Patent ID: 12226276

Like reference numerals will be used to refer to like parts from Figure to Figure in the following description of the drawings.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides improved methods, dental matrices, composite dispensers, and kits for the restoration of a decayed portion of an anterior tooth.

In an example method according to the invention for the restoration of a tooth, the dentist locates a tooth having a cavity. A hollow cavity preparation is prepared in a tooth. The tools and techniques for forming the hollow cavity preparation are well known in the art and therefore will not be explained further.

In order to properly deposit the restorative material on the side of the tooth without undesired leaking of the restorative material beyond the side of the tooth, the dentist places a dental matrix around at least a portion of the tooth. In the invention, a sectional anatomic translucent dental matrix is placed on the tooth. When the matrix is placed around at least a portion of the tooth, the matrix acts as a form for the desired shape of the restored tooth.

The cavity preparation in the tooth is then etched with liquid and/or gel phosphoric acid. The cavity preparation in the tooth is then rinsed and dried. A lightly filled or unfilled light curable resin tooth bonding agent is then applied to the tooth covering the entire cavity preparation. The resin tooth bonding agent is then air thinned except on the tooth surface where a small pool of resin tooth bonding agent is maintained. The resin tooth bonding agent is not light cured at this point. Resin tooth bonding agents improve composite to enamel and/or dentin bonding. One example resin tooth bonding agent is available under the tradename OptiBond Solo Plus®.

A light curable flowable composite resin is then injected directly into the pool of resin tooth bonding agent (under magnification if possible) without incorporating bubbles. A tiny amount of the light curable flowable composite resin is expressed before placement to ensure that there is no air in the cannula. The light curable flowable composite and resin tooth bonding agent are not light cured at this point. Generally, light curable flowable composite resins contain 20-25 percent less filler in the light curable polymeric material than nonflowable paste materials. Light curable flowable composite resins are available under tradenames such as Filtek™, Flow-It™, EsthetX®, Revolution®, AeliteFlo®, PermaFlo®, Dyract Flow®, Tetric®, and Heliomolar®. Light curable resins are preferred as light cured resins are more color stable than chemically cured resins.

A light curable paste composite resin is then extruded into the pool of flowable composite resin and resin tooth bonding agent without creating air bubbles, allowing the composite resin to displace most of the lesser filled flowable composite resin and resin tooth bonding agent (under magnification if possible). Composite resins are available under tradenames such as 3M Z100™, 3M Filtek Supreme™, and Prodigy®. The next steps are burnishing, carving the anatomy and carving excess composite. There is no need to use a condenser or plugger.

The filled cavity preparation is then cured using a curing light such as high intensity light emitting diode (LED) lights, plasma-arc curing lights, halogen lights, and laser lights. The matrix is then removed, and the restored tooth is polished with discs, strips, and rubber tipped and carbide burs.

Optionally, flowable composite resin is not used in the method. In this version of the method, heating the paste composite allows the more highly filled paste composite to be expressed through step down tips according to the invention having smaller inside diameters (about 0.4 millimeters to about 1.6 millimeters).

Looking atFIGS.1A-5B, there is shown the lingual, (palatal or inside) surface1of a left central incisor (LCI), or anterior tooth. The cross hatched area2is an area of interproximal decay or of a previously placed filling. The facial (buccal or outside) surface3of tooth LCI is also shown. The cemento-enamel junction (crown-root interface) is shown at 5.

Various matrices are provided by the invention. Each matrix can be tooth specific, or the matrix can be tooth type specific, or the matrix can be tooth surface specific. By “tooth specific” it is meant that the matrix is configured to conform to the shape of the outer surface of the specific natural tooth being restored such as (without limitation) an upper left central incisor. By “tooth type specific” it is meant that the matrix is configured to conform to the shape of the outer surface of the specific type of natural tooth being restored such as (without limitation) an upper incisor. By “tooth surface specific” it is meant that the matrix is configured to conform to the shape of the outer surface of the specific natural tooth surface being restored such as (without limitation) an upper left incisor mesial surface.

