Dental restoration method

Abstract

The invention relates to a healing element (10) comprising, on the one hand, a device for attachment at one of its ends, the device being configured for direct attachment to an implant (60), and, on the other hand, a lateral surface (13) intended to be integrated within gingiva to permit gingival healing, and an end surface (14) at its other end, a portion of the peripheral lateral surface (13) and of the end surface (14) forming a projecting surface intended to remain outside the gingiva during healing, characterized in that the projecting portion of the healing element comprises photogrammetry patterns (19) by means of which it is capable of performing the function of a photogrammetry coded target.

Description

Dental restoration procedure

[0001] The present invention relates to a photogrammetric healing element. It also relates to a dental restoration method using such a photogrammetric healing element. The invention further relates to a method for manufacturing a dental abutment, bridge, or prosthesis, comprising the implementation of such a dental restoration method. The invention also relates to a dental restoration system.

[0002] Dental restoration allows for the creation of artificial teeth for a partially or completely edentulous patient. It relies on the integration of one or more implants into the bone structure, achieved through an incision in the gum to access and drill into the bone. Next, a healing element is generally attached to an implant, sometimes via a base fixed to the implant. This assembly remains untouched until the implant integrates with the bone through osseointegration and the gum heals around the healing element. The dental restoration can be completed by attaching a restorative abutment to the implant, onto which the dental prosthesis is fixed. The abutment and the dental prosthesis are customized, adapted to the patient's anatomy and the tooth to be replaced, to achieve a result as close as possible to an ideal natural dentition.For this, the precise volume of the space to be restored is generally taken into account by taking an impression, which allows for the personalized manufacture of the dental prosthesis.

[0003] In the current state of the art, existing dental restoration methods encounter some or all of the following technical problems: In many existing procedures, a new intervention on the gum is performed after it has healed following implant placement. This is done to take a physical or digital impression of the space to be restored, while also having a view of the implant and the gum to precisely account for the entire geometry, in order to fabricate an abutment and prosthesis of precise shape. This approach is inherently traumatic. Other existing procedures limit this trauma by using healing components that are not removed during the impression-taking process, so as not to damage the gum. However, these less traumatic methods then present other drawbacks, such as increased complexity and / or less effective optimization of the healing and / or dental restoration phase.

[0004] Thus, a general object of the invention consists of a dental restoration solution that does not include all or part of the disadvantages of the prior art.

[0005] More specifically, a first object of the invention is a dental restoration solution that minimizes patient trauma during the restoration process.

[0006] A second object of the invention is a dental restoration solution that allows for a restoration that is as adapted as possible to the patient's anatomy.

[0007] A third object of the invention is a solution for dental restoration that is as simple as possible.

[0008] To this end, the invention relates to a healing element comprising, on the one hand, a fixing device at one of its ends configured for direct fixing to an implant, and on the other hand, a lateral surface intended for integration within a gingiva to shape the gingiva during its healing, and a terminal surface on another of its ends, a part of the peripheral lateral surface and the terminal surface forming an emergent surface, intended to remain outside the gingiva during its healing, characterized in that the emergent part of the healing element comprises photogrammetry patterns, by which it is able to fulfill the function of a coded photogrammetry flag.

[0009] Photogrammetry patterns can be positioned on at least part of the terminal surface, and on the upper part of the peripheral lateral surface or on the entire peripheral lateral surface.

[0010] The emergent surface can be configured to present an emergent height from the gum greater than or equal to 1 mm, or greater than or equal to 2 mm, and / or less than or equal to 5 mm, or less than or equal to 4 mm.

[0011] The healing element may be a single piece, or consist of two separate parts assembled together in a removable manner, the first part being a base configured for direct attachment to an implant and the second part being a healing cap including said emerging part.

[0012] The healing element may include an anatomical shape, at least its lateral surface being asymmetrical with respect to at least one perpendicular median plane, or

[0013] the emergent surface of the healing element being asymmetric with respect to at least one median plane perpendicular to the emergent surface and passing through the center of the emergent surface or comprising a central axis of the healing element.

[0014] The section by a horizontal and / or vertical plane of the emergent surface may be asymmetrical, in particular the height of the healing element being greater on the lingual side relative to its height on the opposite side and / or the length of the healing element measured tangentially to the gingiva in a horizontal plane being greater on the lingual side relative to its length on the opposite side.

[0015] The healing element may include a through opening for the passage of a fixing screw.

[0016] A cross-section of the lateral surface of the healing element or a projection onto a parallel plane of the emergent surface of the healing element may have: a substantially trapezoidal shape or a substantially polygonal shape, or triangular, or square, or rectangular, or ovoid, or a substantially polygonal shape with rounded corners; and / or a portion intended for outward positioning of the mouth that is larger than a portion intended for inward positioning.

[0017] The terminal surface or emergent surface of the healing element or a screw positioned in the healing element may include at least one indicator to indicate its height and / or identification, including an indicator such as a color and / or a laser marking and / or one or more engravings and / or one or more barcodes and / or one or more datamatrix codes.

[0018] The invention also relates to a dental restoration method, characterized in that it includes a first step of determining the positioning of several dental implants and possibly optional respective bases from a photogrammetric treatment carried out using a stereoscopic camera visualizing several respective healing elements comprising photogrammetric patterns.

[0019] The dental restoration procedure may include a second step of determining the identification and positioning of said several healing elements, by automatic or at least partially automatic recognition of the asymmetric shape of said several healing elements and / or by recognition of one or more indicators on the emergent surface of said several healing elements, from a digitization of said real healing elements by an intraoral camera.

[0020] The second step in determining the identification and positioning of said several healing elements may include a step of at least partially automatic identification of each healing element, a step of displaying a virtual healing element transmitted from a library on an image corresponding to the scan data of the real healing elements, and then a step of automatic or semi-automatic superimposition by shape-overlay software of the virtual emergent surface of the virtual healing element on the digitized emergent surface of a corresponding digitized healing element on said image, to deduce the positioning of the real healing element and the actual geometry of the soft tissues of the gingiva above a corresponding implant.

