System, method and device for correcting malocclusion of teeth

Abstract

A method and system for manufacturing an appliance for correcting a patient's dental malocclusion is provided. The method may include measuring the position of the patient's teeth and receiving tooth movement constraints. The method may also include generating an initial treatment plan based on the measured tooth positions and tooth movement constraints, and measuring the malocclusion of the patient's teeth for one or more types of dental malocclusion. The method may also include generating multiple treatment plans from the initial treatment plan based on the measured malocclusion, and generating a model of the appliance for each stage of the treatment plan. The method may also include generating instructions for manufacturing the appliance for each stage of the treatment plan based on the model of the appliance for each stage of the treatment plan.

Description

[0001] This application is a divisional application of an application with a filing date of August 14, 2018, application number 2018800533854, and invention name “System, method and device for correcting malocclusion of teeth”.

[0002] Cross-references

[0003] This application claims the benefit of U.S. Provisional Application No. 62 / 547,004, filed August 17, 2017, which is incorporated herein by reference. Background Art

[0004] Treatment planning and fabrication of aligners is a linear, back-and-forth process with delays between providing feedback and revising the treatment plan, and requires specialized knowledge to figure out which of the patient's dental malocclusions to correct. This process is not ideal because it leaves room for error during treatment planning. Summary of the invention

[0005] A method for manufacturing an orthodontic appliance is disclosed. The method may include measuring the position of a patient's teeth and receiving tooth movement constraints. The method may also include: for one or more types of tooth malocclusion, measuring a first element of the patient's tooth malocclusion, and generating multiple treatment plans based on the measured tooth position and tooth movement constraints. A first temporary final position may be generated for each of the multiple treatment plans. For the multiple treatment plans, a second element of the patient's tooth malocclusion in the first temporary final position may be measured; for each of the multiple treatment plans, the first temporary final position corrects the element of the patient's tooth malocclusion; and a final position may be generated for each of the multiple treatment plans. The method may also include selecting a treatment plan from the multiple treatment plans and generating a model of the appliance for each stage of the selected treatment plan. Based on the model of the appliance for each stage of the selected treatment plan, instructions for manufacturing the appliance for each stage of the selected treatment plan may be output.

[0006] In some embodiments, the method may include manufacturing an appliance for one or more phases of the selected treatment plan according to instructions for manufacturing a corresponding appliance.

[0007] In some embodiments, the method may include: for each treatment plan, generating two new treatment plans, a first new treatment plan with bicuspid extraction and a second new treatment plan without bicuspid extraction, and for each of the first and second new treatment plans for each of the multiple treatment plans, determining a second temporary final tooth position.

[0008] In some embodiments, the method may include measuring a position of a molar in each of the first and second new treatment plans of each of the plurality of treatment plans to determine a molar class bite for each treatment plan.

[0009] In some embodiments, for each treatment plan, if there is a Class II, Class III, or mixed Class II and Class III malocclusion of the molars in the second temporary final tooth position, the method may include correcting or improving the malocclusion of the molars, and generating a third temporary final tooth position for each of the first and second new treatment plans for each of the multiple treatment plans.

[0010] In some embodiments, the method may include measuring a position of a canine in each of the first and second new treatment plans of each of the plurality of treatment plans to determine a canine class bite for each treatment plan.

[0011] In some embodiments, for each treatment plan, if there is a canine Class II, Class III, or mixed Class II and Class III malocclusion in the second temporary final tooth position, the method may include correcting or improving the canine malocclusion and generating a third temporary final tooth position for each of the first and second new treatment plans for each of the multiple treatment plans.

[0012] In some embodiments, for each treatment plan, based on the presence and strength of the Class II or Class III canine bite, a third and a fourth new treatment plan can be generated, wherein the third new treatment plan includes premolar extraction and the fourth new treatment plan does not include premolar extraction.

[0013] In some embodiments, the method may include measuring the position of teeth in each of the first and second new treatment plans for each of the multiple treatment plans based on the second temporary final tooth position for each treatment plan to determine an amount of overjet for each treatment plan.

[0014] In some embodiments, for each treatment plan, based on the amount of upper buccal and lower lingual horizontal coverage, a third and fourth new treatment plans can be generated, wherein the third new treatment plan includes deglazing the proximal surfaces of the lower anterior teeth and the fourth new treatment plan includes correcting the upper anterior spaces.

[0015] In some embodiments, for each treatment plan, the method may include determining a third temporary final tooth position.

[0016] A system for manufacturing an orthodontic appliance is disclosed. The system may include a processor and a memory, the memory including instructions that, when executed by a process, cause the system to: measure the position of a patient's teeth; receive tooth movement constraints; measure a first element of the patient's tooth malocclusion for one or more types of tooth malocclusion; generate multiple treatment plans based on the measured tooth positions and tooth movement constraints; generate a first temporary final position for the multiple treatment plans; for the multiple treatment plans, measure a second element of the patient's tooth malocclusion in the first temporary final position; modify the first temporary final position of each of the multiple treatment plans to correct the element of the patient's tooth malocclusion and generate a final position for each of the multiple treatment plans; select a treatment plan from the multiple treatment plans and generate a model of an appliance for each stage of the selected treatment plan; and based on the model of the appliance for each stage of the selected treatment plan, output instructions for manufacturing an appliance for each stage of the selected treatment plan.

[0017] In some embodiments, the instructions further cause the system to: fabricate an appliance for one or more phases of the treatment plan from the instructions for fabricating a corresponding appliance.

[0018] The instructions may also cause the system to: for each treatment plan, generate two new treatment plans, a first new treatment plan with extracted premolars (bicuspid) and a second new treatment plan without extracted premolars, and for each of the first and second new treatment plans for each of the multiple treatment plans, determine a second temporary final tooth position.

[0019] In some embodiments, the instructions further cause the system to: measure a position of a molar in each of the first and second new treatment plans for each of the plurality of treatment plans to determine a molar class bite for each treatment plan.

[0020] In some embodiments, for each treatment plan, if there is a Class II, Class III, or mixed Class II and Class III malocclusion of the molars in the second temporary final tooth position, the instructions further cause the system to: correct or improve the malocclusion of the molars, and generate a third temporary final tooth position for each of the first and second new treatment plans for each of the multiple treatment plans.

[0021] In some embodiments, the instructions further cause the system to: measure a position of a canine in each of the first and second new treatment plans of each of the plurality of treatment plans to determine a canine class occlusion for each treatment plan.

[0022] In some embodiments, for each treatment plan, if a canine Class II, Class III, or mixed Class II and Class III malocclusion exists in the second temporary final tooth position, the instructions further cause the system to: correct or improve the canine malocclusion, and generate a third temporary final tooth position for each of the first and second new treatment plans for each of the multiple treatment plans.

[0023] In some embodiments, for each treatment plan, the instructions further cause the system to generate a third and a fourth new treatment plan based on the presence and strength of the Class II or Class III canine bite, wherein the third new treatment plan includes premolar extraction and the fourth new treatment plan does not include premolar extraction.

[0024] In some embodiments, the instructions further cause the system to measure the position of the teeth in each of the first and second new treatment plans for each of the multiple treatment plans based on the second temporary final tooth position for each treatment plan to determine a horizontal overjet amount for each treatment plan.

[0025] In some embodiments, for each treatment plan, the instructions further cause the system to generate a third and a fourth new treatment plan based on the amount of upper buccal and lower lingual coverage, wherein the third new treatment plan includes deglazing the proximal surfaces of the lower anterior teeth and the fourth new treatment plan includes correcting the upper anterior spaces.

[0026] In some embodiments, for each treatment plan, the instructions further cause the system to: determine a third temporary final tooth position.

[0027] Merge by reference

[0028] 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

[0029] The novel features of the present disclosure are particularly set forth in the appended claims. A better understanding of the features and advantages of the present disclosure will be obtained by referring to the following detailed description, which describes illustrative embodiments utilizing the principles of the present invention and in conjunction with the accompanying drawings:

[0030] Figure 1A A tooth repositioning appliance according to one or more embodiments herein is shown;

[0031] Figure 1B A tooth repositioning system according to one or more embodiments herein is shown;

[0032] Figure 1C An orthodontic treatment method using multiple appliances according to one or more embodiments herein is shown;

[0033] Figure 2 A method for determining the geometry of an orthodontic appliance according to one or more embodiments herein is shown;

[0034] Figure 3 A method for digitally planning orthodontic treatment and manufacturing an appliance according to one or more embodiments herein is shown;

[0035] Figure 4 shows a simplified block diagram of a data processing system according to one or more embodiments herein;

[0036] Figure 5A and 5B A method for digitally planning orthodontic treatment and manufacturing an appliance according to one or more embodiments herein is shown;

[0037] Figure 6 A method of generating multiple treatment plans according to one or more embodiments herein is shown.

[0038] Figure 7 A method for correcting bi-maxillary protrusion of teeth in a treatment plan according to one or more embodiments of the present invention is shown;

[0039] Figure 8 A method of correcting malocclusion and position of molars in a treatment plan according to one or more embodiments herein is shown;

[0040] Fig. 9 A method of correcting malocclusion and position of canine teeth in a treatment plan according to one or more embodiments herein is shown;

[0041] Fig.10 A method of correcting tooth overjet in a treatment plan according to one or more embodiments herein is shown; and

[0042] Fig.11 A method of extracting anterior teeth in a treatment plan according to one or more embodiments herein is shown; and

[0043] Fig.12 Shown is the presentation and selection of a treatment plan for treating a patient according to one or more embodiments herein. DETAILED DESCRIPTION

[0044] Figure 1A An exemplary tooth repositioning appliance or aligner 100 is shown, which can be worn by a patient to achieve incremental repositioning of a single tooth 121 in a jaw. The appliance may include a housing 110 (e.g., a continuous polymer shell or a segmented shell) having a tooth receiving chamber 111 that receives and elastically repositions the tooth 121. The appliance or a portion thereof may be indirectly manufactured using a physical model of the teeth. For example, an appliance (e.g., a polymer appliance) may be formed using a physical model of the teeth and a suitable layer of polymer material. In some embodiments, a physical appliance is directly manufactured from a digital model of the appliance, for example using cumulative manufacturing techniques. The appliance may fit on all teeth present in the upper or lower jaw, or on less than all teeth. The appliance may be specifically designed to accommodate the patient's teeth (e.g., the topography of the tooth receiving chamber matches the topography of the patient's teeth), and the appliance may be manufactured based on a positive or negative model of the patient's teeth generated by molding, scanning, etc. Optionally, the appliance may be a universal appliance configured to accommodate teeth, but not necessarily in a certain shape to match the topography of the patient's teeth. In some cases, only certain teeth accommodated by the appliance may be repositioned by the appliance, while other teeth may provide a base or anchor area to hold the appliance in place as the appliance applies force against the repositioned teeth. In some cases, some, most, or even all of the teeth may be repositioned at some point during treatment. The moved teeth may also serve as a base or anchor to hold the appliance while it is worn by the patient. Typically, wires or other devices for holding the appliance in place over the teeth may not be provided. However, in some cases, it may be desirable or necessary to provide separate attachments or other functional components of the aligner to control the transmission and distribution of forces. Example appliances, including Aligners such as those used in the System are described in a number of Align Technology's patents and patent applications, including, for example, U.S. Patent Nos. 6,450,807 and 5,975,893, and on the company's website, which is accessible on the Internet (e.g., see link "invisalign.com"). Examples of tooth-mounted accessories for use with orthodontic appliances are also described in Align Technology's patents and patent applications, including, for example, U.S. Patent Nos. 6,309,215 and 6,830,450.

