Computer-implemented method and system for designing and / or manufacturing orthodontic appliances for treating or preventing temporomandibular joint dysfunction

Abstract

Methods and systems are provided for diagnosing and generating treatment plans for temporomandibular joint dysfunction in which a polymeric shell appliance is utilized to generate one or more activation forces that promote tooth movement. The polymeric shell appliance may include one or more tooth receiving cavities, where each of the plurality of tooth receiving cavities is shaped and arranged to provide a counter torque for each of the plurality of teeth.

Description

[0001] This divisional application is for the divisional application with a filing date of June 29, 2018 and national application number 202210813001.2. The latter divisional application is a divisional application of the PCT national phase application with a filing date of June 29, 2018 and national application number 201880044251.6.

[0002] Cross-references

[0003] This patent application claims priority to U.S. Provisional Patent Application Serial No. 62 / 527,856, filed June 30, 2017, which is incorporated herein by reference. Background Art

[0004] Temporomandibular joint dysfunction (TMD) is a dysfunction of the temporomandibular joint (TMJ) or the muscles of mastication. TMD can cause a wide range of orofacial pain, including headaches, earaches, jaw and neck pain, and abnormal opening and closing of the jaw. Options for managing TMD include devices to modify tooth contacts or condylar position, tooth movement, or surgery. Clear shell appliances can effectively relieve or eliminate pain associated with TMJ. Clear shell appliances can be custom designed for each patient. When designing the appliance, a movement path is determined for one or more teeth to move from an initial arrangement to a target arrangement. An occlusal scan is obtained to determine the current jaw relationship, from which a desired jaw relationship (e.g., an ideal jaw relationship) can be calculated. For example, in some cases, the desired jaw relationship can be a centric relationship, corresponding to a clinically reproducible positioning of the condyle in the mandibular fossa. Orthodontic treatment that does not take into account the desired jaw relationship may restrict condylar position or cause unhealthy muscle activation, which may cause or contribute to TMD. Appliances that are orthodontically moved to the desired jaw relationship prevent undesirable habitual muscle activation and may help alleviate or prevent TMD. Summary of the Invention

[0005] The methods and devices disclosed herein provide improved tooth and jaw movement for treating and / or preventing TMD. In various aspects, a method for treating and / or preventing TMD is provided. First and second bite scan data of a patient's dentition are obtained. The first bite scan data is obtained using the patient's jaw in a target occlusal configuration, and the second bite scan data is obtained using the patient's jaw in a natural occlusal configuration. Based on the first and second bite scan data, a plurality of braces are designed. The braces are configured to apply tooth-moving and jaw-moving forces to the patient's dentition to move the patient's dentition from a natural occlusal configuration to a final occlusal configuration. The final occlusal configuration corresponds to the target occlusal configuration. The plurality of braces are configured to sequentially move the patient's dentition in incremental steps when the plurality of braces are worn consecutively, thereby moving the dentition to the final occlusal configuration. Designing the plurality of braces includes determining, in at least one incremental step, one or more gaps between upper teeth of the dentition and lower teeth of the dentition. At least one of the plurality of braces includes one or more occlusal surface features positioned to fill the one or more gaps when the patient wears the braces. One or more of the plurality of appliances are designed to apply tooth moving forces to close the one or more spaces.

[0006] For example, the one or more gaps may include one or more bite gaps.

[0007] In some aspects, obtaining the first bite scan data includes scanning the patient's dentition in a target bite configuration, and obtaining the second bite scan data includes scanning the patient's dentition in a natural bite configuration.

[0008] The method may include manufacturing a plurality of appliances. Additionally or alternatively, the method may include providing the plurality of appliances to the patient. In some cases, the method includes placing at least one of the plurality of appliances on the patient's dentition.

[0009] In some aspects, each of the plurality of appliances comprises a polymeric shell. In some cases, each of the plurality of appliances comprises a first polymeric shell shaped to receive upper teeth of the dentition and a second polymeric shell shaped to receive lower teeth of the dentition.

[0010] In some aspects, the final bite configuration includes a jaw position corresponding to a target bite configuration, and the position of one or more teeth of the final bite configuration is changed relative to the target bite configuration. In some cases, the position of one or more teeth of the final bite configuration is changed to avoid one or more upper and lower tooth collisions in the target bite configuration. In some aspects, each incremental step in the sequence of incremental steps includes a tooth contact path for each of a plurality of teeth, and wherein designing the plurality of appliances includes optimizing the tooth contact paths of the incremental steps to avoid tooth collisions during the incremental steps.

[0011] In some aspects, at least one of the plurality of appliances is a removable appliance. For example, each of the plurality of appliances can be a removable appliance.

[0012] In many aspects, an appliance for treating or preventing TMD is provided. The housing of the appliance includes a plurality of tooth-receiving cavities shaped to fit the teeth of a first dental arch of a patient's dentition. The appliance also includes a bite repositioning splint. The bite repositioning splint includes a first surface and a second surface, the first surface being shaped to attach to the housing and extend over the plurality of tooth-receiving cavities of the housing, the second surface being opposite the first surface and having a varying surface height. When the appliance is worn, the second surface presents an adjusted occlusal surface on the teeth of the second dental arch of the patient's dentition. The adjusted occlusal surface is shaped to change the natural occlusion of the first dental arch and the second dental arch, thereby converting the patient's occlusion from a natural occlusal configuration to a target occlusal configuration. The occlusal repositioning splint is shaped to fill the gap between the occlusal surfaces of the teeth of the first and second dental arches caused by the target occlusal configuration.

[0013] In some aspects, the appliance further comprises a tooth engagement structure to apply a tooth movement force when the appliance is worn, thereby urging one or more of the patient's teeth to fill the gap between the occlusal surfaces. In some aspects, the adjusted occlusal surface can be shaped to occlude with the appliance housing worn on teeth of the second arch of the patient's dentition.

[0014] In some cases, the bite repositioning splint is removably attached to the shell; in some cases, the bite repositioning splint is integrally attached to the shell.

[0015] The second surface can be shaped to provide for the removal of the posterior teeth in the resting jaw position. Alternatively or additionally, the second surface can include one or more sliding, angled contacts on the patient's anterior teeth. The sliding, angled contacts can be shaped to provide anterior guided occlusion during lateral deviation and protrusion of the jaw.

[0016] In some aspects, a plurality of appliances can be provided, including an appliance for treating or preventing TMD. The plurality of appliances are configured to move the patient's dentition from a natural occlusal configuration to a final occlusal configuration in an incremental sequence of steps when the plurality of appliances are worn consecutively. In some cases, at least one of the plurality of appliances includes a tooth engagement structure to apply tooth moving forces when the appliance is worn, thereby urging one or more of the patient's teeth to fill a gap between the occlusal surfaces. At least one appliance can be the same appliance as the appliance used for TMD treatment, or can be a different appliance. In some cases, each of the plurality of appliances is an appliance used to treat or prevent TMD.

[0017] In various aspects, an appliance for treating or preventing TMD is provided. The appliance includes a housing including a plurality of tooth-receiving cavities shaped to fit teeth of a first dental arch of a patient's dentition, and a lingual repositioning splint attached to and extending away from the housing. The lingual repositioning splint includes a surface shaped to contact one or more teeth of a second dental arch of the patient when the appliance is worn, thereby adjusting the patient's bite from a natural bite configuration toward a target bite configuration based on contact between the one or more teeth of the second dental arch and the surface of the lingual repositioning splint.

[0018] In some aspects, the surface is shaped with indentations to accommodate one or more teeth of the second dental arch. The indentations are positioned to provide incremental adjustment of the patient's bite away from the natural bite configuration and toward the target bite configuration. In some cases, the surface is shaped to correct an overbite; in some cases, the surface is shaped to correct an underbite. The appliance may also include a tooth engagement structure to apply tooth movement forces when the appliance is worn.

[0019] In many aspects, a system for treating and / or preventing temporomandibular joint dysfunction (TMD) is provided. The system includes a processor and a memory storing instructions that, when executed, perform a method. The method includes receiving first and second bite scan data of a patient's dentition. The first bite scan data utilizes the patient's jaw in a target bite configuration; the second bite scan data utilizes the patient's jaw in a natural bite configuration. The method also includes designing a plurality of appliances based on the first and second bite scan data. The plurality of appliances are configured to apply tooth moving forces and jaw moving forces to the patient's dentition so as to move the patient's dentition from a natural bite configuration to a final bite configuration corresponding to the target bite configuration in a sequence of incremental steps when the plurality of appliances are worn consecutively. Designing the plurality of appliances includes determining, in at least one incremental step, one or more occlusal gaps between the upper teeth of the dentition and the lower teeth of the dentition. At least one of the plurality of appliances includes one or more occlusal surface features positioned to fill one or more bite gaps when the patient wears the appliance, and one or more of the plurality of appliances is designed to apply tooth moving forces to close the one or more bite gaps.

[0020] In some aspects, the system is further configured to generate instructions for manufacturing the plurality of aligners. In some aspects, each of the plurality of aligners comprises a polymer shell. In some aspects, each of the plurality of aligners comprises a first polymer shell shaped to accommodate upper teeth of the dentition and a second polymer shell shaped to accommodate lower teeth of the dentition.

[0021] In some aspects, the final bite configuration includes a jaw position corresponding to the target bite configuration, and the position of one or more teeth in the final bite configuration is changed relative to the target bite configuration. In some cases, the position of one or more teeth in the final bite configuration is changed to avoid one or more upper and lower teeth from colliding in the target bite configuration.

[0022] In some aspects, at least one of the plurality of appliances is a removable appliance. In some cases, each of the plurality of appliances is a removable appliance.

