Patent Document

CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation application of application Ser. No. 12/204,894 filed Sep. 5, 2008, which is a nonprovisional application of and claims benefit of the filing date of provisional application No. 60/970,677, filed Sep. 7, 2007, the contents of which are incorporated herein by reference in their entireties. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of the dental and facial irregularities. The technical term for these problems is “malocclusion.” 
         [0003]    Malocclusions can be treated by treatment modalities using fixed or removable appliances, or a combination of both. Fixed appliances are known as braces, and they are most common form of treatment for malocclusion. Braces involve moving teeth into desired position through a system of brackets and wires that apply pressure on teeth and shift in a certain direction. Conventional removable appliances are composed of wires attached to a plastic/polymer base and can be removed by the patient. Malocclusions can also be corrected with the removable appliance named as “aligners,” “tooth positioners” or “correctors.” 
         [0004]    A tooth positioner is a clear and removable orthodontic appliance. 
         [0005]    Tooth positioners were developed over 50 years ago and are made of clear plastic to guide teeth after fixed braces therapy or for minor adjustment of the teeth. 
       SUMMARY OF THE INVENTION 
       [0006]    A method for forming a tooth positioner for repositioning at least one tooth of a patient includes providing a dental arch cast of a patient having at least one tooth to be repositioned, separating at least one tooth from the dental arch cast, including the at least one tooth to be repositioned to provide at least one separated cast tooth having a crown part and a stump representing a root, fixing a pin in the stump part of the at least one separated tooth, and in any non-separated teeth, each of the pins extending outwardly from the stump part, reconstructing the dental arch cast of the patient by aligning the separated teeth to correspond to the alignment in the patient&#39;s mouth and holding the pins in a material that may be softened by heat, heating at least an area of the material that may be softened by heat in which the pin fixed in the at least one tooth to be repositioned is held to soften the area, applying force to at least the pin fixed in the at least one tooth to be repositioned to move the at least one tooth to be repositioned in a desired direction to obtain a realigned arch, cooling the material that may be softened by heat; and forming a tooth positioner corresponding to the realigned arch. 
         [0007]    The tooth positioner can be used by having the patient wear the tooth positioner for a period of time. 
         [0008]    A method for reviewing a diagnostic setup for an orthodontic treatment, includes providing a dental arch cast of a patient having at least one tooth to be repositioned, separating at least one tooth from the dental arch cast, including the at least one tooth to be repositioned to provide at least one separated cast tooth having a crown part, and a stump representing a root, fixing a pin in the stump part of the at least one separated tooth, and in any non-separated teeth, each of the pins extending outwardly from the stump part, reconstructing the dental arch cast of the patient by aligning the separated teeth to correspond to the alignment in the patient&#39;s mouth and holding the pins in a material that may be softened by heat, taking a first photograph of the reconstructed dental arch cast, heating at least an area of the material that may be softened by heat in which the pin fixed in the at least one tooth to be repositioned is held to soften the area, applying force to at least the pin fixed in the at least one tooth to be repositioned to move the at least one tooth to be repositioned in a desired direction to obtain a realigned arch, taking a second photograph of the realigned arch, morphing the first and second photographs, and reviewing the morphed photographs to review a diagnostic setup for an orthodontic treatment. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF DRAWINGS 
         [0009]      FIG. 1  shows an example of an upper impression taken in an impression tray. 
           [0010]      FIG. 2  shows an example of an upper epoxy cast. 
           [0011]      FIG. 3  shows a polymer shell made on an upper epoxy cast. 
           [0012]      FIGS. 4 and 5  show a modified cutting technique and cast teeth separated, trimmed &amp;finished. 
           [0013]      FIG. 6  shows a customized pin fixed inside a cast tooth. 
           [0014]      FIGS. 7A and 6B  show front and side views, respectively, of teeth having pins inserted in an upper zero aligner (ZA). 
           [0015]      FIGS. 8A and 8B  are top and perspective views, respectively, of an arch reconstruction frame (ARF). 
           [0016]      FIGS. 9A and 9B  are side perspective and top perspective views, respectively, of a custom made vertical articulator. 
           [0017]      FIGS. 10A-10G  show successive steps of the zeroing technique of the present invention. 
           [0018]      FIG. 11  shows the heads of the pins will be exposed at the end of this process shown in  FIGS. 10A-10G . 
           [0019]      FIGS. 12A and 12B  show, respectively, the whole upper arch reconstructed and position of teeth inside the patient&#39;s mouth. 
