CN114903623A - 颚轮廓锚固 - Google Patents

颚轮廓锚固 Download PDF

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CN114903623A
CN114903623A CN202210348380.2A CN202210348380A CN114903623A CN 114903623 A CN114903623 A CN 114903623A CN 202210348380 A CN202210348380 A CN 202210348380A CN 114903623 A CN114903623 A CN 114903623A
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patient
teeth
jaw
tooth
forces
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佐藤淳
R·基穆拉
Y·尚亚尼
肯恩·吴
B·佩森蒂
B·卡姆
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Align Technology Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00—Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/08—Mouthpiece-type retainers or positioners, e.g. for both the lower and upper arch
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • 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
    • A61C7/002—Orthodontic computer assisted systems
    • 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
    • A61C7/10—Devices having means to apply outwardly directed force, e.g. expanders
    • 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
    • A61C7/12—Brackets; Arch wires; Combinations thereof; Accessories therefor
    • A61C7/14—Brackets; Fixing brackets to teeth
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0093—Features of implants not otherwise provided for
    • A61C8/0096—Implants for use in orthodontic treatment

Abstract

正畸矫正装置可以具有颚轮廓锚固(PCA)特征，该特征通常与患者的硬颚的形状匹配。这种PCA特征可以稍微偏移构建，以有意地推压患者的颚和/或牙龈，从而提供牙齿的分阶段平移的锚固支撑。通过PCA特征，将所需的锚固从牙齿转移到颚上，相邻的牙齿不再经受不希望的反作用力的副作用。

Description

颚轮廓锚固
本申请是阿莱恩技术有限公司的发明专利申请(申请日为2018年7月20日、申请号为201880061673.4、发明名称为“颚轮廓锚固”)的分案申请。
相关申请的交叉引用
本申请要求2017年7月21日提交的美国临时申请No.62/535,751的优先权，出于所有目的其以引用方式全部并入本文。
通过引用并入
本说明书中提及的所有出版物和专利申请都以相同的程度以引用方式并入本文，就好像每个单独的出版物或专利申请被具体地和单独地指示以引用方式并入本文一样。
技术领域
本发明的实施例总体上涉及用于操纵牙齿的牙科器具，并且更一般地涉及对牙齿和颚和/或牙龈均施加力以操纵牙齿的牙科器具。
背景技术
许多牙科治疗涉及重新定位未矫正的牙齿并改变咬合构造以改善美容外观和牙科功能。正畸(orthodontic)重新定位可以例如通过在一段时间内向一颗或更多颗牙齿施加受控的力来完成。
可通过牙科过程发生的正畸重新定位的示例使用一个或更多个定位牙科器具(诸如矫正器)来使牙齿重新排列。将器具放置在牙齿上可以在特定位置提供受控的力，以逐渐将牙齿移动成新的构造。用渐进构造的连续器具重复此过程可以使牙齿通过一系列中间布置移动到最终期望的布置。
期望提供一种牙科器具，其将牙齿移动到下一个渐进节段的位置，同时减少不希望的牙齿移动。
发明内容
本发明总体上涉及用于操纵牙齿的牙科器具，并且更一般地涉及对牙齿和颚和/或牙龈均施加力以操纵牙齿的牙科器具。
本文描述的方法和设备中的任何一个可以包括：牙齿接触部分(例如，牙齿部分或牙齿接纳部分)，向接纳在其中的牙齿施加力；以及锚固部分，对患者口腔内的牙龈和/或颚的至少一部分施加反作用力，所述反作用力至少部分地平衡通过牙齿部分施加到患者的牙齿或多颗牙齿的力。
例如，本文描述了正畸矫正装置，其包括：牙齿部分，具有被构造为放置在患者的一颗或更多颗牙齿上的牙列接纳腔体，牙齿部分被构造为当牙齿部分放置在患者的一颗或更多颗牙齿上时接触患者的一颗或更多颗牙齿的一个或更多个预定表面；锚固部分，从牙齿部分延伸，锚固部分具有与患者口腔内的患者的牙龈和/或颚的至少一部分的表面轮廓匹配的轮廓，其中，患者口腔内的牙龈和/或颚的所述部分选自于由以下构成的组：硬颚、软颚、颊龈和舌龈；其中，锚固部分被构造为对患者口腔内的牙龈和/或颚的所述至少一部分施加反作用力，所述反作用力至少部分地平衡当牙齿部分放置在患者的一颗或更多颗牙齿上时由牙齿部分施加到患者的牙齿或多颗牙齿的力。
