CN111497248B - Preparation method of appliance for abnormal repositioning of mandible - Google Patents

Preparation method of appliance for abnormal repositioning of mandible Download PDF

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Publication number
CN111497248B
CN111497248B CN202010324204.6A CN202010324204A CN111497248B CN 111497248 B CN111497248 B CN 111497248B CN 202010324204 A CN202010324204 A CN 202010324204A CN 111497248 B CN111497248 B CN 111497248B
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model
jaw
repositioning
mandibular
mandible
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CN111497248A (en
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宁楠
王启超
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Hangzhou Meiqi Technology Co ltd
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Hangzhou Meiqi Technology Co ltd
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    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B29—WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE IN GENERAL
    • B29C—SHAPING OR JOINING OF PLASTICS; SHAPING OF MATERIAL IN A PLASTIC STATE, NOT OTHERWISE PROVIDED FOR; AFTER-TREATMENT OF THE SHAPED PRODUCTS, e.g. REPAIRING
    • B29C64/00—Additive manufacturing, i.e. manufacturing of three-dimensional [3D] objects by additive deposition, additive agglomeration or additive layering, e.g. by 3D printing, stereolithography or selective laser sintering
    • B29C64/30—Auxiliary operations or equipment
    • B29C64/386—Data acquisition or data processing for additive manufacturing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00—Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00—Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/08—Mouthpiece-type retainers or positioners, e.g. for both the lower and upper arch
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y50/00—Data acquisition or data processing for additive manufacturing

Abstract

The invention discloses a preparation method of an appliance for abnormal repositioning of a mandible. Firstly, obtaining an initial dental model of a patient, wherein the occlusion relation of upper and lower dentitions in the initial dental model is used as the initial relative position of the model; determining a lower jaw repositioning model after repositioning the lower jaw of the patient according to the initial relative position of the model; designing an upper jaw tooth grinding jaw pad group and a guide inclined plane model group according to a lower jaw repositioning model, and fusing the structures of the upper jaw tooth grinding jaw pad group and the guide inclined plane model group to obtain a printing model group; designing an orthosis attachment model group adhered to the labial surface or the lingual surface of the teeth; combining the lower jaw repositioning model, the printing model group and the orthosis accessory model group A, then obtaining an upper jaw model and a lower jaw model through 3D printing, and obtaining a lower jaw repositioning orthosis after forming and cutting the printed models through a hot pressing film. In the lower jaw repositioning correction process, the invisible correction and the functional correction are simultaneously carried out.

Description

Preparation method of appliance for abnormal repositioning of mandible
Technical Field
The invention belongs to the field of orthodontics, and particularly relates to a preparation method of an appliance for abnormal repositioning of a mandible.
Background
In the classification of malocclusion in the field of orthodontics, patients of the bone ii type have symptoms of mandibular retrogradation, in addition to crowding of the dentition, in which the development of the mandible is in a state of receding relative to the maxillary process and the first molar is in a distant relationship. In addition to crowding of the dentition, patients of class III have a mesial relationship with the first molar in the mandibular development relative to the hypermandibular development. Bony deformities have a major impact on the facial aesthetics of the patient.
The malocclusion deformity of osseous II and osseous III needs to be treated by functional correction or orthognathic surgery, and the traditional functional correction device can be used with a fixed bracket for correction, so that the teeth are arranged orderly and are subjected to functional correction.
Transparent removable invisible orthodontic appliances have been used in great numbers for aligning teeth in orthodontic procedures due to their advantages of being invisible, convenient and self-removable. However, no clear and clear diagnosis and design method for the treatment function correction of the transparent removable invisible appliance is available.
Disclosure of Invention
In order to solve the problems in the background art, the invention provides a preparation method of an appliance for mandibular abnormality repositioning, which designs and positions an ideal target position of a mandible by identifying and diagnosing mandibular abnormality, designs a guide surface and a jaw pad of a repositioning appliance to perform mandibular repositioning and position maintenance by using a transparent removable invisible appliance, and designs a new molar occlusion relationship for promoting molar elongation and accelerating mandibular position maintenance by gradually reducing the height of the jaw pad during the correction process.
The technical scheme adopted by the invention is as follows:
preparation method of appliance for abnormal repositioning of mandible
Comprises the following steps:
step 1) obtaining an initial dental model of a patient, wherein the initial dental model comprises model scanning data of occlusion relation of upper and lower dentitions of the patient, and the occlusion relation of the upper and lower dentitions in the initial dental model is used as an initial relative position P0 of the model;
step 2) determining a lower jaw repositioning model P1 after repositioning the lower jaw of the patient according to the model initial relative position P0;
step 3) designing an upper jaw tooth grinding jaw pad group M and a guide inclined plane model group B according to a lower jaw repositioning model P1, and fusing the structures of the upper jaw tooth grinding jaw pad group M and the guide inclined plane model group B to obtain a printing model group MB for producing the appliance;
step 4), designing an orthosis accessory model group A adhered to the labial surface or the lingual surface of the tooth;
step 5) combining the lower jaw repositioning model P1, the printing model group MB and the orthosis accessory model group A to obtain an upper jaw model group sequence U and a lower jaw model group sequence L; 3D printing is carried out according to the upper jaw model group sequence U and the lower jaw model group sequence L to obtain an upper jaw model and a lower jaw model, and the printed models are formed and cut through a hot pressing film to obtain the orthosis for repositioning the lower jaw.
