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    • 专利摘要:
    A method for determining an open occlusal plane (60) of a patient, comprising: - obtaining an overall model of the patient's jaw including a model of the mandible (112) and the articulated maxilla; - the determination (120) of the patient's natural occlusal plane (20) from the global model of the jaw in the centric occlusion position; - the determination (122) of the opening (O) necessary to allow the advancement of the mandible (112) of the patient; - the determination (125) of the virtual mandibular plane (50) from the global model of the jaw in the open position according to the opening (O) determined; and - the determination (126) of the occlusal plane in opening (60) from the virtual mandibular plane (50), the natural occlusal plane (20) and the global model of the jaw in the open position according to the opening (O ) determined. Mandibular advancement orthosis and intra-oral orthosis made using this method.
    公开号:FR3038510A1
    申请号:FR1556415
    申请日:2015-07-07
    公开日:2017-01-13
    发明作者:Jean Robichaud
    申请人:PANTHERA DENTAL Inc；
    IPC主号:
    专利说明:

    Design of a mandibular advancement orthosis, mandibular advancement orthosis and intraoral orthosis
    The present invention relates to a method of designing a mandibular advancement orthosis. It also relates to a mandibular advancement dental orthosis and an intra-oral orthosis designed by this method.
    During sleep, there is a muscular loosening of the throat area in humans, causing narrowing of the pharynx. In some humans, this shrinkage creates a problem of airflow and can cause a noise called "snoring," which can reach 90 decibels.
    In some cases, it is possible that the narrowing is so severe that breathing is suspended for a certain period of time. This phenomenon of respiratory arrest is called "sleep apnea".
    There are many devices to prevent snoring and sleep apnea. Among the existing devices, one of the most effective is a dental orthosis that allows the advancement of the mandible, often referred as mandibular protrusion orthosis or mandibular advancement orthosis. This advance of the mandible makes it possible to maintain as much as possible the opening of the pharynx, that is to say, to minimize its narrowing during muscle relaxation.
    There are different types of dental devices that allow for the advancement of the mandible. Some include two gutters, independent of each other and respectively adapted to the upper and lower teeth. These two gutters are connected by two retaining rods (often referred to as "tie rods" or "tie rods"). The retaining rods are attached to the upper gutter at the level of the canines and to the lower gutter at the level of the first or second molars. The length of the retaining rods is selected so that when the orthosis is in the mouth, the jaw of the patient is kept in the advanced position.
    As illustrated in Figure 1, the temporomandibular joint (TMJ, or temporomandibular condyle) is a movable (or synovial) joint that unites the mandibular fossa of the temporal bone with the condyle of the mandible by the intermediate of a fibrocartilaginous articular disc. When opening the mouth, there is a rotational movement of the condyle of the mandible in the capsule of ΓΑΤΜ. This movement is natural and, in principle, does not cause any pain.
    As shown in Figure 2, keeping the mandible in the advanced position, ΓΑΤΜ is also in the advanced position. This advancement of ΓΑΤΜ can sometimes cause pain to the patient.
    In addition, many cases of dropouts gutters during sleep are observed. These stalls are caused by the fact that the retaining rods are oriented obliquely, in a bad position and sometimes too rigid. When the gutters unhook, the orthosis is expelled from its protrusion position and the patient is no longer treated.
    Some orthoses include a system of adjustment of the retaining rods. However, these are generally difficult to control, that is to say it is difficult to know precisely the distance (in millimeters) of advancement of the lower jaw. However, the advancement of the mandible (lower jaw) is the key to the success of the mandibular advancement orthosis for the prevention of snoring and obstructive sleep apnea. In addition, the TMJ is sensitive to each half-millimeter of advancement and each half-millimeter of advancement is very important for a patient sensitive to pain.
    To allow the mandible to be advanced, the mandible must be open to allow it to pass over all cusps of upper and lower teeth. Thus, the mandibular advancement orthoses have the effect of keeping, for several hours, the jaw in the open position and maintain the bone condyle in an advanced and unnatural position in the capsule, as shown in Figure 2. To pass over all cusps of upper and lower teeth, the opening of the jaw created by the orthoses is often 3 to 4 millimeters and sometimes more, which is not negligible. Therefore, it is important that the retaining rods connecting the splints of the orthosis work as much as possible in the same plane as that of ΓΑΤΜ.
    With reference to FIG. 3, the natural occlusal plane (or occlusal plane) of a patient is defined as a virtual surface that corresponds to the centric occlusion of a patient. More particularly, it is defined by the confrontation field of the opposing teeth, that is to say when the occlusal surfaces of the teeth of the mandible and maxillary are in contact, tangent to the incisal edges, to the cusp tips of the premolars and molars of each jaw. The natural occlusion plane 20 then respects the natural position of the patient, illustrated in FIG.
    The majority of orthoses are designed without considering the natural occlusal plane of a patient. Some orthoses, however, are designed to approximate this plan, although there is currently no way for an orthosis to exactly meet the patient's occlusal plane. In addition, with an approximate opening of 3 to 4 millimeters, the natural occlusal plane 20 of the patient is no longer valid.
    Therefore, an object of the present invention is to provide mandibular advancement methods and orthoses to overcome at least one disadvantage of the prior art.
    One method of determining an occlusal plane when opening a patient is a general aspect of the invention. This method comprises: obtaining an overall model of the patient's jaw including a model of the mandible and jaw set in articulation; determining the patient's natural occlusal plane from the overall model of the jaw in the centric occlusion position; the determination of the opening necessary to allow the advancement of the mandible of the patient; determining the virtual mandibular plane from the overall model of the jaw in the open position according to the determined opening; and determining the opening occlusal plane from the virtual mandibular plane, the natural occlusal plane and the overall model of the jaw in the open position according to the determined opening.
    In one embodiment, the determination of the opening occlusal plane comprises determining the median line between the virtual mandibular plane and the natural occlusion plane in the open position according to the determined opening, the median line extending between a posterior section and an anterior section of the overall model of the jaw.
    In one embodiment, the determination of the opening occlusal plane comprises the representation of the occlusal plane opening in the overall model of the jaw in the open position according to the determined opening.
