CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority of U.S. application No. 62/155,649, the entire contents of which are incorporated by reference herein.

TECHNICAL FIELD

[0002] The present application relates generally to a dental prosthesis system and, more particularly, to a guided dental prosthesis design and adaptation system and method of using same for adapting a dental prosthesis to a securing system in the patient's jaw.

[0003] BACKGROUND OF THE ART

[0004] Contemporary dental implant treatments generally comprise three main phases: (1) the diagnostic and treatment planning phase, (2) the surgical phase, and (3) the restorative phase.

[0005] Improvements to all three phases have been made possible by the use of prosthetically-driven virtual treatment planning and guided surgery tools and methods, ultimately increasing the predictability of the treatment outcome. In some known methods, the patient endures limited functionality and esthetics for several months before an adequate prosthesis can be delivered and finally restoring sufficient masticatory function and natural-looking teeth.

[0006] During the diagnostic and treatment planning phase, the combined use of a number of digital datasets allows the craftsman to determine the availability and position of potential implant receptor sites in the patient's jawbone structure. The scope of this virtual exercise can also include the determination of optimal restorative components dimensions and positions, with regards to:

• their potential for osseointegration and long-term function in a load-bearing capacity;

• the feasibility of their placement with the required surgical tools; and the esthetics of their interface with the prosthesis.

[0007] Also known in the art, the resulting data may be used to design guided surgery tools such as surgical guides, being components adapted to be fitted on the patient's anatomy and to receive additional components in order to surgically modify the patient's anatomy and/or insert implants and/or anchoring components with increased effectiveness in comparison to the traditional free-handed approach.

[0008] In general, methods can rely on digital datasets of structures such as the patient's anatomy, the patient's existing or ideal prosthesis, and the components required for the surgical and restoration phases, all of which may vary in format:

• volumetric digital data, acquired by means of imaging such as X-ray computed tomography or magnetic resonance imaging;

• topographical digital data, acquired by means of imaging such as optical scanning;

• two-dimensional or three-dimensional digital data, created, adapted and/or displayed by means such as the use of computer-assisted design software.

• the components required to conduct the surgical and restoration phases may include, among others: o one or more anchoring devices such as pins or screws; o one or more surgical guides adapted with one or more apertures each aligned with one implant or one anchoring device, and positioned at a distance to control drilling depth, and adapted to receive none or one cylinder; o one or more cylinders to receive none or one or more drilling templates; o one or more drilling templates adapted to receive one or more drills; o one or more drills ; o one or more implants; o one or more abutments; o one or more interface components (in the current state of the art, one embodiment of an interface component is commonly referred to as a coping); o a screw-based or cement-based retention system, adapted to secure one or more implants and/or abutments and/or interface components to a prosthesis; o one or more temporary or final prosthesis.

[0009] During the restoration phase, at a time determined by the clinician as a function of clinical requirements and patient instructions, a prosthesis can be loaded to the implants and secured with either a screw-retained or cement-retained system. Although the selection of a retaining system over the other is best done on a case- to-case basis, each is known to be better suited to specific applications.

[0010] A screw-retained system is deemed a good overall solution as it allows quantified and dependable retention and also allows high retrievability of the prosthesis, in case significant alterations are needed. This advantage becomes even more predominant for restorations involving multiple implants.

[0011] On the other hand, a screw-retained system requires an occlusal opening to access the screw channel through which the screw is inserted to secure the interface component to the implant or abutment. Depending on postoperative restorative component positions, screw channels may end up aligned in a manner that limits their accessibility. Also, their alignment may require the deterioration of highly functional and/or aesthetic features. Therefore, a cement- retained system whose retention and retrievability is normally more dependent on the skill of the craftsman can in such cases end up the preferable solution, especially for short- span restorations in critical areas.

[0012] The term "loading" consists in assembling the prosthesis and interface components to the implants so that the masticatory loads are effectively transmitted to the implants and bones, restoring the patient's chewing function. [0013] The delayed loading approach inherently involves a healing period, which consists in waiting for a sufficient period of time following the surgical phase, usually three to six months, to allow the implant to osseointegrate to the patient's bone and for the tissue to adapt to any permucosal components. This approach also often requires the modification of the patient's prosthesis to create housings for the prosthesis to fit passively over any implant system permucosal component (such as an abutment), and minimise masticatory load transmission. While this approach is the most widely used, it is also inconvenient for the patient, who will have to wear a functionally inadequate prosthesis and endure an impacted quality of life for several more months. On the other hand, the healing period will allow sufficient time for the dental laboratory to play its role in the restoration phase and to deliver a final prosthesis meticulously adapted to the patient's anatomy and implants, fulfilling all functional and aesthetic requirements.

[0014] The alternate, immediate loading approach is intended to give patients an increase in quality of life significantly sooner after the surgery by improving the functionality of the prosthesis worn during the healing period. Traditionally in this approach, the postoperative anatomy and implant configuration are visually surveyed by the craftsman in order to adapt the prosthesis for it to be received and loaded on to the implants.

