Patent Grant
12048603
Not Applicable.
This invention relates to methods and devices for closing a space between teeth and/or papilla regeneration.
Gaps or “diastemas” can be present between the teeth for a variety of reasons. These include genetic and ethnic trends where there is a tooth-jaw discrepancy wherein the teeth are too small for the jaws or jaws too large for the tooth size. It is also common for the gums to recede over time creating black triangles or spaces referred to as gingival diastemas. Also, it has been reported that almost 40% of adult orthodontic treatments result in black triangles, which patients may consider a greater aesthetic issue than crowded teeth.
Black triangles have many etiologies including: (i) decreased interproximal bone height from periodontal disease, attachment loss, periodontal surgery, or trauma; (ii) excessive embrasure space and deficient papilla form affected by root angulation, interradicular distance, crown form, and distance between alveolar bone and interproximal contact; (iii) patients' biologic width and inherent or thinning gingival biotype; and (iv) other: age, patient habits, iatrogenic issues. In the modern era of cosmetically aware patients, dentists are often asked to close small and large diastemas.
The question of how to treat open gingival embrasures, or “black triangle disease,” has largely stumped dental professionals. Conventional solutions for black triangles include: (i) orthodontic extrusion, to coronally reposition interproximal bone, and subsequent enameloplasty or restoration; (ii) orthodontic repositioning of divergent roots or widely spaced roots along with enameloplasty to narrow the embrasure space and encourage gingival adaptation; (iii) interproximal bone graft; (iv) soft-tissue graft or papilla reconstruction; (iv) subtractive porcelain restorations or composite bonding (white and/or pink); and (v) removable prosthesis in severely compromised cases.
Reviewing the clinical options, the reasonable choices are papilla reconstruction for limited areas or orthodontics, either alone or with restorative options. Yet, what if the defects are extensive or large; or what if orthodontics has contributed to the problem, and is no longer part of the solution? Orthodontic resolutions are limited by parameters for maintaining an aesthetic maxillary central width-to-height (W/H) ratio of 80% (±5%), aesthetically pleasing relative proportions of maxillary anteriors, and Bolton ratios for appropriate interarch relationships. Surgical options are unpredictable and may not be reasonable for extensive areas. Indirect restorations can extract a high biologic cost. Many patients are unwilling to sacrifice sound tooth structure to treat black triangles, especially if the condition can progress with age. Historically, composite bonding has been too difficult to obtain a long-term healthy and aesthetic result. Black triangles in the aesthetic zone were treated only if requested; the treatment was definitely not considered for the entire mouth.
Most of the solutions to black triangles focus on amplifying the deficient papilla in an attempt to recreate the ideal balance of pink (the soft tissue) and white (the hard tissue or restoration) aesthetics. Dental professionals strive for perfection in orthodontic treatment of children. With adults, dental professionals need a reasonable solution for a compromised clinical situation. As much as dental professionals should strive for an ideal solution, if all else fails, or if the morbidity with treatment is high, should dental professionals accept the best compromise? When considering aesthetic tolerances in dentistry, both dentists and laypersons tolerate asymmetries in pink aesthetics more than asymmetries in white aesthetics. White aesthetics seemingly trump pink aesthetics, likely due to how our eyes see more of a stark contrast. For most patients, noninvasively replacing a black triangle with something that is white (tooth colored) may be a preferable compromise over unpredictable surgical options to replace pink soft tissue.
U.S. Pat. No. 8,393,897 entitled “Methods And Devices For Diastema Closure” to David J. Clark describes unique methods and devices providing a direct restorative solution to black triangles. It is very different from traditional composite bonding in technique and results. Among other things, U.S. Pat. No. 8,393,897 provides a matrix and method to treat the esthetic, functional and health problems associated with a dental black triangle or also referred to clinically as a recessed gingival papilla. The method of U.S. Pat. No. 8,393,897 is described as placement of a matrix around the tooth with a cervical bulge that has a pronounced curvature that simultaneously broadens the contact area to lessen the space between the teeth and also to put lateral pressure on each side of the papilla. This creates a “water balloon effect” as the lateral pressure on both sides of the residual gingiva encourages the papilla to creep incisally (i.e., toward the chewing surface of the tip to form a pointed apex to fill the space vertically). If a contact is within five millimeters of the bone underneath the gingiva near the contact area, a papilla will have sufficient support to form a complete papilla. In other words, once a change is made to move the contact point by growing the volume of the tooth until the contact area is no more than five millimeters away from the underlying bone, the triangular shaped papilla will fill the space completely.
Even with the advancements provided in U.S. Pat. No. 8,393,897, there is a need for further advancement in devices and methods for diastema closure and papilla regeneration.
The foregoing needs are met by the present disclosure which provides a kit that includes a more complete and easier to use and easier to understand method to measure the size of the recessed gingival papilla space, to select appropriate shaped dental matrices for a variety of sizes and shapes of residual spatial defects. In addition, the present disclosure provides advancements to the specific shape of the dental matrix that can create a more predictable process and more predictable shapes and healthier contact areas of adjacent teeth.