    In one embodiment, the determination of the necessary opening comprises the representation of the overall model of the jaw in the open position according to the determined opening.
    In one embodiment, the determination of the opening occlusal plane comprises the representation of the natural occlusal plane in the overall model of the jaw in the open position according to the determined opening.
    In one embodiment, the determination of the virtual mandibular plane in the open position of the mandible of the patient comprises the representation of the virtual mandibular plane in the overall model of the jaw in the open position.
    In one embodiment, determining the patient's natural occlusal plane from the overall model of the jaw comprises: configuring the overall jaw model in a centric occlusion position and defining a line extending between occlusal surfaces of the teeth of the mandible and maxillary in contact, tangent to the incisal edges, to the cusp tips of the pre-molars and molars of the upper and lower jaws. The method may include the definition of a maxillary contact point corresponding to the intersection of the natural occlusal plane on the maxillary incisors in centric occlusion position and a mandibular contact point corresponding to the intersection of the plane of occlusion. natural occlusion on the mandibular incisors in centric occlusion position. The determination of the virtual mandibular plane in the open position may include the definition of a line extending between the occlusal surface of at least one of the mandibular molars and premolars and the mandibular contact point on the mandibular incisors.
    In one embodiment, the determination of the necessary opening includes the evaluation of the distance allowing the incisors of the mandible to be advanced without interfering with the maxillary incisors.
    In one embodiment, obtaining an overall model of the jaw comprises: obtaining the model of the mandible and the maxillary model; obtaining a model of centric occlusion; and the combination of the mandible model, maxillary model, and centric occlusion model to generate the overall model of the jaw in which the mandible and maxillary models are articulated. Obtaining the model of the mandible and the model of the maxilla may include performing an optical scan of the mandible and maxillary or a physical model of the mandible and maxillary. Obtaining the centric occlusion model may include performing an optical digitization of the mandible and maxillary centric occlusion or a physical model of the mandible and maxillary centric occlusion.
    A method of designing a mandibular advancement orthosis for a patient including a lower and an upper gutter is another general aspect. The method comprises: determining the occlusal plane opening the patient by the method described above; determining retaining rods for the mandibular advancement orthosis, retaining rods having a centric line, anterior anchor, posterior anchor, and a length L between the anterior anchor and the posterior anchor; positioning the anterior and posterior anchors so that the centric line of the retaining rods extends substantially parallel to and above the occlusal plane opening the patient; and designing the lower and upper trough of the orthosis from the overall model of the jaw and that the anterior anchors of the retaining rods are connectable to the upper trough and the rear anchors of the rods. retainers are connectable to the lower gutter.
    In one embodiment, the method comprises obtaining the patient's maximum advance and positioning the model of the mandible and maxillary in the open position in an advanced position of the mandible by a displacement along the occlusal plane opening and a distance corresponding to the maximum advance of the patient. The determination of the retaining rods and the positioning of the anterior and posterior anchors can be done on the model of the mandible and maxillary in open and advanced position according to the maximum advance of the patient.
    In one embodiment, the positioning of the anterior and posterior anchorages comprises: positioning the anterior anchorage of each of the retaining rods relative to a respective canine of the maxillary canines on the overall model of the jaw; and positioning the posterior anchor of each of the retaining rods so that the centric line of the retaining rods extends substantially parallel to the occlusal plane opening to the overall model of the jaw. The positioning of the posterior anchorage may comprise the determination of the position posterior to the previous anchorage, a distance corresponding to the length L, in a direction parallel to the occlusal plane opening on the overall model of the jaw in the open position .
    In one embodiment, the design of the lower gutter includes the design of extensions extending above the occlusion surfaces in the posterior sections and aligned with the posterior anchorage of one of the retaining rods.
    In one embodiment, the determination of the necessary opening includes the evaluation of the distance allowing the incisors of the mandible to be advanced without interfering with the maxillary incisors by including the thickness of the upper trough and the trough lower part of the orthosis.
    A mandibular advancement splint is another general aspect. The mandibular advancement orthosis comprises: an upper and a lower gutter designed to cover at least partially and respectively the upper and lower teeth and / or jaw, and two retaining rods connecting the lower and upper gutters; retaining rods extending parallel and above the occlusal plane in opening, determined by the method described above, the retaining rods having a length to maintain the lower jaw in an advanced position relative to the jaw superior when wearing the orthosis.
    In one embodiment, the lower trough and the upper trough comprise flat surfaces at the occlusion faces of the posterior teeth. The flat surfaces of the upper gutter are shorter than the flat surfaces of the lower gutter.
    In one embodiment, the flat surfaces of the upper trough extend approximately from the maxillary canine and posteriorly at least to the distal of the first premolar.
    In one embodiment, the flat surfaces of the upper trough extend posteriorly at most at the distal of the second premolar.
    A mandibular advancement splint is yet another general aspect. It comprises an upper gutter and a lower gutter designed to cover at least partially and respectively the teeth and / or the upper and lower jaw, and two retaining rods connecting the lower gutter and the upper gutter, the upper gutter, the lower gutter and the retaining rods being designed according to the method described above.
    In one embodiment, the lower trough and the upper trough comprise flat surfaces at the occlusion faces of the posterior teeth. The flat surfaces of the upper gutter may be shorter than the flat surfaces of the lower gutter.
    In one embodiment, the flat surfaces of the upper trough extend approximately from the maxillary canine and posteriorly at least to the distal of the first premolar.
    In one embodiment, the flat surfaces of the upper trough extend posteriorly at most at the distal of the second premolar.
    An intraoral orthosis is also another general aspect. The intraoral orthosis comprises an upper and a lower gutter designed to cover at least partially and respectively the teeth and / or the upper and lower jaw, and two retaining rods connecting the lower and upper gutter and having a length to maintain the lower jaw in an open and advanced position relative to the upper jaw and oriented parallel to an opening occlusal plane determined by the opening necessary to advance and maintain the lower jaw in the open and advanced position.
    In one embodiment, the lower trough and the upper trough comprise flat surfaces at the occlusion faces of the posterior teeth. The flat surfaces of the upper gutter may be shorter than the flat surfaces of the lower gutter.