           [0020]      FIGS. 13A-13D  show a bite registration/bite setting technique and reconstruction of the lower arch using arch reconstruction frames (ARFs) and a vertical articulator (VA). 
           [0021]      FIG. 14  shows lower arch reconstructed having zero aligner (ZA) on it at the end of the process shown in  FIGS. 13A-13D . 
           [0022]      FIGS. 15A and 15B  show front views, respectively, of the upper and lower processed arches together and the occlusion in the patient&#39;s mouth while  FIGS. 15C and 15D  show side views, respectively, of the upper and lower processed arches together and the occlusion in the patient&#39;s mouth. 
           [0023]      FIG. 16  shows half portion of thermoplastic material and arch (half on the left in this example) covered with insulating material. 
           [0024]      FIG. 17  shows a cross-section through the arch with an upper/top insulating layer, wax in the middle, and a lower/bottom insulating layer. 
           [0025]      FIGS. 18A and 18B  show, respectively, a top perspective view and a close perspective view of a digital picture recorder (DPR) lodged with reconstructed upper arch. 
           [0026]      FIG. 19  shows the platform of digital picture recorder (DPR) with vertical bars and magnetic system. 
           [0027]      FIG. 20  shows the upper and lower reconstructed arches mounted with the help of vertical bars and magnetic/ball system on platform of a digital picture recorder (DPR). 
           [0028]      FIGS. 21A and 21B  show, respectively, a side perspective view and a top perspective view of a movement platform. 
           [0029]      FIGS. 22A-22B  show mounting teeth having pins into wax, heating and using a customized mechanical movement device to move a pin along with tooth in a measured manner in the desired direction. 
           [0030]      FIGS. 23A-23F  show examples of mechanical movement devices. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0031]    This description is directed to those skilled in the orthodontics art. In this description, contributing parts and procedures that are well known to those skilled in the art or otherwise not essential to an understanding of the invention are described without any unnecessary detail to avoid any confusion. For example, before working on any dental Impression, the orthodontist should disinfect it with a disinfection solution as is known in the art. Since this disinfecting treatment is known in the art, this and similar treatments and products have not been mentioned here. 
         [0032]    The method of the present invention will now be described with reference to the attached Figures. 
         [0033]    Upper and lower impressions of a patient with malocclusion are taken by the doctor, e.g., dentist or orthodontist, in impression trays as shown in  FIG. 1 , which shows an impression  10  of the upper teeth  11  and gum  12  being taken in an impression tray  13 . Impressions are poured with a casting material e.g.: epoxy resin, to make upper and lower dental arch casts, an upper cast  14  with upper cast teeth  11 ′ being shown in  FIG. 2 . Epoxy is a tough synthetic resin, containing epoxy groups, that sets with specific time and further hardens when heat or pressure is applied. The casting material, e.g., epoxy resin is poured in the impression approximately 2 mm above the gum margin as shown in the circled area in  FIG. 1 . After the setting time as specified by the manufacturer, casts are removed from the impressions one by one. Excessive epoxy material is removed from the epoxy casts and any voids created during the casting process are filled out. This produces the exact replica of patient&#39;s teeth in the form of epoxy casts, an upper cast being shown in  FIG. 2 . Both the epoxy casts are placed into occlusion on any flat surface. If required, their bases are trimmed in such a way that when both arches are placed in occlusion their bases are parallel to each other. 
         [0034]    Excessive epoxy material is removed from the epoxy casts, the upper cast  14  of which is shown in  FIG. 2 , and any voids are filled out. Each epoxy cast, e.g., cast  14 , is placed in a thermoforming machine (e.g., a Biostar thermoforming machine) to make the polymer shell  15  on it as shown in  FIG. 3 . In the method described herein, the polymer shell  15  is referred to as a “Zero Aligner” (“ZA”). The polymeric shells  15  fit snugly over the casts  14 , thus creating a plural of the dental casts or zero aligners (ZAs). Zero aligners  15  (ZAs) are trimmed following the curves of scalloped gum line to remove all the excess plastic material around the cast, leaving about 1 mm below the gum line on buccal side, while excess material is left within the configuration of arch form. This is to give more strength to the polymeric shells to ensure the accuracy in the later process as shown in  FIG. 3 . Zero Aligners (ZAs) are then removed from the epoxy casts and stored to be used in the later procedures. The drawings show the manner in which the upper cast and its Zero Aligner (ZA) are made; the lower cast and its Zero Aligner (ZA) are made in a corresponding manner. 
