WO2006100700A1 - Dispositif permettant de simuler les effets d'un appareil orthodontique sur une dentition de modele virtuel - Google Patents

Dispositif permettant de simuler les effets d'un appareil orthodontique sur une dentition de modele virtuel Download PDF

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Publication number
WO2006100700A1
WO2006100700A1 PCT/IT2005/000162 IT2005000162W WO2006100700A1 WO 2006100700 A1 WO2006100700 A1 WO 2006100700A1 IT 2005000162 W IT2005000162 W IT 2005000162W WO 2006100700 A1 WO2006100700 A1 WO 2006100700A1
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Prior art keywords
tooth
appliance
teeth
force
relative
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PCT/IT2005/000162
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English (en)
Inventor
Vincenzo De Dominicis
Original Assignee
Vincenzo De Dominicis
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by Vincenzo De Dominicis filed Critical Vincenzo De Dominicis
Priority to PCT/IT2005/000162 priority Critical patent/WO2006100700A1/fr
Publication of WO2006100700A1 publication Critical patent/WO2006100700A1/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00—Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/002—Orthodontic computer assisted systems

Definitions

  • the present invention relates to a device for simulating the effects of an orthodontic appliance, in accordance with the pre-characterising part of the main claim.
  • the documents of the known art describe devices for three- dimensionally displaying a patient's teeth and the relative malocclusions and offer the possibility of selecting different orthodontic techniques, the relative appliances for implementing a selected technique and particular activations of said appliances, the problem always arises of facilitating the choice and the design of the most suitable orthodontic appliance for solving a particular malocclusion problem of a patient.
  • the documents of the known art always propose arbitrary simulation of the movements induced in the teeth by the appliance and by the relative activation chosen.
  • An object of the present invention is to provide a device able to offer an orthodontist or an orthodontics student an instrument able to help in choosing the most effective technique and the relative appliance and activation for treating a particular malocclusion and which in particular is able to provide information relative to the biomechanics generated on the dental arches in relation to a selected orthodontic technique, appliance and activation applied to the arches.
  • a further object is to provide an instrument which displays the tooth movement generated by the application of a particular selected technique, appliance and activation which takes account of the forces acting on the teeth.
  • a further object is to provide a device which is highly interactive and enables the orthodontist to easily and rapidly observe and analyze the effects of a particular technique, appliance and activation on the teeth.
  • Figure 1 is a block diagram of the device of the invention
  • FIG. 2 is a block diagram of the principal operations implemented by the device
  • Figures 3-6 show four screen representations of a processor programme for implementing the invention
  • Figures 7-10 are schematic views of models of the forces applied to a tooth to which an orthodontic appliance is applied (Figure 7), and of different orthodontic appliances applied to two adjacent teeth respectively ( Figures 8-10).
  • a device of the invention comprises a processor indicated overall by 1 presenting at least one processing unit or CPU 2, interface means comprising a display unit 3, a keyboard 4 and a mouse 5, a main memory 6, for example of RAM type, and a hard disc 7.
  • processors of this type are totally conventional and will not be further described in detail.
  • the processor has an installed programme enabling it to perform a series of operations described in detail hereinafter and shown schematically in Figure 2. Once the programme has started, these operations make it possible to select a particular type of malocclusion, to select an orthodontic technique to resolve the selected malocclusion, to virtually model an orthodontic appliance and to display the effect of said appliance on the dental arches.
  • this shows a representation of the window which opens on selecting "malocclusions" from the menu 25 at the top of the screen on opening the programme (not shown but of conventional type).
  • This step allows selection of the particular malocclusion to be studied, i.e. that malocclusion for which the most effective orthodontic technique and the relative appliance and activation are to be investigated.
  • the malocclusion representation of Figure 3 presents a first window 10 containing a plurality of standard malocclusions of the type known in the literature, selectable by the device user: for example malocclusions of first, second (first and second division), third class.
  • the operation of selecting an item in a window by the mouse 5 or keyboard 4 is conventional. By selecting one of the malocclusions of the window 10 and the virtual command "load" 21 the selected malocclusion is automatically displayed in the adjacent window 11.
  • the user can also modify the display viewpoint of the arch in the window 11. More particularly, by moving the virtual slider 14 of the commands 13 A 1 B 1 C respectively, the displayed image can be shifted relative to the x, y and z axes, whereas by using the commands 13 D 1 E 1 F they can be rotated relative to said axes. In this manner the user can optimally display all selected types of malocclusions.
