Visual restorative and orthodontic treatment planning

Abstract

Systems and methods for improved visual restorative and orthodontic treatment planning are provided herein. In some aspects, a method for preparing teeth of a patient is disclosed. The method may include: establishing a model of the patient's dentition, the model including a model of an initial shape of the teeth. The method may also include: determining a final prepared shape of the teeth. In some aspects, the method may include: generating a treatment plan including multiple steps to modify the initial shape of the teeth to the final prepared shape of the teeth. The method may also include: providing visualization for the multiple steps of the treatment plan, the visualization may depict the removal of tooth material to modify the initial shape of the teeth to the final prepared shape of the teeth.

Description

[0001] This application is a divisional application of the invention patent application with Chinese application number 201980010379.5 (corresponding to PCT international application number PCT / US2019 / 015032), application date January 24, 2019, and invention name “Visual Restoration and Orthodontic Treatment Planning”.

[0002] Cross-references

[0003] This application claims the benefit of U.S. Provisional Application No. 62 / 622,728, filed on January 26, 2018, which is incorporated herein by reference. Technical Field

[0004] The present application relates to the fields of orthodontics and dentistry, and in particular to methods for preparing teeth of a patient and systems for assisting in preparing teeth of a patient. Background Art

[0005] Existing restorative and orthodontic procedures typically involve preparing teeth for receiving prosthetics and for orthodontic movement. Preparation for these treatments may include removing material to shape the teeth to receive prosthetics, or removing material to provide space for orthodontic movement (e.g., interproximal reduction). To achieve these goals, dentists can use a variety of tools to remove material when shaping teeth. Dentists can make educated guesses about the appropriate tools to use and when and how to use them.

[0006] Sometimes, at least in some aspects, these existing restorative and orthodontic methods and systems may result in less than ideal preparation and treatment. In view of the above, there is a need for improved restorative and orthodontic treatment planning, preparation, and treatment. Ideally, such restorative and orthodontic treatment planning, preparation, and treatment will provide more reliable and easier to follow treatment steps, more accurately prepared teeth, and greater confidence for the dentist. Summary of the invention

[0007] Improved systems, methods, and apparatus for repositioning a patient's teeth are provided herein. In some aspects, a method for preparing a patient's teeth is disclosed. The method may include: establishing a model of the patient's dentition, the model including a model of an initial shape of the teeth. The method may also include: determining a final prepared shape of the teeth. In some aspects, the method may include: generating a treatment plan including multiple steps to modify the initial shape of the teeth to the final prepared shape of the teeth. The method may also include: providing a visualization for the multiple steps of the treatment plan, the visualization depicting the removal of tooth material to modify the initial shape of the teeth to the final prepared shape of the teeth.

[0008] In some embodiments, the method may include: establishing a three-dimensional surface model of the patient's dentition from a three-dimensional surface scan of the patient's dentition; establishing a volume model from an infrared scan of the internal structure of the patient's dentition; and establishing a composite model from the three-dimensional surface model and the volume model.

[0009] In some aspects, the three-dimensional composite or volume model includes a plurality of voxels. The voxels may include a location within the composite or volume model, a type of tooth structure of the internal structure, and a density. The voxels may also include a defect type.

[0010] In some embodiments, the tooth structure type, density, and defect type of the internal structure may be determined based on an infrared scan of the internal structure of the patient's dentition or an X-ray image of the internal structure of the patient's dentition.

[0011] In some embodiments, the method may include: determining the material to be removed at each step of the treatment plan, and may also include: selecting a tool for removing tooth material from a plurality of tools for each of the plurality of steps; and selecting a tool head for removing tooth material from a plurality of tool heads for each of the plurality of steps.

[0012] In some aspects, the method may include determining a movement path for each selected tool for removing material for the plurality of steps in the treatment plan. The movement path may include an indication of the translation direction and orientation of the tool head. The visualization may be a three-dimensional visualization. The visualization may be a three-dimensional video simulation of material removal for the plurality of steps of the treatment plan.

[0013] The method may include: re-imaging the patient's dentition after removing a portion of material according to the steps of the treatment plan to establish an updated model of the dentition including an updated model of the patient's teeth; comparing the updated model of the dentition with the model of the dentition of the steps of the treatment plan; and highlighting remaining material that should be removed according to the steps of the treatment plan. In some embodiments, the method may include: determining an updated final prepared shape of the teeth; generating an updated treatment plan including a second plurality of steps to modify the updated model shape of the teeth to an updated final prepared shape of the teeth; and providing a second visualization for the second plurality of steps of the updated treatment plan, the second visualization depicting the removal of tooth material to modify the updated model shape of the teeth to an updated final prepared shape of the teeth. The final prepared shape of the teeth may be the same as the updated final prepared shape of the teeth.

[0014] In some aspects, the method may include: receiving constraints on a final prepared shape of a tooth; and generating a plurality of suggested final prepared shapes of the tooth based on the constraints. The method may also include: receiving a selection of a final prepared shape from the plurality of suggested final prepared shapes, and determining the final prepared shape of the tooth based on the received selection of the final prepared shape.

[0015] A system for assisting in the preparation of a patient's teeth is also disclosed. The system may include one or more processors and a memory, wherein the memory includes instructions executable by the one or more processors to cause the system to perform the following steps: establish a model of the patient's dentition, the model including a model of an initial shape of the teeth; generate a treatment plan including a plurality of steps to modify the initial shape of the teeth to a final prepared shape of the teeth; and provide a visualization for the plurality of steps of the treatment plan, the visualization depicting the removal of tooth material to modify the initial shape of the teeth to the final prepared shape of the teeth.

[0016] In some embodiments, the memory also includes instructions executable by the one or more processors to cause the system to perform the following steps: establishing a three-dimensional surface model of the patient's dentition from a three-dimensional surface scan of the patient's dentition; combining the three-dimensional surface model of the patient's dentition with an imaging of the internal structure of the patient's dentition to form a three-dimensional composite model of the patient's dentition.

