CA1298496C - Submergible screw-type dental implant and method of utilization - Google Patents
Submergible screw-type dental implant and method of utilizationInfo
- Publication number
- CA1298496C CA1298496C CA000546078A CA546078A CA1298496C CA 1298496 C CA1298496 C CA 1298496C CA 000546078 A CA000546078 A CA 000546078A CA 546078 A CA546078 A CA 546078A CA 1298496 C CA1298496 C CA 1298496C
- Authority
- CA
- Canada
- Prior art keywords
- implant
- bone
- ball
- threads
- threaded
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0018—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools characterised by the shape
- A61C8/0022—Self-screwing
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0018—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools characterised by the shape
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0048—Connecting the upper structure to the implant, e.g. bridging bars
- A61C8/005—Connecting devices for joining an upper structure with an implant member, e.g. spacers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0048—Connecting the upper structure to the implant, e.g. bridging bars
- A61C8/005—Connecting devices for joining an upper structure with an implant member, e.g. spacers
- A61C8/0053—Connecting devices for joining an upper structure with an implant member, e.g. spacers with angular adjustment means, e.g. ball and socket joint
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0048—Connecting the upper structure to the implant, e.g. bridging bars
- A61C8/005—Connecting devices for joining an upper structure with an implant member, e.g. spacers
- A61C8/0069—Connecting devices for joining an upper structure with an implant member, e.g. spacers tapered or conical connection
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0048—Connecting the upper structure to the implant, e.g. bridging bars
- A61C8/005—Connecting devices for joining an upper structure with an implant member, e.g. spacers
- A61C8/006—Connecting devices for joining an upper structure with an implant member, e.g. spacers with polygonal positional means, e.g. hexagonal or octagonal
Abstract
ABSTRACT OF THE INVENTION A submergible screw-type implant includes a longitudinal channel which directs bone chips towards the base of a bore in the patient's bone in which the implant is installed. These bone chips promote autogenous rapid regrowth of new bone to securely anchor the implant in place. In order to be able to position the implant at the most advantageous angle at the edentulous sight, angled abutments for supporting an artificial tooth structure or angularly adjustable abutments are provided. A method of installing the angularly adjustable oral implant involves setting the abutment portion at the proper angle for alignment of the artificial tooth and subsequently locking it in that position.
Description
IMPROVED SUBMERGIBLE SCREW--TYPE DENTAL
IMPLANT AND METHOD OF l~TILIZATION
Technical Fi~l~
This invention relatss to dental implants and, more particularly, to submergible screw-type implants.
15 sackqround Art Screw-type implants are well known in the art. U.S.
Patent No. ~,499,22~ of L. I. Lin~ow et al. discloses screw-type implants ~hich may be buried in the alveolar ridge crest bone of a patient in an edentulous region. The implant has a 20 threaded lower poxtion which may`be screwed into an opening created in the bone after the tissue has been displace~. A
coronal portion protrudes above the bone and is used to support an arti~icial dental appliance, e.g. an artificial tooth or bridge.
In ~ore recent year's submergible implants have been created in w~ic~ the threaded po~tions of the implants can be completely embedded in the bone. They may then be covered with tissue and allowed to remain in place while new bone grows around the implant and through vent holes in it. Onc~ it is 30 firmly anchored in new bone (3 to 6 months), the tissue is reopened and an upper post portion is screwed into the implant portion and is used tn mount the artificial dental device.
It is advantageous when installing an implant portion in the patent's bone, if the implant is self-tapping in a bore 3~ created in the bone. This causes it to be anchored better.
Also, it would be advantageous if the bone chips crea ed during a sel~-tapping operation were deposited into the bore or opening because these chips promote ~aster bone yrowth because of their au~ogenous nature.
~g~
In order to align the artificial tooth or other dental devices with the other teeth of the patient, it may be necessary ~o have the post portion at an angle to the implant portion. This may be accomplished by bending the post portion so that its head is at an angle to the threaded ~ha~t~ This bending may be accomplished before the post i threaded into the implant portion or afterward. I~ the post is bent before attachment to the implant, the proper allgnment is diffi~ult to achieve. I~ bent after attachment, there i~ a danger that too much stress will be put on the implant portion and it will loosen in the bone and fail. Also bending the post may fatigue the metal of the post and cause breakage.
Disclosure of the Invention The present invention is directed to a dental implant which, in its preferred form, is of the ~ubmergible screw type with a longitudinal channel or slot through the threads so as to impxove their self-tapping ahility. The implant also has an angled swivelable connector to allow the post for supporting an artificial dental appliance to be positioned in proper alignment with other teeth in the patient'~ mouth without applying stress to the implant.
In an illustrative embodiment of the invention, the implant portion o~ the device includes a threaded region that contains a longitudinal channel through a portion of the outer parts of the threads. The channel i5 wider toward its bottom.
One side of the channel ~s at a right angle to the implant circumference so as to create a cutting edge that assists in the formation of a self-tapping capability for the implant when it is installed in a bore or opening in the patient's bone.
The other side of the channel is at an oblique angle to the circumference.
The channel guide bone chips created during the threading of the implant toward the base Qf the bore in the bone. By terminating the channel below the uppermost threads, epithelial tissue is prevented ~rom growing down into the bone along the channel.
The post ~r abut~ent portion of the implant which supports an artificial dental applia~ce may be ~ ~traight portion on to which the appliance is threaded. However~ in situations where it must ~e at an angle to the implant portion, the abutment may be a separate piece from the implant portion and may be at~ached there~o at an angle by ~eans o~ a 10 connection portion o~ the ~butment~ The connection portion may be in the ~o~m of a rotat~le ~eveled collar, a ball and socket joint, or other ~uita~le means that allow ~he pos~ to ~wivel about the axis of the ~mplant portion and/or to assume various angles with respect to th~t axis. Once in place, means are 15 provided ~or securing the ~butment against ~urther movement with respect to the implant portion. A5 a result the implant can assume a desired angl~ to assure proper alignment of the artificial dental structure with the other teeth of the patient along the occlusal planeO
The ~resent invention also contemplates a unique surgical method. With ~hi~ method an incision i~ made in the tissue covering the alveolar ridge crest bone. This underlying bone is then exposed and ~ bore is drilled into the bone at a depth sufficient to hold t~e implant portion of the device.
25 The bore is made slightly ~maller in diameter than the implant device and is at an angle which will allow it to 0ngage the ma~or por ion of the avail~ble bone. Then the implant device is threaded into the remaining bone about the bore utiliæing its self-tapping threads ~nd the ~el~-tapping feature of the 30 channel along its length. It is typically buried at a depth such that it is submerged ~elow the upper ~urface in the bone and i~ completely ~uried in the bone.
During the insertion procedure bone chips are removed from the walls oP the bor~ while forming the grooves in the 35 bone which match ~he threads in the implant. These bone chips drop along the channel to ~he base of the bore and help to promote growth of new bone which Pirmly anchors the implant in place.
ThrPading ~f the implant portion into place may be accomplished with ~ hexagonal projection or recess located at ~2~9~i the free end of the implant portion. This hexagonal ~ection is connected to a wrench type device to screw the implant int~ the bone.
Once secured in place a cover o~ minimal height may be attached to the exposed surface o~ the implant portion by a screw passing throu~h the cover ~nd threaded into an aperture in that ~urface. The tissue may then ~e sutured over the implant cover. New bone is allowed to grow and to anchor the cover and implant firmly in place. Several weeks or ~onths latex, the tissue is opened again and the cover is removed. A
threaded abutment or po~t is then attached to the threaded aperture in the end ~f the implant portion. This abutment is used for supporting the artificial dental appliance~
The angle at which the implant portion is l~cated in the bone may not be the most conducive to the proper alignment of the artificial tooth or other dental devices with the remaining teet~ of the patient. As a result, the abutment includes an an~led, swivelable connection portion for attaching the abutment to the implant portion~ Xn one embodiment fixed angular devices which are rotatable about the longitudinal axis of the implant are utilized, and in another embodiment the part is continuously swivelable to any desired angle. In either case, after the a~utment or ~upport for the ar~i~icial tooth is at the propcr angle, it is locked such that it remains in that position. Finally, the tissue is closed about the abutment and the arti~icial tooth or bridge support is cemented or screwed to the abutment.
f description of the drawinq~
The foregoing and other features of the present invention will be more readily apparent from the following detailed description and drawings of illustrative embodiments of the invention, in whicho Fi~. 1 is a sc~em~tic cross section of the side of a patient's ~ace showing the alveolar ridge crest with a screw type implant according to the presen~ invention installed therein;
9~ii Fig. 2 is an enlarged view o~ an illustrative embodiment of the implant portion of the device ~ Fig. 1 with an external hex pro~ection;
Fig~ 3 is a top view of the implant por~ion of ~ig. 2 showing ~he external hex portion;
Fig. ~ is a cros~-~ectional view through the i~plank portion o~ Fig. 2 along line 4-4 ~howing the cross-sectional shape of the channel accordin~ to the pr0sent invention;
Fig. 5 is an implant portion o~ a ~crew-type implant according to the present invention with an internal hex recess;
Fig. 6 is a illustrative embodiment of a completed screw-type implant with an angularly positioned threaded sha~t attached thereto;
Fig. 7 is a cross-sectional view of ~ ball and socket connection portion of an abutment according to the present invention;
Fig. 8 illustrates a modi~ication o~ the ball and soc~et joint of Fig. 7;
Fig. 9 illustrates a further modification o~ the ball and socket joint of Fig. 7;
Fig. 10 is a ball and socket joint connection portion with a stationary ball;
Fig. 11 is a side view ~ a healing collar according to the present invention; and Figs 12 and 13 are front and side ~ectional views of an artificial tooth with an abutment according to Fig. 7.
