DE102007018453B3 - Dental implant system - Google Patents

Abstract

The invention relates to a dental implant system consisting of an implant and a superstructure (10, crown, bridge, etc.). The implant is made in one piece and extends from the bone area to the level of the proximal gingival papillae. The endosteal (1, 2) and gingival areas (3) of the implant are shaped according to diagnostically determined patient data. As a result, the enossal area is precisely matched to the crest shape of the jaw and completely replenishes bone dehiscence due to implantation. The gingival area (3) fills in the corresponding cavity in the gingiva. The superstructure (10) is connected over its entire surface to the transgingival implant head (4), which both fill the remaining cavity of the gingiva, and additionally attached to the implant with a prosthetic abutment pin (7). Its adapted surface structure enables complete ingrowth in the endosseous and gingival areas. The emergence of periodontal pockets is completely prevented. Due to the design, no micromotion can occur in the implant system. In addition, an optimal distribution of forces is guaranteed.

Description

The The invention relates to an implant and a suprastructure existing dental implant system.

In Germany is yearly around 700,000 times more artificial Dentures implanted. Usually this consists of three components: an artificial root (root implant), a connector, the so-called abutment, and a superstructure such as the z. B. a crown or a bridge.

To the Insertion of the artificial Dentures would have first the remains of the defective tooth, such as. B. its roots, Completely be removed. Subsequently a hole is made in the jaw or in this thread cut and screwed or screwed in the root implant. The implant is therefore usually in the form of a cylinder or made of a cone. After insertion into the jaw, this must be Healing the implant for three to six months, d. H. stuck with the Fused pine. During this time, the implant may mechanically not be charged. After healing, the abutment is usually with screwed or glued to the implant and then the Superstructure applied to the abutment. The abutment carries one so-called Aufbaustift, which for mechanical attachment of the superstructure used on the abutment.

This However, construction has several disadvantages. By design creates a bacteriological between the implant and the abutment settable gap. Periodontal pockets along the abutment in Direction bones form open entry points for bacteria. Prevent the acids formed by the bacteria as excretions ingrowth of the gum with the implant / abutment in the area of the gap. The jawbone always forms according to the biological latitude back; often occur in addition still inflammation of the gums and other bone burials, as well as others Gum loss on. As a consequence, bacterial Bags that are inaccessible to the patient expensive and for the patient annoying dental Recall measures for bacterial bag cleansing make necessary and regularly too lead to the loss of the implant. The implementation the bags purge also has the Disadvantage that the gums, due to this, in the area above the gap between abutment and implant not with the Abutment may be overgrown. On top of that, the meantime unavoidable poor accessibility The periodontal pockets have a proper oral hygiene in this area prevents and as a result the implant as a result of the patient uncomfortable. While this time the inflammation proceeds and destruction the healthy tissue continues to advance.

One Another disadvantage is that the screw connections between root implant and abutment are exposed to high mechanical loads. Thereby there are regular micro movements between the implant and the abutment and not least to screw fractures with the consequence of high costs. Will the screw connection with cement or glue fixes, so can also leaking material may cause irritation of the gums.

The Root implants are common as graded in different sizes, prefabricated, rotationally symmetrical standard implants executed. by virtue of the CE regulations for The sterilization of medical items is allowed by the implantation by leading Dentist during this does not customize the prefabricated implants. by virtue of the given gradation therefore often compromises regarding the size of the used Implants are received. Another disadvantage is that the implant not due to the drilling of the implant bed in the comb-shaped jaw arising bone dehiscences can be adjusted. Consequently such implants have a much lower bone contact area and associated poorer anchoring than this individual adaptation possible would. Furthermore the anatomical soft tissue requirements of the gums are not taken into account. aesthetics and hygiene are severely limited. The uncompensated Bone dehiscences are a regular cause of education of unwanted Gingival pockets. After all high storage costs arise because the prefabricated standard implants in many sizes and Shapes must be kept.

The Attachment of the superstructure to the abutment with the aid of a post leads to unfavorable force distributions and leverage ratios, causing an increased Risk of breakage exists. In addition, with screwed-on pens still detectable destructive Micro-movements on.

