Patent Publication Number: US-2013230820-A1

Title: Orthodontic devices

Description:
CROSS-REFERENCE TO PRIORITY APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application No. 61/061,435, filed Jun. 13, 2008, U.S. Provisional Application No. 61/088,663, filed Aug. 13, 2008, and U.S. Provisional Application No. 61/122,680, filed Dec. 15, 2008, all of which are incorporated here by reference in their entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to orthodontic devices and to methods of using the same. 
     BACKGROUND 
     Malocclusions of the teeth may cause problems with eating, with the temporomandibular joint, overbites, underbites, cosmetic defects, and variety of other maladies. Malocclusions are commonly treated with braces and other orthodontic devices. 
     SUMMARY 
     Provided herein are orthodontic devices and methods of using the same. An example orthodontic splint device includes a plurality of bases. Each base is configured to be coupled to a portion of a subject&#39;s tooth. For example, a base can be configured to couple to a lingual portion of a subject&#39;s tooth. The device further includes at least one connector configured to couple two or more bases together to form an integral unit such that movement of the unit encourages movement of teeth coupled to the bases of the unit as a set within the mouth of the subject. In one aspect, the orthodontic splint device can include at least one base with a horizontal sheath. The horizontal sheath can be configured to retain a peripheral portion of a transpalatal bar. The transpalatal bar can be configured to couple the splint device to an anchor or to a second orthodontic splint device. 
     In some implementations, the base with the horizontal sheath can further include a horizontal conduit and the horizontal conduit can be configured to retain a wire. The wire can be configured to couple to a tooth adjacent to the tooth coupled to the base comprising the horizontal conduit and horizontal sheath. In one aspect, at least one base can include a vertical sheath. In some aspects, the unit can include an attachment member selected from the group consisting of a hook, button, horizontal conduit, vertical conduit, aperture, cleat, wire, elastic chain, and a rubber band. Optionally, the connector is malleable such that the orientation of the bases relative to each other can be adjusted. 
     In various implementations, orthodontic splint devices may be used to move and/or retain segments of teeth with and without the aid of fixed anchor/anchorage (e.g., miniscrew implants, dental implants, onplants, titanium plates, etc). The orthodontic splint devices may include one or more bases and connectors. The connectors may allow alteration and/or deformation of the device to better fit a specific patient. Various attachment members configured to, during use, couple the device to a portion of the patient&#39;s mouth may also be included on the device. 
     The orthodontic splint devices may be included in a set of orthodontic splint devices such that a user (e.g., dentist, orthodontist, etc.) may select an orthodontic splint device from the set based on patient attributes (e.g., size of teeth, number of teeth to be joined in a segment, treatment to be undergone, age, gender, etc.). The set of orthodontic splint devices may include orthodontic splint devices in a range of sizes based on, for example, norms in a particular population (e.g., humans, animals, children, adults, females, etc.). The selected orthodontic splint devices may then be altered based on patient attributes. For example, the number of bases or base size and/or shape may be altered. Attachment members may also be removed and/or coupled to the orthodontic splint device. 
     In some implementations, a base for an orthodontic splint device may include an attachment member that includes a conduit (e.g., rectangular slot, rectangular cross-sectional area, tubular, etc.) and a sheath. Including a conduit and a sheath on the base may increase the flexibility in use of the base on patients, which may improve patient satisfaction (e.g., since the patient may not need to have a new orthodontic item coupled or anchored), reduce costs and improve treatment (e.g., since the same device may be used for different purposes and/or stages of treatment), and/or increase ease of use. For example, a conduit may be used to couple a tooth to a segment of teeth that has been coupled previously with an orthodontic splint device and/or other orthodontic item. A sheath may be used to couple the base to an anchorage device and/or another orthodontic item (e.g., using a transpalatal bar). 
     The orthodontic splint device may reduce costs and decrease delays in treatment when compared with methods including creating a mold of each patient&#39;s teeth and custom creating an orthodontic item. In addition, since the orthodontic splint device may be altered, it may be used in patients with a variety of different attributes (e.g., tooth sizes, treatments to undergo, etc.). Allowing the orthodontic splint device to be altered may allow a more comfortable fit for a patient while maintaining the convenience to the user and/or patient of a ready-made device. 
     Also provided is an example orthodontic device that includes a pair of peripheral members positionable in a subject&#39;s mouth. Each peripheral member can have a frontal and a dorsal portion with a longitudinal axis running therebetween. A first peripheral member of the pair can be configured to be medial to the lingual side of a first tooth or set of teeth and the second peripheral member of the pair can be configured to be medial to the lingual side of a second tooth or set of teeth on the opposite side of the midline saggital plane of the subject&#39;s mouth. A transpalatal member can be fixed to each peripheral member such that the transpalatal member spans the subject&#39;s hard palate across the saggital midline plane of the subject&#39;s mouth. The transpalatal member can be less rigid than the peripheral members. 
     In some implementations, the peripheral members can have a cross-sectional diameter that is greater than a cross-sectional diameter of the transpalatal member. In some aspects, the transpalatal member can include one or more curved sections for adjusting the spacing of the peripheral members. Optionally, a first curved section is substantially planar with the hard palate of the subject&#39;s mouth. Optionally, the transpalatal member further includes a second curved section that is on a plane that is angled in the direction of the saggital midline plane of the subject&#39;s mouth relative to the curved section that is substantially planar with the hard palate. 
     In one aspect, at least one base including a sheath can be coupled to the first tooth on its lingual side and the first peripheral member can slidably fit within the sheath. A second base including a sheath can be optionally coupled to the second tooth on its lingual side and the second peripheral member can slidably fit within the sheath. 
     In some implementations, the orthodontic device can further include a plurality of bases. Each base can be configured to be coupled to a lingual portion of a subject&#39;s tooth. The orthodontic device can further include at least one connector configured to couple two or more bases together to form an integral unit such that movement of the unit can be used to move the teeth coupled to the bases of the unit as a set within the mouth of the subject. The first peripheral member can be engaged with a base that is coupled to the first tooth and the second peripheral member can be engaged with a base that is coupled to the second tooth. The base coupled to the first tooth and the base coupled to the second tooth can each include a horizontal sheath. Each peripheral member can be sized to slidably move along the horizontal sheath of a base. A spring can be positioned around one or both peripheral members to exert a force for slidable movement of one or both peripheral members through the horizontal sheaths, the force encouraging movement of the teeth coupled to the base members engaged with the peripheral members. 
     In one aspect, the transpalatal member can be configured to receive a force for movement of the teeth coupled to the base members in the direction of the applied force. The force received by the transpalatal member can be on a first side of the center of resistance of the teeth and the force exerted by the spring can be on a second side of the center of resistance of the teeth. Optionally, the first side of the center of resistance of the teeth is above the center of resistance of the teeth and the second side of the center of resistance of the teeth is below the center of resistance of the teeth. 
     Also provided is an example orthodontic device that includes a bar having a first and a second end that extends at least partially across the palate, wherein the bar includes at least two curved sections for adjusting the spacing of the first and second ends of the bar. Optionally, a first curved section can be substantially planar with the hard palate of a subject&#39;s mouth and a second curved section can be on a plane that is angled in the direction of the saggital midline plane of the subject&#39;s mouth relative to the first curved section. The bar can further include a third curved section wherein the third curved section is on a plane that is angled in the direction of the saggital midline plane of the subject&#39;s mouth relative to the first curved section. 
     In some implementations, the bar includes a pair of peripheral members positionable in a subject&#39;s mouth, each member having a frontal and a dorsal portion with a longitudinal axis running therebetween. A first peripheral member of the pair can be configured to be medial to the lingual side of a first tooth or set of teeth and the second peripheral member of the pair can be configured to be medial to the lingual side of a second tooth or set of teeth on the opposite side of the midline saggital plane of the subject&#39;s mouth. The bar can further include a transpalatal member fixed to each peripheral member such that the transpalatal member spans the subject&#39;s hard palate across the saggital midline plane of the subject&#39;s mouth. The transpalatal member can be less rigid than the peripheral members. The example device can further include at least one base coupled to the first tooth on its lingual side, the base having a sheath into which the first peripheral member slides. The device can further include a second base coupled to the second tooth on its lingual side, the base comprising a sheath into which the second peripheral member slides. 
