KR101668919B1 - CAD-CAM based Maxillary Template for Orthognathic Surgery - Google Patents

Abstract

The present invention does not relate to the position of the mandibular condyle in the temporomandibular joint by not using the mid-upper portion of the surgery to overcome the instability of the jaw joint and preparation of the model surgery and the error of the model operation in the jaw correction surgery, We propose a maxillary template for orthognathic surgery that can accurately and easily reposition the maxilla in accordance with the surgical plan without the need for self rotation of the mandibular canine. To this end, a first member previously formed so as to correspond to the shape of the upper and lower entire cutting lines of the maxilla; And a second member previously formed so as to correspond to a shape of a cut line of the maxillary bone, wherein the guide groove of the first member fixed to the maxilla before the fracture step surgery and the guide groove of the first member fixed to the maxillary fragment, The CAD-CAM-based chin correction surgical plate having a structure in which the two-piece guide portions are fitted to each other is provided.

Description

{CAD-CAM based Maxillary Template for Orthognathic Surgery}

The present invention relates to a template for maxillofacial surgery for maxillofacial surgery, and more particularly to a CAD-CAM-based maxillary template for orthognathic surgery using information obtained through 3D virtual surgery surgery.

Malocclusion is defined as a condition in which the teeth are not evenly placed or the relationship between the upper and lower jaws (the arches) does not form a normal occlusion is called malocclusion. The jaws of the upper and lower jaws are discordant, The skeletal malocclusion occurs when the lower jaw and upper jaw growth do not match each other and some or all of the upper jaw and the left and right jaws grow more or less. Chin correction surgery or orthognathic surgery is a surgery that corrects skeletal malocclusion. It includes bare-handed surgery for performing only the lower jaw or upper jaw, and amniocentesis for performing both upper and lower jaw surgery. Many ambulatory surgery is being performed.

The Le Fort I procedure is used extensively for the maxillary fracture of the maxillary or upper jaw. This procedure involves the separation of the horizontal fracture and the pterygoid plate from the medial wall of the maxillary sinus to the zygomatic buttress, separating the maxilla including the upper teeth from the skull and then repositioning it in the planned position It removes the bone interfering parts of the maxilla and skull, which occur during the repositioning, and fixes them by fixing with metal plate and screws.

Surgical intermediate splints or wafers are used to reposition the severed jawbone in the planned position in conventional jaw surgery. In order to do this, model surgery should be done first. To do this, tooth modeling is performed by making upper and lower teeth impression, and facial bow to reproduce the upper and lower arches in the articulator. The upper part of the mandible was fixed to the face and the position of the maxilla was made with wax or the like on the bite fork and the center of the mandible was guided to the center position of the jaw joint The relationship is created. The maxillary tooth model was reproduced in the articulator at the perceived position on the medial and arch plates and fixed with the gypsum. The wax bite, which was obtained by induction of the center of the lower dental tooth model, was placed in the maxillary tooth model fixed to the articulator, Place the lower teeth model and fix it with gypsum. When the gypsum hardens, the positions of the important reference points are measured, then the maxillary tooth model is separated from the gypsum plate and the maxillary tooth model is positioned so that important reference points are moved forward and backward, It is fixed in the articulator with gypsum and filled with a composite material such as resin between the upper and lower teeth model fixed to the articulator to make the middle upper supine like the mouthpiece. Through such a complicated and multi-step process, an intermediate superstructure is created. In each process, various errors occur, and errors may occur depending on the condition of the patient, the degree of coordination, and the skill of the surgeon.

During the operation, the maxilla are separated and the intermaxillary interposition is performed between the maxillary and mandible. The combined maxillary and mandibular fractures were self-rotated around the mandibular condyle that made up the jaw joint, and the osseointegration between the maxilla and the skull occurred due to the repositioning of the maxilla in the planned position. And reposition the maxilla in the planned position. Because of the errors in the multilevel process for preoperative model surgery, especially when the position of the mandibular condyle is set during the induction of the central stomal occlusion, the midline abdomen used during the surgery is made incorrectly and the maxilla can be repositioned to the wrong position Even if it is made correctly, the maxillary bone may be repositioned to the wrong position even if the position of the mandibular condyle is unstable during the operation or if the cadaver keeps the position of the mandibular condyle inappropriately and removes the bone interference. In addition, it is difficult to accurately determine whether the mandibular self-rotation should be removed and repositioned to a certain vertical level, or if excessive or incomplete removal of the bone is performed by mistakenly grasping the bone interfering region, There is a problem that it is set to be incompatible with the plan.