InFIGS.3A and3B and3C, a side specific matrix6for anterior teeth is shown. The matrix6has a side terminal flange3fthat extends away from the surface of the tooth LCI when the matrix6is placed on the tooth LCI. This example would be designated as right side or right hand specific. “Mesial and Distal” orientation is the common anatomic description but the side specific, “right hand” or “right side” naming signifies that the matrix can be used only on the right side of the tooth, which would be the distal surface of a right maxillary (upper) central incisor, or a right maxillary lateral incisor or a right maxillary canine tooth. Conversely the “right hand specific anterior matrix” would be used for the mesial surface of a maxillary left central incisor, or a maxillary left lateral incisor, or a maxillary left canine tooth. The mandibular (lower) anterior teeth would be the inverse orientation of the maxillary teeth. They are labeled as “right hand” or “left hand” specific to account for the asymmetrical shape of the tooth. In this variation, the cingulum shape of the lingual surface is representational and therefore the matrix is not universal and therefore the operator must choose the specific matrix and orientation for the matrix.

InFIGS.4A and4B, a universal sectional type matrix4for anterior teeth with multiple anatomic features but not side or surface specific features is shown. The matrix4has a root-crown interface8and a side terminal flange4fthat extends away from the surface of the tooth LCI when the matrix4is placed on the tooth LCI. The matrix4can be translucent, sectional, and/or anatomically shaped. The matrix4as shown is partially anatomic (i.e., it is less than all anatomic). However, a fully anatomic matrix is also in accordance with the invention. By “anatomic”, it is meant that the matrix has an inner surface that conforms to the shape of the outer surface of the region of the natural tooth being restored.

The sectional matrix4can cover from 90 degrees up to 359 degrees around the lingual side surface1and the facial side surface3of the tooth LCI. Preferably, the sectional matrix4can cover from 90 degrees up to 270 degrees around the lingual side surface1and the facial side surface3of the tooth LCI. More preferably, the sectional matrix4can cover from 90 degrees up to 180 degrees around the lingual side surface1and the facial side surface3of the tooth LCI. Most preferably, the sectional matrix4can cover from 90 degrees up to 120 degrees around the lingual side surface1and the facial side surface3of the tooth LCI. Alternatively, a 360 degree partially anatomic or fully anatomic matrix that can either be continuous or with a cut can be provided. In another alternative, a 360 to 420 degree partially anatomic or fully anatomic matrix with a cut and purposeful overlap to accommodate different variations in circumference of teeth that is seen between different individuals can be provided.

InFIGS.5A and5B, there is shown, a side view of a pre-curved matrix7specific to anterior teeth with one anatomic feature which is the root-crown interface8a. In the example matrix7ofFIGS.5A and5B, the length L of the pre-curved matrix7is approximately 13 millimeters and the height H can range approximately from 10 millimeters to 13 millimeters.

A matrix according to the invention can be anatomically shaped such that the matrix is hands free and self stabilizing (i.e., there is no requirement for a matrix stabilizer that conforms the matrix to the tooth). However, in a two step process, a dentist can forgo the use of a matrix stabilizer for the first step when the cavity is deep and or on the root surface and first apply flowable composite and/or paste composite to create an undercut that will allow the subsequent use of a matrix stabilizer with more ease in a single step injection molding technique to finish the filling.

InFIGS.6-19, there are shown various dental composite dispensers according to the invention.FIG.6shows a side view of a dental composite dispenser gun11and a yet to be inserted capsule15in which the resin composite filling material is pre-loaded.FIG.7shows the capsule15inserted into the dispenser gun11and ready for expressing into a cavity preparation. The piston17drives the rubber plunger21which in turn presses the paste composite resin filling material. The handle12of the dispenser gun11inFIG.7has been pressed and is compressing the spring13. Hinge14allows rotation of the handle12to press the piston17.FIG.8is a side view, close up of the capsule15having a dispensing orifice19with inside diameter O (which can be 2.5 mm), and a rear end20.FIG.9is a cross-sectional view of the capsule15showing the position of plunger21and the pre-loaded resin composite filling material23(shown with cross hatching) which moves forward by way of a rear sliding disc22.FIG.10shows the extrusion of the resin composite material23as the plunger21is driven into the barrel of the capsule15and pressure is applied to the resin composite23.

