TWI438732B - Intergrated method of adapting guide - navigation systems and bio-prosthesis fabrication for dental implantation - Google Patents
Intergrated method of adapting guide - navigation systems and bio-prosthesis fabrication for dental implantation Download PDFInfo
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Description
本發明是有關於一種使用立體定位導引系統之植牙生體贋復物成形的整合性方法,特別是有關於一種虛擬口腔定位系統,以產生虛擬模型,進而可進行虛擬植牙手術,藉以縮短植牙手術時間,並能於真正手術時,避免傷及患者之神經管。 The present invention relates to an integrated method for forming a dental implant body using a stereotactic positioning guide system, and more particularly to a virtual oral positioning system for generating a virtual model, thereby enabling virtual dental implant surgery. Shorten the time of implant surgery and avoid injury to the patient's neural tube during actual surgery.
現今的植牙方法,其包括有下列步驟: Today's dental implant methods include the following steps:
(1)製作模型,牙醫師或技師將患者的牙齒狀態,製成一石膏模型,並於石膏模型中設有具有金屬管之手術參考板,或者其他放射性不透材質(Radio opaque)做為定位點。 (1) Making a model, the dentist or technician will make the patient's tooth state into a plaster model, and set a surgical reference plate with a metal tube in the plaster model, or other radioactive material (Radio opaque) as the positioning. point.
(2)斷層掃描(Computerized Tomography,簡稱CT),患者進行口腔斷層掃描,以取得口腔中之影像,並以前述之定位點與該影像製作以3D渲染模型(Rendering model)。 (2) Computerized Tomography (CT), the patient performs an oral tomography scan to obtain an image in the oral cavity, and a 3D rendering model is created with the aforementioned anchor point and the image.
(3)調整咬合面水平角度。 (3) Adjust the horizontal angle of the occlusal surface.
(4)產生全景(Panoramic view),於冠狀切(Coronal section)平面點選牙弓線,以運算產生全景。 (4) Producing a panoramic view, in a coronal cut (Coronal Section) Plane to select the archwire line to generate a panoramic view.
(5)產生虛擬下顎神經管,於冠狀切、全景或牙弓線交錯區平面,電腦軟體會自動串接形成均一的下顎神經管。 (5) The virtual sacral canal is produced, and the computer software is automatically connected in series to form a uniform sacral canal in the plane of the coronal, panoramic or dental arch line.
(6)虛擬牙齒與設置植體,於牙弓線設置虛擬牙齒,並調整其大小位置,再於牙弓線的正交切面放置虛擬植體。 (6) Virtual teeth and implants, virtual teeth are placed on the arch line, and the size of the teeth is adjusted, and the virtual implants are placed on the orthogonal sections of the arch line.
(7)手術,確認植牙之尺寸,逐一調整其立體位置,並以該資料製作植牙孔徑導引板,患者試戴調整植牙孔徑導引板,或者重新製作,若患者試戴後,並無任何問題,牙醫師可進行手術,以完成植牙之程序。 (7) Surgery, confirm the size of the implant, adjust its stereo position one by one, and use this data to make the implant aperture guide plate, the patient try to adjust the implant aperture guide plate, or re-create, if the patient tries on it, There is no problem, the dentist can perform surgery to complete the procedure of implanting teeth.
然上述之植牙方法於使用上仍存在著諸多缺失,特予分述如下: However, there are still many shortcomings in the above-mentioned method of implanting teeth, which are described as follows:
一、石膏模型往往因檢查結果,而須重複修正其定位板,而使原先所製作之參考板無法應用,而須重新製造,故曠日費時。 First, the plaster model is often subject to inspection results, and the positioning plate must be repeatedly modified, so that the original reference plate can not be applied, but must be remanufactured, so it takes time.
二、患者口中若有金屬假牙,於進行斷層掃描時,金屬假牙會干擾散射,故無法正確呈現患者之牙齒外形,所以另需花時間製作輔助石膏模型,再轉為數位資料,以確認齒列正確外形或更高階影像處理CT資料成形。 2. If there are metal dentures in the patient's mouth, the metal dentures will interfere with the scattering during the tomographic scan, so the shape of the patient's teeth cannot be correctly presented. Therefore, it is necessary to take time to make the auxiliary plaster model and then convert it into digital data to confirm the dentition. Correct shape or higher order image processing CT data shaping.
