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WO2018037337A1 - Dispositif et procédé de réalisation assistée par ordinateur d'une morsure de construction en odontologie - Google Patents

Dispositif et procédé de réalisation assistée par ordinateur d'une morsure de construction en odontologie Download PDF

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Publication number
WO2018037337A1
WO2018037337A1 PCT/IB2017/055056 IB2017055056W WO2018037337A1 WO 2018037337 A1 WO2018037337 A1 WO 2018037337A1 IB 2017055056 W IB2017055056 W IB 2017055056W WO 2018037337 A1 WO2018037337 A1 WO 2018037337A1
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WO
WIPO (PCT)
Prior art keywords
patient
supporting structure
reference planes
planes
dental
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Ceased
Application number
PCT/IB2017/055056
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English (en)
Inventor
Gian Domenico IZZI
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Individual
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Individual
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Filing date
Publication date
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Publication of WO2018037337A1 publication Critical patent/WO2018037337A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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
    • A61C7/08—Mouthpiece-type retainers or positioners, e.g. for both the lower and upper arch
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00—Dental auxiliary appliances
    • A61C19/04—Measuring instruments specially adapted for dentistry
    • A61C19/045—Measuring instruments specially adapted for dentistry for recording mandibular movement, e.g. face bows
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00—Dental auxiliary appliances
    • A61C19/04—Measuring instruments specially adapted for dentistry
    • A61C19/05—Measuring instruments specially adapted for dentistry for determining occlusion
    • A61C19/052—Measuring instruments specially adapted for dentistry for determining occlusion with tracing appliances
    • 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
    • A61C7/36—Devices acting between upper and lower teeth