In order to solve this problem, instead of the conventional operation method using the intermediate upper body, a technique of manufacturing a device using 3D printing technique using 3D virtual surgery and CAD / CAM to reinforce the accuracy of the fore and aft position of the maxilla Shatt et al., Orthognathic Y-splint: a CAD / CAM-engineered maxillary repositioning wafer assembly. Br J Oral Maxillofac Surg 52: 667-669, (Zinser MJ, Mischkowski RA, Sailer HF, et al., Computer assisted orthognathic surgery: feasibility study using multiple CAD / CAM, CAM surgical splints. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 113: 673-687, 2013) have been reported.

However, in the conventional technique, a semicircular device on the front side of the maxilla is connected to a normal intermediate upper part in a chin correcting operation method using the existing middle upper part. In the operation method using the existing middle upper part, Information about the bone interfering site and the information about the maxillary center line, the frontal canting, and the front and rear vertical positions of the maxilla in setting the new maxillary bone position are not reflected in the apparatus to the extent that the accuracy is reinforced. Other prior art techniques disclosed have not only a complicated structure in which three large devices are sequentially screwed and removed to the maxillary bone, but also the screw holes in the thin frontal wall are broken down in the process of fixing and removing the fixing screws 2-3 times The fixture may not be fixed properly, it is difficult to position and manipulate in a narrow mouth, and a difficult working space due to the removal of the fracture end and the bone interfering portion. Among other things, the prior art includes a device capable of recognizing the position of a fracture disconnection, the final position of the maxilla, and the like, but does not include a device capable of easily recognizing the position of the bone interfering portion, In the process of positioning the maxilla according to the CAD-CAM layer, there is a disadvantage in that it is excessively deleted to the area which should not be deleted or not to be done.

Korean Patent Laid-Open Publication No. 2013-0069576 relates to a surgical orthodontic implant and a method of using the same, in which an implant for use in chin-correcting surgery includes a plurality of preformed fingers extending from an upper edge of a plate member and a longitudinal plate member . However, since the above-described technique is complicated in using the fracture guiding implants and the bone-fixed implants alternately in the process of cutting and repositioning the separated maxilla, and since the bone-fixed implants are preliminarily manufactured in a fixed state, There is a problem in that it is impossible to apply the fine positional change.

Therefore, there is a strong need in the art for a surgical template that can help secure the incised jawbone in the correct position so that it can be safely and accurately performed within a short period of time .

Korean Published Patent Application No. 2013-0069576

1. Kang SH et al., Orthognathic Y-splint: a CAD / CAM-engineered maxillary repositioning wafer assembly. Br J Oral Maxillofac Surg 52: 667-669, 2014 2. Zinser MJ, Mischkowski RA, Sailer HF, et al., Computer assisted orthognathic surgery: feasibility study using multiple CAD / CAM surgical splints. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 113: 673-687, 2013

The present invention has been devised on the basis of the foregoing description. In order to overcome the instability of the jaw joint and preparation of the model surgery and the error of the model operation in the jaw correction surgery, A maxillary template for orthognathic surgery, which is independent of the position of the condyle of the mandible and can be repositioned accurately and easily according to the surgical plan, without the need for self-rotation of the mandibular condyle during surgery The purpose is to provide.

In order to solve the above-described problems, the present invention provides a surgical instrument comprising: a first member previously formed to correspond to a shape of an upper portion and a lower portion of a cut line of a maxilla; And a second member previously formed so as to correspond to a shape of a cut line of the maxillary bone, wherein the guide groove of the first member fixed to the maxilla before the fracture step surgery and the guide groove of the first member fixed to the maxillary fragment, The CAD-CAM-based maxillary template for chin orthodontic surgery has a structure in which the two-piece guide portions are fitted to each other.

The present invention is also characterized in that the first member includes an upper structure positioned above the cutting line of the maxilla, a lower structure located below the cutting line, and a connecting portion connecting the upper structure and the lower structure, And the lower structure contacts the forefront boundary of the nasal side wall and is formed on the left and right with respect to the nasal cavity, and the connecting portion connects the upper structure and the lower structure formed by the left and right sides, and the upper structure connected to the left lower structure The right upper structure provides a maxillary template for CAD-CAM-based chin correction surgery, which connects with the lower right structure.

