WO2011155990A2

WO2011155990A2 - Hybrid orthodontic device and system

Info

Publication number: WO2011155990A2
Application number: PCT/US2011/001037
Authority: WO
Inventors: B. Chia Soo
Original assignee: Soo B Chia
Priority date: 2010-06-07
Filing date: 2011-06-06
Publication date: 2011-12-15
Also published as: WO2011155990A3

Abstract

Provided herein is a force system for repositioning teeth and the methods of making and using the system.

Description

HYBRID ORTHODONTIC DEVICE AND SYSTEM

FIELD OF THE INVENTION

The present invention is related generally to the field of orthodontics.

BACKGROUND OF THE INVENTION

Conventional method of repositioning teeth is to make users wear what are commonly referred to as "braces." Braces include a variety of appliances such as brackets, archwires, ligatures, and O-rings. The procedures of conventional orthodontics are briefly described here: Before fastening braces to a user's teeth, at least one appointment is typically scheduled with the orthodontist, dentist, and/or X- ray laboratory so that X-rays and photographs of the user's teeth and jaw structure can be taken. Also during this preliminary meeting, or possibly at a later meeting, an alginate mold of the user's teeth is typically made. This mold provides a model of the user's teeth that the orthodontist uses in conjunction with the X-rays and photographs to formulate a treatment strategy. The orthodontist then typically schedules one or more appointments during which braces will be attached to the user's teeth.

At the meeting during which braces are first attached, the teeth surfaces are initially treated with a weak acid the acid optimizes the adhesion properties of the teeth surfaces for brackets and bands that are to be bonded to them. The brackets and bands serve as anchors for other appliances to be added later. After the acid step, the brackets and bands are cemented to the user's teeth using a suitable bonding material. No force-inducing appliances are added until the cement is set. For this reason, it is common for the orthodontist to schedule a later appointment to ensure that the brackets and bands are well bonded to the teeth.

The primary force-inducing appliance in a conventional set of braces is the archwire. The archwire is resilient and is attached to the brackets by way of slots in the brackets. The archwire links the brackets together and exerts forces on them to move the teeth over time. Twisted wires or elastomeric O-rings are commonly used to reinforce attachment of the archwire to the brackets. Attachment of the archwire to the brackets is known in the art of orthodontia as "ligation" and wires used in this procedure are called "ligatures." The elastomeric O-rings are called "plastics."

After the archwire is in place, periodic meetings with the orthodontist are required, during which the user's braces will be adjusted by installing a different archwire having different force inducing properties or by replacing or tightening existing ligatures. Typically, these meetings are scheduled every three to six weeks.

Therefore, attaching the appliances to a user's teeth is tedious and time consuming enterprise and requires many meetings with the treating orthodontist.

Various methods have been proposed to simplify and to reduce the cost of orthodontics with limited success. For example, Kuroda et al. (1996) Am. J.

Orthodontics 1 10:365-369 describes a method for laser scanning a plaster dental cast to produce a digital image of the cast. See also U.S. Patent No. 5,605,459. U.S.

Patent Nos. 5,533,895; 5,474,448; 5,454,717; 5,447,432; 5,431 ,562; 5,395,238;

5,368,478; and 5, 139,419, assigned to Ormco Corporation, describe methods for manipulating digital images of teeth for designing orthodontic appliances.

U.S. Patent No. 5,01 1 ,405 describes a method for digitally imaging a tooth and determining optimum bracket positioning for orthodontic treatment. Laser scanning of a molded tooth to produce a three-dimensional model is described in U.S. Patent No. 5,338,198. U.S. Patent No. 5,452,219 describes a method for laser scanning a tooth model and milling a tooth mold. Digital computer manipulation of tooth contours is described in U.S. Patent Nos. 5,607,305 and 5,587,912.

Computerized digital imaging of the jaw is described in U.S. Patent Nos. 5,342,202 and 5,340,309. Other patents of interest include U.S. Patent Nos. 5,549,476;

5,382, 164; 5,273,429; 4,936,862; 3,860,803; 3,660,900; 5,645,421 ; 5,055,039;

4,798,534; 4,856,991 ; 5,035,613; 5,059, 1 18; 5,186,623; and 4,755, 139.

U.S. Patent Nos. 6,398,548 and 6,554,61 1 describes using a computer program predict the teeth movement from initial tooth positions to the final tooth positions and design and fabricate a series of appliances having different geometries to achieve the repositioning of the teeth from their initial positions to their final positions in one set of appliances in that the user receives a whole set of appliances from the beginning to the finish. The appliances are numbered or marked in the sequence for use. The problem is that if certain tooth movement is behind the expected tooth position, the discrepancy between actual tooth position and expected (predicted) tooth position will most likely increase further and further during the course of repositioning. In addition, teeth with increased discrepancies between actual and expected positions will experience a disproportionate load of force relative to the other teeth and lead to increased patient pain and discomfort. Another type of common orthodontic devices is removable aligner (see Figures 1 -4). However, such aligners also cause discomfort and speaking hindrance. Patients are reluctant to wear such these in the day time. This will cause the tooth under orthodontic treatment to bounce back/relapse to its original position so as to decrease the effectiveness of orthodontic treatment using these removable devices.

A further problem of current clear tooth aligners is its limited aligning force so as to limit application of clear tooth aligners to light cases.

The embodiments described below address the above identified needs and issues.

SUMMARY OF THE INVENTION

Provided herein is an orthodontic force system for repositioning teeth. In some embodiments, the present invention provides a system for repositioning teeth from an initial tooth arrangement to a final tooth arrangement. The system comprises comprising one or more cycle of successive appliances and one or more retainers, the system comprising:

a first removable aligner or appliance having a geometry selected to reposition the teeth from the initial tooth arrangement to a first intermediate arrangement or the final tooth arrangement;

optionally one or more removable aligners or appliances having geometries selected to progressively reposition the teeth from the first intermediate arrangement to successive intermediate arrangements including a last intermediate tooth arrangement;

a final removable retainer or appliance having a geometry selected to progressively reposition the teeth from the initial tooth arrangement or the last intermediate arrangement to the final tooth arrangement; and

one or more retainer to hold the teeth in the first intermediate arrangement, the successive intermediate arrangements, or the final arrangement,

wherein the appliances comprise successive locks having different geometries shaped to receive and allow the appliances to reposition teeth from one arrangement to a successive arrangement.

