RU2164392C1 - Method for producing individual high precision implant for compensating complex subtotal polyosseous orbital cavity defect - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves measuring middle cranium zone parameters by means of special purpose uniform layer-by- layer tomography information treatment. The received data are used for making synthesis of retained orbit volume parameters and then of the orbit volume parameters for tissues having anatomical defect. Then symmetric, mirror computer transformations are carried out. The parameters being composed (superimposed), their difference estimations are used for determining mathematical spatial parameters of the implant which contact surfaces are adjusted to fit particular anatomical objects of particular person cranium like receiving surfaces of frontal process of the maxilla, zygomatic process of the temporal bone and process of the frontal bone. The complete set of mathematical spatial parameters of individually adjusted implant is exported to automated prototyping device and the implant is manufactured. EFFECT: enhanced accuracy in producing implants; improved anatomical, functional and cosmetic properties. 8 dwg

Description

 The invention relates to medicine, namely to reconstructive surgery - the technology of manufacturing an individualized precision implant to fill the eye socket defect.

 According to various sources, combined cranio-orbit-basal trauma accounts for 5-15% of all craniofacial lesions (M. Greenberg. 1997) and has a steady upward trend. In injuries of the middle zone of the face, the cheek-eye area is damaged in 30% of cases (Kuznetsov I.A., Belchenko V.A. Features of the treatment of patients with comminuted fractures of the zygomatic bone. Anniversary collection of works dedicated to the 60th anniversary of the departments of hospital chir. and people-persons. chir. and hospital ter. dentistry. Part II. M., 1998, p. 35-37). Over the past 10 years, 568 patients with defects and deformations of the skull bones were in the neurotraumatology department of the Institute of Neurosurgery, 74 of them with fronto-orbital localization, which is 13%. Significant difficulties are presented by defects in the supporting apparatus of the eye when the eyeball is “suspended” on the neurovascular bundle (Fig. 1) and serious complications subsequently arise. The appearance of the patient makes a very difficult impression. Deep functional systemic disorders and negative changes in neuropsychiatric status occur. Appearance induces patients to isolation and leads to depressive states. Lost professional, social and personal adaptation. Patients lose their ability to work, become disabled.

 Anatomy of the eye socket. Four bone walls are distinguished in the orbit: external, upper, internal and lower. Seven bones of the skull are involved in the formation of the walls of the orbit.

 The outer wall is formed by the orbital process of the zygomatic bone, the large wing of the main bone, partially the frontal bone.

 The upper wall is mainly the frontal bone and the small wing of the main bone.

 The inner wall is the frontal process of the upper jaw, the lacrimal bone, the plate of the ethmoid bone and the body of the main bone.

 The lower wall - the upper jaw, zygomatic bone and palatine.

 The outer wall borders the temporal fossa. The upper wall is with the anterior cranial fossa and contains the frontal sinus. The inner wall - separates from the cells of the trellis labyrinth (the most fragile). The lower wall is the roof of the maxillary sinus.

 The prior art. The goal of zygomatic orbital region plasty is restoration of the anatomical shape of this region and eye function, elimination of the zygomatic, infraorbital region, bottom of the orbit with a single implant to raise the eyeball up to the anatomical and physiological level (Injuries to the maxillofacial region. Author: N.M. Aleksandrov , P.Z. Arzhantsev, B.S. Vikhriev and others / under the editorship of N.M. Aleksandrov, P.Z. Arzhantseva. - M .: Medicine, 1986.). Autografts, allografts and implants are used to fill defects in the orbit, facial and brain skull.

