Occlusion features for mandibular arch dilation

Abstract

A method and device for holding or treating a dental arch to apply a lateral expansion force to the mandible while allowing one or more teeth to germinate may include using a maxillary dental instrument device and / or a mandibular dental instrument device, the maxillary dental instrument device and / or the mandibular dental instrument device includes a protruding region extending from an occlusal surface of the device to apply a laterally outward expansion force.

Description

[0001] Priority declaration

[0002] This patent application claims priority to U.S. Provisional Patent Application Serial No. 63 / 340,440, filed on May 10, 2022, and entitled “Occlusal Features for Mandibular Arch Expansion,” the entire contents of which are incorporated herein by reference.

[0003] Incorporation by reference

[0004] All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. Background Art

[0005] Conventional thermoformed retainers may not be desirable for adolescents whose erupting teeth are still growing, as such devices may not leave room for the erupting teeth. Conventional retainer shapes over the erupting teeth can be cut out to address this problem. A typical design with such a cutout is the Theroux retainer for the maxilla, which features a through-the-jaw bone design that covers the jaw bone area to ensure that the device has high rigidity. However, due to the presence of the tongue, this design may have little effect on the mandible, and may instead cause insufficient force to retain the mandibular teeth, especially for arch expansion.

[0006] What is needed is an apparatus (eg, device, system, etc.) and method for applying an expansion force to mandibular teeth. Summary of the invention

[0007] Dental devices (e.g., apparatus and systems) and methods of making and using dental devices are described herein, including methods of forming and / or performing dental treatment plans that include these devices. The devices and methods can be configured to expand and / or maintain expansion of a mandibular arch and / or a maxillary arch. In some examples, these devices can include a retainer that is used as a final step (or multiple steps) of a treatment plan. In particular, these devices can include a mandibular dental appliance (e.g., a retainer) for maintaining expansion of a mandibular dental arch.

[0008] The devices and methods described herein can incorporate bite features for mandibular retainers that can retain mandibular teeth better than existing devices. The mandibular retainers described herein can utilize the additional rigidity of the maxillary retainer to provide the force necessary to retain mandibular teeth.

[0009] The devices described herein may include features, for example, on the occlusal plane of either the upper / maxillary and lower / mandibular devices such that the additional stiffness of the upper / maxillary device (e.g., similar to a Theroux retainer) can provide enhanced retention for the mandibular teeth. Typically, while Theroux-type retainers have been proposed for the mandible, these devices are not effective and are therefore less efficient because they do not provide sufficient force, which may be due to insufficient stiffness in combination with space for the tongue and a cutout portion to allow teeth to extrude. The devices and methods described herein include features that enable such devices to apply the necessary expansion force (e.g., in some examples, a force of about 1 Newton or more).

[0010] In general, the devices and methods described herein can be configured to apply an expansion force on a lower (mandibular) dental arch, for example, to expand or help maintain expansion of the lower dental arch. For example, a mandibular dental appliance device can include: a shell body having a lingual side, an occlusal side, and a buccal side, wherein the shell body includes an anterior tooth receiving area, a first posterior tooth receiving area, and a second posterior tooth receiving area; a first opening through the occlusal side of the shell body between the anterior tooth receiving area and the first posterior tooth receiving area, the first opening being configured to allow one or more teeth to erupt through the opening; and a thickened rim extending around the first opening through the occlusal side of the shell body, wherein the thickness of the thickened rim is greater than twice the thickness of the first posterior tooth receiving area. Any of these devices can include: a second opening through the occlusal side of the shell body between the anterior tooth receiving area and the second posterior tooth receiving area, the second opening being configured to allow one or more teeth to erupt through the opening, and a second thickened rim extending around the second opening through the occlusal side of the shell body, wherein the thickness of the thickened rim is greater than twice the thickness of the second posterior tooth receiving area.

[0011] For example, the present invention describes a mandibular dental appliance device comprising: a shell body having a lingual side, an occlusal side, and a buccal side, wherein the shell body comprises an anterior tooth receiving area, a first posterior tooth receiving area, and a second posterior tooth receiving area; a first opening passing through the occlusal side of the shell body between the anterior tooth receiving area and the first posterior tooth receiving area, the first opening being configured to allow one or more teeth to erupt through the opening; a second opening passing through the occlusal side of the shell body between the anterior tooth receiving area and the second posterior tooth receiving area, the second opening being configured to allow one or more teeth to erupt through the opening, and a first thickened edge extending around the first opening passing through the occlusal side of the shell body, and a second thickened edge extending around the second opening passing through the occlusal side of the shell body, wherein the thickness of each of the first thickened edge and the second thickened edge is greater than twice the thickness of the first posterior tooth receiving area or the second posterior tooth receiving area.

[0012] In any of these devices, the rim extending around the opening through the occlusal side of the shell body can extend below the occlusal surface (e.g., extend at least partially below the lingual and / or buccal sides of the shell body). Thus, the rim extending around the opening through the occlusal side of the shell body can be configured to not interfere with cusp engagement even when the rim is thickened as described in some of these examples.

[0013] Any of these devices can include a first maxillary engagement protrusion extending from an occlusal side of a first posterior tooth receiving area and a second maxillary engagement protrusion extending from an occlusal side of a second posterior tooth receiving area, wherein the first maxillary engagement protrusion and the second maxillary engagement protrusion are configured to apply an expansion force (e.g., an expansion force of about 1 Newton or greater) to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area. The maxillary engagement protrusion can be directly engaged with the upper jaw and / or a maxillary dental appliance worn on the upper jaw to apply an expansion force (e.g., generally outward in a buccal direction) to the lower jaw. The maxillary engagement protrusion can engage with a complementary protrusion on the upper jaw (e.g., a complementary protrusion on a maxillary dental appliance).

[0014] For example, the first maxillary engagement projection may extend from the buccal region of the occlusal side of the first posterior tooth receiving area, and the second maxillary engagement projection may extend from the buccal region of the occlusal side of the second posterior tooth receiving area. In some examples, the first maxillary engagement projection and the second maxillary engagement projection do not extend from the lingual region of the occlusal side of the first posterior tooth receiving area, or do not extend from the lingual region of the occlusal side of the second posterior tooth receiving area.

[0015] The first maxillary engagement projection can be configured to engage with a connector on a maxillary dental appliance device worn on a patient's maxillary arch. The first maxillary engagement projection and the second maxillary engagement projection can each include a block of material. In some examples, the first maxillary engagement projection and the second maxillary engagement projection each include a ramp surface facing the lingual side.

[0016] In any of these devices and methods, the mandibular dental appliance device (or a combination of the mandibular dental appliance device and the maxillary dental appliance device) can be configured to apply a predetermined minimum force (e.g., about 1 N, about 1.1 N, about 1.2 N, about 1.3 N, about 1.4 N, about 1.5 N, etc.) or greater expansion force to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area.

[0017] In any of these devices on the mandibular side, the width of the lingual side of the shell body laterally adjacent to the first opening through the occlusal side of the shell body extends to at least 60% (e.g., at least 65%, at least 75%, at least 80%, at least 90%, at least 95%, etc.) of the lingual width of the shell body in the lateral direction of the first posterior tooth receiving area. For example, the lingual side of the shell body laterally adjacent to the first opening through the occlusal side of the shell body can extend from the gum line to within about 1 mm (e.g., about 0.8 mm, 0.7 mm, 0.6 mm, 0.5 mm, 0.4 mm, 0.2 mm, 0.1 mm, etc.) of the occlusal side of the shell body.

[0018] Typically, the opening through the occlusal side can be configured to allow two or more teeth (e.g., 2 teeth, 3 teeth, etc.) to erupt through the opening. In any device described herein, the shell body can be formed of a relatively rigid material, including a polymer material. For example, in some cases, the shell body includes a nylon material.

[0019] The thickness of the first thickened edge and the second thickened edge can be 1.6 mm or greater (for example, 1.7 mm or greater, 1.8 mm or greater, 2 mm or greater, etc.), and the thickness of the first posterior tooth receiving area or the second posterior tooth receiving area can be 0.9 mm or less (for example, 0.8 mm or less, 0.7 mm or less, etc.).

[0020] Any of these devices may include an accessory coupling region configured to engage with an accessory mounted to a patient's tooth. For example, the accessory coupling region may form a cavity on the lingual side of the first posterior tooth receiving region.

[0021] In any of these devices, the lingual and buccal sides of the shell body adjacent to a first opening through the occlusal side of the shell body and the lingual and buccal sides of the shell body adjacent to a second opening through the occlusal side of the shell body can be configured to be offset relative to the outer surfaces of the patient's teeth when the patient wears the device.

[0022] The present invention also describes a mandibular expansion device, comprising: a shell body having a lingual side, an occlusal side and a buccal side, wherein the shell body includes an anterior tooth receiving area, a first posterior tooth receiving area, a second posterior tooth receiving area and a first intermediate area between the anterior area and the first posterior tooth receiving area; wherein the first intermediate area lacks the occlusal side and the buccal side of the shell body but includes the lingual side, and wherein the lingual side of the first intermediate area is thicker than the lingual side of the anterior tooth receiving area.