In the step 1), the initial dental model of the patient is obtained by intraoral scanning of the patient, or by taking a silicone rubber impression of the patient and then performing impression or plaster scanning.
The step 2) is specifically as follows: obtaining a mandibular repositioning model P1 by adjusting the following five elements of the model initial relative position P0; the five elements are respectively as follows: sagittal position relation elements T1 of upper and lower incisors; mandibular anterior segment vertical position element T2; a vertical positional relationship element T3 of upper and lower molars; mandibular horizontal alignment element T4; the mandible is horizontally symmetrical by element T5.
The mandibular repositioning model P1 is a model representing the position and orientation of the mandible after mandibular repositioning, and the mandible position and orientation of the mandibular repositioning model P1 are the same as the model initial relative position P0.
The process of obtaining the mandibular repositioning model P1 by adjusting five elements of the model initial relative position P0 is specifically as follows:
(1) adjusting the sagittal position relation element T1 of the upper incisor and the lower incisor to enable the front-back position tangent LL of the lower incisor to be aligned with the front-back position tangent LU of the upper incisor in front-back;
the front and back tangent LU of the upper incisor is obtained by making a perpendicular line perpendicular to the occlusion plane OP through the cutting end of the upper incisor
A front-back position tangent line LL of the lower jaw incisor is obtained by making a perpendicular line perpendicular to the occlusion plane OP through the cutting end of the lower jaw incisor; the occlusion plane OP is a plane passing through the upper and lower first constant molar occlusal midpoint and the upper and lower central incisor occlusal midpoint;
(2) the vertical position element T2 of the front section of the mandible is the distance value DF of the incisor ends of the upper and lower jaws in the vertical direction; the lower jaw back section vertical position element T3 is a distance value DB of a first molar jaw face of an upper jaw and a lower jaw in the vertical direction; the adjustment of the vertical position element T2 of the anterior mandibular section and the vertical position element T3 of the posterior mandibular section is specifically: for the case type of mandibular protrusion repositioning, the design distance value DB is greater than the distance value DF; for the case type of mandibular retroversion repositioning, the design distance value DB is less than the distance value DF;
(3) adjusting the mandible horizontal alignment element T4 to enable the mandible midline and the facial midline Lmid of the patient to be adjusted to be on the same straight line; the mandible midline is a perpendicular line which is parallel to the facial midline Lmid and is made through a mandible labial frenum characteristic point PLmid;
(4) adjusting the mandibular horizontal alignment element T4 to make the patient's mandible plane parallel to the cranial plane LH; the skull plane LH is extracted through the plane between the eyes in the frontal photograph of the patient, and the mandibular plane of the patient is represented by the plane fitted by the mandibular first permanent molar buccal cusp and the lower central incisor cusp.
The upper jaw molar jaw pad group model M in the step 3) is composed of a series of jaw pad models { M0,M1,M2,,…,MnIs formed by the following steps;
the acquisition process of the jaw pad model M0 is as follows: firstly, obtaining an initial jaw pad model M-init, wherein the upper end face of the initial jaw pad model M-init covers the maxillofacial surfaces of first premolars of the upper jaw and all teeth far away, the lower end face Pm0 is in contact with the functional tips of the mandibular molars and is parallel to the mandibular jaw surface of a mandibular repositioning model P1, and the height is designed according to the vertical height of the teeth in the mandibular repositioning model P1; because of the influence of the material thickness of the transparent appliance, the height of the initial jaw pad model M-init needs to be modified to reach the vertical opening height of the upper jaw and the lower jaw consistent with the pre-designed P1 model, a new lower end surface Pm0 ' is obtained by extending the lower end surface of the initial jaw pad model M-init to be vertical to the lower end surface Pm0 and translating the distance alpha in the upward direction, the lower end surface Pm0 ' intersects with the initial jaw pad model M-init at a point P, the plane Pm0 ' intersects with the initial jaw pad model M-init and takes out the model part to obtain the jaw pad model M-init0(ii) a The distance alpha is the thickness of the tooth socket.
