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A dental implant includes a healing collar that expands to a desired shape. The expandable healing collar has an orifice to permit a filler material to pass into an interior cavity between the healing collar and the base. A plurality of nested frustro-conical sections form the exterior of the healing collar which is urged upwardly by a spring and a screw. The coronal dental prosthesis that results from the expandable healing collar acts as a support for the replacement of a missing tooth so that a crown may be attached to the expanded coronal portion of the implant. This coronal extension may be angled due to its flexible telescoping mechanism and, thereafter, filled with a suitable material such as a thermoplastic resin, an epoxy-like substance or a self-gearing or light-gearing polymer. Additional apparatus and methods are described for anchoring the implant to the jawbone.
1. A dental apparatus for attachment to a vertical post which passes through the gums and is attached to the jawbone, said apparatus comprising:
a base attachable to a first end of said vertical post;
an expandable means attachable to said base for defining an interior cavity with respect to said base; and,
an orifice means in said expandable means for passing filler into said interior cavity through said orifice to expand said expandable means.
2. The apparatus of claim 1 wherein said expandable means comprises an expandable healing collar which includes a plurality of nested, concentric, conical sections which form a frustro-conical shape when said expandable means is expanded by said filler means.
3. The apparatus of claim 2 further comprising:
screw means located inside of said interior cavity to assist in the expansion of said expansion means.
4. The apparatus of claim 3 further comprising:
spring means located inside of said interior cavity to assist in the expansion of said expansion means.
5. The apparatus of claim 4 wherein said vertical post is integrally attached to said base.
6. The apparatus of claim 4 wherein said vertical post includes a threaded means at a first end for attachment to said base.
7. The apparatus of claim 6 further comprising:
an anchor plate locatable in a cavity inside of said jawbone and attachable to a second end of said vertical post opposite from said first end attached to said base.
8. The apparatus of claim 7 further comprising:
threaded means for attaching said second end of said vertical post to said anchor plate.
9. The apparatus of claim 8 wherein said anchor plate is expandable to expand to substantially the size of said cavity in said jaw.
10. The apparatus of claim 9 wherein said anchor plate includes a first and a second section connected together by a rotatable threaded means,
whereby rotation of said rotatable threaded means moves said first and second sections with respect to each other to fill up said cavity in said jaw.
11. The apparatus of claim 9 wherein said anchor plate includes spring-loaded means for automatically filling up said cavity in said jaw.
12. The apparatus of claim 9 wherein said cavity in said jaw is formed by a drill having a head with a cutting surface on its periphery and wherein the diameter of said cutting head is greater than the diameter of the shaft of said drill.
13. The apparatus of claim 12 further comprising:
a sleeve for surrounding said vertical post,
wherein said vertical post includes a plurality of vertical slits so that when passed through a first end of said sleeve it compresses and when it emerges from the other second end of said sleeve, it expands to fill up the cavity formed by said cutting head of said drill.
14. The apparatus of claim 9 wherein said anchor plate includes a plurality of flexible spring-like means which impinge outwardly against the walls of said cavity.
15. The apparatus of claim 8 wherein said filler means comprises a rigid material.
16. The apparatus of claim 8 wherein said filler means comprises a semi-rigid material.
17. The apparatus of claim 8 wherein said filler means comprises a material taken from the group of:
epoxy, thermoplastic, glass ionomers or cement-like fillers.
18. The-apparatus of claim 8 wherein said filler means comprises a light curable material.
19. The apparatus of claim 8 further comprising:
a crown attachable to said expandable means.
20. The apparatus of claim 7 wherein said anchor plate include means to attach at least two vertical posts to said anchor plate.
21. The apparatus of claim 7 wherein said anchor plate is attached substantially perpendicular to said vertical post.
22. The apparatus of claim 7 wherein said anchor plate forms an oblique angle with respect to said vertical post when attached to said vertical post.
23. The apparatus of claim 7 further comprising:
template means locatable in said cavity inside of said jawbone and also locatable above said jawbone for guiding a drill through said jawbone,
wherein a hole is formed in said jawbone properly aligned for receiving said vertical post.
24. The apparatus of claim 23 wherein said template means comprises a three-sided template including:
a top plate locatable above said jawbone and having a first aperture therein;
a bottom plate locatable in the interior cavity in said jawbone and having a second aperture therein; and,
a bridge section connected said top and bottom plates for keeping said top and bottom plates in parallel relationship with respect to each other,
wherein a drill can pass through said first aperture in said top plate and through said second aperture in said bottom plate, thereby aligning the vertical post hole properly with respect to said jawbone.
25. The apparatus of claim 6 wherein said vertical post comprises a sleeve and wherein said sleeve includes a vertical slit therein to accommodate expansion of said sleeve.
26. The apparatus of claim 25 further comprising:
an internal screw accommodated telescopically in said sleeve for expanding said sleeve by expanding said vertical slit in said sleeve.
27. The apparatus of claim 4 further comprising:
tiltable means incorporated in said expandable healing collar for tilting said expandable healing collar with respect to said vertical post.
28. The apparatus of claim 2 further comprising:
shock absorbing means located between said vertical post and said healing collar, said shock absorbing means comprising a spring.
29. The apparatus of claim 2 wherein said vertical post comprises an inner sleeve threadably received within an outer sleeve and wherein said healing collar is attached to said inner sleeve,
whereby rotation of said inner sleeve permits said healing collar and inner sleeve to be removed from said outer sleeve.
30. The apparatus of claim 2 further comprising:
coping means for covering said healing collar when expanded.
31. The apparatus of claim 30 wherein said healing collar may be tilted so that it can receive and accommodate a coronal prosthesis at an angle greater than 0� with respect to the long axis of said vertical implant.
32. The apparatus of claim 1 further comprising:
shock absorbing pad means located between said base and said vertical post for absorbing shock impact imposed upon said expandable means.
33. The apparatus of claim 1 further comprising:
tiltable means to permit said expandable means to tilt with respect to said vertical post.
34. The apparatus of claim 1 wherein said vertical post comprises an inner sleeve and an outer sleeve with a layer of elastomer material interposed internally between said sleeves.
35. The apparatus of claim 1 further comprising:
a clamp mountable on said jawbone for forming a substantially horizontal surface with respect to said jawbone; and,
gear means for locking said clamp in a preselected position,
wherein said expandable means is attachable to said clamp.
36. The apparatus of claim 1 wherein said vertical post comprises:
a tapered vertically split post having threads thereon,
wherein rotation of said split post causes said threads to engage the jawbone in a secure fashion.
37. The apparatus of claim 1 further comprising:
a recombinant granulocyte colony stimulating factor (rG-CSF) applied to said apparatus, whereby the application of said factor assists in promoting healing and preventing infection in said jawbone.
38. The apparatus of claim 1 further comprising:
a hollow tool having a beveled edge and a center pin,
wherein said center pin keeps said hollow tool in alignment with said healing collar and further wherein the beveled edges of said cutting tool cuts a ring in said gum around said healing collar when said hollow tool is rotated to receive a plug of said gum.
39. The apparatus of claim 1 wherein a coronal prosthesis is adapted to mate with said vertical post with a hex-like configuration such that said vertical post includes at least three downwardly depending legs which engage respectively with at least three upwardly depending legs on said vertical post.
40. The apparatus of claim 39 further comprising:
a screw for attaching said coronal prosthesis to said vertical post.
41. The apparatus of claim 1 further comprising a coronal prosthesis which is adapted to engage with a hex-like structure on said vertical post, said coronal prosthesis including at least three downwardly depending legs adapted to engage with at least three slots in the upper portion of said vertical implant.
42. The apparatus of claim 40 further comprising:
a screw for attaching said coronal prosthesis to said vertical implant.
43. The apparatus of claim 1 wherein said expansible means comprises a healing collar and a hex-like structure for engaging said vertical post including at least three downwardly depending legs adapted to engage with three upwardly depending legs forming part of said vertical implant.
44. The apparatus of claim 1 comprising a molly bolt-like structure including:
thread means located in said vertical post; and,
wing means locatable at the end of said vertical post receivable in said incision in said jawbone,
wherein rotation of said threaded means causes said wing means to expand and engage the internal walls of said vertical incision.
45. The apparatus of claim 1 further comprising:
a hollow cutting tool having a beveled edge,
wherein the beveled edge of said cutting tool cuts a ring in said gum around said healing collar when said hollow writing tool is rotated to remove a plug of said gum.
46. The apparatus of claim 1 further comprising:
a clotting factor applied to said apparatus, whereby the application of said factor assists in controlling bleeding from said jawbone.
47. A method for installing a dental implant at a distance from a bony ridge including a vertical post locatable in a jawbone covered with gum tissue, comprising the steps of:
cutting back a flap of said gum to reveal the upper bony ridge of said jawbone;
inserting said vertical post with a healing collar attached into said jawbone;
folding said flap back over said jawbone and said healing collar;
cutting out the area around said healing collar with a hollow tool having a beveled edge and a center pin for keeping said tool in alignment with said healing collar, wherein the beveled edge of said hollow cutting tool cuts a plug in said flap around said healing collar; and,
suturing the flap back in position.
48. The method of claim 47 wherein said healing collar comprises an expandable healing collar, said method further comprises the step of:
filling said expandable healing collar with a filler material to expand said healing collar.
49. The method of claim 48 further comprising:
applying a recombinant granulocyte colony stimulating factor (rG-CSF) to said vertical post in order to control bleeding from said jawbone.
1. Field of the Invention
The invention relates to the field of dental implants and methods for restoring a tooth.
