Patent Publication Number: US-2018049706-A1

Title: Radiographic Guide and Surgical Stent/Guide for Dental Implants

Description:
This application is a divisional of U.S. patent application Ser. No. 15/131,162, filed Apr. 18, 2016, now U.S. Pat. No. 9,770,218, issued Sep. 26, 2017, which claims the benefit of U.S. Provisional Patent Application Ser. No. 62/150,058, filed Apr. 20, 2015, the entireties of which is incorporated by reference herein. 
     This application is related to U.S. patent application Ser. No. 11/197,743, filed Aug. 3, 2005, which is incorporated by reference herein. 
    
    
     FIELD OF THE INVENTION 
     Embodiments of the present invention are generally related to radiographic and surgical guides used to identify an ideal location for a dental implant. In one embodiment, a provisional implant crown is used to fabricate the radiographic guide. In another embodiment, a provisional crown is used to fabricate a surgical stent for implant placement. In another embodiment, a provisional crown is used to facilitate the location of implant placement. 
     BACKGROUND OF THE INVENTION 
     Temporary and permanent crowns are anchored to a patient&#39;s maxilla or jaw by way of dental implant. The current method of placing a dental implant is time consuming, complex, and expensive. More specifically, current implant installation begins with planning from the implant location up to the desired crown location. That is, the dentist or oral surgeon first installs the implant at the tooth extraction site; ideally where ideal bone mass is present. After the implant is installed, an abutment, which connects the crown to the implant, and the crown are added to the implant. Often, the abutment and/or crown may have to be modified to be interconnected to the implant, because the best implant location with respect to the desired crown location is not feasible due to bone availability, implant angulation, and/or issues associated with alignment with, or placement next to, adjacent teeth. 
     The first step in identifying the ideal implant location is accomplished by assessing bone quantity, density, etc., which is done by obtaining radiographic measurements of the patient&#39;s mouth. To ensure the radiographic images correctly characterize the patient&#39;s physiology, a radiographic guide must be made. A common process of radiographic guide fabrication is generally comprised of first forming a cast of the patient&#39;s dental arch that includes at least one void (e.g., area associated with the extracted tooth or teeth) that is to be filled with a dental implant and permanent crown. A denture tooth is adjusted to fit the space and wax, or other adhering substance, is subsequently used to secure the denture tooth within the void of the dental cast. Alternatively, a custom made diagnostic tooth fills the void of the cast. 
     One such method involves using putty to make an impression of the denture tooth or custom made diagnostic tooth and the surrounding portions of the dental arch cast. The putty is then removed to reveal an impression of the denture tooth or custom made diagnostic tooth. The putty is trimmed to remove the impressions of the surrounding teeth. The denture tooth or custom made diagnostic tooth is then removed from the cast. A separating agent is then applied to the dental cast, and the putty impression of the denture tooth or custom made diagnostic tooth is filled with orthodontic resin (acrylic) to form a replica of the original denture tooth or custom made diagnostic tooth. The putty impression with the orthodontic resin is placed over the void and allowed to cure. The cured acrylic tooth that represents the lost tooth is removed from the putty impression and the dental arch cast and trimmed to remove excess resin. 
     Next, undercuts in the dental arch cast are filled with wax and the trimmed acrylic tooth that represents the lost tooth is placed back into the previously-formed putty impression. In addition, an orthodontic acrylic resin is mixed and a monomer is added to the fabricated acrylic tooth. The acrylic tooth, which is still in the putty, is placed back on the dental arch cast at the void site. The previously mixed orthodontic acrylic resin, which is still yet to be fully cured, is placed over the dental arch cast. The partially-cured orthodontic acrylic resin is molded over the “roof” (assuming a tooth associated with the patient&#39;s maxilla requires replacement) of the dental cast and the cast teeth adjacent to the putty-encapsulated acrylic tooth, thereby bonding the acrylic tooth to the orthodontic acrylic resin. Excess resin is trimmed and removed from the portion of the “roof” and from portions of the dental arch cast outer surface. The combination of orthodontic acrylic resin, putty, acrylic tooth, and dental arch cast is secured and the orthodontic acrylic resin is allowed to cure. 
