DE202016005969U1 - Device for the neutral position of a temporomandibular joint - Google Patents

Abstract

A pre-formed, human dental arch-adapted mouth insert with two lateral thermoplastically formable bites (A) connected by a finger-bendable wire (V).

Description

The invention consists of a preformed, the human dental arch adapted track with two lateral Aufbissen (A) made of thermoplastic material for placement on the occlusal surfaces of the left and right molars, which are connected to a thin, flexible wire (V).

• 1. Bei der Therapie der so genannten „Cranio-Mandibulären Dysfunktion” (CMD) bleibt die Tatsache oft unbeachtet, dass sich der Unterkiefer im Menschen selbstständig so positioniert, dass beim Zubeißen ein simultaner und stabiler Kontakt auf den Zähnen möglichst sicher getroffen wird. Verschieben sich Zähne, oder verläuft die Entwicklung der Zahnbögen gestört, so entwickeln sich Unterschiede zwischen dieser so genannten „habituellen Position”, bei der die Zähne am besten aufeinander passen und der orthopädischen Position, bei der Kiefergelenke entlastet und Kaumuskeln optimal funktionsfähig sind. Der Ausgleich dieser Diskrepanz kann die Muskulatur im Lauf der Zeit erschöpfen, Kiefergelenke belasten und so zu Funktionsschäden führen. Es existieren bereits Vorrichtungen mit flüssigkeitsgefüllten seitlichen Aufbisskammern, welche durch einen Schlauch verbunden sind, so dass sich der Druck in der linken und rechten Kammer selbstständig ausgleicht ( US 4 211 008 , DE 10 2012 15 223 146 A1 ). DE 10 2015 206 490 beschreibt eine signifikante Weiterentwicklung dieser Vorrichtungen durch den Antragsteller. Werden diese Vorrichtungen zwischen der oberen und unteren Zahnreihe getragen, so puffern sie die Zahnkontakte ausgleichend ab. Das Entfallen einer Zielposition, bei der ein stabiler Hartkontakt zwischen den Zahnreihen besteht, bewirkt, dass sich die Unterkieferhaltung im Lauf der Zeit wieder der orthopädischen Position annähert. Jedoch besteht diese Wirkung nur so lange diese Vorrichtungen zwischen den oberen und unteren Zähnen getragen werden und das langfristige Tragen solcher Biss-Kissen kann zu Zahnwanderungen führen, denn die Zahnbögen können einander nicht in der Weise abstützen und stabilisieren, wie dies beim Biss direkt auf die Zähne erfolgt.
• 2. Um okklusale Hilfsmittel wie so genannte „Aufbissschienen”, oder okklusale Restaurationen wie Zahnkronen und -brücken in einem zahntechnischen Labor herzustellen, werden Gipsmodelle der Zähne des Patienten benötigt. Um diese in einem zahnärztlichen Artikulator (wie in DE000019945607A1 beschrieben) zu positionieren, wird ein so genanntes „Bissregistrat” benötigt, welches Abdrücke der Kauflächen der oberen und unteren Zahnreihen enthält. Ist die okklusale Oberfläche der Zähne in solchen Registraten detailschärfer abgebildet, als dies bei den Gipsmodellen der Fall ist, so reiten diese z. B. auf der Abformung feiner Fissuren und gelangen nicht in ihre Endstellung. Daraus resultiert dann eine fehlerhafte Zuordnung der Modelle im Artikulator, so dass darauf angefertigte Arbeiten später zeit- udn kostenintensiv korrigiert werden müssen.
• 3. Ein weiteres Problem ist, dass solche Bissregistrate gewöhnlich aus Materialien erstellt werden, welche elastisch sind, z. B. Silikon, oder welche nicht vollständig aushärten, wie dies bei Wachs der Fall ist. Dies führt dazu, dass der Patient die Zuordnung der Zahnreihen im Biss auf diesen Materialien nicht spüren und kontrollieren kann, weil sie entweder ein federndes Gefühl vermitteln, das völlig anders ist, als es beim Biss auf die Zähne entsteht, oder weil er beim Beißen auf Wachsregistrate zu Testzwecken diese verformen und so zerstören könnte. Auch die Auswirkungen einer in einem Bissregistrat abgebildeten Bisszuordnung können nicht getestet werden, weil die hierfür zur Verwendung kommenden Materialien nicht für den längeren Verbleib im Mund geeignet sind. Dies führt zu einer signifikanten Unsicherheit bei der Anfertigung von okklusalen Hilfsmitteln oder Restaurationen, denn erst nachdem die Arbeiten in einem zahntechnischen Labor fertiggestellt und im Mund des Patienten eingesetzt sind, kann getestet werden, in wie weit sich die im Bissregistrat ursprünglich abgebildete Bissrelation als verträglich erweist.
• 4. Die Behandlung der CMD erfolgt oft mit Aufbissschienen, auf welchen der Biss in einer anderen Position abgestützt ist, als dies auf den eigenen Zähnen der Fall ist, um den beschriebenen Unterschied zwischen habitueller und orthopädischer Position auszugleichen. Für die Herstellung solcher Schienen sind nicht nur die beschriebenen Arbeitsunterlagen (Modelle, Bissregistrat, Artikulator) erforderlich, sondern sie erfordert auch Zeit, so dass der Biss des Patienten nicht unmittelbar nach einer therapeutischen Sitzung anders abgestützt ist, sondern bestenfalls in einem Bissregistrat abgebildet werden kann, welches dann für die Einstellung von Gipsmodellen zur Herstellung einer Aufbissschiene verwendet wird. Die Schiene selbst und damit die entsprechend angepasst Abstützung im Biss ist erst zu einem anderen Zeitpunkt verfügbar, zu dem die Wirkung der Therapiesitzung aber womöglich bereits wieder verflogen ist. Daher wäre es wünschenswert, ein Gerät bzw. ein Verfahren zu haben, mit dem sich kurzfristig und in einem Arbeitsgang die Abstützung im Biss anders einstellen lässt.
• 5. Es fehlt die Möglichkeit, die auf einem der beschriebenen flüssigkeitsgefüllten Vorrichtungen entstandene orthopädische Position abzugreifen und Gipsmodelle in der gleichen Zuordnung einzustellen, denn die wassergefüllten Kissen ändern ihre Form ständig und passen diese der Belastung an. Sie stehen daher nicht als Bissregistrat zur Einstellung von Gipfmodellen in einem Artikulator zur Verfügung.

