阅读说明：本技术 一种微种植支抗个性化精准植入的设计制作方法 (Design and manufacturing method for personalized accurate implantation of micro-implant anchorage ) 是由 何瑶 李臻 宋锦璘 黄兰 王超 王春娟 于 2021-09-26 设计创作，主要内容包括：本发明公开了一种微种植支抗个性化精准植入的设计制作方法,包括如下步骤：1)制作带定位网格的标记模型并扫描；2)标记模型与CBCT颌骨数据配准；3)通过定位网格虚拟植入微种植支抗；4)虚拟微种植支抗位置检查；5)标记模型上转移植入位置和方向；6)制作个性化植入导板；7)引导植入及核心附件回收。本发明引入了带有三维属性的双向定位网格,在设计虚拟植体的过程中,通过连接定位孔形成虚拟植体,导入颌骨CBCT数据中检查调整确定最佳植入位置和方向,并在标记模型上进行转移后制作个性化植入导板。其定位可控性好,可重复性高,不需要对导板进行逆向工程设计及3D打印制作,也在一定程度上节约了设计时间和制作成本。(The invention discloses a design and manufacturing method for personalized and accurate implantation of a micro-implant anchorage, which comprises the following steps: 1) making a mark model with a positioning grid and scanning; 2) the marking model is registered with CBCT jaw bone data; 3) virtually implanting micro-implant anchorage through a positioning grid; 4) checking the position of the virtual micro-planting anchorage; 5) transferring the position and the direction of the transplanting on the marking model; 6) manufacturing a personalized implantation guide plate; 7) guiding implantation and core appendage retrieval. The invention introduces a bidirectional positioning grid with three-dimensional attributes, in the process of designing a virtual implant, the virtual implant is formed by connecting positioning holes, the optimal implant position and direction are determined by checking and adjusting the data imported into the jaw CBCT, and the personalized implant guide plate is manufactured after the transfer is carried out on a marking model. The positioning controllability is good, the repeatability is high, reverse engineering design and 3D printing manufacturing of the guide plate are not needed, and the design time and the manufacturing cost are saved to a certain extent.)

1. A design and manufacturing method for personalized and accurate implantation of a micro-implant anchorage is characterized by comprising the following steps:

1) making marking model with positioning grid and scanning

1.1) after an impression of the upper jaw or the lower jaw of a patient is taken, when a plaster model is filled, embedding two-way positioning grids with three-dimensional attributes on two sides of an alveolar bone of an area to be implanted or the other side of an implantation area and the corresponding model base, and respectively naming the two-way positioning grids as an implantation side and an auxiliary positioning side;

1.2) fully exposing the mesh surface after the gypsum impression is poured and condensed;

1.3) scanning the marking model by using a model or an oral cavity scanning instrument to form 3D reconstruction data of the marking model;

2) registration of marker models with CBCT jaw bone 3D reconstruction data

2.1) intercepting parts which are overlapped with the mark model and have clear structures in the CBCT by using Mimics software to serve as overlapped reference models, such as digital models of the front tooth segment, teeth and jawbone;

2.2) fixing the overlapped reference model by using 3-matic software, and carrying out spatial registration on the 3D reconstructed marker model and the overlapped reference digital model;

3) virtual implantation of micro-implant anchorage through positioning grid

3.1) using 3-matic software to select a positioning hole in each of the bidirectional positioning grids at the implantation side and the auxiliary positioning side of the 3D reconstructed marking model, and taking the midpoint of the positioning hole as an implantation marking point;

3.2) connecting the mark points at the two sides to form a cylinder with the diameter same as that of the micro-implant anchorage to be implanted, and using the cylinder as a micro-implant anchorage matrix for virtual implantation;

3.3) calculating from the surface of the implantation part, and intercepting a cylinder with the same length as the anchorage to be implanted as a virtual micro-implantation anchorage;

4) virtual micro-implant anchorage location inspection

Exporting the virtually implanted micro-implant anchorage to Mimics software, and checking whether the virtually implanted micro-implant anchorage is in an ideal position from three dimensions and each section by combining CBCT image data of a patient, namely, the micro-implant anchorage avoids a tooth root and a great vessel nerve and has enough implantation depth; if the position is not in the ideal position, returning to the third step to readjust the position and the direction of the virtual micro-planting anchorage;

5) transfer location and orientation on a marker model

Inserting a positioning auxiliary part (3) on the marking model for transfer according to the position of the positioning hole of the ideal implantation position of the virtual micro-implant anchorage;

6) making personalized implant guides

6.1) installing a metal connecting guide cylinder (4), wherein the guide cylinder is customized and processed by CNC, and the inner diameter of the guide cylinder is embedded with the outer diameter of the positioning sleeve (2) and is also equal to the outer diameter of the head end of the micro-implant anchorage handle;

6.2) after the guide cylinder (4) is fixed, a tooth surface guide plate (5) is manufactured and connected with the guide cylinder;

7) guided implantation and core appendage retrieval

After the guide plate is sterilized, the guide plate is stably worn on the tooth surface, and the micro-implant handle is clamped into the connecting guide cylinder, so that the guide of micro-implant anchorage implantation can be realized; after the guide plate is used, the metal connecting guide cylinder is detached for secondary disinfection.