[0045] Optionally, in situations involving more complex movements or treatment plans, it may be beneficial to utilize auxiliary components (e.g., features, accessories, structures, devices, components, etc.) in conjunction with the orthodontic appliance. Examples of such accessories include, but are not limited to, elastics, wires, springs, bars, arch expanders, palatal expanders, twin blocks, occlusal blocks, bite ramps, mandibular advancement splints, bite plates, pontics, hooks, brackets, headgear tubes, springs, bumper tubes, palatal bars, frameworks, pin-and-tube apparatuses, buccal shields, buccinator bows, wire shields, lingual flanges and pads, lippads or bumpers, protrusions and divots, and the like. Other examples of attachments include, but are not limited to, opposing arch features, occlusal features, torsional stiffness features, occlusal cusps, and bridges. In some embodiments, the appliances, systems, and methods described herein include orthodontic appliances having improved integrally formed features that are shaped to couple to or replace such ancillary components.

[0046] Figure 1BA tooth repositioning system 110 is shown that includes a plurality of appliances 112, 114, 116. Any of the appliances described herein may be designed and / or provided as part of a set of a plurality of appliances for use in a tooth repositioning system. Each appliance may be configured such that a tooth receiving cavity has a geometry corresponding to an intermediate or final tooth arrangement intended for the appliance. The patient's teeth may be progressively moved from an initial tooth arrangement to a target tooth arrangement by placing a series of incremental position adjustment devices on the patient's teeth. For example, the tooth repositioning system 110 may include a first appliance 112 corresponding to an initial tooth arrangement, one or more intermediate appliances 114 corresponding to one or more intermediate arrangements, and a final appliance 116 corresponding to a target arrangement. The target tooth arrangement may be a designed final tooth arrangement selected for the patient's teeth at the end of all designed orthodontic treatment. Alternatively, the target arrangement can be one of a number of intermediate arrangements of the patient's teeth during orthodontic treatment, which can include a variety of different treatment plans, including but not limited to the following: surgery is recommended, appropriate interproximal enamel removal (IPR), scheduling progress checks, anchor position optimization, necessary palate expansion, involving restorative dentistry (e.g., inlays, onlays, crowns, bridges, implants, veneers, etc.). Thus, it will be understood that the target tooth arrangement can be any planned resulting arrangement of the patient's teeth following one or more incremental repositioning stages. Likewise, the initial tooth arrangement can be any initial arrangement of the patient's teeth followed by one or more incremental repositioning stages.

[0047] Figure 1CA method 150 of orthodontic treatment using multiple appliances according to an embodiment is shown. The method 150 can be practiced using any appliance or appliance set described herein. In step 160, a first orthodontic appliance is applied to the patient's teeth so as to reposition the teeth from a first tooth arrangement to a second tooth arrangement. In step 170, a second orthodontic appliance is applied to the patient's teeth so as to reposition the teeth from the second tooth arrangement to a third tooth arrangement. The method 150 can be repeated as needed using any suitable number and sequence of appliance combinations so as to incrementally reposition the patient's teeth from an initial arrangement to a target arrangement. These appliances can be manufactured all at the same stage or in groups or batches (e.g., at the beginning of a treatment stage), or one appliance can be manufactured at a time, and the patient can wear each appliance until the teeth no longer feel pressure or until the maximum amount of tooth movement is reached. A variety of different appliances (e.g., a set) can be designed and even manufactured before the patient wears any of the multiple appliances. After wearing for an appropriate period of time, the patient can replace the current appliance with the next appliance in the series until no more appliances are left. The appliances are usually not fixed to the teeth, and the patient can place and replace the appliances at any time during treatment (e.g., patient-removable appliances). The final appliance or several appliances in the series may have one or more geometries selected for overcorrecting the tooth arrangement. For example, one or more appliances may have such a geometry that (if fully realized) moves a single tooth out of the tooth arrangement that has been selected as the "final". This overcorrection may be desirable to eliminate potential relapses (e.g., allowing a single tooth to move back toward its pre-corrected position) after the repositioning method has ended. Overcorrection may also be beneficial to speed up the correction (e.g., an appliance with a geometry that exceeds the desired intermediate position or final position may move a single tooth to that position at a greater rate). In this case, the use of the appliance can be terminated before the tooth reaches the position determined by the appliance. In addition, overcorrection can be deliberately performed to compensate for any inaccuracies or limitations of the appliance.

[0048] Various embodiments of the orthodontic appliance presented herein can be manufactured in a variety of ways. In some embodiments, the orthodontic appliance (or a portion thereof) herein can be produced using direct manufacturing, such as additive manufacturing technology (also referred to herein as "3D printing") or subtractive manufacturing technology (e.g., milling). In some embodiments, direct manufacturing involves forming an object (e.g., an orthodontic appliance or a portion thereof) without using a physical template (e.g., a mold, a mask, etc.) to define the geometry of the object. For example, stereolithography can be used to directly manufacture one or more appliances herein. In some embodiments, stereolithography involves selectively polymerizing a photosensitive resin (e.g., a photosensitive polymer) using light (e.g., ultraviolet light) according to an expected cross-sectional shape. By sequentially polymerizing the cross sections of multiple objects, a geometry can be established in a layer-by-layer manner. As another example, the appliance herein can be directly manufactured using selective laser sintering. In some embodiments, selective laser sintering involves selectively melting and fusing layers of powdered material using a laser beam according to an expected cross-sectional shape in order to establish a geometry. As yet another example, the appliance herein can be directly manufactured by fused deposition molding. In some embodiments, fused deposition modeling includes melting and selectively depositing filaments of thermoplastic polymers in a layered manner to form an object. In yet another example, material spraying can be used to directly manufacture the aligners described herein. In some embodiments, material spraying involves spraying or extruding one or more materials onto a construction surface to form successive layers of the geometric body.

[0049] In some embodiments, the direct manufacturing methods provided herein build up geometries in a layer-by-layer manner and form continuous layers in discontinuous building steps. Alternatively or in combination, direct manufacturing methods that allow continuous building of geometries can be used, referred to herein as "continuous direct manufacturing". Various types of continuous direct manufacturing methods can be used. Continuous liquid interphase printing is described in U.S. Patent Publication Nos. 2015 / 0097315, 2015 / 0097316, and 2015 / 0102532, the contents of each of which are incorporated herein by reference in their entirety.

[0050] As another example, a continuous direct manufacturing method can achieve continuous construction of a geometric body by continuous movement of the build platform during irradiation (e.g., along the vertical direction or Z direction), so that the hardening depth of the irradiated photosensitive polymer is controlled by the movement speed. Thus, continuous polymerization of the material on the forming surface can be achieved. Such a method is described in U.S. Patent No. 7,892,474, the disclosure of which is incorporated herein by reference in its entirety.

[0051] In another example, a continuous direct manufacturing method may involve extruding a composite material consisting of a curable liquid material surrounding a solid state line. The composite material may be extruded along a continuous three-dimensional path to form an object. Such a method is described in U.S. Patent Publication No. 2014 / 0061974, the disclosure of which is incorporated herein by reference in its entirety.

[0052] In another example, a continuous direct manufacturing method utilizes a "spiral lithography" method, in which a liquid photopolymer is cured using focused radiation while the build platform is continuously rotated and raised. Thus, a geometry can be continuously built along a spiral construction path. Such a method is described in U.S. Patent Publication No. 2014 / 0265034, the disclosure of which is incorporated herein by reference in its entirety.

[0053] In some embodiments, the relatively rigid portion of the orthodontic appliance can be formed by direct manufacturing using one or more of the following materials: polyester, copolyester, polycarbonate, thermoplastic polyurethane, polypropylene, polyethylene, polypropylene and polyethylene copolymers, acrylic, cyclic block copolymers, polyetherketone, polyamide, polyethylene terephthalate, polybutylene terephthalate, polyetheramide, polyethersulfone and / or polytrimethylene terephthalate.

[0054] In some embodiments, relatively elastic portions of an orthodontic appliance may be formed by direct manufacturing using one or more of the following materials: styrene block copolymers (SBCs), silicone rubber, elastomeric alloys, thermoplastic elastomers (TPEs), thermoplastic vulcanizates (TPV) elastomers, polyurethane elastomers, block copolymer elastomers, polyolefin blend elastomers, thermoplastic copolyester elastomers, and / or thermoplastic polyamide elastomers.

[0055] Optionally, the direct manufacturing methods described herein allow for the manufacture of an appliance comprising multiple materials, referred to herein as "multi-material direct manufacturing". In some embodiments, the multi-material direct manufacturing method includes forming an object from multiple materials simultaneously in a single manufacturing step using the same manufacturing machine and method. For example, a multi-tip extrusion device can be used to selectively dispense multiple types of materials (e.g., resins, liquids, solids, or combinations thereof) from different material supply sources in order to manufacture an object from multiple different materials. Such a method is described in U.S. Patent No. 6,749,414, the disclosure of which is incorporated herein by reference in its entirety. Alternatively or in combination, the multi-material direct manufacturing method can include forming an object from multiple materials in multiple sequential manufacturing steps. For example, a first portion of an object can be formed from a first material according to any direct manufacturing method described herein, and then a second portion of the object can be formed from a second material according to the method described herein, and so on, until the entire object is formed.

