Method of and apparatus for orthopedic and/or orthodontic treatment

Method of orthopedic and/or orthodontic treatment comprising the steps of securing bands or the like to selected teeth (e.g., selected molars) of one jaw (e.g., the upper or lower jaw) of a patient with these bands being adapted to hold an archwire. Then, the proper relationship of the mandible to the maxilla is temporarily established, such as through the use of temporary splints, allowing ligaments and muscles to function normally and maintaining the patient's proper mandibular and temporomandibular joint positions. A body of pliable, hardenable material carried by the archwire is placed in the patient's mouth with the patient's mouth open and with the archwire held in place by the bands, the body of pliable, hardenable material is in register with selected teeth (e.g., the incisors) of the patient's other arch. A buccal wire is optionally provided which contacts the outer surfaces of the front teeth and is passed distal to both the cuspids or the laterals, and is imbedded in the hardenable material on the inside of the selected teeth (e.g., front incisors and cuspids). Then, the patient closes his mouth so that with the mandible and temporomandibular joints properly positioned with respect to the maxilla, the selected teeth of the other jaw form an impression in the body of hardenable material such that after hardening of the material and after the temporary splints are removed, the impression formed in the body of the hardenable material by the selected teeth of the other jaw serves as a reference to stabilize the position of the mandible, maxilla and temporomandibular joints during an extended period of orthopedic and orthodontic treatment whereby the patient's teeth may be orthodontically moved to their optimal anatomical and physiological positions with the mandible and temporomandibular joints held in their proper position. Apparatus for carrying out the above-described method is also diclosed.

BACKGROUND OF THE INVENTION 
This invention relates to a method of and apparatus for the orthopedic 
and/or orthodontic treatment of a patient's temporomandibular joints, 
mandible, maxilla and the teeth carried thereby and of the patient's 
muscles of mastication, ligaments and skeletal features constituting the 
masticatory system in which the proper positions of the mandible and 
temporomandibular joints are estabilished with respect to the maxilla and 
in which the teeth are, over an extended period of time, moved to their 
desired locations utilizing the proper position of the mandible, maxilla, 
and temporomandibular joints as a reference so that after treatment, not 
only are the teeth properly positioned, but the position of the mandible, 
maxilla and temporomandibular joints are properly orthopedically 
established and stabilized. 
Oftentimes in orthodontic treatment, the patient's teeth are moved relative 
to one another so as to correct many different problems. Some of these 
problems may include overbite, overject, protruded or intruded teeth, 
rotated teeth, missing teeth, teeth that are maloccluded or that have not 
properly erupted, and teeth which are angularly displaced because 
insufficient room is available in the patient's jaw. Generally, after 
orthodontic treatment, it is desirable that the patient's teeth be 
cosmetically or aesthetically aligned. 
However, in actual practice, it has been found that many times after 
extensive conventional orthodontic treatment, patients sometimes have 
aesthetically aligned teeth, but the proper anatomical relationship of the 
mandible, maxilla, temporomandibular joints, muscles of mastication, 
ligaments and skeletal elements constituting the masticatory system is not 
properly established. Without this proper anatomical relationship properly 
established and stabilized, many well-known problems, including 
malocclusion, difficulty in chewing, severe headaches, neck aches, 
backaches, ear problems (tinnitis), jaw pain, and facial pain can be 
traced to the improper anatomical positioning of the mandible, maxilla, 
muscles of mastication and temporomandibular joints. In severe cases, this 
can result in certain forms of degenerative arthritis of the 
temporomandibular joint, and can lead to and be associated with improper 
positioning of the tongue and loss of oral muscle strength resulting in 
deviate swallowing. 
In general, the correction of a patient's deviate swallow is referred to as 
myofunctional therapy. More particularly, myofunctional therapy relates to 
the selective training, positioning, and strengthening of specific muscles 
or groups of muscles used in speech, mastication, deglutition and 
swallowing, particularly to the selective training of the tongue. 
In general, the prior art orthodontic treatment methods and appliances 
teach the concept of attaching various bands, brackets, and other 
appliances to the teeth or to the patient's head and applying corrective 
orthodontic forces to selected teeth such that these selected teeth are 
moved within the patient's jaw thus straightening the teeth or providing 
room for other teeth thus establishing a desired relationship between all 
of the teeth in the person's mouth. However, as mentioned, oftentimes 
these prior art orthodontic appliances and methods did not utilize the 
desired position of the mandible, maxilla, muscles of mastication, and 
temporomandibular joints as a reference point. Additionally, many prior 
art appliances were cumbersome and could not readily be removed or 
adjusted either by the dentist, orthodontist or by the patient. 
