US20010005577A1 - Subperiosteal bone anchor - Google Patents

Subperiosteal bone anchor Download PDF

Info

Publication number
US20010005577A1
US20010005577A1 US09/783,177 US78317701A US2001005577A1 US 20010005577 A1 US20010005577 A1 US 20010005577A1 US 78317701 A US78317701 A US 78317701A US 2001005577 A1 US2001005577 A1 US 2001005577A1
Authority
US
United States
Prior art keywords
scallops
bone anchor
stemplant
anchor according
subperiosteal bone
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.)
Granted
Application number
US09/783,177
Other versions
US6379154B2 (en
Inventor
John Devincenzo
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.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Priority to US09/783,177 priority Critical patent/US6379154B2/en
Publication of US20010005577A1 publication Critical patent/US20010005577A1/en
Priority to EP01307319A priority patent/EP1236443B1/en
Priority to DE60126734T priority patent/DE60126734T2/en
Application granted granted Critical
Publication of US6379154B2 publication Critical patent/US6379154B2/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0018Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools characterised by the shape
    • A61C8/0022Self-screwing
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0018Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools characterised by the shape
    • A61C8/0031Juxtaosseous implants, i.e. implants lying over the outer surface of the jaw bone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0093Features of implants not otherwise provided for
    • A61C8/0096Implants for use in orthodontic treatment

Definitions

  • This invention relates to a single leaf stemplant or subperiosteal bone anchor to provide a point of tension for the purpose of moving a dental patient's teeth.
  • a basic problem with known subperiosteal bone anchors is that they require complicated surgical procedures to implant them into a patient's bone. Additionally, known anchors are not readily adaptable to a irregular bone surfaces which impedes osteointegration.
  • a subperiosteal bone anchor comprising upper and lower portions joined to form a unitary stemplant and multiple scallops joined to the stemplant and extending outwardly therefrom.
  • FIG. 1 is a front perspective view of subperiosteal bone anchor according to this invention.
  • FIG. 2 is a front elevational view of a modified form of the bone anchor shown in FIG. 1.
  • FIG. 3 is a front perspective view of a further modification of the invention.
  • FIG. 4 is a front elevational view of the stemplant shown in FIG. 3;
  • FIG. 5 is a top plan view of the stemplant shown in FIG. 3.
  • the numeral 1 generally designates the bone anchor constructed according to this invention and which comprises upper portion 2 and lower portion 3 joined together to form an elongated stemplant.
  • Upper portion 2 of bone anchor 1 extends outwardly from a patient's soft tissue and lower portion 3 is installed in a patient's bone.
  • the shape of upper portion 2 can include a variety of shapes and configurations as necessitated by the particulars of the desired end result.
  • lower portion 3 is threaded so as to allow it to be screwed into the bone.
  • the threaded grooves can be eliminated and replaced by vertical grooves or staple-like lateral projections. With vertical grooves or lateral projections, the stemplant is simply pounded or driven into position which is a simpler surgical procedure than screwing it into position.
  • collar 4 is affixed to the stemplant 1 approximately at the midpoint thereof.
  • multiple scallops 5 are attached to collar 4 by any suitable means such as welding and the like and extend outwardly therefrom.
  • Scallops 5 are thin and are made of any known osteointegratable material. Since scallops 5 are malleable they can be bent upwardly to facilitate insertion of stemplant 1 into the bone and then bent downwardly to conform precisely to the varying contours of the surface of the bone. Lamellar bone strips can be laid over scallops 5 to facilitate osteointegration.