[0056] In many embodiments, post-processing of the appliance includes cleaning, post-curing, and / or support removal processes. Relevant post-processing parameters may include purity of the cleaning agent, cleaning pressure and / or temperature, cleaning time, post-curing energy and / or time, and / or consistency of the support removal process. These parameters can be measured and adjusted as part of a process control scheme. In addition, the physical properties of the appliance can be changed by modifying the post-processing parameters. Adjusting the post-processing machine parameters can provide another way to compensate for changes in material properties and / or machine properties.

[0057] Although various embodiments are described herein with respect to direct manufacturing techniques, it should be understood that other techniques, such as indirect manufacturing techniques, may also be used. In some embodiments, the appliances (or portions thereof) herein may be manufactured using indirect manufacturing techniques, such as by thermoforming on a positive or negative mold. Indirect manufacturing of an orthodontic appliance may involve one or more of the following steps: manufacturing a positive or negative mold of the patient's dentition in a target arrangement (e.g., by additive manufacturing, milling, etc.), thermoforming one or more sheets of material to cover the mold to produce an appliance shell, forming one or more structures in the shell (e.g., by cutting, etching, etc.), and / or coupling one or more components to the shell (e.g., by extrusion, additive manufacturing, spraying, thermoforming, adhesives, bonding agents, fasteners, etc.). Optionally, one or more of the auxiliary orthodontic components described herein (e.g., elastics, wires, springs, bars, arch expanders, palatal expanders, twin blocks, occlusal blocks, bite ramps, mandibular advancement splints, bite plates, pontics, hooks, brackets, headgear tubes, bumper tubes, palatal bars, frameworks, pin-and-tube apparatuses, buccal shields, buccinator bows, wire shields, lingual flanges and pads, lip pads or bumper bars) are used. Bumpers, protrusions, divots, etc.) are formed by the appliance shell and coupled to the appliance shell (e.g., by adhesives, bonding agents, fasteners, mounting components, etc.) after the shell is manufactured.

[0058] In some embodiments, a combination of direct and indirect manufacturing techniques can be used to manufacture the orthodontic appliance herein, so that different manufacturing techniques can be used to manufacture different parts of the appliance and assembled to form the final appliance. For example, the appliance housing can be formed by indirect manufacturing (e.g., thermoforming), and one or more structures or components described herein (e.g., auxiliary components, power arms, etc.) can be added to the housing by direct manufacturing (e.g., printing onto the housing).

[0059] The configuration of the orthodontic appliance herein can be determined based on a treatment plan for the patient, for example, a treatment plan involving the sequential application of multiple appliances to gradually reposition the teeth. Computer-based treatment planning and / or appliance manufacturing methods can be used to facilitate the design and manufacture of the appliance. For example, one or more appliance assemblies described herein can be digitally designed and manufactured with the aid of computer-controlled manufacturing equipment (e.g., computer numerical control (CNC) milling, computer-controlled additive manufacturing (e.g., 3D printing), etc.). The computer-based method proposed herein can improve the accuracy, flexibility, and convenience of appliance manufacturing.

[0060] In some embodiments, a computer-based 3D planning / design tool such as Treat from Align Technology can be used. TM Software to design and manufacture the orthodontic appliances described in this article.

[0061] Figure 2 A method 200 for designing an orthodontic appliance to be manufactured according to an embodiment is shown. The method 200 can be applied to any embodiment of the orthodontic appliance described herein. Some or all steps of the method 200 can be performed by any suitable data processing system or device, for example, one or more processors configured with appropriate instructions.

[0062] In step 210, a motion path is determined to move one or more teeth from an initial arrangement to a target arrangement. The initial arrangement can be determined by a mold or scan of the patient's teeth or oral tissue, such as using a wax bite, direct contact scanning, X-ray imaging, tomography, ultrasound, and other techniques for obtaining information about the position and structure of teeth, jaws, gums, and other orthodontically relevant tissues. From the acquired data, a digital data set representing an initial (e.g., pre-processed) arrangement of the patient's teeth and other tissues can be derived. Optionally, the initial digital data set is processed to segment tissue components from each other. For example, a data structure that digitally represents a single crown can be generated. Advantageously, a digital model of the entire tooth can be generated, including measured or inferred hidden surface and root structures, as well as surrounding bone and soft tissue.

[0063] The target arrangement of teeth (e.g., the desired and expected end result of orthodontic treatment) can be received from a clinician in the form of a prescription, can be calculated based on basic orthodontic principles, and / or can be calculated from an outpatient prescription. By specifying the expected final position of the teeth, as well as a digital representation of the teeth themselves, the final position and surface geometry of each tooth can be specified to form a complete model of the dental arrangement at the end of the desired treatment.

[0064] With the initial position and target position of each tooth, a movement path can be defined for the movement of each tooth. In some embodiments, the movement path is configured to move the tooth in the fastest manner with the fewest round trips to bring the tooth from its initial position to its desired target position. Optionally, the tooth path can be segmented, and the segments can be calculated so that the movement of each tooth within the segment remains within linear and translational threshold limits. In this way, the endpoints of each path segment can constitute a clinically feasible repositioning, and the collection of segment endpoints can constitute a clinically feasible sequence of tooth positions, so that moving from one point in the sequence to the next does not result in conflict of the tooth.

[0065] In step 220, a force system is determined to produce movement of one or more teeth along the movement path. The force system may include one or more forces and / or one or more torques. Different force systems will result in different types of tooth movement, such as tilting, translation, rotation, extrusion, intrusion, root movement, etc. Biomechanical principles, modeling techniques, force calculation / measurement techniques, etc., including common knowledge and methods in orthodontics, can be used to determine the appropriate force system to be applied to the teeth to complete the tooth movement. When determining the force system to be applied, sources may be considered, including literature, force systems determined by experiments or virtual modeling, computer-based modeling, clinical experience, minimization of excess force, etc.

[0066] The determination of the force system can be performed in a variety of ways. For example, in some embodiments, the force system is determined on a per-patient basis, for example using patient-specific data. Alternatively or in combination, the force system can be determined based on a general model of tooth movement (e.g., based on experiments, modeling, clinical data, etc.), thereby eliminating the need to use patient-specific data. In some embodiments, the determination of the force system involves calculating specific force values ​​to be applied to one or more teeth to produce a specific movement. Alternatively, the determination of the force system can be performed at a high level without calculating tooth-specific force values. For example, step 220 can include determining a specific type of force to be applied (e.g., an extrusion force, an intrusion force, a translational force, a rotational force, an overturning force, a torsional force, etc.) without calculating the magnitude and / or direction of the specific force.

[0067] In step 230, an appliance geometry and / or material composition for an orthodontic appliance configured to generate a force system is determined. The appliance may be any embodiment of an appliance discussed herein, such as an appliance having variable local properties, integrally formed components and / or power arms.

[0068] For example, in some embodiments, the appliance comprises heterogeneous thickness, heterogeneous hardness, or heterogeneous material composition. In some embodiments, the appliance comprises two or more of heterogeneous thickness, heterogeneous hardness, or heterogeneous material composition. In some embodiments, the appliance comprises heterogeneous thickness, heterogeneous hardness, and heterogeneous material composition. The heterogeneous thickness, hardness, and / or material composition can be configured to generate a force system for moving teeth, for example, by selectively applying force at certain locations on the teeth to move the teeth. For example, an appliance with different thicknesses may include a thicker portion that applies greater force on the teeth than a thinner portion. As another example, an appliance with different hardnesses may include a harder portion than a more elastic portion that applies greater force on the teeth. As described herein, changes in hardness can be achieved by changing the thickness, material composition, and / or degree of photopolymerization of the appliance.

[0069] In some embodiments, determining the geometry and / or material composition of the appliance includes determining the geometry and / or material composition of one or more integrally formed components to be directly manufactured from the appliance shell. The integrally formed components can be any of the embodiments described herein. The geometry and / or material composition of the integrally formed components can be selected to facilitate application of the force system to the patient's teeth. The material composition of the integrally formed components can be the same as or different from the material composition of the shell.

[0070] In some embodiments, determining the geometry of the appliance includes determining the geometry of a customized calibration tooth geometry interference.

[0071] Step 230 may include analyzing the expected force system to determine the geometry and material composition of the appliance that will produce the force system. In some embodiments, the analysis involves determining the characteristics of the appliance (e.g., hardness) at one or more locations to produce the expected forces at one or more locations. The analysis may then include determining the geometry and material composition of the appliance at one or more locations to achieve the specified characteristics. The geometry and material composition of the appliance may be determined using a treatment or force simulation environment. The simulation environment may include, for example, a computer modeling system, a biomechanical system or device, etc. Optionally, a digital model of the appliance and / or teeth, such as a finite element model, may be generated. The finite element model may be created using computer program application software available from various vendors. To create a solid geometry model, a computer-aided engineering (CAE) or computer-aided design (CAD) program may be used, such as the one available from Autodesk, Inc. of San Rafael, California. Software Products. To create finite element models and perform analyses, program products are available from a number of vendors, including the finite element analysis software package from ANSYS, Inc., Canonsburg, Pennsylvania, and the SIMULIA (Abaqus) software product from Dassault Systèmes, Inc., Waltham, Massachusetts.

[0072] Optionally, one or more appliance geometries and material compositions may be selected for testing or force modeling. As described above, the expected tooth movement may be identified, as well as the force system required or expected to cause the expected tooth movement. Using the simulation environment, the geometry and composition of the candidate appliances may be analyzed or modeled to determine the actual force system resulting from use of the candidate appliances. Optionally, one or more modifications may be made to the candidate appliances, and the force model may be further analyzed as described, for example, to iteratively determine an appliance design that produces the expected force system.

[0073] Optionally, step 230 may further include: determining the geometry of one or more auxiliary components to be used in conjunction with the orthodontic appliance so that the force system is applied to one or more teeth. Such auxiliary devices may include one or more of the following: tooth mounting attachments, elastic bands, wires, springs, bite blocks, arch expanders, wire bracket appliances, shell appliances, braces, or any other orthodontic device or system that can be used to combine the orthodontic appliance herein. In the case where it is difficult for the appliance to generate a force system alone, it may be advantageous to use such an auxiliary component. In addition, auxiliary components may be added to the orthodontic appliance to provide other desired functions in addition to generating a pressure system, such as a mandibular advancement splint for treating sleep apnea, a dental bridge for improving aesthetic appearance, etc. In some embodiments, the auxiliary components are manufactured and provided separately from the orthodontic appliance. Alternatively, the geometry of the orthodontic appliance may be modified to include one or more auxiliary components as an integrally formed component.

