Device for adjusting, measuring, and recording occlusal relationships in mandibular protrusion, application to a mandibular protrusion immobilization device

Abstract

"Device for adjusting, measuring, and recording occlusal relationships in mandibular protrusion, application to a mandibular protrusion immobilization device" Device for adjusting occlusal relationships in mandibular protrusion (20) with means for adjusting protrusion.The adjustment device comprises an elongated shell (21) with an inverted U-shaped cross-section and internal and external faces, said shell (21) having an anterior portion facing forward and two lateral portions, right and left, facing backward. The shell (21) is adapted to be placed over a mandibular dental arch for impression taking, with the upper part of the external face abutting the occlusal surfaces of teeth of the maxillary dental arch. The device also includes at least one adjustable protrusion adjustment support (22) comprising a support piece (29) integral with the anterior portion of the shell (21) and intended to bear against teeth of a maxillary dental arch. The support piece (29) can be moved forward or backward relative to the shell for protrusion adjustment. The adjustment device may also allow for measurements and / or recordings. (See abstract figure: Figure 8.)

Description

Title of the invention: Device for adjusting, measuring, recording occlusion ratios in mandibular protrusion, application to a mandibular protrusion immobilization device Technical field

[0001] The present invention relates generally to the field of oral-dental appliances. It relates more particularly to a device for adjusting, measuring and recording occlusion ratios in mandibular protrusion, of the impression tray type, and the application to the manufacture of an oral-dental appliance for immobilizing the mandibular arch in protrusion as well as such an appliance intended to improve the pulmonary ventilation of a subject and essentially nocturnal ventilation. Technological background

[0002] Nighttime breathing difficulties or discomfort, particularly snoring or sleep apnea, are common problems. Many techniques are proposed to eliminate or reduce them. For the most serious cases, mask systems with assisted ventilation are implemented and this represents a significant cost in healthcare costs. For snoring, articulated mouthpieces are proposed which are in practice difficult to tolerate because they are not anatomically correct.

[0003] The present invention provides a device for adjusting, measuring and recording occlusion ratios in particular mandibular protrusion making it possible to manufacture an oral dental appliance which is intended to facilitate ventilation. The appliance in question which can be manufactured is anatomical in the sense that it is adapted to the shape of the dental arches of the subject wearing it and that it is held in place due to this adaptation.

[0004] Devices for taking impressions or allowing adaptation to the teeth of a subject are already known, for example those of documents GB2537313, US5313960 and US20030234022. Oral-dental appliances intended to remedy certain problems are also known, for example those of documents EP2491901B1, US5829441A, EP1659998B1 and EP1838259B1, but they are relatively complex and bulky. Statement of the invention

[0005] According to the invention, a device is proposed for adjusting the occlusion ratios in mandibular protrusion with means for adjusting the protrusion positioning of the mandible relative to the maxilla.

[0006] According to the invention, the adjustment device comprises:

[0007] - an elongated hull in an arc with a section in the approximate shape of an inverted U with a internal face and an external face, said shell having an anterior portion towards the front and two right and left lateral portions towards the rear, said shell being adapted to be placed by its internal face overlapping a mandibular dental arch of a subject for taking an impression of said mandibular dental arch, an upper part of the external face coming opposite occlusal faces of teeth of the maxillary dental arch,

[0008] - at least one adjustable support device for adjusting protrusion, said at least one support device comprising a support piece secured to the anterior portion of the shell and intended to come into contact with teeth of a maxillary dental arch, the support piece being able to be moved forward or backward relative to the shell to adjust the protrusion.

[0009] Other non-limiting and advantageous characteristics of the adjustment device according to the invention, taken individually or in all technically possible combinations, are the following:

[0010] - the support piece is intended to come into contact with the incisors of the dental arch maxillary,

[0011] - the shell is adapted to be placed by its internal face in overlap with play on the mandibular dental arch to allow the presence of an impression paste in the shell, on the internal face of the shell,

[0012] - the means for adjusting the protrusion positioning also allow to record the protrusion adjustment and the support piece is secured to the front portion of the hull by means of a threaded rod immobilized to the hull, said support piece being able to slide along said threaded rod and being sandwiched between a spring on the hull side and a nut on the free end side of the threaded rod, the spring pushing the support piece against the nut, said nut being able to be screwed or unscrewed from the threaded rod to move the support piece forward or backward relative to the hull,

[0013] - the adjustment device with means for adjusting the protrusion positioning further allowing the protrusion adjustment to be recorded can be described as an adjustment and recording device,

[0014] - the support piece can furthermore tilt along the threaded rod,

[0015] - the support piece is intended to come into contact with the front face of the teeth of the arch maxillary dental,

[0016] - the support piece is Y-shaped with two diverging branches and a trunk common, said common trunk of the support piece being integral with the anterior portion of the shell, one of the branches of the Y being intended to come into contact with the front face of the teeth of the maxillary dental arch and the other branch being intended to pass under the tip of the teeth of the maxillary dental arch,

[0017] - the common trunk of the support piece is integral with the front portion of the hull via the threaded rod,

