Orthodontic appliance systems and orthodontic appliances having occlusion guides for use in those systems

Abstract

An orthodontic appliance system (10) for orthodontic treatment includes an aligner (12, 14) including a shell (22, 60) having a plurality of cavities (24, 62) for receiving teeth (18). The shell (22, 60) has a plurality of walls (32, 34, 36, 70, 72, 74), including an occlusal wall (32, 70), defining the cavities (24, 62). The shell (22, 60) has an occlusion guide (42, 80) that forms a portion of the occlusal wall (32, 70). The occlusion guide (42, 80) prevents full closure of the patient's jaws. The occlusion guide (42) defines a socket portion (48) including a recessed region at which the occlusion guide (42) defines an engaged position with a projection (82) on an opposing aligner (14) or with a projection on the patent's opposing jaw when the projection (82) is received in the socket portion (48). When the aligner (12) is worn, the engaged position positions the patient's jaw at a predetermined mandibular relocated position. The recessed region includes a concave surface which may form a recess or a cup. The socket portion (48) may include a lingual lip (54) and a labial lip (56).

Description

ORTHODONTIC APPLIANCE SYSTEMS AND ORTHODONTICAPPLIANCES HAVING OCCLUSION GUIDES FOR USE IN THOSESYSTEMSCROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of priority of U.S. Provisional Application No. 63 / 508,653, filed on June 16, 2023, the content of which is incorporated by reference herein in its entirety.TECHNICAL FIELD

[0002] The present invention relates generally to orthodontic appliance systems for orthodontic treatment and, more particularly, to orthodontic appliances including occlusion guides for use in those systems and methods of using those appliances.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 relative 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 be fabricated from the mold. In this way, the aligner may reflect the position of the patient’s teeth according to one stage of treatment.Manufacturing each aligner in the series typically involves forming a thermoplastic sheet over the mold 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, in a class II malocclusion, 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. Specialized appliances may be required for correcting class II malocclusions. As an example, a specialized appliance mayinclude 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 and extend in an occlusal direction relative to the jaw on which it is worn. 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 in accordance with orthodontic treatment. However, the devices project occlusally and so prevent full closure of the patient’s jaws.

[0010] Specialized appliances can be uncomfortable for the patient for at least that reason. That discomfort can be a cause for noncompliance, because the patient may simply choose not to wear the appliance. Furthermore, these types of structures, which require the patient to close their jaws to generate mandibular repositioning forces, can eventually fail due to the continuous forces on the bite ramps. For example, the forces from biting to engage the opposing bite ramps can cause the ramps to wear and eventually collapse. Failure of the ramps causes inefficient treatment as well as increases the cost of treatment.

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

[0012] Embodiments of the invention overcomes the shortcomings and drawbacks in orthodontic systems including orthodontic appliances 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 first shell having a plurality of cavities for receiving one ormore of the patient’s teeth. The first shell has a plurality of walls, including an occlusal wall, defining the plurality of cavities. The first shell has a first occlusion guide that forms a portion of the occlusal wall. The first occlusion guide is configured to prevent full closure of the patient’s jaws when the first aligner is worn. The first occlusion guide defines a socket portion including a recessed region at which the first occlusion guide defines an engaged position with a projection on an opposing aligner or with a projection on the patent’s opposing jaw when the projection is received in the socket portion.

[0014] In one embodiment, when the first aligner is worn, the engaged position positions the patient’s jaw at a predetermined mandibular relocated position.

[0015] In one embodiment, the recessed region includes a concave surface.

[0016] In one embodiment, the concave surface is defined at least in part by a radius of from 4 mm to 5 mm.

[0017] in one embodiment, the concave surface forms a recess or a cup.

[0018] In one embodiment, the socket portion includes a lingual lip and a labial lip and when the aligner is worn, the lips are configured to inhibit movement of the projection from the socket portion in a lingual direction and labial direction, respectively.

[0019] In one embodiment, the socket portion includes a mesial lip and when the aligner is worn, the lip is configured to inhibit movement of the projection from the socket portion in a mesial direction.

[0020] In one embodiment, the first occlusion guide includes a block-like portion, and wherein the recessed region is nearer to a middle line of the shell than the block-like portion.

