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    • 专利摘要:
    systems and methods of repositioning teeth using one or more appliances for installation on the patient's teeth are described. the apparatus includes an arc-shaped member; a plurality of spring members coupled to or for providing on the spring member; and a plurality of attachment members for securing a corresponding plurality of the patient's teeth on a one-to-one basis, the attachment members being supported by the arch member. the arc-shaped member and the plurality of springs together comprise a two-dimensional structure having a length dimension and a width dimension with varying widths along the length dimension, which is folded into a three-dimensional structure.
    公开号:BR112018011378B1
    申请号:R112018011378-6
    申请日:2016-12-06
    公开日:2021-09-08
    发明作者:Seyed Mehdi Roein Peikar；James Sylvester Wratten Jr.
    申请人:Brius Technologies, Inc.；
    IPC主号:
    专利说明:

    CROSS REFERENCE FOR RELATED PATENT APPLICATIONS
    [001] This application claims priority from each of US Provisional Application No. 62/263659, filed December 6, 2015, US Provisional Application No. 62/352025, filed June 20, 2016, and Provisional Application US Patent No. 62/393526, filed September 12, 2016, each of which is incorporated herein by reference in its entirety. FUNDAMENTALS OF THE INVENTION 1. Field of Invention
    [002] The present embodiments generally relate to systems and methods for repositioning teeth, including orthodontic systems and methods that include or employ one or more appliances that are installed (in a removable or non-removable manner) on the patient's teeth. 2. Fundamentals
    [003] In orthodontics, the repositioning of teeth for aesthetics or other purposes has been performed by orthodontic devices traditionally referred to as braces. Apparatuses are typically composed of brackets, arc wires, sealing rings and ligature wires. In addition to braces that typically have braces in front of the teeth, other methods include lingual orthodontics (which employs braces behind the teeth) and clear aligners such as Invisalign™ aligners (which employ clear polymeric shells on the teeth). DISCLOSURE SUMMARY
    [004] The modalities described here refer to systems and methods for repositioning teeth and include or employ one or more appliances that are installed (in a removable or non-removable manner) on the patient's teeth.
    [005] An apparatus for installing on the patient's teeth according to examples of various modalities comprises an arc-shaped limb; a plurality of spring members coupled to or provided on the arc-shaped member; and a plurality of clamping members for securing to a plurality of the patient's teeth, the clamping members being supported by the arch-shaped member. In such examples, the arc-shaped member and the plurality of springs together comprise a two-dimensionally shaped structure having a length dimension and a width dimension with variable widths along the length dimension, which is folded into a structure. three-dimensional.
    [006] In an apparatus according to a further example, each attachment member comprises: (a) a separate respective male connector element configured to engage with one or more separate respective female connector elements connected to one or more of the patient's teeth; or (b) a separate respective cap configured to fit over and to one or more of the patient's teeth.
    [007] In an appliance according to a further example, the arc-shaped member is configured to mate and extend along an arc of a patient's jaw when the appliance is installed on the patient's teeth; and each spring member is disposed along the arch-shaped member at a location between two teeth in the patient's jaw, when the arch-shaped member extends along the patient's jaw.
    [008] An apparatus according to a further example includes a plurality of arms extending from the arc-shaped member. Each arm is associated with one or more teeth of the patient, wherein each respective fixation member of the plurality of fixation members is attached to at least one respective of the different arms with respect to each other fixation member. In such examples, each fixation member comprises: (a) a separate respective male connector element configured to engage with one or more separate respective female connector elements connected to one or more of the patient's teeth; or (b) a separate respective cap configured to fit over and to one or more of the patient's teeth.
    [009] In an apparatus according to a further example, each respective spring member of the plurality of spring members is provided along a different respective of the arms with respect to each other spring member.
    [0010] In an apparatus according to a further example, each spring member is provided in one of the respective arms, at a location between the arc-shaped member and the clamping member attached to the arm.
    [0011] In an apparatus according to a further example, each clamping member is separate and does not cover any portion of the spring member of the arm to which the clamping member is attached.
    [0012] In an apparatus according to a further example, each attachment member comprises a separate respective cap configured to engage over and to one or more of the patient's teeth when the device is installed, such that the plurality of members The attachment comprises a plurality of caps which are disposed along the arc-shaped member, and wherein each separate respective cap is disconnected from one or more other caps of the plurality of caps.
    [0013] In an apparatus according to a further example, each fixation member comprises a T-shaped member that is configured to engage with a slit in a female connector element connected to one of the patient's teeth.
    [0014] An apparatus for installing on the patient's teeth according to further examples of modalities comprises an arch-shaped limb; a plurality of arms extending from the arch-shaped member, each arm being associated with one or more of the patient's respective teeth relative to the other arm of the plurality of arms; and a plurality of attachment members for securing to a plurality of teeth of the patient, wherein each respective attachment member of the plurality of attachment members is attached to one or more of the arms.
    [0015] In an apparatus according to further examples of the above embodiments, each respective fastening member of the plurality of fastening members is attached to a different respective one of the arms with respect to each other fastening member of the plurality of fastening members.
    [0016] In an apparatus according to further examples of the above embodiments, each attachment member comprises: (a) a separate respective male connector element configured to engage with one or more respective female connector elements connected to one or more of the patient's teeth ; or (b) a separate respective cap configured to fit over and to one or more of the patient's teeth.
    [0017] An apparatus according to further examples of the above embodiments includes a plurality of spring members coupled to or provided in one or more of the plurality of arms such that one or more of the arms includes at least one spring member.
    [0018] In an apparatus according to further examples of the above embodiments, each spring member is provided in one of the respective arms, at a location between the arc-shaped member and the clamping member attached to the arm.
    [0019] In an apparatus according to further examples of the above embodiments, each clamping member is separate and does not cover any portion of the spring member of the arm to which the clamping member is attached.
    [0020] In an apparatus according to further examples of the above embodiments, each attachment member comprises a respective separate cap configured to fit over and to one or more of the patient's teeth when the apparatus is installed, such that the plurality of securing members comprise a plurality of caps which are disposed along an arc formed by the arc-shaped member, and wherein each separate respective cap is disconnected from one or more other caps of the plurality of caps.
    [0021] A method of making an apparatus to install on the patient's teeth according to exemplary embodiments comprises cutting a flat sheet of material into a two-dimensionally shaped structure having a length dimension and a width dimension, and a thickness corresponding to sheet material thickness; bending the two-dimensionally shaped structure into a three-dimensional structure having an arc-shaped member, and a plurality of spring members coupled to or provided on the arc-shaped member; and supporting a plurality of attachment members on the arch-shaped member, the plurality of attachment members for attaching to a plurality of teeth of the patient.
    [0022] In a method according to further examples, each attachment member comprises: (a) a separate respective male connector element configured to engage with one or more respective female connector elements attached to one or more of the patient's teeth; or (b) a separate respective cap configured to fit over and to one or more of the patient's teeth.
    [0023] In a method according to further examples, the arch-shaped member is configured to correspond to and extend along an arch of a patient's jaw when the appliance is installed on the patient's teeth; and each spring member is disposed along the arch-shaped member at a location between two teeth in the patient's jaw, when the arch-shaped member extends along the patient's jaw.
    [0024] In a method according to further examples, cutting further comprises cutting the flat sheet of material to form a plurality of arms extending from the arc-shaped member, each arm being associated with one or more teeth of the patient, wherein supporting the plurality of the attachment members comprises providing each respective attachment member of the plurality of attachment members on a different or combination of arms with respect to each other attachment member.
    [0025] In a method according to further examples, each attachment member comprises: (a) a separate respective male connector element configured to engage with one or more respective female connector elements connected to one or more of the patient's teeth; or (b) a separate respective cap configured to fit over and to one or more of the patient's teeth.
    [0026] In a method according to further examples, each respective spring member of the plurality of spring members is provided along a respective respective one of the arms with respect to the other spring member.
    [0027] In a method according to further examples, each spring member is provided in one of the respective arms, at a location between the arc-shaped member and the clamping member attached to the arm.
    [0028] In a method according to further examples, supporting a plurality of clamping members comprises supporting each clamping member in a position separate from and not covering any portion of the spring member of the arm to which the clamping member fixture is attached.
    [0029] In a method according to further examples, supporting a plurality of attachment members comprises providing a respective separate cover configured to fit over and to one or more of the patient's teeth when the appliance is installed, and supporting each cover so that the caps are arranged along the arc-shaped member, and such that each separate respective cap is disconnected from one or more other caps of the plurality of caps.
    [0030] In a method according to further examples, wherein supporting a plurality of fastening members comprises supporting a plurality of T-shaped members, each T-shaped member being configured to engage a slot in an element female connector attached to one of the patient's teeth.
    [0031] A method according to further examples, further comprising: obtaining an image or three-dimensional model of a desired tooth arrangement of the patient's teeth; and converting the three-dimensional image or model into a two-dimensional image or model; wherein cutting the flat sheet of material into the two-dimensional shape structure comprises cutting the flat sheet of material to a shape corresponding to the two-dimensional image or model.
    [0032] In a method according to further examples, the flat sheet of material comprises a sheet of Nitinol.
    [0033] In a method according to further examples, the flat sheet of material comprises a shape memory metal sheet.
    [0034] In a method according to further examples, at least one length dimension or the width dimension of the two-dimensionally shaped structure varies along the width or length of the two-dimensionally shaped structure. BRIEF DESCRIPTION OF THE DRAWINGS
    [0035] Figure 1 is a representation of a perspective view of an apparatus according to an example of a first embodiment.
    [0036] Figure 2 is a representation of a perspective view of an apparatus according to another example of the first embodiment.
    [0037] Figure 3 is a representation of a perspective view of an apparatus according to another example of the first embodiment.
    [0038] Figures 4a-c are perspective representations of a spring for an apparatus according to various examples of first, second, third and fourth embodiments.
    [0039] Figure 5 is a representation of a perspective view of an apparatus according to another example of the first embodiment.
    [0040] Figure 6 is a representation of a perspective view of an apparatus according to another example of the first embodiment.
    [0041] Figure 7 is a perspective view representation of an upper jaw and a lower jaw having an example of female connector elements.
    [0042] Figure 8 is a representation of a perspective view of an apparatus according to an example of a second embodiment.
    [0043] Figure 9 is a representation of a perspective view of an apparatus according to another example of the second embodiment.
    [0044] Figure 10 is a representation of a perspective view of an apparatus according to another example of the second embodiment.
    [0045] Figure 11 is a representation of a perspective view of an apparatus according to another example of the second embodiment.
    [0046] Figures 12a-h are perspective representations of components of a male connector element and arm for an apparatus according to another example of the second embodiment.
    [0047] Figure 13a is a perspective view representation of an upper jaw having another example of female connector elements.
    [0048] Figure 13b is a perspective view representation of a female connector element of the type in Figure 13a.
    [0049] Figure 14 is a representation of a perspective view of an apparatus according to another example of the second embodiment.
    [0050] Figure 15a is a plan view representation of an example of a male connector element.
    [0051] Figure 15b is a perspective view representation of another example of a female connector element.
    [0052] Figure 15c is a representation of a perspective view of the male connector element of Figure 15a coupled to the female connector element of Figure 15b, attached to a tooth.
    [0053] Figure 16a is a front view of an example of a male connector element for an appliance.
    [0054] Figure 16b is a perspective view of an example of a female connector element that may be employed with the male connector element of Figure 16a.
    [0055] Figure 16c is a perspective view of a male connector element received within a female connector element according to the examples of Figures 16a and 16b.
    [0056] Figure 17a is a representation of a perspective view of an apparatus or component of an apparatus according to another example of the first embodiment.
    [0057] Figure 17b is a representation of a perspective view of the apparatus of Figure 17a, installed on the teeth where the female connector elements are connected.
    [0058] Figures 18a-d are perspective and plan views of limbs and two-dimensional (2D) representations of an apparatus.
    [0059] Figures 18e and 18f are perspective representations of apparatus according to examples of the second mode, configured according to the members and representations of Figures 18a-d.
    [0060] Figures 19a-b are perspective representations of tools and components for making an apparatus according to the third embodiment.
    [0061] Figure 19c is a representation of a perspective view of an apparatus made in accordance with Figures 19a-b, according to the third embodiment.
    [0062] Figure 20 is a flowchart of a process for manufacturing an apparatus according to various modalities.
    [0063] Figure 21 is a flowchart of an additional process of manufacturing an apparatus according to various modalities.
    [0064] Figure 22a is a schematic representation of an apparatus according to the third modality, in a passive state.
    [0065] Figure 22b is a schematic representation of an appliance according to the third modality, connected to teeth and in active state.
    [0066] Figure 23a is a schematic representation of an apparatus according to the fourth modality, in a passive state.
    [0067] Figure 23b is a schematic representation of an appliance according to the fourth modality, connected to the teeth and in an active state.
    [0068] Figure 24 is a generalized schematic representation of a processing system that can be used to implement certain examples of modalities.
    [0069] Figure 25 is a front view representation of an example of a T-shaped male connector element.
    [0070] Figures 26a-f show perspective representations of examples of female connector elements receiving or for receiving a T-shaped male connector element such as, but not limited to, the type shown in Figure 25.
    [0071] Figures 27a and 27b are front view representations of two examples of an annular-shaped male connector element.
    [0072] Figure 28 is a front view representation of a male connector element of Figure 27a engaged with a female connector element. DETAILED DESCRIPTION
    [0073] In the following description of various embodiments, reference is made to the attached drawings which form a part thereof and which are shown by way of illustration of specific embodiments in which the invention may be practiced. It should be understood that other embodiments can be used, and structural changes can be made without departing from the scope of the various embodiments disclosed in the present disclosure.
    [0074] The modalities described here refer to systems and methods for repositioning teeth. Particular modalities refer to systems and methods for repositioning teeth from an original tooth arrangement (OTA) to a desired final tooth arrangement (FTA). In particular embodiments, the repositioning of teeth can be carried out in a single step using an appliance. In other modalities, tooth repositioning involves multiple steps performed progressively using multiple appliances. Modalities involving multiple steps (or multiple appliances, or both) may include one or more intermediate tooth arrangements (ITAs) between an original tooth arrangement (OTA) and a desired final tooth arrangement (FTA).
    [0075] Certain modalities use non-slip mechanics in which one or more appliances can be installed behind the teeth for aesthetically concerned patients. Other embodiments may employ other suitable mechanisms to install one or more appliances behind or in front of the patient's teeth, or both behind and in front of the patient's teeth. The decision whether or not to put the appliance in front of or behind the teeth is usually made by a clinician, physician, or other trained personnel, with the patient.
    [0076] Certain modalities described here include or employ a fixed appliance that cannot be removed by the patient, as the appliance is installed on the patient's teeth. Other modalities described herein include or employ a removable appliance that can be selectively removed and installed on the patient's teeth by the patient. Modalities that include or employ a fixed appliance may require or involve less patient cooperation and training compared to modalities that include or employ removable orthodontic techniques.
    [0077] The particular modalities described here can reduce the number of patient visits to the physician, as well as chair time for the clinician and the patient. Furthermore, particular modalities can shorten the total treatment time compared to traditional orthodontic procedures.
    [0078] In particular modalities described here, tooth movement planning can be computerized, which can simplify the treatment process for the clinician and can increase treatment accuracy compared to traditional techniques.
    [0079] One or more apparatus and methods described herein may include or be combined with one or more bone anchorage devices including, but not limited to temporary anchorage devices, mini-plates, implants, and the like.
    [0080] Systems or methods according to a first embodiment include or employ a pin-and-tube style device. Some pin-and-tube appliances have been employed in traditional systems, such as the Begg appliance system. An apparatus according to the first embodiment includes male connector elements and one or more springs between adjacent male connector elements. In certain examples of the first embodiment, one or more springs are provided between each male connector element and each adjacent male connector element. In other examples of the first embodiment, one or more springs are provided between some but not all pairs of adjacent male connector elements. For example, a rigid portion of the apparatus may be provided between one or a few pairs of adjacent male connector elements. In additional examples, one or more springs may be provided between male connector elements that are not directly adjacent to each other. Each spring is a force-generating component of the device. In particular embodiments, each spring is made of a flexible material, such as, but not limited to, a shape memory alloy, such as, but not limited to, nitinol. In particular embodiments, one or more springs or other portions of the apparatus (or the entire apparatus) are made of a flat sheet of flexible material, such as a shape memory alloy, such as, but not limited to, nitinol, which is cut a desired two-dimensional shape and then bent into a desired three-dimensional shape from an apparatus. In such embodiments, the two-dimensional shape can be configured to desired widths as well as lengths, which can provide additional design options compared to traditional curved wire apparatus systems in which a single diameter wire is bent and placed into the shape. desired. In particular embodiments, computerized design and manufacturing can be employed to design or configure the two-dimensional shape and/or to fold the two-dimensional shape into the three-dimensional shape of the apparatus. In particular examples, each spring is designed using computer design techniques, where the design takes into account which tooth is to be moved as well as the desired amount of movement and tooth direction.
    [0081] In the first mode, the male connector elements are configured to engage with female connector elements or brackets, which are fixed on the surfaces of the teeth. Female connector elements or brackets can be customized in size and/or shape for each tooth or for each patient (or both). Alternatively, the female connector elements or brackets can be configured for application to any patient or tooth (or a group of multiple patients or teeth) and may not be customized for each tooth or patient. Any suitable female connector element configured to engage and secure with a male connector element on the apparatus may be employed in various embodiments described herein, including, but not limited to examples of female connector elements described herein, traditional twin brackets, self-ligating brackets, or the like.
