WO2018153219A1 - 用于矫治牙合干扰的壳状牙科器械 - Google Patents

用于矫治牙合干扰的壳状牙科器械 Download PDF

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Publication number
WO2018153219A1
WO2018153219A1 PCT/CN2018/074343 CN2018074343W WO2018153219A1 WO 2018153219 A1 WO2018153219 A1 WO 2018153219A1 CN 2018074343 W CN2018074343 W CN 2018074343W WO 2018153219 A1 WO2018153219 A1 WO 2018153219A1
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dentition
shell
correcting
jaw
layout
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PCT/CN2018/074343
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English (en)
French (fr)
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郭维华
杨毓芝
廖利君
刘人恺
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四川大学
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Publication of WO2018153219A1 publication Critical patent/WO2018153219A1/zh

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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
    • 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
    • A61C7/36—Devices acting between upper and lower teeth

Definitions

  • the present application generally relates to a shell-like dental appliance for use in correcting occlusal interference and a method of making same.
  • Occclusion is the relationship and function of the upper and lower teeth. Malocclusion and malocclusion will affect the coordination of the occlusal teeth, the aesthetics and function of abnormal occlusion, craniofacial structure and growth direction. Therefore, it is generally recommended that the correction of malocclusion will start as early as possible, and prevent the formation of dental malformations, malformation trends and the causes of dental malformation in the early stage of early childhood growth and development, and maximize the creation of craniofacial
  • stage I correction Conventional comprehensive orthodontic treatment for children and adults who have undergone growth and development is called phase II treatment.
  • the maxillary hyperbolic lingual pad type appliance is used for correction, according to different Adjust the position of the appliance to force the extension of the mandibular function and promote the development of the maxilla.
  • the anterior teeth are usually accepted in the lower jaw and the lower anterior teeth are lowered.
  • the maxillary double-curved maxillary jaw type appliance is widely used in clinical and permanent occlusion. This type of appliance consists of three parts: retention, afterburning and connection.
  • the retaining body is a snap ring made of stainless steel wire, which mainly depends on the concave surface of the crown and the wedge-shaped gap of the two adjacent teeth.
  • the retention method has two drawbacks: on the one hand, children with incomplete deciduous teeth are prone to poor retention, and the retention device is easily deformed after multiple times of wearing, affecting the wearing and treatment effects, and the appliance is easy to loosen. Shedding causes the child to be swallowed; on the other hand, the card ring often presses the gums and causes pain and discomfort in the child. In severe cases, it may even cause swelling and hyperplasia of the gums, which not only affects the oral health of the child, but also easily causes the child to treat the treatment. Resist the psychology.
  • the forcing part is a anterior hyperbolic reed, and the reed is bent by an elastic stainless steel wire of 0.4-0.5 mm, which is directly applied to the anterior lingual surface.
  • the stainless steel wire is easy to scratch the surrounding mucosa.
  • the improper force of the reed can easily cause the gums to tender, and the hyperbolic tongue will easily break after the long-term force, causing the patient to swallow and the sharp end to stimulate the gums.
  • the hyperbolic effect of the hyperbolic reed can only last for 1-2 weeks, the child's follow-up is more frequent. At present, early correction has not been fully popularized, and children are generally treated in different places. Such a follow-up mode is not conducive to patients' adherence to treatment, and many children have delayed treatment due to difficulty in returning to the clinic.
  • the connecting portion (including the posterior jaw pad) is a denture base resin.
  • the main body of the denture base material is polymethyl methacrylate and its modified products, including self-coagulation type and thermosetting type, which will produce irritating chemical odor during the process of adjusting and repairing the jaw pad, which is not good for children's health.
  • the connecting portion of the appliance In order to completely surround the retaining snap ring and the force device, the connecting portion of the appliance is large, and the mucosa of the temporal side is often pressed.
  • the food residue easily enters between the appliance and the mucous membrane, which is not conducive to cleaning.
  • the child's own crotch is sensitive, the pharyngeal reflex is more serious than the adult, the mental immature coordination is low, and the wearing process requires higher comfort.
  • improper wear of the patient and the parent may cause the appliance to deform, and the jaw pad is easily damaged, causing the sharp edge to scratch the mucosa.
  • a maxillary hyperbolic lingual pad type appliance For other occlusal interference problems, it is currently treated with a maxillary hyperbolic lingual pad type appliance.
  • the mandibular and lip appliance device is similar in its kind, and has such problems in terms of retention, afterburning and connection.
  • An aspect of the present application provides a shell-like dental appliance for correcting occlusal interference, which is an integral shell having a cavity for accommodating a plurality of teeth of the first dentition and between the canine and the molar Forming a jaw in the region toward the jaw to open the first dentition and the pair of jaws to a sufficient extent to release the anterior teeth of the pair of dentitions to the first dentition
  • An obstruction of adjustment of the anterior teeth, the cavity having a geometry that repositions the plurality of teeth from the first layout to the second layout, wherein the anterior position of the second layout is different from the first layout .
  • the axial inclination of the anterior teeth of the second layout is different from the first layout.
  • the shape of the first surface of the jaw pad in the direction of the jaw is matched with the shape of the first portion of the jaw tooth covered by the first surface when engaged, such that the first surface is engaged with the first surface
  • the first portion is substantially conformable.
  • the shell-like dental instrument for correcting occlusal interference has a thickness of 0.2 to 2.0 mm.
  • the shell-like dental instrument for correcting occlusion interference is formed with a fixing structure to cooperate with an accessory disposed on the tooth to fix the shell-like dental instrument for correcting occlusal interference. On the teeth.
