Biomechanical training device for the temporomandibular joint

Description

Field of invention

[0001] The invention relates to a custom-made device for training physiologically and biomechanically advantageous jaw positions and movements, particularly for dental and orthodontic applications. The device consists of an upper jaw module for the maxillary arch and a lower jaw module for the mandibular arch. The device is inserted into the patient's mouth and allows the mandible to glide forward and laterally in two dimensions. A nearly frictionless, flat, and predominantly transversely sliding interface exists between the upper and lower jaw modules. The mandible can thus be moved by the laterally directed force component, while the force component of the biting force, acting perpendicular to the interface, presses the two modules against each other at the interface.The field of application of the present invention is in particular the biomechanical neuromuscular training of the muscles that move the lower jaw relative to the upper jaw. State of the art

[0002] Patent DE102012220054 A1 (Dirk Wiechmann, 2012) describes an orthodontic device for repositioning a patient's mandible. It uses two telescopes to exert a transverse force that causes the repositioning. Such devices have the significant disadvantage of creating biomechanically and neurophysiologically very unfavorable conditions in the jaw, even if they produce a cosmetically pleasing tooth position. This results in severe disturbances in the biomechanics and neurophysiology of the jaw muscles and temporomandibular joint, potentially leading to significant discomfort and degenerative diseases.

[0003] EP1147745A2 (Thomas Egli) describes a device that enables transverse displacements. However, the forces exert a stretching effect on the lateral regions of the upper dental arch and maxilla, and it is therefore proposed for palatal expansion. The aim is to orthodontically correct insufficient palatal width. Although the device consists of at least two parts, it does not achieve a biomechanical or neurophysiological improvement.

[0004] US 2018 / 0078344A1 describes a splint with a sliding contact surface, in which contact occurs between the upper and lower parts. However, the sliding plane is not aligned with cranial symmetry but rather with the dental conditions of the arch. In particular, the sliding plane is not inclined relative to the occlusal plane due to its cranial orientation. Furthermore, the splint fits tightly on the teeth and exerts lateral pressure on them. This makes it impossible for the therapeutically effective pressure stimulus to be applied to the dental arch in the correct cranial orientation.

[0005] EP 3 332 731 A1 prescribes orientation along the inner ear axis, but this right-left transverse axis does not define the exact position of the dividing plane in its oblique inclination when viewed from the front and side. Likewise, the position of the support points 125.1 right left and 125.2 right left for the support areas 125 (see Figur 9 (present application). The document describes the design of aligner trays such that they exert a laterally acting force to gradually align the teeth of the dental arch more closely with the orientation of the inner ear axis along their imaginary transverse axis. In contrast, the device according to the invention uses a marginal gap to avoid precisely these laterally acting forces on the teeth.

[0006] The publication by HJ Schindler et al., ZEFQ, 2013, Vol. 107, Issue 4-5, Pages 297-301, entitled "Therapy of Masticatory Muscle Pain with Occlusal Splints," provides an overview of the current state of knowledge regarding therapy with oral splints. A variety of oral splints exist that alter the distance between the articular condyles in the temporomandibular joint, particularly to relieve compression on compressed sides of the jaw. However, a training device for muscularly stabilized transverse movement, which can improve the neuromuscular control of the jaw muscles with high efficiency, is lacking.

[0007] DE 112009001742 T5 concerns an improved mandibular advancement splint.

[0008] EP 2630938 A1 relates to a device for improving a person's breathing.

[0009] US 2015210014 A1 concerns the manufacture of temporomandibular joint splints.

[0010] WO 2014044783 A2 concerns a method for simulating dynamic occlusion.

[0011] The currently standard bite splints prescribed for temporomandibular joint (TMJ) dysfunction have the disadvantage of being worn continuously and can even provoke forceful, persistent clenching. Therefore, patients often complain of even greater neuromuscular tension when wearing these splints. The biomechanical and neurophysiological function of the currently available devices is thus highly inadequate.

[0012] All previously proposed devices and solutions lack the crucial aspect of being able to influence the neuromuscular control of the temporomandibular joint muscles in a suitable, advantageous, and rapid manner. Furthermore, according to the current state of the art, these devices do not neurophysiologically realign and stabilize the relative position of the mandible to the maxilla in a suitable way. On the contrary, they often even perpetuate the biomechanically and neurophysiologically unfavorable situation. Therefore, the therapeutic success achieved with oral splints or other devices worn temporarily or permanently is very limited. Object of the invention

[0013] The object of the present invention is to provide a fast, gentle, and effective training device for achieving neurophysiological, biomechanical, and orthodontic improvements. The device should enable time-limited training sessions of a few minutes without requiring continuous wear. The effect of the training should be that, after training, and especially after repeated training, the neurophysiology and biomechanics of the temporomandibular joint are more favorable than before. An additional objective is to establish a trained, improved state with the aid of the device according to the invention, in order to then carry out further therapeutic steps more efficiently and with even better results. Inventive solution

[0014] The problem is solved by the subject matter of the independent claims. Advantageous further developments of the subject matter of the independent claims are identified in the dependent claims. The wording of all claims is hereby incorporated by reference into the content of this description. The use of the singular is not intended to exclude the plural, and the reverse is also true unless otherwise disclosed.

[0015] The following section describes individual devices and procedure steps in more detail. When describing the device, the reference to the upper jaw (OK) and lower jaw (UK) can be reversed, because the transverse sliding plane (TGE) is of particular interest. Device according to the invention

[0016] To solve the stated problem, a custom-made device 100 is proposed, particularly for training the jaw muscles. Its contact surfaces with the teeth and gums are based on individual 3D tissue data, but it deviates characteristically from the purely 3D digital impression geometry known to those skilled in the art, in a manner according to the invention, in order to achieve the training effect. It also has an inventive and functional shape outside the dental arches, which supports the training effect.

[0017] The training device makes it possible, in particular, to generate a force precisely perpendicular to the separating sliding surface and to introduce chewing pressure into the dental arches of the upper and lower jaw at defined contact points, while minimizing or even eliminating lateral forces acting on the teeth. This serves to generate an effective neurophysiological signal in the masticatory system and to achieve suitable training effects in the sensorimotor area responsible for jaw movement and the generation of chewing forces.

[0018] The device comprises at least one maxillary module 120 and at least one mandibular module 130, separated by a smoothly sliding separating-gliding plane 110. The maxillary module 120 and / or the mandibular module 130 can be a single, monolithic piece or multi-part. The parts of the potentially multi-part module together form a flat separating-gliding plane TGE 110. When the device 100 is inserted, the separating-gliding plane 110 is predominantly horizontally oriented when viewed from the front, or parallel to the transverse axis between right-left symmetrical landmarks of the facial skeleton, such as the zygomatic bone, orbital arch, etc. Viewed from the side, the separating-gliding plane 110 slopes obliquely downwards at an angle of between 5° and 25° from the transverse axis.The separating sliding plane 110 is created by placing the two modules OKM 120 and UKM 130 on top of each other precisely between the contacting modules. The surface has a low roughness, preferably with a roughness value (RZ) of less than 5 micrometers, and particularly preferably without visible grooves and with a roughness value (RZ) of less than 2 micrometers. Preferred embodiments of the invention

[0019] In patients requiring therapy, this separating-gliding plane 110 of the training device is not parallel to the occlusal plane 111, but is inclined in two directions: left-right and anterior-posterior. This separating-gliding plane 110 is parallel to a cranial plane of symmetry oriented to landmarks of the anterior facial skeleton, but its orientation varies depending on the geometry of the cranium, resulting in an individual degree of inclination relative to the individual occlusal plane 111. The occlusal plane 111 of the patient's dentition, however, differs from the separating-gliding plane 110. The training device includes spaces for the teeth of the maxillary and mandibular arches. These spaces are intentionally designed to be locally wider than the corresponding width of the teeth, ensuring that no lateral forces are exerted on the teeth of the arch, as the bearing forces are only perpendicular to the separating-gliding plane 110.The absence of lateral forces between the training device and the dental arch is what fundamentally distinguishes this training device from all other splints and braces, which are used especially for a secure fit and for force-mediated lateral displacement of the teeth backward or forward and / or to the right or left.

[0020] The occlusal plane 111 can be determined by a rigid and flat object, such as a metal plate, which is clamped between the upper and lower jaws when the teeth close. In the clamped position, the plane of the plate corresponds to the occlusal plane 111.

[0021] Due to the smooth and especially polished sliding surface, the mandibular module 130 glides almost frictionlessly against the maxillary module 120, even under pressure (see Fig. 1 ) in two dimensions possible and also a rotation about an axis perpendicular to the separating-sliding plane 160 (see Fig.2 Tilting of modules 120 and 130 relative to each other, in the sense of rotational movements about axes 105 and 115, which are parallel to the separating-gliding plane 110, is not possible as soon as the modules are held together by the biting force. The physical consequence of the smooth, low-friction separating-gliding plane 110 is that the contact force is perpendicular to this plane with negligible friction, as long as the freedom of movement between the mandibular module 130 and the maxillary module 120 is not restricted by lateral stops. Therefore, marginal gaps 122 and 132 are used, which ensure the small-scale but important lateral movement in the gliding direction. Following the respective dental arches 221 and 231, modules 120 and 130 have several recesses 124 in the maxillary module and 134 in the mandibular module.Predominantly in the region of the incisors, but sometimes also in the region of the molars, the depressions 124 of the upper incisors 221 protrude through the maxillary module 120 and reach the mandibular module 130, where they form small, reciprocal depressions in the otherwise flat and smooth septum 133. Conversely, the teeth of the mandible 231 can also occupy depressions 134 in the mandibular module 130, which protrude through the mandibular module 130, creating shallow depressions 122 in the overlying maxillary module, which also have a marginal gap, i.e., they do not make contact with the erupting teeth.

[0022] These through-grooves 132 in the mandibular module and 122 in the maxillary module do not result in the mechanical locking of the maxillary module 120 with the mandibular module 130, because they are characterized by a sufficiently wide circumferential marginal gap that allows lateral freedom of movement for the tooth extending into this shallow groove. The marginal gap between the edge of the shallow groove and the tooth is preferably larger than 0.3 mm, and particularly preferably between 0.4 and 1.4 mm. The freedom of movement of the mandible relative to the maxilla along the sulcus plane 110 is therefore restricted to this important marginal gap of the shallow grooves as soon as such through-grooves 122 or 132 are present.The biomechanical and neurophysiological effect of the device 100, which can be used as a training device, is unaffected by the limited transverse range of motion, because the effect is based on the lateral mobility existing in the equilibrium position, which is present through the marginal gap.

[0023] A marginal gap is also present in the occlusal surfaces of the teeth and in the gingival area. To maintain this marginal gap even under pressure, the modules are supported by locally confined, hill-like or plateau-like projections 125 and 135, respectively, which appear approximately round or oval when viewed superficially, with a diameter of 800 to 6000 micrometers and a height preferably less than 800 micrometers. The contact force is transmitted only at these projections 125 and 135 between module 120 and 130 and the respective dental arch. The projection 125 and 135 itself is form-fittingly adapted to the tooth at the contact surface. If actual openings 126 and 136 are required in the recesses 124 and 134, respectively, the support points 125 and 135 are arranged adjacent to them. Overall, each module is held in a position with edge gaps 122 by at least 3 contact points 125 or 135, even under pressure when biting.The marginal gaps 122 surround all teeth and are at least large enough to ensure that the placement and demolding of the modules is free of undercutting and that a small degree of additional mobility of preferably less than 1200 micrometers is provided between the module and the tooth arch, particularly preferably less than 600 micrometers.

[0024] The biomechanical function of the device 100 with its training effect is achieved after the maxillary module 120 is placed on the mandibular module 130 and both modules are brought into contact with the dental arches of the maxilla 221 and mandible 231 as a unit in the mouth by closing the mouth. The mandible 230 and maxilla 220 are then brought into a relative position defined by the individually manufactured 3D geometry of the modules. Simultaneously, the sliding movement right-left and back-forward, as well as the rotation around the axis 160 perpendicular to the sliding plane, is permitted within certain limits and is almost frictionless. This initiates the effect of the orthogonality condition on the contact force between the maxilla 220 and mandible 230. The equilibrium is biomechanically comparatively unstable or metastable because the retention of the teeth is eliminated by the sliding surface 110.And precisely this unstable or metastable state of force, with the possibility of transverse sliding of the mandible forwards or backwards, as well as to the left or right, represents a mechanical instability that, similar to upright walking, must be stabilized neuromuscularly. This activates the sense of balance, which in turn trains the neurophysiological and sensorimotor structures of the temporomandibular joint and the masticatory apparatus, extending to the muscles of the head and neck.

[0025] For optimal training effect, the correct orientation of the gliding surface is of particular importance. The precise movement of the mandible with the attached mandibular module along the gliding plane depends on the 3D position of the gliding plane 110 relative to the maxilla. Analysis of hundreds of 3D X-ray images of the head has shown that the biomechanically favorable plane of movement is rarely located where the current occlusal plane is visible. The current occlusal plane is where a thin bite plate would lie, with its spatial orientation and position, if it were wedged between the teeth of the maxilla and mandible. The biomechanically favorable plane of movement, however, depends on the symmetry of the facial skeleton in the upper region, and thus hardly on the mandible, but rather on the bony area around the eye sockets on the right and left.

[0026] Surprisingly, numerous practical application trials revealed that the biomechanically favorable, precise orientation of the sliding dividing plane 110 between the upper jaw 120 and lower jaw 130 deviates significantly, measurably, by a tilt angle kappa 112 from the actual occlusal plane AKE 111 of the dental arches, requiring training in most cases. For the fabrication and positioning of the device 100 according to the invention, the dividing plane 110 is not aligned with the dental arches in the upper jaw 220 and lower jaw 230, but rather with the anatomical transverse axes of symmetry in the facial skeleton 200 (in the facial cranium). Those skilled in the art can identify these transverse axes of symmetry in the facial skeleton, for example, in an X-ray image or a 3D CBCT image, based on the clearly identifiable bony landmarks on the zygomatic arch and / or the bony margin of the orbit.Since the modules for the upper and lower jaws are positioned on this septal-gliding plane in the digital virtual 3D model, their position relative to the respective dental arch determines the recess to be created for the teeth. After fabrication of the appliance, the insertion of the modules onto the dental arches again results in the planned position and orientation of the septal-gliding plane relative to the upper jaw and the facial skeleton, which is anatomically connected to the upper jaw. In practice, there is a more or less pronounced and highly individual deviation of the septal-gliding plane (SLP) derived from the facial skeleton from the actual occlusal plane (OPP). In these cases, there is a corresponding asymmetry of the lower facial skeleton, the upper jaw, and the lower jaw. Part of the asymmetry of the lower jaw (LMP) relative to the upper facial skeleton is neuromuscular in origin and a consequence of tension and malposition in the temporomandibular joints.This is where training with the device according to the invention comes into play, in order to restore symmetry step by step.

[0027] A neurophysiologically important contribution to the training effect is achieved through the modules' thick, bulbous shape. Unlike aligner trays or bite splints, the modules feature thick material bulges (121 and 131) extending outside the dental arch, designed to stretch the soft tissue in the lip area. This stretching, caused by the modules' apparent oversized dimensions (barely fitting in the mouth), leads to increased neuromuscular feedback to the sensorimotor system of the jaw and facial muscles. Since the potential for stretching varies considerably from person to person, the thickness of the surrounding material bulges (121) on the maxillary module and (131) on the mandibular module is individually adjusted to the available soft tissue, training needs, and current fitness level.

[0028] The device according to the invention is manufactured by 3D machining of suitable hard materials. During the forming process, the upper and lower jaw parts are given individually characteristic clearances to accommodate the teeth, preferably with a marginal gap. The position of the sliding plane relative to the occlusal plane of the dental arches results from the individual symmetry of the cranium, i.e., the facial skeleton and the skull up to the base of the skull of the patient. This symmetry can preferably be determined using X-ray images. According to the invention, this cranial symmetry is used to align the sliding plane 110 in relation to the occlusal plane 111.

[0029] Numerous tests with test subjects have shown that the device is suitable for achieving extensive relaxation of previously tense and painful jaw joint muscles after just a few minutes in the mouth with actively varying chewing pressure.

[0030] Another important application is that the training results in a better starting point for measuring temporomandibular joint kinematics, thus providing a biomechanically and dentally far more favorable basis for recording physiologically relevant movement data of the mandible relative to the maxilla.

[0031] The foregoing has broadly explained the features and technical effects of the invention. Additional features and technical effects of exemplary embodiments of the present disclosure are explained below, e.g., the subject matter of the claims. It should be recognized by those skilled in the art that the concept and its specific developments can be used as a basis for modifying or designing other structures or processes that have the same or similar purposes as the concept specifically explained here. It should also be recognized by those skilled in the art that equivalent designs do not deviate from the spirit or scope of the disclosure as defined, for example, in the attached claims.

[0032] For a more complete understanding of the disclosed concepts and their technical effects and advantages, please refer to the following description in conjunction with the accompanying figures. The figures are not drawn to scale. The drawings show... List of characters

[0033] Further details and features will become apparent from the following description of preferred embodiments in conjunction with the figures. The respective features can be implemented individually or in combination. The possibilities for solving the problem are not limited to the embodiments shown.