     After the orthodontic acrylic resin is cured, the putty is removed and the acrylic tooth remains associated with the cured resin. The radiographic guide comprises the cured orthodontic acrylic resin removed from the dental arch cast. That is, the radiographic guide comprises an impression of the existing teeth with an interconnected acrylic tooth. Gutta percha markers or other radio-opaque markers, which are familiar to those of ordinary skill in the art, are then added to the radiographic guide. The radiographic guide is placed in the patient&#39;s mouth wherein the representation of the denture tooth or custom made diagnostic tooth is placed in the void associated with the lost tooth, and various radiographic images of the patient&#39;s mouth are obtained. 
     A surgical guide, which may be a copy of the radiographic guide, is then fabricated. Information gleaned from the radiographic images helps to define holes in the surgical guide that help the oral surgeon locate and drill a dental implant into the patient&#39;s mouth. Again, as one of ordinary skill the art will appreciate, this process is time consuming and complex. 
     Thus it is a long felt need in the field of dentistry and oral surgery to provide a more efficient and cost-effective way to create a radiographic and surgical guide. The following disclosure describes an improved method of fabricating a radiographic guide that can also be used as a surgical guide. The contemplated radiographic guide includes a provisional implant crown, or an impression of a provisional implant crown closely matched to a provisional implant crown that will be interconnected to an implant abutment after the implant surgery is completed. 
     SUMMARY OF THE INVENTION 
     It is one aspect of embodiments of the present invention to provide a method of locating a dental implant using a “top-down” approach. As outlined above, dental implants are currently placed in a patient&#39;s mouth at an ideal location with respect to bone mass, without concern for abutment location and the ultimate location of the provisional crown that will be interconnected to the implant. Thus the abutment and crown often need to be modified to be interconnected to the implant, and to accommodate the adjacent teeth, which is a complex and labor intensive process. Newer technologies, such as bone grafts, tissue grafts, implant coatings, abutment designs, etc., allow implant placement to be planned “crown-down.” That is, the oral surgeon places the implant at a location that coincides with an ideal crown position, so long as sufficient bone mass is available or can be grafted at the implant site. This aspect of embodiments of the present invention can be achieved by the processes described herein. 
     More specifically, embodiments of the present invention are directed to a method of fabricating a radiographic guide that is 1) less labor intensive and complex than the prior art process; 2) does not use a denture tooth or custom made diagnostic tooth and the associated putty described above; and 3) is based on the shape of a provisional dental implant crown. Radiographic guides of one embodiment of the present invention are made by first fabricating a dental arch cast using prior art methods. Wax is then used to secure a provisional dental implant crown, which is not a denture tooth or custom made diagnostic tooth, to the dental arch at the site of the lost tooth or teeth. The provisional dental implant crown may be similar to those described in applicant&#39;s U.S. Patent Application Publication No. 20070031792, U.S. Patent Application Publication No. 20070031793, and U.S. Pat. Nos. D733,886, D751,203, D734,465, and D752,752, which are incorporated by reference herein. The provisional dental implant crown may have a symmetrical profile with a hole therethrough. Alternatively, a cavity extending from a lower surface of the provisional dental implant crown upwardly to a point below an upper surface of the provisional dental crown, i.e., a tapped hole, may be provided. The provisional crown may also be transparent or semi-transparent to allow the clinician to see through the crown while placing the implant. Next, undercuts in the dental arch cast are filled with wax as in the prior art method. Partially-cured orthodontic acrylic resin is placed over the dental arch cast and the provisional dental implant crown, and any excess orthodontic acrylic resin is trimmed. The radiographic guide, which comprises an impression of existing teeth made of cured orthodontic acrylic resin and an integrated provisional dental implant crown, is removed from the dental arch cast. Gutta percha markers, or other radio-opaque markers, are then added to the radiographic guide. In addition, a radio-opaque material (ex. gutta percha, barium sulfate, etc.) is used to coat the wall of the hole or tapped hole of the provisional implant crown. The radiographic guide is then placed in the patient&#39;s mouth wherein the provisional implant crown is located in the void defined by the lost tooth. Radiographic images of the patient&#39;s mouth are then obtained. 