    [0082] Systems or methods according to examples of a second embodiment include or employ an apparatus having a plurality of separate arms configured to connect to a corresponding plurality of patient teeth, where each arm of the apparatus is configured to connect to a different one. respective tooth in relation to the other arm of the appliance. In other examples of the second embodiment, the apparatus may include an arm configured to connect to a plurality of teeth, or multiple separate arms configured to connect to one of the patient's teeth, or various combinations of arm-to-tooth connections as described herein. . In such examples of the second embodiment, the apparatus includes a single rigid bar to which each of the separate arms is attached. In other examples, the apparatus includes more than one rigid bar, with one or more arms attached to each rigid bar. One or more (or each) arm can include one or more springs. In particular examples, each arm (or each spring, or both) can be designed using computer design techniques, where the design takes into account which tooth is to be moved, as well as the desired amount of movement and tooth direction.
    [0083] In an apparatus according to the second embodiment, a separate respective male connector element may be formed in or otherwise attached to each respective arm, for example, at one end of each arm opposite the arm end that attaches to the rigid bar. Each male connector element can be configured to engage with a corresponding female connector element or bracket.
    [0084] Similar to the first modality described above, the female connector elements or brackets of the second modality can be customized in size and/or shape for each tooth or for each patient (or both). Alternatively, the female connector elements or brackets can be configured for application to any patient or tooth (or a group of multiple patients or teeth) and may not be customized for each tooth or patient. Unlike certain traditional orthodontic techniques, where all teeth are connected to a single wire, such that moving a tooth can result in unintended movement of nearby teeth, particular modalities described here allow the clinician to control the movement of teeth. each tooth independently of the other teeth.
    [0085] In particular examples of the first and second embodiments, the female connector element is configured as a twin bracket (for example, having a vertical slot and a transverse, horizontal slot) to which the male connector element locks, where the male connector element it is configured as a T-shaped frame or wire that can be fitted into the slits of the twin bracket. After fitting, the T-shaped structure of the male connector element can be secured to the twin bracket by one or more ligature wires, sealing rings or other suitable fastening mechanisms, for example, by a clinician during installation of the device in the teeth of the patient. In other examples, the female connector element is configured as a self-ligating bracket, so the self-ligating bracket can "close" and securely hold the T-arm, with or without an additional clamping mechanism. In other examples, the female connector element and the male connector element have other suitable configurations that allow you to selectively connect and disconnect these elements, with or without an additional fastening mechanism, as described above.
    [0086] Systems or methods according to a third modality include or employ an apparatus that has a configuration similar to the first modality, but are further configured to be selectively removable, to allow a patient (or clinician) to selectively install and remove the braces of the patient's teeth. An apparatus according to the third embodiment includes a plurality of liner caps in place of the male connector elements described above. Each aligner cap is configured to attach to a respective tooth, snapping over and onto the tooth. In other examples, one or more of the liner caps can be configured to secure to a group of teeth per cap. For example, aligner caps can comprise acrylic caps or caps made of other suitable materials, such as materials that help retain each cap on the patient's tooth. In particular embodiments, additional or alternative connector elements may be provided, such as, but not limited to, fasteners or other fastening mechanisms to help attach one or more (or each) of the caps to a respective tooth.
    [0087] In an apparatus according to the third embodiment, one or more springs may be provided between adjacent liner caps. In certain examples of the third embodiment, one or more springs are provided between each liner and each adjacent liner cap. In other examples of the third embodiment, one or more springs are provided between some but not all pairs of adjacent liner caps. For example, a rigid portion of the apparatus may be provided between one or a few pairs of adjacent liner caps. In additional examples, one or more springs may be provided between liner caps that are not directly adjacent to each other. Each spring is a force-generating component of the device. In particular embodiments, each spring is made of a flexible material, such as, but not limited to, a shape memory alloy, such as, but not limited to, nitinol.
    [0088] In the third modality, each cap can be customized in size and/or shape to match the size and shape of the tooth (or teeth) to which the cap fits. Alternatively, aligner caps are configured for application to any patient or tooth (or a group of multiple patients or teeth) and are not customized for each tooth or patient. In certain examples of the third embodiment, each liner cap can be separately connected to a support bar and not directly connected to any other adjacent tooth caps. In other examples, one or more of the liner caps can be connected to one or two adjacent liner caps such that two or more liner caps can be connected together along the arc-shaped structure of the support bar. This gives a device according to the third modality significantly greater flexibility, which can allow the physician to use fewer devices to complete a treatment. In particular examples, each cap is associated with (configured to secure to) a respective single tooth and is separately attached to the support bar with respect to each other cap of the apparatus such that the plurality of separate caps attach to a plurality of teeth separated on a one-to-one basis. In other examples, one or more device caps are configured to cover and engage over (attach to) several adjacent teeth. Such one or more covers configured to attach to multiple adjacent teeth may be separately attached to the support bar, separate from one or more other adjacent covers of the apparatus.
    [0089] Systems or methods according to a fourth modality include or employ an apparatus that has a configuration similar to the second modality, but is further configured to be selectively removable, to allow a patient (or clinician) to selectively install and remove the apparatus of the patient's teeth. Similar to the second embodiment, an apparatus according to examples of the fourth embodiment has a plurality of separate arms configured to individually connect to a corresponding plurality of teeth, where each arm of the apparatus is configured to connect to a respective different tooth relative to each other. arm of the device. In further examples of the fourth embodiment, the apparatus may include an arm configured to connect to a plurality of teeth, or multiple separate arms configured to connect to one of the patient's teeth, or various combinations of arm-to-tooth connections as described herein. . The apparatus includes a single rigid bar, to which each of the separate arms is attached. In other embodiments, the apparatus includes more than one rigid bar, with one or more arms attached to each rigid bar.
    [0090] Instead of the male connector elements of the second mode, an apparatus according to the fourth mode includes a respective aligner cap formed on or otherwise attached to each respective arm, for example, at one end of each arm opposite the arm end that attaches to rigid bar. The aligner caps of the fourth modality can be configured similarly to the aligner caps described herein for the third modality, to secure to a patient's teeth by snapping on and onto the teeth. However, the separate liner caps of the fourth embodiment are attached to the ends of the respective separate arms.
    [0091] Systems or methods according to the second and fourth embodiments (wherein an apparatus includes a plurality of separate arms configured to individually connect to designated teeth or a corresponding plurality of teeth) can provide distinct advantages of providing and controlling the individual tooth movement. Such advantages can allow a clinician to reduce the treatment time of teeth, thus reducing treatment time, root resorption and the number of trips the patient must take to the orthodontist. Thus, compared to traditional orthodontic techniques, in which a plurality of teeth are attached to a single wire, such that moving a tooth results in unintended movement of nearby teeth, particular modalities described here allow a clinician to control movement. of each tooth independently of each other tooth. Additional control may be provided in examples where the apparatus includes temporary anchor device (TAD) brackets as described herein.
    [0092] Systems or methods according to the third and fourth embodiments (wherein an apparatus includes a plurality of aligner caps configured to secure to the patient's teeth by snapping onto and onto the teeth) can provide distinct advantages of an apparatus that can be easily removed by the patient or clinician, similar to traditional clear aligners.
    [0093] In addition, the modalities described here allow for computerized design and fabrication, for example, to design or customize various aspects of one or more appliances, including designing or customizing one or more of the width, thickness, shape and tension of the spring or resistance of each spring in an apparatus. Fabrication techniques and computerized design and fabrication techniques may be employed to design and/or fabricate each spring in apparatus according to any one of the modes, or each arm in apparatus according to the second and fourth modes, on the basis of which the tooth or teeth should be moved and the desired amount and direction of movement. In particular embodiments, a computerization of the shape and characteristics of the apparatus and/or fabrication techniques described herein can provide significant advantages over traditional pin-and-tube apparatus, including those made from hand-bent wires or by robots having segments in U-shape between pairs of adjacent teeth.
    [0094] With systems or methods in accordance with the modalities described here, translational orthodontic movement of teeth is feasible in one or more, or all three directions of space (ie, mesiodistal, bucolingual and occlusogingival). Alternatively or in addition to the tooth translational movement, one or more, or all three rotational movements, including torque, angulation, and rotation (ie, buccolingual root torque, mesiodistal angulation, and mesial outflow-input rotation) are possible. First Mode
    [0095] As discussed above, systems or methods in accordance with a first embodiment include or employ a pin-and-tube style device. The apparatus according to the first embodiment is configured to clamp a plurality of (or all) teeth of an upper or lower jaw of a patient. In particular embodiments, a system and method according to the first embodiment is a non-slip system and method that employs apparatus having non-slip mechanics. In certain instances, an apparatus according to the first modality can be made, after rearranging a three-dimensional (3D) digital OTA to a 3D digital FTA, and designing (through computer-aided drawing or other suitable design techniques) a shape. device configured to transmit forces to the patient's teeth to move the teeth from the OTA to the FTA (or to an ITA, or from an ITA to an FTA or other ITA).
    [0096] Examples of apparatus 100, 200 and 300 according to the first modality are shown in Figures 1-3, respectively. Apparatus 100, 200 and 300 (and apparatus components) may be made of any suitable material including, but not limited to, Nitinol (NiTi), stainless steel, beta-titanium, cobalt-chromium or other metallic alloy, polymers or ceramics, and can be made as a single structure, unitarily formed or, alternatively, as multiple separately formed components connected together in a single structure.
    [0097] In Figure 1, the example apparatus 100 includes an arch-shaped structure that is configured for an upper jaw (to follow the arch of a patient's upper jaw). Apparatus 100 does not include a palatal arch feature. The example apparatus 200 in Figure 2 is similar to the apparatus of Figure 1, but includes a palatal arch feature 202. The example apparatus 300 in Figure 3 includes an arch-shaped structure that is configured for a lower jaw (to follow the lower jaw arch of a patient) and includes stabilizing a lingual arch feature 302. In other examples, an appliance according to the first modality may be configured for a lower jaw, but without a lingual arch feature. Therefore, certain examples of appliances according to the first modality include a palatal arch feature or a lingual arch feature, while other examples of appliances according to the first modality can be configured without a palatal arch feature or a lingual arch feature. lingual arch. Typically, the inclusion of a palatal arch or lingual arch feature will depend on the type of dental malocclusion or the clinician's preferences (or both).
    [0098] Examples of apparatus 100, 200 and 300 shown in Figures 1-3 include a plurality of male connector elements and a plurality of spring members. Apparatus 100 of Figure 1 includes male connecting elements 104 and spring members 106 and 108. Apparatus 200 in Figure 2 includes male connecting elements 204 and spring members 206 and 208. Apparatus 300 in Figure 3 includes male connecting elements 304 and spring members 306 and 308. Each spring member is composed of a portion or segment of apparatus 100, 200 or 300 which has a shape or configuration and resiliency characteristics of a spring to, for example, exert one or more tensile forces. or compression, a force in one or more of the three directions, a torque in one or more of the three directions, or to absorb motion, or combinations thereof. In the example apparatus 100, 200 and 300 in Figures 1-3, each spring member is disposed between a pair of adjacent male connector elements. In other examples, one or more spring members may be disposed between male connector elements that are not directly adjacent to each other. In other examples, one or more pairs of adjacent male connector elements in the apparatus may be connected by a rigid portion of the apparatus, rather than a spring.
    [0099] In the example apparatus 100, 200 and 300, a mesiodistal spring is included between the male elements of the canines and the second premolars, for example, to transmit a directed force to close a space created from a first premolar. -molar by extracting one or both of the adjacent teeth towards the other adjacent tooth (the teeth are not shown in Figures 1-3). In apparatus 100, the mesiodistal springs are shown at 108. In apparatus 200, the mesiodistal springs are shown at 208. In apparatus 300, the mesiodistal springs are shown at 308. One or both of the mesiodistal springs may be omitted from certain other examples of devices according to the first modality.
    [00100] The examples shown in Figures 1-3 include a separate, respective male connector element for each separate tooth in the jaw to which it attaches. In addition, the examples in Figures 1-3 include a separate, respective spring between each pair of adjacent male connector elements (and therefore between each pair of adjacent teeth when the appliance is installed on a patient). In other examples, an apparatus in accordance with the first embodiment may include fewer male connector elements than teeth in the jaw to which it attaches, or may have springs disposed between one or more, but not all pairs of adjacent male connector elements. Typically, the tooth number and location of the male connector elements and springs will depend on a desired tooth repositioning step or procedure, for example, as determined by the clinician.
    [00101] When the appliance 100, 200 or 300 is attached to the patient's teeth, the spring members 106 and 108, or 206 and 208, or 306 and 308 are configured to transmit the necessary forces on the teeth to move the teeth of their OTA to a desired FTA directly in one step or alternatively in multiple steps via one or more ITA(s). Spring members can be configured to move teeth in one or more (or all three) directions of translation. Alternatively or additionally, the spring members can be configured to move the teeth in one or more (or all three) directions of rotation.
    [00102] In the example apparatus 100, 200, and 300 in Figures 1-3, the spring members are shown as having a spiral or loop configuration in which a segment of the spring forms one or more loops. In other examples, one or more (or all) of the springs may have other suitable shapes, such as, but not limited to, U-shaped (having one or more U-shaped segments). In particular examples, the springs are formed from bent segments of a unitary arc-shaped structure of the apparatus. In other examples, springs are formed as separate components that are joined together with (or to form) an arc-shaped structure.
    [00103] Examples of different U-shaped springs 400, 402 and 404 that can be used in apparatus according to the first mode are shown in Figures 4a-4c. In the example in Figure 4a, a U-shaped spring 400 has an increased thickness in the occlusal-gingival direction, which restricts the flexibility of the appliance in that direction. In the example in Figure 4b, one side of spring 402 that is to be attached to the most misaligned tooth is thinner and more flexible than other portions of the spring. The spring can have a variable thickness so that it is thinner (and more flexible) on the side where the tooth needs to be displaced the most. In the example in Figure 4c, the U-shaped spring 404 is configured to be thinner and more flexible in an oblique direction, which allows an adjacent tooth to move simultaneously in the occlusogingival and bucolingual directions, for example, to move in a diagonal vector between the occlusogingival and bucolingual directions.
    [00104] In particular examples, the direction and magnitude of force and torque applied by a spring depend, at least in part, on the shape, width, thickness and length of the spring. In such examples, the shape, width, thickness and length of each spring are selected and designed to produce a desired tooth movement and to take into account the position of the spring in the appliance (including the size and type of teeth between which the spring is connected). For example, the thickness and geometry of each spring can be selected or designed to increase spring flexibility when adjacent teeth need to be further offset or when teeth are smaller in size, such as, but not limited to, lower incisors . In particular examples, processing systems and software with finite element analysis capability can be used to determine an optimal geometry and thickness of the springs, for example, to apply a selected force to accelerate tooth movement in one or more of the springs. buccolingual, occlusogingival and mesiodistal directions.
    [00105] Other examples of apparatus 500 and 600 are shown in Figures 5 and 6, respectively. Exemplary apparatus 500 in Figure 5 is configured for teeth of an upper jaw and is similar to example apparatus 200 in Figure 2, but includes a plurality of U-shaped spring members 506 between some of the adjacent pairs of male connector elements 504 Example apparatus 600 in Figure 6 is configured for teeth of a lower jaw and is similar to example apparatus 300 in Figure 3, but includes a plurality of U-shaped spring members 606 between some of the adjacent pairs of connector elements males 604.
    [00106] In addition, the apparatus 500 and 600 include mesiodistal springs 508 or 608 between the male connector elements to be attached to the female connector elements on the canines and second premolars, for example, to close a space created from the first premolars. - extracted molars (teeth are not shown in Figures 5 and 6). Male connector elements 504 and 604 may be similar in configuration and operation as described herein with respect to male connector elements 104, 204 and 304 in Figures 1-3. The example appliance 500 includes a palatal arch feature 502, while the example appliance 600 includes a lingual arch feature 602. The palatal arch feature 502 and the lingual arch feature 602 may be similar to the palatal arch feature 202 and to the lingual arch feature 302, respectively, as described herein. Other example appliances, according to the first modality, may not include a palatal arch feature or a lingual arch feature.
    [00107] Appliances 500 and 600 may be designed to be installed after a first or subsequently used appliance (such as, but not limited to, a 100, 200 or 300 appliance as shown in Figures 1-3) has moved the teeth of a OTA to an ITA (or from one ITA to another ITA) and was later removed. Thus, the 500 and 600 appliances can be designed to move teeth from an ITA to an FTA (or to another ITA). Alternatively, the 500 and 600 appliances can be designed to move teeth from an OTA to an ITA, or from an OTA to an FTA, without switching appliances in an ITA.
    [00108] The example apparatus 100, 200, 300, 500 and 600 shown in Figures 1-3, 5 and 6 do not include anchor device brackets. However, in other examples, one or more anchor device supports, such as, but not limited to, anchor device supports 812 and 904 (described in connection with examples in Figures 8 and 9) may be included in apparatus 100, 200 , 300, 500, and 600, to enable a clinician to attach one or more temporary anchoring devices TADs (or other suitable anchoring device) as described herein in connection with anchoring device brackets 812 and 904.
    [00109] Example apparatus 100, 200, 300, 500 and 600 as shown in Figures 1-3, 5 and 6 include a separate male connector element for attaching to each respective separate tooth of the jaw to which the apparatus is attached. In other examples, an apparatus according to the first modality may be attached less than all the teeth in a jaw (or it may include fewer male connecting elements than teeth in the jaw to which it attaches). For example, an appliance according to the first modality can be configured as a sectional appliance to move some but not all of the teeth in a patient's jaw.