三、目前部份的植牙電腦軟體仍需繁複操作步驟,並且其大多應用於單一植牙,若應用於多顆植牙,則植牙電腦軟體無法群組化,故應用於多顆植牙手術規劃時,其功效不佳。 Third, some dental implant software still require complicated operation steps, and most of them are applied to single implants. If applied to multiple implants, implanted computer software cannot be grouped, so it is applied to multiple implants. When the operation is planned, its efficacy is not good.
四、電腦軟體所產生之虛擬下顎神經管,多以平均直徑多點串接標示,其誤差值仍偏高,往往無法發揮其警示作用。 Fourth, the virtual sacral neural tube produced by the computer software is often marked by multiple points in the average diameter. The error value is still high, and often it is unable to play its warning role.
五、以現有之方式僅能輸出植牙孔徑導引板,而無法規劃或輸出 立體空間定位導引板的功能。 5. Only the implanted aperture guide plate can be output in the existing way, and cannot be planned or output. The function of the three-dimensional spatial positioning guide.
六、所有植牙之圖形截面或預製之假牙套件,其不符合自然牙根的外形,不符人體工學之設計而且有違美觀達成。 6. The pattern section of all implants or the prefabricated denture kit, which does not conform to the shape of the natural root, does not conform to the ergonomic design and is contrary to aesthetics.
有鑑於上述習知技藝之問題,本發明之目的就是在提供一種使用立體定位導引系統之植牙生體贋復物成形的整合性方法,以解決目前植牙之實體模型所產生的曠日廢時之問題、假牙不美觀且不符人體工學、現有電腦軟體無法發揮應有的警示功能、無法規畫植牙手術、無法克服斷層掃描干擾所產生之誤差與現有電腦軟體僅能使用於單一顆植牙。 In view of the above-mentioned problems of the prior art, the object of the present invention is to provide an integrated method for forming a dental implant body using a stereotactic positioning system to solve the next day of the physical model of the dental implant. The problem of waste time, the dentures are not beautiful and the ergonomics, the existing computer software can not play the proper warning function, the irregular dental painting surgery, the error caused by the interference of the tomographic scan can not be overcome, and the existing computer software can only be used for a single computer. A dental implant.
本發明係提供一種使用立體定位導引系統之植牙生體贋復物成形的整合性方法,其步驟包括有虛擬口腔定位:將口腔印模托盤與戴著口腔印模托盤之患者分別進行斷層掃描,並分別建立二影像,於二影像之間建立座標轉移,以於患者口腔或其數位上下顎模型建立對應座標;虛擬模型建立:使用前述之座標,於患者的斷層掃描之3D模型中建立下顎神經管或切緣管的影像;自然牙與植體之資料庫建立:於一資料庫中設有自然牙資料與各廠牌之植體2D/3D模型資料;以及虛擬植牙手術:選用由前述之影像及資料庫,以產生植體之導引板,於一電腦螢幕模擬於患者之口腔中選用植入點,以植入單顆假牙或多顆假牙,假牙係可模擬自然牙形態,以符合患者口腔中之牙根形態,而電腦螢幕亦顯示植牙機與鑽針之定位與尺寸的設定。 The present invention provides an integrated method for forming a dental implant body using a stereotactic positioning system, the steps of which include virtual oral positioning: respectively, the oral impression tray and the patient wearing the dental impression tray are respectively subjected to a fault Scan and create two images separately, and establish coordinate transfer between the two images to establish corresponding coordinates in the patient's mouth or its digital upper and lower jaw model; virtual model establishment: using the aforementioned coordinates to establish in the 3D model of the patient's tomography scan Imaging of the sacral canal or marginal canal; establishment of a database of natural teeth and implants: natural tooth data and 2D/3D model data of each plant in a database; and virtual dental implant surgery: selection The image and the database are used to generate a guiding plate for the implant, and a computer screen is used to simulate the implantation of the patient's mouth to implant a single denture or a plurality of dentures, and the denture can simulate the shape of the natural tooth. In order to conform to the root shape of the patient's mouth, the computer screen also shows the positioning and size setting of the dental implanter and the drill.