[0015] Optionally, if the immediate loading approach is considered during the treatment planning phase, prefabricated prosthesis may be provided on time for the surgical phase, pre-adapted with features such as blind openings (housings) for cement-retained systems or through openings for screw-retained systems, in alignment with the axis of the planned implant and/or abutment positions (implant system). The geometry and dimensions of these openings must be adapted to allow for adequate seating of the prosthesis into the patient's mouth and to allow the interface components to be assembled to the implants and/or abutments (implant system) when entered through the openings. The method then requires the assembly of the prosthesis to the interface components by the addition of bonding material inside the openings and around each interface component, as well as addition of prosthesis repair material to fill any occlusal openings, if applicable. [0016] Generally, it is accepted that implant positions and patient anatomy geometry observed after the surgical phase may differ from the planned outcome, even with the use of guided surgery components. Postoperative implant positions and patient anatomy geometry can differ from the planned outcome as a result of one or more causes, including:

• Imprecise creation, acquisition and/or processing of one or more replica of the patient anatomy's geometry and of the prosthesis's geometry;

• Imprecise creation, acquisition and/or or processing of one or more digital datasets of the patient anatomy's geometry and the prosthesis's geometry;

• Imprecise creation, acquisition and/or processing of one or more digital datasets of one or more components required to conduct the treatment;

• Imprecise gesture of the clinician when manipulating one or more components required to conduct the treatment;

• Imprecise osteotomy caused by the design of one or more components required to conduct the treatment;

• Imprecise osteotomy caused by the design of the guidance function of one or more surgical guides supporting one or more components required to conduct the treatment;

• Inadequate anchoring of the surgical guide to the patient's anatomy; and

• Biological, geometrical and mechanical properties of the patient's anatomy.

[0017] The components used for the restoration phase may be considered in a virtually planned treatment in an effort to avoid or minimize the functional and aesthetic deficiencies caused by the anticipated use of a screw-retained securing system. However, such deficiencies may be unavoidable as assessed during treatment planning, or unpredictably occur during the surgical phase as observed postoperatively. [0018] This adaptation process is of an iterative nature and conducted with handheld instruments, often requiring several adjustments and seating attempts until the prosthesis can be seated into the patient's mouth and receive the interface components for assembly to the implants and/or abutments. Then more adjustments are needed as the prosthesis is finished with the use of repair materials to reconstruct the areas of the prosthesis that were deteriorated during the adaptation.

[0019] As such, conducting the immediate loading approach may necessitate time- consuming adaptation work and several hours of discomfort for the patient. The outcome of the approach primarily relies on the skill level of the craftsman and on the components used, as the adaptation to a screw-retained system introduces more risks of deterioration to the prosthesis, and can further limit the increase in quality of life to be gained over delayed loading approach. As such, most current techniques do not allow for the provision of an immediately loaded screw-retained prosthesis with sufficient predictability of its functional and aesthetic aspects and therefore, often fall short of fulfilling the expectations of both the clinician and the patient.

[0020] Furthermore, a clinician can be looking to enhance the functionality, estheticism and/or retrievability of a screw-retained prosthesis already worn by a patient. As is customary in the restorative phase of immediate loading cases, the deficient prosthesis worn during the healing period is replaced by one with enhanced load-bearing capacity and esthetics, a process requiring a series of appointments. The current practice requires the acquisition of digital datasets of components such as the patient's post-healing oral anatomy and implant system configuration during a first appointment, allowing proper fitment of the prosthesis on the said components. Then, using CAD/CAM software and manufacturing equipment, the said datasets are used by dental technicians to design and manufacture custom screw-retained abutments or prosthesis, featuring occlusal access openings specifically adapted to a specific securing system in order to minimize deteriorations. Optionally, further optimization is made possible by existing securing systems and aforementioned CAD/CAM tools, allowing for an occlusal access opening to be prepared at an angle from the screw channel and, away from critical areas. An adapted drive design then allows driving and securing a screw with its adapted screwdriver being used through the occlusal access opening at an angle from the screw's longitudinal axis. Once the "final" prosthesis is ready, one or more appointments are needed for the clinician to make final adjustments before loading and securing it to the patient's implants. Although functional and aesthetic improvements are made possible, the delays and costs involved can still be detrimental to patient satisfaction.

[0021] Therefore, an opportunity for improvement resides in the restorative phase. It would be desirable to provide a guided dental prosthesis design and adaptation system and method of using same and/or a cutting guide for forming an occlusal access opening in a dental prosthesis from an occlusal side thereof, that allows the provision of a prosthesis requiring minimal and optimizable adaptation to a securing system, all of which to be achievable chair-side. Such improvements may allow for the adaptation, loading and securing of a functional and esthetic prosthesis during a single appointment, whether right after the surgical procedure if following an immediate loading approach, or at a follow-up appointment for the replacement of an existing prosthesis.

SUMMARY

[0022] In one aspect, there is provided a cutting guide for forming an occlusal access opening in an occlusal surface of a dental prosthesis, the cutting guide comprising: an indexing component configured for mating engagement with an interface component on an intaglio surface of the dental prosthesis, the interface component defining a primary hole having an entry point for receiving a fastener, and a guidance component structurally linked to the indexing component by a support structure, the support structure ensuring relative positioning of the guidance and indexing components, the guidance component being spaced from the indexing component so as to be positioned on an occlusal side of the dental prosthesis when the interface component is engaged with the indexing component, the guidance component having a guiding aperture for guiding a cutting tool along an interface component access path leading to the entry point of the primary hole of the interface component when the interface component is engaged with the indexing component.

[0023] In another aspect, there is provided a cutting guide for forming an occlusal access opening in a dental prosthesis from an occlusal side thereof, wherein the dental prosthesis has an intaglio side opposite to the occlusal side and configured to carry at least one interface component, which is, in turn, configured for mating engagement with at least one corresponding implant or abutment in a patient's jaw, and wherein the at least one interface component has a primary hole for receiving a fastener used for securing the at least one interface component to the at least one corresponding implant or abutment; the cutting guide comprising: an intaglio arm positionable on the intaglio side of the dental prosthesis, an implant or abutment coronal interface replica projecting from the intaglio arm and configured for mating engagement with the interface component, a support column projecting from the intaglio arm, and an occlusal arm projecting from the support column and spaced from the intaglio arm by a distance sufficient to accommodate the dental prosthesis therebetween with the intaglio and the occlusal arms respectively extending on the intaglio and occlusal sides of the dental prosthesis, a guiding aperture extending through the occlusal arm along an axis intersecting an entry point of the primary hole in the at least one interface component when the at least one interface component is engaged with the implant or abutment coronal interface replica.

