treatment element for use with a dental implant part and treatment system

专利摘要:
TREATMENT ELEMENT FOR USE WITH A DENTAL IMPLANT PIECE, TREATMENT SYSTEM AND METHOD FOR CLEANING A DENTAL IMPLANT PIECE. The present invention relates to a treatment element (30, 30, 30) for use with a dental implant piece (2) inserted into a patient's jaw bone and a treatment system (90) with such a element of treatment (30, 30, 30), as well as a method, with which the treatment element (30, 30, 30?) can be inserted in a particularly favorable way. According to the invention, it is provided that the base body (40), for mechanical connection with the dental implant part (2), has a connection system fitted to it and that it is provided with at least one channel center (56) for a cleaning liquid.
公开号:BR112015010747B1
申请号:R112015010747-8
申请日:2013-10-18
公开日:2020-12-08
发明作者:Holger Zipprich
申请人:Zyfoma Gmbh；
IPC主号:

专利说明:

[0001] The present invention relates to a treatment element, particularly for use with a dental implant piece inserted into a patient's jaw bone. It also refers to a treatment system with such a treatment element.
[0002] A treatment system for cleaning a local implant, in which a base body for mechanical connection with an inserted implant part has a connection system suitable for that, is known, for example, from the document US 2012/028215 A1. In this system, a cleaning using diamond dust is provided, therefore, with a mechanical base, in which the remains that remain after cleaning can be washed using a washing liquid. The base body is provided with channels suitable for adding the washing liquid (for example, water). The treatment elements of the known technique are known from US 2010/291506 A1 and US 5,201,656 A.
[0003] .To compensate for the loss of a tooth, dental implants can be used in the context of reconstructive therapy. They are, in general, inserted in the jaw bone in place of an extracted or fallen tooth, in order to keep in that place, after a healing phase of about four to twelve weeks, a prosthetic piece that serves as a substitute tooth. or a crown. For this, such a dental implant is usually formed as a properly shaped metal body, which is inserted by screwing it in the predicted position, in the jaw bone. Thus, the dental implant usually has a self-tapping screw thread at the apical end, most of the time, with which the dental implant is inserted into the correspondingly prepared implant bed.
[0004] However, given the comparatively high number of implants inserted in the human body, in particular, in the dental field, as well as its relatively long useful life, a constant increase in the occurrence of inflammatory conditions of the peri-implant tissue associated with the biofilm was found. A biofilm forms on the solid surface of the implant, surrounded by tissue and interstitial fluid, which is colonized by bacteria, which can ultimately lead to chronic and recurrent infections. This pathological condition is called peri-implantitis. Particularly in the dental field, similarly to parodontitis, a combination of neglected oral hygiene, biofilm adhesion on the normally micro-corrugated surface of the abutment and other factors, is the cause of the general picture of peri-implantitis, which stands out for its load and destruction progressive hard and soft tissue. The areas, in which the hard and / or soft tissues recede, are covered, in this case, as a rule, with a biofilm.
[0005] Both treated and untreated, progress in peri-implant inflammation would lead to implant loss and damage to body and bone tissue in the area of the point of introduction. It is therefore desirable, after finding such inflammation, to introduce appropriate preventive measures as soon as possible. These can range from an optimization of oral hygiene to therapeutic interventions in the form of surgical measures, that is, the removal of the attacked implant and the new introduction of a substitute implant. In particular, however, the last measure mentioned is very stressful for the fabric as a whole and often occurs in conjunction with massive tissue degradation in the environment of the insertion point. Effective alternative measures to combat an imminent or existing peri- implantitis are therefore extremely desirable.
[0006] The invention, therefore, aims to specify a treatment element to combat or contain an impending peri- implantitis, which can be inserted prior to the therapeutic measures themselves, making them possibly unnecessary. In addition, a treatment system with such a treatment element and a method must be specified, with which the treatment element can be inserted in a particularly favorable way.
[0007] The invention assumes that, for an efficient and effective treatment of inflammation symptoms precisely in the environment of an inserted dental implant, therapeutic measures can be avoided or at least its extent can be kept as low as possible because that the bacterial colonization of the implant and its environment is already combated early in a consistent manner. These should already occur, in particular, when no further therapeutic measures are needed. Such a consistent fight against bacterial contamination should follow two main starting points, namely, on the one hand, a safe and as wide as possible elimination of the bacteria and, on the other hand, a comprehensive cleaning of the implant material, with which, possibly adhered or similar organic remains, which could favor a new colonization of bacteria are removed to a more extensive extent.
[0008] As has been surprisingly found, these two objectives can be followed with a joint approach, in which a suitable cleaning liquid is added locally and targeted to the attacked area, for example, through the use of a biocidal liquid selected in a specific way. appropriate or similar. Therefore, the base body of the treatment element is provided with a number of channels for means for a cleaning liquid.
[0009] Preferably, in this case, these channels are conducted and positioned in such a way as to allow a precise admission of the area to be cleaned in the inserted dental implant part. For this, the or each channel for media advantageously has an outlet opening which, in the base body placed on the dental implant part, is positioned at a distance of no more than 10 mm, preferably, no more than 5 mm, particularly preferably, no more than 3 mm, of the dental implant part. In a further advantageous or alternative improvement, the media channel or media channels is / are arranged in the type of integrated structure directly within the base body or body.
[0010] As has been surprisingly found, moreover, a particularly high cleaning action can be obtained on the inserted implant part, in which several cleaning fluids are combined with each other or can be administered sequentially one after the other. In order to selectively allow this and as necessary, the channels for media provided within the base element or body of the treatment element, advantageously, a system of channels that can be applied with at least two partial channels independent of each other. another with liquid. In another more advantageous modality, moreover, at least one reflux channel is provided for reconduction or suction of the cleaning liquid consumed in the area of the insertion position.
[0013] Additionally, it is foreseen to use an electric current specifically as a means to eliminate the bacteria and / or to clean the attacked implant part. Particularly, through the admission of the implant part with electric current, a safe removal of the possibly adherent organic material can be obtained. To allow this, avoiding therapeutic interventions, that is, particularly without surgical removal of the inserted implant, it is foreseen to feed the electric current directly to the attacked implant piece still in the inserted state, that is, without previous removal of the bone tissue.
[0014] For this purpose, the preferred treatment element is made available, which, conditionally designed, is provided for a fixation on the inserted dental implant part and, therefore, presents a connection means adequately adjusted to the inserted dental implant part. In this case, the treatment element is advantageously adapted to be able to apply the current flow for the purpose of cleaning the inserted implant part selectively located directly in the adjacent area. Particularly in this case, it is envisaged, as a design principle for the treatment element, to provide means to conduct a current flow, with which the electric current is fed to the inserted implant part and whose inserted area, particularly, the area of insertion provided with a thread in the bone tissue can be used as an electrode. In order to form an antipole and a counter electrode, the appropriate positioning of a contact surface or an electrical contact point is also provided in the immediate vicinity. The named components must therefore be positioned in such a way and, if applicable, suitable with a current source, so that the electric current applied for the purposes of treatment and cleaning can flow in a comprehensive and direct way through and through from the surface areas of the implant part infected by bacteria, that is, in particular, without „deviations“ over other body tissue or similar, to the contact surface or to the contact point.
[0015] For this purpose, the treatment element comprises, according to the invention, properly positioned and selected driving elements, which, in turn, can be connected to a selected current or voltage source. Thus, conditionally designed, among others, an electrically conductive connection is provided to produce the implant part by means of one of the conduction elements, so that the desired current flow can occur through the inserted implant part and it can form the one of the electrodes.
[0016] The second conductive element that forms the other contact surface, provided in the form of a counter electrode must, therefore, be positioned spatially in the immediate proximity of the implant part. The objective, in this case, is that the current flow occurs, through the contact area of the inserted implant part, to the surrounding bone or soft tissue and, from there, to the contact surface, without the need for a flow current over larger areas of body tissue. For this, the second conductor element is preferably designed in such a geometric way that an "electrically active" zone located in the vicinity of the insertion position results, for example, in the form of a filament or needle type shape. In a further advantageous or alternative improvement, the second conducting element is arranged, for example, in the form of an electrode body, in the form of an embodiment integrated in or in the base body of the treatment element.
