the two halves of the first template segment 901 allows the first template segment 901 to be released or separated from the mandibular basal plate 935 and the bone plate 999.

[0054] In summary, this article describes additional clinical examples. In one implementation, the fibula may be surrounded by a vascular periosteum. Segmentation of the fibula can be performed carefully using a lateral approach to retain as much periosteum as possible attached to the bone. No more than, for example, 50% of the target circumferential area of ​​the periosteum can be detached from the bone. Blood vessels from the muscles can remain attached to the periosteum on the inner surface of the fibula. The cutting guide 920 (C-clamp) of the bone template 900 can partially cover the periosteum on the inner surface to achieve, for example, at least 60% of the clamps positioned or attached to the fibula.

[0055] The bone template 900, and specifically the target template segment, can be stabilized by screws passing through the bone fastener template 910. The fibula can be segmented, and the intersegmental pieces (bone segments 901a, 902a, 903a) can be removed. The intersegmental pieces can then be inserted onto the mandibular basal process (mandibular basal plate 935) of the bone plate 999, and a locating pin 945 can be positioned or inserted through the dental implant opening 915a to lock into the (mandibular basal) opening 940. While this is being performed, portions of the bone template 900 (one or more dissected portions 970) can be peeled off or removed, particularly exposing the bone attachment opening 910a and the mandibular basal plate groove 905a region, which will be positioned against the main support 930 of the bone plate 999.

[0056] The template segment connector 925 of the bone template 900 can be removed as an early step to bring the mating ends of the intersegmental pieces together. Other aspects of the bone template 900 can be removed earlier or later depending on clinical needs to maintain the slippery intersegmental pieces.

[0057] Figure 5 A schematic diagram of a reconstructed mandible according to an embodiment of the present disclosure is shown. In one embodiment, a reconstruction plate 999 may be secured to the lateral mandibular stump via a plurality of fasteners 955 disposed at various locations along a main support 930 of the reconstruction plate 999. A first bone segment 901a and a second bone segment 902a, shown, may be attached to the mandibular basal plate 935 of the reconstruction plate 999 and may also be secured to the reconstruction plate 999 via a plurality of fasteners 955 disposed at various locations along the main support 930 of the reconstruction plate 999 corresponding to bone attachment openings 910a. A dental implant 950 may be inserted through a dental implant opening 915a and connected to an opening 940 of the mandibular basal plate 935. An artery 960 from a free fibular flap is also shown, which may be reattached or reconnected to an existing nearby artery to provide blood supply and a flap free of vasculitis.

[0058] Figure 6A A schematic cross-sectional view of plane A according to an embodiment of the present disclosure is shown. In the embodiment, cross-sectional plane A shows a view orthogonal to the axis of the bone along which the dental implant 950 is connected to the mandibular abdominus bone plate 935 via a dental implant opening 915a through a first bone segment 901a. It is also noteworthy that the apex of the first bone segment 901a is shown planar rather than circular. This planarization can be made as needed based on the dental implant 950 used and the final dental prosthesis installed.

[0059] Figure 6BA schematic cross-sectional view of plane B according to an embodiment of the present disclosure is shown. In one embodiment, cross-sectional plane B shows a view orthogonal to the axis of the bone along which fasteners 955 (shown as bone screws) have been screwed through the reconstructed bone plate 999 and into the first bone segment 901a to secure the main support 930 to the first bone segment 901a.

[0060] Although this specification contains many specific implementation details, these should not be construed as limiting the scope of the claimed protection, but rather as descriptions of features that may be specific to particular implementations.

[0061] Some features described in this specification in the context of independent embodiments may also be implemented in combination in a single embodiment. Conversely, various features described in the context of a single embodiment may also be implemented individually or in any suitable sub-combination in multiple embodiments. Although features may be described above as functioning in certain combinations, and even initially claimed to be so, in some cases, one or more features from the claimed combination may be removed from the combination, and the claimed combination may be for sub-combinations or variations thereof.