[0074] In step 240, instructions for manufacturing an orthodontic appliance having the appliance geometry and material composition are generated. The instructions may be configured to control a manufacturing system or device to produce an orthodontic appliance having a specified appliance geometry and material composition. In some embodiments, the instructions are configured to manufacture an orthodontic appliance using direct manufacturing (e.g., stereolithography, selective laser sintering, fused deposition modeling, 3D printing, continuous direct manufacturing, multi-material direct manufacturing, etc.). Optionally, the instructions may be configured to cause a manufacturing machine to directly manufacture an orthodontic appliance having a tooth receiving cavity having a shape, position, and features as discussed herein. In an alternative embodiment, the instructions may be configured to indirectly manufacture the appliance, for example, by thermoforming.

[0075] Although the above steps illustrate a method 200 for designing an orthodontic appliance according to some embodiments, those skilled in the art will recognize some variations based on the teachings described herein. Some steps may include sub-steps. Certain steps may be repeated as needed. One or more steps of the method 200 may be performed with any suitable manufacturing system or device, such as the embodiments described herein. Some steps may be optional, and the order of the steps may be changed as needed. For example, in some embodiments, step 220 is optional, so that step 230 involves determining the geometry and / or material composition of the appliance directly based on the tooth movement path rather than based on a force system.

[0076] Figure 3 A method 300 for digitally planning orthodontic treatment and designing and manufacturing orthodontic appliances according to an embodiment is shown. The method 300 may be applied to any treatment procedure described herein and may be performed by any suitable data processing system.

[0077] In step 310, the position of the patient's teeth is measured. The measurement may include measuring the surface topography data of the patient's oral cavity (including teeth, gum tissue, etc.). The surface topography data may be generated by directly scanning the oral cavity, a physical model of the oral cavity (positive or negative), or an indentation in the oral cavity using a suitable scanning device (e.g., a handheld scanner, a desktop scanner, etc.).

[0078] At step 314, constraints on tooth movement are received. The constraints may include selecting teeth whose initial and final positions are the same. In some embodiments, these teeth may serve as anchors during one or more phases of treatment, or they may serve as anchors throughout the entire treatment. Teeth may also be designated as inactive teeth because they are not suitable for repositioning, for example, they may contain artificial teeth, such as bridges, implants, crowns, fixed teeth, etc.

[0079] At step 316, the final position of the teeth is determined. The final position of the patient's teeth may be determined based on one or more of the initial malocclusion (or misalignment) of the patient's teeth, the patient's intended treatment (eg, movement of only the front teeth, etc.). Figure 5A , 5B and 6 to 11 describe in more detail the generation of the final position of the patient's teeth. In some embodiments, multiple clinically meaningful treatment plans can be generated. One of the multiple treatment plans can be selected to treat the patient.

[0080] In step 320, one or more treatment stages are generated based on the measured positions of the patient's teeth, which stages may include digital representations of the teeth. The treatment stages may be incremental repositioning stages of an orthodontic treatment procedure that is intended to move one or more teeth of the patient from an initial tooth arrangement to a target arrangement. For example, the treatment stages may be generated by: determining an initial tooth arrangement indicated by the digital representation, determining a final position of the patient's teeth, and determining a movement path for one or more teeth in the initial arrangement to achieve the target tooth arrangement. Optimizing the movement path may be based on: minimizing the total distance moved, preventing conflicts between teeth, avoiding more difficult tooth movements, malocclusion as part of the treatment plan, or any other suitable criteria.

[0081] A plurality of treatment plans are provided to the dental professional, who can then evaluate the treatment plans based on their professional preferences and the patient's preferences. A plan is then selected. The selected treatment plan can then be passed to step 326.

[0082] In step 326, instructions for manufacturing the appliance may be generated. Figure 2 The method 200 is shown and described for generating instructions.

[0083] In step 330, at least one orthodontic appliance is manufactured based on the generated treatment stage. For example, a set of appliances can be manufactured, each appliance is formed according to the tooth arrangement specified by one of the treatment stages, so that the patient can wear these appliances in sequence to gradually reposition the teeth from the initial arrangement to the target arrangement. The set of appliances can include one or more orthodontic appliances described herein. The manufacture of the appliance may include creating a digital model of the appliance for use as an input to a computer-controlled manufacturing system. The appliance can be formed using direct manufacturing methods, indirect manufacturing methods, or a combination thereof as desired.

[0084] In some cases, the planning or treatment phase of various arrangements may not be used in the design and / or manufacture of the appliance. Figure 3 As shown by the dashed lines in , the design and / or manufacture of orthodontic appliances and possible specific orthodontic treatments may include using a representation of a patient's teeth and then designing and / or manufacturing an orthodontic appliance based on the representation of the patient's teeth in the arrangement represented by the received representation.

[0085] Optionally, some or all of the steps of the method 300 are performed locally at the site where the patient is treated during a single visit by the patient or performed on a remote system.

[0086] Figure 4 4 is a simplified block diagram of a data processing system 400, one or more of which may be used to perform the methods and processes described herein. The data processing system 400 typically includes at least one processor 402 that communicates with one or more peripheral devices via a bus subsystem 404. These peripheral devices typically include a storage subsystem 406 (a memory subsystem 408 and a file storage subsystem 414), a set of user interfaces, input and output devices 418, and an interface to an external network 416. The interface is schematically shown as a "network interface" block 416 and is coupled to corresponding interface devices in other data processing systems through a communication network interface 424. The data processing system 400 may include, for example, one or more computers (such as personal computers, workstations, mainframes, laptops, etc.).

[0087] The user interface input device 418 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 "devices" 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.

[0088] The storage subsystem 406 maintains the basic required 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 406. The storage subsystem 406 generally includes a memory subsystem 408 and a file storage subsystem 414. The memory subsystem 408 generally includes a number of memories (e.g., RAM 410, ROM 412, etc.), including a computer-readable memory for storing fixed instructions, instructions and data, a basic input / output system, etc. during program execution. The file storage subsystem 414 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, such as by a server on a network or coupled via the Internet / World Wide Web. In this context, the term "bus subsystem" is generally used to include any mechanism for enabling various components and subsystems to communicate with each other as intended, and may include various suitable components / systems known or considered to be applicable to this article. It is generally believed that the various components of the system can but do not necessarily have to be located in the same physical location, but can be connected through various local area network or wide area network media, transmission systems, etc.

[0089] The system may include a measurement device, such as a scanner 420, which includes any means for obtaining a digital representation (e.g., image, surface topography data, etc.) of a patient's teeth (e.g., by scanning a physical model of the teeth such as a dental cast 421, by scanning an impression of the teeth, or by directly scanning an impression in the mouth), which may be obtained from the patient or from a treating professional such as an orthodontist, and means for providing the digital representation to a data processing system 400 for further processing. The scanner 420 may be located at a remote location relative to the other components of the system, and may transmit image data and / or information to the data processing system 400, such as via a network interface 424. The manufacturing system 422 manufactures the device 423 based on the treatment plan, including the data set information received from the data processing system 400. The manufacturing machine 422 may be located at a remote location and receive the data set information from the data processing system 400 via a network interface 424.

[0090] The data processing aspects of the methods described herein may be implemented in digital electronic circuits or computer hardware, firmware, software, or a suitable combination thereof. The data processing apparatus may be implemented in a computer program product tangibly contained in a machine-readable storage device and executed by a programmable processor. The data processing steps may be performed by a programmable processor that executes program instructions to perform its functions by operating on input data and generating outputs. The data processing aspects may be implemented in one or more computer programs executed on a programmable system, the system comprising one or more programmable processors operably coupled to a data storage system. Typically, the processor may receive instructions and data from a read-only memory and / or a random access memory. Storage devices suitable for tangibly containing computer program instructions and data include all forms of non-volatile memory, such as: semiconductor memory devices, such as EPROM, EEPROM, and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM disks.

[0091] Now refer to Figure 5A and 5B , a method 500 for determining one or more treatment plans is shown. The steps of the method 500 may be part of the method 300 for digitally performing orthodontic treatment and appliance design and manufacturing, as described above. Figure 3 In particular, the steps of method 500 may be part of step 316 for determining the final position of the patient's teeth.

[0092] At step 502, method 500 begins. In some embodiments, instructions stored on a computer-readable medium corresponding to the steps in method 500 are executed by one or more processors (e.g., Figure 4 ) is executed by a processor shown and described in , and then one or more steps of method 500 are performed.

[0093] At step 502, there may be only one treatment plan, which is represented by the initial or default settings of the treatment plan. In the steps of method 500, one or more treatment plans are passed from one step to the next step based on the conditions and actions performed at each step. When a step in the method creates a new branch of the treatment plan, one or more new additional treatment plans will be created. Each new treatment plan can inherit all previous corrections and treatments indicated in the parent treatment plan, and each new treatment plan is then modified based on the remaining steps in method 500 to continue to complete method 500. In this way, many different treatment plans are generated and evaluated as options for treating patients. Using a large data set of treatment plans (where each treatment plan is generated for a specific patient with a specific malocclusion), a wider range of potential treatment methods than before can be evaluated in parallel, and treatment options that have not been considered or proposed to the treating specialist in the past can be proposed, thereby improving treatment outcomes. Improved outcomes may include shorter treatment times, less invasive treatments, and avoiding other less ideal treatments.

[0094] Figure 5 to Fig.11 The shape of each method step in the figure represents the action of each step. Parallelogram-shaped steps do not affect the content of the treatment plan, and rectangles with rounded corners are actions performed in the plan that pass through the square, for example, improving the overbite or indicating that the overbite will be improved in this treatment plan. Some rectangles with rounded corners are bifurcated steps, where the treatment plan is branched or bifurcated to create one or more new treatment plans with different treatment symptoms based on the characteristics of the bifurcation. Each branched treatment plan will be passed to the next step of the method.

[0095] In some embodiments, each treatment plan may include an initial position, a final (or provisional final) position, and settings associated with the treatment of the malocclusion element. In some embodiments, the treatment plan also includes stages and / or tooth movement paths for moving the teeth from the initial position to the final position, while in other embodiments, the treatment plan does not include the stages and tooth movement paths. For example, a tooth movement path may be generated for the treatment plan at step 532.

[0096] Diamond steps are conditional steps where the measured tooth positions are verified against the plan, and based on the results, the diamond determines the next step that the treatment plan flows to. For example, if a molar category problem is diagnosed in the treatment plan through step 520, the plan is passed to step 522, otherwise, the plan is passed to step 524.

[0097] Rectangles with stripes on the left and right sides indicate that additional processing or processes, such as sub-processes, were performed for the treatment plan passed to that block.