Still further, prior art orthodontic treatment methods and appliances did 
not, for the most part, incorporate a simultaneous orthopedic treatment 
which not only resulted in the desired orthodontic results, but also 
resulted in orthopedic stabilization of the mandible, maxilla, muscles of 
mastication, and the tempomandibular joints. Likewise, the prior art 
orthodontic treatments did not address myofunctional swallowing 
impairments oftentimes associated with the above-described orthodontic and 
orthopedic problems. 
Thus, there has been a longstanding need for a method of combined 
orthopedic and orthodontic treatment and apparatus for carrying out the 
method in which the proper relationship of the mandible, maxilla, muscles 
of mastication and the temporomandibular joints are utilized as a 
reference during the entire course of orthodontic treatment such that the 
teeth may be orthodontically moved to their desired positions with respect 
to the proper or normal anatomical positions of the mandible, maxilla, 
muscles of mastication and the temporomandibular joints, and in which 
swallowing myofunctional therapy could be simultaneously given to the 
patient. 
Reference may be made to such U.S. patents as U.S. Pat. Nos. 618,105, 
1,101,504, 1,207,566, 1,429,749, 1,773,588, 2,479,780, 3,327,580, 
3,478,742, 3,925,894 and 4,202,328 which describe prior art orthodontic 
treatments and apparatus in the same general field as the present 
invention. 
SUMMARY OF THE INVENTION 
Among the many objects and features of this invention may be noted the 
provision of a method of orthopedic and/or orthodontic treatment and 
apparatus for carrying out this treatment method which allows mandible 
positioning and which allows the teeth to be moved relative to a properly 
established anatomical reference; 
The provision of such a method and apparatus which, by utilizing the proper 
mandible, maxilla, temporomandibular joint relationship as a reference, 
optimizes muscle function, improves the aesthetics of the orthodontic 
treatment, improves chewing action, and, after treatment, results in a 
masticatory system which is stable; 
The provision of such a method of treatment and apparatus which is useful 
in myofunctional therapy; 
The provision of such a treatment method and apparatus which allows 
multiple orthodontic treatments to proceed at the same time; 
The provision of such a treatment method and apparatus which permits 
maximum flexibility for the treating dentist or orthodontist and which 
eases placement of archwires and other orthodontic appliances; 
The provision of such orthodontic apparatus in which at least certain parts 
of the apparatus are readily removable by the patient for increased 
aesthetic purposes and for cleanability purposes; 
The provision of such an orthodontic method and apparatus which is useful 
in orthodontically treating partially erupted or super-erupted teeth; 
The provision of such an orthodontic method which is useful in oral surgery 
to serve as a reference for a surgically re-located mandible or maxilla; 
The provision of such apparatus which allows for adjustment of the 
apparatus by the patient in accordance with a preestablished schedule thus 
speeding orthodontic treatment and minimizing the number of visits the 
patient must make to the orthodontist's office; 
The provision of such a treatment method and apparatus which allows normal 
development of both arch forms, which allows normal eruption of the 
patient's teeth to their fullest genetic potential, and which allows 
normal alveolar and condylar bone growth; 
The provision of such a treatment method and apparatus which results in 
normal orthopedic position of the mandible, maxilla and tempomandibular 
joints thereby allowing optimal masticatory muscle function; 
The provision of such a treatment method and apparatus which permits the 
arch expansion and distilizing of posterior teeth; and anterior movement 
of the front teeth; 
The provision of such a treatment method in which, after completion of the 
primary orthodontic treatment, certain of the components can be used as a 
temporary retainer; 
The provision of such a treatment method and apparatus which facilitate 
alveolar and condylar bone growth; and 
The provision of such a treatment method and apparatus which is easy to 
install, which is comfortable to the patient, and which is of relatively 
uncomplicated construction. 
Other objects and features will be in part apparent and in part pointed out 
hereinafter. 
