U.S. patent application number 17/412774 was filed with the patent office on 2021-12-16 for apparatus and methods for cleaning teeth and root canals.
The applicant listed for this patent is SONENDO, INC.. Invention is credited to Bjarne Bergheim, Ryan Evans, Mehrzad Khakpour.
Application Number | 20210386532 17/412774 |
Document ID | / |
Family ID | 1000005800499 |
Filed Date | 2021-12-16 |
United States Patent
Application |
20210386532 |
Kind Code |
A1 |
Khakpour; Mehrzad ; et
al. |
December 16, 2021 |
APPARATUS AND METHODS FOR CLEANING TEETH AND ROOT CANALS
Abstract
Various systems, method, and compositions for treating a tooth
are disclosed herein. For example, an apparatus for treating a
tooth is disclosed. The apparatus can include a chamber having an
access port which places the chamber in fluid communication with a
treatment region of the tooth when the chamber is coupled to tooth.
A fluid motion generator can be coupled to the chamber. The fluid
motion generator can be configured to direct fluid across the
access port to generate fluid motion in the chamber. In various
embodiments, fluid motion (e.g., vortices, swirl, etc.) can be
induced at or near treatment regions of the tooth, such as a root
canal or carious region.
Inventors: |
Khakpour; Mehrzad; (Laguna
Hills, CA) ; Bergheim; Bjarne; (Mission Viejo,
CA) ; Evans; Ryan; (Irvine, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
SONENDO, INC. |
Laguna Hills |
CA |
US |
|
|
Family ID: |
1000005800499 |
Appl. No.: |
17/412774 |
Filed: |
August 26, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16436371 |
Jun 10, 2019 |
11103333 |
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17412774 |
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14699878 |
Apr 29, 2015 |
10363120 |
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16436371 |
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14137937 |
Dec 20, 2013 |
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14699878 |
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61986016 |
Apr 29, 2014 |
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62017208 |
Jun 25, 2014 |
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61740351 |
Dec 20, 2012 |
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61907345 |
Nov 21, 2013 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61C 5/40 20170201; A61C
17/0202 20130101; A61C 17/0208 20130101; A61C 17/20 20130101; A61C
17/024 20190501 |
International
Class: |
A61C 17/02 20060101
A61C017/02; A61C 5/40 20060101 A61C005/40; A61C 17/20 20060101
A61C017/20; A61C 17/024 20060101 A61C017/024 |
Claims
1. An apparatus for treating a tooth, the apparatus comprising: a
chamber having an access port which places the chamber in fluid
communication with a treatment region of the tooth when the chamber
is coupled to tooth; a fluid motion generator coupled to the
chamber, the fluid motion generator configured to direct fluid
across the access port to generate fluid motion in the chamber.
2. The apparatus of claim 1, wherein the apparatus is configured to
clean a root canal of the tooth when the chamber is in fluid
communication with the root canal, the root canal having a central
axis, and wherein the fluid motion generator is configured to
direct fluid across the access port in a direction substantially
perpendicular to the central axis of the root canal.
3. The apparatus of claim 1, wherein the apparatus is configured to
clean a root canal of the tooth when the chamber is in fluid
communication with the root canal, the root canal having a central
axis, and wherein the fluid motion generator is configured to
rotate the fluid about an axis transverse to the central axis of
the root canal.
4. The apparatus of claim 1, wherein the access port has a diameter
that is at least as large as a diameter of an access opening of the
tooth.
5. The apparatus of claim 1, wherein the access port defines a
proximal-most plane, and wherein the fluid motion generator is
configured to direct the fluid substantially parallel to the
proximal-most plane.
6. The apparatus of claim 5, wherein the fluid motion generator is
configured such that the momentum of the fluid is in a direction
substantially parallel to the proximal-most plane.
7. The apparatus of claim 1, wherein the fluid motion generator is
configured to direct fluid in a direction substantially
perpendicular to a central axis of the access port.
8. The apparatus of claim 1, wherein the fluid motion generator is
further configured to generate pressure waves through the fluid
having energy sufficient to substantially clean the tooth.
9. The apparatus of claim 1, wherein the fluid motion generator
comprises a liquid jet device.
10. The apparatus of claim 9, wherein the liquid jet device is
configured to substantially clean the tooth using liquid that is
substantially free of dissolved gases.
11. The apparatus of claim 1, wherein the fluid motion generator is
disposed along a wall of the chamber between the wall and the
access port.
12. An apparatus for treating a tooth, the apparatus comprising: a
chamber configured to couple to a tooth; and a fluid motion
generator disposed in the chamber and configured to generate a
rotational motion of fluid in the chamber, wherein when the chamber
is coupled to the tooth, the fluid motion generator is positioned
outside the tooth.
13. The apparatus of claim 12, wherein the apparatus is configured
to clean a root canal of the tooth, the root canal having a central
axis, and wherein the fluid motion generator is configured to
generate the rotational motion about an axis transverse to the
central axis of the root canal.
14. The apparatus of claim 12, wherein the chamber comprises an
access port configured to provide fluid communication with the
tooth, and wherein the fluid motion generator is configured to
direct fluid in a direction substantially perpendicular to a
central axis of the access port.
15. The apparatus of claim 12, wherein the chamber includes an
access port such that, when the chamber is coupled to the tooth,
the access port is proximate an access opening of the tooth.
16. The apparatus of claim 15, wherein the access port has a
diameter that is at least as large as a diameter of the access
opening.
17. The apparatus of claim 12, wherein the fluid motion generator
is configured to pass a stream of the fluid across an access port
of the chamber.
18. The apparatus of claim 17, wherein the access port defines a
proximal-most plane, and wherein the fluid motion generator is
configured to pass the stream of fluid substantially parallel to
the proximal-most plane.
19. The apparatus of claim 12, wherein the fluid motion generator
is further configured to generate pressure waves through the fluid
having energy sufficient to substantially clean the tooth.
20. The apparatus of claim 12, wherein the fluid motion generator
comprises a liquid jet device.
21. The apparatus of claim 20, wherein the liquid jet device is
configured to substantially clean the tooth using liquid that is
substantially free of dissolved gases.
22. The apparatus of claim 12, wherein the fluid motion generator
is disposed near a wall of the chamber between the wall and an
access port of the chamber.
23. A method of treating a tooth, the method comprising:
positioning a fluid motion generator near an access opening of the
tooth; activating the fluid motion generator to pass a stream of
fluid across the access opening of the tooth; and generating fluid
motion at a treatment region of the tooth.
24. The method of claim 23, wherein generating fluid motion
comprises generating fluid motion in a root canal of the tooth.
25. The method of claim 23, wherein positioning the fluid motion
generator comprises positioning the fluid motion generator outside
the tooth.
26. The method of claim 25, wherein the fluid motion generator is
disposed in a chamber, and wherein positioning the fluid motion
generator comprises coupling the chamber to the tooth.
27. The method of claim 26, wherein activating the fluid motion
generator comprises generating rotational motion of the fluid in
the chamber.
28. The method of claim 27, wherein activating the fluid motion
generator comprises generating the rotational motion about an axis
transverse to a central axis of a root canal of the tooth.
29. The method of claim 23, wherein the access opening of the tooth
is in communication with an access port of the chamber, and wherein
activating the fluid motion generator comprises passing the stream
of fluid along a direction substantially perpendicular to a central
axis of the access port.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of U.S. patent
application Ser. No. 14/137,937, filed Dec. 20, 2013, which claims
priority to U.S. Provisional Patent Application No. 61/740,351,
filed Dec. 20, 2012, and to U.S. Provisional Patent Application No.
61/907,345, filed Nov. 21, 2013, the contents of each of which are
incorporated by reference herein in their entirety and for all
purposes. This application also claims priority to U.S. Provisional
Patent Application No. 61/986,016, filed Apr. 29, 2014, and to U.S.
Provisional Patent Application No. 62/017,208, filed Jun. 25, 2014,
the contents of each of which are incorporated by reference herein
in their entirety and for all purposes.
BACKGROUND
Field of the Invention
[0002] The present disclosure relates generally to dentistry and
endodontics and to apparatus, methods, and compositions for
treating a tooth.
Description of the Related Art
[0003] In conventional dental and endodontic procedures, mechanical
instruments such as drills, files, brushes, etc. are used to clean
unhealthy material from a tooth. For example, dentists often use
drills to mechanically break up carious regions (e.g., cavities) in
a surface of the tooth. Such procedures are often painful for the
patient and frequently do not remove all the diseased material.
Furthermore, in conventional root canal treatments, an opening is
drilled through the crown of a diseased tooth, and endodontic files
are inserted into the root canal system to open the canal spaces
and remove organic material therein. The root canal is then filled
with solid matter such as gutta percha or a flowable obturation
material, and the tooth is restored. However, this procedure will
not remove all organic material from the canal spaces, which can
lead to post-procedure complications such as infection. In
addition, motion of the endodontic file and/or other sources of
positive pressure may force organic material through an apical
opening into periapical tissues. In some cases, an end of the
endodontic file itself may pass through the apical opening. Such
events may result in trauma to the soft tissue near the apical
opening and lead to post-procedure complications. Accordingly,
there is a continuing need for improved dental and endodontic
treatments.
SUMMARY
[0004] Various non-limiting aspects of the present disclosure will
now be provided to illustrate features of the disclosed apparatus,
methods, and compositions. Examples of apparatus, methods, and
compositions for endodontic treatments are provided.
[0005] In one embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can include a chamber having an access
port which places the chamber in fluid communication with a
treatment region of the tooth when the chamber is coupled to the
tooth, the access port having a central axis. The apparatus can
include a fluid motion generator being arranged to generate
rotational fluid motion in the chamber. The apparatus can include a
suction port communicating with the chamber on a side of the
chamber opposite of the access port, and being disposed relative to
the access port such that the central axis of the access port
passes through the suction port.
[0006] In another embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can comprise a chamber having a distal
portion defining an access port that places the chamber in fluid
communication with a treatment region of the tooth when the chamber
is coupled to the tooth, the access port having a central axis. The
apparatus can comprise a fluid motion generator coupled to the
chamber, the fluid motion generator configured to generate
rotational fluid motion in the chamber. The distal portion can be
sized and shaped to be inserted into an access opening of the
tooth, the distal portion tapering distally towards the central
axis.
[0007] In another embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can include a chamber having an access
port which places the chamber in fluid communication with a
treatment region of the tooth when the chamber is coupled to tooth,
the access port comprising a central axis. The apparatus can
include a fluid motion generator coupled to the chamber, the fluid
motion generator configured to generate a swirling influent fluid
path around the central axis. The apparatus can include a suction
port configured to remove fluid from the treatment region and the
chamber. The apparatus can be configured to draw outgoing fluid
from the treatment region to the suction port in a path that flows
inside the swirling influent fluid path with a suction force
applied to the suction port.
[0008] In yet another embodiment, a method of treating a tooth is
disclosed. The method can include applying a chamber to a treatment
region of the tooth, the chamber having an access port which places
the chamber in fluid communication with the treatment region, the
access port comprising a central axis. The method can include
swirling influent fluid along a fluid path around the central axis.
The method can include drawing outgoing fluid from the treatment
region to a suction port in a path that flows inside the swirling
influent fluid path.
[0009] In one embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can comprise a chamber having an access
port which places the chamber in fluid communication with a
treatment region of the tooth when the chamber is coupled to tooth.
The apparatus can include a fluid motion generator coupled to the
chamber, the fluid motion generator configured to direct fluid
across the access port to generate fluid motion in the chamber.
[0010] In another embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can comprise a chamber configured to
couple to a tooth. A fluid motion generator can be disposed in the
chamber and configured to generate a rotational motion of fluid in
the chamber. When the chamber is coupled to the tooth, the fluid
motion generator can be positioned outside the tooth.
[0011] In another embodiment, a method of treating a tooth is
disclosed. The method can include positioning a fluid motion
generator near an access opening of the tooth. The fluid motion
generator can be activated to pass a stream of fluid across the
access opening of the tooth. Fluid motion can be generated at a
treatment region of the tooth.
[0012] In another embodiment, a method of treating a tooth is
disclosed. The method can include coupling a chamber to the tooth.
The chamber can have a fluid motion generator disposed therein. The
fluid motion generator can be disposed outside the tooth. The fluid
motion generator can be activated to generate a rotational motion
of fluid in the chamber.
[0013] In another embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can include a chamber configured to couple
to a tooth. The apparatus can include a fluid motion generator
disposed in the chamber and configured to generate a rotational
motion of fluid in the chamber.
[0014] In yet another embodiment, an apparatus for treating a tooth
is disclosed. The apparatus can comprise a chamber configured to
couple to the tooth. A plurality of fluid motion generators can be
disposed in the chamber.
[0015] In another embodiment, a method for treating a tooth is
disclosed. The method can include coupling a chamber to the tooth.
The chamber can include a plurality of fluid motion generators
disposed therein. The plurality of fluid motion generators can be
activated to clean the tooth.
[0016] In another embodiment, a method for treating a tooth is
disclosed. The method can include forming an access opening in the
tooth. The method can include applying a tooth seal around a
perimeter of the access opening, the tooth seal having a peripheral
boundary. The method can include positioning a chamber within the
peripheral boundary of the tooth seal to secure the chamber to the
tooth seal.
[0017] For purposes of this summary, certain aspects, advantages,
and novel features of certain disclosed inventions are summarized.
It is to be understood that not necessarily all such advantages may
be achieved in accordance with any particular embodiment of the
invention. Thus, for example, those skilled in the art will
recognize that the inventions disclosed herein may be embodied or
carried out in a manner that achieves one advantage or group of
advantages as taught herein without necessarily achieving other
advantages as may be taught or suggested herein. Further, the
foregoing is intended to summarize certain disclosed inventions and
is not intended to limit the scope of the inventions disclosed
herein.
BRIEF DESCRIPTION OF THE DRAWINGS
[0018] The foregoing and other features, aspects, and advantages of
the embodiments of the apparatus and methods of cleaning teeth are
described in detail below with reference to the drawings of various
embodiments, which are intended to illustrate and not to limit the
embodiments of the invention. The drawings comprise the following
figures in which:
[0019] FIG. 1A is a schematic diagram of a system that includes
components capable of removing unhealthy or undesirable materials
from a root canal tooth.
[0020] FIG. 1B is a schematic diagram of a system that includes
components capable of removing unhealthy or undesirable material
from a treatment region on an exterior surface of the tooth.
[0021] FIG. 2A is a schematic side cross-sectional view of a
coupling member coupled to a tooth and a pressure wave generator
having a distal end portion disposed in a chamber outside the
tooth.
[0022] FIG. 2B is a schematic side cross-sectional view of a
coupling member coupled to a tooth and a pressure wave generator
having a distal end portion disposed inside the tooth.
[0023] FIG. 3A is a block diagram that schematically illustrates an
embodiment of a system adapted to generate a high-velocity jet of
fluid for use in dental procedures.
[0024] FIG. 3B is a schematic side view illustrating an embodiment
of a handpiece comprising a guide tube for delivery of a liquid jet
to a portion of the tooth.
[0025] FIGS. 4A and 4B are graphs that schematically illustrate
possible examples of power generated by different embodiments of
the pressure wave generators disclosed herein.
[0026] FIG. 4C is a graph of an acoustic power spectrum 1445
generated at multiple frequencies.
[0027] FIG. 5 is a schematic cross-sectional side view of a
coupling member having a fluid inlet passing therethrough.
[0028] FIG. 6 is a schematic cross-sectional side view of a
coupling member having a fluid inlet and a fluid outlet passing
therethrough.
[0029] FIG. 7A is a schematic cross-sectional side view of a
coupling member having a fluid inlet, a fluid outlet, and a vent
configured to regulate a pressure inside the chamber and/or
tooth.
[0030] FIG. 7B is a schematic cross-sectional side view of a
plurality of pressure wave generators coupled with a coupling
member.
[0031] FIG. 8A is a schematic side cross-sectional view of a
coupling member attached or coupled to a tooth by way of a locking
tooth seal.
[0032] FIG. 8B is a schematic side cross-sectional view of a
coupling member having a curved distal end portion shaped to mate
with a curved surface of a tooth seal.
[0033] FIG. 8C is a schematic side cross-sectional view of a
coupling member having an alignment feature comprising a mating
tube sized and shaped to fit through an access opening formed in
the tooth.
[0034] FIG. 9A is a schematic side cross-sectional view of a
coupling member and a pressure wave generator comprising a liquid
jet device.
[0035] FIG. 9B is a schematic side cross-sectional view of a
coupling member and a pressure wave generator comprising a light
emitting element.
[0036] FIG. 9C is a schematic side cross-sectional view of a
coupling member and a pressure wave generator comprising a
vibrating mechanical element.
[0037] FIG. 9D is a schematic side cross-sectional view of a
coupling member 3 and a pressure wave generator comprising a
stirring element.
[0038] FIG. 10A is a side cross-sectional view of a coupling member
having a pressure wave generator comprising a fluid inlet
configured to generate a rotational fluid motion in a chamber of a
coupling member.
[0039] FIG. 10B is a side cross-sectional view of a coupling member
having a pressure wave generator comprising a liquid jet device
configured to generate a rotational fluid motion in a chamber of
the coupling member.
[0040] FIG. 10C is a side cross-sectional view of a coupling member
having a pressure wave generator comprising a light emitting device
configured to generate a rotational fluid motion in a chamber of
the coupling member.
[0041] FIG. 10D is a side cross-sectional view of a coupling member
having a pressure wave generator substantially aligned with a
central axis Z of the root canal.
[0042] FIG. 10E is a side cross-sectional view of a coupling member
having a first pressure wave generator and a second pressure wave
generator.
[0043] FIG. 10F is a schematic top view of a pressure wave
generator at least partially disposed in a chamber and configured
to generate swirl in the chamber.
[0044] FIG. 10G is a schematic top view of multiple pressure wave
generators at least partially disposed in a chamber and configured
to generate counter-swirl fluid motion in the chamber.
[0045] FIG. 11A is a schematic diagram of an experimental setup
designed to measure the power output of various tooth cleaning
devices.
[0046] FIG. 11B is a plot of the voltage (in volts) output by the
hydrophone over time (in seconds) for each device tested.
[0047] FIG. 12A illustrates images of root canals that compare the
use of non-degassed liquid and degassed liquid in the disclosed
pressure wave generators.
[0048] FIG. 12B is a plot comparing the power output for techniques
using non-degassed and degassed liquids.
[0049] FIG. 13 is a plot comparing the rates of tissue dissolution
(in units of % per second) for Applicant's device versus other
devices, for different treatment fluids and compositions.
[0050] FIGS. 14A-14B are plots relating to the pressure measured at
or near the apical opening of the root canal during treatment.
[0051] FIG. 14C is a plot of the mass of material extruded through
the apex for various simulated peri-apical pressures for
Applicant's system and for various needles.
[0052] FIG. 15 is a schematic side sectional view of a dental
treatment system, according to one embodiment.
[0053] FIG. 16 is a schematic top sectional view of the system
shown in FIG. 15.
[0054] FIGS. 16A and 16B are enlarged side cross-sections of the
tooth shown in FIG. 15 that illustrates influent and outgoing fluid
flow paths.
[0055] FIGS. 17 and 18 are schematic side sectional views of a
tooth coupler configured to treat a tooth having multiple
canals.
[0056] FIGS. 17A and 18A are top sectional views of the tooth
couplers shown in FIGS. 17 and 18, respectively.
[0057] FIG. 19 is a schematic side sectional view of a tooth
coupler configured to treat a tooth, according to another
embodiment.
[0058] FIG. 20 is a schematic top sectional view of the tooth
coupler shown in FIG. 19 that illustrates pressurized liquid
entering a chamber through a nozzle.
[0059] FIG. 21A is a schematic perspective view of a handpiece
configured to clean a treatment region of a tooth.
[0060] FIG. 21B is a schematic side cross-sectional view of the
handpiece shown in FIG. 21A taken along section 21B-21B.
[0061] FIG. 22 is a magnified side cross-sectional view of FIG.
21B.
[0062] FIG. 23 is a schematic side-cross-sectional view of the
handpiece of FIG. 21A taken along section 23-23.
[0063] FIG. 24A is a schematic, perspective top sectional view of a
portion of the handpiece shown in FIG. 21A, taken along section
24A-24A.
[0064] FIG. 24B is a top plan view of the section shown in FIG.
24A.
[0065] FIG. 24C is a top sectional view of a portion of the
handpiece shown in FIG. 21A, taken along section 24C-24C.
[0066] FIG. 24D is a side sectional view of the handpiece shown in
FIGS. 21A-24C, in accordance with another embodiment.
[0067] FIGS. 25A-25B are scanning electron microscope (SEM) images
of a tooth after completion of a treatment procedure using the
handpiece shown in FIGS. 21A-24C.
[0068] Throughout the drawings, reference numbers may be re-used to
indicate a general correspondence between referenced elements. The
drawings are provided to illustrate example embodiments described
herein and are not intended to limit the scope of the
disclosure.
DETAILED DESCRIPTION
[0069] The present disclosure describes apparatus, methods, and
compositions for performing dental and/or endodontic procedures.
Various embodiments disclosed herein can effectively and safely
remove unhealthy material from a treatment region of a tooth, e.g.,
from within the tooth and/or from outside surfaces of the tooth. In
particular, the embodiments disclosed herein can remove unhealthy
materials, such as unhealthy organic matter, inorganic matter, pulp
tissue, caries, stains, calculus, plaque, biofilm, bacteria, pus,
decayed tooth matter, and food remnants from the treatment region
without substantially damaging healthy dentin or enamel. For
example, the disclosed apparatus, methods, and compositions
advantageously may be used with root canal cleaning treatments,
e.g., to efficiently remove unhealthy or undesirable materials such
as organic and/or inorganic matter from a root canal system and/or
to disinfect the root canal system. Organic material (or organic
matter) includes organic substances typically found in healthy or
diseased teeth or root canal systems such as, for example, soft
tissue, pulp, blood vessels, nerves, connective tissue, cellular
matter, pus, and microorganisms, whether living, inflamed,
infected, diseased, necrotic, or decomposed. Inorganic matter
includes calcified tissue and calcified structures, which are
frequently present in the root canal system. In some embodiments,
the root canal can be filled with an obturation material (e.g., a
flowable obturation material that can be hardened into a solid or
semi-solid state, gutta percha or other solid or semi-solid
materials) after treatment of the root canal.
I. Overview of Various Disclosed Embodiments
[0070] A. System Overview
[0071] FIG. 1A is a schematic diagram of a system 1 that includes
components capable of removing unhealthy or undesirable materials
from a tooth 10. The tooth 10 illustrated in FIG. 1A is a premolar
tooth, e.g., a tooth located between canine and molar teeth in a
mammal such as a human. The tooth 10 includes hard structural and
protective layers, including a hard layer of dentin 16 and a very
hard outer layer of enamel 17. A pulp cavity 11 is defined within
the dentin 16. The pulp cavity 11 comprises one or more root canals
13 extending toward an apex 14 of each root 12. The pulp cavity 26
and root canal 13 contain dental pulp, which is a soft, vascular
tissue comprising nerves, blood vessels, connective tissue,
odontoblasts, and other tissue and cellular components. Blood
vessels and nerves enter/exit the root canal 13 through a tiny
opening, the apical foramen or apical opening 15, near a tip of the
apex 14 of the root 12. It should be appreciated that, although the
tooth 10 illustrated herein is a premolar, the embodiments
disclosed herein can advantageously be used to treat any suitable
type of tooth, including molars, canines, incisors, etc.
[0072] As illustrated in FIG. 1A, the system 1 can be used to
remove unhealthy materials (such as organic and inorganic matter)
from an interior of the tooth 10, e.g., from the root canal 13 of
the tooth 10. For example, an endodontic access opening 18 can be
formed in the tooth 10, e.g., on an occlusal surface, a buccal
surface, or a lingual surface. The access opening 18 provides
access to a portion of a pulp cavity 11 of the tooth 10. The system
1 can include a console 2, a pressure wave generator 5, and a
coupling member 3 adapted to couple to the tooth 10. The coupling
member 3 can define a chamber 6 configured to retain fluid therein.
In some embodiments, the coupling member 3 can be held or pressed
against the tooth by the clinician. In some embodiments, the
coupling member 3 can be attached to the tooth, e.g., using an
adhesive. One or more conduits 4 can electrically, mechanically,
and/or fluidly connect the console 2 with the coupling member 3 and
pressure wave generator 5. The console 2 can include a control
system and various fluid management systems configured to operate
the pressure wave generator 5 during a treatment procedure.
[0073] As explained herein, the system 1 can be used in cleaning
procedures to clean substantially the entire root canal system. In
other embodiments, such as obturation procedures, the system 1 can
be used to fill substantially the entire root canal system with an
obturation or filler material. For example, in various embodiments
disclosed herein, the pressure wave generator 5 can generate
pressure waves 23 of sufficient power and relatively low
frequencies to produce fluid motion 24 in the chamber 6--such that
the pressure wave generators 5 disclosed herein can act as a fluid
motion generator--and can generate pressure waves of sufficient
power and relatively higher frequencies to produce surface effect
cavitation on a dental surface, either inside or outside the tooth.
That is, for example, the pressure wave generators 5 disclosed
herein can act as fluid motion generators to generate large-scale
or bulk fluid motion 24 in or near the tooth 10, and can also
generate smaller-scale fluid motion at higher frequencies. In some
arrangements, the fluid motion 24 in the chamber 6 can generate
induced fluid motion such as vortices 75, swirl 76 (see FIG. 2B),
etc. in the tooth 10 and root canal 13 that can clean and/or fill
the canal 13.
[0074] FIG. 1B is a schematic diagram of a system 1 that includes
components capable of removing unhealthy or undesirable material
from a treatment region 91 on an exterior surface of the tooth. For
example, as in FIG. 1A, the system 1 can include a coupling member
3 and a pressure wave generator 5. The coupling member 3 can
communicate with a console 2 by way of one or more conduits 4.
Unlike the system 1 of FIG. 1A, however, the coupling member 3 is
coupled to a treatment region 91 on an exterior surface of the
tooth 10. For example, the system 1 of FIG. 1B can be activated to
clean an exterior surface of the tooth 10, e.g., a carious region
of the tooth 10. In other embodiments, the system 1 can be
activated to fill a treated region on the exterior surface of the
tooth 10. As with the embodiment of FIG. 1A, fluid motion 24 can be
generated in the coupling member 3 and chamber, which can act to
clean and/or fill the treatment region 91 of the tooth 10.
[0075] FIG. 2A is a schematic side cross-sectional view of a
coupling member 3 coupled to a tooth 10 and a pressure wave
generator 5 having a distal end portion 25 disposed in a chamber 6
outside the tooth 10. The coupling member 3 can be adapted to
couple to the tooth 10 to provide a stable platform during the
dental procedure. The coupling member 3 can define or include a
chamber 6 configured to retain fluid 22. For example, the chamber 6
can be substantially filled with a fluid 22 to provide a
propagation medium upon and/or through which the pressure wave
generator 5 acts. The fluid 22 can be a treatment fluid in various
cleaning treatments to substantially clean a treatment region of
the tooth (such as in root canal treatments, treatments of carious
regions, treatments of plaque and other unhealthy deposits).
Alternatively, in obturation treatments, the fluid 22 can comprise
a flowable obturation material having a flowable state that can be
hardened into a solid state, and the pressure wave generator 5 can
be activated to substantially fill or obturate the treatment
region. The obturation material, once it fills the treatment
region, can be hardened by a catalyst, be it heat, light, or
chemical.
[0076] Moreover, the chamber 6 and coupling member 3 can prevent
fluid 22 and/or waste materials from leaving the tooth 10. In
various embodiments, the coupling member 3 can also be configured
to regulate fluid pressure in the tooth 10 such that liquid can
flow out from the chamber 6 if pressure rises above a predetermined
threshold. In the embodiment of FIG. 2A, the coupling member 3
comprises a distal portion 21 of a handpiece 20 (see, e.g., FIG.
3B). For example, the distal portion 21 of the handpiece 20 can be
shaped to define walls enclosing the chamber 6. In other
embodiments, the coupling member 3 can be applied to the tooth 10
with a mechanical clasp or clamp, a dental adhesive, or by pressure
applied by the patient by biting on the coupling member 3. In still
other embodiments, a separate cap or fluid retainer can be
removably coupled to the distal portion 21 of the handpiece 20.
[0077] During a dental treatment, a clinician can apply the
coupling member 3 to the tooth 10. As illustrated in Figures lA and
2A, for example, the clinician can apply the coupling member 3 over
the access opening 18. The clinician can secure the coupling member
3 to the tooth 10 by way of a tooth seal 26. In some embodiments,
one or more alignment features can be applied to align the coupling
member 3 to the treatment region of the tooth 10 (see, e.g., FIGS.
8A-8C). In some embodiments, the coupling member 3 can be attached
to the tooth 10 in a manner that permits the clinician to rotate or
otherwise orient the coupling member 3 and pressure wave generator
5 at a desired orientation relative to the tooth 10 (see, e.g.,
FIG. 8B). In still other embodiments, the clinician can apply the
coupling member 3 and pressure wave generator 5 to an exterior
surface of the tooth 10. For example, the clinician can apply the
coupling member 3 over a carious region formed near an outer
surface of the tooth 10. In yet other embodiments, the clinician or
a user can apply the coupling member 3 over an exterior surface of
the tooth 10 to remove undesirable dental deposits, such as plaque,
calculus, biofilms, etc.
[0078] The pressure wave generator 5 can be coupled with or
integrally formed with the coupling member 3. In some embodiments,
the pressure wave generator 5 can comprise an elongated member
extending from the coupling member 3 through a portion of the
chamber 6. As shown in FIGS. 1A and 2A, the distal end portion 25
of the pressure wave generator 5 can be disposed in the chamber 5
defined by the coupling member 3. As shown in FIG. 2A, the distal
end portion 25 of the pressure wave generator 5 can be disposed
outside the tooth 10, e.g., outside the pulp cavity 11. In other
embodiments, the distal end portion 25 of the pressure wave
generator 5 can extend into an interior space of the tooth 10,
e.g., the pulp cavity 11. For example, FIG. 2B is a schematic side
cross-sectional view of a coupling member 3 coupled to a tooth 10
and a pressure wave generator 5 having a distal end portion 25
disposed inside the tooth 10, e.g., inside a portion of the pulp
cavity 11.
[0079] During cleaning procedures, the distal end portion 25 of the
pressure wave generator 5 can be submerged in treatment fluid
retained in the chamber 6 by the coupling member 3. The pressure
wave generator 5 can be activated, and unhealthy materials (e.g.,
unhealthy organic matter, inorganic matter, pulp tissue, caries,
stains, calculus, plaque, biofilm, bacteria, pus, decayed tooth
matter, and food remnants) can be safely and efficiently removed
from the tooth 10. For example, in the embodiments illustrated in
FIGS. 1A-2B, diseased pulp and other undesirable materials can be
removed from the pulp cavity 11 and root canal 13 of the tooth
10.
[0080] The pressure wave generator 5 can clean treatment regions of
the tooth 10 that are remote from the pressure wave generator 5.
For example, in root canal procedures, the pressure wave generator
can clean substantially the entire root canal 13, including
laterally-extending tubules and various small cracks and crevices
that are formed in the tooth 10. Similarly, in other cleaning
procedures, such as procedures that clean carious regions, plaque,
other dental deposits, etc., the pressure wave generators 5
disclosed herein can clean substantially the entire treatment
region of the tooth. The pressure wave generators 5 disclosed
herein can therefore improve patient outcomes by removing unhealthy
materials from the entire treatment region, which reduces the risk
of infection or recurrences of unhealthy material at the treatment
region.
[0081] In other embodiments, the pressure wave generator 5 can fill
or obturate the treatment region of the tooth (e.g., a cleaned root
canal space, a cleaned carious region on an exterior surface of the
tooth, etc.) after cleaning. For example, in root canal procedures,
the disclosed pressure wave generators 5 can substantially fill the
entire root canal system, including the main canals,
laterally-extending tubules, and various small cracks, spaces,
crevices, etc. The improved obturation provided by the pressure
wave generators 5 disclosed herein can improve patient outcomes by
reducing the risk of infection from unobturated spaces in cleaned
canals.
[0082] Various embodiments of the pressure wave generator 5
disclosed herein can clean and/or fill the tooth 10 by way of a
combination of several different phenomena. For example, the
pressure wave generator 5 can generate pressure waves 23 that
propagate through the fluid 22 and inside the tooth 10, and the
pressure wave generator 5 can also act as a fluid motion generator
to generate a motion 24 of fluid 22 in the chamber 6.