2. The design and manufacturing method for personalized precise implantation of a micro-implant anchorage according to claim 1, characterized in that: the positioning auxiliary part (3) comprises a positioning part (1) and a positioning sleeve (2), and the step 5) comprises the following steps:

5.1) inserting the positioning piece (1) according to the position of the positioning hole of the ideal implantation position;

5.2) a positioning sleeve (2) which is matched with the positioning piece (1) in an embedded mode is sleeved on the positioning sleeve.

3. The design and manufacturing method for personalized precise implantation of a micro-implant anchorage according to claim 1, characterized in that: the positioning auxiliary part (3) is formed by a positioning part (1) and a positioning sleeve (2) in an integrated mode.

Technical Field

The invention relates to the field of orthodontic clinical treatment, in particular to a design and manufacturing method for personalized and accurate implantation of a micro-implant anchorage.

Background

At present, when the micro-implant anchorage is clinically implanted, the possible safe implantation position and direction are evaluated most of the time by the experience of a clinician, and CBCT images can be referred to in some cases, but the CBCT images are only limited to structural observation and cannot be accurately combined with the conditions in the mouth of a patient. If want to implant accurately, use reverse engineering technique at present mainly, carry out the virtual implantation after three-dimensional reconstruction dentition and partial jawbone, refabricate digital baffle, use after the 3D prints. The technology needs special digital technicians in the design stage, needs special 3D printing machines in the generation stage, and is high in technical cost and material cost. The cost generated by designing and generating a digital guide plate of the micro-implant anchorage is equivalent to the sum of the micro-implant anchorage material and the treatment cost of clinical operation, so that few clinicians can use accurate implantation. However, with the increase of the number of patients to be corrected, the correction requirement is improved, the application scene of the implant anchorage is wider, and the safety and the accuracy of the implantation need to be ensured.

Disclosure of Invention

Aiming at the defects in the prior art, the invention provides a design and manufacturing method for personalized accurate implantation of a micro-implant anchorage, which replaces a design and production mode of 3D printing and forming of a digital guide plate, and reduces the technical difficulty and the processing cost of accurate implantation of the micro-implant anchorage or an implant on the basis of ensuring the accuracy.

In order to solve the technical problems, the invention adopts the following technical scheme:

a design and manufacturing method for personalized and accurate implantation of a micro-implant anchorage comprises the following steps:

1) making marking model with positioning grid and scanning

1.1) after an impression of the upper jaw or the lower jaw of a patient is taken, when a plaster model is filled, embedding two-way positioning grids with three-dimensional attributes on two sides of an alveolar bone of an area to be implanted or the other side of an implantation area and the corresponding model base, and respectively naming the two-way positioning grids as an implantation side and an auxiliary positioning side;

1.2) fully exposing the mesh surface after the gypsum impression is poured and condensed;

1.3) scanning by using a model or an oral cavity scanning instrument to form 3D reconstruction data of a marker model;

2) registration of marker models with CBCT jaw bone 3D reconstruction data

2.1) intercepting parts which are overlapped with the mark model and have clear structures in the CBCT by using Mimics software to serve as overlapped reference models, such as digital models of the front tooth segment, teeth and jawbone;

2.2) fixing the overlapped reference model by using 3-matic software, and carrying out spatial registration on the 3D reconstructed marker model and the overlapped reference digital model;

3) virtual implantation of micro-implant anchorage through positioning grid

3.1) using 3-matic software to select a positioning hole in each of the bidirectional positioning grids at the implantation side and the auxiliary positioning side of the 3D reconstructed marking model, and taking the midpoint of the positioning hole as an implantation marking point;

3.2) connecting the mark points at the two sides to form a cylinder with the diameter same as that of the micro-implant anchorage to be implanted, and using the cylinder as a micro-implant anchorage matrix for virtual implantation;

3.3) calculating from the surface of the implantation part, and intercepting a cylinder with the same length as the anchorage to be implanted as a virtual micro-implantation anchorage;

