Temporomandibular hypermobility apparatus

Abstract

The invention relates to a mechanical temporomandibular hypermobility apparatus (100) that can be used intraorally in temporomandibular joint (TMJ) hypermobility patients, especially in the field of dentistry, enables the desired mouth opening distance in hypermobility to be restricted / controlled with a distance between 35 and 50 mm, allows the patient to eat during the treatment process and eliminates the risk of possible complications such as osseous and fibrous ankylosis, and degenerated joint cartilage.

Description

[0001] DESCRIPTION

[0002] TEMPOROMANDIBULAR HYPERMOBILITY APPARATUS

[0003] Technical Field

[0004] The invention relates to a mechanical temporomandibular hypermobility apparatus that can be used intraorally in temporomandibular joint (TMJ) hypermobility patients, especially in the field of dentistry, enables the desired mouth opening distance in hypermobility to be restricted / controlled with a distance between 35 and 50 mm, allows the patient to eat during the treatment process and eliminates the risk of possible complications such as osseous and fibrous ankylosis, and degenerated joint cartilage.

[0005] State of The Art

[0006] Immobilisation of the jaw;

[0007] 1 . Barrel bandage (Figure 1 .1 -1 .2),

[0008] 2. Barton bandage (Figure 2.1 -2.2),

[0009] 3. Chin cup (Figure 3. 1 -3.2)

[0010] 4. It can be performed as maxillomandibular fixation (MMF) (figure 4) using intermaxillary fixation screws.

[0011] During conservative treatment, patients are warned not to open their mouths wide for six weeks with immobilisation devices. If patients are going to yawn, they need to support the bottom of their chin to prevent the mouth from opening wide. For this reason, patients need to cut their food into small pieces as the mouth opening may be very narrow.

[0012] The barrel bandage method has an upward and slightly forward traction on the chin. Approximately a 6 feet bandage of 2 to 24 inches is required to perform this method. The middle bandage section is placed under the chin, with the chin just in front of the angle, then a simple knot is tied at the top of the skull. The knot is opened using both hands, the front loop is positioned to the forehead and the back to the occipital. Then, it is tied with a knot slightly in front of and above the ear by applying upward pressure by holding both ends. In the barrel bandaging technique, there is a force that lifts the mandible from bottom to top, depending on the direction of binding.

[0013] In the Barton bandage, an ace bandage is wrapped around the patient's head. Wrapping vertically from the top of the forehead to the top of the chin, the bandage provides the primary force vector. This force is actually the only force that keeps the teeth in occlusion. The lower bandage serves primarily to stabilise the main vertical bandage. The upper bandage serves a similar stabilising purpose. It is undesirable for the bandage to apply horizontal force to the area and may cause incorrect positioning of the jaw. Another disadvantage of the Barton bandage is the risk that the connection between the tip of the chin and the nape of the neck may apply force in the anteroposterior direction, causing the mandible to move backwards.

[0014] Chin-cup treatment applies force to the mandible by rotating the tip of the chin downward and backward. Additionally, as a result of the pressure applied by the apparatus to the lower lip and lower dentition, it causes the lower incisors to tip lingually. Chin cups create pressure in the TMJ area. However, this retrusive effect on the mandible may reduce retrodiscal metabolic activity.

[0015] Intermaxillary fixation screws are made of titanium, usually 7-9 mm long and 2 mm in diameter, and at least 1 is placed in each half jaw. Screws are placed between the canine and first premolar teeth in the lower jaw, and between the lateral and canine teeth in the upper jaw. These screws are placed under local anaesthesia and are screwed directly into the bone through the mucosa; surgery is required, even though minimally. If it is felt that it is not stuck in the bone, it would be appropriate to move it to a new area. The hole in the screw head must remain in the vertical plane; by this way, the risk of the screw turning and loosening when a wire or elastic band is passed through it is reduced. For fixation in the serrated mandible, fixation is provided with a total of at least 6 IMF screws, 3 IMF (Intermaxillary Fixation) screws being in the mandible, one on each side and 1 in the midline, and 3 screws in their maxilla counterparts. Intermaxillary fixation devices may cause possible complications such as osseous and fibrous ankylosis and degenerated articular cartilage.

[0016] Current apparatuses either completely cover the jaw or provide an indefinite restriction. Current immobilisation sources have disadvantages such as IMF being traumatic and preventing feeding, bandages not being stable, and the chin cover being unaesthetic. It is not possible to adjust the mouth opening to the desired size with the existing apparatuses used during treatments. Most of these methods cannot be controlled by the patient. It is very difficult for the patient to maintain oral hygiene and tolerate it psychologically.

