WO2011016075A1

WO2011016075A1 - Surgical set for cutting the gingiva of a patient during positioning of osseointegrated implants

Info

Publication number: WO2011016075A1
Application number: PCT/IT2010/000354
Authority: WO
Inventors: Piero Zoppi; Pier Giuseppe Preda
Original assignee: Piero Zoppi; Pier Giuseppe Preda
Priority date: 2009-08-06
Filing date: 2010-08-04
Publication date: 2011-02-10
Also published as: ITCR20090034A1; IT1395062B1

Abstract

A surgical set for cutting the gingiva (G) of a patient during positioning of osseointegrated implants comprising a plurality of blade instruments, wherein said blade instruments (100, 110, 1, 2, 3) present a shank (5) forming a longitudinal axis (X), where one end of said shank (5) is provided with a tool (101, 120, 6, 14, 16) suitable to operate, in use, with a rotational movement about said axis (X) and where the other end is provided with coupling means (7) of the type with mating parts, suitable to cooperate with specific devices useful to impart a rotation to the entire instrument, respectively during use or during sharpening, and where said surgical set comprises: - a scalpel (100) with circular blade (101 ) in the form of a "flying saucer"; - a scalpel (110) in the shape of an upside-down "T" with flat blade (120) orthogonal to the shank (5); - a scalpel (1 ) with circular blade (6) in the shape of a "bowl", the cutting edge of which can be smooth or serrated; - a flat bur (2) with cutting blades (15), arranged in a plane orthogonal with respect to the longitudinal axis (X) thereof; - a scalpel (3) in the shape of a mucotome, with circular blade (16).

Description

SURGICAL SET FOR CUTTING THE GINGIVA OF A PATIENT DURING POSITIONING OF OSSEOINTEGRATED IMPLANTS

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The present invention relates to a surgical set comprising blade instruments for use in dentistry, that can be used in particular for cutting the gingiva of a patient in order to prepare the bone site in the point in which it must be perforated to position an osseointegrated implant.

The present invention also describes a procedure for cutting the gingiva of a patient and preparing the bone site in the pojnt in which it must be perforated to position an osseointegrated implant using the surgical set according to the invention.

According to prior art, to prepare the bone site of a patient in the point in which it must be perforated to position an osseointegrated implant, an "open flap" is produced, i.e. the gingiva is cut using a conventional scalpel with a knife blade, and the mandibular or jaw bone is completely exposed with a release incision, to allow it to be perforated and threaded in the predetermined point with conventional instruments.

In the subsequent steps, the same scalpel can be used to trim the portion of the implant already positioned in the bone, cutting the part of gingiva that has regrown during the settling and maturing step of the partially produced implant.

Use of the conventional scalpel presents some limits and drawbacks, which can be summed up in difficulty in using an instrument not specifically shaped for the job; in the need to apply sutures to the patient, which can disadvantageously prolong healing times and cause discomfort and pain; in longer operating times, with discomfort for the patient; in the difficulty in completely cleaning the bone, removing the gingiva entirely with an instrument not specifically designed for this purpose.

The aim of the present invention is that of reducing the patient's discomfort and pain caused by the implant, avoiding the "open flap" and consequently also conventional sutures, without however running the risk of scraps of gingiva being driven by the bits into the bone during the step to perforate the bone with the helical drill bits, jeopardizing successful osseointegration of the implant.

More in particular, the aim of the invention is therefore to produce a set of surgical instruments that allows work to be carried out correctly, using specific instruments capable of making a clean, precise and minimally invasive incision of the gingiva, and of implementing a procedure that avoids the subsequent use of sutures, consequently reducing healing times.

The use of the surgical set of the present invention allows removal of the gingiva attached to the bone in the implant site, while saving a part of adherent superficial gingiva.

In fact, there are two types of gingiva, adherent and free. The former remains attached to the bone and is very hard and is suitable to close and prevent permeability around the osseointegrated screw when it projects with a stump. The latter, namely the vestibular gingiva, does not remain adherent to the bone, but is separated therefrom by mucous membrane and loose tissue and is not suitable for closing around the implant.

According to prior art procedures, it is rarely possible to remove a core of adherent gingiva as large as the implant without straying into the free gingiva, which would be detrimental to maturing of the implant.

