WO1999026540A1

WO1999026540A1 - Surgical template assembly and method for drilling and installingdental implants

Info

Publication number: WO1999026540A1
Application number: PCT/US1998/025303
Authority: WO
Inventors: Michael Klein; Michael E. Abrams; Richard J. Manno
Original assignee: Michael Klein; Abrams Michael E; Manno Richard J
Priority date: 1997-11-24
Filing date: 1998-11-23
Publication date: 1999-06-03
Also published as: IL136319A0; IL136319A; US5967777A; JP2001523509A; EP1030598A4; CA2311370A1; AU1609699A; CA2311370C; EP1030598A1; BR9815333A

Abstract

The present invention is a surgical template and method for drilling osteotomies (e.g., holes in a jaw bone), and installing one or more dental implants (170) using a surgical template assembly (10). The surgical template assembly (10) is provided with one or more drill guides (120, 130), and one or more dental implant guides (140). The guides are positioned in the template assembly (10) by a computer driven milling machine (60) interfaced with a computer generated image of a patient's jaw bone, and a computer generated simulation of at least one dental implant so that when the template (100) is placed in the patient's mouth a trajectory of the guides in the template (100) into the patient's jawbone corresponds to a trajectory of the computer generated simulation of the dental implant (170) into the computer generated image of the patient's jawbone. Preferably, three fiducial markers (70) provide positional coordination between the CT scan data, the computer generated simulation of the dental implant, and the computer driven milling machine (60).

Description

SURGICAL TEMPLATE ASSEMBLY AND METHOD FOR DRILLING AND INSTALLING DENTAL IMPLANTS

BACKGROUND OF THE INVENTION

The present invention relates to a surgical

template assembly and method for drilling and installing

dental implants. More particularly, the invention relates

a surgical template assembly and method for precisely

drilling and installing dental implants using a surgical

template assembly having one or more drill guides and one

or more dental implant guides. The guides are located in

the surgical template assembly by a computer-driven milling

machine interfaced with computer-generated images of a

patient's jawbone and a superimposed computer-generated

simulation of one or more dental implants so that when the

surgical template is placed in the patient's mouth a

trajectory of the guides into the patient's jawbone

corresponds to a trajectory of the computer- generated

simulation of the one or more dental implants into the

computer-generated image of the patient's jawbone.

Dental implants are devices which are surgically

implanted into the jawbone of a patient in the areas where the patient is missing teeth. These devices mimic the

roots of teeth and serve to support prosthetic caps,

crowns, bridges or dentures. Dental implants are typically

titanium metal-based and are generally cylindrical or

screw-shaped in design.

Implants must be placed in a specific position

and in alignment to the prospective teeth that they will

eventually support. Therefore, the positioning of these

dental implants must be precise to enable teeth to be made

that will function properly and be esthetic in appearance.

Typically, a dental surgeon, after the gum is

moved aside, uses a hand held drill to make a

hole/osteotomy in the jawbone at the site that is to

receive the dental implant. The hole that is drilled into

in the patient's jawbone needs to have a defined

trajectory, depth and diameter. These parameters are

defined by the anticipated position of the patient ' s teeth

to be replaced and supported by the implant (s) , and

existing anatomic structures, e.g., jawbone height and

width, proximity to nerves, existing tooth roots, and sinus

cavities . It is recommended that a surgical template be

used as a guide to assist the surgeon in positioning and

angling the dental implant drill during dental implant

surgery. However, some surgeons choose not to use a

surgical template. Fabrication of a surgical template,

which acts as a guide for this drilling procedure,

generally includes the following steps:

1) Making a plastic replica of the prospective

teeth; and

2) Modifying the plastic replica teeth to allow

guidance of the position and angulation of the dental

implant drill through the replica teeth. This is

accomplished by making hole(s) in the plastic replica

teeth in the approximate area where the surgeon anticipates

he or she will be placing the implant (s) .

If a computed tomography scan (CT scan) is to be

taken of the patient's jawbone prior to implant surgery, it

is recommended that a CT scan appliance is worn by the

patient during the CT scan procedure. However, some

surgeons choose to have their patients scanned without the

use of a CT scan appliance. Fabrication of a CT scan appliance generally

includes the following steps :

1) Making a plastic replica of the prospective

teeth to be supported by dental implants; and

2) Placing radiopaque material in and/or on the

plastic replica of the prospective teeth. This can be

accomplished by applying a radiopaque paint, e.g., barium

sulfate acrylic, to the surface of the replica or drilling

a groove along the side of the replica and filling the

groove with metallic dental filling material.

Once the CT scan has been taken with the patient

wearing the CT scan appliance, the CT scan data is

reformatted via software to create various two-dimensional

images, e.g., views along a cross-sectional, an axial, and

a panoramic reference planes . A suitable software program

to reformat the CT scan data is SIM/PLANT, manufactured by

Columbia Scientific Inc. of Columbia, Maryland. The

software program enables the surgeon to perform a dental

implant simulation directly onto the reformatted CT scan

images. In particular, the surgeon can view the position

of the patient's jawbone, the dental implant simulation, and the image of the radiopaque material, e.g., the outline

of the plastic replica. The CT scan appliance can now be

modified, as described above, so that it becomes a surgical

template.

