U.S. patent application number 11/829702 was filed with the patent office on 2008-01-24 for embedded features and methods of a dental appliance.
This patent application is currently assigned to Align Technology, Inc.. Invention is credited to Jae Hyun Ahn, Muhammad Chishti, Eric Kuo, Ross J. Miller, Loc X. Phan, H. Robert Van Den Berg.
Application Number | 20080020337 11/829702 |
Document ID | / |
Family ID | 27394049 |
Filed Date | 2008-01-24 |
United States Patent
Application |
20080020337 |
Kind Code |
A1 |
Phan; Loc X. ; et
al. |
January 24, 2008 |
EMBEDDED FEATURES AND METHODS OF A DENTAL APPLIANCE
Abstract
Traditional orthodontic treatment often involves the use of
basic repositioning devices, such as braces, and the use of
supplementary devices, components or accessories to achieve desired
end results. Such components may be mounted on fixed, non-removable
devices or they may be part of a removable appliance typically worn
prior to the application of the fixed devices. As with traditional
treatment, it may be desired to utilize similar components when
repositioning teeth with removable elastic repositioning
appliances. Due to the nature of elastic appliances, such
components may take a variety of forms ranging from readily
available traditional accessories to specially created devices.
Thus, traditional components may be mounted on or embedded in an
elastic appliance, or the appliance may be formed to provide
similar components. Likewise, the appliance may be modified to
provide additional features for specific orthodontic
treatments.
Inventors: |
Phan; Loc X.; (Milpitas,
CA) ; Chishti; Muhammad; (Washington, DC) ;
Miller; Ross J.; (Sunnyvale, CA) ; Van Den Berg; H.
Robert; (San Ramon, CA) ; Kuo; Eric; (Foster
City, CA) ; Ahn; Jae Hyun; (Los Gatos, CA) |
Correspondence
Address: |
TOWNSEND AND TOWNSEND AND CREW, LLP (018563)
TWO EMBARCADERO CENTER, EIGHTH FLOOR
SAN FRANCISCO
CA
94111-3834
US
|
Assignee: |
Align Technology, Inc.
881 Martin Avenue
Santa Clara
CA
95050
|
Family ID: |
27394049 |
Appl. No.: |
11/829702 |
Filed: |
July 27, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10409409 |
Apr 7, 2003 |
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11829702 |
Jul 27, 2007 |
|
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|
09616222 |
Jul 14, 2000 |
6572372 |
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10409409 |
Apr 7, 2003 |
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60199650 |
Apr 25, 2000 |
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60199649 |
Apr 25, 2000 |
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Current U.S.
Class: |
433/6 |
Current CPC
Class: |
A61C 7/08 20130101; A61C
7/00 20130101; A61C 7/36 20130101 |
Class at
Publication: |
433/006 |
International
Class: |
A61C 3/00 20060101
A61C003/00 |
Claims
1. A removable elastic appliance comprising: a thin polymeric shell
which is shaped to be positioned over at least some teeth of a jaw
and adapted to interact with an oral surface to expand the palate
of the jaw.
2. An appliance as in claim 1, wherein the appliance further
comprises an orthodontic component mounted directly on the
shell.
3. An appliance as in claim 1, wherein the orthodontic component is
formed by the shell.
4. An appliance as in claim 3, wherein the component is configured
to interact with the palate.
5. A system comprising two or more removable elastic appliances as
in claim 1.
6. An appliance as in claim 5, wherein the system comprises three
or more elastic appliances.
7. A removable positioning appliance comprising: a thin polymeric
shell having cavities shaped to receive at least some of the teeth
of a jaw and adapted to interact with an oral surface to expand the
palate of the jaw.
8. An appliance as in claim 7, wherein the thin polymeric shell
includes a protrusion having an increased thickness of material in
at least a portion of a posterior occlusal region.
9. An appliance as in claim 7, wherein the thin polymeric shell
includes a protrusion having an extension of at least a portion of
an upper palatal region with added thickness.
10. An appliance as in claim 3, wherein the component comprises a
wire which spans an arch of the shell between the portions which
are positioned over opposing upper molars.
11. An appliance as in claim 3, wherein the component comprises a
wire which is embedded in the polymeric shell.
12. An appliance as in claim 4, wherein the component is a palatal
bar.
13. An appliance as in claim 12, wherein the palatal bar is
corrugated.
14. An appliance as in claim 7, further comprising a wire which
spans an arch of the shell between the portions which are
positioned over opposing upper molars.
15. An appliance as in claim 7, further comprising a wire which is
embedded in the polymeric shell.
16. An appliance as in claim 7, further comprising a palatal bar
formed as part of the shell and spanning an arch between portions
of the shell positioned over opposing upper molars.
17. An appliance as in claim 16, wherein the palatal bar is
corrugated.
18. A system comprising a series of removable thin shell
appliances, including one or more intermediate appliances each of
which has a geometry selected to progressively expand the palate
and a final appliance having a geometry selected to expand the
palate to a target desired breadth.
19. The system of claim 18, wherein each of the appliances
comprises molar cavities adapted to fit over the patient's molars
and a palatal component separating the two molar regions.
20. The system of claim 19, wherein each molar cavity fits over two
posterior molars.
21. The system of claim 18, wherein there are at least two
intermediate appliances.
22. The system of claim 18, wherein there are at least 10
intermediate appliances.
23. The system of claim 18, wherein there are at least 20
intermediate appliances.
24. A method of expanding the palate of a patient using the system
of claim 18, the method comprising positioning each appliance in
the series of appliances to expand the palate of the patient,
leaving the appliance in position for a period of time and
replacing the appliance with the next in the series until the
desired palatal expansion has occurred.