  • the fixed structure is one of: a hollow structure, a concave structure, and combinations thereof.
  • Yet another aspect of the present application provides a method of making a shell-like dental appliance for correcting occlusion interference, comprising: acquiring a first digital model representing a first layout of a first dentition; and acquiring a second dentition a second digital model, wherein the second dentition is a pair of jaw rows of the first dentition; acquiring a jaw pad setting region on the first dentition; acquiring the first dentition and the second a positional relationship between the two when the dentition is opened to a specified extent; generating a third digital model representing the composite dental mold based on the first digital model, the second digital model, the jaw pad setting region, and the positional relationship, wherein the composite dental model Forming a jaw pad model based on the first layout of the first dentition and protruding toward the jaw in the jaw pad setting region; and using the third digital model control device to make a shell for correcting occlusion interference Dental instruments.
  • the deformation of the anterior teeth of the second dentition to the adjustment of the anterior teeth of the first dentition can be released.
  • the jaw pad model is substantially concave-convex matched to the geometry of the surface of the second dentition by the geometry of the surface in the jaw direction.
  • the method further comprises: fabricating a solid model of the composite dental mold using the third digital model control device; and laminating a solid model of the composite dental mold using a hot press film forming technique Or 3D printing to make the shell-like dental instrument for correcting occlusal interference.
  • the method further comprises: generating a fourth digital model representing a negative model of the composite model based on the third digital model; and using the fourth digital model control device to make the A shell-like dental instrument that corrects occlusal interference.
  • the method further includes: maintaining the three-dimensional model represented by the first digital model and the three-dimensional model represented by the second array model in the positional relationship, and the first digital model
  • the jaw pad setting region on the represented three-dimensional model extends a certain distance toward the jaw direction, and the shape of the top surface of the extension portion matches the shape unevenness of the corresponding region of the jaw.
  • FIG. 1A is a schematic view showing an inverted anterior teeth occlusion case according to an embodiment of the present application
  • 1B is a schematic view showing a case of a anterior protrusion of a anterior protrusion of the anterior teeth in an embodiment of the present application
  • FIG. 2 is a schematic flow chart of a method for manufacturing a shell-shaped dental appliance for correcting occlusion interference in an embodiment of the present application
  • Figure 3A schematically illustrates the formation of a jaw pad model in one embodiment of the present application
  • Figure 3B schematically illustrates a composite dental mold in one embodiment of the present application
  • FIG. 4A is a schematic sub-flow diagram of the method shown in FIG. 2 in an embodiment of the present application;
  • FIG. 4B is a schematic sub-flow diagram of the method shown in FIG. 2 in an embodiment of the present application;
  • Figure 5 is a schematic illustration of a shell-like dental appliance for correcting occlusal interference in one embodiment of the present application
  • Fig. 6 is a schematic illustration of the case in which a shell-like dental instrument for correcting occlusal interference is worn on a dentition in one embodiment of the present application.
  • occlusal interference is the key to block prevention from the etiology. This includes deciduous occlusion, deciduous incisor, deciduous dentition and dentition. Or the incisor occlusion, deciduous teeth and dentition anterior axis abnormality caused by abnormal position of the jaw.
  • Deciduous occlusion is the most common type of occlusion malocclusion in early childhood.
  • the causes include maxillary hypoplasia and mandibular hyperplasia. If not corrected in time, the long-term extension of the mandible leads to the active function of the extensor muscle group, and the position of the condyle advances. Long-term over-stimulation can cause excessive growth of the mandibular condyle cartilage, which may lead to further development of the mandibular hypertrophy. At the same time, occlusal interference leads to limited maxillary development, which may also lead to further development of maxillary dysplasia. Studies have shown that the upper and lower jaws show differential growth.
  • the maxillary anterior teeth 101a are tilted inward, and it is necessary to increase the positive torque and adjust the portion close to the cutting edge toward the labial direction, but is hindered by the mandibular anterior teeth 103a. Therefore, when adjusting the maxillary anterior teeth 101a, it is necessary to open the upper and lower jaws to a certain extent to relieve the adjustment of the adjustment of the maxillary anterior teeth 101a by the mandibular anterior teeth 103a.
  • FIG. 2 is a schematic flow diagram of a method 200 of making a shell-like dental appliance for correcting occlusal interference in an embodiment of the present application.
  • a first digital model representing a first layout of the first dentition is obtained.
  • the anterior teeth of the first dentition need to be adjusted to correct the occlusal interference.
  • the first dentition may be an upper dentition or a lower dentition.
  • the first layout of the first dentition differs from the previous layout in that the anterior teeth are different in position, for example, the anterior axis inclination of the two is different.
  • the front tooth position of the first layout is closer to the target position than the previous layout.
  • the first dentition can be sequentially corrected from the original layout to the target layout using a series of geometrically shaped shell-like dental instruments. Therefore, the first layout may be any one of the layout between the first intermediate layout after the original layout and the target layout. In one embodiment, between the first intermediate layout and the target layout, a plurality of successive intermediate layouts and a final intermediate layout may be included.
  • an original digital model representing the original layout of the first dentition and a target digital model representing the target layout of the first dentition may be acquired, and then an interpolation method is used to generate a representative based on the original digital model and the target digital model.
  • an original digital model representing the original layout of the first dentition can be obtained, and then the original digital model can be manually modified on the computer to obtain a digital model representing the first intermediate layout of the first dentition successively to the target layout.
  • an original digital model representing the original layout of the first dentition can be acquired, and then a first intermediate layout representing the first dentition is automatically generated based on the original digital model to the target layout using a specially designed computer program.
