ES2313843A1 - System for the detection and treatment of bruxism and other occlusal conditions - Google Patents

Abstract

The invention relates to a system that can perform the intra-oral detection of bruxist activity and other occlusal conditions and transmit to portable electronic elements which can analyse and interpret the information received and, consequently, act on the patient such as to stop the bruxist activity. The extra-oral actuation is performed by means of elements capable of emitting acoustic, light or vibration signals, as selected, which can be of variable or progressive intensity, so as to alert the patient to his/her unwanted behaviour. The intra-oral actuation stops the bruxist activity through the supply of drugs, bitter substances and/or the application of vibrating or electric stimuli.

Description

System for the detection and treatment of bruxism and other occlusal pathologies.

Technical sector

The invention falls within the technical sector of medical devices for diagnosis and treatment of pain and behavioral disorders More specifically in relation to Temporomandibular and dental joint problems.

State of the art

Bruxism is a condition consisting of grinding or clenching the upper teeth and lower strongly. Both the grinding or sliding as excessive tightening (even causing cracks) causes accentuated tooth wear and produces a sound, which high enough to affect people's sleep with whom the bedroom is shared. The tension produced causes problems in the muscles, tissues and other structures that surrounding the jaw, ear and headaches, injuries to the teeth and disorders in the jaw joints. Everybody these symptoms are usually defined together as problems of Temporomandibular joint "ATM" ("TMJ" temporo mandibular joint) or also Pain Syndrome - Dysfunction Craniomandibular

A traditional treatment for this pathology It consists of the introduction of a protective acrylic material between the teeth, usually known as a splint, that protects mouthpieces of mutual contact, in an attempt to reduce the wear and distribute loads among a greater number of teeth. Although tightening wear is mitigated in this way, the protector does not prevent the grinding or transverse bruxism, which in numerous occasions continue indefinitely. Besides, the introduction of bulky protectors favors in many occasions reflexes that increase the tendency to bite. Among the patents queries related to devices to reduce the effects of bruxism can be cited US 2006021622, JP 2004329242, WO03057097, JP2001161736 and US6302110.

A second traditional treatment for bruxism is the occlusal adjustment, consisting of selective carving of the dental pieces, to get a more bite pattern uniform. Although effective on certain occasions, irreversibility of the process coupled with its complexity are factors that limit the Use of this technique.

Most studies related to etiology of bruxism agree that its origin is a set of combined factors, typically stress or anxiety, coupled with TMJ problems or occlusal defects. Consequently they have developed active systems, which aim to reduce the problem through behavior modification therapies. These systems they generally consist of a sensor, which detects the beginning of Bruxist activity and communicates it to an actuator, which emits a signal to alert the patient of his activity. The intention is to create a conditioned reflex in the patient, who gradually abandons his bruxist habit to avoid the negative stimulus.

As sensors in active anti -ruxist systems two clearly differentiated tendencies are generally used. In first place surface electromyographs (extrabuccal) to Detect the activity of the masseter muscles. Secondly sensors embedded in conventional (intra-oral) splints to Detect the bite.

As actions found in active systems antibruxists to alert the patient stand out, stimuli audible, electrical stimuli, relaxant supply muscle, supply of bitter fluids and injection of painkillers or botulinum toxin.

As part of the State of the Art they are exposed to then some of the active systems to combat the Bruxism that have been patented.

WO2005067833 (Burger Michael Albertus) has a splint with signal receiving antennas electrical muscles of the jaw which, upon detecting the Bruxism, acts by emitting electrical stimuli.

WO03059160 (Yerushalmy Israel) It has a surface electromyography sensor, adapted to provide a relaxing stimulus (nervous or muscular) to the cessation of activity

US6632843 (Friedman Mark) describes a device for supplying a relaxing substance, such as cyclobenzaprine by means of an organic gel. The composition is applied directly to the skin adjacent to the muscles temporary and masseter, cause of the bite.

US6270466 (Weinstein Lee) shows a system that detects bruxist activity by an electromyograph of surface arranged on a patient adjustable facial tape. To the detect the onset of dental clenching, act by issuing a alert sound

Patent US6164278 (Nissani Moti) deals with a bite sensor system that supplies bitter liquid to cause opening of the patient's mouth.

US5586862 (Matz Warren) describes a interdental pressure sensor that activates an alarm to indicate that unwanted behavior is happening. Describe your job in other sleep disorders such as apnea.

