Orthodontic appliance systems and method of treatment using those systems

Abstract

An orthodontic appliance system (10) includes an aligner (12). The aligner (12) has a shell (22) that includes a first pair of cavities (24) and a second pair of cavities (24). Each cavity (24) of the first pair is configured to receive an anterior tooth (56). Each cavity (24) of the second pair is configured to receive a posterior tooth (64). The shell (22) includes a cavity (24) intermediate a first cavity (24) of the first pair of cavities (24) and a second cavity (24) of the second pair of cavities (24). Each intermediate cavity (24) is configured to receive a tooth intermediate the anterior (56) and posterior tooth (64). The intermediate cavity (24) may be oversized relative to the tooth. The shell (22) has walls (32, 34, 36, 40) defining the cavities (24). At least one of the walls (32, 34, 36, 40) of the intermediate cavities (24) includes a region of enhanced rigidity (42) that extends from the first cavity (24) to the second cavity (24) of the pairs of cavities (24). The region (42) may be a structure, such as a reinforcement beam (50).

Description

ORTHODONTIC APPLIANCE SYSTEMS AND METHOD OF TREATMENTUSING THOSE SYSTEMSCROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of priority of U.S. Provisional Application No. 63 / 488,925, filed on March 7, 2023, the content of which is incorporated by reference herein in its entirety.TECHNICAL FIELD

[0002] The present invention relates generally to orthodontic appliances for orthodontic treatment and, more particularly, to orthodontic appliance systems including one or more orthodontic appliances and methods of using orthodontic appliances and systems.BACKGROUND

[0003] Orthodontics is the practice of manipulating teeth to correct malocclusions between the teeth of the upper and lower dental arches. Typically, treatment of malocclusions includes the use of an orthodontic appliance that applies corrective forces to the teeth. Over time, these corrective forces coerce the teeth to move into their orthodontically correct positions. Dental malocclusions can be classified based on the positioning of the patient’s upper and lower molars. To achieve orthodontic treatment, certain types of malocclusions may require use of specialized appliances at one or more periods during treatment.

[0004] One way of applying corrective forces is with orthodontic appliances referred to as aligners. Aligners are supplied as a series of removable appliances that incrementally reposition the patient’s teeth from their initial orientation to their orthodontically correct orientation. Patients being treated with aligners can insert and remove the aligners at will. When one aligner has moved the teeth to at or near a final orientation for that aligner, the patient begins using the next aligner in the series according to a treatment plan, which is prescribed by a clinician.

[0005] To fabricate aligners, the clinician first obtains a computer model of the patient’s dentition. This model may be generated from data by taking animpression of the dentition and scanning the impression into a computer. Alternatively, the data may be generated by directly scanning the patient’ s teeth with an intraoral scanner. In either case, the scanned data is then used to construct the computer model of the patient’s dentition.

[0006] Once the computer model has been obtained, the orthodontist may manipulate individual teeth in the computer model to determine a final orientation of each tooth that provides a corrected dentition. Multiple computer models may then be generated, with each model corresponding to an initial orientation, one or more intermediate orientations, or a final, desired orientation of the dentition. The clinician choreographs the movements of the teeth from the initial orientation through each of the intermediate orientations to the final, desired orientation. This predetermined movement is referred to as a treatment plan.

[0007] Given that some teeth are moved over greater distances than is possible with a single aligner, the treatment plans are often divided into numerous incremental stages of movement. Tooth movement during each stage is often achieved with a single aligner. Each stage may therefore correspond to one computer model of the patient’s teeth at a particular orientation.

[0008] Once the treatment plan is designed with the series of computer models corresponding to the stages of tooth movement, the series of aligners corresponding to the series of models may be manufactured. A mold is first fabricated from each model. An aligner is then fabricated from the mold. In this way, the aligner may reflect the desired position of the patient’ s teeth according to one stage of treatment. Manufacturing each aligner in the series typically involves forming a plastic sheet over the mold that is constructed based on the patient’s teeth at a particular stage of treatment according to the treatment plan. After forming, waste material in the sheet may be trimmed away to produce the aligner. Trimming may utilize CNC milling or another computer controlled cutting system.

[0009] As an example of a particular type of malocclusion requiring a specialized appliance is a class II malocclusion, in which the molars and the anterior teeth of the maxillary jaw protrude relative to the mandibular jaw. This relative orientation of the teeth may cause the patient soft tissue problems, for example, it can cause a misorientation of the patient’s lips. A specialized appliance for correcting class II malocclusions includes a “Carriere motion” appliance. This is a metallicappliance that is attached to the patient’s maxillary jaw. Tooth moving forces are produced with elastics on the appliance. Under the applied force on the maxillary jaw at two locations, class I occlusion is achieved together with mandibular anterior repositioning. Stated differently, the Carriere motion appliance in conjunction with applied force rotates and uprights the patient’s first molars while moving the canine teeth or premolars to molars into their correct orthodontic position.

[0010] Another specialized appliance for correcting class II malocclusions includes a twin block appliance. This appliance includes a pair of devices, that is, a maxillary device and a mandible device. The pair of devices must be worn at the same time. Each of the devices includes a bite ramp. When the devices are worn, the bite ramps oppose one another. The opposing bite ramps interact as the patient closes their jaws. That forcible interaction guides the mandibular jaw into a more forward bite position. In other words, the interaction of the bite ramps generates relative jaw movement.

[0011] While these specialized appliances are generally successful, there remain problems with their use in combination with other orthodontic treatment. Improved orthodontic appliance systems are needed that ease orthodontic treatment and improve treatment efficiency and predictability during treatment with aligners.SUMMARY OF THE INVENTION

[0012] The present invention overcomes the shortcomings and drawbacks in orthodontic systems including orthodontic aligners and attachments heretofore known for use in orthodontic treatment. While the invention will be described in connection with certain embodiments, it will be understood that the invention is not limited to those embodiments. On the contrary, the invention includes all alternatives, modifications and equivalents as may be included within the spirit and scope of the present invention.

[0013] In accordance with the principles of the present invention, an orthodontic appliance system for orthodontic treatment of a patient’s teeth includes a first aligner including a shell having a plurality of cavities. The shell is visually divided at a middle line into a first side and a second side. The shell includes (i) a first pair of cavities. One cavity of the pair of first cavities on each of the first and second sides is configured to receive an anterior tooth. The shell includes (ii) asecond pair of cavities. One cavity of the pair of second cavities on each of the first and second sides is configured to receive a posterior tooth. And, the shell includes (iii) at least one cavity intermediate a first cavity of the first pair of cavities and a second cavity of the second pair of cavities on each of the first and second sides. Each intermediate cavity is configured to receive a tooth that is intermediate the anterior tooth and the posterior tooth. The shell has a plurality of walls defining the plurality of cavities, and at least one of the walls of the intermediate cavities includes a region of enhanced rigidity that extends from the first cavity to the second cavity on each of the first and second sides.

[0014] In one embodiment, the regions of enhanced rigidity are reinforcement beams integral with the at least one of the walls, the reinforcement beams having a non-tooth shape.

[0015] In one embodiment, the reinforcement beams include a first interproximal portion between the first cavity and the at least one intermediate cavity and a second interproximal portion between the at least one intermediate cavity and the second cavity.

[0016] In one embodiment, the reinforcement beams have a U-shaped cross section.

[0017] In one embodiment, (i) at least one of the plurality of walls of each cavity of the first pair of cavities includes a first receptacle that is open to the respective cavity, (ii) at least one of the plurality of walls of each cavity of the second pair of cavities includes a second receptacle that is open to the respective cavity, and (iii) at least one of the plurality of walls of each of the pair of intermediate cavities is configured to be spaced apart from the tooth surface when the aligner is coupled to the patient’s teeth.