At the time of surgery, the surgeon moves the gum

away to expose the patient's jawbone. The surgeon then

places the surgical template in the patient's mouth and to

the best of his or her ability orients and guides the

dental implant drill with the use of the surgical template.

In general, the dental implant drill is inserted

through the hole in the surgical template and oriented by

"eyeballing" the dental implant drill through the hole in

the surgical template into the patient's jawbone. This

procedure is not precise. The diameter of the holes made

in the surgical template are usually much larger than the

diameter of the implant drill bit.

In addition, during dental implant surgery the

implant drill is manipulated by hand and in an up and down

manner by the surgeon. Specifically, the surgeon

"eyeballs" the three-dimensional trajectory/angulation of the implant drill bit relative to the surgical template and

adjacent anatomic structures as he drills into the jawbone.

The trajectory of the drill can be easily changed in an

instant which can ruin the procedure. This aforementioned

drilling process is fraught with the potential for many

drilling errors which can undermine the success and even

result in the failure of the overall procedure.

An attempt to increase the accuracy of locating

a dental implant in a patient's jawbone is disclosed in

U.S. Patent No. 5,320,529 to Pompa. In particular, Pompa

discloses a method of determining dental implant placement

position by taking a CT scan of the patient's upper or

lower jaw and then fabricating a model of . that jaw from the

reformatted CT scan data.

The model is made from a clear plastic/acrylic

material into which the surgeon then drills a hole by hand.

The surgeon then inserts a dental implant replica (a dummy

implant) into the hole and inspects the dummy implant

position for acceptability by looking at the dummy implant

position through the clear model. A cylinder is then attached to the top of the

dummy implant and acrylic is added around the cylinder and

on the surface of the jaw model. The acrylic piece with

the encased cylinder now becomes a surgical template which

rests on top of the patient's jawbone during the actual

implant surgery.

Drawbacks with the method disclosed in Pompa

include the following:

1) Creating a plastic jaw model from the CT

data.

2) Determining the dental implant position

manually. For example, by "eyeballing" the prospective

implant position, the surgeon, via the use of a hand-held

drill, drills a hole into the plastic jaw model. The

surgeon then places a dummy implant into that hole.

3) Lack of visualization of the prospective

teeth to receive the dental implant support. For example,

there is no coordination between prospective tooth position

and dental implant position.

4) Transferring the dental implant position to

the surgical template by attaching cylinders to the top of

dummy implants that were placed into the jawbone model. Thus, there is a need for a novel surgical

template assembly and method which reduces, if not

eliminates, the errors associated with the surgeon

"eyeballing" the proper position and angulation of the

drill during the drilling process of dental implant

surgery. Furthermore, the novel surgical template assembly

is enhanced by a system of interchangeable components for

precisely guiding one or more drill bits, burs, bone taps,

countersinks, other bone or soft-tissue drilling

components, and the dental implant itself during the dental

implant surgical procedure.

SUMMARY OF THE INVENTION

It is therefore an object of the present

invention to provide a novel surgical template assembly for

more accurately locating and positioning both an implant

hole/osteotomy and a dental implant in a jawbone of a

patient .

It is another object of the present invention to

provide a surgical template assembly having one or more

drill guides and one or more dental implant guides which are precisely located via a computer-driven milling

machine .

It is still another object of the present

invention to provide a surgical template assembly having

fiducial markers, e.g., radiopaque markers, for

coordination of the surgical template assembly to a

computer-driven milling machine, and for coordination of

reformatted CT scan data and a computer-generated

simulation of one or more dental implants.

It is yet another object of the present invention

to provide a surgical template assembly having

interchangeable components for precisely guiding one or

more drill bits and desirably a dental implant during

surgery along a predetermined trajectory into the desired

implant position in the patient's jawbone.

It is also an object of the present invention to

provide a novel dental implant drilling and placement

method using such a surgical template assembly. Certain of the foregoing and related objects are

readily obtained according to the present invention in a

method for locating a dental implant in a patient's jawbone

in which the method comprises the steps of fitting a CT

scan appliance to a patient's mouth, obtaining CT scan data

of the patient's jawbone and the CT scan appliance, and

computer generating an image of the patient's jawbone from

the CT scan data and a simulation of a dental implant.

The method also comprises the steps of providing

a computer-driven milling machine, supporting the CT scan

appliance on the computer-driven milling machine, and

drilling a hole in the CT scan appliance to form a surgical

template. The computer-driven milling machine is

interfaced with the computer-generated simulation of the

dental implant so that when the surgical template is

refitted in the patient's mouth, a trajectory of the hole

in the surgical template into the patient's jawbone

corresponds to a trajectory of the corresponding computer-

generated simulation of the dental implant into the

computer-generated image of the patient's jawbone. The method further comprises the steps of fitting

the surgical template to the patient's mouth, and guiding

a drill through the hole in the surgical template and into

the patient's jawbone to form a hole in the patient's

j awbone .