通常，锚固部分可以被构造为分散反作用力，使得施加到牙龈和/或颚的任何离散部分的力的量被限制为在阈值以下，这可以防止当长时间佩戴设备时对这些组织的损伤(包括坏死)。然而，总的来说，由锚固部分施加的力可以是大的，并且足以平衡由牙齿部分施加的力。例如，锚固部分可以具有足够大的表面积以分散反作用力，使得锚固部分被构造为对牙龈和/或颚施加小于预定量的压力。
因此，通常，预定量的压力(和/或预定量的力)可以是对患者口腔内的牙龈和/或颚导致组织损伤的力和/或压力(或阈值力和/或压力，高于所述阈值力和/或压力会引起损伤)。组织损伤可以是毛细血管损伤、脱皮、坏死等。
锚固部分的轮廓通常可以至少部分地匹配硬颚和/或牙龈的一部分的表面轮廓。例如，锚固部分的轮廓可以匹配颊龈的一部分的表面轮廓。锚固部分的轮廓可以匹配舌龈的一部分的表面轮廓。
本文描述的任何设备也可以与一个或更多个附加的锚固装置或固定装置一起使用，包括但不限于临时锚固装置(TAD)。例如，锚固部分可以包括用于接纳植入的临时锚固装置的一部分的临时锚固装置容座。
如所提及的，牙齿部分可以包括一个或更多个锚固容座，所述一个或更多个锚固容座被构造为接纳已经附接到患者的一颗或更多颗牙齿的锚固件。
本文还描述了用于使用本文描述的任何正畸矫正装置来移动患者的一颗或更多颗牙齿的方法。例如，移动患者的一颗或更多颗牙齿的方法可以包括：将正畸矫正装置的牙齿区域放置在患者的一颗或更多颗牙齿上，其中，牙齿区域包括用于接纳患者的一颗或更多颗牙齿的凹面，其中，正畸矫正装置还包括从牙齿区域延伸并匹配患者的颚的锚固部分；用牙齿部分对患者的一颗或更多颗牙齿施加一个或更多个力；用锚固部分对患者的牙龈和/或颚的一部分施加反作用力，所述反作用力至少部分地平衡由牙齿部分施加的一个或更多个力，其中，患者的牙龈和/或颚选自于由以下构成的组：硬颚、软颚、颊龈和舌龈；移动患者的一颗或更多颗牙齿。
在这些方法中的任何一个中，所述方法可以包括在患者的牙龈和/或颚的足够大的表面积上分散反作用力以避免或减少对患者的牙龈和/或颚的损伤。
用正畸矫正装置施加一个或更多个力的步骤可以包括施加被构造为沿远端方向移动一颗或更多颗牙齿的远移力(distalizing force)。可以对硬颚施加反作用力。用正畸矫正装置施加一个或更多个力的步骤可以包括对牙齿施加被配置为使牙齿旋转的旋转力。可以对舌龈或颊龈施加反作用力。用正畸矫正装置施加一个或更多个力的步骤可以包括对一颗或更多颗牙齿施加挤压力。可以对硬颚施加反作用力。替代地或附加地，反作用力可以被施加到硬颚，以向外推动一颗或更多颗前牙。
用正畸矫正装置施加一个或更多个力的步骤可以包括对一颗或更多颗牙齿施加倾斜力。
在一些变型中，由正畸矫正装置对患者的牙齿施加的一个或更多个力连同反作用力一起可以用于向前拉患者的上颌。
本文还描述了制造本文描述的任何正畸矫正装置的方法。例如，制造正畸矫正装置的方法可以包括：接收数据，所述数据包括患者口腔内的患者的牙齿、牙龈和颚的三维表示；使用接收到的数据生成患者口腔内的患者的牙齿、牙龈和颚的模型；基于患者的牙齿的生成的模型，来确定施加到一颗或更多颗牙齿以使一颗或更多颗牙齿沿期望的方向移动的力；基于施加到一颗或更多颗牙齿的确定的力以及患者口腔内的患者的牙齿、牙龈和颚的生成的模型，来确定被施加到患者口腔内的牙龈和/或颚上的一个或更多个位置以用于平衡施加到一颗或更多颗牙齿的力的反作用力；基于患者口腔内的患者的牙齿、牙龈和颚的生成的模型，施加到一颗或更多颗牙齿的确定的力，以及施加到患者口腔内的牙龈和/或颚上的一个或更多个位置的确定的反作用力，来确定正畸矫正装置的形状；基于所确定的形状来制造正畸矫正装置。
例如，一种用于制造正畸矫正装置的方法可以包括：生成患者口腔内的患者的牙齿和颚和/或牙龈的数字模型，其中，每颗牙齿是能够在数字模型中独立移动的单独的对象，其中，颚和/或牙龈也是单独的对象；生成牙齿位置的阶段的有序序列，其中，所述阶段的有序序列包括牙齿的初始位置的阶段、牙齿的多个中间位置的多个阶段以及牙齿的最终位置的阶段；确定能够由牙齿矫正装置施加到牙齿以将牙齿从一个阶段移动到下一个阶段的多个第一力；确定能够由正畸矫正装置施加到牙齿以将牙齿从一个阶段移动到下一个阶段的多个第一力是否包括使一颗或更多颗牙齿沿不希望的方向移动的一个或更多个力；如果多个第一力包括使一颗或更多颗牙齿沿不希望的方向移动的一个或更多个力，则确定由正畸矫正装置施加到颚和/或牙龈的一个或更多个力能否用于代替或抵消使一颗或更多颗牙齿沿不希望的方向移动的一个或更多个力，并且引起能够与施加到颚和/或牙龈的一个或更多个力组合施加到牙齿的多个第二力；基于由正畸矫正装置施加到牙齿的多个第一力或者与施加到颚和/或牙龈的一个或更多个力组合施加到牙齿的多个第二力，来确定正畸矫正装置的形状；基于所确定的形状来制造正畸矫正装置，以将牙齿从一个阶段移动到下一个阶段。
这些方法中的任何一个还可以包括确定当患者佩戴正畸矫正装置时由正畸矫正装置施加到颚和/或牙龈的压力水平。例如所述方法可以包括当由正畸矫正装置施加到颚和/或牙龈的确定的压力水平超过设定或预定水平时，修改正畸矫正装置的形状，其中，正畸矫正装置的修改后的形状使施加到颚和/或牙龈的压力水平降低到设定或预定水平以下。
修改正畸矫正装置的形状可以包括增大正畸矫正装置的被构造为接触颚和/或牙龈的部分的大小。
所述方法还可以包括制造一系列正畸矫正装置以将牙齿从牙齿的初始位置的阶段顺序地移动到牙齿的最终位置的阶段。
在本文描述的装置和方法中的任何一个中，预定量的压力可以是导致患者口腔内的牙龈和/或颚疼痛的压力。
例如，在一些实施例中，预定量的压力可以小于5MPa至90MPa。在其他实施例中，预定量的压力可以小于200克力/平方毫米至1500克力/平方毫米。
在本文描述的装置和方法中的任何一个中，预定量的压力可以是通常由补齿(dentures，义齿)施加到颚组织的压力。例如，压力可以高达大约4kPa至350kPa。
本文还描述了正畸矫正系统，其包括：多个牙科器具，被构造为顺序地应用于患者的牙列和牙龈和/或颚，每个牙科器具包括：牙齿部分，具有被构造为放置在患者的一颗或更多颗牙齿上的牙列接纳腔体，牙齿部分被构造为接触患者的一颗或更多颗牙齿的一个或更多个预定表面；锚固部分，从牙齿部分延伸并且被构造为邻接患者口腔内的患者的牙龈和/或颚的至少一部分，其中，患者口腔内的牙龈和/或颚的所述部分选自于由以下构成的组：硬颚、软颚、颊龈和舌龈；其中，锚固部分被构造为对患者口腔内的牙龈和/或颚的至少一部分施加反作用力，所述反作用力至少部分地平衡当牙齿部分放置在患者的一颗或更多颗牙齿上时由牙齿部分施加到患者的牙齿或多颗牙齿的力；其中，两个顺序地应用的牙科器具的锚固部分被构造为接触患者的牙龈和/或颚的不同部分。
