Patent Publication Number: US-2016228214-A1

Title: Customized orthodontic interface attachment method and device

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a non-provisional application corresponding to the provisional application Ser. No. 62/114,715, filed Feb. 11, 2015, pending; and a continuation-in-part application of application Ser. No. 14/795,764, filed Jul. 9, 2015, pending, which is a non-provisional application corresponding to the provisional application Ser. No. 62/061,130, filed Oct. 7, 2014, now expired. The entire contents of each of these applications are fully incorporated by reference herein. 
    
    
     BACKGROUND OF THE INVENTION 
     A. Field of the Invention 
     This invention relates generally to the field of orthodontics and dentistry. More particularly, the invention relates to an interface attachment device which is customized on one side for placement on a patient&#39;s tooth surface and locked on to the bottom or base of a bracket on the other side. The combination of the interface attachment device and the bracket is bonded to the surface of a tooth for an orthodontic treatment of the patient. One or more interface attachment devices, with or without brackets, can be precisely placed and bonded to the corresponding surfaces of one or more teeth of a patient using a tooth attachment placement device created for the patient. 
     B. Description of Related Art 
     In orthodontics, a patient suffering from a malocclusion is typically treated by bonding brackets to the surface of the patient&#39;s teeth. The brackets have slots for receiving an archwire. The bracket-archwire interaction governs forces applied to the teeth and defines the desired direction of tooth movement. Typically, the bends in the wire are made manually by the orthodontist. During the course of treatment, the movement of the teeth is monitored. Corrections to the bracket position and/or wire shape are made manually by the orthodontist. 
     In conventional orthodontics, accurate placement of the brackets on the teeth is important to ensure that the tooth is moved over the course of treatment to the desired finish position. The proper location of brackets on the teeth is part of treatment planning for the patient performed by the orthodontist. Desired bracket position can be determined in a variety of ways, including mathematical calculation (see Lemchen, US patent RE 35,169 and Andreiko et al., U.S. Pat. Nos. 5,431,562 and 5,683,243), using interactive orthodontic treatment planning software (see published PCT application of OraMetrix, Inc., WO 01/80761), using wax set-ups from a model of the malocclusion, and by the orthodontist mentally visualizing the bracket placement on the tooth. 
     Once the desired bracket position is determined using any of these means, the actual placement of the bracket on the teeth can be carried out directly by bonding the bracket to the teeth, either with or without some bracket placement aids. Bracket placement aids, in the form of customized machined bracket placement jigs and thermoplastic bracket transfer trays, are known in the art. See the above-cited patents to Andreiko, Cohen et al. U.S. Pat. No. 3,738,005 and Cleary et al., U.S. Pat. No. 6,123,544. 
     The present invention provides an interface attachment device which is customized on one side for placement on a patient&#39;s tooth surface and locked on to the bottom of a bracket on the other side. The combination of the interface attachment device and the bracket is bonded to the surface of a tooth for an orthodontic treatment of the patient. One or more interface attachment devices, with or without brackets, can be precisely placed and bonded to the corresponding surfaces of one or more teeth of a patient using a tooth attachment placement device created for the patient. 
     SUMMARY OF THE INVENTION 
     In a preferred embodiment of the invention, an interface attachment device which is customized on one side for placement on a patient&#39;s tooth surface and locked on to the bottom or base of a bracket on the other side is disclosed. The combination of the interface attachment device and the bracket is bonded to the surface of a tooth for an orthodontic treatment of the patient. One or more interface attachment devices, with or without brackets, can be precisely placed and bonded to the corresponding surfaces of one or more teeth of a patient using a tooth attachment placement device created for the patient. 
     The locking mechanism between the interface attachment and the bracket can be (a) form-locked, i.e. male/female arrangement, (b) friction-locked (i.e. using spring, magnetism, shape memory phase shift, shrinkage, etc.), (c) combination of (a) and (b), or (d) any other type. 
     The interface attachment device can be bonded to the tooth surface by any kind of adhesive or composite material. 
     The interface attachment device can be manufactured using generative manufacturing technologies; computer numerically controlled (CNC) machining technologies; or other manufacturing techniques suitable for low volume, high precision, custom parts. 
     These and still other aspects of the invention will be more apparent from the following detailed discussion of presently preferred embodiments of the invention. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Presently preferred embodiments of the invention are described below in reference to the appended drawings, wherein like reference numerals refer to like elements in the various views, and in which: 
         FIG. 1  is block diagram of a system for creating a three-dimensional virtual patient model and for diagnosis and planning treatment of the patient. 
         FIG. 2  shows the in-vivo scanned digital dentition model of a patient with teeth and gingiva in the malocclusion state. 
         FIG. 3  shows the digital model of the patient in  FIG. 2  with teeth and gingiva wherein the teeth are set-up in a target state using the treatment planning instructions provided in the system of  FIG. 1 . 
         FIG. 4A  shows front view of the upper jaw and lower jaw and facial bone with modeled teeth, all obtained from the volume scan of the patient. 
         FIG. 4B  shows left bucal view of the upper jaw and lower jaw and facial bone with modeled teeth, all obtained from the volume scan of the patient. 
         FIG. 5A  shows modeling of teeth obtained from surface scanning of the dentition of a patient. While tooth crowns are displayed in the model, tooth roots and jaw bones are missing. 
         FIG. 5B  shows teeth with roots in malocclusion. The roots are obtained through scanning the patient&#39;s dentition and bones using a CBCT device and integrating the CBCT digital data with the data obtained through in-vivo scanning. 
         FIG. 6  shows patient&#39;s crowns with roots at a target stage. 
         FIG. 7  shows the digital target set-up model of the patient in  FIG. 3  with the brackets placed on the teeth. Gingiva is also present in this figure. 
         FIG. 8  shows the digital target set-up model of the patient with the brackets placed on the teeth of  FIG. 7  with a plane of reference for the brackets. Again, gingiva are also present in this figure. 
         FIG. 9  shows the digital target set-up model of the patient of  FIG. 8  with the brackets repositioned by using the plane of reference for the brackets as a guide. 
         FIG. 10  shows the patient model of  FIG. 7  with an individual bracket repositioned as shown on tooth if desired. 
         FIGS. 11A, 11B and 11C  show examples of bracket positioning on a tooth. 
         FIGS. 12A and 12B  show additional examples of bracket positioning on a tooth. 
         FIG. 13  shows the digital malocclusion model of the patient of  FIG. 2  with the brackets placed on the teeth in accordance with the bracket-positions on the teeth in the target positions per  FIG. 9 .  FIG. 13  shows the target placement of the brackets on the teeth which will be used to design the TAP device in accordance with the invention disclosed herein. 
         FIG. 14  shows the preferred embodiment of the invention, namely the design of the TAP (Tooth Attachment Placement) device created by the system described in  FIG. 1  in accordance with the placement of the brackets on the teeth as shown in  FIG. 13 . 
         FIGS. 15-19  show various applications of the TAP device as described below. 
         FIG. 15  shows a lingual TAP device. Jig is skipped in this case. 
         FIG. 16  shows a labial TAP device for a lower jaw, including jigs, splines and patient identifier. 
         FIG. 17  shows a labial TAP device for an upper jaw. 
         FIG. 18  shows a lingual TAP device placed on the physical model of a jaw. Jig for a tooth is skipped in this case since the tooth is in a rotated position so that the jig cannot be used in this state. 
         FIG. 19  shows a lingual TAP device placed on the physical model of the jaw as shown in  FIG. 18 , and additionally with a patient identification link. 
         FIGS. 20-32  show various details of the TAP device design as described below. 
         FIG. 20  shows the bracket holding geometry of the TAP device including the jig or the holder, the splines, and the bracket. 
         FIG. 21  shows another view of the bracket holding geometry of the TAP device shown in  FIG. 20  including the bracket base. 