[0023] Any of these devices may include a second intermediate region between the anterior region and the second posterior tooth receiving region, wherein the second intermediate region lacks the occlusal and buccal sides of the shell body but includes a lingual side, and wherein the lingual side of the second intermediate region is thicker than the lingual side of the anterior tooth receiving region.

[0024] In any of these devices, the shell body can be a unitary structure, for example, can be a single piece with multiple regions. The shell body can be formed from a single material (e.g., by direct manufacturing, thermoforming, etc.). For example, the shell body can include a nylon material.

[0025] In any shell appliance device described herein, the lingual and / or buccal sides of the first intermediate region and the second intermediate region can be configured to conform to the patient's teeth. Alternatively, the lingual and / or buccal sides of the first intermediate region (and optionally the second intermediate region) can be configured to be offset relative to the outer surfaces of the patient's teeth when worn. This can provide additional space for the eruption of unerupted teeth.

[0026] The lingual thickness of the first intermediate region and / or the second intermediate region may be approximately 1.2 to 4 times the lingual thickness of the anterior tooth receiving region.

[0027] As described above, any of these devices may include a first maxillary engagement protrusion extending from the occlusal side of the first posterior tooth receiving area and a second maxillary engagement protrusion extending from the occlusal side of the second posterior tooth receiving area. The first maxillary engagement protrusion and the second maxillary engagement protrusion may be configured to apply an expansion force of 1 Newton or more to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area. The first maxillary engagement protrusion may extend from the buccal area of ​​the occlusal side of the first posterior tooth receiving area, and the second maxillary engagement protrusion may extend from the buccal area of ​​the occlusal side of the second posterior tooth receiving area. The first maxillary engagement protrusion and the second maxillary engagement protrusion may not extend from the lingual area of ​​the occlusal side of the first posterior tooth receiving area, or may not extend from the lingual area of ​​the occlusal side of the second posterior tooth receiving area. The first maxillary engagement protrusion and the second maxillary engagement protrusion may respectively include a buccal reaction surface, which is configured to engage with a connector on a maxillary dental appliance device worn on the patient's maxillary arch to apply an expansion force between the first posterior tooth receiving portion and the second posterior tooth receiving portion. In some examples, the first maxillary engaging protrusion and the second maxillary engaging protrusion each include a lingually facing ramp surface.

[0028] The mandibular dental appliance apparatus may be configured to apply an expansion force of 1 Newton or greater to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area.

[0029] The thickness of the lingual side of the first intermediate region may be 2 mm or greater, and the thickness of the buccal side of the first posterior tooth receiving area or the second posterior tooth receiving area may be 0.9 mm or less. As described above, any of these devices may include an accessory coupling region configured to engage with an accessory mounted to a patient's tooth.

[0030] Also described herein are systems that include any of the upper dental arch devices (e.g., maxillary dental appliance devices) and lower dental arch devices (e.g., mandibular dental appliance devices) described herein. For example, the mandibular dental appliance device can be any of the devices described herein. In particular, the mandibular dental appliance device and the maxillary dental appliance device can engage with each other, including but not limited to when a subject bites down, so that the maxillary dental appliance device, which is generally more suitable due to the presence of the jaw region, can apply an expansion force on the mandibular dental appliance device, thereby applying an expansion force on the teeth of the lower jaw.

[0031] For example, an orthodontic system may include: a maxillary dental appliance device having a first shell body including an anterior tooth receiving area and a pair of posterior tooth receiving areas separated by a jaw area; and a mandibular dental appliance device having a second shell body including a lingual side, an occlusal side, and a lateral side, wherein the second shell body also includes an anterior tooth receiving area and a pair of posterior tooth receiving areas, wherein a portion of the occlusal side of the second shell body between the anterior tooth receiving area and each posterior tooth receiving area forms an opening to allow teeth to erupt through the opening, and a pair of maxillary engagement protrusions extend from the occlusal sides of the posterior tooth receiving areas, wherein the pair of maxillary engagement protrusions are configured to engage with the maxillary dental appliance device to apply an expansion force (e.g., 1 Newton or greater) to the patient's teeth between the posterior tooth receiving areas of the mandibular dental appliance device.

[0032] In some examples, the mandibular dental appliance assembly does not include a thickened area around the opening, and in some examples the mandibular dental appliance assembly includes a thickened area around the opening. For example, the thickness of the jaw region can be greater than twice the thickness of the anterior tooth receiving region or either posterior tooth receiving region. The mandibular dental appliance assembly can include a thickened rim around the opening through the occlusal side of the first shell body, wherein the thickness of the thickened rim is greater than twice the thickness of the posterior tooth receiving region.

[0033] The maxillary engagement projections may extend from the buccal region of the occlusal side of the posterior teeth receiving area, respectively. For example, the maxillary engagement projections may not extend from the lingual region of the occlusal side of the posterior teeth receiving area. Any of these devices may include a pair of connectors located on the maxillary dental device, which are configured to engage with the maxillary engagement projections. In some examples, the maxillary engagement projections each include a block of material. In some examples, the maxillary engagement projections may each include a ramp surface facing the lingual side.

[0034] For example, a system for expanding a patient's mandibular arch may include: a maxillary dental appliance device (e.g., a shell appliance, a jaw expander, etc.), including: a first tooth receiving area, a second tooth receiving area, and a jaw region extending between the first tooth receiving area and the second tooth receiving area, wherein each of the first tooth receiving area and the second tooth receiving area includes a mandibular engagement projection, the mandibular engagement projection including a maxillary reaction surface extending from an occlusal surface; and a mandibular dental appliance device (e.g., a shell appliance), including: an anterior tooth receiving area, a first posterior tooth receiving area, a second posterior tooth receiving area, wherein each of the first posterior tooth receiving area and the second posterior tooth receiving area includes a maxillary engagement projection, the maxillary engagement projection including a buccal reaction surface, wherein, when the maxillary dental appliance device and the mandibular dental appliance device are worn, the maxillary reaction surface is configured to engage with the buccal reaction surface and apply a combined force between the first posterior tooth receiving area and the second posterior tooth receiving area to expand the mandibular arch. As described above, in some examples, the combined force is 1 Newton or greater.

[0035] In any of these systems, the buccal reaction surface(s) can face in a buccal direction. In some examples, the buccal reaction surfaces are opposite to each other. In some examples, the buccal reaction surfaces are angled at 10 degrees or greater (e.g., 12 degrees or greater, 15 degrees or greater, 17 degrees or greater, 20 degrees or greater, 22 degrees or greater, 25 degrees or greater, 27 degrees or greater, 30 degrees or greater, etc.) relative to a plane passing through an anterior tooth receiving area, a first posterior tooth receiving area, and a second posterior tooth receiving area of ​​the mandibular dental appliance device.

[0036] Either or both of the first and second posterior tooth receiving regions may include an opening through the occlusal side of the mandibular dental appliance device between the anterior tooth receiving region and the first posterior tooth receiving region, the opening configured to allow one or more teeth to erupt therethrough.

[0037] The mandibular dental appliance device can lack a buccal side of the mandibular dental appliance device adjacent to an opening through the occlusal side, further wherein a lingual side of the mandibular dental appliance device adjacent to the opening through the occlusal side is thicker than a lingual side of anterior tooth receiving area. In any of these systems, the mandibular dental appliance device can be one of a plurality of mandibular dental appliance devices, the plurality of mandibular dental appliance devices being a sequence of mandibular dental appliance devices configured to be worn as part of a treatment plan to expand a patient's mandibular arch, wherein a spacing between maxillary engaging projections of mandibular dental appliance devices in the plurality of mandibular dental appliance devices increases across the sequence of mandibular dental appliance devices.

[0038] Treatment plans including these devices and methods of forming these treatment plans are also described herein. For example, the treatment planning method may include: generating a model of a maxillary dental appliance device from a digital model of the patient's teeth, the maxillary dental appliance device having a first shell body, the first shell body including an anterior tooth receiving area and a pair of posterior tooth receiving areas separated by a jaw area; generating a model of a mandibular dental appliance device from a digital model of the patient's teeth, the mandibular dental appliance device having a second shell body including a lingual side, an occlusal side, and a lateral side, wherein the second shell body also includes an anterior tooth receiving area and a pair of posterior tooth receiving areas, wherein a portion of the occlusal side of the first shell body between the anterior tooth receiving area and each posterior tooth receiving area forms an opening to allow the patient's teeth to erupt through the opening, and a pair of mandibular engagement protrusions extend from the occlusal side of the posterior tooth receiving area; and wherein the pair of mandibular engagement protrusions are configured to engage with the mandibular dental appliance device to apply an expansion force (e.g., 1 Newton or greater) to the patient's teeth between the posterior tooth receiving areas.

