Patent Publication Number: US-10307227-B2

Title: Methods for placing an implant analog in a physical model of the patient&#39;s mouth

Description:
RELATED APPLICATIONS 
     This application is a divisional of prior application Ser. No. 13/554,936, filed Jul. 20, 2012, now allowed, which is a continuation of prior application Ser. No. 12/070,922, filed Feb. 22, 2008, now U.S. Pat. No. 8,257,083, which is a continuation-in-part of application Ser. No. 11/585,705, filed Oct. 24, 2006, now U.S. Pat. No. 7,661,956, which claims the benefit of U. S. Provisional Application No. 60/729,506, filed Oct. 24, 2005, each of which is hereby incorporated by reference herein in its entirety. 
    
    
     FIELD OF INVENTION 
     The present invention relates generally to dental implant systems. More particularly, the present invention relates to restoration components for dental implant systems and a computer model for developing an implant analog placement tool to eliminate the need for a surgical index. 
     BACKGROUND OF THE INVENTION 
     The dental restoration of a partially or wholly edentulous patient with artificial dentition is typically done in two stages. In the first stage, an incision is made through the gingiva to expose the underlying bone. An artificial tooth root, usually a dental implant, is placed in the jawbone for integration. The dental implant generally includes a threaded bore to receive a retaining screw holding mating components therein. During the first stage, the gum tissue overlying the implant is sutured and heals as the osseointegration process continues. 
     Once the osseointegration process is complete, the second stage is initiated. Here, the gum tissue is re-opened to expose the end of the dental implant. A healing component or healing abutment is fastened to the exposed end of the dental implant to allow the gum tissue to heal therearound. Preferably, the gum tissue heals such that the aperture that remains generally approximates the size and contour of the aperture that existed around the natural tooth that is being replaced. To accomplish this, the healing abutment attached to the exposed end of the dental implant has the same general contour as the gingival portion of the natural tooth being replaced. 
     During the typical second stage of dental restoration, the healing abutment is removed and an impression coping is fitted onto the exposed end of the implant. This allows an impression of the specific region of the patient&#39;s mouth to be taken so that an artificial tooth is accurately constructed. Thus, in typical dental implant systems, the healing component and the impression coping are two physically separate components. Preferably, the impression coping has the same gingival dimensions as the healing component so that there is no gap between the impression coping and the wall of the gum tissue defining the aperture. Otherwise, a less than accurate impression of the condition of the patient&#39;s mouth is made. The impression coping may be a “pick-up” type impression coping or a “transfer” type impression coping, both known in the art. After these processes, a dental laboratory creates a prosthesis to be permanently secured to the dental implant from the impression that was made. 
     In addition to the method that uses the impression material and mold to manually develop a prosthesis, systems exist that utilize scanning technology to assist in generating a prosthesis. A scanning device is used in one of at least three different approaches. First, a scanning device can scan the region in the patient&#39;s mouth where the prosthesis is to be placed without the need to use impression materials or to construct a mold. Second, the impression material that is removed from the healing abutment and surrounding area is scanned. Third, a dentist or technician can scan the stone model of the dental region that was formed from the impression material and mold to produce the permanent components. 
     Three basic scanning techniques exist, laser scanning, photographic imaging and mechanical sensing. Each scanning technique is used or modified for any of the above-listed approaches (a scan of the stone model, a scan of the impression material, or a scan in the mouth without using impression material) to create the prosthesis. After scanning, a laboratory can create and manufacture the permanent crown or bridge, usually using a computer aided design (“CAD”) package. 
     The utilization of a CAD program, as disclosed in U.S. Pat. No. 5,338,198, (Wu), whose disclosure is incorporated by reference herein, is one method of scanning a dental region to create a three dimensional model. Preferably, after the impression is made of the patient&#39;s mouth, the impression material or stone model is placed on a support table defining the X-Y plane. A scanning laser light probe is directed onto the model. The laser light probe emits a pulse of laser light that is reflected by the model. A detector receives light scattered from the impact of the beam with the impression to calculate a Z-axis measurement. The model and the beam are relatively translated within the X-Y plane to gather a plurality of contact points with known location in the X-Y coordinate plane. The locations of several contact points in the Z-plane are determined by detecting reflected light. Finally, correlating data of the X-Y coordinates and the Z-direction contact points creates a digital image. Once a pass is complete, the model may be tilted to raise one side of the mold relative to the opposite vertically away from the X-Y plane. Subsequent to the model&#39;s second scan, the model may be further rotated to allow for a more accurate reading of the model. After all scans are complete, the data may be fed into a CAD system for manipulation of this electronic data by known means. 
     Photographic imaging can also used to scan impression material, a stone model or to scan directly in the mouth. For example, one system takes photographs at multiple angles in one exposure to scan a dental region, create a model and manufacture a prosthetic tooth. As disclosed in U.S. Pat. No. 5,851,115, (Carlsson), whose disclosure is incorporated by reference herein, this process is generally initiated with the process of taking a stereophotograph with a camera from approximately 50 to 150 mm away from the patient&#39;s mouth. The stereophotograph can involve a photograph of a patient&#39;s mouth already prepared with implantation devices. Correct spatial positioning of the dental implants is obtained by marking the implant in several locations. The resulting photograph presents multiple images of the same object. The images on the photographs are scanned with a reading device that digitizes the photographs to produce a digital image of the dental region. The data from the scanner is electronically transmitted to a graphical imaging program that creates a model that is displayed to the user. After identification of the shape, position and other details of the model, the ultimate step is the transmission of the data to a computer for manufacturing. 
     A third scanning measure uses mechanical sensing. A mechanical contour sensing device, as disclosed in U.S. Pat. No. 5,652,709 (Andersson), whose disclosure is incorporated by reference herein, is another method used to read a dental model and produce a prosthetic tooth. The impression model is secured to a table that may rotate about its longitudinal axis as well as translate along the same axis with variable speeds. A mechanical sensing unit is placed in contact with the model at a known angle and the sensing equipment is held firmly against the surface of the model by a spring. When the model is rotated and translated, the sensing equipment can measure the changes in the contour and create an electronic representation of the data. A computer then processes the electronic representation and the data from the scanning device to create a data array. The computer then compresses the data for storage and/or transmission to the milling equipment. 
     When the stone model of the patient&#39;s mouth is created for use in the scanning process, or in other prior techniques, a second stone model of the patient&#39;s mouth is also typically used to develop a final prosthesis for use in the patient. The prosthesis is typically developed on the second stone model. A surgical index is used to position the implant analog within the second stone model so that the dental laboratory may know the exact position of the implant when making the prosthesis. The surgical index is typically a mold of the patient&#39;s teeth directly adjacent to the implant site that relies upon the position of the adjacent teeth to dictate the location and orientation of the implant analog within the stone model. Unfortunately, the surgical index is an additional step in the process for the clinician that requires additional components. A need exists for a device and method of placing the implant analog within the stone model without using a conventional surgical index. 
     SUMMARY OF THE INVENTION 
     According to one aspect of the present invention, a method of affixing an implant analog in a physical model of a patient&#39;s mouth for use in creating a custom abutment comprises determining, in a three-dimensional virtual model of the patient&#39;s mouth, the location of the implant analog to be placed in the physical model. The method further includes developing implant-analog positional information based on the location of the implant analog in the three-dimensional virtual model and developing an emergence profile contour information to provide for a contour of an opening to be made in the physical model leading to the implant analog. The contour is preferably tapered downwardly toward the implant analog. The method further includes transferring to a robot (i) the implant-analog positional information, and (ii) the emergence profile contour information, using the robot to modify the physical model by creating an opening in the physical model having a tapering contour, and using the robot to affix the implant analog within the opening of the physical model. 
     According to another aspect of the present invention, a method of positioning an implant analog in a physical model of a patient&#39;s mouth for use in creating a custom abutment comprises scanning the physical model to develop scan data of the physical model, transferring the scan data to a CAD program, and creating a three-dimensional model of at least a portion of the physical model on the CAD program using the scan data. The method further includes determining, in the three-dimensional model, the location of the implant analog to be placed in the physical model, developing implant-analog positional information based on the location of the implant analog in the three-dimensional model, and developing an emergence profile contour information to provide for a contour of an opening to be made in the physical model leading to the implant analog. The method further includes transferring to a robot (i) the implant-analog positional information and (ii) the emergence profile contour information, and, by use of at least one tool associated with the robot, modifying the physical model by creating the opening. The opening has an emergence profile corresponding to the emergence-profile contour information. The method may further include, by use of the robot, fixing the implant analog within the opening of the physical model in accordance to the implant-analog positional information. 
