Patent Application
20230058890
The present invention relates to methods and apparatus for orthodontics. More particularly, the present invention relates to methods and apparatus for facilitating the planning and bonding of orthodontic brackets upon teeth for an orthodontic treatment.
Orthodontics is a specialty of dentistry that is concerned with the study and treatment of malocclusions which can result from tooth irregularities, disproportionate facial skeleton relationships, or both. Orthodontics treats malocclusion through the displacement of teeth via bony remodeling and control and modification of facial growth.
A typical treatment generally involves the placement and positioning of braces upon the teeth of a patient for the purpose of applying a static mechanical force to induce bone remodeling, thereby enabling teeth to move. Braces utilize orthodontic brackets affixed to each tooth and an archwire interface interfacing with each of the brackets. As the teeth respond to the pressure applied via the archwire by shifting their positions, the wires are again tightened to apply additional pressure. Each of the brackets are typically aligned in a pre-planned location on each tooth to ensure that tightening of the archwire will result in a desirable tooth movement.
While orthodontists and other practitioners may utilize appliances for affixing brackets onto the teeth, such as indirect bonding trays, many practitioners prefer to position and directly bond the brackets directly on the teeth. Various trays may be created by utilizing a positive mold of a patient's dentition which may be created from an orthodontic 3D scan. Hence the tray may be customized to each particular patient's dentition. These trays may also be transparent to allow for the practitioner to use to curing light to cement the entire arch of brackets simultaneously.
However, there are also deficiencies with many of these tray systems. For instance, some trays may provide for inadequate space for positioning and placing the brackets upon the surfaces of the teeth. Such trays may limit the ability of the practitioner to vary the positioning of the brackets.
Other trays may provide for a template which defines an aperture or opening at a preset location over the surface of the crown within which the bracket is positioned and secured to the crown surface for subsequently coupling to an archwire. However, such templates provide a limited window within which the bracket must be adhered to the crown surface and limits the flexibility of the practitioner to position the bracket upon the crown surface.
Accordingly, there exists a need for an efficient and effective direct bonding system which facilitates placement of orthodontic brackets.
A template guide which is positionable upon the dentition of the patient and which provides a reference surface or shelf may facilitate the rapid attachment of brackets upon the crown surfaces without overly restricting the flexibility or judgment of the practitioner in determining bracket placement. As part of the treatment planning, a three-dimensional (3D) digital scan of the patient's dental arch prior to treatment is typically obtained using any number of scanning methodologies and processes. Using the 3D digital scan, any number of malocclusions may be corrected using various orthodontic appliances such as braces with archwires, aligners, etc.
One variation of a template guide may be formed to correspond to the dentition of the patient's teeth based upon the scanned 3D image. A mold of the patient's dentition may be formed from the digitally scanned image using any number of techniques and the template guide may be fabricated to conform to the dentition or a portion of the dentition. One or more bracket guide attachment members may be formed or positioned upon the surfaces of the crown (buccal or lingual) on the mold in order to form a reference surface or shelf as part of the template guide. Once the template guide has been completed, the guide may be placed upon the dentition of the patient such that the reference surface or shelf provides a guide for readily placing the corresponding bracket upon the surface of the teeth. The template guide may provide the reference surface or shelf upon which the practitioner may move the bracket left or right relative to the midline of each crown (or directly upon the midline) by utilizing their experience. That is, each bracket may be moved in a mesial or distal position along the reference surface or shelf for attachment upon the crown surface as the shelf may provide the predetermined or ideal positioning along the occlusal or gingival direction (apical or basal) of each crown. As the practitioner may simply slide the bracket along the shelf for positioning upon the crown, the placement of each bracket may be located more easily.
The mold of the dentition may incorporate the one or more bracket guide attachment members formed either directly upon the one or more teeth (buccal or lingual surfaces) or they may be attached separately. The bracket guide attachment members may form an interface surface which extends from the surface of the crown (e.g., buccal surface) upon which the template guide may conform to result in the formation of the reference surface or shelf. Each of the bracket guide attachment members (or a select few) may also incorporate an indicator of where the midline of each crown is located to provide yet another reference point for the practitioner in placing and attaching the bracket upon the teeth.
With the bracket guide attachment members attached or formed upon the mold, the template guide may be formed upon the dentition and bracket guide attachment members such that the template guide are conformed against the occlusal surfaces of the teeth and bracket guide attachment members. In this manner, the resulting template guide may be formed much like an aligner which may be removably placed upon the occlusal surfaces of the patient's teeth and which position the reference surface or shelf to extend away (e.g., orthogonally) from the surface of the teeth (e.g., buccal surfaces).