     Also provided is an example orthodontic device that includes a bar that extends at least partially across the palate and includes a first force application point and a second force application point. The first force application point is located on a first side of the center of resistance of at least one tooth to which the bar is coupled and the second point is located on a second side of the center of resistance of the tooth or teeth to which the bar is coupled. A force can be applied to the first force application point by coupling the bar to a fixed point on the hard palate of a subject. The second force application point can be configured to apply a force for compression of a spring, wherein the spring applies a force to the tooth or teeth in a plane on the second side of the center of resistance of the tooth or teeth. 
     In some implementations, the bar can include a peripheral portion and the first force application point can be located medial to the peripheral portion and on the first side of the center of resistance of at least one tooth. A base that includes a horizontal sheath can be coupled to a tooth into which the peripheral portion slidably fits to couple the bar to the tooth. A spring can be located around the peripheral portion of the bar such that application of a force to the first application point of the bar causes compression of the spring. The compressed spring can provide a force to the base, wherein the force from the compressed spring is applied along a plane on the second side of the center of resistance of the tooth or teeth. 
     An example method of moving one or more teeth in the mouth of a subject includes selecting a tooth or a set of teeth to be moved and determining the direction of the desired movement. A first force can be applied to the tooth or set of teeth to provide movement in the determined direction, wherein the first force is applied on a first side of the center of resistance of the tooth or teeth to be moved. A second force can be applied to the tooth or set of teeth to provide movement in the desired direction, wherein the second force is applied on a second side of the center of resistance of the tooth or teeth to be moved. A combination of the first and second applied forces causes movement of the one or more teeth in the mouth of the subject. 
     Another example method of moving one or more teeth in the mouth of a subject includes coupling a first base to the lingual portion of a first tooth, coupling a second base to the lingual portion of a second tooth, and coupling the bases together with a connector to from an integral unit such that movement of the unit encourages movement of the teeth coupled to the bases of the unit as a set within the mouth of the subject. The first and second bases can be selected based on attributes of the subject. In some implementations, the connector can be bent to adjust the relative orientation of the bases prior to coupling at least one of the two bases to the subject&#39;s teeth. 
     The details of these and other aspects and implementations of the disclosure are set forth in the accompanying drawings and the description below. Features of the various implementations will be apparent from the description and drawings. 
    
    
     
       DESCRIPTION OF DRAWINGS 
         FIG. 1A  is a schematic illustration of a first side of an example orthodontic splint device. 
         FIG. 1B  is a schematic illustration of a second side of the orthodontic splint device illustrated in  FIG. 1A . 
         FIG. 2  is a schematic illustration of an example orthodontic splint device. 
         FIG. 3  is a block flow diagram illustrating an example process for using the orthodontic splint device. 
         FIG. 4  is a schematic illustration of an example orthodontic splint device during use. 
         FIG. 5  is a schematic illustration of an example orthodontic splint device during use. 
         FIG. 6  is a schematic illustration of an example orthodontic splint device during use. 
         FIG. 7  is a schematic illustration of an example orthodontic splint device during use. 
         FIG. 8  is a schematic illustration of an example orthodontic splint device during use. 
         FIG. 9  is a schematic illustration of an example bracket. 
         FIG. 10  is a schematic illustration of an example bracket. 
         FIG. 11  is a schematic illustration of an example attachment member. 
         FIG. 12  is a schematic illustration of a portion of an example attachment member. 
         FIG. 13  is a schematic illustration of an example use of the attachment member illustrated in  FIG. 12 . 
         FIG. 14A  is a schematic illustration of a perspective view of an example orthodontic splint device during use. 
         FIG. 14B  is a schematic illustration of a bottom view of an example orthodontic splint device during use. 
         FIG. 15  is a schematic illustration of an example attachment member. 
         FIG. 16  is a schematic illustration of an example use of the attachment member illustrated in  FIG. 15 . 
         FIG. 17  is a schematic illustration of an example attachment member. 
         FIG. 18  is a schematic illustration of an example use of the attachment member illustrated in  FIG. 17 . 
         FIG. 19  is a schematic illustration of an example use of an attachment member. 
         FIG. 20  is a schematic illustration of an example use of the attachment member illustrated in  FIG. 19 . 
         FIG. 21  is a schematic illustration of an example orthodontic splint device. 
         FIG. 22  is a schematic illustration of an example orthodontic splint device in use. 
         FIG. 23  is a schematic illustration of a side view of the orthodontic splint device illustrated in  FIG. 22 . 
         FIG. 24  is a schematic illustration of example bases. 
         FIG. 25  is a schematic illustration of a portion of an example orthodontic splint device in use. 
         FIG. 26A  is a schematic illustration of an example fixation bar. 
         FIG. 26B  is a schematic illustration of a cross-sectional view of the example fixation bar illustrated in  FIG. 26A . 
         FIG. 27A  is a schematic illustration of a portion of an orthodontic splint device in use. 
         FIG. 27B  is a schematic illustration of a portion of an orthodontic splint device with attachment members in use. 
         FIGS. 28A-B  are schematic illustrations of portions of an example orthodontic splint device in use. 
         FIGS. 29A-C  are schematic illustrations of portions of example orthodontic splint devices with coupling members. 
         FIGS. 30A-B  are schematic illustrations of portions of an example orthodontic splint device. 
         FIGS. 31A-B  are schematic illustrations of example locking mechanisms for an orthodontic splint device. 
         FIGS. 32A-C  are schematic illustrations of an example attachment member and tooth moving system. 
     
    
    
     Like reference symbols in the various drawings indicate like elements. 
     DETAILED DESCRIPTION 
     Orthodontic splint devices may include one or more bases and connectors, which couple the bases together. The orthodontic splint device may be a single unit or several pieces coupled (e.g., welded, bonded, adhered, etc.) together. The orthodontic splint device may be used to couple a segment (also referred to herein as a set) of teeth (e.g., two or more teeth) together. The orthodontic splint device may then be used to hold and/or move the segment of teeth, individually or collectively. For example, when malocclusions are corrected, one or more segments of teeth are moved, each as a unit. The orthodontic splint device may be used with and without the aid of fixed anchorage devices (e.g., miniscrew implants, dental implants, onplants, titanium plates, etc). 
       FIG. 1A  illustrates a first side of an example orthodontic splint device  100 . As illustrated, the orthodontic splint device  100  may be used to couple four teeth as a set. A set of teeth is also referred to herein as a segment of teeth and the two terms are used interchangeably throughout. The orthodontic splint device  100  includes bases  110   a ,  110   b ,  110   c , and  110   d . The bases may be various shapes and/or sizes. In some implementations, the shape and/or size of a base  110  may be at least partially based on the tooth that the base is configured to couple to during use. For example, the bases  110   a  and  110   b  may be configured to couple to molars during use and the bases  110   c  and  110   d  may be configured to couple to premolars. As another example, base  110   a  may be configured to couple to a molar, bases  110   b  and  110   c  may be configured to couple to premolars, and base  110   d  may be configured to couple to a canine. Each base can be coupled to a portion of a subject&#39;s tooth. For example, each base can be coupled to a lingual portion of a subject&#39;s tooth. Each base can also be coupled to a buccal portion of a subject&#39;s tooth. Each base can be coupled to a portion of a subject&#39;s tooth using, for example, bonding agents, cements, glues, screws, wire, and the like. 
     A connector  120  may couple at least two bases  110  together to form an integral unit. The connector may be at least partially rigid such that the segment of teeth coupled by the orthodontic splint device  100  may be moved and/or held as a segment (e.g., the force applied to the teeth does not substantially deform the connectors). Thus, at least one connector  120  is configured to couple two or more bases together to form an integral unit such that movement of the unit encourages movement of teeth coupled to the bases of the unit as a set/segment within the mouth of the subject. The connector can be more rigid than standard orthodontic wire. For example, the connector may have a larger cross section than standard orthodontic wire. In one implementation, for instance, the dimensions of the connector can be about 0.020 inches wide by 0.040 inches in height. In another example implementation, the dimensions of the connector can be about 0.024 inches wide by 0.040 inches in height. In these examples, the widest portion is in the vertical (height) dimension, which enhances the ability to bend the connector in the horizontal as desired. For example, the connector can be bent to contour the lingual surfaces of the teeth and to be coupled to a plurality of bases. 
     The connector may be flexible (e.g., at least partially formed of flexible material) and/or deformable (e.g., at least partially formed of a deformable material or at least partially formed of a malleable material such as stainless steel) such that the connector may be deformed for various applications. For example, the connector can be bent to adjust the orientation of the bases relative to each other. Optionally, a connector  120  may be bent about the x-axis  130  and/or y-axis  140 . As another example, a user may bend a connector about an axis perpendicular to the x-axis  130  and/or y-axis  140  (e.g., z-axis, towards a tooth when positioned in a patient&#39;s mouth). In some implementations, a connector may be deformable in one or more axes and inhibit deformation along one or more other axis (e.g., the connector may inhibit deformation when subject to specified forces, such as forces typically encountered when moving teeth). 