附图说明
本发明的新颖性特征在所附的权利要求书中具体阐述。通过参考下面的详细描述和附图，可以获得对本发明的特征和优点的更好的理解，所述详细描述阐述了其中利用本发明的原理的说明性实施例，其中：
图1A示出牙科器具的剖视图，所述牙科器具具有(1)具有牙列接纳腔体的牙齿接纳部分和(2)颚/牙龈轮廓锚固(PCA)特征，所述PCA特征产生用于挤压一颗或更多颗牙齿的挤压力。
图1B示出与上面结合图1A描述的实施例相似的牙科器具的另一实施例的剖视图，但是具有附加的应力消除特征。
图1C是图1A和图1B所示的牙科器具的剖视图，其示出沿x轴、y轴和/或z轴的偏移如何用于控制颚表面接触区域的位置。
图2示出具有牙齿接纳部分和PCA特征的牙科器具的实施例，所述PCA特征产生用于使一颗或更多颗牙齿远移的远移力。
图3示出可以应用于上颌和下颌弓以使牙齿旋转的另一牙科器具300的实施例。
图4A和图4B示出可以应用于上颌和下颌弓以使牙齿旋转的另一牙科器具的实施例。
图5示出可以用于向内或向外倾斜牙齿(特别是后面臼齿)的牙科器具的实施例的剖视图。
图6示出可以用于下颌前进和/或重新定位(诸如向前或向后移动下颌或上颌)的牙科器具的实施例。
图7示出可以用于旋转牙齿的牙科器具的实施例。
图8示出牙科器具的实施例，所述牙科器具可以用于通过对硬颚的前面部分施加力而将前牙向外推。
图9A和图9B示出一种类型的牙科器具如何可以用于根据装置的具体构造产生两种不同的类型的牙齿移动。
图10示出可以用于旋转牙齿的牙科器具的另一实施例。
图11是示出用于制造牙科器具的计算机实施方法的流程图。
图12是示出用于制造牙科器具的另一计算机实施方法的流程图。
图13是示出对于组织损伤或刺激的极限的力与时间之间的关系的图。
图14是患者的颚和牙列的数字模型，其通过对患者的颚和牙列进行数字扫描而构建。
图15示出在保持颚几何静止的同时使牙齿分阶段移动。
具体实施方式
在一些实施例中，用于矫正患者的牙齿的牙科器具包括颚/牙龈轮廓锚固(PCA)特征，所述PCA特征与患者的硬颚、软颚、颊龈和/或舌龈的一部分的形状基本上匹配。这种PCA特征是当患者佩戴其时被设计为稍微偏移地构建，以便有意地推压患者的硬颚、软颚、颊龈和/或舌龈以提供牙齿的分阶段平移的锚固支撑，例如，其可以沿竖直挤入、竖直挤压、中间、颊、舌和/或远端方向。通过PCA特征将所需的锚固从牙齿转移到硬颚、软颚、颊龈和/或舌龈上，相邻的牙齿不再经受不希望的反作用力的副作用或者经受减少量的不希望的反作用力的副作用，从而减少牙齿沿不希望的方向的移动。
在一些实施例中，牙科应用是用于矫正患者的牙齿的正畸矫正装置。所述装置可以是矫正器，诸如具有可以放置在患者的一颗或更多颗牙齿上的牙列接纳腔体的透明壳体矫正器。另外，所述装置可以包括一个或更多个PCA特征。牙列接纳腔体的大小和形状被设置为能装配在一颗或更多颗牙齿上以接触患者的一颗或更多颗牙齿，并且当将牙列接纳腔体放置在患者的一颗或更多颗牙齿上时，向患者的一颗或更多颗牙齿的一个或更多个预定表面施加力。PCA特征可以从牙列接纳腔体延伸并且具有与患者口腔内的牙龈和/或颚的至少一部分的表面轮廓匹配的轮廓。硬颚、软颚、颊龈和/或舌龈可以用于提供PCA特征锚固。
当所述装置被患者佩戴在牙齿上时，PCA特征对患者口腔内的牙龈和/或颚的至少一部分施加反作用力，所述反作用力至少部分地平衡由牙列接纳腔体施加到患者的牙齿或多颗牙齿的力。
通常，PCA特征可以具有足够大的表面积以分散反作用力，使得PCA特征被构造为对牙龈和/或颚施加小于预定量的压力。预定量的压力可以是对患者口腔内的牙龈和/或颚导致疼痛、刺激或组织损伤(诸如毛细血管损伤、炎症、脱皮或坏死)的压力。
在一些实施例中，由PCA特征施加的压力小于大约90Mpa。在其他实施例中，压力小于大约5Mpa至90Mpa，或小于在该范围内的任何值。在一些实施例中，在该范围的下端(即，5MPa)，压力可以在刺激或组织损伤发生之前对颚施加长达2周，而90MPa的压力可以迅速导致刺激或组织损伤。在一些实施例中，装置可以具有PCA特征，所述PCA特征将负荷分布在牙龈和/或颚上并在最大阈值90Mpa之下施加压力。在一些实施例中，即在施加5MPa-90MPa之间或小于5MPa-90MPa的实施例中，可以周期性地改变由PCA特征将负荷施加到颚和/或牙龈的位置，诸如在顺序装置的应用之间，使得颚和/或牙龈上的特定位置在相当长的时间内不会承受可能导致组织刺激和/或损伤的相当大量的压力。
在一些实施例中，施加的压力被选择为在患者的压力疼痛阈值(PPT)以下。在一些实施例中，PPT在大约200克力/平方毫米至1500克力/平方毫米之间。在一些实施例中，在达到PPT阈值之前，使用颚位的PCA特征可以施加的压力水平是颊位的大约4倍。
组织损伤和/或刺激的极限可以如图所示，所述极限是力/压力的量级和施加力/压力的持续时间的函数，如图13所示，通过绘制由PCA特征施加的力/压力与施加力/压力的时间。如图13所示，施加的力/压力越高，在组织损伤和/或刺激发生之前所需的时间越短，相反，施加的力/压力越低，导致组织损伤或刺激所需的时间越长。基于这种力/压力和时间的关系，可以确定，对于施加特定力/压力的PCA特征，应改变颚和/或牙龈上的负荷施加位置的频率。例如，对于施加5MPa的装置，应至少每2周改变一次施加负荷的位置。
在一些实施例中，所施加的压力被选择为在诸如咀嚼食物的各种活动期间对颚组织(例如，颚顶、中间颚区域、颚区域、下颌区域和下颌顶，例如)由补齿施加的压力的范围内。在这些实施例中，压力可以在大约4kPa与350kPa之间。例如，要挤压所有上齿，需要大约56N的力(每齿4N乘以14齿)。使用具有大约20mm×20mm接触面积的PCA特征施加46N的力会引起向接触面积施加大约130kPa的压力(假设由PCA特征施加的所有力都可以用于挤压)，这完全在使用期间补齿所施加的范围内。使用相同大小的接触面积挤压较少的牙齿减小施加的压力，并且减小PCA特征的接触面积增加对于给定力施加到接触面积的压力。可以基于计算出的力来确定PCA接触面积的大小、位置和取向，所述计算出的力是执行期望的牙齿移动和PCA特征要施加的目标压力所需要的。