         [0035]    Each cast tooth  11 ′ is then carefully separated out of epoxy casts using different cutting tools and given a tooth ID so that they are not misplaced later. 
         [0036]    A modified cutting technique, referred to herein as the butterfly technique, can be applicable in some cases. In this technique as shown in  FIGS. 4 and 5 , only those teeth  11 ′ are segmented which are desired to be moved or are mal-aligned, while the rest of teeth  11 ″ are united together, with a metal bar  16 . As shown in  FIGS. 4 and 5 , the butterfly technique is used and a joining bar  16  connects the posterior teeth  11 ″ with each other which are not desired to be cut. 
         [0037]    As shown in  FIG. 5 , all the separated teeth  11 ′ are trimmed and finished in such a way that at the end, a tooth crown  17  with a short stump  18  representing the root is created with a cervical margin  18 ′ there between. The quality of the segmented teeth is verified to check if any tooth structure is lost during this process and is rebuilt if required according to the original dentition. 
         [0038]    Holes are drilled at the base of each tooth stump  18 , and in each uncut segment if the butterfly technique is used, and custom made pins  19  are inserted and fixed inside each hole by using bonding material. The pins  19  have a head  20 , a threaded or corrugated body  21 , first and second band parts  22  and  22 ′, and a neck  22 ″ there between. It can be advantageous to use a pin that has a 5 mm head  20 , an 10 mm threaded or corrugated body  21 , first and second band parts  22  and  22 ′ of 2 mm and 1 mm, respectively, a neck  22 ″ of 1 mm, and a 4 mm tail (the portion not shown within the cast tooth  11 ′). 
         [0039]    Each cut tooth/uncut segment is then manually inserted in already made zero aligners (ZAs) into their own respective position as shown in  FIGS. 7A and 7B  for upper arch. 
         [0040]    A custom made frame, shown in  FIGS. 8A and 8B , referred to herein as an “arch reconstruction frame” (“ARF”) is placed in a custom made articulator, shown herein in  FIGS. 9A and 9B , referred to herein as a “vertical articulator” (“VA”) as shown in  FIG. 10A . 
         [0041]    Arch reconstruction frames (ARFs)  23  are custom made frames made up of varying materials and thickness according to their use as shown in  FIGS. 8A and 8B . Each arch reconstruction frame  23  has a frame body  24  and alignment holes  25 . Each arch reconstruction frame  23  may have metallic balls  26  and screw holes  27 . 
         [0042]    The vertical articulator  28 , as shown in  FIGS. 9A and 9B , has a base  29  and two vertical bars  30  attached to a base  29 . The vertical bars  30  help to secure the arch reconstruction frames (ARFs)  23  during the arch reconstruction procedure and reloading the upper and lower arches in relation as it exists in patient&#39;s mouth (bite setting procedure). 
         [0043]    Arch reconstruction frames (ARFs)  23  are provided on the vertical articulator  28  as shown in  FIG. 10A  and provide a casting boundary which holds and shapes the thermoplastic material, this thermoplastic material shaped in a horseshoe shape provides a medium for holding teeth with the help of their associated fixtures in their original as well as modified positions. 
         [0044]    A non-sticky doughy material  31  is poured inside the arch reconstruction frame (ARF)  23  secured at the base  29  of the vertical articulator (VA)  28  as shown in  FIG. 10B . One non-sticky doughy material that may be used is alginate. Alginate is a type of impression material that is used in dental practice to take the dental impressions. It is available in powder form and when mixed with water it becomes semisolid and then takes a rubbery consistency when finally set within a few minutes. 
         [0045]    As shown in  FIG. 10C , one set of cast teeth  11 ′,  11 ″, upper teeth in this example, along with pins  19  are placed inside the zero aligner (ZA)  15  into a freshly poured alginate impression layer  31  in such a way that heads  20  of the pins  19  dip inside the freshly poured semisolid layer alginate layer  31 . After a few minutes, the alginate material layer  31  gets solidified. Then another arch reconstruction frame (ARF)  23 ′ is placed on the top of already placed arch reconstruction frame (ARF)  23  in the vertical articulator  28  as shown in  FIG. 10D . Any potential gaps between two arch reconstruction frames (ARFs)  23 ,  23 ′ are sealed and blocked, e.g., with any block out material. Alginate/Silicone material  32  is used to fulfill this purpose as shown in  FIG. 10E . 