[0017] The conducting elements can, in this case, in the "conventional" electrode mode, be realized as electrodes suitably selected and configured geometrically, for example, based on metal, in the form of metallic wires, or the like. In this case, the electrode forming the second conducting element is preferably equipped with electrical insulation, for example, as a plastic-coated wire, and for the formation of the contact or the contact surface, for example, at the end, an area pure metal, no longer insulated can be predicted. Alternatively, it is also possible to supply at least one of the conductive elements, preferably the second conductive element based on the use of electrical conductivity of liquids, for example, aqueous solution of salts or the like. In such cases, the respective conductive element can also be formed through a number of channels properly directed within or on the treatment element, which can be applied in application with an appropriately selected liquid of electrical conductivity which, in turn, then again suitable, it is electrically connected to the current or voltage source by a properly positioned electrode. The contact or contact surface for the flow of electric current is formed, in this case, through the end of the outlet surface of the respective channel, through which the liquid conducted in the channel can pass electrically with the environment of the channel in contact. This outlet surface must therefore be suitable in the direction indicated above, to be positioned in the environment close to the inserted implant part.
[0018] Dental implants can be performed as so-called individual implants, which present a construction of their base body essentially in one piece. However, to allow a simplified introduction into the patient's mouth and, in particular, a particularly wide preparation of the prosthesis itself by fixing it on the implant before the patient is treated, for example, in a dental laboratory, dental implants can also be performed in several parts. Particularly in this case, a basically two-part construction can be envisaged, in which the dental implant system comprises a first implant piece intended for insertion into the jaw bone, also referred to as the implant itself or abutment and a second implant piece assigned in addition to this, also known as the second component of construction or support, on which the tooth replacement part, provided as a prosthesis or similar, can be assembled again. The first part of implant or abutment is provided, on its external side, usually with a thread that can be executed as an automatic or non-automatic thread. Generally, in this case, the area that must be implanted in the bones or bone tissue is superficially wrinkled or coated.
[0019] In this case, the construction or support component is generally screwed with a pillar by means of a suitably selected connecting screw.In the introduction, in this case, the thread of the connecting screw is screwed into the pillar, in an assigned female thread. The screw head of the connecting screw, in this case, by screwing it through a countersinking of the construction component, presses it on the column. In a particularly advantageous embodiment, the treatment element is intended for use for such a type of dental implant with two or more parts. For this purpose, its connection system includes a connecting screw for the introduction, in the column screw channel of the abutment, of a dental implant system made in one or more pieces. In this embodiment, the treatment element can therefore be called a "treatment support" which, instead of the support provided for a multi-part dental implant system, can be placed on the abutment, connected.
[0020] In order to produce, in such a construction, a particularly safe and effective access or contact for the insertion area of the inserted pillar, therefore, particularly of its metallic base body, the treatment element is so executed in other advantageous modalities that the connecting screw is connected electrically conductive with the first conductive element.
[0021] Advantageously, the base body of the treatment element is made electrically isolated on its contact surface for the dental implant part. With this, it is ensured that the current or potential conduction can occur in the desired way - namely, with the selective integration of the inserted area of the dental implant part in the current conduction. The base body can therefore be made by you on the basis of an electrically insulating material, for example, such as ceramic bodies or bodies of plastic material, in which case the electrodes can be guided through metal components properly positioned or properly conducted liquid channels. Alternatively, the base body can also be made as a metal body, for example, titanium. In this case, the insulating effect in relation to the dental implant part can be obtained by fixing a suitable insulating element, in particular, an independent component or also a surface coating.
[0022] To particularly favor the conduction of current or potential in immediate spatial proximity to the position of insertion of the implant part, in an advantageous improvement, the second conducting element of the treatment element is supported on it in a longitudinal direction of essentially parallel to the central axis of the base body. In a modality such as an electrode, the same can, therefore, be particularly performed as a needle-type element, for example, in the form of a thin or similar pin, which can be inserted after the assembly of the element of treatment in the dental implant for the insertion area. In one embodiment, such as a channel that conducts conductivity liquid, it is possible to provide, instead, for example, a thin tube, a cannula or the like in which they can be inserted, or in the same way, after the assembly of the element of treatment in the dental implant part for the insertion area, so that its exit surface is positioned close enough to the area that requires treatment of the inserted implant part.
[0023] In an additional advantageous or alternative improvement, the second conducting element is fixed in such a way on the base body that its contact arranged at the end, seen in its lateral direction, can be positioned at a distance of a maximum of 10 mm, preferably maximum of 5 mm, from the central longitudinal axis of the dental implant part and an additional modality or another advantageous modality, seen in its lateral direction, can be positioned at a distance of at most 1 mm, preferably at most 1.5 mm, from the central longitudinal axis of the dental implant part. As a result, the comparatively higher production of electric current densities is immediate at the insertion position of the implant part, which can be obtained particularly favorably in loads of low conservation of other body tissue.
[0024] As already explained, the conducting elements in the "conventional" electrode mode can be performed as electrodes suitably selected and geometrically configured, for example, based on metal. The alternative modality based on the use of the electrical conductivity of liquids is seen, however, as especially advantageous, since, with this, on the one hand, a comparatively high flexibility in the conduction of the channels and, with this also, in the conduction of current or of potential is obtained.
[0025] Regarding the treatment system for a dental implant part, the so-called objective is solved with a treatment element of the prior art whose conductive elements are electrically connected with a current or voltage source.
[0026] As surprisingly found, in this case, an application of the implant infected by bacteria with pulses of current or tension is especially highly effective, particularly with regard to the removal of organic residues that still adhere to the material after the elimination of bacteria. Therefore, the source of current or voltage of the treatment system in the particularly advantageous mode for a, if necessary, pulsed application of the conductive elements is arranged with current or voltage. In this case, an operating voltage of up to 30 V.
[0027] To allow the combination seen as especially advantageous of an electrical treatment of the dental implant part with a liquid-based treatment, an inlet system for a cleaning liquid or a combination of various cleaning fluids is advantageously connected to the cleaning element treatment of the treatment system. Especially preferable, as a cleaning liquid, water is mixed with at least one acid and / or at least one salt. Particularly preferable is therefore intended as acid, phosphoric acid, citric acid, acetic acid, lactic acid, carbonic acid or a combination thereof. In that case, in an alternative or particularly additional way, sodium iodide, chloride, nitrate, carbonate or bicarbonate, calcium, aluminum, magnesium, tin or potassium and / or ammonium chlorite, nitrate or iodine or a combination of them.
[0028] Regarding the method for cleaning a dental implant part, the so-called purpose is solved, in which an electrical voltage is applied to the dental implant part and in which that part is washed with a cleaning liquid. The electrical voltage is advantageously applied in a pulsed manner. In an additional advantageous or alternative improvement, it is thus used as a cleaning liquid in the previously named way.
[0029] The advantages obtained with the invention consist in particular that, through the modality of the treatment element with the conductive elements, particularly and especially preferential, in combination with properly conducted channels for adding a cleaning liquid, a selective application can occur and localized part of the dental implant with adequate pulses of current or tension, without the need to remove it from the patient's mouth or, otherwise, a therapeutic intervention. With this, it is possible to combat bacteria colonization early on the implant part inserted by means of containment prevention measures, whereby the surprising efficacy verified in the elimination of bacteria by electric currents and also by the removal of organic material possibly still adherent to the inserted implant body becomes usable.
[0030] An example of an embodiment of the invention is clarified in detail based on a drawing. It shows:
[0031] Figures 1, 2 respectively an implanted system,
[0032] Figures 3, 4 respectively an implant piece or abutment dental implant system,
[0033] Figure 5 a treatment element for a dental implant piece inserted in a patient's jaw bone in perspective view,
[0034] Figures 6, 7 respectively a variant of the treatment element according to Figure 5 in longitudinal section,
[0035] Figures 8, 9 respectively, another variant of a treatment element in perspective view,
[0036] Figure 10 the treatment element according to Figure 9 in longitudinal cut and
[0037] Figure 11 systematically a treatment system for use of the disposed treatment element.
[0038] Equal parts are provided with the same numerical references, in all Figures.
[0039] The dental implant system 1, according to Figure 1, is intended for use in the jaw bone in place of an extracted or missing tooth, in order to keep in that place a prosthetic piece that serves as a substitute tooth or a crown . The dental implant system 1 is, therefore, executed in several parts and comprises a first implant part 2 executed as, then called, abutment and a second implant part 4 assigned to that denominated as construction or support component, for fixation of a planned tooth replacement part. The first implant part 2 or abutment is thus provided externally with an external thread 6 which is designed particularly at the apical end 8 as an automatic screw thread. With this, the first implant piece 2 or abutment can be inserted in the predicted position in the maxillary bone by means of screwing.
