Implant device for mitigating restriction of airways causing sleep apnea

Abstract

The present embodiments relate to systems and methods relating to an implant that enables the jaw to be held forward while sleeping that advances the lower jaw without the discomfort provided by other techniques. The implant can be configured to be positioned between the mastoid bone and the mandible bone of a user. The implant may not affect natural jaw movement that can include opening and closing of the jaw but also side-to-side movement.

Description

IMPLANT DEVICE FOR MITIGATING RESTRICTION OF AIRWAYSCAUSING SLEEP APNEACROSS-REFERENCE TO RELATED APPLICATION(S)

[0001] The present application claims priority to United States Provisional Patent Application No. 63 / 609,204, titled “IMPLANT DEVICE FOR MITIGATING RESTRICTION OF AIRWAYS CAUSING SLEEP APNEA,” and fded December 12, 2023, the entirety of which is incorporated by reference in its entirety herein.TECHNICAL FIELD

[0002] The present disclosure relates generally to implant devices. In particular, the present disclosure relates to devices, systems, and methods for relieving symptoms associated with upper airway obstructive breathing and snoring using bone implant devices.BACKGROUND

[0003] Upper airway obstructive breathing may be characterized as complete or partial blockage of the upper airway during sleep. Common medical conditions associated with upper airway obstructive breathing may include sleep disordered breathing, sleep apnea, and snoring, to name a few. The obstruction may be caused by relaxation of soft tissues and muscles in or around the throat soft tissues at the base of the tongue and throat, tonsils, uvula, and pharynx, most common during sleep when the muscles in the body tend to relax.

[0004] As a result, a lower jaw (or mandible) of a patient is more susceptible to retrodisplacement, i.e., it settles in a relatively posterior position. In such cases, the risk of the soft tissues at or near the base of the tongue, in the throat collapsing and / or obstructing the upper airway is also increased. People suffering from upper airway obstructive breathing often report low quality sleep or sleep deprivation, which leads to excessive daytime sleepiness, chronic fatigue, headaches, and numerous non-sleep related medical issues.

[0005] There is a need to correct upper airway obstructive breathing during sleep in order to alleviate these negative repercussions in a way that is reproduceable, hygienic, safe, and effective.SUMMARY

[0006] The present embodiments relate to systems and methods relating to an implant that enables the jaw to be held forward while sleeping that advances the lower jaw without the discomfort provided by other techniques. The implant can be configured to be positioned between the mastoid bone and the mandible bone of a user. The implant may not affect natural jaw movement that can include opening and closing of the jaw but also side-to-side movement.

[0007] In an example embodiment, an implant device can be utilized. The implant device can include both a proximal portion configured to be fixed to a mandible bone of a user and a distal portion configured to be fixed to a temporal bone of a user. Further, a piston can connect the proximal portion to the distal portion, with a first end of the piston fixedly engaged to the proximal portion and a second end of the piston slidably engaged within a channel formed in the distal portion. In some embodiments, the piston can be fixed to the distal portion and the piston can be configured to be slidably engaged within a channel in the proximal portion.

[0008] The position of the piston can specify a state of the implant. For example, the piston at a proximal end of the channel disposed closer to the proximal portion can comprise an active state that moves the jaw of the user forward to mitigate constriction of airways that can cause sleep apnea or other conditions. The piston being at a distal end of the channel deeper in the channel can comprise a deactivated state in which the jaw is in a normal position. The piston can include a detent that can interface with a roller or other component to maintain the jaw of the user in the active state when desired.

[0009] In a first example embodiment, an implant device is provided. The implant device can include a proximal portion configured to be fixed to a mandible bone of a user. The implant device can also include a distal portion configured to be fixed to a temporal bone of a user.

[0010] The implant device can also include a piston connecting the proximal portion to the distal portion. A first end of the piston can be fixedly engaged to the proximal portion. A second end of the piston can be slidably engaged within a channel formed in the distal portion. The piston being disposed at a first position within the channel can include an active state and the piston being disposed at a second position within the channel can include a deactivated state.

[0011] In some instances, the implant device can also include a first connection portion with a first external connector configured to connect the proximal portion to the mandiblebone. The first connection portion can provide an interface for one or more fasteners to fasten the first connection portion to the mandible bone. The implant device can also include a second connection portion with a second external connector configured to connect the distal portion to the temporal bone. The second connection portion can provide an interface for one or more fasteners to fasten the second connection portion to the temporal bone.

[0012] In some instances, each of the first connection portion and the second connection portion comprises a pivot joint providing a removable connection between each of the first external connection to the proximal portion and the second external connection to the distal portion.

[0013] In some instances, the implant device can also include a ball and socket joint disposed within each of the proximal portion and the distal portion. Each ball and socket joint can be configured to provide rotational movement of each of the proximal portion and the distal portion based on movement of the user.

[0014] In some instances, the implant device can also include a roller disposed adjacent to the piston. The roller can be configured to provide an upward bias on the piston.

[0015] In some instances, the piston further comprises a detent protruding from the second end of the piston. The detent can be configured to interface with the roller to maintain the piston in the active state.

[0016] In some instances, the first position within the channel comprising the active position is a proximal position within the channel. The second position within the channel comprising the deactivated position is a distal position within the channel.

[0017] In some instances, the implant device can also include any of a flat spring or a flexible component disposed adjacent to the piston to provide an upward bias on the piston and the detent.

[0018] In some instances, the implant device can also include a wheel disposed adjacent to the piston to provide an upward bias on the piston. The wheel can include a cam disposed at a lower end of the wheel, and an indent can be formed within the wheel configured to interface with the detent of the piston.

[0019] In some instances, the implant device can also include a pair of stops each disposed adjacent to the piston. Each of the pair of stops can be configured to engage with detent portions of the piston and lock the piston in the active state.

[0020] In another example embodiment, a device is provided. The device can include a first portion, a second portion, a piston connecting the first portion to the second portion. A first end of the piston can be fixedly engaged to the first portion. A second end of the pistoncan be slidably engaged within a channel formed in the second portion. The piston being disposed at a first position within the channel can include an active state and the piston being disposed at a second position within the channel can include a deactivated state.

[0021] In some instances, the device can also include a first connection portion with a first external connector to provide an interface for one or more fasteners to fasten the first connection portion to a mandible bone and a second connection portion with a second external connector to provide an interface for one or more fasteners to fasten the second connection portion to a temporal bone. Each of the first connection portion and the second connection portion can include a pivot joint providing a removable connection between each of the first external connection to the first portion and the second external connection to the second portion.

[0022] In some instances, the device can also include a ball and socket joint disposed within each of the first portion and the second portion. Each ball and socket joint can be configured to provide rotational movement of each of the first portion and the second portion.

[0023] In some instances, the device can also include a roller disposed adjacent to the piston, the roller configured to provide an upward bias on the piston and a detent protruding from the second end of the piston and configured to interface with the roller to maintain the piston in the active state.

[0024] In some instances, the device can also include any of a: flat spring, a flexible component disposed adjacent to the piston to provide an upward bias on the piston and the detent, and a wheel disposed adjacent to the piston to provide an upward bias on the piston. The wheel can include a cam disposed at a lower end of the wheel, and an indent can be formed within the wheel configured to interface with the detent of the piston.

[0025] In some instances, the device can also include a power source and a direct current (DC) microcontroller configured to move the piston between the active and the deactivated states.

[0026] In some instances, the device can also include a hydraulic pump connected to the DC microcontroller and a fluid reservoir containing a hydraulic fluid. The DC microcontroller can control a volume of hydraulic fluid in a chamber to move the piston between the active and deactivated states.

[0027] In another example embodiment, a method for implanting an implant device is provided. The method can include disposing a first external connector of a first connection portion connected to a proximal portion of an implant device to a mandible bone of a user. The method can also include disposing a second external connector of a second connectionportion connected to a distal portion of the implant device to a temporal bone of the user. The method can also include, responsive to a force applied to the implant device, moving a piston of the implant device between an active state and a deactivated state. A first end of the piston can be fixedly engaged to the proximal portion, and a second end of the piston can be slidably engaged within a channel formed in the distal portion.

[0028] In some instances, disposing any of the first external connector or disposing the second external connector comprises fastening one or more fasteners to either the mandible bone or the temporal bone via openings formed in the first external connector or second external connector.

[0029] In some instances, moving the piston between the deactivated state to the active state includes a detent extending from the piston to interface with a roller disposed in the channel formed in the distal portion.

[0030] In some instances, each of the first connector portion and the second connector portions include a ball and socket joint allowing for rotational movement of each of the proximal portion and the distal portion.BRIEF DESCRIPTION OF THE DRAWINGS

[0031] FIG. 1A illustrates an example of a jaw in a closed jaw position as described in the embodiments disclosed herein.

[0032] FIG. IB illustrates a second position of a jaw opened with no translation as described in the embodiments disclosed herein.

[0033] FIG. 1C illustrates a third position of a jaw at maximum open with translation of the jaw as described in the embodiments disclosed herein.

[0034] FIG. ID illustrates a fourth position comprising a closed jaw and extended as with an implant engaged as described in the embodiments disclosed herein.

[0035] FIG. 2A is a first example illustration of an implant device as described in the embodiments disclosed herein.

[0036] FIG. 2B is a second example illustration showing a cross section of the implant as described in the embodiments disclosed herein.

[0037] FIG. 3 is a perspective view of an implant as described in the embodiments disclosed herein.

[0038] FIGS. 4A-4E are illustrations of different example systems using different piston assemblies as described in the embodiments disclosed herein.

[0039] FIGS. 5A-5B are illustrations of different example systems using a swinging gate assembly as described in the embodiments disclosed herein.

[0040] FIGS. 6A-6C are illustrations of example systems using hinged or jointed assemblies as described in the embodiments disclosed herein.

[0041] FIG. 7 is an illustration of example systems using rack and pinion direct drive assemblies as described in the embodiments disclosed herein.

[0042] FIG. 8 is an illustration of example systems using hydraulic pump and spring dampener assemblies as described in the embodiments disclosed herein.

