Patent Publication Number: US-2023141391-A1

Title: Scan body with healing abutment

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to healing abutments, temporary prosthetic abutment, and scan body units with coding for intraoral scanning to assist in placement of implant-supported crowns and dentures. 
     2. Related Art 
     Coded healing abutments were initially used with conventional impressions and allowed the placement of the definitive crown in fewer appointments and removal of the healing abutment only once, reducing irritation of the peri-implant soft tissues. This technique was later implemented by using intraoral scanners for digital implant scans. The use of these coded abutments with intraoral scans may be advantageous because the scan can be made digitally at the implant placement appointment, during uncovering, or after healing of the soft tissues after uncovering, without direct contact between the impression material and the soft tissues. 
       FIGS.  1 A and  1 B  illustrate a prior art use of a scan body healing abutment  1 . The device has, from top to bottom, a scan body  10  shaped so as to provide information for reading by an intraoral scanner, not shown. The base of the scan body is shaped with a lower vertical indentation  11  insertable into a vertical groove  14  in the healing abutment  12 . The healing abutment  12  has an arcuate profile  16  at the point at which it will contact a patient&#39;s gum tissue  15 . To attach the healing abutment  12  to an implant, or multiunit base, not visible in  FIGS.  1  and  2   , a threaded post  18  is screwed and tightened into a receiving portion of the base or implant. 
     As can be seen in  FIG.  1 B , when so attached to the implant, the scan body  10  projects above the abutment  12  to permit scanning of the scan body  10 , while at the same time the healing abutment presses the gum tissue  15  away from the scan body. Using the scan results, adjustments can be made, such as any needed tightening of the abutment and the like. However, there are often problems with prior art devices in relation to excessive bleeding, insufficient growth of the gum tissue during the healing process, and difficulty in reading the coding on the scan body. 
     Therefore, an improved scan body with healing abutment is needed that addresses the above-mentioned drawbacks. 
     SUMMARY OF THE INVENTION 
     In view of the above problems of the prior art, it is an object of the present invention to reduce bleeding, promote healthy tissue growth, and to ensure that an optical scanner can read all of the scan bodies, even scan bodies that may differ in penetration depth. 
     In a first aspect of the invention there is provided a device, configured to perform a scan body function, and a healing abutment function that allows a temporary tooth to cement correctly and maintain enough height and retention, that prevents cement from going in sulcus, with the device further customized with a skirt to provide a guide to soft tissue. As a result, the device will maintain site-surrounding tissue away from the site, maintain hemostasis, and allow for same day scanning. 
     In an illustrated embodiment the device comprises a skirt, a scan body and a hollow cuff. 
     According to an aspect of the present invention, a scan body with healing abutment for coupling to an implanted dental component is disclosed having a scannable portion, a healing abutment portion, and a skirt positioned between the scannable portion and the healing abutment portion, with the skirt having an upper surface containing indicia, the upper surface of the skirt forming a part of the scannable portion. The scannable portion is positioned at an apical end of the healing abutment portion and has a tapered body. The healing abutment portion includes a lower surface of the skirt and a tapered hollow cuff extending from the lower surface of the skirt toward a distal end. 
     In another aspect, the scannable portion includes an index portion with a flat surface. 
     In another aspect, the indicia comprises one or more dots indicative of a length of the healing abutment portion. 
     In another aspect, the scan body and healing abutment further comprises an internal hollow extending over a portion of the length of the healing abutment portion. 
     In another aspect, the surface of the skirt is planar and lies perpendicular to a longitudinal axis of the healing abutment portion. 
     In accordance with another aspect of the invention, a method of creating a dental restoration using the above-mentioned scan body and healing abutment is described. The method involves: scanning the scannable portion and healing abutment portion with an intra-oral scanner or taking an impression of the scannable portion; using information from the scanning or taking the impression to design a dental restoration; and producing the dental restoration so designed. 
     In another aspect, the healing abutment is configured to be attached to a dental implant or multiunit protrusion, the healing abutment being configured to selectively support a final restoration and having an outer surface that corresponds to a height of soft tissue adjacent the installed dental implant, the height of the soft tissue being limited upwardly by the lower surface of the skirt; and the scannable portion has at least one feature configured to be scanned by an intra-oral scanner or transferred to a physical impression to transfer information regarding the orientation and position of the healing abutment and the dental implant or multiunit protrusion. 
     In another aspect, the skirt has a beveled lateral edge. 
