WO2010058181A1 - Appareils orthodontiques de positionnement de dents - Google Patents

Appareils orthodontiques de positionnement de dents Download PDF

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Publication number
WO2010058181A1
WO2010058181A1 PCT/GB2009/002725 GB2009002725W WO2010058181A1 WO 2010058181 A1 WO2010058181 A1 WO 2010058181A1 GB 2009002725 W GB2009002725 W GB 2009002725W WO 2010058181 A1 WO2010058181 A1 WO 2010058181A1
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WO
WIPO (PCT)
Prior art keywords
appliance
component
anterior
teeth
tooth
Prior art date
Application number
PCT/GB2009/002725
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English (en)
Inventor
Andrew Mccance
Original Assignee
Ortho-Pro-Teknica Limited
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.)
Filing date
Publication date
Application filed by Ortho-Pro-Teknica Limited filed Critical Ortho-Pro-Teknica Limited
Priority to AU2009316973A priority Critical patent/AU2009316973A1/en
Priority to EP09760272A priority patent/EP2378998A1/fr
Priority to US13/130,563 priority patent/US20120129117A1/en
Publication of WO2010058181A1 publication Critical patent/WO2010058181A1/fr

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Classifications

    • 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
    • A61C7/10—Devices having means to apply outwardly directed force, e.g. expanders