25. A method of expanding the palate of a patient, the method
comprising generating from an initial model of the patient's upper
jaw a series of incremental appliances including a first appliance
having a geometry selected to incrementally expand the palate; one
or more intermediate appliances having geometries selected to
progressively expand the palate; and a final appliance having a
geometry selected to expand the palate to a target desired breadth;
and sequentially positioning the appliances over the molars in the
patient's upper jaw for a period of time effective to expand the
palate to approximately the target desired breadth.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This present application is a continuation of U.S. patent
application Ser. No. 10/409,409 (Attorney Docket No.
018563-001540US-9011.ALG.D1), filed Apr. 7, 2003, which was a
divisional of U.S. patent application Ser. No. 09/616,222 (Attorney
Docket No. 018563-001510US-9011.ALG.P), filed Jul. 14, 2000, which
claimed the benefit of prior provisional application No. 60/199,649
(Attorney Docket No. 018563-001500US-9011.ALG.V), and 60/199,650
(Attorney Docket No. 018563-001300US-9010.ALG.V), both filed on
Apr. 25, 2000, the full disclosures of which are incorporated
herein by reference.
[0002] The disclosure of this application is also related to
application Ser. No. 09/616,830 (Attorney. Docket No.
018563-001310US-9010.ALG.P), filed on Jul. 14, 2000, and issued as
U.S. Pat. No. 6,524,101 on Feb. 25, 2003, the full disclosure of
which is incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0003] The present invention is related generally to the field of
orthodontics. Particularly, this invention relates to the use of
removable orthodontic appliances for producing tooth movements.
More particularly, this invention relates to improved devices,
systems and methods for producing such tooth movements with elastic
repositioning appliances.
[0004] Orthodontic treatments involve repositioning misaligned
teeth and bite configurations for improved cosmetic appearance and
dental function. Repositioning teeth is accomplished by applying
controlled forces to the teeth over an extended period of time.
This is conventionally accomplished by wearing what are commonly
referred to as "braces." Braces are typically comprised of brackets
or bands which are bonded to the teeth and linked with the use of
archwires, ligatures and O-rings. After the archwire is in place,
periodic appointments with the orthodontist are required, during
which the patient's braces will be adjusted. This involves
installing different archwires having different force-inducing
properties or by replacing or tightening existing ligatures.
Between meetings, the patient may be required to wear supplementary
appliances, such as elastic bands or headgear, to supply additional
or extraoral forces.
[0005] Although conventional braces are effective, they are often a
tedious and time consuming process requiring many visits to the
orthodontists office. Moreover, from a patient's perspective, they
are unsightly and uncomfortable. The archwire and ligatures which
connect the brackets in a continuous network make brushing,
flossing between the teeth and other dental hygiene procedures
difficult, possibly contributing to the development of gingivitis,
caries, and other dental disease. Consequently, alternative
orthodontic treatments are needed. In particular, it would be
desirable to use appliances which can be removed by the patient
during daily dental hygiene routines, while participating in
athletic activities, or for cosmetic purposes.
[0006] A particularly promising approach relies on the use of
elastic positioning appliances for realigning teeth. Such
appliances comprise a thin shell of elastic material that generally
conforms to a patient's teeth but is slightly out of alignment with
the initial tooth configuration. Placement of the elastic
positioner over the teeth applies controlled forces in specific
locations to gradually move the teeth into the new configuration.
Repetition of this process with successive appliances comprising
new configurations eventually move the teeth through a series of
intermediate configurations to a final desired configuration. A
full description of an exemplary elastic polymeric positioning
appliance is described in U.S. Pat. No. 5,975,89, and in published
PCT application WO 98/58596 which designates the United States and
which is assigned to the assignee of the present invention. Both
documents are incorporated by reference for all purposes.
[0007] In addition to their ease of use, polymeric positioning
appliances are generally transparent, providing an improved
cosmetic appearance, and impart substantial force on the teeth, due
to stiffness of the appliance. The stiffness of an elastic
positioning appliance is a result of the modulus of the
thermoformable polymer materials from which it is made. The higher
the modulus of the materials, the higher the stiffness of the
appliance. By designing the appliance to cover the teeth, a much
larger and/or more varied contact surface area may be afforded
compared to traditional spring retainers and wire-based appliances.
Consequently, more dramatic tooth movements may be achieved.
[0008] In some cases, however, orthodontic treatment may involve
more complex tooth movements or treatment plans requiring
additional devices or accessories. For example, it may be desirable
to apply forces to surfaces of the teeth that may not be easily
achieved by the appliance alone, either due to the location or
characteristics of the surface itself or of the surrounding teeth.
Similarly, it may be desirable to apply extraoral forces to some
tooth surfaces to achieve certain tooth movements or to control
growth and development of the bite and jaws. Likewise, it may be
desirable to achieve such control indirectly through soft tissue
stretch and muscular activity. Alternatively, it may be preferable
to allow the passive eruption and movement of certain teeth, free
of applied forces. The devices and accessories commonly utilized
for these situations are typically separate removable appliances
worn prior to the application of conventional braces, or
accessories used in conjunction with conventional braces. Thus,
such devices and accessories may not be compatible with the use of
elastic polymeric positioning appliances for orthodontic
treatment.
[0009] Consequently, improved methods and apparatus for achieving
these treatment objectives are desired for complete orthodontic
treatment in such patients. Such devices, systems and methods would
maintain the advantages of and be compatible with a removable
appliance while providing supplementary features to assist in the
improvement of jaw structuring, alignment and tooth repositioning,
to name a few. At least some of these objectives will be met by the
designs and methods of the present invention described
hereinafter.