Preferably, the method further comprises the step

of coordinating the CT scan appliance to the computer-

driven milling machine. Desirably, the CT scan appliance

comprises at least one, and desirably three radiopaque

fiducial markers. The fiducial markers provide

coordination between the CT scan data, the computer-

generated simulation of the dental implant, and the

computer-driven milling machine. Advantageously, the

computer-driven milling machine comprises a table with

tooling locators for interlocking with the CT scan

appliance.

Most preferably, the step of guiding a drill

through the hole in the surgical template comprises

inserting a drill bushing in the hole for guiding the

drill. Advantageously, the step of guiding a drill through

the hole in the surgical template comprises the step of inserting a master cylinder in the hole in the surgical

template and inserting a drill bushing in the master

cylinder to form a surgical template assembly.

Also desirably, the method further comprises the

step of guiding a dental implant through the hole in the

surgical template and into the hole in the patient ' s

jawbone, and advantageously, inserting a master cylinder in

the hole in the surgical template and inserting an implant

bushing in the master cylinder to form a surgical template

assembly.

Certain of the foregoing and related objects are

also readily obtained according to the present invention in

a method for locating a dental implant in a patient's

jawbone in which the method comprises the steps of

providing a replica of prospective teeth to be supported by

a dental implant, providing a computer-driven milling

machine comprising a table, securing the replica to the

table, securing at least one fiducial marker to the replica

to form a CT scan appliance, and coordinating the at least

one fiducial marker to the computer-driven milling machine. The method also comprises the steps of

positioning the CT scan appliance in a patient's mouth,

obtaining CT scan data of the patient's jawbone and the at

least one fiducial marker, computer generating an image of

the patient's jawbone from the CT scan data and a

superimposed simulation of a dental implant, resupporting

the CT scan appliance to the table in the computer-driven

milling machine, drilling, via the computer-driven milling

machine, a hole in the CT scan appliance to form a surgical

template, the computer-driven milling machine being

interfaced with the computer-generated simulation of the

dental implant so that when the surgical template is

refitted in the patient's mouth, a trajectory of the hole

in the surgical template into the patient's jawbone

corresponds to a trajectory of the computer-generated

simulation of the dental implant into the computer-

generated image of the patient's jawbone, the at least one

fiducial marker providing positional coordination between

the CT scan data, the computer-generated dental implant

position, and the computer-driven milling machine.

The method further comprises inserting a master

cylinder in the hole in the surgical template, inserting a drill bushing in the master cylinder to form a surgical

template assembly, positioning the surgical template

assembly in the patient's mouth, and guiding a drill

through the drill bushing in the surgical template assembly

to provide a hole in the patient's jawbone.

Preferably, the method comprising the steps of

removing the drill bushing and inserting an implant bushing

in the master cylinder, and guiding a dental implant

through the implant bushing in the master cylinder in the

surgical template and into the hole in the patient's

j awbone .

Certain of the foregoing and related objects are

further readily obtained according to the present invention

in a method for fabricating a surgical template for use in

locating a dental implant in a patient's jawbone in which

the method comprises obtaining a CT scan appliance,

obtaining computer-generated data of the CT scan appliance

and a simulation of a dental implant, supporting the CT

scan appliance in a computer-driven milling machine, and

drilling, via the computer-driven milling machine, a hole

in the CT scan appliance, the computer-driven milling machine being interfaced with the computer-generated

simulation of the dental implant so that when the surgical

template is refitted in the patient's mouth, a trajectory

of the hole into the patient's jawbone corresponds to a

trajectory of the computer-generated simulation of the

dental implant into the computer-generated image of the

patient's jawbone.

Preferably, the CT scan appliance comprises at

least one fiducial marker so that the fiducial marker

provides positional coordination between the CT scan

appliance, the computer-generated simulation of the dental

implant, and the computer-driven milling machine.

Desirably, the method further comprises the steps

of obtaining CT scan data of the patient's jawbone and the

CT scan appliance, and computer generating a simulation of

a dental implant .

Certain of the foregoing and related objects are

further readily attained according to the present invention

in a surgical template positionable in a mouth of a patient

for use in locating a dental implant in a patient's jawbone in which the surgical template comprises a replica of the

prospective teeth to be implanted. The replica comprises

a hole therethrough drilled by a computer-driven milling

machine interfaced with a computer-generated image of a

patient's jawbone and a computer-generated simulation of a

dental implant so that, when the surgical template is

placed in the patient's mouth, a trajectory of the hole in

the replica into the patient's jawbone corresponds to a

trajectory of the computer-generated simulation of the

dental implant into the computer-generated image of the

patient ' s j awbone .