[0021] In one embodiment, the occlusal wall of the block-like portion is a flat planar surface.

[0022] In one embodiment, the flat planar surface is tilted in a direction toward the socket portion.

[0023] In one embodiment, the flat planar surface is configured to partially face toward an anterior region of the patient’s jaw.

[0024] In one embodiment, the flat planar surface is configured to be parallel to an occlusal plane of the patient’s teeth.

[0025] In one embodiment, the first occlusion guide spans at least two cavities.

[0026] In one embodiment, at least a portion of the first occlusion guide is configured to be hollow when the first aligner is worn.

[0027] In one embodiment, the first shell includes a pair of the occlusion guides, including the first occlusion guide and a second occlusion guide, the pair of occlusion guides are spaced apart, each of the occlusion guides of the pair of occlusion guides forming a portion of the occlusal wall of the shell.

[0028] In one embodiment, the system further includes a second aligner comprising a second shell having a plurality of cavities for receiving one or more of the patient’s teeth. The second shell has a plurality of walls, including an occlusal wall, defining the plurality of cavities. The second shell has a second occlusion guide forming a portion of the occlusal wall and configured to prevent full closure of the patient’s jaws. The second occlusion guide defines a projection configured to be received in the recessed region of the first occlusion guide at the predetermined mandibular relocated position.

[0029] In one embodiment, the projection has a spherical surface, a portion of which is received in the recessed region when at the engaged position.

[0030] In one embodiment, the spherical surface is defined at least in part by a radius of 3 mm.

[0031] in one embodiment, at least a portion of the occlusion guide is configured to be hollow when the second aligner is worn.

[0032] In one embodiment, the second shell includes a pair of the occlusion guides that are spaced apart, each forming a portion of the occlusal wall of the second shell.

[0033] In one embodiment, the first shell and the second shell each include a receptacle for receiving an attachment when the attachment is secured to the patient’ s tooth.

[0034] In one embodiment, the system further includes a pair of elastics configured to engage the receptacles during treatment.

[0035] In accordance with another aspect of the invention, in one embodiment there is a method of manufacturing the orthodontic appliance system. The methodincluding thermoforming a thermoplastic sheet over a mold of the patient’s teeth, wherein the mold includes at least one block in the shape of the first occlusion guide.

[0036] In one embodiment, the method further includes manufacturing the mold from a virtual model of the patient’ s teeth.

[0037] In one embodiment, the method further includes creating the virtual model of the patient’s teethBRIEF DESCRIPTION OF THE DRAWINGS

[0038] 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.

[0039] Fig. 1 is a perspective view of an exemplary embodiment of an orthodontic appliance system for orthodontic treatment of a patient.

[0040] Fig. 2A is a perspective view of one embodiment of an upper appliance of the exemplary orthodontic appliance system of Fig. 1 relative to the patient’s maxillary jaw.

[0041] Fig. 2B is perspective view of one embodiment of a lower appliance of the exemplary orthodontic appliance system of Fig. 1 relative to the patient’s mandibular jaw.

[0042] Figs. 3 A, 3B, and 3C are elevation side views of one embodiment of the orthodontic appliance system illustrating relative movement of the mandibular and maxillary jaws in accordance with orthodontic treatment from a disengaged position of Fig. 3A to and engaged position of Fig. 3C.

[0043] Fig. 4 is an enlarged side elevation view of an engaged position of Fig. 3C.

[0044] Fig. 5 is a perspective view of a set of molds for manufacturing appliances according to one embodiment of the invention.

[0045] Figs. 6A and 6B are enlarged views of a mold for manufacturing appliances according to embodiments of the invention.DETAILED DESCRIPTION

[0046] Embodiments of the invention are directed to orthodontic treatment systems. Exemplary systems include one or more orthodontic appliances and,optionally, one or more attachments to be secured to a patient’s teeth and elastics for application of force between a patient’s upper and lower jaws when necessary. Exemplary systems may be capable of producing mandibular relocation during orthodontic treatment in which relocation is combined with tooth movement either in a single stage or in multiple separate tooth movement stages. Mandibular relocation may include advancement, retraction, lateral correction, or a combination of advancement, retraction, and lateral correction. Embodiments of the invention may therefore be prescribed for treating class II malocclusions and class III malocclusions and to correct sleep apnea.