[0043] FIG. 9 is an illustration of example systems using different electromagnetic piston assemblies as described in the embodiments disclosed herein.

[0044] FIG. 10 illustrates an example adjustable tube length design for an implant as described in the embodiments disclosed herein.

[0045] FIGS. 11-12 illustrates example split tube in tube design for use with an implant as described in the embodiments disclosed herein.

[0046] FIG. 13 illustrates an example tube in tube design for an implant that includes an adjustable length clamshell as described in the embodiments disclosed herein.

[0047] FIG. 14 illustrates an example sliding Nitinol flat plate design for an implant as described in the embodiments disclosed herein.

[0048] FIG. 15 illustrates an example implant design with a piston configured to slide within an implant body as described in the embodiments disclosed herein.

[0049] FIG. 16 illustrates an example implant design with a piston configured to move within a body portion of an implant as described in the embodiments disclosed herein.

[0050] FIG. 17 illustrates an example implant design with a piston and hooked detent as described in the embodiments disclosed herein.

[0051] FIGS. 18A-18F illustrate various views of the implant with a piston configured to move between positions via tracks as described herein as described in the embodiments disclosed herein.

[0052] FIGS. 19A-19B illustrates views of an implant with a sheet nitinol piston with a stamped detent and roller as described in the embodiments disclosed herein.

[0053]

[0054] FIGS. 20A-20C illustrates views of an example implant with a ball detent, silicone portions, and a wire piston as described in the embodiments disclosed herein.

[0055] FIG. 21 illustrates views of an example implant with a ball detent, silicone portions, and a wire piston as described in the embodiments disclosed herein.

[0056] FIG. 22 illustrates an example implant design with a ball configured with step detents as described in the embodiments disclosed herein.

[0057] FIG. 23 illustrates an example implant design with an accordion style design as described in the embodiments disclosed herein.

[0058] FIG. 24 is a diagram showing an example networked system which may be used in the embodiments disclosed herein.

[0059] FIG. 25 is a diagram showing an example computing system which may be used in the embodiments disclosed herein.DETAILED DESCRIPTION

[0060] Reference will now be made in detail to embodiments, examples of which are illustrated in the accompanying drawings. In the following detailed description, numerous specific details are set forth in order to provide a sufficient understanding of the subject matter presented herein. But it will be apparent to one of ordinary skill in the art that the subject matter may be practiced without these specific details. Moreover, the particular embodiments described herein are provided by way of example and should not be used to limit the scope of the invention to these particular embodiments. In other instances, well- known data structures, timing protocols, software operations, procedures, and components have not been described in detail so as not to unnecessarily obscure aspects of the embodiments of the invention.Overview

[0061] Sleep Apnea is a common problem for many individuals, which can cause people to wake up during the night due to a constricted airway of the pharynx, soft palate, base of tongue, and hypopharynx. One option to mitigate sleep apnea can include manipulation of the jaw to open that airway, even while asleep using mouth guards, a product which advances the lower jaw forward which in turn pulls the connected soft tissue forward thus opening the airway of user. However, there is a low compliance rate with removable mouthguards since they can be uncomfortable with the pressure being exerted on the teeth of the user to hold the jaw forward. Compliance issues also are notable for users losing their mouthguards, forgetting to put them in, misplacing them, and not wanting to replace them when needed.

[0062] The present embodiments relate to a surgical implant that enables the jaw to be held forward while sleeping that advances the lower jaw without the discomfort provided byother systems. It may allow the user to speak, eat, chew, and conduct normal operation of the jaw while selectively allowing the lower jaw to be moved into a locked forward position during sleep to avoid apnea. Such an implant can be configured to be positioned between the mastoid bone and the mandible bone of a user, with each end anchored to the respective bone as described herein.

[0063] The implant may be any number of configurable mechanical devices that allow for normal jaw operation when disengaged and then engaged to hold the jaw in a forward position for sleep. As such, the position of the mechanical device can specify a state of the implant. For example, in some embodiments, the system may be anchored to the mandible and skull and connected by a piston rod configuration capable of sliding in a channel between activated and deactivated positions. In such examples, a proximal end of the channel disposed closer to the proximal portion can set an active state that holds the jaw of the user forward to mitigate constriction of airways that can cause sleep apnea or other conditions. The device being at a distal end of the channel deeper in the channel can comprise a deactivated state in which the jaw is in a normal position and capable of normal movement and operation.Biomechanical Examples

[0064] Any kind of implant between the jaw and skull would need to allow a full range of motion just as the jaw and skull were capable of before the implant many times in the course of a year. The implant would allow for selective activation by the user, to hold the jaw in one position for sleep to mitigate apnea, as described herein. The implant as described herein can be configured to last for many years or tens of years, with the bearing surfaces resilient, slippery, and very smooth.

[0065] The movement of the jaw can generally be classified as being in multiple positions. A first position can include a closed jaw with teeth being in occlusion. FIG. 1A illustrates an example of a jaw in a closed jaw position 100A. In this position, the temporal bone / mastoid bone 102 and mandible bone 104 can be a first distance 114 apart, measured from points 108, 106. Distance 114 can be measured as a hypotenuse of a right triangle formed by angles 110 and 112. The distance 114 in the first position can be around 1.506 inches and 38.25 mm. In some instances, the implant can have multiple placements on each bone, and a mesh can be used that can be cut to size, the implant can have flexibility with regards to accommodating different lengths of this distance.

[0066] FIG. IB illustrates a second position 100B of a jaw opened pivotly with no translation. As shown in FIG. IB, the distance 114 can be less than that of the first position,being around 1.283 inches or 32.59 mm. The distance 114 can be calculated based on the opening arc of the teeth and the length of the mandible of the user.

[0067] FIG. 1C illustrates a third position 100C of a jaw at maximum open with translation of the jaw. As shown in FIG. 1C, the jaw can be open and translated. This can cause a distance 114 being around 1.227 inches or 31.16 mm.

[0068] FIG. ID illustrates a fourth position 100D comprising a closed jaw with the mandible 104 in a forward position such as when an implant is engaged. As shown in FIG. ID, the distance 110 can be around 1.630 inches and 41.40 mm. A full range of anterior translation of the mandible at neutral can be up to 1.2 cm in length or a range between 3-9mm or between 2- 16mm, for example.

[0069] In some instances, as the jaw opens it can pivot at a point until about 20mm of opening. As it opens greater than 20 mm, the pivot point can translate forward with a max opening of around 52 mm. In some cases, during the first 5mm of the mouth opening, there may be a minimal translation of around 2mm. The range of opening as measured between the upper and lower front teeth (incisors) called the inter-incisor distance for an average adult can be 40-55mm.

[0070] To alleviate sleep apnea, the jaw generally should be displaced in the anterior direction for about 5-7 or 3-10 mm from a normal closed position 100A as shown in FIG. 1A. The full amount may be uncomfortable to users who are starting out. To accommodate this, the implant as described herein can rachet or lock or move into several different displacements within a defined range. For example, jaw translation can start at 2 mm then work up to 5 or 7 mm as described in the various embodiments described herein.

[0071] Systems and methods described here, in any combination or permutation may be used to mechanically actuate and place the jaw in a forward or anterior position to help alleviate sleep apnea, and then be deactivated so the user can normally speak, chew, swallow, etc.System Examples

[0072] As the systems described herein may be implanted in the human body and be subject to repeated movement, they may be made of resilient and strong materials, but also materials that are inert and safe for human implantation. It should be noted that any structures described with material component examples are not intended to be limiting. Any of various materials may be used for component parts and subcomponent parts including but not limited to in some examples, alone or in any combination, such an implant may be composed of oneor more bio-compatible materials as described herein. Example materials of the implant can include any of the following alone or in any combination: ASTM F 138, ASTM F 543, ASTM F899, Titanium, Stainless Steel, Polyethylene (UHMWPE), Silicone, Ceramics, Zirconium, Cobalt-Chrome, PMMA, Al oxide Zirconium oxide, Carbon-silicon, Hydroxyapatite Tricalcium phosphate Bio glass, Polytetrafluoroethylene, Polyurethane, Nitinol, etc. Any of the examples described herein may be made of or include any or all of these materials, in any combination or permutation and any sub-group combination. In some cases, any number of non-biocompatible materials may be used as long as their safety has been proven clinically. For example, the implant can include non-biocompatible materials encased or hermetically sealed within a biocompatible material casing.Piston Examples and Roller Examples

[0073] Any of various mechanical systems are described herein using different embodiments. Such embodiments are described separately but may be combined in any of various ways using any of the sub-component parts in combination. The systems include anchored portions on the jaw mandible and the skull temporal bone. The mechanisms described herein allow normal motion in a deactivated state and then a selectable forward, activated, locked state to abate sleep apnea.

[0074] In one example embodiment, an implant can be anchored to both the mandible jaw and skull and be connected by a translatable piston. In such an embodiment, the user could push the jaw forward and move the translatable piston out until it engages a roller mechanism configured to hold the piston and thereby the jaw in a forward position as disclosed herein. In such examples, the piston mechanism anchors to the bones may include ball and socket joints that can allow for multi-directional, side-to-side natural jaw movement when engaged or disengaged (the implant can be designed to disengage with jaw opening, but lateral movements of the jaw could occur with the implant engaged).

[0075] Referring to FIG. 2A, as described, the jaw is shown in a relaxed normal mode with the implant disengaged. In such a state, the jaw would move normally and not be restricted in normal movement as described herein. FIG. 2A also shows an example implant device 200A. As shown in FIG. 2A, additionally or alternatively, in some examples, alone or in any combination, implant device can include a first section 202, a second section 204, and a piston 206 disposed between first section 202 and second section 204. The piston 206 can be affixed at a first end to the first portion 202 and can be slidably engaged within a channelformed in the second portion 204 at a second end of the piston 206. In some examples, the piston may be oppositely configured and anchored in the other end.