Definitions

  • the present invention relates generally to the field of orthodontics and especially to orthodontic appliances that can be used in the treatment of malocclusions (i.e. misalignments of the teeth). More specifically, the invention relates to orthodontic appliances that can be used to spread, and realign crowded teeth.
  • Malocclusion is the misalignment of teeth and/or an incorrect relation between the teeth of the two dental arches, giving rise to faulty contact between upper and lower teeth; i.e. a lack of normal occlusion. Correcting malocclusions is desirable for functional as well as aesthetic reasons. Uneven distribution of masticatory forces, for example, can result in excessive wear and loosening of teeth and crowding of teeth can mean cleaning is more difficult leading to increased plaque and greater susceptibility to caries.
  • the treatment includes the separation of teeth within the arch to provide satisfactory space. Drawing the teeth outwards to alleviate the crowding of the teeth in the arch is one step towards creating a normal or near-normal occlusion. Afterwards it is often desirable to re-close spaces between teeth, by moving teeth back towards "normal" positions, in order to move further towards normal occlusion.
  • malocclusions are corrected through the use of orthodontic appliances, commonly known as "braces", which may be either “fixed” or removable".
  • Fixed appliances include a series of metal or ceramic attachments that are cemented to the teeth and connected by tensioned wires that apply forces to the attachments, and hence to the teeth, to give the desired movement.
  • tensioning wires There is wide variation in the physical properties of different tensioning wires, enabling many different movements of teeth to be undertaken as desired.
  • stainless steel wires are strong and resilient and can, in sufficient thickness, provide a rigid base upon which the teeth can be moved into ideal final positions, whereas more flexible wires (for example, from Nickel Titanium) known as “memory wires" can be easily deformed and exhibit significant 'spring back' to their original shape when bent. These memory wires are particularly useful in the initial phases of levelling and aligning teeth.
  • removable appliances are able to be removed easily, often by the user, and are not cemented into the mouth.
  • These generally have a rigid base plate, formed from plastic, acrylic or rubber, into which other components can be incorporated to increase the retention of the plate or to facilitate tooth movement.
  • removable appliances are generally fabricated from one major polymer material, for example methyl methacrylate or polymethyl methacrylate. This polymer material is generally held in place by means of additional wire components. Components are also added in the form of screws springs or flexible wires of many varying shapes and designs to act against teeth to obtain the desired movement.
  • the appliance is again made from one main polymer material as detailed above with additional wire components to aid in retention, and also, in some instances, to facilitate individual tooth movements.
  • the appliance is manufactured in a postured jaw position and thus can encourage mandibular or maxillary growth to effect a sagittal correction of the underlying jaws and teeth.
  • the brackets and wires can be sharp and cause ulceration and discomfort by rubbing against the patient's cheek, tongue and lips.
  • Tooth positioners are an alternative to conventional metal braces that have gained in popularity in recent years
  • Kesling proposed a positioner made of a resilient deformable rubber that had opposed 'U'-shape channels moulded to fit over the occlusal and incisal surfaces of the upper and lower arches respectively, applying forces to the teeth to influence their position as well as to maintain a desired relationship between the upper and lower arches. Kesling's positioners are also described in his US patent no.
  • tooth positioner 2,531 ,222 and another early example of a tooth positioner is seen in GB 1550777 (Suyehiro). It is only much more recently, however, that positioners have been proposed as a realistic alternative to conventional metal braces. Recent examples of tooth positioners include those provided by Ortho-Pro-Teknica Ltd under the brand name ClearStepTM and by Align Technology, Inc. under the brand name InvisalignTM.
  • positioners can comprise moulded polymeric trays or shells of generally U-shape form that fit over the teeth of the upper or lower arch. They are colourless and transparent so are aesthetically much improved compared with the conventional braces.
  • a realignment of the teeth can be achieved by using a series of positioners, each positioner typically to be worno for a period of several weeks, to incrementally reposition the teeth.
  • the positioners can be removed by the patient themselves to allow their teeth to be cleaned avoiding the dental hygiene problems associated with the fixings of metal braces.
  • a general aim of aspects of the present invention is to provide removable teeth positioning appliances that are effective and easy to use, hidden from view, and move crowded teeth5 downwards or upwards, moving the teeth into a broader and longer dental arch form, and separating any overlapping teeth, in advance of further repositioning.
  • "Removable appliances” are appliances that can be removed from and replaced on a patient's dental arch relatively easily, typically by the patient themselves. This facilitates cleaning of both the device itself and the dentition. It also means that the appliance can be o manufactured in the lab (or other manufacturing facility) rather than directly in the patient's mouth
  • the invention provides an orthodontic teeth positioning appliance comprising: an anterior positioning component, a posterior component, a resilient means connecting the anterior and posterior components, wherein; the anterior positioning component is configured to be in contact with, in order to push against, the lingual faces of a plurality of anterior teeth, when worn by the user, the posterior component is configured to be anchored to at least one posterior tooth, when worn by the user, and, the resilient means urges apart the anterior positioning component from the posterior component.
  • posterior component In most cases there will be two posterior components, one for each side of the arch, each one secured to a respective tooth distal to the anterior teeth of the arch to which the anterior component is secured.
  • the, or each, posterior component will be secured to only a single tooth, normally a posterior tooth (i.e. a bicuspid or a molar tooth), known as the 'anchoring tooth'.
