Method for establishing a connection between a number of inserted dental implants and a prosthetic body and method for the production of a prosthetic body

Abstract

The aim of the invention is to devise a method for providing a connection between a number of inserted dental implants and a prosthetic body, which makes it particularly simple to establish a reliable and secure connection between the prosthetic body and the inserted implants. For this purpose, according to the invention, the prosthetic body is provided with a recess for each dental implant, said recess being associated with the dental implant and being suitable for accommodating a connecting element of the particular dental implant. Following the insertion of the dental implants into the jawbone of the patient, the intraoral data characteristic of the oral situation of the patient including the inserted dental implants is captured. Using this intraoral data, the geometric data defining the intermediate space formed by the connecting element and the associated recess when the prosthetic body is correctly placed is determined for the connecting element of the dental implant, and, using this data, an intermediate body is produced that fills the intermediate space.

Description

[0001] Description

[0002] Methods for creating a connection between a number of inserted dental implants and a prosthetic body, as well as methods for manufacturing a prosthetic body

[0003] The invention relates to a method for producing a connection between a number of dental implants inserted in a patient's mouth and a prosthetic body. It further relates to a method for producing a connecting piece, in particular for use with such a prosthetic system, as well as a method for producing a prosthetic body.

[0004] In the event of tooth loss, the usual aim is to replace the missing teeth or at least close the resulting gaps. This can be achieved, for example, with bridges. In this process, the teeth adjacent to the gap are prepared (ground down), and crowns are fabricated to replace the missing teeth with corresponding pontics (bridge units). The bridge is mechanically anchored to the prepared teeth. A cantilever can also be attached to a bridge to address a free-end situation. Such a situation can also be treated with removable partial dentures, which are typically supported by natural teeth.

[0005] In addition to bridges, missing teeth can also be replaced with endosseous implants. These typically use threaded posts as artificial tooth roots, onto which the prosthesis can be anchored. This anchorage can be fixed (screwed, cemented, or bonded) or removable. For removable solutions, the retention forces that hold the prosthesis in place are usually based on suction, friction, and / or retention. Depending on the primary stability of an inserted implant, a temporary restoration—such as a crown—can be placed on the implant either immediately after implantation or after a healing period of, for example, four to six weeks. This temporary crown can then be replaced with the final crown at a later date.

[0006] As soon as too few teeth remain in the patient's mouth, other solutions are usually employed. One option is to remove all remaining teeth and use mucosa-supported dentures. These are cost-effective but offer poor chewing comfort for the patient and are often accompanied by bone loss in the upper and lower jaw. Frequently, the remaining teeth and / or endosseous implants are used as abutments for a full denture or a denture covering a relatively large portion of the dentition. For example, in a so-called "all-on-four" concept, a number of, say, four inserted dental implants can be used as abutments to which the prosthetic body is attached.This requires a suitable connection system that allows the inserted dental implants to be securely and reliably connected to the prosthetic restoration, also with regard to the expected forces and loads, such as chewing forces.

[0007] In particular, when providing such a restoration based on a single inserted dental implant or on an "AII-on-four" concept (or, of course, analogously for a different number of abutments), the so-called "navigated implantation" can be used. In such navigated implantation, for example, for use with the "AII-on-four" concept, but not limited to this, the intended implant positions in the patient's jaw are first planned virtually using previously acquired CBCT or CT data depicting the patient's oral situation, with regard to the planned use of implants inserted into the patient's jawbone as abutments for the restoration.Based on this planning, a surgical guide (usually bone-supported, mucosa-supported, or tooth-supported) is fabricated for the actual navigated implantation, along with a temporary prosthesis. This allows the patient to be fitted with fixed teeth on the same day as the surgery or implant placement. For crowns or bridges, a tooth-supported surgical guide is considered the simplest and therefore preferred option. The guide is used to create the drill holes in the jawbone for the implants and to define their final position. In a subsequent step, the implant(s) are inserted through this guide, ensuring they are automatically placed in the correct positions corresponding to the previously drilled holes.

[0008] Typically, regardless of whether navigation or conventional techniques are used, a conventional or digital impression is taken immediately after the insertion of the respective implant(s). This impression captures data reflecting the patient's oral situation and is taken at the level of the implants or the implant abutments. This allows for the precise planning and fabrication of the final dental prosthesis or denture based on the data obtained, which accurately reflects the oral situation including the implants. Following this data acquisition, the provisional prosthesis should be attached to the inserted implant(s) on the same day, specifically by screwing it in place. For this purpose, the special provisional abutments may first be screwed onto the "AII-on-four" abutments.

