WO2020079249A1

WO2020079249A1 - Positioning element for relative positioning of the mandible

Info

Publication number: WO2020079249A1
Application number: PCT/EP2019/078426
Authority: WO
Inventors: Markus LOHSE; Bartholomäus RUDAK; Stephan Weihe
Original assignee: Forstgarten International Holding Gmbh
Priority date: 2018-10-19
Filing date: 2019-10-18
Publication date: 2020-04-23
Also published as: DE102018126097A1

Abstract

Device (100) for securing at least one measuring device to a jaw in a defined position, comprising a retaining arc (10), wherein the retaining arc (10), in the state when secured on a dental arch of a maxilla or mandible, permits an occlusion, and a positioning element (30) which is releasably connectable to the retaining arc (10), wherein a combination of the retaining arc (10) and of the positioning element (30) prevents an occlusion in a state when the retaining arc (10) is secured on the dental arch of the maxilla or mandible.

Description

Positioning element for the relative positioning of the lower jaw

description

Field of the Invention

The invention relates to a device for positioning a retaining bow for fastening measuring devices, in particular for dental medicine and orthodontic applications. The primary task of attaching measuring devices is to make the movement of the lower jaw visible or measurable. The measurement of position and movement values is used to analyze the articulation and the biomechanics of the temporomandibular joint. The measurement provides important information about the properties of the dentition and the temporomandibular joint. The movable measuring devices are preferably attached to the lower jaw, with holders usually being temporarily glued on. The present invention shows a very advantageous holder, which is also suitable as a positioning aid for imaging processes.

The invention additionally relates to a method for using the device.

State of the art

According to the prior art, the anchoring of the measuring devices is carried out using various devices and methods which have the simple aim of fixing and maintaining the relative position of the measuring devices or markers or sensors.

DE 202014102968 U1 describes a coupling spoon for temporarily fixing the lower jaw measuring sensor to the lower jaw. This coupling spoon has on its upper side a sliding surface designed for easy sliding of the front teeth of the upper jaw and with markings which are detectable for a 3D surface scanner with a detection area that is smaller than the longitudinal extension of the arm and designed and arranged in this way. In these and other known technologies, parts of the coupling spoons lie so that they partially or completely cover the occlusal surfaces.

US 7457443 B2 describes a holding device which permanently covers the occlusion, so that the movement analysis cannot be carried out until contact in the final bite. Although this device is easy to use, it hinders the movement to be analyzed.

WO2018065487 A1 calls a so-called non-occlusal attachment as a holding arch for sensory devices, which is fixed to the natural curvatures of the molars and the other teeth by means of the positive clamping tension without covering the occlusion. Although this device allows the movement up to occlusion, its precision suffers from a wobbly positioning in the case of teeth with little crown, in particular if the convexity is convex Lateral surfaces on the molars and canines are little pronounced.

All these devices have the disadvantage that a) a very precise positioning of the measuring devices relative to the lower jaw cannot be achieved at the same time and b) the upper jaw and lower jaw can be positioned very precisely and c) the full freedom of movement is given to the lower jaw, in particular up to occlusion together bitten or grinding teeth. In practice, however, a combination of these three properties a, b and c is required.

Object of the invention

The object of the invention is, in particular, to provide an absolutely precisely positionable device which a) ensures the positionally accurate insertion of the retaining arch relative to the lower jaw and b) precisely defines the relative positioning of the upper and lower jaws in relation to one another in order to thereby start the segmentation of the teeth and dental arches and / or c) which, after imaging, allows freedom of movement up to the occlusal bite without changing the position of the sensors or markers relative to the lower jaw.

Solution according to the invention

The object is solved by the subject matter of the independent claims. Advantageous developments of the subject matter of the independent claims are characterized in the subclaims. The wording of all claims is hereby incorporated by reference into the content of this description. The use of the singular is not intended to exclude the majority, which must also apply in the opposite sense, unless the contrary is disclosed.

The invention relates to a device for fastening at least one measuring device to a jaw in a defined position, comprising a retaining arch, the retaining arch being provided for fastening to a dental arch of an upper or lower jaw and allowing occlusion in the fastened state, and one with the retaining arch Detachably connectable positioning element, the occlusion being prevented, in particular by the positioning element, when the positioning element is connected to the retaining arch on the dental arch in the fastened state of the retaining arch.

It should be noted that the positioning element can also be referred to as a positioning arch.