SUMMARY OF THE INVENTION
[0010] The present invention provides improved devices, systems and
methods for repositioning teeth from a first orientation to a
successive orientation in a series of movements to a final tooth
and bite configuration. Such repositioning is based on a system
comprising at least one and usually a plurality of three or more
elastic repositioning appliances configured to receive the teeth in
a cavity and incrementally reposition individual teeth, usually in
a series of successive steps. In cases involving more complex
movements or treatment plans, it may be desired to utilize
additional devices, components or accessories. The present
invention provides for the utilization of such devices, components
or accessories typically used in conventional orthodontic
treatment. In some instances the present invention provides
improved elastic repositioning appliances that take the place of
such additional accessories. Further, the present invention may
provide improved elastic repositioning appliances that provide
simultaneous repositioning of tooth and bite configurations that
may be unachievable with conventional devices.
[0011] In a first aspect of the present invention, a removable
elastic positioning appliance, typically used in a series of
successive elastic appliances for orthodontic treatment, may be
comprised of a polymeric shell having at least one orthodontic
component or accessory. These components or accessories may be
independent entities that are embedded in the polymeric shell
during production of the appliance. Or, they may be mounted on the
polymeric shell with a suitable adhesive in a post-production
assembly protocol. In either case, the components may be
traditional accessories that are typically used with conventional
orthodontic devices, such as braces, or they may be any other
readily available components used for dental treatment.
Alternatively, the components may be specially created accessories
designed for specific purposes when used with removable elastic
positioning appliances. Such specially created accessories may be
independent entities present on or in the polymeric shell as
described above, or they may be formed by the polymeric shell
itself. In these cases, the component may be a formed protrusion or
shape in the wall of the polymeric shell, providing a variety of
advantages, including but not limited to increased stability,
safety from breakage, ease of manufacturing, cost savings,
shortened treatment time and improved cosmetic appearance and
patient compliance.
[0012] In a first embodiment, the orthodontic components or
accessories may be conventional accessories typically used with
fixed, non-removable orthodontic devices. For example, headgear
tubes are conventional accessories typically mounted on traditional
braces for inserting a headgear device and applying extraoral force
to the teeth and jaws. Tubes for receiving headgear may be mounted
on or embedded in the polymeric shell of an elastic positioning
appliance for a similar effect. Similarly, orthodontic hooks may be
mounted on traditional braces to support elastic bands which may
also apply distinct forces to the teeth and jaws. As with headgear
tubes, such hooks may also be mounted on or embedded in the
polymeric shell of a positioning appliance for a similar effect.
Likewise, a number of other conventional accessories, such as
brackets, springs, bumper tubes, palatal bars, frameworks,
pin-and-tube apparatuses and the like, may be used in conjunction
with polymeric positioning appliances. In some cases, such as with
brackets, the accessory may be used to join a removable elastic
appliance with a portion of teeth supporting fixed conventional
devices, such as braces.
[0013] In a second embodiment, the orthodontic components or
accessories may be those which are primarily exclusive to removable
appliances. These components are not generally suited for use with
fixed appliances and devices due to their bulk and size. In
addition, they are often used prior to the use of fixed devices to
create a favorable environment for later tooth repositioning. For
example, when a patient's teeth are still erupting, a number of
devices may be used to foster improved eruption and development of
the tooth arrangement and bite configuration. These may include
buccal shields, buccinator bows or wire shields, bite plates,
palatal expanders and bars, lingual flanges and pads, lip pads or
bumpers, and the like. Since these components are currently used
with removable appliances, they are ideally suited for use with
removable elastic positioning appliances. Thus, the components may
be mounted on or embedded in the polymeric shell of an elastic
appliance. Similarly, supporting structures for such components may
also be mounted or embedded in the polymeric shell for the
removable application of a component. For example, a bumper tube
may be embedded in the polymeric shell for later insertion and
removal of a bumper. Alternatively, the components may be formed by
the appliance itself, such components comprising a formed
protrusion or shape in the wall of the polymeric shell. In these
cases, the elastic repositioning appliance may take the place of
any additional accessories.
[0014] An added advantage of the use of elastic repositioning
appliances having these components or accessories is the ability to
provide the conventional benefit of the accessory while
simultaneously repositioning the teeth, a combination previously
limited. In conventional treatment, the use of fixed devices to
reposition the teeth negated the ability of simultaneously using
accessories provided by some removable appliances since removable
appliances may not be readily applied with fixed devices in place.
For example, situations in which it is desired to control eruption
of specific teeth concomitant with repositioning of the same or
other teeth would cause great difficulty if not an impossible
dilemma with traditional devices. The present invention may provide
such simultaneous maneuvers which are unachievable with
conventional treatment.
[0015] In a second aspect of the present invention, a removable
dental positioning appliance, typically used in a series of
successive elastic appliances for orthodontic treatment, may be
comprised of at least one protrusion shaped to be used for an
orthodontic function. As described above, such a protrusion may
resemble, in form or function, a traditional component or accessory
used in conventional orthodontic treatment with fixed,
non-removable devices or with removable appliances. For example, an
appliance may have a protrusion or shape in the wall of the
polymeric shell in the form of a hook for mounting flexible bands,
ligatures or adjunct devices. Such a hook may resemble traditional
hooks found in dental care, or it may be specially designed for use
with elastic repositioning appliances. Likewise, such a protrusion
may form a spring which transmits force to one or more teeth to
reposition teeth from a first arrangement to a successive
arrangement. A spring of this type may be of a traditional design
or it may be specially designed for use with elastic repositioning
appliances. Further, it may be specially designed to engage an
attachment body mounted on a tooth, a device primarily utilized in
conjunction with removable elastic appliances. A full description
of exemplary attachment bodies and devices is described in
published PCT application WO 99/28228, which corresponds to
co-pending application Ser. No. 09/454278, assigned to the assignee
of the present invention. Both documents are incorporated by
reference for all purposes. Thus, in these and similar cases, such
as a palatal bar, the protrusion may take the place of a
traditional accessory or component, or it may be utilized in a
specialized manner.
