ORTHODONTIC APPLIANCE TO CAUSE INTRUSION OF POSTERIOR TEETH
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a non-provisional application and claims the benefit of provisional U.S. Patent Application No. 63/232, 136 filed August 11, 2021, which is hereby incorporated by reference in its entirety.
BACKGROUND
[0002] There are very few orthodontic appliances that have been used successfully to reduce the vertical dimensions of the dento-alveolar complex. The term close the bite is often used to describe a vertical change in tooth position which results in increasing the incisor overbite. Closing the bite can be accomplished by molar intrusion or by anterior tooth extrusion.
[0003] Appliances that have been used to close the bite include:
[0004] 1. High-pull headgear. This appliance applies forces to upper molars which are directed superiorly and in a posterior direction. The normal vertical and anterior movement of the molars which occurs with normal growth is reduced or is temporarily stopped completely. If the upper posterior teeth are held in place, and the lower jaw grows normally, the net effect can be closure of the bite.
[0005] 2. Functional appliances. Several of the functional appliances have acrylic blocks designed to inhibit the eruption of posterior teeth. Not all functional appliances are
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SUBSTITUTE SHEET (RULE 26) effective for inhibiting molar eruption. One of the biggest dangers associated with the use of functional appliances is molar eruption, which increases the chance that the jaw joints will not be properly seated in the fossae at the end of treatment.
[0006] 3. Active Vertical Corrector. This appliance was designed by Eugene
Dellinger for the purpose of causing molar intrusion of both the upper and lower molars. Removable upper and lower units completely cover the occlusal surfaces of the posterior teeth. Small rare-earth magnets are contained within the upper and lower units and are positioned to repel each other so that vertical forces are applied against the molars, intruding the upper and lower molars at the same time. The appliance has been shown to be effective for intruding molars, but it is very difficult to wear. In order to accommodate the enclosed magnets, the combined vertical dimension of the upper and lower units often exceeds 5 mm at the second molars which results in a significant opening at the incisors. Speech while wearing the appliance is very difficult. In order to be effective, the appliance needs to be worn as close to 24 hours a day as possible for a time of approximately three or four months. Very few patients are willing to wear such a bulky appliance for that length of time.
[0007] 4. Trans-palatal bars. These appliances are primarily used to control the inter-molar width and to control tipping and rotation of molars. Molar intrusion can occur if the bars are positioned far enough away from the palate so that vertical muscle forces applied by the tongue during swallowing are of sufficient magnitude to move the molars upward.
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SUBSTITUTE SHEET (RULE 26) [0008] 5. Vertical anterior elastics. Use of vertical elastics on anterior teeth to which fixed appliances are attached will extrude anterior teeth. Extruded anterior teeth are often not stable. Use of the vertical elastics tends to move the mandibular condyles vertically downward out of the normal position within the fossae. If the condyles reposition themselves after use of the elastics has stopped, the closure of the bite usually relapses, and often very little tooth movement really occurs.
[0009] Other methods used to close the bite include:
[0010] 1. Equilibration. The careful removal of a portion of the enamel of the posterior teeth can result in closure of the bite. The amount of enamel that can be removed is limited, so this method can only be used to close small open bite problems. Equilibration is often combined with other methods of bite closure to achieve greater amounts of bite closure than are possible with one method alone.
[0011 ] 2. Placement of crowns on posterior teeth. Greater amounts of tooth enamel can be removed than is possible with equilibration alone. If dentin is exposed, it is covered by the crown, thereby avoiding tooth sensitivity problems. It is possible to combine this method with endodontic treatment in order to accomplish even greater amounts of tooth reduction.
[0012] 3. Orthognathic surgery. By using orthodontic treatment combined with orthognathic surgery, severe open-bite problems can be resolved. Almost all significant open-bite cases can be corrected, but the cost of the surgical procedure and the desire to avoid surgery and its associated risks sometimes prevents patients from choosing this method even though it might yield a better result than can be obtained any other way.
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SUBSTITUTE SHEET (RULE 26) [0013] 4. Temporary Anchorage Screws. Temporary anchorage screws are the most widely used and effective method for closing anterior open bites. Small metal screws, usually made of stainless steel or titanium, are placed in the bone tissue above the upper teeth or below the lower teeth to serve as anchor points from which various orthodontic traction devices can be attached to move teeth in a vertical direction (intrusion) to cause the bite to close. This method has been shown to be stable and effective. It is also invasive, requiring the use of local anesthesia for placement of the screws, and sometimes for the removal of the screws at the end of treatment. Failure of the bone to properly retain the screws in place for an adequate period of time to accomplish the desired movement can also be a significant problem in some cases. There is a significant percentage of patients who simply refuse to consider this method of treatment.
[0014] It can be seen that there is a need for additional methods to achieve bite closure. What is desired is an easily controllable orthodontic method that will accomplish significant bite closure, without undue discomfort or adverse effects on speech.
SUMMARY
[0015[ In general terms, this disclosure is directed to a dental appliance to cause orthodontic intrusion of posterior teeth. For example, the dental appliance may improve bite closure by causing the orthodontic intrusion of both upper and lower posterior teeth.
[0016] The dental appliance may be formed from wires and brackets or bands that are attached to a patient’s teeth. In some implementations, the dental appliance is an orthodontic aligner.
[0017] Orthodontic aligners are used to reposition teeth or retain teeth in a current position during orthodontic treatment. Orthodontic aligners may include a thin shell (usually formed from a clear plastic material) that closely follows the contours of a
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SUBSTITUTE SHEET (RULE 26) patient’s teeth. It should be noted that the terms aligner, positioner, and tooth-positioning appliance are largely synonymous as used in the orthodontic field. Some implementations include separate maxillary and mandibular aligners. The tooth-positioning appliances fit over the teeth, covering at least some of the facial and lingual surfaces of some or all of the teeth, and often at least some of the occlusal (or biting surfaces) of the teeth.
