Exhibit 1

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 1 of 44
c12) United States Patent 

Methot 

(54) DENTAL ANALYSIS METHOD AND SYSTEM 

(75) Inventor: Alain Methot, Lorraine (CA) 

(73) Assignee: CENTRE DE RECHERCHE 

MEDICO DENTAIRE AM INC., Laval 

(CA) 

( *) Notice: Subject to any disclaimer, the term ofthis 

patent is extended or adjusted under 35 

U.S.C. 154(b) by 632 days. 

(21) Appl. No.: 13/809,843 

(22) PCT Filed: Jul. 13, 2011 

(86) PCT No.: PCT/CA2011/000800 

§ 371 (c)(l), 

(2), ( 4) Date: Feb.27,2013 

(87) PCT Pub. No.: WO2012/006717 

PCT Pub. Date: Jan. 19, 2012 

(65) 

(60) 

(51) 

(52) 

Prior Publication Data 

US 2013/0158958Al Jun. 20, 2013 

Related U.S. Application Data 

Provisional application No. 61/344,392, filed on Jul. 

12, 2010, provisional application No. 61/491,291, 

filed on May 30, 2011. 

Int. Cl. 

A61C 11100 

G06F 17150 

A61C 13/00 

G06F 19100 

(2006.01) 

(2006.01) 

(2006.01) 

(2011.01) 

(Continued) 

U.S. Cl. 

CPC ............ G06F 17150 (2013.01); A61C 13/0004 

(2013.01); G06F 191321 (2013.01); G06T 

19120 (2013.01); A61B 1/005 (2013.01); A61B 

5/4547 (2013.01); A61 C 9/004 (2013.01); A61C 

I 1111111111111111 11111 1111111111 1111111111 111111111111111 111111111111111111 

US009411910B2 

(10) Patent No.: 

(45) Date of Patent: 

US 9,411,910 B2 

Aug. 9, 2016 

11/00 (2013.01); A61 C 13/0013 (2013.01); 

G06T 2219/2016 (2013.01) 

(58) Field of Classification Search 

None 

See application file for complete search history. 

(56) References Cited 

U.S. PATENT DOCUMENTS 

5,338,198 A * 8/1994 Wu A61C 13/0004 

433/213 

6,261,248 Bl* 7/2001 Takaishi . A61B 5/103 

(Continued) 

FOREIGN PATENT DOCUMENTS 

WO 2012/000511 Al 1/2012 

Primary Examiner - Kibrom K Gebresilassie 

(74) Attorney, Agent, or Firm - BCF LLP 

(57) ABSTRACT 

378/39 

A system for designing the dentition of a patient, comprising 

a first input for providing an image of the smile of the patient 

to the system, an output, a processor for computing and applying a first set of visual indicators onto the image of the smile 

of the patient through the output, the first set of visual indicators indicating ideal positioning of the teeth of the patient, 

and for computing and applying a second set of visual indicators onto the image of the smile of the patient through the 

output, the second set of visual indicators providing adjustment of positioning of the teeth of the patient, a memory 

having stored therein a library of 2D digital images of smiles 

and associated 3D dentition models, a user interface for 

selecting a desired 2D digital image to be applied to the image 

of the smile of the patient and adjusting the second set of 

visual indicators, the adjustment of the second set of visual 

indicators modifying the 2D digital image, wherein the processor modifies the 3D dentition model associated with the 

2D digital image and provides a virtual wax-up of a dental 

restoration of the dentition of the patient. 

19 Claims, 31 Drawing Sheets 

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(51) Int. Cl. 

G06T 19120 

A61C 9/00 

A61B 5100 

A61B 1/005 

(56) 

(2011.01) 

(2006.01) 

(2006.01) 

(2006.01) 

References Cited 

US 9,411,910 B2 

Page 2 

2007/0099147 Al* 

2009/0162813 Al * 

2009/0291408 Al * 

2009/0306939 Al * 

2010/0049351 Al* 

2010/0191510 Al* 

U.S. PATENT DOCUMENTS 

2010/0332253 Al * 

7,153,135 Bl 12/2006 Thomas 

8,092,220 B2 1/2012 Wiedmann 2011/0196524 Al* 

8,376,745 B2 * 2/2013 Stonisch ....................... 433/215 2011/0196653 Al* 

8,423,335 B2 4/2013 Methot 2012/0095732 Al* 8,706,672 B2 * 4/2014 Malfliet et al. .................. 706/47 2013/0017507 Al* 8,753,119 B2 * 6/2014 Fang A61C 11/00 

433/213 

2003/0204150 Al * 10/2003 Brunner . A61B 5/1114 2013/0158958 Al* 

600/590 

2003/0224314 Al* 12/2003 Bergersen ......................... 433/6 2013/0216972 Al* 

2005/0070782 Al* 3/2005 Brodkin . A61C 19/045 

600/407 2013/0218530 Al* 

2005/0089822 Al* 4/2005 Geng ............................ 433/215 

2006/0003292 Al * 1/2006 Lauren . A61C 5/007 2014/0313304 Al * 

433/215 

2006/0127836 Al* 6/2006 Wen. A61C 7/00 

433/24 * cited by examiner 

5/2007 Sachdeva . A61C 7/00 

433/24 

6/2009 Glor et al. ..................... 433/196 

11/2009 Stone-Collonge .. G06F 19/3437 

433/24 

12/2009 Methot ............................. 703/1 

2/2010 Monkmeyer. A61C 13/0004 

700/98 

7/2010 Kopelman A61C 13/0004 

703/1 

12/2010 Adusimilli . A61C 11/00 

705/2 

8/2011 Giasson et al. ............... 700/103 

8/2011 Lajoie et al. ...................... 703/1 

4/2012 Fisker et al. ...................... 703/1 

1/2013 Moffson A61C 1/084 

433/27 

6/2013 Methot A61C 13/0004 

703/1 

8/2013 Kolozsvary . A61C 1/0046 

433/29 

8/2013 Deichmann. A61C 13/0004 

703/1 

10/2014 Adriaens . A61C 11/005 

348/77 

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U.S. Patent Aug. 9, 2016 Sheet 1 of 31 US 9,411,910 B2 

A C B 

FIG. 1 

10 

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13 14 15 16 

17 18 

FIG. 2 

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U.S. Patent Aug. 9, 2016 Sheet 2 of 31 US 9,411,910 B2 

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5· 5· 4· 3· 2· r o· 

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FIG.12 

FIG. 13 

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U.S. Patent Aug. 9, 2016 Sheet 8 of 31 US 9,411,910 B2 

6 5 4 321 0 

140 

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142 

140 

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U.S. Patent Aug. 9, 2016 Sheet 9 of 31 US 9,411,910 B2 

5 4 3 210 

FIG. 16A 

116 16 

6 5 43210 

FIG. 168 

117 17 

7 6 5 4 3 210 

FIG. 16C 

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U.S. Patent Aug. 9, 2016 Sheet 10 of 31 US 9,411,910 B2 

PROVIDING A VISUAL REPRESENTATION 

OF THE DENTITION '"'--302 

INPUTTING THE NUMBER OF TEETH 

ON A SIDE OF THE DENTITION '"'--304 

INPUTTING AT LEAST TWO QUANTITIES 

TAKEN FROM A GROUP CONSISTING OF A I'-.. RATIO, AN INTER-TEETH DISTANCE AND A306 

CENTRAL INCISOR WIDTH 

COMPUTING THE POSITION OF THE I'-- TEETH WITHIN THE DENTITION 308 

JUXTAPOSING POSITIONING LES OVER 

THE VISUAL REPRESENTATION OF '"'--

THE DENTITION 310 

FIG. 17 

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U.S. Patent Aug. 9, 2016 Sheet 11 of 31 US 9,411,910 B2 

308 

I 

I 

--------------------------------------------~------------------

NO 

YES 

NO 

YES 

404 

COMPUTE LINE POSITIONS AD 

CENTRAL INCISOR WIDTH 

408 

COMPUTE LINE POSITIONS AD 

INTER-MOLAR DISTANCE 

410 

COMPUTE LINE POSITIONS AD 

RATIO 

1------------------------------------------------------------- -~ 

FIG. 18 

310 

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Number of Lines 

505 

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FIG. 23 

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FIG. 24 

82 

FIG. 25 

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U.S. Patent Aug. 9, 2016 Sheet 16 of 31 US 9,411,910 B2 

FIG. 26A 

FIG. 268 

FIG. 26C 

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FIG. 27 

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FIG. 29 

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Annotate Measure 

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(§) 65 

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U.S. Patent Aug. 9, 2016 Sheet 31 of 31 

SCANNER 

INTERFACE 

3D SMILE .____ LIBRARY FROM 

2D PICTURES 

SMILE PROJECT 

FILE INTERFACE 

IMAGE&UI 

RENDERING 

AUTOMATIC MESH 

ALTERATION & 

RECOGNITION 

FIG. 52 

8 

USER INTERFACE 

INTERPRETOR 

MANUAL 

ADJUSTMENTS 

STEREOLITHOGRAPHY 

INTERFACE 

US 9,411,910 B2 

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US 9,411,910 B2 

1 

DENTAL ANALYSIS METHOD AND SYSTEM 

CROSS-REFERENCE TO RELATED 

APPLICATION 

This application claims the benefits of U.S. provisional 

patent applications No. 61/344,392 filedJul.12, 2010andNo. 

