WO2007135576A1

WO2007135576A1 - Buccal corrector

Info

Publication number: WO2007135576A1
Application number: PCT/IB2007/051019
Authority: WO
Inventors: Tri Huu Tran; Huu Tam Tran
Original assignee: Diagnotec Ag
Priority date: 2006-03-22
Filing date: 2007-03-22
Publication date: 2007-11-29
Also published as: FR2898803A1; FR2898803B1

Abstract

The present invention relates to a buccal corrector intended to be placed in the buccal cavity of the jaw of a patient in order to correct a condition in which the lower jaw (3) is posterior in relation to the upper jaw (4), consisting of a shell (5) which is open at least on its rear and lower parts and of which the upper part is intended to be applied against the roof of the mouth, characterized in that the shape of the shell (5) is such that, when the corrector is in position in said buccal cavity, it is free of any contact with the teeth (1, 1') of the lower jaw (3), at least one area of its lower part (6a) bears on the gums (7) of the inner part of the lower jaw (3), and it is free of any contact with the gums (7) of the inner part of the upper jaw (4).

Description

Description BUCCAL CONFORMER

[1] The present invention, which is applicable in the field of dento-maxillofacial orthopedics, relates to a functional oral shaper intended to prevent and correct the pathology in which the lower jaw of a jaw of a patient is located. in the retracted position relative to the maxilla, a pathology referred to hereinafter as retromandibulia, which is often associated with bad lingual habits, such as thrust and / or lingual interposition. The present invention also relates to a method of manufacturing such a shaper.

[2] Indeed, in such pathologies, the patient very often presents lingual impulses on swallowing. Or more precisely, at the time of the latter, the patient loosens teeth, contracts his lips, brings the tongue in contact with them to collect saliva, then back his tongue back to swallow. These lingual movements have the adverse effects, among others, the tilting out (pathology called vestibulo- version) of the incisors, the advancement of the alveolar bone anterior (pathology called pro-alveoli) and / or the open bite, related to passage of the tongue with force.

[3] It has been proposed in the prior art various devices and devices intended to remedy such pathologies, and in particular as regards the retromandibulie, the positioner, the functional regulator Frânkel and the monobloc apparatus of Robin.

[4] The positioner consists of a mold having two upper and lower faces corresponding respectively to the impressions of the maxillary upper and lower of the patient. Which faces comprise cells for receiving, in an ideal position, the teeth thereof. The positioner being in place, the patient is then asked to perform exercises consisting of tightening the teeth (dental occlusion position), so that the latter are forced to come and position themselves in the cells provided for this purpose, thereby causing the lower jaw and applying constraints to the latter. The repetition of these stresses has the effect of bringing the entire jaw back to the desired normal position.

[5] Positioners of this type have a number of disadvantages, including that of being made from measurements consisting of statistical means of the sizes and morphologies of the teeth. Thus, the positioners, except to realize them in a personalized way, can not be used in the cases of dental disharmony or tooth extraction other than that of the premolars. Moreover, this technique makes it necessary to make available to the practitioner numerous models of positioners according to the size and / or the number of extraction of the teeth. Finally, a quality result requires a high motivation on the part of the patient who is forced to perform repeated movements of "clenching teeth" throughout the day whereas, in the normal resting position, an individual does not shake not the teeth.

[6] Frânkel's functional regulator consists of a rigid lingual resin plate that bears on the gingiva of the inner part of the lower jaw and is secured to the rest of the appliance by stainless steel wires. This lingual plate stimulates the protractor muscles of the lower jaw by the proprioceptivity of the underlying gingiva and periosteum. Such a device is however difficult to achieve and its cost is accordingly high.

[7] Robin's monobloc apparatus consists of a split palatal plate made from plaster models of the maxillae reproducing the toothed parts. This plaque extends vertically along and beyond the lower dental arch. A jack, stabilized and supported by a slide, is disposed between the two plate members and acts on them essentially at the level of the upper jaw and the toothed portions. In addition to the difficulties of implementation at the patient level, this device is also difficult to manufacture and therefore expensive.

[8] In order to correct the bad lingual position, it has also been proposed to reposition the tongue at the level of the palate by means of a lingual ramp. It has thus been proposed in the patent EP 1 009 616, in the name of Bonnet, to produce a preform for obtaining, after deformation by expansion, orthodontic appliances and custom dentofacial orthopedics. Such a preform, insofar as it reproduces the morphology of the patient, can not provide on the maxillae any corrective action.