    In one embodiment, the flat surfaces of the upper trough extend approximately from the maxillary canine and posteriorly to at least the distal of the first premolar.
    In one embodiment, the flat surfaces of the upper trough extend posteriorly at most at the distal of the second premolar. The invention will now be described with reference to the following appended figures: FIG. 1 is a schematic view of a temporomandibular condyle (ATM) in a normal position; FIG. 2 is a schematic view of a temporomandibular condyle (ATM) in an advanced position; FIG. 3 includes FIGS. 3a and 3b, FIG. 3a is a schematic view of the natural occlusal plane of a patient including ΓΑΤΜ and FIG. 3b is an elevational view of the natural occlusal plane represented on a portion of a global model. jaw including a model of the maxillary and mandible of a patient in a centric occlusion position and illustrating the incisors teeth and premolar or molar teeth of the patient; FIG. 4 is a perspective view of a mandibular advancement orthosis according to one embodiment; FIG. 5 includes FIGS. 5a and 5b, FIG. 5a is a schematic view of the natural occlusal plane and the occlusal plane opening the mandible of a patient including ΓΑΤΜ and FIG. 5b is an elevational view of the natural occlusal plane. and the occlusal plane opening the mandible of a patient shown on the portion of the overall model of Figure 3b; - Figure 6 is a front elevational view of a retaining rod of a mandibular advancement orthosis according to one embodiment; FIG. 7 is an elevational view of the retaining rod of FIG. 6 represented on the portion of the overall model of FIG. 5b and extending in parallel with the occlusal plane opening the patient; FIG. 8 is a schematic flow diagram showing a method for determining the occlusal plane when opening the patient according to one embodiment; FIG. 9 is a schematic flow diagram showing a method for designing a mandibular advancement splint from the occlusal plane in opening according to one embodiment; FIG. 10 is a front elevational view of an maxillary canine with a representation of the anterior anchorage point of the retaining rod; FIG. 11 is a side elevational view of a portion of the overall model of the jaw including a representation of a posterior extension of the orthosis and a retaining rod with the anterior and posterior anchors respectively positioned on the maxillary canine; and on the posterior extension of the portion of the overall model of the jaw; Figure 12 is an elevational view from above of the mandibular advancement splint of Figure 4, in one embodiment; FIG. 13 is a diagrammatic side elevational view of a portion of the orthosis produced by the method, in one embodiment; and Fig. 14 is a schematic side elevational view of a portion of the orthosis produced by the method, including an upper and lower gutter attachment system.
    Referring to the figures, a mandibular advancement (protrusion) orthosis 40 and a method of designing a mandibular advancement orthosis will be described.
    With reference to FIG. 4, it is shown that a mandibular advancement orthosis 40 comprises an upper (or maxilla) gutter 42 having a cavity designed to receive the maxillary of a patient and a lower (or mandibular) gutter 44 having a cavity designed to receive the mandible of the patient. Each gutter 42, 44 includes an occlusion surface 43 (in FIG. 4, only the occlusion surface of the lower gutter 44 is shown), i.e., the surfaces of the gutters that are in contact with each other. occlusion position. In the posterior sections, the lower gutter 44 includes two extensions 46, extending to the upper gutter 42 from the outer surfaces. In the illustrated embodiment, these two extensions extend beyond the occlusion surface 43 of the lower gutter 44.
    The upper and lower gutters 44 are connected by two retaining rods 48 or rods 48. The ends of the retaining rods 48 are pivotally connected to the upper and lower gutters 42 and 42. More particularly, the retaining rods 48 engage the extensions 46 of the lower trough 44. In one embodiment, the retaining rods 48 comprise heads (not shown) which engage in apertures (not shown) defined respectively in the anterior section of the upper trough 42 and in the extensions 46 of the lower gutter 44. In one embodiment, the heads of the retaining rods 48 and the openings are configured so that the retaining rods 48 can not detach from the gutters 42, 44 in positions of normal use. It is appreciated that in alternative configurations (not shown), the attachment means between the retaining rods 48 and the troughs 42, 44 may vary. For example and without being limiting, the retaining rods 48 may include female-type connectors while the gutters 42, 44 may include male-type complementary connectors.
    In the embodiment illustrated in FIG. 4, the retaining rods 48 engage the extensions 46 from the inside towards the outside as they engage the upper trough 42 from the outside to the inside of the trough 42.
    As mentioned above, when a patient carries both gutters 42, 44 and the retaining rods 48 are connected thereto, the mandible of the patient is configured in the advanced and open position.
    It is appreciated that the orthosis, illustrated in Figure 4, is an example only of a mandibular advancement orthosis (or mandibular protrusion) and many variations thereof are possible.
    As illustrated in FIG. 5, when opening the "O" articulation of a patient at the anterior teeth 28, 30, for example, by one millimeter in height, the opening reached at the level of the posterior teeth 24, 34 is not a millimeter. Indeed, the opening is not parallel to the dentition, which causes a change in the occlusal plane.
    In dentistry, for some patients, anterior opening between the mandible and maxilla of 1 mm can cause TMJ pain. However, it is generally observed that, over time, the TMJ will relax and the pain will disappear.
    With a mandibular advancement orthosis 40, the mandible is advanced forward along the axis "X". When the mandible is advanced forward, the anterior mandibular and maxillary teeth do not fit together, which causes a significant imbalance of ΓΑΤΜ.
    In addition, to allow the advancement of the mandible, without creating interference between the mandibular and maxillary teeth, it is necessary, on average, to open the joint of three to six millimeters. This "O" opening must be maintained for entire nights.
    With this "O" aperture, the ATM is in an abnormal position, which can be uncomfortable for the patient. When holding the mandible open and forward, the patient can move the mandible laterally, ie from left to right and vice versa. In addition, in other patients, maintaining the open and forward position of the mandible causes bruxism and / or may encourage opening the mouth.