Definitions

  • the present invention finds its application into the field of dental devices and relates to a device and method for the computer-aided realization of an odontoiatric construction bite.
  • the construction bite is a tool designed for use in dentistry in mandibular repositioning operations necessary to correct conditions of incorrect occlusion of the teeth that may oblige the mandible to assume a non-comfortable position for facial and neck muscles and for temporomandibular articulation.
  • the construction bite is designed to be interposed between the upper and lower dental arch so as to record their mutual position following the mandibular repositioning.
  • Mandibular repositioning is intended to correct the spatial relationship between the upper arch and the lower arch, associating it with a balanced bilateral neuromuscular activity of the chewing muscle and to a non-pathological dynamic function of the temporomandibular articulation.
  • a minimal variation in balance can turn into variations in intensity of strength and coordination skills, as well as causing a state of muscular tension that negatively affects the entire body, decreasing its overall athletic potential.
  • an intraoral device such as the bite, constructed through a valid construction bite
  • the common construction techniques for the construction bites comprise the use of a thermosetting or thermoplastic material, such as a piece of wax, undergoing to heat softening and introduced into the mouth of the patient before manually positioning the mandible into a presumed therapeutic position.
  • the patient can bite the soft material to imprint the marking of dental arch thereon so that with the cooling of the material the reciprocal position of the arches is consolidated.
  • This position may be reproduced at any time by simply repositioning the construction bite on the teeth and making the patient to close the mouth in such a manner that the indentations coincide, forcing the jaw to assume that particular position.
  • a first drawback of this solution is that the effectiveness of the bite thus realized and the consequent position of the mandible can only be verified after the registration of the construction bite, through instrumental tests such as surface electromyography, posture- stabilometric or baro-podometric test or other instrumental exams that provide real-time results.
  • instrumental tests generally provide a first step wherein the patient is asked to tighten the teeth without the wax interposed to tighten successively the teeth on the inserted construction bite, so as to assess whether the new position of the mandible after the repositioning gives an effective improvement of the electromyographic and/or posturo-stabilometric and/or baro-podometric parameters compared to the starting position of the patient in the absence of wax.
  • the construction bite that is found to be more efficient is sent to the dental technician, which uses it to clog the dental plaster arch models and reproduce faithfully on the final device, which can be an orthodontic device, a prosthesis, a reconstruction or a bite, the same ratio between the arches that was detected with the bite considered to be improved by instrumental exams.
  • T.E.N. S. transcutaneous electrical neural stimulation
  • This technique although valid only in certain clinical situations, is uncommon and low used, unlike the classic registration of the construction bite, due to a series of limitations. Specifically, this technique requires long operational times and has difficulty in its executing due to the complex mechanisms that require some operator experience. Moreover, the devices required for this technique are particularly expensive.
  • US2013/280672 discloses a tool for defining and measuring anatomical features of a patient for realizing dentures comprising all of the features of the preamble of claim 1, and in particular a lower structure and an upper structure that define reference planes and operating means for varying the relative position of such plans.
  • this tool does not allow these physical parameters to be determined by varying the relative orientation between these reference plans.
  • the object of the present invention is to overcome the above mentioned drawbacks by providing a device and method for the computer-aided manufacturing of a construction bite that is particularly effective and economical.
  • a particular object is to provide a device and method for the computer-aided manufacturing of a dental construction bite that allows to determine mandibular displacement in a mechanical and accurate manner, to obtain repeatable, predictable results, free from errors due to the greater or lesser ability of the operator.
  • Yet another object is to provide a device and method for the computer-aided realization of a dental construction bite which, in contrast to the known techniques, allow to realize the bite starting from instrumental analysis to carry out, consequently, an optimal mandibular repositioning in an extremely fast and automated manner until the achieving of the desired result.
  • Yet another object is to provide a device and a method for the computer-aided realization of a dental construction bite that are particularly quick and do not require the construction of more bites.
  • a further object is to provide a device and a method for the computer-aided construction of a dental construction bite not affected by inaccuracies due to small variations in the mandibular position during manual repositioning or due to error of perception of the operator.
  • a computer-aided device for realizing a dental construction bite which, according to claim 1, comprises an upper supporting structure and a lower supporting structure to be associated respectively with the upper dental arch and lower dental arch of a patient to define a pair of reference planes, operating means associated with at least one of said supporting structures to vary the relative position of said reference planes and identify respective occlusal planes, electronic control means adapted to be operatively associated with means for detection of physical parameters of the patient adapted to detect the variation of said parameters in relation to the relative positions of said reference planes, said electronic control means being adapted to store the relative positions between said reference planes and to associate each of them with the respective set of detected parameters.
  • the device thus made will allow to perform a continuous repositioning of the mandible according to the results obtained in real time through the simultaneous instrumental analysis.
  • the device will perform a series of displacements corresponding to respective occlusion conditions up to detect the therapeutic mandibular positioning.
  • FIG. 1 is a schematic view of a device applied to a patient
  • FIG. 2 is an exploded front of a device according to the invention
  • FIG. 3 is a front view of the device according to the invention in a first working condition
  • FIG. 4 is a front view of the device of Fig. 3 in a second working condition
  • FIG. 5 is a side view of the device of Fig. 3;
  • FIG. 6 is a side view of the device of Fig. 4;
  • FIG. 7 is a side view of a detail of the device according to the invention in a first working condition
  • FIG. 8 is a side view of the detail of Fig. 7 in a second working condition
  • FIG. 9 is a front view of the device in a second embodiment and in a first working condition
  • FIG. 10 is a front view of the device of Fig. 9 in a second working condition
  • FIG. 11 is a side view of the device according to the invention wherein further details are visible;
  • FIG. 12 is a schematic view of the screen of the monitor of a computer during a step of the method in a first working condition
  • FIG. 13 is a schematic view of the screen of Fig. 12 in a second working condition.
  • Fig. 1 schematically shows the device, indicated generically by 1, inserted during operation within a patient's mouth and associated with detecting means D of the patient's physical parameters to detect the variation of the parameters according to the position taken instantaneously from the mandible and the consequent relative position between the dental arches.
  • the detection means D comprise a plurality of electromyography electrode E of a known type and therefore not described in more detail below.
  • the device 1 may be connected to different detection tools, such as known instruments for carrying out a baro-podometric examination or a posture-stabilometric examination.
  • the device 1 comprises an upper supporting structure 2 and a lower supporting structure 3 which are associated respectively with the upper dental arch As and with the lower dental arch Ai of the patient to define a pair of reference plans.
  • the two supporting structures 2, 3 are structurally similar to the common templates used in orthodontics as containment device according to the prior art and in particular are obtained by thermo forming starting from a thermoplastic or thermosetting material applied to the dental arches As, Ai to define respectively an upper mask 2 and a lower mask 3 having the negative shape respectively of the upper and lower dental arches As, Ai.
  • the masks 2, 3 will be hot molded and made on the plaster model of the upper As and lower dental arch Ai of the patient, so as to precisely follow the shape thereof and covering all the exposed surfaces of the teeth and partly also a portion of the surrounding gum, with an extension just enough to secure the additional elements of the device 1.
  • the supporting structures 2, 3 may also have a different shape and, for example, may be made of simple plates in a material of adequate strength or be completely absent.
  • the device 1 also comprises operating means 4 associated with at least one of the supporting structures, such as the upper structure 2, to operate thereon or, in the absence of them, directly on the arches As, Ai, varying the relative position of the reference planes along at least three mutually orthogonal directions.
  • the control means will store the relative positions taken each time from the reference planes to associate the respective set of detected parameters to each of them, enabling the operator to accurately estimate the optimal position of the reference planes which corresponds to the actual therapeutic position of the mandible.
  • the operating means 4 comprise a plurality of linear driving elements 6 integral with one of the supporting structures, preferably the upper 2, to move it with respect to the other supporting structure 3 along respective movement directions in both directions.
  • the driving elements 6 may be of mechanical, hydraulic, pneumatic, oleodynamic or similar type, without any particular limitations.
  • actuators 6 are provided, two on the left and two on the right of the patient's sagittal plane, in symmetrical positions relative thereto and located at the molars and canines, but their number and position may vary without particular theoretical limitations.
  • the driving elements 6 comprise a single-acting piston 7 sliding inside a cylinder 8 integral with the outer surface of the upper supporting structure 2.
  • the piston 7 is associated with a spring 9 or other elastic element allowing it to return to the starting position.
  • the outer ends 10 of the pistons 7 will act on respective lateral guide slots 11 of the lower structure 3 to define a thrust surface for the linear driving elements 6 against which the latter may exercise their strength and cause the relative movements between the supporting structures 2, 3 and the resulting vertical displacement of the mandible.