[0018] - the adjustment device is further provided with means for adjusting the elevation of occlusion (= adjustment of the opening of the mandible relative to the maxilla), the adjustment device further comprising at least one adjustable spacing device for adjusting the opening, said at least one spacing device being integral with the upper part of the external face of a lateral portion of the shell and comprising a support piece intended to come against occlusal faces of teeth of a maxillary dental arch, the support piece being able to be raised or lowered for adjusting the opening, preferably the adjustment device comprising two adjustable spacing devices for adjusting the opening, one on each lateral portion of the shell,

[0019] - the means for adjusting the elevation of the occlusion also allow to record the adjustment of the occlusion elevation and the adjustable spacing device comprises a base fixed on the upper part of the external face of the lateral portion of the shell, said base forming an inclined plane on which the wedge-shaped support piece can slide to rise or fall depending on the direction of rotation of a screw,

[0020] - the shell comprises at least one passage through the front portion of the shell for protrusion adjustment control and intended to allow the visualization of at least one of the incisors of the mandibular dental arch, the shell further comprising on its external face towards the top of the shell and at the edge of said passage an elongated anteroposterior graduated scale intended to measure the advancement in protrusion between the incisors of the mandibular dental arch and of the maxillary dental arch,

[0021] - the graduated scale can switch between a position where it is extended anteroposteriorly previously to allow the measurement of the protrusion advancement between the incisors of the mandibular dental arch and of the maxillary dental arch and a position where it is vertically extended to allow the measurement of the opening of the elevation of the occlusion between the incisors of the mandibular dental arch and of the maxillary dental arch,

[0022] - the adjustment device with measuring means can be described as a device of adjustment and measurement,

[0023] - the adjustment device with means for adjusting the protrusion positioning further allowing the recording of the protrusion adjustment and measuring means can be described as an adjustment, measurement and recording device,

[0024] - the adjustment device can also allow measurements and / or recordings tremors,

[0025] - the shell comprises at least one passage for filling allowing the introduction of the inside of the shell, on the inner side of the shell, of an impression paste,

[0026] - the passage for adjustment control also constitutes a passage for filling and vice versa,

[0027] - the internal face of the shell has a surface structure in order to ensure a better retention of the impression paste in the shell, the structure being chosen from indentations, blind holes, etc.

[0028] - the shell has through holes intended to ensure better retention impression paste in the shell,

[0029] - the shell is made of a transparent or translucent material.

[0030] The invention also provides a method for manufacturing an oral-dental appliance for immobilizing the protrusion of the mandibular arch and raising the occlusion for a subject, said appliance being able to comprise one or more of the characteristics described and in which method:

[0031] - firstly, we make on the subject, on the one hand, an imprint of the arc maxillary dental arch and, on the other hand, an impression of the mandibular dental arch, the taking of the impression of the mandibular dental arch being carried out with an adjustment device with means for adjusting the positioning in protrusion and adjustment in opening of the mandible relative to the maxilla and also making it possible to record the adjustment in protrusion and in opening and when taking the impression of the mandibular dental arch, the protrusion and the opening are adjusted and recorded for the subject,

[0032] - in a second step, a model of the maxillary dental arch and a model of the mandibular dental arch from the impressions of the maxillary and mandibular dental arches, the two models are installed in an adjustable model holder and said model holder is adjusted by placing on the model of the mandibular dental arch, the adjustment device having recorded the protrusion and opening adjustment in order to configure the model holder with the same protrusion and opening adjustment as on the subject,

[0033] - in a third step, the adjustment device having been removed from the model holder, the device is made on the model of the mandibular dental arch installed in the configured model holder.

[0034] Other non-limiting and advantageous characteristics of the method according to the invention, taken individually or in all technically possible combinations, are the following:

[0035] - the prints on the subject are made with alginates,

[0036] - after making the device on the model of the installed mandibular dental arch in the configured model holder, the device is removed from the model holder and provided to the subject or used for molding a device that will be provided to the subject,

[0037] - the adjustment device with means for adjusting the protrusion positioning and adjustment in opening of the mandible in relation to the maxilla includes means measuring protrusion and opening values,

[0038] - the means for measuring the protrusion and opening values ​​are graduations in units of length,

[0039] - recording of protrusion and opening settings is done on paper or a computer storage means, the measured protrusion and opening values ​​of the setting being noted or entered therein,

[0040] - the recording of the protrusion and opening settings is carried out on the adjustment device itself which remains in the adjusted position obtained on the subject,

[0041] - the production of the device consists of applying material to the model of the arc mandibular dental arch installed in the model holder configured to form an inverted gutter covering the teeth of the mandibular arch and the upper face of the device of which comes into contact with at least a portion of the occlusal faces of the right and left molars of the model of the maxillary dental arch by applying a determined thickness of material between the bottom of the gutter and said upper face, and, in addition, material is applied to said upper face of the device in order to form two fins erected on said upper face and extended upwards, each fin coming to bear against vestibular faces (= external lateral, cheek side) of teeth of the model of the maxillary dental arch, and preferably against teeth 13 to 14 and 23 to 24 respectively,

[0042] - in a simpler variant, the adjustment device only comprises one means of adjustment of the protrusion positioning of the mandible in relation to the maxilla and the device only allows immobilization in protrusion,

[0043] - in a simpler variant, the adjustment device only comprises one means of adjustment in opening of the mandible in relation to the maxilla and the device only allows immobilization in elevation of the occlusion.