     Other objects and features of the present invention will become apparent from the following detailed description considered in conjunction with the accompanying drawings. It is to be understood, however, that the drawings are designed solely for purposes of illustration and not as a definition of the limits of the invention, for which reference should be made to the appended claims. It should be further understood that the drawings are not necessarily drawn to scale and that, unless otherwise indicated, they are merely intended to conceptually illustrate the structures and procedures described herein. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The figures are described as follows: 
         FIGS.  1 A and  1 B  show a scan body and healing abutment according to the prior art; 
         FIG.  2    is an isometric view of the scan body and healing abutment according to the present invention; 
         FIG.  3 A  shows a profile of the scan body and healing abutment according to an embodiment of the present invention; 
         FIGS.  3 B- 3 E  show alternate profiles for the scan body and healing abutment; 
         FIGS.  3 F and  3 G  are sectional views showing the gum tissue in relation to the skirt and cuff of the scan body and healing abutment according to the present invention; 
         FIG.  4 A  is a top view of the scan body and healing abutment according to the present invention showing coding at the upper surface of the skirt in the form of indicia such as holes, protrusions, and the like; 
         FIG.  4 B  is an elevation view of the scan body and healing abutment of  FIG.  4 A ; 
         FIGS.  5 A- 5 F  are side views of a sequence of scan body and healing abutments having differing heights; 
         FIGS.  6 A- 6 F  are top perspective views of the scan body and healing abutments shown in  FIGS.  5 A- 5 F , in which the coding indicia indicating the varying heights are visible; 
         FIGS.  7 A- 7 F  are high perspective views of the scan body and healing abutments shown in  FIGS.  5 A- 5 F , in which the coding indicia indicating the varying heights are visible; 
         FIGS.  8 A- 8 F  are underside perspective views in which the hollow portions of the cuffs are visible; 
         FIG.  9    shows the implant and multi-unit abutment with directional indicators with all the tissue retracted, prior to placement of the cap; 
         FIG.  10    is a view of a patient&#39;s mouth after implantation of the multiunit, with one such device according to the present invention having been installed into the multiunit; 
         FIG.  11    is a view of the patient&#39;s mouth after a set of devices have been installed into the protrusions of the multiunit, and the gum tissue has been stitched around the devices; 
         FIG.  12    is a view of the patient&#39;s mouth in which a set of devices has been installed into a multiunit in the mandible; 
         FIG.  13    is another view of the patient&#39;s mouth in which the set of devices has been installed into a multiunit in the mandible; 
         FIG.  14    shows a scan body and healing abutment being installed into the multiunit using a screwdriver; 
         FIG.  15    is an impression made after the implantation of the scan body and healing abutment into the multiunit; 
         FIG.  16    shows a temporary set of dentures attached to the scan body and healing abutment of the present invention; and 
         FIG.  17    is an x-ray view of the devices with the temporary attached. 
     
    
    
     DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENTS 
       FIG.  2    shows an example scan body with healing abutment (e.g., “cap” or “device”)  20  in accordance with the present invention. The cap  20  performs both the function of permitting intraoral scanning and the function of a healing abutment. 
     The scannable portion of the cap  20  consists of a shaped, contoured and matte or sand or bead-blasted, finished scan body  22 , and the matte finished and coded top surface  27  of the skirt/platform  25  (hereinafter “skirt”). In use, after installation of the cap, to be discussed further below, only the scan body  22  and the coded top surface  27  will protrude above the gums, and be discernable by an intraoral scanner. It should be note that the peripheral/lateral edges of the skirt  25  can have a partial beveling at the top and bottom of the lateral edges, as shown for example in  FIG.  2   . Alternatively, the edges may not have a beveling, as seen, for example, at  FIGS.  5 A to  5 F , but can instead substantially form right angles, but preferably with smooth edges, since a sharp edge might cause irritation. 
     The lower part of the cap  20 , which acts as a healing abutment, consists of the under surface of the skirt  25  and the cuff  28 . In contrast to the matte finished scannable portion of the cap  20 , the metal making up the healing abutment portion of the cap  20 , is highly polished to present soft tissue attachment and healing with no irritation to the patient. The above textures provide a multi-zone design. 
     As discussed below, in a typical use of the cap  20 , plural instances of the cap  20  will be affixed to extensions  21  of a multiunit base. According to an advantageous aspect of the invention, the cap  20  is presented in several varieties, having different length cuffs  28 . The different lengths of the cuffs allows different overall height caps  20  to be used for different depths of the implant or multiunit base, which, among other things, ensures that the top of each cap will protrude by an amount sufficient to allow for accurate intraoral scanning. 
     In general all varieties of cap  20  will have the upper portion of the cap  20 , which includes the scan body  22  and the skirt  25 , having the same dimension, in particular the same height. The differences in dimensions between the varieties of caps  20  are limited to the height of the cuff portion  28 , which after installation, will not be visible, since the growth of the gums is limited by the lower surface of the skirt  25 . To provide information to the scanner regarding the depth of the cuff, coding is provided on the top surface  27  of the skirt  25  that is indicative of the height of the cuff  28  for that particular cap  20 . 
