Abstract:
A system providing transitional bracket and transfer jig modules that have been custom designed to address a rotated or partially erupted tooth in advance of applying a computer aided bracketing system to the tooth. The transfer jigs and brackets are used until the problem tooth is moved into a position that will allow positioning of the “ideal” bracket. Once the ideal brackets are position, the treatment plan can proceed as it would with existing systems to reach the final ideal position. The transitional modules are integrated into the customized treatment plan such that the orthodontist just follows the digitized plan, including correction of misaligned teeth. The computer system that assists with defining the treatment plan takes into account the starting position of the teeth and can adjust the plan, as well as use of transitional brackets, to accommodate many more patients that have one or more problem teeth needing correction.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims priority to and the benefit of U.S. Provisional Patent Application No. 61/713,902, filed Oct. 15, 2012, which is hereby incorporated by reference herein in its entirety. 
     
    
     BACKGROUND 
       [0002]    Existing digital orthodontic systems utilize digitized images of the teeth to generate a customized treatment system of brackets, transfer jigs and wires. This system assumes that all of the custom designed brackets and transfer jigs can be placed on the facial or labial surface of the tooth. Unfortunately, for some patients a tooth may be rotated or otherwise malpositioned such that the facial surface is not facing outward or the tooth has not fully erupted through the gums. In these situations, the orthodontist must first recognize the problem condition and then use manual techniques to de-rotate or otherwise move the tooth so that the “customized” system can then be placed. Given the cost of such customized systems, it then becomes less desirable to use a customized orthodontic set because the orthodontist must use traditional techniques in addition to the customized versions. 
         [0003]    The devices, systems, and methods disclosed herein overcome one or more of the deficiencies of the prior art. 
       SUMMARY 
       [0004]    In a first aspect, the present disclosure provides a method for computer aided tooth alignment correction. The disclosed method includes determining sequential brackets and placement locations on the same tooth to accomplish a computer aided treatment plant. In one aspect, the method can include receiving digital information regarding initial teeth positions; determining desired final teeth positions and a treatment plan of ideal brackets, jigs and wires for achieving the final teeth positions; identifying whether there will be interferences between at least one of the ideal brackets, jigs, wires, teeth and gums; and upon identification of interferences, generating one or more sequential treatment modules addressing the identified interference. In a further aspect, the method further includes packaging the ideal brackets and jigs along with the sequential treatment module. 
         [0005]    In a further embodiment, the present disclosure provides a tooth correction system that can be applied in a sequential manner to the same tooth. In one aspect, the correction system includes a first transfer jig having an occlusal surface configured to engage the occlusal surface of a tooth and a mounting surface having a bracket holding feature, the mounting surface configured for orientation with a first surface of the tooth having a first plane offset at a first acute angle from the tooth longitudinal axis. In another aspect, the system includes a second transfer jig configured to engage the occlusal surface of the tooth and having a second mounting surface having a second bracket holding feature, the second mounting surface configured for orientation with a second surface of the tooth having a second plane offset at a second acute angle from the tooth longitudinal axis. Still further, the system can include a plurality of ideal transfer jigs in addition to the first transfer jig and the second transfer jig, each of the plurality of ideal transfer jigs adapted for engaging different teeth within a patient&#39;s mouth and having a mounting surface having a bracket holding feature, the mounting surface configured for orientation with a facial surface of the tooth. 
         [0006]    In yet a further aspect, the present disclosure contemplates a tooth correction kit comprising a plurality of tooth brackets and a plurality of transfer jigs for positioning the tooth brackets at a predetermined location on the teeth, wherein at least two of the tooth brackets are designed for sequential placement on the same tooth. The tooth correction kit can further included at least two transfer jigs configured for engaging the same tooth at two different angular positions with respect to the longitudinal axis of the tooth. 