[0083] The fluid motion 24 generated by the fluid motion generators
disclosed herein (e.g., the pressure wave generators 5) can be
induced by flowing the fluid across an access port of the chamber 6
and/or the coupling member 3. For example, the fluid 22 can be
flowed across the access port in a direction substantially parallel
to a plane of the access port and/or perpendicular to the central
axis of the root canal 13. The fluid motion 24 described in each
embodiment disclosed herein can comprise rotational or
non-rotational flow patterns in the chamber 6. The fluid motion 24
can be laminar or turbulent. For example, in laminar fluid motions
24, larger or bulk fluid motion may be generated. In turbulent
fluid motions 24, smaller fluid motions or perturbations can be
generated. In some arrangements, a combination of laminar and
turbulent flow may be generated. The fluid flow 24 in the chamber
and the induced flow (e.g., vortices, swirl, etc.) in the tooth can
be generated in a substantially continuous manner or can be
intermittent or periodic. In some embodiments, the fluid motion 24
can comprise rotational motion, e.g., the fluid can rotate about an
axis transverse to a central axis of the root canal 13 (see, e.g.,
FIG. 2A). In some arrangements, the fluid motion 24 can induce
vortices 75 flowing about an axis substantially perpendicular to
the central axis of the root canal 13 (see, e.g., FIG. 2A). In
other embodiments, the fluid motion 24 can be generated about the
central axis of the root canal 13 and can generate a swirl flow 76
that can propagate through the canal 13 (see, e.g., FIG. 2B). In
still other embodiments, the fluid motion 24 can comprise planar
fluid flow, e.g., fluid flow that comprises planar wavefronts. In
some embodiments, the fluid motion 24 can comprise unsteady or
chaotic flow.
[0084] As explained herein, the pressure waves 23 can enhance the
chemical reactions produced between treatment fluids and the
unhealthy material to enable the detachment of unhealthy materials
from the tooth 10 in a safe and efficient manner. For example, the
pressure wave generator 5 can be configured to induce acoustic
cavitation throughout the tooth 10, which can assist in removing
unhealthy materials from larger spaces in the tooth, such as the
main root canal 13, as well as from extremely small spaces in the
tooth 10, such as tubules and various cracks and crevices that may
be formed in the tooth 10.
[0085] In tooth cleaning procedures, the motion 24 of the fluid 22
can also improve the cleaning of the tooth 10 by refreshing the
chemical reactants used in the fluid 22, which can act to speed up
the chemical reactions between the fluid 22 and the unhealthy
materials in the tooth. Furthermore, the motion 24 of the fluid 22
can impart momentum in the tooth 10 that helps to dislodge the
unhealthy or undesirable materials from the tooth 10 and to
irrigate the dislodged materials out of the tooth 10. As explained
herein, the motion 24 of the fluid 22 can also reduce apical
pressures at or near the apical opening 15 of the tooth 10.
[0086] Accordingly, the pressure waves 23 and motion 24 generated
by the systems disclosed herein can improve patient outcomes as
compared with other treatments by cleaning unhealthy materials from
both large and small spaces of the tooth, and by enhancing the
chemical reactions between the fluid 22 and the unhealthy materials
to be removed from the tooth 10. Furthermore, because the tooth 10
is cleaned without the use of a file, drill, brush, or other
abrasive instrument, the systems and methods disclosed herein can
clean the tooth with little or no discomfort to the patient. In
addition, in obturation procedures, the embodiments disclosed
herein can advantageously obturate or fill substantially the entire
canal(s) and/or branch structures therefrom, as explained in
greater detail below.
[0087] In various implementations, the pressure wave generator 5
comprises one or more embodiments of the various apparatus
described herein. For example, the pressure wave generator 5 can
include a liquid jet device. In some embodiments, the liquid jet
device comprises a positioning member (e.g., a guide tube) having a
channel or lumen along which or through which a liquid jet can
propagate. The distal end portion of the positioning member may
include an impingement surface on which the liquid jet impinges and
is deflected into jets or spray. The distal end portion of the
positioning member may include one or more openings that permit the
jet to interact with the fluid in the surrounding environment
(e.g., fluid in the tooth chamber) and also permit the deflected
liquid to exit the positioning member and interact with the
surrounding environment and fluid 22 in the chamber 6 and/or tooth
10. The result of these interactions can be the generation of
pressure waves and fluid motion in the tooth 10, which can at least
partially clean the tooth 10. By generating fluid motion 24 in the
tooth 10, the pressure wave generators 5 may act as fluid motion
generators. In some treatment methods, the openings disposed at or
near the distal end portion of the positioning member are submerged
in the fluid 22 retained in the chamber 6 by the coupling member
3.
[0088] In some embodiments, the pressure wave generator 5 may
include a sonic, ultrasonic, or megasonic device (e.g., a sonic,
ultrasonic, or megasonic paddle, horn, or piezoelectric
transducer), a mechanical stirrer (e.g., a motorized propeller or
paddle or rotating/vibrating/pulsating disk or cylinder), an
optical system that can provides optical energy to the chamber 6
(e.g., an optical fiber that propagates laser light into the
chamber 6), or any other device that can cause sufficient
rotational fluid motion and acoustic waves to be generated in the
tooth or in a propagation medium in the tooth (e.g., the fluid
retained in a tooth chamber).
[0089] B. Enhancing the Treatment of Teeth
[0090] The embodiments disclosed herein can advantageously remove
undesirable or unhealthy materials from a tooth such that
substantially all the unhealthy material is removed while inducing
minimal or no discomfort and/or pain in the patient. For example,
when activated by the clinician, the pressure wave generator 5 can
induce various fluidic effects that interact with the unhealthy
material to be removed, even when the pressure wave generator 5 is
disposed at a position remote from the treatment region of the
tooth, e.g., the region of the tooth that includes the unhealthy or
undesirable material to be removed. The pressure wave generator 5
can impart energy to the fluid 22 that induces the relatively
large-scale or bulk circulation or movement 24 of liquid in the
chamber 6 and tooth 10, and that also generates pressure waves 23
that propagate through the fluid 22 and tooth 10. The generated
fluid motion 24 and pressure waves 23 can magnify or enhance the
properties of the fluid 22 to enhance cleaning of the tooth 10. In
some embodiments, the pressure wave generator 5 can be used to
obturate or fill the root canals and/or other treated regions of
the tooth.
[0091] (1) Chemistry of Various Treatment Fluids
[0092] As explained above, in cleaning procedures, the fluid 22 can
comprise a treatment fluid that can be introduced into the tooth 10
and the chamber 6 to assist in removing unhealthy or undesirable
materials from the tooth 10. The treatment fluids can be selected
based on the chemical properties of the fluids when reacting with
the undesirable or unhealthy material to be removed from the tooth
10. The treatment fluids disclosed herein can include any suitable
fluid, including, e.g., water, saline, etc. Various chemicals can
be added to treatment fluid for various purposes, including, e.g.,
tissue dissolving agents (e.g., NaOCl or bleach), disinfectants
(e.g., chlorhexidine), anesthesia, fluoride therapy agents,
ethylenediaminetetraacetic acid (EDTA), citric acid, and any other
suitable chemicals. For example, any other antibacterial,
decalcifying, disinfecting, mineralizing, or whitening solutions
may be used as well. The clinician can supply the various fluids to
the tooth in one or more treatment cycles, and can supply different
fluids sequentially or simultaneously.
[0093] During some treatment cycles, bleach-based solutions (e.g.,
solutions including NaOCl) can be used to dissociate diseased
tissue (e.g., diseased organic matter in the root canal 13) and/or
to remove bacteria from the tooth 10. One example of a treatment
solution comprises water or saline with 0.3% to 6% bleach (NaOCl).
In some methods, tissue dissolution and dental deposit removal in
the presence of bleach may not occur when the bleach concentration
is less than 1%. In some treatment methods disclosed herein, tissue
dissolution and dental deposit removal can occur at smaller (or
much smaller) concentrations.
[0094] During other treatment cycles, the clinician can supply an
EDTA-based solution to remove undesirable or unhealthy calcified
material from the tooth 10. For example, if a portion of the tooth
10 and/or root canal 13 is shaped or otherwise instrumented during
the procedure, a smear layer may form on the walls of the canal 13.
The smear layer can include a semi-crystalline layer of debris,
which may include remnants of pulp, bacteria, dentin, and other
materials. Treatment fluids that include EDTA may be used to remove
part or all of the smear layer, and/or calcified deposits on the
tooth 10.
[0095] During yet other cycles, for example, the clinician may
supply a treatment fluid that comprises substantially water. The
water can be used to assist in irrigating the tooth before, during,
and/or after the treatment. For example, the water can be supplied
to remove remnants of other treatment fluids (e.g., bleach or EDTA)
between treatment cycles. Because bleach has a pH that tends to be
a base and because EDTA is an acid, it can be important to purge
the tooth 10 and chamber 6 between bleach and EDTA treatments to
avoid potentially damaging chemical reactions. Furthermore, the
water can be supplied with a sufficient momentum to help remove
detached materials that are disrupted during the treatment. For
example, the water can be used to convey waste material from the
tooth 10.
[0096] Various solutions may be used in combination at the same
time or sequentially at suitable concentrations. In some
embodiments, chemicals and the concentrations of the chemicals can
be varied throughout the procedure by the clinician and/or by the
system to improve patient outcomes. For example, during an example
treatment procedure, the clinician can alternate between the use of
water, bleach, and EDTA, in order to achieve the advantages
associated with each of these chemicals. In one example, the
clinician may begin with a water cycle to clean out any initial
debris, then proceed with a bleach cycle to dissociate diseased
tissue and bacteria from the tooth. A water cycle may then be used
to remove the bleach and any remaining detached materials from the
tooth 10. The clinician may then supply EDTA to the tooth to remove
calcified deposits and/or portions of a smear layer from the tooth
10. Water can then be supplied to remove the EDTA and any remaining
detached material from the tooth 10 before a subsequent bleach
cycle. The clinician can continually shift between cycles of
treatment fluid throughout the procedure. The above example is for
illustrative purposes only. It should be appreciated that the order
of the cycling of treatment liquids may vary in any suitable manner
and order.
[0097] Thus, the treatment fluids used in the embodiments disclosed
herein can react chemically with the undesirable or unhealthy
materials to dissociate the unhealthy materials from the healthy
portions of the tooth 10. The treatment fluids can also be used to
irrigate waste fluid and/or detached or delaminated materials out
of the tooth 10. In some embodiments, as explained in more detail
herein in Section VIII, the treatment solution (including any
suitable composition) can be degassed, which may improve cavitation
and/or reduce the presence of gas bubbles in some treatments. In
some embodiments, the dissolved gas content can be less than about
1% by volume. Additional properties and characteristics of the
treatment fluid 22 are presented in more detail herein in Section
VII.
[0098] (2) Enhancement of Cleaning Using Pressure Waves
[0099] As explained herein, a pressure wave generator 5 can remove
unhealthy materials from a tooth by propagating pressure waves 23
through a propagation medium (e.g., the treatment fluid) to the
treatment region, which can include one or more teeth and/or gums.
Without being limited by theory, a few potential ways that the
pressure waves 23 remove undesirable materials are presented
herein. Note that these principles, and the principles described
above, may be generally applicable for each embodiment disclosed
herein.
[0100] In some arrangements, cavitation may be induced by the
generated pressure waves 23. Upon irradiation of a liquid (e.g.,
water or other treatment fluid) with high intensity pressure or
pressure waves 23, acoustic cavitation may occur. The oscillation
or the implosive collapse of small cavitation bubbles can produce
localized effects, which may further enhance the cleaning process,
e.g., by creating intense, small-scale localized heat, shock waves,
and/or microjets and shear flows. Therefore, in some treatment
methods, acoustic cavitation may be responsible for or involved in
enhancing the chemical reactions, sonochemistry, sonoporation, soft
tissue/cell/bacteria dissociation, delamination and breakup of
biofilms.
[0101] For example, if the treatment liquid contains chemical(s)
that act on a particular target material (e.g., diseased organic or
inorganic matter, stains, caries, dental calculus, plaque,
bacteria, biofilms, etc.), the pressure waves 23 (acoustic field)
and/or the subsequent acoustic cavitation may enhance the chemical
reaction via agitation and/or sonochemistry. Indeed, the pressure
waves 23 can enhance the chemical effects that each composition has
on the unhealthy material to be removed from the tooth. For
example, with a bleach-based treatment fluid, the generated
pressure waves 23 can propagate so as to dissociate tissue
throughout the entire tooth 10, including in the dentinal tubules
and throughout tiny cracks and crevices of the tooth 10. As another
example, with an EDTA-based treatment fluid, the generated pressure
waves 23 can propagate so as to remove the smear layer and/or
calcified deposits from the tooth 10, including in the tubules
and/or in tiny cracks and crevices formed in the tooth 10. With a
water-based treatment fluid, the generated pressure waves 23 can
propagate so as to flush and/or irrigate undesirable materials from
the tooth, including in tubules and tiny cracks and crevices.
Accordingly, the generated pressure waves 23 can enhance the
removal of undesirable or unhealthy materials from the tooth 10 by
magnifying the chemical effects of whatever treatment fluid
composition is used during a particular treatment cycle.
[0102] Furthermore, sonoporation, which is the process of using
pressure waves and/or the subsequent acoustic cavitation to modify
the permeability of the bacterial cell plasma membrane, may also
expedite the chemical reaction that removes the microorganisms from
the tooth. It should also be appreciated that generated pressure
waves, and/or the subsequent acoustic cavitation of certain
frequencies, may result in cellular and bacterial rupture and death
(e.g., lysis) as well as removal of decayed and weakened dentin and
enamel. The cellular and bacterial rupture phenomenon may kill
bacteria which might otherwise reinfect the gingival pockets and/or
the oral cavity.
[0103] Generated pressure waves and/or the subsequent acoustic
cavitation may also loosen the bond of the structure of the
unhealthy material (e.g., diseased tissue, calculus, biofilm,
caries, etc.), and/or the pressure waves may dissociate the
unhealthy material from the tooth 10. In some cases, pressure waves
and/or acoustic cavitation may loosen the bond between the cells
and the dentin and/or delaminate the tissue from the tooth.
Furthermore, the pressure waves and/or the subsequent acoustic
cavitation may act on decayed hard tissue (which may be relatively
weak and loosely connected) through vibrations and/or shock waves,
and/or the microjets created as a result of cavitation bubble
implosion, to remove decayed hard tissue from other healthy
portions of the tooth.
[0104] Additional details of the acoustic effects produced by the
pressure wave generators disclosed herein may be found herein in
more detail in Section VII.
[0105] (3) Enhancement of Cleaning Using Large-Scale Fluid
Motion
[0106] In some arrangements, bulk fluid motion 24 (e.g., fluid
rotation, convection, planar flow, chaotic flow, etc.) can enhance
the cleaning of unhealthy material from a diseased tooth. For
example, the fluid motion 24 generated in the chamber 6 and/or
tooth 10 can impart relatively large momentum to the tooth, which
can help dissociate and irrigate unhealthy materials from the
tooth. Furthermore, the fluid motion 24 can induce vortices 75
and/or swirl 76 in the tooth 10 that can result in negative
pressures (or low positive pressures) near the apical opening 15 of
the tooth 10. The resulting negative pressures at the apical
opening 15 can prevent or reduce an amount of material extruded
through the apical opening 15 and into the jaw of the patient. By
preventing or reducing the amount of extruded material, the risk of
infection can be lowered or eliminated, and patient outcomes can be
substantially improved.
[0107] In addition, due to relatively short time scales of the
chemical reaction processes between the fluid 22 and the unhealthy
materials as compared to that of diffusion mechanisms, a faster
mechanism of reactant delivery such as "macroscopic" liquid
circulation may be advantageous in some of the embodiments
disclosed herein. For example, liquid circulation with a time scale
comparable to (and preferably faster than) that of chemical
reaction may help replenish the reactants at the chemical reaction
front and/or may help to remove the reaction byproducts from the
reaction site. The relatively large convective time scale, which
may relate to effectiveness of the convection process, can be
adjusted and/or optimized depending on, e.g., the location and
characteristics of the source of circulation. Furthermore, it
should be appreciated that the introduction of liquid circulation
or other fluid motion 24 generally does not eliminate the diffusion
process, which may still remain effective within a thin microscopic
layer at the chemical reaction front. Liquid circulation can also
cause a strong irrigation effect at the treatment site (e.g.
removing diseased tissue deep in the canal 13 and/or tubules and
small spaces and cracks of the tooth 10) and may therefore result
in loosening and/or removing large and small pieces of debris from
the treatment site.
[0108] In some arrangements, various properties can be adjusted to
enhance bulk fluid motion and/or fluid circulation, e.g., fluid
motion in the chamber 6. For example, the position of the pressure
wave generator 5 relative to the location of the treatment site can
be adjusted. As explained herein, in some embodiments, the pressure
wave generator 5 is disposed such that the pressure wave generator
5 passes a stream of liquid across the access opening 18. For
example, the pressure wave generator 5 can be disposed to induce
fluid motion 24 about an axis transverse to a central axis of the
root canal 13, which can generate vortices 75 that propagate
throughout the canal 13. In some embodiments, the fluid motion 24
can be generated about the central axis of the root canal 13, which
can induce swirl motion 76 in the root canal 13. The fluid flow 24
over the access port or access opening of the tooth 10 can be
varied. For example, the momentum of the fluid 24 can be varied to
create the desired flow in the root canals 13. Furthermore, the
angle of the fluid flow 24 relative to the access port can be
varied to control the apical pressure in the canals 13, e.g., to
induce apical pressures that are more positive, more negative, etc.
The geometry of the space surrounding the pressure wave generator 5
and treatment site (e.g., the geometry of the coupling member 3)
can also be varied. It should also be appreciated that circulation
may be affected by the viscosity of the fluid 22 and/or the
mechanism of action of the pressure wave generator 5. For example,
the pressure wave generator 5, such as a jet of liquid ejected
through an inlet opening, a stirrer such as a propeller or a
vibrating object, etc., can be selected to enhance fluid motion of
the treatment fluid. In some aspects, the input power of the source
of liquid circulation can also be adjusted, such as the source of a
pump that drives a liquid jet in some embodiments.
[0109] (4) Enhancement of Other Dental and Endodontic
Procedures
[0110] In some embodiments, the pressure wave generators 5
disclosed herein can enhance other dental and endodontic
procedures. For example, after cleaning a tooth (e.g., a root canal
inside the tooth, a carious region on or near an exterior surface
of the tooth, etc.), the treatment region can be filled with an
obturation or filler material. In some embodiments, the filler
material can be supplied to the treatment region as a flowable
material and can be hardened to fill the treatment region (e.g.,
the cleaned root canal or carious region, etc.). In some
embodiments, a pressure wave generator 5 can be activated to supply
the obturation material throughout the treatment region.
[0111] For example, after a root canal procedure, the pressure wave
generator can supply the flowable obturation material into the
tooth and root canal. The large-scale fluid movement generated by
the pressure wave generator 5 can assist in propagating the
obturation material throughout relatively large spaces, such as the
main root canal or canals. For example, the pressure wave generator
5 may introduce sufficient momentum such that the flowable
obturation material propagates throughout the canal space without
introducing additional instrumentation into the tooth. For example,
the bulk fluid motion of the obturation material into the canal may
be such that the clinician may not need to or desire to enlarge the
canals. By reducing or eliminating canal enlargement, patient
outcomes and pain levels can be improved. In some arrangements, the
bulk fluid motion of the flowable obturation material can be
generated at relatively low frequencies produced by the pressure
wave generator.
[0112] In addition to generating large-scale or bulk fluid motion
of the obturation material throughout the canal, the pressure wave
generators 5 disclosed herein can generate higher frequency
perturbations to propagate the obturation material into smaller
cracks, spaces, and crevices in the tooth. For example,
higher-frequency effects, such as acoustic cavitation, can assist
in propagating the filler material throughout the tooth.
[0113] Accordingly, the pressure wave generators disclosed herein
can enhance the filling of a treatment region such as a root canal,
carious region of the tooth, etc. For example, the obturation
material can be propagated at a distance such that it flows into
the treatment region from a remote pressure wave generator 5 (which
may be disposed outside the tooth). Large-scale or bulk fluid
motion of the obturation material can fill larger canal spaces or
other treatment regions without further enlargening the treatment
region. Smaller-scale and/or higher frequency agitation by the
pressure wave generator 5 can propagate the obturation material
into smaller cracks and spaces of the tooth. By filling
substantially all the cleaned spaces of the tooth, the disclosed
methods can improve patient outcomes relative to other methods by
reducing the risk of infection in spaces unfilled by the obturation
material.
II. Overview of Features of the Disclosed Systems
[0114] A. Pressure Wave Generators
[0115] A pressure wave generator 5 can be used in various disclosed
embodiments to clean a tooth 10, e.g., from interior or exterior
portions of the tooth 10 and/or gums. In other embodiments, the
pressure wave generator 5 can be used to fill or obturate a cleaned
root canal or other treatment region of the tooth 10. In some
embodiments, the pressure wave generator 5 can comprise an
elongated member having an active distal end portion 25. The active
distal end portion 25 can be activated by a user to apply energy to
the treatment tooth 10 to remove unhealthy or undesirable material
from the tooth 10.
[0116] As explained herein, the disclosed pressure wave generators
5 can be configured to generate pressure waves 23 and fluid motion
24 with energy sufficient to clean undesirable material from a
tooth 10. The pressure wave generator 5 can be a device that
converts one form of energy into acoustic waves and bulk fluid
motion (e.g., rotational motion) within the fluid 22. The pressure
wave generator 5 can induce, among other phenomena, both pressure
waves and bulk fluid dynamic motion in the fluid 22 (e.g., in the
chamber 6), fluid circulation, turbulence, vortices and other
conditions that can enable the cleaning of the tooth. The pressure
wave generator 5 disclosed in each of the figures described herein
may be any suitable type of pressure wave generator.
[0117] The pressure wave generator 5 can be used to clean the tooth
10 by creating pressure waves that propagate through the fluid 22,
e.g., through treatment fluid at least partially retained in the
chamber 6. In some implementations, the pressure wave generator 5
may also create cavitation, acoustic streaming, turbulence, etc. In
various embodiments, the pressure wave generator 5 can generate
pressure waves or acoustic energy having a broadband power spectrum
(see, e.g., FIGS. 4A-4C). For example, the pressure wave generator
5 can generate pressure waves at multiple different frequencies, as
opposed to only one or a few frequencies. Without being limited by
theory, it is believed that the generation of power at multiple
frequencies can help to remove various types of organic and/or
inorganic materials that have different material or physical
characteristics at various frequencies.
[0118] The pressure wave generator 5 (e.g., high-speed liquid jet,
ultrasonic transducer, a laser fiber, etc.) can be placed at the
desired treatment location in or on the tooth 10. The pressure wave
generator 5 can create pressure waves 23 and fluid motion 24 within
the fluid 22 inside a substantially-enclosed chamber 6. In general,
the pressure wave generator 5 can be sufficiently strong to remove
unhealthy materials such as organic and/or inorganic tissue from
teeth 10. In some embodiments, the pressure wave generator 5 can be
configured to avoid substantially breaking down or harming natural
dentin and/or enamel.
[0119] (1) Liquid Jet Apparatus
[0120] For example, in some embodiments, the pressure wave
generator 5 can comprise a liquid jet device. The liquid jet can be
created by passing high pressure liquid through an orifice. The
liquid jet can create pressure waves within the treatment liquid.
In some embodiments, the pressure wave generator 5 comprises a
coherent, collimated jet of liquid. The jet of liquid can interact
with liquid in a substantially-enclosed volume (e.g., the chamber
and/or the mouth of the user) and/or an impingement member to
create the acoustic waves. In addition, the interaction of the jet
and the treatment fluid, as well as the interaction of the spray
which results from hitting the impingement member and the treatment
fluid, may assist in creating cavitation and/or other acoustic
effects to clean the tooth.
[0121] In various embodiments, the liquid jet device can comprise a
positioning member (e.g., a guide tube) having a channel or lumen
along which or through which a liquid jet can propagate. The distal
end portion of the positioning member can include one or more
openings that permit the deflected liquid to exit the positioning
member and interact with the surrounding environment in the chamber
6 or tooth 10. In some treatment methods, the openings disposed at
or near the distal end portion of the positioning member can be
submerged in liquid that can be at least partially enclosed in the
chamber 6 attached to or enclosing a portion of the tooth 10. In
some embodiments, the liquid jet can pass through the guide tube
and can impact an impingement surface. The passage of the jet
through the surrounding treatment fluid and impact of the jet on
the impingement surface can generate the acoustic waves in some
implementations. The flow of the submerged portion of the liquid
jet may generate a cavitation cloud within the treatment fluid. The
creation and collapse of the cavitation cloud may, in some cases,
generate a substantial hydroacoustic field in or near the tooth.
Further cavitation effects may be possible, including growth,
oscillation, and collapse of cavitation bubbles. In addition, as
explained above, bulk fluid motion, such as rotational flow, may be
induced. The induced rotational flow can enhance the cleaning
process by removing detached material and replenishing reactants
for the cleaning reactions. These (and/or other) effects may lead
to efficient cleaning of the tooth.
[0122] FIG. 3A is a block diagram that schematically illustrates an
embodiment of a system 38 adapted to generate a high-velocity jet
60 of fluid for use in dental procedures. The system 38 comprises a
motor 40, a motor controller 54, a fluid source 44, a pump 46, a
pressure sensor 48, a system controller 51, a user interface 53,
and a handpiece 20 that can be operated by a dental practitioner to
direct the jet 60 toward desired locations in a patient's mouth.
The pump 46 can pressurize fluid received from the fluid source 44.
The pump 46 may comprise a piston pump in which the piston is
actuatable by the motor 40. The motor 40 can be controlled by way
of the motor controller 54. The high-pressure liquid from the pump
46 can be fed to the pressure sensor 48 and then to the handpiece
20, for example, by a length of high-pressure tubing 49. The
pressure sensor 48 may be used to sense the pressure of the liquid
and communicate pressure information to the system controller 51.
The system controller 51 can use the pressure information to make
adjustments to the motor 40 and/or the pump 46 to provide a target
pressure for the fluid delivered to the handpiece 20. For example,
in embodiments in which the pump 46 comprises a piston pump, the
system controller 51 may signal the motor 40 to drive the piston
more rapidly or more slowly, depending on the pressure information
from the pressure sensor 48. In some embodiments, the pressure of
the liquid that can be delivered to the handpiece 20 can be
adjusted within a range from about 500 psi to about 50,000 psi (1
psi is 1 pound per square inch and is about 6895 Pascal (Pa)). In
certain embodiments, it has been found that a pressure range from
about 2,000 psi to about 15,000 psi produces jets that are
particularly effective for endodontic treatments. In some
embodiments, the pressure is about 10,000 psi.
[0123] The fluid source 44 may comprise a fluid container (e.g., an
intravenous bag) holding any of the treatments fluids described
herein. The treatment fluid may be degassed, with a dissolved gas
content less than normal (e.g., non-degassed) fluids. Examples of
treatment fluids include sterile water, a medical-grade saline
solution, an antiseptic or antibiotic solution (e.g., sodium
hypochlorite), a solution with chemicals or medications, or any
combination thereof. More than one fluid source may be used. In
certain embodiments, it is advantageous for jet formation if the
liquid provided by the fluid source 44 is substantially free of
dissolved gases, which may reduce the effectiveness of the jet and
the pressure wave generation. Therefore, in some embodiments, the
fluid source 44 comprises degassed liquid such as, e.g., degassed
distilled water. A bubble detector (not shown) may be disposed
between the fluid source 44 and the pump 46 to detect bubbles in
the liquid and/or to determine whether liquid flow from the fluid
source 44 has been interrupted or the container has emptied. Also,
as discussed above degassed fluids may be used. The bubble detector
can be used to determine whether small air bubbles are present in
the fluid that might negatively impact jet formation or acoustic
wave propagation. Thus in some embodiments, a filter or de-bubbler
(not shown) can be used to remove small air bubbles from the
liquid. The liquid in the fluid source 44 may be at room
temperature or may be heated and/or cooled to a different
temperature. For example, in some embodiments, the liquid in the
fluid source 44 can be chilled to reduce the temperature of the
high velocity jet 60 generated by the system 38, which may reduce
or control the temperature of the fluid inside a tooth 10. In some
treatment methods, the liquid in the fluid source 44 can be heated,
which may increase the rate of chemical reactions that may occur in
the tooth 10 during treatment.
[0124] The handpiece 20 can be configured to receive the high
pressure liquid and can be adapted at a distal end to generate a
high-velocity beam or jet 60 of liquid for use in dental
procedures. In some embodiments, the system 38 may produce a
coherent, collimated jet of liquid. The handpiece 20 may be sized
and shaped to be maneuverable in the mouth of a patient so that the
jet 60 may be directed toward or away from various portions of the
tooth 10. In some embodiments, the handpiece 20 comprises a distal
housing or coupling member that can be coupled to the tooth 10.
[0125] The system controller 51 may comprise a microprocessor, a
special or general purpose computer, a floating point gate array,
and/or a programmable logic device. The system controller 51 may be
used to control safety of the system 38, for example, by limiting
system pressures to be below safety thresholds and/or by limiting
the time that the jet 60 is permitted to flow from the handpiece
20. The system 38 may also include a user interface 53 that outputs
relevant system data or accepts user input (e.g., a target
pressure). In some embodiments, the user interface 53 comprises a
touch screen graphics display. In some embodiments, the user
interface 53 may include controls for a dental practitioner to
operate the liquid jet apparatus. For example, the controls can
include a foot switch to actuate or deactuate the jet. In some
embodiments, the motor 40, motor controller 54, pump 46, fluid
source 44, pressure sensor 48, system controller 51, and user
interface 53 can be integrated in the console 2 illustrated
schematically in FIGS. 1A-1B.
[0126] The system 38 may include additional and/or different
components and may be configured differently than shown in FIG. 3A.
For example, the system 38 may include an aspiration pump that is
coupled to the handpiece 20 (or an aspiration cannula) to permit
aspiration of organic matter from the mouth or tooth 10. In other
embodiments, the system 38 may comprise other pneumatic and/or
hydraulic systems adapted to generate the high-velocity beam or jet
60.
[0127] Additional details of a pressure wave generator and/or
pressure wave generator that includes a liquid jet device may be
found at least in [0045]-[0050], [0054]-[0077] and various other
portions of U.S. Patent Publication No. US 2011/0117517, published
May 19, 2011, and in [0136]-[0142] and various other portions of
U.S. Patent Publication No. US 2012/0237893, published Sep. 20,
2012, each of which is incorporated by reference herein in its
entirety and for all purposes.
[0128] As has been described, a pressure wave generator can be any
physical device or phenomenon that converts one form of energy into
acoustic waves within the treatment fluid and that induces
rotational fluid motion in the chamber 6 and/or tooth 10. Many
different types of pressure wave generators (or combinations of
pressure wave generators) are usable with embodiments of the
systems and methods disclosed herein.
[0129] (2) Mechanical Energy
[0130] Mechanical energy pressure wave generators can also include
rotating objects, e.g. miniature propellers, eccentrically-confined
rotating cylinders, a perforated rotating disk, etc. These types of
pressure wave generators can also include vibrating, oscillating,
or pulsating objects such as sonication devices that create
pressure waves via piezoelectricity, magnetostriction, etc. In some
pressure wave generators, electric energy transferred to a
piezoelectric transducer can produce acoustic waves in the
treatment fluid. In some cases, the piezoelectric transducer can be
used to create acoustic waves having a broad band of
frequencies.
[0131] (3) Electromagnetic Energy
[0132] An electromagnetic beam of radiation (e.g., a laser beam)
can propagate energy into a chamber, and the electromagnetic beam
energy can be transformed into acoustic waves as it enters the
treatment fluid. In some embodiments, the laser beam can be
directed into the chamber 6 as a collimated and coherent beam of
light. The collimated laser beam can be sufficient to generate
pressure waves as the laser beam delivers energy to the fluid.
Furthermore, in various embodiments, the laser beam can be focused
using one or more lenses or other focusing devices to concentrate
the optical energy at a location in the treatment fluid. The
concentrated energy can be transformed into pressure waves
sufficient to clean the undesirable materials. In one embodiment,
the wavelength of the laser beam or electromagnetic source can be
selected to be highly absorbable by the treatment fluid in the
chamber or mouth (e.g., water) and/or by the additives in the
treatment fluid (e.g., nanoparticles, etc.). For example, at least
some of the electromagnetic energy may be absorbed by the fluid
(e.g., water) in the chamber, which can generate localized heating
and pressure waves that propagate in the fluid. The pressure waves
generated by the electromagnetic beam can generate photo-induced or
photo-acoustic cavitation effects in the fluid. In some
embodiments, the localized heating can induce rotational fluid flow
in the chamber 6 and/or tooth 10 that further enhances cleaning of
the tooth 10 (see, e.g., FIG. 10C). The electromagnetic radiation
from a radiation source (e.g., a laser) can be propagated to the
chamber by an optical waveguide (e.g., an optical fiber), and
dispersed into the fluid at a distal end of the waveguide (e.g., a
shaped tip of the fiber, e.g., a conically-shaped tip). In other
implementations, the radiation can be directed to the chamber by a
beam scanning system.
[0133] The wavelength of the electromagnetic energy may be in a
range that is strongly absorbed by water molecules. The wavelength
may in a range from about 300 nm to about 3000 nm. In some
embodiments, the wavelength is in a range from about 400 nm to
about 700 nm, about 700 nm to about 1000 nm (e.g., 790 nm, 810 nm,
940 nm, or 980 nm), in a range from about 1 micron to about 3
microns (e.g., about 2.7 microns or 2.9 microns), or in a range
from about 3 microns to about 30 microns (e.g., 9.4 microns or 10.6
microns). The electromagnetic energy can be in the ultraviolet,
visible, near-infrared, mid-infrared, microwave, or longer
wavelengths.