[0034] The exemplary embodiments are shown schematically in the figures. Identical reference numerals in the individual figures denote identical or functionally equivalent elements, or elements that correspond to each other with respect to their functions. Figures 1a to c show the contours of the device 100 and its position based on the bony contours of a head 200. Figures 2a to c show the possible relative movements (2 x translation and 1 x rotation) between the mandible and maxilla within the sling-joint plane TGE. Figure 3 shows a mouth with the device 100 inserted, with the dental occlusal plane 111 clearly inclined compared to the sling-joint plane 110. Figures 4a and b show the preforms 20 and 30 for the fabrication of the modules 120 for the maxilla and 130 for the mandible for material removal. Figures 5a and b show variants with a multi-part maxillary module 120 and a multi-part mandibular module 130, where the sling-joint plane 110 is the contact surface. Fig. 6 shows a transverse section through an individual maxillary module 120 with the recesses 124 for corresponding teeth of the maxillary dental arch.Figure 7 shows the bony contours of the skull with its axis of symmetry 215 and, preferably parallel to it, the transverse axis 115 of the separating-gliding plane 110 of the device 100 inserted in the mouth, which is tilted obliquely to the dental occlusal plane 111. Figure 8 shows the section AB through the device 100 with the recesses 124 and 134 for the corresponding teeth, wherein the recesses 134 partially penetrate the module 130 and recesses 129 also form in the otherwise flat and smooth gliding surface 123 of the module 120. Here, the marginal gaps 122 are visible. Figure 9 shows a maxillary module 120 with, in this example, 4 support points 125, wherein the other teeth without support points have marginal gaps 122. Thus, the modules only bear on the support points 125 at specific points.Figure 10 shows the device 100 in a preferred embodiment with the smoothly machined sliding surfaces 123 and 133, wherein the separating-sliding plane 110 is created by joining the modules for the upper jaw 120 and lower jaw 130. Figure 11a shows the recesses 124 with the dental tooth positions 11 to 17 and 21 to 27 of the upper jaw in the upper jaw module 120, as well as the through-recesses 126. Fig 11 b Figure 1 shows in detail, from above, the tooth of the dental arch 221 with the surrounding gingiva 227 and the maxillary module 120 with gliding surface 123 and bearing point 125 as well as marginal gap 122. Figure 12 shows CBCT 3D radiographs of a head 200 with maxilla 220 and mandible 230 as well as the axes of symmetry 250 superior-inferior, 105 anterior-posterior and 115 right-left based on the bone features in the upper facial skeleton. Figure 13 shows the generation of digital or virtual 3D images of bone structures and 3D structural markers. Figure 14 shows a diagram for the procedure for the individual application of the 3D structural marker. Figure 15 shows the combination of at least two plane packages to form a 3D structural marker. Figure 16 shows representations of the 3D structural marker with an additional sagittal plane package. Fig. 17 shows a particularly preferred isotropic embodiment of each of the five plane packages. Fig. 17a shows a front view of Figur 17 Fig. 18 shows the addition of a double plane package to the plane packages. Fig. 19 shows the transverse section through the bony structure of a skull and shows how the transverse axis 215 is aligned with landmarks, thus defining the sagittal plane Sm. Fig. 20 shows the median sagittal section through the radiographically depicted head with anchor points and with fitted 3D structural marking. Fig. 21 shows the structural marking in the sagittal section before rotation and scaling, etc. Fig. 22 shows the structural marking oriented along the BP-GP axis. Fig. 23 shows the structural marking with the step of scaling to reach the anchor point NP with line F1 and how this defines the ideal incisal point IP. Fig. 24 shows an alternative way to achieve the same result as in Fig. 8 to achieve this, however, on a patient with a receding chin. Fig. 25 shows a transverse section through the dental arch of a symmetrical maxilla with structural markings. Fig. 25a shows a transverse section through the dental arch of an asymmetrical maxilla. Fig. 26 shows a transverse section through the area of ​​the nasal septum with asymmetry. Fig. 27 shows a transverse section through landmarks of the inner ear with the inner ear axis. Fig. 28 shows a frontal section through the temporomandibular joint with visible tilting of the mandible. Fig. 29 shows a frontal section through the molar region with an excessively high occlusal plane. Fig. 30 shows a frontal section through the lower incisors. Fig. 31 shows a top view and a side view of the training device. Fig. 32 shows the detail of a support area in a particularly preferred embodiment. Fig. 33 shows the training device from the side on the dentition with a pronounced tilt.Figure 34 shows the structural marking in the sagittal section with the separating-gliding plane indicated. Figure 35 shows a digital or virtual frontal section through the molar region and reveals a clear obliquity of the current occlusal plane in this example. Figure 36 shows a training device with the separating-gliding plane in the position of the ideal occlusal plane in a rough schematic representation. Figure 37 shows a schematic lateral view of the head with a spatial orientation in which the coordinate system of the skull is perpendicular. Figures and examples of implementation with details Figure 1

[0035] It should be taken into account that Fig. 1a the folding direction of the illustrated device, which results in the view of the lower jaw module 130 from below in Fig. 1a The view of the upper jaw module 120 from above is shown below. The side view is shown in between, with the upper jaw module 120 in direct contact with the lower jaw module 130. The device 100 has an upper jaw module 120 and a lower jaw module 130. The smooth, flat, and sliding separating-sliding surface 110 is formed between the modules 120 and 130. The relative movements possible there are described in Fig. 2 described.

[0036] Fig 1b Figure 100 shows the device 100 being used in the mouth, although the device 100 is only drawn in a highly schematic way, and the head is only indicated by the bony contours 200. The axis 250 runs from top to bottom; when the head is held normally, it runs slightly obliquely, usually at an angle of 5° to 15°. A preferred anchor point for positioning is the nasion point 251 at the root of the nose. The front-to-back axis 245 in the upper skull region is perpendicular to this. The axis 105 for orienting the device runs parallel to 245 through the overlapping area of ​​the incisors, which is called the incision point. These points are familiar to specialists in dentistry and orthodontics. The upper jaw 220 carries the dental arch 221 and the lower jaw 230 carries the dental arch 231. The severing-gliding plane 110 is defined by the axes 105 descending obliquely from front to back and the transverse axis 115 right-left.

[0037] Fig 1c The figure shows the skull in a vertical orientation. The vertical axis 250 is exactly perpendicular to the anterior-posterior axis 105, which runs exactly horizontally. The device 100 is aligned exactly parallel to the right-left axis 115, and the separating-gliding plane 110 is strictly horizontally transversely oriented. From this orientation of the device 100 with maxillary module 120 and mandibular module 130, the relative position of all teeth is determined, and thus the position of the recesses 214 for the corresponding teeth. Figure 2

[0038] Fig. 2a The device shows Fig. 1a with the orthogonal axes 105, 115 and 150.

[0039] Fig. 2b Figure 1 shows the three orthogonal spatial axes of the device 100: the vertical up-down axis 150, the transverse right-left axis 115, and the front-back axis 105. The two axes 115 and 105 define the separating-sliding plane 110.

[0040] Fig 2 c Figure 1 shows the three degrees of freedom of movement that exist for the relative movement between maxillary module 120 and mandibular module 130, insofar as they are not limited by lateral stops. The marginal gaps of the tooth recesses allow the necessary freedom of movement around the unstable equilibrium point. Given the biomechanics of the temporomandibular joint, small rotational movements around a more posteriorly located vertical axis 160 parallel to axis 150 are possible, as well as superimposed small translational movements along the anterior-posterior axis 105 and also along the right-left axis 115. These free movements around the unstable equilibrium position during compression of the device 100 between the maxilla and mandible are important for the neurophysiological and biomechanical effect of the device 100. Figure 3

[0041] Fig. 3 The device 100, with maxillary module 120 and mandibular module 130 partially visible (hatched in those areas), is made of transparent, pressure-resistant material. Teeth 221 and 231 and their obliquely running dental occlusal plane 111 are visible through the image. The lips 223 and 233 obscure the remainder of the device 100, which is indicated by dashed lines. The position of the dental occlusal plane 111 can be determined by having the patient bite into a plate or by placing a best-fit plane between the dental arches of the maxilla and mandible in the digital 3D image. An important measure for the asymmetry of the dentition relative to the upper facial skeleton is the small angle k 112 between the right-left axis 115 of the separating-gliding plane 110 and the dental occlusal plane 111. Figure 4

[0042] Fig. 4a In a preferred embodiment, horseshoe-shaped preforms are used for further machining to produce modules 120 and 130. Alternatively, the modules can be milled from round plastic discs or additively manufactured. The use of transparent plastics is preferred. The material must be pressure-resistant, dimensionally stable, and have good lubricity; preferably, it should be easily polishable to produce a smooth, flat, and virtually frictionless sliding surface on the contact surfaces or separating-sliding surfaces 23 and 33, respectively. PMMA, for example, is suitable.

[0043] Fig. 4b The maxillary preform 20 fits geometrically approximately or exactly with the mandibular preform 30. When the two preforms 20 and 30 are placed against each other at the separating-sliding surfaces 23 and 33, they form a flat, smooth, sliding contact surface that defines the plane 110. This plane 110 is parallel to the anterior-posterior and right-left axes of symmetry of the skull 205 and 215. For the digital 3D fabrication of the modules 120 and 130, the preforms 20 and 30 are digitally positioned relative to the skull 200 and its three orthogonal axes 250, 215, and 205 such that the three orthogonal axes 150, 115, and 105 of the preforms 20 and 30 are parallel to the skull axes. The 3D position of the preforms in the skull is aligned based on skull symmetry so that axis 105 runs at approximately the same distance from the incisors of the upper and lower jaws. The oblique angle from the lateral view is determined by other anatomical landmarks.After defining the position of the package consisting of the two preforms 20 and 30 in the virtual 3D environment, the 3D contour of the dental arches and gingiva is overlaid onto the preforms, creating the necessary recesses in modules 120 and 130. In addition to the geometric volume of the dental arches, the recesses for the teeth are designed more extensively than based on the direct 3D data of the teeth. This is achieved by creating a wider and deeper recess for each tooth in the preform, and also by creating recess areas for the gingiva that are slightly deeper than necessary for a proper fit based on the direct 3D data of the gingival tissue. These more extensive recesses in the preforms initially result in continuous marginal gaps.To maintain the marginal gap even under pressure in real-world applications, contact points are designed where the marginal gap is significantly interrupted in small, localized areas. The recess is only carved out to the exact extent required by the 3D shape of the tooth. These contact points are preferably located at 125 (see...). Fig. 7 , 8 , 9 , 11 ) on selected occlusal surfaces of teeth in a small area of ​​1 to 5 mm diameter, with each module being supported under a biting force of at least 3 contact points against the corresponding dental arch with a marginal gap of 0.3 to 1.3 mm. Figure 5

[0044] As a special embodiment, multi-part preforms 20 and 30 are used to manufacture multi-part modules 120 and 130. Fig. 5a shows a pair of preforms, each consisting of two parts: preforms 20.1 and 20.2, and 30.1 and 30.2. Fig. 5b The figure shows other shape variations. It is known to experts that the same result can be achieved with machining if the machining of a one-piece preform is carried out accordingly. Fig. 5c In this particular embodiment, two-part modules are used for the upper jaw 120.1 and 120.2, as well as for the lower jaw 130.1 and 130.2. A two-part upper module can also be combined with a one-part lower module, and vice versa. Multi-part modules are possible in principle, although one-part and two-part modules are preferred. The arrangement of the three spatial axes 105, 115, 150 in the 3D digital manufacturing system relative to the skull follows the same conditions as for the one-part modules.

[0045] The preforms for parts 120 and 130 preferably already have the nearly frictionless sliding surfaces and are subsequently polished again. These parts exist in the digital image space as 3D reference parts. First, the cranial principal axis system is individually determined in the head, resulting in the principal axes of the cranium: anterior / posterior 205, right / left 215, superior / inferior 250. The two parts 120 and 130 of the training device also have a coordinate system: 305, 315, 350. For the digital generation of the surfaces and volumes of the training device, the reference objects 120 and 130 are positioned in the 3D manipulation system in the vicinity of the dental arches of the maxilla and mandible such that their principal directions are as precisely parallel as possible to the principal axes of the cranium.Since the principal axes of the cranium are not parallel but tilted relative to the principal axes of the dental arches, and thus of the dentition and the occlusal plane, the slightly tilted and rotated arrangement of the preforms for 120 and 130 relative to the dental arches results in the clearances 124 and 134 for the dental arches, plus the marginal gaps 122 and 132, being rotated and tilted relative to the preforms. This shows how far the cranial system of principal directions 205, 215, 250 is tilted and rotated in an individual case relative to the dental system of the occlusal plane 111 with principal directions 105, 115, 150. Figure 6

[0046] The exemplary embodiment shows a one-piece mandibular module 130. In this example, it was milled from a single preform 30; however, the same result can be achieved by a person skilled in the art using other manufacturing techniques, e.g., 3D printing or other additive manufacturing technologies particularly suitable for individualized products. The mandibular module 130, like the maxillary module 120, has a plurality of recesses 134 following the corresponding dental arch 231. The recesses 134 can also be shallower than shown here, e.g., if the gingiva extends close to the occlusal surfaces of the teeth. It is important that, in the preferred case, the recesses 134 are formed more deeply than the teeth everywhere except for a very few points, so that a marginal gap exists between the tooth material and the material of the device 100.In the transverse section DE, it can be seen that large areas of the mandibular part 130 have deep recesses 134 to adapt to the gingiva. On the outer surface, there is a biomechanically and neurophysiologically significant ridge-like accumulation of material 131, which is not milled away. It is often even more pronounced in the mandibular module than in the maxillary module. This circumferential ring ridge 131, in conjunction with the corresponding ring ridge 121 of the maxillary module 120, serves in particular for the symmetrical expansion and stretching of the soft tissue of the lips, the facial muscles, and the fascia. The analogous ring ridge 121 is found in the maxillary module 120 (not shown here). Figure 7

[0047] In a particularly preferred embodiment, the device is used for preparatory training of the temporomandibular joint muscles when the initially existing dental occlusal plane 111 is to be biomechanically corrected. In this case, the dental occlusal plane is asymmetrically oblique to the transverse plane 110 and forms the tilt angle k 112 with it. In the frontal view, the angular deviation between the drawn axes 115 right-left and the dental occlusal plane, which represents the planar best-fit occlusal surface between the teeth, can be seen. In practice, this means that the mandible is oblique relative to the skull. In this embodiment, due to the oblique position of the dental occlusal plane 111, the depression 134.46 of tooth 231.46, among other things, completely penetrates the mandibular module 130 because tooth 231.46 extends so far upwards that its occlusal surface reaches into the maxillary module 120.To enable this, a shallow recess 129 is formed from the separating-sliding plane 110, which has a distinct marginal gap 122 to allow lateral freedom of movement for tooth 231.46, which in this example approaches from below. Tooth 221.17 rests on contact point 125 and tooth 231.37 rests on contact point 135. Apart from these contact points, the marginal gap also exists in these recesses. Figure 8

[0048] In a view from below of a first sliding surface 123 of the maxillary part 120, another embodiment shows a series of several tooth penetrations from below, which penetrate the mandibular module 130 and form more or less shallow depressions 129 in the maxillary module 120. These depressions 129 are extended by marginal gaps 122, which are at least 0.3 mm wide. The width of the marginal gap is practically limited upwards only to the extent that the sliding properties of the separating-gliding plane 110 are not impaired by the depressions 129 and marginal gap 122. For the neurophysiological and biomechanical function of the device, a marginal gap of up to 3 mm is sufficient; preferably, the marginal gap 122 around the shallow depressions 129 is between 0.3 mm and 1.3 mm. The mandibular module 130 has a complete opening 136 at the location of the shallow depression 129.The marginal gap in the depression 134 with eruption 136 in the mandibular module may be slightly narrower than the marginal gap 122 in the shallow depression 129. The same applies when the maxilla and mandible are reversed, if teeth erupt from above into the mandibular module 130. Figure 9

[0049] In another embodiment, there are no openings 136 or 126. The recesses 124 with marginal gaps for the teeth of the dental arch and the contact points 125 are visible; in this example, there are four, but more are possible. At least three, preferably four, contact points 125 are required. Viewed from above or below, the contact points 125 are approximately circular, and their contact surface locally follows the contour of the corresponding tooth, without a marginal gap. In this case, the sliding surface 123 is not interrupted by openings. The section above shows the maxillary module with teeth of the dental arch 221 from the front; the module is horseshoe-shaped and open at the back. The section below shows the same module 120 from the back, without the teeth for clarity. The contact point 125 is clearly visible on the left. What is shown here for the maxillary module 120 also applies analogously to the mandibular module 130. Figure 10

[0050] In this particular embodiment in Fig. 10 The shape of the preform is almost entirely retained during the incorporation of the recesses for the teeth and gums. The smooth, lubricated first and second contact surfaces 123 and 133 are crucial. Together, the two one-piece modules 120 and 130 form the device 100. The maxillary module 120 and the mandibular module, lying directly against each other, form the separating-gliding plane 110. The separating-gliding plane 110 is preferably so flat and smooth that, when moistened with liquid, the well-known adhesive effect of two smooth plates can occur. Relative movements within the plane 110 are possible with almost no friction, but the plates can only be separated perpendicular to the separating-gliding plane 110 with considerable force. This facilitates handling of the modules, especially when they are moistened with water before insertion. Thus, the two modules fall into place if they are sufficiently smooth within the separating-gliding plane 110, e.g.,The polished, moist surfaces do not separate in practice in the mouth, but are laterally movable. In the cross-sectional view, the recesses 124 and 134 are only partially visible because the inner edge of modules 120 and 130, which runs within the respective dental arch, obscures the occlusal surfaces of the teeth. Tooth positions 1 to 7 correspond to the numbering system commonly used in dentistry. Figure 11

[0051] In another particularly preferred embodiment, the area of ​​the incisors is clearly asymmetrical, corresponding to the individual condition of the dental arches. Fig 11a Figure 1 shows the openings 126 through the maxillary module 120 for the depressions of teeth 124.11, 124.21, 124.22, 123.23, and 124.25. The functionally important wide margin 121 outside the dental arch is clearly visible, preferably more than 3 mm wide, and most preferably 3 to 10 mm wide. The margin 131 in the mandibular module 130 can be even wider than in the maxillary module, particularly in the anterior region, and most preferably 4 to 15 mm wide.