[0018] Some implementations include a flexible segment that is made from a flexible, resilient material such as nickel titanium wire. The flexible segment may be generally straight until a force is applied to it. The flexible segment may be joined to the posterior portions of the maxillary appliance and the mandibular appliance such that the flexible segment forms a U-shaped curve between the ends. The U-shaped region may extend in the anterior direction along the buccal surfaces of the patient’s teeth or exterior surface of the appliance. The resiliency of the flexible segment will apply an intrusive force (i.e., pushing down) on the posterior teeth.
[0019] In some embodiments, a dental appliance for correction of intruding posterior teeth includes an attachment device being shaped to attach to one or more teeth of a patient. The attachment device has connector structures coupled to the attachment device. A flexible segment is connected to the connector structures such that in an operative position when the flexible segment is flexed a force for intrusion is applied to the one or more teeth. In different configurations, the attachment device may be molar bands, a shell aligner device or attachments bonded to a patient’s teeth.
[0020] In some embodiments, an aligner device includes a flexible shell portion with an exterior surface and an interior surface. The interior surface is shaped to attach to
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SUBSTITUTE SHEET (RULE 26) multiple teeth of a patient. The exterior surface has an outer side (when fit to the teeth is a buccal side) and an inner side (when fit faces the tongue). The aligner device has a rigid structure that is coupled with the flexible shell portion. The rigid structure is configured and made out of materials that reduce flexing of the flexible shell portion. In one example, the aligner device is made of a full unibody shell portion that is configured to fit about a set of the patient’s upper set of teeth or the patients lower set of teeth. In another example, the aligner device includes two separate shell portions configured to fit about a set of the patient’ s upper set of teeth or the patients lower set of teeth. The two separate shell portions may be connected to each other via the rigid structure. The flexible shell portion may be made from suitable materials commonly used for aligner type devices, materials such as plastic, polymethyl methacrylate, polyurethane, thermo-plastic and medical-grade materials.
[0021] In some embodiments, the aligner device includes a rigid structure disposed about a portion of the exterior surface, disposed about a portion of the interior surface or disposed about a portion of the interior surface and the exterior surface. In some embodiment, the rigid structure is formed integrally with the same material as the flexible shell portion, and may have thickness of the rigid structure to reduce flexing. For example, the rigid structure may have thickness ranging from about 2 mm to 3 mm.
[0022] In some embodiments, the aligner device may have connector structures attached to the exterior surface of the flexible shell portion. The connector structures may be configured such that they couple to a flexible segment. The connector structures may be made of a material is different than the material of the flexible shell portion. The one or
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SUBSTITUTE SHEET (RULE 26) more connector structures may be of different shapes, such as round structures. In some embodiments, the shell portion has a thickness greater for locations of the connector structures than the thickness of other areas of the shell portion. The connector structures may be made from suitable materials for dental appliances, such as stainless steel, nickeltitanium, other alloys, ceramic, plastic and other medical grade materials that provide a strong structure for connecting to the flexible segment.
[0023] In some embodiments, the flexible segment may have a first end and a second end. A first connector structure pivotally couples to the first end, and a second connector structure pivotally couples to the second end of the flexible segment. This structure provides a pivotal connection of the flexible segment to the connector structures. When in operation, the pivotal connection may reduce a rotational force applied by the flexible segment to posterior teeth of the patient. In some embodiments, the flexible segment is connected to an orthodontic band configured for attachment to one or more molars. In some embodiments, the flexible segment may be made from suitable materials for dental appliances, such as stainless steel, nickel-titanium, other alloys, and other medical grade materials that provide a durable flexible segment.
[0024] In some embodiments, the exterior surface has one or more recessed notches formed in the outer side of the flexible shell portion. The one or more recessed notches may have a plate or nut bonded thereto. The plate or nut may be connected to the rigid structure. In some embodiments, the rigid structure is a rigid bar. In some embodiments, the connector structure may include one or more bands interconnected with a rigid bar. In some embodiments, the rigid bar, plate and/or nut may be made from any suitable materials
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SUBSTITUTE SHEET (RULE 26) for dental appliances, such as stainless steel, nickel-titanium, other alloys, and other medical grade materials that provide a durable plate or nut.
[0025] In some embodiments, a dental appliance for correction of intruding posterior teeth includes multiple orthodontic bands for attachment to molars or premolars. In one example, there is the dental applications includes a first orthodontic band, a second orthodontic band, and a flexible segment connected to the first and second orthodontic bands, the orthodontic bands being configured for attachment to any one of upper molars, lower molars and premolars. The first and second orthodontic bands are molar-bands having a post for attachment of the flexible segment.
[0026] In some embodiments, the flexible segment may be made from a flexible, resilient material. The flexible segment may form a U-shaped curve between a first end and the second end of the flexible segment. The flexible segment may be attached, either rigidly or flexibly, to the first and second orthodontic bands. The flexible segment may be configured such that in an operative position when the flexible segment is flexed a force for intrusion of posterior teeth is applied to molar teeth. The force may be applied vertically to both upper and lower molar teeth at the same time.
[0027] In some embodiments, the dental appliance may also include multiple orthodontic bands being connected to a rigid bar. The multiple orthodontic bands each may have a post for connection to the rigid bar.