[0134] The electromagnetic energy can be pulsed or modulated (e.g.,
via a pulsed laser), for example with a repetition rate in a range
from about 1 Hz to about 500 kHz. The pulse energy can be in a
range from about 1 mJ to about 1000 mJ. The pulse width can be in a
range from about 1 .mu.s to about 500 .mu.s, about 1 ms to about
500 ms, or some other range. In some cases, nanosecond pulsed
lasers can be used with pulse rates in a range from about 100 ns to
about 500 ns. The foregoing are non-limiting examples of radiation
parameters, and other repetition rates, pulse widths, pulse
energies, etc. can be used in other embodiments.
[0135] The laser can include one or more of a diode laser, a solid
state laser, a fiber laser, an Er:YAG laser, an Er:YSGG laser, an
Er,Cr:YAG laser, an Er,Cr:YSGG laser, a Ho:YAG laser, a Nd:YAG
laser, a CTE:YAG laser, a CO.sub.2 laser, or a Ti:Sapphire laser.
In other embodiments, the source of electromagnetic radiation can
include one or more light emitting diodes (LEDs). The
electromagnetic radiation can be used to excite nanoparticles
(e.g., light-absorbing gold nanorods or nanoshells) inside the
treatment fluid, which may increase the efficiency of photo-induced
cavitation in the fluid. The treatment fluid can include excitable
functional groups (e.g., hydroxyl functional groups) that may be
susceptible to excitation by the electromagnetic radiation and
which may increase the efficiency of pressure wave generation
(e.g., due to increased absorption of radiation). During some
treatments, radiation having a first wavelength can be used (e.g.,
a wavelength strongly absorbed by the liquid, for instance water)
followed by radiation having a second wavelength not equal to the
first wavelength (e.g., a wavelength less strongly absorbed by
water) but strongly absorbed by another element, e.g. dentin, or
nanoparticles added to solution. For example, in some such
treatments, the first wavelength may help create bubbles in the
fluid, and the second wavelength may help disrupt the tissue.
[0136] The electromagnetic energy can be applied to the chamber 6
for a treatment time that can be in a range from about one to a few
seconds up to about one minute or longer. A treatment procedure can
include one to ten (or more) cycles of applying electromagnetic
energy to the tooth. A fluid can circulate or otherwise move in the
chamber during the treatment process, which advantageously may
inhibit heating of the tooth 10 (which may cause discomfort to the
patient). The movement or circulation of treatment fluid (e.g.,
water with a tissue dissolving agent) in the chamber 6 can bring
fresh treatment fluid to tissue and organic matter as well as flush
out dissolved material from the treatment site. In some treatments
using electromagnetic radiation, movement of the treatment fluid
can increase the effectiveness of the cleaning (as compared to a
treatment with little or no fluid circulation).
[0137] In some implementations, electromagnetic energy can be added
to other fluid motion generation modalities. For example,
electromagnetic energy can be delivered to a chamber in which
another pressure wave generator (e.g., a liquid jet) is used to
generate the acoustic waves.
[0138] (4) Acoustic Energy
[0139] Acoustic energy (e.g., ultrasonic, sonic, audible, and/or
lower frequencies) can be generated from electric energy
transferred to, e.g., an ultrasound or other transducer or an
ultrasonic tip (or file or needle) that creates acoustic waves in
the treatment fluid. The ultrasonic or other type of acoustic
transducer can comprise a piezoelectric crystal that physically
oscillates in response to an electrical signal or a
magnetostrictive element that converts electromagnetic energy into
mechanical energy. The transducer can be disposed in the treatment
fluid, for example, in the fluid inside the chamber. As explained
herein with respect to FIGS. 4A-4C, for example, ultrasonic or
other acoustic devices used with the embodiments disclosed herein
are preferably broadband and/or multi-frequency devices. For
example, unlike the power spectra of the conventional ultrasonic
transducer shown in FIG. 4B, ultrasonic or other acoustic devices
used with the disclosed embodiments preferably have broadband
characteristics similar to those of the power spectra of FIGS.
4A-4B (acoustic power of a liquid jet device).
[0140] (5) Further Properties of Some Pressure Wave Generators
[0141] A pressure wave generator 5 can be placed at a desired
location with respect to the tooth 10. The pressure wave generator
5 creates pressure waves within the fluid 22 inside the chamber 6
(the generation of acoustic waves may or may not create or cause
cavitation). The acoustic or pressure waves 23 propagate throughout
the fluid 22 inside the chamber 6, with the fluid 22 in the chamber
6 serving as a propagation medium for the pressure waves 23. The
pressure waves 23 can also propagate through tooth material (e.g.,
dentin). It is believed, although not required, that as a result of
application of a sufficiently high-intensity acoustic wave,
acoustic cavitation may occur. The collapse of cavitation bubbles
may induce, cause, or be involved in a number of processes
described herein such as, e.g., sonochemistry, tissue dissociation,
tissue delamination, sonoporation, and/or removal of calcified
structures. In some embodiments, the pressure wave generator can be
configured such that the acoustic waves (and/or cavitation) do not
substantially break down natural dentin in the tooth 110. The
acoustic wave field by itself or in addition to cavitation may be
involved in one or more of the abovementioned processes.
[0142] In some implementations, the pressure wave generator 5
generates primary cavitation, which creates acoustic waves, which
may in turn lead to secondary cavitation. The secondary cavitation
may be weaker than the primary cavitation and may be non-inertial
cavitation. In other implementations, the pressure wave generator 5
generates acoustic waves directly, which may lead to secondary
cavitation.
[0143] The energy source that provides the energy for the pressure
wave generator 5 can be located outside the handpiece 20, inside
the handpiece 20, integrated with the handpiece 20, etc.
[0144] Additional details of pressure wave generators (e.g., which
may comprise a pressure wave generator) that may be suitable for
use with the embodiments disclosed herein may be found, e.g., in
[0191]-[0217], and various other portions of U.S. Patent
Publication No. US 2012/0237893, published Sep. 20, 2012, which is
incorporated by reference herein for all purposes.
[0145] Other pressure wave generators may be suitable for use with
the disclosed embodiments. For example, a fluid inlet can be
disposed at a distal portion of a handpiece and/or can be coupled
to a fluid platform in some arrangements. The fluid inlet can be
configured to create movement of the fluid in a chamber 6,
turbulence in the fluid in the chamber, fluid motion 24 of the
fluid 22 in the chamber 6 and/or produce other dynamics in the
fluid in the chamber 6r. For example, the fluid inlet can inject
fluid into or on the tooth to be treated. In addition, mechanical
stirrers and other devices can be used to enhance fluid motion and
cleaning. The fluid inlet can improve the circulation of the
treatment fluid in a chamber, which can enhance the removal of
unhealthy materials from the tooth 10. For example, as explained
herein, faster mechanisms of reactant delivery such as
"macroscopic" liquid circulation may be advantageous in some of the
embodiments disclosed herein.
[0146] In some embodiments, multiple pressure wave generators can
be disposed in or on the chamber 6. As explained herein, each of
the multiple pressure wave generators can be configured to
propagate acoustic waves at a different frequency or range of
frequencies. For example, different acoustic frequencies can be
used to remove different types of materials. The multiple pressure
wave generators can be activated simultaneously and/or sequentially
in various arrangements.
[0147] B. Coupling Members
[0148] The coupling members 3 disclosed herein can be adapted to
couple or orient the pressure wave generator 5 relative to the
tooth 10. In some embodiments disclosed herein, the coupling member
3 can be configured to retain fluid 22 in a treatment chamber 6. In
some embodiments, the coupling member 3 can be coupled to or formed
with a distal portion 21 of the handpiece 20. The coupling member 3
can include or define the chamber 6 configured to retain fluid 22.
Liquid can be introduced into the chamber 6 through a fluid inlet
connected to, or disposed in or on, the handpiece 20. Waste
treatment liquid can be removed through the coupling member 3 by
way of a fluid outlet and further into the handpiece 20. In various
arrangements, the coupling member 3 may be configured to cover a
portion of a tooth, a whole surface of the tooth, and/or multiple
teeth.
[0149] In some embodiments, the coupling member 3 can be applied to
the tooth 10 with a mechanical clasp or clamp, a dental adhesive,
or by pressure applied by the patient by biting on the coupling
member 3. In still other embodiments, a separate cap or fluid
retainer can be removably coupled to the distal portion 21 of the
handpiece 20.
[0150] Additional details of coupling members 3 may be similar to
those of fluid retainers, flow restrictors or caps disclosed, e.g.,
in [0052]-[0053], [0115]-[0117] and various other portions of U.S.
Patent Publication No. US 2011/0117517, published May 19, 2011, and
in [0040]-[0043], [0170]-[01 [0293]-[0299], [0316]-[0319] and
various other portions of U.S. Patent Publication No. US
2012/0237893, published Sep. 20, 2012, each of which is
incorporated by reference herein for all purposes.
[0151] The coupling member 3 can also include various components
that enhance aspiration and irrigation before, during, and/or after
the treatment procedure. In some embodiments, fluid 22 can enter
the chamber 6 via a fluid inlet, such as a treatment liquid inflow
conduit. The fluid inlet can pass through or along the handpiece
20. Under steady state operation, the amount of liquid entering the
at least partially enclosed chamber 6 can be substantially the same
as the amount of liquid leaving chamber 6 through the fluid outlet.
In some embodiments, the fluid inlet can be driven by a pump, which
can be controlled by the console 2. Furthermore, the fluid inlet
can be the same as the pressure wave generator 5 in some
embodiments, such as in embodiments that employ a liquid jet
device. Additional details of fluid inlets that may be suitable for
use with the embodiments disclosed herein may be found, e.g., in
[0075]-[0078] and various other portions of U.S. Patent Publication
No. US 2012/0237893, published Sep. 20, 2012, which is incorporated
by reference herein for all purposes.
[0152] As explained above, the coupling member 3 can also have a
fluid outlet, e.g., an outflow conduit to transfer liquid out of
the chamber 6 during the procedure. In some embodiments, waste
treatment liquid may be allowed to spill directly into the
patient's mouth. In other embodiments, however, waste treatment
liquid (as well as removed material and byproduct gases) can be
transferred through the fluid outlet, which can pass through or
along the handpiece 20. The fluid outlet can be active or passive.
In the case of a passive fluid outlet, the waste treatment liquid
may move through the fluid outlet due to capillary forces, gravity,
or because of a slight overpressure created in the enclosed chamber
6. In the case of an actively pumped fluid outlet, the waste liquid
can be transferred using a pump, suction, or other device that
draws liquid out through the outlet. In one example, the fluid
outlet is connected to the suction system and/or vacuum lines in
the clinician's office. For example, in some embodiments, the inlet
and outlet can be adjusted to maintain a balanced amount of fluid
in coupling member 3. Additional details of fluid outlets that may
be suitable for use with the embodiments disclosed herein may be
found, e.g., in [0079]-[0081] and various other portions of U.S.
Patent Publication No. US 2012/0237893, published Sep. 20, 2012,
which is incorporated by reference herein for all purposes.
[0153] As explained herein, the coupling member 3 can also include
one or more vents to regulate pressure of the fluid 22. The vents
can be disposed in a portion of the handpiece 20 in some
arrangements, such as along a waste line or fluid outlet. The vents
can take the form of a permeable or semi-permeable material (e.g.,
a sponge), openings, pores, or holes, etc. Additional details of
vents that may be suitable for use with the embodiments disclosed
herein may be found, e.g., in [0071]-[0073], [0082]-[0086],
[0177]-[0194] and various other portions of U.S. Patent Publication
No. US 2012/0237893, published Sep. 20, 2012, which is incorporated
by reference herein for all purposes.
[0154] C. Handpiece
[0155] The systems disclosed herein can include a handpiece 20. The
handpiece 20 can be configured to apply the coupling member 3 to
the tooth 10 and/or to position the pressure wave generator 5
relative to the treatment site. Treatment liquids can be
transferred into and out of the chamber 6 by way of the handpiece
20.
[0156] The handpiece 20 can provide the operator, user or clinician
with a handheld device to hold during the procedure. For example,
the handpiece 20 can include user-friendly grips and a
user-friendly shape to grasp. The clinician can manipulate the
handpiece 20 to accurately position the coupling member 3 and/or
pressure wave generator 5 at a desired position on the tooth 10. In
addition, the handpiece 20 can allow the clinician to move or
rotate the coupling member 3 and pressure wave generator 5 during
the procedure so as to dispose the pressure wave generator 5 at a
desirable position relative to the treatment region in the tooth
10. Alternatively, the handpiece 20 can also provide a device for
the operator to clamp or attach to the tooth 10 such that the
handpiece 20 does not require substantial user intervention during
the procedure. The handpiece 20 can be disposable (e.g.,
single-use), or the handpiece 20 can be reusable. In one
embodiment, the handpiece 20 is disposable, but the pressure wave
generator 5 is reusable. The handpiece 20 can be formed of any
suitable material. In some embodiments, the handpiece 20 can be
formed of a plastic material. In other embodiments, the handpiece
20 can be formed of a metal. Additional details of handpieces that
may be suitable for use with the embodiments disclosed herein may
be found, e.g., in [0107], [0138]-[0142], [0156]-[0161] and various
other portions of U.S. Patent Publication No. US 2012/0237893,
published Sep. 20, 2012, which is incorporated by reference herein
for all purposes.
[0157] For example, FIG. 3B is a schematic side view illustrating
an embodiment of a handpiece 20 comprising an embodiment of a guide
tube 27 for delivery of a liquid jet to a portion of a tooth 10.
The handpiece 20 comprises an elongated tubular barrel 29 having a
proximal end 31 that is adapted to engage tubing 32 from the system
38 and a distal end 21 adapted to be coupled or attached to the
tooth 10. The barrel 29 may include features or textures 28 that
enhance grasping the handpiece 20 with the fingers and thumb of the
operator. The handpiece 20 can be configured to be handheld. In
some cases, the handpiece 20 can be configured to be portable,
movable, orientable, or maneuverable with respect to the patient.
In some implementations, the handpiece 20 can be configured to be
coupled to a positioning device (e.g., a maneuverable or adjustable
arm). The distal end 21 of the handpiece 20 can comprise the
coupling member 3 that can be coupled to the tooth 10.
[0158] The handpiece 20 may include a fluid inlet for delivering
fluid 22 to the chamber 6, a fluid outlet for removing fluid from
the tooth 10 (e.g., waste fluid), a pressure wave generator 5, a
power line (e.g., to provide energy to a pressure wave generator),
or a combination of some or all of the foregoing. The handpiece 20
may include other components such as, e.g., an irrigation line to
irrigate the tooth area, a light source to illuminate the tooth
area, etc. In some cases, the pressure wave generator 5 (e.g., a
liquid jet) comprises the fluid inlet (e.g., the jet). The
handpiece 20 can be used to apply the pressure wave generator 5
relative to the tooth 10. The handpiece 20 can be applied to the
tooth 10 so as to create a substantially closed fluid circuit as
the distal end 21 of the handpiece 20 engages the tooth 10, thereby
enabling fluid to be delivered into and out of the chamber 6
without substantial spillage or leakage into the patient's mouth.
As described herein, the handpiece 20 and/or the coupling member 3
may include a fluid retention member (e.g., sponge or vent) to
reduce the likelihood of fluid leakage and/or to allow fluid to
flow from the chamber 6 (e.g., to inhibit overpressurization or
under-pressurization). The fluid retention member can be configured
to inhibit air from entering the chamber 6 and tooth 10 (which may
reduce the effectiveness of cavitation) while permitting air to
enter a fluid outlet (e.g., suction line).
[0159] D. Tooth Seal and Alignment Features
[0160] A tooth seal 26 disclosed herein can be configured to
temporarily secure the coupling member 3 to the tooth 10. The tooth
seal 26 can be configured to flow onto or near an occlusal surface
of the tooth in a flowable state. The tooth seal 26 can be
configured to set and/or harden to hold its shape during treatment.
In addition, the tooth seal 26 can be easily removed or pulled from
the tooth 10 after use. In some arrangements, the sealing material
can easily be reshaped using tools such as a dental bur, knife,
etc. For example, in various embodiments, the sealing material can
be shaped (e.g., planarized or curved) to support a planar coupling
surface (e.g., a washer, one or more support magnets, etc.). The
coupling member 3 and/or handpiece 3 can couple to the coupling
surface, and the pressure wave generator 5 (e.g., a liquid jet
device) can extend through the coupling surface such that a distal
end portion 25 of the pressure wave generator 5 is disposed in the
chamber 6 of the coupling member 3.
[0161] The tooth seal 26 can comprise any suitable sealant. For
example, the tooth seal 26 can be a substantially semi-flexible
material that can set or harden in less than about 30 seconds. The
tooth seal 26 can be any suitable material that is able to seal the
coupling member 3 to the tooth 10, but that also can easily be
removed from the tooth 10. Examples of suitable sealing materials
can include silicones, impression materials, bite registration
materials, etc. In some embodiments, for example, the sealing
materials can include 3M Imprint.TM. Bite, Jet Blue Bite by Coltene
Whaledent.RTM., LuxaBite bite registration material by DMG America,
Alpha-Dam.TM. LC Gingival Dam Material or any other suitable
sealant. In other embodiments, however, the tooth seal may not be
used.
[0162] In some embodiments, the tooth seal 26 can comprise a
permeable or semi-permeable material, such that waste fluid can
flow from within the tooth 10 and/or chamber 6 thorugh the tooth
seal 6 and outside the tooth 10. In various embodiments, the tooth
seal 26 can comprise a peripheral boundary shaped to secure the
chamber 6 and/or coupling member 3 to the tooth seal 26. For
example, in some embodiments, the tooth seal 26 can comprise a
locking wall extending upwardly relative to the tooth. The locking
wall can be shaped to laterally restrain the coupling member 3
during treatment. In some embodiments, a mating tube can extending
outwardly from the chamber 6 and can surround an access port of the
chamber 6. The mating tube can be positioned within the access
opening 18 of the tooth 10 to substantially align the coupling
member 3 and pressure wave generator 5 with the treatment region of
the tooth 10.
[0163] In various embodiments, the tooth seal 26 can be shaped to
permit the user to rotate the coupling member 3 relative to the
tooth 10 to position the pressure wave generator 5 and coupling
member 3 at a desired orientation relative to the treatment region
of the tooth 10. For example, the tooth seal 26 can comprise a
concave surface, and the distal end portion 21 of the handpiece 20
can be pressed against and/or coupled to the concave surface. The
curved distal end portion 21 of the handpiece 20 can have a shape
complementary to that of the curved tooth seal 26.
III. Examples of Power Generated by Pressure Wave Generators
[0164] FIGS. 4A and 4B are graphs that schematically illustrate
possible examples of power that can be generated by different
embodiments of the pressure wave generator 5. These graphs
schematically show acoustic power (in arbitrary units) on the
vertical axis as a function of acoustic frequency (in kHz) on the
horizontal axis. The acoustic power in the tooth may influence,
cause, or increase the strength of effects including, e.g.,
acoustic cavitation (e.g., cavitation bubble formation and
collapse, microjet formation), acoustic streaming, microerosion,
fluid agitation, fluid circulation and/or rotational motion,
sonoporation, sonochemistry, and so forth, which may act to
dissociate organic material in or on the tooth and effectively
clean the undesirable materials, e.g., undesirable organic and/or
inorganic materials and deposits. In some embodiments, these
effects can enhance or enable the obturation or filling of treated
root canals or other treatment regions of the tooth, For example,
the embodiments disclosed herein can advantageously obturate or
fill substantially the entire canal(s) and/or branch structures
therefrom, as explained in greater detail above. In various
embodiments, the pressure wave generator can produce a pressure
wave including acoustic power (at least) at frequencies above:
about 1 Hz, about 0.5 kHz, about 1 kHz, about 10 kHz, about 20 kHz,
about 50 kHz, about 100 kHz, or greater. The pressure wave can have
acoustic power at other frequencies as well (e.g., at frequencies
below the aforelisted frequencies).
[0165] The graph in FIG. 4A represents a schematic example of
acoustic power generated by a liquid jet impacting a surface
disposed within a chamber on or around the tooth that is
substantially filled with liquid and by the interaction of the
liquid jet with fluid in the chamber. This schematic example shows
a broadband spectrum 190 of acoustic power with significant power
extending from about 1 Hz to about 1000 kHz, including, e.g.,
significant power in a range of about 1 kHz to about 1000 kHz
(e.g., the bandwidth can be about 1000 kHz). The bandwidth of the
acoustic energy spectrum may, in some cases, be measured in terms
of the 3-decibel (3-dB) bandwidth (e.g., the full-width at
half-maximum or FWHM of the acoustic power spectrum). In various
examples, a broadband acoustic power spectrum can include
significant power in a bandwidth in a range from about 1 Hz to
about 500 kHz, in a range from about 1 kHz to about 500 kHz, in a
range from about 10 kHz to about 100 kHz, or some other range of
frequencies. In some implementations, a broadband spectrum can
include acoustic power above about 1 MHz. In some embodiments, the
pressure wave generator can produce broadband acoustic power with
peak power at about 10 kHz and a bandwidth of about 100 kHz. In
various embodiments, the bandwidth of a broadband acoustic power
spectrum is greater than about 10 kHz, greater than about 50 kHz,
greater than about 100 kHz, greater than about 250 kHz, greater
than about 500 kHz, greater than about 1 MHz, or some other value.
In some cleaning methods, acoustic power between about 1 Hz and
about 200 kHz, e.g., in a range of about 20 kHz to about 200 kHz
may be particularly effective at cleaning teeth. The acoustic power
can have substantial power at frequencies greater than about 1 kHz,
greater than about 10 kHz, greater than about 100 kHz, or greater
than about 500 kHz. Substantial power can include, for example, an
amount of power that is greater than 10%, greater than 25%, greater
than 35%, or greater than 50% of the total acoustic power (e.g.,
the acoustic power integrated over all frequencies). In some
arrangements, the broadband spectrum 190 can include one or more
peaks, e.g., peaks in the audible, ultrasonic, and/or megasonic
frequency ranges.
[0166] The graph in FIG. 4B represents a schematic example of
acoustic power generated by an ultrasonic transducer disposed in a
chamber on or around the tooth that is substantially filled with
liquid. This schematic example shows a relatively narrowband
spectrum 192 of acoustic power with a highest peak 192a near the
fundamental frequency of about 30 kHz and also shows peaks 192b
near the first few harmonic frequencies. The bandwidth of the
acoustic power near the peak may be about 5 to 10 kHz, and can be
seen to be much narrower than the bandwidth of the acoustic power
schematically illustrated in FIG. 4A. In other embodiments, the
bandwidth of the acoustic power can be about 1 kHz, about 5 kHz,
about 10 kHz, about 20 kHz, about 50 kHz, about 100 kHz, or some
other value. The acoustic power of the example spectrum 192 has
most of its power at the fundamental frequency and first few
harmonics, and therefore the ultrasonic transducer of this example
may provide acoustic power at a relatively narrow range of
frequencies (e.g., near the fundamental and harmonic frequencies).
The acoustic power of the example spectrum 190 exhibits relatively
broadband power (with a relatively high bandwidth compared to the
spectrum 192), and the example liquid jet can provide acoustic
power at significantly more frequencies than the example ultrasonic
transducer. For example, the relatively broadband power of the
example spectrum 190 illustrates that the example jet device
provides acoustic power at these multiple frequencies with energy
sufficient to break the bonds between the decayed and healthy
material so as to substantially remove the decayed material from
the carious region.
[0167] It is believed, although not required, that pressure waves
having broadband acoustic power (see, e.g., the example shown in
FIG. 4A) can generate acoustic cavitation or other means of
cleaning and disinfection that is more effective at cleaning teeth
(including cleaning, e.g., unhealthy materials in or on the tooth)
than cavitation generated by pressure waves having a narrowband
acoustic power spectrum (see, e.g., the example shown in FIG. 4B).
Further, broadband acoustic power can also generate sufficient
energy at frequencies capable of obturating or filling a root canal
or other treatment region (such as a treated carious region on an
exterior surface of the tooth). For example, a broadband spectrum
of acoustic power can produce a relatively broad range of bubble
sizes in the cavitation cloud and on the surfaces on the tooth, and
the implosion of these bubbles may be more effective at disrupting
tissue than bubbles having a narrow size range. Relatively
broadband acoustic power may also allow acoustic energy to work on
a range of length scales, e.g., from the cellular scale up to the
tissue scale. Accordingly, pressure wave generators that produce a
broadband acoustic power spectrum (e.g., some embodiments of a
liquid jet) can be more effective at tooth cleaning for some
treatments than pressure wave generators that produce a narrowband
acoustic power spectrum. In some embodiments, multiple narrowband
pressure wave generators can be used to produce a relatively broad
range of acoustic power. For example, multiple ultrasonic tips,
each tuned to produce acoustic power at a different peak frequency,
can be used. As used herein, broadband frequencies and broadband
frequency spectrum is defined regardless of secondary effects such
as harmonics of the main frequencies and regardless of any noise
introduced by measurement or data processing (e.g., FFT); that is,
these terms should be understood when only considering all main
frequencies activated by the pressure wave generator.
[0168] FIG. 4C is a graph of an acoustic power spectrum 1445
generated at multiple frequencies by the pressure wave generators
disclosed herein. For example, the spectrum 1445 in FIG. 4C is an
example of acoustic power generated by a liquid jet impacting a
surface disposed within a chamber on, in, or around the tooth that
is substantially filled with liquid and by the interaction of the
liquid jet with fluid in the chamber. The spectrum 1445 of FIG. 4C
represents acoustic power detected by a sensor spaced apart from
the source of the acoustic energy, e.g., the pressure wave
generator. The data was acquired inside an insulated water tank
data when the distance between the power wave generator and the
hydrophone (e.g., sensor) being about 8 inches. The vertical axis
of the plot represents a measure of acoustic power: Log
(P.sub.acoustic.sup.2), referred to herein as "power units". The
units of P.sub.acoustic in the measurement were .mu.Pa (micro
Pascal). Thus, it should be appreciated that the actual power at
the source may be of a different magnitude because the sensor is
spaced from the acoustic power generator. However, the general
profile of the power spectrum at the source should be the same as
the spectrum 1445 detected at the sensor and plotted in FIG. 4C. It
should also be understood that, although the plot shows frequencies
only up to 100 KHz, the power above 100 KHz was greater than
zero--the data just was not plotted. It should further be noted
that, as would be appreciated by one skilled in the art, the plot
and the values would also depend on other parameters, such as, for
example, the size and shape of the tank in which data was acquired,
the insulation of the inner surface of the tank, the relative
distance between the source (e.g., power wave generator), and the
free water surface of the tank.
[0169] As shown in FIG. 4C, the spectrum 1445 can include acoustic
power at multiple frequencies 1447, e.g., multiple discrete
frequencies. In particular, the spectrum 1445 illustrated in FIG.
4C includes acoustic power at frequencies in a range of about 1 Hz
to about 100 KHz. The acoustic power can be in a range of about 10
power units to about 80 power units at these frequencies. In some
arrangements, the acoustic power can be in a range of about 30
power units to about 75 power units at frequencies in a range of
about 1 Hz to about 10 kHz. In some arrangements, the acoustic
power can be in a range of about 10 power units to about 30 power
units at frequencies in a range of about 1 KHz to about 100 kHz. In
some embodiments, for example, the broadband frequency range of the
pressure waves generated by the pressure wave generators disclosed
herein can comprise a substantially white noise distribution of
frequencies (see, e.g., FIG. 11B and associated disclosure).
[0170] Pressure wave generators that generate acoustic power
associated with the spectrum 1445 of FIG. 4C can advantageously and
surprisingly clean undesirable materials from teeth. As explained
above, the generation of power at multiple frequencies can help to
remove various types of organic and/or inorganic materials that
have different material or physical characteristics, and/or
different bonding strengths at various frequencies. For example,
some undesirable materials may be removed from the teeth and/or
gums at relatively low acoustic frequencies, while other materials
may be removed from the teeth at relatively high acoustic
frequencies, while still other materials may be removed at
intermediate frequencies between the relatively low and relatively
high frequencies. As shown in FIG. 4C, lower frequency cleaning
phases can be activated at higher powers, and higher frequency
cleaning phases can be activated at lower powers. In other
embodiments, low frequency cleaning phases may be activated at
relatively low powers, and high frequency cleaning phases may be
activated at relatively high powers. Pressure wave generators that
generate acoustic power at multiple frequencies (e.g., multiple
discrete frequencies) are capable of cleaning undesirable materials
and decayed matter from interior and/or exterior portions of
teeth.
[0171] In the embodiments disclosed herein, treatment procedures
can be activated to generate acoustic power at various frequency
ranges. For example, some treatment phases may be activated at
lower frequencies, and other treatment phases may be activated at
higher frequencies. The pressure wave generators disclosed herein
can be adapted to controllably generate acoustic power at any
suitable frequencies 1447 of the spectrum 1445. For example, the
pressure wave generators disclosed herein can be adapted to
generate power at multiple frequencies 1447 simultaneously, e.g.,
such that the delivered acoustic power in a particular treatment
procedure can include a desired combination of individual
frequencies. For example, in some procedures, power may be
generated across the entire frequency spectrum 1445. In some
treatment phases, the pressure wave generator can deliver acoustic
power at only relatively low frequencies, and in other treatment
phases, the pressure wave generator can deliver power at only
relatively high frequencies, as explained herein. Further,
depending on the desired treatment procedure, the pressure wave
generator can automatically or manually transition between
frequencies 1447 according to a desired pattern, or can transition
between frequencies 1447 randomly. In some arrangements, relatively
low frequencies can be associated with large-scale bulk fluid
movement, and relatively high frequencies can be associated with
small-scale, high-energy oscillations.
[0172] In some embodiments, the treatment procedure may include one
or more treatment phases. In each treatment phase, energy can be
applied at a different frequency or band of frequencies. For
example, in one phase, energy (e.g., pressure or acoustic waves)
propagating at a relatively low frequency (or band of frequencies)
may be generated. The low frequency pressure waves can interact
with the treatment fluid in the chamber and can induce removal of
large-scale dental deposits or materials. Without being limited by
theory, the low frequency pressure waves can remove a substantial
portion of the unhealthy materials in the tooth. For example, the
low frequency waves may have a sufficiently high energy at suitably
low frequencies to remove large deposits or materials from the
tooth. The acoustic power at the relatively low frequencies can
include acoustic power at any suitable low-frequency band of the
power spectrum of the pressure wave generator (see, e.g., FIG. 4A).
For example, in some embodiments, the acoustic power in the first,
low-frequency range can include one or more frequencies in a range
of about 0.1 Hz to about 100 Hz, for example in a range of about 1
Hz to about 50 Hz in some arrangements.
[0173] In another phase, acoustic energy may be generated at
relatively high frequencies. At higher frequencies, the pressure
wave generator can be configured to remove smaller deposits and
debris. For example, at higher frequencies, the pressure waves can
propagate through the treatment fluid. The higher frequency waves
can remove smaller portions from relatively small locations, such
as crevices, cracks, spaces, and irregular surfaces of the tooth.
In some embodiments, degassed liquid can be used to enhance the
removal of matter from these small spaces. When the higher
frequency cleaning is performed after the lower frequency cleaning,
in some embodiments, the high frequency waves (and/or intermediate
frequency waves) can clean the remainder of the unhealthy material
left behind from the low frequency cleaning. In the relatively high
frequency phases, acoustic energy can be generated in a range of
about 10 kHz to about 1000 kHz, e.g., in a range of about 100 kHz
to about 500 kHz.
[0174] In some embodiments, the treatment procedure can progress
from the relatively low frequencies (or bands of frequencies)
toward higher frequencies (or bands of frequencies). For example,
the procedure can move from the relatively low frequency phase(s),
through intermediate frequency phase(s), until the high frequency
phase(s) are reached. Thus, in some embodiments, the treatment
procedure can provide a gradual and/or substantially continuous
transition between relatively low and relatively high frequencies.
As the treatment progresses through the frequencies, unhealthy
dental deposits or materials of varying size and type can be
removed by the pressure wave generator. In other embodiments,
however, the treatment procedure can transition or switch between
frequencies (or bands of frequencies) or phases (e.g., between
high, low and/or intermediate frequencies or bands of frequencies)
at discrete levels. At various intermediate frequency ranges,
acoustic energy can be generated in a range of about 100 Hz to
about 10 kHz. For example, in some embodiments, the various phases
of the treatment procedures described above may be activated by the
user or clinician, or the pressure wave generator can be configured
to automatically transition between the phases. In some
embodiments, for example, the pressure wave generator can randomly
switch between high, low, and intermediate frequencies.
[0175] Various treatment procedures may include any suitable number
of treatment phases at various different frequencies. Furthermore,
although various low- and high-frequency phases may be described
above as occurring in a particular order, in other embodiments, the
order of activating the low- and high-frequency phases, and/or any
intermediate frequency phases, may be any suitable order.
Furthermore, the treatment procedures and phases described herein
can also be used to fill or obturate treatment regions of a tooth
after cleaning. In obturation procedures, the embodiments disclosed
herein can advantageously obturate or fill substantially the entire
canal(s) and/or branch structures therefrom, as explained in
greater detail herein.