  • Digital model representing the original layout of the first dentition
  • direct scanning can be performed by means of tomography (CAT scan), digital tomography (CT), cone beam CT (CBCT), nuclear magnetic resonance imaging (MRI), intraoral optical scanning, and the like.
  • the first dentition obtains the original digital model representing the original layout of the first dentition.
  • the gypsum casting of the first dentition can be made by conventional means, and then the gypsum casting is scanned by a scanning device such as a laser scanning device or a CT scanning device to obtain the original number representing the original layout of the first dentition. model.
  • the bite of the first dentition may be acquired first, and then scanned by a scanning device such as a laser scanning device or a CT scanning device to obtain an original digital model representing the original layout of the first dentition.
  • a solid model of the first dentition (such as a plaster cast) can be obtained, wherein the teeth on the solid model that need to be adjusted are movable, and then the positions of the movable teeth are manually adjusted to obtain
  • the first intermediate layout is successively to the target layout, and then the plaster model under each layout is scanned by a scanning device such as a laser scanning device or a CT scanning device, and a digital model representing the first intermediate layout of the first dentition successively to the target layout is obtained.
  • the three-dimensional shape represented by the digital model can include a portion of the gums, mucosal tissue surrounding the teeth.
  • the three-dimensional shape represented by the first digital model may be obtained based on a three-dimensional shape modification of the first layout of the first dentition. For example, to get the corresponding function, you can add the corresponding attachment on the first dentition. For example, in order to prevent certain defects of the shell-shaped dental instrument formed by the hot-pressed film, some parts of the first dentition may be modified, such as filling the undercut to avoid defects such as wrinkles of the shell-shaped dental instrument.
  • a second digital model representative of the second dentition is obtained, wherein the second dentition is a pair of dentitions of the first dentition.
  • a second digital model representing the second dentition can be obtained by reference to the method in 201.
  • the three-dimensional model represented by the second digital model may be the original layout of the second dentition.
  • the three-dimensional model represented by the second digital model may be a three-dimensional model of the second dentition wearing the corresponding appliance when the first dentition wears the shell-like dental appliance.
  • the user may specify an area on the three-dimensional model represented by the first digital model through the user interface of the computer, such as defining a region on the surface of the jaw that defines the jaw pad.
  • the first dentition and the second dentition it is only necessary to open the first dentition and the second dentition to a degree sufficient to relieve the obstruction.
  • the upper and lower jaws can be opened sufficiently large that the mandibular anterior teeth 103a do not hinder the adjustment of the maxillary anterior teeth 101a.
  • the upper and lower jaws can be opened sufficiently large that the upper anterior teeth 101b and the lower anterior teeth 103b do not hinder the adjustment of the other side.
  • a third digital model representing the composite dental mold is generated based on the first digital model, the second digital model, the jaw pad setting region, and the positional relationship when the first dentition and the second dentition are opened to a specified extent.
  • the maxillofacial view of the three dimensional model represented by the first digital model can be displayed on a user interface of the computer, and then the jaw pad setting region is delineated on the three dimensional model represented by the first digital model.
  • the area in which the jaw pad is placed may be specified on the surface of the jaw from the portion of the three-dimensional model represented by the first digital model from the canine to the molar.
  • the three-dimensional model 301 and the second digital model represented by the first digital model may be represented by a positional relationship between the first dentition and the second dentition when the specified degree is opened.
  • the three-dimensional model 303 is positioned.
  • the jaw pad setting region 305 on the three-dimensional model represented by the first digital model is extended in the specified direction A toward the three-dimensional model represented by the second digital model by a certain distance, and the shape of the top surface of the extending portion is made to be the second
  • the shape of the corresponding portion of the three-dimensional model represented by the digital model is bump-fitted to obtain a third digital model.
  • the direction in which the jaw pad extends can be determined based on the direction of the bite. It is also possible to specify the direction of extension by the user.
  • the thickness of the shell-like dental appliance can be considered when determining the distance the jaw pad extends.
  • the composite dental mold 307 includes a first dentition 301 in a first configuration and a jaw pad model 309 formed on a jaw pad setting region of the first dentition.
  • the third digital model can be smoothed to eliminate sharper portions of the three-dimensional model it represents to avoid defects in the shell-like dental appliance made by the hot-press film forming technique.
  • a shell-like dental instrument for correcting occlusal interference is made using a third digital model control device.
  • FIG. 4A is a schematic sub-flow diagram of a method 200 for manufacturing a shell-like dental appliance for correcting occlusal interference in an embodiment of the present application.
  • a positive model entity of the composite dental mold is made using a third digital model control device.
  • the third digital model can be used to control the photocuring device to make a positive model entity of the composite dental mold.
  • the third digital model can be used to control the positive model entity of the composite dental mold made by the numerically controlled machine tool.
  • the third digital model can be used to control the 3D printing device to make a positive model entity of the composite dental mold.
  • a hot stamping technique is used to hot press a film on a positive model body of a composite dental mold to form a shell-like dental appliance for correcting occlusal interference.
  • the shell-shaped dental appliance 500 includes a cavity 501 that houses the first dentition 301, and a jaw pad 503 that protrudes in the direction of the jaw from the region of the canine to the posterior teeth.
  • the cavity 501 has a geometry that repositions the first dentition 301 from the first layout to the second layout.
  • the front dentition inclination of the first dentition 301 in the second layout is different from the first layout.
  • the shape of the surface 505 of the jaw pad 503 by the pair of jaws matches the corresponding portion of the jaw tooth.
