EP1648314A2 - Procede de stimulation de la regeneration tissulaire sur des surfaces de blessures, et dispositif et instrument de traitement ou implant pour la mise en oeuvre de ce procede - Google Patents

Procede de stimulation de la regeneration tissulaire sur des surfaces de blessures, et dispositif et instrument de traitement ou implant pour la mise en oeuvre de ce procede

Info

Publication number
EP1648314A2
EP1648314A2 EP04738114A EP04738114A EP1648314A2 EP 1648314 A2 EP1648314 A2 EP 1648314A2 EP 04738114 A EP04738114 A EP 04738114A EP 04738114 A EP04738114 A EP 04738114A EP 1648314 A2 EP1648314 A2 EP 1648314A2
Authority
EP
European Patent Office
Prior art keywords
implant
wound
treatment instrument
tissue
treatment
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP04738114A
Other languages
German (de)
English (en)
Inventor
Jörg Mayer
Christopher Rast
Marcel Aeschlimann
Laurent Torriani
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Woodwelding AG
Original Assignee
Woodwelding AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Woodwelding AG filed Critical Woodwelding AG
Publication of EP1648314A2 publication Critical patent/EP1648314A2/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
    • A61C1/02—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design characterised by the drive of the dental tools
    • A61C1/07—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design characterised by the drive of the dental tools with vibratory drive, e.g. ultrasonic waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C3/00—Dental tools or instruments
    • A61C3/02—Tooth drilling or cutting instruments; Instruments acting like a sandblast machine
    • A61C3/03—Instruments operated by vibration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1659—Surgical rasps, files, planes, or scrapers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320072—Working tips with special features, e.g. extending parts
    • A61B2017/320078—Tissue manipulating surface
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320089—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic node location
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C17/00—Devices for cleaning, polishing, rinsing or drying teeth, teeth cavities or prostheses; Saliva removers; Dental appliances for receiving spittle
    • A61C17/16—Power-driven cleaning or polishing devices
    • A61C17/20—Power-driven cleaning or polishing devices using ultrasonic waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0018—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools characterised by the shape

Definitions

  • the invention is in the field of medical technology and relates to a method according to the preamble of the first independent claim.
  • the method is used to promote tissue regeneration on wound surfaces that have arisen as a result of surgery, injury or disease and that are intended to grow together with other wound surfaces or with an implant or to heal to tissue surfaces (natural tissue surfaces or scars) through tissue regeneration.
  • the method is used in particular for the treatment of such wound areas in bone tissue.
  • the invention further relates to a device and a treatment instrument or implant according to the preambles of the corresponding independent claims for carrying out the method.
  • the wound surfaces mentioned which have arisen as a result of surgical intervention, injury or disease are treated by curetting or freshening up, that is to say they are mechanically scraped or scratched and then rinsed, as a result of which the tissue layers lying directly on the wound surface are removed and thereby a fresh wound surface is created.
  • such wound areas are also acted on chemically, as a result of which in the area of the wound area Tissue cells or other undesirable biological elements are killed or denatured.
  • the patent specification US-6139320 (Hahn) describes a method for the dental field for the abrasive treatment of surfaces on teeth to be restored or also on surrounding bone tissue.
  • a liquid with abrasive particles suspended in it and an instrument excited with ultrasonic vibrations are used, the liquid being set into a high turbulence by the instrument in such a way that the dentin or bone tissue is removed by cavitation.
  • the instrument is continuously flushed with the liquid during the treatment, that is, the liquid becomes also used to carry away removed material.
  • the instrument must be positioned in such a way that there is always a film of liquid between the surface to be treated and the instrument. Cavitation does not take place if there is no distance between the instrument and the material to be removed (no liquid film), and it does not take place if this distance is too great.
  • the device used for the abrasive treatment according to US Pat. No. 6,139,320 has an electrical / mechanical transducer or vibration drive (generates mechanical vibrations from electrical vibrations, for example using piezo elements).