[0018] In one embodiment, the at least one of the plurality of walls of each cavity of the first pair of cavities and the at least one of the plurality of walls of each cavity of the second pair of cavities is a labial wall.

[0019] In one embodiment, the first receptacles are anterior-most ends of the region, and the second receptacles are posterior-most ends of the region.

[0020] In one embodiment, the first receptacles are in the form of integrated hooks that are configured to receive an elastic.

[0021] In one embodiment, the at least one of the plurality of walls of each cavity of the first pair of cavities includes a cutout configured to receive a button.

[0022] In one embodiment, the system further includes a first attachment secured to each of the anterior teeth and received in a respective one of the first receptacles. In one embodiment, each first attachment has a prism-like configuration with a longitudinal axis that is aligned with a long axis of the anterior tooth. In one embodiment, the system further includes a second attachment secured to each of the posterior teeth and received in a respective one of the second receptacles. In one embodiment, each second attachment has a prism-like configuration with a longitudinal axis that is aligned with a long axis of the posterior tooth.

[0023] In one embodiment, at least one of the pair of intermediate cavities is oversized relative to the tooth in at least one dimension.

[0024] In one embodiment, the system further includes a second aligner. The second aligner includes a shell having a plurality of cavities and is visually divided by a middle line into a first side and a second side. The shell includes a pair of cavities. One cavity is on each side of the middle line. Each cavity of the pair of cavities is configured to receive a posterior tooth. The shell has a plurality of walls that define the pair of cavities. One of the plurality of walls of each of the pair of cavities includes a receptacle that opens to the cavity and is configured to receive an attachment. In one alternative embodiment, the system further includes a second aligner. The second aligner includes a shell having a plurality of cavities and is divided by a middle line into a first side and a second side. The shell includes a pair of cavities. One cavity is on each side of the middle line. Each cavity of the pair of cavities is configured to receive a posterior tooth. The shell has a plurality of walls defining the pair of cavities, and one of the plurality of walls of each of the pair of cavities includes a cutout.

[0025] In one embodiment, each of the shells of the first aligner and the shell of the second aligner includes a pair of blocks. One block is on each side of the middle line and is configured to extend occlusally so that the blocks on the first aligner contact the blocks on the second aligner. When the first and second aligners are coupled to the patient’s teeth, the blocks are configured to advance the patient’s mandibular jaw.

[0026] In one aspect of the present disclosure there is a method of orthodontic treatment using any of the disclosed embodiments of the system.

[0027] In one embodiment, an orthodontic appliance system for orthodontic treatment of a patient’ s teeth includes an aligner. The aligner includes a shell having a plurality of cavities and being divided by a middle line into a first side and a second side. The shell includes (i) a first pair of cavities. Each of the cavities of the first pair of cavities is configured to receive an upper canine. The shell includes (ii) a second pair of cavities. Each of the cavities of the second pair of cavities is configured to receive a upper first molar. The shell includes (iii) two cavities between a first cavity of the first pair of cavities and a second cavity of the second pair of cavities on each of the first and second sides. Each of the two cavities is configured to receive a premolar. The shell has a plurality of walls defining the plurality of cavities and at least a labial wall of each of the two cavities includes a reinforcement beam that extends from the first cavity to the second cavity on each of the first and second sides.

[0028] In one embodiment, each reinforcement beam has a non-tooth shape.

[0029] In one embodiment, each reinforcement beam includes a first interproximal portion between the first cavity and one of the two cavities, a second interproximal portion between the two cavities, and a third interproximal portion between the other of the two cavities and the second cavity.

[0030] In one embodiment, each reinforcement beam has a U-shaped cross section.

[0031] In one embodiment, each of the two cavities between the first cavity and the second cavity is oversized relative to the respective premolar in at least one dimension. In one embodiment, the at least one dimension is configured to position a labial wall of at least one of the two cavities between the first cavity and the second cavity apart from a respective one of the premolars.

[0032] In one aspect of the disclosure, there is a method of treating a patient with an orthodontic appliance system. The method includes inserting a first aligner on the patient’s teeth in an upper jaw. In one embodiment, the first aligner includes a shell having a plurality of cavities and is visually divided at a middle line into a first side and a second side. The shell includes (i) a first pair of cavities. One cavity of the pair of first cavities is on each of the first and second sides. Each cavity of the first pair of cavities receives a corresponding anterior tooth. The shell includes (ii) asecond pair of cavities. One cavity of the pair of second cavities is on each of the first and second sides. Each cavity of the second pair of cavities receives a corresponding posterior tooth. The shell includes (iii) at least one cavity intermediate a first cavity of the first pair of cavities and a second cavity of the second pair of cavities on each of the first and second sides. Each of the at least one cavity receives a tooth that is intermediate the corresponding anterior tooth and the corresponding posterior tooth. The shell has a plurality of walls defining the plurality of cavities and at least one of the walls of the intermediate cavities includes a region of enhanced rigidity that extends from the first cavity to the second cavity on each of the first and second sides. The method includes applying a force on each cavity of the first pair of cavities and / or each anterior tooth. Each region of enhanced rigidity transfers at least a portion of the applied force to each posterior tooth.

[0033] In one embodiment, the method further comprises securing an attachment to each of the corresponding anterior teeth on the upper jaw. Applying the force on each cavity of the first pair of cavities and / or each anterior tooth includes applying the force at the attachment on each anterior tooth.

[0034] In one embodiment, the shell of the first aligner includes a pair of receptacles. Each receptacle of the pair of receptacles opens to a respective one of the first cavities and is positioned at an anterior-most end of the region of enhanced rigidity. During inserting the first aligner, each receptacle of the pair of receptacles receives a respective one of the attachments. Applying the force at the attachment on each anterior tooth includes applying force at each of the receptacles.

[0035] In one embodiment, the method further includes securing an attachment to each of the corresponding posterior teeth on the upper jaw. Applying the force on each cavity of the first pair of cavities and / or each anterior tooth includes transferring a portion of the applied force through each region of enhanced rigidity to each attachment on each of the corresponding posterior teeth.

[0036] In one embodiment, the shell of the first aligner includes a pair of receptacles. Each receptacle of the pair of receptacles opens to a respective one of the second cavities and is positioned at an posterior-most end of the region of enhanced rigidity. During inserting of the first aligner, each receptacle of the pair of receptacles opens to the respective one of the second cavities receives a respective one of the attachments on the posterior teeth.

[0037] In one embodiment, the method further includes securing an attachment to at least two teeth on the patient’s lower jaw. Applying the force on each cavity of the first pair of cavities and / or each anterior tooth includes applying a force to each of the attachments on the patient’s lower jaw.

[0038] In one embodiment, the method further includes inserting a second aligner on the patient’s teeth in a lower jaw.

[0039] In one embodiment, applying the force includes connecting one end of an elastic the first pair of cavities and / or each anterior tooth.BRIEF DESCRIPTION OF THE DRAWINGS

[0040] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the detailed description given below, serve to explain various aspects of the invention.

[0041] Fig. 1 is a perspective view of an exemplary embodiment of an orthodontic appliance system for orthodontic treatment of a patient.

[0042] Fig. 2 is a perspective view of one embodiment of an upper aligner of the exemplary orthodontic appliance system of Fig. 1 relative to the patient’s maxillary jaw.

[0043] Fig. 3A is a cross sectional view of the upper aligner shown in Fig. 1 taken along section line 3A-3A.