[0044] It is also proposed to apply the adjustment device in the manufacturing method as described.

[0045] The invention also relates to an oral dental appliance for immobilizing the mandibular arch in protrusion relative to the maxillary arch, said appliance in the form of an inverted gutter being intended to cover the teeth of the mandibular arch, said inverted gutter being open downwards, closed on the sides by internal lateral walls on the inside of the mouth and external lateral walls on the cheek side and closed at the top by a gutter base, said appliance comprising three main parts, an anterior part towards the front intended to cover the incisors and canines of the mandible and two right and left lateral parts towards the rear intended to cover the premolars and molars on the corresponding side of the mandible, the internal shape of the gutter being adjusted to the teeth of the mandible and corresponding to an impression of said teeth of the mandible, the appliance comprising an upper face, said upper face being intended to come approximately opposite the occlusal faces of the maxillary teeth.

[0046] According to the invention, the appliance is manufactured according to the method of the invention and it comprises two fins erected on the upper face and extended upwards, each fin being positioned approximately in the connection zone between the anterior part and the corresponding right or left lateral part, and extending along the mandibular arch over a determined width, the fins comprising an inner face oriented towards the inside of the mouth and intended to come to bear against vestibular faces (= external lateral, cheek side) of teeth of the maxilla when the appliance is in place in the mouth in order to block the mandible in protrusion (prevents the mandible from moving back).

[0047] Other non-limiting and advantageous characteristics of the apparatus according to the invention, taken individually or in all technically possible combinations, are the following:

[0048] - the occlusal faces of the maxillary incisors do not come into contact with the face upper part of the device,

[0049] - each fin extends along the mandibular arch over a determined width in less than about 15 mm,

[0050] - advantageously, each fin extends along the mandibular arch on a determined width less than approximately 12 mm,

[0051] - each fin extends along the mandibular arch over a width which is not in less than about 5 mm,

[0052] - the device also allows the immobilization by raising the occlusion, at least a portion of the right and left molars of the maxilla resting by their occlusal faces on the upper face of the appliance when the oral appliance is in place in the mouth, the appliance comprising a determined thickness of material between the bottom of the gutter and the upper face at least in the areas where said at least a portion of the right and left molars of the maxilla rest on the upper face of the appliance in order to block the closure and leave a determined height gap between the incisors of the mandible and the maxilla,

[0053] - the external side wall of the device has excess material allowing the vestibular parts of the cheeks to be moved away from the dental arches,

[0054] - each fin has a determined width equal to a maximum of one determined tooth of the maxilla,

[0055] - the determined tooth of the maxilla is the canine and the adjacent premolar,

[0056] - the determined tooth of the maxilla is the premolar,

[0057] - each fin is shaped according to the shape of the canine or premolar,

[0058] - each fin has a determined width equal to a maximum of two teeth de- terminated from the maxilla,

[0059] - the two determined teeth of the maxilla are the canine and the adjacent premolar,

[0060] - each fin is shaped according to the shape of the canine and the premolar adjacent,

[0061] - each fin has a determined width equal to a maximum of two teeth ends of the maxilla which are the canine and the adjacent premolar and is shaped to fit between the canine and the adjacent premolar,

[0062] - the apparatus is configured so that the inner faces of the two fins come apply to the vestibular surfaces of teeth 13 to 14 and 23 to 24 of the maxilla respectively,

[0063] - the apparatus is configured to immobilize the mandibular arch relative to the arch maxilla in protrusion of a determined advancement value, said advancement value being in the range of 1 mm to 4 mm,

[0064] - the advancement value is preferably less than or equal to half of the maximum protrusion capacity of the subject,

[0065] - the advancement value is measured end to end of the central incisors of the arches maxillary and mandibular dental,

[0066] - the advancement value is measured end to end of the central incisors of the arches maxillary and mandibular dental, on a horizontal,

[0067] - the advancement value is advantageously in the range of 1 mm to 3 mm,

[0068] - the apparatus is configured to immobilize the mandibular arch relative to the arch maxillary in elevation of the occlusion by a determined opening value, said opening value being in the range of 1 mm to 10 mm,

[0069] - the aperture value is advantageously in the range of 1 mm to 9 mm,

[0070] - the aperture value is more advantageously in the range of 3 mm to 9 mm,

[0071] - the opening value is measured end to end of the central incisors of the arches maxillary and mandibular dental,

[0072] - the opening value is measured end to end of the central incisors of the arches maxillary and mandibular dental, on a vertical,

[0073] - the apparatus is configured to separate the vestibular parts of the cheeks away from the dental arches of a determined spacing value, said spacing value being in the range of 4 mm to 10 mm,

[0074] - the device is made of a material which is a plastic material chosen from poly- dental acetates, FLEXITE®, VALPLAST®, dental acrylic resins, dental thermoformable plastics, ERKOFLEX®,

[0075] - the material is substantially transparent or translucent,

[0076] - the material is colored in the mass,

[0077] - the front part of the device is thinned,

[0078] - the thinned front part of the device comprises a seat for receiving an ac accessory,

[0079] - the accessory is removable,

[0080] - the accessory is an interlabial air communication insert between the inside of the oral cavity and the external environment,

[0081] - the insert has a U-shaped seat intended to be positioned astride the seat of the front part of the device,