     In the radiographic images, the hole or tapped hole of the provisional crown, previously filled with the radio-opaque material, will directly correspond to the straight line axis of the implant body to be placed. Information from the imaging also provides the angulation of the implant body that is to be attached to the patient&#39;s maxilla or jaw, and spatial relationship of the implant body, abutment and provisional crown positions before surgery commences. 
     The radiographic guide of one embodiment can also be used as a surgical guide, which will replace the need to make a separate surgical guide. That is, if the radiographic images show the bone density and bone quantity is acceptable, the hole provided by the radiographic guide can be used as a drilling template. If, however, the planned implant location associated with the hole is not ideal, the oral surgeon may create a new surgical guide from the radiographic guide, which may comprise repeating the radiographic guide fabrication process described above or utilizing a computer software CAD/CAM program to fabricate the surgical guide. For example, a different or modified provisional dental implant crown may be used to create a new radiographic guide. 
     After drilling is complete and the implant and abutment are placed in the patient&#39;s mouth, a provisional dental implant crown that matches that integrated into the radiographic guide is placed. Because the provisional dental implant crown matches the dimensions of the radiographic guide, it should fit perfectly in the patient&#39;s mouth and interconnect to the abutment. 
     The denture tooth or custom made diagnostic tooth used in the prior art methods does not include a prefabricated, precisely located hole that is of a predetermined tolerance. The dentist or surgeon must modify the denture tooth or custom made diagnostic tooth to create a hole, which will rarely coincide exactly with the axis of the yet-to-be secured implant or abutment. It follows that surgical guides made with modified denture teeth or custom made diagnostic teeth will not be precise. A misaligned hole in the denture tooth or custom diagnostic tooth will likely not fit correctly with the patient&#39;s anatomical topography and more specifically in respect to the surrounding teeth or bone where the implant will be placed. Consequently, when the denture tooth or custom made diagnostic tooth is interconnected to the implant via an abutment, it will have to be modified to be accepted by the abutment and dental implant. A provisional crown made from a denture tooth or custom made diagnostic tooth will not fit the base of the abutment nor will the provisional crown be of the correct vertical dimension, so it will require several modifications to be used as a provisional crown. It is also possible that it cannot be accepted by the implant or abutment and another crown must be custom made to be used as a temporary crown. To address this issue of misaligned implants, angled or non-standard abutments must be employed, and/or the provisional crown must be modified or remade—factors that increase patient “chair time” and cost. Alternatively, oral surgeons must use a software program that allows them to digitally “place an implant” and then have a surgical guide fabricated via CAD/CAM methods. Because digitally placing an implant includes a degree of guess work and “feel,” this method suffers some of the same drawbacks experienced with using modified denture teeth or custom made diagnostic teeth. 
     One of ordinary skill in the art will appreciate that the contemplated hole in the provisional crown provides information during radiographic studies and during surgery for the surgical stent/guide. The prefabricated hole in the provisional crown allows a dentist or surgeon to accurately assess the future implant&#39;s placement and angulation during the radiographic studies, because the orientation of the future implant will coincide with the provisional crown&#39;s hole axis. The axis of the provisional crown may also coincide with the axis of the abutment. 
     The following table provides a comparison of the traditional method described above to embodiments of the present invention. 
     