US5490520 (Siedband Melvin) discloses a splint-shaped device, sensors and electrodes to act issuing small downloads when the activity occurs Bruxist

US5078153 (Nordlander Jeffrey) patent deals with on a splint with piezoelectric sheets that detect the bite and broadcast by radio to an alarm emitter to make Patient aware of their activity.

Patent DE102004043665 (Wolf Bernhard) proposes a splint for intrabuccal magnitude detection and sending said information to an external device for subsequent evaluation. But it does not propose action, neither intra-oral, nor extrabuccal, for the treatment of intrabuccal problems.

Although active systems have been designed to prevent the onset of bruxist activity or eliminate it, these systems have normally had limited effectiveness by numerous reasons, such as excessive size, discomfort for employment daytime or discomfort during sleep. For these reasons the splint Conventional passive is still the most commonly used method against bruxism

A system with this invention is proposed improved to influence the patient's behavior, facing reduce or eliminate your bruxist activity, by means of a comfortable, discreet, aesthetic device that allows its use both day and night, and with performance, both intrabuccal and extra-oral, depending on the user's needs. Also the ability to record information enables work Diagnostic and follow-up.

Detailed description of the invention

The present invention comprises an intrabuccal device capable of detecting and treating bruxist activity and other occlusal pathologies, by means of transmission to portable electronic elements, which, thanks to their ability to analyze and interpret the information received, act (intrabuccal and / or extrabucally) on the patient for the cessation of bruxist activity. The extra-oral action is carried out by means of elements capable of emitting acoustic, vibratory, luminous or combination signals thereof, at the choice of user or of the prescriber and of controllable intensities and durations, which alert the patient to their unwanted behavior. Intrabuccal action stops bruxist activity through the supply of drugs, supply of bitter substances and / or application of electrical or vibratory stimuli. The use is mainly therapeutic, acting to suppress bruxist activity, and the harmful associated effects of dental wear, TMJ problems and muscle and headaches. Its ability to record bite intensity, duration of bruxist events, frequency and time of day, allows
In addition, the use in diagnostic and preventive tasks, as well as in the study of the evolution of patients.

Thus, the anti -ruxist device object of Patent has 5 main functions:

to.

Intrabuccal movement detection as the first step to perceive the beginning of behavior Bruxist

b.

Registration of direct measures in the patient, of joint evaluations of the same and of the device performances. In addition the registration will be used in evaluations of patient improvement by prescribers and in diagnostic and preventive tasks.

C.

Transmission primarily of intra-oral information abroad and, if applicable, information extrabuccal into the mouth. In addition the transmission of device information to a wider network: patient a dentist, and vice versa, allows multiple own functionalities of telemedicine. The transmission also includes the transmission of orders of action on the patient, in the event that the actuator is separated from the control module.

d.

Interpretation - command or confrontation of what is registered with a model to identify the bruxist origin of the signal and start the advisable action. Consequently, generation of orders to execute said action.

and.

Intrabuccal and / or extrabuccal performance by generating a stimulus detectable by the patient - consciously or unconsciously, aimed at suppressing Bruxist episode

The modules that are detailed below are detailed make up the invention, related to the uses of device, the design of the physical support and the functions of detection, registration, transmission, interpretation, command and performance.

The orientation of the device to the treatment it requires a less invasive physical support (that modifies less the usual mandibular interaction), discriminator of the points in those that the contact occurs (along the surface occlusal), and selective regarding the type of bruxist behavior, distinguishing between perpendicular, transverse and intermittent. Your employment throughout the day (day and night) leads to a physical support in which they are taken into account outstanding considerations both ergonomic and aesthetic. Saying support consists of an interdental biocompatible polymeric plate compatible with splint manufacturing processes Traditional The control electronics are housed in the Side lobbies, shown in the accompanying drawings. Likewise the physical support may not cover neither canines nor incisors to allow daytime use comfortably, aesthetically acceptable and that does not make speech difficult. Thanks to its optimized size, the mandibular interaction will be reduced and the bite pattern is not You will see it significantly altered. You can also have a bridge located in the palatal area, to accommodate cables connection between 1 (see Figures 1 and 2).