[0044] Fig. 3B is a cross sectional view of the upper aligner shown in Fig. 1 taken along a similar section line as the cross section shown in Fig. 3A illustrating an exemplary embodiment of the invention.

[0045] Fig. 3C is a cross sectional view of the upper aligner shown in Fig. 1 taken along section line 3C-3C.

[0046] Fig. 4 is perspective view of one embodiment of a lower aligner of the exemplary orthodontic appliance system of Fig. 1 relative to the patient’s mandibular jaw.

[0047] Figs. 5A and 5B depict an elevation view and a plan view of a digital model of a patient’ s teeth, respectively, having one or more interlinked attachments extending from a canine to a fist molar, an attachment on the canine, and an attachment on the first molar (only one side of the jaw is shown with the attachments in Fig. 5B).

[0048] Figs. 5C and 5D depict an elevation view and a plan view of a digital model of a mold of the patient’s teeth corresponding to the model teeth shown in Figs. 5A and 5B showing a digital form built-in to the mold model and over which an aligner is to be formed for use on the teeth shown in Figs. 5A and 5B.

[0049] Figs. 6A, 6B, 6C, and 6D are a series of digital tooth models showing a model of treatment progression with the attachments shown in Fig. 5A under a force (indicated by arrow) produced by an elastic (not shown).

[0050] Fig. 7A is a virtual model illustrating a virtual model of a mold for manufacturing an orthodontic appliance system according to one embodiment of the invention.

[0051] Figs. 7B, 7C, and 7D are photographs of a clinical case with the orthodontic treatment system of Fig. 7A in use.

[0052] Fig. 8A is a virtual model illustrating an orthodontic appliance system.

[0053] Fig. 8B is a photograph of a clinical case with the orthodontic appliance system of Fig. 8A in use.

[0054] Figs. 9A, 9B, 9C, and 9D are photographs of a test arrangement for measuring derotation produced by an orthodontic appliance system manufactured according to the exemplary virtual model of a mold shown in Fig. 7A.

[0055] Figs. 10A and 10B are graphs of rotation versus torque with the arrangement shown in Figs. 9A, 9B, 9C, and 9D.

[0056] Fig. 11 is an elevation view of a virtual model of a patient’s teeth illustrating an orthodontic appliance system according to one embodiment of the invention.

[0057] Fig. 12 is a plan view of a virtual model of an orthodontic appliance system according to one embodiment of the invention.DETAILED DESCRIPTION

[0058] Embodiments of the invention are directed to orthodontic treatment systems. Exemplary systems may include one or more dental aligners, one or more attachments to be secured to a patient’ s teeth, and elastics for application of force to one or more teeth in a patient’s upper jaws. Exemplary systems may be capable of derotating at least one of the patient’s molars and producing maxillary distalization and / or mandibular advancement during orthodontic treatment. Derotation anddistalization and / or advancement may be achieved in exemplary systems in which one or more upper (maxillary) aligners include a region of enhanced rigidity relative to other regions of the aligner. As example, the region of the aligner may be in the form of a built-in reinforcement beam or other structure located adjacent selected teeth and then formed in the aligner during manufacturing. That is, the region is integral to the aligner but may not conform to the patient’s teeth. The region of enhanced rigidity may be designed and positioned to transfer tooth-moving forces between teeth, such as between an anterior tooth (i.e., one of the central incisors, the lateral incisors, or the cuspids) and a posterior tooth (i.e., one of the bicuspids, the premolars, or molars).As an example, the aligner may receive a tooth-moving force, such as externally from an elastic, at the patient’s canine. The elastic may, as an example, be coupled to the patient’s mandibular jaw. That external force is predominately transferred to the patient’s first molar but is not intentionally applied to teeth positioned between the canine and first molar, e.g., a premolar. The external force is transferred to the posterior tooth and, in essence, skips over intermediate teeth, e.g., a premolar. Stated another way, in one embodiment, the region of the aligner does not direct the external force to teeth intermediate the anterior tooth and the posterior tooth on the patient’ s maxillary jaw. Alternatively, any force component from the external force transferred to the teeth intermediate the anterior tooth and the posterior tooth is insufficient to move the intermediate teeth. By contrast to the external force applied at the anterior tooth, the aligner may apply orthodontic forces from other regions of the aligner to the intermediate teeth according to the treatment plan. By the external force transfer, the posterior tooth is derotated. By derotated, it is meant that the tooth is rotated toward its anatomically normal position. Derotation according to embodiments of the invention is achieved in the absence of a mechanical ball joint that is present in metallic appliances, such as the Carriere motion appliance. Following derotation, force on the anterior tooth may permit distalization.

[0059] As another example, pairs of aligners may include opposing, occlusally-extending structures in addition or as an alternative to the region of enhanced rigidity. The occlusally-extending structures, which appear as hollow blocks, interact to produce mandibular advancement as the patient closes their jaws. Exemplary occlusally-extending structures include regularly-shaped volumes built into the aligners that are not tooth shaped. These structures may be designed into amold and then formed during manufacturing of the aligner. Via one or both the exemplary systems, class II malocclusions may be corrected during treatment. It is believed the exemplary systems improve treatment efficiency and so reduce treatment time for adults and for children. Improved treatment efficiency and treatment time reduction may be achieved in the absence of metallic components or metallic appliances. In this way, the aesthetic advantage of aligner treatment is also retained. Further, advantageously, both dental and skeletal changes may be achieved. Other advantages of exemplary systems may include correction of class II malocclusions, even in the case of poor patient compliance.

[0060] To those ends, and with reference to generally to the figures and in particular to Fig. 1, an exemplary orthodontic appliance system 10 includes one or more of an upper aligner 12, a lower aligner 14, one or more attachments 16, and elastics 20. While each of the aligners 12 and 14, the attachments 16, and the elastic 20 are described in more detail below, exemplary orthodontic appliance systems 10 may include one or more of any single one of the aligners 12 and 14 with or without the attachments 16 and with or without elastics 20. Thus, exemplary embodiments of the invention are not limited to the combination of aligners 12 and 14, attachments 16, and the elastic 20 shown in Fig. 1. For example, embodiments of the orthodontic appliance system 10 may include only the upper aligner 12. As another example, one embodiment may include only the lower aligner 14. And, as yet another example, one embodiment may include the upper aligner 12 and the lower aligner 14.

[0061] With reference to Figs. 1 and 2, in one embodiment, the upper (i.e., maxillary) aligner 12 is designed to be attached to a patient’s maxillary jaw and is configured to apply tooth moving forces to one or more of the patient’ s teeth. In that regard, the upper aligner 12 may be one aligner of a set of upper aligners designed to incrementally move one or more teeth from their initial, untreated position and / or orientation to one or more intermediate positions and / or orientations to a final, aesthetic position and / or orientation according to a treatment plan. The treatment plan may be developed by a clinician, and the set of upper aligners may be manufactured according to that treatment plan. As shown, the exemplary upper aligner 12 includes a hollow shell 22 that is configured to encapsulate crowns of a plurality of the patient’s teeth 18. The shell 22 is formed with a plurality of cavities 24 that collectively define an edge 26. One or more of the cavities 24 may be shaped toreceive a specific one of the patient’s teeth 18. Tn the embodiment shown, a middle line 28 of the shell 22 is defined between cavities 24 configured to receive the patient’s central incisors. The middle line 28 of the shell 22 may be offset from a midline of the patient’s facial anatomy. The offset may be corrected during treatment. The edge 26 defines an opening 30 in the shell 22 and defines a gingival edge of the shell 22. The patient’s teeth 18 are received into their respective cavities 24 through the opening 30 when the aligner 12 is placed on the patient’s jaw.

