FR3027792A1 - HEALING ELEMENT FOR DENTAL RESTORATION - Google Patents

Abstract

A healing element suitable for connection with a dental implant, comprising a lateral surface (13) for integration within a gingiva to shape the gingiva during its healing, and an end surface (14), characterized in that a part of the lateral surface (13) and the end surface (14) form an emergent surface, intended to remain out of the gingiva, asymmetrical with respect to at least one perpendicular median plane.

Description

The present invention relates to a healing element for a dental restoration and to a method of manufacturing a dental restoration abutment based on such a healing element. Dental restoration makes it possible to perform an artificial dentition for a partially or totally edentulous patient. It is based on the integration of one or more implants in the bone structure, made by incision of the gum to reach the bone structure and pierce it. Next, a healing element is generally attached to an implant and this assembly remains untouched until the implant is secured to the bone structure by osseointegration and healing of the gingiva around the healing element. Dental restoration can be finalized by attaching a restoration abutment to the implant, to which the dental prosthesis is attached. The abutment and the dental prosthesis are personalized, adapted to the anatomy of the patient and the tooth to be replaced, to reach a result as close as possible to the ideal natural dentition. For that, the precise volume of the space to be restored is generally taken into account, by taking an impression, which allows the personalized manufacture of the dental prosthesis. In the state of the art, the existing methods of dental restoration face all or some of the following technical problems: in many existing methods, a new intervention on the gingiva is performed after its healing after the implant pause, to realize the footprint, material or digital, of the space to restore, while having a view of the implant and the gum to take into account precisely all of this geometry, in order to build a pillar and a prosthesis of precise forms: this approach is naturally traumatic; other existing methods limit this trauma by using healing components that are not removed during an impression, so as not to hit the gum: in return, these processes use particular healing elements, generally of shape substantially cylindrical and standard and sometimes incorporating indicators and / or several complementary components to allow taking into account all or part of the geometry above the implant without having full access by taking an impression. These less traumatic methods then have other disadvantages, complexity and / or less good optimization of the healing phase. Thus, a general object of the invention is a dental restoration solution which does not include all or part of the disadvantages of the state of the art. More specifically, a first object of the invention is a dental restoration solution that minimizes trauma to the patient during the restoration process. A second object of the invention is a dental restoration solution which allows a restoration as adapted as possible to the anatomy of the patient.

A third object of the invention is a dental restoration solution as universal as possible, suitable for any implant and any restoration. A fourth object of the invention is a simplest possible dental restoration solution. For this purpose, the invention is based on a healing element suitable for connection with a dental implant, comprising a lateral surface intended for integration into the dental implant. within a gingiva to form the gingiva during healing, and a terminal surface, characterized in that a portion of the lateral surface and the end surface (14) form an emergent surface, intended to remain out of the gingiva, which is asymmetrical with respect to at least one perpendicular median plane. The emergent surface portions for respectively inward and outward oriented positioning of the mouth may have a different shape. A transverse section of its lateral surface or a projection on a parallel plane of the emergent surface may have: a substantially trapezoidal shape or a substantially polygonal, or triangular, or square, or rectangular, or oval shape, or a shape substantially polygonal with rounded corners, and / or - a portion for an outwardly oriented positioning of the mouth of greater dimension than a portion for inwardly facing positioning, its end surface and / or its emergent surface may have: - a non-planar, curved surface, and / or - a convex surface, and / or a non-protruding surface.The healing element may be a cap which comprises an opening in a surface opposite to the end surface for cooperating with a pillar base The healing element may comprise an anti-rotational element, in particular a groove, for its fastening with a collar e of pillar without rotation around the pillar base.

Its end surface or emerging surface may include an indicator to indicate its height or the healing element may include a color to indicate its height. The healing element may be a healing abutment that includes a connection device with an implant. The invention also relates to an assembly formed by the removable association of a pillar base and a cap, characterized in that the cap is a healing element as described above.

The abutment base may include a connection device with an implant, and the end surface or emergent surface of the cap may include a side parallel to a planar surface of the connecting device.