Bite sensors are placed distributed inside the splint or intrabuccal support during the process of manufacturing, for your protection and to get the thickness final is equivalent to Michigan splints or discharge conventional. Suitable sensors are used as sensors for this end (type of piezoelectric ceramic, conductive elastomers, polymeric sheets, electroactive polymers or others); rehearsed conveniently to optimize its performance, size, sensitivity, repeatability and resistance to wear and consumption, taking into account biocompatibility and avoiding the use of toxic elements

For intrabuccal performance, they are included in the intrabuccal support capsules for drug delivery or bitter substances, as well as stimulus generating elements electric or vibratory

The extrabucal actuation device alerts the patient progressively from the beginning of his bruxist activity, with the intention of raising awareness for the voluntary cessation of said activity. The performance is optional or combined between vibratory, luminous acoustics, according to the needs or preferences of the patient.

The telephone is used as an external actuator mobile, electronic diary, patient PDA or any type of electronic device capable of reproducing acoustic stimuli, vibratory and / or luminous (see Figure 1), together with a communication suitable with the intrabuccal device.

As an external electronic control element that performs registration, interpretation and command functions, is used a remote control unit, a fixed or portable computer, a mobile phone, an electronic phonebook or any device portable or fixed electronic, for reception, processing and registration of the signal sent by the intrabuccal device. The transmission of information from the sensor element and the element of control and action is carried out using any type of means or communication protocol, both wired and wireless (for example Bluetooth, Zig-Bee, radio or infrared).

In the case of space problems and lack of emission power, the use of repeaters is possible intermediate (usually external and close to the face of the patient as earring, necklace, button, glasses or the like) to connect the signals generated by the intrabuccal device with the external control-actuation element (telephone mobile or alternative device). Also to improve the sending of signals generated by extrabuccal devices until the intrabuccal device

The characteristics of the registration system They allow easy use in telemedicine environments. He patient can contribute the information registered to the consultation of the dentist or prescriber; well shaped card carried personally during the consultation, well read directly from the same mobile phone or control element, even being able to carry out the distance reading using the networks existing, such as mobile telephony. The device it also allows the reception of signals from said external networks for modification of their behavior.

Brief description of the drawings

Figure 1.- Schematic representation of the main elements of the invention. They are shown in Figure 1 the different components of the antibruxist device object of the present invention:

1.- Intrabuccal physical support that performs the bite detection, signal preprocessing and its Shipping.

2.- Optional intermediate receiver for support in signal forwarding tasks.

3.- External control element.

Figure 2.- Illustration of the physical support intrabuccal It is basically similar to splints conventional U-shaped, which reproduce the dental form. Without However, the anterior zone (corresponding to incisors and canines) has been eliminated for aesthetic and comfort reasons, which allow its daytime use since the support is hidden. The sides they have housings for the necessary intra-oral electronics, and can be connected to each other by means of a bridge that contributes to the rigidity of the piece.

Figure 3.- Scheme of the necessary electronics to treat and emit the sensor signal.

4.- Sensors.

5.- Power supply.

6.- Electronic circuit.

Figure 4.- Diagram of the silicone matrix for the sensor. The silicone matrix is not shown in Figure 4 conductive necessary as a support for the piezoresistive sensor. The holes and slots in the figure are filled with silicone conductive and the conductive silicone terminals connect to the electronic intra-oral control device.

Exposure of at least one embodiment of the invention

The present invention is further illustrated. by the following embodiment, which is not intended to be limiting its scope.

The manufacture of the physical support corresponds with conventional manufacturing processes by layers of Michigan splints and discharge (Figure 2). In the process itself The sensor is included between two layers of material polymeric support.

In the case of the polymeric piezoelectric sensor, a sheet is cut according to the dimensions of the intrabuccal support of metallized polymer on both sides that act as electrodes. A cable is attached by means of adhesives or welding to each side of the  sheet and connect to the electronic control device intrabuccal

In the case of the piezoresistive sensor, it first manufactures a non-conductive silicone matrix by injection into a mold (Figure 4). Then fill in the holes of the matrix with conductive silicone by means of techniques of  injection or injection-compression. The terminals of conductive silicone connect to the electronic device of intrabuccal control

The vestibular accommodations for the Intra-oral control electronics can be manufactured by injection of thermoplastic material and subsequently join the dental support using biocompatible adhesives, heat welding or any joint in order to obtain complete intrabuccal support.