The present invention is also characterized in that the upper structure comprises left and right upper plates previously formed to correspond to the shape of the cut line of the maxilla; At least one bite opening for fixing each of said top plates to a planned area; A bone interfering rim positioned at a lower edge of each of the upper plates to indicate a bone interfering portion generated when the upper and lower bone fragments are moved after a maxillary fracture; A CAD-CAM-based maxillary template for chin-correcting surgery, the CAD-CAM-based chin orthopedic surgical tool comprising a guide groove that is formed in a protruding shape on an upper portion of each of the upper plates and is fitted to a guide portion of a second member fixed to a fractured- .

The present invention is also characterized in that the guide groove is an open polygonal or circular concave shape and the guide portion is a CAD-CAM based chin correction, which is a polygonal or circular convex shape conforming to the concave shape, A maxillary template for surgery is provided.

The present invention is characterized in that the guide portion is an open polygonal or circular concave shape and the guide groove is a polygonal or circular convex shape conforming to the concave shape, A maxillary template for surgery is provided.

The present invention also provides a maxillary template for CAD-CAM-based chin correction surgery wherein said polygon is triangular.

The present invention is further characterized in that the lower structure comprises: left and right lower plates previously formed to correspond to the shape of the cut line of the maxilla; One or more screw openings for fixing each of said bottom plates to a planned area; And a zigzag engaging portion in which the left and right lower plates are coupled at the upper center line portion when the left and right lower plates are attached to the maxillary bone, respectively, and the lower plate includes a canine Molar) root cover, zygoma buttress cover; And a maxillary template for CAD-CAM-based chin correction surgery, including a piriform aperture lid.

The present invention also relates to a CAD-CAM-based jaw comprising a first connection part and a second connection part spaced apart from each other so that the upper structure and the lower structure can form an interval around a cutting line of the maxillary bone, A maxillary template for orthodontic surgery is provided.

In the present invention, it is preferable that the first connection portion is formed by projecting portions of the upper structure and the lower structure in a ring shape and connected to each other, and the second connection portion is annularly protruded so as not to intersect with the first connection portion, A CAD-CAM-based maxillary template for chin orthodontic surgery that connects the structure and the underlying structure.

The present invention is also characterized in that the second member has a left side portion and a right side portion which are formed laterally with respect to the nasal cavity, the left side portion is aligned with the first member left upper structure and the right side portion is formed with the first member right upper structure To provide a maxillary template for CAD-CAM-based chin orthodontic surgery.

The present invention is also characterized in that the second member is a preformed preform so as to correspond to the shape of the cut line below the maxilla; A screw opening having the same arrangement as the screw opening arrangement of the lower structure of the first member so that the screw fixing position of the fixing plate may be the same as the screw fixing position of the first member lower structure; And a guide portion protruding from the upper portion of the fixing plate and adapted to fit into a guide groove of the upper structure of the first member, wherein the lower plate includes a cannula for facilitating fitting of the upper plate and the maxilla Molar) root cover, zygoma buttress cover; And a maxillary template for CAD-CAM-based chin correction surgery, including a piriform aperture lid.

The second member further includes a column projecting toward the femoral support at a rear portion of the fixing plate, wherein the column is in contact with the optical golfer to stabilize the vertical position of the maxilla, or measure the residual bone interference, CAD-CAM based maxillary template for chin correction surgery.

The present invention also provides a CAD-CAM based maxillary template for chin orthodontic surgery, wherein the material of the first member and the second member is a metal, a synthetic resin, a resin, or a combination thereof.

The present invention also provides a CAD-CAM based maxillary template for chin orthodontic surgery, wherein the first member and the second member are made of 3D printing technology.

The CAD-CAM-based surgical maxillofacial plate for chin orthodontic surgery according to the present invention has a maxillary fracture stage in 3D virtual surgery, And the new position information of the maxillary bone according to the movement of the maxillary bone, and then made by using the three-dimensional printing equipment. The first face member fixed to the craniofacial bone above the burn line of the maxillary fracture and the first member So that the maxillary fragment can be repositioned at a desired position irrespective of the position of the mandibular canal and the rotational movement of the jaw joint, so that the jaw correcting operation can be performed safely and accurately in a short time .