[0040] To allow, after fixing the replacement tooth or prosthesis to the construction component or the second implant part 4, an insertion into the abutment or the first implant part 2 with high mechanical stability, a connection pivot 10 it is formed from the second implant part 4 that can be screwed into the predicted intake channel 12 assigned in the first implant part 2. By inserting the connecting pivot 10 into the intake channel 12, a mechanical connection of the implant parts 2, 4 results each other. For greater mechanical stability, the connection pivot 10 is, therefore, adjusted in its external contour in the internal contour of the intake channel 12 in which both can be formed conically, seen in the longitudinal direction (example of embodiment according to Figure 2) . In addition, as is particularly foreseen in the embodiment example according to Figure 3, the external contour of the connecting pivot 10 - and the internal contour of the correspondingly adjusted intake channel 12 - can be projected in cross section with a multiple symmetry (in the example of implementation, six times) so that, in the union of the so-called components, a rotary blocking result results and, thus, a safe rotational orientation of the construction component relative to the column can be used. In the embodiment example according to Figures 3, 4, for that purpose, an indication or an indication element 14 with, in its turn, a cross-section with multiple symmetries arranged at the end of the connecting pivot 10 for the formation of a rotational lock , which, in the assembled state, engages with a corresponding end channel piece 16 assigned to the intake channel 12.
[0041] The dental implant system 1, in the deconcretization example for a screw connection of the implant parts 2, 4, is executed with each other. For this purpose, a connection screw 18 is provided, which engages with the screw thread 20, respectively provided for in the first implant part 2. In relation to material selection, the implant parts 2, 4 are adjusted according to the purpose of use and are, in principle, finished in ceramic material, such as, for example, zirconium oxide or aluminum oxide, or in properly selected metal, such as titanium.
[0042] Generally, in dental implant systems, particularly also in two-piece implant systems of the technique described above, there is the problem that, through an infiltration of bacteria or germs in the tissue area close to the insertion position, particularly in the area of the external thread 6 inserted in the jaw, inflammations or foci of inflammation may arise. Such existing inflammations, particularly, also due to a so-called peri-implantitis, especially when they can develop and intensify over a long period of time, can lead to serious damage to tissues and bones in the area of the position of insertion. Without adequate preventive measures, these damages can, with this, lead to the fact that the entire implant system, therefore, particularly also the abutment or second implant part 4 already implanted, needs to be removed from the bone again and replaced with another prosthesis. . This expressed unwanted effect caused by peri-implantitis can, with this, lead to a total loss of the implant system, so that surgical measures may again be necessary, such as, for example, a scraping of the affected area in the jaw bone and the new restoration with an implant system. Through such a removal, it can also result in bone loss or other losses of tissue substances, which in extreme cases can even lead to the situation that a new restoration with another implant is no longer possible. Such a need for a new restoration, caused by peri-implantitis, can also occur after a comparatively long period of time, after the first insertion of the implant system, for example, up to a few years or even decades.
[0043] The bacteria or germs observed in conjunction with a peri-implantitis can, with this, at first, colonize the interior of the pillar 2, however, generally adhering, preferably directly to the surface of the pillar 2 inserted in the jaw bone in the area of contact with an adjacent tissue or bone material, therefore, particularly in the area of the external thread 6. In this area, the surface of the pillar 2 can be predicted with a roughness or similar, to favor especially the implantation in the tissue or bones and to support healing of pillar 2 after insertion. Precisely in the area of such a roughness of the surface seen, properly speaking, as especially favorable for the implant system, the colonization of germs or bacteria can witness a multiplication, in which the harshness still additionally hinders the selective removal of existing germs or bacteria.
[0044] Therefore, there is, therefore, an urgent desire for adequate preventive measures, in the case of an existing or imminent peri-implantitis under maintenance of the implant system already implanted, therefore, of the pillar 2 already inserted, to eliminate germs infiltrates and effectively fight inflammation so that healthy tissue or healthy bone substances can later form again in the area around the outer thread 6. For this, it is highly desirable, in addition to the selective elimination of germs or bacteria in the affected area, also safely remove the remains of material and fragments from the affected area, so that, subsequently, the affected area can again be filled with healthy tissue or bone material and an internal connection between the outer surface of the pillar 2 and the surrounding bone tissue or material can again form. In addition, the biofilm formed by the bacteria coating, including the organic remains of eliminated bacteria, are safely eliminated.
[0045] For this purpose, therefore, to eliminate the germs and bacteria in the insertion area of the pillar 2 and particularly also for the subsequent washing, removal and discharge of the remains of tissue and material of the eliminated bacteria, a treatment element 30 is provided , 30 'which is shown in perspective view in Figure 5. A preferred variant of treatment system 30 is thus shown in longitudinal section in Figure 6 and a second preferred variant of treatment system 30' is shown in longitudinal section in Figure 7.
[0046] The treatment element 30, 30 'is, in this case, in the embodiment, due to the implementation itself, in two parts, of the implant system 1, performed in the mode of a treatment support and is provided for the conduction of the treatment named for the represented implant system 1, performed in two parts, in which a temporary setting of the treatment support 30,30 'must occur on the support 2 instead of the support itself or the second implant part 4. The embodiments the following, therefore, refer in this case to a two-piece implant system 1; obviously, in a similar way, a corresponding use for an implant of only one piece can be envisaged; for this purpose, the mechanical connection of the treatment element 30, 30 'must be designed, suitable for the part of the implant system remaining in the jaw bone also during treatment, for example, by means of a suitable contact surface, with which , the treatment element 30, 30 'can be placed in place of a prosthesis, on the implant support. Likewise, the treatment element 30, 30 'can be placed on top, on the support 4 of the implant system 1, so that a use, for example, to combat an inflammation of the soft tissue (mucositis) by through the elimination of bacteria and cleaning of the surface, it can be predicted without the removal of the support itself 4.
[0047] When implementing the two-piece implant system 1 provided in the embodiment example, for conducting the treatment described in detail below - if applicable, after removing the prosthesis attached to the support itself or on the second implant part 4 -, the screw connection between the first and second implant parts 2, 4 is released and the second implant part 4 is removed. The first implant piece or abutment 2 thus remains on the jaw bone. Subsequently, the treatment support 30, 30 'is placed in place of the support itself 4, on the abutment 2.
[0048] Represented in Figures 6 and 7, the variants of the treatment element 30,30 'are constructed in essentially the same way, but differ from each other in the type and manner in which, during the treatment itself, the fixation on the pillar 2 must to be fulfilled. In the variation according to Figure 6, a fixation is foreseen using the screw connection, while in the variant according to Figure 7, only one fitting on the pillar 2 is provided.
[0049] The treatment element 30 shown in Figure 6, after being seated on the pillar 2, is thus connected with it by means of the screw connection, while the treatment element 30 'represented in Figure 7 is inserted in the same by laying on the pillar 2. The treatment element 30, 30 'has, for both purposes, a contact surface 32 in an essentially flat way, with which it can be placed on the front corner 34 of the column 2. The contact surface 32, under circumstances, can also fulfill the function of a sealing surface and be designed accordingly; in particular, it can be performed here conically.
[0050] The treatment support 30, 30 'is based, with respect to its modality and initial embodiments, on two basic points seen respectively as independent and inventive: on the one hand, it is, therefore, designed to selectively eliminate bacteria or germs existing in the insertion area of pillar 2 through the selective addition of a bactericide, but also being compatible with the means of disinfecting or cleaning human organisms. On the other hand, it is, therefore, disposed to separate residues or fragments of germs or bacteria still adhered eventually to the abutment surface, particularly in the area of the external thread 6, by means of pulsed application with electric shocks from the external surface. of column 2, so that they can be washed later.