    [00110] An example of such a scenario is when only the front teeth are misaligned and need to be moved. In this example, an appliance according to the first modality can be configured with male connecting elements for connection to anterior teeth in the jaw (and not to other teeth in the jaw). In other examples, a sectional type of appliance according to the first modality can be configured to make room for an implant or to align teeth that are inclined in an extraction space. In these examples, an apparatus according to the first modality can be configured with male connector elements for connection to one or more teeth that need to be moved to form the desired space or to correct for inclination (and not other teeth in the jaw).
    [00111] As discussed above, male connector elements are configured to engage and connect to female connector elements or brackets that are secured to tooth surfaces. Such female connector elements are fastened to the teeth, prior to installation of the 100, 200, 300, 500 or 600 apparatus.
    [00112] Various examples and configurations of male connector elements, and associated female connector elements can be employed in various examples of the first modality (and other modalities) described here. Certain examples of apparatus in accordance with the first embodiment include male connector elements as described and shown in relation to Figures 1-3, 5 and 6 (for attaching to female connector elements as described in relation to Figure 7). Other example apparatus in accordance with the first embodiment include male connector elements as described and shown in relation to Figures 8-12h (for attaching to female connector elements as described in relation to Figures 13a and 13b). Still other apparatus in accordance with the first embodiment include male connector elements as described and shown in relation to Figures 15a (for attaching to female connector elements as described in relation to Figure 15b, as shown in Figures 15c). Still other apparatus in accordance with the first embodiment include male connector elements as described and shown in relation to Figures 16a (for attaching to female connector elements as described in relation to Figures 16b and 16c. Still other example apparatus in accordance with the first embodiment include male connector elements as described and shown in relation to Figures 17a (for attachment to female connector elements as described in relation to Figure 17b). Other example apparatus according to the first embodiment include male connector elements as described and shown in relation to Figures 18e and 25 (for attachment to female connector elements as described in relation to Figures 26a-f) Other example apparatus in accordance with the first embodiment include male connector elements as described and shown in relation to Figures 27a and 27b (for attachment to female connector elements as described in relation to Figure 28). with the first embodiment include male connector elements having other suitable configurations for attaching to female connector elements having other suitable configurations.
    [00113] In the examples shown in Figures 1-3, 5 and 6, each of the male connector elements includes a generally wedge-shaped body having a wide end portion and a narrow end portion, the wide end portion extending the from the arc-shaped structure of the apparatus. The narrow end portion of each male connector element has a protrusion and indentation which engage a corresponding indentation and protrusion, respectively, on a female connector element when the device is installed on the patient's teeth.
    [00114] Figure 7 shows a representation of an OTA image of an upper and lower jaw of a patient, in which examples of 700 female connector elements are attached to the lingual surface of the teeth, in the upper and lower arches. 700 female connector elements are attached to the teeth on the upper arch, and similar 700 female connector elements are attached to the teeth on the lower arch. In other examples, female connector elements 700 can be attached to the buccal surface of teeth, for example, if preferred by the clinician.
    [00115] A respective separate female connector element 700 is attached to each respective tooth. The female connector elements provide a connection interface for connecting one or more appliances to the teeth, in accordance with the first and second embodiments described herein. While the drawing in Figure 7 shows all teeth in each mandible as having female connecting elements, other modalities may employ respective female connecting elements separated on some but not all teeth in the upper or lower jaw, for example, as selected by the clinician. .
    [00116] The 700 female connector elements can be secured to the teeth by means of direct or indirect attachment, or other suitable means to securely attach the elements to a surface of the teeth. Bonding materials can include adhesives such as but not limited to composite resin. In the case of indirect binding, a clinician can use a template to increase the accuracy of bracket placement. In particular examples, one or more (or all) of the 700 female connector elements are customized in size or shape for each tooth and are configured to have the lowest possible profile (to minimize the size in dimension extending away from the tooth, i.e. , the bucolingual direction). Other examples can be configured to minimize size in the mesiodistal or occlusogengival direction, or combinations thereof. In instances where the 700 female connector elements are to be attached to the teeth via direct attachment, intra-oral sweeping or an impression of the arches can be taken after attaching the female elements to the teeth. Impressions or sweeps (or both) include and thus provide information to help identify the position of the female connecting elements on the teeth. This information is used by physicians, manufacturers or technicians in device design, for example, to help identify the appropriate positions in the equipment to place or form one or more male connector elements, for proper alignment with one or more female connector elements, the teeth .
    [00117] Female connector elements 700 in Figure 7 are configured to engage with male connector elements having configurations as shown in the examples of apparatus 100, 200, 300, 500 and 600 in Figures 1-3, 5 and 6. Each female connector element 700 in Figure 7 includes a generally wedge-shaped basket structure configured to receive a respective one of the male generally wedge-shaped elements 104, 204, 304, 504 or 604 when apparatus 100, 200, 300, 500 or 600 is installed on the patient's teeth. An interior surface of each generally wedge-shaped basket structure has an indentation and a protrusion that engage a corresponding protrusion and indentation, respectively, in a male connector element, when the male connector element is received in the generally wedge-shaped basket structure. wedge. In this way, when the male connector element is received in the generally wedge-shaped basket structure, the male connector element (and thus the apparatus) is secured to the female connector element (and thus the tooth to which the connector element female is attached). In other examples, the female connector element of the apparatus 100, 200, 300, 500 and 600 may have other configurations suitable for engaging and securing to an associated male connector element, including, but not limited to, other examples as described with reference to Figures 13b, 15b, 16b, 17b or Figure 26e.
    [00118] Apparatus according to the first modality, and female connector elements associated with the first modality, may be manufactured in any suitable manner, including, but not limited to molding, casting, machining, 3D printing, stamping, extrusion, or similar. However, in particular examples, apparatus according to the first modality or female connector elements (or both) are made by cutting a two-dimensional (2D) shape of the apparatus from a 2D sheet of material and folding the 2D shape into a shape. 3D desired of the device. As discussed below, such methods are particularly suitable for making apparatus in accordance with examples of the first embodiment described herein.
    [00119] By cutting the 2D member from a flat sheet of material, instead of a traditional single diameter wire, a greater variety of 3D shapes can be made compared to shapes made by bending single diameter wire. The cut 2D member can have dimensioned or variable widths and lengths which, when bent to a desired shape, can result in parts of the 3D device having variations in thickness, width and length dimensions. In this way, the 2D member can be cut into a shape that provides a desired thickness, width and length of spring members, arms or other components of the apparatus, when folded into the 3D shape member of the apparatus.
    [00120] An example of a 3D shape member of an apparatus, formed by bending a 2D member that has been cut from a flat sheet of material is shown in Figure 17a. In particular examples, the sheet material is Nitinol (NiTi). In other examples, the sheet material can be any suitable material such as, but not limited to stainless steel, beta-titanium, cobalt-chromium or other metallic alloy, polymers or ceramics. In other examples (if practical for the desired apparatus shape), an apparatus according to the first embodiment may be configured from a yarn material that is bent or otherwise formed into a desired 3D shape.
    [00121] The apparatus 1700 in Figure 17a includes male connector elements 1702 formed as relatively simple linear members that are configured to engage and secure with female connector elements 1706, as shown in Figure 17b. Each female connector element 1706 includes a linear slot feature, which receives a respective linear member from a male connector element 1702, as shown in Figure 17b. In particular examples, the female connector element 1706 may be a twin bracket type connector.
    [00122] Each 1702 male connector element is separated from each adjacent 1702 male connector element by a spring member 1704. In other examples, one or more male connector elements may be separated from one or two (or more) adjacent male connector elements by a rigid portion of the apparatus which is devoid of a spring member. In the example shown in Figure 17a, each spring member 1704 generally has a U-shaped structure as described herein. In other examples, one or more (or each) spring members 1704 may have another suitable shape such as, but not limited to, other spring shapes shown and described herein or other shapes that can be cut from a flat sheet of material and bent. in a 3D shape. In other examples, an apparatus 1700 of Figure 17a may include other types of male connector elements (such as, but not limited to, those described herein in connection with Figures 1-3, 5, 6, 8-12h, 15a, 16a, 17a , 18c-18f, 25, 27a and 27b) or other types of spring members including but not limited to those described herein (or both). The shapes and types of spring members can be selected and configured, for example, to provide a desired movement and can be based, at least in part, on the type and size of teeth to which the spring is to be connected. Second mode
    [00123] As discussed above, systems or methods according to examples of a second embodiment include or employ an apparatus having a plurality of separate arms configured to connect to a corresponding plurality of patient teeth, where each arm of the apparatus is configured to connect to a respective tooth different from the other arm of the appliance. In further examples of the second embodiment, the apparatus may include an arm configured to connect to a plurality of teeth, or multiple separate arms configured to connect to a corresponding one of the patient's teeth, or various combinations of arm-to-tooth connections such as described here. In certain instances, an apparatus according to the second modality can be made, after rearranging a digital 3D OTA to a digital 3D FTA, and designing (through computer-aided design or other suitable design techniques) a configured device format to transmit forces on the patient's teeth to move the teeth from the OTA to the FTA (or to an ITA, or from an ITA to an FTA or another ITA).
    [00124] Examples of apparatus 800, 900, 1000 and 1100 according to the second mode are shown in Figures 8-11, respectively. The 800, 900, 1000 and 1100 apparatus (and apparatus components) may be made of any suitable material including, but not limited to, Nitinol (NiTi), stainless steel, beta-titanium, cobalt-chromium or other metallic alloy, polymers or ceramic, and can be made as a single structure, unitarily formed or alternatively in multiple separately formed components connected together in a single structure.
    [00125] Each of the 800 and 1000 devices in Figures 8 and 10 can be configured to be installed in the upper jaw of a patient. In particular examples, appliance 800 or 1000 can be configured to help close an extraction space after the patient's first premolars are extracted or to adjust other tooth positions (or both). On the other hand, each of the devices 900 and 1100 in Figures 9 and 11 can be configured to be installed in the lower jaw of a patient.
    [00126] In Figures 8 and 10, the example apparatus 800 and 1000 each include an arc-shaped bar 802 or 1002 that is configured for an upper jaw (to follow the arch of a patient's upper jaw). The 800 and 1000 appliances each include an 804 or 1004 palatal arch feature. In other examples, the 804 or 1004 palatal arch feature may be omitted.
    [00127] Each of the apparatus 800 and 1000 includes a plurality of separate arms (arms 806 in Figure 8 and 1006 in Figure 10). The examples shown in Figures 8 and 10 include twelve arms 806 or 1006, which secure twelve associated teeth, separately and individually, on a one-to-one basis. In other examples, the apparatus may have other suitable numbers of weapons, including fewer or more than twelve arms. The number of arms can be equal to the number of teeth in the jaw that must be moved.
    [00128] Each of the arms 806 on the apparatus 800 (and each of the arms 1006 on the apparatus 1000) may have the same configuration (length, shape, width, etc.) as each of the other arms of the apparatus, as shown in the Figures 8 and 10. Alternatively, some (or each) of the arms 806 of the apparatus 800 (or the arms 1006 of the apparatus 1000) may have a different configuration (length, shape, width, etc.) than some or each of the other arms of this device. In particular examples, the configuration, including the shape and size of each arm, may depend on the desired movement and size of the tooth to which the arm is secured (and may differ for different arms and teeth).
    [00129] Each arm 806 (or 1006) has one end extending from or otherwise connected to bar 802 (or 1002) and a second end at which a male connector element 808 (or 1008) is formed or otherwise connected. Accordingly, a respective separate male connector element is formed or otherwise connected to each respective separate arm. Each male connector element 808 is configured to engage with a corresponding female connector element or bracket when apparatus 800 (or 1000) is installed on the patient's teeth. In particular examples, the male connector elements are configured to secure to female connector elements attached to the patient's teeth, and remain attached to the patient's teeth, until a clinician removes the device.
    [00130] Each arm 806 (or 1006) has a spring member 810 (or 1010) along its length. In the examples of Figures 8 and 10, spring members 810 and 1010 are located at an end portion of the respective arms 806 and 1006 (i.e., the end portion corresponding to the arm end extending from or is otherwise connected to the bar 802 or 1002, and opposite the arm end on which the male connector element 808 or 1008 is located). However, in other examples, spring member 810 (or 1010) may be located elsewhere along the length of arm 806 (or 1006), such as, but not limited to, the middle of the length of arm 806 (or 1006 ) or towards the arm end in which the 808 or 1008 male connector element is located.
    [00131] Spring members 810 and 1010 can be of any suitable configuration and can be designed and manufactured to provide a force or torque (or both) in the desired direction or magnitude (or both). In particular examples, computer-aided design and manufacturing techniques can be employed to design or configure (or both) spring members. Spring members 810 and 1010 may have the same configuration in each of the arms of the apparatus, as shown in Figures 8 and 10. Alternatively, the spring members in some (or each) of the arms 806 of the apparatus 800 (or the arms 1006 of apparatus 1000) may include a different configuration of some or each of the other arms of that apparatus. Spring members 810 (or 1010) may be formed as a single unitarily formed structure with the rest of arms 806 (or 1006), as shown in Figures 8 and 10. Alternatively, spring members 810 (or 1010) may be formed separately from the rest of the arms 806 (or 1006) and then coupled to the arms 806 (or 1006) after being formed.
    [00132] Each spring member 810 in example apparatus 800 of Figure 8 is configured with a plurality of U-shaped segments along a portion of the length of its associated arm 806. In other examples, each spring member may include a single (no more than one) U-shaped segment, or fewer or larger U-shaped segments than shown in the example in Figure 8.
    [00133] Each spring member 1010 in example apparatus 1000 of Figure 10 is configured with a spiral or loop-shaped segment forming a single loop along a portion of the length of its associated arm 1006. In other examples, each member spring 1010 may include a plurality of loops along one or more segments the length of its associated arm 1006. In other examples, other suitable spring configurations may be employed on one or more (or each) of arms 806 or 1006. In other examples, more than one spring member (with the same or different configurations) can be included in each 806 or 1006 arm. The geometries (size, shape, length, etc.) of the spring members and arms can be designed and selected depending on and based on various factors including, but not limited to, tooth type or size, facial morphology, type of malocclusion to be addressed, and other factors specific to each patient.
    [00134] As described above, the example appliances 800 and 1000 shown in Figures 8 and 10 include a palatal arch feature (804 in Figure 8 and 1004 in Figure 10). In the examples shown in Figures 8 and 10, the palatal arch features 804 and 1004 each include a plurality of brackets 812 or 1012 for a corresponding plurality of anchor devices, such as, but not limited to, screws or other anchor devices. temporary (TADs). Three anchor device brackets 812 or 1012 are shown in each of Figures 8 and 10. In other examples, one, two, or more than three anchor device brackets 812 or 1012 can be included in the palatal arch feature 804 or 1004. In other examples, one or more anchor device brackets may be provided at other suitable locations on the apparatus. In still other examples, the anchor device supports 812 and 1012 may be omitted from the palatal arch features 804 and 1004. In particular examples, the inclusion, number and location of the anchor device supports 812 and 1012 may depend, at least in part, the type of malocclusion to be addressed and other factors specific to each patient.
    [00135] One or more anchoring device mounts 812 and 1012 may be used to receive or otherwise maintain a TAD or other anchoring device that is attached to a patient's palate. Thus, if a clinician desires additional anchorage of the device, the clinician may decide to use one or more TAD(s). For example, before or after the male connector elements 808 (or 1008) of an apparatus 800 (or 1000) are attached to female connector elements pre-attached to the patient's teeth, a clinician can attach one or more implantable screws or other TAD structures to one or more anchor device supports 812 (or 1012) and to the patient's palate. In the examples of Figures 8 and 10, the anchoring device supports 810 and 1010 have a ring or annular shape with a central opening through which a length of a screw or other suitable TAD structure can extend, to anchor the apparatus to the patient's palate when a screw or other TAD structure is implanted into the patient's palate. The clinician can anesthetize the area of the patient's palate into which the TADs will be implanted, prior to implantation.
    [00136] In Figures 9 and 11, the example apparatus 900 and 1100 each include an arc-shaped bar 902 or 1102 that is configured for a lower jaw (to follow the arch of a patient's lower jaw). The 900 and 1100 appliances in Figures 9 and 11 do not include a lingual arch support feature. However, other examples may include a lingual arch support feature (for example, but not limited to a feature similar to feature 302 in Figure 3).
    [00137] Each of the apparatus 900 and 1100 includes two anchor device brackets 904 or 1104 extending from the arc-shaped bar 902 or 1102 on the right and left sides of the apparatus. Each anchor device bracket 904 or 1104 is configured to receive and maintain a suitable anchor device, such as, but not limited to, an implantable screw or other suitable TAD structure, to secure the apparatus to the lingual side of the lower jaw.
    [00138] While two anchor device supports 904 or 1104 are shown in each of Figures 9 and 11, in other examples, one or more of two anchor device supports 904 or 1104 may be included in apparatus 900 or 110. In still other examples, anchor device supports 904 and 1104 may be omitted from apparatus 900 or 1100. In particular examples, the inclusion, number, type and location of anchor device supports 904 and 1104 may depend, at least on part, the type of malocclusion to be treated and other factors specific to each patient. Each anchor device holder 904 or 1104 is disposed on the lingual side of the apparatus to receive an anchor device, such as a TAD, attached to a lingual side of the patient's lower jaw, but may be configured and operated as described herein. with regard to the anchor device holders 812 or 1012. In other examples, the anchor device holders may be disposed on the buccal side of the patient's jaw. In other examples, other suitable mechanisms or combinations of mechanisms can be employed to secure the device to the patient's jaw.