The intrabuccal control device consists of an electronic circuit, an energy accumulator, a transducer and an antenna

The electronic circuit is distributed in one or several printed circuit boards, as appropriate to optimize use the available space, and perform the following tasks: intrabuccal sensor signal conditioning, processing of the aforementioned signal, power management for food of any system and communications with the portable device external or, where appropriate, with the external signal repeater.

The signal conditioning consists of correct excitation of the intrabuccal sensor and the adequacy of electrical characteristics of the signal as it is obtained from sensor at values that allow optimal processing of the same.

The processing extracts the information from the signal obtained from the intrabuccal sensor that allows determining the existence or not of a bruxist episode and act accordingly. He processing is distributed between the intra-oral control device and portable external device to optimize restrictions of power consumption and of volume-calculation

Energy management extends the autonomy of device maximizing the useful energy that can be extracted from the accumulator and allows, in the case of a rechargeable accumulator, the recharge it.

Communications, wireless and bidirectional, allow to send the result of the processing of the signal from the intrabuccal sensor to the external portable device and receive commands from the external portable device to modify the  Operation parameters of the intrabuccal device.

The energy accumulator provides the energy electrical necessary for the autonomous operation of the device for enough time to meet your goals in a way practice, although it may require refills or replacements periodic. This accumulator can be based on physical principles (condenser), electrochemical (battery) or both (supercapacitor) and Be rechargeable or not.

The antenna allows to establish a link of bidirectional wireless communication between the device control and external portable device with a speed enough to monitor the bruxist episode in time real.

All these elements of the control device intrabuccal are stuffed during the manufacturing process in the splint material to provide them with mechanical fixation and The necessary tightness.

The signal emitted from inside the mouth is received by the external control and actuation device, by example mobile phone or PDA of the patient. After processing correctly the information received, the action is taken taking advantage of the vibrator or speaker of said mobile phone itself or PDA (Figure 1).

Claims (10)

1. System for detection and treatment of bruxism and other occlusal pathologies, which includes:

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 an intrabuccal physical support that hosts, among other components:

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one sensor or more, for the detection and overall characterization of the  user bruxist activity, distributed in such a way that allow differential diagnosis between perpendicular bruxism, transverse or intermittent;

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intra-oral electronics, with at less battery, processor and antenna, for treatment and shipping to external devices of the information coming from the sensors, as well as for the reception of external signals;

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one or more controlled actuators by intrabuccal electronics to induce cessation of activity bruxist;

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 an electronic element external, with functions of:

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reception and evaluation of intrabuccal signals, with criteria consistent with the pathology of the user and its evolution;

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decision of the proceedings to follow according to the user's needs and send the orders of associated control, for the activation of extra-oral actuators and / or intrabuccal;

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acoustic performance possibilities, vibratory, luminous or combination thereof or any other type, with control over their intensities and durations;

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data storage of the Bruxist activity, of the actions performed on the user and its responses to these actions.

2. System according to claim 1, wherein intrabuccal actuators stop bruxist activity by drug supply, supply of bitter substances and / or application of electrical or vibratory stimuli. 3. System according to claims 1 and 2, in the that the communication of information between the intra-oral device and the external electronic element is realized by means of wireless technologies (for example Bluetooth, Zig-Bee, radio, infrared or any other technology). 4. System according to claims 1 to 3, in the that the external electronic element is a control unit remote, a fixed or portable computer, a mobile phone, an agenda electronics or any portable or fixed electronic device, for the reception, processing and recording of the signal sent by the intrabuccal device 5. System according to claims 1 to 4, in the that one or more portable intermediate devices are used or fixed as signal repeaters. 6. System according to claims 1 to 5, in the that the sensor for the detection of bruxist activity can be manufacture with electroactive polymers or conductive elastomers or combination of both. 7. System according to claims 1 to 6, in the that the sensor for the detection of bruxist activity can be piezoresistive or piezoelectric or combination of both. 8. System according to claims 1 to 7, which employs the communication capabilities of the external element in telemedicine work, for the transmission of information registered or processed, through a public telephone network and / or of data, to a dental checkpoint to be analyzed and decide on possible modifications in the treatment. 9. System according to claims 1 to 8, which employs the communication capabilities of the external element in Telemedicine work, for the reception of information, through of a public telephone and / or data network, from a point of dental control to enable modifications in the treatment. 10. Use of the system described in claims previous for the performance of telemedicine work based on the information recorded, processed or analyzed and to the capacity information exchange with external telephone networks and / or data.