[0009] During the fabrication of the prosthesis, bridge, or crown, preferably the provisional one, suitable recesses or cavities are provided at the positions intended for connection to the abutments or implants, particularly the implant heads. Suitable connecting elements for attaching the prosthesis to the implant heads or abutments can be inserted into these recesses or cavities. These recesses or cavities of the provisional prosthesis or crown are then filled with a resin adhesive, modeling resin, cement, or similar material and fixed to the respective provisional abutment. The connection between the inserted dental implants and the provisional prosthetic body or crown is thus established as a material-bonded connection.

[0010] In view of the inaccuracies that typically occur during data acquisition and processing, as well as the almost unavoidable manufacturing tolerances and tolerances during implant insertion, the recesses or cavities, especially in the basal direction in the case of a crown for a single tooth restoration, are made comparatively generous and usually oversized, not least to give the practitioner degrees of freedom for fine alignment and exact adjustment when attaching the provisional prosthesis, especially to compensate for almost unavoidable inaccuracies during implant insertion (navigated or freehand).However, this approach also presents problems and disadvantages, as a comparatively large amount of adhesive or cement material is required to adequately fill the cavity(ies), resulting in a relatively large amount of excess adhesive or cement material that needs to be removed during placement. Furthermore, this makes precise alignment of the crown or prosthesis in the mouth over the temporary abutments comparatively difficult.

[0011] The invention is therefore based on the objective of providing a method for establishing a connection between a number of inserted dental implants and a prosthetic body or crown of the type mentioned above, with which a reliable and secure connection of the prosthetic body with the inserted implants can be achieved in a particularly simple manner, especially with regard to precise (rotational) alignment.

[0012] This problem is solved according to the invention by providing the prosthetic body or crown for the dental implant(s) with a recess associated with it, suitable for receiving a connecting element of the respective dental implant, wherein, after the insertion of the dental implants into the patient's jawbone, the intraoral data characteristic of the patient's oral situation, including the inserted dental implants, are recorded, wherein, based on these intraoral data, the geometric data defining the space formed by the connecting element and the associated recess when the prosthetic body or crown is correctly placed are determined for the connecting element of the respective dental implant, and based on these data, an intermediate body filling the respective space is manufactured.

[0013] According to aspects of the invention, this concept of the on-demand production of an intermediate body can be used both for single-tooth restorations, in particular for attaching a crown to an associated dental implant, and for the provision of a larger prosthetic body intended for the replacement of several teeth, especially within the framework of a so-called "all-on-four" restoration. In the latter case, in particular for multiple inserted dental implants, the provision of a separate intermediate body, individually adapted to the respective implant, can be provided for each of these implants.The invention is based on the consideration that a significant simplification in providing the connection between the inserted implant and the prosthetic restoration can be achieved by taking into account a particularly high degree of accuracy in the provision of the components intended for the patient's care, preferably accompanied by the need for further correction or rework to the greatest extent possible, at a particularly early stage, and thus the material used to produce the material-bonded connection (gluing or cementing) and the resulting, inherently undesirable, excess material are specifically reduced.For this purpose, based on the known geometric information, the necessarily resulting gap between the connecting element of the respective implant on the one hand and the corresponding contour in the crown or prosthetic body on the other hand should be filled as completely as possible with a provided filler. This should be manufactured as precisely as possible and thus based on the determined actual data, so that the amount of material required to fill the remaining gaps can be minimized.

[0014] Depending on requirements, the intermediate body can be manufactured from a plastic or a particularly durable material (e.g., ceramic, metal, titanium, or the like). It can be manufactured subtractively (e.g., using a machining process) or additively (e.g., through a laser sintering process). Manufacturing the intermediate body using a 3D printing process is considered particularly advantageous and inventive. When manufacturing multiple intermediate bodies, for example, four in an "AII-on-four" application, a single printing process can be used for all intermediate bodies. In this process, they are produced in a suitable cavity, such as a cylindrical interior of the printer or a container filled with printing paste that can be inserted into the printer.To prevent them from being held in place, the printed blanks produced can be connected to each other via connecting bridges, making them manageable together. Once manufactured, they can then be separated by removing the connecting bridges.

