EP3383272A1 - Procédé de détermination de la force occlusale propre à un patient - Google Patents

Procédé de détermination de la force occlusale propre à un patient

Info

Publication number
EP3383272A1
EP3383272A1 EP16801244.1A EP16801244A EP3383272A1 EP 3383272 A1 EP3383272 A1 EP 3383272A1 EP 16801244 A EP16801244 A EP 16801244A EP 3383272 A1 EP3383272 A1 EP 3383272A1
Authority
EP
European Patent Office
Prior art keywords
teeth
specimen
jaw
preformed
bite
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP16801244.1A
Other languages
German (de)
English (en)
Inventor
Nils Hanssen
Joachim Hey
Jochen Kusch
Tobias Lehner
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
SICAT GmbH and Co KG
Original Assignee
SICAT GmbH and Co KG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by SICAT GmbH and Co KG filed Critical SICAT GmbH and Co KG
Publication of EP3383272A1 publication Critical patent/EP3383272A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/22—Ergometry; Measuring muscular strength or the force of a muscular blow
    • A61B5/224—Measuring muscular strength
    • A61B5/228—Measuring muscular strength of masticatory organs, e.g. detecting dental force
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00—Dental auxiliary appliances
    • A61C19/04—Measuring instruments specially adapted for dentistry
    • A61C19/05—Measuring instruments specially adapted for dentistry for determining occlusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/02—Details of sensors specially adapted for in-vivo measurements
    • A61B2562/0247—Pressure sensors