    Maintaining the mandible open for a long period of time has the effect of creating a new occlusal plane 60 that is different from the natural occlusal plane 20, as shown in Figure 5. This new occlusal plane is referred to as the "plan". occlusal opening "60. It is calculated according to the opening of the occlusion" O ". More particularly, the opening occlusal plane 60 is calculated from the natural occlusal plane 20 of the patient as well as the position of the mandible and maxilla in the open position. More particularly, the natural occlusal plane 20 of the patient is represented by the line extending between the occlusal surface 22 of the maxillary molars / premolars 24 as well as the contact point 26 on the maxillary incisors 28. The contact point on the maxillary incisors 28 corresponds to the point of contact 26 between the maxillary incisors 28 and mandibular 30 in the occlusion position (FIG. 3). From the natural occlusal plane shown while the mandible is in the open position, a virtual mandibular plane 50 is defined (Figure 5b). This corresponds to a line extending between the occlusal surface 22 of the mandibular molars / premolars 34 as well as the point of contact on the mandibular incisors 30 (or vertex of the mandibular incisors). The point of contact on the mandibular incisors 30 corresponds to the point of contact between the maxillary incisors 28 and the mandibular incisors 30 in the occlusion position (FIG. 3B). From the natural occlusal plane 20, shown in the open position and the virtual mandibular plane 50, the occlusal plane 60 is determined. It corresponds to the median between the natural occlusal plane 20 and the virtual mandibular plane 50, both at the anterior level and the posterior level. Thus, in the open position, the angle defined between the natural occlusal plane 20 and the occlusal plane in opening 60 is substantially equal to the angle defined between the occlusal plane in opening 60 and the virtual mandibular plane 50. The opening between the mandible and maxilla will be important, plus the occlusal plane in opening 60 will be different from the natural occlusal plane 20 of the patient.
    As mentioned above, the upper and lower (maxillary and mandibular) splints 42, 44 are retained by retaining stems 48, which must work in the occlusal plane 60 to protect the ATM. With reference to FIG. 6, a retaining rod 48 comprises two anchoring points 49a, 49b, spaced apart from each other, for respectively engaging the upper and lower gutters 42, 44. More particularly, the upper gutter 42 is connected to the anterior anchoring point 49a of the retaining rod 48 while the lower trough 44 is connected to the rear anchor point 49b of the retaining rod 48. Each of these anchor points 49 is characterized by a center 51 with a centric line 52 extending between the two centers 51 of the anchoring points 49 of a retaining rod 48.
    For the reasons described above, advancement of the mandible affects the position of the condyle in the joint capsule. In order to minimize the side effects on the TMJ, as illustrated in FIG. 7, in the proposed mandibular advancement orthosis, the retaining rods 48 are held in a plane parallel to and above the occlusal plane in opening. 60, created plane due to the opening and the maintenance of the mandible in the advanced position. More particularly, by aligning the retaining stems 48 with the occlusal plane 60, it has been observed that it is possible to reduce stress at ΓΑΤΜ. As will be described in more detail below, during the wearing of the mandibular protrusion orthosis 40, the mandible in the advanced position slides parallel, along the X axis (FIG. 5B), to the occlusal plane in the opening 60, which is different from the natural occlusal plane 20, and on the occlusion surfaces of the upper and lower gutters 42, 44.
    Referring to Figures 8 and 9, a method of designing a mandibular advancement orthosis 40 is described. This method firstly includes a method for determining the occlusal plane opening 60. This method can be performed using a computer including specialized software and at least one scanner (or "scanner"). The specialized software may be designed to perform, at least partially, the method described below.
    First, with reference to Figs. 7 and 8, the occlusal plane at opening 60 must be determined. In order to calculate the occlusal plane in opening 60, a numerical model of the mouth must be obtained. This model can be obtained from an optical scan (or "scan") of a physical model, for example plaster, of the patient's mouth or from a scan performed directly in the patient's mouth. For example and without being limiting, the scanning can be performed using intraoral optical cameras or a table scanner. The first stage of digitization makes it possible to generate a computer file in three dimensions (3D) including a model of the dentition of the patient including maxillary 110 and mandible 112. These first models are stored in the computer memory or any other medium to contain these digital models.
    Subsequently, "centric" occlusion, also referred to as "bite", must be modeled. Occlusion is the manner in which the upper (maxillary) and lower (mandibular) teeth come into contact when the mouth is in the closed position. Centric occlusion is the manner in which the upper and lower teeth come into contact when the mouth is in the closed position and the mandible is in the centric position. Centric occlusion is the first contact of the teeth and may or may not coincide with maximum intercuspidy. This step 114 can be performed by digitizing the two models of plaster while they are configured centrally. This step 114 can also be carried out directly in the patient's mouth by asking the patient to close his mouth in centric occlusion and to perform the digitization with the aid of an intraoral optical camera, such as an optical scanner, while the mouth is in this position. This stage 114 of digitization of the centric occlusion makes it possible to generate a three-dimensional model (3D) of the centric occlusion of the patient which will serve as an articulator of the models of the mandible and maxilla. This template is also stored in the computer's memory or other media that holds these digital models.
    Models of the maxillary, mandible and centric occlusion of the patient are then combined, using appropriate software, to generate a global model of the jaw in three dimensions (3D) 118. This global model of the jaw is obtained in the form of a computer file in three dimensions (3D) including the combination of models, which is stored in the computer memory or any other medium to contain this global numerical model. It represents the dentition of the patient in a centric position in a virtual articulator. The virtual articulator allows the computer reproduction of the average movement of the mandible, that is to say the opening, closing, advancement and lateral movements (left and / or right). It will be used to determine the occlusal plane in opening 60.
    Subsequently, the natural occlusion plane 20 of the patient must be determined 120. The natural occlusal plane 20 is determined as the plane extending between the occlusal surface 22 of the maxillary molars / premolars 24 as well as the contact points. maxillary and mandibular 26a, 26b on the maxillary incisors 28, as shown in Figure 3. This plan can be determined using the computer including a suitable software and model of the overall jaw previously obtained combining, in the virtual articulator, the models of the maxillary and the mandible. For the determination of the patient's natural occlusal plane, the mandible and maxilla are configured in centric occlusion position in the overall jaw model. The determination of the natural occlusal plane 20 includes the identification of the points of contact between the maxillary molars 24 and mandibular maxillaries 34 as well as the contact points 26a, 26b between the maxillary incisors 28 and mandibular 30.