[0015] Advantageously, and according to one aspect of the invention, the intermediate body or bodies are adapted to the determined gap between the connecting element and the associated crown or prosthetic body in such a way that the intermediate body fills this gap (almost) completely on the one hand, but also (as far as possible) does not protrude into the area not bounded on both sides by the outer contour of the connecting element on the one hand and the inner contour of the cavity in the crown or prosthetic body on the other.Assuming that, with the connecting element properly and accurately positioned within the cavity, the space volume formed by its outer contour on the one hand and the inner contour of the cavity on the other hand is limited in the proximal direction by an annular gap surrounding the connecting element and is thus quantitatively defined, the respective intermediate body has, in particular according to one aspect of the invention, a volume of at least 80% and at most 120%, preferably at least 90% and at most 110% of this space volume.

[0016] For particularly easy assembly, especially by "plugging" the components prosthetic body-intermediate body-connecting element, the latter, and possibly also the other components, is designed with a cross-section that tapers continuously towards its free end. This corresponds to a design of the receiving channel in the prosthetic body with a cross-section that widens continuously towards the free end.

[0017] In a further embodiment, considered to be independently inventive, the respective intermediate body can have a substantially completely convex cross-sectional contour in its cross-section as viewed with respect to the longitudinal axis of the connecting element. In other words, the outer (and, if necessary, also the inner) circumference of the cross-section of the intermediate body is advantageously convex to at least 75%, preferably at least 90%, and particularly preferably at least 95%.

[0018] According to aspects considered to be independently inventive, one or more of the following geometric parameters, individually or in any number and in any combination, are taken into account or specified as a criterion for the design of the intermediate body:

[0019] 1. The average gingival height of the intermediate piece, in particular interpreted as the mean distance of the lower edge region of the intermediate piece (in the assembled state) from the gingiva: this should be less than 0.70 mm, preferably less than 0.50 mm, and most preferably less than 0.25 mm. 2. The average wall thickness of the intermediate piece in any region (without considering any indexing that may be provided in the apical half of the intermediate piece) should be less than 1.00 mm, preferably less than 0.75 mm, and most preferably less than 0.50 mm.

[0020] 3. The total volume occupied by the intermediate piece (without taking into account any indexing that may be provided in the apical half of the intermediate body) should be at most 1 / 3, preferably at most 1 / 5, and most preferably at most 1 / 10 of the volume of the crown.

[0021] 4. The wall thickness of the intermediate body, particularly in the area of ​​any indexing provided in the apical half of the intermediate body, in cross-section should vary by at least 200%, preferably at least 500%, and most preferably at least 1000% in the circumferential area, or in other words, the intermediate body should have a wall thickness (comparable to a “bead thickness” of the molded indexing) of at least twice, preferably at least five times, and most preferably at least ten times the wall thickness of the intermediate body in an area without applied indexing in the area of ​​externally molded indexing.

[0022] Furthermore, in the case of an application for a larger prosthetic body and its attachment to a multiple inserted implants, for example in the context of an “AII-on-four” restoration, the volume of the intermediate pieces in relation to the volume of the total prosthesis can be taken into account as a geometric parameter.

[0023] A particularly advantageous and independently inventive aspect of the invention is that the crown or prosthetic body, preferably the crown or prosthetic body intended for final restoration, is prefabricated, allowing the actual dimensions to be used for its fabrication. This enables a particularly needs-based, and therefore efficient and resource-saving, manufacturing process. According to this aspect of the invention, the respective intermediate component can be manufactured only after the implant(s) have been inserted, the abutment(s) have been planned and fabricated, and the crown or prosthetic body has been planned and fabricated.The intermediate body(s) can thus be manufactured according to this aspect, which is considered independently inventive, taking into account "actual" values, where the crown or prosthetic body actually intended for insertion is measured and its geometric data is considered during the fabrication of the respective intermediate body. This allows manufacturing tolerances or inaccuracies to be compensated for to some extent or completely by the production of the intermediate body(s). In other words, due to the positional tolerance of the inserted implant, a gap always exists between the connecting element or abutment and the crown or prosthetic body. The intermediate body that fills this gap is only manufactured once the implant has already been inserted in the patient's mouth and the crown or prosthetic body has already been fabricated.The data for the cavity intended to receive the connecting element or the "inside" of the crown or prosthetic body can be taken from the planning set of the crown or as actual values ​​measured in the manufactured crown, whereby a particular advantage of using the actual measured values ​​can be seen in the fact that the dental technician no longer has to work on or rework the inside of the crown, because no further adjustment is then necessary.