[0082] - the seat and the seat include complementary means ensuring retention of the insert on the device,

[0083] - the insert comprises at least one hollow tube intended to provide air communication the interior of the oral cavity and the external environment,

[0084] - the insert comprises a central hollow tube,

[0085] - the insert comprises two lateral hollow tubes. Brief description of the drawings

[0086] [fig. 1] represents a frontal / front view from above of an oral appliance manufactured according to the invention,

[0087] [fig.2] represents a right lateral view from above of the oral apparatus of the [fig.l],

[0088] [fig.3] represents a left lateral view from above of the oral apparatus of [fig.l],

[0089] [fig-4] represents a rear view from above of the oral apparatus of [fig.l],

[0090] [fig.5] represents a bottom view of the oral apparatus of [fig.l],

[0091] [fig.6] represents a side view of an adjustable model holder in which two models of the mandibular and maxillary dental arches were installed as well as the dental appliance made on the model of the mandibular dental arch,

[0092] [fig-7] represents a view from a first side, in perspective, of a device of adjustment according to the invention with means for adjusting the positioning in protrusion and adjustment in opening, of the mandible relative to the maxilla,

[0093] [fig.8] represents a view from a second side, in perspective, of the adjustment device of [fig.7],

[0094] [fig.9] represents a top view of the adjustment device of [fig.7],

[0095] [fig. 10] represents a first perspective view of a removable commu insert interlabial air connection between the inside of the oral cavity and the external environment and which can be installed on the thinned anterior part of the device, and

[0096] [fig.l 1] represents a second perspective view of the insert of [fig.10]. Detailed description of an example of implementation

[0097] The description which follows with reference to the attached drawings, given as examples non-limiting, will make it clear what the invention consists of and how it can be implemented.

[0098] The adjustment device of the invention is intended to take an impression of the mandibular dental arch under particular conditions of protrusion and elevation of the opening of the mandible relative to the maxilla on a subject. Preferably, the adjustment device can record the protrusion and the opening to recreate directly on a buccal model the same conditions of protrusion and opening as on the subject, the oral dental appliance being produced on the buccal model. The buccal model consists of a model holder with the models of the mandibular and maxillary dental arches obtained by taking impressions on the subject.

[0099] The oral appliance manufactured using the adjustment device of the invention is simple, original and light. In particular, it does not include any articulation and is related to a minimum of anatomical structures of the subject. In particular, only two small fins, each resting on the vestibular faces of only two teeth adjacent to the maximum of the maxilla, make it possible to block the protrusion of the mandible. The oral appliance acts by three main actions in order to improve ventilation, in particular nocturnal ventilation, and / or reduce, or even eliminate, snoring.

[0100] These actions are:

[0101] 1°) mandibular protrusion,

[0102] 2°) the elevation of the occlusion,

[0103] 3°) improvement of tissue tone in the cheeks and lips by the swelling of both vestibular parts of the subject.

[0104] If the combination of these actions makes it possible to obtain particularly interesting results, each of these actions or combinations of two of them also makes it possible to obtain useful results.

[0105] With regard to the mandibular protrusion permitted by the apparatus of the present invention, it should be noted that it is obtained in a much simpler and more elegant manner than in existing devices where the upper and lower splints are connected by hinges which force the mandible to close in a determined position. These existing devices are not very comfortable for the subject because of pain caused at the level of the temporomandibular joints, causing waking several times during the night and causing congestion of the airways.

[0106] As a reminder of the context, the upper dental arch, called the maxilla, overhangs the lower dental arch, called the mandible. The upper or maxillary arch, which is part of the craniofacial assembly, is fixed and the lower arch or mandible is articulated and mobile.

[0107] We will begin by describing the oral appliance which is manufactured using the adjustment device of the invention before describing the manufacturing method and then describing more precisely the adjustment device used.

[0108] The oral appliance 1 of figures 1 to 5 allows immobilization of the mandible in protrusion with a determined advancement value of the mandible relative to the maxilla. The oral appliance 1 also allows the mandible to be maintained in raised occlusion, that is to say in opening of the oral cavity, with a determined opening value. This appliance 1 has three main parts, an anterior part 2 towards the front and which is intended to cover the incisors and canines of the mandible and two lateral parts, right 4 and left 3 towards the rear, intended to cover the premolars and molars on the corresponding side of the mandible. The respective extents of these three parts are indicative and are given to facilitate explanations.In practice, the transition zone between the anterior part 2 and each lateral part 3, 4 can be located between the canines and premolars or, less preferably, between the premolars or, again, between the premolars and molars.

[0109] The appliance 1 has a reversed gutter shape 10 which matches the shape of the mandibular dental arch and the shape of its teeth because it was made on a molded model of the mandibular dental arch of a subject for whom the appliance is intended. This gutter has two side walls, an internal side wall 6 on the inside of the mouth and tongue, and an external side wall 7 (= vestibular) on the cheek side. This gutter 10 has a gutter bottom 11 which closes it upwards. This gutter bottom 11 made of a thickness of material forms, on the upper side of said material, an upper face 8 intended to come approximately opposite the occlusal faces of the teeth of the maxilla. The thickness of material between the bottom 11 of the gutter 10 and the upper face 8 in the side parts 3, 4 of the appliance 1 determines the extent / size of the occlusion elevation.The greater this thickness, the greater the elevation of the occlusion and therefore the opening value will be.