The dentition of the patient may be digitally scanned either by the practitioner or by a third party to create an electronic digital model of the dentition. This digital model may be received into a treatment planning software which may be used to create and position digital versions of the bracket guide attachment members upon the digital model. Each of the attachment members may be connected laterally along a 3D line in the digital model to an adjacent attachment member to form a continuous line at a distance from the surfaces (e.g., buccal or lingual) of the teeth. The profile of the reference surface or shelf may be derived from this 3D line and the profile may then be extruded towards the base of the digital model (e.g., in the gingival direction) to form the base of the reference surface or shelf. Once the model has been extruded digitally, the model may be cut at the base to reduce the material requirement when fabricated as only half of the model may be used for the actual bonding operations when in use with the patient.
The digital model of the patient's dentition may be received, for example, into a treatment planning software platform which may be used to plan for the steps of correcting any number of malocclusions in the dentition. Once the final position of the patient's teeth have been determined digitally, a position of where the attachment bracket should be attached upon the one or more teeth may be identified in the digital model. The attachment bracket may be positioned at a predetermined distance from each incisal edge of the patient's teeth when in their final positions as these distances will remain unchanged from the initial position of the teeth and the final position of the teeth. These distances may then be used to determine the location of each bracket attachment upon each crown for forming the reference surface or shelf.
The correction of one or more of the teeth may be performed using a treatment planning software platform, as described herein, to result in a final position of the dentition where a position of one or more of the teeth have been corrected. With the one or more teeth in their final position, the bracket guide attachment members may be digitally applied upon the one or more teeth at locations where the brackets can be applied. Each of the bracket guide attachment members (or just a selected number) may include an indicator or projection extending from the member such that the attachment member may be applied upon the crown to align the indicator or projection along a mid-line of the crown to provide an additional guide to the practitioner. Once the attachment members may been applied to the teeth in their final position, the teeth may be reverted back to their initial position with the attachment members still positioned upon each of the teeth.
Once the individual attachment members are positioned upon the teeth and the digital model of the dentition is reverted back to its initial position, the individual attachment members on each of the teeth may be connected laterally to an adjacent attachment to form a continuous line at a distance from the buccal surfaces of the teeth. The profile of the reference surface or shelf may be derived from this 3D line and the profile may then be extruded towards the base of the digital model (e.g., in the gingival direction) to form the base of the reference surface or shelf. Once the model has been extruded digitally, the model may be cut at the base to reduce the material requirement when fabricated.
With the digital model created of the teeth in their initial position, a positive mold of the dentition with attachment members and reference surface or shelf may be fabricated and a template guide may be formed upon the mold. The resulting template guide may correspondingly fit upon the dentition of the patient having the reference surface or shelf formed. Alternatively, the template guide may be fabricated directly using any number of direct printing or additive fabrication techniques to form the resulting template guide.
With the template guide secured upon the patient's teeth, the practitioner may position an orthodontic bracket attachment upon the surface of the crown. As the reference surface or shelf is already situated along the occlusal-gingival direction, the practitioner may utilize the reference surface or shelf for positioning the bracket attachment upon so that the practitioner may move the attachment in a mesial or distal direction (e.g., left or right) upon the crown relative to the groove or mark indicating the crown mid-line. While the practitioner may secure the attachment upon the crown at the mid-line of the groove or mark, they may also use their professional judgement in determining whether to move the attachment in a more mesial or distal position for attachment to the crown to effect any particular desired tooth movement.
Once each of the bracket attachments have been adhered to the respective crown, the template guide may be removed from the dentition to allow for the engagement of the archwire to the bracket attachments. Alternatively, the template guide may be left in place while the archwire is positioned to engage each of the bracket attachments.
The bracket guide attachment members which may be positioned upon the digital model of the dentition or which may be attached or otherwise formed on a mold of the dentition (which may be scanned as a digital model), may be configured in different shapes.
One variation of a template guide for positioning an orthodontic attachment may generally comprise a formed body defining a receiving channel configured to conform to an occlusal surface of one or more teeth of a patient while a remainder of surfaces of the one or more teeth remain exposed and a reference surface or shelf extending along a length of the formed body and projecting at a predetermined angle, wherein the reference surface is configured for locating a bracket attachment upon the surfaces of the one or more teeth.
One variation of a method of forming a template guide for use with an orthodontic attachment may generally comprise receiving a digital model of one or more teeth of a patient, positioning one or more attachments upon the one or more teeth within the digital model, connecting the one or more attachments laterally along a three-dimensional line, deriving a profile from an occlusal plane based on the three-dimensional line, and extruding the profile towards a base of the digital model.