本發明可進一步包括有於上述步驟選用之假牙資料,傳送給電腦 輔助機器或快速成型機,以使假牙製造成型之應用。 The invention may further comprise the denture data selected in the above steps and transmitted to the computer Auxiliary machines or rapid prototyping machines for the manufacture of dentures.
本發明更可進一步包括有一建立雲端資料區,其係將虛擬口腔定位、虛擬模型建立、自然牙與植體之資料庫建立與虛擬植牙手術所使用之電腦程式與資料庫建立於一雲端伺服器中,透過網際網路,並於任何適當位置處進行虛擬植牙手術,藉此雲端技術係可擴大治療結構群參與度,以減少與縮短醫療群的溝通阻礙與工作時間。 The invention further includes a cloud data area for establishing a virtual oral location, a virtual model establishment, a database of natural tooth and implant establishment, and a computer program and a database used for virtual dental implant surgery. In the device, virtual implant surgery is performed through the Internet and at any appropriate location, so that the cloud technology system can expand the participation of the treatment structure group, thereby reducing communication barriers and working hours of the medical group.
承上所述,依本發明之使用立體定位導引系統之生體贋復物的方法,其可具有多個下述優點: As described above, the method of using the stereotactic positioning system of the living body according to the present invention can have a plurality of advantages as follows:
一、本發明係直接藉二斷層掃描之影像,其經比對後所產生之座標,進而產生虛擬模型,並可使該虛擬模型趨近於患者口腔之實際狀態,而使使用端能設計出符合臨床需求之導引板,以預製符合患者之生體贋復物。 1. The present invention directly scans the image of the second tomographic image, and the coordinates generated by the comparison are used to generate a virtual model, and the virtual model can be brought closer to the actual state of the patient's mouth, so that the user can design the terminal. Guide plates that meet clinical needs are prefabricated to meet the patient's biopsy.
二、免除實體模型的製作之曠日費時,並以虛擬模型替代,藉此縮短手術時間,並可同時區分軟硬組織之立體形態,克服以往檢查結果無法一次性完整呈現所有口內狀況。 Second, the elimination of the production of the physical model is time-consuming and replaced by a virtual model, thereby shortening the operation time, and simultaneously distinguishing the three-dimensional shape of the soft and hard tissue, overcoming the previous inspection results can not fully present all the intraoral conditions at one time.
三、本發明係藉患者戴著口腔印模托盤取得斷層掃描影像,進而產生虛擬模型,其可避免金屬假牙的干擾散射,可正確呈現患者之牙齒外形,利於後續之植體規劃。 3. The invention obtains a tomographic image by using a dental impression tray, thereby generating a virtual model, which can avoid the interference scattering of the metal denture, and can correctly represent the shape of the patient's teeth, which is beneficial to the subsequent implant planning.
四、虛擬植牙手術,其係使得牙醫師得以於實際進行手術時,得以精準實施,並可避免可預期地傷害患者之神經管或鼻竇。 Fourth, virtual dental implant surgery, which enables the dentist to be accurately implemented during the actual operation, and can avoid the nerve canal or sinus that can be expected to harm the patient.
五、所製出之假牙,其更趨近於自然牙,並且該假牙之贋復部分 更貼近於原牙齦中的空間,以使該假牙符合美觀與人體工學之設計。 5. The dentures produced are closer to the natural teeth, and the complex parts of the dentures It is closer to the space in the original gums, so that the dentures are aesthetically and ergonomically designed.
六、本發明更可供牙醫師進行手術前之練習,以使牙醫師的手術技術更加精益求精。 Sixth, the invention can be used by the dentist to perform pre-operative exercises to make the dentist's surgical technique more perfect.