4) virtual micro-implant anchorage location inspection

Exporting the virtually implanted micro-implant anchorage to Mimics software, and checking whether the virtually implanted micro-implant anchorage is in an ideal position from three dimensions and each section by combining CBCT image data of a patient, namely, the micro-implant anchorage avoids a tooth root and a great vessel nerve and has enough implantation depth; if the position is not in the ideal position, returning to the third step to readjust the position and the direction of the virtual micro-planting anchorage;

5) transfer location and orientation on a marker model

Inserting a positioning auxiliary piece on the marking model for transferring according to the position of the positioning hole of the ideal implantation position of the virtual micro-implant anchorage;

6) making personalized implant guides

6.1) installing a metal connecting guide cylinder, wherein the guide cylinder is customized and processed by CNC, and the inner diameter of the guide cylinder is embedded with the outer diameter of the positioning sleeve and is also equal to the outer diameter of the head end of the micro-implant anchorage handle;

6.2) after fixing the guide cylinder, manufacturing a tooth surface guide plate to be connected with the guide cylinder;

7) guided implantation and core appendage retrieval

After the guide plate is sterilized, the guide plate is stably worn on the tooth surface, and the micro-implant handle is clamped into the connecting guide cylinder, so that the guide of micro-implant anchorage implantation can be realized; after the guide plate is used, the metal connecting guide cylinder is detached for secondary disinfection.

As a preferable scheme of the present invention, the positioning auxiliary member includes a positioning member and a positioning sleeve, and step 5) includes the steps of:

5.1) inserting a positioning piece according to the position of a positioning hole of an ideal implantation position;

and 5.2) sleeving a positioning sleeve which is matched with the positioning piece in an embedded mode.

As a preferable aspect of the present invention, the positioning auxiliary member is integrally formed by the positioning member and the positioning sleeve.

Compared with the prior art, the invention has the following advantages:

1. the invention discloses a design and manufacturing method for personalized and accurate implantation of a micro-implant anchorage, which aims at clinical pain points needing accurate positioning for implantation of the micro-implant anchorage, accurately transfers the position of the micro-implant anchorage after virtual implantation to the same model through a two-way positioning grid with three-dimensional attributes, and replaces a production mode of 3D printing and forming of a digital guide plate by combining a traditional guide plate manufacturing technology on the model. In addition, the core design and production mode can also be used for implanting the implant by the extension of the technology. This process does not need special digital technical staff and 3D printing machine, on the basis of guaranteeing the accuracy, greatly reduced the technical degree of difficulty and the processing cost that little planting anchorage or planting body were implanted accurately.

2. Simplified and normative operation flow on the basis of keeping accuracy of digital design

The key point that the reverse engineering technology can accurately implant is that the detection of the virtual implant and CBCT data is carried out after the virtual implantation. In the process of designing the virtual implant, the virtual implant can be formed by connecting the implant side and the corresponding positioning holes of the auxiliary positioning side, and the virtual implant is regenerated by changing the positioning holes on the two sides when the position of the virtual implant is not good.

3. The same model is designed and manufactured, and accurate transfer of implantation position is ensured

In the invention, the 3D reconstruction data formed by scanning come from the marking model of the two-way positioning grid with three-dimensional attributes and are the same model with the model of the post-processing implantation guide plate, and due to the existence of the positioning grid, the position and the direction of the implantation of the virtual micro-implant anchorage can be easily and accurately copied to the marking model, thereby ensuring the accuracy of the implantation position transfer.

4. Use CNC customization processing accessory, improve the preparation precision

The guide is implanted key metal and is connected guide cylinder and metal connection accessory and all adopt CNC customization processing in this baffle, and parallel machining precision is 0.005mm, is superior to 3D greatly and prints 0.1mm of general machining precision. And the part can be repeatedly used, and the processing cost is also saved to a certain extent.

5. Flexible and changeable guide plate forming mode, and reduced processing difficulty

Compared with a 3D printer printing digital guide plate which needs to be designed and used in a reverse engineering technology, the tooth surface guide plate is directly manufactured on a plaster model, so that various traditional processing modes such as silicon rubber, resin base or cast metal can finish the manufacture of the corresponding guide plate, the processing cost is saved, and the processing difficulty is reduced.