  • the posterior component is preferably a unit of resilient polymeric material, but can be made from any of a range of materials including rubber, polycarbonate, and acrylic.
  • a second resilient means can be used to urge the posterior components apart from one another (laterally across the patient's arch).
  • This second resilient means may take the form of an omega loop spring, a conventional coil spring, a memory (e.g. Nickel Titanium - 'NiTi') wire, or any other urging means.
  • the (or each) posterior component may comprise a clasp, for instance a clasp that extends part way around one of both sides of crown of the tooth to which it is secured (e.g. a 'J' shape or 'C shape clasp), in order to anchor the posterior component.
  • a clasp for instance a clasp that extends part way around one of both sides of crown of the tooth to which it is secured (e.g. a 'J' shape or 'C shape clasp), in order to anchor the posterior component.
  • the posterior element(s) may also comprise a polymeric "bite block", to prevent upper and lower teeth coming into contact, and serving to open the user's bite.
  • This block is made of a strong and resilient material, sufficient to resist the considerable bite forces of the user.
  • the appliance may be for the maxillary (top) or the mandibular (bottom) arch, For some treatments, a patient may wear a teeth positioning appliance in accordance with this aspect of the invention on each of the maxillary and mandibular arches.
  • the anterior component will be formed from a block of resilient polymeric material, but can be made from any of a range of different materials including rubber, polycarbonate, and acrylic, and is secured to at least one anterior tooth.
  • the anterior component extends across all of the anterior teeth and is individually attached to each tooth.
  • the resilient means may be attached to the posterior component using detachable means such as magnets, clip hooks, or any other detachable method.
  • detachable means such as magnets, clip hooks, or any other detachable method.
  • the anterior component can be removed, separately from the posterior component, to facilitate cleaning, or to replace with another anterior component and resilient means combination.
  • the patient can have a range of urging forces applied, over a long period of time, using a variety of anterior components and resilient means, whilst using a single posterior component that can remain in place.
  • the anterior component may be formed from a material of constant resilience (eg. A Methacrylate polymer, rubber, polycarbonate, or acrylic), so that all of the anterior teeth, that the anterior component pushes against, are acted upon by a substantially constant force.
  • a material of constant resilience eg. A Methacrylate polymer, rubber, polycarbonate, or acrylic
  • the sections of the anterior component which directly contact with the lingual side of each tooth may be formed of materials of differing stiffnesses and/or constructions. This allows each tooth to be acted upon by an individual force, proportional to the stiffness of the material urging it, and allows for greater control of distances moved.
  • the anterior component can bypass attachment to said teeth, and the area of anterior component attached to the lingual side of each tooth can be made of a significantly less dense material, providing little or no movement.
  • the present invention may also comprise a buccal component, comprising, for example, a fixed drape, which stops the teeth being moved more than is desired by the anterior component.
  • a buccal component comprising, for example, a fixed drape, which stops the teeth being moved more than is desired by the anterior component.
  • the lingual face of the buccal component will include indents, into which the teeth can fit, which guide the teeth into predetermined positions, which may be deemed to comprise a "normal occlusion".
  • the buccal component is transparent, which may improve its aesthetic appearance.
  • the buccal component can be substituted for a removable moulded polymeric tray or shell of generally U-shape cross-sectional form that fits over the teeth of the arch in question, which can guide the teeth into precise desired positions.
  • the resilient member is preferably an urging member. It may be a spring, such as a coil spring. A nickel-titanium (Ni-Ti) coil spring is preferred. Alternatively the urging member may be an omega loop, or any other resilient means of applying the desired force.
  • the resilient member can be connected to the anterior component at one end and to the posterior component at the other end and sized so that when the appliance is secured in position in the mouth the resilient member is placed under compression (i.e. squeezed between the two components), to apply the desired force urging (i.e. in this case pushing) the anterior and posterior components away from one another.
  • the resilient member can be a coil spring mounted on a wire (i.e. with the wire passing through the spring's coils).
  • the wire can follow the path of the dental arch, and is embedded in the anterior and posterior components, with a sliding connection, such that the separation of the anterior and posterior components follows a predetermined path.
  • connection portions e.g. hooks, eyes, magnets or other methods of connection
  • the connection portions of the spring are fixed to the anterior and posterior components at points offset from the points at which the wire connects to the anterior and posterior components. Accordingly, possible interference with the sliding of the posterior component over the wire, by the connection portions, can be avoided.
  • the invention provides an orthodontic teeth positioning appliance comprising: a positioning component for mounting against the lingual face of one or more teeth in a dental arch; wherein, the positioning component comprises a plurality of regions that each bear against the lingual tooth surface of one or more teeth, when worn by the user, and each region having differing material properties from that of at least one of the other regions.
  • the positioning component of the appliance may be permanently fixed (e.g. bonded, cemented, etc) to the dentition. More preferably, however, the appliance is removable.
  • the appliance may comprise anterior and posterior positioning components as described above in the context of the first aspect.
  • Each region of the appliance may be specifically designed to have a specific strength or flexibility such that the appliance can deliver different levels of force on individual teeth.
  • the above appliance may have polymers of different physical properties bonded together into a composite appliance, with regions as described above.