[0016] In one embodiment, the protrusion may contact one or more
dental surfaces to assist in holding the elastic appliance in
position. For example, one or more protrusions may be sized and
located to contact interdental areas of the patient's teeth, often
near the gingival margin, when the appliance is properly inserted
and positioned. Such protrusions may be formed in the wall of the
polymeric shell, or they may be adhered to or embedded into the
polymeric shell to protrude from the wall. Such placement of the
protrusions may provide additional friction and "grab" in dental
regions conducive to this effect. Similarly, a protrusion may be
sized and located to contact a tooth along a portion of the
gingival margin, with or without contact in the interdental areas.
Or, the protrusion may be a continuous protrusion contacting more
than one tooth along the gingival margin and the interdental areas.
In each of these cases, the contact of the protrusion may assist in
holding the appliance in proper position.
[0017] In another embodiment, the one or more protrusions may form
a bite plate. A bite plate is a device which prevents the teeth
from closing completely. By opening the bite in this manner,
unopposed teeth may be allowed to passively erupt in a controlled
manner to beneficially alter vertical dental relationships. In
addition, such an open state or disclusion may relieve teeth which
are in crossbite allowing orthodontic forces to correct the
crossbite.
[0018] To provide anterior disclusion, an elastic positioning
appliance may have an increase in thickness of material in the
posterior occlusal regions. This increase in thickness may be
applied to the appliance or formed by the appliance to create a
protrusion over the designated occluding surfaces. Similarly,
posterior disclusions may be provided by forming a protrusion which
extends at least a portion of an upper palatal region with added
thickness. Alternatively, posterior disclusions may be provided by
forming a protrusion in an upper lingual or lower facial anterior
region. Such protrusions may prevent the front teeth from closing
completely, thus discluding the posterior teeth. As previously
described, such protrusions may be formed in the appliance or
applied to the surface of the appliance.
[0019] Such embodiments of the present invention may be utilized in
the treatment of patients with a condition commonly termed a "deep
bite". In these cases, the lower teeth contact the upper teeth
and/or the palate in the natural bite. This occurs when the
posterior teeth are not fully erupted in the correct position
allowing the anterior teeth to become overdosed or overlap more
than is desirable. Such a bite is injurious to the palate, tends to
crowd the lower teeth, and affects flaring of the upper teeth
leading to upper spaces. This may be alleviated with the use of a
bite plate which provides posterior disclusion. Such disclusion
allows the posterior teeth to naturally erupt without contacting
the opposing teeth which may impede their eruption into the correct
position. The present invention may provide the function of a bite
plate while additionally providing repositioning forces and other
orthodontic treatment to the patient. These functions may be
simultaneous, an attribute not previously afforded by conventional
orthodontic treatment.
[0020] In a third aspect of the present invention, a removable
dental positioning appliance, typically used in a series of
successive elastic appliances for orthodontic treatment, may be
comprised of at least one space filler shaped to align with a gap
between adjacent teeth. If a tooth is extracted from a patient's
dentition, a space or gap will be left behind between adjacent
teeth. A similar gap may also be present due to general
misalignment of the teeth. An elastic positioning appliance may be
made to be positioned over a gap and its surrounding teeth. In such
a case, a space filler may be shaped to align with the gap. In a
preferred embodiment, the space filler may be a cavity in the
polymer shell having the shape of at least a portion of a tooth,
dental feature, sphere, oval or three-dimensional curved and/or
flat sided object. In the case of a tooth shape, the space filler
may act as a "pontic," a fake tooth placed where a tooth is missing
to give the appearance of the presence of a tooth. This same effect
may also be given by other shapes. Likewise, as a gap is gradually
eliminated due to repositioning of the teeth, a variety of shapes
may be suitable throughout the repositioning process.
[0021] To further conceal the presence of a space or gap between
teeth during orthodontic treatment, a space filler may be
opacified. By making the space filler at least partially opaque, it
may give a more convincing appearance of the presence of a tooth or
dental feature. Such opacity may be an effect of surface treatment
of the space filler. For example, the inside and/or outside
surfaces of the space filler may be painted with a tooth-colored
material. Alternatively, the surfaces may be microetched to give a
more frosted appearance to the polymeric shell material. In either
case, the space or gap may be less visible.
[0022] In addition to improving cosmetic appearance, a space filler
may also provide structural support for the elastic appliance. When
a space filler is a cavity, as described above, the presence of the
cavity improves the structural integrity of the appliance by
providing a uniform geometry. Alternatively, a space filler may be
any number of structures providing similar support. For example, a
space filler may be a structure that is at least partially solid.
This may be achieved by the formation of a solid section of
material spanning the gap, similar to a bridge or slab between
adjacent teeth. Such a solid section may be formed by the fusing of
the walls of the polymeric shell together. Alternatively, the shell
may be filled with a solid material. In this case, the shell may be
designed with undercuts or prongs to retain the solid material. In
addition, a solid section may be corrugated to additionally improve
the integrity of the appliance.
[0023] In a fourth aspect of the present invention, a removable
dental positioning appliance, typically used in a series of
successive elastic appliances for orthodontic treatment, may be
comprised of a polymeric shell having cavities shaped to receive
and reposition teeth, wherein one or more cavities has a window to
expose at least a portion of a received tooth. Such windows may be
portions of the wall of the polymer shell which are removed. When
the shell is positioned over the patient's teeth, portions of the
teeth beneath the windows may be exposed. Exposing such tooth
surfaces may allow brackets, buttons or other orthodontic
components to be utilized in conjunction with the elastic appliance
or to be exposed for other purposes.