[0028] The details of one or more aspects are set forth in the accompanying drawings and description below. Other features and advantages will be apparent from a reading of the following detailed description and a review of the associated drawings. It is
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SUBSTITUTE SHEET (RULE 26) to be understood that the following detailed description is explanatory only and is not restrictive of this disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0029] FIG. 1 is a schematic diagram of an example of upper and lower lingual holding arches on the first molar teeth
[0030] FIG. 2 is a schematic diagram of a perspective view of example upper and lower lingual holding arches with the flexible segments attached on the buccal surfaces.
[0031] FIG. 3 is a schematic diagram of a right-side view of example orthodontic bands placed on upper and lower 2nd premolars, 1st molars, and 2nd molars, with a heavy wire soldered to the buccal surfaces of the bands.
[0032] FIG. 4 is a schematic diagram of an example of a straight wire, when flexed in the manner shown and held at the ends, that wants to straighten itself out.
[0033] FIG. 5 is a schematic diagram of a right-side view of example orthodontic bands on upper and lower first molar teeth with example lingual arches attached.
[0034] FIG. 6 is a schematic diagram of a lateral view of an example flexed wire segment showing where a heat-treated bend may be placed in some implementations to prevent some of the tipping forces on the molars which are shown in FIG. 5.
[0035] FIG. 7 is a schematic diagram of an example of a flexed wire segment with attachment apparatus affixed to each end.
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SUBSTITUTE SHEET (RULE 26) [0036] FIG. 8 is a schematic diagram of a right-side view showing several example bands attached to an example rigid bar.
[0037] FIG. 9 is a schematic diagram of an example an interproximal view of a molar band showing a cylindrical post to which the flexible segments could be attached.
[0038] FIG. 10 is a schematic diagram of a cross-sectional view showing an example rigid bar which could be made in rectangular or trapezoidal shapes for attaching to the buccal surfaces of posterior teeth as shown in FIG. 8.
[0039] FIG. 11 is a schematic diagram of an example of an embodiment that includes a thin-shell aligner device that is shaped to fit at least a portion of a patient’s teeth
[0040] FIGS. 12 is a schematic diagram of a partial cross-sectional, side view of the example thin-shell aligner of FIG. 11.
[0041] FIGS. 13 is a schematic diagram of a partial cross-sectional, side view of the example thin-shell aligner of FIG. 11.
[0042] FIG. 14 is a schematic diagram of a partial cross-sectional, side view of an example thin-shell aligner (which may be similar to those shown in FIGS. 11-13) in which a connector extends out in the buccal direction from the aligner.
[0043] FIG. 15 is a perspective schematic diagram of a portion of a buccal surface of an example thin-shell aligner similar to those shown in FIGS. 11-13.
[0044] FIG. 16 is a perspective schematic diagram of an example lingual holding arch that may be included in at least some implementations of the thin shell aligner.
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SUBSTITUTE SHEET (RULE 26) [0045] FIG. 17 is a schematic diagram of a partial cross-sectional, side view of example thin-shell aligners (which may be similar to those shown in FIGS. 11-13) in which a round connector extends out in the buccal direction from the aligner.
[0046] FIG. 18 shows an example of a computer device that can be used to in the design and fabrication of the dental appliances described herein.
DETAILED DESCRIPTION
[0047] Various embodiments will be described in detail with reference to the drawings, wherein like reference numerals represent like parts and assemblies throughout the several views. Reference to various embodiments does not limit the scope of the claims attached hereto. Additionally, any examples set forth in this specification are not intended to be limiting and merely set forth some of the many possible embodiments for the technology disclosed herein.
[0048] The present disclosure relates to fabrication of dental appliances that are usable to provide therapy to a patient. In particular, the present disclosure relates to fabrication of orthodontic appliances such as orthodontic aligners. For example, the technology disclosed herein can be used to generate an orthodontic aligner for a patient to apply an intrusive force to the patient’s posterior teeth. This intrusive force may cause the posterior teeth to intrude back into the patient’s gums, reducing the vertical dimension in the posterior. In some implementations, the orthodontic aligner may be part of a series of removable orthodontic aligners to reposition a patient’s teeth over time. The technology
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SUBSTITUTE SHEET (RULE 26) can be used to fabricate the appliance fully or partially within an office of a medical professional.
[0049] In some implementations, orthodontic positioners (or aligners) are made from a set of plaster models derived from three-dimensional (3D) negative dental impressions of a patient’s teeth. The plaster dental models are then modified by cutting the teeth apart using a small jeweler’s saw or rotary cutting discs, followed by repositioning the plaster teeth in a better, straighter, desired arrangement, and then holding the teeth in the new arrangement with dental wax.
[0050] The repositioned teeth molds provide the basis for manufacturing the positioners. The resilience of the material from which the positioner is made provides the energy to move the teeth from their original position toward the new straightened position. A series of aligners may be made to move the teeth in incremental steps. Making a series of appliances is difficult, time-consuming, and error-prone when the tooth arrangement for each step must be made by hand using plaster and wax.
[0051] Digital technologies can be used to overcome at least some of the difficulties associated with fabricating a series of aligners that move teeth incrementally. Computer Aided-Design (CAD)/Computer-Aided Manufacturing (CAM) software can be used to produce tooth models, from which a progressive series of appliances can be manufactured. The tooth models can be generated from 3D images of the patient’s dentition. These tooth models can then be repositioned and used to form aligners. For example, the repositioned tooth models can be used to fabricate dental models upon which aligners are formed using a combination of vacuum, pressure, and heat. This forming
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SUBSTITUTE SHEET (RULE 26) process is informally referred to within the orthodontic laboratory community as the “suck down” process.