[0017] The three-dimensional volume model may be a plurality of voxels. A voxel may include a location within the volume model, a tooth structure type of the internal structure, and a density. A voxel may also include a defect type. The tooth structure type, density, and defect type of the internal structure may be determined based on an infrared scan of the internal structure of the patient's dentition or an X-ray image of the internal structure of the patient's dentition or based on other imaging modalities (e.g., ultrasound, MRI, OCT, etc.).

[0018] In some embodiments, the memory further comprises instructions executable by the one or more processors to cause the system to perform the following steps: determine the material to be removed for each step of the treatment plan. The system may also be configured to: select a tool for removing tooth material from a plurality of tools for each of the plurality of steps; and select a tool head for removing tooth material from a plurality of tool heads for each of the plurality of steps.

[0019] In some aspects, the memory further comprises instructions executable by the one or more processors to cause the system to perform the following steps: determining a movement path for each selected tool for removing material for the plurality of steps in the treatment plan. The movement path may include an indication of the translation direction and orientation of the tool head. The visualization may be a three-dimensional visualization. The visualization may be a three-dimensional video simulation of material removal for the plurality of steps of the treatment plan.

[0020] The system can be configured to: receive an updated image of the patient's dentition after removing a portion of material according to the steps of the treatment plan to create an updated model of the dentition including an updated model of the patient's teeth; compare the updated model of the dentition with the model of the dentition of the steps of the treatment plan; and highlight the remaining material that should be removed according to the steps of the treatment plan.

[0021] In some embodiments, the system can be configured to: determine an updated final prepared shape of the tooth; generate an updated treatment plan including a second plurality of steps to modify the updated model shape of the tooth to the updated final prepared shape of the tooth; and provide a second visualization for the second plurality of steps of the updated treatment plan, the second visualization depicting the removal of tooth material to modify the updated model shape of the tooth to the updated final prepared shape of the tooth. The final prepared shape of the tooth can be the same as the updated final prepared shape of the tooth.

[0022] In some aspects, the system can be configured to: receive constraints on a final prepared shape of a tooth; and generate a plurality of suggested final prepared shapes of the tooth based on the constraints. The memory also includes instructions executable by the one or more processors to cause the system to: receive a selection of a final prepared shape from the plurality of suggested final prepared shapes, and wherein the final prepared shape of the tooth is determined based on the received selection of the final prepared shape.

[0023] Other objects and features of the present invention will become apparent by examining the specification, claims and drawings.

[0024] Merge by reference

[0025] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. BRIEF DESCRIPTION OF THE DRAWINGS

[0026] The novel features of the present invention are particularly set forth in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by referring to the following detailed description and accompanying drawings which set forth illustrative embodiments utilizing the principles of the present invention, wherein:

[0027] Figure 1 A method for planning tooth preparation and preparing a tooth according to an embodiment is shown;

[0028] Figure 2A A method of tooth preparation design according to an embodiment is shown;

[0029] Figure 2Bshows a cross section of a three-dimensional image according to an embodiment;

[0030] Figure 2C It shows that according to the embodiment Figure 2B details of a portion of a three-dimensional image;

[0031] Figure 2D A dentition model before a design is prepared and a dentition model after a design is prepared according to an embodiment are shown;

[0032] Figure 3A A method of treatment planning according to an embodiment is shown;

[0033] Figure 3B showing an indication of material to be removed from a tooth according to an embodiment;

[0034] Figure 3C and 3D shows a visualization of treatment steps in a treatment plan according to an embodiment;

[0035] Figure 4 Methods of evaluating treatment and providing feedback during treatment according to embodiments are shown;

[0036] Figure 5 A system for performing a method of visual restorative and orthodontic treatment planning according to an embodiment is shown. DETAILED DESCRIPTION

[0037] A better understanding of the features and advantages of the present disclosure will be obtained by referring to the following detailed description and the accompanying drawings, which set forth illustrative embodiments utilizing the principles of the embodiments of the present disclosure.

[0038] Although the detailed description contains many details, these details should not be interpreted as limiting the scope of the present disclosure, but are merely to illustrate different examples and aspects of the present disclosure. It should be understood that the scope of the present disclosure includes other embodiments not discussed in detail herein. Without departing from the spirit and scope of the present invention described herein, various other modifications, changes and variations that are obvious to those skilled in the art may be made to the arrangement, operation and details of the methods, systems and devices of the present disclosure provided herein.

[0039] As used herein, the term "and / or" is used as a function word to indicate that two words or sentences are taken together or separately. For example, A and / or B includes: A alone, B alone, and A and B together.

[0040] As used herein, "a plurality of teeth" encompasses two or more teeth. In some embodiments, the one or more posterior teeth include one or more of molars, premolars, or canines, and the one or more anterior teeth include one or more of central incisors, lateral incisors, canines, first bicuspids, or second bicuspids.

[0041] The present disclosure provides systems and related methods for planning tooth preparation procedures and for performing tooth preparation procedures.

[0042] Turning now to the drawings, in which like numerals represent like elements throughout the various views, Figure 1 A method 100 for preparing and treating teeth according to an embodiment disclosed herein is shown. The method 100 for preparing and treating teeth includes tooth preparation and design at frame 200, formulation of a treatment plan at frame 300, and execution and feedback at frame 400. At frame 200, the dentist can make multiple records of the patient. The records can include various imaging records. For example, the dentist can scan the patient's dentition using an intraoral scanner to establish a three-dimensional surface model of the patient's dentition. The dentist can also compile other two-dimensional and three-dimensional images and models, such as ultrasound, MRI, OCT, X-ray images and volumetric data from CBCT scans or transillumination scans, or compile a volume model generated by the method and system described in US15 / 662,234 (the entire contents of which are incorporated herein by reference). The practitioner can also select the teeth to be prepared and provide additional information, such as the type of prosthesis to be placed on the teeth. Also at frame 200, the dentist can identify tooth materials that should be removed during the patient's treatment, such as caries. The dentist may also indicate other treatment parameters, such as the type, make, and model of prosthesis to be used, as well as a preference for using specific types of procedures and tools.

[0043] At block 300, one or more treatment plans are prepared. Preparing a treatment plan may include preparing a plurality of treatment proposals showing the final prepared patient's teeth and models of intermediate steps showing how the teeth are formed from their initial shape to their final prepared shape. A dental professional may select a treatment plan from the plurality of treatment proposals.