[0024] In a preferred embodiment, a polymeric shell may have a
plurality of windows over portions of the occlusal surfaces of the
teeth. In this case, segments of the shell may still be present
along the facial and lingual surfaces of the teeth and across the
interdental regions or spaces between the teeth. Exposure of the
occlusal surfaces in appropriate size and location may allow
interdigitation of the upper and lower teeth. This may also be
achieved with the presence of one or a few larger windows over
portions of the occlusal surfaces of the teeth. In these cases,
segments of the shell may not be present across the interdental
regions or spaces between the teeth. In either case,
interdigitation of at least portions of the upper and lower teeth
may benefit tooth and jaw orientations, leading to improved
treatment, appearance, comfort and consequently patient compliance.
Likewise, similarly placed windows may provide the benefits offered
by a lower elastic modulus, such that the lowest stiffness may be
provided by the absence of the material. Such benefits and a full
description is provided in application Ser. No. 09/616,830
(Attorney. Docket No. 18563-001310), filed on Jul. 14, 2000, and
issued as U.S. Pat. No. 6,524,101 on Feb. 25, 2003, assigned to the
assignee of the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] FIG. 1 is a perspective illustration a variety of
orthodontic components or accessories typically used with fixed
orthodontic devices mounted on or embedded in the polymeric shell
of a removable elastic repositioning appliance.
[0026] FIG. 2 is a perspective illustration of a typical
transpalatal arch bar mounted on or embedded in the polymeric shell
of an appliance.
[0027] FIG. 3 is a perspective illustration an appliance having a
lip pad.
[0028] FIG. 4 is a perspective illustration of an appliance having
a buccal shield.
[0029] FIG. 5 is a perspective illustration of an appliance having
buccinator bow.
[0030] FIG. 6 is a perspective illustration of an appliance having
lingual pad.
[0031] FIG. 7 is a perspective illustration of appliances joined by
frameworks used in Herbst Appliances.
[0032] FIG. 8 is a perspective illustration of appliances joined by
frameworks used in Jasper Jumpers.
[0033] FIG. 9 illustrates of an appliance having a protrusion
formed in the polymeric shell in the shape of a hook.
[0034] FIGS. 10A and 10B illustrate steps of producing a protrusion
depicted in FIG. 9.
[0035] FIG. 11 illustrates an appliance having a protrusion formed
in the polymeric shell in the shape of a spring.
[0036] FIG. 12 is a perspective illustration of an appliance having
a protrusion in the polymeric shell to form a transpalatal bar.
[0037] FIG. 13 is a perspective illustration of an appliance having
a corrugated protrusion in the polymeric shell to form a
transpalatal bar.
[0038] FIG. 14A is a side view of a patient's teeth showing the
placement of protruding divots contacting interdental areas, and
FIG. 14B is a perspective illustration of a portion of an appliance
having such divots.
[0039] FIG. 15A is a perspective illustration of a portion of an
appliance having a continuous protrusion along the gingival line,
and FIG. 15B is a cross-sectional view of a tooth having such an
appliance in place.
[0040] FIG. 16 is a side view of a posterior portion of an
appliance illustrating an increase in thickness of material to form
a bite plate.
[0041] FIG. 17 is a perspective illustration of an appliance having
a protrusion of an upper palatal region to form a bite plate.
[0042] FIG. 18A and 18B are cross-sectional views of appliances
having protrusions in an upper lingual and lower facial anterior
regions, respectively, to form bite plates.
[0043] FIG. 19 illustrates a patient having a gap between adjacent
teeth.
[0044] FIG. 20 is a perspective illustration of an appliance having
a space filler cavity in the shape of a tooth placed over the
patient's dentition illustrated in FIG. 19.
[0045] FIG. 21 is a perspective illustration of an appliance having
a space filling structure formed between two cavities in the
polymeric shell.
[0046] FIG. 22 is a perspective illustration of an appliance having
a space filling corrugated structure formed between two cavities in
the polymeric shell.
[0047] FIG. 23A illustrates an unwanted disclusion due to thickness
of the appliance along the occlusional surfaces. FIG. 23B
illustrates the elimination of the disclusion of FIG. 23A by
eliminating material along the occlusional surfaces. FIG. 23C
illustrates a preferred embodiment of an appliance with portions of
the occlusional surfaces eliminated.
[0048] FIG. 24A illustrates a release tab embedded in the polymeric
shell of an appliance. FIG. 24B illustrates a preferred embodiment
of an appliance with release tabs encircling areas of occlusional
surfaces of the appliance.
DESCRIPTION OF THE SPECIFIC EMBODIMENTS
[0049] Traditional orthodontic treatment often involves the use of
basic repositioning devices, such as braces, and the use of
supplementary devices, components or accessories to achieve desired
end results. As previously described, such supplementary components
may be mounted on fixed, non-removable devices or they may be part
of a removable appliance typically worn prior to the application of
the fixed devices. As with traditional treatment, it may be desired
to utilize similar supplementary components when repositioning
teeth with removable elastic repositioning appliances. Due to the
nature of elastic appliances, such components may take a variety of
forms ranging from readily available traditional accessories to
specially created devices, as will be described below.
[0050] Referring to FIG. 1, a variety of orthodontic components or
accessories typically used with fixed orthodontic devices, such as
braces, are shown in conjunction with a removable elastic
positioning appliance 10. The majority of these accessories may be
readily available since they are typically used with conventional
treatment. They are also typically mounted on fixed devices, so
they are available as separate individual components. As previously
described, these components may be embedded in the polymeric shell
12 of an elastic repositioning appliance 10 during production or
they may be mounted on the shell 12 in a post-production assembly.