Briefly stated, the method of this invention of orthopedic and/or 
orthodontic treatment comprises the steps of securing means (e.g., bands) 
to selected teeth (e.g., to certain of the molars) to one jaw of a patient 
(e.g., the upper jaw) with these securing means being adapted to hold an 
archwire in position. Then, the proper relationship of the patient's 
mandible and temporomandibular joints is temporarily established, as, for 
example, by utilizing conventional splints. A body of pliable, hardenable 
material (e.g., an acrylic plastic or the like) carried by the archwire is 
positioned such that the body of hardenable material is held in place 
within the patient's mouth in register with selected teeth of the 
patient's jaw (e.g., in register with the incisors of the patient's upper 
jaw). A second wire is optionally placed buccal to the front teeth, turned 
distal to the cuspids or laterals, and imbedded in the hardenable plastic. 
This optional buccal wire serves to maintain the anterior position 
archwire and bitepiece so they do not place undue occlusal or orthodontic 
forces on the teeth and so that archwire and bitepiece may be more readily 
inserted and removed. Then, the patient closes his mouth so that with the 
mandible and temporomandibular joints properly positioned, the selected 
teeth of the other jaw (e.g., the lower incisors) form an impression in 
the body of the hardenable material whereby after hardening of the body of 
material and after removal of the means used for temporarily establishing 
the mandible and temporomandibular joints, the impressions formed in the 
body of hardenable material by the selected teeth of the other jaw serve 
as a reference to stabilize the position of the mandible and 
temporomandibular joints during an extended period of treatment whereby 
the patient's teeth may be moved to their respective desired positions 
with the mandible and temporomandibular joints held in their proper 
anatomical positions. 
Apparatus for carrying out the above-described treatment includes means, 
such as bands or the like, which are secured to selected teeth (e.g., the 
molars) on one jaw of the patient (e.g., the upper jaw). These bands 
include means for receiving and holding an archwire. A body of pliable, 
hardenable material is carried by and is held in place on the archwire 
with the body of hardenable material being generally in register with 
selected teeth of the patient's jaw (e.g., in register with the incisors 
of the upper jaw). A reinforcement wire is optionally placed buccal to the 
front teeth, turned distal to the cuspids and imbedded in the hardenable 
material. Thus, when the patient closes his mouth, the selected teeth of 
the other jaw form an impression in the body of hardenable material such 
that after the material has hardened, the impressions formed therein 
establish a reference holding the mandible and temporomandibular joints in 
their desired positions, even after temporary means (e.g., the splints) 
have been removed. Thus, this body of hardenable material (referred to as 
a bitepiece) with the tooth impressions formed therein serves as a 
reference for establishing the proper anatomical position of the mandible 
and temporomandibular joints throughout the entire course of the 
orthodontic treatment whereby various teeth in the patient's mouth may be 
moved to their desired locations utilizing the proper anatomical position 
of the mandible, maxilla, muscles of mastication, and the 
temporomandibular joints as a reference.

DESCRIPTION OF PREFERRED EMBODIMENTS 
Referring now to the drawings, and more particularly to FIG. 1, the head, 
as generally indicated at 1, of a patient is illustrated. The head, of 
course, includes a skull 3 which may be divided into two main sections or 
parts, viz., the cranium and the skeleton of the face. A brief description 
of the various bones which comprise both the cranium and the skeleton of 
the face, as they relate to the method and apparatus of the present 
invention will now be described. Specifically, the skeleton of the face 
includes the maxilla 5 in which the teeth of the upper jaw are embedded 
and the mandible 7 in which the teeth of the lower jaw are embedded. The 
upper teeth are generally indicated by reference character 9 while the 
lower teeth are generally indicated by reference character 11. 
Mandible 7 includes a body (corpus mandibulae) 13. The body of the mandible 
is curved (when viewed in plan) with a ramus portion 15 (ramus mandibulae) 
projecting upwardly at each end. At the upper rear of the ramus, the 
condyle projection 17 is formed, and at the upper front end of the ramus, 
the coronoid process 19 is formed. A so-called mandibular notch 21 arches 
downwardly between condyle 17 and coronoid process 19. 
The cranium portion of the skull includes the zygomatic bones 23 which form 
the outer portion of the eye socket and which are generally known as the 
cheekbones. In addition, the cranium, immediately above the location of 
the ear, includes a temporal bone 25. As indicated at 27, a zygomatic arch 
bridges between the posterior end of the maxilla bone in the lower portion 
of the temporal bones on each side of the head. The condyle projection 17 
of mandible 7 is generally socketed in the glenoid fossa of the temporal 
bone 25 and the coronoid process 19 of the mandible fits behind zygomatic 
bone 23 in the glenoid fossa. 