In one aspect of the present disclosure, there is provided a dental matrix comprising a curved strip of material. The strip can have a length from a first end to a second end sufficient to create a form for molding a restorative material to a surface of a tooth being restored. The strip can have a side surface including a radius and an interruption in the radius with a flat area in an intermediate section of the matrix. The intermediate section is located at a contact area of the tooth being restored when the matrix is placed on the tooth being restored. As one example, the interruption in the radius can be within a range of 12 millimeters to 1 millimeter in size from a top end to a bottom end of the interruption. In another non-limiting example, the interruption in the radius can be within a range of 1.5 millimeters to 0.25 millimeters in size from a front end to a back end of the interruption. Specifically, the interruption in the radius can be approximately 4 millimeters in size from the top end to the bottom end, and the interruption in the radius can be 1.5 millimeters in size from the front end to the back end of the interruption. The interruption in the radius can be flattened in both an occlusal direction from a center of the side surface and a gingival direction from the center of the side surface. In another example, the interruption in the radius can be flattened in both a buccal direction from the center of the side surface to a lingual direction from the center of the side surface. In another non-limiting example, the matrix can include a cutaway defined by a section of a gingival edge of the strip. The gingival edge can further include a concave portion, a first convex portion, and a second convex portion in a side view, such that the section of the gingival edge of the strip corresponds in shape to a coronally directed projection of gingival papilla adjacent the tooth. The material of the dental matrix can be translucent.
In yet another aspect of the present disclosure, there is provided a kit comprising a plurality of dental matrices. The plurality of matrices can include a first matrix and a second matrix. In one example, the first matrix of the plurality of matrices can comprise a first curved strip of material. The first strip can have a length from a first end to a second end and a height from a third end to a fourth end. The length and height of the first strip can be sufficient to create a form for molding a restorative material to a surface of a tooth being restored. The first strip can have a side surface including a radius and an interruption in the radius with a flat area in an intermediate section of the first matrix. The second matrix of the plurality of matrices can comprise a second curved strip of material. The second strip can have a length from a first end to a second end and a height from a third end to a fourth end. The length and height of the second strip can be sufficient to create a form for molding a restorative material to a surface of another tooth being restored. The second strip can have a side surface including a radius and an interruption in the radius with a flat area in an intermediate section of the second matrix. The first matrix and the second matrix can have different overall sizes to fit different teeth height, teeth width, or both teeth height and teeth width to fit varying sizes and shapes of both anterior and posterior teeth, maxillary and mandibular teeth. In one non-limiting example, the first matrix and the second matrix can be tooth specific, tooth type specific, and tooth surface specific.
In another non-limiting example, the present disclosure provides a method for closing a space between a first tooth and a second tooth. The method can comprise providing the plurality of matrices, inserting a root end section of a first dental matrix into the sulcus between gingival papilla and a gingival portion of the first tooth. Thereafter, the method can include placing a composite restorative material between the first dental matrix and a surface of the first tooth, and thereafter curing the composite restorative material. The method can further comprise inserting a root end section of the second dental matrix into the sulcus between gingival papilla and a gingival portion of the second tooth. The method can further comprise placing a second composite restorative material between the second dental matrix and a surface of the second tooth and thereafter curing the second composite restorative material. The space can be selected from a diastema space, a naturally occurring space, a black triangle space, and a missing tooth space.
In another aspect of the present disclosure, there is provided a dental matrix which can have a curved strip of material. The strip can have a length from a first end to a second end sufficient to create a form for molding a restorative material to a surface of a tooth being restored. The strip can also have a side surface, which can include a radius and an interruption in the radius with a flattened area in an intermediate section of a matrix located at a contact area of the tooth being restored when the matrix is placed on the tooth being restored. In one example of the present disclosure, the flattened area can have a second radius of curvature that can be larger than a first radius of curvature of a section of the side surface adjacent the flattened area. The interruption in the radius can be within a range of 12 millimeters to 1 millimeter in size from a top end to a bottom end of the interruption. The interruption in the radius can also be within a range of 1.5 millimeters to 0.25 millimeters in size from a front end to a back end of the interruption. As a non-limiting example, the interruption in the radius can be approximately 4 millimeters in size from the top end to the bottom end of the interruption, and the interruption in the radius can be approximately 1.5 millimeters in size from the front end to the back end of the interruption. The interruption in the radius can be flattened in both an occlusal direction from a center of the side surface and a gingival direction from the center of the side surface. In another example, the interruption in the radius can be flattened in both a buccal direction from the center of the side surface to a lingual direction from the center of the side surface. In another non-limiting example, the matrix can include a cutaway defined by a section of a gingival edge of the strip. The gingival edge can further include a concave portion, a first convex portion, and a second convex portion in a side view, such that the section of the gingival edge of the strip corresponds in shape to a coronally directed projection of gingival papilla adjacent the tooth. The material of the dental matrix can be translucent.