[0023] Incorporated by reference

[0024] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. BRIEF DESCRIPTION OF THE DRAWINGS

[0025] The novel features of the present invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present disclosure will be obtained by referring to the following detailed description and the accompanying drawings, which set forth illustrative embodiments utilizing the principles of the present disclosure, wherein:

[0026] Figure 1 A method of treating TMD according to an embodiment is shown, the method comprising obtaining a scan at a desired jaw position, determining a final position at the desired position, determining tooth paths and intermediate stages, and continuing treatment.

[0027] Figure 2 is a simplified block diagram of a data processing system according to an embodiment;

[0028] Figure 3 A tooth repositioning system according to an embodiment is shown;

[0029] Figure 4 An orthodontic treatment method using multiple appliances according to an embodiment is shown;

[0030] Figure 5 A method for designing an orthodontic appliance according to an embodiment is shown;

[0031] Figure 6A shows a bite repositioning splint positioned on an occlusal surface of a tooth structure according to an embodiment;

[0032] Figure 6B shows a process for repositioning teeth and jaws according to an embodiment;

[0033] Figure 7A shows a lingual repositioning splint positioned along the lingual side of a tooth structure according to an embodiment;

[0034] Figure 7B Anterior open bite of the tooth structure is shown;

[0035] Figure 7C A lingual repositioning splint is shown positioned along the lingual side of a tooth structure and extending beyond the buccal side of the tooth structure to create occlusal balance according to an embodiment;

[0036] Figure 8 It is shown that a lingual repositioning splint placed on the lingual side of the teeth according to embodiments can be used to apply opposing forces of any of the various structures described herein to create bite balance. DETAILED DESCRIPTION

[0037] In many embodiments, a method for moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes providing a polymeric shell appliance shaped to fit a plurality of teeth. The polymeric shell appliance includes one or more tooth-receiving cavities to couple the tooth to one or more other teeth in the plurality of teeth using one or more other tooth-receiving cavities. The polymeric shell appliance applies a force to the tooth and moves the tooth from the first position and orientation to the second position and orientation. The polymeric shell appliance may include a repositioning splint for adjusting bite balance.

[0038] In many embodiments, a method for moving a patient's teeth from a first position and orientation to a second position and orientation is provided. A plurality of orthodontic appliances are provided that are configured to sequentially fit over a plurality of teeth. Each of the plurality of orthodontic appliances includes a repositioning splint sized to extend along a surface of a tooth used for chewing so as to couple the tooth to one or more other teeth in the plurality of teeth. The position of the repositioning splint relative to the one or more teeth receiving the splint is varied between the plurality of orthodontic appliances to produce a symmetrical bite while the teeth are moved from the first position and orientation to the second position and orientation.

[0039] In many embodiments, a method for manufacturing a plurality of orthodontic appliances configured to continuously fit a plurality of teeth is provided. A movement path is determined to move one or more teeth from an initial arrangement to a target arrangement. A force system is determined for generating movement of the one or more teeth along the movement path. An appliance geometry of the orthodontic appliance configured to generate the force system is determined. The orthodontic appliance is directly manufactured based on the determined appliance geometry.

[0040] Treatment plan

[0041] The configuration of the orthodontic appliances herein can be determined based on a treatment plan for the patient, for example, a treatment plan involving the sequential application of multiple appliances to progressively reposition the teeth and jaws. Computer-based treatment planning and / or appliance manufacturing methods can be used to facilitate the design and manufacture of the appliances. For example, one or more appliance assemblies described herein can be digitally designed and manufactured using computer-controlled manufacturing equipment (e.g., computer numerical control (CNC) milling, computer-controlled rapid prototyping methods such as 3D printing, etc.). The computer-based methods proposed herein can improve the accuracy, flexibility, and convenience of appliance manufacturing.

[0042] Automatic diagnosis of TMD

[0043] TMD can be diagnosed in a patient by examining the patient's jaw position during routine mandibular movement. Natural mandibular movement can be captured by three-dimensional scanning of the mandible and maxilla. During mandibular movement, multiple scans, such as X-rays, can be acquired at successive positions. For example, the patient's jaw is scanned in an initial occlusal position, a desired occlusal position, and the jaw and various positions to record the articulation of the patient's jaw and assist in predicting the articulation in the final jaw position after TMD correction. The trajectory of the complete jaw movement can be determined based on multiple scan positions. The trajectory of the patient's jaw movement can be compared with an ideal healthy trajectory of mandibular movement. During the comparison process, qualitative and quantitative differences can be determined based on the trajectory of the jaw movement between the patient and a healthy individual. The qualitative and quantitative differences can include an assessment of the occlusal surfaces of the teeth of the jaw and the position of each tooth in the mandible relative to the position of each tooth in the fixed maxilla. The trajectory of the patient's complete jaw movement can be determined using multiple scans of intraoral scanning (e.g., by using an iTero intraoral scanner) and software post-processing methods. TMD can be diagnosed by examining the complete trajectory of jaw movement as shown in multiple scans and comparing this trajectory to a healthy trajectory of jaw movement (eg, that of a healthy individual or an articulator that mimics the healthy trajectory).

[0044] Automatic verification of the final position of the treatment

[0045] The final position of the teeth can also be predetermined based on the complete jaw movement trajectory. The final position of the teeth can be determined based on the ideal healthy trajectory of mandibular movement. The predetermined final position of the teeth can be tailored to individuals with TMD. The patient's natural mandibular movement can be captured by three-dimensional scans of the upper and lower jaws. Multiple scans can be acquired at successive positions during mandibular movement. The trajectory of the complete jaw movement can be determined based on the scans at multiple positions. The trajectory of the patient's jaw movement can be compared to the trajectory of a healthy mandibular movement. The complete jaw movement trajectory can be verified by reviewing the final positions of the teeth. The final positions of the teeth in the treatment plan can be verified so that no collision of the upper and lower teeth occurs relative to the natural movement of the jaw. The final positions can be modified to eliminate possible collisions. The final positions of the teeth can also be verified so that canine guidance exists in the final positions of the teeth relative to the natural movement of the jaw. The final position of the teeth relative to the natural movement of the jaw can be determined and verified using the patient's complete jaw movement trajectory, which can be determined and reviewed from multiple scans using iTero and software post-processing methods.

[0046] Automatic treatment planning of desired jaw relationships

[0047] The treatment plan can consist of a predetermined trajectory of complete jaw movement. Natural mandibular movement can be captured by three-dimensional scans of the mandible and maxilla. Multiple scans of consecutive positions during mandibular movement can be obtained. The scans can estimate the neutral position of the mandible. The scans can estimate the jaw position of lowest muscle tension. Input from the patient can be recorded during the scan, such as patient feedback regarding neutral muscle tension or lowest muscle tension. After input from multiple patients has been recorded, machine learning can be applied to predict the neutral position for new situations. The treatment plan can consist of an established final position of the bite or closed jaw corresponding to the neutral position of the jaw.

[0048] The steps in the treatment plan can be verified for significant deviations from the mid-bite and the neutral position (staging). The steps can be modified to eliminate significant deviations from the mid-bite and the neutral position.

[0049] Multiple devices

[0050] TMD can be treated with a treatment plan that involves the sequential application of multiple appliances to incrementally reposition the teeth. Figure 1As shown, the treatment plan 100 may include scanning the patient's dentition to obtain a first bite scan. The bite scan may be at a desired jaw position 110. The bite scan may be a scan of the patient's jaw in a natural bite configuration. A final position may be determined according to step 120. The dentition movement path between the natural jaw position and the desired jaw position may be segmented into intermediate stages 130. A plurality of devices are configured to apply tooth moving forces and jaw moving forces to the patient's dentition to move the patient's dentition from the natural bite configuration to a final bite configuration. The movement corresponds to the target bite configuration through a series of incremental steps. A final device of the plurality of devices may be at a final desired jaw position. The final device may also be used to maintain the final jaw position 140 once the dentition reaches the final jaw position.

[0051] Figure 4A method 400 for orthodontic treatment using multiple appliances according to an embodiment is shown. Method 400 can be practiced using any appliance or set of appliances described herein. In step 410, a first orthodontic appliance is applied to the patient's teeth to reposition the teeth from a first tooth arrangement to a second tooth arrangement. In step 420, a second orthodontic appliance is applied to the patient's teeth to reposition the teeth from the second tooth arrangement to a third tooth arrangement. Method 400 can be repeated as needed using any suitable number of consecutive appliances and combinations thereof to incrementally reposition the patient's teeth from an initial arrangement to a target arrangement. The appliances can all be generated at the same stage, or they can be grouped or batched (e.g., at the beginning of a treatment phase), or one appliance can be manufactured at a time, and the patient can wear each appliance until the pressure of each appliance on the teeth can no longer be felt, or until the maximum amount of tooth movement for that given phase has been reached. Multiple different appliances (e.g., a set) can be designed and even manufactured before the patient wears any of the multiple appliances. After wearing the braces for an appropriate period of time, the patient can replace the current braces with the next braces in the series until there are no more braces left. The braces are not usually fixed to the teeth, and the patient can place and replace the braces at any time during the process (e.g., patient-removable braces). The final braces or several braces in the series may have one or more geometries selected to overcorrect the tooth arrangement. For example, one or more braces may have a geometry that moves a single tooth beyond the tooth arrangement that has been selected as the "final" (if fully implemented). This overcorrection may be required to offset the potential return to the original state after the repositioning method has terminated (e.g., allowing each tooth to move back to its position before correction). Overcorrection may also be beneficial for speeding up the correction process (e.g., a braces with a geometry that is positioned beyond the desired intermediate position or final position can shift a single tooth toward that position at a greater rate). In this case, the use of the braces can be terminated before the teeth reach the position defined by the braces. Additionally, overcorrection may be applied intentionally to compensate for any inaccuracies or limitations of the appliance.

