Torsional tightener for bone anchoring or implant elements/tools

Abstract: A torsional tightener (101) is used, inter alia, for anchoring elements (108) in implants (103) anchored in bone. The tightener is releasable at a previously set torque and comprises an electric motor (406), a unit (403) changing the speed down, and a torsional tightening part. For the purpose of achieving a well-defined set torque value, the energy supply circuit of the electric motor can be interrupted at a certain current value in the energy supply circuit. The interruption and the rotational energy in the rotating parts of the torsional tightener after interruption are designed to cause a torsional tightening moment which is situated at or near an optimal or desired point on the particular moment curve for the tightening in question. Alternatively, a disconnection part is used, which interrupts the tightening function at or near the desired point on the moment curve.

Description: The present invention relates to a torsional tightener for dental use in the mouth of a patient to anchor a threaded fastener in dentine or in implants in said dentine. Such tightener comprises an electric motor, an electric supply which increases electrical energy in response to increasing torsional resistance on the tightener from said fastener and interruption means for interrupting the tightener in such a way that the rotational inertia after interruption of the electrical supply results in the fastener being tightened to a preselected optimum torque near but not exceeding the breaking point of the material in question. The interruption means relies on the actual torque excerted by the tightener as well as on a predetermined torque, said torques being based on feedback in the form of increased torsional resistance on the fastener as expressed by increased electrical supply to said motor. A tightening procedure as described above is disclosed in EP-A-0 271 902, albeit not in connection with dental work. In connection with the anchoring of elements in bone or the tightening of screws in implants anchored in bone, it is already known to use tighteners which can be set for different or varying torques. In this respect it is known to use torque tighteners which are actuated by electrical energy and by manual force. In connection with electrical torque tighteners, it is also known to use a unit for indicating and setting the different torque tightening values. However, the tightening of screws in implants anchored in bone presupposes that screwing-in is effected with torques which it must be possible to set exactly. There must be a secure anchoring of the screw, which in turn requires that the yield point (elasticity) of the screw material must be attained but not exceeded. The range for an optimal torsional action in accordance with the above is relatively narrow. In addition, the torque effected with the tightener is relatively great, so that for this reason it may be difficult to distinguish the necessary sensitivity upon torsional tightening. The tool/instrument will be used for working in the mouth of a patient, and this, together with the requirement for a relatively high torsional resistance, rules out manual torque activation, in which respect there may additionally be difficulties in achieving a continuous monitoring of the effected torque during the tightening process from the indication point of view. When screwing an implant, it may be desirable to obtain a suitable indication of the state (softness/hardness) of the bone/dentine. It may therefore be of value to obtain an indication of the torque effected upon screwing-in, this torque corresponding to the torsional resistance from the element/tool (bone/dentine). It is also desirable if the design of the tightener can be included under standard forms already available in the field. The tool can be of a construction in which an angle-piece or hand-piece (gear piece) of standard design can be used. Torsional tighteners in general are previously known, see for instance the above-mentioned EP-A-0 271 902 and DE-A-28 53 869. The first mentioned EP patent does not disclose or discuss high level torque in combination with high sensitivity over a small range and it is not designed to be insertable in the mouth of a patient. DE-A-28 53 869 relates to a general bone screw tightener made for larger (orthopedic) screws and not for use with small dental screws in the mouth of a patient. The present invention proposes a torsional tightener which solves, inter alia, the problems mentioned above. The tightener is characterised in that the electrical motor is transformerless and has a small rotating mass and operates at about 10000 to 15000 rpm so as to be able to exert a high level of torque with high sensitivity over a small range. The tightener also comprises a reduction gear arranged on the motor output shaft between said shaft and the fastener and serving to reduce the output speed of the tightener substantially. The tightener is connected to means for selecting from a range of output torques and speeds (600 to 1800 rpm) depending on the material in question and further comprises control means for sensing the actual torque of the fastener being anchored and for interrupting the electrical supply to the motor at a predetermined electrical supply value in such a way that when the fastener torque increase effectively occurs within a rotation of about 90° to 180° the rotation of the fastener after interruption of the electrical supply amounts to less than 10°. The tightener further comprises means for setting and monitoring of speed and torque values, said means including indicating means arranged to visualize the torque development curve. The electrical supply, the interruption means, the control means, the selecting means and the setting, monitoring and indicating means are arranged in a separate unit electrically connected to the tightener proper. According to the inventive concept, the interruption of the electrical