[9] These different dento-maxillofacial orthopedic devices, language position activators or correctors, whatever their forms and their modes of operation, are only very difficult to support by the patients, because of the great embarrassment suffered by them. It is understandable in these conditions that they are not driven to use these different types of devices very assiduously, while it is precisely their frequent, regular and prolonged wearing which is the key to a therapeutic success.

The object of the present invention is to remedy these drawbacks by proposing an oral shaper capable of preventing and correcting, in a natural and non-aggressive manner, the relative poor positioning of the upper and lower jaws of a patient, and this by exerting a low intensity force substantially continuously and permanently on the gingiva of the inner part of the lower jaw by means of the patient's tongue. Thus, the present invention makes particularly effective use of the tongue of the patient and more specifically the lingual impulses that were so far one of the causes of the pathology for, using the device, use these same lingual impulses to remedy said pathology.

[11] The present invention thus relates to a mouth shaper intended to take place in the oral cavity of the jaw of a patient to correct a pathology in which the lower jaw is recessed relative to the upper jaw, comprising d an open shell at least on its posterior and inferior parts and whose upper part is intended to be applied against the palatal vault, characterized in that the shape of the shell is such that when the shaper is in position in said oral cavity:

[12] - it is free from any contact with the teeth of the lower jaw,

[13] - at least one zone of its lower part rests on the gingiva of the inner part of the lower jaw,

[14] - it is free from any contact with the gingiva of the inner part of the maxilla.

[15] Preferably, the external surface of the shell will be regular and free of any penetration into the interdental spaces of the upper maxillary to allow the forward sliding of the oral shaper and thus the propulsion of the lower jaw.

[16] Furthermore, the shape of the shell will be such that the zone of its lower part bearing on the gingiva of the inner part of the lower jaw, will consist of at least its anterior part. It can also, depending on the specific needs of each pathology, be made up of its entire periphery.

[17] The inner face of the shell constituting the oral shaper according to the invention may comprise, on at least a portion of its periphery, means for guiding the tongue towards its upper part. These guide means may consist of a lingual ramp inclined from top to bottom and from the outside towards the inside with respect to the vertical. Advantageously this lingual ramp will be formed by an inclination of the lower inner face of the shell and / or a lip integral with said inner face and inclined relative thereto.

[18] In order to allow the practitioner to adjust the degree of mandibular propulsion, the shell may include, on its outer face and on at least a portion of its periphery, a lip inclined relative thereto that the practitioner will have any ease to cut to shape and size according to each patient.

[19] Preferably the oral shaper will be made of a flexible and elastic material, including an elastomer. This material may belong to the group consisting of polyethylene, polypropylene, polycarbonate, polymethyl methacrylate, polyvinyl chloride, polyurethane.

[20] According to the invention the oral shaper may consist of a material to even to adsorb and / or absorb aromas which, as and when used will be able to release.

[21] Moreover, in order to allow the patient to perceive the sensation of taste sensed by the palate, the upper face of the oral shaper may be partially perforated or constituted by a mesh.

[22] Advantageously, the mouth shaper may be associated with a labial screen by a connection, in the form of a cord or a ribbon for example, thin, which screen is intended to be placed in the vestibule anterior or anterolateral buccal, or out of the mouth. In both cases, this screen may be associated with an external gripping means.

[23] Finally, the inner wall of the oral shaper may be provided, in the central zone where the tongue is to be positioned, an attractive coating for the latter such as a smooth coating, and, conversely, be provided in areas that it must avoid a repellent coating for it, such as in particular a rough surface or pins.

[24] The present invention also relates to a method of manufacturing a mouth shaper intended to correct a pathology in which the lower jaw of a patient's jaw occupies a position set back from the maxilla, characterized in that it comprises the steps of:

[25] - Take an impression of the upper and lower jaws of the jaw,

[26] - Pouring elements, in particular plaster, from said impressions,

[27] - Position these elements relative to each other, so that they occupy a relative position identical to that which one wishes to obtain for the maxillae after correction, thus forming a basic oral cavity,

[28] - Line the resulting oral cavity with a product the thickness of which is equal to that which is desired to give the oral shaper, so as to obtain a new oral cavity,

[29] - Realize a model, in particular in plaster, constituted by an impression of this new oral cavity,

[30] - Use this model to mold on it, the mouth shaper.

[31] The present invention also relates to a process for the industrial manufacture of a mouth shaper comprising a step of measuring the positioning of the teeth of the maxillary and upper jaw of a patient, using a rule having a general shape of "T" consisting of a central branch and a transverse branch graduated and made of a deformable material. It may also include a U-shaped part in the form of a graduated horseshoe branch.