[0052] Data processing system

[0053] like Figure 2As shown in a simplified block diagram, a data processing system 200 can be used to perform the methods and processes described herein. The data processing system 200 generally includes at least one processor 210, which communicates with one or more peripheral devices via a bus subsystem 220. These peripheral devices generally include a storage subsystem 210 (a memory subsystem 211 and a file storage subsystem 212), a set of user interface input and output devices 223, and an interface 222 to an external network. This interface is shown as a "network interface" block 222 in the figure and is coupled to corresponding interface devices in other data processing systems via a communication network interface 225. The data processing system 200 may include one or more computers such as personal computers, workstations, mainframe computers, portable computers, etc.

[0054] The user interface input device 223 is not limited to any particular device and may generally include, for example, a keyboard, a pointing device, a mouse, a scanner, an interactive display, a touch pad, a joystick, etc. Similarly, a variety of user interface output devices may be used in the system of the present invention and may include, for example, one or more of a printer, a display (e.g., visual, non-visual) system / subsystem, a controller, a projection device, an audio output, etc.

[0055] The storage subsystem 210 maintains the necessary basic programming and includes computer-readable media with instructions (e.g., operating instructions, etc.) and data structures. The program modules discussed herein are typically stored in the storage subsystem 210. The storage subsystem 210 typically includes a memory subsystem 211 and a file storage subsystem 212. The memory subsystem 211 typically includes multiple memories (e.g., RAM 410, ROM 412, etc.), including computer-readable memory for storing fixed instructions, commands, and data during program execution, a basic input / output system, etc. The file storage subsystem 212 provides permanent (non-volatile) storage for program and data files and may include one or more removable or fixed drives or media, such as hard drives, floppy disks, CD-ROMs, DVDs, optical drives, flash drives, etc. One or more of the storage systems, drives, etc. may be located remotely, thus being coupled via a server on a network or via the Internet / World Wide Web. For example, one or more storage systems may include distributed online storage, such as cloud storage. In this context, the term "bus subsystem" is generally used to include any mechanism that enables the various components and subsystems to communicate with each other as intended, and may include various suitable components or systems that will be known or deemed suitable for use therein. It will be appreciated that the various components of the system may, but need not, be located in the same physical location, but may be connected by various local or wide area network media, transmission systems, etc.

[0056] Scanner 224 comprises any device for obtaining a digital representation (e.g., image, surface topography data, etc.) of a patient's teeth (e.g., by scanning a physical model of the teeth, such as a mold 227, by scanning an impression of the teeth, or by directly scanning the oral cavity). The digital representation can be obtained from the patient or from a professional (e.g., an orthodontist), and includes a device for providing the digital representation to data processing system 200 for further processing. Examples of suitable scanners include X-ray, optical, topographic, and ultrasonic scanners, as well as tomographic scanners, such as cone beam computed tomography (CBCT) scanners. Scanner 224 can be located remotely from the other components of the system and can transmit image data and / or information to data processing system 200, for example, via network interface 225. Manufacturing system 226 manufactures appliance 228 based on the treatment plan (including the dataset information received from data processing system 200). For example, manufacturing machine 226 can be located remotely and receive the dataset information from data processing system 200 via network interface 225.

[0057] The data processing aspects of the methods described herein may be implemented in digital electronic circuitry or in computer hardware, firmware, software, or a suitable combination thereof. The data processing apparatus may be implemented in a computer program product tangibly embodied in a machine-readable storage device for execution by a programmable processor. The data processing steps may be performed by a programmable processor executing program instructions to perform functions by operating on input data and generating output. The data processing aspects may be implemented in one or more computer programs executable on a programmable system comprising one or more programmable processors operably coupled to a data storage system. Typically, the processor will receive instructions and data from a read-only memory and / or a random access memory. Storage devices suitable for tangibly embodying computer program instructions and data include all forms of non-volatile memory, for example: semiconductor memory devices such as EPROM, EEPROM, and flash memory devices; magnetic disks such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM disks.

[0058] Tooth movement pathway

[0059] In step 510, a movement path is determined for moving one or more teeth from an initial arrangement to a target arrangement. The initial arrangement can be determined based on a mold or a scan of the patient's teeth or oral tissue, such as using wax bites, direct contact scanning, X-ray imaging, tomography, ultrasound imaging, and other techniques for obtaining information about the position and structure of teeth, jaws, gums, and other orthodontically relevant tissues. From the acquired data, a digital data set representing the initial (e.g., pre-processed) arrangement of the patient's teeth and other tissues can be derived. Optionally, the initial digital data set is processed to segment tissue components from one another. For example, a data structure can be generated that digitally represents a single crown. Advantageously, a digital model of the entire tooth can be generated, including measured or extrapolated hidden surface and root structures, as well as surrounding bone and soft tissue.

[0060] A target arrangement of teeth (e.g., the desired and anticipated end result of orthodontic treatment) can be received from a clinician in the form of a prescription, which can be calculated from basic orthodontic principles and / or can be computationally extrapolated from the clinical prescription. Utilizing a description of the desired final positions of the teeth and digital representations of the teeth themselves, the final position and surface geometry of each tooth can be specified to form a complete model of the desired dental arrangement at the end of treatment.

[0061] Utilizing both the initial position and the target position of each tooth, a movement path can be defined for the movement of each tooth. In some embodiments, the movement path is configured to move the teeth in the fastest manner with the fewest number of round trips to bring the teeth from their initial positions to their desired target positions. The tooth paths can optionally be segmented, and the segments can be calculated so that the movement of each tooth within a segment remains within a threshold range for linear and rotational translation. In this way, the endpoints of each path segment can constitute a clinically feasible repositioning, and the collection of segment endpoints can constitute a clinically feasible sequence of tooth positions. The positions of these teeth can be adjusted using dynamic occlusal information that reflects the articulation and interaction of the teeth when the patient bites, so that movement from one point to the next in the sequence does not result in tooth collision.

[0062] In step 520, a force system is determined to produce movement of one or more teeth along the movement path. The force system may include one or more forces and / or one or more torques. Different force systems may result in different types of tooth movement, such as tilting, translation, rotation, extrusion, intrusion, root movement, etc. Biomechanical principles, modeling techniques, force calculation / measurement techniques, etc., including knowledge and methods commonly used in orthodontics, can be used to determine the appropriate force system to be applied to the teeth to accomplish tooth movement. When determining the force system to be applied, the following sources may be considered, including literature, force systems determined by experiments or virtual modeling, computer-based modeling, clinical experience, minimizing unnecessary forces, etc.

[0063] In step 530, an appliance geometry is determined for an orthodontic appliance configured to generate a force system. The geometry may include one or more tooth engagement structures, and the tooth engagement structures may be configured to engage a surface of at least one tooth. The tooth surface selected for engagement may be an approximal surface of the tooth, a buccal or lingual surface, an occlusal surface, or any other surface, depending on the characteristics of the force to be generated on the tooth. The geometry may also include material specifications based on the location within the orthodontic appliance, for example, specifying that some portions include an elastic polymer material while other portions include a rigid polymer material.

[0064] The determination of the appliance geometry, material composition, and / or properties may be performed using a treatment or force simulation environment. The simulation environment may include, for example, a computer modeling system, a biomechanical system or device, or the like. Alternatively, a digital model of the appliance and / or teeth, such as a finite element model, may be generated. The finite element model may be created using computer program application software available from a variety of vendors. To create the solid geometry model, a computer-aided engineering (CAE) or computer-aided design (CAD) program may be used, such as, for example, the CAD software available from Autodesk, Inc. of San Rafael, California. Software Products. To create finite element models and analyze them, program products from a number of vendors may be used, including the finite element analysis package from ANSYS, Inc. of Canonsburg, Pennsylvania, and the SIMULIA (Abaqus) software product from Dassault Systèmes of Waltham, Massachusetts.

[0065] Optionally, one or more appliance geometries can be selected for testing or force modeling. As described above, desired tooth movement and the force system required or desired to cause the desired tooth movement can be identified. Using a simulation environment, the geometry of the candidate appliance can be analyzed or modeled to determine the actual force system that would result from using the candidate appliance. Optionally, one or more modifications can be made to the candidate appliance, and the force model can be further analyzed as described, for example, to iteratively determine an appliance design that produces the desired force system.

[0066] In step 540, instructions for manufacturing an orthodontic appliance having an appliance geometry are generated. The instructions can be configured to control a manufacturing system or device to produce an orthodontic appliance having a specified appliance geometry. In some embodiments, the instructions are configured to manufacture the orthodontic appliance using direct manufacturing (e.g., stereolithography, selective laser sintering, fused deposition modeling, 3D printing, continuous direct manufacturing, multi-material direct manufacturing, etc.) according to the various methods described herein. In alternative embodiments, the instructions can be configured to manufacture the appliance indirectly, for example, by thermoforming.

[0067] While the above steps illustrate a method 500 for designing an orthodontic appliance according to some embodiments, those skilled in the art will recognize variations based on the teachings described herein. Some steps may include sub-steps. Some steps may be repeated as needed. One or more steps of method 500 may be performed using any suitable manufacturing system or apparatus, such as the embodiments described herein. Some steps may be optional, and the order of the steps may be varied as needed.

[0068] Occlusal balance during tooth movement

[0069] A "dental arch" is one of the two dental arches found in humans and many other species. The upper dental arch is also called the maxillary arch or upper arch. The lower dental arch is also called the mandibular arch or lower arch. When the jaws are closed, the dental arches are close together, and the mouth is biting or closed.

[0070] The "corresponding engaging surfaces" of one or more teeth in the opposing dental arches are the occlusal surfaces of the one or more teeth in the opposing dental arches determined by the natural closure of the jaws.

[0071] "Natural closure of the jaws" is closure of the jaws wherein minimal force is applied to move the jaws into the closed position.

[0072] "Occlusal balance" is the state in which the forces exerted on the jaws after natural closure are zero or minimal.

