WO2008010057A2

WO2008010057A2 - Pre-adjusted self-aligner and method

Info

Publication number: WO2008010057A2
Application number: PCT/IB2007/001988
Authority: WO
Inventors: André J. HORN
Original assignee: Horn Andre J
Priority date: 2006-07-14
Filing date: 2007-07-12
Publication date: 2008-01-24
Also published as: WO2008010057A3

Abstract

A pre-adjusted self-aligner includes two or more attachments for attaching to teeth with an attachment material, tubes passing through each of the two or more attachments, a free floating wire or cable passing through the tubes, and end caps on free ends of the wire or cable. A method of correcting dental misalignments includes providing a representation of a patient's mouth to a computer for determining a course of treatment. Pre-adjusted self-aligners are created corresponding to stages of treatment. Each pre-adjusted self-aligner is removably attached to a corresponding model of the patient's mouth at intermediate stages. A first pre-adjusted self-aligner is removed from the model and attached to the patient's teeth. The first pre-adjusted self- aligner is removed after a predetermined time. A subsequent pre-adjusted self aligner is installed on the patient's teeth and removed after a specified time. The installing and removing process is repeated until treatment is completed.

Description

PRE-ADJUSTED SELF-ALIGNER AND METHOD

BACKGROUND OF THE INVENTION

a. Field of the Invention

Embodiments of this invention relate generally to the field of computer-interactive methods for diagnosis, care and treatment planning, therapeutics and treatment monitoring in the medical arena, including orthodontics. The invention also relates to real-time computer-interactive communication between a medical practitioner and his or her patient regarding diagnosis, care and treatment planning, therapeutics and treatment monitoring, and between a medical practitioner and a remotely located entities regarding these matters.

In the illustrated embodiment, the invention relates to a computerized and interactive method of planning orthodontic treatment for a patient suffering from a malocclusion. In the method, the patient's teeth are represented in a computer as three- dimensional virtual objects. The orthodontist may simulate various types of tooth movement and appliances, analyze the simulation, and thereby explore possible treatment options and appliance designs, prior to initiating treatment. The invention relates generally to types of orthodontic devices for alignment of teeth, and, more particularly, to appliances and methods for the use of pre-fabricated, pre-positioned, and pre-adjusted floating cables to correct dental alignments. b. Description of Related Art

Many forms of orthodontic appliances and methods are currently in use. Many are effective in providing doctors with the ability to move teeth in a patient's mouth. In orthodontics, a patient suffering from a malocclusion is typically treated by tightly bonding brackets to the surface of the patient's teeth. The brackets then have slots for receiving an archwire. The bracket-archwire interaction governs forces applied to the teeth and defines the desired direction of tooth movement. Typically, the bends in the wire are made manually by the orthodontist. During the course of treatment, the movement of the teeth is monitored by a highly trained orthodontist. Corrections to the bracket position and/or wire shape are made manually by the orthodontist.

Thus, a known common existing system for tooth alignment uses brackets attached to teeth by dental cement or other adhesives. A solid wire is then attached to one or more of the brackets. Tension and compression on the wire between the brackets provides the force needed to move each individual tooth into a desired position within the patient's mouth. The tension or compression on the wire is adjusted during periodic and necessary visits to a doctor's office to continue treatment and make any subsequent adjustments.

The key to efficiency in treatment and maximum quality in results is a realistic simulation of the treatment process. Today's orthodontists have the possibility of taking plaster models of the upper and lower jaw, cutting the model into single tooth models and sticking these tooth models into a wax bed, lining them up in the desired position, the so-called set-up. This approach allows for reaching a perfect occlusion without any guessing. The next step is to bond a bracket at every tooth model. This would tell the orthodontist the geometry of the wire to run through the bracket slots to receive exactly this result. The next step involves the transfer of the bracket position to the original malocclusion model. To make sure that the brackets will be bonded at exactly this position at the real patient's teeth, small templates for every tooth would have to be fabricated that fit over the bracket and a relevant part of the tooth and allow for reliable placement of the bracket on the patient's teeth. To increase efficiency of the bonding process, another option would be to place each single bracket onto a model of the malocclusion and then fabricate one single transfer tray per jaw that covers all brackets and relevant portions of every tooth. Using such a transfer tray guarantees a very quick and yet precise bonding using indirect bonding.