[0024] In a further aspect, there is provided a method of forming an occlusal access opening into a dental prosthesis for providing access to an interface component used for seating the dental prosthesis onto an implant or an abutment in a patient's jaw, the method comprising: referencing an indexing component of a cutting guide to the interface component on an intaglio surface of the dental prosthesis, the indexing component being referenced to a guiding aperture of the cutting guide on an occlusal side of the dental prosthesis, and guiding a cutting tool through the guiding aperture to form the occlusal access opening into the dental prosthesis from the occlusal side thereof.

[0025] In a still further aspect, there is provided a method of forming an occlusal access opening into an occlusal surface of a dental prosthesis for providing access to an interface component carried on an intaglio surface of the dental prosthesis, the interface component defining a fastener channel for receiving a fastener to secure the dental prosthesis to an implant or an abutment in a patient's jaw, the method comprising: installing the dental prosthesis on an adaptation tool, the adaptation tool having an indexing component and a guidance component interconnected by a support structure, wherein installing comprises engaging the interface component of the dental prosthesis in mating engagement with the indexing component disposed on an intaglio side of the dental prosthesis, the indexing component on the intaglio side being referenced to a guiding aperture of the guidance component, the support structure holding the guidance component on an occlusal side of the dental prosthesis when the interface component is matingly engaged with the indexing component, and guiding a cutting tool through the guiding aperture to form the occlusal access opening into the dental prosthesis from the occlusal side thereof.

DESCRIPTION OF THE DRAWINGS

[0026] Reference is now made to the accompanying figures in which: [0027] Fig. 1 is a schematic view of a partial prosthesis; [0028] Fig. 2 is a schematic view of a full prosthesis;

[0029] Fig. 3 is a schematic view of the prosthesis shown in Fig. 2 shown from an occlusal point of view;

[0030] Fig. 4 is a schematic planar view of the intaglio side of the prosthesis shown in Fig. 2;

[0031] Fig. 5 is a schematic fragmented cross-sectional view of a multi-component prosthesis;

[0032] Fig. 6 is a schematic view of a prosthesis with blind-openings aligned with implant systems, and with anchoring features assembled with anchoring components;

[0033] Fig. 7 is a schematic cross-sectional view of the prosthesis adapted with anchoring features assembled with anchoring components into existing adapted features of the patient's anatomy;

[0034] Fig. 8 is a schematic exploded isometric view of a two-part surgical guide including a base-plate and removable teeth adaptable for use as a prosthesis;

[0035] Fig. 9 is a schematic view of the two-part surgical guide shown in Fig. 8 after assembly and conversion into a prosthesis; [0036] Fig. 10 is a schematic view of an interface component;

[0037] Fig. 1 1 is a schematic view of the interface component (shown in transparency) mounted to an implant or abutment (implant system);

[0038] Fig. 12 is a schematic cross-sectional view of the interface component secured to an implant or abutment by means of a fastener, a screw in the illustrated exemplary embodiment;

[0039] Fig. 13 is a schematic view of another fastener or mating component that can be used to secure the interface component to the abutment or the implant;

[0040] Fig. 14 is a schematic cross-sectional view of the interface component secured to an abutment or an implant by means of a mating component of the type shown in Fig. 13;

[0041] Fig. 15 is a schematic view of a dental prosthesis having a bling opening defined in an intaglio surface thereof for adjustably receiving an interface component;

[0042] Fig. 16 is a schematic cross-sectional view of the prosthesis shown in Fig. 15;

[0043] Fig. 17 is a schematic cross-sectional view of a blind opening being defined in the intaglio surface of a prosthesis;

[0044] Fig. 18 is a schematic fragmented cross-sectional view illustrating how an opening in a base-plate of a surgical guide adapted for conversion into a prosthesis can be used as is or adapted into a blind opening of a prosthesis system (base-plate and removable teeth component assembled);

[0045] Fig. 19 is a schematic cross-sectional view of an interface component installed in a blind opening in the prosthesis and secured to an implant or abutment;

[0046] Fig. 20 is a schematic view of a fastener that could be used to secure the interface component to the abutment or the implant; [0047] Fig. 21 is a schematic view of a fastener tool that could be used to drive the fastener shown in Fig. 20;

[0048] Fig. 22 is a schematic view illustrating how the tool can be used to tighten the fastener while the axis of the tool is angled relative to the fastener axis;

[0049] Fig. 23 is a schematic cross-sectional view of another securing system that could be used for securing the interface component to an implant, the fastener being shown in the process of being engaged with the implant/abutment;

[0050] Fig. 24 is a schematic cross-sectional view illustrating the final positioning of the securing system shown in Fig. 23 ;

[0051] Fig. 25A is a schematic view of an exemplary embodiment of a cutting guide forming part of a dental prosthesis adaptation system;

[0052] Fig. 25B is a schematic view of a prosthesis occlusal access opening aligned with a guiding aperture of the cutting guide;

[0053] Fig. 26 is a schematic view of a prosthesis (shown in transparency) having one interface component received onto an indexing component of the cutting guide for the creation of an occlusal access opening;

[0054] Fig. 27 is a schematic cross-sectional view illustrating the interface component engaged onto the indexing component of the cutting guide;

[0055] Fig. 28 is a schematic view of the cutting guide in accordance to an alternate embodiment;

[0056] Fig. 29 is a schematic view of the cutting guide in accordance to an alternate embodiment;

[0057] Fig. 30 is a schematic view of the cutting guide in accordance to a still further alternate embodiment;

[0058] Fig. 31 is a schematic cross-sectional view illustrating how the cutting guide system can be adapted and used to form an access opening in a prosthesis having an interface component adapted to be mounted to an implant system having no abutment;