[0110] The interior of the gutter 10 and in particular its bottom 11 therefore contain impressions of the teeth of the mandible. Similarly, the upper face 8 of the appliance 1 contains impressions of occlusal faces of teeth of the maxilla and more particularly of the rear teeth, essentially molars. It should be noted that at the front of the appliance there are no impressions of teeth of the maxilla due to the protrusion and, above all, the blocking in raising the occlusion. It is understood that these impressions on the upper face 8 of the appliance 1 will be more or less extensive / present going towards the front as the raising of the occlusion is less or greater.

[0111] The device 1 comprises two fins 5 erected on the upper face 8 approximately tively in the area between the anterior part 2 and the lateral parts 3, 4. Each of these fins 5 extends along the mandibular arch over a very small determined width, less than approximately 12 mm, and corresponding in practice and at most to the extent of two maxillary teeth on which the fin is applied. These two maxillary teeth are preferably 13, 14 and 23, 24 according to the nomenclature conventionally used and which correspond to canines and first premolars. Moreover, it can be seen in the figures of the device 1 that the inner face 9 of the fins 5 includes impressions of the maxillary teeth on which these fins 5 are applied. Preferably and as shown, the fins 5 have a wider base than at their top.Due to the arched shape of the mandible and maxilla and the shapes of the teeth, in particular a recess existing between two teeth, these wings 5, although of reduced width, allow effective maintenance of the protruding mandible, and this, with a minimum of discomfort and bulk in the mouth.

[0112] Preferably, the front part 2 of the appliance 1 has a thickness of material that is smaller than the rest of the appliance so as not to excessively reduce the surface area for the passage of air between the front teeth of the maxilla and the front part 2 of the appliance 1, so that the subject wearing the appliance can continue to breathe through the mouth properly.

[0113] This reduced thickness of material of the front part 2 may also correspond to a seat 12 or comprise a seat 12 for receiving a removable accessory that can be installed on the appliance 1 if necessary and removed if it is no longer needed. This accessory may be an insert 13 for interlabial air communication between the inside of the oral cavity and the external environment of the user of the appliance, an example of which is shown in FIGS. 10 and 11. This insert 13 comprises a U-shaped seat 14 intended to be positioned astride the seat 12 of the appliance. The seat 14 and the seat 12 may comprise complementary means ensuring a certain retention of the insert 13 on the appliance 1. These complementary means are, for example, protuberances of the seat of the insert returning in a resilient manner into complementary hollows of the seat 12.The seat may extend laterally beyond the seat and therefore have thinner parts laterally.

[0114] The interlabial air communication insert 13 comprises at least one hollow tube 15 intended to provide air communication between the inside of the oral cavity and the external environment even when the user closes his lips since the tube(s) 15 pass between the lips. In the figure, the insert 13 comprises two tubes 15 whose orifices can be seen. The insert 13 installed on the device 1 thus makes it possible to ensure a certain level of gas exchange between the respiratory system and the environment, which is particularly advantageous in the case where the user has a narrowed nasal system, or even obstructed. The tubes may or may not be rigid, preferably with some radial resistance allowing them to remain at least partially open when the person clenches their lips and / or teeth.

[0115] The invention can also be presented in the form of a kit usable by a user and which comprises, on the one hand, the device 1 and, on the other hand, one or more inserts 13 for interlabial air communication, the inserts being able to be of several types: with one or two or more tubes 15.

[0116] In relation to [fig.6], we will now describe the manufacturing method of the oral appliance 1. Preferably, this appliance is custom-made for a given subject but, in alternative embodiments, it is possible to manufacture standardized appliances usable by groups of users having common characteristics and in particular size and / or oral anatomical dimensions. In more advanced variants, standardized appliances are proposed allowing a certain adaptation to the subject using it, for example allowing a molding of the standardized appliance to the subject's teeth. There are in fact thermoplastic materials which can allow impressions of teeth to be taken and it is planned to put them in the enlarged gutter 10 of a standardized appliance, the subject heating his standardized appliance and taking an impression of his mandible to conform his standardized appliance to his mandibular dental arch.

[0117] In order to obtain a custom-made device 1 for a given subject, firstly, an impression of the maxillary dental arch is made on the subject without any particular constraint. Secondly, an impression of the mandibular dental arch is made on the subject but this time with the constraint that the taking of the impression of the mandibular dental arch is carried out with an adjustment device with means for adjusting the protrusion positioning and for adjusting the opening of the mandible relative to the maxilla and which also makes it possible to record the protrusion and opening adjustments. When taking this impression of the mandibular dental arch, the protrusion and opening will have been adjusted and recorded for the subject.Preferably, this recording of the protrusion and the opening is done on the adjustment device with means for adjusting the protrusion positioning and for adjusting the opening which remains in the set configuration (which corresponds to a recording / memorization by the adjustment device which could then be described as an adjustment and recording device). It is possible to provide that the adjustment means are retractable but that after retraction, they resume the position corresponding to the adjustment obtained on the subject. This is the case for the protrusion adjustment with the adjustment device of figures 7 to 9 where, as will be seen, a spring is used for the support device allowing the protrusion adjustment.