[0052] In one process for producing a series of aligners, a technician first scans a patient’s dental model to obtain CAD-manipulatable virtual models of a patient’s dental anatomy. A dental model normally consists of one upper and one lower plaster model of the teeth, palate, and gums. Once the virtual model of the original malocclusion has been obtained, a technician will then undertake steps involving extensive manipulation of the virtual malocclusion. This involves extensive repositioning of the teeth according to a comprehensive and sequential procedure, ultimately arriving at a finished or ideal occlusion for that patient. The finished occlusion in the virtual model is consistent with the complete repositioning of the patient’s upper and lower occlusion that would result at the end of successful conventional orthodontic treatment. After the steps described above are accomplished, the technician possesses two versions of the patient’s teeth available within the virtual CAD environment. One version represents the original malocclusion and the other represents the ideal occlusion. In other words, the technician has models representing the beginning and end states of the patient’s teeth.
[0053] Another step in the process involves the creation of an incremental, progressive series of physical forming models. Each of these forming models represents a snapshot of the patient’s future occlusion at specific incremental steps along the patient’s proposed treatment sequence between the beginning and the end conditions as described above. To accomplish this, the technician creates a virtual first transition model. This virtual first transition model represents some or all of the teeth being subtly moved from
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SUBSTITUTE SHEET (RULE 26) their original pre-treatment positions to a virtual first transition position that is in the direction of their intended finished positions. Additional virtual transition models can be created similarly. In this manner, the technician creates a series of progressive models, with each biased slightly further than the previous one, and each moves the teeth slightly closer to their finished target positions. A final forming model will take the teeth from the series of transition positions and move them into their final, desired positions.
[0054] Once such a series of virtual intermediate forming models has been created and a final forming model has been created by the technician, digital code representing each of the models in the series is directed to operate a rapid prototyping machine. Within a rapid prototyping machine, the series of physical forming models are produced using any of a number of conventional processes, such as computer numerically-controlled (CNC) machining, stereo lithography, or 3D printing. The production step results in the production of hard, physical models that correspond to each of the series of virtual intermediate models and the final model.
[0055] In another step of the process, each of the series of physical models is mounted in a vacuum machine (also referred to as a suck-down machine) where a combination of pressure, heat, and vacuum is used to form the actual series of progressive aligners from plastic sheet material of a constant thickness. Once the series of progressive aligners are formed and trimmed, they are sequentially labeled, packaged, and shipped to the attending orthodontist. The orthodontist then schedules an appointment for the patient, at which time the aligners and instructions for their use are given to the patient. The patient is instructed to wear the first set of aligners for a period of time, typically two weeks. After
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SUBSTITUTE SHEET (RULE 26) that, the first set is discarded and the patient transitions to the next set of the series and so on.
[0056] The aligners can be configured to urge the patient’ s teeth to move according to the positional biases created virtually by the technician. The teeth are progressively biased and urged to move in desired directions toward their predetermined finished positions by the resilience of the polymeric material of the aligner. Ideally, gentle but continuous forces would be delivered by the aligners, causing certain physiological processes involving the creation and/or restoration of the bone supporting the roots of the teeth to take place. The net result should be the slow, progressive orthodontic movement of the roots of the teeth through the underlying bone toward desirable positions and orientations.
[0057] Embodiments of the appliance described herein include a single aligner or one or more aligner from a series of aligners. Some embodiments do not include an aligner, but instead include one or more bands, bars, or brackets that are coupled to the patient’s dentition.
[0058] An example of the appliance includes one or more flexible segments (probably two) of a suitable material, and of a suitable size so that when the segments are flexed, a force suitable for intrusion of posterior teeth is applied vertically to upper and lower molar teeth at the same time. A primary material for the segments (which may be nickel -titanium wire material in at least some embodiments) may be covered by other materials so that it is of sufficient diameter to be comfortable in the buccal and/or lingual
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SUBSTITUTE SHEET (RULE 26) vestibule of the mouth, without causing undue irritation to either the inside of the cheek or the gum tissue.
[0059] The flexible segments are attached, either rigidly or flexibly, to orthodontic bands which are attached to upper and lower molars and/or premolars. In many implementations, the orthodontic bands will need be attached to a lingual attachment apparatus in order to prevent the tipping of teeth in a buccal direction. Alternatively, they may be attached to a removable appliance, such as a Crozat removable appliance, or something such as a Dellinger Active Vertical Corrector, but without magnets as in the AVC.
[0060] The exact manner in which the flexible segments are attached can vary, and several possible, but none limiting, attachment methods are discussed herein.
[0061] The number of teeth to be intruded can vary, depending on how many teeth are present, and the orthodontic problems of a particular patient.
[0062] It is anticipated that in the typical case, two flexible segments will be used on the buccal sides of the teeth, and the segments will be loaded so that force is applied to the buccal surfaces of the appliance that is chosen.
[0063] The attachment apparatus may be flexible or rigid in order to prevent excessive forces from being applied by the flexed segments to the inside surfaces of the cheek, or to the gingival tissues. For example, the material properties of the attachment apparatus may be selected to reduce or prevent movement of the loop in the buccal or lingual direction (which may then contact the soft tissues).
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SUBSTITUTE SHEET (RULE 26) [0064] In some implementations, the rigid attachment method may be similar to a headgear tube. Some implementations may include a slight bend in the end of the Nickel- Titanium wire to lock it at the end of the tube. Some implementations include a heat-treated bend in the Nickel-Titanium wire to prevent tipping forces from being applied to the teeth.
[0065] Some implementations of the flexible segment are attached to the patient’s teeth by placing an axle cylinder on the buccal side of the molar band in such a way that it inserts into a carefully machined cylindrical hole in an attachment apparatus fixed to the end of the flexible segments.