     Allowing a connector to be flexible and/or deformable may allow a user to position the orthodontic splint device in patients with a plurality of different attributes (e.g., sizes of teeth, positions of teeth within a mouth, etc.). For example, if a base in an orthodontic splint device does not contact (e.g., directly or indirectly) a tooth during placement of the device in a patient, one or more connectors proximate the base may be deformed and/or adjusted such that the base contacts the tooth. As another example, if a center point of a tooth, to which a base is to be coupled, lies lower than teeth proximate the tooth, one or more of the connectors proximate the base may be adjusted so that the base is disposed on the tooth. 
     In some implementations, the size of the bases, the connectors, and/or orthodontic splint device may be based on norms or averages for teeth among a population or portion of the population (e.g., humans, people residing in a geographic region, people of a certain age, ethnicity, etc.). As an example, a base for a molar may be approximately 9-10 mm. As another example, a device may be from approximately 18-30 mm. 
     The various components (e.g., bases, connectors, attachment members, etc.) of the orthodontic splint device may include metal such as titanium, metal alloys such as stainless steel, polymers, plastics such as acrylics, various other materials suitable for use in humans and/or animals, and/or combinations thereof. The various components of the orthodontic splint device may include the same materials and/or different materials. The orthodontic splint device and/or portions thereof may be formed by casting, injection molding, welding, bonding, etc. The orthodontic splint device may be formed as a single unit and/or one or more components of the orthodontic splint device may be formed separately. In some implementations, when the bases, connectors, and/or attachment members are formed separately, the components may be welded or otherwise coupled to form the orthodontic splint device. In some aspects, the bases can be selectively attached or removed from one or more connector. Thus, the bases can be coupled to the connector and can optionally be removed from the connector. 
     The device and/or various components may be configured to facilitate cleaning. For example, the device and/or components may include smooth surfaces that may facilitate cleaning. In addition, the device and/or components may include rounded edges to facilitate cleaning. In addition, edge(s) or portions of the edge(s) of the base may be chiseled or beveled to facilitate cleaning. 
       FIG. 1B  illustrates a second side of the orthodontic splint device  100  illustrated in  FIG. 1A . The second side illustrated is opposite to the first side illustrated in  FIG. 1A . As illustrated, the device includes bases  110  coupled with connectors  120 . The base  110  may include a coating  180 , such as a bonding base, or chemical coating that facilitates coupling and/or increases and/or promotes the adhesion of the base to a tooth. The base may include a texture or mesh that may facilitate coupling of the device with the teeth. The base may include a coupling agent such as glue, bond, etc. 
     Although the device in  FIGS. 1A and 1B  illustrate implementations, various other implementations may be utilized. For example, although the orthodontic splint device  100  is illustrated as including four bases to couple four teeth as a segment, the orthodontic splint device may include any number of bases. In addition, a base  110  may be configured to couple to one or more teeth, during use. Furthermore, although the base shapes have been described as corresponding to a specific tooth, a base shape may be used to couple to more than one type of tooth (e.g., incisor and molar) and/or a base shape may be used to couple to a different tooth than illustrated. For example, base  110   a  may be used to couple to premolars or incisors. As another example, base  110   d  may be used to couple to a molar. In addition, the device  100  may not include a coating or texture to facilitate coupling of the device. The device may be coupled to a portion of the patient&#39;s mouth using a composite resin (e.g., a mesh that mechanically retains the base to the resin and the tooth) and/or using an adhesive that chemically bonds with the composite resin to enhance adherence. 
       FIG. 2  illustrates an example orthodontic splint device  200 . As illustrated, the orthodontic splint device  200  may include various attachment members. The attachment members may be coupled to a base  210  and/or connector  220 . The attachment members may include hooks  230 , buttons  240 , horizontal conduit and/or sheath  250 , vertical conduit and/or sheath  260 , apertures  270  (e.g., eyelets), wings or cleats  280 , and/or extension arms  290  that may include hooks  295 , wires, elastic chain, rubberized connector, rubber bands, and/or any other appropriate member for coupling the device (e.g., to a portion of a patient&#39;s mouth, to a patient&#39;s gums, to another device, etc.). Hooks may be coupled directly or indirectly to specified locations, such as fixed anchorage devices (e.g., mini screws, dental implants, titanium plates, etc.). For example, a hook may be coupled to an anchorage device and exert a force on the device in the direction of the anchorage device. Buttons may also be coupled to specified locations through use of, for example, elasticized bands. For example, a rubber band may couple a button to an anchorage device and/or other orthodontic item (e.g., bracket, orthodontic splint device, hook, etc.). Wires may be positioned at least partially in conduits and/or sheaths. The conduits and/or sheaths may retain (e.g., frictionally, using adhesive, etc.) a wire positioned at least partially in the conduit and/or sheath. In some implementations, a wire may be configured such that it is at least partially retained in the conduit and/or sheath. Conduits and sheaths are structures that have a first aperture, a second aperture, and that define a lumen between the first and second aperture. For example, an conduit or sheath can comprise a tubular structure. 
     Vertical conduits and/or sheaths may be used as guides (e.g., to direct movement across the axis parallel to the axis through the lumen of the conduit), to couple other teeth to the device, and/or to apply a force to the device. Horizontal conduits and/or sheaths may be used to apply forces to the device, couple other teeth to the device, and/or couple the device to other orthodontic items. A wire may be threaded through an aperture to couple the base to a specified point. A knot in the wire, an adhesive, and/or a weld may retain the wire in the aperture. A wire may be coupled to a specified position at or proximate a first end and disposed at least partially through the wing or cleat at or proximate the second end. A tension may be created in the wire by applying a force to the wire (e.g., pulling the wire) and then coupling the wire to a second specified position (e.g., the wing or cleat, a portion of the base, etc.). 
     In some implementations, a device  200  may include a plurality of attachment members. A user may utilize one or more of the attachment members during use in a patient. In some implementations, a user may utilize different attachment members during various phases of treatment of a patient. 
     In some implementations, a user may remove one or more attachment members of a device  200  based on the use of the device and/or patient attributes. For example, a user may cut off attachment members that may not be used during treatment of a patient. 
     In some implementations, a user may add one or more attachment members to a device based on the use of the device and/or patient attributes (e.g., missing teeth). For example, a user may couple (e.g., weld, adhere, bond) the attachment member to the device as desired. 
     Although the device in  FIG. 2  illustrates an implementation, various other implementations may be utilized. For example, although the device illustrated in  FIG. 2  includes a plurality of attachment members, the device may include none, one, or more attachment members. The device may also include more than one of the same type of attachment member. For example, a device may include two hooks and a conduit and sheath. The hooks may be used to move and/or retain the segment of teeth at various parts of the treatment of the patient and/or the sheath may be used to retain a transpalatal bar that couples the device to another device. In addition, the orthodontic splint device may be used on both sides of the mouth after being connected using any one of the attachments (e.g., transpalatal bar, welded wire, etc.) and apply a force to both sides of the mouth. In addition, although the device is illustrated as coupled to the inner surfaces of a patient&#39;s teeth, the device may be coupled to any part of a patient&#39;s teeth and/or gums and/or to other orthodontic items as desired. As another example, a device may include a horizontal tube and/or a horizontal sheath. 
     In various implementations, the orthodontic splint device may be a part of a kit. The kit may include a set of orthodontic splint devices. The set may include orthodontic splint devices in a range of sizes (e.g., common sizes used, normals in a population, etc.). For example, the set may include orthodontic splint devices in a range of sizes that correspond to normal patient&#39;s teeth sizes. The set may include orthodontic splint devices in a specified size and varied attachment member combinations. 
     Thus, rather than creating a custom orthodontic device for each patient or for each stage of treatment of a patient, an orthodontic splint device may be selected from the set of orthodontic splint devices. The selected orthodontic splint device may then be altered to better fit the patient and/or treatment. For example, connectors may be deformed such that each base on the orthodontic splint device at least partially contacts (directly or indirectly, such as through an adhesive) a surface of the tooth. As another example, a base shape may be altered if the selected orthodontic splint device includes a base larger than the patient&#39;s tooth. By utilizing ready-made or pre-made orthodontic splint devices, a user may reduce costs and decrease delay times in treating patients. In addition, positioning time may be reduced since users may not be required to customize every part of the orthodontic item. In addition, positioning of orthodontic splint devices in patients may be facilitated since the orthodontic splint devices used among patients will be similar and the user may gain familiarity and speed with the techniques used. Furthermore, overhead costs may be decreased since an orthodontic splint device may fit patients with different patient attributes. 
