U.S. patent application number 11/404332 was filed with the patent office on 2006-12-07 for treatment of teeth by aligners.
This patent application is currently assigned to OrthoClear Holdings, Inc.. Invention is credited to Frank Zhenhuan Liu, Huafeng Wen.
Application Number | 20060275731 11/404332 |
Document ID | / |
Family ID | 37308452 |
Filed Date | 2006-12-07 |
United States Patent
Application |
20060275731 |
Kind Code |
A1 |
Wen; Huafeng ; et
al. |
December 7, 2006 |
Treatment of teeth by aligners
Abstract
A method for moving a subject's teeth in a dental treatment
includes moving the subject's teeth toward desired positions by one
or more dental aligners. A movement pathway may comprise
determining a number of intermediate movement positions on the way
to achieving a final configuration. In selecting the movement path,
movement in one or more directions may be constrained. Feedback
based on the actual position of the subject's teeth during
treatment may be used to modify the treatment, including the
movement path and aligners.
Inventors: |
Wen; Huafeng; (Redwood City,
CA) ; Liu; Frank Zhenhuan; (San Carlos, CA) |
Correspondence
Address: |
MORRISON & FOERSTER LLP
755 PAGE MILL RD
PALO ALTO
CA
94304-1018
US
|
Assignee: |
OrthoClear Holdings, Inc.
Tortota
VG
|
Family ID: |
37308452 |
Appl. No.: |
11/404332 |
Filed: |
April 13, 2006 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
60676278 |
Apr 29, 2005 |
|
|
|
Current U.S.
Class: |
433/24 |
Current CPC
Class: |
B33Y 80/00 20141201;
A61C 7/00 20130101; A61C 7/08 20130101; G06F 3/0484 20130101; A61C
2007/004 20130101; A61C 7/002 20130101; A61C 9/002 20130101 |
Class at
Publication: |
433/024 |
International
Class: |
A61C 3/00 20060101
A61C003/00 |
Claims
1. A dental treatment method for moving a subject's teeth having
feedback, the dental treatment comprising: producing a first dental
aligner for moving the subject's teeth toward a first target
configuration; analyzing the positions of the subject's teeth after
the subject has worn the first dental aligner; determining a second
target configuration in response to the position of the subject's
teeth after the subject has worn the first dental aligner;
producing a second dental aligner for moving the subject's teeth
toward the second target configuration by: producing a dental base
having receiving features, wherein the receiving features
correspond to the second target configuration for the subject's
teeth, the receiving features configured to receive physical tooth
models; assembling the physical tooth models on the dental base to
form a physical arch model; and forming a second dental aligner
using the physical arch model.
2. The method of claim 1, wherein the physical tooth models
comprise registration features configured to be attached to the
receiving features on the dental base.
3. The method of claim 2, wherein the registration features include
one or more of: pins, protrusions, studs, sockets, slots, and
holes.
4. The method of claim 1, further comprising: creating physical
tooth models from the subject's dental arch by producing a template
physical arch model using an impression of the subject's teeth;
incorporating registration features in the template physical arch
model; and separating the template physical arch model into a
plurality of physical tooth models wherein each of the physical
tooth models includes at least one registration feature.
5. The method of claim 1, wherein the receiving features on the
dental base include one or more of a pin, a protrusion, a stud, a
socket, a slot, and a hole.
6. The method of claim 1, further comprising determining a final
target configuration of the subject's teeth, wherein the first
dental aligner and the second dental aligners move the subject's
teeth towards the final target configuration.
7. The method of claim 1, wherein the step of analyzing the
position of the subject's teeth after the subject has worn the
first dental aligner further comprises: producing an impression of
the subject's teeth after the subject has worn the first dental
aligner; and measuring the positions of the subject's teeth using
the impression of the subject's teeth.
8. The method of claim 1, wherein the step of forming the second
dental aligner using the physical arch model comprises: vacuum
forming the second dental aligner using a sheet of aligner-making
material over the physical arch model.
9. The method of claim 6, further comprising: calculating the
differences between the final target configuration of the subject's
teeth and the positions of the subject's teeth after the subject
has worn the first dental aligner.
10. A dental treatment system for moving a subject's teeth,
comprising: a first dental aligner configured to move the subject's
teeth toward a first target configuration; a measurement device
configured to determine the positions of the subject's teeth after
the subject has worn the first dental aligner; a dental base having
receiving features for receiving physical tooth models; and an
analysis device configured to assist a technician in determining a
second target configuration based on the positions of the subject's
teeth after the subject has worn the first dental aligner, wherein
the analysis device is further configured to form the receiving
features of the dental base so that they correspond to the second
target configuration.
11. The dental treatment system of claim 10, wherein the
measurement device comprises a mechanical location device or an
optical scanner.
12. The dental treatment system of claim 10, wherein the analysis
device comprises a computer configured to manipulate a digital
model of the subject's teeth, wherein the analysis device comprises
constraint logic indicating constraints on movement to of the
teeth.
13. A method of fabricating a dental aligner for a subject,
comprising: determining an initial configuration of the subject's
teeth; determining a target configuration of the subject's teeth
from the initial configuration, wherein the teeth in the target
configuration are moved from the initial configuration under the
constraint of no movement in at least one degree of freedom; and
producing a physical model of the dental arch having physical tooth
models arranged in the target configuration.
14. The method of claim 13, wherein the initial configuration
reflects the current configuration of the teeth in the subject's
dental arch.
15. The method of claim 13, wherein the step of determining a
target configuration comprises manually determining a target
configuration.
16. The method of claim 15, wherein the step of determining a
target configuration further comprises using an analysis device
comprising constraint logic that indicates constraints on the
movement of the teeth.
17. The method of claim 13, wherein the degree of freedom is
selected from the group of: the x-direction, the y-direction, the
z-direction, the polar direction, the azimuthal direction, and the
self-rotation direction.
18. The method of claim 13, wherein the constraint of no movement
comprises no translational movement of the teeth in the
x-direction, the y-direction, or the z-direction, or no rotations
of the teeth around the roots of the tooth in the polar direction,
the azimuthal direction, or the self-rotation direction.
19. The method of claim 13, further comprising: vacuum forming the
dental aligner using a sheet of aligner-making material over the
physical tooth model of the dental arch.
20. The method of claim 13, wherein the step of producing a
physical model of the dental arch comprises producing a dental base
having receiving features wherein the receiving features are
configured to mate with the physical tooth models to produce a
physical model of the dental arch having physical tooth models
arrange din a target configuration.
21. A dental treatment system for fabricating a dental aligner,
comprising: an analysis device configured to allow manipulation of
a model of the subject's dental arch from an initial configuration
to a target configuration, wherein the analysis device comprises
constraint logic indicating constraints on movement of the
subject's teeth in the direction of one or more degrees of freedom;
a plurality of physical tooth models configured to form a subject's
dental arch, the physical tooth models having registration features
corresponding to the roots of the subject's teeth; and a dental
base having receiving features configured to receive the physical
tooth models so that the physical tooth models are arranged in the
target configuration.
22. The dental treatment system of claim 21, wherein the degree of
freedom is selected from the group of: the x-direction, the
y-direction, the z-direction, the polar direction, the azimuthal
direction, and the self-rotation direction.
23. The dental treatment system of claim 21, wherein the analysis
device comprises a computer device configured to decouple the
movements of the subject's tooth to rotations around the roots of
the subject's tooth and translations of the subject's tooth.
24. A method for producing a dental aligner to move a subject's
teeth, comprising: producing a tooth model simulating the tooth
body of one of the subject's teeth; affixing to the tooth model one
or more registration features simulating the roots of the subject's
tooth; producing a dental base having one or more receiving
features configured to receive the tooth model; and fabricating a
dental aligner using the tooth model attached to the one or more
receiving features on the dental base.
25. The method of claim 24, wherein the step of fabricating a
dental aligner comprises: producing a plurality of tooth models
simulating the tooth bodies of the subject's teeth; assembling the
physical tooth models on the dental base to form a physical arch
model; and fabricating the dental aligner using the physical arch
model attached to the dental base.
26. The method of claim 24, wherein the registration features on
the physical tooth model comprises pins.
27. The method of claim 24, wherein the receiving features
comprise: sockets, slots or holes.
28. The method of claim 24, wherein the step of producing a tooth
model comprises: producing a physical arch model of the subject's
teeth using an impression of the subject's teeth; and separating
the physical arch model into one or more tooth models.
29. The method of claim 24, wherein the step of fabricating a
dental aligner comprises: vacuum forming the dental aligner using a
sheet of aligner-making material over the tooth model attached to
the dental base.
30. A dental treatment system for moving a subject's teeth,
comprising: a plurality of physical teeth models each having one or
more registration features, wherein the registration features
simulate the roots of the subject's teeth, further wherein each
tooth model comprises a tooth body formed from a model of the
subject's tooth; a dental base comprising one or more receiving
features, the dental base configured to receive the plurality of
teeth models to form a physical dental arch model corresponding to
a target configuration of the subject's dental arch; and a dental
aligner fabricated using the plurality of physical teeth models
attached to the dental base, so that the dental aligner corresponds
to the target configuration of the subject's dental arch.
31. The dental treatment system of claim 30, wherein the dental
aligner is configured to rotate at least one of the subject's teeth
in one or more directions around its roots when the aligner is worn
by the subject.
32. The dental treatment system of claim 30, wherein the dental
aligner is configured to rotate at least one of the subject's teeth
around its roots in one or more of: the polar direction, the
azimuthal direction, and the self-rotation direction.
33. The dental treatment system of claim 30, wherein the dental
aligner is configured to translate at least one or more of the
subject's teeth in one or more of: the x-direction, y-direction,
and the z-direction.
34. The dental treatment system of claim 30, wherein the
registration features on the physical tooth models include one or
more of: a pin, a protrusion, a stud.
35. The dental treatment system of claim 30, wherein the receiving
features on the dental base plate include one of: a socket, a slot,
a hole.
36. A method for treating a subject's teeth, comprising determining
a target configuration for the subject's teeth; producing receiving
features on a dental base in response to the target configuration,
the receiving features being configured to receive physical tooth
models; assembling the physical tooth models on the dental base to
form a physical arch model; and producing a dental aligner using
the physical arch model to move the subject's teeth to the target
configuration.
37. The method of claim 36, wherein the step of producing receiving
features on a dental base comprises: determining the locations of
the receiving features on the dental base in response to the target
configuration for the subject's teeth; and producing the receiving
features at the determined locations on the dental base.
38. The method of claim 36, wherein the physical tooth models
comprise registration features to be attached to the receiving
features on the dental base.
39. The method of claim 38, wherein the registration features on
the physical tooth models include one or more of: a pin, a
protrusion, a stud, a socket, a slot, and a hole.
40. The method of claim 36, wherein the step of producing receiving
features on a dental base further comprises: producing an subject
physical arch model by molding a malleable casting material using
an impression of the subject's teeth; producing the registration
features on the subject physical arch model; and separating the
subject physical arch model into a plurality of physical tooth
models, wherein each physical tooth model includes one or more
registration features.
41. The method of claim 36, wherein the step of determining a
target configuration for the subject's teeth comprises: determining
an initial configuration of the subject's teeth; determining a
final configuration of the subject's teeth; and determining a
target configuration for each of a plurality of treatment steps for
moving the subject's teeth from the initial configuration to the
final configuration.
42. The method of claim 36, wherein the step of producing receiving
features on a dental base comprises: producing the physical tooth
models using CNC based manufacturing.
43. The method of claim 36, wherein the receiving features on the
dental base include one or more of: pins, protrusions, studs,
sockets, slots, and holes.
44. The method of claim 36, wherein the step of producing a dental
aligner comprises: vacuum forming the dental aligner using a sheet
of aligner-making material over the physical arch model.
45. The method of claim 36, wherein the step of producing a dental
aligner comprises: molding a malleable casting material over
physical arch model in a casting chamber to form the dental
aligner.
46. A method for treating a subject's teeth, comprising determining
an initial configuration of the subject's teeth; determining a
final configuration of the subject's teeth; designing a movement
path from the initial configuration to the final configuration for
one or more of the subject's teeth; dividing the movement path into
a plurality of treatment steps, each having a target configuration
for the subject's teeth; producing receiving features on a dental
base in response to the target configuration for the subject's
teeth, the receiving features being configured to receive physical
tooth models; assembling the physical tooth models on the dental
base to form a physical arch model in the target configuration; and
producing at least one dental aligner using the physical arch model
configured to move the subject's teeth to the target
configuration.
47. The method of claim 46, wherein the step of producing receiving
features on a dental base comprises: determining the locations of
the receiving features on the dental base in response to the target
configuration for the subject's teeth; and producing the receiving
features at the determined locations on the dental base.
48. The method of claim 46, wherein the step of assembling the
physical tooth models on the dental base comprises: producing
physical tooth models from a model of the subject's teeth, wherein
the physical tooth models comprise registration features configured
to be attached to the receiving features on the dental base.
49. The method of claim 48, wherein the registration features on
the physical tooth models include one or more of: a pin, a
protrusion, a stud, a socket, a slot, and a hole.
50. The method of claim 46, wherein the step of assembling the
physical tooth models on the dental base comprises: producing a
subject physical arch model by molding a malleable casting material
using an impression of the subject's teeth; producing registration
features on the subject physical arch model; and separating the
subject physical arch model into a plurality of physical tooth
models wherein each physical tooth model includes one or more of
the registration features.
51. The method of claim 46, wherein the step of assembling the
physical tooth models on the dental base comprises: producing the
physical tooth models using CNC based manufacturing.
52. The method of claim 46, wherein the step of producing receiving
features on a dental base: including producing receiving features
comprising one or more of: pins, protrusions, studs, sockets,
slots, and holes.
53. The method of claim 46, wherein the step of producing at least
one dental aligner comprises: vacuum forming the dental aligner
using a sheet of aligner-making material over the physical arch
model.
54. The method of claim 46, wherein the step of producing at least
one dental aligner comprises: producing the dental aligner by
molding a malleable casting material over physical arch model in a
casting chamber.
55. The method of claim 46, wherein the step of producing at least
one dental aligner comprises: producing the dental aligner using
CNC based manufacturing.
56. A dental treatment system for moving a subject's teeth,
comprising: a storage device configured to store an initial
configuration of the subject's teeth, a final configuration of the
subject's teeth, a movement path from the initial configuration to
the final configuration for one or more of the subject's teeth, and
a target configuration intermediate between the initial
configuration and the final configuration along the movement path;
a dental base having receiving features corresponding to the target
configuration for the subject's teeth; a physical arch model
comprising physical tooth models attached to the receiving features
on the dental base; and a dental aligner produced using the
physical arch model, configured to move the subject's teeth toward
the target configuration.
57. The dental treatment system of claim 56, wherein the storage
device comprises a computer.
58. The dental treatment system of claim 57, wherein the computer
is configured to control the fabrication of receiving features on
the dental base at locations in response to the target
configuration for the subject's teeth.
59. A dental treatment system for moving a subject's teeth,
comprising: a computer configured to store a target configuration
for the subject's teeth; a dental base having receiving features
corresponding to the target configuration stored in the computer;
one or more physical tooth models configured to attached to the
receiving features on the dental base; and a dental aligner
produced using the one or more physical tooth models attached to
the dental base, configured to move the subject's teeth toward the
target configuration.
60. The dental treatment system of claim 59, wherein the computer
is configured to control the fabrication of receiving features on
the dental base at locations in response to the target
configuration.
61. The dental treatment system of claim 59, wherein the physical
tooth models comprise registration features configured to mate with
the receiving features on the dental base.
62. The dental treatment system of claim 61, wherein the
registration features on the physical tooth models include one or
more of: a pin, a protrusion, a stud, a socket, a slot, and a
hole.
63. The dental treatment system of claim 59, wherein the computer
is configured to store an initial configuration of the subject's
teeth and a final configuration of the subject's teeth, and a
plurality of target configurations corresponding to treatment steps
from the initial configuration to the final configuration.