[0073] In many embodiments, a method for moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes sequentially providing a plurality of orthodontic appliances shaped to fit over a plurality of teeth. In some embodiments, for each of the plurality of appliances, the one or more tooth-receiving structures include one or more tooth-receiving cavities.

[0074] An orthodontic shell appliance shaped to fit a plurality of teeth is provided. Figure 3 As shown, the shell appliance includes an outer wall extending over the buccal and lingual surfaces of a plurality of teeth. In some embodiments, the wall is shaped to accommodate the one or more teeth, and wherein the wall engages the one or more teeth with a force so as to move the one or more teeth in response to the force.

[0075] In some embodiments, the outer surface of the outer wall comprises a buccal surface of the appliance; in some embodiments, the outer surface of the outer wall comprises a lingual surface of the appliance.

[0076] Repositioning the splint

[0077] In many embodiments, a method of moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes sequentially providing a plurality of orthodontic appliances shaped to fit the plurality of teeth.

[0078] In some embodiments, for each of the plurality of appliances, one or more tooth receiving structures are coupled to the repositioning splint.

[0079] In some embodiments, for each of the plurality of appliances, the one or more tooth receiving structures are coupled to a bite repositioning splint that extends along an occlusal surface of the one or more tooth receiving structures.

[0080] In some embodiments, for each of the plurality of appliances, the one or more tooth receiving structures are coupled to a lingual repositioning splint extending along a lingual surface of the one or more tooth receiving structures.

[0081] In many embodiments, a method for moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes sequentially providing a plurality of orthodontic appliances shaped to fit over a plurality of teeth. For each of the plurality of appliances, one or more tooth-receiving structures are coupled to a repositioning splint extending along an outer occlusal or lingual surface of the one or more tooth-receiving structures. When the plurality of appliances are worn sequentially, the plurality of appliances are capable of causing a plurality of movements of the teeth from the first position and orientation to the second position and orientation.

[0082] In many embodiments, a method of moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes sequentially providing a plurality of orthodontic appliances shaped to fit a plurality of teeth. For each of the plurality of appliances, one or more tooth receiving structures are coupled to a bite repositioning splint, which is a repositioning splint that extends along an occlusal surface of the one or more tooth receiving structures. In some embodiments, the bite repositioning splint contours an outer surface of the tooth receiving structure. When the jaw is naturally closed, each of the plurality of bite repositioning splints can engage with a corresponding engaging occlusal surface. Each of the plurality of repositioning splints can conform to one or more teeth in an opposing dental arch. When the jaw is naturally closed, each of the plurality of bite repositioning splints can achieve bite balance, as well as adjust the bite position to alleviate symptoms associated with TMD, such as muscle strain.

[0083] In many embodiments, a method of moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes sequentially providing a plurality of orthodontic appliances shaped to fit a plurality of teeth. For each of the plurality of appliances, one or more tooth receiving structures are coupled to a lingual repositioning splint, which is a repositioning splint that extends along a lingual surface of the one or more tooth receiving structures. In some embodiments, the lingual repositioning splint contours an outer surface of the tooth receiving structure. When the jaw is naturally closed, each of the plurality of lingual repositioning splints can engage with a corresponding engaging lingual surface. Each of the plurality of lingual repositioning splints can conform to one or more teeth in an opposing dental arch. When the jaw is naturally closed, each of the plurality of repositioning splints can achieve occlusal balance.

[0084] Bite repositioning splints

[0085] Figure 6A A bite repositioning splint 630 shaped to fill an occlusal gap 650 between a patient's upper and lower dentition is shown. The bite repositioning splint 630 may form at least a portion of an appliance comprising a housing having a plurality of tooth-receiving surfaces 620 shaped to receive a plurality of teeth 610 of a first dental arch. The bite splint may have a varying occlusal thickness 650 extending in an occlusal plane defined by the teeth 610 toward the opposing dental arch. In some embodiments, the occlusal thickness 650 may extend in the occlusal plane by an amount that varies along the length 640 of the bite repositioning splint, thereby presenting a variable surface for engaging the opposing dental arch (or engaging an appliance worn on the opposing dental arch). In some embodiments, the occlusal thickness along the entire length of the bite repositioning splint may be equal to or approximately equal to the minimum distance between the occlusal surface of the tooth-receiving structure and the corresponding engaging occlusal surface of one or more teeth in the opposing dental arch, thereby filling a narrow gap between the upper and lower dental arches. In some embodiments, the distance between the surface of the tooth receiving structure and the corresponding engagement surface of one or more teeth in the opposing dental arch can be variable for each position along the tooth receiving structure. In some embodiments, the occlusal thickness 650 of the bite repositioning splint can be arranged to provide a flat or substantially flat surface along at least a portion of the length 640, thereby providing greater freedom of movement to the opposing dental arch. The appliance may also include one or more tooth movement structures to apply tooth movement forces to one or more teeth (e.g., compression, intrusion, translation and / or rotation). As multiple appliances are worn, these forces can be used to incrementally close the bite gap, and the bite repositioning splint can be narrowed accordingly to put the teeth in proper occlusion.

[0086] In some embodiments, the buccal-lingual width of the bite repositioning splint 630 is approximately the width of the patient's teeth. For example, the bite repositioning splint 630 may have a shape that follows at least a portion of the dental arch of the teeth 610. In some cases, the plurality of tooth-receiving surfaces 620 may clamp the teeth 610 of a first dental arch, and the opposing surface 660 of the bite repositioning splint may provide less clamping of the teeth of the opposing dental arch so that the splint remains attached to the first dental arch when the patient's mouth is open. In some cases, the tooth-receiving surfaces 620 may be shaped to form tooth-receiving cavities, and the opposing surface 660 may be shaped to provide an occlusal surface to mate with the opposing dental arch without significantly clamping the opposing dental arch. The surface 660 may be shaped to alter the natural occlusion of the upper and lower dentitions, thereby altering the patient's natural bite. For example, the patient's bite may be altered to move the lower jaw forward or backward relative to the upper jaw. More generally, the splint can facilitate movement in any direction to cause the jaw to move from a first position and orientation (e.g., described in six degrees of freedom) along a path through subsequent positions and orientations toward a final position and orientation. Over time, this can cause the jaw to change in position and orientation and alter the jaw musculature, resulting in a change in the patient's natural bite.

[0087] In some embodiments, the bite repositioning splint 630 is attached to an appliance that receives teeth 610 of the patient's dentition. In some cases, the splint is integrally formed as part of the appliance. In other embodiments, the bite repositioning splint 630 is removable from the appliance that is shaped to receive teeth 610, and the splint is shaped to include a surface 620 that removably engages at least the occlusal side of the appliance.

[0088] In some embodiments, each of the plurality of bite repositioning splints may have an occlusal thickness that is equal to or approximately equal to the distance between the occlusal surface of the tooth receiving structure and the engaging occlusal surface of one or more teeth in the opposing dental arch. Each of the plurality of bite repositioning splints may have a uniform or variable occlusal thickness. The thickness of each consecutive splint may vary at one or more points along the bite repositioning splint. In some embodiments, the thickness of the bite repositioning splint may continuously decrease between the plurality of braces. In some embodiments, the thickness of the bite repositioning splint may continuously increase between the plurality of braces. In some embodiments, the thickness of the bite repositioning splint may be uniform between the plurality of braces. In some embodiments, the thickness at each point along the bite repositioning splint may be the distance between the occlusal surface of the tooth receiving structure at each point and the corresponding engaging occlusal surface at each point in the opposing dental arch.

[0089] Figure 6BThe process of correcting TMD by moving the teeth and jaws is shown. At stage 670, the patient's jaws and teeth are in a position indicating TMD. A first set of appliances can be applied to the patient's dental arch to correct the position of the jaws to the teeth to treat TMD. The appliances can include a bite splint 690 and one or more mandibular positioning features 680 to correct the condylar position, and the mandibular position feature can include a precision wing, a jaw stabilizer, an intercuspation feature, or a combination of two or more such features. The upper mandibular position feature 680 can engage the lower mandibular position feature so that a condylar repositioning force is applied to the mandible to advance the condylar position.

[0090] As treatment progresses, for example at stage 672, the jaw 676 may be in a corrected position, while the teeth may not yet have reached their final position. Therefore, the appliance set 684 may include a jaw position feature 680 and a bite splint 690 to maintain the position of the jaw while the teeth continue to be moved toward their final position during the tooth alignment stage.

[0091] The position of the bite splint 690 can be changed between stages of treatment to maintain the position of the jaw between stages while moving the teeth and jaw 676 to a final position, such as at stage 674. For example, the appliance set 686 includes a splint 690 that is in a different occlusal position than in the appliance set 684. The shift in position accounts for the relative tooth movement between stages, thereby maintaining the position of the jaw between stages.

[0092] In some embodiments, the jaws and teeth are moved within the same set of treatment phases, and in such embodiments, the position and movement of the mandibular position feature and splint from one phase to another can describe the desired tooth and jaw movement throughout the treatment phases. Such a process can include determining the new cusp-to-cusp position for each phase, determining the jaw transformation or movement at that position, and then resolving these relative positions to determine the position and geometry of the mandibular position feature and splint in order to maintain or achieve the prescribed movement of the jaws and teeth.

[0093] Lingual repositioning splint

[0094] In many embodiments, a method for moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes sequentially providing a plurality of orthodontic appliances shaped to fit over a plurality of teeth. In some embodiments, for each of the plurality of appliances, the one or more tooth-receiving structures include a lingual repositioning splint 700 extending lingually from the one or more tooth-receiving structures.