61/491,291 filed May 30, 2011; which are hereby incorporated by reference. 

TECHNICAL FIELD 

The present disclosure relates to a dental analysis method 

and system. More specifically, the present disclosure relates 

10 

to an analysis method and system for the evaluation, planning 15 

and modification of the dentition of a patient. 

BACKGROUND 

In the study of what is considered "beautiful", in nature, 20 

human features, architecture, art, etc., it was discovered that 

there is a common principle at work. This common principle 

is the universal recognition of pleasant proportions. People 

have an inherent ability to recognize that an art object has 

good or bad proportions, or that a person's torso compared to 25 

his/her legs looks too long, or too short and out of proportion. 

This universal common principle thread of proportion, 

known since antiquity, is referred to the Golden Proportion or 

Divine Proportion. 

Human beauty is also governed by the Golden Proportion. 30 

Squares based on the Golden Proportion have been used to 

define the ideal location of the pupils and outside comers of 

the mouth. Lines based on the Golden Proportion have been 

used to define, for example, the ideal positioning of the nose, 

the tip of the nose, the inside of the nostrils, the two rises of the 35 

upper lip, the inner points of the ear, the distance from the 

upper lip to the bottom of the chin, as well as the width of the 

nose, the distance between the eyes and eye brows and the 

distance from the pupils to the tip of the nose. 

The Golden Proportion has also been used to study the 40 

human dentition. The four front teeth, from central incisor to 

premolar constitute the most significant part of the dentition 

and they are in the proportion to each other although they 

don't exactly follow the Golden Proportion. Regardless, the 

Golden Proportion has been combined in a grid which may be 45 

used to assist in perfecting the aesthetics of the front teeth. 

However, such grid displays the four front teeth with mitigated results. Only the upper centrals and sometimes the 

upper laterals follow the Golden Proportion, the other Maxillary teeth usually do not. Accordingly, there is a need for an 50 

analysis method and system for the evaluation, planning and 

modification of the dentition of a patient 

In the present specification, there are described embodiments of a method and system designed to overcome the 

above-described limitations of the conventional techniques. 55 

SUMMARY 

2 

for computing and applying a second set of visual indicators onto the image of the smile of the patient through 

the output, the second set of visual indicators providing 

adjustment of positioning of the teeth of the patient; 

a memory having stored therein a library of 2D digital 

images of smiles and associated 3D dentition models; 

a user interface for selecting a desired 2D digital image to 

be applied to the image of the smile of the patient and 

adjusting the second set of visual indicators, the adjustment of the second set of visual indicators modifying the 

2D digital image; 

wherein the processor modifies the 3D dentition model 

associated with the 2D digital image and provides a 

virtual wax-up of a dental restoration of the dentition of 

the patient. 

The present disclosure further relates to a method of performing the as described above. 

BRIEF DESCRIPTION OF THE DRAWINGS 

A non-limitative illustrative embodiment of the disclosure 

will now be described by way of example only with reference 

to the accompanying drawings, in which: 

FIG. 1 is a schematic diagram illustrating the Golden Proportion concept; 

FIG. 2 is a front view illustration of the upper teeth of an 

FIG. 3 is a front view image of the smile of an individual on 

which are superimposed positioning lines following a Golden 

Proportion with a ratio of 1: 1.618; 

FIG. 4 is a front view image of the smile of an individual on 

which are superimposed positioning lines following the M 

Proportion with a ratio of 1: 1.367; 

FIGS. SA and SB are front views of an image of the smile 

of an individual on which are superimposed angled positioning lines; 

FIG. 6 is a front view image of the smile of an individual on 

which are superimposed two measurement reference points; 

FIG. 7 is a front view image of the smile of an individual on 

which is superimposed a measuring rule; 

FIG. 8 is a front view image of the smile of an individual on 

which are superimposed positioning lines following the M 

Proportion with a ratio of 1: 1.367 and a measuring rule; 

FIG. 9 is a front view image of the dentition of a virtual 

diagnostic wax-up on which are superimposed positioning 

lines following the M Proportion with a ratio of 1: 1.367; 

FIG. 10 is a front view image of the dentition of a virtual 

diagnostic wax-up on which are superimposed angled positioning lines following the M Proportion with a ratio of 

1: 1.367; 

FIG. 11 is a plan view of a diagnostic grid used for laboratory work on which are superimposed positioning tines 

following the M Proportion with a ratio of 1: 1.38; 

FIG. 12 is a front view image of the smile of a diagnostic 

wax-up positioned on top of a diagnostic grid on which are 

superimposed positioning lines following the M Proportion 

with a ratio of 1:1.38; 

FIG. 13 is a front view image of the dentition of a diagnosThe present disclosure relates to a system for designing the tic wax-up positioned on top of a diagnostic grid on which are 

dentition of a patient, comprising: 

an first input for providing an image of the smile of the 

patient to the system; 

an output; 

60 superimposed positioning lines following the M Proportion 

with a ratio of 1: 1.38 and a common diagnostic grid on which 

are superimposed positioning lines following a Golden Proportion with a ratio of 1: 1.618; 

a processor for computing and applying a first set of visual 

indicators onto the image of the smile of the patient 

through the output, the first set of visual indicators indicating Ideal positioning of the teeth of the patient, and 

FIG. 14 is a plan view of an alternative diagnostic grid for 

65 use in an individual's mouth on which are superimposed 

positioning lines following the M Proportion with a ratio of 

1: 1.38; 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 35 of 44
US 9,411,910 B2 

3 

FIG. 15 is a front view image of the smile of an individual 

with the alternative diagnostic grid, on which are superimposed positioning lines following the M Proportion with a 

ratio of 1: 1.38, positioned between his or her upper and lower 

teeth; 

FIGS. 16A, 16B and 16C are bottom views of the upper 

teeth of an individual on which are superimposed positioning 

lines with an associated inter-molar distance; 

4 

FIGS. 45 to 47 are front view images of the virtual diagnostic wax-up of an individual illustrating the adjustment of 

the centered line of the adjustable M Proportion ruler to 

correct midline deviation; 

FIGS. 48 and 49 are illustrations of the alignment of the 

wax-up on a M Proportion ruler using three landmarks; 

FIG. 50 is an illustration of the correlation between a 2D 

simulation and the final restoration; 

FIG. 17 is a flow diagram depicting the M Proportion FIG. 51 shows a 3D model guide; and 

calculator process; 10 FIG. 52 is a block diagram of the dental analysis system. 

FIG. 18 is a flow diagram depicting teeth position computing step of the M Proportion calculator process of FIG. 17; 

FIG. 19 is an example of the M Proportion calculator 

interface; 

FIG. 20 is a front view image of the smile of an individual 

having received corrective crowns following the M Proportion shown in FIG. 19; 

FIG. 21 is a front view image of the smile of an individual 

DETAILED DESCRIPTION 

Generally stated, the non-limitative illustrative embodi15 ment of the present disclosure provides a method and system 

for the evaluation, plamiing and modification of the dentition 

of an individual, such as, for example, a patient, by the application of generally vertical lines, hereby referred to as "posion which are superimposed Y axis and X axis positioning 20 

lines; 

tioning lines" (Y axis), following the herein disclosed M 

Proportion, which may be determined either explicitly or 

implicitly from measurements such as, for example, central 

incisor width and inter-molar distance, onto the dentition of 

the patient in order to determine "ideal" positioning of the 

patient's teeth, and by the application of an horizontal line (X 

FIG. 22 is as representation of the Frankfurt Plane passing 

through the Porion and Orbitalis radiological points; 

FIG. 23 is a top view of a platform on an articulator on 

which is applied the M Proportion ruler template; 

FIG. 24 shows the platform with a template on which is 

placed a maxillary model or cast; 

FIG. 25 is a bottom plan view of a maxillary model or cast 

on which pieces of wax or other adhesive are placed in the 

25 axis) apposed on the incisal edges of the upper centrals. In one 

embodiment, the resulting positioning lines may be applied to 

2D or 3 D digital images, X-rays, computed tomography ( CT) 

scans, etc., of the patient's dentition or may be included as 

molar regions on each side; 30 

part of a modeling or re-modeling software to dispose the 

teeth when creating, for example, ceramic teeth, orthodontic 

molds, dentures, etc. in a further embodiment, the positioning FIGS. 26A, 26B and 26C show a platform with a template 

on which is placed a maxillary model or cast with the pieces 

of wax or other adhesive; 

FIG. 27 is an elevation view of the platform with a template 35 

on which is aligned a maxillary model or cast; 

FIG. 28 is a front view image of the smile of an individual 

on which are superimposed the positioning lines and horizontal line of the M Proportion ruler and showing the calibration 

of the image; 

FIGS. 29 and 30 are front view images of the smile of an 

Individual on which are superimposed the positioning lines 

and horizontal line of the M Proportion ruler, and the platform 

with a template on which is aligned a maxillary model or cast; 

40 

FIGS. 31 to 36 are front view images of the smile of an 45 

individual on which are superimposed M Proportion ruler 

and/or adjustable M Proportion ruler positioning lines 

attached to a smile library over the patient's teeth to achieve 

a virtual wax-up; 

FIG. 36 is an elevation view of the platform on an articu- 50 

lator with an adjustable M Proportion ruler template on which 

is positioned a maxillary model or cast according to given 

measurements; 

lines may be angled at a specific angle in order to address an 

occlusion condition or for aesthetical considerations. 