In another aspect of the present disclosure, there is provided a kit which can comprise a plurality of matrices. The plurality of matrices can include a first matrix of the plurality of matrices can comprise a first curved strip of material. The first strip can have a length from a first end to a second end and a height from a third end to a fourth end. The length and height of the first strip can be sufficient to create a form for molding a restorative material to a surface of a tooth being restored. The first strip can have a side surface which can include a radius and an interruption in the radius with a flattened area in an intermediate section of the first matrix. The plurality of matrices can also include a second matrix of the plurality of matrices. The second matrix can further comprise a second curved strip of material. The second strip can have a length from a first end to a second end and a height from a third end to a fourth end, the length and height of the second strip being sufficient to create a form for molding a restorative material to a surface of another tooth being restored, the second strip can have a side surface which can include a radius and an interruption in the radius with a flattened area in an intermediate section of the second matrix, wherein the first matrix and the second matrix can have different overall sizes to fit different teeth, height, teeth width and both teeth height and teeth width to fit varying sizes and shapes of both anterior and posterior teeth, maxillary and mandibular teeth. The first matrix and the second matrix can be tooth specific, tooth type specific, and tooth surface specific.
As one example of the present disclosure, there is provided a method for closing a space between a first tooth and a second tooth that can comprise providing a plurality of the dental matrices. The dental matrices can include a first dental matrix of the plurality and a second dental matrix of the plurality. The method can further comprises inserting a root end section of the first dental matrix into the sulcus between gingival papilla and a gingival portion of the first tooth. Thereafter, the method can include placing a composite restorative material between the first dental matrix and a surface of the first tooth, and curing the composite restorative material. The method can further comprise inserting a root end section of the second dental matrix into the sulcus between the gingival papilla and a gingival portion of the second tooth, then placing a second composite restorative material between the second dental matrix and a surface of the second tooth, and thereafter curing the second composite restorative material. The space can be selected from a diastema space, a naturally occurring space, a black triangle space, and a missing tooth space.
In another aspect of the present disclosure, there is provided a dental matrix, wherein the dental matrix can comprise a curved strip of material. The strip can have a length from a first end to a second end sufficient to create a form for molding a restorative material to a surface of a tooth being restored. The strip can also have a side surface including a radius and an interruption in the radius with a concave area in an intermediate section of matrix located at a contact area of the tooth being restored when the matrix is placed on the tooth being restored. As one example, the interruption in the radius can be within a range of 12 millimeters to 1 millimeter in size from a top end to a bottom end of the interruption. In another non-limiting example the interruption in the radius can be within a range of 1.5 millimeters to 0.25 millimeters in size from a front end to a back end of the interruption. Specifically, the interruption in the radius can be approximately 4 millimeters in size from the top end to the bottom end, and the interruption in the radius can be 1.5 millimeters in size from the front end to the back end of the interruption. The interruption in the radius can be concave in both an occlusal direction from a center of the side surface and a gingival direction from the center of the side surface. In another example, the interruption in the radius can be concave in both a buccal direction from the center of the side surface to a lingual direction from the center of the side surface. In another non-limiting example, the matrix can include a cutaway defined by a section of a gingival edge of the strip. The gingival edge can further include a concave portion, a first convex portion, and a second convex portion in a side view, such that the section of the gingival edge of the strip corresponds in shape to a coronally directed projection of gingival papilla adjacent the tooth. The material of the dental matrix can be translucent.
In yet another aspect of the present disclosure, there is provided a kit which can comprise a plurality of dental matrices. The plurality of matrices can include a first matrix and a second matrix. In one example, the first matrix of the plurality of matrices can comprise a first curved strip of material. The first strip can have a length from a first end to a second end and a height from a third end to a fourth end. The length and height of the first strip can be sufficient to create a form for molding a restorative material to a surface of a tooth being restored. The first strip can have a side surface including a radius and an interruption in the radius with a concave area in an intermediate section of the first matrix. The second matrix of the plurality of matrices can comprise a second curved strip of material. The second strip can have a length from a first end to a second end and a height from a third end to a fourth end. The length and height of the second strip can be sufficient to create a form for molding a restorative material to a surface of another tooth being restored. The second strip can have a side surface including a radius and an interruption in the radius with a concave area in an intermediate section of the second matrix. The first matrix and the second matrix can have different overall sizes to fit different teeth height, teeth width, or both teeth height and teeth width to fit varying sizes and shapes of both anterior and posterior teeth, maxillary and mandibular teeth. In one non-limiting example, the first matrix and the second matrix can be tooth specific, tooth type specific, and tooth surface specific.
In another non-limiting example, the present disclosure provides a method for closing a space between a first tooth and a second tooth. The method can comprise providing the plurality of matrices, as described above, inserting a root end section of a first dental matrix into the sulcus between gingival papilla and a gingival portion of the first tooth. Thereafter, the method can include placing a composite restorative material between the first dental matrix and a surface of the first tooth, and thereafter curing the composite restorative material. The method can further comprise inserting a root end section of the second dental matrix into the sulcus between gingival papilla and a gingival portion of the second tooth. The method can further comprise placing a second composite restorative material between the second dental matrix and a surface of the second tooth and thereafter curing the second composite restorative material. The space can be selected from a diastema space, a naturally occurring space, a black triangle space, and a missing tooth space.