[0062] The shell 22 has wall portions that contact some of the surfaces of the patient’s teeth 18 and define the cavities 24. By way of example, the shell 22 includes an occlusal wall 32, a labial wall 34, and a lingual wall 36. The shell 22 may also include distal portions 40 that encircle the cavities 24 that receive the rear-most molar teeth. When the cavities 24 receive the patient’s teeth 18, walls 32, 34, 36, and 40 generally conform to, and some cases contact, the corresponding surfaces of a respective one of the patient’s teeth with the edge 26 positioned proximate the patient’s gingiva.

[0063] In an exemplary embodiment, the shell 22 includes a region of enhanced rigidity 42 shown, for example, in the labial wall 34 extending across multiple cavities 24. Although not visible in Fig. 1, a second region of enhanced rigidity 42 may extend across multiple ones of the patient’s teeth 18 on the other side (e.g., the right side) of the patient’s jaw. In that regard, embodiments of the orthodontic appliance system 10 may be symmetrically positioned with respect to the middle line 28 of the shell 22 though embodiments of the invention are not limited to any symmetrical configuration of the aligner 12. In that regard, a region of enhanced rigidity 42 is on the right side of the patient’s teeth but is not visible in Figs. 1 and 2. One or both of the regions of enhanced rigidity 42 may be designed to transfer toothmoving forces between two spaced-apart teeth. For example, the region 42 may transfer a tooth-moving force from an anterior tooth (i.e., one of the central incisors, the lateral incisors, or the cuspids) directly to a posterior tooth (i.e., one of the bicuspids, the premolars, or molars) where the posterior tooth is spaced apart from the anterior tooth by at least one intermediate tooth. The regions 42 therefore span a mesial-distal dimension sufficient to extend across multiple of the patient’s teeth 18 on the left side and / or on the right side of the patient’s maxillary jaw. The regions 42 have an occlusal-gingival height dimension and a labial-lingual width dimensionsufficient to transfer tooth-moving forces. These dimensions may be unrelated to the patient’s anatomy but are designed to resist mesial-distal compression of the respective cavities 24 when these cavities 24 are placed under a compression load, such as from the elastic 20. The selected cavities 24 in the region 42 may therefore retain their as-formed dimensions as an applied force is transferred through the region 42. Thus, where the selected cavities 24 are not contacting the patient’s teeth, application of force from the elastic 20 and its transfer via the region 42 does not cause any of the walls 32, 34, 36, and 40 to contact the tooth if not already in contact. In other words, the walls 32, 34, 36, and 40 do not deform under application of compression on the region 42 sufficient to cause wall-to-tooth contact where there was not contact prior to load application.

[0064] In exemplary embodiment shown in Fig. 2, the region of enhanced rigidity 42 is a result of structure 46 of the shell 22. In other words, in the exemplary embodiment, no separate structure (e.g., a metallic rod) is attached to the shell 22 to provide the rigidity sufficient to transfer forces. By way of example only, the structure 46 may be integral to the labial wall 34 only along selected ones of the cavities 24. Although not shown, the structure 46 may be integral to the lingual wall 36 in addition or as an alternative to the labial wall 34. The structure 46 may be unrelated to the shape of the patient’ s tooth anatomy in each of the occlusal-gingival and labial-lingual dimensions. Nevertheless, despite having a non-tooth like shape, the structure 46 retains the aesthetic transparency of the shell 22.

[0065] In the exemplary embodiment shown in with reference to Figs. 1, 2, and 3A, the structure 46 is a reinforcement beam 50 formed in the labial wall 34 of the shell 22. The reinforcement beam 50 extends from an upper canine cavity (sometimes referred to as a cuspid) 52 to a first molar cavity 54 of the shell 22. The reinforcement beam 50 thus spans a mesial-distal distance between a canine 56 and a first molar 60 over each of a first premolar 62 and a second premolar 64. As an example, the upper aligner 12 may receive a tooth-moving force at the patient’s canine cavity 52. That force is predominately transferred to the first molar cavity 54 via the reinforcement beam 50 in the labial wall 34. The force is not intentionally applied to teeth positioned between the canine 56 and first molar 60, e.g., to either of premolars 62 and 64. The force transfer, in essence, skips over the intermediate teeth 62 and 64. In the example, the reinforcement beam 50 may have a U-shaped cross-sectional configuration (see Fig. 3C) in which the U-shape opens to the cavities 24. By way of example only, and not limitation, an occlusal-gingival height dimension of the reinforcement beam 50 ranges from 1 mm to 3 mm and a labial-lingual width dimension of the reinforcement beam 50 ranges from 1 mm to 3 mm.

[0066] In some embodiments, selected ones of the cavities 24 conform to the patient’s teeth and other cavities 24 may be oversized relative to the corresponding tooth. As an example, and with reference to Figs. 3A and 3C, a labial wall 66a of the shell 22 adjacent the premolar 62 and a labial wall 70a of the shell 22 adjacent the premolar 64 may be spaced apart from the perspective teeth 62 and 64 when the aligner 12 is attached to the patient’s teeth 62, 64. That is, neither the labial wall 66a nor the labial wall 70a of the shell 22 contacts the respective tooth 62, 64 when the aligner 12 is initially inserted into the patient’s jaw or after application of the elastic 20. By way of example, a perpendicular distance 72 between the respective tooth surface and the labial wall 66a, 70a may be sufficient to prevent the labial wall 66a, 70a from contacting the corresponding tooth 62, 64 during application of force to the aligner 12. As an example, the distance 72 may be 1 mm. This spacing may be generated by enlarging the mold of each corresponding tooth 62 and 64 in one or more directions related to the desired spacing. When the aligner 12 is formed over the enlarged molded tooth, the labial wall 66a and 70a of the shell 22 will be spaced apart from the actual tooth during orthodontic treatment.

[0067] Further in that regard, while the labial wall 66a and 77a may be spaced apart from the respective tooth 62 and 64, a lingual wall 66b and 77b with respect to a lingual portion of the corresponding teeth 62, 64 may be formed to conform to the teeth 62, 64. When conforming to the tooth, the upper aligner 12 at the lingual wall 66b and / or lingual wall 77b may contact the corresponding tooth 62, 64 and exert a force sufficient to cause the tooth 62, 64 to move in accordance with a planned orthodontic treatment. Although not shown in Fig. 3A, neither, one, or both of the labial walls 66a, 70a and neither, one, or both of the lingual walls 66b, 70b may exert force on the respective tooth 62, 64 depending on the treatment plan. Embodiments of the upper aligner 12 are not limited to the embodiment shown in Figs. 3A and 3C. The labial walls 66a, 70a and lingual walls 66b, 70b may be individually selectively positioned to move or to not move the respective tooth 62, 64.