2. Description of Related Art
Dental implants commonly employed today have many limitations. For example, there are significant potential areas for error, large inventories are required, and often the implants and techniques used are of great inconvenience to both the dentist and the patient with respect to placement and maintenance. Moreover, typical dental implants require the use of a screw to affix the coronal prosthesis to a previously located implant. The use of such screws require many difficult procedures such as removing the healing collar and affixing the coronal prosthesis to the implant, followed by an overall impression of the coronal prosthesis and the adjacent structures. The impression is then removed from the patient's mouth and the coronal prosthesis, with an attached analog which represents the vertical implant, is inserted and seated into the impression so that the dental laboratory may fabricate the restoration for the missing tooth or teeth. The dental laboratory must then send the finished product back to the dentist who again removes the healing collar and reattaches the coronal prosthesis along with the restoration made by the laboratory which is affixed to the implant by the use of a screw. Such screws have been known to fracture when chewing forces are applied rendering the restoration unsuitable. It has been attempted to place shock absorbing material between the screw and the implant so as to try to prevent the screw from fracturing. This does not always work, however, and it is normal practice to replace the shock absorbing material yearly. This is a costly procedure both in time and money to both the dentist and patient and often causes unnecessary discomfort.
The following U.S. Patents describe relevant dental implants which provide for fixed coronal prostheses: U.S. Pat. Nos. 4,431,416; 4,446,579; 4,645,453; 4,758,161; 5,030,095 and 5,071,350. However, the foregoing does not permit the coronal portion to be of various shapes and configurations such as can be achieved through the present invention.
U.S. Pat. No. 5,004,421 describes an expansion of a dental implant having some limited capabilities.
The following patents show other dental implants of various configurations that do not address the problems solved by the present invention: U.S. Pat. Nos. 4,185,383; 4,304,553; 4,406,623; 4,420,305; 4,439,152; 4,447,209; 4,516,937; 4,661,066; 4,722,688; 4,744,754; 4,744,755; 4,758,160; 4,773,858; 4,792,580; 4,960,381; 5,062,800; and 5,076,788.
Briefly described, the invention comprises a dental implant employing the use of a healing collar having a means for expansion so as to form a coronal prosthesis or attachment for a coronal prosthesis that eliminates the need for the use of screws to affix the coronal prosthesis to the internally threaded shaft of an endosseous dental implant. The expandable healing collar is made up of a plurality of nested frustro-conical sections that are sandwiched between a base and a top section. The unscrewing of a screw assisted by a spring caused the top and base to move away from each other, thereby causing an interior cavity to form as the nested frustro-conical sections telescope outwardly. The interior cavity can be filled through orifices with an appropriate filler such as a thermoplastic material, an epoxy-like material, or a self-curing or light curable polymer.
A further advantage of the present invention rests in the method and preparation of the soft tissue and bone for a dental implant. This method may employ both a vertical and horizontal implant in combination to anchor the healing collar. Additionally, the invention provides means for the implant to be adjusted in situations where the bony preparation was made too large so that the implant can be held in place with a spring-like mechanism.
Accordingly, one of the principal objects of the invention is to provide improved techniques and apparatus for dental implants. A more particular object is to provide techniques and constructions which address the problems of severe bone loss so as to make the implant feasible with a more favorable prognosis. In accordance with one embodiment in the present invention, a horizontal plate is inserted into the jaw through a horizontal incision which may be precisely made with a drill, saw, or a laser, in a limiting manner so as to conserve the amount of bone removed from the jawbone.
A three-sided template is used as a guide which functions to direct and limit the removal of bone. A particular characteristic of the horizontally-directed incision is that it tends to avoid the violation of vital areas, such as the nasal sinus, nerves and blood vessel channels.
The bio-compatible horizontal plate, which may be expandable for closer adaptation to the walls of the incision, is placed in the horizontal incision forming a rigid fixture. Because the plate is expandable, the incision can be made smaller than the plate.
Once the horizontal plate has been set in place, the rigid fixation screws or wires may be applied to maintain its position. A guide, having upper and lower arms, connected by a vertical outer wall, facilitates the making of the vertical incision directly into receptacles provided for in the horizontal plate. These receptacles may be equipped with screw threads, clamps or other means of locking them into the vertical fixture. Once the vertical incision is completed and the vertical implants are screwed to the horizontal structure, all incisions are closed and the vertical and horizontal implants are left in place until osseous integration is completed in approximately 3-6 months after which the same procedure used in the prior art for vertical fixtures is employed for reconstruction in the making of the prosthesis.
Alternative techniques are disclosed for drilling incisions vertically with special drills which enable the incision to be expanded laterally. In such a case, the head of the drill is significantly larger than the shaft and the cutting takes place on the periphery of the head so as to make a cavity, which is larger in diameter at the bottom then it is at the top.
Another alternative calls for the making of an incision into the bone and using a clamp which enables the prosthesis to be held in place on the jawbone.
Other alternative embodiments of the method and apparatus will be apparent from a detailed study of the specification hereafter, with reference to the attached drawings described below.
FIG. 1 is a perspective view of a patient's jaw in the process of undergoing a dental implant in accordance with one embodiment of the present invention.
FIG. 2 is a vertical view showing a cavity in phantom of a vertical implant structure according to prior art practice.
FIG. 3 is a cross-sectional vertical view of a dental implant structure including a vertical implant with accessory screw at the bottom in the process of being secured to a horizontal implant structure in accordance with one embodiment of the present invention.
FIG. 4 is a perspective view of the horizontal implant structure of FIG. 3.
FIGS. 5, 6, 7 and 8 are cross-sectional vertical views, of various orientations of a dental implant structure in accordance with the present invention including an internally screw-threaded vertical implant and a horizontal or transverse implant fastened together with an accessory screw, such that in FIGS. 6 and 8, the bottom of the vertical structure contacts the surface of the lower structure directly, whereas in FIGS. 5 and 7, osseous material intervenes between the bottom of the vertical portion and the surface of the lower structure.
FIGS. 9 and 10 are cross-sectional views through a vertical plane of two different orientations of a modified dental implant in accordance with the present invention, including an internally and externally screw-threaded vertical implant in the process of being interposed into the screw-threaded receptacle of a horizontal or transversely disposed implant.
FIG. 11 is a perspective view of a modification of a combination of FIGS. 9 and 10 in which the vertical implant structure is bifurcated for expansion purposes, and terminates at its bottom end in a screw projection which is accommodated and received in a screw-threaded receptacle in the horizontal plate.
FIG. 12 illustrates in perspective view another modification of the present invention in which the horizontal implant structure has screw-threaded receptacles for two vertical implant structures which are internally and externally screw-threaded.
FIGS. 13A and 13B are vertical cross-sectional elevations showing in two different angular orientations the use of templates which are utilized as guides for the purpose of properly placing and aligning the vertical incision relative to the screw-threaded receptacles in the horizontal implant structure.
FIG. 13C is a top plan view of the templates of FIGS. 13A and 13B showing a scale to determine the proper angular orientation.
FIGS. 14 and 15 are perspective views of the templates of FIGS. 13A and 13B indicating how the angular orientation of the horizontal and vertical members can be varied.
FIG. 16 is a perspective view of a modified template which is vertically and laterally expandable.
FIGS. 17 and 18 are cross-sectional views illustrating an expandable modification of the horizontal implant structure of the present invention seated in an incision and in its contracted and expanded positions, respectively, so as to support two implants.
FIGS. 19 and 20 illustrate the dental implant structures of FIGS. 17 and 18 removed from the jawbone incision.
FIG. 21 is a cross-sectional vertical illustration with a modification of the implant structure of FIGS. 17 and 18 in situ including an enlarged receptacle for the lower terminal portion of two implants interposed through separate incisions at opposite ends.
FIG. 22 is a perspective view with the top removed of a two-part insert having a cylindrical expansible sleeve with an inner member fitting into the sleeve telescopically, and internally screw-threaded to accommodate an axially disposed screw which supports the vertical implant.
FIGS. 23 and 24 are vertical cross-sectional illustrations of the device illustrated in FIG. 22 installed in a vertical incision where the diameter of the internal member becomes smaller as the depth is increased, causing the insert to spread in the incision.
FIGS. 25A and 25B, 26A and 26B, 27A and 27B illustrates modifications of the vertical implant structure of FIG. 23, et seq., in vertical cross-sectional detail comprising an inner and outer sleeve including an elastomer containing material such as aerogel, polyurethane, or a compressible polymer, in various areas, and between the inner and outer sleeves.
FIG. 28 illustrates an expandable horizontal anchor plate including spring-loaded wings which are compressed to fit within a horizontal cavity in the jawbone.
FIG. 29 illustrates the embodiment shown in FIG. 28 with the spring-loaded wings expanded to fill up a larger cavity.
FIG. 30A is a detail of the wing structure illustrated in FIGS. 28 and 29 with the wing expanded outside of the anchor plate.
FIG. 30B illustrates the wing structure of FIGS. 28 and 29 with the wing compressed inside the horizontal anchor plate.
FIG. 31A illustrates the vertical anchor post having spring-loaded wings about to be received in a vertical incision in the jawbone.
FIG. 31B illustrates the vertical anchor post of FIG. 31A with the wings expanded so as to fill up a large cavity and engage the sides of the vertical incision.
FIG. 31C illustrates the vertical post of FIG. 31A with the wings compressed inside a snug fit cavity.
FIG. 32A is a vertical cross-sectional illustration of a further modification of the invention in which a vertical incision is made with an enlarged base portion which is constructed to receive an internally screw-threaded sleeve, the upper portion of which has laterally-extending supporting flanges and the lower walls of which are formed of bendable metal strips and the toggle bolt structure also includes a central axial screw surrounded by an inner screw-threaded sleeve.