[0017] Studies / documents related to the subject of the invention in the state of the art are listed below.

[0018] The summary of the study titled “A Michigan-type occlusal splint with spring-loaded mandibular protrusion functionality for the treatment of reduced anterior disc dislocation” is as follows: Michigan-type splints are frequently used for the treatment of temporomandibular disorders and mandibular advancement devices in patients diagnosed with anterior disc dislocation. Since both types gave good results, the combination of these two mechanisms in a single bimaxillary apparatus was tested in eight patients in whom splint therapy provided a reduction in symptoms but did not completely eliminate them. An existing maxillary Michigan splint was modified so that advancement springs could be installed and the forces produced were transmitted to a mandibular retainer that did not interfere with the function of the splint. The progress of the treatment was monitored by computerised axiography, and in all cases the axiographic traces after bimaxillary treatment did not show any pattern indicating disc dislocation under normal jaw movements.

[0019] The invention with publication number W02019167016A1 relates to a mechanical device for joint distraction of the temporomandibular joint (TMJ) and to a physiotherapy aid for patients with TMJ joint disorders.

[0020] The invention numbered RU2440063C1 relates to medicine, especially dentistry, and can be used in the treatment of diseases associated with limited opening of the mouth and jaw stiffness. An apparatus consists of a cylindrical body equipped with a spring, a handle connected to the spring by a wire, and rods perpendicular to a body and the axis of the spring. The rods can move back and forth and in a vertical direction through a slit coaxial to the body, their ends contained within a box rigidly coupled with a mandibular impression tray. In a screw and nut of the body there is a pair of rods perpendicular to a maxillary table; these rods are equipped with hinges to tilt the tray 10-15°. Spoons are filled with measuring silicone mass. The invention mentioned in the utility model document titled "lower jaw replacement oral rehabilitation machine" with application number CN207785454U falls into the field of medical devices and relates to a jaw opening and closing mouth rehabilitation robot that is especially suitable for patients with temporomandibular joint disorder syndrome.

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[0058] ScienceDirect. Description of The Invention

[0059] The invention relates to a mechanical temporomandibular hypermobility apparatus that can be used intraorally in temporomandibular joint (TMJ) hypermobility patients, especially in the field of dentistry, enables the desired mouth opening distance in hypermobility to be restricted / controlled with a distance between 35 and 50 mm, allows the patient to eat during the treatment process and eliminates the risk of possible complications such as osseous and fibrous ankylosis, and degenerated joint cartilage.

[0060] With the mechanical temporomandibular hypermobility apparatus that is the subject of the invention, patients can easily make all jaw movements, but it may not be possible to restrict the mouth opening distance, which is the criterion for hypermobility, to a distance between 35-50 mm as we would like. Mouth opening, which is considered hypermobility, can be controlled, the patient can feed easily, and since it is an aesthetically pleasing intraoral appliance, psychological tolerance of the patient is also possible. Thus, the development of fibrous or osseous ankylosis or degenerated articular cartilage due to intermaxillary fixation, which is an important complication in the treatment, will be eliminated, the success rate of conservative treatment will increase and the need for surgical treatment will be minimised.

[0061] The apparatus is fixed and cemented into the patient's mouth. Herbst arms can adjust the maximum mouth opening at the desired distance, and with the closed memory coil, all jaw movements can be made easily and can be adjusted vertically to the desired size by simulating the patient's mouth opening movements. It does not apply unwanted force to the jaw in any direction, unlike other devices. There is no application of force to the joint area. It does not hinder nutrition, the patient can easily maintain oral hygiene, and since it is an intraoral appliance, it does not cause any aesthetic problems. There is no risk of possible complications such as osseous and fibrous ankylosis, degenerated joint cartilage.

[0062] Figures

[0063] Figure 1.1 : Barrel Bandage Right-Side View

[0064] Figure 1.2: Barrel Bandage Left-Side View

[0065] Figure 2: Barton Bandage Side View Figure 3.1 : Chin cup Right-Side View

[0066] Figure 3.2: Chin cup Front View

[0067] Figure 4: Isometric View of Temporomandibular Hypermobility Apparatus

[0068] Figure 5: Side View of Temporomandibular Hypermobility Apparatus

[0069] Figure 6: Top View of Temporomandibular Hypermobility Apparatus

[0070] Figure 7: Front View of Temporomandibular Hypermobility Apparatus

[0071] Figure 8: Front-Detail A View of Temporomandibular Hypermobility Apparatus