  • a deflection element which deflects the axial vibrations of the oscillation drive by, for example, 90 ° or 120 °, is optionally coupled to the oscillation drive via a booster (amplitude amplifier).
  • the instrument used for the abrasive treatment is coupled to the deflecting element in such a way that it extends in the direction of the deflected vibrations and thus also swings in the direction of its axis.
  • the above-mentioned publication also proposes using this filling element directly as an ultrasound instrument. Since, as mentioned above, a liquid film must be assumed between the instrument and the wound surface for the abrasive treatment, the opening created with the aid of the filling element cannot represent a firm seat for the filling element. This means that the filling element must finally be fastened in the opening with the aid of, for example, a cement, it being possible for the cement to be introduced only after the opening has been created.
  • the object of the invention is to present a method which can be used to promote tissue regeneration on wound areas, which wound areas are intended to grow together with other wound areas or with an implant or to heal to tissue surfaces through tissue regeneration.
  • the method according to the invention should be simple and also applicable in minimally invasive applications.
  • the results achieved with the aid of the method according to the invention should be at least as good as the results achieved with known methods which serve the same purpose.
  • the method is also intended to make it possible to solve the above-mentioned problem of the undesired cells carried by implants on wound surfaces.
  • Another object of the invention is to provide a device for carrying out the method and a treatment instrument or implant for carrying out the method.
  • the method according to the invention is based on the finding that mechanical vibrations, for example ultrasonic vibrations, which are coupled into a wound area to be treated, in the area of this wound area produce a mechanical and thermal effect which can be controlled very well in terms of intensity, depth and locality, which effect Depending on the strength and tissue in the wound area, create a controlled stimulus, a controlled trauma or a targeted necrosis or cell destruction. Irritation and trauma stimulate the metabolism, and trauma, necrosis and cell destruction also destroy or denature undesirable biological elements. Both of these effects are known to promote tissue regeneration.
  • the tissue, in particular bone tissue can be changed mechanically, for example slightly, by the mechanical effect of the vibrations in the area of the wound area being treated condensed or slightly shifted in areas, which also seems to have a positive effect on tissue regeneration.
  • mechanical vibrations in particular ultrasonic vibrations
  • the tissue vibrates in the area of this wound area (mechanical effect) and a thermal effect is achieved by damping the vibrations in the tissue. Since the method can be adapted very finely to existing conditions in such a way that only a necessary minimum of tissue is influenced in a destructive manner, there is no need in the method according to the invention to remove material from the treatment area during and after the treatment.
  • Either a treatment instrument or an implant is used as a means for coupling the vibrations into the wound surface, the instrument or implant being designed as a vibrating body and, for the treatment, optionally being operatively connected to an oscillation drive via one or more than one more vibrating body, the individual elements of the oscillating system are advantageously matched to one another and to an excitation frequency in such a way that they oscillate like a resonator.
  • a device which has an oscillation drive and optionally one or more oscillation bodies coupled to the oscillation drive, the treatment instrument or implant being coupled or connectable to the oscillation drive or to one of the oscillation bodies. This coupling can be a fixed or detachable connection for a treatment instrument.
  • the coupling is realized by a detachable connection or simply by placing the device on a coupling geometry of the implant provided for this purpose.
  • the treatment instrument is brought into contact with the wound surface to be treated, that is to say pressed against it and set in motion.
  • the implant is positioned in the tissue and then pressed against the tissue and set in vibration, or it is advantageously already positioned in a vibrating manner (e.g. in a tissue opening that is slightly smaller than the instrument or implant, or as a self-tapping implant without a previously created tissue opening or in a Tissue opening that is at least partially significantly smaller than the implant).
  • the contact between the instrument or implant and the wound surface can be stationary or the instrument or implant can be moved over the wound surface.
  • the contact between the instrument or implant and the wound surface is preferably a direct contact for the treatment.
  • the treatment instrument or implant has contact surfaces which are advantageously equipped with energy directors.
  • Such energy direction transmitters are elements that protrude from the contact surface, tapering or edged, such as cones, pyramids, ribs or edges, which concentrate the energy to be coupled essentially on points or lines and thereby multiply them.