Obtaining a jaw pad model { M by adjusting the height of the jaw pad model1,M2,,…,MnTo adapt to the natural elongation of the mandibular molars during orthodontics, jaw pad model { M }1,M2,,…,MnThe acquisition process is as follows: jaw pad model { M1,M2,,…,MnThe corresponding lower tangent planes are respectively { S }1,S2,,…,Sn}, tangent plane S1Jaw pad model M0Point P in (b) and is parallel to the mandibular or maxillary maxillo-facial plane of the mandibular repositioning model P1, and the tangent plane SnBy modeling jaw pad Mn-1Is translated upward by δnIs given bynThe value of (A) is set according to the extension condition of the lower jaw molars of the patient; make the tangent plane SnIntersecting with the initial jaw pad model M-init and taking the upper model part to obtain the jaw pad model Mn。
The inclined plane model group B in the step 3) mainly comprises an upper jaw inclined plane model BU and a lower jaw inclined plane model BL; the upper end surface of the upper jaw inclined plane model BU covers the far middle of the second premolar to the central socket of the upper jaw first molar, and the lower end surface of the upper jaw inclined plane model BU is contacted with the functional tip of the lower jaw first molar; the lower end face of the lower jaw inclined plane model BL covers from the lower jaw first premolar to the lower jaw first molar, and the upper end face of the lower jaw inclined plane model BL is not contacted with the upper jaw; the longitudinal sections of the upper jaw inclined plane model BU and the lower jaw inclined plane model BL are respectively in an inverted trapezoid shape and a regular trapezoid shape, the included angle between the trapezoid inclined plane and the occlusion plane is theta, and the theta angle is larger than or equal to 75 degrees.
The printing model group MB in the step 3) is mainly composed of an inclined plane model group B (including a maxilla inclined plane model BU and a mandible inclined plane model BL) and a series of jaw pad models { M ] in the jaw pad group model M respectively0,M1,M2,,…,MnGet the amalgamation, jaw pad model MnFusing the model with the upper jaw inclined plane model BU by taking respective side surfaces as fusion surfaces to obtain a printing model MBn(ii) a Jaw pad model M0Has the same height as the upper jaw inclined plane model BU except M0External jaw pad model MnA height difference from the inclined plane model group B, and thus, it is necessary to make the impression type MBnCarrying out floating treatment on the bottom surface;
the operation process of the floating treatment comprises the following steps: for the printing model MBnLet jaw cushion model MnThe bottom of the model is a merged maxillary inclined plane model BU, the bottom of the maxillary inclined plane model BU is close to the jaw pad model MnOne side line is BP, the distance between the boundary line AO and the side line BP is calculated, the distance is h, and the jaw pad model MnA reconstruction line MP parallel to the boundary line AO and spaced from the boundary line AO by a distance h is provided on the bottom surfaceA new plane is constructed between the lines BP to finish printing the model MBnFloating the bottom surface to make the printing model MBnThe bottom surface is smooth.
The orthosis attachment model group A is mainly composed of a series of retention models { A }1,A2,A3,…AnComposition, retention model AnIs a convex structure which is adhered to the labial surface or the lingual surface of a single tooth and is prepared by composite resin.
Retention model AnThe cross section is regular or irregular.
The orthosis in the step 5) is positioned on a retention model AnThe tooth bonding position is reserved with a retention model AnA vacuole of the same size, which is associated with the retention model A when the orthosis is placed on the patient's teethnThe complete close fit enhances the retention effect of the orthosis on the teeth.
Retention model AnFor assisting the application and movement of teeth, the retention model AnThe upper end of the orthopedic device is provided with a gap with the vacuole of the orthopedic device, and the vacuole and the retention model AnThe contact surface at the lower end forms an active stress surface which gives the retention model AnA force is applied to the bottom surface, thereby realizing the retention model AnForce is applied to the teeth.
The invention has the beneficial effects that:
the invention provides a method for positioning the normal position of the lower jaw by analyzing the abnormal position of the lower jaw through digital design, and simultaneously uses a transparent appliance material as a repositioning device to adjust and maintain the position of the lower jaw.
Drawings
Fig. 1 is an illustration of a correction procedure for mandibular repositioning;
FIG. 2 is an illustration of normal jaw relation in the abnormal classification of jaw positions;
FIG. 3 is an illustration of underdeveloped jaw condition in abnormal jaw position classification;
fig. 4 is an illustration of a mandibular hyperdevelopmental condition in the abnormal classification of jaw positions;
FIG. 5 is an illustration of anterior-posterior and vertical orientation determining elements during mandibular repositioning;
FIG. 6 is an illustration of a dental bite plane determination;
FIG. 7 is a view of the anterior-posterior and vertical positioning effects of mandibular repositioning;
fig. 8 is a diagram of the effect of horizontal positioning during mandibular repositioning;
fig. 9 is a diagram of the effect of horizontal positioning during mandibular repositioning;
FIG. 10 is an illustration of the construction of a maxillary molar jaw pad set;
FIG. 11 is a diagram of the effect of the application of the maxillary molar jaw pad set;
FIG. 12 is an illustration of ramp group model construction;
FIG. 13 is a print model set MB construction illustration;
FIG. 14 is an illustration of a print model set model MBn optimization;
FIG. 15 is a diagram showing the final effect of the printing model group MB;
FIG. 16 is a different type and configuration of accessory device;
fig. 17 is an illustration of an attachment as an orthotic retention device;
fig. 18 is an illustration of an attachment as an orthotic assisted augmentation device;
FIG. 19 is a schematic view showing the wearing effect of the mouthpiece orthosis;
FIG. 20 is a schematic view showing the wearing effect of the mouthpiece orthosis;
fig. 21 is a schematic view showing the wearing effect of the mouthpiece orthosis.