[0044] After receiving the selection of the treatment plan, the material to be removed from the teeth is determined, and tools for each step in the plan are selected. Finally, images including static two-dimensional images, manipulable three-dimensional surface or volume models, and static and manipulable videos of the treatment plan and each step can be generated and displayed to the dental professional to assist the dental professional in treating the patient.

[0045] At box 400, the treatment performed and feedback on the treatment are provided. During this process, the dental professional begins removing material from the patient's teeth as indicated by the treatment plan. At any time during the treatment, the dental professional can request feedback about the progress. In order to request and receive feedback, the dental professional re-images the patient's dentition. The current physical state of the patient's dentition as shown in the re-imaged data can be evaluated with reference to the treatment plan. The progress of the treatment plan and any deviations from the treatment plan can be indicated to the dental professional. In some embodiments, the treatment plan can be modified based on the updated state of the patient's dentition, and the dental professional can perform treatment based on the modified treatment plan. Process 100 will be described in more detail below.

[0046] One or more steps of method 100 may be performed using the circuits described herein, for example, using one or more of a processor or logic circuit of a computer or computerized system. The circuit may be programmed to provide one or more steps of method 100, and the program may include, for example, program instructions stored on a computer readable memory or programming steps of a logic circuit.

[0047] Figure 2A A method 200 for tooth preparation design according to an embodiment described herein is shown. At frame 202, the method 200 includes imaging the dentition of a patient including the patient's teeth. At frame 204, the method 200 includes receiving and establishing constraints for a treatment plan. At frame 206, the method 200 identifies material to be removed from the teeth in order to prepare the teeth, for example, to receive a prosthesis. At frame 208, the method 200 completes the shaping of the teeth. Although a single tooth is mentioned above and elsewhere herein, the treatment plan and accompanying treatment may include preparing and treating multiple teeth. For example, multiple teeth may be prepared to accommodate a bridge or multiple prostheses, or, for example, teeth adjacent to such teeth may be prepared to facilitate the insertion of a prosthesis. In some embodiments, the teeth are prepared for orthodontic treatment. In such an embodiment, interproximal reduction may be used to provide space in the dental arch for tooth movement and rotation. Material removal and orthodontic movement of interproximal reduction may be considered in the method 200 for tooth preparation design.

[0048] At box 202, a plurality of different imaging and model building processes may be performed. For example, a volumetric three-dimensional model of a patient's dentition may be established as described in US15 / 662,234, previously incorporated by reference. Two-dimensional images such as color surface images and X-ray images may be used to establish the model. Color surface images may be used to color match a prosthesis with a patient's natural teeth to distinguish between teeth and gums. Surface penetrating scans may be used to image the internal structure of a tooth. For example, X-ray images may be used to identify various internal structures of a tooth, such as enamel and dentin. X-ray images may also be used to identify caries and other defects within a tooth. Ultrasonic imaging may be used to identify subsurface, internal features of a tooth. Other techniques (e.g., infrared or near-infrared transmission, small angle penetration imaging, or reflection scanning) may also be used to collect subsurface images of internal features of a tooth, and to help identify various internal structures within a patient's teeth.

[0049] Three-dimensional imaging or volumetric data, such as from a CBCT scan or a three-dimensional surface scan of the teeth, may be combined with the two-dimensional imaging data discussed above to create a volumetric three-dimensional or composite model of the patient's teeth.

[0050] Figure 2B and 2C A two-dimensional cross-section 220 of a three-dimensional volume model of a patient's tooth 221 is depicted. Figure 2B As shown, an integrated volume model of a tooth can be formed by a combination of two-dimensional imaging data (e.g., X-ray and surface penetrating infrared imaging) with a three-dimensional image, which allows both the internal and external structures of the tooth to be displayed. The innermost structure, such as the pulp 224, can be determined based on the X-ray imaging. The location and volume of other internal structures of the tooth 221 can be determined based on a combination of X-ray imaging and surface penetrating infrared imaging. Such internal structures depict the extent and location of the enamel 222 and the dentin 226. In addition to modeling the internal structure of the tooth, other structures of the patient's mouth (e.g., gums 228 and bones 230) can also be modeled using two-dimensional and three-dimensional imaging.

[0051] Surface penetrating infrared imaging and X-ray imaging produce a two-dimensional image of the internal structure of the tooth, but at box 202, method 200 can combine the two-dimensional image of the interior of the tooth with a generic or other non-patient-specific model of the internal structure of the tooth to generate a three-dimensional volumetric model of the patient's teeth.

[0052] Figure 2C A detailed portion of the enamel 222 of the tooth 221 is shown, including caries 232. As described above, Figure 2B and 2CA portion of a volume model 220 of a tooth 221 is depicted. A volume model (e.g., volume model 220) is composed of a number of voxels (e.g., voxels 234, 236). Each voxel 234, 236 represents a discrete volume of the tooth 221. Each voxel 234, 236 may be assigned a quality such as density, tooth structure type, and other properties such as whether a portion of the voxel includes a structural defect (e.g., a portion of a carious tooth). Figure 2C As shown, voxel 236 is a portion of enamel 222 of tooth 221. Thus, voxel 236 may be assigned properties such as a tooth structure type of enamel and a density based on surface penetrating infrared imaging and X-ray determinations at the location of voxel 236.

[0053] Voxel 234 represents the volume of tooth 221 as part of tooth enamel 222 and includes a portion of a structural defect such as caries 234. Therefore, voxel 234 can be assigned properties such as tooth structure type of enamel, defect type of caries, and density determined based on the surface penetration infrared image and X-ray image at the location of voxel 234. Defects can include structural defects or non-structural defects, such as caries, fractures, chips, lesions or other structural defects, and non-structural defects such as neurasthenia or death, tooth fillings, etc.

[0054] At block 204, method 200 includes receiving and establishing constraints for the treatment and preparation of the tooth. Constraints may be received from dental professionals, such as their preferred tools to use, their preferred tooth structure and shape for the prepared tooth, whether it is possible to modify teeth adjacent to the prepared tooth to aid in treatment, and other physician preferences.