    [00139] Each of the example apparatus 900 and 1100 in Figures 9 and 11 includes a plurality of arms 906 or 1106 with spring members 910 or 1110. Each of the example apparatus 900 and 1100 also includes a respective male connector element 908 or 1108 at one end of each respective arm 906 or 1106. Arms 906 and 1106, spring members 910 and 1110 and male connector elements 908 and 1108 may have a configuration and operate similar to arms 806 and 1006, spring members 810 and 1010, and male connector elements 808 and 1008 described herein, but for teeth in the lower jaw of a patient.
    [00140] As discussed above, each male connector element 808, 908, 1008 and 1108 is configured to engage with a respective female connector element or bracket when apparatus 800, 900, 1000 or 1100) is installed on the patient's teeth. In the example apparatus shown in Figures 811, each male connector element 808, 908, 1008 and 1108 may be configured as a unitarily formed structure or formed separately from the arm to which it is connected, or formed unitarily with that arm. These unitary formed structures may be formed by any suitable manufacturing techniques including, but not limited to molding, casting, machining, 3D printing, stamping, cutting, extruding or the like. In certain examples, each male connector element is formed as a unitary structure with other portions of the apparatus by cutting a 2D shaped member from a sheet of suitable material such as, but not limited to Nitinol (NiTi), stainless steel, beta-titanium, cobalt-chromium or other metallic alloy, polymers or ceramics, and bending the 2D shape member into a 3D shape member of the apparatus. In other examples, one or more (or each) male connector element 808, 908, 1008, and 1108 may be formed as a plurality of separate components that are connected together with an arm to form an arm and a male connecting structure of an apparatus. 800, 900, 1000 or 1100.
    [00141] An example of a male connector element and arm structure configured from multiple components that connect together and that connect to an arc-shaped bar of an apparatus is described in relation to Figures 12a-h. The example shown in Figures 12a-h provides a male connector element having a configuration as shown in the example apparatus 800, 900, 1000 and 1100 in Figures 8-11. However, male connector elements as shown in Figures 12a-h may be employed in other apparatus as described herein, including, but not limited to, apparatus 100, 200, 300, 500 and 600 of Figures 1-3, 5 and 6 .
    [00142] The example shown in Figures 12a-h includes an arm structure 1200 (shown in Figure 12a), an arc-shaped structure or bar 1201 having one or more (multiple in the illustrated example) first arm connector components 1202 (shown in Figure 12b), second arm connector components 1204 (shown in Figure 12c), a first male connector element component 1206 (shown in rear, front and side views in Figures 12d, 12e and 12f, respectively), and a second male connector element component 1208 (shown in rear and front views in Figures 12g and 12h, respectively). In particular examples, arm structure 1200 may correspond to any one or more of arms 806, 906, 1006, 1106 of apparatus 800, 900, 1000, and 1100 described herein. Arm structure 1200 includes a first end section 1210 configured to engage a bar (such as, but not limited to, bar 802, 902, 1002 or 1102 of an apparatus 800, 900, 1000 or 1100). In the example shown in Figure 12a, the first end section 1210 of the arm frame 1200 is formed into a loop-shaped section that fits into a corresponding loop-shaped groove in one or both of the first and second connector components. of arm 1202 and 1204 (shown in Figures 12b and 12c).
    [00143] In addition, the arm structure 1200 includes a second end section 1212 configured to connect a male connector element. In the example shown in Figure 12a, the second end section 1212 of the arm frame 1200 is formed into a loop-shaped section that fits into a corresponding loop-shaped groove in one or both of the first and second element components. 1206 and 1208 male connector (shown in Figures 12d-12h). Arm frame 1200 also includes a center section 1214 between the first and shipping end section. One or more spring members (such as, but not limited to, spring members as described herein) may be formed or otherwise provided in center section 1214.
    [00144] The first and second arm connector components 1202 and 1204 shown in Figures 12b and 12c are configured to connect together. Each first arm connector component 1202 may be formed as part of (integral with) the arc-shaped frame or bar 1201 of the apparatus, as shown in Figure 12b. In other examples, each first arm connector component 1202 may be formed separate from the arc-shaped structure or bar and then attached to the arc-shaped structure or bar by adhesive, soldering, or any other suitable attachment mechanism, to form the structure shown in Figure 12b. Arc-shaped structure or bar 1201 may correspond to arc-shaped structures 802, 902, 1002, 1102 described herein with reference to the examples in Figures 8-11, or other suitable example as described herein.
    [00145] One or both of the first and second arm connector components 1202 and 1204 include a slot 1215 and 1217 for receiving the first end 1210 of the arm structure 1200 between the first and second arm connector components 1202 and 1204. specifically, the first end section 1210 of the arm structure 1200 is placed between the first and second arm connector components 1202 or 1204 and the arm connector components 1202 and 1204 are then brought together to surround the first end 1210 of the arm structure. arm 1200 within slots 1215 and 1217. Slots 1215 and 1217 extend to an edge of respective first and second arm connector components 1202 and 1204 such that center section 1214 of arm structure 1200 may extend from the components of connector 1202 and 1204, when connector components 1202 and 1204 are coupled together.
    [00146] One of the first and second arm connector components 1202 and 1204 (e.g., connector component 1202) includes one or more (three in Figure 12b) protrusions 1216 that engage a corresponding one or more recesses or openings 1218 in the other of the first and second arm connector components 1202 and 1204 (e.g. connector component 1204). Protrusions 1216, recesses and openings 1218 help align the first and second arm connector components 1202 and 1204 together in proper alignment with each other and the arm structure 1200, during assembly. In addition, protrusions 1216, recesses and apertures 1218 can be configured to provide a press fit or friction fit connection between the first and second arm connector components 1202 and 1204. alternative or additional connections, including but not limited to screws, adhesives, solder or the like, to connect the 1202 and 1204 connector components together. For example, one or both of the first and second arm connector components 1202 and 1204 may include one or more apertures 1220 for receiving one or more screws, rivets, or other threaded connectors (not shown). In such examples, one or more of the openings may be threaded to thread engagement with the bolt, rivet or other threaded connector (not shown).
    [00147] The first and second male connector element components 1206 and 1208 shown in Figures 12d - 12h are configured to connect together. One or both of the first and second male connector element components 1206 and 1208 include a slot 1222 and 1224 for receiving the second end 1212 of the arm structure 1200 between the first and second male connector element components 1206 and 1208. More specifically, the second end section 1212 of arm structure 1200 is placed between first and second male connector element components 1206 or 1208 and male connector element components 1206 and 1208 are then joined to enclose second end 1212 of arm structure 1200 within. of slots 1222 and 1224. Slots 1222 and 1224 extend to an edge of the respective first and second male connector element components 1206 and 1208 such that center section 1214 of arm structure 1200 can extend from the element components male connector 1206 and 1208, when connector components 1206 and 1208 are coupled together.
    [00148] One of the first and second male connector element components 1206 and 1208 (e.g., connector component 1208) includes one or more (one in Figure 12g) protrusions 1226 that engage a corresponding one or more recesses or openings 1228 in the other of first and second male connector element components 1206 and 1208 (e.g., connector component 1206). Protrusions 1226, recesses or apertures 1228 help align the first and second male connector element components 1206 and 1208 together in proper alignment with each other and with the arm structure 1200 during assembly. In addition, protrusions 1226, recesses or apertures 1228 may be configured to provide a press fit or friction fit connection between the first and second components of male connector elements 1206 and 1208. In other examples, connection mechanisms may be employed alternative or additional, including, but not limited to, screws, adhesives, solder or the like, to connect the 1206 and 1208 male connector element components together. For example, one or both of the first and second male connector element components 1206 and 1208 may include one or more apertures 1230 for receiving one or more screws, rivets, or other threaded connectors (not shown). In such examples, one or more of the openings may be threaded to thread the socket with the bolt, rivet, or other threaded connector (not shown).
    [00149] Consequently, the first and second male connector element components 1206 and 1208 can be assembled and connected to one end of the arm structure 1200. The other end of the arm structure 1200 can be mounted and connected to a bar-shaped arc of an appliance. In this example, an apparatus 800, 900, 1000, or 1100 can be composed of multiple components, formed separately, that are assembled and connected together to form a single unitary apparatus structure.
    [00150] In such examples, each component of an apparatus may be formed separately by any suitable manufacturing technique, including, but not limited to molding, casting, machining, 3D printing, stamping, extrusion, cutting and bending (e.g., cutting of a 2D shape member from a sheet and fold the 2D shape member into a 3D shape member as described herein) or the like, and then assembled with one or more of the other components of the apparatus. In such examples, arm structures 1200 can be formed by any suitable technique including, but not limited to, those discussed above, or by bending techniques. For example, a robot-controlled or automated bending technique can be employed to form or bend desired and precise spring and arm configurations from suitable materials such as, but not limited to, Nitinol (NiTi), stainless steel, beta-titanium , cobalt-chromium or other metallic alloy, polymers or ceramics. In other examples, one or more (or all) of the apparatus structure components may be formed together as a single unitarily formed structure.
    [00151] As discussed above, the example shown in Figures 12a-h provides a male connector element having a configuration as shown in the example apparatus 800, 900, 1000 and 1100 in Figures 8-11. Such male connector elements are configured to engage and secure to female connector elements having a configuration, for example, as shown in Figures 13a and 13b.
    [00152] For example, as best shown in Figures 12e and 12f, the male connector component 1206 includes a bearing portion 1232 the part that includes openings 1228 and 1230 and an extension frame 1234. The extension frame 1234 is configured for engaging a female connector element, for example, of the type shown in Figure 13a and 13b. Extension frame 1234 includes a shelf-shaped extension 1236 that extends outwardly from support portion 1232. Extension frame 1234 also includes a pair of leg members 1238 and 1240 extending from shelf-shaped extension 1236 and are spaced apart from each other by a gap 1242. As shown in Figure 12f, leg members 1238 and 1240 are also spaced apart from support portion 1232 by a gap 1244, by a portion of the extended length of shelf-shaped extension 1236. The free end of each leg member 1238 and 1240 has an enlarged or expanded portion 1239 and 1241, respectively. Male connector component 1206 can be made of any suitable material such as, but not limited to, nitinol, stainless steel, beta-titanium, cobalt-chromium or other metallic alloy, polymers or ceramics, or other material that allows the members to leg 1238 and 1240 are resiliently flexible and flexed inwardly when a force is applied (directed to press leg members 1238 and 1240 together) to reduce the width of the extension frame 1234. In that state, the extension frame it can be inserted into a female connector element, for example, of the type shown in Figures 13a and 13b. Once inserted into the female connector element, force can be released to allow leg members 1238 and 1240 to resiliently move outwardly towards their original position to secure the male connector element (formed by components 1206 and 1208) to the female connector element. In particular examples, male connector component 1206 including shelf-shaped extension frame 1234 and leg members 1240 and 1238 are formed as a unitarily integrally formed frame. In other examples, male connector component 1206 may be formed of multiple separate components connected together.
    [00153] Figure 13a shows a representation of an OTA image of a patient's upper jaw, in which examples of 1300 female connector elements are attached to the lingual surface of the teeth in the upper arch. In other examples, female connector elements 1300 can be attached to the buccal surface of teeth, for example, if preferred by the clinician. A separate 1300 female connector element is attached to each respective tooth. The female connector elements provide a connection interface for connecting one or more appliances to the teeth, in accordance with the first and second embodiments described herein. While the drawing in Figure 13a shows all teeth in each mandible as having female connecting elements, other examples may employ female connecting elements in some, but not all, upper jaw or lower jaw teeth, for example selected by the clinician.
    [00154] The 1300 female connector elements may be attached to the teeth through direct or indirect attachment, or other suitable means to securely attach the elements to a surface of the teeth. Bonding materials can include adhesives such as but not limited to composite resin. In the case of indirect binding, a clinician can use a template to increase the accuracy of bracket placement. In particular examples, one or more (or all) of the 1300 female connector elements are customized in size or shape for each tooth, and are configured to have the lowest possible profile (to minimize the size in dimension extending away from the tooth, ie. ie, the bucolingual direction, or the mesiodistal or occlusogingival directions, or any combination thereof).
    [00155] Figure 13b shows an example of a 1300 female connector element in Figure 13a. In the example of Figure 13b, the female connector element 1300 includes a bearing portion 1302 configured to be attached to a tooth surface of a patient. Female connector element 1300 in Figure 13b also includes a shelf-shaped extension structure 1304 extending outwardly from support portion 1302. Female connector element 1300 in Figure 13b also includes first and second L-shaped extension structures 1306 and 1308 extending outwardly from bearing portion 1302. Extension structures 1304, 1306 and 1308 extend outwardly from bearing portion 1302 in the same direction. However, shelf-shaped extension structure 1304 has a surface with a planar surface dimension extending in a direction (horizontal in Figure 13b) that is perpendicular to a planar surface dimension of a surface of each of the extension structures at L-shape. Extension structures 1304, 1306 and 1308 are arranged to provide a gap 1310 between L-shaped extension structures 1306 and 1308 and an additional gap 1312 is provided between the shelf-shaped extension structure. 1304 and each of the L-shaped extension structures 1306 and 1308.
    [00156] The 1300 female connector element can be made of any suitable material, such as, but not limited to, nitinol, stainless steel, beta-titanium, cobalt-chromium or other metallic alloy, polymers, ceramic or other material that allows the L-shaped extension structures 1306 and 1308 are resiliently flexible and flexed outwardly when a force (directed to press the L-shaped extension structures away from each other) is applied to increase the width of gap 1310. In that state , extension portion 1234 of the male connector element can be inserted into gap 1310. Once inserted, the force can be released to allow L-shaped extension structures 1306 and 1308 to resiliently move towards each other, towards its original position to secure the male connecting element to the female connecting element. In particular examples, the shelf-shaped extension 1236 of the male connector member 1206 fits into the gap 1312 of the female connector element 1300 when the extension portion 1234 of the male connector element is received in the gap 1310. In other examples, the extension structures L-shaped female connector element may be relatively rigid (and not configured to flex too much or not at all), such that the resilient flexibility of male connector element leg members 1236 and 1238 is sufficient to allow insertion of the connector element. male into gap 1310 without requiring the L-shaped extension structures 1306 and 1308 of the female connector element to flex outwardly. In particular examples, female connector element 1300 (including shelf-shaped extension frame 1304 and L-shaped extension frames 1306 and 1308) is formed as a unitarily integral formed frame. In other examples, the female connector element 1300 may be formed of multiple separate components connected together.
    [00157] Each of the L-shaped extension structures 1306 and 1308 of the female connector element 1300 includes a free end having a tab or extension L, extending toward the other of the L-shaped extension structures. extension 1234 of male connector element 1200 is received in spaces 1310 and 1312 of female connector element 1300, as described above, the tab or extension L of L-shaped extension structures 1306 and 1308 fit over leg members 1238 and 1240 of male connector element 1200, for retaining and securing the male connector element. The flared or expanded portion 1239 and 1241 of the leg members 1238 and 1240 and the shelf-shaped extension 1236 help to keep the male connector element 1200 in a properly aligned state with the female connector element 1300 when secured and during installation. In this state, the male connector element 1200 may remain attached to the female connector element 1300, until a clinician removes the male connector element (e.g., forcing leg members 1236 and 1238 of the male connector element inward enough to clean the structures of L-shaped extension cords 1306 and 1308, and then pulling the male connector element away from the female connector element.
    [00158] Male connector elements 808, 908, 1008 and 1108 in certain examples may be configured as described herein in relation to Figures 12a-12g, for engagement with female connector elements 1300 as described herein in relation to Figures 13a and 13b. However, in other examples, the male connector elements 808, 908, 1008 and 1108 according to a second embodiment may be similar to the male connector elements 104, 204, 304, 504 and 604 described herein in relation to the first embodiment. In such examples, the female connector elements may be configured similarly to the female connector elements 700 in Figure 7. Similarly, other examples of the first embodiment may include male connector elements as described in relation to Figures 12a-12g for engagement with connector elements females 1300 as described herein in relation to Figures 13a and 13b.
    [00159] In other examples, male connector elements in appliances according to a second modality (including appliances 800, 900, 1000 and 1100) or according to a first modality may have other suitable configurations such as, but not limited to, the configurations of the examples of male connector element shown in Figure 15a, for engaging and securing to a female connector element 1501 as shown in Figures 15b and 15c. Female connector element 1501 is shown as attached to a tooth in Figure 15c.
    [00160] Male connector element 1500 in Figure 15a includes a shaped body portion having first and second arm sections 1504 and 1506. Each arm section 1504 and 1506 is connected to another arm section at a first end 1508, and extends for a free end 1510, 1512, respectively. Arm sections 1504 and 1506 are spaced apart from each other (except at the connected end 1508) to form a gap 1502 between the arm sections and extending along a portion of the length of each arm section. The male connector element is made of a material sufficiently resilient that it allows the free ends of the arm sections 1504 and 1506 to be forced to move apart or away from each other and then resiliently move into their state. original when the force is removed. When arm sections 1504 and 1506 are forced farther apart, the width dimension of gap 1502 between arm sections 1504 and 1506 increases. In this state, the male connector element 1500 is placed over the female connector element. When placed over the female connector element, the force on the arm sections 1504 and 1506 is released to allow the arm sections to move resiliently towards their unforced or passive state, to lock or secure the male connector element to the connector element. female.