例如，图1A示出牙科器具100的剖视图，所述牙科器具具有(1)具有牙列接纳腔体104的牙齿接纳部分102和(2)PCA特征106，所述PCA特征的形成和大小被设置为推压患者的颚以产生沿相反方向引导并可用于挤压一颗或更多颗牙齿的挤压力。牙列接纳腔体104可以具有用于接纳牙齿锚固件110的容座108，所述牙齿锚固件可被附接到患者的牙齿并促进将挤压力施加到牙齿。替代地或附加地，牙列接纳腔体104的尺寸和形状可以被设置为装配在牙齿底切上，使得牙齿接纳部分102可以经由底切将挤压力传递到牙齿。在没有PCA特征106的情况下，将需要通过向相邻的牙齿施加挤入反作用力来平衡挤压力。
图1B示出与上面结合图1A描述的实施例相似的牙科器具100的实施例。在图1B所示的实施例中，牙科器具还包括应力消除特征112，所述应力消除特征可以定位在牙齿接纳部分102与PCA特征106之间的器具上。在一些实施例中，应力消除特征112可以是折叠状(accordion-like，手风琴状)或弹簧状接合结构，其可以略微屈曲、变形和/或压缩。这种略微的屈曲可以在装置的初始插入期间通过更容易地正确地将容座108固定在锚固件110上而是有帮助的。在一些实施例中，应力消除特征112可以由比器具的其余部分更多弹性的材料制成，和/或可以被制造得比器具的其他部分薄。另外，应力消除特征112还可以像悬架一样发挥作用，以提供一种安全机构，所述安全机构减轻高负荷并有助于将负荷均匀地分布在颚表面的期望部分上。
图1C是图1A和图1B所示的牙科器具100的剖视图，其示出PCA特征106沿X轴、Y轴和/或Z轴相对于颚的偏移如何可以用于控制颚表面接触区域的位置。例如，为了执行如图1A和图1B所示的牙齿挤压，PCA特征106的一部分沿竖直Z轴的偏移可以引起上颚的对应区域上的偏移部分施加压力以用作锚固，随着竖直偏移增大，施加到颚的压力增大。为了指定和/或改变竖直偏移部分在颚上施加压力的位置，当制造用于移动牙齿的一系列器具中的下一个器具时，可以将X轴偏移和/或Y轴偏移应用于PCA特征的Z轴偏移部分。X偏移和Y偏移允许锚固位置在连续的器具之间改变，这减少施加到颚的特定部分的力/压力的持续时间，从而降低刺激和/或颚组织损伤的风险。
图2示出可以应用于上颌和下颌弓以使牙齿远移的牙科器具200的实施例。牙科器具200可以具有牙齿接纳部分202和PCA特征206，所述PCA特征与硬颚的前面部分符合并向其施加压力，以产生可以用于使诸如臼齿的一颗或更多颗牙齿远移的远移力。牙齿接纳部分的大小和形状可以设置为与要移动的牙齿紧密地符合，使得力可以有效地传递到牙齿。替代地或附加地，牙齿锚固件可以附接到牙齿并且用于接纳牙齿锚固件的容座可以被添加到牙齿接纳部分202以帮助将远移力传递到牙齿。在没有前面PCA特征206的情况下，原先传递到PCA特征206的由臼齿移动引起的中间反作用力将取代地被传递到相邻的臼齿。
图3示出可以应用于上颌和下颌弓以使牙齿旋转的牙科器具300的实施例。牙科器具可以具有牙齿接纳部分302和PCA特征306，所述PCA特征从牙齿接纳部分的牙龈切口延伸。PCA特征306可以符合舌龈并用于锚固第一级(z旋转)反作用力，所述第一级反作用力平衡由牙齿接纳部分302施加以旋转牙齿的第一级旋转力。尽管示出了PCA特征306符合舌龈，但是在一些实施例中，PCA特征306可以取代地符合颊龈以沿相反方向产生旋转力。这种类型的PCA特征在本文通常被称为突片(tab)或突片特征。如图3所示，PCA特征306从牙齿接纳部分302的覆盖臼齿的部分延伸，因此PCA特征306还可以被称为臼齿垫。
图4A和图4B示出可以应用于上颌和下颌弓以使牙齿旋转的另一牙科器具400的实施例。牙科器具可以具有牙齿接纳部分402和PCA特征406，所述PCA特征从牙齿接纳部分的牙龈切口延伸。PCA特征406可以符合面/颊龈并用于锚固第一级(z旋转)反作用力，所述第一级反作用力平衡通过牙齿接纳部分402施加以旋转牙齿的第一级旋转力。图3和图4A和图4B中示出的牙科器具可以用于沿任一方向旋转牙齿。
图5示出可以用于向内或向外倾斜牙齿(特别是后面臼齿)的牙科器具500的实施例的剖视图。牙科器具500可以具有牙齿接纳部分502和PCA特征506，所述PCA特征的大小和形状设置为符合颚和/或舌龈。在一些实施例中，PCA特征可以推压颚和/或舌龈的侧面，以产生对牙齿向外和/或向内的力，以使牙齿向外和/或向内倾斜。在一些实施例中，PCA特征没有对颚施加足够量的力以引起颚扩张。
图6示出可以用于下颌前进和/或重新定位(诸如向前或向后移动下颌或上颌)的牙科器具600的实施例。牙科器具可以具有牙齿接纳部分602和PCA特征606，在这种情况下，所述PCA特征是下颌重新定位和/或前进特征，其大小和形状设置为符合上颚和/或舌和/或颊龈。牙科器具600还可以具有从牙齿接纳部分602的相对侧延伸的一对翼608，这对翼向外延伸并朝向下颌延伸。翼608可以从牙齿接纳部分602的接纳臼齿的后面部分延伸。可以将牙科器具与向外延伸并朝向上颌延伸的互补的一对翼一起戴在下牙列上。如本文所述，用于下牙列的器具可以是具有翼并且可选地具有在牙龈上方延伸的PCA特征的矫正器。下颌上的牙科器具可以具有PCA特征，所述PCA特征的形状和大小符合舌和/或颊龈。当嘴闭合时，两对翼锁定在一起以迫使下颌与上颌期望地对齐，诸如使下颌向前移动。PCA特征可以有助于抵消和/或分布由翼产生到颚和/或牙龈的力，而不是将所有的力施加到牙齿。
图7示出可以用于旋转牙齿的牙科器具700的实施例。牙科器具可以具有牙齿接纳部分702和PCA特征706，所述PCA特征符合上颚的至少一部分。如所示的，牙齿接纳部分702仅在每侧上接纳一对臼齿，但是在其他实施例中，牙齿接纳部分702可以接纳更少或更多的牙齿或者上颌中的所有牙齿。牙科器具700的功能类似于图3所示的牙科器具300，除了PCA特征706延伸至覆盖颚而不是相对小的突片型特征之外。通过使具有PCA特征706的一个或更多个离散部分从牙龈和/或颚的自然轮廓偏移，使得当佩戴时偏移部分推压牙龈和/或颚以施加力，PCA特征706可以施加与图3所示的突片特征相似的力。这种力可以用于平衡旋转牙齿所需的力。