         FIG. 22  shows stabilizing the TAP device by closing the teeth. 
         FIG. 23  shows another example of stabilizing the TAP device by closing the teeth. 
         FIG. 24  shows another example of stabilizing the TAP device by closing the teeth. 
         FIG. 25  shows a section of the TAP device showing side view of a counter shaped slot. 
         FIG. 26  shows the sane section of the TAP device of  FIG. 25 , showing front view of the counter shaped slot. 
         FIG. 27  shows a section of the TAP device showing hollow tubes. 
         FIG. 28  shows a section of the TAP device showing an example of the distance between the bracket surface and the tooth surface. 
         FIG. 29  shows a section of the TAP device showing another example that there is no distance between the bracket surface and the tooth surface. 
         FIG. 30  shows a section of the TAP device showing a snap fit. 
         FIG. 31  shows a section of the TAP device showing an example of the form-fitting elements. 
         FIG. 32  shows another embodiment of the invention showing a design of another type of TAP device based upon the brackets placed on the patient&#39;s malocclusion. 
         FIG. 33  shows design of another type of TAP device shown in  FIG. 33  with clips inserted in the clip holder. 
         FIG. 34  shows the design of the TAP device shown in  FIG. 33  with orientation plane of each bracket. 
         FIG. 35  shows a variation of the TAP device previously shown in  FIG. 32  placed on the teeth. 
         FIG. 36A  shows the components of the TAP device for a single tooth, namely cap, metal bracket holder, O-ring and bracket. 
         FIG. 36B  shows the tooth number, for which the particular jig is designed, placed on the front of the cap. 
         FIG. 37  shows configuration of the TAP device where the jigs are removed for the teeth. 
         FIGS. 38A-38H  displays the steps of the process of preparing a jig, bonding a bracket to a tooth, and subsequently removing the cap and the bracket holder. 
         FIGS. 38A and 38B  display how to position bracket holder. 
         FIG. 38C  displays how to place Jig on the tooth. 
         FIG. 38D  displays how to fix the Jig before light hardening. 
         FIGS. 38E and 38F  display how to remove cap. 
         FIG. 38G  displays how to open the bracket door. 
         FIG. 38H  displays how to remove the metal bracket holder. 
         FIG. 39  shows separated jigs designed for two specific teeth. Tooth number is engraved on the jig. 
         FIG. 40  shows a spline joining the separated two jigs shown in  FIG. 39 . 
         FIG. 41  shows a TAP device and a malocclusion model of the dentition of a patient and the brackets are bonded on a quadrant of the malocclusion model in order to determine the accuracy of the placements of the brackets. 
         FIG. 42  shows the TAP device with the brackets. 
         FIG. 43  shows the brackets bonded to the teeth. 
         FIG. 44  shows the in-vivo scanned image of the dentition after the brackets were bonded to the teeth using a customized TAP device. This image enables verification of the accuracy of the placement of the brackets on the teeth. 
         FIG. 45  shows archwire placement through the bonded brackets for verification of the accuracy of the placement of the brackets on the teeth. 
         FIG. 46  shows a jig with the bracket portion cutout. Such a jig can be placed on a patient&#39;s tooth and the cutout portion marked to see where the bracket will be attached. The marked area then can be cleaned. Also, the marked area can be used to verify the accuracy of the placement of the bracket on the tooth. 
         FIG. 47  shows an attachment different from a bracket, such as an attachment to be placed on a tooth for an aligner, placed on the jig of a TAP device. 
         FIG. 47A  shows the attachment in more detail. 
         FIG. 48  shows a cotton roll attached to the spline of the TAP device. The cotton roll will absorb the saliva of a patient when the TAP device is used to place the brackets or other attachments on the teeth of a patient. 
         FIG. 49  shows a bracket with an interface attachment. 
         FIG. 50  shows an example locking mechanism for securely attaching the interface attachment to the bracket base via a cross sectional view of the bracket and the interface attachment shown in  FIG. 49 . 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     In a preferred embodiment of the invention, an interface attachment which is customized on one side for placement on a patient&#39;s tooth surface and locked on to the bottom of a bracket on the other side is disclosed. The combination of the interface attachment and the bracket is bonded to the surface of a tooth for an orthodontic treatment of the patient. One or more interface attachments, with or without brackets, can be precisely placed and bonded to the corresponding surfaces of one or more teeth of a patient using a tooth attachment placement (TAP) device created for the patient. 
     Before describing the features of this invention in detail, an overview of the unified workstation and design and manufacturing of the TAP device will be set forth initially. The workstation provides software features that create two dimensional and/or three-dimensional virtual model of a patient on a computer, which can be used for purposes of communication, diagnosis, treatment planning and designing orthodontic devices or templates for assisting users in placing one or more appliances or attachments on one or more teeth, or other orthodontic customized appliances. 
     The essence of the unified workstation described herein is the ability to capture images from various sources that provide volumetric images, surface images that are 3-D or 2-D in nature, and may be static or dynamic, such as from CBCT, CAT, MRI, fMRI, ultrasound device, cameras that provide still photos, white light and laser based surface scanners, video cameras providing video images, tracking devices and digital cameras. Images from these sources are combined as needed to create a unified simulation model of the craniofacial and dental facial complex, for facilitating diagnosis, communication, treatment planning, and design of appliances for treating craniofacial and dento facial problems. With these images a composite structure of the face can be constructed with dynamic or static behavioral properties. One can also track function or jaw movement and simulate the functional movements, e.g., smile movement of the lower jaw etc. 
     The global positioning of the entire face with respect to its surroundings can be set by the user for planning purposes. In addition, the relative position of each of the structural elements, such as the upper jaw and its teeth when captured independently, can be oriented with respect to any other structure such as the soft tissue face by using specific anatomical land marks or user defined reference planes, either in 2-D or 3-D space. Furthermore, the relationship of the lower jaw and its accompanying teeth can be registered with respect to the upper jaw using a combination of registration techniques. For instance, the bite registration can be recorded by taking an intraoral surface scan of the teeth together and using it as a template to register the relationship of the upper jaw and the lower jaw from a CBCT volumetric scan. 
     Most importantly from volumetric data, one can extract three dimensional structural data which may include crowns and roots of teeth, bone, soft tissue, e.g., gingiva and facial soft tissue and appliances attached to any of these structures, such as orthodontic brackets, implants, etc. Each of these structural elements can be independently manipulated in three-dimensional space to construct a treatment plan, and design the appropriate device for correction of a problem. Furthermore, the interdependencies of the treatment between these various structural components can be modeled to design a holistic treatment plan. Specific relationships between the various structural components can be defined by choosing an appropriate reference plane and capturing the spatial relationships between specific structures. The treatment design may include repositioning, restoring, replacing of any of the structural elements in 2-D or 3-D space. Also function can be simulated or modeled based upon captured data to achieve the desired goals, e.g., the teeth with their roots can be appropriately positioned in the bone to withstand the stresses of jaw movement or the position of the jaw joint, i.e., the condyle is in harmony with the position of the teeth to prevent any source of dysfunction or breakdown of the structural elements. Mechanical analysis, such as finite element method, may also be used to better understand the nature of stresses and strains imposed on the structural elements to design better treatment. All changes may be measured with respect to defined planes of reference to provide numerical output to design a variety of customized treatment devices, such as orthodontic brackets, orthodontic archwires, surgical bite splints, surgical fixation plates, implants, condylar prosthesis, bone screws, periodontal stents, mouth guards, bite plates, removable orthodontic appliances, crowns, bridges, dentures, partial dentures, obturators, temporary anchorage devices from either natural or synthetic substances using printing devices, such as SLA or milling or robotic manufacturing. Any type of dental, orthodontic, restorative, prosthodontic or surgical device which may be tissue borne, dental borne, osseous borne, can be designed in combination, or singularly in serial or in parallel, e.g., indirect bonding trays that allow bonding of brackets, and are also designed to guide implant insertion. Furthermore, if the patient requires surgery, splints, fixation plates, boney screws may all be designed and manufactured simultaneously. The numerical output of the treatment plan can be used to drive navigational systems for performing any procedure. Simulations can be used to train and build skills or examine proficiency. The numerical output of the treatment design can be used to drive robots to perform surgical procedures. Furthermore this output can be used to create a solid model representation of the treatment plan using printing or milling techniques. 