The successive locks can be formed of a material that includes a metallic material, a plastic material, and/or a polymeric material. Some examples of the locks include, e.g., polymer shells, polymer rings, metal wires or clips, hard plastic clips, ceramic clips, or elastic polymeric shells or rings. In some embodiments, the locks specifically exclude polymeric shells.

In some embodiments, the appliances can be made to have different configurations to achieve different force systems. For example, the shells or rings on an appliance can have at least a region including two or more layers of a polymeric material to achieve the force system. In some embodiments, the shells or locks can be made to have uniform or non-uniform stiffness, elastic modulus, and/or thickness in part or the entire body of the shell or lock to generate the force system.

The system provided herein may be specified in the ways known in the art. For example, in a cycle, each appliance can carry specifications for the differential force, for example, specifying the dimensions of one or more appliances, such as the thickness or diameter of the appliances or the material characteristics forming the appliances, such as high, medium, or low differential force. These specifications of the appliances can be marked on each appliance or alternatively, marked on tags or by placement in a package. Some or all of the appliances in a cycle may further bear numeric marks, for example, numbers from 0 through 25 to indicate the anticipated discrepancy between actual teeth positions and expected (predicted) teeth positions as a result of successive changes in appliance geometry.

In some embodiments, to increase anchorage of the appliance, a dental implant can be used in association with the cycle of appliances. The implant can be palatally placed or buccally placed or placed on the retromolar area.

The methods of making and using the system described herein are also described.

BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 shows several exemplary removable aligners (also described as aligners) commonly known in the art, namely, mini-expansion screw aligners, Bloore aligners, spring loaded microscrew aligners, 2-way saggital aligners, and 3-way saggital aligners.

Figure 2 shows examples of Inman spring aligners.

Figure 3 shows some examples of invisible removable aligners.

Figure 4 shows some further examples of invisible removable aligners.

DESCRIPTION OF DETAILED INVENTION

Provided herein is an orthodontic force system for repositioning teeth. The system includes one or more cycles appliances capable of incrementally move the teeth from an initial tooth arrangement to the final tooth arrangement. The system allows a prescribing orthodontic doctor to evaluate a tooth arrangement during the course of treatment and to determine an optimal force application through selection of orthodontic appliances. Optimal force application as used herein is defined as an optimal balance between efficient tooth/teeth movement and patient comfort. From a practical standpoint, optimal force application can be achieved through integrating known teeth positions optimal appliance geometries and forces.

In one aspect, the system includes at least two cycles of successive appliances having geometries selected to successively move or reposition teeth from an initial position to the final position. The first cycle is formed using a digital data set obtained based on the initial tooth arrangement, and the second cycle (which can be an intermediate or the last cycle) is formed using a data set obtained based on the last tooth arrangement achieved by the first cycle or the cycle prior to the last cycle. The second cycle data set is important because it can identify and reduce or minimize discrepancies between actual and predicted positions for tooth/teeth movement. The first cycle data set can be obtained by dental impressions, oral scanners, or other modalities known to those in the art. The second cycle data set (and all other cycles beyond the first set) can be obtained by, e.g., clinical exam, dental impressions, oral scanners, or other modalities known to those in the art. The second cycle data set (and all other cycles beyond the first set) can be digital or non-digital depending on the discretion of the prescribing orthodontic doctor.

In another aspect, the system described herein includes a system of de- escalting and/or escalating forces with each appliance cycle. Each appliance cycle includes at least two appliances of varying geometries and/or forces from which the prescribing orthodontic doctor can decide if de-escalting, escalating and/or combinations of de-escalting/escalating forces are most appropriate.

Specifically, the system described herein includes a cyclic force system for repositioning teeth from an initial tooth arrangement to a final tooth arrangement. The system includes a cycle of a plurality of appliances that includes: (a) two or more appliances having a geometry selected to reposition the teeth from the same initial tooth arrangement to a same first intermediate arrangement; (b) optionally one or more removable aligners or appliances having geometries selected to progressively reposition the teeth from the same first intermediate arrangement to successive intermediate arrangements, each repositioning uses two or more appliances repositioning the tooth (teeth) from the same starting intermediate arrangement to the same next tooth (teeth) arrangement; and (c) tow or more final appliance having a geometry selected to progressively reposition the teeth from the same last intermediate arrangement to the same final tooth arrangement. As used herein, the term "two or more" is inclusive and can include any number of appliances that is higher than one appliance, e.g., 2 appliances, 3 appliances, 4 appliances, 5 appliances, 6 appliances, 7 appliances, 8 appliances, 9 appliances, 10 appliances or more. In some embodiments, the term "two or more" can include 2-15 appliances, 2-10 appliances, or 2-5 appliances.

The appliances in the system described herein may have different forces that can be designed and tailored by varying parameters such as, but not limited to dimensions (e.g., thickness and/or geometry) and/or material characteristics.

The appliances in the system described herein may include successive locks having different geometries shaped to receive and allow the appliances to reposition teeth from one arrangement to a successive arrangement. The locks can be any mechanism capable of receiving the teeth so as to allow the appliances to

incrementally move or adjust teeth from one arrangement to another. The locks can be, for example, metallic, plastic or polymeric wires, clips, rings, caves, or shells. In some embodiments, the locks specifically exclude polymeric shells.

The system described herein may provide specifications of the appliances such that an orthodontic doctor can prescribe the order of use of the appliances based on the specifications. Specifications can include, but are not limited to dimensions (e.g., force, thickness, and/or geometry) and/or material characteristics. In some embodiments, the cycles in the system can be marked to indicate the sequence of cycles. In some other embodiments, the appliances can be marked such that an orthodontic doctor can prescribe the order of using the appliances.

Wire

The present invention provides a novel and unique removable appliance that is easy to manufacture and provides more forceful and less obtrusive movement of teeth while the appliance is worn. The present invention provides relatively pain free and rapid movement of a patient's teeth into a proper orientation. In the preferred embodiment, the invention is a generally horseshoe shaped clear flexible resilient plastic wire-imbedded orthodontic appliance for an upper arch or a lower arch of a patient. The appliance includes a plastic portion with a lingual side, a labial side, a left molar area, a right molar area, a left canine area and a right canine area, and has contours on the lingual side and on the labial side, wherein the contours snugly cover the patient's teeth so that the appliance remains in place over the patient's teeth. One or more flexible wires are imbedded within the lingual side of the plastic portion, extending from the left molar area to the right molar area of the plastic portion, so the wires are able to apply force on the lingual side of the patient's teeth to rapidly correct the orientation of the teeth in the patient's bite.