FIG. 1 is a three-dimensional image in which the first member of the CAD-CAM-based chin orthodontic maxillofacial surgery plate of the present invention is fixed to the maxillary bone.
FIG. 2 is a three-dimensional image showing a broken line of the maxillofacial fracture for dental correction surgery.
FIG. 3 is a conceptual diagram showing a chin orthodontic treatment using a conventional middle-phase surgical technique.
Figure 4 shows the shape of a first member of a CAD-CAM based chin orthotic surgical plate of the present invention.
FIG. 5 is a three-dimensional image showing the right side (at the patient position) of the right and left symmetrical structures of the first member shape of the CAD-CAM-based chin orthopedic surgical upper plate according to the present invention.
FIG. 6 is a three-dimensional image showing an operation procedure using a first member of a maxillofacial plate for a CAD-CAM based chin orthodontic surgery according to the present invention.
FIG. 7 is a cross-sectional view of the CAD-CAM-based chin orthodontic surgical maxillofacial plate according to the present invention. FIG. 7 shows a state in which the lower structure is removed, It is a three-dimensional image showing a single fracture.
8 is a three-dimensional image showing a state in which the second member and the second member are fixed.
FIG. 9 shows a process and state of fixing the repositioned maxilla.
Fig. 10 is a three-dimensional CT image after completion of chin-correcting operation.

Various aspects are disclosed with reference to the drawings. BRIEF DESCRIPTION OF THE DRAWINGS For the purpose of explanation, numerous specific details are set forth below in order to provide a thorough understanding of one or more aspects. It will be appreciated, however, that such aspects may be practiced without the specific details of each. The following description and the annexed drawings set forth in detail certain illustrative aspects of one or more aspects. However, it is to be understood that such aspects are illustrative and that some of the various ways may be used in various aspects of the principles, and that the description set forth is intended to include all such aspects and their equivalents.

Various aspects and features will be presented by a system that may include multiple devices, modules, and the like. It should also be understood and appreciated that the various systems may include additional devices, components, components, etc., and / or may not include all of the devices, components, components, etc. discussed in connection with the drawings.

As used herein, the terms " an embodiment, "" an embodiment, "" an example, "etc. should not be construed as advantageous or advantageous over other aspects or designs. In addition, the term "or" is intended to mean " exclusive or " That is, it is intended to mean one of the natural inclusive substitutions "X uses A or B ", unless otherwise specified or unclear in context. That is, X uses A; X uses B; Or when X uses both A and B, "X uses A or B" can be applied in any of the above cases. It is also to be understood that the term "and / or" as used herein refers to and includes all possible combinations of one or more of the listed items.

Also, the term " comprises "and / or" comprising "means that there is a corresponding feature, step, operation, module, and / Elements, and / or the presence or addition of such groups. In addition, although the terms first and second in the present specification can be used to describe various elements, these elements are not limited by these terms. That is, these terms are only used to distinguish between two or more components, and should not be construed as meaning order or priority. Also, unless the context clearly dictates otherwise or to the contrary, the singular forms in this specification and claims should generally be construed to mean "one or more. &Quot;

Hereinafter, the configuration and the names thereof will be described as an example, but the present invention is not limited thereto, and the understanding and interpretation of the invention should be construed as a corresponding configuration.

FIG. 1 is a three-dimensional image in which a first member of a maxillofacial plate for a chin correcting surgery based on the CAD-CAM of the present invention is fixed to the maxillary bone. The first member includes an upper structure 1, a lower structure 2, and connection portions 3, 4. In order to accurately reproduce the maxillary bone during surgery, the canine (molar) root portion 31, the piriform aperture 33, and the zygoma buttress 32 and covers the protrusion 34 of the maxillary central portion at the center portion where the left and right template meet, to be zigzag-shaped. Dental CAD / CAM refers to the 3D scanning of the equipment necessary for the dental treatment process, or the image of the 3D CT is stored in the computer so that the device can be directly designed (CAD) on the computer and precisely cut (CAM) It means to build up by layering. The introduction of CAD / CAM makes it easier to manufacture devices using materials with excellent mechanical properties and biocompatibility. 1, the screw for fixing the template to the maxillary bone is not shown, and only the opening of the template through which the screw passes is shown.

3D virtual surgery is a method of constructing a three-dimensional image of the human body using computer tomography (CT) and magnetic resonance image (MRI), acquiring digital shape information using three-dimensional model data, And the results are predicted. In one embodiment of the present invention, a three-dimensional image required for chin correction surgery is obtained, and a surgical maxillary template for chin correction surgery is produced using three-dimensional CAD / CAM and three-dimensional printing technology.

