Surgical guides

Abstract

A drill guide uses a hole in a layer to guide a drill along an axial trajectory while permitting off-axis excursions of the drill during use. A number of such drill guides at varying heights from a target surface may be used sequentially or concurrently to enforce the axial trajectory in three dimensions during a surgical operation. A drill guide may include a hole in a layer that establishes a single point along the axial trajectory, or the drill guide may include multiple layers in a single device to establish two or more points along the trajectory while allowing off-axis insertion of a drill into the guide. The drill guide may be cuttable to accommodate intraoperative changes to the axial trajectory. In embodiments, a window or the like may be provided to permit a surgeon to view drill depth, drill orientation, the surgical site and the like during a procedure.

1 . A device comprising:
 a surgical guide for a dental procedure, the surgical guide including a first hole in a first layer, the first hole positioned to align a tool to an axial trajectory at a first point along the axial trajectory and the surgical guide including a second hole in a second layer, the second layer vertically spaced apart from the first layer along the axial trajectory and the second hole positioned to align the tool to the axial trajectory at a second point along the axial trajectory; and   a support to secure the surgical guide in relation to a location where the axial trajectory meets a target surface of a surgical site.   
     
     
         2 . The device of  claim 1  wherein the target surface includes one or more of soft tissue and bone. 
     
     
         3 . (canceled) 
     
     
         4 . The device of  claim 1  wherein the surgical site includes a dental implant site. 
     
     
         5 - 6 . (canceled) 
     
     
         7 . The device of  claim 1  wherein the first hole and the second hole are shaped and sized to align an object to the axial trajectory including one or more of a drill, a surgical drill, a rotary tool, and a surgical hand tool. 
     
     
         8 . The device of  claim 1  wherein the support includes a surface formed to dentition around the surgical site, thereby providing tooth support for the surgical guide. 
     
     
         9 . The device of  claim 8  wherein the surface is formed to a full arch containing the surgical site. 
     
     
         10 . The device of  claim 1  wherein the support includes a surface formed to bone around the surgical site, thereby providing bone support for the surgical guide. 
     
     
         11 . The device of  claim 10  wherein the support includes one or more bone attachment points for securing the device to a jawbone. 
     
     
         12 . The device of  claim 1  wherein the support includes a surface formed to at least one of gingival and mucosa around the surgical site, thereby providing soft tissue support for the surgical guide. 
     
     
         13 - 14 . (canceled) 
     
     
         15 . The device of  claim 1  wherein the first layer contacts the target surface in an area surrounding the first hole when the device is placed for use at the surgical site. 
     
     
         16 . The device of  claim 1  wherein the second layer is spaced apart from the target surface in an area surrounding the second hole when the device is placed for use at the surgical site. 
     
     
         17 . The device of  claim 16  wherein the second hole has a diameter larger than the first hole. 
     
     
         18 . The device of  claim 1  further comprising a space between the first layer and the second layer that permits an insertion of the tool off-axis from the axial trajectory. 
     
     
         19 . The device of  claim 1  wherein at least one of the first layer and the second layer includes one or more visible alignment marks to assist a user in locating a center of the first hole. 
     
     
         20 - 22 . (canceled) 
     
     
         23 . The device of  claim 1  further comprising a window for at least one of visual inspection of the target surface and physical access to the target surface while the surgical guide is in use. 
     
     
         24 . (canceled) 
     
     
         25 . The device of  claim 1  wherein the device is fabricated from a cuttable material. 
     
     
         26 . (canceled) 
     
     
         27 . The device of  claim 1  further comprising a plurality of holes in each of the first layer and the second layer for a plurality of axial trajectories. 
     
     
         28 . The device of  claim 1  further comprising a plurality of devices each including a third hole positioned to align one of a number of progressively larger diameter drills to the first point on the axial trajectory. 
     
     
         29 . (canceled) 
     
     
         30 . The device of  claim 1  wherein at least one of the first hole and the second hole has a sleeve that protects the surgical guide against a cutting edge of the tool. 
     
     
         31 . (canceled) 
     
     
         32 . The device of  claim 1  wherein the surgical guide and the support are formed of a clear material. 
     
     
         33 - 177 . (canceled) 
     
     
         178 . The device of  claim 1  wherein the axial trajectory is determined using implant planning software.