In an alternative embodiment, the plastic portion covers the surface of the patient's teeth from the left rear molar to the right rear molar. Also, the plastic portion may have a first outer section that covers the entire surface of the patient's teeth from approximately the left molars to the left canines, a second outer section that covers the entire surface of the patient's teeth from approximately the right molars to the right canines, and a middle span that covers only the labial side of the patient's teeth approximately between the canines. In this embodiment, the middle span acts as a guide for the force of the wire upon the patient's teeth.

In still another embodiment, the plastic portion has a first outer section that covers the entire surface of the patient's teeth from approximately the left molars to the left canines, and a second outer section that covers the entire surface of the patient's teeth from approximately the right molars to the right canines. Thus, the plastic portion does not touch the patient's teeth approximately between the patient's canines. Also, a plurality of vertically parallel wires may be imbedded within the lingual side of the plastic portion of the appliance. The appliance may also have vertically parallel wires with a length and cross-sectional shape which optimizes the force applied to the patient's teeth. For example, the cross-sectional shape may be rectangular, round, or oval.

The invention is also a method of forming a generally horseshoe shaped clear flexible resilient plastic wire-imbedded orthodontic appliance for an upper bite or a lower bite of a patient. The method generally includes the steps of obtaining a plaster cast of the patient's teeth and gums, removing plaster teeth from the plaster cast of the gums that are appropriate for the formation of proper bite alignment, reattaching the appropriate plaster teeth to the plaster cast of the gums to form a cast of the proper bite alignment, attaching one or more wires to the lingual surface of the plaster teeth so that the wires become imbedded within thermosetting plastic placed over the cast of the proper bite alignment, putting the cast in a thermosetting plastic molding machine and inserting thermosetting plastic in the thermosetting plastic molding machine, and heating the thermosetting plastic around the cast of the proper bite alignment so the wires are imbedded within the thermosetting plastic after the thermosetting plastic cools. In one embodiment, the method includes the steps of removing the appliance from the thermosetting plastic molding machine and trimming the lingual surface of the appliance to form a middle span, wherein the span acts as a guide for the pushing force of the wire on the patient's bite.

Moreover, the invention includes a method of rapidly repositioning teeth from an initial alignment to a proper alignment using a generally horseshoe shaped clear flexible resilient plastic wire-imbedded orthodontic appliance for an upper bite or a lower bite of a patient, comprising the steps of placing a first incremental position adjustment appliance over a patient's teeth, wherein the first appliance has at least one wire imbedded within the lingual side of the first appliance to reposition the teeth from the initial tooth alignment to a first intermediate alignment, successively replacing one or more additional appliances, wherein the additional appliances each have at least one wire imbedded within the lingual side to rapidly reposition the teeth from the first intermediate alignment to successive intermediate alignments and placing a final appliance over a patient's teeth, wherein the final appliance has at least one wire imbedded within the lingual side of the first appliance to reposition the teeth, wherein the final appliance positions the teeth from the last intermediate alignment to a final bite alignment. Alternatively, a plurality of vertically parallel wires is imbedded within the lingual side of the first appliance, the intermediate appliances and the final appliance.

Systems

The system provided herein comprises comprising one or more cycle of successive appliances and one or more retainers, the system comprising:

optionally one or more removable aligners or appliances having geometries selected to progressively reposition the teeth from the first intermediate arrangement to successive intermediate arrangements including a last intermediate tooth arrangement; a final removable retainer or appliance having a geometry selected to progressively reposition the teeth from the initial tooth arrangement or the last intermediate arrangement to the final tooth arrangement; and

optionally one or more retainer to hold the teeth in the first intermediate arrangement, the successive intermediate arrangements, or the final arrangement, wherein the appliances comprise successive locks having different geometries shaped to receive and allow the appliances to reposition teeth from one arrangement to a successive arrangement.

Repositioning is accomplished with a system comprising a series of appliances configured to receive the teeth in a cavity and incrementally reposition individual teeth in a series of at least three successive steps, usually including at least four successive steps, often including at least ten steps, sometimes including at least twenty-five steps, and occasionally including forty or more steps. Most often, the methods and systems will reposition teeth in from ten to twenty-five successive steps, although complex cases involving many of the user's teeth may take forty or more steps. The successive use of a number of such appliances permits each appliance to be configured to move individual teeth in small increments, typically less than 2 mm, preferably less than 1 mm, and more preferably less than 0.5 mm. These limits refer to the maximum linear translation of any point on a tooth as a result of using a single appliance. The movements provided by successive appliances will usually not be the same for any particular tooth.

The system includes cycles of successive appliances with different geometries that define teeth positions corresponding to different stages of treatment. The system may include a multiple cycles of successive appliances; each cycle other than the final cycle is capable of moving the teeth to an intermediate position; and the final cycle is capable of moving the teeth to the final position from the last intermediate position. For example, for a two cycle system, the first cycle can move the teeth from the initial position (position 1 ) to an intermediate position (position 2), and the second cycle can then move the teeth from position 2 to the final position. For a three cycle system, the first cycle can move the teeth from the initial position (position 1 ) to the first intermediate position (position 2), the second cycle can then move the teeth from position 2 the second intermediate position (position 3), and the final cycle can move the teeth from position 3 to the final position. In one aspect of the present invention, the tooth repositioning system described herein comprises at least two successive appliances, e.g., about 2 to about 20 successive appliances, about 2 to about 15 successive appliances, about 2 to about 10 successive appliances, about 2 to about 8 successive appliances, about 2 to about 5 successive appliances, about 3 to about successive 20 appliances, about 3 to about successive 15 appliances, about 3 to about successive 10 appliances, about 3 to about successive 8 appliances, about 3 to about successive 5 appliances, about 4 to about successive 20 appliances, about 4 to about successive 15 appliances, about 4 to about successive 10 appliances, about 4 to about successive 8 appliances, about 4 to about successive 5 appliances, about 5 to about successive 20 appliances, about 5 to about successive 15 appliances, about 5 to about successive 10 appliances, about 5 to about successive 8 appliances, or about successive 5 appliances.

The appliances have one or more geometries defining the positions of the teeth at the onset of the orthodontic treatment (initial positions), in the middle of the orthodontic treatment (intermediate positions), or at the completion point of the orthodontic treatment (final positions). Each of the appliances is different in terms of dimensions (e.g., force, thickness, and/or geometry) and/or material characteristics, which correspond to the torch modulus and forces that progressively move teeth from one position to another.