In this context, the term occlusion is preferably understood to mean the partial to complete contact of the teeth of the upper dental arch with the teeth of the lower dental arch. In occlusion, the bit is in its final bite position, in which lateral relative movement of the upper jaw relative to the lower jaw is no longer possible. As a result Preventing occlusion means preventing the teeth of the upper dental arch from colliding with the teeth of the lower dental arch.

In addition, the device preferably comprises at least one connecting element for releasably connecting the retaining arch to the positioning element, the retaining arch and the positioning element being immovable relative to one another in a lateral direction in the state connected by the connecting element.

The positioning element on the surface facing away from the retaining arch can have at least one spacer element to prevent occlusion.

Furthermore, it is possible for the positioning element to have at least one locking element on the surface facing away from the retaining arch.

The locking element is preferably designed for releasably fixing at least one tooth of the dental arch, to which the retaining arch is not attached, with respect to a movement, in particular a lateral and / or vertical movement, relative to the device.

The at least one spacer element and the at least one locking element can be structurally combined in the positioning element.

The holding sheet can have more than two marking elements, the marking elements being made of a material with X-ray contrast, in comparison to the X-ray density of the material from which the holding sheet is made.

The support bow and the positioning element can be X-ray visible at least in sections.

The connecting element can additionally contain at least one magnet.

It is possible that at least one measuring device is integrated in the tie. Likewise, the retaining bow can have at least one fastening element for the detachable fastening of a measuring device.

It is also possible for the retaining arch and / or the positioning element to have a contour on their inner peripheral surface which essentially represents an impression of a dental arch in the buccal direction, so that the retaining arch and / or the positioning element can be joined to the dental arch in a form-fitting manner.

Furthermore, the invention relates to a method for using the device, the method comprising the steps of connecting the device to the first dental arch of a first jaw, so that the retaining arch is attached to the first dental arch and the positioning element to the retaining arch, for example the retaining arch opposite the first dental arch is biased, relative movement of the first jaw relative to a second jaw up to the stop of a second dental arch of the second jaw on the spacer element, for example at least one tooth of the second dental arch engaging in the locking element, recording one or more tooth and / or jaw positions during the stop of the second dental arch on the spacer element, removal of the positioning arch from the retaining arch, measurement of movements and / or positions of the first and / or second jaw, in particular relative to one another.

Individual devices and method steps are described in more detail below. When describing the device, the reference to the upper jaw and lower jaw can be interchanged because the relative movement is of real interest. The method steps do not necessarily have to be carried out in the order specified, and the method to be described can also have further steps not mentioned.

contraption

To solve the combined task set in dental practice, a combined multi-part device for positioning, stabilizing and tracking the relative movement of the lower jaw to the upper jaw is proposed.

The first part of the device forms a retaining arch, which can be attached to a natural or artificial dental arch made of teeth, preferably by positive contact forces and, if necessary, supported by additional adhesive forces and / or elastic restoring forces.

The retaining arch preferably has positive and at least partially non-positive surfaces which correspond to an impression of tooth surfaces at least in areas. With the help of these surface areas, a non-positive connection of the retaining arch to the teeth is established.

The mounting bracket has a fastening element to which external measuring devices, markers and sensors can be attached. The connection between the fastening element and the holding arch can be made detachable and stretchable.

The second part of the device forms a positioning element which is positively and releasably fixed to the retaining bow by means of connecting elements. The positioning element performs the positioning of the device relative to the dental arch of the lower jaw and also, in special applications, the positioning of the device relative to the upper jaw.

The positioning element has on the underside for the form-fitting receptacles for the connecting elements or for corresponding connecting elements that fit in a form-fitting manner with those of the retaining bow. The positioning element has positioning aids on the top, in particular spacers and locking elements.

The spacing elements create a defined distance that is never exceeded between the dental arch of the upper jaw and the dental arch of the lower jaw, i.e. They keep the upper dental arch in contact with the lower dental arch, creating a gap.

Viewed locally, the locking elements have depressions and or elevations in which teeth of the upper jaw engage and in this way act as a lock against movements within the biting plane, that is to say in particular to the right, left, front and / or rear.

The connecting elements between are preferably designed to be detachable, for example with positive engagement in the corresponding formations in the positioning element. It does not matter whether the elevations and protrusions are present on the side of the retaining arch or on the side of the positioning element.