图8示出牙科器具800的实施例，所述牙科器具可以用于通过对硬颚的前面部分施加力将前牙向外推。牙科器具800可以具有：牙齿接纳部分802，接纳诸如臼齿的牙齿，用作锚固；PCA特征806，其大小和形状设置为符合颚并且当患者佩戴装置时对硬颚的前面部分施加压力。如所示的，PCA特征806可以覆盖硬颚和软颚，但是在下面讨论的其他实施例中，可以仅覆盖硬颚。
图9A和图9B示出一种类型的牙科器具900如何可以用于根据装置的具体构造产生两种不同的类型的牙齿移动。牙科器具900具有牙齿接纳部分902和PCA特征906，所述PCA特征的大小和形状设置为符合硬颚并对硬颚施加压力，特别是硬颚的前面部分。如图9A所示的，如果通过牙齿接纳部分902接纳相当大数量的臼齿以用作锚固件，则通过PCA特征906施加的压力可以用于推出前牙，而引起臼齿没有移动或移动最少。替代地，如图9B所示，如果通过牙齿接纳部分902接纳相当小量的牙齿(诸如臼齿)，则通过PCA特征906对硬颚的前面部分施加的压力可以用于使通过牙齿接纳部分902接纳的后面的牙齿远移。如图9B所示，可以将牙齿锚固件固定到牙齿上，并且可以在牙齿接纳部分902中包括对应的牙齿锚固容座908，以改善力向牙齿的传递并改善装置在牙齿上的稳定性。通常，通过牙齿接纳部分902接纳的牙齿越少，接纳的牙齿由于施加的力而移动越大。相反，由于力分散在大量的牙齿上，这减小了分别施加到每颗牙齿上的力，因此使用更多的牙齿作为锚固件引起较少的牙齿移动。
图10示出牙科器具1000的实施例，所示牙科器具可以用于旋转牙齿并且与图7所示的实施例类似，但是具有附加的PCA特征以提供附加的杠杆作用。牙科器具1000可以具有牙齿接纳部分1002和PCA特征1006，所述PCA特征符合上颚的至少一部分。如所示的，牙齿接纳部分1002仅在每侧上接纳一对臼齿，但是在其他实施例中，牙齿接纳部分1002可以接纳更少或更多的牙齿或者上颌中的所有牙齿。牙科器具1000的功能与图7所示的牙科器具700相似，但是具有一个或更多个附加PCA特征1008、1009，所述附加PCA特征在诸如前臼齿的附加的相邻牙齿周围延伸。附加PCA特征1008、1009可以如所示出那样围绕相邻牙齿在舌龈上延伸和/或可以围绕相邻牙齿在颊龈上延伸并且用于提供附加的杠杆作用以平衡所施加的用于旋转牙齿的力。
本文描述的所有不同类型的PCA特征可以单独使用或组合使用以实现各种类型的牙齿移动。由于PCA特征是低轮廓的，因此它们通常不会干扰舌，并且可以应用在下颌弓、舌龈或颊龈以及硬颚和软颚上。面/颊PCA特征以及本文描述的其他PCA特征的应用、位置、大小和形状可以根据需要而变化和组合，以改善规定的治疗(prescribed treatment)。例如，将面PCA特征与舌PCA特征组合可以用于辅助第一级或z轴旋转。可以将PCA特征放置在牙冠下方或牙间(IP)区域(即，牙冠之间的空间)中，或将两者组合使用。PCA特征的大小(即，表面积)和形状可以根据需要的锚固系统来设计，其可以是对称的或非对称的。
这些PCA特征可以用于增强牙科器具中使用的现有方案，诸如附件、舌根转矩(LRT)、精确切割、咬合斜面等，或设计为独立类型的方案以最小化、减少或消除使用现有方案的需要。
例如，PCA特征可以用作对现有矫正器方案的增强，从而为矫正器的各个节段提供锚固特征(即，例如，如图2所示，位于矫正器的前段上的挤压锚固特征)。
在一些实施例中，矫正器面/颊突片可以包括精确切割特征。在一些实施例中，矫正器可以包括一个或更多个突片，以通过将锚固添加到相邻的牙冠而将一些力从矫正器转移到突片来最小化或减少矫正器的变形。
LRT用于产生一类切向倾斜度，其中牙齿使用冠尖作为旋转中心旋转(即，当牙冠静止时，根部摆动)。LRT增强包括使矫正器张开/变形和/或通过增大矫正器刚度减少极端矫正器轨道激活的需要最小化。可以通过PCA特征或者通过在矫正器的冠部分下方添加材料而延伸矫正器来提供附加锚固，因此矫正器不会张开或变形。例如，可以将矫正器修整得更长，使得矫正器的边缘延伸超过牙龈线。
可以通过在冠下方添加材料(即，将矫正器的边缘延伸超过牙龈线)实现较低的脊放置，这可以防止设备的一部分被切断(例如，如果将一部分放置得离牙龈线太近，则在制造工艺期间会无意地切开设备)，因此不需要与牙龈线大的间隙。通过将矫正器的长度延伸超过牙龈线并且将修整进一步移开，该特征(即，PCA特征)不太可能被意外切断。
在前面咬合斜坡下方添加前面颚轮廓锚固允许咬合力从矫正器分布到PCA特征上，这减少不希望的矫正器变形。
具有PCA特征的矫正器可以用作独立的矫正器方案，并且对于呈现出良好状况的患者使用矫正器可以代替附件的使用。如本文所述，可以使用面/颊侧锚固组合舌锚固来实现第一级牙齿旋转，以使用冠表面产生力矩。可以通过策略性地放置锚固特征以改变矫正器刚度并与分阶段相组合以影响矩力(M/F)比，产生第三级转矩。例如，图7示出对中间远端倾斜控制的支持。如本文所述，可以通过使用锚固特征产生适当的反作用力和挤压力，并通过向矫正器增加刚度，并使用冠底切和分阶段以实现挤压力，实现牙齿挤压。如本文所述，M/F比是生物力学值，其描述对象在施加一个或更多个力时将经历的3D身体运动的类型。“力矩”＝力的力矩＝扭矩＝力X距离。通常，在本文所述的应用中，M/F比为0引起牙齿的身体平移，而M/F比为10引起例如牙冠倾斜。
PCA的优点包括：(1)锚固不是来自相邻的牙冠，这最小化或减小了相邻牙齿上不希望的矫正器反作用力；(2)可以增大矫正器在策略方向上的刚度，从而改善矫正器移动牙齿节段的能力；(3)可用于增强现有的矫正器方案，并可以发展为最小化或替代它们；(4)不需要金属，也不需要手工修补电线以用于安装所需；(5)更舒适，全数字定制有机设计；(6)能够以超越快速颚扩张器扩张的方式移动牙齿；(7)PCA能够以小的精确增量分阶段；(8)PCA偏移被校准以减轻组织损伤。
装置制造
特别针对每个专利的定制特征的设计和制造工艺提供了动态灵活性，以在治疗的特定阶段改变特征位置、大小和形状。例如，该工艺允许(1)在治疗期间移位/移动锚固位置，以减少软组织与矫正器接触的时间，以使刺激最小化；和/或(2)改变锚固位置、形状和/或大小以在治疗期间调整(根据力或压力)以适应弓的改变。合适的制造工艺包括增材制造工艺、一件热成型、一件直接印刷制造、两件搭扣锁、两件声波焊接和两件粘合剂结合。