Definitions

  • the invention relates to a method and a specimen for determining a patient-specific biting force by bite on a introduced between the upper and lower jaw specimens of deformable nature, wherein at a bite a surface of the specimen of the teeth of the patient and / or carried by a jaw means , as a crown, a bridge or a dental splint, and wherein the biting force is determined from the examination of the deformation of the material resulting from the bite process.
  • biting force simple methods are known, which make use of the change of electrical resistances or capacities under pressure. It is also known to use deformation-sensitive piezoelectric films. A particularly simple method makes use of a horseshoe-shaped biting foil with a pressure-sensitive film.
  • DE 10 2013 21 1 623 A1 a method for determining the biting force is known, in which the patient bites on a sample placed between his teeth made of elastic or deformable material and thus presses the smooth surface of the specimen.
  • the deformation of the material is recorded electronically by a movement detection system that detects the movements of the jaw, and from the deformation, the biting force applied to the material is determined on the basis of the material properties of the material deformable material calculated for example by means of the finite element method (FEM).
  • FEM finite element method
  • DE10 2013 21 1 623 A1 uses digital dental impressions which are spatially correct in relation to the recorded movement data. As a result, the compression of the material by the teeth of the patient can be determined at any time and the resulting forces can be determined.
  • US Pat. No. 4,488,873 discloses a method for determining a patient-specific biting force, in which the surface of a test specimen is formed individually by the bite of the teeth.
  • the object of the present invention is now to provide a method to be implemented with simple means and a corresponding test specimen for the improved and spatially resolving determination of patient-specific biting forces.
  • the essence of the invention is to provide the elastic material of the specimen from the outset a defined, the conditions between the jaws individually adapted form and define the position between the jaws of the patient to be examined by this fit.
  • a surface of the test specimen is in front of the bite Patient-individual preformed such that the teeth acting on the specimen and / or the corresponding means carried by the jaw have a defined support during bite.
  • a test specimen according to the invention may consist in one piece of preformed elastic material or have a main body which is covered with preformed surfaces of elastic material.
  • the main body itself can be rigid or elastic.
  • the elastic material does not have to be of homogeneous elasticity.
  • the elasticity of the material in the anterior jaw areas is different than in the rear jaw areas.
  • the elastic material of the specimen is preformed so that the anatomical or implanted conditions, thus the tooth and / or implant surfaces, are embedded in the elastic material of the specimen at least on one side and there is a defined surface bearing in the deformable elastic material.
  • the bite is performed with a certain biting force, so gives the form-fitting preformed material everywhere evenly, in particular with homogeneously distributed drag.
  • the predetermined deformation is thus deepened evenly by the bite and not generated as in the prior art.
  • individual cusps can now be specifically loaded or unloaded.
  • the procedure according to the invention corresponds to a "crash test" in which the deformation is examined after the application of force and the application of force is determined with knowledge of the material properties of the deformed material, in the present case the flexible surface test body, in particular with FEM
  • the specimen is according to the surface of the acting formation preformed.
  • the test specimen can be constructed heterogeneously from different elastic material.
  • the surface is preformed by means of rapid prototyping or a 3D printing process.
  • a variety of elastic materials such as rubber or silicone, can be made into any shape.
  • 3D printing it is even possible to produce a monolithic workpiece that has different degrees of hardness at different points. In this way, optimally adapted to the existing circumstances specimens can be created.
  • the preparation of the test specimens can be carried out on the basis of previously recorded three-dimensional image data.
  • the position of the deformable material with respect to the teeth is exactly defined.
  • An optical scan to detect the position of the elastic material is no longer necessary. Because of the fit of the specimen can be used only in the desired position between the jaws. On the basis of the exact position of the elastic material, a correspondingly accurate force calculation can be carried out. It is sufficient if the test specimen on one side of the jaw fits positively only possibly a few defined places.
  • the forces acting on a tooth relief forces can be considered in advance; if, for example, a single hump (antagonist shape, or similar) is present. Accordingly, the shape of the elastic material for the force measurement can be designed.
  • the specimen can also be optimized by using different Shore hardnesses specifically with regard to the load situation. In addition, it can be designed so that the jaw has to spend a growing closing force when the bite closes. The directions of the vectors from motion data are known. In addition, by dictating the shape of the deformable material, it can be achieved that the patient bites on the material with a predetermined jaw position and jaw orientation.
  • the force distribution can be measured on a therapy rail to compensate for jaw malpositions.
  • the patient wears a system for measuring jaw movement. By measuring jaw movements, the movements can be transferred to the digital impressions of the teeth ("virtual articulator").
  • ⁇ br /> ⁇ br /> In the patient's mouth there is a preformed rubber therapy bar designed in accordance with the invention Knowing the exact position of the preformed therapeutic splint according to the invention, the compression of the splint can be determined by means of the digital impressions.An FEM simulation calculates the forces between the teeth and the rubber bar resulting from the measured displacements.The more uniform the forces on the therapeutic splint the better the therapeutic success will be.
  • the force distribution of a natural final bite can be measured.
  • the patient carries a system for measuring jaw movement. By measuring the movements of the jaw, in turn, the movements can be transferred to the impressions in digital form.
  • the patient carries between the teeth a preformed rubber according to the invention of sufficient thickness, which rests against the lower jaw teeth at least partially positively and which replicates the geometry of the lower jaw teeth on the opposite side. If the patient now bites, the same points between lower jaw (rubber) teeth and upper jaw teeth have contact as in natural occlusion. This performs various jaw closure movements. Since the geometry and location of the rubber are known, the compression of the rubber and, therefrom, the forces at the points of contact between maxillary teeth and lower jaw (rubber) teeth can be determined. If it turns out that the forces (even over time) are unevenly distributed, it is advised to treat the patient with a therapy splint.
  • the procedure according to the invention also makes it possible to determine the force distribution on tooth rails, such as "crunchy splints", in the patient's mouth, for example to compensate for the end bite contacts and to evenly distribute the forces of the contact points
  • tooth rails such as "crunchy splints”
  • the force on the intended splint are determined during biting, the softer the splint, the faster the patient gets into equilibrium of the squeezing forces, as the forces are calculated by the simulation
  • the position where the teeth are in sufficient equilibrium can be recorded and used to make an optimized rail.
  • the printed prototype rail does not have to be completely made of elastic ischemic material but can be combined of soft and hard material.
  • the positive part may be soft and the part that hits the opposing teeth may be hard. This enables the patient to perform sliding movements with the prototype rail as with the final rail, and transverse forces can be measured using the rubber layer.