Systems described herein include successive appliances including at least two first appliances having a geometry selected to reposition a user's teeth from the initial tooth arrangement to a first intermediate arrangement where individual teeth will be incrementally repositioned. In some embodiments, the system further comprises at least one intermediate appliance having a geometry selective to progressively reposition teeth from the first intermediate arrangement to one or more successive intermediate arrangements including a last intermediate tooth arrangement, each of the at least one intermediate appliance includes at least one duplicate of itself. In some embodiments, the system still further comprise at least one final appliances having a geometry selected to progressively reposition teeth from the last intermediate arrangement to the desired final tooth arrangement. In some cases, it is desirable to form the final appliances or several appliances to "over correct" the final tooth position, as discussed in more detail below.

In some embodiments, the term "successive appliance" refers to an appliance having a geometry or geometries for repositioning a tooth or teeth from one position, which can be an initial position or an intermediate position, to another position, which can be an intermediate position or a final position. In the successive appliances in the system described herein, each successive appliance includes a geometry or geometries different from the geometry or geometries in another successive appliance.

As described in more detail below in connection with the methods of the present invention, the systems is planned and all individual appliances for the first cycle fabricated at the outset of treatment, and the appliances is thus be provided to the orthodontic doctor as a single package or system. The anticipated discrepancy between actual teeth positions and expected (predicted) teeth positions as a result of successive changes in appliance geometry are clearly marked on the appliance along with other important dimensions and/or material characteristics useful to the prescribing orthodontic doctor. For example, the first appliance of the first cycle is expected to have a very small discrepancy (e,g., near zero), while the last appliance of the first cycle is expected to have-a larger discrepancy (e.g., larger than zero). The exact units for the discrepancy is expressed as, but not limited to, a percentage, a metric measurement, or other numerical system (e.g., scale of 0 to 25; with 25 being maximum discrepancy). The calculation of the discrepancy can be based to varying degrees on degree of teeth movement required, the appliance dimensions, the appliance material characteristics, and the use or non-usage of anchoring devices (e.g., dental implants in bone).Upon obtaining the proper sequence of appliance usage, the user can place the appliances over his or her teeth at a frequency prescribed by the orthodontist or other treating professional. Unlike braces, the user need not visit the treating professional every time an adjustment in the treatment is made. While the users will usually want to visit their treating professionals periodically to assure that treatment is going according to the original plan, eliminating the need to visit the treating professional each time an adjustment is to be made allows the treatment to be carried out in many more, but smaller, successive steps while still reducing the time spent by the treating professional with the individual user. Moreover, the ability to use polymeric shell appliances which are more comfortable, less visible, and removable by the user, greatly improves user compliance, comfort, and satisfaction.

The individual appliances will preferably comprise a polymeric shell having the teeth-receiving cavity formed therein, typically by molding as described below. Each individual appliance will be configured so that its tooth-receiving cavity has a geometry corresponding to an intermediate or end tooth arrangement intended for that appliance. That is, when an appliance is first worn by the user, certain of the teeth will be misaligned relative to an undeformed geometry of the appliance cavity. The appliance, however, is sufficiently resilient to accommodate or conform to the misaligned teeth, and will apply sufficient resilient force against such misaligned teeth in order to reposition the teeth to the intermediate or end arrangement desired for that treatment step. However, this accommodation or conforming to the misaligned teeth through successive appliance geometries results in increasing discrepancies between actual teeth positions and expected (predicted) teeth positions.

The anticipated discrepancy between actual teeth positions and expected (predicted) teeth positions as a result of successive changes in appliance geometry are clearly marked on the appliance along with other important dimensions and/or material characteristics useful to the prescribing orthodontic doctor. For example, the first appliance of the first cycle is expected to have a very small discrepancy (e,g., near zero), while the last appliance of the first cycle is expected to have a larger discrepancy (e.g., larger than zero). The exact units for the discrepancy is expressed as, but not limited to, a percentage, a metric measurement, or other numerical system. The calculation of the discrepancy can be based variably on the degree of teeth movement required, the appliance dimensions, the appliance material characteristics, and the use or non-usage of anchoring devices (e.g., dental implants in bone).

The individual appliances described herein also exert different forces on a tooth arrangement. The different force pertaining to each appliance is achieved by increasing thickness and rigidity while keeping the same elastic modulus or changing the material properties such as elastic modulus and stiffness while not changing the thickness or changing any combination of thickness, rigidity, elastic modulus, and/or material properties. Note, the force exerted on a given tooth or series of teeth is distinct, although somewhat dependent on the material and/or mechanical properties of the appliance. The force pertaining to the appliance is generally related to the thickness, rigidity, elastic modulus, and/or material properties of the appliance. In contract, the force exerted on a given tooth or series of teeth is generally related to the actual teeth positions and desired teeth positions, geometry of the appliance in achieving the desired teeth positions, as well as the material and/or mechanical properties of the appliance and whether any anchoring dental implant devices are employed. In one embodiment, the system described herein includes one or more than one cycle of appliances with differential de-escalting and/or escalating force system (e.g., from high-to-low, low-to-high, high-to-high, low-to-low, high-to-low-to-high, low-to-high-to-low, etc). The combinations of de-escalting and/or escalating force systems are only limited by appliance number per cycle. For example, the system may include a first removable aligner or appliance with high force having a geometry selected to reposition the teeth from the initial tooth arrangement to a first intermediate arrangement, one or more removable aligners or appliances having geometries and reducing force system selected to progressively reposition the teeth from the first intermediate arrangement to successive intermediate arrangements, and a final appliance with lowest force system in a cycle having a geometry selected to progressively reposition the teeth from the last intermediate arrangement to an end tooth arrangement. If necessary, a new cycle of force system will start from the end tooth arrangement of the previous cycle until the whole treatment finished.

For each cycle, a description of the force systems will be provided to describe the force of each appliance and to suggest to the treating orthodontic doctor the order of using each individual appliance in predetermined differential force which will progressively move the user's teeth toward the final arrangement, a package, said package containing one cycle of appliances, wherein the appliances are provided in a single package to the user. The treating orthodontics will then provide to the user the proper order of using the appliances on the basis of each user's condition and the doctor's professional judgment and discretion.

In some embodiment, the system described herein comprises one or more than one cycle of appliances. Each cycle contains one or more appliances having a differential de-escalting and/or escalating force system as previously described. In some embodiments, each cycle of the system can be marked for the sequence of the cycles.