图11是示出用于制造牙科器具的计算机实施方法的流程图。所述方法可以在具有处理器、存储器和被编程为实现以下步骤的软件的计算机上实现。在步骤1100中，所述方法通过接收数据开始，所述数据包括患者口腔内的患者的牙齿、牙龈和颚的三维表示。例如，可以对患者的牙列和颚进行数字扫描和成像，然后可以将结果数据发送到计算机，如图14所示。在步骤1102中，使用接收到的数据生成患者口腔内的患者的牙齿、牙龈和颚的模型。在步骤1104中，计算施加到牙齿以使牙齿沿期望的方向和量移动的力。在步骤1106中，计算施加到患者口腔内的牙龈和/或颚上的一个或更多个位置的反作用力，以平衡施加到一颗或更多颗牙齿的力。在步骤1108中，基于患者的牙齿、牙龈和颚的生成模型，施加到牙齿的计算出的力，以及施加到牙龈和/或颚上的一个或更多个位置上的计算出的反作用力，确定正畸矫正装置的形状。在步骤1110中，基于所确定的形状来制造正畸矫正装置。
图12是示出用于制造牙科器具的另一计算机实现的方法的流程图。所述方法在步骤1200中通过生成患者的牙齿和颚和/或牙龈的数字模型开始，其中，每颗牙齿是可以在数字模型中独立移动的单独的对象，其中，颚和/或牙龈也是可以独立移动的单独的对象。如上所述，可以对患者的牙列和颚进行数字扫描和成像，并可以将结果数据发送到计算机，如图14所示。在步骤1202中，在保持颚几何静止的同时，生成牙齿位置的阶段的有序序列，如图15所示，其中，阶段的有序序列包括牙齿的初始位置的阶段、牙齿的多个中间位置的多个阶段以及牙齿的最终位置的阶段。在步骤1204中，计算可以由牙齿矫正装置施加到牙齿以将牙齿从一个阶段移动到下一个阶段的力。在步骤1206中，所述方法检查力是否包括使一颗或更多颗牙齿沿不希望的方向移动的一个或更多个力。如果否，则所述方法继续步骤1208以制造正畸矫正装置，以将牙齿从一个阶段移动到下一个阶段而没有任何PCA特征。如果是，则所述方法继续步骤1210，并检查是否将向颚和/或牙龈施加的一个或更多个力用于代替或抵消使一颗或更多颗牙齿沿不希望的方向移动的一个或更多个力。如果否，则所述方法继续步骤1212以制造正畸矫正装置以将牙齿从一个阶段移动到下一个阶段而没有任何PCA特征。如果是，则所述方法继续步骤1214以制造正畸矫正装置，从而将牙齿从一个阶段移动到下一个阶段而具有PCA特征。
上面描述的方法还可以包括计算当由患者佩戴时通过PCA特征施加到颚和/或牙龈的压力水平，以及当施加到颚和/或牙龈的确定的压力水平超过设定或预定水平时，修改PCA特征的大小和/或形状。正畸矫正装置的修改的大小和/或形状可以将施加到颚和/或牙龈的压力水平降低到设定或预定水平以下。
通常，用于制造的软件工作流程可以分为七个步骤：(1)分别划分牙齿和颚；(2)分阶段移动牙齿；(3)评估移动每颗牙齿所需的力/力矩；(4)确定是否需要颚分段；(5)计算每颗牙齿上传递的力/力矩；(6)改变器具的设计；(7)建造器具。
(1)分别划分牙齿和颚：患者的牙齿可以是能够分别独立移动的独立对象。患者的整个上颚也可以是一个单独的对象。
(2)分阶段移动牙齿：根据期望的治疗计划对患者的牙齿进行分阶段。
(3)评估如先前步骤中计划的移动每颗牙齿所需的力/力矩：基于现象学模型的正畸经验可以用于确定应施加到牙齿的力，以便使用下面的公式沿期望的方向移动牙齿：(Fx,Fy,Fz,Mx,My,Mz)＝f(Tx,Ty,Tz,Rx,Ry,Rz)，其中，F＝力(通常以牛顿为单位)，M＝力矩(通常以牛顿-毫米为单位)，T＝平移轴(通常以毫米为单位)，R＝旋转轴(例如，通常以度分段)。例如，可以使用有限元分析(FEA)执行物理模拟。
(4)确定是否需要颚分段：考虑分阶段牙齿移动所需的力或力矩之和是否具有不平衡的力系统，该系统可能产生不希望的副作用，并且考虑移动是否会受益于颚锚固支撑。
(5)根据以下计算通过器具在每颗牙齿上传递的力/力矩：通过将器具修改为包括PCA特征，施加到每颗牙齿的活化量和施加到颚或牙龈的局部压力。可以使用例如基于FEA的矫正器的计算模型来确定力，或者根据美国专利No.9,375,300中描述的方法来确定力，通过全文引用将其并入本文。
(6)通过改变以下来改变器具的设计：激活量，位置和施加到颚和/或牙龈的压力的量。确保施加的压力在安全限度内并且落入允许范围内，以免伤害组织。理想地，力在足够大的区域内分布在整个颚和/或牙龈上，以确保使患者不适的风险最小化。
(7)建造器具：将颚的形状应用于治疗情况的每个阶段并且建造器具。
当特征或元件在本文中被称为在另一特征或元件“上”时，其可以直接在另一特征或元件上，或者也可以存在中间特征和/或元件。相反，当特征或元件被称为“直接在”另一特征或元件“上”时，不存在中间特征或元件。还应理解，当特征或元件被称为“连接”、“附接”或“联接”到另一特征或元件时，其可以直接连接、附接或联接到其他特征或元件或者可以存在中间特征或元件。相反，当特征或元件被称为与另一特征或元件“直接连接”、“直接附接”或“直接联接”时，则不存在中间特征或元件。尽管关于一个实施例进行了描述或示出，但是如此描述或示出的特征和元件可以应用于其他实施例。本领域的技术人员还将理解，提及与另一特征“相邻”设置的结构或特征可以具有与相邻特征叠置或位于其附近的部分。
本文使用的术语仅出于描述特定实施例的目的，并且不旨在限制本发明。例如，如本文所使用的，单数形式“一”、“一个”和“所述”也旨在包括复数形式，除非上下文另外明确指出。还将理解，当在本说明书中使用术语“包括”和/或“包含”时，其指明所述特征、步骤、操作、元件和/或组件的存在，但并不排除存在或添加一个或更多个其他特征、步骤、操作、元件、组件和/或其组。如本文所使用的，术语“和/或”包括一个或更多个相关列出项的任何和所有组合，并且可以缩写为“/”。
为了易于描述，在本文中可以使用诸如“下方”、“在...下面”、“下”、“上方”、“上”等的空间相对术语，以描述一个元件或特征与如图所示的其他元件或特征的关系。将理解的是，除了附图中描绘的取向之外，空间相对术语还意图包括装置在使用或操作中的不同取向。例如，如果附图中的装置是倒置的，则描述为在其他元件或特征“下方”或“下面”的元件将定向为在其他元件或特征“上方”。因此，示例性术语“下方”可以包括上方和下方两个取向。可以采取其他方式定向装置(旋转90度或其他取向)，并据此解释本文使用的空间相对描述语。类似地，除非另外具体指出，否则术语“向上”、“向下”、“竖直”、“水平”等在本文中仅用于解释的目的。