[0098] In step 504, tooth movement restrictions are selected. The dental professional can select teeth in the mouth that remain fixed relative to other teeth. In some embodiments, step 504 or at least a portion of step 504 can be performed after the teeth are scanned in step 506. At least some of the teeth can be automatically selected based on the condition of the teeth. For example, without input from the dental professional, the system can automatically select teeth that were prepared for crowns or bridges that did not have crowns or bridges applied during the scan. Prepared teeth are generally not suitable for movement using shell appliances, and therefore, the system may identify teeth based on the prepared shape that does not conform to the shape of the natural tooth, crown, or bridge.

[0099] In step 506, the position of the patient's teeth is measured. The measurement may include measuring the surface topography data of the patient's oral cavity (including teeth, gum tissue, etc.). The surface topography data may be generated by directly scanning the oral cavity, a physical model of the oral cavity (positive or negative), or an indentation in the oral cavity using a suitable scanning device (e.g., a handheld scanner, a desktop scanner).

[0100] At step 508, a malocclusion of the teeth is diagnosed. This may include additional measurements of the teeth or groups of teeth relative to other teeth or relative to other facial structures or features and in various positions. For example, the amount of open bite may be measured based on a model of the upper and lower dental arches of the patient's teeth in normal occlusion. The amount of overjet (positive or negative) of the molars may be measured for treatment of the molars. The amount of overjet or overbite may be measured for improvement of the overbite. The amount of canine overjet may be measured for determination of improvement in canine position and other corrective measures such as extraction of premolars. As demonstrated by the methods and steps described herein, other measurements of the teeth may also be taken to help correct the patient's malocclusion.

[0101] In step 510, the system may set, receive, or read tooth movement restrictions and other treatment settings. For example, the system or method may receive instructions to improve all malocclusions, limit interproximal deglazing of certain teeth or groups of teeth, and limit space, such as allowing or not allowing space between one or more of the patient's teeth in the final position. In some embodiments, the treatment planning method is continued using only the measured tooth positions and tooth movement restrictions. In some embodiments, the treatment planning method is continued using only the measured tooth positions, tooth movement restrictions, and one or more settings described herein.

[0102] In step 512, the degree of malocclusion of multiple elements of the patient's malocclusion is measured, and the system determines whether to form a treatment branch. The treatment branch may include a branch for correcting the patient's malocclusion element, for example, a branch may be formed as described below with reference to Figure 6Open bite, broad problem diagnosis, posterior crossbite, etc. are shown and described. Each branch can be branched a second time, a third time, etc. For example, two branches can be formed based on whether to treat an open bite malocclusion or to retain an open bite malocclusion. Then, the open bite treatment branch and the retain open bite branch can branch again based on whether the molar relationship is retained or improved. The resulting four branches can then branch again based on whether to treat a posterior crossbite and again based on other malocclusions that can be treated. In this way, multiple clinically distinct plans can be generated based at least in part on measured elements of the patient's malocclusion. For each branch, the correction to the final position of the patient's teeth is determined to treat the corresponding malocclusion.

[0103] In step 514, a temporary final position is determined for one or more (preferably all) of the treatment plans generated in step 512. In some embodiments, rather than determining a temporary final position in step 514 and other steps such as steps 706, 820, 926, and other final position (FiPos) steps, the system stores the settings for each treatment plan without determining a final position and then determines a final position for each treatment plan branch generated by the system running through the process (e.g., in step 532). If a temporary final position is determined to be clinically unacceptable, the treatment plan associated with that particular temporary final position may be discarded, and the system may not take any action in the remainder of the method.

[0104] In step 516, the apical movement is measured between the initial position and the intermediate final position, and based on these measurements, the method proceeds to step 518 or step 519. If the upper and lower buccal protrusions of the apical movement are greater than a threshold value, for example, 2 mm between the initial position and the intermediate final position, the method branches to step 518, otherwise the method proceeds to step 519 without performing bimaxillary protrusion correction. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or a value between any two of these threshold values.

[0105] The thresholds discussed herein may be predetermined, for example, based on a physician's preference or based on a diagnostic assessment for each patient (such as a cephalometric assessment of the patient's CBCT assessment).

[0106] In step 518, a method of correcting bimaxillary protrusion, which is an element of the patient's malocclusion, may be performed as shown and described with respect to FIG. 1. After completing the correction of the bimaxillary protrusion correction process, the method continues to step 519. The biprotrusion correction process may further result in branching of the multiple treatment plans generated in step 512 based on, for example, whether to extract premolars and, if so, how many.

[0107] In step 519, it is determined whether to correct the molar malocclusion, which is another element of the patient's malocclusion. The dentist may indicate that the molar malocclusion should be corrected, or the system may determine that the molar malocclusion should be corrected based on the measured position of the teeth. If molar correction is not selected, the method moves to step 524. If molar correction is selected, the method moves to step 520.

[0108] In step 520, the method determines the molar bite class, also known as the molar relationship. The molar bite class can be determined based on the measured position of the molars, including their orientation. If the system determines that the patient's teeth have a molar bite class I, the method proceeds to step 524. If the system determines that the patient's teeth have a molar bite class II, class III, or a mixed molar class II and molar class III malocclusion, then the method proceeds to step 522 to correct the molar malocclusion.

[0109] In step 522, if Figure 8 As shown and described, the molar relationship is corrected. After the correction of the molar relationship is completed, the method continues to step 524.

[0110] At step 524, the method determines the bite class of the canines, also known as the canine relationship, which is an element of the patient's malocclusion. The bite class of the canines may be determined based on position measurements of one or more of the patient's canines. The position measurements may include orientation. If the system determines that the patient's teeth have a canine class I bite, the method proceeds to step 528. If the system determines that the patient's teeth have a canine class II, canine class III, or a combination of canine class II and canine class III malocclusion, then the method proceeds to step 526 to correct the canine malocclusion.

[0111] In step 526, a method for correcting canine tooth relationship may be performed, such as Fig. 9 As shown and described, after the correction of the canine tooth relationship is completed, the method continues to step 528.

[0112] In step 528, the overjet (one element of the patient's malocclusion) is determined by measuring the overjet of the teeth. For example, if the overjet is between two thresholds (e.g., between 0 mm and 3 mm) and there is no conflict between the lower front teeth and the upper front teeth, the method continues to step 832, otherwise the method continues to step 530. In some embodiments, the thresholds may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, 4.5 mm, 5 mm, or between any two of these thresholds.

[0113] In step 530, if Fig.10As shown and described, the method of overlay correction is performed. After the overlay correction is completed, the method continues to step 532.

[0114] In step 532, the method 500 of determining the final position of the teeth can be completed. After completion, the method can continue to the stage generation and to the aligner manufacturing step. For example, after reaching step 532, the method continues to step 320, such as Figure 3 In some embodiments, at step 532, one or more treatment plans are presented to the dentist, and the dentist selects one of the treatment plans for use in treating the patient. For example, Fig.12 Three treatment plans 1202a, 1202b, 1202c are depicted from which a medical professional can choose. The treatment plans 1202a, 1202b, 1202c are developed by method 500 from an initial scan 1210. The treatment plans can be selected from the various branching treatment plans discussed herein. The treatment plan is selected based on one or more treatment types included in the treatment plan (e.g., whether one or more teeth are to be extracted, the extent of interproximal deglazing to be performed, the number of stages for treatment, and other factors). For example, a treatment plan with the fewest stages and regardless of treatment type, a treatment plan with the fewest stages that includes interproximal deglazing, and a treatment plan with the fewest stages that includes interproximal deglazing of only the anterior teeth can be proposed.

[0115] Now refer to Figure 6 , a method 512 for generating multiple treatment corrections is shown. The degree of malocclusion of multiple elements of a patient's malocclusion is measured, and then the system determines whether to form treatment branches, each of which may include different treatment plans. As described below with reference to the steps, the treatment branches formed may include branches for correcting open bites, main type problem diagnosis, posterior crossbite, and others. Each treatment plan branch can be branched a second time, a third time, and so on. For example, two branches can be formed based on whether to treat an open bite type malocclusion or retain the open bite. Then, the open bite treatment branch and the open bite retention branch are respectively branched again based on whether the molar relationship is retained or improved. Then, the resulting four branches can then each branch be branched again based on whether to treat the posterior crossbite, and then each branch can be branched again based on other treatable malocclusions. In this way, multiple clinically distinct plans can be generated based at least in part on the measured elements of the patient's malocclusion. The final position of the patient's teeth is determined for each corresponding treatment plan branch in order to treat the corresponding malocclusion.

[0116] In step 602, the method 512 of generating a plurality of treatment corrections begins. Here, an initial measured position of the teeth is evaluated, which position may include a three-dimensional model of the teeth.

[0117] In step 604, the amount of open bite (an element of the patient's malocclusion) may be measured based on models of the upper and lower arches of the patient's teeth in normal occlusion, or the amount of overbite previously measured may be evaluated. If the measured amount of open bite is greater than or equal to a threshold value, e.g., -1 mm, the method moves to step 606, and no additional treatment plan branch is created for the open bite. However, if the open bite is less than the threshold value, the method moves to step 608, and two additional treatment plan branches are formed in this step: a branch for not treating the open bite, e.g., a branch for retaining the open bite; and a branch for treating the open bite, e.g., a branch for making modifications to correct or reduce the amount of overbite. In some embodiments, the threshold value may be -1 / 4 mm, -1 / 2 mm, -3 / 4 mm, -1 mm, 1.5 mm, -2 mm, -2.5 mm, -3 mm, -3.5 mm, or -4 mm, or between any two of these threshold values.

[0118] In step 606 , the overbite (as a component of the patient's malocclusion) is corrected as part of determining the final positions of the teeth for each treatment plan branch processed by the system in step 606 .

[0119] In step 608, two branches are created: a branch for untreated open bites (eg, a retention branch), and a branch for treated open bites (eg, modifications are made such that the amount of overbite is corrected or reduced).

[0120] In step 610, the molar positions (elements of the patient's malocclusion) may be measured based on models of the patient's upper and lower arches of teeth in normal occlusion (including the orientation and relationship between the molars of opposing arches), or the previously measured molar positions may be evaluated for each branch treatment plan. Based on these measurements, a molar class problem may be diagnosed. If a molar class problem is not detected, the method continues to step 612 and no additional branches are created. However, if a molar class problem is detected, the method continues to step 614, where two additional treatment plan branches are formed: a branch that does not treat the primary class problem (e.g., a retention branch) and a branch that treats the primary class problem (e.g., an improvement is made to reduce or correct the primary class problem).

[0121] In step 612, the molar relationship is corrected as part of determining the final position of the teeth for each particular treatment plan branch.