[0095] Figure 7AA lingual repositioning splint 713 for moving a jaw from a first configuration 710 to a second configuration 720 is shown. When the splint is worn, the splint can be positioned on a lingual surface 712 of a tooth-receiving structure 711 and can include an occlusal surface 714 shaped to receive and guide the engaging buccal surfaces 715 of one or more teeth in an opposing dental arch 716 from the first configuration 710 to the second configuration 720. For example, the occlusal surface 714 can include a curved shape to apply a force to the opposing dental arch when the dental arch is positioned away from a preferred position. Such a force can urge the patient's jaw into a different position, thereby providing improved cusp alignment. For example, an overbite or underbite can be corrected by applying the lingual repositioning splint to one or more incisors, utilizing the occlusal surface 714 shaped to guide the opposing dental arch into an improved position. More generally, the splint can facilitate movement in any direction to cause the jaw to move from a first position and orientation (e.g., described in six degrees of freedom) along a path through subsequent positions and orientations toward a final position and orientation. Over time, this can cause changes in the position and orientation of the jaws and alter the jaw musculature, leading to changes in the patient’s natural bite.

[0096] The lingual repositioning splint 713 can be shaped to alter the natural occlusion of the upper and lower dentitions, thereby changing the patient's natural bite. For example, the patient's bite can be altered to move the lower jaw forward or backward relative to the upper jaw. Over time, this can cause the position of the jaw and jaw musculature to change, resulting in a change in the patient's natural bite.

[0097] In some embodiments, the lingual repositioning splint 713 is attached to an appliance that receives teeth 711 of the patient's dentition. In some cases, the splint is integrally formed as part of the appliance. In other embodiments, the lingual repositioning splint 713 is removable from the appliance that is shaped to receive teeth 711, and the splint is shaped to include a surface 712 that removably engages at least the lingual side of the appliance.

[0098] Extended Lingual Repositioning Splint

[0099] In many embodiments, a method of moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes sequentially providing a plurality of orthodontic appliances shaped to fit the plurality of teeth. Figure 8 As shown, for each of the plurality of appliances, one or more tooth receiving structures 810 are coupled to an extended lingual repositioning splint 830. In some embodiments, as shown in FIG. Figure 7C As shown, for each of the plurality of appliances, one or more tooth receiving structures are coupled to an extended lingual repositioning splint 740 extending from the one or more tooth receiving structures 741 in a lingual direction 744 .

[0100] like Figure 7B As shown, the patient's upper dental arch 731 and lower dental arch 732 may exhibit an anterior open bite 732. When there is no guidance in the anterior teeth, the posterior teeth may be interfered with during functional movement.

[0101] In some examples, the extended lingual repositioning splint can be coupled to the tooth receiving structure of the dorsal dental arch. In some examples, the extended lingual repositioning splint can be coupled to the tooth receiving structure of the ventral dental arch.

[0102] In some examples, the extended lingual repositioning splint 830 can be placed lingually on one or more teeth of the dorsal arch 800 and can extend to or beyond the buccal surface of one or more teeth of the ventral arch.

[0103] In some examples, the extended lingual repositioning splint can be placed lingually on one or more teeth of the ventral dental arch and can extend to or beyond the buccal surfaces of one or more teeth of the dorsal dental arch.

[0104] The appliance may also include one or more tooth movement structures to apply tooth movement forces to one or more teeth (eg, extrusion, intrusion, translation, and / or rotation).

[0105] In many embodiments, for each of the plurality of appliances coupled to the extended lingual repositioning splint, the thickness of the extended lingual repositioning splint can be equal to or approximately equal to the distance between the lingual surface of the tooth receiving structure and the engaging buccal surfaces of one or more teeth in the opposing dental arch 733. The thickness along the length of the lingual repositioning splint can be a single thickness or a variable thickness. In some embodiments, the thickness along the entire length of the lingual repositioning splint can be equal to or approximately equal to the minimum distance between the lingual surface of the tooth receiving structure and the corresponding engaging buccal surfaces of one or more teeth in the opposing dental arch. In some embodiments, the distance between the lingual surface of the tooth receiving structure and the corresponding engaging buccal surfaces of one or more teeth in the opposing dental arch can vary for each location along the tooth receiving structure.

[0106] Figure 7CAn extended lingual repositioning splint for moving a jaw from a first configuration 740 to a second configuration 750 is shown. When the splint is worn, the splint can be disposed on a lingual surface 745 of a tooth receiving structure 741 and can include a buccal surface 742 shaped to extend beyond the buccal surfaces of one or more teeth in an opposing dental arch 743. For example, the buccal surface 742 can engage one or more teeth in the opposing dental arch to apply a force to the opposing dental arch. Such a force can urge the patient's jaw into a different position, thereby providing improved cusp fit. For example, an overbite or underbite can be corrected by applying the extended lingual repositioning splint to one or more incisors using the buccal surface 742 shaped to guide the opposing dental arch into an improved position.

[0107] The extended lingual repositioning splint 742 can be shaped to alter the natural occlusion of the upper and lower dentitions, thereby changing the patient's natural bite. For example, the patient's bite can be altered to move the mandible forward or backward relative to the maxilla. Over time, this can cause the position of the jaw and jaw musculature to change, thereby causing a change in the patient's natural bite.

[0108] In some embodiments, the extended lingual repositioning splint 742 is attached to an appliance that receives a tooth 741 of the patient's dentition. In some cases, the splint is integrally formed as part of the appliance. In other embodiments, the extended lingual repositioning splint 742 is removable from the appliance that is shaped to receive the tooth 741, and the splint is shaped to include a surface 745 that removably engages at least the lingual side of the appliance.

[0109] The connection between the appliance and the teeth

[0110] In many embodiments, a plurality of orthodontic appliances are provided for moving one or more teeth of a patient from a first position and orientation to a second position and orientation. Each appliance includes a plurality of tooth-receiving cavities, outer walls coupled to the tooth-receiving cavities and extending over buccal and lingual surfaces of the plurality of teeth, respectively, and a repositioning splint sized to achieve a balanced bite when the appliance is worn. The walls of the polymeric appliance can be shaped to receive and engage the one or more teeth.

[0111] In some embodiments, the geometry of the appliance includes at least one repositioning splint configured to engage a biting surface of one or more teeth in an opposing dental arch. The repositioning splint includes extending a length of the biting surface.

[0112] In some embodiments, the outer surface of the outer wall comprises a buccal surface of the appliance; in some embodiments, the outer surface of the outer wall comprises a lingual surface of the appliance.

[0113] In many embodiments, each repositioning splint is shaped to engage an occlusal surface of an opposing dental arch. In some embodiments, the repositioning splint is shaped to engage an occlusal surface of one or more teeth of the opposing dental arch. For example, the repositioning splint may engage one or more teeth of the opposing dental arch on either side of the mid-sagittal line. In another example, the repositioning splint may engage one or more teeth of the opposing dental arch on both sides of the mid-sagittal line.

[0114] In many embodiments, each repositioning splint is shaped to engage an occlusal surface of an opposing dental arch. Repositioning the splint includes extending the length of the occlusal surface. One or more of the length or width of the repositioning splint is varied between the multiple orthodontic appliances to create occlusal balance when the multiple appliances are worn consecutively.

[0115] In some embodiments, each lingual repositioning splint includes a contact surface having a length dimensioned to engage one or more teeth of an opposing dental arch, wherein the length of the contact surface varies between the plurality of appliances to vary the reaction force required to achieve occlusal balance.

[0116] In many embodiments, a method of moving a patient's teeth from a first position and orientation to a second position and orientation is provided. The method includes providing a plurality of polymeric shell appliances shaped to fit over a plurality of teeth. The appliances include an outer wall and a repositioning plate, wherein the outer wall is shaped to extend over exposed buccal, lingual, and occlusal surfaces of the plurality of teeth, and the repositioning plate is sized to achieve occlusal balance when the appliances are worn. The polymeric shell appliances are configured to contact at least about 60% of the circumferential surface of the plurality of teeth when worn. In some embodiments, the appliances contact at least about 80% of the circumferential surface of the plurality of teeth when worn.

[0117] In many embodiments, a method of moving a patient's teeth from a first position and orientation to a second position and orientation is provided, comprising a plurality of orthodontic appliances shaped to fit over a plurality of teeth. Each of the plurality of orthodontic appliances includes walls shaped to accommodate the plurality of teeth and a repositioning splint. The repositioning splint is sized to achieve occlusal balance and includes a length along an occlusal surface of a dental arch when the appliances are worn in the patient's mouth. One or more of the length or thickness of the repositioning splint can be varied between the plurality of orthodontic appliances to move the teeth from the first position and orientation to the second position and orientation when the plurality of appliances are worn consecutively.

[0118] In some embodiments, the repositioning splint includes a contact surface to engage one or more occlusal surfaces of one or more teeth of opposing dental arches, wherein an angle of the contact surface varies among the plurality of appliances to produce bite balance when each appliance applies a force to move the one or more teeth from a first position to a second position. In some embodiments, the repositioning splint includes a contact surface having a length dimensioned to engage the one or more teeth, and wherein the length of the contact surface varies among the plurality of appliances to alter a response to forces during jaw occlusion to produce bite balance.

[0119] In various embodiments, providing the orthodontic appliance includes placing the appliance on the patient's teeth. In various embodiments, the patient places the orthodontic appliance on the teeth.

[0120] In various embodiments, the tooth comprises a plurality of teeth.

[0121] In many embodiments, a polymeric shell appliance is provided for moving a patient's teeth from a first position and orientation to a second position and orientation. The polymeric shell appliance includes a polymeric lingual repositioning splint sized to extend over the occlusal surfaces of one or more teeth in a tooth-receiving cavity. The repositioning splint is configured to apply a reaction force to the occlusal surfaces of one or more teeth of an opposing dental arch when the appliance is worn, thereby moving the teeth from the first position and orientation to the second position and orientation.