[0072] Description of the Reference Numbers in the Drawings

[0073] 100. Temporomandibular Hypermobility Apparatus

[0074] 1. Custom Band

[0075] 2. Herbst Arm

[0076] 3. Flat Nut

[0077] 4. Coil Spring

[0078] 5. Fixing Screw

[0079] 6. Lower Jaw Model

[0080] 7. Upper Jaw Model

[0081] Abbreviations:

[0082] TMJ: Temporomandibular Joint

[0083] IMF: Intermaxillary Fixation

[0084] MMF: Maxillomandibular Fixation Detailed Description of The Invention

[0085] The invention relates to a mechanical temporomandibular hypermobility apparatus (100) that can be used intraorally in temporomandibular joint (TMJ) hypermobility patients, especially in the field of dentistry, enables the desired mouth opening distance in hypermobility to be restricted / controlled with a distance between 35 and 50 mm, allows the patient to eat during the treatment process and eliminates the risk of possible complications such as osseous and fibrous ankylosis, and degenerated joint cartilage, comprising:

[0086] • Custom bands (1 ) that are placed on the right-left second premolar and first molar region in the upper jaw, and on the right-left first premolar, second premolar and first molar teeth in the lower jaw, manufactured in a personalised 3D design with dental software on these dimensions, ensuring that the apparatus that is the subject of the invention remains stable,

[0087] • Herbst arm (2), which is used to restrict jaw opening to a certain distance and allows all directional movements of the jaw,

[0088] • Flat nut (3) of the Herbst arm (2), which allows the Herbst arm and the coil spring (4) to be mounted on the custom bands (1 ).

[0089] • A memory coil spring (4) with a closed form, which allows the jaw to open and close at a certain distance without being deformed, and

[0090] • Fixing screw (5) that ensures the fixing of the herbst arm (2) and the coil spring (4) to the flat nut part.

[0091] Measurements are taken from the patient's mouth, from the lower and upper jaw, classically with a spoon or digitally. If classical impressions are taken, they are digitised; if digital impressions are taken, plaster models are obtained directly. Afterwards, custom bands (1 ) are manufactured on these measurements using dental software with a personalised 3D design for the right-left second Premolar and first Molar region in the upper jaw, and for the right-left first Premolar, second premolar and first Molar teeth in the lower jaw. Custom bands (1 ) designed with dental software are produced with 3D SLM dental metal powders. Levelling and polishing of the individually produced custom bands (1 ) are carried out and placed on the models. The flat nut part (2) of the Herbst arm is cemented to the patient's lower and upper jaw after welding it to the custom bands (1 ). The closed-form coil spring (4) and the herbst arm (3) are mounted in the patient's mouth by inserting the key and the fixing screw (5) into the flat nut (2). The fixing screw (5) is preferably a hexagonal alien head screw. Herbst arms (3) are in a cylindrical and concentric form, preferably with different lengths of 18 mm, 21 mm, 25 mm. The coil spring (4) can be adjusted according to the desired mouth opening. 18 mm herbst arm (3) allows a maximum mouth opening of 45 mm (figure 5), 21 mm herbst arm (3) allows a maximum mouth opening of 52.5 mm, and 25 mm herbst arm (3) allows a maximum mouth opening of 62.5 mm, and while all jaw movements can be made easily with the memory coil spring (4), it can be adjusted vertically to the desired size by simulating the patient's mouth opening movements.

Claims

CLAIMS1. A mechanical temporomandibular hypermobility apparatus (100) that can be used intraorally in temporomandibular joint (TMJ) hypermobility patients, especially in the field of dentistry, enables the desired mouth opening distance in hypermobility to be restricted / controlled with a distance between 35 and 50 mm, allows the patient to eat during the treatment process and eliminates the risk of possible complications such as osseous and fibrous ankylosis, and degenerated joint cartilage, comprising;• Custom bands (1 ) that are placed on the right-left second premolar and first molar region in the upper jaw, and on the right-left first premolar, second premolar and first molar teeth in the lower jaw, manufactured in a personalised 3D design with dental software on these dimensions, ensuring that the apparatus (100) that is the subject of the invention remains stable,• Herbst arm (2), which is used to restrict jaw opening to a certain distance and allows all directional movements of the jaw,• Flat nut part (3) of the Herbst arm (2), which allows the Herbst arm and the coil spring (4) to be mounted on the custom bands (1 ).• A memory coil spring (4) that allows the jaw to open and close at a certain distance without being deformed, and• Fixing screw (5) that ensures the fixing of the herbst arm (2) and the coil spring (4) to the flat nut part.

2. Fixing screw (5) of Claim 1 , wherein, it is preferably a hexagonal alien head screw.

3. Herbst arm (2) of Claim 1 , comprising preferably three concentric cylindrical arms with lengths of 18 mm, 21 mm, 25 mm.

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