     According to yet another process of the present invention, a method of positioning an implant analog in a physical model of a patient&#39;s mouth for use in creating a custom abutment, comprises scanning the physical model to develop scan data of the physical model, transferring the scan data to a CAD program, and creating a three-dimensional model of at least a portion of the physical model on the CAD program using the scan data. The method further includes determining, in the three-dimensional model, the location of the implant analog to be placed in the physical model, and using a robot to place an implant analog within the physical model in accordance with information from the three-dimensional model. 
     According to yet a further aspect of the present invention, a method of performing guided surgery in a patient&#39;s mouth, comprises taking a CT-scan of the patient&#39;s mouth to develop CT-scan data, and developing, on a 3D-computer model, a surgical plan based on the CT-scan data. The surgical plan includes at least one virtual implant. The virtual implant has virtual-implant location data and virtual implant orientation data corresponding to a non-rotational feature on the virtual implant. Based on the surgical plan, the method further may further include manufacturing a surgical guide to be placed in the patient&#39;s mouth for installing an implant in the patient&#39;s mouth at substantially the same location and orientation as the virtual implant on the 3D-computer model, and manufacturing a physical model of the patient&#39;s mouth having an implant analog at substantially the same location and orientation as the virtual implant on the 3D-computer model. The method further includes developing a custom abutment on the physical mode, performing surgery to place the implant in the patient&#39;s mouth as physically guided by the surgical guide in accordance with the surgical plan, and installing the custom abutment on the implant. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1 a    is a top view of a healing abutment; 
         FIG. 1 b    is a longitudinal cross-sectional view of the healing abutment shown in  FIG. 1   a;    
         FIG. 1 c    is the healing abutment shown in  FIG. 1 b    attached to an implant; 
         FIG. 2 a    is a top view of another embodiment of a healing abutment; 
         FIG. 2 b    is a longitudinal cross-sectional view of the healing abutment shown in  FIG. 2   a;    
         FIG. 3 a    is a top view of yet another embodiment of a healing abutment; 
         FIG. 3 b    is a longitudinal cross-sectional view of the healing abutment shown in  FIG. 3 a   ; and 
         FIG. 4 a    is a top view of a further embodiment of the healing abutment; 
         FIG. 4 a    is a top view of a further embodiment of the healing abutment; 
         FIG. 4 b    is a longitudinal cross-sectional view of the healing abutment shown in  FIG. 4   a;    
         FIG. 5 a    is a top view of another embodiment of a healing abutment; 
         FIG. 5 b    is a longitudinal cross-sectional view of the healing abutment shown in  FIG. 5   a;    
         FIG. 6 a    is a top view of another embodiment of a healing abutment; 
         FIG. 6 b    is a longitudinal cross-sectional view of the healing abutment shown in  FIG. 6   a;    
         FIG. 7  is an exploded view of another embodiment of the present application; 
         FIG. 8  is a side view of a method for stereophotographic imaging; 
         FIGS. 9 a -9 p    are top views of a plurality of healing abutments having a binary-type system of information markers; 
         FIG. 9 q    is a top view of a healing abutment having a bar code information marker; 
         FIG. 10  is a perspective view of a coordinate system of one embodiment of the present invention; 
         FIG. 11  is a perspective view of a stone model of an impression of a mouth used with one embodiment of the present invention; 
         FIG. 12  is a perspective view of a 3-D CAD model of the stone model of  FIG. 11 ; 
         FIG. 13  is a perspective view of an altered 3-D CAD model of  FIG. 12  with the healing abutments removed from the CAD model; 
         FIG. 14  is a perspective view of an altered 3-D CAD model of  FIG. 13  with a custom abutment added in the CAD model; 
         FIG. 15  is a perspective view of a 3-D CAD model with an overmold attached over the custom abutment and the adjoining teeth; 
         FIG. 16  is a perspective view of a rapid prototype of the overmold shown in the 3-D CAD model of  FIG. 15  including an implant analog and an abutment; 
         FIG. 17  is a perspective view of an altered stone model of  FIG. 11  with the overmold of  FIG. 16  attached; 
         FIG. 18  is a perspective view of the altered stone model of  FIG. 17  with the overmold removed and the implant analog placed in the stone model and the patient-specific abutment connected to the implant analog; 
         FIG. 19 a    is a perspective view of an embodiment of an altered stone model of a mouth with abutments removed; 
         FIG. 19 b    is a perspective view of an alternative embodiment of an altered stone model of a mouth with abutments removed; 
         FIG. 20  is a perspective view of a 3-D CAD model of a custom abutment and implant analog placed within a mouth; 
         FIG. 21  is a schematic representation of a robot manipulator system adapted to place an implant analog into a stone model according to another embodiment of the present invention; 
         FIG. 22  is a 3D computer model (a virtual model) of a portion of a patient&#39;s mouth; 
         FIG. 23  illustrates a robot that is used to modify the physical model of the patient&#39;s mouth; 
         FIG. 24  illustrates the robot of  FIG. 23  as it modifies the healing abutment replica on the physical model to create an opening in the physical model; 
         FIG. 25  illustrates the robot of  FIG. 23  after it has created an opening in the physical model; 
         FIG. 26  illustrates the robot of  FIG. 23  placing an implant analog in the physical model; 
         FIG. 27  illustrates the details of the opening of the physical model after the robot of  FIG. 23  has placed the implant analog therein; 
         FIG. 28  illustrates a flow diagram for use in creating a custom abutment and modifying a physical model; and 
         FIG. 29  illustrates a flow diagram for use in creating a custom abutment with a CT scan. 
     
    
    
     While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that it is not intended to limit the invention to the particular forms disclosed but, on the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the appended claims. 
     DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     As shown in  FIGS. 1 a  and 1 b   , the healing abutment  10  of one embodiment of the present invention has a main body  15  with a generally circular cross-sectional shape, a first tapered section  17 , a boundary  19 , a second tapered section  21 , an end surface  23 , a hex socket  25  and dimensions that are generally suitable for replicating the emergence profile of a natural tooth. The first tapered section  17  extends downwardly from the main body  15  of the abutment  10  having a diameter at a boundary  19  that is generally larger than the implant (not shown). The boundary  19  separates the first tapered section  17  from the second tapered section  21  that terminates in the end surface  23 . The second tapered section  21  is at an angle with the central axis of the implant that is generally in the range from about 5 degrees to about 15 degrees, with 10 degrees being preferable. Alternatively, the second tapered section  21  may be omitted such that the first tapered section  17  tapers directly to the diameter of the end surface  23  of the implant. In a further embodiment, the first tapered section  17  may merge smoothly into the second tapered section  21 , without the distinct boundary  19  separating the two tapered sections  17  and  21 . The hexagonal orientation socket or hex  25  is for mating with a hexagonal boss on the implant. The end surface  23  has generally the same diameter as the seating surface of the implant. 
       FIG. 1 b    discloses the top view of the same healing abutment  10  shown in  FIG. 1 a   . As shown in  FIGS. 1 a  and 1 b   , the healing abutment  10  has positive information markers  20  protruding from a top surface  29  of the healing abutment  10 . Each of the six positive information markers  20  is disposed such that it aligns with the six corners of the underlying hex  25 . It is also contemplated in accordance with the present invention that the six information markers  20  may also correspond to the height of the healing abutment. For example, two information markers might correspond to a 2 mm tall healing abutment and four information markers might correspond to a healing abutment that is 4 mm tall. In these embodiments, the two or four information markers would still be at the corners of the underlying hex  25  so that the relative position of the hex is known. 
     A socket  30  on the exposed surface of a head portion  40  of an attaching bolt  50  is shaped to accept a wrench (not shown) for turning the attaching bolt  50  into the threaded bore of an implant  70 , as shown in  FIG. 1 c   . It is contemplated in accordance with the present invention that each of the healing abutments described herein and shown in the figures can be secured to an implant by means of an attaching bolt, as is known in the art. An O-ring  60  carried on the head portion  40  of the attaching bolt  50  fills an annular gap left between the head and the entrance section near the outermost (widest) opening in the entrance section. 