A further aim of the use of the surgical set according to the invention is therefore that of attempting to save as much adherent superficial gingiva as possible, whiie removing the deepest part adhering to the bone in the implant site, to avoid fragments of gingival, which would prevent osseointegration of the implant, from being carried in depth by the drill bits. The aims are achieved with a surgical set for cutting the gingiva of a patient during positioning of osseointegrated implants comprising a plurality of blade instruments, wherein said blade instruments present a shank forming a longitudinal axis, where one end of said shank is provided with a tool suitable to operate, in use, with a rotational movement about said axis and where the other end is provided with coupling means of the type with mating parts, suitable to cooperate with specific devices useful to impart a rotation to the entire instrument, respectively during use or during sharpening, and said surgical set is characterized in that it comprises:;

- a scalpel with circular blade in the form of a "flying saucer"

- a scalpel in the shape of an upside-down "T" with flat blade orthogonal to the shank;

- a scalpel with circular blade in the shape of a "bowl", the cutting edge of which can be smooth or serrated;

- a flat bur with cutting blades arranged in a plane orthogonal with respect to the longitudinal axis thereof;

- a scalpel in the shape of a mucotome, provided with circular blade.

According to a preferred aspect of the invention, said shank of some instruments of the surgical set is provided with an axial cylindrical cavity which passes through said tool, suitable to cooperate with a guiding tool provided with a stem which can be inserted in said axial cavity.

According to possible embodiments of the invention, said cutting blades are arranged tangentially to said axial cylindrical cavity or radially with respect to the longitudinal axis of the flat bur to which they belong. According to other preferred aspects, the axial cylindrical cavity can advantageously be smooth or threaded, as can the stem of the guiding tool.

Finally, said devices useful for imparting a rotation to the entire instrument can be composed of a micromotor for use in dentistry, or by a handgrip, permanent or removable, to manually impart a rotation to this instrument.

Advantageously, the stem of the guiding tool terminates with a smooth or threaded end portion, suitable to allow temporary fixing of the guiding tool respectively in a hole made in the bone or in a lead screw present in the screw of the implant previously fixed in the bone of the patient.

According to a further aspect, the guiding tool comprises means with mating parts to cooperate with manual key tools to impart a rotation to the guiding tool during positioning thereof in the lead screw.

The advantages achieved through the present invention essentially consist in the fact that:

- sutures are avoided after the step of cutting the gingiva, with less bleeding of the gingiva and less discomfort and pain for the patient; - the healing time of the patient is reduced;

- the time required for maturing and performing the implant is reduced;

- the risks of infection are reduced.

Further characteristics and advantages of the invention will be more evident from the detailed description set forth below, with the aid of the figures that represent preferred methods of implementation, shown by way of non-limiting example, wherein:

- Figs. 1-2-3 show, in axial section, three types of instruments belonging to the set of surgical instruments according to the invention;

- Figs. 4a and 4b show, in a bottom view, the instrument of Fig. 2 according to two possible embodiments;

- Fig. 5 shows, in a top view, the guiding tool of Fig. 3;

- Figures. 6-7 show, in an axial section, a detail of possible variants of the tool of the instruments of Figs. 1 and 3;

Fig. 8 shows, in cross section, the coupling system of the type with mating parts in the case of manual handling of the instrument of Fig. 3;

Figs. 9a-9b-9c show, in side and partial cross sectional view, another instrument belonging to the surgical set during use according to the procedure of the invention;

Figs. 10a-10b show, in side view and top view, a further instrument belonging to the surgical set during use according to the procedure of the invention;

Figs. 11a-11b show, in side and partial cross sectional view, the instrument of Fig. 1 during use according to the procedure of the invention.

With reference to Figs. 9a-10a-1-2-3 the surgical set to prepare positioning of an osseointegrated implant in a patient through cutting the gingiva G and preparing the bone site O for the implant comprises blade instruments 100, 110, 1 , 2, 3 consisting of a shank 5 having a longitudinal axis X presenting at one end an operating tool 101 , 120, 6, 14, 16 and at the other end coupling means 7 of the type with mating parts, particularly of the type used for micromotors for use in dentistry.