Generally, the temporomandibular joint, as generally indicated at TMJ, 
connects the rear of mandible 7 with the cranium and is a combined 
ginglymus and gliding joint. Generally, the temporomandibular joint TMJ is 
comprised of a number of ligaments (not shown) including the articular 
capsule ligament, the lateral ligament, the sphenomandibular ligament, the 
articular disk, and the stylomandibular ligament. The articulation of 
mandible 7 includes the opening and closing of the jaws, the protrusion in 
fore and aft directions of the mandible, and lateral displacement of the 
mandible. Generally, there are two parts to this articulation, one between 
the condyle and the articular disk (not shown) and between the disk and 
the glenoid fossa. When the jaws are opened and closed utilizing the 
muscles of mastication (not shown), motion takes place on both parts, the 
disk glides anteriorly on the articular tubercle or eminence (not shown), 
and the condyle process 17 moves on the disk like a hinge, causing the 
mandible to rotate about a center of suspension, as indicated at 29, near 
the center of the condyle process. This is a somewhat movable center of 
suspension and is defined by the attachment of the sphenomandibular 
ligament to the lingula (also not shown), and by a sling formed by the 
masseter and the pterygoideus medialis. When the jaws are open, the angle 
of the mandible moves posteriorly while the condyle process 17 glides 
forwardly along the emmenentia of the anterior tubercle as the short arm 
of a lever, and the chin, as the long arm of the lever, describes a wide 
arc. The motion between the condyle process and the articular disk is 
largely one of accommodation to this change in position. When the jaws are 
closed, some of the force is applied to the condyle process as a fulcrum, 
especially in biting with the incisors, but in chewing with the molars, 
the pressure comes more directly between the teeth and the condyle process 
acts as a glide more than as a fulcrum. In grinding or chewing movement of 
the mandible, there is a lateral displacement of the mandible caused by a 
forward movement of the condyle process and then the mandible is brought 
back into place by the action of the closing muscles and the meshing of 
the teeth. The condyle process 17 of the mandible 7 may be displaced 
alternately, or the same one may be displaced repeatedly as in chewing 
with one side of the mouth. 
As is well known, it is imperative that, in order to establish a proper 
bite and chewing action, the relative positions of mandible 7, maxilla 9, 
the above-described bones and ligaments of the cranium and the associated 
primary and secondary muscles of mastication be in their proper anatomical 
relationship. It is an object of this invention that, before orthodontic 
treatment begins, the proper relationship of the mandible 7, maxilla 9, 
and temporomandibular joints be properly orthopedically established and be 
used as a reference throughout the course of treatment whereby not only 
are the teeth orthodontically moved to their desired positions, but the 
mandible and maxilla are orthopedically moved to their respective proper 
anatomical positions, the proper bite is established, the proper positions 
of the mastication muscles are established, and the proper positions of 
the temporomandibular joints are established and stabilized. 
Referring now particularly to FIGS. 2 and 3, apparatus of the present 
invention for carrying out the method of this invention for orthopedic 
and/or orthodontic treatment will now be described in detail. As indicated 
generally at 31, bands or other appliances (such as an Adam's clasp 31A, 
see FIG. 3) may be secured to selected teeth (e.g., selected molars) on 
opposite sides of one of the patient's jaws (i.e., either the upper or the 
lower jaw). Each band 31 includes an inside tube 35 facing generally in 
fore and aft direction. An outside tube 37 may be optionally carried by 
bands 31. An archwire, as generally indicated at 39, is fitted in the 
patient's mouth so as to be on the inside or lingual surfaces of the 
teeth. As indicated at 41, the free ends of archwire 39 are threaded and 
the threaded ends of the archwire are received within inside tubes 35 
provided on bands 31. Thus, these tubes constitute means for receiving and 
holding the archwire. Optionally, tubes 35 may be pivotally secured to 
bands 31 so as to permit the tubes and the archwire received therein to 
pivot about a horizontal axis to aid in alignment of the archwire relative 
to the teeth. 
Further in accordance with this invention, a body 43 of formable, 
hardenable material, such as acrylic plastic or the like, as shown in FIG. 
