Abstract:
A bone plate locking cannula and drill guide assembly having a locking cannula detachably mountable onto screw-receiving apertures of a bone plate and a drill guide received within the locking cannula such that pilot holes are drilled through the apertures into bone at the proper angle to receive bone screws. The screw receiving apertures have a proximal bore of greater diameter than a distal bore, and the proximal bore is provided with internal threading to mate with external threading located on the distal end of the locking cannula. The bone screws are inserted through the locking cannula after removal of the drill guide and fastened into the bone to secure the bone plate in position without having to remove the locking cannulas from the bone plate, the internal diameter of the locking cannula bore being greater than the maximum diameter of the screw heads. The locking cannula is detached from the bone plate after the bone plate has been secured in place on the bone.

Description:
[0001]    This application claims the benefit of U.S. Provisional Patent Application Ser. No. 62/115,990, filed Feb. 13, 2015. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    This invention relates in general to rigid metal plates adapted for attachment to bones (typically referred to as bone plates) with screw-type fasteners (typically referred to as bone screws) and to guide devices used to properly align a drill to create the bore in the bone that will receive the screw-type fastener inserted through an aperture in the bone plate. The invention also relates to tubular drill guides that are used to properly align a drill bit when a pilot hole is being drilled into the bone. 
         [0003]    With many bone fractures or surgical osteotomies it is necessary to secure the bone segments in a fixed, rigid manner such that natural healing may occur. A common way to accomplish this is to provide a rigid metal plate shaped and sized as required to correspond to the bone or bones being secured, the rigid plate having apertures to receive bone screws, the bone screws being inserted through the plate and into the bone to secure the plate to bone and thereby prevent relative movement of the bone segments during the healing process. Additionally, bone plates are utilized in distraction procedures—the bone plates being affixed to opposing bone segments that are slowly separated by a distraction mechanism in known manner to lengthen the bone by osteogenesis. In most cases it is desirable or even necessary to first drill a pilot hole or bore into the bone at the location for each screw so as to prevent fracturing or splintering of the bone when the bone screw is inserted. Given the need to reduce undesirable stresses within the bone material and to accurately and securely attach the bone plate to the bone, it is important that the bores are properly aligned relative to the bone plate and screw receiving apertures, especially when the screw receiving apertures are beveled, shouldered, threaded or otherwise configured to better mate or correspond to a particular bone screw configuration. 
         [0004]    While the pilot holes may be drilled by first marking the location of the screw receiving apertures on the bone through the screw-receiving apertures, removing the bone plate and then manually aligning the drill bit with the markings, a better known methodology for creating the screw-receiving pilot holes is to utilize elongated, tubular drill guides that are aligned with the screw receiving apertures. The drill guides may be temporarily attached or mounted to the bone plates to extend proximally from the screw receiving apertures in order to insure proper location and alignment of the pilot hole and bone screw relative to the bone plate. With such an assembly, the bone plate is manually held or temporarily affixed in proper position over the bone or bone segments, the drill bit is inserted into the drill guide so as to extend through the screw receiving aperture to the bone, the pilot hole is created in the bone, the bit is removed from the drill guide, the drill guide is detached from the bone plate, and the bone screw is inserted through the screw receiving aperture and into the pilot hole to secure the bone plate to the bone. 
         [0005]    A problem that has been noted with the known systems is that the removal of the drill guide members from the bone plate prior to insertion of the bone screws into the apertures often results in movement of the bone plate relative to the bone or bone segments and the pilot holes that have been created. This may results in misalignment of the bone screws when they are implanted to secure the bone plate to the bone or misplacement of the bone plate. 