       FIG. 3 . illustrates an example process  300  for using an orthodontic splint device. Patient attributes may be determined (operation  310 ). For example, a user may measure a patient&#39;s teeth, spaces between a patient&#39;s teeth, the distance of a tooth from a desired position, etc. In some implementations, a user may determine patient attributes from an image (e.g., photograph, x-ray, etc.), mold (e.g., of at least a portion of the patient&#39;s mouth), or patient records. Patient attributes may be any information useful in fitting an orthodontic splint device to a patient, in determining treatment of a patient, etc. 
     An orthodontic splint device, for use in the patient, may be identified based on at least a portion of the patient&#39;s attributes (operation  320 ). For example, a set of orthodontic splint devices may be available and a specific device may be selected from among the set. The set of orthodontic splint devices may include a range of sizes of the device. The orthodontic splint devices in the set may be based on one or more patient attributes (e.g., age, gender, geographic region, treatment). For example, a set of juvenile orthodontic splint devices may include orthodontic splint devices with sizes typical in juvenile patients and/or base shapes common in treatment of patients. As another example, a set of orthodontic splint devices may include orthodontic splint devices in a range of sizes for a specific application, such as treating openbites. As another example, a set of orthodontic splint devices may include orthodontic splint devices with specified attachment members in a range of sizes. As another example, a set of orthodontic splint devices may include orthodontic splint devices in a specified size with varied attachment members. 
     The orthodontic splint devices in the set may include or more indicia such as color or markers that designate patient attributes, such as size. For example, orthodontic splint devices in a set may include a color marker that indicates relative size. As another example, a marker in a specified shape may distinguish juvenile from adult sets. 
     A determination may be made whether the device identified should be modified (operation  330 ). For example, the identified device specifications (e.g., size, shapes, and attachment members) may be compared to the patient attributes. 
     If the device should be modified, the device may be modified (operation  340 ). For example, connectors and/or bases may be deformed. A base may be coupled and/or removed from the device. A base may be altered (e.g., portions removed to reshape the base and/or reduce the size of a base that is too large). Attachment members may be removed and/or coupled to the device. 
     The device may then be disposed in the patient (operation  350 ). If the device should not be modified the device may be disposed in the patient (operation  350 ) without modifications. 
     Process  300  may be implemented using device  100  or similar devices. In addition, various operations may be added, deleted, modified, or reordered in process  300 . For example, the device may be at least partially coupled to a patient and then the device may be modified. 
       FIG. 4  illustrates an example orthodontic splint device  400  during use. As illustrated, the device  400  is disposed in a mouth of a patient. The bases  410  are coupled to the teeth of the patient and the bases  410  are coupled together using the connectors  420 . The device includes an extension arm with a hook  430 . During use, the hook of the extension arm  430  may be coupled (e.g., removably or fixed) to a fixed anchorage device  450  coupled to the patient. The force  460  exerted by the coupling of the extension arm  430  and the fixed anchorage device  450  creates a force to act on the segment of teeth through the orthodontic splint device. The created force may move the segment of teeth and/or hold the segment of teeth at a specified position. 
     The device may also include an aperture  440 . A wire through the aperture  440  may be used to couple the device to the anchorage device  450  and/or other orthodontic items (e.g., another orthodontic splint device, brackets, retainers, etc.). 
       FIG. 5  illustrates an example orthodontic splint device  500  during use. As illustrated, the device  500  includes four bases  510  coupled together using connectors  520 . The device includes a hook  530  and a button  540 . The hook  530  may be coupled directly and/or indirectly (e.g., using an elasticized band, thread, coil spring, etc.) to the anchorage device  550 . An elasticized band (not shown) may couple the button to the anchorage device  550 . 
       FIG. 6  illustrates an example orthodontic splint device  600  during use. As illustrated, the orthodontic splint device  600  includes bases  610  coupled to each other using connectors  620 . The orthodontic splint device  600  includes a horizontal conduit  630  and sheath  640  on the same base. A wire in a first position  650   a  may be coupled to the anchorage device  660  and then move to a second position, as indicated by the wire in the second position  650   b , to be disposed at least partially in the sheath. The wire in the second position  650   b  will exert a force on the sheath, and thus the device, towards the first position. 
       FIG. 7  illustrates an example orthodontic splint device  700  during use. The orthodontic splint device  700  includes bases  710  coupled together using connectors  720 . The orthodontic splint device  700  includes attachment members such as a horizontal conduit  730  and sheath  740 , and hooks  750 ,  760 . The hooks  750 ,  760  may be coupled directly or indirectly to the anchorage device  770 . In some implementations, the hooks  750 ,  760  may be coupled to the anchorage device  770  at different times during treatment (e.g., to move the segment of teeth). For example, if one tooth in a segment of teeth is farther down that the other teeth, a first hook proximate this tooth may first be used to pull the tooth towards the anchorage device (e.g., the gums). Then after the tooth has moved a desired amount, the second hook may be utilized in conjunction with the first hook to move the segment of teeth towards the point of force application or anchorage device. 
     The hooks  750 ,  760  may be coupled concurrently to the anchorage device  770  (e.g., to retain or inhibit movement of the segment of teeth). Whether the segment of teeth moves or is inhibited from moving may depend on the forces  755 ,  765  exerted by the coupling of the hooks  750 ,  760  and the anchorage device  770 . For example, if the forces are approximately equivalent, movement of the segment of teeth may be inhibited. As another example, if the force  755  is greater than the force  765 , then an overall force towards hook  760  may be exerted on the segment of teeth. Hooks proximate opposite ends of the orthodontic splint device may be used concurrently to pull teeth into the gums. 
     The sheath  740  may be configured to retain a wire or transpalatal bar  735  or a portion of a wire or transpalatal bar. A wire or transpalatal bar  735  may couple orthodontic splint devices disposed on opposite sides of a patient&#39;s mouth as one unit. Thus, the coupled orthodontic splint devices may be moved as a unit and/or retained (e.g., movement may be inhibited) in a position as a unit. As another example, a wire positioned in the sheath  740  may be coupled to the anchorage device  770 . The wire may then be used to apply a force in the direction of the anchorage device to the orthodontic splint device. In addition, two separate splints can be connected to each other using an extension (e.g. wire, transpalatal bar, etc) that is inserted in or coupled to (e.g., inserted, welded, casted, or soldered) the sheath or any other attachment member to create a larger unit of teeth. This technique may be implemented on the same side of the mouth, or on opposite sides of the mouth to move teeth simultaneously on both sides. 
       FIG. 8  illustrates an orthodontic splint device  800 , in use, that includes bases  810  coupled using connectors  820 . As illustrated, one of the bases  810  includes a horizontal conduit  830  and sheath  840  as attachment members. A wire  835  may be at least partially disposed and/or retained (e.g., frictionally, bonded, etc.) in the conduit  830 . The wire may couple a proximate tooth  860  to the base  810  with the horizontal conduit  830  and sheath  840 . Thus, if a tooth was not previously coupled to a segment of teeth (e.g., a base of the device was not coupled to the tooth, the tooth had not fully erupted from the gums, a position of the tooth made coupling previously difficult), it may be coupled to the segment using the wire  835 . Thus any force exerted on the device to move the teeth will likewise be exerted on the tooth  860  such that the tooth  860  moves and/or is retained with the segment of teeth  870 . 
     The sheath  840  may retain a transpalatal wire  845  to couple the device to another orthodontic item and/or to retain a wire to couple the device to an anchorage device  850 . Utilizing a base with both a conduit and a sheath may allow greater flexibility in use. Although the base is illustrated with a horizontal conduit and sheath, the base may additionally or alternatively include a vertical conduit and sheath. 
     In some implementations, a bracket may be utilized to, for example, move and/or retain a single tooth and/or for any orthodontic purpose (e.g., in addition to a stainless steel ring).  FIG. 9  illustrates an example bracket  900 . The bracket  900  includes a base  910 . The base includes an attachment member  920  that includes a sheath  930  and a conduit  940  disposed on the base. The sheath and conduit may each be horizontal and/or vertical.  FIG. 10  illustrates an example of a bracket  1000  that includes a base  1010  with a vertical conduit  1020  and sheath  1030 . The bracket  1000  also includes other attachment members, such as an extension arm  1040  and a wing or cleat  1050 . 