Detailed Description
The invention is described in further detail below with reference to the figures and specific embodiments.
Step 1) obtaining an initial dental model of a patient, wherein the model comprises 3-dimensional digital model data of upper and lower dentitions of teeth, and recording the initial relative position of the model as P0, and the initial dental model of the patient can be obtained by carrying out intraoral scanning on the patient or obtaining a silicon rubber impression of the patient and then carrying out impression or plaster scanning. The model initial relative position P0 reflects the occlusion condition in the patient's current mouth.
Step 2) repositioning of the patient's lower jaw, determining a lower jaw repositioning model P1 based on the model initial relative position P0.
The determination of the mandibular repositioning model for a patient is aimed at adjusting the position of the mandible to the normal anterior-posterior position of the maxilla. The position of the mandible relative to the position of the maxilla is divided into 3 cases: (1) fig. 2 shows an example of normal jaw relationships in the jaw malocclusion classification, in which the mandible is in a normal anteroposterior positional relationship with respect to the maxilla. (2) Fig. 3 shows an example of mandibular dysplasia in the classification of jaw malocclusions, where the mandible is in a relatively posterior anteroposterior relationship relative to the maxilla. (3) Fig. 4 shows an example of mandibular dysplasia in the classification of jaw malocclusions, where the mandible is in a relatively advanced anteroposterior relationship relative to the maxilla.
In cases of underdeveloped and underdeveloped jaw, the jaw position needs to be re-determined so that the final position is in the ideal normal jaw relationship. In cases of underdeveloped mandible, the extension of the mandible needs to be designed; in the case of the hypoplasia of the mandible, the retreat of the mandible needs to be designed, and the mandible is influenced by the anatomical structures of the mandible and the maxilla, and the condyles of the mandible and the maxillary joint socket are in contact in the occlusion state of the patient, so that in the case of the hypoplasia of the mandible, the patient needs to be designed to be appropriately occluded and opened so that the mandible condyles and the maxillary joint socket are in non-contact or light contact (non-pressure contact), and in the state, the protrusion or retreat position of the mandible is designed.
Fig. 5-7 illustrate the forward, backward and vertical components of model P1 after mandibular repositioning is determined: (1) mandibular anterior-posterior position element T1; (2) mandibular anterior segment vertical position element T2; (3) the posterior mandible is vertically oriented to position element T3.
As shown by the mandibular anterior-posterior position element T1 in fig. 5. The mandibular anteroposterior position element T1 determines the final anteroposterior position of the mandible, and is specifically implemented by determining the vertical line LL of the vertical anteroposterior position of the mandibular incisors and the anteroposterior position of the mandibular incisors relative to the maxillary incisors, thereby determining the anteroposterior target position of the mandible. Determining the front and back position vertical line LL of the lower jaw incisor can extract the front and back position tangent line LU of the upper jaw incisor through the measurement of the side slice and the mouth external picture, wherein LU and LL are perpendicular to the occlusion plane OP of the patient, and in the specific design process, the front and back position tangent line LU of the upper jaw incisor can be defined as follows: passing through the incisional segment of the upper incisor and making a perpendicular line perpendicular to the combined plane. Correspondingly, the definition of the anterior-posterior mandibular incisor position tangent line LL may be: the segment of the mandibular incisor is passed and a perpendicular is made perpendicular to the occlusal plane OP. The ideal anterior-posterior position of the mandible is the anterior-posterior position alignment of the anterior-posterior position tangent LU of the maxillary incisors and the anterior-posterior position tangent LL of the mandibular incisors,
determination of occlusion plane OP as shown in fig. 6, the method of determination of occlusion plane used in the present method refers to the extraction method of the clinical anatomical jaw plane, i.e. through the line connecting the upper and lower first permanent molar occlusal midpoint with the upper and lower central incisal occlusal midpoint.
The anterior mandibular segment vertical position element T2 determines the vertical opening interval of the anterior mandibular segment by determining the distance value DF between the incisors of the upper and lower mandibles in the vertical direction. The mandibular posterior vertical position element T3 determines the vertical opening interval of the mandibular posterior segment by determining the distance value DB of the upper and lower mandibular first molar face in the vertical direction. According to the growth and development rule of a human body, the protrusion reconstruction of the lower jaw needs to follow the principle of downward-forward rotation, so that for the type of a case needing protrusion repositioning of the lower jaw, a distance value DB is required to be designed to be larger than a distance value DF so as to accord with the growth and development rule of the human body; the retroversion reconstruction of the mandible in correspondence with this needs to follow the principle of "up-backward" rotation, it is then necessary to design the distance value DB smaller than the distance value DF for the type of case in which a retroversion repositioning of the mandible is required. Through the above steps, the front-back and vertical positions of the model P1 are determined.