         [0006]    It is an object of this invention to address this problem by providing a bone plate locking cannula and drill guide assembly, and its method of use, wherein locking cannulas are temporarily attached to the bone plate in proper alignment with the screw-receiving screw receiving apertures, the cannulas being sized to receive a tubular drill guide. The bone plate, screw receiving apertures, bone screws, drill bits, drill guides and locking cannulas of the assembly are sized and structured such that after drilling the pilot bore into the bone and removing the drill bit and drill guide from the locking cannula, the internal diameter of the locking cannula is sufficiently large such that the bone screw may be inserted through the cannula and driven into the bone through the screw receiving aperture to secure the bone plate to the bone without requiring removal of the locking cannula. After the bones screw is fully inserted into the bone, the locking cannula is then removed from the bone plate. These and other objects not expressly set forth in this section will be supported or made obvious based on the following disclosure. 
       SUMMARY OF THE INVENTION 
       [0007]    The invention in various embodiments in general a bone plate locking cannula and drill guide assembly comprising a bone plate and at least one locking cannula member, the bone plate being a rigid body, typically composed of metal, ceramic or hard polymer material, shaped to sufficiently conform for secure attachment to the surface of the bone to be repaired or to provide a framing or base structure to properly align the bone or bone segments during healing, the bone plate having multiple screw-receiving apertures through which bone screws are inserted to fixedly secure the bone plate to the underlying bone or bone segments. An elongated, tubular locking cannula is provided, the locking cannula and bone plate being structured such that the cannula is temporarily mountable to the bone plate utilizing a threaded connection. 
         [0008]    The screw receiving apertures are configured to comprise a proximal or exterior bore and a distal or interior bore, the distal bore being smaller in diameter than the proximal bore. The proximal bore is internally threaded to receive an externally threaded end of the locking cannula in order to temporarily secure the locking cannula to the bone plate. The distal bore of the screw receiving apertures may or may not be internally threaded. The bone screws comprise a threaded shaft adapted to be driven into the bone and a screw head to preclude passage of the bone screw completely through the screw receiving aperture. The maximum diameter of the bone screw is smaller than the internal diameter of the bore of the locking cannula. A pilot hole in the bone is created by inserting an elongated, tubular drill guide into the locking cannula, then inserting a twist drill or drill bit into the drill guide and through the screw receiving aperture. The twist drill and drill guide are then removed from the locking cannula and the bone screw is passed through the locking cannula and into the screw receiving aperture, then driven into the bone without requiring removal of the locking cannula from the bone plate. 
         [0009]    In order to affix the bone plate to underlying bone or bone segments, the bone plate is positioned at its desired location and the locking cannula is mounted to the bone plate. An elongated drill guide is then inserted into the locking cannula and a twist drill or drill bit is inserted into and through the drill guide and the corresponding screw receiving aperture to create a screw-receiving pilot hole in the bone, the affixed locking cannula insuring that the pilot hole is properly aligned relative to the screw receiving aperture and the bone plate. The drill and drill guide are removed and a bone screw is passed down through the locking cannula and inserted into the screw receiving aperture. An elongated drive tool is inserted into the locking cannula and the bone screw is rotationally driven into the bore to secure the bone plate to the bone. These steps are repeated in successive screw receiving apertures until the bone plate is securely fastened onto the bone. 
         [0010]    In addition to an embodiment wherein a single locking cannula is used with each successive screw receiving apertures, in other embodiments all screw-receiving apertures may each be provided with a dedicated locking cannula, while in other embodiments the locking cannulas may be mountable only on selected apertures. The latter embodiment may be necessary when access space is limited. For the latter circumstance, once the bone screws have been properly affixed to the bone in the selected apertures such that the bone plate is secured in proper position on the bone, the locking cannulas are removed. The screw-receiving bores corresponding to the remaining apertures may be created without the use of the locking cannulas. In still another embodiment, selected apertures may be structured to receive the locking cannula, while other apertures on the bone plate may be standard threaded or non-threaded apertures not adapted to receive the locking cannula. 