Description of_Illustrative Embodiments The present invention contemplates at least a two part screw type dental implant, i.e, an implant portion 10 which is buried in the bone of th patient and ~ post or abutment portion 20 which ~s attached thereto and which supports an artificial tooth s~ructure 30. As ~hown in Fig~ 1, an implant screw portion 10 is located in a bore in the aveolar crest 11 at an angle thak causes it to be in the center o~ the thickest portion of good available bone. The abutment 20 is attached both to the implant portion 10 and the artificial tooth 30, and ., .
is s~t ~o that the tooth is at an angle to the i~plant which causes the tooth to be in proper alignment.
In Figs. 2 and 3 the ~crew implant portion 10 of Fig~ 2 i5 illustrated in ~ore detail. This implant portion 10 contains thrQads 13 which extend over the middle region o~ ~he implant portion. ~h~se ~hreads ~ay have ~ fl~t ~o~tom ~nd be angled up to form a Christmas tree shape in cross section. The lower half of the implant portion 10 contains ~ cavity 14 ~shown in dotted line). Also, ~paced a~out the lower end o~
the implant ar~ holes or vents 16, 16a and 16b, which penatrate from its exterior to the interior cavity 14. The purpose of 15 these vents is to allow new bone to grow through and into the center cavity in order to firmly anchor the implant in the patient's bone. The upper surface 17 of the implant portion defines a threaded aperture 19 which is used to connect the abutment 20 to the implant portion 10. The pro~ecting structure 12 which forms sur~ace 17 has a hexagonal ~hape as shown more clearly in Fig. 3. This hexagonal ~hape allows a tool, e.g. a wrench, to be used to rotate the implant portion so as to thread it into the patient's bone.
According to the present invention a channel 18 is cut 25 through the threads 13 a~d possibly in~o the outer casing of the implant portion 10. As depicted in dotted line in Fig. 3 and in cross ~ection in Fig. 4, the channel 18 is one of three channels 18, 18a, 18b in a typical implant portion. ~hese channels are made to intersect the re~pective ven~s ~6, 16a and 30 16~ which are spaced at angles of 120- about the circumference of the implant portion 10. The channels do not extend completely toward the upper surface 12 in order to prevent tissue ~rom growing down along the channel, and to prevent the incursion of food and bacteria. It ~hould be particularly 35 noted in Fig. 4 that the channel~ 18 have one edge wh;ch is at about 90- to the circumference of the implant, i.eO, ~urface ~18', and another m~re obliquely shaped edge, i.e. ~urface 18''.
Durin~ installat~on of the implant, an incision is made in the gum tissu~ o~ the pa~lent and the underlying bone i~
exposed. Then a drill or burr is used to make an opening or bore hole in the bone which is slightly larger in diameter than the implant porti~n body ~o, ~ut which is not as wide as the threads 13. A wider counterbore ~ay be provided to ac~ommodate a protection collar as explained ~ub~equsntly. N~xt the implant is inserted up to the firct thread in the opening in the bone. A tool, such ~s a wrench, ~s u~ed to ~ngage the hex lO portion 12 and to rotate the implant. Th~ threads 13 ar~ made to be self-tapping s~ that ~he implant portion will begin to screw down into the patient's bone. I~ necessary, a b~ne tap can be used to create grooves ;n the hard upper cortical bone prior to insertion of the implant portion. The riqht angle 15 surface 18' of ~he channel also has self-tapping properties so as to ease the insertion of the implant, once it has reached the depth of the channels 18. Further turning o~ ~he implant causes the right an~le surface 18' to ~crape off bone as the implant is being threaded and to push the resulting bone chips 20 forward. This causes the bone chips to fall through the channels 1~ and into the area of the vents 16 where they may penetrate into the interior cavity 14. To facilitate this, the channels 18 are made wider towards the vents 16.
As a result o~ this structure, bon2 chips created 25 during the implant procedure tend to accumulate at the base of the implant in the patient's bone. Because of the autogenous nature of these bone chips they promote the growth of new bone in the area and speed the ~ormation o~ new bone around and through the implant such that it is anchored in place more 30 rapidly.
In Fig. 5 there is shown an implant portion 10 which is nearly i~entical to that shown in Fig. 1. ~he principal difference is that, rather than having a hexagonal projection useful for applying ~orque ~o the implant, a hexagonal reces~
35 12' is provided. In add~tion, ~he threaded aperture 19' is made somewhat smaller and is located at the bas~ of hexagonal reces~ 12'. As explained previously, th~ threaded aperture 19' is used ~or attaching the implant portlon oP the device to ~he abutment portion. One embod?ment o~ such an attachment is shown in Figure 6.
~L2~ L9~i In Figure 6 the upper part ~f the implant portion 10 is shown partly broken away and parkly in ~ection. It ic ~hown partly broken away to ex~ibit the in~erior cavity 1~ and the ~hreads 13. Towards the up~er part o~ t~e implant portion it is shown in ~ross sec~ionO Thi~ implant portion i~ like that shown in Figl 5 with a hexagonal recess 12' ~or rotating it into position in the ~ne. ~s 6hown in Figure 6 the screw type implant portion 10 is connected to an abutment portion 20 that includes a transitional collar 21, an angled threaded shaft 24, and a tooth support cylinder 31~ The threaded 6haft 24 has its lower end æ~rewed into threaded aperture 19' in the implant portion 10. The upper end of the threaded ~ha~t, which is ~et at an angle ~ the lower end, is rec~ived within a threaded aperture 35 in tooth support cylinder 31~ This cylinder 31 contains a recessed por~ion 32 which may ~e utilized in fixing on to the cylinder via cement ~r ome other convenient and well known method, a porc~lain, plastic, or other dental tooth-colored veneering material in the fcrm of ~n ar~i~icial tooth.
The transitional c~llar 21 is located between the upper end of the implan~ portion 10 and t~e ~ylinder 31. This collar has an angled upper surface 25 and a perpendicular lower surface 23. The angle o~ the upper ~urface is ~ade to equal the angle of the upper part of the anyled ~ha~t 24. While collar 21 surrounds threaded shaft 24, it does not engage its threads.
.During an installation procedur~ the implant portion 10 is located in the patient's ~one as previously described. The gingival tissues can then ~e replaced over the implant portion and several weeks or months allowed to pa~s while new bone grows around and through the implant portion. How~ver, alternatively the artificial tooth can be connected to the implant immediat~ly r Whiche~er ~anner is chosen, the attachment is accomplished by selecting an angled ~haft and transition collar which have an angle which will cause ~he artificial tooth to be correctly aligned with the other teeth of the patient. Therefore th~ dentist or oral ~uxgeon must be provided with a variety of such ~hafts a~d collars which are at standard angles. A1SD during the insertion prQcedure the surgeon must appropriately angle the opening in the bone so it penetrates a reas~nably thick area oP good bone. This may requir~ that the open ng in the bone be drilled at an angle in ordPr to av~id penetrating a near~y sinus cavity, passing completely through th~ bone, or contacting a nerve bundle.
10 Rowever, in selecting the angle at which th~ implant is buried, care must be taken to make sure that this angle will accommodate one of the standard angles available with the threaded shafts and collars, e.g. 10, 20 or 30 degrees, ~o as to result in alignment between the new artificial tooth and the 15 remaining teeth of the patient.
Once the threaded sha~t 24 is en~aged with the implant portion 10, the collar 21 is slipped over the free end of the shaft. Then the shaf~ is rotated ~o that it is firmly secured in the implant por~ion and is extending in the proper zO direction. With the collar in place over this shaft, the cylinder portion 31 is threaded oYer the open or free end of the shaft until it makes tig~t contact with the upper urface of the collar and begins to ~ueeze the collar between the cylinder and implant portions. Notches ~nd recesses 22 and 27 2~ are provided in ~he mating surfaces ~uch th~t, once the parts are screwed together, these ~otcnes and recesses engage each other and prevent unintentional unscrewing of the portions of the implant. Wit~ this *irm attachment completed, the artificial tooth can ~hen bP attached over the abutment 30 cylinder 31.