Fig. 8-9 illustrate the determination of the horizontal elements of the mandibular repositioning model P1: (1) mandibular horizontal alignment element T4; (2) the mandible is horizontally symmetrical by element T5.
The mandible horizontal alignment element T4 determines the final lateral position of the mandible in the horizontal direction by determining the patient's midline facial line Lmid and aligning the mandible midline with the midline facial line Lmid. The mandible midline is a straight line capable of reflecting the left and right centers of the mandible, the determination method can be obtained by acquiring a mandibular labial ligament characteristic point PLmid and drawing a perpendicular line parallel to the facial midline Lmid through the straight line, and the position of the mandibular labial ligament characteristic point PLmid is defined as shown in fig. 9.
The horizontal symmetry element T5 of the mandible determines the left-right height symmetry of the mandible in the horizontal direction, and for the case that the mandible needs to be repositioned, the left-right height of the mandible is partially asymmetric, and at the moment, the left-right height of the mandible needs to be corrected, so that the plane of the mandible is parallel to the plane of the skull of the patient. The specific implementation mode is that a skull plane LH of a patient is determined, a mandible plane of the patient is parallel to the skull plane LH, the skull plane LH of the patient reflects the symmetry of the head of the patient, the skull plane LH of the patient can be extracted through a connecting line between two eyes in a frontal photograph of the patient, and the mandible plane of the patient can be represented by a plane fitted by a mandible first constant molar buccal tip and a lower middle incisor tip. Fig. 9 reflects the effect of the horizontal positioning of the mandibular repositioning.
By adjusting the elements of T1-T5 in the model initial relative position P0, the ideal mandibular repositioning model P1 for the patient is determined.
And 3) designing an upper jaw grinding jaw cushion group M and a guide inclined plane model group B according to the lower jaw repositioned position model P1. The upper jaw molar jaw pad group model M consists of a series of jaw pad models { M0,M1,M2,,…,MnAnd (9) composition.
FIG. 10 is a diagram illustrating the construction of a maxillary dental molar cushion set, in which the jaw cushion is designed on the orthosis to maintain the vertical opening distance of the upper and lower jaws of the patient during the treatment, and the specific manufacturing method is to design a digital three-dimensional jaw cushion model set M consisting of a series of digital jaw cushion models { M }0,M1,M2,,…,MnAnd (4) the components correspond to the shapes of jaw cushions required by different treatment stages of a patient. By respectively repositioning jaw pad models in the jaw pad model group M with the upper jawThe types P1 are sequentially fused to form an integral 3D printing model group at each stage, and then the orthosis at each step is obtained through 3D printing and hot pressing film forming.
The initial jaw pad model M-init is designed according to the vertical height of teeth in the repositioning model P1, the upper end face of the initial jaw pad model M-init covers the maxillofacial surfaces of the first premolar teeth of the maxilla and all the teeth in the far middle, and the lower end face Pm0 is in contact with the functional tips of the mandibular molar teeth. Meanwhile, in the actual treatment process, considering the influence of the thickness of the material of the transparent correcting appliance on the jaw face, the height of the M-init model needs to be modified to reach the vertical opening height consistent with the pre-designed P1 model, the specific implementation mode is to set a compensation parameter alpha, the value of the compensation parameter alpha is related to the thickness of the adopted transparent correcting appliance, the M-init lower end plane Pm0 is translated in the direction vertical to the lower end plane and upward by the alpha distance to obtain a new lower end plane Pm0 ', the lower end plane Pm0 ' is intersected with the initial jaw pad model M-init at the P point, the plane Pm0 ' is intersected with the initial jaw pad model M-init, the upper model part is taken out, and the jaw pad model M-init is obtained0。
The jaw pad model is used for maintaining the vertical opening distance of the upper jaw and the lower jaw of a patient in the treatment process, and simultaneously, the height of the jaw pad is gradually adjusted according to needs in the correction process, so that the lower jaw molar and the upper jaw molar are opened, the extension of the lower jaw molar is promoted, the extension of the lower jaw molar can be assisted by the physiological natural extension of the lower jaw molar, and the extension of the lower jaw molar can also be assisted by a transparent removable invisible appliance. The height of the jaw pad model is gradually adjusted according to the extension condition of the lower jaw molar of a patient, so that a gap is reserved between the lower end face of the jaw pad model and the lower jaw molar, and the lower jaw molar can extend.
And in the process of the subsequent maxilla pad { M1, M2, M3 and M4 … } of the maxilla pad model group, firstly, acquiring a cutting plane { S1, S2, S3 and S4 … } corresponding to each step of the maxilla pad model, then, intersecting the cutting plane corresponding to each step with the model M-init, and taking the upper model part to obtain each step of the maxilla pad model. As shown in FIG. 10, the directions of the tangential planes S1, S2, S3, S4 … are parallel, and the tangential plane S is the same as the tangential plane S in the present embodimentnParallel to maxillofacial surface of upper jaw model, fixed plane distance between tangent planes { S1, S2, S3, S4 … } is deltaInterval, delta, for each step of orthotics under different conditionsnThe value of (a) is adjusted according to the elongation of the patient's mandibular molars.