  • the lower structure 3 comprises two side guide planes 11 symmetrical with respect of the sagittal plane of the patient.
  • the two guide planes 11 are, in use, horizontal surfaces perpendicular to the outer surface of the lower supporting structure 3 and extend from the canine to the molars, both on the right and the left side.
  • the independent movement of the driving elements 6 will allow the inclination of the occlusal plane on two or more planes of the space, in an extremely precise and controlled manner.
  • Figs. 3 and 4 show two different positions of the reference planes corresponding to two different inclinations of the occlusal plane obtained by moving only the left driving element 6.
  • Figs. 5 and 6 illustrate the same positions taken by the two arches As, Ai but from a side view.
  • the operating means 4 comprise, for each driving element 6, a corresponding transmission element 12 adapted to be disposed, during use, outside the patient's oral cavity and operatively connected to motor means 13 to transfer its motion to the corresponding driving element 6 and produce the movement along its respective direction of movement X, in both directions.
  • the transmission elements 12 are electrically driven oleodynamic elements with linear motion but may be selected between traction mechanical elements, fluid-dynamic elements, compressed air, electric or equivalent means.
  • the transmission elements 12 are connected to a stepper motor 13 having a screw 14 for rotating clockwise or counterclockwise to move a slider 15 up or down, promoting the input of a fluid inside the cylinder 8 of the driving element 6 through a duct 16 and obtaining the corresponding linear movement of the piston 7 which it is connected to.
  • a stepper motor 13 having a screw 14 for rotating clockwise or counterclockwise to move a slider 15 up or down, promoting the input of a fluid inside the cylinder 8 of the driving element 6 through a duct 16 and obtaining the corresponding linear movement of the piston 7 which it is connected to.
  • Figs. 9 and 10 illustrate the previously described device 1 wherein each driving element 6 is connected to a respective transmission element 12 which can be controlled independently of the others.
  • first sensor means adapted to detect the pressure exerted by each of the driving elements 6 on the respective thrust surface 11.
  • the first sensor means will comprise for each driving elements 6 a pressure sensor for detecting the pressure inside the duct 16 or a sensor operatively associated with the transmission element 12.
  • each mechanical driving element 6 positioned at the mouth is connected to the respective transmission element 12 located out of the mouth, it results that the pressure detected by each sensor will be directly proportional to that exerted in the oral cavity by the relative driving element 6 relative to the guide plane 11 of the lower supporting structure 3.
  • the pressure detection will allow it to be checked uniformly on the arch points where the driving elements 6 are positioned.
  • supporting structures 2, 3 will comprise second sensor means for geometrically detecting the position of the lower supporting structure 3 on the occlusal plane relative to a fixed reference system associated with the upper supporting structure 2.
  • the second sensor means will be of the Hall effect type and comprise at least one pair of position sensors 17 associated with the upper supporting structure 2 and at least one magnet 18, for example of a permanent type, associated with the lower supporting structure 3.
  • the second sensor means will allow to measure the distance between the position sensors 17 and the magnet 18 by exploiting the intensity of the magnetic field that the latter causes on the position sensors 17, which will generate a voltage proportional to the distance.
  • the two position sensors 17 will be placed symmetrically on the outer surface of the upper supporting structure 2, for convenience at the premolars.
  • the magnet 18 will preferably be positioned on the outer surface of the lower structure 3 at the median line, as can be seen in Fig. 11 or more clearly in Fig. 2.
  • control means may comprise an electronic board or similar means provided with a microcontroller adapted to handle input and output signals through input/output ports.
  • the electronic card may also have a USB interface that allows communication with a computer.
  • Position sensors, pressure sensors, and electromyography sensors or other detection means D will be connected to the input ports of the electronic card that may process input information through appropriate software and generate outbound signals to control the motor means 13 through the output ports to which they are connected.
  • the electronic board may be replaced by equivalent means for receiving signals collected from external sensors, processing such signals, and generating outbound signals.
  • the detection means D of the physical parameters to the patient according to the specific instrumental analysis, which may be preferably an electromyography carried out by applying a plurality of electrodes E to the patient's face or a baro-podometric exam or, still, a posture-stabilometric exam, carried out with known type equipment.
  • the specific instrumental analysis may be preferably an electromyography carried out by applying a plurality of electrodes E to the patient's face or a baro-podometric exam or, still, a posture-stabilometric exam, carried out with known type equipment.
  • the upper 2 and lower supporting structures 3 will be applied to the upper dental arch As and to the patient's lower dental arch Ai respectively to define a pair of reference planes.
  • the two supporting structures 2, 3 may be two thermoplastic templates made by known techniques.
  • the device 1 Once the device 1 is inserted into the mouth of the patient, it will be required to swallow it to tighten the teeth, keeping them tight during the procedure.
  • the device 1 will be switched on and the linear mechanical driving elements 6 will be operated so that they will stop as soon as they come into contact with the guide plane 11 of the lower structure 3.
  • the contact will be detected by the pressure sensors described above.
  • control means will read the input signals coming from the first sensor means and elaborate them by means of a special software that generates output commands for the motor means 13.
  • the driving elements 6 will cause the relative movement of the reference planes and the consequent mandibular displacements by exerting a force on the respective lower guide planes 11, which will thus be moved away in each of the contact points with the driving elements 6 independently of each other, so as to handle the mandible movement with wide range of action.
  • driving elements 6 may be managed by the software through various preset modes that may selected at the execution of the procedure.
  • a first mode is the random one, wherein the driving elements 6 are operated so as to test different position combinations that are instantly recorded by the control means that will associate each relative position between the planes to a set of corresponding physical parameters.
  • the software will automatically select the best situation by analyzing the numeric values found through instrumental exams and will indicate the coordinates of the position that gave such results.
  • the coordinates consist of the exact position of the piston 7 of each mechanical driving element 6 that may be indirectly find thorough the software that stores the steps, or the portion of a round, which make each motor 13 to run through the transmission element 12 that connect it to the mechanical driving element 6.
  • This process can be initially conducted with a coarse degree of precision so as to speed up the examination, and then become more and more precise as it approaches the therapeutic position.
  • a second operating mode involves the specific movement of each driving element 6 in a direction until the instrumental analysis values continue to improve.
  • a third mode is the manual one, even if always assisted by the computer, wherein the single driving elements 6 are controlled by the operator through the computer by making them advance in one direction or the other, guided by the graphic visualization of the examination values, so that it is possible to know if you are approaching or not at the desired position.
  • the position search step will be interrupted to leave the linear driving elements 6 locked at that precise point, so fixing the inclination of the occlusal plane on the sagittal and front plane.
  • the mandible may occupy several positions on the occlusal plane, for example, more or less advanced or laterally displaced.
  • the patient will still wear the device 1 with the driving elements 6 that will be locked.
  • the device 1 may be provided with a monitor to graphically display the coordinates of the above point.
  • the optimum point will be represented by a circle locked in the center of the screen, while the instant position appears with a circle of different color.
  • the position of the lower structure 3 may be locked with respect to the upper structure 2, for example by introducing a quick-release fastening material or a light-curing material.
  • the construction bite will be so ready to be sent to the dental technician.
  • the device of the invention is characterized by high resistance which allows it to be used also in electromyographic and posturostabilometric analysis wherein it is necessary to tighten the teeth, always guaranteeing that displacements will be determined with high precision and resolution.
  • position sensors also allows a repositioning not only mechanical, but also physiological, i.e. determined by the swallowing of the patient on the new occlusal plane that has been obtained by previous mechanical movements.
  • This movement step may also be carried out by the same patient by moving the mandible in multiple random directions on said already fixed plane, always simultaneously with the position and electromyographic records, as the device creates a new occlusal plane which to freely occlude on, without holding the mandible tied.
  • the device thus conceived, amongst the various applications, would allow the manufacturing of construction bites also during the physical activity of the subject (treadmill or sports training) without being bound by fixed and heavy external supports, obtaining advantages in making construction bites functionalized in relation to the sport activity of the patient.
  • the device can move the two reference planes directly from the inside of the oral cavity, avoiding significant flexions on the structure that would drastically affect precision and reproducibility, allowing clamping on durable and stable guide planes for executing a EMG test, allows to precisely move each quadrant of the dental arch, allow to control instantly the pressures exerted on each quadrant (on each driving element) and correlate them to instrumental tests.
  • the device has minimal interocclusal encumbrance, essential for the manufacturing of effective construction bites, respecting the oral functions and vertical occlusion size.
  • the device is extremely versatile since the construction bite made therethrough is at the basis of multiple dental procedures, for example within the gnatological, orthodontic, prosthetic, restorative branch.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Dentistry (AREA)
  • Epidemiology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Biophysics (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Abstract