  • the relative command 12B having been selected.
  • the position and orientation of each tooth with respect to a fixed cartesian reference system is identified, in a manner conventional for the expert of the art, by means of a transformation matrix for each tooth.
  • Usual three-dimensional display programmes for example of CAD type, are used to control the aforedescribed operations of completely or partially displaying the dental arches and moving the observation point.
  • the device memory 6 comprises tooth by tooth the data relative to the position and rotation of each tooth for each of said standard malocclusions relative to a fixed cartesian reference axis.
  • the selected standard malocclusion can be personalized via the window 10. More particularly, the window 16 presents a two-dimensional representation of the teeth of the upper and lower arches; by clicking onto one of the teeth it can be selected and the following operations be implemented: elimination of the tooth (to simulate a completed extraction of the selected tooth) (command 17 A), restoration of the tooth (command 17 B), movement or rotation of the selected tooth with respect to the x y z directions (command 18 A-F), inserting in millimetres or degrees the desired positive or negative movement or rotation for the selected tooth (command 19 A-F). Similar movement operations relative to the x-y-z axes can also be implemented for the entire upper or lower arch by operating the commands 20 A, arch selection, and 20 B-D, selection of the extent of movement relative to the three axes.
  • Each of the selected personalizations is immediately displayed in the window 1 1. Again in this case the implementation of said operations is conventional for the expert of the art using known three-dimensional programmes. It should be noted that by virtue of the window icons and the commands 16-19, graphically carrying the relative function, personalization of the selected standard malocclusion is particularly simple and intuitive. By means of the virtual command 12, indicated by “save” in Figure 3, a personalized malocclusion can be saved in the device memory 6; the identifying code (in the example "test 15-10-03") for the saved personalized malocclusion appears in the standard malocclusion window 10 and can be again displayed.
  • the device user can therefore select a standard malocclusion to be studied, or can create a malocclusion which reproduces in detail the actual malocclusion of a particular patient.
  • the invention can also receive, memorize and display malocclusions of actual patients obtained using acquisition instruments of known type, for example by scanner, radiological equipment, ultrasound equipment, with determinations which can be made both on the actual teeth of the patient or on models thereof, as described for example in US 2004/0073417, the contents of which together with the patents and patent applications cited in it are to be considered included in the present text.
  • the device of the invention therefore comprises an acquisition line 23 ( Figure 1 ) for data originating from a three-dimensional measuring apparatus for a patient's teeth, these data being stored in the hard disk 7 of the device and processed by the CPU 2 in matrix form, then stored in the memory 6, to be used in a manner similar to that previously described.
  • Figure 4 shows the screen representation which ' opens on selecting the operation "techniques" from the menu 25; this screen comprises a window 26 comprising a plurality of standard orthodontic techniques, a window 27 comprising the four standard parameters characteristic of the positioning of the brackets of the orthodontic appliance for the selected technique, a window displaying the dental arches identical to the window 1 1 previously described, and a section 29 enabling said standard parameters to be modified.
  • each orthodontic technique provides, for each tooth, devices to be applied to the teeth, hereinafter known as brackets, of standard type and shape and comprising, for each tooth, standard application points and positions, known in the literature.
  • brackets of standard type and shape and comprising, for each tooth, standard application points and positions, known in the literature.
  • These application points and positions for the brackets are conventionally identified by four significant parameters usual for the expert of the art: tip, torque, height and thickness.
  • the device comprises in its memory the relative standard tip, torque, height and thickness values.
  • the known tip, torque, thickness and height values are memorized for the following techniques: Ricketts, M.B.T., Roth, Andrews, Alexander, Two-dimensional, Lingual. Having selected the desired technique via the window 26 the relative values are loaded and made available to the processing programme by operating the virtual screen command 31.
  • the standard tip, torque height and thickness values can be modified tooth by tooth via the section 29.
  • the technique to be simulated is selected from the window 26, then the parameter to be modified is selected from the window 27, for example the torque, then a tooth for which the standard torque value is to be varied is selected from the window 30, the virtual commands of the window 31 are used to increase or decrease this standard value.