FIG. 32B illustrates the composite toggle bolt sleeve of FIG. 32A after it has been screwed into the vertical incision.
FIG. 32C is a vertical cross-sectional illustration of the condition of the central screw after it has been tightened, causing the lower lateral wall of the outer sleeve to draw up and bend outward like a toggle bolt and to lock the outer sleeve in place against the walls of the lower portion of the incision.
FIG. 33A illustrates in a perspective elevation, a vertical incision constructed to accommodate an internally screw-threaded outer sleeve notched at the top which in turn accommodates an internal screw such that the apparatus has near at its bottom end a plurality of spring-biased toggle wings which bend outwardly as the central member is screwed into place.
FIGS. 33B and 33C illustrate in vertical cross-sectional views the central screw in place, with the spring-loaded wings bent outwardly to hold the implant in place in the lower portion of the incision.
FIG. 34 illustrates a prior art drill for drilling a vertical incision.
FIG. 35A illustrates a modification of the drill of FIG. 34 in which the diameter of the head of the drill is larger than the diameter of the shaft of the drill and includes a cutting surface on its periphery.
FIGS. 35B and 35C illustrates the manner in which the drill of FIG. 35A produces an incision which is larger at the bottom than it is at the top.
FIG. 35D illustrates a modification of the drill illustrated in FIG. 35A which includes an upper and lower cutting surface for producing two relatively enlarged horizontal incisions in the jawbone.
FIG. 35E illustrates a vertical post having multiple splits so that it is compressible and can fit into a sleeve which is received in the vertical incision drilled into jawbone.
FIG. 35F illustrates the manner in which the vertical post can be compressed and the manner in which the vertical post expands once it escapes from the bottom of the sleeve.
FIG. 36A illustrates in a perspective vertical fashion, a modification of the implant of FIG. 33A which is constructed to be received telescopically in a cylindrical sleeve which is notched at the top and which is accommodated in a vertical incision such that when the prosthesis support is lowered into the vertical incision, the lower end of the internal screw portion is bent inwardly and upwardly, but is constructed to spread laterally into the lower portion of the incision and flattened against the inner walls of the lower portion of the incision as the support for the prosthesis is tightened into place, as shown in FIGS. 36B and 36C.
FIGS. 37A, 37B and 37C illustrate a technique according to the present invention for employing a clamp on the jawbone to support a prosthesis and for drilling a vertical incision in the jaw.
FIG. 38A illustrates another approach to installing a substitute tooth beginning with the making of an incision with a knife from the top of the jawbone.
FIG. 38B illustrates a drill entering the jawbone after a flap of gum has been cut back and removed to expose the upper bony ridge of the jawbone.
FIG. 38C illustrates the use of a vertical post being attached to a horizontal anchor plate from the top of the exposed jawbone.
FIG. 38D illustrates a surgical incision made with a cutter device down to the horizontal incision made in the jawbone guided by an internal pin in the cutter device contacting the top of the vertical post.
FIG. 38E illustrates the cylindrical cutter device rotated to cut a portion of the gum from the top of the exposed jaw.
FIG. 38F illustrates the cylindrical cutting device after it has operated on the top of the jaw and has actually incised a small cylindrical plug of gum.
FIG. 38G illustrates a cylindrical cutting device having a spiral edge being applied to the top of the patient's jawbone.
FIGS. 38H and 38I illustrate prior art cylindrical cutting devices showing the manner in which a small cylindrical segment has been cut off between the implant and gum.
FIG. 38J illustrates the modification according to the present invention of the device is illustrated in FIGS. 38H and 38I, in which the cutting edge of the cutting device is beveled.
FIG. 39A illustrates the use of a clamp to hold a healing collar with a cutting edge between the gum and the bone, after the flap of gum has been drawn back.
FIG. 39B illustrates the apparatus of FIG. 39A with the flap of gum replaced and sutured into position.
FIG. 40A illustrates in a partial cross-sectional view, a cylindrical healing collar in the vertical plane set in an implant having apertures therein and including a spring that acts as a shock absorber.
FIG. 40B is a vertical, external view of the implant illustrated in FIG. 40A.
FIGS. 40C and 40D are vertical cross-sectional illustrations of a healing collar shown in its collapsed mode in FIG. 40C and in its expanded mode in FIG. 40D.
FIG. 40E is an external, cross-sectional view of an implant having a healing collar on the top thereof, such as illustrated in FIG. 40D.
FIG. 40F illustrates a prior art compressing device which terminates in a nub which is applied by a hand-operated syringe to express a filler into the expanded healing collar such as illustrated in FIGS. 40C-40G.
FIG. 40G illustrates an externally applied plastic or metal cap or coping which fits precisely over the spring-biased healing collar illustrated in FIGS. 40C, 40D or 40E.
FIG. 40H illustrates a tiltable embodiment of the expandable healing collar such as illustrated in FIGS. 40C-40G.
FIG. 40I is a partially exploded, cross-sectional view of a healing collar in its expanded mode with a screw shown in relative alignment above the healing collar and vertical post.
FIG. 40J illustrates the healing collar and post of FIG. 40I after the screw has been screwed down, thereby collapsing the healing collar into the vertical post.
FIGS. 41A through 41E illustrate in partial cross-sectional views, an implant including a flat, shock absorbing rubber-like cap located on the top of the cylindrical insert.
FIG. 41F illustrates the implant including the rubber-like cap with an expandable healing collar expanded and in place on top.
FIG. 42A illustrates in a partial cross-sectional view the healing collar with an elastomer or rubber-like cap in place in the jawbone.
FIG. 42B illustrates the cylindrical implant in full vertical cross-sectional view in place in the jaw and held into position with internal screw threads so that the core can be removed.
FIGS. 42C, 42D and 42E are partial cross-sectional views showing the implant in place in the bone with the rubber or elastomer cap in place across the top.
FIGS. 43A and 43B illustrate in partial cross-sectional views a modification of the implant wherein the threaded exterior body of the implant is received into a horizontal anchor plate.
FIGS. 44A and 44B show modifications of the healing collar such as illustrated in FIGS. 42A et seq., in which the base of the healing collar comprises a hex male/female structure having three legs which are received respectively in three vertical grooves in the vertical implant employed to attach the prosthesis to said vertical post and a screw to keep the structure in place.
FIG. 44C illustrates an alternative embodiment of the versions illustrated in FIGS. 44A and 44B with an expandable healing collar in which the base of the healing collar comprises a hex male/female structure having three legs which are received, respectively, in three vertical grooves in the vertical implant employed to attach the prosthesis to the vertical post which is held in place by a screw once the expandable healing collar is activated.
FIG. 44D illustrates an incision in the jawbone and tooth such as might take place during a root canal procedure.
FIG. 44E illustrates another embodiment of the invention in which the expansible healing collar is located on top of a tapered, threaded, split vertical post.
FIG. 44F illustrates the embodiment of split, tapered, threaded post embodiment of FIG. 44E in position in the root canal.
FIG. 44G illustrates the tapered, split, threaded post embodiment of FIG. 44E with the healing collar expanded.
FIG. 44H illustrates an alternative embodiment of the tapered split vertical post of FIGS. 44E-44G showing the threads on alternate opposite sides of the split vertical post.
During the course of this description, like numbers will be used to identify like elements according to the different views that illustrate the invention.
Referring to FIG. 1, there is shown a schematic of a jaw or jawbone 1 being prepared for an implant in accordance with the present invention.
In accordance with prior art practice, a vertical incision 2 is made in the jaw 1. A sleeve 3 is interposed into the vertical incision 2. The sleeve 3 is internally screw-threaded 3a to accommodate the axially-disposed terminal 4a of the support 4 in which the prosthesis is mounted.
In a modification of the present invention, in addition to the vertical incision 2 and the vertical support 3, a lateral incision 5 is made in a horizontal plane in jawbone 5, into which is interposed a horizontal plate 6. The use of a horizontal or oblique implant 6 in conjunction with a vertical implant 3 increases the retention of the vertical implant and allows the vertical implant to be used in areas close to vital structures such as blood vessels, nerves and sinuses. This feature will be more fully understood with reference to FIGS. 1 and 3-12. Centered in the horizontal plate 6, which being of a biocompatible material, is a screw-threaded receptacle 6a. This accommodates a screw 7 which extends vertically from the bottom of the sleeve 3, as shown in FIG. 3.
FIGS. 5, 6, 7 and 8 show different orientations of the vertical sleeve 3 and the horizontal plate 6.
In FIG. 5, the plate 6 is interposed in a horizontal plane, with the screw 7 extending from the lower end of 3, and screwing into the screw-threaded receptacle 6a shown in FIG. 4.
In FIG. 6, the end of the screw 7 extends beyond the lower surface of the horizontal plate 6.
Because the formation of a vertical and horizontal incision can result in a significant increase of bleeding, it may be desirable to reduce that problem. Accordingly, another embodiment of the invention comprises the use of a coating around the implant which acts to promote clotting so as to control bleeding. Another type of coating which may be used in conjunction with the aforementioned one or separately is a recombinant granulocyte colony stimulating factor (rG-CSF) such as marketed by Amgen, Inc., Thousand Oaks, Calif., under the name of Neupogen� which helps to promote healing and to prevent infection.
In FIG. 7, an incision is made at an angle to the horizontal, and the screw 7 is interposed vertically into the screw-threaded receptacle 6a of the angularly-disposed plate 6.
In FIG. 8, in which the plate 6 is also interposed at an angle to the horizontal, the screw 7 extends beyond the lower surface of plate 6.