In yet another aspect of the present disclosure, there is provided a measuring gauge which can include a handle section and a distal end section connected to the handle section. The distal end section can include graduated sections with different widths, and can be dimensioned to measure a space between teeth in order to select a dental matrix for closing the space between teeth. The distal end section can be used to measure a space between teeth in order to select the dental matrix or a pair of the dental matrices. The space can be selected from a diastema space, a naturally occurring space, a black triangle space, and a missing tooth space. The widths can be in a range from 0.25 millimeters to 5 millimeters and can have an abrupt transition between sizes. The distal end section can have an even and smooth transition between widths, can be round, or triangular in cross section. The widths can be equal steps in size and can be in increments of 0.25 millimeters, 0.5 millimeters, or 1 millimeter.
In another aspect of the present disclosure, there is provided a kit which can comprise a measuring gauge and a plurality of dental matrices. The measuring gauge can further comprise a handle section, and a distal end section connected to the handle section. The distal end section can include graduated sections with different widths, wherein the gauge can include a different indicia associated with each of the widths. The plurality of dental matrices can each comprise a curved strip of material. The strip can have a length from a first end to a second end sufficient to create a form for molding a restorative material to a surface of a tooth being restored, wherein a first of the dental matrices can have a first matrix indicia corresponding to one of the different indicia of the gauge, and a second of the dental matrices can have a second matrix indicia corresponding to another of the different indicia of the gauge. In another non-limiting example, an interruption in the radius can be a flat, flattened, or concave area in an intermediate section of matrix located at a contact area of the tooth being restored when the matrix is placed on the tooth being restored. The flattened area can have a radius of curvature that is larger during the flattened section. In another non-limiting example, the first matrix indicia can be a first color, a first number, a first letter, and a first symbol and the second matrix indicia can be a second color, a second number, a second letter, and a second symbol. In another non-limiting example, the kit can further comprise a tooth chart with symbols so that a user can record each of the different widths and check off an appropriate box with a corresponding matrix of the plurality of dental matrices for each of the different widths. The first of the dental matrices can include a convex inner surface at a root crown junction that extends into a second section thereby forming a bulge for positioning adjacent a gum line of the tooth being restored for closure of a space between the tooth being restored and an adjacent tooth. The second of the dental matrices can include a convex inner surface at a root crown junction that extends into a second section thereby forming a bulge for positioning adjacent a gum line of the tooth being restored for closure of a space between the tooth being restored and an adjacent tooth, wherein the bulge of the first of the dental matrices and the bulge of the second of the dental matrices can have different sizes.
In yet another aspect of the present disclosure, there is provided a method for closing a space between a first tooth and a second tooth. The method can comprise: (i) providing a plurality of dental matrices, (ii) measuring a width of the space with a digital camera or digital scanner, (iii) choosing one of the plurality of matrices by matching the indicia to the width, (iv) inserting a root end section of the one of the plurality of matrices into the sulcus between gingival papilla and a gingival portion of the first tooth, (v) placing a composite restorative material between the one of the plurality of matrices and a surface of the first tooth, and (vi) curing the composite restorative material. Each of the plurality of dental matrices can have an indicia of size. A first matrix of the plurality of matrices can comprise a first curved strip of material. The first strip can have a length from a first end to a second end and a height from a third end to a fourth end, wherein the length and height of the first strip being sufficient to create a form for molding a restorative material to a surface of a tooth being restored. The first strip can have a side surface which can include a radius and an interruption in the radius with a flat area in an intermediate section of the first matrix. The plurality of matrices can further include a second matrix which can comprise a second curved strip of material. The second strip can have a length from a first end to a second end and a height from a third end to a fourth end, wherein the length and height of the second strip being sufficient to create a form for molding a restorative material to a surface of another tooth being restored. The second strip can have a side surface which can include a radius and an interruption in the radius with a flat area in an intermediate section of the second matrix, wherein the first matrix and the second matrix have different overall sizes to fit different teeth height, teeth width or both teeth height and teeth width to fit varying sizes and shapes of both anterior and posterior teeth, maxillary and mandibular teeth. The method can further include a software that suggests the one of the plurality of matrices. In one non-limiting example, choosing one of the plurality of matrices by matching the indicia to the width can further comprise printing or milling the one of the plurality of matrices using a milling or printing machine in a remote facility to be shipped to a user based on the width of the space measured by the camera or the scanner and a computed file created for the printing or milling, and printing or milling the one of the plurality of matrices using a chairside office printer or milling machine that makes the one of the plurality of matrices for immediate use.
In another aspect of the present disclosure, there is provided a method for overmolding or molding a dental restorative material on a tooth. The method can comprise: (i) measuring dimensions of a space adjacent the tooth with a digital camera or digital scanner, and (ii) printing or milling a dental matrix based on the dimensions to create a form for overmolding or molding the restorative material in the space. As one example, the method can further comprise steps: (iii) placing a composite restorative material between the dental matrix and a surface of the tooth, and (iv) thereafter curing the composite restorative material. Printing or milling a dental matrix based on the dimensions to create a form for overmolding or molding the restorative material in the space can further comprise printing or milling the dental matrix using a chairside office printer or milling machine that makes the matrix for immediate use.
In yet another aspect of the present disclosure, there is provided a method for restoring or adding a tooth. The method can comprise: (i) using a gauge, a digital scanner, an x-ray device, an ultrasonic device, an MRI imaging device, or another imaging device to record a shape of a tooth digitally, (ii) digitally creating a design for a new tooth to restore a broken, diseased or worn tooth or to add to a tooth for cosmetic or functional reasons, and (iii) printing or milling either chairside or remotely a dental matrix or a set of dental matrices to be placed on or around the tooth to allow injection molding and injection over-molding of the tooth.