  • a case where the shell-shaped dental instrument 500 is worn on the first dentition 301 is schematically illustrated.
  • the jaw pad 503 opens the first dentition 301 and the second dentition 303 to a specified extent such that the anterior teeth of the second dentition 303 do not interfere with the adjustment of the anterior teeth of the first dentition 301.
  • the jaw pad 503 is matched to the corresponding portion of the second dentition 303 by the shape of the surface 505 of the pair of jaws, making the wearing more comfortable.
  • FIG. 4B is a schematic sub-flow diagram of a method 200 for manufacturing a shell-like dental appliance for correcting occlusion interference in an embodiment of the present application.
  • a fourth digital model representing a negative model of the composite dental mold is generated based on the third digital model.
  • the negative model may be provided with a thickness, such as 0.2 to 2 mm, as the thickness of the shell-like dental appliance.
  • a shell-like dental instrument for correcting occlusal interference is made with a fourth digital model control device.
  • the fourth digital model can be used to control the 3D printing device to make a shell-like dental instrument for correcting occlusal interference.
  • a plurality of successive shell-like dental instruments for correcting occlusal interference can be made to sequentially adjust the axial inclination of the anterior teeth of the first dentition 301 into position.
  • the teeth of the second dentition 303 can be adjusted using a shell-like dental instrument without a jaw pad while the first dentition 301 is being treated with the shell-like dental instrument for correcting occlusion interference of the present application. layout.
  • the jaw pad may be placed on a shell-like dental instrument for correcting the upper dentition, or may be placed on a shell-like dental instrument for correcting the lower dentition. on.
  • various diagrams may illustrate exemplary architectures or other configurations of the disclosed methods and systems that facilitate understanding of features and functionality that may be included in the disclosed methods and systems.
  • the claimed content is not limited to the exemplary architecture or configuration shown, and the desired features can be implemented in various alternative architectures and configurations.