[0021] The invention also relates to a method of manufacturing an abutment or a bridge or a dental restoration prosthesis, intended to be fixed on a dental implant at one end and to receive a prosthesis at its second end, characterized in that it includes a manufacturing step of an abutment or restoration bridge and / or a prosthesis taking into account the positioning of an implant and an optional base and the geometry of the gingiva above this implant and an optional base obtained by a dental restoration process as described above.

[0022] The invention also relates to a dental restoration device, comprising an oral scanner, characterized in that it includes a stereoscopic scanner adapted for photogrammetric processing and a central processing and control unit on which software is run implementing the dental restoration process as described above.

[0023] The invention also relates to a device for manufacturing an abutment or a bridge or a dental restoration prosthesis, intended to be fixed on a dental implant, characterized in that it comprises a dental restoration device as described above and in that the central unit includes a means of communication to a manufacturing device such as a machine tool to transmit manufacturing commands for a restoration abutment, a bridge and / or a prosthesis.

[0024] The invention is more precisely defined by the claims.

[0025] These objects, features and advantages of the present invention will be described in detail in the following description of a particular embodiment, given by way of non-limiting example, in relation to the accompanying figures, among which:

[0026] Figures 1 and 2 respectively represent perspective views from below and above of a healing element used in a restoration process according to an embodiment of the invention.

[0027] Figures 3a to 3c and 4a to 4c respectively represent top and bottom perspective views of a series of healing elements used in a restoration process according to an embodiment of the invention.

[0028] Figures 5a to 5c, 6a to 6c and 7a to 7c respectively represent side, top and bottom views of a series of healing elements.

[0029] Laillustre shows a cross-sectional view of a healing element arranged in an implant.

[0030] Laillustre shows a side view of a healing element placed in an implant.

[0031] This represents a cross-sectional view of an implant

[0032] The illustration shows a cross-sectional view of a healing element fixed to an implant by a screw.

[0033] Figures 12 and 13 respectively represent a side view and a cross-sectional view of an intermediate phase of association of an implant with a healing element and with a screw in a restoration process according to the embodiment of the invention.

[0034] The illustration shows a cross-sectional view of a healing unit comprising a healing element surrounded by gingiva and fixed in an implant.

[0035] Figures 15, 16 and 17 represent two schematic views of a cross-section of a gum in which a healing element is fixed.

[0036] Lare represents the lower and upper teeth in a top view.

[0037] Larepresents a view of the teeth according to a justa-gingival section.

[0038] Lare represents a horizontal section of the dentition at the justa-gingival level as well as the corresponding healing elements retained according to the embodiment of the invention.

[0039] Figures 21 to 23 represent cross-sectional views through a vertical median plane illustrating steps in the restoration process according to one embodiment of the invention.

[0040] Figures 24a to 24c and 25a to 25c respectively represent side and top views of a series of healing elements comprising photogrammetry patterns according to a first variant of the embodiment of the invention.

[0041] Figures 26a to 26c and 27a to 27c respectively represent side and top views of a series of healing elements comprising photogrammetry patterns according to a second variant of the embodiment of the invention.

[0042] Figures 28a to 28c and 29a to 29c respectively represent side and top views of a series of healing elements comprising photogrammetry patterns according to a third variant of the embodiment of the invention.

[0043] Figures 30a to 30c and 31a to 31c respectively represent side and top views of a series of healing elements comprising photogrammetry patterns according to a fourth variant of the embodiment of the invention.

[0044] Figures 32a to 32c and 33a to 33c respectively represent side and top views of a series of healing elements comprising photogrammetry patterns according to a fifth variant of the embodiment of the invention.

[0045] Figures 34a to 34c and 35a to 35c respectively represent side and top views of a series of healing elements comprising photogrammetry patterns according to a sixth variant of the embodiment of the invention.

[0046] To simplify the description, we define the horizontal direction as any direction within a horizontal plane, defined as a plane parallel to the justogingival plane. The horizontal plane of a component outside a user's mouth will be defined as a plane intended to be positioned parallel to the justogingival plane after its placement in the mouth. In addition, the vertical direction is defined as the direction perpendicular to a horizontal plane, along which the height of a component is measured. This perpendicular direction generally corresponds to the axis of an implant.

[0047] The restoration process according to the embodiment of the invention therefore comprises two phases, as explained above: a first phase, called the healing phase, during which one or more monobloc healing elements 10 are used, fixed in position on one or more respective implants 60 placed in the patient's bone structure 62 by osseointegration, as will be detailed later; and then a second restoration phase, during which one or more definitive prostheses are placed directly on the implant(s) 60 or via one or more respective restoration abutments. As mentioned above, the objective is to manufacture the definitive prosthesis in an optimized manner.

[0048] As illustrated in Figures 8 to 14, the implant 60 comprises a cylindrical or frustoconical overall shell and a longitudinal axis L forming an axis of revolution for this overall shell. The implant 60 includes an anchoring means for the patient's bone structure. This anchoring means may be a set of threads arranged around the outer periphery of the implant and comprising a variable thread pitch. A lower portion of the implant 65, i.e., a portion of the implant at the base of the bone structure 62, may comprise larger threads, while an upper portion 66 of the implant, i.e., a portion of the implant on the side facing the surface of the bone structure, may comprise finer threads. The implant includes an opening on the side of its upper end, along the longitudinal axis L, inside which is a connecting device 3 with the healing element 10.The connection device 3 comprises a threaded opening 21, a hexagonal opening 22 extending from the threaded opening, and a conical bearing surface 23 opening onto a top face of the implant. The threaded opening 21, the hexagonal opening 22, and the conical bearing surface 23 are adjacent, coaxial with the longitudinal axis L, and arranged such that the threaded opening 21 is on the lower side of the implant 10, the conical bearing surface 23 is on the upper side of the implant 10, and the hexagonal opening 22 is between the threaded opening 21 and the conical bearing surface 23.