[32] Hereinafter will be described, by way of non-limiting example, one embodiment of the the present invention with reference to the accompanying drawings in which:

[33] - Figure 1 is a schematic view in vertical section and longitudinal median of the jaw of a patient in which the two jaws are in a normal relative position.

[34] - Figure 2 is a schematic view in vertical vertical and longitudinal section of the jaw of a patient in which the lower jaw occupies a position set back from the maxillary upper,

[35] - Figures 3a to 3c are views respectively in vertical and longitudinal longitudinal section, rear and perspective of a mouth shaper according to the invention,

[36] - Figures 4a and 4b are diagrammatic views in vertical section, respectively longitudinal median and transverse passing through the first molars of the jaw of a patient with the pathologies to be corrected, in which we set up a mouth shaper according to the invention,

[37] - Figure 5 is a schematic view in vertical vertical and longitudinal section with a guide plane for the tongue,

[38] - Figure 6 is a schematic view in median longitudinal section of an alternative embodiment of the invention,

[39] - Figures 7a and 7b are schematic perspective views of different embodiments of an embodiment of an oral shaper according to the invention,

[40] - Figures 8a and 8b respectively show a diagrammatic view in vertical vertical and longitudinal section of an alternative embodiment of the invention, comprising a labial screen placed in the oral vestibule and out of the mouth,

[41] - Figure 9 is a bottom view of an upper jaw and a measuring ruler according to the invention, and

[42] - Figure 10 is a vertical and transverse sectional view of an upper jaw and the measuring ruler shown in Figure 9.

[43] There is shown in Figure 1 the lower jaw 3 and upper 4 of the jaw of a patient who are positioned correctly relative to each other. In Figure 2, there is shown the maxillae of a patient with retromandibular, that is to say, the lower jaw 3 is recessed relative to the upper jaw 4, as shown by the arrow F.

[44] The oral shaper according to the invention, which is shown in FIGS.

3c, is intended to correct the aforementioned pathology. For this purpose, it consists of a shell 5 which has a shape such that, when it is in place in the oral cavity of a jaw of said pathology, such as that shown in Figures 4a and 4b, d on the one hand, its lower part 6a bears on the gingiva of the inner part of the lower jaw 3 and its upper part 6c is freed from any contact with the gingiva 7 of the inner part of the upper maxilla 4. Moreover, as shown in Figures 4a and 4b, it is found that the shaper 5 is not in abutment against the teeth 1 and 2.

[45] Under these conditions, the lower part 6a of the buccal shaper 5 fulfills the role of activator by forcing forward the lower maxillary 3 to each lingual impulse, as explained below, the middle part 6b serves as lingual screen preventing the interposition of the tongue 8 between the upper and lower dental arches during swallowing, and the upper 6c and upper 6d parts provide stability in the mouth mouthpiece avoiding any movement of "pitching" or " roll "in the oral cavity.

[46] An essential difference between the mouth shaper according to the invention and the different activating devices of the prior art lies in the fact that they only work in a position of dental occlusion, that is to say when the dental arches are tight. However, we know that this position is taken by an individual for a short time during a day (it is of the order of one hour). The present oral conformer according to the invention is able to act for most of the time, that is to say during periods when the jaw is in the rest position.

[47] Indeed, it was often found that during these, the patient did not clench his teeth, and swallowed unconsciously continuously. However, in the pathologies concerned, it has been found that the swallowing is accompanied by a lingual impulse, so that during the latter the tongue 8 abuts on the middle part 6b of the mouth shaper 5 and thus transmits to the lower jawbone 3 an energy tending to advance it and compensate for its offset with the maxilla 4.

[48] Moreover, the wall of the oral shaper 5 prevents the contact of the tongue 8 with the lips of the patient, and at the same time the collection of saliva, so that it also contributes to the patient lose his bad habits at the same time that it corrects the pathology concerned.

[49] Each forward movement of the tongue 8 is of course not a brutal action, but the permanence and continuity of its actuation, almost without the knowledge of the patient, has the effect of a progressive correction of the area thus solicited and a relative replacement of the two maxillae.

[50] The oral shaper according to the invention also acts when the patient squeezes the teeth, that is to say goes from the rest position to the occlusion position, this movement having the effect of propelling the maxillary forward lower 3 under the action of the lower part 6a of the buccal shaper, made in corrected position of mandibular propulsion described below.

[51] The correction of the pathology is carried out in a natural and progressive way, without exerting on the jaw of the patient constraints which, whatever the method previous implementation, and because of the importance of these, were difficult to tolerate by said patient.