  • the energy directors protrude from the contact surface by 50 ⁇ m to 2 mm and their arrangement must be adapted to whether and how the instrument or the implant is moved relative to the wound surface during the treatment, in such a way that it is possible with the individual energy directors mechanical vibrations coupled into the tissue should be covered over the entire wound area if possible.
  • the effect according to the invention of the coupled sound in bone tissue has a penetration depth or. Has a spread of 3-5 mm. This value is naturally dependent on the action time rsp. the coupled power density (effective amplitude x frequency) and tissue-dependent limited by the regeneration ability of the locally generated trauma.
  • the energy direction indicators for an instrument or implant used in the treatment stationary to the wound surface should not be spaced apart from one another by more than 6-10 mm (advantageously 2 to 5mm).
  • An implant used to carry out the method according to the invention is advantageously already positioned under the influence of the vibrations in a tissue opening or is driven into the tissue without tissue opening or only partial tissue opening, the implant being dimensioned such that the energy direction indicators of the contact surface during this positioning Furrowly squeeze or compress the tissue of the wound surface, creating an intensive contact between the wound surface and energy directors.
  • the vibrations of the instrument or the implant are coupled into the wound surface to be treated via a coupling medium.
  • a liquid or gel medium or also a solid medium is chosen as the coupling medium, which conducts the vibrations to be coupled in (eg ultrasound) well, that is, absorbs as little as possible of the vibrational energy and transfers it as little as possible to the one to be treated Tissue passes on.
  • a chemical-therapeutic effect on the wound area to be treated or underlying tissue areas can additionally be achieved in a manner known per se by adding substances such as anti-inflammatories and growth factors to the coupling medium , Cytostatics, radiating agents, photosensitization gates etc. Such substances can also be specifically introduced into the tissue adjacent to the wound surface through the vibrations.
  • a suitable physiological coupling medium is, for example, a physiological saline solution which is absorbed by the tissue after the treatment.
  • Implants that are suitable for the treatment of wound surfaces surrounding them according to the invention can have a wide variety of implant functions. They are, for example, implants with a mechanical function (support or holding function) and / or a release function (e.g. release of therapeutically active substances or of particulate or non-particulate radiation) or they are placeholders for missing tissue parts, which may only have a temporary function and therefore consist at least partially of absorbable material or material that can be integrated into regeneration tissue.
  • an implant is made to vibrate for the treatment of a wound surface, this means that the treatment is carried out during and / or after the positioning of the implant and that the traumatic or necrotic effect achieved by the treatment, in particular also dragged onto the wound surface with the implant , hits unwanted cells (eg connective tissue cells, mucous membrane cells, tumor cells) so that they can no longer stand in the way of the tissue and implant growing together.
  • unwanted cells eg connective tissue cells, mucous membrane cells, tumor cells
  • an implant In order for an implant to act as a vibrating body, that is to say as a body that transmits vibrations with as little loss as possible, and for the treatment of wound surfaces surrounding the implant to be effected, it consists of a material that has an elastic modulus of at least 0.5 GPa and is designed in this way that it is not significantly deformed under the influence of the vibrations (not even in the area of the energy directors if they are on the Support the wound surface). This means that the implant material, even in the area of its contact with the wound surface, is not brought into a plastic or liquid state in the sense of the method according to publication WO-02/069817 in order to establish a connection with the tissue.
  • Metallic implants made of titanium, for example, or implants made of a ceramic building material easily meet this requirement.
  • the sonotrode of an ultrasound device can be pressed against a coupling surface of the implant provided for this purpose, or the implant can be rigidly but detachably attached to such a sonotrode for the treatment.
  • a coupling element can also be connected between the sonotrode and the implant.
  • the treatment can be carried out in a single treatment period or in a plurality of shorter treatment periods separated by pauses, the effective treatment time being at most a few seconds.