As the fixtures remain in place, bony material 8 grows up in the incisions, holding the vertical support 3, and the horizontal support plate 6 in place in their respective incisions.
FIGS. 9 and 10 show another modification of the structure of the present invention in which the vertical support sleeve 3 of FIGS. 1-8 is screw-threaded both externally, 3b and internally, 3a.
The plate 6 shown in FIGS. 9 and 10 is interposed into a vertical incision 2. Plate 6 has an internally screw-threaded receptacle 6b in the plate, in each case, and is dimensioned to accommodate the external screw threads 3b of the sleeve 3. FIG. 10 shows a plate 6 disposed at an angle to the horizontal plane, the central internally screw-threaded receptacle 6c being dimensioned to accommodate the vertical sleeve or support 3b on a plane transverse to the horizontal.
FIG. 11 shows a further modification of the vertical sleeve 3 in accordance with the present invention in which the internally screw-threaded sleeve 3 is split lengthwise by a pair of diametrical slits 3d which are constructed to open up, or close up to enable the sleeve 3 to fit into the vertical incision 2. The sleeve 3 terminates at its bottom in an externally screw-threaded fitting 3e which is constructed to fit into the internally screw-threaded receptacle 6d of the plate 6 interposed in a horizontal incision.
FIG. 12 shows a modification of the invention in which a single horizontal plate 16 has two internally screw-threaded receptacles 16a and 16b aligned side by side accommodating two vertical externally-threaded sleeves 13 and 14.
One major difficulty associated with prior art bony preparation is the proper angulation of the drill through the jaw. This technique is often performed according to the eye and skill of the dental surgeon, however, it is subject to a significant amount of error. In order to minimize the error problem, an alternative embodiment set forth in FIGS. 13A-16 below call for an adjustable template 20 which permit vertical and horizontal incisions to be made and properly located so that vertical and horizontal implants can be properly placed.
FIG. 13A shows, in vertical section being interposed into the jaw through a horizontal incision, a template 20 having three intersecting legs hinged at the intersections 20a and 20b. Centered in the top leg which is disposed parallel to the top of the jaw, is an opening 20c which is aligned with an opening 20d in the lower leg for receiving and vertically aligning the drill.
FIG. 13B shows the template 20 being interposed at an angle to the horizontal incision.
FIG. 13C is a top view of template 20 showing how the angular position of 20 is set. FIG. 13C is a view looking down on the template of FIGS. 13A and 13B, showing how the template can be rotated to change its angle in the horizontal plane to fit into the incision from a desired angle.
FIGS. 13 and 15 show, in perspective, in several orientations, the metal templates 20, which function as guides for a vertical drill 15, which is interposed into a vertical incision to enable the drill 15 to drill an opening in the horizontal or transverse plate 59 the horizontal incision at the lower level which is aligned with the vertical incision interposed into the upper level of the jaw. It is apparent that legs of the three-legged template 20 is hinged, as shown in FIGS. 14, 15 and 16, so that it can be moved in the vertical incision to position the lower bore 20d in the desired position, aligned with the upper bore 20c.
FIG. 16 shows a template similar to that shown in FIGS. 14 and 15, and having adjustable top and bottom panels, 20f and 20g each having a slidable central panel, which enable the height and width of the template 20 to be adjusted as needed to fit into and fill up the incision.
FIGS. 17 and 18 show in vertical section an incision in the top of the jaw in which expandable plate 26a-26b is interposed into the incision. The two plate sections 26a, 26b are coplanar and are joined on a lateral plane by a screw 26c which enables the gap between them to be opened or closed. Plates 26a-26b are interposed in the incision in parallel-plane relation, so that screw 26c allows the relation between plates 26a and 26b to expand or contract. A hole in screw 26c allows for expansion or contraction of the screw. The vertical sleeves 16a and 16b each terminate at their respective bottoms in a projecting screw, as shown in FIG. 11, which fits into a screw-threaded receptacle centered in a respective one of the horizontal plates 26a and 26b The purpose of the expandable embodiment illustrated in FIGS. 17-21 is to reduce failures of blade-like implants when bony incision is made improperly.
FIG. 17 shows the combination in retracted relation in the incision; whereas FIG. 18 shows the combination in expanded relation, so that the incision is substantially filled.
FIGS. 19 and 20 are views from the top of the expandable plates 26a and 26b which are removed from the incision.
FIG. 21 shows the expandable plates 26a-26b installed in the gum in which the bone has been allowed to grow up between the sleeves 16a, 16b holding them in place to support two prostheses.
FIG. 22 shows in perspective view another modification of the invention in which the cylindrical vertical support comprises an outer sleeve 36 and an inner sleeve 46 which is designed to fit telescopically into the outer sleeve 36. The cylindrical inner sleeve 46 is open at both ends, and is screw-threaded internally 46b, and has a pair of projecting bosses or wings 46a diametrically disposed at its upper end. Extending vertically downward to the bottom of sleeve 46 are a pair of longitudinal slits 46c.
The bosses or wings 46a are designed to seat in a pair of diametrically-disposed slots 36b notched into the top rim of the outer sleeve 36, which terminates at the bottom in a closed, rounded end. On opposite sides of the outer sleeve 36 are a pair of slits 36a, extending from just below the top to the bottom, which are in a plane normal to the plane of the notches 36b.
FIGS. 23 and 24 are vertical sections through the jaw showing the combination of FIG. 22 being put into place in an incision 2, in FIG. 23, and screwed into place and expanded in FIG. 24.
The vertical support member 56 has a top portion 56a which represents an expanded healing collar, shown in FIG. 23, which is designed to support the prosthesis, has a screw-threaded stem 56b which extends down vertically and is accommodated in the screw-threaded interior 46b of the inner sleeve 46. In FIG. 24, the slit 36a of outer sleeve 36 is initially partially closed, and opens up a support member 56 is screwed into place vertically, tending to fill up the incision 2.
Another modification of the invention is shown in FIGS. 25A, 25B, 26A, 26B, 27A and 27B in which a thin lining of compressible elastomer material, 71, such as, for example, polyurethane, aerogel, or other compressible polymers well-known in the art, is interposed between the inner and outer sleeves 47 and 36, respectively. In each of the foregoing, the elastomer coating 71 between the inner and outer sleeve 47 and 36, respectively, is in a slightly different position.
One problem associated with the prior art is the difficulty of absorbing shock imparted to the crown and transmitted to the implant. Shock can cause the crown and/or implant to break or dislodge. One prior art technique to deal with the problem of shock associated with dental implants is described in U.S. Pat. No. 4,452,776. However, an improved technique is described herein. According to one embodiment illustrated in FIGS. 25A-27B, a compressible material is located between the inner and outer wall of the vertical implant so as to act as a shock absorber when excessive forces are applied. Alternatively, as described in FIGS. 40A-40D, a spring can be employed to absorb some of the shock or an elastomer material can be located at the top of the implant between the implant and the healing collar and/or prosthesis.
In FIG. 25A, the inner sleeve 47 is interposed into the incision so that the diametrical projections 47a are level with the top layer of the gum. When the stem of support 66 is screwed into inner sleeve 47, the bottom of inner sleeve 47 does not reach quite to the bottom of the incision. In FIG. 25B, the prosthesis support 66 rests on the upper gum line, and the diametrical projections 47a are located just below the gum line, sealing in the layer 71 of elastomer. the stem 47 of 66 is screwed all the way into the inner sleeve so that the combination fills up the incision.
In FIG. 26A, the outer sleeve 36 is interposed into the vertical incision, so that it extends to the bottom. The elastomer layer 71 is put in place forming an inner lining of sleeve 36. The stem 47 of support 66, which has no projections at the gum surface, is screwed into place, extending nearly to the bottom of the incision. Thus, the annular top edge of the elastomer layer 71 is exposed to the air.
In FIG. 26B, the top edge of the elastomer layer 71 is below the gum line, so that it is sealed in and not exposed to the air. The stem 47 of support 66 is screwed to the bottom of the incision in contact with the elastomer lining.
FIGS. 27A and 27B show other modifications in which the support 66 has diametrical projections 47a. When the inner stem 47 is screwed into the incision, almost to the bottom, the projections 47a close up the opening slightly below the gum level sealing in the elastomer layer 71. In 27B, when the stem 47 is screwed into the bottom of the incision in contact with the elastomer layer 71, the support 66 is embedded in the gum and the projections 47a close off the incision below the level of the gum.
The present invention also provides a means for the implant to be adjusted in situations where the incision made during the bony preparation was too large. A similar problem is addressed in U.S. Pat. No. 5,030,095 but not as extensively or effectively as the modification described in FIGS. 28-36C.
FIGS. 28 and 29, show further modifications of the invention 61, in which the screw-threaded stem 47 of the support 66 extends vertically and is rooted in a horizontal incision in the jaw, resting in an expanded chamber 62 which is the correct size to accommodate and hold in place the lower end of the stem 47 which rests in the horizontal incision 61.
A special feature of this embodiment is a plurality of small leaf-like springs or wings 63 which are connected around the periphery of the metallic rectangular base support 63, which is shown removed from the incision 2 in FIGS. 30A and 30B. The springs or wings are housed in a recess 63a in the lateral wall of the rectangular container 61. FIG. 30A shows one of the wings 63 released outwardly to hold 61 in place in the lower incision 62 if the incision is larger than 61. FIG. 30B shows the wings 63 retracted into recess 63a, in the case in which the rectangular base member 61 fits into the incision 62.
FIGS. 31A, 31B and 31C illustrate the use of wings or springs 63, which are of the form shown in FIGS. 31A, 31B on the body 47 of the vertical support member 66.