64. The dental treatment system of claim 59, wherein the physical
tooth models are fabricated using CNC-based manufacturing.
65. The dental treatment system of claim 59, wherein the receiving
features on the dental base include one or more of: pins,
protrusions, studs, sockets, slots, and holes.
66. The dental treatment system of claim 59, wherein the dental
aligner comprises a formed sheet of aligner-making material vacuum
formed over the physical arch model.
67. The dental treatment system of claim 59, wherein the dental
aligner comprises a molded structure molded from a malleable
casting material over physical arch model in a casting chamber.
68. A dental treatment system for moving a subject's teeth,
comprising: a physical arch model comprising one or more physical
tooth models each having one or more registration features; a
dental base having receiving features configured to receive the
registration features of the physical tooth models to form the
physical arch model; a computer system configured to store a target
configuration for the subject's teeth and to control the
fabrication of the receiving features on the dental base; and a
dental aligner produced using the physical arch model, configured
to move the subject's teeth toward the target configuration.
69. The dental treatment system of claim 68, wherein the computer
system is configured to determine the locations of the receiving
features on the dental base in response to the target configuration
for the subject's teeth to control the fabrication of the receiving
features at the determined locations on the dental base.
70. The dental treatment system of claim 68, wherein the
registration features on the physical tooth models include one or
more of: pins, protrusions, studs, sockets, slots, and holes.
71. The dental treatment system of claim 68, wherein the computer
is configured to store an initial configuration of the subject's
teeth and a final configuration of the subject's teeth, and to
determine target configurations for a plurality of treatment steps
from the initial configuration to the final configuration.
72. The dental treatment system of claim 68, wherein the receiving
features on the dental base include one or more of: pins,
protrusions, studs, sockets, slots, and holes.
73. A dental treatment system for moving a subject's teeth,
comprising: a computer system configured to store a target
configuration for the subject's teeth; one or more physical tooth
models comprising registration features; a dental base having
receiving features to receive the registration features; a device
configured to fabricate the receiving features on the dental base
in response to the target configuration under the control of the
computer system; and a dental aligner formed over the physical
tooth models attached to the dental base, wherein the dental
aligner is configured to move the subject's teeth toward the target
configuration.
74. The dental treatment system of claim 73, wherein the computer
system is configured to determine the locations of the receiving
features on the dental base in response to the target configuration
for the subject's teeth to control the fabrication of the receiving
features at the determined locations on the dental base.
75. The dental treatment system of claim 73, wherein the
registration features on the physical tooth models include one or
more of: a pin, a protrusion, a stud, a socket, a slot, and a
hole.
76. The dental treatment system of claim 73, wherein the receiving
features on the dental base include one or more of: pins,
protrusions, studs, sockets, slots, and holes.
Description
CROSS-REFERENCES TO RELATED INVENTIONS
[0001] This application claims the benefit of U.S. Provisional
Patent application 60/676,278, filed on Apr. 29, 2005, which is
herein incorporated by reference in its entirety.
[0002] The present invention is related to U.S. Provisional Patent
Application Ser. No. 60/676,546, titled "Digitization of dental
arch model components" by Huafeng Wen and U.S. patent application
Ser. No. 11/205,496, titled "System for organizing dental aligners"
by Huafeng Wen, which are herein incorporated by reference in their
entirety.
[0003] The present invention is also related to U.S. patent
application Ser. No. 11/074,301, titled "Dental aligner for
providing accurate dental treatment" by Liu et al, filed Mar. 7,
2005, U.S. patent application Ser. No. 11/074,297, titled
"Producing wrinkled dental aligner for dental treatment" by Liu et
al, filed Mar. 7, 2005, U.S. patent application Ser. No.
11/074,300, titled "Fluid permeable dental aligner" by Huafeng Wen,
filed Mar. 7, 2005, U.S. patent application Ser. No. 11/074,298,
titled "Disposable dental aligner by Huafeng Wen, filed Mar. 7,
2005, and U.S. patent application Ser. No. 11/050,051, titled
"Storage system for dental devices" by Huafeng Wen, filed Feb. 3,
2005, which are herein incorporated by reference in their
entirety.
[0004] The present invention is also related to U.S. patent
application Ser. No. 10/979,823, titled "Method and apparatus for
manufacturing and constructing a physical dental arch model" by
Huafeng Wen, filed Nov. 2, 2004, U.S. patent application Ser. No.
10/979,497, titled "Method and apparatus for manufacturing and
constructing a dental aligner" by Huafeng Wen, filed Nov. 2, 2004,
U.S. patent application Ser. No. 10/979,504, titled "Producing an
adjustable physical dental arch model" by Huafeng Wen, filed Nov.
2, 2004, and U.S. patent application Ser. No. 10/979,824, titled
"Producing a base for physical dental arch model" by Huafeng Wen,
filed Nov. 2, 2004, which are herein incorporated by reference in
their entirety.
[0005] The present invention is also related to U.S. patent
application Ser. No. 11/013,152, titled "A base for physical dental
arch model" by Huafeng Wen, filed Dec. 14, 2004, U.S. patent
application Ser. No. 11/012,924, titled "Accurately producing a
base for physical dental arch model" by Huafeng Wen, filed Dec. 14,
2004, U.S. patent application Ser. No. 11/013,145, titled
"Fabricating a base compatible with physical dental tooth models"
by Huafeng Wen, filed Dec. 14, 2004, U.S. patent application Ser.
No. 11/013,156, titled "Producing non-interfering tooth models on a
base" by Huafeng Wen, filed Dec. 14, 2004, U.S. patent application
Ser. No. 11/013,160, titled "System and methods for casting
physical tooth model" by Huafeng Wen, filed Dec. 14, 2004, U.S.
patent application Ser. No. 11/013,159, titled "Producing a base
for accurately receiving dental tooth models" by Huafeng Wen, and
filed Dec. 14, 2004, U.S. patent application Ser. No. 11/013,157,
titled "Producing accurate base for dental arch model" by Huafeng
Wen, filed Dec. 14, 2004, which are herein incorporated by
reference in their entirety.
FIELD OF THE INVENTION
[0006] This application generally relates to the field of dental
care, and more particularly to the field of orthodontics.
BACKGROUND
[0007] Orthodontics is the practice of manipulating a subject's
teeth to provide better function and appearance. In general,
brackets are bonded to a subject's teeth and coupled together with
an arched wire. The combination of the brackets and wire provides a
force on the teeth causing them to move. Once the teeth have moved
to a desired location and are held in place for a certain period of
time, the body adapts bone and tissue to maintain the teeth in the
desired location. A subject may be fitted with a retainer to help
keep the teeth in the desired location.
[0008] Orthodontists initially base their treatment on a mental
image of the subject's physical orthodontic structure and a mental
image of a desired physical orthodontic structure for the subject,
which may be assisted by x-rays and/or models. Based on these
mental images, the orthodontist relies on his/her expertise to
place the brackets and/or bands on the teeth and to manually bend
(i.e., shape) wire, such that a force is asserted on the teeth to
reposition them into the desired physical orthodontic structure. As
the teeth move towards the desired location, the orthodontist makes
continual judgments as to the progress of the treatment, the next
step in the treatment (e.g., new bend in the wire, reposition or
replace brackets, head gear, etc.), and the success of the previous
step.
[0009] In general, an orthodontist makes manual adjustments to the
wire and/or replaces or repositions brackets based on his or her
expert opinion. Unfortunately, in the oral environment, it is
difficult for a human being to accurately develop a visual
three-dimensional image of an orthodontic structure due to the
limitations of human sight and the physical structure of a human
mouth. In addition, it is difficult (if not impossible) to
accurately estimate three-dimensional wire bends (with accuracy
within a few degrees) and to manually apply such bends to a wire.
Further, it is difficult (or impossible) to determine an ideal
bracket location to achieve the desired orthodontic structure based
on the mental images. It is also extremely difficult to manually
place brackets in what is estimated to be the ideal location.
Accordingly, orthodontic treatment is an iterative process
requiring multiple wire changes, with the success and speed of the
process being dependent on the orthodontist's motor skills and
diagnostic expertise. As a result of multiple wire changes, cost
and subject discomfort is increased. The quality of care may also
vary greatly from orthodontist to orthodontist, as does the time to
treat a subject.
[0010] The practice of orthodontics relies heavily on the expert
opinions and judgments of the orthodontist. Many innovations have
been developed to aid orthodontists and other medical professionals
attempting to align teeth. For example, U.S. Pat. No. 5,518,397 to
Andreiko, et. al. provides a method of forming an orthodontic
brace. The method includes obtaining a model of a subject's teeth
and a prescription of desired positioning of the teeth. The contour
of the subject's teeth is determined from the model. Calculations
of the contour and the desired positioning of the subject's teeth
are made and custom brackets are then created for receiving an arch
wire to form an orthodontic brace system. The device of U.S. Pat.
No. 5,518,397 places an arched wire on the bracket in a progressive
curvature in a horizontal plane and a substantially linear
configuration in a vertical plane. The brackets are customized to
provide three-dimensional movement of the teeth. U.S. Pat. No.
5,518,397 to Andreiko, et. al., and all of the patents and
references referred to in this specification, are hereafter
incorporated by reference in their entirety.
[0011] Other innovations relating to bracket and bracket placements
have also been patented. For example, such patent innovations are
disclosed in U.S. Pat. No. 5,618,716 entitled "Orthodontic Bracket
and Ligature" (a method of ligating arch wires to brackets), U.S.
Pat. No. 5,011,405 "Entitled Method for Determining Orthodontic
Bracket Placement," U.S. Pat. No. 5,395,238 entitled "Method of
Forming Orthodontic Brace," and U.S. Pat. No. 5,533,895 entitled
"Orthodontic Appliance and Group Standardize Brackets therefore and
methods of making, assembling and using appliance to straighten
teeth."
[0012] Kuroda et al. (1996) Am. J. Orthodontics 110:365-369
describes a method for laser scanning a plaster dental cast to
produce a digital image of the cast. See also U.S. Pat. No.
5,605,459, and U.S. Pat. Nos. 5,533,895; 5,474,448; 5,454,717;
5,447,432; 5,431,562; 5,395,238; 5,368,478; and 5,139,419, assigned
to Ormco Corporation, describing methods for manipulating digital
images of teeth for designing orthodontic appliances.
[0013] U.S. Pat. No. 5,011,405 describes a method for digitally
imaging a tooth and determining optimum bracket positioning for
orthodontic treatment. Laser scanning of a molded tooth to produce
a three-dimensional model is described in U.S. Pat. No. 5,338,198,
and U.S. Pat. No. 5,452,219 describes a method for laser scanning a
tooth model and milling a tooth mold. Digital computer manipulation
of tooth contours is described in U.S. Pat. Nos. 5,607,305 and
5,587,912. Computerized digital imaging of the arch is described in
U.S. Pat. Nos. 5,342,202 and 5,340,309.
[0014] Other patents of interest include U.S. Pat. Nos. 5,549,476;
5,382,164; 5,273,429; 4,936,862; 3,860,803; 3,660,900; 5,645,421;
5,055,039; 4,798,534; 4,856,991; 5,035,613; 5,059,118; 5,186,623;
and 4,755,139.
[0015] Realistic simulations of teeth position are extremely
helpful to many orthodontic treatment processes. Orthodontists may
use plaster models of the upper and lower arch, to create a set-up
that may be manipulated to model the starting and finishing
positions of teeth. Thus, the teeth may be modeled to help
eliminate guesswork. Brackets may be bonded to each tooth model to
show the orthodontist the geometry of the wire to run through the
bracket slots to achieve a desired result. The bracket position may
then be transferred to the original malocclusion model. To make
sure that the brackets will be bonded at exactly this position at
the real subject's teeth, small templates for every tooth can be
fabricated that fit over the bracket and a relevant part of the
tooth and allow for reliable placement of the bracket on the
subject's teeth. Alternatively, a transfer tray may be fabricated
for each arch by placing each single bracket onto a model of the
malocclusion and then fabricating a single transfer tray per arch
that covers all brackets and relevant portions of every tooth.
Thus, a transfer tray may help assure a very quick and yet precise
bonding using indirect bonding.
[0016] U.S. Pat. No. 5,431,562 to Andreiko et al. describes a
computerized, appliance-driven approach to orthodontics in which
shape information of teeth is acquired and a target archform is
calculated from the shape information. The shape of customized
bracket slots, the bracket base, and the shape of the orthodontic
archwire, are calculated in accordance with a
mathematically-derived target archform. However, the orthodontist
does not substantially interact with the appliance design.
[0017] Align Technologies also offers transparent, removable
aligning devices. In this system, an orthodontist obtains an
impression model of a subject's dentition and ships this model to a
remote appliance manufacturing center, where it is scanned with a
CT scanner. A computer model of the dentition in a final target
situation is generated at the appliance manufacturing center and
made available for viewing to the orthodontist over the Internet.
The orthodontist indicates changes he or she wishes to make to
individual tooth positions. Later, another virtual model is
provided over the Internet and the orthodontist may review the
revised model, and indicates any further changes. After several
such iterations, the target situation is agreed upon. A series of
removable aligning devices (or shells) are then manufactured and
delivered to the orthodontist. The shells, in theory, will move the
subject's teeth to the desired or (final) target position.
[0018] The coordination of the different steps of the treatment
(the overall treatment process) typically involves early input from
the practitioner (e.g., doctor, dental technician, etc.) in forming
the aligner design referencing only the initial dental alignment of
the subject. Most treatment processes do dynamically react to the
ongoing treatment of the patent by the dental aligner. Thus, it may
be difficult to optimize the interaction between the practitioner
and the ongoing aligners produced.
[0019] U.S. Pat. No. 6,699,037 by Align Technology describes
improved methods and systems for repositioning teeth from an
initial tooth arrangement to a final tooth arrangement.
Repositioning is accomplished with a system comprising a series of
appliances configured to receive the teeth in a cavity and
incrementally reposition individual teeth in a series of at least
three successive steps. The individual appliances preferably
comprise a polymeric shell having the teeth-receiving cavity formed
therein, typically by stereo lithographic molding. Each individual
appliance is configured so that its tooth-receiving cavity has a
geometry corresponding to an intermediate or end tooth arrangement
intended for that appliance. That is, when an appliance is first
worn by the subject, certain of the teeth will be misaligned
relative to an undeformed geometry of the appliance cavity. The
appliance, however, is sufficiently resilient to accommodate or
conform to the misaligned teeth, and will apply sufficient
resilient force against such misaligned teeth in order to
reposition the teeth to the intermediate or end arrangement desired
for that treatment step.
[0020] U.S. Pat. Nos. 6,471,511 and 6,682,346 describe Align
Technology's stereo lithographic fabrication process. Several
drawbacks exist however with the stereo lithography process. The
materials used by stereo lithography processes may be toxic and
harmful to human health. Stereo lithography builds the aligner
layer by layer, which may create spaces susceptible to the growth
of germs and bacteria when it is worn by a subject. Furthermore,
Align Technology's stereo lithography process also requires a
different aligner mold at each stage of the treatment, which
produces a lot of waste and is environmental unfriendly. Thus,
there is a need for practical, effective and efficient methods to
produce a dental aligner.
[0021] Modeling a subject's teeth, such as modeling the upper or
lower dental arches (including the manner in which the teeth
interact) may be an important feature in using and creating an
alignment device. A model of the subject's teeth can help guide the
desired movement of the subject's teeth during an orthodontic
treatment. The model can help avoid interference between a
subject's teeth when undergoing dental re-alignment. A model can
also provide input for the design and manufacturing of dental
aligner devices. Thus, there is a need to accurately and
efficiently obtain models of subjects' dental arches, including
both virtual and actual models.
[0022] Another challenge for orthodontic treatment using aligning
devices is to accurately translate the subject's teeth movement
into treatment measures in the iterative treatment progress. The
current treatment techniques are not able to quantitatively monitor
the teeth movement of the subject's teeth and precisely adjust the
treatment in accordance to the teeth movement of the subject's
teeth.