energy to the electric motor is designed to occur close to the optimal or desired point on the moment curve, and the rotational energy which exists immediately after the interruption has only a marginal effect on the torque value finally obtained. The high-speed electric motor (10000-15000 rpm) is designed with a small rotating weight, which means that the rotational energy remaining after interruption can be kept low. In the case where the growing torsional resistance from the element/tool is effected principally during ¼-½ of a rotational turn, the effect from the remaining rotational energy is over only a few degrees of the total turn. According to the invention, a unit is used or included for setting and indicating the torque values in question. Thus, for example, a liquid-crystal gauge can be used for indicating the torsional resistance effected by the tightener at each moment in time. Close to the liquid-crystal gauge there are elements for indicating the set torque value at which the release of the tightener will take place. When the tightener has reached the set value in question, the liquid-crystal gauge has been activated close to the element in question for the set values, the result of this being that an observer can continuously monitor the torque values up to the value in question. In one embodiment, a special indication is obtained when the set value in question has been reached. The setting and indicating unit can also be designed with members for setting two or more output speeds of the torsion-effecting part (screwdriver part). The energy supply circuit of the electric motor is sensed by a sensing circuit. The latter is actuable when the current in the energy supply circuit reaches a predetermined current value. At the last-mentioned value, the sensing circuit generates and sends an interrupt signal or break signal to the interrupting or breaking members of the energy supply circuit of the electric motor. In addition, the motor can be short-circuited in order to shorten the stoppage time. By virtue of the features mentioned above, the torsional tightener can operate with exact release of the set torque values. The torque tightener can be tailored to a specific purpose, for example tightening screws of gold, titanium etc. in implants anchored in bone. Screw-shaped implants, or thread taps for such implants, can be anchored in or shape bone with the said exactness of release. The connection to one or more indicating and/or setting units makes it possible to obtain, in an extremely simple manner, continuous information on, for example, the state of the bone/dentine in which implanting is to take place. A presently proposed embodiment of an arrangement having the features characteristic of the invention will be described hereinbelow with reference to the attached drawings, in which Figure 1 shows, in vertical section, the anchoring of a prosthesis (dental crown) in a cap which in turn is screwed securely in an implant anchored in the dentine, Figure 2 shows, in vertical section, the threading of the dentine with the aid of a thread tap which is under the torsional influence of a tightening member, Figure 3 shows a torque-speed diagram, Figure 4 shows, in longitudinal section, a torsional tightener with a connector for electrical connection, Figure 5 shows, in a horizontal view, a setting and indicating member for the connector according to Figure 4, Figure 6 shows, in circuit diagram form, the member for sensing the current in the energy supply circuit of an electric motor, the interrupt circuits controlled by the said sensing circuit, and the principle for indicating functions in the unit according to Figure 5, and Figure 7 shows, in circuit diagram form, a disconnection function for a torsional tightener according to Figure 4. Figures 1 and 2 show two exemplary embodiments in which a torsional tightener/screwdriver 101, 201 with inbuilt torque setting can be used. The dentine is symbolised by 102, 202. In Figure 1, an implant is indicated by 103 and a cap anchored to the implant by a screw 104 is indicated by 105. The skin covering is symbolised by 106. A prosthesis 107, for example a tooth, cap etc., is/can be screwed securely in the cap 105 with a screw 108 whose direction of screwing is shown by 109. The screwdriver 201 is used for a thread tap 203, by means of which a thread for the implant is made in the dentine 202. The direction of rotation of the screwdriver 201 is shown by 204. A torque-speed curve for the case according to Figure 1 is shown by 301. A range Δr indicates the actual process of tightening of the screw 108, during which process the underside of the head 108a of the screw 108 cooperates with a bottom surface 110 in a recess 111 of the prosthesis. In addition to the said cooperation, there is cooperation between the thread 112 of the screw and the thread 113 of the recess. The tightening of the screw 108 for its secure anchoring to the prosthesis 107 and the cap 105 assumes that a predetermined point 302 on the curve 301 is reached, at which point a certain stressing of the screw material has taken place. A point 303 indicates the breaking limit for the screw material. The range Δr represents ¼ - ½ of a turn r. According to the invention, an electrical energy supply, described below, will be interrupted when the tightening process is at a point 304. The remaining rotational energy in the tightening tool is able to influence the tightening in such a way that it is possible to arrive at or nearer the point 302 than is shown in the figure. The requirement is to avoid unduly reaching close to or exceeding the breaking limit 303. Δr′ is the angle of rotation range which will preferably be accomplished, and in the exemplary embodiment the said range represents about 10° of a turn. The angle of rotation range Δr″ is a prohibited range, while Δr‴ is the maximum permitted range beyond point 302. Δr‴ is about 15° and Δr″ is about 10°. The straight-line curves 305 and 306 apply to the