FIG. 31A shows the support member 66 with the wing or spring members 63 on the stem 47, in open position, being lowered into the vertical incision 2. FIG. 31B shows the support 66 and stem 47 in place in an oversized incision 2 with the springs or wings 63 in expanded position so as to hold 66 in place in the oversized incision 2. FIG. 31C shows support 66 and its stem 47 in place in an incision 2 which is of the desired size, whereupon the wings or spring 63 are retracted into recesses in the stem 47, in the manner shown in FIG. 31B.
FIGS. 31A, 32B, and 32C show another embodiment of the present invention, in which a vertical incision 72 has been made which terminates at the bottom in an expanded horizontal incision 72a.
Referring to FIG. 32A, a composite metal sleeve 77 is internally screw-threaded and has a pair of wings or springs 73 which extend out horizontally from its upper lip. The lower end of metal sleeve 77 terminates in a pair of linear supporting strips 77a which project downward from the walls of sleeve 77. The supporting strips 77a may comprise, for example, a soft, biocompatible material such as a plastic, ceramic or titanium or titanium alloy and/or any combination of the above. The lower ends of strips 77a are anchored in a collar 77b.
An inner screw 78 is interposed in the screw-threaded interior of sleeve 77, which is adapted to be screwed down vertically in axial relation to the sleeve 77, extending at its lower end through a screw-hole centered in collar 77b.
FIG. 32B shows sleeve 77 interposed into the vertical incision 72, and extending into the expanded chamber 72a, with the bottom of screw 78 being extended beyond the collar 77b to the lower periphery of incision 72a. As the screw 78 continues to be rotated in a clockwise direction so that the lower end extends beyond the collar 77b, the soft metal strips 77a bend upwardly and outwardly against the upper periphery of the horizontal chamber 72a, fastening the sleeve 77 in place at the top and bottom of vertical incision 72.
A further modification of the invention is shown in FIGS. 33A, 33B and 33C. The metal sleeve 3, open at both ends, which is designed to be accommodated in the incision 2, has a pair of diametrically-disposed notches 3a and 3b on its top edge. Sleeve 3 is internally screw-threaded to accommodate the internal screw-threaded member 88 which is equipped near opposite lower edges with a pair of spring-biased wings 88a.
When the member 88 is screwed into place in the internal screw threads of the outer sleeve 3 until it contacts the bottom of the horizontal incision 61, the wings or springs 88a bend outwardly.
In order to tighten the member 88 in the incision 2, member 88 is screwed in the reverse direction, counterclockwise, so that the spring biased wings 88a, 88b abut against the roof of the horizontal incision 61, holding the stem of 66 in place in the vertical incision 2.
FIG. 34 shows the prior art mechanism for drilling the vertical incision 2 from the top of the gum using a conventional drill 50.
Prior art efforts to drill into the jawbone and prepare a site for reception of an implant are described in the prior art in patents such as U.S. Pat. No. 4,431,416. It is difficult, however, to provide a decent base for an implant so that it does not slip out of its incision. In order to avoid this problem, another embodiment of the invention resides in the method of the use of a special drill which has means for cutting on its edges as illustrated in FIGS. 35A-35C. Such a drill is desired when it is necessary to use a small implant and additional means for retention of said implant is desired without deepening the vertical incision. According to this embodiment, a vertical bony incision is made in the usual manner with a prior art drill such as illustrated in FIG. 34. Then the special drill 28 with a special cutting edge having a cutting surface on its periphery 80A is passed down the incision and manipulated in the manner illustrated in FIGS. 35B and 35C. This allows for the placement of a vertical implant such as illustrated in FIGS. 32A, 32B, 32C, 33A, 33B, 33C, 35E, 35F 36A, 36B and 36C which include means for locking into the enlarged bony prepared site. This technique is described in further detail below.
In accordance with the present invention, the vertical incision 2 can be enlarged at any level through its length by the use of a modified drill 80, as shown in FIG. 35A, having an enlarged cylindrical drill head 80a. This may be manipulated in the vertical incision 2, as shown in FIGS. 35B, 35C and 35D, to make enlarged horizontal cavities, extending out from the vertical cavity 2, such as 2a and 2b, at any desired level.
FIGS. 35E and 35F illustrate the use of an expandable implant 90 which when compressed fits inside of sleeve 4. The expandable implant 90 is shown in its expanded state in FIG. 35E prior to insertion into sleeve 4. It includes an expandable head section 90a and bottom section 90b which would fit respectively well into the top and bottom sections 2b and 2a of the vertical cavity illustrated in FIG. 35D. The expandable implant 90 can be compressed to the size shown at the top of FIG. 35F so that it will slide through the top of sleeve 4. Sleeve 4 guides it through the vertical incision 2 so that the bottom section 90b can expand into the bottom section 2a of the incision shown in FIG. 35D and, after sleeve 4 is completely removed, the top section 90a will also expand into its respective cavity 2b.
A further modification of the invention is shown in FIGS. 36A, 36B and 36C. This comprises an outer metal sleeve 3, which is designed to be interposed in a vertical incision 2, similar to that shown in FIG. 34A and having diametrical notches 3a and 3b, in its upper annular end.
An internal member 98 which fits telescopically into the sleeve 3, has a cylindrical top and terminates at its lower end in a pair of spring-biased metal wings or legs 99a and 99b. an axial screw 97 passes between wings or legs 99a and 99b, and is screwed down until 99a and 99b are expanded in opposite directions into the lower horizontal incision 61 as shown in FIG. 36B.
As shown in FIG. 36C, as the axial screw 97 is drawn back up, the wings or legs 99a and 99b being of soft metal, are caused to bend outward, securing the sleeve 3 in place against the roof of the horizontal incision 61. the sleeve 3 serves as a support for the prosthesis 66 at the gum line.
A still further embodiment of the invention described in FIGS. 27A-27C and FIGS. 39A-39B provides for the attachment of an implant in areas where there is very little bone. The implant is in the nature of a strap attached to an expandable healing collar. The adjustable strap may go through a small incision in the bone or completely around the bone where, for example, there might be severe atrophy of the bone of the mandible. Such an implant requires very little bony preparation so as to preserve the remaining existing bone.
In cases in which the jawbone has been found to be too fragile for drilling, a clamp 100 is employed in accordance with the present invention to fit over the upper surface of the jaw 10 as shown in FIGS. 37A-37C. The clamp 100 shown in FIG. 37A is formed of a strip of readily bendable biocompatible, malleable metal, such as titanium or titanium alloy which is adapted to conform to the shape around the upper surface of the jaw 10. Centered along the length of the upper portion of the clamp 100, extending several inches along the length, is a rectangular cut 101a, along one of the long edges of which are a series of gear teeth 101b.
A metal strap 103 fits transversely across strip 100 and engages the edges thereof, slideably, and has interposed at its center an internally screw-threaded receptacle 104 which terminates in an axially extending rotatable toothed wheel 103a which engages the gear teeth 101b in progression.
The internal screw threads 104a are designed to accommodate the screw-threaded projection 66a from the base of the support member 66, holding it in place on 104 which represents a healing collar.
Thus, the position of the support 66 can be fixed as desired on the jaw 10, so that a position can be selected for securing a prosthesis on the jaw.
FIGS. 37B and 37C show a technique developed in accordance with the present invention for using a clamp on the jaw to support a prosthesis instead of drilling an incision in the jaw.
A further advantage of the present invention resides in the method of preparation of the soft tissue 110 and jawbone 10 for a dental implant. This method may be used for both vertical 3 and horizontal 6 implants or a combination of both such as previously described.
FIG. 38A shows a unique approach to installing the substitute tooth by making an incision 110a from along the lateral border of the jaw. The prior art method for a vertical implant involves an incision along the crest of the ridge and healing of the tissue around the healing collar which is often fibrous and not uniform.
FIG. 38B shows the drill 111 being interposed from the top of the jaw, with the lower plate 112 being placed in the cut 110b after a flap of gum 114a has been pulled back.
FIG. 38C illustrates a vertical support post or sleeve 3 being screwed into the horizontal anchor plate 112 through the hole made by the drill 111 in FIG. 38B.
Another embodiment of the invention resides in the use of a cutting device 113 having a central pin that fits into the center of a healing collar and acts as a guide for the cutting device 113 in order to remove a plug of tissue 114b around the healing collar, thereby exposing the healing collar in a rapid and clean fashion. This feature may be more fully understood by reference to FIGS. 38D, 38E, 38F, 38G, and 38J as set forth below.
FIG. 38D shows the cutter device 113 drilling down from the top of the jaw 10 toward the lower plate 112 which is in place in the surgical cut 110 after the flap 114a has been sutured back to the gum.
FIG. 38E shows the cylindrical cutting device 113 in operation on the top of the jaw 10.
FIG. 38F shows the cylindrical cutting device after it has operated on the top of the jaw 10 and has actually incised a small cylindrical piece of gum 114b.
FIG. 38G shows a cylindrical cutter device being applied to the top of the patient's jaw 10 in which the lower blade of the cylindrical cutter is shaped in the form of a spiral.
FIGS. 38H and 38I show cylindrical cutters 112b of prior art form in which a small cylindrical segment 114b has been cut off between the implant and the gum.
FIG. 38J shows a modification of the devices of FIG. 38G and 38H, in which the cutting edge 112a of the cutting device is bevelled. Guide pin 112b contacts the top of vertical post 3 which holds it in rotational position during cutting.
The procedure illustrated in FIGS. 38A-38J should be sufficient to anchor a vertical post 3 to an anchor plate 112 in a jawbone 10. The holding power can be enhanced, however, by other techniques such as using screws to hold the apparatus in position.