    [00161] The female connector element shown in Figure 15b includes a support portion 1514 configured to be attached to a surface of a patient's tooth. An extension portion 1516 composed of four hook-shaped or L-shaped extension members 1518 extends outwardly from the support portion 1514. When the arm sections 1504 and 1506 of the male connector element 1500 are forced to apart as described above, the male connector element 1500 can be placed over the female connector element, such that the hook-shaped extension members 1518 are received in the gap 1502 between the arm sections 1504 and 1506, and the arm sections 1504 and 1506 are received in the female connector element, behind the L-shaped or hook free end of the hook-shaped extension members 1518. In this state, the force on the arm sections 1504 and 1506 is released to allow the arm sections resiliently move towards their unforced or passive state to lock or secure the arm sections 1504 and 1506 between the support portion 1514 and the L-shaped or hook free end of the extension members. the hook-shaped 1518 of the female connector element 1501, as shown in Figure 15c. In this state, the male connector element 1500 may remain attached to the female connector element 1501, until a clinician removes the male connector element (for example, by forcing the arm sections 1504 and 1506 outward enough to clear the L-shaped free end. or hook the hook-shaped extension members 1518, and then pull the male connector element away from the female connector element.
    [00162] In other examples, male connector elements in appliances according to a second modality (including appliances 800, 900, 1000 and 1100) or according to a first modality may have other suitable configurations such as, but not limited to, the configurations of the male connector element 1600 shown in Figure 16a, for engaging and securing to a female connector element 1601, as shown in Figures 16b and 16c. The male connector element 1600 in Figure 16a includes a shaped body portion having first and second arm sections 1604 and 1606. Each arm section 1604 and 1606 is connected to another arm section at a first end 1608, and extends to one end. free 1610, 1612, respectively. Free ends 1610 and 1612 include flared portions or L-shaped end portions with extensions extending outward from each arm section (in a direction away from the other of the two arm sections). Arm sections 1604 and 1606 are spaced apart from one another (except at the connected end 1608) to form a gap 1602 between the arm sections and extending along a portion of the length of each arm section. The male connector element is made of a material sufficiently resilient that it allows the free ends of the arm sections 1604 and 1606 to be forced to move towards each other and then resiliently move into their state. original when the force is removed. When arm sections 1604 and 1606 are forced together, the width dimension of gap 1602 between arm sections 1604 and 1606 decreases. In this state, the male connector element 1600 is placed in a female connector element receptacle 1601. When placed in the female connector element receptacle, the force on the arm sections 1604 and 1606 is released to allow the arm sections to move resiliently to out, towards its unforced or passive state, to lock or secure the male connector element to the female connector element.
    [00163] The female connector element shown in Figure 16b includes a bearing portion 1614, the rear surface of which (the inwardly facing surface in the drawing) is configured to be attached to a surface of a patient's tooth. An extension portion 1616 composed of a box-shaped structure having an opening 1618 forming a receptacle extends outwardly the support portion 1614. The box-like structure of the extension portion 1616 includes two side walls 1620 and 1622, each having an opening 1621 and 1623, respectively. Apertures 1621 and 1623 are configured (in shape and size) to receive the free ends 1610 and 1612 including flared portions or L-shaped end portions at the free ends 1610 and 1612 of the male connector element arm sections 1600, when the male connector element 1600 attaches to female connector element 1601.
    [00164] When the arm sections 1604 and 1606 of the male connector element 1600 are forced together as described above, the male connector element 1600 can be inserted into the opening 1618 of the female connector element 1601 to the flared portions or end portions L-shaped at the free ends 1610 and 1612 of the arm sections of the male connector element 1600 align with the openings 1621 and 1623 in the sidewalls 1620 and 1622 of the female connector element 1601. In this state, the force on the arm sections 1604 and 1606 can be released to allow the arm sections 1604 and 1606 to resiliently move away from each other, to engage and insert the flared portions or L-shaped end portions into the free ends 1610 and 1612 of the arm sections with and to the openings 1621 and 1623 in the side walls 1620 and 1622, to lock or secure the male connector element 1600 to the female connector element 1601. In that state, the male connector element 1600 pos. to remain attached to the female connector element 1601, until a clinician removes the male connector element (for example, forcing arm sections 1604 and 1606 inward toward each other sufficiently to withdraw the flared or shaped end portions of L at the free ends 1610 and 1612 of the arm sections from the openings 1621 and 1623 in the sidewalls 1620 and 1622, and then pulling the male connector element away from the female connector element.
    [00165] In other examples, male connector elements in appliances according to a second modality (including appliances 800, 900, 1000 and 1100) or the first modality may have other suitable configurations such as, but not limited to, the configurations of the element examples male connector shown in Figures 18e and 18f. In the example apparatus 1810 and 1820 shown in Figures 18e and 18f, each male connector element 1802 or 1822 has a T-shaped configuration for engaging and securing to a female connector element. In such an example, the female connector element may have a corresponding T-shaped slot for selectively receiving the T-shaped male connector element.
    [00166] Figure 25 shows an example of a male connector element 2500 having a T-shaped configuration that can be used with embodiments described herein, including but not limited to the embodiments of Figures 18e or 18f. The male connector element 2500 in Figure 25 has a T-shaped body structure provided at the end of an arm of an apparatus. The T-shaped body structure has a first portion 2501 extending in the direction of the arm (in a vertical direction in Figure 25) and a second portion 2502 extending transversely to (such as, but not limited to generally perpendicular) the first portion 2501 (in a horizontal direction in Figure 25).
    [00167] An example of a 2600 female connector element is shown in Figures 26a-26d, for receiving and securing a male connector element with a T-shaped configuration, such as, but not limited to, the 2500 male connector element of Figure 25. The drawings in Figures 26a-26d show a male connector element 2500 received by and secured to a female connector element 2600. The female connector element 2600 includes a bearing portion 2601 and an extension portion 2602 extending outwardly from the bearing portion 2601. Extension portion 2602 has a plurality of hook-shaped extension members 2604 that are spaced apart from one another to form a pair of bushing slots 2606 and 2608. The bushing slots are arranged to cross each other at an angle corresponding to traverse angle of the first and second portions 2501 and 2502 of the T-shaped body of the male connector element 2500.
    [00168] Therefore, the male connector element 2500 can be aligned with and inserted into the through slots 2606 and 2608 of the female connector element 2600, to secure the male connector element to the female connector element. In particular examples, one or both of the slots 2606 and 2608 are slightly smaller in width than the width of the first or second portions 2501 and 2502 of the T-shaped body of the male connector element. In such embodiments, the hook-shaped extension members 2604 may have sufficient flexibility and resiliency to receive the T-shaped body and impart a squeezing force to the T-shaped body when received within the through slots 2606 and 2608, for example, to help retain or secure male connector element 2500 to female connector element 2600.
    [00169] As shown in Figures 26c and 26d, a clinician may add a 2605 retaining structure, such as, but not limited to, a gasket, ligature string or other suitable retaining structure over the plurality of extension members at hook shape 2604 of extension portion 2602 of female connector element 2600, after the T-shaped body of male connector element 2500 is received in female connector element. Hook-shaped extension members 2604 may include a hook or an L-shaped end that retains the sealing ring, ligature string, or other suitable retaining structure in place.
    [00170] In another example, a 2610 female connector element may be configured and operate similar to the 2600 female connector element described herein, but further includes one or more 2612 clamp structures to operate as a self-ligating bracket, as shown in Figures 26e and 26f. Clamp structure 2612 may be provided or secured over one (or a pair of) hook-shaped extension members 2604. In particular examples, clamp structure 2612 has a plate portion 2614 and a spring portion 2616 and is arranged such that spring portion 2616 curves around or is otherwise supported on one or more hook-shaped extension members 2604. Plate portion 2614 is supported to cover a portion of one or both of the slots. traverse by a sufficient amount so as to inhibit removal of the T-shaped body from the male connector element 2600 when the T-shaped body is received within the traverse slots of the female connector element 2610. The spring portion 2616 provides flexibility and sufficient resiliency to allow the plate portion 2614 to be moved outwardly (away) from the extension members 2604 by an amount sufficient to allow the removal (or insertion) of the T-shaped body of the connector element. cho 2600 from (or inward) the traverse slots of the female connector element 2610, after applying sufficient outward directed force on the plate portion 2616 Upon release of the force, the plate portion 2616 resiliently moves back to its original state (as shown in Figure 26f).
    [00171] Figure 27a shows another example of a male connector element 2700 having an annular-shaped configuration (e.g., rectangular-ring with rounded corners), which can be used with embodiments described herein, as an alternative to other male connector elements described here. The corners of the annular shape of the 2700 male connector element are rounded for patient comfort. In other examples, the shape of the male connector element may include square corners. The male connector element 2700 in Figure 27a has an annular body structure 2702 provided at the end of an arm of an apparatus (a spring portion of an arm, shown in Figures 27a and 28). In other examples (consistent with the first modality), the male connector element 2700 may be provided on the arc-shaped bar of the apparatus (instead of on the end of an arm). In the illustrated example of Figure 27a, annular body structure 2702 has a generally rectangular shape with a central opening 2704. In other examples, annular body structure 2702 may have other suitable shapes, including other polygons, ovals, circles or shaped shapes as combinations of portions of polygons and ovals or circles. In other examples, such as, but not limited to the example of the male connector element 2701 shown in Figure 27b, the body structure 2703 may be open at a corner, the bottom, right or left in the illustrated orientation (and thus is partially , but not completely nullify). In the example of Figure 27b, body frame 2703 is open at one corner (the upper left corner, in the orientation shown). A male connector element 2701 that is open at a corner, bottom or side may be easier to form by cutting from a 2D sheet of material, compared to a connector element 2700 that has a closed annular shape.
    [00172] A 2700 or 2701 male connector element, as shown in Figure 27a or Figure 27b, may be configured to engage and secure with a female connector element having a configuration similar to that of the 2610 female connector element described herein. Alternatively, a 2700 or 2701 male connector element may engage and secure to a female connector element which is configured similar to the 2610 female connector element, but where the female connector element need not include a slot (no vertical slot between the extension members 2604 in Figure 26a) and thus can engage and secure to a female connector element having a conventional structure (or more conventional structure). An example of a male connector element 2700 engaged and secured with a female connector element 2610 is shown in Figure 28. When engaged, as shown in Figure 28, a portion of the annular body structure 2702 of the male connector element 2700 is interposed between the portion. of plate 2614 of clamp structure 2612 and bearing portion 2601 of female connector element 2610. Another portion of female connector element 2610 aligns and partially fits into or through central opening 2704 in annular body structure 2702 to help align the male connector element with female connector, when the male connector element 2700 is secured (or is being attached) to the female connector element 2610, as shown in Figure 28. In this way, the male connector element 2700 can be engaged and secured to an element self-ligating female connector or bracket.
    [00173] Various examples and configurations of male connector elements, and associated female connector elements may be used in various examples of the second embodiment (and various examples of the first embodiment) described herein. Certain examples of apparatus in accordance with the second embodiment include male connector elements as described and shown in relation to Figures 1-3, 5 and 6 (for attaching to female connector elements as described in relation to Figure 7). Other example apparatus in accordance with the second embodiment include male connector elements as described and shown in relation to Figures 8-12h (for attaching to female connector elements as described in relation to Figure 13). Still other apparatus in accordance with the second embodiment include male connector elements as described and shown in relation to Figures 15a (for attaching to female connector elements as described in relation to Figure 15b, as shown in Figures 15c). Still other apparatus in accordance with the second embodiment include male connector elements as described and shown in relation to Figures 16a (for attachment to the female connector elements of Figure 16b, as shown in Figure 16c). Still other apparatus in accordance with the second embodiment include male connector elements as described and shown in relation to Figure 17a (for attaching to female connector elements as described in relation to Figure 17b). Other apparatus in accordance with the second embodiment include male connector elements as described and shown in relation to Figures 18e, 18f and 25 (for attachment to female connector elements as described in relation to Figures 26a-f). Other example apparatus in accordance with the second embodiment include male connector elements as described and shown in relation to Figures 27a and 27b (for attachment to female connector elements as described in relation to Figure 28). Still other apparatus in accordance with the second embodiment include male connector elements of other suitable configurations for attaching to female connector elements of other suitable configurations.
    [00174] Systems or methods according to a second modality allow a clinician to move each tooth independently, employing one or more devices that have a separate arm connected to each tooth to be moved. The arms, including spring members of the arms, provide force-generating elements that provide sufficient force on the teeth to move the teeth from your OTA to the desired FTA. In specific examples, the arms are capable of moving the teeth in one or more (or all three) of the translational directions. Alternatively or in addition, the arms are capable of moving the teeth in one or more (or all three) directions of rotation.
    [00175] One or more of the shape, thickness, width or length of each arm may be designed and configured to provide adequate force or torque (or both) to achieve the desired tooth movement. In addition, one or more of the shape, thickness, width, or length of each arm can be designed and configured to match the size and type of tooth the arm is connected to. For example, one or more of the shape, thickness, width, or length of the arms are designed and selected to provide greater flexibility when teeth are displaced a greater distance, or when teeth are smaller in size, such as, but not if, limiting to lower incisors.
    [00176] In particular examples, processing systems and software with finite element analysis capabilities can be used to determine a desired geometry (size, shape, width, thickness, length) of springs or arms (or both) to apply a desired or optimal strength to accelerate the desired tooth movement.
    [00177] A sectional shape of an appliance according to the second modality can be configured to connect some but not all teeth of a mandible, for example, to move only some teeth while keeping other teeth intact. In this case, the number of arms on the appliance may be significantly less than the number of teeth in the given jaw, but the number of arms may match the number of teeth the doctor wants to move. In other examples, one or more arms can be connected to one or more respective teeth to anchor the appliance, and not necessarily to move the teeth to which those arms are connected. In such examples, the one or more arms to be connected to the teeth for anchorage, but without moving the teeth, can be formed relatively strong or thick, to provide sufficient anchorage support. Some uses of specimens for a sectional shape of an appliance under the second modality include, but are not limited to opening space for an implant, aligning teeth that are tilted in the extraction space, and non-comprehensive orthodontic treatment for patients for whom only a few teeth are misaligned. Another example of a sectional form of an apparatus in accordance with the second embodiment includes a molar positioner, as described with reference to Figure 14.
    [00178] The apparatus 1400 in Figure 14 is configured as a molar positioner, for example, for use on upper molars of a patient with an incorrect intra-arch or inter-arch molar ratio. Apparatus 1400 in Figure 14 includes an arc-shaped bar 1402 that forms two arms 1404 and 1406 that are joined at a central portion of bar 1402. Arc-shaped bar 1402 is configured to traverse a patient's palate, as a transpalatal arch (TPA) when the 1400 appliance is installed on the patient's teeth.
    [00179] Each arm 1404 and 1406 extends from the central portion of the bar 1402 to an end segment on which a male connector element is located. Apparatus 1400 includes a first male connector element 1408 formed on or otherwise connected to arm end segment 1404 and a second male connector element 1410 formed or otherwise connected to arm end segment 1406. In the example shown in the Figure 14, apparatus 1400 also includes first and second spring structures 1412 and 1414, where spring structure 1412 is formed on arm 1404 or is connected between arm end section 1404 and male connector element 1408 and where the structure of spring 1414 is formed in arm 1406 or is connected between arm end section 1406 and male connector element 1410.
    [00180] Spring structures 1412 and 1414 may be configured similarly to the spring member configurations (or spring member combinations) described herein. Male connector elements 1408 and 1410 are shown in Figure 14 as having a similar configuration to the male connector element examples described in relation to any one or more of the examples in Figures 8-12g, for engaging female connector elements such as, but not limited to. those described herein with reference to Figure 13. However, in other examples, the male connector elements 1408 and 1410 may have other suitable configurations, such as, but not limited to, those described herein with reference to Figures 1-3, 5, 6, 8-12h, 15a, 16a, 17a, 18c-18f, 25, 27a and 27b) for engaging and securing to female connector elements such as, but not limited to, those described herein with reference to Figures 7, 13a, 13b, 15b, 15c, 16b, 16c, 17b, 26a-f and 28.
    [00181] Apparatus 1400 in Figure 14 includes one or more (three in Figure 14) anchor device brackets 1416. Each anchor device bracket 1416 may be configured and function similarly to those described herein with reference to Figures 8 and 10, or other suitable settings. In particular examples, one or more TADs or other suitable anchorage devices are employed to anchor the apparatus 1400 (via the anchorage device supports 1416) to the patient's palate. In addition, the male connector elements 1408 and 1410 can be attached to female connector elements that have been previously attached to the surfaces of the upper molar teeth on opposite sides of the patient's jaw.
    [00182] The apparatus 1400 can be configured to apply adequate forces on the molar teeth to reposition the molar teeth, for example, to obtain a desired or ideal molar intra-arch to inter-arch ratio. The final position of the molar teeth can be determined by choosing the locations of TADs, which can be accurately implanted using a guide tray.
    [00183] In other examples, a molar positioner as described with reference to Figure 14 could be used in mixed dentition, to make room for unborn premolar and canine teeth, without involving other teeth in the mandible.
    [00184] Apparatus according to the second modality, and female connector elements associated with the first modality, may be manufactured in any suitable manner, including, but not limited to molding, casting, machining, 3D printing, stamping, extrusion, or similar. However, in particular examples, apparatus according to the second modality or female connector elements (or both) are made by cutting a 2D shape of the apparatus from a 2D sheet of material and folding the 2D shape into a desired 3D shape of the apparatus. . As discussed below, such methods are particularly suitable for making apparatus in accordance with examples of the first and second embodiments described herein. By cutting the 2D member from a flat sheet of material, instead of a traditional single diameter wire, a greater variety of 3D shapes can be made compared to shapes made by bending single diameter wire. The cropped 2D member can have dimensioned or variable widths and lengths which, when bent into a desired shape, can result in parts of the 3D device with variations in thickness, width, and length dimensions. In this way, the 2D member can be cut into a shape that provides a desired thickness, width and length of spring members, arms or other components of the apparatus. A greater variety of shapes can be provided by bending a custom cut 2D member as compared to bending a single diameter wire.