In ~igure 6 the level the patient's bone is ~hown as dotted line 70. Since the implant portion is submerged in the bone, the line 70 int~rsects the lower portion o~ the transitional collar 20. The gum tis ue line 72 $s towards the 35 upper portion of ~he transi~ional collar. As a resul~ the collar acts a barrier to prevent the encroachment of bacteria and food into the interior portion o~ the collar and the hex recess of the implant portion.
With the emb~diment of Figure 6 fixed angl~s are provided to the dentist and he must work with the ~tandard ~2~
angles and the angle whi~h ~ create~ for the bore in the patient's ~one~ in ord~r to ~ssure proper alignment o~ the teeth. In ~ome patients who have had ~erious bone disease, the amount of available good bone is li~ited and the d~ntist has only a limited amo~nt o~ ~re4dom in selectin~ the angle at which the bore ~or the implant iR made. Also with the 10 embodiment o Figure 6 ~ necessary for a dentist to keep a stock of various angled shafts and collar5. The difficultly presented by the type o~ implant in Figure 6 is overcome by the implant ~h~wn in Figure 7.
In Figure 7 the angl~d shaft and tran~ition collar are 15 replaced with a ~all and ~oc~et joint which allow~ for the settin~ of the angled relatiDnship between the implant portion and the abutment portion at ~ny selected angle within the range of motion of the ball and socket joint, e.g. up to 30-40 degrees. In Fig. 7 the threaded cavity 19 receives the 20 threaded sha~t o~ a lower or inner abutment casing 42. This casing has a generally Y-shape with the lower portion being the shaft that extends intD and ~ngage the threads of cavity 19.
The upper portiDn o~ casing 42 has a hemispherical ~urface 45 such that it can receiYe a ball 46. An upper or outer casing 25 44 screws ont~ out~r t~reads of the inner casi~g 42 such that ball 46 is trapped within the abutment casiny, but is free to rotata tharein ~o a~ to ~reate a ball and ~ocke~ joint.
A relatively large ~P~ ~crew 48 penetrates the ball completely. This set screw 48 has 4n internal threaded ca~ity 30 55 which passes through an upper ~exagonal projection 56. Once the implant portion 10 has ~een located in the bone at the optimal anqle, the ~all 46 is rotated such that the center axis of the ~et screw i~ a~ the proper angle ~or mounting o~ an artificial ~ooth in lina wit~ o~her ~eeth in the patient's 35 mouth. Then the hexagonal p~rtion 56 is rotated with a wrench or other tool so the set ~craw comes into extreme frictional contact with ~he hemisp~erical surface 45 of inner casing 42.
This prevents further rotation of the ball and the 6et 6crew.
~ he arti~i~ia~ t~Dth.structure in ~he embodimen~ o~
Figure 7 has an interior cylinder 50, abo~lt which the porcelain, plastic or other dental ~aterial i8 formed to create the artificial tooth structure. ThiG cyllnder 50 with the artificial tooth ~tructure ~ounted therson, ~ placed on top oP
the hexagonal projec~ion 56 ~nd i~ ~hen attached thereto by means of a screw 52 which passes through the cylinder 50 and into the threaded aper~ure 55 in set screw 4B.
The bone line 7~ is ~hown in Figure 7 as being approximately mid way through tha lower abutment casing 42, while the gum line 72 is just below th2 upper edge of the outer or upper casing 44. Thus, the bone does not interfere with the setting Qf the proper angle for the abutment and th~ tissue is not likely to contact moveable adjustment part~.
The arrangement of Figure 8 i8 ~ ~odification 0~ that shown in Figure 7. In this arrangement the ~et ~crew 48, which has a threaded recess 55 at its end in Fig. 7, is replaced with a set screw 49 that has a further screw thread 59 on the opposite side of the hex projection 56. This additional screw thread i~ used to mount an arti~icial tooth ~upport cylinder 53 which has an interior threaded cavity. However, this device is essentially located and ~ixed i~ position in the same manner as the implant of Figure 7. One difference with thi6 implant of Figure 8 is that the artificial tooth ~upport cylinder 53 may extend down to and in contact with the outer casing 44. This is done above the gum tissue line 72 as ~hown in the Pigure.
Because of the contact between the cylinder and the casing 44, food and bacteria are prevented from entering between these two parts and the likelihood of infection i~ reduced. However, this arrangement allows for ~omewhat less range of angular adjustment. In particular th~ arrangement o~ Fig. 7 i~ capable of an angular adjustment range of ~pproximately 37 1/2~, while that o~ Fig. 8 is limited to about 30-.
As a further alternative, the ~et screw 48, rather than having a projecting threaded portion located ~bove the hexagonal adjustme~t nut 56, may have a projecting cylinder which is internally threaded (no~ show~). Thus ei~her a male or female connection of this type may be used without difficulty.
~2~ 6 In order to get increased angular adjustment, an arrangement ~uch as that ~hown in Fig. 9 may be used. The abutment arrangement of Figure 9 is es~entially the ~ame as that o~ Figure 7; however, the ball and 60cket ~oint are made smaller and the ball sits higher ~n the .ocket ~intO Further, the set ~crew 54 of Fig. 9 is made to have a beveled surface 57 lO such that a greater angular rotation ~ay be made before it contacts the upper part of the outer casing 44. With ~his arrangement nearly 45 degrees of angular adjustment can be achieved.
The abutment cylinder 50 has ~ recess 51 to receive the 15 outer end of the set screw 54. This allows ~or greater stability when it is attached to the ~et ~crew by m~ans of attachment screw 52. ~he cylinder 50 is also angled in the same manner as the surface 5~ of the ~et ~crew 54 50 that it does not bind against the upper abutment ca~ing 44 and limit 20 angular rotation~
In Fig. 7-9 the ball rotates with the set ~crew during angular adjustment. ~owever, as an alternative, the ball may remain stationery and the abutment casing may rotate as shown in Figure 10. In Figure 10 a threaded ball joint 60 has a 2 projecting thxeaded shaft 61 whiah i5 received in threaded rec~ss l9 of the implant portion 10. Various size prote~tion washers or collars 6~ ca~ be located about the flnial part 67, which connects the ball to the threaded ~ha~k, in order to cover the upper surface of whatever ~mplant portion i~ used, 30 thereby preventing bacteria and food ~rom enterin~ the bore.
The opening in the bone can be countersunk as indicated by dotted line 70 so the collar can extend out beyond the implant portion upper surface, and bone can grvw over part of the upper surface of the collar.
A two-part casing 62, 64 is ~ounted on the ball 60.
The casing includes outer casing porti~n 62, which secures the remote end o~ ~he ball, 2nd an inner casing ~4, which provides the main hemispherical ~urface against which the outer casing holds the ball in a rotatable manner. These two casing parts can be threaded together or attached to each other in any convenient manner. Their attachment, ~owever, i~ ~uch that the casing may rotate ~reely on the ball.
At the opposite end of ball 60 from the ~crew threads is a ~exagonal recess 63, w~ich is ~h~ ~ean~ ~y which this threaded ball joint is screwed into the threaded recess 19 of the i~plant portion. In this arrangemen~ the gum line 72 is 10 shown about 1/3 up ~rom the base of the ball ~oint, but below the lower extension of casing 62.
A hexagonal pro~ection 66 i6 provided on the inner casing 64. This project~on can be us~d to rotate the inner casing 64 so that the ball is sgueezed between it and the outer 15 casing 62 ~o that swiveling can be prevented when th~
arrangement is at the proper angle. A conventional cylinder 50 for a dental prosthesis is attached to the inner casing 64 by means of a screw 52~ This screw 52 p~netrates a threaded aperture in the inner casing.
Installation of submergible implants i generally a two stage procedure. During the first ~tage the implant portion is buried in the bone and the tissue is restored in place over it.
T~me is al~owed to pass while new bone grows about, and often over, the implant~ The tissue i~ then reopened at the start of 25 the ~econd stage. If bone has grown over the 6ubmerged implant, it must be removed by a burr before the abutment can be installed. If the bone grows into the threaded aperture for the abutment, however, removal of this bone may be very di~ficult. Consequentlyt it is conventional to ~nstall a 30 thread cap having a low height into the aperture during the first stage. However, bone also grows over this ca~ and it must be removed in order to replace the cap with the abutment.
Removal of such bone may cau~e some loosening of the implant portion.
With the present invention, the cvllar 65 is used wi~h a screw 68 as a temporary cap a~ ~hown in Fig. 11. Even if bone grows up over the ~dges o~ the collar 65, there is no need to remove it hecause ~t becomes part of the permanent abutment.