[0059] Fig. 32 is a schematic view illustrating an interface component (shown in transparency) mounted to an indexing component of a cutting guide, the indexing component being free to rotate about a longitudinal axis;

[0060] Fig. 33 is a schematic cross-sectional view of an indexing component of the cutting guide, the indexing component being adapted to receive the interface component to limit its freedom of movement to a rotation about a longitudinal axis;

[0061] Fig. 34 is a schematic isometric view of another embodiment of the cutting guide in which the indexing component is replaceable;

[0062] Fig. 35 is a schematic isometric view of a guidance component of the cutting guide;

[0063] Fig. 36 is a schematic view of a retrievability template adapted to be received onto the prosthesis;

[0064] Fig. 37 is a schematic view illustrating the use of guided adaptation system components to adapt the retrievability template with an opening aligned with an occlusal access opening of the prosthesis system (shown in transparency);

[0065] Fig. 38 is a schematic view illustrating how the retrievability template (shown in transparency) can be used to regain access to the securing system following the adaptation, securing and finishing of the prosthesis system;

[0066] Fig. 39 is a schematic view of the prosthesis adapted to the patient anatomy, secured onto implant systems and finished, having obstructed occlusal access openings with optimal functional and esthetic aspects.

[0067] Fig. 40 is a schematic exploded isometric view a two-part dental prosthesis system;

[0068] Fig. 41 is a schematic isometric view of the two-part dental prosthesis system, with a prosthesis portion thereof removed to illustrate the interface components cemented in adjusted positions for alignment with the implants in the patient's jaw, and

[0069] Fig. 42 is a schematic isometric view illustrating a fastener that could be used to secure the cemented interface component to an associated implant in the patient's jaw prior to the dental prosthesis part is seated on the base part of the two part dental prosthesis system.

DETAILED DESCRIPTION

[0070] According to the current techniques, the dental implant treatment includes three main phases: (1) the diagnostic and treatment planning phase, (2) the surgical phase, and (3) the restorative phase. The restorative phase can be conducted with an immediate loading approach or a delayed loading approach.

[0071] In a particular embodiment, the restorative phase involves one or more prosthesis system, each having one or more implant system, each having one or more transitory mating system and one or more securing system. The prosthesis system is provided to the clinician to be adapted to the postoperative patient anatomy and implant system and fitted to the transitory mating system in order to be received on the implant system. The prosthesis system is then adapted to the securing system in order to be secured to the implant system.

[0072] Suboptimal postoperative alignment of an implant system relatively to a patient anatomy can impose the deterioration of functional and esthetic aspects of a prosthesis system when adapting it to a securing system.

[0073] According to one general aspect of an embodiment, there is provided a dental prosthesis CAD/CAM design method enabling the consideration, planning and optimisation of the three main phases of a contemporary dental implant treatment, with the objective of improving the functional and aesthetic aspects of the prosthesis adapted to be worn by a patient in the third phase of the treatment.

[0074] Compatible implant system, transitory mating system and securing system have functional feature dimensions and relative positioning that are known and that can be represented as digital datasets and used in combination to CAD/CAM software and manufacturing equipment. Of all embodiments of those systems, one can be selected during the first phase as a function of the patient's anatomy and intended prosthetics.

[0075] Using digital datasets of the patient anatomy and said systems, the method allows for the determination of one or more optimal implant receptor site and one or more optimal embodiment of compatible implant system, transitory mating system and securing system as a function of the patient anatomy and intended prosthetics. Therefore, this method improves treatment predictability during the first phase by allowing to avoid or minimize the functional and aesthetic deficiencies otherwise caused by the use of a screw-retained securing system, to the furthest extent practicable given the constraints imposed by clinical considerations and the accuracy limitations of guided surgery solutions.

[0076] According to a further aspect, also using digital datasets of the patient anatomy and said systems, the method allows the use of CAD/CAM software and manufacturing equipment for the provision of a prosthesis system adapted with blind openings according to the planned position of at least one implant system, transitory mating system and securing system. This method introduces improvements by potentially removing the need for any adaptation work by the clinician in order to fit the prosthesis to the transitory mating system, or at least minimize its extent and predictability.

[0077] According to a still further aspect, also using digital datasets of the patient anatomy and said systems as well as CAD/CAM software and manufacturing equipment, the method allows the provision of a cutting template adapted to be received on an existing prosthesis, allowing to guide the adaptation of the prosthesis with blind openings according to the planned position of at least one implant system, transitory mating system and securing system. This method introduces an improvement by increasing the predictability of adaptation work by the clinician in order to fit the prosthesis to the transitory mating system.

[0078] According to another general aspect of an embodiment, there is provided a guided dental prosthesis design and an adaptation system and a method of using same enabling the mitigation of suboptimal postoperative implant positions resulting from known treatment plan limitations or unforeseen surgical phase implant deviations, both of which would otherwise introduce deteriorations or limitations to the functional and aesthetic aspects of the prosthesis. As such, the present system and method may be used to ultimately increase the feasibility, predictability and effectiveness of the restorative phase's outcome, and applies to both provisional and long-term prosthesis, and to both delayed and immediate loading approaches.

[0079] In one embodiment, the present system and method enable the conversion of a dental prosthesis system such as a surgical guide, into a temporary or final prosthesis, and to do so without major deterioration of the functional and aesthetic aspects, as would otherwise be expected by a person well versed in the art.

[0080] Many of the surgical guides used today are discarded after surgery and are considered useless. According to a still further aspect, there is provided a method to design surgical guides in such a way that they can be transformed into an implant- supported prosthesis fulfilling the usual functional and aesthetic criteria. This may be achieved by providing a surgical guide which is:

• Adapted to be convertible from its one or more parts into a prosthesis;

• Adapted to be received on the implants at their planned position with minimal adjustments; and

• Fabricated in a material that possesses the pre-requisite properties for a dental prosthesis, among which are biocompatibility, flexural strength, compressive strength, resilience, shade consistency, color stability, transparency, and chemical bondability to other restoration materials used in the restorative phase.