In particular, the surgical set comprises: - a scalpel 100 with circular blade 101 in the form of a "flying saucer";

- a scalpel 110 in the shape of an upside-down "T" with flat blade 120 orthogonal to the shank 5, wherein the shank 5 of the scalpel 110 presents a visual indicator 111 of the position of the blade

120 to facilitate extraction from the gingiva;

- a scalpel 1 with circular blade 6 in the shape of a "bowl", the cutting edge of which can be smooth, as shown in Fig. 1 , or serrated for use as coring instrument, as shown in Fig. 6;

- a flat bur 2 with cutting blades 15, arranged in a plane orthogonal with respect to the longitudinal axis X thereof, suitable to allow smoothing of the bone O;

- a scalpel 3 in the shape of a mucotome, with circular blade 16 of the punch type.

The circular blade 101 of the scalpel 100 is defined as having the form of a "flying saucer" as a diametrical cross section thereof presents a greater thickness in the central portion and decreasing towards the circumference, as shown in Figs. 9a, 9b and 9c.

The shank 5 of the instruments 1 , 2, 3 is provided with an axial cylindrical cavity 8, inside which a stem 9 of a guiding tool 4 can be inserted to guide them correctly during use.

The stem of the guiding tool can be smooth as in Figs. 1-2-3, and the axial cylindrical cavity 8 is in this case also smooth, or, in the case of use with the instrument 3, the stem 9 can be threaded, and therefore the axial cylindrical cavity 8 is also threaded as in Fig. 7.

The guiding tool 4 terminates with a thicker portion of smooth end 10 as in the version shown in Figs. 1-2, suitable to allow temporary fixing by interlocking of the guiding tool 4 in a hole made in the bone O, or terminates with a flared and threaded end portion 20, as in the version shown in Fig. 3, suitable to allow temporary fixing of the guiding tool 4 in a seat with lead screw 11 present in the screw 12 of the implant previously fixed in the bone of the patient.

In the case in which it presents a threaded portion 20, the guiding tool

4 will comprise means of the type with mating parts, such as a square shaped portion 13, to allow screwing of the guiding tool 4 through known manual tools of key type, or will comprise an Allen key seat located at the end of the stem 9.

The cutting blades 15 provided on the flat bur 2, for example nine in number, can be arranged radially with respect to the longitudinal axis X of the bur, as shown in Fig. 4a.

Alternatively, as shown in Fig. 4b, said cutting blades 15 can be arranged tangentially to the axial cylindrical cavity 8 of the bur, so as to reduce the oscillating effect of the instrument during rotation thereof.

The scalpel 3 is made to rotate manually during use, through a handgrip 17, or through direct action on the shank 5 in a knurled area 18. Operation with micromotor only takes place during the sharpening step, for example performed with an Arkansas stone.

The procedure for cutting the gingiva of a patient and preparing the bone site in the point in which it must be perforated to position an osseointegrated implant using the surgical set according to the invention comprises the steps of:

- performing a longitudinal cut of around 5 mm on the gingiva G using a scalpel 100 with a shank 5 provided with coupling means of the type with mating parts and a tool with circular blade 101 in the shape of a "flying saucer" with diameter of around 4 mm, rotating in a plane normal to that of the axis of said shank, as shown in Fig. 9a;

- entering the cut with said scalpel 100 tilting it in the two directions, separating the adherent superficial gingival layer from the deep layer to be removed, as shown in Figs. 9b-9c;

- in the case of particularly deep gingiva, entering the cut with a scalpel 110 in the shape of upside-down "T" with a shank 5 equipped with coupling means 7 of the type with mating parts and a flat blade tool 120 orthogonal to this shank and performing a circular cut in a plane parallel to that of the bone, as shown in Figs. 10a e 10b;

- cutting the deep gingival layer located on the side of the bone O, saving the adherent superficial layer, using a scalpel 1 having a shank 5 provided with coupling means 7 of the type with mating parts and a tool 6 with circular blade in the form of a "bowl", with the smooth cutting edge, as shown in Fig. 1 , where said shank 5 is provided with an axial cylindrical cavity 8 which passes through said tool, moving said tool freely, without any guide, so as to move to the right side and to the left side of the bone O;