The connecting element can also be used as a component between the holding element and the positioning element, e.g. as a small bolt or dowel pin. However, the connecting elements are preferably fastened to one of the two parts in order not to be lost in the mouth. Preferably, more than 2 connecting elements are used in order to produce a connection, which is particularly easy to detach, but nevertheless in particular absolutely precise, between the retaining bow and the positioning element with a defined relative position of the two parts.

The retaining bow and preferably also the positioning element preferably have markings which, in particular, produce an X-ray visibility and which precisely determine the position of the retaining bow using imaging methods, such as Allow DVT. Metal balls or other X-ray absorbing materials can be used for this.

method

To solve the combined task set in dental practice, a multi-stage method for positioning, stabilizing and tracking the relative movement is proposed.

In a first step, the two corresponding parts of the device, the support bow and the positioning element are joined together and brought into a defined relative position. As a result, all position data, which are recorded via the tie, can be transferred to the positioning element and vice versa.

In the next step, the combined device is inserted into the dentition, preferably placed on the lower dental arch, so that the contact surfaces on the mounting arch come into at least partially non-positive and positive contact with the teeth. As soon as defined 3D data on the dental arch is available in the lower jaw, this results in the relative position between the device and the teeth in the lower jaw. The positioning of the device in the dental arch is supported by the special shape in the positioning element, at least by its material In some areas, parts of the occlusal surface of the teeth are also covered, thus producing a mechanical stop with very good positioning accuracy. The shape of the support arch takes into account the existence of gums and other tissue and of implants in the surrounding area.

In the next step, a holding force is built up between the tie and the teeth in the lower jaw. This does not necessarily take place on each tooth but, for example, only on at least 2, preferably more than 2 teeth. In practice, e.g. 4 very precise machined contact points are preferred, which form or stretch a polygon as large as possible for stabilization. The contact force can either arise solely from the positive and non-positive connection by pretensioning the retaining arch, or additional adhesive forces are generated by adhesion promoters.

The next step involves the relative movement of the lower dental arch / lower jaw to the upper dental arch / upper jaw. The teeth of the upper jaw snap into the precisely designed locking elements that are present on the positioning element. In addition, there is the contact, which is forced by the contact pressure, of at least one, preferably more than two spacer elements, which in turn can also have the function of locking elements in a special embodiment.

The subsequent step comprises the preferably digital recordings of the relative positions and the relative movements of the lower jaw and upper jaw. This is made possible by e.g. at least one camera is attached to the subject's / patient's skull, which observes a measuring bracket which is attached to the holding element via the attachment element. With digital 3D images, the distance between the upper and lower dental arch is guaranteed to be maintained due to the effect of the spacer elements. This later enables the very precise and low-error automated separation of the teeth, because they are separated by air or plastic, which have different absorption densities or gray values in the illustration.

In the next step, after the previous 3D images, the positioning element is lifted off while the tie remains exactly fixed in place. The position sheet is removed and stored, it can be reversibly used again, e.g. for further 3D images in the clamped position with distance contact from the upper and lower dental arch.

A subsequent step comprises the assembly or activation of the measuring devices, markers and or sensors or transmitters which are spatially known in relation to the support arch and thus also to the lower dental arch and the lower jaw. The movement tracking of the measuring devices thus generates a tracking and mapping of the movement and positions of the teeth of the lower jaw. If you use a 3D model with skull, upper jaw and lower jaw, you can transfer the measured movement into the dynamic time-varying 3D data model.

The last step finally includes the evaluation of the measurement data on the position and movement of the measuring device, the support arch and the lower jaw. It either becomes absolute recorded and offset against the movement of the upper jaw. Or the movement is measured relatively between the upper jaw and lower jaw. The evaluation allows conclusions to be drawn about the position, shape and health of the temporomandibular joint, the functionality of the teeth and the occlusal surfaces and the corrections that appear necessary in order to obtain optimized biomechanics of the jaw movement. Furthermore, the measurement allows a statement about possible improvements in the shape and position of the occlusal surfaces of the teeth.

Exemplary embodiments and figures

Further details and features emerge from the following description of preferred exemplary embodiments in conjunction with the figures. The respective features can be implemented individually or in combination with one another. The possibilities for solving the task are not limited to the exemplary embodiments. For the special case,. The fact that the device 100 is not mounted on the lower jaw but on the upper jaw is interchanged in the entire context “lower jaw” and “upper jaw” as well as “below” and “above”.