[0122] In step 614, a branch that does not treat the main category problem (e.g., a retained branch) is created and a branch that treats the main category problem (e.g., an improvement is made to reduce or correct the main category problem) is created.

[0123] In step 616, the amount of posterior crossbite may be measured based on a model of the upper and lower arches of the patient's teeth in normal occlusion, or a previously measured amount of posterior crossbite may be evaluated. If the measured amount of posterior crossbite is less than a threshold, or otherwise not diagnosed, the method proceeds to step 618, and no additional treatment plan branches are created for the posterior crossbite. However, if the posterior crossbite is greater than the threshold or otherwise diagnosed, the method moves to step 620, where two additional treatment plan branches are formed: a branch that does not treat the open bite (e.g., a retention branch) and a branch that treats the posterior crossbite (e.g., performs modifications to correct or reduce the amount of the posterior crossbite).

[0124] In step 618, the posterior crossbite is not corrected as part of determining the final positions of the teeth for each particular treatment plan branch processed by the system in step 618, and no additional treatment plan branches are created.

[0125] In step 620, the system may set, receive, or read a setting for posterior crossbite (an element of the patient's malocclusion). For example, the system or method may receive an instruction to improve or correct a posterior double bite or not to correct a posterior double bite. If improving or correcting a double bite is not selected or indicated, the method proceeds to 622 where two additional branches are created for each treatment plan branch: a branch to correct or improve the posterior crossbite, and a branch to not correct or improve the posterior crossbite, otherwise the method proceeds to 624.

[0126] In step 624, two additional branches are created for each treatment plan branch to be evaluated: a branch for correcting or improving the posterior crossbite, and a branch for not correcting or improving the posterior crossbite.

[0127] In step 622, the posterior crossbite is corrected as part of determining the final positions of the teeth for each particular treatment plan branch, and no additional treatment plan branches are created.

[0128] At step 626, the treatment correction branch ends and process 500 continues to step 514, as shown in FIG. Figure 5A shown.

[0129] Reference now Figure 7 The method of correcting bimaxillary protrusion may be performed, for example, as shown and described in the following steps. The bimaxillary protrusion correction process may lead to further branching of the multiple treatment plans created in step 512 based on, for example, whether any premolars are extracted and if so, how many.

[0130] In step 702, each of the treatment plan branches is transmitted to or received by a bimaxillary protrusion correction process.

[0131] In step 704, each treatment plan branch further branches into two additional treatment plans: a branch to retain the premolars and a branch to extract 4 premolars. In some embodiments, more or less than 4 premolars may be extracted, or additional treatment plans may be created in which more or less than 4 premolars are extracted, for example, in some treatment plan branches only 1 or 2 upper premolars are extracted, while in some treatment plan branches only 1 or 2 lower premolars are extracted. Treatment plan branches may be created for each possible permutation and combination of premolar extractions.

[0132] In step 706, the bimaxillary protrusion correction process ends, and the method 500 continues to step 519, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0133] Reference now Figure 8 , as shown and described in the following steps, a method 522 for correcting the molars is performed. If there is a Class II malocclusion of the molars, based on the measured position of the molars (including the molar direction), a method 810 for correcting or reducing the Class II malocclusion of the molars can be performed. If there is a Class III malocclusion of the molars, based on the measured position of the molars (including the molar direction), a method 830 for correcting or reducing the Class III malocclusion of the molars can be performed. If there is a mixed Class II and Class III malocclusion of the molars, based on the measured position of the molars (including the molar direction), a method 860 for correcting or reducing the mixed Class II and Class III malocclusion of the molars can be performed.

[0134] The method 810 for correcting Class II molar malocclusion begins at step 812 .

[0135] In step 812 , each treatment plan branch is communicated to or received by the system for use in method 810 .

[0136] In step 814, molar overjet is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to measure molar overjet. If the overjet in the final position for a particular treatment plan is greater than a threshold value (e.g., 3 mm), then the method continues to step 820 for that particular treatment plan, otherwise, the method continues to step 816 for that treatment plan. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0137] In step 816, apical movement is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to measure apical movement. If the apical movement in the final position for a particular treatment plan is less than or equal to a threshold value, such as 2 mm in the lower lingual, then the method continues to step 818 for that particular treatment plan, otherwise, the method continues to step 820 for that treatment plan. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0138] In step 818, proximal deglazing of the lower posterior teeth on the Class II side of the molar is added to the treatment plan. In some embodiments, the amount of proximal deglazing is also determined in this step.

[0139] In step 820, the molar Class II correction is completed, and the method 500 continues to step 524, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0140] The method 830 for correcting a molar Class III malocclusion begins at step 832 .

[0141] In step 832 , each treatment plan branch is communicated to or received by the system for use in method 830 .

[0142] In step 834, molar overjet is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to measure molar overjet. If the overjet in the final position for a particular treatment plan shows an anterior conflict or negative overjet, then the method continues to step 840 for that particular treatment plan, otherwise, the method continues to step 836 for that treatment plan.

[0143] In step 836, apical movement is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to measure apical movement. If the apical movement in the final position for a particular treatment plan is less than or equal to a threshold value, such as 2 mm supralingual, then the method continues to step 838 for that particular treatment plan, otherwise the method continues to step 840 for that treatment plan. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0144] In step 838, proximal deglazing of the upper posterior teeth on the Class III side of the molar is added to the treatment plan. In some embodiments, the amount of proximal deglazing is also determined in this step.

[0145] In step 840, the molar Class II correction is completed, and the method 500 continues to step 524, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0146] Step 862 begins method 860 of correcting mixed molar Class II and Class III malocclusion.

[0147] In step 862 , each treatment plan branch is communicated to or received by the system for use in method 860 .

[0148] At step 864 , the method performs method 810 as described herein and then proceeds to step 866 .

[0149] At step 866 , the process performs method 830 as described herein and then proceeds to step 868 .

[0150] At step 868, the molar classification method ends and method 500 continues to step 524, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0151] Reference now Fig. 9 , as shown and described in the following steps, a method 526 for correcting canine tooth relationship is performed. If a canine Class II malocclusion exists, then based on the measured canine position (including the orientation of the canine teeth), a method 910 for correcting or reducing the canine Class II malocclusion can be performed. If a canine Class III malocclusion exists, then based on the measured canine position (including the orientation of the canine teeth), a method 930 for correcting or reducing the canine Class III malocclusion can be performed. If a mixed canine Class II and canine Class III malocclusion exists, then based on the measured canine position (including the orientation of the canine teeth), a method 960 for correcting or reducing the mixed canine Class II and canine Class III malocclusion can be performed.

[0152] The method 910 for correcting canine Class II malocclusion begins at step 912 .

[0153] In step 912 , each treatment plan branch is communicated to or received by the system for use in method 910 .

[0154] In step 914, canine overjet is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 or step 522 are used to measure canine overjet. If canine overjet in the final position for a particular treatment plan indicates an anterior conflict or negative overjet, then the method continues to step 926 for that particular treatment plan, otherwise, the method continues to step 916 for that treatment plan.

[0155] In step 916, the molar positions (including orientation) for each treatment plan branch are measured. For example, the final tooth positions determined in step 706 for each treatment plan branch are used to determine the strength of the molar class. If the molar class in the final position for a particular treatment plan is shown to be severe (sometimes referred to as strong) Class II, e.g., the upper and lower molar cusps are aligned with each other, then the method proceeds to step 918 for that particular treatment plan, otherwise, the method proceeds to step 922 for that treatment plan.

[0156] In step 918, each treatment plan branch is further branched into two additional treatment plans: a branch to retain the premolars and a branch to extract 4 premolars. In some embodiments, more or less than 4 premolars may be extracted, or additional treatment plans may be generated in which 4 premolars are extracted, for example, only 1 or 2 upper premolars are extracted in some treatment plan branches, and only 1 or 2 lower premolars are extracted in some treatment plan branches. The method then continues to step 920.

[0157] In step 920, it is evaluated whether a treatment plan for each branch of premolar extraction has been selected or determined. If the premolars are to be extracted, the method continues to step 926. If the premolars are not to be extracted, the method continues to step 922.

[0158] In step 922, the apical approach movement is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to measure the apical movement. If the apical movement of the final position of a particular treatment plan is less than or equal to a threshold value of, for example, 2 mm of the teeth in the lingual direction, then the method proceeds to step 924 for that particular treatment plan, otherwise, the method proceeds to step 926 for that treatment plan. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0159] In step 924, the treatment plan adds deglazing of the upper posterior teeth of the canine teeth. In some embodiments, the amount of deglazing of the proximal surface is also determined in this step. Then, the method proceeds to step 926.

[0160] At step 926, canine Class II correction is complete, and method 500 continues to step 528, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0161] The method 930 for correcting canine Class III malocclusion begins at step 832 .

[0162] In step 932 , each treatment plan branch is communicated to or received by the system for use in method 932 .

[0163] In step 934, canine overjet is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to measure canine overjet. If the canine overjet in the final position for a particular treatment plan is greater than a threshold value, such as 3 mm, then the method continues to step 946 for that particular treatment plan, otherwise, the method continues to step 936 for that treatment plan. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0164] In step 936, the position (including orientation) of the canines is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to determine the strength of the molar category. If the canine category in the final position for a particular treatment plan is indicated as severe (sometimes referred to as strong) Class III, then the method continues to step 938 for that particular treatment plan, otherwise, the method continues to step 942 for that treatment plan.

[0165] In step 938, each treatment plan branch is further branched into two additional treatment plans: a branch to retain the premolars and a branch to extract 4 premolars. In some embodiments, more or less than 4 premolars may be extracted, or additional treatment plans may be generated in which more or less than four premolars are extracted, for example, in some treatment plan branches only 1 or 2 upper premolars are extracted, while in some treatment plan branches only 1 or 2 lower premolars are extracted. The method then continues to step 940.

[0166] In step 940, an evaluation is made as to whether a treatment plan for each branch has been selected or determined for extraction of premolars. If premolars are to be extracted, the method continues to step 946. If premolars are not to be extracted, the method continues to step 942.

[0167] In step 942, the apical approach movement is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 706 are used to measure the apical movement. If the apical movement of the final position of a particular treatment plan is less than or equal to a threshold value of, for example, 2 mm of the teeth in the lingual direction, then the method proceeds to step 944 for that particular treatment plan, otherwise, the method proceeds to step 946 for that treatment plan. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0168] In step 944, the treatment plan adds deglazing of the lower posterior interproximal surfaces of the canines. In some embodiments, the amount of deglazing of the interproximal surfaces is also determined in this step. The method then proceeds to step 946.