  • the appliance is composed of a stiff central core, which is rigid and inflexible, whereby affording the appliance a great degree of strength and stability.
  • material of gradually increasing flexibility may be bonded such that at the tooth level, a very flexible and easily deformable material is in contact with the tooth. This can thus impart relatively gentle repositioning forces to the teeth themselves.
  • a harder, more impact resistant, material may be bonded to the core material, giving a greater resilience.
  • Very soft materials are very poor at retaining the wire components, such as archwires, which can tear the material. Accordingly, in such areas, the wires are encased in a harder impact resistant material providing a greater surface area upon which the more flexible material can be bonded.
  • the invention provides an orthodontic teeth positioning appliance comprising: a positioning component bearing against the lingual face of at least one anterior tooth in a user's dental arch when worn and, a separate, removable buccal component in contact with the buccal face of the at least one anterior tooth in a user's dental arch when worn; wherein, the anterior positioning component urges teeth outwards from the centre of the mouth when worn by the user and, the buccal component retains teeth in such a way that they are not forced outwards by the anterior positioning component more than desired.
  • the appliance of this third aspect may comprise the anterior and posterior positoning components of the first aspect above.
  • the appliance may also comprise the variable stiffness regions of the second aspect above.
  • the buccal component is attached to the same rear anchoring teeth as the posterior components.
  • the buccal component is anchored using resilient elastic members formed of conjoined loops of elastic material in a linear form known as 'power chains'.
  • 'power chains' As these power chains are formed of several consecutive loops, any of these loops can be attached to the anchoring teeth, and thus the power chain can be adjusted to a predetermined, desired, tightness so as to aid the control of how far the teeth move when urged by the anterior component.
  • the buccal component may too have elastic properties, such that it can be applied to the buccal surface of the teeth in tension, such that, over time, it will urge the teeth in a lingual direction without the need for 'power chains'.
  • the buccal component is, or power chains are, attached to the same clasps that attach the posterior component(s), by attachment to "J" or “C” hooks.
  • the buccal component may be attached using other removable means such as magnets, Velcro, or other materials having adhesion properties. This simplifies fitting of the buccal component, allows for ease of removal, and limits the required number of attachment points in a user's mouth.
  • Fig. 1 is a plan view of a teeth positioning appliance according to an embodiment, incorporating the first and second aspects of the invention.
  • Fig. 2 is a plan view of a teeth positioning appliance according to another embodiment, incorporating the first and second aspects of the invention.
  • Fig. 3 is a plan view, on an enlarged scale, of the resilient means used in the appliance of fig. 1.
  • Fig. 4 is a plan view, on an enlarged scale, of the resilient means used in the appliance of fig. 2.
  • Fig. 5 is a plan view of the teeth positioning appliance according to an embodiment, incorporating the first, second, and third aspects of the invention.
  • Fig. 6 is a side elevation view of the appliance of fig. 5.
  • Fig. 7 is a plan view of a teeth positioning appliance in accordance with another embodiment incorporating the first and third aspects.
  • Fig. 8 is a further plan view, on an enlarged scale, of one side portion of the appliance of fig. 7.
  • Fig. 9 is a plan view of a teeth positioning appliance according to an embodiment of the second aspect of the invention.
  • Fig. 10 is plan view of a teeth positioning appliance according to an embodiment of the first and third aspects of the invention.
  • the removable tooth positioning appliance [1] of fig. 1 includes a single anterior component [2] and a pair of posterior components [3].
  • the anterior component [2] When worn by a patient, the anterior component [2] is urged apart from the posterior components [3] by a part of resilient means [5] held between respective ends of the anterior component [2] and the adjacent posterior component [3], in order to separate or spread the teeth [T].
  • the anterior component [2] is formed from a resilient block of acrylic methyl methacrylate, upon which a layer of softer ethylethacrylate polymer is bonded, which lies in contact with, and provides gentle urging forces to, the lingual faces of a plurality of the user's teeth. These two component materials are bonded together by a chemical reaction and by curing with heat and pressure.
  • the exact shape of the anterior component can be formed based on an impression of the patient's arch or, more preferably, a modified or 'ideal' model of the patient's arch.
  • the anterior component [2] is itself an 'active' component and serves to reposition the teeth itself, aided in the anteroposterior alignment by addition of the spring loaded mechanics of the resilient means [5].
  • the posterior component may also be an 'active' component in a similar way.
  • the appliance is configured such that the resilient means [5] is under compression when the appliance is fitted to the user's dental arch [T], and thus exerts a force [F] on the anterior teeth, resulting in a spreading effect.
  • anterior teeth are fitted with fixed (e.g. cemented) attachments [4], with which the anterior component [2] engages, as also seen in figure 7.
  • the anterior component itself can, however, be disengaged form the attachments to enable the patient to remove the appliance themselves.
  • the engagement between the anterior component and the cemented attachments can be configured to help control the direction in which force is applied to the anterior teeth. For example, where the anterior component engages the underside of the attachment it can apply a force to extrude the tooth. This can also be seen in the example of figure 7.
  • attachments can also be cemented onto the posterior teeth to aid in retention and as an aid to uprighting or anti tipping of the teeth on translation of the tooth.
  • the attachment itself is passive but the soft base plate material, for example ethylethacrylate, can be distorted such that it is compressed under the attachment, thus bearing upwards on it, and move the tooth as desired.