[0118] In a variant, means are used for measuring the advancement value of the protrusion and means for measuring the opening value of the occlusion elevation and they are noted or recorded on a paper or other medium for later use. Preferably, the adjustment device with means for adjusting the protrusion positioning and for adjusting the opening also comprises such measuring means (the adjustment device could then be described as an adjustment and measurement device or an adjustment, measurement and recording device depending on the presence or absence of recording means) thus allowing it to be used according to different possibilities and in particular those described by way of example.

[0119] Once these maxillary and mandibular impressions have been obtained, a model of the maxillary dental arch and a model of the mandibular dental arch are produced in a second step. The two models are installed in an adjustable model holder and the said model holder is adjusted by placing the adjustment device having recorded the protrusion and opening adjustment on the mandibular dental arch model in order to configure the model holder with the same protrusion and opening adjustment as on the subject.It is understood that if the adjustment device with means for adjusting the protrusion positioning and adjusting the opening does not allow the recording of the advancement and opening values ​​(or if they have been modified or lost) and if they have been measured and recorded elsewhere at the first time, the adjustment device will be adjusted to reconfigure it with said values ​​in the model holder and then the model holder is configured to correspond to what had been adjusted on the subject.

[0120] Once the adjustment device is removed from the model holder, there is then a model holder with the models of the dental arches which has an identical configuration in protrusion and opening to that which was obtained on the subject in the first stage. It is then possible, in a third stage, to produce the appliance on this model holder configured as on the subject. To do this, material is applied to the model of the mandibular dental arch installed in the configured model holder in order to form an inverted gutter 10 covering the teeth of the mandibular arch. It is ensured that the thickness of material between the bottom 11 of the gutter and the upper face 8 is such that the upper face 8 of the appliance comes into contact with at least a portion of the occlusal faces of the right and left molars of the model of the maxillary dental arch in order to obtain the expected / planned occlusion elevation.Furthermore, the two fins 5 are produced by applying material to the upper face 8 of the device, each fin bearing against vestibular faces of teeth of the model of the maxillary dental arch, and preferably against teeth 13 to 14 and 23 to 24 respectively.

[0121] [Fig.6] shows the apparatus 1 made in the model holder 17 comprising the model of the maxillary dental arch 18 and the model of the mandibular dental arch 19. It can be seen that the model holder comprises means for adjusting the protrusion and the opening which were configured in the second stage to cor respond to those of the subject through the use of the adjustment device which recorded the protrusion and aperture setting on the subject.

[0122] The apparatus 1 produced in the model holder may be the one directly supplied to the subject or, preferably, it may be used for molding an apparatus which will be supplied to the subject.

[0123] For the usable material, any type of resin can be used for the production of the device as long as it is compatible with the production of dental or orthodontic devices: FLEXITE, VALPLAST, and all types of gum pink or transparent dental polyacetates, all types of colored or transparent dental acrylic resins, all thermoformable materials such as ERKOFLEX + transparent resin, transparent or colored.

[0124] We will now describe in relation to figures 7 to 9, an adjustment device 20 with means for adjusting the protrusion positioning and for adjusting the opening of the mandible relative to the maxilla and which also makes it possible to record the protrusion and opening adjustments and to measure these adjustments.

[0125] The adjustment device 20 comprises a shell 21 elongated in an arc and having a section in the approximate shape of an inverted U with an internal face intended to cover the mandibular dental arch and an external face. The shell 21 comprises three portions, an anterior portion towards the front and two right and left lateral portions towards the rear. The internal face of the shell 21 has a certain clearance relative to the mandibular dental arch which it covers so that an impression paste can be introduced between the shell 21 and the molding of the teeth of the mandible can be carried out correctly. The impression paste can optionally be introduced into the shell 21 in place in the mouth, in particular through a passage 24 made in the shell 21 of the adjustment device 20 or be spread in the shell prior to the positioning of the adjustment device on the mandibular dental arch.The shell 21 has through holes 33 intended to ensure better retention of the impression paste in the shell 21. These holes 33 can also, possibly, be used for the possible additional introduction of impression paste. Preferably, impression paste is spread in the shell of the adjustment device then not in the mouth and then it is installed in the mouth to take the mandibular dental impressions.

[0126] Concerning the adjustment of the protrusion, the adjustment device 20 comprises an adjustable support device 22 for adjusting the protrusion. The support device 22 is integral with the external face of the anterior portion of the shell 21 and comprises a Y-shaped support piece 29 intended to come into contact with teeth of the maxillary dental arch. This support piece 29 can be moved forward or backward by sliding along a threaded rod 32 for adjusting the protrusion and it is adjustable by screwing / unscrewing a wing nut 30 on said threaded rod 32 integral with the shell, the support piece 29 being pushed back from the shell 21 by a spring 31, which ensures the recording of the advancement for the protrusion even if the support piece can then be retracted / moved along the threaded rod. It is understood that after the adjustment of the protrusion on the subject by action on the nut 30, the position of the nut 30 will not be modified to maintain / record said adjustment. This support piece 29 can move freely with a certain play along the threaded rod 32 depending on the position of the wing nut 30 and, preferably, it can also tilt or even rotate.

