Dental restoration molds

Abstract

To provide a novel custom tool for forming a dental restoration in a mouth of a patient.SOLUTION: A custom tool for forming a dental restoration in a mouth of a patient is provided, the custom tool including: a facial mold body 12 for a patient-specific, customized fit with the facial side of at least one tooth of the patient. The facial mold body includes a restorative portion 16 and a first engagement portion 18a extending away from the restorative portion; and a lingual mold body for a patient-specific, customized fit with the lingual side of the tooth of the patient. The lingual mold body includes a restorative portion and the first engagement portion extending away from the restorative portion. The first engagement portion of the facial mold body interlocks with the first engagement portion of the lingual mold body. The facial mold body and lingual mold body are configured to form a mold cavity encompassing a missing tooth structure of at least one tooth to be restored.SELECTED DRAWING: Figure 1

Description

[Background technology]

[0001] Dental restorations, or dental fillings, utilize dental restorative materials to improve the function, integrity, and form of missing or irregular tooth structure. For example, dental restorations can be used to correct congenital discrepancies, to repair missing tooth structure after trauma, as part of restorative treatment for caries or decayed teeth, or for aesthetic reasons.

[0002] Restorative dentistry often involves drilling carious areas from infected teeth (commonly referred to as "preparing" the tooth), then isolating, recessing, filling, and contouring the finished restoration using simple instruments and advanced techniques. High-quality isolation with rubber dams is cumbersome and is often omitted, replaced with less effective cotton roll isolation—which increases the risk of contamination and shortens the lifespan of the restoration. Soft and hard tissue recession involves the manipulation of cords, wedges, and matrix bands, and imperfect technique can lead to contamination, difficulty in finishing and / or polishing the interproximal areas, and poor bite fit.

[0003] While "bulk-fill" restorative materials and high-intensity curing lights facilitate relatively fast filling of deep cavities (e.g., 4-5 mm), many restorations are completed with a single shade because practitioners may be uncertain about the correct layering protocol for multiple shades or types of restorative material. Finally, little geometric guidance is available for prepared teeth, and creating the final fill height and occlusal geometry may involve an iterative process of overfilling dental restorative material, followed by grinding with the patient under anesthesia, and verifying tooth contacts and occlusal function. This process can be the most time-consuming part of dental restorations, and negligence can result in tooth sensitivity and a return visit for adjustments.

[0004] Commonly assigned patent applications of the present invention include U.S. Patent Application Publication No. 2018 / 0021113, entitled "Dental Restoration Molding Techniques," filed December 7, 2015; U.S. Patent Application No. 16 / 061362, entitled "One-Piece Dental Restoration Molds," filed December 15, 2016; U.S. Patent Application No. 16 / 061350, entitled "Dental Restoration Molds," filed December 15, 2016; International Publication No. WO 2018 / 022616, entitled "Dental Restoration Molds," filed July 25, 2017; and International Publication No. WO 2018 / 022616, entitled "Dental Restoration Molds," filed September 19, 2017. US Provisional Patent Application No. 62 / 560,457, entitled "Molds," all disclose dental restorative techniques that incorporate molding dental restorative materials directly onto teeth located within a patient's mouth. Summary of the Invention

[0005] The present disclosure relates to methods for dental restorations, custom appliances used for dental restorations, and techniques for manufacturing custom appliances for dental restorations. In one embodiment, the disclosure relates to a custom appliance for forming a dental restoration in a patient's oral cavity. The custom appliance includes: a facial mold body for a patient-specific, customized fit with a facial side of at least one tooth of the patient, the facial mold body including a restoration portion and a first engagement portion extending away from the restoration; and a lingual mold body for a patient-specific, customized fit with a lingual side of the patient's tooth, the lingual mold body including the restoration portion and the first engagement portion extending away from the restoration, wherein the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body, and the facial mold body and the lingual mold body are configured to combine with the patient's tooth to form a mold cavity that covers and surrounds missing tooth structure of the at least one tooth to be restored.

[0006] In another embodiment, the custom appliance comprises a facial mold body for a patient-specific customized fit with a facial side of at least one tooth of the patient, the facial mold body including a restoration, a first engaging portion extending away from the restoration and generally perpendicular to the occlusal plane, and a second engaging portion extending away from the restoration and generally perpendicular to the occlusal plane; and a lingual mold body for a patient-specific customized fit with a lingual side of the patient's tooth, the lingual mold body including the restoration, the first engaging portion extending away from the restoration, and the second engaging portion extending away from the restoration. and a first mesial alignment member on the facial mold body and a second mesial alignment member on the lingual mold body, wherein the first engaging portion of the facial mold body interconnects with the first engaging portion of the lingual mold body, the second engaging portion of the lingual mold body interconnects with the second engaging portion of the lingual mold body, and the first mesial alignment member interconnects with the second mesial alignment member, and the facial mold body and the lingual mold body are configured to mate with a patient's tooth to form a mold cavity that covers and surrounds missing tooth structure of at least one tooth to be restored.

[0007] In another embodiment, a custom appliance for use in dental treatment comprises: a facial body for a patient-specific, customized fit with a facial side of at least one tooth of a patient, the facial body including a tooth contacting portion and a first engaging portion extending away from the tooth contacting portion; and a lingual mold body for a patient-specific, customized fit with a lingual side of a patient's tooth, the lingual mold body including the tooth contacting portion and the first engaging portion extending away from the tooth contacting portion, wherein the first engaging portion of the facial mold body interconnects with the first engaging portion of the lingual mold body, the interconnecting portion configured to provide a clamping force between the facial body and the lingual body.

[0008] In yet another embodiment, the present disclosure is directed to another custom appliance for use in dental treatment, the custom appliance comprising: a facial body for a patient-specific, customized fit with a facial side of at least one tooth of a patient, the facial body including a tooth-contacting portion and a first engaging portion extending away from the tooth-contacting portion; and a lingual mold body for a patient-specific, customized fit with a lingual side of the patient's tooth, the lingual mold body including the tooth-contacting portion and the first engaging portion extending away from the tooth-contacting portion, wherein the first engaging portion of the facial mold body interconnects with the first engaging portion of the lingual mold body, and there is a designed interference between the facial and lingual molds such that a residual seating pressure exists when the engaging portions interconnect.

[0009] In further embodiments, the present disclosure is directed to methods of forming a dental restoration and methods of designing custom appliances for forming a dental restoration on a tooth.

[0010] The custom appliances and methods described herein can be used in combination with any of the foregoing embodiments to create complete, partial, or continuous restorations in a patient's mouth. [Brief explanation of the drawings]

[0011] [Figure 1] FIG. 1 is a front view of one embodiment of a facial mold body that may be part of a custom appliance for forming a dental restoration. [Figure 2] FIG. 2 is a rear view of the face side mold body of FIG. 1. [Figure 3] FIG. 2 is a bottom view of the face side mold body of FIG. 1. [Figure 4] FIG. 1 is a front view of one embodiment of a lingual mold body that may be part of a custom appliance for forming a dental restoration. [Figure 5] FIG. 5 is a rear view of the lingual mold body of FIG. 4. [Figure 6] FIG. 5 is a bottom view of the lingual mold body of FIG. 4. [Figure 7] 5 is a perspective view of the facial mold body of FIG. 1 and the lingual mold body of FIG. 4 prior to interconnection. [Figure 8a] FIG. 5 is a bottom view useful for illustrating how the facial mold body of FIG. 1 and the lingual mold body of FIG. 4 can be interconnected to form one embodiment of a custom appliance for forming a dental restoration. [Figure 8b] FIG. 5 is a bottom view useful for illustrating how the facial mold body of FIG. 1 and the lingual mold body of FIG. 4 can be interconnected to form one embodiment of a custom appliance for forming a dental restoration. [Figure 9] FIG. 8b is a perspective view of the custom device of FIG. 8b. [Figure 10] FIG. 10 is a bottom view of the custom appliance of FIG. 9 in the mouth of a dental patient. [Figure 11a] 10A-B illustrate exemplary steps for using the instrument of FIG. 9 to form a dental restoration in the oral cavity of a dental patient. [Figure 11b] 10A-B illustrate exemplary steps for using the instrument of FIG. 9 to form a dental restoration in the oral cavity of a dental patient. [Figure 11c] 10A-B illustrate exemplary steps for using the instrument of FIG. 9 to form a dental restoration in the oral cavity of a dental patient. [Figure 11d] 10A-B illustrate exemplary steps for using the instrument of FIG. 9 to form a dental restoration in the oral cavity of a dental patient. [Figure 12] FIG. 10 is a front view of another embodiment of a facial mold body that may be part of a custom appliance for forming a dental restoration. [Figure 13] FIG. 13 is a rear view of the face side mold body of FIG. 12. [Figure 14] FIG. 13 is a top view of the facial mold body of FIG. 12 and one embodiment of a lingual mold body that may be part of a custom appliance for forming a dental restoration. [Figure 15] FIG. 10 is a front view of another embodiment of a facial mold body that may be part of a custom appliance for forming a dental restoration. [Figure 16] FIG. 16 is a rear view of the face side mold body of FIG. 15. [Figure 17] FIG. 16 is a bottom view of one embodiment of the facial mold body of FIG. 15 and a lingual mold body for forming a custom appliance for forming a dental restoration. [Figure 18a] 1A-1C are bottom views of more embodiments of custom appliances for forming dental restorations, showing embodiments from partial to full arches in a patient's mouth. [Figure 18b] 1A-1C are bottom views of more embodiments of custom appliances for forming dental restorations, showing embodiments from partial to full arches in a patient's mouth. [Figure 18c] 1A-1C are bottom views of more embodiments of custom appliances for forming dental restorations, showing embodiments from partial to full arches in a patient's mouth. [Figure 19] FIG. 1 is a perspective view of one embodiment of a custom instrument for forming a dental restoration, including an injection port.