However, it is obvious that such an approach requires an extreme amount of time and labor and thus is too costly, and this is the reason why it is not practiced widely. The normal orthodontist does not fabricate set-ups; he places the brackets directly on the patient's teeth to the best of his knowledge, uses an off-the-shelf wire and hopes for the best. There is no way to confirm whether the brackets are placed correctly; and misplacement of the bracket will change the direction and/or magnitude of the forces imparted on the teeth. While at the beginning of treatment things generally run well as all teeth start to move at least into the right direction, at the end of treatment a lot of time is lost by adaptations and corrections required due to the fact that the end result has not been properly planned at any point of time. For the orthodontist this is still preferable over the lab process described above, as the efforts for the lab process would still exceed the efforts that he has to put in during treatment. The patient has no choice and does not know the treatment time could be significantly reduced if proper planning was done. U.S. Pat. No. 5,431 ,562 to Andreiko et al. describes a computerized, appliance- driven approach to orthodontics. In this method, first certain shape information of teeth is acquired. A uniplanar target arcform is calculated from the shape information. The shape of customized bracket slots, the bracket base, and the shape of the orthodontic archwire, are calculated in accordance with a mathematically-derived target archform. The goal of the Andreiko et al. method is to give more predictability, standardization, and certainty to orthodontics by replacing the human element in orthodontic appliance design with a deterministic, mathematical computation of a target archform and appliance design. Hence the '562 patent teaches away from an interactive, computer- based system in which the orthodontist remains fully involved in patient diagnosis, appliance design, and treatment planning and monitoring.

Another existing system for tooth alignment utilizes transparent, customized, clear trays made of plastic or other similar materials. An impression is taken of a patient's dental arch. This impression is then digitized with a scanner. A 3D computer model of the patient's teeth may be computed to create clear trays that a patient places over his or her teeth. The clear trays are designed to provide pressure on teeth such that individual teeth are moved within the mouth to correct any defects in alignment. Clear trays must be replaced every two to four weeks with new clear trays that are molded to further advance movement of the teeth according to the final target situation. Regularly scheduled trips to a dental professional are required to correctly monitor this movement and to assure practitioners success in moving the teeth. The system uses the computer model of the dentition and a treatment planning software made available for viewing by the reviewing doctor over the Internet where the doctor indicates changes to individual tooth positions. The treatment planning software generates several incremental steps at the appliance manufacturing center. A series of removable aligning devices or shells are manufactured and delivered to the orthodontist. The shells, in theory, will move the patient's teeth step-by-step to the desired or target position.

Existing systems require the expertise of dental professionals trained in orthodontics. However, dental professionals are not available to all patients requiring orthodontic care. Patients without access to dental professionals knowledgeable in orthodontics would benefit from pre-adjusted orthodontic appliances that may safely be used by general practice dentists.

Needs exist for improved devices and methods for dental alignment procedures that are pre-adjusted and ready to use.

SUMMARY OF THE INVENTION The invention solves the problems and/or overcomes the drawbacks and disadvantages of the prior art by having a simple, easy to use, ready-to-serve, pre- adjusted form that may be installed by a general practice dentist or an orthodontist. Certain embodiments of the invention accomplish this by providing a ready to use, pre-adjusted self-aligner. The pre-adjusted self-aligner includes two or more attachments for attaching to teeth with an attachment material, tubes embedded in each of the two or more attachments so the tube and pads are one piece, a free floating wire or cable passing through the tubes, and end caps on free ends of the cable.

In a preferred embodiment, the attachment material is a removable, reusable adhesive.

The length, cross section and resilience of the cable is variable. In certain preferred embodiments, mechanical pressure of the cable automatically aligns teeth. The apparatus can be utilized for vestibular or lingual orthodontics.