Golden Proportion 

The Golden Proportion, or Divine Proportion, represents a 

ratio ofl: 1.618. It has been used in a multitude ofapplications 

and is well known in the art Briefly speaking, referring to FIG. 

1 the Golden Proportion may be expressed as: 

AB 

CB 

CB 

AC 

= 1.618. 

Equation 1 

For example, if the distance AB is 10 mm, then the distance 

AC will be 3.82 mm and CB will be 6.18 mm. 

Dentition 

Referring to FIG. 2, the dentition (10) generally comprises 

the central incisor (11), the lateral incisor (12), the canine 

(13), the first premolar (14), the second premolar (15) and the 

first molar (16). The second (17) and third (18) molars are 

usually not visible in the smile. It is to be understood that for 

FIG. 37 is a front view image of the virtual diagnostic the purpose of clarity FIG. 2 only shows the left side of the 

wax-up (new smile) of an individual on which are superimposed positioning lines of the adjustable M Proportion ruler 

bringing soft tissues and lips of the patient on the articulator 

55 dentition (10), the right side being symmetrical. 

by working in correlation with the position of the maxilla on 

the 2D image and the maxillary 3D model position or cast 

given by the digital facebow; 

FIG. 38 is an example of a smile in the 3D model library; 

FIGS. 39 and 40 are front view images of the virtual diagnostic wax-up of an individual for two different pitch values; 

FIGS. 41 to 43 are front view images of the smile of an 

individual during a virtual gingivectomy; 

FIG. 44 is a front view image of a patient showing the 

digital facebow alignment procedure; 

For the sake of clarity, from thereon reference will be made 

to the positioning lines on either the left side or the right side 

of the dentition (10) but it is to be understood that by virtue of 

symmetry, the same comments apply to the positioning lines 

60 on other side of the dentition (10). 

Application of the Golden Proportion 

Referring to FIG. 3, there is shown a front view image of a 

patient's dentition (10) on which is applied the Golden Proportion (ratio of 1: 1.618) with seven positioning lines, result65 ing in a center positioning line (26) and six side positioning 

lines (25, 24, 23, 22, 21, 20) on one side of the dentition (10). 

The center positioning line (26) is positioned at the center of 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 36 of 44
US 9,411,910 B2 

5 

the dentition (10) and the last side positioning line (20) is 

positioned by the user such that the second positioning line 

(25) is positioned between the central incisor (11) and the 

lateral incisor (12). Once the first (26) and last positioning 

lines (20) are positioned, the remaining side positioning lines 5 

(25, 24, 23, 22, 21) are computed using the Golden Proportion 

with a ratio ofl :1.618 .. As maybe seen in FIG. 3, the position 

of the central incisor (11) and the lateral incisor (12) generally 

correspond to side positioning lines (25) and (24), respectively, but the position of the canine (13) does not fit with side 10 

positioning line (23), the side positioning line (23) actually 

passing in the middle of the canine (13). 

Application of the M Proportion 

Referring now to FIG. 4, there is shown an image of the 

patient's smile on which is applied the M Proportion (ratio of 15 

1:1.367) with seven positioning lines, resulting in a center 

positioning line (6) and six side positioning lines (5, 4, 3, 2, 1, 

0) on one side of the dentition (10). The center positioning 

line (6) is fixed at the center of the dentition (10) and the last 

side positioning line (0) is positioned by the user, advanta- 20 

geously on the buccal face of the first molar (16), the remaining side positioning lines (5, 4, 3, 2, 1) being computed using 

the M Proportion with a ratio of 1: 1.367. As may be seen in 

FIG. 4, the position of the central incisor (11), the lateral 

incisor (12), the canine (13) and the first premolar (14) gen- 25 

erally correspond to side positioning lines (5), ( 4), (3) and (2), 

respectively. In an idealized view, shown in FIG. 9, it may be 

seen that the M Proportion may be used to position the central 

incisor (11), the lateral incisor (12), the canine (13), the first 

premolar (14), the second premolar (15) and the first molar 30 

(16) on a virtual wax-up of a patient using side positioning 

lines (5), (4), (3), (2), (1) and (0), respectively. Furthermore, 

referring to FIG. 12, the M Proportion may be used with a real 

wax-up of the patient, which in tum is used to create, for 

example, crowns for the patient. Thus, in this illustrative 35 

embodiment, using the M Proportion, 12 front teeth (six on 

each side) of the dentition (10) were positioned instead of 

only four, as seen in FIG. 3. It is to be understood that the same 

technique described above using seven positioning lines for 

the positioning of 12 front teeth may also be extended to, for 40 

example, nine positioning lines permitting the positioning of 

16 teeth. The number of teeth visible in the smile may vary 

from patient to patient depending on the physiognomy of the 

patient. 

Although in M Proportion with a ratio ofl: 1.367. was used 45 

in FIG. 4, it is to be understood that it may vary depending on 

the physiognomy of the patient or the desired aesthetical 

effect. Common ratio values may be, for example, from 

1: 1.250 to 1: 1.500, though more commonly from 1: 1.360 and 

1: 1.500, and with rare occurrences from 1: 1.500 and 1: 1.618. 50 

It should also be understood that when using software tools, 

such as the M Proportion calculator which will be introduced 

further on, the M Proportion ratio is not limited to three 

decimals and may vary in precision depending on the application. For example, FIG. 19 shows an interface (200) for M 55 

Proportion calculator in which the M Proportion ratio (208) is 

precise up to 13 decimals, i.e. 1.3676540544138. 

Computing the position of the side positioning lines 

6 

where 

n is the number of positioning lines; 

P(i) is the position of positioning line(i), i=0. to n-1; 

P(0) and P(n-1) are given; 

D is the distance between positioning lines (0) and 

(n-1), i.e. [P(0)-P(n-1)]; 

R is the ratio of the M Proportion; 

which in the context of FIG. 4 translates to: 

P(l)=P(0)-D/F 1; 

P(2)=P(l)-D/F 2; 

P(3)=P(2)-D/F 3; 

P( 4)=P(3)-D/F 4; and 

P(S)=P( 4)-D/F 5; 

where: 

R, P(0) and P(6) are given; 

D=P(0)-P(6); and 

F1=Ro+R1+R2+R3+R4+R5. 

Equation 3 

Equation4 

It is to be understood that, as a result of symmetry, Equations 2. to 4. may be adapted for computing the position of 

positioning lines on the other side of the smile or dentition 

(10). Furthermore, it is also to be understood that the positioning of side positioning line (0) may be either dependent or 

independent of the positioning of its corresponding positioning line (00) (see FIG. 4) on the other side of the smile or 

dentition (10). This is to account for the fact that smiles may 

not always be perfectly symmetrical or that an image of the 

patient may not always be perfectly centered. 

In an alternative embodiments, shown in FIGS. SA and 5B, 

the positioning lines (6', 5', 4', 3', 2', 1', 0') may have corresponding angles (86 , 85, 84, 83, 82, Bi, 80 ) while positioning 

lines (6", 5", 4", 3", 2", 1", 0")mayhave corresponding angles 

(t 6 , "t5, 1:4, "t3, 1:2, 1:1, 1:0 ) in order to better conform to the 

natural positioning of the teeth, to address a certain condition 

such as, for example, occlusion, or for aesthetical reasons. For 

example, angles of 0, 1.00, 2.00, 2.50, 3.75, 4.40 and 4.50 

degrees may be used for angles (86 , 85, 84, 83, 82, Bi, 80 . ), 

respectively. It is to be understood that other angles and that a 

combination of angles 8 and -c may also be used. 