  • the order of the blocks presented herein should not be limited to the various embodiments that are implemented in the same order to perform the described functions, unless clearly indicated in the context .

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Abstract

一种用于矫治牙合干扰的壳状牙科器械（500），其为一体的壳状，具有容纳第一牙列（301）多颗牙齿的空腔（501），并且在尖牙至磨牙之间的区域内向对颌方向凸起形成颌垫（503），用于将所述第一牙列（301）与对颌牙列（303）打开到足够的程度，以解除所述对颌牙列（303）的前牙对所述第一牙列（301）的前牙的调整的阻碍，所述空腔（501）具有将所述多颗牙齿从第一布局重新定位到第二布局的几何形状，其中，所述第二布局的前牙位置与所述第一布局不同。

Description

用于矫治牙合干扰的壳状牙科器械 技术领域
本申请总体上涉及用于矫治牙合干扰的壳状牙科器械及其制作方法。
背景技术
牙合(occlusion)是上、下牙齿咬合的关系和功能。错牙合畸形会影响颅面牙牙合协调、美观及功能的异常咬合、颅面结构及生长方向。因此，一般建议错牙合畸形的矫治尽早开始，在儿童早期生长发育阶段对已表现出的牙颌畸形、畸形趋势及可导致牙颌畸形的病因进行预防和阻断，最大限度地创建颅面牙牙合协调发育的口颌环境，这就是目前所提倡的早期矫治(也称为Ⅰ期矫治)。已过生长发育高峰期儿童及成人的常规综合正畸治疗则称为Ⅱ期矫治。
目前，对于上颌发育不足乳、恒牙反牙合的情况，包括前牙内倾型反牙合和前牙前突型反牙合，常用上颌双曲舌簧颌垫式矫治器进行矫正，根据不同情况调整矫治器加力部位，解除下颌功能前伸，促进上颌骨发育。对于下颌发育过度乳牙反牙合的情况，常用下颌唇弓内收下前牙，改善下前牙唇倾。
上颌双曲舌簧颌垫式矫治器在临床乳、恒牙反牙合中应用较为广泛。该类矫治器由固位、加力和连接三部分组成。
固位体为不锈钢丝弯制而成的卡环，主要依靠牙冠颊面倒凹及两邻牙楔状隙固位。该固位方式有两个弊端：一方面，乳牙倒凹不明显的患儿易出现固位不佳，多次摘戴后固位装置易变形，影响戴用及治疗效果，且矫治器易松动脱落导致患儿误吞；另一方面，卡环常压迫牙龈引起患儿疼痛不适，严重者甚至会导致牙龈红肿增生，不仅对患儿的口腔卫生健康有影响，而且容易使患儿对治疗产生抵触心理。
加力部分为前牙双曲舌簧，舌簧由0.4-0.5mm的弹性不锈钢丝弯制，直接作 用于前牙舌面。摘戴过程中不锈钢丝易划伤周围黏膜，舌簧加力不当易造成牙龈压痛，且双曲舌簧长期加力后易疲劳发生断裂，致使患者误吞和尖锐断端刺激牙龈。因双曲舌簧每次加力效应仅能维持1-2周，患儿复诊较为频繁。而目前早期矫正尚未完全普及，患儿异地就医情况普遍，此类复诊模式不利于患者坚持治疗，许多患儿因复诊困难延误治疗时机。
连接部分(包括后牙颌垫)为义齿基托树脂。义齿基托树脂材料主体是聚甲基丙烯酸甲酯及其改性产品，包括自凝型和热凝型，在调磨和修补颌垫过程中会产生刺激性化学气味，对儿童健康不利。为了完全包绕固位卡环和加力装置，矫治器连接体部分较大，常压迫腭侧黏膜。另外，食物残渣容易进入矫治器与粘膜之间，不利于清洁。而儿童本身腭部敏感，咽反射较成人严重，心智未成熟配合程度低，佩戴过程对舒适性要求更高。
此外，在矫治器使用过程中，患者及家长摘戴不当易引起矫治器变形，颌垫易损坏造成锐利边缘划伤黏膜。
对于其他的牙合干扰问题，目前也多是应用上颌双曲舌簧颌垫式矫治器进行治疗。下颌唇弓矫治器装置与其类似，在固位、加力和连接方式上均有此类问题。
传统矫治器治疗牙合干扰在安全性、舒适性以及便捷性方面都有其局限性，还有待进一步改进，因此希望寻求一种更为安全、舒适和便捷的矫治器。
发明内容
本申请的一方面提供了一种用于矫治牙合干扰的壳状牙科器械，其为一体的壳状，具有容纳第一牙列多颗牙齿的空腔，并且在尖牙至磨牙之间的区域内向对颌方向凸起形成颌垫，用于将所述第一牙列与对颌牙列打开到足够的程度，以解除所述对颌牙列的前牙对所述第一牙列的前牙的调整的阻碍，所述空腔具有将所述多颗牙齿从第一布局重新定位到第二布局的几何形状，其中，所述第二布局的前牙位置与所述第一布局不同。
在一些实施方式中，所述第二布局的前牙的轴倾度与所述第一布局不同。
在一些实施方式中，所述颌垫靠对颌方向的第一表面的形状与咬合时对颌牙齿被该第一表面所覆盖的第一部分的形状凹凸匹配，使得咬合时所述第一表面与所述第一部分基本贴合。
在一些实施方式中，所述用于矫治牙合干扰的壳状牙科器械的厚度为0.2～2.0mm。
在一些实施方式中，所述用于矫治牙合干扰的壳状牙科器械上形成有固定结构，以与设置在牙齿上的附件配合，将所述用于矫治牙合干扰的壳状牙科器械固定在牙齿上。
在一些实施方式中，所述固定结构为以下之一：镂空结构、内凹结构及其组合。
本申请的又一方面提供了一种用于矫治牙合干扰的壳状牙科器械的制作方法，包括：获取代表第一牙列的第一布局的第一数字模型；获取代表第二牙列的第二数字模型，其中，所述第二牙列是所述第一牙列的对颌牙列；获取所述第一牙列上的颌垫设置区域；获取所述第一牙列和第二牙列打开指定程度时两者的位置关系；基于所述第一数字模型、第二数字模型、颌垫设置区域以及位置关系，产生代表复合牙模的第三数字模型，其中，该复合牙模是基于所述第一牙列的第一布局并在所述颌垫设置区域向对颌方向凸起形成颌垫模型；以及利用所述第三数字模型控制设备制作用于矫治牙合干扰的壳状牙科器械。