case according to Figure 2. The slopes of the straight-line curves sumbolise the stability in the dentine 202, in which respect 305 relates to a case with softer dentine than 306. Figure 4 shows an exemplary embodiment of a torsional tightener comprising a driving motor 402, a gear part 403 driven by the latter, an electric motor connection line 404 and a connector 405. The part 402 comprises an electric motor 406 which is of the commutated d.c. motor type (Escap MA 16, 16 M 11 210 2430), which is a transformerless motor. The output drive shaft of the motor is indicated by 407. The gear part, which is only shown partially, consists of a previously known standard part of the minimotor type. Figure 5 shows in principle the combined setting and actuating unit, which also effects the current supply to the electric motor 406. The unit 501 is box-shaped, and its gable part 502 is shown in an upturned position for reasons of clarity. The unit 501 is provided with three connections 503, 504 and 505. One of the connections, for example 504, is intended for the connector 405 in Figure 4. The other two connections are intended for electricity supply. The unit 501 is provided with a "liquid-crystal" type gauge which, in the exemplary embodiment, is made up of a number of optical elements, for example light-emitting diodes, arranged in a row one after the other. The light-emitting diodes of the gauge are divided into three groups 506, 507 and 508. The unit also comprises four indicating members 509, 510, 511 and 512 which can consist of optical indicating elements, for example light-emitting diodes. A further indicating element is indicated by 513. The last-mentioned indicating element indicates when a predetermined value has been reached with the tightener according to Figure 4. The unit 501 also comprises a number of actuating members 514, 515, 516 and 517 by means of which it is possible to carry out presettings of the torque for the tightener according to Figure 4. The said presettings correspond to the positions indicated by the indicating members 509-512. The unit also comprises setting and indicating members for different speeds of the output shaft from part 403 of tightener 401. The indicating members for two speeds are shown by 519 and 520, and corresponding actuating members are shown by 522 and 523. The unit 501 also operates with a reverse change-over function comprising an indicating function 518 and actuating member 521. The reversing function can be made in a known manner. The speed-setting achieved using 522, 519 and 523, 520 is also effected in a known manner. One of four predeterminable torque values, at which the tightener 401 will be releasable, can be set using the particular actuating member in question of actuating members 514-517. When the tightening, for example according to the exemplary embodiments in Figures 1 and 2, is started, the light-emitting diodes are lit in sequence in gauge 506, 507 and 508. For example, if the value which is indicated by indicating member 509 is set by 514, then the lowermost light-emitting diode 506′ is first lit when a torque corresponding to this light-emitting diode has been reached. If a torque corresponding to 506″ is reached in the continued torsioning process, this light-emitting diode is also lit. When the torque corresponding to light-emitting diode 506‴ is reached, the light 506‴ is lit. This value is finally indicated by the light-emitting diode 513 lighting. If the torque value according to light 511 is set using setting member 516, underlying light-emitting diodes are lit in sequence until the torque value according to light-emitting diode 511 is reached, after which the light-emitting diode 513 in the same way indicates the finally reached value, and so on. It is desirable for the part 403 to be able to operate at different speeds, and the unit 501 affords, by means of actuating members 521, 522 and 523, the possibility of setting different values, for example 10 rps, 20 rps and 30 rps. The electric motor 406 operates at a high speed, for example between 10000 and 15000 rps per minute. The part 403 changes this speed down considerably, in a manner known per se. In Figure 6, 601 indicates the electric motor described above. The electric motor is connected to a current supply and control circuit 602. The supply lines of the electric motor are indicated by 603 and 604. A sensing circuit 605 is connected to line 604 between the electric motor and a resistor 606 (about 1 ohm). The sensing circuit is provided with an operational amplifier 607 and, connected to this, a control unit 608. The sensing circuit senses the current in the supply circuit 603, 604. When the current assumes a predetermined value which brings about a signal i′ of predetermined magnitude at the output of the amplifier 607, a release signal i″ is received from the unit 608. This release signal activates an interrupt or break member 609, which interrupts or short-circuits the lines 603, 604. The units 608 and 609 are provided with a restoring function for the member 609, so that the electric motor can receive energy supply for new driving. The indicating/light-emitting diode stack divided into groups (cf. 506, 507 and 508) is shown by 610 in Figure 6. In the stack, selected light-emitting diodes, for example the light-emitting diodes which are opposite the indicating members 509, 510, 511 and 512 (Figure 5), are used for effecting the interrupt signal i″ for the member 609 in or at the unit 602. To each selected light-emitting diode there is allocated a transistor coupling. The lighting/activation of each selected light-emitting diode 612 is detected by the respective transistor coupling 611 which, as a function of the lighting/activation, initiates the signal i″ at its output. All the transistor couplings for the stack 610 are connected to a common output 613 so that any transistor coupling can generate the signal i″ when the respective selected light-emitting diode in the stack is lit. The member 