The invention also relates to a series of healing elements, characterized in that it comprises at least two healing elements as described above having different shapes, or in that it comprises at least three healing elements of different forms. The invention also relates to a method of manufacturing a dental restoration abutment, intended to be fixed on a dental implant on a first end and to receive a prosthesis on its second end, characterized in that it comprises the steps following: - taking a manual or digital impression of the oral space comprising a healing element as described above fixed on the implant; - Automatic detection of the positioning of the implant by identifying: - the axis of the implant corresponding to an axis of the healing element identified by the geometry of its emergent surface out of the gum or from an association with a stored healing element stored in a database, in particular from its reference entered in a man-machine interface or its automatic recognition by the shape of its emergent part; - orientation of the implant from the orientation of the emergent surface out of the gum or from an association with a healing element stored in a database, in particular from its reference entered in a human interface machine or its automatic recognition by the shape of its emergent part; - Height of the implant by determining the height of the healing element, from a color or indicator of its emergent surface out of the gum or from a combination with a memorized healing element in a database, in particular from its reference entered in a man-machine interface or from its automatic recognition by the shape of its emergent part. These objects, features and advantages of the present invention will be set forth in detail in the following description of a particular embodiment made in a non-limiting manner in relation to the appended figures, in which: FIGS. 1 and 2 respectively represent views in perspective 30 of a pillar base used in a restoration process according to one embodiment of the invention.

Figures 3 and 4 respectively show perspective views of an intermediate phase of association of a cap on a pillar base in a restoration process according to the embodiment of the invention. Figures 5 and 6 respectively show perspective views of the assembly obtained after fixing a cap on a pillar base in a restoration process according to the embodiment of the invention. Figures 7 and 8 show respectively the same perspective views on which the cap is shown in transparency to view the pillar base. Figure 9 shows the lower and upper teeth in plan view. Figure 10 shows a view of the teeth in a just-gingival section. Fig. 11 shows a horizontal section of the just-gingival dentition and the corresponding caps retained according to the embodiment of the invention. Figures 12a-12d and 13a-13d respectively show perspective views from above and below of a series of caps according to the embodiment of the invention. Figs. 14a to 14d show side views respectively of the series of caps according to the embodiment of the invention. Figures 15a to 15d respectively show top views of the series of caps according to the embodiment of the invention. Figures 16a to 16d respectively show bottom views of the series of caps according to the embodiment of the invention. Figs. 17a to 17d and 18a to 18d respectively show perspective views from above and below of an intermediate phase of association of the series of caps with pillar bases in a restoration method according to the embodiment of the invention. Figures 19a to 19d respectively show side views of the series of caps assembled with pillar bases according to the embodiment of the invention. Figures 20 to 22 show sectional views through a vertical median plane illustrating steps of the restoration method according to one embodiment of the invention. Figure 23 illustrates a sectional view of a cap according to the embodiment of the invention disposed on a pillar base fixed in an implant. According to the embodiment of the invention to be described, a dental restoration uses an intermediate component which we will call pillar base 1, which is sometimes called simply abutment or T-base or Esthetitase. The abutment base 1, particularly shown in FIGS. 1 to 8, comprises two main parts separated by a collar 2. A first part comprises a connection device 3 with an implant. A second coronal portion is intended to receive a healing cap 10. For this, it comprises a connection device 4 with such a cap. According to the embodiment, this device of connexicin 4 comprises a clipping element 5 and an anti-rotational element 6, to prevent the cap from rotating about the longitudinal axis L of the pillar base 1, this longitudinal axis L being further intended for alignment with the axis of an implant. According to the embodiment, the anti-rotational element 6 is a lug. This anti-rotating element 6 is further aligned with a particular surface of the connection device 3 with an implant. In addition, according to the embodiment, the clipping element 5 is formed by several grooves arranged on the circumference of the pillar base 1 in the vicinity of the collar 2. Following the fixation of an implant during a dental restoration method, a pillar base 1 is fixed on the implant 60 by its connecting device 3, and by means of a screw 61, then a cap 10 is fixed on the second coronal portion of the base of pillar. This assembly is illustrated in FIG. 23. As illustrated in particular by FIGS. 3 and 7, the cap 10 comprises an opening 11 in its connecting part and a hollow interior volume, allowing the insertion of the second coronal part of the base. of pillar. The periphery of this opening 11 comprises a surface 12 intended to rest on a corresponding flat surface of the flange 2, after clipping of the cap 10 on the pillar base, to reach the assembled assembly represented by FIGS. 5 to 8. and 19a to 19d.