One such type of component is a tube 14 which is used in pairs to
mount a headgear appliance. Headgear appliances are typically
mounted on opposite posterior molars of the upper jaw for a number
of purposes, including keeping the upper jaw from growing, pulling
the upper teeth backward, and pulling the upper jaw and teeth
upward and backward so that they align with the lower jaw and
teeth. Therefore, tubes 14 for receiving headgear may be mounted on
the buccal surfaces of the polymeric shell 12 covering the
posterior molars. The distal ends of the headgear which enter the
oral cavity may then be inserted into the tubes 14 to apply extra
oral forces to the teeth and jaw. Other components may include
hooks 16, primarily used for mounting elastic bands, brackets 18,
used for mounting additional components and accessories or possibly
for interconnection with fixed brackets or devices, and buttons 20,
primarily used as an attachment point for various purposes. It may
be appreciated that such components have been shown on the same
appliance 10 for illustrative purposes, however typical use may
involve one or a few of such components with varying
arrangements.
[0051] Referring to FIG. 2, an additional component which may be
mounted on or embedded in a polymeric shell 12 is a transpalatal
arch bar 26. Such palatal bars typically span the palate and are
fixed at both ends to permanent devices mounted on opposing molars.
This is often used to stabilize and maintain positioning after
active arch expansion. In the case of an elastic repositioning
appliance 10, the conventional arch bar 26 may be positioned in a
similar location, attached at both ends to the polymeric shell
covering the lingual surfaces of opposing upper molars. In
addition, a low hanging transpalatal bar for control of vertical
dimension may be used. Also shown in FIG. 2, one or more wires 22
may be mounted on or embedded in the polymeric shell 12. Such wires
22 may span the majority of the arch, as in the case of a
conventional archwire, as shown. Or, such wires 22 may span only
portions of the arch, may be present on or within the facial and/or
lingual surfaces of the shell, may be multiple in number at a given
location, and may be curved, straight or a combination of these, to
name a few. The presence of such a wire 22 may be used most
commonly for structural reinforcement but may also be used to aid
in the application of orthodontic repositioning forces. Again, it
may be appreciated that such components have been shown on the same
appliance 10 for illustrative purposes, however typical use may
involve one or a few of such components with varying
arrangements.
[0052] FIGS. 3-8 illustrate the use of a variety of orthodontic
components or accessories which are typically used with removable
functional appliances. These components are not generally suited
for use with fixed appliances and devices due to their bulk and
size. However, they may be readily used with removable elastic
repositioning appliances. In most functional appliances, flanges
are used to provide the stimulus to posture the mandible to a new
position. Growth modification is most effective if the patient uses
his or her own musculature to posture the mandible forward, as
opposed to the mandible being held forward by external pressure
while the patient relaxes. Thus, the key to mandibular
repositioning is the contact of the pad or flange with soft tissue.
Such pads or flanges may be mounted or embedded in elastic
repositioning appliances. Referring to FIG. 3, a lip pad 30 may be
positioned on the polymeric shell 12 so that it is low in the
vestibule, holding the lips away from the teeth and forcing the
lips to stretch to form an oral seal. This forces the lip
musculature to stretch during function, presumably improving the
tonicity of the lips and perhaps promoting some soft tissue
remodeling that would contribute to stability of changes in incisor
position.
[0053] Referring to FIGS. 4 and 5, plastic buccal shields 34 and
wire buccinator bows 36 may be mounted on or embedded in the
polymer shell 12 to hold the soft tissues away from the teeth. A
buccal shield 34 or bow 36 may be positioned on the buccal surface
of the polymeric shell 12 to lie between the teeth and the cheek.
The buccal shield 34 is most useful to hold the cheek away from the
dentition to facilitate posterior dental expansion by disrupting
the tongue-cheek equilibrium. This in turn leads to facial movement
of the teeth and arch expansion. A combination of lip pads 30 and
buccal shields 34 will result in an increase in arch circumference
as well. It may be appreciated that similar shields may be mounted
on the lingual surface of the polymeric shell to remove the resting
tongue from between the teeth. This has the effect of enhancing
tooth eruption in designated areas. In addition, a lingual pad or
flange 38 may be positioned on the lingual surfaces of the
polymeric shell 12 covering the lower anterior teeth, as shown in
FIG. 6. The lingual pad 38 determines the anteroposterior and
vertical mandibular posture for most functional appliances. Such
pads 38 may not only position the mandible forward but also exert a
protrusive effect on the mandibular incisors when the mandible
attempts to return to its original position.
[0054] Referring to FIGS. 7 and 8, a number of components and
accessories may be removably or fixedly attached to both an upper
and lower elastic positioning appliance. Components commonly used
in this arrangement are frameworks used in Herbst Appliances and
Jasper Jumpers. Herbst Appliances are devices in which the
maxillary and mandibular arches are splinted with frameworks that
are connected with a pin-and-tube device that holds the mandible
forward. When used with elastic repositioning appliances, FIG. 7,
the pin-and-tube apparatus 40 may be mounted on the buccal surfaces
of the upper polymeric shell 42 and lower polymeric shell 44 as
shown. The Jasper Jumper functions in a similar manner as the
maxillary and mandibular arches are splinted with frameworks that
are connected with a spring covered by a plastic sheath. When used
with elastic repositioning appliances, FIG. 8, the sheath covered
spring 48 may be mounted in a similar manner as shown.