[0012] The following embodiments are intended to illustrate, but not limit, the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0013] Restorative dentistry can be used to add tooth structure to a patient's dentition, e.g., to existing teeth, to improve at least one of the function, integrity, aesthetics, or form of missing or malformed tooth structure. For example, restorative dentistry can be a cosmetic procedure that improves the appearance of a tooth by, e.g., altering the shape and / or optical properties (e.g., shade, translucency) of the tooth, which can be accomplished using any suitable technique, such as applying veneers, managing the position or contour of adjacent soft tissue, reducing or eliminating gaps (spacing), and / or addressing the appearance of malpositioned teeth. As another example, restorative dentistry can be used to adjust the bite or chewing function of teeth, affect tooth function, and / or affect other aspects of overall oral health, such as temporomandibular joint (TMJ) disorders, excessive wear, periodontal pathology, gingival recession, or as part of a larger plan to create a healthy and stable oral environment.

[0014] In some cases, the dental restoration process involves drilling caries out of an infected tooth or removing unwanted tooth structure (e.g., sometimes called "preparing" the tooth), and then using instruments and skill to manually isolate, retract, fill, and contour the finished restoration, etc.

[0015] Different techniques may be used to isolate dental restorations. High-quality isolation of dental restorations with rubber dams can be cumbersome and is often omitted, replaced with less effective isolation with cotton rolls, which increase the risk of contamination and / or shorten the longevity of the restoration. Soft and hard tissue recession may involve the manipulation of cords, wedges, and matrix bands. Imperfect recession techniques can result in contamination, difficulty achieving proper tooth contour and symmetry, finishing and / or polishing in the interproximal areas, poor contact conformity, or some combination thereof.

[0016] While "bulk-fill" restorative materials and high-intensity curing lights can facilitate relatively fast filling of deep cavities (e.g., 4-5 mm), many restorations can be completed with a single shade because practitioners may be uncertain about the correct layering protocol for multiple shades or types of restorative material. Furthermore, little geometric guidance is available for prepared teeth, and creating the final fill height and occlusal geometry can involve an iterative process of overfilling dental restorative material, followed by grinding with the patient under anesthesia, and verifying tooth contacts and occlusal function. This process can be the most time-consuming part of dental restorations, and mistakes can result in tooth sensitivity and a return visit for adjustments.

[0017] The appliances described herein may include features designed to create interference between the appliance's two main mold sections and certain interconnected mating features. This generally helps prevent relative movement between the mold sections in multiple directions, better clamping the appliance to the patient's teeth, and sealing the two mold sections together. Such interference is digitally designed into the custom mold when it is designed and manufactured. Conventional molds do not have digitally designed interference. Two mold sections may need to be deformed or bent to interconnect or separate from one another. Additionally, the appliances described herein can eliminate the need for external appliances, such as ring clamps, and instead are self-contained, allowing for quicker and easier application to the patient's teeth. The captive door also reduces the number of individual parts that need to be assembled, reducing the likelihood of losing individual parts. Finally, the appliances described herein can reduce burrs and / or allow for increased control over the placement of restorative materials compared to practitioners using more traditional skills, appliances, and techniques.

[0018] In some embodiments, the appliances described herein may be digitally designed. For example, the tools can be designed using a three-dimensional (3D) model of the patient's dental structure (e.g., obtained from an intraoral scan of all or part of the patient's dentition, or from a scan of a traditional impression or cast). The appliances can be manufactured from the digital data using, for example, additive techniques, such as 3D printing, or subtractive techniques, such as CAD / CAM milling.

[0019] In some embodiments, instruments for dental restorations may include molds designed based on a 3D model of a patient's tooth structure, and may include additional features to provide advantages over molds formed simply based on a 3D scan, a wax model, or other molds formed simply based on the shape of the patient's anatomy and / or desired tooth structure. The techniques of the present disclosure may facilitate high-quality dental restorations with improved quality, reduced flash, and reduced time and / or skill requirements compared to conventional dental restoration techniques.

[0020] Exemplary instruments for dental restorations are described in commonly assigned patent applications, including U.S. Patent Application Publication No. 2018 / 0021113, entitled "Dental Restoration Molding Techniques," filed December 7, 2015; U.S. Patent Application No. 16 / 061362, entitled "One-Piece Dental Restoration Molds," filed December 15, 2016; U.S. Patent Application No. 16 / 061350, entitled "Dental Restoration Molds," filed December 15, 2016; International Publication No. WO 2018 / 022616, entitled "Dental Restoration Molds," filed July 25, 2017; and International Publication No. WO 2018 / 022616, entitled "Dental Restoration Molds," filed September 19, 2017. No. 62 / 560,457, entitled "Potentially Insulated Molds," the entire contents of which are incorporated by reference.

[0021] Figures 1, 2, and 3 illustrate one embodiment of a facial portion of a custom appliance 10 of the present invention. Figures 4, 5, and 6 illustrate one embodiment of a lingual portion of a custom appliance 10 of the present invention. As used herein, including the claims, "facial" refers to the direction toward the patient's cheek or lips (i.e., buccal and labial) and opposite the lingual direction. As used herein, including the claims, "lingual" refers to the direction toward the patient's tongue and opposite the facial direction. Figures 7, 8a, 8b, and 9 illustrate how the facial and lingual portions fit together to form a complete custom appliance 10 for creating a patient-specific dental restoration.

[0022] 1-3 are diagrams of a facial mold body 12 of a custom appliance 10 for forming a patient-specific dental restoration. The appliance 10 includes a facial mold body 12 that can be configured to provide a customized fit with at least one tooth of a patient. For example, the facial mold body 12 can be specifically designed to fit adjacent to, mate with, and provide a restoration structure for the at least one tooth. In the example shown in FIG. 1, the facial mold body 12 includes a restoration portion 16 and an engagement portion 18. A practitioner uses the restoration portion 16 of the custom appliance to restore at least one tooth in the patient's mouth. In the illustrated embodiment, there are two engagement portions 18a, 18b located at opposite ends of the restoration portion 16, with the restoration portion 16 positioned between the engagement portions 18a, 18b. This is ideal, but not required. For example, the facial mold body 12 may include only one engagement portion 18 positioned adjacent the restoration portion 16. In an appliance having two engagement portions 18a, 18b, two interconnection points are provided between the lingual mold body 14 and the facial mold body 12.

[0023] Both the first engaging portion 18a and the second engaging portion 18b extend away from the restoration 16. In the illustrated embodiment, the engaging portion 18 extends generally perpendicular to the restoration 16. Compared to a patient's mouth, which includes an occlusal plane generally indicated by line AA (FIG. 2), the engaging portion 18 extends generally perpendicular to such occlusal plane.

[0024] The length of the engagement portion 18 extends some distance from the restoration portion 16 of the facial mold body 12. The length of the engagement portion can be customized and optimized for each individual patient. If the engagement portion is too long, it will pull on the patient's jaw, causing discomfort or pain to the patient. If the engagement portion is too short, the facial mold body 12 will disengage from the patient's teeth. In one embodiment, the length of the engagement portion may be 1 mm to 5 cm in length. However, this may depend on exactly where the engagement portion is located in the patient's mouth. The engagement portion may be longer if it is attached to a patient's teeth near the front of the mouth, such as the incisors. The engagement portion may be shorter if it is attached to a patient's teeth near the back of the mouth, such as the molars. The overall opening distance between the patient's upper and lower dental arches is also a consideration.