FIG.11shows a step-down tip24according to the invention approximated to the capsule15before insertion. The dispensing orifice25of the tip24is a smaller orifice size O′, which diameter can range from approximately 0.75 millimeters to 1.5 millimeters. InFIG.11, the step down tip24is drawn to represent the 1.25 millimeter diameter orifice, which is half the diameter of the size of the dispensing orifice19of the example capsule15inFIGS.6-13.FIG.12shows the step down tip24being inserted in the capsule15, which can be accomplished with finger pressure or with dental pliers or hemostats or with common needle nose pliers.FIG.13shows the step down tip24fully inserted into the capsule15. Note how the annular rib26of the tip24forms a distended wall section27in the capsule15that creates the retention needed to retain the step down tip24.

FIG.14shows four non-limiting examples of the step down tips. In step down tip24a, the orifice Size 18 is in the 1 to 1.5 millimeter range for the inside diameter. In step down tip24b, the orifice Size 19 is for ultraconservative cavities or hard to reach cavities and generally ranges in the 0.75 to 1 millimeter diameter size for the inside diameter. In step down tip24c, the orifice Size 20 is ovoid (about 1×2 millimeters or 1×3 millimeters inside dimension) for class II cavity preparations or other applications where a non round expressed resin composite shape is desired. In step down tip24d, the orifice size is ribbon shaped R with about 0.5×3 millimeters inside dimension. The ribbon shape is good for restorative fillings as a veneer layer of composite, or a ribbon to line a porcelain onlay or veneer for bonded esthetic porcelain dentistry.

Turning now toFIG.15, there is shown a dental composite dispenser11aaccording to the invention. The dental composite dispenser11aincludes a housing including an end section30for dispensing composite. The piston17drives the rubber plunger21which in turn presses the paste composite resin filling material from the capsule15as described above for dispenser11. The end section30has an opening31defining a space33in which the capsule15may be inserted into place as shown inFIG.15. Resistive heating elements35are positioned in the end section30adjacent installed capsule15. The heating elements35are in electrical communication with an electrical power supply37(batteries inFIG.15but AC corded power is also usable). The dispenser11aincludes a switch38for supplying electrical power to the heating elements35for generating heat adjacent the capsule15to heat up the composite material in the capsule15before expressing the composite from the hollow step down tip24e(having an inside diameter in the range of about 0.4 millimeters to about 1.6 millimeters) of the dispenser11a. Heating the composite allows more highly filled composites (e.g., paste) to be expressed through the step down tips having smaller inside diameters (about 0.4 millimeters to about 1.6 millimeters). In one version of the invention, the capsule15is formed from a plastic having higher heat transfer capabilities.

Referring now toFIG.16, there is shown a dental composite dispenser11baccording to the invention. The dental composite dispenser11bincludes a housing including an end section30bfor dispensing composite. The piston17drives the rubber plunger21which in turn presses the paste composite resin filling material from the capsule15as described above for dispenser11. The end section30bhas an opening31bdefining a space33bin which the capsule15may be inserted into place as shown inFIG.16. Resistive heating elements35aare positioned only at the tip of the end section30badjacent the distal end of the installed capsule15to create a heating zone41at the distal end of the installed capsule15. The heating elements35aare in electrical communication with an electrical power supply37(batteries inFIG.16but AC corded power is also usable). The dispenser11bincludes a switch38for supplying electrical power to the heating elements35afor generating heat adjacent the capsule15to heat up the composite material in the capsule15before expressing the composite from the hollow step down tip24e(having an inside diameter in the range of about 0.4 millimeters to about 1.6 millimeters) of the dispenser11b.

Turning toFIG.17, there is a side view of a commercially available syringe43for supplying composite resin. The syringe43includes a plunger44having a threads44sthat is threadingly inserted in the open end45oof hollow barrel45. By rotating the plunger44, the plunger44advances in the barrel45to extrude composite from the tip46of the syringe43.