     The bracket may be coupled to a tooth in a patient&#39;s mouth. The bracket may then be coupled to, for example, an anchorage device to move and/or retain a position of a tooth. In addition, the bracket may be used as a part of braces and/or welded to a stainless steel ring for use in various orthodontic purposes. 
     Various orthodontic devices (e.g. attachment members) may be utilized in conjunction with the above described systems, processes, and apparatuses.  FIG. 11  illustrates an example attachment member  1100 . The attachment member comprises a pair of peripheral members  1110   a  and  1110   b . In one aspect, each peripheral member can have a frontal and a dorsal portion with a longitudinal axis running therebetween. A first peripheral member of the pair can be configured to be medial to the lingual side of a first tooth or set of teeth and the second peripheral member of the pair can be configured to be medial to the lingual side of a second tooth or set of teeth on the opposite side of the midline saggital plane of the subject&#39;s mouth. The attachment member also comprises a transpalatal member  1150 . The transpalatal member can be fixed to one or more peripheral member and can span a subject&#39;s hard palate across the saggital midline plane of the subject&#39;s mouth. The attachment member may be used to apply a force to segments of teeth on opposing sides of a patient&#39;s palate and/or apply a force to a first segment of teeth and inhibit movement of a segment of teeth on an opposing side of a patient&#39;s palate. For example, rather than utilizing a headgear that wraps around an exterior of a patient&#39;s head, the attachment member may be used to exert a force on two segments of teeth on opposing sides from inside the patient&#39;s mouth. 
     The attachment member  1100 , as illustrated, includes two peripheral members  1110   a ,  1110   b  and a transpalatal member  1150 . An end  1120   a ,  1120   b  of a peripheral member  1110   a ,  1110   b  may be rounded. The peripheral member  1110   a ,  1110   b  may also include a stop  1130   a ,  1130   b . The stop  1130   a ,  1130   b  may be a portion of the peripheral member  1110   a ,  1110   b  that has a larger cross-sectional area than an adjacent portion of the peripheral member. The peripheral member  1110   a ,  1110   b  may be tapered and the stop  1130   a ,  1130   b  may be wider portion of the tapered peripheral member. As another example, the stop  1130   a ,  1130   b  may be a protrusion coupled to the peripheral member  1110   a ,  1110   b . In one non-limiting example, the transpalatal member has a cross sectional dimension of about 0.036 inches or larger and each peripheral member has a cross sectional dimension of about 0.055 inches to about 0.072 inches. 
     The peripheral members  1110   a ,  1110   b  and/or the transpalatal member may include a coupling member  1140   a ,  1140   b  that couples a peripheral member to a transpalatal member. For example, the coupling member may be a screw positioned in one or more apertures in the peripheral member and/or transpalatal member. As another example, the coupling member may any other appropriate fitting for coupling the members, such as welding material, etc. 
     The transpalatal member  1150  may include a curved section  1160 . The curved section may be “U” shaped, as illustrated, or otherwise curved (e.g., “W” shaped, “V” shaped, “C” shaped, etc.). The curved section  1160  of the transpalatal member  1150  may facilitate customization of the attachment member for a patient (e.g., the transpalatal member may be altered to improve fit in a specified patient). For example, the illustrated “U” may be compressed to shorten the length of the transpalatal member. As another example, the “U” may be expanded and/or straightened to increase the length of the transpalatal bar. In one aspect, the transpalatal member comprises one or more curved sections. A first curved section can be substantially planar with the hard palate of a subject&#39;s mouth. A second curved section can be on a plane that is angled in the direction of the saggital midline plane of the subject&#39;s mouth relative to the curved section that is substantially planar with the hard palate. 
     The transpalatal member may be formed of a material, such as stainless steel, that is at least partially rigid (e.g., to allow the transpalatal member to exert a force on the peripheral member), but at least partially deformable to allow customization of the transpalatal member. In some implementations, at least a portion of the transpalatal member may have a curvature similar to the curvature of a palate. For example, the curvature of at least a portion of the transpalatal member may be similar to an average palate of a person with specified attribute(s) (e.g., gender, age, ethnicity, etc.). 
     As illustrated, the transpalatal member  1150  may have a cross-sectional area that is less than the cross-sectional area of a peripheral member  1110   a ,  1110   b . For example, the transpalatal member  1150  may include a smaller diameter wire than a peripheral members  1110   a ,  1110   b . Using a thicker dimensioned peripheral member (e.g., a thicker wire) may allow one or both peripheral members to be slip-fitted (e.g., frictionally retained) with a conduit disposed on a bracket. Utilizing a slip-fit between a peripheral member and the conduit may facilitate guiding the direction of the movement of the device and/or segment of teeth. 
     In some implementations, one or both peripheral members can be sized to slide into and through the lumen of a sheath on a base or bracket. One or both peripheral members may be at least partially disposed in a spring  1200  such that at least a portion of the spring contacts the stop of a peripheral member during use. An example spring  1200  is shown in  FIG. 12 . The spring may be compressed during use such that a force is applied to a peripheral member and any orthodontic devices (e.g., orthodontic splint, brackets, etc.) slidably coupled, directly or indirectly, to the peripheral member. Although the attachment member  1100  is described above for use with a spring, other devices that are capable of exerting a force on the attachment member may be used. For example, an elasticized band or other at least partially elastic device may be used with the attachment member. 
     The attachment member  1100  may be used with the various orthodontic splints and/or bracket described and/or with other orthodontic splints and/or brackets. For example, a peripheral member of the attachment member  1100  may be at least partially disposed in a sheath disposed on an orthodontic splint. A peripheral member may be at least partially retained by the sheath such that a force applied on the peripheral member is also at least partially applied to the sheath and thus the segment of teeth. As another example, the attachment member  1100  may be used with other brackets or orthodontic splints. The attachment member may have two diameters along the length of the attachment member (e.g., the peripheral member may have a first diameter and the transpalatal member may have a second diameter). The attachment member may, in some implementations, have two ranges of diameters along a length of the attachment member. For example, a diameter of a peripheral member may taper from a first diameter to a second diameter within a first range of diameters and a diameter of the transpalatal member may taper from a third diameter to a fourth diameter within a second range of diameters. The first range of diameters and the second range of diameters may overlap, partially overlap, be continuous, and/or not overlap. In some implementations, the attachment member may taper from a peripheral member to the transpalatal member. The dimensions of the attachment member  1100  may facilitate retention of a peripheral member in the sheath (e.g., the diameter allows the peripheral member to be frictionally retained). 
       FIG. 13  illustrates an example use of an attachment member  1300 . An orthodontic device such as a bracket  1305  may be coupled to a tooth  1315 . The bracket may include a horizontal conduit with a chiseled end  1310 . The end of the horizontal conduit may be chiseled to improve patient comfort during use. An attachment member  1300  may be disposed at least partially in the bracket  1305 . As illustrated, a peripheral member  1320  is at least partially disposed in the horizontal sheath of the bracket  1305 . The peripheral member  1320  may also be at least partially disposed in an aperture of a spring  1325 . A portion of the spring  1325  may contact the stop  1330  of the peripheral member  1320  when force is applied to the tooth  1315 . A portion of the spring  1325  may contact the horizontal sheath of the bracket  1305  during use. The stop  1330  may inhibit the spring from being disposed about the transpalatal member  1335  of the attachment member. During use, the attachment member  1300  may be modified to improve the fit of the attachment member in the palate  1350  of the patient. For example, the curved section  1340  of the transpalatal member  1335  may be compressed and/or further curved to decrease the length of the transpalatal member. The transpalatal member may also be coupled, directly or indirectly, to an anchorage device. The anchorage device may be coupled to a bone in the palate  1350  of the patient and apply a force  1370  to the transpalatal member. The force may compress the spring  1325 , which causes the spring to apply a force to the horizontal sheath of the orthodontic device  1305 , which exerts a force on the tooth  1315 . A peripheral member may act as a guide and the force may be applied to the tooth, through the orthodontic device, in the same direction as the longitudinal axis  1380  of the peripheral member. As the tooth moves  1315 , the peripheral member  1320  may move in the opposite direction of the force since the spring will exert less pressure on the orthodontic device  1305  as the tooth moves. 
     The attachment member may be utilized with various stages of treatment and/or can be modified for use during various stages of treatment. As the force applied to the attachment member decreases, due to the movement of teeth, the transpalatal member may be coupled to a new anchorage device or using a more rigid elastic band to increase the force applied to the teeth. If a section of teeth has moved to a specified location, the coupling of the transpalatal member may be altered so that the teeth are now inhibited from moving. 