[0039] Any of these methods may include manufacturing a mandibular dental appliance device from a digital model of the mandibular dental appliance device, and manufacturing a maxillary dental appliance device from a digital model of the maxillary dental appliance device. Manufacturing may include manufacturing by direct manufacturing techniques (e.g., three-dimensional (3D) printing, stereolithography, thermoplastic extrusion, laser sintering, etc.). As described above, the thickness of the jaw region may be greater than twice the thickness of the anterior tooth receiving portion or any posterior tooth receiving region. Any of these methods may include receiving a digital model of the patient's teeth. Generating a model of the mandibular dental appliance device and the maxillary dental appliance device may include generating a digital model of the mandibular dental appliance device and the maxillary dental appliance device.

[0040] Generating the model of the mandibular dental appliance apparatus and the maxillary dental appliance apparatus can include configuring the mandibular dental appliance apparatus and the maxillary dental appliance apparatus so that the patient's teeth are maintained in a predetermined position after orthodontic treatment. In some examples, generating the model of the mandibular dental appliance apparatus includes setting the thickness of the thickened rim surrounding each opening through the occlusal side of the first shell body to be greater than twice the thickness of the posterior tooth receiving area.

[0041] Also described herein are software for performing any of these methods, including, but not limited to, non-transitory computer-readable media including content configured to cause one or more processors to perform these methods. For example, the present invention describes a non-transitory computer-readable medium including content that is configured to cause one or more processors to perform a method comprising: generating a model of a maxillary dental appliance device from a digital model of a patient's teeth, the maxillary dental appliance device having a first shell body, the first shell body including an anterior tooth receiving area and a pair of posterior tooth receiving areas separated by a jaw area, and a pair of maxillary engagement protrusions extending from the occlusal side of the posterior tooth receiving areas; generating a model of a mandibular dental appliance device from the digital model of the patient's teeth, the mandibular dental appliance device having a second shell body including a lingual side, an occlusal side, and a lateral side, wherein the second shell body also includes an anterior tooth receiving area and a pair of posterior tooth receiving areas, wherein a portion of the occlusal side of the second shell body between the anterior tooth receiving area and each posterior tooth receiving area forms an opening to allow teeth to erupt through the opening, and a pair of mandibular engagement protrusions extend from the occlusal side of the posterior tooth receiving area; and wherein the pair of mandibular engagement protrusions are configured to engage with the maxillary dental appliance device to apply an expansion force to the patient's teeth between the posterior tooth receiving areas.

[0042] Any of these methods and apparatus (including software for performing any of these methods) may include allowing a user to include, remove, or modify one or more accessory coupling regions and / or accessories for use with these accessory coupling regions. For example, the software may include user-selectable controls (toggle keys, inputs, etc.) as part of a user interface for adding, removing, or adjusting the shape, size, and / or position of one or more accessory coupling regions as part of a mandibular device and / or a maxillary device as described herein. Alternatively or additionally, any of these methods or apparatus may be configured to allow a user to adjust the thickness of all or a portion of a device (e.g., a maxillary device and / or a mandibular device) at one or more predetermined areas, such as a rim extending around an opening through an occlusal side of a shell body, and / or one or more arbitrarily selected areas. For example, the user interface may include user-selectable controls for selecting and adjusting the thickness of all or a portion (either a preset portion or a user-selected portion) of a device.

[0043] Also described herein is a method of manufacturing (e.g., designing, forming, etc.) any of the dental appliances described herein, the dental appliances including a mandibular dental appliance device and / or a maxillary dental appliance device. For example, a method for forming a set of dental appliances may include: forming a maxillary dental appliance device having a first shell body, the first shell body including an anterior teeth receiving region and a pair of posterior teeth receiving regions separated by a jaw region; forming a mandibular dental appliance device having a second shell body, the second shell body including a lingual side, an occlusal side, and a lateral side, wherein the second shell body also includes an anterior teeth receiving region and a pair of posterior teeth receiving regions, wherein a portion of the occlusal side of the second shell body between the anterior teeth receiving region and each posterior teeth receiving region forms an opening to allow teeth to erupt through the opening, and a pair of mandibular engagement projections extend from the occlusal side of the posterior teeth receiving region; and wherein the pair of mandibular engagement projections are configured to engage with the mandibular dental appliance device to apply an expansion force to the patient's teeth between the posterior teeth receiving regions.

[0044] Forming the mandibular dental appliance assembly and the maxillary dental appliance assembly may include forming by direct manufacturing (eg, three-dimensional (3D) printing, etc.).

[0045] All methods and apparatus described herein in any combination are contemplated herein and may be used to achieve the benefits described herein. BRIEF DESCRIPTION OF THE DRAWINGS

[0046] The patent or application file contains at least one drawing executed in color. Copies of the patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

[0047] A better understanding of the features and advantages of the methods and apparatus described herein will be obtained by referring to the following detailed description, which sets forth illustrative embodiments and the accompanying drawings, and in which:

[0048] Figures 1A to 1E One example of an upper jaw (eg, maxillary) dental appliance assembly as described herein is shown that can be engaged with a lower jaw dental appliance assembly to apply an expansion force. Figures 1A to 1C A side perspective view, a bottom view and a top view are shown respectively. Figure 1D Shown is the application to the upper dental arch Figures 1A to 1C Bottom view of the maxillary dental appliance device. Figure 1E yes Figures 1A to 1D Thermal map of a maxillary dental appliance arrangement showing regions of varying thickness as described herein.

[0049] FIG. 2A to FIG. 2C An example of a mandibular dental appliance arrangement is shown. In this example, the dental appliance arrangement includes a thickened area around an opening through which an erupting tooth can pass. Figure 2AA perspective view is shown. Figure 2B and Figure 2C Bottom and top views are shown, respectively.

[0050] Figure 3A and Figure 3B Shows something like FIG. 2A to FIG. 2C Top and side perspective views of another example of a mandibular dental appliance assembly are shown.

[0051] Figure 4 is similar to Figure 3A and Figure 3B A heat map of an example of a mandibular dental appliance arrangement is shown.

[0052] Figure 5A and Figure 5B An example of a mandibular dental appliance assembly and a maxillary dental appliance assembly engaging one another to apply an expansion force on the lower (mandibular) jaw is shown.

[0053] Figure 6 The invention is an example of a mandibular dental appliance device and a maxillary dental appliance device that engage each other to apply an expansion force on the lower (mandibular) jaw. In this example, the mandibular dental appliance device includes a ramp surface (increasing from the lingual side to the buccal side) to engage with the maxillary dental appliance device to generate the expansion force as described herein.

[0054] Figure 7 is an example of a mandibular dental appliance device and a maxillary dental appliance device that engage each other to apply an expansion force on the lower (mandibular) jaw.

[0055] Figure 8 is an example of a dental appliance device including a combined mandibular and maxillary body (eg, a mouthpiece) configured to apply an expansion force on the lower (mandibular) jaw.

[0056] Fig. 9 is another example of a dental appliance assembly that includes a mandibular dental appliance assembly connected to a maxillary dental appliance assembly to apply an expansion force on the lower (mandibular) jaw.

[0057] Fig.10 A method of treating a patient using the dental instrument arrangement described herein is shown.

[0058] Fig.11A and Fig. 11B An example of a mandibular dental appliance arrangement is shown with buccal and occlusal portions removed.

[0059] FIG. 12A to FIG. 12C An example of a mandibular dental appliance arrangement is shown in which the buccal and lingual sides adjacent to the occlusal cutout area are configured to allow additional space for erupting teeth.

[0060] Fig.13 A system for expanding the mandibular arch of a patient as described herein is schematically illustrated. DETAILED DESCRIPTION

[0061] Described herein are maxillary dental appliance devices and / or mandibular dental appliance devices that can apply relatively high (e.g., 1 Newton or greater) expansion forces on the mandibular (e.g., lower) dental arch. These devices (devices, systems, etc.) and methods (e.g., methods of use, methods of manufacture, etc.) can be particularly useful for treating younger patients, including patients whose teeth continue to grow (e.g., erupt). For example, these methods and devices can be configured as dental / orthodontic retainer devices that help retain teeth after all or part of a dental treatment plan. These methods and devices may be referred to in some examples as stage I / stage II retainers, which can be used during treatment planning, including between different stages of treatment planning. Typically, these devices can provide sufficient force to assist or maintain dental arch expansion, for example to reduce anterior crowding.

[0062] For example, maxillary dental appliance devices are described herein having a first shell body including an anterior tooth receiving region and a pair of posterior tooth receiving regions separated by a jaw region. These maxillary dental appliance devices can include any of the features described herein, including a "cut-out" region to allow erupting teeth to be substantially uninhibited by the maxillary dental appliance device, for example, by removing an occlusal surface or covering during the process. Typically, these devices can be configured to include a thicker and / or more supportive jaw region than a more peripheral tooth receiving region.

[0063] The apparatus described herein may alternatively or additionally include a mandibular dental appliance device having a mandibular shell body including a lingual side, an occlusal side, and a lateral side, wherein the mandibular shell body further includes an anterior tooth receiving area and a pair of posterior tooth receiving areas, wherein a portion of the occlusal side of the mandibular shell body between the anterior tooth receiving area and each of the posterior tooth receiving areas forms an opening to allow teeth to extrude therethrough, and a pair of maxillary engagement projections extend from the occlusal side of the posterior tooth receiving areas. The pair of maxillary engagement projections may be configured to engage with the maxillary dental appliance device (or in some examples, directly engage with teeth of the maxillary jaw) to apply an expansion force of 1 Newton or more to the patient's teeth between the posterior tooth receiving areas of the mandibular dental appliance device.