[0023] Another challenge for orthodontic treatment using removable
aligning devices is to accurately and most effectively render teeth
movement. The current treatment techniques are often unable to
account for the real and least resistance movement of the subject's
teeth, which results in wanted teeth movement and/or unnecessary
number of treatment steps.
[0024] By tracking the relative positions of the teeth in the upper
and lower arches, dental aligner devices can be designed and
fabricated to reflect the ongoing treatment by an orthodontist or
user, as well as the effect of the treatment on the subject. This
may ultimately save in cost, treatment time, and may also enhance
user comfort.
[0025] Finally, the dental treatment processes may be designed to
allow modification of the treatment steps based on the movement of
the subject's teeth. Furthermore, there is a need for more optimal
treatment processes, including the manufacturing of the dental
aligners. Described herein are devices, systems, and methods which
may address some of the problems described above.
SUMMARY OF THE INVENTION
[0026] The present invention provides methods, systems, and
apparatus to design, manufacture and use dental alignment devices
based on a subject's dental arches. Implementations of the methods,
devices and systems described herein may include one or more of the
following.
[0027] Generally described herein are methods of moving a subject's
teeth (e.g., treating a subject) in which one or more aligners is
provided to a subject to wear, so that the aligners may exert force
to move the subject's teeth. The aligners may be designed as part
of a series of aligners to be worn. The series may be determined
based on the subject's initial teeth position, and based on input
from a user (e.g., a practitioner such as a doctor, orthodontist,
technician, etc.). In some variations, the treatment series (and
therefore the aligners) may be designed based on feedback from the
subject's teeth position as one or more of the aligners is worn. In
some variations, the user may modify the series during treatment.
In some variations, the series is determined based on one or more
constrained directions of motion (e.g., in a translational
direction or a rotational direction of an individual tooth).
Specific variations and examples of the devices, methods and
systems are provided.
[0028] Described herein are methods for producing a dental aligner
to move a subject's teeth. In general, these methods may include
the steps of: producing a tooth model simulating the tooth body of
one of the subject's teeth, affixing to the tooth model one or more
registration features simulating the roots of the subject's tooth,
producing a dental base having one or more receiving features
configured to receive the tooth model, and fabricating a dental
aligner using the tooth model attached to the one or more receiving
features on the dental base.
[0029] The step of fabricating a dental aligner may include
producing a plurality of tooth models simulating the tooth bodies
of the subject's teeth, assembling the physical tooth models on the
dental base to form a physical arch model, and fabricating the
dental aligner using the physical arch model attached to the dental
base. The registration features on the physical tooth model may
comprise pins or protrusions, and the receiving features may
comprise sockets, slots or holes. The receiving features generally
mate with the registration features. In some variations included
herein, the receiving features may comprise pins or protrusions,
and the registration features may comprise sockets, slots or holes.
Any appropriate registration features and receiving features may be
used.
[0030] A tooth model may be produced by producing a physical arch
model of the subject's teeth using an impression of the subject's
teeth, and separating the physical arch model into one or more
tooth models. A dental aligner may be fabricated by vacuum forming
the dental aligner using a sheet of aligner-making material over
the tooth model attached to the dental base, or by CNC manufacture,
or by casting.
[0031] Also described herein are systems for moving a subject's
teeth, which may include a plurality of physical teeth models each
having one or more registration features (wherein the registration
features simulate the roots of the subject's teeth and wherein each
tooth model comprises a tooth body formed from a model of the
subject's tooth), a dental base comprising one or more receiving
features (the dental base configured to receive the plurality of
teeth models to form a physical dental arch model corresponding to
a target configuration of the subject's dental arch), and a dental
aligner fabricated using the plurality of physical teeth models
attached to the dental base, so that the dental aligner corresponds
to the target configuration of the subject's dental arch.
[0032] The dental aligners described herein are generally intended
to move a subject's teeth from an initial configuration to a final
configuration. Thus aligners may be used to straighten teeth or
correct malocclusion. These dental aligners may move the subject's
teeth by rotating and/or translating the subject's teeth. For
example, the dental aligners may rotate at least one of the
subject's teeth in one or more directions around its roots when the
aligner is worn by the subject. In particular, a dental aligner may
rotate at least one of the subject's teeth around its roots in one
or more of: the polar direction, the azimuthal direction, and the
self-rotation direction. A dental aligner may translate at least
one (or more) of the subject's teeth in the x-direction,
y-direction, and/or the z-direction.
[0033] Another method for treating a subject's teeth includes the
steps of: determining a target configuration for the subject's
teeth, producing receiving features on a dental base in response to
the target configuration (the receiving features being configured
to receive physical tooth models), assembling the physical tooth
models on the dental base to form a physical arch model, and
producing a dental aligner using the physical arch model to move
the subject's teeth to the target configuration. The step of
producing receiving features on a dental base may include
determining the locations of the receiving features on the dental
base in response to the target configuration for the subject's
teeth, and producing the receiving features at the determined
locations on the dental base.
[0034] As described above, the step of producing receiving features
on a dental base may involve the steps of producing an subject
physical arch model by molding a malleable casting material using
an impression of the subject's teeth, producing registration
features on the subject physical arch model, and separating the
subject physical arch model into a plurality of physical tooth
models. Each physical tooth model may include one or more
registration features.
[0035] Determining a target configuration for the subject's teeth
may involve the steps of determining an initial configuration of
the subject's teeth, determining a final configuration of the
subject's teeth, and determining a target configuration for each of
a plurality of treatment steps for moving the subject's teeth from
the initial configuration to the final configuration. Receiving
and/or registration features on a dental base may be fabricated by
any appropriate method, including by CNC-based manufacturing, or
other computer-controlled methods. In some of the methods, devices,
and systems described herein fiduciary marks (e.g., receiving
and/or registration features) are fabricated as part of the aligner
fabrication procedure.
[0036] Also described herein are methods for treating a subject's
teeth, comprising determining an initial configuration of the
subject's teeth, determining a final configuration of the subject's
teeth, designing a movement path from the initial configuration to
the final configuration for one or more of the subject's teeth,
dividing the movement path into a plurality of treatment steps
(each having a target configuration for the subject's teeth),
producing receiving features on a dental base in response to the
target configuration for the subject's teeth (the receiving
features being configured to receive physical tooth models),
assembling the physical tooth models on the dental base to form a
physical arch model in the target configuration, and producing at
least one dental aligner using the physical arch model configured
to move the subject's teeth to the target configuration.
[0037] The step of producing receiving features on a dental base
may include determining the locations of the receiving features on
the dental base in response to the target configuration for the
subject's teeth and producing the receiving features at the
determined locations on the dental base. Further, the step of
assembling the physical tooth models on the dental base may include
producing physical tooth models from a model of the subject's
teeth, wherein the physical tooth models comprise registration
features configured to be attached to the receiving features on the
dental base.
[0038] The physical tooth models may be assembled on the dental
base by producing a subject physical arch model by molding a
malleable casting material using an impression of the subject's
teeth, producing registration features on the subject physical arch
model, and separating the subject physical arch model into a
plurality of physical tooth models wherein each physical tooth
model includes one or more of the registration features. The
physical tooth models may be fabricated using CNC based
manufacturing, for example, or they may be molded. In general, the
dental aligner may be fabricated by vacuum forming the dental
aligner using a sheet of aligner-making material over the physical
arch model, by molding a malleable casting material over physical
arch model in a casting chamber, or by using CNC based
manufacturing.
[0039] Also described herein are dental treatment systems for
moving a subject's teeth. The system may include a storage device
configured to store an initial configuration of the subject's
teeth, a final configuration of the subject's teeth, a movement
path from the initial configuration to the final configuration for
one or more of the subject's teeth, and a target configuration
intermediate between the initial configuration and the final
configuration along the movement path. The system may also include
a dental base having receiving features corresponding to the target
configuration for the subject's teeth, a physical arch model
comprising physical tooth models attached to the receiving features
on the dental base, and a dental aligner produced using the
physical arch model, configured to move the subject's teeth toward
the target configuration. The storage device may be a computer,
which may be configured to control the fabrication of receiving
features on the dental base at locations in response to the target
configuration for the subject's teeth.
[0040] Also described herein are dental treatment systems for
moving a subject's teeth that include a computer configured to
store a target configuration for the subject's teeth, a dental base
having receiving features corresponding to the target configuration
stored in the computer, one or more physical tooth models
configured to attached to the receiving features on the dental
base, and a dental aligner produced using the one or more physical
tooth models attached to the dental base. Because it is produced
from the physical tooth models attached to the dental arch, the
aligner is configured to move the subject's teeth toward the target
configuration. The computer may be configured to control the
fabrication of receiving features on the dental base at locations
in response to the target configuration. The computer may also be
configured to store an initial configuration of the subject's teeth
and a final configuration of the subject's teeth, and a plurality
of target configurations corresponding to treatment steps from the
initial configuration to the final configuration.
[0041] Also described herein are dental treatment systems for
moving a subject's teeth. These systems may include a physical arch
model comprising one or more physical tooth models each having one
or more registration features, a dental base having receiving
features configured to receive the registration features of the
physical tooth models to form the physical arch model, a computer
system configured to store a target configuration for the subject's
teeth and to control the fabrication of the receiving features on
the dental base, and a dental aligner produced using the physical
arch model, configured to move the subject's teeth toward the
target configuration.
[0042] The computer system may be configured to determine the
locations of the receiving features on the dental base in response
to the target configuration for the subject's teeth to control the
fabrication of the receiving features at the determined locations
on the dental base. The computer may also be configured to store an
initial configuration of the subject's teeth and a final
configuration of the subject's teeth, and to determine target
configurations for a plurality of treatment steps from the initial
configuration to the final configuration.
[0043] Also described herein are dental treatment systems for
moving a subject's teeth comprising a computer system configured to
store a target configuration for the subject's teeth, one or more
physical tooth models comprising registration features, a dental
base having receiving features to receive the registration
features, a device configured to fabricate the receiving features
on the dental base in response to the target configuration under
the control of the computer system, and a dental aligner formed
over the physical tooth models attached to the dental base, wherein
the dental aligner is configured to move the subject's teeth toward
the target configuration.
[0044] Also described herein are dental treatment methods for
moving a subject's teeth having feedback. This method of dental
treatment may include the steps of producing a first dental aligner
for moving the subject's teeth toward a first target configuration,
analyzing the positions of the subject's teeth after the subject
has worn the first dental aligner, determining a second target
configuration in response to the position of the subject's teeth
after the subject has worn the first dental aligner, and producing
a second dental aligner for moving the subject's teeth toward the
second target configuration. The step of producing a second dental
aligner for moving the subject's teeth towards a second target
configuration may involve producing a dental base having receiving
features (wherein the receiving features correspond to the second
target configuration for the subject's teeth, the receiving
features configured to receive physical tooth models), assembling
the physical tooth models on the dental base to form a physical
arch model, and forming a second dental aligner using the physical
arch model.
[0045] The method may also include the step of creating physical
tooth models from the subject's dental arch by producing a template
physical arch model using an impression of the subject's teeth,
incorporating registration features in the template physical arch
model, and separating the template physical arch model into a
plurality of physical tooth models wherein each of the physical
tooth models includes at least one registration feature. The method
may further comprising determining a final target configuration of
the subject's teeth, wherein the first dental aligner and the
second dental aligners move the subject's teeth towards the final
target configuration. Analyzing the position of the subject's teeth
after the subject has worn the first dental aligner may involve
producing an impression of the subject's teeth after the subject
has worn the first dental aligner, and measuring the positions of
the subject's teeth using the impression of the subject's
teeth.
[0046] Also described herein are dental treatment systems for
moving a subject's teeth, comprising a first dental aligner
configured to move the subject's teeth toward a first target
configuration, a measurement device configured to determine the
positions of the subject's teeth after the subject has worn the
first dental aligner, a dental base having receiving features for
receiving physical tooth models, and an analysis device configured
to assist a technician in determining a second target configuration
based on the positions of the subject's teeth after the subject has
worn the first dental aligner (wherein the analysis device is
further configured to form the receiving features of the dental
base so that they correspond to the second target configuration).
The measurement device may be a mechanical location device or an
optical scanner. The analysis device may include a computer
configured to manipulate a digital model of the subject's teeth,
wherein the analysis device comprises constraint logic indicating
constraints on movement to of the teeth, as described further
herein.
[0047] Also described herein are methods of fabricating a dental
aligner for a subject, comprising determining an initial
configuration of the subject's teeth, determining a target
configuration of the subject's teeth from the initial configuration
(wherein the teeth in the target configuration are moved from the
initial configuration under the constraint of no movement in at
least one degree of freedom), and producing a physical model of the
dental arch having physical tooth models arranged in the target
configuration. The initial configuration may reflect the current
configuration of the teeth in the subject's dental arch. The step
of determining a target configuration may involve manually
determining a target configuration, and may be aided by using an
analysis device comprising constraint logic that indicates
constraints on the movement of the teeth. The degree of freedom is
typically selected from the group of: the x-direction, the
y-direction, the z-direction, the polar direction, the azimuthal
direction, and the self-rotation direction. The constraint of no
movement may mean no translational movement of the teeth in the
x-direction, the y-direction, or the z-direction, or no rotations
of the teeth around the roots of the tooth in the polar direction,
the azimuthal direction, or the self-rotation direction.
[0048] Also described herein are dental treatment system for
fabricating a dental aligner with movement constraints. This system
may include an analysis device configured to allow manipulation of
a model of the subject's dental arch from an initial configuration
to a target configuration, wherein the analysis device comprises
constraint logic indicating constraints on movement of the
subject's teeth in the direction of one or more degrees of freedom.
The system may also include a plurality of physical tooth models
configured to form a subject's dental arch (the physical tooth
models having registration features corresponding to the roots of
the subject's teeth), and a dental base having receiving features
configured to receive the physical tooth models so that the
physical tooth models are arranged in the target configuration.
[0049] This analysis device may include a computer device
configured to decouple the movements of the subject's tooth to
rotations around the roots of the subject's tooth and translations
of the subject's tooth. As described above, the degree of freedom
may be selected from the group of: the x-direction, the
y-direction, the z-direction, the polar direction, the azimuthal
direction, and the self-rotation direction.
[0050] The disclosed devices, methods and systems may provide
dental aligner devices. The dental aligner devices so obtained are
effective at re-aligning the teeth and may have enhanced comfort
when worn. The disclosed devices, systems and methods may
significantly reduce the treatment time and cost compared to the
prior art systems. Physical tooth models and the dental base can be
shared between treatment steps. Physical arch models can be
configured and re-configured for different treatment steps. The
physical tooth models can be used to form different arch models in
different treatment steps, which may significantly reduce treatment
costs and cycle time required for each treatment step. A dental
base can include a plurality of target configurations each for
different treatment steps. The costs of the dental base can be
shared between treatment steps. Dental aligners can be conveniently
and inexpensively fabricated using the physical arch model.
[0051] The details of one or more embodiments are set forth in the
accompanying drawing and in the description below. Other features,
objects, and advantages of the invention will become apparent from
the description and drawings, and from the claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0052] The accompanying drawings, which are incorporated in and
form a part of this specification, illustrate embodiments of the
invention and, together with the description, serve to explain the
principles of the invention:
[0053] FIG. 1A is a flow chart for providing accurate orthodontic
treatment for a subject in accordance with the present
invention.
[0054] FIG. 1B is a flow chart showing another variation of the
dental treatment method having feedback as described herein.
[0055] FIG. 2 illustrates an exemplified mechanical location device
for acquiring the surface locations of dental impression and
subject's teeth positions.
[0056] FIG. 3A illustrates a subject's tooth and decoupling of
movements.
[0057] FIG. 3B illustrates a tooth model that can simulate the
movements of the subject's tooth in FIG. 3A.
[0058] FIG. 3C illustrates a tooth model having registration
features.
[0059] FIG. 4 illustrates a system for producing receiving features
on a dental base for receiving physical tooth models.