The exemplary embodiments are shown schematically in the figures. The same reference numerals in the individual figures designate the same or functionally identical or corresponding in terms of their functions elements.

Fig. 1 shows a combined device 100 consisting of two preferably arcuate

Divide 10 and 30.

FIG. 2 shows the connection of the retaining bow 10 and the positioning element 30 to a combined device 100 in a view from the side.

FIG. 3 shows the sectional view across a tooth with a support arch 10, a) with and b) without a positioning element 30

Fig. 4 shows schematically the sequence of the method for introducing and using the

Device 100.

Figure 1

1 shows a combined device 100 consisting of two preferably arcuate parts 10 and 30. The holding bow 10 ultimately serves to anchor the measuring devices in a defined position to the lower jaw with the aid of the fastening element 20, these measuring devices, markers, sensors, transmitters etc. also be integrated in the tie 10 itself can. The marking elements 12 shown can consist, for example, of metal balls or of balls with X-ray contrast in comparison to the X-ray density of the material from which the holding sheet 10 is made. Using more than 2 markings in the room, the position of the tie can be determined if the position of the markings relative to the tie is known.

The support bow 10 carries connecting elements 40, be it in a positive protruding or in a negative immersion form. Upon contact with the positioning element 30, the connecting elements produce a close and, in particular, sufficiently stable but securely detachable mechanical connection between the positioning element 30 and the holding arch 10. In the case of normal use in the lower jaw, the connecting elements can have the shape of truncated cones or they carry small magnets in order to secure them to generate a defined stop. It is important that these connecting elements 40 can be released without the relative fixed positioning of the retaining arch 10 being displaced on the dental arch. I.e. the relative position of the support arch to the teeth 50 of the lower jaw remains unchanged if the positioning element 30 is removed after its use for the subsequent movement measurements.

The positioning element 30 to be placed on the support arch 10 has approximately the same shape as the support arch 10, since it encloses the same dental arch. The important difference here is that the retaining arch preferably has no material in the area of the occlusion, while the positioning element has material in the area of the occlusion, which in each case creates a mechanical stop which limits the vertical movement of the device. The sideways movement relative to the teeth of the lower jaw is excluded by the form-fitting shape of the retaining arch 10 and also of the positioning element 30.

The combination of the holding bow 10 and the positioning element 30 results in the device 100 to be positioned very precisely. The connection between the holding bow 10 and the positioning element 30 can be carried out in various ways, preferably by connecting elements 40, which provide a positive connection and relative fixation of the holding bow 10 and Generate positioning element 30.

The connecting elements 40 can be released with a particularly metered amount of force without the connection between the retaining bow 10 and teeth 50 of the lower jaw being released or displaced. In the simplest embodiment, there are three-dimensional non-planar areas in the tie 10, e.g. in the shape of a truncated cone, which mesh with the opposite side in the positioning element 30 in a precisely fitting and demoldable manner.

As soon as pressure is exerted on the positioning element from above, e.g. upon contact of the upper dental arch with the device 100, the at least one connection point 40 locks the two parts 10 and 30 against relative movements between the parts 10 and 30.

In a special exemplary embodiment, the spacer elements 31 are designed separately as small areas, in particular of suitable construction height, around the teeth of the upper jaw that are opposed to them to keep at a distance and not allow direct tooth contact between the upper jaw and lower jaw.

In a further exemplary embodiment, the locking elements 32 are designed separately, which lock the lateral movements to the left, right, front and back between the upper jaw and lower jaw as soon as at least one tooth of the upper jaw engages in at least one locking element.

In particularly preferred embodiments, the spacer elements 31 and the locking elements 32, which each point towards the upper jaw, are structurally combined and have the shape of irregular elevations and depressions in the positioning element 30.

It should be pointed out that features of different exemplary embodiments can of course be combined.

Figure 2

FIG. 2 shows the connection of the retaining bow 10 and the positioning element 30 to a combined device 100 in a view from the side in a simplified sectional view. The section schematically shows the connecting elements 40 as separately placed elements made of a different material. However, the connecting elements 40 can also be formed in a fully integrated manner and then consist of exactly the same material of the retaining bow 10 and or of the positioning element 30 and are preferably made in one piece with the parts 10 and 30, respectively. This has advantages in additive manufacturing e.g. by 3D printing and also in the subtractive manufacturing, for example by machining the device 100.