[0064] In one non-limiting exemplary use case of the devices described herein, the device can be used for a patient, such as a child (e.g., between 7-11 years old), who is initially treated with one or more orthodontic appliances, and then, as the patient continues to grow, can be treated with a second orthodontic appliance or a series of appliances. Any of the devices described herein can be used between these treatments to maintain orthodontic positioning, particularly including positioning of the dental arch width, some of which are used to support the shedding and eruption of the patient's teeth (e.g., for use at night).

[0065] Currently, there are no good options to provide this functionality. Known Theroux retainers have been described for the upper dental arch (e.g., maxillary arch), which include a cut-out area for erupted teeth and a palatal area, however, proposals to create Simar Theroux type retainers for the lower dental arch (mandibular arch) have failed because they were unable to provide adequate retention forces (e.g., greater than 1 Newton), particularly when the cut-out area was large enough for two or more teeth, because the retainers lacked adequate rigidity and support while remaining lightweight.

[0066] Typically, the apparatus described herein may also include an upper arch (maxillary) dental appliance arrangement. For example, Figures 1A to 1E An example of an upper dental appliance device 100 is shown, which includes a shell body having a jaw region 103, an anterior tooth receiving portion 105, a pair of posterior tooth receiving regions 109, 109', and a resection region 107, 107' that can allow one or more teeth to erupt from the upper dental arch. This design can provide a very rigid structure on the upper jaw. In this example, the additional rigidity may come in part from the trans-jaw coverage of the jaw region 103. Figure 1B and Figure 1C Bottom and top views are shown, respectively. The front tooth receiving area can fit the front teeth, while the two rear areas can fit the back teeth. The jaw area can be configured to fit the jaw when worn (or can be slightly separated from the jaw). The entire device can be custom designed and manufactured based on a model (including but not limited to a digital model, such as a digital scan that can be obtained from an intraoral scanner).

[0067] Figure 1D An upper dental appliance assembly 100 is shown worn on teeth 102 of an upper dental arch. In general, the device can be configured to include regions of varying thickness that can provide enhanced comfort and rigidity. For example, Figure 1EAn example of an upper dental appliance device 100 showing different regions of different thicknesses is shown. In this example, a first shell body includes an anterior tooth receiving region 105 formed by a relatively thin material region (e.g., shown here as 0.8 mm), which transitions to an anterior jaw region 113 having a slightly thicker diameter (e.g., 1 mm), and then transitions to a much thicker posterior jaw region 115 between the molars, especially between the posterior tooth receiving regions 109, 109'. This region has a maximum thickness of, for example, 2 mm. The thickness of the posterior tooth receiving regions 109, 109' themselves can be much thinner than the jaw region, including at least on the buccal surfaces (transitioning to the thicker diameter at the lingual side) and occlusal surfaces that are the same minimum thickness as the anterior tooth receiving regions (e.g., 0.8 mm).

[0068] The high stiffness and stability of these maxillary dental appliance devices can be used to provide stability to the mandibular dental appliance devices, even in situations where they themselves may not provide sufficiently high retention forces (e.g., expansion forces). Thus, in any of the devices described herein, either or both of the maxillary dental appliance devices and / or the mandibular dental appliance devices can include one or more bite features that can transmit or provide leverage for causing the expansion force on the mandibular arch to be greater than a threshold amount, such as greater than about 1 Newton.

[0069] The specific shape of the biting feature(s) may vary, but may generally be configured to be able to apply a horizontal force from a retainer on the upper jaw to a retainer on the lower jaw. Figure 5A-5B , 6, 7, 8 and 9 are shown and described in more detail below. For example, blocks 131, 131' ( Figure 1C ) is added to the occlusal plane of the retainer. In some examples, the width of the block can be about half (or less) of the width of the tooth along the buccal-lingual direction. For example, at about the center of the tooth, the edge of the block can be inclined (e.g., ramped) so that when occluded, contact between the blocks in the mandibular dental appliance device and the maxillary dental appliance device can push the mandibular teeth outward (e.g., toward the buccal direction), thereby facilitating expansion of the mandibular arch. This configuration can cause expansion of the mandibular arch rather than contraction of the maxillary arch, because the stiffness of the maxillary dental appliance device can support the mandibular dental appliance device.

[0070] FIG. 2A to FIG. 2CAn example of a mandibular dental appliance device 200 having a shell body including a lingual side 202, an occlusal side 204, and a buccal / lateral side 206 is shown. The shell body can be configured to include an anterior tooth receiving area 215 and a pair of posterior tooth receiving areas 219, 219'. A portion of the occlusal side of the shell body between the anterior tooth receiving area and each of the posterior tooth receiving areas can be cut away (e.g., missing) to form an opening 217, 217', which can allow teeth to extrude through the opening. As described above, any of these mandibular dental appliance devices can include a pair of maxillary engagement projections ( Figures 2A-2C ), in some examples, these maxillary engagement projections may engage directly with the patient's maxillary arch, or preferably, with a maxillary dental appliance device. Figure 2A A top perspective view is shown (showing the occlusal surface). Figure 2B A bottom view is shown (showing the tooth receiving portions in the front 215 and rear 219, 219'. Figure 2C A top view is shown, illustrating the occlusal surface.

[0071] Any of the devices described herein may be configured as or may include a mandibular dental appliance device 200 that is configured to provide enhanced comfort and increased stiffness such that it provides sufficient anti-restoration force, particularly for lower dental arch expansion, while maintaining an opening (e.g., (one or more) cutout areas) (e.g., a closed opening) surrounded by the lingual side 202 and the buccal side 206 that advantageously allows erupting teeth to be extruded. However, as determined experimentally, these openings (cutout areas) may not be conducive to maintaining sufficient stiffness to prevent restoration. Therefore, any of the mandibular dental appliance devices described herein may be configured to provide an expansion force greater than 1 Newton and a torque greater than 5 N·mm by, for example, thickening the local area around the (one or more) openings.

[0072] Such a local thickening of the openings 217, 217' can be achieved, for example, Figures 2A-2C Seen in. Figure 2A and Figure 2C In the mandibular dental appliance 200, the thickness 227 of the opening 217 is configured as a thickened rim 225 that extends completely around the openings 217, 219 on the occlusal side through the shell body. The thickened rims 225 can each have a certain thickness 227 that is greater than the thickness 229 of other areas of the device, including the thickness of the tooth receiving areas, such as the anterior teeth and / or posterior teeth receiving areas. In particular, in the mandibular dental appliance 200, only the areas near the openings 217, 217' can be thickened to this extent. In this example, the thickness of the thickened perimeter of the (one or more) openings is at least twice the thickness 229 of the first posterior teeth receiving area 219 or the second posterior teeth receiving area 219'.

[0073] In general, the device (e.g., a mandibular dental appliance device and / or a maxillary dental appliance device) can be formed of any suitable material. For example, the material can include a material having a material property of an elastic modulus (E) greater than 500 MPa (e.g., greater than 600 MPa, greater than 700 MPa, greater than 750 MPa, between 500 and 1500 MPa, between 700 and 1300 MPa, etc.). For example, the material can be a polymer material, such as, but not limited to, a polyamide (e.g., nylon).

[0074] Any of the mandibular dental appliance device and / or the maxillary dental appliance device can be configured for use with one or more attachments (or pairs of attachments). Attachments mounted to the teeth can be used to help retain the device to the teeth. The device can include an attachment coupling region configured to engage an attachment mounted to the patient's teeth. For example, Figure 2A and Figure 2B As shown, the device may include an accessory coupling area 246 .

[0075] Figure 3A Another example of a device (e.g., mandibular dental appliance device 300) comprising a pair of openings (resection areas) 317, 317' having a thickened local perimeter 325, 325' around the openings is shown. In this example, the openings can allow for extrusion of teeth and, generally, can provide additional space for the teeth while maintaining a high degree of force to maintain, for example, expansion of the dental arch. Figure 3B Shows Figure 3A 300, which shows that in this example, the lateral sides 355 (e.g., buccal and lingual sides) of the device 300 can be long (the length is shown exaggerated in this example). In some examples, the height of the lateral sides of the device can start at or just above the gum line (or in some examples, just below) and can extend on the side of the device toward the occlusal surface, where it extends to the occlusal cut-out area (opening 317, 317').

[0076] In some examples, the device can include an additional offset 341 relative to the tooth surface that can allow for better peeling support. For example, the device can be configured to provide an offset of 0.02 mm to 1 mm relative to the tooth surface (e.g., an offset of about 0.5 mm).