七、下顎神經管或切緣管的影像之建立,使其趨近於患者之真實神經,故誤差值低,所以能確實發揮其警示作用。 Seventh, the establishment of the image of the sacral neural tube or the marginal tube makes it close to the real nerve of the patient, so the error value is low, so it can really play its warning role.
八、本發明係可規劃單一植牙,或者可群組化以應付多顆植牙手術,並可依實際手術狀態,而可於較短的時間內做出相對應的調整。 8. The invention can plan a single implant, or can be grouped to cope with multiple implant operations, and can make corresponding adjustments in a shorter time according to the actual surgical state.
九、本發明更可進一步透過雲端技術,而於任何適當位置處,進行虛擬植牙手術,而使本發明具有較佳之便利性與參與規模。 9. The present invention can further perform virtual dental implant surgery at any suitable position through the cloud technology, so that the present invention has better convenience and participation scale.
a~f‧‧‧步驟流程 a~f‧‧‧Step process
1‧‧‧口腔印模托盤 1‧‧‧Dental impression tray
2‧‧‧下顎神經管 2‧‧‧ Lower jaw neural tube
3‧‧‧下顎骨 3‧‧‧ Lower jaw bone
4‧‧‧導引板 4‧‧‧Guideboard
第1圖係為本發明之使用立體定位導引系統之生體贋復物的方法之流程示意圖。 Fig. 1 is a schematic flow chart showing a method of using a stereotactic positioning system for a living body in accordance with the present invention.
第2圖係本發明之口腔印模托盤之示意圖。 Figure 2 is a schematic illustration of an oral impression tray of the present invention.
第3圖係本發明之下顎神經管之示意圖。 Fig. 3 is a schematic view of the sacral canal of the present invention.
第4圖係本發明之下顎骨之示意圖。 Figure 4 is a schematic illustration of the tibia below the present invention.
第5圖係本發明之導引板之示意圖。 Figure 5 is a schematic view of the guide sheet of the present invention.
第6圖係本發明之局部植牙動作演練之示意圖。 Figure 6 is a schematic view of a partial dental implant exercise of the present invention.
請配合參考第1圖所示,本發明係一種使用立體定位導引系統之植牙生體贋復物成形的整合性方法之流程示意圖。圖中,本發明之步驟包括如下: Referring to FIG. 1 , the present invention is a schematic flow chart of an integrated method for forming a dental implant body using a stereotactic positioning guide system. In the figure, the steps of the present invention include the following:
a、虛擬口腔定位:第2圖係本發明之口腔印模托盤之示意圖。於口腔印模托盤1(Dental impression tray)中填充印模材,口腔印模托盤1具有多個定位點或多邊形之物件,並將此一口腔印模托盤1進行斷層掃描(CT),以建立影像,患者再戴著此口腔印模托盤1進行斷層掃描,並建立另一影像,口腔印模托盤1的影像與患者的影像之間建立一對一座標轉移關係,以於患者口腔內或其數位上下顎模型建立相對應座標。此外,口腔印模托盤1係可於其三點以上位置處分別設有放射不透材質(Radio opaque),以做為定位點。 a. Virtual Oral Positioning: Figure 2 is a schematic view of the oral impression tray of the present invention. The impression material is filled in the Dental impression tray 1. The dental impression tray 1 has a plurality of positioning points or polygonal objects, and the dental impression tray 1 is subjected to tomography (CT) to establish Image, the patient then wears the dental impression tray 1 to perform a tomographic scan and establish another image, and establish a one-to-one label transfer relationship between the image of the dental impression tray 1 and the patient's image for the patient's mouth or The digital upper and lower 颚 model establishes the corresponding coordinates. In addition, the dental impression tray 1 can be provided with a radio opaque at its three or more positions as a positioning point.