Un dispositif pour une réalisation assistée par ordinateur d'une morsure de construction dentaire comprend une structure de support supérieure (2) et une structure de support inférieure (3) conçues pour être respectivement associées à l'arcade dentaire supérieure (As) et à l'arcade dentaire inférieure (Ai) d'un patient pour définir une paire de plans de référence, des moyens d'actionnement (4) associés à au moins l'une des structures de support (2, 3) pour faire varier la position relative des plans de référence et identifier les plans occlusales respectifs, des moyens de commande électronique conçus pour être associés de manière fonctionnelle à des moyens de détection (D) de paramètres physiques du patient conçu pour détecter la variation des paramètres en fonction des positions relatives des plans de référence, le moyen de commande électrique étant conçu pour stocker les positions relatives entre les plans de référence et pour associer à chacun de ceux-ci l'ensemble respectif de paramètres détectés.
PCT/IB2017/055056 2016-08-23 2017-08-22 Dispositif et procédé de réalisation assistée par ordinateur d'une morsure de construction en odontologie Ceased WO2018037337A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT102016000086724A IT201600086724A1 (it) 2016-08-23 2016-08-23 Dispositivo e metodo per la realizzazione computer-assistita di un morso di costruzione odontoiatrico
IT102016000086724 2016-08-23