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and advantages of the

present invention will become apparent from the following

description of the accompanying drawings, which disclose

several embodiments of the present invention. It is to be

understood that the drawings are to be used for purposes of

illustrations only, and not as a definition of the

invention. In the drawings, wherein similar reference

numerals denote similar elements throughout the several

views :

FIG. 1 is an exploded side elevational view of

one embodiment of a novel surgical template assembly

according to the present invention;

FIG. 2 is a side elevational view of a patient's

jaw in which two teeth border a space where teeth are

missing;

FIG. 3 is a side elevational view of a plastic

replica (prospective teeth and anchors) which is

positionable in the space where the teeth are missing shown

in FIG. 2;

FIG. 4A is a top view of a model for supporting

the plastic replica shown in FIG. 3 ;

FIG. 4B is a top view of the plastic replica

shown in FIG. 3 supported on the model shown in FIG. 4A; FIG. 5 is a top view of a table used to interface

with the computer-driven milling machine (FIG. 10) ;

FIG. 6 is a top view of a table shown in FIG. 5,

along with the plastic replica shown in FIG. 3 supported on

the model shown in FIG. 4;

FIG. 7 is a top view of a plastic replica with

attached radiopaque fiducial markers so as to form a CT

scan appliance;

FIG. 8 is a side elevational view of the CT scan

appliance shown in FIG. 7 ;

FIGS. 9A-9C are computer-generated images of the

patient's jaw and superimposed computer-generated

simulation of dental implants;

FIG. 10 is a side elevational view of a computer-

driven milling machine illustrating the operation of

drilling a hole precisely into the CT scan appliance; FIG. 11 is an enlarged top view of the surgical

template shown in FIG. 1;

FIG. 12 is a side elevational view of the

surgical template shown in FIG. 11;

FIGS . 13 and 14 are enlarged top and side

elevational views, respectively, of a master cylinder shown

in FIG. 1;

FIGS. 15 and 16 are enlarged top and side

elevational views, respectively, of a first drill bushing

shown in FIG. 1 for guiding a drill bit for drilling a

pilot hole in a patient's jawbone;

FIGS. 17 and 18 are enlarged top and side

elevational views, respectively, of a second drill bushing

shown in FIG. 1 for guiding a drill bit for enlarging the

pilot hole in a patient's jawbone;

FIGS. 19 and 20 are enlarged top and side

elevational views, respectively, of an implant bushing shown in FIG. 1 for guiding a dental implant into a

patient's jawbone;

FIGS. 21 and 22 are top and side elevational

views, respectively, of the surgical template shown in

FIGS. 11 and 12, and the master cylinder shown in FIGS. 13

and 14, forming a surgical template assembly;

FIG. 23 is a side elevational view of the

surgical template assembly shown in FIG. 22 in position

over a patient's jawbone with the gum opened;

FIG. 24 is a top view of the surgical template

assembly shown in FIG. 21 with the first drill bushing

shown in FIG. 16;

FIG. 25 is a side elevational view of the

surgical template assembly shown in FIG. 24 guiding a drill

bit for drilling a pilot hole in the patient's jawbone;

FIG. 26 is a top view of the surgical template

assembly shown in FIG. 21 with the second drill bushing

shown in FIG. 18; FIG. 27 is a side elevational view of the

surgical template assembly shown in FIG. 26 guiding a drill

bit for enlarging the pilot hole in the patient's jawbone;

FIG. 28 is a side elevational view of the

surgical template assembly shown in FIG. 22 with the

implant bushing shown in FIG. 20 for guiding a dental

implant into the patient's jawbone; and

FIG. 29 is an exploded side elevational view of

another embodiment of a novel surgical template assembly

according to the present invention for drilling and guiding

two dental implants.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring now in detail to the drawings and, in

particular to FIG. 1 thereof, therein illustrated is one

embodiment of a novel surgical template assembly 10

according to the present invention for precisely locating

and surgically implanting a dental implant 170 (FIG. 28) in

the jawbone of a patient. In this illustrated embodiment,

surgical template assembly 10 includes a surgical template 100, a master cylinder 110, a first drill bushing 120 for

precisely guiding a drill bit for drilling a pilot hole in

a patient's jawbone (FIG. 25), a second drill bushing 130

for precisely guiding a drill bit to enlarge the pilot hole

(FIG. 27) , and an implant bushing 140 for precisely guiding

a dental implant into the enlarged hole in the patient's

jawbone (FIG. 28) .

As will become apparent from the detailed

description below, the present invention provides surgical

template assembly 10 with both drill and dental implant

guides which, when the surgical template assembly is

positioned in the patient's mouth, are aligned with and

correspond to a trajectory of a computer-generated

simulation of one or more dental implant positions

superimposed on computer-generated images of the patient ' s

jawbone. The simulated dental implant position and

trajectory are interfaced with and transferred to a

computer-driven milling machine for positioning the master

cylinder, drill bushing and dental implant bushing in the

surgical template assembly. Coordinating indicia or

fiducial markers are used to interface the computer-

generated simulation of the dental implant to a computer- driven milling machine for precisely locating the position

and orientation of the drill and implant bushings.

In the fabrication of surgical template assembly

10 initially, diagnostic steps are taken to determine final

tooth position for a dental prosthesis. For example, FIG.

2 illustrates a patient's jaw 20 in which two teeth 22 and

24 border a space where teeth are missing. As shown in

FIG. 3, a plastic replica 30 comprising teeth 32 and 34 to

be implanted is made which demonstrates final tooth

position. Preferably, plastic replica 30 comprises anchors

36 and 38 for attaching plastic replica 30 to the patient's

teeth 22 and 24 (FIG. 2) bordering the space.

FIGS. 4-8 illustrate the procedure for converting

plastic replica 30 (FIG. 3) to a CT scan appliance 80

(FIGS. 7 and 8) so that plastic replica 30 can be

coordinated to a computer-driven milling machine 60 (FIG.