    Once the natural occlusion plane 20 in centric occlusion position determined, the opening "O" required between the mandible and the maxilla is determined 122. This opening "O" must be sufficient to allow the incisors of the mandible 30 to be advanced without interfering with the incisors of maxillary 28. This determination must be made by considering the necessary thickness of the material constituting the upper and lower gutter 42, 44. This evaluation can be made using the global model of the jaw as well as the computer including the specialized software. From this information, the models of the mandible and jaw of the global model of the jaw are configured in open position, corresponding to the opening "O" from the information obtained in step 122.
    With the overall model of the jaw configured in the open position, a line, corresponding to the natural occlusal plane in the open position, is shown 124, as shown in Figure 5. This line extends between the occlusal surface 22 molars / maxillary premolars 24 and the maxillary contact point 26a on the maxillary incisors 28. Again, this representation is made using the global model of the jaw and specialized software included in the computer.
    Subsequently, a line extending between the occlusal surface 22 of the mandibular molars / premolars 34 as well as the mandibular contact point 26b on the mandibular incisors 30 is determined 125. This step 125 consists of the identification of the virtual mandibular plane 50 (Figure 5). With the aid of the two lines (natural occlusal plane 20 represented in the open position (represented in step 124) and the virtual mandibular plane 50 (step 125)), the occlusal plane in opening 60 is determined 126. This corresponds to the median line between the two lines 20, 50, as described above with reference to Figure 5. It is therefore located midway between the natural occlusal plane 20 in the open position and the virtual mandibular plane 50. Once determined, the occlusal plane in opening 60 is represented on the overall model of the jaw configured in the open position according to the opening "O".
    Now, referring to Figure 9, from the occlusal plane 60, the mandibular advancement orthosis 40 can be designed. To design a mandibular advancement orthosis 40 from the occlusal plane in opening 60, the mandible must be advanced according to the maximum advancement of the patient. The patient's maximum advance is determined and recorded by the dentist. For example, it comes with the prescription for the mandibular advancement orthosis. The maximum advance is different for each patient. To realize the advancement of the mandible according to the maximum advance of the patient, the teeth of the mandible are slid along the axis "X" (Figure 5B) respecting the occlusal plane in opening 60 previously determined.
    Once the progress has been made on the model, the retaining rods 48 that will be used with the orthosis 40 will be selected. These are characterized by two anchoring points 49a, 49b each having a center 51, a centric line 52 extending between the two centers 51 of the anchoring points 49a, 49b and a length determined by the length of the rod centric 52 between the two centers 51. If the centric line 52 is not provided during the identification of the retaining rods 48 which will be used with the orthosis 40, it is first determined using specialized software. This centric line 52 of the retaining rods 48 will be employed when positioning the retaining rods 48 relative to the upper and lower troughs 42, 44. More particularly and, as described in more detail below, the centric line 52 of the rods Retainer 48 will be positioned above the line of the occlusal plane in opening 60 and parallel thereto.
    Although the method includes the positioning of two retaining rods 48, one for the right side and one for the left side of the orthosis 40, the method described below relates to the positioning of one of the two retaining rods 48. , the method being repeated for the other rod 48. The method described below makes it possible to position the centric line 52 of the retaining rod 48 above the line of the occlusal plane in opening 60 and parallel to it.
    The distance between the retaining rod 48 and the opening occlusal plane 60 is firstly determined 130. This distance is typically between 4 and 15 mm and is represented by lines 80a, 80b in FIG. 11. In one embodiment, this distance is determined indirectly by positioning the center 51 of the front anchorage 49a of the retaining rod 48 relative to the maxillary canine 70 on the overall model. In some embodiments, the center 51 of the anterior anchor 49a is positioned 132 towards the middle third of the maxillary canine 70, as illustrated in FIG. 10. This positioning can be performed using the specialized software with the control dental technician or other person skilled in the art.
    An maxillary canine 70 is characterized by a distal side 72 (i.e., away from the middle, the side of a tooth that is closest to the posterior or rear of the mouth), a mesial side 74 (that is, oriented towards the middle, the side of a tooth that is closest to the anterior or front of the mouth), an incisal tip 76, opposite to a neck of the tooth 78. When positioning the center 51 of the anterior anchor 49a of the retaining rod 48 relative to the maxillary canine 70 of the patient 132, the technician can move the center 51, either to the mesial side 74, or to the distal side 72, either towards the incisive tip 76, or towards the neck of the tooth 78. The next step is to design the support, that is to say the extension 46, of the retaining rod 48 to the lower trough 44. Once the position of the anterior anchoring 49a of the determined holding rod 48 (step 132) is carried out, the construction of the shape of the extension 46, which serve for anchoring the retaining rod 48 in the lower gutter 44 (step 136).
    According to the patient's maximum advance, the length of the retaining rod 48 is determined. This length varies according to the patients. The retaining rod 48 is then positioned in step 132 and parallel to the occlusal plane 60
    As mentioned above, the posterior anchor 49b of the retaining rod 48 is connected to the lower trough 44 and, in one embodiment, to one of the extensions 46 of the lower trough 44. Therefore, the lower trough 44 of the orthosis must at least be partially designed including the section on which the posterior anchor 49b of the retaining rod 48 will be connected.
    The position of the posterior anchor 49b of the retaining rod 48 and therefore of the extension 46, if any, depends on the length of the selected retaining rod 48, i.e. the length of the centric line 52. The length of the retaining rod 48 will serve as a starting advance from the position of the prior anchorage. More particularly, using the global model in which the jawbone and mandible, articulated, are positioned in open and advanced position, the retaining rod 48 is positioned 138 parallel to the occlusal plane in opening 60, in s extending to the posterior section of the gutter 44 from the position of the anterior anchorage of the retaining rod 48. This positioning of the retaining rod 48 can be achieved using the specialized software and the overall model. This step 138 makes it possible to determine the anchoring point of the retaining rod 48 on the lower trough 44 and, in one embodiment, on the extensions 46 of the lower trough 44, so that they extend parallel to the occlusal plane opening 60.