    [00185] In certain instances where the apparatus is formed from a cut 2D sheet of material that is bent into a desired 3D shape, the male connector element can be configured to be made of a flat sheet material that is cut or bent (or both) into a desired shape of the male connector element. Figure 18e shows an example of a device 1800 according to an example of the second embodiment and formed from a cut 2D sheet of material that is folded into a desired 3D shape. In particular examples, the 3D molded article may have a shape defined by any suitable shape shaping procedure, including, but not limited to heat treatment. The example of Figure 18e includes a plurality of male connector elements, each male connector element having a generally T-shaped configuration, as discussed above. Each T-shaped male connector element is configured to engage and secure with a respective female connector element having a configuration such as, but not limited to, those shown in Figures 26a-f.
    [00186] However, in other examples, an apparatus according to the second modality can be configured from a yarn material that is bent into a desired 3D shape. In particular examples, the yarn material is Nitinol. In other examples, the wire material can be any suitable material, such as, but not limited to, stainless steel, beta-titanium and shape memory alloys.
    [00187] An appliance according to several examples of the second modality may be configured to treat impacted teeth, such as, but not limited to, canines. For example, an appliance in accordance with the second embodiment can be configured to bring impacted teeth into the mouth by configuring an arm of the appliance to grip the impacted tooth and applying a force to pull the tooth towards the patient's dental arch. In particular examples, the apparatus may include one or more anchoring device mounts to connect to one or more TADs or other anchoring devices implanted in the patient, to help apply the desired force or torque (or both) to the impacted tooth, to move the impacted tooth to its desired or ideal final position. The appliance can be configured to be passive (and no longer apply force or torque to the tooth) when the tooth is in its final position, but active (to apply a force or torque, or both, to the tooth) in any other position.
    [00188] Thus, compared to traditional appliances, a appliance according to the second modality can be configured to apply an appropriate force and torque to an impacted tooth, from the beginning of exposure, such that the tooth can be attracted to the patient's dental arch is rotated in an appropriate direction to achieve a desired or ideal final position. In contrast, a traditional braces orthodontic technique may involve moving teeth into the arch without any torque control, followed by additional treatment to apply torque to the tooth. Therefore, examples of devices according to the second modality can be configured to speed up the treatment time by applying force and torque at the same time, throughout a treatment. Also, by employing TADs or TPAs as in the examples of appliances as described here, the reaction force (of the force applied to the tooth) is applied to the TADs or TPAs, which can minimize the side effects of the reaction force. Braces, according to several examples, can reduce the circular paths of the teeth, which can reduce treatment time, root resorption and provide other benefits. third modality
    [00189] As discussed above, systems or methods according to a third modality include or employ an apparatus that has a configuration similar to the first modality, but are further configured to be selectively removable, to allow a patient (or clinician) to install selectively and remove the appliance from the patient's teeth. An apparatus in accordance with the third embodiment includes a plurality of caps (such as, but not limited to, liner, acrylic or polymer caps) in place of the male connector elements described above. However, other features of an apparatus in accordance with the third embodiment may be configured and function as described above with respect to examples of the first embodiment (including, but not limited to, examples shown in Figures 1-3, 5, 6, 16 and 17).
    [00190] In an apparatus according to the third embodiment, each aligner cap is configured to secure to a respective tooth by snapping on and onto the tooth. For example, caps can be made of a polymer, acrylic, or other suitable materials, such as materials that help retain each cap on a patient's tooth. In particular examples, additional or alternative connector elements may be provided to help attach one or more (or each) of the caps to a respective tooth.
    [00191] In specific examples of systems and methods according to the third modality, the caps can be configured to hold and hold teeth, involving natural cutouts in the surfaces of the teeth, or through artificial cutouts provided by accessories or buttons attached to the teeth . These accessories can be made of metal, polymers, ceramics or other suitable materials. In certain instances, the accessories can be the same color or similar color to the teeth, to be less visible and more aesthetically pleasing. Fittings with the same or similar color as the teeth may be of materials such as, but not limited to, composite resins, polymers or ceramics. In particular examples, an accessory can be secured to the patient's tooth with a tray that helps the clinician install the accessory in a desired position.
    [00192] In the third modality, each cap can be customized in size and/or shape to match the size and shape of the tooth to which the cap fits. Alternatively, aligner caps are configured for application to any patient or tooth (or a group of multiple patients or teeth) and are not customized for each tooth or patient. In certain examples of the third embodiment, each liner cap can be separately connected to a support bar and not directly connected to any other adjacent tooth caps. In other examples, one of the liner caps (or each of a plurality of liner caps) may be connected to two or more adjacent teeth, for example, to move a group of teeth in unison or to provide additional anchorage. This gives a device according to the third modality significantly greater flexibility, which can allow the physician to use fewer devices to complete a treatment.
    [00193] As shown in Figure 19c, an example of an apparatus 1920 according to the third embodiment may include an arc-shaped structure 1902 (better shown in Figure 19a) and a plurality of caps 1922. The arc-shaped structure 1902 includes a molded support member which can be made of any suitable material such as, but not limited to, Nitinol (NiTi), stainless steel, beta-titanium, cobalt-chromium or other metallic alloy, polymers or ceramics. Arc-shaped structure 1902 can be formed into a desired shape using any suitable form-forming procedure, including, but not limited to, the methods described herein for forming apparatus in accordance with the first embodiment. In the example of Figure 19c, the arch structure 1902 may have a configuration similar to the apparatus shown and described in relation to Figure 17a, or other suitable configuration.
    [00194] In particular examples, the arc-shaped structure 1902 of the apparatus 1920 is configured to follow the arch of a patient's upper jaw (for example, as described in relation to the arc-shaped structures of the apparatus 100, 200 and 500). In other examples, the arc-shaped structure of the apparatus is configured to follow the arc of a patient's lower jaw (for example, as described in connection with the arc-shaped structures of apparatus 300 and 600). Some or all of the arc-shaped structure of an apparatus in accordance with the third embodiment may be made of any suitable material including, but not limited to, nitinol, stainless steel, beta-titanium, cobalt-chrome or other metallic alloy, polymers or ceramics, and can be made as a single structure, unitarily formed or, alternatively, in multiple separately formed components connected together in a single structure.
    [00195] A plurality of 1904 cap connector elements are formed or attached to the arc-shaped structure of an apparatus according to the third embodiment, at locations spaced along the length of the arc-shaped structure (instead and in place of the male connector elements shown in the apparatus examples in Figures 1-3, 5 and 6). In an apparatus according to the third embodiment, one or more springs 1906 are provided between adjacent cap connector elements 1904 (and therefore between adjacent liner caps). In certain examples of the third embodiment, one or more springs are provided between each cap connector element and each adjacent cap connector element. In other examples of the third embodiment, one or more springs are provided between some but not all pairs of adjacent cap connector elements. For example, a rigid portion of the apparatus may be provided between one or a few pairs of adjacent cap connector elements. In additional examples, one or more springs may be provided between cover connector elements that are not directly adjacent to each other. Each spring is a force-generating component of the device. In particular examples, each spring is made of a flexible material, such as, but not limited to, a shape memory alloy, such as, but not limited to, nitinol.
    [00196] Each cap connector element 1904 is configured to connect and retain a respective separate cap 1922, with respect to each cap connector element. In other examples, multiple caps may be connected and retained by one or more (or each) respective cap connector element. In other examples, one or more (or each) cap connector element may respectively connect to and retain more than one cap. Therefore, individual caps 1922 are attached to bow member 1902 at separate and spaced locations along the bow member such that each cap 1922 is separate from (not directly connected to) an adjacent cap. In this way, device covers (and teeth to which these covers are attached) can move separately and independently of other covers on the device (and teeth to which these covers are attached), and need not restrict the movement of other covers on the device (and teeth to which these caps are attached). In certain examples, the covers do not cover the springs located between the adjacent covers of the apparatus. In particular examples, adjacent tooth caps can be configured and mounted to the arch-shaped frame in locations where they do not come into contact with each other during the entire course of treatment. In other examples, the apparatus may be configured with one or more covers that fit a plurality of teeth (or have several adjacent covers connected together), while one or more other covers on the apparatus are separate and independent from other covers on the apparatus.
    [00197] In examples of an apparatus according to the third embodiment, each cap 1922 may comprise an aligner. In such examples, an Essix® machine or other suitable thermoforming or vacuum forming machine may be used to secure each liner cap to a respective cap connector element on the bow member.
    [00198] In certain instances, the aligner may cover the entire device, for example, to be more comfortable for the patient. In such examples, a gap or gap can be formed between the springs and the liner. In such instances, the patient may experience additional comfort as the patient's tongue will only contact the smooth surface of the aligner rather than the arms or metal bar of the device. The liner can be trimmed manually or with another suitable machining or cutting method (such as, but not limited to, laser cutting, milling or similar).
    [00199] In other examples of an apparatus according to the third or fourth modality, as an alternative to or in addition to one or more of the male connector elements, the device may include other mechanisms for engaging and securing to one or more teeth of the patient. For example, one or more engagement mechanisms can be configured to pass the lingual surface of the teeth through the incisal or interproximal surfaces and secure the teeth from the buccal side (e.g. similar to a closure in partial denture). In other examples, one or more engagement mechanisms may be configured to pass the buccal surface of the teeth through the incisal or interproximal surfaces and secure the teeth from the lingual side (eg similar to a closure on a partial denture) .
    [00200] In several examples of systems and methods according to the third modality, the appliance can be configured to move the teeth until the caps of the removable appliance are passive and does not apply force to the teeth.
    [00201] Similar to other embodiments described herein, apparatus according to the third embodiment can be designed and manufactured using computerized design and manufacturing techniques, such as, but not limited to, those described herein. Braces according to the third modality can be configured to exhibit elasticity for longer ranges of motion compared to traditional removable braces. For example, the inclusion of spring members between covers and the use of separately connected covers (not directly connected to adjacent covers) can allow greater ranges of movement than devices that do not include spring members or that employ interconnected covers. Consequently, examples of methods according to the third modality may involve fewer appliances to complete a treatment compared to traditional removable appliances with stainless steel springs or compared to traditional alignment treatment (such as, but not limited to Invisalign® or ClearCorrect®).
    [00202] In other examples of an appliance according to the third modality, any suitable combination of aligners on some teeth and fasteners on other teeth may be used. In such embodiments, the apparatus may include one or more aligners at locations for one or more corresponding teeth, and one or more locks at locations for one or more other teeth in the patient's jaw. Alternatively or additionally, different types of closures can be employed at different locations on the teeth in the appliance. For example, the flexibility of NiTi clasps on posterior teeth can increase the holding capacity of the appliance. This can be useful if a malocclusion requires more retention of the appliance on the teeth.
    [00203] An apparatus according to the third modality may include one or more palatal arch features or lingual arch features, for example, but not limited to palatal arch feature 202 or 804 in Figures 2 and 8, respectively, or arch feature lingual 302 in Figure 3.
    [00204] An apparatus according to the third embodiment may include one or more anchoring device supports, for anchoring the apparatus to a patient's palate or buccal shelf, as described herein in relation to anchoring device supports 812 or 904 in the Figures 8 and 10. For example, one or more anchorage devices (such as, but not limited to, TADs) can be implanted in a patient's palate or buccal shelf, or other suitable locations on the patient. A removable appliance in accordance with the third modality may include one or more engagement features configured to engage and connect to the implanted anchorage device when the appliance is installed on the patient's teeth, and selectively disconnect from the implanted anchorage device for removal of the device. In such embodiments, the engagement feature may include one or more of a snap-in connector (for snap-in connection to the implanted anchoring device), slip connector (for sliding connection to the implanted anchoring device), or other suitable connector. Alternatively, or in addition, a platform may be secured to the patient's palate or buccal shelf, where the platform includes one or more fittings, blades or other engagement features suitable for engaging and connecting with one or more fittings, blades or other engaging features. suitable attachments on the detachable apparatus for selective connection and disconnection of the apparatus from the platform. In additional examples, any suitable bone anchoring device can be used in place of or in addition to one or more TADs. Fourth modality
    [00205] As discussed above, systems or methods according to a fourth modality include or employ an apparatus that has a configuration similar to the second modality, but is additionally configured to be selectively removable, to allow a patient (or clinician) to selectively install and remove the braces from the patient's teeth. Similar to the second embodiment, an apparatus according to the fourth embodiment has a plurality of separate arms configured to individually connect to a plurality of teeth, through caps, wherein each arm of the apparatus is configured to connect to a respective tooth different from the other. arm of the device. In other examples, one or more of the liner caps (or each of a plurality of liner caps) may be individually connected to two or more adjacent teeth, for example, to move a group of teeth together or to provide additional anchorage.
    [00206] Accordingly, various features of a fourth mode apparatus can be configured and function as described above with respect to the second mode examples (including, but not limited to, the examples shown in Figures 8-12g). However, in place of the male connector elements of the second embodiment, an apparatus according to the fourth embodiment includes a plurality of caps (such as, but not limited to, liner caps, acrylic caps or polymer caps). A separate respective cover is formed on or otherwise attached to each respective arm, for example, on one end of each arm opposite the arm end that attaches to an arc-shaped bar of the apparatus. The caps are configured to hold the appliance on the patient's teeth and keep the appliance in the desired position during use.
    The caps of the fourth modality can be configured similarly to the caps described herein for the third modality, to secure the patient's teeth by snapping onto and to the teeth. However, the separate covers of the fourth embodiment are attached to the ends of the respective separate arms, rather than directly to the arc-shaped structure of the apparatus.
    [00208] Systems or methods according to the fourth embodiment (wherein an appliance includes a plurality of separate arms configured to individually connect to a corresponding plurality of teeth) can provide distinct advantages of providing and controlling individual tooth movement. Such advantages can allow a clinician to reduce the treatment time of teeth, thus reducing treatment time, root resorption and the number of trips the patient must take to the orthodontist. Thus, compared to traditional orthodontic techniques where a plurality of teeth are connected to a single wire in such a way that moving a tooth results in the unintended movement of nearby teeth, specific examples described here allow a clinician to control the movement of each tooth independent of each of the other teeth.
    [00209] In several examples of systems and methods according to the fourth modality, the appliance can be configured to move the teeth until the caps of the removable appliance are passive and does not apply force to the teeth. Similar to other embodiments described herein, apparatus in accordance with the fourth embodiment may be designed and manufactured using computerized design and manufacturing techniques, such as, but not limited to, those described herein.
    [00210] Similar to the third modality, various examples of an apparatus in accordance with the fourth modality may include any suitable combination of aligners for some teeth and fasteners for other teeth in a patient's jaw. In such embodiments, the apparatus may include one or more aligners at locations for one or more corresponding teeth, and one or more locks at locations for one or more other teeth in the patient's jaw. Alternatively or additionally, different types of closures can be employed at different locations on the teeth in the appliance. For example, the flexibility of NiTi clasps on posterior teeth can increase the holding capacity of the appliance. This can be useful if a malocclusion requires more retention of the appliance on the teeth.
    [00211] An apparatus according to the fourth modality may include one or more palatal arch features or lingual arch features, for example, but not limited to the palatal arch feature 202 or 804 in Figures 2 and 8, respectively, or the arch feature lingual 302 in Figure 3. An apparatus in accordance with the fourth embodiment may include one or more anchoring device supports for anchoring the apparatus to a patient's palate or lingual site, as described herein in connection with anchoring device supports 812 or 904 in Figures 8 and 10. In these examples, one or more anchoring devices (such as, but not limited to, TADs) can be implanted in a patient's palate or lingual area for engagement and disengagement (and connection and disconnection selective) as described for the third modality.
    [00212] In particular examples of systems and methods according to the fourth modality, the caps can be configured to hold and hold teeth, involving natural cutouts in the surfaces of the teeth, or through artificial cutouts provided by accessories or teeth-safe buttons , as described above in relation to the third modality.
    [00213] The arms of an apparatus according to the fourth modality (similar to an apparatus according to the second modality) may include one or more flexible elements, such as springs, that apply a force and have a selectable flexibility or custom, based on the size of the tooth as well as the desired movement of the tooth the arm is connected to. In an apparatus according to examples of the fourth embodiment, a single cap is attached to each arm and, in particular examples, does not cover any portion of the flexible elements of the arm or bar. In other examples, more than one cap is attached to one arm, or more than one of the arms is attached to the plurality of caps, or combinations thereof. A cap connector element (e.g., similar to cap connector element 1804 described above) may be formed or otherwise connected to an end section of each respective arm and may connect to a single respective cap. In other examples, more than one cap connector is connected to one of the caps, or more than one cap is attached to the plurality of cap connectors, or combinations thereof.
    [00214] In particular examples, the caps are configured to secure to the patient's teeth so as to avoid contact between the caps of adjacent teeth. In this way, the appliance lids (and the teeth on which these lids are held) can move separately and independently of other lids on the appliance (and teeth on which these lids are attached), and it is not necessary to restrict the movement of other lids on the appliance (and the teeth on which these caps are attached).