[0025] 3 , the engagement portion 18 of the facial mold body 12 can include various engagement surfaces configured to properly mate with engagement surfaces on the lingual mold body 14. The engagement portions 18a, 18b of the facial mold body 12 may include protrusions 20a, 20b, respectively, or may include some other feature known in the art for interconnecting with the lingual mold body 14. In the illustrated embodiment, the protrusion 20 includes a first engagement surface 24, a second engagement surface 26, and a third engagement surface 28. The protrusions 20a, 20b are sized and shaped to interconnect or snap-fit with recesses 30a, 30b of the lingual mold body 14. Alternatively, the mating portion 18 of the facial mold body 12 may include a protrusion on one end and a recess on the opposite end, and the lingual mold body 14 may include a recess on one end and a protrusion on the opposite end, allowing the two bodies 12, 14 to interconnect. Various structures known in the art can be substituted for the protrusion 20 and recess 30 as long as they help securely interconnect the facial mold body 12 to the lingual mold body 14. For example, dovetail vertical slides or buttons and snaps can also be used as interconnecting features of the mating portion.

[0026] Engagement portions 18a, 18b of facial mold body 12 are constructed to engage or interconnect with engagement portions 31, 32, and 33 on lingual mold body 14, as described in more detail below with reference to Figures 7, 8, and 9.

[0027] In the illustrated embodiment, the restorative mold body 16 is sized and shaped to fit over the patient's anterior teeth. The engagement portion 18 is sized and shaped to abut the posterior teeth. However, in other embodiments (not shown), the engagement portion 18 may abut the anterior teeth and the restorative portion 16 may abut the posterior teeth.

[0028] In the example shown in FIG. 1 , the facial body 12 includes one or more openings 34, each configured to align with a portion of the facial surface of a corresponding patient's tooth to be restored. In some examples, the portion is a majority of the facial surface of the tooth to be restored. For example, opening 34 a may be configured to align with a portion of a majority of the facial surface of one tooth, and opening 34 b may be configured to align with a portion of a majority of the facial surface of another tooth. The tooth surface to be restored and aligned with the openings 34 may be defined, for example, by existing tooth structure or by a dental restoration formed using the facial mold body 12 and the lingual mold body 14.

[0029] Each of the openings 34 has a suitable configuration (e.g., shape and / or size) for introducing restorative material into a mold cavity defined by the interior surface 42 of the door 40 and the interior mold surface 64 (shown in FIG. 4 ) and covering a portion of the surface of the tooth to be restored, where both interior surfaces 42, 64 are surfaces that face one or more teeth to be restored. When the door 40 is mated with the corresponding opening 34, the surface 42 of the door 40 and the patient's tooth structure can help to shape the restorative material placed within the mold cavity, for example, to define the surface of the tooth to be restored.

[0030] In some embodiments, the shape of one or more openings 34 may be designed to substantially match the shape of the tooth and / or tooth portion to be restored. For example, the openings 34 may be substantially non-circular. However, in other examples, the shape of one or more openings 34 may be circular.

[0031] The opening 34 can be larger than the tip of a dental capsule or the tip of a syringe used to introduce dental restorative material into the mold cavity defined by the mold bodies 12, 14. The opening 34 may be large enough to allow placement and flow of the restorative material to cover a portion of the surface of the tooth being restored. Additionally, or alternatively, the opening 34 may be large enough to allow movement of the tip of the capsule or syringe tip within the opening 34.

[0032] The facial mold body 12 may have individual doors 40 sized to fit snugly within the corresponding openings 34. Each door 40 may be attached to the facial mold body 12, as indicated by a hinge 48 and hinge pin 46 at one end and an attachment mechanism 44 at the other end. The attachment mechanism 44 in this case is a clip 44 designed to clip or snap onto an engagement surface 43 (shown in FIGS. 5 and 6 ) on the lingual mold body 14. In this manner, the hinge 48 and hinge pin 46 are adjacent the gingiva of the patient's teeth, and the clip 44 and engagement surface 43 are located adjacent the occlusal surfaces of the patient's teeth or near the incisal edges of one or more teeth to be restored. This arrangement advantageously allows the clip to snap shut, spaced lingually, beneath the occlusal surfaces or incisal edges of the patient's teeth. However, in other embodiments not shown, their relative positions may be reversed, with clip 44 and engagement surface 43 adjacent the gingiva of the patient's tooth and hinge 48 and hinge pin 46 adjacent the incisal or occlusal surface of the patient's tooth.

[0033] In the illustrated embodiment, the door body 40 and the face side mold body 12 are mechanically connected to one another through the use of hinges 48 and hinge pins. This configuration helps maintain proper alignment between the door body 40 and the corresponding opening 34 during use of the custom fixture 10. However, the door body 40 and the face side mold body 12 may be connected by snap-fit hinges, living hinges, barrel hinges, pin-joint hinges, or any other suitable type of hinge. The door hinges 48 and hinge pins 46 may be formed separately from the door body 40 and / or the face side mold body 12, or the door hinges 48 and hinge pins 46 may be formed as an integral part of the door body 40 and / or the face side mold body 12.

[0034] The facial mold body 12 may include a first alignment member 52 that assists in properly aligning the facial mold body 12 and the lingual mold body 14 before they are interconnected. In the illustrated embodiment, the first alignment member 52 is a post that is sized to fit into a second alignment member 54 on the lingual mold body 14, shown as a slot 55 in FIGS. 4-6.

[0035] The facial mold body 12 and the lingual mold body 14 can be configured to combine with at least one tooth of the patient to define a mold cavity that encloses at least a portion of the desired tooth structure of one or more teeth to be restored. For example, in the illustrated example, the facial mold body 12 and the lingual mold body 14 can combine with the patient's teeth to define a mold cavity that encloses at least a portion of the desired tooth structure for each tooth having a facial portion aligned with the openings 34a and 34b. In some embodiments, the dental restoration may include a dental veneer restoration on one or more teeth to be restored, and the openings 34a and 34b may allow the practitioner to have greater control over the placement of the restorative material within the mold cavity compared to previous molds. For example, the openings 34 that align with a majority of the lingual or facial surface of a tooth may allow the practitioner to have greater control over the final appearance of that surface, including the final surface texture, shading, and layering of the restorative material.

[0036] In the illustrated example, the door body 40 includes a vent 50. The vent 50 may be configured to allow excess repair material to escape from the mold cavity so that it can be removed (e.g., with a scalar device) before curing, making flash removal easier. Alternatively or additionally, the vent 50 may be configured to allow air to escape from the mold cavity.

[0037] The facial mold body 12 may include a custom gingival surface 36 that is generally contoured to conform to but not engage the gingiva, allowing for clean removal of excess restorative material. The facial mold body 12 may also include facial ribs 38 to provide overall strength to the facial mold body.

[0038] The custom appliance 10 may include a lingual mold body 14, which may also be configured to provide a customized fit with at least one tooth of the patient. FIGS. 4, 5, and 6 show diagrams of one embodiment of the lingual mold body 14. The facial mold body 12 and the lingual mold body 14 may be configured to mate with at least one tooth of the patient to form a mold cavity. For example, the facial mold body 12 and the lingual mold body 14 may be configured to mate with each other and / or to be attached to at least one tooth to form a mold cavity. In some examples, the lingual mold body 14 is separable and engagable with respect to the facial mold body 12, while maintaining the integrity of each mold body through the use of their engagement portions 18, 19.

[0039] In the example shown in FIGS. 4-6 , the lingual mold body 14 includes a restoration portion 17 and an engagement portion 19. A practitioner uses the restoration portion 17 of the custom appliance to restore at least one tooth in a patient's mouth. In the illustrated embodiment, there are two engagement portions 19a, 19b located at opposite ends of the restoration portion 17, with the restoration portion 17 positioned between the engagement portions 19a, 19b. This is ideal, but not required. For example, the lingual mold body 14 could include only one engagement portion 19 located adjacent to the restoration portion 17. An appliance having two engagement portions 19a, 19b provides two interconnection points between the facial mold body 12 and the lingual mold body 14, respectively.

[0040] The lingual mold body 14 includes a first engaging portion 19a and a second engaging portion 19b. The engaging portions 19a, 19b of the lingual mold body 14 are constructed to engage or interconnect with the engaging portions 18a, 18b on the facial mold body 12, as described in more detail below with reference to Figures 7, 8, and 9.

[0041] Both the first engaging portion 19a and the second engaging portion 19b extend away from the restoration 17. In the illustrated embodiment, the engaging portion 19 extends generally perpendicular to the restoration 17. Compared to a patient's mouth, which includes an occlusal plane shown as reference line AA (shown in FIG. 6), the engaging portion 19 extends generally perpendicular to the occlusal plane.

[0042] As shown in FIG. 6 , the engagement portion 19 of the lingual mold body 14 can include various engagement surfaces configured to properly mate with the engagement surfaces 24, 26, and 28 on the facial mold body 12. The engagement portions 19a and 19b of the lingual mold body 14 can include recesses 30a and 30b, respectively, or some other feature known in the art for interconnecting with the facial mold body 12. In the illustrated embodiment, the recess 30 includes a first engagement surface 31, a second engagement surface 32, and a third engagement surface 33. The recesses 30a and 30b are sized and shaped to interconnect or snap-fit with the protrusions 20a and 20b of the facial mold body 12. Various structures known in the art can be substituted for the recesses 30 and protrusions 20, as long as they help securely interconnect the lingual mold body 14 to the facial mold body 12.