    More particularly, in one embodiment, with reference to FIG. 11, using geometric calculations, the position of the rear anchor point 49b of the holding rod 48 is determined from: the position of the prior anchoring 49a of the retaining rod 48, the length of the centric line 52 of the retaining rod 48 and the position of the occlusal plane in opening 60. As shown in FIG. 11, right angles (90 °) are defined between two lines 80a, 80b extending perpendicularly to the occlusal plane in opening 60, towards the maxillary, and the centric line 52 of the retaining rod 48.
    More particularly, in one embodiment, the positioning of the front anchor 49a of the upper gutter 42 and the rear anchor 49b of the lower gutter 44 is made in the following manner. As mentioned above, the position of the anterior anchoring point 49a of the retaining rods 48 of the upper trough 42 at the level of the canines 70 (step 136) is determined first. This point 49a is generally located in the middle third or cervical third. When the anterior anchor 49a is positioned on the overall model in which the articulated mandible and jaw are positioned in the open and advanced position, the software projects the line 80a from the center 51 of the prior anchor point 49a. to the line representing the occlusal plane in opening 60 so that the line 80a is perpendicular (defining an angle of 90 °) to the occlusal plane in opening 60. From the intersection between the line 80a and the occlusal plane in opening 60 (point A), the software determines a point (point B), by translation in the posterior direction and along the occlusal plane in opening 60. The distance of the translation in the posterior direction and along the occlusal plane in opening 60 from the intersection between the line 80a and the occlusal plane in opening 60 is determined by the length of the centric line 52 (between the two centers 51). From this new point B, the software determines the posterior anchoring point 49b (step 138), on the lower gutter 44, by translating upwards, perpendicularly to the occlusal plane in opening 60, along the line 80b. The translation distance is determined by the line length 80a where the translation is made to the intersection with the centric line 52 of the retaining rod 48, which extends parallel to the occlusal plane 60. Since the stem retaining wall 48 extends parallel to the occlusal plane in opening 60, lines 80a and 80b have the same length and extend perpendicular to the centric line 52 of the retaining rod 48 and the occlusal plane in opening 60.
    Thus, the retaining rod 48 will be found above the occlusal plane in opening 60, above the natural occlusal plane 20 and will extend parallel to the occlusal plane in opening 60.
    When the position of the posterior anchor 49b is determined, the software, with the assistance of a skilled person such as a dental technician, completes the design of the upper 42 and lower 44 gutters (step 140). In this step, the geometric shape of the extension 46 joining the posterior anchoring point 49b to the lower gutter 44 is determined.
    Still with the aim of protecting the ATM, this invention also makes it possible to ensure that there is substantially no tension on the retaining rods due to anchors in the opposite position. With reference to FIG. 12, which is a top view of an orthosis 40 designed by the proposed method, the surfaces 47 of the front and rear anchors 49a and 49b to which the ends of the retaining rods 48 are engaged extend substantially. parallel to each other. In the illustrated embodiment, the two surfaces 47 are parallel and aligned along the "T" axis. However, in an alternative embodiment (not shown), the two surfaces 47 may be parallel but not aligned along the same axis. Thus, it is possible to position the anterior anchors 49a and posterior 49b respecting the initial shape of the retaining rods 48. When the mandible is in the advanced position, that is to say when wearing the orthosis 40, it It is important for the orthosis 40 to keep the mandible in the centric position as easily as possible, that is to say by minimizing the tensions. If the orthosis 40 seeks to position itself out of the centric position and moves the mandible laterally, either to the left or to the right, the muscles of the ATM will then be solicited more rigorously. By designing the orthosis so that the surfaces 47 of the front 49a and posterior 49b anchors extend substantially parallel to each other, the tensions in the holding rods 48 are reduced.
    Once conceived by the method described above, the mandibular advancement orthosis 40 improves the preservation of ΓΑΤΜ, in an open and advanced position, according to the occlusal plane in opening 60. More particularly, the retaining rods 48 are positioned substantially parallel to and above the opening occlusal plane 60. Thus, the design method, which can be performed with specialized 3D software, makes it possible to mathematically determine the occlusal plane 60 and to position the retaining stems 48 substantially in parallel. and above the occlusal plane in opening 60. Thus, the retaining rods 48 work in a plane parallel to the occlusal plane in opening 60.
    Referring to FIG. 13, to reduce friction at the posterior teeth and to promote working in a plane parallel to the occlusal plane in opening 60, during the step of designing the upper 42 and mandible 44 (step 140), these can be designed with flat surfaces at the occlusal surfaces of the posterior teeth. Thus, the four occlusion faces of the upper 42 and lower 44 gutters at the posterior teeth are also in the same plane as the occlusal plane in the opening 60.
    More particularly, the upper trough 42 includes, in the posterior sections, two flat surfaces 82 (only a flat surface is shown in FIG. 13), a flat surface located on the right posterior side and a flat surface located on the left posterior side. In one embodiment, these extend from the maxillary canine 70 and posteriorly to the distal of the first premolar or the distal of the second premolar. In one embodiment, the flat surfaces 82 extend posteriorly at most at the distal of the second premolar.
    The other two flat surfaces 82 are located on the lower trough 44 (only a flat surface is shown in Fig. 13), a flat surface located on the right posterior side and a flat surface located on the left posterior side. In one embodiment, these extend from the first premolar to the distal of the first molar.
    The four flat surfaces 82 are in the same plane as the opening occlusal plane 60 defined by the method described above, that is to say that the planes are aligned.
    During the design of the gutters 42, 44 of the orthosis 40, four flat surfaces 82 (or trays) are therefore created at the occlusal faces of the troughs 42, 44. These flat surfaces 82, aligned with the occlusal plane 60 , allow to: 1) maintain the determined opening; and 2) sliding lateral movements without obstruction of the dental cusps.
    In one embodiment, the planar surfaces at the upper gutter 42 are slightly shorter (i.e., of shorter length) than the planar surfaces at the mandibular gutter 44. This difference in length makes it possible to reduce the forces applied on ΓΑΤΜ when wearing the orthosis 40. In addition, when the patient will perform lateral movements (that is to say from left to right), there will be sliding of the mandible, guided and supported on the occlusal plane in opening 60, plane which is determined by the opening "O" of the mandible.
