COMPUTER-AIDED DESIGN OF A THIN-LAYER DRILL GUIDE
A drill guide uses a hole in a layer to guide a drill along an axial trajectory while permitting off-axis excursions of the drill during use. A number of such drill guides at varying heights from a target surface may be used sequentially or concurrently to enforce the axial trajectory in three dimensions during a surgical operation. A drill guide may include a hole in a layer that establishes a single point along the axial trajectory, or the drill guide may include multiple layers in a single device to establish two or more points along the trajectory while allowing off-axis insertion of a drill into the guide. The drill guide may be cuttable to accommodate intraoperative changes to the axial trajectory. In embodiments, a window or the like may be provided to permit a surgeon to view drill depth, drill orientation, the surgical site and the like during a procedure.
1 . A method comprising:
obtaining three-dimensional data from beneath a surface of a surgical site;
determining an axial trajectory for an implant to be placed in the surgical site based upon the three-dimensional data; and
fabricating a device for guiding a tool in a dental procedure based upon the three-dimensional data, the device including a support fitted to an area around the surgical site and a surgical guide including a hole that aligns the tool to the axial trajectory at a first point along the axial trajectory while permitting off-axis excursions of the tool from the axial trajectory at a second point along the axial trajectory away from the hole when the surgical guide is placed for use at the surgical site.
2 . The method of claim 1 wherein fabricating the device includes manually fabricating the support and applying the three-dimensional data to create the hole in the surgical guide.
3 . The method of claim 1 wherein fabricating the device includes applying the three-dimensional data to generate a digital model of the surgical guide including the hole and fabricating the surgical guide from the digital model.
4 . The method of claim 1 wherein determining the axial trajectory for the implant includes positioning an implant with implant planning software.
5 . The method of claim 1 wherein fabricating the device includes applying the three-dimensional data to create the hole in the digital model of the device.
6 . The method of claim 1 wherein fabricating the device includes:
capturing a physical impression of the surgical site;
using the physical impression to fabricate a physical model; and
using the physical model to manually fabricate the device.
7 . The method of claim 6 wherein obtaining three-dimensional data includes obtaining x-ray tomography data of the device and applying the three-dimensional data to create a digital model of the device.
8 . The method of claim 7 wherein fabricating the device includes applying the three-dimensional model to a computerized fabrication system to fabricate the surgical guide.
9 . The method of claim 6 further comprising creating the hole in the surgical guide with a computer-controlled machine.
10 . The method of claim 9 wherein the computer-controlled machine includes a computer-controlled drilling machine.
11 . The method of claim 1 wherein obtaining three-dimensional data includes obtaining x-ray tomography data from the surgical site.
12 . The method of claim 1 wherein obtaining three-dimensional data includes creating a digital three-dimensional surface model of the surgical site.
13 . The method of claim 12 wherein obtaining three-dimensional data includes creating a digital three-dimensional surface model of a full dental arch, and wherein fabricating the device includes using the digital three-dimensional surface model to fabricate the device using a computerized fabrication system.
14 . The method of claim 13 wherein the computerized fabrication system includes a stereolithography system.
15 . The method of claim 1 wherein fabricating the device includes forming a material to a physical model of a dental arch containing the surgical site.
16 . The method of claim 1 wherein fabricating the device includes fabricating the support to secure the surgical guide in a desired location relative to the surgical site.
17 . The method of claim 16 wherein the support includes a surface formed to dentition around the surgical site, thereby providing tooth support for the surgical guide.
18 . The method of claim 17 wherein the surface is formed to a full arch containing the surgical site.
19 . The method of claim 16 wherein the support provides soft tissue support for the surgical guide.
20 . The method of claim 1 wherein fabricating the device includes fabricating a two-layer surgical guide having a first hole in a first layer centered around a first point on the axial trajectory and a second hole in a second layer centered about a second point on the axial trajectory.
21 . The method of claim 20 wherein obtaining three-dimensional data includes obtaining a digital three-dimensional surface model of the surgical site.
22 . The method of claim 21 wherein fabricating the device includes using the digital three-dimensional surface model to fabricate the surgical guide using a computerized fabrication system.
23 . The method of claim 20 wherein fabricating the device includes fabricating a window between the first layer and the second layer.
24 . The method of claim 1 wherein fabricating the device includes fabricating the device with a plurality of holes for a plurality of axial trajectories.
25 . The method of claim 1 further comprising fabricating a plurality of devices each including a progressively larger diameter hole shaped and positioned to align one of a number of progressively larger diameter drills to the first point on the axial trajectory.
26 . The method of claim 1 wherein the device includes a thin layer surgical guide having a layer including the hole, and wherein the hole is vertically spaced apart from the surface of the surgical site when the device is placed for use, and wherein fabricating the device further includes fabricating a window between the layer and the surface for at least one of physical access to the surgical site and visual access to the surgical site when the device is placed for use.