[0068] With continued reference to Figs. 2 and 3A, in the exemplary embodiment, the upper aligner 12 includes a receptacle 74 open to the cavity 54 that is configured to receive the first molar 60. According to some embodiments, an attachment 76 is secured to the patient’s first molar 60. The attachment 76 is received in the receptacle 74 when the upper aligner 12 is applied to the patient’s jaw. In one embodiment, the attachment 76 is beveled and has a generally prism-like shape. The attachment 76 may have an elongated dimension which may be aligned with a long axis of the first molar 60 when the attachment 76 is adhesively secured to the first molar 60. In the aligner 12, the receptacle 74 may be at a posterior-most end 82 of the reinforcement beam 50. As shown, a surface 80 of the attachment 76 faces an anterior direction, that is, toward the canine 56. The attachment 76 is proximate the posterior-most end 82 of the reinforcement beam 50 and is positioned for forcible engagement with the reinforcement beam 50, in particular, at the surface 80, which may be flat. The contact between the surface 80 and the reinforcement beam 50 may be generally perpendicular (e.g., ± 10 °). It is believed that the reinforcement beam 50 contacts the surface 80 during application of force with the elastic 20. That is, when a load is applied to the reinforcement beam 50, it pushes against the surface 80. Due to the orientation of the reinforcement beam 50 with the surface 80, there is load transfer from the beam 50 to the attachment 76 at the surface 80. In turn, the attachment 76 moves causing the first molar 60 to derotate. Contact between the aligner 12 and the attachment 76 is a sliding contact. The first molar 60 derotates under a force applied at the surface 80 by the beam 50. While not shown, the aligner 12 may cause the first molar 60 to derotate or move without application of the elastic 20, that is, any single one or a combination of the walls 32, 34, 36, and 40 may forcibly contact the first molar 60 and cause tooth movement. An orientation and a shape of the attachment 76 on the first molar 60 facilitates this force transmission and sliding connection and thus derotation. This sliding contact, force-transfer mechanism is described with reference to Figs. 6A-6D below.

[0069] As shown in Figs. 2 and 3A, in the exemplary embodiment, the upper aligner 12 includes a receptacle 84 open to the cavity 52 configured to receive the canine 56. According to some embodiments, an attachment 86 is secured to the patient’s canine 56. The attachment 86 is received in the receptacle 84 when the upper aligner 12 is applied to the patient’s jaw. In one embodiment, the attachment86 has a hook shape and the receptacle 84 also has a hook shape. This configuration may more effectively transfer an applied load from the elastic 20 (Fig. 1) to the canine 56 into the aligner 12 to be transferred to the reinforcement beam 50 and then to the first molar 60, described above. The receptacle 84 may be positioned at an anterior- most end 90 of the reinforcement beam 50. The attachment 86 is therefore proximate the reinforcement beam 50 and may forcibly engage the reinforcement beam 50. In particular, engagement may be at the attachment 86 when a load is applied via the elastic 20. In other embodiments, a button (not shown) may be attached to the canine 56. The aligner 12 may then have a cutout (not shown) to cooperate with the button. The button may then directly receive the elastic 20. In still other embodiments, an attachment and a button are attached to the canine 56. The button receives the elastic 20 and the attachment engages the reinforcement beam 50 in a similar manner as the attachment 86 described above.

[0070] With reference to Fig. 3A, in one embodiment, the reinforcement beam 50 is formed of a plurality of interproximal portions 88. As shown, the interproximal portions 88 are located in the labial wall 34 of the shell 22 and span regions between adjacent cavities 24. In the exemplary embodiment shown, for example, the interproximal portion 92 bridges a valley between the labial walls 66a and 70a, the interproximal portion 94 spans a valley between the labial wall 66a and the receptacle 84, and the interproximal portion 96 spans a valley between the labial wall 70 and the receptacle 74. The reinforcement beam 50 may prevent a bellows type of compression between adjacent cavities 24 where the labial, lingual, and occlusal walls deform and the cavities 24 collapse under the compression force. The minimum labial-lingual dimension of the reinforcement beam 50 may be equal to a distance between an intersection between adjacent labial walls 66a and 70a and the labial-most extent of one of the labial wall 66a and 70a. In other words, the minimum dimension may be equal to the labial-lingual depth of a valley between each cavity 24 so that the beam 50 just fills the valleys between cavities and is flush with an outermost surface of the labial walls 66a and 70a. The maximum labial-lingual dimension of the reinforcement beam 50 may be greater than the depth of the valley between each cavity 24. In this configuration, as shown, rather than individual, spaced apart interproximal portions 88, the reinforcement beam 50 would has a continuous outwardly extending labial appearance from the receptacle 74 to the receptacle 84.

[0071] With reference to Fig. 3B, in one embodiment, the region of enhanced rigidity 42 may be another reinforcement mechanism in the labial wall 34 between the receptacles 74 and 84. That is, instead of a structure 46, like the beam 50, the labial wall 34 may be treated (as is indicated by shading at region 87) so that the material itself is capable of transferring a force applied to the receptacle 84 to the receptacle 74 without significant deformation of the labial walls 66a and 70a. For example, the labial walls 66a and 70a may not deform sufficiently to contact the respective adjacent tooth 62, 64. With reference to Figs. 1 and 4, in one embodiment, the lower (i.e., mandibular) aligner 14 is designed to be attached to a patient’s mandibular jaw and is configured to apply tooth moving forces to one or more of the patient’s teeth 18. In that regard, the lower aligner 14 may be one aligner of a set of lower aligners designed to move one or more teeth from their initial, untreated position and / or orientation to one or more intermediate positions and / or orientations to a final, aesthetic position and / or orientation according to a treatment plan. The treatment plan may be developed by a clinician, and the set of lower aligners may be manufactured according to that treatment plan. The lower aligner 14 may be used in conjunction with the upper aligner 12 shown in Figs. 1 and 2. As shown, the exemplary lower aligner 14 includes a hollow shell 100 that is configured to encapsulate crowns of a plurality of the patient’s teeth 18. The shell 100 is formed with a plurality of cavities 102 that collectively define an edge 104. One or more of the cavities 102 may be shaped to receive a specific one of the patient’s teeth 18. The edge 104 defines an opening 106 in the shell 100 and defines a gingival edge of the shell 100. The patient’s teeth 18 are received into their respective cavities 102 through the opening 106 when the aligner 14 is placed on the patient’s jaw.

[0072] The shell 100 has wall portions that contact some of the surfaces of the patient’s teeth 18 and define the cavities 102. By way of example, the shell 100 includes an occlusal wall 110, a labial wall 112, and a lingual wall 114. The shell 100 may also include distal portions 116 that encircle the cavities 102 that receive the rear-most molar teeth. When the cavities 102 receive the patient’s teeth 18, walls 110, 112, 114, and 116 generally conform to, and some cases contact, the corresponding surfaces of a respective one of the patient’s teeth with the edge 104 positioned proximate the patient’s gingiva.

[0073] As is shown in Fig. 4, in an exemplary embodiment, the shell 100 includes a receptacle 120 in the labial wall 112. By way of example, the receptacle 120 is open to a cavity 122 configured to encapsulate a first molar 124. In the embodiment shown, the receptacle 120 may be in the form of an integral hook that is configured to receive the elastic 20 (shown in Fig. 1). In that regard, embodiments of the orthodontic appliance system 10 may be symmetrically positioned with respect to the middle line 128 of the shell 100. Thus, although not visible in Fig. 4, a receptacle may be formed in the shell 100 on the right-side first molar.

[0074] An attachment 126 is secured to the first molar 124. In one embodiment, the attachment 126 has a hook- like shape is configured to secure the elastic 20. When the lower aligner 14 is applied to the patient’s mandibular jaw, the attachment 126 is received in the receptacle 120. Application of the elastic 20 to the lower aligner 14 at the receptacle 120 and attachment 126 applies a force tending to advance the patient’s mandibular jaw relative to the maxillary jaw. See, for example, Fig. 1. While the integral hook is shown, embodiments of the invention are not limited to the integral hooks. For example, as an alternative to the receptacle 120, the lower aligner 14 may include a cutout (not shown) in the labial wall 112. A cutout would expose a surface of the first molar 124 on which a button (not shown) is attached. In such embodiments, the button receives the elastic 20.