    [00215] In the examples of an apparatus according to the fourth embodiment, each cap may comprise a liner. In such examples, an Essix® machine or other suitable thermoforming or vacuum molding machine can be used to secure each liner cap to a respective cap connector element on an arm of the apparatus.
    [00216] In certain instances, the aligner may cover the entire device, for example, for the comfort of the patient. In such examples, a space or gap can be formed between the springs in the arms and the aligner in the arm. In these examples, the patient may experience additional comfort as the patient's tongue will only contact the smooth surface of the aligner rather than the arms or metal bar of the device. The liner can be trimmed manually or with another suitable machining or cutting method (such as, but not limited to, laser cutting, milling or the like).
    [00217] In other examples, teeth can be held by configuring one or more of the arms to pass the lingual surface of the teeth through the incisal or interproximal surfaces and secure the teeth from the buccal side (similar to different forms of closures in a partial denture). In another example, an appliance in accordance with the fourth embodiment includes a bar on the buccal side and the arms pass over the teeth to the lingual side such that the tip of the arm on the removable appliance is on the lingual side.
    [00218] Systems or methods according to the third and fourth embodiments (wherein an apparatus includes a plurality of aligner caps configured to secure the patient's teeth by snapping onto the teeth) can provide distinct advantages of an apparatus that can be easily removed by the patient or clinician, similarly to traditional clear aligners. Fabrication Methods and Use of Modalities
    [00219] Systems and methods according to modalities described herein can be employed to move or reposition teeth using one appliance, or through the progressive use of various appliances, for example, depending on the complication of dental malocclusion.
    [00220] According to the various examples and modalities described here, appliances can be configured and used in techniques that can achieve orthodontic translational tooth movement in one or more (or all three directions) of space (ie, mesiodistal, bucolingual and occlusogengival ). Alternatively or additionally, such appliances can be configured and used in techniques that can achieve rotational movements, such as torque, angulation and rotation (ie, bucolingual root torque, mesiodistal angulation, and mesial in and out rotation).
    [00221] An example of a method 2000 of making and using an apparatus in accordance with various examples and modalities described herein is described with reference to Figure 20.
    [00222] Method 2000 in Figure 20 includes obtaining (2002) data representing a 3D OTA of a patient's mandible. 3D OTA data can include, for example, digital image data obtained using an intraoral scanner on the patient or using an extraoral scanner on plaster casts of the patient's upper and lower dental arches. In other examples, 3D OTA data can be obtained from other suitable devices and methods, such as, but not limited to, imaging a tooth arrangement by cone beam computed tomography (CBCT) or magnetic resonance imaging ( MRI). In examples where plaster is used, the relationship between the teeth in the upper and lower arches (inter-arch ratio) can be obtained by taking a bite of wax from the patient in the central position. In examples involving intraoral scanning, the relationship between arcs could be recorded by the scanner.
    [00223] A digital 3D image of teeth obtained from the 3D OTA data is cut (2004) into single teeth or multiple tooth blocks (in one or more digital images of individual teeth). The 3D digital image can be cropped and manipulated using suitable processing systems and software, such as, but not limited to, a processing device running computer aided design (CAD) software. The processing device may include any suitable computer system, mainframe, desktop computer, laptop computer, computer network device or system, mobile electronic block or communication device, or the like, having operating capabilities as described herein.
    [00224] Using the appropriate processing device and software, the digital images of the individual teeth are then moved (2006) to a desired or favorable inter-arch and intra-arch arrangement, for example, based on a clinician's prescription. For example, one or more (or all) of the upper or lower jaw teeth (or both) are moved until their cusps have good interdigitation and fit. A desired or ideal arrangement of teeth in a mandible can be identified as the FTA for the patient. In specific examples, a qualified clinician may approve the rearrangement after obtaining the 3D digital FTA from the 3D digital OTA.
    [00225] The processing system interpolates (2008) the movement of teeth from the 3D digital OTA to the 3D digital FTA. In examples where multiple appliances are used progressively through treatment to achieve one or more ITAs before reaching an FTA, the processing system interpolates tooth movement from the digital 3D OTA to one or more ITAs, and the from an ITA to an FTA. In other examples, a clinician may choose an FTA or ITA, without the use of a computerized interpolation, for example, based on the clinician's experience and knowledge, predefined guidelines, or combinations thereof.
    [00226] The processing system determines (2010) a three-dimensional configuration of the device, based on the interpolated movement of the teeth between the OTA and the FTA (including any ITAs). The processing system calculates (or uses calculations of) the forces and torques required to move each tooth from the OTA to the FTA and any ITAs. The processing system also calculates (or uses calculations of) forces and torques provided by the dimensions and configurations of the equipment and, based on these calculations, designs or otherwise determines an appropriate apparatus configuration to provide the forces and torques required to move each tooth from the OTA to the FTA and any ITA. Determining the appropriate thicknesses, widths and configurations of springs, arm bars and other components of an apparatus in accordance with one or more of the first, second, third and fourth embodiments described herein, an apparatus configuration that applies forces and torques to the appropriate teeth to move teeth to the FTA or an ITA is determined. A device configuration is determined for the FTA and a separate device configuration is determined for each ITA. The processing system provides data corresponding to each device configuration.
    [00227] In specific examples, device design may be performed by a clinician, manufacturer, or technician, with the appropriate processor system and design software, such as, but not limited to CAD software, such as, but not limited to, Solidworks ®, Autodesk® Inventor, Creo® or similar. FEA software such as, but not limited to Abaqus, Ansys, etc. they can be used to design the springs and arms to apply the desired or optimal force to the teeth. For example, in relation to the first and third modalities, such software and processing systems can be employed to design and change the thickness, cut width, length, as well as the overall configuration of each interdental spring based on the desired movement of the teeth to the which spring is connected.
    [00228] With respect to the second and fourth modalities, such software and processing systems can be employed to design and change the thickness, cut width, length, as well as the overall design of each arm based off the tooth movement for which the arm is connected. For example, if a tooth needs to be moved a greater distance or the tooth is smaller (eg lower incisors), the spring or arm can be designed in such a way that it is more flexible. In addition, if necessary, springs/arms can be designed to transmit less force on some or all teeth due to periodontal problems such as bone resorption, root resorption or attachment loss. The ability to customize the force or torque (or both) applied to each tooth can provide significant advantages over traditional orthodontics.
    [00229] One or more devices are manufactured (2012), based on data provided by the processing system. The processing system can be connected to provide design data corresponding to device configuration for one or more manufacturing or manufacturing systems, to control one or more manufacturing or manufacturing systems to make one or more devices (or components of one or more appliances), which are configured to provide the forces and torques to move each tooth from the OTA to the FTA and any ITAs. The connection of the processing system to one or more manufacturing or manufacturing systems may be direct, for example, through an electronic network or other digital connection, or indirect, for example, by storing data from the processing system on a non- transitional and deliver the storage medium to one or more manufacturing or manufacturing systems.
    [00230] A process according to Figure 20 can be employed to manufacture one or more apparatus according to modalities described herein. Each appliance can be fitted to the patient's teeth, as described here, to move the teeth from an OTA to an FTA (or to an ITA, or from an ITA to an FTA or another ITA). Braces can be designed to treat a variety of dental malocclusions that can be treated in traditional orthodontics. Additionally, systems and methods, including devices in accordance with the modalities described herein, can be configured to decrease typical treatment time, reduce chair time, decrease the number of clinic visits and decrease the complexity of the work performed by the clinician . Another advantage available with embodiments described herein is that apparatus according to such embodiments can be configured to be installed behind the teeth, if desired, for example to minimize visibility. Modalities described here are adaptable to changes in the patient's teeth that may occur as part of the treatment process. For example, a clinician may extract one or more teeth from the patient, due to lack of space for all the teeth to fit into the arch (or other reasons) as part of the treatment. In this case, extracted teeth can be erased from the 3D digital images used in the calculations described above. If the clinician decides that the teeth need to be made smaller due to lack of space, interproximal reduction (IPR) can be performed on the patient. In this case, removal and reduction of the size of teeth in 3D digital images can be performed to match the IPR done by the physician.
    [00231] In the first and second embodiments described herein, the manufactured device is configured to be installed on the patient's teeth, engaging male connector elements on the device with female connector elements connected to the teeth. In such modalities, the 3D digital OTA can be used by a clinician when selecting the location and size of the female connector elements (brackets). In certain examples, female connector elements can be selected or customized to the tooth surface geometry so that they fit precisely to the tooth surface. One option is to join the female connecting elements behind the teeth (to the lingual side of the teeth), for example, to make the appliance more aesthetically appealing. Another option is to join the female elements to the front of the teeth (the buccal side of the teeth). The buccal version may be preferred in cases of orthognathic surgery, where the surgeon would benefit from easy access to the device during surgery. However, even in cases of orthognathic surgery, it is possible to use the lingual version. In this case, the female connecting elements can be installed on the buccal side before surgery and then removed, for example, within a few weeks after surgery.
    [00232] A custom tray can be made for the indirect connection of the female connector elements to the tooth surface using the digital 3D OTA. The clinician can use the custom tray to secure the female connecting elements to the surface of the teeth using a composite resin or other bonding material. The tray can help the physician to bond the brackets in the ideal tooth position. If necessary, another custom tray can be made, using the OTA, to help the clinician deploy the Temporary Anchorage Devices (TADs) in the optimal position. Before using the tray as a guide for inserting the TADs, the clinician may anesthetize the desired insertion site for patient comfort. TADs are placed if additional anchorage is required for tooth movement. The decision on whether or not to use TADs can be made by the physician and the chosen treatment plan. If desired, stabilization can be increased by including a palatal arch in the upper jaw appliance or a lingual arch in the lower jaw appliance.
    [00233] Alternatively, the physician can directly attach the female elements to the teeth, without the aid of a tray. Likewise, the physician could insert the TADs into the jaw without using a guide tray. In that case, an intraoral scan, cone beam computed tomography (CBCT) or other suitable scan or image can be taken of the patient after the female elements or TAD(s) are placed manually. The device will then be manufactured or manufactured based on the position of the female parts or TADs that the physician has chosen.
    [00234] For devices according to the third and fourth modalities, the clinician can use the 3D digital OTA to select the location and size of each cap as well as the fixation members. Caps and clamping members can be adapted to the geometry of the surface of the teeth so that they precisely fit the surface of the teeth. In some instances, the accessories are attached behind the teeth (the lingual side of the teeth), which makes the appliance more aesthetically appealing. In other examples, the attachments are attached to the front of the teeth (the buccal side of the teeth). The buccal version may be preferred in cases of orthognathic surgery, where the surgeon would benefit from easy access to the device during surgery. However, even in cases of orthognathic surgery, it is possible to use the lingual version. In this case, the accessories can be installed on the buccal side before surgery and then removed, for example, within a few weeks after surgery.
    [00235] A custom tray can be made for indirect attachment of accessories to the tooth surface using digital 3D OTA. The clinician can use the custom tray to attach the accessories to the surface of the teeth using composite resin or other bonding material. The tray can help the physician to attach the accessories in the desired or ideal position. If necessary, another custom tray can be made, using the OTA, to allow the clinician to insert anchorage devices (TADs) in a desired or optimal position. Before using the tray as a guide for inserting the TADs, the clinician may anesthetize the desired insertion site for patient comfort. These TADs are placed if additional anchorage is required for tooth movement. The decision on whether or not to use TADs will be made by the physician and the chosen treatment plan. If desired, stabilization can be increased by including a palatal arch in the upper jaw appliance or a lingual arch in the lower jaw appliance.
    [00236] Alternatively, the physician can attach the accessories directly to the teeth, without the aid of a tray. Likewise, the physician could insert the TADs into the jaw without using a guide tray. In that case, an intraoral scan, CBCT or other suitable scan or image can be taken of the patient after the female elements or TAD(s) are placed manually. The device will then be manufactured or manufactured based on the position of the accessories or TADs that the physician has chosen.
    [00237] In the first and second embodiments, after each apparatus is manufactured and the female connector elements are connected to the teeth, each male element of the apparatus will be engaged with its associated female element to install the apparatus. Once installed, the appliance transmits forces and torques to the teeth to move the teeth to the desired FTA or ITA. Upon completion of each treatment step (OTA for FTA, OTA for ITA, ITA for ITA, or ITA for FTA), the male elements will passively remain in the female elements and force will no longer be applied to the teeth. At this stage, the male elements can be removed and the next apparatus can be installed, using the same female connector elements. However, if the previous appliance was made on the basis of the FTA, the treatment was completed. Based on the clinician's opinion, one or more appliances can be constructed and installed for finishing, detailing and positioning of the teeth's ends.
    [00238] In the third and fourth modes, after each appliance is manufactured, each appliance cover can be coupled with the appropriate tooth or teeth, in some instances, with the help of an accessory. Once installed, the appliance transmits forces and torques to the teeth to move the teeth to the desired FTA or ITA. Upon completion of each treatment step (OTA for FTA, OTA for ITA, ITA for ITA, or ITA for FTA), the caps will passively rest on the teeth and force will no longer be applied to the teeth. At this stage, the caps will be removed and the next device will be inserted into the patient's mouth. However, if the previous appliance was made on the basis of the FTA, the treatment was completed. Based on the clinician's opinion, one or more appliances can be built and installed for finishing, detailing and the best fine positioning of the teeth.
    [00239] Apparatus according to the first and second embodiments, and female connector elements associated with these embodiments, may be manufactured in any suitable manner, including, but not limited to molding, casting, machining, 3D printing, stamping, extrusion or the like. For example, 3D metal printers can be used to directly print devices with nitinol, steel, beta-titanium or other suitable metals or alloys. In other examples, the apparatus is first printed from fusible wax and then the wax pattern is the investment cast in Nitinol, steel, beta-titanium, among other metals or alloys. In another example, the apparatus is printed directly with a polymer or elastomeric material.
    [00240] However, in particular embodiments, devices or female connector elements (or both) of examples of various embodiments described herein are made by cutting a 2D shape of the device from a 2D sheet of material and folding the 2D shape into a shape. 3D desired of the device. Such methods are particularly suitable for making apparatus according to examples of the first and second embodiments described herein, or for the arc-shaped structure or metal part of an apparatus according to examples of the third and fourth embodiments described herein.
    [00241] Thus, a method for manufacturing an apparatus according to any exemplary embodiment described herein, and in particular, for preparing an apparatus according to embodiments described herein, includes designing an apparatus configuration using processing systems and hardware suitable, for example, as described herein with reference to method 2000, where the fabrication (2012) of one or more apparatus involves cutting a 2D shape of the apparatus from a 2D sheet of material and folding the 2D shape into a desired 3D shape of the device.
    [00242] More specifically, referring to Figure 21, an example of a manufacturing method 2100 (corresponding to feature 2012 in method 2000), includes the formation of a 3D image or model (2102), based on the 3D configuration determined in 2010 in method 2000. The device image or model may be designed by a clinician, manufacturer, or technician using a processor system and appropriate design software such as, but not limited to, CAD software such as, but not limited to, SolidWorks ®, Autodesk® Inventor, Creo® or similar. An example of a 3D 1800 model of a device, as designed in SolidWorks® and Autodesk® Inventor, is shown in Figure 18a.
    [00243] Method 2100 includes converting (2104) the 3D image or model to a 2D image or template. Such conversion may be performed using an appropriate processor system and flattening software such as, but not limited to, ExactFlat® or other suitable software. Figure 18b shows an example of an 1802 image or 2D model of the 3D model in Figure 18a.
    [00244] Then, a 2D representation of the device is formed (2106) and based on the 2D image or template, using a processor system and appropriate software, such as, but not limited to, CAD software such as, but not limited to, Solidworks®, Autodesk® Inventor, Creo® or similar. Figure 18c shows an example of a 2D 1804 representation of an apparatus, based on the 2D image or template of Figure 18b. In particular examples, the 2D representation may include one or more temporary arms 1806 that are used to secure the apparatus to a mandrel during bending or setting (heat treatment) procedures. In additional examples, the 2D representation may include one or more anchoring device supports, such as, but not limited to, those described herein.
    [00245] Thereafter, the data corresponding to the 2D representation of the apparatus is provided (2108) to a suitable manufacturing device (such as, but not limited to, one or more machines performing cutting, laser cutting, milling, wire EDM , water blasting, punching (stamping) or the like) to cut a flat sheet of material into a member having a 2D shape of the 2D representation of the apparatus. The fabrication device is data driven to fabricate a 2D member that has a shape of the 2D representation of the device. The 2D member may be cut (2110) from a flat sheet of any suitable material, such as, but not limited to, nitinol, stainless steel, cobalt chromium or other type of metal. In specific examples, the flat sheet of material is a Nitinol (NiTi) sheet, such that the 2D member cut from the flat sheet is shaped like a 2D representation of the apparatus, in Nitinol (NiTi). Figure 18d shows an example of a 2D member 1808 fabricated based on the 2D 1804 representation of Figure 18c. In examples where temporary arms 1806 have been added, the temporary arms may be omitted from the 2D member (or may be included and subsequently cut or removed from the 2D member).
    [00246] After cutting the 2D member from a flat sheet of Nitinol (NiTi) or other suitable material, the method includes bending (2112) the 2D member into a desired 3D shape corresponding to the 3D image or template of which the 2D member was done. In certain examples, one or more mandrels are configured for use in bending the 2D member into a desired 3D shape configuration. In such examples, after cutting the 2D member, the 2D member is fixed to or between one or more mandrels. The 2D member is bent over or between the mandrels to form a desired 3D shape. Figure 18e shows an example of an apparatus 1810 having a 3D shape that has been formed by bending the 2D member 1808 of Figure 18d to a desired configuration.