IV. Examples of Coupling Members
[0176] FIG. 5 is a schematic cross-sectional side view of a
coupling member 3 having a fluid inlet 61 passing therethrough. In
FIG. 5, the coupling member 3 comprises a distal portion 21 of a
handpiece 20. A pressure wave generator 5 can be coupled to or
integrally formed with the coupling member 3. As shown in FIG. 5,
the pressure wave generator 5 can be disposed inside a chamber 6 of
the coupling member 3 and outside the tooth 10. The coupling member
3 can be applied over an access opening 18 of the tooth 10. For
example, a tooth seal 26 can be applied in flowable form over a top
(e.g., occlusal) surface of the tooth 10 to provide a stable
coupling surface to which the coupling member 3 can be secured. In
some embodiments, the tooth seal 26 can be hardened to form a
substantially solid material.
[0177] Once the coupling member 3 is secured to the tooth 10, the
chamber 6 of the coupling member 3 can be at least partially, and
in some arrangements substantially, filled with a suitable fluid
22. For example, as explained above, a treatment fluid can be used
in cleaning treatments. An obturation material can be used in
filling or obturation procedures. The fluid inlet 61 can comprise a
hole or port in fluid communication with a fluid inlet line passing
through or along the handpiece 20. Fluid 22 can be supplied
actively (e.g., by way of a pump) or passively (e.g., by way of
gravity or other potential flow) from the console 2 through the
inlet line of the handpiece 20 and into the chamber 6. The pulp
cavity 11 and/or chamber 6 of the coupling member 3 can be
substantially filled with the fluid 22. For example, a controller
in the console 2 can controllably direct the fluid 22 into the
chamber 6 through the fluid inlet 61.
[0178] During a treatment procedure, the pressure wave generator 6
can be activated to generate sufficient fluid motion 24 and/or
pressure waves 23 to clean unhealthy materials from the tooth 10,
e.g., from the pulp cavity 11 and root canal 13. The fluid motion
24 can act to detach or break up the undesirable materials in the
tooth 10, and can remove the materials from the tooth 10. For
example, the fluid motion 24 can remove large particles or deposits
of diseased tissue in some arrangements. The fluid motion 24 can
also act to replenish chemical reactants supplied with the fluid
22. The pressure waves 23 can propagate through the fluid 22 and
tooth to enhance the reactivity of the fluid 22 with the unhealthy
materials in the tooth 10. For example, the pressure waves 23 can
induce acoustic cavitation and other fluidic effects described
herein that can enable the removal of unhealthy or undesirable
materials from small spaces in the tooth 10, such as tubules,
cracks, crevices, etc. The pressure wave generator 5 of FIG. 5 can
be any suitable pressure wave generator disclosed herein, such as,
a liquid jet device. In other embodiments, as explained above, the
pressure wave generator 5 can also be used to fill or obturate the
root canal 13. In such arrangements, the fluid 22 can comprise a
flowable obturation material. The embodiments disclosed herein can
advantageously obturate or fill substantially the entire canal(s)
and/or branch structures therefrom, as explained in greater detail
herein.
[0179] The tooth seal 26 can comprise a fluid-permeable material in
the embodiment of FIG. 5. For example, the tooth seal 26 can
include pores or other spaces through which waste fluid can flow.
Accordingly, during a treatment procedure, fluid 22 can enter the
tooth 10 and chamber 6 by way of the fluid inlet 61, and waste
fluid can exit the tooth 10 and/or chamber 6 by way of the
permeable tooth seal 26.
[0180] FIG. 6 is a schematic cross-sectional side view of a
coupling member 3 having a fluid inlet 61 and a fluid outlet 62
passing therethrough. As with FIG. 5, a pressure wave generator 5
can be coupled to or integrally formed with the coupling member 3,
and can be disposed in the chamber 6 of the coupling member 3. As
explained herein, the pressure wave generator 5 can be used to
clean and/or fill a tooth 10. Furthermore, as with the embodiment
of FIG. 5, the fluid inlet 61 can be formed through the handpiece
20 and coupling member 3 to supply fluid 22 to the chamber 6 and
the tooth 10. As above, the pressure wave generator 5 can be
activated to induce pressure waves 23 and fluid motion 24 to clean
unhealthy materials from the tooth 10. The pressure wave generator
5 of FIG. 6 can be any suitable pressure wave generator disclosed
herein, such as, a liquid jet device.
[0181] In addition, a fluid outlet 62 can be disposed through the
handpiece 20 to convey fluid out of the tooth 10 and chamber 6. For
example, the fluid outlet 62 can act as a waste line, in which
waste fluid can be expelled from the chamber 6 and tooth 10. The
fluid outlet 62 can be incorporated to allow waste liquid to exit
the chamber 6 into a hose which can be connected to a collection
canister or a drain. The fluid outlet 62 can be an active or
passive outlet. For a passive fluid outlet 62, in some cases the
waste treatment liquid moves through a conduit due to capillary
forces, gravity, or because of a slight overpressure created in the
enclosed volume. For an actively pumped fluid outlet 62, the waste
liquid can be transferred using a pump, suction, or other device
that draws liquid out through an outflow conduit. In some
arrangements, for example, the fluid outlet 62 can be connected to
the suction system and/or vacuum lines in the clinician's office.
In the embodiment of FIG. 6, the tooth seal 26 may or may not be
permeable to fluid.
[0182] Accordingly, the embodiment disclosed in FIG. 6 can include
both the inlet port 61 and the outlet port 62, which can balance
the amount of fluid 22 in the tooth 10 at a given time. For
example, the console 2 can be programmed such that the amount of
fluid entering the tooth 10 and/or chamber 6 through the inlet port
61 is substantially the same as the amount of fluid exiting the
tooth 10 and/or chamber 6 through the outlet port 62.
[0183] FIG. 7A is a schematic cross-sectional side view of a
coupling member 3 having a fluid inlet 61, a fluid outlet 62, and a
vent 63 configured to regulate a pressure inside the chamber 6
and/or tooth 10. As with the embodiments of FIGS. 6A and 6B, the
coupling member 3 can be coupled to or formed with a pressure wave
generator 5 adapted to clean and/or fill a tooth 10. The coupling
member 3 can be part of the distal end portion 21 of the handpiece
20. The coupling member 3 can couple to the tooth by way of the
tooth seal 26.
[0184] The pressure wave generator 5 can be disposed inside the
chamber 6 outside the tooth 10. The pressure wave generator 5 of
FIG. 7A can be any suitable pressure wave generator disclosed
herein, such as, a liquid jet device. Fluid 22 can be supplied to
the tooth 10 and chamber 6 by way of the fluid inlet 61. For
example, the fluid 22 can substantially fill the chamber 6. The
pressure wave generator 5 can be activated to clean unhealthy
material from the tooth 10. For example, as explained herein, the
pressure wave generator 5 can generate pressure waves 23 and fluid
motion 24 sufficient to clean and/or fill the tooth 10.
[0185] As shown in FIG. 7A, one or more vents 63 can be provided or
formed in the coupling member 3 and/or the distal end portion 21 of
the handpiece 20. The vent(s) 63 can act to at least partially
regulate pressure of the fluid 22 inside the chamber 6 of the
coupling member 3. For example, the vent(s) 63 can be disposed
along the fluid outlet 62 (e.g., waste line). The vent 63 can
fluidly communicate with the exterior environs, and air from the
exterior environs can be entrained with the fluid outlet line
62.
[0186] In some vented arrangements, the inlet and outlet flow rates
can be driven by independent driving forces. For example, in some
implementations, the fluid inlet 61 can be in fluid communication
with and driven by a pressure pump, while the fluid outlet 62 can
be in fluid communication with and controlled via an evacuation
system (e.g., a suction or vacuum pump). In other implementations,
the fluid inlet 61 or outlet 62 can be controlled with a syringe
pump. The pressures of the fluid inlet 61 and the fluid outlet 62
can be such that a negative net pressure is maintained in the
chamber 6. Such a net negative pressure can assist delivering the
treatment fluid into the chamber 6 from the fluid inlet 61.
[0187] In various embodiments described herein, the vents 63 can
take the form of a permeable or semi-permeable material (e.g., a
sponge), openings, pores, or holes, etc. The use of vents in a
controlled fluid system can lead to one or more desirable
advantages. For example, the evacuation system can collect waste
fluid from the chamber 6, as long as there is any available. If
there is a pause in treatment (e.g. the time between treatment
cycles), waste fluid flow may stop, and the evacuation system may
start drawing air through the one or more vents 63 to at least
partially compensate for the lack of fluid supplied to the
evacuation system, rather than depressurizing the chamber 6. If the
evacuation system stops working for any reason, the waste fluid may
flow out through the one or more vents 63 into the patient's mouth
or onto a rubber dam (if used), where it can be collected by an
external evacuation line. Therefore, the use of vent(s) can tend to
dampen the effects of the applied pressure differential, and
therefore can inhibit or prevent negative or positive pressure
buildup. Also note that positive or negative pressure inside the
chamber 6 can exert some amount of force on the sealing
material(s), and as such a stronger seal may be required to
withstand such force in some cases. Possible advantages of some
vented systems include that the vent(s) help relieve pressure
increases (or decreases) inside the chamber 6, reduce or eliminate
the forces acting on the tooth seal 26, and therefore render the
sealing more feasible and effective.
[0188] FIG. 7B is a schematic cross-sectional side view of a
plurality of pressure wave generators 5A, 5B, 5C coupled with a
coupling member 3. As with the embodiments of FIGS. 5-7A, the
pressure wave generators 5A, 5B, 5C can be disposed in the chamber
6 of the coupling member 3 outside the tooth 10. For example, the
pressure wave generators 5A, 5B, 5C can be coupled to walls of the
coupling member 3. The pressure wave generators 5A, 5B, 5C of FIG.
7B can be any suitable pressure wave generator disclosed herein,
such as a liquid jet device. In some embodiments, at least one of
the pressure wave generators 5A, 5B, 5C can comprise an acoustic
energy source. The pressure wave generators 5A, 5B, 5C can be the
same type of pressure wave generator, or they can be different
types of pressure wave generators. Although three pressure wave
generators 5A, 5B, 5C are shown in FIG. 7B, it should be
appreciated that there could be any suitable number of pressure
wave generators, such as one, two, four, five, or more.
[0189] As above, the coupling member 3 can be coupled to the tooth
10 by way of the tooth seal 26. Fluid 22 can be supplied to the
chamber 6 by way of the fluid inlet 61. For example, the fluid 22
can substantially fill the chamber 6. The fluid outlet 62 can
convey waste fluid out of the tooth 10 and the chamber 6. Although
not illustrated in FIG. 7B, one or more vents can also be provided
to regulate the pressure in the chamber 6 and tooth 10.
[0190] During a treatment procedure, the pressure wave generators
5A, 5B, 5C can be activated sequentially or simultaneously.
Advantageously, in some embodiments, the pressure wave generators
5A, 5B, 5C can be configured to generate corresponding pressure
waves 23A, 23B, and 23C having different frequencies and/or powers.
For example, the pressure wave generator 5A can generate a
corresponding pressure wave 23A having a first frequency or a first
range of frequencies. The pressure wave generator 5B can generate a
corresponding pressure wave 23B having a second frequency or a
second range of frequencies different form the first frequency or
first range. The pressure wave generator 5C can generate a
corresponding pressure wave 23C having a third frequency or a third
range of frequencies that are different from the first and second
frequencies/ranges. In some embodiments, the frequency ranges may
overlap. In still other embodiments, the frequencies and ranges of
frequencies can be about the same. For example, in some
embodiments, each pressure wave generator 5A, 5B, 5C can generate
pressure waves 23A, 23B, 23C across the full spectrum illustrated
in FIG. 4A or 4C.
[0191] As explained herein, different frequencies of pressure waves
may be effective at detaching or disrupting different types of
tissue. For example, some frequencies may be more effective at
detaching relatively large portions of unhealthy material from the
tooth 10, and other frequencies may be more effective at detaching
relatively small portions of unhealthy material from the tooth 10.
Still other frequencies may be particularly effective at detaching
intermediate sized portions from the tooth 10. In some embodiments,
the acoustic frequencies that are effective at detaching material
from the tooth 10 may be related to the composition of unhealthy
material to be removed. For example, some frequencies may be more
effective at removing diseased pulp tissue, while other frequencies
may be more effective at removing calcified deposits. Still other
frequencies may be effective at removing bacteria, biofilms,
caries, plaque, calculus, etc.
[0192] To completely clean the tooth 10, it can be desirable to
remove all types of unhealthy or undesirable materials from the
tooth 10. For example, it can be desirable to remove organic and
inorganic tissue from the root canal 13, in addition to bacteria,
biofilms, and portions of the smear layer (if applicable). For
exterior surfaces or portions of the tooth 10, it can be desirable
to remove carious regions, in addition to dental deposits such as
plaque, calculus, etc. Accordingly, during a treatment procedure,
it can be desirable to propagate pressure waves 23A, 23B, 23C
across the full range of frequencies that correspond to effective
detachment of all types of unhealthy materials. In some
embodiments, the full range of frequencies can be applied
substantially simultaneously. For example, an acoustic signal
comprising a random or noisy distribution of frequencies can be
applied to the tooth 10 to clean all the unhealthy portions from
the tooth 10.
[0193] In other embodiments, pressure wave generators 5A, 5B, 5C
corresponding to a particular range of frequencies may be applied
sequentially to sequentially remove the various types and/or sizes
of unhealthy material from the tooth 10. For example, during a
first treatment phase, the pressure wave generator 5A may be
activated first to propagate pressure waves 23A corresponding to
the first frequency or range of frequencies. During a second
treatment phase, the pressure wave generator 5B may be activated
next to propagate pressure waves 23B corresponding to the second
frequency or range of frequencies. During a third treatment phase,
the pressure wave generator 5C may be activated to propagate
pressure waves 23C corresponding to the third frequency or range of
frequencies. In some embodiments, the clinician can select the
treatment phase as desired, e.g., to target a specific type or size
of unhealthy material. In other embodiments, the system can be
configured such that the treatment phases are automatically cycled
in order to activate each of the plurality of pressure wave
generators. In some arrangements, the system can be configured such
that the treatment phases are randomly cycled.
[0194] Furthermore, the pressure wave generators 5A, 5B, 5C can act
to induce bulk fluid movement, e.g., fluid motion 24 in the chamber
6, as described herein. In addition, in some embodiments, the
pressure wave generators 5A, 5B, 5C can act to obturate or fill a
treated tooth or treatment region. Accordingly, in the embodiment
of FIG. 7B, multiple pressure wave generators 5A, 5B, 5C can be
used sequentially and/or simultaneously to propagate acoustic waves
in multiple frequency bands to substantially clean and/or fill the
tooth 10 or a treatment region thereof.
V. Examples of Tooth Seals and Alignment Features
[0195] FIG. 8A is a schematic side cross-sectional view of a
coupling member 3 attached or coupled to a tooth 10 by way of a
locking tooth seal 26. It can be important to provide a stable
coupling surface upon which to couple the coupling member 3. For
example, if the coupling member 3 and pressure wave generator 5 are
permitted to move significantly relative to the tooth 10, then the
results of the procedure may be inconsistent and unsuitable.
[0196] Accordingly, the clinician can form an access opening 18 in
the tooth 10. The tooth seal 26 can be applied around a perimeter
of the access opening 18 such that the tooth seal 26 comprises a
peripheral boundary. The chamber 6 and positioning member 3 can be
positioned within the peripheral boundary of the tooth seal 26 to
secure the chamber 6 and positioning member 3 to the tooth seal 26.
Furthermore, it can be important to prevent or reduce lateral
movement of the positioning member 3 relative to the tooth 10,
e.g., movement transverse to a central axis Z of the root canal 13.
For example, a locking wall 64 can be defined along the periphery
of the tooth seal 26. The locking wall 64 can extend upwardly
relative to the tooth 10, such that the wall 64 prevents lateral
movement of the positioning member 3 and to help secure the
coupling member 3 to the tooth 10. The lateral wall 64 can be
defined to have a width or diameter slightly larger than a
corresponding width or diameter of the coupling member 3. The
lateral wall 64 can be defined to have tolerances such that a snug
fit is formed between the seal 26 and the coupling member 3.
[0197] In some embodiments, the clinician can form the tooth seal
26 and locking wall 64 using a mold. The mold can be shaped to
correspond to the ultimate profile of the seal 26 and locking wall
64. For example, the clinician can apply the mold about the tooth
10 and can flow the sealing material inside the mold in a flowable
state. The sealing material can be cured (e.g., heated, exposed to
ultraviolet light, etc.) such that the sealing material hardens
into a solid or semi-solid state. In other embodiments, the
clinician can manually shape the tooth seal 26 and locking wall 64
to have the desired dimensions and shape.
[0198] The clinician can apply the coupling member 3 to the seal 26
between and/or within the boundary defined by the locking wall 64.
The seal 26 can comprise a substantially planar surface upon which
the distal end of the coupling member 3 rests. As explained above,
the locking walls 64 can prevent lateral movement of the coupling
member 3. In some embodiments, the coupling member 3 can be
attached to the seal 26, while in other embodiments, the clinician
can press the coupling member 3 against the seal 26.
[0199] Fluid 22 can be supplied to the chamber 6 by way of the
fluid inlet 61 such that the chamber 6 is at least partially or
substantially filled with the fluid 22. The pressure wave generator
5 can be activated to substantially clean and/or fill the tooth 10.
For example, as explained herein, the pressure wave generator 5 can
induce pressure waves 23 and fluid motion 24 in the chamber 6
and/or tooth 10 that are sufficient to clean and/or fill the tooth
10. As above, the pressure wave generator 5 of FIG. 8A can be any
suitable pressure wave generator, such as a liquid jet device.
Waste fluid can flow out of the tooth 10 and chamber 6 by way of
the fluid outlet 62 along the handpiece 20. A vent 63 can be
provided to regulate the pressure in the tooth 10 and/or chamber 6.
As shown in FIG. 8A, for example, the vent 63 can be formed through
a wall of the coupling member 3 to provide fluid communication with
the exterior environs, e.g., air.
[0200] FIG. 8B is a schematic side cross-sectional view of a
coupling member 3 having a curved distal end portion 65 shaped to
mate with a curved surface 66 of a tooth seal 26. As shown in FIG.
8B, the coupling member 3 can be ball-shaped in some embodiments.
In some procedures, it may be desirable for the clinician to rotate
the coupling member 3 and pressure wave generator 5 to a desired
orientation relative to the tooth 10. For example, the clinician
may desire to position the pressure wave generator 5 at a
particular location and/or orientation relative to the access
opening 18 of the tooth 10. As explained herein, it can be
advantageous in some arrangements to direct or pass fluid across
the access opening 18 transverse to a central axis Z of the root
canal 13.
[0201] In some embodiments, the tooth seal 26 can be applied to the
tooth 10 about the access opening 18 such that the tooth seal 26
comprises a curved surface 66, e.g., a surface defining a concave
portion facing the coupling member 3 and an opposing convex portion
facing the tooth 10. As above, the seal 26 can be formed using a
mold in some embodiments. In other embodiments, the clinician can
manually shape the curved surface 66 of the tooth seal 26. The
curved surface 66 of the tooth seal 26 can be defined to have a
curvature (e.g., a radius of curvature) that is approximately the
same as a curved distal portion 65 of the coupling member 3.
[0202] After forming the tooth seal 26, the clinician can apply the
curved distal portion 65 of the coupling member 3 to the
corresponding curved surface 66 of the tooth seal 26 such that the
curved distal portion 65 mates with the complementary curved
surface 66 of the seal 26. In some embodiments, the tooth seal 26
is fixed relative to the tooth 10 and the curved distal portion 65
is rotationally free to move relative to the seal 26. In other
embodiments, the curved surface 66 of the tooth seal 26 and the
curved distal portion 65 are coupled together and free to rotate
relative to the tooth 10 and access opening 18.
[0203] As explained above, fluid 22 is supplied to the chamber 6
and the tooth 10 by way of the fluid inlet 61. For example, the
chamber 6 can be substantially filled with the fluid 22. The
pressure wave generator 5 can be activated to substantially clean
the tooth 10, e.g., to remove unhealthy materials from the tooth.
The pressure wave generator 5 can generate pressure waves 23 and
fluid motion 24 sufficient to clean the tooth 10. Waste fluid can
be removed from the tooth 10 and chamber 6 by way of the fluid
outlet 62. The vent 63 can be provided in the coupling member 3 to
regulate the pressure in the tooth 10 and/or chamber 6.
[0204] During the treatment procedure, the clinician may want to
manipulate the coupling member 3 and/or pressure wave generator 5
to orient the pressure wave generator 5 at a desired orientation
and/or position. In the embodiment of FIG. 8B, for example, the
clinician can manually rotate the handpiece 20, which in turn
rotates the coupling member 3 and the curved distal portion 65 of
the coupling member 3. The curved distal portion 65 can rotate
relative to the curved surface 66 of the tooth seal 26 until the
coupling member 3 and pressure wave generator 5 are oriented
relative to the tooth 10 at a desired orientation. Accordingly, the
tooth seal 26 and curved coupling member 3 can advantageously be
used by a clinician to rotate the coupling member 3 relative to the
tooth 10.
[0205] FIG. 8C is a schematic side cross-sectional view of a
coupling member 3 having an alignment feature comprising a mating
tube 67 sized and shaped to fit through an access opening 18 formed
in the tooth 10. As shown in FIG. 8C, the coupling member 3 can
comprise an access aperture 70 that defines an opening configured
to provide fluid communication between the chamber 6 and the tooth
10. The mating tube 67 can surround and extend from the access
aperture 70 of the coupling member 3.
[0206] In some embodiments, such as treatment procedures applied to
a premolar tooth, it can be challenging to align the coupling
member 3 to the access opening 18 of the tooth 10. Accordingly, in
some embodiments, the clinician can form the access opening 18 and
can apply the tooth seal 26 about the access opening 18 of the
tooth 10. The clinician can apply the coupling member 3 to the
tooth seal 26 such that the mating tube 67 is inserted through the
access opening 18 and into a portion of the tooth 10. As shown in
FIG. 8C, the mating tube 67 can help the clinician find the access
opening 18 during treatment. Furthermore, the mating tube 67 can
help laterally secure the coupling member 3 relative to the tooth
10. For example, the mating tube 67 can prevent the coupling member
3 from translating in a direction transverse to a central axis Z of
the root canal 13 during treatment. The coupling member 3 can be
attached to the seal 26, or the clinician can press the coupling
member 3 against the tooth seal 26.
[0207] As above, the chamber 6 can be substantially filled with
fluid 22 supplied by the fluid inlet 61. The pressure wave
generator 5 can be activated to generate pressure waves 23 and
fluid motion 24 in the chamber 6 and/or tooth 10. The pressure wave
generator 5 can act to substantially clean and/or fill the tooth
10. Waste fluid can be removed by the fluid outlet 62. A vent 63
can be provided to regulate the pressure in the tooth 10 and/or
chamber 6. Accordingly, the embodiment disclosed in FIG. 8C can
advantageously align the coupling member 3 with the access opening
18 of the tooth 10 and can help to secure the coupling member 3
relative to the tooth 10.
VI. Examples of Pressure Wave Generators
[0208] FIG. 9A is a schematic side cross-sectional view of a
coupling member 3 and a pressure wave generator 5 comprising a
liquid jet device. As with the embodiments of FIG. 5-8C, the
coupling member 3 can couple to the tooth 10 by way of a tooth seal
26. The pressure wave generator 5 can be disposed in the chamber 6
of the coupling member 3 outside the tooth 10. The fluid inlet 61
can supply fluid 22 to the tooth 10, and the pressure wave
generator 5 can be activated to clean the tooth 10.
[0209] As shown in FIG. 9A, the pressure wave generator 5 comprises
a liquid jet device. The liquid jet device can include a guide tube
60 and an impingement member 69 disposed at a distal end of the
guide tube 60. A liquid jet 60 can be formed by a nozzle or orifice
disposed in the distal end portion 21 of the handpiece. The jet 60
can propagate through a channel of the guide tube 27. One or more
openings in the guide tube 27 can permit the jet 60 to interact
with the fluid 22 filling the chamber 6. The jet 60 can impinge
upon the impingement member 69, and can form a spray 68 of fluid
that disperses through the fluid 22 in the chamber 6. Additional
details of the liquid jet device disclosed in FIG. 9A can be found
at least in [0045]-[0050], [0054]-[0077] and various other portions
of U.S. Patent Publication No. US 2011/0117517, published May 19,
2011, and in [0136]-[0142] and various other portions of U.S.
Patent Publication No. US 2012/0237893, published Sep. 20, 2012,
each of which is incorporated by reference herein in its entirety
and for all purposes.
[0210] A fluid inlet 61 can supply fluid 22 to the tooth 10. In the
embodiment of FIG. 9A, the liquid jet device can comprise the fluid
inlet 61. As explained herein, the interaction of the liquid jet 60
with the fluid 22 and the impingement member 69 can create pressure
waves 23 and fluid motion 24 that are sufficient to clean the tooth
10 (or fill or obturate the tooth in obturation treatments). As
above, waste fluid can be removed from the chamber 6 and tooth 10
by way of the fluid outlet 62. One or more vents 63 can be provided
to regulate the pressure in the tooth 10 and/or chamber 6.
[0211] FIG. 9B is a schematic side cross-sectional view of a
coupling member 3 and a pressure wave generator 5 comprising a
light emitting element 71. Unless otherwise noted, the components
illustrated in FIG. 9B are similar to or the same as similarly
numbered components in FIG. 9A. The light emitting element 71 can
be disposed in the chamber 6 of the coupling member 3. A laser beam
or other suitable light source can propagate electromagnetic energy
into the chamber 6, and the electromagnetic energy can be
transformed into pressure waves 23 as it enters the fluid 22. In
some embodiments, the laser beam can be directed into the chamber 6
as a collimated and coherent beam of light. The collimated laser
beam can be sufficient to generate pressure waves 23 as the light
delivers energy to the fluid 22. The concentrated energy can be
transformed into pressure waves 23 sufficient to clean the
undesirable dental matter. In some embodiments, the wavelength of
the laser beam or electromagnetic source can be selected to be
highly absorbable by the treatment fluid in the chamber or mouth
(e.g., water) and/or by the additives in the treatment fluid (e.g.,
nanoparticles, etc.). For example, at least some of the
electromagnetic energy may be absorbed by the fluid (e.g., water)
in the chamber, which can generate localized heating and pressure
waves 23 that propagate in the fluid. The acoustic waves generated
by the electromagnetic beam can generate photo-induced or
photo-acoustic cavitation effects in the fluid. In some
embodiments, the localized heating can induce rotational fluid flow
24 in the chamber 6 and/or tooth 10 that further enhances cleaning
of the tooth 10. In obturation procedures, the pressure wave
generator 5 of FIG. 9B can be used to substantially fill the
treated root canal 13.
[0212] FIG. 9C is a schematic side cross-sectional view of a
coupling member 3 and a pressure wave generator 5 comprising a
vibrating mechanical element 72. Unless otherwise noted, the
components illustrated in FIG. 9C are similar to or the same as
similarly numbered components in FIGS. 9A-9B. The vibrating
mechanical element 72 can comprise a piezoelectric element that
vibrates in response to an applied electrical signal. As with the
pressure wave generators 5 disclosed herein, the vibrating
mechanical element 72 can be disposed in the chamber 6. When
activated, the vibrating mechanical element 72 can propagate
pressure waves 23 through the fluid 22 and tooth 10 and can induce
fluid motion 24 in the chamber 6. The pressure wave generator 5 of
FIG. 9C can therefor act to clean and/or fill the tooth 10, as
explained herein.
[0213] FIG. 9D is a schematic side cross-sectional view of a
coupling member 3 and a pressure wave generator 5 comprising a
stirring element 73. Unless otherwise noted, the components
illustrated in FIG. 9D are similar to or the same as similarly
numbered components in FIGS. 9A-9C. The stirring element 73 can
comprise a rotational drive axis and a propeller coupled to the
drive axis. When rotated, the drive axis can rotate the propeller
of the stirring element 73 to generate pressure waves 23 and/or
fluid motion 24 in the chamber 6 and/or tooth 10 to clean and/or
fill the tooth 10.
[0214] FIG. 10A is a side cross-sectional view of a coupling member
3 having a pressure wave generator 5 configured to generate a fluid
motion 24 in a chamber 6 of the coupling member 3 and/or pressure
waves 23 in the fluid 22. As above, the coupling member 3 can be
formed with or coupled to a distal end portion 21 of a handpiece
20. In the embodiment of FIG. 10A, the coupling member 3 is coupled
to the tooth 10 by way of a tooth seal 26. A mating tube 67 can be
used to align and/or secure the positioning member 3 to the tooth
10. The mating tube 67 can extend about and define an access
aperture or port 70 of the coupling member 3 that provides fluid
communication between the chamber 6 and the tooth 10. As shown in
FIG. 10A, the root canal 13 can have a central axis Z extending
along a major length or dimension of the root canal 13. The mating
tube 67 can prevent the coupling member 3 from translating in a
direction X transverse to the central axis Z.
[0215] In the embodiment of FIG. 10A, the pressure wave generator 5
can be disposed in the chamber 6, which can be outside the tooth
10. The pressure wave generator 5 can be positioned offset from a
central region of the coupling member 3, e.g., positioned along a
wall of the coupling member 3. As shown in FIG. 10A, the pressure
wave generator 5 can comprise a fluid inlet 61 configured to supply
a fluid 22 to the chamber 6 of the coupling member 3. For example,
in some embodiments, the fluid inlet 61 can be configured to supply
a treatment fluid. In embodiments using a treatment fluid, the
pressure wave generator 5 can be configured to clean the tooth. As
explained herein, the pressure wave generator 5 can enhance the
effects of the treatment fluid to clean both larger canal spaces
and smaller cracks and crevices of the tooth. The pressure wave
generator 5 can be activated to generate a broad spectrum of
acoustic frequencies to clean different types of material from
differently-sized spaces of the tooth 10.
[0216] In other embodiments, the fluid inlet 61 can be configured
to supply a flowable obturation material. As explained above, in
these embodiments, the pressure wave generator can supply the
flowable obturation material in a flowable state and can propagate
the flowable obturation material throughout the root canal, e.g.,
through both the larger root canal space and smaller cracks,
spaces, crevices, tubules, etc. of the tooth. By filling
substantially the entire root canal system, the pressure wave
generator 5 can prevent infection or other negative patient
outcomes by preventing the growth of bacteria in unfilled or
unobturated spaces.
[0217] The fluid inlet 61 can be in fluid communication with the
console 2, and a controller can control the flow of flowable
material 22 through the inlet 61. As explained herein, the
controller can supply the fluid 22 (e.g., the treatment fluid or a
flowable obturation material) through the inlet 61 at various
frequencies during a treatment phase of the procedure. In some
embodiments, the chamber 6 can be filled or substantially filled
with a flowable material 22, such as a treatment fluid or an
obturation material, and the pressure wave generator 5 can be
activated once the chamber 6 is filled with the flowable material
22 at a desired level and/or can be activated to substantially fill
the chamber 6.
[0218] As shown in FIG. 10A, the fluid inlet 61 can supply the
fluid 22 into the chamber 6 to introduce fluid motion 24 in the
chamber. As shown in FIG. 10A, for example, the fluid motion 24
comprises a rotational flow of fluid in the chamber 6. The fluid
motion 24 can define a rotational flow path or field substantially
about an axis transverse to the central axis Z of the root canal 13
(e.g. the fluid flows in a direction .omega. about axes transverse
to the central axis Z).
[0219] For example, one way to induce the fluid motion 24
illustrated in FIG. 10A is to position a distal end portion 25 of
the pressure wave generator 5 adjacent to the access port 70 of the
coupling member 3. As explained herein, the pressure wave generator
5 can act as a fluid motion generator to generate fluid motion 24
in the chamber 6. The distal end portion 25 of the fluid inlet 61
can direct a stream or beam of fluid across the access opening 18
of the tooth 10 (and/or across the access port 70 of the coupling
member 3 and chamber 6) along an X direction transverse to the
central axis Z of the root canal 13. For example, in some
embodiments, the fluid inlet 61 can direct a stream of fluid 22
along a direction that is substantially perpendicular to the
central axis Z of the root canal 13, e.g., in a direction that is
more or less orthogonal to a major axis of the canal 13.
Furthermore, the fluid (e.g., the momentum of the fluid stream) can
be directed along and/or substantially parallel to a plane near the
proximal-most end of the access port 70 to induce the fluid motion
24 shown in FIG. 10A. The fluid flow 24 across the access port 70
can be varied to control a desired apical pressure near the apex of
the tooth 10. For example, the momentum of the fluid motion 24 can
be controllably adjusted by way of the system controller 51.
Further, the angle relative to the central axis Z can also be
adjusted to control apical pressure. Indeed, the parameters of the
pressure wave generator 5 can be adjusted to increase, decrease,
and/or maintain the apical pressure to improve patient
outcomes.
[0220] The motion 24 of the fluid 22 in the chamber 6 across the
port 70 (which may induce flow in the rotational direction w shown
in FIG. 10A) can induce vortices 75 throughout the root canal 13.