3, is applied to and carried by the front or center portion of archwire 39 
so as to form an impression of the inside or lingual faces of the selected 
teeth of the one jaw (e.g., the incisors I and the canine teeth C of the 
patient's upper jaw). An optional buccal holding or bracing wire 44 is 
placed in contact with the buccal or outer surfaces of the front teeth. 
This wire is bent distal to the cuspid or laterals and is imbedded in the 
hardenable acrylic. This wire 44 serves to support the appliance in the 
mouth, aids in guidance and prevents any flaring of the anterior teeth, 
and aids in removal and insertion of arch wire 39. Further, optional 
buccal wire 44 may be formed so as to exert a resilient or spring force on 
bitepiece 43 so as to more positively hold the bitepiece in position on 
the selected lingual surfaces of the teeth throughout the course of 
treatment, even in archwire 39 would inadvertently be bent. 
With the patient's mandible and temporomandibular joints TMJ properly 
established in the conventional manner, such as by using splints between 
the rear molars as required, the patient is then instructed to close his 
mouth so that selected teeth in the other jaw (e.g., the incisors of the 
lower jaw) move into engagement with the body of hardenable material or 
bitepiece 43 or archwire 39 behind the incisors of the upper jaw thereby 
to form an impression 49 therein. Upon hardening, the body 43 of 
hardenable material forms a so-called bite piece which conforms not only 
to the lingual or inside surfaces of the upper incisors, but also has an 
impression 49 formed therein of the incisors of the opposite or lower jaw. 
It will be appreciated that with the temporary splints removed from 
between the patient's molars and with the patient's lower incisors fitted 
into impressions 49 formed in bite piece 43, the mandible and 
temporomandibular joints TMJ are thus positively held in their preferred 
anatomical positions. Thus, in accordance with the method and apparatus of 
this invention, bite piece 43 carried by archwire 39 serves as a reference 
point throughout the entire course of orthodontic treatment of the patient 
for maintaining the mandible and temporomandibular joints in their proper 
orthopedic positions and providing a reference to which the patient's 
teeth may be orthodontically moved so that after orthodontic treatment, 
not only are the teeth orthodontically moved to their desired locations, 
but the bite of the patient is established so as to maintain the proper 
orthopedic position of the mandible and temporomandibular joints, even 
after removal of all orthodontic appliances. 
Further in accordance with this invention, the shape of bitepiece 43, 
particularly the rear or anterior portions thereof, may be shaped to fit 
into the patient's mouth so as to serve a guide for the tongue aiding in 
myofunctional therapy thus aiding and correcting any swallowing 
difficulties that the patient may have. More particularly, the curvature 
of the threaded arch wire 39 posteriorly of bite piece 31 and the shape of 
the lingual tubes 35 carried by bands 31 serve as a guide for placement of 
the tongue against the maxilla (i.e., the hard palate) and against the 
soft palate thus aiding normal swallowing actions. The lingual or inside 
tubes 35, the shape of arch wire 39, and the upper and lingual surfaces of 
bite piece 43 serve as guides and physical reminders to the patient so as 
to prevent placement of the tongue against the teeth and so as to properly 
position the tongue within the mouth for proper swallowing. Thus, arch 
wire 39 and bite piece 43 may serve the dual function of not only 
establishing a reference point for orthopedic and/or orthodontic treatment 
in which the temporomandibular joint is held in its desired position, but 
it also may serve as a myofunctional therapy mouthpiece. 
As generally indicated by reference 51, means may be installed in the 
patient's mouth for applying desired orthodontic forces to selected of the 
patient's teeth so as to move these selected teeth for desired orthodontic 
purposes. Specifically, arch wire 39 may be utilized to apply forces to 
the teeth which may be utilized to expand or contract the arch of the 
teeth. An adjustment nut 53 may be threaded onto the threaded ends 41 of 
arch wire 39 and a compression coil spring 55 is interposed between tube 
35 carried by band 31 and the adjustment nut so that the spring exerts a 
forwardly directed force on the adjustment nut and on the arch wire and a 
distillizing force on the molars to which bands 31 are attached. These 
forces tend to expand the arch and to distilize the posterior teeth. Also, 
a stop nut 57 may be threaded on the threaded ends 41 of the arch wire and 
with adjustment nut 53 in its desired position so that spring 55 exerts a 
predetermined amount of force, the stop nut may be tightened against the 
adjustment nut thereby locking both nuts in their desired position and 
thus maintaining the desired force on the arch wire. It will be 
appreciated that the patient may readily reach into his mouth and grasp 
the front portion of the arch wire and, by pulling it forwardly, the ends 
of the arch wire will slip free of inside tubes 35 thus permitting the 
removal of the arch wire and the bitepiece for cleaning or for aesthetic 
reasons. With springs 53 in place on the ends of the arch wire, the 
patient may readily re-insert the ends of the arch wire and, because of 
the lingual impressions of the front teeth formed on the bite piece 43 and 
the buccal bracing wire 44, the arch wire may be readily re-installed in 
its predetermined position in the mouth and the pre-adjusted orthodontic 
forces will automatically be re-applied to the teeth. Of course, by 
periodically adjusting the position of adjustment nuts 53, springs 55 may 
be progressively compressed thereby to increase the amount of force 
applied to the teeth. Thus, a predetermined adjustment schedule may be 
prearranged by the dentist or orthodontist (e.g., the progressive 
adjustment of nuts 53 and 57 and the periodic changing of springs 55) may 
be given by the dentist or orthodontist to the patient thus reducing the 
need for office visits. 