Embodiments of the present invention also include methods of correcting dental misalignments. A representation of a patient's current mouth status is created. Preferably, the representation is a digital model that can be created by CT scans or other types of scans. The representation information is then preferably provided to a computer program for determining a final status of a patient's mouth and intermediate stages. Based upon the results of the computer program, one or more pre-adjusted self-aligners are created corresponding to the intermediate stages of treatment. Preferably two or more pre-adjusted self aligners are used; most preferably three or more aligners are used. One or more models of the patient's mouth at intermediate stages are created. Each pre-adjusted self-aligner may be removably attached to a corresponding model in the position of installation in a patient's mouth. In certain embodiments the combined pre-adjusted self-aligners are then sent directly to a patient or medical professional. A first pre-adjusted self-aligner is removed from the model. The first pre-adjusted self-aligner is then attached to the patient's teeth. The patient is released and preferably returns in approximately two to three months. At that time, the first pre-adjusted self-aligner can be removed. A subsequent pre-adjusted self aligner is installed on the patient's teeth. The subsequent pre-adjusted self-aligner is removed after a specified time. The installing and removing process is repeated until all the pre-adjusted self-aligners have been used.

In a preferred embodiment, a medical professional may clean the patient's teeth before installation of the first pre-adjusted self-aligner.

In a preferred embodiment, the pre-adjusted self aligners may be installed on the inside or outside surfaces of teeth.

Preferably, the creating of multiple pre-adjusted self-aligners is performed offsite at a centralized location. In a preferred embodiment, a patient and/or medical professional may adjust a course of treatment before installing subsequent pre-adjusted self-aligners. A course of treatment may include approximately two to three pre-adjusted self-aligners.

The present invention may also include a post-alignment treatment. The post- alignment treatment may include use of a post-alignment pre-adjusted self-retainer. Additional features, advantages, and embodiments of the invention may be set forth or apparent from consideration of the following detailed description, drawings and claims. Moreover, it is to be understood that both the foregoing Summary and the following detailed description are merely exemplary and intended to provide further explanation without limiting the scope of the invention as claimed.

BRIEF DESCRIPTION OF THE INVENTION

The accompanying drawings, which are included to provide a further understanding of the invention and are incorporated in and constitute a part of this specification, illustrate preferred embodiments of the invention and together with the detailed description serve to explain the principles of the invention. In the drawings: Fig. 1 is a top view of a self-aligner installed on outer surfaces of bottom teeth on a mold.

Fig. 2 is a detail view of the self-aligner device of Fig. 1.

Fig. 3 is a detail of the cable end of the self-aligner device of Fig. 1.

Fig. 4 is a top view of a self-aligner device installed on inner surfaces of upper teeth on a mold.

Fig. 5 is a perspective view of an embodiment of an attachment with a cable passing though a tube.

Fig. 6 is an end view of the attachment of Fig. 5 without the associated cable.

Fig. 7 is a vertical cross section of the attachment of Fig. 6. Fig. 8 is a horizontal cross section of the attachment of Fig. 6.

Fig. 9 is an end view of an embodiment of an attachment.

Fig. 10 is a vertical cross section of the attachment of Fig. 9.

Fig. 11 is a horizontal cross section of the attachment of Fig. 9. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention is an improved device and method for alignment of teeth. While prior art methods require highly trained orthodontics experts to interact directly with the patient, embodiments of the present invention can be performed by inexperienced dentists or technicians. Instead of highly trained experts in the field directly interacting with the patient, embodiments of the present invention utilize highly trained individuals at a central factory. Thus, they can utilize economics of scale to service a greater number of individuals. This also permits orthodontic services to be delivered to remote and inaccessible areas. The present invention anticipates a proper alignment of teeth and provides a series of sequential steps for correcting dental alignment. During each sequential step, a patient is provided with a new pre-adjusted self-aligner that is removably installed on the patient's teeth. After each sequential step, progress is checked before a new pre-adjusted self-aligner is installed. After treatment, the last pre-adjusted self-aligner is removed from the patient's mouth.