     Each cuff  28 , regardless of height, has an arcuate curvature of its wall  30  such that the diameter of the cuff  28  is at its smallest just below the skirt  25 , and increases thereafter as one moves down the wall  30 . The cuff may terminate at a constant diameter region ( 29  in  FIG.  2   ) at the distal end thereof. In contrast to the matte finish of the upper portions of the cap, the lower surface of the skirt  25 , and the entire outer surface of the cuff  28  are preferably polished to a mirror finish to ensure comfort and cleanliness for the growth of the gums and/or other surrounding tissue. 
     The longest cuffs  28  will be configured with the portion  29  of either constant or nearly constant diameter ( FIG.  2   ). Also the cuff is hollow at region  32  to permit the cap  20  to fit over a protrusion of a multiunit and to guide at least some of the gum tissue up and into the hollow portion of the cuff  28 , to facilitate, i.e., provide clearance for, gum growth. 
     Differing cuff profiles can be seen in  FIGS.  3 A to  3 E , with the profile of  FIG.  3 E  being most preferred. This profile of  FIG.  3 E  advantageously provides for the deepest indentation inwardly under the lip of the skirt  25 , which allows for building out of bigger gum tissue when the cap  20  is clamped down so that the skirt  25  holds the tissue down vertically, but the presence of the indentation to the extent of this particular profile allows the tissue to have room to grow in this indentation, even as its vertical growth is stopped by the skirt  25 . 
       FIGS.  3 F and  3 G  show how the gum tissue  150  grows upwardly around the cuff  28 . The tissue modeling is guided by the cuff both in height and width and the preliminary healing occurs between 3-8 weeks. The tissue can grow upwardly toward, and eventually reaching an upper limit at  FIG.  3 G . As can be seen in these figures, the preferred profile allows for a considerable amount of tissue expansion and growth, and the healing abutment portion of the cap, consisting of the lower surface of the skirt  25  and the cuff  28 , taken with the scan portion of the cap, consisting of the scan body  22  and the upper coded surface  27  of the skirt  25 , allows the whole cap  20  to act as a scanning abutment that moves tissue out of the way, maintains Hemostasis and allows same day scanning. Healing of the implant in which the bone grows can vary from a period of 3 weeks to 18 months. The tissue can heal as fast as 3 weeks to as long as 1 year. The cap allows the position of the tissue to be predictably calculated within 6-8 weeks. 
     When plural ones of the device or cap  20  are installed, the skirt  25  sits on top of the gum tissue  150 . Specifically, when this cap  20  is screwed into the multiunit, the cap  20  clamps and guides the soft tissue under it so that almost no blood will go above it. This is especially the case once all of the tissue across a portion of the upper or lower multiunit posts has been sealed with the cap  20 . 
     The portion below the skirt  25  is a soft tissue area  150  which, due to the topography of the patients palate, for example, will have multiple different heights (in this convention, from the palate, “heights” means extending downward toward the mandible). In the palate, after installation of the multiunit, a large amount of loose tissue will be present. But, as will be discussed below, with the use of the multiple instances of the cap  20  that functions as a healing abutment and a scan body (i.e., scannable portion), this loose tissue can be tucked out of the way to allow for a clear optical scanning of the scannable portions of the scan bodies, since this tissue, under the skirts  25 , and with stitching around the caps is substantially not visible to the intraoral scanner. 
     The scan body (top part) will rest at multiple tissue heights. And because of the coding provided by the indicia on the skirt surface  27 , the scan body portion of the cap will always protrude entirely out of the gum, so that the intraoral scanner will always see it, and the designer of the prosthesis will always have the full body of the scan body part outside of the gum line, and will have the information as to the heights of the cuff of each cap  20  that is scanned. 
       FIGS.  4 A to  8 F  show the coding indicia, for example, dots, on the upper surface  27  of the skirt  25  at different vantage points and caps  20  of different cuff lengths. 
       FIG.  4 A  shows a cap  20  that illustrates an exemplary coding of the scan body scannable portion formed by the upper surface  27  of the skirt  25 . In this embodiment the coding is formed by dots  27   a  to  27   d  in the case of four dots, as in  FIG.  4 A . Preferably the more dots formed on the surface  27  the longer the cuff. In the preferred embodiment, the 4 dots will represent a cap with the longest cuff, for example 4 mm, 3 dots will indicate a cuff length of 3 mm, 2 dots indicates 2 mm, and 1 dot 1 mm. It should be appreciated that any form of indicia instead of the illustrated dots, can be used to signify the length of the cuffs. This is advantageous in that the designer of the denture or tooth or bridge will instantly know the size of each cap because the optical scan will indicate the number of dots. 