10), e.g., a three or five axis computer numerical control

(CNC) milling machine, and interfaced with a computer-

generated image of the patient's jawbone and superimposed

computer-generated simulation of a dental implant. A model or support 40 (FIG. 4A) is used to

position and support plastic replica 30 (FIG. 4B) on a

table 50 (FIGS. 5 and 6) of computer-driven milling machine

60 (FIG. 10) . Preferably, model 40 is in the form of the

portion of the patient's jaw and soft tissue where the

patient is missing teeth. Desirably, model 40 is

fabricated from plaster, stone, or other rigid material.

As will be explained in greater detail below, the model may

be in the form of the complete upper or lower jawbone and

soft tissue of the patient. This would be particularly

suitable for implanting several dental implants.

As shown in FIG. 5, table 50 is provided with

spaced-apart slidable tooling locators 52 and 54 movable

along slots 56 and 58 in the directions of double headed

arrows S. Slots 56 and 58 are disposed along a line

defining an axis X. Tooling locators 52 and 54 are also

provided with vertically extending pins 51 and 53,

respectively. In addition, table 50 is provided with a

plurality of spaced-apart holes 57 disposed along a line

defining an axis Y which is disposed at right angles, i.e.,

90 degrees, preferably on both sides of axis X. From the

present description, it will be appreciated to those skilled in the art that tooling locators 52 and 54 and

holes 57 define orthogonal axes wherein the intersection of

the axes define an origin A which may be suitably

initialized with and/or coordinated to the drill bit of

computer-driven milling machine 60 (FIG. 10), e.g., the

starting point or initial value, e.g., X = 0, Y = 0.

With model 40 and plastic replica 30 placed on

table 50, as shown in FIG. 6, tooling locators 52 and 54

are adjusted so that pins 51 and 53 are positioned adjacent

to plastic replica 30. A pin 55 is inserted into one of

holes 56 adjacent to plastic replica 30. Pins 51, 53, and

55 are used to position and fix the fiducial markers to

plastic replica 30.

Preferably, the three fiducial markers 70 (FIGS.

7 and 8), e.g., radiopaque markers, are hollow and have

conical -shaped upper portions. One fiducial marker is

placed on each of pins 51, 53, and 55, and attached to

plastic replica 30 with acrylic or other suitable adhesive

so as to form a CT scan appliance 80. Advantageously, the

three fiducial markers 70 are positioned in a plane

parallel to table 50, e.g., preferably the fiducial markers are all placed at the same height above table 50. As will

become apparent from the following description, CT scan

appliance 80 can be removed from model 40 and table 50, and

be readily repositioned thereon by sliding fiducial markers

70 over pins 51, 53, and 55.

From the present description, it will be

appreciated that model 40 need not be in the form of the

patient's teeth so long as it provides a suitable support

for the plastic replica of the prospective teeth and

coordination of the fiducial markers with the computer-

driven milling machine. In addition, the table may be

provided solely with a plurality of holes with defined

orthogonal axes. From the present description, it will be

appreciated by those skilled in the art that the plastic

replica can be made of or have embedded therein radiopaque

materials, magnetic materials, optical materials, or

combinations thereof, so long as the CT scan appliance can

be three-dimensionally coordinated to the computer-driven

mi11ing machine .

After attaching fiducial markers 70 to plastic

replica 30, CT scan appliance 80 is removed, and repositioned in the mouth of the patient during a CT scan

procedure of the patient's jawbone and teeth when present.

FIGS. 9A-9C illustrate the CT scan data reformatted through

a surgical simulation software program and displayed on a

computer screen. A suitable surgical simulation software

is SIM/PLANT produced and sold by Columbia Scientific,

Inc., of Columbia, Maryland. The software also enables

the surgeon to superimpose three-dimensional simulated

dental implants 4 and 5.

For example, FIG. 9A is an axial view looking

down on the patient's jaw with superimposed simulated

dental implants 4 and 5 and visible fiducial markers 70,

FIG. 9B is a frontal panoramic view with simulated dental

implants 4 and 5 and visible fiducial marker 70, and FIG.

9C are cross-sectional views of the patient's jaw, spaced

1-mm apart from each other, of the jaw portion containing

simulated dental implant 5.

Suitable software coordinates the software

program, e.g., the simulated dental implant position and

angulation, to the computer-driven milling machine 60 by,

e.g., extrapolating the position and angulation for the computer-driven milling machine based on measurements

relative to the plane of the fiducial markers. In

addition, an origin A' (FIG. 9A) is readily coordinated to

origin A on the table of the computer-driven milling

machine 60. Alternatively, the software program also

provides defined three-dimensional axes 90, 91 and 92 (FIG.

9) which correspond to simulated dental implant 5 and which

are suitably coordinated three-dimensionally relative to

the fiducial markers 70, and thus, to computer-driven

milling machine 60.