在一些实施方式中，所述第一牙列和第二牙列打开所述指定程度时，能够解除所述第二牙列的前牙对所述第一牙列的前牙的调整的阻碍。
在一些实施方式中，所述颌垫模型靠对颌方向的表面的几何形状与第二牙列对应部分的几何形状基本凹凸匹配。
在一些实施方式中，所述方法还包括：利用所述第三数字模型控制设备制作所述复合牙模的实体模型；以及利用热压膜成型技术在所述复合牙模的实体模型 上压膜或3D打印制成所述用于矫治牙合干扰的壳状牙科器械。
在一些实施方式中，所述方法还包括：基于所述第三数字模型产生代表所述复合模型的负模型的第四数字模型；以及利用所述第四数字模型控制设备制成所述用于矫治牙合干扰的壳状牙科器械。
在一些实施方式中，所述方法还包括：将所述第一数字模型所表示的三维模型和所述第二数组模型所表示的三维模型保持在所述位置关系，将所述第一数字模型所表示的三维模型上的颌垫设置区域向对颌方向延伸特定距离，并且使得该延伸部的顶面的形状与对颌相应区域的形状凹凸匹配。
附图说明
以下将结合附图及其详细描述对本申请的上述及其他特征作进一步说明。应当理解的是，这些附图仅示出了根据本申请的若干示例性的实施方式，因此不应被视为是对本申请保护范围的限制。除非特别指出，附图不必是成比例的，并且其中类似的标号表示类似的部件。
图1A为本申请一个实施例中内倾型乳前牙反牙合病例的示意图；
图1B为本申请一个实施例中前突型乳前牙反牙合病例的示意图；
图2为本申请一个实施例中用于矫治牙合干扰的壳状牙科器械的制作方法的示意性流程图；
图3A示意性地展示了本申请一个实施例中颌垫模型的形成；
图3B示意性地展示了本申请一个实施例中的复合牙模；
图4A为本申请一个实施例中图2所示方法的示意性子流程图；
图4B为本申请一个实施例中图2所示方法的示意性子流程图；
图5示意性地展示了本申请一个实施例中的用于矫治牙合干扰的壳状牙科器械；以及
图6示意性地展示了本申请一个实施例中用于矫治牙合干扰的壳状牙科器械佩戴在牙列上的情况。
具体实施方式
以下的详细描述中引用了构成本说明书一部分的附图。说明书和附图所提及的示意性实施方式仅仅出于是说明性的目的，并非意图限制本申请的保护范围。在本申请的启示下，本领域技术人员能够理解，可以采用许多其他的实施方式，并且可以对所描述实施方式做出各种改变，而不背离本发明的主旨和保护范围。应当理解的是，在此说明并图示的本申请的各个方面可以按照很多不同的配置来布置、替换、组合、分离和设计，这些不同配置都在本申请的保护范围之内。
对于儿童早期牙合干扰错牙合畸形，去除牙合干扰是从病因层面进行阻断预防的关键，这包括乳牙反牙合、乳牙切牙合、乳牙列及替牙列个别前牙反牙合或切牙合、乳牙列及替牙列前牙轴倾度异常导致的对颌位置异常等。
乳牙反牙合是儿童早期牙合干扰错牙合畸形中最常见的一种，病因包括上颌发育不足和下颌发育过度。若不及时纠正，下颌长期前伸导致前伸肌群功能活跃，髁突位置前移，长期的过度刺激可造成下颌髁突软骨的过度生长，可导致骨性的下颌发育过度畸形进一步发展。同时牙合干扰导致上颌发育受限，也会引起上颌骨发育不足进一步发展。研究表明，上下颌骨呈现差异性增长，在6-20岁期间，上颌骨生长较早完成，下颌骨生长时间较晚且持续时间长，下颌长度变化是上颌的两倍。因此，若不在早期及时纠正儿童上颌骨发育不足的问题，后期上下颌骨发育差异会进一步加大。上颌发育不足及下颌发育过度最终易发展成为骨性Ⅲ类错牙合畸形。骨性Ⅲ类错牙合畸形患者面中份发育不足，侧貌凹陷，对患者美观、咀嚼功能、心理成长都有很大影响。
请参图1A，示意性地展示了内倾型乳牙反牙合的一个病例。
在该病例中，上颌前牙101a内倾，需要加大正转矩并将靠近切缘的部分往唇侧方向调整，但受到下颌前牙103a的阻碍。因此，在调整上颌前牙101a时需要把上、下颌打开到一定程度，以解除下颌前牙103a对上颌前牙101a的调整的阻碍。
请参图1B，示意性地展示了前突型乳牙反牙合的一个病例。
在该病例中，需要将上颌前牙101b整体往唇侧调整，并把下颌前牙103b往内收，但上颌前牙101b与下颌前牙103b相互阻碍对方的调整。因此，在调整上颌前牙101b与下颌前牙103b时，需要把上、下颌打开到一定程度，以解除上颌前牙101b与下颌前牙103b对对方的调整的阻碍。
以上两个示意性的病例是较典型的牙合干扰病例，以下对本申请用于矫治牙合干扰的壳状牙科器械及其制作方法的具体实施例进行详细说明。
图2为本申请一个实施例中用于矫治牙合干扰的壳状牙科器械的制作方法200的示意性流程图。
在201中，获取代表第一牙列的第一布局的第一数字模型。
第一牙列的前牙需要调整，以纠正牙合干扰。其中，第一牙列可以是上颌牙列，也可以是下颌牙列。
第一牙列的第一布局与前一布局相比，两者的前牙位置不同，比如，两者的前牙轴倾度不同。相比前一布局，第一布局的前牙位置更接近目标位置。
在一个实施例中，可以利用一系列几何形状逐次变化的壳状牙科器械把第一牙列从原始布局逐次矫正到目标布局。因此，第一布局可以是原始布局之后的第一中间布局到目标布局之间的任何一个布局。在一个实施例中，从第一中间布局到目标布局之间，可以包括逐次的多个中间布局以及最后中间布局。
在一个实施例中，可以获取代表第一牙列的原始布局的原始数字模型以及代 表第一牙列的目标布局的目标数字模型，然后利用插值法，基于原始数字模型和目标数字模型产生代表第一牙列的第一中间布局到最后中间布局的数字模型。
在一个实施例中，可以获取代表第一牙列的原始布局的原始数字模型，然后在计算机上手动修改原始数字模型，以获得代表第一牙列的第一中间布局逐次到目标布局的数字模型。