In particular cover ~crew 68 is removed during the second stage operation, which may require the removal of a ~mall amount o~
~2~ 6 bone ~hat has grow~h over the ~crew. ~h~n th~ cover ~crew 68 is replaced with threaded shaft of abutment ball 60 which has ~he abutment casings ~2, ~4 already installed. Thu5 the collar S5 ~hich is anchored in bone, need not be freed from the bone as in prior art caps, but becomes part of the ~inal abukment structure.
lo Figs. 12 and 13 ~how front and ~ide ~ectional views of an incisor o~ a patient whic~ is supported hy an implant according to the present invention. As can be . een, particularly ~rom Fig. 13, the patient' 8 upper ~ront jaw bone ~as only a thin amount of good bone 11 and thi~ bone is at an angle to the regular alignment of the other incisors in the patient's mouth. Utilizing the present invention, i~plant portion 10 is located in the center of the main portion of this bone. After this implant portion 10 is firmly anchored in good bone, either immediataly after its insertion or ~fter several weeks or months have been allowed to pass, the abutment portion is installed. The a~utment portion is a ball and socket ~oint like that in Fig. 7 having a set ~crew 48 which locks the ball 46 at the proper angle. The cylinder 50 of the artificial tooth support is then attached to the ~et screw via an attachment screw 52. As shown in cross ection in Fig. 13, cast metal 58 surrounds cylinder 50 and a porcelain or plastic dental material 70 forms the tooth structure ~baut the metal.
Besides being used to mount a single toath, the implants according to the present invention can be used as supports for a permanent bridge or a removable bridge. In the case of ~ removable bridge the abutment cylinder is in the form of small copings w~ich can be spaced throughout the edentulous span of a patient. These copings ~upport a bar onto which the bridge structure may be screwed or clipped.
While the inventio~ has been particularly shown and described with reference to pr ferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be ~ade thereon without departing from the spirit and scope of the invention.
IMPLANT AND METHOD OF l~TILIZATION
Technical Fi~l~
This invention relatss to dental implants and, more particularly, to submergible screw-type implants.
15 sackqround Art Screw-type implants are well known in the art. U.S.
Patent No. ~,499,22~ of L. I. Lin~ow et al. discloses screw-type implants ~hich may be buried in the alveolar ridge crest bone of a patient in an edentulous region. The implant has a 20 threaded lower poxtion which may`be screwed into an opening created in the bone after the tissue has been displace~. A
coronal portion protrudes above the bone and is used to support an arti~icial dental appliance, e.g. an artificial tooth or bridge.
In ~ore recent year's submergible implants have been created in w~ic~ the threaded po~tions of the implants can be completely embedded in the bone. They may then be covered with tissue and allowed to remain in place while new bone grows around the implant and through vent holes in it. Onc~ it is 30 firmly anchored in new bone (3 to 6 months), the tissue is reopened and an upper post portion is screwed into the implant portion and is used tn mount the artificial dental device.
It is advantageous when installing an implant portion in the patent's bone, if the implant is self-tapping in a bore 3~ created in the bone. This causes it to be anchored better.
Also, it would be advantageous if the bone chips crea ed during a sel~-tapping operation were deposited into the bore or opening because these chips promote ~aster bone yrowth because of their au~ogenous nature.
~g~
In order to align the artificial tooth or other dental devices with the other teeth of the patient, it may be necessary ~o have the post portion at an angle to the implant portion. This may be accomplished by bending the post portion so that its head is at an angle to the threaded ~ha~t~ This bending may be accomplished before the post i threaded into the implant portion or afterward. I~ the post is bent before attachment to the implant, the proper allgnment is diffi~ult to achieve. I~ bent after attachment, there i~ a danger that too much stress will be put on the implant portion and it will loosen in the bone and fail. Also bending the post may fatigue the metal of the post and cause breakage.
Disclosure of the Invention The present invention is directed to a dental implant which, in its preferred form, is of the ~ubmergible screw type with a longitudinal channel or slot through the threads so as to impxove their self-tapping ahility. The implant also has an angled swivelable connector to allow the post for supporting an artificial dental appliance to be positioned in proper alignment with other teeth in the patient'~ mouth without applying stress to the implant.
In an illustrative embodiment of the invention, the implant portion o~ the device includes a threaded region that contains a longitudinal channel through a portion of the outer parts of the threads. The channel i5 wider toward its bottom.
One side of the channel ~s at a right angle to the implant circumference so as to create a cutting edge that assists in the formation of a self-tapping capability for the implant when it is installed in a bore or opening in the patient's bone.
The other side of the channel is at an oblique angle to the circumference.
The channel guide bone chips created during the threading of the implant toward the base Qf the bore in the bone. By terminating the channel below the uppermost threads, epithelial tissue is prevented ~rom growing down into the bone along the channel.
The post ~r abut~ent portion of the implant which supports an artificial dental applia~ce may be ~ ~traight portion on to which the appliance is threaded. However~ in situations where it must ~e at an angle to the implant portion, the abutment may be a separate piece from the implant portion and may be at~ached there~o at an angle by ~eans o~ a 10 connection portion o~ the ~butment~ The connection portion may be in the ~o~m of a rotat~le ~eveled collar, a ball and socket joint, or other ~uita~le means that allow ~he pos~ to ~wivel about the axis of the ~mplant portion and/or to assume various angles with respect to th~t axis. Once in place, means are 15 provided ~or securing the ~butment against ~urther movement with respect to the implant portion. A5 a result the implant can assume a desired angl~ to assure proper alignment of the artificial dental structure with the other teeth of the patient along the occlusal planeO
The ~resent invention also contemplates a unique surgical method. With ~hi~ method an incision i~ made in the tissue covering the alveolar ridge crest bone. This underlying bone is then exposed and ~ bore is drilled into the bone at a depth sufficient to hold t~e implant portion of the device.
25 The bore is made slightly ~maller in diameter than the implant device and is at an angle which will allow it to 0ngage the ma~or por ion of the avail~ble bone. Then the implant device is threaded into the remaining bone about the bore utiliæing its self-tapping threads ~nd the ~el~-tapping feature of the 30 channel along its length. It is typically buried at a depth such that it is submerged ~elow the upper ~urface in the bone and i~ completely ~uried in the bone.
During the insertion procedure bone chips are removed from the walls oP the bor~ while forming the grooves in the 35 bone which match ~he threads in the implant. These bone chips drop along the channel to ~he base of the bore and help to promote growth of new bone which Pirmly anchors the implant in place.
ThrPading ~f the implant portion into place may be accomplished with ~ hexagonal projection or recess located at ~2~9~i the free end of the implant portion. This hexagonal ~ection is connected to a wrench type device to screw the implant int~ the bone.
Once secured in place a cover o~ minimal height may be attached to the exposed surface o~ the implant portion by a screw passing throu~h the cover ~nd threaded into an aperture in that ~urface. The tissue may then ~e sutured over the implant cover. New bone is allowed to grow and to anchor the cover and implant firmly in place. Several weeks or ~onths latex, the tissue is opened again and the cover is removed. A
threaded abutment or po~t is then attached to the threaded aperture in the end ~f the implant portion. This abutment is used for supporting the artificial dental appliance~
The angle at which the implant portion is l~cated in the bone may not be the most conducive to the proper alignment of the artificial tooth or other dental devices with the remaining teet~ of the patient. As a result, the abutment includes an an~led, swivelable connection portion for attaching the abutment to the implant portion~ Xn one embodiment fixed angular devices which are rotatable about the longitudinal axis of the implant are utilized, and in another embodiment the part is continuously swivelable to any desired angle. In either case, after the a~utment or ~upport for the ar~i~icial tooth is at the propcr angle, it is locked such that it remains in that position. Finally, the tissue is closed about the abutment and the arti~icial tooth or bridge support is cemented or screwed to the abutment.
f description of the drawinq~
The foregoing and other features of the present invention will be more readily apparent from the following detailed description and drawings of illustrative embodiments of the invention, in whicho Fi~. 1 is a sc~em~tic cross section of the side of a patient's ~ace showing the alveolar ridge crest with a screw type implant according to the presen~ invention installed therein;
9~ii Fig. 2 is an enlarged view o~ an illustrative embodiment of the implant portion of the device ~ Fig. 1 with an external hex pro~ection;
Fig~ 3 is a top view of the implant por~ion of ~ig. 2 showing ~he external hex portion;
Fig. ~ is a cros~-~ectional view through the i~plank portion o~ Fig. 2 along line 4-4 ~howing the cross-sectional shape of the channel accordin~ to the pr0sent invention;
Fig. 5 is an implant portion o~ a ~crew-type implant according to the present invention with an internal hex recess;
Fig. 6 is a illustrative embodiment of a completed screw-type implant with an angularly positioned threaded sha~t attached thereto;
Fig. 7 is a cross-sectional view of ~ ball and socket connection portion of an abutment according to the present invention;
Fig. 8 illustrates a modi~ication o~ the ball and soc~et joint of Fig. 7;
Fig. 9 illustrates a further modification o~ the ball and socket joint of Fig. 7;
Fig. 10 is a ball and socket joint connection portion with a stationary ball;
Fig. 11 is a side view ~ a healing collar according to the present invention; and Figs 12 and 13 are front and side ~ectional views of an artificial tooth with an abutment according to Fig. 7.