    [00247] One or more 2114 shape setting procedures, such as but not limited to heat treatment, can be applied to the 3D shape, during or after the bending operation, to define the desired 3D shape. A shape setting procedure involving a heat treatment may include rapid cooling, after heating the limb during or after flexion.
    [00248] An example of a heat treatment procedure may include heating the limb (during or after it has been bent into the desired 3D shape) to a selected temperature (such as, but not limited to, 550 degrees Fahrenheit) for a selected period of time. of time (such as, but not limited to 10 minutes), followed by blast chilling. Rapid cooling can be achieved by any suitable cooling procedure, such as but not limited to water cooling or air cooling. In other examples, the time and temperature for heat treatment may differ from those discussed above, eg based on the specific treatment plan. For example, the heat treatment temperatures can be within a range of 200 degrees Fahrenheit to 700 degrees Fahrenheit and the heat treatment time can be a time in the range of up to about one hundred and twenty minutes. In particular examples, the heat treatment procedure can be carried out in a vacuum or air oven, salt bath, fluidized sand bed or other suitable system. After completing the heat treatment, the device has the desired 3D shape and configuration. In other examples, other suitable heat treatment procedures may be employed, including, but not limited to, heating or resistive heating by passing a current through the metal of the apparatus structure. One or more additional post-processing operations, for example, may be provided on the article in 3D form, including but not limited to polishing, electropolishing, electroplating, coating, sterilizing or other cleaning or decontamination procedures).
    [00249] As described above, Figure 18e shows an example of an apparatus 1810 having a 3D shape that has been formed by bending the 2D member 1808 of Figure 18d to a desired configuration. Another example of an 1820 apparatus having a 3D shape that was formed by bending a 2D member into a desired configuration is shown in Figure 18f. Example apparatus 1820 in Figure 18f includes a plurality of arms having male connector elements 1822, similar to male connector elements 1802 of apparatus 1810 in the example of Figure 18e. However, the springs 1824 in the arms of the apparatus 1820 have a different shape than the springs in the arms of the apparatus 1810. In addition, the apparatus 1820 has TAD 1826 holders which generally have a U- or Y-shaped structure compared to the ring or o-ring shape of the TAD holders of the 1810 apparatus in the example shown in Figure 18e. Apparatus 1820 in Figure 18f may be made in a manner similar to the manner of making apparatus 1810 described herein.
    [00250] In the examples where the apparatus is made of multiple components, some (or each) of the components of the apparatus may be made according to the methods described above (including but not limited to methods 2000 and 2100), and then connected together to form the desired configuration of the 3D device. In these or other examples, the apparatus (or some or each component of the apparatus) can be made in other suitable methods, including, but not limited to: direct metal printing, first printing a wax member, and then casting of wax member in a metallic material or other material, printing of elastomeric material or other polymer, or cutting the components of a metal sheet and shaping to the desired 3D configuration.
    [00251] As discussed here, one or more mandrels can be configured for use in bending a 2D member cut into a desired 3D shape configuration. In particular examples, one or more mandrels (such as, but not limited to custom-made) are provided for each jaw of a patient. For example, mandrels can be customized in shape and configuration for each patient and can be made in any suitable way, including molding, machining, direct printing of stainless steel metal or other suitable metals, 3D printing of a suitable material such as , but not limited to a steel/copper mixture via binder blasting, as well as first printing the configuration in wax and then melting the wax into various metals. In several examples described herein, the mandrel can be configured of material that is sufficiently resistant to the heat treatment temperature. In particular examples, one or more robots can be employed, with or without the one or more mandrels, to bend the cut 2D member into a desired 3D shape configuration.
    [00252] By employing a 2D cut member instead of a traditional single diameter wire, a greater variety of 3D shapes can be made compared to shapes made by bending single diameter wire. The cropped 2D member can have dimensioned or variable widths and lengths that, when folded into a desired shape, can result in parts of the 3D device with variations in thickness, width, and length dimensions. In this way, the 2D member can be cut into a shape that provides a desired thickness, width and length of spring members, arms or other components of the apparatus. A greater variety of shapes can be provided by bending a custom cut 2D member as compared to bending a single diameter wire.
    [00253] As discussed above, a method 2100 in which a 3D apparatus configuration is made from a cut 2D member may be particularly suitable for making an apparatus according to the first and second embodiments or metal part of a cutting apparatus. according to the third and fourth modalities. In particular examples, the complete apparatus (including male connector elements and springs) is configured by bending the cut 2D member into the desired 3D shape member. In other examples, additional components may be attached to the 3D shape, for example after bending 2112, where such additional components may include, but are not limited to, male connector elements (such as, but not limited to those shown in Figure 12), members springs, arms, cap connector elements, TAD brackets or the like. Such additional components may be attached to the 3D shape member by any suitable attachment mechanism including, but not limited to, adhesive material, soldering, friction fit, or the like.
    [00254] Similarly, the metallic portion of an apparatus in accordance with the third and fourth embodiments may also be made from a 2D cut limb, using methods 2000 and 2100 as described herein. Once the metal part of the apparatus is set up (cut from a 2D sheet of material and folded into a member of the desired 3D shape), one or more covers can be attached to fastening members formed on (or attached to) the part. of metal. In particular examples, the caps may be configured and secured to the member in a 3D shape such that the adjacent tooth caps may not come into contact with each other during the course of treatment. In certain examples, an Essix® machine or other suitable thermoforming or vacuum forming machine can be used to secure each cap to a respective cap connector element on the 3D shaped member.
    [00255] Additional components may be attached to the member in a 3D fashion, eg after bending (2112), where such additional components may include, but are not limited to, male connector elements (such as, but not limited to, those shown in Figure 12 ), spring members, arms, cap connector elements, TAD brackets or the like. Such additional components may be attached to the 3D shape member by any suitable attachment mechanism including, but not limited to, adhesive material, soldering, friction fit or the like.
    [00256] The covers can be configured and connected to the member in a 3D shape with sufficient clearance between the adjacent covers so as to provide space for the springs and arms to move. In additional examples, the liner cap is configured to cover the teeth only, and the liner can be trimmed manually or with another cutting method described herein.
    [00257] Another method of fabricating an apparatus according to the third embodiment is described and shown in Figures 19a-19c. Referring to Figure 19a, a 1900 3D printed model or mold of the patient's ITA or FTA is produced in accordance with the procedures described herein. The model or mold 1900 can be made of any suitable polymer, ceramic, metal or the like. In other examples, the cast may include a larger portion of the patient's palate than shown in Figures 19a-19c. Furthermore, an arc-shaped structure 1902 is made of metal or other suitable material, in accordance with the procedures described herein for producing an apparatus of the first embodiment. In one example, an arch-shaped structure 1902 has a similar shape and configuration to the apparatus in Figure 17a which is produced as described herein. In other examples, arc-shaped members with other suitable shapes may be employed. Arc-shaped structure 1902 is placed on the template or mold, or is secured to the template or mold, as shown in Figure 19a by any suitable attachment mechanism, including, but not limited to, an adhesive, string, or the like.
    [00258] The thermally adjustable material is then pressed into the 1900 model or mold, for example, using an Essix® machine or other suitable thermoforming or vacuum forming machine, while the 1902 arc-shaped structure is present in the model. or mold. As a result, the arc-shaped structure is embedded in the thermally adjustable material. In particular examples, the thermally configurable material is a thermally configurable plastic, such as, but not limited to, an Essix® plastic sheet with a thickness of up to about 2mm.
    [00259] In other examples, one or more layers of a thermally configurable material may be pressed into the 1900 model or mold, before the 1902 arc-shaped structure is placed in the model or mold. Then, the arch-shaped structure 1902 can be placed on top of the thermally configurable material (before or after setting the thermally configurable material into the shape of the model or mold). Then, one or more additional layers of thermally configurable material can be placed on the arch-shaped structure 1902 and on the previously placed thermally configurable material, and placed in the shape of the model or mold. Consequently, the arch-shaped structure 1902 can be secured between two or more layers of thermally adjusted material formed in the shape of the model or mold. In particular examples, the thermally configurable material can be cut and removed in areas covering spring members or other flexible portions of the arc-shaped member or arms extending from the arc-shaped member (before or after thermal configuration), to minimize or eliminate any obstruction to movement and flexibility of spring members or flexible portions.
    [00260] When sufficiently cured, the thermally configurable material (with the arc-shaped member) is removed from the 1900 model or mold. When removed from the model or mold, the molded plastic (and arc-shaped structure embedded in the molded plastic) forms a 1910 three-dimensional structure of a cap for the entire jaw of the teeth, as shown in Figure 19b. The molded plastic structure 1910 is then cut, by forming cuts between each pair of adjacent teeth, to form an apparatus 1920 as shown in Figure 19c. Such cutting can be performed by any suitable cutting procedure, such as, but not limited to milling, laser cutting, or the like. While various materials can be used for example apparatus in accordance with the embodiments described herein, particular examples are made from a shape memory alloy, such as Nitinol (NiTi), which contains Nickel and Titanium. Nitinol can be sufficiently elastic and has shape memory properties. Consequently, using Nitinol, the force applied to the teeth can decay more slowly than force generators in traditional braces. Therefore, systems and methods in accordance with embodiments described herein can be configured to require fewer appliances (thus simplifying treatment) compared to traditional orthodontics and techniques.
    [00261] In the course of some treatments, a clinician may perform an extraction for a variety of reasons, including: crowded teeth due to relatively large teeth compared to the patient's jaw, damaged teeth that need to be extracted, or other reasons. When an extraction is performed, neighboring teeth that are not extracted tend to move towards each other to close the extraction space. Certain systems and methods (including apparatus) in accordance with embodiments described herein can be employed to close an extraction space, either asymmetrically, which is called minimum/maximum anchorage, or symmetrically, which is called moderate anchorage. In particular examples, TADs can also be used to provide anchorage to close the extraction space. In such examples, one or more TADs can be arranged to hold a passive device toward one side of the extraction space to asymmetrically close the space. On the other hand, one or more TADs can be arranged in the middle of a passive apparatus, to symmetrically close a space. Closure of the space can be achieved by employing apparatus in accordance with embodiments described herein to change the angulation of the teeth or using stiffer springs for the teeth which are intended to move relatively less. Likewise, more flexible springs could be used for teeth that need to be moved even further.
    [00262] Examples of processes for closing an extraction space, using an apparatus according to modalities described herein, are shown and described with reference to Figures 22a and 22b. Referring to Figures 22a and 22b, an apparatus 2200 (shown in partial view) includes a plurality of caps 2201, in accordance with the third embodiment. The 2200 appliance is shown as disengaged from the teeth in Figure 22a and in an untensioned or passive state. Apparatus 2200 is shown as engaged and secured to the teeth in Figure 22b. In Figure 22b, an extraction space 2202 is shown, for example, at a location where a tooth (such as but not limited to a premolar) has been extracted. When the 2200 appliance is installed, a spring member (formed by an interdental loop 2204) is in a tensioned state and transmits a force on one or both of the adjacent teeth (eg, upper second premolar 2206 and upper canine 2208), to move these teeth and close the extraction space 2202.
    [00263] Another apparatus according to the fourth embodiment is described and shown in relation to Figures 23a and 23b. In Figure 23a, an apparatus 2300 (shown in partial view) in accordance with an example of certain embodiments described herein is in a passive state, such as before being placed in the patient's mouth. In Figure 23b, appliance 2300 is attached to teeth, for example, using caps as described herein. In Figure 23b, arm 2302 of apparatus 2300 is attached to a canine tooth and is stretched compared to arm 2302 shown in Figure 23a, due to the extraction space and spring force in arm 2302.
    [00264] Methods described with reference to Figures 20 and 21 can be performed with a clinician (or other appropriate personnel) using a processing system as described. A generalized representation of a 2400 processing system that may be employed for such methods is shown in Figure 24 and includes a 2401 processor, a 2402 input device, a 2403 display device, and a 2404 imaging or scanning device (or other device). suitable for imaging a patient's OTA). The 2401 processor may be connected to one or more 2406 fabrication systems (including fabrication machines) for fabrication of apparatus (and their components and tools) as described herein. The 2401 processor may be connected to the 2406 manufacturing system(s) by any suitable 2408 communication connection including, but not limited to, a direct electronic connection, network connection, or the like. Alternatively, or in addition, connection 2408 may be provided by delivering to fabrication system 2406 a physical, non-transient storage medium on which data from the processor has been stored. The non-transient storage medium may include, but is not limited to, one or more of an RSB pluggable memory, a memory chip, a floppy disk, a hard disk, a compact disk, or any other suitable non-transient data storage medium. .
    [00265] While various embodiments and examples described herein include or employ male connector elements in an apparatus that engage and secure female connector elements on teeth, other configurations and examples can be similarly configured, but with the female connector elements in the apparatus and male connector elements on the teeth.
    [00266] The modalities disclosed herein are to be considered in all respects as illustrative and not restrictive. The present disclosure is by no means limited to the embodiments described above. Various modifications and alterations can be made to the modalities without departing from the spirit and scope of the revelation. Various modifications and changes which are within the meaning and equivalence range of the claims are intended to be within the scope of the disclosure.
    权利要求:
    Claims (13)
    [0001]
    1. Orthodontic appliance, characterized by the fact that it comprises: an arch-shaped limb configured to be placed behind and along a patient's teeth; and a plurality of arms extending from the bow-shaped member, each of the arms including (i) a proximal end portion on the bow-shaped member, (ii) a connector portion configured to be coupled to one of the teeth. , and (iii) a spring member configured to apply a directed force on at least one of the teeth, the spring member disposed along the arm between the proximal end portion and the connector portion, wherein the member is shaped like a bow and at least some of the plurality of arms together comprise a single unitary body that forms a three-dimensional structure.
    [0002]
    Apparatus according to claim 1, further comprising a plurality of attachment members, wherein each attachment member is configured to be disposed on one of the teeth, and wherein the connector portion of each of the arms is configured to be coupled to one of the teeth through a corresponding one of the clamping members.
    [0003]
    3. Apparatus according to claim 1, characterized in that the spring member comprises a part of the three-dimensional structure.
    [0004]
    4. Apparatus according to claim 1, characterized in that the spring member comprises nitinol.
    [0005]
    5. Apparatus according to claim 1, characterized in that the arms comprise: a first arm including a first spring member having a first shape, and a second arm including a second spring member having a second shape different from first way.
    [0006]
    6. Apparatus according to claim 1, characterized in that the arms comprise: a first arm including a first spring member having a first thickness, and a second arm including a second spring member having a second thickness different from first thickness.
    [0007]
    7. Apparatus according to claim 1, characterized in that the arms comprise: a first arm including a first length, and a second arm including a second length different from the first length.
    [0008]
    8. Apparatus according to claim 1, characterized in that the arc-shaped member is non-removable by the patient.
    [0009]
    9. Orthodontic appliance for repositioning a patient's teeth, the appliance comprising: an arch-shaped member configured to extend across the patient's teeth; and a plurality of arms extending from the arc-shaped member, each of the arms including: a spring portion configured to apply a directed force on one of the teeth, and a connector portion distal to the spring portion, wherein the connector portion is configured to be coupled to one of the teeth, wherein the arc-shaped member and at least some of the arms together comprise a single unitary body which forms a three-dimensional structure.
    [0010]
    10. Apparatus according to claim 9, characterized in that the arc-shaped member and the arms comprise substantially the same thickness.
    [0011]
    11. Apparatus according to claim 9, characterized in that one or more of the arms comprises a shape memory material.
    [0012]
    12. Apparatus according to claim 9, characterized in that one or more of the arms comprises nitinol.
    [0013]
    13. Orthodontic appliance characterized by comprising: an elongated member configured to extend along a back of a patient's teeth; and a plurality of arms spaced apart along the elongate member, each of the arms including: a first portion configured to be coupled to one of the corresponding teeth, and a second proximal portion of the first portion along the respective one of the arms, wherein the the second portion is resiliently flexible, so that when the first portion is coupled to one of the corresponding teeth, the second portion is configured to move from a tensioned state to an untensioned state, thus repositioning the one of the corresponding teeth from an original position towards a desired end position, and wherein the elongated member and at least some of the arms together comprise a single unitary body which forms a three-dimensional structure.
    类似技术:
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    Ye et al.2006|Status of lingual orthodontics.
    Nur et al.2010|Zygoma-gear appliance for intraoral upper molar distalization
    Jacobson2021|18 Advances in Orthodontic Treatment
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    法律状态:
    2020-05-19| B25A| Requested transfer of rights approved|Owner name: MECHANODONTICS, INC. (US) |
    2020-06-09| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2021-05-04| B25D| Requested change of name of applicant approved|Owner name: BRIUS TECHNOLOGIES, INC. (US) |
    2021-05-25| B25G| Requested change of headquarter approved|Owner name: BRIUS TECHNOLOGIES, INC. (US) |
    2021-07-20| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-08-24| B350| Update of information on the portal [chapter 15.35 patent gazette]|
    2021-09-08| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 06/12/2016, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US201562263659P| true| 2015-12-06|2015-12-06|
    US62/263,659|2015-12-06|
    US201662352025P| true| 2016-06-20|2016-06-20|
    US62/352,025|2016-06-20|
    US201662393526P| true| 2016-09-12|2016-09-12|
    US62/393,526|2016-09-12|
    US15/370,704|2016-12-06|
    US15/370,704|US10383707B2|2015-12-06|2016-12-06|Teeth repositioning systems and methods|
    PCT/US2016/065174|WO2017100198A1|2015-12-06|2016-12-06|Teeth repositioning systems and methods|
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