In another aspect of the present disclosure, there is provided a measuring gauge. The gauge can comprise a handle section, and a distal end section connected to the handle section. The distal end section can include a plurality of contiguous surface sections, wherein each surface section can be dimensioned to have one of a plurality of different indicia to be used as a gauge to select an appropriate thickness of light curable flowable composite resin to be placed in a cavity preparation. Each of the plurality of different indicia can be a different color, a different number, or a different symbol. The plurality of contiguous surface sections can comprise: (i) a first surface section which can have a first longitudinal length extending from a tip of the distal end section to a proximal end of the first surface section, wherein the first longitudinal length corresponding to a depth of cure value of the light curable flowable composite resin, and (ii) a second surface section extending proximally from the proximal end of the first surface section. As one example, the plurality of contiguous surface sections can comprise: (i) a first surface section which can have a first longitudinal length extending from a tip of the distal end section to a proximal end of the first surface section, the first longitudinal length corresponding to a first depth of cure value of the light curable flowable composite resin at a first location in the cavity preparation, (ii) a second surface section extending proximally from the proximal end of the first surface section such that a second longitudinal length extending from the tip of the distal end section to a proximal end of the second surface section corresponds to a second depth of cure value of the light curable flowable composite resin at a second location in the cavity preparation, and (iii) a third surface section extending proximally from the proximal end of the second surface section.
As another non-limiting example, the present disclosure provides a method for restoration of a tooth. The method can comprise: (i) removing a portion of the tooth to form a hollow cavity preparation, (ii) inserting the distal end section of the gauge into the hollow cavity preparation until a tip of the distal end section of the gauge contacts a bottom surface of the cavity preparation, (iii) observing a location of an upper edge of the cavity preparation relative to the distal end section of the gauge and choosing one of the surface sections that is closest to the upper edge of the cavity preparation, (iv) injecting a depth of light-curable flowable composite resin into the cavity preparation based on the indicia of the one of the surface sections that is closest to the upper edge of the cavity preparation, and (v) light curing the flowable composite contained in the cavity preparation.
It is an advantage of the present invention to provide methods and devices for closing a space and/or papilla regeneration between teeth that provide rounded marginal profiles.
It is another advantage of the present invention to provide methods and devices for closing a space and/or papilla regeneration between teeth that do not compromise the root-crown architecture.
It is yet another advantage of the present invention to provide methods and devices for closing a space and/or papilla regeneration between teeth that provide for bulbousness near the gum line to fill the gingival gapping.
It is still another advantage of the present invention to provide a matrix for closing a space and/or papilla regeneration between teeth wherein the matrix has an anatomic shape in the gingival portion but then with varying levels of exaggerated profile at the root-crown junction.
It is yet another advantage of the present invention to provide a matrix for closing a space and/or papilla regeneration between teeth wherein the matrix is a sectional matrix that is specific to the anterior teeth and specifically designed for diastema closure with bonded composite filling material.
It is still another advantage of the present invention to provide a matrix for closing a space and/or papilla regeneration between teeth wherein the matrix is a matrix specifically designed for the closure of diastema (tooth gapping).
It is yet another advantage of the present invention to provide a matrix for closing a space and/or papilla regeneration between teeth wherein the matrix is a sectional matrix that is tooth specific.
It is still another advantage of the present invention to provide a matrix for closing a space and/or papilla regeneration between teeth wherein the matrix is a sectional matrix that is tooth and surface specific with an exaggerated root-crown profile.
It is yet another advantage of the present invention to provide devices for closing a space and/or papilla regeneration between teeth with precise fit of custom matrices that allows the matrices to be used without interdental wedges or elastic separators or spacers.
It is still another advantage of the present invention to provide methods and devices for closing a space and/or papilla regeneration between teeth that allow for formation of aesthetically pleasing papilla between adjacent teeth after diastema closure.
It is yet another advantage of the present invention to provide methods and devices for closing a space and/or papilla regeneration between teeth that avoid subsequent deterioration in periodontal health after diastema closure.
It is still another advantage of the present invention to provide a matrix for closing a space and/or papilla regeneration between teeth wherein the matrix can slide to the depth of the sulcus without lacerating the tissue.
These and other features, aspects, and advantages of the present invention will become better understood upon consideration of the following detailed description, drawings and appended claims.
Like reference numerals will be used to refer to like parts from Figure to Figure in the following description of the drawings.