Drawings

FIG. 1 is a schematic illustration of making a model of a marked grid and scanning;

fig. 2 is a schematic diagram of registration of a marker model with CBCT jaw 3D reconstruction data;

FIG. 3(a) is a schematic diagram illustrating the selection of target points in the implant area on both sides of the alveolar bone; (b) is a schematic diagram of a virtual micro-planting anchorage;

FIG. 4 is a schematic diagram of virtual micro-implant anchorage location inspection;

FIG. 5(a) is a schematic view illustrating a position where the positioning member is inserted into the positioning hole; (b) is a schematic view of connecting the positioning sleeve; (c) is a schematic structural diagram of the positioning piece; (d) is a structural schematic diagram of the positioning sleeve sleeved on the positioning piece; (e) is a structural schematic diagram of the positioning piece and the positioning sleeve which are integrally formed;

fig. 6(a) is a schematic view of the mounting of the connecting guide; (b) the schematic diagram of the connection between the tooth surface guide plate and the fixed guide cylinder is manufactured;

FIG. 7 is a schematic structural view of a fabricated micro-implant anchorage guide plate;

FIG. 8 is a schematic illustration of a clinical trial;

FIG. 9 is a schematic view of the micro-implant anchorage handle head end being snapped into the metal connection guide cylinder;

FIG. 10 is a schematic illustration of the accurate transfer of the position and orientation of a virtually implanted micro-implant anchorage into the same marking model;

figure 11 is a schematic view of the implant side and the secondary positioning side distributed on both sides of the implant structure.

In the figure: 1-a positioning element; 2, positioning a sleeve; 3-positioning auxiliary parts; 4, a guide cylinder; 5, a tooth surface guide plate; 6-micro-planting anchorage handle head end; 7-implantation side; 8-auxiliary positioning side.

Detailed Description

The invention is described in further detail below with reference to the figures and specific embodiments.

A design and manufacturing method for personalized and accurate implantation of a micro-implant anchorage comprises the following steps:

1) making marking model with positioning grid and scanning

1.1) after an impression of the upper jaw or the lower jaw of a patient is taken, when a plaster model is filled, embedding two-way positioning grids with three-dimensional attributes on two sides of an alveolar bone of an area to be implanted or the other side of an implantation area and the corresponding model base, and respectively naming the two-way positioning grids as an implantation side and an auxiliary positioning side; 1.2) fully exposing the mesh surface after the gypsum impression is poured and condensed; 1.3) scanning by using a model or an oral cavity scanning instrument to form 3D reconstruction data of a marker model; as shown in fig. 1.

2) Registration of marker models with CBCT jaw bone 3D reconstruction data

2.1) intercepting parts which are overlapped with the mark model and have clear structures in the CBCT by using Mimics software to serve as overlapped reference models, such as digital models of the front tooth segment, teeth and jawbone;

2.2) fixing the overlapped reference model by using 3-matic software, and carrying out spatial registration on the 3D reconstructed marker model and the overlapped reference digital model; as shown in fig. 2.

3) Virtual implantation of micro-implant anchorage through positioning grid

3.1) using 3-matic software, respectively selecting a positioning hole from the bidirectional positioning grids at the implantation side and the auxiliary positioning side of the 3D reconstructed marking model, and taking the midpoint of the positioning hole as an implantation marking point, as shown in fig. 3 (a); 3.2) connecting the mark points at the two sides to form a cylinder with the diameter same as that of the micro-implant anchorage to be implanted, and using the cylinder as a micro-implant anchorage matrix for virtual implantation; 3.3) calculating from the surface of the implantation part, and intercepting a cylinder with the same length as the implant anchorage to be implanted as a virtual micro-implant anchorage, as shown in fig. 3 (b).

4) Virtual micro-implant anchorage location inspection

Exporting the virtually implanted micro-implant anchorage to Mimics software, and checking whether the virtually implanted micro-implant anchorage is in an ideal position from three dimensions and each section by combining CBCT image data of a patient, namely important structures such as tooth roots and great vessel nerves are avoided, and the implantation depth is enough; if the position is not in the ideal position, the method returns to the third step to readjust the position and the direction of the virtual micro-implant anchorage, as shown in fig. 4.

5) Transfer location and orientation on a marker model

According to the position of the positioning hole of the ideal implantation position of the virtual micro-implant anchorage, the positioning auxiliary member 3 is inserted on the marking model for transfer, as shown in fig. 5 (b).

The positioning auxiliary member 3 comprises a positioning member 1 and a positioning sleeve 2, the positioning member 1 and the positioning sleeve 2 can be two independent members, as shown in fig. 5(c) and 5(d), two fitting separation forms are used to facilitate the development of subsequent related research, and the steps are as follows: 5.1) inserting the positioning piece 1 according to the position of the positioning hole of the ideal implantation position, as shown in figure 5 (a); 5.2) the positioning sleeve 2 which is matched with the positioning piece 1 in a matching way is sleeved on the positioning piece, as shown in figure 5 (b).