For example, shear forces in the fluid 22 induced by the rotational
flow 24 can generate vortices 75 that rotate or circulate in
opposite directions (e.g., clockwise and counterclockwise as shown
in FIG. 10A). For example, in some arrangements, stronger vortices
75 may be created near the access port 70, and weaker vortices 75
may be created nearer the apical opening 15. In some embodiments,
the vortices 75 may gradually weaken along the length of the canal
from a point near the access port 70 to the apical opening 15. The
weaker vortices 75 nearer the apical opening 15 may help to prevent
or reduce the risk of extrusion of material through the apex of the
tooth, which can lead to safer treatment procedures. The vortices
75 can be adjusted by controlling the parameters of the pressure
wave generator 5 and the fluid motion 24 generated by the pressure
wave generator 5. In some embodiments, the vortices 75 can be
steady in size, shape, and/or direction. In other embodiments, the
vortices 75 can be unsteady or chaotic.
[0221] Furthermore, the alternating directions of the vortices
along the root canal 13 can advantageously create a negative
pressure (or low positive pressure) near the apical opening 15 of
the tooth 10. For example, the vortices 75, which also rotate about
axes transverse to the central axis Z of the root canal 13, may
cause micro-flows upwards towards the access opening 18 such that
fluid 22 tends to experience a slightly negative pressure (e.g., a
slight tendency to flow upwards through the canal 13 towards the
access opening 18) near the apical opening 15. As explained below
with respect to FIGS. 14A-14C, the negative pressure near the
apical opening 15 can prevent material in the tooth 10 from
extruding out through the apical opening 15. In other treatments,
for example, the pressure near the apical opening 15 can be
positive such that material is pushed out, or extruded, through the
apical opening 15 and into the jaw of the patient. Such extrusion
can lead to undesirable patient outcomes such as infection, high
levels of pain, etc.
[0222] In some embodiments, it can be advantageous to dispose the
pressure wave generator 5 within the chamber 6 and to use a
coupling member 3 with an access port 70 as large as possible. By
increasing the diameter or major dimension of the access port 70,
more energy can be directed into the tooth 10, which can enhance
the tooth cleaning procedure. Increasing the diameter or major
dimension can also enhance the obturation procedure when used in
such embodiments. In some embodiments, for example, the mating tube
67 may not be used so as to increase the size of the access port 70
by about twice a thickness of the walls of the mating tube 67.
Accordingly, in various embodiments, the access port 70 of the
coupling member 3 can be at least as large as a diameter or major
dimension of the access opening 18 formed in the tooth 10. In some
embodiments, for example, the access port 70 can be about the same
size as the access opening 18 formed in the tooth 10.
[0223] As above, the pressure wave generator 5 can also be
configured to generate pressure waves 23 through the fluid 22 and
the tooth 10. As explained herein, in cleaning treatments, a
combination of the pressure waves 23, fluid motion 24, and
chemistry of the treatment fluid can act to substantially remove
unhealthy materials from the tooth 10, including in small spaces,
cracks, and crevices of the tooth 10. Waste fluid and detached
materials can be removed from the tooth 10 and/or the chamber 6 by
way of a fluid outlet 62. As explained above, one or more vents 63
can be provided through the coupling member 3 to regulate the
pressure in the chamber 6. In filling or obturation procedures, the
pressure waves 23, fluid motion 24, and chemistry of the obturation
material can act to substantially fill the entire root canal
system.
[0224] FIG. 10B is a side cross-sectional view of a coupling member
3 having a pressure wave generator 5 comprising a liquid jet device
configured to generate a fluid motion 24 in a chamber 6 of the
coupling member 3. Unless otherwise noted, the components
illustrated in FIG. 10B are similar to or the same as similarly
numbered components in FIGS. 9A and 10A. As with the pressure wave
generator 5 of FIG. 10A, the liquid jet device can be disposed
along a wall of the coupling member 3. The liquid jet device can
include a guide tube 27 along which the jet 60 propagates. The
guide tube 27 can include one or more openings that permit fluid
communication between the jet 60 and the fluid 22 in the chamber 6.
In some embodiments, the fluid 22 may be supplied by an inlet other
than the jet 60. In other embodiments, the jet 60 can comprise the
fluid 22 and can supply the fluid 22 to the chamber 6. In some
embodiments, the chamber 6 can be filled or substantially filled
with the fluid 22.
[0225] The pressure wave generator 5 can be activated, and the jet
60 can impact the impingement member 69, which can deflect the jet
60 into a spray 69. For example, the spray 69 can generate fluid
motion 24 across the access port 70, as explained above with
respect to FIG. 10A. The liquid jet device can induce fluid motion
24 in the chamber, e.g., in a rotational direction .omega. about an
axis transverse to a central axis Z of the root canal. For example,
the spray 68 can induce a stream of fluid passing across an access
aperture 70 of the coupling member 3, e.g., along a direction X
transverse to (e.g., substantially perpendicular to) the central
axis Z of the root canal 13 and/or a central axis of the chamber.
The spray 69 can induce fluid flow 24 in a direction parallel to a
plane of the access port 70, e.g., a proximal-most plane of the
access port that defines an opening between the chamber 6 and the
tooth. The fluid flow 24 can induce opposing vortices 75 throughout
the root canal 13. The fluid motion 24 induced in the tooth 10
(possibly in combination with pressure waves 23) can act to remove
unhealthy materials from the tooth 10. Furthermore, as explained
above with respect to FIG. 10A, the induced vortices 75 can create
a negative pressure at or near the apical opening 15, which can
advantageously prevent the extrusion of material through the apical
opening 15. In addition, as with FIG. 10A, the diameter of the
access port 70 of the coupling member 3 can be at least as large as
the access opening 18 formed in the tooth 10, e.g., about the same
size as the access opening 18. Furthermore, in obturation
treatments, the pressure wave generator 5 of FIG. 10B can act to
substantially fill the entire root canal system.
[0226] FIG. 10C is a side cross-sectional view of a coupling member
3 having a pressure wave generator 5 comprising a light emitting
element 72 configured to generate a fluid motion 24 in a chamber 6
of the coupling member 3. Unless otherwise noted, the components
illustrated in FIG. 10C are similar to or the same as similarly
numbered components in FIGS. 9B and 10A-10B. As with the embodiment
of FIG. 9B, the pressure wave generator 5 can comprise a laser or
other light source. The light emitting element 72 can propagate
high intensity light onto a localized reservoir 78 of fluid 22,
such as a treatment fluid, an obturation material, etc. For
example, a gate 77 can selectively permit fluid 22 to flow from the
chamber 6 into the localized reservoir 78. The light propagating
from the light emitting element 72 can impinge upon the fluid 22 in
the reservoir 78 and can locally heat the fluid 22 in the reservoir
78. Heating the fluid 22 in the reservoir 78 to a sufficient degree
may cause the fluid 22 to move out of the reservoir along a
direction X transverse to a central axis Z of the root canal 13 of
the tooth 10. For example the fluid 22 can move out of the
reservoir 78 substantially perpendicular to the central axis Z of
the root canal and/or in a direction substantially parallel to a
proximal-most plane of the access port 70.
[0227] As with the embodiments disclosed above with respect to
FIGS. 10A-10B, the flow of flowable material 22 from the reservoir
78 can induce a rotational fluid flow 24 about a rotational
direction w. The rotational flow 24 can induce vortices 75
throughout the root canal 13 that can induce negative pressures at
or near the apical opening 15 of the tooth 10. Furthermore, a
diameter of the access port 70 can be at least as large as the
access opening 18 in some embodiments. As above, in cleaning
procedures, the fluid motion 24 and the pressure waves 23 can act
to substantially clean the tooth 10. In obturation procedures, the
pressure wave generator 5 can act to substantially fill the entire
root canal system.
[0228] FIG. 10D is a side cross-sectional view of a coupling member
3 having a pressure wave generator 5 substantially aligned with a
central axis Z of the root canal 13. The pressure wave generator 5
of FIG. 10D can be a nozzle configured to output a fluid 22 into
the chamber 6, or any of the other pressure wave generators
disclosed herein. Unless otherwise noted, the components
illustrated in FIG. 10D are similar to or the same as similarly
numbered components in FIGS. 10A-10C. The pressure wave generator 5
can be any suitable pressure wave generator disclosed herein, such
as a liquid jet device, a fluid inlet, a light emitting element,
etc. Unlike the embodiments of FIGS. 10A-10C, which may be offset
from the Z-axis, the pressure wave generator 5 of FIG. 10D is
generally aligned with the Z-axis.
[0229] Furthermore, unlike the embodiments of FIGS. 10A-10C, the
pressure wave generator 5 of FIG. 10D can be configured to generate
a fluid motion 24 of flowable material 22 about the Z-axis. The
fluid motion 24 substantially around the Z-axis can generate a
swirl 76 of fluid, which can propagate through the root canal 23.
Similar to the embodiments above, the rotational power of the fluid
motion 24 can be adjusted to control the amount of swirl 76 to
assist with the treatment procedure. As above, in cleaning
treatments, the pressure wave generator 5 can clean substantially
the entire root canal 13. In obturation treatments, the pressure
wave generator 5 can fill or obturate substantially the entire root
canal 13, including branch structures, as explained in more detail
herein.
[0230] FIG. 10E is a side cross-sectional view of a coupling member
3 having a first pressure wave generator 5a and a second pressure
wave generator 5b. Unless otherwise noted, the components
illustrated in FIG. 10E are similar to or the same as similarly
numbered components in FIG. 10D. However, unlike the embodiment of
FIG. 10D, the two pressure wave generators 5a, 5b can be disposed
offset from the central axis Z. In the illustrated embodiment, the
pressure wave generators 5a, 5b can be disposed eccentrically with
respect to the Z-axis (e.g., a central axis of the root canal
and/or a central axis of the chamber 6), e.g., the pressure wave
generators 5a, 5b can be at about the same distance from the
Z-axis. Like the embodiment of FIG. 10D, each pressure wave
generator can generate a corresponding fluid motion 24 about the
direction of the Z-axis, but the rotation is offset from the
Z-axis, as shown in FIG. 10E. Furthermore, in the illustrated
embodiment, the pressure wave generator 5a can generate fluid
motion 24a about the Z-axis in one direction, and the pressure wave
generator 5b can generate fluid motion 24b about the Z-axis
direction in an opposite direction. The counter-flows induced by
the two pressure wave generators 24a, 24b can cooperate to induce
swirl 76 that propagate through the root canal 13. As explained
above, the induced swirl 76 and pressure waves 23 can clean
substantially the entire root canal 13 in cleaning treatments. In
obturation treatments, the induced vortices and pressure waves 23
can fill or obturate substantially the entire root canal
system.
[0231] FIG. 10F is a schematic top view of fluid motion generator 5
at least partially disposed in a chamber 6 and configured to
generate swirl 76 in the chamber 6. The fluid motion generator 5 of
FIG. 1OF can comprise a nozzle or outlet configured to supply fluid
23 into the chamber 6. In the embodiment of FIG. 10F, the central
Z-axis of the root canal is coming out of the page. As shown in
FIG. 10F, the fluid motion generator 5 can direct fluid motion 24
in a direction transverse (e.g., substantially perpendicular to)
the major axis of the root canal, e.g., across the access port 70.
The fluid motion 24 can impact walls of the chamber 6 and can shear
inwardly to create the swirl motion 76. As explained above, the
swirl 76 can propagate through the root canal 13 to clean and/or
fill the root canal 13. The fluid motion generator 5 can be
disposed anywhere along the height of the chamber 6. Furthermore,
as explained herein, the fluid motion generator 5 may also comprise
a liquid jet, fluid inlet, etc.
[0232] FIG. 10G is a schematic top view of multiple fluid motion
generators 5a, 5b at least partially disposed in a chamber 6 and
configured to generate counter-swirl fluid motion 76a, 76b in the
chamber 6. As shown in FIG. 10G, for example, the fluid motion
generators can be disposed eccentrically relative to the central
axis Z of the root canal and/or the central axis of the chamber 6
(e.g., out of the page). Each fluid motion generator 5a, 5b can
propagate fluid motion 24 across the access port 70 in a direction
transverse to (e.g., substantially perpendicular to) the central
axis Z. Each counter-swirl 76a, 76b can rotate in opposing
directions about the Z-axis of the root canal and can interact with
one another to generate swirl 76 throughout the root canal to clean
and/or fill the canals.
VII. Additional Details Regarding Enhanced Cleaning of Teeth
[0233] It is believed, although not required, that some or all of
the effects described herein may be at least in part responsible
for advantageous effects, benefits, or results provided by various
implementations of the treatment methods and systems described
herein. Accordingly, various embodiments of the systems disclosed
herein can be configured to provide some or all of these
effects.
[0234] In the following description, unless a different meaning is
indicated, the following terms have their ordinary and customary
meaning. For example, a chemical reaction front may generally refer
to an interface between the tissue and the solution which contains
a chemical such as a tissue dissolving agent. Tissue may refer to
all types of cells existing in the tooth as well as bacteria and
viruses. Calcified tissue may refer to calcified pulp, pulp stones,
and tertiary dentin. Bubbles includes but is not limited to bubbles
created due to a chemical reaction, dissolved gas remaining in the
fluid after degassing (if used) and released as bubbles in the
fluid, and any bubbles which are introduced into the tooth due to
imperfect sealing.
[0235] Tissue cleaning treatments may utilize one or more of the
physicochemical effects described herein to clean and remove tissue
and/or calcified tissue from a tooth chamber. In some cleaning
treatments, the combination of (1) acoustic or pressure waves
(e.g., generation of acoustic cavitation), (2) circulation of fluid
in the chamber (e.g., macroscopic eddies and flows), and (3)
chemistry (e.g., use of a tissue dissolving agent, use of degassed
fluids) can provide highly effective cleaning. Accordingly, certain
embodiments of the systems disclosed herein utilize a pressure wave
generator to generate the acoustic waves, a fluid platform (e.g.,
fluid retainer) to retain treatment fluid in the tooth chamber and
to enable circulation of the treatment fluid, and a treatment fluid
that is degassed or includes a chemical agent such as a tissue
dissolving agent.
[0236] A. Pressure Waves
[0237] A pressure wave generator can be used to generate pressure
waves that propagate through the fluid in the chamber 6 (and the
tooth). Upon irradiation of a fluid with high intensity pressure
waves (e.g., broadband frequencies), acoustic cavitation may occur.
As has been described herein, the implosive collapse of the
cavitation bubbles can produce intense local heating and high
pressures with short lifetimes. Therefore, in some treatment
methods, acoustic cavitation may be responsible for or involved in
enhancing chemical reactions, sonochemistry, sonoporation, tissue
dissociation, tissue delamination, as well as removing the bacteria
and/or the smear layer from the root canals and tubules. The
effects of enhancing chemical reaction via vibrations or
sonochemistry will be described below in the section on
chemistry.
[0238] Sonoporation is the process of using an acoustic field to
modify the permeability of the cell plasma membrane. This process
may greatly expedite the chemical reaction. It may be advantageous
if the acoustic field has a relatively broad bandwidth (e.g., from
hundreds to thousands of kHz). Some frequencies (e.g., low
frequency ultrasound) may also result in cellular rupture and death
(e.g., lysis). This phenomenon may kill bacteria which might
otherwise reinfect the tooth. Acoustic waves and/or acoustic
cavitation may loosen the bond between cells and/or may dissociate
the cells. Acoustic waves and/or acoustic cavitation may loosen the
bond between cells and dentin and/or delaminate the tissue from the
dentin.
[0239] For removing calcified tissue, acoustic waves may induce
sonochemistry and microscopic removal of calcified structures due
to shock waves and/or microjets created as a result of cavitation
bubble implosion. Pressure or acoustic waves may break microscopic
calcified structures through structural vibrations. If a chemical
(e.g., a chelating agent such as, e.g., EDTA) is used for this
procedure, the acoustic waves may enhance the chemical
reaction.
[0240] Certain properties of the system can be adjusted to enhance
the effects of the acoustic waves. For example, properties of the
fluid including, e.g., surface tension, boiling or vapor
temperature, or saturation pressure can be adjusted. A degassed
fluid with a reduced dissolved gas content can be used, which may
reduce the energy loss of acoustic waves that may be generated by
hydrodynamic cavitation or any other sources. The fluid can be
degassed, which may help preserve the energy of the acoustic waves
and may increase the efficiency of the system.
[0241] B. Fluid Circulation
[0242] Some treatment systems and methods use diffusion and/or
acoustically enhanced diffusion of reactants and byproducts to and
away from the chemical reaction front. However, due to the
relatively short time scale of the reaction process, a faster
mechanism of reactant delivery such as "macroscopic" fluid motion,
circulation, convection, vorticity, or turbulence may be
advantageous in some of the embodiments disclosed herein. For
example, fluid inflow into the tooth chamber may induce a
macroscopic circulation in the pulp cavity (see, e.g., FIGS. 1A and
10A-10C). A liquid jet device not only may create acoustic waves
but may also induce circulation as the jet and/or spray enter the
chamber 6. Other pressure wave generators can produce fluid
circulation via their interaction with ambient fluid (e.g., via
localized heating of the fluid, which may induce convection
currents and circulation).
[0243] Fluid circulation with a time scale comparable to (and
preferably faster than) that of chemical reaction may help
replenish the reactants at a chemical reaction front and/or may
help to remove reaction byproducts from the reaction site. The
convective time scale, which may relate to effectiveness of the
convection or circulation process, can be adjusted depending on,
e.g., the location and characteristics of the source of
circulation. The convective time scale is approximately the
physical size of the chamber divided by the fluid speed in the
chamber. Introduction of circulation generally does not eliminate
the diffusion process, which may still remain effective within a
thin microscopic layer at the chemical reaction front. Fluid
circulation may create flow-induced pressure oscillations inside
the root canal which may assist in delaminating, loosening, and/or
removing larger pieces tissue from the root canal.
[0244] For removing calcified tissue, fluid circulation may create
flow-induced pressure oscillations inside the root canal which may
assist in removing larger pieces of calcified structures from the
root canal.
[0245] Certain properties of the system can be adjusted to enhance
the effects of the circulation in the tooth. For example, the
location of the source of circulation inside the tooth, the source
flow characteristics such as shape (e.g. planar vs. circular jets)
or velocity and/or direction of a fluid stream, and the fluid
kinematic viscosity may be adjusted. The circulation may also be
effected by the anatomy of the tooth or the canal orifice or root
canal size. For example, a narrow root canal with constrictions may
have a lower solution replenishment rate than a wide canal with no
constrictions. If the source of convection/circulation is placed
near the pulp chamber floor, a tooth with a smaller pulp chamber
may have stronger circulation than one with a larger pulp chamber.
Convection-induced pressure exerted at the periapical region of the
tooth may be controlled to reduce or avoid extrusion of the
treatment fluid into the periapical tissues. Large magnitude vacuum
or low pressure in the tooth may cause discomfort in some patients.
Thus, the properties of the coupling member 3 (e.g., vents,
sponges, flow restrictors, etc.) can be adjusted to provide a
desired operating pressure range in the chamber 6 and/or tooth
10.
[0246] C. Chemistry
[0247] As explained herein, various reaction chemistries can be
adjusted or designed to improve the cleaning process. For example,
to enhance the dissolution of organic tissue, a tissue dissolving
agent (e.g., a mineralization therapy agent, EDTA, sodium
hypochlorite--NaOCl) can be added to the treatment liquid. The
agent may react with various components at the treatment site. In
some cases, tissue dissolution may be a multi-step process. The
agent may dissolve, weaken, delaminate or dissociate organic and/or
inorganic matter, which may result in better patient outcomes. The
chemical reaction can modify the physical characteristics of the
treatment solution locally (e.g., reducing the local surface
tension via saponification), which may assist in the penetration of
the treatment liquid into gaps and small spaces in the treatment
sites or to remove bubbles formed during the chemical reaction. A
tissue dissolving agent (e.g., sodium hypochlorite or bleach) may
be added to the treatment fluid to react with tissue. Tissue
dissolution may be a multi-step and complex process. Dissolution of
sodium hypochlorite in water can include a number of reactions such
as, e.g., the sodium hypochlorite (bleach) reaction, a
saponification reaction with triglycerides, an amino acid
neutralization reaction, and/or a chloramination reaction to
produce chloramine. Sodium hypochlorite and its by-products may act
as dissolving agents (e.g. solvents) of organics, fats, and
proteins; thereby, degrading organic tissue in some treatments.
[0248] Sodium hypochlorite may exhibit a reversible chemical
equilibrium based on the bleach reaction. Chemical reactions may
occur between organic tissue and sodium hypochlorite. For example,
sodium hydroxide can be generated from the sodium hypochlorite
reaction and can react with organic and fat (triglycerides)
molecules to produce soap (fatty acid salts) and glycerol (alcohol)
in the saponification reaction. This may reduce the surface tension
of the remaining solution. Sodium hydroxide can neutralize amino
acids forming amino acid salts and water in the amino acid
neutralization reaction. Consumption of sodium hydroxide can reduce
the pH of the remaining solution. Hypochlorous acid, a substance
that can be present in sodium hypochlorite solution, can release
chlorine that can react with amino groups of proteins and amino
acids to produce various chloramines derivatives. For example,
hypochlorous acid can react with free amino acids in tissue to form
N-chloro amino acids which can act as strong oxidizing agents that
may have higher antiseptic activity than hypochlorite.
[0249] Chemical(s) in the fluid, depending on their type, may
affect the surface tension of the solution, which in turn may
modify the cavitation phenomenon. For example, solution of an
inorganic chemical such as, e.g., sodium hypochlorite in water, may
increase the ion concentration in the solution which may increase
the surface tension of the solution, which may result in stronger
cavitation. In some cases, the magnitude of a cavitation inception
threshold may increase with increasing surface tension, and the
cavitation inducing mechanism (e.g., a pressure wave generator) may
be sufficiently intense to pass the threshold in order to provide
inception of cavitation bubbles. It is believed, but not required,
that once the cavitation threshold is passed, increased surface
tension may result in stronger cavitation. Reducing the dissolved
gas content of a fluid (e.g., via degassing) can increase the
surface tension of the fluid and also may result in stronger
cavitation. Addition of chemicals, agents, or substances (e.g.,
hydroxyl functional groups, nanoparticles, etc.) to the treatment
may increase the efficiency of conversion of a pressure wave into
cavitation, and such chemoacoustic effects may be desirable in some
treatment procedures.
[0250] In some methods, a chemical, such as sodium hypochlorite,
may cause saponification. The removal of bubbles created or trapped
inside the root canals (or tubules) may be accelerated due to local
reduction of surface tension at the chemical reaction front as a
result of saponification. Although in some methods it may be
desirable to have a relatively high surface tension at the pressure
wave source (e.g. inside the pulp chamber), inside the canals it
may be beneficial to have locally reduced surface tension to
accelerate bubble removal. This phenomenon may happen as tissue
dissolving agent(s) react with the tissue. For example, sodium
hypochlorite can act as a solvent degrading fatty acids,
transforming them into fatty acid salts (soap) and glycerol
(alcohol) that can reduce the surface tension of the remaining
solution at the chemical reaction front.
[0251] A number of variables or factors may be adjusted to provide
effective cleaning. For example, each chemical reaction has a
reaction rate determining the speed of reaction. The reaction rate
may be dependent on several parameters including temperature. The
concentration of reactants can be a factor and may affect the time
for the reaction to complete. For instance, a 5% sodium
hypochlorite solution generally may be more aggressive than a 0.5%
sodium hypochlorite solution and may tend to dissolve tissue
faster.
[0252] The refreshment rate of reactants may be affected by some or
all of the following. Bubbles may form and stay at the chemical
reaction front (e.g., due to surface tension forces) and may act as
barriers at the chemical reaction front impeding or preventing
fresh reactants from reaching the reaction front. Accordingly,
circulation of the treatment fluid can help remove the bubbles and
the reaction byproducts, and may replace them with fresh treatment
fluid and fresh reactants. Thus, use of an embodiment of the fluid
platform that can provide fluid circulation in the tooth chamber
advantageously may improve the cleaning process.
[0253] Heat may increase the chemical reaction rate and may be
introduced through a variety of sources. For example, the treatment
solution may be preheated before delivery to the tooth chamber.
Cavitation, exothermic chemical reactions, or other internal or
external dissipative sources may produce heat in the fluid, which
may enhance, sustain, or increase reaction rates.
[0254] Sonication of the fluid may increase chemical reaction rates
or effectiveness. For example, upon irradiation of a fluid (e.g.,
water) with high intensity pressure waves (including, e.g., sonic
or ultrasonic waves, or broad spectrum acoustic power produced by a
liquid jet) acoustic cavitation may occur. The implosive collapse
of the cavitation bubbles can produce intense local heating and
high pressures with short lifetimes. Experimental results have
shown that at the site of the bubble collapse, the temperature and
pressure may reach around 5000 K and 1000 atm, respectively. This
phenomenon, known as sonochemistry, can create extreme physical and
chemical conditions in otherwise cold liquids. Sonochemistry, in
some cases, has been reported to enhance chemical reactivity by as
much as a million fold. In cases where acoustic cavitation does not
occur (or occurs at a relatively low amplitude), the vibration of
reactants, due to the pressure waves, may enhance the chemical
reaction as it assists in replacing the byproducts by fresh
reactants.
[0255] For removing calcified tissue, a decalcifying agent (e.g.,
an acid such as, e.g., EDTA or citric acid) may be added to the
treatment fluid. The decalcifying agent may remove calcium or
calcium compounds from the tooth dentin. The substances remaining
after treatment with the decalcifying agent may be relatively
softer (e.g., gummy) than prior to treatment and more easily
removable by the fluid circulation and acoustic waves.
VIII. Degassed Treatment Fluids
[0256] As will be described below, the treatment fluid (and/or any
of solutions added to the treatment fluid) can be degassed compared
to normal liquids used in dental offices. For example, degassed
distilled water can be used (with or without the addition of
chemical agents or solutes).
[0257] A. Examples of Possible Effects of Dissolved Gases in the
Treatment Fluid
[0258] In some procedures, the treatment fluid can include
dissolved gases (e.g., air). For example, the fluids used in dental
offices generally have a normal dissolved gas content (e.g.,
determined from the temperature and pressure of the fluid based on
Henry's law). During cleaning procedures using a pressure wave
generator, the acoustic field of the pressure wave generator and/or
the flow or circulation of fluids in the chamber can cause some of
the dissolved gas to come out of solution and form bubbles.
[0259] The bubbles can block small passageways or cracks or surface
irregularities in the tooth, and such blockages can act as if there
were a "vapor lock" in the small passageways. In some such
procedures, the presence of bubbles may at least partially block,
impede, or redirect propagation of acoustic waves past the bubbles
and may at least partially inhibit or prevent cleaning action from
reaching, for example, unhealthy dental materials in tubules and
small spaces of the tooth 10. The bubbles may block fluid flow or
circulation from reaching these difficult-to-reach, or otherwise
small, regions, which may prevent or inhibit a treatment solution
from reaching these areas of the tooth.
[0260] In certain procedures, cavitation is believed to play a role
in cleaning the tooth. Without wishing to be bound by any
particular theory, the physical process of cavitation inception may
be, in some ways, similar to boiling. One possible difference
between cavitation and boiling is the thermodynamic paths that
precede the formation of the vapor in the fluid. Boiling can occur
when the local vapor pressure of the liquid rises above the local
ambient pressure in the liquid, and sufficient energy is present to
cause the phase change from liquid to a gas. It is believed that
cavitation inception can occur when the local ambient pressure in
the liquid decreases sufficiently below the saturated vapor
pressure, which has a value given in part by the tensile strength
of the liquid at the local temperature. Therefore, it is believed,
although not required, that cavitation inception is not determined
by the vapor pressure, but instead by the pressure of the largest
nuclei, or by the difference between the vapor pressure and the
pressure of the largest nuclei. As such, it is believed that
subjecting a fluid to a pressure slightly lower than the vapor
pressure generally does not cause cavitation inception. However,
the solubility of a gas in a liquid is proportional to pressure;
therefore lowering the pressure may tend to cause some of the
dissolved gas inside the fluid to be released in the form of gas
bubbles that are relatively large compared to the size of bubbles
formed at cavitation inception. These relatively large gas bubbles
may be misinterpreted as being vapor cavitation bubbles, and their
presence in a fluid may have been mistakenly described in certain
reports in the literature as being caused by cavitation, when
cavitation may not have been present.
[0261] In the last stage of collapse of vapor cavitation bubbles,
the velocity of the bubble wall may even exceed the speed of sound
and create strong shock waves inside the fluid. The vapor
cavitation bubble may also contain some amount of gas, which may
act as a buffer and slow down the rate of collapse and reduce the
intensity of the shockwaves. Therefore, in certain procedures that
utilize cavitation bubbles for tooth cleaning, it may be
advantageous to reduce the amount of the dissolved air in the fluid
to prevent such losses.
[0262] The presence of bubbles that have come out of solution from
the treatment fluid may lead to other disadvantages during certain
procedures. For example, if the pressure wave generator produces
cavitation, the agitation (e.g. pressure drop) used to induce the
cavitation may cause the release of the dissolved air content
before the water molecules have a chance to form a cavitation
bubble. The already-formed gas bubble may act as a nucleation site
for the water molecules during the phase change (which was intended
to form a cavitation bubble). When the agitation is over, the
cavitation bubble is expected to collapse and create pressure
waves. However, cavitation bubble collapse might happen with
reduced efficiency, because the gas-filled bubble may not collapse
and may instead remain as a bubble. Thus, the presence of gas in
the treatment fluid may reduce the effectiveness of the cavitation
process as many of the cavitation bubbles may be wasted by merging
with gas-filled bubbles. Additionally, bubbles in the fluid may act
as a cushion to damp pressure waves propagating in the region of
the fluid comprising the bubbles, which may disrupt effective
propagation of the pressure waves past the bubbles. Some bubbles
may either form on or between tooth surfaces, or be transferred
there by the flow or circulation of fluid in the tooth. The bubbles
may be hard to remove due to relatively high surface tension
forces. This may result in blocking the transfer of chemicals
and/or pressure waves into the irregular surfaces and small spaces
in and between teeth, and therefore may disrupt or reduce the
efficacy of the treatment.
[0263] B. Examples of Degassed Treatment Fluids
[0264] Accordingly, it may be advantageous in some systems and
methods to use a degassed fluid, which can inhibit, reduce, or
prevent bubbles from coming out of solution during treatments as
compared to systems and methods that use normal (e.g.,
non-degassed) fluids. In dental procedures in which the treatment
fluid has a reduced gas content (compared with the normal fluids)
tooth surfaces or tiny spaces in the tooth may be free of bubbles
that have come out of solution. Acoustic waves generated by the
pressure wave generator can propagate through the degassed fluid to
reach and clean the surfaces, cracks, and tooth spaces and
cavities. In some procedures, the degassed fluid can be able to
penetrate spaces as small as about 500 microns, 200 microns, 100
microns, 10 microns, 5 microns, 1 micron, or smaller, because the
degassed fluid is sufficiently gas-free that bubbles are inhibited
from coming out of solution and blocking these spaces (as compared
to use of fluids with normal dissolved gas content).
[0265] For example, in some systems and methods, the degassed fluid
can have a dissolved gas content that is reduced when compared to
the "normal" gas content of water. For example, according to
Henry's law, the "normal" amount of dissolved air in water (at 25 C
and 1 atmosphere) is about 23 mg/L, which includes about 9 mg/L of
dissolved oxygen and about 14 mg/L of dissolved nitrogen. In some
embodiments, the degassed fluid has a dissolved gas content that is
reduced to approximately 10%-40% of its "normal" amount as
delivered from a source of fluid (e.g., before degassing). In other
embodiments, the dissolved gas content of the degassed fluid can be
reduced to approximately 5%-50% or 1%-70% of the normal gas content
of the fluid. In some treatments, the dissolved gas content can be
less than about 70%, less than about 50%, less than about 40%, less
than about 30%, less than about 20%, less than about 10%, less than
about 5%, or less than about 1% of the normal gas amount.
[0266] In some embodiments, the amount of dissolved gas in the
degassed fluid can be measured in terms of the amount of dissolved
oxygen (rather than the amount of dissolved air), because the
amount of dissolved oxygen can be more readily measured (e.g., via
titration or optical or electrochemical sensors) than the amount of
dissolved air in the fluid. Thus, a measurement of dissolved oxygen
in the fluid can serve as a proxy for the amount of dissolved air
in the fluid. In some such embodiments, the amount of dissolved
oxygen in the degassed fluid can be in a range from about 1 mg/L to
about 3 mg/L, in a range from about 0.5 mg/L to about 7 mg/L, or
some other range. The amount of dissolved oxygen in the degassed
fluid can be less than about 7 mg/L, less than about 6 mg/L, less
than about 5 mg/L, less than about 4 mg/L, less than about 3 mg/L,
less than about 2 mg/L, or less than about 1 mg/L.
[0267] In some embodiments, the amount of dissolved gas in the
degassed fluid can be in a range from about 2 mg/L to about 20
mg/L, in a range from about 1 mg/L to about 12 mg/L, or some other
range. The amount of dissolved gas in the degassed fluid can be
less than about 20 mg/L, less than about 18 mg/L, less than about
15 mg/L, less than about 12 mg/L, less than about 10 mg/L, less
than about 8 mg/L, less than about 6 mg/L, less than about 4 mg/L,
or less than about 2 mg/L.