    Referring to Figure 14, it is shown that the gutters 42, 44 can be constructed with other features. For example, in the illustrated embodiment, the lower gutter 44 includes two slots 84 extending upwardly from the lower edge of the lower gutter 44. A resilient loop-shaped member 86, such as an elastic, can be engaged with these two slots 84 and coupled with the front anchor 49a of the retaining rod 48 to control the opening of the gutters 42, 44 and prevent their detachment.
    Thus, a method of designing a mandibular advancement orthosis 40 is provided that produces a mandibular advancement orthosis 40 that protects the ATM by reducing the forces applied thereto. When wearing the mandibular advancement orthosis 40 designed by the method described above, the retaining rods 48 work in the occlusal plane in opening 60, which corresponds to the plane in which the ATM is in the open position. The mandibular advancement orthosis 40 or the intraoral orthosis thus conceived may subsequently be manufactured by the techniques known to those skilled in the art.
    Moreover, although the embodiments of the mandibular advancement orthosis designed as well as its components consist of certain geometric configurations, as explained and described above, only a portion of these components and geometries is essential and so the majority of these should not be interpreted in a restrictive sense. As apparent to one skilled in the art, other components and cooperation between them, as well as other geometric configurations, may be used for the mandibular advancement orthosis, as briefly explained below. above and as it is possible to infer it for a person skilled in the art. In addition, it is appreciated that the positions of the description, such as "above", "below", "left", "right", and similar positions, should be interpreted in the context of figures, unless otherwise specified, and should not be construed as limiting.
    Several alternative embodiments and examples have been described and illustrated above. The embodiments of the invention described above are only examples. One skilled in the art will appreciate the characteristics of the individual achievements, as well as the possible combinations and variations of the components. One skilled in the art will also appreciate that any of the embodiments can be made in any combination with the other embodiments described above. It is appreciated that the invention may be embodied in other specific forms without departing from the spirit or main features thereof. The examples and embodiments described are to be considered in all aspects as illustrative and non-restrictive, and the invention is not limited to the particulars given. Thus, although specific embodiments have been illustrated and described, many modifications are apparent without departing from the spirit of the invention.
    权利要求:
    Claims (17)
    [1" id="c-fr-0001]
    1.- Method for determining an occlusal plane in opening (60) of a patient, comprising: - obtaining an overall model of the jaw of the patient including a model of the mandible and maxilla articulated; determining (120) the natural occlusal plane (20) of the patient from the overall model of the jaw in the centric occlusion position; - determining (122) the opening (O) necessary to allow the advancement of the mandible (112) of the patient; the determination (125) of the virtual mandibular plane (50) from the global model of the jaw in the open position according to the determined opening (O); and - determining (126) the opening occlusal plane (60) from the virtual mandibular plane (50), the natural occlusal plane (20) and the overall model of the jaw in open position according to the opening (O). ) determined.
    [2" id="c-fr-0002]
    2 - Method according to claim 1, wherein the determination (126) of the opening occlusal plane (60) comprises determining the median line between the virtual mandibular plane (50) and the natural occlusion plane (20) in position open according to the opening (O) determined, the median line extending between a posterior section and an anterior section of the overall model of the jaw.
    [3" id="c-fr-0003]
    3. - Method according to one of claims 1 and 2, wherein the determination (122) of the opening (O) required comprises the evaluation of the distance allowing the incisors (30) of the mandible to be advanced without interfering with the incisors (28) of the maxillary and the representation (124) of the overall model of the jaw in the open position according to the opening (O) determined; the determination (126) of the opening occlusal plane (60) comprises the representation of the natural occlusal plane (20) in the overall model of the jaw in the open position according to the determined opening (O) and the representation of the occlusal plane in opening (60) in the overall model of the jaw in the open position according to the opening (O) determined; and determining (125) the mandibular virtual plane (50) in the open position of the mandible of the patient comprises representing the virtual mandibular plane (50) in the overall model of the jaw in the open position.
    [4" id="c-fr-0004]
    4. - Method according to one of claims 1 to 3, wherein the determination (120) of the natural occlusion plane (20) of the patient from the overall model of the jaw comprises: the configuration of the overall model of the jaw in the centric occlusion position and the definition of a line extending between the occlusal surfaces (22) of the teeth of the mandible and maxillary in contact tangent to the incisal edges, the cusp tips of the premolars and molars of the jaw upper and lower jaw, the method comprising defining a maxillary contact point corresponding to the intersection of the natural occlusal plane (20) on the maxillary incisors (28) in centric occlusion position and a mandibular contact corresponding to the intersection of the natural occlusal plane (20) on the mandibular incisors (30) in centric occlusion position and wherein the determination (125) of the plane virtual mandible (50) in the open position includes defining a line extending between the occlusal surface (22) of at least one of the mandibular molars and premolars (34) and the mandibular contact point on the mandibular incisors ( 30).
    [5" id="c-fr-0005]
    5. - Method according to one of claims 1 to 4, wherein obtaining an overall model of the jaw comprises: - obtaining the model of the mandible and the maxillary model; obtaining (114) a model of centric occlusion; and - the combination of the mandible model, the maxillary model and the centric occlusion model to (118) generate the overall model of the jaw in which the models of the mandible and maxillary are articulated.
    [6" id="c-fr-0006]
    6. - Method according to claim 5, wherein obtaining the model of the mandible and the model of the maxillary comprises performing an optical digitization of the mandible (112) and maxilla (110) or a model. of the mandible and the maxilla and obtaining the centric occlusion model includes performing (118) an optical digitization (110, 112) of the mandible and maxillary in the centric occlusion position or a physical model of the mandible and maxillary centric occlusion.