The fastening device 20 serves to adjust and fix measuring devices to be attached. The relative position of the measuring devices in relation to the holding sheet 10 can be reversibly released and restored by means of a detachable connection 21, this relative position of the measuring device relative to the holding sheet 10 remaining the same after the restoration. As a result, the measuring device can e.g. for X-rays or 3D DVT recordings.

The preferably several markings 12 are advantageously located in the holding sheet 10, because this also remains positioned in the lower jaw during the movement measurements, while the positioning element 30 is removed for movement measurements.

The geometry of parts 10 and 30 depends on the individual anatomical and biomechanical conditions. The basic shape of the parts 10 and 30 which appears to be rectangular is a highly schematic version, in practice the parts 10 and 30 are anatomically adapted to the conditions of the test subjects / patients in the best possible way.

So-called preforms, that is to say semi-finished parts, are preferably used for production, provided that the parts are not produced by complete additive production. Figure 3

FIG. 3a shows the section across a tooth 50 of the lower jaw with gums 60 with a holding arch 10 attached and a positioning element 30 fastened thereon. Of particular importance is the area of the occlusal occlusal surface 53 and the area of the contact surface 11 laterally non-occlusal between tooth 50 and holding arch 10. In the section, the connecting element 40 is shown schematically, which, together with the other connecting elements 40, provides the precise positioning of the positioning element 30 relative to the retaining bow 10. Also shown is a marking element 12 which, in cooperation with the other marking elements, serves to detect the position of the holding sheet 10.

The connecting element 40 shows corresponding shapes in the connected parts 10 and 30 or else it is designed as a separately inserted part 40 which can be inserted in a form-fitting manner in each of the parts 10 and 30. The spacer element 31 is shown schematically at the top of the holding arch 30. What is important is the occlusal stop area 33 in the positioning element 30, which serves to ensure that the retaining arch cannot be shifted too far towards the tooth roots in the vertical position. In contrast to the holding arch 10 which does not cover the occlusal area 11, the positioning element 30 has at least 2 occlusal abutment areas 33 which protrude from the side into the area of the occlusal surface 53 of the tooth 50.

3b shows the same cross section after removal of the positioning device 30. The holding device remains in the position previously also fixed with the aid of the positioning element 30, with the aid of the relative connection between the holding arch and teeth, in particular on the contact surfaces 11. The positive and non-positive contact surfaces 11 of the arch 10 do not extend to occlusion but form retentions because the surfaces are generally not flat and in particular spherical and the arch 10 exerts a prestress on the tooth 50 via the contact surface 11.

As soon as the positioning element 30 is removed after the position recordings and only the retaining arch 10 remains on the lower jaw, there is no longer an occlusal covering 33 and the entire range of motion of the lower jaw up to occlusion and the entire grinding movements of the lower jaw are released. This serves e.g. undisturbed movement analysis and position analysis in the field of orthodontics and dentistry.

Figure 4

FIG. 4 shows a method for introducing the device 100 preferably into the area of the lower jaw, for the precise positioning and fixing of the retaining arch 10 and for the use of the positioning element 30 for the production of contact-free recordings of the jaw with the teeth. The method assumes that with the help of at least partially digital technologies, a digital 3D model of the dentistically and orthodontically relevant head area with the upper jaw and Lower jaw and TMJ are created. For tooth-bearing rehearsals / patients, this model includes the current dental arches in the upper and lower jaw. A segmentation into bone substance, tooth substance and soft tissue has preferably taken place. Since the position of the dental arch relative to the jaw is known from this 3D model, the position of the lower jaw can be inferred in particular from the position of the lower dental arch, which is measured. This is compared to the position of the upper jaw and this is used to calculate the relative position and, in the case of motion pictures, the relative movement in the temporomandibular joint. In order to be able to make the measurements, one must, for example, equip the lower jaw with sensors or equip metrological devices on the dental arch of the lower jaw. For this purpose, the support arch 10 is attached to the dental arch of the lower jaw via the contact surfaces 11. The particular challenge is to make the assembly of the measuring devices precise and reversible. For this reason, a non-occlusal support arch 10 is used in the exemplary embodiments, which does not reach the occlusal surfaces 53 but only builds up suitable holding forces buccally, that is to say laterally on the tooth. Either suitable retentions can be used and mechanical clamping tension can be exerted or additional adhesive forces can be used, for example by using adhesives which produce releasable connections, in particular in contact areas 11 between retaining bow 10 and tooth 50. The method according to the invention, which will now be described, serves for the purpose of optimal positioning and use of the device.