         [0046]    A thermoplastic material  33 , such as wax, is melted and poured inside the arch reconstruction frame (ARF)  23 ′ over the alginate layer  31  in such a way that all the threaded/corrugated portions  21  of pins  19  are provided within and surrounded by molten wax  33 . The wax  33  is poured up to the band part  22  of the pins  19  as shown in  FIG. 10F . The wax  33  cools down after a few minutes; this cooling process can be accelerated by application of some cooling agent. Once the wax  33  cools down and gets hard, the block out material  32  which was used to seal and block the gap between two arch reconstruction frames (ARFs) is removed. The second arch reconstruction frame (ARF)  23 ′ is taken out of the vertical articulator  28 , as shown in  FIGS. 10G and 11 . The second arch reconstruction frame (ARF)  23 ′ has pins  19  embedded in the wax  33  up to the band part  22  of the pins  19 , while heads  20  of the pins will be exposed as the alginate  31  will not let the wax  33  come in contact with the pin heads  22  and, at the same time, the alginate  31  will not stick to the pin heads  20 . This technique is termed “Pin&#39;s head exposing technique.” 
         [0047]    After the second arch reconstruction frame (ARF)  23 ′ is taken out of the vertical articulator  28 , the entire upper arch has been reconstructed.  FIGS. 12A and 12B  show, respectively, the whole upper arch reconstructed and position of teeth inside the patient&#39;s mouth. As can be seen comparing  FIG. 12A  with  FIG. 12B , the position of teeth in the reconstructed arch achieved after going through this process will essentially be same as the position of teeth inside the patient&#39;s mouth or the position of teeth in an impression taken by the doctor (see  FIG. 1 ). This technique is referred to herein as “Zeroing”. The ZA is then cut and separated from the upper reconstructed arch. 
         [0048]    In the following discussion, bite registration means the inter-arch relationship of upper and lower teeth of the patient. An accurate bite registration is necessary to establish the proper occlusal relationship during mounting of the two arches. It is also necessary while correcting malocclusions so that teeth can be reconstructed and adjusted without creating inter-arch interferences. A negative replica of this relationship may be provided by the treating dentist or orthodontist along with the patient&#39;s impressions. In dentistry, occlusion refers to the manner in which the teeth of upper and lower arches come together when the mouth is closed. 
         [0049]    Two new arch reconstruction frames (ARFs)  34 ,  35  are mounted one by one at the base  29  of a vertical articulator  28 . Any potential gaps between two arch reconstruction frames (ARFs)  34 ,  35  are sealed and blocked out, e.g., with a block out material  32 ′. The arch reconstruction frame (ARF)  23 ′ having upper cast teeth  11 ′,  11 ″ are then placed in the vertical articulator  28  in such a way that heads of the pins  20  face upwards as shown in  FIG. 13A . Then a zero aligner (ZA)  15  having lower teeth with attached pins  19  is brought in close approximation with the upper reconstructed arch held in the arch reconstruction frame (ARF)  23 ′. Once the desired position representing the occlusion of patient is achieved, sticky material  36  (see  FIG. 13D ) is used to glue the two arches in that position as shown in  FIG. 13B . To maximize the accuracy of this inter-arch relationship, the patient&#39;s bite registration and photographs can be used. 
         [0050]    A freshly mixed alginate layer is placed inside the arch reconstruction frame (ARF)  35  already placed at the base of the vertical articulator (VA)  28 . Then, the whole assembly of upper reconstructed arch held in arch reconstruction frame (ARF)  23 ′ along with the glued lower zero aligner (ZA)  15  having lower cast teeth in it is brought to the base of a vertical articulator  28  in such a way that heads of the pins  19  of the lower teeth dip inside the freshly mixed alginate material. Once the alginate is solidified, melted wax  33 ′ is poured inside the arch reconstruction frame (ARF)  34  over the alginate layer in such a way that all of the threaded/corrugated portion  21  of pins  19  of the lower cast teeth are dipped inside the wax  33 ′ and threaded/corrugated portion  21  of the pins  19  is surrounded by molten wax. The wax  33 ′ is poured up to the band part  22  of pins  19  of lower teeth as shown in  FIGS. 13C and 13D . The wax  33 ′ cools down after a few minutes; this cooling process can be accelerated by application of some cooling agent. Once the wax  33 ′ cools down and gets hard, the glue  36  used to unite the upper reconstructed arch held in the arch reconstruction frame (ARF)  23 ′ and the lower zero aligner (ZA)  15  and the block out material  32 ′ that was used to seal and block the gap between two arch reconstruction frames (ARFs)  34 ,  35  are removed. Upper arch reconstruction frame (ARF) is taken out of the vertical articulator leaving behind the lower reconstructed arch enclosed in lower zero aligner (ZA)  15  as shown in  FIG. 14 . The lower zero aligner  15  is then cut and removed from the lower reconstructed arch. 