[0077] Figure 44 is a diagram showing different thicknesses of an example of a mandibular dental appliance device 400 including a pair of openings 417, 417' therethrough, the pair of openings including a thickened region 425 having a thickness (in this example) of 2.0 mm, while the remainder of the device 436 has a thickness in this example of approximately 0.8 mm. Other thicknesses may be used, but the ratio of thickness (e.g., the relative thickness of the region surrounding the openings to the remainder of the device (e.g., the anterior tooth receiving region and / or the posterior tooth receiving region)) may be greater than 2 times (2x) (e.g., 2x, 2.1x, 2.2x, 2.3x, 2.4x, 2.5x, 2.6x, 2.7x, 2.8x, 3x, etc.). Figure 4 The diagrams shown show an angle of looking down (e.g., in the xy plane toward the occlusal surface). The thickness distribution along the length (e.g., along a hypothetical z-axis) can also have a non-uniform distribution. For example, the thickness of the shell wall can be thinner in some areas than in other areas. In some examples, the wall of the shell can be thinner at the occlusal end of the cut-out area, which can enhance comfort.

[0078] Surprisingly, even without an engagement area for engagement with the maxillary teeth or a maxillary dental appliance device, this construction can provide sufficient rigidity and support to produce an expansion force of 1 Newton or more, regardless of the size of the opening (e.g., an opening for one tooth, two teeth, or three teeth). Generally, the larger the opening, the less likely the device will be to provide sufficient expansion force. Alternatively, the device can include a maxillary engagement protrusion extending from the occlusal side of the posterior tooth receiving area. The maxillary engagement protrusion in any of these examples can be constructed to apply an expansion force of 1 Newton or more (e.g., 1.2N, 1.4N, 1.5N, 1.6N, 1.8N, 2.0N, etc.) to the patient's teeth located between the posterior tooth receiving areas.

[0079] Figure 5A and Figure 5B Two examples of engagement projections (e.g., an upper jaw engagement projection and a lower jaw engagement projection) that may be included in any of these devices are shown. Figure 5A In the present invention, the system includes a mandibular dental appliance device 501 and a maxillary dental appliance device 500. Both devices are configured to include engagement protrusions. The mandibular dental appliance device 501 includes a maxillary engagement protrusion 573 ("mandibular block"), and the maxillary dental appliance device 500 includes a mandibular engagement protrusion ("maxillary block") 575. Figure 5A and Figure 5BIn the embodiment, the maxillary engagement protrusion 573 is positioned on the occlusal surface of the posterior tooth receiving portion and is positioned on the buccal side of the occlusal surface, while the mandibular engagement protrusion 575 of the maxillary dental appliance device 500 is located on the lingual side, so that the force applied by the maxillary dental appliance device 500 can be directed buccally (outwardly) as an expansion force on the mandible. Figure 5A In the embodiment, the engaging protrusion may be hollow, and in the embodiment Figure 5B In the embodiment, the engagement protrusion is solid (eg, filled).

[0080] The mandibular engagement projection includes a maxillary support reaction surface 580 that can apply a force to a corresponding reaction surface on the maxillary engagement projection of the mandibular dental appliance device. In particular, on the buccal reaction surface 578 of the maxillary engagement projection. Typically, the maxillary dental appliance device 500 may include a jaw region that acts as a brace or support to resist compression so that when the patient's jaw is closed, the maxillary support reaction surface 580 applies a maxillary support force 581 to the buccal reaction surface 578 to generate a buccal force (buccal combined force 579) on the teeth of the mandible through the mandibular dental appliance. The position and shape of the maxillary engagement projection and the mandibular engagement projection can determine the direction of the buccal force, although typically the buccal force can be configured to widen the mandible by applying a force in the buccal direction.

[0081] There are many different ways to design the engagement protrusions so that they can allow for horizontal interaction between the mandibular dental appliance device 501 and the maxillary dental appliance device 500 (on the upper and lower jaws). In some examples, the design can depend on the manufacturing method of the device. For example, for direct manufacturing (e.g., printing methods), the engagement protrusions can be directly incorporated into the device geometry. If the device described herein is formed by a thermoforming method, a preformed block can be inserted into the pocket and welded to a thermoformed appliance (e.g., Figure 5B ). Various angles of the engaging protrusions (e.g., block features) can be used to customize the jaw expansion force based on the patient's treatment needs. For example, Figure 6 An example of an engagement projection including a ramped surface is shown. In this example, a maxillary engagement projection 673 extending from a mandibular dental appliance includes a ramp extending across the occlusal surface of a posterior tooth receiving area. The complementary ramped surface of a mandibular engagement projection 675 extending from a maxillary dental appliance can tend to drive expansion of the mandible when worn. In this example, the applied force (e.g., the expansion force generated) can be adjusted by the force when the jaw is compressed (e.g., the bite force applied).

[0082] Generally, an engagement protrusion having any of these configurations may be used as part of a treatment plan during one or more stages of a treatment plan. For example, an engagement protrusion may be used during an initial portion of a treatment plan (initial phase) but not used later in the treatment plan. Alternatively or additionally, the force (e.g., an expansion force) applied by the engagement protrusion may be adjusted during the stages of the treatment plan. Thus, different stages of a treatment plan may include an engagement protrusion configured to apply a plurality of different expansion forces, and may be configured differently to achieve this. In some examples, different stages of a treatment plan may include different types of engagement protrusions. For example, the initial stage(s) of a treatment plan may include an engagement protrusion similar to Figure 6 The ramp-shaped engagement protrusion shown can provide a variable expansion force according to the bite force applied, and the later stage can include a similar Figure 5A-5B or Figure 7 The engagement protrusion shown, although it may include a ramp-shaped component, includes a stopper or box-shaped member that limits the force applied. Alternatively, the initial stage may include a similar Figure 5A-5B The bite block shaped engagement protrusion shown, while the later stage may include a ramp shaped engagement protrusion, allowing the patient to adjust the expansion force based on the applied bite force. In any ramp shaped engagement protrusion, the angle of the ramp can be selected and / or can be varied according to the stage. For example, the inclination of the ramp can decrease or increase as the stage increases. Figure 6 and Figure 7 In, with Figure 5A-5B As in the embodiment, the maxillary engagement protrusion and the mandibular engagement protrusion may each include a reaction surface, for example, the maxillary engagement protrusion may include a ramped maxillary support reaction surface, and the mandibular engagement protrusion may include a ramped buccal reaction surface 578, such as Figure 6 As shown. Figure 7 In the present invention, the buccal reaction surface can be part of the cusp-fitting shape with the maxillary occlusal projection, although the force can be directed along the Figure 5A-5B and Figure 6 The same directions as in the example were applied.

[0083] In some examples, the retainers for the upper and lower jaws can engage each other to provide a higher expansion force. Figure 7 As shown, the occlusal surfaces of the upper (maxillary 775) and lower (mandibular 773) engagement projections of the dental appliance can be releasably coupled together to provide a lateral outward (distraction) force.

[0084] Alternatively or additionally, the mandibular dental appliance apparatus and the maxillary dental appliance apparatus may be configured to be integrated as a single piece. Figure 8 and Fig. 9 Two examples are shown in FIG.

[0085] and Figure 5A-5B , 6 and 7 are similar, Figure 8 and Fig. 9 The example shown can also allow additional stiffness on the upper jaw to be applied to the lower jaw teeth. Figure 8 In the maxillary dental appliance assembly (upper) and the mandibular dental appliance assembly (lower jaw) are one unitary component 800 and cannot move relative to each other. Although this design provides sufficient rigidity between them, the user can maintain their bite in order for the assembly to function. Fig. 9 In the embodiment of the present invention, this situation can be alleviated by including a connector structure 910 between the upper dental appliance device (upper) and the lower dental appliance device (lower jaw). The connector structure 910 can allow relative movement in the occlusal-gingival direction and relative rotation between the upper and lower retainers, while prohibiting relative movement in the dental arch expansion direction. Therefore, even when the user opens his mouth, this design can allow the dental arch expansion force to be transmitted from the upper jaw to the lower jaw.

[0086] In operation, any of these devices may be used to retain teeth, particularly mandibular teeth, while wearing the device as described above. Fig.10 An example of a method of treating a patient using the device described above is shown. Fig.10 In the present invention, the maxillary dental appliance device and the mandibular dental appliance device can be applied to the upper dental arch 1001 and the lower dental arch 1003. Once worn, a pair of maxillary engagement protrusions can engage with the maxillary dental appliance device (e.g., directly with the device, or with the mandibular engagement protrusions on the maxillary dental appliance device). This engagement can transmit force and / or support from the maxillary dental appliance device, thereby generating an expansion force in the lower jaw 1005. Optionally, in any of these devices and methods, one or more openings through the occlusal surface of the mandibular dental appliance device allow one or more teeth to extrude, and the one or more openings can be supported by a thickened area around the opening(s) of the mandibular dental appliance device 1007.

[0087] Additional Examples

[0088] Fig.11A and Fig. 11B , FIG. 12A to FIG. 12C and Fig.13 Additional examples illustrating the above features are shown. For example, Fig.11A An example of a device similar to that shown above (e.g., a mandibular instrument device) is shown. Fig.11AIn the example, the mandibular appliance device 1101 includes a shell body having a lingual side, an occlusal side, and a buccal side. The shell body includes at least three regions: an anterior tooth receiving region 1105, a first posterior tooth receiving region 1199, and a second posterior tooth receiving region 1199. In this example, the device also includes an intermediate region 1117, 1117' located between the anterior region and the first posterior tooth receiving region. The intermediate region can be configured as a cut-out region, in which the occlusal and buccal sides of the shell body are not present, but the anterior tooth receiving portion is connected to the posterior tooth receiving portion by the lingual side. The lingual side can be thickened 1166, as shown in this example and / or can be reinforced in other ways.