[0055] Other constraints may depend on the type of prosthesis used, its wall thickness and edge shape. For example, the manufacturer of a particular prosthesis may recommend certain shapes of teeth to be prepared, certain minimum thicknesses and tolerances or spacings relative to adjacent teeth, retention levels of the prosthesis, edge shapes, edge seals between teeth in the prosthesis, and other constraints. These constraints and other constraints can be used to determine and identify the material to be removed and the final prepared tooth shape. In some embodiments, multiple suggested preparations are determined based on the constraints. These multiple suggested preparations can be displayed to the dental professional, and a selected preparation can be received from the dental professional.

[0056] In some embodiments, multiple suggested preparations can be determined based on the different priorities of each constraint. For example, in some embodiments, some constraints are mutually exclusive, for example, a dental professional may prefer a subgingival margin line and also select a specific prosthesis, but the prosthesis manufacturer of the selected prosthesis recommends a super gingival margin preparation. Therefore, a suggested preparation may include a subgingival margin line and a prosthesis for selection, while a second suggested preparation may include a super gingival margin line and the selected prosthesis. Similarly, the optimization of a constraint may result in insufficient preparation relative to the optimization of the second constraint. In such an embodiment, multiple suggested preparations may also be suggested. The suggested preparation may include a first suggested preparation optimized for the first constraint, a second suggested preparation optimized for the second constraint, and a third suggested preparation balancing the two constraints.

[0057] Next, at block 206, method 200 proceeds to identify materials to be removed for each proposed preparation design. Some of the materials identified to be removed may include caries within the teeth. For example, a dental professional may refer to the above, for example, Figure 2B and 2C In the volume model discussed, shown and described, voxels that include a portion of caries or other defects within a tooth are identified. In such an embodiment, at box 206, the method marks each voxel that includes at least a portion of caries for removal. In other embodiments, other portions of the tooth can be identified for removal based on other constraints described above, such as the marginal seal recommended by the prosthesis manufacturer, the retention level desired by the dental professional, and the material strength of the prosthesis.

[0058] Identifying material to be removed may also take into account the location and shape of nearby teeth. For example, a properly fitted prosthesis may require a specific prosthesis insertion path. In some embodiments, the insertion path may interfere with adjacent teeth or a standard abutment shape. Therefore, material may be removed from adjacent teeth or the teeth receiving the prosthesis to provide a clear and unobstructed insertion path for the prosthesis.

[0059] In some embodiments, material removal may include modeling interproximal and occlusal contacts to ensure that when the prosthesis is placed on the prepared tooth, the prosthesis interacts properly with adjacent teeth and teeth of the opposing jaw during natural occlusion.

[0060] In some embodiments, material removal may include interproximal removal of one or more teeth. For example, if the patient has a crowded dental arch, treatment may include determining the amount and location of interproximal removal of one or more teeth of the dental arch. In determining the amount of interproximal removal, the method may evaluate the thickness of enamel depicted in biological three-dimensional and volumetric models or other two-dimensional and three-dimensional images to select candidates for interproximal removal such that the remaining enamel in each tooth of the dental arch is clinically acceptable.

[0061] Next, at block 208, one or more suggested preparation designs are presented to the dental professional, and a selected final shape is received. Figure 2D As shown, a model of the current state of the dentition 260 can be displayed together with a model 280 of the dentition with prepared teeth 282. The model 280 shows the prepared teeth 282, including the location and shape of the edge line 284 and the prepared abutment shape 286 of the teeth 282. In addition to displaying the suggested preparation 280, some embodiments also show the intermediate steps leading to the suggested preparation 280 for review by a dental professional to help determine the selected final preparation design from one or more suggested final preparation designs. After the final preparation design is selected, the final tooth shape is determined, and the process 100 proceeds to block 300.

[0062] One or more steps of the method 200 may be performed using the circuits described herein, for example, using one or more of a processor or logic circuit of a computer or computerized system. The circuit may be programmed to provide one or more steps of the method 200, and the program may include, for example, program instructions stored on a computer readable memory or programming steps of a logic circuit.

[0063] Turning to FIG. 3 , a method 300 of treatment planning is described according to embodiments described herein. Preparing a treatment plan may include preparing a plurality of treatment suggestions showing the final prepared patient's teeth and models of intermediate steps showing how the teeth are formed from their initial shape to their final prepared shape in each treatment suggestion. The treatment suggestions may also describe a material removal process using different tools or different material removal steps. The dental professional may select a treatment plan from the plurality of treatment suggestions.

[0064] After a treatment plan is selected, images including static two-dimensional images, three-dimensional models, and videos may be generated for each step of the treatment plan and displayed to the dental professional to help the dental professional treat the patient.

[0065] The method 300 for treatment planning may include block 302, wherein intermediate material removal steps are determined for each of the individual material removal steps. At block 304, the material to be removed at each step is identified, such as by highlighting or displaying it in a contrasting color. Figure 3B shown.

[0066] Figure 3B Three models 320, 330, 340 of a patient's teeth during a treatment phase are depicted. Each of the models 320, 330, 340 indicates the same total amount of interproximal removal 322 between each tooth depicted in the corresponding model. However, each model shows a different option for treatment with interproximal removal. A model (e.g., model 320) may be displayed to an experienced dentist who does not wish to highlight each of the individual interproximal removals, but instead uses only the amount of interproximal removal indicated in the model.

[0067] Models 330, 340 can be shown to a dentist who wishes to obtain guidance on interproximal removal, or when there are multiple clinically acceptable types of interproximal removal available. For example, model 330 shows an option for interproximal removal, wherein the two upper central incisors 332, 333 have an equal amount of interproximal removal 334, 335 indicated as 0.3 mm applied to each tooth. The contrast or highlighting of the interproximal removal 334, 335 provides a visual guide for the dental professional as he or she performs interproximal removal on the patient, and the location and extent of the interproximal removal are shown on the model. Model 340 shows an alternative interproximal removal, wherein material is removed only from the upper right central incisor 332. As shown in model 340, the entire 0.3 mm of interproximal removal is removed from the right central incisor 332. Models 320, 330, 340 can be presented to the dentist, and a selection of a desired model can be received. In some embodiments, a preferred model can be presented that is based in part on volumetric data of the teeth requiring interproximal removal. For example, if the volumetric data or other surface penetrating image data (e.g., X-ray, CBCT, etc.) indicates that two teeth have an equal amount of enamel, then interproximal removal may be distributed equally between the teeth. In other examples, if the volumetric data or other surface penetrating image data indicates that one tooth has more enamel than an adjacent tooth, then interproximal removal may be distributed more toward the tooth with more enamel (e.g., with a weight or ratio depending on the difference in enamel thickness between the teeth).