Measurements 

In order to facilitate the work of the practitioner, reference 

points (51, 52) on the image of the patient may be identified, 

as shown in FIG. 6, and the distance (53) separating them 

inputted into the system, as shown in FIG. 7. In the example 

of FIGS. 6 and 7, the reference points (51, 52) are positioned 

at the centerof the left and right pupils, respectively, and their 

distance (53) of 61 mm inputted as a reference. Therefore, 

using this reference, the measurement of various features on 

the image of the patient may be computed by relating the 

inputted distance (53) to the number of pixels between the 

two reference points (51, 52). For example, as shown in FIG. 

8, the patient's inter-molar distance (54) may be computed 

using the system, in this example the inter-molar distance (54) 

being 52 mm. In this example, the inter-molar distance is the 

distance between the buccal faces of the left and right first 

upper molars (see FIG. 18A for the identification of the first 

upper molars (116, 16)). 

Virtual diagnostic wax-up 

As mentioned above, the central positioning line (6) is 

placed in the centerof the smile and dentition (10) and the last 60 

side positioning line (0) is positioned by the user, advantageously on the buccal face of the first molar (16), the remaining side positioning lines (5, 4, 3, 2, 1) being computed using 

the M Proportion for a given ratio. The side positioning lines 

Referring to FIG. 9, the practitioner may use the measurement of the inter-molar distance (54) or the measurement of 

the central width to create a virtual diagnostic wax-up (100) 

65 using the positioning lines (6, 5, 4, 3, 2, 1, 0) as guidelines as 

to the size and positioning of the teeth (11, 12, 13, 14, 15, 16). 

In an alternative embodiment, shown in FIG. 10, angled posi-

(5, 4, 3, 2, 1) may be computed as follows: 

Equation 2 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 37 of 44
US 9,411,910 B2 

7 

tioning lines (6', 5', 4', 3', 2', 1', 0') may also be used. It is to be 

understood that although not shown, angled positioning lines 

(6", 5", 4", 3", 2", 1", 0"), as illustrated in FIG. 5B, may also 

be used. 

The image of the virtual diagnostic wax-up (100) may then 5 

be superimposed on the image of the patient and properly 

scaled so as to be able to view its appearance as a replacement 

to the patient's dentition (10). If the practitioner wishes to 

make changes to the virtual diagnostic wax-up (100) he may 

make measurements directly on the image. 10 

Once the practitioner is satisfied with the aesthetics of the 

virtual diagnostic wax-up (100), he may then use the measurements thus obtained to create a real diagnostic wax-up. 

8 

In an alternative embodiment shown in FIG. 14, a diagnostic grid (140), following M Proportion ratio of 1:1.38, may 

have a configuration and dimensions suited for insertion in 

the mouth of a patient. Referring now to FIG. 15, the practitioner may position the diagnostic grid (140) between the 

upper (142) and lower (144) teeth of a patient and use positioning lines (6, 5, 4, 3, 2, 1, 0) as guidelines as to the 

positioning of the teeth (11, 12, 13, 14, 15, 16). The practitioner may then establish a diagnostic regarding the dentition 

(10) of the patient. 

In a further alternative embodiment, the diagnostic grid 

(140) may have some sort of handle or protuberance at the 

front (not shown) so as to permit easy insertion and removal 

of the diagnostic grid (140) from the patient's mouth. 

In typical applications the diagnostic grids (110, 140) may 

be created with a specific central incisor (11) width, i.e. 

distance between positioning lines ( 6) and (5), and a specific 

M Proportion ratio, the placement of the other positioning 

lines ( 4, 3, 2, 1, 0) being set using the selected M Proportion 

It is to be understood that the virtual diagnostic wax-up 15 

(100) and the M Proportion may be included as part ofa CAD 

CAM, modeling or re-modeling software using, for example, 

2D or 3D models, X-Rays or CT scans ofa patient's mouth to 

dispose the teeth when creating, for example, ceramic teeth, 

orthodontic molds, dentures, etc. 20 ratio and central incisor (11) width. For example, the width of 

the central incisor (11) may typically vary from 7.5 mm to 10 

mm in increments of0.5 mm and the M Proportion ratio may 

vary from 1: 1.36 to 1: 1.44 in increments of 0.01, it is underReal diagnostic wax-up 

The practitioner may use an image of the real diagnostic 

wax-up, such as the one shown in FIG. 12, and superimpose 

stood that more precise in paper. It is to be understood, however, that other values may be used for the central incisor (11) 

as well as other M Proportion ratios as previously disclosed. 

It is to be understood that the above described diagnostic grids 

are based on the width of the central incisor (11) and a given 

ratio and that more precise diagnostic grids may be created by 

it on the image of the patient, properly scaled according to the 

inter-molar distance (54) or the central width measured on the 25 

image of the patient, in order to view the real wax-up in the 

patient mouth. It is to be understood that real diagnostic 

wax-up created by other processes such as, for example, 

laboratory work, may be so viewed, not only those created 

from the virtual diagnostic wax-up. 30 using M Proportion calculator, which will be described further below. These more precise diagnostic grids may also be 

printed directly on paper, as will be seen below. 

Diagnostic grid 

Referring to FIG. 11, there is shown a plan view of a 

diagnostic grid (110) on which is applied the M Proportion 

(ratio of 1:1.38) with seven positioning lines, resulting in a 

center positioning line ( 6) and six side positioning lines (5, 4, 35 

3, 2, 1, 0). The diagnostic grid (110) may be made of a 

material such as, for example, plastic, paper, cardboard, plasticized paper, metal, etc. 

Referring now to FIG. 12, a diagnostic wax-up (120) may 

be positioned on top of the diagnostic grid (110) and the 40 

positioning lines (6, 5, 4, 3, 2, 1, 0) may be used as guidelines 

as to the size and positioning of the teeth (11, 12, 13, 14, 15, 

16) of the diagnostic wax-up (120). The diagnostic grid (110) 

may also be used, for quality control, to diagnose a case, to 

treatment plans, to verify a diagnostic wax-up (120) created 45 

from measurements obtained from the virtual diagnostic 

wax-up (100), from measurements obtained from the image 

of the patient such as shown in 

M Proportion calculator 

As previously mentioned, the M Proportion may be 

included as part of a modeling and/orre-modeling software or 

system using, for example, 2D or 3 D models, images, X-Rays 

or CT scans of a patient's mouth to dispose the teeth when 

creating, for example, ceramic teeth, orthodontic molds, dentures, etc. 

To this end, with reference to FIG. 4, Equations 2, 3 and 4 

may be adapted and incorporated into a modeling and/or 

re-modeling software or system to calculate the position ofY 

axis side positioning lines (5, 4, 3, 2, 1, 0) from information 

inputted by the user of the software or system and position 

them onto a 2D or 3D model, image, X-Ray or CT scan of a 

patient's mouth, or even print them on some supporting 

media. In particular, the position of the side positioning lines 

(5, 4, 3, 2, 1, 0) may be computed from inputting at least two 

FIG. 8, measurements obtained directly on the patient or quantities such as, for example, a ratio, i.e. M Proportion 

from model casts of his teeth. 

Referring to FIG. 13, there is shown, for comparison purposes, the wax-up (120) and diagnostic grid (110) of FIG. 12, 

the diagnostic grid (110) following M Proportion ratio of 

50 ratio, an inter-molar distance and a central incisor width. The 

various quantities may be inputted either from a user interface, such as, for example, a keyboard, a configuration file, by 

dragging and positioning the positioning lines (6, 5, 4, 3, 2, 1, 

1: 1.38, under which is placed a conventional diagnostic grid 

(130) following a standard Golden Proportion ratio of 55 

1:1.618. As it may be observed, the first three positioning 

lines (6, 5, 4) of diagnostic grid (110) and the first three 

positioning lines (36, 35, 34) of conventional diagnostic grid 

(130) generally correspond to the positioning of the central 

incisor (11) and the lateral incisor (12). However, it may also 60 

be observed that the remaining positioning lines (3, 2, 1, 0) of 

diagnostic grid (110) generally correspond to the positioning 

of the canine (13), the first premolar (14), the second premolar 

(15) and the first molar (16) while the remaining positioning 

lines (33, 32, 31, 30) of conventional diagnostic grid (130) do 65 

not at all. it is apparent that in order to follow the Golden 

Proportion, the maxillary arch would need to be very narrow. 

0) or by using some software tool or interface. 

The molars used for the measurement of the inter-molar 

distance may vary depending on the number of positioning 

lines used, i.e. depending on the number of teeth that may be 

seen in the smile of the patient. For example, referring to 

FIGS. 16A, 16B and 16C, in the case where six positioning 

lines (5, 4, 3, 2, 1, 0) are used (FIG. 16A) the inter-molar 

distance (95) is taken between the two second premolars (15, 

115), in the case where seven positioning lines (6, 5, 4, 3, 2, 1, 

0) are used (FIG. 16B), the inter-molar distance (96) is taken 

between the two first molars (16, 116) and in the case where 

eight positioning lines (7, 6, 5, 4, 3, 2, 1, 0) are used (FIG. 