     Although the system in  FIG. 13  illustrates a specific implementation, various other implementations may be utilized. For example, the orthodontic device utilized in conjunction with the attachment member  1300  may be any orthodontic device, such as the orthodontic devices described above.  FIGS. 14A-B  also illustrate a perspective view and a bottom view of an orthodontic splint with which the attachment member may be used. As illustrated, the orthodontic splint  1400  may include bases  1410  that are coupled to teeth  1430 . The orthodontic splint  1400  may include a horizontal sheath or conduit  1420  in which the attachment member may be at least partially disposed. An anchorage device  1450  may also be used to apply a force to the orthodontic splint  1400 , through the attachment member. In addition, other attachment members may be coupled to the orthodontic device and apply additional forces to various teeth and/or inhibit movement of a tooth or teeth. 
       FIG. 15  illustrates an example attachment device  1500 . The attachment member may be utilized to exert a force on a segment of teeth on a side of a patient&#39;s mouth, for example. The attachment member  1500  includes a peripheral member  1510  and a second member  1550 . The second member can include a bar that extends at least partially across the palate. The peripheral member  1510  and/or the second member  1550  may have similar cross-sectional areas (e.g., diameters). For example, the peripheral member and the second member may have diameters of approximately 0.070-0.075 inches. In some implementations the peripheral member  1510  may have a cross-sectional area that is less than the cross-sectional area of the second member  1550 . For example, the peripheral member may have a diameter less than approximately 0.075 inches and the second member may have a diameter greater than 0.075 inches. When the second member  1550  has a larger cross-sectional area than the peripheral member  1510 , the rigidity of the second member may be increased. 
     The peripheral member  1510  may include a rounded end  1520  and a stop  1530 . The stop  1530  may be a portion of the peripheral member that has a greater cross-sectional area than the peripheral member. The peripheral member may be coupled (e.g., affixed, welded, glued, screwed, etc.) to the second member  1550  at an attachment point  1560 . 
     The second member  1550  may include recesses  1570  (e.g., notches) and/or a tapered (e.g., chiseled) end  1580 . The tapered end  1580  may increase patient comfort compared to a non-tapered end. The recesses  1570  may couple to anchorage devices during use (e.g., directly or indirectly). For example, during use an anchorage device may be at least partially disposed and retained in a recess  1570  of the attachment member  1500 . By disposing the anchorage device in the recess, a force may be exerted on the second member  1550  which is translated to the peripheral member  1560  and spring  1540 . The force exerted on the spring may be applied to a bracket to move teeth attached to the bracket. 
     Although the system in  FIG. 15  illustrates a specific implementation, various other implementations may be utilized. For example, the stop  1530  may a protrusion or recess on the peripheral member. As another example, the second member may include protrusions and anchorage devices may be disposed between two protrusions to apply forces during use. As another example, at least a portion of the surface recess may have a similar shape to a portion of an exterior surface of an anchorage device. As another example, the peripheral member may have a smooth portion that improves sliding. Allowing the peripheral member to slide when disposed in a portion of the bracket may inhibit additional unintended forces from being applied to a segment of teeth (e.g., if a rough portion of the peripheral member gets caught on the bracket an additional unplanned force may be applied). 
       FIG. 16  illustrates an example of an attachment member  1600  used in a patient&#39;s mouth. A bracket  1610  may be coupled to a tooth  1605  in a patient&#39;s mouth. The attachment member may include a peripheral member  1620  at least partially disposed in an aperture of a spring  1630 . The spring may contact a surface of the stop  1640  on the attachment member  1600 . The second member  1650  may include recesses  1660  and a tapered end  1680 . The second member  1650  may be curved. The curvature of the second member may be similar to a palate of a patient and/or be adjusted to be similar to a palate of a patient. The second member  1650  may be moved such that the anchorage device  1670  is at least partially disposed in a recess  1660  of the second member. The recess selected for the anchorage device to rest in may depend on the strength and the direction of the force desired. 
     Although the system in  FIG. 16  illustrates a specific implementation, various other implementations may be utilized. For example, other attachment members may be used and/or the attachment member  1600  may be used with a different bracket or orthodontic splint. 
       FIG. 17  illustrates an example of an attachment member  1700 . The attachment member  1700  includes two peripheral members  1710  coupled to a transpalatal member  1730 . The peripheral members may be free at one end  1715  and coupled to the transpalatal member  1730  at a second end  1720 . The transpalatal member  1730  may include more than one curved section  1740 ,  1750 ,  1760 . A curved section, such as curved sections  1740  and  1750 , may be configured to receive an anchorage device. For example, the anchorage device may be at least partially disposed in the curve such that it is retained by the curve and exerts a force on the transpalatal member. A curved section, such as curved section  1760 , may be configured such that the transpalatal member may be modified (e.g., lengthened or shortened by adjusting the curvature). The use of a transpalatal member  1730  with curved sections for retaining anchorage devices and/or for modifying the size of the transpalatal member may facilitate the ease of use of the device. Another example of an attachment member is shown schematically in  FIGS. 32A-C . The attachment member includes two peripheral members  3202 . The attachment member further includes a transpalatal member  3201 . The transpalatal member  3201  can be less rigid than either peripheral member  3202 . The transpalatal member can have at least two curved section, for example, the transpalatal member can have three ( 3208 ,  3204  and  3206 ) or more curved sections. The transpalatal member can be curved to approximate the contour of the subject&#39;s hard palate and each curved section can be substantially planar with the subject&#39;s hard palate. As shown schematically in  FIG. 32B , the attachment can be coupled to at least one tooth  3212  using a splint  3210  or a bracket. As shown schematically in  FIG. 32C  the splint or bracket can be coupled to a connector  3216 . A peripheral members can be configured to slide within the lumen of a conduit or sheath  3218 . Further a spring  3214  can be positioned over a portion of at least one peripheral member. The spring  3214  can be compressed and expansion of the compressed spring can apply a force to the coupled tooth or teeth. 
       FIG. 18  illustrates an example of a use of an attachment device  1800 . A bracket  1810  may be coupled to a tooth  1815  and include a horizontal conduit configured to receive a peripheral member  1820 . The peripheral member  1820  may be at least partially disposed in the spring  1830 , which when compressed during use applies a force to the bracket  1810 . The stop  1840  on the attachment device may inhibit the spring  1830  from decompressing during use. The transpalatal member  1850  of the attachment member  1800  may include a curved portion  1860  adapted to receive an anchorage device  1870 . The curved portion  1860  may retain the anchorage device  1870  in the curved portion by contacting and retaining the anchorage device using the sides (e.g., arms of the U) of the curved portion. The curved portion may include a surface or coating configured to frictionally retain the anchorage device in the curved portion. As another example, an elastic band may retain the anchorage device in the curved portion. 
     When the anchorage device is disposed in the curved portion  1860  of the second member  1850 , a force is applied to the second member. This force causes the spring  1830  to be compressed an exert a force on the bracket  1810  which applies the force to a tooth  1815 . 
       FIG. 19  illustrates an example attachment device  1900  prior to coupling to an anchorage device  1950  and  FIG. 20  illustrates the example attachment device  1900  illustrated in  FIG. 19  coupled to an anchorage device  1950 . As illustrated in  FIG. 19 , the attachment device  1900  is coupled to a segment of teeth  1910 . The peripheral member  1920  is slip-fit into the conduit  1930 . Since the attachment device is not coupled to the anchorage device  1950 , the spring  1940  is not compressed. As illustrated in  FIG. 20 , the attachment device  1900  is coupled to the anchorage device  1950  (e.g., the transpalatal member is coupled to the anchorage device). The coupling causes the spring  1940  to be compressed. The compression of the spring  1940  exerts a force  1960  upon the conduit  1930 , which applies a force to the segment of teeth  1910 . Thus, the conduit guides the teeth in the direction of the force  1960 . 