         [0051]    In order to attain the same vertical position every time whenever desired, two screws  38  can be provided at the boundary of arch reconstruction frame (ARF) in screw holes  27  (see  FIG. 20 ). 
         [0052]    The above-described process provides upper and lower reconstructed arches, with each tooth  11 ′ and uncut segment  11 ″ having a pin  19 , the corrugated portion  21  of pins  19  being surrounded by wax  33 ,  33 ′ and heads  20  of the pins  19  exposed. Moreover, when the two arches are placed inside the vertical articulator (VA)  28 , they represent the occlusion present inside the patient&#39;s mouth. The occlusion of reconstructed arches is established with the help of specially designed arch reconstruction frames (ARFs)  23 ′,  34  and vertical articulator (VA)  28  as shown in  FIGS. 15A-15D .  FIGS. 15A and 15B  show front views, respectively, of the upper and lower processed arches (held in arch reconstruction frames (ARFs)  23 ′,  34 ) together and the occlusion in the patient&#39;s mouth while  FIGS. 15C and 15D  show side views, respectively, of the upper and lower processed arches (held in arch reconstruction frames (ARFs)  23 ′,  34 ) together and the occlusion in the patient&#39;s mouth. 
         [0053]    The separated teeth  11 ′ present in wax  33 ,  33 ′ can now be moved progressively to obtain their desired position (aligned position) depending on the malocclusion and as required by the treating doctor. 
         [0054]    As shown in  FIGS. 16 and 17 , thin layer of a good insulating material  37 , i.e., a thermo-resistant material (e.g., alginate or silicone material), which melts at a higher temperature than wax  33 , is placed on the top and bottom exposed surfaces of wax  33  present in arch reconstruction frame (ARF)  23 ′. This will prevent the heat from reaching the wax  33  directly that can melt the whole wax layer especially wax present around the neighboring teeth. If the insulating layer is placed on one surface then it is named as “double layer technique” and if on both the surfaces then it is named as “triple layer technique” as shown in  FIG. 17 . 
         [0055]    In order to keep a digital picture record of the progressive movements of tooth/teeth, a Digital Picture Recorder (DPR) is used. As shown in  FIGS. 18A ,  18 B and  19 , the Digital picture Recorder (DPR)  39  has a platform  40 , which supports arch reconstruction frames (ARFs)  23 ′,  34  and one or more cameras  41   a,    41   b,    41   c  and  41   d.  The arch reconstruction frames (ARFs)  23 ′,  34  and one of the cameras  41   a  are supported on a vertical bars platform  42 . As better shown in  FIG. 19 , vertical bars platform  42  includes a plurality of magnets  43  that correspond in location to the balls  26  on the arch reconstruction frames (ARFs)  23 ′,  34 . This magnet/ball system  43 ,  26  will allow the arch reconstruction frames (ARFs)  23 ′,  34  to be placed at the same position every time. Bars  30 ′,  30 ′ also provide for alignment of the arch reconstruction frames (ARFs)  23 ′,  34  using holes  25  in the arch reconstruction frames (ARFs)  23 ′,  34 , as shown in  FIGS. 19 and 20 . Digital cameras  41   a,    41   b,    41   c  and  41   d  are placed all around the platform  40  to take the pictures from different perspective angles/views as shown in  FIG. 18A . 
         [0056]    Before giving any movement to any tooth, an arch reconstruction frame (ARF) having a reconstructed arch is placed on the platform  42  of digital picture recorder (DPR)  39  as shown in  FIG. 18B . Photographs are then taken with digital cameras  41   a,    41   b,    41   c  and  41   d  placed around the platform  40  to take the pictures from different perspective angles/views as shown in  FIG. 18A  and the photographs appropriately named, e.g., as “Picture# 1 .” The arch reconstruction frame (ARF) is then removed and desired tooth/teeth are moved using following process. 
         [0057]    To move any tooth in a reconstructed arch, the insulating layer  37  is removed around that specific tooth. The arch reconstruction frame (ARF) containing that reconstructed arch is placed in a movement platform with heads  20  of the pins  19  exposed, e.g., facing downward. Depending upon the desired movement which can be in any one axis, a mechanical movement device is placed under that tooth in such a way that the pin&#39;s head  20  fits into the tooth fixture clamp/slot present in the mechanical movement device. Then it is locked to stabilize the whole assembly. 