Description of_Illustrative Embodiments The present invention contemplates at least a two part screw type dental implant, i.e, an implant portion 10 which is buried in the bone of th patient and ~ post or abutment portion 20 which ~s attached thereto and which supports an artificial tooth s~ructure 30. As ~hown in Fig~ 1, an implant screw portion 10 is located in a bore in the aveolar crest 11 at an angle thak causes it to be in the center o~ the thickest portion of good available bone. The abutment 20 is attached both to the implant portion 10 and the artificial tooth 30, and ., .
is s~t ~o that the tooth is at an angle to the i~plant which causes the tooth to be in proper alignment.
In Figs. 2 and 3 the ~crew implant portion 10 of Fig~ 2 i5 illustrated in ~ore detail. This implant portion 10 contains thrQads 13 which extend over the middle region o~ ~he implant portion. ~h~se ~hreads ~ay have ~ fl~t ~o~tom ~nd be angled up to form a Christmas tree shape in cross section. The lower half of the implant portion 10 contains ~ cavity 14 ~shown in dotted line). Also, ~paced a~out the lower end o~
the implant ar~ holes or vents 16, 16a and 16b, which penatrate from its exterior to the interior cavity 14. The purpose of 15 these vents is to allow new bone to grow through and into the center cavity in order to firmly anchor the implant in the patient's bone. The upper surface 17 of the implant portion defines a threaded aperture 19 which is used to connect the abutment 20 to the implant portion 10. The pro~ecting structure 12 which forms sur~ace 17 has a hexagonal ~hape as shown more clearly in Fig. 3. This hexagonal ~hape allows a tool, e.g. a wrench, to be used to rotate the implant portion so as to thread it into the patient's bone.
According to the present invention a channel 18 is cut 25 through the threads 13 a~d possibly in~o the outer casing of the implant portion 10. As depicted in dotted line in Fig. 3 and in cross ~ection in Fig. 4, the channel 18 is one of three channels 18, 18a, 18b in a typical implant portion. ~hese channels are made to intersect the re~pective ven~s ~6, 16a and 30 16~ which are spaced at angles of 120- about the circumference of the implant portion 10. The channels do not extend completely toward the upper surface 12 in order to prevent tissue ~rom growing down along the channel, and to prevent the incursion of food and bacteria. It ~hould be particularly 35 noted in Fig. 4 that the channel~ 18 have one edge wh;ch is at about 90- to the circumference of the implant, i.eO, ~urface ~18', and another m~re obliquely shaped edge, i.e. ~urface 18''.
Durin~ installat~on of the implant, an incision is made in the gum tissu~ o~ the pa~lent and the underlying bone i~
exposed. Then a drill or burr is used to make an opening or bore hole in the bone which is slightly larger in diameter than the implant porti~n body ~o, ~ut which is not as wide as the threads 13. A wider counterbore ~ay be provided to ac~ommodate a protection collar as explained ~ub~equsntly. N~xt the implant is inserted up to the firct thread in the opening in the bone. A tool, such ~s a wrench, ~s u~ed to ~ngage the hex lO portion 12 and to rotate the implant. Th~ threads 13 ar~ made to be self-tapping s~ that ~he implant portion will begin to screw down into the patient's bone. I~ necessary, a b~ne tap can be used to create grooves ;n the hard upper cortical bone prior to insertion of the implant portion. The riqht angle 15 surface 18' of ~he channel also has self-tapping properties so as to ease the insertion of the implant, once it has reached the depth of the channels 18. Further turning o~ ~he implant causes the right an~le surface 18' to ~crape off bone as the implant is being threaded and to push the resulting bone chips 20 forward. This causes the bone chips to fall through the channels 1~ and into the area of the vents 16 where they may penetrate into the interior cavity 14. To facilitate this, the channels 18 are made wider towards the vents 16.
As a result o~ this structure, bon2 chips created 25 during the implant procedure tend to accumulate at the base of the implant in the patient's bone. Because of the autogenous nature of these bone chips they promote the growth of new bone in the area and speed the ~ormation o~ new bone around and through the implant such that it is anchored in place more 30 rapidly.
In Fig. 5 there is shown an implant portion 10 which is nearly i~entical to that shown in Fig. 1. ~he principal difference is that, rather than having a hexagonal projection useful for applying ~orque ~o the implant, a hexagonal reces~
35 12' is provided. In add~tion, ~he threaded aperture 19' is made somewhat smaller and is located at the bas~ of hexagonal reces~ 12'. As explained previously, th~ threaded aperture 19' is used ~or attaching the implant portlon oP the device to ~he abutment portion. One embod?ment o~ such an attachment is shown in Figure 6.
~L2~ L9~i In Figure 6 the upper part ~f the implant portion 10 is shown partly broken away and parkly in ~ection. It ic ~hown partly broken away to ex~ibit the in~erior cavity 1~ and the ~hreads 13. Towards the up~er part o~ t~e implant portion it is shown in ~ross sec~ionO Thi~ implant portion i~ like that shown in Figl 5 with a hexagonal recess 12' ~or rotating it into position in the ~ne. ~s 6hown in Figure 6 the screw type implant portion 10 is connected to an abutment portion 20 that includes a transitional collar 21, an angled threaded shaft 24, and a tooth support cylinder 31~ The threaded 6haft 24 has its lower end æ~rewed into threaded aperture 19' in the implant portion 10. The upper end of the threaded ~ha~t, which is ~et at an angle ~ the lower end, is rec~ived within a threaded aperture 35 in tooth support cylinder 31~ This cylinder 31 contains a recessed por~ion 32 which may ~e utilized in fixing on to the cylinder via cement ~r ome other convenient and well known method, a porc~lain, plastic, or other dental tooth-colored veneering material in the fcrm of ~n ar~i~icial tooth.
The transitional c~llar 21 is located between the upper end of the implan~ portion 10 and t~e ~ylinder 31. This collar has an angled upper surface 25 and a perpendicular lower surface 23. The angle o~ the upper ~urface is ~ade to equal the angle of the upper part of the anyled ~ha~t 24. While collar 21 surrounds threaded shaft 24, it does not engage its threads.
.During an installation procedur~ the implant portion 10 is located in the patient's ~one as previously described. The gingival tissues can then ~e replaced over the implant portion and several weeks or months allowed to pa~s while new bone grows around and through the implant portion. How~ver, alternatively the artificial tooth can be connected to the implant immediat~ly r Whiche~er ~anner is chosen, the attachment is accomplished by selecting an angled ~haft and transition collar which have an angle which will cause ~he artificial tooth to be correctly aligned with the other teeth of the patient. Therefore th~ dentist or oral ~uxgeon must be provided with a variety of such ~hafts a~d collars which are at standard angles. A1SD during the insertion prQcedure the surgeon must appropriately angle the opening in the bone so it penetrates a reas~nably thick area oP good bone. This may requir~ that the open ng in the bone be drilled at an angle in ordPr to av~id penetrating a near~y sinus cavity, passing completely through th~ bone, or contacting a nerve bundle.
10 Rowever, in selecting the angle at which th~ implant is buried, care must be taken to make sure that this angle will accommodate one of the standard angles available with the threaded shafts and collars, e.g. 10, 20 or 30 degrees, ~o as to result in alignment between the new artificial tooth and the 15 remaining teeth of the patient.
Once the threaded sha~t 24 is en~aged with the implant portion 10, the collar 21 is slipped over the free end of the shaft. Then the shaf~ is rotated ~o that it is firmly secured in the implant por~ion and is extending in the proper zO direction. With the collar in place over this shaft, the cylinder portion 31 is threaded oYer the open or free end of the shaft until it makes tig~t contact with the upper urface of the collar and begins to ~ueeze the collar between the cylinder and implant portions. Notches ~nd recesses 22 and 27 2~ are provided in ~he mating surfaces ~uch th~t, once the parts are screwed together, these ~otcnes and recesses engage each other and prevent unintentional unscrewing of the portions of the implant. Wit~ this *irm attachment completed, the artificial tooth can ~hen bP attached over the abutment 30 cylinder 31.
In ~igure 6 the level the patient's bone is ~hown as dotted line 70. Since the implant portion is submerged in the bone, the line 70 int~rsects the lower portion o~ the transitional collar 20. The gum tis ue line 72 $s towards the 35 upper portion of ~he transi~ional collar. As a resul~ the collar acts a barrier to prevent the encroachment of bacteria and food into the interior portion o~ the collar and the hex recess of the implant portion.
With the emb~diment of Figure 6 fixed angl~s are provided to the dentist and he must work with the ~tandard ~2~
angles and the angle whi~h ~ create~ for the bore in the patient's ~one~ in ord~r to ~ssure proper alignment o~ the teeth. In ~ome patients who have had ~erious bone disease, the amount of available good bone is li~ited and the d~ntist has only a limited amo~nt o~ ~re4dom in selectin~ the angle at which the bore ~or the implant iR made. Also with the 10 embodiment o Figure 6 ~ necessary for a dentist to keep a stock of various angled shafts and collar5. The difficultly presented by the type o~ implant in Figure 6 is overcome by the implant ~h~wn in Figure 7.