[0060] FIG. 5 is a top view of a dental base comprising a plurality
of sockets for receiving pins affixed on the physical tooth
models.
[0061] FIG. 6 illustrates a physical tooth model comprising two
pins that allow the physical tooth model to be plugged into two
corresponding sockets in a dental base.
[0062] FIG. 7 illustrates an arrangement of fabricating a dental
aligner using a dental arch model.
[0063] FIG. 8 shows a flow chart describing one variation of a
treatment method for treating misaligned teeth as described
herein.
DESCRIPTION OF INVENTION
[0064] The following detailed description should be read with
reference to the drawings. The drawings, which are not necessarily
to scale, depict selective embodiments and are not intended to
limit the scope of the invention. The detailed description
illustrates by way of example, not by way of limitation, the
principles of the invention. This description will clearly enable
one skilled in the art to make and use the invention, and describes
several embodiments, adaptations, variations, alternatives and
uses, including what is presently believed to be the best mode of
carrying out the invention.
[0065] It is to be understood that unless otherwise indicated, the
methods, systems and devices described herein need not be limited
to applications in orthodontic treatments. As one of ordinary skill
in the art having the benefit of this disclosure would appreciate,
variations may be utilized in various other dental applications,
such as fabrication of and/or treatment planning for dental crowns,
dental bridges, and aligners. The dental models may also be
modified to support research and/or teaching applications.
Moreover, it should be understood that variations of the methods,
devices and systems described herein may be applied in combination
with various dental diagnostic and treatment devices to improve the
condition of a subject's teeth.
[0066] It must also be noted that, as used in this specification
and the appended claims, the singular forms "a," "an" and "the"
include plural referents unless the context clearly dictates
otherwise. Thus, for example, the term "a tooth" is intended to
mean a single tooth or a combination of teeth, "an arch" is
intended to mean one or more arches (e.g. both upper and lower
dental arches). Furthermore, as used herein, "calculating," and
"formulating" may include the process of utilizing manual and/or
computer calculations, such as those used to create a numeric
representation of an object (e.g., a digital model) or to measure
differences in tooth position. For example, a digital
representation may comprise a file saved on a computer, wherein the
file includes numbers that represent a three-dimensional projection
of a tooth arch. In another variation, a digital representation
comprises a data set including parameters that can be utilized by a
computer program to recreate a digital model of the desired
object.
[0067] Described herein are treatment methods for treating a
subject's misaligned teeth. FIG. 8 illustrates a schematic overview
of the treatment method. This method generally includes steps of
analyzing the subject's dental arches 801, formulating a treatment
plan 803, beginning the treatment plan 805, monitoring the
treatment plan 807, revising the treatment plan if necessary 809,
and continuing the treatment plan until a desired endpoint is
achieved 811.
[0068] The treatment plan may include any appropriate treatment
plan, but typically includes designing and providing a dental
appliance (also referred to as a dental aligner) to alter the
subject's dental arch. The treatment plan may include steps for
analyzing the subject's dental arch, modeling the dental arch, and
designing a dental arch to be worn by the subject to alter the
dental arch in a desirable manner. The treatment plan may also
include steps for preparing the subject's dental arch (e.g., by
extracting, shaping, trimming, or otherwise altering one or more of
the subject's teeth). Finally, the treatment plan may include steps
for designing one or a series of dental aligners, and for
fabricating one or a series of dental aligners.
[0069] Provided below are examples of treatment methods, including
specific steps which may be included as part of a treatment method,
or features of the treatment method. In particular, dental aligners
that are used as part of a treatment method are described.
Treatment Method
[0070] The treatment methods described herein include steps for
fabricating of one or more dental aligners. Dental aligners
(aligners) may be formed as a series of polymeric dental aligners
molded over tooth models. This step typically includes forming
sheets of standard, dental grade polymer (e.g., dental grade
polymer available from RainTree Essix) over models of the subject's
dental arch fabricated from an epoxy cast of the subject's actual
teeth, then hand trimming and polishing them to conform to the
subject's gingiva.
[0071] Separate computerized processes may facilitate the process.
For example, a software program may facilitates on-line
communication with a dental practitioner, (e.g., orthodontist,
doctor, etc.). The subject's dental arch (e.g., dental models) may
be scanned to record the tooth positions to help the technician or
practitioner manipulate a 3D model of the teeth to graphically
depict tooth movement. The recorded tooth positions on the
manipulated 3D model may then direct a CNC (Computer Numerical
Controlled) machine to drill holes in a base plate into which the
individual, epoxy cast teeth are placed for forming. These
computer-aided processes expedite the process of mass aligner
production the core action of fabricating aligners. A practitioner
may progressively adjust the epoxy tooth arrangements to create a
new model on which to heat-form aligners. Further description of
the computer-assisted steps and method of forming a dental aligner
may be found in co-pending PCT application titled "COMPUTER AIDED
ORTHODONTIC TREATMENT PLANNING", by Huafeng WEN, Muhammad Ziaullah
Khan CHISHTI, Frank Zhenhuan LIU, Kashif MOHAMMED, Syed Wasi Mohsin
Raza RIZVI, and Yasser BASHIR, filed ______, herein incorporated by
reference in its entirety.
[0072] The practitioner may communicate his or her instructions and
adjustments over the course of the treatment process, so that the
manufacture of sequential aligners for an individual subject may be
modified during the treatment process. Furthermore, individual
subject information (e.g., response to treatment) may be
incorporated into the design of the dental aligner, and into the
overall treatment method. For example, written instructions and the
manipulation of 3D graphics (e.g., digital dental models) may be
used to modify the design of dental aligners. This communication
may allow a technician to precisely follow instructions or comments
from the dental care practitioner (or subject) during each step in
aligner fabrication. In contrast, other aligner fabricators
techniques do not afford the practitioner the opportunity to adjust
aligners (and therefore treatment) on a continuing basis; instead,
a computer algorithm determines the tooth movement and the
practitioner or subject receives several years worth of dental
aligners for treatment at a single time.
[0073] The treatment methods described herein provide the
practitioner the opportunity to review the treatment (e.g., the
current tooth position during treatment) and to modify the
treatment by modifying the aligner shape, and effect on the dental
arch at appropriate times (e.g., before the next aligner is
fabricated).
[0074] An exemplary treatment method begins with an analysis of a
subject's dental arch. For example, a practitioner (e.g., a doctor,
such as a dentist or orthodontist, technician, or the like) may
make an impression of the subject's teeth and gingiva. Impressions
are typically taken of both the upper and lower jaw. The
impressions may be prepared using standard techniques, such as a
dental tray filled with polyvinysiloxane (PVS). In addition to
trays with the impressions, a Panorex, bite registration,
intra-oral photographs, extra-oral photographs, and a written
prescription describing the professional's desired repositioning of
the subject's teeth may be used to manufacture a model (or models)
of the subject's dental arch, and to help design the subject's
treatment plan. As mentioned, a practitioner may submit
instructions or observations (e.g., a prescription) describing a
desired dental arrangement, or manner of achieving a desired dental
arrangement. This prescription may be based upon the professional's
observations of the locations of the subject's teeth and possible
improvements thereof. This prescription may be transmitted in any
appropriate form, including being written on a form that has blanks
for identifying which teeth are to be treated, what treatment is
desired. The prescription may be freeform or may include a menu of
choices. In some variations, the prescription may include specific
points such as the inter-proximal reduction (IPR) desired, and may
include observations such as which teeth are facially restored (and
therefore should not receive anchoring buttons), may include
existing occlusion information, may indicate where extractions are
to be performed, and/or may indicate other specifics of the
treatment to be applied. This information from the practitioner may
also be entered into a computerized form by the practitioner in his
or her office, and made available on-line via for review by other
practitioners or by the aligner manufactures.
[0075] This dental impressions, images, and any other data
collected from the subject's dental arch may be analyzed in order
to model the subject's dental arch. For example, a device called a
MicroScribe may be used to identify the location and orientation of
each tooth within both the upper and lower impression. Such
positional information may then used (e.g., by a CNC machine) to
create a "base plate" for modeling the dental arch. The process of
modeling the dental arch is described in more detail below, as well
as in the references previously incorporated. One variation of this
process is summarized here to illustrate a treatment method. A base
plate may be used to form a physical model of the dental arch that
may also be used to form a dental aligner. For example, the base
plate may have holes drilled in locations and orientations
corresponding to the positions of the teeth roots. Pins may be
placed into these holes, and may act as fiduciary markers, as well
as helping to model the movement and position of the teeth. In one
variations, pins are approximately 1.6 mm diameter and extend
outwardly from the base plate approximately 5 mm.
[0076] The subject's dental arch impression (e.g., PVS impression)
may then be placed into a casting container along with the above
mentioned base plate with the pins inserted. The impression may
then be cast (e.g., using a hard epoxy-type material) to form a
precision duplicate of a subject's teeth with metal pins embedded
inside each tooth. After the epoxy hardens, the castings can be
removed from the impressions, forming positive models of the
subject's teeth in their initial untreated positions (as well as
the subject's gingiva).
[0077] In some variations, two model arches, one for the upper arch
and one for the lower arch, are made, and put together with the PVS
Bite provided. Known points on the 2 arches may be measured to
determine the bite relationship between the two arches.
[0078] The base plate can then be removed from the positive model.
The positive models are cut apart so that each section of the model
comprises one individual model tooth and the adjacent gingiva.
Typically, each model tooth with its gingiva has two pins
protruding from it. As mentioned, these pins may act as both
fiduciary markers (showing the relative orientation of the teeth
with respect to each other, and may also represent "roots" of the
teeth.
[0079] Each model tooth can then be individually scanned with a
Laser scanner to generate a three-dimensional computer model of the
tooth, which includes the exposed surfaces of the model tooth, and
the positions and orientations of the two pins that extend from the
tooth. A computer model of the arch may be re-constructed based on
the scan data. The stored pin positions and the stored virtual
model teeth are combined with a random positional generator to
create a digital model of the dental arch. For convenience, this
digital dental arch is referred to herein as the "working
arch."
[0080] The positions of the subject's teeth in the virtual (e.g.,
working) arch(es) may be manipulated into a desired position based
upon the input from the practitioner (e.g., the written input
provided). A technician may use the digital model to create a
target arrangement (typically an intermediate target arrangement)
of the dental arch from the working arch. In some variations, the
physical march is manipulated to form the target dental arch. The
dental arch may be manipulated into a target dental arch by the
technician or practitioner. The technician may apply his or her own
experience in forming the target arrangement of the dental arch, as
well on guidelines set by the practitioner. In some variations, the
technician forms the target dental arch based on movement
constraints implicit in the movement of the subject's teeth, as
described further below. A digital model formed by the target
arrangement may also be referred to as a "prescription view" (or
"RxView") of the virtual tooth positions, in the virtual
arch(es).
[0081] The target arrangement of the dental arch may be the final
target arrangement, in which the teeth are arranged in a desired
final position, or it may be an intermediate target arrangement, in
which the teeth are being moved toward the final target
arrangement. Each target arrangement (both intermediate and final)
may be associated with one or more dental aligners.
[0082] Thus, a RxView is typically a visual representation of the
technician's interpretation of the prescription from the doctor.
Typically, this RxView (digital dental arch model) is not used to
fabricate an aligner. For example, this digital dental arch model
may have teeth that have small gaps which may not reflect a good
treatment, and the teeth may even overlap with each other. The
RxView is typically a visual guide that does not direct the
physical placement of the epoxy teeth models used, as described
below, to generate the aligner.
[0083] RxView data may be disseminated to the practitioner. For
example, via software running on a web-based account. The
practitioner can then either modify the digital dental arch model
(RxView) using software, or can send comments suggesting further
modification of the target dental arch model. A technician may
incorporate these comments.
[0084] For example, a technician may manipulate the positions of
the subject's teeth in the digital model (either the initial model
or the RxView model) using a computer program. The teeth of the
dental arch may be manipulated into a position so that an aligner
formed to correspond to this position (the "next appliance
position") will move the teeth toward the desired alignment. Thus,
in the first pass, the dental arch model will be in a "current
position" (reflecting the current position of the teeth), and can
be moved into the "next appliance" position which is first
appliance position. In one variation of this process, the RxView
may be used by the technician as a visual reference, but it is
typically not a source of digital information used in the
manipulations performed by the technician. Rather, the technician's
manipulations of the current tooth positions are based upon the
technician's visual judgment of how those current positions relate
to the desired positions as visually represented in the RxView, and
based upon the judgment in the technician's mind of the best
approach to moving the teeth from their current positions toward
those desired positions.
[0085] During this step, the software may impose
anatomically-derived limitations (constraints) on the extent of
movement and/or force applied to each tooth, e.g., limiting
movement to 0.3 mm or less. When tooth movements are completed, the
technician typically stores the new virtual arches (having teeth
positions corresponding to the positions of the teeth to be
achieved by the next appliance). These "next appliance" digital
models may include simulated gingiva and roots that may be appended
to the exposed surfaces of the teeth that are included in the
virtual model teeth.
[0086] Prior to manufacture of an aligner using the device, a
practitioner may be notified that the "next appliance" model is
ready, and can be reviewed. The practitioner may view the virtual
arch(es) of the virtual model teeth in their current untreated
positions, the virtual arch(es) of the virtual model teeth in the
RxView, and the virtual arch(es) of the virtual "next appliance"
model teeth as they will be positioned by the forthcoming aligner.
The practitioner can modify both the RxView tooth positions, and
the positions for the next appliance, using controls by which a
tooth may be selected and moved, as described in more detail in
some of the patent applications previously incorporated by
reference. Typically, the practitioner eventually approves (e.g.,
via computer access), the (potentially modified) RxView and the
(potentially modified) virtual arch tooth positions for the next
appliance. The "next appliance" will then be the manufactured. In
some variations, multiple (e.g., two) appliances are manufactured
at a time. Thus, both an immediately "next appliance" and the
appliance following the "next appliance" may be modeled (digitally)
and then fabricated as described above.
[0087] As described in more detail below, the aligner manufacturing
process is used to produce one or more dental aligners using the
digital model by forming a physical (non-digital model). Once the
RxView is finally approved by the practitioner, the locations of
the pins in the virtual model teeth for the first appliance may be
used to program a CNC machine, to drill holes (e.g., receiving
features) in a staging plate or plates (also referred to as a base
plate) that correspond to the positions of the pins of the model
teeth for the forthcoming appliance. Model teeth with pins are
manually inserted into the holes in the staging plate(s) drilled by
the CNC machine, creating a physical arrangement of the teeth in
the positions for the appliance to be formed.
[0088] An aligner may then be fabricated over the model teeth that
are positioned in the staging plate(s), using a "drape and form"
process with a dental pressure forming machine, and the aligner can
then be trimmed. Aligners may also be fabricated with special
features requested by the practitioner, such as buttons and windows
to assist certain teeth movement. For example, buttons and windows
may be used to help secure the aligner to the dental arch, and may
be used to direct force to move the teeth of the dental arch. For
example, if such features are requested, small buttons can be
installed on the model teeth in the manufacturing process. A
template plastics tray will be made to assist the doctors to place
the buttons in a subject's teeth. Aligners can then be fabricated
with windows (e.g., small cut-outs) at the location of each
prescribed button.
[0089] After manufacture, the aligners can be marked for case
number and subject's name (or otherwise labeled), cleaned,
sterilized, and packaged for shipment. In some variations, a box is
shipped to the practitioner that includes two plastic bags
containing two sets of appliances formed in the preceding steps,
plus the templates for buttons, if any. The practitioner examines
the appliance (the "next aligner") on the subject to test the fit.
During the first visit to the practitioner after impressions have
been made, the "next appliance" will be the first appliance. If the
practitioner deems the aligner fit to be correct, the subject can
leave with the current appliance, and the next appliance, and wears
each for three weeks in succession.