  • scallops 5 bone has difficulty in growing over a projection, such as scallops 5 , more than 0.015 of an inch thick.
  • optimumly scallops 5 should be thinner at the peripheries than the remainder of the scallops and the peripheries should be in the range of 0.006 to 0.007 of an inch thick.
  • the relative thinness of scallops 5 allows the practitioner to bend the individual scallops in order to closely approximate the undulations in the adjacent surface of the bone.
  • stemplant 1 comprises a single unitary stem comprising upper portion 2 and lower portion 3 , scallops 5 are extendable outwardly 360 degrees around stemplant 1 to provide more positioning sites with the maximum number of scallops 5 available for adaptation to the bony surface. Additionally, since scallops 5 closely approximate the surface of the bone, bone overgrowth and resultant osteointegration are enhanced.
  • the unitary feature of the stemplant maximizes access to difficult areas in the mouth, facilitates insertion into the bone and eliminates the need for multiple screws or other attachment means.
  • collar 4 provides a definitive stopping point during the insertion procedure.
  • the single unitary central stemplant is adaptable for increased load capacity by simply increasing the diameter of the stemplant. The length and width of scallops 5 can be increased which allows for added surface contact with the bone.
  • FIG. 2 A variation of the invention is shown in FIG. 2 whereby rigid cap 6 is provided and includes aperture 7 .
  • upper portion 2 is inserted through aperture 7 thereby causing cap 6 to overlie scallops 5 .
  • Cap 6 is vertically adjustable and is maintained in position by the tension of the overlying periosteum. The purpose of cap 6 is to prevent connective tissue ingrowth and facilitate bone overgrowth.
  • FIGS. 3, 4 and 5 A modification of the stemplant according to this invention is shown in FIGS. 3, 4 and 5 and includes multilateral upper portion 8 and threaded lower portion 9 .
  • Indented ring 10 is formed in upper portion 8 and sphere 11 is integrally joined to the top of upper portion 8 .
  • Multiple scallops 12 extend from the stemplant generally at the junction between upper portion 8 and lower portion 9 .
  • Each scallop 12 is separated from the adjacent scallop by elongated narrow slits 13 .
  • Slits 13 provide flexibility in adapting each scallop 12 to the underlying surface of the bone.
  • V-shaped sections 14 are formed in scallops 12 so as to promote migration of bone cells onto the upper surfaces of scallops 12 which substantially facilitates osteointegration.
  • the diameter of sphere 11 is less than the distance between parallel sides of multilateral upper portion 8 . This is essential whereby a socket wrench can be slipped over sphere 11 and onto multilateral upper portion 8 and manipulated so as to screw threaded lower portion 9 into the patient's bone. Then the desired orthodontic appliance is attached to the stemplant at indented ring 10 so as to effectuate the desired force. Indented ring 10 prevents the vertical migration of the attached orthodontic appliance in the direction of the soft tissue which often occurred in prior stemplants thereby causing them to fail.
  • a stemplant is provided which is much quicker to insert because it is simply screwed or pounded into a patient's bone whereas previous devices required attachment by means of separate screws which, of course, requires precise alignment in the drilling process. Additionally, the use of screws limited the areas in which the stemplant could be placed and required that it be placed where access was the greatest.
  • the stemplant can be placed in almost any part of the mouth without having to first tap the one or more screw holes as required for stabilization during the osseointegration process.