[0047] According to embodiments, a patient may wear a pair of orthodontic appliances, such as a pair of aligners. One or both the opposing aligners of the pair may include one or more occlusion guides. The occlusion guide(s) is configured to cooperate with the opposing aligner of the pair of aligners to maintain the patient’ s mandible in a predetermined mandibular relocated position. Unlike bite ramps, the occlusion guide may not require a force from patient clinching their jaw to relocate the mandibular jaw. Rather, according to embodiments, once the occlusion guide reaches a predetermined position, the occlusion guide may hold the patient’s jaw in the predetermined position.

[0048] In one exemplary embodiment, each aligner of the pair of orthodontic appliances includes an occlusion guide, and the opposing guides cooperate with one another at the predetermined mandibular relocated position. Specifically, at the relocated position, the occlusion guides engage one another. Therefore, at the predetermined mandibular relocated position, there is an engaged position between the opposing occlusion guides. At the engaged position, and in the absence of biting forces, the aligners maintain a force on the mandible to correct for class II malocclusions, class III malocclusions, or other types of misalignment of the mandible. In other words, the engaged position results in the patient’s malocclusion being treated without the aid of input force from the patient. In some respects, engagement may be considered to be a stable, holding position in which the opposing aligners are fit together in a manner that resists unintentional disengagement. The fit between the guides may be analogous to the fit of a hip joint. The occlusion guides provide a single predetermined mandibular relocated position when joined together at the engaged position. The occlusion guides then maintain the patient’s jaws at thepredetermined mandibular relocated position with little or no input force from the patient. The patient may therefore relax during mandibular relocation. The engaged position may be referred to as a rest position for the patient. The joint formed at the engaged position is in contrast to a variable sliding position provided by two opposing wedge surfaces (e.g., in a twin block system) in which the contact surfaces are flat or convex and are movable relative to one another (and so provide a variable treatment position) depending on the patient’s biting force. Generally, with twin blocks, for example, the more force with which the patient bites on the blocks, the greater the mandibular displacement.

[0049] In some embodiments, at the engaged position, the occlusion guide may limit further mandibular advancement, mandibular retraction, and lateral retraction. That is, additional mandibular movement is inhibited. For example, during treatment in which the mandible is advanced, when the aligners reach the predetermined mandibular advanced position and the occlusion guides are engaged, additional advancement of the patient’s mandible is inhibited by the occlusion guides. Therefore, at the engaged position, the patient may notice that their mandible reaches a stable advanced position, but the occlusion guides inhibit further advancement past the predetermined mandibular relocated position. The occlusion guides may resist unintentional disengagement.

[0050] To disengage the occlusion guides, the patient may intentionally disengage the occlusion guides before the patient may further advance or retract their jaw away from the predetermined mandibular relocated position. As an example, disengagement may be achieved by initial movement separating the occlusion guides. In other words, the occlusion guides must be moved in a direction generally away form one another by the patient opening their jaws. This movement separates the joint. Thus, the engaged position may provide a stable relative mandibular position that requires intentional disengagement in a predetermined direction. Absent that patient intent, the occlusion guides remain engaged.

[0051] When not engaged, at all other relative mandibular locations and orientations, the occlusion guides may contact one another to prevent full closure of the patient’s jaws but do not otherwise limit relative movement of the patient’s jaws. That is, the patient is essentially free to move their jaws in any direction hut closure when the occlusion guides are not at the engaged position. It is believed theexemplary embodiments improve treatment efficiency and so reduce treatment time for adults and for children. 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. The systems, appliances, and methods disclosed herein are applicable for use with Spark™ Clear Aligner System commercially available from Ormco Corporation.

[0052] 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.

[0053] With reference to Figs. 1 and 2A, in one embodiment, the upper (i.e., maxillary) aligner 12 is configured to be removably coupled to a patient’s maxillary jaw and is configured to apply tooth moving forces to one or more of the patient’s teeth 18. In that regard, the upper aligner 12 may be one aligner of a set of upper aligners designed to incrementally move one or more of the patient’s 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.