[0068] Moving to box 306, constraints for tool selection are received or otherwise determined. Constraints can include physical constraints such as the size or dimensions of the patient's mouth and access to the oral cavity. For example, children have relatively small openings, which may require that only certain smaller tools can be used during the procedure. In some embodiments, the patient may have physical limitations on how much they can open their mouth, which may also require the use of smaller tools. Additionally, other constraints may include a physician's preference for certain types of tools and drills. In another example, in patients with larger mouths, tools with additional reach or length or a specific minimum reach or length may be used as a constraint, while shorter tools may not be considered.

[0069] After receiving and analyzing the constraints at box 306, method 300 continues to box 308, where the tools for each step of the treatment are determined. The tools, including hand tools and tool heads, are determined based on the location of the material to be removed, the amount of material to be removed, and any other constraints (e.g., those discussed above). After identifying the tools used in each step of the treatment plan, at box 310, the path, position, and orientation of the tool are determined for each material removal step. In some embodiments, the determination of each tool and the determination of the path, position, and orientation of the tool are determined together, rather than being determined at a separate box. In some embodiments, the tool position and tool path information can be used to generate instructions for a robotic or computer-controlled material removal process (e.g., a CNC process).

[0070] After the tool positions and tool paths are determined at block 310 , process 300 continues to block 312 where a visualization is generated for each treatment step. Figure 3C and 3D Visualization of the two steps of the material removal process for a treatment plan is depicted. Figure 3C The proximal preparation of tooth 356 is depicted. Figure 3C , the buccal surface of tooth 356 has been prepared in a previous step of the preparation process. The visualization shows the position and orientation of tool 350 and tool head 352 relative to tooth 356 being prepared. The orientation of tool 350 and tool head 352 can be shown relative to, for example, a central axis 359 of the tooth, which extends from the center of the root of the tooth through the center of the occlusal surface of the tooth. The visualization can also include a depiction or indication of tool type 358 and tool head type 357. Finally, the visualization also includes an indication of the direction 354 in which tool head 352 should be moved, including translation and rotation, in order to remove appropriate material from tooth 356 for this particular step of the treatment plan.

[0071] Although depicted as a two-dimensional image, Figure 3CThe visualization shown in can be a manipulable three-dimensional model that allows the practitioner to rotate, zoom, and otherwise manipulate the model so that the practitioner can view the material removal steps from several angles. In addition, in some embodiments, the visual depiction can show the process in a two-dimensional or three-dimensional video or moving form. In such an embodiment, in addition to indicating the direction of tool movement, the video can also depict a simulation of the material removal process, including depicting the movement of the tool, showing the direction of tool movement translation and rotation and the appropriate speed at which the tool should move during the material removal process.

[0072] Figure 3D Further preparation of the upper left central incisor 356 is shown. The visualization shows the position and orientation of the tool 360 and tool head 362 relative to the tooth 356 being prepared. The tool 360 and tool head 362 may be different from Figure 3C The tool 350 and tool head 352 are depicted in FIG. Figure 3C As with the treatment steps shown in , the orientation of tool 360 and tool head 362 can be shown relative to, for example, the central axis of tooth 356, which extends from the center of the root of the tooth through the center of the occlusal surface of the tooth. Figure 3D The visualization in may also include a depiction or indication 368 of the tool type and tool head type. Finally, the visualization may also include an indication of the direction 364 in which the tool head 362 should be moved in order to remove the appropriate material from the tooth 356.

[0073] Although depicted as a two-dimensional image, Figure 3D The visualization shown in can be a manipulable three-dimensional model that allows the practitioner to rotate, zoom, and otherwise manipulate the model so that the practitioner can view the material removal steps from several angles. In addition, in some embodiments, the visual depiction can show the process in a two-dimensional or three-dimensional video or moving form. In such an embodiment, in addition to indicating the direction of tool movement, the video can also depict a simulation of the material removal process, including depicting the movement of the tool, showing the direction of tool movement translation and rotation and the appropriate speed at which the tool should move during the material removal process.

[0074] In some embodiments, at box 312 or box 402, the dental professional can perform simulated material removal in a computer simulation environment using a virtual tool, such as a tool that resembles an actual tool, or by using a digital volume removal tool to simulate the removal of material, but without displaying and simulating the presence of the tool. Such simulated material removal is shown using a model (e.g., a volume model or a surface model) of the patient's mouth, teeth, and / or gums. In such a simulation, for example, when the dental professional moves the virtual tool, or the digital volume removal tool model is modified to show simulated changes to the teeth, the volume model can be updated by removing volume from the model, or the surface model can be updated to reflect an updated surface contour, which reflects the material removed by the dental professional using the tool.

[0075] One or more steps of method 300 may be performed using circuits described herein, for example, using one or more of a processor or logic circuit of a computer or computerized system. The circuit may be programmed to provide one or more steps of method 300, and the program may include, for example, program instructions stored on a computer readable memory or programming steps of a logic circuit.

[0076] Figure 4 A method 400 for evaluating treatment and providing feedback during treatment is shown in accordance with an embodiment described herein. The method 400 may include material removal, re-imaging of the dentition, and updating the treatment plan. At box 402, the dental professional may attempt to remove material from the teeth, as depicted in one or more steps of a treatment plan generated according to the methods described above. After some material has been removed from the patient's teeth, at box 404, the dental professional may rescan the patient's dentition, including, for example, the teeth being prepared. The re-imaging of the patient's dentition or teeth may include the above-described steps described in connection with method 200 (with respect to Figure 2A After re-imaging and reconstructing an updated model of the patient's dentition, the model may be marked to indicate remaining material to be removed from the teeth. For example, an updated model may be generated, such as Figure 3B The model shown in FIG. 1 and displayed to a potential medical practitioner. The model may indicate the amount of material to be removed numerically and also by highlighting on the model (e.g., using a heat map, etc.) the material that remains to be removed.