在一个实施例中，可以获取代表第一牙列的原始布局的原始数字模型，然后利用特别设计的计算机程序，基于原始数字模型自动产生代表第一牙列的第一中间布局逐次到目标布局的数字模型。
在一些实施例中，可以通过层析X射线扫描(CAT扫描)、数字化断层X线扫描(CT)、锥束CT扫描(CBCT)、核磁共振造像(MRI)、口内光学扫描等手段，直接扫描第一牙列，获得代表第一牙列的原始布局的原始数字模型。在又一些实施例中，可以先用常规手段制作第一牙列的石膏铸件，再通过扫描设备比如激光扫描设备、CT扫描设备扫描该石膏铸件，获得代表第一牙列的原始布局的原始数字模型。在又一些实施例中，可以先获取第一牙列的咬模，再通过扫描设备比如激光扫描设备、CT扫描设备扫描该咬模，获得代表第一牙列的原始布局的原始数字模型。
在一个实施例中，可以获取第一牙列的实体模型(比如石膏模型)，其中，该实体模型上需要调整的牙齿是可活动的，然后手动调整这些可活动的牙齿的位置，以得到从第一中间布局逐次到目标布局，再通过扫描设备比如激光扫描设备、CT扫描设备扫描处于各布局下的石膏模型，获得代表第一牙列的第一中间布局逐次到目标布局的数字模型。
在一些实施例中，数字模型所表示的三维形状可以包括牙齿周围的部分牙龈、黏膜组织。
在一些实施例中，第一数字模型所表示的三维形状可以是基于第一牙列的第一布局的三维形状修改获得。比如，为获得相应的功能，可以在第一牙列上添加相应的附件。又比如，为防止热压膜成型的壳状牙科器械出现某些缺陷，可以对 第一牙列的某些部位进行修改，比如填充倒凹，以免壳状牙科器械出现褶皱等缺陷。
在203中，获取代表第二牙列的第二数字模型，其中，第二牙列是第一牙列的对颌牙列。
可以参照201中的方法获取代表第二牙列的第二数字模型。
若第二牙列的牙齿无需矫正，第二数字模型所表示的三维模型可以是第二牙列的原始布局。
若第二牙列的牙齿需要矫正，第二数字模型所表示的三维模型可以是第一牙列佩戴壳状牙科器械时佩戴有相应矫治器的第二牙列的三维模型。
在205中，获取颌垫设置区域。
在一个实施例中，用户可以通过计算机的用户界面在第一数字模型所表示的三维模型上指定设置颌垫的区域，比如在该三维模型靠对颌的表面上划定设置颌垫的区域。
在207中，获取第一牙列和第二牙列打开指定程度时的位置关系。
在一个实施例中，只需要把第一牙列和第二牙列打开到足以解除阻碍的程度即可。
比如，对于图1A所示的内倾型乳牙反牙合病例，可以把上下颌打开到足够大，使得下颌前牙103a不阻碍上颌前牙101a的调整。
比如，对于图1B所示的前突型乳牙反牙合病例，可以把上下颌打开到足够大，使得上颌前牙101b与下颌前牙103b不阻碍对方的调整。
在209中，基于第一数字模型、第二数字模型、颌垫设置区域以及第一牙列和第二牙列打开指定程度时的位置关系，产生代表复合牙模的第三数字模型。
在一个实施例中，可以在计算机的用户界面上展示第一数字模型所表示的三 维模型的颌面观，然后在第一数字模型所表示的三维模型上划定颌垫设置区域。比如，可以在第一数字模型所表示的三维模型从尖牙到磨牙之间的部分靠对颌的表面上指定设置颌垫的区域。
请参图3A，在一个实施例中，可以按打开指定程度时第一牙列和第二牙列之间的位置关系，把第一数字模型所表示的三维模型301和第二数字模型所表示的三维模型303进行定位。然后，使第一数字模型所表示的三维模型上的颌垫设置区域305沿指定方向A朝第二数字模型所表示的三维模型延伸一定距离，并且使得该延伸部的顶面的形状与第二数字模型所表示的三维模型的相应部分的形状凹凸匹配，获得第三数字模型。
在一些实施方式中，可以根据咬合的方向来确定颌垫延伸的方向。也可以由用户指定延伸方向。
在一些实施方式中，在确定颌垫延伸距离的时候可以考虑壳状牙科器械的厚度。
请再参图3B，示意性地展示了第三数字模型所表示的三维模型，即复合牙模307。在该实施例中，复合牙模307包括处于第一布局的第一牙列301以及在第一牙列的颌垫设置区域上形成的颌垫模型309。
在一些实施例中，可以对第三数字模型进行平滑处理，以消除其所表示的三维模型上比较尖锐的部分，以避免基于热压膜成型技术制作的壳状牙科器械产生缺陷。
在211中，利用第三数字模型控制设备制作用于矫治牙合干扰的壳状牙科器械。
请参图4A，为本申请一个实施例中用于矫治牙合干扰的壳状牙科器械的制作方法200的示意性子流程图。
在2111A中，利用第三数字模型控制设备制成复合牙模的正模型实体。在一些实施例中，可以利用第三数字模型控制光固化设备制成复合牙模的正模型实 体。在又一些实施例中，可以利用第三数字模型控制数控机床制成复合牙模的正模型实体。在又一些实施例中，可以利用第三数字模型控制3D打印设备制成复合牙模的正模型实体。
在2113A中，以热压膜成型技术在复合牙模的正模型实体上热压膜形成用于矫治牙合干扰的壳状牙科器械。
请参图5，示意性地展示了本申请一个实施例中用于矫治牙合干扰的壳状牙科器械500。壳状牙科器械500包括容纳第一牙列301的空腔501，以及在尖牙至后牙的区域向对颌方向凸起形成颌垫503。其中，空腔501具有把第一牙列301从第一布局重新定位到第二布局的几何形状。其中，第一牙列301在第二布局下的前牙轴倾度与第一布局不同。其中，颌垫503靠对颌的表面505的形状与对颌牙齿的对应部分凹凸匹配。
请参图6，示意性地展示了壳状牙科器械500佩戴在第一牙列301上的情况。颌垫503将第一牙列301与第二牙列303打开指定的程度，使得第二牙列303的前牙不干扰第一牙列301的前牙的调整。颌垫503靠对颌的表面505的形状与第二牙列303相应的部分凹凸匹配，使得佩戴更为舒适。
请参图4B，为本申请一个实施例中用于矫治牙合干扰的壳状牙科器械的制作方法200的示意性子流程图。