         [0007]    It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory in nature and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. In that regard, additional aspects, features, and advantages of the present disclosure will be apparent to one skilled in the art from the following detailed description. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]    The accompanying drawings illustrate embodiments of the devices and methods disclosed herein and together with the description, serve to explain the principles of the present disclosure. Throughout this description, like elements, in whatever embodiment described, refer to common elements wherever referred to and referenced by the same reference number or character. The characteristics, attributes, functions, interrelations ascribed to a particular element in one location apply to those elements when referred to by the same reference number or character in another location unless specifically stated otherwise. 
           [0009]    The figures referenced below are drawn for ease of explanation of the basic teachings of the present disclosure only; the extensions of the figures with respect to number, position, relationship, and dimensions of the parts to form the following embodiments will be explained or will be within the skill of the art after the following description has been read and understood. Further, the exact dimensions and dimensional proportions to conform to specific force, weight, strength, and similar requirements will likewise be within the skill of the art after the following description has been read and understood. 
           [0010]    The following is a brief description of each figure used to describe the present invention, and thus, is being presented for illustrative purposes only and should not be limitative of the scope of the present invention. 
           [0011]      FIG. 1  is a stylized view of a portion of a computer aided treatment plan according to a prior art system. 
           [0012]      FIG. 2  is a stylized view of a portion of a computer aided treatment plan according to an as aspect of the present disclosure. 
           [0013]      FIG. 3A  is top view of a transfer jig and bracket system being applied to a series of teeth. 
           [0014]      FIG. 3B  is a partial cross sectional side view of the transitional jig and bracket of  FIG. 3A . 
           [0015]      FIG. 4  is a top view of the transitional bracket of  FIG. 3A  bonded to the tooth and attached to the wire in an initial position. 
           [0016]      FIG. 5  is a top view of the transitional bracket of  FIG. 3A  bonded to the tooth and attached to the wire in a first transitional position. 
           [0017]      FIG. 6A  is top view of a second transfer jig and bracket system being applied to the series of teeth. 
           [0018]      FIG. 6B  is a partial cross sectional side view of the second transitional jig and bracket of  FIG. 6A . 
           [0019]      FIG. 7  is a top view of the second transitional bracket of  FIG. 6A  bonded to the tooth and attached to the wire in a first transitional position. 
           [0020]      FIG. 8  is a top view of the second transitional bracket of  FIG. 6A  bonded to the tooth and attached to the wire in a second transitional position. 
           [0021]      FIG. 9  is a top view of an ideal bracket of  FIG. 1  bonded to the tooth in the second transitional position of  FIG. 8 . 
           [0022]      FIG. 10  illustrates the ideal bracket of  FIG. 9  attached to the wire. 
           [0023]      FIG. 11  illustrates the ideal bracket of  FIG. 9  with the tooth shown in the finished rotational position. 
           [0024]      FIG. 12  is a stylized version of a bracket and transfer jig system for treating a patient&#39;s teeth according to one aspect of the present disclosure. 
           [0025]      FIG. 13  is an exemplary derotation module associated with the bracket and transfer jig system of  FIG. 12  according to another aspect of the present disclosure. 
           [0026]      FIG. 14  is a block diagram of a process flow implementing at least one aspect of a computer aided sequential treatment system. 
       
    
    
     DETAILED DESCRIPTION 
       [0027]    For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the embodiments illustrated in the drawings, and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the disclosure is intended. Any alterations and further modifications to the described devices, instruments, methods, and any further application of the principles of the present disclosure are fully contemplated as would normally occur to one skilled in the art to which the disclosure relates. In particular, it is fully contemplated that the features, components, and/or steps described with respect to one embodiment may be combined with the features, components, and/or steps described with respect to other embodiments of the present disclosure. For the sake of brevity, however, the numerous iterations of these combinations will not be described separately. For simplicity, in some instances the same reference numbers are used throughout the drawings to refer to the same or like parts. 