  • the modification is then saved in the memory 6 by operating the relative virtual command 32, in a manner conventional to the expert of the art and made available in the techniques list of window 26. It should be noted that as shown in Figure 4 the window 28 does not display the brackets relative to the particular technique selected nor their positioning, but only the malocclusion selected in the preceding operation relative to the "malocclusion" step.
  • brackets or at least a simplified graphic representation can be automatically displayed in addition to their positioning on the teeth of the previously selected particular malocclusion. Displays of this type are described for example in the already cited patent application
  • Figure 5 shows the screen representation which opens on selecting
  • this screen representation comprises a window 32 in which the name of the technique selected in the previously described operating step, a window 33 for the selected technique lists all the different conventional types of arch usable, a window 34 which for each type of arch lists all the different conventional wires usable , and a section 35 for selecting the type of activation desired for the particular arch and wire selected.
  • the expert of the art it is also conventional for the expert of the art to use a plurality of wires having different technical characteristics; for example for the Ricketts technique and a sectional levelling arch it is known to use a steel wire of dimensions 0.16 x 0.16 mm, or 0.16 x 0.22 mm, or in beta titanium with dimensions 0.16 mm x 0.22 mm or 0.17 mm x 0.25 mm, or in nickel titanium with dimensions 0.16 mm x 0.22 mm.
  • the possible types of arch usable and for each arch the dimensional characteristics of the possible usable wires are stored in the memory 6 of the device for each of the known orthodontic techniques.
  • the user is able to set a preferred activation of the selected appliance, the appliance in the present context meaning the combination of a particular type of arch bracket, dependent on the particular technique selected, and the relative wire.
  • the user firstly selects via one of the virtual pushbuttons 36 that therapy step to which the activation to be selected refers.
  • therapy step to which the activation to be selected refers.
  • appliances of different type for example arches of different shape and/or different activations
  • Each appliance and the relative activation is arranged to achieve a particular movement of the teeth, which when attained the appliance is no longer effective and must be replaced.
  • the virtual pushbuttons 36 the user is therefore able to select and memorize to which therapy step the current selection refers.
  • the user selects the teeth through which the arch has to pass; in this step all the teeth can be selected or only some as in the example shown in the figure relative to a sectional arch involving only five teeth.
  • This selection is made by clicking onto the teeth to be involved by the arch, a two-dimensional graphic symbol 39 identifying a bracket appearing on the selected teeth, Using a slider 38 a pair of teeth are selected onto which to apply a particular activation of the relative arch.
  • the virtual pushbuttons 39 are used to select the shape of any loop to give to the arch in the interdental space of the pair of teeth selected.
  • the pushbuttons 39 comprise all the main known loops for an arch, i.e.: an omega loop 39A, a droplet loop 39B, a vertical loop 39C, an L-loop 39D, a T-loop 39E, a looped vertical loop 39F, a double looped vertical loop 39G, no loop 39H.
  • the programme automatically displays in the window 37 the type of loop chosen for the particular pair of teeth selected.
  • the virtual pushbuttons 40 are then used to select any bend to be given to the arch within the interdental space selected by the slider 38; the pushbuttons 40 comprise all the known bends, for example stepped 40A-B or V 40C-D or wire twist 43.
  • the window 41A displays the extent of activation in mm; for the V bends the window 41 B displays the extent of activation in degrees and for the wire twist the window 41 C displays the extent of activation in degrees).
  • Any eccentricity of the stepped bend can be set by the slider 42A, and any eccentricity of the V bend by the slider 42B. Having made all the arch, wire and activation choices for a determined step, these are saved in the device memory 6 by the relative "save" command 44.
  • the screen representation of Figure 5 comprises a window for displaying the selected malocclusion identical to the previously described window 1 1.
  • the activation step for the orthodontic appliance could be assisted by the display window 1 1 , either as an alternative to or in combination with the two-dimensional dental arch window 37.
  • the procedure would be as in the previously described case, however the selected brackets, arch and activations would be also displayed three- dimensionally on the three-dimensional graphic representation of the malocclusion which appears in Figure 11.
  • Figure 6 shows the screen representation which opens on selecting "simulation" from the menu 25.
  • the user To activate the animation, the user must firstly select the type of patient to receive the selected appliance, for which purpose a plurality of pushbuttons 50A-C are provided, each relative to a particular type of patient, i.e. growing patient, adult patient, parodontopathic patient.