[0049] The healing element 10 is monobloc, meaning it is made of a single piece and preferably from a single material. As illustrated in Figures 11 to 13, the healing element 10 comprises an upper portion 31 intended to be in contact with the gingiva 63 and a lower portion 32 intended to be inserted into the implant opening to cooperate with the connecting device 3. The healing element includes a through-hole 11 oriented along an axis 12 and intended to receive a screw 40 screwed into the threaded opening 21 of the implant. The healing element is therefore intended to be fixed to the implant by means of the screw 40. When the healing element is fixed to the implant, the axis 12 of the through-hole coincides with the longitudinal axis L of the implant. This assembly is illustrated in particular by figures 11 and 14.The through opening 11 is generally cylindrical in shape and includes, at one end on the upper part, a conical bearing surface 33. This conical bearing surface 33 is designed to cooperate with a conical bearing surface of a screw head 41 of complementary shape so as to form a sealing interface. The conical bearing surface 33 and the screw head 41 thus function as a sealing cone.

[0050] The healing element 10 includes at least one thread 34 located at the opening 11 and adapted to cooperate with a threaded portion 42 of the screw 40 to prevent dissociation between the screw 40 and the healing element 10 by a single translational movement. The screw 40 includes an unthreaded cylindrical portion 43 between the threaded portion 42 and the screw head 41. The threaded portion 42 is designed to cooperate with the threaded opening 21 of the implant to lock the healing element in position. The cylindrical portion 43 of the screw is designed to be positioned along the opening 11 of the healing element. When assembling the screw 40 with the healing element 10, the screw must be screwed through at least one thread 34. The screw is designed so that, when the screw head 41 is in contact with the conical bearing surface 33 of the healing element, at least one thread 34 is opposite the cylindrical part 43 of the screw.Advantageously, the threaded portion 42 of the screw 40 cannot simultaneously engage with the at least one thread 34 and the threaded opening 21 of the implant. This captive screw assembly prevents accidental separation of a healing element from its associated screw. For example, this assembly prevents the screw from falling out when handling the healing element. The healing element and the screw can thus be delivered pre-assembled, reducing the amount of handling required by the dentist. Furthermore, the at least one thread 34 also provides an attachment point for the healing element, which can be used during subsequent removal of the healing element.Indeed, the dentist can then partially unscrew the screw to separate its threaded portion 42 from the threaded opening 21 of the implant, while maintaining a grip on the threaded portion 42 on at least one thread 34 of the healing element. The dentist can then easily grasp the screw head and pull on it to remove the healing element without transmitting any force to the implant and without causing discomfort to the patient.

[0051] The healing element 10 includes, at its lower end and on its outer periphery, a hexagonal portion 35 adapted to cooperate with the hexagonal opening 22 of the implant. The interface thus formed ensures fixation of the healing element 10 in a single orientation, without rotation of the healing element around the implant 60. The hexagonal portion 35 and the hexagonal opening 22 are anti-rotational elements that could be replaced by any other equivalent anti-rotational elements. The healing element thus includes an implant fixation device at its lower end. Furthermore, the healing element also includes, on the outer periphery of its lower portion 32, a frustoconical or substantially frustoconical portion 36 adapted to cooperate with the conical bearing surface 23 of the implant to form a watertight interface between the implant and the healing element.The frustoconical portion 36 forms a boundary between the lower part 32 and the upper part 31 of the healing element. The conical bearing surface 23 and the frustoconical portion 36 act as a sealing cone and also uniquely position the healing element relative to the implant. In fact, the assembly of the conical bearing surface 23 with the frustoconical portion 36 constitutes a pivot joint whose axis coincides with the longitudinal axis L. Specifically, after tightening the screw 40, such a joint eliminates any translational play between the healing element and the implant along the longitudinal axis L or any axis perpendicular to the longitudinal axis L.Furthermore, as rotation of the healing element relative to the implant is impossible thanks to the interface formed by the hexagonal section portion 35 and the hexagonal section opening 22, the connection between the healing element and the implant is a particularly rigid connection.

[0052] The upper part of the healing element comprises an end face 14 through which the conical bearing surface 33 of the opening 11 opens, and a peripheral lateral surface 13 around which the gingiva 63 is intended to heal. The conical bearing surface is oriented towards the interior of the healing element so that the screw head 41 is recessed within the healing element. Thus, the screw head 41 does not protrude from the end face 14. The end face, excluding the opening 11, advantageously has a continuous and smooth shape, which may be substantially flat, or convex or concave. Preferably, it does not have any hollow portions, excluding the opening 11, to promote overall hygiene.When the screw is positioned in the implant in the position of fixing the healing element, its screw head 41 closes the opening 11 of the terminal surface, forming a continuous and smooth surface, including at the interface between the terminal surface 14 and the screw head 41.

[0053] Existing implants can have different shapes and, in particular, different connection devices. There can be as many different healing elements as there are different connection devices, so that each existing implant can have a healing element with a connection device that is suitable for it.

[0054] The healing element 10 is designed to be placed within the incised gingiva after implant placement. The final configuration is shown in Figure 60. In this configuration, the implant 60 is secured to the bone structure 62 and protrudes slightly from the bone into the gingiva 63. The healing element 10 is fixed to the implant 60 so that the gingiva 63 is almost exclusively in contact with the healing element 10. The healing element temporarily participates in the restoration process, allowing for healing and the smooth fabrication of the final prosthesis, as will be detailed later.