A treatment according to certain embodiments of the present invention begins with a trip to a medical professional. The medical professional is preferably an orthodontist or general dentist or dental hygienist. However, any medical professional may be trained to use the apparatus and method of the present invention. During the initial visit, a model of the patient's mouth is made. Preferably, the model is generated by a scan or three dimensional digital examination of the patient's mouth. The data collected for the scan can be transmitted to a remote location via the Internet for further processing. In this manner, preferred embodiments of the invention use 3-D computer imaging technology to depict the complete treatment plan from the current state of the patient's mouth to the final desired position. A digital or other representation of the patient's mouth is prepared from the scan. Such scanning systems are known in the art. For example, U.S. Pat. No. 4,837,732 and U.S. Pat. No. 4,575,805 to Brandestini and Moermann, which are herein incorporated by reference in their entirety, propose a scanning system for in vivo, non-contact scanning of teeth. The patents describe a procedure for optically mapping a prepared tooth with a non-contact scan-head. The scan-head delivers the contour data, converted to electrical format, to be stored in a memory. A computer reads the memory following a line scan pattern. A milling device is slaved to follow this pattern by means of position control signals and mills an implant for the prepared tooth cavity. U.S. Pat. No. 5,372,502 to Massen et al., also incorporated by reference in its entirety, similarly describes an optical probe for measuring teeth that works on a similar principle. U.S. Pat. No. 7,029,275, incorporated by reference in its entirety, also describes computer based digital transformation for orthodontic purposes. In a preferred embodiment, the scan is completed with a CT scanner or a CBCT scanner. Alternatively, an impression of the patient's mouth may be made from traditional methods and materials. This impression or mold can be sent to a remote location for scanning and/or other manipulation. The scan or impression represents the current state of the patient's mouth.

A final alignment of a patient's teeth is anticipated based upon the current state of the patient's mouth, a desired end result and input from the medical professional and patient. Using the scan or impression of the initial state of a patient's mouth, the final state of a patient's treatment is anticipated. A computer program determines a preferred course of treatment. Intermediate stages along the preferred course of treatment are then determined to allow a transition from the current state of the patient's mouth to the anticipated final state. Each intermediate stage corresponds to a unique pre-adjusted self-aligner. Embodiments of the invention move teeth through the appropriate placement of controlled forces are transmitted through cable that is partly constrained by the attachment.

The specific placement of attachments is determined along with treatment length and other information is determined. While a wire through the tubes will provide excellent results, other more preferred embodiments utilize a cable of two and preferably three or more strands of wire. The strands are twined to form a wire rope. In certain preferred embodiments the cable is drawn through successive dies to reduce its diameter until the outer surface of the cable is substantially smooth. A cable of all nickel- titanium alloy strands has been found to have an improved elasticity over a super elastic nickel-titanium wire of the same diameter. See U.S. Pat. No. 6,278,057, which is herein incorporated by reference in its entirety. The cable is often used in medical devices in which increased elasticity of a wire-like element is desired. Twisted and drawn cables incorporating a strand of a radiopaque metal or alloy with one or more nickel-titanium strands may be used in devices in which radiopacity of a flexible portion of the device is desired. Thus, the elasticity of the cable can be manipulated by a number of factors, including variation in the pitch and rise of the helix in the cable, the number of wires in the actual cable, and whether the cable is made up of one or more cables itself. The cable composition, structure, a manipulation by a practitioner can affect its "memory", which some embodiments of this invention utilize to assist in the archwise movement of the teeth. Tempering a wire or cable can also affect the memory of the wire or cable in a manner well known to those in the metallurgical arts.

The cross section, resilience and end length of a wire or cable is determined for each pre-adjusted self-aligner. The end length is important for sizing purposes. Calculation of the total length of the wire or cable is calculated in excess to allow for automatic alignment. These determinations may be completed at the medical professional's office or at a laboratory where the pre-adjusted self-aligners are manufactured.

Once each distinct stage of the treatment is determined, the individual pre- adjusted self-aligners are fabricated and can be supplied to the patient.

Figs. 1 - 3 show views of a pre-adjusted self-aligner 11 that span the entire set of teeth. Naturally, the practitioner can also manipulate a subset of the teeth, e.g., only the left upper molars. The pre-adjusted self-aligner 11 is installed on a mold 13 in a laboratory or factory. The pre-adjusted self-aligner 11 includes a cable 15 and two or more attachments 17. The attachments 17 are preferably made from ivory colored plastic, however, other colors and materials may be used. The attachments 17 are attached to preselected, individual teeth with a bonding agent 19. A tube 21 perforates each individual attachment 17. The tubes 21 are preferably made of metal and are approximately 0.020 or 0.022 inches in diameter. The cable 15 is threaded through each tube 21 in each attachment 17. End caps 23 prevent the floating cable 15 from sliding completely through the tubes 21. The cable 15 is varied with each individual pre- adjusted self-aligner 11. The cross section and resilience of each cable 15 is gradually increased with each pre-adjusted self-aligner 11. Preferably, the first pre-adjusted self- aligner 11 has a cable 15 with an approximately 0.016 inch cross section. Subsequent cables 15 have cross sections of approximately 0.018 or 0.020 inches.