  • the effect of the vibrational energy coupled into the wound surface is mechanical and thermal. The relative proportion of the two effects depends on the damping of the vibrations in the tissue coupled into the wound surface (higher damping results in a higher thermal component, less damping results in a greater mechanical effect). In a relatively hard tissue such as bone tissue, for example, the mechanical effect will not be negligible, which in such a tissue can also lead to the densifications or displacements mentioned above.
  • Figure 1 shows the treatment of a wound surface in a wound caused by surgery, injury or disease with a vibrating treatment instrument that is coupled to an ultrasonic hand device;
  • FIG. 2 shows the treatment of a wound surface that arises when a helical, self-tapping implant is positioned
  • FIGS. 3 to 8 show exemplary embodiments of treatment instruments or implants according to the invention with contact surfaces which are equipped with energy directors;
  • Figure 9 shows an embodiment of an amplitude and / or direction changing element for use in a device according to the invention.
  • Figures 10 and 11 further embodiments of instruments for performing the inventive method.
  • FIG. 1 shows the treatment of a wound area 1 in a wound in a tissue which has arisen as a result of a surgical intervention, as a result of an injury or as a result of illness, for example in the wound in a bone which has been caused by the removal of a tumor.
  • the treatment essentially consists of contacting the wound area 1 to be treated with a treatment instrument 2, the instrument 2 being designed as a vibrating body and directly or via one or more further vibrating bodies 3 (boosters, transmission element, Coupling element) is connected to an oscillation drive.
  • Vibration drive and other vibrating bodies are, for example, components of a hand-held device 4, for example a hand-guided ultrasound device.
  • the vibration drive has, for example, a stack of piezo elements, which is set into mechanical vibrations with an electric drive frequency.
  • Vibration drive and treatment instrument 2 optionally together with the further vibrating body or the further vibrating bodies (booster, transmission element, etc.), are designed, for example, in such a way that they vibrate like a resonator at the excitation frequency of the vibratory drive.
  • Applicable ultrasound devices are known, for example, in dentistry for removing tartar or from the publication US 6139320 (Hahn) mentioned at the beginning.
  • the instrument 2 can also be driven by an oscillatable, relatively long and thin, possibly also flexible transmission element and with the appropriate dimensions, they are also suitable for minimally invasive interventions.
  • FIG. 2 shows the treatment of a wound surface 1 which arises when a self-tapping implant 5 is positioned and surrounds it.
  • the implant 5 is, for example, a self-tapping screw which is driven into a correspondingly predrilled bone for fastening a plate 6.
  • the screw is driven into the bone tissue by rotation and it is subjected to ultrasound, for example, after driving in or already during driving.
  • the vibrations are coupled into the bone tissue in particular in the area of the thread that functions as an energy direction sensor.
  • the threads should be created in such a way that they are not more than 6-10 mm apart if the surface in between is free of other energy direction sensors.
  • a correspondingly designed sonotrode 7 of an ultrasound device is placed on the head of the screw and pressed against the screw.
  • the sonotrode can also be used to screw in the screw, the vibrations significantly reducing the torque or the friction to be overcome during the rotary movement.
  • the sonotrode is arranged in a rotating manner on a hand-held device and, as shown in FIG. 2, can be placed on the screw head or secured to it in a manner secured against rotation (e.g. square).
  • the screw can also be screwed in with a known device and only then subjected to ultrasound.
  • FIGS. 3 to 8 show exemplary embodiments of distal ends of treatment instruments or implants for performing the inventive processes that have different energy direction indicators on the contact surfaces.
  • the distal ends of treatment instruments and implants do not differ in principle since they are designed to carry out the same procedure.
  • the proximal end of treatment instruments advantageously has means for releasable coupling to a device with an oscillation drive, but can also be permanently connected to such a device.
  • the proximal end of implants can also have means for releasable coupling to a device with a vibration drive.
  • the proximal end of the implant can also simply have a coupling surface or coupling geometry which is equipped for coupling the vibrations by pressing on a vibrating body on the device side.
  • FIG. 3 shows in cross section an implant 5 according to the invention (e.g. dental implant) which is positioned in a tissue opening 10.