FIG. 39A shows the use of a clamp 100 between the gum 110 and the bone 10 at the top of the jaw after an incision has been made.
FIG. 39B shows the bone emplacement 109 in place in the jaw after the flap 114a has been sutured back.
The preferred embodiment of the invention comprises a dental implant and stresses more specifically the use of a healing collar 116 having a means for expansion so as to form a coronal prosthesis or attachment for a coronal prosthesis that eliminates the need for the use of screws to affix such coronal prostheses to the internally threaded shaft of an endosseous dental implant.
Prior art surgical screws on healing collars are known in the art and are frequently made of non-corrosive, safe material such as titanium. However, the use is severely limited by the fact that they have to be acquired in the correct size for the proper procedures and are not as versatile as the ones described in the preferred embodiment that follows.
FIG. 40A shows a cross-section view of a cylindrical healing collar 116 in a plane vertical to the plane of the gum 110. the implant 109 is located inside the lower inside tip of the healing collar 116. A coil spring 117 depends internally from the collar 116 around the top of the cylinder, which is shown internally in FIG. 40A. FIG. 40B is an external view of the healing collar 116 and implant 109 of FIG. 40A.
FIGS. 40C and 40D show in detailed sectional views the axial spring 114 of the healing collar 116 collapsed around the implant 109 in FIG. 40C and expanded in FIG. 40D. FIG. 40E is an external view of the healing collar 116 expanded as shown in FIG. 40D.
The healing collar assembly 116 comprises a spring-loaded orifice and top plate 116a, a plurality of interlocking, frustro-conical sections 116b, a base 116c, a cap 116e and threaded post 116d for connecting the cap 116e and orifice top plate 116a to the base 116c in the top of implant 109.
FIG. 40F shows a prior art compressing device 119 terminating in a nub 120 which is applied by a hand-operated clamp to the orifice 116a at the top of a spring 117 mounted on a healing collar 116. Internally surrounding the spring 117 in FIG. 40F is a compressible flexible material 116f, which when the prior art clamp is compressed, comprising the spring, bringing pressure on the top of the healing collar 116, thereby forcing material 116f inside.
The compressible, flexible material 116f may be a thermoplastic and/or epoxy-like material in nature or self-curing or light curable and being of a rigid or semi-rigid nature upon setting after insertion by compressing device 119 into the expandable healing collar 116. Materials are available on the market that might be suitable for such purpose. Such materials are available, for example, through Darby Dental Supply Co., Inc., 3890 Park Central Boulevard North, Pompano Beach, Fla. 33064.
FIG. 40G shows externally an elastomeric cap 118 which fits over the spring-biased top shown in FIGS. 40C, 40D and 40E.
Efforts have been made in the prior art to deal with the problem of coronal prostheses that are not truly vertical to the gum line. Prior art approaches have been fairly complicated and expensive. Note, for example, the tiltable, adjustable insert for dental implant described in U.S. Pat. No. 5,071,350 which requires a ball and collar arrangement in order to produce a tiltable, rotatable, adjustable prosthesis connector. Devices such as that can be acquired, for example, from Universal Prosthetics, 15821 Ventura Boulevard, Suite 420, Encino, Calif. 91436. However, an easier, and less expensive, approach is described below.
FIG. 40H illustrates an alternative embodiment 116f of the expandable healing collar 116 in which the frustro-conical sections are nested in such a way as to tilt the filled healing collar 116f so as to accommodate a crown that is mounted at an angle with respect to the gum line 110.
The preferred embodiment of the expandible healing collar 116 includes a plurality of interlocking, frustro-conical sections 116b as shown in FIG. 40E. It is possible, however, to provide for expandability by other means. For example, instead of using interlocking, frustro-conical sections like 116b, it would also be possible to have pleated sides which can expand or collapse or use a balloon-like structure. The important characteristic is that the healing collar structure be capable of expanding and collapsing in a manner consistent with the teachings of this invention.
FIG. 40I illustrates the manner in which a threaded post in the form of a screw 116d is aligned above an expanded healing collar 116 formed of sections 116b above implant 109. When screw 116d is rotated clockwise, it advances into the post 109 thereby collapsing the healing collar 116 into the cavity in the top of the post 109.
FIGS. 41A through 41D show in section a healing collar in which a flat rubber cap 121 is applied across the top covering the cylindrical insert which extends into the collar internally in vertical telescopic relation to the healing cylinder. The insert may extend to different depths in the enclosing healing sleeve as shown in FIGS. 41A, 41B or 41C.
FIGS. 41D, 41E and 41F show the relationship between the gum line 110 and the bone line 10 when the healing collar 116 having a rubber cap 112 has been inserted into the jaw 10. In particular, FIG. 41 shows the expandable healing collar 116 in position above rubber cap 112.
Another embodiment of the invention described in FIGS. 42A-42E allows for the removal of an inner core which is threadably received in an outer core when the threaded internal portion which carries the coronal prosthesis is defective.
FIG. 42A shows in section, the healing cylinder or cap 116 with the elastomer or rubber cap 121 in place in the jaw 10.
FIG. 42B shows the cylindrical implant 122 in section in place in the jaw 10, held in place by screws 123 at the top and at the bottom 124 which is semi-spherical in form with a plurality of openings 125 at the lower end to allow contact with the bone 10.
FIGS. 42C, 42D and 42E are cross-sectional views of the implant 122 in place in the bone 10 with the rubber or elastomer cover 121 in place across the top of the gum 110.
FIGS. 43A and 43B show in partial cross-sectional views modifications of the implant 125 with the healing cylinder or cap 116 in place in which the external wall of the outer cylinder 125 is screw-threaded with threads 125a to be screwed into place in the top of the jaw and received in plate 6.
FIG. 44A is a modification of the healing collar 116 shown in FIGS. 42A-43B in which the implant 126 in place in the jaw 10 is topped by a device 127 in the form of a frustro-conical member which terminates at its bottom end in a key 128 which is constructed to fit into the keyhole 129 of the implant 126. A screw 130 holds the assembly in place.
FIG. 44B is a modification of the embodiment of FIG. 44A where the key 128 fits into a special keyhole 130 in modified healing collar 131.
FIG. 44C shows a modified healing collar 132 terminating at its lower end 128 in a female/male hex which is shaped to fit into and lock in place with the key 129 of implant 126.
Another embodiment of invention provides for the use of an expandable healing collar with a thread and/or screw which can be affixed to a previously endontically treated tooth, whereby the expandable healing collar is affixed to the canal of the root of a tooth and filled so as to restore the broken coronal portion of the tooth. The embodiment calls for the use of a tapered and at least partially threaded and split vertical post. While the use of split, threaded vertical posts in known in the prior art, the use of the combination of a tapered split vertical post, especially one wherein the threads are not continuous around the sides and further in combination with an expandable healing collar is not known or used.
One of the concerns with prior art implants is that there is a tendency to rotate. In order to minimize that factor, certain prior art implants include an internal hex to provide a stronger, more precision-like fit. See, for example, the Spectra System™ implants made by Cor-Vent of Encino, Calif. which includes an internal hex configuration or the IMZ™ implants made by Interpore which include an external hex configuration. A significant improvement over that structure is described in FIGS. 44A-44C which provide for a split male/female hex-like configuration which has superior anti-rotational factors and, in addition, allows the use of a wider screw so as to reduce the incidence of fracture to the screw.
FIGS. 44D through 44H describe an alternative embodiment of the invention in which the vertical implant post 133 is split and includes threads 134. The tapered vertical post 133 is adapted to fit in the cavity 138 left after a root canal such as illustrated in FIG. 44D. The vertical implant post 133 includes a slot 135 at the bottom so that it can wedge into the tapered cavity of a root canal opening 138. Threads 134 preferably completely surround the tapered vertical post 133 as shown in FIG. 44E. The tapered post 133 is preferably capped with an expandable healing collar 116.
FIG. 44F illustrates the tapered, threaded implant 133 in position in a root canal cavity 138 prior to expansion of the healing collar 116. FIG. 44G illustrates the tapered, threaded vertical implant 133 shown in FIG. 44F with the healing collar assembly 116 expanded according to the method previously described. FIG. 44H is an alternative embodiment 139 of the tapered implant 133 in which alternate sides of the split, tapered implant include threads. As shown in FIG. 44H, one side of the split, tapered vertical implant includes threads 136 across from which there is no threaded area. Similarly, the other side of the tapered, split vertical implant 139 includes threaded sections 137 which correspond and line up across from non-threaded sections on the opposite side. In other words, the threaded sections 136 and 137 are alternately located on opposite sides of the split portions of the vertical tapered threaded implant 139.
While the invention has been described with reference to a preferred embodiment, it will be understood by those of ordinary skill in the art that various changes in structure and function can be made without departing from the spirit and scope of the invention as a whole.
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What it is formulated to do:
This deluxe bronzing powder gives your complexion the warmth and luminosity of naturally sunkissed skin. Hydrating, silky-smooth & long-wearing, it also protects against free radicals. Kabuki brush included.
Beneficial ingredients and what they do:
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Use included kabuki to sweep bronzer where you would naturally tan – cheekbones, forehead, chin & bridge of nose.
Mica, Magnesium Stearate, Hydrogenated Polyisobutene, Dimethicone, Polybutene, Isopropyl Myristate, Bis-Diglyceryl Polyacyladipate-2, Phenoxyethanol, Tocopheryl Acetate. [+/- Titanium Dioxide (CI 77891), Iron Oxides (CI 77499, CI 77492, CI 77491)]. 10.21g / 0.36oz
Ingredients are subject to change. For the most complete and up-to-date list of ingredients, refer to the product packaging.