 Transplants Use the rib, the outer edge of the scapula, the ilium scallop, the tibia, the radius, the cleaved free bone autografts of the cranial vault, the anterior wall of the maxillary sinus, the cartilage of the nasal septum, the cortical plate of the iliac crest, the formalized cartilage grafts and the bone grafts. Apply Filatov stalk flap (Balon L.R., Kostur L.R. Compensation of defects in the maxillofacial region and neck organs. - L.: Medicine, 1989; Reshetov I.V., Kravtsov S.A., Matorin O.V. . and others. Plastic surgery in the treatment of malignant tumors of the upper jaw and orbit using musculoskeletal flaps with the inclusion of the ribs. Annals of plastic, reconstructive and aesthetic surgery. 1998. 3, p. 42-43). Simultaneous bone grafting by known methods is associated with complications. Such methods require an extensive additional and rather traumatic, organ-damaging surgery, additional surgical team. It is necessary to form a graft during surgery - with an open wound (N.A. Plotnikov. Bone grafting of the lower jaw M .: Medicine, 1979). To maintain the position of the eyeball, restoration of the bottom (only the bottom!) Of the orbit according to Koenig is considered optimal (F. Konig, 1900; Fig. 2). In this method, the temporal muscle is used to support the eyeball. After exposure of the front edge of the lower jaw branch, its coronoid process and the place of attachment to the last temporal muscle are isolated. The coronoid process is cut off, after which the temporal muscle that attaches to the latter is mobilized. The muscle fibers are delaminated and, together with the coronoid process, are placed in place of the missing wall of the orbit. The cut off coronoid process is fastened with the remains of the frontal process of the upper jaw or with the nasal processes of the frontal bone. Subsequently, the muscle keeps the eyeball from sagging (Paches A.I. Tumors of the head and neck. - 3rd ed. - M.: Publishing house "DE JURE". 1996; Treatment of malignant tumors of the maxillofacial region. B. D.Kabakov, I.I. Ermolaev, Yu.I. Vorobev, N.M. Aleksandrov. M., "Medicine", 1978; Clinical operative maxillofacial surgery. Edited by M.V. Mukhin. Leningrad. -in "Medicine", Leningradskoe Otdel, 1974. Clinical Operative Maxillofacial Surgery. A Manual for Doctors / Edited by Prof. V.N. Balin and N.M. Aleksandrov, 3rd ed. - St. Petersburg: "Special literature ", 1998). Reconstructive operations on supporting tissues performed according to the given methods are complex and rather traumatic interventions; the time and number of operations are clinically unreasonably increased (due to technical reasons). The use of cadaveric tissue is accompanied by negative biological, moral and ethical and legal problems.

 Implants In modern publications, the main attention is paid to the plastic surgery of individual walls of the orbit (Plastic surgery of the adnexal apparatus of the eye and orbit. Materials scientific and practical conference. June 4-5, 1996, M., 1996). To eliminate deformations and defects of the cheekbone-orbital complex, sculpturally-modeled siloxane implants made according to indirect measurements are used (L. Brusova M. Restorative operations on the face with the use of siloxane compositions. Auth. Diss ... Doctor of medical sciences. M., 1996).

 Apply sets of implants made of ceramics, carbon, titanium (MN Kosyakov, AA Nikitin, M.Yu. Gerasimenko, etc. The use of the NSI-R kit in maxillofacial surgery. The use of biocomposite materials in maxillofacial surgery and Dentistry, Abstract of the 1st All-Russian Scientific Conference Moscow, November 20-21, 1997, MONIKI. M., 1997, p. 33; Nikitin A.A., Zhdanov E.V., Gerasimenko M. Yu. Et al. The Use of Biocomposite Materials in Craniofacial Surgery, ibid., Pp. 41-42. F. Nabiev. Clinical and experimental rationale for the use of carbon-containing material ov in maxillofacial surgery. Abstract of thesis ... doctor of medical science M., 1997; Semkin VA Pathogenesis, clinic, diagnosis and treatment of disorders of the lower jaw movement. Abstract of thesis. doctor of medical science Science. M., 1997). However, being standard, they are not provided and cannot correspond to the parameters of the anatomical defect of the skull of a specific individual.

 Implants from perforated titanium plates are modeled and prepared taking into account the anatomical structure during surgery with an open wound, in conditions of increased life risk - anesthesia (V. A. Belchenko. Reconstruction of the upper and middle areas of the face in patients with post-traumatic defects and deformations of the facial skeleton using autografts of membranous origin and metal structures made of titanium. Author's thesis ... Doctor of Medical Sciences. M., 1996. V.A. Belchenko, V.P. Ippolitov, N. A. Rabukhina. Problems of modern orbital surgery. book: Reconstructive surgery of the maxillofacial region. -M., 1995, pp. 97-101. Central Research Institute. JSC "Dentistry"; Medvedev Yu. A. Possibilities of using implants from porous titanium nickelide in reconstruction of injuries of the lower wall of the orbit, p. 91-93. In the book: Reconstructive surgery of the maxillofacial region. -M. 1995. -208 pp. Central Research Institute of Automatics. JSC "Dentistry"; Mirgazizov MZ, Gunter V.E., Itin V.I. and others Superelastic implants and designs from alloys with shape memory in dentistry. 1993, by Quintessens Verlags - GmbH. Berlin). This requires manual labor and a certain level of sculptural skills by the surgeon. The time of surgery increases and the risk of complications increases, the patient stays under the influence of potent expensive drugs and other costs increase. According to experts, fitting the implant during surgery is an anachronism.