[0055] As an alternative to mounting or embedding conventional
orthodontic components on an elastic repositioning device,
protrusions or other shapes may be formed in the polymeric shell of
the device to be used for orthodontic functions. For example,
referring to FIG. 9, a hook 50 may be formed in the polymeric shell
12 of an elastic repositioning appliance 10 for use in mounting a
flexible band 52. Such a hook 50 may resemble traditional hooks
found in dental care, or it may be specially designed for use with
elastic repositioning appliances. The embodiment illustrated in
FIG. 9 may be produced by a series of production steps. First, a
mold of the dentition is produced by any method. Second, FIG. 10A,
a wedge or similar protruding mass 54 is then mounted on the mold
55 in the location desired for the resulting hook. It may be
appreciated that such a protruding mass 54 may be formed in the
original mold 55 by a variety of methods, particularly in the case
of computer-guided production methods. Next, a polymeric sheet is
thermoformed over the mold 55 to form the appliance 10. The
appliance 10 may then be trimmed along the dashed line 56, FIG.
10B, and the polymeric material removed from the joining area 57 to
create a hook 50 shown in FIG. 9.
[0056] In another embodiment, shown in FIG. 11, a spring 60 may be
formed in the polymeric shell 12 of an elastic repositioning
appliance 10 for use in transmitting repositioning force to one or
more teeth. Such a spring 60 may resemble traditional springs found
in dental care, or it may be specially designed for use with
elastic repositioning appliances. In this example, the spring 60 is
comprised of a pre-formed strip or portion of the polymeric shell
12 which engages an attachment body 62 mounted on an underlying
tooth 64. The attachment body 62 is accessible through a window 66
in the appliance 10.
[0057] In further embodiments, larger protrusions may also be
formed in the polymeric shell to provide additional support for the
appliance and/or to provide orthodontic functions. Such a
protrusion may form a palatal bar 70, as shown in FIG. 12. Here, a
palatal bar 70 is formed in the polymeric shell 12 itself. In
addition, a variety of palatal bars may be formed in the shell,
such as a low hanging transpalatal bar for control of vertical
dimension. These may provide orthodontic functions as described
above in relation to conventional palatal bars, and they may also
provide support for the appliance 10. This may be particularly
useful in highly flexible appliances. For increased support of the
construction, the protrusion may be a corrugated palatal bar 71, as
shown in FIG. 13.
[0058] In still further embodiments, protrusions in an elastic
repositioning appliance may assist in holding the elastic appliance
in place when it is properly inserted and positioned. Such
protrusions may be divots 74 sized and located to contact
interdental areas 76 of the patient's teeth 78, often near the
gingival margin 79 as shown in FIG. 14A. Such placement may provide
additional friction and "grab" in dental regions conducive to this
effect. Such divots 74 may be most visible by viewing the hollow
cavities of the appliance 10, as shown in FIG. 14B. These
protrusions may be solid divots 80 adhered to or embedded in the
polymeric shell 12 to inwardly protrude from the wall.
Alternatively, the protrusions may be formed divots 82 in the wall
of the polymeric shell 12 so that essentially the wall protrudes
inwardly in these areas. As shown, the divots may be of any shape,
number and configuration, including paired divots 84 and single
divots 86 as shown.
[0059] Similarly, these protrusions may be a continuous protrusion
contacting more than one tooth along the gingival margin and the
interdental areas. This is illustrated in FIG. 15A as a continuous
protrusion 90 is shown along the edges of the hollow cavities of
the appliance. This may be a solid protrusion 92 adhered to or
embedded in the polymeric shell 12 to inwardly protrude from the
wall, or it may be a formed protrusion 94 in the wall of the
polymeric shell 12 so that essentially the wall protrudes inwardly
in these areas. When the appliance is positioned over the teeth,
such a protrusion 90 may fit in the undercut of the tooth 64 along
the gingival margin 79, as shown in FIG. 15B. Here a solid
protrusion 92 and a formed protrusion 94 are shown in
cross-section. Such positioning along the undercut of the teeth may
assist in holding the appliance in place. It may be appreciated
that such a protrusions may be sized, formed and located in any
combination within the polymer shell so as to assist in holding the
appliance in a desired position.
[0060] In another embodiment, the one or more protrusions may form
a bite plate. A bite plate is a device which prevents the teeth
from closing completely. The resulting open state, or disclusion,
may be useful for a number of orthodontic treatments, including
crossbite correction and controlled passive eruption. To provide
anterior disclusion, an elastic positioning appliance 10 may have
an increase in thickness of material 100 in the posterior occlusion
regions of the polymeric shell 12, as shown in FIG. 16. The
increase in thickness of material 100 may be applied to the
appliance 10 or formed by the appliance 10 to create a protrusion
over the designated occluding surfaces. Similarly, as shown in FIG.
17, posterior disclusions may be provided by forming a protrusion
102 in the polymer shell 12 which extends at least a portion of an
upper palatal region with added thickness. This protrusion may be
formed in the appliance 10 or applied to the surface of the
appliance 10.
[0061] Alternatively, posterior disclusions may be provided by
forming a protrusion in an upper lingual or lower facial anterior
region, as depicted in FIGS. 18A and 18B. Here, the bite is shown
in cross-section, with an upper incisor 110 overlapping a lower
incisor 112 and a molar 114 positioned for reference. In FIG. 18A,
the polymeric shell 12 of an elastic positioning appliance 10 is
shown covering the upper incisor 110. On the lingual surface of the
shell 12, a protrusion 116 is shown which may contact the lower
incisor 112 during biting, thus acting like a bite plate. This
protrusion 116 may be formed into the polymeric shell 12 or applied
along the lingual surfaces of the appliance 10. Such an arrangement
may thus provide posterior disclusions. Similarly, the polymeric
shell 12 may cover the lower incisor 112, as shown in FIG. 18B. In
this case, a protrusion 118 on the facial surface of the shell 12
is shown which may contact the upper incisor 110 during biting.
Again, this protrusion 118 may be formed into the polymeric shell
12 or applied along the facial surfaces of the appliance 10. This
arrangement may also provide posterior disclusions.