In Recent years have seen significant progress in implant technology reached; many developments are directed towards elimination the o. g. Problems.

So will in DE 196 47 489 A1 proposed to apply to the abutment at the point of contact to the endosseous implant body directly aufgalvanisierte, plastically deformable metal layer. This is to avoid the formation of the bacteriologically colonizable gap between the abutment and the implant become. Analogously, in DE 196 47 490 A1 stimulated to insert a gold disc between the implant and the implant abutment. Although both solutions result in a minimization of the gap, it is expected that the contact between titanium, gold and gums as well as saliva causes irritative chemical reactions. A bacteriological colonization can not be ruled out.

In WO2004 / 058096 A1 an abutment is described, which is provided with an axial continuous bore. It is intended to screw the abutment to the implant, whereby the screw connection is additionally fixed with cement. The continuous bore serves to push excess cement out during bonding and collect on the flat head of the implant. From the head, the cement can be easily removed. Thus, gingivitis can be prevented by leaking cement in other places.

DE 10 2005 027 402 A1 discloses a method for making an individualized replacement tooth that can be received via a connecting pin in a healing implant. To reduce the effort in the creation of dentures, it is proposed to produce the replacement tooth in one piece. This can be dispensed with a separate abutment. This is undoubtedly Ver simplification achieved, but the problem of bacteriologically populated gap remains.

In EP 0 967 931 B1 a dental implant is presented, which consists of a conical shaft portion and a divergent head portion, wherein both portions are formed integrally or as a connected part. The dental implant system also includes an abutment matching the dental implant that supports a dental prosthesis / crown. The abutment is screwed into the conical shaft section of the dental implant using a screw.

By the one-piece or integral design of shaft and head section Although a micro-gap in the endosseous area is avoided, the training a bacteriologically settable gap between the shaft / head section and abutment in the gingival area, however, is inevitable.

In EP 0 891 163 B1 a dental support bearing is described, which is composed of an implant and an abutment. The upper edge of the abutment and correspondingly the lower edge of the attached crown are adapted to the corresponding exit profile and the sizes of the tooth to be replaced upon exiting the gum.

Thereby, that the boundary between abutment and crown adapted to the course of the gum becomes, become aesthetic and functional advantages over rotationally symmetric solutions reached. However, the border between abutment and crown is exactly at the height the gumline or above. Since gums usually recede over time, let yourself do not avoid that after some time the metallic abutment on the Gingiva reaches and becomes visible.

As an alternative to the tooth replacement described above, it is generally state of the art to use a rotationally symmetrical implant in which the endosseous parts of the implant, the abutment and possibly the build-up pin are made of one piece or at least joined seamlessly (see FIG. DE 10 2005 001 185 A1 ).

such Implants accordingly avoid from the outset a gap in the border area between jawbone and gums, The gums can easily grow together with the implant Micro-movements are avoided. Nevertheless, these implants could for several key reasons do not enforce. One reason is that the lift pin is by design sticking out into the mouth. this leads to inevitably to mechanical stresses on the implant during the Growing in and out frequently for failure of implantation. Another reason is that due the rotational symmetry of the implant this at the transition from crown to gum remains visible, which is particularly aesthetic when using titanium establish is not acceptable. It is particularly disadvantageous that the through the Bore in the comb-shaped Jawbones caused vestibular / buccal and palatal / lingual bone dehiscences not taken into account by the shape of the implant.

task The invention is to eliminate the disadvantages of the prior art. In particular, should be an aesthetic appealing dental implant system invisible to the gumline be created, which is a good ingrowth of the gums in the gingival area allows and a mechanically stable and durable connection of a tooth structure ensured with the jawbone.

These The object is achieved by the characterizing features of claim 1 solved; further advantageous embodiments arise from the claims 2 to 8.

It is based on a dental implant system, which consists of an implant and a superstructure built on it. The implant tartar is composed of a typically lower or upper endosteal area, a widening upper enossal area with a roughened surface, a transgingival area with a smooth wall surface and a transgingival implant head. All these areas connect seamlessly and without gaps.