FIG. 2 is a three-dimensional image in which the maxillary fracture disconnection line 60 is indicated by a dotted line for a jaw correcting operation. The maxillary bone 30 is divided into a maxillary bone 37 and a maxillary bone 38 connected to the craniofacial bone without changing the position of the maxillary fracture. Most of the chin orthodontic surgery is performed by sequentially moving the maxillary bone piece 37 and the distal bone piece 44 of the mandible 40. In order to move the maxillary bone piece 37, The maxillary bone containing the craniofacial cortex and the root of the craniofacial bone is fractured along the fracture disconnection (60), and moves forward and backward, up and down, left and right lateral movements (parallel movement and rotational movement) to conform to the surgical plan. In the prior art, an intermediate wafer is used to connect the maxillary bone fragment to the mandible for repositioning the fractured maxillary bone fragment according to the surgical plan.

FIG. 3 is a conceptual diagram showing a chin orthodontic treatment using a conventional surgical intermediate sheath. FIG. 3a shows a tooth model of the upper and lower jaws 30 and 40, The relationship is reproduced in the articulator. FIG. 3B is a state in which the upper teeth model is moved according to the surgical plan in the articulator, and the model is operated after the operation. The upper jaw 35 restored by the movement is located in comparison with the upper jaw 30 before the movement Can be confirmed. FIG. 3C shows a state in which the resin is inserted into the space between the upper and lower tooth models after the model operation, and the intermediate upper part (50) is formed and then mounted on the tooth model. FIG. 3D shows the process of making an intermediate splint of the maxilla using CAD / CAM equipment after virtual surgery of the maxillary bone in a three-dimensional image, not by hand in the articulator. As shown in FIG. 3, the process of making the surgical upper half of the upper body reproduces the tooth model of the upper and lower jaws and the upper and lower jaw joints in the articulator, moves the upper teeth model according to the operation plan in the articulator, And then repositioned, the resin is placed in the space between the upper and lower teeth models and trimmed to form the middle upper body. Alternatively, this process may be done by hand in the articulator, but it may be possible to make an intermediate splint of the maxilla using CAD / CAM equipment after a virtual surgery of the maxilla in a 3D image.

This method, however, removes bone interferences between the craniofacial bones and the cut maxillae while allowing the upper and lower jaw complexes of the upper and lower jaws to engage with the mandibular condyle in the jaw joint, The position of the mandibular canal is inadvertently created by the errors in the multi-step process for preoperative model surgery, especially when the position of the mandibular condyle is set in the process of inducing the central occlusion, If the position of the mandibular canal is unstable during surgery, or if the caretaker improperly maintains the position of the mandibular canal, even if the maxilla is repositioned to the wrong position, the bone of the maxillary bone and craniofacial bone Even when bone interferences are interfered with each other, the maxilla can be relocated to the wrong position. In addition, it is difficult to accurately determine whether the mandibular self-rotation to remove and reposition the mandibular canal to any vertical level, and if excessive or incomplete removal of the bone is performed by mistakenly grasping the bone interfering region, There is a problem that it is set to be incompatible with the plan.

Fig. 4 shows the shape of a first member of a maxillofacial molding for a CAD-CAM based chin orthodontic surgery of the present invention. It is made up of two left and right, respectively, and is mounted on the maxilla and then met at the central zigzag coupling part. The CAD-CAM-based chin orthodontic surgery top plate according to an embodiment of the present invention includes a first member previously formed so as to correspond to the upper and lower entire shapes of the cut line 6 of the maxillary bone, ; And a second member previously formed so as to correspond to a shape of a cut line of the maxillary bone, wherein the guide groove of the first member fixed to the maxilla before the fracture step surgery and the guide groove of the first member fixed to the maxillary fragment, The two-piece guide portion has a structure (8, 300) fitted to each other. The upper part of the cutting line includes a maxilla 38 fixed to the craniofacial bone, and the lower part of the cutting line includes a maxilla piece 37 whose position is shifted after surgery.

 In one embodiment of the present invention, the first member includes an upper structure 1 positioned above the cutting line of the maxilla, a lower structure 2 located below the cutting line, and a lower structure 2 connecting the upper structure and the lower structure Wherein the upper structure and the lower structure contact with the forefront boundary of the nasal wall and are formed to the left and right with respect to the nasal cavity, Connect the left upper structure to the left lower structure and the right upper structure to the lower right structure.