Next, CT scan appliance 80 is repositioned on

model 40 and table 50, i.e., fiducial markers 70 are

repositioned on pins 51, 53, and 55, as shown in FIG. 10,

and the surgical simulation software is interfaced with

computer-driven milling machine 60 via a wire or computer

cable 64 attached to a computer 65 to send three-

dimensional positioning data regarding the position and

angulation of simulated dental implant 5 to computer-driven

milling machine 60. A drill bit 62 of computer-driven

milling machine 60 accurately drills a hole 102 (best seen

in FIG. 11) , corresponding to the defined three-dimensional

trajectory of simulated dental implant 5 into CT scan appliance 80 (FIGS. 7 and 8) to form a surgical template

100 shown in FIGS. 11 and 12. The forward or upper portion

of hole 102 of surgical template 100 is desirably removed

in such a fashion as to provide a cutout 104 for receiving

master cylinder 110, as will be explained below.

FIGS. 13-20 show various interchangeable

components that fit into surgical template 100 (FIGS. 11

and 12) to form surgical template assembly 10 (FIG. 1) .

For example, in this illustrated embodiment, the components

include master cylinder 110, first drill bushing 120,

second drill bushing 130, and implant bushing 140. Master

cylinder 110 comprises a generally hollow cylindrical body

112 having an outer diameter which is sized to be received

in hole 102 of surgical template 100 and an inner axial

bore 114 as explained below, which is sized for holding the

various guide and dental implant bushings in position.

Outwardly extending from the top portion of master cylinder

110 is a flange 116 having a setscrew 118.

Bushings 120, 130, and 140 comprise generally

hollow cylindrical bodies 122, 132, and 142, with upper

outwardly extending rims 124, 134, and 144, respectively. The outer diameter of bushings 120, 130, and 140 are sized

to be received in axial bore 114 of master cylinder 110.

As seen in FIGS. 15-20, first bushing 120 has an axial bore

126, second drill bushing 130 has an axial bore 136 which

is larger than axial bore 126 of first drill bushing 120,

and implant bushing 140 has an axial bore 146 which is

larger than axial bore 136 of second drill bushing 130 for

guiding a dental implant. Flange 116 of master cylinder

110 is provided with a threaded hole in which is receivable

setscrew 118 to releasably lock bushings 120, 130, and 140,

to master cylinder 110 and prevent rotation and

disengagement .

With reference now to FIGS. 21 and 22, cutout 104

of surgical template 100 receives outwardly extending

flange 116 of master cylinder 110 when master cylinder 110

is placed into hole 102 in surgical template 100 thereby

forming surgical template 10. In particular, flange 116 of

master cylinder 110 is designed to prevent rotation, and

thus, prevent master cylinder 110 from unseating or

spinning during the dental implant drilling procedure.

From the present description, it will be appreciated to

those skilled in the art that fiducial markers 70, having served their function of providing positional coordination

between the CT scan data, the computer-driven milling

machine, and the computer-generated simulated dental

implant, can be removed after hole 102 (FIG. 11) has been

drilled, and thus, are not shown FIGS. 21-29.

FIGS. 23-28 illustrate the procedure of

installing a dental implant in a patient's jawbone using

surgical template assembly 10. First, the patient's gum is

opened and surgical template assembly 10 is attached to the

patient's teeth, as shown in FIG. 23. From the present

description, it will be appreciated to those skilled in the

art that surgical template assembly 10 can be placed on top

of the gums, the teeth and/or previously installed

implants .

Next, first drill bushing 120 is secured in

master cylinder 110 by setscrew 118 (FIG. 24) and a surgeon

guides a drill bit 150 to form a pilot hole 26 in the

patient's jawbone (FIG. 25). First drill bushing 120 is

then removed, and second drill bushing 130 having a larger

diameter axial bore compared to first drill bushing 120 is

inserted in master cylinder 110 and secured with setscrew 118 (FIG. 26) . The surgeon performs a second drilling

operation with a drill bit 160 to enlarge hole 26 to a

properly sized hole 28 for receiving a dental implant (FIG.

27) . FIG. 28 illustrates a dental implant 170 inserted and

guided by implant bushing 140 in master cylinder 110 and

secured to the patient's jawbone. From the present

description, it will be appreciated to those skilled in the

art that the dental implant can be a screw-type dental

implant, a press-fit dental implant, or combination

thereof. Alternatively, a separate countersinking drill,

other drills or burs, or a bone tap can be used which is

guided by a bushing prior to installing the dental implant.

From the present description it will also be

appreciated to those skilled in the art that the various

bushings allow the drill bits and implants to pass through

them while at the same time rigidly holding each of them in

the same fixed trajectory to precisely cut a hole and

install the dental implant into the patient's jawbone to

match the computer-generated simulation of the dental

implant previously performed. While only one master cylinder and two different

sized drill bushings are shown, it will be appreciated to

those skilled in the art that various bushings can be

utilized for guiding drills, punches, taps, and implants,

e.g., a round bur bushing, an initial 2-mm bushing, a soft-

tissue punch bushing, a 3 -mm bushing, a bone tape bushing,

countersink bushing, and a dental implant bushing.

While the illustrated embodiment of surgical

template assembly 10 is described with reference to

implanting one dental implant, it will be appreciated to

those skilled in the art that a surgical template assembly

and method can be applied to the installation of several

implants, e.g., a surgical template in the form of an arch

corresponding to the jawbone of a patient.