         [0028]    Referring initially to  FIG. 1 , there is shown a graphic representation of the output of a computer aided bracketing system treatment plan. Features of such systems are described in the U.S. Pat. Nos. 5,368,478; 6,358,044; 6,846,179; 7,641,473; and 7,869,983 the disclosure of each of with is incorporated by reference herein in their entirety. Stylized images of digitized teeth T 1 , T 2  and T 3  are shown in their original starting position. Each tooth T 1 , T 2 , and T 3  has a longitudinal axis L 1 , L 2 , and L 3  generally aligned with trough  158 ,  258  and  358 , respectively. Teeth T 1  and T 3  have generally aligned axes L 1  and L 3  with facial surfaces  150  and  350 , and lingual surfaces  156  and  356  of teeth T 1  and T 3  each oriented facial and lingually, respectively. As shown in  FIG. 1 , the axis L 2  of tooth T 2  is rotationally offset from the axis L 1  of the adjacent tooth T 1  by an angle A 2 . In the illustrated embodiment, the angle A 2  is approximately 70 degrees, although this angle could range from 15-110 degrees. Given the rotational offset of the tooth T 2  with respect to the adjacent teeth, the facial surface  250  is facing tooth T 1  while the lingual surface  256  is facing tooth T 3 . Similarly, the side surface  252  is oriented facially along with the more highly curved transition zone  254  extending between the facial surface  250  and the side surface  252 . The side surface  253  opposing the surface  252  is disposed generally lingually in the illustration of  FIG. 1  while the lingual surface  256  is substantially facing toward tooth T 3 . 
         [0029]    Existing computer aided orthodontic appliance planning systems utilize the starting position of the digitized teeth to develop a placement plan for a bracket and wire system to move the teeth to a desired finished position. In the illustrated version, the system determines the “ideal position,” generally the midpoint,  160 ,  260 , and  370  of the facial surface of each tooth T 1 , T 2  and T 3 , respectively. The system then assigns a bracket to be placed on the tooth in the ideal position to accomplish the movement to the final position. Based on calculations performed by a processor executing a treatment program, the brackets I 1 , I 2  and I 3  are considered the “ideal” brackets to accomplish the tooth movement from the starting position into the final, finished position. In the ideal position, the axis of each ideal bracket intersects the tooth axes L 1 , L 2 , and L 3 , respectively, at a substantially perpendicular angle. For example, in the ideal position  260 , the axis LI 2  of the ideal bracket I 2  for tooth T 2  intersects the tooth axis L 2  at a substantially perpendicular angle. 
         [0030]    However, as shown in  FIG. 1 , bracket  12  has an overlap zone  230  with adjacent tooth T 1 . It will be appreciated that the bracket I 2  cannot be placed in the ideal position  260  on the facial surface  250  of tooth T 2  in the current orientation because there would be interference between the bracket I 2  and adjacent tooth T 1 . Other forms of interference can also be determined by the computer aided design system, such as bracket to tooth, jig to tooth, bracket to gum, and wire to tooth interferences. When such interferences are identified, the proposed computer aided treatment plan must be abandoned in favor of a traditional manually defined treatment plan or the tooth T 2  must be manually realigned before the computer aided treatment plan can be applied. In either situation, the healthcare provider must make adjustments to the position of at least tooth T 2  based on observation and without the benefit of a computer aided treatment plan that will lead the to the fastest, most accurate correction of the teeth. 
         [0031]    Referring now to  FIG. 2 , there is shown an output of a computer aided treatment plan to move teeth T 1 , T 2  and T 3  into a final position. As illustrated, the computer aided treatment plan has determined that based on the angle of rotation A 2  of tooth T 2 , two rotational brackets A and B will be need before the ideal bracket  12  can be applied to at the ideal position central facial surface. Thus, a transitional tooth module has been defined by the system to include three brackets A, B and  12 , each being placed at a different angular location on the tooth in relation to axis L 2 . A description of the system for determining whether a derotation module will be initiated and what the components will is described below in relation to  FIG. 14 . 
         [0032]    As shown in  FIG. 2 , while there is minimal overlap between bracket B and tooth T 1 , the system determined that the transfer jig  600  (shown in dashed lines) needed to properly place bracket B created a zone of overlap  602 , thus requiring placement of the initial bracket A. The bracket A will be placed at a first offset position on a plane of the tooth T 2  with the bracket axis LA intersecting the tooth axis L 2  at a first offset angle A 3 . The first offset angle A 3  is an acute angle relative to the tooth axis L 2 . In the first offset position, at least a portion of a mounting pad  603  of the bracket A is bonded to the side surface  252  and the transition surface  254 . The term “offset” is used to describe a bracket position on a surface of the tooth that is offset from the ideal position calculated by the computer aided planning system. As shown in  FIG. 3A , the jig needed to place bracket A in the first offset position is configured to avoid a zone of overlap with adjacent teeth. 