[0054] 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. The edge 26 defines an opening 30 in the shell 22. One or more of the cavities 24 may be shaped to receive a specific one of the patient’s teeth 18. The patient’s teeth 18 are received into their respective cavities 24 through the opening 30 when thealigner 12 is placed on the patient’s jaw. 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.

[0055] Further, 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.

[0056] As is shown in Fig. 2A, in an exemplary embodiment, the shell 22 includes an occlusion guide 42 shown forming a portion of the occlusal wall 32. The occlusal wall 32 of the shell 22 will be oriented so that it generally faces an occlusal wall of the aligner 14 on the patient’s mandible. As shown, the aligner 12 includes two occlusion guides 42. The occlusion guides 42 form the occlusal wall 32 for cavities 24 encapsulating each of the left and right cuspid and first premolar.Although not shown, the occlusion guides 42 may form the occlusal wall 32 across a single cavity receiving a single tooth or across more than two cavities 24 for receiving more than one tooth. As shown, the pair of occlusion guides 42 may be spaced apart and generally symmetrically formed about the middle line 28 (i.e., one guide on the left side and one guide on the right relative to the middle line 28) in the aligner 12 as two separate portions of the occlusal wall 32 of the shell 22. While described below in conjunction with Figs. 3A-3C, one or both the occlusion guides 42 is configured to provide an engaged position at a predetermined mandibular relocated position during orthodontic treatment.

[0057] As shown in Fig. 2A, in one embodiment, the occlusion guides 42 includes a generally block-like portion 46 in which there is a recessed region or socket portion 48 at or near an anterior-most region of the occlusion guide 42. The generally block-like portion 46 may appear as an occlusal projection beyond the surrounding shell 22. In one embodiment, the occlusion guide 42 is hollow and so results in an empty pocket between the shell 22 and the patient’s teeth when worn. In Fig. 2A, the surrounding shell 22 has the appearance of the patient’s teeth, but the occlusionguides 42 do not. In that regard, while appearing as an occlusal projection, the blocklike portion 46 does not extend labially beyond the labial wall 34 or extend lingually beyond the lingual wall 36 of the teeth-like portion (e.g., the cavities 24) of the shell 22. For example, the block-like portion 46 includes a labial wall portion 50 that may be generally coextensive with the labial wall 34 of the adjacent cavity 24, a lingual wall portion (not shown) that may be generally coextensive with the lingual wall 36 of the adjacent cavity 24, and a distal wall portion 52 at the opposite end of the occlusion guide 42 from the socket portion 48. In one embodiment, the occlusion guide 42 forms an occlusal-most extending portion of the upper aligner 12 but does not extend in the labial or lingual directions beyond one or both the labial wall 34 or the lingual wall 36. As shown, the occlusion guides 42 inhibit full closure of the patient’s jaws.

[0058] In the exemplary embodiment shown, the socket portion 48 is formed by recessed region in the block-like portion 46. In other words, the socket portion 48 may be defined by a surface that forms a recess or cup in the block-like portion 46. In the exemplary embodiment, the cup extends distally or away from the middle line 28 into the block-like portion 46. This configuration may include a lingual lip 54, a labial lip 56, and, possibly, a mesial lip 58 in the socket portion 48 to define the cup. See Figs. 2A and 4. The socket portion 48 therefore forms a mesial portion (i.e., nearest the anterior region of the shell 22) of the occlusion guide 42 and generally faces in a mesial direction toward the middle line 28. By way of example and not limitation, the socket portion 48 may include a concave surface defined by a sphere or defined, at least in part, by a radius of curvature. Other surface configurations may include a replica of the patient’s lower teeth, or a simple polygonal shape. By contrast, the socket portion 48 is not a planar, mesial-facing surface or a convex mesial-facing surface at the anterior-most portion of the occlusion guide 42. The socket portion 48 has a receptacle-like function and in that regard, is configured to receive a protrusion, such as from the lower aligner 14 or the patient’s teeth on the mandible at a predetermined mandibular relocated position.

[0059] In the exemplary embodiment, the upper aligner 12 may include receptacles 44 for receiving attachments 16. The receptacles 44 may permit elastics 20 to directly engage the corresponding attachments 16 via an opening. In one embodiment, the attachment 16 has a hook shape and the receptacle 44 also has a hook shape. This configuration may more effectively transfer an applied load fromthe elastic 20 (Fig. 1 ) to the canine into the aligner 12 to assist in relocating the mandible during treatment.