[0051] In a first aspect seen independently and as an incentive, both in relation to the system modality and in relation to the method steps of the treatment method, the treatment element 30, 30 'is arranged, therefore, both structurally and functionally / conceptually, to feed a treatment liquid to eliminate germs or bacteria and / or to clean the implant part 2 selectively in the insertion area of the abutment 2, particularly in the area of its external thread 6. Especially preferred, in this In this case, water mixed with at least one acid and / or with at least one salt is provided as a treatment liquid. Particularly preferable is therefore intended as acid, phosphoric acid, citric acid, acetic acid, lactic acid, carbonic acid or a combination thereof. In that case, in an alternative or particularly additional way, sodium iodide, chloride, nitrate, carbonate or bicarbonate, calcium, aluminum, magnesium, tin or potassium and / or ammonium chlorite, nitrate or iodine or a combination of them. In this case, the cleaning liquid must be fed close to the treatment element 30, 30 'and, therefore, in direct proximity to the affected area, therefore, to the insertion area of the pillar 2.
[0052] In a second inventive independent aspect, both in relation to the modality of the system and in relation to the method steps seen in the treatment method, the treatment element 30, 30 'is arranged, therefore, to safely separate the bacteria or eliminated germs or their remains or fragments, from the outer surface of the pillar 2, so that they can be cleaned and, subsequently, the healthy bone tissue or material can adhere to the surface of the pillar 2 and it can be fully implanted again in healthy bone tissue or material. For the separation of bacteria or germs or their remains or fragments from the surface, it is intended to be used with an electrically conductive liquid under application with pulsed electric shocks. As in the same way, namely, surprisingly verified, this pulsed application with electric shocks already seems to cause, in a particularly safe way, the dissolution of bacteria or germs or their fragments or remains, on the underlying surface, even when it is scraped and, in fact, the adhesion of organic materials is particularly favored due to its surface structure.
[0053] In this case, the surprising finding has the purpose that the application of the pillar 2 itself with pulsed electric shocks in the area of its external surface, therefore, particularly in the area of the external thread 6, leads to a dissolution of material fragments of the material itself of pillar, therefore, for example, titanium, from the surface. Particularly, in this case, the application is carried out with electric shocks, in the case of conductivity liquid selected in an appropriate way, for example, with acid or ion components, for the formation of TiO2 areas, which subsequently dissolve at from the Ti surface. Through this dissolution of components from the surface of pillar 2, components or fragments of germs or bacteria that are superficially adhered are completely removed with separation, so that they cannot form any base and any nutritive substrate for new colonization germs in these areas. In reverse, a porous and rough pillar 2 surface remains, free of germs, bacteria or their components or debris, which can serve as a basis for future integration into the renewed bone tissue. The surface that remains can, in this case, be formed by means of a layer of titanium oxide, which would also arise by anodizing the surface.
[0054] Another favorable aspect of this desired separation of the components of the inserted column 2 surface, in the sense of a safe cleaning of the surface, is obtained by means of an advantageous execution, particularly suitable for application with chain. This can be done in such a way that, as a consequence of the current flow, a formation of electrolytic gas bubbles occurs in the inserted surface area. On that occasion, pillar 2 can be connected anodically or cathodically. Particularly, in an at least temporary cathodic connection of pillar 2, the gases of hydrogen, oxygen, nitrogen and carbon dioxide emerge. The gas bubbles thus formed rise in the surrounding liquid and thus create dead weights on which the surface components called wear can be transported externally. For example, it was surprisingly observed that, using a solution containing positive ions, for example, an aqueous salt solution, these ions, in a cathode connection of pillar 2, precipitate in it and, with this, significantly strengthen the formation of gas bubbles. For example, the presence of Na + ions in the cathodic lining of pillar 2 leads to substantial gas bubble formation since Na leads directly to oxidation.
[0055] In a third independent and inventive aspect, in the same way, both in relation to the modality of the system and in relation to the method steps seen in the treatment method, the treatment element 30, 30 'is designed for an efficient maintained combination of denominated aspects. In this case, the purpose of the concept is that both the adduction of the cleaning liquid and the selective removal of debris and fragments of bacteria and germs through an application of the so-called current pulses in a joint system can thus be obtained with means of particularly simple maintenance.
[0056] With respect to these design objectives, the treatment element 30,30 'has a constructive assembly, as the same can be deduced, according to the representation in the perspective view of Figure 5 and in the longitudinal section according to Figure 6, respectively, to Figure 7. In these Figures, the treatment element 30,30 'is represented respectively in a state mounted on the pillar 2. Likewise, a ring-shaped area 36 that surrounds the pillar 2 in the area of its external thread is represented. 6 in the maxillary bone 38, which is infected with peri-implantitis and, correspondingly, overloaded with bacteria.
[0057] The treatment element 30, 30 'has a base body 40 executed essentially as a casing body of the cylinder which, with its front surface 42 formed by the contact surface 32, is placed on the front surface or upper corner 34 of the pillar 2 For high mechanical stability, in addition, a connecting pivot 43 is formed in the base body 40 which, with respect to the contour and geometric parameters, is adjusted in the intake channel 12 in the pillar 2 and can be screwed into it in such a way secure positioning and temporary fixing to the bolted connection pivot is possible.
[0058] In the internal space of the base body 40 and in a coaxial manner, a central internal channel 44 is provided. The treatment element 30 in the variant according to Figure 6 is arranged for the use of the screw connection during the treatment phase seen , and correspondingly, a connecting screw 46 in the internal channel 44 is made in this variant. The connecting screw 46 engages with its screw thread 48 on the screw thread 20 provided inside the pillar 2. Unlike the connecting screw 18 provided for the connection of the support itself 4 with the pillar 2, the connecting screw 46 is not arranged for a high mechanical load capacity and longevity of the produced screw connection; other disposition criteria, on the contrary, support the connection screw 46. Thus, the course of the treatment explained below is particularly considered, in which the connection screw 46 and the pillar 2, with it, must serve as an electrode for the current pulses. Consequently, the connecting screw 46 is finished from an electrically conductive material, particularly from a metal, for example, titanium.
[0059] In the variants - if not essentially the same construction - according to Figure 7, the treatment element 30 ', on the other hand, is arranged for a fitting connection with the column 2. For this, in this variant, a contact element electric 49 is conducted in the internal channel 44 and preferably supported in a longitudinal direction. For the arrangement of the electrical contact element 49 and its spatial configuration, the course of the treatment explained below is also considered, whereby the electrical contact element 49 and the pillar 2, with it, must serve as an electrode for current pulses. Consequently, in this variant, the electrical contact element 49 is finished from suitable electrically conductive material, in particular, from a metal, such as titanium and in such a way that it is supported and conducted in the internal channel 44, that the even, in the fully screwed-in state in the inner channel 44, it hits with its needle tip 50 in the base 52 or in another area of the inner channel 44 and, with this, it produces a safe electrical contact with the pillar 2. Alternatively, the electrical contact element 49 can be executed in its end area also as an elastic expansion element, which produces a safe electrical contact on the internal side surfaces of the internal channel 44.
[0060] The treatment element 30, 30 'is arranged for the addition of the cleaning liquid in area 36, which, among others, can also act in the elimination of germs or bacteria. For this, the base body 40 is provided with a number of channels for means 56 which are connected at the inlet side with a supply or supply system for the treatment liquid. In an example of an embodiment, the channels for means 56, in this case, are formed through grooves 59 inserted in the surrounding annular body 58 in one of the base bodies 40. The annular body 58 is thus pushed into the base body 40, so that the grooves 59 are closed inwardly, through the outer covering of the base body 40 and thereby form a channel system from the media channels 56. Alternatively, the media channels could, of course, also be inserted in another way, directly into the base body 40.
[0061] In the immediate proximity to a contact area of the front surface 42 of the base body 40 with the front corner 34 of the pillar 2, the channel system formed by the channels for means 56 has a number of outlet openings 60, of which, for the sake of clarity, in Figures 6,7 respectively, only two are shown. Each channel for means 56, in the embodiment example, is provided with an outlet opening 60. The outlet openings 60 can be adjusted in cross-section and in number, but also in individual specifications. For example, an individual outlet opening could be envisaged, which would form, for example, a completely circumferential annular space between the front surface 42 and the front corner 34. Alternatively, a greater number of outlet openings 60 can be provided, which, particularly seen in the direction of extension of the base body 40, can be uniformly arranged around that extension. Alternatively, only one channel for individual media 56 can also be provided with an individual outlet opening 60 assigned, which can preferably be positioned individually and thus can be designed for the localized production of treatment liquid in a limited area .
[0062] The channel system formed through the parameeal channel (s) 56 flows out, with its outlet openings 60, immediately adjacent to the front surface 42 and thereby immediately above area 36, so that the medium flowing from the openings exit 60 reaches more or less directly to the underlying area 36. As a result, as an inventive and individual view of the base body 40, the treatment element 30, 30 'forms a channel system, with which a treatment liquid can be inserted selectively and efficiently, directly into the area 36 that requires treatment.