Abstract

A unitary subperiosteal bone anchor having upper and lower portions joined to form a stemplant, and multiple scallops joined to the stemplant and extending outwardly therefrom.

Description

  • This is a continuation-in-part of application Ser. No. 09/421,019 filed Oct. 19, 1999. [0001]
  • BACKGROUND OF THE INVENTION
  • This invention relates to a single leaf stemplant or subperiosteal bone anchor to provide a point of tension for the purpose of moving a dental patient's teeth. A basic problem with known subperiosteal bone anchors is that they require complicated surgical procedures to implant them into a patient's bone. Additionally, known anchors are not readily adaptable to a irregular bone surfaces which impedes osteointegration. [0002]
  • SUMMARY OF THE INVENTION
  • A subperiosteal bone anchor comprising upper and lower portions joined to form a unitary stemplant and multiple scallops joined to the stemplant and extending outwardly therefrom. [0003]
  • BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
  • In the drawings, [0004]
  • FIG. 1 is a front perspective view of subperiosteal bone anchor according to this invention; [0005]
  • FIG. 2 is a front elevational view of a modified form of the bone anchor shown in FIG. 1. [0006]
  • FIG. 3 is a front perspective view of a further modification of the invention; [0007]
  • FIG. 4 is a front elevational view of the stemplant shown in FIG. 3; and [0008]
  • FIG. 5 is a top plan view of the stemplant shown in FIG. 3. [0009]
  • DETAILED DESCRIPTION OF THE INVENTION
  • In the drawings, the numeral [0010] 1 generally designates the bone anchor constructed according to this invention and which comprises upper portion 2 and lower portion 3 joined together to form an elongated stemplant. Upper portion 2 of bone anchor 1 extends outwardly from a patient's soft tissue and lower portion 3 is installed in a patient's bone. Of course, the shape of upper portion 2 can include a variety of shapes and configurations as necessitated by the particulars of the desired end result. As shown in the drawings, lower portion 3 is threaded so as to allow it to be screwed into the bone. Of course, the threaded grooves can be eliminated and replaced by vertical grooves or staple-like lateral projections. With vertical grooves or lateral projections, the stemplant is simply pounded or driven into position which is a simpler surgical procedure than screwing it into position.
  • According to one feature of this invention, [0011] collar 4 is affixed to the stemplant 1 approximately at the midpoint thereof. To complete the basic elements of the stemplant, multiple scallops 5 are attached to collar 4 by any suitable means such as welding and the like and extend outwardly therefrom. Scallops 5 are thin and are made of any known osteointegratable material. Since scallops 5 are malleable they can be bent upwardly to facilitate insertion of stemplant 1 into the bone and then bent downwardly to conform precisely to the varying contours of the surface of the bone. Lamellar bone strips can be laid over scallops 5 to facilitate osteointegration.
  • Through clinical research, it has been determined that bone has difficulty in growing over a projection, such as [0012] scallops 5, more than 0.015 of an inch thick. In fact, optimumly scallops 5 should be thinner at the peripheries than the remainder of the scallops and the peripheries should be in the range of 0.006 to 0.007 of an inch thick. Also, the relative thinness of scallops 5 allows the practitioner to bend the individual scallops in order to closely approximate the undulations in the adjacent surface of the bone.
  • To those skilled in the art, it will be understood that since stemplant [0013] 1 comprises a single unitary stem comprising upper portion 2 and lower portion 3, scallops 5 are extendable outwardly 360 degrees around stemplant 1 to provide more positioning sites with the maximum number of scallops 5 available for adaptation to the bony surface. Additionally, since scallops 5 closely approximate the surface of the bone, bone overgrowth and resultant osteointegration are enhanced.
  • Of course, the unitary feature of the stemplant maximizes access to difficult areas in the mouth, facilitates insertion into the bone and eliminates the need for multiple screws or other attachment means. Also, [0014] collar 4 provides a definitive stopping point during the insertion procedure. In addition, the single unitary central stemplant is adaptable for increased load capacity by simply increasing the diameter of the stemplant. The length and width of scallops 5 can be increased which allows for added surface contact with the bone.
  • A variation of the invention is shown in FIG. 2 whereby [0015] rigid cap 6 is provided and includes aperture 7. During the insertion procedure, upper portion 2 is inserted through aperture 7 thereby causing cap 6 to overlie scallops 5. Cap 6 is vertically adjustable and is maintained in position by the tension of the overlying periosteum. The purpose of cap 6 is to prevent connective tissue ingrowth and facilitate bone overgrowth.
  • A modification of the stemplant according to this invention is shown in FIGS. 3, 4 and [0016] 5 and includes multilateral upper portion 8 and threaded lower portion 9. Indented ring 10 is formed in upper portion 8 and sphere 11 is integrally joined to the top of upper portion 8. Multiple scallops 12 extend from the stemplant generally at the junction between upper portion 8 and lower portion 9. Each scallop 12 is separated from the adjacent scallop by elongated narrow slits 13. Slits 13 provide flexibility in adapting each scallop 12 to the underlying surface of the bone. Further, V-shaped sections 14 are formed in scallops 12 so as to promote migration of bone cells onto the upper surfaces of scallops 12 which substantially facilitates osteointegration.
  • In FIG. 5, it is readily apparent that the diameter of sphere [0017] 11 is less than the distance between parallel sides of multilateral upper portion 8. This is essential whereby a socket wrench can be slipped over sphere 11 and onto multilateral upper portion 8 and manipulated so as to screw threaded lower portion 9 into the patient's bone. Then the desired orthodontic appliance is attached to the stemplant at indented ring 10 so as to effectuate the desired force. Indented ring 10 prevents the vertical migration of the attached orthodontic appliance in the direction of the soft tissue which often occurred in prior stemplants thereby causing them to fail.
  • Therefore, by this invention, a stemplant is provided which is much quicker to insert because it is simply screwed or pounded into a patient's bone whereas previous devices required attachment by means of separate screws which, of course, requires precise alignment in the drilling process. Additionally, the use of screws limited the areas in which the stemplant could be placed and required that it be placed where access was the greatest. By this invention, the stemplant can be placed in almost any part of the mouth without having to first tap the one or more screw holes as required for stabilization during the osseointegration process. [0018]

Claims (12)