[0060] With reference now to Figs. 1 and 2B, in one embodiment, the lower (i.e., mandibular) aligner 14 is configured to be removably coupled 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 configured 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 alone or in conjunction with the upper aligner 12 shown in Figs. 1 and 2A.

[0061] As shown, the exemplary lower aligner 14 is much like the upper aligner 12 and includes a hollow shell 60 that is configured to encapsulate crowns of a plurality of the patient’s teeth 18. The shell 60 is formed with a plurality of cavities 62 that collectively define an edge 64. The edge 64 defines an opening 66 in the shell 60. One or more of the cavities 62 may be shaped to receive a specific one of the patient’s teeth 18. The patient’s teeth 18 are received into their respective cavities 62 through the opening 66 when the aligner 14 is placed on the patient’s jaw. In the embodiment shown, a middle line 68 of the shell 60 is defined between cavities 62 configured to receive the patient’s central incisors.

[0062] Further, the shell 60 has wall portions that contact some of the surfaces of the patient’s teeth 18 and define the cavities 62. By way of example, the shell 60 includes an occlusal wall 70, a labial wall 72, and a lingual wall 74. The shell 60 may also include distal portions 76 that encircle the cavities 62 that receive the rear-most molar teeth. When the cavities 62 receive the patient’s teeth 18, walls 70, 72, 74, and 76 generally conform to, and some cases contact, the corresponding surfaces of a respective one of the patient’ s teeth with the edge 64 positioned proximate the patient’s gingiva.

[0063] As is shown in Fig. 2B, in an exemplary embodiment, the shell 60 includes an occlusion guide 80 shown forming a portion of the occlusal wall 70. As shown, the aligner 14 includes two occlusion guides 80. The occlusion guides 80 form portions of the occlusal wall 70 for cavities 62 encapsulating each of the left andright cuspid and a portion of the cavity configured to receive the first premolar. Although not shown, the occlusion guides 80 may form the occlusal wall 70 across a single cavity receiving a single tooth or across more than two cavities 62 for receiving more than one tooth. As shown, the pair of occlusion guides 80 may be spaced apart and generally symmetrically formed about the middle line 68 (i.e., one guide on the left side and one guide on the right side relative to the middle line 68) in the aligner 14 as two separate portions of the occlusal wall 70 of the shell 60. While described below in conjunction with Figs. 3A-3C, one or both the occlusion guides 80 is configured to provide an engaged position at a predetermined mandibular relocated position during orthodontic treatment. By way of example, the occlusion guides 42 of the upper aligner 12 may engage the occlusion guides 80 of the lower aligner 14 at a predetermined mandibular relocated position determined according to a treatment plan.

[0064] In the exemplary embodiment shown in Figs. 2B and 4, the occlusion guides 80 may include a projection 82. The projection 82 is configured to be received in the socket portion 48 of the occlusion guide 42 of the upper aligner 12 in the engaged position, shown in Fig. 4. At the engaged position, each of the pair of occlusion guides 42 engage a corresponding one of the pair of occlusion guides 80. Further, in the exemplary embodiment, the projection 82 is received in the socket portion 48 at the predetermined mandibular relocated position. As shown, the projection 82 is shaped to fit into and cooperate with the socket portion 48 to provide a stable engagement position between the upper aligner 12 and the lower aligner 14. Essentially, once at the engaged position, the relative position of the mandible and maxilla does not change. Each of the labial lip 56, lingual lip 54, and mesial lip 58 may inhibit relative movement of the projection 82 out of the socket portion 48. Disengagement of the joint formed is thereby inhibited in each of corresponding directions. By way of example, and not limitation, the projection 82 may have a spherical shape and so have a ball-like appearance or the projection 82 may be at least partly defined by a radius of curvature.