[0043] In the illustrated embodiment, restoration portion 17 is sized and shaped to mate with the patient's anterior teeth. Engagement portion 19 is sized and shaped to abut a posterior tooth. However, in other embodiments (not shown), engagement portion 19 may abut an anterior tooth and restoration portion 17 mates with a posterior tooth.

[0044] The lingual mold body 14 includes a plurality of engagement surfaces 43 that are located adjacent the occlusal surfaces of the patient's teeth or proximate the incisal edges of one or more restored teeth. This arrangement conveniently allows clips 44 (shown in FIGS. 1-3) to snap shut lingually spaced apart under the occlusal surfaces or incisal edges of the patient's teeth. However, in other embodiments not shown, the engagement surfaces 43 may instead be adjacent the gingiva of the patient's teeth, with the clips 44 similarly positioned.

[0045] The lingual body 14 includes a mold surface 64 that is sized to mate with the interior surface 42 of the door 40 (shown in FIGS. 1-3) and / or with the patient's dental structure to create a suitable mold cavity and serve to shape restorative material placed within the mold cavity to define one or more dental surfaces to be restored.

[0046] To provide additional clamping or fit to an individual patient's mouth, the lingual mold body 14 may include custom lingual ribs 39 .

[0047] The lingual mold body 14 may include a second alignment member 54 that is sized and shaped to mate with the first alignment member 52. In the illustrated embodiment, the second alignment member 54 may be a mesial alignment receptacle. Specifically, the second alignment member may be a slot 55 sized to receive the post 52 on the facial mold body 12.

[0048] Figures 8a, 8b, 9, and 10 are useful in explaining how the facial mold body 12 and the lingual mold body 14 are assembled together around the patient's teeth to form the custom appliance 10. One of the key advantages of this design is that, once assembled, movement between the facial and lingual mold bodies is limited in multiple directions and rotations. As a result, the practitioner can create a more precise restoration for the patient.

[0049] 8a and 8b, the practitioner can first position the lingual mold body 14 behind the patient's teeth with the second alignment member 54 centered adjacent to the occlusal surfaces of the patient's teeth. The practitioner can then place the facial mold body 12 over the front of the teeth and align the first alignment member 52, i.e., post, by engaging it with the second alignment member 54, i.e., hole. However, in other embodiments, the mold bodies 12, 14 may include indicia or alignment features (e.g., visual indicators, other forms of mechanical interlocking features, keyholes, notches, etc.) to help the practitioner properly align and easily engage the facial mold body 12 and lingual mold body 14 with one another.

[0050] The facial mold body 12 and the lingual mold body 14 are preferably made of a flexible material so that they can be bent at a specific radius and interconnect well, as shown in Figures 8a and 8b. The physician interconnects the mold bodies 12 and 14 by placing the protrusions 20a and 20b into the corresponding recesses 30a and 30b. Release tabs 22a and 22b may optionally be used to facilitate fitting the protrusions 20a and 20b into the recesses 30a and 30b. Custom appliances can be made from a range of 3D printed, molded, or CAD / CAM-molded polymer materials with a specific desired strength, flexibility, translucency, or color. For example, the mold material can be a polymer material that can be transparent, translucent, or opaque. In some embodiments, the transparent or substantially transparent polymeric material may include, for example, one or more of an amorphous thermoplastic polymer, a semi-crystalline thermoplastic polymer, a transparent thermoplastic polymer, and a thermosetting polymer. The thermoplastic resin may be selected from polycarbonate, thermoplastic polyurethane, acrylic, polysulfone, polypropylene, polypropylene / ethylene copolymer, cyclic olefin polymer / copolymer, poly-4-methyl-1-pentene or polyester / polycarbonate copolymer, styrenic polymeric material, polyamide, polymethylpentene, polyetheretherketone, and combinations thereof. In another embodiment, the mold may be selected from transparent or substantially transparent semi-crystalline thermoplastic resins, crystalline thermoplastic resins, and composites, such as polyamide, polyethylene terephthalate, polybutylene terephthalate, polyester / polycarbonate copolymer, polyolefin, cyclic olefin polymer, styrenic copolymer, polyetherimide, polyetheretherketone, polyethersulfone, polytrimethylene terephthalate, and mixtures and combinations thereof. In some embodiments, the mold is a polymeric material selected from polyethylene terephthalate, polyethylene terephthalate glycol, polycyclohexylene dimethylene terephthalate glycol, and mixtures and combinations thereof.In further embodiments, the thermoset polymers include acrylics, urethanes, esters, silicones, thiolenes, epoxies, olefin metathesis, and combinations thereof.

[0051] The custom appliance 10 is designed to ensure a relatively tight fit between the mold bodies 12, 14 while helping to reduce or eliminate burrs along the edges where the two mold bodies 12, 14 mate, ensuring an accurately and precisely molded restoration. Any burrs that do occur can be very thin along the incisal edges and can be easily removed with dental instruments. Providing a relatively tight fit along the incisal edges or other edges of the mold bodies 12, 14 can help excess restorative material flow preferentially toward the vents 50, where the burrs are relatively easy to find and remove during finishing of the restoration.

[0052] FIG. 8b is useful for illustrating the clamping force that can be generated between the facial mold body 12 and the lingual mold body 14. The facial mold body 12 has a particular dental arch length (C), and the lingual mold body 14 has a particular dental arch length (D). When the custom appliance 10 is made, the shape of the facial mold body 12 and / or the lingual mold body 14 is altered. For example, the dental arch length C of the facial mold body 12 can be shortened while maintaining the dental arch length D of the lingual mold body; this configuration creates a clamping force between the two mold bodies 12, 14 when they are assembled. The mold bodies 12, 14 are also strong enough not to break or buckle, allowing the protrusions 20 and recesses 30 to interconnect without creating excessive pressure in the patient's mouth. A clamping force can also be created by slightly reducing the radius of curvature of the facial mold body 12 while maintaining the radius of curvature of the lingual mold body 14. The angle θ indicates the latching plane relative to the tangent of the dental arch.

[0053] The degree of clamping force between the facial body 12 and the lingual body 14 should be adjusted to balance the security of the appliance 10 around the patient's teeth with sealing the appliance 10 against the gum tissue while allowing the appliance 10 to be easily placed in and removed from the patient's mouth. The degree of clamping force can be increased by increasing the stiffness of the mold bodies 12, 14 by changing the material, shape, amount of shortening, and / or reducing the radius of curvature of the facial mold body 12. Modifications to the mold bodies 12, 14 can be applied to the entire mold body, for example, by applying an appropriate shrinkage ratio, or modifications can be applied locally to various areas of the mold body and / or the latching mechanism between the two mold bodies. The ease of latching and engagement and disengagement can be adjusted by adjusting the latch angle, the length of the latching faces 31, 32, 33, and the topography of the surfaces 24, 26, 28 to achieve the best balance of performance. Tools such as finite element modeling can be used to predict appropriate parameters for a given custom appliance based on test results from previously tested cases. Machine learning (including feedback from physicians on clinical performance) can be applied to improve predictive capabilities over time. Digital design and manufacturing, such as 3D printing or CNC machining, are particularly useful for creating custom appliance molds with active clamping forces.

[0054] 10 shows the custom dental restoration appliance 10 properly clamped around a patient's teeth 72 within the patient's oral cavity 70. First mating portions 18a, 19b of the facial mold body 12 and the lingual mold body 14 are interconnected intraorally, offset from the occlusal surfaces of the premolars, and extend toward the patient's tongue (not shown). Similarly, second mating portions 18b, 19b of the facial mold body 12 and the lingual mold body 14 are interconnected. In the illustrated embodiment, the patient is having five teeth restored.

[0055] Figures 11a-11d conveniently illustrate steps in a method for using the custom appliance 10 of the present invention after the custom appliance has been properly applied within a patient's oral cavity 70. Figure 11a shows some of the doors 40 open to allow access to the tooth to be restored. Figure 11b shows restorative material 80 applied to the tooth to be restored. Figure 11c shows the restorative material 80 curing within the custom appliance 10. Figure 11d shows the restored tooth 72 in the patient's oral cavity 70.

[0056] In some embodiments, the opening 34 of the appliance 10 may allow the practitioner to apply the restorative material 80 directly to the tooth to be restored. However, in other embodiments, the practitioner may apply the restorative material 80 to the tooth to be restored or to the mold bodies 12, 14 before applying the mold bodies 12, 14 over the patient's tooth 72.