[0063] Additionally, the treatment element 30, 30 'is still specifically designed as an electrical system. Thus, it is particularly envisaged as a disposition principle, a pulsed application of the medium conducted in the channels for means 56, particularly, which allows the conduction of the saline solution with pulses of current. The treatment element is thus arranged, for the purpose of cleaning the inserted implant part, to be able to apply the predicted current flow selectively and located in the area 36 that requires treatment. The treatment element 30,30 'is thus formed according to the design principle that the electric current adds to the inserted implant part 2 and it can be used as an electrode. For this, the treatment element 30,30 'comprises a first electrically conducting element 62 connected with the implant part 2 that forms an electrical current circuit and by means of the connection screw 46 or the electrical contact element 49 which, in turn, it can be connected to a properly selected voltage or current source.
[0064] To form an antipole or counter electrode, the use of electrical conductivity of the cleaning liquid conducted in the channels for media 56 is envisaged. For this purpose, the internal space of the channels for media 56 is, in turn, electrically connected with other poles of the current or voltage source. Thus, from an electrical point of view, the outlet openings 60 of the channels for media 56 form a contact 64 or an electrical contact point, through which the current flow occurs in the implant part 2 or from the implant part. implant 2. Through this use, the outlet openings 60 positioned in immediate proximity to the area requiring treatment are obtained as electrical contacts 64, so that the electric current applied for treatment and cleaning purposes can flow comprehensively and directly to the along and from the surface areas of the implant part infected by bacteria, that is, in particular, without „deviations“ over other body tissue or the like, to the contact surface or to the contact point. The channels for media 56, including the electrical conductivity cleaning liquid conducted there and the corresponding connection elements thus form, in an embodiment example, a second conductive element 66 which forms a current circuit electrical to the end assigned to contact 64.
[0065] Alternatively, conductive element 66 could be performed, however, also in the mode of a "conventional" electrode, therefore, particularly as an electrically conductive needle-like element made of metal. It could be supported particularly in a longitudinal direction essentially parallel to the central axis of the base body 40, which can be displaced therein. For the formation of this electrode or also of a third electrode provided additionally, if necessary, which, for example, can be provided for the local production of an electric field, for example, for the strengthening of the field, it can also be provided, if it is case, another suitably formed metal body 68. Thus, the treatment element 30, 30 'can also be executed without the channels for means, in which the counter electrode and, thus, the second circuit of electric current, can be formed later by means of the metal body 68. In this case , the contact 64 is formed on the free end surface of the respective electrode body.
[0066] By positioning the outlet openings 60 and / or the end contact surface 69 of the metal body 68, it is further ensured that the contact surface 64 of the second conductor element 66 formed through them, seen in lateral direction, be positioned at a distance of at least 1 mm and a maximum of 10 mm from the central longitudinal axis of the dental implant part 2.
[0067] The base body 40 of the treatment element 30, 30 'could be formed by an insulating material, such as, for example, a ceramic or a plastic material. In the embodiment example, however, it is finished in metal, namely titanium. In order to ensure a safe electrical isolation of the components from each other, it is provided on its front surface 42, which forms the contact surface in relation to the dental implant part 2, with an insulating coating 70, being, therefore, electrically insulated. In addition, the annular body 58 is made from insulating materials, such as ceramic.
[0068] In an alternative embodiment not shown, a non-dense connection in the seating of the base body 40 can also be provided on the front surface 34 of the pillar 2. This allows, during the treatment phase, an infiltration of the liquid of cleaning or treatment provided for in the internal space of the pillar 2, so that it can likewise be subjected to cleaning.
[0069] In an alternative embodiment, the treatment element 30 ", as shown in perspective view in Figure 8, provided with another channel system, can be provided, for example, as a reflux channel for the liquid for cleaning purposes, as a separate supply conductor for the introduction of a mixture of media or also as a suction channel, for this purpose, the annular body 58 is surrounded by another annular body 71 in which grooves 74 are inserted on the side likewise for the formation of other channels for media 72.
[0070] In the embodiments explained above, the channels for means 56 and / or the conducting elements 60, 66 are executed in an essentially integrated construction form and conducted within the base body 40 or the latter connected to the annular bodies 58, 71. Alternatively or additionally, one or all channels for means 56 and / or conductive elements 60, 66 can be arranged on the outside of the base body 40 and be connected to it by means of suitable restraint systems. This embodiment is shown in the embodiment in perspective view, according to Figure 9 and in the longitudinal section, according to Figure 10. In addition to the components already explained, the treatment element 30 "'previously shown is provided with channel elements 80 displaceable in the longitudinal direction disposed externally in the annular body 58. These can, similarly to the channels for means 56, be executed in the form of cannulas or similar and receive the application of the cleaning liquid and, additionally, serve as a conductive element 66. Alternatively, however, they can also be made of metal and be made in the form of electrodes and are electrically connected appropriately with the current or voltage source.Additionally, in the embodiment example according to Figure 9, a variant is also shown , in which, in addition to channels for media formed by channel elements 80 externally assigned, channel s for means 56 integrated through the grooves 59 formed in the annular body 58.
[0071] The treatment element 30,30 ', 30 ", 30"' is preferably used in a treatment system 90, as shown in Figure 10. Treatment system 90 is intended for a dental implant piece or abutment 2 inserted and comprises the treatment element 30, 30 ', 30 ", 30"' and in addition to that, a connecting element 92 between that and a hose package 94, a plug connection 96 between that and a control unit and food 98 disposed externally to the patient's mouth. This control and supply unit 98 contains an electrical supply which, between the electrode on pillar 2 and another electrode, which can be found in the treatment element 30,30 ', 30 ", 30"', in the 96 connections, in the hose package 94 and / or in the control and supply unit 98, you can apply a voltage and / or let a current flow. This electrode has an electrically conductive contact position to the media / electrolytes.
[0072] This voltage or current can be applied as current / continuous voltage, from the polarity in both directions or as alternating voltage in both electrodes. In the case of an alternating voltage, it can be sinusoidal, triangular, rectangular or any imaginable superposition of one of these frequencies. In addition, this alternating voltage can be superimposed by a continuous voltage. There is also the possibility of using a continuous voltage For the creation of an electric field, a third electrically isolated electrode can be fixed preferably on the treatment element 30, 30 ', 30 ", 30"'.
[0073] In addition, the control and supply unit 98 contains reservoirs for at least two liquids or electrolytes. These can be driven, simultaneously (merged) or in sequence, through pumps and by one or more valves or valve units, through the hose package 94, in the treatment element 30, 30 ', 30 ". In a particular case , the control and feeding unit 98 also contains a suction, which can suck again, through the treatment element 30, 30 ', 30 ", 30"' liquids or electrolytes added after using them. The control unit and Feed 98 contains, in a particularly favorable embodiment, in addition, a CO2 recovery process for water or other liquids / electrolytes.To optimize the process, a tempering medium can also be integrated in the control and feeding unit 98.
[0074] The hose pack 94 and the plug connections 96 are so arranged that they can ensure the current flow and the media flow. In a complete equipment, three electrical conductors and two electrolyte / liquid conductors would be composed in particular.
[0075] The electrode material can be composed of the same material as the pillar 2. Since the pillars 2 are preferably produced from titanium or a titanium alloy, it is preferable to conduct the other electrodes from another metal. Titanium and titanium-like metals form, by anodic energization, most of the time, a protective oxide layer that acts as an insulator. In order not to limit, by cathodic energization of the pillar 2, the current flow through such an oxide layer, it is advantageous to use a metal or any metal that does not form an oxide layer as a counter electrode. In an especially favorable case, these electrodes corrode either by contact with the media / electrolytes or by applying a voltage or a current. Preferably these electrodes are conducted from gold, platinum, palladium.
[0076] If the interior of the implant / abutment 2 inserted is contaminated and then cleaned, there is the possibility to wash the interior separately or together with a medium and apply it by chain.
[0077] The conductive elements can also be designed in the form of a rigid or flexible membrane that does not allow the passage of any liquid, but only ions existing in the electrolytes. In such an embodiment, one of the electrical current circuits preferably flows into the interior of the pillar 2 and passes, in this case partially or not at all, on the sealed contact surfaces 32, to the outside of the surface of the pillar 2.