  • the posterior component [3] lies in contact with the lingual face of a plurality of posterior teeth, for example premolars and molars.
  • the posterior component is also anchored to at least one posterior tooth, for example a molar [M].
  • the anchor may be an Adam's Crib [13], which is securely engaged around the molar [M] 1 with its ends embedded into the posterior component [3]. This can also be seen in the examples of figs. 2, 5, 9 and 10.
  • the resilient means [5] is shown as a coil spring mounted substantially concentrically about an archwire [6].
  • the archwire [6] which may be stainless steel and is preferably of rectangular (or other noncircular) cross-section, although very large diameter round wires may be also used, is embedded into the anterior component [2]. It may be held in place, for example, by a layer of an acrylic resin material bonded over the archwire [6] onto the material of the anterior component [2] or it may be moulded into the anterior component itself. This can also be seen in the examples of figs. 3, 7, and 8.
  • the face of the anterior component [2] which is in contact with the lingual side of the anterior teeth comprises regions of differing stiffness [15], such that while a constant force [F] is applied to the anterior component [2] by the resilient means, each tooth, or group of teeth, can have a different force applied to them, proportional to the stiffness of the region of anterior component [2] bearing against them.
  • a constant force [F] is applied to the anterior component [2] by the resilient means
  • each tooth, or group of teeth can have a different force applied to them, proportional to the stiffness of the region of anterior component [2] bearing against them.
  • a second resilient means [19] extends between the two posterior components [3].
  • This second resilient means which may be an omega spring, urges the two posterior components outwards in the direction of force 'S'. In this way the posterior components serve to urge the posterior teeth they contact outwardly to further open the arch. This can also be seen in the examples of figs. 2, 5, 9, and 10.
  • opposite ends of the archwire [6] are terminated within expansion chambers [9] inside respective posterior components [3].
  • the ends of the archwire are 'L' shaped to restrict the archwire [6] from leaving the chamber [9].
  • the archwire is thus slidably connected to the posterior component [3] such that as the anterior component is urged away in the direction of force [F], the resilient means [5] expands, and the archwire [6], slide within the chamber [9], whilst keeping the posterior [3] and anterior [2] components aligned.
  • the anchor can alternatively be, or comprise, a "bite block" [14], as also seen in fig.2, which will serve to additionally open the user's bite, and should be constructed from an impact resistant, relatively resilient, material to resist bite forces.
  • anchor wires [13] may also be embedded in a strong, generally non-flexible material, in order to resist rotation and tearing of the posterior component. This negates the possibility of the wires spinning or rotating in the base material and then ulcerating through and damaging the soft tissue cheek, lip, tongue, gingivae or mucosa of the patient's mouth.
  • the resilient means [5] can also be seen in figure 2 as an internal coil spring.
  • the coil spring [5] is retained inside an expansion chamber [9] inside the posterior component.
  • the spring acts on a plunger [10] at the end of the archwire [6].
  • the other end of the spring being formed with an anchor wire [11], which terminates in an 'L' shape [12], embedded in the posterior component [3]. This can also be seen in the example of figure 5, and as an enlarged version in figure 4.
  • Figure 3 illustrates the spring's two connection portions [7], one connection portion [7] being provided at either of its ends, and attached to, or butted against, the posterior [3] and anterior [2] components respectively.
  • Figure 4 illustrates, on an enlarged scale, the internal coil spring [5] as described above.
  • one resilient means [5] is as shown as an omega loop spring.
  • the omega loop spring forms part of the archwire [6] and thus guides the anterior [2] and posterior [3] components, as well as providing the urging force, as they move relative to one another. This can also be seen in the example of figure 10.
  • the posterior component [3] or Adams cribs [13] can be fitted with an external anchoring hook [16], which extends outwards beyond the buccal side of the teeth [T].
  • These anchoring hooks [16] can be used to retain a buccal component [17], which serves to guide and ultimately restrain the outward movement of the anterior teeth, in accordance with the third aspect of the invention ensuring that they are not urged further in the direction of force [F] than desirable.
  • This buccal component [17] can, optionally, be restrained to the anchoring hooks by means of power chains [18], or adhesion pads, , advantageously meaning that the. extent to which the buccal component [17] is restrained can be varied, also seen in figs. 5 and 6.
  • Figure 6 is a side elevation of an embodiment of the third aspect, and includes the anchoring hooks [16], power chains [18], buccal component [17] and Adam's cribs [13] described above.
  • Figure 7 shows yet another aspect of the invention, wherein the teeth positioning appliance can, optionally, be used in conjunction with a removable moulded polymeric tray or shell of generally U-shape cross-sectional form that fits over the teeth of the arch in question tooth positioner [20]. This can also be seen in the example of figure 8.
  • the posterior components [3] are fixedly mounted to the lingual face of the polymeric tray [21] as seen in fig.7.
  • the anterior component [2] then exerts force [F] on the anterior teeth, as described, which urge the teeth against the polymeric tray [20], which in turn guides the teeth into predetermined positions.
  • the lingual side of an anterior portion of the tray [21] is cut away in order that the anterior component [2] can contact the anterior teeth directly.
  • Figure 8 shows the coils spring [5], along with some of the other aspects shown in figure 7 on an enlarged scale.
  • Fig. 9 shows a further embodiment of the invention, according to the second aspect of the invention, where the anterior and posterior components are substituted by a single, sufficiently resilient component which extends throughout the anterior and posterior teeth. Regions [15] of an anterior portion of the positioning component have different stiffnesses from one another to apply different pressure to the teeth they contact in the manner already discussed above.