[0057] The practitioner can fill the mold cavity defined by the mold bodies 12, 14 and the tooth around which the mold bodies 12, 14 are disposed with the restorative material 80 by introducing the restorative material 80 into the mold cavity through one or more of the openings 34 (FIG. 11b). In some embodiments, the practitioner may use various instruments to place the restorative material into the mold cavity. In some embodiments, the restorative material 80 may be placed into the mold cavity through multiple openings 34. One preferred dental restorative material is Filtek™ Supreme Universal™, commercially available from 3M Company (St. Paul, Minnesota). After at least some of the restorative material 80 has been introduced into the mold cavity, the practitioner may then close the door body 40 into the corresponding opening 34 (FIG. 11c). The inner surface 42 of the door body 40 and the mold surface 64 may be used to mold one or more layers of the restorative material 80 onto the facial or lingual surface of the tooth 72, to compress the restorative material 80 within the mold cavity, or any combination thereof.

[0058] In some embodiments, the practitioner can cure the restorative material 80 while the door body 40 is closed within the opening 34 of the facial mold body 12. For example, if the restorative material is light-curable, the practitioner can expose the restorative material to a curing light (e.g., blue light) through one or both of the mold bodies 12, 14, which can be formed from a material transparent to the curing light. The practitioner can remove the facial mold body 12 and the lingual mold body 14 from the tooth 72 (which already has a restored structure defined by the restorative material) (FIG. 11d). Removing the mold bodies 12, 14 from the oral cavity 70 may include separating the facial mold body 12 from the lingual mold body 14, which may include, for example, disengaging one or more of the first engaging portions 18a, 19a of the mold bodies 12, 14 from the second engaging portions 19a, 19b of the mold bodies 12, 14. In some embodiments, one or more of the door bodies 40 may leave "marks" on the lingual or facial surfaces of the teeth, but such marks may be relatively thin and therefore relatively easily removable. In some embodiments, the practitioner may finish the tooth (including the restored dental structure already defined by the restorative material), such as by polishing, to remove burrs or other undesirable surface imperfections.

[0059] In some examples, the practitioner may place a release film on at least a portion of the surface 42 of the door 40 before placing the door 40 within its respective opening 34. The release film may reduce the likelihood of trapping air in the mold cavity while stamping the restorative material 80 with the door and / or may allow the restorative material 40 to more easily release from the surface 42 of the door 40.

[0060] In addition to, or instead of, a release film, in some embodiments, a device manufacturer or physician may apply a coating to at least a portion of the door 40 and / or door body surface 42 before placing the door 40 within its respective opening 34. The coating may reduce the likelihood of trapping air in the mold cavity while stamping the repair material with the door and / or may allow the repair material to easily release from the door surface. Release coatings may also be applied to any of the mold components during the manufacturing process.

[0061] Introduction of restorative material 80 into the mold cavity may have sufficient force to cause portions of mold bodies 12, 14 to separate from one another, thereby weakening the engagement between facial mold body 12 and lingual mold body 14 and / or weakening the customized fit with one or more teeth. However, engaging portions 18, 19 help mold bodies 12, 14 to self-align with one another and remain firmly secured relative to one another.

[0062] 12-14 illustrate another embodiment of a custom instrument 110 of the present invention. The custom instrument 110 is configured similarly to the custom instrument 10 described in detail above with respect to FIGS. 1-11, except that the custom instrument 110 includes at least one door 140 covering two openings 142.

[0063] Figures 12 and 13 show one embodiment of a facial mold body 112 of a custom appliance 110 of the present invention. Figure 13 shows a rear view of the facial mold body 112. Figure 14 shows one embodiment of a lingual portion 114 of a custom appliance 110 of the present invention in combination with the facial mold body 112, illustrating how the two bodies fit together to form a complete custom appliance 110 for creating a patient-specific dental restoration.

[0064] Like the exemplary facial mold body 12 shown in FIG. 1 , the facial mold body 112 includes a restoration portion 116 and an engagement portion 118. However, there are two restoration portions 116 that are used to restore the teeth on either side of the mesial incisors. In the illustrated embodiment, there are two engagement portions 118a, 118b located at opposite ends of the restoration portion 116. Like the custom appliance 10, the custom appliance 110 has first engagement portions 118a, 119a and second engagement portions 118b, 119b, which provide two interconnection points between the facial mold body 112 and the lingual mold body 114, respectively.

[0065] Both the first engaging portion 118a and the second engaging portion 118b extend away from the restoration. In the illustrated embodiment, the engaging portion 118 extends generally perpendicular to the restoration. Compared to a patient's mouth, which includes an occlusal plane BB established by the incisal and occlusal surfaces of all teeth in the upper and lower dental arches, the engaging portion 118 extends generally perpendicular to the occlusal plane.

[0066] 13 , the engaging portion 118 of the facial mold body 112 can include various engaging surfaces configured to properly mate with engaging surfaces on the lingual mold body 114. The engaging portions 118a, 118b of the facial mold body 112 can include protrusions 120a, 120b, respectively, or some other feature known in the art for interconnecting with the lingual mold body 114. In the illustrated embodiment, the protrusion 120 includes a first engaging surface 124, a second engaging surface 126, and a third engaging surface 128, as described above. The protrusions 120a, 120b are sized and shaped to interconnect or snap-fit with the recesses 130a, 130b of the lingual mold body 114. Various structures known in the art can be substituted for the protrusions 120 and recesses 130 as long as they help securely interconnect the facial mold body 112 to the lingual mold body 114 .

[0067] The engaging portions 118a, 118b of the facial mold body 112 are constructed to engage or interconnect with engaging portions on the lingual mold body 114, as described in more detail above with reference to the facial mold body 12 and lingual mold body 14 of Figures 7, 8, and 9.

[0068] In the illustrated embodiment, the restorative mold body 116 is sized and shaped to mate with the patient's anterior teeth. The engagement portion 118 is adjacent to the posterior teeth. However, in other embodiments (not shown), the engagement portion 118 may be adjacent to the anterior teeth and the restorative portion 116 may be sized and shaped to mate with the posterior teeth.

[0069] In the example shown in FIGS. 12 and 13 , the facial body 112 includes one or more openings 134, each configured to align with a portion of the facial surface of a corresponding patient's tooth to be restored. In some examples, the portion is a majority of the facial surface of the tooth to be restored. In the embodiment shown in FIGS. 12-14 , there is a double door 140 covering two openings 134. As such, the door 140 is configured to align with a portion including a majority of the facial surface of the two teeth, and the two openings 134 are configured to align with a portion including a majority of the facial surface of the two teeth. The tooth surfaces to be restored and aligned with the respective openings 134 may be defined, for example, by existing tooth structure or by a dental restoration formed using the facial mold body 112 and the lingual mold body 114.

[0070] Figures 15 and 16 show one embodiment of the facial mold body 212 of the custom appliance 200 of the present invention. Figure 17 shows one embodiment of the lingual portion 214 of the custom appliance 200 of the present invention in combination with the facial mold body 212, illustrating how the two bodies fit together to form a complete custom appliance 200 for creating a patient-specific dental restoration. The embodiment shown in Figures 15-17 is very similar to the embodiment shown in Figures 11-13, except that the relative positions of the hinge 148 and door 140 have been swapped.

[0071] Like the exemplary facial mold body 12 shown in FIG. 1 , the facial mold body 212 includes a restoration portion 216 and an engagement portion 218. However, there are two restoration portions 216 that are used to restore the teeth on either side of the mesial incisors. In the illustrated embodiment, there are two engagement portions 218a, 218b located at opposite ends of the restoration portion 216. Like the custom appliance 10, the custom appliance 200 has first engagement portions 218a, 219a and second engagement portions 218b, 219b that provide two interconnection points between the facial mold body 212 and the lingual mold body 214.

[0072] Both the first engaging portion 218a and the second engaging portion 218b extend away from the restoration. In the illustrated embodiment, the engaging portion 218 extends generally perpendicular to the restoration. Compared to a patient's mouth, which includes an occlusal plane C established by the incisal and occlusal surfaces of all teeth in the upper and lower dental arches, the engaging portion 218 extends generally perpendicular to the occlusal plane.

[0073] The engaging portion 218 of the facial mold body 212 may include various engaging surfaces configured to properly mate with engaging surfaces on the lingual mold body 214. The engaging portions 218a, 218b of the facial mold body 212 may include protrusions 220a, 220b, respectively, or may include some other mechanism known in the art for interconnecting with the lingual mold body 214. In the illustrated embodiment, the protrusion 220 includes a first engaging surface 224, a second engaging surface 226, and a third engaging surface 228. The protrusions 220a, 220b are sized and shaped to interconnect or snap-fit with recesses 230a, 230b on the lingual mold body 214. Various structures known in the art may be substituted for the protrusions 220 and recesses 230, as long as they assist in securely interconnecting the facial mold body 212 to the lingual mold body 214.

[0074] The engaging portions 218a, 218b of the facial mold body 212 are constructed to engage or interconnect with engaging portions on the lingual mold body 214, as described in more detail above with reference to the facial mold body 12 and lingual mold body 14 of Figures 7, 8, and 9.