[0076] In some instances, the piston 206 can be telescopic that can allow the piston to collapse to a shorter length when retracted and extend into a longer range. Such a telescopic configuration may be used with any of the pistons described herein, and may utilize one or two portions of piston tubing that fit within one another such that one piston with a smaller diameter is nested within anther piston with a larger diameter, thus allowing the two nested piston portions to work in concert to retract or extend as the movement of the jaw brings the first 202 and second 204 portions closer or farther apart. One example telescoping example is described in FIG. 23.

[0077] The first section 202 can include a first connecting portion 210 affixing the implant to the mandible bone 104. The second section 204 can include a second connecting portion 208 affixing the implant to the temporal bone (or mastoid portion of the temporal bone) of the skull 102. The first connecting portion 210 and second connecting portion 208 can include ball pivots 214, 216 that can recess inside first section 202 and second section 204 to allow for movement of the implant device in multiple dimensions and degrees of freedom as the jaw moves naturally in eating, speaking, breathing, etc.

[0078] As shown, the implant device can include both a proximal portion 202 configured to be fixed or anchored 210 to a mandible bone 104 of a user and a distal portion 204 configured to be fixed or anchored 208 to a temporal bone 102 of a user. In such examples, a translatable piston 206 can connect the proximal portion 202 to the distal portion 204 and allow the proximal portion 202 and distal portion 204 to slide closer or farther away from each other as described herein.

[0079] Additionally or alternatively, in some examples, alone or in any combination, FIG. 2B shows an implant system 200B with piston 206 slidably engaged within a channel 224 formed in the distal portion 204 in an engaged position which pushes the jaw forward in order to open the airway as described to aid in reduction of sleep apnea. The implant example of FIG. 2B shows a first anchor portion 210 with a first external connector configured to connect the proximal portion 202 to the mandible jawbone 104. The first connection portion 210 can provide an interface for one or more fasteners screws to fasten the first connection portion to the mandible bone, via openings formed in first external connector 210. The implant can also include a second connection or anchor portion 208 with a second external connector configured to connect the distal portion 204 to the temporal bone 102 as described herein. The first portion 202 is connected to the first anchor portion 210 by a ball and socket214 connection allowing for multiple degrees of freedom of movement. The second portion 204 is shown connected the second anchor portion 208 by a ball and socket 216 allowing for multiple degrees of freedom of movement. The balls of the ball and socket joints in FIG. 2B are shown on the anchor portion side, but in some embodiments, the ball could be on the system side although not shown in FIG. 2B.

[0080] Additionally or alternatively, in some examples, alone or in any combination, as shown, in FIG. 2B, the first portion 202 includes a piston 206 attached to it. In some examples, the piston 206 includes an optional pivoting joint 203 by which it attaches to the first portion 202. This pivoting joint 203 may be a swivel joint, ball and socket joint, a rotating pivot joint, a flexible strut, or any other kind of joint that allows the piston 206 to remain connected to the first portion 202 yet move in accordance with the natural movement of the jaw mandible 104.

[0081] As shown in FIG. 2B the piston 206 can slide 250 along or, in and out of, a channel 224 disposed in the second portion 204 while remaining connected to the first portion 202. In such a way, the first portion 202 and second portion 204 work in unison with the piston 206 connected to the first portion 202 but sliding in and out of or along 250 the channel 224 in the second portion 204. In some examples, the piston 206 could be reversed and connected to the second portion 204 and sliding in and out of or along a channel in the first portion 202, although not shown in the example of FIG. 2B.

[0082] For example, in normal jaw movement the system can allow for the piston 206 to move naturally and unimpeded 250 connected to the first portion 202 and second portion 204. This may be considered a deactivated position for the system because the jaw is allowed to move freely and operate normally and naturally. The system is also configured to activate and hold the mandible jaw 104 forward to aid in sleep apnea mitigation as described.

[0083] In some examples, as shown in FIG. 2B, the piston 206 includes a detent bump 222 or protrusion to work in conjunction with a roller 218 rotatably connected to the second assembly 204 that together allow for the system to activate and hold the jaw mandible 104 in an open, forward position. In such examples, the roller 218 may be circular in shape and able to spin, rotate, or otherwise circularly move about an axis point affixed in the second assembly 204. The roller may be made of silicone, plastics, resins, ceramics, metals, elastomers, liquid filled, or be gas-filled , for example. In some examples, the roller 218 may have a silicon bearing assembly to allow it to spin freely. In some examples, the roller 218 may be slightly deformable or malleable, if enough force is placed on it.

[0084] In such examples, if the mandible bone 104 and piston 206 are moved far enough out, such that the first section 202 pulls the piston 206 out where the detent bump 222 is positioned to and then past the roller 218 (as shown in FIG. 2A) the piston 206 will then be disposed in a forward position and the detent bump 222 can interact with the roller 218. Different example rollers may be used to interact with and allow travel of the detent bump 222 past the roller 218 and then hold the piston 206 and detent bump 222 past the roller 218 unless enough force is applied by the user. In some examples, in order to get the piston detent bump 222 past the roller 218, the force may be enough to deform the material in the roller 218 by the detent bump 222. In some examples, the force may be enough to pressure a spring-loaded bias force holding the roller 218 in place. Any number of optional features may be used to allow for the roller 218 to move, slide, deform, or otherwise allow the detent bump 222 past the roller and back again, sliding in the channel 224 but only if the requisite amount of force is applied as shown in FIG. 2B.

[0085] To unlock the piston 206 into a deactivated position, an amount of force or another trigger can move the detent 222 over the roller 218 for whatever configuration is made as described herein, such that the piston 206 can slide 250 back and forth in the channel 224 to allow for normal jaw movement again.

[0086] In some examples, the roller 218 may also provide an upward bias on the piston to allow smooth operation of the piston 206 sliding in and out of or within the system 250 through channel 224. The size of the roller can range from diameter of 0.005 inches / 0.127 mm to diameter of 0.500 inches / 12.7 mm The roller can be fixed to the housing or optionally it can be fixed to the sliding piston member.

[0087] In some examples, each of the first connection portion 210 and the second connection portion 208 comprises a pivot joints or ball and socket joint 202, 216 respectively to allow for side-to-side motion of the jaw that may occur during normal chewing or speaking operation. Each ball and socket joint can provide rotational movement of each of the proximal portion and the distal portion based on movement of the user. Optionally the ball pivot can be assembled to a linear slot or curved slot - this would allow for pivoting and some additional translation gained over the regular movement provided by the travel of the piston. While joints such as pivot joints or ball and socket joints are described, any type of removable connection can be used. Other examples can include a push to connect joint with a snap lock, an external tool to apply a force to connect and disconnect the joint, a threaded joint, a press-fit joint, a magnetic joint, a friction fit joint, a clamping joint, etc.

[0088] Further, in some examples, the implant system can be removed without removing the mounting plates 210 and 208 which may remain screwed or otherwise anchored to the respective bone. This can be advantageous because bone may grow into and around the mounting plates which provides good fixation. This can allow the implant to be removed for a number of reasons like perhaps the user needs a different force value or size, or if the implant wears out.

[0089] Additionally or alternatively, in some examples, alone or in any combination, FIG. 3 is a perspective view of an implant 300. As shown in FIG. 3, the implant 300 can include the first section 302, second section 304, and piston 306 interconnecting the two. A first connecting portion 310 can be used to anchor or connect to the first section 302 to the bone as described and a second connecting portion 308 can connect or anchor the second section 304 to the bone as described. In the example shown in FIG. 3, each mounting plate 310, 308 includes a central element 312A, 312B respectively that can removably connect each connecting portion 308, 310 to a pivot joint 314 such as a ball and socket joint as described. In the example of FIG. 3, the removable section is a screw example that allows the mounting plates to remain affixed while the first section 302 and second section 304 be removed for replacement, repair, etc. In some examples, these mounting plates may include a pivot joint 314 that can be connected to the ball joints and enable the connecting portions 308, 310 to pivot in multiple directions while in use. While a pivot joint is described, any other type of release mechanism can be used to explant the implant as needed, while leaving the connection portion to the bone of the patient intact.

[0090] Thus, as shown in FIG 3., portions 312A, 312B may provide a removable connection between each of the first external connection 310 to the proximal portion 202, 302 and the second external connection 308 to the distal portion 204, 304.Examples with Pistons

[0091] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a straight piston may be used to allow movement between two anchored points as described, and then the piston may include some locking mechanism to hold it in an engaged or locked position.

[0092] The examples in this section do not show the mounting brackets to the mandible and temporal bones as shown above and in other examples. This is not intended to be limiting. The examples in this section show only the piston and detent examples that may be utilized instead of the piston example such as mechanism 204 in FIG. 2A and piston / detentexamples described elsewhere in the description. The detent and piston sections are described herein to be combined with those elements described above.

[0093] Additionally or alternatively, in some examples, alone or in any combination, FIG. 4A shows another embodiment of the piston roller design which may be used in the system as described herein additionally or alternatively in any combination. In the example of FIG. 4 A, a roller 408 can include a hard material that is biased with a spring mount 409 to push or bias upward as described against the piston detent bump 410. FIG. 4A is an illustration 400A of an example piston 402 that can translate or slide along a channel 404. In the example, additionally or alternatively, in the channel are a number of parallel grooves 406 that coincide with and match up to corresponding grooves in the piston 402 (not shown on back side). In such a way, smooth operation of the piston 402 sliding in the channel 404, in and out of the system may be allowed with minimal chance the piston 402 may torque or pivot out of plane. The parallel groove embodiment between the piston and channel may be utilized in any or all of the example embodiments described herein and is not limited to FIG. 4A. The grooves allow for minimal surface area contact between the sliding parts. Additionally having the grooves parallel with the direction of motion enable a line or lines of points of contact can be used for moving parts. This can create a balance between friction and constraint.

[0094] The roller 408 may be positioned such that it spins or otherwise rotates around an axis point that is anchored to the system 400A. By so rotating, the roller 408 may interact with the piston 402 as it slides back and forth within the channel 404. In some examples, the roller does not interact with or touch the piston 402 as it slides in normal operation until it slides out far enough to interact with a detent bump or protrusion 410 when the piston 402 extends far enough as the detent bump 410 is affixed at an end of the piston 402. In some examples, the detent bump 410 may not necessarily be at the end of the piston where more piston length extends beyond the bump.