FIG. 5 is a three-dimensional image showing the right side (at the patient position) of the right and left symmetrical structures of the first member shape of the CAD-CAM-based chin orthopedic surgical upper plate according to the present invention. The upper structure of the right structure includes an upper plate previously formed to correspond to a shape of a cut line of the maxilla; At least one borehole (5) for fixing said top plate to a corresponding site; A bone-interfering rim (7) located at a lower edge of the upper plate and indicating a bone-interfering site occurring when the maxillary bone fragment moves after the maxillary bone fracture; And a guide groove 8 protruding from the upper portion of the top plate and adapted to engage with a guide portion of a second member fixing the fractured bone. In one embodiment of the present invention, the guide groove is a guide recess, and the guide portion is a guide protrusion, and the shape of the guide groove may be triangular, polygonal, circular, or the like. In another embodiment of the present invention, the guide groove may be a guide convex portion, and the shape thereof may be various, such as a triangular shape, a polygonal shape, a circular shape, and the guide portion is a guide concave portion.

In one embodiment of the present invention, the lower structure of the right (at the patient position) structure comprises a lower plate previously formed to correspond to the shape of the cut line below the maxilla; At least one screw opening (5) for fixing the bottom plate to a corresponding portion; A canine root cover 11, a zygoma buttress lid 12 and a piriform aperture lid 13 to facilitate fitting (fit) of the lower plate and maxilla. The canine root canopy lid 11, the zygoma buttress lid 12 and the piriform aperture lid 13 are formed in the canine root portion of the facial bone portion shown in Fig. (31), a piriform aperture (33), and a zygoma buttress (32). The root of the canine protrudes relatively forward from the alveolar bone, and the zygoma buttress and piriform aperture protrude and the facial bone is prone to flexion, making it suitable for adjusting the position. Because it can be placed on the maxilla in the same position as when designing in the image. In the embodiment of the present invention, the right lower structure has an inner boundary 9 along its nasal structure and a lower portion thereof has a right lower structure and a zigzag joint 10 to be mounted on the maxillary bone. The lower structure of the template is engaged and can be positioned more accurately.

In an embodiment of the present invention, the connecting portions 3 and 4 include a first connecting portion 3 which keeps a gap between the upper structure and the lower structure so as to form an interval around the cutting line 6 of the maxillary bone, And a second connecting portion (4). In an embodiment of the present invention, the first connection part 3 is formed by projecting the upper structure and the lower structure in a ring shape on the inner side and the outer side in the vicinity of the face side part and the second connection part 4 in the vicinity of the nasal cavity do.

The first member is fixed to the maxillary bone by fastening screws to the maxillary bone through at least one screw opening 5 provided in the upper structure and the lower structure of the first member.

FIG. 6 is a three-dimensional image showing a surgical procedure using a first member of a maxillofacial plate for a chin orthodontic surgery according to the present invention, FIG. 6B is a three-dimensional image in which the joints 3 and 4 are removed after the member is fixed to the maxillary bone. FIG. 6B is a view showing the CAD-CAM-based chin- FIG. 6C is a three-dimensional image showing a fracture end along a fracture end guide for removing a bone intervention site. FIG.

After the first member is fixed to the maxillary bone as shown in FIG. 1, the connecting portions 3 and 4 are removed, and the removal prevents the upper mold plate from being finely changed in position due to an impact caused by vibration generated by a motor- It is advantageous to use a piezoelectric cutting device using a piezo method. After removing the connecting portion, the bone is cut along the fracture disconnection 60 exposed between the upper structure and the lower structure of the first member (FIG. 6B) to separate the upper and lower bone fragments including the upper teeth from the facial bone, (Fig. 6C) along the margins of the bone interferences set in the lower part of the structure to remove bone interferences where bone interferences occur.

FIG. 7 is a cross-sectional view of the CAD-CAM-based chin orthodontic surgical maxillofacial plate according to the present invention. FIG. 7 shows a state in which the lower structure is removed, It is a three-dimensional image showing a single fracture. After removal of the bone intervention site, the first member lower structure fixed to the separated upper and lower fragments is removed. When the fixing screw is removed, the screw opening formed in the maxillary bone through the screw opening of the lower structure is carefully removed So that the second member can be fixed to the same screw opening formed in the maxillary bone piece when fitting and fixing the second member to the maxillary fragment.

8 is a three-dimensional image showing a state in which the second member and the second member are fixed to the maxillary bone fragment and the first member upper structure. 8A is a three-dimensional image showing the right side (at the patient position) of the second member. The second member is preformed to correspond to the shape of the cut line below the maxilla. That is, the second member has a left side portion and a right side portion that are formed laterally with respect to the nasal cavity, and the left side portion is aligned with the first member left upper structure and the right portion is aligned with the first member right upper structure. In an embodiment of the present invention, the right side includes a fixing plate 100 previously formed to correspond to a shape of a cut line of the maxilla; In order to allow the second member to be positioned at the same position as the position where the lower structure of the first member is fixed to the maxilla and the first member, A borehole opening (200) having the same arrangement as the screw opening of the structure; And a guide part 300 protruding from the upper part of the fixing plate and fitted in the guide groove of the upper structure of the first member. In one embodiment of the present invention, the guide groove is a guide recess, and the guide is a guide protrusion, and may be formed into a polygonal shape or a circular shape including a triangle. In another embodiment of the present invention, the guide portion is a guide concave portion, and the guide groove is a convex portion, and may be formed into a polygonal shape or a circular shape including a triangle.