     A healing abutment  100  of  FIG. 2 a    comprises many of the same features as the healing abutment  10  shown in  FIG. 1 a   . Dashed lines  125  in  FIG. 2 b    correspond to the underlying hex  125  of the healing abutment  100  in  FIG. 2 a   . A top surface  129  includes negative information markers (recesses)  120  that are displayed in  FIG. 2 a    as dimples extending below the top surface  129  of the healing abutment  100 . The top surface  129  of the healing abutment  100  also possesses six notches  130  that are machined into the corners. The top surface  129  is generally flat and merges into a rounded shape at the periphery of the healing abutment  100 . 
     The notches  130  are used, for example, to determine the identification of the underlying implant hex position  125  or the height of the healing abutment or the diameter of the healing abutment. This embodiment is not limited to comprising six notches in the top surface  129  of the healing abutment  100 . It is also contemplated that one embodiment of the present invention may possess four notches or even two notches for indicative purposes. Furthermore, it is contemplated that the information marker and notch approach could be combined or modified to provide information regarding the underlying implant seating surface diameter and implant hex angulation. 
     In another embodiment of the present invention, a healing abutment  200  shown in  FIGS. 3 a  and 3 b    displays four positive information markers  220  shown to, for example, indicate a 4 mm tall healing abutment  200 . It is contemplated that the number of information markers  220  could decrease or increase depending on the height of the healing abutment  200  or another variable that the information markers have been designated to correspond. The positive information markers  220  also define a corresponding one of the six flat surfaces of an underlying hex  225 . Furthermore, dashed lines  225  in  FIG. 3 b    correspond directly to the underlying hex  225 . 
     Two notches  230  have also been etched or machined onto a top surface  229  of the healing abutment of  FIG. 3 b   . These notches may indicate the diameter of the implant&#39;s seating surface. Lines  240  are scribed on the top surface  229  of the healing abutment  200 . The lines  240  are used to provide positioning or other information to the dentist or laboratory. Here, the lines  240  indicate the diameter of the healing abutment (e.g., 4 mm). In summary, the number of the positive information markers  220  indicates the height of the healing abutment  200 . The position of the positive information markers  220  indicates the orientation of the hex  225  that is the orientation of the hexagonal boss on the implant. The notches  230  indicate the diameter of the seating surface of the implant. The lines  240  indicate the diameter of the healing abutment  200 . generally 
     In yet another embodiment of the present invention, a top surface  329  of the healing abutment  300  of  FIGS. 4 a  and 4 b    comprises an etched or machined hex  335 . Corners  322  of the etched hex  335  correspond directly to the position of the corners of an underlying hex  325  shown in  FIG. 4 a   . It is contemplated in accordance with one embodiment of the present invention that further information markers may be added to the healing abutment for the dentist or laboratory to ascertain different heights or diameters. 
     A top surface  429  of a healing abutment  400  shown in  FIGS. 5 a  and 5 b    contains an etched or machined triangle  435 . Dashed lines  425  in  FIG. 5 b    indicate the location of an underlying hex  425 . Corners  422  of the etched triangle  435  correspond to three of the six corners of the underlying hex  425 . Furthermore, two negative information markers  420  are shown in  FIG. 5 b   . As above, it is contemplated in accordance with the present invention that fewer than six information markers may exist to account for differing heights or diameters of the healing abutments. 
     Another embodiment of the present invention is shown in  FIGS. 6 a  and 6 b   . The healing abutment  500  displayed in  FIGS. 6 a  and 6 b    is a shorter version of the healing abutment  10  shown in  FIGS. 1 a  and 1 b   . Two positive information markers  520  are shown in  FIG. 6 b    to identify the height of the healing abutment  500 . Dashed lines  525  of the healing abutment  500  correspond with the location and orientation of the underlying hex  525 . Two notches  530  are also shown in a top surface  529  of this embodiment of the present invention to show the orientation of two of the underlying flats of the underlying hex  525 . A numeral “4” at  537  is located on the top surface  529  of the healing abutment  500  to indicate, for example, the diameter of the healing abutment  500 . As shown, the numeral “4” at  537  corresponds to a healing abutment  500  with a diameter of 4 mm. It is contemplated in accordance with the present invention that other numerals could be placed on the top surface  529  of the healing abutment  500  to indicate other healing abutment diameters. Further, it is also contemplated that the numeral could represent the height of the healing abutment or the diameter of the underlying implant. 
     During the second stage of the prosthetic implementation process and after a healing abutment with the information markers has been placed, an impression of the mouth is made with only the healing abutments as described herein and without the use of an impression coping. A model of the impression is poured with, for example, die stone. Since the information markers are disposed on the top and/or side of the healing abutment, the laboratory has all necessary information to define the gingival aperture, the implant size and the orientation of the underlying hex. This enables the laboratory to quickly prepare the permanent components. The system of the present invention also allows the maintenance of the soft-tissue surrounding the healing abutment where in prior systems the soft tissue would close once the healing abutment was removed. The system spares the patient from the pain of removing the healing abutment. 
     To create a permanent prosthesis, the dental region is scanned, as described above, from a stone model, from the impression material, or directly in the mouth using a laser scanning technique, a photographic scanning technique or a mechanical sensing technique.  FIG. 8  shows stereophotographic imaging, one method used for scanning. Stereophotography with a camera  703  is performed directly on the mouth cavity  705  of the patient  707 . A clinician can photograph implants and other components that have been placed into or adjacent the patient&#39;s jawbone  709 . 
     The scanned information is then transferred into a graphical imaging program for analysis. The graphical imaging software program, due to the information markers on the surface of the healing abutment, can perform a wide variety of functions. The graphical imaging program can scan an opposing cast in order to develop an opposing occlusal scheme and relate this information back to the primary model. This feature is extremely important because many clinical patients have implants in both maxillary and mandibular locations. 
     The graphical imaging software program is capable of generating a three-dimensional image of the emergence profile contours used on the healing abutment. If the implant is not placed in the desired esthetic location, the software program relocates the position of the restoration emergence through the soft tissue. The graphical imaging software program is also able to accurately relate the gingival margin for all mold, model, implant and abutment dimensions. The software creates a transparent tooth outline for superimposition within the edentulous site. The occlusal outline of the “ghost” tooth should, if possible, be accurate and based on the scanned opposing occlusal dimensions. It is contemplated in accordance with the present invention that an occlusal outline is created by scanning a wax-up in order to maintain a proper plane of occlusion and healing abutment height. 
     The software program subtracts a given dimension from the mesial, distal, buccal, lingual, and occlusal areas of the superimposed tooth dimension. This allows for an even reduction of the healing abutment during fabrication to allow for proper thickness of the overlying materials (e.g., gold, porcelain, targis, etc.). The graphical imaging software program also incorporates angulation measurements into the custom abutment and subsequently calculates the dimensions of the prosthesis that are checked and modified, if necessary, by a laboratory technician. Each of the features is analyzed and determined from the different information markers that exist on the healing abutments of the present invention. 
     The final dimensional information determined by the graphical imaging computer program is transferred from the computer to a milling machine (e.g., a 5-axis milling machine) to fabricate the custom abutment. It is contemplated in accordance with the present invention that the custom abutment can be fashioned from gold or titanium or other similar metals or composites. A custom milled coping can then be fabricated. It is contemplated in accordance with the present invention that the custom milled coping can be formed from titanium, plastic, gold, ceramic, or other similar metals and composites. 
       FIG. 7  shows the exploded view of another embodiment of the present invention. A cap  602  is placed on a healing abutment  600  and later removed during the process of taking the impression of the healing implant and surrounding features of the patient&#39;s mouth. It is contemplated in accordance with the present invention that the cap  602  could be formed from plastic or metal or a composite material. As shown in  FIG. 7 , notches  604  are formed in the side(s) of the healing abutment  600 . These notches correspond to notches  606  that have been preformed in the cap  602 . When the cap  602  is placed onto the healing abutment  600 , the cap only fits snugly and properly if the number of notches  606  in the cap  602  corresponds exactly to the number of notches  604  in the side wall(s) of the healing abutment. It is contemplated in accordance with the present invention that there could be many less or more notches than is depicted in  FIG. 7 . These notches correspond to information parameters such as healing abutment height, healing abutment and/or implant diameter and other parameters as listed above. 