  • the implant has axially extending edges 11, through which the wound surface 1 to be treated (inner surface of the tissue opening 10) is slightly furrowed and which in this way serve as an energy direction indicator.
  • This implant is also subjected to, for example, ultrasound during and / or after its positioning in the tissue opening 10, for which purpose it is attached to a sonotrode or pressed into the tissue opening by means of the sonotrode.
  • FIG. 3 can be understood in the same way as a cross section through the distal end of a treatment instrument 2.
  • the edges 11 should be arranged at intervals of no more than about 6-10 mm, in particular if, as shown in FIG. 3, the grooving only one affects a small part of the wound area.
  • FIG. 4 shows a further implant 5 (possibly also the distal end of a treatment instrument) which is particularly suitable for carrying out the method according to the invention if it is placed in a conical or stepped tissue opening. position.
  • the implant 5 has a distal tip 40 and. a plurality of substantially cylindrical (possibly slightly conical) regions 41, the diameters of the cylindrical regions 41 increasing away from the tip 40 and the tip 40 and cylindrical regions 41 having axially extending, projecting edges 11 which form the inner surface of the for Furrow the tissue opening (wound area) provided for the implant.
  • the extent of the pre-existing tissue opening can be adapted to the requirements. For example, in spongy or osteoporotic bone, a previous opening can be dispensed with at all and the implant can be advanced to compress the bone in these areas.
  • the steps between the cylindrical regions 41 are also designed as furrowing edges 42.
  • the proximal end face 43 of the implant 5 is designed as a coupling surface, for example with a sonotrode, which means that, for example, a sonotrode can be held against it, so that the vibrations of the sonotrode are transmitted to the implant.
  • This proximal end face 43 is thus, for example, a flat surface with the smallest possible roughness.
  • FIG. 5 shows very schematically a diagram of the oscillation amplitude as a function of time t, as it is advantageously coupled into an implant as shown in FIGS. 3 and 4. Since only parts of the vibration in one direction (only thrusting, no pulling, so-called half-vibration) can be transmitted via the coupling, which is only achieved by attaching it, there are only amplitudes on one side (half-amplitudes, here positive side) of the abscissa. It has proven to be advantageous to overlay a vibration with a relatively high frequency (e.g.
  • FIGS. 6A to 6C show a further exemplary implant 5, which, like the implant according to FIG. 4, has furrowing edges which on the one hand run in the axial direction and on the other hand around the circumference of the implant.
  • the implant is shown three-dimensionally in FIG. 6A, as an axial section in FIG. 6B and in cross section in FIG. 6C.
  • the implant 5 is, for example, a tooth implant which is implanted in a conical opening of a jawbone, the axially extending edges 11 furrowing the opening wall essentially during the entire implantation movement (direction of implantation: arrow I) and the edges 42 running around the implant circumference at least in one last stage of implantation when they sit on the opening wall.
  • edges running around the implant circumference can also contribute to the stability of the implant, they are advantageously slightly protruding and undercut against the distal end of the implant, as can be seen from FIG. 6B. It can also be advantageous to give the peripheral edges a certain clearance angle, as shown, in order, for example, to further concentrate the energy input. It is not a condition that the circumferential edges 42 run at a constant axial height and extend all the way around the circumference. Likewise, it is not a condition that the axially running edges run continuously or in a constant number or geometry over the length.
  • FIGS. 7 and 8 show distal ends of treatment instruments 2 (or, if appropriate, implants) which have a contact surface 15 with a pattern of energy directors 16 (for example pyramids protruding from the contact surface).
  • the instrument 2 shown in FIG. 7 can be used for axial vibrations (double arrow A) or for bending vibrations (double arrow B), the instrument shown in FIG. 8 is advantageously designed for axial vibrations.
  • the distances between the tips of the energy directors are to be matched to a relative movement between the instrument and the wound surface such that each area of the wound surface to be treated during treatment is at least once in an area of no more than about 3 to 5 mm (advantageously 1 to 2.5 mm ) comes to lie around such a tip. If the instrument is not to be moved relative to the wound surface, the tips should be arranged at intervals of less than 6 to 10 mm (advantageously 2 to 5 mm).