[0066] Multiple bands may be attached together in a semi-rigid manner to keep the teeth fairly level as they are being intruded. The bands can be soldered together with a wire on the buccal or lingual surfaces, or a bar on the buccal or lingual surfaces. Archwires with conventional edgewise appliances on the buccal or lingual surfaces may also be used to connect the bands together.
[0067] Removable appliances may also be used as the base for attachment of the flexible segments such as a Crozat appliance with a soldered molar crib, or an acrylic splinttype appliance.
[0068] Some implementations include components that prevent lateral forces from displacing either the teeth or the mandibular condyles in a lateral direction. For example, some implementations may include acrylic shields on the buccal surfaces of the appliances to prevent lateral movement of the jaws or teeth when the appliance is worn. Either custom or stock plastic shields may be used with this appliance in at least some implementations.
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SUBSTITUTE SHEET (RULE 26) [0069] Various embodiments may provide various levels of force to induce molar intrusion. Various embodiments may use various materials, wire or otherwise, for the flexible segments. For example, some implementations of the flexible segments include Nickel- Titanium wire material, that is approximately 0.045 inches in diameter, or smaller. For example, the flexible segments may have other diameter thickness ranging from 0.030- 0.045 inches in diameter. Various embodiments include various sized loops for the flexible segments. The flexible segments may have various cross-sectional shapes to inhibit or encourage flexing in specific directions. Various attachment mechanisms may be used in various embodiments based on effectiveness and patient comfort. Various embodiments of the dental appliance may attach to various of the patient’s teeth. Various embodiments may use various different techniques or components to reduce or prevent lateral tooth or condylar displacement.
[0070] FIG. 1 is a schematic diagram of an example of an upper lingual holding arch 102 and lower lingual holding arch 104 on the first molar teeth, which in some implementations serve as a base for attachment of flexible segments.
[0071 ] FIG. 2 is a schematic diagram of a perspective view of example upper and lower lingual holding arches with the flexible segments 202, 204 attached on the buccal surfaces. The flexible segments are shown in a flexed, or active position, much as they would be while in the mouth.
[0072] FIG. 3 is a schematic diagram of a right-side view of example orthodontic bands 302, 304 placed on upper and lower 2nd premolars, 1st molars, and 2nd molars, with
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SUBSTITUTE SHEET (RULE 26) a heavy wire 306 soldered to the buccal surfaces of the bands. The flexible segments 308 are shown attached to the buccal surfaces of the 1st molar bands 304.
[0073] FIG. 4 is a schematic diagram of an example of a straight wire 402, when flexed in the manner shown and held at the ends, that wants to straighten itself out. The directions of the forces applied at the ends of the wire are shown by the arrows 404, 406.
[0074] FIG. 5 is a schematic diagram of a right-side view of example orthodontic bands 502, 504 on upper and lower first molar teeth with example lingual arches 506, 508 attached. If flexible segments are attached rigidly to these bands, such as with buccal tubes, a force will be applied to the bands in the direction of the large arrows 510, 512, Although this force is primarily an intrusion force, which is desirable, a tipping force is also present, which may cause the anterior part of the lingual arch to move away from the anterior teeth in the direction of the small arrows 514, 516.
[0075] FIG. 6 is a schematic diagram of a lateral view of an example flexed wire segment 602 showing where a heat-treated bend may be placed in some implementations to prevent some of the tipping forces on the molars which are shown in FIG. 5. The amount of the bend shown in this figure is exaggerated for illustrative purposes. Various implementations may have various amounts of bend in the flexible segment.
[0076] FIG. 7 is a schematic diagram of an example of a flexed wire segment 702 with attachment apparatus 702, 704 affixed to each end. The apparatus has a cylindrical hole to slide over a cylindrical post which is attached to a molar band. The flexible attachment avoids applying a tipping force to the molar (or other posterior teeth). In some implementations, a head may couple to the cylindrical post to secure the end of the flexible
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SUBSTITUTE SHEET (RULE 26) segment to the post. In some examples, the length of the flexed wire segment is in a range anywhere from 3 inches to 5.5 inches long. The length of the flexed wire segment may be sized for fitment as to the respective patient. The flexed wire segment may be heat treated first in a straight shape, and then bent to form a U-shape of the flexed wire segment. The heat treatment and U-shape configuration may provide a flexible wire segment where the ends of the wire exert an upward and downward when the ends of the flexed wire segment are placed in a flexed position. The flexed wire segment may be coated or encased in plastic protective covering or shield.
[0077| FIG. 8 is a schematic diagram of a right-side view showing several example bands 802, 804, 806, 808 attached to an example rigid bar 810. In some implementations, the bar is soldered or spot-welded to the bands. In alternative embodiments, 802, 804, 806, 808 could instead of bands, could be bonded attachments to the teeth directly.
[0078] FIG. 9 is a schematic diagram of an example an interproximal view of a molar band 902 showing a cylindrical post 904 to which the flexible segments could be attached.
[0079] FIG. 10 is a schematic diagram of a cross-sectional view showing an example rigid bar 1002 which could be made in rectangular or trapezoidal shapes for attaching to the buccal surfaces of posterior teeth as shown in FIG. 8. An example post attachment 1004 is also shown. The post attachment could be made to fit over the bar where it could be soldered or welded to hold it in place.
[0080] FIG. 11 is a schematic diagram of an example of an embodiment that includes a thin-shell aligner device 1100 that is shaped to fit at least a portion of a patient’ s
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SUBSTITUTE SHEET (RULE 26) teeth. In this example, the aligner device 1100 includes a reinforced region 1104 (i.e., a rigid structure) that fits over bonded attachments that have been bonded to the patient’s dentition.