[0122] In many embodiments, a plurality of orthodontic appliances are provided for moving a patient's teeth from a first position and orientation to a second position and orientation. Each appliance includes a repositioning plate sized to extend over an occlusal surface of one or more teeth in a tooth-receiving structure to produce occlusal balance. The position of the repositioning plate relative to the one or more tooth-receiving structures is varied between the plurality of orthodontic appliances to produce occlusal balance when the appliances move the teeth from the first position and orientation to the second position and orientation while the plurality of appliances are worn consecutively.

[0123] force

[0124] chewing force

[0125] Chewing forces are the forces generated by the muscles of mastication during the action of opening and closing the jaws. The distribution of chewing forces can vary. In some cases, the chewing forces may be greatest in the anterior arch. In some cases, the chewing forces may be greatest in the posterior arch. In some cases, the maximum chewing forces may be distributed unilaterally on the arch. Unilateral distribution may be on either side. In some cases, the maximum chewing forces may be distributed bilaterally on the arch. In some cases, the maximum chewing forces may be evenly distributed across the arch. In some cases, the chewing forces may be distributed differently along the buccolingual axis. In some cases, the chewing forces may even be distributed along the buccolingual axis. In some cases, the distribution curve along the buccolingual axis may vary along the mesio-distal axis. In some cases, the distribution curve along the buccolingual axis may vary along the mesio-distal axis on either side of the midsagittal line.

[0126] In many embodiments, a plurality of orthodontic appliances are provided for moving a patient's teeth from a first position and orientation to a second position and orientation. Each appliance includes a repositioning splint sized to extend over an occlusal surface of one or more teeth in a tooth-receiving cavity to produce a balanced occlusal position. The repositioning splint applies a reaction force that is equal to or approximately equal to a force exerted on the jaw due to occlusion, and applies the reaction force to produce a balanced occlusal position. In many embodiments, the reaction force is applied in all directions.

[0127] Forces used to move teeth

[0128] As used herein, the terms "torque" and "moment" are treated synonymously.

[0129] As used herein, the term "and / or" is used as a function word to indicate that two words or expressions are to be taken together or separately. For example, A and / or B includes A alone, B alone, and A and B together.

[0130] As used herein, a "torque" includes a force acting on an object, such as a tooth, at a distance from a center of resistance. For example, a torque can be calculated using a vector cross product of vector forces applied to a location corresponding to a displacement vector from the center of resistance. The torque can include a vector pointing in one direction. For example, a moment that is opposite to another moment can include a moment vector toward a first side of an object (e.g., a tooth) and another moment vector toward an opposite side of the object (e.g., a tooth).

[0131] As used herein, "differential torque" encompasses two or more torques coupled to each other to provide opposing torques to one or more teeth. The differential torque may include a first torque applied to the tooth and a second opposing torque. Alternatively or in combination, the differential torque may include a first torque of a first one of the one or more teeth of the dental arch coupled to a second opposing torque of a second one of the one or more teeth of the dental arch. The first one of the one or more teeth of the dental arch may include a first segment of the dental arch and the second one or more teeth of the dental arch may include a second segment of the dental arch, wherein the first torque of the first segment of the dental arch is coupled to the second opposing torque of the second segment of the dental arch. The first one of the one or more teeth may include a first plurality of adjacent teeth of the first segment of the dental arch and the second one or more teeth may include a second plurality of adjacent teeth of the second segment of the dental arch, wherein the first torque of the first plurality of adjacent teeth of the dental arch is opposite to the second opposing torque of the second plurality of adjacent teeth of the dental arch.

[0132] As used herein, a tooth comprising a moment is a tooth having a force acting on the tooth about a center of resistance. The force can be generated by an appliance coupled to the tooth, either directly, using attachments on the tooth, or a combination thereof.

[0133] The counter-torque as disclosed herein can be used to precisely control the movement of one or more teeth and can be used to provide anchoring of one or more teeth. In many embodiments, the plurality of posterior teeth include a counter-torque to improve the anchoring of the posterior teeth, and the one or more posterior teeth include a smaller counter-movement and move toward the plurality of posterior anchor teeth. Alternatively, the counter-torque of one or more of the plurality of posterior teeth can be configured to allow the one or more posterior teeth to move toward the anterior teeth.

[0134] To control tooth movement, the moments of multiple groups of one or more teeth can be coupled to one another, and the moments of one or more groups of teeth can be coupled to one another in a variety of ways. The moments of one or more groups of teeth can be coupled to one another using biasing moments and / or balancing moments to provide preferential movement to one or more groups of one or more teeth. For example, the posterior teeth can have a greater counter-moment than the anterior teeth to move the anterior teeth toward the posterior teeth.

[0135] The moments and counter-torques disclosed herein are well-suited for moving many types of teeth and dental conditions and are well-suited for use in many conditions of teeth. The embodiments disclosed herein can be used to treat one or more cants of the occlusal plane, for example, to elevate teeth on one side of the mouth and lower teeth on the opposite side of the mouth, to expand teeth overall along the dental arch, to close extraction sites, to intrude, to extrude, to rotate, to tilt, and combinations thereof.

[0136] In many embodiments, the one or more posterior teeth include one or more of molars, premolars, or canines, and the one or more anterior teeth include one or more of central incisors, lateral incisors, canines, first bicuspids, or second bicuspids.

[0137] Embodiments disclosed herein can be used to couple one or more groups of teeth to one another. The one or more groups of teeth can include a first group of one or more anterior teeth and a second group of one or more posterior teeth. The first group of teeth can be coupled to the second group of teeth using a polymer shell appliance as disclosed herein.

[0138] The first set of teeth can be coupled to the second set of teeth in many ways, and in many embodiments, the first set of one or more teeth includes a first moment and a first counter-moment, and the second set of one or more teeth includes a second moment and a second counter-moment. The first moment and the first counter-moment may include a combined first moment and a combined first counter-moment of the first set of one or more teeth, and the second moment and the second counter-moment may include a combined second moment and a combined second counter-moment of the second set of teeth. The combined first moment, the combined first counter-moment, the combined second moment, and the combined second counter-moment may be coupled to each other with a polymeric shell appliance to move the first set of one or more teeth or the second set of one or more teeth, or combinations thereof.

[0139] In many embodiments, each of a first group of one or more teeth includes a first torque and a counter-torque, and each of a second group of one or more teeth includes a second torque and a second counter-torque. The first torque can be generated by one or more first forces applied to a first tooth at a first region or location of the first tooth, and the counter-torque can be generated by an opposing force applied to one of the first teeth at an opposite location. The second torque can be generated by one or more second forces applied to a second tooth at a region of the second tooth, and the counter-torque can be generated by an opposing force applied to one of the second teeth at an opposite location.

[0140] For example, the center of resistance of a single tooth may be located near the furcation or furcation of the tooth root. For a single-rooted tooth, the center of resistance may be located somewhere between about 25% and about 70% of the distance from the alveolar ridge to the root end (e.g., about 40% of the distance).

[0141] The center of resistance for a group of tooth segments comprising a plurality of teeth can be determined in one or more of a number of ways. For example, the center of resistance can be determined using finite element modeling, values published in the scientific literature, benchmark tests with experimental loads, mathematical formulas and approximations, and combinations thereof. For example, the center of resistance can be determined in response to supporting tooth structures such as the periodontal ligament, soft tissue, and bony support structures. Although the center of resistance for a group of teeth can change with the direction of movement, the center of resistance can be determined by one of ordinary skill in the art based on the embodiments disclosed herein.

[0142] The embodiments disclosed herein are well suited for moving one or more teeth in a first group of one or more teeth or moving one or more teeth in a second group of one or more teeth, and combinations thereof.

[0143] The embodiments disclosed herein are well suited for combination with one or more known commercially available tooth movement components, such as attachments and polymer-shelled appliances. In many embodiments, the appliance and one or more attachments are configured to move one or more teeth along a tooth movement vector comprising six degrees of freedom, three of which are rotational and three of which are translational. The embodiments disclosed herein can provide a differential torque vector to each of the plurality of teeth based on a torque and a reaction torque. The differential torque vector can provide improved tooth movement accuracy and can result in a reduction in the amount of force required to move the one or more teeth.

[0144] The present disclosure provides orthodontic systems and related methods for designing and providing improved or more effective tooth movement systems to induce desired tooth movement and / or reposition teeth into a desired arrangement.

[0145] In various embodiments, at least one appliance comprises a plurality of materials.

[0146] In various embodiments, at least one appliance comprises a plurality of materials. In various embodiments, the appliance is configured to be manually removable by the patient.

[0147] In some embodiments, one or more repositioning splints comprise a material that elastically deforms or bends in response to forces from the teeth.

[0148] Although reference is made to appliances comprising polymer shell appliances, the embodiments disclosed herein are well suited for use with many appliances that house teeth, for example, appliances that do not have one or more polymers or shells. The appliance can be manufactured from one or more of a number of materials, such as metal, glass, reinforced fibers, carbon fibers, composite materials, reinforced composite materials, aluminum, biomaterials, and combinations thereof. The appliance can be formed in a number of ways, such as by thermoforming or direct manufacturing as described herein. Alternatively, or in combination, the appliance can be manufactured by machining, such as by computer numerical control machining from a block of material.

[0149] Tooth movement

[0150] In some embodiments, the plurality of movements may include one or more of translations or rotations about a center of rotation of one or more teeth.

[0151] In various embodiments, moving one or more teeth comprises translating one or more teeth. In some embodiments, moving one or more teeth comprises rotating one or more teeth. In some embodiments, rotating comprises rotating about a vertical axis. In some embodiments, rotating comprises rotating about a buccal-lingual axis.

[0152] In some embodiments, the plurality of movements comprises continuous rotation of the one or more teeth about an axis of rotation extending through a center of rotation and an occlusal surface of the one or more teeth.