[0169] At step 946, canine Class III correction is complete, and method 500 continues to step 528, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0170] Step 862 begins method 960 of correcting mixed canine Class II and Class III malocclusion.

[0171] In step 962 , each treatment plan branch is communicated to or received by the system for use in method 960 .

[0172] At step 964 , the method performs method 910 as described herein and then proceeds to step 966 .

[0173] At step 966 , the process performs method 930 as described herein and then proceeds to step 968 .

[0174] At step 968, the mixed canine category method ends and method 500 continues to step 528, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0175] Reference now Fig.10 , the method of correcting overlay 530 may be performed, for example, as described and illustrated with reference to the following steps.

[0176] In step 1002 , each treatment plan branch is communicated to or received by the system for use in method 1018 .

[0177] In step 1004, overjet is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 526 are used to measure molar overjet. If the overjet in the final position for a particular treatment plan shows an anterior conflict or negative overjet, the method continues to step 1008 for that particular treatment plan, otherwise, the method continues to step 1020 for that treatment plan.

[0178] In step 1008, the apical position is measured and the distance of the apical displacement is determined. Based on the displacement, the method selects a path for continuing the method. If the upper cheek displacement is greater than a threshold of 2 mm and the lower tongue displacement is less than or equal to a threshold of 2 mm, the method continues to step 1012. If the upper cheek displacement is less than or equal to a threshold of 2 mm and the lower tongue displacement is less than or equal to a threshold of 2 mm, the method continues to step 1014, in which an additional treatment plan branch is created. If the upper cheek displacement is less than a threshold of 2 mm and the lower tongue displacement is less than a threshold of 2 mm, the method continues to step 1020. If the upper cheek is less than or equal to a threshold of 2 mm and the lower tongue displacement is greater than a threshold of 2 mm, the method continues to step 1010. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0179] In step 1010 , the treatment plan is modified so that anterior space is allowed between the teeth. After determining that anterior space is allowed, or after indicating that anterior space is allowed in the treatment plan when the final position of the patient's teeth is determined, the method proceeds to step 1020 .

[0180] In step 1012, proximal deglazing of the lower anterior teeth is performed as part of the treatment plan. After corrective proximal deglazing of the lower anterior teeth, or after corrective proximal deglazing of the lower anterior teeth is indicated in the treatment plan when the final position of the patient's teeth is determined, the method proceeds to step 1016.

[0181] In step 1014 , two additional treatment plan branches are formed from each existing treatment plan: a branch for performing interproximal deglazing of the lower anterior teeth, and a branch for correcting the space between the upper anterior teeth. After creating the two new branches, the method proceeds to step 1016 .

[0182] In step 1016, the provisional final positions of the teeth in each treatment plan branch are recalculated based on the settings of the current treatment plan for each branch.

[0183] In step 1018, each treatment plan branch that has passed through steps 1012 and 1014 proceeds to Fig.11The anterior tooth extraction process 1018 shown in . After the anterior tooth extraction process 1018 is completed, the method continues to step 1020.

[0184] In step 1020, overjet is measured for each treatment plan branch. For example, the final tooth positions determined in step 1118 of the anterior extraction process 1018 or determined from a previous final position calculation completed earlier in the method 500 (e.g., the canine relationship correction process 526 calculated as part of the molar relationship correction process 522, or elsewhere in each treatment plan branch) are used to measure overjet. If the overjet of the final position for a particular treatment plan is greater than a threshold of 3 mm, then the method continues to step 1022 for that particular treatment plan, otherwise, the method continues to step 1026 for that treatment plan. In some embodiments, the threshold may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these thresholds.

[0185] In step 1022, the apical position of the patient's tooth is measured and the distance of the apical displacement is determined based on the final position determined in step 1020. Based on the displacement, the method selects a path to continue the method. If the upper lingual apical position has a deviation greater than or equal to a threshold of 2 mm, the method continues to step 1024, otherwise, the method continues to step 1026. In some embodiments, the threshold can be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these thresholds.

[0186] In step 1024, proximal deglazing of the upper anterior teeth is added as part of the treatment plan. After proximal deglazing of the upper anterior teeth is included, or after proximal deglazing of the upper anterior teeth is indicated in the treatment plan when determining the final position of the patient's teeth, the method continues to step 1026.

[0187] At step 1026, the overlay correction process ends and the method 500 continues to step 532, as shown in FIG. Figure 5A and 5B In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

[0188] Reference now Fig.11 , perform the anterior tooth extraction method as shown in the following steps and described.

[0189] In step 1102 , each treatment plan branch is communicated to or received by the system for use in method 1018 .

[0190] In step 1104, overjet is measured for each treatment plan branch. For example, the final tooth positions determined for each treatment plan branch in step 1016 are used to measure molar overjet. If overjet in the final position for a particular treatment plan is negative or anterior conflict exists, the method continues to step 1108 for that particular treatment plan, otherwise, the method continues to step 1118 for that treatment plan.

[0191] In step 1108, an anterior tooth extraction setting may be set, received, or read by the system. For example, the system or method may receive an instruction to include proximal deglazing of the lower anterior teeth in the treatment plan. If proximal deglazing of the lower anterior teeth is selected or indicated, the method proceeds to step 1110, otherwise, the method proceeds to step 1118.

[0192] In step 1110, the position of the apex is measured and the distance of the apex displacement is determined. Based on the displacement, the method selects a path for continuing the method. If the upper cheek displacement is greater than a threshold of 2 mm and the lower tongue displacement is less than or equal to a threshold of 2 mm, the method continues to step 1116. If the upper cheek displacement is less than or equal to a threshold of 2 mm and the lower tongue displacement is less than or equal to a threshold of 2 mm, the method continues to step 1114, in which an additional treatment plan branch is created. If the upper side displacement is less than or equal to a threshold of 2 mm and the lower tongue displacement is greater than a threshold of 2 mm, the method continues to step 1112. If the cheek displacement is greater than a threshold of 2 mm and the tongue displacement is greater than a threshold of 2 mm, the method continues to step 1118. In some embodiments, the threshold value may be 1 / 4 mm, 1 / 2 mm, 3 / 4 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 3.5 mm, or 4 mm, or between any two of these threshold values.

[0193] In step 1112 , proximal enamel removal of the lower anterior teeth and space correction of the upper anterior teeth are added to the treatment plan, and the method then continues to step 1118 .

[0194] In step 1114, two additional treatment plan branches are formed: a branch that adds lower incisor extraction to the treatment plan and removes any previous proximal deglazing from the treatment plan, and a branch that performs proximal deglazing of the lower anterior teeth and corrects the upper anterior teeth void. After creating the two new branches, the method continues to step 1118.

[0195] In step 1116, the lower incisor extraction is added to the treatment plan, and the anterior proximal deglazing is removed from the treatment plan.

[0196] In step 1118, the anterior tooth extraction process ends and the method 500 continues to step 1020, as shown in FIG. Fig.10In some embodiments, a temporary final position of the teeth in each treatment plan branch is determined.

Claims

1. A method for manufacturing an orthodontic appliance, the method comprising: receiving a three-dimensional model representing a patient's teeth; measuring the position of the patient's teeth based on the three-dimensional model; Identify a plurality of malocclusions of the patient's teeth based on the three-dimensional model, the plurality of malocclusions comprising a first malocclusion and a second malocclusion; receiving treatment constraints for the patient's teeth; generating a first plurality of treatment plans based on the received treatment constraints; modifying some of the first plurality of treatment plans to treat the first malocclusion to provide a second plurality of treatment plans; modifying some of the second plurality of modified treatment plans to treat the second malocclusion to provide a third plurality of modified treatment plans; selecting a treatment plan from the third plurality of modified treatment plans; Generate appliance models for each phase of the selected treatment plan; as well as Based on the appliance model at each stage of the selected treatment plan, instructions for manufacturing the appliance at each stage of the selected treatment plan are output.

2. The method according to claim 1, wherein: The three-dimensional model was collected from an intraoral scanner.

3. The method according to claim 1, wherein: The first malocclusion comprises a molar malocclusion.

4. The method according to claim 3, wherein: Identifying the plurality of malocclusions includes identifying whether the molar malocclusion is a Class II molar malocclusion or a Class III molar malocclusion.

5. The method according to claim 1, wherein: The second malocclusion includes canine malocclusion.

6. The method according to claim 5, wherein: Identifying the plurality of malocclusions includes identifying whether the canine malocclusion is a Class II canine malocclusion or a Class III canine malocclusion.

7. The method according to claim 1, wherein: The treatment constraints include selecting teeth that are not to move during orthodontic treatment.

8. The method according to claim 7, wherein: The teeth selected serve as anchor points throughout orthodontic treatment.

9. The method according to claim 1, wherein: The treatment constraints include limiting interproximal enamel removal to specific teeth or groups of teeth.

10. The method according to claim 1, wherein: The second plurality of modified treatment plans includes at least one treatment plan that does not treat the first malocclusion.

11. The method according to claim 1, wherein: The third plurality of modified treatment plans includes at least one treatment plan that does not treat the first malocclusion, at least one treatment plan that does not treat the second malocclusion, and at least one treatment plan that does not treat the first malocclusion or the second malocclusion.

12. The method according to claim 1, wherein: The treatment plan is selected based at least in part on one of whether to extract one or more teeth, whether and to what extent proximal deglazing is to be performed, and a number of stages for treatment.

13. The method according to claim 1, wherein: Each stage of the selected treatment plan is intended to incrementally reposition at least one tooth of the patient toward a final tooth position.

14. The method according to claim 1, wherein: The instructions for manufacturing the aligners for each stage of the selected treatment plan include thermoforming.

15. The method according to claim 1, wherein: The instructions for fabricating the appliances for each stage of the selected treatment plan include directly fabricating each appliance by building up the corresponding geometric shape in a layer-by-layer manner.

16. The method according to claim 1, wherein: Generating the first plurality of treatment plans includes modeling tooth movement in a force system.

17. The method according to claim 1, wherein: Generating the first plurality of treatment plans includes determining a type of tooth movement of at least one tooth of the patient.

18. The method according to claim 17, wherein: The type of tooth movement includes at least one of tilting, translation, rotation, extrusion, intrusion or root movement.

19. The method according to claim 1, wherein: The plurality of malocclusions further includes a third malocclusion, wherein the third malocclusion includes overbite.

20. The method according to claim 19, wherein: The third plurality of modified treatment plans includes at least one treatment plan that treats the coverage.