       
         
           
               
               
               
             
               
                   
               
               
                   
                 Traditional 
                 Embodiments of the 
               
               
                 Feature 
                 method 
                 present invention 
               
               
                   
               
             
            
               
                 Initial impression of the 
                 Required 
                 Required 
               
               
                 patient&#39;s mouth 
               
               
                 Fabricating a dental cast from 
                 Required 
                 Required 
               
               
                 the impression 
               
               
                 Type of “tooth” incorporated 
                 Denture tooth or 
                 Provisional crown 
               
               
                 into the gaps of the missing 
                 custom diagnostic 
               
               
                 teeth 
                 waxed tooth 
               
               
                 Take an impression of the 
                 Required 
                 Not required 
               
               
                 dental cast containing the 
               
               
                 denture tooth 
               
               
                 Fabricating a replica tooth in 
                 Required 
                 Not required 
               
               
                 orthodontic resin from the 
               
               
                 impression 
               
               
                 Application of partially-cured 
                 Required 
                 Required 
               
               
                 orthodontic acrylic resin, or 
               
               
                 other material as is known in 
               
               
                 the art, over the cast and 
               
               
                 replacement tooth 
               
               
                 Fabricate a hole through the 
                 Required 
                 Not required 
               
               
                 tooth along the anticipated 
               
               
                 implant axis 
               
               
                 Application of radio-opaque 
                 Required 
                 Required 
               
               
                 material to the guide 
               
               
                 Fabrication of a new surgical 
                 Required 
                 Not required - can be 
               
               
                 guide 
                   
                 converted from the 
               
               
                   
                   
                 radiographic guide 
               
               
                   
               
            
           
         
       
     