[0268] In other embodiments, the amount of dissolved gas can be
measured in terms of air or oxygen percentage per unit volume. For
example, the amount of dissolved oxygen (or dissolved air) can be
less than about 5% by volume, less than about 1% by volume, less
than about 0.5% by volume, or less than about 0.1% by volume.
[0269] The amount of dissolved gas in a liquid can be measured in
terms of a physical property such as, e.g., fluid viscosity or
surface tension. For example, degassing water tends to increase its
surface tension. The surface tension of non-degassed water is about
72 mN/m at 20.degree. C. In some embodiments, the surface tension
of degassed water can be about 1%, 5%, or 10% greater than
non-degassed water.
[0270] In some treatment methods, one or more secondary fluids can
be added to a primary degassed fluid (e.g., an antiseptic solution
can be added to degassed distilled water). In some such methods,
the secondary solution(s) can be degassed before being added to the
primary degassed fluid. In other applications, the primary degassed
fluid can be sufficiently degassed such that inclusion of the
secondary fluids (which can have normal dissolved gas content) does
not increase the gas content of the combined fluids above what is
desired for a particular dental treatment.
[0271] In various implementations, the treatment fluid can be
provided as degassed liquid inside sealed bags or containers. The
fluid can be degassed in a separate setup in the operatory before
being added to a fluid reservoir. In an example of an "in-line"
implementation, the fluid can be degassed as it flows through the
system, for example, by passing the fluid through a degassing unit
attached along a fluid line (e.g., the fluid inlet). Examples of
degassing units that can be used in various embodiments include: a
Liqui-Cel.RTM. MiniModule.RTM. Membrane Contactor (e.g., models
1.7.times.5.5 or 1.7.times.8.75) available from Membrana-Charlotte
(Charlotte, N.C.); a PermSelect.RTM. silicone membrane module
(e.g., model PDMSXA-2500) available from MedArray, Inc. (Ann Arbor,
Mich.); and a FiberFlo.RTM. hollow fiber cartridge filter (0.03
micron absolute) available from Mar Cor Purification (Skippack,
Pa.). The degassing can be done using any of the following
degassing techniques or combinations of thereof: heating, helium
sparging, vacuum degassing, filtering, freeze-pump-thawing, and
sonication.
[0272] In some embodiments, degassing the fluid can include
de-bubbling the fluid to remove any small gas bubbles that form or
may be present in the fluid. De-bubbling can be provided by
filtering the fluid. In some embodiments, the fluid may not be
degassed (e.g., removing gas dissolved at the molecular level), but
can be passed through a de-bubbler to remove the small gas bubbles
from the fluid.
[0273] In some embodiments, a degassing system can include a
dissolved gas sensor to determine whether the treatment fluid is
sufficiently degas sed for a particular treatment. A dissolved gas
sensor can be disposed downstream of a mixing system and used to
determine whether mixing of solutes has increased the dissolved gas
content of the treatment fluid after addition of solutes, if any. A
solute source can include a dissolved gas sensor. For example, a
dissolved gas sensor can measure the amount of dissolved oxygen in
the fluid as a proxy for the total amount of dissolved gas in the
fluid, since dissolved oxygen can be measured more readily than
dissolved gas (e.g., nitrogen or helium). Dissolved gas content can
be inferred from dissolved oxygen content based at least partly on
the ratio of oxygen to total gas in air (e.g., oxygen is about 21%
of air by volume). Dissolved gas sensors can include
electrochemical sensors, optical sensors, or sensors that perform a
dissolved gas analysis. Examples of dissolved gas sensors that can
be used with embodiments of various systems disclosed herein
include a Pro-Oceanus GTD-Pro or HGTD dissolved gas sensor
available from Pro-Oceanus Systems Inc. (Nova Scotia, Canada) and a
D-Opto dissolved oxygen sensor available from Zebra-Tech Ltd.
(Nelson, New Zealand). In some implementations, a sample of the
treatment can be obtained and gases in the sample can be extracted
using a vacuum unit. The extracted gases can be analyzed using a
gas chromatograph to determine dissolved gas content of the fluid
(and composition of the gases in some cases).
[0274] Accordingly, fluid delivered to the tooth from a fluid inlet
and/or the fluid used to generate the jet in a liquid jet device
can comprise a degassed fluid that has a dissolved gas content less
than normal fluid. The degassed fluid can be used, for example, to
generate the high-velocity liquid beam for generating acoustic
waves, to substantially fill or irrigate a chamber, to provide a
propagation medium for acoustic waves, to inhibit formation of air
(or gas) bubbles in the chamber, and/or to provide flow of the
degassed fluid into small spaces in the tooth (e.g., cracks,
irregular surfaces, tubules, etc.). In embodiments utilizing a
liquid jet, use of a degassed fluid can inhibit bubbles from
forming in the jet due to the pressure drop at a nozzle orifice
where the liquid jet is formed.
[0275] Thus, examples of methods for dental and/or endodontic
treatment comprise flowing a degas sed fluid onto a tooth or tooth
surface or into a chamber. The degassed fluid can comprise a tissue
dissolving agent and/or a decalcifying agent. The degassed fluid
can have a dissolved oxygen content less than about 9 mg/L, less
than about 7 mg/L, less than about 5 mg/L, less than about 3 mg/L,
less than about 1 mg/L, or some other value. A fluid for treatment
can comprise a degassed fluid with a dissolved oxygen content less
than about 9 mg/L, less than about 7 mg/L, less than about 5 mg/L,
less than about 3 mg/L, less than about 1 mg/L, or some other
value. The fluid can comprise a tissue dissolving agent and/or a
decalcifying agent. For example, the degassed fluid can comprise an
aqueous solution of less than about 6% by volume of a tissue
dissolving agent and/or less than about 20% by volume of a
decalcifying agent.
IX. Various Performance Characteristics of the Disclosed Systems
and Methods
[0276] The disclosed methods, compositions, and systems (e.g., the
disclosed pressure wave generators, treatment fluids, etc.) may
clean outer and inner surfaces of teeth better than other systems,
and may do so more safely than the other systems.
[0277] FIG. 11A is a schematic diagram of an experimental setup
designed to measure the power output of various tooth cleaning
devices. As shown in FIG. 11A, a tank was filled with a liquid
(e.g., water), and a tip of the device to be tested was placed
underneath the surface of the liquid. A hydrophone was placed in
the tank to measure the output of each device under operating
conditions. A voltage amplifier, circuit board, a DC power supply,
and a workstation were used to measure the voltage output from the
hydrophone for each measurement.
[0278] FIG. 11B is a plot of the voltage (in volts) output by the
hydrophone over time (in seconds) for each device. Measurements for
four experiments are shown in FIG. 11B. In particular, the plot in
the upper left corner is a measure of voltage output over time for
systems disclosed in this Application that are adapted to clean a
molar tooth (referred to herein as "Applicant's Molar Cleaning
Apparatus"). In particular, Applicant's Molar Cleaning Apparatus
used in the experimental setup of FIG. 11A is generally similar to
the handpiece 50 described in relation to FIGS. 15A-15C of U.S.
Patent Publication No. 2012/0237893, which is incorporated by
reference herein. An impingement member having a concave
impingement surface similar to the impingement members 110
described in relation to FIGS. 12A-12C of U.S. Patent Publication
No. 2011/0117517, which is also incorporated by reference herein,
can be disposed at a distal portion of the guide tube. Furthermore,
Applicant's Molar Cleaning Apparatus can include a jet device
configured to form a liquid jet beam at a pressure of about 9000
psi, +/-about 1000 psi. The jet can be formed by passing
pressurized liquid through a nozzle having a diameter of about 63
microns, +/-about 5 microns. In general, the parameters for the
nozzle and guide tube can be similar to those described in U.S.
Patent Publication No. 2012/0237893 and U.S. Patent Publication No.
2011/0117517 such that a coherent, collimated jet with a length of
at least about 1 mm is produced. The plot in the upper right corner
is a measure of voltage output over time for systems disclosed in
this Application that are adapted to clean a pre-molar tooth
(referred to herein as "Applicant's Pre-Molar Cleaning Apparatus").
In Applicant's Pre-Molar Cleaning Apparatus, a jet similar to the
one described for the Molar Cleaning Apparatus can be used. The jet
device for the Pre-Molar Cleaning Apparatus can be used in
conjunction with a pre-molar handpiece such as the one illustrated
in FIG. 10B. The plot in the lower left corner is a measure of
voltage output over time for a Fotona photon induced photoacoustic
streaming (PIPS.RTM.) device. The plot in the lower right corner is
a measure of voltage output over time for a Piezon.RTM. Master
ultrasonic device.
[0279] As shown in FIG. 11B, Applicant's Molar and Pre-Molar
Cleaning Apparatuses generate a voltage output (representative of
power) over time that includes multiple frequencies. Indeed, as
shown in FIG. 11B, Applicant's Molar and Pre-Molar Cleaning
Apparatuses can generate a signal including a significant amount of
noise. For example, the frequencies in the signal may include
multiple, substantially random frequencies (e.g., approximating
white noise in some arrangements). By contrast, the signal produced
by the PIPS device includes pulses generated at substantially
regular intervals, and the signal produced by the ultrasonic device
can include a substantially periodic signal, e.g., one frequency,
or only a few frequencies. As explained herein, the broadband
signals generated by Applicant's Molar and Pre-Molar Apparatuses
can advantageously clean different types of materials from the
tooth and can do so quickly and effectively. For example, different
frequencies may clean different types and/or sizes of materials
effectively.
[0280] FIG. 12A illustrates images of root canals that compare the
use of non-degassed liquid and degassed liquid in the disclosed
pressure wave generators. As shown in image 1201 on the left side
of FIG. 12A, the use of non-degassed liquid may cause bubbles to
form in the canals, which may inhibit the propagation of energy in
some arrangements. As shown in image 1202 on the right side of FIG.
12A, the use of degassed liquid may substantially prevent the
formation of bubbles in the root canals when exposed to broadband
acoustic or pressure waves. FIG. 12B is a plot comparing the power
output for techniques using non-degassed and degassed liquids. The
power outputs plotted in FIG. 12B are measured based on the liquid
jet device described above with respect to Applicant's Molar
Cleaning Apparatus. As shown in FIG. 12B, at higher acoustic
frequencies, the use of degassed liquid in the disclosed systems
can generate significantly more power than in techniques using
non-degassed liquid. As illustrated in FIG. 12B, for example, at
high acoustic frequencies, the difference between power generated
by degassed and non-degassed liquids can be given by .DELTA.P,
which can be in a range of about 5 dB to about 25 dB for
frequencies in a range of about 20 kHz to about 200 kHz. For
example, for frequencies in a range of about 70 kHz to about 200
kHz, .DELTA.P can be in a range of about 10 dB to about 25 dB. At
lower frequencies, the differences in power generated by degassed
and non-degassed techniques may not be noticeable. At lower
frequencies, relatively high powers may be generated even with
non-degassed liquid because low frequency, large-scale fluid motion
may produce substantial momentum that contributes to the cleaning
of the tooth.
[0281] FIG. 13 is a plot comparing the rates of tissue dissolution
(in units of % per second) for Applicant's device versus other
devices, for different treatment fluids and compositions. As used
herein, the data labeled "Applicant's system" was obtained from a
system similar to that described above in relation to Applicant's
Molar Cleaning Apparatus. In FIG. 13, the plot compares tissue
dissolution rates for pure water, 0.5% NaOCl, 3% NaOCl, and 6%
NaOCl. For example, FIG. 13 compares tissue dissolution rates at
room temperature for Applicant's device, a 27 G irrigation needle
supplying irrigation fluid at a rate of 10 mL/min, an activated
Piezon Master device, an activated Piezon Master Agitation in
addition to some fluid irrigation, and an activated PIPS device. As
shown in FIG. 13, for each treatment fluid and concentration,
Applicant's system cleans at substantially higher rates than the
other tested devices. For example, tissue dissolution rates for
each treatment solution using Applicant's system may be at least
8-10 times the dissolution rates for the other tested devices.
[0282] FIGS. 14A-14B are plots relating to the pressure measured at
or near the apical opening of the root canal during treatment. As
used herein, the data labeled "Applicant's system" was obtained
from a system similar to that described above in relation to
Applicant's Molar Cleaning Apparatus. As explained herein, it
should be appreciated that high apical pressures can harm the
patient. For example, high apical pressures can cause fluid or
other material to extrude through the apex and into the patient's
jaw. Extrusion through the apex can cause the patient substantial
pain and can cause various health problems. Accordingly, it can be
desirable for endodontic treatments to have low or negative apical
pressures. FIG. 14A is a plot of mean apical pressure versus the
hand file size used to enlarge the apex. As shown in FIG. 14A,
Applicant's system generates negative pressures for each file size.
Such negative pressures can advantageously prevent extrusion
through the apex. For example, as explained above, the induced
vortices can cause the pressures at or near the apical opening to
be slightly negative. For example, the mean apical pressures can be
in a range of about -5 mmHG to about -15 mmHg.
[0283] FIG. 14B is a plot comparing the apical pressures during
treatments using Applicant's system and various other devices, such
as various sizes of and flow rates dispensed from open-vented
needles. The plot of FIG. 14B includes data for a distobuccal
canal, and the plot compares the pressures for different amounts of
canal shaping (e.g., no shaping, minimal shaping, traditional
shaping, apical enlargement). As shown in FIG. 14B, Applicant's
techniques and systems produce negative apical pressures, as
compared to the high, positive apical pressures generated by the
other plotted devices.
[0284] The negative apical pressures generated by Applicant's
systems can advantageously improve patient outcomes by preventing
and/or reducing extrusion of materials through the apex. FIG. 14C
is a plot of the mass of material extruded through the apex for
various simulated peri-apical pressures for Applicant's system and
for various needles. As used herein, the data labeled "Applicant's
system" was obtained from simulations of a system similar to that
described above in relation to Applicant's Molar Cleaning
Apparatus. As shown in FIG. 14C, the mass of material extruded when
Applicant's system and methods are used to clean canals is less
than that of other devices. Indeed, the disclosed systems and
methods can clean root canals with minimal or no material extruded
through the apex.
X. Additional Examples of Fluid Motion Generators
[0285] FIGS. 15-24C illustrate additional examples of systems for
treating teeth and root canals. FIG. 15 is a schematic side
sectional view of a system 1, according to one embodiment. FIG. 16
is a schematic top sectional view of the system 1 shown in FIG. 15.
As explained above, a tooth coupler 3 can be configured to be
applied to (e.g., pressed against or attached to) a treatment
region of the tooth 10. A fluid motion generator 5 (which may be a
pressure wave generator) can be activated to clean (or fill) the
treatment region. The system 1 can include a console 2 (similar to
the console 2 described in the above embodiments) configured to
control the operation of the system 1 and one or more conduits 4
that provide fluid communication (and/or electrical or
wireless/electronic communication) between the tooth coupler 3 and
the console 2. The console 2 can include one or more fluid pumps
and reservoirs that can supply treatment liquids to the treatment
region of the tooth 10. The console 2 can also comprise a fluid
removal system including a suction pump and a waste reservoir for
removing liquids and waste materials from the tooth 10 by way of
the conduit(s) 4. The console 2 can also include one or more
processors that are configured to electronically control the
operation of the evacuation and/or delivery pumps to control and
the delivery of liquid to the tooth and the removal of liquid from
the tooth.
[0286] The system 1 shown in FIG. 15 can include a tooth coupler 3
that is sized and shaped to couple to a treatment region of the
tooth 10. For example, as explained above, the tooth coupler 3 can
comprise a distal portion of a handpiece that is manually pressed
against the tooth by the clinician. In various embodiments, the
tooth coupler 3 can be attached to the tooth 10 for the treatment
procedure. The tooth coupler 3 in FIG. 15 is shown in connection
with a root canal treatment procedure; however, it should be
appreciated that the tooth coupler 3 can also be used with other
treatment procedures, such as the caries treatment procedure
described in FIG. 1B. The tooth coupler 3 can comprise a chamber 6
defined at least in part by an upper wall 232 and a side wall 220
that extends transversely from the upper wall 232. When coupled to
the tooth 10 (e.g., pressed against the tooth or attached to the
tooth), the chamber 6 can retain liquid and other materials during
a treatment procedure. The upper wall 232 and side wall 220 may be
integrally formed as a single component in some embodiments; in
other embodiments the upper wall 232 and side wall 220 may comprise
separate components that are connected or joined together. The side
wall 220 can extend annularly relative to the upper wall 232 to at
least partially define the chamber 6. It should be appreciated that
the upper wall 232, as used herein, refers to the wall near the
proximal end of the chamber 6; thus, during some treatments (such
as those of upper teeth), the upper wall 232 may be disposed in a
downward orientation.
[0287] In addition, the tooth coupler 3 or chamber 6 can include a
distal portion 227 configured to contact the treatment region of
the tooth (or a portion thereof). The distal portion 227 can define
an access port 231 that provides fluid communication between the
chamber 6 and the treatment region of the tooth 10 (e.g., the root
canal 13). In various arrangements, the distal portion 227 can
taper radially inwardly towards a central axis Z of the tooth
coupler 3 and/or chamber 6. The central axis Z can be perpendicular
to and comprise a central axis of the access port 231. For example,
the side wall 220 can comprise a substantially conical taper that
continuously and substantially linearly tapers inwardly and
distally. Thus, as shown in FIG. 15, a proximal portion of the
chamber 6 can have an inner diameter D.sub.3 (or other major
dimension) and the access port 231 of the distal portion 227 can
have an inner diameter D.sub.1 (or other major dimension) that is
smaller than D.sub.3. The chamber 6 may also have a height h. The
height h of the chamber 6 can be less than about 5 cm in various
embodiments, e.g., less than about 2 cm. Moreover, although not
illustrated in FIG. 15, a sealing member (which can be the same as
or similar to the sealing member 105 shown in FIG. 21A) can be
disposed about the chamber 6 and tooth coupler 3. The sealing
member can comprise a compressive material (such as a foam) that
can seal the treatment region when pressed against the tooth by the
clinician. When pressed against the tooth, the tooth coupler 3 can
be urged into the tooth such that the sealing member is proximal
the distal end of the tooth coupler 3.
[0288] For root canal treatments, as shown in FIG. 15, the distal
portion 227 can be inserted into or onto an access opening of the
tooth 10 to provide fluid communication with the root canal 13. A
sealing material 225 may be applied between the distal portion 227
and the tooth 10 to create or enhance a fluid seal such that
liquid, air, and/or debris does not escape to or from the chamber 6
and/or the tooth 10. As shown in FIG. 15, the distal portion 227
can be tapered such that the taper extends from an intermediate or
proximal portion of the tooth coupler 3 to the distal-most end of
the tooth coupler 3. For example, as shown in FIG. 15, the side
wall 220 of the tooth coupler 3 can comprise a generally straight
or cylindrical portion 203 (along which the diameter D.sub.3
remains substantially constant) and a tapered or conical portion
204 that tapers inwardly and distally from the straight portion 203
such that the inner diameter D.sub.1 decreases along the distal
direction (e.g., towards the tooth 10 in FIG. 15). The tapered
portion 204 can be disposed distal the straight portion 203 and can
include the distal portion 227 and the distal-most end of the tooth
coupler 3. Tapering the tooth coupler 3 as shown in FIG. 15 can
advantageously enable the clinician to conduct treatment procedures
on teeth of any size, including very small teeth or teeth that have
very small root canal spaces, e.g., the smallest human tooth that
would be treated by the system 1. For example, the distal portion
227 can be sized to treat teeth with endodontic access openings
having sizes (e.g., diameters or other major dimension) in a range
of about 0.5 mm to about 5 mm.
[0289] The inner diameter D.sub.1 of the access port 231 may be
smaller than the access opening of the tooth (e.g., the opening
that the clinician forms to access the interior of the tooth),
larger than the access opening, or the same size as the access
opening. In some embodiments, advantageously, the outer diameter
(and the inner diameter D.sub.1) of the access port 231 may be
smaller than the access opening so as to enable the distal portion
227 to be inserted into the access opening. In other embodiments,
the outer diameter of the distal portion 227 may be the same size
as or larger than the access opening. Accordingly, the distal
portion 227 of the tooth coupler 3 may be inserted into the
endodontic access opening such that the access port 231 and the
access opening are substantially aligned and/or overlapping.
[0290] The inner diameter D.sub.1 of the opening defined by the
distal portion 227 can be in a range of about 0.3 mm (+/-0.05 mm)
to about 5 mm (+/-1 mm), e.g., in a range of about 0.5 mm (+/-0.1
mm) to about 3 mm (+/-0.5 mm), or in a range of about 1 mm (+/-0.1
mm) to about 2 mm (+/-0.1 mm). The distal portion 227 of the tooth
coupler 3 may have a wall thickness in a range of about 0.001 mm
(+/-0.0001 mm) to about 5 mm (+/-1 mm), e.g., in a range of about
0.01 mm (+/-0.001 mm) to about 1 mm (+/-0.1 mm). Further, the outer
diameter of the distal portion 227 (e.g., the inner diameter
D.sub.1 plus twice the wall thickness of the distal portion 227)
may be in a range of about 0.5 mm (+/-0.1 mm) to about 5 mm (+/-1
mm), e.g., in a range of about 1 mm (+/-0.1 mm) to about 2 mm
(+/-0.1 mm). The inner diameter D.sub.3 of the proximal portion of
the chamber 6 may be less than about 5 cm (+/-1 cm), e.g., less
than about 1 cm (+/-0.1 cm). For example, the inner diameter
D.sub.3 may be in a range of about 0.5 cm (+/-0.1 cm) to about 1.5
cm (+/-0.3 cm), or in a range of about 0.7 cm (+/-0.1 cm) to about
1 cm (+/-0.1 cm). Moreover, as shown in FIG. 15, the conical shape
of the tooth coupler 3 can have a tapering angle .alpha. that
defines the amount by which an outside surface of the side wall 220
tapers inwardly and distally to the distal-most end of the tooth
coupler 3. In FIG. 15, an inner surface of the side wall 220 may
not taper inwardly. However, in other embodiments, the inner
surface of the side wall 220 may taper inwardly, similar to the
embodiment shown in FIG. 23. The tapering angle .alpha. can be in a
range of about 0.degree. (+/-1.degree.) to about 45.degree.
(+/-1.degree.), or more particularly, in a range of about
0.5.degree. (+/-0.1.degree.) to about 45.degree. (+/-1.degree.),
e.g., in a range of about 0.5.degree. (+/-0.1.degree.) to about
20.degree. (+/-1.degree.). In some embodiments, the tapering angle
.alpha. can be in a range of about 1.degree. (+/-0.1.degree.) to
about 15.degree. (+/-1.degree.), or in a range of about 1.degree.
(+/-0.1.degree.) to about 10.degree. (+/-1.degree.).
[0291] The fluid motion generator 5 (which may also be a pressure
wave generator, as described above) can be disposed on and/or
through the side wall 220 of the tooth coupler 3. The fluid motion
generator 5 can supply liquid 221 to the chamber 6 so as to
generate rotational liquid motion in the chamber 6. The supplied
liquid 221 can comprise a degassed liquid as explained herein. The
supplied liquid 221 can be any suitable type of treatment fluid,
including, e.g., water, EDTA, bleach, obturation material (for
filling procedures), etc. For example, a fluid inlet 61 can supply
pressurized liquid 221 to the chamber 6. In FIG. 15, the
pressurized liquid 221 can be passed through a nozzle 210 at a
location in the side wall 220 of the tooth coupler 3 (e.g., a
sealing cap) at a location near the top wall 232. As shown in the
top sectional view of FIG. 16, the fluid motion generator 5 may be
off-center or asymmetric relative to the tooth coupler 3 or sealing
cap. For example, the fluid inlet 61 and the nozzle 210 can be
offset relative to the central axis Z of the tooth coupler 3. In
FIG. 16, the fluid motion generator can be radially offset relative
to the central axis Z and can be directed in a direction X
transverse to the central axis Z. As shown in FIG. 15, the central
axis Z can pass distally along the height h of the tooth coupler 3
through the center of the access port 231, e.g., the central axis Z
can be transverse to the access port 231at or near the center of
the access port 231. The central axis Z can also define the central
longitudinal axis of the conical shape of the tooth coupler 3,
e.g., transverse to the radial direction of the conical shape.
[0292] The pressurized liquid 221 supplied by the fluid motion
generator 5 can induce liquid circulation in the chamber 6 of the
tooth coupler 3. For example, the fluid motion generator 5 (e.g.,
the inlet 61 and/or nozzle 210) can generate a swirling, rotational
motion of influent liquid 222 about the central axis Z of the
chamber, which can be transverse to (e.g., substantially
perpendicular to in some arrangements) the X axis along which the
liquid is introduced into the tooth coupler 3. In some
arrangements, rotational or circulatory motion can also be induced
about other directions, e.g., about axis parallel to the direction
of fluid introduction. As shown in FIG. 15, the influent liquid 222
can introduce rotational flow near and/or along walls 205 of the
canal spaces 13 as the rotating liquid 222 enters the canal spaces
13.
[0293] In some embodiments, the pressurized liquid 221 can pass
through the nozzle 210 and can emerge as a coherent, collimated
liquid jet, which can act as a fluid motion generator and/or
pressure wave generator, as explained above. In various embodiments
of the nozzle 210, an orifice or opening in the nozzle may have a
diameter d.sub.1 at an inlet or a diameter d.sub.2 at an outlet
that may be in a range from about 5 microns to about 1000 microns.
Other diameter ranges are possible. In various embodiments, one or
both of the diameters d.sub.1 or d.sub.2 of the nozzle opening may
be in a range from about 10 microns to about 100 microns, a range
from about 100 microns to about 500 microns, or range from about
500 microns to about 1000 microns. In various other embodiments,
one or both of the orifice diameters d.sub.1 or d.sub.2 may be in a
range of about 40-80 microns, a range of about 45-70 microns, or a
range of about 45-65 microns. In one embodiment, the orifice
diameter d.sub.1 is about 60 microns. The ratio of axial length
L.sub.1 to diameter d.sub.1, the ratio of axial length L.sub.2 to
diameter d.sub.2, or the ratio of total axial length
L.sub.1+L.sub.2 to diameter d.sub.1, d.sub.2, or average diameter
(d.sub.1+d.sub.2)/2 may, in various embodiments, be about 50:1,
about 20:1, about 10:1, about 5:1, about 1:1, or less. In one
embodiment, the axial length L.sub.1 is about 500 microns.
Additional examples of nozzles may be found in U.S. Patent
Publication No. US 2011/0117517, which is incorporated by reference
herein.
[0294] In some embodiments, the liquid 221 may comprise a stream of
liquid that is not a jet, or that is not a circular jet. After
entering the chamber 6, the liquid 221 can impact the side wall 220
of the tooth coupler 3. In some arrangements, the jet may impact an
impingement surface before entering the chamber, e.g., a surface in
the inlet path leading to chamber 6. The angle of the jet at the
impact may be adjusted such that the impact leads to minimal loss
of momentum. The fluid motion generator 5 can be angled such that,
upon impingement of the liquid 221 against the wall 220, a rotating
sheet of influent liquid 222 is generated in which the sheet of
influent liquid 222 rotates in a swirling motion about the central
axis Z and travels distally along the side wall 220 in the chamber
6 towards the opening 227 in the tooth coupler. The rotating sheet
of influent liquid 222 can continue downward along the inner walls
205 of the root canal(s) 13 towards the apical opening 15 of the
tooth 10. The rotating liquid 222 can effectively and efficiently
clean the entire root canal space 13. For example, the rapid, bulk
fluid motion of the influent liquid 222 can interact with diseased
matter in the root canal 13 and can dislodge or otherwise remove
the diseased matter from the root canal 13.
[0295] As shown in FIG. 16, it can be advantageous to orient the
fluid motion generator 5 such that sufficient rotational influent
flow 222 is provided in the chamber 6 and treatment region. For
example, the inlet 61 and nozzle 210 can be directed along the
X-direction, which can be transverse to (e.g., perpendicular to)
the central axis Z. The X-direction along which liquid is directed
can be oriented at an angle between 80.degree. and 100.degree., or
more particularly, between 85.degree. and 95.degree., relative to
the central axis Z. The X-direction can be generally tangent to the
outer edge of the side wall 220. The X-direction may be slightly
angled relative to the tangent T of the side wall 220 at the
location at which the inlet 221 and nozzle 210 intersect the wall
220 of the chamber 6. For example, the X-axis along which the
ingoing liquid 222 is directed may be at an inlet angle .theta.
relative to the tangent T. The inlet angle .theta. can be at or
close to zero. For example, .theta. can be in a range of about
0.degree. to about 15.degree., or in a range of about 0.degree. to
about 10.degree.. In some embodiments, the angle .theta. can be in
a range of about 1.degree. to about 10.degree., or in a range of
about 1.degree. to about 5.degree.. The fluid motion generator 5
can also be disposed such that the center of the influent stream
222 enters the chamber 6 at a distance .delta., from the outermost
edge of the wall 220. The distance .delta. can be relatively small,
e.g., in a range of about 5 .mu.m to about 2 mm, or in a range of
about 15 .mu.m to about 40 .mu.m. As shown in FIGS. 15-16, the
fluid motion generator 5 can be oriented such that the X-axis is
directed perpendicular to the central axis Z such that the X-axis
is substantially horizontal relative to the chamber 6. In some
embodiments, the X-axis can be directed distally or proximally to
assist in generating downward or upward rotating influent flow 222
into the treatment region. In some cases, the angle of impact
.theta., the angle of distal/proximal bias, and/or the shape of the
impact region on the surface can be adjusted to adjust the flow
properties that may affect efficacy of the procedure. The flow
entering the chamber 6 may comprise one or more of the following: a
jet impacting a surface of the chamber 6 which turns into a
rotating sheet of fluid, a sheet of fluid (planar flow) as a result
of impact of the jet onto a surface before entering the chamber, a
planar flow generated via flowing a fluid through a slit, and/or
any other suitable technique for generating a sheet of fluid
[0296] Furthermore, in the embodiment shown in FIG. 15, when the
liquid jet emerges from the nozzle 210, the jet can interact with
treatment liquid in an interaction zone 230 near the interface
between the nozzle 210 and the chamber 6. As explained herein, the
liquid jet can pass through the liquid and can generate pressure
waves 23 that propagate through the liquid in the chamber 6 and
root canal 13 of the tooth 10. As shown in FIG. 15, and as
explained above, the pressure waves 23 can propagate from the
interaction zone 230 distally into the canal 13 of the tooth 10.
The pressure waves 23 can comprise multiple frequencies that can
cause liquid to flow into small spaces, cracks, and tubules of the
tooth 10 to substantially clean the tooth 10. In some arrangements,
the bulk flow of influent liquid 222 or large scale fluid motion
may act to remove larger amounts of diseased material from
relatively large spaces of the tooth, and the pressure waves 23 can
flow into smaller spaces that may not be exposed to the bulk flow
of liquid 222 or large scale fluid motion. The combination of
rotating influent liquid 222 and pressure waves 23 can act to
substantially clean the tooth, including large and small spaces of
the tooth that may include different types and sizes of organic and
inorganic matter.
[0297] It can be important to enable the influent liquid 222 to be
removed from the treatment region to ensure that waste materials
(e.g. dislodged debris, etc.) are irrigated from the tooth 10
and/or to enhance the fluid rotation at the treatment region.
Accordingly, a fluid outlet 62 can be provided in and/or through
the top wall 232 of the tooth coupler 3. The fluid outlet 62 can
comprise a suction port 233 defining an opening between the chamber
6 and an outlet passage 209 (which may be one of the conduit(s) 4
described above) that conveys outgoing fluid to the waste system by
way of a suction pump. The suction pump can apply suction to the
outlet passage 209 and outlet 62 to draw fluids out of the chamber
6 and towards a reservoir outside the tooth coupler 3.
[0298] The fluid outlet 62 may have an inner diameter D.sub.2 that
is equal to or smaller than the inner diameter D.sub.1 of the
distal portion 227 of the chamber 6 of the tooth coupler 3. In
other embodiments, the fluid outlet 62 may have an inner diameter
D.sub.2 that is larger than the inner diameter D.sub.1 of the
distal portion 227. The relative size of D.sub.2 and D.sub.1 may be
selected base on the desired type and rate of fluid flow. In FIG.
15, the inner diameter D.sub.2 is smaller than D.sub.1. The inner
diameter D.sub.2 may influence the depth at which the flow
stagnates and changes direction (e.g., the return location V), from
a spiraling downward motion next to the walls of the root canal to
the spiraling upward motion through the interior of the influent
flow 222. For example, in some embodiments, the inner diameter
D.sub.2 of the suction port 233 may in a range of about 0.1 mm to
about 5 mm, e.g., in a range of about 0.1 mm to about 2 mm. The
fluid outlet 62 can be disposed at or near the center of the top
wall 232 of the tooth coupler 3. As shown in FIG. 15, the central
axis Z of the tooth coupler 3 and access port 231 can pass through
both the access port 231 of the distal portion 227 and the suction
port 233 of the outlet 62. The central axis Z can be perpendicular,
or substantially perpendicular, to the suction port 233. For
example, the central axis Z can be disposed at about a 90.degree.
angle (between 70.degree. and 110.degree., or more particularly
between 80.degree. and 100.degree., or more particularly between
85.degree. and 95.degree.) relative to the suction port 233. For
example, in some embodiments, the access port 231 can define a
plane that is transverse to (e.g., perpendicular to) the central
axis Z, and the central axis Z can pass through the center of the
access port 231 and through at least a portion of the suction port
233. In some embodiments, the suction port 233 can define a plane
that is transverse to (e.g., perpendicular to) the central axis Z,
and the central axis Z can pass through the center of the suction
port 233 and through at least a portion of the 231 access port 231.