[0055] The gingiva 63 heals around the peripheral lateral surface 13 of the healing element 10. For this reason, this lateral surface 13 is chosen to best match the patient's oral environment. The terminal surface 14 of the healing element is designed to remain visible above the gingival surface 64 of the gingiva 63, since the gingiva remains in full contact with the lateral surface 13 of the healing element. Note that the upper part of the lateral surface 13 and the terminal surface 14 thus form an emergent surface of the healing element. This emergent surface is illustrated in Figures 15 to 17. Therefore, healing elements of different heights can be provided to adapt to various oral geometry configurations. As examples, three different standard heights allow for good adaptation to all situations.This height is advantageously between 3 and 7 mm. Color-coding the screw allows for quick identification of the healing element's height. For example, a blue screw can be associated with a small healing element, a green screw with a medium-sized healing element, and a red screw with a large healing element. This simplifies communication between dentists and dental technicians. Alternatively, any indicator, such as a color or printed code, can be positioned on the terminal surface 14, or more generally on the emerging surface, to indicate the healing element's height.

[0056] According to the embodiment of the invention, the shape of the healing element is specifically chosen to promote gingival healing, according to an anatomical shape that best corresponds to the tooth to be replaced and consequently also to the future prosthesis intended to occupy this oral space. This shape is characterized in particular by the plane section of its lateral surface 13, this section being a transverse section by a plane perpendicular P to the lateral surface 13, shown in Figure 6, and substantially parallel to the terminal surface 14. As a note, this section is substantially reproduced by the shape of the terminal surface 14, or more precisely by the projection of this terminal surface 14 onto such a perpendicular plane, that is to say, substantially parallel to the gingival surface 64. Such a perpendicular plane P is thus substantially perpendicular to the axis 12 of the healing element, and is substantially horizontal.Advantageously, the cross-section of the healing element is constant over at least part of its height, on the side of the emerging surface of the healing element, this cross-section being particularly reduced near the intended connection with an implant. The projection of the emerging surface onto a horizontal plane also advantageously has a shape identical to this constant cross-section.

[0057] To understand the approach used, Figure 1 illustrates a top view of the upper and lower teeth, and Figure 2 illustrates a cross-sectional view at the level of the justogingival plane PJ of a dentition, shown in Figure 3, at the level of the roots of the emerging teeth. These figures show that the teeth have cross-sections of different shapes, which can be simplified as rectangular and / or square and / or triangular shapes, but are more precisely trapezoidal. These cross-sections correspond to the aforementioned transverse sections.

[0058] Depending on the chosen embodiment, a series of healing elements 10 of different shapes will allow for the best possible reproduction of these different shapes. Figure 1 represents a top view of the sections of all the teeth and a top view of the healing elements 10 associated with each tooth. The shapes of the different series of teeth, numbered 11 to 18, 21 to 28, 31 to 38, and 41 to 48 in this figure (these numbers should not be confused with the numerical references used elsewhere in the other figures to designate the features of the invention), are all approximated by means of four different healing elements 10, referenced A to D. For some teeth, or even all the teeth, several healing elements from among those A to D appear suitable.

[0059] In the chosen embodiment illustrated in Figure 1, healing elements A are suitable for restoring the upper lateral incisors and all lower incisors. Healing elements B are suitable for restoring the canines and premolars, healing elements C are suitable for restoring the intermediate molars, and healing elements D are suitable for restoring the largest molars. Alternatively, the series of healing elements 10 could include a completely different number of different healing elements, for example, three or five different healing elements.

[0060] These healing elements will now be described in more detail by considering a series of three healing elements A, B, and C. Healing element A is particularly illustrated by Figures 3a to 7a, healing element B by Figures 3b to 7b, and healing element C by Figures 3c to 7c. To avoid making the figures too large, numerical references are not included for all the healing elements shown in these figures; however, all these healing elements possess the same characteristics, which will be described.

[0061] As can be seen from figures 3 and 6, the terminal surfaces 14 of these healing elements 10 (A to C), intended for positioning above the gingival emergence, are substantially flat and intended for positioning parallel to a horizontal plane (parallel to the justogingival plane PJ, between 1 and 2 mm inclusive above this plane) corresponding to the plane of the cut. They are however slightly domed, convex, presenting a central part 145, more particularly visible on figures 5a to 5c, intended to rise more beyond the gingiva than its peripheral parts 146.

[0062] The cross-section of the healing element, by a plane P perpendicular to its lateral surface 13, as explained previously, which gives the final shape to the gingiva after healing, is essentially reproduced by the terminal surface 14 of the healing element, which is its extension. The cross-sections of all the healing elements are essentially trapezoidal in shape. They comprise a longer side 141, which will be positioned on the outside of the mouth (vestibular side), a parallel shorter side 142, which will be positioned on the inside of the mouth (lingual side), connected by two sides 143, 144. The intersection of the diagonals of the trapezoid defines a center 15.Furthermore, considering the center 17 of the substantially circular opening 11 of the healing element 10 at its lower end, it is possible to define a central axis 18 of the healing element, passing through the two central points 15, 17. This axis 18 of the healing element 10 is perpendicular to the terminal surface 14. The axis 18 is also coincident with the axis of the opening 11 and the longitudinal axis L of the implant.

[0063] The three types of healing elements 10, A, B, and C, differ primarily in the trapezoidal shape of the cross-section of their lateral surfaces 13. Depending on the specific healing element, the trapezoidal shape may be closer to a triangular, rectangular, or even square shape. Figures 7a to 7c provide approximate dimensions of these healing elements, in millimeters, as examples of their construction.

[0064] Naturally, this roughly trapezoidal shape features rounded corners and curved sides to ensure it does not impinge on the gums. Furthermore, the terminal surface 14 of each healing element, with the exception of the opening 11, is a continuous surface, free of ridges, hollows, grooves, edges, and / or asperities, as previously mentioned. This surface is convex. This smooth geometry promotes oral hygiene, reduces food accumulation, and minimizes plaque buildup.