There is as much different pillar base as different connection devices existing implants, to be able to have, for each existing implant, a pillar base with a connection device 3 which is adapted. The advantage of this approach is that it keeps the entire second coronal portion of the pillar bases, from the collar 2, unchanged, regardless of the implant corresponding to the pillar base. Naturally, it is also possible to provide different second coronary parts for different pillar bases, depending on their intended use. In all cases, the second coronal portion of the abutment base is independent of the implant, decorrelated from the implant fixation device.

The cap 10 has the function of being housed within the incised gingiva, after fixation of an implant, by attachment to a pillar base connected to the implant. The gingiva thus heals around the lateral surface 13 of the cap 10. For this, this lateral surface 13 is chosen to best match the oral medium of the patient. The end surface 14 opposite the opening 11 of the cap is intended to remain visible above the surface of the gingiva, since the gingiva remains in full contact with the lateral surface 13 of the cap. As a remark, the upper part of the lateral surface 13 and the end surface 14 thus form an emergent surface of the cap. For this, caps of different height can be provided to adapt to different configurations of the oral geometry. As exemplary embodiments, three different standard heights allow a good adaptation to all situations. This height is advantageously between 3 and 7 mm. Because of the use of a pillar base which acts as an interface, the same cap 10 is thus universally adapted to all existing implants. According to the embodiment of the invention, the shape of the cap is specifically chosen to promote the healing of the gingiva, in an anatomical form corresponding best to the tooth to be replaced and therefore also to the future prosthesis intended to occupy this space oral. This shape is particularly characterized by the flat section of its lateral surface 13, this section being a transverse section by a plane perpendicular to the lateral surface, and substantially parallel to the end surface 14. As a remark, this section is substantially reproduced by the shape From this end surface 14. To understand the approach adopted, FIG. 9 illustrates a view from above of the upper and lower teeth and FIG. 10 illustrates a sectional view at the just-gingival level of a dentition, at the level of the root. emergence of teeth. These figures show that the teeth have sections of different shapes, which can be simplified by rectangular shapes and / or square and / or triangular, but more precisely trapezial. According to the embodiment chosen, a series of caps 10 of different shapes will make it possible to best reproduce these different shapes. Figure 11 thus shows a top view of the sections of all the teeth and a top view of the caps associated with each tooth. The shapes of the different series of teeth, numbered from 11 to 18, from 21 to 28, from 31 to 38 and from 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 caps 10, referenced A to D. For some teeth, or all teeth, several caps, among the caps A to D, appear suitable. In the exemplary embodiment chosen and illustrated in FIG. 11, the caps A are adapted to treat the restoration of the upper lateral incisors and all the lower incisors. The caps B are suitable for restoring the canines and premolars, the caps C are suitable for restoring the intermediate molars and then the caps D are suitable for restoring the larger molars. These caps will now be described in more detail. The cap A is particularly illustrated in FIGS. 12a to 16a, the cap B in FIGS. 12b to 16b, the cap C in FIGS. 12c to 16c and the cap D in FIGS. 12d to 16d. In order not to weigh down the figures, the numerical references are not reproduced on all the caps of these figures; however, all these caps have the same characteristics, which will be described. As is apparent from FIGS. 12 and 15, the end surfaces 14 of these caps 10 (A to D), intended for positioning above the gingival emergence, are substantially planar and intended for positioning parallel to a horizontal plane ( parallel to the right-gingival plane, between 1 and 2 mm included above this plane) corresponding to the section plane of Figure 9. They are, however, slightly curved, having a central portion 145, more particularly visible in Figures 14a to 14d, intended to rise further beyond the gumline than its peripheral parts 146. The transverse section of the cap, which gives the final shape to the gingiva after healing, is substantially reproduced by the end surface 14 of the cap, which comes in its extension. The sections of all the caps all have a substantially trapezoidal shape. They comprise a large side 141, which will be arranged on the side of the outside of the mouth, a small parallel opposite side 142, which will be arranged on the side of the inside of the mouth, connected by two sides 143, 144. The cross diagonals of the trapezium makes it possible to define a center 15. Moreover, by considering the center 17 of the substantially circular opening 11 of the opposite surface of the cap 10, it is possible to define an axis 18 of the cap passing through the two points. 15, 17. This axis 18 of the cap 10 is perpendicular to the end surface 14. The entire architecture of the pillar base and associated cap 10 is designed so that the axis 18 of the cap corresponds to the longitudinal axis L of the abutment base, and to the axis of the implant.