         [0033]    According to the defined treatment plan illustrated in  FIG. 2 , the bracket B will then be placed at a second offset location on a plane of the tooth closer to the ideal position with bracket axis LB forming a second offset angle A 3 ′ (larger than the first acute angle) with respect to tooth axis L 2 . The second offset position has the bracket B positioned more facially with a portion of the pad bonded to the facial surface  250  and a portion bonded to the transition surface  254 . It will be appreciated that one or more rotational brackets can be used to move the tooth. Further, as illustrated, the centers of the transitional brackets A and B do not align with the center  260  of the facial surface  250 . As shown in  FIG. 2 , the bracket  12  can later be positioned at the ideal position  260  to form a substantially perpendicular angle A 3 ″ with the axis L 2 . 
         [0034]    Referring to  FIGS. 3A and 3B , there is a shown a further portion of a transitional module according to another aspect of the present disclosure. More specifically, as is known with existing systems, custom designed transfer jigs  400  and  410  are provided to apply the ideal brackets I 1  and I 3 , respectively, to the designated teeth. As shown in  FIG. 3A , a transitional transfer jig  420  is shown with the rotational bracket A positioned on tooth T 2 . The transfer jig  420  is oriented along the direction of arrow  480  with side walls  450  and  452  positioned at a non-orthogonal angle with respect to axis L 2 . As shown in  FIG. 3B , the jig  420  extends across a trough  258  to span the tooth from the side surface  252  to the opposing side surface  253 . The jig  420  is maintained in position by the engagement of recesses  442  and  444  with tooth peaks  272  and  274 , respectively. In this position, a recessed sidewall portion  454  is positioned adjacent tooth T 1  and a front wall  456  is positioned generally facially. The engagement of the transitional jig  420  allows the rotational bracket A to be held in place in the position calculated by the computer aided treatment system as shown in  FIG. 2 . 
         [0035]      FIG. 4  illustrates the rotational bracket A offset position on tooth T 2 . The bracket A is interconnected with the brackets I 1  and I 3  via a wire W. The wire W is configured to partially rotate tooth T 2 . The remaining portions to the sequential treatment brackets B and I 2  are shown below T 2  and are retained by the orthodontist for later installation on the tooth. 
         [0036]    Referring now to  FIG. 5 , the bracket A is shown aligned along the wire W with the brackets I 1  and I 3 . Tooth T 2  has been rotated by an angle of A 1  from the initial position at L 2  to a first intermediate rotational position L 2 ′. In one embodiment, A 1  is in the range of approximately 15-30 degrees. Once the teeth positioning has progressed to the positions shown in  FIG. 5 , the treatment plan may be continued with the second module of the transitional treatment plan. 
         [0037]    Referring now to  FIGS. 6A and 6B , the bracket A has been removed from tooth T 2 . The brackets I 1  and I 3  remain on teeth T 1  and T 3 , respectively. A second transitional transfer jig  600  is shown with the rotational bracket B positioned on tooth T 2 . The transfer jig  420  is oriented along the direction of arrow  680  with side walls  650  and  652  positioned at a non-orthogonal angle with respect to axis L 2 ′, although the angle of orientation is not less than the angle A 2  from  FIG. 1 . 
         [0038]    As shown in  FIG. 6B , the jig  600  extends across the trough  258  to span the tooth T 2  from the side surface  252  to the opposing side surface  253 . The jig  600  is maintained in position by the engagement of the occlusal surfaces or recesses  642  and  644  with the occlusal tooth surfaces or tooth peaks  272  and  274 , respectively. In this position, a sidewall portion  654  is positioned adjacent tooth T 1  and a front wall  656  positioned generally facially with the bracket B contacting at least a portion of the facial surface  250  of tooth T 2 . The engagement of the transitional jig  600  allows the intermediate rotational bracket B to be held in place in the offset position calculated by the computer aided treatment system as shown in  FIG. 2 . The intermediate rotational bracket B may be bonded to tooth T 2  in the offset position shown in  FIGS. 6A and 6B . 