In some embodiments, the access port 231 and the suction port 233
define respective planes that are both transverse to (e.g.,
perpendicular to) the central axis Z, and the central axis Z can
pass through both the access port 23 land the suction port 233. In
some embodiments, the central axis Z can pass through the center of
both the access port 23 land the suction port 233. The suction port
233 can be symmetric about the central axis Z in some embodiments.
In some embodiments, a center of the suction port 233 can lie on
the central axis Z. In some embodiments, a flange 62A of the outlet
62 can extend partially into the chamber 6 by a length p. The
length p can be adjusted to improve the fluid outflow and/or fluid
rotation in the chamber 6 and/or tooth 10. The length p of the
flange 62A may also influence the depth of the return location V,
e.g., the depth at which the flow stagnates and changes direction
from spiral downward motion next to the walls to the spiral upward
motion through the center. For example, the length p of the flange
62A may be in a range of about 0.1 mm to about 10 mm. In some
embodiments, the length p may be about the same as the height h of
the chamber 6, such that the flange 62A extends downwardly to near
the access port 231.
[0299] The outlet 62 and chamber 6 can be configured such that the
influent liquid 222 turns back proximally at a return location V to
be drawn out of the chamber 6. At the return location V (which may
be at or near the apical opening 15), the treatment liquid can turn
back towards the tooth coupler 3 in an outgoing fluid path 224. The
outgoing fluid path 224 may be different from the flow path or
pattern of the influent liquid 222. For example, the returning or
outgoing flow 224 path can comprise rotational (or semi-planar)
flow near the center of the canal spaces and/or within the swirling
influent flow path 222. In some embodiments, the outgoing flow 224
can comprise a spiral flow path that passes inside the rotating
influent liquid 222. The induced outward flow 224 can be carried
outside the treatment region to carry waste and other matter away
from the treatment region (e.g., outside the canal 13 and tooth
10). Moreover, the suction provided by the outlet 62 and/or the
rotating influent liquid 222 can provide a negative pressure at the
apical opening 15 in which treatment liquid and/or waste is
prevented from passing through the apical opening 15, which can
reduce the risk of infection and/or pain to the patient. The
outgoing liquid 224 can pass through the suction port 233 and can
be drawn to the waste reservoir through the outlet line 209 by the
suction pump. In addition, although not illustrated in FIG. 15, a
vent assembly can be provided to enhance the removal of waste
fluids from the system. For example, one or more vents can be
provided through the tooth coupler 3 downstream of the suction port
233. In addition, in some embodiments, an auxiliary port can be
provided on the tooth coupler 3. The auxiliary port can include a
one way valve, such as a duckbill valve. If the pressure inside the
chamber 6 increases, for example, due to a clog in the outlet
passage 209, the rising pressure inside the chamber 6 may exceed
the cracking pressure of the safety valve so that the valve can
relieve pressure. The auxiliary safety valve may be disposed
anywhere on the tooth coupler 3 with at least one opening to the
chamber 6. Examples of vent assemblies can be found in, e.g., U.S.
Patent Publication No. 2012/0237893, which is incorporated by
reference herein in its entirety.
[0300] FIGS. 16A and 16B are enlarged side cross-sections of the
tooth 10 shown in FIG. 15 that illustrates the influent and
outgoing fluid flow paths 222, 224. FIGS. 16A and 16B illustrate
the flow patterns that can be generated by the embodiments of FIGS.
15 and 17-24C. As explained herein, it can be important to
configure the fluid motion generator 5, the shape of the chamber 6,
and/or the outlet 62 such that the influent rotating flow 222
effectively cleans a large volume of the root canal 13 or other
treatment region. For example, it can be important to generate
influent rotational flow 222 that comprises a thin sheet of
treatment liquid that flows distally into the tooth 10. In FIG.
16A, the sheet of influent liquid 222 has a sheet thickness S.sub.1
relative to the wall 205 of the canal 13. As shown in FIG. 16A, the
sheet of liquid 222 along the wall 205 can converge at the return
location V.
[0301] Upon converging at the return location V, the liquid turns
back proximally and the outgoing liquid 224 returns towards the
tooth coupler 3. As shown in FIG. 16A, the outgoing liquid 224 can
comprise rotational fluid flow that passes within or inside the
rotating influent flow 222 as it flows towards the outlet 62. With
the sheet thickness S.sub.1, the return location V may be at a
distance w.sub.1 from the apical opening 15 of the tooth 10. The
distance w.sub.1 may be as small as zero, resulting in the rotating
influent flow 222 reaching the apical opening of the tooth and
turning at the apical opening. Because the rotating sheet of
influent liquid 222 converges at location V, the effectiveness of
the bulk fluid motion of the influent liquid 222 may be reduced for
locations that are below or distal the location V. However, as
shown in FIG. 16A, the pressure waves 23 may propagate through the
liquid past the return location V to clean the regions of the tooth
10 that are below or distal the return location 222.
[0302] In FIG. 16B, the fluid motion generator 5, the chamber 6,
and/or the outlet 62 are configured to generate a sheet of rotating
influent liquid 222 that has a sheet thickness S.sub.2 that is
smaller than the sheet thickness S.sub.1 shown in FIG. 16A. The
reduced thickness S.sub.2 may cause the return location V to be
positioned further along the root canal 13 than in the example
shown in FIG. 16A. For example, the influent liquid 222 can
converge at the location V that is at a distance w.sub.2 that is
closer to the apical opening 15 than the return location V in FIG.
16A. By having the return location V nearer the apical opening 15,
the bulk fluid motion of the influent liquid 222 can clean deeper
into the canal 13. In addition, as explained above, the pressure
waves 23 can clean the smaller spaces and cracks of the tooth 10
that may not be exposed to the bulk motion of the influent liquid
222. Other phenomena that may help clean the region distal to
return location V can include mass transfer via diffusion and/or
via the fluid displacement due to the transport of bubbles
generated through tissue dissolution from the apical region of the
tooth towards the coronal region of the tooth.
[0303] Various parameters can enhance the influent and outgoing
flow patterns 222, 224 shown in FIGS. 15-16B. For example, the
centrally-located outlet 62 along the upper wall 232 can
advantageously pull the outgoing fluid 224 out of the chamber 6 and
tooth 10 in a flow pattern that causes the fluid 224 to pass within
the rotating influent liquid 222. Such flow patterns can enable
effective cleaning and irrigation of the treatment region.
Furthermore, providing a suction port 233 with an inner diameter
D.sub.2 that is smaller than the inner diameter D.sub.1 of the
distal access port 231 can also help enable the central outgoing
liquid flow path 224. For example, the larger distal access port
231 can enable the rotating influent liquid 222 to flow distally
along the wall 220 of the chamber 6 and the canal walls 205, and
the smaller suction port can draw the outgoing liquid 224
proximally within the rotating influent flow 222. As explained
herein, an evacuation apparatus (e.g., vacuum pump) can apply a
suction force to the suction port to draw the outgoing liquid 224
out of the suction port 233 within rotating (e.g., swirling)
influent liquid 222. In addition, the inner diameter D.sub.2 of the
suction port 233 may be selected to create desired rotational and
outflow profiles. For example, the suction port 233 may be
sufficiently narrow such that the return location V is sufficiently
deep in the canal space 13 to provide deeper penetration of the
rotational influent liquid 222, yet wide enough to prevent
over-pressurization at the outlet 62.
[0304] In addition, the characteristics of the inlet fluid 221
(such as speed, flow rate, cross-sectional shape of inlet stream,
angle of inlet stream relative to chamber and wall, etc.) may be
selected so as to improve the influent and outgoing flow 222, 224
through the canal spaces 13. For example, to at least partially
enable a thin sheet of influent liquid 222, the jet may have a
relatively small diameter so as to provide a relatively small flow
rate. In some embodiments, the operating pressure of the system may
be between 1000 psi and 20000 psi, e.g. in a range of 5000 psi and
15000 psi, e.g. about 9000 psi (+/-1000 psi). In some embodiments,
for example, the diameter (or other major dimension) of the jet may
be in a range of about 30 .mu.m to about 90 .mu.m, e.g., in a range
of about 45 .mu.m to about 70 .mu.m, e.g., about 55 .mu.m. Other
jet (e.g., nozzle) diameters may be used depending on the operating
pressure of the system. The operating flow rate may be in a range
of 10 cc/min to 150 cc/min, e.g. in a range of 30 cc/min to 70
cc/min, e.g. about 40 cc/min (+/-5 cc/min). The pressure and the
flow rate may be constant during procedure or may vary.
Furthermore, the shape and dimensions of the chamber 6 defined by
the tooth coupler 3 can be selected to enhance circulation. For
example, a height of the cylindrical portion 203 of the tooth
coupler 3 or sealing cap, a height of the conical portion 204, the
major dimensions (e.g., diameters) of the chamber, surface quality,
tapering of the conical portion 204 (e.g., the angle .alpha.), and
other parameters may be configured to improve cleaning. In some
embodiments, an interface between the access port 231 of the
chamber 6 and the access opening of the tooth may be a
substantially water-proof and/or air-tight seal. Providing a fluid
seal at the interface between the access opening and the distal or
bottom portion of the sealing cap (which may be part of a
handpiece) can enhance the fluid dynamic and pressure wave effects
of the embodiments disclosed herein. The vents and waste collection
systems can also be configured to enhance removal of waste
materials. For example, the size of the suction port 233 on the
chamber 6 can be configured to enhance material removal.
Advantageously, the embodiments disclosed herein can enable a
reduction in the volume of fluid used and a reduction in cost of
manufacturing. Further, the shear stress exerted on the root canal
walls 205 may be stronger, and the outflow 224 of fluid through the
outlets can be enhanced without impairing the amount of influent,
fresh treatment fluids 222. Further, it should be appreciated that,
although the side cross-section of FIG. 15 shows the inlet 61 and
outlet 62 as being co-planar for ease of illustration, the inlet 61
is instead offset relative to the outlet 62 and the central axis Z
as shown in the top cross-section of FIG. 16.
[0305] The tooth coupler 3 shown in FIG. 15 comprises a conical
shape, but in other embodiments, the tooth coupler 3 can have other
suitable shapes. For example, the tooth coupler 3 may be straight,
may comprise a straight section and a conical section extending
from the straight section (or vice versa), or may comprise a
straight section, a conical section and a straight section. The
conical section may have a single tapering angle or multiple
tapering angles. In various embodiments, the tooth coupler 3 may
have a single wall thickness or multiple wall thicknesses. In the
embodiment of FIG. 15, the tooth coupler 3 may be axisymmetric
about the central axis Z, but in other embodiments, the tooth
coupler 3 may be asymmetric, which can assist in controlling
sealing with the tooth 10. The internal surface of the chamber may
have a smooth finish to minimize momentum loss and maintain the
influent flow substantially laminar and undisturbed. The inner
surface of the wall 220 may be smooth or rough, or may have both a
smooth portion and a rough portion. The inner surface of the wall
220 may also include channels to help direct the rotational flow.
For example, the channels can have a predetermined pitch. The
channels can have a depth in a range of about 0.001 mm to about 10
mm deep, e.g., a depth in a range of about 0.01 mm to about 1 mm.
The channels may have a width in a range of about 0.001 mm to about
10 mm, e.g., a width in a range of about 0.01 mm to about 1 mm.
[0306] The system 1 shown in FIG. 15 may be configured to treat
teeth with various anatomical and/or morphological features. For
example, the system 1 can be used to treat premolar teeth, anterior
teeth, molar teeth, teeth with various occlusal anatomies (e.g.,
various number of cusps, decayed or not, slanted or not), teeth
with circular endodontic access openings, teeth with oval
endodontic access openings, teeth with irregular endodontic
openings, teeth with straight endodontic access, teeth with curved
endodontic access, teeth with an endodontic access opening having
an axis not aligned with the axis of root canals, teeth with
multiple roots, teeth with a single root, teeth with curved roots
(e.g., teeth with curvatures up to about 90 degrees), teeth with
various lengths of roots (e.g., lengths in a range of about 5 mm to
about 30 mm), teeth with canals with circular and/or large
cross-sectional aspect ratios, teeth with canal constrictions,
teeth with canal contractions, teeth with auxiliary canals, teeth
with multiple islands, teeth with a single island, teeth with
bifurcations, teeth with trifurcations, teeth with multiple
furcations, teeth with apical deltas, and/or teeth with multiple
apical terminations.
[0307] Although the rotational influent flow 222 may be generated
as described above with respect to FIGS. 15-16B, the influent
rotational flow may be generated by a rotating chamber, a partially
rotating chamber, a rotating chamber upper wall 232, and/or a
rotating side wall 220. The rotating components of the chamber 6
may be smooth or rough, and may comprise features that improve
fluid entrainment (such as teeth, blades, etc.). Rotational flow
may also be generated by a rotating evacuation feature, e.g., a
rotating outlet 62. The rotating evacuation feature may be smooth
or rough, and the rotating evacuation feature may have features
improving fluid entrainment (e.g. teeth, blades, etc.).
[0308] In the embodiment of FIG. 15, the rotational fluid flow
(e.g., influent flow 222) may be generated by injection of liquid
into the chamber 6. There may be a single inlet 61 or multiple
inlets. The fluid may be injected with an impingement angle between
0 deg and +90 deg. The fluid may be injected with a latitude angle
between -45.degree. and +45.degree., e.g., a latitude angle between
-10.degree. and +10.degree. is preferred. The fluid may be injected
from near the top of the chamber 6 as shown in FIG. 15. The
incoming liquid 221 can be injected by a bulk flow or a jet (which
may be cylindrical or planar). The fluid inlet 61 may be any
suitable cross-sectional shape, including rectangular, oval,
square, circular, etc. The inner diameter of the inlet 61 may be
less than or equal to about half the diameter D.sub.3 of the
chamber 6.
[0309] The rotational influent flow 222 may comprise a sheet that
swirls or rotates about the wall 220 of the chamber 6. Downward
rotational flow may be induced in the outer layer of the fluid
inside the chamber 6. In other embodiments, the downward flow may
be induced on the inner axis of the fluid chamber. The influent
flow 222 can rotate at a speed in a range of about 0.1 to about
100,000 revolutions per second, e.g., in a range of about 1 to
50,000 revolutions per minute. The incoming liquid 221 may be
injected into the chamber 6 through the inlet 61 at flow rates in a
range of about 0.1 mL/min to about 100 mL/min.
[0310] The treatment fluid supplied to the chamber 6 may comprise
any suitable treatment fluid, such as a cleaning liquid or an
obturation material. For example, in cleaning procedures, the
supplied cleaning liquid can rotate as shown in FIGS. 16A and 16B,
and can interact with diseased matter to clean the tooth. In
obturation procedures, the supplied obturation material can
similarly rotate as shown in FIGS. 16A and 16B, and can
substantially fill the treatment region (e.g., a treated root
canal, a treated carious region, etc.). In addition, although not
shown in FIG. 15, the tooth coupler 3 can have one or more
additional openings that can supply obturation material to the
treatment region.
[0311] FIGS. 17 and 18 are schematic side sectional views of a
tooth coupler 3 configured to treat a tooth 10 having multiple
canals 13A, 13B (e.g., a molar tooth in some arrangements). FIGS.
17A and 18A are top sectional views of the arrangements shown in
FIGS. 17 and 18, respectively. Unless otherwise noted, the tooth
coupler 3 is the same as or substantially similar to the tooth
coupler 3 illustrated and described above in connection with FIGS.
15-16B. The arrangements shown in FIGS. 17-18 illustrate that the
tooth coupler 3 may be used to treat teeth that have various
internal geometries, e.g., teeth with different number and shapes
of root canals. As shown in FIG. 17, the tooth coupler 3 can be
configured such that the rotating influent liquid 222 splits into
the two canals 13A, 13B to clean each canal. The influent liquid
222 may rotate in a swirling path (e.g., about the central axes of
the canals 13A, 13B) and/or may include rotation components about
axes transverse to the central canal axes. The outgoing or return
liquid 224 can return through the outlet 62 (which may include a
venting system) near the center of the main canal after reaching a
floor 214 of the pulp chamber 215. Thus, in FIG. 17, the liquid can
turn around at the floor 214 of the pulp chamber 215 rather than
within the canals 13A, 13B. As shown in FIG. 18, the system can be
configured such that the outgoing or return liquid 224 returns
through the outlet 62 by way of a central return path 224 and
multiple return paths 224A, 224B in each of the canals 13A, 13B. As
explained above, various parameters of the inlet fluid, the outlet,
the shape of the chamber, etc., may be selected to achieve the flow
patterns of FIGS. 17 and 18. Thus, depending on the geometry of the
particular treatment tooth, the fluid flow paths may vary, but the
tooth coupler 3 can still provide sufficient cleaning and
irrigation of the treatment region. It should be appreciated that,
although the pressure waves 23 are not illustrated in FIGS. 17-18,
pressure waves still may be generated by interaction of the liquid
jet with liquid in the chamber 6, as in the embodiment of FIGS.
15-16B.
[0312] FIG. 19 is a schematic side sectional view of a tooth
coupler 3 configured to treat a tooth 10. FIG. 20 is a schematic
top sectional view of the tooth coupler 3 shown in FIG. 19 that
illustrates pressurized liquid 221 entering a chamber 6 through a
nozzle 210. Unless otherwise noted, the tooth coupler 3 shown in
FIGS. 19-20 is substantially similar to the tooth coupler 3
described above in connection with FIGS. 15-16B. For example, the
tooth coupler 3 can include a side wall 220 and a top wall 232 that
at least partially define a chamber 6. The tooth coupler 3 can
comprise a fluid motion generator 5 that supplies liquid 221 to the
chamber 6 by way of an inlet 61. The nozzle 210 can convert the
liquid 221 to a jet which can generate fluid motion and/or pressure
waves in the chamber 6 and tooth 10. The dimensions and other
characteristics of the tooth coupler 3 may be substantially the
same as those described above in connection with FIGS. 15-16B,
except where denoted herein.
[0313] As shown in FIG. 19, the incoming fluid 221 (shown coming
into the page in FIG. 19) can generate two influent rotational flow
paths 222A, 222B passing through the chamber 6 of the tooth coupler
3, the pulp chamber, and into corresponding canal spaces 13A, 13B.
Unlike in the embodiment of FIGS. 15-16B, however, the fluid motion
generator 5 and inlet 61 may pass transverse to and through the
central axis Z of the chamber 6. As shown in FIG. 20, the liquid
222 can pass through a central portion of the chamber and can
impinge on an opposing surface at a location I on the wall 220 in
or on the chamber 6. The impingement can induce bifurcated flow,
which can cause two co-existing, influent rotational flows 222A,
222B in the chamber 6. The two rotational flows can act to clean
multiple (e.g., two) root canal spaces 13A, 13B of a tooth 10. The
two influent rotational flow paths 222A, 222B can pass through the
root canal spaces 13A, 13B and, upon reaching respective return
locations V.sub.1, V.sub.2 (which may be at or near the apical
openings 15A, 15B), can return along respective central paths 224A,
224B near the center of the root canal spaces 13A, 13B and within
the influent flow paths 222A, 222B. The outgoing or exiting fluid
224A, 224B can exit through one or more corresponding outlets. As
shown in FIG. 19, for example, the tooth coupler 3 can include two
outlets 62A, 62B that can draw the outgoing liquid 224A, 224B
towards a waste reservoir. The central axis Z can be disposed
between the outlets 62A, 62B. The rotational fluid flow disclosed
herein can act to effectively treat (e.g., clean) a tooth 10.
[0314] FIGS. 21A-24C illustrate another embodiment of a system
configured to clean a tooth. The embodiment of FIGS. 21A-24C may be
similar to those described above in connection with FIGS. 15-16B.
FIG. 21A is a schematic perspective view of a handpiece 3A
configured to clean a treatment region (e.g., a root canal) of a
tooth. FIG. 21B is a schematic side cross-sectional view of the
handpiece 3A shown in FIG. 21A taken along section 21B-21B. FIG. 22
is a magnified side cross-sectional view of FIG. 21B. FIG. 23 is a
schematic side-cross-sectional view of the handpiece 3A of FIG. 21A
taken along section 23-23. FIG. 24A is a schematic, perspective top
sectional view of a portion of the handpiece 3A shown in FIG. 21A,
taken along section 24A-24A. FIG. 24B is a top plan view of the
section shown in FIG. 24A. FIG. 24C is a top sectional view of a
portion of the handpiece 3A shown in FIG. 21A, taken along section
24C-24C. The handpiece 3A shown in FIGS. 21A-24C may be configured
to clean a root canal of a tooth, similar to the embodiment
described above in connection with FIGS. 15-16B.
[0315] The handpiece 3A can include a body portion 201 and an
interface member 202. During a treatment procedure, the clinician
can hold the body portion 201 in his or her hand, and can press a
sealing member 105 against the tooth to substantially seal the
treatment region. In other embodiments, the clinician can attach
the sealing member 105 to the tooth for the treatment procedure.
The sealing member 105 may comprise a compressible material, such
as foam, that can deform when applied to the tooth. The sealing cap
105 can be disposed about chamber 6. When the clinician presses the
handpiece 3A against the tooth, the sealing cap 105 can be
compressed to create a substantially sealed environment within the
chamber 6 and/or tooth. The interface member 202 can removably
engage fluid conduit(s) that extend from the console (not shown),
e.g., including a high pressure supply line that supplies treatment
liquid to the handpiece 3A. Additional details of the handpiece 3A
(including the interface member 202) may be similar to those
described in U.S. Patent Publication No. US 2015/0010882, the
contents of which are incorporated by reference herein in their
entirety and for all purposes.
[0316] As shown in FIGS. 21B-23, a sealing cap 3B (which may be the
same as or similar to the tooth coupler 3 described in connection
with FIGS. 15-16B) may be coupled with a distal portion of the
handpiece 3A. As with the tooth coupler 3 of FIGS. 15-16B, the
sealing cap 3B can include a tapered portion that tapers inwardly
and distally. The distal-most end of the sealing cap 3B can be
inserted into an access opening of a root canal. For example, when
the clinician presses the sealing member 105 against the tooth, the
sealing cap 3B can be urged into the access opening. When the
distal portion 227 of the sealing cap 3B is disposed in the tooth,
the distal end of the sealing member 105 is disposed proximal the
distal end of the cap 3B. Further, a central axis Z can pass
vertically through the center of the sealing cap 3B, as well as
through the center of the distal portion of the handpiece 3A. In
particular, the central axis Z lies on the plane at which the
cross-section of FIG. 23 is taken. As with the embodiment of FIGS.
15-16B, liquid can be supplied to a chamber 6 along the
X-direction, which can be generally transverse to (e.g.,
perpendicular to) and offset from the central axis Z. The
X-direction along which liquid is directed can be oriented at an
angle between 80.degree. and 100.degree., or more particularly,
between 85.degree. and 95.degree., relative to the central axis Z.
The X-axis or direction can lie on the plane at which the
cross-section of FIG. 21B is taken.
[0317] The sealing cap 3B can comprise the chamber 6 that is
defined at least in part by an upper wall 232 and a side wall 220
that extends transversely from the upper wall 232. When coupled to
the tooth (e.g., pressed against the tooth or attached to the
tooth), the chamber 6 can retain liquid and other materials during
a treatment procedure. The upper wall 232 and side wall 220 may be
integrally formed as a single component in some embodiments; in
other embodiments the upper wall 232 and side wall 220 may comprise
separate components that are connected or joined together. The side
wall 220 can extend annularly (e.g., in a conical shape) relative
to the upper wall 232 to at least partially define the chamber 6.
It should be appreciated that the upper wall 232, as used herein,
refers to the wall near the proximal end of the chamber 6; thus,
during some treatments (such as those of upper teeth), the upper
wall 232 may be disposed in a downward orientation
[0318] In addition, as shown in FIG. 23, the sealing cap 3B or
chamber 6 can include a distal portion 227 configured to contact
the treatment region of the tooth (or a portion thereof). The
distal portion 227 can define an access port 231 that provides
fluid communication between the chamber 6 and the treatment region
of the tooth (e.g., the root canal). In various arrangements, the
distal portion 227 can taper radially inwardly towards the central
axis Z of the sealing cap 3B and/or chamber 6. The central axis Z
can be perpendicular to and comprise a central axis of the access
port 231. For example, the side wall 220 can comprise a
substantially conical taper that continuously and substantially
linearly tapers inwardly and distally. Moreover, in some
embodiments, the side wall 220 can comprise a shoulder portion 220A
that defines a transition from a thick wall portion to a thin wall
portion distal the thick wall portion. Thus, as shown in FIG. 23, a
proximal portion of the chamber 6 can have an inner diameter
D.sub.3 (or other major dimension) and the access port 231 of the
distal portion 227 can have an inner diameter D.sub.1 (or other
major dimension) that is smaller than D.sub.3. The chamber 6 may
also have a height h (see FIG. 15). The height h of the chamber 6
can be less than about 5 cm in various embodiments, e.g., less than
about 2 cm.
[0319] For root canal treatments, the distal portion 227 can be
inserted into an access opening of the tooth to provide fluid
communication with the root canal. A sealing material may be
applied between the distal portion 227 and the tooth to create or
enhance a fluid seal such that liquid and/or debris does not escape
from the chamber 6 and/or the tooth. As shown in FIG. 23, the
distal portion 27 can be tapered such that the taper extends from
an intermediate or proximal portion of the sealing cap 3B to the
distal-most end of the cap 3B. For example, as shown in FIG. 23,
the side wall 220 of the sealing cap 3B can comprise a generally
straight or cylindrical portion 203 (along which the diameter
D.sub.3 remains substantially constant) and a tapered or conical
portion 204 that tapers inwardly and distally from the straight
portion 203 such that the inner diameter D.sub.1 decreases along
the distal direction. The tapered portion 204 can be disposed
distal the straight portion 203 and can include the distal portion
227 and the distal-most end of the sealing cap 3B. Tapering the
sealing cap 3B as shown in FIG. 23 can advantageously enable the
clinician to conduct treatment procedures on teeth of any size,
including very small teeth or teeth that have very small root canal
spaces, e.g., the smallest human tooth that would be treated by the
system. For example, the distal portion 227 can be sized to treat
teeth with endodontic access openings having sizes (e.g., diameters
or other major dimension) in a range of about 0.5 mm to about 5 mm.
In some embodiments, an extension portion can be attached to and
can extend distally from the distal portion 227 illustrated in FIG.
23. The extension portion can be further tapered (e.g., so as to
fit within smaller teeth) in some arrangements. In other
arrangements, the extension portion can be straight or cylindrical
(without a taper) to be used for teeth that have a small chamber
opening or for those that are recessed compared to adjacent
teeth.
[0320] The inner diameter D.sub.1 of the access port 231 may be
smaller than the access opening of the tooth (e.g., the opening
that the clinician forms to access the interior of the tooth),
larger than the access opening, or the same size as the access
opening. In some embodiments, advantageously, the outer diameter
(and the inner diameter D.sub.1) of the access port 231 may be
smaller than the access opening so as to enable the distal portion
227 to be inserted into the access opening. In other embodiments,
the outer diameter of the distal portion 227 may be the same size
as or larger than the access opening. Accordingly, the distal
portion 227 of the tooth coupler 3 may be inserted into the
endodontic access opening such that the access port 231 and the
access opening are substantially aligned and/or overlapping.
[0321] The inner diameter D.sub.1 of the access port 231 defined by
the distal portion 227 can be in a range of about 0.3 mm (+/-0.05
mm) to about 5 mm (+/-1 mm), e.g., in a range of about 0.5 mm
(+/-0.1 mm) to about 3 mm (+/-0.5 mm), or in a range of about 1 mm
(+/-0.1 mm) to about 2 mm (+/-0.1 mm). The distal portion 227 of
the sealing cap 3B may have a wall thickness in a range of about
0.001 mm (+/-0.0001 mm) to about 5 mm (+/-1 mm), e.g., in a range
of about 0.01 mm (+/-0.001 mm) to about 1 mm (+/-0.1 mm). Further,
the outer diameter of the distal portion 227 (e.g., the inner
diameter D.sub.1 plus twice the wall thickness of the distal
portion 227) may be in a range of about 0.5 mm (+/-0.1 mm) to about
5 mm (+/-1 mm), or in a range of about 0.5 mm (+/-0.1 mm) to about
3 mm (+/-0.5 mm) e.g., in a range of about 1 mm (+/-0.1 mm) to
about 2 mm (+/-0.1 mm). The inner diameter D.sub.3 of the proximal
portion of the chamber 6 may be less than about 5 cm (+/-1 cm),
e.g., less than about 1 cm (+/-0.1 cm). For example, the inner
diameter D.sub.3 may be in a range of about 0.5 cm (+/-0.1 cm) to
about 1.5 cm (+/-0.3 cm), or in a range of about 0.7 cm (+/-0.1 cm)
to about 1 cm (+/-0.1 cm).
[0322] Moreover, as shown in FIG. 23, the conical shape of the
sealing cap 3B can have a tapering angle .alpha. that defines the
amount by which an outside surface of the side wall 220 tapers
inwardly and distally to the distal-most end of the tooth coupler
3. The outside surface tapering angle .alpha. can be in a range of
about 0.5.degree. (+/-0.1.degree.) to about 65.degree.
(+/-1.degree.), e.g., in a range of about 0.5.degree.
(+/-0.1.degree. to about 20.degree. (+/-1.degree.). In some
embodiments, the outside tapering angle .alpha. can be in a range
of about 1.degree. (+/-0.1.degree. to about 15.degree.
(+/-1.degree.), or in a range of about 1.degree. (+/-0.1.degree.)
to about 10.degree. (+/-1.degree.). The outside tapering angle
.alpha. can advantageously allow the sealing cap 3B to fit within
the smallest access opening. For example, the clinician can insert
the tapered distal portion 227 within the access opening until the
tapered outer surface contacts the walls of the root canal. In
addition, the conical shape of the sealing cap 3B can have an inner
tapering angle .beta. that defines the angle by which an inner
surface of the wall 220 tapers. Advantageously, the inner tapering
angle .beta. can enable the access opening 231 (with inner diameter
D.sub.1) to be smaller than the inner diameter of the proximal
portion of the chamber (e.g., D.sub.3). Such a smaller opening can
result in a smooth transition of flow from the proximal portion of
the chamber 6 (e.g., portion 203) to the distal portion 227. For
example, the increased space at the proximal portion of the chamber
can give the influent flow 222 more room to smooth out before
entering the tooth, and can prevent or reduce interference between
the influent flow 222 and the outgoing flow 224. The inner surface
tapering angle .beta. can be in a range of about 0.5.degree.
(+/-0.1.degree. to about 65.degree. (+/-1.degree.), e.g., in a
range of about 0.5.degree. (+/-0.1.degree.) to about 20.degree.
(+/-1.degree.). In some embodiments, the inner tapering angle
.beta. can be in a range of about 1.degree. (+/-0.1.degree.) to
about 15.degree. (+/-1.degree.), or in a range of about 1.degree.
(+/-0.1.degree. to about 10.degree. (+/-1.degree.).
[0323] As shown in FIGS. 21B-22, the handpiece 3A can comprise a
fluid inlet 61 that includes a high pressure supply line 26
configured to convey a pressurized treatment fluid to the treatment
area. A fluid motion generator 5 (which can also be a pressure wave
generator) can be disposed near a distal portion of the handpiece
3A and in fluid communication with the supply line 26. The fluid
motion generator 5 can comprise a nozzle 210 configured to convert
the pressurized fluid to a liquid jet, e.g., a coherent, collimated
jet, or a planar jet. The chamber 6 can be disposed distal the
fluid motion generator 5. A pumping system (e.g., in the console)
can be configured to drive treatment fluid along the supply line 26
to the fluid motion generator 5. In addition, a first fluid seal
211A and a second fluid seal 211B can be disposed about the high
pressure supply line 26 proximal the nozzle 210. The seals 211A,
211B can prevent air from being entrained in the liquid that forms
the jet and/or can prevent liquids from leaking from the
handpiece.