The different force pertaining to each appliance is made different by changing the dimension and/or material characteristics of the appliances. For example, the appliances can be made to have different thickness to generate different forces. For example, the appliances can have a thickness ranging from about 0.01 mm, about 0.1 mm, about 0.2mm/about 0.3 mm, about 0.4 mm, about 0.5 mm, about 0.6 mm, about 0.7 mm, about 0.8 mm, about 0.9 mm, about 1 mm, about 1 .1 mm, about 1 .2 mm, about 1.3 mm, about 1 .4 mm, about 1 .5 mm, about 1 .6 mm, about 1.7 mm, about 1.8 mm, about 1.9 mm or about 2.0 mm. In some other embodiments, different forces of appliances can be achieved using different material forming the appliances. For example, the material can be blended with reinforcement materials such as fibers, pieces, strips, wires, mesh, lattices, networks, interpenetrating networks, or combinations thereof to cause the appliances to have different forces.

To achieve desired speed of orthodontic treatment, the forces of individual appliances in a cycle can be tailored to meet the needs of treatment. For example, in each cycle, the subsequent appliance can be made to differ from the prior appliance stiffness, in the range from, e.g., about 0.1 to about 8 Gpa. In some embodiments, in each cycle of appliance, the prior appliance can be made to have an elastic modulus that differs from the elastic modulus of the subsequent appliance by about 1 % to about 800%. In some other embodiments, in each cycle, the subsequent appliance thickness can be made to differ from the prior appliance thickness, in the range from about 0.1 to about 2 mm.

In some embodiments, the present invention provides a system for

repositioning teeth from an initial tooth arrangement to a final tooth arrangement. The system comprises one or more cycle of successive appliances, the system including:

(a) at least one first appliance having a geometry selected to reposition the teeth from the initial tooth arrangement to a first intermediate arrangement or the final tooth arrangement;

(b) optionally one or more removable aligners or appliances having geometries selected to progressively reposition the teeth from the first intermediate arrangement to successive intermediate arrangements including a last intermediate tooth arrangement; and

(c) at least one final appliance having a geometry selected to progressively reposition the teeth from the initial tooth arrangement or the last intermediate arrangement to the final tooth arrangement,

wherein the appliances comprise successive locks having different geometries shaped to receive and allow the appliances to reposition teeth from one arrangement to a successive arrangement, and

wherein the system provides specifications of the appliances such that an orthodontic doctor can prescribe the order to use the appliances based on the specifications. The successive locks can be formed of a material that includes a metallic material, a plastic material, and/or a polymeric material. Some examples of the locks include, e.g., polymer shells, polymer rings, metal wires or clips, hard plastic clips, ceramic clips, or elastic polymeric shells or rings. In some embodiments, the locks specifically exclude polymeric shells.

As used herein, the terms "tooth" and "teeth" are interchangeable.

As used herein, the terms "align", "realign", "rearrange" and "reposition" are interchangeable.

As used herein, the term "removable aligner" is used to denote an aligner that is different from an appliance. Examples of such removable aligners are shown in Figures 1 -4. In some embodiments, a removable aligner can also refer to a removable retainer similar to Hawley retainers and ASTICS™ retainers. In contrast, an appliance, as used herein, generally refers to elastic polymeric appliance as described below, which is sometimes clear and invisible. As used herein, the term "corresponding" shall mean an appliance having the same geometry for a particle tooth arrangement as that of a removable aligner.

Removable aligners

The removable aligners described herein can be of any design. Figure 1 provides several exemplary retainers (also described as aligners) commonly known in the art, namely, mini-expansion screw aligners, Bloore aligners, spring loaded microscrew aligners, 2-way saggital aligners, and 3-way saggital aligners. Each of these aligners provide aligning forces and can be tailored to apply to a patient with a particular orthodontic condition.

Figure 2 shows other examples of removable aligners, which are referred to as Inman spring aligners. A removable orthodontic appliance repositions misaligned anterior teeth mainly with different designs. For example, one design of an embodiment of such removable aligners is as below:

1 . a labial wire with acrylic padding and a palatal//lingual wire with acrylic padding.

2. a plurality of springs and a labial wire each secured to an acrylic palatal fitting. Each spring has a head portion in the shape of an eyelet which is positioned on the lingual side of an anterior tooth and a foot portion secured to the fitting. The springs provide lingual-to-labial force to the teeth, and the labial wire provides labial-to- lingual force to the teeth. A spring may engage the lingual surface of a tooth to provide active force to urge the tooth labially into a proper position, or may be spaced away from a tooth at a desired position to engage the tooth as it move lingually. The springs may be positioned on a mesial or a distal surface of a tooth to induce rotation. Further, the springs may provide passive resistance to maintain a properly positioned tooth in place. Each spring is made of a single strand of wire which has one end terminating at the head portion and the other end terminating at the foot portion. The orthodontic appliance also has a pair of stress-breaking clasps which dislodge the appliance if the labial wire or the springs are too heavily

activated.( http://www.freepatentsonline.com/5580243.html)

More design: http://aztecortholab.com/springtooth.htm

http://www.greatlakesortho.com/lab-services/featured-appliances/inman-aligner/ In one embodiment, the removable aligner is an Inman Aligner™. The Inman Aligner™ appliances are designed for quick correction of anterior rotations, crowding, and adult relapse without the need for multiple appliances. The Inman Aligner appliances use NiTi coil springs to apply steady, gentle forces to teeth - without the need for costly multiple appliances to complete correction. Both the lingual and labial components work together as opposing pistonlike forces to move teeth. The Inman appliances achieve controlled, continuous movement of the anterior teeth (2x2). These pre-programmed appliances make adjustments virtually unnecessary. Precision alignment is accomplished with just one appliance. For more information, download the fliers and brochures below or go to www.inmanaligner.com.

Note, the aligners shown in Figures 1 and 2 all include metallic wiring that fits the outer contour or surface of teeth and a plastic base for setting in the inner contour of teeth. The plastic base may further include one or more springs to provide aligning forces tailored to target at one or more teeth.

Figure 3-4 show examples of invisible removable aligners. In these examples, the part that fits in the outer contour or surface of teeth is made of a clear plastic material so as to become invisible.