[0095] When the detent 410 and roller 408 interact, the detent bump 410 pushes against the upward bias spring force of the roller 408. The roller in this case can spin on an axis such as a dowel 480. The dowel can be able to translate towards and away from the piston as shown by the slot in the housing in FIG. 4A. The spring applies a bias force on the doweFroller assembly. In such examples, it takes more force to push the piston 402 detent bump 410 past the extension point of the roller 408 than it does just sliding back and forth in normal operation. In such examples, to activate the system, the user can push the jaw, and thereby the piston 402 far out enough for the piston 402 detent bump 410 to interact with the roller 408 and push the spring down against the upward bias force and the detent to push pastthe roller 408 in a forward locked position (not shown in FIG. 4A). When engaged, the detent bump 410 can lock the piston 402 in an active forward position and prevent the piston 402 from sliding back into the housing 412 until enough force is placed on the piston to push the detent bump 410 again back over the roller 408 and the spring force bias. In some instances, a flat spring can be used to perform the interference with the piston instead of a roller.

[0096] Additionally or alternatively, in some examples, alone or in any combination, FIG. 4B is an example illustration 400B similar to FIG. 4A but an example piston 402 and a flat spring 414 detent instead of a roller. As shown in FIG. 4B, the flat spring 414 can be fixed to the housing 412 such that the piston 402 and detent 410 contact the spring 414 when pushed far enough forward. The spring 414 can be disposed around multiple protrusions or anchors and can bias against the piston detent 410 such that it takes more force to push the piston detent 410 over the flat spring 414 into a forward position, thereby locking it forward in the activated state (not shown in FIG. 4B) and again back into normal position if slid back over the flat spring 414 into normal position. Such a spring 414 may be made of flattened steel or other metal the is deformable if enough force is applied, but also resilient to spring back into form once the force is removed or lessened. The spring 414 can be made of steel, carbon fiber, composite, polymer, or elastomer. The spring 414 can range in thickness from less than 0.005 inches / 0.127 mm to greater than 0.25 inch / 6.35 mm.

[0097] Additionally or alternatively, in some examples, alone or in any combination, further, as shown in FIG. 4C, similar to FIG. 4A-B, in some instances, a different flexible component 414 can be used as the detent to lock the piston 402 with detent bump 410. Such a flexible component 214 may be a different flexible component 416 than the flat spring or roller in FIG. 4A-B, such as a deformable but rigid flexible material, such as silicone, plastic, resin, rubber, or other material for example, anchored to the system by an anchor 411 around which the material 416 is wrapped or wound. The material would push against the detent bump 410 when interacting with it, but with enough force, the detent bump 410 could be pushed over the flexible material 416 to lock in the forward position for sleep apnea mitigation, and then with enough force pushed back into normal working position. While a flat spring or a flexible component are described, any other type of member or geometry providing a biasing force to enable a detent configuration can be used in the implants as described herein. In the example, the flexible component can include a substantially elliptical shape with curved ends 416 in any shape to allow for rigid yet flexible movement when enough force is put on the sliding piston 402 to push the detent 410 over the material 416 shaped with an apex and sloped sides. The material of the deformable but rigid material mayinclude any of a metal, polymer, elastomer, or composite. Wall thickness can range from less than 0.005 inches / 0.127 mm to greater than 0.25 inch / 6.35 mm.

[0098] Additionally or alternatively, in some examples, alone or in any combination, FIG. 4D illustrates yet another example using a slidable piston 402 but with a wheel 418 instead of roller, spring, or other deformable material as a detent mechanism. In such examples, a different bias system may be arranged such as a rotatable wheel 418 used to bias against the piston 402 and / or detent 410. The wheel can be anchored to the system 400D with an axis 417 around which the wheel 418 is configured to spin or rotate. In some examples, this may be a rigid dowel pin or in some examples, non-existent where the wheel 418 could be centered using the exterior of the circle contacting the housing geometry. The wheel 418 may be made of slightly flexible material and include a cam 419 on one side. The cam 419 can be configured to change the activation force throughout the spinning travel of the wheel 418. In some instances, the piston can include the cam geometry to act on the wheel while the wheel is held in a fixed position.

[0099] In some instances, there can be three pegs on the piston that can each pass the wheel or activation spot, and may have the indent for the three different pegs so that the mandible could be advanced to any number of different forward positions from a far back, stowed position, such as at 3 mm, 5 mm, or 7 mm, extended for example.

[0100] The wheel can be made from an elastic material such as but not limited to metal, polymer, elastomer, or composite and can feature cutout geometry to guide the flexing of the wheel acting as a spring exerting force on the cam follower. This can allow for the locking and unlocking of the detent to be tailored in several ways relating to how and when force is applied on the piston. Varying the angle of the cam surface can allow for variable force feedback on the piston and engineered stop points.

[0101] In some examples, the wheel 418 may include a notch 421. In such examples, the notch 421 may be configured to accept the detent bump 410 when the piston 402 slides into position. In such examples, the notch 421 may interact with the detent bump 410 and when the piston 402 is extended forward, to rotate the wheel 418 and thereby engage the cam surface 419 while rotating. In such a way, the friction force of the cam 419 may keep the piston 402 and detent bump 410 forward in an active position until enough force is applied to the piston 402 to push the detent bump 410 back again to rotate the wheel 418 back against the cam friction force 419 into the normal position again.

[0102] Additionally or alternatively, in some examples, alone or in any combination, FIG. 4E is an illustration of another example embodiment similar to FIG. 4A-D but with a piston402 and roller 422 and soft end stop 420. In such examples, a soft end stop 420 can be added to a roller 422 within the system 400E. For example, as shown in FIG. 4E, when the jaw and thereby piston 402 is extended forward, the soft end stop 420 may prevent the user from feeling a rigid stop from the implant. In such examples, the end stop 402 may provide a failsafe that does not allow the piston 402 to travel too far within the channel 406 and thereby fall out of the channel 406 or hyperextend the jaw. In such examples, the soft end stop 420 can be disposed adjacent to the roller 422 which can allow the detent bump 410 to go over it if enough force is applied as explained here, but the end stop 420 may be configured to interact with the detent bump 410 in such a way that the soft end stop 420 can prevent the detent bump 410 from driving past it because the end stop 420 is too big, no matter the force, to allow the detent bump 410 from extending past it. The example embodiment of the end stop may be utilized with any or all of the example embodiments described herein. It may be utilized with any or all of the FIG. 4A-E example embodiments as shown in FIG. 4E.

[0103] In some example embodiments, alone or in any combination, pivotable gates may be used to engage the piston instead of a roller or spring as described in FIG. 4A-E to allow for a forward detent position for sleep apnea mitigation. In such examples, one or two pivoting gates 508A-B may be pivotably mounted in the system 500A by an anchor or axis point 509A-B. Such gates 508A-B may be able to pivot about their respective axis points 509A-B, and when the piston 502 is pushed out far enough within the channel 506, engage with the piston detent bumps 504A-B. In the example, the gates 508A, 508B may include a spring tension or other bias that requires a force to rotate them by the user to pivot about their respective axis or pivot points 509A-B to allow the piston 502 to slide past the detent portion and forward into the activated, sleep apnea mitigation position as shown in FIG. 5B. In some examples, the swinging gates include deformable portions in the middle, which when pressed by the detent bumps 504A-B if enough force is applied, the swinging gates 508A-B may deform a little and allow the detent bumps 504A-B to rotate or pivot and move the piston 502 forward.

[0104] The overall width between the opposing detents on the piston can be larger than the opening between the two gates. As the piston moves forward the detents can first contact tabs on the gates which can pull the gates inward toward the piston. The gates can be flexible and deform as the detents exert lateral force on the gates. This is the mechanism that holds the detent in the locked position. When the detents are not in contact with the gates the gates are held in place by the friction of the top and bottom housing components. Alternately, the gates could have a spring bias in one-direction such as with a torsion spring or similar.

[0105] As shown in FIG. 5B, if the piston 502 is slid forward enough to engage the swinging gates 508A-B and push them in the forward engaged configuration, they can hold the piston 502 in the forward position. In such a position, the piston 502 and thereby the mandible jaw (not shown) can be held in the forward activated position by the interaction of the detent bumps 504A-B and the swinging gates 508A-B.Examples with Hinged Arms

[0106] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a hinged arm arrangement may be used to allow movement between two anchored points as described, and then the hinged arm may include some locking mechanism to hold it in an engaged or locked position.

[0107] Additionally or alternatively, in some examples, alone or in any combination, FIG. 6A illustrates an example embodiment implant design 600 illustrating multiple pivoting arms 602, 604 connected at a central hinged element 606. As shown in FIG. 6A, the straight portions 602, 604 can be attached to anchors 614 and 612 which may be connected to the temporal bone 102 and mandible bone 104 respectively. The central hinged element 606 can connect the straight portions 602, 604. The central element 606 can include a connector such as a hinge, locking mechanism, etc. to allow pivoting movement of the two straight portions 602, 604 relative to one another as shown 699. In use, the hinge 606 allows for the mandible 104 to open and close normally to speak, eat, etc. To activate the embodiment in FIG. 6A, an external force may be applied between the straight portions 602, 604 to cause the implant hinge 606 to lock into an active state with the two portions 602, 604 aligned. FIG. 6A shows the hinged portion in a deactivated state. In some examples, a detent could be located in one of the straight portions 602, 604 and when the other respective straight portion 602, 604 rotates over it can make contact with the detent. Alternately, the links could have a ratcheting cam type geometry that contact one another and a spring to apply pressure. In either example, an activated state would have the two straight portions 602, 604 aligned by the pivot 606 portion such that they are straight (not shown).

[0108] FIG. 6A also shows an example where the anchors 612, 614 are connected to ball socket hinges 608, 610 respectively at each end of their respective straight portions 602, 604 respectively. In such an embodiment, the ball and socket hinges 608, 610 may allow for multi-dimensional rotation and pivoting when in use during opening and closing as well as pivoting into the activated position.