[0052] Figur 11b Figure 11b shows a detail of a contact point 125 in the maxillary module. The tooth of the dental arch 221 is surrounded on the upper side by gingiva 227. The marginal gap 122 exists at the gingiva and the tooth, except at contact point 125. At contact point 125, the material of the maxillary module rests directly against the tooth; its shape corresponds to the 3D surface of the tooth at this point. The thickness of the marginal gap there is minimal, almost zero, depending on the load from masticatory pressure, etc. The flat, first smooth gliding surface 123 is located at the bottom of Figure 11b. The same applies to the mandibular module 130 and its contact points 135, each approximately mirrored at the dividing-gliding plane. Figure 12

[0053] Figur 12 The diagram shows DVT 3D X-ray images of a head 200 with maxilla 220 and mandible 230, as well as the symmetry axes 250 (top-bottom), 105 (front-back), and 115 (right-left), based on the bone features in the upper facial skeleton. The positioning of the device in the 3D digital model of the skull is a prerequisite for the actual 3D geometry of the device 100 to be manufactured. The resulting geometry of modules 120 and 130 is as individual in detail as the dental arches of the test subjects or patients. The position of modules 120 and 130 relative to the skull 200, maxilla 220, and mandible 230 determines the depth and location of the recesses 124 and 134 for the teeth and the depth of the recesses for the gums and soft tissues, including the marginal gap. (Sagittal section) Fig. 12a The almost vertical axis 250 is visible running from top to bottom. The device 100 is positioned such that its vertical axis 150 is parallel to the axis 250 and preferably runs entirely or almost exactly along the axis 250. The frontal view from the front shows the following in the cross-sectional view. Fig 12b The slightly inclined right-left axis of the skull 215 is used as a reference axis, and the device 100 is digitally positioned in the 3D model so that the right-left axis 115 of the device 100 runs parallel to the axis 215. The transverse view Fig 12c Figure 1 shows the position of axis 215 as seen from above. The oblique inclination of axis 205, running from front to back and diagonally downwards, results from the position of anatomical landmarks of the skull, as visible in the X-ray image. The orientation of device 100 is digitally set in the 3D model so that axis 105 of device 100 runs parallel to axis 205 and passes through the incision area, the overlap between the upper and lower incisors. If the recesses 124 and 134 for the teeth and gums, along with marginal gaps 122 and contact points 125, are then digitally generated from the digital 3D model, these contours can be precisely transferred to actual workpieces. After manufacturing, the device 100, corresponding to the 3D geometry of the model, is ready and can be used on the individual patient whose skull and tooth data were used.The device 100 will fit this patient as long as the tooth positions do not change significantly, i.e., as long as the mobility at the marginal gaps is sufficient.

[0054] The alignment or position of modules 120 and 130, and thus the determination of the separating sliding plane 110, can be advantageously and precisely determined by the following procedure.

[0055] The following figures illustrate aspects of the invention in a simplified and schematic representation. As a preferred embodiment, the application of 3D structural marking is explained using the jaw as an example and in dental and orthodontic treatment planning, and as a means of manufacturing suitable devices. However, the potential applications are not limited to this specific use but generally relate to biomechanics and neurophysiology.

[0056] Fig. 13 Figure 1 shows a device for generating suitable X-ray images. The 3D X-ray images are transferred to a computer system, where reference objects can be copied into the image of the skull, superimposed, and aligned. The generation of these reference objects results in virtual 3D images of bone structures and 3D structural markers. In a real 3D space 40, there is a real body with body part 90a, in this embodiment a patient's head 90. The bony structure 91 of the skull is located within this space. An arm 82 moves a radiation-sensitive array 83, which successively creates several images from different directions. A CBCT (digital volume tomography) imaging unit 80 receives the sensor information and transmits it directly or indirectly to a computer system 81, which calculates a 3D image from the multiple radiation-sensor images.Ultimately, this process generates a data set 22, which in particular shows the radiation-absorbing tissues and materials, especially primarily bones, teeth, and / or implant materials. The data set 22 thus contains digital spatial data 22a. The data set 22 is stored in a data storage device 60 or in a storage unit 60a, possibly along with data sets from devices 33 and data sets from structural markers 55, as well as data sets from other aids 66, e.g., axes and planes, which can be positioned, aligned, and shown or hidden in the 3D image space. Via data transfer, a computing unit 71 can access the data sets 22, 33, and 55, etc., and generate visualized views 72 from the virtual 3D images, e.g., as a perspective view or as a section view. The specialists know how to use the operating devices 73 to appropriately modify the section planes and the views 72 and to modify data sets or data objects 22, 33, 55, and 66, etc.suitable for displaying, relocating, and combining in 3D space. The specific technology of the 3D structure marking, represented here by data set 55, is specified. This technology is displayed in the visualized views 72 and can be moved, rotated, and scaled using the operating devices 73. The visualized views 72 are displayed, for example, on a suitable output unit 72a, such as a monitor or display. The operating devices 73 can also be referred to as input units 73a and include, for example, a computer mouse, a keyboard, a trackball, and / or a voice command input system.

[0057] Components of a data processing system 100 can be: the computing unit 71, the output unit 72a, the input unit 73a and storage unit 60a.

[0058] An optional Cartesian coordinate system KS0 can be defined in real 3D space. The KS0 coordinate system can have an x-axis x0, a y-axis y0 orthogonal to it, and a z-axis z0 orthogonal to both x0 and y0. With reference to the KS0 coordinate system, a first coordinate system KS1 can be defined in the image space. This first system can be structured like the KS0 coordinate system, and its coordinate axes point in the same direction as the corresponding x0, y0, and z0 coordinate axes (see, for example, [reference]). Fig. 20 .

[0059] Fig. 14 Figure 1 shows a diagram illustrating the procedure for the individual application of 3D structural marking. First, the median sagittal plane can be defined in order to align the structural marking accordingly. Since the 3D structural marking itself has transverse and frontal planes that define transverse axes 215 as intersection lines, the 3D structural marking itself can essentially be used to define the sagittal plane.

[0060] The following describes a preferred method for first defining the transverse direction using landmarks, and then performing the subsequent adjustment steps. The user can either create an axis, such as 215, in an image plane relative to a landmark, such as 281, or a plane that is perpendicular to the image plane, since this plane appears as a line in the cross-sectional view.

[0061] Procedure 700: In a first step 710, a 3D image of body part 90a, e.g., the head 90 of a patient, is generated. Through image processing, a digital or virtual 3D body is created in step 720. In step 730, cross-sectional images of this 3D body are displayed (see Fig. 19a In step 740, landmarks of the bony structures are identified in appropriately selected cross-sectional images (see Fig. 19b , 281L and 281R). In step 750, at least one transverse direction is defined that connects two symmetry-giving landmarks (see Fig. 19b , 215). This can be done by an axis (in the exemplary embodiment 215) or by a plane and a second plane intersected with it. In step 760, the position of the sagittal planes 503 (Sm) is defined, the normal to which is orthogonal to the transverse axis 215. In step 770, the midpoints 211 between suitable landmarks 281 are determined in order to precisely define the median sagittal plane Sm of the upper facial skull (see Fig. 19 and 27 This may not be entirely clear, because the skull often has a different orientation in the posterior region than in the anterior upper facial skull by up to 2 degrees (see Fig. 27 In step 790, or a number of such steps, other cross-sectional views are adopted to check positions and directions or to address other tasks and questions. The order of the steps can be changed, as long as the result is that the orientation of the sagittal plane is defined using the landmarks.

[0062] Method 800: In a first step 810, the 3D structure marker 500 is introduced into the 3D image space and displayed so that it is visible in the display. The layer packages now appear as parallel lines. In a step 820, the structure marker with its inner sagittal plane structure 503 is aligned perpendicular to the transverse axis 215 of the bony structures. In an independent step 830, the 3D structure marker 500 is placed on an anchor point 602 in the median sagittal plane, in the exemplary embodiment at the intersection point of lines or planes T3 and F5 in the median sagittal plane, on the base point BP. In step 840, the 3D structure marker 500 is oriented by rotation about an axis parallel to the transverse axis 215 so that in the sagittal section image the transverse planes 501 run in the direction of the connecting line 602-603, i.e. in the direction of the axis BP-GP.In this embodiment, the rotation occurs around the fixed point 602, where the intersection point T3 and L5 lies. The rotation positions line T3 so that it passes through anchor points 602 and 603. This aligns the 3D structure marking 500 at an angle.

[0063] In step 850, the size of the 3D structure marking 500 is adjusted so that a frontal line passes through a suitably chosen anchor point 601. In the exemplary embodiment, the anchor point 601 is the nose point NP, see Fig. 20 , 21 , 22 The individually correct size is achieved in the exemplary embodiment when the frontal line F1, and thus the frontal plane 502.1, passes through the nasal point NP. In a subsequent step 860, the symmetry and harmony of the proportions in the body part can optionally be analyzed. This often reveals tilting, for example, of the jaw and the current occlusal plane (see Fig. 27 and 28In a further step 870, the transverse plane 501.1 (T1) is used as an idealized occlusal plane to align, for example, dental prostheses or appliances. In the case of separable appliances 300 with upper part 320 and lower part 330, the parting plane 301 between the parts is particularly preferably designed as a parting-sliding plane 301, without retentions (protrusions) and with very low friction. The position of the parting-sliding plane 301 is placed as precisely as possible in the digital or virtual 3D space during the planning and shaping of the appliance on the position of the idealized occlusal plane 201.

[0064] In step 880, following procedure step 870, the space for the teeth and / or dental implants of the upper and lower dental arches is created so that the device later fits precisely onto the individual dental arches without jamming or injuring the gums.

[0065] The completion of the form in step 880, with the planned form fit between the devices and the dental arch, results in an exact definition of the position of the device 300 with its parts 320 and 330 in the mouth (see Fig. 32 In a subsequent step 890, the device 300, in its parts 320 and 330, is manufactured specifically for this individual case and can then be used for this patient.

[0066] Fig 15 Figure 5 shows the application of a reference object 500 as a 3D marker, consisting of three stacks of perpendicular parallel planes, the spacing of which follows a harmonic distance relationship. This is a particularly preferred embodiment of a reference body used to recognize cranial symmetry and orientation in 3D image space and to precisely align the separating sliding plane of the training device with the individually adapted reference device, even if it is then inclined relative to the individual occlusal plane, which is the case in the vast majority of cases requiring therapy.

[0067] Fig. 15 shows the combination of at least two layer packages to create the 3D structure marker 500. Fig. 15a shows the view of the 3D structure marker 500 in a sagittal cross-sectional view. Fig. 15 Figure 15c shows the 3D reference object 500 in a cross-sectional view and in a semi-perspective view. While the upper transverse plane T3 is aligned using the anatomical landmarks in the region of the eye sockets, the position of the lower transverse plane T1 defines the position of the dividing plane. Because the sagittal planes lie in the image plane, only the intersection lines with the transverse planes of the plane package 501 and the intersection lines with the frontal planes 502 appear. The preferred embodiment has 5 planes per plane package, i.e., T1 to T5 and F1 to F5. In the particularly preferred embodiment, the distances shown follow the Fibonacci sequence, and t1 = 3, t2 = 5, t3 = 8, t4 = 13, each in scalable units. The same applies here to the distances f of the frontal planes F. In the claims, the following applies: T is a first plane, i.e. a transverse plane, F is a second plane, i.e. a frontal plane, and S is a third plane, i.e. a sagittal plane.

[0068] Fig. 15b Figure 500 shows structure 500 in a frontal view. The sequence of transverse intersection lines 501.1 to 501.5 of the transverse plane package 501 (T1 to T5) is again recognizable. The vertical intersection lines are the sagittal planes of the double plane package 503, composed of a sub-plane package 503R and a sub-plane package 503L, where only 4 planes per sub-package are drawn here, i.e., a total of 8 planes. Due to the Fibonacci sequence with the numbers 3+5=8 and 5+8=13, the planes coincide at least partially. Only the two planes 503R.2 and 503L.2 stand alone. Otherwise, for example, plane 503R.4 is identical to plane 503L.1. In a particularly preferred embodiment, the sagittal plane package 503 is symmetrical about the median sagittal plane 503R.3 = 503L.3.

[0069] Fig. 15c Figure 1 shows an embodiment of a 3D structural marker 500 in a perspective view. Three transverse planes 501.1 (T1), 501.2 (T2), and 501.3 (T3) form the plane package 501. Three further planes perpendicular to these, 502.1 (F1), 502.2 (F2), and 503.3 (F3), form the plane package 502. The plane spacings are designated with lowercase letters as f1 between F1 and F2 and f2 between F2 and F3, and t1 between T1 and T2 and t2 between T2 and T3, respectively. These spacings are characteristic, and their ratio does not change when the 3D structural marker 500 is scaled. In the sagittal section view, the section lines T1 to T3 are visible, and perpendicular to them, the section lines F1 to F3. The spacings of the planes correspond to the spacings of the section lines in the orthogonal section.

[0070] An optional Cartesian coordinate system KS2 can be defined with respect to the 3D structure marker 500. The coordinate system KS2 can have an x-axis x2, a y-axis y2 orthogonal to it, and a z-axis z2 orthogonal to both x2 and y2. A plane spanned by the x-axis x2 and the y-axis y2 can be parallel to the transverse planes 501.1 (T1), 501.2 (T2), and 501.3 (T3) of the plane package 501. A plane spanned by the y-axis y2 and the z-axis z2 can be parallel to the frontal planes 502.1 (F1), 502.2 (F2), and 503.3 (F3) of the plane package 502. A plane spanned by the x-axis x2 and by the z-axis z2 can be parallel to sagittal planes S or 500R.1 to 500R.5 of the subplane package 503R or to sagittal planes S or 500L.1 to 500L.5 of the subplane package 503L.

[0071] Fig. 16 shows representations of the 3D structure marker with additional sagittal plane package 503. Fig 16 Figure 1 shows the complex semi-perspective representation of the three intersecting plane stacks 501, 502, and 503, which is individually adjusted to define the position of the separating sliding plane without altering the harmony of the distance relationships through stretching, rotation, and translation. The harmony of the distance relationships of the planes particularly concerns the position of the frontal planes F, which intersect the transverse planes T in a line running from right to left. These lines of intersection define the orientation of the connecting line between the support points 125.1 (right and left) and the support points 125.2 (right and left). Figur 30 The perspective view of a particularly preferred embodiment of the 3D structural marking shows the orthogonal arrangement of the plane packages 501, 502, and 503, with each individual plane represented as a circular disk that appears elliptical in perspective. Each plane package has a different pattern. The transverse planes 501 (T1 to T5) are drawn horizontally from bottom to top, with a black and white striped pattern. On the far right, in black, is the fifth plane R5 of the right-running sub-plane package 503R, opposite which is the last plane L5 of the left-running sub-plane package 503L. Perpendicular to these are the frontal plane packages, with two packages A and B superimposed. Here too, the Fibonacci sequence 3, 5, 8, 13, 21 etc. applies to the intervals within the sub-packages. For application in the area of ​​the bony skull, the diameter of the plane packages is at least 6 cm (centimeters) to 30 cm.The maximum diameter of the layer packages for applications on the bony skull can range from 35 cm to 50 cm. For other applications on different body parts, such as the neck and back, the layer packages are larger. However, the circular edges are purely for graphical purposes, serving only to improve visualization. Mathematically, the layers have no limit. In the... Fig. 16 A left side (L) of the skull or cranium would be located on the left side. A right side (R) of the skull or cranium would be located on the right side.