[0065] In the exemplary embodiment, and with reference to Fig. 4, the projection 82 is spherically shaped, and the socket portion 48 has a concave spherical configuration. The dimension of the projection 82 may be less than the corresponding dimension of the socket portion 48. Thus, the socket portion 48 and the projection 82may not be equivalent in size / dimension. Rather, there is a relative size difference. This size difference may enhance patient comfort and facilitate more consistent engagement at the engaged position (as shown) or allow for tooth movement in accordance with treatment, because the size difference eases engagement of the projection 82 in the socket portion 48. By way of example, the projection 82 may have a radius R 1 that is 1 mm to 2 mm smaller than a radius R2 of the concave surface of the socket portion 48. The dimensions of the occlusion guide 42 and the occlusion guide 80 may be dependent on patient anatomy. However, as a further example, the socket portion 48 may include a concave surface having a radius of 4 mm to 5 mm and the projection 82 may have a spherical surface defined at least in part by a radius of 3 mm. Further, while embodiments are disclosed and described with the occlusion guide 42 including the socket portion 48 on the upper aligner 12 and the occlusion guide 70 including the projection 82 on the lower aligner 14, embodiments are not limited to that orientation. For example, the upper aligner 12 may include an occlusion guide with a projection to be received by the lower aligner 14 having the socket portion.

[0066] Referring to Figs. 1, 2B, 3A-3C, and 4, in the exemplary embodiment, the lower aligner 14 may include receptacles 90 for receiving attachments 16. The receptacles 90 may permit elastics 20 to directly engage the corresponding attachments 16. In one embodiment, the attachment 16 has a hook shape and the receptacle 90 also has a hook shape. This configuration may more effectively transfer an applied load from the elastic 20 (Fig. 1) to the molar into the aligner 14 to assist in relocating the mandibular jaw. By way of example, the mandible may be advanced (as shown in Fig. 1) during treatment with the elastic 20 assisting in that advance movement and facilitating engagement of the socket portions 48 of the occlusion guide 42 of the upper aligner 12 with the projections 82 of the lower aligners 14. While the integrated hook is shown, embodiments of the invention are not limited to the integrated hooks. For example, as an alternative to the receptacle 90, the lower aligner 14 may include a cutout (not shown) in the labial wall 72. A cutout would expose a surface of the first molar on which a button (not shown) is attached. In such embodiments, the button receives the elastic 20.

[0067] With reference now to Figs. 3A, 3B, 3C, and 4, during treatment, the patient wears the aligners 12 and 14 as shown. The occlusion guides 42, 80 maymove generally from a contacting, but disengaged position (Fig. 3A) to an engaged position (Fig. 3C). This movement may be with the aid of an elastic 20 as shown in Fig. 3B. As shown in Fig. 3A, the upper aligner 12 and the lower aligner 14 contact one another at the respective occlusion guides 42 and 80. The occlusion guides 42 prevent the patient from closing their jaws and blocks the patient’s untreated bite preference. In this position, and while preventing full close of the patient’s jaws, the patient may move their mandible relative to their maxilla according to the arrow. Fig. 3A depicts an untreated mandibular position.

[0068] As the patient or the elastic 20 advances the patient’ s mandible, the projection 82 may slide along the block-like portion 46 toward the socket portion 48. In that regard, in the exemplary embodiment shown, the occlusal wall 32 of the blocklike portion 46 may be a flat planar surface. As shown, the flat planar surface is tilted to partially face toward an anterior region of the patient’s jaw. This may be referred to as a mesial tilt, mesial sloping, or mesially facing surface. The titled surface may not be parallel to the occlusal plane of the teeth 18. The tilt encourages relative movement of the projection 82 toward the socket portion 48. In other words, once the projection 82 contacts the tilted surface, the projection 82 is more easily moved toward the engaged position in the socket portion 48, because a component of an applied force between the projection 82 and the flat planar surface (i.e., from the patient or from an elastic) is directed toward the socket portion 48. In this embodiment, there is a preferred sliding direction toward the engaged position. The projection 82 may therefore slide along the block-like portion 46 with little resistance. As one alternative, as shown in phantom line, the flat planar surface may be generally parallel to an occlusal plane of the teeth 18 of the upper jaw when the aligner 12 is worn. Relative to a tilted surface, relative sliding movement is not inhibited, and a preferred sliding direction is not established. Embodiments of the occlusion guide 42 are not limited to a planar surface parallel to an occlusal plane or to a mesial tilted surface. For example, a flat planar surface on the block-like portion may be titled in a posterior direction. In this case a preferred sliding direction of the projection 82 would be toward the molar teeth.