[0127] Still in relation to the protrusion but this time concerning the measurement of the advancement value, the adjustment device 20 comprises a graduated scale 25 making it possible to directly measure the distance substantially on a horizontal line between the respective tips of the central incisors of the maxillary and mandibular dental arches. To locate the tips of the mandibular incisors, the passage 24 can be used and / or a transparent shell 21 can be used. The passage 24 can act as a passage for checking and for measuring protrusion and / or opening adjustment(s).

[0128] Concerning the adjustment of the occlusion / opening elevation, the adjustment device 20 comprises two adjustable spacing devices 23 for adjusting the opening, one on each lateral portion of the shell 21. Each spacing device 23 comprises a base 26 secured to the upper part of the external face of the lateral portion of the shell 21 and a support piece 27 intended to come against teeth of a maxillary dental arch, more specifically against occlusal faces of molars. The support piece 27 can be mounted or lowered on the base 26 for adjusting the opening due to the wedge shapes of the support piece 27 and the base 26. A screw 28 allows the adjustment of the spacing device 23 by screwing and unscrewing.

[0129] Still in relation to the occlusion elevation but this time concerning the measurement of the opening value, the vertical distance between the respective tips of the central incisors of the maxillary and mandibular dental arches can be measured with an attached / external ruler. In a variant, a graduated scale of the type 25 but this time vertical, arranged on the adjustment device, can be provided. In a particular mode, the graduated scale 25 can switch between a substantially horizontal position and a substantially vertical position.

[0130] In order to facilitate the protrusion and opening adjustments as well as the measurements, it is possible to provide that the shell is made of a transparent or translucent material.

[0131] An adjustment device has been described by way of example allowing both adjustments: of protrusion and of the elevation in occlusion, as well as the recording of the adjustments and at least the measurement of the advancement value for the protrusion. In other implementation methods, the adjustment device only allows the adjustment of the protrusion or the adjustment of the occlusion elevation. In certain implementation methods, the adjustment device does not allow the recording of the adjustment(s). In certain implementation methods, the adjustment device does not allow direct measurements, i.e. without using an external measuring means. In these cases, the corresponding means are absent from the adjustment device, which is thus simplified.

Claims

Claims

1. Device for adjusting occlusion ratios in mandibular protrusion (20) with means for adjusting the positioning in protrusion of the mandible relative to the maxilla, characterized in that it comprises - a shell (21) elongated in an arc of approximately inverted U-shaped section with an internal face and an external face, said shell (21) having an anterior portion towards the front and two right and left lateral portions towards the rear, said shell (21) being adapted to be placed by its internal face overlapping on a mandibular dental arch of a subject for taking an impression of said mandibular dental arch in order to be able to produce a model of the mandibular dental arch, an upper part of the external face coming into contact with occlusal faces of teeth of the maxillary dental arch, - at least one adjustable support device (22) for adjusting protrusion,said at least one support device (22) comprising a support piece (29) secured to the front portion of the shell (21) and intended to come into contact with teeth of a maxillary dental arch, the support piece (29) being able to be moved forward or backward relative to the shell for adjustment of the protrusion.,

2. Adjustment device (20) according to claim 1, characterized in that the protrusion positioning adjustment means also make it possible to record the protrusion adjustment and in that the support piece (29) is integral with the front portion of the shell (21) by means of a threaded rod (32) immobilized to the shell (21), said support piece (29) being able to slide along said threaded rod (32) and being sandwiched between a spring (31) on the shell side and a nut (30) on the free end side of the threaded rod (32), the spring (31) pushing the support piece (29) against the nut (30), said nut (30) being able to be screwed or unscrewed from the threaded rod (32) to move the support piece (29) forward or backward relative to the shell (21).

3. Adjustment device (20) according to claim 1 or claim 2, characterized in that the support piece (29) is Y-shaped with two diverging branches and a common trunk, said common trunk of the support piece (29) being integral with the anterior portion of the shell, one of the branches of the Y being intended to come to bear against the front face of the teeth of the maxillary dental arch and the other branch being intended to pass under the tips of the teeth of the maxillary dental arch.

4. Adjustment device (20) according to any one of claims 1 to 3, characterized in that it is further provided with means for adjusting the elevation of the occlusion, the adjustment device further comprising: - at least one adjustable spacing device (23) for adjusting the opening, said at least one spacing device being integral with the upper part of the external face of a lateral portion of the shell (21) and comprising a support piece (27) intended to come against occlusal faces of teeth of a maxillary dental arch, the support piece (27) being able to be raised or lowered for adjusting the opening, preferably the adjustment device (20) comprising two adjustable spacing devices (23) for adjusting the opening, one on each lateral portion of the shell (21).

5. Adjustment device (20) according to claim 4, characterized in that the means for adjusting the occlusion elevation further allow the adjustment of the occlusion elevation to be recorded and in that the adjustable spacing device (23) comprises a base (26) fixed on the upper part of the external face of the lateral portion of the shell (21), said base (26) forming an inclined plane on which the wedge-shaped support piece (27) can slide to rise or fall depending on the direction of rotation of a screw (28).