    [7" id="c-fr-0007]
    7. - Method for designing a mandibular advancement orthosis for a patient including a lower gutter (44) and an upper gutter (42), said method comprising: - determining (126) the opening occlusal plane (60) of the patient by the method according to one of claims 1 to 6; the determination (130) of retaining rods (48) for the mandibular advancement orthosis, the retaining rods (48) having a centric line (52), anterior anchorage (49a), a posterior anchor (49b) and a length L between the front anchor (49a) and the rear anchor (49b); positioning the anterior (49a) and posterior (49b) anchors so that the centric line (52) of the retaining rods (48) extends substantially parallel to and above the occlusal plane in opening (60); ) the patient; and - designing the lower gutter (44) and the upper gutter (42) of the orthosis from the overall model of the jaw and so that the front anchors (49a) of the retaining rods (48) are connectable to the upper gutter (42) and that the rear anchors (49b) of the retaining rods (48) are connectable to the lower gutter (44).
    [8" id="c-fr-0008]
    8. - Method according to claim 7, comprising obtaining the maximum advance of the patient and the positioning of the model of the mandible and maxillary in the open position in an advanced position of the mandible by a displacement along the occlusal plane opening. (60) and a distance corresponding to the patient's maximum advance and wherein the determination of the retaining rods (48) and the positioning of the anterior (49a) and posterior (49b) anchors is effected on the model of the Mandible and maxillary in open and advanced position according to the maximum patient advance.
    [9" id="c-fr-0009]
    9. - Method according to one of claims 7 and 8, wherein the positioning of the anchorages anterior (49a) and posterior (49b) comprises: - the positioning (132) of the front anchor (49a) of each of the rods of restraint (48) relative to a respective canine of maxillary canines (70) on the overall model of the jaw; and positioning (138) the posterior anchor (49b) of each of the retaining rods (48) so that the centric line (52) of the retaining rods (48) extends substantially parallel to the occlusal plane in opening (60) on the global model of the jaw.
    [10" id="c-fr-0010]
    10. - Method according to claim 9, wherein the positioning (138) of the posterior anchor (49b) comprises the determination of the position posterior to the previous anchorage (49a), a distance corresponding to the length L, in a direction parallel to the occlusal plane in opening (60) on the overall model of the jaw in the open position.
    [11" id="c-fr-0011]
    11. - Mandibular advancement orthosis comprising: an upper gutter (42) and a lower gutter (44) adapted to cover at least partially and respectively the teeth and / or the upper and lower jaw, and two retaining rods (48) connecting the lower gutter (44) and the upper gutter (42), the retaining rods (48) extending parallel to and above the occlusal plane in opening (60), determined by the method according to one of the Claims 1 to 6, the retaining rods (48) having a length to maintain the lower jaw in an advanced position relative to the upper jaw when wearing the orthosis.
    [12" id="c-fr-0012]
    12. - mandibular advancement orthosis comprising: an upper gutter (42) and a lower gutter (44) designed to cover at least partially and respectively the teeth and / or the upper and lower jaw, and two retaining rods (48) connecting the lower gutter (44) and the upper gutter (42), the upper gutter (42), the lower gutter (44) and the holding rods (48) being designed according to one of claims 7 to 10.
    [13" id="c-fr-0013]
    13. - Mandibular advancement orthosis according to one of claims 11 and 12, wherein the lower trough (44) and the upper trough (42) comprise flat surfaces (82) at the occlusion faces of the posterior teeth. .
    [14" id="c-fr-0014]
    The mandibular advancement orthosis of claim 13, wherein the planar surfaces (82) of the upper gutter (42) are shorter than the flat surfaces (82) of the lower gutter (44), and wherein preferably, the flat surfaces (82) of the upper trough (42) extend approximately from the maxillary canine (70) and posteriorly to at least the distal of the first premolar and preferably the flat surfaces (82). ) of the upper trough (42) extend posteriorly at the distal maximum of the second premolar.
    [15" id="c-fr-0015]
    15. - Intra-oral orthosis comprising an upper gutter (42) and a lower gutter (44) designed to cover at least partially and respectively the teeth and / or the upper and lower jaw, and two retaining rods (48) connecting the lower trough (44) and the upper trough (42) and having a length to maintain the lower jaw in an open and advanced position relative to the upper jaw and oriented parallel to an opening occlusal plane (60) determined by the opening (O) necessary to advance and maintain the lower jaw in the open and advanced position.
    [16" id="c-fr-0016]
    The intraoral orthosis of claim 15, wherein the lower trough (44) and the upper trough (42) comprise planar surfaces (82) at the occlusal surfaces of the posterior teeth.
    [17" id="c-fr-0017]
    17. Intraoral orthosis according to claim 16, wherein the flat surfaces (82) of the upper trough (42) are shorter than the flat surfaces (82) of the lower trough (44), preferably the flat surfaces. (82) of the upper trough (42) extend approximately from the maxillary canine (70) and posteriorly to at least the distal of the first premolar, and preferably the flat surfaces (82) of the upper trough (42) extend posteriorly at the distal maximum of the second premolar.
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    同族专利:
    公开号 | 公开日
    CA2934398A1|2017-01-07|
    US10285784B2|2019-05-14|
    FR3038510B1|2022-03-04|
    US20170007371A1|2017-01-12|
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    法律状态:
    2016-05-30| PLFP| Fee payment|Year of fee payment: 2 |
    2017-01-13| PLSC| Publication of the preliminary search report|Effective date: 20170113 |
    2017-07-20| PLFP| Fee payment|Year of fee payment: 3 |
    2018-06-18| PLFP| Fee payment|Year of fee payment: 4 |
    2020-06-30| PLFP| Fee payment|Year of fee payment: 6 |
    2021-07-29| PLFP| Fee payment|Year of fee payment: 7 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1556415A|FR3038510B1|2015-07-07|2015-07-07|METHOD FOR DESIGNING A MANDIBULAR ADVANCED ORTHESIS, MANDIBULAR ADVANCED ORTHESIS AND INTRA-ORAL ORTHESIS|FR1556415A| FR3038510B1|2015-07-07|2015-07-07|METHOD FOR DESIGNING A MANDIBULAR ADVANCED ORTHESIS, MANDIBULAR ADVANCED ORTHESIS AND INTRA-ORAL ORTHESIS|
    CA2934398A| CA2934398A1|2015-07-07|2016-06-27|Design process for an orthotic to advance the mandible orthotic and orthotic to advance the mandible|
    US15/204,640| US10285784B2|2015-07-07|2016-07-07|Method of designing a mandibular advancement device and mandibular advancement device|
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