The invention simplifies operations in several areas of dentistry.

• 1. In the treatment of so-called "cranio-mandibular dysfunction" (CMD), the fact is often ignored that the lower jaw in humans independently positioned so that when biting a simultaneous and stable contact on the teeth is made as safe as possible. If teeth move or the development of the dental arches is disturbed, differences develop between this so-called "habitual position" where the teeth fit together best and the orthopedic position relieves jaw joints and masticatory muscles are optimally functional. Compensating for this discrepancy can deplete the muscles over time, burdening temporomandibular joints and thus lead to functional damage. Devices already exist with liquid-filled lateral bite chambers, which are connected by a hose, so that the pressure in the left and right chambers automatically compensates ( US 4 211 008 . DE 10 2012 15 223 146 A1 ). DE 10 2015 206 490 describes a significant further development of these devices by the applicant. If these devices are worn between the upper and lower rows of teeth, they buffer the tooth contacts compensating. The elimination of a target position where there is a stable hard contact between the rows of teeth causes the mandibular position to return to the orthopedic position over time. However, this effect exists only as long as these devices are worn between the upper and lower teeth, and the long-term support of such bite pads can lead to tooth migration because the dental arches can not support and stabilize each other in the same manner as when biting directly on the teeth Teeth done.
• 2. In order to produce occlusal devices such as so-called "bite splints" or occlusal restorations such as dental crowns and bridges in a dental laboratory, plaster models of the patient's teeth are required. To put these in a dental articulator (as in DE000019945607A1 described), a so-called "bite registration" is needed, which contains impressions of the chewing surfaces of the upper and lower rows of teeth. If the occlusal surface of the teeth in such registries is shown in more detail than is the case with the plaster models, then these z. B. on the impression of fine fissures and do not reach their final position. This then results in a faulty assignment of the models in the articulator, so that work on it must be later corrected time-consuming and cost-intensive.
• 3. Another problem is that such bite registrations are usually made from materials that are elastic, e.g. As silicone, or which do not cure completely, as is the case with wax. As a result, the patient is unable to sense and control the alignment of the rows of teeth in the bite on these materials because they either provide a resilient sensation that is completely different than that produced by biting the teeth, or because they bite Wax registries could deform and destroy them for testing purposes. Also, the effects of a bite registration displayed in a bite registration can not be tested because the materials used for this purpose are not suitable for prolonged use in the mouth. This leads to a significant uncertainty in the production of occlusal aids or restorations, because only after the work in a dental laboratory finished and used in the patient's mouth, it can be tested to what extent the bite relation originally shown in the bite registration proves to be tolerated ,
• 4. The treatment of CMD is often performed with bite splints on which the bite is supported in a different position than is the case on one's own teeth to compensate for the described difference between habitual and orthopedic position. For the production of such splints not only the work documents described (models, bite registration, articulator) are required, but it also requires time, so that the bite of the patient is not supported differently immediately after a therapeutic session, but at best can be mapped in a bite registration , which is then used for the setting of plaster models for the production of a bite splint. The splint itself and thus the correspondingly adapted support in the bite is only available at a different time, to which the effect of the therapy session may have already disappeared. Therefore, it would be desirable to have a device or a method with which the support in the bite can be adjusted in a short time and in a single operation.
• 5. It lacks the ability to tap the resulting on one of the described liquid-filled devices orthopedic position and set gypsum models in the same assignment, because the water-filled cushions change their shape constantly, adapting them to the strain. They are therefore not available as a bite registration for setting plaster models in an articulator.