The removable aligners can be designed and formed by established methods of computer-aided fabrication. Generally, such methods generally include:

obtaining a digital data set representing the initial tooth arrangement of one or more teeth,

generating a digital image representing the initial tooth arrangement, moving one or more teeth in the digital image representing the initial tooth arrangement to generate a digital image representing a final tooth arrangement,

moving one or more teeth in the digital image representing the initial tooth arrangement or the digital image representing a final tooth arrangement to generate one or more digital images representing one or more intermediate tooth arrangements, the one or more intermediate tooth arrangements represent one or more tooth positions between the initial tooth arrangement and the final tooth arrangements as judged proper by an orthodontic practitioner,

fabricating one or more removable aligner capable of moving teeth

from the initial tooth arrangement to one sub-intermediate arrangement; from one sub-intermediate arrangement to a successive sub- intermediate arrangement to the final tooth arrangement; or

from one sub-intermediate arrangement to the final arrangement. As used herein, the term sub-intermediate arrangement refers to one intermediate tooth arrangement of two or more intermediate tooth arrangements.

Computer-aided fabrication of tooth aligners are well documented in the art. For example, For example, Kuroda et al. (1996) Am. J. Orthodontics 1 10:365-369 describes a method for laser scanning a plaster dental cast to produce a digital image of the cast. See also U.S. Patent No. 5,605,459. U.S. Patent Nos. 5,533,895;

5,474,448; 5,454,717; 5,447,432; 5,431 ,562; 5,395,238; 5,368,478; and 5, 139,419, assigned to Ormco Corporation, describe methods for manipulating digital images of teeth for designing orthodontic devices.

U.S. Patent No. 5,01 1 ,405 describes a method for digitally imaging a tooth and determining optimum bracket positioning for orthodontic treatment. Laser scanning of a molded tooth to produce a three-dimensional model is described in U.S. Patent No. 5,338, 198. U.S. Patent No. 5,452,219 describes a method for laser scanning a tooth model and milling a tooth mold. Digital computer manipulation of tooth contours is described in U.S. Patent Nos. 5,607,305 and 5,587,912.

5,382, 164; 5,273,429; 4,936,862; 3,860,803; 3,660,900; 5,645,421 ; 5,055,039;

4,798,534; 4,856,991 ; 5,035,613; 5,059, 1 18; 5, 186,623; and 4,755, 139.

The teachings in the above references are incorporated herein in their entirely by reference.

Materials

The appliances can be formed of an elastic material that may include one or more polymers. The polymer is preferably inert and biocompatible. The polymer is also sufficiently flexible to allow easy removal and application for the user, but also sufficiently rigid to allow controlled teeth movement. Any conventional material normally used in dental treatments for fabricating removable appliances can be used in this invention. Specific examples of useful polymers include any elastic polymeric materials, such as those commonly used in the art of dentistry, e.g, olefin polymers or copolymers, such as polyethlyene, polybutylene, polyisobutylene, polypropylene, ethylene vinyl acetate, polyvinyl alcohol, polystyrene, copolymers that include two or more of ethylene, propylene, butylene, isobutene, pentene, styene, vinyl acetate, vinyl alcohol and a combination thereof, or a mixture thereof. The polymeric material may further include a material to modify the biocompatibility. Such biocompatibility modifying materials include, e.g., polyethylene glycol, polypropylene glycol, polyethylene oxide or a natural polymer such as cellulose or alginate, collagen, and the like.

In some embodiment, the polymeric materials may further include a reinforcing material such as fibers, chips, wires, glass fibers, carbon fibers, pieces, strips, mesh, lattices, and networks and interpenetrating networks. Some

representative reinforcing materials include, for example, micro or nano aluminum oxide phases, carbon fibers, etc, or mixtures thereof.

Method of forming the appliances

The system can be formed by (a) receiving prescribed orthodontic information for a user in need of orthodontic treatment, (b) forming a cycle of appliances comprising individual appliances, and (c) forming a cycle of appliances.

In one aspect, the appliances can be formed by ( 1 ) generating/obtaining an initial data set such as an initial digital data set (IDDS) representing the initial tooth arrangement, (2) generating a digital data set (DDS) or non-digital data set (NDDS) representing an intermediate tooth arrangement, (3) generating an end or a final data set such as a DDS or NDDS representing an end tooth arrangement or a final tooth arrangement, and (4) optionally producing a plurality of successive digital data sets based on both of the first digital data set and the final digital data set, wherein the plurality of successive data sets represent a series of successive tooth arrangements progressing from the intermediate tooth arrangement last end tooth arrangement to the end tooth arrangement or the final tooth arrangement, and (5) forming an appliance or a plurality of appliances based on the digital data sets. In some embodiments, the digital data sets can be converted into visual images representing a tooth arrangement, and the appliances can be formed based on the visual images. Methods of obtaining the IDDS and DDS, generating a visual image based on DDS and forming an appliance based on the visual image are described in U.S. Patent Nos. 6,398,548; 6,544,61 1 ; 5,895,893; 6,244,861 ; 6,616,444; 5,645,420; and 5,447,432, the teachings of which are incorporated herein by reference.

The initial digital data set may be provided by any techniques known in the art, including digitizing X-ray images, images produced by computer-aided tomography (CAT scans), images produced by magnetic resonance imaging (MRI), images produced by photo scanning, and the like. The images will be three-dimensional images and digitization may be accomplished using known technology. For example, the initial digital data set is provided by producing a plaster cast of the user's teeth (prior to treatment) by techniques known in the art. The plaster cast so produced may then be scanned using laser or other scanning equipment to produce a high resolution digital representation of the plaster cast of the user's teeth.

In a preferred embodiment, a wax bite is also obtained from the user using standard methods. The wax bite allows plaster casts of a user's upper and lower dentition to be placed relative to one another in the centric occlusal position. The pair of casts then can be scanned to provide information on the relative position of the jaw in this position. This information is then incorporated into the IDDS for both arches.

Once the digital data set is acquired, an image can be presented and

manipulated on a suitable computer system equipped with computer-aided design software, as described in greater detail below. The image manipulation will usually comprise defining boundaries about at least some of the individual teeth, and causing the images of the teeth to be moved relative to the jaw and other teeth by

manipulation of the image via the computer. Methods are also provided for detecting cusp information for the teeth. The image manipulation can be done entirely subjectively, i.e. the user may simply reposition teeth in an aesthetically and/or therapeutically desired manner based on observation of the image alone. Alternatively, the computer system could be provided with rules and algorithms which assist the user in repositioning the teeth. In some instances, it will be possible to provide rules and algorithms which reposition the teeth in a fully automatic manner, i.e. without user intervention. Once the individual teeth have been repositioned, a final digital data set representing the desired final tooth arrangement will be generated and stored.