     Template data or normative data stored in memory can be used to plan any of the structural changes or design of the devices. In addition, reference data from the non-affected structural elements may be used as templates to provide design parameters to plan and correct the affected side. 
     One can also replace or remove any of the structures to achieve the desired goal, e.g., extraction of teeth, root amputation, sinus lift, veneers, inter-proximal reduction, etc. The codependency of movement of one object and its effect on another can also be simulated for all three tissue types, e.g., when the tooth moves how does it affect the gum soft tissue, when the tooth moves where does the root move in reference to the bone, or how does the bone change, how does the face change when the bones move. All types of planning can be executed by different modalities or professionals in an interactive manner asynchronously or synchronously. 
     In summary, the unified workstation provides the ability to plan crowns with roots thereby optimizing the planning by changing the root position so that the crown planned is designed such that axial forces are transmitted to the roots to add to the stability of the crown minimizing aberrant forces that can lead to root fracture, crown fracture, and breakdown of the periodontium or bone. Similarly, for surgical patients one can plan root positions so that the surgeon can cut between the roots and prevent damage besides planning the movement of the bones. Similarly for implants, one can move the roots in a desirable location so that the implant when inserted doesn&#39;t damage the roots. The user can also size the implants correctly so that they don&#39;t encroach on root space. All this planning would be impossible if the roots were not made separate objects that could move. Finally one can move the roots preferentially to create bone. As one extrudes a root one can create bone. Similarly one can change the gum tissue architecture by moving roots and for orthodontic movement one can avoid moving roots where there is no bone or selectively move teeth to prevent root collision or move roots away from areas where there is lack of bone into the areas where there is bone as one plans to move them towards their final destination. Again, not only can one plan tooth movement but bone movement and soft tissue gum and face as well to achieve the goals. One can, alter the spatial position of all the objects which are extracted, change their shape form and volume to restore and or reconstruct. One can sculpt or remove selectively any region gum soft issue bone dentition. Although one can use a fusion technique, the preference is to extract the data from the CBCT for bone and dentition with roots at a minimum. One can take partial intramural scans where distortion is expected, e.g., large metal crowns or fillings, or one can scan an impression in those areas or plaster limited to the region of interest. 
     The images of the roots can be taken with CBCT and affixed to crowns taken by scanning intramural impressions or models. The preferred process does not require fusing a model of the dentition into the crank facial structure. All needed information can be captured in one shot and extract individual features. The unified workstation captures the dental and osseous and soft tissue as one and segregates them in to individual components for planning treatment. The optimization of the treatment plan can be achieved by using different approaches, e. g., correcting crowding by minimizing tooth movement and planning veneers or minimizing tooth preparation for veneer construction by positioning the teeth appropriately. This can be said for any structure and the decision can be driven by the patients need, time constraints, cost risk benefit, skill of operator, etc. 
     Many of the details and computer user interface tools which a practitioner may use in adjusting tooth position, designing appliance shape and location, managing space between teeth, and arriving at a finish tooth position using interaction with a computer storing and displaying a virtual model of teeth are set forth in the prior application Ser. No. 09/834,412 filed Apr. 13, 2001, and in published OraMetrix patent application WO 01/80761, the contents of which are incorporated by reference herein. 
     General Description 
     A unified workstation environment and computer system for diagnosis, treatment planning and delivery of therapeutics, especially adapted for treatment of craniofacial structures, is described below. In one possible example, the system is particularly useful in diagnosis and planning treatment of an orthodontic patient with other craniofacial disorders or conditions requiring surgery, prosthodontic treatment, restorative treatment, etc. 
     As depicted in  FIG. 1 , the overall system  50  includes a general-purpose computer system  10  having a processor (CPU  12 ) and a user interface  14 , including screen display  16 , mouse  18  and keyboard  20 . The system is useful for planning treatment for a patient  34 . 
     The system  50  includes a computer storage medium or memory  22  accessible to the general-purpose computer system  10 . The memory  22 , such as a hard disk memory or attached peripheral devices, stores two or more sets of digital data representing patient craniofacial image information. These sets include at least a first set of digital data  24  representing patient craniofacial image information obtained from a first imaging device and a second set of digital data  26  representing patient craniofacial image information obtained from a second image device different from the first image device. The first and second sets of data represent, at least in part, common craniofacial anatomical structures of the patient. At least one of the first and second sets of digital data normally would include data representing the external visual appearance or surface configuration of the face of the patient. 
     In a representative and non-limiting example of the data sets, the first data set  24  could be a set of two dimensional color photographs of the face and head of the patient obtained via a color digital camera  28 , and the second data set is three-dimensional image information of the patient&#39;s teeth, acquired via a suitable scanner  30 , such as a hand-held optical 3D scanner, or other type of scanner. The memory  22  may also store other sets  27  of digital image data, including digitized X-rays, MRI or ultrasound images, CT scanner, CBCT scanner, jaw tracking device, scanning device, video camera, etc., from other imaging devices  36 . The other imaging devices need not be located at the location or site of the workstation system  50 . Rather, the imaging of the patient  34  with one or other imaging devices  36  could be performed in a remotely located clinic or hospital, in which case the image data is obtained by the workstation  50  over the Internet  37  or some other communications medium, and stored in the memory  22 . 
     The system  50  further includes a set of computer instructions stored on a machine-readable storage medium. The instructions may be stored in the memory  22  accessible to the general-purpose computer system  10 . The machine-readable medium storing the instructions may alternatively be a hard disk memory  32  for the computer system  10 , external memory devices, or may be resident on a file server on a network connected to the computer system, the details of which are not important. The set of instructions, described in more detail below, comprise instructions for causing the general computer system  10  to perform several functions related to the generation and use of the virtual patient model in diagnostics, therapeutics and treatment planning. 