         [0011]    In alternative terms, the invention in various aspects is a bone plate locking cannula assembly comprising a bone plate comprising screw receiving apertures, each said screw receiving aperture comprising an internally threaded proximal bore having a proximal bore internal diameter and a coaxially aligned distal bore having a distal bore internal diameter, said proximal bore internal diameter being greater than said distal bore internal diameter; a locking cannula detachably mounted to one of said screw receiving apertures, said locking cannula having a proximal end, a tubular shaft, a longitudinal bore having a longitudinal bore internal diameter, and a distal end having external threading, said distal end sized and configured to be received by and mate with said internally threaded proximal bores of said screw receiving apertures; and bone screws each comprising an externally threaded shaft and a screw head, said bone screws being sized so as to pass through said locking cannula longitudinal bore, wherein said externally threaded shaft is sized to pass through said distal bores of said screw receiving apertures and said screw head is sized to be precluded from passing through said distal bores of said screw receiving apertures. Furthermore, the invention is such an assembly wherein said distal bores are non-threaded; wherein said distal bores are internally threaded; each of said screw receiving apertures further comprising a transition shoulder between said proximal bore and said distal bore, and wherein said distal end of said locking cannula contacts said transition shoulder when said locking cannula is detachably mounted to said screw receiving apertures; each of said screw receiving apertures further comprising a transition shoulder between said proximal bore and said distal bore, and wherein said screw heads are received within said distal bores and are precluded from passing through said distal bores by said transition shoulder; wherein said externally threaded distal end of said locking cannula defines an abutment shoulder, and wherein said abutment shoulder of said locking cannula contacts said bone plate when said locking cannula is detachably mounted to said screw receiving apertures; wherein said bone plate further comprises conventional screw receiving apertures not adapted to receive said locking cannula; wherein said screw heads are externally threaded so as to be received by said internally threaded distal bores; further comprising a drill guide, said drill guide comprising an elongated tubular shaft and a drill guide longitudinal bore, said tubular shaft having an external diameter smaller than said internal diameter of said locking cannula longitudinal bore such that said tubular shaft is removably received within said locking cannula longitudinal bore; said drill guide longitudinal bore having an internal diameter smaller than said distal bore internal diameter of said screw receiving apertures; further comprising a drill received within said drill guide longitudinal bore, said drill having an external diameter smaller than said internal diameter of said drill guide longitudinal bore; and/or further comprising additional locking cannulas. 
         [0012]    In alternative terms, the invention in various aspects is a bone plate locking cannula and drill guide assembly comprising a bone plate comprising screw receiving apertures, each said screw receiving aperture having an internally threaded proximal bore with approximal bore internal diameter and a distal bore with a distal bore internal diameter, said proximal bore and said distal bore being coaxial, said proximal bore internal diameter being greater than said distal bore internal diameter whereby a transition shoulder is disposed between said proximal bore and said distal bore; at least one elongated locking cannula detachably mounted to said screw receiving apertures, said at least one locking cannula having a proximal end, a tubular shaft, a longitudinal bore having an internal diameter, and a distal end having external threading, said externally threaded distal end sized and configured to threadingly mate with said internally threaded proximal bores of said screw receiving apertures to removably mount said at least one locking cannula to said bone plate; at least one drill guide, said at least one drill guide comprising an elongated tubular shaft and a drill guide longitudinal bore having an internal diameter, said tubular shaft having an external diameter smaller than said internal diameter of said locking cannula longitudinal bore such that said tubular shaft is removably received within said locking cannula longitudinal bore; and bone screws each comprising an externally threaded shaft and a screw head having a maximum diameter, said internal diameter of said locking cannula longitudinal bore being greater than said maximum diameter of said screw head, such that said bone screw are passable through said locking cannula longitudinal bore, wherein said externally threaded shaft is sized to pass through said distal bore and said screw head is sized to be precluded from passing through said distal bore by said transition shoulder. Furthermore, the assembly wherein said distal end of said at least one locking cannula contacts said transition shoulder when said at least one locking cannula is detachably mounted to said screw receiving apertures; said externally threaded distal end of said at least one locking cannula defining an abutment shoulder, and wherein said abutment shoulder of said at least one locking cannula contacts said bone plate when said at least one locking cannula is detachably mounted to said screw receiving apertures; wherein said bone plate further comprises conventional screw receiving apertures not adapted to receive said drill guides. 