[0090] During the 6 week period of use of the appliances most
recently delivered to the subject, a technician may manipulate the
"current" positions of the subject's teeth (which are the positions
used to create the appliance(s) most recently delivered to the
subject), to move the teeth in the manner the technician believes
should be done by the next appliance. This proposed new position
may be made available to the practitioner for approval or
modification, as described above, and may then be used to form the
next appliance, in the manner described above.
[0091] The subject typically returns to the practitioner after
having worn for each of the two aligners received for the
appropriate time (e.g., three weeks). The practitioner may then
monitor the effect of the aligner use to determine if the subject
is progressing as expected, or if the treatment plan needs to be
modified. For example, the practitioner may take additional images
of the subject, or may take additional casts of the subject's
teeth. The monitoring and analysis of the subject's treatment maybe
sent to the manufacturer (e.g., for use by the technician
manufacturing the aligners). If no modification is necessary, or
after modification, the steps of approval, further modification of
the digital model and manufacture of the new aligners is repeated
substantially as described above.
[0092] These steps may be repeated until the practitioner and/or
subject discontinue the treatments. Discontinuing the treatment
typically means that the treatment goal has been reached, treatment
is terminated, or the practitioner or subject aborts the
treatment.
[0093] The steps of the treatment methods described herein may
include additional step, or may omit steps. Furthermore, any
appropriate method may be used to perform the different steps
included. For example, any appropriate method or device may be used
for designing and forming a dental aligner by modeling the dental
arch. In some variations, an aligner is formed by first modeling
the dental arch.
Dental Model
[0094] A dental model may be created from an actual image, imprint
or reproduction of a subject's tooth or teeth, or a model may be
produced from measurements or other information derived from a
subject or representation of a subject. As used herein, unless the
context makes clear otherwise, the terms "model," "dental model,"
"tooth model," and "arch model" may refer to actual (e.g.,
physical) or virtual (e.g., digital) models. Further, the models
described herein may include all or portions of a single tooth, all
or portions of multiple teeth, and all or portions of the dental
arches (including the gingival, tooth, root, jaw, etc.). Thus, the
models described herein may include information about or
representation of any of the features of the dental arches,
particularly those features that are relevant to the function and
appearance of teeth. For example, the model may represent tooth
appearance (e.g., location, size, position, color, shape,
orientation, texture, etc.), interaction (e.g., proximity to other
dental and mandibular features, kinetics, etc.) and the like.
[0095] As used herein, a "subject" may include any subject (human
or animal) whose dental structure (e.g., teeth, gingival, etc.) may
be modeled by the devices, methods, and systems described herein,
including orthodontic patients.
[0096] There are many uses for models of a subject's teeth. In
particular, the models may be used to understand and to treat a
subject's dental alignment. The models may be manipulatable so that
different alignments of the subject's teeth may be modeled. In some
variations, the models may comprise limitations on the movement or
arrangement of teeth (constraints). These constraints may be based
on physiological constraints, including the orientation of other
teeth, the bite alignment, and the ease or difficulty of moving
actual teeth in one or more directions. The manipulatable models
may be digital (computer-manipulatable) or physical models.
1. Creation of a Dental Model
[0097] A dental model may be created using any appropriate method.
Furthermore, the model may be a physical model or a virtual model.
For example, models may be constructed from imprints, molds,
measurements, images, or measurements of a subject's dental
features. One model may be made (or derived) from another model.
Thus, a physical model may be made from a virtual model, and a
virtual model may be made from a physical model. In particular, a
model may be altered and then one or more derived models may be
generated from the original model. For example, components of a
model (e.g., individual teeth) may be moved slightly to form a
second model. Thus, the model may represent the actual arrangement
of a subject's teeth, or a derived arrangement. Features not
present on a subject's teeth (e.g., crowns, dentures, etc.) may be
included as part of the dental model.
[0098] In one variation, a model may be generated using a mold
(e.g., a positive or negative model) of a subject's upper dental
arch and a mold of a subject's lower dental arch. In addition, a
registration device (e.g., a bite-down registration device) may
also be used to model the subject's bite registration. Fiduciary
references may be used to align any of the components of the
model.
[0099] For example, at the start of the modeling procedure, a
physical model (e.g., mold or cast) may be made of a subject's
upper and lower dental arches. Any appropriate method of making a
cast or model of a subject's dental arches may be used. In one
variation, a negative mold is made from all (or a portion) of a
subject's upper and lower arches. For example, a dental cast made
be made showing the arrangement of the subjects upper and lower
teeth with respect to each other. A positive replica may then be
formed using this negative mold. The positive and negative mold may
also be used to accurately model the relationship of the individual
teeth with respect to each other, as described in many of the
patent applications mentioned above. Other examples of molding
dental arch models are disclosed in the above referenced U.S.
patent application Ser. No. 11/013,160 ("System and methods for
casting physical tooth model"), and U.S. patent application Ser.
No. 10/979,823 ("Method and apparatus for manufacturing and
constructing a physical dental arch model").
[0100] Thus, a dental model may be made for the subject's current
arrangement of teeth (or "initial" arrangement). The dental models
may include any feature of the actual dental arches, or a subset of
these features. For example, the dental model may include the crown
regions of the teeth, the gums (gingival), the roots, etc. Some of
these features may be actually measured or derived. For example,
the structure and locations of the roots of the teeth may be
calculated (or computer-generated) from measurements taken from the
crown region or other portions of a subject's teeth or mouth, as
described in U.S. Provisional patent application titled "COMPUTER
AIDED ORTHODONTIC TREATMENT PLANNING" by Huafeng Wen, et al, filed
Apr. 19, 2005.
[0101] In some variations, the dental model may be made by directly
scanning a subject's teeth. For example, an intraoral 3-D imaging
device, such as OraScanner.RTM. manufactured by OraMetrix.RTM., can
be utilized to digitize the subject's tooth arch. The digital
dental arch model is subsequently segmented into individual teeth,
which comprises digital representations of the crown portion of the
individual teeth. In one application, the scanning of the subject's
teeth is conducted at the dentist's office. The data generated from
scanning, i.e., the digital representation of the subject's arch,
is then transmitted over a computer network to a receiving computer
for further processing.
[0102] A physical dental model may also be used to construct a
digital dental model. For example, a positive model of the
subject's tooth arch may be created from a negative impression of
the subject's teeth. The teeth of the positive mold may then be
segmented into individual units (e.g., teeth) and digitized or
scanned by various 3D scanning techniques and reconstructed to
digitally represent the subject's upper or lower arch. Examples of
appropriate scanning techniques that may be used to create a
digital model are described further below. A physical model of the
dental arches may also be made from a digital model. For example,
physical models of the upper and/or lower arches may be fabricated
using Computer Numerical Control (CNC) manufacturing (such as
milling, stereo lithography, and laser machining).
[0103] It may also be beneficial to include markings such as
fiduciary references on the upper and lower arch models.
2. Fiduciary References
[0104] Fiduciary references may be used to aligning the teeth to
form the dental model. Virtually any mark, object or region of an
object may be identified as a fiduciary reference for purposes of
aligning the arch models. A fiduciary reference may be a
stereotyped reference mark by which the orientation and/or location
of an arch model or components of an arch model (e.g., individual
teeth) may be identified. A fiduciary reference may include
multiple marks, or an asymmetric mark. Fore example, a fiduciary
reference may be a point or set of points scribed onto the arch
model or onto an object to which the arch model is attached.
[0105] In some variations, a model includes a fixture that may be a
plate (e.g., a base plate or dental plate) that is not part of the
subject's actual dental arch, but to which the dental arch model is
attached. The fixture may comprise a fiduciary reference.
Components of the dental arch (e.g., individual teeth models) may
be secured to the fixture so that the dental arch does not change
position relative to the fixture. Thus, the fiduciary reference(s)
may be marked on the dental arch itself or it may be marked on the
fixture, or both. In one variation, the fixture comprises
attachment or receiving sites that mate with fiduciary components
on the teeth models to provide fiduciary reference. Thus, the
fixture may include engagement surfaces to align (and/or secure)
other components of the dental model.
[0106] For example, the tooth models may comprise registration
features compatible with the receiving features on the dental
plate. Examples of registration features that may be used include,
but are not limited to pins, protrusions, posts, snaps, and the
like. In some variations, the registration features may model the
orientation of the roots of the teeth. In registration systems as
described above, the individual tooth models may be used with
different dental plates in order to show different arrangements of
the teeth. For example, if a tooth is to be moved to create a
modified dental model, the model may be readily constructed by
moving the receiving feature on the dental plate, and using the
same tooth model. Additional examples of registration features are
described in the Examples given below.
[0107] The location and orientation of the fiduciary marker may be
selected by the user ("user" may refer to the technician,
manufacturer or in some cases, practitioner), or may be
automatically selected (e.g., as by a computer). For example, the
user may indicate on a scan of the dental arch where to place
registration features (e.g., pins) on each tooth.
[0108] Fiduciary references may include any number of markers. For
example, a single fiduciary mark may be used to indicate location
and orientation of dental arch components. A fiduciary reference
may comprise two, three, or more individual marks. In some
variations, the fiduciary reference is a three-dimensional
structure (e.g., a cut, a pit, etc.). In some variations, the
fiduciary reference is a two-dimensional structure (e.g., a mark).
In some variations, the fiduciary reference may comprise a color or
texture that is distinguishable from the rest of the dental arch
model.
[0109] As described, a registration device may be used to more
accurately model a subject's dental arches. For example, a
bite-down registration device may be used, and may comprise a
material that conforms to the spaces between the upper and lower
arches when the subject bites down (e.g., a wax bite). Additional
materials may be used to form the dental models, including images
(scans, X-rays, etc.) and the like.
Scanning
[0110] The teeth (e.g., a model of the teeth) may be scanned or
measured to determine the position of the teeth. Any appropriate
technique may be used to measure the positions of the teeth,
including manual measurement, contact scanning and non-contact
types of scanning. Contact scanning includes scanning by actual (or
computer assisted) measurement, including mechanical location
devices such as a Microscibe. The scanner may be used to acquiring
coordinates (e.g., 3D coordinates) from the dental arches including
the fiduciary references.
[0111] For example, a Microscibe is a 3D digitizer that can develop
a digital computer model from an existing 3D object. Exemplary
Microscribes are available from Immersion and Phantom. A contact
Microscibe scanner may comprise one or more mechanical arms that
have mechanical joints with precision bearings including sensors.
For example, the Microscibe may move a stylus over the dental model
and record accurate 3D positional and angular information of the
points that the stylus touches. Thus, the stylus may touch (or be
directed to touch) the teeth, base plate, and any fiduciary
references. The mechanical location device may also comprise
additional sensors (e.g., a sensor located on the tip of the stylus
of a Microscribe) for specifically or automatically detecting the
fiduciary reference. Examples of additional sensors include optical
sensors, RF sensors, and the like.
[0112] When scanning a physical dental model, the model may be
broken into pieces (e.g., by tooth) for scanning of the individual
pieces. The individual scans may then be re-assembled later (using
the fiduciary marks, for example). Furthermore, it may be
advantageous to set or affix the model (or model pieces) to a scan
plate (e.g., a surface from which the scanning may take place). For
example, the model may be attached to a scan plate that rotates or
otherwise moves to position the assembly so that it might be
accurately scanned. In some variations, the assembly is secured to
a scan plate.
[0113] The dental model (or teeth) may also be scanned by
non-contact methods. Examples of 3D non-contact scanners and
scanning techniques include, but are not limited to, laser
scanning, optical scanning, destructive scanning, CT scanning, and
sound wave scanning. In some variations, images (e.g., X-rays,
etc.) may be analyzed to determine the position of dental
components. This analysis may include image analysis techniques,
such as tomography.
[0114] The scanner may communicate with a computer that may be used
to control the scanning, and/or to store information from the scan.
Position and orientation information can be obtained, stored and
analyzed. The computer may also act as a controller, and may
control other portions of the scanning process, including the scan
plate. For example, the computer may allow user input, and may also
provide output.
[0115] For each portion of the dental model, a fiduciary reference
may also be scanned as part of the individual scans, and digital
models of the teeth (dental arches) are made from these scans. Each
digital model may have its own coordinate system. In some
variations, an individual arch may be scanned in pieces or
sections, and later reconstructed to form a model of a single
dental arch, having a single coordinate system.
[0116] Based on the positional information identified from the
scanning, the relative positions of the teeth may be calculated,
and movement of the teeth after or between treatment steps may be
measured.
Aligners
[0117] The term "dental aligner" may refer to a dental device for
rendering corrective teeth movement or for correcting misaligned
teeth. One or more dental aligners can be worn on the subject's
teeth so that a subject wearing the dental aligners will gradually
have his or her teeth repositioned by the dental aligner "pushing"
(or pulling) against the teeth, or gums (gingiva).
[0118] Aligners may be fabricated from the dental models described
herein. Details of fabricating dental aligners are disclosed in the
above referenced U.S. patent application Ser. No. 10/979,497,
titled "Method and apparatus for manufacturing and constructing a
dental aligner" by Huafeng Wen, filed Nov. 2, 2004, U.S. patent
application Ser. No. 11/074,301, titled "Dental aligner for
providing accurate dental treatment" by Liu et al, filed Mar. 7,
2005, U.S. patent application Ser. No. 11/074,297, titled
"Producing wrinkled dental aligner for dental treatment" by Liu et
al, filed Mar. 7, 2005, U.S. patent application Ser. No.
11/074,300, titled "Fluid permeable dental aligner" by Huafeng Wen,
filed Mar. 7, 2005, and U.S. patent application Ser. No.
11/074,298, titled "Disposable dental aligner by Huafeng Wen, filed
Mar. 7, 2005.
[0119] Any appropriate fabrication method may be used to form a
dental aligner from the dental model. For example, a dental aligner
can be made by molding a malleable casting material in a casting
chamber. The mold can include at least a portion of a dental arch
model. The dental arch model can include a plurality of the
subject's physical tooth models that are positioned in the target
configuration specified for the specific treatment step.
[0120] The dental aligners can also be fabricated by a Computer
Numeric Control (CNC) based manufacturing. A CNC based drilling or
milling machine can receive a digital aligner model as input and
produce a dental aligner compatible with the target configuration
at the specific treatment step. Details of producing physical
dental arch model and associated base are disclosed in the above
referenced and commonly assigned U.S. patent application Ser. No.
10/979,823, titled "Method and apparatus for manufacturing and
constructing a physical dental arch model" by Huafeng Wen, filed
Nov. 2, 2004, U.S. patent application Ser. No. 10/979,497, titled
"Method and apparatus for manufacturing and constructing a dental
aligner" by Huafeng Wen, filed Nov. 2, 2004, U.S. patent
application Ser. No. 10/979,504, titled "Producing an adjustable
physical dental arch model" by Huafeng Wen, filed Nov. 2, 2004, and
U.S. patent application Ser. No. 10/979,824, titled "Producing a
base for physical dental arch model" by Huafeng Wen, filed Nov. 2,
2004. The disclosure of these related applications are incorporated
herein by reference.
[0121] In one variation, the dental aligner is formed from a dental
model by vacuum forming. For example, a sheet of aligner-making
material is attached to a sheet holder and then lifted up near a
heating element. The sheet can be made of uniform distribution of a
single material or comprise multiple layers of different materials.
After the aligner-making material is heated by a specified time,
the sheet holder is pressed on the subject's dental arch model on
the base plate. A vacuum pump removes air at the bottom of the base
plate to cause the softened aligner making material to relax and
fittingly form around the surface the subject's dental arch model.
This process of aligner making is referred to as the vacuum
forming.
[0122] In one embodiment, the subject's dental arch model includes
through holes which may mate with connectors attached to the
subject's teeth. Examples of such snap-on aligner are described in
U.S. Provisional Application, titled, "DENTAL ALIGNER DEVICES
HAVING SNAP-ON CONNECTORS," by Huafeng Wen, et al. filed Apr. 15,
2005, herein incorporated by reference in its entirety.
[0123] One or a plurality of dental aligner can be provided to the
subject at each step of the dental treatment. Each of the aligners
can be worn for a period of time from a few hours to a few weeks.