[0081] The aligner device 1100 includes a flexible shell portion 1102 with an exterior surface and an interior surface. The interior surface is shaped to attach to multiple teeth of a patient. The exterior surface has an outer side (when fit to the teeth is a buccal side) and an inner side (when fit faces the tongue). The aligner device has a rigid structure 1104 that is coupled with the flexible shell portion. The rigid structure is configured and made out of materials that reduce flexing of the flexible shell portion. In this example, the aligner device includes a rigid structure disposed about a portion of the exterior surface. In some examples, the rigid structure may have thickness ranging from about 2 mm to 3 mm, and other thickness of the rigid structure may be used.
[0082] In one example, the aligner device 1100 is made of a full unibody shell portion that is configured to fit about a set of the patient’s upper set of teeth or the patients lower set of teeth. In another example, the aligner device includes two separate shell portions configured to fit about a set of the patient’s upper set of teeth or the patients lower set of teeth. For example, the two separate shell portions (e.g., a right portion and a left portion) for an upper set of teeth may be connected to each other via the rigid structure. The flexible shell portion 1102 may be made from suitable materials commonly used for aligner type devices, materials such as plastic, polymethyl methacrylate, polyurethane, thermo-plastic and medical-grade materials. The flexible shell portion may be 3-D printed and may be formed with any suitable 3-D printable materials.
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SUBSTITUTE SHEET (RULE 26) [0083] The aligner device may have connector structures 1106 attached to the exterior surface of the flexible shell portion. The connector structures 1106 may be configured such that they couple to a flexible segment (not shown, but otherwise described herein). The connector structures 1106 may be made of a material is different than the material of the flexible shell portion. The one or more connector structures 1106 may be of different shapes, such as round or square structures. In some examples, the shell portion has a thickness greater for locations of the connector structures than the thickness of other areas of the shell portion. The connector structures 1106 may be made from suitable materials for dental appliances, such as stainless steel, nickel-titanium, other alloys, ceramic, plastic and other medical grade materials that provide a strong structure for connecting to the flexible segment.
[0084] FIGS. 12 and 13 are schematic diagrams of a partial cross-sectional, side view of the example thin-shell aligner 1200 with support structures 1201, 1202 of FIG. 11. Here, the cross-section includes a lingual holding arch, which may be formed with the thin- shell aligner or may be embedded in or attached to the thin-shell aligner. Here, a portion of the thin-shell aligner on the buccal side is also shown. In FIG. 13, the buccal side of the thin-shell aligner is built up to provide additional strength and rigidity to better withstand the forces applied by the flexible segments. The outer side of the exterior surface of the thin-shell aligner 1200 has the built up portion 1204. In this example, the inner side of the exterior surface 1202 of the thin-shell aligner is of a normal or ordinary thickness for a typical aligner.
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SUBSTITUTE SHEET (RULE 26) [0085] FIG. 14 is a schematic diagram of a partial cross-sectional, side view of an example thin-shell aligner 1200 (which may be similar to those shown in FIGS. 11-13) in which a connector extends 1206 out in the buccal direction from the aligner. The connector may be a round structure. In some examples, the connector pivotally couples an end of the flexible segment to the buccal surface of the thin shell aligner. The pivotal connection may reduce the rotational force (torque) applied by the flexible segments to the posterior teeth. The connector may be formed integrally with the aligner (e.g., from the same material as part of a monolithic structure) or may be formed from a different material that is attached to the aligner.
[0086] FIG. 15 is a perspective schematic diagram of a portion of a buccal surface of an example thin-shell aligner may have the connecting structure 1201 similar to those shown in FIGS. 11-13. Here, the buccal surface of the aligner has a scalloped shape that approximates the buccal contours of the patient’s dentition. In this example, the surface includes recesses 1210 to attach to bonded attachments on the patient’s teeth, and a connector structure 1214 that extends out from the buccal surface. The connector structure may allow a flexible segment to pivotally connect to the buccal surface of the aligner. In this example, the connector structure 1214 has a hexagonal-shaped head, but other implementations may have different shaped heads, such as circular, rectangular, hexagonal, oval, spherical, dome-shaped, triangular or other shapes.
[0087] FIG. 16 is a perspective schematic diagram of an example lingual holding arch 1202 that may be included in at least some implementations of the thin shell aligner 1200. The lingual holding arch may be formed integrally with the lingual surface 1202 (i.e.,
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SUBSTITUTE SHEET (RULE 26) the interior side of the exterior surface of the aligner) of the thin shell aligner or may be coupled to the lingual surface of the thin shell aligner. The lingual holding arch 1202 may have a concave portion facing towards the teeth when the aligner is placed in position over the teeth, and has a convex or curved outer buccal surface.
[0088] FIG. 17 is a schematic diagram of a partial cross-sectional, side view of example thin-shell aligners 1200 (which may be similar to those shown in FIGS. 11-13) in which a round connector 1206 extends out in the buccal direction from the aligner. FIG. 17 also includes a side view of flexible segment 1216 that may be attached to the connectors 1206 extending out from the buccal surface of the aligner. In this example, the ends of the of the flexible segment include loops that can be fit over the connectors and secured with the heads at the end of the connectors. In at least some implementations, when worn, the arc of the flexible segment extends along the buccal surface of the patient’s teeth. The flexible segment may be made from a material having resilient properties such that the flexible segment would extend in straight line if no other forces are applied to it. The resilient properties of the flexible segment may apply an intrusive force on the aligners (and the underlying posterior teeth) as the flexible segment tries to return to a straight configuration.