[0078] The treatment liquid provided for the execution of the method is, in an especially advantageous modality, in view of the aforementioned aspect, composed and selected appropriately. The selection and composition of the basic components of the treatment liquid are thus carried out, particularly in view of the proposed action, that is, the application of an electric current in the surface area that requires treatment, in which it is particularly ensured that there is, for that purpose, a sufficiently high electrical conductivity in the treatment liquid. This must be ensured particularly through a sufficiently high ion density selected in the treatment liquid. For this, a metal salt is provided as the basic constituent of the treatment liquid, preferably in aqueous solution. It supplies the ions for the current transport and, in addition, the resulting reaction products after the respective reaction of the electrodes, may also have adequate biochemical effects. Through the selective choice of a sufficiently high electrical conductivity, it must be ensured, through the implementation of a cleaning method on the inserted implant, that the current flow occurs through the treatment liquid and with it through the parts and components that require treatment and not through the patient's body tissue, so that a risk to the patient through an undesired current flow in the soft, bone, blood and / or other body materials can be minimized. In this case, the electrical conductivity of the treatment liquid must possibly have a multiple of the electrical conductivity of blood, bones, soft tissue, adipose tissue or other body materials.
[0079] Consequently, due to the selection and composition of the basic components for the treatment liquid, the following conductivity values are particularly considered (the electrical conductivity a is, in this case, presented in the conventional unit mS / cm):
[0080] Skin: 0.03 to 0.1 mS / cm
[0081] Bones: 0.06 to 0.2 mS / cm
[0082] Adipose tissue: 0.20 to 1.0 mS / cm
[0083] Muscle tissue: 0.80 to 2.5 mS / cm
[0084] Blood: about 6.7 mS / cm
[0085] Other body fluids: about 15 mS / cm
[0086] In order to maintain the risk potential to the appropriate patient and limit the current flow over the desired regions, the electrical conductivity must, therefore, behave at least twice, preferably five times, in particular, preferably, ten times the conductivity of such bodily fluids. Therefore, the electrical conductivity of the treatment liquid must have a value of at least 30 mS / cm, preferably at least 75 mS / cm and in particular, preferably at least 150 mS / cm. In comparison to blood, this means that the electrical conductivity of the treatment liquid preferably comprises at least about five times, preferably at least about ten times, and in particular, preferably at least about twenty times the blood conductivity. Measurements have found that, by using a treatment liquid so selected, the electrical voltage to which body tissue, blood, body fluids, etc., is exposed is less than 6 V, preferably less than 3 V, in particular, preferably less than 1.5 V. As a result, damage to the patient due to being kept at a low value can be safely ruled out. For the fulfillment of such conductivity, the concentration of ions in the treatment liquid and the components formed therein is selected high enough; for this, alkalis, acids, salts and other substances that form ions can be used.
[0087] By the selection and composition of the basic components of the treatment liquid, it is considered in particular that the effect of the treatment with cleaning electrolytes and separation of the biofilm from a contaminated implant surface is based on a combination of several reasons that should be made available to each other in a complementary way. First, gases or gas bubbles can be formed by the current flow through the electrolytes, preferably in the area of the electrodes, which have a (mechanical) suspension effect on the biofilm. The formation of these gases occurs directly on the implant surface that serves as an electrode and, therefore, between this and the biofilm. The resulting gas bubbles therefore influence the separation process with their growth rate and maximum size.
[0088] As a second reason for the effect of the electrolytic process that cleans the implant or separates the biofilm, the corrosive, destructive and separating effect of the resulting electrolytic substance or of the substance's connections on the biofilm's adhesion on the surface of therefore, implant on the anchoring or adhesion mechanism.
[0089] The third reason for the effect of cleaning or separating the electrolytic process is based on the material wear effects of the implant material, in which components or particles of the implant itself can be dissolved from the surface area of the same.
[0090] The fourth reason for the effect of cleaning and separation of the electrolytic process is based on the formation of an oxide layer of the metallic implant, which allows it. On that occasion, metal atoms of the metallic base material pass through the oxide layer that may already exist on the electrical tension created and react with the electrolyte substance (in most cases oxygen => metal oxide formation). In metals, in which no layer of oxide or any layer of mechanically stable oxide is formed, connections of non-oxide substances (most of the time, salts) may result, which are found in the solution.
[0091] The basic components provided for the formation of the treatment liquid are, in view of these effects, properly selected and combined with each other. In addition, it is considered as a basic disposal objective that no toxic or otherwise harmful or unpleasant effects should appear for the patient, so that the treatment liquid is suitable for use in the inserted dental implant, therefore , in the patient's mouth. In the embodiment example, basic components are provided, in this case, at least one salt, on the one hand, and an acid, on the other hand, preferably diluted with water, the selection and composition of which are preferably guided according to the mentioned criteria. Particularly preferable is therefore intended as acid, phosphoric acid, citric acid, malic acid, acetic acid, lactic acid, carbonic acid or a combination thereof. In that case, in an alternative or particularly additional way, sodium salt, iodide, chloride, nitrate, carbonate or bicarbonate, calcium, aluminum, magnesium or potassium and / or ammonium chlorite, nitrate or iodine or a combination are provided as salt of the same.
[0092] Furthermore, it is considered, in this case, that the predicted electrolytic process can optionally be conducted with the anodic or cathodic circuit of the column. Consequently, it will then be divided into an anodic reaction and a cathodic reaction.
[0093] In an anodic reaction, therefore, in an anodic circuit of pillar 2, the anions in the treatment liquid are usually oxidized by removing electrodes at the anode. In this case, there may be an immediate reaction with the material, particularly, for the formation of an oxide layer and / or a salt with the implant material. Bone implants and correspondingly also the abutment 2 consist, in most cases, of titanium, zirconium, tantalum or alloys of these metals. In addition, still other metals are bonded. These metals or metal alloys have, in most cases, a high degree of oxide layer formation. This formation of an oxide layer has a passivating effect on the surface. The consequence of this is the prevention or at least a very strong reduction of the anodic reaction of these metals or metal alloys. Since, in most cases, there are substance connections with oxygen in the biofilm, in most cases, it is not possible to prevent this passivation. If an abutment is connected anodically, then the cleaning and separation effect is, in most cases, limited on the formation of an oxide layer. At high mains voltages of, for example, more than 10 V, it can be demonstrated by extensive investigations that a material removal process is possible in which, however, it is connected to a strong generation of heat. This heat generation can lead to unwanted bone necrosis. In addition, the accompanying material removal also unwantedly alters the characteristics of the original implant surface.
[0094] As an exception, it was surprisingly demonstrated here that, in a base material of pillar 2, in which there is aluminum as an alloy constituent (for example, in grade 5 titanium, which has about 6% of aluminum part and 4% vanadium part), anodic energization of pillar 2 is also possible, without the formation of an oxide layer harming the process a lot. By this means, depending on the composition of the treatment liquid, chlorine gas or iodine gas or even CO2 can be directly produced on the surface of pillar 2 and, with this, it can be used immediately for the desired separation of the biofilm. For such an execution of the method, the treatment element 30 is provided especially advantageously with a conductive surface coating, for example, DLC ("diamond-type carbon"), a metal, conductive plastic material or electrically conductive ceramic .
[0095] As particularly advantageous, it has been demonstrated that, in a material of grade IV titanium or grade V titanium of the abutment through the addition of CO2 in the treatment liquid, despite the oxide layer formed by energization anodic, CO2 formation, Cl formation and / or I formation is possible, which allows a greater and continuous current flow.
[0096] Due to the reasons mentioned, pillar 2, in the treatment with the treatment liquid is preferably, however, in general, cathodically connected. In this case, positively charged ions (cations) move to the surface of pillar 2. These can be, particularly H + ions, metal ions or long chain hydrocarbon ions, for example, ionic liquids. The salt provided as a base constituent for the treatment liquid is, therefore, particularly selectively selected in view of the characteristics of the cations, which should favor or allow the mentioned process. For the production of a possibly high electrical conductivity, small ions (H + ions or metal ions) are particularly qualified, which, in addition, in the form of another particularly favorable effect, can, if necessary, cross the existing biofilm in a comparatively simple way. The H + ions are reduced to the elemental hydrogen H at the cathode formed by the pillar 2. This produces a bubble formation. Another cathodic reaction is the precipitation of elemental metals. Most metals would precipitate, however, as metallic precipitation of covered surface. This would be an unwanted effect, since the coating would have unfavorable adhesion properties and unfavorable chemical (electrochemical and biochemical) properties.