The teeth movement caused by the dental aligner is normally not
exactly the same as designed by the treatment plan.
[0124] In general, aligners are fabricated so that they apply force
to move the teeth, resulting in the re-alignment of the teeth.
Thus, aligners are typically fabricated using models that represent
the teeth in positions which have been shifted slightly in a
direction leading to a desired alignment position, so that the
teeth will tend to move towards the desired position. The selection
of the ultimate (e.g., desired) position of the teeth, as well as
the movement path to move the teeth into the desired position may
be chosen by an orthodontist.
Selecting the Movement Path
[0125] A dental model may be used to determine a final position for
aligning teeth. For example, an orthodontist may manipulate a
dental model to determine the final alignment position of the
teeth. In some variations, the orthodontist may use computer
software to determine the final position of the teeth. The final
position of the teeth may be used to determine a movement path in
order to move a subject's teeth from a first position (e.g., the
initial position or a subsequent position after staring the
alignment process) to the final position.
[0126] The movement path may be selected manually, automatically,
or it may be selected by a user with computer assistance. Examples
of methods, devices and systems for choosing a final position
and/or a movement path for aligning a subjects teeth may be found
in many of the patent applications previously referred to and
incorporated by reference, including U.S. patent application Ser.
No. 11/013,145, titled "Fabricating a base compatible with physical
dental tooth models" by Huafeng Wen, filed Dec. 14, 2004, U.S.
patent application Ser. No. 11/013,156, titled "Producing
non-interfering tooth models on a base" by Huafeng Wen, filed Dec.
14, 2004.
[0127] For example, software may be used to assist the user in
choosing a final alignment of a subject's teeth. In one example,
digital representations for the teeth are provided from a digital
tooth arch model. A digital tooth arch model is then utilized to
provide visual feedback to the user when the position and/or
orientation of one or more of the individual teeth within the tooth
arch are modified. Individual physical models of the teeth within a
subject's tooth arch may be used to represent the tooth arch.
[0128] In another variation, software running on a computer
generates a user interface to allow the user to display and modify
one or more of the teeth within the tooth arch model. The position
of individual teeth within the tooth arch model may be electively
modified (e.g., displaced, rotated, etc.) relative to the other
teeth in the tooth arch model. The user interface may display the
pre-modified tooth arch model and the post-modified tooth arch
model in a side-by-side manner. This display permits the user to
verify the changes by comparing the modified arch with the original
arch (starting arch). Three or more digital arches models of the
same subject may be provided with various changes or adjustments to
one or more of the teeth. The user interface may be configured to
allow the user to select any two of the arch models and display
them side-by-side for comparison.
[0129] In some variations, once a target (or final) alignment
positions for the teeth has been determined, the movement pathway
may be determined. The movement pathway may be calculated based on
a number of parameters, including the total distance of tooth
movement, the difficulty in moving the teeth (e.g. based on the
surrounding structures, the types and locations of teeth being
moved, etc) and other subject-specific data that may be provided.
Based on this sort of information, the software may generate an
appropriate number of intermediary steps (corresponding to a number
of treatment steps, or aligners to be manufactured). In some
variations, the user may specify a number of steps/aligners, and
the software maps different aligner configurations accordingly.
Alternatively, the movement pathway may be guided by (or set by)
the user.
[0130] In one example, a series of nine pairs of different tooth
arches, representing projected teeth positions during the course of
an orthodontic treatment plan, are generated by a computer after
the user selects the final alignment position. The user may elect
any of the tooth arches within the treatment plan and display them
in a side-by-side manner. The user may be permitted to make changes
to the teeth within the tooth arches. For example, one window may
show the tooth arch with the teeth in the original untreated
positions. A second window may show the tooth arch with the teeth
in their indented target positions. The user may modify the tooth
arches in a window if desired. An aligner may then be created based
on the modified tooth arch in the window based on the digital
representations of the tooth arches at different stages of the
treatment.
[0131] Software may also be configured to allow the user to rotate
the tooth arch, such that the tooth arch can be examined from
different views. In one variation, the two set of arches in right
and left windows are always shown in the same directional view,
such that if the user rotates the post-modified tooth arches in the
right window, the corresponding pre-modified tooth arches will also
rotate in the same direction and in the same amount. If the
pre-modified tooth arches in the left window is rotated by the
user, the corresponding post-modified tooth arches will also rotate
in the same amount simultaneously. In one variation, a curser
controlled by a computer controller (e.g., a computer mouse, touch
pad, etc.) may be utilized to drag the digital representation of
the tooth arch shown in the user interface to rotate the tooth
arch. Optionally, icons representing selective predefined views of
the tooth arch may be provided within the user interface, such that
the user can show a desired view by selecting an icon. In one
variation, by clicking on an icon, the tooth arches displayed in
different windows will be changed to show selected view of the
tooth arches.
[0132] The computer software may simulate constraints to movement
when both selecting a final tooth conformation and when choosing a
movement pathway. For example, the digital representation of the
teeth may simulate potential collision between the teeth as the
positions of the teeth are modified by the user or through a
computer program. In addition, boundary conditions may be
predefined to limit the amount of movement of the tooth (e.g., root
rotation). For example, rotation of the crown of a tooth may cause
large displacement at the tip of the root, which can cause the root
to collide with the root of an adjacent tooth. In one variation,
the computer software is configured to detect collision when a
boundary parameter representing a first root is crossing over a
boundary parameter representing a second root. The software may
indicate to the user that collision has occurred, or may simply not
allow a movement pathway in which collision will occur. In another
variation, once collision has been detected, the software will not
allow the user to rotate the tooth further in the collision
direction, and may begin looking for a different movement pathway
to achieve the same (or a similar) final alignment position. In
another example, each of the teeth (i.e., crown and/or root) is
represented by a mesh of points. When the mesh of points
representing the first teeth and the mesh of points representing
the second teeth occupies the same space, this would indicate that
the two teeth have collided.
[0133] In another variation, boundary parameters may be defined to
simulate physiological conditions in the subject's mouth and jaw
that would limit the rotation and/or displacement of the tooth. In
one example, the software utilizes boundary parameters to prevent
over-rotation of the teeth. For example, a boundary condition may
be defined for each tooth to limit the amount of the rotation
and/or displacement that can be prescribed by the user. The
boundary condition may be generated based on population sample data
of humans' teeth, gum, and jaw structures. The boundary condition
may then be utilized to prevent the user from directing the
rotation or displacement of the teeth to an unrealistic condition.
Furthermore, boundary conditions may be determined for different
population subgroups. For each subject, the boundary condition from
the appropriate population sub-group that matches the subject's
physical parameters may be used to provide better estimation of the
physiological limitations. In some variations, the boundary
conditions may be determined for each individual patent based on
data supplied (e.g., from X-rays, the model, etc).
[0134] The practitioner (e.g., an orthodontist) may manually
determine (e.g., by entering into the computer) a movement pathway,
or the computer may generate a suggested movement pathway. In
either case, the user may adjust the movement pathway either before
making any aligners, or after the subject has begun wearing an
aligner or series of aligners. This allows the orthodontist to
correct the prescription if necessary. Furthermore, the user may
provide comments or instructions that may be used when creating the
movement pathway and/or the corresponding aligners. Thus, the
orthodontist may modify his prescription for a new aligner by
modifying one or more of the teeth in the digital representation of
the tooth arch.
1. Constraints on Movement
[0135] As described above, movement of components of the model
(e.g., the teeth) to formulate a movement pathway or a final
alignment may be constrained by various factors.
[0136] A tooth model may be described as having a tooth body and
tooth roots. In general, the tooth movements can be decoupled into
rotations around the roots and translations of the roots. The
translations of the roots may be described by a coordinate system,
such as a Cartesian coordinates defined by X-, Y-, and Z-axes. In
one variation, movement of the tooth roots may be though of as
movement of the center of the tooth separate from the "orientation"
of the tooth. The longitudinal axis, L, of a tooth can rotate along
a polar direction P, a direction of self-rotation S, and an
azimuthal direction A. Movement in P, S and A may be thought of as
orientation movements. Although alternative descriptions of
movements exist, his definition of the tooth movement has the
advantage of decoupling the large (rotational) orientation
movements from small (translational) movements. Since the roots are
generally anchored, the easiest movements of a tooth 300 under
external forces are the rotations around the roots, whereas the
translations of the roots are of much smaller magnitudes. Thus, the
rotation or orientation movements can be viewed as movements about
a pivot point about which the tooth rotates. FIGS. 3A and 3B
illustrate these axes of movement (X,Y,Z) and (P,S,A).
[0137] Thus, movements of the tooth model can be described by
coordinate systems identical to those used for the subject's tooth.
For example, the roots of the teeth may be simulated by the
registration features, as described above. Translation of the
registration features may be described by a Cartesian coordinate
system based on the X'-, Y'-, and Z'-axes, and rotation of the
tooth model can be described by the rotations of the longitudinal
axis L' of the tooth model along the polar direction P', the
self-rotation direction S', and the azimuthal direction A'.
[0138] In some variations, movement in one or more of these
directions is limited or constrained. For example, when planning
the movement pathway (or helping the user select a movement
pathway) the software or physical model may prevent certain types
of movement (e.g., in constrained direction) or may prefer
alternative types of movement in order to achieve a final alignment
of the teeth. In some variations, the software may "weight" certain
types of movement differently, e.g., corresponding to the
difficulty in moving in one or more directions. These weights may
be used in calculating the movement pathways. In some variations,
the software may tell the user when a movement in a constrained
direction has been chosen, or the software may simply prevent the
technician or practitioner from selecting movement in that
direction.
[0139] In some variations, because the registration features mimic
the roots of the subject's teeth, the tooth models attached to the
dental base can most closely simulate the present or the target
configurations of the subject's teeth. The movements of the
subject's teeth are decoupled to large movements (i.e. rotations
around the registration features or the roots of the teeth) and
small movements (i.e. translations of the registration features or
the roots). The dental aligner can therefore be designed to focus
on the large movements at each treatment step, which normally
involves minimal translation of the roots. Dental aligner can be
thus be formed using the tooth models generated at various points
along the movement pathway. Thus, a treatment series may be
generated having some number of positions (e.g., an initial or
starting position, a first treatment position, a second treatment
position, etc. until achieving a final position).
[0140] In some variations, the practitioner may adjust the
treatment positions while the subject is still undergoing
treatment, either based on user preference or based on feedback
from the subject's treatment to date.
2. Feedback in Forming the Movement Pathway
[0141] As described above, a movement pathway may be adjusted
during treatment of a subject. For example, after selection of an
alignment pathway, and construction of one or more aligners,
additional subject data (e.g., teeth measurements taken during
treatment) may be used to refine or alter the movement pathway and
therefore re-design the movement pathway, possibly including the
final alignment position. In some variations, the practitioner
(e.g., an orthodontist) may refine the treatment pathway, including
the final position, during treatment.
[0142] In some variations, the treatment path may be modified by
measuring the actual position of the subject's teeth during the
alignment procedure. For example, measurements of the subject's
teeth may be taken by any appropriate method, including the
scanning methods previously described. In one version, a negative
impression of the subject's teeth is taken at some point during the
treatment period, after the subject has worn an aligner.
Measurements taken from the subject's teeth may then be compared to
the initial position, the final position, and any of the
intermediate treatment positions. These measurements may then
provide information that is feed back into the design of the next
treatment steps.
[0143] In some variations, measurements taken during treatment may
provide subject-specific information on how responsive a subject is
to the treatment, and may allow further customizing of the
treatment. For example, if a subject has worn a first aligner
(corresponding to a first alignment position) for a specified
amount of time, the movement of the teeth from the original
position to the first alignment position may be determined by
comparing the actual position of the teeth after wearing the first
aligner to the initial and first alignment positions. The movement
path may then be modified to correct for differences between the
anticipated first alignment position and the actual first alignment
position. In some cases, additional alignment steps may be added to
the movement pathway, or the movement pathway may be changed to
indicate previously unsuspected constraints on the movement of some
or all of the teeth.
[0144] Described below are Examples of many of the different
components of the devices, methods and systems of alignment
described herein. Any of the steps described may be used in
combination with any of the other steps, or parts of other
steps.
EXAMPLES
Example 1
Treatment Method with Feedback
[0145] FIG. 1A illustrates one method for providing orthodontic
treatment for a subject using feedback. First, the initial
configuration of the subject's dental arch(s) is measured 110. The
initial configurations of the subject's teeth can include the
positions and the orientations of the subject's teeth before the
treatment begins. The analysis of the initial configuration of the
subject's teeth can include making dental impressions of the
subject's upper and/or lower arches. A digital model of the
subject's dental arches can then be produced. The surface locations
of the dental impressions can be measured to determine the
positions and the orientations of the subject's teeth, as described
above and in the incorporated references. For example, details of
conducting measurement on dental impressions are disclosed in the
above referenced U.S. patent application Ser. No. 11/013,159,
titled "Producing a base for accurately receiving dental tooth
models" by Huafeng Wen, filed Dec. 14, 2004 and U.S. patent
application Ser. No. 11/013,157, titled "Producing accurate base
for dental arch model" by Huafeng Wen, filed Dec. 14, 2004.
[0146] A practitioner may determine a target configuration for the
subject's teeth. This target configuration may be a final target
configuration 120 (e.g., indicating a final configuration of the
teeth at the end of the treatment), or it may indicate an
intermediate target configuration. The practitioner may indicate a
target configuration by manipulating a physical or digital model
and providing the manipulated model, or by providing verbal or
written instructions on how the teeth should be positioned with
respect to their current position (or other reference), or some
combination thereof.
[0147] The practitioner may design a treatment plan by determining
a target arrangement of the teeth 120 (e.g., a final target
arrangement). As mentioned above, a final target arrangement does
not have to be explicitly determined at the early stage; treatment
can begin and the practitioner can settle on the final arrangement
only after seeing how the subject's teeth respond to treatment.
Once a target arrangement is determined, a movement path may be
determined 130. The movement path is the path taken by the teeth as
they are moved by the aligner or aligners in order to achieve the
target arrangement. The aligners typically move the teeth
incrementally. If the movement path requires that the teeth move
more than a predetermined amount (e.g., 0.3 mm or less in X or Y
translation), then the movement path may be divided up into
multiple steps, where each step corresponds to a separate target
arrangement 140. The predetermined amount is generally the amount
that an aligner can move a tooth in a particular direction in the
time required for each treatment step (e.g., 3 weeks). A dental
aligner may be fabricated for each of these treatment steps
150.
[0148] The movement path may be determined with the assistance of
an analysis device such as a computer analysis device (e.g., a
computer running analysis logic). For example, the analysis device
may be configured to include constraint logic that indicates the
constraints on the movement of the teeth, as described above. Thus,
the movement path may be explicitly indicated by the practitioner,
or may be suggested by the analysis device and approved by the
practitioner. In some variations, the movement pathway is generated
by a technician with the assistance of analysis software (see
Example 2, below). The computer analysis device is typically
configured to store the initial and the target configurations
(e.g., final and intermediate target configurations) of the
subject's teeth as well as the movement path(s) from the initial
configuration to the target configuration. The movement path may
avoid teeth collision and overlap, and may also take into account
movement constraints for the teeth, including constraints on how
much a tooth may move during a given treatment step.
[0149] As mentioned, the movement paths may be divided into a
plurality of successive treatment steps 140. There can be, for
example, ten to forty steps. One or more dental aligners can be
fabricated for each treatment step 150. The subject wears one of
the dental aligners to move his or her teeth as part of each step
160.
[0150] Dental aligners may be fabricated as described herein. One
or a plurality of dental aligner can be provided to the subject at
each step of the dental treatment. Each of the aligners can be worn
for a period of time from a few hours, to a few weeks (e.g., 3
weeks). Aligners may be worn continuously over for a portion of a
day.
[0151] As described, orthodontic treatment methods may include
"feedback" allowing the teeth to be iteratively adjusted during
treatment based on how the teeth have responded to one or more of
the dental aligners. Thus, one or more aligners may be designed for
future treatment steps only after analyzing the arrangement of the
subject's dental arch after the subject has worn a dental aligner
as part of the ongoing treatment.