Of the lower enossal area is common rotationally symmetric cylindrical / conical, combined rotationally symmetric cylindrical / conical, rotationally symmetric stepped cylindrical / conical or combined rotationally symmetrical stepped cylindrical / conical shaped. It is preferred with a honeycomb structure with peaks at the corners provided for a good ingrowth behavior in the jawbone is known.

To proviso According to the invention, the upper enossal area is in vestibular / buccal direction and in the palatal / lingual direction a different shortening. Accordingly, the upper enossal area, in places, on which he rests on the side of the ridge, executed higher. This will make the implant exactly adapted to the patient-specific comb shape of the jaw and As a result, the resulting from the bore of the implant bed Bone Dehiscences Completely considered by the implant. Due to the fact that the upper enossal area widens upwards, When implanting a larger bone contact surface and thus achieved a better grip of the implant in the jawbone.

Of the smooth transgingival area is corresponding to the cavity in the gum shaped of the patient. Due to this anatomical shape points the transgingival region at each longitudinal and each cross section a different shape than in the corresponding before or after lying longitudinal or Cross-section on.

Of the transgingival area becomes upward through an individually shaped, Three-dimensionally differentiated in height, width and depth shaped transgingival Implant head limited, d. H. the implant head forms the "lid surface" of the implant. He also shows each longitudinal section and a different shape to each cross section than before or after lying longitudinal section or cross-section on. The way through the transgingival area and corresponds to the transgingival implant head formed, circumferential edge here the preparation border and is shaped so that they are scarce after implantation, typically 1 mm, below the gingival margin.

Of the Transgingival implant head has a flat in its center Range up. This is surrounded by a steep sloping section, which connects the flat portion with the transgingival portion. In this case, that is formed by the flat region of the implant head Plateau arranged so high that it is in an approximal direction height of upper gum line is located.

conditioned by adapting the upper endosteal area to the patient-specific comb shape of the jaw, is the steeper portion of the implant head in vestibular / buccal Direction as well as in the palatal / lingual direction longer and steeper than in the rest Directions.

On the entire area of the implant head is a superstructure with its underside, which is adapted to the shape of the implant head, glued or cemented. This compound takes up much of the between implant and superstructure acting forces. To avoid a lateral Shift and to achieve further mechanical stabilization, is additional a construction post about in the center of the preparation area in the screwed on transgingival region of the implant and on the other side connected to the superstructure. The basal surface of the The abutment lies on the flat part of the transgingival implant head on and acts as a force-compensating Kippmeider and as force-absorbing and transferring Part.

The Implant is advantageously made of one piece (blank). When proven medical technology Titanium and zirconium oxide as well as all materials are available here suitable materials for dental implantation.

The Dental implant system according to the invention shows opposite usually used systems several advantages.

An essential advantage of the implant system is that it does not require an abutment, which avoids a bacteriologically settable gap in the border area between the jawbone and gum from the outset. Since the preparation margin is just below the gingival margin, it is accessible to the patient and can be easily cleaned by the patient. The need for dental bag cleanings is eliminated. In addition, during the ingrowth phase of the enossal area into the jawbone, the implant can simultaneously grow together with the gum in the transgingival area. This is particularly beneficial when the gum is still "fresh and bloody" due to the procedure for implantation, and since there is no need to clean up the pelvis, the gum that has grown on the implant does not have to be loosened again later and annoying for the patient Re call measures are avoided and also, since not as usual, form periodontal pockets, the implant is hardly perceived by the patient as a foreign body, since the measures for oral hygiene in this area are simple and above all safe to deal with.

By the removal of the screw connection between implant and abutment, become the otherwise constructive micro-movements between implant and abutment that often the cause of screw breaks though also for a regression of the surrounding jawbone section and subsequently also the cause for the degeneration of the above Jawbone and supported by the bone and stabilized gums are excluded.

By the individual size and shape adapted to the anatomy of the patient of the lower enossal area, the greatest possible bone contact area is achieved. Due to the upward widening shape and the exact adjustment of the upper enossal area to the crest of the jawbone and the associated complete Adaptation to the bone dehiscences arising from implant bed drilling, will be alike a big bearing surface ensured in the upper area of the jawbone. Due to his structured or rough surface The endosteal area of the implant can move quickly and with the jawbone safely grown together.