[0081] The combination of the listed attributes can result in a prosthesis that will resist masticatory loads, transmit those loads to the patient's anatomy directly and/or by means of implants in a clinically adequate manner, will have a natural aesthetic aspect, will be retrievable from the mouth and repairable by the clinician when needed, and will enable the patient to benefit from a satisfying quality of life shortly after the surgical phase.

[0082] In one aspect, the above system and method can, in one embodiment, be used to provide a prosthesis that features the listed attributes, but without necessarily being adapted and intended to be used during the surgical phase as a surgical guide.

[0083] According to a still further general aspect the system and method can, in various embodiments, be used to minimise or avoid compromises to the functional and aesthetic aspects of the prosthesis when loading and securing it to any number of implant, abutment and interface component during the restorative phase of the treatment, regardless of the number of teeth that the prosthesis is intended to replace, and be used for full arch, multiple teeth or single tooth dental prosthesis.

[0084] There will now be described an embodiment of a guided dental prosthesis design and adaptation system and a method of using the same and the design and adaptation of a dental prosthesis (either a single unit prosthesis such as a crown, or a multi-unit prosthesis such as a full prosthesis) for loading and securing the dental prosthesis onto implants using a fastener, such as a screw-based retention system. Improvements over the current systems and methods are offered by providing means to compensate for suboptimal postoperative implant positions in the patient's jawbone structure, otherwise compromising the effectiveness of the restorative phase.

[0085] According to at least some of the embodiments, improvements include, among others, the reduction of the time normally required for the prosthesis adaptation process, an increased preservation of the functional and aesthetic aspects of the prosthesis during the adaptation process, and an increased ease of access for securing the prosthesis to the implants and for retrieving it should the need arise.

[0086] The guided dental prosthesis design and adaptation system may generally include an implant system, a prosthesis system, a transitional system, a guided adaptation system and a securing system.

[0087] According to an embodiment, a dental prosthesis system 50 is provided with one or more prosthesis components. The prosthesis 50 has a geometry adapted to some areas of the patient's oral and maxillofacial anatomy 100 (Fig. 6) and is intended to restore a patient's dentition, for example on a given arch, in part, to replace a tooth, as shown in Fig. 1 as a partial prosthesis 50A or in its entirety, for a set of teeth, as shown in Fig. 2 as a full prosthesis 50B.

[0088] Referring to Figs. 3 and 4, the dental prosthesis 50 define an occlusal surface 51 having an occlusal feature 52 (Fig. 3) and an intaglio surface 53 having an intaglio feature 54 (Fig. 4). The occlusal feature 52 can be adapted as a function of the desired prosthesis' functional and esthetic requirements. The occlusal surface 51 includes the buccal, lingual and palatal sides or portions. The intaglio feature 54 can be adapted to be mounted to the patient's jaw.

[0089] According to a particular embodiment, and as shown in Fig. 5, the prosthesis 50 is obtained by connecting, for example by bonding, a removable teeth component 55 and a superstructure. The removable teeth component 55 can include the occlusal feature 52 and a mating interface adapted to be received on the superstructure. The superstructure can include the intaglio feature 54 which is adapted to be received on the patient's anatomy, and has a mating interface adapted to receive the removable teeth component 55. The removable teeth component 55 may include one or more teeth replicas and/or prosthesis sections 50A, 50B. In the embodiment shown at Fig. 5, the superstructure includes a baseplate 56 having the intaglio feature 54. In an alternate embodiment, the base-plate

56 can include one more anchoring features 57 which are adapted to be received on the patient's anatomy. Therefore, the base-plate 56 can be in direct contact with the patient's jaw or, in an alternate embodiment, the base-plate 56 can be used in securing the prosthesis 50 to the patient's jaw without contacting the patient's jaw.

[0090] Referring to Fig. 6, the prosthesis 50 has one or more anchoring feature(s)

57 adapted to receive one or more anchoring component(s) 58, such as a pin or screw. Referring to Fig. 7, the anchoring feature 57 is used to receive a corresponding anchoring component 58 for assembly of the prosthesis 50 into an existing feature of the patient's anatomy which is adapted to receive the anchoring component 58.

[0091] Referring to Figs. 8 and 9, there is shown a two-part surgical guide that is adapted to be subsequently used as a dental prosthesis. The surgical guide comprises a base plate 56 and the teeth component 55. The teeth component 55 is removably securable to the base plate 56 to convert the guide (i.e. the base plate) into prosthesis 50. The base-plate 56 is adapted for use in the surgical phase. The base plate 56 has one or more aperture(s) 59 adapted to provide guidance for modifying the patient's anatomy and/or inserting implant systems 60 into the patient's anatomy using additional components, for example, such as drilling templates, drills and implant insertion tools. The implant system 60 can include an implant 60A and or an abutment 60B

[0092] In a particular embodiment, the removable teeth component 55 is not permanently attached to the base-plate 56 until each aperture 59 of the base-plate 56 has been adapted to interface with adjacent components and/or after the occlusal surface 51 or feature 52 has been adapted with an opening in order to facilitate adjustments of the components.

[0093] An interface component, such as the one shown in Fig. 10 at 61 , is typically adjustably mounted in an oversized blind opening 62 (Fig. 18) defined in the intaglio surface 53 of the prosthesis 50. The interface component 61 is adapted to be seated on the implant system 60, such as implants 60A or abutments 60B in the patient's jaw. A bonding material (e.g. cement) or another suitable securing system is used to secure the interface component 61 in place after the same has been properly aligned with the actual position of the implant 60 in the patient jaw. The size of the blind opening 62 must be sufficient to encounter for the difference between the preoperative^ planned position of the implant and the actual position of the implant in the patient jaw. As shown in Fig. 10, the interface component 61 can take the form of a coping. However, it is understood that the interface component 61 can be any other structure allowing an interface between the prosthesis 50 and the implant 60 (or associated abutment). The interface component 61 has a geometry adapted to be received in the blind opening 62 of the prosthesis system 50, and secured to said system using an attachment feature such as mechanical retention or chemical bonding material.