     Specifically, after the healing abutment has been secured to the implant, the cap  602  is securely placed over the top of the healing abutment  600 . The impression material is then placed over the top of the cap  602 . The impression is then either scanned in the patient&#39;s mouth or the impression material (with the cap  602 ) is then scanned and the process continues as described above. 
       FIGS. 9 a -9 p    depict yet another embodiment of the present invention. Specifically,  FIGS. 9 a -9 p    show the top view of a plurality of healing abutments, each of which has four marking locations on the top surface of the healing abutment. For each healing abutment, a marker is either present or absent in each of the four marking locations, and the presence or absence can be interpreted either visually or by a scanning device. As explained below in detail, the markers in the marking locations permit identification of healing abutment characteristics, such as dimensions of the healing abutment. 
     In  FIGS. 9 a -9 p   , the four rows correspond to four different healing abutment heights (e.g., 3 mm, 4 mm, 6 mm, and 8 mm). The four columns of the coding key correspond to four different diameters of the healing abutment seating surfaces (e.g., 3.4 mm, 4.1 mm, 5.0 mm, and 6.0 mm). Accordingly, sixteen unique healing abutments are present. 
     The top surface of each of the healing abutments has from zero to four information markers located in the four marking locations. As shown in  FIGS. 9 a -9 p   , the marking locations extend radially from a central region of the healing abutment to the outer region of the top surface of the healing abutments (i.e., at locations of 12 o&#39;clock, 3 o&#39;clock, 6 o&#39;clock, and 9 o&#39;clock). 
     As is well known, a binary-coded system exists as an array of digits, where the digits are either “1” or “0” that represent two states, respectively, ON and OFF. For each marking location, the presence of a marker (“ON”) is a 1 and the absence of a marker (“OFF”) is a 0. By grouping sets of 1&#39;s and 0&#39;s together, information about each healing abutment is known. In the illustrative embodiment, the determination of the sets of 1&#39;s and 0&#39;s derived from the information markers (e.g., via visual inspection, scanning in the mouth, scanning of the impression, or scanning of the model created by the impression) provide information on the height of the healing abutment and the diameter of the seating surface of the attached implant. 
     The information markers shown in  FIGS. 9 a -9 p    are in the form of grooves having rounded cross-sections. The present invention, however, provides that the cross-section of these grooves can be rectangular, triangular, or various other shapes. When an impression is created from the healing abutment, the grooved marking locations produce a protruding “mound”-like element in the impression. This impression is then scanned so that identifying features regarding the healing abutment can be obtained. Alternatively, a model of the patient&#39;s mouth is created from the impression such that the markings are again grooves in the model that substantially replicate the grooves in the healing abutments. Of course, the markers could also be protrusions instead of grooves. Further, if the unique characteristics of the healing abutment are to be identified through scanning in the mouth or simply visual scanning by the clinician, then markers not producing features in impression material, such as etched or laser marking, may also be used. 
     Turning now to the specifics of each healing abutment,  FIG. 9 a    illustrates a top view of a healing abutment  801  that includes orientation pick-ups  802 . These orientation pick-ups  802  are also present in each of the healing abutments shown in  FIGS. 9 b -9 p   . The most counterclockwise of the orientation pick-ups  802  (i.e., the horizontal pick-up at the lower region of  FIGS. 9 a -9 p   ) is always parallel to one flat of the implant hex, as viewed from the top of the healing abutment. As shown, the orientation pick-ups  802  are a pair of bevels on the sides of the healing abutments in  FIGS. 9 a -9 p   . Alternatively, the orientation pick-ups  802  can be grooves or protruding ridges, as well. 
     The orientation pick-ups  802  serve a second function in that they dictate which of the four marking locations is the first marking location. The other three marking locations are then read in clockwise order, proceeding from the most counterclockwise pick-up  802  to the other three marking locations on the top surface of the healing abutment. In other words, as illustrated in  FIGS. 9 a -9 p   , the information marker at 6 o&#39;clock is the first digit in the binary code, the information marker at 9 o&#39;clock is the second digit in the binary code, the information marker at 12 o&#39;clock is the third digit in the binary code, and the information marker at 3 o&#39;clock is the fourth digit in the binary code. In summary, the position of the orientation pick-ups  802  allows for the determination of the position of one of the hex flats of the healing abutment (and, likewise, one of the hex flats on the implant), and also the starting point to check for the presence or absence of information markers. 
     The results of a scan (computer or visual) of the four information markers on the healing abutment  801  produce no information markers at the four marking locations on the healing abutment  801  of  FIG. 9 a   . Thus, the binary code for the healing abutment  801  is 0000, indicating that no grooved marker is present in any of the four predetermined positions. Since the coding key is preset (on a chart or in computer software), the binary code 0000 indicates that the healing abutment  801  is a resident of first row and first column of the matrix depicted by  FIG. 9 , having a height of 3 mm and a seating surface diameter of 3.4 mm. Thus, the three distinct pieces of information obtained from the top of the healing abutment allow the clinician or laboratory to know (i) the orientation of the hex of the implant, (ii) the height of the healing abutment (i.e., the location of the implant&#39;s seating surface below the healing abutment), and (iii) the seating surface diameter of the healing abutment (or the size of the implant&#39;s seating surface). 
     The healing abutment  806  in  FIG. 9 b    possesses a binary code of 0100 because only one information marker  807  is present in the second marking location. Thus, it is understood from the binary code that the healing abutment  806  is 3 mm in height and has a seating surface diameter of 4.1 mm. The two healing abutments  811 ,  816  in  FIGS. 9 c , 9 d    have binary codes of 1000 and 1100, respectively. Healing abutment  811  has an information marker  812  in the first marking location, while healing abutment  816  has information markers  817 ,  818  in the first two locations. Thus, the unique characteristics of these two healing abutments are known. 
     The healing abutments  821 ,  826 ,  831 ,  836  shown in  FIGS. 9 e -9 h    and having heights of 4 mm, but with varying seating surface diameters, would be interpreted as having binary codes 0010, 0110, 1010, and 1110, respectively. Healing abutment  821  has one information marker  822  present in the third marking location, thus resulting in a binary code of 0010, which is indicative of a healing abutment height of 4 mm and a seating surface diameter of 3.4 mm. Similar analyses on healing abutment  826  with information markers  827 ,  828 , healing abutment  831  with information markers  832 ,  833 , and healing abutment  836  with information markers  837 ,  838 ,  839  allow determinations of the unique characteristics of these healing abutments. 
     The healing abutments  841 ,  846 ,  851 ,  856  shown in  FIGS. 9 i -9 l    and having heights of 6 mm, but with varying seating surface diameters, would be interpreted as having binary codes 0001, 0101, 1001, and 1101, respectively. Healing abutment  841  has one information marker  842  present in the fourth marking location, thus resulting in a binary code of 0001, which is indicative of a healing abutment height of 6 mm and a seating surface diameter of 3.4 mm. Similar analyses on healing abutment  846  with information markers  847 ,  848 , healing abutment  851  with information markers  852 ,  853 , and healing abutment  856  with information markers  857 ,  858 ,  859  allow determinations of the unique characteristics of these healing abutments. 
     The healing abutments  861 ,  866 ,  871 ,  876  shown in  FIGS. 9 m -9 p    and having heights of 8 mm, but with varying seating surface diameters, would be interpreted as having binary codes 0011, 0111, 1011, and 1111, respectively. Healing abutment  861  has two information markers  862 ,  863 , which is indicative of a healing abutment height of 8 mm and a seating surface diameter of 3.4 mm. Similar analyses on healing abutment  866  with information markers  867 ,  868 ,  869 , healing abutment  871  with information markers  872 ,  873 ,  874 , and healing abutment  876  with information markers  877 ,  878 ,  879 ,  880  allow determinations of the unique characteristics of these healing abutments. 
     While the matrix of the sixteen healing abutments in  FIGS. 9 a -9 p    show four implant seating surface diameters and four heights, the matrix could include other physical characteristics of the healing abutment. For example, the maximum diameter of the healing abutment could be information obtainable through the binary-coded system. The type of fitting on the healing abutment and, thus, the implant (i.e., internal hex or external hex) could be provided. Information unrelated to the healing abutment, but related to only the implant, could be used. For example, the manufacturer of the implant could be noted. Or, information regarding the type of screw that mates with the internally thread bore of the implant could be provided. 