The only connection point of the dental implant system is chosen so that On the one hand, it can be cleaned by the patient, but on the other hand mechanical loads during the ingrowth phase by mechanical contact, such. B. with others teeth be largely avoided.

in the Contrary to the dental implant systems used so far, in which the mechanical connection between implant and superstructure mainly over a Abutment / a build-up pin takes place in the system according to the invention a large area cohesive connection, made by glue or cement between implant head and bottom the superstructure, the mechanical loads. The used Prosthetic post has a supporting function, prevents one lateral shifting during of introducing the superstructure, and acts by the basal Support on the flat part of the transgingival implant head with lateral forces as a force-absorbing element.

The manufacture of a dental implant system and its introduction into the jaw or oral cavity of the patient comprises the following steps:
First, the jaw shape and the shape of the gum of the patient to be treated are recorded by CT (computed tomography), DVT (volume tomography) or, alternatively, with OPG.

At a blank from which the entire implant can be made is first determined on the basis of the determined anatomical diagnostic data shaped the endosseous section using the CAD / CAM technique. This Section is rotationally symmetric cylindrical / conical, combined rotationally symmetric cylindrical / conical, rotationally symmetric stepwise cylindrical / conical or combined rotationally symmetric stepped cylindrical / conical shaped. To allow a good ingrowth in the bones, the endosseous section is provided with a structure. Preferably This is a proven Honeycomb structure, which has tips at their vertices, chosen.

Subsequently, will adjacent to the endosseous section corresponding to the anatomical Diagnostic data another endosseous area shaped by CAD / CAM. For individual adaptation to the comb shape of the jaw is here in vestibular / buccal Direction a stronger one and in the palatal / lingual direction a smaller shortening incorporated. This way will be later Bone dehiscences arising during the drilling of the implant bed from the implant shape completely considered.

After that becomes a transgingival region based on the determined anatomical Diagnostic data by manual processing or possibly by CAD / CAM produced. The individual shape, in any case the transgingival region in each longitudinal section and each cross-section one other than the one before or after longitudinal section or cross section.

thereupon becomes the transgingival region bordering the transgingival region Implant head by manual processing or if necessary by CAD / CAM produced. The implant head is based on the diagnostic survey data the shape and the edge of the cavity in the gingiva so formed that through the preparation surface and the edge formed after the transgingival region after implantation runs below the gum line. Approximately in the middle of the implant head becomes a shallow subarea and surrounding it a steeper sloping Shaped section. Due to the steeper part of the area flatter subregion and the transgingival region with each other connected. Furthermore is a threaded hole for the inclusion of a recording post in the flat part of the Implant head introduced.

When next becomes the transgingival area and the transgingival implant head smoothed. The smoothing is preferably carried out by mechanical manual polishing or through CAD / CAM.

In one next Step, the roughening of the surface of the entire endosseous Area of the implant by means of suitable techniques.

When Next Step is a gradual approach leading to the diameter of drilling implant bed. This is done first in the jawbone the implant bed gradually with appropriate drills, starting at a diameter of about 1 mm smaller to a 0.5 mm smaller diameter as the lower endosteal area of the implant. Subsequently, will Based on the bore or by further test methods, the hardness or quality of the bone. Since the bone quality and hardness during the Extension of a well can drastically change the diameter of the borehole gradually increased in increments of 0.1 mm. With every completed drilling will determine the bone quality and the diameter drilling using suitable measuring instruments and procedures checked. The hole is gradually enlarged until the bone quality and the Size of the borehole are optimally matched to each other.

After that Insertion of the implant by knocking the endosseous Area in the borehole.

Then heals the implant over a period of 3 to 6 months in the jaw.

In a further step, a suitable post is selected or produced. If the implant shows no angulation, then a straighter, Prefabricated post, threaded on one side for screwing into the transgingival implant head and on the opposite Side uses a pin for attachment to the superstructure used become. When an angulation occurs, a sheath becomes off burnable plastic either subtractive by mechanical Abtrag or additive individually formed by applying wax. The model thus produced is then modeled after the casting method of lost model cast from metal, with a screw in the longitudinal direction through the sleeve guided is and the pin sleeve on Transgingival implant head screwed by means of this screw becomes. Alternatively, the post can also be completely by means of CAD / CAM are produced.