  • FIG. 9 shows an amplitude and / or direction-changing element 20 already mentioned above, which is advantageously connected in a device according to the invention between treatment instrument 2 or possibly implant and vibration drive 21 or possibly booster, but which itself can also serve as a treatment instrument.
  • the element 20 is annular, for example. It is designed in such a way that it vibrates in resonance at a predetermined excitation frequency, namely in the radial direction with four nodes K (points of minimal vibration amplitude and two-dimensional vibration) and four points Ml to M2 of maximum vibration amplitudes (one-dimensional vibrations).
  • the ring In the axial direction, the ring has an extent such that vibrations with an axial amplitude remain negligible.
  • the amplitude is smaller than in places with a lower mass or lower stiffness.
  • the locations M1, M3 and M4 have larger local masses than the location M2, at which a higher amplitude is therefore to be expected (illustrated by a longer double arrow). If further elements (eg treatment instrument 2) are coupled at the points Ml to M4, their effect with regard to mass and ring rigidity at the coupling point must be taken into account, or compensated accordingly at the other points.
  • the vibration drive 21 (optionally via a booster) is advantageously coupled to a point of maximum vibration amplitude (M1 to M4), as a result of which the drive amplitude is transmitted to this point.
  • a treatment instrument 2 for a high amplitude and one-dimensional vibration is also coupled to a point M or for a small amplitude and two-dimensional vibrations to a point K.
  • the instrument 2 is coupled at the point M2 (smallest local ring mass or smallest ring stiffness, that is to say the greatest amplitude) and the vibration drive 21 at the point Ml, so that the ring functions as an amplitude amplifier and as a direction converter (90 °). If the vibration drive 21 is coupled at the point M4, the element 20 acts only as an amplitude amplifier.
  • An amplitude and / or direction-changing element 20 according to FIG. 9 for an excitation frequency of approx. 20 KHz is, for example, a ring made of steel with a diameter of approx. 8 mm, to which instruments of approx. 0.5 g weight can be coupled. So that the instrument can function as a resonator in a rigid connection, it should have a length that corresponds to half a wavelength (for steel and 20 kHz: approx. 14 mm) or a multiple thereof. Instead of the instrument 2 shown in FIG.
  • a corresponding extension (not shown) can be provided at the same location, which can be placed on the proximal end face of an implant and with which the implant is simultaneously driven into a tissue opening and excited to vibrate.
  • Elements which can also be used in the method according to the invention and which change in amplitude and / or direction are generally geometrical bodies, such as bending beams, rings or hollow spheres, wherein annular elements can also have shapes other than circular, for example polygonal, shapes.
  • the rings can also be designed for natural vibrations with, for example, three, five or more nodes, that is, for changes in direction at angles other than 90 °. If directional changes in three-dimensional space are to be made possible, a hollow body is to be provided as element 20, for example a hollow sphere or a hollow polyhedron. Both rings and hollow bodies can have a plurality of coupling points both for an instrument 2 or possibly an implant and for the vibration drive 21.
  • vibrations are to be adapted to specific applications, it proves to be advantageous to design the instrument 2 and the amplitude- and / or direction-changing element 20 as a unit and for different direction changes. to equip with various coupling points, for example, with the aid of which this unit can be coupled to a vibration drive 21 equipped as standard, for example integrated in a hand-held device.
  • FIG. 1 Such a unit of amplitude and / or direction changing element 20 and treatment instrument 2 is shown in FIG.
  • a treatment instrument 2 is coupled to the point M2 of the amplitude and / or direction-changing element 20 according to FIG. 10.
  • Coupling means 30 are provided at points Ml, M3 and M4, for example snap elements, by means of which a booster element of the vibration drive 21 is pulled non-positively into a seat 31 of the element 20. With increasing spring force, the injected shaft will approach the one specified by the sonotrode.
  • the element 20 is also advantageous to provide means which allow the coupling of the element 20 to the oscillation drive 21 (which can also be designed flexibly for endoscopic applications and as a multiple of half the wavelength) after introduction of the distal end of the device, i.e. if this is the case located in the treatment area.