Abstract

L'invention concerne un appareil orthodontique de positionnement de dents, qui comprend un composant antérieur de positionnement, un composant postérieur et un moyen élastique qui relie le composant antérieur et le composant postérieur. Le composant antérieur de positionnement est configuré de manière à être en contact avec les surfaces linguales de plusieurs dents antérieures pour les repousser lorsqu'il est porté par l'utilisateur, et le composant postérieur est configuré pour être ancré sur au moins une dent postérieure lorsqu'il est porté par l'utilisateur, de telle sorte que le moyen élastique écarte le composant antérieur de positionnement du composant postérieur. De préférence, l'appareil peut être enlevé par l'utilisateur.
PCT/GB2009/002725 2008-11-21 2009-11-20 Appareils orthodontiques de positionnement de dents WO2010058181A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
AU2009316973A AU2009316973A1 (en) 2008-11-21 2009-11-20 Orthodontic teeth positioning appliances
EP09760272A EP2378998A1 (fr) 2008-11-21 2009-11-20 Appareils orthodontiques de positionnement de dents
US13/130,563 US20120129117A1 (en) 2008-11-21 2009-11-20 Orthodontic teeth positioning appliances

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB0821366.2 2008-11-21
GBGB0821366.2A GB0821366D0 (en) 2008-11-21 2008-11-21 Orthodontic teeth positioning appliances

Publications (1)

Publication Number Publication Date
WO2010058181A1 true WO2010058181A1 (fr) 2010-05-27

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US (1) US20120129117A1 (fr)
EP (1) EP2378998A1 (fr)
AU (1) AU2009316973A1 (fr)
GB (1) GB0821366D0 (fr)
WO (1) WO2010058181A1 (fr)

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