     Further, while  FIGS. 9 a -9 p    demonstrate the ability of the four digit, binary-coded system to provide two physical characteristics of the healing abutment, it could provide three or more physical characteristics. For example, two seating surface sizes, four heights, and two maximum diameters would provide sixteen unique healing abutments. If more information were needed, a fifth marking location could be added to provide the opportunity for displaying thirty-two physical characteristics of the healing abutments and/or implant. And, while one marking location has been shown with marker, it is possible to have two or more markers in each marking location. For example, one circumferential groove and one radial groove within one location could represent two digits of a binary system. Alternatively, having two widths possible for each groove could provide additional indicia representative of certain information about the healing abutment. 
     While the invention has been described with round healing abutments, healing abutments anatomically shaped like teeth can take advantage of the information markers. Thus, the set of healing abutments could include components shaped like the various teeth, and the information markers could provide the information regarding which tooth shape is present on the healing abutment. For example, a set may include four types of molar-shaped healing abutments, four types of bicuspid-shaped healing abutments, four types of incisor-shaped healing abutments and four types of round abutments. The four information marker locations on each component in the set provide the information to determine which one of the sixteen healing abutments is being used. 
     It is contemplated that the present invention also covers a set of eight unique healing abutments (as opposed to the sixteen shown) requiring only three marking locations. The computer software and/or the visual chart in this situation would identify these eight unique healing abutments through binary codes possessing three digits. The potential binary codes corresponding to an ON or OFF determination at the three marking locations are 000, 100, 010, 001, 110, 101, 011, and 111. Similarly, if the set has only four unique healing abutments, only two marking locations would be required on the healing abutments to determine features regarding the healing abutment and the attached dental implant. The potential binary codes in a four healing abutment matrix are 00, 10, 01, and 11. 
     After the top surface of a healing abutment (or the impression of the top surface, or the model of the impression of the top surface) is analyzed, the orientation of the hex is known from the location of the orientation pick-ups  802  and, via the binary code, the abutment height and the seating surface of the healing abutment is known. Other information regarding the healing abutment and the attached implant can also be determined by adding other markers of the type previously shown. 
     In addition to the markers described, it is further possible to provide a bar-coded system for providing information about the particular component, as shown in  FIG. 9 q   . The bar code  894  can be located on the top surface on the healing abutment  892  such that it can be scanned or read easily. Thus, the bar code  894  would provide the same type of information described above with respect to the information markers. 
     Referring to  FIG. 10 , when scanning techniques are used to learn of the information on the top of the healing abutment, the computer software is able to determine the position and orientation of the implant  900  relative to the adjacent teeth. The position of the implant  900  is defined in a Cartesian coordinate system having “X,” “Y,” and “Z” axes. The common point is at the intersection of the centerline of the implant and a plane  920  representing the seating surface  925  of the implant  900 . 
     As noted above, the information markers assist in determining the height of the healing abutment above the implant. This height can be used to identify the zero point on the “Z” axis, which is in the plane  920  containing the seating surface  925  of the implant  900 . The “Y” axis  910  is within the plane  920  representing the seating surface  925  with the positive-“Y” direction as close to the direction of facial to buccal as possible. The “X” axis  915  is in the plane  920  and is perpendicular to an implant hex face. Thus, the width of the seating surface  925  in the plane  920  is known, as is the width of the healing abutment emerging through the gingiva. Thus, the emergence profile of the artificial tooth is known, as well. 
     Turning now to  FIG. 11 , a perspective view of a stone cast  1000  of a mouth of a patient is shown with a stone-cast model of a healing abutments  1002  which has configurations on its upper surface that corresponds to the healing abutments previously described. The stone cast  1000  is made from an impression of the mouth as previously described. 
     Once the stone cast  1000  is prepared, it is scanned using a scanning technique previously described, the scanned data is transferred into a graphical imaging program, such as a Computer Aided Design (“CAD”) program so that a three-dimensional (“3-D”) CAD model  1100  of the stone cast  1000  ( FIG. 11 ) is created, as shown in  FIG. 12 . 
     As shown in  FIG. 13 , the CAD model  1100  ( FIG. 12 ) of the stone cast  1000  ( FIG. 11 ) is modified to create a first modified CAD model  1200  that removes the healing abutment  1002  ( FIG. 11 ) so that the position of an implant  1202 , or the top surface of an implant, underlying the healing abutment  1002  ( FIG. 11 ) is displayed. 
     The CAD program is additionally used to design a custom, patient specific, abutment adapted to attach to the implant  1202 . The custom abutment supports a final prosthesis, often referred to as a crown. A modified version of the stone model  1000  is used to design the crown to fit between the adjacent teeth based on the specific dimensions and conditions of a patient&#39;s mouth. Thus, obtaining an accurate position of the dental implant is critical to designing an accurate crown. Once the CAD program has been used to design a custom abutment, the design of the custom abutment is input into a precision manufacturing device, such as a CNC milling machine, to create the custom abutment from a blank of metal, usually titanium, or a titanium alloy, or from a ceramic material. 
     As shown in  FIG. 14 , a CAD model of a custom abutment  1402  is shown located between a CAD model of the adjacent teeth  1404  that has been created by scanning the stone model  1000 . Using the CAD program, an overmold  1502  is created, as shown in  FIG. 15 . The overmold  1502  fits over the custom abutment  1402  and the adjacent teeth  1404  in the 3-D CAD model  1400 . The overmold  1502  is adapted to fit over a stone model of the patient&#39;s teeth to allow an actual custom abutment  1604  ( FIG. 18 ) to be positioned in substantially the identical location and orientation as the custom abutment  1402  in the 3-D CAD model  1400 . 
     Once the overmold  1502  has been designed in the 3-D CAD model  1400 , the CAD program allows a rapid prototype overmold  1602  ( FIG. 16 ) corresponding to the 3-D CAD model of the overmold  1502  to be created using rapid prototype equipment. It is contemplated that many rapid prototyping techniques may be utilized with the present invention such as: stereolithography, laminated-object manufacturing, selective laser sintering, solid ground curing, or other known rapid prototyping processes. The 3-D CAD model of the overmold  1502  is used by the equipment controlling the rapid prototype equipment to create the rapid prototype overmold  1602 . 
     Turning now to  FIG. 16 , a rapid prototype assembly  1600  is shown having the rapid prototype overmold  1602 , a custom abutment  1604 , and an implant analog  1606 . The rapid prototype overmold  1602  is adapted to receive the custom abutment  1604  via a snap-fit connection created by snapping the overmold  1602  over an edge of the custom abutment  1604 . It is additionally contemplated that a press fit may be used to secure a custom abutment to a rapid prototype overmold by using an interference fit. The custom abutment  1604  is secured to the implant analog  1606  using a screw. 
     The custom abutment  1604  ( FIG. 18 ) produced on the precision manufacturing device must then be placed within an altered stone model  1700  as shown in  FIG. 17 , so that the crown may be created. The altered stone model  1700  has had the healing abutment  1002  from the stone cast  1000  ( FIG. 11 ) removed, so that an opening  1702  is present where the healing abutment  1002  from the stone cast  1000  ( FIG. 11 ) had been located. The opening  1702  is of a sufficient size so as to receive the implant analog  1606 . A gap  1706 , or a hole large enough to receive an implant analog, exists in the stone model  1700  between the implant analog  1606  and the walls defining the opening  1702 . The rapid prototype assembly  1600  is placed over the stone model  1700 , positioning the custom abutment  1604  and the implant analog  1606  as in the 3-D CAD model. The gap  1706  is then filled with a securing material, such as epoxy, to secure the implant analog  1606  to the stone model  1700 . Once the securing material sets, the implant analog  1606  is properly positioned within the stone model  1700 , at substantially the same location as the implant in the patient&#39;s mouth relative to the teeth adjacent to the implantation site. The implant analog  1606  and the custom abutment  1604  may be removed from the rapid prototype overmold  1602 , as shown in  FIG. 18 . The final prosthesis may then be created using the stone model  1700  having the properly positioned implant analog  1606  and custom abutment  1604 . 