 The determination of the average statistical parameters characterizing the shape and size of the organ revealed significant variability that is not characterized by any fixed values.

 The disadvantages of the known methods is the low accuracy of measuring defect parameters, the use of linear measurements, rather than volumetric parameters. The history of creating volumetric images of the internal structure of biological objects of front-orbit-basal localization using computer technology and modern imaging methods is relatively short and its advantages in various branches of medicine are not yet fully disclosed. The first monograph on this subject was published in 1985 by J. Marsh (craniomaxillary surgeon) and M. Vannier (radiologist) (Using three-dimensional computed tomography in reconstructive operations for bone defects and deformations of front-orbit-basal localization. Eropkin SV , Arutyunov N.V., Potapov A.A. et al. Cranioorbital trauma, Mater, 2nd Moscow Scientific and Practical Neurophthalmologist Conf. RAMS.N.N. Burdenko Research Institute of Neurosurgery M., 1998 , p. 4-5 .; Filimonov G.P., Ternovoi S.K., Shalumov A.Z. Importance of X-ray computed tomography in the diagnosis of combination constant cranial trauma, eye socket, the upper and middle areas of the face. Ibid, p. 6-7).

 The well-known "Method of manufacturing a transplant to eliminate defects and deformations of supporting tissues" (RF patent N 2073490), based on the reproduction of missing tissues by symmetric transformations of preserved tissues of the opposite side. However, it is not provided and does not take into account the individual characteristics of a particular individual, while it has been established that there are no symmetrical skulls (Rabukhina N.A. Ryabova I.V., Gunko V.I. et al. // Dentistry: 1996. - T. - 75, N 2, pp. 44 - 45; Kalamkarov H.A., Rabukhina N.A., Bezrukov V.M. Deformations of the facial skull. - M., Medicine, 1981). Since the shape and size of the skull of each individual have peculiarities unique to him, it is necessary to select a graft that corresponds not only to the preserved part of the organ, but also to the structure of the skeleton, while the graft should not exceed the anatomical parameters of the tissue being restored.

 However, computer tomographic studies, the results of their analytical processing are not used as design and technological information for automatic design systems (CAD) in the manufacture of individualized precision eye socket implants. The issues of anatomical and functional rehabilitation of patients are solved fragmentarily and do not represent a single complete system and technology.

 Existing methods do not allow preventively - before surgery, to identify the volumetric mathematical parameters of an orbital defect. They do not allow carrying out volumetric mathematical design, modeling and adaptation to the receiving bed, they do not allow proactively producing an implant corresponding to the volumetric mathematical parameters of the anatomical defect of the orbit of a particular individual. These methods do not constitute a single system - such a set of components (elements) whose interconnected functioning is aimed at solving a problem common to the system. They do not constitute a complete technology, including all stages of the patient's surgical rehabilitation.

 "Despite all the new methods of treatment, the problems of helping patients with defects and deformations of the bones of the middle zone of the face continue to be confused by surgeons involved in their reconstruction (V.A. Belchenko, V.P. Ippolitov, V.I. Lizunkov, etc. Reconstruction of the upper and middle zones of the face in patients with post-traumatic defects and deformities using autografts of the cranial vault and titanium constructions. Mater. II International Conference of Human Persons. June 20-21, 1996, St. Petersburg, p. 8).

 The main principles of modern reconstructive and reconstructive surgery of the face are considered the adequacy of the transplant to the structure, consistency, shape, volume and function of the organ that is being restored; symmetry of the restored paired organ or its site (Bernadsky Yu.I. Traumatology and reconstructive surgery of the craniofacial area. - 3rd ed.-M .: Medical literature. 1999; Rootman J., Stewart., Goldberg RA Orbital surgery : A conceptual approach. - Plymouth: Lippencott-Raven Publ., 1996). It is necessary to select a transplant that corresponds to the individual characteristics of a particular individual - not only the preserved part of the organ, but also the structure of the skeleton.