         [0039]      FIG. 7  illustrates the intermediate rotational bracket B positioned on tooth T 2 . The bracket B is interconnected with the brackets I 1  and I 3  via the wire W. The wire W is configured to partially rotate tooth T 2 . The remaining portion of the sequential treatment system, the bracket I 2 , is shown below T 2  and is retained by the orthodontist for later installation on the tooth. 
         [0040]    Referring now to  FIG. 8 , the wire W has effected additional rotation of tooth T 2  through bracket B such that longitudinal axis L 2 ″ is now offset from the starting longitudinal axis L 2  by an angle of A 1 ′ (which is larger than the angle A 1  of  FIG. 5 , but is still smaller than the original offset angle A 2  of  FIG. 1 ). 
         [0041]    Referring now to  FIG. 9 , tooth T 2  has been rotated by the application of rotation module brackets A and B sufficiently to apply the ideal bracket  12  to the facial surface  250  of tooth T 2  in the calculated ideal position (e.g., position  260  shown in  FIGS. 1-2 ). In other words, the tooth T 2  has been rotated sufficiently to reduce the interferences or areas of overlap enough to allow for the placement of the bracket  12  in the ideal position (e.g., position  260  shown in  FIG. 1 ). As shown, the bracket  12  is positioned substantially in line with arrow  680 ′ which is substantially perpendicular to the axis L 2 ″ of tooth T 2 . 
         [0042]    With reference to  FIG. 10 , the wire W may not be interconnected with the brackets in a traditional fashion to complete the computer generated treatment plan. 
         [0043]    As shown in  FIG. 11 , upon completion of the treatment, the tooth T 2  has been rotated through an angle A 1 ″ substantially matching the original offset angle A 2 . Similarly, a longitudinal axis L 2 ′ of the tooth T 2  is generally aligned with the axis L 1  of tooth T 1  and the axis L 3  of tooth T 3 . While the illustrated embodiment is shown with substantially linearly aligned teeth for ease of illustration, it will be appreciated that teeth structures in the mouth vary and that often teeth are aligned along a curve or arc rather than in a pure linear fashion. The description of the alignment of teeth is illustrative, it being understood that the rotation of the intermediate tooth to affect the computer aided treatment plan allows final positioning of the teeth in the desired position. 
         [0044]    Referring now to  FIG. 12 , there is shown a treatment system kit  1200  according to another aspect of the present disclosure. More specifically, the treatment system kit  1200  includes a series of brackets and transfer jigs necessary to implement a traditional computer aided tooth correction plan. However, in the illustrated embodiment a cap  1210  covers one of the brackets and transfer jigs. The cap  1210  provides a visual indicator to the user that the underlying bracket and jig should not be used in the initial installation on the teeth. Instead, the user must first apply one or more sequential treatment modules to the tooth of interest before the final treatment bracket positioned under cap  1210  can be applied. As described above, the sequential treatment needed may be a derotation of a tooth, such that the cap is an indicator that rotation sequence has been engaged by the computer aided treatment plan. 
         [0045]    Thus,  FIG. 12  illustrates a computer designed orthodontic treatment system kit with user indication signaling the need for sequential treatment of at least one tooth. A sequential treatment module package  900  is shown positioned centrally in the packaging of the treatment system. As discussed above, the computer aided design system determines the treatment plan for movement of the teeth including whether any teeth need sequential treatment by one or more preliminary offset brackets before placement of the final, ideal brackets. In the pictured embodiment, the sequential treatment module package  900  includes a series of a sequential treatment modules  910  and  920 . 