     Thus according to the present invention, the same stone model may be used for a scanning process to make the patient specific custom abutment  1604  and for receiving an implant analog  1606  for mating with the custom abutment  1604  to develop a final prosthesis. 
     While the preceding embodiment has been described for creating a final prosthesis, it is contemplated that the process may be used to create a temporary prosthesis as well. 
     According to anther embodiment of the present invention, an implant analog is placed within a stone model using a robot manipulator. As previously described herein, a stone cast  1000  of a mouth of a patient is produced from taking an impression of the patient&#39;s mouth. The stone cast is scanned to generate a 3-D CAD model  1100  of the stone cast  1000 . The CAD program is used to design a custom abutment  1604 . The custom abutment  1604  is produced on a precision manufacturing device using information from the CAD program. 
     As shown in  FIG. 19 a   , a modified stone cast  1900  is created by removing a section of the stone cast  1000  that contains the healing abutment  1002  ( FIG. 11 ). The CAD program used to generate the custom abutment  1604  is used to generate a 3-D CAD model containing a custom abutment having an implant analog attached. Thus, a 3-D CAD model  2000  exists where the proper position of the implant analog  2002  relative to adjacent teeth  2004  is created as shown in  FIG. 20 . Using a coordinate system within the 3-D CAD model  2000 , the relative position of the implant analogs  2002  and the adjacent teeth  2004  may be generated. A common base plate  2106  ( FIG. 21 ) may be used in scanning the stone cast  1000  and in placing an implant analog  2102  ( FIG. 21 ) using a robot manipulator  2100  ( FIG. 21 ). The robot manipulator  2100  ( FIG. 21 ) is located at a known position relative to the base plate  2106  ( FIG. 21 ). A scanner measures an X, Y, and Z position of the healing abutment  1002  in the stone cast  1000  relative to axes on the base plate  2106 , also referred to as the base plate  2106  origin. Thus, when the base plate  2106  is in a known position with respect to the robot manipulator  2100 , an exact location of an implant analog  2102  ( FIG. 21 ) may be determined. 
     Once the relative position of the implant analog  2002  and the adjacent teeth  2004  has been generated, this position information is input to a robot manipulator. The robot manipulator  2100  uses the relative position information to place an implant analog  2102  into a securing material  2104 , such as epoxy, located on the modified stone cast  1900  where the healing abutments had been located, as shown schematically in  FIG. 21 . The robot manipulator  2100  is able to accurately place the implant analog  2102  in the securing material  2104 , such that the position of the implant analog  2102  within the modified stone cast  1900  is substantially identical to the position of the implant analog  2002  within the 3-D CAD model  2000 . 
     According to a further alternative embodiment of the present invention, instead of using a robot manipulator to place an implant analog into a securing material of a modified stone cast, the robot manipulator may instead be a multiple handed robot manipulator adapted to drill a hole  1902  in a stone cast  1901  (as shown in  FIG. 19 b   ) with a first hand, and place an implant analog in the hole with a second hand. One example of a robot that performs multiple drilling functions and accurately places the implant analog into the drilled hole in the stone cast  1901  is described with reference to  FIGS. 22-28 . 
       FIG. 22  is similar to  FIG. 20  in that it illustrates a 3-D CAD model  2200  (on a computer display) of a virtual custom abutment  1604  and a virtual implant analog  2202  that are adjacent to teeth  2204  after a stone cast of the patient&#39;s mouth has been scanned. An opening  2206  in the CAD model  2200  is tapered as it leads towards the virtual implant analog  2202 . This tapering is chosen by the operator of the CAD model  2200  after consideration of the location of the underlying dental implant that has been dictated by the stone cast model having the healing abutment (e.g., replica of the healing abutment  1002  in stone cast model  1000  in  FIG. 11 ) and the location of the adjacent teeth  2204 . Further, the tapering is also dictated by the size and shape of the virtual custom abutment  1604  that has been designed by the operator. Although the opening  2206  has been illustrated having a straight-wall taper, the opening  2206  may have a curved-wall taper. Further, the opening  2206  at its terminal and may be circular, elliptical, or other non-circular shapes as dictated by the virtual custom abutment  1604  and the three-dimensional “saddle” shape of the gingival tissue between the left and right adjacent teeth  2204 . This opening  2206  may be created by the robot manipulator  2100  of  FIG. 21 , or the alternative robot  2300  discussed with reference to  FIGS. 23-27 . 
       FIG. 23  illustrates a simple schematic construction for a robot  2300 . The skilled artisan would appreciate that numerous types of robots are available having various control features, motors, and manipulating arms and tools. For example, the robot  2300  could be an Epson PS5 six-axis robot with an Epson RC520 controller. The robot  2300  in  FIGS. 23-27  performs various functions related to modifying the stone cast  1000  and placing the actual implant analog. In particular, as will be described in more detail below, the robot  2300  modifies the stone cast  1000  to create an actual opening that is substantially similar to the virtual opening  2206  in  FIG. 22 . Further, the robot  2300  places an implant analog in substantially the same position and with substantially the same orientation as the virtual implant analog  2202  in  FIG. 22 . 
     The robot  2300  includes a base structure  2302  that is supported on a table or other work bench. The base structure  2302  typically has one or more moving arms  2304  having a terminal structure  2310  for supporting one or more tool holders  2312 ,  2314  that grip and/or manipulate tools or other components. As shown, the base structure  2302  includes an arm  2304  having multiple pivotable sections  2304   a  and  2304   b , and the tool holder  2312  includes a drill bit  2320 . The terminal structure  2310 , the arm  2304 , the base structure  2302 , and/or the tool holders  2312 ,  2314  include gears and other common components for transmitting rotational energy to a tool (e.g., the drill bit  2320 ) being held by one of the tool holders  2312 ,  2314 . 
     The arm  2304  (and thus the terminal structure  2310 ) can be moved in all directions relative to the stone cast  1000  and a pallet  2340 . The pallet  2340  includes a specific sequence of tools or other components that are placed within the pallet  2340  prior to the operation of the robot  2300 . As shown, the pallet  2304  includes an additional drill bit  2342  at one location and an implant analog holder  2344  at a second location. Typically, after the data from the 3-D CAD model  2200  of  FIG. 22  is transferred to the control system for the robot  2300 , the operator of the robot  2300  will be instructed to provide a certain sequence of tools or other components in the pallet  2340  to accommodate the development of the particular opening and the placement of the particular implant analog for the case. 
     In  FIG. 23 , the stone cast  1000  is directly coupled to a base structure  2350  that is the same base structure that was used for scanning the stone model  1000  prior to development of the virtual custom abutment  1604 . As such, the base structure  2350  is used in both the scanning of the stone cast  1000  and in the later modification of the stone cast  1000  by the robot  2300 . The base structure  2350  includes alignment features and magnetic features for precision mating with corresponding structures on a work structure  2352  associated with the robot  2300 . The work structure  2352  is at a known location relative to the base structure  2302  such that any tool or other component within the tool holders  2312 ,  2314  can be accurately positioned relative to be work structure  2352 . 
     To help arrange for the precision location of the tool  2320  relative to the stone cast  1000 , the stone model  1000  (and its base structure  2350 ) has an abutment coordinate system, which is labeled as X A , Y A , Z A  for locating the custom abutment, which will ultimately fit on the implant analog to be located within the opening in the stone cast  1000 . Further, the robot  2300  (and the scanning system previously used) has its own base coordinate system, which is labeled as X B , Y B , Z B . 
     When the data from the 3-D CAD model  2200  is transferred to the control system for the robot  2300 , the data includes at least three types of data sets. A first data set will indicate the type of implant analog that will be used in the stone cast  1000 . A second data set will indicate the relative location of the abutment coordinate system to the base coordinate system so that the creation of the hole in the stone cast  1000  and the placement of the implant analog is substantially identical to that which has been virtually modeled. A third data set will define the gingival margin of the custom abutment  1604  (e.g., having a saddle shape) so that a properly sized opening can be created above the implant analog, allowing the custom abutment to fit properly within the stone cast. This third data set is helpful because the actual custom abutment is larger in diameter than the implant analog such that the opening must be contoured in a tapered fashion (e.g., straight-wall taper, curved wall taper, etc) to accommodate the actual custom abutment. 