The four types of caps 10, A, B, C and D, therefore differ in particular by the trapezoidal shape of the transverse section of their lateral surfaces 13. The trapezium of the smaller cap A approaches a triangle because its small side 142 is very small. The trapezium of the cap B approaches a rectangle, whose long side goes from the outside of the mouth towards the inside, and corresponds to the sides 143, 144. On the contrary, the trapezoids of the caps C and D are close to a rectangle, or even a square, whose long side is in the opposite direction, and corresponds to the sides 141, 142, which are of close length but slightly different. By way of exemplary embodiments, FIGS. 16a to 16d give orders of magnitude of the dimensions of these caps, in millimeters. Naturally, this substantially trapezoidal retained shape has rounded corners and curved sides, to ensure that it does not hit the gum. In addition, the end surface 14 of each cap has a continuous surface, without relief, and / or without hollow portion, and / or without groove, and / or without stops, and / or without asperity. This surface is convex. This stepless geometry is favorable to oral hygiene, for example preventing the accumulation of food and the deposition of dental plaque. As a variant, the series of caps could comprise a different number of different geometries, for example at least 3, or even at least two. In a simplified embodiment, a single cap shape could be suitable for all teeth. According to other embodiments, the cross section of a cap at its lateral surface 13 could approach any polygon, such as a polygon with three, five or six sides. Alternatively, the angles of these polygons could be so rounded that the overall shape would approach an oblong shape, or even an ovoid section, or even any form further away from a polygon. Advantageously, this shape comprises at least one center or point perfectly defined geometrically to define a center 15, or even a possible axis 18 of the cap, this center being advantageously, but not necessarily, in alignment with the longitudinal axis L of the pillar base. According to the embodiment, the geometry of the visible emergent surface of the hood on the side of the inside of the mouth differs from the geometry on the outside, to take into account the curvature of the gingiva. This shape of the emergent surface of the cap is therefore asymmetrical with respect to a median plane containing the tangent T to the gingiva, shown in FIGS. 15a to 15d and more specifically in FIG. 9, considering a tooth 50 to be restored. Thus, a circular shape, associated with a cylindrical cap, is unsuitable. More generally, any plane curve having a symmetry around a point or an axis is little or not adapted, 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 cap is therefore not symmetrical with respect to at least one, or even several planes parallel to its axis 18 and including this axis 18, or several planes perpendicular to the emerging surface and passing by its center, which we call perpendicular median planes. In the example shown, only the plane perpendicular to the tangent plane T mentioned, passing in the middle of the two sides 141, 142, forms a plane of symmetry.

This emergent surface of a cap can finally take any identifiable three-dimensional shape, allowing the cap used to be recognized and possibly to know its orientation. The end surfaces 14 of the caps are extended from their periphery 146 by the lateral surface 13 around which the gingiva heals, and which thus gives the shape of the gingiva adapted to the future prosthesis.

This lateral surface 13 has several surfaces 131, 132, 133, 134, which are substantially flat, possibly slightly curved, extending in a direction substantially parallel to the axis 18 of the cap and / or parallel to the longitudinal axis L of the pillar base, respectively extending the different sides 141, 142, 143, 144 of the end surface 14 of the cap. The interfaces between the end surface 14 and these different parts of the lateral surface 13 are formed by rounded, smooth surfaces, in particular convex surfaces.