         [0046]      FIG. 13  illustrates an enlarged view of the package  900  having the series of sequential treatment modules  910  and  920  according to at least one aspect of the present disclosure. Although for some patients, only a single treatment module will be needed before sequentially applying the final treatment bracket, the illustrated version includes two pre-final, offset brackets A and B as previously described along with their associated transfer jigs. As set forth above, the brackets and transfer jigs of each module have been computer designed based on imaging of the teeth to provide a custom fit for the tooth at an initial offset starting position for the module  910  and at a calculated intermediate offset position for module  920 . In addition, since more than one treatment module is included in the sequential treatment system, a cover  930  is positioned over the intermediate module  920  to indicate to the user to apply the module  910  first and retain the module  920  for later application. 
         [0047]    Although the sequential treatment module package  900  is shown positioned within the packaging of the ideal bracket system, it will be appreciated that the modules may be packaged completely separately. In addition, it is contemplated that in an alternative form, the position of the tooth needing sequential treatment may have a layered packaging system such that the user peels away layers to expose the next bracket and jig module needed to affect the desired treatment. Still further, while the description is in relation to derotation of a tooth, it will be appreciated that the description is not limited to any particular tooth misalignment and the general concepts disclosed herein can be applied to other misalignments including partially erupted teeth, baby teeth, and overlapped starting alignments of adjacent teeth or interference between top and bottom teeth. 
         [0048]    Referring now to  FIG. 14 , there is shown a block diagram of an implementation flow diagram  1400  of how the sequential treatment system may be implemented in at least one embodiment. The following description is made in relation to enhancement of existing computer aided treatment systems such as described above and incorporated by reference herein. At step  1402 , a computer system receives digitized information representative of the initial tooth positions within the mouth. Often, this information is obtained via a scan of the mouth, although other forms of obtaining such information are contemplated. The computer system then determines the desired final tooth positions at step  1404 . At step  1406 , the computer system determines the plan for moving each tooth from the initial position to the final position. As part of this determination, the system determines the type of ideal bracket needed for each tooth, its ideal bonding location on the tooth and the shape of a transfer jig necessary to align the bracket with the desired position on the tooth. At step  1408 , the system then determines if there are any interferences between the teeth, gums, ideal brackets, jigs or wires at any point during the treatment path. If there are no interferences identified, then the system moves on to sending instructions for manufacturing the custom components in step  1430 . If interferences are detected at step  1408 , then the system alerts the user at step  1410  and asks whether the system should implement sequential treatment modules to address the identified interferences. The system may be configured such that the system always performs the sequential module without waiting for user input. In the illustrated embodiment, at step  1410  the user indicates whether a computer aided sequential module should be initiated. If no, the system moves to step  1430 . If yes, the system moves to step  1420  and generates the necessary sequential treatment modules needed to move at least one tooth into position to receive the ideal bracket system previously identified at step  1406 . Although not illustrated, it will be appreciated that the user can approve or reject computer aided design options for the sequential modules and may have access to modify the proposed sequential modules. 
         [0049]    Once the sequential treatment modules have been developed, the computer system next determines the package layout or configuration at step  1422  such that the manufacturing portion of the system will provide the sequential treatment system in a unique form to the end user, such as an orthodontist, in a manner that will alert the user to the existence of at least two treatment brackets for a single tooth. The computer aided designs along with packaging information are then forwarded, typically by sending electronic data, at step  1430  to the manufacturing system. The components of the system are selected from inventory or custom manufactured as necessary and then packaged in step  1440  according to the packaging instructions. The complete sequential treatment system, including sequential modules, may then be shipped to the end user at step  1450 . In an alternative form, only the brackets and jigs needed for the initial installation are shipped initially with the sequential brackets following separately based on the timing determined by the computer aided treatment plan. 
         [0050]    Persons of ordinary skill in the art will appreciate that the embodiments encompassed by the present disclosure are not limited to the particular exemplary embodiments described above. In that regard, although illustrative embodiments have been shown and described, a wide range of modification, change, and substitution is contemplated in the foregoing disclosure. It is understood that such variations may be made to the foregoing without departing from the scope of the present disclosure. Accordingly, it is appropriate that the appended claims be construed broadly and in a manner consistent with the present disclosure.