       FIG.  4 B  is an isometric view of a 4 dot cuff length, i.e., the longest cuff length, cap  20 , the components of which have been discussed in detail above. 
       FIGS.  5 A- 5 F  show a series of side by side caps  20 , from the highest cuff version at the upper left of the figure to the lowest cuff version at the lower right. In this view, the top surface of the skirt is only slightly visible.  FIGS.  6 A- 6 F  show the same caps  20  shown in  FIGS.  5 A- 5 F  but angled such that it can be seen that the caps  20  having the longer cuffs have more of the dots. This is even more clear in  FIGS.  7 A- 7 F , which are top views of the caps  25  of the previous sets of figures. In this case 4, 3, and 2 dots are visible in the highest, second-highest and third-highest cuff versions, respectively. 
     Finally,  FIGS.  8 A- 8 F  are bottom perspective views of the same set of caps shown in the immediately preceding drawings. In these views looking up into hollow cuff portion  32 , a hole  200  can be seen. This hole allows a threaded screw to pass through the top of the cap to secure the cap to a protruding portion of a multiunit base or a single implant. The screws are shown in figures below. 
       FIG.  9    shows the implant and multi-unit abutment with directional indicators with all the tissue retracted, prior to placement of the cap. 
       FIG.  10    is a view of a cap  20  that has been installed into a protrusion  21  of a multiunit, other as yet uncapped portions  21  of the multiunit being visible at the right side of the figure. At this stage of installation, the single cap  25 , with a signaling dot visible, has begun the process of sealing the palate  100  via the clamping down of the nearby palate tissue with the underside surface of the skirt  25 . The remainder of the palate is still hanging loosely. 
       FIG.  11    shows the point at which a complete set of caps  20  have been installed into corresponding portions of the multiunit, via the screws  31 , and a stitch is done as well, to the right of the cap. 
     Between the stage shown in  FIG.  10    and that shown in  FIG.  11   , after the single cap  20  is provided, as shown in  FIG.  10   , the tissue, in this case palate and/or gum tissue, in each area is clamped down by the skirts  25  of further caps  20 , which, with appropriate stitching  60  provided around the caps  20 , stops the bleeding and allows the procedure to continue, one after another until all are installed as shown in  FIG.  11   . By virtue of this process, the multiunit can be chosen not based on the ability to have the healing abutment stick out so as to visible, but on the ability to create an emergence profile and how much tissue there actually is. 
     Also, by the above method and cap  20 , no more will all of the healthy palatal tissue be cut away. Instead it is preserved by clamping everything down under the cap  20 , in combination with the appropriate stitching. 
       FIG.  12    shows the end result of same procedure as outline above, but performed in a lower jaw. That is, in the mandible it can be seen in this figure how the skirt  25  holds the tissue down, and a thicker band of tissue  150  is provided around the implants. As can be seen in this figure, each skirt has a different arrangement and number of dots. 
     As can be seen in  FIG.  13   , for example, the scan bodies are always protruding and easy to scan, and the tissue  150  is held down and spread appropriately, making it easy for the designer to align the scan bodies. 
       FIG.  14    shows cap being screwed into an implant of a multiunit with a driver  60 . With regard to the clamping and the stitching, it is preferable to suture a restoration flap and then place the cap on top so the tissue is approximated to where you want it to be and it will clamp the tissue right back down. you can see the male protrusions of the multiunit over which the bottom of the cap sits at the lower right in the next slide. 
       FIG.  15    shows a shaped impression  64 , namely the space made by the cap in the temporary teeth that will be filled with cement and placed in the mouth on the cap. The  FIG.  16    shows a temporary denture  66  that is attached to the caps  20  in the time in which the permanent one is being prepared based on the intra oral scan. 
       FIG.  17    is an x-ray view that illustrates the retention of the temporary denture with the caps  20 . 
     Thus, while there have been shown and described and pointed out fundamental novel features of the invention as applied to a preferred embodiment thereof, it will be understood that various omissions and substitutions and changes in the form and details of the devices illustrated, and in their operation, may be made by those skilled in the art without departing from the spirit of the invention. For example, it is expressly intended that all combinations of those elements and/or method steps which perform substantially the same function in substantially the same way to achieve the same results are within the scope of the invention. Moreover, it should be recognized that structures and/or elements and/or method steps shown and/or described in connection with any disclosed form or embodiment of the invention may be incorporated in any other disclosed or described or suggested form or embodiment as a general matter of design choice. It is the intention, therefore, to be limited only as indicated by the scope of the claims appended hereto.