Referring to
In a smaller space, the matrix 1 can “bully” the other matrix 1a, and the convexity of the side surface 5 of matrix 1 on the left crumples the side surface 5a of matrix 1a on the right in mid tooth. See
To alleviate the problem with improperly altered shapes of a matrix, such as that shown in the examples of
The present disclosure provides advancements that eliminate the problems identified with reference to
Referring now to
Still looking at
A light curable flowable composite resin is then injected directly on the resin tooth bonding agent (under magnification if possible) without incorporating bubbles. A tiny amount of the light curable flowable composite resin is expressed before placement to ensure that there is no air in the cannula. The light curable flowable composite and resin tooth bonding agent are not light cured at this point. Generally, light curable flowable composite resins contain 20-25 percent less filler in the light curable polymeric material than nonflowable paste materials. Light curable flowable composite resins are available under tradenames such as Filtek™, Flow-It™, EsthetX®, Revolution®, AeliteFlo®, PermaFlo®, Dyract Flow®, Tetric®, and Heliomolar®. Light curable resins could be preferred as light cured resins can be more color stable than chemically cured resins. However, chemical cure or any type of polymerization/hardening/curing of the filling material can also be used. The use of a metallic matrix may dictate the use of a chemical cure. Also, the method is not limited to flowable composite resins with lesser filler particles. One example variation includes an initial placement of a more flowable composite first, which can include flowable composites that are made less viscous than paste composite materials by virtue of lower filler content, but also from thixotropic effect of extrusion thru a small orifice tip, heating of a highly filled paste material that has temporary decreased viscosity to allow more flow and easier placement; or any modification of the paste through chemical and filler content formulation change, temporary or transitional viscosity decrease thru heat, and or pressure and or other physical effect.
A light curable paste composite resin is then extruded onto the flowable composite resin and resin tooth bonding agent without creating air bubbles, allowing the composite resin to displace some of the lesser filled flowable composite resin and resin tooth bonding agent (under magnification if possible). Composite resins are available under tradenames such as 3M Z100™, 3M Filtek Supreme™, and Prodigy®. The next steps are burnishing, carving the anatomy and carving excess composite. There is no need to use a condenser or plugger. Immediately after using the injection molding technique, the matrices 13, 14 move nicely to close the incisal gap but continue to hug the cervical area of the teeth. The gingival sulcus itself provides stabilization. Alternatively, other products such as silicon stabilizer specific or non-specific wedges also can be used with the matrix depending on the specific case or operator preference. Wedges can press the matrix against the root of the tooth. While traditional wedges can smash the exaggerated crown-root junction profile of the matrix, certain wedges may work with delicate stabilization. If a metallic matrix or thick polymeric matrix is used, a traditional wedge will not smash the exaggerated crown-root junction profile of the matrix.
The filled preparation is then cured using a curing light such as high intensity light emitting diode (LED) lights, plasma-arc curing lights, halogen lights, and laser lights. The matrices 13, 14 are then removed, and the restored maxillary central incisors are polished with discs, strips, and rubber tipped and carbide burs. A seamless filling is achieved.
In
In
In
Thus, a method of the present disclosure to determine the actual clinical width of the black triangle that corresponds to the appropriate matrix utilizes a graduated gauge 90 that can be inserted between the teeth to record a measurement of the size (e.g., width in millimeters) of the black triangle. It should be appreciated that the use of the colors blue, green, yellow and pink in the sections 95, 96, 97, 98 of the graduated gauge 90 and the matrices 13, 14, 17, 18, 21A, 21B, 24 and 25 is a non-limiting example embodiment of the invention. Other colors can be used as indicia to match the size of the space to the pair of matrices. Alternatively, each surface section 95, 96, 97, 98 of the graduated gauge 90 can have a different indicia to be used as a gauge to select the matrices. The different indicia can be different numbers, or different symbols, for example. In addition, the graduated gauge 90 may have a different number of indicia coded sections to match a different number of indicia coded matrices. Also, alternative matrix selection tools can be used in place of the graduated gauge 90. For example, the width of the space can be measured using optical measuring devices. The width obtained using such an optical measuring device can be matched to a pair of matrices by looking at table correlating the measured width to a color of the proper pair of matrices. Furthermore, the graduated gauge 90 and the matrices 13, 14, 17, 18, 21A, 21B, 24 and 25 can be used between any neighboring teeth, not just the maxillary central incisors described in
A kit of the present invention may include a matrix selection tool (e.g., the graduated gauge 90) and a supply of a plurality of each of the indicia (e.g., color) coded matrices which may have different curvatures, from mild to aggressive that are designed to be sold in at least four degrees of curvature. The multiple matrices with differing amounts of gingival curve or bulge of the matrix accommodate different sizes of black triangles to treat different widths of black triangles, an enhancement in the contact area.
In
In
In
Thus,
As another advantage, the matrices 13, 14, 17, 18, 21A, 21B, 24 and 25 can be tooth specific. For example: maxillary central incisor, maxillary lateral incisor, maxillary canine, mandibular incisor, etc. Alternatively, the matrices 13, 14, 17, 18, 21A, 21B, 24 and 25 can simply go from small to large to accommodate different teeth with variations in size present in all human dentitions. There is also a wide range difference in sizes between different sized patients, such as small females to large males. A central incisor, for example can vary between 7 millimeters in width up to 11 millimeters in width. By “tooth specific”, it is meant that at least a section of the matrix 13, 14, 17, 18, 21A, 21B, 24 and 25 is configured to conform to the shape of the outer surface of the specific natural tooth being restored, such as (without limitation) a maxillary lateral incisor.
As another advantage, the matrices 13, 14, 17, 18, 21A, 21B, 24 and 25 can be tooth type specific. By “tooth type specific” it is meant that at least a section of the matrix is configured to conform to the shape of the outer surface of the specific type of natural tooth such as (without limitation) an incisor.