[0152] The teeth movement caused by the dental aligner is normally
not exactly the same as designed by the treatment plan. Thus, as
described above, the movement of the teeth may be analyzed after an
aligner has been worn 170 to determine their position, in the
dental arch, or how much they have moved since beginning the
previous treatment step (or steps). The movement resulting may be
factored into the treatment plan, particularly in the design of
additional aligners. The positions and orientations of the
subject's teeth can be measured, which can serve as a feedback to
the adjustment of the treatment plan.
[0153] A negative impression of the subject's dental arch can be
obtained after the subject has worn the dental aligner for a period
of time, and measurements taken as described above for determining
analyzing the configuration of the subject's dental arch. FIG. 2
illustrates one method for determining the configuration of a
subject's dental arch. A subject's negative dental impression 280
can be fixed in a container 290 using an epoxy. The container 290
can be marked by one ore more reference marks 295 that can define
the coordinates of the impression 280. The relative positions of
the subject's teeth are measured off the impression using a
mechanical location device 200. An example of a mechanical location
device is the Microscribe available from Immersion and Phantom.
Microscribe is a hand-held 3D digitizer that can develop a digital
computer model for an existing 3D object. The mechanical location
device 200 can include mechanical arms 210, 220 having one or more
mechanical joints 230. The mechanical joint 230 is equipped with
precision bearings for smooth manipulation and internal digital
optical sensors for decoding the motion and rotation of the
mechanical arms 210, 220. The end segment is a stylus 240 that can
be manipulated to touch points on the dental impression 280 held in
the container 290. The mechanical location device 200 can be fixed
to a common platform as the container 290. Accurate 3D positional
and angular information of the points that the stylus touches can
be decoded and output at the electronic output port 270. The
positional and orientational information can be obtained by
additional decoders. Additional sensors can be placed at the tip of
the stylus to measure the hardness of the surface of the
measurement object. Immersion Corp.'s MicroScribe uses a pointed
stylus attached to a CMM-type device to produce an accuracy of
0.009 inches.
[0154] In measuring the teeth positions from the impression of the
subject's teeth, the MicroScribe digitizer is mounted on a fixture
fixed to a base plate. The device can communicate with a host
computer via USB or serial port. A user (e.g., a technician or
manufacturer) then selects points of interest at each tooth
positions in the impression and places the stylus at the point of
interest. Positional and angular information are decoded and then
transmitted to the computer. The Cartesian XYZ coordinates of the
acquired points are then calculated and logged for each first
feature location and orientation (or alternatively each tooth).
[0155] A new coordinate system is established based on the
container chamber in which the arch impression is held. This system
is established by taking readings for two points on two sides of
the container to define the x-axis. Another reading on the plane
establishes the x-y plane. An origin is then determined on the x-y
plane. The z-axis will be established by taking the cross product
of the x-axis and y-axis.
[0156] The user next selects a plurality of points on the surfaces
of the arch impression corresponding to each tooth. The 3D points
measured from the impression surfaces are then interpolated to
create surfaces and solids integrated into an overall design.
[0157] The number of points defining the curves and number of
curves depends on the desired resolution in the model. Surfacing
functions offered by the design application are used to create and
blend the model surfaces. The model may be shaded or rendered,
defined as a solid or animated depending on the designer's
intentions. All the readings acquired by the stylus can be rendered
in real time to allow the user to visualize the digital tooth
models. The coordinate axes and points can be rendered in the
software using different colored cylinders/spheres etc. so as to
distinguish the different meanings of values.
[0158] The teeth positions can also be obtained by optically
scanning the dental impression or tooth models molded using the
dental impression. An optical scanning system can include a scan
table on which the dental impression or the tooth models can be
mounted. The scan table can be rotated by a rotation mechanism
under the control of a computer. One or more image capture device
can capture images of the dental impression or tooth models molded
as the scan table is turned to an angular position. The optical
axis of the image capture device can be for example 45 degree off
the vertical axis (or the top surface of the scan table).
[0159] A digital dental arch model can include a plurality of
digital tooth models. The digital dental model can be developed
based on the first feature locations and orientations or
alternatively the coordinates of the physical tooth models acquired
by the mechanical location device.
[0160] The images of the dental impression or tooth models are
analyzed. The coordinates of a plurality of surface points on the
dental impression or tooth models are computed by triangulation
using the captured image data. The surfaces of the dental
impression or tooth models are constructed by interpolating
computed coordinates of the points on the surface. The positions of
the subject's teeth can thus be obtained. The positions of the
subject's teeth can also be measured by a laser tracking system and
a motion tracking system. Details of measuring location information
on a dental impression of a subject are disclosed in the above
referenced U.S. patent application Ser. No. 11/013,159, titled
"Producing a base for accurately receiving dental tooth models" by
Huafeng Wen, filed Dec. 14, 2004 and commonly assigned U.S. patent
application Ser. No. 11/013,157, titled "Producing accurate base
for dental arch model" by Huafeng Wen, filed Dec. 14, 2004.
[0161] The measured positions of the subject's teeth are compared
to the target configurations at the treatment step in the treatment
plan in step 180. If the target configurations are achieved within
a specified tolerance, the treatment can proceed according to the
original design. One or more aligners can be produced for the next
treatment step as originally planned in step 190.
[0162] If it is found that the dental aligner did not move the
subject's teeth to the desired target configurations in step 180,
the orthodontist can design another dental aligner in response to
the measured current teeth positions and the desired positions for
the subject's teeth at this stage of the treatment. Typically, the
orthodontist uses computer software to simulate the teeth movement
to the target configurations for the subject's teeth. The target
configurations include desired teeth positions and orientations.
The target configurations can be specified in the original
treatment plan for this or the next step of the treatment.
Furthermore, the orthodontist can also dynamically adjust the
target teeth configurations for the next treatment step in
accordance to the movement of the subject's teeth.
[0163] As described, dental aligners can be fabricated with the
assistance of physical tooth models that can be assembled to form a
physical dental arch model. The physical dental arch model can be
formed on a dental base. The physical tooth models of the subject's
teeth can be fabricated and used for one or more treatment steps.
The dental base can include a plurality of receiving features for
receiving the tooth models. The tooth models can comprise
registration features compatible with the receiving features. The
dental base can include different configurations each corresponding
to one or more treatment steps. Dental aligners can be conveniently
and inexpensively fabricated using the physical arch models at
different treatment steps. The shared use of physical tooth models
and the dental base between treatment steps significantly reduces
the treatment time and cost. Various steps of the disclosed
treatment system and methods are disclosed in the above referenced
and commonly assigned U.S. patent applications, the disclosures of
which are incorporated herein by reference.
[0164] Physical tooth models can be fabricated before the first
treatment step or produced again in any of the subsequent steps if
any of the tooth models are worn or damaged. A plurality of tooth
models can also be fabricated at once to save set-up time and
handling cost. In one example, the physical tooth models can be
molded using the negative impression 280 in a casting chamber or
the container 290. The container 290 can be filled with a malleable
casting material. The container 290 can be sealed. The casting
material is solidified with the assistance of heating, pressure,
and/or UV irradiation. A physical arch model of the subject's arch
can then be obtained by removing the solidified casting material.
The physical arch model can then be separated into a plurality of
tooth models. The one ore more reference marks 295 can be
simultaneously molded on the physical arch model such that the
surface points on the physical arch model can be accurately
translated back to the original coordinates for the negative arch
impression. Details of molding physical arch models are disclosed
in the above referenced and commonly assigned U.S. patent
application Ser. No. 11/013,160, titled "System and methods for
casting physical tooth model" by Huafeng Wen, filed Dec. 14, 2004
and U.S. patent application Ser. No. 10/979,823, titled "Method and
apparatus for manufacturing and constructing a physical dental arch
model" by Huafeng Wen, filed Nov. 2, 2004, the disclosures of which
are incorporated herein by reference.
[0165] FIG. 3A illustrates a subject's tooth 300 that includes a
tooth body 310 and roots 320. In accordance with the present
invention, the tooth movements can be decoupled into rotations
around the roots 320 and translations of the roots 320. The
translations of the roots 320 can be described by a coordinate
system, such as a Cartesian coordinates defined by X-, Y-, and
Z-axes. The longitudinal axis L of the tooth 300 can rotate along
the polar direction P, the direction of self-rotation S, and the
azimuthal direction A. Although alternative descriptions of
movements exist, the disclosed definition of the teeth movement has
the advantages of decoupling the large (rotational) movements from
the small (translational) movements. Since the roots 320 are
anchored down deep, the easiest movements of a tooth 300 under
external forces are the rotations around the roots 320, whereas the
translations of the roots 320 are of much smaller magnitudes. The
roots of the tooth can be viewed as a pivot point about which the
tooth rotates.
[0166] FIG. 3B illustrates a tooth model 350 that can simulate the
movements of the subject's tooth 300 in FIG. 3A. The tooth model
350 can include a tooth model body 360 and one or more registration
features 370. The tooth model body 360 can simulate the tooth body
310. In accordance with the present invention, the registration
features 370 can simulate the roots 320. The registration features
370 can include a pin, a protrusion, a stud, a socket, a slot, a
hole, and other features that can be attached to the receiving
features on the dental base as shown in FIGS. 5 and 6.
[0167] The simulation of the registration features 370 of the roots
320 can be assisted by a digital representation of the subject's
tooth, that is, a digital tooth model. Images of the subject's
teeth including the roots can be can be captured by X-ray in
different directions. 3D digital models of the subject's teeth can
be constructed from the images. The tooth model can also be scanned
optically or measured by a location device to obtain a digital
tooth model. The digital tooth model can be extrapolated to
describe the roots of the tooth. The registration features 370 can
then be simulated such that the ends of the registration features
370 are at the same locations relative to the tooth model 350 as
the roots 320 relative to the tooth 300.
[0168] The movements of the tooth model 350 can be described by
coordinate systems identical to those used for the subject's tooth
300 in FIG. 3A. The translation of the registration features 370 is
described by a Cartesian coordinate system based on the X'-, Y'-,
and Z'-axes. The rotation of the tooth model 350 can be described
by the rotations of the longitudinal axis L' of the tooth model 350
along the polar direction P', the self-rotation direction S', and
the azimuthal direction A'.
[0169] FIG. 3C shows a generalized tooth model 380, having a tooth
body 380 and alignment pins (simulating roots) 390.
[0170] Dental aligner can be formed using the tooth models attached
to the dental base at each step of the dental treatment. Because
the registration features mimic the roots of the subject's teeth,
the tooth models attached to the dental base can most closely
simulate the present or the target configurations of the subject's
teeth. The movements of the subject's teeth are decoupled to large
movements (i.e. rotations around the registration features or the
roots of the teeth) and small movements (i.e. translations of the
registration features or the roots). The dental aligner can
therefore focus on the large movements at each treatment step,
which normally involves minimal translation of the roots. The
dental aligner produced can therefore produce more accurate
movement in the subject's teeth.
[0171] The disclosed dental aligners can also be more effective in
moving subject's teeth. The prior art dental aligners often attempt
to rotate the subject's teeth around point above the roots of the
teeth, which often creates un-realistic or unwanted movements. The
undesirable movements often have to be corrected in rework steps.
The disclosed system can reduce the number corrective or rework
treatment steps, thus minimizing the total number of treatment
steps. The cost and time for the treatment are reduced.
[0172] The disclosed system and methods also simplifies the
orthodontic treatment process compared to the prior art systems.
The decoupling between rotations around the roots of the subject's
teeth and the translation of the roots helps to focus the teeth
movements on the primary movements, that is, the rotations around
the roots of the teeth. In many cases, no or only minimal
translational movements are required at the roots of the teeth.
[0173] As described above, constraining the movement of components
of the dental arch (e.g., teeth) may also help in determining the
intermediate digital (or physical) models interpolated from the
initial model and the final (desired) dental arch configuration. In
particular, constraining the movement of the teeth so that they
more accurately model the movement of teeth whose roots are
embedded within the gingiva and jaw is likely to result in more
accurate and effective aligner designs. One way to achieve this is
to constrain or limit movement in X-, Y- and/or Z-axes, while more
readily allowing movement about the roots (e.g., azimuth and polar
movement).
[0174] In other cases, a tooth can be constrained to rotate along
just one or two of the polar, self-rotation, and the azimuthal
directions in a particular treatment step. In other cases, the
roots of a tooth can be constrained not to move in the X-, Y- or
Z-directions in another treatment step. The constraints on the
rotational movements help to reduce the variable degrees of freedom
adjusting teeth configurations, which simplifies treatment
designs.
[0175] In one aspect, the constrained teeth movement reduces the
probability of interference between neighboring teeth. Details of
designing teeth movement without interference between adjacent
teeth are disclosed in the commonly assigned and above referenced
U.S. patent application Ser. No. 11/013,156, titled "Producing
non-interfering tooth models on a base" by Huafeng Wen, there
content of which is incorporated herein by reference.
[0176] In another aspect, different constrained tooth movement at
different treatment steps makes it easier to monitor the teeth
movement over the treatment process. The treatment can be more
focused and the teeth can be moved more directly to the final
configuration of the treatment plan. The simplified teeth movement
also reduces the chance for incorrect movement and thus reduces the
corrective measures in the treatment. The number of treatment steps
can be reduced as a result, which decreases the cost and time
spent.
[0177] The registration features 370 can be simultaneously produced
in the molding process by molding them into the malleable casting
materials. For examples, the registration features 370 can be pins
that are inserted into the malleable casting material before it is
solidified. Alternatively, the registration features 370 can be
produced in the tooth model 350 after the making of the physical
arch model and before the physical arch model is separated into
tooth models 350. For example, the registration features 370 can
include sockets that can be drilled by a drilling system 400 on the
physical arch model as shown in FIG. 4. Details of obtaining a
physical dental arch model having registration features and 3D
reference positions are disclosed in above referenced US patent
application titled "Producing a base for accurately receiving
dental tooth models" by Huafeng Wen, filed Dec. 14, 2004, the
content of which is incorporated herein by reference.
[0178] The tooth model 350 shown in FIG. 3B can include a tooth
model body 360 and one or more registration features 370. The
registration features 370 can include a pin, a protrusion, a stud,
a socket, a slot, a hole, and other features that can be attached
to the receiving features on the dental base as shown in FIGS. 5
and 6. The registration features can be simultaneously produced in
the molding process by molding them into the malleable casting
materials in step 185. For examples, registration features that are
pins can be inserted into the casting material before it is
solidified. Alternatively, the registration features 370 can be
produced in the tooth model 350 after the making of the physical
arch model and before the physical arch model is separated into
tooth models 350. For example, the registration features 370 can
include sockets that can be drilled by a drilling system 400 on the
physical arch model as shown in FIG. 4. Details of obtaining a
physical dental arch model having registration features and 3D
reference positions are disclosed in above referenced US patent
application titled "Producing a base for accurately receiving
dental tooth models" by Huafeng Wen, filed Dec. 14, 2004, the
content of which is incorporated herein by reference.
[0179] Receiving features for receiving the registration features
in the tooth model are next produced on a dental base in step 186.
The receiving features on the dental base are complimentary to and
compatible with the registration features on the tooth models. The
receiving features can include one or more of pins, protrusions,
studs, sockets, slots, and holes. As shown in FIG. 4, the dental
base 410 is held to a stage 415. A drilling device 430 is mounted
on a positioning system 440 that can move the drilling device 430
in three dimensions. The positioning system 440 first locates the
reference points 412 on the dental base 410 under the control of a
computer 420. The reference points 412 precisely correspond to the
reference marks 295 in the dental impression 280. The positioning
system 440 can define a coordinate system based on the reference
points on the dental base 410. The coordinates of the dental base
410 can be quantitatively translated to the original coordinates of
the negative dental impression 280 using the reference marks 295.