[0024] In an alternative variant, considered to be independently inventive, instead of producing an intermediate or filler body that fills the gap as much as possible or almost completely, a positioning framework body can also be provided. This framework body can be designed, particularly with regard to its contouring and / or surface finish, such that contact with the surrounding components is established in the assembled system, thereby ensuring the precise and correct orientation and spatial positioning of these components relative to one another. Such a positioning framework body, provided according to this aspect of the invention, thus ensures the correct positioning of the components, and the gaps left behind by this framework-like body can be filled with adhesive or cement during installation or integration.Advantageously, the positioning framework body can be provided with a groove, preferably designed as an internally or externally mounted thread, through which excess adhesive or cement material can flow away or be removed. In a further alternative variant, considered to be independently inventive, a tertiary framework body can be produced for the manufacture of intermediate bodies for a plurality of implants, for example in an "AII-on-four" configuration. The intermediate bodies can be attached and / or fixed to this framework body in a pre-assembled manner. During assembly, this tertiary framework body can be applied as a whole to all the inserted implants, so that in this case all intermediate bodies are assembled together in a single step.The prosthetic body, with its number of receiving spaces corresponding to the number of implants, can then be placed onto the ensemble of implants provided with the tertiary framework body.

[0025] If the intermediate body, and in this specific case the positioning framework body, is manufactured using an additive manufacturing process (3D printing, laser sintering, etc.), the manufacturing time for the positioning framework body is significantly reduced compared to the manufacturing of the entire framework body. Preferably, the positioning framework body fills less than 70%, advantageously less than 50%, and particularly less than 30% of the volume of the intermediate piece, so that the manufacturing time can be minimized accordingly.

[0026] For the sake of clarity, the following explanations refer to the intermediate body. Of course, the following further training and aspects can also be applied analogously to the aforementioned positioning framework body.

[0027] In an advantageous embodiment, analogous to the conventional process described above, the prosthetic body is manufactured as a provisional prosthesis, wherein the four recesses or cavities corresponding to the contact points (according to the "All-on-Four" concept) each have a defined geometry, conceivable as a "matrix". A significant advantage of the present invention is that, even with the concept now provided, the prosthetic body can be manufactured in advance and provided as a prefabricated part during insertion. In an advantageous embodiment, the aforementioned geometry or shape can be designed such that the associated connecting element, conceivable as a "patrix" corresponding to the respective matrix, is defined as precisely as possible, advantageously in terms of both orientation and, if necessary,The implant can also be precisely fixed or attached in a clearly defined position from a rotational perspective. In principle, any dental implant could be designed as a so-called one-piece implant, in which the connecting element located at the head is integral with the post that is inserted or can be inserted into the patient's jawbone. However, advantageously, and to promote particularly high flexibility in the configuration or manufacture of the components, the dental implant is designed as a so-called two-piece implant, in which the respective connecting element is designed as an abutment and can be attached to the inserted post of the implant via suitable connecting means, such as a connecting pin that can be inserted into a receiving channel. Therefore, preferably, such an abutment is used as the connecting element.Alternatively, the actual implant can also be equipped with a so-called "AII-on-four" abutment for the purpose of connecting it to the final prosthetic body. However, for providing a temporary prosthesis—that is, a provisional prosthetic body that is later to be replaced by the final one—so-called "provisional abutments" can also be used as connecting elements. These can be (temporarily) attached to the actual "AII-on-four" abutments of the implants in the manner of an intermediate support, preferably screwed in place.

[0028] According to one aspect of the invention, the prosthetic body is thus screwed onto the actual “All-on-four” abutments of the implants via the secondary abutments after the intermediate pieces produced as described above have been glued into their respective cavities in the prosthetic body and bonded to the temporary or secondary abutments.

[0029] According to one aspect of the invention, after implant insertion, whether using navigation or conventional methods, and optionally the mounting of the "AII-on-four" abutments, the intraoral data are acquired as directly as possible, for example by taking a digital impression or a conventional impression and scanning the fabricated master model. Subsequently, the resulting data set, describing the current position of the implants within the oral cavity, can be superimposed with the data of the desired implant positions in the mouth. This allows the data to capture the space between the prosthetic body or crown—already fabricated, as explained above, according to a particularly advantageous aspect—and the respective abutments or provisional abutments forming the connecting element.A significant advantage of the present invention is seen in the fact that, with the concept now envisaged, the prosthetic body can be manufactured in advance and provided as a pre-made part during the insertion.