16C), the inter-molar distance (97) is taken between the two 

second molars (17, 117). In another example (not shown), 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 38 of 44
US 9,411,910 B2 

9 

four or five positioning lines may be used, in which case the 

inter-molar distance would be taken between the canine and 

first premolars, respectively. 

It is to be noted, however, that although reference will be 

made to FIG. 16B, in which there are seven positioning lines 5 

(6, 5, 4, 3, 2, 1, 0), this is for illustrative purpose only and the 

following discussion may similarly apply to other numbers of 

positioning lines. Accordingly, for the sake of clarity, the 

discussion will focus on the use of seven positioning lines ( 6, 10 5, 4, 3, 2, 1, 0) while the procedures will be presented such as 

to be applicable to varying numbers of positioning lines. 

In a first non-restrictive embodiment, the position of the 

side positioning lines (5, 4, 3, 2, 1, 0), referred to as LinePosition(i) where i is the numeral identifying the positioning 15 

line, may be calculated from inputting M Proportion ratio, 

referred to as Ratio, and an inter-molar distance (96), referred 

to as InterMolarDistance and applying the procedure "Centra!IncisorWidth". It is to be understood that in the example of 

FIG. 16B with seven positioning lines, the variable #OfLines, 20 

which represents the number of positioning lines, will be 

equal to seven. As for the inter-molar distance (96), it will be 

measured between the two first molars (16,116). It should be 

noted that in addition to calculating the position of the side 

positioning lines (5, 4, 3, 2, 1, 0), the procedure also provides 25 

the central incisor width. 

Calculate Central Incisor Width 

CentrallneisorWidth (Ratio, #OfLines, InterMolarDistanee) 

LinePosition (#OfLines - 1) - InterMolarDistanee / 2 

LinePosition (0) - 0 

Constant (1) - GetFirstPhi (Ratio, #OfLines - 2) 

For i - 2 to #OfLines - 2 

Constant (i) - Content (i-1) / Ratio 

Nexti 

For i - 1 to #OfLines - 2 

LinePosition (i) - (LinePosition (#OfLines - 1) -

LinePosition (0)) / Constant (i) -

LinePosition (i-1) 

Nexti 

CentrallneisorWidth - LinePosition (i-1) - LinePosition (i-2) 

RETURN CentrallneisorWidth 

GetFirstPhi (Ratio, #OfLines-2) 

For n - 1 to #OfLines - 2 

GetFirstPhi - GetFirstPhi + (Ratio n) 

Nextn 

GetFirstPhi - GetFirstPhi + 1 

RETURN GetFirstPhi 

30 

35 

40 

45 

10 

-continued 

Cale () 

For i - #OfLines - 1 to O step -1 

LinePosition (i) - LinePosition (i) - LinePosition (0) 

Nexti 

InterMolarDistanee - LinePosition (#OfLines - 1) * 2 

RETURN InterMolarDistanee 

Cale () 

For i - #OfLines - 1 to 2 step -1 

LinePosition (i-2) - LinePosition (i-1) - (LinePosition (i) -

LinePosition (i-1 )) / Ratio 

Nexti 

In a third non-restrictive embodiment, the position of the 

side positioning lines (5, 4, 3, 2, 1, 0), referred to as LinePosition(i) where i is the numeral of the positioning line, may be 

calculated from inputting a central incisor (11) width, 

referred to as Centra!IncisorWidth, and an inter-molar distance (97), referred to as InterMolarDistance, and applying 

the procedure "Ratio". It is to be understood that in the 

example of FIG. 18B with seven positioning lines, the variable #OfLines, which represents the number of positioning 

lines, will be equal to seven. It should be noted that in addition 

to calculating the position of the side positioning lines (5, 4, 3, 

2, 1, 0), the procedure also provides the corresponding M 

Proportion ratio. 

Calculate Ratio 

Ratio (InterMolarDistanee, #OfLines, CentrallneisorWidth) 

LinePosition (#OfLines - 1) - InterMolarDistanee / 2 

LinePosition (#OfLines - 2) - LinePosition (#OfLines - 1) -

CentrallneisorWidth 

Ratio-! 

Cale () 

p - ratio/ 2 

Forn-1 to 100 

IfLinePosition (0) < 0 Then 

Ratio - Ratio + p 

Else 

Ratio - Ratio - p 

End If 

Cale () 

p -p / 2 

Nextn 

RETURN Ratio 

It is to be understood that in the loop "For n=l to 100", 

during the calculation of the M Proportion ratio, the number 

of times the loop is executed, namely 100, may vary depending on the desired precision of the result and as such, the 

number of times the loop is executed may be more or less than 

50 100. 

In a second non-restrictive embodiment, the position of the 

side positioning lines (5, 4, 3, 2, 1, 0), referred to as LinePosition(i) where i is the numeral of the positioning line, may be 

calculated from inputting M Proportion ratio, referred to as 

Ratio, and a central incisor (11) width, referred to as Centra!IncisorWidth, and applying the procedure "InterMolarDistance". It is to be understood that in the example of FIG. 

16B with seven positioning lines, the variable #OfLines, 55 

which represents the number of positioning lines, will be 

equal to seven. It should be noted that in addition to calculating the position of the side positioning lines (5, 4, 3, 2, 1, 0), 

the procedure also provides the inter-molar distance (96), 

which is the distance between the two first molars (16, 116), 60 

Calculate Inter-molar Distance 

InterMolarDistanee (Ratio, #OfLines, CentrallneisorWidth) 

LinePosition (#OfLines - 1) - 0 

LinePosition (#OfLines - 2) - LinePosition (#OfLines - 1) -

CentrallneisorWidth 

Referring now to FIG. 17, there is shown a flow diagram of 

the M Proportion calculator process. The steps composing the 

process are indicated by blocks 302 to 310. 

The process starts at block 302, where a visual representation of the dentition is provided. Then, at block 304, a value 

representative of the number of teeth on a side of the dentition 

is inputted, this value will be used to determine the number of 

positioning lines, i.e. number of teeth plus one, and between 

which teeth the inter-molar distance is to be measured. 

At block 306, at least two quantities taken from a group 

consisting of a ratio, an inter molar distance ( also referred to 

as inter-teeth distance because, depending on the value inputted at block 304, the measurement may not necessarily be 

taken between molars as explained previously) and a central 

65 incisor width are inputted. 

At block 308, the process computes the position of the 

positioning lines, which are used to determine the position of 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 39 of 44
US 9,411,910 B2 

11 

the teeth Within the dentition, by applying a mathematical 

function to the value representative of the number of teeth 

inputted at block 304 and the quantities inputted at block 306. 

The mathematical function will be further detailed below. 

Finally, at block 310, the positioning lines computed at 5 

block 308 are juxtaposed over the visual representation of the 

dentition. 

Referring to FIG. 18, there is shown flow diagram depicting teeth position computing ofblock 308 of the M Proportion 

calculator process described above, The steps composing the 10 

process are indicated by blocks 402 to 410. 

At block 402, the process verifies if a central incisor width 

was inputted. If a central incisor width was not inputted, the 

process executes, at block 404, the Centra!IncisorWidth procedure and then proceeds to block 310 ofFIG.19. If a central 15 

incisor width was inputted, the process proceeds to block 406. 

12 

ues displayed in the interface (500) of FIG. 19. It may be 

observed that the corrected positions of the central Incisor 

(11), lateral incisor (12), canine (13), first premolar (14), 

second premolar (15) and first molar (16) are now generally in 

accordance with the corresponding center positioning line ( 6) 

and six side positioning fines (5, 4, 3, 2, 1, 0). 

Incorporating anAdjustable M Proportion Ruler in the Virtual 

Wax-up 

Referring to FIG. 38, the lines of the M Proportion ruler 

(98) are attached to the each tooth in the teeth library. When 

clicking on a smile (202) in the library, the M Proportion ruler 

(98) vertical lines (98a) and the horizontal line (98b) are fused 

over the patient mouth to the distal part of each tooth and the 

incisal edge of the centrals, respectively. This results in an 

immediate virtual wax-up. 

Referring to FIGS. 33 and 34, the adjustable, M Proportion 

ruler (99) superimposed over the M Proportion ruler (98) 

enables the displacement of each tooth individually to adapt 

the virtual wax-up (100) to the pre-op teeth and gum to 

execute a more accurate virtual wax-up (100). 