[0075] In the illustrated embodiment, the restorative mold body 216 is sized and shaped to mate with the patient's anterior teeth. The engagement portion 218 is adjacent to the posterior teeth. However, in other embodiments (not shown), the engagement portion 218 can be adjacent to the anterior teeth and the restorative portion 216 can be sized and shaped to mate with the posterior teeth. Figures 18a-18c show further embodiments of the custom appliance of the present disclosure.

[0076] In the example shown in FIG. 16 , the facial body 212 includes one or more openings 234, each configured to align with a portion of the facial surface of a corresponding patient's tooth to be restored. In some examples, the portion is a majority of the facial surface of the tooth to be restored. In the embodiment shown in FIGS. 15-17 , there is a double door 240 covering two openings 234. As such, the door 240 is configured to align with a portion including a majority of the facial surface of the two teeth, and the two openings 234 are configured to align with a portion including a majority of the facial surface of the two teeth. The tooth surfaces to be restored and aligned with the respective openings 234 may be defined, for example, by existing tooth structure or by a dental restoration formed using the facial mold body 212 and the lingual mold body 214.

[0077] Figures 18a-18c show additional embodiments of custom appliances 300, 302, 304 of the present invention, where hinge 144 pivots adjacent the patient's gums. The embodiments shown in Figures 18a-18c are very similar to the embodiments shown in the other figures, except that they engage different portions of the patient's oral cavity.

[0078] FIG. 18a illustrates an embodiment of a custom appliance 300 engaging a portion of a dental arch of a patient's oral cavity 70, specifically the portion of the patient's dental arch extending between the molars and incisors. Engagement portion 119 of lingual mold body 114 mates with engagement portion 118 of facial mold body 112 to form a complete custom appliance 300 for forming a patient-specific dental restoration. Engagement portion 119a mates with protrusion 120a of engagement portion 118a to interconnect with an adjacent one of the patient's incisors. Engagement portion 119b mates with protrusion 120b of engagement portion 118b to interconnect with an adjacent one of the patient's molars. Optional release tabs 122a, 122b may be used to facilitate engagement of protrusions 120a, 120b into recesses 130a, 130b. To provide an additional clamping or fit to the individual patient's mouth, the lingual mold body 114 may include custom lingual ribs 139 .

[0079] FIG. 18b illustrates an embodiment of a custom appliance 302 engaging a complete dental arch of a patient's oral cavity 70, specifically the portion of the patient's dental arch extending between one molar and another. Engagement portion 119 of lingual mold body 114 mates with engagement portion 118 of facial mold body 112 to form a complete custom appliance 302 for forming a patient-specific dental restoration. Engagement portion 119a mates with protrusion 120a of engagement portion 118a to interconnect with an adjacent one of the patient's incisors. Engagement portion 119b mates with protrusion 120b of engagement portion 118b to interconnect with an adjacent one of the patient's molars. Optional release tabs 122a, 122b may be used to facilitate engagement of protrusions 120a, 120b into recesses 130a, 130b. To provide an additional clamping or fit to the individual patient's mouth, the lingual mold body 114 may include custom lingual ribs 139 .

[0080] FIG. 18c illustrates an embodiment of a custom appliance 304 engaging a portion of a dental arch of a patient's oral cavity 70, specifically the portion of the patient's dental arch extending between the molars and premolars. Engagement portion 119 of lingual mold body 114 mates with engagement portion 118 of facial mold body 112 to form a complete custom appliance 300 for forming a patient-specific dental restoration. Engagement portion 119a mates with protrusion 120a of engagement portion 118a to interconnect with an adjacent one of the patient's incisors. Engagement portion 119b mates with protrusion 120b of engagement portion 188b to interconnect with an adjacent one of the patient's molars. Optional release tabs 122a, 122b may be used to facilitate engagement of protrusions 120a, 120b into recesses 130a, 130b. To provide an additional clamping or fit to the individual patient's mouth, the lingual mold body 114 may include custom lingual ribs 139 .

[0081] 19 shows an embodiment of a custom appliance 500 for forming a dental restoration, the custom appliance 500 including an injection port 520 and two different embodiments of engagement portions 519a, 519b. The custom appliance 520 includes an injection port 520 for delivering dental restorative material into a mold cavity formed between a facial mold body 512 and a lingual mold body 514. In this embodiment, the port 520 is formed when the facial mold body 512 and the lingual mold body 514 are mated to form the complete custom appliance 500 for forming a patient-specific dental restoration. Optionally, the custom appliance 500 may include a plug (not shown) for placement in the port 520 after the dental restorative material has been injected into the mold cavity.

[0082] The facial mold body 512 may include first alignment members 552a, 552b, and the lingual mold body 514 may include second alignment members 554a, 554b, all of which aid in properly aligning the facial mold body 512 and the lingual mold body 514 before interconnecting them. The first alignment member 552a interconnects with the second alignment member 554a. The first alignment member 552b interconnects with the second alignment member 554b. In this embodiment, the injection ports 520 are positioned between the alignment members 552a, 554a, 552b, 554b, respectively, although this is not required.

[0083] Lingual mold body 514 may include engagement portions 519a or 519b as shown, however, as noted above, other engagement portions may be used.

[0084] The custom molds of the present invention have advantages over the prior art. As an example, U.S. Patent No. 8,366,445 (Vuillemot) shows alignment features in FIGS. 4 and 5 for aligning buccal and lingual mold portions. The alignment features are located at the interface between the buccal and lingual molds. The alignment features may be allowed to provide some frictional resistance to secure the assembled mold. This has several disadvantages compared to interlocking, spaced-apart mating portions. For example, retention features such as those shown in Vuillemot complicate mold seating and curing. To create space for the retention features, the mold interface area must be increased, resulting in a bulkier design. When using frictional forces to secure the mold, these same frictional forces must be overcome to seat the mold, making it difficult to know when the mold halves are fully seated together. If the mold is not fully seated, the composite will flow into the gap during use, leading to flash. Retention features on the mating surfaces will cause the composite to bond to the mold during the curing process, making mold removal extremely difficult.

[0085] In contrast, the interlocking engagement portions of the present invention are not located along the interface but rather are located separately from the interface. This provides several advantages. The interface between the lingual and facial molds is not enlarged or complicated by fine registration features, but rather is smooth, making it easy to seat and verify the seating in the closed state. There is a smooth interface to minimize the retention of any hardened flash at the interface. The latching mechanism (interlocking engagement portions) is physically separated from the area where flash may develop during filling. The latching mechanism (interlocking engagement portions) is activated separately from the seating and release of the facial and lingual molds by easy-to-grip tabs. Finally, the latching mechanism (interlocking engagement portions) can be configured to provide a designed interference between the facial and lingual molds so that even when the facial and lingual molds are closed, there is a residual seating pressure when the engagement portions are interconnected. This seating pressure helps keep the custom appliance securely closed even under the pressure of composite filling.

[0086] The custom appliances described herein can be created based on a digital model of an individual patient's teeth and oral cavity, which may be created from a three-dimensional intraoral scan, such as with an intraoral scanner. In one specific example, the custom appliance may be digitally designed using CAD software, such as solid modeling software, based on a digital model of the planned and restored dentition. The custom appliance is designed to fit over one or more teeth to be restored (restoration portion) and portions of adjacent teeth (engagement portion). A tooth structure model of the restored teeth can then be digitally subtracted from a mold block to create the appliance. Alternatively, a reverse image of the tooth structure may be inverted in software to define the mold block. The engagement portion may be located in an area of the tooth corresponding to the area from which the tooth will extend.

[0087] Within the digital model, the mold block design is divided into two sections (a facial mold body and a lingual mold body) to facilitate final assembly of the appliance components on the teeth with specific geometric interferences selected relative to the arch length to provide the desired clamping force, as described above. Within the digital model, engaging portions are designed with certain interconnecting geometries, with the overall height of the engaging portions selected based on where they will be placed in the patient's mouth, as explained in more detail above.

[0088] Exemplary Embodiments Embodiment 1 is a custom appliance for forming a dental restoration in a patient's oral cavity, the custom appliance comprising: a facial mold body for a patient-specific, customized fit with a facial side of at least one tooth of the patient, the facial mold body including a restoration portion and a first engagement portion extending away from the restoration portion; and a lingual mold body for a patient-specific, customized fit with a lingual side of the patient's tooth, the lingual mold body including a restoration portion and a first engagement portion extending away from the restoration portion, the first engagement portion of the facial mold body interconnecting with the first engagement portion of the lingual mold body, the facial mold body and the lingual mold body configured to combine with the patient's tooth to form a mold cavity that covers and surrounds missing tooth structure of the at least one tooth to be restored.

[0089] Embodiment 2 is a custom appliance described in embodiment 1, wherein the facial mold body includes a second engagement portion extending away from the restoration portion, the lingual mold body includes a second engagement portion extending away from the restoration portion, and the second portion of the facial mold body interconnects with the second portion of the lingual mold body.