[0062] Similarly, although operations are depicted in a specific order in the accompanying drawings, this should not be construed as requiring such operations to be performed in the specific order shown or in sequential order, or requiring all shown operations to achieve the desired result. In some cases, multitasking and parallel processing may be advantageous. Furthermore, the separation of the various system modules and components in the above embodiments should not be construed as requiring such separation in all embodiments, and it should be understood that the described program components and systems can generally be integrated together in a single software product or packaged into multiple software products.

[0063] Specific embodiments of the subject matter have been described. Other embodiments are within the scope of the following claims. For example, the actions recited in the claims can be performed in a different order and still achieve the desired result. As an example, the flow depicted in the drawings does not necessarily require the specific order or sequence shown to achieve the desired result. In some cases, multitasking and parallel processing may be advantageous.

[0064] The embodiments disclosed herein may also be described as shown in parentheses below.

[0065] (1) A mandibular reconstruction and dental implant system comprising: a first reconstruction template including: a body; a first cutting guide and a second cutting guide, the first cutting guide being disposed at a first edge of the body and the second cutting guide being disposed at a second edge of the body; a first mandibular basal plate groove template disposed along the body, the first mandibular basal plate groove template being configured to receive an opening therein for a drill; a first bone fastener template disposed along the body, the first bone fastener template being configured to receive an opening therein for the drill; and a first implant template disposed along the body and aligned with the first mandibular basal plate groove template, the first implant template being configured to receive an opening therein for the drill, an axis passing through the first implant template being orthogonal to an axis passing through the first mandibular basal plate groove template; and a reconstruction plate including a main support and a first mandibular basal plate projecting orthogonally from the main support, the first mandibular basal plate including an orifice.

[0066] (2) The system according to (1), wherein the main support includes at least one opening configured to receive fasteners therein for attaching the main support to an adjacent bone segment.

[0067] (3) The system according to (1) or (2), wherein the orifice includes threads for receiving and frictionally fixing a complementary thread inserted therein.

[0068] (4) The system according to any one of (1) to (3) further includes a positioning pin configured to be inserted through an opening in the bone formed by the dental implant opening and connected to the mandibular abutment plate.

[0069] (5) The system according to any one of (1) to (4) further includes a dental implant configured to be inserted through an opening in the bone formed by the dental implant opening and connected to the mandibular abdominus bone plate.

[0070] (6) The system according to any one of (1) to (5), wherein the angle of the plane of the first cutting guide is based on the obtained medical image.

[0071] (7) The system according to any one of (1) to (6), wherein the angle of the plane of the second cutting guide is based on the obtained medical image.

[0072] (8) The system according to any one of (1) to (7), wherein the cross-sectional shape of the mandibular basal plate bone groove template is rectangular, and the cross-sectional shape of the mandibular basal plate is a rectangular shape complementary to the mandibular basal plate bone groove template.

[0073] (9) The system according to any one of (1) to (8), wherein the cross-sectional shape of the bone template is C-shaped, and the bone template is configured to engage the donor bone via push-in engagement.

[0074] (10) The system according to any one of (1) to (9), wherein the cross-sectional shape of the bone template is a circle with split semicircles, and the bone template is configured to engage the donor bone by opening the bone template and arranging the bone template on the donor bone.

[0075] (11) The system according to any one of (1) to (10) further includes a second reconstruction template, wherein the first reconstruction template and the second reconstruction template are attached to each other via a template segment connector.

[0076] (12) The system according to any one of (1) to (11), wherein the arrangement of the mandibular base plate bone groove template is aligned with the bone fastener template along the length of the body.

[0077] (13) The system according to any one of (1) to (12), wherein the arrangement of the bone fastener template is not aligned with the implant template along the length of the body.

[0078] (14) The system according to any one of (1) to (13), wherein the reconstructed bone plate includes a second mandibular basal plate groove disposed proximal to the first mandibular basal plate groove, and the reconstruction template includes a second mandibular basal plate groove template disposed at a corresponding relative position between the first mandibular basal plate groove and the second mandibular basal plate groove.

[0079] (15) The system according to any one of (1) to (14), wherein the material of the reconstructed bone plate is titanium, and the reconstructed bone plate is formed by additive manufacturing.