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Recycled paper barrel with wooden clip. Chisel tip highlighter. Fade resistant ink. Pen includes black ink. Highlighter yellow ink. Complies with ANSI, ASTM, CPSIA, FDA, Prop 65. 5 1/2" H
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Want to know what your next phone's operating system will look like, how Google wants to manage all your photos or how you'll pay with your Android phone? Look here.
The Chinese maker of smartphones and PCs will partner with regional online retailer Lazada to sell its budget A7000 handset through flash sales.


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Vincent Vega
In Pulp Fiction, Vincent Vega is the hitman played by John Travolta. Vega is full of fast food trivia, can rock the short shorts, and when visiting Jack Rabbit Slim's, catches a case of Saturday night fever.
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Ryan Gosling plays the unnamed "Driver" in the movie Drive. The character seems to have a stable, yet lonely, life, working three jobs as a mechanic, stuntman, and a secret getaway driver. Though his life changes when he meets his new neighbors, Driver is consistently seen in his scorpion jacket and chewing on a toothpick throughout the film.September 17, 2013 by Tom
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Michael October 10, 2014 Reply
Can you provide a better link for the suit? It's perpetually out of stock.
Hi Mike, thanks for the notice. The links have been updated.


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Riding an R1200GSA on NorCal's #2 Best Riders Road in the State!
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Mad Kaw
purveyor of fine BS
Joined: Sep 2010
Location: The OK state ;)
Oddometer: 42
Originally Posted by
I have done half dozen trips from Victoria BC to California,
For me Avenue of the Giants, then the turn off on the 1 at Leggett to Fort Bragg, continue South on the Coast and back East on the 20 to Willits.
You have it all: Giants trees, hairpins, Elevation at the pass, Coastal cliffs, Evergreen Forests, Wineries, and some rolling desert like terrain, all on beautiful grippy tarmac with no traffic.
Ditto - I've ridden damn near everything in NorCal over the past 10 years...on every bike imaginable 1200GS, 70's superbikes, Goldwings, and a ZX14 with hardbags. The road from Leggett to Fort Bragg is as good as it gets anywhere in the continental USA. I've ridden that stretch at least half a dozen times...BOTH WAYSS. 20+ miles highly tortuous tarmac through the "Sherwood Forest" with little to zero traffic. It just doesn't get much better than this.
The Republic was healthy until Congress discovered it could tax the producers then leverage those monies to buy the votes of the freeloading zombies.
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Welcome !!
Winston's bistro & bar south shore
2015 is our 7th year of opening.
After 6 fantastic years at highfield rd business is still doing well. we are striving to be as popular as ever trying lots of theme nights and live music events.
Relax and enjoy.
Whether you are coming in for a drink with friends, a celebration with family, or a romantic meal for two, you can be sure there will be a warm and friendly welcome here at Winston's. Sit back, relax and let us do all the work.
More affordable than you think.
with our lunchtime menu 2 courses only £5.95 or a light bite starting from £4.95 or breakfasts the works only £4.95 which we think is the best breakfast in town. for those looking for an early diners option we have a fab early bird for £9.95 for two courses, and not forgetting our fantastic had made artisan burgers starting at £6.95 with the best selection of vegetarian burgers and other options in town. Eating out Couldn't get better.
Tailored to your dietary requirements.
becauce we make everything ourselves we can adjust almost anything on the menu to your needs, and we will if asked put dishes together for you.
Our chefs will be glad to assist you with any special dietary requirements. Our chefs are happy to alter your chosen dishes to your liking.
Call us today to book your table!
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Roll In One Meat Loaf
1 Mar 2010
|Condensed tomato soup
|10 3⁄4 Ounce (1 Can)
|Ground beef
|1 1⁄2 Pound
|Dry bread crumbs
|1⁄2 Cup (8 tbs)
|Minced onion
|1⁄4 Cup (4 tbs)
|Chopped parsley
|2 Tablespoon
|1 , beaten
|1⁄2 Teaspoon
|1 Dash
|Frozen cut green beans
|9 Ounce, frozen (1 Package)
Combine 1/2 cup soup with all ingredients except beans.
Mix well.
On waxed paper, pat into a 12x9-inch shape.
Spread beans to within 1 inch of all edges; pat into meat.
With aid of waxed paper, roll meat tightly, jelly-roll fashion, starting at long edge.
Seal ends; use waxed paper to transfer to baking dish.
Bake at 350 °F. for 40 minutes.
Spoon off fat.
Pour remaining soup over loaf.
Bake 10 minutes longer.
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0 Comments
Roll In One Meat Loaf Recipe


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Attend One Of Our Free Workshops!
Meet the authors of Cruising Through Retirement: Avoiding the Potholes! Our live workshops provide Illinois seniors with the road map they need to protect themselves from unexpected financial loss due to Wall Street games, rising health care costs, and a government gone wild! You could attend a complimentary workshop at one of our Chicagoland locations. Check out the listings on the right side of this page to find an event in your area and to RSVP now! Space is limited, so act today! » Here's just some of what you will discover...
- How to avoid having your life savings wiped out by a nursing home
- How to get your ducks in a row with a powerful estate plan that protects vulnerable loved ones, including children with special needs or destructive lifestyle choices.
- Veteran's benefits that most people know nothing about.
- How to keep your widow from living in poverty.
Upcoming Workshops
Or, maybe you are caring for a loved one with chronic healthcare needs, mobility issues, or memory problems?
Do you wish it were easier to plan for the future and ensure your family doesn't end up out of money and out of options?
You already know that an estate plan is important for you to have. If you're a healthy, vigorous senior who wants to be sure you're protected from devastating nursing home costs and other dangers that wait in the shadows to swallow up your life savings, you're in the right place.
Working with a qualified Elder Law attorney like those at Law ElderLaw can save you thousands – even hundreds of thousands – of dollars and years of heartache down the road.
Families sometimes come to me after they failed to put together a powerful plan and wound up with embarrassing court proceedings as their family tried to pay for their care, bleeding money at a rate of $7,000 or $10,000 per month because of a dread diagnosis, or families torn apart as they argued over how best to treat their family member.
We help these families, but so much heartache and huge amounts of money could have been saved had they put together a powerful plan before disaster struck.
That's the problem – not every plan is powerful enough to protect you! Even more importantly – you must have a plan that protects your beloved spouse and loved ones if you become unable to make decisions or pass away suddenly.
Too many families have an out-dated will or estate plan, or put together a do-it-yourself estate plan with papers they printed off the internet. Big promises are made by the companies that provide them, but rarely do they contain the protections or benefits that a plan unique to your family can give you.
That's why hundreds of Illinois families flock to Law ElderLaw every year. We listen to our clients wishes and put together a plan that helps you acheive your goals. Our clients may want to
- safeguard their money so that they won't end up out of money and out of options during their lifetimes
- protect their spouse financially in the event of their death
- help a loved one with college tuition
- give to their church or favorite charity
- provide for a child or grandchild with special needs
- even make sure their pet is taken care of if they become incapacitated
- protect some of their estate from the devastating cost of a dread diagnosis
Every family's situation is different, but the emotional, financial and physical burdens that go along with caring for an aging and ill parent or loved one are universal.
I began working in Elder Law in 2005, after a frantic phone call from a close friend.
"Bob's been diagnosed with Alzheimer's," she told me.
Am I going to lose my home?
Are we going to lose everything?"
The truth was, at that time I didn't know the answer. But I helped them find a qualified Elder Law attorney who showed them that they didn't have to lose their home. Even better, they qualified for benefits to pay for care because of Bob's service in the armed forces.
That's when I felt – and my wife knew – that the next best step for me was to apply my law degree to the area of Elder Law. Many years later, I can now say that we've helped hundreds of families put plans in place to help them gain peace of mind and save them years of heartache.
Your family may not have to spend everything on long term care and other healthcare needs.
Many of our clients come to us because they know there are benefits out there to help pay for care, but they're not sure how to go about applying for them.
Still others find that there are ways to help preserve some of their life savings – and even stay at home longer – when they thought they would lose everything!
Law ElderLaw can help you find the safest path.
Each family's situation is different,
and we help our Illinois clients reach their goals whenever possible.
- A family member is suffering from memory problems, dementia or Alzheimer's
- Parents who want to provide for a vulnerable child with destructive lifestyle choices
- A loved one has just entered a nursing home, or may soon need nursing care, and their family doesn't know how they'll be able to shoulder the overwhelming costs
- Healthy, vigorous seniors want to put a plan in place in case they're one of the 70% of aging Americans who will spend time in a nursing home
- Folks want to ensure their special-needs child or grandchild has the best opportunities and is provided for in the future
- An aging veteran wants to stay at home longer, but needs help paying for care
- A parent wants to provide for a child who's gone astray without risking a misuse of the assets that are there to aid them
We're here to help you find the safest path along your journey. Over the years, hundreds of Chicagoland families have come Law ElderLaw to find assistance with the maze of applying for Medicaid and Veteran's benefits, or to put measures in place so that loved ones can live with dignity instead of becoming destitute.
If you or a loved one are beginning to have memory or mobility issues, it may be time to start planning. There are virtually always more options available to you when you start planning early.
But if you're already well past the beginning – if your family already is in crisis – the time to call is now.
It may not be too late!
You may have been told by a social worker or friend that there's nothing left to do. While they may mean well, you likely need an adviser that works in the field of Elder Law every day to help you discover your options.
We'll let you know what the next steps may be. And if you don't need to do anything at this time – we'll tell you that, too.
We use only honest, legal solutions to help you reach the best possible outcome, so that you and your loved ones can have peace of mind.