The M Proportion Ruler 

At block 406, the process verifies if an inter-molar distance 

was inputted. if an inter-molar distance was not inputted, the 

process executes, at block 408, the InterMolarDistance procedure and then proceeds to block 310 of FIG. 17. If an 20 

inter-molar distance was inputted, the process proceeds to 

block 410. Referring back to FIG. 32, the red lines (98a) between the 

center and the last lines moves along with the M Proportion 

calculator values based on the central width, the inter molar 

25 width and the M Proportion ratio of the patients mouth. The 

red lines (98a) cannot be moved individually, they are locked 

with the values of the M Proportions calculator. 

At block 410, the process executes the Ratio procedure and 

then proceeds to block 310 of FIG. 17. 

Referring to FIG. 19, there is shown an example of an 

interface (500) that may be used with the M Proportion calculator. A first (502), second (504), third (506) and fourth 

(508) input boxes may be used to enter the number oflines to 

be displayed ( #OfLines ), the central incisor width (Centra!IncisorWidth), the inter-molar distance (InterMolarDistance) 

and the M Proportion ratio (Ratio), respectively. As discussed 

previously, after the number oflines has been entered in input 

box (502), which may also be in the form of a scroll down 

menu, at least two of input boxes (504), (506) and (508) must 

be filled, i.e. two out of the central incisor width, inter-molar 

distance and M Proportion ratio must be entered. 

Referring to FIGS. 33 and 34, the center blue line (99e) can 

move left or right to change the position of the adjustable M 

30 Proportion ruler to be able to put the maximum of red lines at 

the distal part of the maxillary teeth. 

The last green lines can be moved through or against the 

center blue line to bring the green lines of the M Proportion 

ruler on to the buccal crest of the first molar. 

35 The Adjustable M Proportion Ruler 

To activate the M Proportion calculator, the activation buttons (505), (507) and (509) corresponding the missing quantity is selected. For example, if the central incisor width (504) 

and inter-molar distance (506) are entered, then activation 40 

button (509) is selected. The M Proportion calculator will 

then use the Ratio procedure to calculate the position of the 

side positioning lines (5, 4, 3, 2, 1, 0) as well as the M 

Proportion ratio, which is then displayed in input box (208). 

Each horizontal blue line (99b, 99c, 99d) can be moved up 

or down: 

the upper horizontal line (99c) moves the ginvigal height; 

the middle horizontal line (99b) moves the incisal edge of 

all teeth; and 

the lower horizontal line (99d) moves the lower teeth in 

height 

By moving both upper and middle horizontal (99c, 99b) 

lines, this increases or decreases the length of the teeth. 

It is to be understood that procedures 

Centra!IncisorWidth and InterMolarDistance are similarly 

used when activation buttons (505) and (507) are selected, 

respectively. 

The positioning lines (6, 5, 4, 3, 2, 1, 0) may then be 

displayed (510) on the M Proportion calculator interface 

(500) and/or on an image of the patient's dentition (10), as 

shown in FIG. 22. Furthermore, the interface (500) may have 

various options such as, for example, the ability to print the 

positioning lines (6, 5, 4, 3, 2, 1, 0) on a sheet of paper or to 

create, for example, diagnostic grids such as shown in FIGS. 

11 and 14, by selecting the print button (512). 

Referring back to FIG. 18, there is shown an example of 

possible values obtained from the M Proportion calculator 

with seven lines (input box 502), a central incisor width of 

8.25 mm (input box 504), an inter-molar distance of 52 mm 

(input box 506) and M Proportion ratio of 1.3676540544138 

(input box 508). The resulting positioning lines (6, 5, 4, 3, 2, 

1, 0) are displayed (510) on the M Proportion calculator 

interface (500). 

Referring now to FIG. 20, there is shown representation of 

an image of the dentition (10) of a patient having received 

corrective crowns following the M Proportion calculator val45 Each vertical blue line (99a ), except the centered line, can 

be moved to the right or to the left to accommodate the pre-op 

teeth and gum. The centered line is able to move by 1 mm 

through the facial to correct midline deviation, FIGS. 45 to 47 

show the adjustment of the center line (99e) with respect to 

50 the midline (117). 

The blue square (104) attached to the lower blue horizontal 

line is a pitch adjustor that moves the posterior teeth in the 

library on a parabolic curvature when the blue square (104) is 

moved up or down, thus changing the pitch. This changes the 

55 angulation of the occlusal plane in accordance with the smile 

line. 

The M Proportion ruler (98) is used to diagnose, and to 

dispose teeth in their best position in orthodontic treatment, 

prosthodontic treatment ( crowns, bridges, veneers) or for 

60 dentures. The adjustable M Proportion ruler (99) in the virtual 

wax-up (100) is automatically adapted to the horizontal line 

and the center vertical line of the M Proportion ruler (98) to 

achieve the best disposition of teeth in the dental arch, Taking 

in consideration the periodontal tissues of the underneath 

65 tooth contour and gum, the virtual wax-up (100) is customized to each mouth (best seen in FIG. 34 at the distal of the left 

lateral), 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 40 of 44
US 9,411,910 B2 

13 

Gingivectomy 

Referring to FIGS. 41 to 43, the system allows very accurate gingivectomies. The library smiles (202) slide between 

the teeth and gum (101) in the patient's mouth on the facial 

picture. The upper horizontal blue line (99c) of the adjustable 5 

M Proportion is pulled up to bring the teeth of the library 

(202) under the patient's gum (101). A round size adjustable 

tool (103) allows the gingivectomy by cutting the gum (101) 

of the patient and showing the underneath tooth or teeth of the 

library (202). 10 

Digital Facebow Using a 2D Facial Photograph. 

Referring to FIG. 44, a part of the digital facebow is in the 

rotation application that positions the long axis of the face 

perpendicular to the floor. This application set up the position 15 

of the patient face ( 40) on the articulator. The long axis is 

usually used as the standard position but the upper lip line or 

inter papillary line can be used. 

When aligning the vertical line (110) to the long axis of the 

face the intersection of both horizontal (111) and vertical 20 

(110) lines are brought at the intersection of the incisal edges 

of the upper centrals and the dental midline of the upper 

centrals on the image (40). The horizontal line (111) is 

apposed at the incisal edges of the upper centrals and is 

perpendicular to the vertical line (110) passing through the 25 

dental midline. The intersection of the vertical and horizontal 

line is pivot of the digital facebow. 

Referring to FIG. 21, the M Proportion with the positioning 

lines (6, 5, 4, 3, 2, 1, 0) in conjunction with the horizontal line 

( 41) passing at the incisal edges of the centrals (11) is used in 30 

order to implement a digital facebow from a 2D facial photograph or a 3D facial photograph or 2D and 3D video to 

transfer the 3D position of the maxillary on an articulator or 

any 3D software. 

The digital facebow replaces existing facebows or fox 35 

plates that are not accurate to wax up cases by using a simple 

facial photograph (40) of the patient in a frontal view. Accurate correlation between a 2D or 3D image or video and 3D 

model or cast is impossible using mechanical face bows. In the 

illustrative embodiment, the facial photograph (40) of the 40 

patient is taken while the patient looks to the horizon while 

having its head parallel to the floor so as to have the articulator 

parallel to the floor. The Frankfurt Plane can be used as a 

reference position to position the head of the patient parallel 

to the floor. Referring to FIG. 22, the Frankfurt Plane is a line 45 

( 42) passing through two radiological points; the Porion ( 43) 

and the Orbitalis (44). 

It is to be understood that a certain variance in the parallelism of the 2D photograph (40) or 3D photograph or video 

of the face of the patient to the flooris acceptable and does not 50 

compromise the transfer of the maxillary 3D position on the 

platform of the articulator or any 3D software for the functional or aesthetic side. 

It is to be understood the digital facebow will position the 

model or cast of the teeth on the articulator in correlation with 55 

the teeth position on the image. For example the pre-op teeth 

on the image ( 40) will serve to mount the pre-op model or cast 

on the articulator. The provisional teeth on the image will 

serve to mount the provisional teeth on the model or cast. If 

the post-op model is mounted on the articulator: the post op 60 

teeth on the image will serve to mount the post op model or 

cast. 

Each patient facial photograph ( 40) and each positioning of 

the vertical (110) and horizontal (111) lines on the facial 

photograph (40) will give different position of the model on 65 

the articulator and are treated as different digital facebow 

positions. 

14 

Facebows are used to transfer the maxillary position on an 

articulator with the upper maxillary centrals at an approximated distance of 110. mm from the hinge axis of the articulator, to mimic the anatomy of the masticatory system. 

Referring to FIG. 23, it is possible to transfer, the position 

of the maxillary model or cast in 3D aero special position on 

an articulator (60) using the digital facebow, with a distance 

ofl 10 mm from the centrals to the hinge axis of the articulator 

by transferring the teeth positions in the X, Y and Z axis of the 

existing model on the installed platform (62) on the articulator (60). Referring to FIGS. 48 and 49, the X axis is positioning the Pitch and Roll and the Y axis is positioning the Yaw of 

the model or cast on the platform of the articulator. 