In Figure 7 the angl~d shaft and tran~ition collar are 15 replaced with a ~all and ~oc~et joint which allow~ for the settin~ of the angled relatiDnship between the implant portion and the abutment portion at ~ny selected angle within the range of motion of the ball and socket joint, e.g. up to 30-40 degrees. In Fig. 7 the threaded cavity 19 receives the 20 threaded sha~t o~ a lower or inner abutment casing 42. This casing has a generally Y-shape with the lower portion being the shaft that extends intD and ~ngage the threads of cavity 19.
The upper portiDn o~ casing 42 has a hemispherical ~urface 45 such that it can receiYe a ball 46. An upper or outer casing 25 44 screws ont~ out~r t~reads of the inner casi~g 42 such that ball 46 is trapped within the abutment casiny, but is free to rotata tharein ~o a~ to ~reate a ball and ~ocke~ joint.
A relatively large ~P~ ~crew 48 penetrates the ball completely. This set screw 48 has 4n internal threaded ca~ity 30 55 which passes through an upper ~exagonal projection 56. Once the implant portion 10 has ~een located in the bone at the optimal anqle, the ~all 46 is rotated such that the center axis of the ~et screw i~ a~ the proper angle ~or mounting o~ an artificial ~ooth in lina wit~ o~her ~eeth in the patient's 35 mouth. Then the hexagonal p~rtion 56 is rotated with a wrench or other tool so the set ~craw comes into extreme frictional contact with ~he hemisp~erical surface 45 of inner casing 42.
This prevents further rotation of the ball and the 6et 6crew.
~ he arti~i~ia~ t~Dth.structure in ~he embodimen~ o~
Figure 7 has an interior cylinder 50, abo~lt which the porcelain, plastic or other dental ~aterial i8 formed to create the artificial tooth structure. ThiG cyllnder 50 with the artificial tooth ~tructure ~ounted therson, ~ placed on top oP
the hexagonal projec~ion 56 ~nd i~ ~hen attached thereto by means of a screw 52 which passes through the cylinder 50 and into the threaded aper~ure 55 in set screw 4B.
The bone line 7~ is ~hown in Figure 7 as being approximately mid way through tha lower abutment casing 42, while the gum line 72 is just below th2 upper edge of the outer or upper casing 44. Thus, the bone does not interfere with the setting Qf the proper angle for the abutment and th~ tissue is not likely to contact moveable adjustment part~.
The arrangement of Figure 8 i8 ~ ~odification 0~ that shown in Figure 7. In this arrangement the ~et ~crew 48, which has a threaded recess 55 at its end in Fig. 7, is replaced with a set screw 49 that has a further screw thread 59 on the opposite side of the hex projection 56. This additional screw thread i~ used to mount an arti~icial tooth ~upport cylinder 53 which has an interior threaded cavity. However, this device is essentially located and ~ixed i~ position in the same manner as the implant of Figure 7. One difference with thi6 implant of Figure 8 is that the artificial tooth ~upport cylinder 53 may extend down to and in contact with the outer casing 44. This is done above the gum tissue line 72 as ~hown in the Pigure.
Because of the contact between the cylinder and the casing 44, food and bacteria are prevented from entering between these two parts and the likelihood of infection i~ reduced. However, this arrangement allows for ~omewhat less range of angular adjustment. In particular th~ arrangement o~ Fig. 7 i~ capable of an angular adjustment range of ~pproximately 37 1/2~, while that o~ Fig. 8 is limited to about 30-.
As a further alternative, the ~et screw 48, rather than having a projecting threaded portion located ~bove the hexagonal adjustme~t nut 56, may have a projecting cylinder which is internally threaded (no~ show~). Thus ei~her a male or female connection of this type may be used without difficulty.
~2~ 6 In order to get increased angular adjustment, an arrangement ~uch as that ~hown in Fig. 9 may be used. The abutment arrangement of Figure 9 is es~entially the ~ame as that o~ Figure 7; however, the ball and 60cket ~oint are made smaller and the ball sits higher ~n the .ocket ~intO Further, the set ~crew 54 of Fig. 9 is made to have a beveled surface 57 lO such that a greater angular rotation ~ay be made before it contacts the upper part of the outer casing 44. With ~his arrangement nearly 45 degrees of angular adjustment can be achieved.
The abutment cylinder 50 has ~ recess 51 to receive the 15 outer end of the set screw 54. This allows ~or greater stability when it is attached to the ~et ~crew by m~ans of attachment screw 52. ~he cylinder 50 is also angled in the same manner as the surface 5~ of the ~et ~crew 54 50 that it does not bind against the upper abutment ca~ing 44 and limit 20 angular rotation~
In Fig. 7-9 the ball rotates with the set ~crew during angular adjustment. ~owever, as an alternative, the ball may remain stationery and the abutment casing may rotate as shown in Figure 10. In Figure 10 a threaded ball joint 60 has a 2 projecting thxeaded shaft 61 whiah i5 received in threaded rec~ss l9 of the implant portion 10. Various size prote~tion washers or collars 6~ ca~ be located about the flnial part 67, which connects the ball to the threaded ~ha~k, in order to cover the upper surface of whatever ~mplant portion i~ used, 30 thereby preventing bacteria and food ~rom enterin~ the bore.
The opening in the bone can be countersunk as indicated by dotted line 70 so the collar can extend out beyond the implant portion upper surface, and bone can grvw over part of the upper surface of the collar.
A two-part casing 62, 64 is ~ounted on the ball 60.
The casing includes outer casing porti~n 62, which secures the remote end o~ ~he ball, 2nd an inner casing ~4, which provides the main hemispherical ~urface against which the outer casing holds the ball in a rotatable manner. These two casing parts can be threaded together or attached to each other in any convenient manner. Their attachment, ~owever, i~ ~uch that the casing may rotate ~reely on the ball.
At the opposite end of ball 60 from the ~crew threads is a ~exagonal recess 63, w~ich is ~h~ ~ean~ ~y which this threaded ball joint is screwed into the threaded recess 19 of the i~plant portion. In this arrangemen~ the gum line 72 is 10 shown about 1/3 up ~rom the base of the ball ~oint, but below the lower extension of casing 62.
A hexagonal pro~ection 66 i6 provided on the inner casing 64. This project~on can be us~d to rotate the inner casing 64 so that the ball is sgueezed between it and the outer 15 casing 62 ~o that swiveling can be prevented when th~
arrangement is at the proper angle. A conventional cylinder 50 for a dental prosthesis is attached to the inner casing 64 by means of a screw 52~ This screw 52 p~netrates a threaded aperture in the inner casing.
Installation of submergible implants i generally a two stage procedure. During the first ~tage the implant portion is buried in the bone and the tissue is restored in place over it.
T~me is al~owed to pass while new bone grows about, and often over, the implant~ The tissue i~ then reopened at the start of 25 the ~econd stage. If bone has grown over the 6ubmerged implant, it must be removed by a burr before the abutment can be installed. If the bone grows into the threaded aperture for the abutment, however, removal of this bone may be very di~ficult. Consequentlyt it is conventional to ~nstall a 30 thread cap having a low height into the aperture during the first stage. However, bone also grows over this ca~ and it must be removed in order to replace the cap with the abutment.
Removal of such bone may cau~e some loosening of the implant portion.
With the present invention, the cvllar 65 is used wi~h a screw 68 as a temporary cap a~ ~hown in Fig. 11. Even if bone grows up over the ~dges o~ the collar 65, there is no need to remove it hecause ~t becomes part of the permanent abutment.
In particular cover ~crew 68 is removed during the second stage operation, which may require the removal of a ~mall amount o~
~2~ 6 bone ~hat has grow~h over the ~crew. ~h~n th~ cover ~crew 68 is replaced with threaded shaft of abutment ball 60 which has ~he abutment casings ~2, ~4 already installed. Thu5 the collar S5 ~hich is anchored in bone, need not be freed from the bone as in prior art caps, but becomes part of the ~inal abukment structure.
lo Figs. 12 and 13 ~how front and ~ide ~ectional views of an incisor o~ a patient whic~ is supported hy an implant according to the present invention. As can be . een, particularly ~rom Fig. 13, the patient' 8 upper ~ront jaw bone ~as only a thin amount of good bone 11 and thi~ bone is at an angle to the regular alignment of the other incisors in the patient's mouth. Utilizing the present invention, i~plant portion 10 is located in the center of the main portion of this bone. After this implant portion 10 is firmly anchored in good bone, either immediataly after its insertion or ~fter several weeks or months have been allowed to pass, the abutment portion is installed. The a~utment portion is a ball and socket ~oint like that in Fig. 7 having a set ~crew 48 which locks the ball 46 at the proper angle. The cylinder 50 of the artificial tooth support is then attached to the ~et screw via an attachment screw 52. As shown in cross ection in Fig. 13, cast metal 58 surrounds cylinder 50 and a porcelain or plastic dental material 70 forms the tooth structure ~baut the metal.
Besides being used to mount a single toath, the implants according to the present invention can be used as supports for a permanent bridge or a removable bridge. In the case of ~ removable bridge the abutment cylinder is in the form of small copings w~ich can be spaced throughout the edentulous span of a patient. These copings ~upport a bar onto which the bridge structure may be screwed or clipped.