[0077] In some embodiments, material removal may be performed by robotic-assisted methods such as robotic-assisted surgery, in which a dental professional controls the movement of a robot and attached dental tools via a telemanipulator or by computer control. Material removal may also be performed by computer numerical control (CNC), in which automation of one or more machine tools is controlled by means of one or more computers that execute a preprogrammed sequence of machine control commands.

[0078] In some embodiments, the method 300 for generating a visualization can be repeated based on the updated model. In such embodiments, updated tool information including tool type, tool position, and tool path can be used to generate an updated visualization of the treatment. In some embodiments, the updated visualization performed simply depicts updates to a specific step in the treatment plan, such as a current step for removing remaining tooth material.

[0079] However, in some embodiments, the dentist may have removed material that was not indicated to be removed according to the treatment plan. In such embodiments, the updated scans may be used to modify the treatment planning process. Figure 2A The method 200 shown and described generates a new final tooth shape and can be based on the Figure 3A The method 300 shown and described may be used to generate a new visualization. After generating the updated visualization, the dentist may continue with the treatment. The dentition may be rescanned at block 404 and an updated treatment plan may be generated at block 406, as many times as desired by the dental professional performing the preparation until the preparation is complete.

[0080] One or more steps of method 400 may be performed using circuits described herein, for example, using one or more of a processor or logic circuit of a computer or computerized system. The circuit may be programmed to provide one or more steps of method 400, and the program may include, for example, program instructions stored on a computer readable memory or programming steps of a logic circuit.

[0081] Figure 5 A system for performing a method of visual restorative and orthodontic treatment planning according to an embodiment is shown. Figure 55 is a simplified block diagram of a data processing system 500 that can be used to perform the methods and processes described herein. The data processing system 500 typically includes at least one processor 502 that communicates with one or more peripheral devices via a bus subsystem 504. These peripheral devices typically include a storage subsystem 506 (a memory subsystem 508 and a file storage subsystem 514), a set of user interface input and output devices 518, and an interface 516 to an external network. The interface is schematically shown as a "network interface" box 516 and is coupled to corresponding interface devices in other data processing systems via a communication network interface 524. The data processing system 500 may include, for example, one or more computers, such as personal computers, workstations, mainframes, laptop computers, etc.

[0082] The user interface input device 518 is not limited to any particular device, and may generally include, for example, a keyboard, a pointing device, a mouse, a scanner, an interactive display, a touch pad, a joystick, etc. Similarly, various user interface output devices may be used in the system of the present invention, and may include, for example, one or more of a printer, a display (e.g., visual, non-visual) system / subsystem, a controller, a projection device, an audio output, etc.

[0083] The storage subsystem 506 maintains the basic necessary programs, including computer readable media with instructions (e.g., operating instructions, etc.) and data structures. The program modules discussed herein are generally stored in the storage subsystem 506. The storage subsystem 506 generally includes a memory subsystem 508 and a file storage subsystem 514. The memory subsystem 508 generally includes a number of memories (e.g., RAM 510, ROM 512, etc.), including computer readable memory for storing fixed instructions, instructions and data during program execution, basic input / output systems, etc. The file storage subsystem 514 provides persistent (non-volatile) storage for program and data files, and may include one or more removable or fixed drives or media, hard disks, floppy disks, CD-ROMs, DVDs, optical drives, etc. One or more of the storage systems, drives, etc. may be located at a remote location, for example, via a server on a network or coupled via the Internet / World Wide Web. In this context, the term "bus subsystem" is used generically to include any mechanism for enabling the various components and subsystems to communicate with each other as intended, and may include various suitable components / systems that will be recognized or deemed suitable for use herein. It will be recognized that the various components of the system may, but need not necessarily, be located in the same physical location, but may be connected via various local or wide area network media, transmission systems, etc.

[0084] Scanner 520 includes any means for obtaining a digital representation (e.g., image, surface topography data, etc.) of a patient's teeth, which may be obtained from the patient or from a treating professional (e.g., an orthodontist) (e.g., by scanning a physical model of the teeth such as a cast 521, by scanning an impression taken from the teeth, or by directly scanning the oral cavity), and includes means for providing the digital representation to data processing system 500 for further processing. Scanner 520 may be located at a remote location relative to the other components of the system, and may transmit image data and / or information to data processing system 500, for example, via network interface 524. Manufacturing system 522 manufactures appliance 523 based on a treatment plan including data set information received from data processing system 500. Manufacturing machine 522 may be located at a remote location, for example, and receive data set information from data processing system 500 via network interface 524.

[0085] Although preferred embodiments of the present invention have been shown and described herein, it will be apparent to those skilled in the art that such embodiments are provided as examples only. Those skilled in the art will now appreciate many variations, changes and substitutions without departing from the present invention. It should be understood that various alternatives to the embodiments of the invention described herein may be adopted when implementing the present invention. Various different combinations of the embodiments described herein are possible, and such combinations are considered to be a part of this disclosure. In addition, all features discussed in conjunction with any one of the embodiments herein may be easily adapted to be used in other embodiments herein. It is intended that the appended claims define the scope of the invention, and therefore cover methods and structures within the scope of these claims and their equivalents.

Claims

1. A non-transitory computing device readable medium storing instructions executable by a processor to cause a computing device to perform a method, the method comprising: receiving an initial representation of a patient's dentition, wherein the initial representation includes a representation of the patient's teeth in an initial shape; generating a treatment plan comprising a plurality of steps to modify an initial shape of the patient's teeth to a final shape, wherein the treatment plan is based at least in part on an initial representation of the patient's dentition; receiving an updated representation of the patient's dentition, wherein the updated representation includes a subsequent representation of the patient's teeth after portions of material have been removed according to steps of the treatment plan; determining whether a subsequent representation of the patient's teeth corresponds to an expected treatment progression of the steps of the treatment plan; and The treatment plan is updated based on determining that the update represents an expected treatment progress that does not correspond to a step of the treatment plan.