[0089] In some examples, the mandibular instrument device is configured as a mandibular expansion instrument device for use with a maxillary instrument device, as described above (e.g., in Figure 5A-5B , 6 and 7). For example, in Fig. 11B The device comprises Fig.11A The same features as shown (e.g., the buccal and occlusal areas between the anterior and posterior tooth receiving areas are removed and the lingual side is thickened), but the device can also include a pair of maxillary engagement projections 1173, 1173' located on each of the posterior tooth receiving portions 1199, 1199'. Each maxillary engagement projection can include a buccal reaction surface 1178, 1178', which is configured to engage with (and receive force from) the maxillary support reaction surface of the mandibular engagement projection on the mandibular appliance device, thereby generating a buccal resultant force 1179 that can drive the mandibular arch expansion.

[0090] In any of the example appliances described herein (both mandibular appliances and maxillary appliances), the appliance may include a single cut-out region or a pair of cut-out regions (e.g., a middle region) on either side of the appliance. Although the figures show examples where both sides of the appliance include cut-out regions, it should be clear that examples with only a single lateral dentition (e.g., regions corresponding to unerupted or incompletely erupted teeth) are apparent.

[0091] FIG. 12A to FIG. 12C Additional examples are shown. Fig. 12A In the present invention, the mandibular appliance is configured to provide additional space (e.g., a vacancy) for the eruption of one or more teeth by changing the shape of the buccal / lingual sides to provide a smooth transition within these areas. This can provide additional space for the eruption of the teeth, can allow for errors in the prediction of eruption, and can avoid stress concentrations when the appliance is worn. For example, in Fig. 12A, a mandibular appliance 1201 includes an anterior tooth receiving portion 1205 and a pair of posterior tooth receiving portions 1299, 1299'. In this example, a pair of occlusal cutout regions 1217, 1217' are shown on either side of the appliance, for example, in a medial region, having buccal sides 1206, 1206' and lingual sides 1202, 1202'. In some examples, the appliance can be configured so that the lingual and / or buccal sides of the medial region closely conform to the external shape of the patient's teeth, including any erupted and / or predicted unerupted or partially erupted teeth. Alternatively or additionally, as Fig. 12B As shown, one or both of the lingual and / or buccal sides of the intermediate region may be configured to be spaced apart from the patient's teeth, including unerupted and / or erupted teeth.

[0092] Fig. 12C Shows something like Fig. 12B The example of a mandibular appliance device shown, for example, includes a reinforced region for tooth expansion and includes a pair of maxillary engagement protrusions, which respectively include buccal reaction surfaces 1278, 1278' facing the buccal side, which are configured to engage with a reaction surface of a maxillary appliance device (e.g., a maxillary support reaction surface) to apply a buccal expansion force 1279.

[0093] Fig.13 This interaction between the mandibular and maxillary appliance devices is schematically illustrated, wherein the stiffness of the maxillary appliance device 1300, including the jaw region 1303, can support expansion of the patient's mandibular arch due to the lateral (and buccal) expansion forces exerted by the interaction of a pair of mandibular engagement projections 1375, 1375' on the posterior tooth receiving portion 1309, 1309' of the maxillary appliance device and a pair of maxillary engagement projections 1373, 1373' on the mandibular appliance device 1301, 1301'. As described above, the maxillary support reaction surfaces 1380, 1380' of the mandibular engagement projections 1375, 1375' can exert a buccal resultant force on the buccal reaction surfaces 1375, 1378' of the maxillary engagement projections 1373, 1373'. Thus, the maxillary appliance device can provide a maxillary support force 1381, 1381' that opposes the compression of the maxillary appliance and produces an expansion force (buccal expansion forces 1379, 1379') on the mandibular arch.

[0094] It should be appreciated that all combinations of the foregoing concepts and additional concepts discussed in greater detail below (provided such concepts are not mutually inconsistent) are considered to be part of the inventive subject matter disclosed herein and can be used to achieve the benefits described herein.

[0095] The process parameters and step sequences described and / or illustrated herein are provided as examples only and may be changed as desired. For example, although the steps illustrated and / or described herein may be illustrated or discussed in a particular order, the steps do not necessarily need to be performed in the order illustrated or discussed. The various example methods described and / or illustrated herein may also omit one or more of the steps described or illustrated herein, or include additional steps in addition to those disclosed.

[0096] Any of the methods described herein (including user interfaces) may be implemented as software, hardware, or firmware, and may be described as a non-transitory computer-readable storage medium storing a set of instructions executable by a processor (e.g., a computer, tablet, smart phone, etc.), which, when executed by the processor, causes the processor to control the execution of any of the steps, including but not limited to: display, communication with a user, analysis, modification of parameters (including timing, frequency, intensity, etc.), determination, warning, etc. For example, any of the methods described herein may be performed at least in part by an apparatus including one or more processors having a memory storing a non-transitory computer-readable storage medium storing a set of instructions for the process(es) of the method.

[0097] A processor as described herein may be configured to perform one or more steps of any method disclosed herein.Alternatively or in combination, a processor may be configured to combine one or more steps of one or more methods as disclosed herein.

[0098] When a feature or element is referred to as being "on" another feature or element in this article, it can be directly located on other features or elements, or there may also be intervening features or elements. On the contrary, when a feature or element is referred to as being "directly on" another feature or element, there are no intervening features or elements. It should also be understood that when a feature or element is referred to as being "connected", "attached" or "coupled" to another feature or element, it can be directly connected, attached or coupled to other features or elements, or there may be intervening features or elements. On the contrary, when a feature or element is referred to as being "directly connected", "directly attached" or "directly coupled" to another feature or element, there are no intervening features or elements. Although described or shown with reference to one embodiment, the features and elements described or shown in this way can be applied to other embodiments. Those skilled in the art will also recognize that the reference to the structure or feature of the "adjacent" another feature setting can have a part overlapping with the adjacent feature or below the adjacent feature.

[0099] The terms used herein are only used for the purpose of describing specific embodiments and are not intended to limit the present invention. For example, unless the context clearly states, the singular forms "one", "an" and "said" as used herein are intended to include plural forms as well. It should also be understood that the terms "include" and / or "comprise" when used in this specification specify the presence of stated features, steps, operations, elements and / or components, but do not exclude the presence or addition of one or more other features, steps, operations, elements, components and / or their groups. As used herein, the term "and / or" includes any and all combinations of one or more of the associated listed items, and can be abbreviated as " / ".

[0100] Spatially relative terms (such as "under ... ", "below ... ", "lower part", "above ... ", "upper part", etc.) may be used herein to facilitate description of the relationship of one element or feature to another element or feature or to multiple elements or features as shown in the drawings. It should be understood that spatially corresponding terms are intended to include different orientations of the device in use or operation other than the orientation depicted in the drawings. For example, if the device in the drawings is inverted, the element described as "under other elements or features" or "below other elements or features" can be oriented as "on other elements or features". Therefore, the exemplary term "under ... " can cover two orientations of on ... and under .... The device can be oriented otherwise (rotated 90 degrees or in other orientations), and the spatially corresponding descriptors used herein are interpreted accordingly. Similarly, unless otherwise specifically stated, the terms "upward", "downward", "vertical", "horizontal", etc. are used for illustrative purposes in this article.

[0101] Although the terms "first" and "second" may be used herein to describe various features / elements (including steps), these features / elements should not be limited by these terms unless the context indicates otherwise. These terms may be used to distinguish one feature / element from another feature / element. Therefore, without departing from the teachings of the present invention, the first feature / element discussed below may be referred to as the second feature / element, and similarly, the second feature / element discussed below may be referred to as the first feature / element.

[0102] Throughout this specification and the appended claims, unless the context requires otherwise, the word "comprise" and variations such as "include" and "comprising" mean that various components (e.g., compositions and devices including apparatus and methods) can be used together in methods and articles. For example, the term "comprising" will be understood to imply the inclusion of any stated elements or steps but not the exclusion of any other elements or steps.

[0103] In general, the devices and methods described herein should be understood to be inclusive, but all or a subset of components and / or steps may alternatively be exclusive and may be expressed as "consisting of" or alternatively "consisting essentially of" the various components, steps, subcomponents or substeps.