[0080] (16) The system according to any one of (1) to (15), wherein a first side of the main support of the reconstruction template is configured to be fixed to a first mandibular stump, and a second side of the main support of the reconstruction template is configured to be fixed to a second mandibular stump.

[0081] (17) A reconstruction template device comprising: a main support; and a first mandibular basal plate orthogonally projecting from the main support, the first mandibular basal plate including an orifice.

[0082] (18) The device according to (17), wherein the main support includes at least one opening configured to receive fasteners therein for attaching the main support to an adjacent bone segment.

[0083] (19) The device according to (17) or (18), wherein the orifice includes threads for receiving and frictionally securing a complementary thread inserted therein.

[0084] (20) The apparatus according to any one of (17) to (19), wherein a first side of the main support of the reconstruction template is configured to be fixed to a first mandibular stump, and a second side of the main support of the reconstruction template is configured to be fixed to a second mandibular stump.

[0085] (21) A method for reconstructing a mandible, comprising obtaining an image of teeth in the mandible including vestigial portions for resection; attaching a reconstruction template to a donor bone, the reconstruction template comprising: a body; a first cutting guide and a second cutting guide, the first cutting guide being disposed at a first edge of the body and the second cutting guide being disposed at a second edge of the body; a first mandibular basal plate groove template disposed along the body, the first mandibular basal plate groove template being configured to receive an opening therein for a drill; a first bone fastener template disposed along the body, the first bone fastener template being configured to receive an opening therein for the drill; and a first implant template disposed along the body and aligned with the first mandibular basal plate groove template, the first implant template being configured to receive a drill therein. An opening is formed in the donor bone through an axis orthogonal to the axis passing through the first mandibular abdominus bone plate groove template; the opening is formed in the donor bone using the first mandibular abdominus bone plate groove template, the first bone fastener template, and the first implant template; the donor bone is cut along the first cutting guide and the second cutting guide to generate a first bone segment; a reconstructed bone plate is attached to the first bone segment via the opening corresponding to the first mandibular abdominus bone plate groove template, the reconstructed bone plate including a main framework and a first mandibular abdominus bone plate orthogonally projecting from the main framework, the first mandibular abdominus bone plate including an orifice; the reconstructed bone plate having the attached first bone segment is attached to the mandible; and a dental implant is attached to the first mandibular abdominus bone plate through the attached first bone segment via the opening formed corresponding to the implant template.

[0086] Therefore, the foregoing discussion has only disclosed and described exemplary embodiments of this disclosure. Those skilled in the art will understand that this disclosure may be embodied in other specific forms without departing from its spirit. Therefore, the content of this disclosure is intended to exemplify the scope of this disclosure and the other claims, and not to limit the scope of this disclosure and the other claims. This disclosure, including any readily identifiable variations taught herein, partially defines the scope of the foregoing claim terminology so that the subject matter of the invention is not exclusive to the public.

Claims

1. A mandibular reconstruction and dental implant system, comprising: The first reconstruction template includes: main body, A first cutting guide and a second cutting guide, wherein the first cutting guide is disposed at a first edge of the main body and the second cutting guide is disposed at a second edge of the main body. A first mandibular basal plate bone groove template, disposed along the main body, is configured to receive an opening therein for a drill bit. A first bone fastener template, disposed along the body, is configured to receive an opening therein in the drill bit, and A first implant template, disposed along the body and aligned with the first mandibular basal plate groove template, is configured to receive an opening for a drill bit therein, and an axis passing through the first implant template is orthogonal to an axis passing through the first mandibular basal plate groove template; and Reconstruction of the bone plate includes: Main support, and A first mandibular basal plate, which protrudes orthogonally from the main support, includes an orifice.

2. The system of claim 1, wherein the main support includes at least one opening configured to receive fasteners therein for attaching the main support to an adjacent bone segment.

3. The system of claim 1, wherein the orifice includes threads for receiving and frictionally securing a complementary thread inserted therein.

4. The system of claim 1, further comprising a locating pin configured to insert through an opening in the bone formed by the dental implant opening and to connect to the mandibular abdominus bone plate.