The computer 420 stores the locations of the sockets to be made on
the dental base 410. The locations of the sockets correspond to the
registration features 370 (pins) on the tooth model 350. Both the
sockets and the registration features 370 can be defined by the
original reference marks 295. For example, the locations of the
receiving features on the dental base can depend on at least two
factors: first, the measured positions of the subject's teeth after
the teeth movement caused by the last dental aligner; and second,
the desired positions of the subject's teeth.
[0180] The positional system 440 moves the drilling device 430 to
the intended locations for the sockets stored in the computer 420.
Drilling device 430 can drill the sockets using a mechanical drill
bit or by burning to form them with any appropriate device, such as
a high-power laser beam.
[0181] Alternatively, the dental base 410 rather than the drilling
device 430 can be mounted on a positioning device. The positioning
device is capable of producing relative movement between the dental
base 410 and the drilling device 430. A coordinate system is
developed based on the reference points 412 that can be
quantitatively translated to the coordinate system based the
reference marks 295 on the dental impression 280. The dental base
410 is moved to positions to allow the sockets to be drilled at the
intended locations. The precise registration between the teeth
positions on the dental base 410 assures the tooth models 350
accurately mounted on the dental base 410 as specified by the
desired positions (or the target configurations) of the teeth for
the next treatment step.
[0182] FIG. 5 is a top view of a dental base 500 comprising a
plurality of sockets 510 and 520 for receiving the studs of a
plurality of tooth models. The positions of the sockets 510,520 are
determined by either the initial teeth positions in a subject's
arch or the teeth positions during the orthodontic treatment
process. The base 500 can be in the form of a plate as shown in
FIG. 5, comprising a plurality of pairs of sockets 510,520. Each
pair of sockets 510,520 is adapted to receive two pins associated
with a physical tooth model. Each pair of sockets includes a socket
510 on the inside of the tooth arch model and a socket 520 on the
outside of the tooth arch model.
[0183] FIG. 6 shows a tooth model 610 affixed with two pins 615. A
dental base 620 includes sockets 625 that can be in registration
with the pins 615. The sockets 625 are adapted to receive the two
pins 615 to allow the tooth model 610 to be assembled with the
dental base 620. Since the sockets 625 and the pins 615 are
fabricated based on the same coordinate system. They can be in
precise registration to allow they to be assembled together. The
tooth models 610 are assembled onto the dental base 620 to form a
dental arch model in step 187.
[0184] A dental aligner can be conveniently fabricated using the
dental arch model in step 188. FIG. 7 illustrates an arrangement of
fabricating a dental aligner using a dental arch model. A sheet 710
of aligner-making material is attached to a sheet holder and then
lifted up near a heating element. The sheet can be made of uniform
distribution of a single material or comprise multiple layers of
different materials. After the aligner-making material is heated by
a specified time, the sheet holder is pressed on the subject's
dental arch model on the base plate. A vacuum pump removes air at
the bottom of the base plate to cause the softened aligner making
material to relax and fittingly form around the surface the
subject's dental arch model. This process of aligner making is
referred to as the vacuum forming.
[0185] The subject's dental arch model can include registration
points 412 that can be copied onto the sheet 710 of aligner-making
material during vacuum forming. The copied registration marks 720
are formed on the aligner 750. A digital arch model captures the
shape information of the subject's tooth models and the information
about the registration marks. The digital arch model can further
specify the location of the features to be produced on the
subject's teeth to receive the through holes that can allow the
dental aligner to be snapped onto the subject's teeth.
[0186] An aligner obtained as described herein may be specifically
designed to move the subject's teeth at the current stage of the
treatment process toward the desired positions. The aligner is to
be worn by the subject in step 160. The process from step 160 to
step 180 can be repeated.
[0187] The physical tooth models and the dental base can be shared
between different treatment steps. Physical arch models can be
configured and re-configured for different treatment steps. Dental
aligners can be conveniently and inexpensively fabricated using the
physical arch model.
Example 2
Manual determination of Movement Path and Intermediate Target
Configurations
[0188] In one variation, the method of producing removable
orthodontic appliances (aligners) relies upon a technician to
initially set the intermediate target configurations (treatment
steps). The aligners are made of clear plastic and are molded to
fit snugly over a subject's teeth, as described above.
[0189] Overall, the treatment system includes a series of aligners,
each of which has a configuration that differs slightly from the
untreated position of the subject's teeth. Each aligner exerts
pressure upon the subject's teeth, forcing the teeth to conform to
the configuration of the aligner. When the subject's teeth have
conformed to the configuration of a particular aligner, the subject
moves on to a new aligner. In general, the treatment process is
finished when the subject's teeth have reached the configuration
desired by the treating clinician.
[0190] FIG. 1B illustrates the steps followed by one variation of
this treatment method. The manufacturing process begins with
subject information provided by practitioner 1010. This information
is collected by the practitioner, through his examination of a
subject, and includes dental impressions of the subject's upper and
lower teeth, a "wax bite" (i.e., an impression of the subject's
teeth that the subject creates by biting into a piece of wax),
x-rays of the subject's teeth, photographs of the subject's face,
and a prescription. The manufacturing entity uses this information
to manufacture the aligners customized for each subject.
[0191] A physical model of the subject's teeth is created from the
provided information by the manufacturing entity 1020. The dental
impressions and x-rays of the subject's teeth are used to create a
physical model of the subject's teeth. This creation of a physical
model is accomplished through the following steps. First, a
technician reviews the dental impressions and x-rays to determine
the orientation of each of the subject's teeth. By looking at the
dental impressions and x-rays, the technician is able to determine
the z-axis of each tooth, i.e., the direction in which the tooth
points. This "z-axis" information is input into a three dimensional
digitizer. As described above, a three dimensional digitizer is a
spatial measuring tool used to determine the x, y and z coordinates
of points on the surface of an object. In this case, the three
dimensional digitizer is used to determine the x, y and z
coordinates of points on the surface of the subject's dental
impressions. The "z-axis" information is typically calculated by
using a 3D digitizer, (e.g., a MicroScribe) to obtain several
coordinates on the crown. These coordinates are then used to
estimate the positions of the roots of each individual tooth of the
subject.
[0192] Next, a computer numerical controlled (CNC) milling machine
is used to drill a series of holes, which correspond to the
estimated root positions, into a plastic plate, (base plate). Two
holes are drilled for each tooth and a pin is inserted into each
hole. The length of each pin is greater than the depth of each
hole, such that, once inserted, each pin partially protrudes from
the base plate. Two base plates are created-one for the subject's
upper arch and one for the subject's lower arch.
[0193] Modeling material is next poured into the subject's dental
impressions and the base plates are mated to the dental impressions
so that the pins, protruding from the base plates, protrude into
the liquid modeling material. As the modeling material hardens, the
pins become embedded in the material, creating a model of the teeth
with two pins protruding from each tooth. The models of the teeth,
including the pins, are removed from the dental impressions and
base plates. Finally, these models are then separated, i.e., cut
apart to create individual models of each of the subject's
teeth.
[0194] A digital image of the subject's teeth (a digital model) is
then produced to help guide the treatment formulation 1030. The
models of the subject's teeth, the estimated positions of the roots
of the subject's teeth, and the practitioner's prescription are
used to create a digital image of the prescribed position of the
subject's teeth. This process is accomplished through the following
steps. First, the models of each of the subject's teeth are mounted
onto another base plate, referred to as a "scanning plate," one at
a time (or in some variations, in a group). The scanning plate may
be made of the same kind of material as the base plate used in the
modeling process described above, but is given a different name to
indicate that it is used at a different point in the process and
for a different purpose.
[0195] The model of each tooth, once mounted onto the scanning
plate, is scanned using a laser to obtain data representing its
three dimensional geometry. These data, combined with the estimated
root positions and the practitioner's prescription, are used to
create a digital image of the prescribed position of the subject's
teeth, i.e., an image of the subject's teeth positioned in
accordance with the practitioner's prescription. This digital image
is referred to as the "PrescriptionView Image" or RxView. The
PrescritionView is a computer graphic image encoded in a data
format. The data contained in the PrescriptionView Image is
adequate to create a visual representation of the subject's teeth,
however, by itself it may not be adequate to provide a basis for
the manufacture of physical aligners.
[0196] The PrescriptionView is typically an image of the entirety
of the subject's teeth, including the portion of the teeth below
the gum line. The PrescriptionView of the portion of the teeth
above the gum line is created using the data obtained from the
laser scan of the model teeth. The PrescriptionView of the portion
of the teeth below the gum line is an approximation based on the
type of tooth represented--for example, the image of a molar is
based on the shape of a molar and the image of a bicuspid is based
on the shape of a bicuspid. The PrescriptionView may be provided to
the practitioner via computer for approval. The practitioner
examines the PrescriptionView using a computer program known,
allowing the practitioner to submit instructions and treatment
modifications. Once the practitioner has viewed the
PrescriptionView, the practitioner may either approve the
PrescriptionView or modify the PrescriptionView.
[0197] After the practitioner determines that an acceptable
PrescriptionView has been created, a technician (e.g., part of the
manufacturing entity) begins producing the aligners individually,
for shipment of two sets at a time. A "set" of aligners includes an
aligner for the subject's top teeth and an aligner for the
subject's bottom teeth, unless the subject seeks treatment for his
top or bottom teeth, exclusively, in which case his "set" of
aligners will consist of a single aligner.
[0198] The physical manufacture of the aligners may utilize a third
computer program that uses the data obtained from the laser scan of
the individual model teeth and the estimated positions of the roots
of the subject's teeth to create a digital image of the current
position of the subject's teeth 1040. A technician then looks at
this digital image and, using the software, manually adjusts the
positions of the teeth to a first-modified position 1050. The
technician generally relies upon judgment and experience to
manually adjust the positions of the teeth using the software, so
that the movement necessary to change the position of a tooth from
the current position to the first-modified position can be achieved
using a single aligner. In making this adjustment, the technician
may refer to the PrescriptionView as a visual guide only, much as a
lab technician would look at a physical model of teeth as a guide.
Data from the PrescriptionView does not need to be used in modeling
these intermediate treatment steps (intermediate target
configurations of the teeth). In some variations, the software used
to model these intermediate target configurations may apply the
constraints to the technician's ability to move the teeth. For
example, the technician may be limited in how far he or she can
move a tooth in rotation about the roots, or translate the teeth in
x-, y- or z-directions, as described above. The software used by
the technician to model the intermediate target configurations may
also protect against technician error by limiting the range of
movement allowed each tooth. For example, it may prohibit the
technician from positioning the teeth in undesirable or impossible
orientations, e.g., overlapping orientations.
[0199] Once this adjustment is complete, a dental aligner is
manufactured from the first intermediate target configuration (the
"first modified position" described above) 1060. A computer
numerical controlled (CNC) milling machine is used to drill a
series of holes, corresponding to the "first-modified" root
positions, into a base plate referred to as a "staging plate." The
staging plate is identical to the casting and scanning plates
described above, but is given a different name to indicate that it
is used at a different point in the process. The technician inserts
each physical tooth model into its corresponding pair of holes in
the "first-modified" staging plate. This creates a physical model
of the first-modified target position of the subject's teeth. The
technician then creates an aligner by thermoforming a polymer shell
over this physical model.
[0200] In some variations, a second-modified target position (e.g.,
a second intermediate target configuration) may be generated
immediately from which a second aligner may be produced. The
technician looks at the digital image of the first-modified
position with the software and, using his judgment and experience,
manually adjusts the first-modified position to a second-modified
position, as described above. A computer numerical controlled (CNC)
milling machine is then used to drill a series of holes,
corresponding to the "second-modified" target root positions, into
a staging plate. The technician inserts the model teeth into the
new staging plate holes, and a second aligner is molded over the
physical model.
[0201] Typically two aligners may be fabricated at a time, spanning
six weeks of treatment, and provided to the subject direction, or
to the practitioner to provide to the subject to be worn 1070.
These aligners may be worn, for example, for 21 days. Two sets of
aligners are sent to a practitioner at one time. The time during
which the subject wears these two sets of aligners, 42 days
(.about.6 weeks) is referred to as the "treatment period." After
two sets of aligners are provided to the practitioner, the
practitioner receives a message inquiring whether the practitioner
would like to make adjustments to the treatment, consult with
technician, or have the technician design and manufacture two more
aligners.
[0202] As the stages of treatment progress, the practitioner may
view the newly modified teeth positions and provides feedback and
input to the technician, changing the treatment pathway (e.g., the
course of the treatment) as the subject progresses from aligner to
aligner. Subsequent aligners can be created by repeating this
process, with continuing practitioner input and modification as
treatment progresses.
[0203] The practitioner has the ability to make adjustments to the
next two sets of aligners for approximately four weeks after the
start of each treatment period (leaving two weeks during which the
next two sets of aligners can be manufactured). This interactive
process ensures that each pair of aligners can provide
repositioning based on the current state of the subject's teeth, as
examined by the clinician.
[0204] As described herein, the actual movement of the dental arch
(teeth) may be feed back into the treatment. For example, the
position of the teeth after the subject has worn one or more
aligners may be used to plan the next (or next few) treatment
steps. In some variations, the practitioner provides information
about the configuration of the subject's teeth after the subject
has worn one or more dental aligners to the technician
(manufacturer) 1080. The manufacturer (or the practitioner) may
determine the change in position for individual teeth 1090, and may
adjust the next target configuration accordingly 1050. If one or
more teeth is proving particularly resistant to movement, the
practitioner may increase the amount of force applied to that tooth
by the next aligner(s) or may change the way that the tooth is
being moved by the aligner. In some variations, the actual position
of the subject's teeth after wearing the most recent aligner can
serve as the actual starting point for determining the next target
configuration, rather than using the previously determined intended
target configuration, as described above.
[0205] In this example, the aligners are shipped to the
practitioner two sets at a time, with the packaging being designed
to allow the clinician to select the proper set to give the subject
without the necessity of placing marks or instructions on the
aligners. For example, each set is packaged individually and the
packages are stacked one on top of the other, such that the top set
must be removed first, leaving the bottom set intact and attached
to the package, to be used during the second half of the treatment
period. The manufacturer can continue to fabricate and deliver
aligners until the practitioner informs them that treatment is
complete.
[0206] In some variations of the aligners, buttons may be used in
conjunction with the treatment. Buttons are small structures that
are physically bonded to a subject's teeth. Aligners can be
manufactured such that they include "windows," i.e., holes through
which these buttons protrude. When aligners with windows are fitted
onto teeth with buttons, the aligners can exert additional or
different forces upon selected teeth allowing for more aggressive
or more specialized tooth movement. The practitioner may indicate
whether the subject requires buttons and, if so, the prescription
indicates where the buttons should be positioned. Based upon this
prescription, the manufacturer creates a template, which the
practitioner uses to attach, i.e. glue, the buttons to the
subject's teeth.
[0207] Thus, in the example provided above, the intermediate target
positions of a subject's teeth are determined using a technician's
judgment and experience, and are not determined by any mathematical
algorithm or formula. However, it should be clear that in forming
the intermediate target positions, the technician may be guided or
assisted by software which assists in both modeling the movement of
teeth (e.g., reflecting realistic interaction between teeth and
difficulty to move in certain directions, etc.).
[0208] Although specific embodiments of the present invention have
been illustrated in the accompanying drawings and described in the
foregoing detailed description, it will be understood that the
invention is not limited to the particular embodiments described
herein, but is capable of numerous rearrangements, modifications,
and substitutions without departing from the scope of the
invention. The following claims are intended to encompass all such
modifications.
[0209] All of the references provided herein are incorporated by
reference in their entirety for all reasonable purposes, and their
disclosures are intended to be considered part of the full
disclosure.
[0210] Although specific embodiments of the present invention have
been illustrated in the accompanying drawings and described in the
foregoing detailed description, it will be understood that the
invention is not limited to the particular embodiments described
herein, but is capable of numerous rearrangements, modifications,
and substitutions without departing from the scope of the
invention. The following claims are intended to encompass all such
modifications.
* * * * *