6. Adjustment device (20) according to any one of claims 1 to 5, characterized in that the shell (21) comprises at least one passage (24) through the anterior portion of the shell for protrusion adjustment control and intended to allow the visualization of at least one of the incisors of the mandibular dental arch, the shell (21) further comprising on its external face towards the top of the shell (21) and at the edge of said passage (24) a graduated scale (25) elongated anteroposteriorly intended to measure the advancement in protrusion between the incisors of the mandibular dental arch and of the maxillary dental arch.

7. Adjustment device (20) according to claim 6, characterized in that the graduated scale (25) can switch between a position where it is elongated anteroposteriorly to allow measurement of the protrusion advancement between the incisors of the mandibular dental arch and of the maxillary dental arch and a position where it is elongated vertically to allow measurement of the opening of the occlusion elevation between the incisors of the mandibular dental arch and of the maxillary dental arch.

8. Adjustment device (20) according to any one of claims 1 to 7, characterized in that the shell comprises at least one passage (24) for filling allowing the introduction inside the shell, on the internal face side of the shell, of an impression-taking paste.

9. Method for manufacturing an oral dental appliance (1) for immobilizing the protrusion of the mandibular arch and for raising the occlusion for a subject, characterized in that: - firstly, an impression of the maxillary dental arch and, on the other hand, an impression of the mandibular dental arch are made on the subject, the impression of the mandibular dental arch being taken with an adjustment device (20) with means for adjusting the protrusion positioning (22) and for adjusting the opening (23) of the mandible relative to the maxilla and also making it possible to record the protrusion and opening adjustment, said adjustment device (20) being according to claim 5 in its combination with claim 2, and when taking the impression of the mandibular dental arch, the protrusion and opening are adjusted and recorded for the subject,- in a second step, a model of the maxillary dental arch and a model of the mandibular dental arch are produced from the impressions of the maxillary and mandibular dental arches, the two models are installed in an adjustable model holder (17) and said model holder (17) is adjusted by placing on the model of the mandibular dental arch, the adjustment device (20) having recorded the protrusion and opening adjustment in order to configure the model holder (17) with the same protrusion and opening adjustment as on the subject, - in a third step, the adjustment device (20) having been removed from the model holder (17), the apparatus is produced on the model of the mandibular dental arch installed in the configured model holder,the production of the apparatus (1) consisting of applying material to the model of the mandibular dental arch installed in the model holder configured in order to form an inverted gutter (10) covering the teeth of the mandibular arch and of which the upper face (8) of the apparatus (1) comes into contact with at least a portion of the occlusal faces of the right and left molars of the model of the maxillary dental arch by applying a determined thickness of material between the bottom (11) of the gutter and said upper face (8), and in that in addition material is applied to said upper face of the apparatus in order to form two fins (5), erected on said upper face and extended upwards, each fin (5) coming to bear against vestibular faces of teeth of the model of the maxillary dental arch, and preferably against teeth 13 to 14 and 23 to 24 respectively.

10. Oral dental appliance (1) for immobilizing the protrusion of the mandibular arch relative to the maxillary arch manufactured according to the method of claim 9, said appliance in the form of an inverted gutter (10) being intended to cover the teeth of the mandibular arch, said inverted gutter (10) being open downwards, closed on the sides by internal lateral walls (6) on the inside of the mouth and external lateral walls (7) on the cheek side and closed at the top by a gutter bottom (11), said appliance (1) comprising three main parts, an anterior part (2) towards the front intended to cover the incisors and canines of the mandible and two right (4) and left (3) lateral parts towards the rear intended to cover the premolars and molars on the corresponding side of the mandible, the internal shape of the gutter (10) being adjusted to the teeth of the mandible and corresponding to an impression of said teeth of the mandible,the device comprising an upper face (8), said upper face being intended to come approximately opposite the occlusal faces of the teeth of the maxilla, characterized in that the device (1) comprises two fins (5) erected on the upper face (8) and extended upwards, each fin (5) being positioned approximately in the connection zone between the anterior part (2) and the corresponding right (4) or left (3) lateral part, and extending along the mandibular arch over a determined width, the fins (5) comprising an inner face (9) oriented towards the inside of the mouth and intended to come to bear against vestibular faces of teeth of the maxilla when the device (1) is in place in the mouth in order to block the protrusion of the mandible, the inner faces (9) of the two fins (5) coming to bear on the vestibular faces of the teeth respectively 13 to 14 and 23 to 24 of the maxilla,and in that it further allows the immobilization in elevation of the occlusion, at least a part of the right and left molars of the maxilla resting by their occlusal faces on the upper face (8) of the appliance (1) when the appliance (1) is in place in the mouth, the appliance (1) comprising a determined thickness of material between the bottom (11) of the gutter and the upper face (8) at least in the zones where said at least a part of the right and left molars of the, maxillary rest on the upper face of the appliance in order to block the closure and leave a determined height gap between the incisors of the mandible and the maxilla.

11. Oral-dental appliance (1) according to claim 10, characterized in that the front part (2) of the appliance (1) is thinned and the thinned front part (2) of the appliance (1) comprises a seat (12) for receiving a removable accessory which is preferably an insert (13) for interlabial air communication between the interior of the oral cavity and the external environment, the insert (13) comprising a U-shaped seat (14) intended to be positioned astride the seat (12) and at least one hollow tube (15) intended to provide air communication between the interior of the oral cavity and the external environment.

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