[0075] In one exemplary embodiment, and with reference to Figs. 5A and 5B, a virtual model 132 for manufacturing the aligner 12, described above, is shown. In one embodiment, a virtual elongated horizontal beam attachment 130 may be attached to the intermediate teeth and be extended from an anterior tooth to a posterior tooth. In the exemplary embodiment shown in Figs. 5A and 5B, the virtual elongated horizontal beam attachment 130 may be a single horizontal attachment or a plurality of horizontal beam attachments 134 on to the model teeth 62 and 64. Individual, virtual horizontal beam attachments 134 may be interlinked or are in contact with one another to form a single virtual beam attachment. A mold representing the virtual model 132 is manufactured. The mold includes a form representing the attachment 130. The aligner 12 may be formed with the reinforcement beam 50 being formed by the mold. In other words, in the embodiment shown, the reinforcement beam 50 is as- formed in the aligner 12.

[0076] Referring now to Figs. 5C and 5D, in an alternative embodiment to Figs. 5A and 5B, the reinforcement beam 50 is formed during manufacturing of the mold. As an example, on a virtual mold 150 of the teeth 18, a single form 152 extends from the canine 56 to the first molar 60. The single form 152 is constructed to span over the premolars 62 and 64. A mold may be manufactured based on the virtual mold 150. The aligner 12 is manufactured by deforming a worksheet over the mold and over the form 152 to create the reinforcement beam 50. The reinforcement beam 50 thus has an internal hollow core in the shape of the form 152.

[0077] With reference to Figs. 6A, 6B, 6C, and 6D, derotation in a virtual model is illustrated in accordance with the virtual model 132 shown in Fig. 5 A. The attachment 130 illustrates force transfer in accordance with use of the aligner 12 having the regions 42. In the series of figures, an elastic (not shown) may be attached to a button 136 on the canine 56. When the elastic applies force (indicated by arrow 140 in Figs. 6B, 6C, and 6D) at the button 136, that force is transmitted via the canine 56 to the attachment 86. The attachment 86 contacts the elongated horizontal beam attachment 130. The force is transmitted from the attachment 86 through the elongated horizontal beam attachment 130 to the attachment 76 at its contact point with the elongated horizontal beam attachment 130. The molar 60 is derotated according to arrow 142 in Figs. 6B, 6C, and 6D. A degree of derotation of the molar 60 is shown by relative movement of an axis 144 of the molar 60.

[0078] Although not shown in Figs. 6A-6D, one advantage to treatment with embodiments of the orthodontic appliance systems disclosed herein is the incremental, staged movement of the teeth according to a treatment plan. With a conventional Carriere motion device, derotation and distalization must be completed. Typically, this results in large gaps between the patient’s canines and the central incisors. The gap can be noticeable and visually awkward. The patient may be more self-conscience because of the gap. Once the gap is formed, the Carriere motion device is removed. The patient’s anterior teeth are then retracted into the gaps. That is, there are two stages of treatment, derotation / distalization and retraction. With embodiments of the invention, the gaps need not be formed. That is, a treatment plan may call for incremental derotation followed by anterior tooth retraction. The treatment plan may iterate between incremental derotation followed by incrementalanterior retraction. By doing each movement incrementally, large, unsightly gaps are avoided.

[0079] In one exemplary embodiment, and with reference to Figs. 1, 2, and 4, the upper aligner 12 includes an occlusally extending block 160, and the lower aligner 14 includes an opposing occlusally extending block 162. The blocks 160, 162 are integral with the shell 22, 100 and may be hollow. As shown, each of the blocks 160, 162 includes an angled surface 164, 166, respectively. The blocks 160, 162 are located in the respective aligners 12, 14 so that the blocks 160, 162 engage one another when the patient closes their jaws. As can be appreciated by Fig. 1, as the patient closes their jaws, the mandible jaw approaches the maxillary jaw and the angled surface 166 comes in the sliding contact with the angled surface 164. Due to the angled nature of the surfaces 164, 166, further closure of the jaws causes a force on the mandible jaw to advance anteriorly.

[0080] At some predetermined distance, represented by a height of the block 160 on the upper aligner 12 or a height of the block 162 on the lower aligner 14, further closure of the jaws is prevented by tooth contact with one or both blocks 160, 162. By way of example only, and not limitation one or both of the blocks 160, 162 may be less than 6 mm in height. By way of further example, the height of the blocks 160, 162 may be less than 4 mm. Embodiments of the invention are not limited to aligners 12 and 14 having blocks 160 and 162, respectively. For example, aligners 12 and 14 may be utilized without blocks 160 and 162. In an exemplary embodiment in which the reinforcement beam 50 and blocks 160, 162 are utilized together, mandibular advancement may be achieved more rapidly, because the mandibular jaw will be advanced under the tension of the elastic 20 when the blocks 160, 162 are not engaged and the mandibular jaw will be advanced when the blocks 160, 162 are engaged. Thus, the mandibular jaw will be advanced at all times or continuously. Further, it is believed that by use of the elastics 20, the height of the blocks 160 and 162 may be reduced by 50% while still retaining the desired mandibular advancement. Further, in the absence of patient compliance with use of the elastics 20 or with full jaw closure, some mandibular advancement will be achieved. The combination of blocks 160 and 162 with elastics 20 work in harmony and compliment one another to orthodontically and orthopedically treat the patient.

[0081] In one embodiment of the invention, there is a class IT malocclusion correction device, due to the sagittal shift of the upper and lower jaws; comprising an upper aligner; featuring outer lateral cutouts of the aligners in front of the upper canines, and lower first molars; comprising on each upper canine and on each lower first molar a button housed in the cutout of the aligner and glued to the tooth; comprising, on each side of the mouth, an elastic return device stretched between the button of the upper canine and the button of the lower first molar; and comprising a means of transmission, between the upper canine and the upper first molar, of the tensile force exerted by the elastic return device, characterized in that: the upper canine carries a first cleat bonded to its outer lateral face; the first upper molar has a second cleat bonded to its outer side face, and; the upper aligner comprises a reinforcing arch, forming an integral part of the rigid aligner housed between the two cleats, to transmit to the upper first molar part of the tensile force exerted on the upper canine by the device elastic return.

[0082] According to one embodiment of the invention, the first cleat is parallel to the axis of the tooth and distal to the button, for support distal to the upper canine. According to one embodiment, the second cleat extends horizontally and it is beveled on the mesial side of the upper first molar. According to one embodiment, the upper aligner has no contact with the upper premolars. According to one embodiment, the upper aligner exerts a forward sagittal force on the upper incisors. In Fig. 11, a partial side view of the teeth of a jaw bearing the elements, bonded to the teeth, of the device correction of type II malocclusion. In Fig. 12, there is a view from below of an upper half-jaw of Fig.11.

[0083] According to one embodiment, the second cleat extends horizontally and it is beveled on the mesial side of the upper first molar, semi-maxillary includes upper teeth: incisors 7, 6, canine 1, premolars 4, 5, first molar 3. The semi-mandible includes lower teeth, including the first molar 2. The aligners, or gutters, upper and lower, substantially transparent plastic material, are not shown. On their outer lateral face, the aligners have cutouts in front of the upper canine 1 and the lower first molar 2. These cutouts provide access to the outer or vestibular lateral face of each of the teeth 1, 2.