     These functions include a function of automatically, and/or with the aid of operator interaction via the user interface  14 , superimposing the first set  24  of digital data and the second set  26  of digital data so as to provide a composite, combined digital representation of the craniofacial anatomical structures in a common coordinate system. This composite, combined digital representation is referred to herein occasionally as the “virtual patient model,” shown on the display  16  of  FIG. 1  as a digital model of the patient  34 . Preferably, one of the sets  24 ,  26  of data includes photographic image data of the patient&#39;s face, teeth and head, obtained with the color digital camera  28 . The other set of data could be intra-oral 3D scan data obtained from the hand-held scanner  30 , CT scan data, X-Ray data, MRI, etc. In the example of  FIG. 1 , the hand-held scanner  30  acquires a series of images containing 3D information and this information is used to generate a 3D model in the scanning node  31 , in accordance with the teachings of the published PCT application of OraMetrix, PCT publication no. WO 01/80761, the contents of which are incorporated by reference herein. Additional data sets are possible, and may be preferred in most embodiments. For example the virtual patient model could be created by a superposition of the following data sets: intra-oral scan of the patient&#39;s teeth, gums, and associated tissues, X-Ray, CT scan, intra-oral color photographs of the teeth to add true color (texture) to the 3D teeth models, and color photographs of the face, that are combined in the computer to form a 3D morph-able face model. These data sets are superimposed with each other, with appropriate scaling as necessary to place them in registry with each other and at the same scale. The resulting representation can be stored as a 3D point cloud representing not only the surface on the patient but also interior structures, such as tooth roots, bone, and other structures. In one possible embodiment, the hand-held in-vivo scanning device is used which also incorporates a color CCD camera to capture either individual images or video. 
     The software instructions further includes a set of functions or routines that cause the user interface  16  to display the composite, combined digital three-dimensional representation of craniofacial anatomical structures to a user of the system. In a representative embodiment, computer-aided design (CAD)-type software tools are used to display the model to the user and provide the user with tools for viewing and studying the model. Preferably, the model is cable of being viewed in any orientation. Tools are provided for showing slices or sections through the model at arbitrary, user defined planes. Alternatively, the composite digital representation may be printed out on a printer or otherwise provided to the user in a visual form. 
     The software instructions further include instructions that, when executed, provide the user with tools on the user interface  14  for visually studying, on the user interface, the interaction of the craniofacial anatomical structures and their relationship to the external, visual appearance of the patient. For example, the tools include tools for simulating changes in the anatomical position or shape of the craniofacial anatomical structures, e.g., teeth, jaw, bone or soft tissue structure, and their effect on the external, visual appearance of the patient. The preferred aspects of the software tools include tools for manipulating various parameters such as the age of the patient; the position, orientation, color and texture of the teeth; reflectivity and ambient conditions of light and its effect on visual appearance. The elements of the craniofacial and dental complex can be analyzed quickly in either static format (i.e., no movement of the anatomical structures relative to each other) or in an dynamic format (i.e., during movement of anatomical structures relative to each other, such as chewing, occlusion, growth, etc.). To facilitate such modeling and simulations, teeth may be modeled as independent, individually moveable 3 dimensional virtual objects, using the techniques described in the above-referenced OraMetrix published PCT application, WO 01/80761. 
     The workstation environment provided by this invention provides a powerful system and for purposes of diagnosis, treatment planning and delivery of therapeutics. For example, the effect of jaw and skull movement on the patient&#39;s face and smile can be studied. Similarly, the model can be manipulated to arrive at the patient&#39;s desired feature and smile. From this model, and more particularly, from the location and position of individual anatomical structures (e.g., individual tooth positions and orientation, shape of arch and position of upper and lower arches relative to each other), it is possible to automatically back solve for or derive the jaw, tooth, bone and/or soft tissue corrections that must be applied to the patient&#39;s initial, pre-treatment position to provide the desired result. This leads directly to a patient treatment plan. 
     These simulation tools, in a preferred embodiment, comprise user-friendly and intuitive icons  35  that are activated by a mouse or keyboard on the user interface of the computer system  10 . When these icons are activated, the software instruction provide pop-up, menu, or other types screens that enable a user to navigate through particular tasks to highlight and select individual anatomical features, change their positions relative to other structures, and simulate movement of the jaws (chewing or occlusion). Examples of the types of navigational tools, icons and treatment planning tools for a computer user interface that may be useful in this process and provide a point of departure for further types of displays useful in this invention are described in the patent application of Rudger Rubbert et al., Ser. No. 09/835,039 filed Apr. 13, 2001, the contents of which are incorporated by reference herein. 
     The virtual patient model, or some portion thereof, such as data describing a three-dimensional model of the teeth in initial and target or treatment positions, is useful information for generating customized orthodontic appliances for treatment of the patient. The position of the teeth in the initial and desired positions can be used to generate a set of customized brackets, and customized flat planar archwire, and customized bracket placement jigs as disclosed herein. Alternatively, the initial and final tooth positions can be used to derive data sets representing intermediate tooth positions, which are used to fabricate transparent aligning shells for moving teeth to the final position, as described in the above-referenced Chisti et al. patents. The data can also be used to place brackets and design a customized archwire as described in the previously cited application Ser. No. 09/835,039. 
     To facilitate sharing of the virtual patient model among specialists and device manufacturers, the system  50  includes software routines and appropriate hardware devices for transmitting the virtual patient model or some subset thereof over a computer network. The system&#39;s software instructions are preferably integrated with a patient management program having a scheduling feature for scheduling appointments for the patient. The patient management program provides a flexible scheduling of patient appointments based on progress of treatment of the craniofacial anatomical structures. The progress of treatment can be quantified. The progress of treatment can be monitored by periodically obtaining updated three-dimensional information regarding the progress of treatment of the craniofacial features of the patient, such as by obtaining updated scans of the patient and comparison of the resulting 3D model with the original 3D model of the patient prior to initiation of treatment. 
     Thus, it is contemplated that system described herein provides a set of tools and data acquisition and processing subsystems that together provides a flexible, open platform or portal to a variety of possible therapies and treatment modalities, depending on the preference of the patient and the practitioner. For example, a practitioner viewing the model and using the treatment planning tools may determine that a patient may benefit from a combination of customized orthodontic brackets and wires and removable aligning devices. Data from the virtual patient models is provided to diverse manufacturers for coordinated preparation of customized appliances. Moreover, the virtual patient model and powerful tools described herein provide a means by which the complete picture of the patient can be shared with other specialists (e.g., dentists, maxilla-facial or oral surgeons, cosmetic surgeons, other orthodontists) greatly enhancing the ability of diverse specialists to coordinate and apply a diverse range of treatments to achieve a desired outcome for the patient. In particular, the overlay or superposition of a variety of image information, including 2D X-Ray, 3D teeth image data, photographic data, CT scan data, and other data, and the ability to toggle back and forth between these views and simulate changes in position or shape of craniofacial structures, and the ability to share this virtual patient model across existing computer networks to other specialists and device manufacturers, allows the entire treatment of the patient to be simulated and modeled in a computer. Furthermore, the expected results can be displayed beforehand to the patient and changes made depending on the patient input. 
     Treatment Planning 
     Various treatment planning steps are explained through  FIGS. 2-13 . 