[0065] Alternatively, the healing element series could include a different number of different geometries, for example at least two. In a simplified embodiment, a single healing element shape could be suitable for all teeth.

[0066] According to other embodiments, the cross-section of a healing element at its lateral surface 13 could approximate any polygon, such as a three-, five-, or six-sided polygon. Alternatively, the angles of these polygons could be so rounded that the overall shape would approximate an oblong shape, or even an ovoid cross-section, or any other shape further removed from a polygon. Advantageously, this shape includes at least one geometrically defined center or point to define a center 15, or even a possible axis 18, of the healing element.

[0067] Depending on the embodiment, the geometry of the visible emergent surface of the healing element on the inside of the mouth differs from the geometry on the outside, to account for the curvature of the gingiva. This shape of the emergent surface of the healing element is therefore asymmetrical with respect to a median plane parallel to the tangent T to the gingiva, shown in Figures 6a to 6c, and more specifically in Figure 1, considering a tooth 50 to be restored. This particular median plane, also called the tangent T plane, is parallel to or containing the tangent T to the gingiva, perpendicular to the justogingival plane PJ, and passes through the midline 15 of a healing element.

[0068] As mentioned above, the healing element can exhibit a first difference in geometry when considering its cross-section, i.e., along a horizontal plane, and considering respectively the side facing the inside of the mouth and the side facing the outside of the mouth in this section. It can exhibit a second difference in geometry in a perpendicular direction, essentially vertical: indeed, the geometries respectively facing the inside of the mouth and oriented towards the outside of the mouth can have different heights, as can be seen, for example, in the image, when observing a section through a vertical plane oriented from the lingual side to the vestibular side.

[0069] Thus, a circular shape for the cross-section of a healing element, associated for example with a cylindrical healing element, is less advantageous because it is not anatomical. More generally, any plane curve exhibiting symmetry around a point or axis is poorly suited or unsuitable for the aforementioned cross-section of the healing element, because, on the one hand, it would not be adapted to the anatomy of the mouth and, on the other hand, its circular orientation around this axis would no longer be identifiable. For the same reasons, the emergent and visible surface of the healing element is therefore not symmetrical with respect to at least one, or even several, planes parallel to its axis 18, and / or including this axis 18. It is not symmetrical with respect to at least one, or several, planes perpendicular to the emergent surface and passing through its center 15, which we call perpendicular median planes.In the example shown, only the plane perpendicular to the aforementioned tangent plane T, passing through the midpoint of the two sides 141 and 142, forms a plane of symmetry. The preceding remarks apply to the emergent surface of the healing element, or to its cross-section by a previously defined cutting plane P, or to the projection of its emergent surface onto such a plane P. The perpendicular median plane is then any plane perpendicular to plane P and passing through the center of the considered geometry of the healing element. Alternatively, a perpendicular median plane can be defined as any plane containing the axis 18 of the healing element. This emergent surface of a healing element can ultimately take any identifiable three-dimensional form, allowing the healing element used to be recognized and, if necessary, its orientation to be determined, thus fulfilling a second function that will be detailed later.

[0070] In addition to the asymmetry described above, which is manifested in a horizontal plane parallel to the justogingival plane, the healing element advantageously includes, as a variant or complement, a vertical asymmetry, that is, in the direction perpendicular to the justogingival plane. Indeed, according to the embodiment, particularly visible in Figures 14, 16, 21, and 22, the healing element has a greater height on its lingual side compared to its height on the opposite vestibular side. This additional asymmetry, called vertical asymmetry, also offers the first advantage of providing an anatomical shape, and the second advantage of contributing to the recognition of the identity and / or positioning of the healing element. In the embodiment illustrated in Figures 14, 16, 21, and 22, it is noted that the upper surface of the healing element is generally inclined relative to a horizontal plane.This inclination is substantially constant, the cross-section of the surface represented by la showing a substantially linear upper end.

[0071] The terminal surfaces 14 of the healing elements extend from their periphery 146 by the lateral surface 13 around which the gingiva heals, thus giving the gingiva shape adapted to the future prosthesis. This lateral surface 13 has several surfaces 131, 132, 133, 134, substantially flat, possibly slightly curved, extending in a direction substantially parallel to the axis 18 of the healing element and / or parallel to the longitudinal axis L of the implant, respectively extending the different sides 141, 142, 143, 144 of the terminal surface 14 of the healing element. The interfaces between the terminal surface 14 and these different parts of the lateral surface 13 are formed by rounded, smooth surfaces, in particular convex ones.

[0072] The healing element can be made of a medical-grade plastic material and is available in pink, white, or cream. Specifically, it can be made from a polymer material, particularly PEEK. Alternatively, it can be made of metal, such as titanium (grade 2 or 4), or a Ta6V titanium alloy, or zirconia. It can also be made from a zirconium-titanium alloy, a niobium-titanium alloy, or tantalum. Furthermore, it may or may not include a surface treatment, such as a zirconium nitride (ZrN), titanium nitride (TiN), or titanium nitrocarbide (TiC) coating, or simply be anodized. The healing element can be manufactured by machining, molding, and / or additive manufacturing, i.e., 3D printing.

[0073] The use of healing elements therefore promotes ideal gum healing in a dental restoration procedure, as has been discussed, due to its geometry designed in line with oral anatomy.

[0074] The invention is not limited to the healing element described above.

[0075] According to a first embodiment, this healing element could be non-anatomical and have a simplified outline forming a cylindrical healing surface. In such a case, it could include several indicators on its terminal surface, or even on its emergent surface, to indicate, in particular, its orientation, diameter, and height.

[0076] According to a second embodiment, this healing element may not be a single unit. For example, it may consist of two complementary elements: a base, corresponding to the lower part of the healing element, intended for its attachment to an implant, and a separate healing cap, corresponding to the upper part of the healing element, intended for its positioning within the gingiva to participate in its shaping during the healing phase, and including, in particular, the previously defined emergent surface comprising the multitude of photogrammetric patterns. The base and the healing cap include respective connecting elements enabling their attachment, by which they together fulfill the same function as a healing element described previously.