[0097] For the reasons mentioned, metals are preferentially predicted for the cathodic reaction on the implant surface, whose cations do not represent any potential risk for patients and they, in an elementary state, perform a likely strong chemical reaction with water in the electrolytes. Alkali metals, earth metals and aluminum react immediately with the electrolytic reduction in the cathode with the water surrounding elementary hydrogen and its metal cations and OH ions. This means that hydrogen bubbles and the hydroxide of the metal ions used form. Through the combination of these components, in addition to the separation effect of the existing hydrogen, the metal hydroxide acts in an antibacterial manner and has a thinning or separation effect on the biofilm or the adhesion mechanism.
[0098] To avoid intolerances with body tissue, metal cations, in particular, endogenous ones (eg, potassium and / or sodium ions) are especially preferred. In addition, calcium, magnesium and / or aluminum ions also qualify. The salt provided as a base constituent for the treatment liquid is, therefore, particularly preferred, a salt of these metals, particularly, since these metal cations can be made available, in any way, only in the form of a salt, for example, diluted in water.
[0099] These metal salts can be bonds of the mentioned metals with a suitable salt former, for example, with sulfur, phosphorus, nitrogen, fluorine, chlorine, iodine, bromine, hydrocarbon, oxygen, boron or other non-metallic elements. The salt builder is advantageously selected in an appropriate way, considering the principle „the larger the anion, the lower the electrical conductivity" and in view of the high electrical conductivity at first desired. As an anion they are preferably considered substances that do not affect even health nor the peri-implant tissue. In addition, it is important to note that unpleasant odors or flavor connections are unwanted. For these reasons, sulfur anions or sulfur-containing anions in combination with oxygen or other elements are seen as truly inadequate. it is valid for fluorine, bromine, sulfur and boron ions, as appropriate, also in combination with other elements.
[00100] Contrary to them, phosphates, phosphate ions and hydrogen phosphate ions have, in most cases, no or no harmful effects. Chlorine ions or ions that contain chlorine have, in most cases, an antibacterial effect. If, however, the chlorine ion is electrolytically oxidized and exists elementally in water, then hydrochloric acid and hypochlorous acid are formed. This would, in fact, lead to neutralization in combination with the existing cathodic hydroxide. However, it has been shown in analyzes that chlorine, which results in the counter electrode to the implant (anode), largely escapes the electrolyte as a gas. If the chlorine cannot be removed completely by the treatment, it can cause severe burns on the lungs and / or mucous membranes. Here, it is worth weighing whether the benefits to patients outweigh the risks to them.
[00101] Among the phosphates of aluminum, potassium, sodium, calcium or magnesium, it should also be noted that the solubility in water is so low that a sufficient electrical conductivity of the electrolyte cannot be guaranteed (these phosphates qualify, however, very well as a complementary substance of the electrolyte to buffer the pH value). Although the chloride of the four metals already mentioned had sufficient solubility in water and a good cleaning and elimination effect on the biofilm, they could not be considered as ideal. When nitrates and / or nitrites are used, the risk to the patient through the formation of NOx gases can be expected. For this reason, the use of nitrites or nitrates is discouraged.
[00102] With respect to the aforementioned disposal objectives, in particular, for particularly good tolerability for the patient, iodine is supplied as a salt builder, in the preferred mode. It is particularly advantageous that the potassium iodine and sodium salts are also present in the human body naturally. In the oxidation of iodine ions at the anode, elemental iodine is obtained first, which can be dissolved in a sodium iodide / potassium iodide solution. Thus, a solution of potassium iodine-iodide or a sodium iodine iodide solution. Both solutions are strong disinfectants that have proven to be effective in human medicine.
[00103] Pure solutions of sodium or potassium iodide or a mixture of both have, however, as a possible disadvantage, the formation of sodium and / or potassium hydroxide and result in the associated increase in the pH value. In general, the previously described formation of metal hydroxide could be classified as problematic, since a metal hydroxide increases the pH of the electrolyte. Such a high pH value and the alkaline solution that forms or base of the metal hydroxide could have an undesired effect on the surrounding tissue in the patient's mouth and, particularly on the bones. Surrounding teeth could also be damaged. In addition, the formation of hydroxides could cause these, due to their low solubility in water, to precipitate on pillar 2 or, in general, on the component that requires treatment and, thus, impair the flow current and therefore the process as a whole. At best, by using a calcium salt in the treatment liquid, the resulting calcium hydroxide, which appears as a constituent of bone material, could be integrated into the bones; therefore, calcium is particularly preferable to the salt constituent. To compensate for this unwanted effect, the treatment liquid has a pH buffer or acid reduction in the form of another base constituent.
[00104] The acid is, in this case, in turn, specifically selected in the type of a disposal criterion, so that it, if possible, does not threaten the patient or the peri-implant tissue, but that, first, neutralize the hydroxide (and also, if possible, do not allow the pH value to rise above 7), where, secondly, the reaction products must serve the very purpose of cleaning the implant body and eliminating the biofilm. As mineral acids, phosphoric acids and / or phosphate acids are preferred. These should be limited, for reasons of health risks and / or risks attached / bone, to a maximum value of 30% or preferably, 10 to 20%. A preferred acid, in particular, which is seen as mineral salt and has an especially positive effect on the general purpose of disposal and cleaning, is, however, carbonic acid. This is, however, limited in its applicable quantity, due to the comparatively low dissolving power in water.
On the other hand, organic acids provide, in a similar way, such mineral acids, H + ions that neutralize the hydroxide with a reduced pH value. Since they do not, in addition, produce any damage or, at best, cause minimal damage to tissue or the patient, in general, such organic acids are particularly preferred as basic components for the treatment liquid. Organic acids would be, for example, alkanoic acids, fruit acids, carboxylic acids and hydroxycarboxylic acids. Α-hydroxycarboxylic acids have been shown to be especially suitable acids. In particular, the particularly preferred acids of lactic, citric and malic acid do not show any adverse effects on the health of the patient in general or of the peri-implant tissue. Especially in implants heavily contaminated with biofilm, on which dental calculus was formed, lower doses of acetic acid have proven to be a good cleaning agent. Other acids, which have the cleansing as well as the effect of eliminating bacteria, but, for health reasons, are not imaginable, would be fumaric acids, gluconic acid, glycolic acid, salicylic acid, mandelic acid, tartaric acid, oxalic acid and formic acid.
[00106] When neutralizing the OH- hydroxide ion with the corresponding H + ion of an acid, the acid metal salt used from the corresponding metal hydroxide is additionally obtained. The predicted use of the acid is thus advantageous, not only for buffering the pH value, but also contributes to the conversion of the relatively bad dissolving hydroxide in water into a salt that of relatively good dissolving in water and prevents, with this, the unwanted deposition and precipitation harmful to the process on the component that requires treatment. The salts mentioned are used particularly for combining layers of matter, among others, in medicine. By neutralizing potassium, sodium and / or calcium hydroxide with lactic acid, potassium lactate (which has a large-scale antimicrobial effect), sodium lactate or calcium lactate is formed. If the hydroxides formed are neutralized with citric acid, potassium, sodium or calcium citrate is formed. Sodium citrate is particularly advantageous, since it prevents blood from clotting. This is particularly advantageous because, during the process of leakage, blood clotting of the implant surface, the migration of ions to the implant surface could, with this, prevent the continuation of the treatment process and harm it as a whole.
[00107] In the neutralization of hydroxides with malic acid, on the other hand, malates of the respective cation appear, which likewise have favorable effects on the process. The neutralization of hydroxides with acetic acid results in potassium, sodium and / or calcium acetate, which likewise have a favorable effect on the process.
[00108] Lactates, citrates, malates and / or acetates of potassium, sodium and / or calcium all have an acid regulating effect and are therefore compatible in such a way that they meet EU regulations for additives food in its use of any quantity limitation.
[00109] When using acids in the electrolytes in combination with iodides and / or chlorides of potassium, calcium, magnesium, aluminum and / or calcium, it was surprisingly proved by the electrolytic use that, through the direct reduction of H + ions, bubble formation is positively influenced, so that the biofilm separates better more quickly. With this, a plurality of comparatively small balls is obtained, with a high production rate, which, due to their comparatively smaller size, are unable to release the biofilm from the underlying surface, either as a whole or in a localized manner. Thus, the biofilm is preferably raised as a whole or in cohesive parts of comparatively larger size and instead of a plurality of small fragments, which conditions a better cleaning effect.