       FIG. 2  shows the in-vivo scanned digital dentition model of a patient with teeth  110  and gingiva  112  in the malocclusion state. The in-vivo scanning is performed using a hand held, white light scanner. Alternately, the scanning can be done through other scanning devices including a laser scanner. Also, a similar model can be obtained through scanning an impression of the dentition or a physical model of the dentition created from the impression. 
       FIG. 3  shows the digital model of the patient in  FIG. 2  with teeth and gingiva  112  wherein the teeth  120  are set-up in a target state using the treatment planning instructions provided in the system of  FIG. 1 . This can be achieved through treatment planning simulations to realize the target set-up. The target set-up may be the final desired state or an intermediate state depending on the treatment plan chosen for the patient. 
     Alternately, the treatment planning can be done using the dentition models with teeth only, and without gingiva, as explained in  FIGS. 4-6 . 
       FIG. 4A  shows front view of the upper jaw  52  and lower jaw  54  and facial bone 56 with modeled teeth  58 , all obtained from the volume scan of the patient. 
       FIG. 4B  shows left bucal view of the upper jaw  60  and lower jaw  62  and facial bone 64 with modeled teeth  66 , all obtained from the volume scan of the patient. 
       FIG. 5A  shows modeling of teeth obtained from surface scanning of the dentition of a patient. While tooth crowns  70  are displayed in the model, tooth roots and jaw bones are missing. 
       FIG. 5B  shows teeth  72  with roots in malocclusion. The roots are obtained through scanning the patient&#39;s dentition and bones using a CBCT device and integrating the CBCT digital data with the data obtained through in-vivo scanning. 
       FIG. 6  shows patient&#39;s crowns with roots  74  at a target stage. 
       FIG. 6  shows the digital model of the patient in  FIG. 5  set-up in a target state by taking into account the positions of the roots using the treatment planning instructions provided in the system of  FIG. 1 . The advantage of this approach is that the root positions are taken into consideration while planning the target set-up thereby avoiding any teeth movements that may not be feasible due to root positions. 
       FIG. 7  shows the digital target set-up model of the patient in  FIG. 3  with the brackets  130  placed on the teeth  120 . Gingiva  112  are also present in this figure. The brackets  130  may be automatically selected from a bracket library and automatically placed at desired locations on the teeth by the instructions in the system of  FIG. 1 . Alternately, the brackets may be selected by an operator and placed at locations selected by the operator. If the brackets are automatically placed by the instructions in the system of  FIG. 1 , then one or more of them can be selected and moved to a different location by the operator. 
       FIG. 8  shows the digital target set-up model of the patient with the brackets  130  placed on the teeth  120  of  FIG. 7  with a plane of reference  140  for the brackets. Again, gingiva  112  is also present in this figure. With the plane of reference, all the brackets can be moved to a different position globally. 
       FIG. 9  shows the digital target set-up model of the patient of  FIG. 8  with the brackets  132  repositioned by using the plane of reference for the brackets as a guide. Teeth  120  and gingiva  112  are also present in this figure. 
       FIG. 10  shows the patient model of  FIG. 7  with an individual bracket  134  repositioned as shown on tooth  122  if desired. 
       FIGS. 11A, 11B and 11C  show examples of bracket positioning on a tooth.  FIG. 11A  shows the bracket  136  touching at a single point  136   a  on the surface of the tooth  124  thereby creating a gap  136   b  between the base of the bracket  136  and the surface of the tooth  124 ;  FIG. 11B  shows the bracket  137  not touching the surface of the tooth  124  at all and thereby creating a gap  137   a  between the base of the bracket  137  and the surface of the tooth  124 ; and  FIG. 11C  shows the bracket  138  touching the surface of the tooth  124  at two points  138   a  and  138   b  thereby leaving no gap between the base of the bracket  138  and the surface of the tooth  124 . The operator can thus modify the positioning of the base of any bracket on the surface of a tooth as desired in order to realize the treatment goals. The shape of the gap between the base of a bracket and the surface of the corresponding tooth dictates the shape of the pad necessary to properly bond the bracket to the tooth. 
       FIGS. 12A and 12B  show additional examples of bracket positioning on a tooth.  FIG. 12A  shows the bracket  142  touching at one point  142   a  on the tooth  126 ; and  FIG. 12B  shows the bracket  144  touching at the opposite point  144   a  on the tooth  126 . 
     Thus, different bracket placements are designed with respect to the tooth surface in order to realize different forces, such as torque, angulation and/or translational or rotational movements of the tooth in the desired directions. 
       FIG. 13  shows the digital malocclusion model of the patient of  FIG. 2  with the brackets placed  150  on the teeth  120  in accordance with the bracket-positions on the teeth in the target positions per  FIG. 9 .  FIG. 13  shows the target placement of the brackets on the teeth which will be used to design the TAP device in accordance with the invention disclosed herein. 
     One skilled in the art would appreciate that the target set-up can be done either automatically or manually by an operator or a combination of the two can be used as well. 
     TAP Device Design &amp; Manufacturing 
       FIG. 14  shows the preferred embodiment of the invention, namely the design of the TAP (Tooth Attachment Placement) device created by the system described in  FIG. 1  in accordance with the placement of the brackets on the teeth as shown in  FIG. 13 . The TAP device  200  consists of single tooth jigs  210  interconnected through splines  300  and  310 . Each jig  210  has a specific tooth number  320  engraved on it indicating the particular tooth associated with the jig. Each jig is designed to hold an attachment or a bracket to be placed on a tooth. Additionally, there are over mold retention pegs  322  attached to the spline  310 . Geometry of the TAP device is automatically designed by the system described in  FIG. 1 , without requiring any manual interaction of an operator. The design is created in the form of a digital STL File for exporting it to an apparatus for manufacturing the TAP device. 
     The spline is made with unique width in a small shape from rigid material. This design helps in keeping the elements of the TAP device in the desired position. The cross section of the spline can be different for each spline and designed to carry the UV rays as well as provide the snap points to break the sections apart when needed. 
     The distances between the jigs on the spline can vary depending upon the geometry of the dentition, and for providing enough space to effectively place the jigs, and thereby the brackets or the attachments on the teeth. 
     The Tap device can be designed to serve the upper jaw and the lower jaw together. 
     Bracket placement within the TAP device jigs can be made either manually or with a robot. 
     The TAP device can be designed for a single tooth, multiple teeth or the full arch. The TAP device can be designed in segments as well. 
     The TAP device can be made locally at an orthodontist&#39;s practice or remotely at a manufacturing facility. 
     The bracket holder in a jig in a TAP device can have two walls, three walls or four walls for properly holding the bracket. 
     The TAP device is made from a non-flexible, biocompatible material using an additive manufacturing process apparatus such as a 3D printer. Properties of the preferred biocompatible material are listed in Table 1. The preferred material for making the TAP device is in the liquid form; however materials in the powder form or any other form suitable for 3D printing apparatus can also be used. 
     The TAP device is preferably made from clear/transparent or translucent material. The splines are made in the form of tubes. Such a design enables the spline to carry ultra-violate light or rays for curing the bracket pads attached to the teeth surfaces; thereby enabling firm attachments of the brackets to the teeth once the brackets are placed on the teeth using the TAP device. 
     There are marks placed on the splines so that the splines can be broken at those points in order to remove the jigs or the holders once the brackets are bonded to the teeth. 
     The TAP device described above can be used for attaching other types of attachments, such as aligner attachments, to the teeth as well. 
     The TAP devices are packaged in ultra-violate resistance boxes for storage and shipping purposes. 