[0090] Embodiment 3 is the custom appliance of embodiments 1 and 2, wherein the patient's oral cavity includes an occlusal plane, and the first engagement portion of the facial mold body and the first engagement portion of the lingual mold body extend generally perpendicular to the occlusal plane.

[0091] Embodiment 4 is the custom appliance of embodiments 1 and 2, wherein the first engagement portion is adjacent to the patient's anterior teeth and the second engagement portion is adjacent to the patient's posterior teeth, and the restoration portion of the facial mold body and the restoration portion of the lingual mold body mate with either the anterior teeth or the posterior teeth.

[0092] Embodiment 5 is a custom appliance according to embodiments 1 and 2, wherein the patient's oral cavity includes an occlusal plane, the first and second engagement portions of the facial mold body extend generally perpendicular to the occlusal plane, and the first and second engagement portions of the lingual mold body extend generally perpendicular to the occlusal plane.

[0093] Embodiment 6 is a custom appliance according to any of the previous embodiments, further including a first mesial alignment member on the facial mold body and a second mesial alignment member on the lingual mold body.

[0094] Embodiment 7 is a custom appliance according to any of the previous embodiments, wherein the facial mold body restoration portion and the lingual mold body restoration portion mate with the patient's anterior teeth and the engagement portion is adjacent to the patient's posterior teeth.

[0095] Embodiment 8 is a custom appliance according to any of the previous embodiments, wherein the restoration portion of the facial mold body and the restoration portion of the lingual mold body mate with the patient's posterior teeth and the engagement portion is proximate the patient's anterior teeth.

[0096] Embodiment 9 is a custom appliance according to any of the previous embodiments, wherein the first engagement portion of the facial mold body includes a protrusion and the first engagement portion of the lingual mold body includes a recess, and wherein the protrusion of the facial mold body interconnects with the recess of the lingual mold body adjacent the occlusal plane of the patient's oral cavity.

[0097] Embodiment 10 is a custom appliance according to any of the previous embodiments, wherein the first engagement portion of the lingual mold body includes a protrusion and the first engagement portion of the facial mold body includes a recess, and wherein the protrusion of the lingual mold body interconnects with the recess of the facial mold body adjacent to the occlusal surface of the patient's oral cavity.

[0098] Embodiment 11 is a custom appliance according to any of the previous embodiments, wherein the facial mold body has a customized fit with the facial sides of the patient's teeth and the lingual mold body has a customized fit with the lingual sides of the patient's teeth.

[0099] Embodiment 12 is a custom appliance according to any of the previous embodiments, wherein the patient's oral cavity includes an occlusal plane, and wherein the first engagement portion of the facial mold body and the first engagement portion of the lingual mold body extend in a facial direction relative to the occlusal plane.

[0100] Embodiment 13 is a custom appliance according to any of the previous embodiments, wherein the patient's oral cavity includes an occlusal plane, and the first engagement portion of the facial mold body and the first engagement portion of the lingual mold body extend in a lingual direction relative to the occlusal plane.

[0101] Embodiment 14 is a custom appliance for forming a dental restoration in a patient's oral cavity, the patient's oral cavity including an occlusal plane, the custom appliance comprising: a facial mold body for a patient-specific customized fit with a facial side of at least one tooth of the patient, the facial mold body including a restoration, a first engagement portion extending away from the restoration and generally perpendicular to the occlusal plane, and a second engagement portion extending away from the restoration and generally perpendicular to the occlusal plane; and a lingual mold body for a patient-specific customized fit with a lingual side of the patient's tooth, the lingual mold body including the restoration, the first engagement portion extending away from the restoration, and a second engagement portion extending away from the restoration. a lingual mold body including a first engaging portion and a second engaging portion extending away from the first engaging portion; and a first mesial alignment member on the facial mold body and a second mesial alignment member on the lingual mold body, wherein the first engaging portion of the facial mold body interconnects with the first engaging portion of the lingual mold body, the second engaging portion of the lingual mold body interconnects with the second engaging portion of the lingual mold body, and the first mesial alignment member interconnects with the second mesial alignment member, and the facial mold body and the lingual mold body are configured to mate with a patient's tooth to form a mold cavity that covers and surrounds missing tooth structure of at least one tooth to be restored.

[0102] Embodiment 15 is a custom appliance for use in dental treatment, comprising: a facial body for a patient-specific, customized fit with a facial side of at least one tooth of a patient, the facial body including a tooth contacting portion and a first engagement portion extending away from the tooth contacting portion; and a lingual mold body for a patient-specific, customized fit with a lingual side of the patient's teeth, the lingual mold body including the tooth contacting portion and the first engagement portion extending away from the tooth contacting portion, wherein the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body, and the interconnecting portion is configured to provide a clamping force between the facial body and the lingual body.

[0103] Embodiment 16 is a method of forming a dental restoration, comprising the steps of: placing a patient-specific facial mold body over at least one patient's tooth to be restored, the facial mold body having a customized fit with a facial side of the patient's at least one tooth, the facial mold body including a restoration portion and a first engagement portion extending away from the restoration portion; and placing a patient-specific lingual mold body over the at least one patient's tooth to be restored, the lingual mold body having a customized fit with a lingual side of the patient's at least one tooth. and positioning a patient-specific lingual mold body having a misaligned fit, the lingual mold body including a restoration and a first engagement portion extending away from the restoration; interconnecting the first engagement portion of the facial mold body with the first engagement portion of the lingual mold body to combine with the patient's teeth to form a mold cavity that covers and encloses missing tooth structure of at least one tooth to be restored; introducing a restorative material into the mold cavity; allowing the restorative material to harden; and removing the facial mold body and the lingual mold body from the at least one tooth.

[0104] Embodiment 17 is the method of embodiment 16, wherein the introducing step occurs before the interconnecting step.

[0105] Embodiment 18 is a method of forming a dental restoration, comprising the steps of: superficially applying a dental restoration material to cover at least one tooth to be restored of a patient; placing a patient-specific facial mold body over the at least one tooth to be restored and the dental restoration material, the facial mold body having a customized fit with a facial side of the patient's at least one tooth, the facial mold body including a restoration portion and a first engagement portion extending away from the restoration portion; and placing a patient-specific lingual mold body over the at least one tooth to be restored and the dental restoration material, the lingual mold body having a customized fit with a facial side of the patient's at least one tooth. and removing the facial and lingual mold bodies from the at least one tooth. The method includes the steps of: positioning a patient-specific lingual mold body having a customized fit with the lingual side of the patient's tooth, the lingual mold body including a restoration portion and a first engagement portion extending away from the restoration portion; interconnecting the first engagement portion of the facial mold body with the first engagement portion of the lingual mold body to combine with the patient's tooth to form a mold cavity that covers and surrounds missing tooth structure of the at least one tooth to be restored, wherein a dental restorative material is contained within the mold cavity; hardening the restorative material; and removing the facial and lingual mold bodies from the at least one tooth.

[0106] Embodiment 19 is a method of designing a custom appliance for forming a dental restoration of a tooth, comprising the steps of receiving, by one or more processors, three-dimensional scan data of a patient's supragingival dental structure; and designing, by the one or more processors, a custom appliance for forming a dental restoration of the tooth based on the three-dimensional scan data of the patient's supragingival dental structure and a desired dental structure of at least one tooth to be restored of the patient, wherein the appliance is a facial side mold body for a patient-specific customized fit with a facial side of the patient's at least one tooth, the facial side mold body comprising a restoration portion and a dental restoration from the restoration portion. and a lingual mold body for a patient-specific, customized fit with the lingual side of the patient's tooth, the lingual mold body including a restoration and a first engagement portion extending away from the restoration, wherein the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body, and the facial mold body and the lingual mold body are configured to combine with the patient's tooth to form a mold cavity that covers and surrounds missing tooth structure of at least one tooth to be restored.

[0107] Embodiment 20 is the method of embodiment 19, wherein the facial mold body and the lingual mold body are manufactured by three-dimensional printing.

[0108] Embodiment 21 is the method of embodiments 19 and 20, wherein the facial mold body and the lingual mold body are manufactured by a CAD / CAM milling process.

[0109] Embodiment 22 is the method of embodiments 19-21, further comprising receiving, by one or more processors, information regarding the patient's subgingival tooth structure.

[0110] Embodiment 23 is a custom appliance for use in dental treatment, comprising: a facial body for a patient-specific, customized fit with a facial side of at least one tooth of a patient, the facial body including a tooth contacting portion and a first engagement portion extending away from the tooth contacting portion; and a lingual mold body for a patient-specific, customized fit with a lingual side of the patient's teeth, the lingual mold body including the tooth contacting portion and the first engagement portion extending away from the tooth contacting portion, wherein the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body, and wherein there is a designed interference between the facial mold and the lingual mold such that there is residual seating pressure when the engagement portions interconnect.

[0111] Embodiment 24 is the custom appliance of embodiment 1, wherein the custom appliance is configured to mate with a portion of the patient's dental arch extending between the molars and incisors.