在2111B中，基于第三数字模型产生代表复合牙模的负模型的第四数字模型。
在一些实施例中，可以为该负模型设置一定厚度，比如0.2～2mm，作为壳状牙科器械的厚度。
在2113B中，以第四数字模型控制设备制成用于矫治牙合干扰的壳状牙科器械。
在一些实施方式中，可以第四数字模型控制3D打印设备制作用于矫治牙合干扰的壳状牙科器械。
在一些实施方式中，可以制作多个逐次的用于矫治牙合干扰的壳状牙科器械，以将第一牙列301的前牙的轴倾度逐次地调整到位。
在一些实施方式中，在利用本申请的用于矫治牙合干扰的壳状牙科器械矫治第一牙列301的同时，可以采用不带颌垫的壳状牙科器械调整第二牙列303的牙齿布局。
对于上、下颌前牙均利用壳状牙科器械进行调整的病例，颌垫可以设置在用于矫正上颌牙列的壳状牙科器械上，也可以设置在用于矫正下颌牙列的壳状牙科器械上。
尽管在此公开了本申请的多个方面和实施例，但在本申请的启发下，本申请的其他方面和实施例对于本领域技术人员而言也是显而易见的。在此公开的各个方面和实施例仅用于说明目的，而非限制目的。本申请的保护范围和主旨仅通过后附的权利要求书来确定。
同样，各个图表可以示出所公开的方法和系统的示例性架构或其他配置，其有助于理解可包含在所公开的方法和系统中的特征和功能。要求保护的内容并不限于所示的示例性架构或配置，而所希望的特征可以用各种替代架构和配置来实现。除此之外，对于流程图、功能性描述和方法权利要求，这里所给出的方框顺序不应限于以同样的顺序实施以执行所述功能的各种实施例，除非在上下文中明确指出。
除非另外明确指出，本文中所使用的术语和短语及其变体均应解释为开放式的，而不是限制性的。在一些实例中，诸如“一个或多个”、“至少”、“但不限于”这样的扩展性词汇和短语或者其他类似用语的出现不应理解为在可能没有这种扩展性用语的示例中意图或者需要表示缩窄的情况。

Claims (12)

  1. 一种用于矫治牙合干扰的壳状牙科器械，其为一体的壳状，具有容纳第一牙列多颗牙齿的空腔，并且在尖牙至磨牙之间的区域内向对颌方向凸起形成颌垫，用于将所述第一牙列与对颌牙列打开到足够的程度，以解除所述对颌牙列的前牙对所述第一牙列的前牙的调整的阻碍，所述空腔具有将所述多颗牙齿从第一布局重新定位到第二布局的几何形状，其中，所述第二布局的前牙位置与所述第一布局不同。
  2. 如权利要求1所述的用于矫治牙合干扰的壳状牙科器械，其特征在于，所述第二布局的前牙轴倾度与所述第一布局不同。
  3. 如权利要求1所述的用于矫治牙合干扰的壳状牙科器械，其特征在于，所述颌垫靠对颌方向的第一表面的形状与咬合时对颌牙齿被该第一表面所覆盖的第一部分的形状凹凸匹配，使得咬合时所述第一表面与所述第一部分基本贴合。
  4. 如权利要求1所述的用于矫治牙合干扰的壳状牙科器械，其特征在于，它的厚度为0.2～2.0mm。
  5. 如权利要求1所述的用于矫治牙合干扰的壳状牙科器械，其特征在于，所述用于矫治牙合干扰的壳状牙科器械上形成有固定结构，以与设置在牙齿上的附件配合，将所述用于矫治牙合干扰的壳状牙科器械固定在牙齿上。
  6. 如权利要求5所述的用于矫治牙合干扰的壳状牙科器械，其特征在于，所述固定结构为以下之一：镂空结构、内凹结构及其组合。
  7. 一种用于矫治牙合干扰的壳状牙科器械的制作方法，包括：
    获取代表第一牙列的第一布局的第一数字模型；
    获取代表第二牙列的第二数字模型，其中，所述第二牙列是所述第一牙列的对颌牙列；
    获取所述第一牙列上的颌垫设置区域；
    获取所述第一牙列和第二牙列打开指定程度时两者的位置关系；
    基于所述第一数字模型、第二数字模型、颌垫设置区域以及位置关系，产生代表复合牙模的第三数字模型，其中，该复合牙模是基于所述第一牙列的第一布局并在所述颌垫设置区域向对颌方向凸起形成颌垫模型；以及
    利用所述第三数字模型控制设备制作用于矫治牙合干扰的壳状牙科器械。
  8. 如权利要求7所述的用于矫治牙合干扰的壳状牙科器械的制作方法，其特征在于，所述第一牙列和第二牙列打开所述指定程度时，能够解除所述第二牙列的前牙对所述第一牙列的前牙的调整的阻碍。
  9. 如权利要求7所述的用于矫治牙合干扰的壳状牙科器械的制作方法，其特征在于，所述颌垫模型靠对颌方向的表面的几何形状与第二牙列对应部分的几何形状基本凹凸匹配。
  10. 如权利要求7所述的用于矫治牙合干扰的壳状牙科器械的制作方法，其特征在于，它还包括：
    利用所述第三数字模型控制设备制作所述复合牙模的实体模型；以及
    利用压膜成型或3D打印技术在所述复合牙模的实体模型上制成所述用于矫治牙合干扰的壳状牙科器械。
  11. 如权利要求7所述的用于矫治牙合干扰的壳状牙科器械的制作方法，其特征在于，它还包括：
    基于所述第三数字模型产生代表所述复合模型的负模型的第四数字模型；以及
    利用所述第四数字模型控制设备制成所述用于矫治牙合干扰的壳状牙科器械。
  12. 如权利要求7所述的用于矫治牙合干扰的壳状牙科器械的制作方法，其特征在于，它还包括：将所述第一数字模型所表示的三维模型和所述第二数组模 型所表示的三维模型保持在所述位置关系，将所述第一数字模型所表示的三维模型上的颌垫设置区域向对颌方向延伸特定距离，使得该延伸部的顶面的形状与对颌相应区域的形状基本凹凸匹配，从而获得所述第三数字模型。
PCT/CN2018/074343 2017-02-27 2018-01-26 用于矫治牙合干扰的壳状牙科器械 WO2018153219A1 (zh)

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