While the brackets to be bonded to the surface of the crown may be freely placed using the experience of the practitioner, a template guide which is positionable upon the dentition of the patient and which provides a reference surface or shelf may facilitate the rapid attachment of brackets upon the crown surfaces without overly restricting the flexibility or judgment of the practitioner in determining bracket placement.
As part of the treatment planning, a three-dimensional (3D) digital scan of the patient's dental arch prior to treatment is typically obtained using any number of scanning methodologies and processes. Using the 3D digital scan, any number of malocclusions may be corrected using various orthodontic appliances such as braces with archwires, aligners, etc. Particular treatment planning processes are described in further detail in U.S. Pat. Nos. 10,624,717; 10,335,250; 10,631,953; 10,357,336; 10,357,342; 10,588,723; 10,548,690, as well as U.S. Pat. Pubs. 2017/0100208; 2019/0321135; 2020/0205936; 2019/0343602; 2020/0170762; 2018/0078343; 2018/0078344; 2018/0078335; 2020/0146775. The details of these references are incorporated herein by reference in their entirety and for any purpose.
One variation of a template guide is illustrated in the front, side, and perspective views of
As shown, the mold 10 of the dentition may incorporate the one or more bracket guide attachment members 12 formed either directly upon the one or more teeth (buccal or lingual surfaces) or they may be attached separately. The bracket guide attachment members 12 may form an interface surface which extends from the surface of the crown (e.g., buccal surface) upon which the template guide 14 may conform to result in the formation of the reference surface or shelf 16. Each of the bracket guide attachment members 12 (or a select few) may also incorporate an indicator of where the midline of each crown is located to provide yet another reference point for the practitioner in placing and attaching the bracket upon the teeth.
With the bracket guide attachment members 12 attached or formed upon the mold 10, the template guide 14 may be formed upon the dentition and bracket guide attachment members 12 such that the template guide 14 are conformed against the occlusal surfaces of the teeth and bracket guide attachment members 12. In this manner, the resulting template guide 14 may be formed much like an aligner which may be removably placed upon the occlusal surfaces of the patient's teeth and which position the reference surface or shelf 16 to extend away (e.g., orthogonally) from the surface of the teeth (e.g., buccal surfaces).
As described, once the individual attachment members are positioned upon the teeth and the digital model of the dentition is reverted back to its initial position, as shown in perspective view of the digital model 60 of
With the digital model created of the teeth in their initial position, as described herein, a positive mold of the dentition with attachment members and reference surface or shelf may be fabricated and a template guide 70 may be formed upon the mold. The resulting template guide 70 may correspondingly fit upon the dentition of the patient having the reference surface or shelf formed. Alternatively, the template guide 70 may be fabricated directly using any number of direct printing or additive fabrication techniques to form the resulting template guide 70.
With the template guide 70 secured accordingly, the practitioner may position an orthodontic bracket attachment 92 upon the surface of the crown, as shown in
Although the orthodontic attachments are illustrated as bracket attachments 92, the application of the apparatus and methods described herein are not limited to the use of brackets may include any type of orthodontic attachments which are adhered or otherwise secured to the patient's teeth. Examples of various orthodontic attachments which may be used with the embodiments herein may include, but are not limited to, brackets, aligner attachments, clear aligner attachments, tubes, buttons, motion devices, power arms, etc.
Once each of the bracket attachments 92 have been adhered to the respective crown, the template guide 70 may be removed from the dentition to allow for the engagement of the archwire 96 to the bracket attachments 92. Alternatively, the template guide 70 may be left in place while the archwire 96 is positioned to engage each of the bracket attachments 92, as shown in
The bracket guide attachment members which may be positioned upon the digital model of the dentition or which may be attached or otherwise formed on a mold of the dentition (which may be scanned as a digital model), may be configured in different shapes. One variation is shown in the perspective views of
Another variation of the bracket guide attachment member 120 is shown in the perspective views of
While different features are discussed, the system may incorporate any number of different features into a single system in any number of combinations. A single system provided may, for example, include or incorporate every feature described herein or it may include a select number of features depending upon the desired system.
The applications of the devices and methods discussed above are not limited to the one described but may include any number of further treatment applications. Modification of the above-described assemblies and methods for carrying out the invention, combinations between different variations as practicable, and variations of aspects of the invention that are obvious to those of skill in the art are intended to be within the scope of the claims.
This application claims priority to U.S. Patent Application No. 63/234,805 filed Aug. 19, 2021, the content of which is incorporated herein by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 63234805 | Aug 2021 | US |