Fig. 11 illustrates a front-back cut view of a maxillo-mandibular model set with maxillary molars 1101 and mandibular molars 1102 held vertically open by a maxillo-mandibular 1103, wherein the initial model M-init is designed such that its lower end plane is in contact with and parallel to the mandibular-maxillofacial surface. The subsequent jaw pad sets { M1, M2, M3, M4 … } are then progressively gapped so that the mandibular molars 1102 can naturally elongate.
Fig. 12 illustrates the design process of the slope model group B, wherein the model BU and the model BL are respectively an upper jaw slope model and a lower jaw slope model. The inclined plane model group B mainly comprises an upper jaw inclined plane model BU and a lower jaw inclined plane model BL, the upper end surface of the model BU covers the far middle of the second premolar to the central fossa of the upper first mandibular molar, and the lower end surface of the model BU is contacted with the functional cusp of the lower first mandibular molar; the lower end face of the model BL covers the first lower molar to the first molar. 1201 and 1202 are mandibular repositioning ramps, the purpose of which is to maintain the patient's mandibular position after repositioning. The planar distance d between bevels 1201 and 1202 is also set to take into account the effect of the material thickness, which is a value related to the thickness of the transparent appliance used. The slope of the bevels 1201 and 1202 is related to the angle theta, defined as the angle between the bevel and the patient's occlusal plane, which is equal to or greater than 75 deg..
Fig. 13 illustrates a process of fusing the inclined plane model group B and the jaw pad model group M, and a series of printing model groups MB for producing the appliances are obtained by fusing the inclined plane model group B and the jaw pad models one by one.
FIG. 14 shows a printing model MB obtained by fusing a slant model group model B and a jaw pad model group model Min(ii) a In some cases, fused MBnThe model can have larger steps, namely the bottom surface and the M of the model BUnThe bottom surface of (1) has a large height difference, and at this time, the model needs to be subjected to a "floating" treatment, and the implementation mode can be that a BU model and an M are setnThe bottom boundary line after model fusion is AO, and the distance between the AO boundary line and the bottom surface inflection line Bp of the BU model is calculatedAnd is recorded as h; at MnAnd taking a reconstruction line Mp from the bottom surface of the model, enabling the distance between the reconstruction line Mp and AO to be equal to h, and constructing a new plane between Mp and Bp to enable the jaw pad model MBi to be smoother.
Fig. 15 shows an effect diagram of the printing model group MB, in which the maxillo-mandibular pad model 1401 is fused with the maxillo-mandibular model to form a maxillo-mandibular printing model, and the mandibular bevel model 1201 is fused with the mandible model to form a mandible printing model.
Step 4), designing an orthopedic device accessory model group A, wherein the retention model group A consists of a series of retention models { A1,A2,A3,…AnAnd (9) composition. Transparent removable invisible appliance in many cases needs to assist the retention and stressing of the appliance by means of an "attachment", usually a composite resin structure that adheres to the labial or lingual surfaces of the teeth, in order to enhance the ability of the invisible appliance to hold the teeth, as shown in fig. 16, showing attachments 1601 of different types and shapes, in this method, the same need to design attachment means and retention model anTo increase the retention and control of the orthosis over the teeth.
Fig. 17 illustrates the attachment as a retention device to help the orthosis better conform to the patient's crown surface. When the accessory is used for fixing, the accessory is bonded to the upper first molar and the second molar, and the lower first premolar and the second premolar. Where 1701 is an attachment means for attachment to a tooth, a cavity of the same size as 1701 is provided in the orthosis 1702, and when the orthosis is placed over a patient's tooth, the cavity will fit snugly and completely over the attachment means, enhancing retention of the orthosis to the tooth.
Fig. 18 illustrates the attachment as an auxiliary force device to help the orthosis better control the forces on the teeth, and in some cases the orthosis assists in the application and movement of the teeth in addition to maintaining the mandibular repositioning position. The attachment is adapted to adhere to the mandibular second molar when the attachment is applied to assist in extending the mandibular second molar. In this case, it is desirable to design the attachment means 1801 to assist in applying force, and when the orthosis 1802 is fitted to the teeth, the cavity 1803 of the orthosis will impart a specific force application effect to the attachment 1801, specifically, the cavity 1803 will make force application contact with a specific surface of the attachment 1801 to form an active force application surface 1804, and the force application to the teeth will be achieved by applying force to the attachment 1801.
Step 5) manufacturing an orthosis, combining the model P1 after the mandible of the patient is repositioned, the printing model group MB for producing the orthosis and the model group A of the orthosis retaining device to obtain an upper jaw model group sequence U and a lower jaw model group sequence L; 3D printing is carried out according to the upper jaw model group sequence U and the lower jaw model group sequence L to obtain an upper jaw model and a lower jaw model, and the printed models are formed and cut through a hot pressing film to obtain a transparent orthopedic device for lower jaw repositioning.