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WO2018037337A1 true WO2018037337A1 (fr) 2018-03-01

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IT (1) IT201600086724A1 (fr)
WO (1) WO2018037337A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2020116275A (ja) * 2019-01-25 2020-08-06 株式会社Ｇｒｉｎ 歯科用測定器具、測定方法、及びアタッチメント器具

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080072915A1 (en) * 2003-08-08 2008-03-27 Nelissen Jozef F Device for treating nighttime breathing problems
US20130280672A1 (en) * 2010-11-03 2013-10-24 Global Dental Science, LLC Combination Tool For Anatomical Measurement for Denture Manufacture
US20150282900A1 (en) * 2013-11-12 2015-10-08 Sung-wan Lee Orthopedic appliance for temporomandibular joint
US20160106525A1 (en) * 2013-05-16 2016-04-21 Eq. Co., Ltd. Upper and lower tray apparatus for manufacturing dentures

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080072915A1 (en) * 2003-08-08 2008-03-27 Nelissen Jozef F Device for treating nighttime breathing problems
US20130280672A1 (en) * 2010-11-03 2013-10-24 Global Dental Science, LLC Combination Tool For Anatomical Measurement for Denture Manufacture
US20160106525A1 (en) * 2013-05-16 2016-04-21 Eq. Co., Ltd. Upper and lower tray apparatus for manufacturing dentures
US20150282900A1 (en) * 2013-11-12 2015-10-08 Sung-wan Lee Orthopedic appliance for temporomandibular joint

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2020116275A (ja) * 2019-01-25 2020-08-06 株式会社Ｇｒｉｎ 歯科用測定器具、測定方法、及びアタッチメント器具

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