b、虛擬模型建立:請參閱第3圖所示,其為本發明之下顎神經管之示意圖。使用上述之座標,於患者的斷層掃描之3D模型的切面之單點或多點位置處,以實際大小形成下顎神經管2或切緣管(Incisal canal);請參閱第4圖所示,其為本發明之下顎骨之示意圖。而可較精準評估其結構於患者之下顎骨3內的立體位置與大小,以助於牙科手術之進一步風險評估,該牙科手術可為植牙或正顎矯正;並藉由影像翻模技術對口腔印模托盤的影像進行運算,以產生上下顎實體或數位模型。 b. Virtual model establishment: Please refer to Fig. 3, which is a schematic diagram of the sacral canal of the present invention. Using the above coordinates, the sacral canal 2 or the Incisal canal is formed at the actual size of the single or multiple points of the section of the 3D model of the patient's tomography; see Figure 4, It is a schematic diagram of the tibia under the present invention. The stereo position and size of the structure under the patient's tibia 3 can be accurately evaluated to facilitate further risk assessment of dental surgery, which can be corrected for dental implants or orthognathic surgery; The images of the dental impression tray are manipulated to produce an upper and lower squat entity or a digital model.
c、自然牙與植體之資料庫建立:資料庫中之自然牙資料係包含有自然牙3D模型形態,以便製作個人化牙根形態之形變之假牙贋復部分,其係選定植牙之上部平台直徑,並與欲製作假牙之正常牙根立體,相互重疊相減2mm~4mm 形漸變,以製出3D模型圖檔;該資料庫亦包含有各廠牌之植體2D/3D模型資料,該資料為平台、植體直徑與長度。 c. Establishment of the database of natural teeth and implants: The natural tooth data in the database contains the shape of the natural tooth 3D model, in order to make the deformation of the individual tooth root shape, which is the upper platform of the selected dental implant. Diameter, and the normal root of the tooth to be made of dentures, the overlap of each other by 2mm~4mm The gradual change is made to produce a 3D model image file; the database also contains the 2D/3D model data of the implants of the various brands, which are the platform, the diameter and length of the implant.
d、虛擬植牙手術:請配合參考第5圖所示,其為本發明之導引板之示意圖,操作者選用由步驟a至c所產生影像及資料庫,以產生植體之導引板4,操作者可於一電腦螢幕模擬於患者之口腔中選用一植入點,以植入單顆假牙或多顆假牙,該假牙係可模擬自然牙形態,以符合患者口腔中之牙根形態,而該電腦螢幕亦顯示植牙機與鑽針之定位與尺寸的設定。 d, virtual implant surgery: please refer to the reference figure 5, which is a schematic diagram of the guide plate of the present invention, the operator selects the image and database generated by steps a to c to generate the guide plate of the implant 4. The operator can select an implant point in a patient's mouth in a computer screen to implant a single denture or a plurality of dentures, which can simulate the shape of the natural tooth to conform to the root shape of the patient's mouth. The computer screen also shows the positioning and size setting of the implanter and the drill.
該植入點設定如下:以欲植牙之位置為植入點,並以植入點之牙弓線(X軸)為主;牙弓線以冠狀切景之圖像,於上下顎之齒槽骨之牙齒位置點出連線;牙弓線兩側各1至2公分之後度產生全景;牙弓線正交為切面(Y軸),以產生2D模型影像,並維持正交點調整不同X、Y軸之夾角度(2至5度/次),以符鄰牙之牙軸,並與正焦點可前後或左右水平移動,以調整至理想之植入點,並於確認之切面建立其植牙植入立體軸向;選擇植入立體軸向,以成立參考軸,可於不同位置之欲平行植牙群可套用,並以群組化調整共同平行軸向,而一組牙弓線可建立多個群組,以簡化植牙規劃步驟,每一患者可建立多組牙弓線,其係分為上下兩類,並同時可調整植入物之直徑大小3.25至6mm並提供植體安全間距值設定,或者以相關植入物之立體圖投影至相關2D/3D模型圖影中。 The implantation point is set as follows: the position of the implanted tooth is the implantation point, and the arch line (X-axis) of the implant point is mainly; the arch line is the image of the crown cut, and the teeth of the upper and lower jaws The teeth of the trough are pointed out; the sides of the arch line are 1 to 2 cm each, and the arch line is orthogonal to the section (Y axis) to generate 2D model images and maintain orthogonal point adjustment. The angle between the X and Y axes (2 to 5 degrees/time), to the axis of the adjacent teeth, and the positive focus can be moved horizontally back and forth or left and right to adjust to the ideal implantation point, and establish the confirmed cut surface The implanted teeth are implanted in a stereoscopic axis; the stereoscopic axial direction is selected to establish a reference axis, and the parallel implanted groups can be applied at different positions, and the common parallel axes are adjusted in groups, and a set of dental arches The line can establish multiple groups to simplify the planning procedure of implant planning. Each patient can establish multiple sets of archwire lines, which are divided into upper and lower categories, and can adjust the diameter of the implant to 3.25 to 6mm and provide planting. The body safety spacing value is set or projected into the relevant 2D/3D model image with a perspective view of the relevant implant.