The mandible orthosis has two manufacturing methods according to the extension mode of the molar designed by the mandible orthosis: as shown in fig. 19, when the orthopedic procedure relies on natural elongation of the molars, the appliance is wrapped only around the distal extremity of the ramp model and the attachments are cemented to the upper first and second molars and the lower first and second premolars 1901, which is a diagram of the effect of the mouthpiece after wearing. As shown in fig. 20, when the orthopedic procedure relies on the auxiliary force-applying device to help the molar to extend, the appliance is wrapped in the full dentition, the attachments are bonded to the upper first molar and the second molar, and the lower first molar and the second molar, 2001 is an effect diagram after the mouthpiece is worn, 2002 is an auxiliary force-applying attachment, and the extension of the molar is assisted by the auxiliary force applied to the attachments by the mouthpiece.
In the design process of the upper jaw orthosis, in order to realize the establishment of the occlusion of the posterior teeth more quickly, the extension of the posterior teeth of the upper jaw can be assisted by designing an auxiliary stressing device accessory, as shown in fig. 21, the accessory is bonded to the first molar and the second molar of the upper jaw and the first premolar and the second premolar of the lower jaw, 2101 is an effect diagram after the facing is worn, 2102 is an auxiliary stressing accessory, and the extension of the molar of the upper jaw is assisted by the auxiliary stressing of the accessory by the facing.

Claims (8)

1. A preparation method of an appliance for abnormal repositioning of a mandible is characterized by comprising the following steps:
step 1) obtaining an initial dental model of a patient, wherein the initial dental model comprises model scanning data of occlusion relation of upper and lower dentitions of the patient, and the occlusion relation of the upper and lower dentitions in the initial dental model is used as an initial relative position P0 of the model;
step 2) determining a lower jaw repositioning model P1 after repositioning the lower jaw of the patient according to the model initial relative position P0;
step 3) designing an upper jaw tooth grinding jaw pad group M and a guide inclined plane model group B according to a lower jaw repositioning model P1, and fusing the structures of the upper jaw tooth grinding jaw pad group M and the guide inclined plane model group B to obtain a printing model group MB for producing the appliance;
step 4), designing an orthosis accessory model group A adhered to the labial surface or the lingual surface of the tooth;
step 5) combining the lower jaw repositioning model P1, the printing model group MB and the orthosis accessory model group A to obtain an upper jaw model group sequence U and a lower jaw model group sequence L; 3D printing is carried out according to the upper jaw model group sequence U and the lower jaw model group sequence L to obtain an upper jaw model and a lower jaw model, and the printed models are formed and cut through a hot pressing film to obtain an orthosis for repositioning the lower jaw;
the upper jaw molar jaw pad group model M in the step 3) is composed of a series of jaw pad models { M0，M1，M2，...，MnIs formed by the following steps;
the acquisition process of the jaw pad model M0 is as follows: firstly, obtaining an initial jaw pad model M-init, wherein the upper end face of the initial jaw pad model M-init covers the maxillofacial surfaces of first premolars of the upper jaw and all teeth far away, the lower end face Pm0 is in contact with the functional tips of the mandibular molars and is parallel to the mandibular jaw surface of a mandibular repositioning model P1, and the height is designed according to the vertical height of the teeth in the mandibular repositioning model P1; extending the lower end surface of the initial jaw pad model M-init to be perpendicular to the lower end surface Pm0 and translating the lower end surface by a distance alpha in an upward direction to obtain a new lower end surface Pm0 ', intersecting the lower end surface Pm0 ' with the initial jaw pad model M-init at a point P, intersecting the plane Pm0 ' with the initial jaw pad model M-init, taking the upper model part, and obtaining the jaw pad model M0；
Obtaining a jaw pad model { M by adjusting the height of the jaw pad model1，M2，...，MnTo adapt to the mandible during orthodonticsNatural elongation of molars, jaw pad model { M1，M2，...，MnThe acquisition process is as follows: jaw pad model { M1，M2，...，MnThe corresponding lower tangent planes are respectively { S }1，S2，...，Sn}, tangent plane SnBy modeling jaw pad Mn-1Is translated upward by δnIs given bynThe value of (A) is set according to the extension condition of the lower jaw molars of the patient; make the tangent plane SnIntersecting with the initial jaw pad model M-init and taking the upper model part to obtain the jaw pad model Mn。
2. The method for preparing an appliance for abnormal repositioning of the mandible according to claim 1, wherein the initial dental model of the patient is obtained in step 1) by intraoral scanning of the patient, or by taking a silicone impression of the patient followed by an impression or plaster scan.