609 is activated as long as the signal i″ is present, and, when the signal i″ ceases, the member 609 assumes the initial position when the motor 601 receives supply current. The activated transistor coupling is deactivated by means of a logic circuit 614 of known type. For deactivating the activated transistor coupling, the logic circuit connects up a diode 615, whose connection results in the deactivation. The logic circuit ensures that only one transistor coupling at a time can be connected and the circuit 614 is controlled from the change-over switches 514, 515, 516 and 517. The lighting and extinguishing of the diodes 509, 510, 511, 512 and 513 can be effected from the unit 608 and as a function of the activation of the actuating members 514, 515, 516 and 517. The light-emitting diodes 509-512 can be designed so as to be actuable by means of the change-over switches 514-517, and the light-emitting diode 513 can be designed so as to be actuated by the output signal from the respective transistor coupling 611. Figure 7 relates to a case where the interrupt function according to Figure 6 has been replaced with a disconnection function 701. The disconnection function operates with an electromagnet function, whose winding is indicated by 702. This winding receives current supply with the aid of actuation member 703. Actuation member 703 closes an actuation circuit 704, with battery 705 or other energy supply, for the winding 702. When the winding receives current supply, the disconnection comes into operation and the rotating shaft of the gear part, as symbolised by 706, is disconnected from the drive shaft for driving the screwdriver function (cf. 101 in Figure 1). When activation of the winding (electromagnet) 702 ceases, the shaft parts 706 and 707 come into cooperation, etc. The invention is not limited to the embodiment shown above by way of example, but can be modified within the scope of the following patent claims.

Claims: A torsional tightener (401) for dental use in the mouth of a patient to anchor a threaded fastener (108, 203) in dentine or in implants in said dentine, the tightener comprising an electrical motor (406, 601), an electrical supply (602) which increases electrical energy (i) in response to increasing torsional resistance on the tightener from said fastener, interruption means (609) for interrupting the tightener in such a way that the rotational inertia after interruption of the electrical supply results in the fastener being tightened to a preselected optimum torque (302) near but not exceeding the breaking point (303) of the material in question, whereby said interruption means relies on the actual torque exerted by the tightener as well as on a predetermined torque, said torques being based on feedback in the form of increased torsional resistance on the fastener as expressed by increased electrical supply (i) to said motor, characterised in that, the electrical motor (406, 601) is transformerless, has a small rotating mass and operates at about 10000 to 15000 rpm, so as to be able to exert a high level of torque with high sensitivity over a small range, the tightener (401) comprises a reduction gear (403) arranged on the motor output shaft (407) between said shaft and the fastener and serving to reduce the output speed of the tightener substantially, the tightener is connected to means (514-517, 521-523) for selecting from a range of output torques and speeds (600 to 1800 rpm) depending on the material in question, the tightener comprises control means (608) for sensing the actual torque of the fastener being anchored and for interrupting the electrical supply to the motor (406, 601) at a predetermined electrical supply value (i'') in such a way that when the fastener torque increase effectively occurs within a rotation of about 90° to 180° the rotation of the fastener after interruption of the electrical supply amounts to less than 10°, the tightener comprises means for setting and monitoring of speed and torque values, said means including indicating means (506, 508) arranged to visualize the torque development curve, and in that the electrical supply (602), the interruption means (609), the control means (608), the selecting means (514-517, 521-523), and the setting, monitoring and indicating means are arranged in a separate unit (501) electrically connected to the tightener proper. A torsional tightener according to claim 1, characterised in that the setting and indicating means are designed with a liquid-crystal gauge, including said indicating means (506-508) in the form of first optical elements. A torsional tightener according to claim 2, characterised in that it has first indicating elements (509-512), for example second optical elements, which indicate different values of the set torque, and in that the first indicating elements are arranged close to and alongside the said liquid-crystal gauge (506, 507, 508). A torsional tightener according to claim 2, characterised in that each growing torque effect can be monitored on the liquid-crystal gauge which has, opposite the indicating elements (509-512) which indicate the different values of the set torque, other indicating elements so that, when the torque from the torsional tightener has reached the respective set value, the first optical elements which represent values lying under the set value are activated, and in that a third indicating element (513) at the upper end of the liquid-crystal gauge is designed so as to be actuable when the respective set value has been reached. A torsional tightener according to any one of claims 2-4, characterised in that the setting and indicating unit (501) is designed with setting of two or more output speeds (518-520 and 521-523) for the said torsion-effecting part (101, 201).

Inventors: CARLSSON LENNART, CARLSSON, LENNART
Applicants: NOBEL BIOCARE AB, NOBEL BIOCARE AB (REG. NO. 556002-0231)
Application year: 1991
Main classification: B25B23
IPC codes: B25B23, A61B17, A61C1, A61C13, A61C8