[0094] Referring to Fig. 1 1 , a mating Interface 63 of the interface component 61 is shown. The mating interface 63 is adapted to be received on the mating interface of a compatible implant system 60. The interface component 61 can also include a separate mating component having the mating interface, the separate mating component forming part of a set of replaceable mating component to adapt to different implant configurations.

[0095] Referring to Fig. 12, a fastener channel of the interface component 61 is shown. The fastener channel may include a primary hole 64 of a diameter and depth to receive a fastener 65 and adapted to position the fastener 65 at a desired distance from a coronal interface of the implant system 60. In the embodiment shown, the primary hole 64 is adapted to receive a first portion of the fastener 54, such as a screw head portion. In such an embodiment, the channel also includes a secondary hole 66 concentric to the primary hole 64 and of a diameter smaller than the diameter of the primary hole 64 and of a depth to receive a second portion of the fastener 65, such a screw's threaded shank portion or a portion of the fastener 65 below the first portion of the fastener 65, in a desired position to be received into the implant system's 60 temporary mating feature and/or securing feature and, in combination with the screw head adaptation, maintain the assembly of the interface component 61 to the implant system 60. In an alternate embodiment, the fastener channel includes one hole or opening, for example the primary hole 64, to receive the first and second portions of the fastener 65.

[0096] Figs. 13 and 14 illustrate another type of fastener or mating component for securing the interface component to the implant/abutment system. The mating component 67 may be suitably joined to the interface component 61 for engagement with the implant system 60. For instance, the mating component 67 may be pressed fit into the interface component 61.

[0097] Figs. 15-17 show the blind opening 62 defined in the intaglio surface 53 of the prosthesis 50 for receiving interface component 61. The blind opening 62 is provided with an entry onto the intaglio feature 54 of the prosthesis system, which in one embodiment, refers to the base-plate 56 assembled to removable teeth component 55. The blind opening 62 is sized according to dimensions adapted to preserve the integrity of the occlusal feature 52 and according to dimensions adapted to receive the interface component 61 and the attachment feature, such as bonding material 68 (Fig. 19) for example.

[0098] In one embodiment, the blind opening 62 can be formed using a cutting template 69 in combination with a cutting tool 70 (Fig. 17). Furthermore, the blind opening 62 can be the same as the opening in the base-plate 56 of a surgical guide or adapted from the said opening (Fig. 18).

[0099] Referring to Fig. 19, an attachment feature 71 of the dental prosthesis system is shown. The dental prosthesis system can include one or more attachment feature(s) 71. In an alternate embodiment, the attachment feature 71 can be omitted. The attachment feature 71 is used to attach the interface component 61 to an opening, such as blind opening 62. The attachment feature 71 can include bonding material 68, mechanical retention and the like. In one embodiment, one or more component of a transitional mating system or of a securing system, such as a screw, may be received into an interface component 61 of a prosthesis 50 system prior to its attachment to the opening, such as the blind opening 62. A screw channel blocking material or cap 61 a may be fitted over the screw 65 to prevent the bonding material from clogging the tool receiving hole in the top of the screw head.

[00100] Referring to Figs. 20-22, the securing system according to a particular embodiment is shown. The securing system include a fastener 65, such as a screw, having a drive design adapted to receive a screw-driver 72 (Fig. 71), or the like, rotating about an axis aligned with the longitudinal axis of the screw, permitting sufficient torque transmission for assembly of an interface component 61 to a compatible implant system 60 and/or an abutment 60A. The fastener 65 can be replaced by any other suitable fastening devices.

[00101] In an alternate embodiment, the securing system include an angulated drive design having the fastener 65 or a screw adapted to be driven by receiving a screw-driver itself adapted for rotating about an axis that is angulated from the longitudinal axis of the screw 73 (Fig. 22), permitting sufficient torque transmission for assembly of the interface component 61 to the compatible implant system 60 or abutment 60A. For example, a screw can be provided with head and threaded shank portions adapted to allow the screw to be received into the interface component 61 and permitting assembly of the interface component 61 to the implant system 60 and/or abutment 60A(Fig. 22).

[00102] Referring to Figs. 23-24, the position of the fastener 65 is shown before engaging the implant system 60 and or abutment 60A (Fig. 23) and after engaging the implant system 60 and or abutment 60A (Fig. 24). [00103] Referring to Figs. 25A and 25B, the guided adaptation system in accordance to a particular embodiment is shown. The guided adaptation system includes a cutting guide 74 for forming an occlusal access opening 75 (Fig. 25) in the occlusal surface 51 of a dental prosthesis 50. The occlusal access opening 75 can have a rounded, elliptical and/or rectangular shape. For example, the occlusal access opening 75 can include a slot, an elongated opening and the like.

[00104] The cutting guide 74 includes an indexing component 76 to engage with the interface component 61 on the intaglio surface 53 of the dental prosthesis 50. The indexing component 76 may include a replica of a coronal interface of the implant system 60 to which the interface component 61 is intended to be joined. The indexing component 76 receives the interface component 61 and forms a reference point for guiding the cutting tool 70. The cutting tool used in the cutting guide 74 may be the same or different from the cutting tool used to form the blind opening. It is understood that the indexing component 76 can include a replica of any other structure used to secure the prosthesis 50 on the patient's jaw and/or can be used with structures other than the interface component 61.