         [0058]    An example of a movement platform is shown in  FIGS. 21A and 21B , which show, respectively, a side perspective view and a top perspective view of the movement platform  44 . The movement platform  44  shown in this example is a custom made device having a base  45  supported on legs  46 . Vertical bars  47 , spaced a distance corresponding to the bars  30  of the vertical articulator  28 , are provided to be inserted through holes  25  of an arch reconstruction frame (ARF) to hold the arch reconstruction frame (ARF) containing a reconstructed arch in place. The base  45  has a U-shaped track  48  to guide an adjustment arm  49  on which a mechanical movement device can move. The adjustment arm  49  can be locked in a desired position in the U-shaped track  48  using a locking screw  50 . 
         [0059]    Mechanical movement devices, generally designated by the reference numeral  51  (see  FIGS. 22A and 22B ) are customized mechanical tools designed to move an individual tooth with its associated pin fixture in either direction along or around a single axis. There are at least four types of movement tools, including a:
       i. rotational tool (for movement of tooth around long axis of its pin);   ii. tipping tool (for movement of crown in one direction and of its pin in opposite direction);   iii. translational tool (for bodily movement of tooth as a whole in linear plan); and   iv. vertical correction tool (for downward/upward, i.e., intrusion/extrusion movement of tooth).       
 
         [0064]    Each movement tool assembly has some basic parts which are common in all tools, although the principle design which determines the type of movement that a tool will produce varies in the different tools. In almost every tool there is a tooth fixture clamp/slot, generally designated by the reference numeral  52 , which will receive and snugly engage/receive the head  20  of the pin fixture  19  coming out of the tooth  11 ′. Every tool has a ball bearing joint with a rotational base that provides a freedom of adjustment to the tooth fixture clamp/slot  52 . 
         [0065]    As shown in  FIG. 22A , an arch reconstruction frame (ARF)  23 ′ is then slid along twin vertical bars  47  of the movement platform  44 . A mechanical movement device  51  is provided on the adjustment arm  49  and the adjustment arm  49  moved along U-shaped track  48  so that head  20  of the tooth desired to be moved is aligned with the tooth fixture clamp  52  of the movement tool  51  along the long axis of pin  19  fixed to tooth  11 ′. The adjustment arm  49  is locked in a desired position in the U-shaped track  48  using the locking screw  50 . After this visual adjustment of movement tool&#39;s passive components, the arch reconstruction frame (ARF)  23 ′ is slid down along the twin vertical bars  47  so that pin&#39;s head  20  (of tooth desired to be moved) fits in the tooth clamp/slot fixture  52  and it is tightened. 
         [0066]    In this state, as shown in  FIG. 22B , the pin  19  of the tooth  11 ′ desired to be moved has its corrugated portion  21  surrounded by wax  33  and its head  20  fitted/locked into the tooth clamp/slot fixture  52  of the mechanical movement device  51 . Heat is applied from heater  53  to the tooth fixture clamp/slot  52  of the mechanical movement device  51 , which softens the wax  33  around the corrugated portion  21  of the pin  19  (as heat is transferred to the pin  19 ). The thin layer of insulating material  37  surrounding other pins&#39; heads  20  will prevent heat from melting unnecessary wax. 
         [0067]    With the help of the mechanical movement device  51 , measured movement is applied to move the individual tooth into the desired direction in along or about one axis. 
         [0068]    The wax  33  is again left for some time to cool down and then the mechanical device  51  is unlocked and removed. Upper and Lower arches are replaced in the vertical articulator and brought in close approximation with each other to check any inter-arch interferences etc. 
         [0069]    The arch reconstruction frame (ARF) having the moved tooth/teeth is placed again on the platform  40  of a digital picture recorder (DPR)  39  and additional picture(s) taken again, e.g., named as “Picture# 2 .” The pictures can be loaded in software that has the ability to give following benefits:
       to show the transition from one step to next step to see any unnecessary/unintentional movement of tooth/teeth   to keep a digital picture record of the all the previous steps. Pictures taken by the above method can also be loaded in certain commercially available software for review.       
 
         [0072]    The arch reconstruction frame (ARF), having moved tooth/teeth in a new position, is now placed inside the thermoforming machine to fabricate a tooth positioner on it. The top insulting layer will prevent the heat of thermoforming machine from melting unnecessary wax and will resist the air pressure as well. Tooth positioner is trimmed, finished and is worn by the patient for given time. 