- making a first hole with diameter of around 2.2 mm in the bone O with a drill bit and placing therein a titanium guiding tool 4, around 22 mm in length, provided with a stem 9 suitable to be inserted in an axial cavity 8 present in the shank 5 of some instruments 1 , 2, 3 of the surgical set, to guide them during use, and with a thicker end 10, with diameter of around 2 mm, suitable to be inserted with precision in said first hole made in the bone;

- cutting a circular core of gingiva with said scalpel 1 with circular blade 6 in the form of a "bowl" with serrated cutting edge, as shown in Fig. 6, inserting the stem 9 of the guiding tool 4 into the axial cylindrical cavity 8 present in the shank 5 of the scalpel, as shown in Fig. 1 ;

- smoothing the bone O and removing the gingival remains using a flat bur 2 provided with cutting blades 15, having a shank 5 provided with coupling means 7 of the type with mating parts, inserting the stem 9 of the guiding tool 4 into the axial cylindrical cavity 8 present in the shank 5 of the bur, as shown in Fig. 2;

- enlarging the hole in the bone O with other conventional drill bits, threading the hole and screwing the implant 12 into the bone O;

- after osseointegration has occurred, therefore at a distance of 2-3 months, screwing a guiding tool 4 with a threaded end 20 into the lead screw 11 of the screw 12 of the implant and using the stem 9 of said guiding tool 4 to guide a scalpel 3 having a shank 5 provided with coupling means 7 of the type with mating parts and a tool with circular blade 16 in the form of mucotome to cleanly cut the adherent gingiva G that has grown to cover the implant, as shown in Fig. 3;

- screwing a space maintainer of known type (not shown) onto the implant and waiting for healing, which takes place in 3-4 days.

Naturally, the embodiments, the materials employed, the dimensions and the constructional details can be widely varied with respect to what is described and illustrated as a function of application requirements, without however departing from the scope of the present invention.

Claims

1. A surgical set for cutting the gingiva (G) of a patient during positioning of osseointegrated implants comprising a plurality of blade instruments, wherein said blade instruments (100, 110, 1 , 2, 3) present a shank (5) forming a longitudinal axis (X), where one end of said shank (5) is provided with a tool (101 , 120, 6, 14, 16) suitable to operate, in use, with a rotational movement about said axis (X) and where the other end is provided with coupling means (7) of the type with mating parts, suitable to cooperate with specific devices useful to impart a rotation to the entire instrument, respectively during use or during sharpening, and said surgical set is characterized in that it comprises:

- a scalpel (100) with circular blade (101) in the form of a "flying saucer";

- a scalpel (110) in the shape of an upside-down "T" with flat blade (120) orthogonal to the shank (5);

- a scalpel (1 ) with circular blade (6) in the shape of a "bowl", the cutting edge of which can be smooth or serrated;

- a flat bur (2) with cutting blades (15), arranged in a plane orthogonal with respect to the longitudinal axis (X) thereof;

- a scalpel (3) in the shape of a mucotome, with circular blade (16).

2. A surgical set according to claim 1 , characterized, in that said shank (5) of the scalpel (110) presents a visual indicator (111) of the position of the blade (120) to facilitate extraction from the gingiva (G).

3. A surgical set according to claim 1 , characterized in that said shank (5) of some instruments (1 , 2, 3) of the surgical set is provided with an axial cylindrical cavity (8) which passes through said tool (6, 14, 16), suitable to cooperate with a guiding tool (4) provided with a stem (9) which can be inserted in said cavity (8).

4. A surgical set according to claim 1 and 3, characterized in that said cutting blades (15) are arranged tangentially to said axial cylindrical cavity (8).

5. A surgical set according to claim 1 , characterized in that said cutting blades (15) are arranged radially with respect to the longitudinal axis (X) of said flat bur (2).

6. A surgical set according to claim 3, characterized in that said axial cylindrical cavity (8) and said stem (9) are mutually smooth or threaded.

7. A surgical set according to claim 3, characterized in that said guiding tool (4) terminates with a thicker portion of smooth (10) or threaded (20) end.

8. A surgical set according to claim 3, characterized in that said guiding tool (4) comprises means of the type with mating parts suitable to allow screwing thereof by manual tools.

9. A surgical set according to claim 1 , characterized in that said coupling means (7) of the type with mating parts are of the type used for micromotors and are suitable to cooperate with specific automatic motor means or manual devices (17) useful to impart a rotation to the entire instrument during use or during sharpening.