The positioning auxiliary member 3 can also be formed by integrally forming the positioning member 1 and the positioning sleeve 2, i.e. the positioning member 1 and the positioning sleeve 2 are combined into a fitting, as shown in fig. 5 (e).

Wherein the positioning piece 1 and the positioning sleeve 2 are both customized by Computer Numerical Control (CNC), can be used for a plurality of times and do not need special disinfection treatment.

6) Making personalized implant guides

6.1) installation metal connection guide cylinder 4, as shown in fig. 6(a), this guide cylinder uses CNC customization processing, but repetitious usage, and its internal diameter and the external diameter gomphosis of position sleeve 2 also equal to little planting anchorage handle head end external diameter, make it can accurately block little planting anchorage handle head end when actual use, ensure that the planting anchorage is accurately implanted according to the position and the direction of design.

6.2) after fixing the guide cylinder 4, the tooth surface guide 5 is connected thereto (the material of the tooth surface guide 5 may be silicone rubber, resin base, cast metal, or other various means), as shown in FIG. 6 (b).

7) Guided implantation and core appendage retrieval

After the guide plate is sterilized, the guide plate is stably worn on the tooth surface, and the micro-implant handle is clamped into the connecting guide cylinder, so that the guide of micro-implant anchorage implantation can be realized; after the guide plate is used, the metal connecting guide cylinder is detached for secondary disinfection.

The fabricated micro-implant anchorage guide plate is shown in fig. 7. The micro-implant anchorage guide plate can be operated according to the following steps: clinical trial wearing is performed, as shown in fig. 8; secondly, after the guide plate is fixed, the head end 6 of the micro-implant anchorage handle is clamped into the metal connecting guide cylinder, and as shown in fig. 9, micro-implant anchorage is implanted under local anesthesia; thirdly, separating the metal connecting guide cylinder part after the guide plate is used, and reusing the guide cylinder part after disinfection.

The key points of the invention are as follows:

1) introduction of bidirectional positioning grid with three-dimensional properties

In the past, a micro-implant anchorage accurate implantation method using a reverse engineering technology cannot realize accurate transfer from a virtual implantation position to an actual model position, so that a digital guide plate needs to be manufactured and then 3D printing forming is carried out. The method can accurately transfer the position and the direction of the virtually implanted micro-implant anchorage to the same marking model by embedding the bidirectional positioning grid with the three-dimensional attribute into the plaster model to form the marking model and then using the marking model for fixed-point design, as shown in figure 10. This bi-directional positioning grid should be substantially perpendicular to the implantation site and distributed on both sides of the implanted structure, wherein the side in contact with the implantation site is the implantation side 7 and the other side is the auxiliary positioning side 8, as shown in fig. 11. If the positioning grid is applied to a scene of implant implantation, the implantation side of the positioning grid should be embedded on the surface of the gypsum impression in the alveolar ridge, the lower part of the alveolar bone conforming to the implantation direction is an auxiliary positioning side, and theoretically, the farther the distance between the two sides is, the more precise the optional positioning division is.

2) Fixed-point forming micro-implant anchorage virtual implant

In the virtual implantation process of micro-implant anchorage by using a reverse engineering technology, because no positioning grid exists, the virtual implantation process is manually debugged. If the structures such as the tooth roots and the like need to be seen, the tooth roots are required to be reconstructed, and the design time is increased. The implantable area is clearly divided into the three-dimensional space grids, so that the rapid positioning can be realized, the design process is simplified and standardized, and the repeatability of the design is improved. Under the condition that the implantation position needs to be adjusted as the same as the virtual implantation of the traditional reverse engineering technology, due to the existence of the positioning grid, the controllable adjustment can be realized more quickly and accurately, and the design time is saved.

3) More flexible and changeable guide plate forming mode for replacing 3D printing

The micro-implant anchorage position after virtual implantation can be accurately transferred to the same model by using the connecting accessory through the method of the invention. After the metal connecting guide cylinder is arranged on the connecting accessory, the implanting guide plate can be manufactured on the same model. Because the guide plate does not need 3D printing and forming any more, corresponding guide plate manufacturing can be completed by various traditional processing modes such as silicon rubber, resin base or cast metal, coordination can be carried out according to respective conditions of a processing center, the processing difficulty is reduced, and meanwhile, the processing cost is also saved.

Finally, the above embodiments are only for illustrating the technical solutions of the present invention and not for limiting, although the present invention has been described in detail with reference to the preferred embodiments, it should be understood by those skilled in the art that modifications or equivalent substitutions may be made to the technical solutions of the present invention without departing from the spirit and scope of the technical solutions of the present invention, and all of them should be covered in the claims of the present invention.