[0112] Embodiment 25 is the custom appliance of embodiment 1, wherein the custom appliance is configured to mate with a portion of the patient's dental arch extending between one molar and another molar.

[0113] Embodiment 26 is the custom appliance of embodiment 1, wherein the custom appliance is configured to mate with a portion of the patient's dental arch extending between the molars and premolars.

[0114] Embodiment 27 is the custom appliance of embodiment 1, further comprising a port through which dental restorative material can be injected into the mold cavity. [Explanation of symbols]

[0115] 10...custom appliance, 12...facial mold body, 14...lingual mold body, 16...restoration portion of facial mold body, 17...restoration portion of lingual mold body, 18a...engagement portion of facial mold body, 19a...first engagement portion of lingual mold body.

Claims

1. 1. A custom instrument for forming a dental restoration in a patient's mouth, comprising: a facial side mold body for a patient-specific customized fit with a facial side of at least one tooth of the patient, the facial side mold body including a restoration portion and a first engagement portion extending away from the restoration portion; a lingual mold body for a patient-specific customized fit with a lingual side of the patient's tooth, the lingual mold body including a restoration and a first engagement portion extending away from the restoration; the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body; a facial mold body and a lingual mold body configured to mate with the patient's teeth to form a mold cavity that covers and surrounds missing tooth structure of at least one tooth to be restored.

2. 10. The custom appliance of claim 1, wherein the facial mold body includes a second engaging portion extending away from the restoration and the lingual mold body includes a second engaging portion extending away from the restoration, the second portion of the facial mold body interconnecting with the second portion of the lingual mold body.

3. 10. The custom appliance of claim 1, wherein the patient's oral cavity includes an occlusal plane, and wherein the first engaging portion of the facial mold body and the first engaging portion of the lingual mold body extend generally perpendicular to the occlusal plane.

4. 3. The custom appliance of claim 2, wherein the first engagement portion is adjacent to the patient's anterior teeth and the second engagement portion is adjacent to the patient's posterior teeth, and the restoration portion of the facial mold body and the restoration portion of the lingual mold body mate with either the anterior teeth or the posterior teeth.

5. The custom appliance of claim 1 , further comprising a first mesial alignment member on the facial mold body and a second mesial alignment member on the lingual mold body.

6. 10. The custom appliance of claim 1, wherein the restoration portion of the facial mold body and the restoration portion of the lingual mold body mate with the patient's anterior teeth and engagement portions are proximate the patient's posterior teeth.

7. 10. The custom appliance of claim 1, wherein the restoration portion of the facial mold body and the restoration portion of the lingual mold body mate with the patient's posterior teeth and engagement portions are proximate the patient's anterior teeth.

8. 10. The custom appliance of claim 1, wherein the first engagement portion of the facial mold body includes a protrusion and the first engagement portion of the lingual mold body includes a recess, and the protrusion of the facial mold body interconnects with the recess of the lingual mold body adjacent an occlusal plane of the patient's oral cavity.

9. 10. The custom appliance of claim 1, wherein the first engagement portion of the lingual mold body includes a protrusion and the first engagement portion of the facial mold body includes a recess, the protrusion of the lingual mold body interconnecting with the recess of the facial mold body adjacent an occlusal surface of the patient's oral cavity.

10. 10. The custom appliance of claim 1, wherein the facial mold body has a customized fit with the facial sides of the patient's teeth and the lingual mold body has a customized fit with the lingual sides of the patient's teeth.

11. 10. The custom appliance of claim 1, wherein the patient's oral cavity includes an occlusal plane, and the first engaging portion of the facial mold body and the first engaging portion of the lingual mold body extend in a facial direction relative to the occlusal plane.

12. 10. The custom appliance of claim 1, wherein the patient's oral cavity includes an occlusal plane, and the first engaging portion of the facial mold body and the first engaging portion of the lingual mold body extend in a lingual direction relative to the occlusal plane.

13. The custom appliance of claim 1 , wherein the custom appliance is configured to mate with a portion of the patient's dental arch extending between the molars and incisors.

14. 10. The custom appliance of claim 1, wherein the custom appliance is configured to mate with a portion of the patient's dental arch extending between one molar tooth and another molar tooth.

15. The custom appliance of claim 1 , wherein the custom appliance is configured to mate with a portion of the patient's dental arch extending between the molars and premolars.

16. The custom appliance of claim 1 , further comprising a port through which dental restorative material can be injected into the mold cavity.

17. 1. A custom appliance for forming a dental restoration in a patient's oral cavity, the oral cavity of the patient including an occlusal plane, the custom appliance comprising: a facial side mold body for a patient-specific customized fit with a facial side of at least one tooth of the patient, the facial side mold body including: a restoration; a first engagement portion extending away from the restoration and generally perpendicular to the occlusal plane; and a second engagement portion extending away from the restoration and generally perpendicular to the occlusal plane; a lingual mold body for a patient-specific customized fit with a lingual side of the patient's tooth, the lingual mold body including a restoration, a first engagement portion extending away from the restoration, and a second engagement portion extending away from the restoration; a first mesial alignment member on the facial mold body and a second mesial alignment member on the lingual mold body; the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body; the second engagement portion of the lingual mold body interconnects with the second engagement portion of the lingual mold body; the first mesial alignment member interconnects with the second mesial alignment member; a facial mold body and a lingual mold body configured to mate with the patient's teeth to form a mold cavity that covers and surrounds missing tooth structure of at least one tooth to be restored.

18. A custom instrument for use in dental treatment, comprising: a facial body for a patient-specific customized fit with a facial side of at least one tooth of the patient, the facial body including a tooth contacting portion and a first engagement portion extending away from the tooth contacting portion; a lingual mold body for a patient-specific customized fit with the lingual sides of the patient's teeth, the lingual mold body including a tooth contacting portion and a first engagement portion extending away from the tooth contacting portion; the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body; A custom appliance, wherein an interconnecting portion is configured to provide a clamping force between the facial body and the lingual body.

19. 1. A method of forming a dental restoration, comprising: placing a patient-specific lingual mold body over at least one tooth to be restored, the lingual mold body having a customized fit with the lingual side of the patient's tooth, the lingual mold body including a restoration portion and a first engagement portion extending away from the restoration portion; placing a patient-specific facial mold body over at least one restored tooth of the patient, the facial mold body having a customized fit with a facial side of the patient's at least one tooth, the facial mold body including a restoration portion and a first engagement portion extending away from the restoration portion; interconnecting the first engaging portion of the facial mold body with the first engaging portion of the lingual mold body to form a mold cavity in combination with the patient's tooth that covers and encloses missing tooth structure of at least one tooth to be restored; introducing a repair material into the mold cavity; allowing the restorative material to harden; and removing the facial mold body and the lingual mold body from the at least one tooth.

20. 20. The method of claim 19, wherein the introducing step occurs before the interconnecting step.

21. 1. A method of forming a dental restoration, comprising: applying a dental restorative material superficially over at least one patient's tooth to be restored; placing a patient-specific facial mold body over the at least one restored tooth and the dental restoration material, the facial mold body having a customized fit with the facial side of the patient's at least one tooth, the facial mold body including a restoration portion and a first engagement portion extending away from the restoration portion; placing a patient-specific lingual mold body over the at least one restored tooth and the dental restoration material, the lingual mold body having a customized fit with the lingual side of the patient's tooth, the lingual mold body including a restoration portion and a first engagement portion extending away from the restoration portion; interconnecting the first engaging portion of the facial mold body with the first engaging portion of the lingual mold body to form a mold cavity in combination with the patient's tooth that encloses missing tooth structure of at least one tooth to be restored, wherein the dental restorative material is contained within the mold cavity; allowing the restorative material to harden; and removing the facial mold body and the lingual mold body from the at least one tooth.

22. 1. A method for designing a custom appliance for forming a dental restoration of a tooth, comprising: receiving, by one or more processors, three-dimensional scan data of the patient's supragingival dental structure; and designing, by the one or more processors, a custom appliance for forming the dental restoration of the tooth based on the three-dimensional scan data of the patient's supragingival tooth structure and a desired tooth structure of the patient's at least one tooth to be restored, wherein the appliance comprises: a facial side mold body for a patient-specific customized fit with a facial side of at least one tooth of the patient, the facial side mold body including a restoration portion and a first engagement portion extending away from the restoration portion; a lingual mold body for a patient-specific customized fit with a lingual side of the patient's tooth, the lingual mold body including a restoration and a first engagement portion extending away from the restoration; the first engagement portion of the facial mold body interconnects with the first engagement portion of the lingual mold body; The method, wherein the facial mold body and the lingual mold body are configured to combine with the patient's teeth to form a mold cavity that covers and surrounds missing tooth structure of at least one tooth to be restored.

23. 23. The method of claim 22, further comprising receiving, by one or more processors, information regarding the patient's subgingival dental structure.

Images