Referring now toFIG.18, there is shown a dental composite dispenser11caccording to the invention. The dental composite dispenser11cincludes a housing including an end section30cfor dispensing composite. The end section30chas an opening31cdefining a space33cin which the barrel45of the syringe43ofFIG.17may be inserted into place as shown inFIG.18. The piston17drives the rubber plunger21which in turn presses the paste composite resin filling material from the barrel45. Resistive heating elements35bare positioned adjacent barrel45to create a heating zone47. The heating elements35bare in electrical communication with an electrical power supply37(batteries inFIG.18but AC corded power is also usable). The dispenser11cincludes a switch38for supplying electrical power to the heating elements35bfor generating heat adjacent the barrel45to heat up the composite material in the barrel45before expressing the composite from the barrel45through passage48and into hollow step down tip24f(having an inside diameter in the range of about 0.4 millimeters to about 1.6 millimeters) of the dispenser11c.

Turning now toFIG.19, there is shown a dental composite dispenser11daccording to the invention. The dental composite dispenser11dincludes a housing including an end section30dfor dispensing composite. The end section30dhas an opening31ddefining a space33d. The end section30dhas an a chamber51with a fill hole53for accepting composite material. After composite is filled into the chamber51, the piston17drives the rubber plunger21with plunger head55which in turn presses the paste composite resin filling material from the chamber51. Resistive heating elements35care positioned adjacent chamber51to create a heating zone56. The heating elements35care in electrical communication with an electrical power supply37(batteries inFIG.19but AC corded power is also usable). The dispenser11dincludes a switch38for supplying electrical power to the heating elements35cfor generating heat adjacent the chamber51to heat up the composite material in the chamber51before expressing the composite from the chamber51through passage57and into hollow step down tip24g(having an inside diameter in the range of about 0.4 millimeters to about 1.6 millimeters) of the dispenser11d.

Based on the description above of the example dental composite dispensers11a,11b,11c,11d, it can be appreciated that the dental composite dispensers can include an AC power cord or be cordless (include a battery). The switch38of the example dental composite dispensers11a,11b,11c,11dcan include appropriate electrical circuitry such that the heat of the composite can include multiple settings for heat (e.g., 99° F., 130° F., 155° F. or 180° F.) or the heat setting can be variable from 99° F. to 180° F. InFIG.16, the dispenser11bcan only heat the composite as it exits, therefore not heating the whole capsule15. The advantage is that the eventual deterioration of the composite from extended and multiple heatings is avoided. With respect toFIGS.17and18, generally a syringe43can provide composite to multiple appointments or multiple fillings. A capsule15by contrast will only do one or two or three fillings at most. Some fillings require two or more capsules15because of the capsule's small size. InFIG.19, paste composite can be dumped from a tub or a syringe43into the chamber51, then the composite is heated in the chamber51and extruded through assorted tips, generally 14 needle gauge up to 20 needle gauge and also non round orifice ribbon shape or ovoid. Because the chamber requires maintenance, it may be preferred to use a disposable chamber that you dump into or a syringe43that you load in the dispenser after removing the twisty plunger44and use the straight plunger21of the dispenser to force composite out of the syringe43. Of course, a capsule15that conforms to the dispenser is also suitable. One can also use a unidose capsule that either has step down tip or the manufacturer of the composite makes preferred orifice sizes. Also, the invention may use a unidose tip from a composite manufacturer with a small orifice (14-20needle gage—an inside diameter in the range of about 0.4 millimeters to about 1.6 millimeters) that can only be used with heat. This would likely only work if composite is heated.

Referring now toFIG.20, there is shown another capsule115for use in a dental composite dispenser according to the invention. The capsule115includes a hollow body116having an inner surface117and a proximal opening118at a proximal end119of the body116. An outwardly directed flange120is provided at the proximal end119of the body116. A plunger121contacts a movable piston122that engages the inner surface117of the body116. The piston122seals the proximal opening118of the body116. The piston122and the inner surface117of the body116define an interior space123of the body116.

The capsule115includes a hollow dispensing orifice124having a passageway125extending from an inlet126to an outlet127. The inlet126is in fluid communication with the interior space123of the body116. A viscous highly filled dental restorative material (not shown) is placed in the interior space123of the body116. Movement of the piston122toward the dispensing orifice124in direction Q extrudes dental restorative material from the outlet127of the dispensing orifice124. The passageway125of the dispensing orifice124has an inside diameter in the range of about 0.4 millimeters to about 1.8 millimeters, preferably in the range of about 0.6 millimeters to about 1.6 millimeters, more preferably in the range of about 0.6 millimeters to about 1.2 millimeters, and most preferably in the range of about 0.6 millimeters to about 1.0 millimeters.