[0072] Fig. 17 Figure 1 shows a particularly preferred isotropic embodiment of five plane packages 501 and 502. In a particularly preferred embodiment, plane package 501 (T) comprises five transverse parallel planes 501.1 (T1) to 501.5 (T5). Orthogonally intersected to this is plane package 502 (F), consisting of five frontal parallel planes 502.1 (F1) to 502.5 (F5). Optionally, further plane packages are added, together forming the 3D structural marking. The spacing of the planes is particularly preferably in a harmonic ratio of equal proportionality; the spacing sequence shown here is t1=3, t2=5, t3=8, t4=13, and analogous for f1 to f4. Other spacing ratios or other spacing patterns can also be used. The orthogonally intersected plane packages are a characteristic feature. The lines shown as dashed lines are the orthogonally crossed lines that are displayed in the sagittal section view.When cut in the direction of the sagittal plane perpendicular to 501 and 502, the sagittal plane packages are not visible.

[0073] Fig. 17a shows a front view of Figur 17 The diagram shows the five transverse parallel planes 501.1 (T1) to 501.5 (T5). Orthogonally intersected is the plane set 502 (F) consisting of five frontal parallel planes 502.1 (F1) to 502.5 (F5). The distances between planes t1, t2, t3, and t4 are also shown.

[0074] Fig. 18 Figure 1 shows the addition of the plane packages by a double plane package 503R and 503L, or by sub-plane packages 503R and 503L. This results in a transverse cross-sectional view through the 3D structural marker 500. The arrangement of the sagittal planes in the transverse cross-sectional view shows the frontal planes 502 (F1 to F5) running in a right-left direction and, perpendicular to these, the two sub-plane packages 503R (R1 to R5) and 503L (L1 to L5) as intersection lines of the plane-parallel sagittal planes running in an anterior-posterior direction. In the preferred embodiment shown here, the sagittal planes L3 and R3 form the median sagittal plane. The distances between the planes are preferably in a harmonious ratio of equal proportionality; the distance sequence shown here is I1=3, I2=5, I3=8, I4=13. Other spacing ratios or spacing patterns can also be used.

[0075] Fig. 19 shows the transverse section through the bony structure of a skull or cranium 200 and shows how the transverse axis 215 is aligned with landmarks and thus defines the sagittal plane Sm. Fig. 19 Figure 1 shows an embodiment of how the position of the reference body 500 is individually aligned using 3D X-ray imaging based on anatomical landmarks 215L and 215R in the area of ​​the outer orbits, in order to then determine the alignment of the separating glide plane 110 115 and the position of the occlusal bearing areas with the help of the adapted reference body 500. Fig. 19b This example shows that cranial symmetry in the region of the eye sockets exhibits a transverse axis 215 that is not parallel to the inner ear axis. If the cranial transverse axis used subsequently is shifted parallel to the inner ear, it becomes apparent that the inner ear is not intersected equally on the right and left sides. Therefore, the transverse axis 215 is not the same as the inner ear axis according to Hornung. (See above.) Fig. 19a A radiographically generated transverse section through the skull, specifically the cranium 200, of a person is shown. The contours are superimposed and approximately drawn within this section. Contour finding can preferably be performed using 3D imaging software. Below in Fig. 19b The bony contours of the cranium 200 are visible, along with suitable landmarks 281L and 281R, which show a transverse section through the zygomatic arches. The points marked 215L and 215R are, in this case, tangent points suitable, for example, for aligning axis 215 in the transverse image plane. A similar alignment can and should also be performed in the frontal plane to define the position of the axis. In the frontal plane or in a frontal section, the zygomatic bones can also serve as landmarks or features for aligning axis 215. Alternatively, other landmarks can be used, such as the inferior margins of the orbits. While the direction of the sagittal planes is defined by the direction of axis 215, which runs transversely between right and left, defining the coordinate position of the median sagittal plane Sm requires the additional specification of its center point 211. This can be determined, for example, by...In terms of measurement, this is the midpoint of the distance between 215L and 215R, or the midpoint of comparable landmarks to the right and left, such as those that can be found further back in the area of ​​the middle ear 280L and 280R.

[0076] Fig. 20 Figure 5 shows an embodiment for the orientation of the reference body 500 as seen from the side in sagittal section. Here, too, the definition of the tilt angle of the sling plane, now visible from the side and which usually deviates from the inclination of the occlusal plane, is achieved by the reference body 500, by individually adapting it to the basal point BP, the palatal roof point GP, and the nasion point NP, as described in Figure 500. Fig. 20 This is shown. This defines the relative orientation and position of the transverse plane, which runs perpendicular to the sagittal plane or image plane through line T1. Shown is the median sagittal cross-sectional image through the head radiographically represented in a digital or virtual space 50 with anchor points 601 (NP), 602 (BP) and 603 (GP) as well as with fitted 3D structural markers. The sagittal cross-sectional image also passes through the 3D structural marker 500 after individual fitting into the bony structures of the cranium 200 of an individual head 90, see Figur 1 The anchor points 601 (nose point NP) and 602 (base point BP) as well as 603 (palate point GP) serve to correctly position the 3D structural marker 500 on the bony landmarks. The following applies to the claims: Anchor point 601 (nose point NP) is a third anchor feature, anchor point 602 (base point BP) is a first anchor feature, and anchor point 603 (palate point GP) is a second anchor feature.

[0077] To correctly align the sagittal plane, the transverse axis, which is fundamentally perpendicular to the sagittal plane, has already been aligned. The sagittal plane is the image plane. It is defined by the perpendicular axes 205 and 250 of the cranium 200. The nasal point 601 (NP) designates the vertex above the nasal root. It is defined three-dimensionally by simultaneously considering the vertex of the curvature of this area in the transverse section. The palatal point 603 (GP) is defined by the highest point of the bony dome of the palate, which is seen in the sagittal section from the side and in the frontal section from the front. More precisely, the palatal point 603 (GP) lies in the somewhat less dense cancellous bone (spongy inner tissue of the bones) between the compact edges of the palatine vault and the base of the skull. Base point 602 (BP) is defined as the apex of the bone surrounding the foramen magnum.It is clearly visible in the sagittal and transverse sections. Below base point 602 (BP), the contours of the uppermost extensions of the cervical spine 270 are visible. The grid lines are created by the intersection of plane packages T1 to T5 and F1 to F5 with the median sagittal image plane. The 3D structure marker is positioned and scaled so that the following anchor points are fixed: The intersection of line (plane) T3 with line (plane) F5 lies on base point BP. Line T3 runs forward through base point BP and palate point GP. Line F1 runs vertically upwards through nose point NP. The position of GP happens to be on line F3, but this is not necessarily the case.

[0078] The current situation in Fig. 19 This shows that the mandible 230 tends to be underdeveloped; consequently, the teeth of the mandible 231 are positioned too high, and the current occlusal plane is somewhat too high. The physiologically optimal occlusal plane lies directly on T1, which coincides with the main axis 205. Training devices 300 for this patient will have the separating-gliding plane positioned at plane T1 to achieve the best possible physiological results.

[0079] The Fig. 20 Figure 1 shows an optional first coordinate system KS1 of the digital image space 50 and the optional coordinate system KS2, which can be assigned to the structure marker 500. The coordinate system KS1 can have an x-axis x1, a y-axis y1 orthogonal to it, and a z-axis z1 orthogonal to both axes x1 and y1. Fig. 19 This shows the result of orienting the structural marker 500, which can also be described as a second reference system, to anchor points 601 to 603. The individual steps of this orientation are described below using the following examples. Figuren 20 (Alignment / Positioning), 21 (Rotation / Orientation), and 22 (Optional Scaling) are explained in more detail. After the orientation of the structure marker 500, the optional coordinate system KS2 would be aligned with respect to the optional coordinate system KS1 as described in the Fig. 8 The position shown is that both coordinate systems KS1 and KS2 would be fixed in their relative position to each other if, at the end of the orientation of the structure marker 500, the structure marker 500 is fixed with respect to the digital image data or spatial data 22a.

[0080] Fig. 21 Figure 500 shows the structural marker 500 in sagittal section before rotation and scaling, etc. The structural marker 500 is shown here in a simplified form because only a few levels are required to describe the positioning, orientation, and scaling process. The transverse level package 501 comprises at least levels T1, Tx, and Tn, as well as F1 and Fn. In the preferred embodiment, from Fig. 21 where n=5 and x=3. The positioning or alignment is preferably achieved by translational movements such that the intersection point between Tx and Fn is placed on the posterior anchor point 602 (BP). The anterior anchor point 603 is designated as the palatal point GP in the exemplary embodiment. The superior anchor point 601 is designated as the nasal point NP in the exemplary embodiment. The 3D structural marking 500 is preferably shifted in the median sagittal section such that, for example, the intersection point of lines Tx and Fn lies as the pivot point at the anchor point, i.e., here at the base point BP. Considering the particularly preferred embodiment of the structural marking with five levels each... Fig. 18 and Fig. 21 The pivot and anchor point is the intersection of line T3 and line L5. An angle 203 indicates the inclination of a line through anchor points 602 and 603 with respect to the horizontal plane in the coordinate system KS1. Specifically, the inclination of the separating-gliding plane 110 results in the above embodiment from the position of the cranial points BP (basal point) and GP (palatal point) as soon as the 3D reference object 500, which can be individually adjusted by stretching and rotating, is adapted to the cranial anatomy of the individual head in digital 3D space. If, for example, the palate is higher, the separating-gliding plane 110 slopes more steeply upwards. In an alternative embodiment, other planes are created, whereby the cranial orientation remains in the transverse axis and the sagittal plane, resulting in different positions and rotation angles of the reference object 500 and consequently a different inclination of the separating-gliding plane 110.

[0081] Fig. 22 The structural marker 500 is shown oriented along the axis through anchor point 602 (BP) and anchor point 603 (GP). The structural marker 500 is preferably rotated around anchor point 602 after this positioning or orientation, thereby changing the spatial direction 205 of the transverse lines T1 to Tn in digital or virtual 3D space. More precisely, the structural marker is rotated by a rotation angle W1 or 203 and around a rotation axis D, which results from the intersection of the transverse plane Tx with the frontal plane Fn, i.e., for example, the intersection of the transverse plane T3 and the frontal plane F5. The rotation ends as soon as the T-line passes from rotation point 602 through the anterior anchor point 603, here through the palatal point GP. Alternatively, one can also rotate until the transverse lines are parallel to the connecting line between the posterior anchor point 602 and the anterior anchor point 603. This leads to the same intermediate result.The orientation of structure marker 500 is now correct, but the scaling is still not right because the vertical intersection line, here of the plane or line F1, does not yet pass through the upper anchor point 601.

[0082] Fig. 23 The structural marker 500 is shown at a suitable scale to align the line F1 with the anatomical anchor point or landmark in the individual cross-sectional image. The scaling can be performed according to the directional orientation; alternatively, several scaling steps can be used and combined with translations and / or rotations. To scale the size of the structural marker 500, in a particularly preferred embodiment, the structural marker 500 is enlarged or reduced with the posterior anchor point 602 as a fixed point, while maintaining the same position and orientation of line T1, until the line F1, which leads perpendicularly upwards to it, passes through the upper anchor point 601, which in this embodiment is the nasal point NP.

[0083] The scaling preferably affects the three spatial directions equally, i.e., it scales isotropically, thus enlarging the structural marker not only in the sagittal plane but also in its transverse extent. An inclination angle 203 lies between the cranial anterior-posterior axis 205 and the image horizontal. The inclination angle 203 serves in particular to adjust the position of the anterior-posterior axis 205. An axis 205a lies parallel to the anterior-posterior axis 205.

[0084] These operations lead to a unique and individual result. The coordinate position, spatial orientation, and scaling of the 3D structure marker 500 are thereby determined. The steps described above can be varied in order and supplemented. The same steps can also be used with the particularly preferred version from Fig. 16 or to carry out differently designed 3D structural markings 500, as long as they have the intersection points T3 with F5 and the lines T1 and F1 in the sagittal section. The line T1 or the transverse plane T1 can be used as a reference plane, see e.g. reference plane T1a in the Figur 32 .

[0085] The particular significance of this positioning and spatial orientation of structure marker 500 (in six degrees of freedom of movement) relative to the individual skull of a patient lies in the fact that, based on structure marker 500 and its intersection points of the lines appearing in the cross-sectional image, the ideal positions of important biomechanical, anatomical, and dental points can now be defined. One of these important points is the so-called incisal point 604 (IP), i.e., the point of contact between the two lower central incisors (mesial proximal contact). Incisal point 604 (IP) is the anterior anchor point through which the idealized occlusal plane passes. The intersection line of the idealized occlusal plane with the sagittal plane is marked as line 205.

[0086] Of course, the tooth alignment is not always as ideal as in Figur 23 It has been shown that a person can, for example, also have a receding chin, as in Fig. 24 This shows teeth 231 in the mandible 230 that are too far back and / or teeth 221 in the maxilla 220 that are unfavorably positioned. It should be noted that, due to the cranial reference points 601, 602, 603, which are not located in the jaw area, the orientation points determined by structural marker 500 are independent of any malposition of the teeth or of the entire jaw area. The largely independent determination of the ideal positions from the tooth position has the particular advantage that, even in cases of severely spaced dentition, injured or deformed jaws, or even completely edentulous jaws, the ideal position, e.g., of the incisal point 604 (IP), can be precisely defined for the first time using structural markers, thus making digital reconstruction and planning of a biomechanically, anatomically, and neurophysiologically ideal jaw and dentition possible for the first time.Of course, the planner or practitioner who digitally plans a denture, prosthesis, or orthodontic treatment using the Structure Mark 500 can orient themselves towards the overall cosmetic appearance. A crucial advantage, achievable for the first time with the Structure Mark 500, is that the ideal position can now be digitally determined in advance, and that the digital creation of appliances such as crowns, implants, braces, and retainers (tooth stabilizers) can at least strive for this ideal state. The importance of achieving the most ideal state possible stems primarily from the fact that the loads in the temporomandibular joint are then optimally distributed, and that the neuromuscular coupling leads to an actively stable balance, which is physiologically very beneficial.

[0087] Fig. 24 shows an alternative way to achieve the same result as in Fig. 20 This can be achieved, however, in a case with a receding chin where the mandibular teeth 231 and 230 are positioned significantly further back than ideal. For the positioning (translation), orientation (rotation), and scaling (size adjustment) of the structural marker 500, there are several alternative methods that lead to the same result.

[0088] For example, you can first place the intersection point of line (plane) T1 and line (plane) Fn on the rear anchor point 602 and then rotate it until line T1 passes through anchor point 603. Afterwards, however, you must move the 3D structure marker 500 downwards in the direction of the F lines until the transverse line or transverse plane T3 passes through the rear anchor point 602 and the front anchor point 603, as indicated by the downward-pointing arrows in the Fig. 24 Then the scaling can be done, for example, as with... Fig. 23 The following is described. This alternative method is less direct and somewhat more cumbersome, but equally effective.

[0089] The positioning, orientation, and scaling of the structural marker can lead to the same result if the following condition is applied: The line of the frontal plane Fn in the median sagittal section should pass through the base point 602 (BP), in the particularly preferred embodiment with a structural marker similar to Fig. 16 and 17 and 20 Fn=F5. The line of the transverse plane T3 in the sagittal section should pass through base point 602 (BP) and through palatal point GP (603). Furthermore, the line of the frontal plane F1 should pass through nasal point 601 (NP), which results in a defined individual size scaling.

[0090] Here too, the ideal incisal point 605 (IP) can be clearly defined. However, in the cross-sectional image, it is not located precisely between the upper and lower incisors but further forward. This is due to the underdeveloped mandible, which is evident in the receding chin. The structural marker is in the target position at Figur 20 and Fig. 23 and Fig. 24 The incisal point is the same because the cranial region is the same. Therefore, the incisal point is located in the same position relative to the upper cranial bone structures BP, GP, and NP. The definition of the incisal point 604 (IP) is successful even if the mandible is no longer defined in its shape, for example, after a comminuted fracture, or if it had to be removed due to carcinoma. If, at the same time, the maxilla is damaged or deformed in its dental curve, the application of the structural marker 500 according to the invention can, for the first time, offer the possibility of digitally producing anatomically, medically, physiologically, and biomechanically correct reconstructions, which can then be realized using devices and implants.

[0091] Fig. 25 shows a transverse section T through the dental arch of the upper jaw (OK) or through the area of ​​the dental arch with the sagittal plane, with structure marking 500. Figur 25 This shows a rare, almost symmetrical condition. Most patients requiring treatment, however, exhibit significant deviations from this symmetry, so that the cranial sagittal plane S4 or 205 usually does not run through the midline between the incisors, but rather the incisors are offset from the sagittal midline, as in Fig. 30 The image shows a transverse section through the area of ​​the maxillary dental arch near the occlusal plane. In this case, the dental arch is fully occupied with seven teeth on each side; the wisdom teeth were previously extracted. The section through the periarticular region (tooth 275) is visible on the lower right and left, revealing the approximate symmetry of the mandible. The vertical planes in the image represent the sagittal planes, labeled S1 to S5. The horizontal planes represent the anterior planes (F1 to F5). The anterior plane (F5), or frontal line F5 in the section, typically runs through the periarticular region (tooth 275). The transverse line F4 usually runs near the molar at position 6, but not necessarily precisely at that position. The symmetry in this example is quite good, but some deviations are present.Line F3 runs transversely, approximately through tooth position 4, i.e., behind the canines. See further details on the structure of the sagittal plane packages. Fig. 16 and 19 .