Platforms exist in many manufacturing companies. The Z 

axis (61) is given by the teeth on the maxillary model or cast 

of the patient. The platform (62) on the articulator (60) has 

two lines, Z axis (61) and Y axis (63), crossing each other at 

approximately 110. mm from the hinge axis; depending of the 

brand of articulator (60) and platform (82). The adjustable 

and/or the M Proportion ruler is apposed against the Z axis 

line on the platform (62). The X andY axis coordinates of the 

2D pre op virtual wax up on the picture will be transpose in 3 D 

on the pre-op model. 

TheYaxis 

The adjustable and/or the M Proportion ruler provide the Y 

axis of the ideal position for each tooth in the maxillary. 

Referring to FIG. 26, a printed template (70) is positioned on 

the platform (62) against the Z axis line (61). The template 

(70) lines (71, 72, 73, 74, 75, 76) are positioned parallelto the 

center Y axis line (63) on the platform (62). 

Referring to FIG. 24, the maxillary model or cast (80) is 

then positioned on the template (70); the buccal edges of the 

centrals (81) of the maxillary model (80) are applied on the 

platform (70) against the Z axis line (61) and the midline of 

the centrals (81) is positioned on the midline of the template 

(70). In some cases were the dental midline needs to be moved 

on one side in the patient's mouth, the dental midline of the 

model or cast will not be positioned on the midline of the 

template. The midline of the model will be positioned on the 

original vertical centered line of the digital facebow passing 

through the midline of the pre-op centrals on the facial photograph. 

Referring now to FIG. 25, two pieces of wax (82) (or other 

adhesive or supporting material) are placed in the molar 

regions on each side and then, referring to FIGS. 26A, 26B 

and 26C, the model (80) is positioned on the template (70) 

relatively to the midline (76) and one of the last side lines on 

the left (71', 72') and right (71, 72) in correlation with the lines 

on the image showing the same teeth to secure de Yaw position. To achieve the correlation in the Yaw position between 

the image and the 3D model, the midline of the central on the 

model must be locked with the central line on the template of 

the platform ( or locked on the original dental midline on the 

pre-op facial photograph if the midline is changed). The 

model is turned slightly on the left and/or the right to correlate 

the landmark position on each side of the model and the 

image. 

It is to be understood that the digital facebow can be done 

with or without the template or M Proportions, as long as it 

meet the following requirements: 

1-The image needs to be calibrated with the real measurements of the patient. 

2----Combine with the rotation application using the intersection of the vertical and horizontal line at the junction 

of the dental midline and incisal edge of the upper centrals on an image with placement the same intersection 

of the vertical and horizontal line at the junction of the 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 41 of 44
US 9,411,910 B2 

15 

dental midline and incisal edge of the upper centrals of 

the correspondent model or cast of the teeth ( shown on 

the image) on the platform of the articulator. For 

example any landmark on the model, at least one landmark on the right and one landmark on the left are 5 

needed to correlate with the image as long as it can be 

measured from the center line to the landmark on a side 

tooth (in the premolar or molar area) or the gum junction 

16 

axial inclinations, and emergence profile of each teeth, ect. 

The resulting virtual wax-up (100) is then transferred with the 

X and Y axis on the mounted model or cast to do the wax-up, 

i.e. (80) or the final restoration (102) manually by a dental 

technician or transferred to 3D software that will print or mill 

a cast of the 2D virtual wax-up. The 3D wax-up done manually or printed or milled or saved as a 3D file by 3D software 

will be used as the architectural plan to produce the final 

on the image and correlate those measurements from the restorations. When the wax up is done manually by a lab 

center line to the landmark on the same side tooth or the 

gum junction on the platform. It is to be understood that 

each rotated image used to mount the model on the 

articulator as a specific position. With the same image, 

the model or cast can be mounted in as many positions as 

the intersection of the vertical and horizontal lines is 

applied on different position of the incisal edges and 

dental midline on the image. Those different positions of 

the model on the platform of the articulator and are 

treated as different digital facebow positions. 

1 o technician, he will take the measurement in height from the X 

axis on the screen (the line passing through the incisal edge of 

the upper centrals) to the tip of each tooth in the virtual wax up 

in the image on the screen. The technician will also localize 

the position of the tip of the cusp between the medial and 

15 distal lines to localize the tip of each cusp on the wax up (102) 

(see FIG. 50). The lab technician will also mimic the morphology of the virtual wax up on the image to the wax up or 

the final restorations on the model or the cast. 

Once the maxillary pre-op model is transferred on the 

TheX axis 

Referring to FIG. 27, the O starting point on the X axis (65) 

is the top of the platform (62) from a frontal view. The X axis 

will determine the pitch and the roll of the model in 3D aero 

special position on the platform in correlation with the same 

measurements on the chosen teeth on the image. 

20 articulator (60), the platform (62) is taken out of the articulator (60) to permit the mounting of the lower model in occlusion with the maxillary pre-op, wax-up, or final restorations 

model to verify the functional side of the wax up. 

25 

Referring now to FIG. 28, both central widths from distal to 

distal is calibrated according to the first red lines of the M 

Proportion lines at the distal of the centrals (75, 75'). In the 

present example, both centrals (11) width is 17. 7 5 mm, the M 

Proportion ruler central width is automatically calibrated at 30 

8.8750. mm. The central width can be recalibrated at any time 

to insure an exact calibration of the measuring tool. The 

measuring tool is used to take the measurements ofX and Y 

axis on the screen on the 2D photograph. 

Referring to FIGS. 29 and 30, the incorporation of a hori- 35 

zontal line ( 41) to the M Proportion ruler passing at the incisal 

edges of the centrals (11) on the facial photograph (40) provides the X axis ( 65) representing the O starting point of the 

model (80) centrals (81), which is equal to the top of the 

platform (62) (see FIG. 27). Two measurements from the 40 

horizontal line (41) to the incisal (91) or gingival (92) edges 

are taken on the facial photograph ( 40); one on the left and the 

other on the right in the premolar or molar regions (14, 15) 

(best seen in FIG. 30). 

It is to be understood that any reference point on any part of 45 

a tooth or gum junction on each side of the maxillary can be 

taken to correlate the image and the model on the platform. 

Referring back to FIG. 27, those two measurements (91, 

92) are used on the platform (62) representing the O starting 

point to position the maxillary model (80) with the right pitch 50 

and roll. 

Transferring the 2D Virtual Wax Up to 3D Wax Up Manually 

Referring to FIG. 36, both adjustable and/or M Proportion 

rulers can be printed on a template (70') and apposed on the 

platform (62) the virtual diagnostic wax-up for veneers, 55 

bridges and crowns will be achieved with the adjustable M 

Proportion, the best position for orthodontic treatment and 

dentures will be done with the M Proportion, i.e. model (80). 

Referring now to FIG. 37, both M (98) and adjustable M 

(99) Proportion rulers bring soft tissues and lips of the patient 60 

on the articulator by working in correlation with the position 

of the maxilla from the 2D image and the maxillary 3D model 

position on the articulator given by the digital facebow. The 

digital facebow function with both M and adjustable M Proportion rulers. The diagnostic wax-up (100) is done on the 65 

picture ( 40) with the adjustable M Proportion ruler respecting 

the smile line, the position of the lips, gingival architecture, 

2D denture virtual set up and manual positioning of teeth 

To match the pre-op facial photograph of the patient, the 

actual upper denture is duplicated in wax and is mounted on 

the platform of the articulator with the same technique 

describe for a patient with natural teeth. Before mounting the 

duplicated denture an accurate impression of the edentulous 

maxillary tissues have been taken with the duplication process or after and is mounted with the duplicated denture on the 

platform of the articulator. The same process can be done on 

the lower denture when both dentures are done at the same 

time by articulating the lower duplicated denture in occlusion 

with the upper duplicated denture. 

In this method the denture pictures are in the 2D libraries. 

A variety of different dentures teeth in shape, size, and colors 

are stored in the 2D libraries from different suppliers. The 

correspondent 3D dentures have been scarmed and placed in 

the 3D software. The denture libraries in the 2D software are 

calibrated with the central width and height of each for each 

set of dentures teeth. Those measurements are locked in the 

denture image with tracking lines that will stick to the adjustable or M Proportion lines on the teeth of the facial photograph. 

The M Proportion ruler is placed and calibrated on the teeth 

of the patient actual denture or the trial denture over the 

patient facial photograph. 