As another advantage, the matrices 13, 14, 17, 18, 21A, 21B, 24 and 25 can be tooth surface specific. By “tooth surface specific” it is meant that at least a section of the matrix is configured to conform to the shape of the outer surface of the specific natural tooth surface such (without limitation) a lingual or buccal incisor surface.
Referring now to
The matrix 130 has a root end section 132 that is anatomic in shape. The root end section 132 terminates at a gingival edge 138. The actual anatomic shapes of the root end section 132 of the matrix 130 can be created from scans of natural teeth, molds of natural teeth, and/or molds of tooth models. Thus, by “anatomic”, it is meant that the root end section 132 of the matrix 130 has an inner surface that conforms to the shape of the outer surface of a particular region of the natural tooth that contacts the root end section 132 of the matrix 130.
The mesial side of the root end section 132 of the matrix 130 has an upward cut away 136 creating a gingival edge 138 that corresponds in shape to an upward projection of gingival papilla at the gingival margin 119 adjacent the tooth 111 and underlying periodontal and bony attachments of the tooth 111. The distal side of the root end section 132 of the matrix 130 can also have an upward cut away 136 creating a gingival edge 138 that corresponds in shape to an upward projection of gingival papilla at the gingival margin 119 adjacent the tooth 111 and underlying periodontal and bony attachments of the tooth 111. The root end section 132 of the matrix 130 can be fully or partially anatomic. As a result, the matrix 130 can be used without interdental wedges or elastic separators or spacers. The anatomic shape allows hands-free and wedge-free use as the matrix 130 hugs the tooth 111. The root end section 132 can have a vertical dimension in the range of 0.5 to 2 millimeters. The sectional matrix 130 has a second section 134 that is integral with the root end section 132. In the non-limiting embodiment of
Turning now to
The sectional matrix 230 has a second (crown root junction profile) section 234 that is integral with the root end section 232. The second section 234 is not anatomically shaped to conform to the shape of the outer surface 218 of the incisor I. The outer surface 218 may have been created by removal of portions of the incisor I. Specifically, looking at
Because gingiva adapts to a wide range of shapes, clinicians can now create convenient interproximal shapes using a pair of complementary matrices 13, 14, 17, 18, 21A, 21B, 24, 25, 130 and 230 where the restorations are smooth and without a sharp marginal ledge. Bridge abutments and exotic implant emergence profiles have aptly demonstrated this clinical reality. Restoratively driven papilla regeneration according to the invention should become a viable option for all restorative dentists. Until now, there were very few dedicated tools or techniques for restoratively driven papilla regeneration. Previous attempts at both diastema closure and papilla regeneration using direct composites often ended with significant compromise in periodontal health. The interdental papilla serves as both an esthetic and functional asset, and anatomically ideal interproximal composite shapes formed using the methods of the invention can serve as a predictable scaffold to regain this valuable gingival architecture.
It is becoming increasingly common for dentists to take digital impressions of teeth after grinding a tooth down for purposes of rebuilding the tooth with materials like zirconia, porcelain, gold, etc. The crown or veneer is then milled with CAD CAM and then cemented onto the stump of residual tooth. Sometimes the tooth is scanned before the grinding of the tooth to obtain a form that will be duplicated in the milled restoration.
The grinding of the tooth is traumatic and more conservative treatments are needed. Currently, matrices sold under the trademark Bioclear® provide a myriad of prefabricated shapes but a customized matrix specific for every tooth in every patient would be beneficial.
To meet this need, the present invention also provides a method for using a gauge, a digital scanner, an x-ray device, an ultrasonic device, an MRI imaging device, or another imaging device to record the shape of a tooth digitally. Then designs are made digitally to restore a broken, diseased or worn tooth or to add to a tooth for cosmetic or functional reasons, and then a matrix or a set of matrices are printed or milled either chairside or remotely, to then be placed on or around the tooth to allow injection molding and injection over-molding of said tooth.
When used in dental restoration techniques, light curable composite resins require light in a certain wavelength to excite a photo-initiator, which begins the polymerization process. If the light penetration is insufficient, poor initiation of this reaction can result, which can lead to under-cured or uncured material. The incomplete curing of composite resins is associated with a reduction in their mechanical properties and biocompatibility. As a result, manufacturers and suppliers of dental resins provide recommendations about depth of cure. For example, a manufacturer may recommend the use of some specific light exposure time to cure a two millimeter or four millimeter thickness of composite resin. Accordingly, dentists place light curable flowable composite resins in increments, such as two or four millimeters, to achieve good depth of cure.
With deeper cavity preparations, it can be appreciated that it takes time to place, adapt and cure each increment of a plurality of increments. However, reduction in the number of increments is limited by manufacturer's recommendations on a maximum thickness of composite resin that provides an acceptable depth of cure. Therefore, what is needed is a device that allows a dentist to determine the depth of a cavity preparation so that manufacturer's recommendations on a maximum thickness of composite resin for adequate depth of cure are not exceeded.