1. A subperiosteal bone anchor comprising an elongated stemplant, multiple elongated planar scallops attached to said stemplant and extending outwardly therefrom, said scallops being moldable to conform to the contours of adjacent bone, and said scallops being equal to or less than 0.015 of an inch thick.
2. A subperiosteal bone anchor according to
claim 1
wherein said stemplant comprises lower and upper portions with a collar disposed intermediate said portions.
3. A subperiosteal bone anchor according to
claim 1
wherein said scallops extend 360 degrees around the periphery of said collar.
4. A subperiosteal bone anchor according to
claim 1
wherein a rigid cap is coaxially disposed with respect to said upper portion and overlies said scallops.
5. A subperiosteal bone anchor according to
claim 1
wherein the peripheries of said scallops are thinner than the remainder thereof.
6. A subperiosteal bone anchor according to
claim 1
wherein said scallops are of substantially uniform width.
7. A subperiosteal bone anchor according to
claim 1
wherein said stemplant comprises lower and upper portions and wherein lateral projections are formed on said lower portion.
8. A subperiosteal bone anchor comprising an elongated stemplant, multiple planar scallops attached to said stemplant and extending outwardly therefrom, said scallops being moldable to conform to the contours of adjacent bone, said scallops being separated by elongated narrow slits, and V-shaped cutouts formed in said scallops.
9. A subperiosteal bone anchor according to
claim 8
wherein said stemplant comprises an upper portion and a lower portion and wherein said upper portion is of a multilateral configuration.
10. A subperiosteal bone anchor according to
claim 9
wherein an indented ring is formed in said upper portion.
11. A subperiosteal bone anchor according to
claim 10
wherein a sphere is integrally joined to the top of said upper portion and wherein the diameter of said sphere is less than the distance between parallel sides of said upper portion.
12. A subperiosteal bone anchor according to
claim 9
wherein said lower portion is threaded.
US09/783,177 1999-10-19 2001-02-14 Subperiosteal bone anchor Expired - Fee Related US6379154B2 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US09/783,177 US6379154B2 (en) 1999-10-19 2001-02-14 Subperiosteal bone anchor
EP01307319A EP1236443B1 (en) 2001-02-14 2001-08-29 Subperiosteal bone anchor
DE60126734T DE60126734T2 (en) 2001-02-14 2001-08-29 Superiosteal bone anchor

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US42101999A 1999-10-19 1999-10-19
US09/783,177 US6379154B2 (en) 1999-10-19 2001-02-14 Subperiosteal bone anchor

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US42101999A Continuation-In-Part 1999-10-19 1999-10-19

Publications (2)

Publication Number Publication Date
US20010005577A1 true US20010005577A1 (en) 2001-06-28
US6379154B2 US6379154B2 (en) 2002-04-30

Family

ID=25128420

Family Applications (1)

Application Number Title Priority Date Filing Date
US09/783,177 Expired - Fee Related US6379154B2 (en) 1999-10-19 2001-02-14 Subperiosteal bone anchor

Country Status (3)

Country Link
US (1) US6379154B2 (en)
EP (1) EP1236443B1 (en)
DE (1) DE60126734T2 (en)

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1236443A1 (en) * 2001-02-14 2002-09-04 John Devincenzo Subperiosteal bone anchor
US20060281049A1 (en) * 2005-06-14 2006-12-14 Chih-Chung Ho Abutment for dental implant
US20100331997A1 (en) * 2008-02-23 2010-12-30 Karl-Heinz Sorg Implant for introduction into an alveolar space
US20110008745A1 (en) * 2008-02-01 2011-01-13 Mcquillan Paul Orthodontic bone anchor plate with mesh pad
US20150125818A1 (en) * 2013-11-01 2015-05-07 Medintal Ltd. Sub-periosteal extension for a dental implant
US20150157424A1 (en) * 2012-05-10 2015-06-11 Homayoun H. Zadeh Dental devices for extraction site reconstruction
EP2946745A1 (en) * 2003-09-16 2015-11-25 Bredent Dentalgeräte und Materialien Fach- und Organisationsberatung Peter Brehm Positioning screw for the production of a set of dentures for an untoothed or partially toothed jaw
US11452583B2 (en) * 2019-01-10 2022-09-27 Paramvir Singh Dental implant evaluation unit

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100256773A1 (en) * 2007-07-03 2010-10-07 Vlaamse Instelling Voor Technologisch Onderzoek N.V. (Vito) Surgical implant composed of a porous core and a dense surface layer
EP3128988B1 (en) 2014-04-11 2019-12-25 Biomet 3i, LLC Implant with high primary stability and accelerated secondary stability
TWI746408B (en) * 2021-05-20 2021-11-11 浩鋒 關 Dental implants that can improve stability