[0062] Referring to FIG. 19, many patient's dentition present a gap
120 or space between adjacent teeth 67. Such a gap 120 may be the
size of a tooth 67, as may be the case when a tooth is extracted,
or the gap 120 may be larger or smaller than the size of a typical
tooth 67, as is often the case due to general misalignment of the
teeth. In either case, an elastic positioning appliance 10 may be
made to be positioned over the gap 120 and the surrounding teeth 67
with a space filler aligning with the gap 120. In a preferred
embodiment, shown in FIG. 20, the space filler may be a cavity 122
in the polymer shell 12 having the shape of a tooth. Thus, the
space filler may act as a "pontic", a fake tooth placed where a
tooth is missing to give the appearance of the presence of a tooth.
Likewise, such a cavity 122 may have the shape of any portion of a
tooth, dental feature, sphere, oval or three-dimensional curved
and/or flat sided object for any desired effect. To further conceal
the presence of a space or gap 120 between teeth 67 during
orthodontic treatment, the space filler may be opacified, as
depicted by shading 124 in FIG. 20.
[0063] In addition to improving cosmetic appearance, a space filler
may also provide structural support for the elastic appliance. When
a space filler is a cavity, as described above, the presence of the
cavity improves the structural integrity of the appliance by
providing a uniform geometry. Alternatively, a space filler may be
any number of structures providing similar support. In a preferred
embodiment, shown in FIG. 21, the space filler may be a structure
130 formed between two cavities in the polymeric shell 12 of an
appliance 10. The structure 130 may be comprised of the facial wall
132 and lingual wall 133 of the polymeric shell 12 fusing together
to form an at least partially solid slab or bridge. In addition,
suitable fillers or reinforcements may be used in the fusing or
similar process for added support. Likewise, a corrugated structure
135 may be formed between the cavities, as shown in FIG. 22. Such
corrugation may further reinforce the structure for added support.
In any case, a designated cavity 122 or structure 130, 135 in the
polymeric shell 12 may be designed to align with a gap 120 between
adjacent teeth 67 when the appliance 10 positioned over the
patient's teeth for improved cosmetic appearance and/or structural
support.
[0064] Although forming protrusions or adding additional material
to elastic repositioning appliances may provide useful features in
orthodontic treatment, it may also be beneficial to remove material
or form windows in an appliance. Referring to FIG. 23A, if the
occlusional surfaces 140 of an upper appliance 142 and a lower
appliance 143 are relatively thick, simultaneous wearing of the
appliances 142, 143 may provide unwanted disclusion of the teeth.
For example, when closing the jaws, the double layer of occlusional
surfaces 140 between the jaws may cause the posterior teeth to
prematurely contact, thus preventing the anterior teeth to suitably
close. This may be avoided by reducing or eliminating the
occlusional surfaces of the appliances, as shown in FIGS. 23B and
23C. In a preferred embodiment, shown in FIG. 23C, a polymeric
shell 12 of an appliance 10 may have a plurality of windows 150 in
the portions which cover the occlusal surfaces of the teeth. In
this example, segments of the shell 12 are still present along the
facial surfaces 152 and lingual surfaces 153 of the appliance 10
and across the interdental regions 154 or spaces between the teeth.
When such an appliance is placed over the upper teeth 155 and lower
teeth 156, the teeth may interdigitate, as shown in FIG. 23B.
Interdigitation of at least portions of the upper and lower teeth
may benefit tooth and jaw orientations, leading to improved
treatment, appearance, comfort and consequently patient
compliance.
[0065] Removal of material may be aided by the use of a release tab
200, as shown in FIGS. 24A and 24B. A release tab 200 may be used
to remove a layer of material from the polymeric shell 12 or to
remove an entire portion of the shell 12, such as to either create
a window, as described above, or to eliminate the shell 12 from
covering specific teeth or portions of the patient's teeth.
Referring to FIG. 24A, a release tab 200 may be embedded in the
polymeric shell 12 along a line 202 for future separation between
portion A (shaded) and portion B. Although such a line 202 is
depicted as a dashed line adjacent to the tab 200 edge, such a line
202 may lie directly over the tab or in any close relation to the
tab 202. In the case of a polymeric shell 12 comprised of multiple
layers of material, the tab 200 may be embedded between the layers
with a portion exposed for grasping. By grasping the tab 200 and
pulling the tab 200 along its length, one or more layers of
material may be released along a line 202 of separation and removed
from the shell 12. In this example, the result may be portion A
comprising two layers of material and portion B comprising only
one. Alternatively, the result may be portion A comprising one or
more layers and portion B removed entirely. Other combinations or
examples are possible. Such alterations may be beneficial for
patient comfort, ease of use, or obtainment of orthodontic
repositioning goals, to name a few. FIG. 24B illustrates a
preferred embodiment of placement of such a release tab 200 in a
polymeric shell 12 of an elastic repositioning appliance 10. The
tab 200 may be placed to encircle areas 206 of the occlusional
surfaces of the appliance 10. Thus, the orthodontic treatment of a
patient may allow material in these areas 206 of an appliance 10
for a given duration of the treatment plan. At a given point in the
treatment, the orthodontic practitioner may prefer to remove a
layer of material or the material entirely in these areas 206
during a patient office visit. The practitioner may perform such a
removal by pulling on the appropriate release tabs 200 as described
above. This may thus reduce time and cost of patient treatment.
[0066] Although the forgoing invention has been described in some
detail by way of illustration and example, for purposes of clarity
of understanding, it will be obvious that various alternatives,
modifications and equivalents may be used and the above description
should not be taken as limiting in scope of the invention which is
defined by the appended claims.
* * * * *