  • the element 20 is therefore coupled, for example, for the introduction to the treatment area at the point M4 (no change of direction and the smallest dimension of the device transversely to the direction of insertion) and for the treatment or part of the treatment at the point M1 or M3 (change of direction each 90 ° ).
  • the instrument 2 can also be coupled to the inside of the element and protrude from it on the opposite side through a corresponding opening 35, as shown in FIG. 11 is shown. This is particularly advantageous if, for reasons of space (eg device for minimally invasive sive method) the instrument 2 should protrude as little as possible above the element 20 and still have a predetermined length for reasons of resonance.
  • reasons of space eg device for minimally invasive sive method
  • Treatment instruments 2 which are each rigidly connected to a precisely matched amplitude and / or direction-converting element 20, make it possible to use a single device that can essentially provide an excitation frequency or a small number of selectable excitation frequencies, optimal treatment conditions for a wide variety of applications Applications to achieve.
  • Such treatment instruments can be used not only in the method according to the invention but also in other methods in which vibrating treatment instruments are used, in particular in various methods of dental medicine which are known per se.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Epidemiology (AREA)
  • Dentistry (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Abstract

L'invention concerne la stimulation de la régénération tissulaire sur des surfaces de blessures (1) qui, par exemple, devraient cicatriser avec d'autres surfaces de blessures ou avec un implant, ou cicatriser pour former des surfaces tissulaires. Selon l'invention, pour stimuler cette régénération, des vibrations mécaniques sont induites dans lesdites surfaces de blessures. A cet effet, on utilise un instrument de traitement (2) qui est couplé à une source de vibrations (convertisseur de vibrations électromécanique), ou bien on soumet un implant à des vibrations pendant et/ou après sa mise en place dans les tissus. Des vibrations ultrasonores conviennent particulièrement pour ce traitement. Ces vibrations ont un effet mécanique et thermique dans la zone de la surface de blessure (1) traitée et elles ont un effet, en fonction de leur intensité, stimulant, traumatique, nécrotique ou de destruction cellulaire, ce qui a pour résultat de tuer ou de dénaturer les éléments biologiques gênant la régénération cellulaire et de stimuler le métabolisme dans la zone de la surface de blessure. En outre, l'effet peut être également mécanique, ce qui a pour résultat une légère compression ou une dislocation partielle des tissus. Etant donné que le traitement peut être effectué pendant ou après la mise en place d'un implant, la nécrose concerne en particulier les cellules indésirables introduites dans la surface de blessures avec implant, telles que des cellules de tissu conjonctif, des cellules des muqueuses ou des cellules malades qui peuvent perturber la cicatrisation des tissus et de l'implant. Les instruments de traitement (2) ou les implants utilisés pour le traitement se présentent sous la forme de corps vibrants et sont couplés ou peuvent être couplés à un dispositif de mise en vibrations, ou bien présentent une surface de couplage sur laquelle peut être placée une sonotrode. Ces instruments ou implants présentent, à leur extrémité distale, des surfaces de contact avec des guides d'énergie.
EP04738114A 2003-07-31 2004-07-29 Procede de stimulation de la regeneration tissulaire sur des surfaces de blessures, et dispositif et instrument de traitement ou implant pour la mise en oeuvre de ce procede Withdrawn EP1648314A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
CH13382003 2003-07-31
PCT/CH2004/000474 WO2005009256A2 (fr) 2003-07-31 2004-07-29 Procede de stimulation de la regeneration tissulaire sur des surfaces de blessures, et dispositif et instrument de traitement ou implant pour la mise en oeuvre de ce procede

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EP1648314A2 true EP1648314A2 (fr) 2006-04-26

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Country Link
US (1) US20060122543A1 (fr)
EP (1) EP1648314A2 (fr)
JP (1) JP2007500521A (fr)
WO (1) WO2005009256A2 (fr)

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WO2005009256A2 (fr) 2005-02-03
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JP2007500521A (ja) 2007-01-18

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