[0109] FIG. 6B illustrates three examples of a similar embodiment of FIG. 6A but now showing stages of movement of an example implant design at multiple mandible positions 602A-C. For instance, the implant design 602A is shown in an open position of the mandible, implant design 602B is shown in a closed position of the mandible, and implant design 602C is shown in a protruded position of the mandible, in an activated or locked state. In the open position, the implant 602A, can include hinged straight portions 602, 604 that can pivot oriented such that the connection of the portions 602, 604 at the central hinged element 606 formed an acute angle or a right angle (e.g., an angle of around 90 degrees or less). Further, in the closed position, the implant 602B can include portions 602, 604 oriented such that the connection of the portions 602, 604 at the central hinge element 606 formed an angle greater than 90 degrees but less than 180 degrees. In the protruded, locked, or otherwise activated position, the implant 602C can include straight portions 602, 604 locked into a similar plane or comprising roughly a 180-degree angle with respect to central hinge element 606. To get the system into this locked or activate position, an external force may be applied to the straight portions 602, 604 and a detent in the hinge portion 606 may be activated. To deactivate the system, and return it to normal operating position (602A and 602B), a force may be applied externally to the straight portions 602, 604 to overcome the mechanical detent in the central hinged portion 606.

[0110] FIG. 6C illustrates an example implant design similar to FIG. 6A and 6B without the human anatomy shown. In the example, the first anchor 610 may be attached by screws to the temporal bone (not shown). This anchor is shown connected to a straight portion 604 by a hinged element 620 allowing the straight portion 604 and anchor 610 to pivot relative to one another. In the example of FIG. 6A, this hinge was a ball and socket hinge. In the example of FIG. 6C it is a rotating pin hinge. Any combination or option of hinge may be used to connect these portions as described. The first straight portion 604 s shown with a detent extension 680. Such a detent extension 680 may interact with a detent bump 682 located on or as part of the second straight portion 602 connected to the first straight portion 604 by a central pivoting hinge 606. In such examples, as shown in FIG. 6C, the deactivated state where the two straight portions 602, 604 are not locked, the user can operate the mouth and jaw normally. But when an external force is applied and the two straight portions 602, 604 are brought in alignment with one another about the central hinge 606, the detent extension 680 and detent bump 682 physically interact and hold the two straight portions 602, 604 in alignment. This is a locked or activate position which is held to stop the sleep apnea as described herein by holding the mandible in a forward position.

[0111] To deactivate, an external force may be applied to one or both of the straight portions 602, 604 to overcome the detent lock and thereby allow the two straight portions 602, 604 to pivot relative to one another. In some examples, an implant can be activated or deactivated by a force from the user manually moving their jaw forward to engage the implant. In other example, a power source can cause the implant to move and move the jaw itself. This could be an advantage if the user yawns or otherwise accidentally opens their jaw while they sleep causing the implant to unintentionally disengage.

[0112] As shown in FIG. 6C, the forward straight portion 602 is connected to another anchor 608 which may be attached to a mandible (not shown). This connection between straight portion 602 and anchor 608 may be by a pivoting hinge 622 or other connection as described herein.

[0113] Any portion or feature of any of the examples shown or described in FIGs 6A-6C may be swapped, replaced, changed, augmented, or otherwise combined in any embodiment to achieve the desired activated and deactivated states as described herein.Examples with Rack and Pinions

[0114] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a piston having a rack and pinion assembly may be used to allow movement between two anchored points as described, and then the rack and pinion assembly may include some locking mechanism to hold it in an engaged or locked position.

[0115] Additionally or alternatively, in some examples, alone or in any combination, FIG. 7 is an illustration 700 of a rack and pinion direct drive implant. The implant can include a brushless DC motor 706, a battery 703 powering the motor, and / or a wireless charger 704 able to recharge the battery 703. A pinion 702 system with linear gears or cogs is mounted on the mandible 104 side and interacts with and slides in and out of a sleeve or tube 720 mounted on the temporal bone side. The pinion may slide in a liner motion in and out of the tube or slide side 702 which may both be mounted with a hinge to allow for rotation relative to the mandible and temporal mounting positions.

[0116] The motor 706 may include cogs 710 which may rotate 790 about an axis 799 to interact with matching cogs to move the pinion 702 back and forth between a back and forward position and in between in a linear motion 750. As the motor 706 turns, the gears or cogs on the motor 710 interact with and move the pinion 702 in a linear forward or backward 750 motion as controlled by the system. The number or amount of motor rotations correlates with the amount of linear motion of the pinion to push the mandible 104 forward. Gearmaterials can be biocompatible if external to the housing, but alternately if the housing were to be hermetically sealed the gear materials could be anything. Gears could include a spur gear, helical gear, or any gear tooth profile, for example.

[0117] In some examples, no separate brake or lock may be needed if the motor 706 itself stops when not activated. This embodiment may simply hold the pinion 702 in place when not moving.

[0118] The implant example can also include a wireless charger 704 to charge a battery 703. The wireless charger 704 can be electromagnetic or infrared techniques to charge the battery 702. The charger 704 can be wirelessly charged by positioning a power source near the charger. The battery 702 can store power for the motor 706 operation. Such motor operation 706 may be controlled by a button, wireless command from a control box, a wireless command from a smartphone or other computer device. Such wireless commands may be made by WiFi, Bluetooth Low Energy, cellular, or any other kind of wireless communication protocol. Computer software may be used to send commands to the motor 706 to move the piston 702 back and forth automatically.

[0119] The use of the motor and wireless communication arrangement may be utilized on any or all of the examples described herein. The example of using it on the example of FIG. 7 is not intended to be limiting. Adding electronics enables the potential for additional sensors which can provide value to the patient. For example, the quality of sleep can be measured and output to the user via a smart phone app. Some examples of applicable sensors include accelerometers, gyroscopes, rotary encoders, capacitance, etc.Examples with Hydraulic Pistons

[0120] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a piston having a hydraulic assembly may be used to allow movement between two anchored points as described, and then the piston assembly may include some locking mechanism to hold it in an engaged or locked position.

[0121] Additionally or alternatively, in some examples, alone or in any combination, FIG. 8 is an illustration 800 of an implant using a hydraulic pump and spring damper to move a piston similarly to the other examples described herein but with a hydraulic force instead. As shown in FIG. 8, a piston 802 can be pivotably anchored 803 to the mandible jaw 104 and moved between open and closed states using a hydraulic fluid pressure as described herein. For example, a microcontroller 816 can control a DC brushless motor 808 that can pump fluid into or out of a chamber 806 by controlling a hydraulic pump 814. In some instances, a- 11 -device external from the body can be used that provides power for wireless transmission to the implant or uses a magnetic field to manipulate movement of the implant. The pump 814 may move fluid from a reservoir 812 pump into a chamber 806 to add to the volume of fluid in the chamber pushing on the piston 802 to move the piston forward 890. In reverse, the hydraulic pump 814 may pull fluid from the chamber 806 and put it back into the reservoir 812 to decrease the volume of fluid in the chamber 806 to draw the piston 802 in the reverse direction. A wireless charger 804 can charge the battery 818 to power the pump 814 as described herein. Further a spring dampener can provide a bias force forward to work against the hydraulic piston force. The spring damper can be adjusted via electromagnetic piston from an external wearable device.

[0122] Additionally or alternatively, in some examples, alone or in any combination, FIG. 9 is an illustration 900 of an implant with an electromagnetic piston similar to the other examples described herein to move the mandible forward in a locked, activated position and then relaxed in a deactivated position but using a different actuator mechanism. As shown in the detail 990, in the example of FIG. 9, the piston 902 can be connected to a hydraulic ram 910 to move the piston between forward and back positions based on the fluid 920 volume in a ram chamber 910. To move between states and operate the system, a magnet 904 can be disposed adjacent to an electromagnet 908 to control operation of the fluid 920 movement. In such examples, the magnet 904 may be placed by a user on the outside of the jaw, outside the skin or dermis layer 906 for ease of operation. When the outside magnet 904 comes close enough to the electromagnet 908 inside the system, it activates the ram 910 to push fluid 920 into the chamber and push the piston 902 into a forward position. In some instances, any of the magnets as described herein can include standard magnet types (e.g., neodymium magnets) or of an electromagnetic type. If the implant uses a powered external device, the device can provide a magnetic field that can act upon the internal plunger in the implant that can include a magnetic material. To deactivate, the external magnet 902 is removed from the proximity of the internal electromagnet 908 and the fluid 920 is no longer pressurized to push into the chamber 910 and therefore the piston 902 is no longer pushed forward and is allowed to freely slide back and forth in a deactivated or unlocked state.

[0123] The external magnet 902 can be wearable 902 to hold it in place, for example during sleep, to provide a reaction force to trigger a state change of the piston 902 to hold it in the forward apnea mitigation state or activated state. The magnetic wearable 902 could have headphones as part of it to give the user feedback say for example if there was an issuewith the system. The wearable can be ergonomic and low profile enough to not interfere with the patient’s sleeping positions.Examples with Flanged Tubing

[0124] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a piston having a flanged portion assembly may be used to allow movement between two anchored points as described, and then the piston assembly may include some locking mechanism to hold it in an engaged or locked position. Again, the detent and piston sections are described herein to be combined with those elements described above.

[0125] In some instances, the implant can include an adjustable tube length design. FIG. 10 illustrates an example adjustable tube length design for an implant that could be used in any of the embodiments described herein. As shown in FIG. 10, an inner tube 1002 can have a series of laser cuts or knurled portions 1006. The inner tube 1002 can further be disposed within an outer tube 1004 shown in a cutaway view of FIG. 10. The outer tube 1004 can be ribbed with ribs 1008 to grab the inner tube 1002 knurls 1006. The outer tube 1004 can include grooves 1012 for an outer top 1020 to connect to the outer tube 1004. A chamfered screw slot 1014 can be formed in the outer tube 1004 to attach to the outer top 1020 via a screw 1016 to hold it in place via screw threads 1010. This can allow for changing the length of the components in the piston / cylinder embodiments. In some cases, the length of both the pistons and cylinders can be adjusted during implantation to accommodate variations in the anatomy of the patient. The inner and outer tube can slide together, and the distance from end to end can be adjusted and subsequently locked in place using a fastener set screw or another similar fastener.