     The robot  2300  of  FIG. 23  may also include a calibration mechanism  2360  such that the tool (e.g., the tip end of drill bit  2320 ) is placed at a known location and “zeroed” before developing the opening and/or placement of the implant analog. As shown, the calibration system  2360  includes two intersecting lasers (e.g., HeNe lasers)  2362 ,  2364 . Prior to any work on the stone cast  1000 , the tool is placed at the intersection of the two lasers  2362 ,  2364  to insure accuracy of the tool within the base coordinate system (X B , Y B , Z B ). The operator can slightly adjust the tool to place it at the intersection of the two lasers  2362 ,  2364 , assuming the calibration system  2360  indicates that an adjustment is needed or if the operator can visualize that an adjustment is needed. Once calibration is complete, the robot  2300  moves the tool  2320  directly over the stone replica of the healing abutment  1002 , as shown in  FIG. 23 , as part of a visual verification step. When this occurs, the operator knows that the data entered into the robot  2300  is correct as the robot  2300  is now ready to begin modification of the stone model  1000 . Had the drill bit  2320  been placed over the adjacent teeth, and not the stone replica of the healing abutment  1002 , then the operator would know that incorrect data has been loaded. 
     In  FIG. 24 , the drill bit  2320  has been moved by the robot  2300  on to the stone replica of the healing abutment  1002  to begin the development of the opening in the stone model  1000 . Particles  1002   a  of the healing abutment  1002  are disbursed from the stone model  1000  as the drill bit  2320  works on the stone replica of the healing abutment  1002 . Initially, the drill bit  2320  removes the most, if not all, of the protruding structure of the stone replica of the healing abutment  1002 . In some instances, corners sections of the protruding structure may remain. The drill bit  2320  then creates the contoured pocket of the opening (as dictated by the tapered opening  2206  in  FIG. 22 ). The drill bit  2320  has a smaller diameter than any portion of the opening such that it is used as a milling tool to create the contoured pocket. The drill bit  2320  then creates the lower portion of the opening that will receive the implant analog. In doing so, the drill bit  2320  of the robot  2300  creates a bottom wall to the opening that is located at a position within the stone cast  1000  that will cause the particular implant analog for that case to have its upper mating surface (see  FIG. 27 ) at a location that is substantially identical to the location of the implant in the patient&#39;s mouth, as indicated by the healing abutment that was placed within the patient&#39;s mouth and subsequently scanned to develop the 3-D CAD model  2200  of  FIG. 22 . In doing so, the system takes into account the fact that the implant analog will be held in position in the opening by an adhesive (discussed below), such that it may be suspended in the opening and not in contact with the walls of the opening. 
       FIG. 25  illustrates the end result of the opening  2380  that was created in the stone cast  1000  by the robot  2300 . While the development of the opening  2380  has been described by the use of a single drill bit  2320 , it should be understood that the robot  2300  can utilize multiple tools (e.g., a second drill bit  2342  in the pallet  2340 , or a more traditional milling tool) to create the opening  2380 . Further, because the stone cast may contain multiple replicas of healing abutments  1002 , the robot  2300  may be required to create multiple openings  2380 , each of which uses multiple tools from the pallet  2340 . The use of multiple tools may require a calibration by the calibration system  2360  ( FIG. 23 ) prior to the use of each tool. 
       FIG. 26  illustrates the movement of the robot  2300  to grip an implant analog holder  2344  from the pallet  2340  by use of the tool holder  2314  for placement of the implant analog  2386 . Once the opening  2380  has been completed, the operator will remove all remaining particles and debris from the drilling process from the stone cast  1000 . An adhesive is placed within the opening  2380  and, optionally, also placed (e.g., manually brushed) on the terminal end of the implant analog  2386 . Alternatively, an adhesive activator agent is placed on the implant analog  2386  to accelerate the curing process. It should be understood, however, that the work station for the robot  2300  can have bins of adhesive (and activator agents) such that the robot  2300  “dips” the end of the implant analog  2386  into one or more of these bins without manual operator intervention. Further, the robot  2300  may have an adhesive applicator tool in the pallet  2340  that is used to automatically place the adhesive (and possibly the ideal amount of the adhesive) in the opening  2380 . 
     After calibrating the location of the implant analog  2386  with the calibration system  2360  ( FIG. 23 ), the robot  2300  then moves the implant analog holder  2344  in such a manner so as to place the implant analog  2386  at the bottom of the opening  2380 . In doing so, the orientation of the anti-rotational feature of the implant analog  2386  is critical such that it matches the orientation of the anti-rotational feature of the implant in the patient&#39;s mouth (i.e., all six degrees of freedom are constrained in the same manner as the implant that is located in the patient&#39;s mouth). When the robot  2300  has finished placement of the implant analog  2386  within the opening  2380 , an energy source (e.g., UV light source) is used to quickly cure the adhesive such that the implant analog  2386  is physically constrained and attached to the stone model  1000  within the opening  2380 . Preferably, the adhesive is a UV-curable adhesive. 
     Once the adhesive has cured, the robot  2300  commands the gripping mechanism of the tool holder  2314  to release the implant analog holder  2384 . The implant analog holder  2344  is held to the implant analog  2386  through a long screw. Thus, the operator removes the long screw such that the implant analog  2386  remains by itself within the opening  2380  (attached via the adhesive), as is shown in  FIG. 27 . In particular, the implant analog  2386  and its threaded bore  2390  and anti-rotational feature  2392 , are located at a specific position and orientation within the opening  2380 . It should be understood that the robot  2300  could also include the necessary tools (e.g. screwdriver tip) in the pallet  2350  to release the implant analog holder  2344  from the implant analog  2386  so that no operator intervention is required. 
       FIG. 28  illustrates a flowchart of the entire process that is used to create a custom abutment and the final restorative components that fit upon the custom abutment. At step  2502 , a patient is fitted with a dental implant and an associated healing abutment, like those shown in  FIGS. 1-7 and 9 . At step  2504 , an impression of the patient&#39;s mouth is taken with the healing abutment(s) installed on the implant. At step  2506 , a stone cast (e.g., the stone cast  1000 ) of the patient&#39;s mouth is developed from the impression of the patient&#39;s mouth. The stone cast would include a stone replica of the healing abutment(s) which provides information regarding the underlying dental implant as well as the gingival opening created by the healing abutment(s). The development of the stone cast may also include the development of a stone cast of the opposing (upper or lower) teeth, which are then placed in an articulator device, as is commonly known, to locate the stone cast relative to the opposing upper or lower set of dentition. 
     At step  2508 , the stone cast is scanned so as to produce a virtual model of the stone cast. This scanning step may also include the scanning of the cast of the opposing upper or lower dentition to constrain the height of the eventual custom abutment that is designed and manufactured. The opposing cast scan is articulated relative to the initial cast scan. The articulation can be achieved through various methods. For example, the articulation axis from the articulator used to articulate the physical casts can be stored in the computer (with respect to a common calibration standard used with the scanner and articulator) such that the opposing cast can be articulated correctly. Another example is the use of the “virtual articulation” software module available in the 3Shape Dental Designer software (3 Shape A/S, Copenhagen, Denmark). This allows a set of casts to be articulated in the computer by taking an additional scan in which the casts are positioned in the articulated condition. The software uses a shape-matching algorithm to articulate the opposing cast scan relative to the initial cast scan by referencing geometry from all three scans. 
     At step  2510 , the scanned data of the stone cast is interpreted. Further, using the marker system associated with the set of healing abutments, a virtual healing abutment that matches the scanned data of the stone replica of the healing abutments is aligned with the scanned data such that the exact location, size, and orientation of the entire healing abutment (and, thus, the underlying dental implant) is known. For example, the operator may have a library of possible healing abutments and the one that matches the size and markers at the top of the scanned healing abutment is selected to be aligned on the scanned healing abutment. Once the location and orientation of the underlying dental implant is known, the operator preferably manipulates the model to produce a 3-D CAD model of only the specific area containing the stone replica of the healing abutment(s), as is shown in  FIG. 20 or 22 , to decrease the amount of data required for the process. 