  • the device memory 6 contains stored therein for each type of patient a bone tissue model or a plurality of parameters able to characterise the resistance to movement of the teeth of the various types of patient. Specifically, for each of the three aforesaid types of patient and for each tooth the following data are stored relative to: - elastic constant k1 , i.e. a value indicative of the return force acting on the tooth opposing that exerted by the orthodontic appliance and related to the fact that each tooth if subjected to a force tending to displace it has a natural tendency to return to its initial position. - damping factor b, i.e. a value indicative of the friction force acting on the tooth opposing that exerted by the orthodontic appliance,
  • - minimum movement activation threshold i.e. a value relative to the initial detachment friction, related to the fact that a minimum determined force has to be applied to succeed in displacing each tooth, - interdental elastic bond, i.e. a value which takes account of the existence of the tra ⁇ sectal oxytalanic fibres of the parodontal ligament between one tooth and the next,
  • the data relative to the bone tissue model of the three patient types are chosen from the following value range: - elastic constant: 50/100 g
  • the positions of the relative centres of resistance are also stored in the memory 6.
  • the centre of resistance of a tooth is the point through which any force, or the resultant of a force, must pass to obtain a bodily movement of the tooth.
  • the programme comprises a step of quantitatively calculating the force generated by the orthodontic appliance which does not take account of the position of the tooth and of the appliance brackets and a quantitative calculation step which takes account of said positions identifies the orientation of said force and relative movement.
  • each appliance is considered to be a wire divided into a plurality of segmented arches, consequently the force system generated by the arch of an appliance is studied considering the wire portion present between two consecutive teeth or connections.
  • the programme calculates the load/movement ratio applied by the appliance and the relative movement, using Hook's law for the calculation according to which this ratio is equal to an elastic constant characteristic of the wire used multiplied by the wire cross-section to wire length ratio.
  • the calculation unit applies Hooke's law to that determined wire, then knowing its length, its cross- section and its modulus of elasticity, it obtains the relative load/movement ratio.
  • a loop or a bend are seen by the programme as an additional length of wire, of known dimension, which can be added into the interconnection space, then again using Hooke's law the programme calculates any force system generated by the particular activation selected for said loops or bends.
  • the programme of the invention is based on the aforesaid studies of Burnstone the content of which is to be considered as part of the present patent application.
  • the arch of the orthodontic appliance is modelled as a straight wire, modelled to be able to pass through two non- aligned connections indicated by 41 in Figure 8 (connections in the present context meaning the usual groove provided in conventional brackets through which the wire of the orthodontic appliance passes).
  • connections in the present context meaning the usual groove provided in conventional brackets through which the wire of the orthodontic appliance passes.
  • the force system generated depends on the system geometry, in particular on the ratio between the angles ⁇ a and ⁇ b , these angles being those which the connections make to the ideal line joining them.
  • Burnstone has identified six classes defined by six different values of the ratio ⁇ b / ⁇ a with ⁇ a > ⁇ b which generate six quantitatively different force systems, these six classes being known as Burnstone classes.
  • the six Burnstone classes define six force systems identified by the ratios F b /F a ; M b /M a ; M a /F a
  • the aforesaid articles explain how to obtain a qualitative measurement of the forces and moments generated by the wire of the orthodontic appliance based on the value of the aforesaid angles, the interconnection distance L and the wire characteristics. It should be noted that the value of said angles is given by the tip and torque settings selected for each tooth and by the position selected for said tooth at the malocclusion selection step.
  • the calculation unit identifies the Burnstone class to which two consecutive brackets belong taking account of the particular position selected (at the malocclusion selection step) for the teeth of these brackets, the relative tip and torque values and for all three spatial planes.
  • the calculation unit extracts from its memory the interconnection distances of the brackets for the particular malocclusion being studied, and the Burnstone angles. Knowing the angle to moment ratios for the six classes, a fuzzy logic approximator is applied to calculate the moments on the connections. This calculation uses the tabulated ratios of moments, forces and moments to forces for the six classes defined in the Burnstone article
  • the programme of the invention calculates the values of k1 and k2 in the following manner: - the tabulated values of k1 are divided by the number
  • G (E.S)/4
  • E is the elastic constant of the material of the wire used in the experimental test (400000 psi)
  • S is the cross-sectional area of the wire used in the test [ ⁇ .(0,016/2) 2 ]
  • the values corresponding to the angle ratio are obtained by non-linear interpolation of the tabulated values (fuzzy logic interpolators)
  • the value of k1 is multiplied by the number
  • E f is the elastic constant of the material used for the wire
  • S f is the cross-section of the wire used.