[0030] Using suitable software, preferably computer-aided design (CA), the transitions from the respective abutment to the crown (preferably already fabricated) or to the prosthetic body can be calculated and the gap determined. The data set characteristic of this gap can then be used as the basis for the subsequent fabrication of the intermediate piece or body for each of the aforementioned contact points. Thus, according to one aspect of the invention, the corresponding intermediate pieces can be fabricated, either using navigation or conventional methods, for each of the individual abutment-recess connections, preferably four. Subsequently, the fabricated intermediate pieces can be unambiguously fixed in the matrices or recesses of the prosthesis, and according to another aspect of the invention, also in a definite rotational position, preferably by bonding or cementing.The abutments are then fixed to the prosthesis, preferably by bonding or cementing. Alternatively, the abutments can first be fixed to the abutments, and then the prosthesis, including the abutments, can be fixed to the prosthesis. In the case of a single-tooth restoration, the abutment can then be screwed onto the implant with the crown. It is also possible to attach the crown and / or the abutment to the abutment while the patient is in the mouth.

[0031] Advantageously, in the case of multiple implants, the recesses associated with each dental implant have different geometries. It is particularly preferred that the connecting element of each dental implant be manufactured with a geometry adapted to the geometry of its associated recess. This ensures a high degree of avoidance of confusion and unambiguous component identification throughout the entire process. In one embodiment and according to one aspect, this can be achieved, for example, by an individualized height offset. Alternatively or additionally, the recesses—preferably provided in the prosthesis body—can have a contour in cross-section that extends, particularly in the mesiodistal direction. This contour is preferably designed in a poka-yoke manner for each position to prevent confusion.In particular, the cross-sections can be contoured and dimensioned in such a way that incorrect insertion is rendered impossible due to their shape. This ensures that the respective components can be clearly identified and assigned at any time, even during the manufacturing process. In a further advantageous embodiment, the geometry of the recess in the respective prosthetic body and the geometry of the connecting element associated with it can be selected such that the connection between the connecting element and the associated prosthetic body is possible in only one rotational orientation.

[0032] In particular, the respective intermediate body can be provided on its outer surface with a longitudinally molded positioning lip that corresponds to a corresponding groove in the inner surface of the associated recess in the respective prosthetic body. More generally, the respective prosthetic body can be provided on its inner surface in the area of ​​its recess with one or more guide contours into which corresponding outer features on the intermediate body can be incorporated, so that the number, position, and geometry (depth, height, width, shape) of these pairings of features on the one hand and corresponding guide contour or groove on the other uniquely define the rotational position of the intermediate body in the receiving space.In the case of a multi-tooth restoration, such guide contours are advantageously and in accordance with an independent inventive aspect arranged essentially in the mesial-distal direction of the dentition, since this is where the most installation space is available for such indexing. In contrast, in a single-tooth restoration, the positioning of such an indexing element is provided in a rotational direction in which the outer contour of the respective crown has a particularly large radial value, preferably a maximum radial value. This makes correct rotational positioning particularly easy for the clinician when inserting the restoration into the oral cavity, even visually. This can be particularly significant in combination with the aforementioned joint fabrication of multiple intermediate bodies, as it makes it much easier for the clinician to assign the respective intermediate body to the respective connecting element.is possible for the respective recess.

[0033] In a particularly advantageous variant, the contact points, preferably four but also two to eight, each formed by a combination of a connecting element of an implant on the one hand and a corresponding recess in the prosthetic body on the other, are designed such that the corresponding number of male components, preferably four, are not interchangeable, but rather there are preferably four (or possibly two to eight) unique female component geometries. Thus, the fabrication of each male component can be carried out in a manner precisely matching a specific female component, whereby subsequent attachment or fixation can also be provided for in exactly one rotational position within the corresponding female component. The aforementioned provisional abutments are typically not restricted in their rotation on the "AII-on-four" abutments.It is therefore also possible to place the uniqueness in the connection between the “AII-on-four” abutment and the provisional abutment or in the connection between the intermediate piece and the provisional abutment.