         [0073]    The same steps are repeated and next tooth positioner is made and worn by the patient till the time that desired position of tooth/teeth is achieved. 
         [0074]    A diagnostic setup may be accomplished using the described tools and method, which is similar to the process described above and involves:
   1.1. Zeroing   1.2. Arch reconstruction   1.3. Establishing bite registration/occlusion   1.4. Taking picture # 1     1.5. Mounting on the movement platform   1.6. Moving one or more tooth/teeth using different movement tools   1.7. Taking picture # 2 
 
The only differences from the process for making the tooth positioner described above is that optionally the type of casting material used can differ (less expensive casting materials such as plaster can be used in this diagnostic setup process), the amount of movement which is given through the movement devices (the cast tooth/teeth is/are moved to the desired positions) and, as this is a diagnostic setup for review only, no tooth positioner is made. Rather, the pictures can be uploaded in a flash based software program which morphs the two pictures so that they can be reviewed to see if the goals set by the treating doctor/orthodontist are achieved, keeping in mind all the basic principles of orthodontics.
   
 
         [0082]    Examples of mechanical movement devices are shown in  FIGS. 23A-23F . 
         [0083]      FIG. 23A  shows an example of the rotational mechanical movement device  51   a.  The rotational mechanical movement device  51   a  includes a sliding base  54   a  into which the adjustment arm  49  of the movement platform  44  is inserted. A ball bearing joint  55   a  helps the tooth fixture clamp  52   a  to align in the same axis as that of the head  20  of the pin  19  and its associated tooth  11 ′. The ball bearing joint  55   a  is locked with the help of locking key  56   a.  The clamp adjustment wheel  57   a  is used to tighten the tooth fixture clamp  52   a  around a head  20  of a pin  19 . The rotational base  58  is rotatable about a longitudinal axis of the tooth fixture clamp  52   a  and the rotational base  58  in the direction of the arrows  59   a  or  59   a ′. A gauge wheel  60  is provided to help to determine the amount of movement given. A connecting rod  61  connects the gauge wheel  60  to the ball bearing joint  55   a  and a connecting bar  62  connects the tooth fixture clamp  52   a  to the rotational base  58 . A screw  67  is provided for easy handling of the device. Rotating the rotational base  58  and the tooth fixture clamp  52   a  about their longitudinal axis in the direction of the arrows  59   a  or  59   a ′ gives rotational movement to a cast tooth  11 ′. 
         [0084]      FIGS. 23B and 23C  show an example of a tipping mechanical movement device  51   b.  The tipping mechanical movement device  51   b  includes a sliding base  54   b  into which the adjustment arm  49  of the movement platform  44  is inserted. Thus, sliding base  54   b  is fixed in position with respect to the base  45  by being fixed to adjustment arm  49  in U-shaped track  48  with the help of locking screw  50 . A tooth fixture slot element  52   b  is shaped to receive, in slots provided on two opposite sides thereof, the head  20  of the pin  19  of the associated tooth  11 ′ that is to be moved. The slots of the tooth fixture slot element  52   b  do not enclose pin&#39;s head  20 ; rather each slot just pushes the pin&#39;s head  20  in any given direction to generate a rotational movement in which crown  17  and pin&#39;s head  20  move in opposite directions. The tooth fixture slot element  52   b  is attached to a sliding platform  64   b  by a primary engaging bar  65   b.  When gauged handle  63   b  is rotated it will move the sliding platform  64   b  in linear direction along and with respect to the sliding base  54   b  through action of mechanism  66   b.  Movement given to the sliding platform  64   b  will be transferred in the primary engaging bar  65   b  and tooth fixture slot element  52   b  as they are attached with the sliding platform  64   b.  This will push the head  20  of the pin  19  in one direction with out any counter acting force at the opposing end, causing the crown  17  and pin&#39;s head  20  to move in opposite directions as shown by arrows  59   b,    59   b ′. Measurement present on the gauged handle  63   b  will enable to determine the extent of movement. Of course, as shown in  FIG. 23C , by using the slot on the opposite side from that shown being used in  FIG. 23B , the crown  17  and head  20  can be made to move in opposite directions (shown by arrows  59   b,    59   b ′) opposite to those in  FIG. 23B . 