[0104] As used herein in the specification and claims, including in the examples, unless otherwise expressly stated, all numbers may be read as if beginning with the word "about" or "approximately", even if the term does not appear explicitly. The phrase "about" or "approximately" may be used when describing the amplitude and / or position to indicate that the value and / or position described is within the reasonable expected range of the value and / or position. For example, a numerical value may have a value of + / -0.1% of a set value (or range of values), + / -1% of a set value (or range of values), + / -2% of a set value (or range of values), + / -5% of a set value (or range of values), + / -10% of a set value (or range of values), etc. Unless the context indicates otherwise, any numerical value given herein is also understood to include being about that value or approximately that value. For example, if the value "10" is disclosed, "about 10" is also disclosed. Any numerical range described herein is intended to include all subranges contained therein. It should also be understood that when a value is disclosed as "less than or equal to" the value, "greater than or equal to the value" and possible ranges between values ​​are also disclosed, as should be appropriately understood by those skilled in the art. For example, if the value "X" is disclosed, "less than or equal to X" and "greater than or equal to X" (e.g., where X is a numerical value) are also disclosed. It should also be understood that throughout the application, data is provided in a variety of different formats and that the data represents endpoints and starting points and ranges for any combination of data points. For example, if a specific data point "10" and a specific data point "15" are disclosed, it should be understood that greater than, greater than or equal to, less than, less than or equal to, and equal to 10 and 15 are considered to be disclosed as well as between 10 and 15. It should also be understood that every unit between two specific units is also disclosed. For example, if 10 and 15 are disclosed, 11, 12, 13, and 14 are also disclosed.

[0105] Although various illustrative embodiments are described above, any of a number of changes may be made to the various embodiments without departing from the scope of the invention as described in the claims. For example, in alternative embodiments, the order in which the various described method steps are performed may generally be changed, and in other alternative embodiments, one or more method steps may be skipped altogether. Optional features of the various device and system embodiments may be included in some embodiments and not included in other embodiments. Therefore, the foregoing description is provided primarily for exemplary purposes and should not be construed as limiting the scope of the invention as set forth in the claims.

[0106] The examples and descriptions included herein show specific embodiments in which the subject matter can be practiced by way of illustration and not limitation. As described above, other embodiments can be utilized and derived therefrom so that structural and logical replacements and changes can be made without departing from the scope of the present disclosure. For convenience only, such embodiments of the subject matter of the invention may be referred to herein individually or collectively by the term "invention", and it is not intended that the scope of the present application be actively limited to any single invention or inventive concept, if in fact more than one is disclosed. Therefore, although specific embodiments have been illustrated and described herein, any arrangement calculated to achieve the same purpose may replace the specific embodiments shown. The present disclosure is intended to cover any and all modifications or variations of various embodiments. After reviewing the above description, those skilled in the art will understand the combination of the above embodiments and other embodiments not specifically described herein.

Claims

1. A mandibular dental instrument device, comprising: a shell body having a lingual side, an occlusal side, and a buccal side, wherein the shell body includes an anterior tooth receiving area, a first posterior tooth receiving area, and a second posterior tooth receiving area; a first opening through the occlusal side of the shell body between the anterior tooth receiving region and the first posterior tooth receiving region, the first opening being configured to allow one or more teeth to erupt through the first opening; and A rim extends around the first opening through the occlusal side of the shell body, wherein a thickness of the rim is greater than a thickness of the first posterior tooth receiving area.

2. The device according to claim 1, wherein: The rim includes a thickened rim having a thickness greater than twice a thickness of the first posterior tooth receiving area.

3. The device of claim 2 further comprising a second opening through the occlusal side of the shell body between the anterior tooth receiving region and the second posterior tooth receiving region and configured to allow one or more teeth to erupt through the second opening and a second thickened rim extending around the second opening through the occlusal side of the shell body, wherein The thickness of the thickened rim is greater than twice the thickness of the second posterior tooth receiving area.

4. The apparatus of claim 1 further comprising a first maxillary engagement protrusion extending from an occlusal side of the first posterior tooth receiving area and a second maxillary engagement protrusion extending from an occlusal side of the second posterior tooth receiving area, wherein The first maxillary engaging protrusion and the second maxillary engaging protrusion are configured to apply an expansion force of 1 Newton or greater to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area.

5. The device according to claim 4, wherein: The first maxillary engaging projection extends from an occlusal buccal region of the first posterior tooth receiving area, and the second maxillary engaging projection extends from an occlusal buccal region of the second posterior tooth receiving area.

6. The device according to claim 5, wherein: The first maxillary engaging projection and the second maxillary engaging projection do not extend from an occlusal lingual region of the first posterior tooth receiving area, or do not extend from an occlusal lingual region of the second posterior tooth receiving area.

7. The device according to claim 4, wherein: The first maxillary engagement projection is configured to engage with a connector on a maxillary dental appliance device worn on a maxillary arch of a patient.

8. The device according to claim 4, wherein: The first maxillary engaging protrusion and the second maxillary engaging protrusion each comprise a block of material.

9. The device according to claim 4, wherein: The first maxillary engaging protrusion and the second maxillary engaging protrusion each include a slope surface facing the lingual side.

10. The device according to claim 1, wherein: The mandibular dental appliance apparatus is configured to apply an expansion force of 1 Newton or greater to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area.

11. The device according to claim 1, wherein: A lingual width of the shell body laterally adjacent the first opening through the occlusal side of the shell body extends for at least 75% of a lingual width of the shell body in a lateral direction of the first posterior tooth receiving area.

12. The device according to claim 1, wherein: A lingual side of the shell body laterally adjacent to the first opening through the occlusal side of the shell body extends from the gum line to within about 1 mm of the occlusal side of the shell body.

13. The device according to claim 1, wherein: The first opening through the occlusal side is configured to allow two or more teeth to erupt through the first opening.

14. The device according to claim 1, wherein: The shell body includes nylon material.

15. The device according to claim 1, wherein: The thickness of each of the first thickened edge and the second thickened edge is 2 mm or more, and the thickness of the first posterior tooth receiving area or the second posterior tooth receiving area is 0.9 mm or less.

16. The apparatus of claim 1, further comprising an accessory coupling region configured to engage an accessory mounted to a patient's tooth.

17. The apparatus of claim 1 further comprising an accessory coupling region forming a cavity on the lingual side of the first posterior tooth receiving area.

18. The device according to claim 1, wherein: The lingual and buccal sides of the shell body adjacent to the first opening through the occlusal side of the shell body and the lingual and buccal sides of the shell body adjacent to the second opening through the occlusal side of the shell body are configured to be offset relative to the outer surface of the patient's teeth when the device is worn by the patient.

19. An orthodontic system comprising: A maxillary dental appliance device having a first shell body including an anterior tooth receiving region and a pair of posterior tooth receiving regions separated by a jaw region; as well as A mandibular dental appliance device having a second shell body, the second shell body including a lingual side, an occlusal side and a lateral side, wherein the second shell body further includes an anterior tooth receiving area and a pair of posterior tooth receiving areas, wherein a portion of the occlusal side of the second shell body between the anterior tooth receiving area and each of the posterior tooth receiving areas forms an opening to allow teeth to erupt through the opening, and a pair of maxillary engagement projections extend from the occlusal side of the posterior tooth receiving areas, Wherein, the pair of maxillary engagement projections are configured to engage with the maxillary dental appliance device to apply an expansion force to the patient's teeth between the posterior tooth receiving areas of the mandibular dental appliance device.

20. The system of claim 19, wherein: The expansion force is 1 Newton or greater.

21. The system of claim 19, wherein: The thickness of the jaw region is greater than twice the thickness of the anterior tooth receiving region or either of the posterior tooth receiving regions.

22. The system of claim 19, wherein: The mandibular dental appliance assembly includes a thickened rim surrounding an opening through an occlusal side of the first shell body, wherein a thickness of the thickened rim is greater than twice a thickness of the posterior tooth receiving area.

23. The system of claim 19, wherein: The maxillary engagement projections extend respectively from buccal regions on the occlusal side of the posterior tooth receiving region.

24. The system of claim 19, wherein: The maxillary engagement projection does not extend from the lingual region of the occlusal side of the posterior tooth receiving area.

25. The system of claim 19, wherein: Also included is a pair of connectors on the maxillary dental appliance assembly, the connectors being configured to engage with the maxillary engagement projections.

26. The system of claim 19, wherein: The maxillary engaging projections each comprise a block of material.

27. The system of claim 19, wherein: The maxillary engaging projections each include a ramp surface facing the lingual side.

28. A method comprising: generating a model of a maxillary dental appliance apparatus from a digital model of the patient's teeth, the maxillary dental appliance apparatus having a first shell body including an anterior tooth receiving region and a pair of posterior tooth receiving regions separated by a jaw region; generating a model of a mandibular dental appliance device from a digital model of the patient's teeth, the mandibular dental appliance device having a second shell body, the second shell body comprising a lingual side, an occlusal side, and a lateral side, wherein the second shell body further comprises an anterior tooth receiving region and a pair of posterior tooth receiving regions, wherein a portion of the occlusal side of the first shell body between the anterior tooth receiving region and each of the posterior tooth receiving regions forms an opening to allow the patient's teeth to erupt through the opening, and a pair of mandibular engagement projections extend from the occlusal sides of the posterior tooth receiving regions; And wherein the pair of mandibular engagement projections are configured to engage the mandibular dental appliance device to apply an expansion force to the patient's teeth between the posterior tooth receiving areas.