  • the Burnstone studies are not directly applicable and in the literature there are no studies on the force system generated by these forms with non-linear connections.
  • the calculation unit approximates the situation of V or stepped wires to the previously treated situation of straight wires as schematically shown in Figures 10A 1 B.
  • the angles between the connections and the wire branches positioned such as to pass through the centre of the connection and use these angles in a manner totally similar to that previously illustrated in the case of angles formed by straight wire.
  • the programme of the invention calculates the force and moment exerted by the wire of the orthodontic appliance on each tooth, again in relation to the angle formed between the groove and the wire passing through the centres of the connection points of two brackets of two adjacent teeth.
  • the calculation unit 2 of the device is arranged to calculate and display for each tooth the movement induced on the teeth by a particular orthodontic appliance and with a particular activation thereof, also taking account of the resistance to movement forces characteristic of the teeth.
  • the calculation unit carries out the following operations for each tooth:
  • - k elastic constant
  • - F external force applied by the orthodontic appliance
  • the point of origin Xo is not fixed but is calculated at each integration step by taking a weighted average of the positions of the last 8 weeks.
  • the elastic constant is not fixed, but varies according to the patient type on which the effect of the orthodontic appliance is to be simulated.
  • This constant is tabulated and stored for three patient types: the brachy patient, the meso patient and the dolicho patient.
  • the brachy patient for example there is a greater muscular force and hence a greater control over tooth movement. This translates into an increase in resistance and in the value of the constant k.
  • this comprises a dental arch display window equal to the previously described window 1 1 , a virtual pushbutton 51 for loading and displaying the simulation of all steps of the previously selected orthodontic treatment, four virtual pushbuttons 52A-D for quick passage to the previous or next step, two windows 53A-B for graphically displaying the state of advancement in the simulation of the selected treatment step, with reference to the upper arch and lower arch respectively, and two virtual pushbuttons 54A-B to interrupt simulation of the selected treatment step of the lower arch and upper arch respectively.
  • the programme calculates and displays, in accordance with the previously selected settings, a simulation of the effects of the orthodontic appliances of the various treatment steps on the teeth of the virtual arches. If the simulation is too slow and it is desired to pass to the display of the effects of a particular treatment step, for example the last, this can be done by acting on the pushbuttons 52A-C. If during display of the effects of a particular treatment step the user notices an undesired movement of the teeth of the upper and/or lower arch, by acting on the pushbuttons 545A-B the simulation is interrupted and the previous screen relative to modelling is displayed. This screen repeats the parameters relative to the treatment step in which simulation was interrupted. The user is therefore able to check these parameters and modify them.

Abstract

L'invention concerne un dispositif permettant de simuler les effets d'un appareil orthodontique classique sur un modèle virtuel d'arcades dentaires de patient, d'un type comprenant: un processeur (1) présentant une unité de traitement (2), des moyens interface (3, 4, 5) comprenant au moins une unité d'affichage (3); et au moins une mémoire (6, 7) destinée à stocker: au moins un modèle virtuel des arcades des dents d'un patient; et au moins une technique orthodontique classique, des caractéristiques propres à au moins un appareil orthodontique, permettant la mise en oeuvre de cette technique, des paramètres standard servant à positionner ledit appareil orthodontique au moins sur les dents, et au moins une activation standard associée, un programme de processeur pouvant être exécuté par le processeur, permettant l'accès au modèle virtuel et l'affichage de celui-ci sur l'unité d'affichage (3), ledit programme comprenant des instruments de navigation permettant à un utilisateur de sélectionner la technique orthodontique standard, l'appareil standard associé au moins et l'activation standard au moins, ladite mémoire comprenant au moins un paramètre décrivant les caractéristiques de résistance au mouvement des dents soumises à l'action d'un appareil orthodontique classique.
PCT/IT2005/000162 2005-03-24 2005-03-24 Dispositif permettant de simuler les effets d'un appareil orthodontique sur une dentition de modele virtuel WO2006100700A1 (fr)

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