Finally, the lateral surface 13 of the caps terminates in a substantially frustoconical surface 19 to the substantially circular aperture 11 mentioned above. This opening 11 opens on a hollow portion internal to the cap 10, which allows the housing of the second coronal portion of the pillar base. This hollow portion is provided with a fixing device 15 complementary to that 4 of the pillar base. In the embodiment, these are beads intended to snap on the grooves 5 of the pillar base. Finally, a substantially longitudinal groove 16 is arranged in this hollow portion of the cap, to cooperate with the lug, thus forming a locked connection in rotation, and perfectly indexed, the orientation of the cap being unique and perfectly imposed. Figures 3 to 8 and 17a to 17d, 18a to 18d and 19a to 19d, particularly show the assembly of a cap 10 with a pillar base 1. The cap may be of plastic material, compatible with medical use , and pink, white or cream. Alternatively, it may be metal, for example titanium, or may be zirconia. The use of healing caps thus makes it possible to promote ideal healing of the gingiva in a dental restoration process, as has been discussed, because of its geometry designed in phase with the oral anatomy. The solution has been described with a healing cap in the previous embodiment. Alternatively, a solution without a pillar base can be implemented, by means of a single healing element, or abutment, comprising a connection device with an implant and a shape corresponding to the cap described above. Thus, the invention relates to any healing element, for example a cap associated with any subgingival healing screw or abutment, which comprises the characteristics of the cap described above. As a remark, this healing element may alternatively be totally subgingival and invisible, then made visible by intervention on the gingiva to implement the remainder of the recognition process which is described below. In addition to the advantages described above, the healing element allows the implementation of an advantageous restoration process, including a method of manufacturing a permanent dental prosthesis and abutment, with minimal traumatization of the gingiva. Indeed, it is possible to obtain a digital or physical impression of the area to be restored without removing the healing element in the mouth, so without hitting the gum.

For this, a practitioner can take a digital impression of the patient's mouth without removing the healing element. Scanning data, obtained by any device such as an oral scanner, for example, is automatically transmitted to a computer with dental restoration software. This software is equipped with a human machine interface, by which an operator can indicate the model of cap he has used, or more generally the reference of the healing element, and possibly the implant and / or the pillar base used.

From the digitization data, a software automatically determines the axis of the healing element, by geometric construction, for example from the identification of the center and the direction perpendicular to the end surface passing through it. center 15. By this construction, it can thus automatically determine the axis of the implant, without having to view it directly. Then, as the geometry of the healing element corresponds to a single positioning around its axis 18, or around the longitudinal axis 10 L of the abutment base, to respect the oral environment and in particular the geometry of the gum towards the inside of the mouth which differs from its outward geometry, it is possible to deduce from its orientation the orientation of the axis of the connection device with the implant, for example the connection device 3 of the abutment base with the implant: this allows to deduce automatically the positioning of the connection device of the implant, without having to see it directly. By way of example, it is possible to impose during this construction that one of the parallel sides of the trapezoidal shape of the visible surface 14 of the cap is parallel to one side of the hexagon of the fixing device of a implant.

Finally, in the case where healing elements of different height exist, it remains to determine this height, to perfectly position the invisible implant. A first approach may be to form differently colored healing elements for different heights.

A second approach is to place any indicator on the visible surface 14 of the healing element to indicate this height, this indicator being able to consist of numbers and / or letters and / or any symbol and / or colors and / or or laser markings. A third approach may be to form healing elements having a different visible surface 14 depending on their height. By way of example, the caps A, B, C, D could retain the same shape but with slightly larger dimensions for greater heights, thus making it possible to differentiate them automatically and then to determine their height. In an alternative or additional embodiment, an operator enters the reference of the healing element via a man-machine interface, which enables the software to find the characteristics of this healing element such as its height, center and / or axis. in a library in the form of a database stored in an electronic memory which it can consult. Figure 20 illustrates by way of example a virtual cap 10 'stored in the library associated with the restoration software. A mark in the space 50 'is associated with the cap, allowing its positioning in the space. Alternatively, the software can automatically recognize the healing element from its geometric characteristics, without manual entry of its reference. From the digitized data, the software therefore associates the virtual healing element from its library with the digitized oral environment, replacing the actual healing element, to obtain a more perfect digital reproduction. As a remark, the shape of the real healing element makes it possible to determine its orientation, in particular because of its asymmetrical shape, as mentioned above. As shown in Fig. 21, the actual mark 50 of the actual cap 10 is thus automatically determined by the software. It is possible to position the virtual healing element perfectly on the digital impression, automatically or possibly via an intervention of an operator on a man-machine interface for visualizing the impression of the mouth and the element. healing. This perfect positioning of the virtual healing element 30 makes it possible to deduce all the neighboring geometries from known references stored in the database associated with the precise healing element in question, including the position of the implant 60. and the geometry of the healed gingiva without the presence of the cap 10 ni 'of the abutment base, as represented by FIG. 22. When the restoration software has accurately repositioned the positioning of the hidden implant, it deduces from this knowledge the final geometry of the restoration abutment to be manufactured, which must be fixed to the implant and occupy all the gingival volume defined by the healing element, then the geometry of the dental prosthesis intended to be fixed on this pillar, so as to known. As a remark, this restoration process can be done totally numerically, so virtually, or include phases of construction of a plastic model or plaster. In the latter case, a physical impression, for example made of silicone, can be made, a plaster can be cast in the impression to create the make model, ie a replica of the dental arch to be restored, which is then scanned in the laboratory to reconstruct a digital image. 20