     It is one aspect of embodiments of the present invention to provide a method of fabricating a radiographic guide, comprising: taking an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; using wax to interconnect a provisional implant crown to the cast, the provisional implant crown being associated with the at least one void; applying partially-cured orthodontic acrylic resin over the cast and the provisional implant crown; allowing the orthodontic acrylic resin to cure, which causes the provisional implant crown to bond with the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and interconnected provisional implant crown from the cast. 
     It is another aspect of embodiments of the present invention to provide a method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast. 
     It is yet another aspect of embodiments of the present invention to provide a radiographic guide, comprising: a shaped member having a plurality of recesses adapted for receipt of patient&#39;s teeth, the shaped member having an outer profile that generally corresponds to the shape of at least one of the patient&#39;s teeth; a provisional dental implant crown positioned in one of the plurality of recesses, the provisional dental implant comprises a hole. 
     It is another aspect of embodiments of the present invention to provide a method of placing a provisional implant crown into a patient&#39;s maxilla or jaw, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including a void that corresponds with an extracted tooth; associating a tooth representation with void, the tooth representation having a hole; applying orthodontic acrylic resin over the cast and the tooth representation; curing the orthodontic acrylic resin; removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast; placing the radiographic guide into the patient&#39;s mouth wherein the tooth representation is associated with the site of the extracted tooth; obtaining a radiographic image of the radiographic guide; analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant; using the radiographic guide as a surgical guide, wherein the hole is used to guide surgical tools that prepare the patient&#39;s maxilla or jaw for receipt of an implant; interconnecting the implant to the patient&#39;s maxilla or jaw; interconnecting an abutment to the implant; and interconnecting the provisional implant crown to the abutment. 
     Further aspects of the present invention are provided in the following embodiments: 
     A method of fabricating a radiographic guide, comprising: taking an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; using wax to interconnect a provisional implant crown to the cast, the provisional implant crown being associated with the at least one void; applying partially-cured orthodontic acrylic resin over the cast and the provisional implant crown; allowing the orthodontic acrylic resin to cure, which causes the provisional implant crown to bond with the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and interconnected provisional implant crown from the cast, wherein the provisional implant crown includes a hole therethrough. 
     A method of fabricating a radiographic guide, comprising: taking an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; using wax to interconnect a provisional implant crown to the cast, the provisional implant crown being associated with the at least one void; applying partially-cured orthodontic acrylic resin over the cast and the provisional implant crown; allowing the orthodontic acrylic resin to cure, which causes the provisional implant crown to bond with the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and interconnected provisional implant crown from the cast, wherein the provisional implant crown includes a hole therethrough, further comprising at least one of coating a surface of the hole with a radio-opaque material, and adding radiographic markers to the radiographic guide. 
     A method of fabricating a radiographic guide, comprising: taking an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; using wax to interconnect a provisional implant crown to the cast, the provisional implant crown being associated with the at least one void; applying partially-cured orthodontic acrylic resin over the cast and the provisional implant crown; allowing the orthodontic acrylic resin to cure, which causes the provisional implant crown to bond with the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and interconnected provisional implant crown from the cast, further comprising adding a separating agent to the cast, but not the provisional implant crown. 
     A method of fabricating a radiographic guide, comprising: taking an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; using wax to interconnect a provisional implant crown to the cast, the provisional implant crown being associated with the at least one void; applying partially-cured orthodontic acrylic resin over the cast and the provisional implant crown; allowing the orthodontic acrylic resin to cure, which causes the provisional implant crown to bond with the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and interconnected provisional implant crown from the cast, further comprising obtaining a radiographic image of the radiographic guide positioned in the patient&#39;s mouth, and analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant. 