[0069] Further, and with continued reference to Fig. 3A, the occlusion guide 42 may span two teeth on the upper jaw, as shown. In that regard, the block-like portion 46 may be dimensioned to prevent the projection 82 of the occlusion guide 80from contacting the distal wall portion 52 of occlusion guide 42. The mesial-distal dimension of the block-like portion 46 may be dependent on the patient’s anatomy, particularly the range of articulation of the patient’ s mandible. The dimension of the block-like portion 46 is sufficient to prevent the patient from being able to unintentionally force the projection 82 into contact with the distal wall portion 52.

[0070] With reference to Fig. 3B, under the force of the stretched elastic 20, the occlusion guide 80 may move from the untreated mandibular position of Fig. 3 A to a predetermined mandibular relocated position shown in Fig. 3C. An elastic 20 may be beneficial when the patient is sleeping so as to maintain an advancement force of the patient’s jaw while they are unconscious. The elastic 20 may not be needed during awake time. While an elastic 20 is shown in Fig. 3B, the patient may be able to intentionally move their mandible from the untreated mandibular position of Fig. 3A to the predetermined mandibular relocated position shown in Fig. 3C without the use of the elastic.

[0071] In Fig. 3C, the projection 82 is seated in the socket portion 48. When in this position, the occlusion guides 42, 80 are in an engaged position. The engaged position may be maintained without the patient clinching the jaws together. In other words, the occlusion guides 42, 80 maintain the engaged position while the patient’s jaws are relaxed. The tendency of the mandible to revert toward the untreated mandibular position may provide a residual force sufficient to maintain engagement between the occlusion guides 42, 80 in the engaged position shown. Advantageously, this configuration is more comfortable for the patient.

[0072] According to some embodiments, once engaged, disengagement may be achieved if the patient intentionally separate their jaws to remove the projection 82 from the socket portion 48. In other words, the projection 82 is separable from the socket portion 48 by occlusal-gingival separation of the aligners 12 and 14, such as according to arrow in Fig. 3C.

[0073] In another aspect of the invention, and with reference to Fig. 5, 6A, and 6B, the aligners 12 and 14 may be manufactured by thermoforming a thermoplastic sheet over a mold of the patient’s teeth. As an example, Fig. 5 depicts a mold 100 for thermoforming the aligner 12 (Fig. 1) and a mold 102 for thermoforming the aligner 14. In general, the mold 100 may be manufactured from a virtual model (not shown) of the patient’ s upper teeth. In turn, the virtual model maybe generated based on data obtained from scanning the patient’s teeth or scanning an impression of the patient’s teeth. During preparation of the virtual model, the clinician adds a virtual block to the model. When the virtual model is manufactured, such as by 3D printing, the mold 100 includes a pair of blocks 104 in the shape of the occlusion guides 42. When a thermoplastic sheet (not shown) is formed over the mold 100, the sheet forms around the mold 100, including the blocks 104.

[0074] Similarly, the mold 102 may be manufactured from a virtual model (not shown) of the patient’ s lower teeth. That virtual model may be generated based on data obtained from scanning the patient’s teeth or scanning an impression of the patient’s teeth. During preparation of the virtual model, the clinician adds a virtual block to the model. When the virtual model is manufactured, such as by 3D printing, the mold 102 includes a pair of blocks 106 in the shape of the occlusion guides 80. When a thermoplastic sheet (not shown) is formed over the mold 102, the sheet forms around the mold 102, including the blocks 106.

[0075] Referring now to Figs. 6A and 6B, alternative blocks in the mold 100 are shown. The alternative blocks provide a corresponding alternative occlusion guide in an aligner following thermoforming thereof. For example, and with reference to Fig. 6A, block 108 includes an imprint of the occlusal anatomy of the teeth in the lower arch, when the mandible is in the predetermined mandibular relocated position. Therefore, it is believed that this will be more comfortable to the patient, since this mimics that patient’s existing bite. In other words, the occlusion guide meshes with the teeth in the most conforming manner. As an additional example, and with reference to Fig. 6B, block 112 includes a plurality of socket portions 114 in the form of a replica of the patient’s tooth surface. In this way, the normal feel of the patient’s teeth are replicated in a new position as determined by the predetermined mandibular relocated position. When shape of either of the blocks 108, 112 is transferred to an aligner, the patient may be treated according to that described above.