  • the flexible material of the test specimen can either rest positively only on the upper jaw or only on the lower jaw.
  • the respective other side can be arbitrarily, in particular flat.
  • a bilateral positive connection on the upper jaw and the lower jaw is provided.
  • a specific mandibular position and / or mandibular angle can be specified.
  • FIG. 1 shows a side view of a human denture with a test piece of printed rubber on both sides
  • FIG. 2 shows a strip-shaped test specimen lying against the upper jaw
  • FIG. 3 shows a strip-shaped test specimen lying against the lower jaw
  • FIG. 4 shows two strip-shaped test bodies
  • FIG. 5 introduced between the test specimens according to FIG.
  • FIG. 6 shows an additional strip-shaped test specimen
  • FIG. 7 shows a test piece of printed rubber in a defined manner
  • Opening position which rests at least partially positively on the lower jaw and replicates the contact points of the lower jaw teeth on the upper jaw
  • FIG. 8 shows a printed tooth inserted in a main body
  • Figure 9 is a view from the front of a denture with tooth rail.
  • FIG. 1 shows a side view of a human dentition.
  • the test specimen 1 is a rubber preformed by a 3D printing process, which rests on both the teeth 2 of the upper jaw and on the teeth 3 of the lower jaw in a form-fitting or force-fitting manner. In the position shown, the patient does not apply any biting force.
  • the test piece 4 rests on the teeth 2 of the upper jaw as a thin strip of printed rubber.
  • the test piece 4 replicates the shape of the upper teeth 2.
  • the load situation of the final bite can be simulated with the actual tooth contacts.
  • the sample strip 5 rests against the teeth 3 of the lower jaw.
  • the the Teeth-facing surface of the respective sample strip has a structure corresponding to the opposite faults, thus replicating the surface of the opposite teeth. This can be realized in particular in small jaw openings, characterized in that the sample strip 4 is formed as a rubber strip of uniform thickness to the teeth.
  • a test strip 6 is applied as a layer of printed rubber form-fitting manner to the teeth 2 of the upper jaw and a test strip 7 to the teeth 3 of the lower jaw.
  • This variant is the combination of the two aforementioned, in which case the teeth of both rows of teeth are simulated in the final bite.
  • a further additional layer 8 of specific thickness and individual shaping is now introduced between the two test strips of printed rubber which abut against the rows of teeth of both jaws according to the variant according to FIG.
  • the middle additional layer 8 may be a layer that is available in various thicknesses, hardnesses and jaw angles and can be replaced accordingly.
  • the middle additional layer may also have different elastic ranges.
  • the variant according to FIG. 6 corresponds to that according to FIG. 5, except that the test strips 9 and 10 made of printed rubber each have a plane surface facing away from the teeth.
  • This has the advantage that only the upper and the lower rubber element must be made individually for the patient.
  • the middle additional layer 1 1 is universal and can be used and reused for different patients. The middle additional layer 1 1 can in turn held in different hardnesses, thicknesses and jaw angles and quickly exchanged between individual measuring steps.
  • a commercially available sensor film 12 can also be inserted between the plane boundary surfaces of the test strips 9 and 10. Thus, additional information regarding the biting force can be determined and taken into account in the FEM simulation. Due to the plan interfaces, the measurement is not like in a normal slide measurement falsified there, where the film is discarded by the tooth fissures. A sensor film 12 introduced between the planar interfaces may supplement the FEM force calculation and / or be used for the absolute calibration of the bite forces.
  • the elastic material does not necessarily have to be such that it assumes its original shape when released. It can also be a viscoelastic material that continues to deform without the counterforce of the material increasing. This allows the patient to bite into his individual bite, so that a Quetschbissregistrat arises and a force measurement is possible into the final bite. By knowing the particular viscoelastic material properties, the resulting forces can be calculated down to the final bite situation. An optical image of the material thus deformed into the final bite can give further information of the deformation path, if this can not be completely determined by the simulation.
  • the teeth move apart at larger openings at an angle: The front teeth are typically a greater distance than the rear teeth.
  • the lower jaw moves forward, the farther the mouth is opened, as the jaw joint is a rotary / slip joint.
  • the angle ratio and the lower jaw feed are patient-specific.
  • test piece of preformed rubber is dimensioned such that it matches the patient-individual opening angle ratio and the lower jaw feed.
  • FIG 7a the teeth are shown in the natural final bite.
  • the teeth 2 of the upper jaw have defined patient-specific contact points on the teeth 3 of the lower jaw. For a specimen preformed in this condition, the points of contact would not be the same as in the natural final bite.
  • FIG 7b a wedge-shaped specimen 13 of printed rubber is shown, which is adapted to the individual opening angle situation of the patient. The underside of the wedge 13 is positively against the lower jaw teeth 3, the top of the rubber replicates the shape of the lower jaw teeth as in the natural final bite and also compensates for the lower jaw feed at large opening.
  • a force measurement can now be performed with the same contact points as in the natural final bite.
  • the jaw muscles act in slightly different angles compared to the real final bite, but - because of the knowledge of the opening angle - also this misinformation can be excluded in the simulation.
  • the Shore hardness of the rubber on the front teeth can be made smaller than on the molars. By appropriate distribution of the Shore hardnesses, a linearized force response can be generated because the front teeth travel a greater distance than the molars.
  • the reverse case is also adjustable, with the rubber on the upper side in a form-locking / force-fitting manner against the upper jaw and the underside of the rubber replicating the shape of the upper jaw teeth.
  • the lower jaw variant has the advantage that the rubber can rest on the teeth and does not have to be fastened non-positively to the teeth of the upper jaw.
  • FIG. 8 shows a situation similar to that in FIG. However, a single printed tooth 14 is inserted into the wedge-shaped preformed specimen 15.
  • the printed tooth 14 corresponds to the underlying natural tooth 16 or replaces a tooth gap to be closed by a crown. In this way, the end bite load can be limited to specific teeth.
  • the remaining teeth of the row of teeth 17 have no contact during the measurement.
  • the inserted printed tooth 14 may - as here - correspond to the natural shape of an existing tooth or a planned crown. It can be made of rubber or a harder material, since the wedge-shaped rubber blank yields and is therefore suitable for force measurement.
  • the wedge 15 may be made of a hard material and only the inserted tooth 14 may be made of rubber. It can also be the same tooth used in wedges of different rubber hardnesses. Provided by all around the specimen Mechanical recordings can be used at each tooth position different individual teeth or groups of teeth in the sample body.
  • Figure 9 shows a frontal section through the molars with a view from the front of the patient's mouth.
  • the dental splint rests positively on the right side of the jaw 18 and on the left side of the jaw 19 at least on the upper jaw or lower jaw.
  • the rubber material 20 on the left side is more elastic than the material 21 on the right side. This allows the patient on one side to be brought into an equilibrium of forces faster.
  • Different elasticities could be realized not only by using different base materials, but also by printing cavities or microstructures that can selectively control the elasticity of different areas of the printed products.
  • the cavities could also be filled with a liquid so that different areas of the printed product "communicate" with each other (communicating tubes), thus establishing equilibrium faster.