The tasks to be solved in the invention:
Determination of volumetric mathematical parameters of the missing tissues of the orbit of a specific individual based on computer tomographic studies;
The production of an individualized precision implant based on volumetric mathematical parameters to fill in the missing tissues of the orbit - a complex subtotal polyossal defect.

Technical result:
Creating (manufacturing) an implant corresponding to the shape and volume of the missing tissues of the orbit, and the contacting surfaces of which are a mirror copy of the preserved tissues of the orbit.

 A method of manufacturing an individualized precision implant to make up for a complex subtotal polyossal orbital defect.

The execution of the method:
The method is carried out on a completed open technological system consisting of a number of links-sectors (Appendix 1 see at the end of the description), operating on the basis of mathematical integration (Appendix 2 see at the end of the description) according to a certain procedure (Appendix 3 see at the end descriptions).

Clinical surgery sector - the clinic, which is the first (examination, establishment of a clinical and radiological diagnosis) and the last ringing (surgical treatment - replenishment of the defect) of the technological chain;
Sector of computed tomographic diagnostics;
Sector of computer design and modeling;
The experimental production sector.

 The function of the first link.

 Fulfillment: the patient is examined, a clinical and radiological diagnosis is established, tasks and the volume of a computer tomographic study of the skull tissue are indicated (Fig. 1).

 The function of the second link.

 Fulfillment: computed tomographic examination of the skull is carried out using a special technique that takes into account bilaterality (pairedness), syntopy and topographic anatomy of a person. The patient is placed symmetrically with respect to the scanning device, which prevents spatial distortions during reconstruction of the object according to the scan results, and they achieve a strictly symmetrical computer image of the facial skull. The sagittal plane passing through the rooster crest and the perpendicular plate of the ethmoid bone, the spinous crest of the lower edge of the pear-shaped opening, and the central incisal line of the upper jaw are taken as the median line — the axis of symmetry. A vertical light visor of a computer tomograph is installed on it. For the horizontal - axial plane take a horizontal line passing along the lower edge of both eye sockets, then along the zygomatic arches to the upper edge of the external auditory meatus. A horizontal light sight of a computer tomograph is installed on it. Computed tomography of the patient’s facial skull is performed in the frontal projection (parallel to the frontal bone plane) in depth - in the interval from the surface of the frontal and zygomatic bones to the top of the orbit pyramid, in height - in the segment from the cranial vault to the top of the alveolar process of the upper jaw. Studies are performed in layers (Fig. 3) with the thickness of the test tissue up to 1 mm by successive scans in a segment in depth - from the surface of the frontal and zygomatic bones to the top of the orbit pyramid. Data from a computer tomograph (CT) is transmitted via a standard dicom3 interface to a workstation in which images are recorded and a 3D array of tomographic data is synthesized. The necessary segment of the bones of the skull is isolated for operational mathematical processing. A complete set of layered tomographic information (a digitized set of sections) in the form of a package of files in the .iges format is exported to a personal computer (personal electronic computer) either via a telecommunication network or using a hard data carrier.

 The function of the third link.

 Fulfillment: the computer receives computer mathematical information from: a) a workstation of a computer tomograph in a clinic for network communications; b) from an external clinic - the customer via a telecommunication network (Internet). In the automatic design system (CAD / CAM) volumetric mathematical parameters of the skull are determined. Volumetric parameters of the tissues of the preserved anatomically complete orbit are determined by integral computer processing of the entered information. Using symmetric computer transformations according to the volumetric parameters of the tissues of the preserved eye socket, volumetric mathematical parameters of the missing tissues of the damaged eye socket are synthesized like a mirror image (Fig. 4): for each layer of tomograms, a plane-oriented image of the corresponding section of the eye socket with defect. The volumetric mathematical parameters of the tissues of a symmetric anatomically complete orbit are imposed on the obtained volumetric mathematical parameters of the defect by a mirror symmetric computer transformation.