2. The non-transitory computing device readable medium of claim 1, wherein: The initial representation of the patient's dentition includes a three-dimensional surface scan.

3. The non-transitory computing device readable medium of claim 1, wherein: The initial representation of the patient's dentition includes multiple two-dimensional infrared image scans.

4. The non-transitory computing device readable medium of claim 1, wherein: The initial representation of the patient's dentition includes multiple two-dimensional near-infrared image scans.

5. The non-transitory computing device readable medium of claim 1, in, The initial representation of the patient's dentition includes a plurality of two-dimensional infrared image scans or a plurality of two-dimensional near infrared image scans, and The method further includes establishing a volume model based on multiple two-dimensional infrared image scans or multiple two-dimensional near-infrared image scans.

6. The non-transitory computing device readable medium according to claim 5, wherein: A volume model includes a plurality of voxels.

7. The non-transitory computing device readable medium of claim 1, wherein: The method also includes determining a tooth enamel thickness; and wherein generating a treatment plan is based at least in part on the determined tooth enamel thickness.

8. The non-transitory computing device readable medium of claim 1, wherein: The method further includes detecting caries based on the received initial representation; and wherein a treatment plan is generated based at least in part on the detected caries.

9. The non-transitory computing device readable medium of claim 1, wherein: The method further includes determining a dental defect type based on the received initial representation; and wherein generating a treatment plan is based at least in part on the determined dental defect type.

10. The non-transitory computing device readable medium of claim 1, wherein: The method further includes determining a tooth enamel structure based on the received initial representation; and wherein generating a treatment plan is based at least in part on the determined tooth enamel structure.

11. The non-transitory computing device readable medium of claim 1 , wherein: The method also includes receiving patient-specific constraints, and wherein the treatment plan is generated based at least in part on the patient-specific constraints.

12. The non-transitory computing device readable medium of claim 1, wherein: Treatment planning provides orthodontic treatment.

13. The non-transitory computing device readable medium of claim 1, wherein: Treatment planning provides visual restorative treatment.

14. The non-transitory computing device readable medium of claim 1, wherein: The method also includes generating a visualization of the treatment plan, wherein the visualization includes depicting the patient's dentition through a plurality of steps of the treatment plan.

15. The non-transitory computing device readable medium of claim 14, wherein: The visualization includes a video file depicting the patient's teeth through the various steps of the treatment plan.

16. The non-transitory computing device readable medium of claim 14, wherein: The visualization includes a manipulable three-dimensional model that is configured to be rotated, magnified, and viewed from different angles.

17. The non-transitory computing device readable medium of claim 14, wherein: The method also includes providing the visualization to a dental professional.

18. The non-transitory computing device readable medium of claim 14, wherein: Visualize the simulation depicting the material removal process according to the steps of the treatment plan.

19. The non-transitory computing device readable medium of claim 18, wherein: The simulation of the material removal process includes tool movement parameters including translation, rotation and velocity.

20. The non-transitory computing device readable medium of claim 1, wherein: The method also includes updating the visualization of the treatment plan based on determining that the updated representation does not correspond to the expected treatment progress of the steps of the treatment plan.

21. A non-transitory computing device readable medium storing instructions executable by a processor to cause a computing device to perform a method, the method comprising: receiving an initial representation of a patient's dentition, wherein the initial representation includes a representation of the patient's teeth in an initial shape; accepting restrictions on the treatment of the patient's teeth; and generating a treatment plan including a plurality of steps to modify an initial shape of the patient's teeth to a final shape, wherein the treatment plan is based at least in part on the treatment constraints and the initial representation of the patient's dentition; wherein the method further comprises establishing a volume model based on the initial representation of the patient's dentition and subsurface image data of the internal structure of the patient's dentition, Wherein the volumetric model includes a plurality of voxels depicting an internal structure of the patient's dentition, at least one voxel includes a dental defect type, and wherein the treatment plan is generated based at least in part on the dental defect type.

22. The non-transitory computing device readable medium of claim 21, wherein: The initial representation of the patient's dentition includes a three-dimensional surface scan.

23. The non-transitory computing device readable medium of claim 21, wherein: The initial representation of the patient's dentition includes multiple two-dimensional infrared image scans.

24. The non-transitory computing device readable medium of claim 21, wherein: The initial representation of the patient's dentition includes multiple two-dimensional near-infrared image scans.

25. The non-transitory computing device readable medium of claim 21, wherein: The initial representation of the patient's dentition includes a plurality of two-dimensional infrared image scans or a plurality of two-dimensional near infrared image scans.

26. The non-transitory computing device readable medium of claim 21, wherein: Treatment constraints include the dental tools to be used in the treatment plan.

27. The non-transitory computing device readable medium of claim 21, wherein: The treatment constraints include characteristics of a prosthesis to be used in the treatment plan; wherein the characteristics of the prosthesis include one of shape, minimum thickness, or spacing tolerance.

28. The non-transitory computing device readable medium of claim 21, wherein: The treatment constraints include patient-specific characteristics; wherein the patient-specific characteristics include one of a size of the patient's mouth, a physical limit to how wide the patient's mouth can open, and a thickness of tooth enamel.

29. The non-transitory computing device readable medium of claim 21, wherein: The treatment plan includes the distribution of interproximal removal between two teeth.

30. The non-transitory computing device readable medium of claim 29, wherein: The distribution of interproximal removal between two teeth is based at least in part on the difference in enamel thickness between the two teeth.

31. The non-transitory computing device readable medium of claim 21, wherein: The method also includes determining a tooth enamel thickness; and wherein generating a treatment plan is based at least in part on the determined tooth enamel thickness.

32. The non-transitory computing device readable medium of claim 21, wherein: The method further includes detecting caries based on the received initial representation; and wherein a treatment plan is generated based at least in part on the detected caries.

33. The non-transitory computing device readable medium of claim 21, wherein: The method also includes determining a dental defect type based on the received initial representation.