[0092] Fig. 25a The tilt, labeled 117, is projected onto the transverse plane T. The occlusal plane is oblique in its symmetry line 105 within the coordinate system of the training device, shown here in an exaggeratedly clear schematic representation. This is shown in Fig 25a The vertically oriented coordinate system with principal directions 205 and 215 is aligned with the orientation of the transverse axis 215, which is achieved by individually positioning it in 3D image space according to anatomically symmetrical features in the patient's head. The angle 117 between direction 205 and direction 105 is the same as that between transverse directions 215 and 115.

[0093] Fig. 26 shows a transverse section through the area of ​​the nasal septum with asymmetry. Fig. 26 The visible contours of the skull are shown schematically as lines. The ruler-like stripes above, below, and to the right of the image illustrate the harmony of the plane spacing of the 3D reference body 500. In detail, the asymmetry of the cranium is also visible despite its apparent symmetry. The symmetry of the dental arches in the upper and lower jaws can deviate significantly from the symmetry of the cranium in its mid-plane; that is, the occlusal plane can be tilted and rotated. This is frequently the case, especially in situations requiring treatment. A transverse cross-sectional image is generated in the digital or virtual 3D imaging system from the digital or virtual 3D X-ray image of a head with a particularly preferred embodiment of the 3D structural marker 500 in the region of the lateral zygomatic arch. The image clearly shows the highly asymmetrical structure of the bony structures in the area of ​​the nasal septum and the pharynx.The precise alignment of the transverse main axis 215 can be determined in the 3D image system on several of these transverse cross-sectional planes using multiple right-left pairs of landmarks. The cross-sectional image shows line packages R1 to R5 and L1 to L5 of the sagittal plane packages and line package F1 to F5 of the frontal planes of the structural marker 500. Lines 520.1 and 502.2, etc., all run in the direction of the transverse right-left axis 215. Lines R and L of the sagittal planes all run in the direction of the anterior-posterior axis 205.

[0094] Fig. 27 shows a transverse section through landmarks / features of the inner ear with the inner ear axis 285. Fig. 27 Figure 1 shows, in one embodiment, the position of the reference body 500 based on the visible axis 215 and the section axis of the sagittal plane 205, and, for comparison, the inner ear axis 285 IOA according to Hornung, which is not parallel to the transverse axis 215. Only in extremely symmetrical special cases are the transverse axis 115 and the inner ear axis 285 parallel. A transverse cross-sectional image is obtained in the virtual 3D image system from the virtual 3D X-ray image of a head with a particularly preferred embodiment of the 3D structural marking in the area of ​​the lateral zygomatic arch and the inner ear, specifically with a section through the vertically oriented arch of the vestibular organ 280. The image in the Fig. 27 The image clearly shows the connecting line 285 (IOA) as the inner ear axis between landmark 280R in the right inner ear and landmark 280L in the left inner ear. The same image also shows the orientation of the transverse axis 215 with its tangential landmarks 215L and 215R. The inner ear axis 285 is inclined relative to the main axis 215 of the anterior facial skull. The angle between the two axes is approximately 2.0 degrees. Figur 15 This illustrates the high precision that can be achieved for the first time with the 3D Structure Marking 500. Previously, it was assumed that the inner ear axis 285 and the transverse axes of the anterior facial skeleton were parallel. As a direct consequence of the angle between the inner ear axis 285 and the transverse axis 215, a difference arises in the center of the desired position of the incisors, depending on which axis is used as the transverse axis. The method described here does not use the inner ear axis as the transverse axis, but rather the transverse axis 215 determined as shown above, which can be aligned with the anterior facial skeleton, as indicated by points 215L and 215R. This allows the position of the optimal center between the incisors in the frontal view to be determined with an accuracy of approximately 0.5 mm to 1 mm for the dental arches.This center 211 is defined by the median sagittal plane, which in the illustrated embodiment is identical to planes R3 and L3. It should be noted that, as effective therapy progresses, the bony skull and jaw can remodel themselves in such a way that the two axes 215 and 285 become increasingly parallel. The goal of therapy can therefore be anatomically comparable to the orientation derived from the inner ear axis. However, the starting position for the appropriate therapy can be determined, as suggested here, from the direction of the principal axes 215 and 205 and from the position of the median sagittal plane of the anterior facial skeleton determined here.

[0095] Fig. 28 shows a frontal section through the temporomandibular joint with visible tilting of the mandible (UK). Fig. 28 The figure shows the oblique position of the mandible 230 in thin dashed lines in comparison to the cranial symmetry of the maxilla 220, which is schematically represented in thick dashed lines. This results in a frontal cross-sectional view through the maxilla and mandible of a patient. The human head comprises the cranium 200 with the maxilla 220 firmly attached to the bone and the mandible 230 articulated within the temporomandibular joint. The virtual cross-sectional image runs through the temporomandibular joint and shows the digitally or virtually sectioned bone structures of the maxilla 2 on the upper right and left, and the digitally or virtually sectioned bone structures of the mandible 2 below, in an elongated position. The layer packages of the structure marker 500.A of the cranium 200 are shown in bold grid lines at the top. The optional coordinate system KS2 can be assigned to the structure marker 500.A.The median sagittal plane lies in its orientation exactly in the direction of the vertical axis 250 of the cranium, the transverse axis 215 lies exactly in the direction of the transverse planes.

[0096] Below, drawn in fine lines, lies a second structural marker 500.B, tilted and slightly displaced, which is fitted into the mandible (UK). Structural marker 500.B can also be referred to as the third digital reference system. If the second lower structural marker 500.B is aligned with the condyles (bony part of a joint) of the mandible (UK) in the temporomandibular joint (TMJ) on the right and left, a tilt angle W2 results between structural marker 500.B of the mandible (UK) and structural marker 500.A of the cranium (UK). In this embodiment, the 3D structural markers 500.A and 500.B are used to precisely and clearly measure angular deviations between the maxilla (OK) and mandible (UK) relative to the ideal position. An optional coordinate system KS3 can be assigned to structural marker 500.B.

[0097] Fig. 29 shows a frontal section F through the molar region with a chewing plane that is too high. Fig. 29 The image shows a 3D frontal X-ray section through a patient's head, individually fitted with the 3D reference object 500 and its transverse planes, visible in the section as straight lines T1, T2, ..., T5. The lower transverse plane T1 forms the individual separating glide plane, which is taken into account in the 3D design of the training device. The training device, consisting of upper and lower jaw components, is created in 3D to incorporate the appropriately positioned separating glide plane. The marginal gaps around the teeth and the occlusal contact areas are also designed. The training device, individually adapted to the dental arch and cranial symmetry in its shape, is then manufactured, for example, by milling or additive manufacturing. (See image above.) Fig. 29a The radiographic section is shown in the three main planes F, T, and S. The large image window on the left shows the frontal section F, the small window at the top right shows the transverse section T, and the small image window at the bottom right in the upper area shows the sagittal section S.

[0098] Below shows Fig. 29b The frontal section F is shown schematically as bony contours. The bony structures 200a and, aligned with them, the position of the transverse lines are not directly visible because the anchor points and points of tangency for these do not lie in the section plane. The T-lines T1 to T5, which run horizontally in the image, are created by the intersection of the frontal image plane with the transverse planes 501.1 to 501.5. For clarity, the vertical grid of lines of the sagittal planes S is hidden here. On the right side of the image is a scale made up of small squares to illustrate the distances between the transverse planes T1 to T5. T2 is 3 squares away from T1. T3 is 5 squares away from T2. T4 is 3 + 5 = 8 squares away from T3. T5 is 5 + 8 = 13 squares away from T4. This is the well-known Fibonacci sequence, which exhibits approximately proportional distances.The oblique mandible 230 and the unilateral compression are clearly visible between transverse planes T1 and T2, on the right side of the image. The image also shows the alignment of the 3D structural marker 500 to the bony structures in the upper frontal cranium, i.e., in the area of ​​lines / planes T4, T5, and above. There, the external bony structures exhibit symmetry, while the internal structures of the nasal septum and its surroundings are clearly asymmetrical and unsuitable or not favored for aligning the structural marker. The main direction 215 in the transverse right-left direction is evident at each of the parallel transverse planes and their intersection lines T1 to T5.

[0099] Fig. 30 shows a frontal section F through the lower incisors. Top in Fig. 30a The radiographic section of a frontal view F through the lower incisors is shown. The horizontal T-lines and the vertical S-lines, arranged symmetrically around the median sagittal plane, are visible as white lines. The direction of the transverse axis 215 is indicated horizontally.

[0100] Below in Fig. 30b The contours of the frontal section F are shown schematically. The T-lines of the transverse planes T1 to T5 are drawn here, as are the vertical intersection lines of the sagittal planes R1 to R5 and L1 to L5. Further details on the sagittal plane set can be found in Figure 3b. 4 and 6The scales formed by square boxes show the spacing ratios between the planes, which in this preferred embodiment are the same in both directions (horizontal or right-left versus top-bottom or vertical). In contrast, there is an alternative embodiment, especially for elongated head shapes, in which the boxes are taller in the vertical direction than their width in the transverse direction. Isotropy of the spacing between the plane groups 501 (T), 502 (F), and 503 (S or R and L) is not a necessity, but a highly preferred embodiment.

[0101] Fig. 31 The top image shows the frontal section through the maxillary part 120, and the bottom image shows the top view of the maxillary part 120, revealing the spaces 124 for the teeth and the contact points 125. In this individually schematic case, there is no penetration from below. The posterior-anterior main direction 205 of the cranial system determines the posterior-anterior main direction of the maxillary part 120. The transverse right-left main direction 215 determines the position of the sliding surface 110. The almost frictionless sliding surface 123 ensures that the resulting force can only act perpendicular to the sliding surface 110, especially as long as the teeth do not abut laterally due to the marginal gap 122. In the top view, it can be seen that the exact position of the bearing points 125 is determined by the crossed plane system with the projection lines 215 and 205; in particular, the frontal planes F3 and F4 are crucial.Since the dental symmetry system with the principal directions 105 and 115 is tilted by three spatial angles, the free space 214 for the dental arch in the upper part 120 is oblique and the occlusal plane 111 is inclined to the siding plane 110.

[0102] Figur 31 The first smooth sliding surface 123 is shown schematically, which corresponds as closely as possible to a cranially oriented transverse plane that lies parallel to the axes 110 and 115. Figur 31 The occlusal plane 111, viewed from the front, is also shown to be inclined obliquely to the direction of the transverse axis 110. The occlusal plane is also usually inclined obliquely to the first smooth gliding surface 123 when viewed from the side in sagittal section (in Fig. 31 (not shown). If one examines the teeth, numbered 1 to 7 according to the standard dental numbering system, starting from the central incisor, a clear asymmetry becomes apparent. In this example, this asymmetry is due to the absence of molar number 7 on the right side of the image. The contact points 125 are still oriented along cranial planes of symmetry. Therefore, the connecting line between contact points 125.1 (right 3) and 125.2 (left 3) is not symmetrical to the dental arch but rather follows the different cranial symmetry. Similarly, the posterior connecting line between contact points 125.2 (right-left) is not symmetrical to the dental arch but symmetrical to the cranial symmetry. This cranial symmetry, in particular, determines the attachment points of the muscles and is crucial for neuromuscular function.Considering the mechanical contact points and force transmission, the sectional view AB shows the edge gap 122, preferably 0.4 mm wide, which prevents direct lateral force transmission to the teeth 221. Due to the edge gap 122 with its partially arcuate shape and the clearances 124 for the teeth, the device according to the invention does not form a tightly fitting rail but rather a loosely fitting device, which in the exemplary embodiment rests only on the support areas 125.1 and 125.2. If the edge gap 122 were omitted and the rail 120 were allowed to rest directly against the teeth, as is the case with other rails, the teeth would be subjected to lateral force, and the resulting forces on the teeth would no longer be perpendicular to the separating sliding plane.Since the occlusal surfaces of teeth 221 would also form a laterally acting interlock with the splint 120, they are not impressioned. Instead, the marginal gap 122 extends to the bearing surfaces 125, which preferably transmit only compressive forces and not lateral forces. From a neurophysiological perspective, the very low-friction transverse gliding surface 123 has the effect that the resulting force can only act perpendicular to it as long as there is no contact between the gliding surfaces of the maxillary and mandibular parts. The force stimulus of this perpendicular compressive force is detected via the periodontal ligaments and transmitted to the sensory system of the masticatory apparatus. Simultaneously, the muscle spindles and the synaptic spindles also report the load and stretching of the muscles, ligaments, and tendons. This alters the control of the muscles by the sensorimotor area of ​​the brain.For this biomechanical and neurophysiological training functionality, it is of great importance that the severing glide surface is not located in the current occlusal plane 111 but in the cranial transverse plane 110, 115. Due to the oblique position of the severing glide plane 123 compared to the occlusal plane 111, eruption of some maxillary teeth into the mandibular portion often occurs. In . Fig. 11a The openings 126 are shown schematically, here, however, on a dental arch that appears rather symmetrical from above.

[0103] Fig. 32 Figure 1 shows a detail of a support area 125 in a particularly preferred embodiment. The position of the support area is determined – as shown below – by Fig 31 The design is based on the cranial symmetry of the patient's skull, as can be seen, for example, in a CBCT scan of the head. The contact area is as laterally restricted as possible. Additionally, there is a marginal gap 122. The contact area does not necessarily have to be circular and is designed so that as few lateral forces as possible are exerted. A preferred design rests on a cusp in a small area, and the marginal gap begins around this area. Thus, the contact area transmits forces perpendicular to the gliding plane, but it does not clamp the teeth laterally, unlike a normal aligner tray, which is used, for example, to reposition teeth. The pressure force from chewing is transmitted only at a single point in a rather small area 125.Preferably the bearing area has a diameter of less than 4 mm, particularly preferably less than 2.5 mm, and the edge gap is preferably less than 1 mm, particularly preferably less than 0.5 mm.

[0104] Fig. 33 The training device is shown from the side, with the teeth at a pronounced angle. The side view shows that the separating-gliding plane 110 is not located in the occlusal plane 111. Compared to the occlusal plane 111, the separating-gliding plane 110 is positioned lower posteriorly (right in the image) at the molars. The mandibular molars are therefore digging into the area of ​​the maxillary portion. A correction of the training device is therefore necessary. The correction involves a parallel shift of the transverse plane (separating-gliding plane 110) upwards or downwards, parallel to plane T1, as also shown in the [reference missing]. Figuren 16-18 This is shown to reduce the wall thickness of the remaining remnants of the milled preforms to a feasible minimum, to prevent excessive tooth penetration on the opposing side, or to ensure adequate wall thickness on the training device. The sliding direction, viewed from the front and side, does not change when the transverse plane is shifted upwards or downwards.

[0105] Fig. 33 Figure 300 further shows a schematic cross-sectional view through the device 300 with upper jaw part 120 and lower jaw part 130. The predominantly solid material of the training device and the spaces 124 and 134, including the marginal gap, are shown in black. The support points 125 and 135 are indicated. Since the occlusal plane KE in the lateral section is inclined at an angle 116 in the direction 105 relative to the sliding plane TGE in the direction 205 or 305, the solidly filled space between the teeth runs obliquely from the lower left to the upper right in the image. Consequently, in the upper jaw part 120, there is an opening 126 from below, providing a space for the molars of the lower jaw. In the lower jaw part 130, there is an opening 136, providing a space for the incisors of the upper jaw. The spaces include a marginal layer to allow additional freedom of movement for the teeth, enabling lateral sliding movement of the lower jaw part 130 relative to the upper jaw part 120.

[0106] Fig. 34 The sagittal section shows the structural marking with the separation-gliding plane TGE or 110 marked. The design is shown from the side, with the optional upward displacement of the T1 plane, e.g., by 2 or 4 mm, correspondingly from axis 205 to 205* in the figure, to obtain the separation-gliding plane TGE, which can also be built in reality. The occlusal plane KE or 111 is shown at an oblique angle to this.

[0107] Fig. 35 Figure 1 shows a digital or virtual frontal section F through the molar region and reveals a clear tilt of the current occlusal / chewing plane 216 in this example. In the schematically shown frontal section F through the virtual 3D volume image of a skull 200 with maxilla 220 and mandible 230 and dental arches 221 upper and 231 lower, one can analyze the extent of any asymmetry or tilting of the dentition and jaws. The vertical axis 250 of the cranium 200 and the horizontal axis 215 perpendicular to it are shown in bold dashed lines. At first glance, it appears as if the teeth are aligned with the transverse axis 215. However, closer inspection shows that the current occlusal plane 216 in the maxilla is tilted by an angle 214 relative to the transverse axis 215 of the cranium 200.Accordingly, the surface normal 256 is also tilted onto the current occlusal plane; angle 254 is equal to angle 214. The orbits 223 are also bony structures of the cranium 200. The lower margins of the orbits 223 are, for example, also suitable for aligning the structure marker 500.