[52] In order to facilitate the positioning of the tongue 8 of the patient against the anterior middle portion 6b of the buccal shaper 5, the lower inner face thereof may, as shown in FIG. 5, form with the vertical an angle α of greater value than that formed by its outer face, so as to form an inclined lingual ramp 6f guiding the tongue 8 to the upper part of the shaper. Advantageously, as shown in Figure 96, this lingual ramp may be formed by a lip 9i integral with said inner face of the mouth shaper which extends over at least a portion of the periphery thereof and which is inclined d an angle α with respect to this wall from the top to the bottom and from the outside to the inside. This angle α may become progressively more acute from back to front, and the implantation line of said lip on the inner face of the mouth shaper may progressively rise from its lower portion 6a back to its mean portion 6b forward.

[53] As shown in Figure 6, and to allow the practitioner to adjust the degree of mandibular propulsion, the mouth shaper may include on its outer face and on at least a portion of its periphery a lip 9th inclined upwards or downwards from an angle β with respect thereto, that the practitioner will be able to cut easily in order to shape and size it according to each patient.

[54] The oral shaper according to the invention can be made from rigid materials especially from poly-methacrylate group resins, or polyurethane. It can also be made from flexible materials especially from elastomers belonging to the group consisting of polyethylene, polypropylene, polycarbonate, polymethyl methacrylate, polyurethane or polyvinyl chloride.

[55] When the oral shaper is made of a flexible material, and because of its plasticity, the patient can block it in the upper jaw with the help of the tongue, which allows him to speak much more audibly that it could not do it with the correcting apparatuses of the prior state of the art, which favors the habituation of the patient to the shaper and therefore the effectiveness of this one.

[56] In an alternative embodiment of the invention, the upper face of the mouthpiece 5 may be partially perforated as shown in Figure 7a, or constituted by a mesh, as shown in Figure 7b, to allow the patient to perceive the taste sensation transmitted by the palate.

[57] The material constituting the mouth shaper according to the invention may be able to adsorb and / or absorb aromas which, as and when the use can be released so as to improve the attractive side especially in the children. [58] Advantageously, the mouth shaper may be associated with a labial screen 11 by a link 12, in the form of a cord or a ribbon for example, of a small thickness, preferably less than 2 mm, and according to a direction perpendicular to the plane of the jaws, which screen can be placed in the anterior or anterolateral buccal vestibule (Figure 8a), or out of the mouth (Figure 8b). In these two cases, this screen may be associated with an external gripping means 13, for example a ring or a rod or a cord.

[59] It will also be possible to provide the inner wall of the oral shaper with coatings that will be attractive to the tongue (smooth and silky) in the area where it is to be positioned and, conversely, repellent for it (pins or elements). raspberry) in the areas to be avoided.

[60] The embodiment of the oral shaper according to the invention can be carried out individually or industrially.

[61] will be described below an individual embodiment of an individual embodiment of an oral conformer according to the invention.

[62] In a first step, and in a conventional manner, it is first carried out impression lower jaw 3 and upper 4 directly on the patient, in particular using an alginate product type. From these fingerprints, elements are cast, most of the time in plaster, of the two maxillae.

[63] Then, in a second step, these elements are positioned relative to one another, so that they occupy a relative position such that it is desired to obtain it after correction. An internal volume or oral cavity of base Cb is thus obtained.

[64] In a third step, the toothed portion is masked internally by means of a masking product, such as, for example, wax, silicone, putty, etc., so as to obtain an oral cavity corresponding to that which one wishes to have after correction of the jaws and teeth. This gives the oral cavity Cn. Although this step is not essential, it will be done most of the time, and this to correct any malpositions of teeth.

[65] In a fourth step, the oral cavity is lined, either the cavity Cb if there has been no masking, or the cavity Cn if there has been masking, with a product whose thickness is equal to that which is desired to give the oral shaper. A third oral cavity C1 is thus obtained.

[66] A model is made (for example in plaster) constituted by an impression of the third oral cavity C1.

[67] Finally, this model is used to mold, on the latter, for example by thermoforming, the buccal shaper 5.

[68] It is understood in these conditions that when the latter is placed in the oral cavity of a patient of the aforementioned pathology, its lower part will bear on the gingiva of the inner part of the lower jaw 3 and its upper part 6c will be clear of any contact with the gingiva of the inner part of the maxillary upper 4.

[69] Of course, the present invention may also be implemented industrially. In this type of implementation, it will not realize then taking personalized impressions of the upper and lower jaws of the jaw of the patient.

[70] The oral conformator will be made from statistical measurements performed on groups of individuals considered normal with oral characteristics. Within each group of individuals, a statistical average of the sizes of the oral shaper will be established and a mean oral shaper will be made for each group which can be worn by any individual in this group. This will provide a set of "sizes" of the oral shaper.