     A method of fabricating a radiographic guide, comprising: taking an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; using wax to interconnect a provisional implant crown to the cast, the provisional implant crown being associated with the at least one void; applying partially-cured orthodontic acrylic resin over the cast and the provisional implant crown; allowing the orthodontic acrylic resin to cure, which causes the provisional implant crown to bond with the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and interconnected provisional implant crown from the cast, further comprising obtaining a radiographic image of the radiographic guide positioned in the patient&#39;s mouth, and analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant, further comprising removing the radiographic guide from the patient&#39;s mouth, removing the radio-opaque material from the hole, creating a new hole in the provisional implant crown, and coating the new hole with a radio-opaque material, placing the radiographic guide into the patient&#39;s mouth, and obtaining a second radiographic image, and analyzing the second image to assess if the new hole is positioned and aligned with the area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant. 
     A method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast, wherein the at least one tooth representation is a provisional implant crown that substantially matches the shape of a provisional implant crown that will be interconnected to a dental implant via an abutment. 
     A method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast, wherein the at least one tooth representation is bonded to the cured orthodontic resin. 
     A method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast, wherein the at least one tooth representation is selectively interconnected to the cured orthodontic resin. 
     A method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast, wherein the hole does not extend through the at least one tooth representation. 
     A method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast, further comprising at least one of coating the hole with a radio-opaque material, and adding radiographic markers to the radiographic guide. 
     A method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast, further comprising obtaining a radiographic image of the radiographic guide positioned in the patient&#39;s mouth, and analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant. 
     A method of fabricating a radiographic guide that can be used as a surgical guide, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including at least one void; associating at least one tooth representation with the at least one void, the at least one tooth representation having a hole; applying orthodontic acrylic resin over the cast and the at least one tooth representation; curing the orthodontic acrylic resin; and removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast, further comprising obtaining a radiographic image of the radiographic guide positioned in the patient&#39;s mouth, and analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant, further comprising removing the radiographic guide from the patient&#39;s mouth, removing the radio-opaque material from the hole, creating a new hole in the provisional implant crown, and coating the new hole with a radio-opaque material, placing the radiographic guide into the patient&#39;s mouth, and obtaining a second radiographic image of the radiographic guide, and analyzing the second image to assess if the new hole is positioned and aligned with the area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant. 
     A radiographic guide, comprising: a shaped member having a plurality of recesses adapted for receipt of patient&#39;s teeth, the shaped member having an outer profile that generally corresponds to the shape of at least one of the patient&#39;s teeth; a provisional dental implant crown positioned in one of the plurality of recesses, the provisional dental implant comprises a hole, wherein the provisional dental implant does not correspond to the outer shape of the patient&#39;s extracted tooth. 
     A radiographic guide, comprising: a shaped member having a plurality of recesses adapted for receipt of patient&#39;s teeth, the shaped member having an outer profile that generally corresponds to the shape of at least one of the patient&#39;s teeth; a provisional dental implant crown positioned in one of the plurality of recesses, the provisional dental implant comprises a hole, wherein the shaped member is made of acrylic that includes radio-opaque areas. 
     A radiographic guide, comprising: a shaped member having a plurality of recesses adapted for receipt of patient&#39;s teeth, the shaped member having an outer profile that generally corresponds to the shape of at least one of the patient&#39;s teeth; a provisional dental implant crown positioned in one of the plurality of recesses, the provisional dental implant comprises a hole, wherein the provisional dental implant crown is selectively interconnected to the shaped member. 
     A method of placing a provisional implant crown into a patient&#39;s maxilla or jaw, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including a void that corresponds with an extracted tooth; associating a tooth representation with void, the tooth representation having a hole; applying orthodontic acrylic resin over the cast and the tooth representation; curing the orthodontic acrylic resin; removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast; placing the radiographic guide into the patient&#39;s mouth wherein the tooth representation is associated with the site of the extracted tooth; obtaining a radiographic image of the radiographic guide; analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant; using the radiographic guide as a surgical guide, wherein the hole is used to guide surgical tools that prepare the patient&#39;s maxilla or jaw for receipt of an implant; interconnecting the implant to the patient&#39;s maxilla or jaw; interconnecting an abutment to the implant; and interconnecting the provisional implant crown to the abutment, wherein the tooth representation has a shape substantially similar to that of the provisional implant crown. 