 By means of a differential evaluation of parameters superimposed by overlapping (between synthesized volumetric mathematical parameters of healthy eye socket tissues and volumetric parameters of an orbit with a defect), volumetric mathematical parameters of the implant are determined. The resulting image of the implant is adapted to the receptive bed - the preserved anatomical objects of the orbit. Mathematically, the surfaces are congruently mirrored in the form of a “stamp-counter stamp”. To the measured surface of the preserved zygomatic process of the frontal bone - the frontal process of the mathematical image of the implant, and to the zygomatic process of the temporal bone - the temporal process of the image of the implant so that they are aligned and that the outer edge of the healthy eye socket and the outer edge of the implant are symmetrically the same distance from the center line of symmetry . The contact medial (facing the middle of the skull) surface of the implant image is adapted to the surface of the preserved frontal process of the upper jaw so that the surface of the lower wall of the healthy eye socket and the lower wall of the mathematical image of the implant are in the same anatomical plane. Thus, the reproduced volumetric mathematical image of the implant is individualized for a particular patient and a specific defect.

 After a satisfactory assessment, the synthesized volumetric mathematical parameters of the individualized implant in the form of a package (full set; Fig. 5) of .stl files are exported to a stereo lithograph for the manufacture of the implant (or its model).

 When the technology operates in the open mode, the primary information is digitally received via telecommunications (Appendix 1, see the end of the description) from any peripheral medical institutions with the ability to perform computed tomographic diagnostics. Then it is launched into technological development.

 The function of the fourth link.

 Execution: information from the PC in the form of a package (set) of files in the format. stl with volumetric mathematical parameters of the implant is taken to an automatic prototyping device (laser stereolithograph, multi-jet polymer printer, CNC machine, etc.) and the implant is created physically from a biocompatible material or its master model (Fig. 6). If necessary: a) a stereolithographic model is used for the manufacture of a forming tool in which an implant is formed from a biocompatible material; b) the forming tooling is made, bypassing the stage of manufacturing the master model. The resulting product (prototype or implant) can be examined in a clinic at the consultation, analyzed, and if necessary, make adjustments. The manufactured implant is subjected to long-term (months, years) sterilization and placed in special packaging ready for use, storage and transportation. Labeled, indicated passport data of the patient, the name of the anatomical object, the material of manufacture, sterilization time, conditions of detention and the necessary additional information.

 The final stage of the implementation of the method (surgical clinic): the implant is used in one of four ways: 1. In the clinic, an operation is performed - the defect is made up with an individualized precision implant (Fig. 7); 2. The implant is sent to the customer clinic, where the patient is; 3. The implant is stored for the operation at an acceptable time for the patient and medical indications; 4. The surgical team goes to the clinic with the implant and performs the operation at the patient’s place of residence.

 A method of manufacturing an individualized precision implant to make up for a complex subtotal polyossal orbital defect.

 Implementation example.

 The patient Mr. V.A., 50 years old, was admitted to the hospital with a diagnosis of Subtotal traumatic defect of the left orbit. Hypophthalmus. Enophthalmos. Diplopia. Disabled. Revealing of the left half of the face, displacement of the left eyeball down and inward (Fig. 1. Photo of G-VA V.A., 50 years old).

 The patient underwent computed tomographic examination of the skull (CT Hi speed sti - GE spiral tomograph) according to a special technique: layer-by-layer (Fig. 3), with a step of 1 mm, in a segment: in the frontal projection (parallel to the plane of the frontal bone) in depth - in the interval from surface of the frontal and zygomatic bones to the top of the pyramid of the orbit, in height - in the segment from the cranial vault to the top of the alveolar process of the upper jaw inclusive. Data from a computer tomograph using the standard dicom3 interface was transferred to a workstation in which images were recorded and a 3D array of tomographic data was synthesized. The necessary segment of the bones of the skull was selected for operational mathematical processing, a digitized set of sections (a set of files) in the .iges format was exported to a personal computer (personal electronic computer).

 In a personal computer in the automatic design system (CAD: CAD / CAM), by integrating the entered information, the volume mathematical parameters of the tissues of the right anatomically complete orbit and the left orbit with a defect were determined. Layer-by-layer symmetric (mirror) transformations of the mathematical parameters of the tissue of a healthy right eye socket (Fig. 4) were performed with the left eye socket defect in the defect zone and, thus, a complete array of volumetric mathematical parameters of missing left eye socket tissues was synthesized. Then, by means of a differential assessment of parameters superimposed by overlapping (between the synthesized volumetric mathematical parameters of the tissues of the right healthy eye socket and the volumetric parameters of the left eye socket with a defect), the volumetric mathematical parameters of the implant were determined. The resulting image of the implant was adapted to the preserved anatomical objects of the left eye socket - the receptive bed. Mathematically, congruence of the surfaces of the type of "stamp-counter-stamp" was created. To the measured surface of the preserved zygomatic process of the frontal bone is the frontal process of the implant image, and to the zygomatic process of the temporal bone is the temporal process of the implant image so that they are aligned and that the outer edge of the healthy eye socket and the outer edge of the implant are at a symmetrical equal distance from the center line of symmetry. The contact medial (facing the middle of the skull) surface of the implant image was adapted to the surface of the preserved frontal process of the upper jaw so that the surface of the lower wall of the healthy eye socket and the lower wall of the mathematical image of the implant were in the same anatomical plane. The individualization of the mathematical image of the implant to the parameters of the patient’s skull and the parameters of the orbital defect was achieved.