         [0013]    Alternatively, in other aspects, the invention is a method of affixing a bone plate to bone comprising the steps of (a) providing a bone plate locking cannula and drill guide assembly comprising a bone plate comprising screw receiving apertures, each said screw receiving aperture having an internally threaded proximal bore with approximal bore internal diameter and a distal bore with a distal bore internal diameter, said proximal bore and said distal bore being coaxial, said proximal bore internal diameter being greater than said distal bore internal diameter whereby a transition shoulder is disposed between said proximal bore and said distal bore; at least one elongated locking cannula detachably mounted to said screw receiving apertures, said at least one locking cannula having a proximal end, a tubular shaft, a longitudinal bore having an internal diameter, and a distal end having external threading, said externally threaded distal end sized and configured to threadingly mate with said internally threaded proximal bores of said screw receiving apertures to removably mount said at least one locking cannula to said bone plate; at least one drill guide, said at least one drill guide comprising an elongated tubular shaft and a drill guide longitudinal bore having an internal diameter, said tubular shaft having an external diameter smaller than said internal diameter of said locking cannula longitudinal bore such that said tubular shaft is removably received within said locking cannula longitudinal bore; and bone screws each comprising an externally threaded shaft and a screw head having a maximum diameter, said internal diameter of said locking cannula longitudinal bore being greater than said maximum diameter of said screw head, such that said bone screw are passable through said locking cannula longitudinal bore, wherein said externally threaded shaft is sized to pass through said distal bore and said screw head is sized to be precluded from passing through said distal bore by said transition shoulder; (b) positioning said bone plate on a bone; (c) mounting said at least one locking cannula to one of said screw receiving apertures; (d) inserting said drill guide into said locking cannula; (e) providing a drill and inserting said drill into said drill guide and drilling a pilot hole into said bone through said one of said screw receiving apertures; (f) removing said drill and said drill guide from said locking cannula; (g) inserting a bone screw into said locking cannula and driving said bone screw through said one of said screw receiving apertures into said bone; (h) removing said locking cannula from said one of said screw receiving apertures; (i) mounting said at least one locking cannula to another of said screw receiving apertures; and (j) repeating steps (d) through (h). Furthermore, the method wherein said step of providing a bone plate locking cannula and drill guide assembly comprises providing a bone plate having conventional screw receiving apertures not adapted to matingly receive said at least one locking cannula in addition to said screw receiving apertures adapted to matingly receive said at least one locking cannula; and further comprising the step of driving said bone screws directly into bone through said conventional screw receiving apertures; and/or wherein said step of mounting said at least one locking cannula to one of said screw receiving apertures is performed by first inserting said locking cannula through body tissue. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]      FIG. 1  is a partial cross-sectional view of an embodiment of the invention showing a portion of the bone plate, the screw receiving aperture, the locking cannula mounted to the bone plate, the drill guide inserted within the locking cannula and a drill guided by the drill guide and creating a pilot hole, the distal bore of the screw receiving aperture being non-threaded and comprising a shoulder to receive the screw head. 
           [0015]      FIG. 2  is a partial cross-sectional view of the embodiment of  FIG. 1  showing the locking cannula mounted to the bone plate, the drill and drill guide having been removed from the locking cannula. 
           [0016]      FIG. 3  is a partial cross-sectional view of the embodiment of  FIG. 1  showing the bone screw fully inserted into the screw receiving aperture prior to removal of the locking cannula from the bone plate. 
           [0017]      FIG. 4  is a partial cross-sectional view of the embodiment of  FIG. 1  showing the bone screw fully inserted into the screw receiving aperture after removal of the locking cannula from the bone plate. 
           [0018]      FIG. 5  is a partial cross-sectional view of another embodiment of the invention showing a portion of the bone plate, the screw receiving aperture, the locking cannula and the bone screw inserted into the bone, the distal bore of the screw receiving aperture being internally threaded and receiving the externally threaded portion of the screw head. 