Fig. 4 shows a view of a pre-adjusted self-aligner 25 from below a top portion of a mouth. The pre-adjusted self-aligners may be installed on the inside surfaces or outside surfaces of the patient's teeth. In Fig. 4, the pre-adjusted self-aligner 25 may be installed on the inside surfaces of the upper teeth.

Figs. 5 - 8 are views of an embodiment of an attachment 31. A surface 33 can be applied to a tooth with an adhesive. The opposite surface 35 may preferably be rounded. A tube 37 preferably perforates the attachment 31 , entering at a first end 39 and exiting at a second end 41. The tube 37 is preferably cylindrical, and may have beveled ends 43. This configuration creates an inner tube 49 that is narrower than the entrance and exit of the tube 37. A cable 45 passes through the tube 37 and may have an end cap 47. In a preferred embodiment, the attachment 31 may be sized as follows: width approximately 2.5 mm, length approximately 2.3 mm, height approximately 1.5 mm, diameter of the inner tube approximately 0.5 mm, height of center point of tube 57 above surface 53 approximately 0.5 mm, and length of bevels approximately 0.3 mm.

Figs. 9 - 11 are views of an embodiment of an attachment 51. A surface 53 can be applied to a tooth with an adhesive. The opposite surface 55 may preferably be rounded. A tube 57 preferably perforates the attachment 51 , entering at a first end 59 and exiting at a second end 61. The tube 57 is preferably cylindrical, and may have beveled ends 63. This configuration creates an inner tube 69 that is narrower than the entrance and exit of the tube 57. In a preferred embodiment, the attachment 51 may be sized as follows: width approximately 3.5 mm, length approximately 2.3 mm, height approximately 1.2 mm, diameter of the inner tube approximately 0.5 mm, height of center point of tube 57 above surface 53 approximately 0.5 mm, and length of bevels approximately 0.3 mm.

The pre-adjusted self-aligners are fabricated at an offsite laboratory or factory. The only information that is required for manufacturing of the pre-adjusted self-aligners is the results of the. scan or impression performed at the medical professional's office. The patient does not need to be present at the laboratory or factory. This decentralized manufacturing process allows medical professionals from diverse geographic areas to use a limited number of manufacturing locations. The pre-adjusted self-aligners are manufactured and adhered to a model of the patient's mouth with removable glue or adhesive. The model is preferably a silicon cast of the patient's mouth made according to the medical professional's scan or impression. The attachments are placed on the model in the position that they should be placed on the patient's teeth. The position of each attachment is chosen to affect the desired dental alignment. A complete series of pre-adjusted self-aligners may be fabricated based on the anticipated stages of treatment. The pre-adjusted self-aligners and model are shipped to the medical professional's office by mail or other means. The patient is brought in to begin treatment. Preferably, a medical professional cleans the patient's teeth before beginning treatment. A first pre-adjusted self-aligner is selected. The attachment material connecting the first pre-adjusted self-aligner to the mold of the patient's mouth is removed. The location of the attachments on the mold shows the medical professional where to attach the attachments on each individual tooth.

The medical professional then uses an attachment material to adhere the attachments on the patient's teeth in the location indicated by the mold. The attachment material is preferably a removable, reusable, temporary adhesive. The adhesive is strong enough to hold the attachments on the teeth during the patient's daily course of activities, but still allows for easy removal of the attachments during installation of the subsequent pre-adjusted self-aligner. Alternatively, traditional dental cement or other adhesives may be used to attach the attachments to the teeth. After installation of the pre-adjusted self-aligner, the cable is a free floating cable.