Family Cites Families (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4531916A (en) * 1983-07-08 1985-07-30 W. L. Gore & Associates, Inc. Dental implant with expanded PTFE gingival interface
US5052930A (en) * 1989-11-22 1991-10-01 Lodde Jean Pierre Dental implant and method of implantation
US5378152A (en) * 1992-05-01 1995-01-03 Dental Marketing Specialists, Inc. Method and apparatus for installation of dental implant
US5427526A (en) * 1993-12-13 1995-06-27 Fernandes; Americo Dental implant and dentistry implant method
US5571017A (en) * 1994-10-05 1996-11-05 Core-Vent Corporation Selective surface, externally-threaded endosseous dental implant
US5853291A (en) * 1997-10-10 1998-12-29 Devincenzo; John Subperiosteal bone anchor
DE19907420B4 (en) * 1999-02-20 2005-08-11 Universität Leipzig Subperiosteal implant system to stimulate new bone formation
US6379154B2 (en) * 1999-10-19 2002-04-30 John Devincenzo Subperiosteal bone anchor

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1236443A1 (en) * 2001-02-14 2002-09-04 John Devincenzo Subperiosteal bone anchor
EP2946745A1 (en) * 2003-09-16 2015-11-25 Bredent Dentalgeräte und Materialien Fach- und Organisationsberatung Peter Brehm Positioning screw for the production of a set of dentures for an untoothed or partially toothed jaw
US20060281049A1 (en) * 2005-06-14 2006-12-14 Chih-Chung Ho Abutment for dental implant
US7351060B2 (en) * 2005-06-14 2008-04-01 Ho Chih-Chung Abutment for dental implant
US20110008745A1 (en) * 2008-02-01 2011-01-13 Mcquillan Paul Orthodontic bone anchor plate with mesh pad
US20100331997A1 (en) * 2008-02-23 2010-12-30 Karl-Heinz Sorg Implant for introduction into an alveolar space
US20150157424A1 (en) * 2012-05-10 2015-06-11 Homayoun H. Zadeh Dental devices for extraction site reconstruction
US20230181293A1 (en) * 2012-05-10 2023-06-15 Homayoun H. Zadeh Dental devices for extraction site reconstruction
US20150125818A1 (en) * 2013-11-01 2015-05-07 Medintal Ltd. Sub-periosteal extension for a dental implant
US9782240B2 (en) * 2013-11-01 2017-10-10 Medintal Ltd. Sub-periosteal extension for a dental implant
US11452583B2 (en) * 2019-01-10 2022-09-27 Paramvir Singh Dental implant evaluation unit
US20220401190A1 (en) * 2019-01-10 2022-12-22 Paramvir Singh Dental implant evaluation unit

Also Published As

Publication number Publication date
DE60126734T2 (en) 2007-12-06
EP1236443A1 (en) 2002-09-04
DE60126734D1 (en) 2007-04-05
US6379154B2 (en) 2002-04-30
EP1236443B1 (en) 2007-02-21

Similar Documents

Publication Publication Date Title
US5759034A (en) Anatomical restoration dental implant system for posterior and anterior teeth
US6394806B1 (en) Snap-in healing cap
EP2713939B1 (en) Dental implant
US5853291A (en) Subperiosteal bone anchor
US5362235A (en) Anatomical restoration dental implant system with interlockable angled abutment assembly
US5697779A (en) Temporary implant for use as an anchor in the mouth
US5547377A (en) Anatomical restoration dental implant system with interlockable various shaped healing cap assembly and matching abutment member
US6827574B2 (en) Skeletal transmucosal orthodontic plate and method
US6733292B2 (en) Universal implant
US6655961B2 (en) Modified dental implant fixture
US6644969B2 (en) Snap-in healing cap and insertion tool
US7258545B2 (en) Orthodontic anchor
US20070259306A1 (en) Orthodontic Plate and Method
US5944526A (en) Method and apparatus for a dental implant system
US6379154B2 (en) Subperiosteal bone anchor
US20110008745A1 (en) Orthodontic bone anchor plate with mesh pad
US4600388A (en) Osseous integrated submergible implant
US7559764B2 (en) Orthodontic bone anchor
KR100807150B1 (en) Implant for overdenture
EP1695671B1 (en) Dental implant
US4828492A (en) Dental implant
US8251698B2 (en) Orthodontic implant
US7556500B2 (en) Bone-adaptive surface structure
JPH0449958A (en) Artificial tooth root
US20040152048A1 (en) Temporary attachment for jaw implants

Legal Events

Date Code Title Description
FPAY Fee payment

Year of fee payment: 4

FPAY Fee payment

Year of fee payment: 8

REMI Maintenance fee reminder mailed
LAPS Lapse for failure to pay maintenance fees
STCH Information on status: patent discontinuation

Free format text: PATENT EXPIRED DUE TO NONPAYMENT OF MAINTENANCE FEES UNDER 37 CFR 1.362

FP Lapsed due to failure to pay maintenance fee

Effective date: 20140430