[0153] In some embodiments, the appliance is configured to produce movement of the teeth when worn continuously, the movement comprising one or more of a translation or a rotation, and wherein the plurality of distances decreases as a function of the movement of the teeth. In some cases, the appliance is configured to produce translation of the teeth when worn continuously, and wherein the plurality of distances decreases as a function of the translation of one or more teeth. In some cases, the appliance is configured to produce rotation of the teeth when worn continuously, and wherein the plurality of distances decreases as a function of the rotation of one or more teeth about a center of rotation.

[0154] In some embodiments, the appliance is configured to produce rotation of the teeth when worn continuously, and wherein the plurality of distances decrease continuously according to the continuous rotation of the one or more teeth about an axis of rotation extending through the center of rotation and the occlusal surface of the one or more teeth.

[0155] manufacture

[0156] Various embodiments of the orthodontic appliances presented herein can be manufactured in a number of ways. In some embodiments, the method further comprises manufacturing a plurality of orthodontic appliances, each of the plurality of orthodontic appliances being configured to produce movement along a movement path.

[0157] In some embodiments, the orthodontic appliances (or portions thereof) herein may be produced using direct manufacturing such as additive manufacturing techniques (also referred to herein as "3D printing") or subtractive manufacturing techniques (e.g., milling).

[0158] In some embodiments, direct manufacturing involves forming an object (eg, an orthodontic appliance or a portion thereof) without using a physical template (eg, a mold, a mask, etc.) to define the geometry of the object. Additive manufacturing technologies can be summarized as follows: (1) vat photopolymerization (e.g., stereolithography), in which an object is constructed layer by layer from vats of liquid photopolymer resin; (2) material jetting, in which material is jetted onto a build platform using a continuous or drop-on-demand (DOD) method; (3) binder jetting, in which alternating layers of building material (e.g., powder-based material) and binding material (e.g., liquid adhesive) are deposited by a print head; (4) fused deposition modeling (FDM), in which material is drawn through a nozzle, heated, and deposited layer by layer; (5) powder bed fusion, including but not limited to direct metal laser sintering (DMLS), electron beam melting (EBM), selective heat sintering (SHS), selective laser melting (SLM), and selective laser sintering (SLS); (6) sheet lamination, including but not limited to layered object manufacturing (LOM) and ultrasonic additive manufacturing (UAM); and (7) directed energy deposition, including but not limited to laser engineered mesh forming, directed light manufacturing, direct metal deposition, and 3D laser cladding. For example, stereolithography can be used to directly manufacture one or more of the appliances herein. In some embodiments, stereolithography involves using light (e.g., ultraviolet light) to selectively polymerize a photosensitive resin (e.g., a photopolymer) according to a desired cross-sectional shape. By sequentially polymerizing the cross-sections of multiple objects, the geometry of the object can be established in a layer-by-layer manner. As another example, selective laser sintering can be used to directly manufacture the appliances herein. In some embodiments, selective laser sintering involves using a laser beam to selectively melt and fuse layers of powdered material according to a desired cross-sectional shape to establish the geometry of the object. As yet another example, the appliances herein can be directly manufactured by fused deposition molding. In some embodiments, fused deposition molding involves melting and selectively depositing filaments of thermoplastic polymers in a layer-by-layer manner to form an object. In yet another example, material jetting can be used to directly manufacture the appliances herein. In some embodiments, material jetting involves spraying or extruding one or more materials onto a forming surface to form continuous layers of the object geometry.

[0159] Alternatively, or in combination, some embodiments of the appliances (or portions thereof) described herein may be manufactured using indirect manufacturing techniques, such as by thermoforming on a male or female mold. Indirect manufacturing of an orthodontic appliance may involve producing a male or female mold of the patient's dentition in a target arrangement (e.g., by rapid prototyping, milling, etc.), and thermoforming one or more layers of material onto the mold to create the appliance shell.

[0160] In some embodiments, the direct manufacturing methods provided herein build up the geometry of the object in a layer-by-layer manner and form continuous layers in discontinuous building steps. Alternatively or in combination, a direct manufacturing method that allows the continuous establishment of the geometry of the object can be used, referred to herein as "continuous direct manufacturing". Various types of continuous direct manufacturing methods can be used. As an example, in some embodiments, the orthodontic appliance of the present invention is manufactured using "continuous liquid interphase printing", wherein the object is continuously built from a reservoir of photopolymerizable resin by forming a gradient of partially cured resin between the building surface of the object and a "blind spot" where polymerization is inhibited. In some embodiments, a semipermeable membrane is used to control the transmission of a photopolymerization inhibitor (e.g., oxygen) into the blind spot to form a polymerization gradient. Continuous liquid interphase printing can achieve a manufacturing speed that is about 25 times to about 100 times faster than other direct manufacturing methods, and can achieve about 1000 times the speed by combining a cooling system. Continuous liquid mesophase printing is described in U.S. Patent Publication Nos. 2015 / 0097315, 2015 / 0097316, and 2015 / 0102532, the disclosures of each of which are incorporated herein by reference in their entirety.

[0161] As another example, a continuous direct manufacturing method can achieve continuous construction of the object geometry by continuously moving the build platform (e.g., in the vertical or Z direction) during the irradiation phase, thereby controlling the hardening depth of the irradiated photopolymer by the movement speed. Thus, continuous polymerization of the material on the building surface can be achieved. Such a method is described in U.S. Patent No. 7,892,474, the disclosure of which is incorporated herein by reference in its entirety.

[0162] In another example, a continuous direct manufacturing method can involve extruding a composite material consisting of a curable liquid material surrounding a solid strand. The composite material can be extruded along a continuous three-dimensional path to form an object. This method is described in U.S. Patent Publication No. 2014 / 0061974, the disclosure of which is incorporated herein by reference in its entirety.

[0163] In yet another example, a continuous direct manufacturing method utilizes a "spiral lithography" approach, in which a liquid photopolymer is cured using focused radiation while the build platform is continuously rotated and elevated. Thus, the object geometry can be continuously built along a spiral construction path. This method is described in U.S. Patent Publication No. 2014 / 0265034, the disclosure of which is incorporated herein by reference in its entirety.

[0164] Direct manufacturing method provided herein is compatible with multiple materials, including but not limited to following one or more: polyester, copolyester, polycarbonate, thermoplastic polyurethane, polypropylene, polyethylene, polypropylene and polyethylene copolymer, acrylic acid, cyclic block copolymer, polyetheretherketone, polyamide, polyethylene terephthalate, polybutylene terephthalate, polyetherimide, polyethersulfone, polytrimethylene terephthalate, styrene block copolymer (SBC), silicone rubber, elastomer alloy, thermoplastic elastomer (TPE), thermoplastic vulcanizate (TPV) elastomer, polyurethane elastomer, block copolymer elastomer, polyolefin blended elastomer, thermoplastic copolyester elastomer, thermoplastic polyamide elastomer or its combination. Material for direct manufacturing can be provided in uncured form (for example, with forms such as liquid, resin, powder), and can be cured (for example, by photopolymerization, light curing, gas curing, laser curing, crosslinking etc.), to form orthodontic appliance or its part. Material property before curing may be different from material property after curing. Once cured, the materials herein can exhibit sufficient strength, stiffness, durability, biocompatibility, etc. for use in orthodontic appliances. The post-curing properties of the materials used can be selected based on the desired properties of the corresponding portion of the appliance.

[0165] In some embodiments, relatively rigid portions of an orthodontic appliance may be formed by direct manufacturing using one or more of the following materials: polyester, copolyester, polycarbonate, thermoplastic polyurethane, polypropylene, polyethylene, polypropylene and polyethylene copolymers, acrylic, cyclic block copolymers, polyetheretherketone, polyamide, polyethylene terephthalate, polybutylene terephthalate, polyetherimide, polyethersulfone, and / or polytrimethylene terephthalate.

[0166] As used herein, the terms "hardness" and "rigidity" are used interchangeably.

[0167] In some embodiments, the relatively elastic portion of the orthodontic appliance can be formed by direct manufacturing using one or more of the following materials: styrene block copolymers (SBC), silicone rubber, elastomeric alloys, thermoplastic elastomers (TPE), thermoplastic vulcanizate (TPV) elastomers, polyurethane elastomers, block copolymer elastomers, polyolefin blend elastomers, thermoplastic copolyester elastomers and / or thermoplastic polyamide elastomers.

[0168] Machine parameters may include curing parameters. For digital light processing (DLP)-based curing systems, curing parameters may include power, curing time, and / or grayscale of the entire image. For laser-based curing systems, curing parameters may include power, speed, beam size, beam shape, and / or beam power distribution. For printing systems, curing parameters may include material droplet size, viscosity, and / or curing power. These machine parameters can be monitored and adjusted regularly (e.g., some parameters every 1-x layers and some parameters after each build) as part of process control on the manufacturing machine. Process control can be achieved by including sensors on the machine that measure power and other beam parameters every layer or every few seconds and automatically adjust them through a feedback loop. For DLP machines, grayscale can be measured and calibrated before, during, and / or at the end of each build and / or at predetermined intervals (e.g., every n builds, once an hour, once a day, once a week, etc.), depending on the stability of the system. Additionally, material properties and / or light properties can be provided to the manufacturing machine, and the machine process control module can use these parameters to adjust machine parameters (e.g., power, time, grayscale, etc.) to compensate for changes in material properties. By implementing process control on the manufacturing machines, reduced variability in appliance precision and residual stress can be achieved.

[0169] Alternatively, the direct manufacturing methods described herein allow for the manufacture of appliances comprising multiple materials, referred to herein as "multi-material direct manufacturing". In some embodiments, the multi-material direct manufacturing method involves forming an object from multiple materials simultaneously in a single manufacturing step. For example, a multi-tip extrusion device can be used to selectively dispense multiple types of materials (e.g., resins, liquids, solids, or combinations thereof) from different material supply sources to manufacture an object from multiple different materials. Such a method is described in U.S. Patent No. 6,749,414, the disclosure of which is incorporated herein by reference in its entirety. Alternatively or in combination, the multi-material direct manufacturing method can include forming an object from multiple materials in multiple sequential manufacturing steps. For example, a first portion of an object (e.g., an appliance housing) can be formed from a first material according to any direct manufacturing method described herein, and then a second portion of the object (e.g., one or more elastic members) can be formed from a second material according to the methods described herein, and so on, until the entire object is formed. The relative arrangement of the first and second portions can be changed as desired, for example, the first portion can be partially or completely enclosed by the second portion of the object.