[0084] On the outer lateral face of the upper canine 1 and on the first lower molar 2, are glued buttons, respectively 8 and 9. Between the two buttons 8 and 9 isstretched an elastic return device which, in a classic, submit the mandible to forward traction. On the outer side face of the upper canine 1 is glued a first cleat 10 distal to the button 8, comprising a substantially vertical rear face, parallel to the axis of the tooth, to provide support distal to the canine 1. On the outer side face of the first upper molar 3, is glued a second cleat 11 vestibular and centered, which extends horizontally and has a beveled front face, constituting a support surface in the direction of recoil and derotation. In the thickness of the upper aligner is housed a rigid reinforcing hoop, designed in the same plastic material as the aligner, and symbolized at 12. The ends of the arch 12 are applied respectively, one 13 on the vertical rear face of the first cleat 10, the other 14 on the beveled front face of the second cleat 11. Between the upper canine 1 and the upper first molar 3, the upper aligner and the arch 12 are without contact with the premolars 4 and 5. The elastic return device subjects the mandible to forward traction to reduce the offset between the upper and lower arches, typical of class II malocclusions. Simultaneously, the upper canine 1 is subjected to a tensile force exerted by the elastic return device. This tensile force is transmitted to the first cleat 10, which transmits it to the reinforcement arch 12 of the upper aligner, which transmits it to the second cleat 11 of the first upper molar 3. The beveled face of the second cleat 11 ensures the application to the first upper molar 3 of a force resulting in a mesio- vestibular rotation and a distalization of the molar 3.

[0085] At the same time, the upper aligner exerts a sagittal force on the maxillary incisors to drive them forward by creating a useful overhang for the progression of the mandible under the action of the elastic return device.

[0086] Class II malocclusion correction device, due to the sagittal shift of the upper and lower jaws; comprising an upper aligner on the maxillary teeth and a lower aligner on the mandibular teeth; featuring outer lateral cutouts of the aligners in front of the upper canines, and lower first molars; comprising on each upper canine 1 and on each lower first molar 2 a button 8, 9 housed in the cutout of the aligner and glued to the tooth 1, 2; comprising, on each side of the mouth, an elastic return device stretched between the button 8 of the upper canine 1 and the button 9 of the lower first molar 2; and comprising a means of transmission, between the upper canine 1 and the upper first molar 3, of the tensile force exerted by the elastic return device, characterized in that: - the upper canine 1 bears a first cleat 10 bonded to its outer sideface; - the upper first molar 3 carries a second cleat 11 bonded to its outer side face, and; - the upper aligner comprises a reinforcing arch 12, forming an integral part of the aligner, rigid, housed between the two cleats 10, 11, to transmit to the upper first molar 3) part of the tensile force exerted on the upper canine 1 by the elastic return device.

[0087] In one embodiment of the invention, there is a correction device characterized in that: - the first cleat 10 is parallel to the axis of the tooth and distal with respect to the button 8, for support distal to the upper canine 1.

[0088] In one embodiment of the invention, there is a correction device characterized in that: - the second cleat 11 extends horizontally, and it is beveled on the mesial side of the upper first molar (3).

[0089] In one embodiment of the invention, there is a correction device, characterized in that the upper aligner has no contact with the upper premolars 4, 5.

[0090] In one embodiment of the invention, there is a correction device characterized in that the upper aligner exerts a forward sagittal force on the upper incisors 6, 7.

[0091] In one embodiment, there is a device for correction of class II malocclusion, due to sagittal discrepancy of the jaws upper and lower; comprising an upper aligner for the maxillary teeth and a lower aligner for the mandibular teeth; featuring outer lateral cutouts of the aligners in front of the upper canines, and lower first molars; comprising on each upper canine 1 and on each lower first molar 2 a button 8, 9 housed in the cutout of the aligner and glued to the tooth 1, 2; comprising, on each side of the mouth, an elastic return device stretched between the button 8 of the upper canine 1 and the button 9 of the lower first molar 2; and comprising a means of transmission, between the upper canine 1 and the upper first molar 3, of the tensile force exerted by the elastic return device, characterized in that: the upper canine 1 carries a first cleat 10 bonded to its outer side face; the upper first molar 3 carries a second cleat 11 bonded to its outer side face, and; the upper aligner comprises a reinforcement arch 12, integrated, rigid, housed between the two cleats 10, 11, to transmit to the upper first molar 3 part of the tensile force exerted on the upper canine 1 by the elastic return device.

[0092] In order to facilitate a more complete understanding of the invention, the following non-limiting examples are provided.Examples

[0093] Two clinical evaluation cases having elongated horizontal beam attachments were evaluated. The first clinical case is shown in Figs. 7A, 7B, 7C, and 7D, in which Fig. 7A depicts a model of the arrangement of attachments and the use of a button and a vertical rectangular attachment on the canine. Figs. 7B, 7C, and 7D are photographs of the clinical case of the arrangement shown in Fig. 7A. From the clinical arrangement shown, it is possible to utilize a bonded metallic button to transmit force from an elastic to perpetuate the motion simulation.

[0094] The second clinical case is shown in Figs. 8 A and 8B, in which Fig. 8A illustrates the horizontal beam attachments and Fig. 8B is a photograph of the clinical case showing the use of an integrated hook on the aligner at the canine (shown without an elastic). From the clinical arrangement shown, it is possible to utilize integrated plastic features with attachments to transmit force from an elastic to perpetuate the motion simulation.

[0095] Testing was conducted to determine a biomechanical effect of the arrangement similar to that shown in Fig. 7A. The aligner included a reinforcement beam, an integrated hook, and a beveled attachment. As shown in Figs. 9A, 9B, 9C, and 9D, a test arrangement was prepared in which a mold of the patient’s teeth was fixed on a platform. The first molar of the mold was removed. The mold is shown attached to the platform in Fig. 9A. An aligner having an integrated hook with oversized intermediate cavities at each of the premolars was coupled to the mold. The first molar cavity of the aligner was attached to a six-axis force measurement apparatus. The mold and aligner are shown assembled in Fig. 9B. As is shown in Figs. 9C and 9D, an elastic was coupled to the integrated hook in extended to a fixed location on the platform. The amount of rotation at the first molar was measured via the six-axis force measurement apparatus. The degree of rotation is graphically illustrated in Figs. 10A and 10B.

[0096] While the present invention has been illustrated by a description of various embodiments and while these embodiments have been described in some detail, it is not the intention of the inventors to restrict or in any way limit the scope of the appended claims to such detail. Thus, additional advantages and modifications will readily appear to those of ordinary skill in the art. The various features of theinvention may be used alone or in any combination depending on the needs and preferences of the user.

Claims

What is claimed is:

1. An orthodontic appliance system for orthodontic treatment of a patient’s teeth, the system comprising: a first aligner comprising a shell having a plurality of cavities and being divided at a middle line into a first side and a second side, the shell including:(i) a first pair of cavities, one cavity of the pair of first cavities on each of the first and second sides and being configured to receive an anterior tooth,(ii) a second pair of cavities, one cavity of the pair of second cavities on each of the first and second sides and being configured to receive a posterior tooth, and(iii) at least one cavity intermediate a first cavity of the first pair of cavities and a second cavity of the second pair of cavities on each of the first and second sides, each intermediate cavity being configured to receive a tooth that is intermediate the anterior tooth and the posterior tooth, wherein the shell has a plurality of walls defining the plurality of cavities and at least one of the walls of the intermediate cavities includes a region of enhanced rigidity that extends from the first cavity to the second cavity on each of the first and second sides.

2. The system of claim 1, wherein the regions of enhanced rigidity are reinforcement beams integral with the at least one of the walls, the reinforcement beams having a non-tooth shape.

3. The system of claim 2, wherein the reinforcement beams include a first interproximal portion between the first cavity and the at least one intermediate cavity and a second interproximal portion between the at least one intermediate cavity and the second cavity.