           [0019]      FIG. 6  is a partial cross-sectional view of another embodiment of the invention showing a portion of the bone plate, the screw receiving aperture, the locking cannula and the bone screw inserted into the bone, the distal bore of the screw receiving aperture being internally threaded to receive the externally threaded portion of the bone screw shaft, the diameter of the distal bore being significantly less than the diameter of the proximal bore such that a shoulder is defined to receiver the screw head. 
           [0020]      FIG. 7  is a plan view of the proximal side of a representative embodiment of a bone plate. 
           [0021]      FIG. 8  is a side view of the bone plate embodiment of  FIG. 7 . 
           [0022]      FIG. 9  is a view of a representative embodiment of a locking cannula. 
           [0023]      FIG. 10  is a view of a representative embodiment of a drill guide. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0024]    With reference to the embodiments shown in the representative drawings, the number of which is not meant to be limiting in terms of the possible embodiments or the scope and definition of the invention, the invention can be considered to comprise in general an assembly comprising a bone plate  10  and a locking cannula  20 , as well as its method of use, the bone plate  10  being a rigid member, typically metal, ceramic or had polymer, shaped to conform to the surface of a bone or bone segments  99  to be repaired or alternatively to provide a framework or base for rigid attachment of bone or bone segments  99 , the bone plate  10  having multiple screw-receiving apertures  11  through which bone screws  30  are inserted to secure the bone plate  10  to the underlying bone or bone segments  99 . The bone plate  10  may be configured and structured to secure a single bone or bone segments  99 , or may be configured and structures to connect bones or bone segments  99  to a distractor device or other instrumentation. Elongated, tubular locking cannulas  20  are provided as part of the assembly, the locking cannulas  20  and bone plates  10  being structured such that the locking cannulas  20  are temporarily mountable to the bone plate  10  utilizing a threaded connection. The assembly may further comprise a tubular drill guide  40 , the drill guide  40  being sized to so as to coaxially disposed within the locking cannula  20 . The drill guide  40  properly orients the drill relative to the screw receiving aperture  11  during creation of a pilot hole  98  to later receive the bone screw  30 . The internal diameter  25  of the locking cannula  20  is greater than the maximum diameter  35  of the bone screw  30 , such that upon removal of the drill guide  40  from the locking cannula  20 , the bone screw  30  may be delivered through the locking cannula  20  and inserted into the bone  99  without requiring removal of the locking cannula from the bone plate  10 . 
         [0025]    As used herein, terms such as proximal shall refer to the side or direction away from the bone or bone segments  99  to which the bone plate  10  is being affixed, while terms such as distal shall refer to the side or direction toward the bone or bone segments  99  to which the bone plate  10  is being affixed. In terms of the surgeon implanting the bone plate  10 , proximal is toward or near to the surgeon and distal is away are farther from the surgeon. 
         [0026]    The hollow, longitudinally bored, tubular locking cannula  20  comprised a tubular shaft  21  having a longitudinal bore  27 , the locking cannula  20  having a proximal end  26  and a distal end  22 . The distal end  22  is provided with external threading  23  adapted to mate with internal threading  16  present in the proximal bore  13  of the bone plate  10 . The threaded distal end  22  may be reduced in external diameter relative to the tubular shaft  21  to define an abutment shoulder  24  that functions to stop advancement of the locking cannula  20  into the bone plate  10 , as shown in  FIGS. 1 and 5 , or the connection between the bone plate  10  and the locking cannula  20  may be structured such that the distal end  22  bottoms out on the transition shoulder  18  between the proximal bore  13  and the distal bore  12  of the base plate aperture  11  without the abutment shoulder  24  contacting the base plate  10 , as shown in  FIG. 6 . With this structure the locking cannula  20  may be temporarily yet rigidly mounted onto bone plate  10  and subsequently removed from the bone plate  10  by rotating the locking cannula  20  relative to the bone plate  10 , preferably utilizing a handled trocar or other member or mechanism to provide for manual rotation of the locking cannula  20 . 