While the inventio~ has been particularly shown and described with reference to pr ferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be ~ade thereon without departing from the spirit and scope of the invention.
Claims (31)
PROPERTY OR PRIVILEGE IS DEFINED ARE CLAIMED AS FOLLOWS:
1. An implant portion of an implant designed for supporting a prosthetic structure comprising:
an implant body having threads over at least part of its exterior surface and being adapted to be threaded into an opening in a bone of a patient which bone has been exposed by an incision in the covering tissue; and at least one channel formed such that it at least extends through threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads, said one edge being adapted (i) to promote self-tapping of the threads in the bone, (ii) to shave off pieces of bone during threading of the implant portion into the bone, and (iii) to direct the pieces of bone into the channel such that the channel may direct pieces toward the base portion of the opening.
an implant body having threads over at least part of its exterior surface and being adapted to be threaded into an opening in a bone of a patient which bone has been exposed by an incision in the covering tissue; and at least one channel formed such that it at least extends through threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads, said one edge being adapted (i) to promote self-tapping of the threads in the bone, (ii) to shave off pieces of bone during threading of the implant portion into the bone, and (iii) to direct the pieces of bone into the channel such that the channel may direct pieces toward the base portion of the opening.
2. An implant portion of an oral implant designed for supporting an artificial tooth structure comprising:
a generally cylindrical implant body having a plurality of circumferential projections extending over at least part of its exterior surface and being adapted to be installed in an opening in the bone of a patient by rotation thereof at least in part; and at least one channel formed such that it extends generally longitudinally through the projections of the body for directing bone chips towards a base portion of the opening in the bone, one edge of the projections at one side of said channel beings substantially at a right angle to the circumferential direction of the implant body, said one edge being adapted (i) to promote self-tapping of the projections in the bone during rotation of the body, (ii) to shave off pieces of bone during rotation of the implant body, and (iii) to direct the pieces of bone into the channel such that the channel may direct the pieces toward the base portion of the opening.
a generally cylindrical implant body having a plurality of circumferential projections extending over at least part of its exterior surface and being adapted to be installed in an opening in the bone of a patient by rotation thereof at least in part; and at least one channel formed such that it extends generally longitudinally through the projections of the body for directing bone chips towards a base portion of the opening in the bone, one edge of the projections at one side of said channel beings substantially at a right angle to the circumferential direction of the implant body, said one edge being adapted (i) to promote self-tapping of the projections in the bone during rotation of the body, (ii) to shave off pieces of bone during rotation of the implant body, and (iii) to direct the pieces of bone into the channel such that the channel may direct the pieces toward the base portion of the opening.
3. An implant as claimed in claim 2 wherein the projections are threaded and the implant portion is installed by threading it into the opening in the bone.
4. An implant portion of an oral implant designed for supporting an artificial tooth structure comprising:
an implant body having threads over at least part of its exterior surface and being adapted to be threaded into an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering fibromucosal tissue; and at least one channel formed such that it at least extends through the threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads and the other edge of the threads at the other side of the channel being at an oblique angle to the circumferential direction of the threads, said one edge being adapted (i) to promote self-tapping of the threads in the bone, (ii) to shave off pieces of bone during threading of the implant portion into the bone, and (iii) to direct the pieces of bone into the channel such that the channel may direct pieces toward the base portion of the opening.
an implant body having threads over at least part of its exterior surface and being adapted to be threaded into an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering fibromucosal tissue; and at least one channel formed such that it at least extends through the threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads and the other edge of the threads at the other side of the channel being at an oblique angle to the circumferential direction of the threads, said one edge being adapted (i) to promote self-tapping of the threads in the bone, (ii) to shave off pieces of bone during threading of the implant portion into the bone, and (iii) to direct the pieces of bone into the channel such that the channel may direct pieces toward the base portion of the opening.
5. An implant portion as claimed in claim 4 wherein the implant body has a cylindrical shape and at least one vent extending at least part way into the body.
6. An implant portion as claimed in claim 5 wherein the channel is formed generally in the direction of the longitudinal axis of the cylindrically shaped body at the circumferential location of the vent.
7. An implant portion as claimed in claim 6 wherein a plurality of vents and channels are located over the circumference of the body.
8. An implant as claimed in claim 6 wherein the channel is wider in the longitudinal direction of the body toward the vent and the vent is towards the end of the body remote from the artificial tooth support structure.
9. An implant portion as claimed in claim 6 wherein the body is hollow over a lower section thereof which is adapted to be positioned toward the base of the opening in the bone, the lower section creating an open interior cavity and the vent being located so as to penetrate to the interior cavity.
10. An implant portion as claimed in claim 4 wherein an upper section thereof, which is adapted to be directed away from the base of the opening in the bone when installed, includes connecting means for connecting an abutment for supporting an artificial tooth structure to the implant portion.
11. An implant portion as claimed in claim 10 wherein said connecting means is a threaded recess in said upper section.
12. An implant portion as claimed in claim 10 further including an engagement means attached to said implant body for facilitating the connection of a tool to the body for the rotation of the body so as to thread it into the opening in the bone, said engagement means being formed on said upper section.
13. An implant portion as claimed in claim 12 wherein said engagement means is a hexagonal projection on the upper section which is penetrated by said threaded recess.
14. An implant portion as claimed in claim 12 wherein said engagement means is a hexagonal recess in said upper section which terminates said threaded recess.
15. An implant portion as claimed in claim 4 wherein the body is adapted to be completely buried in the bone.
16. An implant portion as claimed in claim 15 wherein an upper section of the implant portion is remote from the base of the opening in the bone when the implant portion is installed, and further including:
connecting means for connecting an abutment for supporting an artificial tooth structure to the implant portion, a healing cap, and means for attaching the healing cap to the upper section such that bone cannot regrow into the connecting means.
connecting means for connecting an abutment for supporting an artificial tooth structure to the implant portion, a healing cap, and means for attaching the healing cap to the upper section such that bone cannot regrow into the connecting means.
17. An oral implant for supporting an artificial tooth structure comprising:
an implant portion adapted to be fitted in an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering of fibromucosal tissue;
a support for an artificial tooth structure;
a threaded angular shaft connected at one end to an outer end of said implant portion which is directed away from the opening in the bone when the implant portion is installed therein, the other end of the shaft being at a preselected angle to the one end connected to the implant portion and being adapted for threaded engagement with said support; and a beveled transition collar located about the shaft between the upper end of the implant portion and the support, the collar having one end surface at a right angle to the collar axis and the other end surface being at an angle with respect to the one end surface which is substantially the same angle as the shaft angle, threading of the abutment onto the shaft being effective to cause the abutment and the implant portion to frictionally engage the collar, thereby impeding disconnection of the shaft and abutment from the implant portion.
an implant portion adapted to be fitted in an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering of fibromucosal tissue;
a support for an artificial tooth structure;
a threaded angular shaft connected at one end to an outer end of said implant portion which is directed away from the opening in the bone when the implant portion is installed therein, the other end of the shaft being at a preselected angle to the one end connected to the implant portion and being adapted for threaded engagement with said support; and a beveled transition collar located about the shaft between the upper end of the implant portion and the support, the collar having one end surface at a right angle to the collar axis and the other end surface being at an angle with respect to the one end surface which is substantially the same angle as the shaft angle, threading of the abutment onto the shaft being effective to cause the abutment and the implant portion to frictionally engage the collar, thereby impeding disconnection of the shaft and abutment from the implant portion.
18. An oral implant as claimed in claim 17 wherein the surfaces of said collar, the upper end of the implant portion and the support have projections and recesses to increase the frictional engagement.
19. An oral implant as claimed in claim 17 wherein the implant portion comprises;
an implant body having threads extending over at least part of its exterior surface and being adapted to be threaded into the opening in the bone of the patient; and at least one channel formed such that it at least extends through the threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads and the other edge of the threads at the other side of the channel being at an oblique angle to the circumferential direction of the threads, said one edge being adapted (i) to promote self-tapping of the threads in the bone, (ii) to shave off pieces of bone during threading of the implant portion into the bone, and (iii) to direct the pieces of bone into the channel such that the channel may direct the pieces toward the base portion of the opening.
an implant body having threads extending over at least part of its exterior surface and being adapted to be threaded into the opening in the bone of the patient; and at least one channel formed such that it at least extends through the threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads and the other edge of the threads at the other side of the channel being at an oblique angle to the circumferential direction of the threads, said one edge being adapted (i) to promote self-tapping of the threads in the bone, (ii) to shave off pieces of bone during threading of the implant portion into the bone, and (iii) to direct the pieces of bone into the channel such that the channel may direct the pieces toward the base portion of the opening.