[00105] In an alternate embodiment, multiple replaceable indexing components 76 can be provided with the cutting guide 74. Each indexing component 76 features a mating interface 77 replicating the mating interface of one or more implant system(s) 60 and therefore is adapted to receive at least one compatible interface component 61 , for example from a variety of different dental prosthesis 50. The use of multiple replaceable indexing components 76 with multiple mating surfaces 77 allows the compatibility with different implant systems. Each indexing component 76 can then receive its corresponding compatible interface component 61 associated with a corresponding dental prosthesis 50. Moreover, the replaceable indexing components 76 can have different longitudinal heights of the mating interface in relation to the guidance component.

[00106] In an alternate embodiment, the mating interface 77 is adapted to receive the interface component 61 while allowing its free rotation about a common longitudinal axis 78 (Fig. 32).

[00107] In an alternate embodiment, the mating interface 77 is adapted to receive the interface component 61 while allowing the free rotation of the interface component 61 about the common axis 78, and adapted with a feature engaging the interface component's secondary hole 66, in a manner to limit degrees of freedom other than the rotation about the common longitudinal axis 78 (Fig. 33).

[00108] In an alternate embodiment, an assembly interface 79 is adapted to permit assembly and disassembly of the indexing component 76 from the cutting guide 74 (Fig. 34).

[00109] In a particular embodiment, the interface component 61 defines the primary hole 64 with an entry point 80 (Fig. 22) for receiving a fastener 65. The entry point 80 of the primary hole 64 refer to any portion of an inlet opening of the primary hole 64. The inlet opening refers to an end surface delimiting the primary hole 64 facing towards the occlusal side.

[00110] In a particular embodiment, the interface component 61 is free to rotate about the replica but is prevented against lateral movements relative thereto. The lateral movements refer to movements in a plane perpendicular to a longitudinal axis of the replica.

[00111] Referring back to Figs. 25-31 , the cutting guide 74 also includes a guidance component 82 structurally linked to the indexing component 76 by a support structure 83. The support structure 83 ensures a relative position between the guidance 82 and indexing 76 components. The relative position provides a distance sufficient to accommodate the dental prosthesis 50 between the guidance 82 and indexing 76 components. The guidance component 82 is spaced from the indexing component 76 so as to be positioned on an occlusal side of the dental prosthesis 50 when the interface component 61 is engaged with the indexing component 76.

[00112] In an alternate embodiment, the guidance component 82 has at least one hole or opening adapted to receive a component such as a drill or drilling template and aligns it in an intended guidance trajectory.

[00113] In an alternate embodiment, the guidance component 82 has a geometry adapted to stop the insertion of a component into the hole or opening at an intended position along an intended guidance trajectory. The intended guidance trajectory refers to the trajectory of the cutting tool 70 through the prosthesis 50 relative to the entry point 80 of the primary hole 64.

[00114] In an alternate embodiment, an assembly mechanism is adapted to assemble and disassemble the guidance component 82 to the support structure 83 of the guided adaptation system 74.

[00115] In an alternate embodiment, the support structure 83 is adapted in a manner permitting the indexing component 76 to receive one interface component 61 assembled to a prosthesis 50, and adapted so that one indexing component 76 and one guidance component 82 are positioned relative to one another to permit the creation of the occlusal access opening 75 into the prosthesis 50 from the occlusal surface 51 through to the blind opening 62 (Figs. 27 and 31), with a geometry allowing the ulterior insertion and drive of the securing system to secure the prosthesis system to the implant system 60 (Figs. 23-24).

[00116] In an alternate embodiment, at least one support structure 83 comprising the indexing component 76 and at least one guidance component 82 and an adjustment mechanism 84. The adjustment mechanism 84 is adapted to displace and secure the guidance component 82 at a desired position relatively to the support structure 83, in a manner to adjust the guidance component's drilling trajectory relatively to the position of the indexing component's mating interface (Fig. 28). The adjustment mechanism 84 includes an insert 85 to engage one of longitudinally spaced apart slots 86 for positioning the guidance component 82.

[00117] In an alternate embodiment, the at least one support structure 83 includes at least one indexing component 76 and at least one guidance component 82 including an assembly mechanism 87 adapted to assemble and disassemble the guidance component 82 to the support structure 83 is shown in Figs. 29 and 35.

[00118] In an alternate embodiment, the support structure 83 includes the indexing component 76 and the guidance component 82 having its intended guidance trajectory coinciding with a longitudinal axis common to the indexing component 76, interface component 61 , and securing system's screw 65 is shown in Fig. 27. [00119] In an alternate embodiment, the support structure 83 includes the indexing component 76 and the guidance component 82. The guidance component 82 is adapted to have its intended guidance trajectory angulated from the longitudinal axis common to the indexing component 76, interface component 61 , and securing system's fastener 65, and adapted to a securing system itself having an angulated drive design is shown in Figs. 30-31.

[00120] In an alternate embodiment with reference to Fig. 34, the indexing component 76 is connected to an intaglio arm 88 and the guidance component 82 is connected to an occlusal arm 89. The intaglio 88 and occlusal 89 arms projects from the support structure 83, shown as a support column. Although the intaglio and occlusal arms 88, 89 are shown as elongated plates projecting from the support column, they can include other shapes and/or configurations. The support column refer to any structure, such as a telescoping arm, that allow a relative positioning between the intaglio and occlusal arms 88, 89. The support column can be activated mechanically, electrically, hydraulically or pneumatically.

[00121] The guidance component 82 has a guiding aperture 90 for guiding the cutting tool 70 along an interface component access path. The cutting tool 70 can include a drilling tool, a laser or other suitable types of cutting devices. For example, the guidance component 82 can be adapted to receive one drilling component such as a drill or a drilling template itself adapted to receive a drill. The interface component access path leads to the entry point of the primary hole 80 of the interface component 61 when the interface component 61 is engaged with the indexing component 76.