4. The system of claim 2 or claim 3, wherein the reinforcement beams have a U- shaped cross section.

5. The system of any preceding claim, wherein(i) at least one of the plurality of walls of each cavity of the first pair of cavities includes a first receptacle that is open to the respective cavity,(ii) at least one of the plurality of walls of each cavity of the second pair of cavities includes a second receptacle that is open to the respective cavity, and(iii) at least one of the plurality of walls of each of the pair of intermediate cavities is configured to be spaced apart from the tooth surface when the aligner is coupled to the patient’ s teeth.

6. The system of claim 5, wherein the at least one of the plurality of walls of each cavity of the first pair of cavities and the at least one of the plurality of walls of each cavity of the second pair of cavities is a labial wall.

7. The system of claim 5 or claim 6, wherein the first receptacles are anterior- most ends of the region, and the second receptacles are posterior-most ends of the region.

8. The system of claim 5, 6, or 7, wherein the first receptacles are in the form of integrated hooks that are configured to receive an elastic.

9. The system of claim 5 or claim 6, wherein the at least one of the plurality of walls of each cavity of the first pair of cavities includes a cutout configured to receive a button.

10. The system of claim 5, 6, or 7, further comprising: a first attachment configured to be secured to each of the anterior teeth and received in a respective one of the first receptacles when the first attachments are attached to a respective anterior tooth.

11. The system of claim 10, further comprising: a second attachment configured to be secured to each of the posterior teeth and received in a respective one of the second receptacles when the second attachments are attached to a respective posterior tooth.

12. The system of claim 11 , wherein each second attachment has a prism-like configuration with a longitudinal axis that is aligned with a long axis of the posterior tooth.

13. The system of any preceding claim, wherein at least one of the pair of intermediate cavities is oversized relative to the tooth in at least one dimension.

14. The system of any preceding claim, further comprising: a second aligner comprising a shell having a plurality of cavities and being divided by a middle line into a first side and a second side, the shell including a pair of cavities, one cavity on each side of the middle line, each cavity of the pair of cavities being configured to receive a posterior tooth, wherein the shell has a plurality of walls defining the pair of cavities and one of the plurality of walls of each of the pair of cavities includes a receptacle that opens to the cavity and is configured to receive an attachment.

15. The system of one of claims 1-13, further comprising: a second aligner comprising a shell having a plurality of cavities and being divided by a middle line into a first side and a second side, the shell including a pair of cavities, one cavity on each side of the middle line, each cavity of the pair of cavities being configured to receive a posterior tooth, wherein the shell has a plurality of walls defining the pair of cavities and one of the plurality of walls of each of the pair of cavities includes a cutout.

16. The system of claim 14 or claim 15, wherein each of the shells of the first aligner and the shell of the second aligner includes a pair of blocks, one block on each side of the middle line and being configured to extend occlusally so that the blocks on the first aligner contact the blocks on the second aligner, and when the first and second aligners are coupled to the patient’s teeth, the pairs of blocks are configured to advance the patient’s mandibular jaw.

17. A method of orthodontic treatment using the system of any preceding claim.

18. An orthodontic appliance system for orthodontic treatment of a patient’s teeth, the system comprising: an aligner comprising a shell having a plurality of cavities and being divided by a middle line into a first side and a second side, the shell including:(i) a first pair of cavities, each of the cavities of the first pair of cavities being configured to receive an upper canine,(ii) a second pair of cavities, each of the cavities of the second pair of cavities being configured to receive an upper first molar, and(iii) two cavities between a first cavity of the first pair of cavities and a second cavity of the second pair of cavities on each of the first and second sides, each of the two cavities being configured to receive a premolar, wherein the shell has a plurality of walls defining the plurality of cavities and at least a labial wall of each of the two cavities includes a reinforcement beam that extends from the first cavity to the second cavity on each of the first and second sides.

19. The system of claim 18, wherein each reinforcement beam has a non-tooth shape.

20. The system of claim 18 or 19, wherein each reinforcement beam includes:(i) a first interproximal portion between one of the first cavities of the first pair of cavities and one of the two cavities between the first cavity and the second cavity,(ii) a second interproximal portion between each of the two cavities, and(iii) a third interproximal portion between the other of the two cavities between the first cavity and the second cavity and the second cavity.

21. The system of one of claims 18-20, wherein each reinforcement beam has a Ilshaped cross section.

22. The system of one of claims 18-21, wherein each of the two cavities between the first cavity and the second cavity is oversized relative to the respective premolar in at least one dimension.

23. The system of claim 22, wherein the at least one dimension is configured to position a labial wall of at least one of the two cavities between the first cavity and the second cavity apart from a respective one of the premolars.

24. A method of treating a patient with an orthodontic appliance system, the method comprising: inserting a first aligner on the patient’s teeth in an upper jaw, the first aligner comprising a shell having a plurality of cavities and being divided at a middle line into a first side and a second side, the shell including:(i) a first pair of cavities, one cavity of the pair of first cavities on each of the first and second sides, each cavity of the first pair of cavities receiving a corresponding anterior tooth,(ii) a second pair of cavities, one cavity of the pair of second cavities on each of the first and second sides, each cavity of the second pair of cavities receiving a corresponding posterior tooth, and(iii) at least one cavity intermediate a first cavity of the first pair of cavities and a second cavity of the second pair of cavities on each of the first and second sides, each of the at least one cavity receiving a tooth that is intermediate the corresponding anterior tooth and the corresponding posterior tooth, wherein the shell has a plurality of walls defining the plurality of cavities and at least one of the walls of the intermediate cavities includes a region of enhanced rigidity that extends from the first cavity to the second cavity on each of the first and second sides; and applying a force on each cavity of the first pair of cavities and / or each anterior tooth, whereby each region of enhanced rigidity transfers at least a portion of the applied force to each posterior tooth.

25. The method of claim 24, further comprising: securing an attachment to each of the corresponding anterior teeth on the upper jaw, wherein applying the force on each cavity of the first pair of cavities and / or each anterior tooth includes applying the force at the attachment on each anterior tooth.-SO-26. The method of claim 25, wherein the shell of the first aligner includes a pair of receptacles, each receptacle of the pair of receptacles opening to a respective one of the first cavities and being positioned at an anterior-most end of the region of enhanced rigidity, wherein during inserting the first aligner, each receptacle of the pair of receptacles receives a respective one of the attachments, and wherein applying the force at the attachment on each anterior tooth includes applying force at each of the receptacles.

27. The method of any one of claims 24-26, further comprising: securing an attachment to each of the corresponding posterior teeth on the upper jaw, wherein applying the force on each cavity of the first pair of cavities and / or each anterior tooth includes transferring a portion of the applied force through each region of enhanced rigidity to each attachment on each of the corresponding posterior teeth.

28. The method of claim 27, wherein the shell of the first aligner includes a pair of receptacles, each receptacle of the pair of receptacles opening to a respective one of the second cavities and being positioned at an posterior-most end of the region of enhanced rigidity, wherein during inserting of the first aligner, each receptacle of the pair of receptacles opening to the respective one of the second cavities receives a respective one of the attachments on the posterior teeth.

30. The method of any one of claims 24-29, further comprising: securing an attachment to at least two teeth on the patient’s lower jaw, wherein applying the force on each cavity of the first pair of cavities and / or each anterior tooth includes applying a force to each of the attachments on the patient’s lower jaw.31 . The method of any one of claims 24-30, further comprising: inserting a second aligner on the patient’s teeth in a lower jaw.

32. The method of any one of claims 24-31, wherein applying the force includes connecting one end of an elastic the first pair of cavities and / or each anterior tooth.

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