Of Furthermore, an individual is connected to the diagnostic data of the patient adapted suprastructure, such. As a crown or bridge made. It can for the Bottom of the superstructure, which serves as a connection surface to the Implant serves, for the formation of the edge the already existing geometric data the preparation margin and for the shaping of the topology of the surface the bottom uses the inverted data of the surface of the implant head become.

To Successful healing of the implant is the build - up pin in the Screwed on the implant head threaded hole.

Subsequently, will the underside formed according to the shape of the implant head the superstructure adhered to the entire surface of the implant head or cemented. In the same step, the pylon with the Suprastructure mechanically connected.

The The invention will be explained in more detail with reference to an embodiment; For this show in a schematic representation:

1 : a dental implant with crown (section, view of vestibular)

2 : a dental implant (section; view of approximal)

3 : an implant head in plan view

In 1 is a one-piece dental implant made of titanium with a crown attached to it 10 shown as a cross section with a palatal view. For better clarity shows 2 an implant with a prosthetic abutment post 7 in cross-section, but with a viewing direction in the direction of the jawbone.

The implant consists of a lower enossal area 1 , an upper enossal area 2 , a transgingival area 3 and a transgingival implant head 4 , To produce the implant area 1 and area 2 with the help of CAD / CAM as well as area 3 and the transgingival implant head 4 molded from a blank using CAD / CAM or manual machining.

The deep enossal area sitting deep in the jawbone 1 has a honeycomb pattern with peaks in each of the corners of the honeycomb. This proven structure allows for optimal ingrowth of the implant.

At the lower endostal area 1 closes the upper endosseous area 2 which is shaped so that its upper edge just to the top of the comb-shaped jawbone 5 enough. To achieve this, usually the upper enossal area 2 on the vestibular side we considerably shorter and slightly shorter on the palatal side than in the remaining places. However, there are also cases where the palatal side has to be made shorter than the vestibular one for exact adaptation to the crest shape of the jaw. Bone dehiscence, which results from drilling the implant bed, is completely anatomically captured by this special design. In addition, a wider contact surface and a better distribution of forces in the bone 5 to reach, becomes the upper endosseous area 2 wider towards the top (funnel shape). Due to its roughened surface, the area can 2 also with the jawbone 5 overgrown.

The area 2 follows the smooth polished transgingival region 3 , This area is shaped so that it extends circumferentially to about 1 mm below the gingival margin, which corresponds approximately to the depth to which even with a healthy tooth, the gum is not fused with the tooth, but only loosely. The smooth polished titanium surface allows a good and irritation-free growth of the gums 6 ,

At the end of the transgingival area 3 , which at the same time the preparation margin 11 forms, the transgingival implant head closes 4 at. The implant head 4 consists of a flat, almost flat inner portion 12 and a surrounding, steeper shaped partial area 13 , The steeper part 13 connects the flat part area 12 with the transgingival area 3 , Due to the adaptation of the implant to the comb shape of the jawbone 5 is the subarea 13 in the vestibular / buccal direction usually much longer and steeper and in the palatal / lingual direction slightly longer and steeper than in the remaining places.

How out 3 can be seen, is located in the flat portion 12 of the implant a threaded hole for the attachment of the prosthetic post. Also, in the subsection 12 a groove 14 embedded in the form of a circular segment piece, which prevents twisting of the crown; this is on the bottom of the crown 10 formed a corresponding counterpart. As in 2 is an individually created prosthetic post 7 used. This also engages in the groove 14 and is thus secured against twisting. Becomes a straight, standardized post 7 used, so this does not engage in the groove 14 but only its pin-shaped part is beveled. When later cementing the pin in the crown 10 , in turn, over the groove 14 and the actual shape of the implant head 4 right up to the preparation margin 11 is secured against rotation on the implant, this is then against rotation with the crown 10 connected.