Alternatively, adjustment nuts 53 and stop nuts 5 may be provided on the 
rear of the threaded ends of the inner arch wire behind tube 35 with the 
spring interposed between the adjustment nut and the rear end of the tube 
so that the arch wire is retracted rearwardly thus moving the posterior 
teeth forwardly. 
As in conventional orthodontic practice, various pads or brackets may be 
adhesively bonded to the inside or outside of the patient's teeth, 
generally as indicated at P in FIG. 6, and connected to the inner archwire 
39 so that a correcting force may be applied to the teeth to form the 
arch. 
Further in accordance with this invention, inner arch wire 39' may be 
formed in two parts, as indicated at 39R, 39L in FIG. 6 with threads 
formed on the inner ends thereof. The inner threads of threaded portions 
39R are right-hand threads while the threads on portion 39L are left-hand 
threads. These threaded inner ends of the inner arch wire are threadably 
received in a barrel member 59 which has corresponding right and left-hand 
threaded openings therein so that the barrel together with the inner ends 
of the arch wire constitute a turn buckle assembly. Thus, upon rotating 
barrel 59, the inner arch wire 39' may be selectively expanded or 
contracted independently of springs 55. 
Additionally, an outer (buccal) arch wire 60 is received in outer tubes 37 
on bands 31 and is fitted to the teeth with the outer arch wire received 
in various pads brackets or bonds P bonded or cemented to the outside 
(buccal) faces of the teeth. In the conventional and well-known manner, 
these inner and outer arch wires 39', 60 and the brackets may be utilized 
with various springs and elastomeric orthodontic appliances to apply 
whatever forces are required to orthodontically treat the patient's teeth. 
A detailed description of the various orthodontic force applying apparatus 
and techniques is not herein required because these are well-known to 
those skilled in the art. 
Specifically, referring to the method of orthodontic treatment of the 
present invention, reference may be made to FIGS. 1-4 of the drawings. 
Generally, the treating dentist or orthodontist will affix a pair of bands 
31 to selected rear molars in the patient's mouth, for example to the rear 
molars of the upper jaw as indicated in FIG. 2. Then the proper positions 
of the mandible, maxilla, and the temporomandibular joints are established 
utilizing temporary splints (or other suitable means) which are fitted 
between the upper and lower molars in the conventional manner so that the 
position of the condyle 17 and the coronoid process 19 and the body of the 
mandible 7 are in proper anatomical relationship with the glenoid fossa of 
the temporal plate 25 and maxilla 5. 