[0077] On the other hand, the emerging portion of the healing element 10 includes photogrammetric patterns 19, enabling it to function as a coded photogrammetric flag. The healing element thus directly fulfills the function of a coded photogrammetric flag, without the need for a separate element. To simplify the illustrations, these photogrammetric patterns 19 are not shown in the figures described above, but they are shown in Figures 24a to 35c. However, all healing elements 10 of the invention include photogrammetric patterns 19, which may be, according to the variants shown in Figures 24a to 35c, or according to any other variant.

[0078] The photogrammetry patterns 19 extend at least over the emergent part of the healing element, therefore at least over the upper part of the transverse walls 13, as shown in figures 24, 26, 28, 30 and 34, and over its terminal surface 14. Alternatively, these photogrammetry patterns 19 can extend over the entire height of the lateral wall 13 of healing, to optimize their visualization in all gingival configurations, as shown in figures 32.

[0079] The invention does not relate to the photogrammetric patterns 19 as such. These photogrammetric patterns 19 can take many forms. Advantageously, they include simple shapes, such as dots, circles, squares, and / or triangles. All the photogrammetric patterns 19 of the same healing element 10 can be identical to each other, as shown in Figures 26a to 26c, 27a to 27c, 28a to 28c, 29a to 29c, 30a and 31a. Alternatively, the photogrammetry patterns 19 can combine different patterns, such as triangles and squares, etc., on the same healing element, as represented by figures 24a to 24c, 25a to 25c, 32b, 32c, 33b, 33c, 34a to 34c, 35a to 35c.Furthermore, the healing elements of the same series may all exhibit the same patterns among themselves, as for example represented by figures 24a to 24c and 26a to 26c, or exhibit different patterns, as represented by figures 30a to 30c, 31a to 31c, and 32a to 32c, 33a to 33c.

[0080] As mentioned previously, one or more specific indicators can also be placed on the emerging surface of the healing element to fulfill a function complementary to that of the photogrammetric patterns, such as identifying the healing element and / or providing information about its geometry, such as its height, orientation, etc. As an example, Figures 35a to 35c illustrate an implementation in which the terminal surface includes the printing of a QR code or datamatrix code.

[0081] To facilitate photogrammetric processing, which will be detailed later, it is optimal to choose an emerging portion that extends at least 1 mm, or even 2 mm, above the gingival surface, particularly on the vestibular side, facing outwards. Advantageously, this emerging height is between 1 and 5 mm, or even between 2 and 4 mm.

[0082] In addition to the advantages described above, the healing element allows for a cost-effective restoration procedure and a manufacturing process for a dental prosthesis, bridge, and / or abutment with minimal trauma to the gums. Indeed, it is possible to obtain a digital impression of the area to be restored without removing the healing element from the mouth, thus avoiding any impact on the gums. Therefore, in addition to its primary healing function, detailed previously, the healing element fulfills a second function during the restoration process by allowing for the advantageous definition of the shape of the restorative abutment and / or prosthesis before its removal. This function complements its primary healing function, as it prevents further trauma to the gums after healing, allowing for the creation of a chosen, anatomically advantageous shape.

[0083] To this end, at the end of the healing phase of the dental restoration procedure, a practitioner can take a digital impression of the patient's mouth to implement an initial step of automatically determining the positioning of several dental implants (60), and possibly optional bases attached to these implants, using photogrammetric processing with a stereoscopic camera. In this first step, the healing elements (10), as described previously and attached to the implants (60), are used as photogrammetric markers, thus allowing for very precise identification of the positioning of their respective implants (60) without removing the healing elements (10) from the mouth, and therefore without disturbing the gums.Precise knowledge of the positioning of implants 60, and in particular their inclination, and possibly of any optional bases attached to these implants, is an essential first step in dental restoration. Photogrammetry allows this knowledge to be acquired with very high precision and very quickly.

[0084] Photogrammetry uses stereoscopic cameras, which have a dual-lens image capture system, providing a two-dimensional view with a wide field of view. This can ultimately generate a three-dimensional image, similar to human vision. This approach offers greater precision than oral cameras, also called oral scanners or intraoral scanners, traditionally used outside of photogrammetry, which only offer a single viewpoint (and are therefore not stereoscopic). These traditional cameras use processing software that stacks successive images. Each superposition of these images introduces a small error, which remains acceptable for small prosthetic reconstructions, but less so for larger reconstructions.For large-span reconstructions exceeding half an arch, the insufficient precision of traditional cameras necessitates a non-passive bridge, meaning one that exerts tension on the implants or abutments. Photogrammetry, therefore, employs a different approach than the traditional method, which relies on stereoscopic cameras. These cameras generate a three-dimensional (3D) image at each viewpoint, which software then overlays with another 3D image. The result is ultimately much more precise with photogrammetry, since the overlay utilizes images with an additional depth axis and a wider field of view compared to traditional oral cameras. This ultimately requires less image overlay. Furthermore, stereoscopic cameras operate with a monochrome approach to focus solely on the photogrammetric patterns.The cameras thus see these photogrammetric patterns in 3D (each coded flag can have different patterns to recognize the coded flag and its position, preventing the camera from getting lost while scanning different coded flags and reducing the risk of errors in image overlays). The stereoscopic camera software can access a library where it finds the virtual coded flag corresponding to each scanned coded flag. Based on this, it then finds information about the implant and any base attached to the implant to which the coded flag is fixed.