[00110] Instead of metal cations, ammonium cations can be used. With this, however, there is a risk that, through the electrolytic process, other ammonium connections (for example, ammonia) may be formed. This represents a risk to the patient and is also shown through an unpleasant taste and smell.
[00111] It was observed by attempt that the biofilm partially detaches in small fragments or in larger cohesive parts. The latter is preferred, since, with this, comparatively larger surfaces can produce very favorable cleaning results. Analyzes also showed that the removal of the loose biofilm and / or its fragments through the formation of foam on the implant surface is favored. It has been proved that it is favorable that, after the use of an electrolyte of the metal salts, acids and water described, which are particularly competent for elimination and separation, a second electrolyte is used which additionally presents a foam formation in the cathode area . Such foaming can be achieved, in which a substance is preferably admitted in addition to the electrolyte, which has at least three CH2 chain links or at least one CH2 chain link and at least one carbon ring connection . Here, oil or chlorhexidine can be used. In addition, ionic liquids can also be used, which preferably have a CI- and / or OH ions. Since the organic portion of cations in an ionic liquid is reduced under circumstances of the implant surface and disappears there, it is possible, in a particularly favorable execution, to attach bone growth factors to that portion of cations.
[00112] If the chlorides and iodides are mixed in the correct proportion, the uncomfortable formation of chlorine gas can be avoided. The anode results in: 2J + 5CI + 6H2O -> 10HCI + 2HIO3
[00113] This means that both hydrochloric acid and hydroiodic acid are formed at the anode. They certainly have a strong antimicrobial effect and are again neutralized together with the cathodic hydroxide formed.
[00114] A particularly preferred composition of the treatment liquid, which has been shown in laboratory research for particularly favorable cleaning properties, comprises an aqueous solution of sodium iodide (Nal) or potassium iodide (Kl) in a mixture ratio of at least 5, preferably at least 10, in particular, preferably at least 20 g of salt per 30 ml of liquid (ie water, H2O, if applicable, enriched with CO2), by means of addition of lactic acid at a pH value of about 2.7 to 2.9.
[00115] In the execution of the process, an average current density in the pillar 2, or in the component that requires treatment, is provided for, at least 50 mA / cm2, advantageously at least 100 mA / cm2, in particular, preferably at least 250 mA / cm2, in which this current density is applied to the outer surface of pillar 2 (therefore without considering the surface properties, such as roughness or surface structure). For the separation of the biofilm, an average current density of 50 mA / cm2 to 300 mA / cm2 was proved to be particularly favorable, advantageously from 100 mA / cm2 to 200 mA / cm2. For the removal of the biofilm fragments, the average current density had to be increased preferably in the range of 300 mA / cm2 to 5,000 mA / cm2 or, particularly advantageous, from 1,000 mA / cm2 to 2,000 mA / cm2.
[00116] With the addition of H2O2 the effervescence effect on the cathode is greatly reduced or avoided. This results in a strong formation of H2O, which can be used for cleaning the surface.LIST OF REFERENCE CHARACTERISTICS LIST OF REFERENCE CHARACTERISTICS 1 dental implant system 2 first implant part / abutment 4 second implant part 6 external thread 8 apical end 10 connecting pivot 12 intake channel 14 indicating element 16 end channel piece 18 connecting screw 20 screw thread 30,30 ', 30 ”, 30' '' treatment element / treatment support 32 contact 34 front corner 36 area 40 base body 42 front surface 43 connection pivot 44 internal channel 45 spacing pieces 46 connection screw 48 screw thread 49 electrical contact element 50 needle tip 52 base 56 channel / channel for media 58 ring body 59 grooves 60 outlet opening 62 guide element 64 contact 66 conductor element 68 metal body 69 contact surface 70 insulating coating 71 ring body 72 channel for media 74 ra slot 90 treatment system 92 connection element 94 hose pack 96, 98 control and supply unit

权利要求:
Claims (12)
[0001]
1. Treatment element (30, 30 ', 30 ”, 30' '') for use with a dental implant piece (2) inserted into a patient's jaw bone, which has a base body (40) provided for the mechanical connection with the dental implant part (2), the base body (40) being provided with at least one channel for means (56) for a cleaning liquid, the base body (40) carrying a first conductive element (62), which forms an electrical current circuit and which can be connected with the dental implant part (2), and a second conductive element (66), which is electrically isolated from the first conductive element (62) and which forms an electrical current circuit for a contact (64) disposed at the end, and whose contact (64) can be positioned in an area (36) close to the dental implant part (2), characterized by the fact that the second conductive element (66) is formed by one or some of the channels for means (56).
[0002]
2. Treatment element (30, 30 ', 30 ”), according to claim 1, characterized by the fact that the base body (40) includes a connection system adapted to the dental implant part (2), for mechanical connection in it.
[0003]
Treatment element (30, 30 ', 30 ") according to either of claims 1 or 2, characterized by the fact that its second conducting element (66) is performed as an electrode or channel element (80) which is or are supported on it in a longitudinal direction, essentially parallel to the central axis of the base body (40).
[0004]
Treatment element (30, 30 ', 30 ") according to any one of claims 1 to 3, characterized in that the second conducting element (66) is fixed in such a way to the base body (40) , that its contact (64) disposed at the end, seen in its lateral direction, can be positioned at a distance of a maximum of 10 mm, preferably of a maximum of 5 mm, from the central longitudinal axis of the dental implant piece (2).
[0005]
5. Treatment element (30, 30 ', 30 ”) according to any one of claims 1 to 4, characterized by the fact that its base body (40) is electrically isolated on its contact surface (42) in relation to the dental implant part (2).
[0006]
6. Treatment element (30, 30 ', 30 ”) according to any one of claims 1 to 5, characterized in that its connection system comprises a connection screw (46) for insertion into the screw channel of the abutment (2) of a dental implant system (1) executed in one or more pieces.
[0007]
7. Treatment element (30, 30 ’, 30") according to claim 6, characterized in that the connecting screw (46) is electrically conductive connected with the first conductive element (62).
[0008]
8. Treatment system (90) for a dental implant part (2) with a treatment element (30, 30 ', 30 ”), as defined in any one of claims 1 to 7, characterized by the fact that its elements conductors (62, 66) are electrically connected with a current or voltage source.
[0009]
9. Treatment system (90), according to claim 8, characterized by the fact that its current or voltage source for a pulsating application, if necessary, is designed with current or voltage.
[0010]
10. Treatment system (90) according to either of claims 8 or 9, characterized by the fact that it is designed for an operating voltage on the electrodes of up to 30 V.
[0011]
11. Treatment system (90) according to any of claims 8 to 10, characterized in that an inlet system for cleaning liquid is connected to its treatment element (30, 30 ', 30 ”) .
[0012]
12. Treatment system (90), according to claim 11, characterized by the fact that, as a cleaning liquid, water mixed with at least one acid and / or with at least one salt is provided.

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法律状态:
2018-11-21| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-11-26| B25A| Requested transfer of rights approved|Owner name: HOLGER ZIPPRICH (DE) ; URS BRODBECK (CH) ; ZYFOMA |

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2019-12-10| B25A| Requested transfer of rights approved|Owner name: URS BRODBECK (CH) ; ZYFOMA GMBH (DE) |

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2019-12-24| B25A| Requested transfer of rights approved|Owner name: ZYFOMA GMBH (DE) |

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2020-04-14| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-09-24| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2020-12-08| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 18/10/2013, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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DE102012022227.0|2012-11-14|

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DE102012022593.8A|DE102012022593B8|2012-11-14|2012-11-14|Treatment element for use with a dental implant part and treatment system for cleaning a dental implant part|

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DE201210022227|DE102012022227A1|2012-11-14|2012-11-14|Treatment element for use with dental implant element inserted into jawbone of patient, has conductor element forming contact that is arranged at end side of current path, where contact is positioned in space in vicinity of implant element|

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DE102012022593.8|2012-11-14|

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DE102013201883.5|2013-02-05|

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PCT/EP2013/003150|WO2014075755A1|2012-11-14|2013-10-18|Treatment element for use together with a dental implant part, treatment system and method for cleaning a dental implant part|

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