34. The non-transitory computing device readable medium of claim 21, wherein: Treatment planning provides orthodontic treatment.

35. The non-transitory computing device readable medium of claim 21, wherein: Treatment planning provides visual restorative treatment.

36. The non-transitory computing device readable medium of claim 21, wherein: The method also includes generating a visualization of the treatment plan, wherein the visualization includes depicting the patient's dentition through a plurality of steps of the treatment plan.

37. The non-transitory computing device readable medium of claim 36, wherein: The visualization includes a video file depicting the patient's teeth through the various steps of the treatment plan.

38. The non-transitory computing device readable medium of claim 36, wherein: The visualization includes a manipulable three-dimensional model that is configured to be rotated, magnified, and viewed from different angles.

39. The non-transitory computing device readable medium of claim 36, wherein: Visualize the simulation depicting the material removal process according to the steps of the treatment plan.

40. The non-transitory computing device readable medium of claim 39, wherein: The simulation of the material removal process includes tool movement parameters, which include translation, rotation and speed.

41. The non-transitory computing device readable medium of claim 21, wherein: The method also includes receiving an updated model of the patient's teeth, wherein the updated model represents the patient's teeth after removing a portion of material according to the steps of the treatment plan; and comparing the updated model of the patient's teeth to an expected treatment progression of the steps of the treatment plan.

42. A non-transitory computing device readable medium storing instructions executable by a processor to cause a computing device to perform a method, the method comprising: receiving an initial representation of a patient's dentition, wherein the initial representation includes a representation of the patient's teeth in an initial shape; Receive treatment constraints for the patient's teeth; generating a treatment plan including a plurality of steps to modify an initial shape of the patient's teeth to a final shape, wherein the treatment plan is based at least in part on the initial representation of the patient's dentition and the treatment constraints; receiving an updated representation of the patient's dentition, wherein the updated representation includes a subsequent representation of the patient's teeth after portions of material have been removed according to the steps of the treatment plan; and Compare updated models of the patient's teeth with the expected treatment progress of the steps in the treatment plan; Wherein the treatment constraints include at least one of dental tools to be used in the treatment plan, characteristics of a prosthesis to be used in the treatment plan, or patient-specific characteristics, and wherein the treatment plan is generated at least in part based on different priorities for each treatment constraint.

43. The non-transitory computing device readable medium of claim 42, wherein: The method also includes determining whether a subsequent representation of the patient's teeth corresponds to an expected treatment progression of the steps of the treatment plan; and updating the treatment plan based on determining that the updated representation does not correspond to the expected treatment progression of the steps of the treatment plan.

44. The non-transitory computing device readable medium of claim 42, wherein: The method also includes indicating remaining material that should be removed according to the steps of the treatment plan.

45. The non-transitory computing device readable medium of claim 42, wherein: The initial representation of the patient's dentition includes a three-dimensional surface scan.

46. ​​The non-transitory computing device readable medium of claim 42, wherein: The initial representation of the patient's dentition includes multiple two-dimensional infrared image scans.

47. The non-transitory computing device readable medium of claim 42, wherein: The initial representation of the patient's dentition includes multiple two-dimensional near-infrared image scans.

48. The non-transitory computing device readable medium of claim 42, wherein: The method further includes establishing a volumetric model based on an initial representation of the patient's dentition, and wherein the initial representation of the patient's dentition includes a plurality of two-dimensional infrared image scans or a plurality of two-dimensional near infrared image scans.

49. The non-transitory computing device readable medium of claim 48, wherein: A volume model includes a plurality of voxels.

50. The non-transitory computing device readable medium of claim 48, wherein: Each of the plurality of voxels includes a location within the volume model, a tooth structure type, and a density.

51. The non-transitory computing device readable medium of claim 48, wherein: The method also includes: establishing a three-dimensional surface model of the patient's dentition from a three-dimensional surface scan of the patient's dentition; and establishing a composite model from the three-dimensional surface model and the volume model.

52. The non-transitory computing device readable medium of claim 42, wherein: The characteristics of the prosthesis include one of shape, minimum thickness, or spacing tolerance.

53. The non-transitory computing device readable medium of claim 42, wherein: The patient-specific characteristics include one of the size of the patient's mouth, the physical limit to how wide the patient's mouth can open, and the thickness of tooth enamel.

54. The non-transitory computing device readable medium of claim 42, wherein: The treatment plan includes the distribution of interproximal removal between two teeth.

55. The non-transitory computing device readable medium of claim 54, wherein: The distribution of interproximal removal between two teeth is based at least in part on the difference in enamel thickness between the two teeth.

56. The non-transitory computing device readable medium of claim 42, wherein: The method also includes determining a tooth enamel thickness; and wherein generating a treatment plan is based at least in part on the determined tooth enamel thickness.

57. The non-transitory computing device readable medium of claim 42, wherein: The method further includes detecting caries based on the received initial representation; and wherein a treatment plan is generated based at least in part on the detected caries.

58. The non-transitory computing device readable medium of claim 42, wherein: The method further includes determining a dental defect type based on the received initial representation; and wherein generating a treatment plan is based at least in part on the determined dental defect type.

59. The non-transitory computing device readable medium of claim 42, wherein: Treatment planning provides orthodontic treatment.

60. The non-transitory computing device readable medium of claim 42, wherein: Treatment planning provides visual restorative treatment.

61. The non-transitory computing device readable medium of claim 42, wherein: The method also includes generating a visualization of the treatment plan, wherein the visualization includes depicting the patient's dentition through a plurality of steps of the treatment plan.

62. The non-transitory computing device readable medium of claim 61, wherein: The visualization includes a video file depicting the patient's teeth through the various steps of the treatment plan.

63. The non-transitory computing device readable medium of claim 61, wherein: The visualization includes a manipulable three-dimensional model that is configured to be rotated, magnified, and viewed from different angles.

64. The non-transitory computing device readable medium of claim 61, wherein: Visualize the simulation depicting the material removal process according to the steps of the treatment plan.

65. The non-transitory computing device readable medium of claim 64, wherein: The simulation of the material removal process includes tool movement parameters, which include translation, rotation and speed.

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