5. The system of claim 1, further comprising a dental implant configured to be inserted through an opening in the bone formed by the dental implant opening and connected to the mandibular abdominus bone plate.

6. The system of claim 1, wherein the angle of the plane of the first cutting guide is based on the obtained medical image.

7. The system of claim 6, wherein the angle of the plane of the second cutting guide is based on the obtained medical image.

8. The system according to claim 1, wherein The cross-sectional shape of the mandibular base bone plate groove template is rectangular, and The cross-sectional shape of the mandibular basal plate is a rectangular shape that complements the mandibular basal plate bone groove template.

9. The system of claim 1, wherein the cross-sectional shape of the bone template is C-shaped, and the bone template is configured to engage donor bone via push-in engagement.

10. The system of claim 1, wherein the cross-sectional shape of the bone template is a circle with split semicircles, and the bone template is configured to engage the donor bone by opening the bone template and arranging the bone template on the donor bone.

11. The system of claim 1, further comprising a second reconstruction template, wherein the first reconstruction template and the second reconstruction template are attached to each other via a template segment connector.

12. The system of claim 1, wherein the arrangement of the mandibular base plate bone groove template is aligned with the bone fastener template along the length of the body.

13. The system of claim 12, wherein the arrangement of the bone fastener template is not aligned with the implant template along the length of the body.

14. The system of claim 1, wherein the reconstruction plate includes a second mandibular basal plate groove disposed proximal to the first mandibular basal plate groove, and the reconstruction template includes a second mandibular basal plate groove template disposed at corresponding relative positions from the first mandibular basal plate groove to the second mandibular basal plate groove.

15. The system of claim 1, wherein the material of the reconstructed bone plate is titanium, and the reconstructed bone plate is formed by additive manufacturing.

16. The system of claim 1, wherein a first side of the main support of the reconstruction template is configured to be fixed to a first mandibular stump, and a second side of the main support of the reconstruction template is configured to be fixed to a second mandibular stump.

17. A reconstruction template device, comprising: Main support; and A first mandibular basal plate, which protrudes orthogonally from the main support, includes an orifice.

18. The apparatus of claim 17, wherein the main support includes at least one opening configured to receive fasteners therein for attaching the main support to an adjacent bone segment.

19. The apparatus of claim 17, wherein the orifice includes threads for receiving and frictionally securing a complementary thread inserted therein.

20. The apparatus of claim 17, wherein a first side of the main support of the reconstruction template is configured to be fixed to a first mandibular stump, and a second side of the main support of the reconstruction template is configured to be fixed to a second mandibular stump.

21. A method for reconstructing the mandible, comprising: Obtain images of the teeth in the mandible, including the vestigial portions to be removed; A reconstruction template is attached to the donor bone. The reconstruction template includes: a body; a first cutting guide and a second cutting guide, the first cutting guide being disposed at a first edge of the body and the second cutting guide being disposed at a second edge of the body; a first mandibular basal plate groove template disposed along the body, the first mandibular basal plate groove template being configured to receive an opening therein for a drill; a first bone fastener template disposed along the body, the first bone fastener template being configured to receive an opening therein for the drill; and a first implant template disposed along the body and aligned with the first mandibular basal plate groove template, the first implant template being configured to receive an opening therein for the drill, the axis passing through the first implant template being orthogonal to the axis passing through the first mandibular basal plate groove template; An opening is formed in the donor bone using the first mandibular base bone plate groove template, the first bone fastener template, and the first implant template. The donor bone is cut along the first cutting guide and the second cutting guide to generate a first bone segment; A reconstructed bone plate is attached to the first bone segment via the opening corresponding to the bone groove template of the first mandibular basal bone plate. The reconstructed bone plate includes a main support and a first mandibular basal bone plate orthogonally projecting from the main support. The first mandibular basal bone plate includes an opening. The reconstructed bone plate having the attached first bone segment is attached to the mandible; and The dental implant is attached to the first mandibular abdominus bone plate via the opening formed corresponding to the implant template and through the attached first bone segment.

Images