[0126] In some instances, the implant can include a piston in a movable disengaged position that is then held in place in an engaged position by bumps that mate with a flexible tube with corresponding bumps. In such examples, a split tube design with a flexible outer tube and mating bumps to allow for movement between detents. Additionally or alternatively, in some examples, alone or in any combination, FIGs. 11-12 illustrate an example detent using extending and contracting piston section 1112 of the system that includes an arrangement of a split tube outside the main piston 1106. As shown in FIG. 11, the outer tube 1108 may be anchored to the temporal bone. In some instances, the implant can be mounted to a temporal / temporal bone around the contracting piston section 1112 or the outer tube 1108, and the implant can be mounted to the mandible around the ball joint 1102. The outer tube 1108 can include bumps or grooves 1110 that mate with bumps or grooves on the mainpiston 1 106. The outer tube also can include flanges cut in the transverse direction allowing the outer tube to flex slightly to open or expand if enough force is exerted on it 1150. In such a way, the bumps of the piston 1106 may push the outer tube bumps 1108 and flex them apart 1150 and allow the piston 1106 to rest in the first detent with the matching mated bumps between the two parts holding them in place. Then if enough pressure is applied, the inner piston 1 106 can again push the outer tube flanges 1108 open 1150 and move to the next detent or out of the detent 1152. Additionally, various types of flexible bands can be placed around the grooves on 1110, which can allow for adjustment of the retention force.

[0127] In the example as shown in FIG. 11, a screw 1104 with an outer diameter of the head larger than the adjacent piston body can be disposed in the inner tube 1106 to act as a travel stop to prevent unintended removal of the piston 1106 from the cylinder body 1112. Further, the inner tube 1106 can connect to a ball joint 1102 at a first end of the inner tube 1106. FIG. 12 shows an exterior view of the outer tube 1208 and inner tube 1206 with the flexible flanges 1210 shown.

[0128] In some instances, the implant can implement an adjustable length clamshell design. Additionally or alternatively, in some examples, alone or in any combination, FIG. 13 illustrates an example tube in tube design for an implant that includes an adjustable length clamshell. As shown in FIG. 13, an outer tube 1302 can include a roughened or textured surface 1304. The tube 1302 can be disposed within a clamshell enclosure 1306. The outer tube 1302 can be adjusted along a length by moving the tube relative to the clamshell enclosure 1306. The texture allows for security in preventing unintended loosening after being fastened. Additionally 1304 can represent formed threads allowing the surgeon to rotate the outer shell with respect to the inner tube to adjust the length.

[0129] The tube 1302 can connect to a wire 1310 and can have shape curves 1312 at the end of the tube 1302. The tube 1302 can further include a hinge 1308 for the clamshell enclosure 1306. The clamshell enclosure 1306 can include a lock 1314 to lock two halves together after setting a length of the tube 1302.

[0130] In some instances, the implant can implement a sliding flat plate design. Additionally or alternatively, in some examples, alone or in any combination, FIG. 14 illustrates an example sliding flat plate design for an implant. As shown in FIG. 14, the design can include a top plate 1402, a middle plate 1404, and a bottom plate 1406. The use of a flat plate as shown in FIG. 14 can allow more flexibility in multiple directions and may also reduce the implant profile.

[0131] The top plate 1402 can be machined or molded, and an area 1412 of the top plate 1402 can be formed to connect with the bottom plate 1406. The top plate 1402 can also include a slot 1414 for a weld ball 1416 to freely slide along the top plate 1402 until the weld ball is in a locked position, such as the weld ball 1416 being disposed in a locking mechanism 1422.

[0132] The ball 1416 can move between an unlocked and a locked position. For instance, the weld ball 1416 can be slid into a locked position in a lock (e.g., 1422) formed in the middle plate 1404. Further, the bottom plate 1406 can be machined or molded, and the bottom plate can include an area 1418 to connect with the top plate 1402. The bottom plate 1406 can further include a center slot 1420 that is open to fit the middle plate 1404. The flat plate, the wire, or the weld ball as described in FIGS. 13-14 can use a material such as Nitinol, for example. Other materials can be used that have a controllable flexibility through various heat treatments and forming processes.

[0133] In some instances, the flat plate design 1400 can include a mastoid attachment 1408 to connect to a mastoid bone of a patient and a mandible attachment 1410 to attach to a mandible bone of the patient.Examples with Piston Hooked Detents

[0134] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a piston having a hooked detent portion assembly may be used to allow movement between two anchored points as described, and then the piston assembly may include some locking mechanism to hold it in an engaged or locked position. Again, the attachments to the mandible and temporal bones are not shown or described in these sections but would be like those described above, the detent and piston sections are described herein to be combined with those elements described above.

[0135] Additionally or alternatively, in some examples, alone or in any combination, FIG. 15 illustrates an example implant design with a piston configured to slide within an implant body. As shown in FIG. 15, the device can include a slidable piston 1508 connecting to a body 1504. The piston 1508 can be locked to the body 1504 via a locking pin, and the piston 1508 can be configured to move laterally along an opening or channel 1510 formed in the body 1504 to move the implant between multiple positions. This portion of the arrangement is similar to the embodiments of FIGs. 4A-E and 5A-B above, but with a different detent as described.

[0136] The body 1504 can include a top portion 1502 that comprises a silicone joint to be rested against the patient. This joint may be used on any of the example embodiments described herein, the inclusion of it in FIG. 15 is merely as an example. The silicone joint can include a recessed ring around the top of the silicone element for fitting a plate that attaches the piston / housing assembly (including the silicone piece) to the mastoid. Further, openings 1506A-B embedded in the body portion 1504 are configured to allow a fastener, such as a screw or pins, to connect the silicone piece to the rigid piston housing for replacement or repair as needed.

[0137] Further, a locking pin 1512 can lock a position of the piston. For instance, the locking pin 1512 can lock the position of the piston 1508 in a locked state, and a threshold amount of force applied to the piston 1508 may allow the locking pin 1512 to disengage and move the piston 1508 into an unlocked position.

[0138] Additionally or alternatively, in some examples, alone or in any combination, FIG. 16 illustrates an example implant design of FIG. 15 but with a view of the internal workings showing a piston 1602 configured to move within a body portion of an implant. As shown in FIG. 16, the implant can include a piston 1602 configured to move within a body portion 1616 of the implant. The body portion 1616 can include a top portion 1612 and openings 1614A-B configured to allow a fastener to hold portions of the body 1616 together or to attach the implant to the patient as described.

[0139] The body portion 1616 can include a cavity configured to allow the piston 1602 to move within the cavity. The piston 1602 can attach to a pin 1610 that connects the piston 1602 to a curved body 1606. The curved body 1606 can move within the cavity and, in some cases, extend beyond the body portion of the implant. An end portion 1608 can connect to the curved body, and a series of steps 1604 can allow the piston to move along the steps 1604. The steps 1604, curved body 1606, and end portion 1608 can be part of a cam track, wherein the curved element 1606 allows the piece to flex as the pin 1610 on the piston is pulled across the ratchet element or steps 1604 of the cam track. The shape of the cam track teeth and the spring tension in the curved element allow the piston to lock into a pulled- forward position (at either of two locking points), resisting backdriving until either a sufficient force is applied or the piston is pulled forward beyond the second locking point, which releases the mechanism and allows the piston to be retracted. The end portion 1608 can include a tab that holds the cam track in place in the piston housing. FIG. 16 shows the piston 1602 and hook 1606 also separately from the housing 1616 just for clarity purposes.

[0140] Additionally or alternatively, in some examples, alone or in any combination, in some instances, the implant can include a piston configured to move between positions via tracks. FIG. 17 illustrates two views of an example implant design with a piston and track detent. As shown in FIG. 17, the implant can include piston 1702 connected to a handle 1708 via a locking pin 1706. The handle 1708 can move along cam tracks 1710 on a body 1704 to move the piston 1702 between locked and unlocked positions. The tracks 1710 can include multiple steps to allow the handle 1708 to move along the steps and position the piston 1702 into one or more positions to lock or engage.

[0141] FIGS. 18A-F illustrate various views 1800A-F of the implant with a piston configured to move between positions via detent tracks as described herein. For instance, the implant as shown in FIG. 18A illustrates a piston 1802, a handle 1804, and a body 1806 with tracks 1808. The piston 1802 and handle 1804 can connect via a lock 1812. Further, the handle 1804 can include an angled portion 1810. FIG. 18B shows a detail of the piston 1802 and the handle 1804 with a curved and hinged portion 1812. This portion allows the handle 1804 to pivot slightly in relation to the piston 1802 and thereby move among and between the different stepped detents in the housing as shown in FIG. 18A. FIG. 18B shows another detail of the same.

[0142] The position of the handle 1804 can move between detent positions relative to the detent tracks in the housing as shown in FIGS. 18D-F, for example. For instance, FIG. 18D illustrates the implant 1800D in a disengaged position on a return track part of the tracks 1808. In FIG. 18E, the implant 1800E can be in an almost reset position. Further, in FIG. 18F, the implant 1800F can be in a reset position, ready to be re-engaged. In some instances, in the implant 1800F as shown in FIG. 18F, the implant 1800F can be in a reset position, where if the piston is re-extended, the handle can re-enter a locked position again.Examples with Roller Detents

[0143] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a slider having a roller detent portion assembly may be used to allow movement between two anchored points as described, and then the slider assembly may include some locking mechanism to hold it in an engaged or locked position.