In step 1010, the two parts 10 and 30 are first assembled. For this purpose, the connecting elements 40 are used, which generate a precisely defined relative position between the holding bow 10 and the positioning element as soon as the two parts are joined together.

In step 1020, the combined device 100 thus produced is jointly fixed to the dental arch of the lower jaw. The positioning uses the precisely shaped contact surfaces 11 and the contact surfaces in the positioning element, which are similar to an impression, including the stop regions 33 in the region of the chewing surfaces 53.

In step 1030, the support bow 10 is fixed in a sufficiently stable but nevertheless particularly removable manner on the dental arch of the lower jaw, while the positioning element 30 is not fixed on the teeth but is only fixed by positive locking to the teeth 50 and by the connecting elements 40 relative to the support bow 30 . The holding force of the holding sheet 10 can be increased if necessary by adhesives.

Now in step 1040 the lower jaw is moved upwards relative to the upper jaw, so that at least one tooth of the upper jaw touches the positioning element and begins to build up force downwards towards the lower jaw. As a result, the lower jaw snaps into space using its 6-dimensional mobility, which is determined by the locking elements 32. The spacer elements 31 ensure that the teeth of the upper jaw and lower jaw do not touch. This serves to simplify and improve the automated segmentation and separation of the dental arches in the following 3D imaging processes. In step 1050, the 3D recordings are now made in the position specified by the positioning device 30, in particular with a slight biting force. The device 100 is used in particular for perfect stabilization against relative movements between the upper jaw and lower jaw. The images preferably show clearly separable and segmentable, for example bone tissue, soft tissue, tooth substance and, if present, implant material. These 3D images also show the markings 12 and thus permit the exact 3D location of the support bow 10.

After these recordings, the reversible connection between the holding bow 10 and the positioning element 30 is released in step 1060. The positioning element 30 is removed. The fixation of the arch 10 on the dental arch of the lower jaw remains intact.

In the subsequent step 1070, the measuring devices, sensors, markers and or transmitters are attached to the holding sheet 10 or activated if they are integrated in the holding sheet 10. The fastening elements 20 and 21 allow the defined relative position of measuring devices etc. and the retaining bow 10 to be restored.

With mounted measuring devices, the measurement and evaluation of positions and movements now take place in step 1080, in particular during chewing movements and crunching movements. The measurement data are transferred to an IT system, recorded and evaluated later or in real time.

The evaluation of the recorded measurement data or images about positions and or movements takes place in a digital IT system. The IT system can, in particular, display stationary and moving 2D sectional images, delimit 3D part quantities of the space on the basis of material parameters and display and move the 3D objects thus formed relative to one another.

The invention further relates to the following aspects:

1. Device consisting at least of a support arch and positioning element for reversibly releasable attachment to real or artificial teeth of a lower jaw or upper jaw, with a support arch with concave surface areas, which are each designed to contact a lateral, in particular buccal, surface area of a tooth, in each case to form a positive connection, the retaining arch leaving the occlusal surfaces of all teeth free, so that a chewing movement is not hindered, characterized in that in the transition region between the retaining arch and the positioning element there is at least one connecting element which forms a spatially precise locking between the positioning element and the retaining arch, or in that at least one protrusion or a retention is formed in the separable transition region of the holding arch and the positioning element, which provides a positionally precise, reversibly releasable attachment of the positioning element on the Tie allowed.

2. Device according to aspect 1, wherein the positioning element partially covers the occlusal occlusal surfaces of the dental arch at least in some areas and thereby at least two stop elements are formed, which are used for the exact positioning of the positioning element, and thereby also the holding arch is exactly positioned under the mechanical mediation of the connecting elements between the holding arch and the positioning element.

3. Device according to one of the preceding aspects, wherein the positioning element has at least one spacer element that establish a defined minimum distance between the upper jaw and lower jaw, so that the teeth of the upper jaw cannot touch the teeth of the lower jaw, this spacer element either being applied to the positioning element or is integrated three-dimensionally into the positioning element by additive or subtractive manufacturing.

4. Device according to one of the preceding aspects, wherein at least one

Stop element of the positioning element is simultaneously effective as a spacer for at least one tooth on the opposite side.