The underside of the crown used as a connection to the implant 10 is exactly to the shape of the implant head 4 right up to the preparation margin 11 customized. It is advantageous that for the design of the edge of the bottom of the already existing geometric data of the preparation border 11 and for the production of the surface of the bottom the inverted geometrical data of the implant head 4 can be used.

The thus adapted underside of the crown 10 is full-surface and gap-free with the transgingival implant head 4 connected by cement or glue. Possibly occurring during bonding or cementing material may be due to the good accessibility of the preparation margin 11 be removed easily. In addition, in the crown is the smooth part of the prosthetic post 7 cemented. The construction pencil 7 is with the other, helical side in the implant head 4 screwed. Here, the entire surface bonding between crown takes 10 and implant a large proportion of the forces occurring during chewing. The over the prosthetic post 7 made compound and flat overlay on the flat part 12 of the implant head 4 serves to prevent lateral displacement and support the absorption and transmission of shear forces.

1

lower endosseous area

2

upper endosseous area

3

transgingival Area

4

transgingival implant head

5

jawbone

6

gingiva

7

prosthetic structure pin

8th

thread

9

threaded hole

10

Crown

11

Preparation border / edge

12

flat subregion

13

steeper subregion

14

groove

15

vestibular / buccal shortening

16

palatal / lingual shortening

Claims (8)

A dental implant system comprising an implant and a superstructure constructed thereon, wherein the implant consists of a honeycomb-shaped or thread-shaped, rotationally symmetric cylindrical / conical, combined rotationally symmetric cylindrical / conical, rotationally symmetric step-shaped cylindrical / conical or combined rotationally symmetrical step-shaped cylindrical / conical lower endosseous region ( 1 ), widening towards the top upper enossal area ( 2 ) with a roughened surface, a transgingival region ( 3 ) with a smooth wall surface and a transgingival implant head ( 4 ) and connect all areas seamlessly and without gaps, characterized in that - the upper endosseous area ( 2 ) in the vestibular / buccal direction a stronger shortening ( 15 ) and in the palatal / lingual direction a smaller shortening ( 16 ), whereby the geometry of the implant of the patient-specific comb shape of the jawbone ( 5 ), - and the transgingival area ( 3 ) is shaped according to the cavity in the gum of the patient, whereby the transgingival region ( 3 ) has a different shape for each longitudinal section and each cross-section than for each before or after longitudinal section or cross-section, - and the transgingival section ( 3 ) to the top by a trans-divergent implant head (three-dimensionally differentiated in height, width and depth) ( 4 ), wherein the peripheral edge ( 11 ), which by the contiguity of the implant head ( 4 ) and the transgingival area ( 3 ) is formed, after implantation runs below the gum line, - and the implant head ( 4 ) has a flat partial area approximately in its middle ( 12 ), at which a steep sloping subregion ( 13 ), through which the flat portion ( 12 ) and the transgingival area ( 13 ), wherein the underside of a superstructure ( 10 ), which conform to the shape of the implant head ( 4 ) is adapted to the entire surface of the implant head ( 4 ) is glued or cemented and for mechanical support and as a force-absorbing element a building post ( 7 ) with its one side approximately in the center of the flat portion ( 12 ) of the implant head ( 4 ) and glued into the superstructure on the other side. Dental implant system according to claim 1, characterized in that the implant, consisting of the lower enossal area ( 1 ), the upper endosseous area ( 2 ), the transgingival area ( 3 ) and the transgingival implant head ( 4 ), is made in one piece. Dental implant system according to claims 1 and 2, characterized in that the implant consists of titanium. Dental implant system according to claims 1 and 2, characterized. that the implant consists of zirconium oxide. Dental implant system according to claims 1 to 4, characterized in that the edge ( 11 ) after implantation approx. 1 mm below the gingival margin. Dental implant system according to claims 1 to 5, characterized in that the transgingival implant head ( 4 ) a recess ( 14 ), which serve as a safeguard against twisting of the superstructure ( 10 ), has. Dental implant system according to claim 6, characterized in that the recess ( 14 ) has the shape of a circle segment. Dental implant according to claims 1 to 7, characterized in that a prosthetic abutment post ( 7 ) in the recess ( 14 ) intervenes.