The passageway125of the dispensing orifice124can have other sizes. The passageway125can be in the 1 to 1.5 millimeter range for the inside diameter. The passageway125can be in the 0.75 to 1 millimeter diameter size for the inside diameter. The passageway125can be ovoid (about 1×2 millimeters or 1×3 millimeters inside dimension) for class II cavity preparations or other applications where a non round expressed resin composite shape is desired. The passageway125can be about 0.5×3 millimeters inside dimension. The ribbon shape is good for restorative fillings as a veneer layer of composite, or a ribbon to line a porcelain onlay or veneer for bonded esthetic porcelain dentistry.

The piston122may connected to the plunger121which is part of a syringe-type delivery system. The plunger121moves the piston122toward the dispensing orifice124. Alternatively, the capsule115may be inserted in a compartment of a dispensing gun (like dispensing gun11ofFIG.6). The plunger121is part of the dispensing gun (like21inFIG.6). The plunger121moves the piston122toward the dispensing orifice124to extrude dental restorative material from the outlet127of the dispensing orifice124. Optionally, the dispensing gun includes a device for multiplying a force applied to the plunger121by a user. This provides extra force extrude the viscous highly filled dental restorative material through the outlet127of the dispensing orifice124. Alternatively, a device for reducing the viscosity of the dental restorative material is provided with the capsule115. For example, resistive heating elements (such as35inFIG.15) can be positioned in the end section of the dispensing gun adjacent installed capsule115. The capsules115can also be heated in a separate heater before or after installation in the dispensing gun.

The dental restorative material includes a polymerizable (e.g., light curable) resin and a filler. Non-limiting examples of suitable resins include acrylate resins, methacrylate resins, and silorane-based resins. Non-limiting examples of suitable fillers include silica, silicate glass, quartz, barium silicate, strontium silicate, barium borosilicate, strontium borosilicate, borosilicate, lithium silicate, lithium alumina silicate, amorphous silica, calcium phosphate, alumina, zirconia, tin oxide, and titania. The paste composite can include greater than 30% by volume filler, or greater than 40% by volume filler, or greater than 50% by volume filler, or greater than 60% by volume filler, or greater than 70% by volume filler, or greater than 80% by volume filler, or greater than 90% by volume filler. Preferably, the dental restorative material has a volume shrinkage of 3% or less upon curing, More preferably, the dental restorative material has a volume shrinkage of 2% or less upon curing. Most preferably, the dental restorative material has a volume shrinkage of 1% or less upon curing.

Thus, the invention provides methods for the restoration of a decayed portion of an anterior tooth or re-restoration of a previously filled anterior tooth, and also provides dental matrices and composite resin dispensers that may be used in the methods for the restoration of a decayed portion of an anterior tooth.

The invention has many advantages. For example, the step down tips and the heating of the composite allow the dentist to make smaller cavities that would be too small to fill easily with larger tips, especially in light of the fact that most United States dentists are now using magnification (e.g., oculars, operating microscopes and digital video clinical magnification). Also, the step down tips and/or the heating of the composite allow the dentist to more efficiently use an anatomic matrix. An anatomic matrix has more closed off access. Without a smaller orifice on the dispenser tip, it can be difficult to do injection molded composites as the dentist cannot get the large tip of a larger syringe into a conservative cavity that has an anatomic matrix that is “pre-wrapped”, impeding the placement of the capsule tip. Without (i) the step down tips and/or (ii) the micro-tip/heated only/paste specific capsules and/or (iii) the composite heater gun with micro-tip paste extrusion tips, a dentist could only squirt the paste on to the tooth or on a pad, then scoop it up on a dental instrument and then try to pack it manually into the cavity preparation. A dental composite dispenser according to the invention heats the composite as the composite is injected into the cavity preparation, that is, the same dispenser heats and injects the composite. Those skilled in the art would recognize further advantages of the invention.

Although the invention has been described in considerable detail with reference to certain embodiments, one skilled in the art will appreciate that the present invention can be practiced by other than the described embodiments, which have been presented for purposes of illustration and not of limitation. Therefore, the scope of the appended claims should not be limited to the description of the embodiments contained herein.