It is an object of the present invention to overcome the described limitations in the prior art, to register the orthopedic lower jaw position, to enable the test and, if necessary, the correction of this position, to allow the positioning of plaster models in an articulator in that position, as well as time and to save costs in the treatment of the CMD, while at the same time reducing possible errors.

The object is achieved by a device which connects two lateral bites (A) consisting of a thermoplastic material which fully cures at mouth temperature (typically 35 ° C) with a flexible wire (V).

The thermoplastic resin batches (A) can be softened in hot water at a temperature between 60 ° C and 80 ° C to be plastically moldable and then slowly harden in the mouth as the patient moves his lower jaw back to the orthopedic position. Due to the delayed hardening, the patient feels a steadily tightening support on the molars and has the possibility to shape any interfering contacts by biting them in correctly. Partial reheating allows the bite to be modified until all the criteria set by the dentist are met, and the superficial, brief warming allows even the finest corrections to be made, because after such a heated device is reinserted in the patient's mouth, it can When biting with the teeth no longer altogether, but depending on the duration of rewarming be deformed only in a more or less thin surface layer. After curing, the patient also feels subtle disagreements in the support of his rows of teeth, because then give the Aufbisse (A) a similar hard contact feeling, as with the bite on your own teeth. A particularly advantageous thermoplastic for this task is polycaprolactone (PCL).

The connecting wire (V) consists of a hypoallergenic material and is designed so that it can be easily bent with the fingers and then remains bleitot and does not spring back. It allows the device to be adapted to different jaw shapes, so that the bites (A) in the correct orientation come to rest on the molars. When heating the Aufbisse (A) of the connecting wire (V) serves as a handle, so that the Aufbisse (A) can be completely immersed in the water bath.

Upon insertion in the mouth, the softened lateral bites (A) can be molded internally and externally to the teeth of the wearer jaw so that after curing, the device is worn by the patient like a bite splint and also tested for extended periods of time (days or weeks) can be. In this way costs and time can be saved in the therapy of the CMD, because the adjustment of the models in the dental articulator takes place only when an allocation of the rows of teeth during the bite in the mouth of the patient has already been tested and has proven itself. This is particularly important, as in the CMD therapy a bite change is always accompanied by risks, because according to the conventional methods, the compatibility of the new bite position turns out only after incorporation of a laboratory-made work and the reactions of the patient are often difficult to predict.

drawings

1 The described device with the two lateral thermoplastic bites (A) connected by a bendable, lingually guided connecting wire (V).

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• US 4211008 [0002]
• DE 10201215223146 A1 [0002]
• DE 102015206490 [0002]
• DE 000019945607 A1 [0002]

Claims (11)

A pre-formed, human dental arch-adapted mouth insert with two lateral thermoplastically formable bites (A) connected by a finger-bendable wire (V). An oral insert according to claim 1, characterized in that the anterior connecting wire (V) is guided lingually without touching the upper or lower incisors. Mouthpiece according to claim 1, characterized in that the bite is carried by the molars after formation of the thermoplastic Aufbisse (A) and the anterior teeth have no contact. An oral insert according to claim 1, with lateral thermoplastic bites (A), which are characterized in that they can be made partially or completely plastically moldable by partial or complete reheating as often as desired, so that the support of the teeth can be modified in steps so long in steps until all requests for a therapeutic bite have been met. Mouthpiece according to claim 1, characterized in that it can be worn for several days by the patient in the mouth, such as a so-called "bite splint", which normally has to be produced with much more effort and expense in the dental laboratory. Mouthpiece according to claim 1, characterized in that it can be formed as a bite bar, without that impressions, tooth models, or any other work documents are required. Mouthpiece according to Claim 1, characterized in that a therapeutic bite can be tested over days and weeks by means of its side hard bites (A) formed on the molars, whereby the tooth contacts impart to it a similarly hard bite feeling as it does on one's own teeth , Mouthpiece according to claim 1, characterized in that it allows at the same time the setting of tooth models in a dental articulator, so that the gypsum teeth in the bite are in exactly the same relation as in the mouth with the teeth of the patient is the case when this bites on it. Mouthpiece according to claim 1, characterized in that the lateral thermoplastic Aufbisse (A) cure after softening by heating during the cooling delayed. Mouthpiece according to claim 1, with lateral thermoplastic bites (A), characterized in that they consist of polycaprolactone (PCL). Mouthpiece according to claim 1, characterized in that it makes it possible to fix the orthopedic position of the lower jaw, which results from the wearing of compensating cushions, in particular the so-called "FreeBite balance" or "FreeBite air", in the mouth and onto the Transfer setting of plaster models into a dental articulator, creating a new system for treating CMD.

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