An exemplary method for determining the final tooth arrangement is for the treating professional to define the final tooth positions, e.g. by writing a prescription. The use of prescriptions for defining the desired outcomes of orthodontic procedures is well known in the art. When a prescription or other final designation is provided, the image can then be manipulated to match the prescription. In some cases, it would be possible to provide software which could interpret the prescription in order to generate the final image and thus the digital data set representing the final tooth arrangement.

In yet another aspect, methods described herein are provided for producing a plurality of digital data sets representing a series of discrete tooth arrangements progressing from an initial tooth arrangement to a final tooth arrangement. Such methods comprise providing a digital data set representing an initial tooth

arrangement (which may be accomplished according to any of the techniques set forth above). A digital data set representing a final tooth arrangement is also provided. Such final digital data set may be determined by the methods described previously. A plurality of successive digital or non-digital data sets are then produced based on the initial digital data set and the final digital data set. Usually, the successive digital data sets are produced by determining positional differences between selected individual teeth in the initial data set and in the final data set and interpolating said differences. Such interpolation may be performed over as many discrete stages as may be desired, usually at least three, often at least four, more often at least ten, sometimes at least twenty-five, and occasionally forty or more. Many times, the interpolation will be linear interpolation for some or all of the positional differences. Alternatively, the interpolation may be non-linear. In a preferred embodiment, non-linear interpolation is computed automatically by the computer using path scheduling and collision detection techniques to avoid interferences between individual teeth. The positional differences will correspond to tooth movements where the maximum linear movement of any point on a tooth is 2 mm or less, usually being 1 mm or less, and often being 0.5 mm or less.

Often, the user will specify certain target intermediate tooth arrangements, referred to as "key frames," which are incorporated directly into the intermediate digital data sets. The methods of the present invention then determine successive digital data sets between the key frames in the manner described above, e.g. by linear or non-linear interpolation between the key frames. The key frames may be determined by a user, e.g. the individual manipulating a visual image at the computer used for generating the digital data sets, or alternatively may be provided by the treating professional as a prescription in the same manner as the prescription for the final tooth arrangement.

In still another aspect, methods described herein provide for fabricating a plurality of dental incremental position adjustment appliances. Said methods comprise providing an initial digital data set, a final digital or non-digital data set, and producing a plurality of successive digital or non-digital data sets representing the target successive tooth arrangements, generally as just described. The dental appliances are then fabricated based on at least some of the digital data sets representing the successive tooth arrangements. Preferably, the fabricating step comprises controlling a fabrication machine based on the successive digital data sets to produce successive positive models of the desired tooth arrangements. The dental appliances are then produced as negatives of the positive models using conventional positive pressure or vacuum fabrication techniques. The fabrication machine may comprise a stereolithography or other similar machine which relies on selectively hardening a volume of non-hardened polymeric resin by scanning a laser to selectively harden the resin in a shape based on the digital data set. Other fabrication machines which could be utilized in the methods of the present invention include tooling machines and wax deposition machines.

In still another aspect, methods of the present invention for fabricating a dental appliance comprise providing a digital data set representing a modified tooth arrangement for a user. A fabrication machine is then used to produce a positive model of the modified tooth arrangement based on the digital data set. The dental appliance is then produced as a negative of the positive model. The fabrication machine may be a stereolithography or other machine as described above, and the positive model is produced by conventional pressure or vacuum molding techniques.

In a still further aspect, methods for fabricating a dental appliance described herein comprise providing a first digital data set representing a modified tooth arrangement for a user. A second digital data set is then produced from the first digital data set, where the second data set represents a negative model of the modified tooth arrangement. The fabrication machine is then controlled based on the second digital data set to produce the dental appliance. The fabrication machine will usually rely on selectively hardening a non-hardened resin to produce the appliance. The appliance typically comprises a polymeric shell having a cavity shape to receive and resiliently reposition teeth from an initial tooth arrangement to the modified tooth arrangement.

In some embodiments, the orthodontic doctor can take an imprint or scan a last intermediate tooth arrangement after the user has undergone the treatment of one or more cycles of appliances. A digital data set of the last intermediate tooth

arrangement of the previous cycle thus can be obtained based on the imprint or scan. This digital data set of the last intermediate tooth arrangement of the previous cycle is then used as the initial point for generating a new set of digital data and visual images based on the new set of digital data representing one or more new intermediate tooth arrangements and a final tooth arrangement for the fabrication of a new cycle of appliances. In some embodiments, the final tooth arrangement can be achieved with the application of two or more cycles of appliances, and each cycle of the appliances incrementally move the teeth starting from the tooth arrangement positioned by the last appliance of the previous cycle. Cycles of appliances can therefore be made according to the principles described above.

Method of Using

According to a method of the present invention, a user's teeth are repositioned from an initial tooth arrangement to a final tooth arrangement by placing a series of incremental position adjustment appliances in the user's mouth. Conveniently, the appliances are not affixed and the user may place and replace the appliances at any time during the procedure. The first appliance of the series will have a geometry selected to reposition the teeth from the initial tooth arrangement to a first intermediate arrangement. After the first intermediate arrangement is approached or achieved, one or more additional (intermediates appliances will be successively placed on the teeth, where such additional appliances have geometries selected to progressively reposition teeth from the first intermediate arrangement through successive intermediate arrangement(s). The treatment will be finished by placing a final appliance in the user's mouth, where the final appliance has a geometry selected to progressively reposition teeth from the last intermediate arrangement to the final tooth arrangement. The final appliance or several appliances in the series may have a geometry or geometries selected to over correct the tooth arrangement, i.e. have a geometry which would (if fully achieved) move individual teeth beyond the tooth arrangement which has been selected as the "final." Such over correction may be desirable in order to offset potential relapse after the repositioning method has been terminated, i.e. to permit some movement of individual teeth back toward their pre- corrected positions. Over correction may also be beneficial to speed the rate of correction, i.e. by having an appliance with a geometry that is positioned beyond a desired intermediate or final position, the individual teeth will be shifted toward the position at a greater rate. In such cases, treatment can be terminated before the teeth reach the positions defined by the final appliance or appliances. The method will usually comprise placing at least two additional appliances, often comprising placing at least ten additional appliances, sometimes placing at least twenty-five additional appliances, and occasionally placing at least forty or more additional appliances. Successive appliances will be replaced when the teeth either approach (within a preselected tolerance) or have reached the target end arrangement for that stage of treatment, typically being replaced at an interval in the range from 2 days to 20 days, usually at an interval in the range from 5 days to 10 days.