         [0027]    The screw receiving apertures  11  are structured to comprise a proximal or exterior bore  13  and a coaxial distal or interior bore  12 , the distal bore  12  having an internal diameter  14  lesser than the internal diameter  15  of the proximal bore  13  such that a transition shoulder  18  is formed between the proximal bore  13  and the distal bore  12 . The proximal bore  13  comprises internal threading  16  to receive and mate with external threading  23  disposed on the distal end  22  of the locking cannula  20 . The distal bore  20  may or may not be internally threaded. The embodiment of  FIG. 1  shows a non-threaded distal bore  20  while the embodiments of  FIGS. 5 and 6  show threaded distal bores  20 . In the embodiment of  FIG. 5 , the distal bore  20  is tapered in the distal direction, with the internal diameter  14  as used herein being defined as the maximum diameter of the distal bore  20 . The provision of a larger proximal bore  13  and a smaller distal bore  12  is desirable as with this structure the screw head  32  is received in a recessed manner and does not significantly protrude above the exterior or proximal surface of the bone plate  10  once implanted. Most preferably the depth of the proximal bore  13  is equal to or greater than the depth of the screw head  32 , such that no portion of the screw head  32  extends above the exterior surface of the bone plate  10  once the bone screw  30  is fully inserted. 
         [0028]    The bone screws  30  each comprise a threaded shaft  31  with external threading  34 , adapted to extend through the bone plate  10  to be received by the bone  99 , and a larger screw head  32 , preferably circular to define a maximum diameter  35  adapted to preclude passage of the bone screw  30  completely through the bone plate  10 . The screw head  32  is structured in known manner, e.g., slotted or provided with a non-circular recess, to receive the end of a drive tool, e.g., a screwdriver. The maximum diameter  35  of the screw head  32 , and any portion of the bone screw  30 , is smaller than the internal diameter  25  of the locking cannula bore  27 , such that the bone screw  30  may be inserted through the proximal end  26  down through tubular shaft  21  and past the distal end  22  of the locking cannula  20  such that the threaded shaft  31  extends into and through the screw receiving aperture  11 , whereupon it may be driven into the bone  99 . In this manner the threaded shaft  31  extends through the screw receiving aperture  11  into the bone  99 , while the transition shoulder  18  between the proximal bore  13  and the distal bore  12  defines a stop against further advancement of the screw head  32 , the screw head maximum diameter  35  being greater than the distal bore diameter  14 . The screw head  32  may be provided with no threading, as shown in  FIGS. 1 and 6 , or may be provided with external threading  33 , as shown in  FIG. 5 . 
         [0029]    All of the apertures  11  of the bone plate  10  may be structured to temporarily receive the locking cannulas  20 . Alternatively, as illustrated in  FIGS. 7 and 8 , the bone plate  10  may be provided with some apertures  11  capable of receiving the drill guides and other conventional screw receiving apertures  19 , either threaded or non-threaded, through which bone screws  30  may be driven, such conventional apertures  19  lacking the proximal bore/distal bore structure required for mounting the locking cannula  20  to the bone plate  10 . 
         [0030]    In certain embodiments the assembly further comprises an elongated, hollow drill guide  40  having an elongated tubular shaft  41 , a distal end  42 , a proximal end  46 , a longitudinal bore  47  and a handle  45 . The tubular shaft  41  has an external diameter  44  and the longitudinal bore  47  has an internal diameter  44 . A representative drill guide  40  is shown in  FIGS. 1 and 10 . The drill guide external diameter  44  is smaller than the internal diameter  25  of the locking cannula longitudinal bore  27 , such that the drill guide tubular shaft  41  is coaxially insertable into the locking cannula longitudinal bore  27 , as shown in  FIG. 1 . The drill guide internal diameter  43  is smaller than the distal bore diameter  14  of the bone plate  10 . The assembly may further comprise a drill or drill bit  50 , such as a manual twist drill for example, wherein the external diameter  51  of the drill  50  is smaller than the drill guide internal diameter  43  and smaller than the distal bore diameter  14  of the bone plate  10 , as seen in  FIG. 1 . The drill  50  is utilized to create a pilot bore or hole  98  to receive a bone screw threaded shaft  31  in normal manner. 