[0144] In some instances, the implant can include a sheet piston comprising a material such as Nitinol with a stamped detent and roller. Such an example embodiment allows for movement between a free disengaged position to a locked or engaged position as described herein, in this example using a roller detent. FIGS. 19A-B illustrates views 1900A-B of animplant with a sheet piston with a stamped detent and roller. For instance, in a first view1900A, the implant can include a first end 1902, a second end 1904, and a piston 1906 disposed between the ends 1902, 1904. In some examples, the anchor points 1902, 1904 may be any kind of anchor points as described herein including anchor plates that allow screws to hold the anchors in place on the mandible and temporal bones.

[0145] In some examples, the piston in this example is a flat element with a slight curve or bend as shown. The piston 1906 can include a detent 1908A configured to interact with a roller 1910A. The detent 1908A can be disposed past the roller 1910A in the first view 1900A. In some examples, this detent may be a portion of the flat piston that is cut out and may deflect over the roller when it interacts on that portion of the throw. In such examples, the detent 1908A may act like a living hinge that may flex but only under predetermined amount of force. In such a way, the detent 1908A may only interact with the roller detent portion when it is in an extended position and not when it is in a normal disengaged position.

[0146] In a second view 1900B, the implant is in a second position, with the detent 1908B disposed before to the roller 1910B to engage or lock the jaw forward as described herein.The detent 1908B and roller 1910B can allow for the implant to move between different positions.

[0147] In some cases, the implant can include one or more silicone joints. The silicone joints on the implant can provide finger joints that can be high durability for minor deflections occurring during the movement of the jaw. The joints may also be unaffected by tissue ingrowth and can be less likely to cause an injury if the implant is moved. The joints can also be shaped to enhance the jawline in some instances.Examples with Ball Detents

[0148] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a piston having a ball detent portion assembly may be used to allow movement between two anchored points as described, and then the piston assembly may include some locking mechanism to hold it in an engaged or locked position.

[0149] Additionally or alternatively, in some examples, alone or in any combination, FIGs. 20A-C illustrates views 2000A-C of an example implant with a ball detent, silicone portions, and a piston. In some examples, this piston 2008 may be tube shaped, having a circular cross section. As shown in FIG. 20A, the implant can include a first end 2002 and a second end 2004 connected by a piston 2008. The piston 2008 can have an end 2010 disposedin an opening 2012 formed in a base part 2006 of the second end 2004. The end 2010 of the piston 2008 can move throughout the opening 2012 based on movements of the jaw.

[0150] Further, a ball 2014 with a spring can be biased against the end 2010. The ball 2014 can hold the piston 2008 in a position such that a requisite force is to be applied to the piston 2008 to move the end 2010 from the ball 2014. The spring can offer a preload force on the end 2010.

[0151] In some instances, the implant can include various silicone portions 2016A-B. The silicone portions 2016A-B can be disposed adjacent to the first end 2002 and second ends 2004 to provide durability and comfort to the patient, as described herein.

[0152] Additionally or alternatively, in some examples, alone or in any combination, the implant can include a ball and spring locking mechanism, alone or in combination with any of the teachings or embodiments described herein. FIG. 21 illustrates an example end-on view 2152 and top-down view 2150 of a ball and spring locking mechanism for an implant. Again, the connection elements to the bones as described throughout are not shown here, just the piston and detent mechanism meant to be combined with those anchor assemblies as described.

[0153] The detent mechanism of the embodiment of FIG. 21 includes a piston section 2110 having multiple detent notches therein 2111. The piston 2110 is configured to slide in and out of a main housing 2102. The housing 2102 includes a channel 2106 in which a free floating ball 2108 is placed. This ball 2108 is held in the channel 2106 by a screw 2104. A spring 2112 is located in the channel 2106 between the ball 2108 and the screw 2104. In such a way, the ball 2108 may move back and forth in the channel 2106 and land in the detent positions 2111 of the piston 2110 to hold the piston 2110 in place. If enough force is applied to the piston 2110 to overcome the spring force 2112 holding the ball 2108 in the channel 2106, then the piston 2110 may move within the housing 2102 such as in a disengaged position. But when engaged, and the locked, the ball 2108 holds the piston 2110 in the housing 2102 by the spring force 2112 until a strong enough force pushes it out of detent.

[0154] FIG. 22 illustrates an example implant design where the piston 2202 includes a ball attached to it as a way to engage different detent steps within the system housing, hold in an engaged position and then with enough force move back into a disengaged or free position.

[0155] In this example, a flexible, semi-deformable but rigid ball configured to move along a set of detent tracks. As shown in FIG. 22 from two different angles, A and B, a piston 2202 can have a ball 2204 attached and located within a housing 2208. The piston 2202 and the ball 2204 can move freely within the cavity of the housing until the piston and ball arepulled into a set of detent tracks, stairs, bumps, or other impediments 2206 formed on the cavity of the housing 2208 of the system. In such a way, if enough force is placed on the ball, it may be wedged into one of the detents by slight deflection or deformation and with enough force, pushed out so as to be able to freely move.Example Fenced Accordion

[0156] Additionally or alternatively, in some examples, alone or in any combination, in some examples, a accordion fence having a detent portion assembly may be used to allow movement between two anchored points as described, and then the accordion assembly may include some locking mechanism to hold it in an engaged or locked position.

[0157] FIG. 23 illustrates an example implant design with an accordion style design with a series of straight bars 2330 pivotably mounted 2332 to one another in a stretchable gate or accordion gate system. In such an arrangement, the accordion may be stretched out long and pushed together shorter. As shown in FIG. 23, the implant can include a mandible mounting anchor 2302 configured to connect to a mandible of a patient and a mastoid mounting anchor 2304 configured to connect to a temporal bone of a patient as described throughout the disclosure. A ball joint 2306 can connect the anchor 2302 to the accordion structure as shown. In some examples, a silicone flex joint 2308 can connect the temporal mounting anchor to the accordion implant second side.

[0158] The example of FIG. 23 includes a fixed point 2318. This point of the accordion structure would not move relative to the anchor mount 2308. As the accordion structure is pulled to be elongated and contracted 2399, the free or non- fixed accordion pivot or hinge points 2314 will move up and down 2398 relative to the one fixed accordion pivot or hinge point 2318. As the up and down motion 2398 of the free end point 2310 scissors closer to and farther apart from the fixed point 2318, depending on how the accordion structure moves, a detent mechanism 2310 may be arranged to hold the free pivot or hinge point 2314 in place when the entire system is in an elongated position 2399. In such a way, the accordion may be stretched out

[0159] In some examples, the implant body can include a flexible balloon-type silicone sleeve 2312 to cover the entire system to avoid any kind of pinching from the pivoting sections within the accordion structure.Computer and Computer Network Examples

[0160] Additionally or alternatively, the systems described here may be used to actuate a sleep apnea device to hold in an anterior position the jaw during sleep. In some examples, the semi-automated manner may be arranged in a remote setting, allowing for a human to interact with the systems as described herein. Such an arrangement may be made possible by a network and computer arrangement shown in FIG. 24 and / or FIG. 25.

[0161] The variations on these options depend on how much a remote or local computing system may be programmed to operate the system. For example, in a fully manually controlled system, a human operator may control the movements of the system. In some examples remote operation of the system such as by wireless control through some kind of wireless uplink may be made.

[0162] The other extreme of control systems would be a fully automated system. In such a system, the processing center may be interconnected through an IP network which may include local private wireless networks, private wide area networks and / or public networks such as the Internet as described in FIGS. 24 and 25.

[0163] In example systems described herein, various computing components may be utilized to operate the systems. For example, a communication computing system may allow for remote operation, for example by software on a smartphone. In some examples, machine learning / artificial intelligence / and / or neural networks may be employed by computing systems to control the systems. In some examples, alternatively or additionally, a WiFi system / cellular system / Bluetooth system, or any other communication system, with the appropriate antenna system and a processor and memory as described herein, may be used on a system. In some embodiments, alternatively or additionally, the hardware may include a single integrated circuit containing a processor core, memory, and programmable input / output peripherals. In some examples, various computing components may be used in the seeker and / or systems, as well as the communication systems, control systems, and / or any other portion of the systems described herein.

[0164] FIG. 24 shows an example networked system which could be used in the systems and methods here. In FIG. 24, the computer system 2402 onboard the system described herein.

[0165] As shown in FIG. 24, the various computing systems may be in communication with a back-end computing system 2430 and / or data storage 2432 to send and receive data regarding the operations systems described herein. In some examples, this may includeremote operation. In some examples, the communication may be a wireless transmission 2410 by a radio, cellular or WiFi transmission with associated routers and hubs.

[0166] In some examples, the transmission of data may include transmission through a network such as the internet 2420 to back-end server computers 2430, and associated data storage 2432. In some examples, the networked computer resources 2430 may be spread across many multiple computer resources by a cloud infrastructure. In some examples, the networked computer resources 2430 may be virtual machines in a cloud infrastructure.