For example, FIG. 29 shows an alternative

embodiment of a surgical template assembly 10' for locating

and surgically implanting two dental implants, e.g., dental

implants corresponding to simulated dental implants 4 and

5 in FIG. 9. Surgical template assembly 10' is similar to

surgical template 10 with the addition of a second set of

components comprising a master cylinder 110 ' and bushings 120', 130', and 140'. It will be appreciated that a

surgical template assembly can accommodate any number of

implants, e.g., for installing ten dental implants along

the arch of a patient's jawbone and include a number of

interchangeable components.

As described and illustrated, surgical template

assembly 10 and 10' guide various sized drill bits as well

as the dental implant itself. This results in the dental

implant (s) being placed where the dental implant (s)

simulation dictates.

From the present description it will be

appreciated that the present invention provides:

(a) a method of transferring CT data to a

computer-driven milling machine for precisely locating the

drill and dental implant guides in a surgical template;

(b) a component system to rigidly hold and

guide various drill bits and the dental implant during

surgery; and

(c) a method of using a surgical template

assembly designed from the start with tooth orientation and

dental implant positioning based on CT scan data of the patient's jawbone and computer-generated simulation of the

dental implant by interfacing with a computer-driven

milling machine, and which comprises a component system

which ensures precision dental implant surgery.

From the present description, it will also be

appreciated by those skilled in the art that a dental

surgeon can obtain and make a plastic replica of the teeth

that a patient is missing. The surgeon can then send the

plastic replica to a radiological laboratory where the

laboratory attaches fiducial markers to the plastic replica

to form a CT scan appliance and takes a CT scan of the

patient wearing the CT scan appliance. The CT scan data

can then be transferred to the surgeon wherein using a

software program the location of a simulated dental implant

can be determined. Alternatively, the laboratory can also

determine the location of a simulated dental implant . The

computer-generated simulated dental implant data can then

be sent to a machine shop, where via interfacing with a

computer-driven milling machine, a hole can be located in

the CT scan appliance to form a surgical template. The

surgical template can then be returned to the dental surgeon for locating and installing a dental implant in the

patient as explained above.

Thus, while only several embodiments of the

present invention have been illustrated and described, it

will be appreciated to those skilled in the art that many

changes and modifications may be made thereunto, without

departing from the spirit and scope of the invention.

Claims

WHAT IS CLAIMED IS :

1. A method for locating a dental implant in a patient's

jawbone, said method comprising the steps of:

fitting a CT scan appliance to a patient's mouth;

obtaining CT scan data of the patient's jawbone

and said CT scan appliance;

computer generating an image of the patient's

jawbone from said CT scan data and a simulation of a dental

implant ;

providing a computer-driven milling machine ;

supporting said CT scan appliance on said

computer-driven milling machine;

drilling, via said computer-driven milling

machine, a hole in said CT scan appliance to form a

surgical template, said computer-driven milling machine

being interfaced with said computer-generated simulation of

said dental implant so that when said surgical template is

refitted in the patient's mouth, a trajectory of said hole

into the patient's jawbone corresponds to a trajectory of

said computer-generated simulation of said dental implant

into said computer-generated image of the patient's

j awbone ; fitting said surgical template to the patient's

mouth; and

guiding a drill through said hole in said

surgical template and into the patient's jawbone to form a

hole in the patient's jawbone.

2. The method according to Claim 1, further comprising

the step of coordinating said CT scan appliance to said

computer-driven milling machine.

3. The method according to Claim 1, wherein said CT scan

appliance comprises at least one fiducial marker, said

fiducial marker providing coordination between said CT scan

data, said computer-generated simulation of said dental

implant, and said computer-driven milling machine.

4. The method according to Claim 3, wherein said at least

one fiducial marker is a radiopaque marker.

5. The method according to Claim 3 , wherein said CT scan

appliance comprises three radiopaque fiducial markers, said

radiopaque fiducial markers providing coordination between

said CT scan data, said computer-generated simulation of said dental implant, and said computer-driven milling

machine .

6. The method according to Claim 1, wherein said

computer-driven milling machine comprises a table.

7. The method according to Claim 6, wherein said table

comprises tooling locators and holes for locating said CT

scan appliance.

8. The method according to Claim 1, wherein said step of

guiding a drill through said hole in said surgical template

comprises inserting a drill bushing in said hole for

guiding said drill.

9. The method according to Claim 8, wherein said step of

guiding a drill through said hole in said surgical template

comprises inserting a master cylinder in said hole in said

surgical template and inserting a drill bushing in said

master cylinder to form a surgical template assembly.

10. The method according to Claim 1, further comprising

the step of guiding a dental implant into said hole in said surgical template and into said hole in the patient's

j awbone .

11. The method according to Claim 10, wherein the step of

guiding a dental implant comprises the steps of inserting

a master cylinder in said hole in said surgical template

and inserting an implant bushing in said master cylinder

for guiding said dental implant into said hole in the

patient's jawbone.