     A method of placing a provisional implant crown into a patient&#39;s maxilla or jaw, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including a void that corresponds with an extracted tooth; associating a tooth representation with void, the tooth representation having a hole; applying orthodontic acrylic resin over the cast and the tooth representation; curing the orthodontic acrylic resin; removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast; placing the radiographic guide into the patient&#39;s mouth wherein the tooth representation is associated with the site of the extracted tooth; obtaining a radiographic image of the radiographic guide; analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant; using the radiographic guide as a surgical guide, wherein the hole is used to guide surgical tools that prepare the patient&#39;s maxilla or jaw for receipt of an implant; interconnecting the implant to the patient&#39;s maxilla or jaw; interconnecting an abutment to the implant; and interconnecting the provisional implant crown to the abutment, wherein if after analyzing, the proposed implant placement is not ideal, removing the radiographic guide from the patient&#39;s mouth, removing the radio-opaque material from the hole, creating a new hole in the provisional implant crown, and coating the new hole with a radio-opaque material, placing the radiographic guide into the patient&#39;s mouth, and obtaining a second radiographic image of the radiographic guide, and analyzing the second image to assess if the new hole is positioned and aligned with the area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant. 
     A method of placing a provisional implant crown into a patient&#39;s maxilla or jaw, comprising: obtaining an impression of a patient&#39;s dental arch; using the impression to create a cast of a patient&#39;s dental arch, the cast including a void that corresponds with an extracted tooth; associating a tooth representation with void, the tooth representation having a hole; applying orthodontic acrylic resin over the cast and the tooth representation; curing the orthodontic acrylic resin; removing the cured orthodontic acrylic resin and the at least one tooth representation from the cast; placing the radiographic guide into the patient&#39;s mouth wherein the tooth representation is associated with the site of the extracted tooth; obtaining a radiographic image of the radiographic guide; analyzing the image to assess if the hole is positioned and aligned with an area of the patient&#39;s maxilla or jaw that is conducive for accepting and securing a dental implant; using the radiographic guide as a surgical guide, wherein the hole is used to guide surgical tools that prepare the patient&#39;s maxilla or jaw for receipt of an implant; interconnecting the implant to the patient&#39;s maxilla or jaw; interconnecting an abutment to the implant; and interconnecting the provisional implant crown to the abutment, further comprising at least one of coating the hole with a radio-opaque material, and adding radiographic markers to the radiographic guide. 
     These and other advantages will be apparent from the disclosure of the invention(s) contained herein. The above-described embodiments, objectives, and configurations are neither complete nor exhaustive. As will be appreciated, other embodiments of the invention are possible using, alone or in combination, one or more of the features set forth above or described below. Further, the Summary of the Invention is neither intended nor should it be construed as being representative of the full extent and scope of the present invention. Moreover, references made herein to “the present invention” or aspects thereof should be understood to mean certain embodiments of the present invention and should not necessarily be construed as limiting all embodiments to a particular description. The present invention is set forth in various levels of detail in the Summary of the Invention as well as in the attached drawings and the Detailed Description of the Invention and no limitation as to the scope of the present invention is intended by either the inclusion or non-inclusion of elements, components, etc. in this Summary of the Invention. Additional aspects of the present invention will become more readily apparent from the Detail Description, particularly when taken together with the drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and together with the general description of the invention given above and the detailed description of the drawings given below, serve to explain the principles of these inventions. 
         FIG. 1  is a provisional dental crown used in one embodiment of the present invention; 
         FIG. 2  is a cross-sectional view of  FIG. 1 ; 
         FIG. 3  is a perspective view of a dental arch cast; 
         FIG. 4  is a perspective view of a dental arch cast with an interconnected provisional dental crown; 
         FIG. 5  is a top plan view of the dental arch cast and provisional dental crown with a layer of orthodontic acrylic resin applied thereto; 
         FIG. 6  is a side elevation view of a radiographic guide; and 
         FIG. 7  is a top plan view of the radiographic guide shown in  FIG. 6 . 
     