[0108] Fig. 36 Figure 32a shows a training device 300 with a separating-gliding plane 301 in the position of the ideal occlusal plane 201 in a rough schematic representation. Figure 32a schematically shows the bony structures 200a of the cranium 200 with the maxilla 220 and the mandible 230, which is not part of the cranium. The dental arch 221 of the maxilla and the dental arch 231 of the mandible are obscured here by the device 300. The bony structures 200a of the cranium, particularly in the area around the eyes, i.e., not those in the maxilla itself, can be analyzed to define the position and directional orientation of the principal axes. The transverse axis 215 and the vertical axis 250, as well as the anterior-posterior axis 205, which is not visible from the front, can be crucial.

[0109] Fig. 36b Figure 32b schematically shows the lateral view of the bony structures of a cranium (skull) 200 in virtual 3D space, where the head is tilted forward such that the anterior-posterior axis 205 of the cranium 200 runs horizontally in the image. The transverse right-left axis 215 runs perpendicular to the image in Figure 32b, i.e., perpendicularly out of the image plane or perpendicularly into the image plane. The idealized occlusal plane 201 is defined by these two axes 205 and 215 and is perpendicular to the vertical axis 250 and contains the axis 205. The separating-sliding plane 301 of the device 300 is positioned precisely so that it coincides with the occlusal plane 201. In the sectional or side view, the anterior-posterior axis 305 of the device 300 lies on the anterior-posterior axis 205 of the cranium 200. The vertical axis 350 of the device 300 runs parallel to the vertical axis 250 of the cranium 200.

[0110] Fig. 36c shows the frontal view with superimposed contours of the device 300 with separating-sliding plane 301 over the frontal section from Fig. 36 The separating-gliding plane 301 lies as precisely as possible on the idealized occlusal plane 201. This figure illustrates the positioning and orientation of the biomechanically and neurophysiologically important location and orientation of the separating-gliding plane 301 between the upper part 320 and the lower part 330 of the device 300. In practice, this is determined individually by the positive fit of the device parts 320 and 330, provided they are manufactured precisely to match the dental arches. The device 300 can be, for example, a training device or an orthosis. The device 300, with its at least two parts 320 and 330, can also be constructed with unilateral asymmetrical design and / or as a multi-part device.

[0111] The reference plane for planning and manufacturing the device 300, particularly for training the temporomandibular joint muscles or treating the temporomandibular joint, cannot be the current occlusal plane with the transverse direction 216, but rather the transverse plane T1 of the cranium with the transverse direction 215 and the direction of the anterior-posterior axis 205. This is the idealized occlusal plane T1a or the reference plane T1a and thus the plane in which the lateral sliding movement of the mandible 230 with the device 300 inserted relative to the maxilla 220 is possible. In two-part devices 300 with a separating-sliding plane 301, digital or virtual preforms for the manufacture of parts 320 and 330 are oriented accordingly during planning in digital or virtual 3D space, according to a preferred procedure.The device 300 is virtually oriented with its separating-sliding plane 301 such that this separating-sliding plane 301 lies in the orientation of the idealized occlusion plane 201. In a particularly preferred embodiment, the separating-sliding plane 301 is identical in its angular orientation and vertical position to the transverse plane T1 or the reference plane T1a, which was determined on the basis of the 3D structural marking 500.

[0112] Fig. 37 The diagram schematically shows the head from the side in a spatial orientation where the skull's coordinate system is vertical. In this spatial orientation, the anterior-posterior main direction 105 of the occlusal plane 110 appears obliquely inclined relative to the transverse main direction 205 of the skull, along which the sliding plane is oriented. The transverse main direction 305 of the device 300 is thus precisely aligned with the orientation of the main direction 205 of the skull by appropriately positioning the preforms in the 3D image space, in order to create the training device as a superposition of the contours of the preforms and the contours of the dental arches, including the air gap. The same applies to the orientation in the other two spatial angles, which are seen from the front and from above, but not from the side.

[0113] The following section describes in further detail the structural markings 500, the procedures and their use in the manufacture of real devices.

[0114] Areas of application include analysis, measurement, design, planning, diagnostics, training and / or therapy in connection with movable body parts, in particular with the position and movement of the mandible (UK) to the maxilla (OK), as well as the definition of the position and orientation of teeth, dental arches, implants and / or biomechanical and orthodontic devices, e.g. 300.

[0115] The description uses anatomical terminology that is also technically understandable: □ Transversalachse: zwischen Rechts und Links verlaufend □ Vertikalachse: zwischen Oben und Unten verlaufend □ AP-Achse: running between front (anterior) and back (posterior) □ Frontal plane: Section plane with principal axes right-left and top-bottom □ Transverse plane: Section plane with principal axes right-left and front-back □ Sagittal plane: Section plane with principal axes front-back and top-bottom Description of the structure marking 500

[0116] The 3D structure marking 500 comprises at least two plane-parallel plane packages 501 and 502 which are perpendicular to each other in the digital or virtual 3D space 50. Fig. 16Figure 1 shows a preferred embodiment with three mutually perpendicular plane sets in a perspective view. Each section plane displays the planes parallel to the plane as parallel lines. Due to the mutually perpendicular plane sets, intersecting sets of parallel lines are formed in the section view. In the preferred embodiments, the section planes are set parallel to one of the plane sets 501, 502, or 503 for visualization in the 3D image system. The section lines of the other plane sets are then seen as a right-angled intersecting grid of parallel lines, whereby the line sets may exhibit a characteristic spacing pattern or ratio.

[0117] Each layer package can consist of at least 3 layers (T1, T2, T3 or F1, F2, F3). In the preferred case of the 3D structure marking 500, a layer package 591 to 595 consisting of 5 layers (F1 to F5) is combined with a second layer package 581 to 585 consisting of 5 layers (T1 to T5), orthogonally positioned to it, see [reference]. Fig. 17 .

[0118] In a further developed embodiment, the group consisting of two orthogonally positioned plane packages (F1 to Fn) and (T1 to Tn) is supplemented by at least one plane package (S1 to Sn) positioned perpendicular to them. Particularly preferred is the sagittal plane package S a combined plane package consisting of two parallel sub-packages (S1R to SnR) and (S1L to SnL) arranged symmetrically around the median sagittal plane Sm, for example, by making the two planes S3L and S3R identical and forming the median sagittal plane. Alternatively, only one plane package can be used, for example, the plane package containing the transverse planes.

[0119] In the general embodiment, the spacing patterns of the plane spacings for the plane packages can differ. In the particularly preferred embodiment, all plane packages have the same spacing pattern and the same spacing ratios, see [reference]. Fig. 17 .

[0120] The spacing between planes parallel to the plane within a plane package can vary. In a particularly preferred embodiment, they behave according to a Fibonacci sequence, such as...

[0121] a1=3, a2=5, a3=8, a4=13, a5=21, where a3=a1+a2; a4=a2+a3; a5=a3+a4; etc.

[0122] In another embodiment, the distance ratio can also be a constant proportionality: a2 / a1 = a3 / a2 = a4 / a3 = a5 / a4 etc., where the proportionality factor is preferably chosen between 1.80 and 1.50, and particularly preferably between 1.65 and 1.60.

[0123] In the case of the 3D structural marker 500, which is particularly preferred for orthodontic applications, a layer package 501 consisting of five layers with distances of 3, 5, 8, and 13 units is combined with a second layer package 502 consisting of five further orthogonal layers with the same distances of 3, 5, 8, and 13 units. Perpendicular to this is a third layer package 503, a double layer package consisting of two sub-packages 503R and 503L, which themselves have distances of 3, 5, 8, and 13 units. The sub-packages 503R and 503L can be oriented in opposite directions and symmetrically, corresponding to the fundamental symmetry in the body's anatomy.

[0124] The 3D structure marking 500 has the following options for individualized settings: □ The size scaling of the 3D structure marker 500 is individually adjustable, meaning the structure marker can be enlarged or reduced. □ The spatial angular orientation of the 3D structure marker 500 and its principal axes is individually adjustable, meaning the three principal directions of the orthogonal plane packages can be aligned as needed in digital or virtual space 50, corresponding to the three degrees of freedom of rotation. □ The spatial position of the 3D structure marker 500, or rather its center of gravity, is individually adjustable, meaning the three spatial coordinates (x, y, z) of the fixed group of orthogonal plane packages can be adjusted in accordance with the three degrees of freedom of translation.

[0125] For the individual adaptation of the 3D structure marking 500 to the conditions of the bony skull, anatomical landmarks / features of symmetry and other anchor features, e.g. anchor points, are used, which can be found in suitable cross-sectional views 72 in the virtual 3D image of the skull.

[0126] For the application of the 3D structural marking 500 according to the invention, a virtual 3D image of at least one real body part, e.g., the head 90a of a patient, is provided, in the preferred embodiment, e.g., via a modern 3D CBCT X-ray system, see Fig. 13 .

[0127] The spatial resolution of such 3D X-ray images can reach values ​​around 0.1 mm (millimeters), with even better resolutions expected in the future, i.e., resolutions smaller than 0.1 mm but, for example, larger than 0.001 mm. This is sufficient for precise positioning and orientation.

[0128] The virtual section images are visualized, for example, using a monitor as output unit 72a, which usually shows the views of selected section planes and the perpendicular orientations of other section planes side by side in different screen areas.

[0129] The image area and the orientation and position of the section planes can be moved, rotated and scaled by means of operating elements or operating devices 73.

[0130] Method for aligning the 3D structural marking a) Representation and 3D positioning of landmarks / features in general b) Representation, positioning and orientation of axes c) Alignment of image planes with the principal planes and principal axes of the body part d) Display of the 3D structure marker in the digital or virtual image space e) Degrees of freedom and individually definable parameters of the 3D structure marker f) Positioning, alignment and scaling of the 3D structure marker in the digital or virtual image spacevirtual image space g) Use of multiple 3D structural markers 500 h) 3D structural marking for analyzing harmony and symmetry in the considered body part i) Planning of dental prostheses or tooth modifications using 3D structural marking j) Planning and manufacturing of training devices and orthoses k) Special significance of the transverse idealized occlusal plane as a separating-gliding plane a) Representation and 3D position determination of landmarks / features in general □ Selection of the main view so that the landmarks are visible; for symmetrical landmarks, at least one of the two, and determination of the 3D position. □ For approximately symmetrical landmarks that do not lie exactly in one image plane, adjustment of the image plane as needed and 3D determination of the second landmark in the same way.□ If necessary, switch the main view to the other two orthogonal image planes so that the appropriate section planes can be displayed depending on the situation and the current question in the procedure. □ To precisely define, for example, right-left symmetrical landmarks, the sagittal section plane is moved into the area of ​​these landmarks as needed, as are the transverse and / or frontal section planes. This allows for the definition of anatomical landmarks with high precision. b) Representation, Positioning, and Orientation of Axes □ Axes result as continuous connecting lines between two landmarks, each of which has a defined 3D position. □ Axes are usually defined as digital objects 66 in the 3D image system and can be shown and / or hidden in the virtual 3D space 50. □ Axes also result as intersection lines between two non-parallel planes.c) Alignment of the image planes with the principal planes and principal axes of the body part □ Alignment of the sectioning plane of the visualization 72 so that the surface normal to the sectioning plane as transverse axis 215, see . Fig. 19 , runs through right-left symmetrical landmarks 281 of the bony structures. □ In the preferred embodiment, alignment with the apexes of the zygomatic arches, see Fig. 19 , 215L and 215R. This defines the orientation of all sagittal planes that are fundamentally perpendicular to the transverse axis 215. Other symmetrical landmarks of the cranium 200 can also be used, provided they are located in the upper and anterior facial skull. However, the area of ​​the nasal septum and the pharynx is very asymmetrical and therefore hardly or less suitable. □ In addition, the midpoint 211 of the distance between the symmetrical landmarks, or of several distances, is determined in order to find a suitable position for the median sagittal plane Sm. Fig. 19 and Fig. 27 The distance 209 to the center 211 on both sides and the median sagittal plane Sm, which passes through the center 211, are shown. □ Optional: Check the position of the center 211 by comparing it to the position of the nose point 601, see Figs. 20 to 24 , above the bridge of the nose. Since, geometrically speaking, anchor point 601 in the chosen embodiment of the head (nose point NP) is located at a saddle surface, the position of anchor point 601 as the center 211 of the transverse axis 215 may be rather imprecise. □ Optional alignment with the center 212 of the inner ear axis 285 between the right-left symmetrical landmarks 280L and 280R of the inner ear or the vestibular system, see Fig. 27Although a measurable deviation of the axis direction 285 from the transverse axis direction 215 defined above is often evident, the landmarks 280L and 280R on the inner ear are very suitable for determining the center 212 and thus the central position of the median sagittal plane Sm. □ Selection of the image plane perpendicular to the transverse axis 215 defined above and through the center 211, 212 defined above, and, if necessary, taking into account the optional additional anchor points 602, 603. □ Display of the median sagittal plane Sm as a section plane at least in a partial area of ​​the visualization device 72. d) Display of the 3D structure marking in the virtual image space. After this initial alignment of the image planes (sagittal planes, frontal planes, transverse planes) for the visualization 72, the 3D structure marking 500 according to the invention can be inserted and aligned by: □ Creating a digital orA virtual image of the 3D structure marker 500, preferably located in data area 60 as data object 55, is displayed as a scalable 3D object 500. □ The virtual 3D image of the body part or skull is superimposed on the 3D structure marker 500 in digital or virtual space 50. □ Layer packages 501, 502, 503 are displayed in the cross-sectional view, with the layers of the layer packages appearing as parallel lines in the cross-sectional view. Layers perpendicular to each other appear as right-angled intersecting lines T, F, S (oriented R and L) when the angle is preserved. □ Layer packages can be shown and / or hidden as needed, or individual layer packages can be shown and / or hidden.e) Degrees of freedom and individually definable parameters of the 3D structure marker. The exact individual scaling, positioning, and orientation of the 3D structure information 500 can generally comprise at least 7 degrees of freedom: □ 3 degrees of freedom (parameters) for translation on the three coordinate axes. □ 3 degrees of freedom (parameters) for rotation of the spatial orientation of the principal axes. □ At least 1 degree of freedom (parameter) for scaling the 3D structure marker 500. f) Positioning, alignment, and scaling of the 3D structure marker 500 in the digital or virtual image space 50.

[0131] The first main purpose of the structural marking according to the invention can be the analysis of the symmetry and harmony of the body part, in particular the skull and the jaw areas of the maxilla (OM) and mandible (MJ). For this purpose, the 3D structural marking 500 can first be aligned on the sagittal main plane and subsequently the transverse main plane can be defined with the aid of the structural marking 500 itself by: □ Introducing the virtual 3D structure marker 500 as a digital or virtual object into the virtual image space 50. In the sagittal section, the grid of the parallel lines T1 ... Tn and F1 ... Fn can be seen. □ Aligning the 3D structural marker 500 with its median sagittal plane directly into the median sagittal plane Sm of the high-contrast imaged body part, in the preferred embodiment, in particular the bony skull 200. □ Displaying the anchor points 601, 602, 603 for aligning the 3D structural marker 500. □ In the embodiment on the head for dental and orthodontic applications, anchor point 601 (nasal point NP) is positioned in the nasion, anchor point 602 (base point BP) is positioned in the basion, and anchor point 603 (palatal point GP) is positioned in the bony area between the palate and the base of the skull. Other anchor points or more or fewer anchor points are also possible.□ Positioning of the unoriented and unscaled 3D structure marker 500 with a pivot point, for example, at anchor point 602. Preferably, the intersection point of T and L lines is suitable as the pivot point or axis of rotation D. In the exemplary embodiment, the intersection point of line F5 with T3 is positioned directly on anchor point 602 (BP). □ Rotation of the 3D structure marker 500, preferably about anchor point 602, so that the spatial direction of the T lines is parallel to the line through anchor points 602 and 603. In the exemplary embodiment, rotation about GP until line T3 runs tangentially through anchor point 603 (GP). □ Optionally, scaling of the 3D structure marker 500 by reducing or enlarging it until a defined F line runs through anchor point 601 (NP). In the exemplary embodiment, scaling with fixed point 602 (BP) without rotation, until line F1 runs tangentially through anchor point 601 (NP).Line T3 continues to pass through anchor point 602 (BP) and tangentially through anchor point 603 (GP) even after scaling. Alternatively, the optional scaling can also be performed before rotation. □ This defines the position of the 3D structure marker 500 in the three spatial coordinates, as well as its spatial orientation in the three solid angles. Furthermore, the size of the 3D structure marker 500 can now also be defined. For example, the isotropic scaling in the three spatial directions also results in the plane spacing of all plane packages 501 (T transverse), 502 (F frontal), 503 (S or R and L sagittal), see [reference]. Figs. 19 to 22 .

[0132] The positioning, orientation, and scaling steps described above can alternatively be performed in a different sequence and / or extended by additional translations, rotations, and scaling operations. One of the operations—positioning, orientation, and rotation—can also be omitted. Alternatively, several of these operations can be omitted. Crucially, upon completion of the alignment process, the 3D structure marker 500 must be individually scaled, and the landmarks / features and anchor points must be appropriately reached, i.e., properly overlapped. The above example is one of the most direct ways to achieve this.