The end of the cable are designed or capped in such a manner that they will not slip out of the two most distal tubes. When a new cable is to be installed, one of the cables caps is removed and the old cable pulled out. A new, pre-tensioned and shaped cable is then pulled through the empty tubes and the cable end(s) capped. Tension or compression of the cable provides the pressure necessary to force movement of the teeth in a desired direction. The physical memory of the cable is used to treat dental misalignments. The cable is bent during installation and the inclination to return to a relaxed state provides the necessary force to adjust the dental alignment. The cable is not fixed to the attachments, but is allowed to float within the tubes. The mechanical pressure of the cable automatically aligns the teeth. By varying the thickness of the cable as well as the pitch and tightness of the coiling in the strands of the cable, the forces exerted on individual teeth can be modified. While the cable is free floating within the attachment tube in preferred embodiments, fixing the cable to specific individual teeth while permitting free floating of the cable in others is also contemplated in certain embodiments.

The patient is released and returns to the medical professional's office within a prescribed time, preferably after approximately two to three months. Time between visits to the medical professional's office varies depending on the circumstances of the individual treatment. In many cases, after wearing the first pre-adjusted self-aligner for about three months, approximately fifty percent of the patient's tooth malocclusions are fixed. Manipulations of different cables can be utilized for much of the tooth movement; however, the attachments can also be moved to better focus the forces of the cable. In this embodiment, the existing pre-adjusted self-aligner is removed from the patient's mouth. The bond between the attachments and the teeth is broken and the entire pre- adjusted self aligner is removed. The medical professional checks the progress of the dental alignment. If adjustments to the treatment are required, the medical professional notes those changes. If necessary, a new scan or impression is taken and sent to the laboratory for creation of new, subsequent pre-adjusted self-aligners. If the treatment is progressing as anticipated or when new pre-adjusted self- aligners arrive, the medical professional installs a second pre-adjusted self-aligner in a manner as described above for the first pre-adjusted self-aligner.

The patient is again released and returns to the medical professional's office after a pre-determined time. After wearing the second pre-adjusted self-aligner for about two to three months, approximately seventy to seventy five percent of the patient's tooth misalignments are fixed. The second pre-adjusted self aligner is removed from the patient's mouth and the medical professional assesses the status of the treatment. If this is the last pre-adjusted self-aligner required in the course of treatment and the medical profession and patient are satisfied with the results, the patient is released. Final adjustments may be performed with a specially fabricated post-alignment pre- adjusted self-aligner. For example, embedded tubes may be squared with an approximately 0.022 by approximately 0.022 inch section. Alternatively, clear trays may be used or classic adhesive bonding techniques for post-alignment treatment. If more treatment is required other than the post-alignment treatment, subsequent pre-adjusted self-aligners are installed as described above. The process is iterative until a desired final result is achieved. Any post-alignment treatment is then performed. Preferably, about three to five pre-adjusted self-aligners are required for a standard course of treatment with the pre-adjusted self-aligners being replaced roughly every three months. Other courses of treatment are possible depending on individual circumstances.

The pre-adjusted self-aligners may be made for vestibular or lingual use. Although the foregoing description is directed to the preferred embodiments of the invention, it is noted that other variations and modifications will be apparent to those skilled in the art, and may be made without departing from the spirit or scope of the invention. Moreover, features described in connection with one embodiment of the invention may be used in conjunction with other embodiments, even if not explicitly stated above.

Claims

WHAT IS CLAIMED IS:

1. A pre-adjusted self-aligner apparatus comprising: two or more attachments for attaching to teeth with an attachment material, tubes passing through each of the two or more attachments, a free floating wire passing through the tubes, and end caps on free ends of the cable.

2. The apparatus of claim 1 , wherein the wire is a polymer or metal cable.

3. The apparatus of claim 1 , wherein the attachment material is a removable, reusable adhesive.

4. The apparatus of claim 1 , wherein the length, cross section and resilience of the cable is variable.

5. The apparatus of claim 1 , wherein the apparatus is used for one portion of an overall treatment.

6. The apparatus of claim 4, wherein the entire apparatus is removed after one portion of an overall treatment and replaced with a new prefabricated apparatus.