[0089] FIG. 18 shows an example of a computer device that can be used to in the design and fabrication of the dental appliances described herein. For example, the computer device may be used to design an aligner or a series of aligners that include at least some of the functionality described herein. In this example architecture, a computing device 1850 can be used to implement aspects of the present disclosure, including methods of planning
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SUBSTITUTE SHEET (RULE 26) treatments, designing thin-shell aligners, fabricating thin-shell aligners, and placing attachments for the flexible segments on digital representations of thin-shell aligners.
[0090] The computing device 1850 illustrated in FIG. 18 can be used to execute the operating system, application programs, and software modules (including any software engines) described herein.
[0091] The computing device 1850 includes, in some embodiments, at least one processing device 1860, such as a central processing unit (CPU). A variety of processing devices are available from a variety of manufacturers, for example, Intel or Advanced Micro Devices. In this example, the computing device 1850 also includes a system memory 1862, and a system bus 1864 that couples various system components including the system memory 1862 to the processing device 1860. The system bus 1864 is one of any number of types of bus structures including a memory bus, or memory controller; a peripheral bus; and a local bus using any of a variety of bus architectures.
[0092] Examples of computing devices suitable for the computing device 1850 include a desktop computer, a laptop computer, a tablet computer, a mobile computing device (such as a smart phone, an iPod® or iPad® mobile digital device, or other mobile devices), or other devices configured to process digital instructions.
[0093] The system memory 1862 includes read only memory 1866 and randomaccess memory 1868. A basic input/output system 1870 containing the basic routines that act to transfer information within computing device 1850, such as during start up, is typically stored in the read only memory 1866.
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SUBSTITUTE SHEET (RULE 26) [0094] The computing device 1850 also includes a secondary storage device 1872 in some embodiments, such as a hard disk drive, for storing digital data. The secondary storage device 1872 is connected to the system bus 1864 by a secondary storage interface 1874. The secondary storage devices 1872 and their associated computer readable media provide non-volatile storage of computer readable instructions (including application programs and program modules), data structures, and other data for the computing device 1850.
[0095] Although the example environment described herein employs a hard disk drive as a secondary storage device, other types of computer readable storage media are used in other embodiments. Examples of these other types of computer readable storage media include magnetic cassettes, flash memory cards, digital video disks, Bernoulli cartridges, compact disc read only memories, digital versatile disk read only memories, random access memories, or read only memories. Some embodiments include non- transitory computer-readable media. Additionally, such computer readable storage media can include local storage or cloud-based storage.
[0096] A number of program modules can be stored in secondary storage device 1872 or system memory 1862, including an operating system 1876, one or more application programs 1878, other program modules 1880 (such as the software engines described herein), and program data 1882. The computing device 1850 can utilize any suitable operating system, such as MicrosoftWindows™, Google Chrome™ OS or Android, Apple OS, Unix, or Linux and variants and any other operating system suitable for a computing
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SUBSTITUTE SHEET (RULE 26) device. Other examples can include Microsoft, Google, or Apple operating systems, or any other suitable operating system used in tablet computing devices.
[0097] In some embodiments, a user provides inputs to the computing device 1850 through one or more input devices 1884. Examples of input devices 1884 include a keyboard 1886, mouse 1888, microphone 1890, and touch sensor 1892 (such as a touchpad or touch sensitive display). Other embodiments include other input devices 1884. The input devices are often connected to the processing device 1860 through an input/output interface 1894 that is coupled to the system bus 1864. These input devices 1884 can be connected by any number of input/output interfaces, such as a parallel port, serial port, game port, or a universal serial bus. Wireless communication between input devices and the interface 1894 is possible as well, and includes infrared, BLUETOOTH® wireless technology, 802.11a/b/g/n, cellular, ultra-wideband (UWB), ZigBee, or other radio frequency communication systems in some possible embodiments.
[0098] In this example embodiment, a display device 1896, such as a monitor, liquid crystal display device, projector, or touch sensitive display device, is also connected to the system bus 1864 via an interface, such as a video adapter 1898. In addition to the display device 1896, the computing device 1850 can include various other peripheral devices (not shown), such as speakers or a printer.
[0099] When used in a local area networking environment or a wide area networking environment (such as the Internet), the computing device 1850 is typically connected to the network through a network interface 1000, such as an Ethernet interface or WiFi interface. Other possible embodiments use other communication devices. For
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SUBSTITUTE SHEET (RULE 26) example, some embodiments of the computing device 1850 include a modem for communicating across the network.
[0100] The computing device 1850 typically includes at least some form of computer readable media. Computer readable media includes any available media that can be accessed by the computing device 1850. By way of example, computer readable media include computer readable storage media and computer readable communication media.
[0101] Computer readable storage media includes volatile and nonvolatile, removable and non-removable media implemented in any device configured to store information such as computer readable instructions, data structures, program modules or other data. Computer readable storage media includes, but is not limited to, random access memory, read only memory, electrically erasable programmable read only memory, flash memory or other memory technology, compact disc read only memory, digital versatile disks or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store the desired information and that can be accessed by the computing device 1850.
[0102] Computer readable communication media typically embodies computer readable instructions, data structures, program modules or other data in a modulated data signal such as a carrier wave or other transport mechanism and includes any information delivery media. The term “modulated data signal” refers to a signal that has one or more of its characteristics set or changed in such a manner as to encode information in the signal. By way of example, computer readable communication media includes wired media such as a wired network or direct-wired connection, and wireless media such as acoustic, radio
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SUBSTITUTE SHEET (RULE 26) frequency, infrared, and other wireless media. Combinations of any of the above are also included within the scope of computer readable media.