[0076] 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 first shell having a plurality of cavities for receiving one or more of the patient’s teeth, wherein the first shell has a plurality of walls, including an occlusal wall, defining the plurality of cavities, and wherein the first shell has a first occlusion guide that forms a portion of the occlusal wall, the first occlusion guide being configured to prevent full closure of the patient’s jaws when the first aligner is worn, and the first occlusion guide defining a socket portion including a recessed region at which the first occlusion guide defines an engaged position with a projection on an opposing aligner or with a projection on the patent’s opposing jaw when the projection is received in the socket portion.

2. The system of claim 1, wherein when the first aligner is worn, the engaged position positions the patient’s jaw at a predetermined mandibular relocated position.

3. The system of claim 1 or claim 2, wherein the recessed region includes a concave surface.

4. The system of claim 3, wherein the concave surface is defined at least in part by a radius of from 4 mm to 5 mm.

5. The system of claim 3 or claim 4, wherein the concave surface forms a recess or a cup.

6. The system of any preceding claim, wherein the socket portion includes a lingual lip and a labial lip and when the aligner is worn, the lips are configured to inhibit movement of the projection from the socket portion in a lingual direction and labial direction, respectively.

7. The system of any preceding claim, wherein the socket portion includes a mesial lip and when the aligner is worn, the lip is configured to inhibit movement of the projection from the socket portion in a mesial direction.

8. The system of any preceding claim, wherein the first occlusion guide includes a block-like portion, and wherein the recessed region is nearer to a middle line of the shell than the block- like portion.

9. The system of claim 8, wherein the occlusal wall of the block-like portion is a flat planar surface.

10. The system of claim 9, wherein the flat planar surface is tilted in a direction toward the socket portion.

11. The system of claim 10, wherein the flat planar surface is configured to partially face toward an anterior region of the patient’s jaw.

12. The system of claim 9, wherein the flat planar surface is configured to be parallel to an occlusal plane of the patient’s teeth.

13. The system of any preceding claim, wherein the first occlusion guide spans at least two cavities.

14. The system of any preceding claim, wherein at least a portion of the first occlusion guide is configured to be hollow when the first aligner is worn.

15. The system of any preceding claim, wherein the first shell includes a pair of the occlusion guides, including the first occlusion guide and a second occlusion guide, the pair of occlusion guides are spaced apart, each of the occlusion guides of the pair of occlusion guides forming a portion of the occlusal wall of the shell.

16. The system of any preceding claim, wherein the system further comprises:a second aligner comprising a second shell having a plurality of cavities for receiving one or more of the patient’s teeth, wherein the second shell has a plurality of walls, including an occlusal wall, defining the plurality of cavities, and wherein the second shell has a second occlusion guide forming a portion of the occlusal wall and configured to prevent full closure of the patient’s jaws, the second occlusion guide defining a projection configured to be received in the recessed region of the first occlusion guide at the predetermined mandibular relocated position.

17. The system of claim 16, wherein the projection has a spherical surface, a portion of which is received in the recessed region when at the engaged position.

18. The system of claim 16, wherein the spherical surface is defined at least in part by a radius of 3 mm.

19. The system of any of claims 16-18, wherein at least a portion of the occlusion guide is configured to be hollow when the second aligner is worn.

20. The system of any of claims 16-19, wherein the second shell includes a pair of the occlusion guides that are spaced apart, each forming a portion of the occlusal wall of the second shell.

21. The system of any of claims 16-20, wherein the first shell and the second shell each include a receptacle for receiving an attachment when the attachment is secured to the patient’ s tooth.

22. The system of claim 21, further including a pair of elastics configured to engage the receptacles during treatment.

23. A method of manufacturing the orthodontic appliance system of claim 1 comprising: thermoforming a thermoplastic sheet over a mold of the patient’s teeth, wherein the mold includes at least one block in the shape of the first occlusion guide.

24. The method of claim 23, further comprising: manufacturing the mold from a virtual model of the patient’ s teeth.

25. The method of claim 24, further comprising: creating the virtual model of the patient’ s teeth.

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