         [0031]    In one embodiment of the method, such as for a transbuccal implantation for example, the bone plate  10  is positioned against the bone  99  at the desired attachment location. The distal end  22  of the tubular shaft  21  of the locking cannula  20  is inserted through a small incision or puncture in the cheek tissue in known manner, typically with a trocar inserted into the longitudinal bore  27  to occlude the longitudinal bore  27  during insertion. The locking cannula  20  is aligned with the proximal bore  13  of one of the screw receiving apertures  11  and axially rotated such that the locking cannula external threading  23  mates with the proximal bore internal threading  16 , thereby properly coaxially aligning and orienting the axis of the locking cannula  20  to the axis of the proximal bore  13  and the shared axis of the distal bore  12 . The trocar is removed and the drill guide  40  is inserted into the locking cannula  20  such that the axis of the drill guide longitudinal bore  47  is coaxially aligned with the axis of the locking cannula longitudinal bore  27 . The drill  50  is then inserted into the drill guide  40  and a centered, coaxially aligned pilot hole  98  is created in the bone  99 , as shown in  FIG. 1 . 
         [0032]    The drill  50  and the drill guide  40  are then removed from the locking cannula  20 , as shown in  FIG. 2 . Because the internal diameter  25  of the locking cannula internal bore  27  is greater than the external diameter  44  of the bone screw  30 , the bone screw is inserted into the proximal end  26  of the locking cannula  20  and guided or funneled to the screw receiving aperture  11 . Utilizing a drive tool, not shown, the externally threaded shaft  31  of the bone screw  30  is maneuvered through the aperture  11  and into the pilot hole  98 , then rotated in known manner such that the bone screw  30  advances into the bone  99 . As the bone screw  30  is advanced the distal side of the screw head  32  abuts the abutment shoulder  24  between the wider proximal bore  13  and the narrower distal bore  12  of the screw receiving aperture  11 , such that the plate  10  is affixed securely on the bone  99 , as shown in  FIG. 3 . The presence of the locking cannula  20  further insures that the bone screw  30  is properly oriented into the bone  99  relative to the bone palte aperture  11 . With the bone screw  30  fully inserted, the locking cannula  20  is now rotated and removed from the bone plate  10 . For implantation of subsequent bone screws  30  the process is then repeated from the step of inserting the locking cannula  20  through the cheek forward. The description of a transbuccal implantation is not meant to be limiting, as the assembly and its methodology may be utilized at other locations. 
         [0033]    In an alternate method embodiment in circumstances where the attachment zone for the bone plate  10  is adequately exposed, plural locking cannulas  20  are mounted to some or all of the screw receiving apertures  10  on the bone plate  10  and the bone plate  10  is positioned at the proper location on the bone or bone segments  99 . The bone screws  30  are then inserted into the bone  99  as set forth above and with the bone plate  30  properly secured to the bone  99 , the locking cannulas  20  are removed from the bone plate  10 . In still another alternate method embodiment, wherein some of the screw receiving apertures  11  are covered by body tissue and other apertures  19  are externally exposed, the locking cannulas  20  may be utilized for the covered apertures  11  in the manner set forth above and bone screws  30  may be inserted in direct manner into the conventional screw receiving apertures  19 , the conventional screw receiving apertures  19  not having any internal threading. 
         [0034]    The embodiments discussed and illustrated are not meant to be limiting, and it is understood and contemplated that equivalents and substitutions for some elements set forth above may be obvious to those of skill in the art, and therefore the true scope and definition of the invention is to be as set forth in the following claims.