     Information resulting from step  2510  is then used for two purposes. First, it is used within step  2512  to design a virtual custom abutment (e.g., custom abutment  1604 ) with the use of the 3-D CAD model. The data is ultimately transferred to a milling machine to manufacture the actual custom abutment. And second, the information from step  2510  can also be sent to a robot (such as the robot  2100  in  FIG. 21  or the robot  2300  in  FIG. 23 ) at step  2514  to modify the stone cast that was developed in step  2506 . As described above, this modification of the stone cast may include the development of a contoured opening in the stone cast in the area that was previously occupied by a stone replica of the healing abutment. Further, the modification may also include the placement of the implant analog, which as described above, can be accomplished by use of the same robot. In summary, step  2514  entails the methodology and processes that are generally discussed with reference to  FIGS. 19-27 . 
     At step  2516 , the custom abutment that was manufactured in step  2512  can be placed on the modified stone cast created in step  2514 . In doing so, the final restorative component(s) (e.g., porcelain tooth-shaped material to be cemented to the custom abutment) can be created on the custom abutment, often by a dental laboratory. The development of the final restorative component(s) take into account the adjacent teeth in the modified stone cast as well as the contour of the opening in the stone cast that leads to the implant analog. At step  2518 , the custom abutment and the final restorative component(s) are then sent to the clinician who installs the custom abutment and mating restorative component(s) onto the dental implant. 
     As an alternate methodology to that which is shown in  FIG. 28 , at step  2502 , an impression can be taken of the patient&#39;s mouth prior to installation of the dental implants and the associated healing abutments (e,g., the very first visit to the clinician at which the dental implant installation is recommended to the patient). The stone cast from that impression is then scanned for later usage. After a subsequent visit in which the dental implant is installed along with the associated healing abutment, a scan of the patient&#39;s mouth with the associated healing abutment is created. That scanned data of the patient&#39;s mouth is then merged, via a shape-matching algorithm (e.g., a scanner and associated software from 3Shape A/S of Copenhagen, Denmark), with the initial scan of the stone cast. The result is that there is electronic data that is analogous to the result of scanning the stone cast in step  2508  of  FIG. 28 . In this alternative embodiment, step  2510  to  2518  would continue as discussed above with the primary difference being that the stone cast modified by the robot  2300  would lack the stone replica of the healing abutment that was described above with respect to  FIGS. 23-26  since the stone replica was taken prior to installation of the healing abutment. 
     As a further option to the alternative procedure in the preceding paragraph, instead of a scan of the patient&#39;s mouth with the healing abutment in place, an abutment-level impression (as in step  2504 ) can be taken after the healing abutment and implant are installed and the impression (or resultant stone cast) could be scanned by a lab. This scanned data could again be merged with the data set from the initial stone cast. In either of these two options, the primary advantage is that overall process can be expedited. This is due to the fact that the entity that modifies the stone model already has the stone model in hand and can begin altering the stone model with the robot once it receives the electronic transfer of the scan data from the (i) scan of the patient&#39;s mouth with the healing abutment (as described in the preceding paragraph), or (ii) the scan of the impression of the patient&#39;s mouth with the healing abutment (as described in this paragraph). 
     In a further alternative to either of the previous paragraphs, instead of receiving a stone cast of the patient&#39;s mouth prior to installation of the dental implant and healing abutment, the entity involved with the modification of the stone model receives a CT scan of the patient&#39;s mouth. In doing so, the CT scan allows that entity to build a physical stone model of the patient&#39;s mouth through a rapid prototyping technique. In other words, in this further alternative, there is no need to make a stone model or transfer a stone model created by an impression of the patient&#39;s mouth. The CT scan and the subsequent transfer of that scanned data allows for the creation of a model of the patient&#39;s mouth through a rapid prototyping technique. 
     In yet another alternative, after the patient has been fitted with the implant and the associated healing abutment, the patient receives a CT scan. That scanned data is then transferred to the entity involved with the modification is stone model. That entity then uses the data from the CT scan to create a rapid prototyping, which will ultimately serve as the stone model  1000  described above. Further, that same CT scan data can be used to design manufacture the custom abutment. In other words, in such a methodology using a CT scan of the patient&#39;s mouth that includes the healing abutment, once a rapid prototype is built from that scanned data, the methodology continues from step  2510  in  FIG. 28 . 
     In a further alternative, no healing abutments with informational markers are necessary, as will be described with reference to  FIG. 29 . At step  2602 , the CT scan of the patient&#39;s mouth is taken prior to installation of the implants (or any surgery). At step  2604 , the CT scan data is then used to develop a surgical plan for the installation of the dental implants in the patient&#39;s mouth, which includes virtual implants “virtually” installed at certain locations of the patient&#39;s mouth. From the surgical plan, at step  2606 , a surgical guide is developed that fits precisely over the patient&#39;s gingival tissue and/or dentition. The surgical guide includes holes through which tissue punches and drill bits can be inserted to create an osteotomy. Further, the dental implants can be installed at a precise location and orientation by insertion through the holes of the surgical guide that is precisely fit within the patient&#39;s mouth. As such, the CT scan allows for the virtual installation of the dental implant pursuant to the surgical plan, and the building of a surgical guide that will allow the clinician to actually install the properly sized dental implant at the location and orientation dictated by the surgical plan. One example of the use of a CT-scan to develop a surgical plan involving a surgical guide is disclosed in U.S. Patent Application Ser. No. 61/003,407, filed Nov. 16, 2007, and described in Biomet 3i&#39;s Navigator™ system product literature, “Navigator™ System For CT Guided Surgery Manual” that is publicly available, both of which are commonly owned and herein incorporated by reference in their entireties. Another example of the use of a CT-scan to develop a surgical plan is disclosed in U.S. Patent Publication No. 2006/0093988, which is herein incorporated by reference in its entirety. 
     Once the CT scan is created and the surgical plan with the associated virtual implants is known, at step  2608 , the CT scan data and virtual implant data can be used to develop a cast, such as a rapid prototype model, that will ultimately replicate the conditions in the patient&#39;s mouth after the surgical plan is effectuated. As such, the CT scan data and the surgical plan data can be used to develop a rapid prototype model of the patient&#39;s mouth. Further, this data can also be used to install implant analogs at locations within that rapid prototype model that correspond to locations of the virtual implants dictated by the surgical plan. For example, the robot  2300  can be used to install implant analogs in the rapid prototype model as described above with reference to  FIGS. 23-27 . Or, the rapid prototype manufacturing method can directly incorporate an implant analog structure without the use of the robot  2300 , as described in some of the previous embodiments lacking a robot. Hence, the model of the patient&#39;s mouth with the implant analogs can be developed before the patient has undergone any surgery whatsoever (i.e., without the use of the previously disclosed healing abutments having the information markers). At step  2610 , the model or cast is then used to develop a custom abutment (or a bar for attachment to multiple implants and for receiving a denture) and the associated restorative components. 
     Once the surgical guide from step  2606  is completed, it can be transferred to the clinician for use in the patient at step  2612 . Thus, the patient receives dental implants installed in accordance with the dental plan (i.e., the proper size implants, their orientation, and their location are finalized in the patient in accordance to virtual implants of the surgical plan). Further, the custom abutment and restorative components (e.g., porcelain tooth-shaped material, associated screw, etc) are transferred to the clinician and can be installed on the dental implants at step  2614 . Consequently, under the methodology of  FIG. 29 , it is possible for custom abutment and restorative components to be installed in the patient on the same day that he or she receives the dental implants installed via the surgical guide. 
     While the preceding embodiments have been described for creating a final prosthesis, it is contemplated that the process may be used to create a temporary prosthesis as well. 
     While the preceding embodiments have been described by scanning a cast of a patient&#39;s mouth, it is also contemplated that an intra-oral scan, a CT scan, or other known type of medical scan, may be taken to generate data used for a 3-D CAD model. 
     While the preceding embodiments have been described using a healing abutment containing a variety of markings, it is further contemplated that a scanning abutment may be placed into a stone model before a scan is performed. According to such an embodiment, a first stone model of a patient&#39;s mouth would be made, and a portion of the first stone model corresponding to a healing abutment would be removed and replaced with a scanning abutment containing a variety of markings as previously described. A scan would then be performed of the first stone model containing the scanning abutment, and a 3-D CAD model of the patient&#39;s mouth would be created. The 3-D CAD model would then be used as previously described. 
     While particular embodiments and applications of the present invention have been illustrated and described, it is to be understood that the invention is not limited to the precise construction and compositions disclosed herein and that various modifications, changes, and variations may be apparent from the foregoing descriptions without departing from the spirit and scope of the invention as defined in the appended claims.