[0034] A particularly advantageous benefit achievable with the present method is that the connection between the connecting elements or abutments of the implants, on the one hand, and the prosthetic body, on the other, can be established with minimal effort and, in particular, relatively quickly. To further facilitate this, a particularly efficient and, above all, rapid production of the respective intermediate pieces or bodies is highly desirable. To enable these to be produced quickly and cost-effectively, each intermediate body can be manufactured using a 3D printing process, according to a concept considered to be independently inventive. This method of production with a 3D printer is particularly simple and economical, especially when dealing with a temporary prosthesis.If the prosthesis is a final prosthesis, it might be more advantageous to manufacture it from titanium, preferably by machining or additive manufacturing. Regarding the machining method, according to a further development, blanks could be used that already have the intended connection to the prosthesis, so that only the connection for the abutments needs to be manufactured, or vice versa.

[0035] According to one aspect of the invention, in the case of a single-tooth restoration, the crown is bonded to the intermediate body or to the connecting element or abutment of the implant extraorally. In other words (also in the case of the framework), the printed product can be bonded into the crown; the adhesive then does not run into the abutment or the other components. The crown can then be inserted. The framework allows for the time-saving creation of a guide element that ensures precise positioning.

[0036] This design could be particularly advantageous in cases where the crown already exists. Alternatively, it might be more economical to manufacture the crown from ceramic or titanium, preferably by machining or additive manufacturing. Regarding the machining method, a further advantageous development could utilize blanks that already have the intended connection to the implant or abutment, so that only the connection for the prosthesis needs to be fabricated.

[0037] In a particularly preferred embodiment, the (preferably temporary) abutments can be clamped into a 3D printer, which prints the space-filling intermediate pieces or bodies directly onto the abutments, allowing them to be fixed directly into the prosthesis or crown. In other words, according to this aspect of the invention, the respective intermediate body can be printed directly onto the connecting element of the respective dental implant, thus eliminating the need for cementing the intermediate body to the abutment. Similarly, according to another aspect considered to be independently inventive, the respective crown or prosthesis can be clamped into a 3D printer, which prints the space-filling intermediate pieces or bodies directly into the crown, allowing the abutment(s) to be fixed directly into it.

[0038] In a further concept, considered independently inventive, it is also possible to eliminate the need for crown fabrication prior to treatment. According to one aspect of this embodiment of the invention, after implant insertion, either with navigation or conventionally, intraoral data, preferably for both jaws, are acquired, for example, by taking a digital impression or by taking a conventional impression and scanning the fabricated master model. The resulting data set, describing the current position of the implants within the oral cavity, can then be used in software or computer simulation to calculate the entire crown or prosthetic restoration. This data set, describing the current situation, can be superimposed, for example, with the data of the planned position and shape of the entire prosthetic restoration in the mouth.

[0039] This allows the desired design of the crown, its position on the implant, and its orientation relative to the implant, including the abutment forming the connecting element, to be recorded data-wise.

[0040] Using suitable software, preferably computer software, the entire crown can be calculated based on this information. The resulting data set can then be used as the basis for the subsequent fabrication of the crown. Following this, the crown, according to one aspect of the invention, can be fixed in a specific rotational position and then fixed to the abutment, preferably by bonding or cementing. This can be done intraorally or extraorally.

[0041] Even in this embodiment, which is considered independently inventive, a particularly preferred further development allows the (possibly temporary) abutment to be clamped into a 3D printer, which prints the crown directly onto the abutment. In other words, according to this aspect of the invention, the crown can be printed directly onto the connecting element of the respective dental implant.

[0042] A printer suitable for such applications, and considered to be independently inventive in this case, has, according to aspects of the invention, a rotary axis ("C-axis") which accommodates the abutment or connecting element to be printed. This rotary axis can also be moved in the axial direction ("X-axis"). To check the exact dimensions of the abutment or connecting element, this rotary axis can preferably be moved via the X-axis to a distance sensor (or a similar measuring instrument such as an optical micrometer). The component can be measured at the area to be printed via the rotation and the C-axis. According to one aspect of this independent invention, an additional Z-axis allows the print head (preferably designed as a print element or filament holder) of the 3D printer to be moved to the correct distance to apply the material, preferably plastic.

[0043] The actual printing element, in particular the so-called filament holder or similar component, should, according to a further aspect of the invention, be able to be moved up and down along a Z-axis (preferably oriented at a 90° angle to the X-axis). According to another aspect of the invention, the 3D printer can also have a pivoting axis ("B-axis") that can pivot the axis of rotation up to an angle of 90° to the X-axis. With a printer designed in this way, the intermediate piece can be printed directly onto the abutment, which significantly simplifies and speeds up the manufacturing process. In this way, the crown, as well as the intermediate piece with or without a screw channel, can be produced. It is possible that after printing the intermediate piece or the positioning framework, the abutment may need to be shortened in the occlusal direction.In the above-mentioned applications, a printing material or printing paste is preferably used, in accordance with one aspect of the invention, which comprises ceramic particles embedded in a matrix or carrier material. These are preferably provided in a volume fraction of at least 40%, more preferably at least 60%, and most preferably at least 80%.