5. Device according to one of the preceding aspects, wherein the

Positioning element has at least one locking element which, when in contact with a tooth on the opposite side, establishes a defined position of the lower jaw relative to the upper jaw, so that the teeth of the lower jaw relate to each other when the locking elements interact

Sideways movements to the left, right, front, back can be positioned exactly.

6. Device according to one of the preceding aspects, wherein the retaining sheet has at least one marking element that is exactly reproduced in its spatial orientation in imaging methods, preferably via at least 3 marking elements that allow position detection.

7. Device according to one of the preceding aspects, wherein the

Positioning element on the side facing the tooth roots towards the arch has receptacles for its connecting elements and at the same time on the opposite occlusal side has a combination of spacing elements and locking elements so that the lower jaw relative to the upper jaw when the device is used when the upper jaw and lower jaw are clenched in one defined minimum distance and at the same time the relative position of the upper jaw and lower jaw is fixed sideways to the right, left, back, front.

8. Device according to one of the preceding aspects, wherein the support arch (10) has a reversibly releasable fastening element to which measuring devices can be fastened, which serve to detect the position or movement of the lower jaw relative to the upper jaw.

9. A method using the device consisting at least of a tie and positioning element, wherein a. brought the positioning element into positive contact with the retaining bow will, b. with the help of the stop elements, the device is positioned exactly in the lower or upper jaw, c. the relative position of the arch to the dental arch in the lower jaw or upper jaw is carried out by the concave surface areas of the arch in the position directly adjacent there, by the action of positive retention forces or supplemented by adhesive forces, d. the lower jaw is moved relative to the upper jaw so that non-positive contact is created, with at least one tooth on the opposite side snapping into the locking element in such a way that the lateral movements to the front or back or to the right or left are fixed, and with spacing elements or spacing areas integrated in the positioning element, a minimum spacing is secured between the upper jaw and lower jaw e. and due to the minimum distance the contact between teeth or artificial teeth of the upper jaw or lower jaw is prevented when clenched.

10. The method according to the preceding aspects wherein, when biting, the position of the lower jaw relative to the upper jaw is adjusted by means of a plurality of spacer elements such that a particular positioning or relief of at least one of the temporomandibular joints takes place by the rear spacer elements closer to the temporomandibular joint a greater distance between the upper and Adjust the lower dental arch than is present when the temporomandibular joint makes mechanical contact.

1 1. Method according to the preceding aspects, wherein in the fixed relative position of the upper jaw and lower jaw produced by means of the device, at least one at least two-dimensional, preferably three-dimensional imaging image of the dental arches in the upper jaw and lower jaw takes place.

12. Method according to one of the preceding aspects, wherein X-rays are used for imaging and the X-ray image reveals tooth material and bone material and soft tissue, so that material areas can be segmented and separated.

13. Method according to one of the preceding aspects, the dental arches of the upper jaw and lower jaw being digitally segmented in a 3D model by an automated device from the images of the upper jaw and lower jaw in the locked position with a minimum spacing.

14. The method according to one of the preceding aspects, wherein the locked position of the upper jaw and lower jaw is left again according to the imaging images and the positioning element is removed from the area of the lower jaw or upper jaw during the tie, in particular by holding action on the concave surface areas of the tie remains fixed to the teeth without the relative position of the retaining arch relative to the dental arch thereby changes.

15. The method according to any one of the preceding aspects, wherein after the removal of the positioning element with the support bow inserted, movement recordings or position recordings take place via measuring devices which are either integrated in the support bow or which are fastened to the support bow.

glossary

Buccal: To the cheek side of a tooth.

Measuring device: sensor, signal transmitter, transmitter, marking etc.

Non-occlusal: not touching the occlusal surfaces, not obstructing the biting movement.

DVT: digital volume tomogram, 3D x-ray image with low

Radiation exposure.

Opposite side: dental arch of the upper jaw when attaching the retaining arch to the lower jaw,

Dental arch of the lower jaw when attaching the retaining arch to the upper jaw

Occlusal: In relation to the occlusal surface of the tooth or the chewing plane

Occlusion: Bit with contact between the upper dental arch and the lower dental arch

Separation: Delimitation of individual 3D room areas with certain signal properties or material properties, without making contact with anatomically or

there are biomechanically separate parts. E.g. Clear separation of the two dental arches in the upper and lower jaw.