     There are many advantages of the TAP device over the conventional similar devices. The TAP device is created in labial and lingual versions. It provides better fit compared to the conventional deep-drawn Indirect Bonding (IDB) Trays. Bonding of all brackets can be achieved in one step. If needed, the TAP device can be cut into segments for certain malocclusions. Re-bonding of a single tooth can be achieved by using only one cut-out jig. TAP device can be designed to include jigs for later bonding of teeth that cannot be bonded initially (because the tooth is not erupted, or requires rotation, etc.). The cost of producing a customized TAP device is low compared to commercially available Indirect Bonding (IDB) Trays. 
       FIGS. 15-19  show various applications of the TAP device as described below. 
       FIG. 15  shows a lingual TAP device  220 . Jig at the location  221  is skipped in this case since the corresponding tooth is in position so that the jig cannot be used along with the other jigs. So, an additional jig  222  is added for a later use. The figure shows the patient identifier link  324 . The patient identifier link  324  as well as the additional jig  222  can be detached from the TAP device before bonding the brackets on the teeth using the TAP device. Every jig can be broken apart at points  224  on the splines after bonding. The jig  222  can be used at a later appropriate time for bonding a bracket on the particular tooth at the position  221  that was initially skipped. 
     The calculation of how much occlusal surface to cover on each tooth is a critical parameter. In crowded cases it is tricky to create enough space between the jigs to allow for the bends in the splines. The TAP device design disclosed herein, which aims at effectively creating a TAP device with spaces in between is indeed unique. The jigs are attached by one or more splines of various potential shapes. Varying the width trades flexibility (thinner jigs) of the TAP device against stability (wider jigs). Stability can be offset by bonding multiple teeth at once or by going to a single jig with full occlusal coverage in situations where the tooth is hard to get to at the same time as bonding the adjacent teeth. Having the space will also reduce the printing cost which is calculated by material needed. 
       FIG. 16  shows a labial TAP device  230  for a lower jaw, including jigs  234 , splines  236  and  238  and patient identifier  326 . 
     Similarly,  FIG. 17  shows a labial TAP device  240  for an upper jaw. 
       FIG. 18  shows a lingual TAP device  250  placed on the physical model  260  of a jaw. Jig for tooth  261  is skipped in this case since the tooth is in a rotated position so that the jig cannot be used in this state. 
       FIG. 19  shows a lingual TAP device  250  placed on the physical model  260  of the jaw as shown in  FIG. 18 , and additionally with a patient identification link  270 . In this view also the jig for tooth  261  is skipped in this case since the tooth is in a rotated position so that the jig cannot be to used in this state. 
       FIGS. 20-32  show various details of the TAP device design as described below. 
       FIG. 20  shows the bracket holding geometry of the TAP device including the jig or the holder  400 , the splines  410  and  412 , and the bracket  420 . 
       FIG. 21  shows another view of the bracket holding geometry of the TAP device shown in  FIG. 20  including the bracket base  422 . 
       FIG. 22  shows stabilizing the TAP device by closing the teeth. This figure shows the lower teeth  430 , the jig or the holder  432 , the spline  434 , the bracket  436 , the spline breaking point  438  and bite  440 . 
       FIG. 23  shows another example of stabilizing the TAP device by closing the teeth. The lingual view is shown. This figure shows the lower teeth  430 , the jig or the holder  432 , the bracket  436  and the upper teeth  450 . 
       FIG. 24  shows another example of stabilizing the TAP device by closing the teeth. The labial view is shown. This figure shows the lower teeth  430 , the jig or the holder  432 , the spline  434 , the bracket  436  and the upper teeth  450 . 
       FIG. 25  shows a section of the TAP device showing side view of a counter shaped slot. This figure shows the jig or the holder  432 , the spline  434 , the bracket  436  and the pad  437 . 
       FIG. 26  shows the sane section of the TAP device of  FIG. 25 , showing front view of the counter shaped slot. This figure shows the jig or the holder  432 , the spline  434 , the bracket  436  with the base  439 . 
       FIG. 27  shows a section of the TAP device showing hollow tubes. This figure shows the tooth  430 , the jig or the holder  432 , the spline  434  and the bracket  436 . It should be noted that the splines are made of hollow tubes. They are translucent and designed to carry UV light to cure the bracket pads for attaching the brackets to the teeth. 
       FIG. 28  shows a section of the TAP device showing an example of the distance between the bracket surface and the tooth surface. This figure shows the tooth  430 , the jig or the holder  432 , the spline  434 , the bracket  436  and the pad  437  filling the distance between the surface of the tooth  430  and the base of the bracket  436 . 
       FIG. 29  shows a section of the TAP device showing another example that there is no distance between the bracket surface and the tooth surface. This figure shows the tooth  430 , the jig or the holder  432 , the spline  434  and the bracket  436 . There is no distance between the surface of the tooth  430  and the base of the bracket  436 . So, the bracket base has a thin layer for attaching the bracket to the tooth. 
       FIG. 30  shows a section of the TAP device showing a snap fit. The figure shows the jig or the holder  433 , the spline or the frame of the TAP device  435  and the bracket  436 . the frame of the TAP device  435  holds the jig  433  with the snap  460 . Alternately, this holding arrangement can be in the form of a ball and socket. 
       FIG. 31  shows a section of the TAP device showing an example of the form-fitting elements. The figure shows a portion of the spline or frame  434  and an over mold  462  performing the form fitting in to the frame  434 . 
     One skilled in the art would appreciate that other designs of the TAP device are possible. 
       FIG. 32  shows another embodiment of the invention showing a design of another type of TAP device based upon the brackets placed on the patient&#39;s malocclusion. The figure shows teeth  600 , clip holder  602 , retention peg  604  and bracket  608 . 
       FIG. 33  shows design of another type of TAP device shown in  FIG. 33  with clips  606  inserted in the clip holder  602 . The figure also shows teeth  600 , retention peg  604  and bracket  608 . 
       FIG. 34  shows the design of the TAP device shown in  FIG. 33  with orientation plane  610  of each bracket. The figure also shows teeth  600 , clip holder  602 , retention peg  604 , the clip  606  and bracket  608 . 
       FIG. 35  shows a variation of the TAP device  620  previously shown in  FIG. 32  placed on the teeth  621 . The TAP device  620  comprises single jigs to bond brackets indirectly to the lingual surface of the teeth. There are several advantages of this TAP device: (a) precise and fast bonding of the brackets on the teeth, (b) single Jig positioning, (c) no deforming of the plastic cap and (d) easy and precise re-bonding of the brackets is possible. The TAP device  620  is manufactured using 3D printing apparatus. Further details regarding the components of this TAP device are explained in  FIGS. 36A and 36B . 
       FIG. 36A  shows the components of the TAP device  620  for a single tooth, namely cap  622 , metal bracket holder  624 , O-ring  626  and bracket  628 . The TAP device is mounted on the tooth  623 . The cap fits to the individual tooth and holds the assembly in place. The metal bracket holder is assembled into the cap and holds the bracket in place. The O-ring fixes the metal bracket holder to the cap. 
       FIG. 36B  shows the tooth number, for which the particular jig is designed,  629  placed on the front of the cap  622 . 
     In case of heavy crowding it is sometime needed to bond brackets later in the treatment. Crowding, especially in the lower jaw, makes it sometimes necessary to bond first alternating bracket. In order to realize such a configuration of the TAP device, the O-Ring, cap and metal bracket holder are removed for selected teeth from the TAP device and bonded after the rest of the brackets are bonded to the teeth. The reason for taking this approach is that the caps sometimes do not fit side by side in case of crowding. 
       FIG. 37  shows configuration of the TAP device  630  where the jigs are removed for the teeth  631 . 
     The process of preparing a jig, bonding a bracket to a tooth, and subsequently removing the cap and the bracket holder using the TAP device  620  is as follows: 
     Step 1. Prepare Jigs
         a. Carefully remove the Jig from the printed model.   b. Clean the bonding surface of the bracket. Make sure that no cleaning fluid like acetone or others come in contact with the cap or O-Ring.   c. Add glue to the bonding surface of the bracket and make sure that the applied amount of glue is in the right range. If using too much glue, it could cause the risk to bond also the cap to the tooth, and removal of the cap will be difficult later on.   d. Prepare tooth surface.    Note: Light bond glue (light polymerization) is preferred to make sure that there is enough time for a precise positioning of the jig.       