[0044] In an alternative embodiment, considered to be independently inventive, the provision of a final crown, in the sense of a definitive prosthetic restoration, can also be provided. According to one aspect of the invention, the crown can be designed as a ceramic body. In this case, instead of the aforementioned fabrication of the crown by printing directly onto the abutment, the crown can be fabricated by a laser sintering process directly onto the abutment. This constitutes an additive process, and in one embodiment of the invention, the ceramic materials can be applied and, during the rotation of the abutment, preferably by a laser, melted and bonded to the abutment or to the ceramic materials already applied.

[0045] In an alternative embodiment, also considered independently inventive, the respective connecting element or abutment can be provided in the form of a blank or intermediate product for subsequent machining, wherein such a blank can comprise a base body made of a biocompatible, high-strength material, preferably titanium or a titanium alloy, which is additionally provided with a plastic coating. This coating can then be machined away according to one aspect of the invention in such a way that the remaining plastic coating constitutes the aforementioned intermediate body and thus appropriately fills the gap determined by the data.

[0046] According to another aspect considered to be independently inventive, the method can be used in conjunction with training or education for the practitioner. In this context, the invention allows the practitioner to draw conclusions about the quality of their insertion procedure, as well as the components and tools used, based on information about the dimensions of the aforementioned gaps or the wall thicknesses and dimensions of the spacers to be manufactured for filling them. In particular, this makes it possible to obtain information regarding the (individual or objective) accuracy and precision of the navigated implantation.Especially when systematically comparing relevant quality indicators or statements derived from them over a certain period or a certain number of treatments, the practitioner can also gain insights in the form of feedback.

[0047] If, based on such an evaluation, the practitioner determines that they have succeeded in improving this precision over time or through multiple treatments, resulting in increasingly smaller or thinner-walled intermediate pieces, it becomes possible, after a certain period, to completely dispense with the provisional prosthesis and fabricate the final prosthetic body in advance. This final prosthesis, along with the fabricated intermediate pieces, can then be inserted into the patient's mouth on the day of implantation. In other words, such a feedback system can enable the practitioner, once they have acquired the necessary skills and experience, to plan for the fabrication of the final prosthesis from the outset; the targeted guidance of the practitioner towards this goal can be considered an ingenious, fundamental concept of the training system.This would significantly and sustainably reduce the costs of such treatment.

[0048] To enable such systematic information processing, according to one aspect of the invention and in a particularly advantageous embodiment, the geometric data defining the gaps can be stored in a database. According to another aspect of the invention, a characteristic value for the fit of the components can be determined based on the geometric data defining the gaps. This value can then be used as a success criterion for the precision of the manufacturing process and / or for the quality of the treatment. This allows conclusions to be drawn about the overall quality of the insertion, which could, for example, be reflected in a decreasing volume or wall thickness of the spacers required for compensation over time or with each trial.Alternatively or additionally, systematic errors caused individually by the practitioner, such as a pre-drilled hole consistently placed slightly too deep, can also be detected and used as a basis for compensation. For example, if the practitioner notices that all their implants are consistently inserted at least 1.0 mm too high or too low, this can be determined by a computer and taken into account when designing future surgical guides. Similarly, if the axial angle is always inclined buccally or in another consistent direction, the practitioner can consider this in future insertions and thus increase their precision. The same applies, of course, to all other spatial directions where a pattern is recognized by the software (preferably a computer).

[0049] Possible parameters to be considered in such an evaluation could include, but are not limited to:

[0050] 1. Wall thickness of the intermediate body, especially in the area of ​​space laterally surrounding the connecting element

[0051] 2. Volume or weight of the intermediate body (primarily an indicator of height accuracy)

[0052] 3. Wall thickness uniformity or tolerance

[0053] 4. Centricity of the abutment's male matrix in the recess of the prosthetic body

[0054] Advantageously, for a number of treatments, the characteristic parameters for the fit of the components are stored together with reference data characteristic of the respective treatment in a database. This allows for an evaluation of the stored data at a later time, for example, linked to pattern recognition or analysis, in order to identify aspects or factors that contribute to treatments considered particularly successful, as well as those considered unsuccessful or substandard. As a result, a recommendation for action can be generated for the user based on a number of the stored characteristic parameters for fit, in a manner considered to be independently inventive. This allows, among other things, the provision of personalized or individualized correction data, which leads to correction suggestions for the respective practitioner.