         [0085]      FIG. 23D  shows an example of a translational mechanical movement device  51   d.  The translational mechanical movement device  51   d  includes a sliding base  54   d  into which the adjustment arm  49  of the movement platform  44  is inserted. A tooth fixture clamp  52   d  receives and clamps the head  20  of the pin  19  of the associated tooth  11 ′ that is to be moved. The clamp adjustment wheel  57   d  is used to tighten the tooth fixture clamp  52   d  around a head  20  of a pin  19 . The tooth fixture clamp  52   d  is attached to a sliding platform  64   d  by primary engaging bar  65   d  and a ball bearing joint  55   d.  When gauged handle  63   d  is rotated it will move the sliding platform  64   d  in linear direction along the sliding base  54   d  through action of mechanism  66   d.  Movement given to the sliding platform  64   d  will be transferred in the primary engaging bar  65   d  and tooth fixture clamp  52   d  as they are attached with the sliding platform  64   d.  Since the tooth fixture clamp  52   d  is locked with the help of clamp adjustment wheel  57   d,  the whole pin  19  is translated along with the tooth  11 ′ in the direction of arrows  59   d  and  59   d ′. A pillar  68  is fixed on top surface of the sliding platform  64   d.  A connector  69  with U-shaped hook  70  can be placed into a slot in a vertical adjustable holder  71  with locking screw  72  present on the pillar  68 , which is adjustable vertically. The length of connector  69  can also be changed horizontally to reach to the neck part  22 ″ of the post  19 . Once the whole assembly is locked, connector  68  with a U-shaped hook  70  at its end is placed in the neck part  22 ′ of the pin  19 . This will help to achieve the movement of pin  19  and tooth  11 ′ as a whole in the same direction. The translational mechanical movement device  51  d can be used without this connector  69 , but without connector  69  there may be a possibility that the cast tooth  11 ′ will lag behind the head  20  of pin  19  which is firmly gripped in the pin fixture clamp  52   d.  Measurement present on the gauged handle  63   d  will enable to determine the extent of movement. 
         [0086]      FIG. 23E  shows two different connectors  69 ′,  69 ″ for the translational mechanical movement device  51   d  shown in  FIG. 23D . Each connector  69 ′,  69 ″ includes a U-shaped hook  70 ′,  70 ″, the connector  69 ′,  69 ″being chosen according to the direction of movement desired as shown by the arrows. 
         [0087]      FIG. 23F  shows an example of a vertical correction mechanical movement device  51   f.  The vertical correction mechanical movement device  51   f  includes a sliding base  54   f  into which the adjustment arm  49  of the movement platform  44  is inserted. A tooth fixture clamp  52   f  receives and clamps the head  20  of the pin  19  of the associated tooth  11 ′ that is to be moved. Ball bearing joint  55   f  will help the tooth fixture clamp  52   f  to align in the same axis as that of the pin fixture  19  and its associated tooth  11 ′. Ball bearing joint  55   f  is locked with the help of its locking key  56   f.  The head  20  is tightened and locked in the tooth fixture clamp  52   f  with the clamp adjustment wheel  57   f.  When gauged handle  63   f  is rotated (clockwise/anti-clockwise) it will move the sliding cylinder  65   f  in downward/upward direction by a mechanism (not shown). Since the tooth fixture clamp  52   f  is locked with on the head  20 , the whole pin  19  is translated along with the tooth  11 ′ downwards or upwards as shown by the arrow  59   f.  Measurement present on the gauged handle  63   f  will enable to determine the extent of movement. 
         [0088]    The present invention provides an improved way to replicate the initial position of the patient&#39;s dentition without any chances of adding any error. It also provides an accurate and precise movement to a tooth in an intended direction using mechanical devices capable of moving tooth in a measured manner in at least one direction in or about only one axis. Such movements combined over a number of tooth positioners manufactured following movements given through mechanical devices will correct malocclusion as planned. Another improvement in the present invention is addition of two insulating layers around the thermoplastic layer (which holds the teeth) which provides insulation and stability to the setup at initial and during the course of treatment. The present invention also provides a provision of digital visualization of the patient&#39;s dentition using initial images of the patient&#39;s dentition from different perspectives and images during and at the proposed end of treatment from different perspectives, morphing these to show the transition of treatment and proposed final correction of malocclusion. This gives the treating practitioner and patient an opportunity to view, change or accept the proposed treatment outcome before it is incorporated in the active appliance. 
         [0089]    While the accompanying figure shows and this description describe some embodiments of the invention, the invention is not limited thereto. One skilled in the art will understand that numerous variations and modifications are possible without departing from the spirit and scope of the invention defined by the following claim(s).

Technology Category: 1