7. The apparatus of claim 1 , wherein the apparatus is prefabricated in a factory or laboratory.

8. The apparatus of claim 1 , wherein the apparatus is installed on the inside or outside surfaces of teeth.

9. The apparatus of claim 1 , wherein mechanical pressure of the cable automatically aligns teeth.

10. The apparatus of claim 1 , wherein the apparatus is replaced after approximately two to three months of wear.

1 1. The apparatus of claim 1 , wherein the apparatus is for vestibular or lingual use.

12. A method of correcting dental misalignments comprising: creating a representation of a patient's current mouth status, providing the representation information to a computer program for determining a final status of a patient's mouth and intermediate stages, creating one or more pre-adjusted self-aligners corresponding to the intermediate stages, wherein the one or more pre-adjusted self-aligners comprise two or more attachments for attaching to teeth with an attachment material, tubes passing through each of the two or more attachments, a free floating cable passing through tubes, and end caps on the free ends of the cable, creating one or more models of the patient's mouth at intermediate stages, removably attaching each pre-adjusted self-aligner to a corresponding model in the position of installation in a patient's mouth, removing a first pre-adjusted self-aligner from the model, attaching the first pre-adjusted self-aligner to the patient's teeth, removing the first pre-adjusted self-aligner from the patient's teeth after a specified time, installing a subsequent pre-adjusted self aligner to the patient's teeth, removing the subsequent pre-adjusted self-aligner after a specified time, and repeating the installing and removing process until all the pre-adjusted self-aligners have been used.

13. The method of claim 12, further comprising cleaning the patient's teeth before installation of the first pre-adjusted self-aligner.

14. The method of claim 12, wherein the representation of the patient's current mouth status is a digital representation.

15. The method of claim 12, further comprising varying the cross section, resilience and length of the cable between pre-adjusted self-aligners.

16. The method of claim 12, wherein the pre-adjusted self aligners are installed on the inside or outside surfaces of teeth.

17. The method of claim 12, wherein the creating of one or more pre-adjusted self-aligners is performed offsite at a centralized location.

18. The method of claim 12, wherein the attachment material is a removable, reusable adhesive.

19. The method of claim 12, wherein mechanical pressure of the cable automatically aligns teeth.

20. The method of claim 12, wherein time between installations of pre- adjusted self-aligners is approximately two to three months.

21. The method of claim 12, further comprising adjusting a course of treatment before installing subsequent pre-adjusted self-aligners.

22. The method of claim 12, further comprising a post-alignment treatment.

23. The method of claim 22, wherein the post-alignment treatment comprises use of a post-alignment pre-adjusted self-aligner.

24. The method of claim 12, wherein a course of treatment comprises four to five pre-adjusted self-aligners.

25. The method of claim 12, wherein the pre-adjusted self-aligners are for vestibular or lingual use.

26. A method of correcting dental misalignments comprising: creating a digital representation of a patient's initial mouth status, providing the digital representation to a computer program, determining a desired final status of a patient's mouth, determining at least one intermediate stage of treatment, creating two or more pre-adjusted self-aligners corresponding to an initial treatment and treatments for each of the at least one intermediate stage of treatment, wherein the creating is performed at an off site, centralized location, wherein the two or more pre-adjusted self-aligners comprise two or more attachments for attaching to teeth with an attachment material, tubes passing through each of the two or more attachments, a free floating cable passing through tubes, and end caps on the free ends of the cable, creating two or more models of the patient's mouth at an initial stage and at the at least one intermediate stage corresponding with the two or more pre-adjusted self-aligners, removably attaching each pre-adjusted self-aligner to a corresponding model in the position of installation in a patient's mouth, sending the two or more pre-adjusted self-aligners to a patient, removing a first pre-adjusted self-aligner from the model, attaching the first pre-adjusted self-aligner to the patient's teeth, removing the first pre-adjusted self-aligner after a specified time, installing a subsequent pre-adjusted self aligner to the patient's teeth, removing the subsequent pre-adjusted self-aligner after a specified time, repeating the installing and removing process until all the pre-adjusted self-aligners have been used.

27. A method of doing business wherein the digital image of a person's teeth are transmitted to a remote location and pre-adjusted self aligners are manufactured and sent back to the remote location for use in the method of claim 26.