20. An oral implant for supporting an artificial tooth structure comprising:
an implant portion adapted to be fitted in an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering fibromucosal tissue, said implant portion including an implant body having threads extending over at least part of its exterior surface and being adapted to be threaded into the opening in the bone of the patient in the vicinity of the occlusal plane, and at least one channel formed such that it at least extends through the threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads and the other edge of the threads at the other side of the channel being at an obtuse angle to the circumferential direction of the threads; and an abutment for supporting an artificial tooth structure, said abutment including ball and socket joint means for connecting said implant portion to said artificial tooth structure at selected angular positions with respect to each other, said ball and socket joint means including a generally spherical ball and socket casing surrounding a portion of the ball sufficient to retain the ball in the socket casing and locking means for locking the implant portion and abutment at the selected angular position.
an implant portion adapted to be fitted in an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering fibromucosal tissue, said implant portion including an implant body having threads extending over at least part of its exterior surface and being adapted to be threaded into the opening in the bone of the patient in the vicinity of the occlusal plane, and at least one channel formed such that it at least extends through the threads on the body for directing bone chips toward a base portion of the opening in the bone, one edge of the threads at one side of the channel being substantially at a right angle to the circumferential direction of the threads and the other edge of the threads at the other side of the channel being at an obtuse angle to the circumferential direction of the threads; and an abutment for supporting an artificial tooth structure, said abutment including ball and socket joint means for connecting said implant portion to said artificial tooth structure at selected angular positions with respect to each other, said ball and socket joint means including a generally spherical ball and socket casing surrounding a portion of the ball sufficient to retain the ball in the socket casing and locking means for locking the implant portion and abutment at the selected angular position.
21. An oral implant for supporting an artificial tooth structure comprising:
an implant portion adapted to be fitted in an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering fibromucosal tissue; and an abutment for supporting an artificial tooth structure, said abutment including ball and socket joint means for connecting said implant portion to said artificial tooth structure at selected angular positions with respect to each other, said ball and socket joint means including a generally spherical ball and a socket casing surrounding a portion of the ball sufficient to retain the ball in the socket casing, and locking means for locking the implant portion and abutment at the selected angular position, the socket casing includes an inner casing with a generally hemispherical surface for engaging one hemisphere of the ball and an outer casing which is attachable to the inner casing and engages portions of the other hemisphere of the ball, the inner casing having an opening at one side which is larger than the ball and the outer casing acting to at least partially close that opening when engaged with the inner opening so as to trap the ball between the casings.
an implant portion adapted to be fitted in an opening in a bone of a patient in the vicinity of the occlusal plane, which bone has been exposed by an incision in the covering fibromucosal tissue; and an abutment for supporting an artificial tooth structure, said abutment including ball and socket joint means for connecting said implant portion to said artificial tooth structure at selected angular positions with respect to each other, said ball and socket joint means including a generally spherical ball and a socket casing surrounding a portion of the ball sufficient to retain the ball in the socket casing, and locking means for locking the implant portion and abutment at the selected angular position, the socket casing includes an inner casing with a generally hemispherical surface for engaging one hemisphere of the ball and an outer casing which is attachable to the inner casing and engages portions of the other hemisphere of the ball, the inner casing having an opening at one side which is larger than the ball and the outer casing acting to at least partially close that opening when engaged with the inner opening so as to trap the ball between the casings.
22. An oral implant as claimed in claim 20 wherein the ball and socket joint means is in threaded connection with the implant portion.
23. An oral implant as claimed in claim 20 wherein the socket casing has a threaded projection received in a threaded recess in an outer end surface of the implant portion, said ball being rotatable and said locking means being in the form of a set screw which is received in a threaded aperture which extends completely through the ball and makes frictional contact with the socket casing.
24. An oral implant as claimed in claim 23 wherein the set screw has an attachment means remote from the end that engages the casing, which attachment means extends from the ball, said attachment means being provided for attaching a tool to the set screw so as to thread it into engagement with the casing.
25. An oral implant as claimed in claim 24 wherein the set screw has a threaded recess penetrating the attachment means, the artificial tooth support has an internal cylinder, and an attachment screw is positioned in the cylinder and engages the threaded recess in the set screw to secure the cylinder to the ball and socket joint means.
26. An oral implant as claimed in claim 24 wherein the set screw has a threaded projection extending beyond the attachment means, the artificial tooth support has an internal threaded cylinder which is positioned to be engaged in the threaded projection of the set screw.
27. An oral implant as claimed in claim 26 wherein the end of the cylinder adjacent the ball and socket joint means has a hemispherical shape matching that of the ball and casing, such that when it is threaded into place, a seal is formed between the cylinder and the ball and socket joint means so as to prevent foreign matter from entering the region between the cylinder and joint means.
28. An oral implant as claimed in claim 22 wherein the ball has a threaded projection received in a threaded recess in the outer end surface of the implant portion, said casing has an internal threaded recess, said artificial tooth support has an internal threaded cylinder, and an attachment screw is positioned in the cylinder and engages the threaded recess in the casing so as to secure the artificial tooth support to the ball and socket joint means.
29. An oral implant as claimed in claim 28 wherein the locking means comprises means for threading the inner casing into engagement with the outer casing so as to squeeze the ball between them.
30. An oral implant as claimed in claim 28 further including a collar located about a finial section between the ball and the threaded projection.
31. An implant as claimed in claim 28 further including a healing cap comprising:
a collar adapted to be located about a finial section between the ball and the threaded projection when the ball is installed in the implant body, said collar being over an upper end surface of the implant; and a screw adapted for penetrating the collar and engaging in a threaded recess in the upper end surface.
a collar adapted to be located about a finial section between the ball and the threaded projection when the ball is installed in the implant body, said collar being over an upper end surface of the implant; and a screw adapted for penetrating the collar and engaging in a threaded recess in the upper end surface.
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US904,381 | 1978-05-10 | ||
US06/904,381 US4713004A (en) | 1986-09-04 | 1986-09-04 | Submergible screw-type dental implant and method of utilization |
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CA1298496C true CA1298496C (en) | 1992-04-07 |
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CA000546078A Expired - Lifetime CA1298496C (en) | 1986-09-04 | 1987-09-03 | Submergible screw-type dental implant and method of utilization |
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EP (2) | EP0263274B2 (en) |
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-
1986
- 1986-09-04 US US06/904,381 patent/US4713004A/en not_active Expired - Lifetime
-
1987
- 1987-08-19 EP EP87112031A patent/EP0263274B2/en not_active Expired - Lifetime
- 1987-08-19 AT AT87112031T patent/ATE75590T1/en active
- 1987-08-19 DE DE3789973T patent/DE3789973T2/en not_active Expired - Fee Related
- 1987-08-19 EP EP91106346A patent/EP0449334B1/en not_active Expired - Lifetime
- 1987-08-19 DE DE8787112031T patent/DE3778817D1/en not_active Expired - Fee Related
- 1987-08-19 AT AT91106346T patent/ATE106221T1/en not_active IP Right Cessation
- 1987-09-02 IE IE872355A patent/IE872355L/en unknown
- 1987-09-02 AU AU77940/87A patent/AU7794087A/en not_active Abandoned
- 1987-09-02 BR BR8705136A patent/BR8705136A/en unknown
- 1987-09-03 NO NO873695A patent/NO873695L/en unknown
- 1987-09-03 DK DK459287A patent/DK459287A/en not_active Application Discontinuation
- 1987-09-03 CA CA000546078A patent/CA1298496C/en not_active Expired - Lifetime
- 1987-09-04 AR AR87308624A patent/AR242105A1/en active
- 1987-09-04 JP JP62221791A patent/JP2551779B2/en not_active Expired - Fee Related
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1990
- 1990-01-18 AU AU48540/90A patent/AU4854090A/en not_active Abandoned
- 1990-01-18 AU AU48541/90A patent/AU4854190A/en not_active Abandoned
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1991
- 1991-07-09 AU AU80321/91A patent/AU8032191A/en not_active Abandoned
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NO873695D0 (en) | 1987-09-03 |
DK459287A (en) | 1988-03-05 |
AR242105A1 (en) | 1993-03-31 |
AU4854090A (en) | 1990-05-10 |
DK459287D0 (en) | 1987-09-03 |
JPS63125251A (en) | 1988-05-28 |
AU7794087A (en) | 1988-03-10 |
EP0263274A1 (en) | 1988-04-13 |
DE3789973T2 (en) | 1995-01-19 |
EP0263274B1 (en) | 1992-05-06 |
BR8705136A (en) | 1988-11-29 |
DE3789973D1 (en) | 1994-07-07 |
ATE75590T1 (en) | 1992-05-15 |
ATE106221T1 (en) | 1994-06-15 |
AU8032191A (en) | 1991-10-03 |
IE872355L (en) | 1988-03-04 |
NO873695L (en) | 1988-03-07 |
AU4854190A (en) | 1990-05-10 |
EP0449334B1 (en) | 1994-06-01 |
DE3778817D1 (en) | 1992-06-11 |
JP2551779B2 (en) | 1996-11-06 |
EP0263274B2 (en) | 2000-06-28 |
EP0449334A1 (en) | 1991-10-02 |
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