 Further, the obtained volumetric mathematical parameters of the implant in the form of files (a complete set of layers; Fig. 5) in the .stl format were exported to a laser stereo lithograph (SLA-250). Based on the received files, a model of an individualized precision left eye socket implant was made (Fig. 6).

 The resulting model is presented at a medical consultation. Clinical discussion of the shape of the implant, its contact surface (docking unit). The implant model is approved and transferred as a master model to production for the manufacture of the implant from a biocompatible material. The obtained individualized precision left eye socket implant was sterilized and stored in a packaged form in a clinic. After 3 months (time selected by the patient), the patient was admitted for surgery.

 An operation was performed (Fig. 7) to fill up a complex subtotal polyossal defect of the left eye socket with an individualized precision implant made of biocompatible material.

 In the postoperative period after the restoration of the anatomical structure of the eye socket, a course of functional rehabilitation therapy was carried out. After 1 month, binocular vision was restored. After 2 months, binocular vision was stable in nature, which allowed the patient to return to his professional intellectual activity (working with computer technology, driving vehicles).

 6 months after the operation, during a control computed tomographic examination of G-d, Mr. V.A., 50 years old, it was established: reconstructed outer and lower walls of the left orbit, a fragment recreating the zygomatic bone, are visible on layered scans (Fig. 7).

 Thus, the claimed method allows to increase the efficiency of operations to replenish complex subtotal polyossal defects of the eye socket due to the accuracy of the manufacture of the implant corresponding to the parameters of the anatomical defect of the skull of a particular individual. This provides the specified anatomical, functional - the restoration of binocular vision and cosmetic requirements for the implant. Provides high-precision industrial serial technologies in the manufacture of an individual product, reduces the material consumption of manufacturing an individualized precision implant. Reduces injuries, reduces the number of operations, the time of surgery, treatment and restoration of professional disability. The aesthetic appearance of the patient is restored. Achieved labor, professional, social and personal, neuropsychiatric rehabilitation. Increases the cost-effectiveness of rehabilitation treatment.

Claims (1)

 A method of manufacturing an individualized precision implant to make up for a complex subtotal polyossal eye socket defect, including determining volumetric mathematical parameters of deformed or with anatomical defect and healthy tissues symmetrical to it using sequential thin-layer computed tomography with a uniform step of up to 1 mm, comparing paired anatomical structures and obtaining volumetric mathematical parameters of the defect , production of an implant according to the obtained difference math data, characterized in that the skull segments are measured from the arch to the top of the alveolar process of the upper jaw, from the surface of the frontal bone to the top of the pyramid of the orbit, using the mathematical volumetric parameters of the tissues of the preserved orbit, synthesized by mirror symmetrical transformations, they synthesize volumetric mathematical parameters of the damaged eye socket, contact surfaces of the mathematical the image of the implant is adapted to the receiving bed in a mathematical way to create surface congruence it is of the “stamp-counter” type, for which the frontal process of the implant image is adapted to the measured surface of the preserved zygomatic process of the frontal bone, and the temporal process of the image of the implant is adapted to the zygomatic process of the temporal bone so that they are aligned and that the outer edge of the healthy eye socket and the outer edge of the implant were at the same symmetrical distance from the axial line of symmetry, the contact medial surface of the implant image is adapted to the surface of the preserved frontal process of the upper jaw so m a manner that the surface of the bottom wall of the orbit and healthy bottom wall mathematical image of the implant are from one anatomical plane, whereupon the implant voluminous mathematical parameters transmitted to the means for automatically manufacturing an article, the implant is sterilized and filled into packaging.

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