尽管本文可以使用术语“第一”和“第二”来描述各种特征/元件(包括步骤)，但是除非上下文另外指示，否则这些特征/元件不应受这些术语的限制。这些术语可以用于将一个特征/元件与另一特征/元件区分开。因此，在不脱离本发明的教导的情况下，下面讨论的第一特征/元件可以被称为第二特征/元件，并且类似地，下面讨论的第二特征/元件可以被称为第一特征/元件。
在整个本说明书和以下的权利要求书中，除非上下文另有要求，否则词语“包括”以及诸如“包含”和“具有”的变体意味着可以在方法和物品中共同采用各种组件(例如包括装置和方法的组合物和设备)。例如，术语“包括”将被理解为暗示包括任何所述元件或步骤，但是不排除任何其他元件或步骤。
如本文在说明书和权利要求书中所使用的，包括在示例中所使用的，并且除非另有明确说明，否则所有数字可以被读作好像由词语“大约”或“近似”开头，即使该术语没有明确地出现。当描述量级和/或位置时，可以使用短语“大约”或“近似”来指示所描述的值和/或位置在值和/或位置的合理预期范围内。例如，数字值的值可以是陈述值(或值的范围)的+/-0.1％，陈述值(或值的范围)的+/-1％，陈述值(或值的范围)的+/-2％，陈述值(或值的范围)的+/-5％，陈述值(或值的范围)的+/-10％等。除非上下文另外指出，否则本文给出的任何数值也应理解为包括大约或近似该值。例如，如果公开值“10”，则也公开“大约10”。本文叙述的任何数值范围旨在包括其中包含的所有子范围。还应理解，如本领域技术人员适当理解的那样，当公开的值“小于或等于”该值时，还公开了“大于或等于该值”以及值之间的可能范围。例如，如果公开了值“X”，则还公开了“小于或等于X”以及“大于或等于X”(例如，其中X是数值)。还理解的是，在整个申请中，以多种不同格式提供数据，并且该数据代表端点和起点以及数据点的任何组合的范围。例如，如果公开了特定数据点“10”和特定数据点“15”，则应理解，认为大于、大于或等于、小于、小于或等于以及等于10和15以及在10与15之间被公开。还应理解，还公开了两个特定单元之间的每个单元。例如，如果公开了10和15，则还公开了11、12、13和14。
尽管上面描述了各种说明性实施例，但是在不脱离如权利要求所描述的本发明的范围的情况下，可以对各种实施例进行多种改变。例如，在替代实施例中，可以经常改变执行所描述的各种方法步骤的顺序，并在其他替代实施例中，可以完全跳过一个或更多个方法步骤。在一些实施例中可以包括各种装置和系统实施例的可选特征，而在其他实施例中可以不包括。因此，前面的描述主要是为了示例性目的而提供的，并且不应解释为限制本发明的范围，如权利要求书中所阐述的。
本文所包括的示例和图示通过说明而非限制的方式示出了可以实践主题的特定实施例。如所提及的，可以利用其他实施例并从中得出其他实施例，使得可以在不脱离本公开的范围的情况下进行结构和逻辑上的替换和改变。仅为了方便本文中可以单独地或共同地用术语“发明”来指代本发明主题的这些实施例，而无意将本申请的范围自发地限制为任何单个发明或发明构思，如果事实上已披露不止一个。因此，尽管本文已经图示和描述了特定实施例，但是计算出的用于实现相同目的的任何布置都可以代替所示的特定实施例。本公开意图覆盖各种实施例的任何和所有改编或变化。通过阅读以上描述，以上实施例的组合以及本文中未具体描述的其他实施例对于本领域技术人员将是显而易见的。

Claims (32)

1.一种正畸矫正装置，所述装置包括：
牙齿部分，具有被构造为放置在患者的一颗或更多颗牙齿上的牙列接纳腔体，所述牙齿部分被构造为接触患者的一颗或更多颗牙齿的一个或更多个预定表面，以施加沿远端方向移动一颗或更多颗牙齿的远移力；以及
锚固部分，从所述牙齿部分延伸并且被构造为邻接位于患者口腔内的患者的颚的至少一部分，其中，位于患者口腔内的颚的所述部分选自于由以下构成的组：硬颚和软颚；
其中，所述锚固部分包括颚轮廓锚固特征，所述颚轮廓锚固特征具有足够大的表面积以分散作用于位于患者口腔内的颚的所述至少一部分的反作用力，所述反作用力至少部分地平衡当所述牙齿部分放置在患者的一颗或更多颗牙齿上时由所述牙齿部分施加到患者的该颗牙齿或多颗牙齿的力。
2.根据权利要求1所述的装置，还包括位于所述颚轮廓锚固特征与所述牙齿部分之间的应力消除特征。
3.根据权利要求2所述的装置，其中，所述应力消除特征被配置为屈曲、变形和/或压缩，以使所述装置的初始插入更容易。
4.根据权利要求3所述的装置，其中，所述应力消除特征包括间隙。
5.根据权利要求1所述的装置，其中，所述锚固部分具有与位于患者口腔内的患者的颚的至少一部分的表面轮廓匹配的轮廓。
6.根据权利要求1所述的装置，其中，所述锚固部分具有足够大的表面积以分散所述反作用力，使得所述锚固部分被构造为对颚施加小于预定量的压力。
7.根据权利要求6所述的装置，其中，所述预定量的压力是对位于患者口腔内的颚导致组织损伤的压力。
8.根据权利要求7所述的装置，其中，所述组织损伤是毛细血管损伤、脱皮或坏死。
9.根据权利要求1所述的装置，其中，所述锚固部分的轮廓至少部分地匹配所述硬颚的一部分的表面轮廓。
10.根据权利要求1所述的装置，其中，所述锚固部分包括用于接纳所植入的临时锚固装置的一部分的临时锚固装置容座。
11.根据权利要求1所述的装置，其中，所述牙齿部分包括一个或更多个锚固容座，所述一个或更多个锚固容座被构造为接纳已经附接到患者的一颗或更多颗牙齿的锚固件。
12.一种正畸矫正装置，所述装置包括：
牙齿部分，具有被构造为放置在患者的一颗或更多颗牙齿上的牙列接纳腔体，所述牙齿部分被构造为接触患者的一颗或更多颗牙齿的一个或更多个预定表面，以施加沿远端方向移动一颗或更多颗牙齿的远移力；以及
锚固部分，从所述牙齿部分延伸并且被构造为邻接位于患者口腔内的患者的颚的至少一部分，其中，位于患者口腔内的颚的所述部分选自于由以下构成的组：硬颚和软颚；
其中，所述锚固部分包括颚轮廓锚固特征，所述颚轮廓锚固特征具有足够大的表面积以分散作用于位于患者口腔内的颚的所述至少一部分的反作用力，所述反作用力至少部分地平衡当所述牙齿部分放置在患者的一颗或更多颗牙齿上时由所述牙齿部分施加到患者的该颗牙齿或多颗牙齿的力；和
应力消除特征，位于所述颚轮廓锚固特征与所述牙齿部分之间。
13.一种用于使用正畸矫正装置移动患者的一颗或更多颗牙齿的方法，所述方法包括：