The foregoing need is satisfied by a measuring gauge comprising: a handle section; and a distal end section connected to the handle section. The distal end section includes a plurality of contiguous surface sections. Each surface section has a different indicia to be used as a gauge to select an appropriate thickness of light curable flowable composite resin to be placed in a cavity preparation. The different indicia can be different colors, or different numbers, or different symbols.
In a method of the present disclosure, a tooth can be restored using the steps of: (a) removing a portion of the tooth to form a hollow cavity preparation; (b) inserting the distal end section of the gauge into the hollow cavity preparation until a tip of the distal end section of the gauge contacts a bottom surface of the cavity preparation; (c) observing a location of an upper edge of the cavity preparation relative to the distal end section of the gauge and choosing one of the surface sections that is closest to the upper edge of the cavity preparation; (d) injecting a depth of light-curable flowable composite resin into the cavity preparation based on the indicia of the one of the surface sections that is closest to the upper edge of the cavity preparation; and (e) light curing the flowable composite contained in the cavity preparation.
Turning now to
The measuring gauge 390 has a handle section 391, an intermediate section 392 angled 70° with respect to the handle section 391, and a distal end section 388 angled 105° with respect to the intermediate section 392. The distal end section 388 includes a first section 393 color coded red, a second section 394 color coded yellow, and a third section 395 color coded green.
The distal end section 388 of the measuring gauge 390 is inserted into a hollow cavity preparation 397 of a tooth 396 until a tip of the distal end section of the measuring gauge 390 contacts a bottom surface of the cavity preparation 397. See
The third section 395 (color coded green—“go”) may have length of four millimeters from the tip of the distal end section of the measuring gauge 390. The second section 394 (color coded yellow—“caution”) may be located from four to five millimeters from the tip of the distal end section of the measuring gauge 390. The first section 393 (color coded red—“no go”) may be located starting at greater than five millimeters from the tip of the distal end section of the measuring gauge 390. Thus, the non-limiting example measuring gauge 390 is a 4 millimeter (green), 5 millimeter (yellow), and a no go (red) depth gauge as current bulk fill dental composites may have a 4 millimeter and 5 millimeter maximum depth of cure (e.g., interproximal is 5 millimeters, middle of the tooth is only 4 millimeters because of no 3-point curing, i.e., 3-point curing is from occlusal, buccal and lingual which is only possible in the interproximal).
Different manufacturers may have different recommendations on a maximum thickness of a specific composite resin that provides an acceptable depth of cure for the specific composite resin. Therefore, the measuring gauge 390 can be dimensioned specifically for a specific composite resin. For example, one composite resin may have a three millimeter depth of cure specification. A unique measuring gauge could be sold with this composite resin. The measuring gauge can have a second section (color coded green—“go”) with a length of three millimeters from the tip of the distal end section of the measuring gauge. The measuring gauge can have a first section (color coded red—“no go”) having a location starting at greater than three millimeters from the tip of the distal end section of the measuring gauge. Another composite resin may have a two millimeter depth of cure specification. A unique measuring gauge could be sold with this composite resin. The measuring gauge can have a second section (color coded green—“go”) with a length of two millimeters from the tip of the distal end section of the measuring gauge. The measuring gauge can have a first section (color coded red—“no go”) having a location starting at greater than two millimeters from the tip of the distal end section of the measuring gauge. Similar unique measuring gauges can be provided for composite resins having a different depth of cure.
Different manufacturers may have different recommendations on a maximum thickness of a specific composite resin that provides an acceptable depth of cure for the specific composite resin for specific tooth locations. For example, the maximum thickness of a specific composite resin that provides an acceptable depth of cure at an interproximal region of the tooth may be 5 millimeters, whereas an acceptable depth of cure for the same resin at a middle region of the tooth may be 4 millimeters. Therefore, the measuring gauge 390 can be dimensioned specifically for the specific composite resin, and the unique measuring gauge can be sold with this composite resin. A third section 395 of the measuring gauge 390 (color coded green—“go”) may have length of four millimeters from the tip of the distal end section of the measuring gauge 390 indicating that the resin is suitable for filling all tooth locations. The second section 394 (color coded yellow—“caution”) may have a location at four to five millimeters from the tip of the distal end section of the measuring gauge 390 indicating that the resin is suitable for filling interproximal tooth locations. The first section 393 (color coded red—“no go”) may have a location of greater than five millimeters from the tip of the distal end section of the measuring gauge 390 indicating that the resin is not suitable for single layer curing.
Although the invention has been described in considerable detail with reference to certain embodiments, one skilled in the art will appreciate that the present invention can be practiced by other than the described embodiments, which have been presented for purposes of illustration and not of limitation. Therefore, the scope of the appended claims should not be limited to the description of the embodiments contained herein.
This application represents the national stage entry of PCT/US2018/051784 filed Sep. 19, 2018, which claims the benefit of U.S. Provisional Patent Application 62/560,504, filed Sep. 19, 2017, both of which are incorporated by reference herein in their entirety for all purposes.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2018/051784 | 9/19/2018 | WO |
| Publishing Document | Publishing Date | Country | Kind |
|---|---|---|---|
| WO2019/060436 | 3/28/2019 | WO | A |
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| Number | Date | Country | |
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| 20200246114 A1 | Aug 2020 | US |
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| 62560504 | Sep 2017 | US |