[0133] With suitable technological means of pattern recognition and automation, these steps and parameter assignments can be partially or completely automated. g) Using multiple 3D structure markers 500

[0134] The 3D structure marking 500 according to the invention can be copied into the digital or virtual 3D space 50 once or multiple times: □ Multiple uses can be employed, for example, to assign a 3D structure marker to several body parts that are movable relative to each other, e.g., 500.A and 500.B. □ Thus, a 3D structure marker can be assigned to both the cranium 200 and the mandible UK, see Fig. 28 □ More than one 3D Structure Mark 500 can be used within a single body part. □ For many applications, an additional 3D Structure Mark 500 can be added to align it with non-physiological, asymmetrical, or disharmonious features, thus making their deviation from symmetry and harmony of form visible and measurable. h) 3D structural marking 500 for analyzing harmony and symmetry in the considered body part

[0135] The fitted 3D structure marking 500 can show the symmetry and geometric harmony of the body part: □ In the upper anterior cranium 200, the symmetry according to which the transverse axis 215 and the median sagittal plane Sm were defined may be evident. □ Further down in the skull, i.e., in the region of the nasal septum and the pharynx, distinct asymmetries may be evident, see e.g. Fig. 19 , 26 , 27□ When measuring the inner ear axis 285 using the inner ear landmarks 280L and 280R, a spatial orientation of the inner ear axis 285 (IOA) may result that is not always parallel to the transverse axis 215, which results from the bony landmarks of the anterior superior facial skeleton, especially from anatomical landmarks. This may be a sign of asymmetry of the anterior cranium 200 compared to the posterior cranium 200. □ When fitting a structural marker 500 to the anatomy of the dental arches 221 and 231, especially to the dental arch 221 of the maxilla, see Figs. 29 to 32A tilt angle 214 can often occur in the frontal section, with which the current occlusal plane may be tilted relative to the cranial transverse plane. □ The current axis 216 can be both tilted and displaced relative to the transverse axis 215. In many cases, the current occlusal plane may be positioned too high, e.g., if the mandible is too small and the teeth have already been worn down, see e.g. Fig. 29 □ If a structural marker 500.A is fitted into the cranium 200 as described above and a second structural marker 500.B is fitted into the mandible (UK) at the temporomandibular joint, the tilting and displacement of the mandible (UK) can be clearly seen and directly measured, see Fig. 28 . i) Planning of dental prostheses or dental modifications using 3D structural marking 500

[0136] The transverse plane 501.1 (T1), see Fig. 20 , 23 , 24 , 29 , 30 , 31 ,32 , or the reference plane T1a, see Figure 20 , with fitted 3D structure marking 500, can mark the idealized position of the occlusion plane 201, aligned with the landmarks of the bony structures of the skull 200: □ In most practical cases, the current position of the occlusal plane can deviate from the ideal occlusal plane 201. □ The deviation can exist in the vertical position, as well as in the lateral inclination to axis 215, and in the posterior inclination to axis 205. □ Particularly in the fabrication of dental prostheses, the teeth are preferably aligned with the ideal occlusal plane 201 and thus, deviating from the previous situation, arranged and shaped so that the new occlusal plane is closer to the ideal occlusal plane 201. □ Cosmetic constraints can be met in this way. However, the modification based on the 3D structural marker 500 can, in the vast majority of cases, lead to very significant improvements in the visual appearance as well, because the symmetry in the mandible (UK) and maxilla (UK) with the upper facial skeleton is now better than before.Instead of implants and crowns, veneers can also be fabricated to correct the occlusal plane, thus increasing the distance between the mandible (lower jaw) and maxilla (upper jaw) when the teeth are in occlusion. The aesthetic effect can be a younger, more dynamic appearance. The biomechanical effect can be a significant reduction in stress on the temporomandibular joint. j) Planning and manufacturing of training devices and orthoses

[0137] The structural marking 500 and the ideal position of the occlusal plane 201 determined with it can be used in the planning and manufacture of devices 300 for training and / or therapy in cases of malposition, especially of the temporomandibular joint: □ In one step, the image planes can be aligned as described above. □ In a further step, at least one 3D structure marker 500 can be introduced. □ The 3D structure marker can be positioned and / or aligned and / or scaled as described above. □ This allows the idealized occlusion plane 201 to be defined; in the preferred embodiment, it lies in plane 501.1 (T1), see e.g. Fig. 31 and 32□ This idealized occlusal plane 201 with its spatial directions 205 and 215 can now serve as the basic plane for constructing devices 300, etc., in digital or virtual space. □ For devices 300 with upper part 320 and lower part 330, the dividing plane 301 between 320 and 330 can be positioned in the location of the idealized occlusal plane 201; that is, in particular, the principal axes 315 and 305 of the device 300 can be aligned with the principal axes 215 and 205 of the cranium 200. □ In this alignment of the device 300 relative to the cranium 200, a fixed relationship to the teeth of the maxilla (OK) can be established. The relationship to the teeth of the mandible (UK) can be less fixed, which is why design possibilities for therapy and / or training and possibly cosmetic purposes are possible here.□ The recesses for teeth, gums, and other volume-occupying parts in the mouth can result from the overlap of the tissues depicted in virtual space with the materials of the device 300. Boolean operators can be used here, in particular subtraction, AND, NOT, OR, or combinations of these operators. □ The upper part 320 can show the overlap with the dental arch of the maxilla 220, whereby the recesses in the material of the upper part 320 can be designed so that no collisions occur and that the device 320 fits precisely on the dental arch 221 in the mouth without injuring the softer tissues in the maxilla 220. □ The lower part 330 can show the overlap with the dental arch 231 of the mandible after the mandible has been positioned biomechanically and physiologically appropriately in digital or virtual space 50.For this purpose, the idealized occlusal plane, which in the described procedure corresponds to plane T1 or the reference plane T1a, can be suitable. Here, too, the recesses in the material of the molded part 330 can be designed so that no collisions occur and that the device 330 fits precisely on the dental arch 231 in the mouth without damaging the softer tissues in the upper jaw 230. □ The device 300 with parts 320 and 330 can be manufactured as a real device after being designed in virtual 3D space, either additively, e.g., by 3D printing, or subtractively, e.g., using 3D preforms that are machined with 3D milling machines. □ The manufactured molded parts can be precisely fitted to the individual's dental arches and can be positioned with absolute accuracy in the individual's mouth.□ The realized separation plane between upper part 320 and lower part 330 can, according to the design, lie parallel to the transverse planes T and ideally on the transverse plane T1 or on the reference plane T1a. k) Special significance of the transverse idealized occlusion plane as a separating-gliding plane

[0138] The fitted 3D structural marker 500 can define the position and orientation of the transverse planes: □ The ideal occlusal plane, or chewing plane, can be such a transverse plane and thus be orthogonal to the vertical axis. □ The muscles that lift the mandible (UK) and press it against the maxilla (OK) attach symmetrically to the right and left sides of the cranium. □ If the movement of the mandible (UK) is allowed to move laterally in the transverse plane by a suitable device, this can result in an unstable equilibrium under pressure. □ This unstable equilibrium can arise because, with free lateral movement, the resulting force between the mandible (UK) and maxilla (OK) is perpendicular, similar to a dancer or figure skater balancing on one leg. □ Such instability can train the regulatory or autonomic nervous system, and this can have significant and beneficial effects on the neurophysiological control and the sensorimotor system of the masticatory apparatus.□ In a particularly preferred embodiment, the parting line between upper part 320 and lower part 330 can be designed as a smooth, retention-free (i.e., no protrusions) and / or low-friction parting-gliding surface 301, such that the contact force is perpendicular to this parting-gliding surface as long as no lateral stops are reached. □ In a particularly preferred embodiment, a device designed in this way can be fitted precisely into the virtual space such that the parting-gliding surface 301 lies exactly in the idealized occlusal plane 201 or is at least approximately located there. □ When such devices with a parting-gliding surface 301 are inserted into the mouth with individualized orientation, demonstrably very beneficial training effects on the jaw muscles and the temporomandibular joint result, even leading to significant therapeutic effects.

[0139] In this way, 500 highly effective devices can be designed and manufactured using the 3D structural marking according to the invention, which show excellent therapeutic effects.

[0140] Functional tests have shown that a 3D structural marking, which adheres as precisely as possible to the plane spacing of the Fibonacci sequence 3, 5, 8, 13, is particularly well-suited for manufacturing devices that lead to very good therapeutic and, where applicable, also very good cosmetic results. Therefore, the most preferred embodiments of the 3D structural marking utilize precisely this spacing ratio; see rulers in [reference missing]. Fig. 26 and Fig. 29 up to 32.

[0141] Conversely, the effectiveness of the devices in use can be reduced if they deviate from the orientation of the principal planes and principal directions of the cranium 200 and from the harmonic symmetry of the principal planes. This could result in the idealized position of the occlusal plane 201, see e.g. Fig. 19 , as they result from the application of the 3D structural marking 500 according to the invention, have already been comprehensively demonstrated in practical application.

[0142] The devices can be iteratively adjusted, for example, after several weeks, whereby the 3D structural marker is positioned in a new image of the patient's skull to change the occlusion plane, which may now be in a different location than at the beginning of the procedure.

[0143] Numerous 3D image viewing systems are available on the market that allow objects to be fitted into other 3D image data, for example, using a computer mouse, a trackball, or even voice control—that is, semi-automatically with a certain manual component. The objects can be pens, implants, or similar items. Alternatively, the object can also be a structural marker that has been previously defined using the 3D image viewing system or another program, such as image editing software or CAD (Computer-Aided Design). For example, the program Extraoral-3D-Family can be used, or another suitable program, such as one from Sirona3D.

[0144] In a further development stage, the 3D image viewing system can be adapted so that the 3D structure marking is automatically aligned to the anchor features or anchor points, with translations, rotation, and scaling also being performed automatically or fully automatically. Manual intervention or readjustment may still be possible.

[0145] The embodiments shown are not to scale and are not limiting. Modifications within the scope of a skilled person's work are possible. Although the invention has been illustrated and described in detail by the preferred embodiment, the invention is not limited by the disclosed examples, and other variations can be derived from them by a person skilled in the art without departing from the scope of protection of the invention. The further developments and embodiments mentioned in the introduction can be combined with one another. The embodiments mentioned in the description of the figures can also be combined with one another. Furthermore, the further developments and embodiments mentioned in the introduction can be combined with the embodiments mentioned in the description of the figures.

[0146] The proposed procedure and its advanced training cannot be used for the treatment of the human or animal body and cannot be a diagnostic procedure practiced on the human or animal body. Alternatively, the proposed procedure and its advanced training can be used for the treatment of the human or animal body and can be a diagnostic procedure practiced on the human or animal body.

[0147] A 3D structural marking system has been revealed as a novel 3D tool for aligning virtual 3D objects in spatial relation to body parts such as the head or spine, which are also virtually represented in 3D systems after image-based 3D capture. This alignment in virtual space aims to virtually bring teeth, implants, and devices, which are individually aligned to the bone structure, into the highest possible physiologically functional state, in order to subsequently manufacture them with this excellent property based on the virtual 3D data. In a particularly favored application on the head and jaw of patients, the 3D structural marking system serves to perform the otherwise very complex and time-consuming definition of the principal axes and planes very quickly, reliably, and elegantly.The principal axes and planes of the cranium are crucial for the functionality of teeth, dentures, and orthodontic appliances. A particularly effective application is the use of 3D structural marking for planning and manufacturing appliances that feature a sling-slide plane oriented as parallel as possible to the cranial transverse plane. Furthermore, the 3D structure of the 500 structural marking allows for the simple yet precise vertical positioning of the ideal occlusal plane, which would be difficult or impossible to achieve with other methods. The 3D structural marking can also be referred to as a 3D ruler, especially when scales are displayed, which can be adjusted as needed using the optional scaling function.

[0148] The disclosure also relates to the following features and combinations of arbitrarily selected features, wherein the invention is defined by the patent claims: 3D tool

[0149] A 3D structure marker 500 as a tool for application in virtual 3D space, comprising at least two plane packages, each consisting of plane-parallel planes, wherein each of the plane packages consists of at least 3 planes that are in a characteristic distance ratio, wherein at least two plane packages 501 and 502 are perpendicular to each other in their orientation.

[0150] The 3D structure marking 500 can have a transverse axis, which serves the transverse orientation and alignment of the structure marking in virtual space, in particular the alignment to bony structures of body parts in a virtual 3D image of the respective body parts.

[0151] In the 3D structure marking 500, the distances between the plane-parallel planes within at least one plane package can have a defined distance ratio that corresponds at least partially to the formation law of the Fibonacci series 3, 5, 8, 13, 21 etc.

[0152] In the 3D structure marking 500, the distances between the plane-parallel planes of at least one plane package can have a constant proportionality ratio, with the distance of the subsequent plane to the preceding distance being in a ratio between 1.8 and 1.5.

[0153] In the 3D structure marking 500, the distances of the plane-parallel adjacent planes can be completely or almost exactly proportional, and the proportionality factor can be between 1.60 and 1.65.

[0154] With 3D structure marking 500, at least three mutually orthogonal layer packages can be combined to form a virtual 3D structure.

[0155] In the 3D structure marking 500, the layer packages can be oriented in combination so that a first layer package 501 includes at least 3 transverse layers, a second layer package 502 includes at least 3 frontal layers and a third layer package 503 includes at least 3 sagittal layers in relation to a body part.

[0156] The 3D structure marking 500 can include intersection lines of the planes in space, which appear as intersection points in the perpendicular section plane, whereby in this image plane the intersection lines of the parallel planes of the plane packages with the image plane appear as parallels.

[0157] Seven degrees of freedom for positioning are composed of the definition of three degrees of freedom of translation and three degrees of freedom of rotation, and at least one degree of freedom of scaling to define the relative position, orientation, and size of a structural marker. 50 are characterized by the fact that: Frontal plane Fn passes through anchor point 601, and / or transverse plane Tx passes through anchor points 602 and 603, and / or frontal plane F1 passes through anchor point 601.

[0158] This defines an anchor point for the positional alignment of the idealized occlusal plane (biomechanically, individually ideal position of the occlusal plane based on the shape and structure of the skull) by an intersection between the transverse plane T and the frontal plane F of the structural marker in the sagittal view. The spatial orientation of the idealized occlusal plane is parallel to the transverse plane of the structural marker.

[0159] A structural marking according to [standard / method] is particularly preferred. Fig. 4 generated in cross-sectional view according to Fig. 8 : Frontal plane F5 passes through anchor point 601 BP, and / or transverse plane T3 passes through anchor points 602, BP and 603 GP, and / or frontal plane F1 passes through anchor point 601 NP, and / or defines incisal point 604, IP as the intersection point of F1 with T1, preferably in the median sagittal plane. 3D process

[0160] In a method for applying a 3D structure marking 500, the structure marking is aligned in its transverse axis to bony structures, whereby approximately symmetrical landmarks in the bony structures to the right and left are used to make tangential approximations with transverse axes and / or to place the axis through these landmarks, wherein the transverse thus aligned serves as the surface normal of the sagittal planes, which are used as image planes in a 3D image system for the further alignment of the 3D structure marking.

[0161] In this method, the bony structures of the anterior facial skeleton on the right and left sides can be used as the transverse axis for alignment. The 3D structural marker can be positioned at additional anchor points in at least one coordinate and aligned in at least one solid angle by using anchor points that lie in a plane either in the image plane or parallel to the image plane.

[0162] In this method, the 3D structural marker can be enlarged or reduced to such an extent that at least two given anchor points are touched or intersected by predefined lines. In this method, the 3D structural marker 500 can be enlarged or reduced to such an extent that at least three given anchor points are touched or intersected by predefined lines. In this method, the 3D structural marker 500 can be positioned around an anchor point in a cross-sectional view in one step and rotated by an angle in another step, so that a main axis of the structural marker points in the direction of the connecting axis of two anchor points of a body part. In a third step, scaling is performed so that at least two anchor points pass through defined lines or intersection points of the 3D structural marker in the cross-sectional view.

[0163] In the procedure, the 3D structural marker 500 can be oriented in its sagittal planes 503 parallel to the sagittal plane of the body part, in particular the head, wherein in at least one positioning step the structural marker 500 is positioned so that a pivot point is defined and in a second step a rotation of the structural marker by an angle takes place, so that the transverse plane in the sagittal section runs parallel to the connecting line between two anchor points 602 and 603 and in a further step the scaling of the size and the plane distances of the structural device 500 is set so that the structural marker with a frontal plane intersects a further anchor point 601.

[0164] In the procedure, the positioning of the 3D structure marker 500 can accurately take into account at least one 3D position of an anchor point 602 that lies in the sagittal plane, and the axis alignment of the structure marker 500 can be positioned such that a transverse plane of the 3D structure marker 500 passes approximately tangentially through the second anchor point 602, and a plane perpendicular to the transverse plane and the sagittal plane intersects at least one further anchor point 601, and the scaling of the 3D structure marker is appropriately adjusted to fulfill these conditions simultaneously.