     Although the above implementation is described in terms of two peripheral members and one transpalatal member, other implementations may include one or more peripheral members and/or one or more transpalatal members. In addition, ends of peripheral members and/or transpalatal members may be have shaped configured to increase patient comfort during use, such as rounded ends, curved ends, chiseled or angular ends, or any other appropriate shape. In some implementations, the peripheral member(s) and the transpalatal member may be a single unit. For example, a wire may be formed to create the peripheral member(s) and the transpalatal member. The wire may be uniform (e.g., a single dimension wire, the same cross-sectional area across the wire, etc.) or not uniform (e.g., dual or multi dimension wire, different cross-sectional areas and/or shapes across the wire, etc.). For example, the peripheral member may have a diameter of approximately 0.075-0.030 inches and the transpalatal member may have a cross-sectional area of approximately 0.030-0.040 inches. The cross-sectional area of the transpalatal member may be less than the cross-sectional are of the second member so that the transpalatal member may be adapted, for example, to better fit a patient&#39;s palate and so that the peripheral member is at least rigid enough to apply a force to a bracket in a palate without substantially deforming. 
     Although the above implementation is described as having a first dimension across the peripheral member and a second dimension across the transpalatal member, the attachment member includes other variations. For example, the attachment member may have a uniform cross-sectional area and/or shape (e.g., a round cross-sectional area wire of a single diameter, a square conduit, etc.). As another example, the attachment member or a portion thereof may have a tapered shape (e.g., cross-sectional area increases from a free end  1120   a  to an attached end, proximate coupling member  1140   a , of a peripheral member). As another example, the attachment member may have varying cross-sectional areas across the length of the attachment member. In addition, the peripheral members and/or transpalatal members may be hollow, partially hollow, include a solid material, and/or combinations thereof. 
     In some implementations, an orthodontic splint may include bases coupled with a single connector or fixation bar. Including bases without a connector disposed between bases to form a single unit may provide an operator with different types of flexibility with respect to use. For example, if a tooth were to fall out while the orthodontic splint was in use, and if the bases were not coupled together with connectors disposed between each base, the loose/fallen tooth and the base coupled to the tooth could be removed without having to detach bases from other teeth. 
       FIG. 21  illustrates an example of an orthodontic splint  2100  with multiple bases  2110  connected with a single connector called a fixation bar  2120 . As illustrated, bases  2110  are coupled to teeth  2130 . The bases  2110  are coupled together with a fixation bar  2120 . Although the fixation bar is illustrated as a wire, the fixation bar may have any appropriate cross-sectional area (e.g., square, triangular, oval) and/or dimensions. The fixation bar  2120  may couple the bases  2110  such that the teeth  2130  to which the bases are coupled act as a segment/set of teeth. Thus, when a force is applied to the orthodontic splint, such as by a transpalatal bar disposed in an attachment member  2140  of a base  2110 , the force is applied to the teeth  2130  such that the teeth move as a set. Moving teeth as a segment may allow an operator, such as an orthodontist, to position teeth relative to each other and then move the teeth as a segment to a desired position with respect to the palate. Allowing teeth to move as a segment may allow the operator to move the segment of teeth without readjusting tooth position relative to adjacent teeth in the segment. 
     Various implementations may include one, more, or none of the following features. The orthodontic splint may be used on the palatal surface of the upper posterior teeth. The orthodontic splint may split upper posterior teeth (e.g., premolar and molars) as a single rigid unit. Thus, a force applied to the teeth using the splint will cause the teeth to move as a segment of teeth rather than individually. The fixation bar may be altered to better fit a patient&#39;s dental position while having enough rigidity to allow the teeth to act as a segment (e.g., as opposed to individually) during use. In some implementations, the force applied to the orthodontic splint may not be affected by the flexibility of the connectors and/or force applied to the splint is approximately evenly distributed in the area of the roots of the teeth in the segment. The orthodontic splint may move teeth as a segment, as opposed to lingual or conventional braces that move teeth individually. 
     In some implementations, the bases may be made in different sizes. An operator may select the size(s) that best fit a patient&#39;s anatomy. For example, an operator may be provided with a kit that includes bases of different sizes and shapes and/or fixation bars of varying lengths. The operator may then easily customize the orthodontic splint using the kit components. The kit may decrease the time it takes to position the splint in the patient, decrease costs, and/or improve patient comfort (since the splint may be customized). 
     In contrast to acrylic alignment devices that cover all surfaces of a dental crown, such as Invisaline®, commercially available from Align Technologies (Santa Clara, Calif.) or acrylic alignment devices commercially available from AOA Laboratories (Sturtevant, Wisc.), the orthodontic alignment devices described may have many features. First, patient hygiene may be improved, because unlike acrylic alignment devices which cover all surfaces of the dental crown and are difficult to clean, the orthodontic splint may be more easily cleaned. In addition, placement may be easier than with acrylic alignment devices. When using the described orthodontic splints, the operator may customize the splint to fit the patient using a variety of sizes, such as from a kit. Thus, placement of the described orthodontic splint may be easier and/or quicker and/or creation of the orthodontic splint may be easier and quicker. In addition, since acrylic alignment device are bulky, the patient&#39;s esthetics and speech may be affected. However, the more streamlined design of the orthodontic splint device may not affect aesthetics and/or speech as adversely. Furthermore, the orthodontic splint device may not interfere with occlusions, unlike acrylic alignment devices which interfere with occlusion, since the acrylic alignment device covers all surfaces of the teeth and, thus, opposing teeth touch acrylic rather than opposing teeth. Use of a described orthodontic splint device may also decrease mastication alteration, when compared to acrylic alignment devices which alter a patient&#39;s mastication due to acrylic covering the patient&#39;s masticatory surfaces. 
     Furthermore, the described orthodontic splint may include features such as lingual and buccal brackets and/or bands that join teeth together. For example, unlike with the described orthodontic splints, buccal or lingual brackets have a greater degree of flexibility in the wire used to couple the teeth. This greater flexibility causes the teeth to have the potential to move individually rather than as a segment. In addition, the brackets are designed to hold a tooth in a position rather than move teeth as a segment. Unlike bands used to solder teeth together (e.g., a tooth is disposed in a ring of metal), the described orthodontic splints may not require a gap between the teeth. Gaps between teeth and the band may require additional movement of teeth, which increases discomfort for patients, and/or may reduce aesthetics of a patient&#39;s dental placement. In addition, since the bands are formed from molds created of the patient, use of bands may increase placement time (e.g., due to the extra step) and/or costs. Bands may also be less easily cleaned, when compared to the described orthodontic splints. 
       FIG. 22  illustrates another example of an orthodontic splint  2200  in use. As illustrated, the orthodontic splint  2200  includes bases  2210  individually coupled to teeth  2230 . A fixation bar  2220  couples the bases  2210  together. As used throughout, a fixation bar is a non-limiting example of a connector for coupling a plurality of bases. An attachment member, such as the dual-dimensioned transpalatal bar (e.g., a wire with a first dimension for the peripheral member and a second dimension for the transpalatal member), may be at least partially disposed in a sheath  2240  of a base  2210 . During use, the transpalatal bar  2250  may be coupled to a miniscrew implant  2270 , for example, and a force may be applied to a spring  2260  disposed about the transpalatal bar  2250  such that the teeth  2230  coupled to the bases  2210  are moved as a segment of teeth. As illustrated, the transpalatal bar  2250  may be coupled to both sides of the palate (e.g., via the orthodontic splints) so that two segments of teeth on opposing sides of the palate are moved as a single unit. For example, the transpalatal bar  2250  may be coupled to the miniscrews  2270 , as illustrated, and the segment of teeth  2280  may be moved as the force from the coupling of the transpalatal bar to the miniscrews is applied to the orthodontic splint device  2200 . 
       FIG. 23  illustrates a side view of the orthodontic splint device illustrated in  FIG. 22 . As illustrated the orthodontic splint device  2300  includes bases  2310  coupled to teeth  2330  and to each other through a fixation bar  2320 . As illustrated, the orthodontic splint device is designed so that a base  2310  includes a sheath  2340  as an attachment member. A transpalatal bar  2350  is disposed at least partially in the sheath  2340  and a spring  2360 . Thus, during use, the transpalatal bar  2350  is coupled to a miniscrew  2370  and the force from the coupling is applied to a spring  2360 . This force is then at least partially transferred to the bases and the segment of teeth  2380  to move the segment of teeth to a desired position and/or to maintain a desired position of the segment of teeth. The orthodontic splint may operate by applying forces at various positions relative to the segment of teeth. As illustrated Force A, applied by the coupling of the transpalatal bar  2350  to the miniscrew  2370 , is above the center of resistance (CRes) for the teeth/segment of teeth, and Force B, applied by spring  2360 , is below the center of resistance for the teeth/segment of teeth. 