    
    
     To assist in the understanding of one embodiment of the present invention the following list of components and associated numbering found in the drawings is provided herein: 
     
       
         
           
               
               
             
               
                   
               
               
                 # 
                 Component 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
            
               
                 2 
                 Provisional dental crown 
               
               
                 6 
                 Outer surface 
               
               
                 10 
                 Conical portion 
               
               
                 14 
                 Hole 
               
               
                 18 
                 Radiographic guide 
               
               
                 22 
                 Dental arch cost 
               
               
                 26 
                 Tooth representation 
               
               
                 30 
                 Void 
               
               
                 34 
                 Wax 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
               
             
               
                   
               
               
                 # 
                 Component 
               
               
                   
               
             
            
               
                 38 
                 Orthodontic acrylic resin 
               
               
                 40 
                 Recess 
               
               
                 42 
                 Marker 
               
               
                 46 
                 Radio-opaque material 
               
               
                   
               
            
           
         
       
     
     It should be understood that the drawings are not necessarily to scale. In certain instances, details that are not necessary for an understanding of the invention or that render other details difficult to perceive may have been omitted. It should be understood, of course, that the invention is not necessarily limited to the particular embodiments illustrated herein. 
     DETAILED DESCRIPTION 
       FIGS. 1 and 2  show a provisional dental crown  2  that may be used with some of the processes described herein. The provisional dental crown  2  includes a symmetrical outer surface  6  that terminates in a conical or semi-conical portion  10  designed to interface with the base of an abutment and the patient&#39;s gum line. Those of ordinary skill in the art will appreciate that the shape of the provisional dental crown need not be symmetrical and can be made to any shape to fit the dentist&#39;s or oral surgeon&#39;s needs or to fit an abutment with a non-planar collar. The provisional dental crown includes a hole  14  that allows access to screws or fasteners that interconnect the abutment to the implant to be accessed. After the provisional dental crown is in placed on the abutment, the hole  14  is filled with a cotton pellet and a dental material such as composite, resin, or temporary filling material. When the dental implant is osseo-integrated into the bone and tissue healing is complete, the provisional dental crown  2  is removed and a permanent crown is attached to the existing abutment, or a new abutment may be placed using known techniques. Embodiments of the present invention contemplate using these types of provisional dental crowns to fabricate radiographic guides or surgical guides. 
       FIGS. 3-7  illustrate the process of fabricating a radiographic guide  18 , which may be used as a surgical guide of one embodiment of the present invention. Here, the provisional dental crown  2  is used instead of a denture tooth to fabricate the radiographic guide  18 . This process omits the need to make a cast of the denture tooth with putty as done in the process described above. In operation, a dental arch cast  22  is initially made of the patient&#39;s teeth. The dental arch cast  22  will include existing tooth representations  26  and voids  30  associated with missing teeth. Next, the provisional dental crown  2 , which may be the same shape as the provisional dental crown that will be placed in the patient&#39;s mouth after surgery, is affixed to the dental arch cast  22  using wax  34  (see  FIG. 4 ). 
     Next, as shown in  FIG. 5 , orthodontic acrylic resin  38 , or similar material, is added over the dental arch cast  22  and is used to create an impression of the existing tooth representations  26  and the provisional dental crown  2 . As one of ordinary skill in the art will appreciate, before the orthodontic acrylic resin  38  is applied to the dental arch cast  22 , a separating agent is applied such that once the orthodontic acrylic resin  38  cures it can be easily removed from the dental arch cast  22 . The separating agent is not added to the provisional crown so the acrylic resin will bond to the provisional crown. In other embodiments, the separating agent is applied to the provisional crown so it is not bonded to the acrylic resin. In this example, the provisional crown, or another crown of same or similar shape, is selectively interconnected to the radiographic and/or surgical guide. 
       FIGS. 6 and 7  show the radiographic guide  18  of one embodiment of the present invention that is made up of the cured orthodontic acrylic resin  38  removed from the dental arch cast. The orthodontic acrylic resin  38  is bonded to the provisional dental crown  2  and, thus, includes a member that corresponds with the void in the patient&#39;s mouth associated with the extracted tooth. The radiographic guide will also include recesses  40  that receive the patient&#39;s existing teeth. A plurality of markers  42  may be added to the radiographic guide  18 . Further, the hole  14  of the provisional dental crown can be filled with radio-opaque material. The hole  14  of the provisional crown directly correlates with the axis of the dental abutment and implant. Thus, by filling the hole  14  with a radio-opaque material, the radiographic images portray the exact location and angulation that the dental implant should be placed. This gives the oral surgeon information on quantity and quality of bone at the desired implant location. In operation, the radiographic guide  18  is placed in the patient&#39;s mouth wherein the provisional dental crown  2  will seat in the void associated with the missing tooth or teeth. Various radiographic images are then taken of the patient&#39;s mouth wherein the markers  42  and radio-opaque material  46  positioned in the provisional dental crown  2  will help the dentist and oral surgeon assess the viability of placing the implant. Accordingly, instead of starting bottom-up from the bone wherein the provisional dental crown is made by traditional methods, the implant is planned top-down wherein the provisional dental crown will define the implant location. If the radiographic tests indicate the predetermined location for the implant is not ideal, the location of the present provisional dental crown and associated hole can be altered in a new radiographic guide that can be made relatively quickly. If the implant location as defined by the radiographic guide is acceptable, the radiographic guide can be used as a surgical guide wherein the hole of the provisional dental crown or an added metal guide sleeve (placed into the hole of the provisional crown) is used to guide the oral surgeon&#39;s drill. 
     After the implant is placed, an abutment is interconnected. The abutment will accept a provisional dental crown of the same or similar shape as that used to create a radiographic guide or surgical stent. Once the patient&#39;s gum tissues and bone have healed, the provisional dental crown is removed and a suitable permanent crown is interconnected to the same abutment or a new abutment is used. 
     While various embodiments of the present invention have been described in detail, it is apparent that modifications and alterations of those embodiments will occur to those skilled in the art. However, it is to be expressly understood that such modifications and alterations are within the scope and spirit of the present invention, as set forth in the following claims. Further, the invention(s) described herein is capable of other embodiments and of being practiced or of being carried out in various ways. In addition, it is to be understood that the phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting. The use of “including,” “comprising,” or “having” and variations thereof herein is meant to encompass the items listed thereafter and equivalents thereof as well as additional items.