For each denture in the denture libraries placed in the 

patient mouth, the green lines in the picture of the library are 

fused to the red lines of the M Proportion on the patient's 2D 

photograph. The denture is adjusted automatically to the real 

size of the patient's mouth for the patient to visualize a realistic view of is future smile. The denture teeth are adapted to 

the lip and mouth of the patient with the movement of the 

adjustable M Proportion. The blue vertical lines are restricted 

to some minor adjustment of0.5 mm on each side of the M 

Proportion (Red line) to make minor rotations. The upper 

horizontal line for the adjustment of the lip line (level of the 

upper gum), the middle horizontal line for the position of the 

incisal edges of the upper centrals, the length of the centrals is 

locked to, the size of the denture teeth insert over the patient's 

actual denture. The parabolic curvature blue box attached to 

the lower horizontal line adapts the occlusal plane to the smile 

line by draging the blue square up or down. 

From the choosen denture library on the screen, the new set 

of teeth of that library are placed directly on the upper dupliCase 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 42 of 44
US 9,411,910 B2 

17 

cated denture in wax. The technician will used the same 

technic as previously. All the teeth will be positionned in the 

wax of the upper duplicated denture with the template ( of 

adjustable M Proportion or M Proportion ruler used for the set 

up on the screen.) on the platform of the articulator. This 5 

technic saves multiple appointments for the practionner and 

the patient. 

Transferring the 2D Virtual Wax Up to a 3D Software Manufacturing a Computerized Wax Up Using 3D Modeling 

The 2D libraries are in the 2D software for consultation, 10 

diagnosis and treatment planning with the patient. The 3D 

correspondent libraries of the 2D images are in the 3D software. In this method the 2D virtual wax up placed over the 

patient pre op teeth in the 2D software is reproduced on the 3D 

pre op model of the patient inside the 3D software by over- 15 

laying the correspondent 3D library of the 2D library used in 

the 2D virtual wax up. 

In the present method the 2D libraries used for virtual wax 

up come from real patient's mouth with natural teeth or 

restored teeth or it can come from other sources. All the smile 20 

and teeth pictures in the 2D libraries have their correspondent 

3D model or cast stored and scanned In 3D 

The 2D smile project file interfaces is proceeding by automatic mesh alteration and the used same algorithm ratio, 

central width and inter molar width used in the 2D software. 25 

Once the 3 D virtual wax up is overlaying the 3D pre-op model 

in the teeth data the lab technician will manually do alteration 

and adjustments on the teeth data model. 

In the 3D software the wax up are done: 

1-For dentures; 3D modeling of the smile under con- 30 

straint (red lines). In this solution, the 3D model can 

admit small adjustments for each teeth 

2-Forcrowns, veneers, bridges: 3D modeling of the smile 

that can be modified (blue lines). In this solution, the 3D 

model will adjust itself to the smile as a whole. The 3D 35 

model will have to respect the data from the patient (i.e. 

2D coordinated (X, Y). anatomic reference points of the 

smile) as well as measurements from the wax model or 

scan of the mouth of the patient (i.e. depth in the Z axis). 

Referring to this FIG. 51 a model of the 3D wax-up in the 40 

3D software is printed by a stereolithographic printer. From 

that model a clear thin plastic shell (106) is done to guide the 

practitioner for the depth of cut for the placement of ceramic 

or other material as final restorations on the prepped teeth. A 

second clear plastic shell is done to produce the provisional's 45 

in the patient's mouth with a temporary composite material 

after prepping the teeth or putting abutment on implants to 

duplicate the virtual wax up in the patient's mouth. 

Although the present disclosure has been described by way 

of an illustrative embodiment and example thereof, it should 50 

be noted that it will be apparent to persons skilled in the art 

that modifications may be applied to the present particular 

embodiment without departing from the scope of the present 

disclosure. 

It is to be understood that the disclosed non-limitative 55 

18 

wherein, in the library, each digital image of a smile is 

associated to a corresponding 3D dentition model; 

a user interface for selecting a digital image of a smile to be 

applied to the image of the smile of the patient; and 

a processor for: 

applying a set of positioning indicators over the image of 

the patient's smile, the positioning indicators providing adjusted teeth positioning over the image of the 

patient's smile, 

modifying, based on the positioning indicators, a 3D 

dentition model associated with the selected digital 

image of a smile, and 

providing a virtual wax-up of a dental restoration of the 

dentition of the patient based on the modified 3D 

dentition model. 

2. A system according to claim 1, wherein the user interface 

is configured so as to allow the adjustment of at least one of a 

pitch, yaw and roll of the associated 3D model. 

3. A system according to claim 1, further comprising a 

scanner for acquiring at least one of a digital image of a smile 

and a 3D dentition model. 

4. A system according to claim 3, further comprising a 

system to manufacture a 3D model guide of the virtual waxup. 

5. A system according to claim 3, further comprising a 

printer for providing a 3D model guide of the virtual wax-up. 

6. A system according to claim 5, wherein the printer is a 

stereolitographic printer. 

7. A system according to claim 1, wherein the processor 

processes a horizontal line passing at incisal edges of central 

incisors of the patient, at least one vertical line on the dental 

midline of the patient, and one vertical line passing on each 

side of the maxillary to implement a digital facebow from one 

of a 2D facial photograph, a 3D facial photograph, a 2D video, 

or a 3D video. 

8. A system according to claim 7, wherein the processor 

uses the digital facebow to transfer a 3D position of the 

maxillary on an articulator or a 3D software. 

9. A system according to claim 1, wherein the library of 

digital images of smiles comprises a library of 2D digital 

images of smiles. 

10. A system according to claim 1, wherein the processor is 

further configured to: 

define a first axis passing substantially at incisal edges of 

central incisors of the image of the patient's smile; 

define a second axis substantially on the dental midline of 

the image of the patient's smile, the second axis being 

substantially perpendicular to the first axis; and 

define coordinates of the virtual wax-up based on the first 

and second axes. 

11. The system according to claim 10, wherein the coordinates of the virtual wax-up and the first and second axes of the 

image of the patient's smile are transferable on an articulator, 

allowing to adjust, on the articulator, a pitch and a roll of a pre 

op model of the patient about the first axis and to adjust a yaw 

of the pre op model of the patient about the second axis. 

illustrative embodiments may be used for assisting in various 

dental works such as, for example, surgery, fabrication and 

positioning of Implants, fabrication of ceramic veneers and 

crowns, fabrication of dentures, orthodontic molds, partial 

and complete prostheses, etc. 

What is claimed is: 

1. A system for designing the dentition of a patient, comprising: 

12. The system according to claim 10, wherein adjustments 

of the pitch, yaw and roll of the pre op model of the patient 

60 allow to produce a real wax-up based on the coordinates of the 

virtual wax-up and on an adjusted position of the pre op 

model. 

an input for providing an image of the patient's smile to the 

system; 

a memory having stored therein a library of digital images 

of smiles and of corresponding 3D dentition models 

13. The system according to claim 10, wherein the coordinates of the virtual wax-up and the first and second axes of the 

65 image of the patient's smile are transferable in a 3D software, 

allowing to adjust, in the 3D software, a pitch, a roll and a yaw 

of the 3D dentition model of the patient. 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 43 of 44
US 9,411,910 B2 

19 

14. The system according to claim 13, wherein adjustments 

of the pitch, yaw and roll of the 3D dentition model of the 

patient allow to produce a real wax-up based on the coordinates of the virtual wax-up and on an adjusted position of the 

3D dentition model of the patient. 5 

15. A system according to claim 1, wherein the library is 

stored in the memory before the provision of the image of the 

patient's smile to the system. 

16. A system according to claim 1, wherein the library 

contains information from one or more suppliers. 10 

17. A system for positioning a 3D model of the maxillary of 

a patient on an articulator or 3D software, comprising: 

an input for providing one of a 2D facial photograph, a 3D 

facial photograph, a 2D video, or a 3D video; and 

a processor for implementing a digital facebow by placing, 15 

on the one of the 2D facial photograph, 3D facial photograph, 2D video, or 3D video, a horizontal line passing 

20 

at incisal edges of central incisors of the patient to define 

a first axis, at least one vertical line on or near the dental 

midline of the patient to define a second axis, and one 

reference point on each side of the maxillary to define 

vertical distances between the first axis and the reference 

points, the processor defining the positioning of the 3D 

model based on the placement of the first axis and of the 

second axis, and based on the vertical distances between 

the first axis and the reference points. 

18. A system according to claim 17, wherein the processor 

uses the digital facebow to transfer a 3D position of the 

maxillary on the articulator or on the 3D software. 

19. A system according to claim 17, comprising a user 

interface configured so as to allow the adjustment of at least 

one ofa pitch, yaw and roll on the 3D model of the maxillary 

of the patient. 

* * * * * 

Case 0:20-cv-61596-RS Document 1-1 Entered on FLSD Docket 08/05/2020 Page 44 of 44