     Step 2. Bond Brackets
         a. Make sure that the bracket holder is in position before placing the jig (see  FIGS. 38A and 38B  to position the bracket holder).   b. Place the single jig on the tooth and remove exceeding glue if needed (see  FIG. 38C ).   c. Fix the Jig before light hardening (see  FIG. 38D ).       

     Step 3. Remove cap and Bracket holder
         a. Remove O-ring.   b. Remove the cap by swiveling the lower part of the cap. as shown. Use a small tool to start the swiveling (see  FIGS. 38E and 38F ).   c. Open the bracket door (see  FIG. 38G ).   d. Remove the metal bracket holder from the bracket (see  FIG. 38H ).       

       FIG. 39  shows separated jigs  640  and  642  designed for two specific teeth. Tooth number  644  is engraved on the jig. 
       FIG. 40  shows a spline  646  joining the separated two jigs shown in  FIG. 39 . The figure also shows the jigs  640  and  642  and tooth number  644 . 
     Although the preferred embodiment of the invention disclosed above describes the design of the TAP device based upon the target set-up determined through treatment planning, one would appreciate that the TAP device can be designed simply based upon the placement of the brackets on the dentition determined by any method, such as placing the brackets by a practitioner on the malocclusion based on gut-fill and experience or any other method including combination of treatment planning and best judgment. Furthermore, the TAP device can be made for bracket or other attachment placement at any point during the treatment. In other words, the TAP device is not limited for use only with the final stage of the treatment. 
     It should be noted that the TAP device can be used for placement of any type of attachment, including brackets, attachments for aligners, pad attachments or any other type of attachment, on a patient&#39;s dentition. 
     Attachment Placement Verification 
     It is important to verify accuracy of the placement of the attachments on the teeth using the TAP device. The placement accuracy process is described below. 
       FIG. 41  shows a TAP device  652  and a malocclusion model  650  of the dentition of a patient and the brackets  654  are bonded on a quadrant of the malocclusion model in order to determine the accuracy of the placements of the brackets. 
       FIG. 42  shows the TAP device with the brackets. 
       FIG. 43  shows the brackets bonded to the teeth. 
       FIG. 44  shows the in-vivo scanned image of the dentition after the brackets were bonded to the teeth using a customized TAP device. This image enables verification of the accuracy of the placement of the brackets on the teeth. 
       FIG. 45  shows archwire placement through the bonded brackets for verification of the accuracy of the placement of the brackets on the teeth. 
       FIG. 46  shows a jig with the bracket portion cutout. Such a jig can be placed on a patient&#39;s tooth and the cutout portion marked to see where the bracket will be attached. The marked area then can be cleaned. Also, the marked area can be used to verify the accuracy of the placement of the bracket on the tooth. 
       FIG. 47  shows an attachment  714  different from a bracket, such as an attachment to be placed on a tooth for an aligner, placed on the jig of a TAP device. In this manner, the customized TAP device can be used to place attachments on the teeth of a patient. 
       FIG. 47A  shows the attachment  714  in more detail. The figure shows pad  716  and staff  718 . 
       FIG. 48  shows a cotton roll  744  attached to the spline  722  of the TAP device. The cotton roll will absorb the saliva of a patient when the TAP device is used to place the brackets or other attachments on the teeth of a patient. Although not shown in this figure, a tongue blocker can also be attached to the spline of the TAP device in order to prevent the tongue of the patient from interfering with the placement of the TAP device on the dentition of the patient. 
     Interface Attachment Device Design and Manufacturing 
       FIG. 49  shows an interface attachment device  843  attached to the base  845  of the bracket  842 . Such an interface attachment device can replace the pad  437  shown in  FIGS. 25 and 28  filling the distance between the surface of the tooth  430  and the base of the bracket  436  as shown in  FIG. 28 . One surface of the interface attachment device is attached to the bracket base and the other is customized to match the surface contour of the patient&#39;s tooth where it will be placed during an orthodontic treatment.  FIG. 49  also shows a generic wire retention receptacle  846  and the arch wire  844  which is inserted into the bracket as shown to provide the desired torque or force system on the corresponding tooth. 
       FIG. 50  shows an example locking mechanism for securely attaching the interface attachment device  843  to the bracket base  845  of the bracket  842  via a cross sectional view of the bracket and the interface attachment device shown in  FIG. 49 . The example locking mechanism comprises a groove  847  placed on the bracket base  845  which receives the securely fitting projection (or protrusion)  849  of the interface attachment device  843 . The surface  848  of the interface attachment device  843  faces the patient&#39;s tooth surface and its shape is customized to match the surface of the tooth where it will be placed. Such a customized design for the surface  843  is realized based on the digital model of the tooth obtained as described earlier using the software instructions in the workstation also described earlier. The geometrical shapes of the groove  847  and the projection (or protrusion)  849  are matching in order to achieve secure fitting of the interface attachment device  843  on the bracket base  845 . One skilled in the art would appreciate that the geometrical shape can be square, rectangular, cylindrical, hexagonal or any other suitable shape. One skilled in the art would appreciate that the number of groves (or slots, or holes) and projections (or protrusions, or pins) can be more than one where each projection matches a corresponding grove. Also the projections can be placed on the interface attachment device and groves on the bracket base; or vice-a-versa. One skilled in the art would also appreciate that, although not shown here, there are other mechanisms or configurations possible, such as clips, latches or receptacles, for securely holding the interface attachment to the base of the bracket. The locking mechanism between the interface attachment device and the bracket base can be (a) form-locked, i.e. male/female arrangement, (b) friction-locked (i.e. using spring, magnetism, shape memory phase shift, shrinkage, etc.), (c) combination of (a) and (b), or (d) any other type. 
     The interface attachment device can be attached to the tooth surface by any kind of adhesive or composite material. The interface attachment device is generally attached to the surface of the tooth with a thin layer of glue. 
     The interface attachment device can be manufactured using generative manufacturing technologies; computer numerically controlled machining technologies; or other manufacturing techniques suitable for low volume, high precision, custom parts. The interface attachment device can also be made by any additive manufacturing technology such as 3D printing. 
     The interface attachment device can be made from composite material, which may be different from the material used to make the bracket. 
     In one embodiment, it would be possible to keep the interface attachment device mounted on the tooth surface, while the bracket is replaced by another one. 
     If need be, the bracket base can also be customized to match the bracket-side surface of the interface attachment device. 
     Manufacture of an interface attachment device can be done as follows:
         (a) a three-dimensional virtual model of a patient&#39;s dentition and a three-dimensional virtual model of a bracket as placed on surface of a tooth in the three-dimensional virtual model of the patient&#39;s dentition are stored in the memory of a workstation. This can be achieved through treatment planning for the patient, including scanning the dentition of the patient.   (b) Then, using a processing unit (or a workstation), the three-dimensional shape of the interface attachment device is derived from the three-dimensional virtual models described in step (a), wherein one surface of the interface attachment device is customized for placement on a tooth surface and the other surface is designed with a locking mechanism for securely attaching the interface attachment device to base of the bracket.   (c) Finally, interface attachment device is manufactured according to the derived three-dimensional shape including the locking mechanism using a manufacturing system.       