Abstract

Procédé de détermination de la force occlusale propre à un patient par morsure dans un corps de test à capacité de déformation introduit entre la mâchoire supérieure et la mâchoire inférieure, la force occlusale étant déterminée par l'examen de la déformation du corps de test provoquée par la morsure. Selon l'invention, une surface du corps de test est formée de manière propre au patient avant la morsure pour obtenir un appui défini du corps de test sur les dents et/ou sur des systèmes portés par la mâchoire.
EP16801244.1A 2015-11-30 2016-11-25 Procédé de détermination de la force occlusale propre à un patient Withdrawn EP3383272A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102015120744.3A DE102015120744A1 (de) 2015-11-30 2015-11-30 Verfahren zur Bestimmung der patientenindividuellen Beißkraft
PCT/EP2016/078764 WO2017093128A1 (fr) 2015-11-30 2016-11-25 Procédé de détermination de la force occlusale propre à un patient

Publications (1)

Publication Number Publication Date
EP3383272A1 true EP3383272A1 (fr) 2018-10-10

Family

ID=57394591

Family Applications (1)

Application Number Title Priority Date Filing Date
EP16801244.1A Withdrawn EP3383272A1 (fr) 2015-11-30 2016-11-25 Procédé de détermination de la force occlusale propre à un patient

Country Status (4)

Country Link
US (1) US20180368750A1 (fr)
EP (1) EP3383272A1 (fr)
DE (1) DE102015120744A1 (fr)
WO (1) WO2017093128A1 (fr)

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN113940657B (zh) * 2021-10-22 2024-02-23 宁波口腔医院集团有限公司 一种颞下颌关节动态核磁共振的检查装置

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4488873A (en) * 1983-06-14 1984-12-18 Pennwalt Corporation Piezoelectric polymeric film occlusal force indicator
US5078153A (en) * 1989-03-16 1992-01-07 Jeffrey Y. Nordlander Method and apparatus for sensing and treating bruxism
US6613001B1 (en) * 2000-08-14 2003-09-02 Jeffrey B. Dworkin Intraoral appliance, monitoring device and method of treating patient
JP2012065941A (ja) * 2010-09-27 2012-04-05 Gc Corp 咬合圧測定手段、及び咬合圧測定装置
DE202013101234U1 (de) * 2013-03-22 2014-03-24 Claus-Hinrich Beckmann Bissschiene
DE102013211623B4 (de) 2013-06-20 2016-04-07 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Verfahren zur Bestimmung einer Beißkraft

Also Published As

Publication number Publication date
US20180368750A1 (en) 2018-12-27
WO2017093128A1 (fr) 2017-06-08
DE102015120744A1 (de) 2017-06-01

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