[0055] In a suitably equipped treatment system, user-specific parameters of the aforementioned type can thus be stored in an independently inventive manner, enabling the provision of individualized recommendations for action, in the form of individualized training or instruction. Alternatively or additionally, according to a further aspect of the invention, this stored data and these parameters can be used to determine and calculate possible improvements and adjustments to the template used for navigation, i.e., to modify the manufacturing process of the template.

[0056] If a navigated procedure is not used for implant insertion, the basal cavity in the already fabricated crown is designed to be somewhat larger, according to one aspect of the invention. In this case, after implant insertion and superimposition of the data sets, either the most suitable abutment for the restoration is selected, or a CAD / CAM abutment including an intermediate body is fabricated directly.

[0057] The embodiments described above are particularly suitable for cases where the intermediate body is also intended as a temporary measure, for use only on a temporary basis. In an advantageous embodiment, the intermediate piece produced in this way can subsequently be removed and replaced by a final fitting made of a particularly durable material (e.g., ceramic, titanium, or the like). This can be manufactured subtractively (e.g., by machining) or additively (e.g., by laser sintering). According to an inventive aspect, the geometric data acquired during the aforementioned production of the intermediate body and stored in the database can be reused for the production of the final intermediate body, since, by design, it contains the geometric data actually required for the restoration.According to one aspect of the invention, the recorded intraoral data are therefore appropriately stored in the database, in particular provided with a suitable identifier and linked data-wise, which also contains the exact assignment to the respective patient, and / or further treatment-relevant information, even at a later time, possibly even after years.

[0058] The advantages achieved with the invention lie particularly in the fact that, by capturing intraoral data after implant insertion, the positioning and alignment intermediate body, which ensures precise alignment, can be manufactured with exceptional accuracy and precision, but especially quickly and flexibly, particularly when using a prefabricated prosthetic body. This enables high-quality provisional restoration of the patient on the day of implant insertion in a particularly cost-effective manner. A further advantage of the method is that, after fabrication of the intermediate body, it can be bonded extraorally to the crown or bridge and the connecting element to the implant, for example, an abutment, and does not require precise positioning within the patient's mouth during intraoral bonding.

Claims

Claims 1. A method for providing a connection between a number of inserted dental implants and a prosthetic body, which is provided for each dental implant with a recess suitable for receiving a connecting element of the respective dental implant, wherein, after the insertion of the dental implants into the patient's jawbone, the intraoral data characteristic of the patient's oral situation, including the inserted dental implant(s), are recorded, wherein, based on this intraoral data, the geometric data defining the space formed by the connecting element and the associated recess when the prosthetic body is correctly placed and already manufactured are determined for the connecting element of the respective dental implant, and based on this data, an intermediate body filling the space and adapted to its volume is manufactured.

2. Method according to claim 1, wherein actual values ​​of the previously manufactured prosthetic body measured for the determination of the geometry data for the recess in the prosthetic body are taken into account.

3. Method according to claim 1 or 2, wherein an abutment associated with the respective dental implant is used as the connecting element of the respective dental implant.

4. Method according to one of claims 1 to 3, wherein the geometry of the recess in the respective prosthetic body and the geometry of the connecting element associated therewith are selected such that the connection of the respective connecting element with the associated prosthetic body is possible in only one rotational orientation.

5. Method according to one of claims 1 to 4, wherein the recesses assigned to the different dental implants each have different geometries.

6. Method according to any one of claims 1 to 5, wherein the intermediate body or each intermediate body is manufactured using a 3D printing process.

7. Method according to claim 6, wherein the respective intermediate body is printed directly onto the connecting element of the respective dental implant.

8. Method according to any one of claims 1 to 7, wherein the geometry data defining the spaces are stored in a database.

9. Method according to one of claims 1 to 8, wherein a characteristic value for the fit of the components is determined on the basis of the geometry data defining the gaps.

10. Method according to claim 9, wherein, for a plurality of treatments, the characteristic values ​​for the fit of the components are stored together with reference data characteristic for the respective treatment in a database.

11. Method according to claim 10, wherein a recommendation for action for the user is determined on the basis of a plurality of the stored characteristic values ​​for the accuracy of fit.