21. A method of manufacturing an orthodontic appliance, the method comprising: receiving a three-dimensional model representing a patient's teeth; measuring the position of the patient's teeth based on the three-dimensional model; Identify a plurality of malocclusions of the patient's teeth based on the three-dimensional model, the plurality of malocclusions comprising a first malocclusion and a second malocclusion; generating a first plurality of treatment plans based on the position of the patient's teeth; generating, for each of the first plurality of treatment plans, a first plan that treats the first malocclusion and a second plan that does not treat the first malocclusion, thereby providing a second plurality of treatment plans; generating, for each of the second plurality of treatment plans, a first plan that treats the second malocclusion and a second plan that does not treat the second malocclusion, thereby providing a third plurality of treatment plans; receiving a treatment plan selected from the third plurality of treatment plans; Generate appliance models for each phase of the selected treatment plan; as well as Based on the appliance model at each stage of the selected treatment plan, instructions for manufacturing the appliance at each stage of the selected treatment plan are output.

22. The method according to claim 21, wherein: The three-dimensional model was collected from an intraoral scanner.

23. The method according to claim 21, wherein: The first malocclusion comprises a molar malocclusion.

24. The method according to claim 23, wherein: Identifying the plurality of malocclusions includes identifying whether the molar malocclusion is a Class II molar malocclusion or a Class III molar malocclusion.

25. The method according to claim 21, wherein: The second malocclusion includes canine malocclusion.

26. The method according to claim 25, wherein: Identifying the plurality of malocclusions includes identifying whether the canine malocclusion is a Class II canine malocclusion or a Class III canine malocclusion.

27. The method of claim 21, wherein: The first plurality of treatment plans are generated based in part on treatment constraints.

28. The method according to claim 27, wherein: The treatment constraints include selecting teeth that are not to move during orthodontic treatment.

29. The method according to claim 27, wherein: The teeth selected serve as anchor points throughout orthodontic treatment.

30. The method of claim 27, wherein: The treatment constraints include limiting interproximal enamel removal to specific teeth or groups of teeth.

31. The method of claim 21, further comprising: The third plurality of treatment plans is provided to the dentist for selection.

32. The method according to claim 31, wherein: A selection of the selected treatment plan is received from the dentist.

33. The method of claim 21, further comprising: A subset of the third plurality of treatment plans is provided to the dentist for selection.

34. The method of claim 21, wherein: The selected treatment plan is selected based at least in part on one of whether to extract one or more teeth, whether and to what extent proximal deglazing is to be performed, and a number of stages for treatment.

35. The method of claim 21, wherein: Each stage of the selected treatment plan is intended to incrementally reposition at least one tooth of the patient toward a final tooth position.

36. The method of claim 21, wherein: The instructions for manufacturing the aligners for each stage of the selected treatment plan include thermoforming.

37. The method of claim 21, wherein: The instructions for fabricating the appliances for each stage of the selected treatment plan include directly fabricating each appliance by building up the corresponding geometric shape in a layer-by-layer manner.

38. The method of claim 21, wherein: Generating the first plurality of treatment plans includes modeling tooth movement in a force system.

39. The method of claim 21, wherein: Generating the first plurality of treatment plans includes determining a type of tooth movement of at least one tooth of the patient.

40. The method of claim 39, wherein: The type of tooth movement includes at least one of tilting, translation, rotation, extrusion, intrusion or root movement.

41. The method of claim 21, wherein: The plurality of malocclusions further includes a third malocclusion, wherein the third malocclusion includes overbite.

42. The method according to claim 41, wherein: The third plurality of modified treatment plans includes at least one treatment plan that treats the coverage.

43. A method of manufacturing an orthodontic appliance, the method comprising: receiving a three-dimensional model representing a patient's teeth; measuring the position of the patient's teeth based on the three-dimensional model; receiving tooth movement constraints; For one or more types of tooth malocclusion, measuring a first element of the patient's malocclusion of the patient's teeth based on the three-dimensional model; generating a plurality of treatment plans based on the measured tooth positions and the tooth movement constraints; generating a first temporary final position for each of the plurality of treatment plans, wherein at least one of the first temporary final positions corrects a first element of the patient's malocclusion; for each of the plurality of treatment plans generated, measuring a second element of the patient's malocclusion in the first temporary final position; modifying at least one of the plurality of treatment plans to correct a second element of the patient's malocclusion and generating an updated position in at least one of the plurality of treatment plans; selecting a treatment plan from the plurality of treatment plans; Generate appliance models for each phase of the selected treatment plan; and Based on the appliance model at each stage of the selected treatment plan, instructions for manufacturing the appliance at each stage of the selected treatment plan are output.

44. The method of claim 43, wherein: Appliances are manufactured for the one or more phases of the selected treatment plan according to instructions for manufacturing the corresponding appliances.

45. The method of claim 43, further comprising: For each treatment plan, two new treatment plans are generated, a first new treatment plan with premolar extraction and a second new treatment plan without premolar extraction; as well as For each of the first new treatment plan and the second new treatment plan of each treatment plan in the plurality of treatment plans, a second provisional final tooth position is determined.

46. ​​The method of claim 45, further comprising: In each of the first new treatment plan and the second new treatment plan of each treatment plan in the plurality of treatment plans, positions of molars are measured to determine a molar class occlusion for each treatment plan.

47. The method of claim 45, further comprising: In each of the first new treatment plan and the second new treatment plan of each treatment plan in the plurality of treatment plans, a position of canine teeth is measured to determine a canine class occlusion for each treatment plan.

48. The method of claim 45, further comprising: Based on the second provisional final tooth positions for each treatment plan, positions of teeth are measured in each of the first new treatment plan and the second new treatment plan for each treatment plan in the plurality of treatment plans to determine an amount of coverage for each treatment plan.

49. The method of claim 43, wherein: One of the first temporary final positions does not correct the first element of the patient's malocclusion.

50. The method of claim 43, wherein: The tooth movement constraints include selecting teeth that do not move during orthodontic treatment, and wherein the selected teeth serve as anchor points throughout the orthodontic treatment.

51. The method of claim 43, wherein: The tooth movement constraints include limiting interproximal deglazing to specific teeth or groups of teeth.

52. The method of claim 43, further comprising: The plurality of treatment plans are provided to the dentist for selection.

53. The method of claim 43, wherein: The selected treatment plan is selected based at least in part on one of whether to extract one or more teeth, whether and to what extent proximal deglazing is to be performed, and a number of stages for treatment.

54. The method of claim 43, wherein: The instructions for fabricating the appliances for each stage of the selected treatment plan include directly fabricating each appliance by building up the corresponding geometric shape in a layer-by-layer manner.

55. The method of claim 43, wherein: Generating the plurality of treatment plans includes modeling tooth movement in a force system.

56. The method of claim 43, wherein: Generating the plurality of treatment plans includes determining a type of tooth movement of at least one tooth of the patient.

57. The method of claim 56, wherein: The type of tooth movement includes at least one of tilting, translation, rotation, extrusion, intrusion or root movement.

58. A system for manufacturing an orthodontic appliance, the system comprising: processor; as well as A memory comprising instructions that, when executed by a process, cause the system to: receiving a three-dimensional model representing a patient's teeth; measuring the position of the patient's teeth based on the three-dimensional model; receiving tooth movement constraints; For one or more types of tooth malocclusion, measuring a first element of the patient's malocclusion of the patient's teeth based on the three-dimensional model; generating a plurality of treatment plans based on the measured tooth positions and the tooth movement constraints; generating a first temporary final position for each of the plurality of treatment plans, wherein at least one of the first temporary final positions corrects a first element of the patient's malocclusion; for each of the plurality of treatment plans generated, measuring a second element of the patient's malocclusion in the first temporary final position; modifying at least one of the plurality of treatment plans to correct a second element of the patient's malocclusion and generating an updated position in at least one of the plurality of treatment plans; selecting a treatment plan from the plurality of treatment plans; Generate appliance models for each phase of the selected treatment plan; and Based on the appliance model at each stage of the selected treatment plan, instructions for manufacturing the appliance at each stage of the selected treatment plan are output.

59. The system of claim 58, wherein: The instructions also cause the system to: Appliances are manufactured for one or more phases of the treatment plan according to instructions for manufacturing the corresponding appliances.

60. The system of claim 58, wherein: The instructions also cause the system to: For each treatment plan, two new treatment plans are generated, a first new treatment plan with premolar extraction and a second new treatment plan without premolar extraction; as well as For each of the first new treatment plan and the second new treatment plan of each treatment plan in the plurality of treatment plans, a second provisional final tooth position is determined.

61. The system of claim 60, wherein: The instructions also cause the system to: In each of the first new treatment plan and the second new treatment plan of each treatment plan in the plurality of treatment plans, positions of molars are measured to determine a molar class occlusion for each treatment plan.

62. The system of claim 60, wherein: The instructions also cause the system to: In each of the first new treatment plan and the second new treatment plan of each treatment plan in the plurality of treatment plans, a position of canine teeth is measured to determine a canine class occlusion for each treatment plan.

63. The system of claim 60, wherein: The instructions also cause the system to: Based on the second provisional final tooth positions for each treatment plan, positions of teeth are measured in each of the first new treatment plan and the second new treatment plan for each treatment plan in the plurality of treatment plans to determine an amount of coverage for each treatment plan.

64. The system of claim 58, wherein: One of the first temporary final positions does not correct the first element of the patient's malocclusion.

65. The system of claim 58, wherein: The tooth movement constraints include selecting teeth that do not move during orthodontic treatment, and wherein the selected teeth serve as anchor points throughout the orthodontic treatment.

66. The system of claim 58, wherein: The tooth movement constraints include limiting interproximal deglazing to specific teeth or groups of teeth.

67. The system of claim 58, further comprising: The plurality of treatment plans are provided to the dentist for selection.

68. The system of claim 58, wherein: The selected treatment plan is selected based at least in part on one of whether to extract one or more teeth, whether and to what extent proximal deglazing is to be performed, and a number of stages for treatment.

69. The system of claim 58, wherein: The instructions for fabricating the appliances for each stage of the selected treatment plan include directly fabricating each appliance by building up the corresponding geometric shape in a layer-by-layer manner.

70. The system of claim 58 wherein: Generating the plurality of treatment plans includes modeling tooth movement in a force system.

71. The system of claim 58, wherein: Generating the plurality of treatment plans includes determining a type of tooth movement of at least one tooth of the patient.

72. The system of claim 71, wherein: The type of tooth movement includes at least one of tilting, translation, rotation, extrusion, intrusion or root movement.

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