Segmentation: generation of spatial areas based on signal properties, e.g.

based on the x-ray density. E.g. Generation of the contiguous area for bone material.

Tooth: natural tooth or artificial tooth or crown tooth or implant etc.

Reference numerals

10 ties with concave surface areas, leaving the occlusal surfaces free

1 1 concave surface areas on the tie,

12 Marking element for imaging processes

20 fastening element for measuring devices

21 fastener on the tie e.g. pluggable connection

30 positioning element, partially covering the occlusal surfaces 31 Spacer, acting on the tooth on the opposite side

32 Locking element acting on the tooth on the opposite side

33 stop element on the occlusal surface

40 connecting element with relative position fixation

50 tooth, artificial tooth or implant

53 occlusal surface of a tooth

60 gums, soft tissue

100 device, tie 10 connected to positioning element 30

1000 positioning and acquisition procedures

1010 Manufacture of device 100

1020 inserting and positioning the device 100

1030 Fixation of the holding frame 10 on the dental arch

1040 Snap the teeth of the upper jaw into the fixation elements 32 at a distance 31

1050 3D image in the fixed position at a distance

1060 removal of the positioning element 30

1070 Attaching or activating the measuring devices etc.

1080 measurement movements and positions and evaluation

Claims

Expectations

1. Device (100) for fastening at least one measuring device to a jaw in a defined position, comprising

a holding arch (10), the holding arch (10) being provided for attachment to a dental arch of an upper or lower jaw and allowing occlusion in the fastened state, and a positioning element (30) releasably connectable to the holding arch (10), wherein if the positioning element (30) in the fastened state of the retaining arch (10) on the dental arch is connected to the retaining arch (10), the occlusion is prevented, in particular by the positioning element (30).

2. The device (100) according to claim 1, further comprising at least one connecting element (40) for releasably connecting the retaining arch (10) to the positioning element (30), the retaining arch (10) and the positioning element (30) in through the connecting element ( 40) connected state are immovable relative to one another in a lateral direction.

3. Device (100) according to one of claims 1 to 2, wherein the positioning element (30) on the surface facing away from the retaining arch (10) has at least one spacer element (31) to prevent occlusion.

4. The device (100) according to any one of claims 1 to 3, wherein the positioning element (30) on the surface facing away from the holding arch (10) has at least one locking element (32).

5. The device (100) according to claim 4, wherein the locking element (32) for releasably fixing at least one tooth of the dental arch, to which the retaining arch (10) is not attached, relative to a movement, in particular a lateral and / or vertical movement to the device (100) is designed.

6. The device (100) according to any one of claims 1 to 5, wherein the at least one spacer element (31) and the at least one locking element (32) are structurally combined in the positioning element (30).

7. The device (100) according to any one of claims 1 to 6, wherein the retaining sheet (10) has more than two marking elements (12).

8. The device (100) according to claim 7, wherein the marking elements (12) made of a material with X-ray contrast, in comparison to the X-ray density of the material from which the retaining sheet (10) is made.

9. The device (100) according to any one of claims 1 to 8, wherein the support sheet (10) and the positioning element (30) are at least partially X-ray visible.

10. The device (100) according to any one of claims 1 to 9, wherein the connecting element (40) contains at least one magnet.

1 1. Device (100) according to any one of claims 1 to 10, wherein at least one measuring device is integrated in the support sheet (10).

12. The device (100) according to any one of claims 1 to 10, wherein the retaining arch (10) via at least one fastening element (20) for releasably fastening a measuring device.

13. A method of using the device (100) according to any one of claims 1 to 12, the method comprising the steps

a) connecting the device (100) with the first dental arch of a first jaw, so that the retaining arch (10) is attached to the first dental arch and the positioning element (30) to the retaining arch (10).

b) relative movement of the first jaw relative to a second jaw until a second dental arch of the second jaw stops on the spacer element (31),

c) recording one or more tooth and / or jaw positions during the abutment of the second dental arch on the spacer element (31),

d) removing the positioning sheet (30) from the holding sheet (10),

e) measurement of movements and / or positions of the first and / or second jaw, in particular relative to one another.

14. The method for using the device (100) according to claim 13, wherein in step b) at least one tooth of the second dental arch engages in the locking element (32).

15. The method for using the device (100) according to any one of claims 13 to 14, wherein in step a) the retaining arch (10) is biased relative to the first dental arch.