Often, it may be desirable to replace the appliances at a time before the "end" tooth arrangement of that treatment stage is actually achieved. It will be appreciated that as the teeth are gradually repositioned and approach the geometry defined by a particular appliance, the repositioning force on the individual teeth will diminish greatly. Thus, it may be possible to reduce the overall treatment time by replacing an earlier appliance with the successive appliance at a time when the teeth have been only partially repositioned by the earlier appliance. Thus, the FDDS can actually represent an over correction of the final tooth position. This both speeds the treatment and can offset user relapse.

In general, the transition to the next appliance can be based on a number of factors. Most simply, the appliances can be replaced on a predetermined schedule or at a fixed time interval (i.e. number of days for each appliance) determined at the outset based on an expected or typical user response. Alternatively, actual user response can be taken into account, e.g. a user can advance to the next appliance when that user no longer perceives pressure on their teeth from a current appliance, i.e. the appliance they have been wearing fits easily over the user's teeth and the user experiences little or no pressure or discomfort on his or her teeth. In some cases, for users whose teeth are responding very quickly, it may be possible for a treating professional to decide to skip one or more removable aligners or appliances , i.e. reduce the total number of appliances being used below the number determined at the outset. In this way, the overall treatment time for a particular user can be reduced.

In another aspect, methods of the present invention comprise repositioning teeth using appliances comprising polymeric shells having cavities shaped to receive and resiliently reposition teeth to produce a final tooth arrangement. The present invention provides improvements to such methods which comprise determining at the outset of treatment geometries for at least three of the appliances which are to be worn successively by a user to reposition teeth from an initial tooth arrangement to the final tooth arrangement. Preferably, at least four geometries will be determined in the outset, often at least ten geometries, Frequently at least twenty-five geometries, and sometimes forty or more geometries. Usually, the tooth positions defined by the cavities in each successive geometry differ from those defined by the prior geometry by no more than 2 mm, preferably no more than 1 mm, and often no more than 0.5 mm, as defined above.

It must be noted that the use of removable aligners can be highly flexible. For example, in some embodiments, one can wear a removable aligner continuously or intermittently as long as a corresponding appliance is used when one removes the removable aligner in use. For example, one can wear a removable aligner for a period of 24 hrs, over night, or every other day, as long as he wears a corresponding appliance is used when he/she removes the removable aligner in use.

The system can be used to treat or prevent orthodontic conditions such as malalignment, crowding, spacing, overjet, overbite problem, and a combination thereof.

While the above is a complete description of the preferred embodiments of the invention, various alternatives, modifications, and equivalents may be used. Therefore, the above description should not be taken as limiting the scope of the invention which is defined by the appended claims.

Claims

Claims:

1. A system for repositioning teeth from an initial tooth arrangement to a final tooth arrangement, comprising one or more cycle of successive appliances and one or more retainers, the system comprising:

2. The system of claim 1 , wherein the appliances comprise polymeric shells having cavities shaped to receive and resiliently reposition teeth from one arrangement to a successive arrangement.

3. The system of claim 1 , wherein each cycle contains a customized force system prescribed by an orthodontic doctor.

4. The system of claim 1 , wherein each cycles contains a de-escalating, escalating, and/or combinations of de-escalting/escalating force system.

5. The system of claim 1 , comprising at least two cycles of appliances.

6. The system of claim 1 , wherein the first appliances are the final appliances.

7. The system of claim 1 , comprising from 2 to 20 successive appliances.

8. The system of claim 7, wherein each of the successive appliances comprises from 3 to about 10 duplicate appliances.

9. The system of claim 1 , wherein each of the appliances carries specifications to specify the differential force.

10. The system of claim 1 , wherein each of appliances carries specification to specify the dimension or material characteristics of the appliance.

1 1 . The system of claim 1 , wherein the specification specifies the geometry or thickness of the appliances, the high, medium, or low differential force of the appliances, and/or the anticipated discrepancies of the appliances.

12. The system of claim 21 wherein the specifications of the appliances are marked on a package, marked on tags or marked by placement in a package.

13. The system of claim 1 , wherein each of the appliances carries specifications to specify the differential force.

14. The system of claim 1 , wherein each of appliances carries specification to specify the dimension or material characteristics of the appliance.

15. The system of claim 1 , wherein the specification specifies the geometry or thickness of the appliances, the high, medium, or low differential force of the appliances, and/or the anticipated discrepancies of the appliances.

16. The system of claim 1 , wherein the specifications of the appliances are marked on a package, marked on tags or marked by placement in a package.

17. The system of claim 1 , wherein the appliances comprise polymeric shells having cavities shaped to receive and resiliently reposition teeth from one

arrangement to a successive arrangement.

18. The system of claim 1 , comprising two or more appliances, wherein the second appliance from the first appliance in stiffness in the range from about 0.1 to about 8 Gpa.

19. The system of claim 1 , comprising two or more appliances, the first appliance having an elastic modulus that differs from the elastic modulus of the second appliance by about 1 % to about 800%.

20. The system of claim 1 , where any of the cycles comprises two or more appliances, the subsequent appliance having a thickness that differs from the thickness of the prior appliance in the range from about 0.1 to about 2 mm.

21 . The system of claim 1 , wherein at least a region of an individual lock or shell comprises two or more layers of a polymeric material.

22. The system of claim 1 , wherein at least a region of an individual lock or shell comprises a material reinforced with a structure selected from the group consisting of pieces, strips, wires, mesh, lattices, interpenetrating networks, networks and combinations thereof.

23. The system of claim 1 , wherein each of the rings or shells in each appliance has uniform stiffness, elastic modulus, or thickness over the entire lock or shell.

24. The system of claim 1 , wherein each of the rings or shells in each appliance has non-uniform stiffness, elastic modulus, or thickness over the entire lock or shell.

25. The system of claim 1 , further comprising a dental implant to increase anchorage.

26. The system of claim 25, wherein the implant can have a diameter from about 2 mm to about 10 mm.

27. The system of claim 1 , wherein the lock comprises polymer, metal wire, a hard plastic material, or a ceramic.

28. The system of claim 1 , wherein the lock is a polymeric ring.

29. A method of making the system of claim 1 .

30. A method of using the system of claim 1.

31. The method of claim 30, for treating a disorder selected from the group consisting of malalignment, crowding, spacing, overjet, overbite problem, and a combination thereof.