3D模型可半透明化,以顯示其中之實際尺寸之神經管,以及植牙 外形圖,並可套用不透明/透明不同之表面顏色。 The 3D model can be translucent to show the actual size of the neural tube, as well as the implant Outline drawing, and can be applied with opaque/transparent surface colors.
不同3D模型可以透過患者的影像與數位模型之間建立一對一座標轉換,影像融合(Image fusion)係規劃植體路徑與數位牙齒,並可套疊,以評估植牙空間與原自然牙之差異性。 Different 3D models can establish a one-to-one conversion between the patient's image and the digital model. Image fusion is used to plan the implant path and digital teeth, and can be nested to evaluate the implant space and the original natural tooth. difference.
植體之導引板4為植體孔徑導引板、植體定位導引板與複合式植體導引板,藉由影像特徵擷取、影像分割與影像成長,以對口腔印模托模的影像模型進行運算,以產生植體植入路徑且其他完全密合於牙齒及牙齦表面之植體定位導引板或植體孔徑導引板,或依手術需求提供更多手術區域的齒槽骨接觸面之複合式植體導引板。 The guiding plate 4 of the implant is an implant aperture guiding plate, an implant positioning guiding plate and a composite implant guiding plate, and the image impression is taken, the image segmentation and the image growth are performed to control the dental impression die. The image model is computed to create an implant placement path and other implant positioning guides or implant aperture guides that are fully adhered to the tooth and gum surface, or provide more surgical area of the cochlear area as required by the surgical procedure. Composite implant guide plate for bone contact surfaces.
e、實體假牙成型:將步驟d於資料庫中所選之假牙資料傳送給電腦輔助機器或快速成型機,以使所選用之假牙製造成型。請參閱第6圖所示,其為本發明之局部植牙動作演練之示意圖。如圖所示,於此本步驟中,牙醫師可使用前述之導引板與已為成之假牙,進行植牙前之演練與預習,以降低實際植牙時可能會發生之風險性或錯誤,並增進其醫療技巧。 e. Solid denture molding: Transfer the denture data selected in step d to the computer aided machine or rapid prototyping machine to make the selected dentures into shape. Please refer to FIG. 6 , which is a schematic diagram of a partial dental implant exercise of the present invention. As shown in the figure, in this step, the dentist can use the above-mentioned guide plates and the existing dentures to perform pre-tooth implant exercises and previews to reduce the risk or error that may occur during actual implants. And improve their medical skills.
f、建立雲端處理區:前述步驟a至d所使用之電腦程式與資料庫係可建立於一雲端伺服器中,透過網際網路,以讓操作者得以於任何適當位置處進行虛擬植牙手術,並可藉此雲端技術係可擴大治療結構群參與度,以減少與縮短醫療群的溝阻礙與工作時間。 f. Establishing a cloud processing area: The computer programs and database used in the foregoing steps a to d can be built in a cloud server through the Internet to allow the operator to perform virtual implant surgery at any suitable location. The cloud technology system can be used to expand the participation of the treatment structure group to reduce and shorten the barriers and working hours of the medical group.
以上所述僅為舉例性,而非為限制性者。任何未脫離本發明之精神與範疇,而對其進行之等效修改或變更,均應包含於後附之申請專利範圍中。 The above is intended to be illustrative only and not limiting. Any equivalent modifications or alterations to the spirit and scope of the invention are intended to be included in the scope of the appended claims.
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