[0324] The fluid motion generator 5 (which may also be a pressure
wave generator, as described above) can be disposed on and/or
through the side wall 220 of the sealing cap 3B. The fluid motion
generator 5 can supply liquid to the chamber 6 so as to generate
rotational liquid motion in the chamber 6. The supplied liquid can
comprise a degassed liquid as explained herein. The supplied liquid
can be any suitable type of treatment fluid, including, e.g.,
water, EDTA, bleach, obturation material (for filling procedures),
etc. For example, the fluid inlet 61 can supply pressurized liquid
to the chamber 6. As with the embodiment of FIG. 15, the
pressurized liquid can be passed through the nozzle 210 to generate
a coherent, collimated liquid jet. In various embodiments of the
nozzle 210, an orifice or opening in the nozzle may have a diameter
d.sub.1 at an inlet or a diameter d.sub.2 at an outlet that may be
in a range from about 5 microns to about 1000 microns. Other
diameter ranges are possible. In various embodiments, one or both
of the diameters d.sub.1 or d.sub.2 of the nozzle opening may be in
a range from about 10 microns to about 100 microns, a range from
about 100 microns to about 500 microns, or range from about 500
microns to about 1000 microns. In various other embodiments, one or
both of the orifice diameters d.sub.1 or d.sub.2 may be in a range
of about 40-80 microns, a range of about 45-70 microns, or a range
of about 45-65 microns. In one embodiment, the orifice diameter
d.sub.1 is about 60 microns. The ratio of axial length L.sub.1 to
diameter d.sub.1, the ratio of axial length L.sub.2 to diameter
d.sub.2, or the ratio of total axial length L.sub.1+L.sub.2 to
diameter d.sub.1, d.sub.2, or average diameter (d.sub.1+d.sub.2)/2
may, in various embodiments, be about 50:1, about 20:1, about 10:1,
about 5:1, about 1:1, or less. In one embodiment, the axial length
L.sub.1 is about 500 microns. Additional examples of nozzles may be
found in U.S. Patent Publication No. US 2011/0117517, which is
incorporated by reference herein.
[0325] As shown in the top sectional view of FIG. 24C, the fluid
motion generator 5 may be off-center or asymmetric relative to the
sealing cap 3B. For example, the fluid inlet 61 and the nozzle 210
can be offset relative to the central axis Z of the tooth coupler
3. In FIG. 24C, the fluid motion generator 5 can be radially offset
relative to the central axis Z and can be directed in a direction X
transverse to the central axis Z. As shown in FIG. 23, the central
axis Z can pass distally along the height of the sealing cap 3B
through the center of the access port 231, e.g., the central axis Z
can be transverse to the access port 231 at or near the center of
the access port 231. The central axis Z can also define the central
longitudinal axis of the conical shape of the sealing cap 3B, e.g.,
transverse to the radial direction of the conical shape.
[0326] The pressurized liquid supplied by the fluid motion
generator 5 can induce liquid circulation in the chamber 6 of the
sealing cap 3B. For example, as with the embodiment of FIGS.
15-16B, the fluid motion generator 5 (e.g., the inlet 61 and/or
nozzle 210) can generate a swirling, rotational motion of influent
liquid 222 about the central axis Z of the chamber, which can be
transverse to (e.g., substantially perpendicular to in some
arrangements) the X axis along which the liquid is introduced into
the sealing cap 3B. In some arrangements, rotational or circulatory
motion can also be induced about other directions, e.g., about axis
parallel to the direction of fluid introduction. As with the
embodiment of FIGS. 15-16B, the influent liquid can introduce
rotational flow near and/or along walls of the canal spaces as the
rotating liquid enters the canal spaces.
[0327] As with the embodiment of FIGS. 15-16B, in some embodiments,
the pressurized liquid can pass through the nozzle 210 and can
emerge as a coherent, collimated liquid jet, which can act as a
fluid motion generator and/or pressure wave generator, as explained
herein. In some embodiments, the supplied liquid may comprise a
stream of liquid that is not a jet. After entering the chamber 6,
the liquid can impact and/or slide along the side wall 220 of the
sealing cap 3B. The fluid motion generator 5 can be angled such
that, upon impingement of the liquid against the wall 220, a
rotating sheet of influent liquid is generated in which the sheet
of influent liquid rotates in a swirling motion about the central
axis Z and travels distally along the side wall 220 in the chamber
6 towards the opening 227 in the sealing cap 3B. The rotating sheet
of influent liquid can continue downward along the inner walls of
the root canal(s) towards the apical opening of the tooth. The
rotating liquid can effectively and efficiently clean the entire
root canal space. For example, the rapid, bulk fluid motion of the
influent liquid can interact with diseased matter in the root canal
and can dislodge or otherwise remove the diseased matter from the
root canal.
[0328] As shown in FIGS. 16 and 23, it can be advantageous to
orient the fluid motion generator 5 such that sufficient rotational
influent flow 222 (see FIGS. 15 and 16) is provided in the chamber
6 and treatment region. For example, the inlet 61 and nozzle 210
can be directed along the X-direction, which can be transverse to
(e.g., perpendicular to) the central axis Z. The X-direction can be
generally tangent to the outer edge of the side wall 220. The
X-direction may be slightly angled relative to the tangent T of the
side wall 220 at the location at which the inlet 221 and nozzle 210
intersect the wall 220 of the chamber 6 (see FIG. 16). For example,
the X-axis along which the ingoing liquid 222 is directed may be at
an inlet angle .theta. relative to the tangent T (see FIG. 16). The
inlet angle .theta. can be at or close to zero. For example,
.theta. can be in a range of about 0.degree. to about 15.degree.,
or in a range of about 0.degree. to about 10.degree.. In some
embodiments, the angle .theta. can be in a range of about 1.degree.
to about 10.degree., or in a range of about 1.degree. to about
5.degree.. The fluid motion generator 5 can also be disposed such
that the center of the influent stream 222 enters the chamber 6 at
a distance .delta., from the outermost edge of the wall 220 (see
FIGS. 15 and 16, and the description thereof). The distance .delta.
can be relatively small, e.g., in a range of about 5 .mu.m to about
2 mm, or in a range of about 15 .mu.m to about 40 .mu.m. As shown
in FIGS. 15-16, 23, and 24C, the fluid motion generator 5 can be
oriented such that the X-axis is directed perpendicular to the
central axis Z such that the X-axis is substantially horizontal
relative to the chamber 6. In some embodiments, the X-axis can be
directed distally to assist in generating downward or distal
rotating influent flow into the treatment region.
[0329] Furthermore, as with the embodiment shown in FIG. 15, in the
embodiment of FIGS. 21A-14C, when the liquid jet emerges from the
nozzle 210, the jet can interact with treatment liquid in an
interaction zone near the interface between the nozzle 210 and the
chamber 6. As explained herein, the liquid jet can pass through the
liquid and can generate pressure waves (see FIGS. 15-16B) that
propagate through the liquid in the chamber 6 and root canal of the
tooth. The pressure waves can propagate from the interaction zone
distally into the canal of the tooth. The pressure waves can
comprise multiple frequencies that can cause liquid to flow and
deliver energy into small spaces, cracks, and tubules of the tooth
to substantially clean the tooth. In some arrangements, the bulk
flow of influent liquid may act to remove larger amounts of
diseased material from relatively large spaces of the tooth, and
the pressure waves can flow into smaller spaces that may not be
exposed to the bulk flow of liquid. The combination of rotating
influent liquid and pressure waves can act to substantially clean
the tooth, including large and small spaces of the tooth that may
include different types and sizes of organic and inorganic matter.
During an obturation or filling procedure, the rotational flow
and/or pressure waves can act to substantially fill the treatment
region.
[0330] FIG. 23 illustrates a sectional view of the outlet 62 which
extends along the central axis Z of the sealing cap 3B and chamber
6. As with the embodiment of FIGS. 15-16B, it can be important to
enable the influent liquid to be removed from the treatment region
to ensure that waste materials (e.g. dislodged debris, etc.) are
irrigated from the tooth and/or to enhance the fluid rotation at
the treatment region. Accordingly, the fluid outlet 62 can be
disposed in and/or through the top wall 232 of the sealing cap 3B.
The fluid outlet 62 can comprise a suction port 233 defining an
opening between the chamber 6 and an outlet passage 209 (which may
be one of the conduit(s) 4 described above) that conveys outgoing
fluid to the waste system by way of a suction pump. The suction
pump can apply suction to the outlet passage 209 and outlet 62 to
draw fluids out of the chamber 6 and towards a reservoir outside
the sealing cap 3B.
[0331] The fluid outlet 62 or suction port 233 may have an inner
diameter D.sub.2 (or other major dimension) that is equal to or
smaller than the inner diameter D.sub.1 of the distal portion 227
of the sealing cap 3B. In FIG. 23, the inner diameter D.sub.2 is
smaller than D.sub.1. For example, in some embodiments, the inner
diameter D.sub.2 of the suction port 233 may in a range of about
0.1 mm to about 5 mm, 0 e.g., in a range of about 0.1 mm to about 2
mm. The fluid outlet 62 can be disposed at or near the center of
the top wall 232 of the sealing cap 3B. As shown in FIG. 23, the
central axis Z of the sealing cap 3B and access port 231 can pass
through both the access port 231 of the distal portion 227 and the
suction port 233 of the outlet 62. The central axis Z can be
perpendicular, or substantially perpendicular, to the suction port
233. For example, the central axis Z can be disposed at about a
90.degree. angle (between 70.degree. and 110.degree., or more
particularly between 80.degree. and 100.degree., or more
particularly between 85.degree. and 95.degree.) relative to the
suction port 233. For example, in some embodiments, the access port
231 can define a plane that is transverse to (e.g., perpendicular
to) the central axis Z, and the central axis Z can pass through the
center of the access port 231 and through at least a portion of the
suction port 233. In some embodiments, the suction port 233 can
define a plane that is transverse to (e.g., perpendicular to) the
central axis Z, and the central axis Z can pass through the center
of the suction port 233 and through at least a portion of the
access port 231. In some embodiments, the access port 231 and the
suction port 233 define respective planes that are both transverse
to (e.g., perpendicular to) the central axis Z, and the central
axis Z can pass through both the access port 231 and the suction
port 233. In some embodiments, the central axis Z can pass through
the center of both the access port 231 and the suction port 233.
The suction port 233 can be symmetric about the central axis Z in
some embodiments. A center of the suction port 233 can lie on the
central axis Z.
[0332] The outlet 62 and chamber 6 can be configured such that the
influent liquid turns back proximally at a return location to be
drawn out of the chamber 6, as explained above in connection with
FIGS. 16A-16B. At the return location V (which may be at or near
the apical opening), the treatment liquid can turn back towards the
sealing cap 3B in an outgoing fluid path. The outgoing fluid path
may be different from the flow path or pattern of the influent
liquid. For example, the returning or outgoing flow path can
comprise rotational (or semi-planar) flow near the center of the
canal spaces and/or within the swirling influent flow path. In some
embodiments, the outgoing flow can comprise a spiral flow path that
passes inside the rotating influent liquid. The induced outward
flow can be carried outside the treatment region to carry waste and
other matter away from the treatment region (e.g., outside the
canal and tooth). Moreover, the suction provided by the outlet 62
and/or the rotating influent liquid can provide a negative pressure
at the apical opening in which treatment liquid and/or waste is
prevented from passing through the apical opening, which can reduce
the risk of infection and/or pain to the patient. The outgoing
liquid can pass through the suction port 233 and can be drawn to
the waste reservoir through the outlet line 209 by the suction
pump.
[0333] In addition, as shown in the side sectional view of FIG. 23
and in the top sectional views of FIGS. 24A and 24B, the handpiece
3A can include one or more vents 213. The vent 213 can be
configured to permit fluid from the chamber 6 to flow out of the
vent 213, for example, if the fluid pressure becomes too large in
the chamber 6. The vent 213 can also act as a relief valve to
inhibit over-pressurization of the chamber 6. the vent 73 may be
configured to permit air to enter the fluid outlet 72 and be
entrained with fluid removed from the tooth chamber 65. For
example, as shown in FIGS. 24A-24B, the vents 213 may be positioned
and oriented such that ambient air flows into the fluid outlet 62
in the direction of the fluid flow in the outlet 62. In such
embodiments, the flow in the fluid outlet 72 includes both fluid
from the chamber 6 and ambient air. In some implementations, the
vent 213 is disposed near the entry point of fluid into the outlet
62, e.g., within a few millimeters, which may make it easier for
fluid to flow from the chamber 6 if the pressure therein rises too
high. In various embodiments, a plurality of vents 213 may be used
such as, two, three, four, or more vents. The vents 213 may be
sized, shaped, positioned, and/or oriented to allow fluid to flow
from the chamber 6 while inhibiting air from entering the chamber
6. Additional examples of vent assemblies that can be used in
conjunction with the handpiece 3A of FIGS. 21A-24C can be similar
to the vents 73 described in, e.g., U.S. Patent Publication No.
2012/0237893, which is incorporated by reference herein in its
entirety and for all purposes.
[0334] In the embodiment illustrated in FIGS. 24A-24B, two vents
213 are illustrated. The vents 213 are angled towards the direction
of flow in the outlet passage 209 such that air is directed in the
outward flow of fluid rather than towards the chamber 6. The vents
213 can be positioned downstream of the suction port 233 such that
the suction port 233 is between the chamber 6 and the vents 213.
Moreover, as shown in FIG. 24A-24B, the vents 213 can comprise a
channel or lumen that extends from an outer surface of the
handpiece 3A to the outlet passage 209. The vents 213 can be
symmetric with respect to outlet passage 209 or can be distributed
alongside the outlet passage 209. The number of vents can be
combination of even or odd numbers (e.g., 2, 3, 4, etc.). The angle
between vent axes and the outlet passage 209 can vary between 0.1
to 90 degrees (perpendicular), or between 0.1 to 179.1 degrees.
[0335] FIG. 24D is a side sectional view of the handpiece 3A shown
in FIGS. 21A-24C, in accordance with another embodiment. The
handpiece 3A can be the same as that shown and described in
connection with FIGS. 21A-24C, except in FIG. 24D, one or more wall
openings 265 are provided in the side wall 220 of the tooth coupler
3. As shown, the wall openings 265 can be disposed at or near the
distal portion 227. During a treatment procedure, some treatment
fluid can leave the chamber 6 through the wall openings 265 to flow
along the walls of the root canal, while the rest of the fluid
passes from the chamber 6 to the treatment region by way of the
access port 231. By dispensing fluid to the treatment region
through the wall openings 265 in addition to the access port 231,
the effectiveness of a cleaning procedure can be improved. For
example, the portion of the tooth adjacent the wall 220 of the
chamber can be cleaned by the fluid that passes through the
openings 265. In addition, the openings 265 can also be provided on
the distal portion 227 of the tooth coupler 3 described and
illustrated in connection with FIG. 15.
[0336] Thus, in various embodiments disclosed herein, high momentum
fluid can be introduced at the top of the fluid chamber 6 by way of
a high velocity treatment fluid stream, which can be formed by the
nozzle 210. The stream of liquid can pass in a direction transverse
(e.g., almost or substantially perpendicular) to the central axis
of the chamber 6, e.g., the axis that is directed towards the tooth
during treatment. The stream may be transverse the longitudinal
axis of the chamber 6 and may also be offset relative to the center
of the chamber 6 such that the stream eccentrically flows relative
to the chamber 6. The high momentum, thin treatment fluid stream
can then travel downward towards the tooth while rotating inside
the chamber 6. The chamber 6 may be straight or slightly converge
to reduce the diameter of the chamber 6. For example, the chamber 6
can be tapered in various arrangements. The rotational high
momentum fluid exits the chamber 6 through a bottom access port 231
that is large enough to ensure efficient delivery of the high
momentum fluid into the tooth and allow for the exhaust path, yet
small enough to ensure adequate interaction and sealing on all
potential anatomies and geometries that the teeth may have. An
interface mechanism (e.g., the sealing member 105) can allow the
sealing cap 3B and chamber 6 to be applied onto the tooth in such a
way that it allows the rotational fluid to enter the tooth with
minimum interruption or loss and maintain the safety and efficacy
of treatment. The sealing member 105 provides a seal both to
prevent air from entering the tooth and chamber 6 and to minimize
the amount of liquid leaking out or chamber and tooth. After
exiting the fluid chamber 6, the high momentum treatment fluid
generates a high shear stress rotational flow inside the root canal
cavity or treatment region. The high shear stresses generated on
the pulp tissue and the dentin walls contribute to efficient
cleaning of the root canal. The momentum carried by the fluid
introduced into the tooth can be selected to ensure deep
penetration into the root canal system, while ensuring a safe
delivery. At the point of deepest penetration, the rotational flow
may converge to the centerline of rotation, and flow reversal
occurs at the return point V which allows for evacuation of debris
and waste fluid through the center of the influent rotational flow.
An inner vortex may be formed that flows through the evacuation
opening located at the center of the top of the chamber 6. The
evacuation opening can be connected to an external vacuum that is
used in the collection of waste fluid. The evacuation vacuum can
also combined with a set of vents 213 that are sized in order to
maintain a safe pressure inside the fluid chamber 6 and
consequently the treatment tooth.
[0337] In addition to the high momentum, high shear stress fluid
being supplied to the tooth, wide spectrum (broadband) pressure
waves can be generated through the interactions of the high
velocity liquid jet. The treatment fluid may be degassed and
contain chemicals to accelerate the rate of cleaning. The mechanism
can also be used for obturation or filling of the treatment
region.
[0338] The treatment fluid supplied to the chamber 6 in FIGS.
21A-24D may comprise any suitable treatment fluid, such as a
cleaning liquid or an obturation material. For example, in cleaning
procedures, the supplied cleaning liquid can rotate as shown in
FIGS. 16A and 16B, and can interact with diseased matter to clean
the tooth. In obturation procedures, the supplied obturation
material can similarly rotate as shown in FIGS. 16A and 16B, and
can substantially fill the treatment region (e.g., a treated root
canal, a treated carious region, etc.). In addition, although not
shown in FIGS. 21A-24D, the chamber 6 or sealing cap 3B can have
one or more additional openings that can supply obturation material
(or a component of an obturation material) to the treatment region.
The additional openings can be used to fill the treatment
region.
[0339] FIGS. 25A-25B are scanning electron microscope (SEM) images
of a tooth after completion of a treatment procedure using the
handpiece 3A shown in FIGS. 21A-24C. As shown in FIG. 25A, for
example, the handpiece 3A has substantially cleaned the root canal
13 of diseased materials. In FIG. 25B, tubules 305 are also shown
to be substantially clean. As explained herein, the combination of
rotational fluid motion and pressure waves can substantially clean
the entire treatment region.
XI. Examples of Various Embodiments
[0340] In one embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can include a chamber having an access
port which places the chamber in fluid communication with a
treatment region of the tooth when the chamber is coupled to the
tooth, the access port having a central axis. The apparatus can
include a fluid motion generator being arranged to generate
rotational fluid motion in the chamber. The apparatus can include a
suction port communicating with the chamber on a side of the
chamber opposite of the access port, and being disposed relative to
the access port such that the central axis of the access port
passes through the suction port. In some embodiments, the suction
port can be disposed at or near a center of a top wall of the
chamber. The suction port can be symmetric about the central axis.
A center of the suction port can lie on the central axis. The fluid
motion generator can generate a swirling influent fluid path around
the central axis. The apparatus can be configured to draw outgoing
fluid from the treatment region to the suction port in a path that
flows inside the swirling influent fluid path with a suction force
applied to the suction port. The central axis can lie substantially
perpendicular to the suction port. The suction port can have a
major dimension that is not greater than a major dimension of the
access port. The suction port can be smaller than the access port.
The fluid motion generator can be disposed on a side wall of the
chamber and can be oriented to direct liquid in a flow direction
that lies generally transverse to the central axis of the access
port. The flow direction may not intersect the central axis. The
fluid direction can be generally tangent to a wall of the chamber.
The suction port can be disposed on a top wall of the chamber that
opposes the access port. The chamber can comprise a distal portion
that defines the access port, the distal portion being sized and
shaped to be inserted into an access opening of the tooth, and
tapering distally towards the central axis. An inner surface of the
distal portion can taper distally towards the central axis. An
outer surface of the distal portion can taper distally towards the
central axis. The chamber can comprise a cylindrical portion
coupled to or formed with the distal portion, the cylindrical
portion being disposed between the distal portion and the suction
port. The distal portion can taper at an angle in a range of about
0.5.degree. to about 20.degree.. The distal portion can taper at an
angle in a range of about 1.degree. to about 10.degree.. The fluid
motion generator can comprise a liquid jet device. The liquid jet
device can comprise an inlet to receive pressurized liquid and a
nozzle being configured to convert the pressurized liquid to a
coherent, collimated liquid jet. At least one vent can be disposed
downstream of the suction port such that the suction port lies
between the chamber and the vent along an outlet passage that
extends from the suction port. At least one additional vent that
communications with the outlet passage can be downstream of the
suction port. Each vent can be disposed along the outlet passage
and can be angled towards the direction of fluid outflow in the
outlet passage. A handpiece and a tooth coupler can be at a distal
portion of the handpiece, the chamber being disposed within the
tooth coupler. A sealing member can extend from the tooth coupler,
the sealing member being configured to seal the treatment region. A
console can be in fluid communication with the chamber, the console
comprising one or more pumps to drive fluid to and aspirate fluid
from the chamber. The fluid motion generator can be a pressure wave
generator configured to propagate pressure waves through the
treatment region to substantially clean the treatment region. An
outer diameter or major dimension of the access port can be in a
range of about 0.5 mm to about 5 mm. The outer diameter or major
dimension of the access port can be in a range of about 0.5 mm to
about 3 mm. The outer diameter or major dimension of the access
port can be in a range of about 1 mm to about 2 mm. An inner
diameter or major dimension of the access port can be in a range of
about 0.3 mm to about 5 mm. The inner diameter or major dimension
of the access port can be in a range of about 0.5 mm to about 3 mm.
The inner diameter or major dimension of the access port can be in
a range of about 1 mm to about 2 mm. A diameter or major dimension
of the suction port can be in a range of about 0.1 mm to about 5
mm. The diameter or major dimension of the suction port can be in a
range of about 0.1 mm to about 2 mm. A flange can extend from the
suction port into the chamber. A distal portion of the chamber can
comprise one or more side openings in a side wall of the chamber to
provide fluid communication with the treatment region.
[0341] In another embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can comprise a chamber having a distal
portion defining an access port that places the chamber in fluid
communication with a treatment region of the tooth when the chamber
is coupled to the tooth, the access port having a central axis. The
apparatus can comprise a fluid motion generator coupled to the
chamber, the fluid motion generator configured to generate
rotational fluid motion in the chamber. The distal portion can be
sized and shaped to be inserted into an access opening of the
tooth, the distal portion tapering distally towards the central
axis. In some embodiments, a suction port can be disposed at or
near a center of a top wall of the chamber. The suction port can be
symmetric about the central axis. A center of the suction port can
lie on the central axis. The fluid motion generator can generate a
swirling influent fluid path around the central axis. The apparatus
can be configured to draw outgoing fluid from the treatment region
to the suction port in a path that flows inside the swirling
influent fluid path with a suction force applied to the suction
port. The central axis can lie substantially perpendicular to the
suction port. The suction port can have a major dimension that is
not greater than a major dimension of the access port. The suction
port can be smaller than the access port. The fluid motion
generator can be disposed on a side wall of the chamber and can be
oriented to direct liquid in a flow direction that lies generally
transverse to the central axis of the access port. The flow
direction may not intersect the central axis. The fluid direction
can be generally tangent to a wall of the chamber. The suction port
can be disposed on a top wall of the chamber that opposes the
access port. An inner surface of the distal portion can taper
distally towards the central axis. An outer surface of the distal
portion can taper distally towards the central axis. The chamber
can comprise a cylindrical portion coupled to or formed with the
distal portion, the cylindrical portion being disposed between the
distal portion and the suction port. The distal portion can taper
at an angle in a range of about 0.5.degree. to about 20.degree..
The distal portion can taper at an angle in a range of about
1.degree. to about 10.degree.. The fluid motion generator can
comprise a liquid jet device. The liquid jet device can comprise an
inlet to receive pressurized liquid and a nozzle being configured
to convert the pressurized liquid to a coherent, collimated liquid
jet. At least one vent can be disposed downstream of the suction
port such that the suction port lies between the chamber and the
vent along an outlet passage that extends from the suction port. At
least one additional vent that communications with the outlet
passage can be downstream of the suction port. Each vent can be
disposed along the outlet passage and can be angled towards the
direction of fluid outflow in the outlet passage. A handpiece and a
tooth coupler can be at a distal portion of the handpiece, the
chamber being disposed within the tooth coupler. A sealing member
can extend from the tooth coupler, the sealing member being
configured to seal the treatment region. A console can be in fluid
communication with the chamber, the console comprising one or more
pumps to drive fluid to and aspirate fluid from the chamber. The
fluid motion generator can be a pressure wave generator configured
to propagate pressure waves through the treatment region to
substantially clean the treatment region. An outer diameter or
major dimension of the access port can be in a range of about 0.5
mm to about 5 mm. The outer diameter or major dimension of the
access port can be in a range of about 0.5 mm to about 3 mm. The
outer diameter or major dimension of the access port can be in a
range of about 1 mm to about 2 mm. An inner diameter or major
dimension of the access port can be in a range of about 0.3 mm to
about 5 mm. The inner diameter or major dimension of the access
port can be in a range of about 0.5 mm to about 3 mm. The inner
diameter or major dimension of the access port can be in a range of
about 1 mm to about 2 mm. A diameter or major dimension of the
suction port can be in a range of about 0.1 mm to about 5 mm. The
diameter or major dimension of the suction port can be in a range
of about 0.1 mm to about 2 mm. A flange can extend from the suction
port into the chamber. A distal portion of the chamber can comprise
one or more side openings in a side wall of the chamber to provide
fluid communication with the treatment region.
[0342] In another embodiment, an apparatus for treating a tooth is
disclosed. The apparatus can include a chamber having an access
port which places the chamber in fluid communication with a
treatment region of the tooth when the chamber is coupled to tooth,
the access port comprising a central axis. The apparatus can
include a fluid motion generator coupled to the chamber, the fluid
motion generator configured to generate a swirling influent fluid
path around the central axis. The apparatus can include a suction
port configured to remove fluid from the treatment region and the
chamber. The apparatus can be configured to draw outgoing fluid
from the treatment region to the suction port in a path that flows
inside the swirling influent fluid path with a suction force
applied to the suction port. In some embodiments, a suction port
can be disposed at or near a center of a top wall of the chamber.
The suction port can be symmetric about the central axis. A center
of the suction port can lie on the central axis. The fluid motion
generator can generate a swirling influent fluid path around the
central axis. The central axis can lie substantially perpendicular
to the suction port. The suction port can have a major dimension
that is not greater than a major dimension of the access port. The
suction port can be smaller than the access port. The fluid motion
generator can be disposed on a side wall of the chamber and can be
oriented to direct liquid in a flow direction that lies generally
transverse to the central axis of the access port. The flow
direction may not intersect the central axis. The fluid direction
can be generally tangent to a wall of the chamber. The suction port
can be disposed on a top wall of the chamber that opposes the
access port. An inner surface of the distal portion can taper
distally towards the central axis. An outer surface of the distal
portion can taper distally towards the central axis. The chamber
can comprise a cylindrical portion coupled to or formed with the
distal portion, the cylindrical portion being disposed between the
distal portion and the suction port. The distal portion can taper
at an angle in a range of about 0.5.degree. to about 20.degree..
The distal portion can taper at an angle in a range of about
1.degree. to about 10.degree.. The fluid motion generator can
comprise a liquid jet device. The liquid jet device can comprise an
inlet to receive pressurized liquid and a nozzle being configured
to convert the pressurized liquid to a coherent, collimated liquid
jet. At least one vent can be disposed downstream of the suction
port such that the suction port lies between the chamber and the
vent along an outlet passage that extends from the suction port. At
least one additional vent that communications with the outlet
passage can be downstream of the suction port. Each vent can be
disposed along the outlet passage and can be angled towards the
direction of fluid outflow in the outlet passage. A handpiece and a
tooth coupler can be at a distal portion of the handpiece, the
chamber being disposed within the tooth coupler. A sealing member
can extend from the tooth coupler, the sealing member being
configured to seal the treatment region. A console can be in fluid
communication with the chamber, the console comprising one or more
pumps to drive fluid to and aspirate fluid from the chamber. The
fluid motion generator can be a pressure wave generator configured
to propagate pressure waves through the treatment region to
substantially clean the treatment region. An outer diameter or
major dimension of the access port can be in a range of about 0.5
mm to about 5 mm. The outer diameter or major dimension of the
access port can be in a range of about 0.5 mm to about 3 mm. The
outer diameter or major dimension of the access port can be in a
range of about 1 mm to about 2 mm. An inner diameter or major
dimension of the access port can be in a range of about 0.3 mm to
about 5 mm. The inner diameter or major dimension of the access
port can be in a range of about 0.5 mm to about 3 mm. The inner
diameter or major dimension of the access port can be in a range of
about 1 mm to about 2 mm. A diameter or major dimension of the
suction port can be in a range of about 0.1 mm to about 5 mm. The
diameter or major dimension of the suction port can be in a range
of about 0.1 mm to about 2 mm. A flange can extend from the suction
port into the chamber. A distal portion of the chamber can comprise
one or more side openings in a side wall of the chamber to provide
fluid communication with the treatment region.
[0343] In yet another embodiment, a method of treating a tooth is
disclosed. The method can include applying a chamber to a treatment
region of the tooth, the chamber having an access port which places
the chamber in fluid communication with the treatment region, the
access port comprising a central axis. The method can include
swirling influent fluid along a fluid path around the central axis.
The method can include drawing outgoing fluid from the treatment
region to a suction port in a path that flows inside the swirling
influent fluid path. In some embodiments, swirling the influent
fluid can comprise activating a fluid motion generator. Activating
the fluid motion generator can comprise activating the fluid motion
generator with a console in fluid communication with the chamber.
Drawing outgoing fluid can comprise activating a vacuum pump in
fluid communication with the suction port by way of an outlet
passage. Swirling influent fluid can comprise directing liquid
along an axis transverse to the central axis. Directing the liquid
can comprise directing the liquid along the transverse axis that is
offset from the central axis. Activating the fluid motion generator
can comprise activating a liquid jet device. Tthe chamber can
comprise a distal portion that defines the access port, the distal
portion tapering distally and inwardly towards the central axis,
wherein applying the chamber can comprise inserting the tapered
distal portion into an access opening of the tooth. Applying the
chamber can comprise pressing the chamber against the tooth.
Applying the chamber can comprise attaching the chamber to the
tooth. The method can include supplying substantially degassed
liquid to the tooth. The method can include generating pressure
waves in the treatment region. Generating pressure waves can
comprise generating multiple acoustic frequencies.
[0344] Although the tooth schematically depicted in some of the
figures is a pre-molar, the procedures can be performed on any type
of tooth such as an incisor, a canine, a bicuspid, a pre-molar, or
a molar. Further, although the tooth may be depicted as a lower
(mandibular) tooth in the figures, this is for purposes of
illustration, and is not limiting. The systems, methods, and
compositions can be applied to lower (mandibular) teeth or upper
(maxillary) teeth. Also, the disclosed apparatus and methods are
capable of any portions of a tooth, including interior spaces such
as root canals, pulp cavity, etc., and/or exterior surfaces of the
tooth. Moreover, the disclosed apparatus, methods, and compositions
can be applied to human teeth (including juvenile teeth) and/or to
animal teeth.
[0345] Reference throughout this specification to "some
embodiments" or "an embodiment" means that a particular feature,
structure, element, act, or characteristic described in connection
with the embodiment is included in at least one embodiment. Thus,
appearances of the phrases "in some embodiments" or "in an
embodiment" in various places throughout this specification are not
necessarily all referring to the same embodiment and may refer to
one or more of the same or different embodiments. Furthermore, the
particular features, structures, elements, acts, or characteristics
may be combined in any suitable manner (including differently than
shown or described) in other embodiments. Further, in various
embodiments, features, structures, elements, acts, or
characteristics can be combined, merged, rearranged, reordered, or
left out altogether. Thus, no single feature, structure, element,
act, or characteristic or group of features, structures, elements,
acts, or characteristics is necessary or required for each
embodiment. All possible combinations and subcombinations are
intended to fall within the scope of this disclosure.
[0346] As used in this application, the terms "comprising,"
"including," "having," and the like are synonymous and are used
inclusively, in an open-ended fashion, and do not exclude
additional elements, features, acts, operations, and so forth.
Also, the term "or" is used in its inclusive sense (and not in its
exclusive sense) so that when used, for example, to connect a list
of elements, the term "or" means one, some, or all of the elements
in the list.
[0347] Similarly, it should be appreciated that in the above
description of embodiments, various features are sometimes grouped
together in a single embodiment, figure, or description thereof for
the purpose of streamlining the disclosure and aiding in the
understanding of one or more of the various inventive aspects. This
method of disclosure, however, is not to be interpreted as
reflecting an intention that any claim require more features than
are expressly recited in that claim. Rather, inventive aspects lie
in a combination of fewer than all features of any single foregoing
disclosed embodiment.
[0348] The foregoing description sets forth various example
embodiments and other illustrative, but non-limiting, embodiments
of the inventions disclosed herein. The description provides
details regarding combinations, modes, and uses of the disclosed
inventions. Other variations, combinations, modifications,
equivalents, modes, uses, implementations, and/or applications of
the disclosed features and aspects of the embodiments are also
within the scope of this disclosure, including those that become
apparent to those of skill in the art upon reading this
specification. Additionally, certain objects and advantages of the
inventions are described herein. It is to be understood that not
necessarily all such objects or advantages may be achieved in any
particular embodiment. Thus, for example, those skilled in the art
will recognize that the inventions may be embodied or carried out
in a manner that achieves or optimizes one advantage or group of
advantages as taught herein without necessarily achieving other
objects or advantages as may be taught or suggested herein. Also,
in any method or process disclosed herein, the acts or operations
making up the method or process may be performed in any suitable
sequence and are not necessarily limited to any particular
disclosed sequence.
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