[0103] The computing device illustrated in FIG. 18 is also an example of programmable electronics, which may include one or more such computing devices, and when multiple computing devices are included, such computing devices can be coupled together with a suitable data communication network so as to collectively perform the various functions, methods, or operations disclosed herein.
[0104] It will be appreciated that the present disclosure may include any one and up to all of the following examples.
[0105] Example 1: A dental appliance for correction of intruding posterior teeth comprising: an attachment device being shaped to attach to one or more teeth of a patient; the attachment device having connector structures coupled to the attachment device; and a flexible segment connected to the connector structures such that in an operative position when the flexible segment is flexed a force for intrusion is applied to the one or more teeth.
[0106] Example 2. The dental appliance of Example 1, wherein the attachment device comprises: an aligner having a flexible shell portion with an exterior surface and an interior surface, the interior surface being shaped to attach to the one or more teeth of the patient, the exterior surface having an outer side and an inner side; and a rigid structure coupled with the flexible shell portion, the rigid structure configured to reduce flexing of the flexible shell portion.
[0107] Example 3. The dental appliance of any one of Example 1-2, further comprising: one or more connector structures attached to the exterior surface, the one or more connector structures being configured to couple to a flexible segment, the connector
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SUBSTITUTE SHEET (RULE 26) structures comprising a material that is different than material of the flexible shell portion, the flexible segment having a first end and a second end.
[0108] Example 4. The dental appliance of any one of Examples 1-3, wherein a first connector structure pivotally couples to the first end, and a second connector structure pivotally couples to the second end, thereby providing a pivotal connection of the flexible segment to the connector structures.
[0109] Example 5. The dental appliance of any one of Examples 1-4, wherein the pivotal connection may reduce a rotational force applied by the flexible segment to posterior teeth of the patient.
[01.10] Example 6. The dental appliance of any one of Example 1-5, wherein the connector structures are round structures.
[0111] Example 7. The dental appliance of any one of Examples 1-6, wherein the rigid structure is disposed about a portion of the exterior surface.
[0112] Example 8. The dental appliance of any one of Examples 1-7, wherein the flexible shell portion is a full unibody shell portion configured to fit about a set of the patient’s upper set of teeth or a set of the patient’s lower set of teeth.
[0113] Example 9. The dental appliance of any one of Examples 1-8, wherein the flexible shell portion is comprised of two separate shell portions configured to fit about a set of the patient’s upper set of teeth or the patients lower set of teeth, the two shell portions being connected to each other via the rigid structure.
[0114] Example 10. The dental appliance of any one of Examples 1-9, wherein the rigid structure is disposed about a portion of the interior surface.
[OHS] Example 11. The dental appliance of any one of Examples 1-10, wherein the rigid structure is formed integrally with the same material as the flexible shell portion, with a thickness of the rigid structure to reduce flexing, with a thickness of the rigid structure ranging from about 2 mm-3 mm.
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SUBSTITUTE SHEET (RULE 26) [0116] Example 12. The dental appliance of any one of Examples 1-11, wherein the exterior surface has one or more recessed notches formed in the outer side, with the one or more recessed notches having a plate or nut bonded thereto, with the plate or nut being connected to the rigid structure.
[0117] Example 13. The dental appliance of any one of Examples 1-12, wherein the shell portion has a thickness greater for locations of the connector structures than the thickness of other areas of the shell portion.
[0118] Example 14. The dental appliance of Example 1, wherein the attachment device comprises one or more orthodontic bands being configured for attachment to any one of upper molars, lower molars and premolars.
[01.19] Example 15. The dental appliance of Example 14, wherein the flexible segment is connected to the one or more orthodontic bands.
[0120] Example 16. The dental appliance of any one of Examples 14-15, wherein at least two of the orthodontics bands are interconnected with a rigid structure.
[0121 ] Example 17. The dental appliance of any one of Example 14-16, wherein the rigid structure is a rigid bar.
[0122] Example 18. The dental appliance of any one of Examples 14-17, wherein the one or more orthodontic bands are molar-bands having a post for attachment to the flexible segment.
[0123] Example 19. The dental appliance of any one of Examples 14-18, wherein the flexible segment is attached, either rigidly or flexibly, to the one or more orthodontic bands.
[0124] Example 20. The dental appliance of any one of Examples 1-19, wherein the at least one flexible segment is made from a flexible, resilient material.
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SUBSTITUTE SHEET (RULE 26) [0125] Example 21. The dental appliance of any one of Examples 1-20, wherein the flexible segment forms a U-shaped curve between a first end and the second end of the flexible segment.
[0126] Example 22. The dental appliance of any one of Examples 1-21, wherein the flexible segment is configured such that in an operative position when the flexible segment is flexed a force for intrusion of posterior teeth is applied to molar teeth.
[0127] Example 23. The dental appliance of any one of Examples 1-22, wherein the force is applied vertically to both upper and lower molar teeth at the same time.
[0128] A number of embodiments have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention.
[0129] In addition, the logic flows depicted in the figures do not require the particular order shown, or sequential order, to achieve desirable results. In addition, other steps may be provided, or steps may be eliminated, from the described flows, and other components may be added to, or removed from, the described systems.
[0130] In the foregoing disclosure, implementations of the disclosure have been described with reference to specific example implementations thereof. It will be evident that various modifications may be made thereto without departing from the broader spirit and scope of implementations of the disclosure as set forth in the following claims. The disclosure and drawings are, accordingly, to be regarded in an illustrative sense rather than a restrictive sense.
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SUBSTITUTE SHEET (RULE 26)