     In one aspect, the transpalatal member can be configured to receive a force for movement of the teeth coupled to the base members in the direction of the applied force. The force received by the transpalatal member can be on a first side of the center of resistance of the teeth and the force exerted by the spring can be on a second side of the center of resistance of the teeth. Optionally, the first side of the center of resistance of the teeth is above the center of resistance of the teeth and the second side of the center of resistance of the teeth is below the center of resistance of the teeth. 
     Also provided is an example orthodontic device that includes a bar that extends at least partially across the palate, for example a transpalatal bar, and includes a first force application point and a second force application point. The first force application point is located on a first side of the center of resistance of a tooth to which the bar is coupled and the second point is located on a second side of the center of resistance of the tooth to which the bar is coupled. A force A can be applied to the first force application point by coupling the bar to a fixed point on the hard palate of a subject. The second force application point can be configured to apply a force for compression of a spring, wherein the spring applies a force B to the tooth in a plane on the second side of the center of resistance of the tooth. 
     In some implementations, the bar can include a peripheral portion and the first force application point can be located medial to the peripheral portion and on the first side of the center of resistance of a tooth. A base that includes a horizontal sheath  250  or a bracket with a sheath  920  can be coupled to the tooth into which the peripheral portion slidably fits to couple the bar to the tooth. A spring can be located around the peripheral portion of the bar such that application of a force to the first application point of the bar causes compression of the spring. The compressed spring can provide a force to the base or bracket, wherein the force from the compressed spring is applied along a plane on the second side of the center of resistance of the tooth. 
       FIG. 24  illustrates an example of bases  2400 . As illustrated, bases  2410   a - d  include at least two parts, a first part A that is configured to couple to a tooth, and a second part B that includes an attachment member. 
     As illustrated in  FIG. 24 , the base  2410   a - d  or at least a portion thereof, such as second part B, may include a flexible and/or deformable material (e.g., metals, plastics, etc.) such that the base may be altered to better fit a shape of a tooth. For example, a base may be altered such that a portion includes a curvature similar to a curvature of a portion of a tooth. Allowing the base to better fit a shape of a tooth may improve durability (i.e., since adhesion to the tooth may be improved) and/or comfort for a patient. The base, or portions thereof, may be provided to an operator in sets. Each set may include preconfigured shapes of a base based on a population (e.g., age, gender, ethnicity, etc.). The operator may then utilize bases from a selected set and, optionally, further modify the shape to fit the tooth of a patient. However, in some implementations, the bases may be utilized with little or insignificant modifications, which may reduce costs and decrease placement in patient time. 
     The bases may also include one, more, or no attachment member, such as hooks, tubes, sheaths, and/or any other appropriate attachment member. The attachment members may be coupled to the bases by welding and/or by casting the attachment member as a portion of the base, for example. 
     As illustrated in the portion  2500  of the orthodontic splint,  FIG. 25  shows that the fixation bar  2520 , which is an example connector, may be at least partially disposed between the base  2510  and attachment member  2530  in the orthodontal splint device  2500 , in some implementations. The fixation bar  2520  may be, in some implementations, provided in varying lengths. Thus, an operator may be able to select the desired length from a set of fixation bars for use in a patient. Reducing the need for and/or the amount of customization without significantly decreasing operability may reduce costs and/or placement in patient times. The fixation bar  2520  may be alterable so that the curvature of the fixation bar may be similar to the curvature of the teeth of a patient. For example, if a first tooth protrudes greater than an adjacent tooth, then the fixation bar may be bent so that the single fixation bar can couple to the bases on both teeth. Altering the fixation bar, rather than modifying bases to lie in the same plane so that they can be coupled by a rigid, straight wire, may increase patient comfort (e.g., since the bases and fixation bar may align more with the current contours of the teeth). The fixation bar may have rigidity such that force may be applied to the segment of teeth, during use, without substantially deforming the fixation bar while allowing an operator to alter the fixation bar. If a fixation bar lacks the required rigidity, when a force is applied to move a segment of teeth during use, the fixation bar may deform and the teeth may not be moved as a segment of teeth. For example, a fixation bar may include a wire that has width greater than 0.022 inches and height greater than 0.028 inches. 
     Fixation bars may be solid and/or hollow, for example. Fixation bars may have various features to aid coupling with a base.  FIG. 26A  illustrates an example fixation bar  2600  with a recess  2610 .  FIG. 26B  illustrates a cross-sectional view of the example fixation bar  2600  in  FIG. 26A . As illustrated the fixation bar may have a rectangular cross-sectional shape. The fixation bar  2600  may also include a recess  2610 . The recess  2610  may help retain the fixation bar in the base. For example, as illustrated in  FIG. 27A , the recess  2745  of the fixation bar  2740  may receive a portion of a base  2710 , such as a protrusion  2730 . The base may include a portion  2720  adapted to receive the fixation bar. As illustrated, the base may include an aperture formed by, for example, a c-shaped wire. The fixation bar may be disposed in and retained in the aperture. As illustrated, the base  2710  of the orthodontic splint device  2700  may also include tooth fixation members  2715 , such as protrusions, recesses, ridges, etc., that facilitate and/or strengthen the coupling between the base and tooth  2750 . An adhesive or other coupling material may be applied to the base proximate the tooth fixation members  2715  and/or the tooth  2750  and couple the base to the tooth. 
       FIG. 27B  illustrates an example orthodontic splint device  2700  similar to the orthodontic device illustrated in  FIG. 27A . As illustrated, various attachment members  2760  may be included on a base  2710 . The attachment members  2760  may be coupled to an exterior surface of the base  2710 . 
       FIGS. 28A-B  illustrate example orthodontic splint devices  2800 . As illustrated, the base  2810  may include tooth fixation members  2815 , such as protrusions. The base  2810  may also include a portion  2820  configured to retain at least a portion of the fixation bar  2850  in an aperture  2835  of the base  2810 . The base may be deformable (e.g., include a deformable material, such as a malleable material) about a point  2805  or include a hinge at a point  2805  such that the portion  2820  may be moved to increase the size of the aperture  2835 . Increasing the size of the aperture  2835  may facilitate positioning of the fixation bar  2850  in the aperture. The fixation bar  2850  may be retained in the aperture using a retaining member  2825  coupled to the base and/or a protrusion  2830  configured to be received by the fixation bar. 
     As illustrated in  FIGS. 29A-C , other coupling members may be used to retain the fixation bar in the aperture of the base of the orthodontic splint device  2900 . The coupling members may be used in conjunction with, or as an alternative, to other coupling features  2915  of the base (e.g., protrusion, retaining member, etc.). As illustrated in  FIG. 29A , a coupling member such as a screw  2930  may contact the fixation bar  2920  and, by applying pressure to the fixation bar, retain the fixation bar in the aperture of the base. As illustrated in  FIG. 29B , a screw  2930  may form a wall configured to retain the fixation bar  2920  in the aperture of the base. As illustrated in  FIG. 29C , a wire  2950  (e.g., a ligature wire), thread, or other appropriate coupling member may be used to tie the fixation bar to the base and thus retain the fixation bar in an aperture of the base. 
     In some implementations, a base  3010  of the orthodontic splint device  3000  may include a locking member  3020 . The locking member may include a different material than the base. For example, the locking member may include a metal alloy that has shape memory properties. As another example, the locking member may include a material with less resistance to deformation than the base. When in use, the locking member  3020  may be deformed to a first shape to facilitate positioning of the fixation bar  3030  in an aperture of the base  3010 . Then the locking member  3020  may be deformed to a second shape, which may be the same as the original shape or a new shape, to retain the fixation bar  3030  in the aperture of the base  3010 , as illustrated in  FIG. 30B . 
       FIGS. 31A-B  illustrate examples of locking mechanisms  3130  in orthodontic splint devices  3100 ,  3102 . As illustrated in  FIG. 31A , the locking mechanism  3130  may be a single bar that extends from the base  3110  coupled to a tooth  3140  and at least partially around the fixation bar. As illustrated in  FIG. 31B , the locking mechanism  3130  may be more than one bar that extends from the base and at least partially around the fixation bar. The locking mechanisms may apply pressure to the fixation bar to retain the fixation bar in an aperture of the base and/or form a wall to at least partially close the aperture and retain the fixation bar in the aperture of the base. 
     A number of implementations have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the implementations. Accordingly, other implementations are within the scope of this application. 
     It is to be understood the implementations are not limited to particular systems or processes described which may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular implementations only, and is not intended to be limiting. As used in this specification, the singular forms “a”, “an” and “the” include plural referents unless the content clearly indicates otherwise. Thus, for example, reference to “an attachment member” includes a combination of two or more interfaces and reference to “an adhesive” includes different types of adhesives.