29. The method according to claim 28, wherein: The pair of mandibular engagement projections are configured to engage the mandibular dental appliance device with an expansion force of 1 Newton or greater.

30. The method of claim 28, further comprising manufacturing the mandibular dental appliance assembly from a digital model of the mandibular dental appliance assembly and manufacturing the maxillary dental appliance assembly from a digital model of the maxillary dental appliance assembly.

31. The method of claim 28, wherein: Manufacturing includes fabrication through direct manufacturing techniques.

32. The method of claim 28, wherein: The thickness of the jaw region is greater than twice the thickness of the anterior tooth receiving region or either of the posterior tooth receiving regions.

33. The method of claim 28, further comprising receiving a digital model of the patient's teeth.

34. The method of claim 28, wherein: Generating models of the mandibular dental appliance apparatus and the maxillary dental appliance apparatus includes generating digital models of the mandibular dental appliance apparatus and the maxillary dental appliance apparatus.

35. The method of claim 28, wherein: Generating the models of the mandibular dental appliance apparatus and the maxillary dental appliance apparatus includes configuring the mandibular dental appliance apparatus and the maxillary dental appliance apparatus such that the patient's teeth are maintained in a predetermined position after orthodontic treatment.

36. The apparatus of claim 28, wherein: Generating a model of the mandibular dental appliance arrangement includes setting a thickness of a thickened rim surrounding each opening through an occlusal side of the first shell body to be greater than twice a thickness of the posterior tooth receiving area.

37. A non-transitory computer-readable medium comprising content configured to cause one or more processors to perform a method comprising: generating a model of a maxillary dental appliance apparatus from a digital model of the patient's teeth, the maxillary dental appliance apparatus having a first shell body including an anterior tooth receiving region and a pair of posterior tooth receiving regions separated by a jaw region; generating a model of a mandibular dental appliance device from a digital model of the patient's teeth, the mandibular dental appliance device having a second shell body, the second shell body including a lingual side, an occlusal side, and a lateral side, wherein the second shell body further includes an anterior tooth receiving area and a pair of posterior tooth receiving areas, wherein a portion of the occlusal side of the first shell body between the anterior tooth receiving area and each of the posterior tooth receiving areas forms an opening to allow teeth to erupt through the opening, and a pair of mandibular engagement projections extend from the occlusal sides of the posterior tooth receiving areas; And wherein the pair of mandibular engagement projections are configured to engage the mandibular dental appliance device to apply an expansion force to the patient's teeth between the posterior tooth receiving areas.

38. A method for forming a set of dental appliances, the method comprising: forming a maxillary dental appliance assembly having a first shell body including an anterior tooth receiving region and a pair of posterior tooth receiving regions separated by a jaw region; forming a mandibular dental appliance device having a second shell body, the second shell body including a lingual side, an occlusal side, and a lateral side, wherein the second shell body further includes an anterior tooth receiving region and a pair of posterior tooth receiving regions, wherein a portion of the occlusal side of the second shell body between the anterior tooth receiving region and each of the posterior tooth receiving regions forms an opening to allow teeth to erupt through the opening, and a pair of mandibular engagement projections extend from the occlusal sides of the posterior tooth receiving regions; And wherein the pair of mandibular engagement projections are configured to engage the mandibular dental appliance device to apply an expansion force to the patient's teeth between the posterior tooth receiving areas.

39. The method of claim 38, wherein: Forming the mandibular dental appliance assembly and the maxillary dental appliance assembly includes forming by direct manufacturing.

40. A mandibular expansion device, comprising: a shell body having a lingual side, an occlusal side, and a buccal side, wherein the shell body includes an anterior tooth receiving region, a first posterior tooth receiving region, a second posterior tooth receiving region, and a first intermediate region between the anterior region and the first posterior tooth receiving region; wherein the first intermediate region lacks the occlusal side and the buccal side of the shell body and includes the lingual side, And wherein the lingual side of the first intermediate region is thicker than the lingual side of the anterior tooth receiving region.

41. The apparatus of claim 40 further comprising a second intermediate region between the anterior region and the second posterior tooth receiving region, wherein The second intermediate region lacks the occlusal side and the buccal side of the shell body and includes the lingual side, and wherein the lingual side of the second intermediate region is thicker than the lingual side of the anterior tooth receiving region.

42. The device according to claim 40, wherein: The shell body comprises a unitary structure.

43. The device according to claim 40, wherein: The lingual sides of the first intermediate region and the second intermediate region are configured to conform to the patient's teeth.

44. The apparatus of claim 40, wherein: The lingual sides of the first and second intermediate regions are configured to be offset relative to outer surfaces of the patient's teeth when worn.

45. The apparatus of claim 40, wherein: The lingual thickness of the first intermediate region and the second intermediate region is between about 1.2 and 4 times the lingual thickness of the anterior tooth receiving region.

46. ​​The apparatus of claim 40 further comprising a first maxillary engagement projection extending from an occlusal side of the first posterior tooth receiving area, and a second maxillary engagement projection extending from an occlusal side of the second posterior tooth receiving area.

47. The device according to claim 46, wherein The first maxillary engaging protrusion and the second maxillary engaging protrusion are configured to apply an expansion force of 1 Newton or greater to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area.

48. The apparatus of claim 46, wherein: The first maxillary engaging projection extends from an occlusal buccal region of the first posterior tooth receiving area, and the second maxillary engaging projection extends from an occlusal buccal region of the second posterior tooth receiving area.

49. The apparatus of claim 48, wherein: The first maxillary engaging projection and the second maxillary engaging projection do not extend from an occlusal lingual region of the first posterior tooth receiving area, or do not extend from an occlusal lingual region of the second posterior tooth receiving area.

50. The apparatus of claim 46, wherein: The first maxillary engagement protrusion and the second maxillary engagement protrusion each include a buccal reaction surface configured to engage with a connector on a maxillary dental appliance device worn on a patient's maxillary arch to apply an expansion force between the first posterior tooth receiving portion and the second posterior tooth receiving portion.

51. The apparatus of claim 46, wherein: The first maxillary engaging protrusion and the second maxillary engaging protrusion each include a slope surface facing the lingual side.

52. The apparatus of claim 40, wherein: The mandibular dental appliance apparatus is configured to apply an expansion force of 1 Newton or greater to the patient's teeth between the first posterior tooth receiving area and the second posterior tooth receiving area.

53. The apparatus of claim 40, wherein: The shell body includes nylon material.

54. The apparatus of claim 40, wherein: The thickness of the first intermediate region on the lingual side is 2 mm or more, and the thickness of the first posterior tooth receiving region or the second posterior tooth receiving region on the buccal side is 0.9 mm or less.

55. The apparatus of claim 40, further comprising an accessory coupling region configured to engage an accessory mounted to a patient's tooth.

56. A system for expanding a mandibular arch of a patient, the system comprising: a maxillary dental appliance device comprising a first tooth receiving area, a second tooth receiving area, and a jaw region extending between the first tooth receiving area and the second tooth receiving area, wherein each of the first tooth receiving area and the second tooth receiving area comprises a mandibular engagement projection comprising a maxillary reaction surface extending from an occlusal surface; and A mandibular dental appliance device comprising an anterior tooth receiving area, a first posterior tooth receiving area, and a second posterior tooth receiving area, wherein each of the first posterior tooth receiving area and the second posterior tooth receiving area comprises a maxillary engagement projection, the maxillary engagement projection comprising a buccal reaction surface, Wherein, when the maxillary dental appliance device and the mandibular dental appliance device are worn, the maxillary reaction surface is configured to engage with the buccal reaction surface and exert a combined force between the first posterior tooth receiving area and the second posterior tooth receiving area to expand the mandibular arch.

57. The system of claim 56, wherein: The combined force is 1 Newton or greater.

58. The system of claim 56, wherein: The buccal reaction surface faces in a buccal direction.

59. The system of claim 56, wherein: The buccal reaction surface is angled greater than 10 degrees relative to a plane passing through the anterior tooth receiving area, the first posterior tooth receiving area, and the second posterior tooth receiving area of ​​the mandibular dental appliance device.

60. The system of claim 56, wherein: Either or both of the first and second posterior tooth receiving regions include an opening through an occlusal side of the mandibular dental appliance device between the anterior and first posterior tooth receiving regions, the opening being configured to allow one or more teeth to erupt therethrough.

61. The system of claim 60, wherein: The mandibular dental appliance device lacks a buccal side of the mandibular dental appliance device adjacent the opening through the occlusal side, and wherein a lingual side of the mandibular dental appliance device adjacent the opening through the occlusal side is thicker than a lingual side of the anterior tooth receiving area.

62. The system of claim 60, wherein: The mandibular dental appliance apparatus is one of a plurality of mandibular dental appliance apparatuses, the plurality of mandibular dental appliance apparatuses being a sequence of mandibular dental appliance apparatuses configured to be worn as part of a treatment plan to expand a mandibular arch of a patient, wherein the spacing between the maxillary engaging projections of the mandibular dental appliance apparatuses of the plurality of mandibular dental appliance apparatuses increases throughout the sequence of mandibular dental appliance apparatuses.

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