Generally, these splints are hard acrylic orthodontic appliances 
specifically fabricated to fit over the upper or lower teeth. These 
splints may be reinforced with bent metal wires. The acrylic portion of 
the splint is made to fit over the teeth of the selected arch (i.e., the 
upper or lower molars) and may be attached to the teeth by means of 
conventional orthodontic clasps or wires. A soft acrylic layer is 
typically added to the outer surfaces of the splints. The teeth are then 
closed together so that the opposing teeth form an impression in the soft 
acrylic layer on the splints. The opposing arch is positioned relative to 
the splints applied to the selected teeth of the other arch so that the 
mandible and temporomandibular joints are in proper anatomical and 
physiological position with respect to the maxilla (the base of the 
cranium). The acrylic surfaces on the splints are then allowed to set up 
or harden so that the teeth have a permanent place therein in which they 
may interdigitate. The acrylic is adjusted to allow proper freedom of 
movement of all lateral and protrusive jaw movements. Sometimes, guidance 
planes may be built into the splints to aid these lateral or protrusive 
movements. This relative position of the parts of the patient's cranium 
and jaw is maintained until an improvement of a symptom, such as headache, 
neck aches, backaches, muscle spasms, reduction of jaw locking pain, 
difficulty in swallowing, clicking or popping noises in the 
tempomandibular joints, noise in the ears, or an improvement of postural 
changes associated in normal opening, closing, and sidewise movement of 
the mandible are observed. It has been observed that with the mandible, 
the maxilla, and the tempomandibular joints properly anatomically 
positioned, certain of the above-mentioned symptoms will improve. This is 
an indication that the masticatory system is in its proper anatomical 
position. Further, with the mandible and tempomandibular joints properly 
positioned, the ligaments that hold the cartilaginous disk between the 
glenoid fossa and the head of the condyle projection may return to their 
normal anatomical lengths and positions. 
With the position of the mandible and temporomandibular joints temporarily 
positioned by the splints, as described above, arch wire 39 with the 
pliable bite piece 43 installed thereon is fitted in the patient's mouth 
and the forward face of the bite piece 43 is impressed against the inner 
or lingual faces of the incisors and canine teeth of the upper jaw. Thus, 
an impression of the lingual surfaces of these teeth are formed in the 
bite piece. Buccal wire 44 is placed to contact the outer surface of the 
anterior teeth, is contoured to bend toward and is embedded into the 
hardening acrylic. Then, the patient is instructed to close his jaws until 
the rear molars come in contact with splints thus properly positioning the 
mandible and temporomandibular joints and simultaneously forming 
indentations 49 in the lower face of the bite piece by the incisors and 
canine teeth of the opposite or lower jaw. Upon hardening of the bite 
piece material, the temporary splints S may be removed and upon the 
patient closing his mouth, the bite piece 43 fits snugly against the 
lingual surfaces of the selected teeth of the upper jaw and receive the 
selected teeth (e.g., the incisors and possibly canine teeth) of the 
opposite (lower) jaw thereby to hold the mandible and temporomandibular 
joints TMJ in their proper anatomical positions. Thus, throughout the 
course of orthopedic and/or orthodontic treatment method of the present 
invention, which may require an extended period of time (e.g., many 
months), bite piece 43 serves as a permanent reference between the 
patient's mandible, maxilla, teeth and temporomandibular joints. As 
orthopedic and/or orthodontic forces are applied to the teeth to move them 
to their proper and desired positions, the teeth are moved not only so as 
to be cosmetically correct, but also so as to establish a proper bite when 
the temporomandibular joints and the mandible are in their proper 
anatomical positions. At the end of the treatment, not only are the 
patient's teeth orthodontically aligned, but the mandible, maxilla and 
temporomandibular joints are orthopedically stabilized in their proper 
positions. 
Referring to FIG. 3, the orthodontic apparatus of the present invention may 
be alternatively fitted to the lower teeth 11 in the manner 
above-described and may be utilized in accordance with the above-described 
orthodontic treatment method. 
As utilized throughout the above disclosure of the orthopedic and/or 
orthodontic method of treatment and apparatus of the present invention, 
the term "tempomandibular joint" is defined to include not only the 
specific portions of the mandible and cranium skeletal structure together 
with the associated ligaments as heretofore described, but also to include 
the proper positions of the mandible and the maxilla. Thus, throughout 
this specification and the following claims, when it is stated that in 
accordance with this invention one establishes the proper relationship of 
the patient's tempomandibular joints, it will be understood that not only 
is the center of suspension of the joint, as indicated at 29 in FIG. 1 is 
properly positioned, but also that the disappearance of one or more of the 
symptoms heretofore described oftentimes associated with improperly 
positioned tempomandibular joints may be dissipated or improved. Thus, it 
is expressly intended that in this specification that the term 
"tempomandibular joint" shall be interpreted in a broad and not a limiting 
manner. 
In view of the above, it will be seen that the other objects of this 
invention are achieved and other advantageous results obtained. 
As various changes could be made in the above constructions or methods 
without departing from the scope of the invention, it is intended that all 
matter contained in the above description or shown in the accompanying 
drawings shall be interpreted as illustrative and not in a limiting sense.