[00122] In an alternate embodiment, the cutting axis 91 of the guiding aperture 90 is inclined relative to an axis of the primary hole 64 of the interface component 61. In the embodiment shown in Fig. 30, the cutting axis 91 guides a cutting axis of the cutting tool 70 to intersect the entry point of the primary hole 64 and therefore to form the interface component access path, such as a channel for receiving the fastening tool, between the occlusal access opening 75 and the primary hole 64.

[00123] Referring to Figs. 36-39, a retrievability template 92 is shown. The retrievability template 92 that is adapted to be received onto prosthesis 50 as shown in Fig. 36. The retrievability template 92 is adapted by forming at least one opening 93 in a trajectory aligned to the trajectory of at least one occlusal access opening 75 in the prosthesis 50 with the use of the cutting guide (Fig. 37) and may be received onto the corresponding prosthesis 50 after the prosthesis 50 has been secured onto the patient's at least one implant system 60 and finished, with its occlusal access opening 75 obstructed with repair material, to guide the clearance of the said occlusal access openings 75 as required to regain access to the interface component 61 and screw 65 for disassembly of the prosthesis 50 (Figs. 38-39).

[00124] According to a particular embodiment, an implant system includes at least one implant, one or none abutment, at least one mating interface, one transitional mating feature and one securing feature.

[00125] According to a particular embodiment, a prosthesis system includes one or more prosthesis (partial or full, one-component or multiple-component design, surgical guide (one-component or multiple-component design), one or more or none blind opening, one or more entry point, one or more or none attachment feature, one or more interface component (such as coping), and featuring one or more or none blocking material component (to prevent any bonding material used as attachment feature from entering the cavity).

[00126] According to a particular embodiment, a transitional mating system includes one or more interface component, one or more or none mating component, one or none screw and one or none screwdriver.

[00127] According to a particular embodiment, a guided adaptation system includes one or more indexing component, one or more guidance component, a support structure (used to ensure the relative positioning of both indexing and drilling guidance components), one or more or none cutting template and one or more or none retrievability template.

[00128] According to a particular embodiment, a securing system includes one screw and one screwdriver.

[00129] According to a particular embodiment, a method is provided for forming the occlusal access opening 75 into the dental prosthesis 50 for providing access to the interface component 61 used for seating the dental prosthesis 50 onto the implant 60 or the abutment 60A in a patient's jaw. The method includes referencing the indexing component 76 of the cutting guide 74 to the interface component 61 on the intaglio surface 53 of the dental prosthesis 50. This step includes engaging the interface component 61 with the replica of a coronal interface of the implant 60 or the abutment 60A to which the interface component 61 is intended to be mounted, such as the implant 60 used on the patient's jaw. The indexing component 76 is then referenced to the guiding aperture 90 of the cutting guide 74 on the occlusal side of the dental prosthesis 50. Referencing the indexing component 76 can depend on the functional and aesthetic aspects and/or needs of the patient. For example, the guiding aperture 90 can be referenced relative to the indexing component 76 such that the occlusal access opening 75 is not visible, or have limited visibility, when looking through the patient's mouth from the front side.

[00130] The method also include guiding the cutting tool 70 through the guiding aperture 90 to form the occlusal access opening 75 into the dental prosthesis 50 from the occlusal side thereof. The cutting tool 70 can be guided by orienting the guiding aperture 90 such that the cutting axis 91 intersects a main axis of the interface component 61 and/or the entry point of the primary hole 80. The fastener 65 can then be used to secure the interface component 61 to the implant 60 or abutment 60A through the channel or access path between the occlusal access opening 75 and the primary hole 64.

[00131] According to a further embodiment and referring to Figs. 40-42, a dental prosthesis system 50 may include a removable teeth component 55, a primary bar 94 and a base-plate 56, as for instance described in US Pat. No. 8,529,255, the entire contents of which are incorporated by reference herein. In an alternate embodiment, the base-plate 56 includes the primary bar 94, for example where the base-plate 56 and the primary bar 94 are manufactured as a single part referred to as a superstructure.

[00132] In this particular embodiment, the method for forming the occlusal access opening 75 includes, prior to referencing the indexing component 76 of the cutting guide 74 to the interface component 61 , securing the dental prosthesis system on the patient's jawbone, with the primary bar 94 having at least an aperture aligned with at least one implant system 60 in the patient's jawbone, removing the removable teeth component 55 from the superstructure, seating the interface component 61 on the implant system 60, received for example in the primary bar's aperture, securing the interface component 61 to the primary bar 94, the primary bar 94 and the base plate 56 forming a superstructure which is received on the implant system 60, and retrieving the dental prosthesis system from the patient's jawbone and retrieving the superstructure from the implant 60, inserting the fastener 65 into the primary hole 64 of the interface component 61 and securing the removable teeth component 55 onto the superstructure. The method also includes referencing and guiding the cutting tool 70 through the guiding aperture 90 to form the occlusal access opening 75, the method further includes securing the dental prosthesis system on the implants 60.

[00133] Advantageously, the fastener 65 is inserted before securing the removable teeth component 55 on the superstructure, therefore, the occlusal access opening 75 can be sized according to the size of the fastening tool instead of the both the fastening tool and the fastener 65. In some cases, the fastening tool is smaller than the fastener 65 and therefore the occlusal access opening 75 can have a relatively smaller size. A smaller occlusal access opening 75 may require less repair material to prepare the prosthesis for use on the patient's jaw.

[00134] The above description is meant to be exemplary only, and one skilled in the art will recognize that changes may be made to the embodiments described without departing from the scope of the invention disclosed. Still other modifications which fall within the scope of the present invention will be apparent to those skilled in the art, in light of a review of this disclosure, and such modifications are intended to fall within the appended claims.