[0170] Direct manufacturing can provide various advantages compared to other manufacturing methods. For example, in contrast to indirect manufacturing, direct manufacturing allows orthodontic appliances to be produced without utilizing any molds or templates to shape the appliance, thereby reducing the number of manufacturing steps involved and improving the resolution and accuracy of the final appliance geometry. In addition, direct manufacturing allows precise control of the three-dimensional geometry of the appliance, such as the thickness of the appliance. Complex structures and / or auxiliary components can be integrally formed as a single body with the appliance shell in a single manufacturing step, rather than being added to the shell in a separate manufacturing step. In some embodiments, direct manufacturing is used to produce appliance geometries that are difficult to create using alternative manufacturing techniques, such as appliances with very small or fine features, complex geometries, undercuts, intermediate structures, shells with variable thickness, and / or internal structures (e.g., for improving strength by utilizing reduced weight and material usage). For example, in some embodiments, the direct manufacturing method herein allows the manufacture of orthodontic appliances having a feature size of less than or equal to about 5 μm, or in the range of about 5 μm to about 50 μm, or in the range of about 20 μm to about 50 μm.

[0171] The direct manufacturing techniques described herein can be used to produce appliances with substantially isotropic material properties (e.g., substantially the same or similar strength in all directions). In some embodiments, the direct manufacturing methods herein allow for the production of orthodontic appliances having strength variations of no more than about 25%, about 20%, about 15%, about 10%, about 5%, about 1%, or about 0.5% in all directions. In addition, the direct manufacturing methods herein can be used to produce orthodontic appliances at a faster rate than other manufacturing techniques. In some embodiments, the direct manufacturing methods herein allow for the production of orthodontic appliances in a time interval of less than or equal to about 1 hour, about 30 minutes, about 25 minutes, about 20 minutes, about 15 minutes, about 10 minutes, about 5 minutes, about 4 minutes, about 3 minutes, about 2 minutes, about 1 minute, or about 30 seconds. Such manufacturing speeds allow for the rapid "chairside" production of customized appliances, for example, during routine appointments or examinations.

[0172] In some embodiments, the direct manufacturing methods described herein implement process control of various machine parameters for the direct manufacturing system or apparatus to ensure that the final appliance is manufactured with a high degree of precision. Such precision may be advantageous for ensuring that the desired force system is accurately transmitted to the teeth to effectively induce tooth movement. Process control may be implemented to account for process variations arising from a variety of sources, such as material properties, machine parameters, environmental variables, and / or post-processing parameters.

[0173] Material properties may vary depending on the properties of the raw materials, the purity of the raw materials and / or the process variables during the mixing of the raw materials. In many embodiments, the resin or other materials for direct manufacturing should be manufactured under strict process control to ensure that the optical properties, material properties (e.g., viscosity, surface tension), physical properties (e.g., modulus, strength, elongation) and / or thermal properties (e.g., glass transition temperature, heat distortion temperature) are substantially unchanged. Process control of the material manufacturing process can be achieved by screening the raw materials for physical properties and / or controlling temperature, humidity and / or other process parameters during the mixing process. By implementing process control on the material manufacturing process, the variability of the process parameters can be reduced and the material properties of each batch of materials can be made more uniform. As further discussed herein, process control on the machine can be used to compensate for residual changes in material properties.

[0174] Machine parameters may include curing parameters. For curing systems based on digital light processing (DLP), curing parameters may include power, curing time, and / or grayscale of the entire image. For laser-based curing systems, curing parameters may include power, speed, beam size, beam shape, and / or power distribution of the beam. For printing systems, curing parameters may include material drop size, viscosity, and / or curing power. These machine parameters may be monitored and adjusted regularly (e.g., some parameters every 1-x layers and some parameters after each build) as part of process control on the manufacturing machine. Process control can be achieved by including sensors on the machine that measure power and other beam parameters every layer or every few seconds and automatically adjust them through a feedback loop. For DLP machines, grayscale can be measured and calibrated at the end of each build. Additionally, material properties and / or light properties may be provided to the manufacturing machine, and the machine process control module may use these parameters to adjust machine parameters (e.g., power, time, grayscale, etc.) to compensate for variations in material properties. By implementing process control on the manufacturing machine, variability in appliance accuracy and reduced residual stress can be achieved.

[0175] In many embodiments, environmental variables (e.g., temperature, humidity, sunlight, or exposure to other energy / curing sources) are maintained within narrow ranges to reduce variability in appliance thickness and / or other properties. Optionally, machine parameters can be adjusted to compensate for environmental variables.

[0176] In many embodiments, post-processing of the appliance includes cleaning, post-curing, and / or support removal processes. Relevant post-processing parameters may include the purity of the cleaning agent, cleaning pressure and / or temperature, cleaning time, post-curing energy and / or time, and / or consistency of the support removal process. These parameters can be measured and adjusted as part of a process control scheme. In addition, the physical properties of the appliance can be changed by modifying the post-processing parameters. Adjusting the post-processing machine parameters can provide another way to compensate for changes in material properties and / or machine characteristics.

Claims

1. An appliance for treating or preventing temporomandibular joint dysfunction (TMD), comprising: a shell comprising a plurality of tooth-receiving cavities shaped to fit teeth of a first arch of a patient's dentition; as well as a lingual repositioning splint attached to the shell, wherein the lingual repositioning splint extends over the incisor portions of the plurality of tooth-receiving cavities, The lingual repositioning splint is shaped to alter the patient's natural bite and encourage the patient's bite from the natural bite configuration toward a target bite configuration, thereby reducing orofacial pain.

2. The appliance according to claim 1, wherein The repositioning splint includes a buccal surface shaped to extend beyond one or more teeth in an opposing dental arch.

3. The appliance according to claim 1, wherein The target bite configuration corrects an overbite or an underbite.

4. The appliance according to claim 1, wherein The target occlusal configuration provides improved cusp alignment.

5. The appliance according to claim 1, wherein The repositioning splint is shaped to apply a jaw repositioning force to the opposing dental arch.

6. The appliance according to claim 1, wherein: The repositioning cleat includes a sliding ramp.

7. The appliance according to claim 6, wherein: The sliding ramp provides contact on the patient's anterior teeth, and wherein the contact is shaped to provide anterior guidance during lateral deviation and protrusion of the jaw.

8. The appliance according to claim 1, wherein: The repositioning splint is removably attached to the housing.

9. The appliance according to claim 1, wherein: The repositioning cleat is integrally attached to the housing.

10. The appliance according to claim 1, wherein The repositioning splint spans a plurality of adjacent teeth.

11. The appliance according to claim 1, wherein: The appliance is manufactured in an additive, layer-by-layer process.

12. The appliance according to claim 1, wherein The appliance is manufactured using stereolithography, in which a photosensitive resin is selectively polymerized according to the desired cross-sectional shape.

13. The appliance according to claim 1, wherein: Modifying the patient's natural bite includes moving at least a portion of the patient's first dental arch closer to at least a portion of the patient's second dental arch, thereby narrowing a gap between the natural bites of the first and second dental arches.

14. The appliance according to claim 1, wherein The appliance is one of a range of orthodontic appliances used to treat temporomandibular joint dysfunction (TMD).

15. The appliance according to claim 14, wherein The series of orthodontic appliances incrementally adjusts the patient's natural bite from a natural bite configuration toward a target bite configuration.

16. A method of designing a plurality of dental appliances, comprising: obtaining first occlusal scan data corresponding to the patient's jaw in a target occlusal configuration; obtaining second occlusal scan data corresponding to the patient's jaw in a natural occlusal configuration; as well as designing a plurality of appliances based on the first bite scan data and the second bite scan data, the plurality of appliances being configured to apply tooth-moving forces and jaw-moving forces to the patient's dentition to move the patient's dentition from a natural bite configuration to a target bite configuration in an incremental sequence of steps as the plurality of appliances are successively worn, The geometric shape of each of the plurality of orthodontic appliances comprises: a housing comprising a plurality of tooth-receiving cavities shaped to fit the teeth of a first arch of the patient's dentition; and a lingual repositioning splint attached to the shell, wherein the lingual repositioning splint extends over the incisor portions of the plurality of tooth-receiving cavities, The lingual repositioning splint is shaped to alter the patient's natural bite and encourage the patient's bite from the natural bite configuration toward a target bite configuration, thereby reducing orofacial pain.

17. A non-transitory computing device readable medium storing instructions executable by a processor to cause a computing device to perform a method comprising: receiving first bite scan data corresponding to the patient's jaw in a target bite configuration; receiving second bite scan data corresponding to the patient's jaw in a natural bite configuration; as well as designing a plurality of appliances based on the first bite scan data and the second bite scan data, the plurality of appliances being configured to apply tooth-moving forces and jaw-moving forces to the patient's dentition to move the patient's dentition from a natural bite configuration to a target bite configuration in an incremental sequence of steps as the plurality of appliances are successively worn, The geometric shape of each of the plurality of orthodontic appliances comprises: a housing comprising a plurality of tooth-receiving cavities shaped to fit the teeth of a first arch of the patient's dentition; and a lingual repositioning splint attached to the shell, wherein the lingual repositioning splint extends over the incisor portions of the plurality of tooth-receiving cavities, The lingual repositioning splint is shaped to alter the patient's natural bite and encourage the patient's bite from the natural bite configuration toward a target bite configuration, thereby reducing orofacial pain.

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