[0085] Next, in a second step of the process, the practitioner implements a second step of determining the geometry of the soft tissues above each implant 60. From the exact position of an implant 60 and the possible base, and the knowledge of this geometry representing the space available in the gingiva, as defined by the healing element 10 (or the healing cap) during the healing phase, the process makes it possible to know precisely the exact volume disposed above an implant 60 and the possible base, so as to be able to manufacture an abutment or restoration bridge which corresponds to this precise geometry, while being adapted for mounting on said implant 60 and the possible base, in a configuration called passive fit, in which the stresses and tensions exerted on said implant are zero or minimal.This second step of determining the geometry of the gum above said implants can be implemented by any known method.

[0086] Advantageously, this second step is also automated, or at least partially automated, starting with taking a digital impression of the patient's mouth without removing the healing elements to avoid damaging the gums. The scan data, obtained by any device such as a stereoscopic camera suitable for photogrammetric processing in the first step, and by an oral scanner, also called an intraoral scanner, in the second step, for example, is then automatically transmitted to a computer equipped with dental restoration software. This software has a user interface, through which an operator can specify the model of healing element used, or more generally, the reference of the healing element, and possibly the implant or base used.

[0087] Advantageously, this second step includes determining the identification and positioning of said multiple healing elements through automatic or at least partially automatic recognition of their asymmetrical or anatomical shape. Alternatively or in addition, one or more specific indicators of the emerging surface of said healing elements may enable all or part of their identification and positioning.

[0088] Thus, according to one embodiment of the second step, an operator enters the reference of the healing element via a human-machine interface. This allows the software to retrieve the characteristics of this healing element, such as its height, center, and / or axis, from a library stored as a database in electronic memory that the operator can consult. The illustration shows, as an example, a virtual healing element 10' stored in the library associated with the restoration software. A spatial reference point 51' is associated with the healing element, enabling its positioning in space. Alternatively, the software can automatically recognize the healing element 10 from its geometric characteristics, its anatomical shape, and / or indicators present on its surface, without requiring manual entry of its reference.An operator can assist software in correctly positioning the reference mark 51 of the actual healing element, i.e., in recognizing its actual positioning, by capturing on an image obtained by the digitization step mentioned above and presented to the operator on a screen of a human-machine interface one or more points of the emergent surface of the digitized healing element.

[0089] From the digitized data, and possibly with the help of points on the surface of the healing element manually entered by an operator, the software can associate the virtual healing element from its library with the digitized oral environment, replacing the digitized healing element to obtain the most accurate digital reproduction possible. Note that the shape of the actual healing element allows its orientation to be determined, particularly due to its asymmetrical shape, as mentioned previously. Note that, as described, this asymmetry can be simple, in a horizontal and / or vertical plane, or it can be a bi-asymmetry, both horizontal and vertical. As shown in Figure 1, the actual reference point 51 of the digitized healing element 10 is thus automatically determined by the software.It is possible to perfectly position the virtual healing element on the digital impression, either automatically or, if necessary, through operator intervention via a human-machine interface that allows visualization of the buccal impression and the healing element. This perfect positioning of the virtual healing element makes it possible to deduce all the surrounding geometries, particularly the tissue in which the healing element is positioned, from the known references stored in the database associated with the specific healing element in question.

[0090] In other words, software enables the perfect overlay of the virtual healing element onto the digitized real healing element, allowing the actual positioning of this element to be determined. This overlay software performs this overlay automatically, based on the most optimized automatic alignment of the two surfaces, digitized and virtual respectively, according to any known overlay algorithm. In this approach, an operator can participate in the process by manually positioning the virtual healing element on a scanned image, on which the emerging portion of the digitized healing element is visible. This manual positioning represents a starting point that accelerates the overlay process, which is finalized by the overlay software.Alternatively, an operator can identify several points on the digitized and virtual emergent surfaces using a human-machine interface. The software then initiates its overlay process, starting from an initial position where the points indicated by the operator are either superimposed or positioned close to each other. In all cases, the software automatically overlays the virtual emergent surface onto the digitized emergent surface, thanks to the asymmetrical shape of the latter. Once the two surfaces are superimposed, the virtual healing element occupies the exact position of the real healing element in the three-dimensional coordinate system on the screen displaying the digitized data. This operation is repeated for all healing elements.

[0091] Note that if the healing element is not anatomical, does not have the aforementioned asymmetrical shape, but is, for example, generally cylindrical, it is not possible to automatically superimpose the two emerging surfaces using the aforementioned overlay software. In such a case, it is necessary to add indicators to determine the model and orientation of the healing element.

[0092] Note that if healing elements of different heights exist, but with the same emerging surface area, it is necessary to determine this height. One approach could be to form healing elements or screws of different colors for different heights. A second approach is to place an indicator on the visible terminal surface 14 of the healing element to indicate this height; this indicator could be composed of numbers and / or letters and / or any symbol and / or colors and / or laser markings and / or one or more barcodes and / or Data Matrix codes and / or any identification code. A third approach could be to form healing elements with a different visible terminal surface 14 depending on their height.For example, healing elements A, B, and C could retain the same shape but with slightly larger dimensions for greater heights, thus allowing them to be automatically differentiated and their height determined. In all these cases, the height indicator assists recognition software, which can automatically deduce information from the digitized emerging surface, but not the height of the healing element since its lower part is invisible, hidden within the gum.

[0093] When the restoration software has accurately repositioned the hidden implant positioning as well as the precise positioning of an identified healing element, it deduces from this knowledge the final geometry of the restoration abutment or bridge to be manufactured, which must be fixed to the implant and occupy the entire gingival volume defined by the healing element, and then the geometry of the dental prosthesis intended to be fixed to this abutment, in a known manner.