8B shows a state in which the guide portion 300 of the second member is fitted into the guide groove 8 provided in the upper structure of the first member as the maxilla is repositioned according to the surgical plan, to be. The second member fixing plate is fixed to the maxilla by the screw opening of the second member fixing plate having the same arrangement as the arrangement of the screw openings of the lower structure of the first member during chin correction operation. The upper and lower skeletal fragments are shifted by fitting the second member guide portion into a guide groove provided in the first member upper structure by moving the fixed skeletal fragment. At this time, only the maxilla can be positioned, or the distal piece 44 of the mandible 40 in which the ascending branch is divided into a sagittal teeth and the maxillary teeth are made to be in a normal occlusion, and the upper and lower teeth or the orthodontic bracket are wire- And the above procedure may be carried out.

FIG. 8C shows the pitch rotation of the maxilla when the contact between the maxillary bone fragment 37 and the craniofacial bone is poor in the maxillary bone on the right side (at the patient position) and in another form of the second member, And the vertical position in the maxillary posterior or zygoma buttress (32) may be unstable due to the occurrence of a movement of the upper and lower parts of the maxilla, And a column 500 protruding from the rear of the second member fixing plate toward the femoral support base 32 comes into contact with the femoral base to stably hold the vertical position of the maxillary bone at the femoral support. In one embodiment of the present invention, the column 500 is in contact with the upper position of the optical golfer zone 32.

After the maxillary bone is repositioned with the maxillary template, it is fixed firmly using the metal plate 800 so that it can be permanently corrected to the repositioned position.

9A shows a cutting line 700 for cutting a first member of a maxillofacial surgery plate for chin orthopedic surgery and a part of a second member plate in a region where a metal plate 800 is to be placed to fix a repositioned maxilla . 9B is a clinical photograph showing a state in which a part of the template is cut out from the upper left side of the patient and the metal plate is fixed.

FIG. 10 shows a state in which the repositioned maxillary bone is finally fixed with a metal plate, a sagittal mandibular mesial bone fragment is positioned at the correct position of the jaw joint, a region overlapping with the distal bone fragment is resected, Dimensional CT images. The maxillary bone piece 37 in which the posterior position of the maxillary bone 30 is moved and the maxillary bone 38 remaining in the cranial facial bone without the position change by the surgery are fixed by the metal plate 800, The shape of the mandible 40 can also be observed.

In one embodiment of the present invention, the first member and the second member may be made of a metal, a synthetic resin, a resin, or a combination thereof, and the first member and the second member may be a three- 3D printing). In the embodiment of the present invention, VIPER Si2 equipment of 3D systems (US) was used as a three-dimensional printing technology equipment, and WaterShed (TM) 11122XC manufactured by DSM (US) was used.

The description of the disclosed embodiments is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other embodiments without departing from the scope of the invention. Thus, the present invention is not intended to be limited to the embodiments shown herein but is to be accorded the widest scope consistent with the principles and novel features presented herein.

1. First member superstructure
2. First member substructure
3. First connection
4. Second connection part
5. Screw openings
6. Guide to fracture end
7. Bone marginal margin
8. First member upper structure guide groove
9. Inner boundary of the first member lower structure
10. Zigzag boundaries of the first member substructure
11. First member canine (molar)
12. The first member zygoma buttress cover
13. A first member piriform aperture cover
30. Maxilla
31. Cranial (molar) root portion of facial bone
32. Zygoma buttress in the facial bone area.
33. A piriform aperture in the facial bone area,
34. The protrusion of the maxillary mid-
37. Maxillary incision
38. Maxilla connected to craniofacial bone
40. Mandibular
44. Centrifugal fragment
60. fracture disconnection
100. Second member moving plate
200. Second member screw opening
300. Second member guide portion
500. Columns protruding toward the optic support
700. A cutting tool for cutting a part of a first member and a second member type plate with a tool
800. Metal plate

Claims (14)