     Modifications to the illustrated embodiments are within the scope of the invention. The scope is to be determined by reference to the appended claims, interpreted in light of the foregoing specification. 
     
       
         
           
               
               
               
               
             
               
                 TABLE 1 
               
               
                   
               
               
                 Property 
                 ASTM 
                 Metric 
                 Imperial 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
               
               
            
               
                 Tensile Strength 
                 D-638-03 
                 MPa 
                 50-65 
                 psi 
                 7,250-9,450 
               
               
                 Modulus of Elasticity 
                 D-638-04 
                 MPa 
                 2,000-3,000 
                 psi 
                 290,000-435,000 
               
               
                 Elongation at Break 
                 D-638-05 
                 % 
                 10-25 
                 % 
                 10-25 
               
               
                 Flexural Strength 
                 D-790-03 
                 MPa 
                  75-110 
                 psi 
                 11,000-16,000 
               
               
                 Flexural Modulus 
                 D-790-04 
                 MPa 
                 2,200-3,200 
                 psi 
                 320,000-465,000 
               
               
                 Izod Notched Impact 
                 D-256-06 
                 J/m 
                 20-30 
                 ft lb/in 
                 0.375-0.562 
               
               
                 HDT at 0.45 MPa 
                 D-648-06 
                 ° C. 
                 45-50 
                 ° F. 
                 113-122 
               
               
                 Water Absorption 
                 D570-98 24 Hr 
                 % 
                 1.1-1.5 
                 % 
                 1.1-1.5