将所述正畸矫正装置的牙齿区域放置在患者的一颗或更多颗牙齿上，其中，所述牙齿区域包括用于接纳患者的一颗或更多颗牙齿的腔体，其中，所述正畸矫正装置还包括从所述牙齿区域延伸并匹配患者的颚的锚固部分；
用牙齿部分对患者的一颗或更多颗牙齿施加一个或更多个远移力，以沿远端方向移动一颗或更多颗牙齿；
用所述锚固部分对患者的颚的一部分施加反作用力，所述反作用力至少部分地平衡由所述牙齿部分施加的一个或更多个力，其中，所述反作用力被分布；以及
包括颚轮廓锚固特征，所述颚轮廓锚固特征具有足够大的表面积以分散作用于位于患者口腔内的颚的所述至少一部分的反作用力，所述反作用力平衡所述一个或更多个远移力。
14.根据权利要求13所述的方法，还包括使用所述颚轮廓锚固特征在患者的颚的足够大的表面积上分散所述反作用力以避免或减少对患者的牙龈和/或颚的损伤。
15.根据权利要求13所述的方法，还包括屈曲、变形和/或压缩位于所述颚轮廓锚固特征与所述牙齿部分之间的应力消除特征，以使所述装置的初始插入更容易。
16.根据权利要求13所述的方法，其中，用所述正畸矫正装置施加一个或更多个力的步骤包括施加被构造为沿远端方向移动一颗或更多颗牙齿的远移力。
17.根据权利要求13所述的方法，其中，对硬颚施加所述反作用力。
18.根据权利要求13所述的方法，其中，用所述正畸矫正装置施加一个或更多个力的步骤包括对牙齿施加被配置为使所述牙齿旋转的旋转力。
19.根据权利要求13所述的方法，其中，用所述正畸矫正装置施加一个或更多个力的步骤包括对一颗或更多颗牙齿施加挤压力。
20.根据权利要求19所述的方法，其中，对硬颚施加所述反作用力。
21.根据权利要求13所述的方法，其中，用所述正畸矫正装置施加一个或更多个力的步骤包括对一颗或更多颗牙齿施加倾斜力。
22.根据权利要求13所述的方法，其中，所述反作用力被施加到硬颚以向外推动一颗或更多颗前牙。
23.根据权利要求13所述的方法，其中，由所述正畸矫正装置对患者的牙齿施加的所述一个或更多个力连同所述反作用力一起向前拉患者的上颌。
24.一种用于制造正畸矫正装置的方法，所述方法包括：
接收数据，所述数据包括位于患者口腔内的患者的牙齿、牙龈和颚的三维表示；
使用接收到的数据生成位于患者口腔内的患者的牙齿、牙龈和颚的模型；
基于所生成的患者的牙齿的模型，确定施加到一颗或更多颗牙齿以使一颗或更多颗牙齿沿远端方向移动的力；
基于施加到一颗或更多颗牙齿的确定的力以及所生成的位于患者口腔内的患者的牙齿和颚的模型，来确定被施加到位于患者口腔内的颚上的一个或更多个位置以用于平衡施加到一颗或更多颗牙齿的力的反作用力；和
基于所生成的位于患者口腔内的患者的牙齿和颚的模型，施加到一颗或更多颗牙齿的确定的力，以及施加到位于患者口腔内的颚上的一个或更多个位置的确定的反作用力，来确定所述正畸矫正装置的形状，从而使得所述反作用力通过颚轮廓锚固特征来分布，所述颚轮廓锚固特征具有足够大的表面积以分散所述反作用力；以及
基于所确定的形状来制造所述正畸矫正装置。
25.根据权利要求24所述的方法，还包括在具有用于接纳患者的一颗或更多颗牙齿的腔体的牙齿部分与所述颚轮廓锚固特征之间形成应力消除特征。
26.根据权利要求24所述的方法，还包括确定当患者佩戴所述正畸矫正装置时由所述正畸矫正装置施加到颚的压力水平。
27.根据权利要求26所述的方法，还包括当由所述正畸矫正装置施加到颚的确定的压力水平超过设定或预定水平时，修改所述正畸矫正装置的形状，其中，所述正畸矫正装置的修改后的形状使施加到颚的压力水平降低到所述设定或预定水平以下。
28.根据权利要求27所述的方法，其中，修改所述正畸矫正装置的形状包括增大所述正畸矫正装置的被构造为接触颚的部分的大小。
29.根据权利要求24所述的方法，还包括制造一系列正畸矫正装置，以将牙齿从所述牙齿的初始位置的阶段顺序地移动到所述牙齿的最终位置的阶段。
30.一种正畸矫正装置，所述装置包括：
牙齿部分，具有被构造为放置在患者的一颗或更多颗牙齿上的牙列接纳腔体，所述牙齿部分被构造为接触患者的一颗或更多颗牙齿的一个或更多个预定表面；以及
锚固部分，从所述牙齿部分延伸并且被构造为邻接位于患者口腔内的患者的牙龈和/或颚的至少一部分，其中，位于患者口腔内的牙龈和/或颚的所述部分选自于由以下构成的组：硬颚、软颚、颊龈和舌龈；
其中，所述锚固部分包括颚轮廓锚固特征，所述颚轮廓锚固特征是偏移的，并且具有足够大的表面积以分散位于患者口腔内的牙龈和/或颚的所述至少一部分上的反作用力，所述反作用力至少部分地平衡当所述牙齿部分放置在患者的一颗或更多颗牙齿上时由所述牙齿部分施加到患者的该颗牙齿或多颗牙齿的力。
31.一种用于使用正畸矫正装置移动患者的一颗或更多颗牙齿的方法，所述方法包括：
将所述正畸矫正装置的牙齿区域放置在患者的一颗或更多颗牙齿上，其中，所述牙齿区域包括用于接纳患者的一颗或更多颗牙齿的凹面，其中，所述正畸矫正装置还包括从所述牙齿区域延伸并匹配患者的颚的锚固部分；
用牙齿部分对患者的一颗或更多颗牙齿施加一个或更多个力；
用所述锚固部分对患者的牙龈和/或颚的一部分施加反作用力，所述反作用力至少部分地平衡由所述牙齿部分施加的所述一个或更多个力，其中，患者的牙龈和/或颚选自于由以下构成的组：硬颚、软颚、颊龈和舌龈；以及
移动患者的一颗或更多颗牙齿。
32.一种用于制造一系列正畸矫正装置的方法，所述方法包括：
接收数据，所述数据包括位于患者口腔内的患者的牙齿、牙龈和颚的三维表示；
使用接收到的数据生成位于患者口腔内的患者的牙齿、牙龈和颚的模型；
对于每个正畸矫正装置：
基于所生成的患者的牙齿的模型，确定施加到一颗或更多颗牙齿以使一颗或更多颗牙齿沿期望的方向移动的力；
基于施加到一颗或更多颗牙齿的确定的力以及所生成的位于患者口腔内的患者的牙齿、牙龈和颚的模型，来确定被施加到位于患者口腔内的牙龈和/或颚上的一个或更多个位置以用于平衡施加到一颗或更多颗牙齿的力的反作用力；
基于所生成的位于患者口腔内的患者的牙齿、牙龈和颚的模型，施加到一颗或更多颗牙齿的确定的力，施加到位于患者口腔内的牙龈和/或颚上的一个或更多个位置的确定的反作用力，以及基于所述反作用力的力/压力和时间关系，来确定所述正畸矫正装置的形状，从而使得所述反作用力通过颚轮廓锚固特征来分布，并具有足够大的表面积以分散所述反作用力；以及
基于所确定的形状来制造所述一系列正畸矫正装置。
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