[0167] FIG. 25 shows an example computing device 2500 that may be used in practicing example embodiments described herein. FIG. 25 could describe computers such as 2402, 2430 or other systems as described in FIG. 24. In FIG. 25, the computing device could be a smartphone, a laptop, tablet computer, server computer, or any other kind of computing device. The example shows a processor CPU 2510 which could be any number of processors in communication via a bus 2512 or other communication with a user interface 2514. The user interface 2514 could include any number of display devices 2518 such as a screen. The user interface also includes an input such as a touchscreen, keyboard, mouse, pointer, buttons, joystick or other input devices. Also included is a network interface 2520 which may be used to interface with any wireless or wired network in order to transmit and receive data. Such an interface may allow for a smartphone, for example, to interface a cellular network and / or WiFi network and thereby the Internet. The example computing device 2500 also shows peripherals 2524 which could include any number of other additional features such as but not limited to, sensors 2525, and / or antennae 2526 for communicating wirelessly such as over cellular, WiFi, NFC, Bluetooth, infrared, or any combination of these or other wireless communications. The computing device 2500 also includes a memory 2522 which includes any number of operations executable by the processor 2510. The memory in FIG. 25 shows an operating system 2532, network communication module 2534, instructions for other tasks 2538 and applications 2538 such as send / receive command data 2540. Also included in the example is for data storage 2558. Such data storage may include data tables 2560, transaction logs 2562, user data 2564 and / or encryption data 2570. The computing device 2500 also include one or more graphical processing units (GPUs) for the purposes of accelerating in hardware computationally intensive tasks such as execution and or evaluation of the neural network engine. The computing device 2500 may also include one or more reconfigurable hardware elements such as a field programmable gate array (FPGA) for the purposes of hardware acceleration of computationally intensive tasks.CONCLUSION

[0168] As disclosed herein, features consistent with the present inventions may be implemented by computer- hardware, software and / or firmware. For example, the systems and methods disclosed herein may be embodied in various forms including, for example, a data processor, such as a computer that also includes a database, digital electronic circuitry, firmware, software, computer networks, servers, or in combinations of them. Further, while some of the disclosed implementations describe specific hardware components, systems and methods consistent with the innovations herein may be implemented with any combination of hardware, software and / or firmware. Moreover, the above-noted features and other aspects and principles of the innovations herein may be implemented in various environments. Such environments and related applications may be specially constructed for performing the various routines, processes and / or operations according to the invention or they may include a general-purpose computer or computing platform selectively activated or reconfigured by code to provide the necessary functionality. The processes disclosed herein are not inherently related to any particular computer, network, architecture, environment, or other apparatus, and may be implemented by a suitable combination of hardware, software, and / or firmware. For example, various general-purpose machines may be used with programs written in accordance with teachings of the invention, or it may be more convenient to construct a specialized apparatus or system to perform the required methods and techniques.

[0169] Aspects of the method and system described herein, such as the logic, may be implemented as functionality programmed into any of a variety of circuitry, including programmable logic devices (“PLDs”), such as field programmable gate arrays) (“FPGAs”, programmable array logic (“PAL”) devices, electrically programmable logic and memory devices and standard cell-based devices, as well as application specific integrated circuits. Some other possibilities for implementing aspects include: memory devices, microcontrollers with memory such as 1PROM, embedded microprocessors, Graphics Processing Units (GPUs,) firmware, software, etc. Furthermore, aspects may be embodied in microprocessors having software-based circuit emulation, discrete logic (sequential and combinatorial, custom devices, fuzzy (neural logic, quantum devices, and hybrids of any of the above device types. The underlying device technologies may be provided in a variety of component types, e.g., metal-oxide semiconductor field-effect transistor (“MOSFET”) technologies like complementary metal-oxide semiconductor (“CMOS”), bipolar technologies like emitter- coupled logic (“ECL”), polymer technologies silicon-conjugated polymer and metal- conjugated polymer-metal structures, mixed analog and digital, and so on.

[0170] It should also be noted that the various logic and / or functions disclosed herein may be enabled using any number of combinations of hardware, firmware, and / or as data and / or instructions embodied in various machine-readable or computer-readable media, in terms of their behavioral, register transfer, logic component, and / or other characteristics. Computer- readable media in which such formatted data and / or instructions may be embodied include, but are not limited to, non-volatile storage media in various forms optical, magnetic or semiconductor storage media and carrier waves that may be used to transfer such formatted data and / or instructions through wireless, optical, or wired signaling media or any combination thereof. Examples of transfers of such formatted data and / or instructions by carrier waves include, but are not limited to, transfers, uploads, downloads, e-mail, etc. over the Internet and / or other computer networks by one or more data transfer protocols HTTP, FTP, SMTP, and so on.

[0171] Unless the context clearly requires otherwise, throughout the description and the claims, the words “comprise,” “comprising,” and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in a sense of “including, but not limited to.” Words using the singular or plural number also include the plural or singular number respectively. Additionally, the words “herein,” “hereunder,” “above,” “below,” and words of similar import refer to this application as a whole and not to any particular portions of this application. When the word “or” is used in reference to a list of two or more items, that word covers all of the following interpretations of the word: any of the items in the list, all of the items in the list and any combination of the items in the list.

[0172] Although certain presently preferred implementations of the invention have been specifically described herein, it will be apparent to those skilled in the art to which the invention pertains that variations and modifications of the various implementations shown and described herein may be made without departing from the spirit and scope of the invention. Accordingly, it is intended that the invention be limited only to the extent required by the applicable rules of law.

[0173] The foregoing description, for purpose of explanation, has been described with reference to specific embodiments. However, the illustrative discussions above are not intended to be exhaustive or to limit the invention to the precise forms disclosed. Many modifications and variations are possible in view of the above teachings. The embodiments were chosen and described in order to best explain the principles of the invention and its practical applications, to thereby enable others skilled in the art to best utilize the inventionand various embodiments with various modifications as are suited to the particular use contemplated.The foregoing description, for purpose of explanation, has been described with reference to specific embodiments. However, the illustrative discussions above are not intended to be exhaustive or to limit the invention to the precise forms disclosed. Many modifications and variations are possible in view of the above teachings. The embodiments were chosen and described in order to best explain the principles of the invention and its practical applications, to thereby enable others skilled in the art to best utilize the invention and various embodiments with various modifications as are suited to the particular use contemplated. Etc.

Claims

CLAIMSWhat is claimed is:

1. An implant device comprising: a proximal portion configured to be fixed to a mandible bone of a user; a distal portion configured to be fixed to a temporal bone of a user; a piston connecting the proximal portion to the distal portion, wherein a first end of the piston is fixedly engaged to the proximal portion, and wherein a second end of the piston is slidably engaged within a channel formed in the distal portion, wherein the piston being disposed at a first position within the channel comprises an active state and the piston being disposed at a second position within the channel comprises a deactivated state.

2. The implant device of claim 1, further comprising: a first connection portion with a first external connector configured to connect the proximal portion to the mandible bone, wherein the first connection portion provides an interface for one or more fasteners to fasten the first connection portion to the mandible bone; and a second connection portion with a second external connector configured to connect the distal portion to the temporal bone, wherein the second connection portion provides an interface for one or more fasteners to fasten the second connection portion to the temporal bone.

3. The implant device of claim 2, wherein each of the first connection portion and the second connection portion comprises a pivot joint providing a removable connection between each of the first external connection to the proximal portion and the second external connection to the distal portion.

4. The implant device of claim 2, further comprising: a ball and socket disposed within each of the proximal portion and the distal portion, wherein each ball and socket is configured to provide rotational movement of each of the proximal portion and the distal portion based on movement of the user.

5. The implant device of claim 1, further comprising: a roller disposed adjacent to the piston, the roller configured to provide an upward bias on the piston.

6. The implant device of claim 5, wherein the piston further comprises a detent bump protruding from the second end of the piston, wherein the detent bump is configured to interface with the roller to maintain the piston in the active state.

7. The implant device of claim 1, wherein the first position within the channel comprising the active position is a proximal position within the channel, and wherein the second position within the channel comprising the deactivated position is a distal position within the channel.

8. The implant device of claim 6, further comprising: any of a flat spring or a flexible component disposed adjacent to the piston to provide an upward bias on the piston and the detent bump.

9. The implant device of claim 6, further comprising: a wheel disposed adjacent to the piston to provide an upward bias on the piston, wherein the wheel comprises a cam disposed at a lower end of the wheel, and wherein an indent is formed within the wheel configured to interface with the detent of the piston.

10. The implant device of claim 1, further comprising: a pair of swinging gates each disposed adjacent to the piston, wherein each of the pair of swinging gates are configured to engage with detent portions of the piston and lock the piston in the active state.

11. A device comprising: a first portion; a second portion; a piston connecting the first portion to the second portion, wherein a first end of the piston is fixedly engaged to the first portion, and wherein a second end of the piston is slidably engaged within a channel formed in the second portion, wherein the piston being disposed at a first position within the channel comprises an active state and the piston being disposed at a second position within the channel comprises a deactivated state.

12. The device of claim 11, further comprising: a first connection portion with a first external connector to provide an interface for one or more fasteners to fasten the first connection portion to a mandible bone; and a second connection portion with a second external connector to provide an interface for one or more fasteners to fasten the second connection portion to a temporal bone, wherein each of the first connection portion and the second connection portion comprises a pivot joint providing a removable connection between each of the first external connection to the first portion and the second external connection to the second portion.

13. The device of claim 12, further comprising: a ball and socket disposed within each of the first portion and the second portion, wherein each ball and socket is configured to provide rotational movement of each of the first portion and the second portion.

14. The device of claim 1, further comprising: a roller disposed adjacent to the piston; and a detent protruding from the second end of the piston and configured to interface with the roller to maintain the piston in the active state.

15. The device of claim 14, further comprising: any of a: flat spring, a flexible component disposed adjacent to the piston to provide an upward bias on the piston and the detent, and a wheel disposed adjacent to the piston to provide an upward bias on the piston, wherein the wheel comprises a cam disposed at a lower end of the wheel, and wherein an indent is formed within the wheel configured to interface with the detent of the piston.

16. The device of claim 11, further comprising: a power source; a direct current (DC) microcontroller configured to move the piston between the active and the deactivated states.

17. The device of claim 16, further comprising: a hydraulic pump connected to the DC microcontroller and a fluid reservoir containing a hydraulic fluid, wherein the DC microcontroller controls a volume of hydraulic fluid in a chamber to move the piston between the active and deactivated states.

18. A method for implanting an implant device, the method comprising: disposing a first external connector of a first connection portion connected to a proximal portion of an implant device to a mandible bone of a user; disposing a second external connector of a second connection portion connected to a distal portion of the implant device to a temporal bone of the user; and responsive to a force applied to the implant device, moving a piston of the implant device between an active state and a deactivated state, wherein a first end of the piston is fixedly engaged to the proximal portion, and wherein a second end of the piston is slidably engaged within a channel formed in the distal portion.

19. The method of claim 18, wherein disposing any of the first external connector or disposing the second external connector comprises fastening one or more fasteners to either the mandible bone or the temporal bone via openings formed in the first external connector or second external connector.

20. The method of claim 18, wherein moving the piston between the deactivated state to the active state includes a detent extending from the piston to interface with a roller disposed in the channel formed in the distal portion.

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