[71] Clinically, the practitioner will simply take "in the mouth" measurements of the maxillary without being forced to take fingerprints of the latter. These measurements may in particular be taken by means of a measurement rule such as that represented in FIGS. 9 and 10.

[72] This rule 10 has a general shape in the form of a "T" "U". It is made of a sheet of easily deformable material, and essentially consists of a central branch 10a, a transverse branch 10b and a horseshoe branch 10c.

[73] The branches 10a to 10c are provided with graduations to record the different measurements in the lower jaw using the branch 10c, and the upper jaw using the branches 10a and 10b.

[74] Using the transverse branch 10b, measure the gap b existing between the symmetrical teeth 2 and 2 'of the upper maxillary while the graduations of the branch 10a give for this distance b the distance a separating these teeth from the anterior part of the maxillary. As shown in FIG. 9, measurement rule 10 can also be used to determine, for each pair of symmetrical teeth 2, 2 ', the height h of the palatal vault at this location. To achieve this, the clinician will press the "palate" rule on the "0" scale in the mouth and measure the length e using the ruler (Figure 10). The distance d = b / 2 being known, a simple calculation will give the value h of the height of the vault at this point: h = Ve ² -d ² .

Claims

Claims [1]

1. Oral conformer intended to take place in the oral cavity of a patient's jaw in order to correct a pathology in which the lower jaw (3) is set back from the upper jaw (4), associated with the vestibulo-version teeth, comprising a shell (5) open at least on its posterior and lower parts and whose upper part is intended to be applied against the palatal arch, characterized in that the shape of the shell (5) is such that when the shaper is in position in said oral cavity:

it is free from any contact with the teeth (1, 1 ') of the lower jaw (3),

- at least one zone of its lower part (6a) abuts on the gingiva (7) of the inner part of the lower jaw (3),

- It is released from contact with the gum (7) of the inner part of the maxilla (4).

2. Oral conformator according to claim 1 characterized in that the shape of the shell (5) is such that the aforesaid zone (6a) consists of at least its anterior portion.

3. Oral conformer according to one of the preceding claims characterized in that the shape of the shell (5) is such that the aforesaid zone (6a) consists of the entire periphery thereof.

4. mouthpiece according to one of the preceding claims characterized in that the inner face of the shell (5) comprises, on at least a portion of its periphery, means for guiding the tongue (8) towards its upper part, consisting of an inclined lingual ramp (6f, 9i) of an angle (α) from the top to the bottom and from the outside inwards with respect to the vertical, which ramp is formed by an inclination (6f) of the inner face of the middle portion (6b) or lower (6a) of the shell (5) and / or a lip (9i) integral with said inner face.

5. Oral conformer according to one of the preceding claims characterized in that the shell (5) has on its outer face and on at least a portion of its periphery a lip (9e) inclined at an angle (β) with respect to it.

6. Oral conformer according to one of the preceding claims characterized in that its upper face (6d) is partially openwork or consists of a mesh.

7. mouthpiece according to one of the preceding claims, characterized in that its outer face is connected to a labial screen (11) by a link (12), in the form of a cord or a ribbon, and in a direction perpendicular to the plane of the jaws, which screen is intended to be placed either in the anterior or anterolateral mouth vestibule, or out of the mouth.

8. A method of manufacturing a buccal shaper intended to correct a pathology in which the lower jaw (3) of the jaw of a patient occupies a position set back from the upper jaw (4), characterized in that comprises the steps of:

- Take an impression of the upper and lower jaws,

- Pouring elements, especially plaster, from said fingerprints,

- Positioning these elements relative to each other, so that they occupy a position relative to that which is desired for the maxilla after correction, these elements thus defining a base cavity (Cb),

- Lining said resultant oral cavity with a masking product, the thickness of which is equal to that which is desired to give the oral shaper, so as to obtain a third oral cavity (Cl),

- Make a model, especially in plaster, of the third oral cavity (Cl),

- Use this model to mold on it, the mouth shaper.

9. A method according to claim 8 characterized in that it comprises an intermediate step consisting, once said two elements positioned, to mask internally the toothed portion of these elements with a masking product, so as to obtain an oral cavity (Cn).

10. Method according to one of claims 8 or 9 characterized in that the molding of the mouth shaper (5) on said model is made by thermoforming.

11. A method of manufacturing an oral shaper according to one of claims 1 to 10 characterized in that it comprises a step of measuring the positioning of the teeth of the lower jaw (3) and / or upper (4) of the jaw of a patient, by means of a rule consisting of a central branch (10a) and a transverse branch (10b) graduated forming a "T", made of a deformable material.