[0165] In a procedure for positioning, orientation and scaling a 3D position marker 500, the base point BP at the foramen magnum can be used as an anchor point for positioning and rotation, the palatine point GP at the uppermost point of the palatine roof in the middle of the spinous process or in the middle of the concrete compact bone margins between the palate and the skull base can be used as an anchor point for the angular alignment of the transverse plane, and the nasal point NP at the nasion above the nasal root can be used as an anchor point for scaling the structure marker 500. use

[0166] A use of the principal planes and principal directions defined by the alignment of the 3D structure marking 500 for the exact angular alignment and 3D positioning of the separating-sliding plane of devices, wherein this separating-sliding plane allows, within other mechanical limits, low-friction lateral movement in the directions of the plane and rotation about the normal axis perpendicular to the separating-sliding plane.

[0167] The transverse plane T1 can be used as an alignment plane for the idealized separating-sliding plane of devices or the idealized occlusion plane of the dentition.

[0168] The idealized separation-sliding plane defined by means of the 3D structural marking, with position and orientation as the separation plane, can be used for the production of real devices consisting of at least two parts for insertion into the body or for attachment to the body part.

[0169] The idealized separation-gliding plane defined by means of the 3D structure marking 500 parallel to the cranial transverse plane T1 can be used for the manufacture of dental prostheses or implants or devices for insertion into the mouth, in particular for placement on the dental arches.

[0170] Although the invention has been illustrated and described in detail by the preferred embodiment, the invention is not limited by the disclosed examples, and other variations can be derived from them by a person skilled in the art, the scope of protection being defined by the claims. The same reference numerals refer to the same technical features unless otherwise stated. Where "may" is used in this application, it means both the possibility of realization and the actual technical implementation. Concepts of the disclosure are described above with reference to preferred embodiments in a specific context, namely a structural marking on a head, in particular for positioning devices in the area of ​​the teeth.However, the disclosed concepts can also be applied to other situations and / or arrangements, in particular to structural markings on other body parts and to devices that are arranged on these other body parts. glossary

[0171] Buccal: The back-side surface of a tooth. Lingual: Side facing the tongue Occlusal: Facing the occlusal surface Marginal gap: Gap between device 100 and body tissue such as tooth or gum CBCT: Digital Volume Tomogram, stationary 3D radiograph OK: Maxilla 220 OKP: Maxilla preform 20 OKM: Maxilla part 120 of device 100 UK: Mandible 230 UKP: Mandibular preform 30 UKM: Mandibular part 130 of device 100 TGE: Separation-gliding plane 110 between OKM 120 and UKM 130 AKE: Actual occlusal plane 111, approximate, usually oblique to TGE 110 Anterior-posterior + sterior running from front to back BP Base point at the basion of the foramen magnum, preferably as anchor point 2 CBCT Digital Volume Tomogram, stationary 3D radiograph f1, f2, f3...Distance of the frontal planes F First plane F1 to F5 Frontal plane F, plane with principal directions Right-Left and Up-Down GP Palate point, preferably as anchor point 3 Cranium Bony skull Lleft L1 to L5 Left-running sagittal planes, plane with principal directions Anterior-Back and Up-Down NP Nasal point on the nasion, preferably as anchor point 1 OK Upper jaw 220 Rright R1 to R5 Right-running sagittal planes Second plane . t1, t2, t3...Distance of the transverse planes T s1, s2, s3...Distance of the sagittal planes S Topmost section plane T1aReference plane TxTransverse plane passing through anchor points 602 and 603 TTthird plane T1 to T5Transverse plane, plane with principal directions front-back and right-left UKManjaw 230 KS0Reference system x0, y0, z0Axis, coordinate KS1First digital reference system x1, y1, z1Axis, coordinate KS2Second digital reference system x2, y2, z2Axis, coordinate KS3Third digital reference system x3, y3, z3Axis, coordinate Reference sign

[0172] 1 to 8 Tooth positions in the jaw 20 Upper jaw preform (OKP) 22 Data object as a representation of the predominant bony structures of the body part 22a Spatial data 30 Lower jaw preform (UKP) 33 Data object as a representation of the device 300 and its parts 40 Real space with real objects 50 Digital or virtual space of the 3D structure marking 55 Data set, data object as a representation of the 3D structure marking 60 Data space with data objects in storage unit 60a Storage unit 66 Data set, other data objects 71 Computing unit, 3D image system with processor 72 Visualized views for digital or virtual 3D objects 72a Output unit, monitor 73 Input device for positioning, rotation,Scaling etc. 73a Input unit 80 Imaging unit 81 Image data storage and generation of 3D image data set 82 Arm of a 3D X-ray imaging device with multiple imaging directions 83 Radiation-sensitive array for image generation 90 Head of an individual 90a Body part 91 Radiopaque bony structures in the head 100 Device 105 Front-back axis in the device 110 Separation-gliding plane TGE between upper and lower jaw 111 Actual occlusal plane OCE without correction of the position of the lower jaw 112 Tilt angle Kappa between OCE 111 and TGE 110 113 Cranial symmetry point right, preferably in the facial skull 114 Cranial symmetry point left,preferably in the facial skeleton 115 Axis right-left in the device 100 116 Transverse tilting angle 117 Sagittal tilting angle 120 Maxilla part OKM 121 Training ridge on the outside of the OKM, circumferential 122 Marginal gap in the maxillary module 123 Planar smooth separating sliding surface on the OKM 124 Recess in the OKM corresponding to tooth and gingiva 125 Tuberous or plateau-like projection as a bearing point in the OKM 127 Lateral walls of the recesses 124 in the OKM preferably with marginal gap, not abutting 129 Indentations from the teeth of the mandible into the sliding surface 123 in the OKM 130 Mandibular part UKM 131 Training ridge on the outside of the UKM, circumferential 132 Marginal gap in the mandibular module 133 Smooth planar sliding surface and separating surface on the UKM 134 Recess in the UKM corresponding to tooth and gum 135Hump-like or plateau-like projection as a bearing point in the mandibular ridge 136Breakthrough of the depression 134 through the separating sliding surface 133 137Lateral walls of the depressions 124 in the mandibular ridge preferably with marginal gap,non-adherent 150 axis top-bottom in the device 200 cranium, bony skull 200 bony structure 201 idealized occlusion plane, physiological position of the separating-gliding plane 203 angle of inclination between the cranial anterior-posterior axis 205 and the image horizontal,especially for horizontal image alignment of the AP axis 215 205 Axis front-back tilted slightly obliquely backwards and downwards with upright head position 205a Anterior-posterior axis parallel axis 209 Distance to the center 211 Center 214 Tilt angle of the current occlusal plane e.g. at the dental arch of the maxilla relative to the cranial transverse axis 215 215 Axis right-left based on anatomical landmarks preferably of the facial skeleton 216 Tilted current occlusal plane 215 R / L Alignment points for the cranial transverse axis 215 in the anterior facial skeleton 220 Maxilla 221 Dental arch in the maxilla 223 Orbit 228 Tooth from the dental arch of the maxilla 230 Mandible 231 Dental arch in the mandible 238 Tooth from the dental arch of the mandible 245 Orientation axis in the upper facial skeleton 250 Axis top bottom in skull 256 Tilted vertical (surface normal) perpendicular to current occlusion plane 216 270 Upper extensions of the cervical spine 275 Temporomandibular joint bones,280 Inner ear structure, in particular the arch of the vestibular system 281 R / L Symmetrical landmarks 285 Inner ear axis IOA 295 Perpendicular to the inner ear axis 301 Low-friction flat separating-gliding plane of the device 300 between upper part 320 and lower part 330 5003D Structural marker as a digital or virtual 3D object 501 First layer package, transverse layer package, 501.1 to 501.n layer 502 Second layer package, frontal layer package, 502.1 to 502.n layer 503 Third layer package, sagittal layer package, 503R Right-running sagittal layer package 503R.1 to 503R.5 layer 503L Left-running sagittal layer package 503L.1 to 503L.5 layer 515 first principal direction of a plane 550 second principal direction of a plane 601 third anchor feature or first anchor point superior cranially in the region of the forehead / nose 602 first anchor feature or second anchor point posteriorly cranially in the region of the base 603 second anchor feature or third anchor point anteriorly in the region of the palate 604,IPI Ideal incisal point between the upper and lower incisors, determined using the structural marking 500 W1, W2 Angle D Rotation axis 700, 800 Procedure 710 to 790 Step 810 to 890 Step,

Claims

1. Device for training the muscular, sensorimotor and neurophysiological system of the temporomandibular joint and for positioning and guidance of the lower jaw relative to the upper jaw, - wherein the device (100) comprises at least two modules (120, 130) which bear against one another in the region of a comparatively large, smooth and flat separation-sliding-plane (110) without teeth or tooth fissures or comparable forms hindering the lateral movement of the modules with respect to one another along the separation-sliding-plane (110), wherein - at least one of the two modules (120, 130) is designed as an upper jaw module (120) having a plurality of approximately arcuate recesses (124) for the teeth (221) of the upper jaw (220) and a first smooth sliding surface (123) and - at least one of the two modules (120, 130) is designed as a lower jaw module (130) having a plurality of recesses (134) for the teeth (231) of the lower jaw (220) as well as a second smooth sliding surface (133), wherein the smooth, flat first and second sliding surface of the modules (123; 133) has a good flatness, a low roughness, preferably with an RZ below 5 micrometres, and / or a very low frictional resistance, such that a laterally sliding slide movement, guided in a planar and flat manner in two spatial directions and / or a rotation about the axis perpendicular to the separation-sliding-plane (110) can take place along the separation-sliding-plane (110), wherein the separation-sliding-plane (110), together with a dental-occlusal-plane (111), forms a first angle k (112), wherein the lower jaw and the upper jaw form the dental-occlusal-plane (111) in the state of mechanical contact.

2. Device according to claim 1, wherein a) the first angle k (112) is determined in plan view perpendicular to a sagittal section of the cranium (200), wherein the first angle is preferably <10°, and / or b) the separation-sliding-plane (110), together with the dental-occlusal-plane (111), forms a second angle (116), which is determined in a plan view of a sagittal section of the cranium (200), wherein the second angle (116) is formed by a first axis (202), which intersects the base point (BP) when being displaced parallel to the dental-occlusal-plane (111), and a second axis (205), which intersects the base point (BP) and the high point of the palate (GP).

3. Device according to claim 2, wherein the second angle (116) is between 0° and 10°.

4. Device according to one of claims 1 to 3, which is rotated in the separation-sliding-plane (110) by an angle of rotation (117) which, starting from a sagittal plane extending through the incisors, forms an angle <10°.

5. Device according to any of the preceding claims, wherein a) the recesses (134; 124) are designed to be widened in depth and in extent parallel to the separation-sliding-plane (110) as compared to the 3D tooth geometry to such an extent that edge gaps (122) remain between the material of the modules (120;130) and the body tissue and or the tooth material when placing the modules on the dental arches, and / or wherein b) selected recesses (124; 134) have bump-like or plateau-like contact points (125; 135) at a closely delimited local point, corresponding to the occlusal surface of a tooth, wherein, directly at the contact points, the 3D geometry corresponds to the 3D surface of the teeth without edge gap and the contact points are surrounded by regions with edge gap (122), and / or wherein c) at least one module and at least one recess (124; 134) therein has an open aperture (126; 226) through the material of the module (120; 130), at least partially in the region of the occlusal surface of the tooth, wherein the recess is designed such that in the region of the opposite module (130; 120) the tooth with its occlusal surface lies partially outside the module (120; 130), , and / or wherein d) at least one sliding surface (123; 133) of the modules (120; 130) is locally perforated by at least one recess (129) which corresponds to a tooth of the opposing dental arch, wherein this recess (129) is expanded at least by an edge gap (122) which allows the lateral movability of the tooth of the opposite side passing into the recess (129) along the separation-sliding-plane (110), and / or wherein e) the material of the modules (120; 130) forms a bead-shaped edge (121; 131) outside the arc of the recesses (124; 134), which takes up a large volume in the oral cavity, in particular so that the soft tissues, muscles and fasciae are stretched in a defined manner by this bead edge (121; 131), and / or wherein f) the modules (120; 130) have an approximately horseshoe shape and each comprise a dental arch, wherein the position of the device is determined by an orthogonal axis system (105; 115; 150), wherein the modules are placed against one another on the sliding surfaces (123, 133) to form the separation-sliding-plane (110) and can be displaced almost without friction in this contact position, in particular if a force in the sense of a compression force that is not exactly perpendicular to the separation-sliding-plane (110) is exerted on the two modules by the lower jaw (230) in the direction of the upper jaw (230).

6. Device according to any of the preceding claims, wherein in at least one of the modules, the dental-occlusal-plane (111), which is formed by the occlusal surfaces of the teeth of the dental arch, is oblique to the separation-sliding-plane (110), which separates the upper jaw modules and lower jaw modules and guides them slidingly against one another, wherein a clearly measurable tilting angle k (112) of more than 0.2 degrees is formed between the planes (111) and (110).

7. Device according to claim 5 or 6, when dependent on claim 5, wherein the device in the inserted mouth stretches the lips more than 10% by the bead edges (121; 131) and the device can be covered by the lips to a maximum of 90% when seen from the front, wherein the separation-sliding-plane (110) is visible from the front and the transversal right-left axis (115), in its axial direction, can be detected by measurement.

8. Device according to any of the preceding claims, wherein at least one of the modules is designed in multiple parts, in particular in two parts, wherein the modules have recesses (124; 134) that predominantly correspond to the molars and or the canines of the respective dental arch, wherein the parts of a module together form the same separation-sliding-plane (110) when they are inserted jointly into the mouth and positioned on the dental arch.

9. Device according to claim 5 or any of the claims 6 to 8, when dependent on claim 5, wherein the bead-shaped edge (131) of the lower jaw module (130) is more than 1 mm wider than the bead-shaped edge (121) of the upper jaw module (120) in the region of the anterior teeth and the two modules have an approximately flat transition on the outer regions towards the cheek without significant contour steps.

10. Device according to any of the preceding claims, wherein the position of the recesses (124; 134) in the modules (120; 130) is set 6-dimensionally, with 3 spatial positions and 3 spatial directions, by fitting a digital 3D model of the device into the digital 3D model of the skull in such a way that the orthogonal axes of the facial skull (205; 215; 250) are parallel to the orthogonal axes (105; 115; 150) of the separation-sliding-plane (110), wherein the right-left axes (115; 215) and the front-rear axes (105; 205) and the up-down axes (150; 250) are perpendicular to one another in the sense of orthogonality, and the position of the orthogonal axes of the skull is defined on the basis of typical osseous landmarks of the skull, in particular the facial skull in the 3D model.

11. Device according to any of the preceding claims, wherein at least one of the recesses (124; 134) comprises both a contact point (125; 135) and an aperture (126; 136), wherein the region of the contact point is designed with an edge gap (122; 132).

12. Device according to any of the preceding claims, wherein the edge gaps (122; 132) in the region of the penetrating recesses (129, 139) in the separation-sliding-plane (110; 123; 133) are worked out to such an extent that a laterally sliding movement in two directions right-left and or rear-front and combined by at least 0.3 mm, particularly preferably at least 0.4 to 1.4 mm, is possible.

13. Device according to claim 12, wherein the right-left position of the device (100) relative to the skull (200) is determinable by the right-left symmetry along the right-left axis (215) of the osseous features of the facial skull and or the right-left symmetry of the upper jaw in the anterior tooth region, and further wherein the up-down position of the device (100) along the up-down axis (250) of the skull is determinable by the intersection region of the incisors and the dental arches in the anterior tooth region, respectively, and additionally the rear-front position of the device (100) along the rear-front axis (205) is determinable by the region between the upper and lower anterior teeth.

14. Device according to claim 12 or 13, wherein in the 3D model of the device, as an extension of the volume occupied by teeth and gums, an edge gap layer (122; 132) can be produced, which is maintained, even under pressure, by individual contact points (125; 135), on which the device (100) rests on the dental arches (221; 231) in the occlusal pressure direction, in that, at the position of the contact points, the modules are formed locally without edge gap (122; 132) in positive fit with the corresponding tooth, and then this module (129; 130) 3D geometry for the dental arches is produced with edge gap and contact points and the position and location of the recesses (124; 134) resulting from the orientation, including edge gaps (122) and contact points (125).

15. Method for producing an individually developed device (100) according to any of the preceding claims for use in the mouth, in particular of a person, comprising at least one upper jaw module (120) and at least one lower jaw module (130), wherein the modules have a common separation-sliding-plane (110), wherein a digital 3D model of the device as preforms (20; 30) with its orthogonal axes (105; 115;150) is positioned in a 3D model of the head with its orthogonal axes (205; 215; 250) in such a way that the axes of the device are parallel to the axes of the head, wherein the axes of the head (205; 215; 250) result predominantly from landmarks in the region of the facial skull, and thereby the position of the recesses is defined, which are produced for the teeth of the dental arches of the upper jaw and the lower jaw in the preforms in the 3D digital model, in order to subsequently produce the modules (120; 130) with these recesses (124; 134) additively or subtractively in terms of production.