Claims (12)

1. Healing element suitable for connection with a dental implant, comprising a lateral surface (13) intended for integration within a gingiva to shape the gingiva during its healing, and a terminal surface (14). ), characterized in that a part of the lateral surface (13) and the end surface (14) form an emergent surface, intended to remain out of the gingiva, which is asymmetrical with respect to at least one median plane perpendicular to the emergent surface and passing through the center of the emerging surface. 2. Healing element according to the preceding claim, characterized in that the parts of the emergent surface intended respectively for a positioning oriented towards the inside and towards the outside of the mouth have a different shape. 3. Healing element according to one of the preceding claims, characterized in that a transverse section of its lateral surface (13) or a projection on a parallel plane of the emergent surface has: - a substantially trapezoidal shape or a substantially polygonal, or triangular, or square, or rectangular, or ovoid, or a substantially polygonal shape with rounded corners; and / or a portion for an outwardly facing position, the mouth of larger dimension than a portion for inwardly facing positioning. 4. healing element according to one of claims 1 or 2, characterized in that its end surface (14) and / or its emergent surface has: - a non-planar surface, curved; and / or - a convex surface; and / or- a surface without asperity. 5. Healing element according to one of the preceding claims, characterized in that there is a cap (10) which comprises an opening (11) in a surface opposite to the end surface (14) to cooperate with a pillar base (1). 6. Healing element according to the preceding claim, characterized in that it comprises an anti-rotational element, in particular a groove (16), for its attachment with a pillar base (1) without rotation around the base of pillar. A healing element according to one of the preceding claims, characterized in that its end surface (14) or emergent surface comprises an indicator to indicate its height or that the healing element comprises a color to indicate its height. 8. Healing element according to one of claims 1 to 4, characterized in that it is a healing abutment which comprises a connection device with an implant. 9. Trainer formed by the detachable combination of a pillar base (1) and a cap (10), characterized in that the cap (10) is a téille elementization according to one of claims 1 to 7. 25 10. Assembly according to the preceding claim, characterized in that the abutment base (1) comprises a connection device (3) with an implant, and in that the end surface (14) or the emergent surface of the cap (10). ) comprises a side parallel to a flat surface of the connection device (3), to be able to deduce from its orientation the orientation of the connection device (3). 11. Series of healing elements, characterized in that it comprises at least two healing elements according to one of claims 1 to 8 having different shapes, or in that it comprises at least three healing elements according to one of claims 1 to 8 of different shapes. 12. A method of manufacturing a dental restoration abutment, intended to be fixed on a dental implant on a first end and to receive a prosthesis on its second end, characterized in that it comprises the following steps: a manual or digital impression of the oral space comprising a healing element according to one of claims 1 to 8 attached to the implant; - Automatic detection of the positioning of the implant by identifying: - the axis of the implant corresponding to an axis of the healing element identified by the geometry of its emergent surface out of the gum or from an association with a stored healing element stored in a database, in particular from its reference entered in a man-machine interface or its automatic recognition by the shape of its emergent part; - orientation of the implant from the orientation of the emergent surface out of the gum or from an association with a healing element stored in a database, in particular from its reference entered in a human interface machine or its automatic recognition by the shape of its emergent part; height of the implant by determining the height of the healing element from a color or indicator of its emerging surface from the gingiva or from an association with a healing element stored in a database, in particular from its reference entered in a man-machine interface or its automatic recognition by the shape of its energizing part.