A first member previously formed so as to correspond to a shape of an upper portion and a lower portion of the cut line of the maxilla; And
And a second member previously formed to correspond to the shape of the cut line of the maxillary bone,
The guide portion of the first member fixed to the maxilla before the fracture plate operation and the guide portion of the second member fixed to the maxilla fragment after the fracture plate operation are fitted to each other,
Wherein the first member comprises:
A top structure positioned above the cutting line of the maxilla, a bottom structure positioned below the cutting line, and a connecting portion connecting the top structure and the bottom structure, wherein the top structure and the bottom structure are arranged at the forefront boundary And the connecting portion connects the upper structure and the lower structure formed by the right and left sides, the left upper structure connects with the lower left structure, the right upper structure connects with the lower right structure,
Wherein the upper structure comprises:
A left and right upper plate previously formed to correspond to the shape of the cut line of the maxilla;
At least one bite opening for fixing each of said top plates to a planned area;
A bone interfering rim positioned at a lower edge of each of the upper plates to indicate a bone interfering portion generated when the upper and lower bone fragments are moved after a maxillary fracture; And
And a guide groove which protrudes from the upper portion of each of the upper plates and is fitted to the guide portion of the second member fixed to the fractured bone,
CAD-CAM based maxillary template for chin correction surgery.
delete delete The method according to claim 1,
The guide groove has an open polygonal or circular concave shape,
Wherein the guide portion has a polygonal or circular convex shape conforming to the concave shape,
CAD-CAM based maxillary template for chin correction surgery.
The method according to claim 1,
The guide portion may have an open polygonal or circular concave shape,
Wherein the guide groove has a polygonal or circular convex shape conforming to the concave shape,
CAD-CAM based maxillary template for chin correction surgery.
The method according to claim 4 or 5,
Wherein the polygon is a triangle,
CAD-CAM based maxillary template for chin correction surgery.
The method according to claim 1,
The substructure may comprise:
A left and right lower plate previously formed to correspond to the shape of the cut line of the maxilla;
One or more screw openings for fixing each of said bottom plates to a planned area; And
Wherein when the left and right lower plates are attached to the maxilla, the left and right lower plates are coupled at the upper center line,
Wherein the lower plate comprises:
A root canal covering the upper plate and the maxilla; a zygoma buttress lid; And a piriform aperture cover,
CAD-CAM based maxillary template for chin correction surgery.
The method according to claim 1,
Wherein the connection portion includes a first connection portion and a second connection portion that are spaced apart from each other so that the upper structure and the lower structure can form an interval around a cut line of the maxilla,
CAD-CAM based maxillary template for chin correction surgery.
9. The method of claim 8,
Wherein the first connection portion connects the protruding portions of the upper structure and the lower structure to each other in a ring-
And the second connection part projects in a ring shape so as not to intersect with the first connection part to connect the upper structure and the lower structure,
CAD-CAM based maxillary template for chin correction surgery.
The method according to claim 1,
The second member
A left side portion and a right side portion which are formed laterally on the basis of the nasal cavity,
Wherein the left side portion is aligned with the first member left upper structure and the right side portion is aligned with the first member right upper structure,
CAD-CAM based maxillary template for chin correction surgery.
11. The method of claim 10,
Wherein the second member is a preformed preform so as to correspond to the shape of the cut line of the maxilla;
A screw opening having the same arrangement as the screw opening arrangement of the lower structure of the first member so that the screw fixing position of the fixing plate may be the same as the screw fixing position of the first member lower structure; And
And a guide portion protruding from an upper portion of the fixing plate and adapted to fit into a guide groove of the upper structure of the first member,
The substructure may comprise:
A left and right lower plate previously formed to correspond to the shape of the cut line of the maxilla;
One or more screw openings for fixing each of said bottom plates to a planned area; And
Wherein when the left and right lower plates are attached to the maxilla, the left and right lower plates are coupled at the upper center line,
Wherein the lower plate comprises:
A root canal, a zygoma buttress lid, and a canine to facilitate fit (fit) of each of the lower plates to the maxilla; And a piriform aperture cover,
CAD-CAM based maxillary template for chin correction surgery.
12. The method of claim 11,
Wherein the second member further comprises a column projecting toward the femoral support at a rear portion of the fixing plate,
The column is in contact with the optical golfer zone to stabilize the maxillary vertical position, to measure residual bone interference,
CAD-CAM based maxillary template for chin correction surgery.
The method according to claim 1,
The material of the first member and the second member may be,
Metal, synthetic resin, resin, or a composite thereof,
CAD-CAM based maxillary template for chin correction surgery.
delete

Images