[0094] As can be seen from the description above, the final phase of the restoration process relies on a restoration device, which includes a central processing and control unit. This unit comprises at least one microprocessor connected to electronic memory, on which software is run to implement all or part of the steps of the restoration process described above. This central unit is connected via a communication device to a module for acquiring digital data representing all or part of a patient's dentition. This module may consist of a device such as an oral scanner, and may also include a stereoscopic scanner adapted for photogrammetric processing. It is also connected to a human-machine interface, including, for example, a screen and / or a keyboard, to allow communication with an operator, as explained above.The central unit then performs all necessary processing, calculations, and other operations using software. It advantageously utilizes overlay software, as explained above. Finally, it is capable of generating and transmitting manufacturing commands to a device for manufacturing a restoration and / or prosthesis abutments. Furthermore, it can be connected via a second communication device to a manufacturing device such as a machine tool.

[0095] In conclusion, the device combines two complementary steps, based on two different image processing methods: stereoscopy on the one hand, and digitization and virtual overlay on the other, in order to obtain the most precise information possible in the fastest possible way. Photogrammetry, with its precision, provides the location of the implant and any abutment. The intraoral camera provides the surface of the soft tissues visible in contact with the healing elements. Reconstruction software then aligns the two sets of information to design the final prosthesis.

Claims

Healing element (10) comprising on the one hand a fixing device at one of its ends configured for direct fixing on an implant (60), and comprising on the other hand a lateral surface (13) intended for integration within a gingiva to shape the gingiva during its healing, and a terminal surface (14) on another of its ends, a part of the peripheral lateral surface (13) and of the terminal surface (14) forming an emergent surface, intended to remain outside the gingiva during its healing, characterized in that the emergent part of the healing element comprises photogrammetry patterns (19), by which it is able to fulfill the function of a coded photogrammetry flag. Healing element (10) according to the preceding claim, characterized in that the photogrammetry patterns (19) are positioned on at least a part of the terminal surface (14), and on the upper part of the peripheral lateral surface (13) or on the entire peripheral lateral surface (13). Healing element (10) according to any one of the preceding claims, characterized in that the emerging surface is configured to have an emerging height from the gum greater than or equal to 1 mm, or greater than or equal to 2 mm, and / or less than or equal to 5 mm, or less than or equal to 4 mm. Healing element (10) according to any one of the preceding claims, characterized in that it is monobloc, or is presented in two distinct parts assembled together in a removable manner, a first part being a base configured for direct attachment to an implant (60) and a second part being a healing cap comprising said emerging part. Healing element (10) according to any one of the preceding claims, characterized in that it comprises an anatomical shape, at least its lateral surface (13) being asymmetric with respect to at least one perpendicular median plane, or the emergent surface of the healing element (10) being asymmetric with respect to at least one median plane perpendicular to the emergent surface and passing through the center of the emergent surface or comprising a central axis (18) of the healing element. Healing element (10) according to the preceding claim, characterized in that the section by a horizontal and / or vertical plane of the emerging surface is asymmetric, in particular the height of the healing element (10) being greater on the lingual side relative to its height on the opposite side and / or the length of the healing element (10) measured tangentially to the gingiva in a horizontal plane being greater on the lingual side relative to its length on the opposite side. Healing element (10) according to one of the preceding claims, characterized in that it comprises a through opening (11) for the passage of a fixing screw (40). Healing element (10) according to any one of the preceding claims, characterized in that a cross-section of the lateral surface (13) of the healing element (10) or a projection onto a parallel plane of the emergent surface of the healing element has: a substantially trapezoidal shape or a substantially polygonal shape, or triangular, or square, or rectangular, or ovoid, or a substantially polygonal shape with rounded corners; and / or a part intended for outward positioning of the mouth that is larger than a part intended for inward positioning. Healing element (10) according to any one of the preceding claims, characterized in that the terminal surface (14) or the emergent surface of the healing element (10) or a screw (40) positioned in the healing element (10) comprises at least one indicator to indicate its height and / or its identification, in particular an indicator such as a color and / or a laser marking and / or several barcodes and / or datamatrix codes. Dental restoration process, characterized in that it includes a first step of determining the positioning of several dental implants (60) and possibly optional respective bases from a photogrammetric treatment carried out using a stereoscopic camera visualizing several respective healing elements (10) including photogrammetry patterns (19). Dental restoration method according to the preceding claim, characterized in that it comprises a second step of determining the identification and positioning of said several healing elements (10), by automatic or at least partially automatic recognition of the asymmetrical shape of said several healing elements (10) and / or by recognition of one or more indicators on the emergent surface of said several healing elements (10), from a digitization of said real healing elements (10) by an intraoral camera. A dental restoration method according to the preceding claim, characterized in that the second step of determining the identification and positioning of said several healing elements (10) comprises a step of at least partially automatic identification of each healing element (10), a step of displaying a virtual healing element transmitted from a library on an image corresponding to the digitization data of the real healing elements, and then a step of automatic or semi-automatic superimposition by shape superimposition software of the virtual emergent surface of the virtual healing element on the digitized emergent surface of a corresponding digitized healing element on said image, to deduce the positioning of the real healing element and the real geometry of the soft tissues of the gingiva above a corresponding implant. Method of manufacturing an abutment or a bridge or a dental restoration prosthesis, intended to be fixed on a dental implant (60) on one end and to receive a prosthesis on its second end, characterized in that it comprises a step of manufacturing an abutment or a restoration bridge and / or a prosthesis taking into account the positioning of an implant and an optional base and the geometry of the gingiva above this implant and an optional base obtained by a dental restoration method according to one of claims 10 to 12. Dental restoration device, comprising an oral scanner, characterized in that it comprises a stereoscopic scanner adapted for photogrammetric processing and a central processing and control unit on which is executed software implementing the dental restoration process according to any one of claims 10 to 12. A device for manufacturing an abutment, a bridge, or a dental restoration prosthesis, intended to be fixed to a dental implant (60), characterized in that it comprises a dental restoration device according to the preceding claim and in that the central unit comprises a means of communication to a manufacturing device such as a machine tool to transmit manufacturing commands for a restoration abutment, a bridge, and / or a prosthesis.

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