It might be memory problems or Alzheimer's, Lou Gherig's Disease (ALS), Multiple Sclerosis, a stroke, Parkinson's, or one of many other common health issues that can arise as we age. We're here to offer options for care – and show you how you may qualify for help paying for that care.
There may be options available to you.
If it's planning for an assisted living or nursing home stay, or to allow your loved one to stay at home longer, there may be resources available to make that possible.
What's more, in many cases, there is help to pay for nursing care… if you understand the rules about when and how the application should be filled out.
Contact my office to find out what steps may be available for you to take, right now. The sooner you act, the easier it is to safely find your way on the complex, and sometimes precarious, path of the Elder Care Journey.
Put your mind at ease – it costs nothing to find out what options are available to you.
That's right – your first consultation is absolutely free!
Find out what plans you can put in place to help make your life better, today.
You don't need to walk this path alone.
We've been there before, and we can help you find the safest way.
Rick L. Law
Your Family's Situation is Unique.
If you're like most of my clients, you want to find out exactly the right path to give you the best possible outcome for your situation.At Law ElderLaw, you'll find answers to your burning questions. We'll let you know what actions will help you reach your goals and gain peace of mind. Or, if there's nothing you need to do right now, we'll tell you that, too. Simply enter your questions in the form to the right, and you'll hear from one of our caring staff members shortly.
Request a Consultation By Filling Out the Form Below


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Thursday, July 12, 2012
Julylights: July 12th, Chris Neil Crushes Clayton Stoner
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You put a lot of effort into making sure you show as much Rams spirit as possible. This Double magnet pack will work just as hard. The 6'' x 12'' sheet features a team logo magnet and a team helmet magnet for a double-dose of St. Louis pride! Honk twice if you love the Rams!
- Heavy-gauge magnetic vinyl
- Helmet measures approximately 5.25" x 4"
- Logo measures approximately 5.75" x 6.5"
- Made in the USA
- Officially licensed
- Printed graphics
Special event items are produced by manufacturers only after the outcome of a game or event. These are advanced sale items and will ship immediately after they are received in our warehouse.
Manufacturer direct items are shipped directly from the manufacturer. These items are not available for international or expedited shipping.
Customized items can be personalized with options such as your name, your favorite number, and/or designs. Some options may be limited by league rules.


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Most people in the United States don't think about journalism in the Caribbean region.
Dr. Juliette Storr isn't most people.
The associate professor of communications at Penn State Beaver has a special connection to journalism in the Caribbean.
Storr, a native of The Bahamas, worked as both a broadcast journalist and newspaper reporter in her country before coming to Penn State.
With that background, Storr's research has focused on how influential cultures such as those of the United States and the United Kingdom have affected smaller media systems in the Caribbean region.
Storr attended the University of Windsor, Canada, for her undergraduate degree and received her master's degree from Wayne State University in Detroit.
Despite joking about always winding up in cold climates, she wasn't finished with winter when Ohio University offered her a scholarship to get her doctorate.
Storr thought she'd finally escaped the cold when she took a job teaching at North Carolina State University, but an offer from Penn State brought her back north in the fall of 2005.
Both her academic and work experiences have given Storr a unique perspective in the classroom, and she tries to expose students to different cultures, something she knows can't always be done through class lecture notes or textbooks.
One year Storr took students from her Intercultural Communications class on a weeklong trip to Trinidad and Tobago to give them a taste of what being in another culture is really like.
Storr said she would like to see more students at Beaver campus exposed to different cultures. One way this can happen, she said, is through the campus' plan to recruit international students, who can share their culture with students here.
"Most students are willing to experience different cultures," she said. "I think students are, on the surface, more open."
Originally written by Matt Jones '10 for the Penn State Beaver Nittany News alumni magazine, Spring 2011.
Ph.D in Mass Communication
Ohio University
Certification in Contemporary History
Ohio University
Master of Arts in Radio-Television-Film
Wayne State University
Teaching Certification in Language Arts
The College of the Bahamas
Bachelor of Arts in Mass Communication
University Of Windsor, Canada
Associate of Arts, Language Arts
The College of the Bahamas
- Faculty Profiles
- Ms. Karen Barr
- Mr. Kevin Bennett
- Dr. Robin Bower
- Dr. Cassandra Miller-Butterworth
- Dr. John Chapin
- Dr. Abhijit Dutt
- Dr. Michael Hay
- Mr. Jim Hendrickson
- Mrs. Michelle Kurtyka
- Mrs. Tiffany MacQuarrie
- Dr. Mari Pierce
- Dr. Juliette Storr
- Dr. Robert Szymczak
- Mr. Leo Takahashi
- Dr. Keith Willson
- Dr. Chris Wu
- Back to Faculty


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the direction of requiring additional supports for more students, some policy changes exert countervailing pressure. Proposed 2001 congressional reauthorizations of Title I and other sections of the Elementary and Secondary Education Act would affect the delivery of services to students at high risk of educational failure through the inclusion of new emphases on reading and limitations on bilingual education. The availability of additional resources for compensatory and bilingual education allows for the needs of more students to be addressed in the general education context, reducing pressure to expand the numbers of students requiring special education.
The impact of the standards movement and high-stakes testing on disproportionality in identification of and services for gifted students remains to be seen. The imposition of high-stakes testing may reduce the amount of time that is devoted to teaching high-end learning that will stimulate the talent and thinking of the gifted student, particularly in classes in which many students struggle to meet the standards.
Our first task as a committee was to look at the data on students assigned to special education and gifted education by racial/ethnic groups to determine whether and to what extent disproportion exists. We present our analysis of the available data in Chapter 2. Part II of the report looks at early experience. To understand the observed disproportion, we address our first question in Chapter 3: "Is there reason to believe that there is currently a higher incidence of special needs or giftedness among some racial/ethnic groups?" We look at influences in the early childhood period that may affect the cognitive and behavioral development of children in ways that raise the probability of later special education placement—or lower the probability of being identified for gifted and talented programs. In Chapter 4 we look at early intervention programs designed to improve the developmental trajectory of disadvantaged children.
In Part III we look at the school experience, beginning with general education and then special and gifted education. In Chapter 5 we address our second question: "Does schooling independently contribute to the incidence of special needs or giftedness among students in different racial/ ethnic groups through the opportunities that it provides?" The chapter spans issues of educational resources, potential bias toward minority students, and instructional and classroom management practices that may be helpful in placing at-risk students on a path to school success.
In the next three chapters we look at referral and assessment practices in special and gifted education. Here we address our third question: "Does the current referral and assessment process reliably identify students with special needs and gifts? In particular, is there reason to believe that the


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Mountain biking
Whiteface's 27 mountain bike trails will be open seven days a week starting June 25, but those anxious for a thrill can get started with a "bonus weekend" June 18-20.
Co-operated by ORDA and High Peaks Cyclery, the hand-built trails are open 9 a.m. to 3:30 p.m.
Guided tours of the new cross country "flume" trails will be offered throughout the weekend and Giant Bicycles will have their latest cross country bikes available for rental.
The downhill trails will also be open and will host the Pump Track Challenge at noon June 19 and a Super D race at noon June 20.
Day passes for the cross-country trails are $10 or $75 for a season pass. Access to the expert downhill trails require a gondola lift ticket.
Other events
Cyclists and spectators can also stop by the Wilmington dirt jump and skills park 5-11 p.m. June 19 for the Kyle Ebbett and Friends Jump Jam.
Some of the top pros will be on hand, but the contest is open to amateurs in all age groups and abilities with prizes to be awarded for style and creativity.
Other events during the Jump Jam include live music from Damaged Goods and a free showing of a local bike film. The evening ends with the feature film, "Follow Me."
The ninth annual Whiteface Uphill Bike Race is also slated for June 19. Riders from all over the country will ascend up the eight-mile long scenic Whiteface Veterans Memorial Highway. Cyclists begin the 3,500-foot climb at 5:30 p.m. in group waves.
A barbecue dinner will be held following the race, and awards will be presented to the men's and women's overall winner and the top three finishers in each class.
The first Freaky Friday ice skating show of the season and the summer's opening Saturday night ice skating shows are also slated to begin this weekend.
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Not everything showbiz related at Comic-Con is innately douchey. There are even some panels that sound downright FASCINATING. Like these. But get there early. Also check out my PW story on the top COMICS panels of the show. THURSDAY 10:30am – 11:30am Legends of TV Land Indigo Ballroom, Hilton San Diego Bayfront Get up close and […]
SDCC 2014: The Beat Picks Showbiz Panels You Can Go To Without Ruining Comic-Con
Is the Betty White comic book the solution to everything?
We declared a moratorium on Bluewater Comics news a while ago due to their awful back-end work for hire contract (and were taken off their PR list as a result) but whatever we think of their business model, we do have to give credit where it is due: they are absolute monsters at PR, and the recently announced Betty White Female Force comic is no exception. It's popped up on our news feed from EW, the LA TImes, the New York Times and everywhere else; a Google search for "Betty White Bluewater" yields 74,000 results. Even the Today Show blog picked up the Reuters story about the comic.


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Etienne-Nicolas Mehul Strings Sheet Music: 1 items found
Three sonatas for harpsichord or fortepiano, Opus I. Three sonatas for harpsichord or fortepiano with violin accompaniment, Opus 2.
Composed by Etienne-Nicolas Mehul (1763-1817). Edited by Joel Pontet. For Harpsichord, Fortepiano, Violin. This edition: Facsimile. Collection Dominantes. Chamber Music. 94 pages. Published by Anne Fuzeau Productions - France (FZ.1279)
Usually leaves our warehouse: Within 4 to 6 weeks
Etienne-Nicolas Mehul