12. A method for locating a dental implant in a patient's

jawbone, said method comprising the steps of:

providing a replica of prospective teeth to be

supported by a dental implant;

providing a computer-driven milling machine

comprising a table;

securing said replica to said table ;

securing at least one fiducial marker to said

replica to form a CT scan appliance;

coordinating said at least one fiducial marker to

said computer-driven milling machine;

positioning said CT scan appliance in a patient's

mouth; obtaining CT scan data of the patient's jawbone

and said at least one fiducial marker;

computer generating an image of the patient's

jawbone from said CT scan data and a superimposed

simulation of a dental implant;

resupporting said CT scan appliance to said table

in said computer-driven milling machine;

drilling, via said computer-driven milling

machine, a hole in said CT scan appliance to form a

surgical template, said computer-driven milling machine

being interfaced with said computer-generated simulation of

said dental implant so that when said surgical template is

refitted in the patient's mouth, a trajectory of said hole

in said surgical template into the patient's jawbone

corresponds to a trajectory of said computer-generated

simulation of said dental implant into said computer-

generated image of the patient's jawbone, said at least one

fiducial marker providing positional coordination between

said CT scan data, said computer-generated dental implant

position, and said computer-driven milling machine;

inserting a master cylinder in said hole in said

surgical template; inserting a drill bushing in said master cylinder

to form a surgical template assembly;

positioning said surgical template assembly in

the patient's mouth;

guiding a drill through said drill bushing in

said surgical template assembly to provide a hole in the

patient's jawbone.

13. The method according to claim 12, further comprising

the steps of removing said drill bushing and inserting an

implant bushing in said master cylinder, and guiding a

dental implant through said implant bushing in said master

cylinder in said surgical template and into said hole in

the patient's jawbone.

14. The method according to Claim 12, wherein said

fiducial marker is a radiopaque marker.

15. The method according to Claim 12, wherein said replica

provides final tooth position.

16. The method according to Claim 12, wherein said replica

comprises plastic.

17. A method for fabricating a surgical template for use

in locating a dental implant in a patient's jawbone, said

method comprising the steps of:

obtaining a CT scan appliance;

obtaining computer-generated data of the CT scan

appliance and a simulation of a dental implant;

supporting said CT scan appliance in a computer-

driven milling machine; and

drilling, via said computer-driven milling

machine, a hole in said CT scan appliance, said computer-

driven milling machine interfaced with said computer-

generated simulation of said dental implant so that when

said surgical template is refitted in the patient ' s mouth,

a trajectory of said hole in said CT scan appliance into

the patient's jawbone corresponds to a trajectory of said

computer-generated simulation of said dental implant into

said computer-generated image of the patient's jawbone.

18. The method according to Claim 17, wherein said CT scan

appliance comprises at least one fiducial marker, said

fiducial marker providing positional coordination between

said CT scan appliance, said computer-generated simulation of said dental implant, and said computer-driven milling

machine .

19. The method according to Claim 17, further comprising

the step of obtaining CT scan data of the patient's jawbone

and said CT scan appliance, and computer generating a

simulation of a dental implant.

20. A surgical template positionable in a mouth of a

patient for use in locating a dental implant in a patient's

jawbone, said surgical template comprising:

a replica of prospective teeth to be implanted

comprising a hole therethrough drilled by a computer-driven

milling machine interfaced with a computer-generated image

of a patient's jawbone and a computer-generated simulation

of a dental implant so that, when said surgical template is

placed in the patient's mouth, a trajectory of said hole in

said replica into the patient's jawbone corresponds to a

trajectory of said computer-generated simulation of said

dental implant into said computer-generated image of the

patient ' s j awbone .

21. The surgical template according to Claim 20, further

comprising at least one drill bushing releasably insertable

in said hole in said replica for guiding a drill.

22. The surgical template according to Claim 21, further

comprising a master cylinder insertable in said hole in

said surgical template and in which is receivable said at

least one drill bushing.

23. The surgical template according to Claim 22, further

comprising an implant bushing releasably insertable in said

master cylinder for guiding a dental implant.

24. The surgical template according to Claim 20, wherein

said replica comprises at least one fiducial marker.

25. The surgical template according to Claim 24, wherein

said replica comprises three fiducial markers.

26. The surgical template according to Claim 24 wherein

said at least one fiducial marker is a radiopaque marker.

27. The surgical template according to Claim 20, wherein

said replica comprises plastic.

28. The surgical template according to Claim 20, wherein

said replica comprises at least one anchor for attaching to

the patient's teeth.

29. The surgical template according to Claim 20, wherein

said replica comprises a plurality of holes therethrough

drilled by a computer-driven milling machine interfaced

with a computer- generated image of a patient's jawbone and

a computer-generated simulation of a plurality of dental

implants so that, when said surgical template is placed in

the patient's mouth, trajectories of said plurality of

holes into the patient's jawbone correspond to trajectories

of said computer-generated simulation of said plurality of

said simulated dental implants into said computer-generated

image of the patient's jawbone.

30. The surgical template according to Claim 29, further

comprising a plurality of master cylinders each insertable

in one of said plurality of holes in said surgical

template, a plurality of drill bushings each releasably insertable in one of said plurality of implant cylinders

for guiding at least one drill, and a plurality of master

bushings releasably insertable in said master cylinder for

guiding a plurality of dental implants.