3. The method for preparing an appliance for abnormal repositioning of the mandible according to claim 1, wherein the step 2) is specifically as follows: obtaining a mandibular repositioning model P1 by adjusting the following five elements of the model initial relative position P0; the five elements are respectively as follows: sagittal position relation elements T1 of upper and lower incisors; mandibular anterior segment vertical position element T2; a vertical positional relationship element T3 of upper and lower molars; mandibular horizontal alignment element T4; the mandible is horizontally symmetrical by element T5.
4. The method for preparing an appliance for the abnormal repositioning of the mandible as claimed in claim 3, wherein the process of obtaining the mandibular repositioning model P1 by adjusting five elements of the initial relative position P0 of the model is as follows:
(1) adjusting the sagittal position relation element T1 of the upper incisor and the lower incisor to enable the front-back position tangent LL of the lower incisor to be aligned with the front-back position tangent LU of the upper incisor in front-back;
the front and back tangent LU of the upper incisor is obtained by making a perpendicular line perpendicular to the occlusion plane OP through the cutting end of the upper incisor
A front-back position tangent line LL of the lower jaw incisor is obtained by making a perpendicular line perpendicular to the occlusion plane OP through the cutting end of the lower jaw incisor; the occlusion plane OP is a plane passing through the upper and lower first constant molar occlusal midpoint and the upper and lower central incisor occlusal midpoint;
(2) the vertical position element T2 of the front section of the mandible is the distance value DF of the incisor ends of the upper and lower jaws in the vertical direction; the lower jaw back section vertical position element T3 is a distance value DB of a first molar jaw face of an upper jaw and a lower jaw in the vertical direction; the adjustment of the vertical position element T2 of the anterior mandibular section and the vertical position element T3 of the posterior mandibular section is specifically: for the case type of mandibular protrusion repositioning, the design distance value DB is greater than the distance value DF; for the case type of mandibular retroversion repositioning, the design distance value DB is less than the distance value DF;
(3) adjusting the mandible horizontal alignment element T4 to enable the mandible midline and the facial midline Lmid of the patient to be adjusted to be on the same straight line; the mandible midline is a perpendicular line which is parallel to the facial midline Lmid and is made through a mandible labial frenum characteristic point PLmid;
(4) adjusting the mandibular horizontal alignment element T4 to make the patient's mandible plane parallel to the cranial plane LH; the skull plane LH is extracted through the plane between the eyes in the frontal photograph of the patient, and the mandibular plane of the patient is represented by the plane fitted by the mandibular first permanent molar buccal cusp and the lower central incisor cusp.
5. The method for preparing an appliance for abnormal repositioning of the mandible according to claim 1, wherein the slope model group B in the step 3) mainly comprises a maxillary slope model BU and a mandibular slope model BL; the upper end surface of the upper jaw inclined plane model BU covers the far middle of the second premolar to the central socket of the upper jaw first molar, and the lower end surface of the upper jaw inclined plane model BU is contacted with the functional tip of the lower jaw first molar; the lower end face of the lower jaw inclined plane model BL covers from the lower jaw first premolar to the lower jaw first molar, and the upper end face of the lower jaw inclined plane model BL is not contacted with the upper jaw; the longitudinal sections of the upper jaw inclined plane model BU and the lower jaw inclined plane model BL are respectively in an inverted trapezoid shape and a regular trapezoid shape, the included angle between the trapezoid inclined plane and the occlusion plane is theta, and the theta angle is larger than or equal to 75 degrees.
6. The method of claim 1, wherein the printing model group MB in the step 3) is mainly composed of a slant model group B and a series of jaw pad models { M in the jaw pad group model M respectively0，M1，M2，...，MnGet the amalgamation, jaw pad model MnFusing the model with the upper jaw inclined plane model BU by taking respective side surfaces as fusion surfaces to obtain a printing model MBn(ii) a For printing model MBnCarrying out floating treatment on the bottom surface;
the operation process of the floating treatment comprises the following steps: for the printing model MBnLet jaw cushion model MnThe bottom of the model is a merged maxillary inclined plane model BU, the bottom of the maxillary inclined plane model BU is close to the jaw pad model MnOne side line is BP, the distance between the boundary line AO and the side line BP is calculated, the distance is h, and the jaw pad model MnTaking a reconstruction line MP which is parallel to the boundary line AO and has a distance h from the boundary line AO on the bottom surface, constructing a new plane between the reconstruction line MP and the side line BP, and completing the printing of the model MBnAnd (5) leveling the bottom surface.
7. The method of claim 1, wherein the set A of orthosis attachment models consists essentially of a series of retention models { A }1，A2，A3，…AnComposition, retention model AnIs a convex structure which is adhered to the labial surface or the lingual surface of a single tooth and is prepared by composite resin.
8. The method for preparing an appliance for abnormal repositioning of the mandible according to claim 1, wherein the orthosis in the step 5) is positioned in a retention model AnThe tooth bonding position is reserved with a retention model AnA vacuole of the same size, which is associated with the retention model A when the orthosis is placed on the patient's teethnThe complete close fit enhances the retention effect of the orthotics on the teethAnd (5) fruit.
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